Gordy is a four and a half year old boy who has attended individual speech and language therapy at this office since April, 1994. Gordy was initially scheduled for two, 30 minute sessions per week; this was reduced to one weekly session in October, 1994. Attendance in therapy is excellent.
At the onset of therapy, Gordy presented significant deficits in language processing and production. He had difficulty following directions, answering questions and remaining on-task for an appropriate length of time. Expressive language was characterized by jargon, echolalia, and perseverative utterances.
Therapy activities have consisted of "structured" tasks, using a variety of pictures and materials, to increase Gordy's ability to follow directions, answer questions. and process various language input. Less structured activities, such as play, assembling "colorform" pictures, and reading books have been utilized as well. Gordy's interest in colors, shapes, numbers and letters has been used as warranted to work on various language goals.
Gordy has made tremendous progress in therapy to date. He has adapted well to the therapy routine and generally follows the rules with a minimal amount of prompting. Gordy continues to "fuss" on occasion, but recently, with prompts is beginning to express his feelings (ex. "I'm sad"). Appropriate verbalizations have increased tremendously. Echolalic and perseverative responses are still present, although they have diminished greatly (as has Gordy's repetition of various videos and books). More specific goals and progress are summarized below.
Goal; Increase ability to answer questions appropriately.
Progress. Gordy now answers a variety of "yes/no" and "wh" questions about structured, concrete topics with fairly good accuracy. He continues to confuse "wh" question forms (ex. "who, where, what") at times, but usually answers correctly given prompting or choices. Gordy is able to answer a "choice" question (ex.. "Is it ___ or ___?") at approximately 75% accuracy when talking about objects or pictures. He is able to name the function of an object when asked, "What do you do with a __ ?" at 70% accuracy. He answers simple "wh" questions (ex. "who, what, where, what doing?") about pictures or ongoing activity at approximately 70% accuracy as well.
Gordy is beginning to answer questions about more abstract topics. He can usually be prompted to provide at least one answer for "What did you do at school today?". Written prompts are often helpful to encourage Gordy to answer questions which he has difficulty with. the question and answer are written out and "rehearsed" in order to build up his understanding of the relationship between questions and answers.
Goal; Increase comprehension and expression of personal pronouns.
Progress: Gordy continues to exhibit difficulty with pronouns, although progress is observed with this goal. He continues to refer to himself as "Gordy", but can easily be prompted to use my, me, mine" as appropriate (and does use 'I, my" spontaneously on Many occasions). Gordy is also easily prompted to use "you, your appropriately. Written cues are often effective to increase correct pronoun usage (ex. Gordy fills in "My name is ______, Your name Is ___ "). Gordy continues to have difficulty transitioning between subject-possessive-object pronouns, with lots of overgeneralization (ex. "The toy belongs to him. It is him toy"). Continued work with a variety of pronouns is warranted.
Goal: Increase appropriate language usage; decrease perseverative and unintelligible verbalizations.
Progress:Gordy has made excellent progress in using his language more effectively and appropriately. He now uses verbalizations to greet, request, protest, question, gain attention, and make statements. During structured therapy tasks, the vast majority of Gordy's utterances are now appropriate to the topic. Verbal perseveration and echolalia have decreased dramatically over the past several months. Gordy continues to exhibit some "TV" or "video talk", but recently he has been able to identify where his Monologue comes from given some prompting. Gordy's ability to listen and process language, and to produce appropriate responses, has Improved significantly. On task behavior and attention span have also increased.
ASSESSMENT RESULTS
Gordy's speech and language skills were re-evaluated in December, 1994 and January, 1995 with results as summarized below.
Goldman--Fristoe Test of Articulation
Gordy named 27 of the 35 stimulus pictures spontaneously. Articulation substitutions were developmental in nature, as follows: slight distortion of /r/ medial, final and in some blends; f/th Initial and final; s/th medial; omission of /1/ in some blends.
Intelligibility of Gordy's speech is good at the single word level. In connected speech, intelligibility varies according to the content of Gordy's speech (whether he is using meaningful language or jargon). When Gordy is purposefully communicating, his verbal Intelligibility is generally good.
Preschool Language Scale - 3
This instrument measures a variety of receptive and expressive language skills through tasks such as pointing to pictures. following directions, answering questions, and using specific syntax structures. Gordy achieved the following results;
Standard Percentile Age
Score Rank Equivalent
Auditory Comprehension 75 5 3-7
Expressive Communication 62 1 3-0
Total Language Score 65 1 3-3
These results indicate significant deficits in both receptive and expressive language skills. It should be noted, however, that substantial progress (as measured by this test) is present as compared to a previous administration (6/94). Most progress was noted in receptive skills. Items at or below age level which continue to be difficult Included understands negatives (a 3 - 3-1/2 year task); compares objects (a 3 1/2 - 4 year task); understands spatial concepts, understands complex directions, identifies pictures (4 - 4-1/2 year tasks). On the expressive subtest of the PLS-3. Gordy did not correctly complete: produces basic sentences (a 2-1/2 - 3 year task); answers questions logically, uses several pronouns spontaneously, tells about remote events (3 - 3-1/2 year tasks); repeats sentences (a 3-1/2 - 4 year task); and all items beyond the 4 year level. Gordy's ability to remain on task during this part of the test, where many of the items are not accompanied by visual stimuli, was much improved over the previous administration.
Peabodv Picture Vocabulary Test
This test measures the child's receptive (listening) vocabulary by requiring him to point to a picture (from a choice of 4) corresponding to a spoken word. Gordy's results were as follows:
Chronological Age: 4 years, 6 months
Age Equivalent: 3 years
Standard Score: 65
Percentile Rank: 1
These results suggest a significant deficit in Gordy's receptive language skills. When compared to a previous administration of this test (7/94, Chronological Age 4-i, Standard Score 75), Gordy's score on this test decreased significantly. This difference may be attributed to Gordy's use of "computer talk" during the current administration of the PPVT. Gordy pointed to each picture on the page, cueing himself as if playing a computer game ("You're right" or "Try again"). It is felt that perhaps Gordy was focusing more on this aspect of the test, and not paying as close attention to the stimulus word and pictures.
Expressive One Word Picture Vocabulary Test
This test measures the child's expressive (speaking) vocabulary by requiring him to name a series of pictures. Gordy's results were as follows:
Chronological Age: 4 years, 6 months
Age Equivalent: 3 years, 5 months
Standard Score: 81
Percentile Rank: 10
These results indicate a moderate deficit In Gordy's expressive language skills. Pictures he was able to name correctly included "stool, tractor, skeleton", while he did not correctly name "bird, watch, clock". Gordy's responses were often close, but not precise enough to be counted as correct (ex. "wheel/tire, purse/suitcase, fire/fireplace").
A sample of Gordy's language was obtained by telling Gordy a story which he then re-told using picture cues. Gordy exhibited good, active listening during the telling of the story. When retelling the story, Gordy generally produced 1-3 utterances per page with some prompting. Sentences were somewhat telegraphic, with some word order and word choice errors. Pronoun confusions were evident throughout the re-telling of the story. Other syntax errors included omission of verb tense markers, "to be" verbs, possessive markers and articles. Gordy answered approximately 90% of simple "wh" questions regarding the story appropriately.
Hearing screening was attempted (1/95) but was not completed, as Gordy would not tolerate wearing the headphones. This should be attempted sometime in the future.
SUMMARY AND RECOMMENDATIONS
Gordy Whaley is a four and a half year old boy who has made excellent progress in his communication development to date. Gordy continues to exhibit difficulty with pragmatic skills, auditory processing, and expressive language. Continued enrollment in weekly or bi-weekly speech and language therapy is recommended, in addition to his participation in a language-based preschool. Auditory Integration training should also be considered for Gordy.