P.O. Box 357 Normal, Alabama 35762 (256) 372-5534, Fax: (256) 372-4055
DIAGNOSTIC REPORT
Name: Ann JonesDate of Birth: 03/17/1995 Age: 19.6 Address: 123 Main Street
Anytown, AL 30000
Telephone: 256-123-4567 Informant: Ann Jones
Examiner: Susie Speech, Graduate Clinician
Date of Evaluation: 2/2/2015, 2/4/2015, 2/9/2015, 2/11/2015, and 2/16/2015 Diagnosis: Language/Reading Referred by: Self
Client's Occupation: Student
Supervisor: Cynthia Lewis, M.S., CCC-SLP
STATEMENT OF THE PROBLEM
Ann Jones is a 19 year 6 month old African American female who was seen at Alabama A&M University’s Communicative Sciences and Disorders Clinic beginning February 2, 2015 full a full speech-language re-evaluation. Ann was originally evaluated at the AAMU CSD Clinic in the fall of 2013. Ann referred herself to the clinic due to difficulty reading and comprehending materials from her school work as a student at Alabama A&M University. She also expressed concerns regarding her spelling. Ann served as her own informant.
BACKGROUND INFORMATION
Ann reported a history of allergies, asthma, and difficulties with hearing. It should be noted however that Ann passed her hearing screening prior to the evaluation at the AAMU Speech and Hearing clinic. Ann reported that she currently has asthma and received the diagnosis when she was born. Ann stated that her main concern is keeping up with her school work. Ann sought services in the fall of 2013 and diagnostics were performed beginning in November of 2013. Ann has been receiving services at the AAMU Speech and Hearing clinic since the 2014 spring semester to address phonological awareness and reading comprehension skills.
OBSERVATIONS AND ASSESSMENT RESULTS Oral Peripheral Examination:
An oral peripheral exam was completed to determine the adequacy of the client’s oral structures and their functions for speech purposes. Examination of the oral musculature revealed
structures to be symmetrical. The client exhibited typical labial strength and range of motion; occlusion, lingual elevation, lateralization, and strength were adequate. Palatal height and width were normal. The clinician noted small dark spots on the client’s tongue. When asked about them, the client reported that she was born with them and the doctor stated that they are either birthmarks or simply discoloration of the tissue’s pigment. The structure and function of the oral mechanism were found to be within typical limits.
The client’s sequential motion rates were assessed via the following repetitious productions of: /p^/, /t^/, /k^/, and /p^t^k^/. Soun d Times Produced Repetitions per Second
Norms (Repetitions per Second) Above/Below Average Range p^ 23 4.6 5-7 Slightly Below t^ 22 5.5 5-7 Slightly Below k^ 22 3.6 5-7 Below p^t^k^ 13 2.1 2-6 Slightly Below Hearing Screening:
The client was administered a pure-tone audiological screening on February 2, 2015. The client’s hearing was assessed at 1,000, 2,000, and 4,000 Hz with 20 dB HL as the criterion. The client responded appropriately to all tones presented. After testing, the client’s hearing was judged to be within typical limits bilaterally.
Articulation:
Articulation skills and speech intelligibility were assessed informally during conversation with the client. No substitutions, distortions, or omissions were noted. The client’s speech was found to be 100% intelligible at the conversational level.
Language/Reading:
Gray Oral Reading Test-Fourth Edition (GORT-5)
The clinician administered the Gray Oral Reading Test-5, Form A. This test consists of two parallel forms, each containing 14 developmentally sequenced reading passages with five comprehension questions following each passage. This test provides an efficient and objective measure of growth in oral reading and is an aid in the diagnosis of oral reading difficulties. It is normed for ages 6.0 through 18.11 years. The results were as follows (mean/average Oral Reading Index = 100 with a typical range of 90-110):
Gray Oral Reading Test Raw Score Standard Score (8-12=WNL); Standard Deviation= Percentile Age Equivalent Grade Equivalent Rate 39 6 9 22-6 6.0 Accuracy 31 4 2 9-9 4.2 Fluency 41 2 <1 8-0 2.4 Comprehension 29 3 1 9-0 3.4
Sum of Fluency & Comprehension SS’s 5 Oral Reading Percentile <1 Oral Reading Index (ORI) 60
*This test was given for informational purposes only. Norms are based on a test age equivalence of 18 years of age versus the client’s chronological age of 19.5.
The client’s Oral Reading Index of 60 on the GORT-5 indicates deficits in oral reading skills. Weaknesses were noted in reading rate, accuracy fluency and comprehension.
Language/Literacy
Comprehensive Test of Phonological Processing 2nd edition (CTOPP-2)
The clinician administered the Comprehensive Test of Phonological Processing 2nd edition
(CTOPP-2). The CTOPP-2 is a highly reliable, comprehensive assessment designed to measure phonological awareness, phonological memory, and rapid naming skills of most individuals from ages 5:0 to 24:11. Rather than relying on a single measure, the CTOPP-2 provides two measures for each composite score, increasing the reliability of the measurement tool. The following results were obtained (mean/average subtest scaled score =10 with a typical range of 8-12): Subtests Raw Score Age Equivalent Grade Equivalent
%-ile Rank Standard Score Elision (EL) 16 6-9 1.7 2 4 Blending Words (BW) 14 5-6 k.4 <1 2 Phoneme Isolation (PI) 23 7-0 2.0 2.5 8 Memory for Digits (MD) 18 10-6 5-4 37 9 Nonword Repetition (NR) 14 6-0 1.0 5 5 Rapid Digit Naming (RD) 10 >14-9 >9.7 75 12 Rapid Letter Naming (RL) 9.94 >14-9 >9.7 84 13 Blending Non-words (BN) 8 5-0 K.0 <1 1
Segmenting Non-words (SN)
7 4-9 <K.0 1 3
CTOPP-2 subtest results indicate weaknesses in the areas of elision, blending words, non-word
repetition, blending non-words, and segmenting non-words. All other subtest results fell within typical limits.
The following composite scores were obtained for the CTOPP-2 (mean/average standard score = 100 with a typical range of 85-115):
Composite Scores Sum of Standard Scores
Percentile Composite Scores
Phonological Awareness 14 1 67 Phonological Memory 14 12 82 Rapid Symbolic Naming 25 86 116 Alt. Phonological Awareness (BN+ SN) 4 <1 52
Composite score results obtained for the CTOPP-2 are indicative of weaknesses in the areas of phonological awareness), phonological memory and alt. phonological awareness skills.
Language/Reading
Test of Word Reading Efficiency, Form A, (TOWRE)
The clinician administered the Test of Word Reading Efficiency, Form A, (TOWRE). This test measures an individual's ability to pronounce printed words accurately and fluently. The
following scores were obtained by using age-appropriate norms (mean/average standard score = 100 with a typical range of 85-115):
TOWRE Subtests
Raw Score Standard Score Percentile Age Equivalent Grade Equivalent Sight Word Efficiency 85 94 35 15-6 10.0 Phonemic Decoding Efficiency 29 77 6 8-6 3 Total Word Reading Efficiency Index 85
The client’s Total Word Reading Efficiency Index of 85 falls at the lower end of typical limits. The client demonstrated strength in the area of Sight Word Efficiency; however, the client’s standard score of 77 for Phonemic Decoding Efficiency indicates deficits in this area.
Language/Literacy
Clinical Evaluation of Language Fundamentals- Fifth Edition (CELF-5)
The clinician administered the Clinical Evaluation of Language Fundamentals- Fifth Edition
ability for ages 5-21. The CELF-5 tests core language skills, receptive and expressive language, as well as formulating sentences, recalling sentences, and using word structure correctly. The results were as follows:
Subtests Raw Score Scaled Score Percentile Rank Age Equivalent Growth Scale Value Word Classes 31 7 16 12-7 592 Following Directions 26 8 25 13-4 579 Formulated Sentences 44 10 50 18-7 566 Recalling Sentences 52 7 16 18-7 539 Understanding Spoken Paragraphs (USP) 14 9 91 Word Definitions 15 11 95 >21-5 557 Sentence Assembly 16 9 37 15-7 568 Semantic Relationships 15 9 37 15-4 538 Pragmatics Profile 199 11 63 19-7
The client’s performance for all subtests on the CELF-5 fell within typical limits with the exception of Word Classes and Recalling Sentences.
Core Language Scores and Index Scores
Sum of Scaled Scores
Standard Score Confidence Percentile Rank
Core Language Score 35 91 86-96 27 Receptive Language Index 25 90 85-95 25 Expressive Language Index 26 91 86-96 27 Language Content Index 25 90 85-95 25 Language Memory Index 25 89 83-95 23
The client’s composite standard scores on the CELF-5 fell within typical limits indicating age appropriate oral language skills.
Fluency:
Fluency was assessed informally throughout all diagnostic sessions. The clinician did not note any repetitions, prolongations, or hesitations during conversational speech. Fluency appeared to be within normal limits for age, gender, and sex.
Voice quality was assessed informally throughout all diagnostic sessions. The client’s voice quality, resonance, and pitch appear to be within normal limits for size, age, and gender.
SUMMARY OF FINDINGS
Based on the formal and informal test results, Ann Jones exhibits a reading deficit which is related to a weakness in phonological awareness and phonological processing skills. According to results obtained from the Comprehensive Test of Phonological Processing- second edition
(CTOPP-2) Ann exhibits weaknesses in the areas of phonological awareness, phonological
memory and alt. phonological awareness skills. Specific areas of weakness include elision,
blending words, non-word repetition, blending non-words, and segmenting non-words.
Additionally, the Gray Oral Reading Test fifth Edition (GORT-5) revealed weaknesses in reading
rate, accuracy, fluency, and comprehension. Administration of the TOWRE-2 also revealed that
Ann’s overall reading accuracy and fluency fell at the lower end of typical limits (Total Word
Reading Efficiency Index of 85). Strength was noted in the area of reading sight words
accurately and fluently (Sight Word Efficiency SS=94). However, Ann’s ability to read non-words accurately and fluently (Phonemic Decoding Efficiency SS=77) fell below typical limits indicating a deficit in this area. According to the results of the Clinical Evaluation of Language
Fundamental 5 (CELF-5), Ann’s receptive and expressive oral language skills fall within typical
limits. However, weaknesses were noted in the areas of recalling sentences and word
associations. Ann’s oral peripheral exam, hearing, articulation, voice and fluency were found to be within typical limits.
PROGNOSIS
The prognosis for Ann Jones to improve language/literacy skills is good. Ann appears to be highly motivated to improve and seems willing to work hard in order to do so.
RECOMMENDATIONS
It is recommended that Ann Jones be enrolled in language therapy for the spring 2015 semester at the Alabama A&M University Speech-Language Clinic for two fifty minute sessions per week targeting an increase in phonological awareness and language-based reading comprehension skills.
LONG TERM OBJECTIVES Long term objectives should include, but not be limited to:
1. The client will demonstrate auditory discrimination skills by identifying phoneme sounds with 100% accuracy.
2. The client will increase phonological awareness in areas of elision tasks and segmenting tasks with 90% accuracy.
3. The client will increase phonological awareness in areas of elision tasks and segmenting tasks with 90% accuracy.
4. The client will demonstrate age appropriate vocabulary skills with 90% accuracy.
SHORT TERM OBJECTIVES Short term objectives should include, but not be limited to:
1a. The client will decode and produce consonant/digraph sounds at the word level with 100% accuracy.
2a. The client will correctly identify and differentiate initial, medial, and final sounds within words with 90% accuracy.
2b. The client will correctly identify and differentiate sound blends with 90% accuracy. 3a. The client will correctly decode words/nonsense words containing short vowel phonemes with the aid of grapheme cues with 90% accuracy.
3b. The client will correctly decode words/nonsense words with long vowel phonemes with the aid of grapheme cues with 90% accuracy.
3c. The client will correctly decode CVVC/CCVVC words with long vowel phonemes with the aid of grapheme cues with 90% accuracy.
3d. The client will differentiate (read) minimal pair words/nonsense words that vary in vowel (long/short-ex. sop vs. sope) with 90% accuracy.
4a. The client will either define vocabulary word or match a definition to a target vocabulary word with 90% accuracy.
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