Signature Assignment - Mejia-2

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University of St. Augustine for Health Sciences *

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Apr 3, 2024

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1 Signature Assignment Christina A. Mejia SLP 5115: Early Language Disorders University of St. Augustine for Health Sciences Dr. Ward August 9, 2023
2 Client: Varie US Clients (VS) DOB: 7/4/2017 Parents: George & Martha Clients Clinician: Christina Mejia CASE HISTORY Health/Physical Development: VS was born during the end of the second trimester at 26 weeks. Before he was discharged home, he stayed in the NICU for three months. He required feedings through G-tube and needed to be placed on oxygen. During his NICU stay, Theo was diagnosed with bronchopulmonary dysplasia, gastrostomy dependence, GERD and faced challenges with feeding. As of 10/27/2015, he showed no signs of difficulty with hearing or vision. He has shown difficulties with eye tracking, feeding and communication. Cognitive Development: VS’ screening results were a Cognitive Standard Score of 84, indicating his cognitive development abilities are below average range. There are concerns with some of his cognitive milestones not being met. He shows challenges with the ability to focus on objects within his environments. Communication: VS received a total language score of 59. His expressive language skills consist of canonical syllables with either no or little syllable repetition. He is able to turn-take with sound-making, but is not able to imitate the following sounds /g, k, m, b/. He shows variation with expressive language through laughing, making raspberries and gurgles. Self-Care Adaptive Skills: VS has refused feeding accompanied with oral preparatory delays as a result of his feeding aversion. His caloric intake is considerably low and a concern. During the month of March 2015, he has not made the transition from smooth to lumpy foods as he gags and chokes. Gross/Fine Motor Development: VS received placement in the average range with his Standard Score of 87. He exhibited the ability to move his head side to side but showed difficulties with eye tracking. His evaluation of motor development resulted in a score of 83. His strength and balance take significant effort, and he tries to move throughout his home. As of March 2015, VS shows no concern with crawling, using a pull method to stand, but he cannot successfully cruise. He exhibits behaviors that are motor compensation behaviors and does not have all of his foundational skills.
3 Socioemotional Development: His expressive development is a strength where he laughs and smiles. His Social-Emotional Standard Score of 103 indicates he is within the average range. As of March, 2015, VS produces sounds and attempts eye contact. Caregiver’s Concerns: Finances have been indicated to be a concern due to the reduction of hours the father is receiving. This has extended issues to lack of transportation, the need to feed VS and their other children and having hospital bills to pay. They have concerns with his communication development and being able to share these issues with his grandparents. They are concerned with receiving resources for infant/toddler stimulation groups. Questions to ask: 1. Has VS received a comprehensive eye exam? 2. Does VS alternate his gaze between something he wants or showing? 3. Does VS respond to a stimulus such as a sound, and does he make eye contact in the direction of the sound? SERVICES Functional Communication Functional communication is how children use either symbols or actions to express their basic needs and wants. Before children can use language to communicate, they use presymbolic communication which includes bodily movements, facial expressions, and gestures to interact in meaningful ways (Owens, 116). The first example of functional communication was in VS’- Typical Language Development Simucase. He was expressing his wants by raising his pitch while babbling “ba da da.” He also communicated through the form of using body language such as waving his arm up and down and briefly made eye contact towards the end of the video. The second example of functional communication was in VS’-Typical Language Development: Variegated Babbling Simucase. VS maintained eye contact with the caregiver Martha while expressing himself when he babbled “la da da.” Family Centered Family Centered Intervention places an emphasis on the role of the family’s involvement in their child’s development. A key component of family-centered intervention is the “family’s daily routines,” that can be done with both the parent and child such as feeding (Owens, 64). This type of intervention takes place in “natural learning environments,” such as the home where routines are completed on a daily basis (Owens, 64). The first example of functional communication was in VS’- Typical Language Development Simucase. He was expressing his wants by raising his pitch while babbling “ba da da.” He also communicated through the form of using body language such as waving his arm up and down and briefly made eye contact towards the end of the video. The second example of
4 functional communication was in VS’-Typical Language Development: Variegated Babbling Simucase. VS maintained eye contact with his caregiver Martha while expressing himself when he babbled “la da da.” Generalization Generalization is when a child is able to learn a specific skill during a therapy session, and is then capable of applying the learned skill in a different environment. The purpose behind generalization is to help the child transfer a skill beyond a therapy setting and apply the learned skill in real-life situations. To simplify the definition, it means to carryover (Owens, 64). The first example of generalization was in VS’- Typical Language Development: 1 Step Directions simucase. His caregiver Martha asked Riley to close the drawer and repeated the direction until the child completed the task. By reciting “close the drawer,” this can be carried over into a different scenario such as closing the drawer’s in school, or closing clothing drawers at home. Another example of generalization that could be used as a way to practice these phrases in different settings such as at home, day care, or in school would be a two word phrase such as “All done.” This could be used when they are done eating, putting on their shoes or putting away toys. To keep your child motivated during this type of practice, you can use objects such as “toys, food, or everyday items” that are in your child’s interest to keep their engagement (Owens, 64). This example was seen in VS’-Typical Language Development: 1 Step Directions simucase when Martha waited until VS was done putting away the tupperware and closed the drawer and said “All done,” before positively praising VS. ASSESSMENT Speech-language screeners, evaluations, and assessments There is a differentiation between a speech-language screener, evaluation, and assessment. A screener is the initial step that clinicians take to determine if a child needs to be further evaluated and referred for intervention. A screener serves the purpose of detecting potential communication delays or disorders and/or deficits in “feeding and swallowing development” (Owens, 143). A screener is used to build connections between families and an SLP. They are informative sessions that can be in the form of a standardized test, or a report completed by a parent. There is an emphasis on the screening measures being “valid, reliable, sensitive, specific and representative” (Owens, 144). A screening includes the obtaining of information from parents and/or teachers who can speak on the child’s language skills, a proper hearing screening, parent questionnaire, play-based observation and an “informal language sample” (ASHA). If a child passes their screening, parents will be informed that it is a “general estimate of the child’s performance” at that time, and that there should be progress monitoring with the suggestion of further evaluation if concerns continue or new concerns come up (Owens, 144). If a child does not pass their screening, they will receive an evaluation. An evaluation is done to determine if the child does have a disability or delay, and their eligibility for early intervention services ( Küpper, 5). It is a comprehensive assessment that provides details regarding a child’s strengths and weaknesses in their overall communication development. An
5 assessment is defined as the “ongoing process” of determining a child’s needs as well as keeping in mind the primary concerns of the family and the extent of early intervention services (Owens, 450). Rather than a test-based assessment, SLP’s obtain “early communication data” through an assessment that features a play component (Owens, 99). An assessment is “not used to highlight what is wrong,” but it is used as a tool that defines the level of support the child needs (Owens, 98). The role of parents and caregivers in assessment Parents and caregivers play an important role and contribute to the progression of their child's communicative development. They spend the most time with their child, which makes them a valuable resource who provides reliable information. Parents and caregivers understand their child the best and can provide insight into the “conditions of their child’s interactions” (Owens, 101). The benefits of family involvement in the assessment process include an increase in understanding of their child’s strengths and weaknesses and the potential shortening of an assessment because of thorough information that is provided. By implementing a parental role throughout an assessment, it makes them feel like an equal contributor to the process and may increase the likelihood of following the suggested recommendations. Importance of knowing developmental milestones when providing a screener, assessment, and/or evaluation. It is crucial for a speech-language pathologist to know developmental milestones when providing a screener, assessment, and/or evaluation. ASHA states that milestone checklists are just one component of what is “recommended for developmental surveillance during early childhood” (ASHA). Having a clear understanding that developmental milestones are an evidence-based reference point helps the clinician to compare the client’s behaviors and performance to others of the same age. It helps identify any signs of delays and/or speech and language difficulties. Knowing age-appropriate milestones helps determine if further evaluation is needed. If it is needed, clinicians will carefully select appropriate and individualized methods and assessments to determine services (ASHA). An SLP is also an educator who communicates their findings in a parent-friendly manner. SLPs show they are the trusted professionals when informing families on their child’s abilities in comparison to age-appropriate norms. It is used to help both professionals and families make informed decisions that are in the child’s best interest (Owens, 97). Importance of differential diagnosis and knowledge of developmental milestones when assessing for speech-language abilities As children learn to communicate, they transition from non-symbolic to symbolic behaviors. SLP’s should be able to identify age-appropriate means of communication. For instance, children use gestures to communicate their wants and needs. Our textbook indicates
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