Poway Unified School District SPEECH AND LANGUAGE EVALUATION SUMMARY DATE OF REPORT: 3/19/2012 NAME: Student SCHOOL YEAR: 2011-2012 DATE OF BIRTH: AGE: 4 GRADE: PK CURRENT PROGRAM: CS Preschool SCHOOL OF ATTENDANCE: SCHOOL OF RESIDENCE: TEACHER: PRIMARY LANGUAGE: English ASSESSOR: Sarilyn Zinn, CCC-SLP EL: x_ No _ Yes- Level:_ REASON FOR REFERRAL Student was referred for evaluation since he will be transitioning to Kindergarten to determine continued eligibility for speech and/or language services. EDUCATIONALLY RELEVANT HEALTH, DEVELOPMENTAL AND/OR MEDICAL FINDINGS Please see Psycho-Educational report (dated March 2012). LANGUAGE BACKGROUND Student’s primary language is English; the primary language of the home is English. EDUCATIONAL HISTORY/INTERVENTIONS Please see Psycho-Educational report (dated March 2012). RELEVANT BEHAVIOR NOTED DURING OBSERVATION Student was assessed over several sessions in a quiet room by this examiner. He would not leave his classroom to come to the speech room for assessment. However, he comes to speech class with his peer’s bi weekly. He was comfortable staying in the speech room when his peers left to be assessed. EVALUATION PROCEDURES The assessment instruments and procedures used are valid for the purpose of this evaluation, are nondiscriminatory, and were administered by qualified personnel. The standardized tests administered are normed for the student’s age. The student’s language proficiency was considered in the administration of all instruments and procedures. The evaluation included review of records, speech/language evaluation, clinical observation, progress review, and teacher/parent feedback. SPEECH AND LANGUAGE EVALUATION RESULTS This speech and language evaluation was conducted by Sarilyn Zinn, SpeechLanguage Pathologist. ARTICULATION/PHONOLOGY Student’ articulation skills are developmentally appropriate based on informal observation. VOICE When Student chooses to speak orally his voice is age, gender, and contextually appropriate. He requires verbal and visual cues to use his voice in an appropriate volume. He will often whisper. FLUENCY Student fluency is within normal limits. LANGUAGE Cognitive Measure: Please see Psycho-Educational Report (dated March 2012). Formal Language Assessment Results: The Comprehensive Assessment of Spoken Language (CASL) is a norm-referenced oral language assessment battery of tests for children and young adults aged 3 through 21 years. Each of the CASL tests is individually administered and is based on a well-defined theory of language. The results provide information on oral language skills that children and adolescents need to become literate as well as to succeed in school and in the work environment. The CASL provides an in-depth evaluation of 1) the oral language processing systems of auditory comprehension, oral expression, and word retrieval, 2) the knowledge and use of words and grammatical structures of language, 3) the ability to use language for special tasks requiring higher-level cognitive functions, and 4) the knowledge and use of language in communicative contexts. Specifically, the battery is designed to measure the processes of comprehension, expression, and retrieval in four language categories: 1. Lexical/Semantic–assesses knowledge and use of words and word combinations 2. Syntactic–assesses knowledge and use of grammar (morphology and syntax) 3. Supralinguistics–measures comprehension of complex language in which meaning is not directly available from lexical or grammatical information. 4. Pragmatic–measures awareness of the appropriateness of language in relation to the situation in which it is used and ability to modify language to the situation. The following table illustrates Student’s performance on this measure. Please note that Standard Scores of 85-115 are within the average range. CASL Subtest Standard Score Performance Basic Concepts 102 Average Syntax Construction 81 Below Average Pragmatic Judgment 80 Below Average Student achieved an overall Core Composite Standard Score of 86, indicating average performance for his age. Student demonstrated weaknesses in Syntax Construction (e.g. using correct grammatical structures to describe pictures) and in Pragmatic Judgement in the area of making requests. The Preschool Language Scale-4 (PLS-5) was given to assess Student’s receptive and expressive language skills. This assessment has two subtests; Auditory Comprehension that looks at following directions, understanding concepts, vocabulary and the Expressive Communication subtest that looks at the ability to answer questions, label vocabulary and name categories. Student received the following scores. PLS-4 Standard Score Performance Auditory Comprehension 96 Average Expressive Communication 91 Average Total Language Score 93 Average Student achieved an overall Total Language Score of 93, indicating average performance for his age. . PRAGMATICS Pragmatics is how we use language socially in daily living to express intentions and obtaining, responding to and giving information. Several pragmatic checklists were completed by Student’s teacher, Speech Therapist and Parents to help determine the effectiveness and appropriateness of his pragmatic language skills at school and at home. On the Descriptive Pragmatics Profile (CELF-Preschool-2) statements are rated by the following scale: 1 Never 2 Sometimes 3 Often 4 Always Student received the following scores: Descriptive Pragmatics Profile Criterion Score Performance Teacher/SLP Responses Expected Criterion Score 56 >/=70 Inadequate The Descriptive Pragmatics Profile is a checklist that contains three sections: 1. Nonverbal Communication Skills 2. Conversational Routines and Skills 3. Asking for, Giving, and Responding to Information Student’s score of 56 does not meet or exceed the expected criterion of 70 for children his age. At school, Student shows weaknesses in nonverbal communication skills, conversational routines and skills and asking for, giving and responding to information. Student will answer questions when asked without being cued to answer. However, if he does not know the answer he will remain silent. He does not spontaneously offer verbal information to teachers or peers. He is well liked by her peers. The Children’s Communication Checklist-2 (CCC-2) was also filled out by the school and his mother. This is a measure designed to assess children’s communication skills in the areas of pragmatics, syntax, morphology, semantics, and speech. It is administered using a Response Form on which the caregiver rates the frequency that the child demonstrates the communication behavior described in each item. On the parent checklist, Student received a general communication composite (GCC) standard score of 80. Student’s mother reported the following: SCALE Speech (Articulation)Syntax (Grammar) Semantics STANDARD SCORE 105 70 65 Coherence 65 Initiation 95 Scripted Language 75 DESCRIPTION Student is pronouncing sounds and words correctly. Mixes up he/she, produces long complicated sentences. Forgets words he knows, mixes up words of similar meaning, and is able to name categories. Uses terms like “he/it” without making it clear what he is talking about, difficult to tell if he is talking about something real or make believe, confuses the sequence of events when trying to retell a story/event, explains a past event clearly e.g. what he did at school. Less than once a week starts a conversation with people without any encouragement; several times a day asks a question even though he has been given the answer, less than once a week talks to others about their interests. Does not use scripted language, able to answer questions without being over-precise; you can have an enjoyable conversation with Context 75 Nonverbal Communication 70 Social Relations 65 Interests 85 him. Ability to communicate varies from situation to situation. Frequently looks blank in a situation where most children would show a clear facial expression, does not look at the person he is talking to, occasionally ignores conversational overtures from others (e.g. if asked, “What are you making?” does not look up and just continues working), makes good use of gestures to get his meaning across, occasionally smiles appropriately when talking to people. More than twice a day/or always appears anxious in the company of other children, frequently seems inattentive, distant with familiar adults, frequently bullied or teased by other children, occasionally left out of joint activities with other children, does not hurt or upset other children, always shows concern when other children are upset, frequently talks about his friends. More than twice a day/always chooses same favorite activity to play, less than once a week/never talks about lists of things he has memorized, less than once a week/never moves the conversation to a favorite topic or surprises people by his knowledge of unusual words, more than twice a day or always shows interest in things or activities that most people would fined unusual, occasionally reacts positively when a new and unfamiliar activity is suggested, less than once a week/never shows flexibility in adapting to unexpected situations. On the teacher response form, the consistency check when scoring was not passed therefore, standard scores were not obtained. The following summarizes the teacher/SLP response and how it compares to the parent report. Text in bold print indicates the differences seen at school. SCALE Speech (Articulation)- COMARISON TO PARENT RESPONSES Similar DESCRIPTION Student is pronouncing sounds and words correctly. Syntax (Grammar) Semantics Some Differences Significant Differences Coherence Significant Differences Significant Differences Initiation Scripted Language Significant Differences Context Similar Nonverbal Communication Significant Differences Social Relations Some Differences Interests Some Differences Mixes up he/she, does not produces long complicated sentences. Due to lack of verbal language at school, Student is not demonstrating a wide use of vocabulary at school. Does not verbally retell stories or share information regarding a past event. Never starts a conversation with people without any encouragement; asks a question even though he has been given the answer or talks to others about their interests. Does not use scripted language, able to answer questions without being overprecise, difficult to have an enjoyable conversation with him. Ability to communicate varies from situation to situation. Frequently looks blank in a situation where most children would show a clear facial expression, does not look at the person he is talking to, frequently ignores conversational overtures from others (e.g. if asked, “What are you making?” does not look up and just continues working), does not make good use of gestures to get his meaning across, less than once a week/never smiles appropriately when talking to people. More than twice a day/or always appears anxious in the company of other children, frequently seems inattentive, distant with familiar adults, frequently bullied or teased by other children, occasionally left out of joint activities with other children, does not hurt or upset other children, always shows concern when other children are upset, less than once a week/never talks about his friends. More than twice a day/always chooses same favorite activity to play, less than once a week/never talks about lists of things he has memorized, less than once a week/never moves the conversation to a favorite topic or surprises people by his knowledge of unusual words, once a week/never shows interest in things or activities that most people would find unusual, occasionally reacts positively when a new and unfamiliar activity is suggested, frequently shows flexibility in adapting to unexpected situations. The Social Skills Rating System (SSRS) was filled out by school staff and Student’s mother. This test provides a broad, multi-rater assessment of student social behaviors that can affect teacher-student relations, peer acceptance and academic performance. The SSRS documents the perceived frequency and importance of behaviors influencing the student’s development of social competence and adaptive functioning at school and at home. Social skills are socially acceptable learned behaviors that enable a person to interact effectively with others. Student received the following scores: AREA STANDARD SCORE TEACHER 72 86 STANDARD SCORE PARENT 87 97 SOCIAL SKILLS PROBLEM BEHAVIORS The test consists of five Subscales: Cooperation: behaviors such as helping others, sharing materials and complying with rules and directions. Assertion: initiating behaviors such as: asking others for information, introducing ones self and responding to the actions of others Responsibility: ability to communicate with adults rand regard for property or work Empathy: behaviors that show concern and respect for others; feeling s and viewpoints Self control: behaviors that emerge in conflict situations such as responding to teasing and in non-conflict situations that require taking turns and compromising. The school staff is reported in black and the parent in red. Student demonstrated the following: Cooperation: Very often: follows directions, attempts classroom tasks before asking for help, participates in games or group activities, uses free time in an acceptable way, finishes class assignments within time limits, puts work materials or school property away. Uses free time in an appropriate way, completes household tasks within a reasonable time, congratulates family members on accomplishments, follows household rules, and communicates problems to parent. Sometimes: produces correct school work, uses time appropriately while waiting for your help. Attempts household tasks before asking for help, volunteers to help family members with tasks. Never: joins ongoing activity or group without being told to do so. Helps with household tasks without being asked. Puts away toys or household property. Assertion: Very often: None. Shows interest in a variety of things, is liked by others. Sometimes: None. Participates in organized group activities, starts conversations rather than waiting for others to talk first, receives criticism well. Never: makes friends easily, tells you if he has been treated unfairly, questions rules that may be unfair, gives compliments to peers, helps you without being asked, acknowledges compliments or praise from peers, says nice things about himself, initiates conversations with peers, invites others to join activities, volunteers to help peers in classroom tasks. Introduces himself to new people without being told, makes friends easily, is self confident in social situations such as parties or group outings, joins group activities without being told. Self Control Very often: controls temper in conflict situation with an adult and peers, waits turn in games or other activities, follows rules when playing games with others, compromises in conflict situations by changing his own ideas to reach agreement, receives criticism well. Follows instructions, avoids situations that are likely to result in trouble, controls temper when arguing with children, follows rules when playing games, waits turn in games or other activities, speaks in an appropriate tone of voice at home. Sometimes: cooperates with peers without prompting responds appropriately to peer pressure. Controls temper in conflict with mother, attends to mother’s instructions, ends disagreements with you calmly. Never: responds appropriately to teasing by peers. Responds appropriately when hit or pushed by other children. Responsibility: Very often: Appropriately questions household rules that may be unfair, politely refuses unreasonable requests from others, answers the phone appropriately, congratulates family on accomplishments. Sometimes: Gives compliments to friends or other children in the family, invites others to your home, compromises in conflict situations by changing own ideas. Never: Asks permission before using another family member’s property, asks sales clerk for information. Problem Behaviors: Very often: appears lonely (internal behavior). Fidgets or moves excessively, says nobody likes him. Sometimes: shows anxiety about being with a group of children, acts sad or depressed (these behaviors fall under “internal behaviors”). Has temper tantrums, shows anxiety about being with a group of children. Never: has temper tantrums, fidgets or moves excessively, argues with others, disturbs ongoing activities, says nobody likes him, is aggressive, disobeys rules or requests (external behaviors). Argues with others, disturbs ongoing activities, appears lonely, disobeys rules or requests, acts sad or depressed. The School questionnaire for Teachers and for Parents on Selective Mutism by Bruce Black, M.D. was also utilized to gain information. This checklist requires the rater to determine if the child does one on the following on items: *has no difficulty speaking *is somewhat reluctant to speak *very reluctant to speak *has never spoken in this situation According to the Teacher form, Student is “very reluctant” to speak in the following situations: *in class to other children *in class to teacher *in class to other adults *on playground to other children or teacher He has never spoken in the following situations: *speaking to unfamiliar adults or children The following narrative is information gained from questions on this questionnaire. His teacher, Mrs. Phelps has heard Student speak normally when she has talked to him on the phone and bumped into him out in the community. He has the same amount of difficulty talking to children, adults, males or females. He has never told her why he is reluctant to speak. She reports that he generally seems anxious or very shy. When there are new activities, field trips, classroom performances or new people, Student has been observed to become more anxious/nervous. He also becomes more anxious if he feels he is the center of attention. For example during a class party where the class as a whole sang some songs or when new people come into the room (e.g. the custodian). On the parent portion of this checklist, Student’s mother reported the following: Student is reluctant to speak in certain situations. He is able to understand spoken language and can speak. He is able to speak normally in some situations. He has always been this way and is slowly getting better. He has told her he doesn’t talk because he is shy. She describes Student as moderately shy but that it depends on the setting. He can become extremely anxious in social situations. For example he doesn’t look forward to school parties because he doesn’t want to sing or stand in front of people. She doesn’t feel that when dealing with other people that he becomes overly self conscious or overly concerned that he may say or do something that might embarrass or humiliate himself. She reported he fears/avoids certain situations such as: being alone in unfamiliar places and speaking in front of a group. He has not demonstrated fear or avoidance in the following situations: riding in a car, eating out, movie theaters, malls, attending social gatherings or school. Mrs. Kiernan also shared that as a teenager and in her twenties she was reluctant to speak to others. She rated herself as extremely shy or having anxiety in social situations and a fear of public speaking. She has reported that this is no longer the case. Student has two older sisters (ages 16 and 8) and a younger brother (age 2). She reports that her 16 year old daughter went through a phase of extreme anxiety from 9-12 years of age. According to the Parent form, Student is “very reluctant” to speak in the following situations: *in school to other children and adults *with unfamiliar adults and children away from home *with unfamiliar children in his home He is somewhat reluctant to speak in the following situations: *in school to his teacher *with familiar adults away from his home * With unfamiliar adults in his home *with familiar children in his home or away from his home *with store clerks or doctors Student has no difficulty speaking in the following situations: *with mother in his home *with father in his home *with father/mother away from home *with siblings away or in the home *with extended family when away from home *with familiar adults in the home The school staff also filled out the Social-Communication Anxiety Inventory (SCAI), by Bergman. This scale requires the rater to indicate levels of functioning in a variety of school situations using the following scale: never, sometimes, most of the time or always. The rater must also look at the type of communication such as: *does not initially engage e.g. may freeze *nonverbal response *nonverbal initiative *transitional; moving from nonverbal to verbal e.g. may be using a whisper *verbally responsive Verbally initiative In his classroom in a large group, small group, one on one and on the playground Student was observed to never nonverbally initiate, he will sometimes whisper to respond to questions, he will sometimes be appropriately verbally responsive and never verbally initiate. One on one with the teachers Student was observed to never nonverbally initiate, he will sometimes whisper to respond to questions, he will most of the time appropriately verbally responsive and never verbally initiate. This checklist also looks at different dynamics during communication. The rater uses the following scale: always, often, seldom, never. Student seldom talks to most peers and teachers at school. He seldom speaks in groups or in front of the class. He often answers when called on by his teacher. When appropriate he never asks his teacher questions. A Language Sample was not obtained due to lack of verbal output by Student. During assessment he answered questions and responded appropriately to receptive language tasks by pointing to pictures. Fee play was attempted but Student remained silent. He has known me for one year. This examiner has never heard a spontaneous initiation or comment from Student. This examiner planned a “coincidence” meeting with Student and his mom at the local park one evening hoping that Student would converse more freely. (During Christmas he ran into his teacher, Mrs. Phelps out in the community and was very talkative with her.) During the visit at the park, Student ignored this examiner. Anytime I attempted to interact or play with him he ran off. Student observed me playing with his little brother. When the sand toys were brought out, I asked Student to help me make a birthday cake for his brother and he did. But he soon left the sand area. After about 40 minutes I walked to my car. As I was leaving Mrs. Kiernan called to me to come back. Student had asked her if I could sit with him while he ate his snack. During this time Student spoke a little bit more. At first he would say to his mother, “You tell her.” He soon answered some questions but again no spontaneous initiation. On the PLS-5 Language Sample checklist Student demonstrated the following: *did not talk spontaneously *played with this examiner *answered when talked to *did not tell me about an event or object *did not maintain a conversation *did not use language to control other’ behavior *did not use language to interact with another person SUMMARY The results indicate that Student exhibits a disorder in the area of pragmatics in comparison to his chronological age. Student is showing characteristics of Selective Mutism. Selective Mutism is the inability to communicate in select social settings despite being able to verbally communicate in others. For example, a child who speaks freely at home but is verbally shut down at school daily. This differs from shyness. In shyness there is a slow warm up period and a child can often respond with a nod or small smile. The child has the same demeanor everywhere-quiet and reserved. In Selective Mutism the warm up time is much longer than expected; the child cannot respond and may appear frozen. The child is restrained at school and talkative at home. Research indicates that the following may be causes of Selective Mutism: inhibited temperaments, decreased threshold of excitability in the amygdala, genetic predisposition of anxiety. There is NO evidence that the cause is related to a trauma. Student’s speech or language performance is not due to cultural, environmental, or economic disadvantages, limited school attendance, or second language acquisition. The disability may not be corrected solely through modification of regular education. The results of this evaluation will be brought to the IEP team for consideration. A copy of this evaluation will be provided to the parents. __________________________ Sarilyn Zinn, M.S., CCC-SLP STRATEGIES *Selective Mutism is about the fear of the expectation to speak *don’t ever force the child to speak *there should never be negative reinforcement for being mute *focus on positive reinforcement *young children benefit from a more “play-based” approach *older children may benefit from a cognitive behavioral approach *focus on engaging non verbally, then bridging to verbal *use visuals to encourage spontaneous communication (e.g. frog chart, every time the child speaks spontaneously the frog is moved/jumped into the water) *sticker chart or reward to take home each day for positive reinforcement of verbally interacting at school *have staff close their eyes after asking the child a question *use humor, make mistakes that a child may need to correct e.g. call them by the wrong name *accept head nods, pointing etc. *stay patient and positive *use visuals for loudness levels e.g. sound chart showing a whisper voice, just right voice, too loud voice (just right voice is shown on the chart in the color green, green zone. Whisper and too loud can be in red zones) *implement class activities that have the class talk using a whisper, a loud voice and a “just right” voice *play games that the class has to judge if the teacher is talking in a whisper, a loud voice or a just right voice *use visuals to make a “talking scale”; discus if it is easy, medium or hard to speak in different situations *talk about talking; talk about being brave vs. shy; using a brave voice *social stories about talking e.g. using a brave loud voice, that it is good to share our thoughts and ideas, turn taking etc. *point out when you, as a staff member, make mistakes and that it is o.k. to make mistakes *be sure all staff working with the child is aware of these strategies *make alternative ways the child can complete any oral assignments e.g. video it at home instead of presenting in front of the class *make sure to warn the child before you ask them a question; let child observe peers doing a task/answering questions first, and then call on the child. *teach the strategy that if they don’t know the answer it is o.k. to say, “I don’t know.” *minimize special attention to the child (e.g. coming up in front of the class to talk) *do not use terms like Selective Mutism in front of the child. *remember this point: “ANY COMMUNICATION IS GOOD COMMUNICATION”
