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Case Study 27 – A Four year old Child Diagonised with delayed speech and language problem

This child aged, 4 years/ male diagnosed with delayed speech and language secondary to macrocephaly with Hemi hyperplasia has been attending speech therapy since 1 year.

When the child came to me, he was lacking eye contact, listening skills, compliance, communication skills and even social interaction. During the initial sessions for about 1 month, it was difficult to work with him. On baseline, he could only name very few common lexical items which limited to his daily living. My first motive was to build a rapport with the child and to make him adaptive to the new situation. For that, I started to sing rhymes and engaged the child to play during the sessions. Gradually, he started to understand the situation and got adjusted to the sessions within one month. As the child had poor pre linguistic skills (Eye contact, attention and name call response) my next goal was to implement activities to improve the same. The child was provided with different play activities that would facilitate attention. The technique really worked which resulted to settle his preliminary language skills. Another goal was to incorporate meaningful play to his development. Initially, the child did not know how to play with the toys and he just arranged all of them in a tray. However, during sessions I had started holding his hand and showed him how to play with it and this was continued for a month. Later on, the child started to explore the toys and even started to play meaningfully. The child even exhibited poor imitation skills despite of having repetition of about 4 words. During the session, I have introduced different gross as well as fine motor actions pertaining to body movements and even the verbal productions which extended till words. Even though he had difficulty during the initial sessions, he could make up the activities and was able to achieve the imitation skills.

Communication skills were one of the milestones which was lacking in him. Although, implementation of self talk and parallel talk was really useful in developing verbal communication skills for him. Self talk and parallel talk were consistently used in clinics, even his parents were asked to use the same in home. This resulted in a dramatic change in his communication skills. Child communication skills had developed from one word utterance to phrase level and then to sentence level. However the communication was not appropriate to the situation and constrained within the sessions. Henceforth, for further development the child was exposed to different situations and even to role play. The parents were also counseled to include the same during his general situations.

Now the child succeeded in terms of communication skills and social interaction. Currently he answers all type of “wh” questions. However he still had the problem with adaption, for this I counseled the parents to prepare him using visual cards before being to a new situation. He gradually started to understand the situation and got adapted to all of them.

I am sincerely happy to work for this lovely child. I also want to use this opportunity to thank Child’s mother who was really hard working throughout the intervention process .Without her support I wouldn’t have been able to do this successful intervention within this short period of time.

Rayga

Speech Language Pathologist

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