| 58991 | | Plan Date: 03-18-2026 | | Speech Assessment Summary: Johnathan is a 3-year, 5-month-old male who presents with a severe receptive and expressive language disorder, confirmed through formal standardized assessment and clinical observation. Administration of the Preschool Language Scale, Fifth Edition (PLS-5) yielded profoundly delayed scores, including a Total Language Score of 50, which falls at the 1st percentile and is more than 3.0 standard deviations below the normative mean. His performance indicates auditory comprehension skills equivalent to an 11-month-old and expressive communication skills at a 9-month-old level, representing a significant delay of up to 32 months. These objective findings directly correlate with clinical observations of the patient's functional impairments. While Johnathan was alert and separated easily from his caregiver, he demonstrated a notable inability to utilize eye contact, follow single-step commands, answer simple questions, or engage in reciprocal social exchanges. Functionally, these severe language deficits profoundly impact his ability to communicate basic wants and needs, leading to frequent communication breakdowns and placing him at risk for frustration-based behaviors. This communication impairment severely limits his capacity for social participation with peers, hinders his ability to engage in pre-academic activities, and presents safety concerns due to his inability to comprehend verbal directions. The global nature of his presentation, particularly the deficits in attention, turn-taking, and ability to follow commands, suggests that a multidisciplinary approach is essential for meaningful progress.
Given the severity of his functional impairments and the significant impact on his ability to participate in daily routines, skilled Speech Therapy is determined to be medically necessary. The patient's inability to engage in purposeful play, follow directions, and participate in social turn-taking indicates deficits in regulation, attention, and processing that are critical for functional independence and safety. An intensive therapeutic model is warranted to address these profound delays and prevent further regression. Therefore, it is recommended that Johnathan receive Speech Therapy two times per week to reduce measurable deficits in these areas and improve his ability to safely and effectively interact with his environment. Deferring this essential intervention would place Johnathan at significant risk for a widening of developmental gaps across multiple domains, negatively impacting his social-emotional development and limiting his potential to benefit from other therapeutic and educational opportunities. | | Speech Progress to Date: Baseline is currently at 0. | | Speech Rehabilitation Potential: Good. with consistent Speech Therapy and parental support. Johnathan will be discharged when he achieves a standard score above 1.5 standard deviations from the mean for all impairments, indicating that his speech and language skills will be in the mild to average range and he will have met all long term therapy goals. | | Speech and Language Long Term Goals: | | Category | Goal Description | | Home Management Intervention Program | When counseled by the clinician, parents will incorporate the home management intervention program as a daily and weekly activity to transfer skills learned in therapy into the home environment. Home management training will optimize patients functional communication tasks in the home. | | Receptive Language | Johnathan will demonstrate improved receptive language abilities to support functional understanding of his environment, including comprehension of spoken language and environmental cues, in order to increase his participation, safety, and independence in daily routines. | | Expressive Language | Johnathan will demonstrate improved expressive communication abilities using a total communication approach to effectively express wants, needs, and social intent, in order to enhance functional communication and reduce communication breakdowns across environments. |
| | Speech and Language Short Term Goals: | | Category | Goal Description | | Expressive Language | Johnathan will use a total communication approach (e.g., gestures, signs, vocalizations, or AAC) to communicate wants, needs, and protests in 4 out of 5 opportunities with moderate support across 3 consecutive sessions. | | Expressive Language | Johnathan will imitate a variety of vocalizations, animal sounds (e.g., “moo,” “woof”), and environmental/exclamatory sounds (e.g., “beep beep,” “uh-oh,” “vroom”) during play-based activities in 4 out of 5 opportunities with moderate modeling and verbal/visual cues across 3 consecutive sessions. | | Receptive Language | Johnathan will demonstrate understanding of functional and early symbolic play by appropriately engaging with toys (e.g., feeding a baby doll, pushing a car, pretending to drink from a cup) following clinician modeling or verbal prompts in 4 out of 5 opportunities with moderate visual and verbal cues across 3 consecutive sessions. | | Receptive Language | Johnathan will follow familiar one-step directions (e.g., “give me,” “come here,” “sit down”, “pick up”, “stop”, “wait” ) in 4 out of 5 opportunities with moderate gestural cues across 3 consecutive sessions. | | Receptive Language | Johnathan will receptively identify familiar objects from a field of 2 (e.g., “Where’s the ball?”) in 4 out of 5 opportunities with moderate cues across 3 consecutive sessions. | | Receptive Language | Johnathan will respond to his name (e.g., orienting head, making eye contact, or pausing activity) in 4 out of 5 opportunities with moderate cues across 3 consecutive sessions. |
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