K is a client that I have been seeing for about 18 months. I have decided to write a blog about her DLD journey with me as I have learned so much from working with her. I hope my thoughts (sometimes random and they are not ‘clinical notes’) will help other therapists in the same position.
Let me introduce K. She is a polite, engaging 8 year old girl who immigrated to Australia about 3 years ago. Her bilingualism was unfortunately a red herring to those who met her early on and initially she was schooled with the idea that she needed to catchup on English. After about 6 months at the school they started to notice that she didn’t seem to be ‘picking up’ words like a lot of the other students. They also noticed that she needed so much more help to finish tasks. She was referred to me by the family interpreter who attended a lot of appointments in those early days.
Her initial case history from both her dedicated parents showed motor milestones were typical. Her speech though had been slow to progress in her first language and she only began to use some words at 3 years of age. She was described as a messy eater even now and seemed to take a long time to finish her meals. She had a history of ear infections but had never had a hearing test. (She subsequently passed this later in the year).
At her initial assessment, K ( C.A. 7 years) was very keen to play with me and the toys in my office. She liked the doll play and sat at the table for some picture tasks without any problems. She spoke some words and phrases in her home language – directed to her mum or the interpreter. It’s always so difficult to get a good handle on a child’s first language skills through an interpreter but we tried our best over a few sessions. With some coaching, the interpreter asked her to follow some instructions in her home language. She managed up to 3 word level commands (3ICW Derbyshire) such as ‘put the doll under the bed’. In English she was consistent more at 2ICW but there were huge gaps in her single word receptive vocabulary in both languages. Words like arm, knee, dress, boots were new to her and so we used visual cues to support her for every interaction.
Her expressive language skills were poorer. She used some phrases in her home language (which she preferred), although syntactically it could not be easily translated across for assessment purposes. Her English skills were very very limited. She tried in so many ways to get her message across to me by pointing and looking at me and she genuinely enjoyed all our interactions. She loved all the activities presented to her and was cooperative despite the very real problems she faced every day trying to communicate with people. Here is an (English) language sample from her first appointment using the RAPT. Her home language skills were stronger but described as ‘stilted’ and use of the wrong words.
‘She is bear’.
‘Mum a shoe’
‘Horse is walking’
‘A cat is mouse touching’
‘She is baby is’
‘Boy is. Dog is. Shoes.’
‘boy is apple pick. She is apple fall’.
I’ll talk about her first block of therapy next time…