www. marshall.

edu
Department of Communication Disorders
Speech & Hearing Center
CAA Accredited  A Board of Governors’ Program of Excellence

Marshall University Speech and Hearing Center

SPEECH AND LANGUAGE EVALUATION

6/17/2020
Name: Witten Wright MRN: 000234658696
Parents: Sarah and James Wright Birthdate: 07/16/2017
Address: 33 Marco Dr. Huntington WV, 25705 Telephone: Home (304) 123-4567
Email: merryheart@aol.com Cell: (304) 567-1234

Communication Diagnosis: N/A

Medical Diagnosis: N/A
Procedure/CPT Code: 92506

Referral Information

Witten, a two-year, 11-month old male participated in an early intervention exit evaluation at the Marshall University
Speech and Hearing Center (MUSHC) due to getting ready to age out of early intervention services. During parent
interview, Witten’s mother reported notable progress in expressive language abilities since the beginning of
services. Per parent report, Witten produces statements to express his thoughts and no longer identifies objects by
using one-word utterances. Witten’s mother expressed that she feel’s confident in her son’s overall progress;
however, she still identified concerns with a new behavior of repeating the same word (e.g. “eat eat”) when excited
and an inability to produce multiple sentences, especially when expressing emotions. Witten’s Early Intervention
Service Coordinator, Matt Braun, also indicated that Witten’s parents had expressed concerns about not being able
to communicate well with Witten and differences between Witten’s communication abilities and his peers. Braun
stated that Witten’s family was requesting an updated evaluation to determine if Witten’s communication skills are
at age level.

Background Information

Witten’s mother provided the following information in the case history and pre-interview.

Witten’s mother reported an unremarkable birth history. She reported a healthy 39-week pregnancy and vaginal
delivery with no complications. She reported that Witten weighed 9 lbs, 3 oz. at birth and did not experience any
unusual conditions immediately following birth.

Witten’s developmental milestones were provided at the time of intake (12 months). During this time, Witten’s
mother reported that he did not crawl until 11-12 months, did not sit by himself until 8-9 months, and was not yet
pulling himself up to stand. These milestones were determined to be delayed as a child should start crawling
around 6-10 months, sit with no support around 6 months, and pull themselves up to stand around 8 months.
Witten’s mother also reported that her son was feeding himself by grasping food with his fingers but did not provide
an age at which he started. She also indicated that Witten had not yet mastered walking and dressing himself. At

One John Marshall Drive  Huntington, West Virginia 25755-2675  Tel 304/696-3640  Fax 304/696-2986
Speech and Hearing Center Office 304/696-3641  www.marshall.edu/commdis
A State University of West Virginia  An Affirmative Action/Equal Opportunity Employer
Last Name, First Name Page 2

the time of intake, not reaching these milestones were considered typical for Witten’s age as typical developing
children cannot dress themselves until around three years old and some do not start walking until around 14
months old. However, additional parent interview needs to be conducted to determine if/when Witten met these
milestones and if they were met at an appropriate age. Case history also revealed that Witten’s mother expressed
concerns regarding motor skills as she felt that he was delayed in this area.

Further investigation revealed no behavior or play concerns. At the time of the case history (12 months), Witten’s
mother indicated that her son played with familiar people but was a little shy around new people. She stated no
concerns with attending to tasks or play activities. Parent interview at the time of the evaluation indicated that
Witten was in the parallel play stage as he often played alongside and mirrored his friends’ behaviors but did not
play with them. Witten’s mother attributed the parallel play to being too engrossed with the toy that Witten was
playing with.

Case history revealed appropriate and concerning speech developmental milestones. Case history indicated that
Witten began to babble at 6 months and had not yet produced a first word, combined words, or used sentences at
12 months old. Witten’s ability to babble at 6 months was typical for his age as children begin to babble around 4 to
6 months. His inability to produce sentences was also normal as one does not develop this skill until around 48 to
60 months; however, his mother expressed recent concerns in this area. During parent interview, Witten’s mother
indicated that “sentences are few and far between” but she felt the capacity was growing. Regarding his first word,
typical developing children begin to speak their first word around 12 months. Witten’s lack of meeting this milestone
is of concern; however, it cannot be determined as a delay until further interview is conducted to determine when
he achieved this milestone. Witten’s mother also reported that at 12 months, he was using gestures and “playing
with sounds” to communicate his thoughts and needs.

Witten’s mother reported an unremarkable medical history. Before 12 months, Witten did not experience any
illnesses except a common cold at 8 months old and did not exhibit a medical diagnosis. Witten had not
experienced any surgeries, accidents, or hospitalizations. Witten’s mother also reported no current medications and
up to date immunizations.

Witten has received speech-language services through MUSHC since May 2018. Witten’s parents have also
utilized an Early Intervention Service Coordinator, Mr. Matt Braun, which has provided an Individuals Family
Service Plan (IFSP) to assist in meeting Witten’s needs.

Observations and Test Results

Witten participated in an at home speech-language evaluation and was accompanied by his mother, father, and
younger brother. Witten cooperated during testing which lasted approximately 75 minutes. Testing consisted of
informal/formal measures. Test results were judged to be reliable due to similar findings during parent interview and
informal observations.

PLS-5

The Preschool Language Scales-5th Edition (PLS-5) is a standardized, norm referenced assessment that provides a
comprehensive language assessment to determine if children are age appropriate in expressive and receptive
abilities. The PLS-5 assesses skills ranging from pre-verbal, interaction-based skills to emerging language to
emerging literacy. The following are results of the PLS-5:
Last Name, First Name Page 3

Subtests Standard Confidence Percentile Interpretation of

Scores Intervals Ranks Scores
Based on a In Relation Based on a
Mean of 100 to the Mean of 50
and a Standard Average
Standard Score at a Performance
Deviation 90% level of =
(SD) of 15 Confidence
Percentile
Average Ranks of 1684
Performance=
SS of 85-115

Auditory 93 86-97 27 Average

Comprehension
Expressive 90 86-97 27 Average
Communication

Total Language 91 86-97 27 Average

Score

Based on the above information, Witten obtained a standard score of 93 on the Auditory Comprehension portion of
the PLS-5 which was between 1 SD below the mean and at the mean of 100. Witten obtained a standard score of
90 on the Expressive Communication portion of the PLS-5 which was between 1 SD below the mean and at the
mean of 100. Witten obtained a Total Standard Score of 91 on the PLS-5 which was between 1 SD below the mean
and at the mean of 100.

Witten displayed the following strengths on the Auditory Comprehension portion of the PLS-5: correctly answer
items that were appropriate for his age such as identifying body parts, identifying things to wear, following simple
commands, and engaging in symbolic play. Weaknesses included the comprehension of items that were
considered to be above his developmental range, such as making inferences. Witten also displayed the following
strengths on the Expressive Language portion of the PLS-5: correctly complete age appropriate items that required
him to name familiar objects, use words more often than gestures, use words for a variety of pragmatic functions,
and use different word combinations. Weaknesses included items that were considered to be out of his
developmental range, such as utilizing grammatical morphemes (-ing, plurals).

Witten’s parents were also provided the PLS-5 Home Communication Questionnaire. Parent report indicated that
Witten engages in a variety of activities with familiar adults and plays well with other children. The questionnaire
also revealed that Witten pays attention to what is happening around him, enjoys interacting with others, follows
directions, communicates with a combination of gestures, phrases and emerging sentences, and produces speech
that is understood by familiar listeners.

Language Sampling/Observation Assessment:

A language sample was gathered and analyzed during play-based activities to assess qualitative data on
expressive and receptive language abilities. Play-based activities included a kitchen activity, large motor activity,
and a picture book activity. During all activities, Witten displayed strong receptive language abilities as
demonstrated by following simple commands and answering simple questions appropriately. Witten followed simple
commands that were presented to him by the examiner such as when he opened the fridge upon request and when
he gave a high five upon request. Witten also exhibited the ability to answer simple questions when he answered
questions such as “the fire’s on” when asked about what he saw during the kitchen activity and “all done” when
asked if there were more pages in the picture book. Like strengths, Witten demonstrated a receptive language
weakness as evident by the ability to follow complex direction during play activities.
Last Name, First Name Page 4

In addition to receptive language, Witten also demonstrated strengths in expressive language during the same play-
based activities. Witten exhibited an ability to express his thoughts and needs, use different word combinations, and
name familiar objects. Throughout all activities, Witten used a variety of words and gestures to express his
thoughts. Witten also demonstrated an ability to spontaneously use and imitate multiple two, three, and four-word
combinations such as “daddy shoes”, “yes it does”, and “He ride fire truck.”. Lastly, Witten displayed an ability to
spontaneously produce several familiar items, such as the following: shoes, pants, socks, bee, fire engine, kitty cat,
fish, and strawberries; and was able to imitate items such as muffins, microwave, and stove. Like strengths, Witten
exhibited weaknesses in expressive language which included the following: an inability to use articles (e.g. “the, a”)
and an inability to appropriately express his feelings. Although still intelligible, Witten spontaneously produced
utterances without the use of articles such as “turn page” (omitted “a”) and “he ride fire truck” (omitted “the”). He
also displayed difficulty in using words to express his frustration, such as when he told his brother “no” and whined
and pushed instead of using more words.

Information gathered during informal observation aligned with information presented during parent interview and on
Witten’s most recent progress report. During interview, Witten’s mother confirmed that receptive language is an
area of strength for her son as does very well with following directions and is a “rule follower”. Similar findings were
also evident regarding expressive language as Witten’s mother reported that her son began to imitate words at the
initial stage of therapy. Witten’s recent progress report indicated similar findings as Witten has improved his verbal
output by spontaneously producing utterances and relying less on models and prompts. Additionally, his progress
report indicated that Witten has improved his ability to produce statements as demonstrated by the production of
three-word phrases without prompts and four-word phrases in facilitated activities. All of these findings strengthen
the information obtained during the observation assessment.

In addition to determining Witten’s receptive and expressive capabilities, the clinician examined parent support and
provided direct feedback and modeling during the play-based activities. During all activities, Witten’s parents did a
phenomenal job in supporting their child’s language, although a few suggestions were provided. The clinician
provided direct feedback when Witten experienced a mild meltdown that resulted from not wanting to share with his
brother. The clinician explained that teaching Witten a replacement behavior such as the sign for “nice hands” and
together identifying a toy that he is willing to share will provide him with more socially acceptable ways to express
his emotions. Additionally, the clinician informed the parents that phrasing contributions, such as comments and
statements, and providing choices will encourage back and forth turn taking. The clinician also modeled parallel
play to the parents, as it can be utilized to increase Witten’s exposure to language and allows room for additional
strategies; expansions, as it provides exposure to language by making utterances more adult like; and joint
attention to ensure Witten’s focus is on his communication partner. The last progress report also addressed some
of these strategies and stated that Witten’s parents were provided materials on the It Takes Two program to
incorporate family coaching strategies in daily routines. Witten’s mother displayed an understanding of open-ended
questions and expansions during parent interview by describing what they are and explaining that they have been
using the strategies at home.

Based on informal observation, Witten displayed speech skills that were primarily understood by the clinician and
parents. Parent interview revealed similar findings as Witten’s mother stated that most people can understand her
son when he is contextually speaking. During observation, Witten also demonstrated parallel and an emergence of
associated play skills. During play, Witten primarily played beside the clinician and his parents and appeared to be
engaging with his partners. Witten’s mother indicated similar findings during parent interview as she stated that
Witten plays in the parallel stage at preschool. In addition to play skills, Witten also displayed the following
pragmatic abilities: eye contact, the initiation of conversation, turn taking, ability to attend, and communicate with
intent.

Receptive Language

Witten’s receptive language abilities were within normal limits during both formal and informal assessment. Witten
displayed age appropriate receptive language skills by scoring an average (93 out of 100) on the PLS-5 and
demonstrating the following skills during formal and/or informal assessment: ability to follow simple commands,
engage in symbolic play, and answer questions appropriately. These skills were determined to be age appropriate
as children begin to follow simple commands by age two, engage in symbolic play by age 18 to 24 months, and
answer simple questions by two to three years old. The identified area of weaknesses of making inferences and
Last Name, First Name Page 5

following complex directions were also determined to be age appropriate as children typically do not begin to make
inferences until four years old and do not follow complex directions until around three to four years old.

Expressive Language

As identified during formal and informal testing, Witten primarily communicates using multiple word utterances (two
to four words per utterance), gestures (e.g. pointing), and sign language (e.g. “all done”). Witten’s means of
communication are primarily commenting and answering by using both gestures and verbal productions. Such
means were especially evident during the picture book activity as Witten made comments such as “He ride fire
truck” and answered questions such as “meow” when asked what a kitty says. Other types of communication such
as requesting, acknowledging, and protesting were evident; however, did not occur as frequent. Witten also
imitated words and phrases that were provided by the clinician and his parents. For example, Witten repeated
several words and phrases such as “microwave”, “stove”, and “I’m sorry” during play activities. Witten’s expressive
language skills were determined as age appropriate based on scoring an average (90 out of 100) on the PLS-5 and
informal observation. Witten aligns with typical developing children as most children begin to use two-word phrases
by 18 to 23 months, gestures from 9 to 16 months, and sign language as early as around 8.5 months. In addition,
children begin to nonverbally communicate by requesting etc. as early as 0 to 18 months and begin to verbally
communicate by refusing, requesting, and commenting by 12 to 36 months; and begin to imitate words as early as
12 months of age and continue to do so throughout development. Identified areas of weaknesses including an
inability to use articles (e.g. “the, a”) and an inability to appropriately express feelings were also determined to be
typical for his age as children do not typically use articles until around 3 years old and do not control their emotions
until they are at a later age.

Speech
Based on informal observation, Witten obtained a speech intelligibility rating of 90% to 100% in known context and
a rating of 80% to 89% in unknown contexts based in informal observations. These ratings are expected as his
speech production abilities are emerging.

Play
Witten demonstrated appropriate play skills as parallel play is typically established around two years of age.
Emerging associated play was also typical for his age as children begin to develop this skill around three to four
years of age.

Social/Pragmatics
Witten’s social/pragmatic skills were deemed as appropriate as eye contact, the initiation of conversation, turn
taking during conversation, ability to attend, and communication with intent are typically achieved by the age of
three. In addition, Witten’s lack of appropriate sharing is still appropriate for his age as children do not develop this
skill until three and a half to four years old.

Voice
The client exhibited appropriate pitch, loudness and quality for age and gender.

Fluency
The child exhibited no disfluencies during connected speech.

Hearing Screening
Due to his age, a hearing screening was not conducted. Witten responded to speech at a conversational level and
his mother denied any concerns with his hearing. A hearing screening is recommended once Witten turns three
years old.

Impressions

Based on the above test results, Witten exhibited age appropriate language skills. Receptive language strengths
included: identifying familiar words, following simple commands, and engaging in symbolic play Receptive language
weaknesses included: making inferences… Expressive language strengths included: naming familiar objects,
using words more often than gestures, and using different word combinations. Expressive language weaknesses
Last Name, First Name Page 6

included: utilizing grammatical morphemes (-ing, plurals), an inability to use articles, and an inability to
appropriately express his feelings.

Witten had normal production of speech sounds.

Witten exhibited normal voice and fluency skills.

Diagnosis- Witten exhibited normal speech and language skills.

Prognosis- Witten’s prognosis is excellent given the continued amount of support that is provided by his parents.
The clinician explained the importance of providing models and cues at home to enhance Witten’s communication
abilities. Both parents displayed understanding and agreement.

Recommendations
Speech therapy services should cease at this time. If concerns arise, Witten’s parents should contact his local
school for services. Parent support should continue to be provided at home to increase Witten’s communication
abilities.

Thank you for choosing Marshall University Speech and Hearing Center for your communication and swallowing
needs. Please do not hesitate to contact us in the future if we can be of service to you. Our number is 304-696-
3641.

Hannah Searls _________________________________

Graduate Clinician Supervisor’s name, CCC-S (Use a signature font size 10)
NPI Number: Clinical Supervisor
Last Name, First Name Page 7

I agree with some, but not all of Simucase. I agree that Witten did not exhibit any language concerns as
evident by the PLS-5 scores and informal observation. However, I do not totally agree with the recommendations
that were provided. I do agree that speech-therapy services should be discontinued at this time, but I believe the
recommendation was lacking as it did not provide parent support. Since Witten did not reach full age appropriate
language skills, I believe that continuing at home support is essential, and Simucase should have provided
recommendations for his parents to continue at home to encourage efficient communication. Although I disagree
with the recommendation, I do agree with all the formal and informal assessment that was conducted. I would not
change any part of this assessment as I believe that it provided enough information about Witten’s speech and
language abilities. However, I would have chosen to ask several pertinent questions about speech milestones
during the parent interview. Several milestones were not achieved at the time of intake, but still considered age
appropriate at that time. I believe that obtaining more accurate information in this area would have provided a more
precise speech history.