Unmet need: what, as a profession, can we do?

I work with children and adults, as both an independent practitioner and a member of my local NHS team. I am asked for help on a regular basis by either individuals or someone else on their behalf.   

Here are some recent examples.

As an Independent Practitioner

  • Young adult with Autistic Spectrum Condition, no learning difficulties but high anxiety, voice dysfunction
  • Adult with Development Language Delay (DLD) self referral
  • Adult DLD diagnosed at age around 50 years, also stammers
  • As part of local authority legal services child protection proceedings : psychologist assessed the capacity of the parent and recommended SLT assessment (in Urdu)
  • As part of child protection proceedings, local authority social worker requested SLT assessment

In my NHS role

  • Young adult ASC (no learning difficulties, therefore can’t access adult LD team), his mother requested SLT and psychologist. This is one of a number of similar referrals
  • Referral from GP: young adult asked her GP for assessment as she suspected she has auditory processing disorder

There is no service for these kinds of need.

As independent practitioners we have the option to accept or decline cases as they present themselves.  These are complex cases: the decision to decline is almost always a matter of not having the capacity to do them justice.

In terms of the gaps in NHS services, the matter is out of my hands.  However, I do feel there is a responsibility to flag up the demand.

‘Based on my experience working with children and teenagers, I think that there is a gap in services for adults such as these patients and others who have developmental language disorder, or autism but not learning disabilities.  There are premature babies who grow up with language and communication difficulties. They grow up with a mild to moderate difficulties which do not just disappear when they turn 18. 

Often these young people do not have Education, Heath and Care Plans which can give them access to support and funding up to age 25 years.  Many attended mainstream schools and needs remained unidentified.  They do not meet adult learning difficulties team criteria.  It is almost inevitable that their difficulties will have far-reaching consequences for access to further and higher education, to employment and for general functioning.

These cases do not meet adult acquired/neurological or adult stammering criteria either as they are outside the commissioned core business (and if they did the team just wouldn’t have the capacity)..

There is a generation or two whose needs are not being met as adults. 10% or so of adults of working age struggle to function due to persistent developmental communication difficulties.

Short of lobbying the government, I don’t have an answer.

Written by Shahzeb Kauser

December 13, 2023

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