Evaluation Report- Kirsten CSCD 4396

Running head: REPORT OF SPEECH-LANGUAGE EVALUATION 1

Report of Speech-Language Evaluation

Jeremy Love

CSCD 4396

Temple University

REPORT OF SPEECH-LANGUAGE EVALUATION 2

Temple University Speech Language Hearing Center

Speech Language Evaluation Report

NAME: Kiersten Jones D.O.B.: 11/17/2006

ADDRESS: 1213 Holly Drive CA: [6yr; 10 mo]

PHONE: (609)-745-9945 D.O.E.: 09/17/2013

SLP: Jeremy M. Love (912886699)

Statement of the Problem

Kiersten, accompanied by her mother, Dee, arrived at the Temple University Speech

Language Hearing Center on 09/17/2013, seeking a second opinion, after receiving services from

a Speech-Language Pathologist at Kierstens elementary school. While Kierstens condition has improved since she began receiving speech therapy in Kindergarten, her mother is concerned that

she may not hear or even notice the speech errors that Kiersten makes, after Kierstens grandmother said that she does not understand her. When Kiersten first entered Kindergarten, her

teacher had trouble understanding her, but by the end of the year, Kierstens speech improved to the point where her speech was intelligible to her teacher. Kierstens progress continued through first grade, as her next teacher said that she did not have any problems understanding Kiersten.

History/Background Information

About two years ago, when Kiersten was in preschool, she began to exhibit problematic

symptoms such as leaving off the beginnings and endings of words, not pronouncing letters

correctly, problems with tense (has vs. have), and occasional verb-tense difficulty. However,

Kierstens symptoms likely manifested earlier than preschool, according to her mother, and this


may be the result of Kiersten not fully mastering communication skills. Kierstens mother noticed that Kierstens older siblings would typically answer for her, and she may have felt that she didnt have to speak up for herself, thus inhibiting Kierstens speaking skills, as a result. After first noticing Kierstens speech problems, her preschool teacher requested that she be evaluated by a Speech-Language Pathologist. In addition, members of Kierstens family have had speech problems in the past; Kierstens father had difficulties pronouncing letters and words, and he stuttered, Kierstens older sister, Chelsea, had a lisp, and Kierstens older brother, Andrew, had difficulties with pronouncing /f/ and /s/, and he stuttered for a short time.

Medical History

Kierstens mother was in good health during the pregnancy, and Kiersten was born after 7 hours of labor, and weighed 7 lbs; 6 oz. The problem that arose after birth was that Kiersten had

to be seen by a neonatologist because it was believed that she swallowed meconium during

delivery, but this turned out not to be the case, and she was released a short time later. The only

major illness that Kiersten has had was Croup at 11 months of age. Besides that, she has had

regular, seasonal colds, and the occasional high fever. Kiersten has never had any surgeries, she

has not had any major accidents or hospitalizations, and she is not currently on any medications.

Kiersten once had a negative reaction to Amoxicillin, and broke out in a rash after taking it, so

she is likely allergic to it. In terms of developmental history, Kiersten learned to crawl, sit, stand,

walk, feed herself, dress herself, and use the toilet at the normal age, according to her mother. In

addition to this, Kiersten began to use single words, combine words, name simple objects, use

simple questions, and engage in a conversation at normal age. It is likely that Kierstens mother is using her older children as models to Kierstens developmental history, as she is unable to


provide approximate ages for these milestones. In terms of motor development, Kiersten has

never had any difficulties with walking, running, or activities that required small or large muscle

coordination, and she never had any problems with feeding.

Educational History

Kiersten is currently attending first grade at Makefield Elementary School, and she is doing

very well academically; she is currently at the highest reading level for her age group, and there

are no areas of concern, according to Kierstens teachers. In terms of special services, Kiersten is only receiving speech therapy once a week, at her school, and she currently has an Individualized

Educational Plane (IEP), with only speech goals. These goals include making Kierstens syllables more clear, practice with verb tenses, practice with endings of words (i.e. ed, -ing), and pronunciation goals with producing /f/ and //. Because of Kierstens speech problems, she can be shy and quiet, at times, but once she warms up to someone, she is more talkative and outgoing.

General Behavioral Observations

Kiersten was very cooperative and well behaved during the evaluation. As part of the

evaluation, Hedbanz was played, which is a game in which the players wear a blue headband with an object card, and try to guess the contents of the card by asking questions to other players

and receiving yes/no answers. During the game, Kiersten exhibited excellent turn-taking skills by

patiently waiting for her turn to come, and not exhibiting any frustration. In addition, when

answering questions, Kiersten was very cooperative and answered fully and to the best of her

ability. While in the presence of the clinicians, Kiersten appeared to be slightly shy, and there

were a few instances in which she did not project her voice. However, this did not prevent

Kiersten from participating and engaging in activities or answering questions. Kiersten also


appeared to be very attentive, and remained engaged while answering questions and engaging in

the Hedbanz activity. Overall, Kiersten appears to be a high-functioning, bright child and her motivation for speech therapy and ultimately remediating her speech problems appears to be

high.

Tests Administered

As part of Kierstens evaluation, the following standardized tests were administered, Goldman-Fristoe Test of Articulation-2 (GFTA-2), subtests from the Clinical Evaluation of

Language Fundamentals-Fourth Edition (CELF-4), The Oral Peripheral Examination, and

Audiological Screening. To give a brief overview of each test, the GFTA-2 is used to measure a

childs articulation of consonants of Standard American English, and it samples spontaneous and imitative speech production in three subtests (sounds in words, sounds in sentences, and

stimulability). The CELF-4 is used to determine whether a child has a language disorder or

delay, by measuring Receptive Language and Expressive Language scores of the child, in 19

subtests. The test also contains four levels of analysis {1) identify whether language disorder is

present, 2) describe nature of disorder, 3) evaluate underlying clinical behaviors, and 4) evaluate

language and communication in context}.

Oral-Peripheral Examination

Overall Structure

-Evaluation of Jaw: Kiersten exhibits a normal range of motion, normal symmetry, and normal

movement of the jaw. On addition, TMJ noises appear to be absent.


-Evaluation of Teeth (Dentition): Kiersten appears to have normal motor relationship occlusion.

However, in terms of incisor relationship, the client has cross-bite. In other words, contact

between the maxillary arch and the mandible is normal in the molars, but not the incisors. All

teeth are present, and are arranged normally, with the exception of cross-bite occlusion of the

incisors.

-Evaluation of Lips: Kiersten appears to exhibit a normal range of motion of the lips and normal

symmetry, while puckering the lips and smiling, and normal strength when pressing her tongue

blade against her lips. However, while doing this, Kiersten needed a model to imitate pushing

tongue against side of her cheeks, before she was able to perform the task. When smiling,

Kiersten exhibits a normal range of motion. While puffing the cheeks and holding air, Kiersten

appears to exhibit weak lip strength, as she has difficulties with pursing her lips against the

tongue depressor, but has an absence of nasal emission.

Evaluation of Tongue: The surface of the tongue is normally colored, abnormal movements are

absent, and the size of the tongue and frenum are both normal.

1. Excursion: The excursion of the tongue appears to be normal when the client protrudes,

retracts, and moves the tongue tip to the left and right of the mouth.

2. Range of motion: The range of motion of the tongue is normal when Kiersten protrudes,

retracts, moves the tongue tip to the left and right of the mouth, moves the tongue tip up

and down, and when the tongue moves rapidly from side to side.

3. Speed of motion: The speed of motion of the tongue is normal when Kiersten protrudes

and retracts the tongue.


4. Strength: The strength of the tongue when applying opposing pressure with the tongue

blade is normal when Kiersten protrudes, and moves the tongue tip to the left and right.

5. Movement: The movement of the tongue is normal when the client moves the tongue tip

up and down.

6. Rate: The rate of the tongue, when making rapid side-to-side movements is normal.

-Evaluation of Pharynx: The color of the pharnx is normal in color, and the tonsils are present.

-Evaluation of Hard and Soft Palates: The color of the hard and soft palates is normal, the rugae

is normal, the height and width of the arch is normal, and both growths and fistulas are absent.

Clefting of the hard and soft palates are absent, there is normal symmetry at rest, and the gag

reflex is normal. When phonating /a/, there is normal symmetry of movement, posterior and

lateral movement is present, nasality is absent, and there is no deviation of the uvula.

Diadochokinetic Syllable Rates

In 20 repetitions, Kiersten articulated the /p^/ syllable at 4.4 seconds (0.8 SD), which is above

average for her age group. Kiersten articulated the /t^/ syllable at 4.9 seconds (1 SD), which is

the exact average for her age group. However, Kiersten articulated the /k^/ syllable at 6.2

seconds, which is considerably below average for her age group. Despite this, Kiersten

articulated /p^t^k^/ at 6.9 seconds (1.5 SD), which is above the mean for her age group. These

results indicate that Kiersten is able to produce /p^/ and /t^/ at normal pace, but cannot articulate

/k^/ at normal pace, while in isolation. However, when /k^/ is presented in a sequence, Kiersten

is able to articulate it at normal pace.

Hearing

Kiersten passed a pure tone audiological screening presented at 20dB, with test frequencies of


500, 1000, and 2000 Hz bilaterally. This indicates that Kiersten has normal binaural hearing and

responds to all sounds. Before this screening, Kierstens mother stated that Kiersten has had her hearing tested in the past, and there were no notable concerns.

Articulation/Phonology

While Kiersten exhibited some misarticulations during the evaluation, Kiersten had a

relatively high rate of intelligibility in her speech. On a Likert-scale of 5 (1=completely

unintelligible and 5=completely intelligible), Kiersten would likely a conversational speech level

of 4, which indicates that she has intelligible speech, with the exception of a few words or

phrases. During the evaluation, Kiersten exhibited misarticulations when producing words with

/r/ (/wajt/ for /rajt/), // (/nd/ for /nr/), and /t/ (/d/ for /t/). On the Goldman-Fristoe Test of Articulation-2 (GFTA-2), Kiersten received a raw score of 18 for the sounds in words subtest,

with a standard score of 77, and a 4% percentile rating. These results indicate that Kiersten

produced 18 errors out of 77 sounds. Kierstens obtained standard score at the 4% percentile indicates that she is significantly below the normal range of children in her age group.

Sound errors that Kiersten made on the GFTA-2 include: 1) /s/ produced as voiceless // in initial and medial positions of words [/srz/ for /szrz/], 2) /s/ in the blend /sl/, /sp/, and /sw/ produced as voiceless // in initial position of words [/wm/ for /swm/], 3) /z/ produced as voiced // in medial position of words [/srz/for /szrz/], 4) /r/ produced as /w/ in initial position of words and as derhotic sound in medial and final positions, 5) /r/ blends

produced as sound + /w/ in initial position of words [/dwm/ for /drm/], 6) /t/ produced imprecisely in the initial position of the target word, 7) /d/ produced imprecisely in the medial

position of the target word, 8) distortion of vowels were in the context of /r/, 9) /r/ blends, and

/s/, and 10) the presence of a frontal lisp [// for /s/] in production of single words.


Language

During the evaluation, Kiersten was administered the core language subtests of the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4), but due to time

constraints, only two out of four of these subtests were administered, Concepts & Following

Directions and Word Structure. For the subtest Concepts & Following Directions, Kiersten

received a raw score of 43, a scaled score of 13, and a percentile rank of 84. This indicates that in

this particular area, Kiersten is above average for her age group, and 84% of children in her age

group had a lower raw score. For the subtest Word Structure, Kiersten received a raw score of

27, a scaled score of 12, and a percentile rank of 75. These results indicate that Kiersten is

slightly above average in this particular area, for her age group, with a score on the 75%

percentile. As a whole, these subtests are compiled with other subtests to find the Core Language

Score.

Areas of Success

Expressive Language: Kiersten correctly modified word roots, modified nouns to create regular

plural (horses), used subjective, reflexive, and possessive pronouns (She, himself, yours) , used

possessive nouns (Paulas boot), and derived nouns from verbs (change sing to singer), modified verbs to correctly use third person singular s (She reads), used the verb is in contractible situations (She is happy), used the verb is with a verb ending in ing (girl is listening) used regular & irregular past tense (change climb to climbed & draw to drew), used future tense (they

will eat next), and modified adjectives with the comparative and superlative marker (faster and

fastest).


Receptive Language: Kiersten followed directions including adjectives (big/small, first/last),

special concepts (top/bottom), and sequenced tasks (After I point to the fish, point to the house).

Areas of Difficulty

Receptive Language: Kiersten had difficulty following multi-step direction (pointing to two sets

of objects, one after the other) and directions that asked her to point to items in a right to left

orientation (pointing to three pictures in a row, starting from the last and moving to the first).

Kiersten is just learning the basics of following directions, based on her age, so it is likely that

she does not quite have the capacity to interpret multi-step directions, as of yet. The acquisition

of directionality is age-specific.

Expressive Language: Kiersten had some difficulty modifying nouns to create irregular plurals

(mouse/mice), She did not demonstrate the use of objective pronouns (used us instead of them),

and she did not derive adjectives from nouns (luck to lucky). These expressive language skills

are most likely not age appropriate to Kierstens age group, as the creation of irregular plurals from modified nouns, the use of objective pronouns, and the derivation of adjectives from nouns

is specific to older age groups.

Fluency

For the most part, it appeared that Kiersten had a steady flow of speech, but she

occasionally exhibited the core behaviors that are associated with fluency disorders, such as

prolongations of single words, and repetitions of sounds, syllables, and whole words. For

example, in the beginning of the speech sample, Kiersten repeats a whole word and three times


(and, and, and you can guess like what it is), and inserts an interjection like into her sentence, which is a secondary avoidance behavior. Kiersten also exhibits other secondary

behaviors associated with disfluency, such as eye blinks and slight head nods, while speaking.

Kiersten is six years old, so it is unlikely that her disfluencies are developmental, because these

behaviors are typically seen in developing children between the ages of 2 and 4. Therefore, it is

likely that the mild disfluencies that Kiersten exhibits are symptoms of stuttering. As reported in

the case history report, Kierstens father and brother have had a history of stuttering, so it is possible that Kiersten has a predisposition to stuttering.

Voice

While Kiersten has a relatively normal production of her voice, she appears to have some

difficulties with projecting her voice, and there are certain instances where her voice fades to a

level where it is difficult to understand what she is saying. For example, when Kiersten was

asked a question of whether the clinician had to put cards in a pile, as part of the activity,

Kiersten responded with what appeared to be aphonia, which is an absence of audible phonation.

This occurred a few times over the course of the speech sample, but this does not necessarily

mean that Kiersten is exhibiting a voice disorder, as shyness could also play a role in the

spontaneous absence of phonation that Kiersten exhibits. It was reported in Kierstens case history that she is slightly shy because of her speech problems, and that she is slow-to-warm-up,

as a result. While speaking, Kiersten did not exhibit any problems with maintaining pitch and a

consistent fundamental frequency for her age and gender, which would be about 265 Hz.

Summary/Recommendations

Based on results from the Oral-Peripheral Examination, and more specifically, the

GFTA-2, and subtests from the CELF-4, Kierstens primary diagnosis is mild-to-moderate


articulation disorder. The Oral-Peripheral Exam showed that Kiersten has cross-bite and

difficulties with pursing her lips against a tongue depressor, which could be directly causing

Kierstens misarticulations, as proper dentition and lip suction/control is needed to correctly produce phonemes, particularly voiceless lingua-dental fricatives such as // and voiceless labiodental fricatives such as /f/, which Kiersten has the most difficulties producing, according to

her IEP.


http://www.rit.edu/ntid/speechlang/slpros/assessment/speechvoice/training/1

Evaluation Report- Kirsten CSCD 4396

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