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

Seeing the Educational Psychologist

I recently requested a progress meeting with school to discuss how Little Bear is getting on. I feel lucky that so far the staff have been very approachable and accommodating. We had the meeting and as usual were able to identify progress and also areas that we want to work on. During the meeting Little Bear’s teacher wanted to ask me something: would I consent to him being seen by an Educational Psychologist (EP)?

She explained that the EP had made routine contact with school to check whether they needed to consult regarding any pupils this term. The SENCO had thought of Little Bear. What did I think?

I had a couple of initial thoughts, most of which I kept to myself. Firstly, eek! Out of the whole school of almost 200 pupils Little Bear was the first child that they thought of. In fact, I have since found out that he was the only child. What did that say about the severity of his needs? Those old feelings around whether I really do accept his needs, just as they are, were getting a little airing.

My main thought though was one of cautious gratitude. I couldn’t see any negatives of involving another agency and if anything it could lead to positives such as more tailored input or dare I even think it, funding. My previous experiences of working alongside an EP Service elsewhere were of an extremely stretched and in demand service. Children frequently waited long periods to be seen and schools had to juggle and prioritise the most needy to maximise their allocation of time. Once a school’s EP allowance ran out, children just had to wait, irrespective of their level of need. Given that experience I felt lucky that in his second term at school, Little Bear was already getting an opportunity to be seen, without me even having to ask for it: no battle needed.

I consented straight away then instantly became anxious that the appointment might happen without any of my involvement (not that I’m a control freak!). When I worked as a Speech and Language Therapist (SaLT) in an NHS Department I worked closely with the EP’s. I knew them and they knew me. We had a mutual respect for one another’s work and often spoke regarding specific children. Occasionally we would have some healthy professional debate (AKA a polite argument), usually when I was putting my neck on the line about a child needing a specific provision that nobody wanted to pay for. However, most of the time we worked in partnership to make things happen for children.

It was feeling very strange to be on the other side of this equation. Would I be respected and listened to in my role as parent? Would I be involved at all?

Increasingly I have also found myself taking the role of Little Bear’s SaLT – out of necessity to fill the gaping void left by our local NHS Service. I wondered whether my opinions with my SaLT hat on would be considered or valued when the EP came either.

When I asked Little Bear’s teacher whether we might be able to meet with the EP or be part of the consultation when the time came, she replied with a brisk “I wouldn’t have thought so”, confirming my fear that they thought I didn’t have anything to contribute as a parent or as a professional. Feeling a little disheartened and somewhat undervalued I felt as though I would just have to go with it. I can see how easily you can become disempowered as a parent, particularly one of a child with additional needs.

However, something changed somewhere and a week or so later I got an e-mail inviting me to attend the meeting with the EP. Greatly relieved I then began to wonder what the EP might be like. Although not meaning to stereotype I assumed it would be a middle-aged no-nonsense lady.

This week Grizzly and I have attended the meeting. It turns out that the EP was actually a young man and he was lovely. He was very good at listening to us and tweaking his advice accordingly. He wasn’t in any way judgemental and we did feel like valued members of the meeting. I think that is so important.

We had been told that the EP would have seen Little Bear prior to the meeting and would be feeding back to us. However, in reality it was a consultation meeting and the EP had never met Little Bear. Apparently we would create strategies during the meeting and then reconvene to review them before deciding whether Little Bear would require further assessment or not. I think school might have felt a bit fobbed off by this.

In the meeting, Little Bear’s teacher talked about his educational levels, his behaviour in the classroom (generally a little less challenging than at home) and his attitude to learning. I had expected much of the focus to be on his communication difficulties and ways to manage that within his learning. However, we talked a lot more about his social communication, his ability to identify and regulate his own emotions and ways to develop his skills in these areas. The EP seemed versed in early trauma and attachment and was interested in our perspectives. He was clear on the links between Little Bear’s early life experiences and his approach to learning now. We talked about how he can be oppositional and how the very fact of you wanting him to do something makes him not want to do it. We talked about him not showing his full ability and sometimes making purposeful errors. We talked about Little Bear easily entering fight or flight mode and how that can lead to him lashing out.

Whilst acknowledging and problem-solving these things with us the EP was not alarmist. At the moment the challenges do not seem to be things that we cannot overcome. The strategies seem practical and hopefully fun for Little Bear – including an adapted version of Lego Therapy to help build his resilience and ability to play with his peers with less adult support. We had to adapt it because Little Bear doesn’t always have the resilience for Lego so school have agreed to try it with Duplo instead.

A lot of the strategies were around Emotional Literacy – giving Little Bear a wider emotional vocabulary; helping him to identify his own feelings; giving him strategies to use when regulating himself is difficult. School are going to identify a safe space for him to retreat to when he needs it and will support him in using it appropriately.

We both came away from the meeting feeling pleased.

Another bonus for me was some of the comments the EP made. He said he felt we had “already done a lot of psychological unpicking” and that we understand Little Bear’s needs well. At the end he commented that he had enjoyed listening to our story and was pleased to hear so many positives in our descriptions of Little Bear.

It is very easy to forget how hard we work (I mean all adopters) and how much time and effort we put into trying to understand our children and what makes them tick. It is easy to forget that we are experts in them. If I went on Mastermind and my specialist subject was Little Bear, the only other person in the world who could beat me would be Grizzly. Nobody knows him like we do. It is hugely beneficial and confidence-boosting for that to be acknowledged by a Professional person working with your child.

I also found it surprisingly emotional to tell our story (the EP knew nothing more than Little Bear’s name so we had to fill him in on his background and progress to date) and to hear Grizzly sharing parts of our story. In the day to day craziness of our lives, it’s so easy to forget the highs and lows of the rollercoaster ride we’ve been on. At one point we spoke about how Little Bear used to bang his head and I had honestly forgotten that he used to do that. I felt proud of us as a couple for having tackled so many things in such a joined up way. As a parent it is easy to fall into a mode of constant self-deprecation but occasionally you have to allow yourself some credit. Perhaps we are doing an okay job after all.

At the end of the meeting we booked in a review date. The EP said he felt he knew Little Bear quite well now and didn’t feel the need to actually see him. Grizzly said he felt an observation would be useful and so did Little Bear’s teacher. She commented that in all her years of teaching, she had never taught a child quite like Little Bear! And I don’t think she meant because of his background as she has 4 other adopted children in her current class, irrespective of any who have gone before. I do know what she means; he is a complicated little chap.

So observation is going to happen and the EP is going to attempt some 1:1 assessment. Oh how we laughed when he said he would allow 1 hour for that! Little Bear finds 5 minutes of an adult-directed table top activity challenging. I would love to be a fly on the wall. I guess we are going to find out what the poor EP is really made of..

 

 

 

 

 

Seeing the Educational Psychologist