Cognitive Disability: Misc Issues, 2nd Grader

Question

A new second grade female student has been brought to my attention. She has a primary disability of cognitive disability and she is not hearing impaired. She is not able to verbalize. She makes great attempts to repeat one-syllable words. All of her c

Answer

It is of course difficult to address questions of this nature given the many factors that impact student development and learning. Thus, the following ideas are based on these assumptions about this student:

1. The student is with her age/grade peers in the classroom and between 7 and 8 years old.
   
   
2. The student is at least partially included in the general education curriculum.
   
   
3. The student's estimated cognitive level is above the severe range and her language age is near her estimated cognitive level.
   
   
4. A motor speech disorder and/or developmental apraxia of speech has not been ruled out.
   
   
5. The student has not had assistive technology intervention.
   
   
6. A recent inventory of the student's sound system is available as well as other other assessment results.

The most critical information the SLP needs in cases such as this is a thorough description of what the student knows and is able to do, as well as any factors that contribute to the problem. If a detailed analysis of her sound inventory has not been completed, this is an important step in determining the nature of the problem. The symptoms reported (not able to verbalize; great attempts to repeat one syllable words; severely distorted consonants and vowels) suggest that a motor speech problem and/or developmental apraxia of speech should be investigated. Certainly cognitive difficulties likely contribute to her overall speech and development, but this alone does not fully explain the reported symptoms. A thorough analysis of phonemes at the word level (repetition can be used) will provide more detail about the types of errors that occur, such as distortions, omissions, or substitutions. If the errors are primarily distortions, then motor speech and/or DAS is a suspicion. A thorough oral-motor examination will also reveal any structural or functional problems with the speech mechanism. If errors are primarily omissions and substitutions, a phonological disorder is the likely choice.

Once the nature of the speech production is determined, there are several choices of intervention strategies. Motor speech production intervention typically involves training of speech sounds with emphasis on motor planning, shaping of desired targets and guided practice in simple to complex phonetic contexts. Phonological intervention involves strategies that build the system and decreases the use of phonological processes. It is possible that this child may need combined approaches if both motor and language-based errors dominate her speech production.

When any individual faces significant challenges with verbal communication, assistive technology should be considered. This particular student is a good candidate considering her cognitive (and likely reception language difficulties) and her speech production difficulties. It is not always necessary or even desirable to opt for high technology solutions to communication disorders. An evaluation will determine the type and amount of support this particular child needs.

Kathleen Fahey, Ph.D., CCC-SLP is a professor and the chair of the Department of Communication Disorders at the University of Northern Colorado. She is the author of the text "Language Development, Differences, and Disorders: A Perspective for General and Special Education Teachers and Classroom-Based Speech-Language Pathologists, as well as many articles and presentations. Kathleen teaches undergraduate and graduate courses in phonology and language.