Case Study: Auditory/Language Processing, Attention

Associate’s Name/Discipline:
Shannon L. Williamson, Ph.D., CCC-SLP

Name of Organization:
Upstate Pediatric Speech Therapy Services, Inc.

Presenting Problem:
Auditory/language processing, working memory, attention/concentration, organization

Will was referred to this examiner due to concerns regarding processing. He was having difficulty particularly with math. Teacher ratings indicated concerns with following instructions, timely completion of assignments and organizational skills that were affecting reading and math. Weaknesses were also noted in accuracy of completed work and retention of factual information.

Psychological assessment at that time revealed an average full scale IQ. Verbal comprehension was in the average range, and perceptual reasoning or nonverbal intelligence was above average. However, weaknesses at that time were evident in working memory and processing speed. The total working memory index score was borderline and processing speed was below average. The achievement scores indicated no concerns regarding a learning disability as his achievement was commensurate with his ability level

Will was home-schooled due to performance anxiety at school and increased demands. The parents wanted help to address the processing and working memory deficit.

Summary and Diagnosis:
1. Will was given the Clinical Evaluation of Language Fundamentals-4^th Edition (CELF-4). This assessment measures receptive, expressive language, language content, language memory and working memory. The results were indicative of overall borderline language functioning for his core score with his total test score falling one standard deviation below the mean. This assessment revealed that Will had significant working memory deficits, with his index standard score falling below the first percentile.

2. Language content, or his semantic knowledge of language, was within the average range.

3. Language memory was in the mildly deviant range. His working memory deficits most likely have affected his ability to follow directions, recall auditory information, as well as understand information present and derive meaning from it. Expressive language skills were also borderline.

4. Will demonstrated a deficient processing speed as demonstrated by his slower performance on the “Rapid Automatic Naming” subtest.

Treatment Goals and Protocol:
Therapeutic goals focused on addressing the working and language memory deficit though a combined program of iLs and traditional speech therapy. Will engaged in 40 one-hour sessions over a four-month period utilizing the iLs Reading/Auditory Processing Program.

Auditory processing tasks were implemented with physical activities or various forms of movement (iLs Playbook), simultaneous to listening, for the first half hour of each session. During the second half hour, Will engaged in traditional processing types of tasks of repeating information, speed drills, following directions and auditory memory types of tasks while he was listening to iLs’ Reading/Auditory Processing Program.

Post-Test Results:
The Clinical Evaluation of Language Fundamentals-4^th Edition (CELF-4) was re-administered at the end of the four months to assess receptive and expressive language as well as language content and memory. The results were as follows:

Conclusions and Recommendations:
Pre-program testing showed that all index scores were below average, low average or borderline. All index scores post-treatment are within the average range. Will continues to demonstrate strengths in language content, or the semantics of language (although not targeted in his intervention plan, even this score improved to the high average range). Significant improvement was observed in his “Working Memory” score, with his current score being in the average range of functioning.

Will’s parents noticed particular improvement with his memory skills. Will’s caregivers observed that he was able to perform mental math operations in his head, a task that he had struggled with previously. They noted he had better sustained focus and attention.

Will’s self-confidence and ability to handle stressful situations grew noticeably toward the completion of his 40-session program. He had high expectations, a perfectionist tendency and was very hard on himself at the beginning of therapy and became angry when he missed questions. By the end of the treatment, there was less anxiety and better emotional regulation about his responses. Due to significant improvements in the processing and memory domains, as well as his ability to handle the stress of the classroom, Will was enrolled back in school the semester following his speech/iLs therapy program.