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.

What To Expect (Almost) Age4, PDD Edition: Communication

As promised, a WTE post on speech and communication.

His most recent speech stats are here, but that doesn't really tell the whole story.

I'm proud to report...drumroll please...Brad is talking. Well that isn't exactly news, but it is a fair description of his ability. His progress on the speech front has been slow and steady. When exactly his speech took off is hard to pinpoint. At this juncture, he can express his needs and even his emotions, and his conversation skills are budding. Exhibit A:



And if it isn't obvious, the more he talks, the more he charms us with his sweet nature.

Not to take away from his progress, but there are still many challenges ahead. He's still scripting. Or something. For example, often our exchanges will go like this:

Me: "How was school?"
Brad: "The name of the day is Friday. Friday is a tuna fish day."

That having been said, on the whole, we're very pleased, and proud of his progress.

"Excuse me, Mommy."

Music to my ears.

After what has felt like a verbal plateau for the last six months, it appears Brad's speech is taking off again. He's surprising us lately with a fullness of expression and a budding personality. My fave: "excuse me, Mommy", used appropriately when he wants my attention. And if I don't attend right away, he keeps saying it, with increasing volume. And I'm only too happy to pay attention.

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."

Speech

• Goldman Fristoe Test of Articulation- 2. Brad scored 108. Mean is 100. Mild speech dysfluency observed.