‘Communication Disorders and Sciences Speech-Language-Hearing Clinic iuman Services Cemer, Second Floor (ootinen ree RN Charleston, tino 619203099 LLINOLs ac dvs Pe Gun eres wmv edulcommdis CONFIDENTIAL CONFIDENTIAL ‘Communication and Hearing Diagnostic Report ‘Adelmo Uribe Date of Evaluation: 6/27/2022 11/29/16 Clinicians: Laurel Teller, PhD, CCC-SLP, 5:6 Heidi Ramrattan, AuD, CCC-A, ‘Address: 1943 E 1650 North Road ‘Student Clinician: Nathaniel Schug, B.A. Shelbyville, IL 62565 iagnosis Receptive and expressive Phone: 217-820-2206 language delay; Mild hearing loss in the left ear Background Information Referral and Complaint ‘Adelmo Uribe, a 5-year 6-month-old male from Colombia, was referred to the Eastern Illinois University (EIU) Speech-Language-Hearing Clinic (Clinic) by his host family member, Angela Miller, At the time of referral, Mrs. Miller stated that Adeimo primarily communicated via pointing to demonstrate his wants and needs and via single two-syllable words (‘mama’, “papa’, "hoy’). ‘Angela Miller's goal for the evaluation was to better understand his communication and hearing needs so that she can advocate for him in finding an adoptive family that can help him with those needs. The following information about Adelmo's birth, family, medical, and developmental history was collected from the case history form completed by Mrs. Miler. Case History ‘According to the case history, Adelmo is an orphan currently living with foster parents and.4aree- fesier-cisters-in Colgmbia. Adelmo has been exposed to trauma. ‘Adelmo's mother did not receive prenatal care, He was born full-term at home and weighed 6.17 pounds. Immediately after his birth, he was taken to the hospital due to bacterial neonatal sepsis. {At the hospital Adelmo stayed in the NICU. His liver and kidneys were evaluated, and he was found to have cirthosis of the liver. He had additional liver biopsies at 1 month and at approximately 2% years. At 2% years he also had a bilateral inguinabhernia repair. ‘Adelmo's difficulties with communication were first noted by his foster mother when he was 3 years old. Adelmo has been evaluated by several healthcare professionals. At 4 years, he was ‘evaluated by neurology who diagnosed him with a developmental delay, mild mental retardation, and expressive language disorder. Additionally at 4 years, he was diagnosed with a hearing loss by an otolaryngologist. At 4% years, he was evaluated by a neuropsychologist who diagnosed him with a pervasive developmental disorder and a developmental delay. The neuropsychologist noted that Adelmo did not use language and did not follow instructions. ‘COUNCIL ON ACADEMIC ACCREDITATION ACCREDITED SPEECH-LANGUAGE PATHOLOGY Scanned with CamScannerUribe, Adelmo Diagnostic Report — p. 2 ‘June 27, 2022 ‘At5 years, he was evaluated by phonoaudiology (ie., speech-language pathology) who observed that Adelmo could locate sound, but could not understand directions, that he did not tolerate loud sounds, and that he communicated nonverbally via gestures. ‘Adelmo previously received occupational, physical, and speech therapy, but this therapy did not continue after the onset of COVID-19 in 2020. He has not received therapy since that time, Developmental Milestones and Observations Mrs. Miller provided information about Adelmo’s developmental milestones on the case history form. In regard to general milestones, Adeimo leamed to dress himself at the same age as peers but has not yet learned to use the toilet on his own. In regard to communication and swallowing milestones, Adeimo has not yet started to combine 2-3 words or to make sentences and engage in conversation. He responds to his name, retrieves and points to common objects upon request, ‘and responds to yes/no questions. He has a good appetite and enjoys bread, beef, and chicken. He prefers fruits in juices rather than chewing. In regard to social milestones, he is cooperative, able to adapt, attends to people, separates from his caregiver, plays alone for reasonable lengths of time, plays appropriately with peers, and is willing to try new activites. Informal Communication Assessment Mrs. Miller and her school-age daughter and Tatiana Romero, a bilingual psychologist, accompanied Adelmo to his evaluation. Adelmo's communication skills in Spanish were assessed informally using several measures to guide the observations as described below. Observations were made by Laurel Teller and Nathaniel Schug. Additional information about development was provided by Ms. Romero. Fundacion MacArthur Version Breve del Inventario del Desarrollo de Habilidades The Fundacién MacArthur Versién Breve del Inventario del Desarrollo de Habilidades Comunicativas: Inventario | (Spanish Version of the MacArthur-Bates Communicative Development Inventories Short Form |) is a vocabulary checklist designed to measure children’s early vocabulary comprehension and production. A caregiver is asked to mark words and sounds that the child understands as well as words and sounds that the child understands and says. Ms. Romero completed the form and marked that Adelmo understood 23 of the 104 possible words and sounds (gato, perro, vaca, tigre, tren, agua, came, leche, huevo, pan, zapato, boca, ojos, pelota, llaves, comer, dormir(se), jugar, sentar(se), caliente, grande, mio, no hay) but did not mark that Adelmo could produce any of the words. It is possible that this measure is an underestimate of Adelmo's skills because Ms. Romero is not his primary caregiver and thus, has not observed ‘Adelmo extensively over a long period of time. However, her report aligns with Adelmo’s reported deficits in expressive and receptive language and provides an important snapshot of his skils. The Rossetti Infant-Toddler Language Scale The Rossetti Infant-Toddler Language Scale (Rossetti) is a criterion-referenced instrument designed to assess the communication skills of children from birth to 36 months of age. Skills are tested across several age bands (e.g., 15-18 months) to determine a child's level of functioning for a given skil. Informal observations of Adelmo's communication skills guided by the Rossetti. Scanned with CamScannerUribe, Adeimo Diagnostic Report —p. 3 ‘June 27, 2022 This instrument was selected due to Adelmo's reported language deficits. We assessed Adelmo's skills in pragmatics, gesture, play, language comprehension, and language expression. Within our brief evaluation, we generally did not assess a sufficient number of skills to allow us to report official scores. However, we report our observations on each skill below. Pragmatics: Pragmatics is a child's use of communication for social purposes such as requesting, ‘commenting about the surrounding environment, and social interaction. Adelmo demonstrates social interaction skills such as responding to adult interaction, showing interest in people, seeking to make eye contact with adults, laughing at amusing activities, crying and vocalizing to get attention, controlling his behavior and that of others, using gestures to protest, and pointing to, showing, and giving objects to others. Adelmo uses gestures and/or vocalizations for a variety of communicative purposes to comment (e.g, pointing), have social interaction (e.g., clapping), and indicate wants/needs. He demonstrated awareness of faces in pictures. For example, when he saw a mad face in a picture, he imitated that face. ‘Adelmo plays games and interacts with adults. For example, Ms, Romero reported that when she initiates a peeking game, he will tum away from her and then tun back toward her in a turn-taking fashion. Ms. Romero said that Adelmo wants adult attention and shows adults what he wants. He will hug her and try to whisper in her ear in an apparent attempt to share affection although she cannot understand what he is trying to communicate. Adelmo demonstrated a sense of humor during the evaluation by pointing and laughing at one of the clinicians when the clinician made a silly mistake. During the evaluation the adults clapped for him when he responded. Subsequently he initiated clapping for himself after he responded ‘Adelmo is responsive to other children. For example, he played with Mrs. Miller's school-age daughter and responded positively when she encouraged him to participate in the evaluation. ‘Adelmo demonstrates a variety of pragmatic abilities. However, based on the Rossetti due to his, lack of age-appropriate language expression skils (Le., lack of words), Adelmo demonstrates delays in his pragmatic skills relative to sarie-age peers. These deficits are feltto be secondary to deficits in expressive language. Additionally, Adelmo’s case history has likely impacted his socialinteractional skills. Thus, itis ikely that as he gains other communication skills and becomes more adapted to his environment, his pragmatic skils will prove. His ability to initiate games and to take communicative tums using gestures and vocalizations at an age-appropriate level should continue to be monitored. Gesture: Relative to other skils, Adelmo demonstrates a relative strength in gestural ‘communication. He mainly indicates his needs via pointing and might close his eyes if he does not want something. During the evaluation he gestured to wave ‘hi’, pointed to show awareness of objects, shook his head ‘no’, pretended to play a guitar after a model, pretended to fly an airplane with his hands, demonstrated a gesture to indicate a bicycle, colored in a coloring book, indicated need to use the bathroom, pretended to talk on the phone, and gave the clinician a “high five’. He appeared to make up his own sign as needed (.e., aifplane). Per Ms. Romero, he will lead a caregiver to a desired object and sometimes indicates when his pants are wet. Play: During the evaluation, Adelmo played with several different toys including an airport magnet board scene, a dinosaur, and a book. He demonstrated an age-appropriate attention span and ly between multiple toy options. He was fascinated with exploring toys. He pointed to pictures in the book and attempted to open the flaps to see what was behind them. ‘Adelmo played with a dinosaur toy that shot a ball out ofits mouth when Adelmo squeezed it Scanned with CamScannerUribe, Adelmo Diagnostic Report =p. 4 June 27, 2022 He anticipated the response of the dinosaur and allowed the clinician to help him squeeze the toy. He demonstrated the ability to share the dinosaur with adult encouragement but appeared to prefer to keep it to himself. He demonstrated functional use of he clinician's cell phone by figuring ‘out how to take pictures. In addition to exploring toys, using toys in a functional way, and anticipating future action, children develop symbolic play, which is the ability to use one thing to represent something else. For example, a child may pretend that a biock is a car. Symbolic play typically develops between 18 and 20 months of age. According to Ms. Romero, Adelmo does not demonstrate symbolic play, Which suggests that Adelmo demonstrates delays in his play skills relative to same-age peers. Further, observation of his play skills is recommended. Language Comprehension: Language comprehension is a child's abilty to understand language. During the evaluation, Adelmo attended to people and pictures and sometimes looked at or pointed to objects that were named. He identified the following body parts on himself when the Words were stated in Spanish: hand, eye, mouth, hair, nose, ears, and knees. He answered Yyesino questions about what he likes with shaking his head for “no" and /¥ for “si” (yes), When Gre of the adults asked if something was “para mi" (for me ~ meaning for the adult), Adelmo pointed to himself meaning no, it was for him. Given a gesture, he followed a command to give the clinician one block. ‘According to Ms. Romero, Adelmo recognizes his own name and follows commands (e.g. put Something in the trash) and will then repeat the routine (e.g., put something inthe trash again), Ms Romero reported that Adeimo recently played a tablet game with the concepts of “up” and ‘dewn" With practice he began to understand the game; he understood “up” betfer than “down.” ‘Additionally, Mrs. Miler reported that when they played checkers, he demonstrated that he knew the color terms red and blue, Based on these informal observations and caregiver reports, Adelmo demonstrates delays in his language comprehension relative to same-age peers. Five-year-old children should be able to ‘anowera variety of wh-questions including why and how questions and understand sequence words (2.9, first, second). Further observation of Adelmo's language comprehension with ‘dynamic assessment (e.g., brief teaching to determine his rate of learning) is recommended, particularly given his apparent ability to learn quickly with instruction. Language Expression: Language expression is a chile’s ability to express himself using words ‘and vocalizations. Adelmo vocalizes for a variety of purposes including answering yesino Questions, labeling pictures, and laughing. Adelmo attempted some sounds in words as described in the Speech Sound Production section below. According to the case history form, he can say ‘words like ‘hoy’, “mama", and ‘dada," but he did not produce any fully inteligible words during the evaluation. Likewise, Ms. Romero stated that she has not heard him produce any words. She also reported that he cannot produce animal sounds; for example, when she modeled a cow ‘sound, he did not demonstrate lip closure to say ‘moo’. Based on the Rossetti and informal observations, Adelmo demonstrates severe delays in his verbal language expression relative to samee-age peers with performance at about the 12 to 15 month old level. This observation, however, does not provide a complete picture of Adelmo's communication demonstrated by his relative strength in gestural communication. Scanned with CamScannerUribe, Adelmo Diagnostic Report ~ p. 5 ‘June 27, 2022 speech Sound Production: Adelmo produced the following sounds during the evaluation: Ip.tk, hx [velar frcative in Spanish simitar toh lke at the beginning of jabon - soapy “ch” and *y" as Well as the vowels /, 0, e/. Additionally, he made a sound in which blew air through his ips to ae his lips. He produced it/ for ‘si" (yes), /o/ for "bus", (pal for perro (dog), and /pe/ for "pez" is Regarding his oral motor skills, Adelimo spontaneously puckered his tips, Blew: smiled, stuck his tongue out, and masticated crackers. Based on Adelmo’s attempts to use communication through gestural means alongside delayed speech sound production for his age. ‘speech Sound disorder Is suspected. A more in-depth oral mechanism exam is recommended. Receptive One Word Picture Vocabulary Test Edition (ROWPVT) ‘Spanish-Bilingual ‘The Receptive One Word Picture Vocabulary Test — Edition (ROWE YT) ‘Spanish-Bilingual ee egetive vocabulary test in vnich a child is asked to identiy one of four pictures stated by the examiner, A newer version is currently available and thus norms Are ‘outdated. If the child ‘ie caites the. picture incorrectly in one language (e.@.. Spanish), the child has a second opportunity to identify the picture in the other language (©-0.. English). We used the ROWPVT cooly with Adelmo in Spanish only. Adelmo's receptive vocabuy performance on this test appears to be severely delayed relative to his same-age peor This performance aligns with appear observations and the vocabulary checklist. When the cent dit not know a word on the no ayT Ms, Romero would tll him the word, afew facts, and then ask him again to show her To word. The client was able to point tothe “learned! object nearly every time. Behavioral Observations ‘Adelmo demonstrated appropriate communication precu Ae ern soks, tne wal onthe clock, toys), eye contact (e.g, frequent made Sve contact ene one was speaking to him or playing with hi), gestures (e.G- poling mouth for the eee” [eat] or waving his hand in the sky for "avin’ airplane), faci CxpreS OEE (ea. yor oot eves, ahakinghis head "no", and gracing when "zanahorias" [carrots] was 2 prompt), and response to his name. rsor abilities such as joint attention (¢.9-, Regarding pragmatics, the client demonstrated social inten, seeking out Mrs, Miler ® daughter, Feo raed Ms. Romero for play. He also drew attention to whomever was in his proximity to tell him what the name of the object in a picture was. Regarding receptive language, the client followed some 1-step commands, responded to his Reger J identified some ‘common nouns (pictures or real objects). He demonstrated cevorstanding that an object represents a picture (e.g., he found a balloon to demonstrate the bbject represented the balloon) in a picture. Thus, the client demonstrated comprehension of Symbolie communication and would be a potential candidate for a trial of augmentative and alternative (AAC), which allows children to communicate via picture pointing. Regarding expressive language, Adelmo regularly relied on a combination of behaviors and gestures to communicate his wants and needs. For example, when the client protested, he would ether shake his head "no" end lose is eye, oF ‘walk away, cry, or have a tantrum. If the client wanted someone's attention, he would point at them and make eye contact, it he wanted/needed or make a gesture. ye acer pot haere Scanned with CamScannervy Uribe, Adetmo Diagnostic Report ~p. 6 June 27, 2022 ne cient demonstrated the abilty to leam new things and words when dynamically assessed. fr example, the client learned how to place a block in a bucket during the audiology evaluation fren the beep happened in a relatively short amount of time. After being shown how to use the yey in the door, the client twisted it to open the door. Additionally, he demonstrated some improvement in performance when he was given additional clues about the word on the ROWPVT. Observations are mainly consistent with the case history report. Adelmo communicates mainly by gestures. However, we did not observe any examples of clear words during the evaluation although he appeared to approximate a couple of words with a CV (consonant-vowel) production. ‘Additionally, the client did not appear to be hypersensitive to sound as was stated in a previous report. This was confirmed by Ms. Romero as well. According to Ms. Romero, he enjoyed listening to teenagers playing loud music and being around a group of children who were running. He sometimes needs help to regulate himself in stressful situations and transitions (¢.9.. headphones, massage). During the evaluation, the client did struggle somewhat with transitions but was able to regulate with a play break or with massage from Ms. Romero or Mrs. Miller. Ms. Romero reported that Adeimo likes to control situations, which is typical for someone with his background. Clinical Impressions Completion of an otoscopic examination revealed clear canal and intact tympanic membranes come ot ectig wes provided under HDA 200 supra-aural eagpnenes. Condioned play audiometry was used to obtain responses fo both pure tones and speech stimar, Ader oy ated a consistent response. Results showed normal hearing in the right ear 260 Hz.So0 Peery g mild hearing oss in the left ear at 250 Hz and 500 Hz rising to normal hearing at 1000 ea cut 8000 Hz. Speech recognition thresholds (SRT) were 5 dB in both ears. SRT's were in good agreement with pure tone averages. Results ofthe hearing evaluation indicate that Adelmo has adequate hearing for speech language Gsvelopment. Hearing should continue to be monitored for any changes. Five-year-old children should be able to be understood 90-100% of the time, ask and answer a ect of wh-questions including why and how questions, understand sequence words (e.g, fist weretky, tell stories, and use adult-ike grammar when they talk. Adelmo demonstrated See rcteristos of a receptive and expressive language delay characterized by deficits in sEesptive vocabulary, responding to questions, and minimal vocalizationsiverbalizations. A ‘SSvere speech sound disorder Is suspected with possible apraxia of speech, but additional Seuluation in speech sound disorders is needed to confirm or disconfirm this diagnosis. Additional evaluation by a psychologist is recommended to rule out additional diagnoses. ‘Adelmo has a relative strength in his gestural communication. He used gestures, facial expressions, vocalizations, and picture pointing to communicate. Adelmo participated socially but demonstrated delays in his pragmatic skils due to his inability to use words to express himself for a variety of communicative purposes. These delays may be due to his general lack of spoken language. Overall, his biggest barrier to communication is his lack of spoken language. Thus, it is difficult to fully assess his other communication skills. Adelmo did not appear to demonstrate characteristics of autism during the evaluation. However, we recommend continued monitoring for signs of autism due to the brevity of the evaluation alongside past concern. Scanned with CamScannerrrr Evaluation Trial Adelmo's skills with using an AAC device, 2, Complete an oral motor evaluation 3, Consider further Uribe, Ade!mo Diagnostic Report ~p. 7 June 27, 2022 /estigation for possible apraxia of speech, 4. Observe Adelmo's ability to initiate routines and games to take turns in a nonverbal manner (2.9, throwing bal back and forth) or wth gesturesvocalizations (eg, pretend {0 have a sill conversation with sounds, gestures) 7 2 Noe assess and treat his needs. ve ‘Communication Strategies at Home x 1. Provide Adelmo with a rich language environment regular basis. Observe Adelmo's play skills particularly in relation to symbol Further probe Adelino’ abil fo follow diferent types of question. Complete cognitive testing to rule out delays in cognition ora learning disabilly. Speech- language pathologists are not qualified to complete cognitive testing Gain additional information about Adelmo's birth and developmental history to better in which he hears new words on a m). You do not need to 2. Model early-developing speech sounds for Adelmo (e.9.. b, Py ‘See https: //bilinquistics, com/articulation-norms-for- insist that he repeat what you say. spanish-and-englishi for Spanish articulation norms. z 3, Exzourage Adelmo to use signs to communicate, Using signs will enhance, his ‘work on his speech sound production. communication while he receives speech therapy to ided low-tech AAC board to comment Prontize ye 4 Encourage Adelmo to point to pictures on the provi “bys and request and to interact socially #4 5 Encourage Adelmo to play turn-taking games (ea, playing ball and other sports, table mibolic play (¢.9., pretending a block is over 51g gree SE games), pretend pay (eg playing house), and y Sit God a cell phone) wih aduts and oer children. Lo 0 fe ‘ oe speech Therapy Recommendations carey Pee ech Adelmo strategies to use his AAC device. 4 2, Teach Adelmo strategies 3. Consider the potential benefit ‘communication needs Itis important to give hit 3 4, Teach receptive language skills. ‘5. Monitor social and play skills: Sunol Taurel Teller, PhD, CCC-SLP 4 i Nathaniel Schug, Stu@ent Clinician is as he receives assistance i im the opportunity to learn how to use new words. we for speech sound production. ‘of teaching Adelmo more signs to fill a gap in his in his development of spoken language. Adosds Rannraltion~ Cit grist Heidi Ramrattan, AuD, CCC-SLP prioritized oven ) became Scanned with CamScanner