Hi Group,
I am a new grad working in rural-regional NSW in a community health clinic. I have found this list serve particularly helpful and thoroughly enjoyed Caroline's PACT & CAS workshop in Sydney earlier this year. I have incorporated lots of Caroline's ideas into my therapy, as well as other helpful ideas/comments I have come across by trawling this listserve- so thank you! However, I am seeing a little boy, 3;8, who is quite unique (I haven't worked with anyone presenting with his speech characteristics before). I guess I'm seeking some re-assurance/ assistance in terms of `where to' from here, including how long I can expect to work with him and what would be a typical time frame to get his speech inline with his age peers? I'm not sure whether I keep persevering with my current goals and approaches, or look at trying something new?
My observations to date are as such:
-age: 3;8
-phonemic inventory: stimuable to all phonemes except r, ch, th, sh
-syllable shapes: CV, VC , CVC, CVCV - however can only produce a select number of words in each combination, and at connected speech level has a habit of speaking using only vowels. –this typcially breakdowns with increase sentence length and word complexity
-his prosody, rate, voice quality and pitch all appear appropriate
-cognitive level- above average. –on PLS-4 scored above average in auditory comprehension and expressive language concepts- however am predicting that when I administer the CELF-P he will have a deficit in expressive language (expressive/receptive gap)
- Unintelligible speech to most listeners. I am starting to understand what he is saying, only because I am aware of his errors and getting used to his speech. He is usually dependent on his mum to decipher his speech.
-ICD
-FCD
-fronting
-stopping
-consonant harmony (guckie/duckie, gark/dark)
-vowel distortions (bored/bird)
-haven't computed MLU, however he generally attempts/speaks in 3-4 word utterances
-english speaking
-has communicative intent, however is extremely shy until he feels comfortable. Very sensitive and aware he is unintelligible.
- Some age appropriate processes including gliding and cluster
reduction
- Minimal improvement in accuracy of speech production when he epeats a model- sometimes can imitate model (with cued artic and verbal cue), however mostly inconsistent
- loves cars / engines and makes the most fantastic imitations of engine noises (never used to imitate noises or babble much as a baby)
-no hx of ear infections> normal hearing
-delayed acquisition of motor milestones- crawled 12months, walked 18months
-strengths: highly motivated, enjoys drill practice and insists on doing `more' even at home, enjoys coming to rx, parent support++
-oldest of two children. His younger brother appears to be having similar speech issues (eek!)
-currently not enrolled in any preschool / day care, however hoping that next term a place will be available in an early intervention pre-school class which is devoted to working in small structured groups. His Mo is keen for this, as she is currently daunted at sending him to a mainstream preschool for fear of social exclusion (kids not understanding him)
-currently having weekly 45min rx sessions. We have just commenced his 3rd block of rx (10 weeks on, 2-4weeks off).
To date, we have worked on
C inventory expansion- sound play
V inventory expansion- sound play
Syllable shape inventory expansion- phonotactice rx / Velleman- word flips / baba boards
Word shape inventory expansion- brag book (which he loves)
Functional 2-word phrases
Syllabification awareness
I think his difficulties are essentially phonological (he can make the sounds but not 'organise' them), with occasional anxiety-based issues (he is too afraid to try something new). He has made a significant amount of progress in the last 6 months- one of the biggest feats was him calling his mum "mummy" as he generally says `mu'. He has also started to include some initial and final consonants at single word and short phrase level, however usually produces them with a notable hiatus eg t-wo, He has a habit of speaking in vowels only at connected speech level. He is a dear little boy with a very anxious family, and I just want the best for him. Is there anything I should be doing that I'm not? Does anyone recommend anything? How can I generalise initial and final consonant inclusion?
A sample of his speech (apologies for absence of phonetic symbols):
Owe t-oo oow/go to school
Boy ea a boon/boy eat a spoon
One-t-wo, ee, four, five, ix, e-en, eigh, eye, en/one, two, three, four, five, six, seven, eight, nine, ten
A ark/a shark
ae-a-baw/catch a ball
oo-i at/pussy cat
ink/drink
ee/cheese
I am open to ANY thoughts, questions, comments!
Apologies for the length of this post!
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