Case Study EDS 718
Name: Daniel Date: 06/12/01
D.G.B.: 06/18/98
C.A. 2 years, 11 months Report: Psychological Evaluation
Reason for Evaluation
Daniel is a 2 year, 11 month old boy who currently attends ASP five afternoons a week. In addition to special instruction, Daniel receives speech/language therapy, occupational therapy and family training through Early Intervention. The current psychological evaluation is part of an overall assessment of Daniel's developmental prior to review of his school district's Committee for Preschool Special Education.
Behavioral Observation
Daniel willingly accompanied the examiner to the evaluation room. Daniel communicated using 2-3 word utterances along with several articulation errors. During formal testing, Daniel demonstrated inconsistent attention and concentration skills. He attempted initially to control the situation, preferring to engage in self-selected activities, but was redirected through playful interactions. Daniel's flexibility and acceptance of limits increased with time, though he required moderate redirecting throughout testing. Daniel remained cheerful and verbal throughout the remainder of testing, with a few very brief periods of pouting and avoidance, which were overcome through play tactics. Daniel presented with highly limited persistence in the face of challenge. When tasks appeared challenging to him, Daniel required an excessive amount of coaxing and redirection, as well as occasional promise of activity reinforcement (e.g.: playing with a dinosaur) in order to persist. He frequently responded to tasks by stating, "no" or "no blocks". Daniel typically persisted on request, though seemingly painfully aware of when he performed correctly and when he did not. In fact, Daniel became immensely enthusiastic, including smiling, laughing and clapping his hands when succeeding on a task he initially avoided. When unable to succeed, he became briefly sullen and sometimes notably frustrated. Daniel responded very favorably to all verbal praise, and seemed to crave the positive adult interaction. He was noted to have difficulty at times, transitioning from preferred activities, doing so with extra coaxing and prompting. Daniel's performance on testing is felt to be an accurate reflection on his current functioning ability. Once the evaluation was complete and Daniel was given permission to play, he did so with great enthusiasm. His play skills were appropriate for his age. He carried on elaborate conversations with the toys in a thematical play approach.
Following the evaluation, as the evaluator spoke briefly with his teacher, Daniel was noted to tantrum verbally and physically (crying, demanding and pouting). He was finally responsive to verbal redirection/request to relax and rejoin the class. After a few minutes he repeated the same behaviors during circle time. His teacher reports that such behavior is not uncommon.
Bayley Scales of Infant Development - 2nd Edition (BSID-II) Mental Development Index = 85 normal limits 35 months Psychomotor Dev. Index = 80 mildly delayed 28 months
Cognitive Development
On the mental scales of the Bayley Scales of Infant Development: 2nd Edition, Daniel achieved a Mental Development Index of85, which reveals that his overall cognitive functioning is within normal limits, Clinical concerns are raised regarding his overall motor functioning, behaviors, expressive language and articulation.
In the area of nonverbal visual motor integration skills, Daniel was able to build a tower and a wall using cubes and imitated a vertical and horizontal crayon stroke. He was unable to build a bridge using cubes or count blocks with a one-to-one correspondence. With regard to expressive language-oriented tasks, Daniel demonstrated the ability to pose' questions, name pictures and produce multiple words in response to a picture book. He was unable to answer gender questions correctly or name four colors. The examiner also noted several articulation errors. Receptively, Daniel was able to display verbal comprehension, understand the concept of one, and compare masses. He was unable to understand two prepositions or discriminate pictures,
On the psychomotor subscale, Daniel's performance reflects functioning at the 28-month level, a delay of 7 months. Both gross motor and fine motor skills were delayed. In the fine motor functioning, Daniel could lace three beads, grasp a pencil and copy a circle. He was unable to copy a square and a plus sign or button one button. In gross motor functioning, Daniel is independently ambulatory and is able to walk up stairs in a step-by-step fashion. He was unable to walk on his tiptoes or walk sideways. It is the examiner's opinion that a low score in his overall motor functioning may be due to his uncooperation with the tasks.
Social Emotional Development
Daniel’s mother describes him as being distractible and having a low frustration tolerance. She states, "Daniel's behavior has improved dramatically since attending ASP. He has been learning to accept limits put on him and is working through his frustration." In the classroom, Daniel continues to have difficulties with transitions and acceptance of limits. His temper tantrums are significantly less severe and he is able to recuperate from his tantrums quicker. His play skills appear to be appropriate for his age. He carries on elaborate conversations with toys in a thematical play approach. However, it is important to note that he does not yet initiate play activities with the other children in his class.
SPEECH AND LANGUAGE EVALUATION
Daniel
DOB: / 6-13-98
C.A.: / 3.1
BACKGROUND INFORMATION:
Daniel is a three year, one month old boy who attends Genesis five afternoons per week. He has been enrolled in the toddler program since October 2000. He receives speech and language services two times per week as well as occupational therapy twice weekly.
The current evaluation is to assess Daniel's overall communication skills and his present needs for the purpose of speech and language recommendations.
Daniel is the product of a full-term, uncomplicated pregnancy, and weighing eight pounds, seven ounces. He was born via Cesarean section. Medical history is significant for frequent and recurring middle ear infections. Daniel also has a history of excessive wax build-up in both ears. Mother has attempted to remove the earwax with over-the counter medication without success. An otolaryngologist saw Daniel on February 21, 2001. Findings from a tympanogram revealed that there was middle ear fluid in both ears. Myringotomy surgery for placement of PE tubes was performed on March 8, 2001 as well as adenoid removal. An audiological evaluation was performed at Good Samaritan Hospital in October 2000 and it was reported that high frequency sounds were within normal limits. Developmental milestones included sitting at six months, standing at eight months, walking at 15 months and producing first word at 12 months of age.
Summary and Recommendations
Daniel is a 2 year, 11 month old undergoing evaluation due to his transition from Early Intervention to his Preschool Special Education. He is currently receiving occupational therapy and speech and language therapy,
family training and special instruction provided by the Health Department’s Early Intervention program. Formal testing revealed cognitive functioning within normal limits and overall motor delay. It is the examiner's opinion that his overall motor functioning may be a low estimate due to his behavioral difficulties during formal testing. Clinical concerns exist regarding his expressive language, articulation, peer interaction and behavioral issues.
TESTS ADMINISTERED:
Preschool Language Scale - 3 (PLS-3)
%
Auditory Comprehension: / 83 / 13 / 2.6
Expressive Communication: / 76 / 5 / 2.2
Total Language Score: / 77 / 6 / 2.5
Goldman-Fristoe Test of Articulation - 2 (GFIA-2)
TEST INTERPRETATIONS:
Receptive and Expressive Language Skills:
The Preschool Language Scale - 3 (PLS-3) was administered to assess Daniel's overall language comprehension and use.
Receptively, Daniel attained a standard score of 83, with a percentile rank of 13, and _ age equivalent of two years, six months (C.A., three years, one month). This is seven months' below Daniel's chronological age, indicating a mild delay in receptive language skills. These scores are -1.0 to -1.5 standard deviations below the mean. Daniel demonstrated understanding of action words in pictures (e.g., washing), descriptive concepts (e.g., wet, big), part/whole relationships (e.g., "Show me the nose of
the cow."), and pronouns (e.g., he, they). Areas of difficulty included grouping objects (e.g., "Show me all the animals."), understanding negatives (e.g., no, not), identifying colors, comparing objects (e.g., "Which one is heavier - a boot or a shoe?"), and making inferences (e.g., "Charlie played outside and got his shoes all wet. What was it like outside?").
Expressively, Daniel attained a standard score of 76, with a percentile rank of 5, and an age equivalent of two years, two months (C.A., three years, one month). This is 11 months below Daniel's chronological age, indicating a mild to moderate delay in expressive language skills. These scores are -1.5 to -2.0 standard deviations below the mean. Daniel was able to use a question inflection, use three words in a sentence, name pictures, and answer what, where and yes/no questions. Areas of difficulty included using plurals ( e.g., shoes), using present progressive verbs (e.g., eating), producing basic sentences, using possessives, telling how an object is used and answering questions logically.
Articulation:
The Goldman Fristoe Test of Articulation-2 (GFTA-2) was administered to collect a single word example of Daniel's speech. He named pictures to sample each sound in the initial, medial and final positions of words. Speech sounds that were not elicited at the spontaneous level were elicited in imitation. A summary of responses revealed 56 errors. Daniel achieved a standard score of74, with a percentile rank of 10, and an age equivalent of below 24 months of age (C.A., three years, one month). These scores represent a moderate delay in articulation skills. Errors were characterized by omissions and substitutions. The most prevalent phonological processes were medial and final consonant deletion. Errors were as follows:
Initial Position:
Substitution of:
w/l, w/r, d/dz, f/o, s/z, d/o
Blends:
b/bl, b/br, j/dr, f/ft, s/fr, g/gl, g/gr, k/kl, k/kr, w/kw, p/pl, s/sl, p/sp, t/st, f/sw, t/tr
Medial Position:
Substitution of:
p/f, f/o
Omission of:
p, b, g, k, d, ng, t, S, tS, 1, r, dz, v, s, z, 0
Final Position:
Omission of:
m, n, b, g, k, f, d, ng, t, S, tS, 1, dz, 0, v, s
Intelligibility of speech is poor in both known and unknown contexts. Daniel exhibits frustration when not understood by others. He frequently relies on pointing and pouting to achieve his wants/needs. Error sound patterns are inconsistent as Daniel is able to produce a sound in familiar words, but does not use the sound in other words. He exhibits difficulties with sequencing sounds to form words. Multi-syllabic words are reduced in complexity via syllable omissions and final consonant deletion.
Educational Report
Name: Daniel
Daniel is the middle child, with an older sister ad a younger brother. He comes from an intact English speaking family and was evaluated due to concerns regarding his speecb/1anguage development.
His mother was extremely helpful in providing any necessary information regarding Daniel's Development.
Oral-Motor Examination
Daniel has an open and closed mouth position with no drooling at rest and while moving around the environment. An intermittent open mouth posture is observed during motor tasks. Evaluation of the jaw revealed difficulty with jaw grading and jaw instability. Range of
motion is adequate. There is reduced strength in the jaw.
SUMMARY:
Daniel is a three year, one month old boy who presents with delays in receptive and expressive language skills. Scores from the PLS-3 revealed that receptive language skills fell-La to -1.5 standard deviations below the mean, indicating a mild delay, and expressive language skills fell -1.5 to -2.0 standard deviations below the mean, indicating a mild to moderate delay. Findings from the GFTA-2 indicated scores were moderately delayed and were below the' 24 month age 1_-6ingle word level. Daniel exhibits difficulties with motor sequencing skills as evidenced b.l2"eduction of multi-syllabic words and syllable omission, deletion of medial and final and inconsistent error sound patterns. Intelligibility of speech is poor given known and unknown contexts. Delays in oral-motor skills are also observed characterized by weakness and reduced range of motion of the jaw, lip and tongue musculature.
BEHAVIOR DURING ASSESSMENT
Daniel was tested within his home in an area free from distraction. He was somewhat reticent and required a short warm up period. Daniel's attention was fleeting. He had difficulty attempting some of the tasks and would discard them if he did not achieve immediate success. Daniel was eager to explore this examiner's testing material and had difficulty maintaining focus on one task. Daniel was expressive during the exam; however, his language consisted of babble with minimal gestures. Daniel was observed to pull his mother’s hand in order to lead her to what he wanted. If she did not go immediately Daniel would tantrum. His tantrums were somewhat frequent during the evaluation, however short-lived.
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Gross motor skills prove Daniel to be at an age equivalent of 17 months which is in the 1st percentile. This indicates a 33% delay in this area
Visual receptive (cognitive) skills appear to be delayed as Daniel is in the 1st percentile, with an age equivalent of 13 months. A 33% delay is noted in this area. Daniel] enjoyed looking for a car covered with a washcloth and attended to pictures in a book. He was able to turn several pages in a book" however, not singly.
Daniel’s motor skills need improvement, as he scored an age equivalent of 18 months and is in the 1st percentile. Fine motor skills show that Daniel is exhibiting an overall 33% delay. He is able to use a pincer grasp and two hands together. Daniel did not attempt to imitate crayon strokes. He did stack blocks and attempt to make a train with blocks, however was unsuccessful. Daniel enjoyed putting pennies in a bank. both vertica1ly and horizontally.
Social/emotional skills, according to the HELP strands checklist indicate Daniel is able to display independent behavior (24-30 months). and feels strongly possessive of loved
ones (24-36 months). He does not use his own name to refer to himself) or use self- centered pronouns (24-30 months). Daniel is able to recognize himself in a photograph and experiences a strong sense of self importance (18-24 months). Taking pride in clothes or distinguishing between sexes has yet to develop (24-30 months). Daniel will comfort others in distress and dramatize (22-30 months). Daniel does easily tantrum (18-24 months). He engages in parallel play (18-24 months) Mrs.