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Department of Communication Disorders
Speech & Hearing Center
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Marshall University Speech and Hearing Center

SPEECH AND LANGUAGE EVALUATION

8/5/2020
Name: MRN:
Parents:(when appropriate) Birthdate:
Address: Telephone: Home:
Work:
Email: Cell:

Communication Diagnosis: F80.0 Lisping

Medical Diagnosis: N/A
Procedure/CPT Code: 92522 Evaluation of Speech Sound Production

Referral Information
Client, a, female, participated in a speech and language evaluation at the Marshall University Speech and Hearing
Center (MUSHC) in August 2020. She was accompanied by her mother who remained with her during the
evaluation process. She was referred by her pediatrician due to parental concerns of a lisp. Client’s mother
indicated that she “has a lisp when saying words like ‘couch’” which causes her to “become frustrated at times”.
Despite this, client’s mother indicated that client’s speech difficulty does not place a negative impact on her daily
living.

Background Information

Birth/Developmental History
Client’s mother reported via case history a full-term pregnancy of 40 weeks and three days with no complications.
She was delivered via c-section and weighted a healthy weight of 7lbs. 3oz. After birth, client experienced low
oxygen rates when feeding which resulted in a one week stay in the NICU. Her mother reported that client had to
learn to “stop and take breaths while eating”. Due to this, client was bottle fed. Her mother also reported that she
had a “piece of skin between her two front teeth” that was cut shortly after birth. Client passed her newborn hearing
screening.

Client appropriately met all developmental milestones as indicated on the case history report. She began to babble
at four months, spoke her first word and began putting two words together at one year, and spoke in short
sentences at two and a half years. These ages were considered to be within the typical developmental period as
children typically begin to babble around seven months, speak their first word and begin to combine words at one
year, and begin to speak in short sentences around two years. Additionally, client appropriately achieved feeding
milestones as she began to feed herself with a spoon and chew solid food around two years. This was determined
typical as children begin to feed self and chew solid foods at around 18 to 24 months.

One John Marshall Drive  Huntington, West Virginia 25755-2675  Tel 304/696-3640  Fax 304/696-2986
Speech and Hearing Center Office 304/696-3641  www.marshall.edu/commdis
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Medical History
Client’s medical history was unremarkable. During interview and case history review, her mother reported no
concerns with he health and no previous relevant illnesses. No concerns were noted regarding client’s hearing.

Social/ Intervention History

Client’s mother reported via case history that she resides with her mother, father, and siste who is 5 months old.
She attended daycare from 2017 to 2020 but now stays at home with her mother due to COVID-19.

Observations and Test Results

Client was evaluated at MUSHC and was accompanied by her mother who remained in the examining room during
the evaluation process. The evaluation consisted of a combination of formal testing, informal observations, and
parent report. During formal testing, client required positive reinforcement using a token economy system (tokens
exchanged for a reinforcer) and verbal praise (e.g., “you are working so hard”) in order to stay motivated. The
clinician provided her with a magnetic chip to place on a blank card for every response. Once the card was full,
client was given a magnetic wand to pick up the chips. This system was successful for client during speech
assessment as she remained motivated and on task. Client also required small breaks in between tasks in which
she played a game of Pop the Pirate. Reinforcements and breaks allowed the clinician to obtain an adequate
amount of information to indicate client’s speech and language abilities.

Language

Due to observations of strong language abilities during conversation with client, expressive and receptive language
skills were informally assessed. Select items from the CELF P-2 were used to assist in informal screening of
receptive language. These items are used to evaluate the ability to interpret spoken sentences of increasing
lengths and complexity.

Receptive Language
Auditory comprehension skills (what she understood) that were observed during both informal observation and the
CELF P-2 screening included the following:
Auditory Comprehension Skills Observed

Following 2-step related commands (e.g. “Pick a chip and put it on the card.”)
Responds to commands involving body parts (e.g. “Stick your tongue out.”)
Comprehension of prepositions (e.g. “Put your tongue up behind your teeth.”)
Responds to a variety of more complex wh- questions (e.g. “Why does the pirate have a sword?”)
Identified most common object names (e.g. table, chair, spoon)
Recognizes family labels (e.g. “mommy”, “daddy”)
Understands position words (e.g. “Point to the spotted puppy that is in the box.”)
Understands concept of time (e.g. “We will be finished soon.”)
Understands colors (e.g. “Can you find the pink chip?”)
Understands prepositional phrases (e.g. “in the wagon”)
Comprehension of modifications (e.g. “big, spotted, black, white”)
Understands negations (e.g. “not”)

Expressive Language
Expressive communication skills (what she produced) that were observed included the following:
Expressive Language Skills Observed

Producing different types of consonant-vowel combinations

Using words more often than gestures to communicate
Consistently uses plurals (e.g. “crayons”)
Frequently asks -wh questions (e.g. “Why does the pirate pop?”; “What is this?”)
Uses completed sentences containing four to five words (e.g. “I’m coloring the bear”)
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Frequently uses verbs ending in -ing (e.g. “fighting”, “coloring”)

Uses past tens verbs (e.g. “The pirate popped.”)
Demonstrates the use of pronouns (e.g. “I want to color.”; “You do it.”)
Demonstrates the use of articles (e.g. “This is a house.”; “I want the cars.”)
Conjoins nouns with conjunctions (e.g. “A spoon and fork and knife.”)
Uses future tense (e.g. “I will turn the next page.”)
Demonstrates the use of contractable copula (e.g. “It’s red and silver.”)
Displays inversions for questions (e.g. “Is it a fruit.”)
Demonstrates the use of infinitives (e.g. “I need to scoot my chair in.”)
Uses irregular past tense verbs (e.g. “I saw some gumballs outside.”)

Results of language testing revealed typical receptive and expressive language skills based on client’s age.
Regarding receptive language, client demonstrated the ability to understand comments/questions varying in
complexity (e.g. “What is this?”, “Point to the spotted puppy that is in the box?”). Regarding expressive language,
client primarily communicated in sentences containing four to five words (e.g. “I want to color.”, “I saw some
gumballs outside.”), along with the use of gestures (e.g. pointed to the Pop the Pirate game from across the room).

Social/Pragmatics
Client demonstrated appropriate pragmatic skills. She displayed an ability to attend during formal testing and
maintained appropriate eye contact with the examiner and her mother. She communicated with intent by vocalizing
her thoughts (e.g. “I want to play cars”), pointing, and gesturing. Client also displayed an ability to initiate a
conversation and to appropriately take turns both conversationally and socially.

Articulation
The Goldman Fristoe Test of Articulation, 3rd Edition (GFTA-3) was used to assess her articulation skills at the
single word level. The following speech sound errors were noted:

 Distortion of /n/ characterized as dentalizations (tongue slightly forward between teeth) in the final position
of words (e.g. “lion”)
 Distortion of /d/ characterized as dentalizations in the initial position of words (e.g. “drum”)
 Omission of /g/ in the initial position of words (e.g. “uitar” for “guitar”)
 Distortion of /t/ characterized as dentalizations in the initial position of words (e.g. “table”)
 Distortion of /l/ characterized as dentalizations in the initial, medial position of words (e.g. lion, elephant”)
 Substitution of /w/ for /r/ in the medial position of words (e.g. “cwown” for “crown”)
 Substitution of /f/ for /θ/ in the initial, final position of words (e.g. “fum” for “thumb”; “tif” for “teeth”)
 Substitution of /s/ for /ʃ/ (“sh”) with distorted characteristics of dentalizations in the initial, final position of
words (e.g. “su” for “shoe”, “fis” for “fish”)
 Substitution of /t/, /s/ and /t s/ for /ʧ/ (“ch”) with distorted characteristics of dentalizations in the final position
of words (e.g. “wats” for “watch”), lateralizations (sound escaping out sides of teeth) in the initial position of
words (e.g. “seeze” for “cheese”) and the medial position of words (“teatser” for “teacher”)
 Substitution of /s/ for /ʧ/ (“ch”) with distorted characteristics of lateralizations in the initial position of words
(e.g. “teacher”)
 Distortion of /s/ characterized as dentalizations in the initial, medial, final position of words (e.g. “house”,
“princess”, glasses”)
 Distortion of /z/ characterized by lateralizations in the final position of words (e.g. “cheese”) and
dentalizations in the initial, medial, and final position of words (e.g. “zebra”, “puzzle”, “glasses”)
 Substitution of /ʊ/ (short “oo”) for /ɚ/ (“er”) in the final position of words (e.g. “hammu” for “hammer”)
 Substitution of /ʒ/ (“zsh”) for /ʤ/ (“j”) with distorted characteristics of lateralizations in the initial position of
words (e.g. “zshuice” for “juice”)

Client demonstrated multiple speech sound errors that were appropriate for her developmental age including
substitutions for ”ch”, “r”, “er”, “sh”, “voiceless th”, and “j” and distortions characterized by dentalizations on ”sh”,
“ch”, “j”, “s”, “t”, “d”, “l”, and “z”. These speech sound errors were considered typical as children do not typically
develop “d” and “g” until around age 1.5 to 4; “t” until around age 2 to 6; “r” and “l” until around age 3 to 6; “ch” and
“sh” until around age 3.5 to 7; voicless “th” until around age 4.5 to 7; “s” until around age 3 to 8; “z” until around age
3.5 to 8; and “j” until around age 6 to 8.5. Client also displayed speech sound errors that were not appropriate for
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her age including distortions characterized by lateralizations (sound escaping out sides of teeth) on “ch” and “j”; and
dentalizations on “n”. Lateralizations are not considered to be developmentally appropriate at any age and “n” is
typically mastered by age three. However, the distortion of “n” was not determined to be of concern as it was not
common in her speech which suggests that it is emerging. The clinician attempted to test stimulability (how well a
sound can be made with cues) for the lateralizations of “sh” and “ch” by providing cues (e.g. “put your teeth closer
together” “close your teeth in the back”) which resulted in no notable improvements. The clinician also provided
cues to test the stimulability of the dentalized “s” (e.g. “keep your tongue in the cage”) which was also unsuccessful.
Speech sound errors at the single word level were consistent with client’s connected speech, such as the
substitution of “s” for “ch” with characteristics of lateralizations in the utterance “I like chocolate chip”; and the
presence of a dentalized “l” in the utterance “I want a gumball”.

Overall, client’s speech intelligibility appeared to be excellent with a familiar listener (mom) and good with an
unfamiliar listener (clinician) (e.g. mother’s understanding of request for “cars”). Her intelligibility was better with
known contexts. She also displayed good comprehensibility as the clinician did not have to work hard to understand
her speech in most situations.

Please see below for formal test scores.

Goldman Fristoe Test of Articulation-3

Mean=100, SD=15

Raw Score 44
Standard Score 89
Percentile Rank 23

Oral Peripheral Examination

An oral peripheral examination was completed to evaluate oral structures and functions. Results of the oral
peripheral examination revealed no abnormalities of the lips, tongue, jaw, palate, and teeth. She displayed
appropriate lip size and symmetry and demonstrated an ability to open and close the lips, smile, and protrude the
lower lip on command. Examination of the tongue revealed typical size, color, symmetry, and no presence of an
ankyloglossia (tongue tie). She displayed the ability to protrude the tongue, point the tongue to the nose and chin,
point the tongue behind the upper teeth, swing the tongue side to side, and run the tongue around the lips.
Examination of the jaw revealed an appropriate size and an ability to open and close the jaw effectively.
Examination of the hard and soft palate indicated no concerns (characterized by typical color, no evidence of a cleft
palate, etc.) and proper elevation of the soft palate when saying “ah, ah, ah”. Client’s teeth were appropriately
arranged (absence of gaps, spaces, misalignment, etc.) and she displayed an appropriate molar relationship
(typical bite), and incisor relationship (absence of overbite, underbite, crossbite). These typical findings suggested
that cleint’s oral and facial structures are capable of producing speech sounds correctly.

Hearing
A hearing screening was attempted but could not be completed due to an inability to condition the client during pure
tone screening. The clinician was able to determine no observable abnormalities of the outer ear during visual
inspection and obtain a type A tympanogram which suggested typical middle ear functioning (characterized by
appropriate pressure and volume). Informal observations suggested no concerns with hearing as client
appropriately responded to speech sounds.

Fluency:
Client displayed fluent speech during conversational speech.

Voice
Client demonstrated appropriate pitch, loudness, and quality for age and gender.

Impressions
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Client was a pleasant and interactive toddler with outstanding language skills and growing speech sound skills.
Evaluation results indicated typical language skills and typical speech sound errors based on client’s age, except
for lateralizations on the dentalization of /n/. Voice and fluency were also within functional limits.

Diagnosis: Results revealed a speech sound disorder characterized by a lateral lisp.

Prognosis: N/A

Recommendations
Based on client’s age and lack of stimulability, the clinician did not recommend speech services at this time. The
clinician recommended client’s mother to monitor her child’s speech skills and to seek services at around age four
and a half if speech sound errors persist.

Treatment Plan
N/A

Thank you for choosing Marshall University Speech and Hearing Center for your communication and swallowing
needs. Please don’t hesitate to contact us in the future if we can be of service to you. 304-696-3641.

Hannah Searls, B.S.

Graduate Clinician

Jennifer Baker, M.A., CCC-SLP

Clinical Supervisor
1770758328