INITIAL DEVELOPMENTAL AND



INITIAL DEVELOPMENTAL ANDSPEECH AND LANGUAGE ASSESSMENTNAME: XXXX XXX DOB: 2/24/2012CA:2 years (24 months) PARENTS: XXXXXXXADDRESS: 22603 Little Cedar Way Santa Clarita, CA 91350TELEPHONE: 661-755-5059CASE MANAGER: Angela Morgan REGIONAL CENTER: North Los Angeles County Regional CenterTEST DATE: 3/19/2014REPORT DATE: 3/19/2014BACKGROUND INFORMATION/HISTORY OF PRESENT PROBLEMXXXX is a 24-month-old female who was referred to Speech, Language, and Educational Associates by North Los Angeles County Regional Center due to concerns regarding her delayed speech and language. Mrs. XXXX, XXXX’s mother, was present for the interview and testing and served as valuable and reliable source of information. Mrs. XXXX expressed concern with XXXX’s delayed speech and language as well as her pronunciation of sounds. BIRTH AND PERINATAL HISTORYMrs. XXXX reported that she received prenatal care from the beginning of pregnancy and continued to receive care until delivery. XXXX was born full term and was delivered via c-section as she was positioned with her face up. XXXX’s weight at birth was not reported to this clinician. There were no complications during pregnancy and no other complications during labor or delivery. MEDICAL HISTORYXXXX’s medical care is currently performed by Dr. Kandavel Address: 13652 Cantara St. Panorama City, CA 91402 XXXX was born with mild jaundice, which was resolved shortly after birth with sunlight. Mrs. XXXX reported that XXXX has had a couple of common colds and coughs but has had no serious illness, injuries, or accidents. She is not taking any medications. At this present time, she is reported to be in good health. DEVELOPMENTAL HISTORYPer mother report, XXXX first rolled over at 4 months, sat alone at 6 months, “scooted” but never crawled, and walked at 15 months. XXXX is able to self feed by picking up finger foods and feeds herself with a spoon but she is typically assisted with feeding for meals. XXXX eats well and has no known food allergies. Mrs. XXXX reported that XXXX has shown interest in beginning to toilet train but because of the recent move and busy schedule, she has not yet began toilet training. XXXX reportedly will indicate when her diaper needs to be changed. She has not yet established hand dominancy but appeared to use her right hand more during this evaluation. XXXX is reportedly a good sleeper as she sleeps through the night and takes one nap during the day. SPEECH AND LANGUAGE HISTORYDuring the assessment, XXXX used gestures, vocXXXXtions, babbling, facial expressions, pointing, and approximations of words to communicate. Mrs. Coronado reported that XXXX typically uses gestures, unintelligible speech sounds, and vocXXXXtions to express her wants and needs. Speech and language milestones were achieved as follows: XXXX babbled during her first 6?months, and said her first word at 14 months. English is the only language spoken at home. XXXX’s grandparents speak Tagalog but usually will speak to her in English. XXXX will say “mama” to gain her mother’s attention. She currently has around 8 meaningful words and around 15 unintelligible words. XXXX attempts to imitate words overheard in conversation and usually tries to model words upon request. She prefers to use gestures over words to communicate. Her mother reported that she undersXXXXds everything and that her receptive language is much better than her expressive language. XXXX follows routine directions well. She undersXXXXds new words quickly. XXXX has some difficulty following 2-step or novel directions. SOCIAL HISTORYXXXX currently lives with her parents and her three month old sister. She is not yet enrolled in a preschool or daycare program. She will initiate interaction with children and enjoys playing with other children. Mrs. XXXX reported that XXXX shares well with other children. She demonstrates good eye contact, joint attention, and turn taking skills during games. She enjoys pretend play. XXXX plays with most toys appropriately and enjoys a variety of toys such as puzzles, playing with legos, stacking blocks, and playing catch with a ball. Mrs. XXXX reported that XXXX’s father was a “late talker” and did not begin speaking until 3 years old. There is no other family history of hearing, speech, or language difficulties. ASSESSMENT RESULTS:Tests and assessment materials and procedures used for the purposes of assessment and placement of individuals with exceptional needs are selected and administered so as to not be racially, culturally, or sexually discriminatory. In addition, tests have been validated for the specific purpose for which they are used and administered by trained personnel in accordance with the instructions of the producer.The following information was obtained through administration of the Bayley Scales of Infant Development, Third Edition (BSID-3), the Social-Emotional and Adaptive Behavior Subtests of the Developmental Assessment of Young Children (DAYC), the Rossetti Infant-Toddler Language Scale (Rossetti), a short oral-peripheral examination, informal observation, pragmatic observation, and parent interview. Supplemental information was obtained through informal sensorimotor play activities for assessment of developmental levels of behavior and cognition, motor, and social-emotional skills, as well as receptive, expressive, and pragmatic speech-language skills. The BSID-3 was used to assess cognition and fine and gross motor skills, the DAYC was used to assess Social-Emotional and Adaptive Behavior skills, and the Rossetti was used to evaluate speech and language skills. XXXX was assessed in the home setting with her mother present. The assessment was conducted in English. BAYLEY SCALES OF INFANT AND TODDLER DEVELOPMENT, THIRD EDITION (BAYLEY-III):COGNITIVE SCALE: The Bayley III Cognitive Scale assesses sensorimotor development, exploration and manipulation, object relatedness, concept formation, memory, and other aspects of cognitive processing. The Bayley III Cognitive Scale was administered to assess overall cognitive skill development. Developmental Level: 23 monthsScaled Score=9, Composite=95, Percentile 37According to the test, XXXX is able to, pull string adaptively, retain 3 blocks, place 9 blocks in a cup at one time, take 3 blocks out of cup, look at one more pictures with interest or recognition, explore holes in pegboard, push car, find hidden object, suspend ring, retrieve an object through open end of a box and from the sides of a box, complete a pink board series, remove lid from bottle, complete a pegboard series, demonstrate relational play, match pictures, complete a blue board series According to the test, XXXX is not yet able to assemble a ball puzzle, engage in representational play, imitate a 2-step action, match 3 colors, undersXXXXd concept of one, undersXXXXd size concepts, group objects by colorMOTOR SCALE: The Bayley III Motor Scale assesses control of fine and gross motor skills. The fine motor subtest assesses prehension, perceptual-motor integration, motor planning, and motor speed. The gross motor subtest assesses movement of the limbs and torso, static positioning, dynamic movement, and motor planning. Play tasks were utilized to assess control of the fine and gross motor groups including movements associated with rolling, crawling, sitting, sXXXXding, walking, running, and jumping.Fine Motor – Developmental Level: 21 monthsScaled Score=8According to the test, XXXX is able to bring spoons to midline, use pad of her thumb and any fingertip to grasp pellet, lift cup by handle, turn pages of a book, use a palmar grasp to hold pencil, isolate extended index finger, scribbles sponXXXXeously, imitate random stroke, place 5 coins in narrow slot, stack 6 blocks, connect blocks together, take blocks apart, build train of blocks, place 10 pellets in bottleAccording to the test, XXXX is not yet able to use hand to hold paper in place, imitate a horizontal stroke, imitate a vertical line, imitate a circular line, string 3 blocks, imitate hand movement. Gross Motor – Developmental Level: 23 monthsScaled Score=9 According to the test, XXXX is able to raise self to sXXXXding position, sit down with control, sXXXXd alone, walk alone, throw ball, squat without support, run with coordination, walk up stairs with support, walk down stairs with support, walk sideways without support, walk two steps backward, balance on right foot with support, balance on left foot with support, jump from bottom step, kick ball,According to the test, XXXX is not yet able to walk forward on a path, walk up stairs both feet on each step alone, walk down stairs with both feet alone, jump forward four inches, balance on one foot without support. Motor score: Composite score= 91, Percentile=27THE DEVELOPMENTAL ASSESSMENT OF YOUNG CHILDREN (DAYC):The Developmental Assessment of Young Children (DAYC) was used to assess functional skills utilized in activities of daily life in the areas of Social-Emotional and Adaptive Behavior skills per observation and parent report. The results are as follows:Social-Emotional Subtest: Age Equivalent = 24 Months SXXXXdard Score=104, 61st PercentileThe DAYC Social-Emotional Subtest measures a child’s social awareness, social relationships, and social competence. Social skills permit the establishment of a relationship between two or more people through which they mutually influence each other’s behavior. Emotions refer to the expression of one’s feelings. Social-Emotional skills enable children to engage in meaningful social interactions with parents, caregivers, peers, and others in their environment.According to the test, XXXX is able to beginning to function on her own; may periodically return to the parent for reassurance and attention, brings toys to share with caregiver, has temper XXXXtrums when frustrated, insists on trying to do many things without help (e.g. eating with a spoon, putting on a coat), shows independence, plays well for a brief time in groups of two or three children, attempts to comfort others in distress, enjoys simple make-believe, says “please” and “thank you”; may need to be reminded, separates from caregiver in a familiar surrounding without crying, sponXXXXeously greets familiar person by hugging, usually takes turns, laughs at combinations of incongruous events and use of words, shows pride in accomplishments. According to the test, XXXX is not yet able to shows anxiety at separation from caregiver, show special dependence on primary caregiver, purposefully refuse to comply with requests, state whether she is a boy or girl, play in a group gram with simple rules Adaptive Behavior Subtest: Age Equivalent = 21 Months SXXXXdard Score=97, 42nd PercentileThe DAYC Adaptive Behavior Subtest measures a child’s independent functioning in her environment. Self-help skills include toileting, feeding, dressing, and personal responsibility.According to the test, XXXX is able to drink from a cup, sip liquid from a glass or cup using a straw, feed self finger foods, brushes teeth with assisXXXXce, sometimes washes hands and face, help with simple household tasks, sometimes removes loose clothing such as jacket or shorts without assisXXXXce, opens door by turning handle. According to the test, XXXX is not yet able to put on simple clothing, squat, hold self, or verbalize bowel and bladder needs, sit on toilet for at least one minute supervised, wipe nose; may need to be reminded, independently eats entire meal with spoon. THE ROSSETTI INFANT-TODDLER LANGUAGE SCALESubtestDescriptionAge in MonthsStrengthsXXXX is able to:WeaknessesXXXX is unable to:Interaction-AttachmentThe cues and responses that reflect a reciprocal relationship between the caregiver and the child.15-18 months (no items above this age) Plays away from familiar peopleRequests assisXXXXce from adult (sometimes)Retreats to caregiver when an unfamiliar adult approaches PragmaticsThe way the child uses language to communicate with and affect others.9-12 months (with scattered skills up to 15-18 months) Vocalizes to call othersIndicates a desire for a change in activitiesVocalizes when another person callsImitates other childrenUses vocXXXXtions more frequently during interactions Initiates turn-taking routinesPoints to, shows, or gives objectsResponds to other children’s vocXXXXtions Uses more words during turn takingGestureThe child’s use of gesture to express thought and intent prior to the consistent use of spoken language.18-21 months (with scattered skills in 24-27 months) Leads caregiver to a desired objectIndicates that pants are wetPretends to play a musical instrumentPuts on or takes off clothingPretends to dance to musicPushes a stroller or shopping cartFlies a toy airplanePretends to talk on the phoneWipes hands and face (when asked)Slaps hand in response to “give me five”Gestures in indicate toileting needsPretends to pour from a containerPlayThe changes in a child’s play that reflect the development of representational thought.24-27 months (scattered skills in 27-30 months)Performs many related activities during playChooses toys selectivelyUses most toys appropriatelyDemonstrates parallel play with other childrenShares toys with other childrenTalks more in play around other childrenActs out familiar routinesPerforms longer sequences of play activitiesLanguage ComprehensionThe child’s undersXXXXding of verbal language with and without linguistic cue.21-24 months (with skills in 24-27 months) Chooses one object from a group of five upon requestFollows a two-step related commandUndersXXXXds new words rapidlyPoints to four action wordsRecognizes family member namesUndersXXXXds the concept of oneUndersXXXXds size conceptsIdentifies four objects by functionLanguage ExpressionThe child’s use of preverbal and verbal behaviors to communicate with others. 12-15 months (with few scattered skills in 15-18 months) Shakes head “no”Says 8 to 10 words sponXXXXeouslyNames one object frequentlyImitates new words sponXXXXeouslyCombines vocXXXXtion with gesture to obtain objectUses true words with jargon-like utterancesImitates three animal soundsAsks for “more” Says 15 meaningful wordsUses consonants such as t, d, n, and hTalks rather than uses gesturesImitates words overheard in conversationAsks “what’s that?”Names five to seven familiar objects upon request (may try but difficult to undersXXXXd) Based on the results of the Rossetti Infant-Toddler Language Scale and parent interview, XXXX presents with delays in pragmatics and language expression. SPONXXXXEOUS ORAL LANGUAGE:XXXX produced the following words/utterances/vocXXXXtions during the assessment:hi byeneow (meow)eth (yes)yeth (yes)youmamabatoo too (tweet twee)oh oh (uh oh)babywoofmooARTICULATION:XXXX presented with limited speech productions and vocXXXXtions during this evaluation but presented with sound substitutions when she did produce words such as “neow” for “meow.” Her articulation should be monitored as her oral verbal output increases.VOICE AND FLUENCY:Based on limited verbXXXXtions produced during the assessment, voice and volume were within normal limits. Due to limited expressive language, fluency was unable to be assessed at this time. ORAL-FACIAL EXAMINATION:An informal oral-peripheral examination was administered to determine the status of XXXX’s articulators for speech production. Her hard palate, and soft palates appeared to be within nomal limits. No flaccidities, tremors, or award movements were clinically observed. No drooling was observed during the time of this assessment. XXXX was unable to complete lingual exercises such as moving her tongue up and down and from side to side with models and appeared to present with lingual weakness. She was able to produce a variety of sounds and moved from one position in the mouth such as the back position /k/ to the front position /ba/ or /ma/ easily. At this time, oral-motor structures and movements should continue to be monitored for adequate oral speech production.HEARING:Mrs. XXXX reported that XXXX was administered an audiological evaluation at birth and passed the exam in both ears. She reported that XXXX has not been administered a hearing exam since birth. This examiner did not evaluate hearing. During the assessment, XXXX responded to noise made by toys, her mother’s verbXXXXtions, and the therapist’s verbXXXXtions. She followed directions without difficultyBEHAVIOR DURING TESTING:XXXX was evaluated in the home setting at 10:30 am. She had recently woken up and was happy and playful. She greeted the clinician upon request. The television was on but XXXX was not very interested in the show and wanted to play with the clinician. XXXX wanted to sit down with the clinician and her mother as they spoke at the dining room table and vocalized and gestured that she wanted to sit in the chair. Before beginning the evaluation, XXXX showed the clinician some of her toys, including a bike that she had in the room. She was excited to show the clinician her bike and rang the bell on the bike upon request. When asked if she wanted play, XXXX approximated a word for “yes” while nodding her head. Mrs. XXXX reported that XXXX is able to respond to yes and no questions and is encouraged to say yes when asked a question instead of using a head nod or gesture. XXXX participated in all tasks during the assessment and had little difficulty following directions. She reached her hand into the clinician’s suitcase multiple times as she was eager to see what other toys were in the suitcase. She continued to attempt to get toys out herself despite multiple prompts to wait for the clinician to open the suitcase. XXXX engaged in pretend play with presented with a stuffed animal bear and a spoon as well as some other items. She pretended to feed the bear and put the bear to sleep. She also pretended to give the bear a kiss. If XXXX was not able to complete a task during the assessment, she did not give up and continued to try to complete the task. For example, she could not assemble the ball puzzle and tried 4-5 times before moving on to the next task. While reading a story, XXXX wanted to hold the book and flip quickly through the pages. XXXX was able to attend to the story with redirection and prompting to listen. She smiled and excitedly produced different animal sounds while reading the farm animal book such as “moo”, “meow”, and “woof.” XXXX was given a snack at the end of the evaluation as she was a little hungry. She walked around the room while eating her snack. She offered the clinician some of her snack upon request and smiled when the clinician took some of the snack. When the clinician walked out of the room to leave, XXXX said “bye”, waved, and blew a kiss. SUMMARY AND RECOMMENDATIONSAssessment Results: Bayley Scales of Infant and Toddler Development, 3rd EditionCognitive: 23 monthsPercentile Rank: 37th Fine motor: 21 monthsGross motor: 23 months Percentile Rank: 27th The Developmental Assessment of Young Children (DAYC):Social-Emotional: 24 monthsSXXXXdard Scor= 104, Percentile Rank= 61st percentileAdaptive Behavior: 21 monthsSXXXXdard Score= 91, Percentile Rank= 42nd Rossetti Infant-Toddler Language ScaleInteraction/Attachment:15-18 Months (No test items above this age level)Pragmatics: 9-12 Months with scattered skills up to 15-18 monthsGesture: 18-21 with scattered skills up to 24-27 monthsPlay: 24-27 Months with scattered skills in 27-30 monthsReceptive Language: 21-24 Months with scattered skills up to 24-27 monthsExpressive Language: 12-15 Months with scattered skills up to 15-18 monthsRECOMMENDATIONSBased on these results of the sXXXXdardized assessments and informal observations, XXXX presents with delayed expressive language skills, and pragmatic skills (secondary to an expressive language delay) which decreases the effectiveness of her communication attempts and restricts her access to her environment, activities of daily life, and limits her ability to interact with other children. Therefore, XXXX would benefit from the following recommendations: Speech and Language services one-on-one to increase expressive language skills for 60 minutes a session. Per parent request, therapy should be conducted in a clinic settingParents are encouraged to participate in therapy to acquire strategies and techniques for increasing XXXX’s communication skills.The following goals should be targeted during speech and language therapy: EXPRESSIVE LANGUAGE:1. XXXX will use a variety of words (at least 25) including objects, body parts, and actionsCreate situations to tempt XXXX to communicate?by adapting the situation so that she feels it is necessary to communicate something. Do not anticipate her wants/ needs. For insXXXXce, arrange the environment moving his favorite toys out of his reach, but within sight; hold out on giving XXXX a toy that she likes, and expect him to request them appropriately, initially by pointing, while the adult models the word, gradually expecting him to imitate the word, and eventually, expecting him to say the word without the adult’s model.?2. XXXX will answer concrete choice, yes-no, “what” and “where” questions consistently (80% or more of the time)Ask XXXX simple concrete questions and model the desired response as needed: e.g. the adult asks “do you want an apple? while holding an apple. the child reaches for the apple. The adult then models head nodding, while modeling the word “yes”. The adult waits for XXXX to imitate, and when he does, the adult gives him the apple.?3. XXXX will label at least 40 familiar pictured items (including body parts and actions) 80% or more of the time.●?????Work with themes (e.g. clothes, food, things in the house, animals, etc.). Begin by focusing on vocabulary around XXXX’s daily environments and preferences.●?????Talk about the targets in daily routines (e.g. while getting groceries, you can talk about items at the store; while doing laundry, you can talk about clothes).●??????Engage in “talking while doing” and “Simon Says”. For insXXXXce, say “wash wash” while washing hands.4.?XXXX?will imitate various syllabic strings consisting of VC, CV, CVC, and CVCV patterns as demonstrated by the clinician with 80% accuracy. (*C=consonant; V=vowel)?PARENTAL SUGGESTIONS FOR MODELING AND ELICITATION OF EXPRESSIVE LANGUAGE:Parent will demonstrate the ability to model and expand XXXX’s communication skills through:Self-Talk- During play the parent will verbally describe actions and objects in order to model expressive language for your child. . Cooperative Play- The parent will engage in play utilizing sharing common objects to provide a motivating environment with multiple opportunities for verbalization and functional use of language. Parent can engage in activities of daily routines (e.g., self-care habits such as brushing teeth, preparing simple snacks, and taking a bath) with simple language-based description and instruction to expand XXXX’s acquisition of the language used in those routines.It was a pleasure working with XXXX. If there are any questions regarding this report or if you desire further information, please do not hesitate to contact me at (818) 788-1003.____________________________________Rina Rome, M.A., CCCM.A. Speech Language Pathology License # SP 20951Helen Sherman-Wade, MA, CCCM.A. Special EducationM.A. Speech Language PathologyLicense # SP 3460 ................
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