Graduate Students
Engaged: Early
Intervention Group
Therapy as Clinicians
and Learners
SDSU Graduate students:
Alyson Fargher, Laurel Quinn ,
Maddy Long , Michelle Ortega
and Clinical Faculty Susie
Thorpe M.S. CCC-SLP
Disclosure Statement
•We have no relevant financial or nonfinancial relationships
to disclose.
2
Early Intervention Summer Intensive:
Group Structure
We had two groups sessions, Monday-Thursday for 1.5 hours daily. Each session
lasted two weeks, eight sessions total. Families were offered to enroll in one or both
sessions, depending on their schedule.
Clients were found via referrals, current clinic clients, and social media.
Five graduate students, one undergraduate volunteer and clinical supervisor worked to
create literacy based themed units.
Each graduate student was assigned one week of the session to design the
curriculum. Their theme ideas were presented and suggestions were given by the
supervisor.
3
Early Intervention Summer Intensive:
Group Structure
Graduate students and the clients were in one room with an adjoining observation room for the majority of
the session. During the sensory activity, we were able to use our clinic’s back patio to allow the clients
some outside time.
Daily Schedule:
10-10:20am Welcome Circle
10:20-10:40 Arts and Crafts
10:40-11am Sensory Activity
11-11:15am Snack
11:15-11:30 Closing Circle
4
Literacy Based Themes
We used two main sources to develop our themes:
1. Early Literacy in Action: The Language-Focused Curriculum for
Preschool By: Betty H. Bunce Ph.D SLP
2. Language and Literacy Disorders Infancy Through Adolescence By:
Nikola Wolf Nelson
5
Student Designed Literacy Based
Curriculum Themes
1. Bugs
2. Camping
3. Animals
4. Things That Go
6
Parent Education Component
Parents attended each session and observed through a one way mirror.
The clinical supervisor spoke to the parent group about a different topic each
week.
Child’s status and individualized goals, following the child’s lead, expanding
utterances, difference between articulation and phonology, and pre-literacy skills.
Guided observations were conducted each week where the clinical supervisor
pointed out various techniques the students were using in group.
7
Importance of Early Intervention
Children with childhood language impairment are more likely to experience:
Persistent behavior problems (Qi and Kaiser,
2004)
Social difficulties (Fujiki, et.al., 2001)
Poor academic performance
Reading difficulties (Tomblin et.al., 1997)
Writing difficulties (Stothard et. al., 1998)
Poor word learning (Montgomery, 2003)
Information processing difficulties
8
Meet
EO
Background:
EO is 2;9 year old girl suspected of an expressive language impairment, who was referred by her mother
for a comprehensive speech and language evaluation at SDSU’s language Summer Intensive
Program
No previous history of speech-language services.
Based on parent report, she met her developmental milestones within a typical timeframe.
She lives with her mother, father, and two sisters.
English is the only language spoken in the home.
She attends daycare five days a week.
Her mother reported that shy behavior is typical for EO when meeting new people.
9
EO Concerns
Concerns about EO’s speech arose when EO was around 2 ½ years of age.
During interview her mother stated that EO “talks a lot but that her words are
jumbled and not as clear as other children her age”
Additionally, it was mentioned that she is often unintelligible to people other than
her parents
EO’s daycare provider also expressed difficulty understanding her at times
According to parent report, no concerns regarding EO’s receptive or expressive
language, social interaction skills or behavior before were reported.
10
EO Pretesting
Behavioral Observation:
● Exhibited play skills that were typical for her age.
●
●
She showed interest in interacting with the examiner but was hesitant to answer questions or initiate
conversation.
She spoke more as the evaluation progressed but spoke at a whisper throughout the entire
evaluation
Receptive Language:
Auditory Comprehension subtest of The Preschool Language Scales, Fifth Edition
●
Results indicate auditory comprehension skills that are within normal limits with typical scores falling
between 85-115.
11
Pretesting
Expressive Language:
Expressive Communication subtest of The Preschool Language Scales, Fifth Edition
●
A basal score was achieved at the 2;0-2;6 age range, but a ceiling was not reached due to time
constraints.
●
EO primarily communicated in response to questions or prompts from the examiner, using one-word
utterances.
●
EO did not verbally request actions, repetition, assistance, or attention, and did not produce any
verbs spontaneously.
Language Sample summary
●
MLU in words and her total number
of utterances are lower than expected
based on parent report of her typical
utterance length.
MLU: 1.59
NDW: 31
% Intelligible
utterances:
67%
12
Summary of Baseline:
Play skills are typical for her age
Receptive comprehension skills are typical for her age
Expressive production skills are limited
One word utterances to express herself with occasional two word productions with
maximum assistance (e.g. prompting).
Decreased Intelligibility
Hesitant to initiate conversation with the examiner and spoke at a whisper
Reduced expressive vocabulary (e.g. wider variety of novel words including nouns,
verbs, descriptors, and proper use of pronouns)
13
Treatment Goals
Short Term Goal 1
● Produce three-word utterances to make her wants and needs known over two
consecutive sessions
○ Goal was met in intensive Phase 1
○ Baseline for first day was at zero spontaneous productions and mostly
repetitions of imitation modeling. First day consisted of getting client to
become accustomed to the routine,minimize separation and detachment
difficulties and minimizing self-stimulatory behaviors (e.g. hand in mouth)
14
Treatment Goals
Long Term Goal 1
● Increase expressive language through spontaneously production of intelligible
four-word utterances to make her wants and needs known in 6/7 opportunities
across two consecutive sessions, as measured by the clinician records and
observations.
○ Goal was met and exceeded in intensive Phase 1
○ Client produced one 7 word utterance spontaneously and intelligibly
○ Generalization for production goal was also observed across sessions in
intensive Phase 1 and intensive phase 2
15
Treatment Goals
Long Term Goal 2
● Maintaining an appropriate volume when requesting items of interest and
interacting with peers with 70% accuracy when given less than two verbal
prompts, across two consecutive sessions, as judged by a clinician.
○ Goal was met ; however, variability in volume appropriateness continued
across intensive phase 1 and 2.
○ Client benefitted from increased verbal prompts to increase volume and
carry over of this strategy was also implemented in the home
○ From Phase 1 to Phase 2 client increase volume with clinicians;
however, demonstrated some variability with peers.
16
Results
Expressive
Language goal
met and exceeded
Generalization
can be attributed to:
Intensive Program
Parent integration
of suggested language
production strategies
in the home
Days of treatment
17
Meet GB
Background:
GB is 3;3 year old boy initially diagnosed by the San Diego Regional Center with an expressive
language impairment.
He was referred by his parents for a comprehensive speech and language evaluation at SDSU’s Early
Intervention Summer Intensive Program as they were seeking additional support and services.
He had been seen for individual weekly home speech-language intervention through the First-5 program
for 10 months after his initial diagnoses.
At three, he was discharged and re-referred for a speech and language evaluation in a school district
where he did not qualify for speech-language services.
Subsequently, per parent request, GB was re-evaluated by a different school and still did not qualify for
services
18
Meet GB
Background:
Based on parent report, GB presented with delayed language development since the age
of one; however, he met his motor developmental milestones within a typical timeframe.
GB lives with his father, mother, and his sister (17-month-old). English is the only language
spoken in the home. He attends daycare during the week. His mother reported that GB
is an independent and social boy who has a delayed ability to speak.
19
Concerns
Concerns about GB’s communication arose at the age of one.
During interview, his mother stated that he “ talks a lot but is misunderstood by others.”
Additionally, it was mentioned that GB “does not produce many sounds correctly when speaking and
seems to have trouble getting the words out.”
According to parent report, GB’s receptive language, social interaction skills and behavior were of no
concern.
20
Pretesting
Behavioral Observation & Parent Interview:
● Exhibited play skills that were typical for his age.
●
He plays with other children in his age range but tends to initiate conversation less frequently, and
takes ownership of his toys by grabbing them all and reverting to independent play.
●
Shows increased interest to initiate conversation and play when playing with age matched peers
○
Can mimic communication and play behaviors of age matched peers
Receptive & Expressive Language:
●
Most current expressive and receptive language assessment results were provided by the client’s
parents to show within average performance in these areas
21
Pretesting
Speech Production:
Goldman Fristoe Test of Articulation-2 (GFTA-2) Sounds-in-sentences subtest
Increased difficulty in the less structured sounds-in-sentences subtest
GFTA-2 spontaneous speech sample results were consistent with language sample with phonological
deviations mostly uncommon productions noticed /k/, /g/, and /t/, substituted for /t/,/k/,/d/.
Sound distortions, fronting, omissions, and substitutions
Speech Sample:
● increased articulatory errors on certain sounds
● Use of fillers or consonant repetitions and frequent approximation, on words that included sounds
that were difficult for him to produce.
22
Pretesting
Dynamic Assessment
Resulted in increased accuracy of production of sounds in sentences with
various visual prompts and modeling (e.g. hand gesture with sound
production) given by the clinician.
Client used compensatory strategies when sounds were hard for him to produce
such as changing the topic, changing the intended word; or reverting to
independent play.
23
Summary of Baseline:
Play skills are typical for his age
Receptive and Expressive language skills are average for his age
Reduced expressive vocabulary (e.g. wider variety of novel words including nouns, verbs,
descriptors, and proper use of pronouns)
Monitor phonological skills as expressive language abilities improve.
Speech
He correctly produces many different phonemes through imitation and spontaneous productions
but they are frequently unintelligible.
Decreased intelligibility at the four word utterance level in connected speech
Difficulty articulating words that included the certain sounds and sound combinations:
Frequent omissions and substitutions and distortions at the sentence level
24
Treatment Goals
Short Term Goal 1
● Increase expressive language through spontaneous production of intelligible four-word utterances in
connected speech when communicating
○ Goal was met and exceeded in the first two weeks of treatment
○ Generalization for production of four word utterances was observed across sessions as well as
across the four designed curriculums
Long Term Goal 1
● Increase expressive language through spontaneously production of intelligible five-word utterance
in connected speech when communicating his wants and needs, requesting and interacting with
peers in 4/5 opportunities over two consecutive sessions, as judged by the clinician.
○ Progress in goal was observed from all weeks of treatment
○ Client was able to produce five word utterances in connected speech; However, they were not
across consecutive sessions.
25
Treatment Goals
Long Term Goal ( LTG) 2
● Reduce the phonological process (e.g. fronting, word final devoicing) to fewer than 40% in 6/10
occurrences in structured tasks/spontaneous speech with fading cues for two consecutive sessions,
as measured by the clinician records and observations.
○ Goal was met in the last two weeks of treatment
○ Client benefitted from clinician modeling, tactile and visual cues, and repetition of correct
production
○ Client demonstrated improved reduction of the phonological processes of fronting; however,
client would benefit from continued therapy for this goal.
26
Treatment Goals
Long Term Goal ( LTG) 3
● Client will increase his use of verbal requests to make his needs known to his peers in play in 4/5
opportunities, with minimal assistance, across two consecutive sessions, as measured by the
clinician records and observations.
○ Goal was met in the last two weeks of treatment
○ Client increased verbal requests when communicating with peers for items of interest and
often waited for peer to share item of interest and engage in communication.
○ Per parent report, carryover of goal was observed by client in the home as client began to
express his want for desired object from baby sister through verbal request before reverting to
taking the object of interest.
27
Results
Generalization
occurred in Phase 1
Variability
in production was
observed in Phase 2
Overall,
improvement from
baseline observed in
Phase 2
Number of words
Expressive
language goal
met and exceeded
Days of treatment
28
Introducing JV
Background & Concerns:
JV, a 2;10 year old boy, was diagnosed with Global Developmental Delay prior to attending the SDSUSLC for assessment and intervention
Unremarkable health history
Delayed developmental milestones
Concurrent outside services: speech and language therapy, physical therapy, and occupational therapy
Parental concerns: JV was referred to SDSU-SLC by his parent’s regarding his speech and language
abilities
29
Assessment Results
Behavioral Observation:
During play/language sample: Immediately engaged with the toys, showed appropriate use of toys but
played alone. Initially avoided interaction with the clinician, but eventually participated in a play
routine and displayed joint attention, appropriate eye contact, and reciprocal play skills
Throughout the remainder of assessment, JV continued to display these skills but required multiple redirections for staying on-task. Work avoidance appeared to be due to lack of interest in the tasks
that comprised the Preschool Language Scales - Fifth Edition (PLS-5 Zimmerman, Steiner, & Pond,
2011)
30
Assessment Results continued...
Receptive and Expressive Language: PLS-5
Subtest
Standard Score
95% CI
Interpretation
Auditory
Comprehension
98
91-105
Within Normal
Limits / Average
Expressive
Communication
106
98-113
Within Normal
Limits / Average
Total Language
Score
102
96-108
Within Normal
Limits / Average
31
Assessment Results continued...
Expressive Language: Systematic Analysis of Language Transcripts (SALT Miller, 2012)
SALT Analysis
Language Sample
Age-Matched
Peers
Interpretation
MLU in Words
1.7
3.09
Below Average
MLU in Morphemes
1.75
3.35
Below Average
TTR
.54
.51
Within Normal
Limits
Different Root
Words
37
62.67
Below Average
Different Main Body
Words
68
123.67
Below Average
32
Assessment Results continued...
Speech: Preschool Language Scales - Fifth Edition (PLS-5 Zimmerman, Steiner, & Pond, 2011).
Articulation Screener was administered, JV exhibited correct production of a variety of consonants
including: (/p, t, d, g, m, k, h, s, sh, l, and r/)
He also correctly verbalized vowels including: (/ir, or, and ar/)
Correct production was observed more through imitation than spontaneous production
JV scored a total of 15/23, which is within normal limits for his age
33
Summary of Baseline
Typical play skills
Typical receptive language
Mild expressive language impairment characterized by:
Primarily used two-three word utterances to express himself
Exhibited the ability to use complex morphemes such as present progressive (e.g., eating) and
regular plural /s/ (e.g., cats) but did not use them frequently/regularly during the evaluation
Mild speech production disorder characterized by:
Unintelligible approximations for speech sounds, accurate production achieved through imitation
34
Treatment Goals
Goal 1:
By June 25, 2015, JV will spontaneously produce intelligible three and four word utterances for
requesting, labeling, and communicating his wants and needs in 4/5 opportunities
Goal 2:
By June 25, 2015, JV will increase his expressive vocabulary in session by spontaneously producing
seven different three and four words utterances using a variety of nouns, modifiers, pronouns, and
verbs
35
Results
Maintenance can be attributed to:
Intensive Program
Parent integration
of suggested language
production strategies
in the home
36
Progress Summary
Summary of Progress:
Goal 1:
Met and exceeded by end of Intensive Phase 1
Continuously produced spontaneous three and four word utterances expressing his wants and
needs during all structured activities
Surpassed his goal by producing five and six word utterances
Verbal prompts were used (e.g., what do you need?)
37
Progress Summary continued...
Goal 2:
Met and exceeded by end of Intensive Phase 1
Expanded his expressive vocabulary by producing three and four word utterances consisting of a
variety of nouns (e.g., stars, ladybug, spider, marshmallow), modifiers (e.g., green, little, red,
hard), pronouns (e.g., my), and verbs (e.g., flying, close, has) that were related or a part of the
targeted themed vocabulary
Surpassed his goal by producing more than seven utterances consisting of three and four words
that included a variety of nouns, modifiers, pronouns and verbs
He also produced utterances of five and six words consisting of targeted vocabulary (e.g.,
“Spider right here on the table”)
He even acknowledged his peers by referencing them and stating what they had during snack
time
Verbal prompts were used (e.g., “What do you have?”, “What are you doing?”, and “What do you
38
see?”)
Introducing ES
Background & Concerns:
ES, a 2;2 year old girl, was diagnosed with impaired expressive language and decreased syntax skills,
as well as an articulation/phonological disorder by an outside speech-language pathologist prior to
attending the SDSU-SLC for assessment and intervention
Medical history is significant for frenulectomy and clipping of the upper labial frenulum
Developmental milestones met within a normal timeframe with the exception of speech and language
Referred to SDSU-SLC by parent due to concerns about expressive language
Used same sound sequence to indicate different items (e.g., “bop”)
Used single words often, had some two and three word utterances
Used up to 50 different words
39
Assessment Results
Behavioral Observation:
Es quickly warmed up to the clinicians during the assessment
Demonstrated good joint attention and appropriate eye contact
Engaged in structured activities and demonstrated age-appropriate attention to adult-directed activities
Became uninterested in assessment stimuli but responded well to re-directions for staying on-task
Play sample:
According to the Westby Play Scale (Westby, 1980), ES’ symbolic play skills fell between stages
IV (19-22 months) and V (24 months) indicating typical play skills for her age.
40
Assessment Results continued...
Receptive and Expressive Language: informally assessed through parent report and observation
Receptive Language:
Followed two-step directions (e.g., bring the chair here and sit down)
Accurately answered yes/no questions
Inconsistent answered wh-questions (e.g., answered with “two” for “what are you doing?”)
Understood a variety of verbs (e.g., sit, jump, pour)
Result are consistent with previous outside evaluation, no concerns with receptive language
Expressive Language:
Used more words than gestures
41
Assessment Results continued...
Expressive Language continued…
Used words to express she needed assistance (e.g., “help”)
Used words paired with gestures to request items
Demonstrated a decreased knowledge of a variety of words, indicating a decreased type token ratio
ES produced approximation when imitating words spontaneously and upon request
Speech: Hodson Assessment of Phonological Processes 3rd edition (HAPP-3; Hodson, 2004)
Majority of stimulus items were produced through imitation due to ES’ decreased expressive vocabulary
Spontaneous utterances that were produced were inconsistent
Exhibited the following processes: gliding, stopping, coalescence, and substitutions
42
Assessment Results continued...
Speech: Hodson Assessment of Phonological Processes 3rd edition (HAPP-3; Hodson, 2004)
Single Consonants
Present: p b t d k g f v s z j tʃ dʒ m n ŋ l r w h
Not observed: θ ð ʒ
Prevocalic/Word-Initial Consonant Clusters
Present: kl- mj- kw- sp- grNot observed: fl- gl- pl- skr- sl- sm- sn- skw- ststr- sw- tr- kr- bl- θr-
Intervocalic/Word-Medial Consonant
Sequences
Present: -mpNot observed: -sk- -nd- -skj- -kb- -dr- -θbr-
Postvocalic/Word-Final Consonant Clusters
Present: -dz -bz -sk -ks
Not observed: -ts -nz
43
Summary of Baseline
Typical play skills
Typical receptive language
Mild expressive impairment characterized by:
Use of single words primarily to get express herself
Use of same single word for multiple objects
Infrequent use of two and three word utterances
Decreased vocabulary, TTR
Mild articulation/phonological impairment characterized by:
gliding, stopping, coalescence, and substitutions
Stimulus target word produced inconsistently
44
Treatment Goals
Goal 1:
By June 25, 2015, ES will spontaneously produce intelligible two-word utterances for requesting,
labeling, and communicating her wants and needs in 4/5 opportunities.
Goal 2:
By June 25, 2015, ES will increase her expressive vocabulary by spontaneously producing 5 different
two-word utterances using a variety of nouns, modifiers, pronouns, and verbs.
45
Results
Maintenance can be
attributed to:
Intensive Program
Parent integration
of suggested language
production strategies
in the home
46
Progress Summary
Summary of Progress:
Goal 1:
Met and exceeded by end of Intensive Phase 1
More frequent, spontaneous use of two word utterances (e.g., “more water”, “pig please”, “more
chocolate”)
Also used three word utterances at times to communicate what she wanted (e.g., “wipe my
nose”)
ES responded will to multiple verbal prompts such as “What do you need?”
47
Progress Summary continued...
Goal 2:
Met and exceeded by end of Intensive Phase 1
Produced well over five different utterances consisting of a variety of nouns (e.g.,
duck, net, pig), modifiers (e.g. yellow, yummy), pronouns (e.g., I, you, my), and
verbs (e.g., got, open, wipe, sit)
Her expressive vocabulary expanded to include the targeted vocabulary
She also interacted with her peers by producing two word utterances describing what
they had or giving them directions such as “sit down”
ES also responded well to prompts (e.g. wh- questions) that the clinician provided
48
Meet BB
Background & Concerns:
2;9 female diagnosed with a moderate expressive language disorder by the San Diego Regional Center
She previously received speech and language services through the SDSU Speech and Language Clinic
Unremarkable health history and met all developmental milestones within normal limits
Demonstrates typical play and social skills
Parents concerned with her speech and language abilities, mainly that she is mostly using gestures to
communicate
49
Pretesting
Behavioral Observation:
● Easily engaged in all presented activities and demonstrated age appropriate
attention
● Interacted appropriately with clinicians and other clients
● Demonstrated good eye contact and joint attention
● Overall, BB is happy and easygoing
50
Pretest
Receptive & Expressive Language: The Rossetti Infant-Toddler Language Scales
Basal Score
Ceiling Scores
Observations
Interpretation
Language
Comprehension
27-30 months
range
Scattered skills up
to 33-36 months
range
Difficulty following
2-3 step
instructions and
answering wh- and
yes/no questions
Within normal
limits/ below
average in some
areas
Language
Production
6-9 months
ranges
Scattered skills up
to 12-15 months
range
Uses more
gestures than
words
Below average
51
Summary of Baseline:
Typical play skills
Moderate expressive language delay characterized by:
Uses more gestures than words to communicate
Occasionally uses 1-word utterances paired with a gesture or facial expression
Vocabulary is very limited
Receptive language weakness in the following areas:
Answering yes/no and wh- questions
Following 2- and 3-step directions
52
Treatment Goals
Long Term Goal 1
BB will spontaneously produce four 2-word utterances over 2
consecutive sessions
○ Goal was met at exceeded.
○ BB spontaneously produced six 2-word utterances and five spontaneous
2-word utterances over consecutive session.
○ Utterances included a variety of words and structures (modifier+noun,
noun+action, quality+ noun, greetings noun, negation+noun, negation+
action)
○ BB occasionally produced three word utterances
53
Treatment Goals
Long Term Goal 2
BB will increase her expressive vocabulary to include 6 of 10 new target vocabulary words
each week
○ Goal met each week.
○ BB produced 6 or more of the target vocabulary words each week,
○ Exhibited carryover of the words from one week to the next
Long Term Goal 3
BB will answer yes/no and wh- questions with 80% accuracy over two consecutive sessions
○ Goal was met.
○ BB was able to answer yes/no and wh- questions with 80% accuracy using gestures (head
no/shake or point) or speech.
54
Results
LTG1: 2-word utterances
Generalization
can be attributed to:
Intensive Program
Parent integration
of suggested language
production strategies
in the home
55
Results
LTG3: yes/no and
wh- questions (in %)
Generalization
can be attributed to:
Intensive Program
Parent integration
of suggested language
production strategies
in the home
56
Post Test
Receptive & Expressive Language: The Rossetti Infant-Toddler Language Scales
Basal Score
Ceiling Scores
Interpretation
Change from PreTest
Language
Comprehension
33-36 months
range
33-36 months
range
Within normal
limits/ areas
Increase in
abilities,
comprehension is
WNL in all areas
Language
Production
27-30 months
ranges
Scattered skills up
to 33-36 months
range
Average- below
average in some
areas
Large increase in
basal abilities,
some abilities WNL
but still areas of
concerns
57
Progress Summary
BB increased her expressive language skills
Entered the program communicating mostly in gestures and facail expressions, occasionally
pairing with 1 word. She left the program communicating in mostly 2-word utterances, and
occasionally producing 3-word utterances.
Increased vocabulary size greatly, adding between 6 and 8 new words each week. She showed
carryover of words from each week.
BB increased her comprehensive language skills
Entered the program able to answer yes/no and wh- questions with 45% accuracy, left the
program able to answer questions with 80-100% accuracy
Demonstrated carryover of abilities from week to week, and maintained skills during two week
gap in the program
58
Meet JP
Background & Concerns:
3;1 male diagnosed mild Spastic Diplegia Cerebral Palsy (CP), developmental delay, hypotonia, and an abnormal
MRI of the brain which revealed damage to the inferior parietal lobe
Diagnosed with a severe expressive language disorder and moderate receptive language disorder by the San
Diego Regional Center using Receptive-Expressive Emergent Language Scale - 3rd Edition (REEL-3)
He previously received speech and language services for one semester through the SDSU Speech and
Language Clinic
Delayed developmental milestones secondary to medical history
Demonstrates limited functional play and social skills
Parents concerned with his communication abilities, mainly that he is mostly using gestures and vocalizations to
communicate
59
JP Pre-testing
Behavioral Observation:
● Engaged in most presented activities
● Reduced attention span to task
● Interacted appropriately with clinicians
● Demonstrated good eye contact and joint attention
● Intermittently interacted (e.g. playing bubbles) with clients independently
60
Pre-Testing cont.
Standardized Testing By Previous Clinician:
●
●
●
Westby Symbolic Play Checklist (Westby, 1980) - used informally
○ Limited functional play & emerging pretend play
Preschool Language Scales - Fifth Edition (PLS-5; Pearson, 2011) - abandoned due to non-compliance
MacArthur-Bates Communicative Development Inventories - Words and Gestures (CDI; Fenson,
Marchman, Thal, Dale, Reznick, & Bates, 2007
○ Per parent report - JP understands 224 words; JP uses 20 words or approximations
○ JP tends to use mostly gestures, eye contact, and grunts to communicate his wants and needs
Current Pre-Test Data:
●
Language Play Sample - using car garage
○ produced one word “yeah” and signed for “more,” “please,” and “thank you”
○ Phonetic inventory - Phonetic Inventory /j,b,p,d,m,β/
○
Parents reported that the play interaction was typical of his day-to-day communication
61
Summary of Baseline
Limited functional play skills & emerging symbolic skills
Severe expressive language delay characterized by:
Uses more gestures and vocalizations than words to communicate
Occasionally uses 1-word utterances paired with a gesture or facial expression
Vocabulary is very limited
Receptive language weakness in the following areas:
Answering yes/no and wh- questions
Following 2- and 3-step directions
62
Treatment Goals
Long Term Goal 1:
JP will imitate an approximation of 4 out of the 10 target vocabulary words for the week in 4 out of 5
trials across 2 sessions
●
●
●
Goal was met at exceeded
JP appropriately approximated 6 out of the 10 vocabulary words spontaneously while pointing to the
correct object
Upon reaching the goal, the client consistently approximated for at least 50% of the vocabulary words for
each week
63
Long Term Goals
Long Term Goal 2:
JP will produce the relational word “more” when relation is displayed using objects, by the
clinician (recurrence and nonexistence) with 50% accuracy across 2 sessions
●
●
●
●
Goal was met at exceeded
JP produced “more” when tactile and phonemic cueing was provided, in direct imitation
JP was able to say “more” spontaneously when dealing with recurrence of wanted objects/toys (e.g.
bubbles)
When prompted with the sign and verbal cue JP could imitate two word utterances (e.g. more
bubbles) for wanted objects/toys with a 1-2 second pause in between the words.
64
Long Term Goals
Long Term Goal 3:
JP will produce 2 two-word phrases (request or protest) in direct imitation from the clinician in 4
out of 5 opportunities across two sessions
●
●
●
Goal was met at exceeded
JP could produce two -word utterances when provided with visual and tactile cues with 100%
accuracy
JP produced “more bubble” and “blow bubble” spontaneously
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Post Test
● Formally assessed using The Preschool Language Scales
○ Auditory Comprehension: Standard Score 81, 10th percentile
○ Expressive Communication: Standard Score 79, 8th percentile
○ Total Language Score: Standard Score 79, 8th percentile
● Language sample with SALT analysis
○ MLU in words 1.26
○ NDW 26
○ Play skills - self-talk during play, turn-taking, and symbolic play
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Progress Summary
JP increased his expressive language skills
Entered the program communicating mostly in gestures and vocalizations, occasionally pairing with 1
word. He left the program communicating in mostly words and some 2 & 3-word utterances
Increased vocabulary size greatly, adding between 6 and 8 new words/approximations each week. He
showed carryover of words from each week.
JP increased his play skills
Entered the program with limited play skills and upon leaving program used symbolic play skills
JP increased his pragmatic skills
Entered program with no pragmatic skills with peers; upon leaving program was exhibiting turn taking;
joint attention; and toy talk with peers
Demonstrated carryover of abilities from week to week, and maintained skills during two week gap in the
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program
What Worked and Why?
High clinician to client ratio
Motivating topics and activities
Targeted and individualized attention
Consistent and frequent therapy
Parent involvement
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Parent Feedback:
What did you see as the best part of the group?
It really was a combination of the peer influence, the individualized attention and the fact it was
speech and language driven.
What was the biggest change you saw in your child?
He went from a vocabulary of probably 20-30 words with only one word approximations, to two and
three word combinations with a huge jump in vocabulary.
What, if any, unique service or experience did our group provide to you or your child that you hadn't
experienced elsewhere?
First, it worked! He enjoyed coming, it was speech therapy in an environment he enjoyed and
excelled.
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References
Bunce, Betty. Early Literacy in Action: The Language-Focused Curriculum for Preschool. Baltimore: Brookes Publishing; 2008. Print.
Fujiki, M., Brinton, B., Isaacson, T., & Summers, C. (2001). Social Behaviors of Children With Language Impairment on the
Playground: A Pilot Study. Language Speech Hearing Service School, 32(2), 101-113. doi: 10.1044/0161-1461(2001/008).
Montgomery, W. J. (2003). Working memory and comprehension in children with specific language impairment: What we know so far.
Journal of Communication Disorders, 36(3), 221-231
Nelson, Nickola W. Language and Literacy Disorders Infancy Through Adolescence. London: Pearson; 2009. Print.
Tomblin, J. B., Records, N., Buckwalter, P., Zhang, X, Smith, E., & O'Brien, M. (1997). Prevalence of specific language impairment in
kindergarten children. Journal of Speech, Language, and Hearing Research, 40, 1245-1260.
Stothard, S. E., Snowling, M. J., Bishop, D. V. M., Chipchase, B. B., & Kaplan, C. A. (1998). Language-Impaired Preschoolers: A
Follow-Up Into Adolescence. J Speech Language Hearing Research, 41(2), 407-418. doi: 10.1044/jslhr.4102.407.
Qi, C., & Kaiser, A. (2004). Problem behaviors of low-income children with language delays: an observation study. Journal Of Speech,
Language & Hearing Research, 47(3), 595-609 15p. doi:10.1016/S0021-9924(03)00021-2.
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