Okay so those SLTs who read this blog will be pretty clear that no matter what caseload you work with there’s no one intervention method that works for every child, adolescent or adult with a specific need. Each individual client is wholly individual and this is also the case with the caseload I work with, often with a co-morbid impairments and a rich mix of sociological; familial and cultural ingredients.
I recently took on a family from a country within the GCC who were being seen by a SLT / P whom advocated for approaches written solely in THEIR OWN BOOK only.
Now I’m all for experts in our field writing up their successful approaches for others to learn from however I would bet my life that the vast majority of these would caveat their work.
Ignoring the requests of the clinician I powered ahead with an eclectic mix of interventions. So here goes:
Child’s age: 4
Expressive language skills: 20 or so single words used sparingly (when everything else they have tried to get what they want hasn’t worked they will speak).
Joint attention: Up to 10 seconds at a time.
Receptive language skills: Following familiar instructions/ directions but contextual (eg sit down; give me your foot; let’s go).
Play skills: Limited to lining up preferred items in a particular order in isolation. Will not tolerate others touching their toys when they are playing with them.
Social interaction and social communication skills: Limited eye contact; no response to name; no integration of speech with facial expressions and / or eye contact.
Those of you reading the above will most likely be wearing their diagnostic hats and shouting at the screen however this particular family does not, at present, what an ‘answer’ to whythey just want functional and realistic targets to develop the child. Based on where they live (outside of the UK) will also 100% mean that they are marginalised and stigmatised should their child be given a diagnosis. This may change in the future but I have to respect their situation.
So based on the above, whilst the ‘other’ SLT / P has recommended only ABA and zero SLT intervention the strategies she had provided parents were based solely on modelling Makaton. Three weeks into this “intervention” I discussed evidence based approaches that I found work well together and setup a programme based on:
- Attention Autism – his joint attention moved on from, no word of a lie, 10 seconds to FOURTY MINUTES of active engagement.
- PECS – he began to use “I want + object” spontaneously (away from PECS).
- TEACCH – he followed a schedule and could complete 4-5 independent tray based activities (with some physical prompting only).
- Intensive Interaction – used throughout the day.
All of the above took place over 2 trips to the UK (one in August and one in October) and a total direct intervention time of 20 hours.
Moving back to his home country between sessions is a challenge as he cannot access SLT outside of the previous clinician (that parent discontinued before I had chance to express my concerns) and as such we use Skype on a bi-weekly basis to keep on top of the targets ?.
I’d love to hear what other approaches people would use with such a profile.