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
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