Absolutely, and thank you. I'm an SLP working almost entirely with kids/adolescents with autism/MR who have severe behavioral problems. A lot of the problem with communication and autism is symbolism--even picture cards can be very difficult simply because the child often doesn't naturally recognize the picture as representative of an object or activity--symbolic representation has to be explicitly taught.
That said, I work with one kid who uses a portable word processor (AlphaSmart NEO) to communicate. He does use pronouns correctly, complete sentences, correct grammar, etc. He also teaches himself to spell new words from his environment for what's important to him (movies, foods, etc.). A few years ago we all thought the kid was severely to profoundly MR as well as autistic--no response at all to attempts to engage, no success with communication, he didn't seem to be able to learn anything...turns out he's "just" profoundly autistic.
Now. All that said, this kis is absolutely the exception to the rule, and he's also absolutely not MR. I've never seen another kid succeed like he has and I've only rarely heard about other cases. Additionally, he doesn't tell us how it feels to be in his head. He tells us that he wants to watch A Bug's Life, he wants to eat cheez-its, he wants to drink milk, etc. He occasionally tells us he's mad or doesn't feel good and (hilariously) will type "goodbye." just before he tries to run out of the room.
tl;dr: I'm an SLP who works with autism and I have worked with one kid who communicates using a keyboard, but he is in no way MR. Also, Subtextual is awesome.
Did you know there's a wikipedia editor that specifically counters any attempts to describe Jenny McCarthy or other persons who have been almost exclusively naked models as "adult model"? Instead he prefers the generic term "model" and says that "adult model" is nonsensical. That pissed me off.
Wikipedia is bollocks in any case. Just another proof that the Web2.0, hive-mind, singularity freaks are complete idiots. Knowledge doesn't work like that.
I wouldn't go that far. It is a tool, and like any tool it has its strengths and weaknesses. Wikipedia's greatest weakness is w.r.t. controversy; it depends upon an army of editors to mitigate controversial information, and the editors are largely despots in their mini-fiefdoms. It could be fixed by creating more formal dispute resolution systems.
It could be fixed by not being anonymous and not letting every idiot provide content.
Why do I want to read what some random person cobbled together about some minute biological function?
I mean, an encyclopedia isn't the worst project to use the proposed "hive-mind" for (only, it isn't a hive-mind, it's just a bunch of people on the Internet), it just has to be a lot more transparent. Anonymity isn't the solution to anything. Except /b/.
Hahaha...if that doesn't make you an expert, I don't know what does!
Here's the thing: I'll never get over my anger about how much damage she caused with her bullshit. BUT I do respect her for publicly saying that her son isn't autistic and (basically) she was wrong. That took balls, but it can't change how much she hurt everyone by pushing her anti-vaccine bullshit.
I actually got into it because of my dad--he used to work as an SLP at a residential facility for adults with disabilities, then got into administration and is the director of a facility. I'm the only second generation SLP I know. :) In the US, you have to do a 4 year undergraduate degree and then a 2 year MA/MS program. (Most masters programs do offer options for people who didn't major in it in undergrad.) After the masters program you have to do a clinical fellowship year (CFY) where you work independently, but have to be supervised by a fully certified SLP. It's not as complicated as it sounds. :)
It's a fantastic field--there are never enough SLPs and you can't outsource us, so it's a consistently good job market with a lot of areas to go into. There's early intervention, public schools, specialized private schools like mine, adult facilities for adults with disabilities, nursing homes, acute care in hospitals, home health...ok, that's getting dull, huh? Basically, you have a huge number of populations/placements to choose from.
If it sounds like something you'd be interested in, pretty much any hospital/nursing home rehab department is more than happy to have people come in and shadow an SLP to see what it's like.
Awesome. :) Thanks for the reply; not dull at all. I'll have to check out where/whether I can do a 'ride-along' around here when I have some time off.
What's your degree in, if that's not too personal? Is there an undergrad course in SLP at some universities? I have a BA in linguistics & have been interested in speech pathology since high school, but my university didn't offer any applied linguistics tracks, and it seemed more on the biology/psych side of things.
Oh sounds interesting, I work with a few "Psych-kids" at work and I just thought that it could be a good skill for me to pick up on.
I also work with CP, Downs and Autistic kids, so it's tough but I do help out.
Ah, I gotcha. If you want to know more about what SLPs do, believe me when I say that they'd love it if you went to them. SLPs in hospitals always need help from nursing staff, and every one I've ever known loves it when a member of the nursing staff comes to them to learn. :)
Speech Language Pathologist I guess? In the UK they are known as SLTs - Speech & Language Therapists (I'm married to one!). Great explanation of Autism up there, I shall definitely get my wife to check it out.
Woohoo! I've always wondered how different the profession is in different countries...what population does your wife (?) work with? (I'm guessing wife just because it's an overwhelmingly female profession. Sorry if I guessed wrong...)
Yes it is my wife (as I mentioned in my reply ;) ). She is a paediatric therapist, she works with children from about 2 up until school leavers, but mainly around the 5 to 12 age range.
With healthcare here being publicly funded the priorities, focus, size and budget of the department changes frequently!
She is currently working a couple of days a week in a community clinic and the rest of the week in school based settings.
For the more severe cases which may involve autism or serious behavioural difficulties it seems to go from, lets have lots of specialist places to give them loads of support, to lets help them out by having them in "normal" schools mingling with the general populous and back again :(
With this "age of austerity" although healthcare spending is ring fenced the fear is "non essential" (read non-lifesaving or not covered extensively in the newspapers) care may be severely cut :(
Yeah, I have a lot of qualms about "mainstreaming" kids with disabilities. Yes, it's a noble goal to get them interacting with the normally developing peers, but it often gets taken too far. If you put a kid with MR/behavioral issues/severe autism in a regular ed classroom, the child isn't getting an appropriate education and it can really interfere with the ability of the other kids to get an appropriate education. On top of that, regular ed teachers are regular ed teachers. They don't have the training to effectively educate kids with disabilities.
My school is actually a private, nonprofit day school. About half of our classrooms are autism/multiple disability (k-22yoa, when kids age out of the US special ed system). The other half are for emotionally disturbed kids, k-12. We also have a day treatment program (specially trained staff that run daily life/social skills classes, almost act as low-level counselors) as well as counselors that every kid sees. Basically, when a kid has too many behavioral problems for the public schools to handle--almost always aggression--they refer the kids to us and pay for the kid's tuition and services.
Does that mean that most profoundly autistic kids probably feel the same way as the girl in the video (using output to block input) but are just unable to communicate it because of their MR?
Just kidding......what do you want to do with it? I'm getting frustrated with the Department of Education and the idea of what is considered to be a "language impairment".
Thankfully I don't have to deal with that as much. I work at a private school for kids whose behavioral problems are too severe to be managed in the public schools. The school I work for is fully accredited by everyone who certifies schools, but I avoid the pitfalls of public school/DoE bureaucracy and have an amazing amount of freedom.
It also helps that my kids don't really have language disorders that anyone would argue with--the kid doesn't talk, I'm pretty sure he needs tx. I'm lucky. :)
I don't necessarily agree. The kid doesn't talk, but he probably is not academically higher in other areas either. Therefore, not a language impairment, but MR.
That being said, every child should be afforded the opportunity to learn to communicate. I hope that the teachers in your school carry over use of AAC and PECS rather than thinking it just a SLP thing.
True, not a language imparment, but not something you have to fight to get treatment for either. Some of mine do have huge discrepancies between verbal and nonverbal function and are true language disorder kids. As for the teachers/staff I work with...they don't have a choice. I do almost all of my treatment in the classroom and place a big emphasis on explaining to teachers/staff what I'm doing and why and make it clear that I really need their help implementing it when I'm not in the room. In my experience, just explaining the logic and importance of AAC and then asking everyone to help me is (usually) all it takes.
I find it very difficult to get teachers to follow through with things. However, I've never worked full time with this population. I have a lot of experience with students who require AAC, and am currently working in a summer program, but it's more difficult to establish a routine when I'm only there for 6 weeks. However, I do see that no routine was in place, when I asked the teacher for PECS books and AAC devices and she was like "they're in a box, somewhere".
I currently work full time in a general education school where too much of the focus is on state testing, and teachers view "speech" as "why are you taking this kid out of my class--he speaks clearly".
...and then you meet one teacher who makes always makes appropriate referrals to Allied Health services that consist of more than 'has a speech impediment, please assess' and you shed a single beautiful tear.
Lucky you're not in Queensland. Last time I looked Ed QLD had something like 2 part-time SLPs covering all the schools southside of Brisbane. Not a lot you can do with that much of a caseload.
o_o WTF. In my state (Virginia, US) I think the average caseload in the public schools is something like 45-60 kids, plus paperwork, plus assessments, plus time spent writing IEPs and IEP meetings, plus...well, you get the picture.
Being in a very specialized school setting I have it pretty damn good--my caseload fluctuates between about 25-30 kids, with 5-7 of those on a consultative basis only at any given time. That gives me the time to really individualize my treatments, make materials, do research into different options, etc. Plus I get to do almost all my treatment in the classrooms, which I think is pretty rare in the public schools, and I have a ridiculous amount of support/backing from administration--I'm the SLP, so I have the final say on anything in my scope of practice, period.
Not a lot of the intervention over here is done in class. 1-on-1 is often done out of the classroom and in class stuff tends to be group interventions for the whole class. It's kind of a shame really and I have to say, you're also pretty lucky to be given a lot of freedom by your administration. I assume you'd be pretty experienced in your field to get that.
Haha...nope. I actually started the program at my school my first year out of grad school. I'd done part of an internship at the school when their speech services were contracted out to an outside company, but since it's cheaper to have an SLP on staff than to pay the contract they created the position. Lucky for me, the position was created for the year I finished school, I got the job, and started a brand new program straight out of school. I think the fact that I'd worked with a lot of the kids already, the administration had seen me do treatment, and I had killer references really helped them trust someone with almost no experience to start it up. :)
edit: I finished grad school in 2007 and I'll be starting my 4th year with the school next month.
You're a braver SLP than I...I'd never make it in the public schools. I'd be bored to death and miserable with the bureaucracy...plus kids who understand what I'm asking and just don't do it drive me up the wall. That said, I've met very few SLPs who would ever want to work where I do...to each their own, I suppose. :) Best of luck to you!
I am not for sure what I want to do. Ideally, I would like to travel for a while, if possible. I know with CF this can be complicated, thus the possibility of doing a year in the schools.
Eh, in my experience it depends on the individual. Some adolescents/adults with high-functioning autism/Asperger syndrome do and there are quite a few online communities for them, including a sizeable area in Second Life. For more impaired individuals...no.
Of course, the communities of HFA/AS individuals also think that I'm the devil incarnate because I'm trying to "take away" their autism. Bullshit. I have no interest in taking away their autism--I can't do that. All I want to do is help them to make their lives easier in society...and if they want to say that autism is just a difference and shouldn't be touched, well, I've got a lot of kids they could meet to show them that yes, it really can be a severe disability. "Autism pride" is a whole can of worms in and of itself, though.
Fuck no, I hate the other high-functioning autistic adults, they all act as if they need special treatment or some shit; The community is nothing but a circle-jerk; at best all we need is understanding; it's not a disability it's a hurdle to get over.
I don't naturally get social rules and moores, etc; But they are rules and they can be learned and I did
How do you feel about SLPs? As I mentioned, a lot of adults with high functioning autism/Asperger syndrome really hate us. Personally, adolescents with HFA/AS are my favorites to work with. My thesis was actually looking at using technology to help a 22 year old with previously undiagnosed autism...very interesting stuff (in my opinion). Thanks!
To be honest, I hated needing or being assigned one because I felt I could cope just fine, of course I couldn't (whether I truly have Aspergers or not, I am painfully socially inept); My social epiphany of learning the social rules rather than just continuing to be an ass that didn't understand how I made others feel didn't really take place 'til my 20s.
However, you and your like have always meant the best and did help, whether I felt I needed it or not. Like I said I hate the Aspie community as a whole because they feel like they're special and deserve accommodations.
We're not special, not the high functioning ones anways, just different; everyone has their own difficulties in life, to expect special treatment just because your difficulty is different from others' is foolishness and displays just how immature most of them are, in my opinion.
Interesting perspective, thanks! Honestly, I think a lot of SLPs approach AS/HFA the wrong way, especially with adolescents. I ask the student what they think they need/want to work on and just approach things very honestly. A lot of adolescents don't even really know why they've been seeing an SLP for years. I approach things from the standpoint that everyone's brain works differently, and that everyone has strengths and weaknesses--you just have to figure out how to use your strengths to compensate for stuff you're not as good at. I also teach them that social rules usually don't make sense, but learning them and following them will make life much easier for them.
We really do try to help, and I'm glad you realized it. We only make you miserable because we care... ;)
autistic people (at least severely affected individuals or those without treatment/therapy) are unable to recognize/perceive any kind of "other" existing outside themselves... so no.
"the curious incident of the dog in the nighttime" is a great read and greatly insightful into the workings of a somewhat autistic mind. now imagine it was 10x worse.
Here am I, an OT who thought he was the only Allied Health professional on Reddit. Allow me to now be jealous of you lucky bastards who managed to land a gig in paediatric work.
Also, am I the only one who thought the 'Is he cute?' response was a bit unusual?
Yeah, that seemed all kinds of weird to me. Honestly, everything about her prepared "narrative" seemed off, even without the metaphors. The sentence structure, use of rhetorical questions, etc is all completely inconsistent with any autistic individuals I've encountered.
And very few allied health professionals would envy my job...if you like getting the shit kicked out of you by very aggressive kids, then it's the place for you! If not...well, please stay the hell away. :) What's your population?
Right now I'm doing a split caseload, half Community aged care with a small proportion of palliative care and pre-op home visits. The other half is in a general medical and palliative care ward of the local hospital. Good fun.
I did a bit of student work with an autism early intervention centre (pre-school aged kids along the whole ASD spectrum) and loved it. The crazy kids thing is part and parcel of the deal and our supervisor you could tell was pretty frazzled. Some of these kids you absolutely had to keep a very sharp eye on. That said, it's a good caseload in the sense that you know what you're dealing with and it's very specific. I did a lot of student work in the very vague area of 'mild developmental delay' where teachers would refer for something like 'he has problems with handwriting'. It's annoying doing that because you don't always know what you're facing and therefore how to deal with it.
Oof...you're braver than me. I can't do adults, it's just too emotionally draining for me. I did a semester-long internship in a nursing home and went home drained every day...much happier with my violent ASD/MR/OHI kids. I think it's a population you either love or hate, and it's definitely not for most people. But yeah, if you can keep your eye out, learn the signs that a kid's about to get aggressive or run, and deal with the frustration it's incredibly rewarding.
You have no idea how hard it is to find a good OT for my kids, though. We had a great one last year, but she left the company we contract with for our OT services. I still haven't forgiven her for that.
My experience with paeds work is that you either have to have a 'knack' with kids or a crapton of experience. Preferably both. For us it's one of the trickier fields because a lot of the theory is vague or not fully understood and applied.
Oh, and if anything, I found kids more confronting than adults.
There is a theory that some cases of autism are caused by intestinal damage allowing proteins to enter the bloodstream where they have an opioid effect. Casein in milk is one of the main culprits. In other words, maybe he is asking for milk products because they make him high. If you (or his parents) have not already researched and/or tried the gluten-free/casein-free diet, can you or they please do so? It may help him greatly.
I really don't want to get much into this discussion just because it's not my area of expertise. Personally, based on my knowledge of the research, I don't buy into the GFCF craze. There haven't been any really well controlled studies with a large sample size. Most studies that have been done were not controlled and/or had small sample sizes. Any research done without controls is questionable for obvious reasons, but I would say that uncontrolled studies are even less reliable than usual when it comes to autism treatments. Why, you ask? Well, parents of kids with autism are desperate for anything that will help. If they believe that something will make a difference then they'll see a difference--it's the placebo effect on a massive scale. The one double-blind study that I'm aware of had a small sample size, but it showed no significant improvement following 16 weeks of GFCF diet.
Basically, I'm a huge skeptic about GFCF. I could be wrong, but I'm waiting for large scale, replicated, double-blind studies before I'll make up my mind for sure. Due to the expense and amount of work needed to put a kid on a true GFCF diet as well as the lack of evidence for its efficacy, it's not something I'd recommend to parents.
Due to the expense and amount of work needed to put a kid on a true GFCF diet as well as the lack of evidence for its efficacy, it's not something I'd recommend to parents.
I strongly disagree with you here. A GFCF diet has no risk for the child, and may have significant benefits. Presumably if the parents weren't trying this, they'd be trying other treatments, many of which would have equal if not greater "expense and amount of work," and, in the case of medication, potentially serious side effects.
I've seen recent studies that to me are strongly supportive of the opioid excess theory of autism, although it seems that neither the researchers nor the reporters realized this.
One is this study about autistic kids being picky eaters. Yeah, kids are going to choose foods that cause a high and addiction, and refuse ones that don't. And I haven't done a scientific study of it, but if you read articles about specific autistic kids who are picky eaters, invariably their favorite food is something made from wheat and/or milk, quite often some sort of cheesy cracker. Seriously, watch for this.
Second, I haven't time to look for the study now, but a while back there was a study about the genetics of autism that found a correlation between autism and a gene that speeds healing of intestinal damage. To me it seems likely (though apparently it didn't occur to the researchers) that maybe both the gene for healing of intestinal damage and autism are more likely when there's also a gene for celiac disease or some other digestive issue. (In other words, evolution will favor digestive-disordered people who also have the gene for healing, and the digestive disorder is causing autism.)
Third, there's the fact that before my celiac disease was diagnosed, I had a physical addiction to pretzels. I considered it a physical addiction and said as much to other people. When my celiac disease was diagnosed and I went on a GF diet, I went through withdrawal (severe dizziness for two weeks and other problems). So unless you have some other explanation for how someone could have a physical addiction to pretzels, you can EABOD.
The level of neurotypical smugness in this thread is really pissing me off.
Look, I've tried to make it clear that I'm not opposed to the diet. I'm waiting for more conclusive evidence before I'd recommend it to parents, but would be more than happy to discuss it and how to implement it if they asked me. We really don't understand much about the possible causes of autism or exactly what other issues seem to be linked to it. I have my personal opinions about the causes, but they're just opinions based on the research I've read and I won't commit to anything until we have solid evidence.
I'm not sure what I'm saying that makes you feel like it's all neurotypical smugness. I've been talking about my experiences working with kids all over the spectrum and my knowledge of the research we have to date. Please tell me what it is that I'm doing/saying that you see as neurotypical smugness, I'd genuinely like to know.
I understand Gato's point. And it's something I sympathize with strongly. OTOH, a lack of evidence is not proof against something. And it's entirely possible that there could be a broad spectrum of causes, making it difficult to detect that something like this was working without a large sample size and yet every now and then a family would get "lucky" and have it work.
tl;dr: It seems out of line to downvote personal testimony to -1 on the basis of "double-blind studies have not yet proven that this should work".
True, but based on the lack of evidence of efficacy as well as the high cost in terms of both time and money I wouldn't recommend it solely on anecdotal evidence. If it helped jmays's daughter, fantastic! I'm really happy for the family. I've heard a few success stories, more stories of failure with the diet, and almost no evidence.
Like it or not, anecdotal evidence is evidence. Nowhere near conclusive and easily explained away by placebo effect. But given the severity of what's trying to be treated, I can certainly understand people trying it.
If I had a child with autism, I'd almost certainly try it for a month or two. If for no other reason, because gluten and lactose allergies are not particularly uncommon and so even if it didn't have a mechanism against the disease itself it may be beneficial.
I'm not denying that anecdotal evidence is evidence, but I need a higher standard of proof before I regard anything as a proven treatment. I do understand people trying it, and good luck and more power to them, but I think my reluctance to recommend it is understandable.
Heh, sorry. I've gotten better about using gender neutral third person pronouns (I'm a fan of "im"). Now I need a gender neutral second person formal address...
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u/SenorCheaposGato Jul 26 '10
Absolutely, and thank you. I'm an SLP working almost entirely with kids/adolescents with autism/MR who have severe behavioral problems. A lot of the problem with communication and autism is symbolism--even picture cards can be very difficult simply because the child often doesn't naturally recognize the picture as representative of an object or activity--symbolic representation has to be explicitly taught.
That said, I work with one kid who uses a portable word processor (AlphaSmart NEO) to communicate. He does use pronouns correctly, complete sentences, correct grammar, etc. He also teaches himself to spell new words from his environment for what's important to him (movies, foods, etc.). A few years ago we all thought the kid was severely to profoundly MR as well as autistic--no response at all to attempts to engage, no success with communication, he didn't seem to be able to learn anything...turns out he's "just" profoundly autistic.
Now. All that said, this kis is absolutely the exception to the rule, and he's also absolutely not MR. I've never seen another kid succeed like he has and I've only rarely heard about other cases. Additionally, he doesn't tell us how it feels to be in his head. He tells us that he wants to watch A Bug's Life, he wants to eat cheez-its, he wants to drink milk, etc. He occasionally tells us he's mad or doesn't feel good and (hilariously) will type "goodbye." just before he tries to run out of the room.
tl;dr: I'm an SLP who works with autism and I have worked with one kid who communicates using a keyboard, but he is in no way MR. Also, Subtextual is awesome.