Birth tо 5 Pediаtric Lаnguаge A parent brings 3.7-year-оld child, Nick, fоr an updated evaluation. At 2 years old, Nick was diagnosed with Autism and he received speech services, OT services and PT services twice per week for 30 minutes in the home setting through Early Intervention. Motor developmental milestones were all delayed. In terms of Speech and language milestones, Nick minimally babbled at 10 months and started using first words at 24 months. His current skills include labeling (numbers, shapes, colors) but he struggles with engaging in interactive play. When Nick was transitioning from an IFSP to an IEP just before he turned 3, a comprehensive assessment was conducted, and the evaluator dropped his Speech services from his recommended services. The parents are requesting a re-evaluation as the teachers at his Pre-K-3 classroom are very concerned with his pragmatic language skills. His teachers believe that his expressive and receptive language skills are within normal limits, but they are concerned with his pragmatic language skills. Nick’s teachers do not feel that his current speech and language evaluation results accurately reflect Nick’s current skills and believe that he does need speech and language services added to his IEP to address their pragmatic language concerns. Nick was raised in a monolingual English home where General American English was spoken. His older brothers are ages 6 and 9. They love their brother and spend lots of time playing with Nick after school and on weekends. His parents both attended college and work full time jobs in education and the hospitality industry. #1. What information would you want to know to help you determine a differential diagnosis? #2. How would you assess that his language skills are age appropriate, especially his pragmatic language skills? #3. Why did Nick not qualify for speech and language services? Results of the assessment This evaluation was conducted by a monolingual speech-language pathologist. Nick uses very few gestures to communicate, struggles with interpersonal communication, especially with peers. When he wants something, he takes an adult’s hand and walks them to his desired object and sometimes grunts or uses one-word utterances. His receptive language skills were within normal limits on the CELF-P but further assessment, revealed that he often does not respond to questions or comments from peers or adults. His expressive language demonstrated that he predominantly labels words but struggles to use language to express his basic wants and needs. Nick did not consistently respond to his name, struggled with joint attention, preferred to play alone, and used toys in a non-functional way (e.g., in the kitchen area, he pulled the pretend food out of the kitchen and left it on the floor, while his classmates pretended cooking food). Examples of his expressive language include “This is red, yes this one’s red, it’s not blue” (spontaneously said when looking at a plastic red tomato without any prompting from another person). When touching toys, he often will call out the name of the color of the toy or the shape of the toy but not directing his speech to anyone. For example, he will say, “this is a circle, can you say circle” and “the blue crayon, this is a blue crayon”; “Do you want to go to the bathroom?” (when asked by his teacher, “Nick, do you want to go to the bathroom?” and he clearly needed to go;) and “Be careful of the dog” (when he is in a situation that might be dangerous such as when there are scissors on the table or the a carton of milk spills). His mother did tell the teachers that one time his sister was bitten on the leg by a dog and his mom yelled, “Be careful of the dog!” #4. Given the results of your assessment, do you think Nick has a language disorder? Why or why not? #5. Why do you think these results varied from the original evaluation, which primarily relied on the results of the CELF-P? #6. Identify two annual goals to address Nick’s pragmatic language deficits and two annual goals for development of his expressive language skills.