Detailed Speech/Lang Eval. Report

[MicheleB]

I received the details speech/lang. eval in the mail today (for my 9yo ds). Here's what was specifically pinpointed. The therapist did not send any recommendations, though maybe that's in a separate letter. However, if you have any recommendations, I'd be glad to hear them. (If I could not decipher the handwriting, I've put a ? by the word....)

 

The test administered was the C(?) ELF-3.

 

Concepts, directions and (?) sentences subtests fell at low normal level with standard scores of & each. Word classes subtest and formulated sentences showed a moderate impairment with of 5 and 6 respectively.

 

Overall a mild to moderate language delay is noted.

 

Test for Auditory Comprehension of Language-Revised: Overall, fell at the 3rd percentile for his CA (calculated age?). Age equivalency range of 8yrs, 7mos to 9yrs, 11 mos. Although this falls within normal limits, subtest testing word classes and relations was <1st percentile and grammatical morphones(?) fell at the first percentile. Elaborated sentences fell at the 29th percentile, raising the overall score.

 

Impression: Mild to moderate language delay with weakness in the areas of word classes, syntax, comprehension and expression.

 

If you can make more sense of this for me as well, that'd be wonderful. :)

[Claire]

I'm surprised the report wasn't typed!

 

The CELF-3 is Clinical Evaluation of Language Fundamentals. The mean Standard Score for each subtest area is 10. The mean standard score total for the whole test is 100. My dd tested with a SS of 7 in word classes when she was 9yo. Other scores were above the mean, so her total SS was within normal limits (WNL). The SS of 7 was considered 1 standard deviation below the norm. (On a different test with mean SS of 10, a SS of 5 was 1.8 standard deviations below the norm.)

 

I'm wondering if the Test for Auditory Comprehension of Language-Revised was the phonemic awareness and phonological testing. She probably meant grammatical morphemes (morphemes are the smallest units of language that retain meaning).

 

To me, it looks as if the delays are in both receptive language and expressive language. Her recommendation is probably going to be for him to do speech therapy with her. If at all possible, you want a ST who will provide you with work to do at home, as that can make progress go much faster.

[MicheleB]

 

Test for Auditory Comprehension of Language-Revised: Overall, fell at the 3rd percentile for his CA (calculated age?). Age equivalency range of 8yrs, 7mos to 9yrs, 11 mos. Although this falls within normal limits, subtest testing word classes and relations was <1st percentile and grammatical morphones(?) fell at the first percentile. Elaborated sentences fell at the 29th percentile, raising the overall score.

 

What does this all mean? Esp. the 8yrs, 7mo, etc. part?

 

Do you feel the "mild to moderate" is accurate? I guess I'm focusing on the first percentiles part.

 

What types of therapy is done for these types of issues? What can be expected as far as an outcome? You had said before they were not easy to fix issues... do they ever resolve with therapy?

 

Also, given the sensory issues, academic difficulties and these speech delays, do you have a sense of "what" the big picture is here? I was thinking more high-functioning autism, because Aspergers doesn't seem to fit anymore. ???

[Claire]

The way I read this, the range of 8 yrs 7 mos to 9 yrs 11 mos was on the subtests of the Auditory Comprehension of Language testing. Those scores would be within normal limits for his age of 9yo. However, the very low percentile scores on certain subtests indicates substantial weakness in those areas.

 

I would say her overall impression of "mild to moderate" is accurate because he wasn't low across the board. It's just that the subtests where he scored low, he scored very low.

 

Speech therapy should help. Those are the types of problems that speech therapists are trained to work on. What I meant by not easy to fix is that a child is unlikely to outgrow these problems without targeted help, and probably it needs to be professional help.

 

My biggest concern would be the impact of these specific problems on comprehension. Language is a basic, foundational learning medium. A child with articulation errors is still going to be able to comprehend spoken material. However, a child who doesn't understand word relationships is going to be at a huge disadvantage in most learning environments.

 

A child can have sensory issues, academic difficulties, and speech delays and not be on the autism spectrum at all. A complete neuro-psych eval could pinpoint whether autism is likely, but OT and speech evals by themselves wouldn't be enough to either rule it out or identify it.

[MicheleB]

Thanks again Claire.

 

I am really surprised about the receptive part. Since he loves me reading aloud to him and I spend a substantial amount of time everyday doing that, I guess it seemed his receptive language was pretty OK. Not that I'm questioning the results of the tests... because when she did explain it by breaking it down to "opposites" or words that are similar in meaning, I see what she means.

 

One more question if you can bear it..... Since this ds reverses quite a lot, does this receptive language difficulty perhaps tie into that?

 

We are set up for the n.p., in August and OT is on a waiting list as well.

[Claire]

Since this ds reverses quite a lot, does this receptive language difficulty perhaps tie into that?

 

By reversals, do you mean writing reversals? Or is it something with oral language?

[MicheleB]

By reversals, do you mean writing reversals? Or is it something with oral language?

 

Writing reversals, reading reversals (such as, "prose" might read "ropes" kind of thing), and oral reversals (refrigerator/freezer; washer/dryer; saying too "tight" when he means too "loose", etc).

 

The reason I mentioned in the other post about autism is his behavior. It's beyond "quirky". Crying over his cookie being broken; everything has to be "fair", very black/white, no middle road; very literal, etc.

 

Also, is there an official name for his dx other than receptive and expressive language delays? IOW, are those things themselves broken down into more specific dx? I know she told me the subtests names....

 

Also, do you have any idea *how* this therapy works? I guess I just don't get how you teach a child these things. Not that I doubt it can be done, just not sure what to expect, ask for and look for.

 

Thanks so much again. :001_smile:

[Claire]

The writing and reading reversals are examples of weak directionality and sequencing skills. These are cognitive skills that can usually be trained with exercises. However, you have to make sure that the sensory foundation is solid first (motor and vestibular development, visual and auditory development) or at least as optimal as possible.

 

The refrigerator/freezer, washer/dryer substitutions are word retrieval issues. This is a language-based problem rooted in neurology. The only program I know of that will even attempt to work on this issue is NeuroNet, which is an OT-based therapy that tries to re-organize neurology. It is thought that the substitutions relate to a poor "filing system" in the brain so that the wrong word gets pulled out.

 

The quirky behavior can be related to autism spectrum disorders. Some of it could also be OCD (obsessive-compulsive disorder), which is highly treatable with anti-depressants. I think sometimes those two issues are co-morbid too.

 

Speech therapists are trained in methods for explicitly teaching things like word classes, word relationships, etc. I have no idea what exactly those methods are, though.

[MicheleB]

The writing and reading reversals are examples of weak directionality and sequencing skills. These are cognitive skills that can usually be trained with exercises. However, you have to make sure that the sensory foundation is solid first (motor and vestibular development, visual and auditory development) or at least as optimal as possible.

Okay. OT is coming... on a long waiting list.

 

The refrigerator/freezer, washer/dryer substitutions are word retrieval issues. This is a language-based problem rooted in neurology. The only program I know of that will even attempt to work on this issue is NeuroNet, which is an OT-based therapy that tries to re-organize neurology. It is thought that the substitutions relate to a poor "filing system" in the brain so that the wrong word gets pulled out.

Forgive me for being so dense.... My brain is slowly absorbing all this. :001_smile: If it's rooted in neurology, then I'm guessing you're saying ST isn't going to help it. So I'm thinking my choices are to either wait for the n.p. evaluation OR go ahead with NeuroNet now and see how it does?

 

The quirky behavior can be related to autism spectrum disorders. Some of it could also be OCD (obsessive-compulsive disorder), which is highly treatable with anti-depressants. I think sometimes those two issues are co-morbid too.

Goodness! I don't know why I didn't think of that! OCD runs on both sides of the family... Thank you for mentioning that.

 

We're now set up for ST twice a month with programs to work on at home. We'll continue that till we see the n.p. and if he thinks we need something else, we'll go from there.

 

Does this sound like a good plan?

[Claire]

Yes. Usually speech therapy doesn't help word retrieval issues because the problem is related to poor neurological organization. NeuroNet uses lots of body exercises to try to stimulate neurological re-organization. That is why it is sometimes successful with word retrieval issues. There are no guarantees, however.

 

The n.p. eval may give you lots of additional information about OCD, autism spectrum, etc. However, it probably won't tell you anything new about word retrieval beyond what you have already observed. Personally, if this were my child and I had the option to start NeuroNet now, I would do that. As far as I know, it would replace regular OT because it would include everything that an OT would do plus much additional work tailored to your specific child's needs.