A.K.

Case Study
Mary Salama
FTP Phase 2

Case History

8-year old boy who has a diagnosis for cerebral palsy, microcephaly, static
encephalopathy with significant left-sided spasticity (left hemiplegic type of
CP), esotropia, ADHD of combined type, and global developmental delays

Additionally he has asthma but is not taking medication for it

Born full-term through C-section but stayed in NICU due to meconium

aspiration

Failed hearing screening due to impulsivity and inability to tolerate wearing

headphones does inconsistently respond to his name, environmental
sounds, and attends to conversational speech

Requires use of a wheelchair, vest, belt, and bilateral solid ankle AFOs

Eats a diet of varied textures; does not present with any swallowing
difficulties

Presents with increased activity level, distractibility, hyperactivity, and

impulsivity

Receives individual services for physical therapy, occupational therapy, and

speech and language therapy

Currently receives individual 30-minute sessions 3 times per week to

address: receptive and expressive language skills, feeding and oral motor
skills

Microcephaly and
Effects on Speech &
Language

On 4/29/2010, A.K. was evaluated with the

Developmental Assessment of Young
Children (DAYC) Communication Subtest.

He received a standard score of 57 and a

percentile rank of 0.2, placing him in the
very poor range in functional
communication skills compared to same
aged peers.

Based on parent interview and presented

tasks, A.K. demonstrated knowledge of
month
The PLS-4 was attempted but not
many tasks that fall within the 0-12
completed due to A.K.s difficulty
age range.
understanding task directions and
poor picture scanning abilities.

Based on this formal assessment,

informal assessment, and
therapists observations, it appears
that A.K. presents with significant
delays in both receptive and
expressive language which impacts

Speech-Language Treatment Plan

Short-Term Objectives

Expressive Language

1. A.K. will provide imitation of simplistic nouns and verbs when presented with toys, objects, and
photos, given verbal, visual, and tactile prompts with 80% accuracy.

2. A.K. will respond appropriately to yes/no questions when participating in a structured speech
activity, given verbal, visual, and tactile prompts with 80% accuracy.

3. A.K. will produce spontaneous 1-3 + word utterances, word approximations or signs, to express
pleasure or displeasure, given verbal, visual, and tactile prompts with 80% accuracy.

Receptive Language

1. A.K. will consistently comprehend and perform simplistic, 2-step directives, given verbal, visual,
and tactile prompts with 80% accuracy.

2. A.K. will receptively identify common objects, verbs, body parts, and foods, when presented in a
field of two, given verbal, visual, and tactile prompts with 80% accuracy.

Feeding/Oral Motor

1. A.K. will consistently demonstrate self-feeding skills providing appropriate rate and bolus size,
given verbal, visual, and tactile prompts with 80% accuracy.

2. A.K. will maintain his hands in a downward/relaxed position when edibles or liquids are
presented with no aggressive behaviors observed (i.e. grabbing, throwing, or destroying edibles,
utensils, or plates), given verbal, visual, and tactile prompts with 80% accuracy.

Treatment Methods

Play-based method, art projects, singing/musical activities

Breaking down directions, hand-over-hand assistance, and other prompts

Oral motor exercises; monitoring and light physical assistance during feeding

Recommended Strategies from Feedback

Use action figures and other toys to elicit spontaneous 1-3+ word utterances with nouns and verbs

Closure with physical prompt to swallow extra saliva

Address 2 word utterances and requesting

Evidence-Based Practice

Docking, K., Munro, N., Cordier, R., & Ellis, P. (2013). Examining the
language skills of children with ADHD following a play-based
intervention. Child Language Teaching and Therapy, 29 (3), 291-304.

Within-group pilot study

This study examined whether pragmatic and problem-solving skills

improved in children with ADHD after a play-based intervention
conducted by occupational therapists and speech-language
pathologists.

Conclusions: Play skills and prediction skills improved following a

play-based intervention, but pragmatic skills did not present with
significant differences between pre- and post-test.

Recommendations: Play-based intervention is beneficial for children

with ADHD, but further studies need to be conducted to maximize
clinical application for this intervention. Also, play-based intervention
has possible benefits when done in collaboration with OTs.

General Reference

Applications to Therapy with A.K.

Using toys that interest A.K. such as Mr. Potato Head

and art projects to elicit 2 word utterances

Promoting expressing wants through eliciting child to

request toys

Future Applications to Therapy

Using toys to facilitate production of expanded

utterances

Utilizing toys in turn-taking to promote turn-taking in

speech

Using toys to elicit spontaneous productions utilizing

utterances to comment, label, and answer questions

Problem Statement
While A.K. has made progress, he still
produces abundant amounts of echolalia
and jargon on a consistent basis.
He also presents with impulsivity and
reduced attention as is consistent with his
diagnosis of ADHD.
His spontaneous productions are still
limited and his utterances tend to be very
imitative and consist of 1-3 words.
What are some other suggestions to elicit
more spontaneous, elongated and complex
utterances?