Going from bad to worse

The results were dramatic the last time I interviewed Clothra N∅ Cholmβin of the school of clinical speech and language studies…

The results were dramatic the last time I interviewed Clothra N∅ Cholmβin of the school of clinical speech and language studies, Trinity College Dublin. After the article about the appalling lack of speech and language therapists was printed, a mother marched into N∅ Cholmβin's office with her child and refused to budge until she got an appointment. A year later, that child is still receiving therapy from N∅ Cholmβin's unit. The mother did the wise thing because the original unit to which her child was referred hasn't had a speech and language therapist for a year.

A year after that article things are even worse, says N∅ Cholmβin. In one Dublin community care area there are three speech and language therapists where there should be 27. Some clinics have had no speech and language therapist for over a year. Your child may spend three years on a waiting list because there is no therapist, only to drop off the list without ever getting any therapy. This happens when clinics finally manage to hire therapists. The new therapists prioritise the youngest children most in need rather than those who were longest on the list. So the youngest children in need of early intervention are prioritised. If your child was young and most in need of therapy three years ago, it may be too late now.

"Angry" is how Tom Murray, president of Down Syndrome Ireland, feels. If he sees one more working party established to look at why we haven't got enough speech and language therapists, he won't be able to hold his temper, he says. You can't blame him.

If your child needs early intervention with speech and language therapy and can afford to pay for it privately, you are a little better off - if you can find a therapist with a place open on her books. This a tragedy for all children with learning disabilities. The fact that children with Down Syndrome are being neglected by the State in this way is but one example, but it's a good one. Down Syndrome affects about one in 600 births and there are 7,000 children and adults living with the condition in the Republic.

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"Early intervention from six months of age onwards with speech therapy is absolutely essential for children with Down Syndrome," says Murray, the father of a seven-year-old girl with the condition. "It makes all the difference to their entire further development and their whole quality of life. The development of words and the ability to communicate determines whether they will be able to go to mainstream schools, whether they will be acceptable amongst their peers. Speech and language underpin everything."

There are longitudinal studies indicating the benefit of early intervention with these children. But there is no ultimate proof that early intervention works, the way there is proof that smoking is bad for you or even that fresh vegetables are good. N∅ Cholmβin says those arguing for the Government to pour more money into speech and language therapy have a problem: they cannot prove in a court of law that the Government is failing in its responsibilities by not providing enough speech and language therapy.

It has been proved in court, through the Sinnott case, that the Government has a responsibility to provide education to all children, whatever their ability.

In response to this, the Minister for Health and Children, MichΘal Martin, has made much of the investment in classroom assistants to enable children with learning disabilities, such as Down Syndrome, to attend mainstream school.

But - and this is "outrageous" in N∅ Cholmβin's view - up to this year there has been no academic qualification whatsoever for classroom assistants.

It's recently been mooted that a Junior Cert will be required. "These people are not skilled and have no training. I would be concerned if it was my child," she says.

There is a "window of optimal learning" for children with learning disabilities in the first five years of life. That window starts to close at the age of seven or eight. Waiting lists are more than that: they are deterioration lists. They are lists that prevent the full potential of the child being realised.

"The responsibility for language is being pushed from the Department of Health to the Department of Education without Education being given the resources to deal with it," says N∅ Cholmβin. Yet speech and language therapists are not employed by the Department of Education.

In the long run, it would be cost-effective for the Government to help children with Down Syndrome enter mainstream school and become independent by providing early intervention.

But will it happen? For seven years, parents in Down Syndrome Ireland have been calling for early intervention as their number one priority. The Government has not responded adequately so far.