Severe Speech-Sound Disorder with Motor Involvement
AB’s parents were aware of delays in her speech development from the age of 18 months (i.e., no spoken words); however, AB did not undergo formal assessment due to limited access in the rural region where they resided. The family moved to a more urban center when AB was 3.6 years of age. At that time, AB’s family doctor suspected a global developmental delay and referred her for further assessment. Audiological assessment revealed normal hearing acuity and examination by an ear, nose, and throat (ENT) specialist was unremarkable. Occupational therapy (OT) assessment revealed average fine and gross motor skills. Assessment by a speech-language pathologist (SLP) indicated that AB could follow most simple one- and two-step directions and understood a variety of vocabulary, but had difficulty following longer, more complex instructions at an age-appropriate level. Her expressive language consisted of mostly unintelligible single words and her speech was limited to almost exclusively vowel sounds. Through publicly funded preschool speech-language services, AB received two blocks of weekly speech therapy, eight sessions each, focused on the production of bilabial speech sounds (/p/, /b/, /m/). Psychological assessment at age 4.11 years indicated AB had average nonverbal reasoning skills.