Ava is a 12:5-year-old female.

She participated in an evaluation of speech and language

at Clarion University Speech and Hearing Clinic on October 27, 2014. Ava was accompanied to
the assessment by her mother, Kelsey who served as her informant. She reported that she is
concerned about her daughters ability to efficiently express her wants and needs. Kelsey stated
that Ava has minimal ability to communicate and would like for her to be able to do so more
efficiently. Her mother recalled the pregnancy as not being full term with Ava; she was Cyanotic
and weighed 5 pounds 2 ounces at birth. Avas motor development was not delayed. She began
to sit up on her own at five months and began to crawl at eight months old. Her mother stated
that she began walking around 11 months.

Ava has had delayed speech and has trouble with expression. She first babbled at 2
years old, spoke her first word at 9 years old and has yet to combine two words together. Ava
has good receptive abilities and seems to understand what is said to her. When Ava does
communicate she does so in the forms of single words, gestures and guttural noises. Ava
participated in speech and language services starting at age two. She currently receives speech
and language therapy from Mrs. McCullough at the Clarion Area Junior Senior High School that
she attends. Ava also receives Occupational therapy from John Johnson at Clarion Hospital.

The medical history of Ava has diagnoses of Down Syndrome and Pulmonary
Hypertension. Common anatomical differences for those with Down Syndrome are found with
Ava in the forms of Macroglossia and a higher height of the hard palate .Medication is taken for
the Pulmonary Hypertension in the form of Digoxin in a 50mcg/mL (0.05mg/mL) dosage. This
medication is administered through G/J tube from the tracheostomy preformed by Dr. Eisley
June of 2002, weeks after her birth, at Childrens Hospital of Pittsburgh. The tracheostomy was
preformed due to the lack of lung strength caused by symptoms of her Pulmonary Hypertesion.
Minor illness during childhood in the form of ear infections, three during the first year of life, and
influenza occurred. Medical history revealed no presence of visual or hearing problems.