J is a 2 year, 10 month old monolingual Spanish child who has never received services. His parents are new immigrants from Mexico, and only Spanish is spoken in the home. J presents with at least a 25% delay in expressive language development, and uses multiple phonological processes in his speech. This evaluation was completed by Dr. Catherine Crowley.
Background Information:
J has never received services. He was referred for this evaluation by his pediatrician because he does not speak. His mother provided much of the background information for this evaluation and was judged to be a reliable informant. All developmental milestones, except for speech-language milestones, were within normal limits. He sat at six months and walked at 12 months. He produced his first intentional word at 18 months. He does not use phrases. J lives with his mother and 14-month-old sister. His parents are separated, but his father visits approximately two times a week. His mother completed sixth grade and his father graduated from high school. Both parents are from Mexico and emigrated from Mexico two years ago. According to the mother, her sister did not talk or walk until she was six years old. No one in her family knew why. Other than this sister, there is no history of speech-language problems or academic problems in either the mother’s or the father’s family. J was hospitalized for one week when he was six months old due to a high fever from an ear infection. At 1.2 years, he was hospitalized again for the same reason.
Language Background and Use:
Only Spanish is spoken at home. J reportedly did not respond to English. J and his mother are monolingual Spanish speakers, and they speak the standard Mexican dialect of Spanish.
Behavior:
J was curious, cooperative, and focused throughout the evaluation.
Play Skills:
Play skills appeared to be age-appropriate. He played functionally and manipulatively with the toys presented to him. When presented with a plastic, lifelike, bug, J explored it visually and tactically in an engaging and wonderfully curious manner. When he was given a few bugs, he first lined them up according to type and then made them interact by having them jump on each other. When he was given a book, J sat and went through it page by page attending to all the pictures appropriately. When J was given a toy telephone, he mimed dialing the numbers and then put it to his ear and said, “Ooh, ooh” with a tone that communicated, “Hola, hola” (Hello, hello).
Oral Peripheral Examination:
J’s face was symmetrical at rest. Oral posture and control of oral secretions were adequate. J demonstrated appropriate mandibular control for opening his mouth and biting down. Labial-facial and lingual control appeared adequate and tongue movements were smooth and coordinated. His mother reports that J does not have and has never had a history of any eating or swallowing issues.
Voice and Fluency:
Could not be assessed due to limited verbalizations.
Hearing:
According to his mother, J received a full audiological evaluation and was determined to have hearing within normal limits. Given his history of high fevers from ear infections and numerous middle ear infections, annual hearing evaluations are strongly recommended.
Articulation and Speech Intelligibility:
His speech production indicated moderately severe phonological delays. Assessment of J’s overall articulation pattern revealed production of the phonemes /m, k, g, sh, h, p, b, n, y, w/. J produced CV, VC, and an occasional VCV (allí) combination. His phonemic inventory is moderately delayed for his age. Phonological processes present in his speech were weak syllable deletions (mo/quemo, ka/carro), assimilations (papa/zapato and toto/pelota), backings (ko/ojo), and numerous idiosyncratic processes and gross delays such as sho/sucio, com/escoba, chin/luz. In addition, he demonstrated numerous vowel errors. Intelligibility for connected speech was moderately severely impaired. His mother understands most of his utterances as long as they are context-embedded. By the end, this evaluator also understood most of what he was saying because he used other modalities, beyond just words, to communicate. J’s phonological development was marked by fewer than 50% of consonants correct, poor speech intelligibility, restricted syllable structure, and vowel errors. According to the NYSDOH practice guidelines (1999), these factors can be predictors of continued language delay in children of J’s chronological age (p. 127). Overall, his speech development presents as at least moderately severely delayed.
Language:
Assessment Materials:
Rossetti Infant-Toddler Language Scale (Rossetti)* Clinical Practice Guides Communication Disorders NYSDOH Early Intervention Program* Language sample Parent interview Informed clinical opinion *Neither validity nor reliability has been determined for these assessment instruments. They provide criterion-referenced information. Appropriate applicability to Latino or Spanish-speaking populations has not been considered by these instruments.
NOTE: Testing materials are not available in standardized form for J’s bilingual and bicultural background. Use of standard scores would be inaccurate and misleading so, the results reported are presented in a descriptive form with reference to the literature.
Receptive Language:
J demonstrated age-appropriate receptive skills. He responded to simple questions, understood location phrases, understood five common action words, followed two-step unrelated commands, understood the concept of “one” and “all,” and answered “yes” and “no” questions correctly. The mother confirmed that she felt his comprehension skills were appropriate for a child of his age in their community. The mother reported that J plays with other Spanish-speaking children his age and appears to understand what they are saying without difficulties.
During the evaluation, J understood questions in Spanish such as, “Will you share your bread with me?” “Do you want to see the bus?” “Where is the dog’s eye?” He understood directions such as, “Put the car inside the truck” and “First put the truck away and then I will give you another toy.”
J understood all age-appropriate questions, directions, and statements. He attended well to what people said, both to him and to his mother. Based upon the assessment materials administered and clinical judgment, receptive skills were within normal limits.
Expressive Language:
It is estimated that J has a vocabulary well over 50 words. During the evaluation, he used approximately thirty-five words including “Mami,” “Papi,” “Jessica,” “jugo,” “no,” “si,” “este” (that), “uh oh,” “aquí,” “allá” (there), “acá” (here), “vamos” (let’s go), “guagua” (bus), “meow”, “quemo” (burned), “ojo” (eye), “ten” (take), “bicicleta” (bike), “luz” (light), “libro” (book), “pelota” (ball), “escoba” (broom), “sucio” (dirty), “guardé” (I put away), “guantes” (gloves), “cojer” (to hold), “zapato” (shoe), and “gracias.”
J primarily communicates through one- and two-word utterances, with a few three-word utterances. His communications are greatly enhanced by his excellent use of intonation, facial expressions, and gestures to communicate his intent. His mother related a story that is an excellent illustration. J wanted a pair of sneakers that light up when the child steps. His mother told his father this. When he came home, J ran to his mother excitedly, pointed to his feet, and said, “Yo Papi shin,” (I Daddy light). (“Shin” is how J consistently produced “luz” (light) during the evaluation.)
J also demonstrated appropriate knowledge of functions. For example, when presented with a picture of an iron, he said, “Mo,” meaning “me quemó” (It burned me). When presented with a picture of a bicycle, J said, “Ir [a]llá” (to go there).
His mother reported that J would tell her nonverbal stories. For example, when she asked him what he did with his friends outside, he showed with his hands and acted out that they were playing baseball. When J was given some bugs to play with, he was clearly interested in them and wanted to know their names. He held each one up and said, “Uh?” with an intonation that communicated that he wanted to know what it was and his mother named each bug. When he discovered the second beetle in the group, he fished out the first beetle and held both up demonstrating that he was engaged in the activity and intellectually involved in grouping the bugs.
When J was tired of the evaluation and wanted to go, he subtly cocked his head toward the door and quietly said, “Ma” to his mother in a plaintive manner. His communication was effective since both his mother and this evaluator understood what he meant.
J requested toys by saying, “Ma ka” (Mommy [give me the] car). When his mother told him that he could play with a different toy if he put the other one away, he put the toy away, pointed to it, looked at his mother and said, “Ya de” meaning, “Ya guardé” (I put it away).
Based upon the assessment materials used and informed clinical opinion, J’s expressive skills appear to be in the mildly to moderately delayed range, indicating at least a 25% delay. He communicates primarily in one- and two-word utterances, with some three-word utterances. He uses gestures and intonations to supplement his expressive skills. These expressive delays appear to be directly related to the phonological delays. With his intellect, this child may have learned that if he uses little speech, supplemented with nonverbal communications, he will be better understood.
CONCLUSIONS
1. J is a monolingual Spanish speaker. He essentially has had no exposure to English and did not respond to English. The mother concurred with the results of this evaluation and indicated that J’s performance was representative of his language skills in other settings.
2. J evidenced age-appropriate comprehension of Spanish. His play skills were also age-appropriate. J presented with a curiosity and keen interest in making connections. Expressive skills were in the mild to moderately delayed range, with at least a 25% delay in expressive language development. He has a vocabulary of well over 50 words. Although he generally uses only one- or two-word utterances, J on occasions will use three-word utterances. He communicates well through gestures, intonation, and facial expressions.
3. J produced the phonemes /m, k, g, sh, h, p, b, n, y, w/. J produced CV, VC, and an occasional VCV combination. His speech production indicated moderately severe phonological delays. Phonological processes present in his speech were weak syllable deletions, assimilations, frontings, and numerous idiosyncratic processes and gross delays. Intelligibility was moderately severely impaired. Percent of consonants correct was less than 50 percent. Speech production and intelligibility appeared to be at least 33% delayed.
4. Although a late talker with normal comprehension skills would not generally be eligible for speech and language services, with such a reduced phonemic repertoire, limited syllabic development, and severe intelligibility problems, this is an appropriate case for speech and language services. Based upon J’s current language profile, it is quite possible that as J’s expressive language expands, he will present primarily with moderately severe phonological delays. Given his use of non-verbal communication and his obviously strong linguistic skills, he may have determined that he will find other ways to communicate rather than do so using verbal language that people cannot understand (Olswang, Rodriguez, & Timler, 1998).
RECOMMENDATIONS
Bilingual speech-language therapy is recommended.
Annual audiological evaluations are recommended.
References
New York State Department of Health, Early Intervention Program. (1999). Clinical practice guideline: Report of the recommendations. Communication disorders, assessment and intervention for young children (age 0-3 Years). Albany, NY: Author.
Olswang, L., Rodriguez, B., & Timler, G. (1998). Recommending intervention for toddlers with specific language learning difficulties: We may not have all the answers, but we know a lot. American Journal of Speech-Language Pathology, 7, 23-32.
