History and Presenting Complaint
G, a 14-year-old male, was seen at the Samford clinic for a language evaluation on August 2018. His past medical history includes having allergies. G’s mother expresses concern within the educational environment. She reports that he has difficulty with planning and organizing, completing an activity, expressing himself, concentrating, written expression, reading, and learning/remembering new information. G has had previous evaluations done through his school and did not qualify for services. He has recently had a hearing screening with normal results and a vision screening which resulting in glasses. The goal for this evaluation was to assess G’s general language ability in comparison to other children his age.
Behavioral Observations
Overall G’s activity level throughout the Comprehensive Assessment of Spoken Language Second Edition (CASL-2) assessment was appropriate. G was engaged with the clinician and maintained attention throughout the task, generating responses promptly and asking for repetitions when allowed. Due to the behavior of G and the clinician’s standardized instructions throughout the administration, validity and reliability were maintained.
Language Assessment
The CASL-2 was administered to gather information on G’s strengths and weaknesses in his expressive and receptive oral language skills. These skills were tested in subtests that include a variety of contexts, such as receptive vocabulary, antonyms, synonyms, expressive vocabulary, idiomatic language, sentence expression, grammatical morphemes, sentence comprehension, grammaticality judgement, nonliteral language, meaning form context, inference, double meaning, and pragmatic. Total raw scores from each subtest can be converted into standard scores, with scores between 85-115 representing typical language development. These standard scores are used to compare G’s performance to a standardized group of children the same age with typical language skills.
Receptive Vocabulary: The receptive vocabulary subtest measures the client’s ability to understand the perceptual and conceptual relations of words that are spoken. These skills are important for being able to distinguish, conceptualize, and understand the meaning of target words in a group. G received a standard score of 87 on the subtest placing him at the average level and in the 19th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in being able to distinguish, conceptualize, and understand the meaning of spoken words that were verbs.
Antonyms: The antonyms vocabulary subtest measures the client’s awareness and understanding of words with opposite meanings, and the ability to orally express them. It is important to have these types of specific word knowledge skills to be able to distinguish, conceptualize, and produce words with opposite meanings. G received a standard score of 95 on the subtest placing him at the average level and in the 37th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in understanding the opposite meaning of words that were nouns.
Synonyms: The synonyms vocabulary subtest measures the client’s ability to acknowledge words with the same meaning through multiple choice formatted questions. It is important to have these types of specific word knowledge skills to be able to distinguish, conceptualize, and produce words with the same meanings. G received a standard score of 75 on the subtest placing him at the below average level and in the 5th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in identifying words of the same meaning that were adjectives.
Expressive Vocabulary: The expressive vocabulary subtest measures the client’s awareness and understanding of words to complete a sentence, and the ability to orally express them. These word knowledge skills are important for being able distinguish, conceptualize, and produce meaningful sentences. G received a standard score of 85 on the subtest placing him at the average level and in the 16th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in completing sentences using words that were nouns.
Idiomatic Language: The idiomatic language subtest measures the client’s awareness and understanding of idioms and the ability to orally express them. These skills are important to be able to distinguish, conceptualize, and produce sentences with non-literal meanings. G received a standard score of 70 on the subtest placing him at the below average level and in the 2nd percentile rank when compared with other children of the same chronological age. He demonstrated strengths in understanding idiomatic language when nouns were used.
Sentence Expression: The sentence expression subtest measures the client’s ability to orally express sentences using the correct type of syntax. These skills are important for being able to produce sentences that are structurally correct with the right word order and grammatical morphemes. G received a standard score of 89 on the subtest placing him at the average level and in the 23rd percentile rank when compared with other children of the same chronological age. He demonstrated strengths in expressing simple or complex sentences using verbs with different tenses.
Grammatical Morphemes: The grammatical morphemes subtest measures the client’s awareness and understanding of inflection and function words, and the ability to orally express them. These skills are important to be able to follow rules of morpheme expression, and to be able to use problem-solving and reasoning skills. G received a standard score of 66 on the subtest placing him at the below average level and in the 1 percentile rank when compared with other children of the same chronological age. He demonstrated strengths in expressing prepositions and irregular past verb tense.
Sentence Comprehension: The sentence comprehension subtest measures the client’s ability to identify the meaning of sentences that have comparable words and structure. These skills are important for being able to distinguish different sentence types and have an understanding that meaning of a sentence can change when the word order is changed. This helps a person understand directions and explanations that are given. G received a standard score of 91 on the subtest placing him at the average level and in the 27th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in understanding sentences with nouns and prepositions.
Grammaticality Judgement: The grammaticality judgement subtest measures the client’s ability to determine if a sentence is accurate according to its syntax and to grammatically correct it. These skills are important for being able to judge the accuracy of spoken language when it comes to the pattern of sentences, syntax, and grammar. G received a standard score of 90 on the subtest placing him at the average level and in the 25th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in correcting noun-verb agreement in sentences.
Nonliteral Language: The nonliteral language subtest measures the client’s awareness and understanding of the meaning of a spoken sentence beyond the literal interpretation. These skills are important to be able to understand figurative speech, indirect requests, and sarcasm. G received a standard score of 87 on the subtest placing him at the average level and in the 19th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in understanding figurative language and sarcasm.
Meaning From Context: The meaning form context subtest measures the client’s ability to discern the meaning of a new word from its given context. These skills are important to be able to make inferences and generalize the meaning of a new word based on the sentence that it is provided in. G received a standard score of 88 on the subtest placing him at the average level and in the 21st percentile rank when compared with other children of the same chronological age. He demonstrated strengths in discerning the meaning of new words that were nouns, adjectives, and verbs from its given contexts.
Inference: The inference subtest measures the client’s ability to draw conclusions based on past experiences or knowledge. These skills are important to be able to combine what a person previously knows and has experienced to the little information provided so that a conclusion can be made. G received a standard score of 86 on the subtest placing him at the average level and in the 18th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in making inferences from different types of contexts.
Double Meaning: The double meaning subtest measures the client’s awareness and understanding of words that have two possible meanings, and the ability to orally express the different interpretations the word may have on a sentence. These skills are important to be able to interpret words used in a sentence to understand the overall meaning. G received a standard score of 79 on the subtest placing him at the below average level and in the 8th percentile rank when compared with other children of the same chronological age. He demonstrated strengths in making inferences from contexts.
Pragmatic Language: The pragmatic language subtest measures the client’s ability to comprehend and use the rules of pragmatic language that is recognized by society to be appropriate during certain communicative contexts. These skills are important for being able to interact in a social situation appropriately. G received a standard score of 88 on the subtest placing him at the average level and in the 21st percentile rank when compared with other children of the same chronological age. He demonstrated strengths in appropriately expressing himself and requesting information.
The standard scores from the subtests were summed together and converted to six index scores which include the general language ability index, the receptive language index, the expressive language index, the lexical/semantic index, the syntactic index, and the supralinguistic index. Scores between 85-115 represent typical language development. The index scores measure general language ability and provide information on the client’s strengths and weaknesses.
General Language Ability Index: The general language ability index measures the client’s overall skills in spoken language. The standard scores from the five subtests synonyms, sentence expression, nonliteral language, meaning from context, and double meaning were summed together and converted to a standard score of 70. This score places G at the below average level and in the 8th percentile rank when compared with other children of the same chronological age.
Receptive Language Index: The receptive language index measures the client’s overall auditory comprehension skills. The standard scores from the four subtests receptive vocabulary, synonyms, sentence comprehension, and meaning from context were summed together and converted to a standard score of 79. This score places G at the below average level and in the 8th percentile rank when compared with other children of the same chronological age.
Expressive Language Index: The expressive language index measures the client’s overall oral expression skills. The standard scores from the four subtests expressive vocabulary, sentence expression, grammatical morphemes, and inference were summed together and converted to a standard score of 79. This score places G at the below average level and in the 8th percentile rank when compared with other children of the same chronological age.
Lexical/Semantic Index: The lexical/semantic index measures the client’s overall receptive and expressive word knowledge. The standard scores from the four subtests receptive vocabulary, antonyms, synonyms, and idiomatic language were summed together and converted to a standard score of 73. This score places G at the below average level and in the 4th percentile rank when compared with other children of the same chronological age.
Syntactic Index: The syntactic index measures the client’s overall receptive and expressive understanding and use of grammatical structures. The standard scores from the three subtests sentence expression, grammatical morphemes, and grammaticality judgement were summed together and converted to a standard score of 75. This score places G at the below average level and in the 5th percentile rank when compared with other children of the same chronological age.
Supralinguistic Index: The supralinguistic index measures the client’s overall receptive and expressive understanding and use of vocabulary and syntax to be able to use language flexibly. The standard scores from the four subtests nonliteral language, meaning form context, inference, and double meaning were summed together and converted to a standard score of 83. This score places G at the below average level and in the 13th percentile rank when compared with other children of the same chronological age.
The following table reflects the six index standard scores that G received from the CELF-5 assessment.
Summary and Diagnostic Impressions
As a result of the assessment conducted, it was determined that G has a mild to moderate deficit in his oral language skills. G showed strengths in the receptive vocabulary, antonyms, expressive vocabulary, sentence expression, sentence comprehension, grammaticality judgement, nonliteral language, meaning from context, inference, and pragmatic language subtests. He demonstrated difficulty in the synonyms, idiomatic language, grammatical morphemes, and double meaning subtests. Even though G was on average for most of the subtests, he was still underperforming for his age in comparison to his typically developing peers. Based on G compliance with therapy conditions the prognosis is good.
Recommendations
Therefore, it is recommended that G be enrolled in speech and language therapy services, for 30-minute sessions, 2 times a week. Therapy should focus on improving G’s oral expressive and receptive language use utilizing the following goals:
Goals
Long Term Goal:
G will improve overall oral expressive and receptive language use through various activities in the speech therapy room with 80% accuracy over the semester.
Short Term Goals:
1. G will produce grammatically correct, simple sentences in the past verb tense utilizing target word cards in the speech therapy room with 80% accuracy with minimal cues from the speech therapist over three consecutive sessions
2. G will produce grammatically correct sentences, replacing curriculum-based vocabulary target words with a synonym in the speech therapy room with 80% accuracy with minimal cues from the speech therapist over three consecutive sessions.
3. G will produce grammatically correct, simple sentences utilizing words with multiple meanings in the speech therapy room with 80% accuracy with minimal cues from the speech therapist over three consecutive sessions.
4. G will edit syntactical and grammatical errors in curriculum-based passages in the speech therapy room with 80% accuracy with minimal cues from the speech therapist over three consecutive sessions.
It was a pleasure working with G. Please do not hesitate to contact us if you have any further inquiries or concerns.