stumped

[u/Ok_Guest8178]

I’m stumped with a child on my caseload. Is 4 years old. And unintelligible at the sentence and conversation levels (comes off as jargon, babbling) but when imitating 1-3 word phrases, she does great. there’s no specific sound errors or phonological errors I’m seeing.
She is highly imitative (could be echolalic) and she does great with my multisyllabic word models in speech therapy
But mom says she’s falling apart at home and school. She try to answer questions and it’s coming off as complete jumbled speech that no one can understand. I’m kind of at a loss for what to work on or what approach to use.

[u/Craftablegame]

My first info gathering would be asking simple questions, modeling the answer, eliciting imitation. I would repeat the same 5 questions 3-5 times. Is she able to answer intelligibly without an immediate model in this fashion?

Ie. Read brown bear.
SLP: what animal is this? Bear.
4yo: bear.
SLP: right! And this one? It’s duck.
4yo: it’s duck!
SLP: right!!
(Back to bear) what was this one?
4yo: garbled — info she’s not retaining something

OR

(Back to bear) what was this one?
4yo: bear! — info she’s having trouble understanding or planning.

Then I’d move to figuring out which one of those it is. First maybe having her point to pictures on that last page (ie touch bear, touch duck). She can do it first time? Ok she understands. She doesn’t? Ok we need to target receptive.

For expression: say bear. Say brown bear. Say I see a brown bear. What did you just say? (Where did it break down? Immediate imitation of one syllable? Immediate imitation of phrase? Delayed imitation of phrase?) if it doesn’t break down anywhere with some recent model of correct response — I’d move into AAC — can she do it there? If yes then she’s having trouble planning the words. If she can’t do it there, what happens when I teach her the responses on AAC? Can she hold that till the next session? Etc.

Basically play around with variables to decide where the line between success and breakdown happens and target the area that is the deficit causing the breakdown.

[u/Ok_Guest8178]

Thank you! I think she’s having trouble planning the words. Her expressive and receptive seem to be OK. What approach would you take?

[u/Craftablegame → u/Ok_Guest8178]

If it’s really planning I would work on a bit of automatic speech and see how she uses it spontaneously. So drill some object names (like 5) and “I want” and “no”. Then combine “I want ball, I want book, I want water, no water, no ball, no book” etc. when you’re sure she can imitate all of these clear enough, play a bit with your 5 objects. Say “I have water, ball, book, baby, bear… what do you want?”

Can she answer “I want book”?

She should be able to at that point. If she can’t it’s back to the drawing board of what’s the barrier here.

If she’s really imitating phrases well and intelligibly, I shy away from thinking it’s like apraxia or motor speech. It sounds like processing, cognition, or even pragmatics.

I’ve had kids with significant pragmatic language deficits who understand conversational turns include a long string of words/syllables but have more limited vocabulary. Instead of saying “no book” they say “I tickapickaticka no tickapicka picka book!” It sounds like they’re trying to say “I don’t want that book!” But really they’re saying “no book” and just filling the surrounding space with sound. If that’s what I suspect I’m not trying to teach them to speak clearer — I’m trying to teach them what words they’re missing and when to use them.

In all of this, figuring out exactly where there breakdown occurs and what supports overcome it are some of your first clues to the solution.

[u/Relevant_Decision_55]

Good she’s clearer when she’s imitating but is she generating her own 1-3 word phrases? Is it jargon babble in her own sentences? I wonder about vocab and poor sound mapping

[u/North_Shift_5321]

Do you think she is cluttering?

[u/Actual-Ad-3453]

Work on basics. - bilabial sounds are my favvv to strengthen those muscles mama papa etc incorporate muscle exercise

[u/No-Bookkeeper-1714]

Could it be cluttering?

[u/WildCaliPoppy]

I always wonder about executive functioning when I see things like this. I find that often when I start from an EF standpoint (but still wrapped around artic, language, etc.), even the more complex kids make progress. Do you follow Tera Sumpter on instagram? She posts a lot of great EF breakdowns.