SPEECH AND LANGUAGE ASSESSMENT



SPEECH AND LANGUAGE ASSESSMENTNAME: XXXX XXXDOB: 6/15/2012CA: 1 year 23 months PARENTS: XXXX and XXXXX ADDRESS:XXXXXXXXXXXXXXXXXXTELEPHONE: (424) 744- 8442SERVICE COORDINATOR:Suraiya MotalaUCI: 7632468REGIONAL CENTER: Westside Regional CenterTEST DATE: 7/11/2014REPORT DATE: 7/11/2014BACKGROUND INFORMATION/HISTORY OF PRESENT PROBLEM:XXXX, a 2-month-old male, was referred to Speech Language and Educational Associates for a speech and language evaluation by Westside Regional Center due to delays in speech and language. This assessment was conducted within the home setting in Pacific Palisades, California. Mrs. Eastland, XXXX’s mother, was present throughout the testing session and served as a reliable informant. She expressed concerns with XXXX’s delayed speech and language skills. She reported that he is not yet speaking words and does not imitate sounds or words upon request. This evaluation was also used to determine XXXX’s speech and language skills and to identify strategies that could be used to develop his communication skills.BIRTH/MEDICAL HISTORY:Mrs. XXXXreported that she received prenatal care from before conception and continued to receive care until delivery. She reported that XXXX was born full term at 39 weeks gestation via natural vaginal delivery and weighed 7 pounds 6 ounces at birth. Mrs. XXXXreported that the doctors found 3 heart murmers at birth. XXXX now sees a cardiologist once a year. After the last doctor’s appointment, XXXX was found to have only one heart murmer. Also as a newborn, XXXX was diagnosed with an enlarged head size. He received tests to rule out any problems in his brain. He was found to have cysts in his brain at 3 months of age but Mrs. XXXXwas told that the cysts showed no indication of being dangerous. He is not currently taking medication and has no known allergies. She reported that XXXX has a history of feeding difficulties as he refused to eat at 6 month and had difficulty transitioning from baby food to more real foods. He continues to refuse to eat certain textures such as meat. Mrs. XXXXreported that she will supplement XXXX’s meals with Pediasure. XXXX reportedly presented with recurrent ear infections from age 4 months until 12 months. Pressure equalizing tubes (PE tubes) were placed in his ears at 1 year. He recently received an audiological exam to assess his hearing and passed the hearing test in both ears.XXXX’s medical care is currently provided by Dr. Liliana SloninskyAddress: 8631 West 3rd Street #725-E Los Angeles, CA 90048 Phone: (310) 854-3043DEVELOPMENTAL MOTOR MILESTONES:Mrs. XXXXreported that XXXX achieved all developmental milestones as follows: he first rolled over very early at 4 weeks, sat alone at 6-7 months, crawled at 10 months, and walked at 13 months. He is not yet potty trained but will sit on a toilet supervised and will sometimes indicate when his diaper needs to be changed. XXXX reportedly uses both his left and ride hands often and has not yet established hand dominancy. He began eating a meal independently using a spoon at 22 months. He sleeps from around 7:30 to 6:30 and takes one nap during the day for around two hours. SOCIAL HISTORY:XXXX lives at home with his parents, 14 year old brother, 11 year old brother, and 4 year old sister. English is the only language spoken at home. Ms. XXXXreported that XXXX spends most of his time at home with his mother. He is not yet attending a daycare or school-based program. He sees other children at least once a week at Church as he plays in a group with other children ages 18 months to 36 months. He will play for a short time away from his mother at the church but will then begin to cry for her. XXXX reportedly is able to play away from familiar adults when playing at home or at his grandparents’ house. XXXX does not yet play together with other children but will play alongside other children and will imitate the play of other children. He will sometimes share with other children depending on his mood. XXXX plays with a variety of toys and plays appropriately with most toys. He engages in pretend play as he will pretend to feed others, will put stuffed animals or dolls to sleep, and will pretend to feed himself with an empty cup or spoon. Mrs. XXXXreported that XXXX enjoys music. He does not yet dance along to music but he will jump or move along to music at times. Mrs. XXXXreported that when they are in the car, XXXX will babble along to music in a sing-song way but does not sing along consistently to music and does not yet sing independently. XXXX presents as a very happy and curious boy. He consistently greets and bids farewell by waving. He maintains eye contact when motivated and engaged and will engage in joint attention while playing some games. He does not yet engage in joint attention while reading books. Mrs. XXXXreported that XXXX presents with a short attention span and transitions quickly between activities. She also reported that he will only sit for books at night or when he is tired. XXXX was observed to throw a ball back and forth with an adult and reportedly engages in simple back and forth games. SPEECH AND LANGUAGE HISTORY:Mrs. XXXXreported that XXXX did not babble during his first 6 months of age and did not say his first word approximation until 20 months. XXXX currently communicates using some gestures, pointing, vocalizations, screaming, facial expressions, and crying. He produces approximations of some words such as “da” for “dada”, “ma” for “mama”, “ma” for “more.” He says some single words at times but not always appropriately such as “off.” He will mostly say “ah ah” or “mm mm” and point to indicate his wants and needs. He is able to express himself using gestures. XXXX will frequently bring a caregiver over to the item that he wants in order to obtain the desired object or request help. For example, if he wants food he will bring his mother over to the refrigerator in the kitchen. XXXX becomes frustrated easily when he is unable to be understood and when he does not get what he wants. Ms. Mendez reported that Jayden does not yet follow 1-step directions consistently. Mrs. XXXXreported that XXXX is becoming more frustrated recently and his tantrums are escalating. XXXX reportedly follows directions well. He will follow familiar and unfamiliar 1-step directions. He inconsistently follows 2-step directions depending on his distractibility and focus. He does not yet produce animal sounds or imitate environmental noises. Mrs. XXXXreported that she sometimes hears an approximation for “woof” for a dog sound but reported that unfamiliar listeners would not be able to understand him. He does not yet model sounds or words upon request or attempt to produce non-speech sounds. He recently started babbling in the past 4 months. There is no family history of a speech, language, or hearing impairment. HEARING:XXXX appeared to hear adequately throughout the testing process. Mrs. XXXXreported that XXXX passed his hearing screening at birth in both ears. His hearing was not formally assessed during this evaluation but he responded to the clinician and caregiver’s vocalizations and to sounds made from toys during the assessment. XXXX was recently administered an audiological evaluation after receiving PE tubes in his ears and passed the hearing test in both ears. ?ASSESSMENT RESULTS:The following assessment tools were used to evaluate Bryon’s speech and language skills:Rossetti Infant-Toddler Language ScaleInformal observationParent interviewPreschool Language Scale, 5th Edition (PLS-5) 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.XXXX was assessed in the home setting with his mother present. THE ROSSETTI INFANT-TODDLER LANGUAGE SCALE:The Rossetti Infant-Toddler Language Scale assesses the language skills of children from birth through 3 years of age. The scale assesses preverbal and verbal areas of communication and interaction through direct observation and caregiver report. Areas assessed include (1) Interaction-Attachment (relationship between the caregiver and the infant), (2) Pragmatics (the way language is used to communicate and affect others), (3) Gestures, (4) Play (both individual and interactive), (5) Language Comprehension, and (6) Language Expression.THE ROSSETTI INFANT-TODDLER LANGUAGE SCALESubtestDescriptionAge in MonthsStrengthsXXXX is able to:WeaknessesXXXX is not yet able 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 people Requests assistance from an adultRetreats to caregiver when an unfamiliar adult approachesPragmaticsThe way the child uses language to communicate with and affect others.15-18 months Points to, shows, or gives objects Controls the behavior of self and othersUses words to protestEngages in adult-like dialogueUses vocalizations and words during pretend playUses words to interact with othersTakes turns talking during conversationGestureThe 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 up to 24-27 months) Leads caregiver to a desired objectsIndicates that pants are wetPretends to play a musical instrumentGestures to request actionPushes a toy stroller or shopping cartPretends to write or typePretends to talk on the phoneWipes hand and faceSlaps a palm in response to “high five” Puts on or takes off clothingFlies a toy airplanePretends to dance to music PlayThe changes in a child’s play that reflect the development of representational thought.24-27 months Imitates some housework activitiesGroups objects in playStacks and assembles toys and objectsChooses toys selectivelyUses two toys together in pretend play Puts away toys upon requestAttempts to repair broken toysPerforms many related activities during playSlaps a palm in response to “give me five” Demonstrates parallel play with other children Talks more in play around other childrenLanguage ComprehensionThe child’s understanding of verbal language with and without linguistic cue.24-27 monthsPoints to four action words in picturesRecognizes family member namesUnderstands the concept of one Understands size conceptsResponds to simple questionsIdentifies objects by function (can do sometimes)Understands location phrasesLanguage ExpressionThe child’s use of preverbal and verbal behaviors to communicate with others. 6-9 months (with few scattered up skills up to 12-15 months) Vocalizes four different syllables Vocalizes a two-syllable combinationVocalizes in response to objects that moveImitates duplicated syllablesVocalizes during gamesSings along to a familiar songShouts or vocalizes to gain attention Vocalizes a desire for a change in activitiesShakes head “no”Varies pitch when vocalizingSays “mama” or “dada” meaningfullyImitates consonant and vowel combinationsImitates non-speech soundsVocalizes with intent frequentlyUses a word to call a personSays one to two words spontaneouslyImitates the name of familiar objects Names one object frequentlyImitates new words spontaneouslyImitates three animal soundsSings independently Based on the results of the Rossetti Infant-Toddler Language Scale and parent interview, XXXX presents with age appropriate interaction/attachment, gesture, and play, and language comprehension. He presents with a severe delay in language expression and moderate delay in pragmatics (secondary to an expressive language delay) The Preschool Language Scale-5th Edition (PLS-5) was used to measure XXXX’s receptive and expressive language abilities. Receptively, the test assessed XXXX’s appropriate use of manipulatives, attention, and understanding of basic concepts and knowledge of language. He was also required to demonstrate understanding of how to play appropriately and respond appropriately to simple directions. Expressively, the test assessed XXXX’s vocal/gestural behaviors, and different levels of play. On the Auditory Comprehension subtest of the PLS-5 Spanish Edition, XXXX earned a standard score of 103, placing him in 58th percentile for his age, with an age equivalent score of 2 years 4 month. Based on this measure, the following was notedXXXX displays the following skills:XXXX does not yet display the following skills:Responds to inhibitory word (e.g. no)Understands a specific word or phrase without the use of gestural cuesDemonstrates functional playDemonstrates relational play Demonstrates self-directed playFollows routine, familiar directions with gestural cuesIdentifies basic body partsIdentifies clothing items Identifies familiar objects from a group of objects without gestural cuesIdentifies photographs of familiar objectsFollows commands with gestural cuesUnderstands verbs eat, drink, and sleep in contextEngages in pretend playUnderstand pronouns (me, my, your)Follows commands without gestural cuesEngages in symbolic playRecognizes action in pictures Understands spatial concepts (in, out, out of, off) without gestural cues Understands quantitative concepts (one, some, rest, all)Makes inferencesUnderstands analogiesThe PLS-5 Expressive Communication (EC) subscale was administered in order to determine the level of XXXX’s general language expression. The tasks on this subscale that are designed for infants and toddlers address vocal development and social communication. On the Expressive Communication subtest of the PLS-5, XXXX earned a standard score of 71, placing him in the 3rd percentile with an age equivalent score of 1 year 3 months. Based on this measure, the following was noted: XXXX displays the following skills:XXXX does not display the following skills:Babbles two syllables togetherUses a representational gesture Produces syllable strings with inflection similar to adult speechParticipates in play with another person for at least 1 minute using appropriate eye contactInitiates a turn-taking or social routineUses a representational gestureUses gestures and vocalizations to request objects. Imitates a wordProduces different types of consonant-vowel (C-V) combinationsUses at least 5 wordsProduces syllable strings (two or three syllables) with inflection similar to adult speechImitates a wordNames objects in photographs Uses words more often than gestures to communicateUses words for a variety of functions Uses different word combinations Names a variety of pictures objectsXXXX earned a Total Language Score of 86 with an age equivalent score of 1 year 9 months for his overall language. SPONTANEOUS ORAL LANGUAGE:XXXX produced the following words/utterances/vocalizations during the assessment:Mm Uh uhMm MaMamaMoOff (2x)GaARTICULATION AND PHONOLOGY:Formal assessment was not possible at this time secondary to limited verbal output. XXXX’s articulation should continue to be monitored as his verbal output increases. ORAL-PERIPHERAL EXAMINATION:An informal oral-peripheral examination was administered to determine the status of XXXX’s articulators for speech production. His hard palate, soft palates, and tongue appeared to be within normal limits. No flaccidities, tremors, or award movements were clinically observed. No drooling was observed during the time of this assessment. At this time, oral-motor structures and movements should continue to be monitored for adequate oral speech production.VOICE AND FLUENCY:Voice and fluency were not formally assessed due to XXXX’s limited verbal output but appeared within normal limits for his age and gender. PLAY/BEHAVIORAL OBSERVATIONXXXX was standing by the door when the clinician arrived. He smiled and waved “hi” as the clinician approached the door. When the clinician entered the evaluation room, the play room, XXXX wanted to show the clinician his toys. He vocalized and pointed repeatedly to indicate that he wanted to show the clinician wanted to get the toys off the shelf. He beSUMMARY AND RECOMMENDATIONS:Jayden is an adorable 18 month-old male. Based upon the results of informal testing as well as parent interview, Jayden presents with moderate to severe delays in receptive and expressive language. He demonstrated a preference of using gestures and vocalizing over words, produces less than 5 words, and has difficulty communicating his wants and needs. Jayden is not yet following directions consistently. He becomes very frustrated when not able to communicate or not understood by listeners. It is recommended that Jayden: Receive Speech-Language therapy 2 times a week for 60 minutes each session to increase receptive and expressive language skills. Parents are encouraged to participate in therapy to acquire strategies and techniques for increasing Jayden’s communication skills.Family should communicate with Jayden in the language that they are most fluent in to provide him the best linguistic model possible. Parents should also remember that is important for each person to remain consistent in the language they are using. Bilingualism does not cause or exacerbate a language delay/disorder. ?A complete evaluation administered by an Occupational Therapist is recommended to identify or rule out any motor or sensory needs. ?The following goals should be addressed in speech and language therapy: EXPRESSIVE LANGUAGE:1. Jayden?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)?2. Jayden will use a variety of words (at least 50) including objects, body parts, and actionsCreate situations to tempt Jayden to communicate?by adapting the situation so that she feels it is necessary to communicate something. Do not anticipate her wants/ needs. For instance, arrange the environment moving his favorite toys out of his reach, but within sight; hold out on giving Jayden 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.??3. Jayden will label at least 25 familiar pictured items (including body parts and actions) or objects 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 Jayden’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 instance, say “wash wash” while washing hands.RECEPTIVE LANGUAGE Jayden will identify at least 25 familiar pictured items ((including body parts and actions) or objects 80% or more of the time.Jayden will follow 1-step directions including basic prepositional concepts (in, out, off, on) with 80% or more of the time. PARENTAL SUGGESTIONS FOR MODELING AND ELICITATION OF EXPRESSIVE LANGUAGE:Parent will demonstrate the ability to model and expand Jayden’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 Jayden’s acquisition of the language used in those routines.Other suggestions to facilitate language:Encourage music, nursery rhymes, shapes, colors, and other activities that will promote speech, language, and play skills. Sabotage (e.g., close lid on bubbles, stopping a wind-up toy, giving her a small piece of food) in order for Jayden to initiate, comment, request, negate etc.Talk while doing things and going places. When taking a walk in the stroller, for example, point to familiar objects (e.g., cars, trees, and birds) and say their names. "I see a dog. The dog says 'woof.' This is a big dog. This dog is brown."When Jayden produces a word approximation such as “ba” for ball, parent should promote the correct and complete word production by sitting down to the child’s level (for attention) and repeating “ball.” Encourage music, nursery rhymes, shapes, colors, and other activities that will promote speech, language, and play skills. Encourage finger plays/puppets.Use simple but grammatical speech that is easy for your child to imitate.Take a sound walk around your house. Introduce him to Timmy Clock, who says "t-t-t-t." Listen to the clock as it ticks. Find Mad Kitty Cat who bites her lip and says "f-f-f-f" or Vinnie Airplane who bites his lip, turns his voice motor on and says "v-v-v-v." These sounds will be old friends when your child is introduced to phonics in preschool and kindergarten.Expand on words. For example, if your child says "car," you respond by saying, "You're right! That is a big red car."Continue to find time to read to your child every day. Try to find books with large pictures and one or two words or a simple phrase or sentence on each page. When reading to your child, take time to name and describe the pictures on each page. (You do not need to read full text of pages- make up your own short story if you want while point to pictures!)Have your child point to pictures that you name.Ask your child to name pictures. He may not respond to your naming requests at first. Just name the pictures for him or her. One day, she will surprise you by coming out with the picture's name.Visit for information pertaining to speech and language development/milestones.It was a pleasure working with Jayden in conjunction with Westside Regional Center. 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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