Hannah's evaluation at Vanderbilt University was in August 2004. She was 32 months old at that time. We waited only a few moments before Mary (Camarata) came to get us. Right away, any fears or concerns I had about being there, were washed away. Mary very briefly said hello to my husband and me, but then focused her attention on Hannah. At the time, Hannah had about 60 words (mostly nouns), and most of those were indistinguishable to anyone but me. Even at that young age, Hannah was always able to discern if people were really interested in her or not. People who threw too many words at her too quickly, would quickly be ignored. People who took the time to speak simply and slowly, and who also took in anything Hannah communicated (verbally or otherwise), would have Hannah's full attention and joy.
After a brief elevator ride, we were greeted by Dr. Camarata (Mary's husband, Stephen. He is one of the best researchers and evaluators in childhood language disorders, late-talking, and autism). He also engaged Hannah quickly and easily. I do need to give Hannah a little credit though, because she is a very easy-going kid who is not rattled by new things or new adventures and approaches these situations with the attitude of "this is going to be great!".
The evaluation room was purposely sparse in appearance, with some simple furniture and a large mirror (two-way). Unlike the horrible evaluation I discussed previously, this room had no toys, no books ... nothing to overwhelm or distract. We spent some time chatting, asking and answering questions. Then my husband and I left the room, and Stephen and Mary got to work.
Following is the list of test and evaluations that were conducted. I have not included all that was in the report, as it got very technical and lengthy at times:
Leiter International Performance Scale – Revised (Leiter-R): The Leiter-R is an individually administered test of nonverbal cognitive performance. It yields a cognitive performance score with a mean of 100 and standard deviation of 15. Hannah’s nonverbal cognitive performance fell in the average range of functioning. This is an estimate of global nonverbal intellectual abilities based on the performance of complex nonverbal mental processes involving conceptualization, visualization, and inductive reasoning.
Preschool Language Scale, Fourth Edition (PLS-4): Auditory Comprehension: Raw Score 24, Percentile Rank 1st, Standard Score 66; Expressive Communication: Raw Score 29, Percentile Rank 6th, Standard Score 77: Total Language Score: Standard Score 69 Percentile Rank 2nd.
Peabody Picture Vocabulary Test-Third Edition (PLS-4)
Childhood Autism Rating Scale (CARS): Non-Autistic Range.
Spontaneous Speech and Language Sample (SSLS) was collected and produced a mean length of utterance (MLU) of 1.16 morphemes. This MLU fell more than –2.33 deviations below the expected mean for a child Hannah’s age and is more typical of a child 18 to 22 months of age (remember she was 32 months old at the time of testing). Though Hannah’s use of language was limited, she did use it in appropriate contexts (i.e. labeling objects of play, saying "down" when she wanted down, pairing words with play actions "wee!"). Her speech was very difficult to understand. Vowel and consonants were inaccurate and phonemic combinations were reduced.
Summary and Recommendations
Based on these findings, Hannah currently exhibits a mixed receptive/expressive language disorder. Hannah’s language and interaction skills pattern more like a child with language deficits, rather than a child with Autism which has pervasive social/pragmatic concerns at it’s core. Language intervention should focus primarily on increased receptive and expressive language skills with emphasis on understanding at the single-word and two-word level. This level of focus is also recommended for the phonological needs.
As we got ready to leave Vanderbilt, Dr. Camarata walked out with us ... he was rather taken with Hannah .... he reassured me again that Hannah was not autistic. He told me to focus on building language and not to even worry about the phonological problem ... the first goal was to increase spoken and understood language. We could clean up pronounciation problems later. At one point during the wrap-up, Mary wanted to include a diagnosis of dysarthria (Hannah tended to try to say some words with her lips basically closed ... such as pillow or balloon), but Dr. C. said "no", because Hannah could whistle and that immediately removes that diagnosis. Hannah actually spent much of Christmas day when she was just 24 months old, playing with wrapping paper and teaching herself to whistle. I whistle a lot, and even though speech was difficult, she managed to figure out how to whistle. She's still a great whistler.
We left there, armed with the truth to hush the nay-sayers who kept pushing autism at me. It was also at that point when our work and our journey began in earnest.
More to come ...
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