I'd appreciate some advice. My son is 4.5 years old. He is the first child. We live in the UK but speak a different language at home. My son was late to start speaking and despite being in the nursery all last year he made little progress. He used to have obsessions with wheels and certain movie clips but he currently moves from one activity to the other throughout the day and does not seem any particular obsessions. He will engage in new activities if it is interesting to him with no problems. He has no behavioural issues either. He is rather social and loves outdoors/gatherings. He seems to have good relationship with his 2.5 years old sister. He likes and demands hugs and kisses although not excessively. I personally -and his mother- doesn't feel he has autism.

Since starting reception in Septmeber he seemed to have made some progress. We are seeing a speech and language therapist and have been given advice that we are applying to some effect. He will be seeing an educational psychologist in few weeks and we will know more then. His current situation is as follow: in terms of understanding, he seems to be quite functional in our mother tongue at home and there is little/no chance to test him in other environments. I would not be able to check him academically in our mother tongue since all his "academic knowledge" is in English (numbers, colours, shapes, animal names, verbs and tasks not used in a home environment ... etc). His understanding of English does have some defects in that if told a sentence made of words he knows, he seems to -sometimes- miss parts of the sentence or not interpret it completely right. Examples include: put the dish on/under the pillow. He would do something with them but not always capture the on/under part of the sentence (i.e he will put one on the other - sometimes right and sometimes not). Another example is when asked about the colour/shape of the object he would understand that: 1. he is being asked and 2. it is to do with the object pointed to but not always get the charachteristic he is asked about. Words said are many and he can name most familiar objects, animals, shapes and colours. He says short sentences related to familiar situations (e.g. I need the toilet, I don't want it .. etc) and he would make up sentences to indicate his wants (e.g. dady come play swords) or emotions (e.g. my sad). He does mix our mother language and English in terms of both words and grammar. He is quite chatty during games but all short -although appropiate- sentences. Examples include: well done, its your turn, not the same, I miss, under the tunnle, nice one! .. etc. Beside that there is a lot of incomprehensible speak that is difficult/impossible to understand. He also seems to hate verbal activities and become distant and detached when trying to read him a story or the like. The cartoons he likes are also rathr not very verbal (e.g. Tom & Jerry). I feel he is not as emotionally mature -and therefore not as attentive- as his peers and I see lots of 4 year olds in my work. He is certainly more mature than his sister though. His other abilities seem fine. His motor development is OK (he can dress himself, play the WII, use keyboard/mouse .. etc). He can -unaided- complete a totally new 24 piece puzzle in 13 minutes. He plays matching cards competitively and would win sometimes. He likes numbers and can do sums of numbers up to 5 (so it can be calculated on his fingers) without a problem. In a simple flashing cards game, he would guess rightly most of the time or at least make the correct choice if offered two different options.

My questions is in two parts: one, what do you think is going on ? and two, I might be moving to the states in July for work reasons and he will be 5 then. If he still need SLT support is that available in schools in the states and at what costs ? Is SLT covered by a regular health insurance ? In the UK everything is free.

Many thanks for your help. Yours, a VERY worried parent.

Hi mom2payton

Many thanks for your comprehensive reply. If I'm moving to the States then I will be working in a children hospital which is affiliated to a university but I'm not sure if they have an SLT department there. Apparently you could be given health insurance by the hospital but again I'm not sure it will cover SLT. Will that be an option at an extra cost ? I'm likely to be in either Ohio or Alabama. From reading through the forum it sounds that you get better SLT in the states compared to the UK but you will have to pay for it. How much roughly is private SLT likely to cost?

I really need some encouraging but realistic advice. The input I had so far from professionals has not been great. The nursery SLT who was seeing him last year made little difference. He seemed to pick a word a week but he did pick up "please" and "thank you". The paediatrician is telling me he is on the ASD but she only saw him for a short period of time and did not seem willing to take my observation into consideration. The advice we had from the new SLT seems to be working better but we are doing most of the work. Encouragingly, over the last 3 months there is a new word almost every day. This whole issue is causing me a lot of stress and it is like nothing I had before. My wife is a stay at home mom and she is putting a lot of effort with our son but I still feel guilty for being away 14 hours a day and not participating enough in his care. I feel I could do a better job with him due to my background and better knowledge in English. Seeing every 4 years old in my job has become a painful experience. He is on my mind all the time and I have started to think that I should take some prolonged leave just to be with him. I feel guilty investing my time in my career and not in my son.

Is my son ever going to speak normally ? I appreciate he may not be the brightest and may not achieve academically but I hope he will at least have a functional life and I will be able to instil some values in him.

Hi mom2payton

Many thanks really for your sympathetic post. It brought tears to my eyes. You seem to understand how difficult it is. I have now reached the stage where I get the urge to check the date of birth of every talking child I see on the ward round. It really helps to hear stories about positive outcomes like yours.

I will sure read more on this forum and have already got few ideas to implement. I'm sure I will become a frequent visitor.

Best wishes

I am of the belief that it is never too late! Although we know that sooner is better than later, I don't think there is a magical date that if missed there is nothing you can do.

Now that you have some information, you have reached the next stage - panic. Fear and sadness were first for me (what was wrong, why did this happen) then followed by panic (I haven't done enough, will we have enough time for him to catch up, we must have therapy around the clock). Good news! When you have a good therapy plan in place and you start seeing the results, you start to panic less. Eventually the panic leaves and you become confident that you are on the right track. There will be bumps in the road that bring the fear/sadness/panic back but never fear, it will gradually go away.

I'm so glad you are getting some great ideas from Mary Lou's book. The upside down pyramid was a very, very important part of our son's ability to understand language. And because I just talked and talked, it was very important for me to learn to slow down, to stop constantly questioning our son and speak in statements...with a good long (30 seconds in the beginning) pause between each sentence. It made a huge difference.

You and your wife are doing a wonderful job! Your son is lucky to have two great parents working together for him.

Hello optimistic2007 (this is a great posting name--you should remain optimistic about your son's development while at the same time doing what you are doing--asking a lot of questions and working very hard with him at home and via the schooling and therapy you choose for him)

I have followed your posts with interest. I have questions and comments from all of the posts. What did the SLT at your hospital conclude about your son's high ability to memorize and recall the picture cards? That he has strong visual perceptual skills and memory? Something else?

Regarding your question as to whether your son is just showing delayed maturity, my response would be "no" to the word "delay". Delay to me suggests that a child will eventually outgrow his difficulties without intervention. At age 4 1/2, your son would have outgrown a true "delay". From what you have described (comprehension difficulty for concepts such as prepositions of location, for color and shape descriptions, for lengthy directions, expressive limitations such as demonstrating little generative grammar to create a wide range of novel utterances of good length to express most any idea, and unclear speech--due to articulation difficulty or due to jargon/made-up words?)--I think you should be exploring the diagnosis of receptive-expressive language disorder. I do not say this to disappoint you but rather to spur you forward in your excellent efforts to learn as much as possible about your son's abilities and needs and to put together a very strong program of specific intervention at home, at school, and in therapy.

If you move to the US to work, you will have a new opportunity for assessment (diagnosis) and perhaps different treatment methodologies. Also, if you work for a children's hospital, it is highly likely there will be a speech-language pathology program there. In terms of cost, either the health insurance you will receive as a staff member/employee will cover most of the expense, or, your hospital may provide such service to you as a staff member as a professional courtesy (are you a physician?) Before selecting the home you will live in, ask some contacts at the hospital which school district in the area is known as being the best for providing special education (including therapy) services to children. Services can vary widely by school district. There may be several school districts within driving distance of your hospital. Your son likely will qualify for service, and those services are free.

You mentioned that your son does not like to sit to have a book read to him. Since book-sharing time is one of the best language-learning times for a child, I recommend that you follow my suggestions about "Talking a Book" in my e-book that you are reading. Talking about the pictures in fun and interesting ways and pacing the time on each page according to the interest level of the child at any given time are superior to reading the text, at your son's language level. I would urge you to use the techniques I describe in my book and set a goal that he will enjoy a book with you or your wife at least once a day. I would hope he would soon get to the point where he would request more and more book time with you.

Since you are away from home so much (and not feeling good about that) would it help if you and your wife discussed a daily plan for your son's daily activities at home, including specific times for one-on-one play, talking a book, making things together (such as snacks, art projects, etc.) going for walks, playing at the park, playing or listening to music, etc.? I do suggest extremely limited TV-watching. Your wife likely could benefit from a lot of reinforcement for her efforts. And you could identify what specific kinds of tasks you would like to do with him on the weekends. Definitely keep a log of your son's new accomplishments. Your career provides you and your family with financial security and now an opportunity to live for awhile in the US and access all of our services. I urge you to think long and hard before giving that up. If you lay out a plan, perhaps that will make you feel you are providing a lot to your son in that regard.

Are you continuing to build your son's skills in your primary language?

I would urge you and your wife to make a very concerted effort to learn to use my Upside-Down Pyramid speaking technique, along with my other techniques such as highlighting language and reducing the use of direct questions, and to give your son's teachers an opportunity to learn them from you if they are willing. I feel that these technique make it much easier for a child to learn language and to be "set-up" to practice based on the models presented. I do not feel that the methods come naturally to most people, but, once learned, they can be blended very naturally into daily verbal interactions with children.

Best wishes to you and your family!

Mary Lou

Hello again,

To me, SLI means specific language impairment which means language disorder. What are the inclusions and exclusions in your country in terms of your son qualifying for the special school (language unit)? If he is not comprehending well in his current class, why wouldn't he qualify to be in a classroom where the teacher is more trained to address comprehension needs?

It is great that you and your wife are working with your son so much at home. This will be extremely helpful to him.

Do you think you will move to the US?

I cannot answer your direct questions about your son. You and his teachers and therapists will be able to answer those good questions over time as you observe your son's rate of improvement. I can answer the question whether I have seen children with significant language difficulties become verbal and independent. I have worked with many children over the years who were not doing well at all when young who have gone on to college and even further on to achieve advanced degrees.

I hope you will continue to write as your son makes progress.

Mary Lou

Hi mom2payton

I've been reading your past posts with interest. You mentioned your son had ADHD. I feel this is part of my son's problem. What age did you make the diagnosis at and did you give him any medicines ? I'm interested to know more about your son's musical therapy as well.

Many thanks

Sorry I did not make myself clear. "visual" meaning written language. My son seems to be quite interested in the alphabet and likes spelling so I had this crazy thought of getting him to "read" his speech (hence the reference to deaf children).

My son's speech is not clear at all. Most of it is jumbled up speech and of that there is a lot. The words we understand seems to have problems as well. He omits a lot of "s" and "b" and especially in the beginning of the word. "r" is often replaced by "l". Somehow he manages to say "octopus" correctly though. Getting him to say the sounds of the alphabet he struggles with "th", "z". I have not noticed motor planning issues in his limbs. He has not had a formal articulation assessment. He often drops prepositions and "the" in sentences said spontaneously and would drop them even when we get him to repeat after us unless we insist.

Today I noticed that his 2.5 years old sister is modelling him as well ! She is saying "quare" instead of "square" which is what he does ! She is always around when I'm shadowing him so it feels we are working on two children at the same time. Any advice what more we can do ?

Hello again

I thought I should post this update now it's been few weeks since the last one. Quite a few things happened in the meanwhile. I have passed my exams and now it looks certain I will be in the USA in July pending some paper work (visa .. etc). We have a treatment programme consisting of an SLP seeing my son at school weekly and skilling up staff at school so they can do 1:1 sessions with him daily. We have alternate weekly private sessions as well. We are doing a lot of modelling work with him at home and mostly following the pyramide model also it does not seem we need to be as slow in talking. We now got him an ipad and he is absolutely loving it and there are plenty of really useful apps on it and he is clearly benefiting from it. We also read him a picture book daily. In terms of diagnosis, there is still a disagreement as to what is exactly. I personally have given up chasing this and just focused on what he needs (i.e. his language).

In terms of the progress he is making, there is almost daily progress. He is more responsive and communicative. He now can talk about some past events also still limited. He asks questions (what, where, who) and yesterday he used (why) for the first time ! He uses his language to negotiate and argue (like telling the nurse "its not food" when she tried to give a bad tasting medicine and lying to his mom saying "I'm poorly" to avoid going to school and "5 minutes" when denied playing the Wii). He now understands most prepositions also still get confused between "in" and "on". His understanding has otherwise gone leaps. He now makes regular 3 parts sentences and less often omits the small part of speech (is, on, the .. etc). Now that we understand more of his speech, articulation & grammar issues are surfacing up though. He is showing signs of breaking/remaking the sentence to change what he means (like changing the position of the "is" in a sentence to make it a question). He also seems to be faring far better at home than he does at school - maybe due to being less confident with his speech at school. This has been confirmed by SLP who saw him in both environments. He is no where where he should be though. I think he is maybe 18 months behind or so but I feel there has certainly been some catching up over the last few months and seems to have accelerated over the last few weeks. Overall I'm not pessimistic but to say I'm very concerned is an understatement !

The input I had from Mary's book and from this forum has been valuable and helpful. Thank you very much indeed.

Hello! How nice to get your update. Sounds like your son is really making some great improvements in his ability to communicate. How wonderful!

I'm sorry I didn't respond to your questions when they were posted. I completely missed them.

Our son was given and ADHD diagnosis at 4.5 years by a neuropsychologist. She also saw him at 3.5 years but was not comfortable with giving him the diagnosis then. As you well know ADHD can be so different from child to child so I can only tell you what worked for our son...you will figure out what works for your child. We chose not to use any medications with our son. This does not mean that we would not ever consider it but that it has not been the right route for him so far.

We have worked very, very hard to help him learn to control his body, identify when he feels out of control and give him tools to help with that. His responses can definitely be tied to how he responds to too much stimuli - bright lights, loud noises, smells, textures. He really seems to have a very overreactive sensory system. When we can control the input to his system and help him learn to get rid of excess energy, he does really well.

In our case his music therapist has been instrumental in assisting him. Other people have an OT that they work with. The key is to find whoever works best with your child. Our therapist has identified sounds that relax him (and they are not sounds that relax me!). We can literally play a particular song and visually see him relax. She has worked on his fine motor skills as well. Our son responded to music long before he responded to words. We made up songs and sang to him as he was gaining spoken language skills.

The American Music Therapy Association (http://www.musictherapy.org/) is the national organization here that can help you locate a professional in your area. The key to finding a music therapist is to make sure you are actually getting a music therapist! A music therapist should have completed an internship and then taken national boards. There are plenty of people out there saying they do "music therapy" but without those credentials, I would not even consider them. Our music therapist has been with us since our son with 3.5 years old. We have been really fortunate to have her.

Congratulations on your new job and keep focusing on the things you can do to help your son. As MaryLou said it makes no difference what kind of diagnosis you get, the treatment plan is most important.

I hope things continue to keep looking up for you and your family.

K