Thursday, August 30, 2012

Data and Diagnosis

Let's take some snapshots.

Ava just shy of two years old. No words. Three consonants and one vowel in her phonemic inventory. Not able to imitate. History of reduced babbling. Lots of red flags for Childhood Apraxia of Speech.

Ava at three. Decent phonetic inventory. Speaking in multi-word sentences. Significantly reduced intelligibility. Exhibiting many age inappropriate phonological processes. Diagnosis would look a lot like a phonological processing disorder with a motor-planning (apraxic) component.

Ava at 3 1/2. Intelligibility is improving. Many phonological processes are resolving - even the ones that are still age appropriate (cluster reduction, stopping of stridents, etc.). It would be difficult to describe Ava's speech problems as a phonological processing disorder at this point. She has numerous speech errors which are resistant to intervention due to the underlying motor planning component (stubborn, stubborn velars).

Same kid. Same neurology. The "diagnosis" looks different at different points. We get so hung up on a label. We need them for insurance and schools. Parents and SLP's tend to like them too. It is more important to understand the characteristics of the speech at that point in time and to have a plan to remediate the current spectrum of problems. Then you have to periodically re-evaluate with an open mind and be responsive to change.

Fascinating stuff.


(Typically, you'd never administrate the same instrument three times in five months. In this particular case it was done because of the timing of Ava's IEP. They assessed her at intake, at the end of the school year, and then at the beginning of this school year. The results are not simply an artifact of retesting though. She has indeed made progress in the areas noted. It's pretty amazing actually.)

3 comments:

  1. What assessment instrument are they using?

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    Replies
    1. Sorry guys, I had to cut off the name of the instrument in the picture to cut off Ava's personal information. I should have known all my sharp SLP readers would want to know what instrument they're looking at (I've gotten a couple of email inquiries too). It is the Assessment of Phonological Processes - Revised. I've never actually administered that test myself, but the results on the data sheet are pretty self-explanatory.

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  2. Very interesting. This looks A LOT like my son's would have come out. I may sound like a broken record, but from personal experience, I'd like to encourage you to hang in there with the velars and the /r/. Velars came at three and a half for L.E., English /r/ first appeared around four and has become quite good in all the different positions by now (half a year later). The last remaining problem is his lisp - he's good on the syllable level, improving with whole words, but not so in conversations.

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