Indiana University of Pennsylvania

Speech Language and Hearing Clinic

Assessment & Background Information

Fall 2017

NAME: Anthony Johnson BIRTHDAY:

ADDRESS: AGE: 4:4

CLINICIAN: Taylor Roggenbaum PARENT/GUARDIAN:

SUPERVISOR: Lisa Price, M.S., CCC-SLP DIAGNOSIS:

REASON FOR REFERRAL

Anthony Johnson, a 4 year 4 month old male, was referred to Indiana University of Pennsylvania (IUP)
Speech, Language, and Hearing Clinic by his Head Start teacher, Trina Ragan; concerning his lack of
participation in class, lack of peer interaction, inability to use language to obtain desired objects, and
behavioral issues.

HISTORY
Anthony lives with his mother, Ms. Johnson, sister (6 years old), and brother (1 year old) in a group home
with two other families and a counselor. They have lived there for one year as part of a drug rehabilitation
program. Ms. Johnson is progressing well in rehabilitation and is currently looking for independent
housing. Prior to the group home, Anthony spent two years moving between relative’s houses and
motels.

Anthony’s mother reported that her pregnancy and delivery with Anthony were normal. She also reported
that Anthony met typical developmental milestones as an infant and toddler. He responded to his name
at 9 months, said his first words at 12 months, and combined two-word utterances at 24 months.
However, he does not always respond to his name. Anthony currently speaks in 3-6 word utterances, and
most of what he says is repetition of others. Ms. Johnson reported that she, and Anthony’s siblings, can
understand his speech most of the time, but when he is overstimulated or excited, he will produce
unintelligible speech. She also reported that Anthony frequently repeats lines from movies to himself,
even when he is the only one in the room.

Anthony is affectionate towards his family and will allow others to comfort him when he is upset. His
mother reported that Anthony enjoys taking things apart and putting them back together (especially
fascinated with clocks and small appliances). Anthony avoids using language and will pull people towards
objects he wants, rather than use language to request help. His mother’s biggest concern is related to his
tantrums and lack of expressive language. She reported that Anthony is easily upset and cannot tell her
what is wrong. If she cannot figure out what he wants, he will cry for extended periods of times and
express items he does not want. Ms. Johnson would like to be able to take Anthony to a store or
restaurant without a tantrum.

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Anthony started Head Start this year. He attends five days a week for four and a half hours per day. This is
his first school experience. His teacher, Ms. Ragan, reported that Anthony is smart. He knows numbers and
can put together the calendar each month independently. Ms. Ragan also reported that Anthony can read
words including names, months, days of the week, and weather words.

Anthony plays functionally with toys at school and engages in parallel play alongside his peers for
extended periods of time. He appears to enjoy singing and acting out motions to songs. Ms. Ragan
reported that Anthony appears interested in his peers but does not yet play with other children or
understand turn taking. Ms. Ragan also reported that Anthony appears to have a strong language base
due to his repetition of movie lines, paragraphs, and entire pages from books. Anthony says hello and
goodbye and will occasionally make comments about actions and events aloud, but these comments are
often said to himself, not directed at anyone. Anthony is easily redirected when he has trouble following
directions.

Ms. Ragan reported that her biggest concerns regarding Anthony’s behavior in the classroom are related
to transitioning activities and peer relations. He has difficulty communicating his desires and cannot
answer yes/no questions or tell her when he does not like something. She reported that Anthony often
moves away from other children to play by himself, and often hits other children when he gets upset. Ms.
Ragan would like to see Anthony be able to better connect with his peers

BEHAVIOR
Ms. Johnson reported that Anthony will frequently rub the palms of his hands (and her’s) on his face or
ears for an extended period of time. He also is fixated with Dora the Explorer and Diego figurines, and will
throw a tantrum if they are moved from their designated locations or missing. Anthony does not like
taking baths, washing his hands, or playing at sand/water tables. He will not eat chewy foods, like fruit
roll ups or fruit snacks. His teacher reported that Anthony avoids activities that involve paint, glue, or
slimy substances. She stated that she has only seen Anthony throw a tantrum at school occasionally, but
when he does, it lasts 20-30+ minutes; and a sensory room with dim lights and swinging chair appear to
help him during this time. He responds positively to squeezing and rocking, but it can take a long time to
calm him down.

EVALUATION
The following evaluation tools were administered to assess Anthony’s speech/language skills and
behavior:
1. Oral Peripheral Mechanism Exam
2. Hearing Screening
3. Phoneme Inventory and Speech Sample
4. Preschool Language Scale (5th edition)
5. Language sample during play
6. Voice and Fluency Screening
7. M-CHAT

ORAL MECHANISM EXAM

Screening of the orofacial mechanisms indicated structure and function were within normal limits.

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HEARING SCREENING
During his hearing screening, Anthony would not allow headphones to be placed over his ears for pure-
tone testing. An OAE screening indicated that Anthony’s hearing was within normal limits between 2000
and 5000 Hz; and tympanometry results indicated a Type A (normal) results. A second attempt for pure-
tone testing is advised, but current results are enough to suggest peripheral hearing mechanisms are
intact.

PHONEME INVENTORY AND SPEECH SAMPLE

A phonemic inventory and speech sample were recorded by the SLP. She reported that Anthony
produced all consonants and vowels correctly, and his speech was 97% intelligible. Normative data
indicates that Anthony is at an age-appropriate level for phonological inventory and does not show signs
of a speech-sound disorder.

PRESCHOOL LANGUAGE SCALE (5TH EDITION)

Auditory Comprehension Portion of PLS-5

Standard Score = 73 4th Percentile Standard Deviation = Borderline impaired

Anthony was able to do the following:

• Point to pictures of objects
• Respond appropriately to quantitative concepts (who has the most crayons?)
• Identify pictures assessing (1) present progressive, (2) regular plurals, (3) past tense -ed
• Excellent understanding of colors

Anthony struggled with the following:

• Understanding pronouns (he, she, his, her, they)
• Qualitative concepts (shapes, big/small)

Expressive Portion of PLS-5

A portion of the Expressive PLS-5 was administered before Anthony became tired and inattentive to the
task. Testing was discontinued before reaching a ceiling, which is required to score the test.

Anthony was able to do the following:

• Present progressives - (1) picture of girl eating (2) “Tell me about the girl, she is___.” (3) Anthony
said, “Tell me about the girl, she is eating.”
• Plural - (1) picture of multiple horses (2) “What are these?” (3) Anthony said, “Go go go ride the
horses on the carousel!”
• Prepositions - (1) SLP put spoon inside box (2) “Where is the spoon?” (3) Anthony said, “Get in
and we’ll go for a ride!”

Anthony struggled with the following:

• Using a specific phrase in a sentence
• Naming described items (ex. What toy is round and bounces? You play catch with it?)
• Possessives (ex. This is the boy’s cat. Who’s can is this?)
• Functions of objects (ex. This is a coat. What do you do with a coat?)

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LANGUAGE SAMPLE DURING PLAY
A language sample was collected during 20 minutes of play with toys, including a barn set and cooking
set. Both the SLP and Anthony’s mother present and interacting. The SLP assessed Anthony for play skills,
expressive language skills, and speech intelligibility. The following information was reported:
• Total of 70 utterances, 3-12 words in length, all appeared to be echolalic in some manner
• Did not do developmental sentence scoring or MLU because even though utterances varied in
complexity, most of what Anthony says is echolalia from other people or Gestalt phrases from
movies.
• Play behaviors:
o Used many objects functionally and appropriately
o Used objects and self in pretend scenarios
o Used self as agent
o Used doll as agent
• Most play was solitary or parallel. Anthony would look at his mother or SLP doing something
with their toys but would not engage directly.
• Language sample used to fill out pragmatic inventory with Ms. Johnson’s help.
o Request objects and actions
o Greeting toys to each other
o Initiate play with mother
o Protest putting toys away

VOICE AND FLUENCY SCREENING

SLP observed voice quality and fluency during play and language sample. SLP reported pitch, loudness,
and voice quality were all appropriate for his age/sex. No stuttering was observed.

M-CHAT
Anthony’s M-CHAT results (completed by his mother) indicated 13/20 red flags for Autism Spectrum
Disorder (ASD). Ms. Johnson reported that Anthony does not facilitate or participate in joint attention
tasks, including presenting objects of interest to others, and attending to stimulus pointed out across a
room. Anthony does not engage in pretend play and does not share eye contact when talking or playing
with others. Ms. Johnson reported that Anthony does not try to copy others, nor does he request the
attention of others when doing a task independently. Ms. Johnson reported that she has wondered if
Anthony was deaf in the past because he does not always respond to his name, but normal OAE results
indicate his hearing system is intact, suggesting Anthony has lack of auditory awareness. Makes unusual
finger movements near his eyes, does not point with one finger to indicate an object of interest, or to
request help with objects.

SUMMARY/ CONCLUSION
Anthony presents with behaviors and tendencies that resemble Autism Spectrum Disorder (ASD). Results
from the test battery indicate impaired understanding of pragmatics, semantics, syntax. Phonological and
morphological abilities appear to be intact and are supported by data from both the oral-mech exam and
phonemic inventory.

Prognosis for improvement is favorable given reported data that Anthony has a full phonemic inventory,
intact oral-peripheral mechanisms, and intact central and peripheral hearing mechanisms. Despite non-
compliance in many social situations, Anthony displays basic understanding of social interactions and will
tolerate playing near other children. Anthony enjoys movement, climbing, giving hugs, and smiling, and
can complete tasks that are asked of him.

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RECOMMENDATIONS
It is recommended that Anthony receive speech-language services to (1) increase expressive language
abilities (2) increase independently generated speech (3) improve syntax, semantic, and pragmatic
understanding.

Referrals to other professions:

• Psychologist: to perform full evaluation to diagnose or eliminate ASD as root of behavior
• IEP program: once a diagnosis is finalized, obtain parent permission to refer Anthony for IEP
services in his school district

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Taylor Roggenbaum, Undergraduate Clinician

__________________________________________

Lisa Price, M.S., CCC-SLP