History: A 3 year old male child was brought to jewel autism and child developmental centre with the concerns of reduced age-appropriate speech output and poor peer group interaction. There were no significant concerns throughout the prenatal period. The child was born by caesarean delivery and his birth cry was normal and birth weight was 3.23 Kg. All of his motor milestones were age- appropriate. Speech milestones were reported to be delayed
The child’s prelinguistic skills such as eye-contact, sitting, attention and imitation for verbal and non-verbal was also reported to be poor. The child had comprehension of immediate family members and basic lexicals. The child expresses his needs through physical manipulation.
All other articulators except tongue (limited range and rate of motion) were structurally and functionally adequate.
The initial assessment tool used was assessment of language development.
Receptive language age: 1.0 to 1.5 years
Expressive language age: 6 months to 11 months
Provisional diagnosis: Child with language disorder
Situation:
His family wanted to encourage development of receptive language, purposeful expressive language, and speech sound production. At that time, he could only say ‘blue ‘ whenever he sees the colour. The child had difficulty imitating actions/gestures such as clapping hands, rubbing, and identifying body parts. He had difficulty imitating simple sounds such as animal sounds, consonant and vowel sounds, and vocalizing on command. The child also had difficulty imitating oral motor movements such as sticking out tongue on command and puckering lips. He had a short attention span, difficulty transitioning tasks, and following adult direction activities.
Objective: Speech therapy was based on the stimulation of comprehension and expressive language. The session was carried out in a playful way, with the objective of developing good rapport with the child, communicative intention, and communicative function, improve symbolic play, turn taking etc.
Intervention: Initial goals for the therapy mainly focused on building good rapport with the child and to improve pre-linguistic skills like eye-contact, attention, sitting tolerance and non-verbal imitations. And these goals achieved in first month, techniques used were modelling and prompting.
Once non-verbal imitations achieved, focus was placed on imitations of sounds. Simultaneously focused on improving tongue strengthening with tongue exercise. Imitations of sounds were achieved and sound combinations were also practiced during therapy and later started with single words labelling without prompt. Introduced 2-word phrase and slowly started with 3-to-4-word combination. Techniques used were expansion, parallel and self-talk. The child started comprehending and answering simple to complex ‘what’ and ‘where’ questions and simple ‘when’ and ‘why’ questions. The child’s family have been given home programs to assist in generalization and carryover.
Post- therapy (after 5 months)
Assessment of language development.
Receptive language age: 2.6 to 2.11 years scattered till 3.0 to 3.11 years
Expressive language age: 2.6 to 2.11 years
Provisional diagnosis: Child with Expressive language disorder
Challenges faced during therapy
- Unintelligible speech
- Inconsistent speech sound productions
- Planned ignorance
- Escapism
STRENGTH OF THE CHILD
- Fast learner
- Regular to session
- Cooperative parents
Devika S (BASLP)
Speech Language Pathologist