Kara Lynn Knowledge Check
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SLP5115300
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Communications
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Feb 20, 2024
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Uploaded by ElderRock13394
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Kara Lynn Knowledge Check
Master of Science-Speech Language Pathology
SLP 5115500
January 28, 2024
Southwest Speech and Hearing Clinic
900 Park Lane
2
Dallas, Texas 75231
Name: Kara Lynn
Date of birth:
Chronological age: 3;6
INTRODUCTION:
This is not a comprehensive speech evaluation. According to ASHA (n.d.) there are 11 components that need to be assessed during a comprehensive evaluation. These components include case history, hearing evaluation, oral mechanism evaluation, a single word assessment, connected speech sample, severity, intelligibility, stimulability, speech perception, phonological processing, and language. While case history, hearing, oral mechanism, single word, connected speech sample, intelligibility, severity, stimulability, phonological processing and language were all
assessed, speech perception was not assessed. REASON FOR REFERRAL:
Kara Lynn is a 3;6 year old female who was referred by her preschool teacher, Ms. Jenkins, because of concerns with her intelligibility. No concerns were reported except for the concerns about her speech. CASE HISTORY:
A case history was obtained through an interview with Kara Lynn’s mom. Questions on all aspects of case history were addressed regarding; family information and language; areas of concern; prenatal/birth history; developmental milestones; hearing/vision background; medical history; feeding/swallowing history; interpretation of speech/language/and voice; language/ literacy; social behavior; and educational information. ASHA supports gathering information about these topics in order to get a complete case history. (ASHA, n.d.) Answers show that English is Kara and her families only spoken language. Kara has one older sister. All previous medical history is irrelevant to Kara’s speech concerns. All developmental milestones are also within normal limits aside from her speech. Kara’s first word appeared around her first birthday, two-word utterances by her second birthday, and she started using sentences around two and a half years old. She currently attends a preschool and enjoys going and socializing with her peers. Kara’s mother also notes that Kara’s father had difficulties saying the /r/ sound growing up but never received any speech therapy. The only concerns are of Kara unintelligible speech as certain sounds are
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harder for her to say. An additional interview was conducted with Kara’s preschool teacher to evaluate her perspective of Kara’s speech abilities. ASHA includes that the “teachers' perspective of the child’s intelligibility and participation in the school setting” (ASHA, n.d) is important for case history information as well. Mrs. Jenkins, Kara’s
preschool teacher, also has concerns about Kara’s unintelligible speech and adds that she becomes very frustrated when asked to repeat herself among adults but has witnessed her ability to simplify her speech in order to get her point across when talking to her peers. In addition, Kara is very social and interactive in school despite her challenges.
HEARING SCREENING:
It is important to conduct a hearing screening to determine if the hearing mechanisms are functioning correctly (ASHA, n.d.). A hearing screening was conducted by the nurse practitioner at Kara Lynn’s school. The results indicate that Kara’s hearing is within normal limits. ORAL MECHANISM EXAM: An oral mechanism exam should be conducted to determine if the correct structure and functions are present for speech production (ASHA, n.d.). An oral mechanism exam was completed to evaluate the function and structures of
the speech mechanism. Results showed that Kara’s speech mechanism passed and are within normal limits. SPEECH SOUND ASSESSMENT:
Single word assessment:
Single word assessment was given via the Goldman-Fristoe Test of Articulation-3 (GFTA-3) and the Khan-Lewis Phonological Analysis 3
rd
Edition (KLPA-3). These tests were chosen because both are appropriate for ages 2-21;11. The GFTA-3 assesses the correct and incorrect production of speech sounds (Goldman, n.d.). The KLPA-3 assesses the phonological processes and determines how often each phonological process occurs (Khan-Lewis, n.d.). On the GFTA-3, Kara obtained a standard score of 62, percentile of 1%. Specific errors included /t, k, g, s, z, ʃ, t͡ʃ, θ, ð, d, w, f,
v, ŋ, r/. Kara Lynn was not able to produce the following blends: /bl, br, pl, sp, fl, kl, gl, sl, dr, kr, st, sw, tr, fr, gr/. On the KLPA-3 Kara Lynn obtained a standard score of 74, percentile of 5%. She demonstrated the phonological processes of final consonant deletion, stopping, cluster simplification, liquid simplification, fronting, deaffrication and initial voicing. Connected speech assessment:
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According to ASHA (n.d.), a connected speech sample should be taken to determine if speech sound errors in the single word assessment present themselves within connected speech. This sample should be taken “in a variety of talking tasks…and with a variety of communication partners” (ASHA, n.d). A connected speech sample was taken by
asking Kara Lynn to retell a story of a time she got hurt. She was asked a series of three questions “how she got hurt, where she was when she fell down, and who was with her when she fell” in which she responded. An observation of connected speech was also analyzed while Kara participated in free play with one of her peers. Results from the connected speech sample show that Kara Lynn produced the same errors in connected speech.
INTELLIGIBILITY:
Intelligibility was assessed through the connected speech sample. After Kara was asked to retell a story of when she
got hurt and while she participated in free play with a peer, the total number of unintelligible words were counted and divided by the total number of words said. This criterion-referenced qualitative measure is appropriate based on ASHA’s comprehensive assessment guidelines (ASHA, n.d.). Results showed intelligibility to be 47%. Based on Coplen and Gleason’s intelligibility screener at 37 months a child should be 75% intelligible (ASHA, n.d.). Kara is well
below this measure with 47% intelligible at 42 months old. SEVERITY:
A severity rating was determined by intelligibility and standard scores. According to ASHA a criterion-referenced approach by Prezas and Hodson can be used to determine continuum of severity (ASHA, n.d). Results based on SLP’s judgment gives Kara a severity rating of moderate-severe. ASHA deems standard scores of below 70 to be severe and between 71-77 a moderate disorder (ASHA, n.d.). As well, intelligibility scores of 40% falls into the moderate-to-severe range (ASHA, n.d.).
STIMULABILITY:
Stimulability should be assessed to determine the ability to produce sounds in imitation and what level of cueing is necessary for those productions (ASHA, n.d.). Stimulability was assessed based on inaccurate sounds produced within the GFTA-3. Results showed that Kara was stimulable for /p, k, g, s, z, v, ŋ, l/ when provided a model. She was stimulable for /ʃ
, ʧ, l/ when provided a mode of verbal and visual cues. She was not stimulable for /ð, θ/.
PHONOLOGICAL PROCESSING:
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Phonological processing includes phonological awareness, phonological working memory and phonological retrieval. Phonological awareness is knowing how the sounds in a language work and ability to manipulate the sounds. This can be assessed by sound segmentation and blending syllables (ASHA, n.d.) Kara Lynn was assessed with the Assessment of Metaphonological Skills-Preschool. On the syllable segmentation section, she was able to correctly segment four out of six words; however, she needed extensive modeling in order to complete this task. On the rhyming section she received two out of eight answers correctly. For blending syllables, she correctly answered four out of six questions. In total, Kara Lynn was able to correctly answer ten of the twenty questions.
LANGUAGE:
Language was assessed by administration of the Preschool Language Scale 3
rd
ed. This norm referenced test can be used for children from birth through 7;11(Preschool, n.d.). It measures both expressive and receptive language skills ranging from pre-verbal skills to emerging language skills and beginning literacy skills (Preschool, n.d.). On the expressive language subtest Kara Lynn obtained a standard score of 102 and percentile rank of 55%. On the auditory comprehension subtest Kara received a standard score of 107 and percentile rank of 68%. Both subtest results are within normal limits. MISSING COMPONENTS:
SPEECH PERCEPTION:
Kara’s ability to distinguish differences between speech sounds was not addressed during assessments (ASHA, n.d.).
This will be done through picture identification tasks. In these tasks the clinician will show Kara two to four pictures. These pictures will be items with “minimal phonetic differences” (ASHA, n.d.). The SLP will then ask the patient to point to the picture of the word the SLP says. This will help the SLP determine if Kara can hear the differences in the phonemes (ASHA, n.d.).
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References
ASHA. “Speech Sound Disorders: Articulation and Phonology.” (n.d.). American Speech-Language-Hearing Association
, American Speech-Language-Hearing Association, www.asha.org/practice-portal/clinical-
topics/articulation-and-phonology/#collapse_5. Accessed 24 Jan. 2024. Goldman-Fristoe Test of Articulation 3.” (n.d.). GFTA-3
, www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Developmental-
Early-Childhood/Goldman-Fristoe-Test-of-Articulation-3/p/100001202.html. Accessed 25 Jan. 2024. Khan-Lewis
, www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/
Developmental-Early-Childhood/Khan-Lewis-Phonological-Analysis-%7C-Third-Edition/p/100001242.html. Accessed 26 Jan. 2024. “Preschool Language Scales: Fifth Edition.” (n.d.). PLS-5 Preschool Language Scales 5th Edition
, www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Speech-%26-
Language/Preschool-Language-Scales-%7C-Fifth-Edition/p/100000233.html. Accessed 25 Jan. 2024.
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