Saturday, 1 February 2014

Great Ormond Street Update - Speech and Language

This week we made a return visit to Great Ormond Street with Sasha, and this time it was for an appointment with their Specialist Speech and Langauge Therapist.

After our 3 hour session there the last time, Sasha wasn't exactly keen to return, but we managed to persuade her with the promise of chips afterwards (that girl can eat her own bodyweight in chips!!).

We arrived and were shown into a small room where Sasha was asked to sit on a child-size chair at a table whilst mummy, daddy and the Speech Therapist sat on adult ones. Not a great start as Sasha would have much preferred a big chair - so we sorted that out before too long. Next we were asked several questions about Sasha's history regarding speech, and we covered the story from the beginning again.

Sasha always made plenty of noise as a baby, but we referred her for speech around the age of 2 as she wasn't forming many recognisable words. It was the speech therapist then who referred us on to a paediatrician where we received the diagnosis of ASD (autism spectrum disorder) for her. Sasha's speech development has actually progressed quite well, although her speech sounds remain a little unclear.

Sasha listened to us recapping the history but wasn't keen on answering many questions herself. She did join in a little though, by sometimes whispering some answers in mummy or daddy's ears. She was slumping in her chair and walking around, telling us she was too tired, and all the usual avoidance strategies.

Luckily, the Speech Therapist very quickly picked up how she needed to act in order to encourage Sasha, and we managed to persuade Sasha to begin the 'official' testing. This involved Sasha sitting at the table (by now on the 'adult' chair) and looking at a set of cards with pictures on, then answering a question on each one before it was flipped over and a different card was shown to her, with the speech therapist asking a different type of question.

The questions ranged from 'point to the smallest dog' to 'can you point to the girl who is unhappy' and a whole lot more inbetween. They were testing for vocabularly, and comprehension, and understanding of tenses - one picture showed a man on a ladder, and next to that an empty ladder, then Sasha was told the first picture was 'the man is climbing a ladder' and she had to explain what was happening in the second one (the man has climbed the ladder). One section had pictures of 6 animals or so in a line, maybe two cats followed by a dog, another cat, a monkey and a dog again. Sasha was then asked in one go 'point to the first dog, then the second cat, then the monkey'. The few she was asked like this were particularly interesting, as it became clear that Sasha looks at the page from right side to left side (rather than left to right, as you would read). So she understood the request perfectly, but would point to the dog on the right hand side as being the first dog, then the 'first' (as we would see it) cat as being the second cat etc.

Some sections were not visual, and just involved Sasha listening to the Speech Therapist and giving the right answers. The final test was one of these, where the Speech Therapist read out three words at a time, asked Sasha to say which two were linked in some way, and to give the reason for that link. So for example, knife, dog, fork, and her answer was knife and fork, because you eat with them. This then progressed to four words, and towards the end even I was struggling to pick out the two linked words, but Sasha got them all right. In fact, over the hour of testing, Sasha got them ALL right. 

We had had to try extremely hard to keep her on task for all this time, and there were breaks where she wandered around and made up the usual excuses, but we managed to get through it all. I'm not at all sure she would have stayed and co-operated if mummy and daddy hadn't been in the room, which is what happened on our previous visit. Probably the most amazing part of the day for us was when the Speech Therapist offered Sasha a Dora sticker as a reward if she carried on to the end - and Sasha's eyes lit up! This is a girl who has rarely been swayed by any sort of reward (other than chips) if she doesn't want to do something, so Chris and I nearly fell off our seats at that point. She earned herself two Dora stickers by the end and was very proud of them - most bizarre!

At the end of the testing, the Speech Therapist was really quite excited, and said that she hadn't known of anyone Sasha's age getting all the answers right before. She suggested that Sasha should be at the top of her class with regards speech, vocabulary and understanding. Sasha's trouble with speech sounds is likely to be bad habits, and the Speech Therapist recognised that it would be difficult to change them now until Sasha herself really wanted to put the effort in to make those changes. We could be waiting a while for that.... but it's good to know that her general understanding is definitely there, and that means no learning disability in that area.

All of this has led to a lot more thought from me about how we will progress with Sasha's schooling going forward. It's clear that she can learn, but thanks to the PDA (Pathological Demand Avoidance), it needs to be in a way that suits Sasha, to actually achieve the best that she is capable of. Now we just need to explore what options are out there for her. Watch this space - any ideas also welcomed!