About this blog.

My son was diagnosed with PDD-NOS at 24 months. I created this blog to bring meaning to the often-confusing label. Sometimes I have answers. Other times, just more questions.

Wednesday, July 15, 2009

Speech Assessment

Now for the numbers.

I received a full evaluation report from Brad's private speech pathologist. The conclusion:
Brad presented with a mixed profile in receptive-expressive language skills with average receptive and expressive vocabulary, mild deficits in direction following, question comprehension and verbal reasoning, mild deficits in semantic organization, and severe deficits in language formulation for a variety of purposes. Deficits were also noted in Brad's symbolic play, as he did not engage in pretend play and dmonstrated some rigid and atypical play behaviors. With regards to speech skills, Brad presented with a mild phonological disorder with a motor component.
Drilling down:

Behavior: "bruxism" noted. That's medical-speak for teeth grinding, which is self-stimulatory. He does this quite a bit now. Also observed: reduced eye contact. But: "Brad maintained selective and sustained attention for the entire two-hour assessment and complied with both play and language based tasks."

Play: Rigidity observed. For example, "when given a chair, table, tablecloth, fork, knife, plate and doll, Brad placed the doll on the chair, pushed her to the table, and then set the table. He did this silently and did not narrate his play scheme or interact with the doll." Tough grader. I guess I should get used to it.

Receptive language:
  • The Peabody Picture Vocabulary Test-4: Brad scored 88. The mean is 100 with a standard deviation of 15
  • Verbal Comprehension Scale A from Reynell Development Language Scales: Brad scored 82. The mean is 100 wiht a standard deviation of 15.
  • Informal probe: Answers yes/no and what questions accurately. Inconsistent accuracy for where questions. Innaccurate for why questions.

Expressive language:

  • Expressive One Word Picture Vocabulary Test: Brad scored 98. Mean is 100.
  • Expressive Language Scale from the Reynell Developmental Language Scales. Brad scored 70. The mean is 100 with a standard deviation of 15. This is by far his lowest score. Based on this, he was judged to have a severe expressive language impairment. "Error responses consisted of visual/verbal association errors. For example, when asked to label and illustration of a window, Brad responded 'book.'" But it was only pictures that tripped him up. He scored 100% identifying actual objects, and 63% with illustrations.
  • Informal analysis: Possible language organization and/or word retrieval deficits. "Several lengthy response latencies were noted during both word-level and sentence-level testing. Response latencies ranged from two to eight seconds. this degree of response latency might have resulted from mild word retrieval deficits. Further characteristics of word retrieval difficulties were noted in Brad's use of non-specific terminology throughout assessment. Characteristics of language organization deficits were noted in difficulties disambiguating illustrations of visually similar objects, such as a feather and a leaf, and reduced use of specific vocabulary to describe part/whole relationships."
  • Goldman Fristoe Test of Articulation- 2. Brad scored 108. Mean is 100. Mild speech dysfluency observed.


sajasajana said...

Laura, does all this fit with your experience of Brad?

I suspect our youngest (now 16 months) may be on the spectrum, too. Unlike most parents, however, I'm actually kind of excited about it. :-) Being on the spectrum myself, I know how rich an autistic person's life is firsthand, to counter the negative press autism gets as purely a disorder.

Do you think the interventions Brad's getting are working positively? Just curious...there were no interventions for people on the high end of the spectrum when I was growing up, and I often wonder how I'd have turned out if there had been, and I'd been identified.

Laura said...

Interesting. For what it's worth, in a lot of ways, Brad is easier to parent than a typical kid. I honestly couldn't tell you what interventions are appropriate for something like asperger's. For PDD, Brad's moderate interventions seem effective to me. That's my drumbeat for A Little Bit Autistic. Moderate interventions.

As for the eval, you know, I agree with all of the primary observations, but I was surprised by the conclusions. I would have thought his severe deficit was receptive, and mild deficit was expressive, not vice versa. I was also surprised that she thinks he has a language organization problem - I associate that with semantic/pragmatics, and he doesn't have those issues, at least I don't think he does. And I never thought the picture (not object) identification problem was related to language organization. I'm still trying to figure that out.

Brenda said...

I must say - this is the most comprehensive speech evaluation I've ever seen! Ours were not near so detailed. But I can see these same issues with JBear. I also have more than a bit of skepticism about speech eval conclusions - as they identified JBear as way above age in expressive and receptive, yet did not identify the content or conversational issues.

I'd love to hear why you find Brad easier to parent than typical kids...

Laura said...

Brenda - I know! At first I was a little defensive when the SLP relayed her initial impressions to me, but damn she's thorough. I give her props.

As for my editorial on having it easy, it's just based on my experience with one typical and one atypical. My typical son was colic-y as a baby, had sleep issues and is demanding (in a very normal toddler way). Brad, by contrast, was not colic-y, loves to sleep, loves his bed, loves to nap, follows directions well, and he's very independent. As for behaviors, that's neutral, in that both my kids potty trained at the same time and neither has behavior problems. Just last weekend, we were hanging out with a fam with two typical children who were age matched to mine, only Brad was SO much easier his age-matched peer, who wasn't potty trained, was prone to tantrums and kind of a mess. Brad just does his own thing with a smile on his face. That's Brad.

Brenda said...

You are lucky, girl! We got enough sleep issues for two. Sounds like JBear is the polar opposite: has acid reflux since a baby, requires a lot of help, attention, intervention. It truly is a spectrum, isn't it.

Kris said...

I agree that is a pretty thorough speech assessment!
Alec has been in speech therapy since age 18 months. His first scores were "very poor" with standard scores in all areas in the 50's.
Restesting scores at age 2 1/2 were still "very poor" with scores in the 50's and 60's.
Testing at age 4 showed much improvement with standard score on the Peabody at 91 and PLS-4 score at 107.
Restesting at age 5 showed further improvement with the Peabody at 102 and the CELF at 117.

The school stopped providing speech therapy at age 4 and we began private speech therapy at age 5. Why you may ask? Because he still has problems with COMMUNICATION - he has the skills but has difficulty using them. For example he can't describe things, he still stumbles over words when he talks, etc.
Was the speech therapy responsible for his progress in speech/language? I think partly. I think partly it is just maturation. And it is interesting to note that the private evals ALWAYS come out with lower scores than the ones through the school. The above scores were through the school. I take it all with a grain of salt and continue to give him therapy because I still see deficits in his communication.

But he has come A LONG way from those early days.
Is Brad doing speech therapy?

Nyx said...

Hmmm. Initial thought: Could part of the problem here be visual procesing ?

Laura said...

Kris, it really sounds like Brad is following in Alec's footsteps. Yeah, Brad just started private speech therapy on Wednesday of this week. He'll be going 2x per week until the end of 2009. (We have a 60 visit per year max.) He also gets 2x per week half hour SLP pullouts through his school.

Nyx, exactly.

Nyx said...

I have been thinking about this all night, because I had exactly the same experience at my son's speech evaluation when he was 19 months. I was shocked by his receptive scores! But I have noticed that he frequently gets sort of sloppy when he's pointing at pictures in the books sometimes, especially if he's bored. Sometimes he points at the empty space right next to the right object. This morning it hit me: in order to point at a picture when prompted you have to *simultaneously* process proprioceptive and visual information, all while rehearsing the auditory information in the question!! I feel certain this is the problem. I read somewhere (I wish I were a better notetaker) that children with autism do not enjoy playing in front of the mirror and watching themselves in the mirror (they like to look at light reflections and such, but not themselves) ... the author said it was because it was difficult for them to process visual and proprioceptive data at the same time. I think more and more that the whole concept of having difficulty processing more than one kind of data at the same time really explains a lot about what is going on. It certainly explains the language delay.

alison said...

Hi there!
You don't know me (and I don't know you!) but I stumbled across your blog via a blog of a friend of mine (she follows you). I was skimming through your posts and saw your post of your son's speech evaluation - as a pediatric SLP, I sincerely hope that what you posted was just snippets of each of those sectinos and not the sections in their entirety. If, by some odd chance the sections WERE posted in their entirety, I apologize sincerely on behalf of our profession as that seems to be a pretty bare-bones speech assessement! I hope that you are happy with your therapist and that the eval was, in fact, much more thorough than that!

Laura said...

Hi Alison,
ha! No apology needed. This was just very small snippets. This was from a lengthy report, which included an exhibit listing each of the words he uttered during one of the vocabulary tests.