Question
I recently have been working with an 8 year old who has had an abusive 1st 4 years of life, and a loving, ideal second 4 years. He has stuttering, articulation, and expressive language issues. He was recently diagnosed with ADHD and mild Fetal Alcohol Sy
Answer
Thank you for providing a sample of this child's language structures as it clarifies the intervention program for him. I believe his primary communication challenge is language and cognition, not stuttering or articulation. Although someone indicated that fetal alcohol syndrome was not a factor here, I would consider it the main factor. This condition frequently presents with ADHD, cognitive challenges, language confusions, and speech prosody and timing effects. I think you are looking at all of those conditions in this child. I suggest you focus intensively on improving expressive language. This might include sentence imitation (try for accurate imitation of 7-10 word sentences); oral comprehension strategies ("Is a lamp a toy or a piece of furniture?" "Is a roof on top of your house or under your house?" "Are dogs more often brown or green?") and oral cloze sentences from children's literature or expository text that you read to him. Then select 5 sentences from the text that are content loaded. Read each of them aloud. Go back to the first one and read all but the last 3 words. Ask him to complete it- that is, cloze it. He should be able to do it even with the interruption of other sentences. If not, go to the cloze activity immediately after you say each sentence. You did not indicate if he reads -if he does, extend the last intervention by asking him to read the passage silently and then complete the cloze exercises you present aloud.
Provide his intervention in several short (5 minute) episodes repeated often in a 30 minute session- or even several times a day if you have access to him, or a paraprofessional can use the same language stem sentences each day. He needs lots of repetitions to reduce his verbal circumlocutions and replace them with meaningful word choices. I think you will also see a decline in stuttering-like behaviors if he has better cognitive patterns for listening and responding.
Dr. Judy Montgomery, a professor of special education at Chapman University in Orange, CA is an SLP with both school-based and academic experience. She is a Board Recognized Specialist in Child Language, and the Choir of the Scientific and Professional Education Board of ASHA.
Judy Montgomery, Ph.D,CCC-SLP
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