Speech and Language Pathology

Evaluation date: 10/12/06

Initial Evaluation

Age: 14 months
Initial Communicative Diagnosis: Severe oral motor delay, Severe expressive language delay, Moderate receptive language delay
Mother accompanied her son, D, to our Center for Childhood Speech and Language Disorders on 10/12/2006 for a speech and language evaluation.

Background Information: information was obtained through a case history and parent interview. Developmental milestones for early speech and language development were reported to be delayed. D did vocalize and babble as an infant. Babbling and some jargon persist. First words have not yet emerged. Mom reported that she first became concerned regarding D's speech and language development following his diagnosis of CBPS, IS, PMG. In February of 2006 D began therapy with Carol, physical therapist. Mom indicated that D has been receiving both PT and OT from February 2006 to the present.

Dr. Cukrowski, Ophthalmolgist, and Dr. Dobyns, Genetics, Neurology, Pediatrics both indicated that D's vision is good with no apparent issues.

Mom reported that audiological screening was conducted during D's hospital stay following his birth. No apparent difficulty with hearing acuity was revealed at that time.

Dr. Alpiner, Pediatric and Adult Physical Medicine and Rehabilitation indicated that D is behind on his motor skills.

Mom reported that D will be seen by the early intervention program through the public school system in June of 2007 for PT, OT and speech and language treatment.

Behavioral Observation:
Upon meeting D int eh waiting room, he was seating in a reclining position within his stroller. He was noted to be smiling and quite interactive with his mother. Separation was not attempted and mom and D accompanied this clinician to the diagnostic suite where they remained for the entire 45 minute session. D was cooperative throughout the evaluation and demonstrated good eye contact and facial expression. Play skills were clearly delayed due to D's reduced upper extremity control.

Receptive Language Functioning:
Mom was invited to remain in the diagnostic suite and act as an informant as the Rosetti Infant Toddler Language Scale (RITLS) was administered. The RITLS is a developmental checklist, which assesses different areas of development in different age ranges. This test is based on development in different age ranges. This test is based on developmental norms.

Receptive Language Functioning:
Results of the RITLS placed D receptive language skills within the six to nine month range. He demonstrated most of the skills in the upper age range such as recognizing family members names, attending to music or singing, responding to "no" most of the time, stopping when name is called, attending to pictures and occasionally waving "bye-bye" During the evaluation D demonstrated difficulty gesturing in response to verbal requests, following simple commands that required movement, and verbalizing or vocalizing in response to verbal requests. It should be noted that vocalizations and verbalization were present but were delayed in nature. It appeared that D had difficulty initiating oral/vocal motor movement. Based on observation and developmental checklist of the RITLS D is demonstrating a moderately severe receptive language delay. It should be noted that it is probably that demonstration of auditory comprehension is greatly effected by D's difficulty with initiation of motor movements as well as difficulty with gross and fine motor planning.
Play Skills:
The RITLS also assesses play skills. D is demonstrating a severe delay in play skills at this time as his scores are falling the three to six month age range. D's delay in development of play skills is clearly directly related to his decreased motor planning. For example, D smiles at himself in the mirror and enjoys frolic play, however, he had great difficulty initiating reaching for objects or participating in games with adults due to his decreased upper extremity motor planning.
Oral Motor Development:
D presented with symmetrical facial features. He appeared to have proper lip closure. D demonstrated production of numerous vowel sounds and when babbling he produced age appropriate phonemes such as /p, b, m, g,d/. An oral peripheral examination was not completed on this date due to D's young age and inability to imitate oral motor movements at this time. Motor planning for oral motor movement was reduced, however, spontaneous smiling was frequent.

Mom reported that D is receiving feeding treatment by an OT. She reported that D sometimes chokes on food, does not yet chew, and is taking stage 3 baby foods.

Expressive Language Functioning:
The RITLS was used to assess D's expressive language skills. At the time of evaluation D demonstrated the ability to vocalize four different syllables and vocalization of two syllable combinations such as "mama" is emerging. Mom reported that D is beginning to repeat syllables but only for the word "mama' at this time. D is demonstrating a severe expressive language delay.

Summary:
D is a 14 month old child who participated in a speech and language evaluation at WBH. Based on parent reported, informal observation and development checklist, D is presenting with a moderate receptive language delay, a severe oral motor delay and a severe expressive language delay.

Recommendations:
A conference was held immediately following the diagnostic session with mom. At that time the above mentioned diagnostic impressions as well as treatment recommendations were discussed. Recommendations are as follows:
1) That D participate in an individual speech and language treatment stimulation program within our center one time weekly for one half hour session.
2) That the family continue with the early intervention program at home and within their public school system

Long Term Goals:
Goal for the first interim may include, but are not limited to the following:
1)Provide the family with an intensive language stimulation home program.
2) Provide a speech and language stimulation treatment program within our center with Anna, SLP. Anna is a speech and language Pathologist who has certification in neurodevelopmental training.