SaLT, EP & an Assembly

It has been a busy week at Bear HQ for meetings with professionals and thinking about Little Bear’s needs. On Wednesday we had our second session with his Speech and Language Therapist (SaLT); on Thursday Grizzly and I met with school and the Educational Psychologist (EP) and today Little Bear had an assembly and his first taste of public speaking. Each event has been thought provoking in its own way.

SaLT Session 2:

This week’s session consisted of further assessment and rapport building. The Therapist is continuing to impress me. This week she gave me the assessment findings from the previous week as she said she would. I find it is all very well professionals promising things but it is the actually doing them that earns brownie points.

The results are interesting, with scores ranging from the 5th to 75th percentiles. For those not familiar with percentiles, a score at the 5th percentile means that if you took 100 children the same age as Little Bear, he would score better than only 5 of them but at the 75th percentile, he is scoring better than ¾ of them. It is an unusual and atypical scoring profile. You would usually expect children to have a cluster of scores round about the same level across all of their skills. As all of these scores relate to his comprehension (understanding) of language it is even more unusual but nevertheless it is as I had expected for him.

Little Bear scored well on his understanding of basic concepts such as hot/cold, same/different, in/on/under. We have worked on these concepts so I would expect his knowledge to be fairly good. The longer or more complex an instruction became, the more difficult Little Bear found it to follow. Instructions containing more complex concepts such as before/after and ‘all except’ were also tricky for him. This fits with our feeling that he can understand a lot more than he used to but that we still need to simplify our language and that the more complex an idea is, the more repetition Little Bear needs.

His grasp of different sentence structures was at the lower end of the expected range and was impacted by his lack of awareness of pronouns.

Despite all that, the scores do also reflect positive progress as at first assessment (when he was seen briefly by a private provider in his pre-school) all his scores were at the 1st percentile. That shows me that his attention and ability to be assessed has improved as well as SaLT input having being effective. Working on language really does make measurable differences in performance. It will be  interesting to see how his scores change over time, especially now that he is having formal therapy alongside the things we do at home.

The Therapist gained more brownie points as she had evidently reflected on Little Bear since our last session. She had noted the unusual quality of his speech and had suspected his vowel sounds might be distorted. This is not a typical pattern of errors and is not a part of “normal development” i.e. most children make speech errors when they are first learning to speak. The errors usually follow a pattern e.g. back sounds such as ‘k’ are made at the front of the mouth instead sounding like ‘t’. This is an expected part of development and it usually rights itself as children develop. However, making vowel distortions is not a typical developmental process. In fact it is fairly rare and neither Little Bear’s Therapist nor myself have ever tackled it in therapy before. Little Bear’s Therapist could have pretended to me that she did know what to do and could have just made up some therapy as she went along. However, she identified that she needed to know more and discussed Little Bear with a colleague who specialises in hearing impairment and would be more knowledgeable about vowels. Consequently she now has a more targeted assessment that she is going to try next week. I find this honesty and seeking of support reassuring. It is important to know when you don’t know. In my view, it makes her more competent, not less. There is nothing worse than somebody who doesn’t know that they don’t know (“unconscious incompetence”) and just blunders on anyway.

The other thing this conversation did for me was provide me with relief that finally another professional (who isn’t me) has identified that Little Bear does not have run of the mill SaLT difficulties and that between his spiky language profile and his dodgy vowels, he does have a Speech and Language Disorder not a straightforward language delay. For any SaLT’s reading, she has not used the new terminology of “Developmental Language Disorder” yet, a term which I do think applies. It will be interesting to see whether she does as we go forwards.

Meeting the EP again

We first met the EP a few weeks ago when we had a consultation meeting. You can read about it here: Seeing the Educational Psychologist

Since then he has spent a morning in class with Little Bear. He observed and played with him and took him out of class for some formal assessment. His teacher told me on the day that Little Bear had been exceptionally well behaved and she wasn’t sure the EP would have seen all the things we had been worried about.

Interestingly the first point that he raised at our feedback meeting was that he had noted Little Bear playing well and interacting appropriately but mostly minding his own business. He had observed on a number of occasions that some of the other boys were quick to blame him for various things when in fact he hadn’t done anything wrong at all. We have had our suspicions about scapegoating and other children exploiting Little Bear’s difficulties with communication but it is different to have that confirmed by a neutral professional. Obviously it is completely wrong and worrying because nobody wants their child to be victimised. I am glad that school are aware of it but I do understand their difficulty in policing everything that happens as they can’t be everywhere or see everything. We shall be keeping a very close eye though.

In general, the EP was pleased with Little Bear’s social and play development. He had carried out some assessment and that showed Little Bear’s non-verbal (cognitive) scores to be around the 10th percentile (below average) and his verbal score to be around the 38th (within the average range). This result is completely at odds with my hunch which is that Little Bear has good cognitive skills and significantly poorer speech and language skills. I think there are a few reasons why it may have come out this way:

  • We have worked A LOT on language and Little Bear has made a lot of progress. We have probably worked on the types of activity that were used in the verbal assessment but not on the ones in the non-verbal bit so he was essentially more practised at the verbal one
  • The verbal assessment used won’t be as accurate as anything used by the SaLT
  • It is difficult to truly separate verbal and non-verbal abilities when so many activities intrinsically rely on language knowledge. The EP talked about picture matching activities such as bird with nest and dog with ? This type of task relies on a child’s knowledge of vocabulary and the meaning of words (semantics). It relies on them having good semantic links between words, something I suspect Little Bear doesn’t have. He does have a lot of words now but I suspect they are stored in a jumble, not nice and orderly and therefore it is hard for him to find the ones that should go together. I feel this says more about his language ability than his cognitive function.

Although the EP is lovely and I have found him very useful, this just highlighted to me how pernicious language difficulties are and how difficult it is to get even very educated professionals to truly understand the impact of them. I am so grateful that I finally have another SaLT on side who really does GET IT. I hope.

The rest of the meeting was taken up with reviewing the strategies already put in place. I was very pleased that school were able to give detailed feedback so are evidently using the strategies and they seem to be working well.

We also discussed transition to year 1. Thankfully Little Bear’s teacher is going to move up with him which assuages a lot of our concerns but it is the jump from EYFS provision to more formal learning that is worrying us all. Little Bear is certainly not ready to sit at a desk all day or to complete learning tasks independently. School are absolutely brilliant at providing him with the specific intervention he needs but we have all agreed to apply for funding in the hope that this will secure ALL the right things next year, when a TA in the classroom is not a given. Next week’s job will be completing all the paperwork…

Assembly:

During the Easter break we were tasked with helping Little Bear learn his words for today’s assembly. I was a bit concerned as only a couple of months ago, Little Bear struggled to hold 3 numbers in his auditory memory long enough to repeat them back to me. Learning words was not going to be easy for him. Yet today he stood up in front of the whole school and a load of parents, walked sensibly to the microphone and speaking loudly, without any sort of prompt, said all of his words: “Every day we are running or walking a mile and its keeping us fit and healthy”. I don’t think everyone understood what he was saying but I don’t care because it was a phenomenal achievement for him.

I have just picked him up from school and he has the dreaded take home book. I absentmindedly flicked through it when he handed it to me and was shocked to see pages of children’s handwriting. “Oh God, look at this” I said, waving it under my friend’s nose. “Don’t worry” he tried to reassure me “they’ve had that for a week”. I didn’t like to tell him that it wouldn’t matter how long we had it for, Little Bear still wouldn’t be able to write more than a copied or dictated very tiny sentence. It is SO hard not to compare and not to feel disheartened. However, I know that my gorgeous little dude is working as hard as he can with every fibre of his being and in his language disordered world, learning 16 words off by heart is incredible. Writing or no writing, he’s still incredible.

 

SaLT, EP & an Assembly

Too fast, too hard, too loud

Little Bear’s sensory needs can pretty much be summed up by the title of this post. Why walk if you can run instead? Why move things gently if you can slam them? Why say things quietly when you can shout?

Like many children who have experienced early neglect, Little Bear does have some quirks in his sensory system. However, as evidenced by the fact that it has taken me 51 posts to get around to talking about it, his needs are not that severe in the grand scheme of things. I’ve certainly met children who are more sensory seeking; whose whole environment needs to be changed to help them get the sensory input they crave; who cannot engage in everyday tasks in a functional way because they have to incessantly hunt for sensory stimulation.

Little Bear can function well enough in his everyday life, though we do notice that his sensory system is a little different at times.

I think we mainly notice it when we have to overuse the word “gently”. Little Bear finds it hard to grade his movements, always going in too hard. I constantly have to remind him that if he bashes his toys together they will break. Little Bear is what you would probably describe as “heavy handed” and is fairly prone to breaking things. It is no longer purposeful but usually due to accidentally pulling/ pushing/ pressing/ bashing too hard. He has written off many a felt tip pen and I have to buy the kind with an indestructible nib. We always have to consider the robustness of a toy before purchasing anything for him.

Little Bear often comes in with too much force for cuddles too, frequently head first. We must be used to dodging but if someone is caught unawares it tends to really hurt them whereas Little Bear hardly feels it. I guess all the head-banging he used to do may well have contributed to this. On a positive note, we have noticed that Little Bear seems to be getting more sensitive to touch on his head and does frequently cry now if he accidentally bashes himself (his head is currently at door handle height so he seems to bash it quite often) which is a far more ‘normal’ reaction than not really noticing that he’s injured himself.

The surprising thing is that Little Bear can be really gentle when he tries: he will stroke your face or stroke the cats with the right amount of pressure but during play or when he isn’t consciously thinking about it, his default is to crash and bash.

Little Bear seeks movement too and can often be found bouncing/ jumping/ hanging upside down. As soon as we get outside he has a tendency to run. We are quite outside-y as a family so Little Bear gets plenty of exercise as part of day to day life which probably helps to regulate his system. However, as I’ve got to know Little Bear better I have realised that when he starts bouncing and spinning all over the place it is not necessarily a sign that he needs more exercise. Sometimes it seems to be more of a self-stimulating activity that he uses when he’s tired or getting over-excited. It usually means that he needs calming and a rest. Giving him more movement at this point is likely to tip him further into over-stimulated territory.

Little Bear is more easily over-stimulated than your average child and when he gets to that point, he cannot yet bring himself back from it. There will undoubtedly be a period of him being generally out of control followed by a meltdown. As his parent I have to be vigilant of his level of sensory alertness and I have to intervene to stop him from getting to that point. I think it can sometimes seem as though I spoil his fun, especially when it comes to rough and tumble play. However, I can see him getting more and more excited and I know that he isn’t able to regulate this aspect of himself yet. He needs external help to identify when he has had enough and to find ways appropriate ways to calm down.

Little Bear is also pretty loud. I’m not sure I can totally blame his sensory system as Big Bear is one of the loudest children you could meet so he might just be following his brother’s example! However, Little Bear is loud within his own right. In his nativity play this week, he understandably struggled to learn the myriad of words needed to be able to join in with the songs but what he lacked in clarity, he certainly made up for in volume!

Interestingly for me, with my Speech and Language Therapy hat on, Little Bear is also too noisy in his speech. Most sounds in English have a voiced (noisy) and voiceless (quiet) counterpart. For example, ‘t’ and ‘d’ sounds are made in exactly the same way in your mouth. The only difference between them is that to make a ‘d’ sound your vocal cords vibrate but for a ‘t’ they do not. Therefore ‘d’ is really just a noisy ‘t’. Little Bear replaces almost all the quiet sounds with their noisy partners e.g. he says “gat” instead of ‘cat’, “bear” instead of ‘pear’, “do” instead of ‘two’. It is one of the reasons his speech has such an unusual quality to it and why he is so difficult to understand.

Little Bear obviously has quite significant speech and language difficulties but I do wonder whether some aspects of those difficulties are due to the way his sensorimotor system has developed.

So yes, Little Bear has his sensory quirks and at the moment he requires external help with staying regulated. However, he is not the only one with a quirky system. A little bug bear of mine (rant alert) is that people often talk about “sensory integration difficulties” while seeming to forget that we all have sensory integration systems that are constantly working to process the different stimuli that come our way. We all need to process and respond to movement, touch, smells, tastes, sounds, visual stimuli and challenges to our balance and position in space. We will all have different preferences when it comes to each sense. Some people like moving fast and being upside down and consequently love rollercoasters. Other people hate them as they make them sick and dizzy. Some people love spicy food, the spicier the better; others prefer more bland cuisine. As a migraine sufferer I am particularly sensitive to light and changes to light and will find things that others wouldn’t even notice very uncomfortable.

Everyone has a sensory integration system and everyone’s functions a little differently. Although I have described Little Bear’s in a fair amount of detail, I don’t view it as a huge problem, just a part of ‘normal’ sensory variation. Little Bear’s is different to mine which is different to Grizzly’s. As long as everyone is getting what their system needs and not too much of the things it doesn’t, we are generally ok.

I think true Sensory Integration Difficulties exist when a child can no longer function at home or in the classroom because of their need to seek or avoid certain stimuli. That is when referrals and further help are needed.

Thankfully we are not at that point. However, if you meet us you’ll hear us before you see us; brace yourself, mind your head and don’t lend Little Bear your felt tips. Oh, and I’ll sit with my back to the window ta, the light is a bit weird.

 

Too fast, too hard, too loud