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 7, 2010

Speech Update: Four Years, Three Months

I received the written report from his most recent speech evaluation. (A post on last year's evaluation here.)

Bad News First: Overall, his expressive communication was pegged at two years nine months. Over the twelve months from May 2009, he only progressed five months. He scored a 63 on the expressive language portion of the Reynell Developmental Language Scale, a test in which the mean for his age is 100 plus or minus 15. So that's discouraging.

His deficits appear to stem from four types of issues: verbal/visual association errors, paragraph comprehension, semantic errors and rigidity. The examiner also observed "as expressive language tasks became more complicated and Brad was ask to describe pictures or re-tell narratives, he began to resist." Go figure. He's four years old!

Excerpted from the report, for your information and amusement:
Although Brad responded accurately with regard to production of grammatical skills, errors were noted in semantic abilities. For example, when asked to label an illustration of a group of men, Brad responded, "children." When shown a picture of several people trying to escape the rain and asked, "What's happening," Brad responded, "It's not raining." The examiner continued "It is raining. And the people are getting ____" and Brad responded, "frozen." He provided definitions for concrete or abstract concepts with inconsistent accuracy. When asked, "what's an apple - what do you do with an apple?" Brad responded correctly by showing the examiner eating. Error responses were predominantly reiterations of the targeted concept. For example when asked, "What does cold mean, "Brad responded, "I'm cold." Brad's motivation waned when asked to describe a group of illustrations depicting a family engaged in various tasks. He fell out of his chair and told the examiner that the task was "so so hard. It might take a very long time." With encouragement, Brad provided short sentences that in general described the pictures. For example, in response to a picture of a family washing the dishes, Brad responded, "She's making a recipe." In response to a picture of the same family setting the table, Brad provided, "He's making dinner." Brad substituted "he" and "she" pronouns thoughout.

The picture card sequence probe outlined in the language comprehension section of this report was used to assess Brad's formulation skills for sequenced activities. Brad experienced difficulty on this task. He repeatedly pointed out numbers on the cards that existed outside the illustrations. He appeared to focus on pictured details and neglected salient features of the illustrations. For example in the sequence that depicted a girl making her bed, the line that the sheet's border had created intrigued Brad. He ran his finger along this line and asked the examiner about the "rope."
That's Brad in a nutshell. Marching to the beat of his own drum. Falling behind in communication but getting ahead in numeracy.

As a parent reading the report, it was hard for me to figure out how much was attributable visual/verbal association problems versus semantics versus he's four years old and the exam was taxing on his attention.

The good news: The perpetual tough grader wrote:
In contrast to previous testing, Brad made several improvements in nonverbal and verbal pragmatic skills. During current assessment, Brad followed the examiner's gaze and engaged in joint attention.
He also did very well with object identification, sentence completion, syntax construction and pragmatic judgment, scoring within the average range for each of those assessments.


Kris said...

Interesting....I imagine this testing is hard for our little guys. No fun! Some of his repsonses struck me as funny and I could picture my NT kids responding that way at 4. He is still so young...

Alex's testing has demonstrated significant problems with rapid naming where he consistently scores <1% and verbal inhibition, also <1%. Anything where he needs to be "quick" he runs into trouble. His processing speed is a huge issue with his receptive language processing and also affects his expressive speech. When formally tested, he scores low average on most tests - however, when you talk to him informally, you definitely notice the deficits, stated in a report as: "Alex has difficulty with fluently expressing his ideas in an efficient and coherent manner" and the neuropsych attributes much of this to a slow processing speed and problems with executive functioning. Other examiners have said simply "a language disorder". I'm not sure if it is a true language disorder or if the language problems are due to problems with processing speed/executive functioning. It should be noted these examiners did not dx ASD; they felt the correct dx was ADHD and/or SPD. Hence, the need to "explain" the language problems in the absence of an ASD dx. Whew...confusing!!

Nyx said...

I love the "so so hard. It might take a very long time!" Hilarious! It's sort of amazing to me how familiar all of this is. I wondered about the raining/not raining thing. I mean, for the people who are trying to escape the rain, they are going somewhere where it is not raining, right? That kind of makes sense. Toby does something similar, to me. If Simon is getting on his nerves, instead of saying he wants Simon to leave, he will always say he wants Simon in the hallway. As for the dishwashing/making a recipe, maybe he's been hanging out in my house, where I have to wash the dishes before I can cook anything. LOL. But seriously, you're right, it sounds to me also like maybe a visual thing is going on. The thing about the rope, for example, really does sound like a visual thing to me. Do you remember that section in Mislabeled Child about pattern processing? I can't remember it very well, but I remember an illustration showing how hard it could be to find something in the refrigerator. if his depth perception kind of goes in and out, might that not create a problem like that?

Nyx said...

ps -- we definitely have a big dose of the slow processing Kris talked about. In fact, sometimes Toby's speech actually slows down to the point where he sounds like he's doing a parody of an old LP on the wrong speed, he stretches out every syllable. But it comes and goes. It really seems like it's an intermittent thing. I wish I could detect a pattern in the intermittency. I feel like there is something there.

Laura said...

Thanks Kris - yes, totally confusing but makes perfect sense. I am SO ready to send Brad to a neuropsych but you really can't until they're a little older. I look forward to having more data - processing speed, sensory, etc - to figure out what's going on in there.

Nyx - exactly, most of the test is administered using these cards which he struggles to discern or discriminate. So in some respects, I feel like his score is artificially low. But anecdotally his speech seems to be on a par with my neighbor's child, who happens to be two years and 9 months -ish. So it's not just the pictures or the visually processing. And yes, processing speed seems to be part of it. Speak quick and he's totally lost.

Anonymous said...

It will be great to have this to look back on in time. Reading this inspired me to keep better track of specific conversation records with our girl. I know her language has progressed, but I forget sometimes how it was a while back.
So interesting also what called his attention and what he found to be overwhelming (or uninteresting). Leave it to our kids to tune in to things the rest of us miss and to find less intriguing the things we focus on.
"Marching to the beat of his own drum" - this is the one we always come back to as well.

Elizabeth Channel said...

Marching, marching...some of his responses remind me of my E's responses when he took an IQ test at age four. He argued *a lot* with the examiner about specifics on the pictures, like the "sheet rope" in your situation. Now at 8, he is so better-able to read these types of images. And I agree that testing is so, so difficult for any four-year-old!