Panama-Buena Vista Union School District
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******Unified School District
1717 W. Merced Avenue
West Covina, CA 91790
(626) 939-4600, FAX: (626) 939-4701
|SPEECH AND LANGUAGE EVALUATION REPORT |
This report contains confidential information and is the property of
******Unified School District
|NAME: |***** |HOME SCHOOL: |Merced |
|DATE OF BIRTH: |****** |TEACHER: |****** |
|AGE: |****** |GRADE: |Pre-K |
|ETHNICITY: |**** |PARENT(S): |***** |
|PRIMARY LANGUAGE: |English |DATE OF IEP: |***** |
REASON FOR ASSESSMENT
***** is a four-year, eight-month old male who was seen for a speech and language evaluation per request of his father due to concerns with limited speech intelligibility and expressive speech. ****** currently resides in the ******Unified School District (W******) and is currently attending ****** Preschool program in Covina Valley Unified School District since March 2012. The data collected will assist the IEP team to determine whether the student demonstrates a significant need for special education services under federal and state guidelines.
Home, Language, and Community:
***** currently resides in an English speaking home with his biological parents, ****, and older sisters (age 7 years). English is the primary language spoken in the home.
Health and developmental history were obtained through parent report. Prenatal care and delivery were unremarkable. ****** was delivered full-term with no complications and was 6.9 lbs. at birth. There were no medical problems with ****** following his delivery and he was discharged home with his mother. Developmental milestones were reported to be within normal including speech development. ****** was reported to sit at 5 months old, stand at 8 months old, and walk at 12 months old. He began producing single words at 12 months and started combining words at approximately 2 years old. ****** can feed himself using a fork or spoon and drinks from an open cup. ****** is able to dress and undress himself. He is able to wash his hands and brush his teeth independently. ****** is potty trained.
****** has had no serious illnesses requiring hospitalizations and he has no medical diagnosis. His vision and hearing were informally assessed by the district nurse******, on 5/7/14. He passed his hearing and vision screenings with no concerns. According to the nurse, ******’s asthma is well controlled and he does not require a health plan for school at this time. The reader is referred to the Health Report for further information.
****** currently attends ****** Children’s Center preschool full-time (from 9 am until 3 pm) since March 2012. The primary language of the Preschool facility is English. Parent reported that he is able to follow routines well.
******, Preschool teacher, stated that ****** is doing well in class. He has come a long way. ****** is more vocal and social now. Ms. ******is concern with his speech. ******’s speech is not clear and it is difficult to understand him. Academically, ****** can spell his name. He is starting to learn his address and phone number. ****** is a fast learner.
Preschool Classroom Observations:
****** was observed on 5/29/14 for approximately 30 minutes at his preschool during centers by the examiner. During the observation, ****** followed verbal directions given by his teachers and the classroom routines. He worked with blocks at the table without being prompted. The teacher’s aide asked, “******, what are you making?” He answered, “Making a house.” She asked, “What is this for?” ****** answered, “The roof.” The aide asked, “Are you going to your sister’s school?” He answered, “I’m at school right now.” ****** continued building a house with another student. He commented, “This is a door and a door.”, “Right here and right here.”, “2”, “I have 2 restroom”, “Daddy sleep in my bed.” The teacher’s aide asked, “Do you like to dance?” ****** replied, “No.” ****** and another student left the table. He followed the aide’s instructions to come back and clean up their area. ****** called the other student to come back to help. A ball bounced and rolled by him. He commented, “That is cool.” ****** participated during centers by listening, answering questions, commenting, and sharing blocks. He was observed to give appropriate eye contact with teachers and peers. Observation of peer interaction and sharing skills indicate appropriate social interaction skills.
****** was assessed over four days in the speech room at ****** for completion of formal and informal assessments and observations. All assessments were completed in English since that is the primary language of the home. When ****** entered the assessment room, he was initially shy and quiet. However, he eventually greeted the examiner and rapport was easily established during play. He appeared eager to play with toys and enjoyed looking at the pictures presented to him. ****** was polite, friendly, and well-groomed. He was observed to demonstrate appropriate eye-contact and good sharing skills with the examiner. A play-based assessment approach was initiated. Gradually, some more formal and standardized assessments were also introduced. ****** transitioned smoothly between tasks and participated in all activities presented to him. He required some prompting from the examiner for redirection to attend to task, especially near the end of the assessment. Overall, information obtained through this evaluation is regarded as valid and representative of ******’s current speech and language abilities.
ASSESSMENT INSTRUMENTS AND PROCEDURES USED
Hodson Computerized Analysis of Phonological Patterns (HCAPP)
Preschool Language Scale-5th Edition (PLS-5)
Clinical Evaluation of Language Fundamentals Preschool – 2nd Edition (CELF Preschool-2)
Expressive One Word Picture Vocabulary Test (EOWPVT)
Receptive One Word Picture Vocabulary Test (ROWPVT)
Oral Mechanism Examination
Westby Symbolic Play Checklist
Informal Language Samples
Alternative assessment instruments were also included in this evaluation. These measures included language sampling, informal assessment and observation of communication interactions, and interpretation of standardized test results. All assessment procedures measure specific samples of the student total language repertoire. The selected measures should only be interpreted within the limits of their measure of validity. W****** has implemented procedures to ensure that those methods used to assess children in our district are adequate, have a research base, are considered “best known practices,” do not discriminate against race, culture, or sex and meet a goal of linking assessment and instruction. Any deviations from these standards will be explained in this report.
Throughout this evaluation, many numbers will be utilized to define levels in a variety of areas. Many of the scores are reported by what has been termed standard scores. For most of the tests in the battery, standard scores have a mean of 100 and a standard deviation of 15. Standard scores show how well the student did compared to a group of individuals of approximately the same age from across the United States. Generally speaking, the standard scores range from 0 to 130+. Standard scores convert to the following categories. [Many test authors, publishers, and researchers use the following terms and metrics for descriptive purposes]: 69 or below (deficient), 70-79 (borderline), 80-89 (low average), 90-109 (average), 110-119 (high average), and 120+ (superior range). However, 50% of children fall between standard scores of 90-110 and 68% of children fall between standard scores of 85-115. This is based upon testing instruments, which have a mean of 100 and a standard deviation of 1.5. The scores are reported with a 95% level of confidence, which indicates that 95 times out of 100, scores will fall between the marked interval.
Many of the tests in this battery also generate subtest scores. Some subtests use the same standard score criteria described above, while others, generate standard scores called scaled scores. As with standard scores, scaled scores show how well an individual did compared to others the same age from across the United States on the individual subtests. The highest possible scaled score on a subtest is 19, and the lowest possible score is 1. Half of all individuals will score less than 10, and half will score more than 10. Scores of 3 and below are considered deficient; 4 to 5 borderline; 6 to 7 low average; 8 to 12 average; 13 to 14 above average; 15 to 16 superior; and 17 to 19 very superior.
The Hodson Computer Analysis of Phonological Processes (HCAPP) is an objective, standardized, dynamic assessment instrument that is both norm-referenced and criterion-referenced. The HCAPP was designed to a) assess and categorized phonological deviations, b) provide a treatment direction for children whose speech is highly unintelligible, and c) yield post-treatment data that can be used for evidence-based practice documentation. The HCAPP uses a combination of stimulus objects and picture cards to elicit a child’s spontaneous productions of fifty words. The Severity Interval rating is based on total occurrences of major phonological deviations. The designations are as follows:
|Number of occurrences |Severity Rating |
|1–50 |Mild |
|51–100 |Moderate |
|101–150 |Severe |
|>151 |Profound |
The following information was elicited from ******’s responses to determine total occurrences of major phonological deviations used for specifying severity intervals and calculating percentages of occurrences for ten major phonological deviations categories.
|Phonological Deviations |Percentage of Occurrence |
|Syllable Reduction |0 |
|Prevocalic Singleton |0 |
|Intervocalic Singleton |21 |
|Postvocalic Singletons (endings) |0 |
|Consonant Sequences /st, sp, etc./ | 33 |
|Stridents /f, v, s, z, sh, ch/ |17 |
|Velars /k, g/ |27 |
|Prevocalic Liquids /l, r/ |84 |
|Nasals /m, n, ŋ / |5 |
|Glides /w, j/ |0 |
Average Phonological Processes: 46
Severity Interval: High Mild
****** achieved a rating of “High Mild” on this measure with significant pattern deviations in prevocalic liquids. In the prevocalic liquids deviation, ******’s liquid sounds /l, r/ are omitted or replaced. For example, ****** produces the word “rock” as “wock”. Research indicates that these sounds are not mastered until a later age and therefore these errors are considered developmentally appropriate. His spontaneous speech also appears intelligible and void of significant articulation or phonological pattern deviations. Overall, speech intelligibility is age appropriate at this time.
An oral mechanism examination was conducted to evaluate the structural and functional integrity of the oral-mechanism. ******’s oral mechanism appears to be adequate for the production of speech.
A Spontaneous Informal Language Sample was collected in order to assess ******’s expressive, receptive, and pragmatic language skills. A sample of 89 utterances was collected and analyzed. Informal analysis indicated that he communicated with a mean length of utterance (MLU) of 3.9, with an upper bound of 8 morphemes, which is below for his chronological age. For the purpose of this assessment, utterances that were direct repetitions or unintelligible were not included in this sample. During spontaneous conversation, ****** used a variety of sentence lengths, however he had difficulty formulating correct sentence structures (word order) and demonstrating age appropriate grammatical skills.
The following grammatical components were observed during this sample: pronouns (I, my, me, it, he, her, we, they, them), prepositions (in, on, off), negatives (no, not), articles (a, the), wh- questions (what, where, why), and plurals. ****** demonstrated the ability to ask and answer yes/no questions and WH- questions. Overall, linguistic structures appeared to be below for his chronological age.
The Expressive One Word Picture Vocabulary Test-4th Edition, (EOWPVT-4) is an individually administered, norm referenced assessment to measure expressive vocabulary and word retrieval for children, aged two, through geriatrics (80+ years). The EOWPVT-4 measures expressive vocabulary knowledge by asking the student to name objects, actions, and concepts when presented with color illustrations. ****** achieved the following scores:
|Raw Score |49 |
|Standard Score |97 |
|Confidence Interval (95%) |90.6-103.4 |
|Percentile Rank |42 |
Results indicate that ******’s expressive vocabulary abilities fell in the average range on this measure.
The Receptive One Word Picture Vocabulary Test-4th Edition (ROWPVT-4) is an individually administered, untimed, norm referenced, wide-range test of receptive vocabulary acquisition through picture identification. The ROWPVT-4 targets the ability to understand the meaning of words spoken without context by matching a spoken word with an image of an object, action, or concept. The test is designed for ages two years to eighty years of age. ****** achieved the following scores:
|Raw Score |62 |
|Standard Score |104 |
|Confidence Interval (95%) |98.9-109.1 |
|Percentile Rank |61 |
Results indicate that ******’s receptive vocabulary abilities fell within the average range on this measure.
The Preschool Language Scale-5th Edition (PLS-5) is designed for children from birth through seven years eleven months of age and is an individually administered test used to identify children who have language disorders of delays. The test is comprised of two subscales, auditory comprehension and expressive communication. These subscales are used to evaluate how much language a child understands and how well they communicate with others.
1) The auditory comprehension scale is used to evaluate the scope of a child’s comprehension of language. The test items on this scale that are designed for infants and toddlers target skills that are considered important precursors for language development (i.e., attention to speakers, appropriate object play). The items designed for preschool-aged children are used to assess comprehension of basic vocabulary, concepts, morphology, and early syntax. Items for children ages 5 to 7 years old evaluate the ability to understand complex sentences, use language to make comparisons/inferences, and demonstrate emergent literacy skills.
2) The expressive communication scale is used to determine how well a child communicates with others. The test items on this scale which are designed for infants and toddlers address vocal development and social communication. Preschool-age children are asked to name common objects, use concepts that describe objects, express quantity, use specific prepositions, grammatical markers, and sentence structures. Items for 5-, 6-, and 7-year-old children are used to examine emergent literacy skills (i.e., phonological awareness and ability to retell a short story in sequence) and, integrative language skills (i.e., smile use, synonyms use, use of language to classify words). Based on ******’s performance and parent report, the following scores were obtained:
| |Standard |Confidence |Percentile |Age |
| |Score |Interval |Rank |Equivalence |
| | |(95% level) | | |
|Auditory Comprehension |81 |75-90 |10 |3 years, 9 months |
|Expressive |79 |74-86 |8 |3 years, 6 months |
|Communication | | | | |
|Total Language |79 |74-86 |8 |3 years, 7 months |
The Auditory Comprehension scale is used to evaluate the scope of a child’s comprehension of language. ******’s score fell in the low average range. ****** was able to:
1. Understand spatial concepts (under, in back of, in front of)
2. Understand pronouns (his, her, he, she, they)
3. Understand quantitative concepts (more, most)
4. Identify shapes (star, circle, square, triangle)
5. Identify letters
****** was unable to:
1. Identify advanced body parts (forehead, wrist)
The Expressive Communication scale was administered to evaluate ******’s expressive language skills in the areas of vocal development, social communication, vocabulary concepts, and grammatical markers. ******’s score fell within the borderline range. He was able to:
1. Use present progressive (verb + ing)
2. Use plurals (babies, cats, etc.)
3. Answer what and where questions
4. Use possessives (the girl’s, cat’s)
5. Answer questions logically (What do you do when you are hungry?)
6. Answer questions about hypothetical events (what would you do if you felt sick?)
7. Name categories
8. Use modifying nouns
****** was unable to:
1. Name described object (What toy is round and bounces? You can play catch with it.)
2. Use possessives (the cat’s)
******’s total language score fell within the borderline range. Overall language appears to be emerging at a 3 year, 7 month level on this measure.
The Clinical Evaluation of Language Fundamentals Preschool- 2nd edition (CELF Preschool-2) was administered to identify the presence of a language disorder, to describe the nature of the disorder, evaluate early classroom/literacy fundamentals, and communication in context. This assessment provides multi-perspective assessment processes for pinpointing a student’s language and communication strength and weaknesses, and for making educationally relevant recommendations for intervention and accommodations. ****** achieved the following scores:
|Subtest |Raw |Scaled |Percentile |
| |Score |Score |Rank |
|Sentence Structure |9 |6 |9 |
|Word Structure |5 |4 |2 |
|Expressive Vocabulary |10 |6 |9 |
|Concepts & Following Directions |8 |7 |16 |
|Recalling Sentences |4 |4 |2 |
|Basic Concepts |16 |9 |37 |
|Composite Scores |Sum of Scaled Scores |Standard Score |Percentile |
| | | |Rank |
|Core Language |16 |73 |4 |
|Receptive Language |22 |85 |16 |
|Expressive Language |14 |69 |2 |
|Language Content |22 |85 |16 |
|Language Structure |14 |69 |2 |
******’s receptive language and language content fell within the low average range. His core language fell within the borderline range. His expressive language and language structure scores fell within the deficient range. He had difficulties with word structure and recalling sentences.
The core language index score represents the student’s ability to understand and use language with appropriate content and structure. ******’s score fell within the borderline range in this area. The subtests within this index include: sentence structure (understand spoken sentences), word structure (word meanings and rules), and expressive vocabulary (labeling objects, people, and actions). ****** scored in the low average range in sentence structure and expressive vocabulary; however, scored in the borderline range in word structure.
The receptive language index score represents the student’s ability to understand what is being spoken. ******’s score fell within the low average range. The subtests with this index include: sentence structure (understand spoken sentences), concepts and following directions (understand descriptions of items in terms of location, quality, quantity and single to multiple step commands), and basic concepts. ****** scored in the low average range for sentence structure and concepts/following directions; however, scored average range in basic concepts.
The expressive language index score represents the student’s ability to communicate thoughts orally while using correct word structure and grammar. ******’s score fell within the deficient range. The subtests within this index include: word structure (word meanings and rules), and expressive vocabulary (labeling objects, people, and actions), and recalling sentences (repeating a sentence that was spoken). ****** scored in the borderline range for word structure and recalling sentences; however, scored low average range in expressive vocabulary.
The language content index score represents the student’s understanding of words and their meanings and how the student uses these words in oral communication. ******’s score fell within the low average range. The subtests within this index include: expressive vocabulary (labeling objects, people, and actions), concepts and following directions (understand descriptions of items in terms of location, quality, quantity and single to multiple step commands), and basic concepts. ****** scored in the low average range for expressive vocabulary and concepts/following directions; however, scored average range for basic concepts.
The language structure index score represents the student’s ability to interpret and produce words and sentence structure. ******’s score fell within the deficient range. The subtests within this index include: sentence structure (understand spoken sentences), word structure (word meanings and rules), and recalling sentences (repeating a sentence that was spoken). ****** scored in the borderline range for word structure and recalling sentences; however, scored low average range in sentence structure.
******’s voice quality was informally assessed. His overall pitch, quality, and volume were within functional limits. Breath support appears adequate for speech production.
Subjective assessment of ******’s connected speech revealed his fluency to be within functional limits. He is capable of delivering a coherent, complete, fluent question or comment during the majority of his utterances.
The Westby’s Symbolic Play Checklist was administered through structured observation and parent report of ******’s symbolic play skills. It is designed to analyze a child symbolic or representational play. The transition to symbolic play comes as a child begins to use objects in a pretend manner, such as to eat from an empty spoon. It is important to consider symbolic play skills because of the relationship between symbolic play and language and cognition. ****** demonstrated purposeful exploration of several of toys. He demonstrated a variety of motor depictions, such as coloring with crayons, throwing a ball, and stacking blocks. He presented with appropriate eye contact and was able to maintain some attention to preferred activities. ****** was observed to join in the examiner’s play and allowed the examiner to join in his play. He was observed to initiate play interaction the examiner and showed appropriate sharing skills. ****** was observed to transition from one task to another. No Repetitive and/or echolalic verbal language were observed during the play observation or in parent reports. Overall, play and language skills appear to be average for his chronological age.
******, age 4 years, 8 months currently resides in the ******Unified School District. This was an initial assessment to determine current eligibility for speech and language services. Results of the current speech and language evaluation based upon parent interview, observations, and a variety of play-based and standardized assessment measures suggest that ******’s overall communication abilities to be within the borderline range for his chronological age. Information obtained from the Preschool Language Scale-5, as a criterion-referenced measure, identified low average scores in Auditory Comprehension and borderline scores in Expressive Communication tasks. His total language score fell within the borderline range and appears to be emerging at a 3 years, 7 months level. Information obtained from the Clinical Evaluation of Language Fundamentals Preschool-2, identified borderline to deficient scores in his core language, expressive language, and language structure skills. His receptive and expressive vocabulary skills appear to be within average range for his chronological age. ****** received a rating of “High Mild” on the Hodson Computerized Analysis of Phonological Patterns (HCAPP) assessment with no significant phonological process errors at this time. Overall speech intelligibility is considered to be average for his chronological age at this time. Assessment results which were obtained on standardized assessment measures were supported through alternative assessment measures, such as spontaneous language samples and observations. ****** communicates with a variety of multi-word utterances, with an MLU of 3.9 which is in the below for his chronological age. Voice, fluency, and pragmatic language skills appear within functional limits at this time.
It does not appear that ****** will be successful in general education preschool activities without special education intervention. The IEP team should consider all services, supports, and placements available when recommending the least restrictive environment to support and encourage ******’s academic and pre-academic progress.
******’s primary language, racial, and ethnic background were considered prior to the selection and interpretation of evaluation procedures and measures. Overall assessment results appear to be a valid and an accurate representation of his articulation, language, and fluency abilities at this time.
The final determination of eligibility, placement, services, and educational programming are the responsibilities of the IEP team. This report is submitted to assist in this process. Under California Department of Education guidelines, statistical data is only one criterion that must be met in order to qualify a student as eligible for special education services. Other factors that may be the primary cause of a student’s academic deficits must be ruled out prior to assuming that a disability exists. These factors are cultural, economic, limited English, lack of instruction in reading or math, temporary disability, social maladjustment, and/or environmental detriments. To the extent that any or all of these conditions may be shown to be the primary cause of a student’s academic problems, a disability may be ruled out.
A pupil shall qualify as an individual with exceptional needs, pursuant to Section 56026 of the Education Code, if the results of the assessment as required by Section 56320 demonstrate that the degree of the pupil’s impairment as described in Section 3030 (a through j) requires instruction, services, or both which cannot be provided with modifications of the regular school program. The decision as to whether or not the assessment results demonstrate that the degree to which the pupil’s impairment requires special education shall be made by the individualized education program team, including assessment personnel in accordance with Section 56431(d) of the Education Code. The individualized education program team shall take into account all the relevant material, which is available on the pupil. No single score or product of scores shall be used as the sole criterion for the decision of the individualized education program team as to the pupil’s eligibility for special education. (California Code of Regulations Section 3030)
In order for ****** to qualify for special education services under Language and Speech Disorder (56333 and 56026), the student must demonstrates difficulty understanding or using spoken language to such an extent that it adversely affects the student’s educational performance and cannot be corrected without special education and related services. The student shall be assessed by a language, speech, and hearing specialist who determines that such difficulty results from any of the following disorders:
A) Articulation Disorders: such that the pupil’s production of speech significantly interferes with communication and attracts adverse attention.
1) The pupil displays reduced intelligibility or an inability to use the speech mechanism which significantly interferes with communication and attracts adverse attention. Significant interference in communication occurs when the pupil’s production of single or multiple speech sounds on a developmental scale of articulation competence is below that expected for his or her chronological age or developmental level, and which adversely affects educational performance.
2) A pupil does not meet the criteria for an articulation disorder if the sole assessed disability is an abnormal swallowing pattern.
B) Abnormal Voice: A pupil has an abnormal voice which is characterized by persistent, defective voice quality, pitch, or loudness.
C) Fluency Disorders: A pupil has a fluency disorder when the flow of verbal expression including rate and rhythm adversely affects communication between the pupil and listener.
D) Language Disorder: The pupil has an expressive or receptive language disorder when the student meets one of the following criteria:
1) The pupil scores at least 1.5 standard deviations below the mean, or below the 7th percentile, for his or her chronological age or developmental level on two or more standardized tests in one or more of the following areas of language development: morphology, syntax, semantics, or pragmatics. When standardized tests are considered to be invalid for the specific pupil, the expected language performance level shall be determined by alternative means as specified on the assessment plan.
2) The pupil scores at least 1.5 standard deviations below the mean or the score is below the 7th percentile for his or her chronological age or developmental level on one or more standardized tests in one of the areas listed in subsection (A) and displays inappropriate or inadequate usage of expressive or receptive language as measured by a representative spontaneous or elicited language sample of a minimum of fifty utterances. The language sample must be recorded or transcribed and analyzed, and the results included in the assessment report. If the pupil is unable to produce this sample, the language, speech, and hearing specialist shall document why a fifty utterance sample was not obtainable and the contexts in which attempts were made to elicit the sample. When standardized tests are considered to be invalid for the specific pupil, the expected language performance level shall be determined by alternative means as specified in the assessment plan.
E) Hearing Loss: which results in a language or speech disorder and significantly affects the student’s educational performance.
1) A pupil has a hearing impairment, whether permanent or fluctuating, which impairs the processing of linguistic information through hearing, even with amplification, and which adversely affects educational performance. Processing linguistic information includes speech and language reception and speech and language discrimination.
2) A pupil has concomitant hearing and visual impairments, the combination of which causes severe communication, developmental, and educational problems
Based on these criteria, current evaluation results indicate ****** does qualify for special education services under the handicapping condition of Language and Speech Disorder under Section 3030 D2 because:
o Student scores at least 1.5 standard deviations below the mean or below the 7th percentile in one of the following areas of language:
▪ Morphology/Syntax (grammar usages and sentence structure)
Speech and language services are recommended for ****** to improve his expressive communication abilities. Goals and objectives should be developed in order to improve his expressive language skills. The Individualized Education Program Team (IEPT) will need to consider all assessment information when determining final eligibility and the most appropriate educational services to address ******’s needs. The final determination of eligibility, placement, services, and educational planning is the responsibility of the Individualized Educational Program Team (IEPT). This report is submitted to assist in this process. Under California Department of Education guidelines, statistical data is only one criterion that must be met in order to qualify a student eligible for special education services. Other factors that may be the primary cause of a student’s academic deficit must be ruled out prior to assuming that a disability exists. These factors are cultural, economic, and/or environmental determinants. The least restrictive environment should be considered when making a final determination as to ******’s education. The least restrictive environment should be determined by the IEPT. The final determination of eligibility, placement, services, and education programming are the responsibilities of the IEPT. All information should be considered when determining ******’s appropriate educational services.
The following supports could be provided to ****** in an educational setting:
• Model expected responses
• Expand and provide corrected models of student’s spontaneous utterances.
• Encourage daily language stimulation and experience with language enriched activities, such as answering open-ended questions, retelling stories, and describing pictures or events.
• Stimulate expression by asking who, what, when, where, and why questions.
• Allow for increased time to given response.
• Encourage carryover across all settings.
Vivian Tran, M.S., CCC
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