Oscar is a 4 year, 2 month old child who is strongly English dominant. His mother is African-American and speaks English. His father is of Puerto Rican decent and is fluent in Spanish and English. Oscar is a bright boy, but with some evidence of concrete thinking similar to that seen with Asperger’s syndrome.
Background Information:
Oscar was referred for this bilingual speech-language evaluation because his family is concerned about his speech-language development. Oscar is from an intact family. He lives with his parents and brother, who will be two years in August. (The younger brother appeared to have some delays in speech-language development. His parents also want him to be evaluated.)
Motor developmental milestones were reportedly within normal limits. He sat at five to six months and walked at 9.5 months. Speech-language milestones were delayed.
Oscar reportedly has little contact with other children. He does not have any cousins he sees. The family brings him to the neighborhood parks, but reportedly, the children seem to shy away from playing with Oscar. He apparently comes up to them and introduces himself, but in a way that, reportedly, is too strong for the other children. He does not have play dates with other children. His little brother, who will be two years in August, is too young to play with and quite unrelated.
The mother is epileptic, and developed grand mal seizures approximately six years ago. Prior to that time, she only experienced petit mal seizures. The mother was taking dilantin for the seizures. One of the side effects of dilantin was that a woman could appear pregnant. As a result, the mother thought that she was not pregnant and only experiencing a side effect of dilantin. It was only when she was eight months pregnant that she found out that she was, in fact, pregnant.
During the pregnancy, but before she knew she was pregnant, the mother had two grand mal seizures. Oscar was the product of a full term birth. The family reported no complications at birth.
Oscar has had no major illnesses. He has not been hospitalized.
The mother has one brother who is profoundly retarded and autistic. He lives in an institution. She has another brother who is a slow learner and mildly retarded. He lives with her parents in Virginia.
The father was born in New York City and is of Puerto Rican descent. He completed four years of college, and earned a degree in computer science. He works as a computer programmer. The mother is African-American and from North Carolina. She finished her associate degree. Before her children were born, she worked as an administrative assistant at the Lifetime Insurance Company.
Language Background and Use:
Oscar was strongly English dominant in all areas tested and by parental report. His mother knows no Spanish and uses only English. His father is fluent in English and Spanish, but apparently only uses English in a naturalistic way with Oscar.
Based upon parental report, Oscar has not been exposed to Spanish in a naturalistic way. The father wants his son to learn Spanish, so he will sometimes repeat in Spanish what he has first said in English in an instructive way. The father reported that Oscar primarily knows nouns in Spanish. During the evaluation, Oscar did use “leche” for milk by inserting it in the middle of a sentence in English (e.g., Is the leche in the refrigerator?). His father used Spanish with him in the same way. For example, he asked Oscar, “What color is the cuchara?” These are not examples of code-switching, since the way the Spanish words were used was in an instructive way–so Oscar would learn the nouns–rather than in a communicative way.
The father reported that he has asked his family to speak Spanish to Oscar. His sisters said that they want him to learn English, so they only speak English to Oscar. Oscar’s paternal grandmother has also refused to use Spanish with Oscar. Even when Oscar went to Puerto Rico with his father, the father’s aunt and uncle would only speak English to Oscar.
The father estimated that Oscar hears approximately 25 percent Spanish and the rest English. It is unlikely that this is true. Oscar demonstrated no understanding of even simple questions, directions, and instructions in Spanish. Moreover, his father said that Oscar is learning nouns in Spanish. So, even when Oscar hears Spanish, it is a single noun planted in the middle of an English sentence.
Hearing:
According to the father, Oscar’s hearing was tested at X Hospital and was determined to be within normal limits. A copy of the audiological evaluation has been requested by The Village School.
Behavior:
Oscar was interactive with this evaluator in that he played with the toys and followed her lead in whatever toys or activities she presented. He sat well and attended well to the presenting tasks.
Oscar’s eye contact was limited during the evaluation with both this evaluator and his parents. His father and mother both agreed that Oscar has excellent eye contact with them. They felt he was shy and uncomfortable in the evaluation room. His father said that when he wants his father’s attention when he is watching television, Oscar would stand in front of the father, and stare at him until his father pays him attention and plays with him. Towards the end of the evaluation, this evaluator said to the father that Oscar was a charming child. Oscar looked at her directly and smiled, indicating that his parents might be right about his shyness and discomfort in the evaluation setting.
Play skills:
Symbolic play skills appeared age-appropriate. Oscar played well with the Fisher Price house. He put the furniture in the appropriate rooms. He also put some of the people to bed, and sat others at the table and pretended to give them food.
His father noted that Oscar could build elaborate buildings with his Megablocks. He also uses the Megablock people as true people who live and interact with the structures he creates.
Oral Peripheral Examination:
Gross examination of oral-peripheral speech mechanism revealed structures to be within normal limits in symmetry, size, shape, color, and function.
Voice:
Vocal parameters for pitch, intensity, and quality were within normal limits for Oscar’s age and gender.
Fluency:
No clinical dysfluencies were noted during the evaluation.
Articulation:
Assessment of Oscar’s overall speech pattern revealed distortions of /s, dz, z, l, r, th (voiced), th (unvoiced)/. Phonological processes present were cluster reductions (sall/small), ency/empty), reverse assimilations (kakorn/popcorn, tete/siete), final consonant deletions (los/lost, twe/twelve, ehpeh/airplane), and backings (du/push). Some of his productions were idiosyncratic such as twinin/playing, pukle/purple, and duk/stop. Articulation and phonological delays were moderate to severe.
Speech Intelligibility:
Intelligibility for connected speech was moderately-severe to severe.
Language:
Tests Administered:
- Preschool Language Scale-3 (PLS-3)*
- Preschool Language Scale-3-Spanish (PLS-3-Spanish)**
- Language sample
- Parent interview
- Clinical assessment
*No norms are available for a bilingual population.
**The PLS-3-Spanish is a translated test, except in a few discrete instances. No norms are available for the Spanish version of this test and test scores reported for this test are based upon a monolingual English sample.
NOTE: Testing materials are not available in standardized form for Oscar’s bilingual and bicultural background. Use of standard scores would be inaccurate and misleading so, the results reported are presented in a descriptive form. Raw scores are occasionally reported for gross comparisons of past and future performances of this particular student on the specific test.
Receptive Language:
On the Auditory Comprehension portion of the PLS-3-English, the stimuli were presented first in English and if Oscar did not respond, repeated in Spanish. At no time did the use of Spanish improve his performance. Oscar understood the spatial concepts “in” and “off”; understood the quantity concepts “one” and “all”; and recognized actions in pictures such as “washing” and “playing.” He understood the use of objects such as “what you can ride” and “what we use to sweep the floor”; the descriptive concepts “big,” “little,” “wet,” “heavy,” and “empty”; and the colors red, orange, yellow, purple, green, and blue. Oscar did not indicate understanding of part/whole relationships such as the “door of the car” or the “nose of the cow”; grouping objects such as “things we eat” and “animals”; understanding negatives such as “which toy is not in the box”; or comparing objects such as “which one is heavier.”
Oscar’s eye contact and somewhat unrelated manner seemed to indicate that he would have difficulty understanding directions, questions, and statements. Yet, he did understand many questions and statements that were not context-embedded. For example, when asked by the evaluator if he had been to Puerto Rico, he responded affirmatively. When asked what he did in Puerto Rico, he told her whom he played with there (his aunt and grandmother) and that he rode his bike.
His father described him as a future lawyer because of how precise he is about information. As an example, his father said he told Oscar to stop jumping off the bed. When his father saw him doing it again a few minutes later, Oscar told him that he was not jumping, he was flying. Then his father said no jumping or flying off the bed. A few minutes later, his father caught him going off the bed. This time, Oscar said that he was not jumping or flying, but falling off the bed. Although this might indicate a creative mind, it seemed rather to indicate an unusual level of concrete thinking, which seemed consistent with his expressive language.
Although his thinking often seemed concrete, at times he could respond in a way that demonstrated more fluid thinking. For example, when asked where his toes were, he pointed correctly to the tip of his shoes. When the evaluator said, “That’s your shoe. Where are your toes?” Oscar correctly responded, “They in der” (They are in there), while pointing to the tips of his shoes.
He also knew many of the labeling questions commonly used with preschool children from middle class homes. For example, he identified the colors of every object that his father asked of him. He also identified some objects by their shape, also a task his father appears to have worked on with him. He also knew body parts, including elbow, knee, toes, and eyebrows. Oscar can identify all the letters of the alphabet and can count by rote to 20 in English, and to 10 in Spanish.
Expressive Language:
On the Expressive Communication section of the PLS-3-English, Oscar used question inflection, combined three words in spontaneous speech, named pictures of common objects, and used the “verb plus -ing” form (sleeti/sleeping, traini/playing). He did not tell how an object is used, answer questions logically (e.g., what does he do when his hands are dirty), use several pronouns spontaneously, or tell about remote events such as what to do when something is lost.
Overall, Oscar’s expressive language forms were quite simple, moderately to moderately-severely delayed. When he wanted to try how to use a toy, he said, “I wa do i” (I want to do it). When asked which of two items he wanted, he said, “I wa di one” (I want this one). He commented about his brother by saying, “He a monsa” (He’s being a monster). When he was playing with the dollhouse, he said, “Eh da a leche en da refrigerator” (Is the a leche in the refrigerator). When the father said he had to go to work, Oscar said, “Daddy, you go a work. You buy me Oscar” (Daddy, you are going to work. Please buy me a present).
When Oscar was told that his mother, Debbie, was going to go out of the room with his brother, Oscar said, “I stay Debbie. I stay you.” He meant to say that his mother was going out of the room but that he was going to stay with his father. Thus, Oscar generally understood what was happening, but his language was not developed enough to communicate affirmatively that he knew what was happening.
Oscar’s concrete thinking was evident in the example his father gave of his strongest skill. His father said that Oscar regularly describes how to get to different places. For example, during the evaluation, when asked how to get to where his maternal grandparents live, he said,
“We going 34 Street. [“Then what?”] And we see grandma grandpa. [“How did you get there?”] We take a E train. We go a take a bus.”
He also reportedly will say exactly what forms of transportation, in the proper sequence, he takes to the Toys-R-Us store at Union Square. When asked whether Oscar will say these directions at other times, his father said that sometimes when Oscar is eating a meal, he would start saying how to get to different places by himself.
Beyond the trip to his grandparents, he did not give detailed descriptions. For example, when asked how to get to the supermarket, he said, “We buy leche and jugo and chicken.” When asked where the toy store is, he said, “Over there.” Then he said, “Want a get a train,” indicating that he wanted a toy train from the store.
A further indication of his level of concrete thinking is how he categorizes objects and maintains that categorization. An example his father shared is that he has an alphabet picture that has “Glass” for the letter “G.” When Oscar wanted to use the word “cup” for the same object, he now consistently says, “Glass cup.” Apparently, he cannot replace the cup object with the word “cup” so he must maintain the label he originally learned (glass) and pair it with cup, to create “glass cup.” Another example occurred when Oscar went to the dentist. Because he first knew the word “doctor” for that type of person (presumably a white-coated, medical person), he could not just use the new word “dentist.” Instead, he had to use the compound “dentist doctor,” which he continues to use for his dentist. One final example, his aunt (titi) looks like his grandmother (nana), so he calls her “Titi nana,” thereby combining the two words because the connection to his grandmother is too strong for him to release.
Oscar has little use of simple past tense. When describing what he did the other day, he said, “I go to store. I play toys. I go see Titi nana. Took me park.” Similarly, he does not use the simple future tense.
The only Spanish words Oscar used were single nouns, placed within an otherwise entirely English sentence. He did not use any phrases in Spanish.
Oscar’s expressive language was characterized by quite simple sentences, using only the words most needed to communicate his meaning. Often his sentences were not understandable without context.
Pragmatic language skills were delayed, but as his father said, his somewhat lack of relatedness appeared due to his shyness and lack of comfort in the evaluation setting. Although he did not always appear to be focused on the presenting task, or on what the evaluator or his father were saying, he generally knew what was going on and would respond appropriately.
CONCLUSIONS
1. Oscar has extremely limited skills in Spanish, with significantly stronger skills in English.
2. Oscar was a quietly charming boy. He evidenced moderate to moderately-severe delays in receptive and expressive skills, including vocabulary skills; language form; development of syntax and morphological indicators; categorization skills; ability to make connections between words; ability to follow oral directions; ability to organize, sequence, and verbalize information in a temporal and sequential manner; and pragmatic language skills. He demonstrated mild evidence of concrete, inflexible, thinking that seems to be reflected in his language comprehension and production.
3. Oscar evidenced distortions of /s, dz, z, l, r, th (voiced), th (unvoiced)/. Phonological processes present were cluster reductions, reverse assimilations, final consonant deletions, and backings. Some of his productions were idiosyncratic such as twinin/playing, pukle/purple, and duk/stop. Overall intelligibility for connected speech was moderately-severely impaired.
RECOMMENDATIONS
Speech-language therapy is recommended three times a week for thirty minutes in a group of up to 3 students. Treatment is to be conducted in English.
Obtain an audiological evaluation to confirm absence of hearing loss.
