SPEECH AND LANGUAGE PATHOLOGY (SLP) INITIAL EVALUATION

March 9, 2022

I. DEMOGRAPHIC DATA
Name : Dylan Ezekiel (Zekie) P. Sarmiento
Medical Diagnosis : None
Date of birth : January 20, 2020
Chronological age : 2-years-1-month
Address : II. Oriole St. Molave Highlands Subd. Lamac Consolacion Cebu
Mother : Jrea Mary Mae P. Sarmiento
Father : Daniel James A. Sarmiento
Informant : Jrea Mary Mae P. Sarmiento (Dylan Ezekiel’s Mother)
Evaluator : Colita, Hanna

II. BACKGROUND INFORMATION

Dylan was seen for speech and language evaluation at Happy Hands Pediatric and Adult Therapy Center. For the
case history interview, the information is Dylan’s biological mother Mrs. Jrea Mary Mae P. Sarmiento.

A. Statement of the Problem

Informant stated: “I notice that Zekie couldn’t communicate and express his feelings and thoughts”

B. Birth and Medical History

During Mrs. Sarmiento’s pregnancy, she gave birth to Dylan on her 38th week. There were no complications reported
and Dylan was delivered via cesarean section. Informant indicated that Dylan has no allergies, no maintenance
medication taken, no surgeries performed, and no other significant medical conditions present.

C. Developmental History
Informant reported that Dylan’s sitting, crawling, standing, and walking is developing within the usual acquisition
for these milestones. However, it was stated that the use of single words were limited as he would only produce
approximations.

D. Family and Social History

The languages used at home are English and Bisaya. No family history of speech, language, or hearing difficulty
was noted. Dylan’s social interaction is limited to adults at home and is less exposed to kids.

E. Goal
Informant stated: “I want Zekie to be able to construct at least two words sentences and phrases”.
 III. TESTS AND OBSERVATIONS
A series of tests were done to assess and evaluate Dylan’s speech, language, Oral Peripheral Mechanism (OPM)
skills, behavior, and hearing. The results of this assessment only represent his performance during the evaluation period.
The evaluation was performed in the gym and cubicle area at Happy Hands Pediatric and Adult Therapy Center. The
materials used were various toys, 2-D picture cards, and puzzles.

A. PRECURSORY SKILLS
Precursory skills were assessed using Lahey’s Precursory Skills Checklist. These refer to the skills required in order to
develop language skills such as knowledge of various concepts and expressing oneself through the use of words. Dylan
was presented with various toys (e.g. cooking set, puzzles, ball).

Table 1: Precursory Skills

PRESENT EMERGING ABSENT
Content  Gaze at moving object
 Look for reappearance
 Separate and join objects as presented
 Search for partially hidden object
 Search for object visually displaced
 Search for object invisibly displaced
 Search for object during free play
 Search to relate objects to others
 Imitate object-specific actions
Form  Copies of motor and vocal behavior
 Reduplicated Consonant-Vowel (CV) sequences
Use  Reach towards  Turn-taking
 Reach for object and vocalize  Gesture to request
 Show/give objects for help and action
 Exhibit eye contact for approximately 5-7 seconds
 Focused joint attention for approximately 10 seconds
 Protest/reject

Impression: Table 1 shows that Dylan presents with mostly present precursory skills. At Dylan’s chronological
age, he is already expected to master all these skills. His precursory skills will help improve on his form and use of
communicative functions necessary for further language acquisition/development.

B. PLAY SKILL
A low structured observation was done and the Westby Play Assessment Scale was used as a basis to assess Dylan’s play
skill level. He was presented with various toys (e.g. cooking set, Mr. Potato Head, and superhero doll).

Table 2: Play Skill

Mastered Emerging Absent
Symbolic Level 1 Symbolic Level II Symbolic Level III
 Performs familiar, everyday  Short, isolated schema  Elaborated single schemas
activities in which Dylan has been combinations (combining two (represents daily experiences with
an active participant (e.g. eating, actions or toys in pretend, e.g. details, e.g. puts lid on pan, puts
sleeping) pouring from pitcher into cup, or pan on stove; collects items
 Short isolated schemas (single feeding Mr. Potato Head from association cooking)
pretend actions) plate with spoon)  Reverses roles- “I’ll play you and
 Uses self as agent  Perform pretend actions on more you play me.”
(e.g. pretends to eat from a spoon than one object or person (e.g.  Comments on activity of self
and drink from an empty cup) feeds self, Mr. Potato Head, and  (-) uses phrases and short sentences
 Language function: directing the clinician/another doll)
(requesting, commanding), self-
 maintaining (protesting),  (-) word combinations with
commenting (objects and activity) following semantic relations:
agent-action, action-object, agent-
object

Impression: Table 2 shows that Dylan’s play skill appears to be mostly at Symbolic Level 1. At Dylan’s
chronological age, he is expected to be within the Symbolic Stage III, which constitutes play skills involving the use of
language to set roles and scenes with highly imaginative schemas.

C. RECEPTIVE LANGUAGE
It is the understanding of an information, concepts, words, sentences, etc. This includes (a) Vocabulary and Concepts-
words or concepts that Dylan understands and (b) Auditory Processing- how he understands and follow verbal instructions
and answers questions. Informal Assessment adapted from Brigance and low structured observation was done. He was
presented with puzzles, 2-D picture cards, and various toys.

Table 3: Receptive Language

a. Vocabulary and Concepts
 Dylan was noted to identify common animals (e.g. cow, dog, sheep, pig) and food item (e.g. fish, apple, orange,
hotdog) when presented with animal puzzle and food items.
 He was noted to demonstrate emerging skills in identifying common verbs (e.g. eat, drink, swim, reading book,
riding bike) when presented with 2-D picture cards, and common objects (e.g. cup, fork, plate, pan, shampoo,
sink) when presented with cooking set and mini-erasers.

b. Auditory Processing
 Dylan was noted to follow 1-step routine/familiar (e.g. clap, hi-five, hug, jump, eat, drink) and contextual
commands (e.g. get, give) when given verbal instructions.
 He exhibited difficulty in answering YES/NO questions regarding preference and regarding visual information
(e.g. It this car?) when presented with toys.
 He exhibited difficulty in processing WH- questions regarding personal information (e.g. name, age) and in
identifying objects given its appropriate actions (e.g. sitting-chair, drinking cup).

Impression: Table 3 shows that Dylan exhibited limited identification of nouns and verbs. He also showed
difficulty in answering questions regarding personal information, visual information, and object-function.

D. EXPRESSIVE LANGUAGE
It is the ability to code, regulate and express Dylan’s needs, wants, emotions, and etc. through the use of various forms
of communication. He was presented with puzzles, 2-D picture cards, and various toys.

Table 4: Expressive Language

 Dylan was noted to exhibit object relation by producing 1-word approximation of concepts that is within his
receptive vocabulary (i.e. common animals, food items, attribution; colors) upon presentation of the stimulus.
 He was only noted to use language to label, emote (e.g. smile, frown), affirm (e.g. nod + /m/ to respond), respond
(e.g. when asked WH- questions), imitate (e.g. approximate farm animal sounds), and regulate (e.g. vocalizes
while pointing to the ball).

Impression: Table 4 shows that Dylan exhibited difficulties in expressive language. When he was asked to name
nouns, he was not able to produce complete words and his utterances were mostly syllabicated despite modelling from the
clinician.
 E. SPEECH
Dylan’s speech was assessed in terms of phonetic repertoire (the sound he is able to produce across different positions at
the word level) and canonical forms (the word forms he is able to produce). He was presented with various toys, puzzles,
and 2-D picture cards.

Table 5: Phonetic Repertoire

Phonetic repertoire
Phonetic repertoire refers to speech sounds that Dylan was able to produce at least once. This is to see what sounds are
present and what are absent. A comparison McLeod & Crowe’s consonant acquisition was administered.
Speech Sound Development Dylan’s Phonetic Repertoire
2-3 years /b/ /ba/ chicken sound
/p/, /b/, /m/ /p/ /pa/ imitation during OPM exam
/d/, /n/, /t/ /m/ /ma/ when calling for his mother
/k/, /g/, /ng/ /d/ /de/ green
/y/, /h/ /t/ /ta/ lion sound
/y/ /yeye/ red
/h/, /n/, /k/, /g/, /w/, /ng/, /f/, y/ – not observed

Table 6: Canonical Forms

Canonical Forms
The canonical forms of speech production follow a hierarchy of producing speech sounds on different levels and patterns.
It starts from isolation, syllabicated, non-reduplicated, reduplicated, monosyllabic or single syllabic production and
multisyllabic words. This would identify Dylan’s level of production or current pattern of speech production that he can
produce consistently.
Isolation (+) vowels (/a/, /e/, /o/, /u/)
/o/ - orange, /a/ - up, /o/ woof *dog sound imitation*
early sounds (/b/, /p/, /m/, /d/, /t/, /y/)
Syllabicated /bo/ - ball, /bu/- blue, /ba/ - bakbak *chicken sound imitation*, /de/ green
(e.g. ba, mi, po)
Reduplicated (CVCV) /yeye/ - red, /mama/ - Dylan’s mother
(e.g. mama, papa)
Non-reduplicated (CVCV) /babu/
(e.g. dadi)
Monosyllabic words (CVC) Not observed
(e.g. hat, cat, mat, bed)
Multisyllabic words Not observed
(e.g. water, apple)

Impression: Table 5 and 6 shows that isolated and syllabicated pattern is Dylan’s primary means of speech
production. Longest canonical form produced was C1V1C1V2. For Dylan’s chronological age, he is already expected to
produce mostly monosyllabic and multisyllabic words.
 F. ORAL PERIPHERAL MECHANISM (OPM)
It is an examination of facial structure (e.g. lips, facial muscles, tongue, mandible) affecting speech production. It is used
to determine if there are problems in structure and or function of speech mechanism.

Table 7: Oral Peripheral Mechanism

Structure Remarks
Lips/Face Lips at rest were observed to be symmetrical, with no indication of clefts. No drooling was noted and no
atypical movements of the face (e.g. rigidity, tremors, tics, grimaces) at rest were seen. General movement
of the lips and face was deemed to be good.
Tongue Tongue was observed to have normal symmetry, tone, and size relative to dental arch. He was able to imitate
protrusion, lateralization, and elevation of his tongue.
Mandible He was able to depress and elevate his jaw with good mobility, motor control, and functional strength.

Impression: Table 7 shows that Dylan’s OPM was observed to be unremarkable. No structural deviations,
malformations, nor deformations were noted. In addition, mobility of the oral structures appeared to be with functional
limits, as he assumed the target positions without difficulty.

G. BEHAVIOR
Dylan showed no signs of separation or stranger anxiety during the evaluation session. His sustained attention span
(e.g. approximately 10-15 seconds) was observed to be fair, as he was sometimes distracted by visual and verbal stimuli.
He was noted to exhibit good frustration tolerance, as he did not whine when his desired toys were not given to him or
during termination of his activity. Furthermore, he was observed to exhibit good compliance as evidenced by engaging with
the activities presented by the clinician.

Impression: Overall, Dylan exhibited fair to mostly good work behaviors. This will positively impact his
engagement and performance towards therapy.

H. HEARING
Hearing was assessed through observation. Dylan was able to detect, discriminate, identify, and comprehend
environmental and speech sounds. He was noted to localize to sound, identify some words through getting puzzle pieces,
and was noted to follow some simple instructions.

Impression: Hearing was observed to be unremarkable and functional for his age. This will be a positive
prognosticating factor for the perception and production of speech sounds.

OVERALL CLINICAL IMPRESSION

Dylan, a 2-year-old pediatric male patient, appears to be functioning with speech and language delay as
characterized by limited play skill, limited receptive and expressive language, and limited speech. Furthermore, he showed
difficulty processing information presented verbally such as processing WH- questions regarding personal information and
yes/no questions. Moreover, Dylan’s speech is not functional for effective communication considering that his speech
production are mostly syllabicated. Due to this, expressive skills that are expected to emerge in his age (e.g. word
combinations, short phrases) are not evident. In addition, his OPM skills and hearing were deemed essentially within
functional limits which allows for efficient speech production.

Given his age and current skills, prognosis is fair in achieving age-appropriate skills. Moreover, areas such as OPM
and hearing were deemed unremarkable. Early intervention and family’s support is also considered good prognosticating
factor in achieving overall progress.
 IV. PRESENT PROBLEM LIST/GOALS
Below is a summary of all of the concerns and goals that we have to work on.

A. Pragmatics
a. Turn-taking
i. Engage in 5 turn taking exchange from clinician or peer during non-structured task or play
b. Engagement
i. Respond to greetings and farewells with a clinician or peer through gesture paired with a verbal
production of “hi” and “bye”
B. Play Skills
a. Age-appropriate play skill (e.g. symbolic level)
i. Engage in pretend play for 3 or more consecutive actions given verbal and visual prompts from
clinician
C. Language
a. Increasing receptive language for improved comprehension
i. Identifying common nouns : objects and verbs
b. Increasing expressive language for increased communicative ability
i. Increase answering of yes/no questions regarding preference and object-name through gesture
paired with a verbal approximation of “yes” and “no”
ii. Exhibit an increase in vocabulary through pointing or showing to the appropriate object given its
associated function with the cue question (“what do you use __ for?”)
iii. Increase requesting of objects through using the palm-up gesture paired with a verbal
approximation of “give me” to obtain object
iv. Recurrence of object through verbal approximation of “more”
v. Produce simple action words (e.g. open, put, turn) during a non-structured task or play
D. Speech
a. Increase in vocalization through accurate verbal imitation of CV sequences targeting the early sounds
a. Improve articulation of bilabial sounds /p/, /b/, and /m/ in all position of words at the word level
b. Improve articulation of lingual sounds /t/, /d/ in all position of words at the word level

V. PLANS AND RECOMMENDATIONS

The clinician respectfully recommends the following:
a. Provision of a regular (one-on-one) speech and language therapy sessions, at least twice-a-week, and speech and
language re-evaluation after 6 months of intervention to assess progress in therapy
b. Strict follow up of the speech and language management at home to provide consistency and continuity of
intervention
c. Consult a Developmental Pediatrician regarding Dylan’s overall development

Thank you for your consult. For questions, clarifications, comments, or concerns regarding the contents of this report, please
do not hesitate to send an email to hcolita.slp@gmail.com.

Prepared by: Noted by:

Mench Marie Suner-Pilones, OTRP, MAOT, CPMT

Colita, Hanna Lic. No. 000-3189
Certified Speech-Language Pathologist CEO Happy Hands Adult and Pediatric Center
CSP-PASP No.: 19-0776 Yati-Liloan Cebu