Question
I am presently working with a 6.4yr. old (semi) verbal male who attends a private Kindergarten three days a week. He has received private Sp. therapy for 2 yrs. and was labeled as dyspraxic. I have worked with him for almost 1 school year, and have these concerns:
he has a highly developed visual system.
his auditory processing system is somehow compromised or underdeveloped.
his hearing has been checked by an audiologist and is normal, yet what few words he verbalizes, his speech has a deaf sounding quality.
he has been evaluated by a pediatric neurologist who ruled out autisim.
in evaluating him, his (most recent) receptive vocabulary and listening comprehension skills range between 4- 4-10yrs. and his oral vocabulary and oral expression skills range between 2.6-3.6yrs.
His oral motor functioning is normal, aside from a frontal tongue carriage. He can make most early developing sounds and can make the other phonemes with modeling. He omits most medial and final sounds in words during testing. He really does not use any vowels except for the /i & e/. I have tried to teach language through signs (he doesn't use consistently) and a rebus picture sentence system. He can identify the entire alphabet through sign and with some verbalization. His phoneme segmentation and blending is very good and I have him reading simple picture books through the 'Sound Partner' program. Story comprehension continues to improve. His social skills are deficient; he does perseverate on certain things that are of interest (colors, #s) and transitioning is still a concern. I do not have access to a school psych at this pt. in time. He has to continually be encouraged to verbalize as this is not automatic. I would like to know if there are any other recommendations that you would be able to share with me and if any other professionals have had experience in working with children with similar characteristics. Also, what might be the prognosis for verbalizing on a consistent basis?
Answer
You have described a complicated and puzzling case. The child's diagnosis is "dyspraxic", yet the child can produce sounds with modeling and his oral-motor skills are intact. As I read more about his behaviors, I developed several alternative diagnosis based on the presenting characteristics: auditory processing system is compromised or underdeveloped=Central Auditory Processing Deficits (CAPD), yet he can segment and blend sounds; receptive and expressive language skills are below chronological age level=language delay with possible cognitive deficits, yet he can identify letters and read simple picture books; social skills are deficient and he perseverates=Pervasive Developmental Disorders (PDD) or Autism Spectrum Disorders (ASD); yet a pediatric neurologist ruled out this diagnosis.
You asked if there are any other recommendations and the prognosis for developing oral language. My first recommendation is that I would have the child evaluated by a team of professionals who can determine the child's functional skills within the medical and educational settings. I'm not sure you have an accurate diagnosis or at least, a complete diagnosis of the child's disorder(s). A child development team should be comprised of at least the following professionals: pediatric or developmental neurologist, psychologist and pediatrician; educational diagnostician; audiologist, and speech-language pathologist. A comprehensive and wholistic evaluation by the team may yield more or different information about the child's condition, and that information will help determine the child's prognosis.
Dr. Paula S. Currie is the Head of the Department of Communication Sciences & Disorders at Southeastern Louisiana University. She has more than 25 years of experience working with individuals with a variety of communication disorders and teaching undergraduate and graduate students in speech pathology programs. She has authored several books and given numerous professional presentations on a variety of topics.
Paula S. Currie
Head of Speech-Language Pathology at Southeastern Louisiana University
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/giving-children-voice-in-their-37407Giving Children a Voice in Their Hearing Care Appointments: Using Ida Institute’s My Hearing Explained for Children in Your Daily PracticeHow can pediatric hearing care professionals meet the challenge to support the 1989 United Nations “Convention on the Rights of the Child” rights in a family-respectful way? What are the benefits of following the principles of a new model of child-centered care and tools to ensure that children are at the center of hearing care? In this session, we will introduce a conversation guide, My Hearing Explained for Children. My Hearing Explained for Children is a free pediatric tool that helps hearing care professionals empower children and their families to make informed decisions about their hearing care.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comGiving Children a Voice in Their Hearing Care Appointments: Using Ida Institute’s My Hearing Explained for Children in Your Daily PracticeHow can pediatric hearing care professionals meet the challenge to support the 1989 United Nations “Convention on the Rights of the Child” rights in a family-respectful way? What are the benefits of following the principles of a new model of child-centered care and tools to ensure that children are at the center of hearing care? In this session, we will introduce a conversation guide, My Hearing Explained for Children. My Hearing Explained for Children is a free pediatric tool that helps hearing care professionals empower children and their families to make informed decisions about their hearing care.37407OnlinePT60M
How can pediatric hearing care professionals meet the challenge to support the 1989 United Nations “Convention on the Rights of the Child” rights in a family-respectful way? What are the benefits of following the principles of a new model of child-centered care and tools to ensure that children are at the center of hearing care? In this session, we will introduce a conversation guide, My Hearing Explained for Children. My Hearing Explained for Children is a free pediatric tool that helps hearing care professionals empower children and their families to make informed decisions about their hearing care.
2https://www.audiologyonline.com/audiology-ceus/course/assessing-auditory-functional-performance-goals-33024Assessing Auditory Functional Performance: Goals and Intervention Considerations for Individuals with Hearing LossFunctional auditory assessment and continuing assessment is critical in order to determine the current level of function, develop appropriate goals for intervention, and achieve maximum outcomes. Learning to listen drives everything else: speech intelligibility, language competence, reading, academics, and life-long learning. This course offers a detailed look at functional auditory assessment and intervention, to provide audiologists with a better understanding of hearing loss in children in terms of the broader speech, language, learning and academic contexts. Additional videos to demonstrate key points will be included.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comAssessing Auditory Functional Performance: Goals and Intervention Considerations for Individuals with Hearing LossFunctional auditory assessment and continuing assessment is critical in order to determine the current level of function, develop appropriate goals for intervention, and achieve maximum outcomes. Learning to listen drives everything else: speech intelligibility, language competence, reading, academics, and life-long learning. This course offers a detailed look at functional auditory assessment and intervention, to provide audiologists with a better understanding of hearing loss in children in terms of the broader speech, language, learning and academic contexts. Additional videos to demonstrate key points will be included.33024OnlinePT60M
Functional auditory assessment and continuing assessment is critical in order to determine the current level of function, develop appropriate goals for intervention, and achieve maximum outcomes. Learning to listen drives everything else: speech intelligibility, language competence, reading, academics, and life-long learning. This course offers a detailed look at functional auditory assessment and intervention, to provide audiologists with a better understanding of hearing loss in children in terms of the broader speech, language, learning and academic contexts. Additional videos to demonstrate key points will be included.
3https://www.audiologyonline.com/audiology-ceus/course/improving-ehdi-with-caeps-clinical-31492Improving EHDI with CAEPs: Clinical Assessment of the Cortical Auditory Evoked Potential in Children with Hearing LossThis course will provide an overview of cortical auditory evoked potentials, current research, benefits and limitations to using CAEPs in a busy clinic, and several case studies.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comImproving EHDI with CAEPs: Clinical Assessment of the Cortical Auditory Evoked Potential in Children with Hearing LossThis course will provide an overview of cortical auditory evoked potentials, current research, benefits and limitations to using CAEPs in a busy clinic, and several case studies.31492OnlinePT60M
'Very pragmatic presentation regarding the clinical applications of cortical auditory evoked potentials and the value in using this procedure for the assessment of infants and children'Read Reviews
This course will provide an overview of cortical auditory evoked potentials, current research, benefits and limitations to using CAEPs in a busy clinic, and several case studies.
4https://www.audiologyonline.com/audiology-ceus/course/school-audiology-and-community-partnerships-30988School Audiology and Community Audiology PartnershipsThis course will focus on the critical partnership between educational/school audiology and community audiology services. Issues that maximize educational and communication outcomes for school-aged children will be highlighted.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comSchool Audiology and Community Audiology PartnershipsThis course will focus on the critical partnership between educational/school audiology and community audiology services. Issues that maximize educational and communication outcomes for school-aged children will be highlighted.30988OnlinePT60M
This course will focus on the critical partnership between educational/school audiology and community audiology services. Issues that maximize educational and communication outcomes for school-aged children will be highlighted.
5https://www.audiologyonline.com/audiology-ceus/course/new-evidence-based-approach-for-39694A New Evidence-Based Approach for Hearing Screening of Preschool and School Age ChildrenThe course begins with a summary of the limitations of pure tone hearing screening followed by a review of the rationale for objective hearing screening of younger school age and preschool children. Most of the course is devoted to a description of critical steps in the development and implementation of an evidence-based efficient and effective hearing screening program for children of all ages.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comA New Evidence-Based Approach for Hearing Screening of Preschool and School Age ChildrenThe course begins with a summary of the limitations of pure tone hearing screening followed by a review of the rationale for objective hearing screening of younger school age and preschool children. Most of the course is devoted to a description of critical steps in the development and implementation of an evidence-based efficient and effective hearing screening program for children of all ages.39694OnlinePT60M
The course begins with a summary of the limitations of pure tone hearing screening followed by a review of the rationale for objective hearing screening of younger school age and preschool children. Most of the course is devoted to a description of critical steps in the development and implementation of an evidence-based efficient and effective hearing screening program for children of all ages.
