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Case Study 1 – Child Diagnosed with Delayed Speech and Language Skills

Child aged 3.4years/ male diagnosed with Delayed Speech and Language Skills secondary to Autism Spectrum Disorder, has been attending speech therapy sessions since 7 months in Jewel Autism Centre.

When this case was assigned to me, the following were the observations:

  • Lack of eye contact
  • Poor sitting tolerance
  • Stereotypical behaviours like rocking, jumping and vacant stare
  • Showing temper tantrums like hitting his mother when he gets angry or when he hears group clapping,  when his mother sings songs and when others shouts at him.
  • Was not interested in toys
  • Constantly and continuously cries throughout the session
  • Lacking communication skills and social interaction. In the presence of unfamiliar people he always cling towards mother
  • Communicate his needs through non-conventional gestures and just vocalises/a/ with limited babbling.

To conclude: all the triad symptoms of autism was very evident in this child.

Language test was administered which suggests that the receptive and expressive language age was below 1 year of age.

I counselled his mother regarding his condition, the importance of early intervention and appropriate home training activities were given.

Intervention process:

Step 1:
Client centered approach and calming down strategy

Based on the above observation, I have decided to carry out client centered approach and calming strategy and then to focus on the pre-linguistic skills. As I had told before, he was aggressive and clings to his mother when he meets unfamiliar people, so I asked the mother to stay outside the session until he feels comfort. Initially, I had no idea how to calm him as he was not interested with toys or bubbles. After few sessions, I noticed some changes in him in the presence of music. He enjoys listening to rhymes as well as the song sung by myself and by playing audio except his mother singing(even though she was having a sweet voice) by rocking his body in rhythmic fashion with finger tapping. Along with musical therapy( either the clinician sings or rhymes were played in the background of a therapy session) he was wrapped in a blanket and made himself calm. Along with it, fine motor activities were given as he was showing interest towards it. He also started to show interest towards soft toys which was used during singing rhymes. This really surprised me that musical therapy was really working for him to develop non-verbal and verbal imitations.

Step 2:
Clinician centered Approach and Pre-linguistic skills

It took him around 2 to 3 weeks to get adjusted to the session and then the client centered approach was terminated. In this span of time as he was feeling calm, I started to focus on pre-linguistic skills. I was very amazed that he started showing good non verbal imitations along with syllable and word productions. After 3 weeks of sessions he showed tremendous changes such as improved eye contact, improved joint attention, improved sitting tolerance, initiated pointing , improved communication skills and started doing non verbal and verbal imitations.

Another challenge he faced was lack of meaningful play, initially the child was not knowing how to play with the toys and was rotating wheels / throwing it. Then I started to held his hands and showed him how to play with it.This was continued for a month & later on the child started to explore the toys & started to play.

Step 3: Language skills

Initially I started with the identification of kinship terms, which was done using scrap book with photos of family members stuck on it and he gave a good response towards it and in turn his pointing skills has also improved. Then I carried out appropriate language goals with reference to standardised language test material and normal scenario of language development. I was very surprised that he was quickly grasping and was showing a good positive responses.

Speech and language stimulation techniques such as self talk, parallel talk, modelling, demonstration was consistently used in clinic and home which helped him to increase his verbal responses. Now the child identifies and labels the common objects, all lexical categories and body parts as well. He started to communicate his needs in more than 2 to 3 words by addressing the person and by using appropriate personal pronouns. He reciprocate greeting gesturally and verbally. Now the receptive language skills has become age adequate as per the standardised test material Assessment of Language development. He started to initiate and respond to joint attention tasks and labels by himself by pointing. He follows 3 step commands.

As I had told before that he starts crying, hits his mother and shows temper tantrums when he hears group clapping, making ‘yea’ sound in a group, mother singing song and Happy birthday song; so for this I had decided to expose this situations on a daily basis so that he could adapt to this condition as this was one of the primary concerns of the mother as they couldn’t conduct birthday parties at home( joint family).Initially he was finding difficult and was showing aggression to cope up with this condition and it gradually took him time to adapt with this condition. Now he is fine with all kinds of above mentioned sounds except he shows aversion and shows temper tantrums towards the sound ‘yea’.

As he was finding very difficult in social interaction, he was exposed to different social scenario like meeting and made him to interact with unfamiliar people, by forming small peer groups, taking him to different public places, neighbourhood etc which helped him a lot to adapt to different social scenario. Now I am really happy for him that his social interaction and communication skills have improved.

I made sure that appropriate positive and negative reinforcements were given depending upon his responses. Reinforcement play a crucial role in order to obtain positive responses from our child.

I am sincerely very happy to serve this smart little charm. I was very amazed that he was grasping all the skills very quickly in this very short span and he showed a very drastic change from his past condition which was a very surprising for everyone. I would like to use this opportunity to thank the mother and his elder brother as they were very motivated and dedicated that they were strictly following the home training program throughout the intervention process. Without their constant support I wouldn’t have been able to do this successful intervention within this short period of time.

NOTE: Many parents make the mistake of considering speech therapy as a miracle cure, the solution to get their children up to speed in terms of their expressive, linguistic skills. It is not a cure, it is just training them to be better and help them to cope up with the surroundings. Just sending the child to a speech therapist for a few hours is not enough for training. The activities need to be practiced at home but make sure that it should not frustrate the child. Results are fast and evident within few sittings. Results need time and patience. Parents need to replicate the plan explained by the therapist at home. Therapy must be a part of routine activity in such a way that the child should not be even aware about what he or she is undergoing in a “therapy session”.

Practitioner : 
Lekshana Umesh
Speech language pathologist

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