CASE STUDY REPORT

Specialized Language Intervention for a case of Language

Development Delay

Presented by:

PROMOTION 2010

To opt for DIPLOMA of:

ORAL LANGUAGE THERAPY DEVELOPING MULTIPLE

INTELLIGENCES
 CHAPTER I
THEORETICAL FRAMEWORK

1.1 GENERAL ASPECTS

1.1.1. GENERAL OUTLOOK:

1.1.1.1. The language:

Oral language is the exclusive means of communication of the human race. Through it
we express our ideas, transform thoughts into words and communicate them to our
peers, adjusting to a special code specific to the language we speak.
Language, the word, constitutes a necessary condition for the existence of thought. It is
not possible to think without language: words set the contents of the things we think
about.

Language is a form of communication – whether spoken, written or by signs – that is

based on a system of symbols. Language consists of the words a community uses and
the rules for combining them. We need language to speak with others, to listen to
others, to read and to write. Our language allows us to describe past events in detail
and plan for the future. Language allows us to pass information from one generation to
the next and create a rich cultural heritage.
John W. Santrock (2004)

1.1.1.1.1. Language components

The language is extremely orderly and organized (Berko Gleason, 2005). The
organization includes components:

The phonetic component:

Study how speech sounds are produced and perceived. It studies production, that is,
phonation (generation of the sound wave by the vocal cords and folds) and articulation
(studies the resonance cavities that modulate the wave to achieve sounds).

The phonological component: (sound component)

All languages are made of basic sounds . Phonology is the sound system of a
language, including the sounds used and the way they can be combined (Menn and
Stoel-Gammon, 2005).
The phonological component refers to the perception and expression of sounds, it
allows the understanding and emission of phonemes or functional sounds, the same
ones that give meaning to their own language, discovering them in the interaction with
the speakers in their environment, imitation being in A communicational context is the
primary means used by the infant for learning.

The morphological component:

It deals with the study of the structure of a word. Study the types of words: nouns,
gender, number, article, pronoun, adjective, adverb, verbs, preposition and conjunction.

The syntactic component:

It refers to the way words are combined to form acceptable phrases and sentences.
Study the structure of sentences in a language. Combination of words in a way
according to the language spoken.
Determine the structure of the sentences so that their meaning is interpreted
appropriately.

The semantic component: (meaning component)

Semantics refers to the meaning of words and sentences. Each word includes a set of
semantic features or necessary attributes related to the meaning.
It refers to the words (vocabulary) that every speaker has.
This component refers to the understanding of grammatical structures (sentences) that
the child hears or apprehends from the environment in his interactions with it. It is also
linked to the increase in vocabulary.

The pragmatic component:

Referring to the use of language in specific situations, we will demonstrate a lower or
higher level of language to the extent that the infant uses the expressions appropriately
according to the situation, the logic of the child's expressions, that is, it has to do with
how and when the language is used.
It refers to the appropriate use of language in different contexts. Pragmatics is applied
when: we take turns when speaking in a conversation or use a question to order
something, use friendly language in appropriate situations (for example when talking to
your teacher) or tell interesting stories.
It is dedicated to the study of language as a system with a communicative purpose in
order to exchange experiences and knowledge.

Language is the content of what is spoken, written, read or understood. Language can
also be transmitted through gestures, as in the case of body language or sign
language.

1.1.1.1.2.Language areas:
It is classified into two areas: receptive and expressive.
The ability to understand another person's speech or gestures is called receptive
language .
The ability to create a spoken message that others can understand is called
expressive language.
( Patricia McAller Hamaguchi)

It is important to describe some indicators of each of them that allow us to know the
degree of mastery that children have in these areas. (Philip S. Go ahead)
Receptive Language
It allows you to understand language and acquire the meaning of words, that is, what
the child stores, and forms the basis for the development of semantics in oral
language.
They are indicators of receptive language:
 Perception and auditory discrimination of words, phrases and sentences.
 auditory memory
 Order Execution
 Following instructions
  Understands the meaning of the language he hears and his responses are
appropriate.

The child presents difficulties in receptive language when difficulty is

observed in understanding spoken language, and may present any of the
following characteristics:
 Constant question: Oh, what?
 Can't understand the meaning of long sentences
 It is difficult for him to follow complex and simple instructions.
 Generally, he imitates or follows communication behaviors exhibited by his
classmates.

Expressive Language
Expressive language is what allows the child to express himself through gestures,
signs or words.
Verbal expressive language is determined by the following indicators:
 Adequate and precise vocabulary
 Combining words into phrases and sentences
 Grammatical construction of sentences
 Logical and sequential ordering of language.
 Avoid unnecessary repetition of phonemes, words and/or ideas

1.1.1.1.3. Language Development Process:

During the first four to five years of children's development, language emerges and
grows to be a flexible, functional, and interpersonal tool. Initially, children are
cognitively and perceptually tied to the here and now, and the content of their language
is correspondingly linked to an egocentric vision of the world. As pragmatic ability
grows and they learn to produce communicative expressions, language becomes more
complex until they are eventually capable of the variety of modulations used in mature
language.

The vast majority of authors, when referring to the stages of language development,
agree that there are two major stages: a prelinguistic level and a linguistic level.

The Pre-Linguistic stage develops from birth to twelve months.

The linguistic stage: from 12 months onwards.

 Pre-linguistic Stage: From birth to 12 months of age

First Stage of the Vocal game Second Proprioceptive Stage

(it's free, all children Auditory. From 4 to 8 months
go through this stage)

5th -6th 7th 8th month

1st 2nd 3rd 4th
month month month
month month month
Screams * babbling *Repetitive *Play The
* laleos Pay attention syllables.
Crying sounds chatter
* richest stage to noises. *Exchange of Who
smiles Combine
in the vocalizations. listens.
production sounds *He is losing *Feedback:
*twitters of sounds, consonant the The answer
*Outburst does not with richness of is a
s vowel Smile.
search sounds *Language
*Emission Imitate sounds. free and start
Improve the is
s anyone. listen to generated
* everyone rhythm and Generate
vowels the
Abroad.
goes through understandin
this intonation. g.
stage
because it
responds
even an
internal part .

Third Stage: Passage from vocal play to

language

10 – 12th
9 – 10th month
month

You can now

Pre-conversation,
understand
let's talk
some
to adults and plays
words and smile
the game
at them.
vocal in silences like
answer".
 Linguistic Stage: From 12 months onwards
The child has a communicative intention

12 to 1.6 2 years 2.6 years

months
Vocabulary 40-50 Comprehension of 1000
words. words
Echolalia (repeat phrases *The word you don't
words, stories) Understands simple
They are accentuated in know commands.
psychotics, he replaces it with *You can point out
autistic and dysphasic . silences figures.
*Vocabulary of 3 to 15 or ditties. *3-4 word sentences
words. *Comprehension from
*Union of two words and
The article and some
200 to appear
they form sentences.
300 words. pronouns.
Comprehension from 50
to 100 *Holophrases or *You can express your
words (comprehension phrases name.
linked to telegraphic.
situations) *Name figures or
*Jargon appears . engravings.
*Can speak using
plurals.
*The
slang and combine
more words.

4 years 56 years
3 – 3.6 years

Fluency in *80% is integrated Acquisition ends

communication of the structure Basic at a phonetic
(speaks in sentences). grammar of the level
*Use of questions: what? language Linguistic and
like when? Maternal. grammatical
*Comprises around 1200 *Comprehension of *Vocabulary breadth
words. 1500 and learning of
words. Reading and writing.
*Ask why *Mating and
things. correspondence of
*Expresses names and elements (color-shape)
full surnames. *Vocabulary of 1500
to 3000 words.
*Correct use of
Conjunctions (I),
Possessive pronouns,
And verb tenses.
 TABLE OF LANGUAGE DEVELOPMENT IN THE FOUR COMPONENTS BY
AGE:

Phonetic-Phonological Morphosyntax Lexico-Semantic Pragmatic

Around 3 years: 3.1 to 4 years 3.1 to 4 years From 3.1 to 4

Acquisition of the sounds “m”, Use of synonyms Increase in words Establish long
“n”, ñ, p, t, k, b, j, l, g, f, s, ch. and antonyms. belonging to the conversations.
Acquisition of decreasing Use of the adverb of categories: Maintains a topic of
diphthongs:ai, ei, oi, au, eu. place “here” in their nouns, verbs, conversation with
Example: air, car. statements. adjectives and more than 4
Pronunciation of the groups CV Use of determinants adverbs. exchanges.
+ m,n. Example: ”the”, “my”, and Establishment of Expresses a wish or
change, drum, sing, handle, etc. “that” in their relationships event, describes an
Pronunciation of the groups V + statements. between the experience or explains
m/n. Example: both, before, etc. Use of simple meanings of fictitious events to the
sentences with SVO words, giving rise interlocutor.
structures. to the Create narratives in a
Elaboration of phenomena of coherent way.
sentence collections synonymy and
using the antonymy.
conjunction “and” They have a
(mom dances and productive
dad dances). vocabulary of
Correct use of about 1000
plurals in personal words.
pronouns “us and
us”.
Emission of
sentences joined by
conjunctions: “and”,
“but”, or “why”.
Use of the
prepositions “for”,
“with” and “for” in
their sentences.
Emission of oral
expressions of four
elements.
Correct use of
verbal inflections of
gender, number,
time or person.
 4.1 to 5 years

Formulation of more 4.1 to 5 years

complex coordinated
Around 4 years: and subordinate From the age of Uses language for the
sentences. 4: purpose of controlling
Acquisition of the d, y, r. Variety in the use of Use of discourse others, interacting
Acquisition of consonant groups different categories connectors socially, attracting
(p,b,t,c,f, g) + l. Example: or linguistic units (relative and attention, and initiating
banana, blouse, athlete, nail, (adjectives, anaphoric new topics.
flute, balloon. pronouns, adverbs pronouns, causal Maintains several
and prepositions). and temporal intervention shifts.
Correct use of verb conjunctions), Provide adequate
tenses, especially adverbs and information to the
the present, future prepositions interlocutor, if he or
and past forms. List of sequenced she requests
Acquisition and and ordered clarification.
gradual mastery of events. Respond to the
the most complex There is cohesion interlocutor's
syntactic structures. and coherence in communication
his speech. comments with
The vocabulary statements referring to
has increased to the topic.
about 1,600 Control when the
words. situation requires
changing the
language.
Create coherent
narratives.

More than 5 years: 5 years:

Correct use of 5 years:
adverbs and Their productive
Around 5 years: prepositions. vocabulary Children of this age
Replacement of reaches 2,200 use language with
Acquisition of the syllables CV + coordinated and words, although adult characteristics,
s; V+s. Example: prado, arm, juxtaposed their verbal although many of the
train, chrome, strawberry, etc. structures with concepts are not more subtle syntactic
subordinate ones, yet complete, so structures are still
establishing they will continue absent.
agreement between to be refined On the other hand,
all elements. throughout life. they still need to
Changing the order acquire some of the
of elements in a pragmatic skills
sentence to give necessary to establish
emphasis. effective
communication.

Their sentences can

be complex and are
usually correctly
constructed.
Communicate your
thoughts.
 Productive
vocabulary of
Around 6 years old: about 2,600
words.
Acquisition of the rr.
Acquisition of the syllables CV
+l/r; V + l/r. Example: stop, letter,
etc.
Acquisition of increasing
diphthongs: ia, ie, io, ua, ue, uo.
Examplepiano, honey, louse,
molar, quota, Juana, etc.

1.1.1.1.4. Oral Language Disorders:

Oral language disorders or alterations are understood to be any deficiency that

interferes or hinders the ability of a subject to communicate verbally with the
people around them.
It has been demonstrated that language is progressively developed through a
process of continuous interaction of the subject with its environment, a process
that is not sufficiently known and depends on the degree of maturation and the
physiological functioning of the organism, the socio-cultural context in which the
child develops and of gender and the frequency of verbal stimulation received in
the area of interpersonal relationships. (Estienne, 1991)
The complex activity of language can be altered for various reasons (absence
of a common code, defective articulations, dysfunctions in the message,
insufficient cognitive level, blockage or accidental deviation of language
development, sensory deficiency...), given the set of organs that they intervene
in their articulation. For this reason, subjects sometimes notice language with
more or less significant (qualitative-quantitative) deviations, registering
exclusively linguistic disturbances or various pathologies in which language
dysfunctions can be observed, in addition to others.
 Classification:

Levels disorders

Communication disorders  Serious communication problems:

(permanent) - Autism
- Psychosis
- Severe mental retardation.

. Communication difficulties associated with

linked to other pathologies:
- Minimal dysfunction.
- Severe hearing impairment.
- Child brain paralysis.

Language disorders - Simple Language Delay (RSL).

(temporary or permanent) - Moderate Language Delay
(Dysphasias).
- Severe Language Delay (Aphasias).
Speech disorders. (temporary
or permanent) - Dislalias
 At the articulatory level - Dyglossias
- Dysarthrias

 In verbal fluency - Dysphemias: stuttering,

tachyphemia

Voice disorders - Dysphonias

- Aphonias

1.1.2. DEFINITION AND TERMINOLOGICAL CLARIFICATION OF THE CASE:

DELAY OF THE
LANGUAGE:

1.1.2.1.Delays in language acquisition and development:

By language delay we understand any disorder in the acquisition, development and
organization of language, in the absence of sensory, organic, intellectual or behavioral
deficits that justify said delay (Launay and Borel Maisonny, 1989; Perelló and Cols,
1984).
Language delay is characterized by the non-appearance of language at the age it
normally occurs and the permanence of linguistic patterns that characterize younger
children, beyond what is normal.
For a child's language to evolve properly, a certain psychological and physiological
maturity is necessary, and an appropriate sociocultural environment, stimulating both
socially and emotionally. Therefore, it is common for a child with emotional
deficiencies, belonging to an unstimulating family where there is an absence of
communicative interactions between its members, to manifest delays in the acquisition
and development of language.
Language delays affect both the expression and understanding of language. The
different language components (phonology, morphology, syntax, semantics and
pragmatics) of the child with delay will be affected to a greater or lesser extent
depending on the severity.
1.1.2.1.1.Classification:
Although there is difficulty in establishing what the different types of language delays
are, it can be said that a delay in the development and acquisition of language can
imply, depending on its severity and the age of the child, three levels of severity. :
a) Mild or simple language delay
b) Moderate language delay or Dysphasia
c) Severe language delay

a) Simple or Mild Delay:

It refers to a concept whose borders are quite imprecise and about which there
is little consensus among the authors. For some, it is a delay in the appearance
of the levels or components of language, which mainly affects expression and
which cannot be explained by intellectual, sensory, or behavioral deficits. The
mechanisms and evolutionary stages of normal development are theoretically
respected, but with a chronological lag. (Juarez and Monfort, 1992).

The fundamental characteristic of this disorder is that it cannot be explained by

intellectual, sensory or behavioral deficits. “There is no manifest pathological
cause” (Perelló 1984) considers that delay in language development is a
disorder of language acquisition or language organization without physiological,
sensory or neurological alteration.

A child with mild language delay, without obvious pathological cause, presents
a gap in the acquisition and development of language with respect to other
children of the same chronological age.
The child communicates verbally with the environment, but shows
comprehension and oral expression below the “normal” level. The difficulties
are greater in expression than in understanding.
The first words appear after two years, instead of 12-18 months, first
combinations of two or three words at three years instead of two.
At the phonological level, the child has a tendency to reduce the adult
consonant system to a simpler one, which avoids the production of a smaller
number of consonants. It does this through omissions (generally /rr/) and
substitutions of some phonemes for others (/s/ for /t/ and /r/ for /d/), even if it is
capable of emitting them, and also through some assimilations.
At a semantic level, the child uses a reduced, approximate vocabulary (lexical
poverty), limited to less than 200 words expressed at 3 and a half years old, but
the language used is intelligible.
At a morphosyntactic level, it omits articles and possession markers, the use of
pronouns, especially the personal pronoun “I”, appears around the age of 4
(when it is appropriate at 3 years). The child's language is telegraphic (loaded
with agrammatisms), lasting beyond the age of 4 (when the normal range is
between 15 and 18 months). It uses simple sentences, filling in the empty
spaces with indecipherable sounds, giving the sensation of long sentences. At
4-5 years old he still does not make complex sentences. He uses few plurals
and uses poorly structured phrases syntactically, without respecting the order.
Talk about him in the third person.
They usually compensate for their expression deficits with excessive
gesticulation. This makes them well understood by their environment and in turn
causes a reinforcement of gestural expression to the detriment of oral language.
This mode of expression considered normal at a certain age is considered
pathological when it remains in the child beyond 4 years of age.
Children with simple delay have difficulty understanding spatial concepts (left,
right, up, down, first, last, etc.), temporal concepts (yesterday, today, tomorrow,
day, night, etc.).
He also has difficulty repeating phrases and words. Above all, it appears
incapable of repeating linguistic structures that it has not yet integrated.
Repetition of phrases, words or logos is very difficult for him.
Significant improvement is observed with age, even without therapeutic
intervention, with complete resolution of the disorder before 6 and 7 years of
age.
The prognosis is usually favorable in most cases. What distinguishes mild delay
from other more severe levels is that, generally, the child with simple delay
evolves towards “normal” language. Sometimes, this does not happen and is
further aggravated due to the child's limitations in grasping language adequately
at school, leading to difficulties in later learning (dyslexia and dysorthography).

b) Moderate Delay or Dysphasia:

There is still no unanimous consensus on the concept and delimitation of the
term “dysphasia”, which is why some authors prefer to speak of “Specific
language disorders”. Children who have this disorder form a heterogeneous
group whose common denominator is that their language system, for some
reason, does not correspond to their cognitive abilities.
Abnormal acquisition, understanding or expression of language. It can involve
all or some of the components of the language. They show processing,
abstraction and memory problems.
It is characterized by a late and imperfect elaboration of the language
(Ajuriaguerra, 1980). For Launay (1989) it is “a global disorder of expression,
with automatic expressions, poor vocabulary, simple words and short phrases.”
In other words, it is a delay in oral language that is diagnosed from the age of 6,
is characterized by a lack of organization of the language in evolution and that
can have an impact on written language, giving rise to the appearance of
dyslexia-dysorthography in subjects. normally developed, without sensory,
motor, or phonatory insufficiency, but with a particular mental structure that
would prevent intelligence from accessing the analytical stage. It is necessary to
rule out deafness, mental retardation, motor deficit, emotional disorder and
alterations in the child's personality.
Semantically, the poverty of expressive vocabulary is already noticeable; they
name familiar objects but do not know the names of many other objects and
concepts known to children their age. From the morphosyntactic point of view,
the signs that determine primary semantic functions are present: question,
denial, etc. It is in the signs that determine secondary semantic functions of
nominal category (gender and number) and verbal where clear deficits are
manifested. Language functions are linguistically poorly updated, with abundant
imperatives and verbal gestures calling for attention.

Classification and subtypes:

There is no universally accepted classification of childhood dysphasias.
Most classificatory systems are based on the reception-expression model.

Many authors have made a classification of this disorder. One of the interesting
ones is that of Rapin and Allen (1991) who propose 6 descriptive categories
applicable to the language of a dysphasic subject. The same subject,
throughout its evolution, can move from one category to another.

1. Verbal dyspraxia
Normal or almost normal understanding.
Affected articulation, difficulties in organizing the sequence of sounds. His
statements are limited to one or two words, hardly intelligible.
In severe cases, very limited spontaneous speech and even absence of
speech.

2. Phonological programming deficit

Normal or almost normal comprehension with a certain fluidity of production.
Speech that is difficult to intelligible due to difficulties in knowing and using
phonetic features. The improvement in articulatory quality in tasks of repetition
of isolated elements is notable. (syllables, short words).
3. Auditory-verbal agnosia
Comprehension severely impaired, even absent.
No or very limited language production, even in repetition tasks. (emissions of
an element)
Important phonological alterations
Disturbed verbal fluency
Adequate non-vocal communicative development
4. Phonological-syntactic deficit
Understanding is equal to or superior to expression. Speech can be telegraphic
with difficulties in articulation and fluency, poor vocabulary, and grammatical
errors. It is a variable syndrome in terms of severity; they usually have learning
problems at school age, but in general the prognosis is good.
5. Semantic-pragmatic deficit
These are hyperverbal children with serious deficits in the conversational use of
language, in understanding open questions and in formulating coherent and
rational discourse. Some children with this syndrome speak correctly with good
phonology and syntax. Its lexical fluidity masks the poverty of the content.
Poor understanding sometimes translates into echolalic expressions and
perseverations, insistently repeating clichés or TV commercials. The
disprosody, rhythm, intonation and atypical melody of speech are striking. It is a
common, but not exclusive, syndrome in autism. With growth and education,
they learn to improve their expression although they always retain something
strange in their way of conversing.
6. Lexical-syntactic deficit:
The central deficit is constituted by the disorder in lexical recovery, failures in
naming (dysnomias) and in the formulation of complex discourse.
Understanding single words is usually normal, but not longer phrases. Unusual
difficulties in telling a story. An abundance of fillers, latencies, interruptions,
circumlocutions, and reformulations are recorded within4 a great difficulty in
maintaining sequential order and correctly using morphological markers when
they have to express more complex statements than simple everyday
dialogues.

These six categories can be grouped into:

 Expressive aspect disorder: Which includes two subtypes, phonological
programming disorder and verbal dyspraxia.
 Comprehension and expression disorder: Phonological-syntactic disorder
and auditory-verbal agnosia are included.
 Central processing and formulation processing disorder: semantic-
pregmatic disorder and lexical-syntactic disorder are considered within
this disorder .

d) Severe language delay or Aphasia:

Language impairment caused by brain injury, after the individual has acquired
language. There are different types depending on where the injury is located.
Severe difficulty in the normal acquisition and elaboration of language. It can be
congenital or acquired. Recovery depends on the patient's age and the severity
of the injury.
Children have their phonological patterns reduced almost to a minimum and
multiple dyslalia occurs. The area of meaning is small in quantity and quality. Its
syntax resembles that of very primitive stages (holophrase, telegraphic speech).
In pragmatics, a self-centered conversation is perceived. In these children, it is
necessary to make a differential diagnosis regarding mild intellectual delay,
inattention syndrome and, above all, dysphasia or SLI.

The child with severe delay at the age of 5 has not acquired any type of
language or the acquisition is minimal (they only say a few words). As in the
previous cases, the child does not present cognitive or auditory deficits. You
can find children whose verbal comprehension is practically zero (appearing
deaf due to the indifference they show to the human voice), and, on the other
hand, others can have almost normal comprehension.

Generally, these linguistic symptoms are accompanied by considerable motor

delay, significant learning difficulties, and psychoaffective alterations. Likewise,
intelligence can be affected by the absence of language.

A differential diagnosis must be made with respect to other types of clinical

conditions such as mental retardation (through the application of non-verbal
tests that exclude intellectual disability, deafness and autism.

1.1.2.1.2.Causes:

Most authors agree on the fact that a single cause of language delays cannot
be established, but rather an accumulation of multiple factors.

Some research (Debray, 1978; Aimard, 1972; etc.) indicates the existence of a
genetic factor in language delays (family history with linguistic alterations in the
organization of language, in lateralization, orientation, notions of space and
time, psychomotor skills, etc.)

Other studies indicate the presence of neurological factors (minimal brain

dysfunction) in children with language delays (Debray, 1976). Juárez and
Monfort (1989) point out the importance of sociocultural and affective factors as
determinants of the appearance of delays in the acquisition and development of
language (educational and cultural level of the family, inadequate linguistic
models, few affective and communicative relationships between members of the
family unit, deficient verbal, sensory and motor stimulation.

1.1.2.1.3.Evaluation:

To evaluate the child, it will be necessary to examine the external speech

apparatus, breathing and orolinguofacial praxis. Phonetics and phonology,
semantics, morphosyntax and pragmatics will be evaluated and, depending on
the case, other alternative tests such as cognitive tests will be carried out.
Speech therapy intervention will depend on the severity of the delay, and it is
necessary to begin as soon as possible in severe delays.

As you can see, there are several subtypes of SLI, depending on the linguistic
component affected. Therefore, it is important to carry out a thorough
evaluation of the language, both from the expressive and comprehensive
aspects and at all levels: phonology, semantics, pragmatics and morphosyntax.
There are numerous tests on the market to evaluate language, both in general
and in one of the components. But this type of evaluation cannot always be
carried out (it will depend on the child's linguistic level), so it is advisable to
carry out an analysis of a sample of spontaneous language. On the other hand,
it is necessary to evaluate not only the linguistic component but also cognition,
hearing...in short, it is essential to evaluate those components that serve to rule
out SLI (Leonard criteria).

1.1.2.1.4. Speech therapy intervention

will depend on the identified SLI subtype. One of the most important aspects to
take into account in speech therapy rehabilitation is to know which language
components are most altered and those that are best preserved to build an
individual model of representation of the communicative and linguistic
functioning of each subject. There are functional stimulation strategies ,
which correspond to what has been called "natural methods", where the aim is
to facilitate the child's access to language through privileged communication
situations, in which he can clearly receive the elements linguistic difficulties that
his difficulty does not allow him to extract from the "chaos" that for him
represents the normal stimulation of his environment. They are based on the
stability and high frequency of linguistic models, achieved thanks to the close
control of the material and the situations used, both in re-education sessions
and in the family environment. Restructuring strategies can also be used,
where these programs aim to build or "reconstruct" the bases of language
acquisition and its first stages through an organized symptomatological
approach that provides the child with facilitation systems. They include activities
to develop auditory discrimination, activities for attention control and
psychomotor development, activities for the development of certain mental
functions, such as immediate memory, sequencing of chained actions or
background-form perception, and linguistic activities. Another type of strategy is
alternative communication. Alternative and augmentative communication
systems are giving good results and are usually used when other types of
strategies fail. The choice of system must be adjusted to the specific case of
each child. Whatever the orientation chosen, it is necessary to respect a series
of principles: maintain a slow pace in the presentation of the stimuli. Maximum
clarity must be sought in the contextual presentation of lexical and syntactic
units. It is necessary to reduce the reasons for dispersion of attention as much
as possible. Another principle is that any language work must start from
communication and include the possibility of integrating any initiative of the
child. It is important to take advantage of all sensory pathways. It is necessary
to carry out specific work on auditory perception and of course, as in any
speech therapy intervention, the family must be integrated into the child's
educational process.

Intervention Levels:
Phonological : Prerequisites (attention, perception and auditory discrimination.
Tone, coordination and motor execution of the orofacial structures. Phono-
respiratory coordination...). Phonetic production. Phonetic
integration/phonological programming.
Morphology : Gender and number, adjectives, regular and irregular verbal
forms, participles, comparatives and superlatives, nouns and derived adjectives,
personal pronouns depending on subject and object, reflexives and
possessives, prepositions and conjunctions.
Syntax : Simple sentences increasing their complexity, negative sentences,
passive voice, interrogative sentences, coordinated, subordinate, comparative...
Semantics: Acquisition based on functionality criteria: semantic families.
Synonymy and antonymy. Associations and series.

Pragmatics: Greetings and goodbyes, requesting, demanding attention,

pleading, demands for specific information, demands for confirmation or denial,
asking questions, making comments, showing approval and disapproval,
protests.

Marc Monfort and Juárez (1993) proposed a series of very interesting

principles for intervention: principle of intensity and long duration of treatment,
principle of precocity, principle of priority of communication, enhancement of
skills, multisensory , continuous review.

Differences between simple delay and moderate delay (Dysphasia)

Simple Delay Moderate Delay

-The language is delayed -Language structure that does not exceed a
evolving and continuing its certain stage.
development.
-It is overcome after 3 or 4
years. -Lasts after 5 years.
-The appearance of the first words occurs after
the age of 3.
-The appearance of the first word
combinations after the age of 4.
-Persistence of a schematic language beyond
-Here the child usually follows 6 years of mental age.
the normal evolutionary -Tremendous heterogeneity of the lexicon
patterns of language (appearance of “complex” words, appropriate
development, but more slowly for their age, coinciding with the absence of
than those of a “normal” child. very simple words, which correspond to the
first learning of the lexicon).
-Usually responds very well to -Evolution is slow or very slow. The
speech therapy intervention or generalization of what is taught by the speech
family programs, and therefore, therapist or by the family is very slow and
the evolution is generally rapid. scarce, especially in the morphosyntactic
aspects.
Vizcarra, 2010; based on Moreno Manso and other authors)

1.1.2.2.Speech disorders: Dyslalias:

According to Pilar Pascual García Dyslalias are alterations in the articulation of one
or some phonemes, either due to the absence or alteration of some specific speech
sounds or due to the substitution of these for others, inappropriately, in people who
do not show pathologies of the central nervous system. , nor in the phonoarticulatory
organs at an anatomical level.

It is the consequence of an abnormal functioning in the acquisition and development

of language, motivated by different causes, therefore having a completely positive
prognosis for recovery.
These alterations last beyond four years, until then they appear very frequently.
They are the most frequent and well-known of all language disorders.

 Van Ripper, C. maintains that articulation problems (dyslalias) consist of the

abnormal substitution, distortion, insertion or omission of speech sounds.
 Lee Edward Travis maintains that defective articulation is due to defective learning
or abnormality of the external speech organs, and not due to lesions of the central
nervous system.
  Dr. Jorge Perello maintains that Dyslalia is the disorder of the articulation of
phonemes due to functional alterations of the peripheral organs of speech.
 Dr. Julio Bernaldo de Quiroz maintains that they are disorders of pronunciation (or
speech articulation) that are not due to pathology of the central nervous system.
 Dr. Juan Azcoaga, Berta Derrnan maintains that dyslalias are pronunciation
anomalies.
 Dr. Alfredo Cordero, Rosa M. de Quantin maintains that dyslalia is a language
disorder characterized by the inability to pronounce certain phonemes well; That is,
placing the speaking organs in the correct position.
 Dr. Russel Dejong maintains that it is a pronunciation disorder not due to a neurological
defect but due to structural damage to the articulatory apparatus. It can be caused by
wounds of the lips, tongue, palate, floor of the mouth, maxillofacial injuries,
perforations of the palate, cleft lip, cleft palate, tumors of the palate and tongue.

1.1.2.2.1. Classification of Dyslalias:

There are many classifications of dyslalias, we have followed the etiological one
of PASCUAL (1988).

a) Evolutionary or physiological dyslalia : To correctly articulate the phonemes of a

language, a maturity of the brain and the speech apparatus is required. There is a
phase in language development in which the child does not articulate or distorts some
phonemes; These errors are called evolutionary dyslalias. They normally disappear
over time and should never be intervened before the age of four, especially /r/ and
symphonies.

They tend to cause some anxiety in some parents who believe they see in them a
symptom of delay and they should be advised to speak clearly to their child,
abandoning the persistent patterns of child language. The best intervention is to
convince the family to stop these bad habits.

b) Audiogenic dyslalia : Its cause is a hearing deficiency. The boy or girl who
does not hear well does not articulate correctly, he or she will confuse
phonemes that offer some similarity by not having correct auditory
discrimination. These types of alterations are called audiogenic dyslalias. The
hearing impaired will present other language alterations, mainly voice, and the
study of their audiometry will give us guidelines on the possible adaptation of a
prosthesis. The intervention will basically be aimed at increasing your auditory
discrimination, improving your voice or correcting altered phonemes and
implanting non-existent ones.

c) Organic dyslalia : Joint disorders whose cause is organic are called

organic dyslalia.

If the brain's neural centers (CNS) are affected, they are called dysarthrias and are
part of the language disorders of those with motor disabilities.

If we refer to anomalies or malformations of the speech organs: lips, tongue, palate,

etc. They are called dysglosias.

d) Functional dyslalia:

According to Jorge Perelló, it is the articulation produced by a malfunction of the

peripheral speech or articulatory organs, without there being an injury or malformation
of them. The child who suffers from it does not use these organs correctly when
articulating a phoneme despite there being no organic cause. It is the most frequent.
Therefore, in some cases the child knows that he articulates poorly and would like to
correct himself, so he tries to imitate, however his organs do not obey and they do not
find the desired movement.
The language of a dyslalic child, if it is greatly affected by the difficulty extending to
many phonemes, may become unintelligible due to the continuous verbal distortions
used, as occurs in multiple dyslalias.

Some authors mention that dyslalias, depending on the number of altered sounds, can
be:

Simple Dyslalia
They are mild delays in the development and maturation of speech due to an
insufficiently mature oral-speaking apparatus. It manifests itself as a difficulty in
correctly pronouncing some phonemes, leading to them being replaced by another or
altering the learning of reading and writing.
If the defect that manifests is the disorder of the pronunciation of the sounds of an
articulatory group (whistling or velars for example) it is a simple dyslalia.
Multiple dyslalia
If the defect spreads in two or more articulatory groups (rhotacism, sigmatism and
lambdacism) it is multiple dyslalia.
They are articulatory difficulties due to a disorder in the discrimination of sounds. There
may be several phonemes mispronounced.
In multiple dyslalias,
The language of a dyslalic child, if it is very affected as the difficulty extends to many
phonemes, can become unintelligible due to the continuous verbal distortions it uses.
The production of altered or substituted phonemes is relatively constant. The main
consequence of multiple dyslalias is the difficulty in learning to spell, since the sound
value of the spelling is not adequately discriminated, resulting in writing in the same
way as speaking.

1.1.2.2.2. Errors in Dislalias:

The most frequent errors that we find in a dyslalic child are:

 Substitution
Articulation error in which one sound is replaced by another. The student
finds himself unable to pronounce a specific articulation, and instead,
utters another that is easier and more accessible. For example, say “can”
instead of “rat.”
This substitution error can also occur due to difficulty in auditory
perception or discrimination. In these cases, the child perceives the
phoneme, not correctly, but as he emits it when replaced by another. For
example, say “jueba” instead of “play.”
 Distortion
We speak of distorted sound when it is given in an incorrect or deformed
way, being able to approximate more or less the corresponding
articulation. That is, when it is not a replacement, it does not emit the
sound correctly.
Distortions are usually very personal, making them very difficult to
transcribe into written language. They are generally due to an imperfect
position of the articulation organs, or to the inappropriate way of exit of
the speaking air. For example, say “thistle” instead of “cart.”
Distortion along with substitution are the most frequent errors.

 omitted
 The child omits the phoneme that he does not know how to
pronounce. Sometimes the omission affects only the consonant, for
example, it says “apato” instead of “shoe.” But the omission of the
complete syllable that contains said consonant also usually occurs, for
example, it says “lida” instead of “salida”. In symphonies or consonant
groups in which two consonants in a row must be articulated, such as
“bra,” “cla,” etc., the omission of the liquid consonant is very common
when there is difficulty in articulation.

 Addition
It consists of inserting, next to the sound that you cannot articulate, another that
does not correspond to the word. For example, say “balanco” instead of
“blanco”, “teres” instead of “tres”.
 Investment
It consists of changing the order of the sounds. For example, say “cocholate”
instead of “chocolate.”

There are also errors that occur due to modifications and alterations in the
articulation of phonemes. Among these errors we have:

* Sigmatism: It is a defect in the articulation of the phoneme /s/, giving rise to

what in Spanish is called LISP. For example, a girl says: "I love Zarita." Here he
usually places his tongue between his teeth, producing sigmatism or lisp.

* Rotacism: It is an error in the articulation of the phoneme /r/. This phoneme, due
to its delicate articulation mechanism, is the most difficult sound to pronounce,
which is why this type of error is quite common in children, who distort their
pronunciation due to trembling noises, crackling rubbing noises or, in their defect,
completely replacing it with another phoneme, giving rise in this case to
pararrotacism.

 Lambdacism: This is the name given to defects in the articulation of

the /l/
 Deltacism: This is the name given to defects in the articulation of the /d/
 Gamacism: This is the name given to defects in the articulation of /g/
 Capacism: This is the name given to defects in the articulation of /k/
 Jitism: This is the name given to defects in the articulation of the /j/
 Yotacism: This is the name given to defects in the articulation of the /y/
  But when the child shows pronunciation errors in all the consonants, it is
called Hottentocism.

1.1.2.2.3. Causes of Functional Dyslalia

- Lack of control in fine motor skills. The articulation of language requires great
motor skill. Proof of this is that those phonemes that require greater control of
the articulatory organs, especially the tongue, are the last to appear (/l/, /r/ /r/
and symphonies).
- Deficit in auditory discrimination. The child does not correctly decode the
phonemic elements of his/her language and does not perceive phonological
differentiations such as voiceless/voiced, dental/velar, plosive/fricative, etc.,
producing errors in oral imitation.
- Perceptual errors and impossibility of imitating movements.
- Deficient linguistic stimulation. This explains the frequency of dyslalias in
children from deprived sociocultural environments, abandoned ones, in
situations of bilingualism, etc.
- Psychological: overprotection, trauma, etc., which cause childhood articulatory
models to persist.
- Intellectual deficiency. Dyslalias are an additional problem to the language
problems of the deficient boy or girl. Its correction must be considered in the
longer term, it is slower and will be conditioned by your auditory discrimination
capacity and your motor ability.

1.2 SPECIFIC ASPECTS OF THE CASE:

The boy Tommy Bryan is currently 6 years and 7 months old, he is in the second grade
of primary education at “Los Próceres” school. The evaluated person is the second
son of two brothers. His older brother is 12 years old.
The father is 43 years old, he completed secondary school, with a merchant
occupation. The mother is 40 years old, she completed secondary school, occupation
as a housewife and eventually cosmetology, at home.
Your home is located in the Forest Seed Bank Association.
The pregnancy number was the second, the gestation was normal, the pregnancy
lasted 9 months, she was checked at the medical clinic, she had no illnesses,
accidents or worries during the pregnancy.
The delivery was normal and the baby presented head first.
At birth the child took a while before crying but did not need to be resuscitated with
oxygen; the color he presented, according to the father, was a little purple.
The child's current state of health is normal, he only has an allergy to sweets.
The father reports that the child has had several falls, hitting the back of his head
repeatedly; however, after these falls the father has not observed any change in his
son.
The father reports that the child said his first words at 1.2 months. He also observed
that he repeated what the adult told him.
Currently the child has difficulty pronouncing the phoneme “rr”. The father and family
members who live with him understand the spoken language used by the child; the
child has never received speech therapy.
The child was breastfed until he was 1 year 6 months old, he started giving him solid
foods at 8 months old, and his first teeth appeared at one year old.
The father reports that the child eats without help and receives three meals a day.
In the family there is an aunt who is deaf, she took care of the child from 1 year old until
he was three years old while the mother worked.
The mother states that she has an explosive character that before being treated with a
psychologist she could not control. Now it has improved.
It is the first time that the parents attend a consultation of this type, which is why the
child does not have any diagnosis.
The parents observe that the child has difficulty producing the phoneme “rr” since the
child was in the initial level.
Likewise, the father observes that the child plays very little with his classmates, staying
on the sidelines, a situation that worries him.
The mother reports that she has problems paying attention, especially when reading,
and that she cannot make sentences.

1.3 SPECIALIZED INTERVENTION:

For the intervention process, the approach of language components and multiple
intelligences was applied.

1.3.1. Language Components:

To address the child's language disorders, the Phonetic-Phonological, Lexicon-
Semantic, Morpho-syntactic and Pragmatic components were worked on with the aim
of strengthening the point and mode of articulation of the multiple vibrating phoneme
“rr”, and stimulating their expressive and comprehensive language as follows: manner:
- Phonology. Through praxias, logotomes in songs, articulatory activities
of syllables or words, saying names of objects that contain difficult
phonemes, recognition of sounds in different words, etc.
- Semantics. The child was taught the lexicon based on what the child
knew and through activities of naming objects and their characteristics,
similarities and differences were established, synonyms and antonyms,
verbal absurdities were searched, words were classified according to a
given criterion, analogies, etc
- Morphosyntax. It was necessary to facilitate the structuring of
statements. Previously he was asked to execute actions or errands
(one, two and then three orders).
- It began by consolidating the grammatical rules that the child already
knew and then teaching him useful and functional grammatical
structures.
- Pragmatics. Functional skills were developed that allow effective
communication. Encourage initiative and spontaneity in conversation,
promote the establishment of turns, through non-verbal and verbal
interaction activities (through pauses by the speech therapist and verbal
 and non-verbal signals), new conversation topics were effectively
introduced , the linguistic resources worked on were incorporated into
natural contexts, etc.

Place the components box

All the components were worked under the approach of multiple intelligences that I will
detail:

1.3.2. Multiple intelligences:

The theory of multiple intelligences is a model proposed by Howard Gardner in which

intelligence is not seen as something unitary, which groups together different specific
abilities with different levels of generality, but as a set of multiple, different and
independent intelligences. Gardner defines intelligence as the " ability to solve
problems or produce products that are valuable in one or more cultures ."

First, it broadens the scope of what intelligence is and recognizes what was intuitively
known: That academic brilliance is not everything. When it comes to getting ahead in
life, it is not enough to have a great academic record. There are people with great
intellectual capacity but incapable of, for example, choosing their friends well; On the
contrary, there are less brilliant people at school who succeed in the business world or
in their personal lives. Succeeding in business, or in sports, requires being intelligent,
but each field uses a different type of intelligence. Not better or worse, but different. In
other words, Einstein is neither more nor less intelligent than Michael Jordan, their
intelligence simply belongs to different fields.

Second, and no less important, Gardner defines intelligence as a capacity. Until very
recently, intelligence was considered something innate and immutable. You were born
intelligent or not, and education could not change that fact. So much so that in very
early times, mentally deficient people were not educated, because it was considered a
useless effort.

Considering the importance of the psychology of multiple intelligences, it must be more

rational to have an object for everything we do, and not only through these
intelligences. Since it leaves aside objectivity, which is the order to grasp the world.

Intelligence types
a- Linguistic intelligence: the ability to use words effectively, whether
orally or in writing. This intelligence includes the ability to manipulate the
syntax or meanings of language or practical uses of language. Some
uses include rhetoric (using language to convince others to take a
certain course of action), mnemonics (using language to remember
information), explanation (using language to inform), and metalanguage
(using language to talk about language).

b- Logical-mathematical intelligence: the ability to use numbers

effectively and reason appropriately. This intelligence includes sensitivity
to logical schemes and relationships, statements and propositions (if-
then, cause-effect), functions and abstractions. The types of processes
used in the service of this intelligence include: categorization,
classification, inference, generalization, calculation, and hypothesis
testing.

c- Body-kinetic intelligence: the ability to use the whole body to express

ideas and feelings (for example an actor, a mime, an athlete, a dancer)
and the ease in using one's own hands to produce or transform things
(for example a craftsman, sculptor, mechanic, surgeon). This intelligence
includes physical abilities such as coordination, balance, dexterity,
strength, flexibility and speed, as well as self-perceptive and tactile
abilities and the perception of measurements and volumes.

d- Spatial intelligence: the ability to accurately perceive the visual-spatial

world (for example a hunter, explorer, guide) and to execute
transformations on those perceptions (for example an interior decorator,
architect, artist, inventor). This intelligence includes sensitivity to color,
line, shape, space and the relationships that exist between these
elements. It includes the ability to visualize, to graphically represent
visual or spatial ideas.

e- Musical intelligence: the ability to perceive (for example a music fan),

discriminate (for example, as a music critic), transform (for example a
composer) and express (for example a person who plays an instrument)
musical forms. This intelligence includes sensitivity to the rhythm, pitch,
melody, timbre, or tonal color of a piece of music.
f- Interpersonal intelligence: the ability to perceive and establish
distinctions in the moods, intentions, motivations, and feelings of other
people. This may include sensitivity to facial expressions, voice and
gestures(2), the ability to discriminate between different kinds of
interpersonal signals, and the ability to respond effectively to these
signals in practice (e.g. influencing a group). of people to follow a certain
line of action).

g- Intrapersonal intelligence: knowledge of oneself and the ability to

adapt one's own ways of acting based on that knowledge. This
intelligence includes having an accurate picture of oneself (one's own
powers and limitations), awareness of one's inner moods, intentions,
motivations, temperaments and desires, and the capacity for self-
discipline, self-understanding and the self-esteem.

reasonable ence. Whether intelligence develops or not depends on three

main factors:
a-Biological endowment: including genetic or hereditary factors and any
damage or wounds that the brain may have received before, during or
after birth.
b- Personal life history: including experiences with parents, teachers,
peers, friends, other people who help intelligence grow or keep it at a
low level of development.
c- Cultural and historical background: including the time and place
where one was born and raised, and the nature and state of cultural or
historical developments in different domains.

ACTIVATORS OR DEACTIVATORS OF INTELLIGENCES

Crystallizing experiences or paralyzing experiences are two key processes
in the development of intelligence. Crystallizers are the "key points" in the
development of a person's talents and abilities. Often, these events occur in
 early childhood or occur at any time in life. They are the sparks that ignite
an intelligence and begin its development towards maturity.
Conversely, the term paralyzing experiences "close the doors" of
intelligence. They are often filled with shame, guilt, fear, anger and other
emotions that prevent our intelligence from growing and developing.
There are other environmental influences that also promote or retard the
development of intelligence. They include the following:
to. Access to resources or mentors. If your family is very poor, perhaps
you will never be able to own a violin, piano or other instrument, it is very
likely that musical intelligence will not develop.
b. Historical-cultural factors: if you are a student who has an inclination
towards mathematics and at that time the educational institutions
received abundant funds, it is very likely that logical-mathematical
intelligence will be developed
c. Geographic factors: If you grew up on a farm, you are more likely to
have had opportunities to develop certain aspects of your bodily-kinetic
intelligence.
d. Family factors: If you wanted an artist but your parents wanted you to
be a lawyer, this influence may have promoted the development of your
linguistic intelligence, to the detriment of the development of your spatial
intelligence.
and. Situational factors: If you had to help care for a large family growing
up, and now have a large family of your own, you may have had little
time to develop in promising areas unless they were interpersonal in
nature.

THE SEVEN TYPES OF LEARNING STYLES

CHILDREN THEY THINK THEY LOVE NEED

WITH A
MARKED
TREND

Linguistics In words Read, write, tell stories, Books, writing

play word games, etc. materials, paper,
journals, dialogue,
 discussion, debates,
etc.

Mathematical Through reasoning Experiment, ask Things to explore and

questions, solve logical think about, science
logician
puzzles, calculate, etc. materials, things to
manipulate, visits to the
planetarium and
science museum, etc.

Space In images and Design, draw, visualize, Art, Lego, videos,

photographs doodle, etc. movies, slides,
imagination games,
mazes, puzzles, picture
books, museum visits,
etc.

Body-kinetics Through somatic Dance, run, jump, build, Acting games, theater,
sensations touch, gesture movement, things to
build, sports and
physical games, tactile
experiences, direct
learning experiences,
etc.

Musical Through rhythms Sing, whistle, sing Time dedicated to

and melodies melodies with your singing, attending
mouth closed, beat the concerts, playing music
rhythm with your feet or at home and/or at
hands, listen, etc. school, musical
instruments, etc.

Interpersonal Exchanging ideas Direct, organize, relate, Friends, group games,

with other people manipulate, attend social gatherings,
parties, mediate, etc. communal festivities,
clubs,
master/apprentice
learning

Intrapersonal very intimately Set goals, meditate, Secret places, time to

dream, be quiet, plan. be alone, projects
handled at your own
pace, alternatives, etc.
1.4. FUNDAMENTALS OF THE INTERVENTION PLAN TO BE USED IN THE
CASE:

After having evaluated Nahely and having as a diagnostic presumption a delay in

language development, it has been considered pertinent and appropriate to develop an
intervention plan in language therapy, taking as reference the difficulty he presents and
his characteristics already mentioned.

All areas were worked on because there is a delay in the birth of all levels of language,
which mainly affects expression, although comprehension is less affected.

When we talk about a delay in the appearance or development of language, it is

because the phonological, morphosyntactic, semantic and pragmatic levels are not
adequately presented at their age; all codes are affected.

Simple language delay is a dysfunction that usually affects more than one of the levels
of language, with phonology and syntax being the most affected; these mainly affect
expression and in some, comprehension without the cause being due to a hearing
impairment or neurological disorder. This shows slow language development that does
not correspond to chronological age. It presents as an insufficiency of the linguistic
aspect at the expressive, comprehensive and articulatory level.

RSL uses a reduced vocabulary and truncated speech. He generally omits initial
syllables and usually has infantilized speech.
It is observed that:
 At the phonological level, the child speaks like a baby.
 At a semantic level, he has few words to communicate, only everyday things,
this prevents him from advancing in his knowledge.
 At a morphosyntactic level, the sentences with which it is expressed are short.
 At a pragmatic level, having little vocabulary does not allow him to express
himself freely, generally in short form, this influences the description of objects
and the development of thought.

In understanding, gaps may appear in temporal-spatial notions, difficulties in school

learning because it only understands specific situations and their family environment.
The causes may be socio-cultural because it depends on the family model, it may also
be due to emotional factors because overprotection predominates, mothers who guess
what they say, think and speak or, on the contrary, abandonment or indifference to the
child's needs.

RSL is an evolutionary language dysfunction with chronological mismatch, children

who do not present obvious intellectual, relational, motor or sensory alterations.
Their multiple intelligences are discovered and developed, in this case their musical,
physical-kinesthetic, visual-spatial, interpersonal, intrapersonal intelligence
predominated and ecological intelligence, mathematical logic, and linguistics were
included, which predominated to a lesser degree.
Working on all areas allowed him to improve the point and mode of articulation,
increase his vocabulary, improve the structure of his sentences, teach him that there
are words that he should use to have a good and better relationship with the people
around him and thus he would be improving. their verbal expression and
understanding.

CHAPTER II
METHODOLOGY

2.1. DIAGNOSIS
Simple delay in language development and simple dyslalia of the multiple vibrating “rr”
phoneme or rhotacism.

2.1.1. Behavior observation:

The boy Tommy Bryan, with dark skin, short hair, droopy eyes, has a stained and
decayed front tooth, his face is not very expressive. At first he was insecure, shy, quiet,
and even in the evaluations when he did not understand the instructions he stayed
looking at me in silence without getting a response, but in the process of the sessions
he was collaborating and showing interest, because he was motivated by the bubble
games and the different materials that were applied.
During the sessions he collaborates with enthusiasm.
He jumps with both feet but his movements are not coordinated, he colors in only one
direction and he likes to draw.
He cuts and pastes properly and does it with pleasure.

2.1.2. Managed instruments:

review
Considering that Tomy Bryan is a child with a language disorder, the administration of
the following instruments was considered pertinent:
 Orthophonic Examination that measures the type of breathing, sucking, chewing, and
swallowing. Organic appearance of the lips, labial and lingual praxis. Organic
appearance of the Palate, teeth, bite, jaw, tonsils.

Orofacial Practices Examination: Measures the practices that the child can perform by
age (from 2 to 8 years old)

Joint Exam:
repeated language
Directed language (Melgar test) It is a language test aimed at children from three years
of age and allows us to know if the child has good articulation of phonemes, consonant
groups, and diphthongs in their different initial and middle positions. , final and inverse
in some cases. Likewise, it allows us to know whether or not these have appeared at
the age at which each one should appear.
It lets us know which phoneme the child has difficulty with and thus prepare a good
rehabilitation program.

Plon – R It is a test that serves as a rapid detection of oral language development.

Navarra Oral Language Test (PLON) (Aguinaga et al., 1990). It is an individual

application test aimed at children from 3 to 6 years old. It evaluates the child's oral
language and the phonological, morphological, pragmatic and lexical aspects in the
early stages of schooling (form, content and use). It evaluates the following: the
informative function (referential, denominative, tact...), the request function
(imperative, regulatory, self-regulatory, command, etc.), the metalinguistic function
and the language that the child uses spontaneously throughout the test. from a
functional point of view.

Peabody

Evaluate the vocabulary level. Age of application: between 2.5 and 18 years. A
measure of general intelligence. This scale should be seen as an achievement test
since it demonstrates the extent of the subject's Spanish vocabulary acquisition. And
on the other hand, it can be conceived as a test to discern scholastic aptitude From 2
and a half to 18 years. Measures the individual's receptive or auditory vocabulary. It
suggests (verbal ability or intelligence) or as one among the elements of a global
battery of tests of cognitive processes. Although far from a perfect predictor, a
vocabulary test has been found to be the single best index of school success.

Expressive Language Test (Gardner): Which allows obtaining an estimate of the child's
expressive vocabulary of words.
Comprehensive Language Test (Gardner): Which allows obtaining an estimate of the
auditory vocabulary of individual words that the child has acquired.
2.1.3. Specialized Report:

THERAPY EVALUATION REPORT

ORAL LANGUAGE

GENERAL DATA
Surnames and names : Ccala Zuloaga, Tommy Bryan
Sex : Male
Age : 6 years 6 months
Birthdate : July 15, 2003

Exam date : January 16, 19, 23, 26, 30.

Informant : Parents and the child
Examiner : Victoria Vizcarra V.

Techniques used : - Observation

- Interview

Applied tests :- Orthophonic Examination

- Orofacial Praxias Examination
- Joint Examination
- Evaluation of Multiple Intelligences
- Receptive Language Word Figure Test
- Expressive Language Word Figure Test
- Navarra Oral Language Test: 6, 5, 4
- Peabody Picture Vocabulary Test
_______________________________________________________________

REASON FOR CONSULTATION

The boy Tommy Ccala was brought for consultation by his father who reported
that his child does not pronounce the “rr” well, that he has difficulty paying
attention, formulating sentences and that he does not have friends at school.

BEHAVIORAL OBSERVATIONS
The boy Tommy, 6 years and 6 months old, is a boy with dark skin, straight
black hair, he wears it very short, he is missing two teeth.
At first he seemed somewhat shy and quiet but then he began to let go and
express his feelings, needs and ideas.
Collaborated during the evaluations.
He appears neat and is punctual.
Likewise, it is observed that he presents eye contact and follows short
instructions of one statement, but not those of two or three, since it presents
difficulty.

RESULTS
In the lexical-semantic component :
He performed below his chronological age, in expressive vocabulary, with a
performance age of 4 years 2 months (lower), and in comprehensive vocabulary
with an age of 4 years 8 months on the Peabody test (moderately low) and a
age 5 years 5 months on Gardner test (below average)
He managed to identify the basic colors: “red”, “green”, “yellow”, “blue”;
recognized spatial notions: “in front”, “behind”, “to the side”. He verbalized the
opposite of “big,” “hot,” tomorrow,” “fast,” “thin,” failing at “hard.”
He orally expressed the solution to three basic needs (what do you do if you are
sleepy, hungry, cold, thirsty?) failing in the last one.
Only one category was distinguished: clothing, presenting difficulty in food, toys,
vehicles and furniture.
He pointed out some parts of the body such as: “elbow”, “knee”, “neck”, “foot”
failing in: “ankle” and “heel”.
He named the following verbs: “cut out”, “jump”, “paint”
Explain what they are used for: the eyes, mouth, ears and hands, failing the
nose.
He defined only three words out of six proposed for his age.
He identified three elements, proposed for his age, that do not belong to a given
category.
He had difficulty executing three simple commands in the indicated sequence.
He pointed out four objects that serve an indicated function, failing in one.
He does not know several expected words for his age and for younger ages.

In the morphosyntactic component:

In front of a sheet he produced six short sentences, mostly of 4 elements, with
flaws in their structuring.
Omits the article and the subject, has difficulty identifying and naming some
nouns and verbs; as well as to conjugate them, it does not use pronouns,
adjectives, adverbs of time. It manages to retain a morphosyntactic structure of
8 elements.

In the pragmatic component:

The child, after gaining trust with the examiner, was able to transmit his tastes
and experiences spontaneously in a low voice.
In front of a picture he is not able to describe what is happening, limiting himself
to naming what he observes using short phrases.
He is not able to order the sequence of a three-story story and he is not able to
tell it, he only limited himself to uttering a short sentence of two elements for
each image observed.
He was not able to explain how to play chapadas, a game that he usually plays.
In the phonological phonetic component:
In the articulation test in repeated language, he was able to emit the direct
syllables, except the one that has the multiple vibrating phoneme "rr", replacing
it with the phoneme "d", he was able to emit the inverse syllables, the
consonant groups and diphthongs appropriately, and he also repeated the
appropriately proposed phrases, except the word dog since it distorts the
multiple vibrating phoneme “rr” emitting a sound similar to the phoneme “d”.
In directed language, the multiple vibrating phoneme “rr” also distorts the
phoneme, making a sound similar to the “d” phoneme.

CONCLUSIONS:
- In the orthophonic examination, it is observed that he has audible, nasal,
clavicular breathing.
He manages to suck, chews the bread with a little effort, clicking and with
his mouth closed.
He has already lost two teeth and one is decayed and stained, and he
has a short and thick lingual frenulum.
- In the pragmatic component, he is able to establish eye contact and
maintain a conversation, uses short sentences in a low voice and is not
able to describe or relate.
- In the lexical-semantic component he performed below his chronological
age. In expressive language with an age of 4 years 2 months (lower)
In comprehensive language, he reached an age of 4 years 8 months in
test (moderately low).
- In the morphosyntactic component there is difficulty in structuring
sentences.
- In the phonetic-phonological component, he is capable of emitting the
phonemes expected for his age except for the multiple vibrating
phoneme “rr”, since it distorts it, emitting a sound similar to the phoneme
“d”.
He carried out the proposed practices except: tongue up, tongue down,
Wide tongue, stuffed, rotating, showing teeth, blowing
sticking out lips, tongue over teeth, biting upper lip,
apex behind the upper incisor.

RECOMMENDATIONS:
To the kid
- It is recommended that the child begin language therapy in a sustained
and constant manner that affects the lexical-semantic components to
increase their level of comprehensive and expressive, morphosyntactic
and pragmatic vocabulary as well as the phonetic-phonological
 component to acquire the correct production of the expected phonemes
for their age.
- Strengthen the stomatognathic functions that thus allow greater strength
in the phonoarticulatory apparatus: these are: chewing, swallowing,
sucking, breathing.
To the parents
- Increase your comprehensive vocabulary through activities of daily living,
completing small errands with one, two, and then three prompts at a
time.
- Narrate the activities that are carried out daily at home so that the child
increases his or her expressive and comprehensive vocabulary.
- Properly name objects that the child does not know.
- Exercise at home what you worked on in therapy.

………………………………………….

2.1.4. Evaluation Profile:

LEVEL

SKILL AREAS LOWER BELOW AVERAGE ABOVE SUPERIOR

AVERAGE AVERAGE
SYNTAX
MORPHO:
-Variable words x
-Invariable words
-Sentence
structuring x

SEMANTICS
-Expressive x
Vocabulary
-Comprehensive x
Vocabulary x
-Categorizations
- Meaning of
phrases and x
sentences.
PHONETIC
PHONOLOGICA
L
Functional
Anatom. x
-Breathing x
-Blew it x
-Facial x x
Bucolinguo x
Praxias x
-Relaxation x
-Suction
-Chewing
-Swallowing
-Point and mode
PRAGMATIC
-Eye contact x
-Responses to
communicative x
exchanges
-Maintenance of a x
theme x
-Gest. Expression
Victoria Vizcarra 2010

x
Performance Profile after Evaluation

2.2. SPECIALIZED INTERVENTION :

2.2.1. Intervention Plan:

INTERVENTION PLAN UNDER THE APPROACH OF MULTIPLE INTELLIGENCES

I. GENERAL DATA
Names and surnames : Tommy Bryan Ccala Zuloaga
Age : 6 years 6 months
Birthdate : July 15, 2003
School grade : 2nd grade of Primary
School : The proceres
Intervention period : From January 16 to
Intervention schedule : Tuesday from 4:00 to 4:40 and
4:50
 to 5:30.
Saturdays from 11:00 to 11:45

Practitioner Specialist : Victoria Vizcarra V.

II. COMPETENCE
Communicates their needs, interests and feelings using oral language,
facilitating an adequate establishment of interpersonal relationships.

II. GENERAL PLAN

AREA SUB-AREA

LANGUAGE Functional Anatom:

Relaxation
Lingual and labial praxias
Breathing, blowing, sucking, chewing, swallowing, massage
functions

Phonological phonetic:
Auditive discrimination
Point and mode of articulation.

Pragmatics:
Conversational resources
Ability to inform, describe, narrate.

Semantic lexicon
Expressive vocabulary
Comprehensive vocabulary
Categorizations.

Morphosyntactic:
Sentence construction
Sentence Structuring
Construction of discourse.

2.2.2. Session Development:

 II.2.3. Intervention Period Report

REPORT ON SPECIALIZED INTERVENTION OF LANGUAGE LEVELS

I. GENERAL DATA:
Surnames and names : Ccala Zuloaga Tommy Bryan
Sex : Male
Age : 6 years 6 months
Birthdate : July 15, 2003
Scholarship : Second grade of primary school

______________________________________________________________________

Intervention Period: From January 16 to 03/20/10

Intervention Hours: Tuesdays from 4:00 to 4:40 and from 4:50 to 5:30
Saturdays from 11 a.m. to 11:45 a.m.

II. BEHAVIORAL OBSERVATIONS:

The boy attended all the sessions punctually and enthusiastically, in the
company of his older brother, missing only one.
He collaborated during all the sessions, paying attention and showing enthusiasm
and tolerance for the activities. At first he did not like the practices very much but
the material used motivated him and upon seeing his progress he showed greater
interest.
He likes to play with blowing materials: blow box, whistles, trumpets, blowing out
the candle, balloons, blowing water through straws, pinwheels, bubbles, mother-in-
law scares, stuffed animals with sound and plastic animals.
He also likes to draw and cut out.

III. AREAS WORKED:

LANGUAGE
PHONETIC SEMANTIC SYNTACTIC PRAGMATIC
PHONOLOGICAL LEXICON MORPHO

- Relaxation was - Worked -Worked on - Communicative

worked on vocabulary executing errands intentionality was
- Lingual praxias and expressive and of 1, 2 and 3 orders reinforced through
Lipstick. receptive. at a time. spontaneous and
- Massages for the - Categorizations. -Nouns, verbs, verb directed dialogues,
Tongue and frenulum - Opposites tenses, adjectives, storytelling,
Sublingual. - Verbal absurdities articles in singular responses,
- Functions of: and plural form. descriptions,
Breathing, blowing, -Sentence narrations.
Suction, formation.
Chewing,
Swallowing.
- Discrimination
Auditory.
- Point and mode
joint of the
phoneme “rr”.

IV. ACHIEVEMENTS
IV.1 Phonetic Phonological Area:
- He managed to perform most of the lingual practices.
- He learned the mechanics of breathing and blowing.
- The mechanics of sucking, chewing and swallowing were exercised and
matured.
- He exercised his auditory discrimination, managing to identify the sounds in
words while developing his attention and concentration.
- He learned the point and mode of articulation of the phoneme “rr” through
repetition.

4.2 Semantic Lexical Area:

- Name the parts of your body
- Name your family members
- Name fruits
- Name vegetables
- Name farm animals and their onomatopoeia
- Answer simple riddles
- Name items of clothing for men, women, boys, girls.
- Name foods
- Name means of transportation
- Understand and use opposite words.
- Name school supplies.
- Name household furniture.
- Name cleaning supplies.

4.3 Morphosyntactic Area

V. DIFFICULTIES
V.1 Phonetic Phonological Area
-He was unable to blow above his lower lip.
-He was unable to produce the phoneme “rr” spontaneously.

V.2 Morphosyntactic Area

-He makes short sentences for his age, he is not yet able to make more
complex sentences.

5.3. Pragmatic Area

-Has difficulty telling the correct sequence of stories and stories.

VI. CONCLUSION:
During the intervention period, a great improvement was noted in the
phonetic-phonological area and in the lexical-semantic area, increasing their
expressive and comprehensive vocabulary. But the phonetic-phonological,
semantic, morphosyntactic and pragmatic components are still in process,
having achieved a progress of 60%.
 VII. RECOMMENDATIONS:
To the kid:
- Continue with speech therapy in 45-minute sessions three times a week.
- Continue working on the phoneme “rr” in your spontaneous language as
well as reading stories and practicing answering questions about them.

To the parents
- Increase your comprehensive vocabulary through activities of daily living,
completing small errands with one, two, and then three prompts at a
time.
- Narrate the activities that are carried out daily at home so that the child
increases his or her expressive and comprehensive vocabulary.
- Properly name objects that the child does not know.
- Exercise at home what you worked on in therapy using the notebook as
a model.
- Use the strategies provided in the parent workshop.

To the teachers:
- Reinforce what has been learned through the use of multiple intelligences
in their school activities.

2.2.4. Comparative Intervention Profile:

LEVEL

SKILL AREAS LOWER BELOW AVERAGE ABOVE SUPERIOR

AVERAGE AVERAGE
SYNTAX
MORPHO:
-Variable words x x
-Invariable words
-Sentence
structuring x x

x x
SEMANTICS
-Expressive x x
Vocabulary
-Comprehensive
Vocabulary x x
-Categorizations x x
- Meaning of
phrases and x x
sentences.
PHONETIC
PHONOLOGICA
L
Functional
Anatom. x x
-Breathing x x
-Blew it
-Facial x x
Bucolinguo
Praxias x x
-Relaxation x x
-Suction x x
-Chewing x x
-Swallowing x x
-Point and mode

PRAGMATIC
-Eye contact xx
-Responses to
communicative x x
exchanges
-Maintenance of a xx
theme
-Gest. Expression x x
Victoria Vizcarra 2010

x
Performance Profile after Assessment

x Performance Profile at the end of the Intervention period

 CHAPTER III
RESULTS

3.1. CONCLUSIONS

3.2. RECOMMENDATIONS

CHAPTER III RESULTS

3.1 CONCLUSIONS
During all sessions we worked on combining the 4 areas of language with
multiple intelligences, obtaining a positive result for the child.
 In the Phonetic-Phonological component combined with activities related to multiple
intelligences, the child was able to correctly produce the direct phonemes that he was
missing /S/, /L/, /N/, /G/ and /D/, unfortunately due to lack of time the child has not yet
internalized the phonemes /S/ and /D/ in spontaneous language; Due to the small
number of sessions, I did not have enough time to work on the rest of the phonemes
that are missing, which are the locked, liquefying and the vibrant and simple 7R/.
Currently, Carlos's expressive language is more understandable, since before the
sessions he spoke like a baby and omitted and distorted many syllables in his short
sentences.
 In the Semantic component, it was possible to significantly increase the child's
vocabulary through games based on multiple intelligences such as songs, riddles,
puzzles, games with plastic dolls, miniature fruits, etc. Carlitos increased his vocabulary
in the categories: Clothing, body parts, means of transportation, animals, wild animals,
domestic animals, professions, trades, fruits, vegetables and insects, managing to
categorize each of them by 85%.
 In the Morphological component Carlitos did not structure the sentences correctly since
he omitted several phonemes and only spoke sentences of 3 or 4 words, which is not
appropriate for his age, after many activities such as games, stories, songs, riddles,
rhymes, etc The child structures longer sentences and can express his thoughts and
ideas more easily.
 In the Pragmatic component, Carlos showed during the evaluations little creativity, poor
memory, and little attention to me and to the images presented so that he could
describe them in detail. Currently, after having worked with songs, puppets, color and
black and white plates, stories, verbal absurdities, graphic absurdities, etc. Carlos
shows greater confidence when speaking and when telling his experiences, he now
explains his ideas better, understands the messages received, and answers correctly
the questions raised referring to a topic worked on by 95%.
 The family collaborated very little, since the mother does not stop with the child during the day
since she is working and only sees him at night and no longer has time to review her
notebook; The one who did show concern at all times was his grandmother. She took him to
therapy and made him review his notebook. Unfortunately, since he has several
grandchildren, two more of whom also went to therapy with Carlitos, the attention was not
100%. with Carlos.

3.2 RECOMMENDATIONS
3.2.1 For the child:
o Continue with therapies.
o Evaluate it every six months to see if there are further improvements.

3.2.2 For Parents:

o Dedicate more time to your child
o That during the short time they see him they do not conceive him much, they should
not confuse conceit with spoiling.
o Enroll your child to continue with speech therapies and be punctual in going to all
appointments.
o Don't leave all the responsibility to grandma.
o That parents receive couple talks so that they know how they can better raise their
children.
3.2.3 To teachers:
o That they understand that each child learns differently and that is why it is best to
teach based on multiple intelligences.
o That they be trained in teaching through multiple intelligences so that they can better
reach all their students.

BIBLIOGRAPHY

BUSTO MARCOS, MC (1998): Manual of school speech therapy. Madrid: CEPE.

BUSTS, I. (1984): Auditory discrimination and speech therapy. Madrid: CEPE.

MIRAS MARTÍNEZ, FRANCISCO. Evaluation of articulatory development. Cisspraxis

SA

MONGE DÍEZ, R. (1999)Myofunctional Therapy. Lingual Praxias. Barcelona: Isep

intervention.

PASCUAL, P. (1988): Dyslalia. Madrid: CEPE.

PASCUAL GARCÍA, PILAR. Treatment of articulation defects in the child's language.

Cisspraxis SA

PEÑA CASANOVA, J. (1990): Manual of speech therapy. Barcelona: Masson.

PUYUELO, M. AND OTHERS (1997, 2001). Clinical cases in speech therapy 1.

Barcelona: Masson.
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