Jai has been receiving intensive and individualized speech-language services 15 hours per week since 10/11/10. Long-term goal areas include receptive and expressive language skills (grammar, vocabulary, basic concepts, following directions, asking and answering questions), literacy skills, feeding skills, and social language skills.
An initial summary of skills (10/11/10)
When Jai first began receiving services, he presented with significant delays in receptive and expressive language skills, literacy, and feeding skills. He also demonstrated limited attention to structured tasks and tabletop activities. Jai spoke in short sentences (often 1-2 words), demonstrated grammatical and word-order errors. He had difficulty using language to request, protest, and ask for help. Jai did not independently use language to comment on objects or actions during play. He answered what and what happening questions with approximately 70% accuracy. He had more difficulty with response to who, when, where, and why questions. Jai demonstrated delays in understanding the concepts (spatial, number, time) and followed 1-step directions approximately 50-60% of the time. Jai was at the pre-literacy stage of reading development and recognized 8/26 letters in the alphabet and 4 sound/symbol combinations. He had difficulty with auditory discrimination of sounds (e.g. /p/ vs /b/, /m/ vs /n/).
Jai has made steady and significant progress on his speech-language, literacy, and feeding goals since he began therapy. Jai learns best-given repetition of information, opportunities for practice, and through the use of hands-on materials and visual prompts. Jai demonstrates good retention of information once he has learned it. He responds well to verbal models and prompts.
Receptive/Expressive Language: In terms of receptive and expressive language skills, Jai now speaks in sentences up to 5-6 words in length with varying levels of complexity. He continues to produce grammatical errors, but responds well to verbal prompts to correct error sentences and retains information/skills gained during structured tasks that target appropriate grammatical usage. Grammatical skills targeted include regular and irregular past tense verbs, plurals, and subject+verb agreement ( He is writing; They are running ). Jai uses appropriate question forms to request activities, objects, or toys. He is working to use appropriate phrases and sentences to protest or indicate that he does not like something. Jai asks for help 8/10 opportunities and he is working to use more specific language when asking for help e.g. rather than saying, Help me please, Jai instead will say, Please help me move these books to the table. Jai now uses language to comment during play. He has increased the scope, complexity, and flexibility of play schemes and engages in age-appropriate pretend play. He enjoys playing with pirates, legos, play-doh, turn-taking games, and computer or iPod games. Jai has increased his understanding of spatial concepts during structured tasks and identifies in, out, under, on, next to/beside, behind, and in front with 90-100% accuracy. He continues to work on expressively using these locatives. He also continues to work on increasing his knowledge of opposites, number concepts, and temporal concepts. Jai follows 1-step directions with 100% accuracy and 2-step directions with 70-75% accuracy. Jai s vocabulary continues to increase on a daily basis. He has been and continues to be exposed to new, different, and exciting cultures, people, and experiences here in New York. He has learned about the changing seasons, weather, Halloween, Thanksgiving, ice skating, etc. Jai has increased his categorization skills and can identify and talk about how/why pictures, objects, and/or words can go together. Categories include food, colors, shapes, numbers, vehicles, tools, animals, and furniture. Jai has increased his ability to accurately answer a variety of wh question forms. During structured activities and when given verbal and visual prompts, Jai answers what questions with 90% accuracy, where questions with 80% accuracy, who and when questions with 70% accuracy, and why and how questions with approximately 50-60% accuracy. He has increased his ability to answer all question forms with more accuracy during less structured activities and conversational exchanges.
Literacy: Jai now identifies 21/26 letters of the alphabet (all except h, w, g, q, y) and demonstrates knowledge of sound/symbol awareness of these letters. He auditorily discriminates between /p/-/b/ and /m/-/n/ with 90-100% accuracy. Jai has been introduced to rhyming words: cat, hat, fat, sat, mat, bat, pat, rat, and can, fan, man, pan, tan, van. He is able to read these words with 80% accuracy and spell them with 70% accuracy during structured tasks. Jai enjoys books and shows a desire to read and learn new information through reading. He appears to have acquired a good foundation and knowledge base to develop literacy skills. He makes attempts to sound out new words and is more confident in his skills. Each week Jai shows significant improvement in this area.
Impressions and Recommendations
Jai has made amazing gains since beginning therapy 1 month ago. He has set the foundation for learning and literacy development. He has increased his abilities in the following areas: attention for structured tasks and for sustained focus, e.g. to discriminate sounds, confidence, willingness to try new and/or difficult tasks, retention of information, retrieval of information, carryover of skills, and independence in demonstration of knowledge and skills. He responds well to the clinician s models and prompts. He shows excellent potential for continued learning and skill development.
Suggested goals at this time include:
1) Emerging literacy skills.
a) Jai will sound out letters
b) Jai will identify letters in words in short phrases
c) Jai will identify rhyming words
d) Jai will discriminate sounds l, h, w, g, q, y
e) Jai will identify sight words
f) Jai will read sight words
g) Jai will write short words and sentences, given prompts.
2) Expressive language
a) Social language
b) Jai will use his words to ask questions, request, comment, protest, etc
c) Jai will use words to answer questions
3) Sentence formulation
a) In the appropriate context, Jai will use simple complete sentences (noun and verb phrase) to request, protest, comment, and ask for help.
b) Jai will increase his vocabulary, including acquiring more verbs
c) Jai will appropriately use negations
d) Jai will appropriately use spatial concepts
e) Jai will use words to answer “why” questions
f) Jai will use age-appropriate syntactic/grammatical forms (plurals, regular and irregular past tense verbs).
4) Receptive language
a) Increase accuracy of comprehension and use of spatial concepts and prepositions (in, out, on, under, next to, behind, in front)
b) Increase accuracy of following 2 directions.
c) Increase accuracy of 1 step 2 unit directions (e.g. “Find the big white dog”) and 2-step directions
a) Jai will learn basic opposites
b) Jai will learn all four seasons
6) Attention and Behavior
a) During focused academic activities, Jai will sustain attention for 30-40 minutes before needing a break.
b) Jai will speak to his mother in English during meals
c) Jai will learn to wait 5 minutes before he can interrupt his mother while she is engaged in a conversation
a) Jai will eat thicker pieces of food in his current diet, he will eat a larger variety of foods, and he will practice eating solid snacks to facilitate his chewing skills.
Sarah is a Speech-Language Pathologist who provides home-based assessment and therapy services in the Park Slope and Carroll Gardens neighborhoods of Brooklyn, NY. She specializes in working with children and adolescents who have difficulty with articulation, phonology, language, fluency/stuttering, literacy skill development, pragmatics, and social language. Sarah develops individualized and evidence-based therapy plans that include frequent and ongoing collaboration with parents, caregivers, teachers, and educators in order to maximize the potential of each child. She can be reached at [email protected] or www.brooklynletters.com