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Augmentative and Alternative Communication for a Client with Broca’s Aphasia
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
78.5 Description of Problem and
Recommended Treatment
EB presented with characteristics consistent with Broca’s aphasia. She had received prior therapy focused on restoring language expression abilities; however, little improvement was
observed from this intervention. Given her desire to return to
social routines, the decision was made to implement AAC supports to compensate for her language deficits. Recognizing the
benefits of a multimodal communication approach, an appropriate high-technology AAC device was identified and EB was
also trained on other communication strategies including communicative drawing and the use of gestures and facial expressions to increase communicative effectiveness.
EB trialed three high-technology devices during communication activities in therapy sessions to determine the most effective device to address her communication needs. The clinician
observed EB using these devices. After using each device, EB
and her husband provided input on their strengths and weaknesses. This information was taken into consideration, and a
final device was ordered for EB. The selected device was a lightweight tablet that EB found easy to carry given her continued
issues with hemiparesis. In addition, the device allowed EB to
take photos and import them as communication supports.
78.6 Outcome
Upon receiving her AAC device, EB and her husband attended
12 therapy sessions over the course of 6 weeks focused on programming and functional use of the device. As recommended
by the clinician, EB and her husband identified two key times of
the day during which they felt that communication was an
obstacle and that they had time to devote to incorporating AAC.
It was during these specific times that they were instructed to
practice using AAC and to document any challenges that arose
from those interactions. They then met with the clinician to discuss the documented challenges and to develop appropriate
strategies to improve their interactions. After approximately 3
weeks of gradual implementation of the AAC system and
receiving feedback from the clinician, EB and her husband
began to report increased communication success. Further
treatment was provided to increase the time they spent focused
on AAC implementation. Recognizing that EB would need consistent ongoing support with her AAC system, the clinician also
provided EB’s husband and adult daughter with training on
programming the device and assisting her with communication
breakdowns.
After discharging from therapy, EB began attending individual and group therapy at a local university clinic focused on the
use of the camera in device to document her day for future
communication interactions and on improved verbal and written expression abilities. Although retesting using the WAB-R
indicated minimal improvement, EB and her husband reported
that she had returned to some of her former social routines. She
began to attend a weekly lunch with old friends and started to
go to church again. EB’s children reported that she is more
engaged and appears happier than she was before she began
outpatient therapy. She particularly enjoys attending group
therapy, and although she still gets frustrated with communication challenges, she remained hopeful of continued improvement and increased independence.
78.7 Key Points
●
Although restorative therapy is essential for individuals with
aphasia, it is imperative that clinicians also identify effective
compensatory communication methods. EB’s initial therapy
focused solely on improved expression, but she was unable to
meet her communication needs. Effective AAC supports
should be a focus of treatment early in recovery along with
restorative interventions.
●
It is essential to assess the unique needs of each client with
aphasia to design the most effective AAC systems possible. A
needs assessment must address communication partners, frequent environments, important topics, and hobbies.
●
People who rely on AAC often benefit from the support of a
facilitator for programming and maintenance of AAC systems
and for assistance when interacting with less familiar communication partners. As such, clinicians should consider identifying a facilitator for clients who rely on AAC.
Suggested Reading
[1] Simmons-Mackie N, King JM, Beukelman DR, Eds. Supporting Communica-
tion for Adults with Acute and Chronic Aphasia. Baltimore, MD: Brookes;
2013
Reference
[1] Kertesz A. Western Aphasia Battery-Revised (WAB-R). San Antonio, TX: Pear-
son; 2006
309
Utilization of Self-Help Activities for an Adult Who Stutters
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
79 Utilization of Self-Help Activities for an Adult Who
Stutters
Mitchell Trichon, Annie Bradberr y, and Shane Wilmoth
79.1 Introduction
Stuttering has often been defined by the overt features that can
be heard or seen when speaking. To many people who stutter
(PWS), such definitions ignore some aspects that affect quality
of life, such as negative thoughts and feelings associated with
speech or the decision not to speak to avoid stuttering. Such negative feelings can include helplessness, shame, fear, embarrassment, frustration, and loneliness.
far-reaching and can impact a person’s personality, education,
relationships, and career.
activities can lessen the negative impact stuttering can have by
providing positive experiences, which can be beneficial in
improving quality of life. Self-help activities are an underutilized resource for many people with communication disorders.
However, more PWS are seeking these activities as they are
increasingly accessible through self-help organizations (e.g.,
National Stuttering Association and Friends – The National Association of Young People Who Stutter) and Internet-based
options such as Facebook groups and video-conferencing communities (e.g., Stutter Social). In addition, evidence now suggests that participation in such activities is helpful to PWS.
2,3
1,2
The impact of stuttering is
Connecting PWS through self-help
4,5,6,7
79.2 Clinical History and
Description
DR was a 41-year-old male who stuttered; he self-referred for
therapy following an increase in stuttering. He attributed the
increase in disfluency to increased stress at work as a result of a
job change requiring more verbal communication with teenagers. DR reported that he had stuttered since age 5 and had a
grandfather who reportedly outgrew his stuttering as a child.
DR received therapy from elementary school through high
school. He reported that, during early elementary school, he
and his clinician worked on using a metronome and tapping his
Table 79.1 Stuttering Severity Instrument-Fourth Edition (SSI-4) results
SSI–4 categories Data Task score
Frequency Percentage of stuttered
syllables—reading 10%;
speaking 17%
Duration 5.7 seconds average of
longest three
Physical concomitants High pitch during prolon-
gation, throat clearing,
open mouth articulatory
posture, eye twitching,
reduced eye contact,
head turning, laryngeal
tension, limb movements
Total 42
15
12
15
hand to his leg to control his speech rate. He found both to be
ineffective at improving fluency and attributes them as contributing factors to his secondary behaviors. He also reported
using filler words to avoid or delay stuttering. In his early 20 s,
he attended a university clinic where he learned fluency-shaping skills, including easy onsets and pausing/phrasing to
improve his fluency. He found that the easy onsets helped him
to communicate more easily until he returned home from college when he discontinued regular use of these skills.
79.3 Clinical Testing
The initial evaluation took place at a university clinic. Oral
peripheral examination was within normal limits and hearing
screening revealed normal responses to pure tone screening at
20 dB at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz in both ears.
DR reported increased difficulty talking under time pressure,
with smaller groups, and on the telephone. He reported that
stuttering interfered with work and social relationships, but
had little impact on family relationships. DR also reported that
he lacked self-confidence, and often felt lonely, anxious, and
frustrated. He described positive experiences with previous
therapy and was interested in participating in a support group.
The Stuttering Severity Instrument-Fourth Edition (SSI-4)
was administered to assess the severity of overt features of stuttering (i.e., frequency, duration, physical concomitants). DR’s
overall score was a 42, which corresponded to a “very severe”
fluency disorder, as shown in ▶ Table 79.1, based on a reading
and speaking task, both with over 300 syllables.
The Overall Assessment of the Speaker’s Experience of Stuttering-Adult Version (OASES-A)
uate four different aspects of DR’s perception of observable
stuttering behaviors, his reac tions to stuttering, challenges with
communication in daily situations, and how stuttering interfered with quality of life. The 100-item questionnaire includes
questions on a 5-point scale, with 5 meaning the most severe
negative impact of stuttering. DR’s scores of each section and
the total are presented in ▶ Table 79.2.
Table 79.2 Overall Assessment of the Speaker’s Experience of Stuttering
(Adults) (OASES-A) results
Section Impact score Impact rating
I—General information
II—Your reaction to
stuttering
III—Communication in
daily situations
IV—Quality of life 2.90 Moderate
Total 3.19 Moderate/severe
3.33 Moderate/severe
3.31 Moderate/severe
3.22 Moderate/severe
9
was also administered to eval-
8
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Utilization of Self-Help Activities for an Adult Who Stutters
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
An informal fluency probe was also conducted to determine
which fluency-enhancing behaviors were optimal for fluencyfocused therapy. DR successfully implemented easy-onset phonation 10/10 times (100%) at both word and sentence levels
with clinician modeling. DR was also able to use light articulatory contacts 10/12 times (83%) at both word and sentence levels with clinician modeling. DR had difficulty with pausing and
phrasing during a reading task but successfully implemented
reduced speech rate to increase his fluency.
DR was cooperative throughout the assessment. He
expressed motivation to gain more control of his stuttering and
expressed an interest in revisiting strategies he previously had
success with, including easy onsets and light articulatory contacts. He was also open to other recommendations.
79.4 Questions and Answers for
the Reader
1. Why is it important to assess the client’s perceptions and
attitudes about their stuttering and communication, in addition to the severity of the observable features of stuttering?
a) Severity of observable features of stuttering are not a good
indicator of how stuttering impacts a client’s daily life.
b) Client perceptions and attitudes of their stuttering and
communication may provide valuable information that
can guide therapy and help address specific challenging
situations.
c) Client perceptions and attitudes help the clinician to
understand how the client experiences their stutter,
instead of how others experience the client’s stuttering.
d) All of the above.
Answer: d is correct. The observable severity of a person’s stut-
ter often does not correlate with how stuttering impacts their
life. For example, someone who may be good at avoiding stuttering may be severely impacted by their stuttering. As stated
in b, assessing the client’s perceptions and attitude about their
stuttering can give the clinician valuable information about
what to do in therapy. As stated in c, it provides insight into the
client’s thoughts and feelings about their stuttering and provides a potential way to discuss feelings and attitudes with clients when reviewing the assessment with them.
a, b, and c by themselves are incorrect. They leave out the
other correct answers.
2. Which of the following benefits is least likely to occur by par-
ticipating in a self-help activity for PWS (with verbal communication)?
a) Receive training in the mechanics of particular speech
skills.
b) Learn about others’ experiences of using various speech
skills.
c) Have a supportive forum to potentially practice speech
skills that they learned in therapy.
d) Receive exposure to various views and ideas about stut-
tering and being a person who stutters.
Answer: a is correct. A person who participates in a self-help
activity is not likely to receive training in the mechanics of
speech skills. This may be a topic of discussion but speech train-
ing is usually discouraged by self-help activity leaders. If speech
training is involved in such a forum by a licensed professional,
then it should be labeled as a therapy group.
b is incorrect. PWS often discuss their experiences of current
or past therapies or speech skills that were used. This is especially true when someone is asking questions about using a particular approach or speech skill.
c is incorrect. Many PWS use verbal self-help activities as a
supportive environment in which they can practice or use
speech skills or a therapy approach that they have previously
learned.
d is incorrect. One of the benefits of participating in self-help
activities for PWS is learning about how PWS have different
attitudes and ideas about stuttering and being a PWS. This
often results in giving clients more options related to their stuttering and related feedback about how others manage challenging situations.
3. A client presents with severe stuttering (observable fea-
tures). The client also reports that he avoids verbal communication because of the shame and embarrassment associated with stuttering. Which of the following statements is
least likely to be a possible successful therapy outcome for
this client?
a) Reduced number of moments of stuttering (frequency)
inside and outside of the clinic.
b) Reduced amount of physical struggle when stuttering
(duration of moments of stuttering/secondary character-
tering outside of the clinic.
c) Increased everyday conversation initiation with less fear
of speaking, with no or minimal change in observable
stuttering severity.
d) Increased fluent speech in the clinic by using speech skills,
but chooses not to use speech skills outside of the clinic
because of self-reported unnatural sounding speech.
e) Increased fluent speech in the clinic by using speech
skills, but chooses not to use speech skills outside of the
clinic because his new sense of self-acceptance and
reduced stigma associated with stuttering.
Answer: d is correct. A client who has learned skills to speak
more fluently but chooses not to use these skills due to his/her
belief about the social acceptability of the technique (social validity) should not be considered as having achieved a successful
therapy outcome since the learned speech skills will not result
in improved verbal communication or reduction of stigma.
a is incorrect. A reduction of stuttering frequency that can be
generalized to everyday communication and should be considered a successful therapy outcome.
b is incorrect. A reduction of the physical struggle, which
includes shorter durations of moments of stuttering and reduction of secondary characteristics or physical concomitants of
stuttering, should be considered a successful therapy outcome,
even without a reduction of frequency of stuttering since it
would result in improved verbal communication.
c is incorrect. An increase in everyday conversation initiation
by someone who avoided conversation due to embarrassment
should be considered a successful therapy outcome since it
would result in increased verbal communication with less fear
of stigmatization of stuttering.
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Utilization of Self-Help Activities for an Adult Who Stutters
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
e is incorrect. A client who has learned speech skills to speak
more fluently who chooses not to use speech skills in everyday
conversation because he feels more empowered and less stigmatized by his stuttering should be considered as having
achieved a successful therapy outcome.
79.5 Description of Problem and
Recommended Treatment
DR was a good candidate for therapy and was recommended to
work with a speech-language pathologist once per week for 6
months before reevaluation. Since DR was motivated to gain
more control of his stuttering and was stimulable for easy-onset
and light articulatory contacts, it was important to include
working on these skills as a component of treatment. DR also
reported that he was fearful of speaking situations and often
tried to avoid stuttering, which had negatively impacted
aspects of his life.
DR expressed a willingness to meet with other PWS. He was
given information about the National Stuttering Association
(NSA) and their local chapter(s) and it was recommended that
he look into connecting with the local chapter for support.
79.6 Outcome
DR attended therapy and reported that he did not benefit much
because he was increasingly focused on becoming fluent
instead of improving communication, including reduced struggle when stuttering, reduced fear, increased initiation of conversation, and increased fluency. Despite the original recommendation, DR did not pursue a self-help group, but after a year
of treatment, DR found a website/organization called Stutter
Social. The organization is an Internet-based community of
PWS with voluntary hosts who guide supportive discussions
through scheduled video conferences. DR became a regular
weekly participant and integrated his experiences in the group
and the topics they discussed into discussions within his oncampus therapy sessions.
In communicating with other PWS, DR learned about various
self-help organizations, including the NSA and their supportive
activities. After a year of learning about people’s experiences
with the NSA through Stutter Social, DR traveled to and participated in an annual NSA conference and reported it to be “lifechanging.” He att ributed his self-acceptance of stuttering to his
experiences of participating in these various self-help activities.
During the next half year of treatment, DR became open to the
idea of using the strategy “voluntary stuttering” in his speech
as a way to stutter more easily. He had reported some success
in using this technique as one of his st rategic options. A year
and a half af ter becoming involved with the self-help stuttering
community, DR decided to terminate speech therapy services.
Although DR’s observable stuttering behavior remained severe,
he reported a reduction of stigmatization of stuttering, which
he attributed to the supportive relationships built through selfhelp organizations for PWS. DR also reported that he took com-
fort in knowing that he could go back to using his speech skills
such as easy onsets and voluntary stuttering if he wished.
DR continued his regular attendance in Stutter Social’s scheduled video-conference meetings. He also became more involved
in the NSA by regularly attending regional and annual conferences and taking on leadership roles to help other PWS.
79.7 Key Points
●
Participation in self-help activities for PWS has the potential
to reduce stigma and improve quality of life, empowerment,
and self-acceptance. Self-help activities are also a supportive
forum to practice therapy techniques and conversational
speech outside of the clinic and can assist with maintenance
and transfer of therapy techniques to real-life situations.
●
Depending on the therapy approach, some speech skills may
require cognitive or attitudinal changes for the client to begin
to use the new speech skill outside of the clinic and be generalized to everyday use. For example, empowerment and selfacceptance may be necessary to implement voluntary stuttering as a viable speech skill in everyday communication.
●
Success in stuttering treatment can be defined in various
ways, including reduced struggle of stuttering, increased fluency, reduced fear of speaking, and increased enjoyment of
speaking.
●
Self-acceptance of stuttering often reduces the negative feelings associated with stuttering and can support a drive to
manage one’s stuttering.
Suggested Reading
[1] Trichon M, Tetnowski J. Self-help conferences and change in the experience
of stuttering: preliminary findings and implications for self-help activities.
Paper presented at: Proceedings of the Tenth World Congress of the International Fluency Association, July 6–8, 2015; Lisbon, Portugal
References
[1] Corcoran JA, Stewart M. Stories of stuttering: A qualitative analysis of inter-
view narratives. J Fluency Disord. 1998; 23(4):247–264
[2] Trichon M. Self-help Conferences for People Who Stutter: An Interpretive
Phenomenological Analysis [dissertation]. Lafayette, LA: University of Louisiana at Lafayette;2010
[3] Klompas M, Ross E. Life experiences of people who stutter, and the perceived
impact of stuttering on quality of life: personal accounts of South African individuals. J Fluency Disord. 2004; 29(4):275–305
[4] Boyle MP. Psychological characteristics and perceptions of stuttering of adults
who stutter with and without support group experience. J Fluency Disord.
2013; 38(4):368–381
[5] Raj EX, Daniels DE. Psychosocial support for adults who stutter: Exploring the
role of online communities. Speech Lang Hear. 2017; 20(3):144–153
[6] Trichon M, Raj EX. Peer-support for people who stutter: history, benefits, and
accessibility. In: Amster BJ, Klein E, Eds. More than Fluency: The Social, Emotional, and Cognitive Dimensions of Stuttering. San Diego, CA: Plural Publishing; 2018:187–214
[7] Trichon M, Tetnowski J. Self-help conferences for people who stutter: a qual-
itative investigation. J Fluency Disord. 2011; 36(4):290–295
[8] Riley GD. Stuttering Severity Instrument. 4th ed. Austin, TX: Pro-Ed; 2009
[9] Yaruss JS, Quesal RW. OASES-A: Overall Assessment of the Speaker’s Experi-
ence of Stuttering (Adults). McKinney, TX: Stuttering Therapy Resources 2016
312
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copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
80 Targeting Social Communication Skills for an Adult
Client with Autism Spectrum Disorder
Jarrod B. Zinser
80.1 Introduction
Deficits in social communication skills are a hallmark of autism
spectrum disorders (ASDs) (DSM-5, 2013). This case provides a
framework to address social communication deficits in a young
adult with ASD.
80.2 Clinical History and
Description
TB was a 25-year-old male college student diagnosed with ASD
in 2012 at a local behavioral health clinic after being admitted
for attempted suicide. He cited a “difficult home life” as well
as an inability to establish lasting connections with his peers
(specifically females) as catalysts to this attempt. TB initially
sought improved understanding of his diagnosis and skills to
better interact with others, both socially and professionally. He
reported difficulties maintaining various jobs, as well as dating.
TB reported no previous speech-language treatment; he denied
speech, language, or hearing difficulties in his family. TB lived at
home with both parents, hoping to move out postgraduation.
At the time of his initial evaluation, he was a junior at Florida
State University, majoring in criminology. He was a member of
the university’s marching band and was also a client of Vocational Rehabilitation Services.
Table 80.1 Probes for eliciting conversational behavior in adults
“Tell me about the type of job you want.”
“Where do you see yourself in five years?”
“What types of music do you listen to? Why is that your favorite?”
“What genres of movies do you like? Tell me about it.”
“Tell me about your hobbies. How do you spend your down time?”
“Are you currently dating? Is that one of your personal goals?”
“Tell me about your friends. What do you do together? How often did
you see each other?”
TB achieved a standard of 90, a low-average score. The Making
Inferences subtest of the Social Language Development Test Adolescent (SLDT-A; Bowers, Huisingh, LoGiudice, 2010) was
also administered informally to assess TB’s ability to detect
nonverbal and context clues in a picture of a person or people,
assume the perspective of a specific person in the picture, infer
what the person is thinking, express the person’s thought as a
relevant, direct quotation, and state the visual clue that suggests
what the person is thinking using an “I” statement. TB received
a score of 0 out of 10 possible points, indicating a weakness in
this area. Speech, voice, and fluency were all subjectively
judged to be within normal limits.
80.4 Questions and Answers for
the Reader
80.3 Clinical Testing
TB was evaluated at a university speech and hearing clinic to
assess his pragmatic language skills, formally and informally.
TB was compliant throughout testing, completing each task
without complaint. He produced minimal to no emotion during
formal and informal measures and his eye gaze rarely deviated
from the treatment room table.
Both hearing screening and oral mechanism exams were unremarkable. TB then participated in a conversational exchange/
sample. He avoided eye contact upon greeting, lacked a greeting
upon arrival, and often responded with brief or limited information. Because TB produced brief responses, conversational probes
were utilized (see ▶ Table 80.1). The Comprehensive Assessment
of Spoken Language (CASL; Carrow-Woolfolk, 1999)-Book Three
was administered to assess TB’s supralinguistic and pragmatic
language skills. He completed the following four subtests: Nonliteral Language, Meaning from Context, Ambiguous Sentences,
and Pragmatic Judgment. TB’s standard score for each subtest fell
two standard deviations below the mean (100), indicating
below-average performance. Nonverbal intelligence was also
assessed to rule out cognitive deficits that impact his ability
to interact with others. Using the Test of Nonverbal Intelligence, Fourth Edition (TONI-4; Brown, Sherbenou, Johnsen, 2010),
1. Why is assessing narrative skills imperative for those
diagnosed with ASD?
a) The ability to understand and produce a narrative
monologue is an important aspect of typical pragmatic
development.
b) To obtain a mean length of utterance (MLU).
c) To assess literacy skills.
Answer: a is correct. A cohesive narrative is required for effec-
tive conversational exchanges.
b is incorrect. Collecting MLU is inappropriate. It is typically
used with children to measure language proficiency.
c is incorrect. Assessing TB’s reading and writing skills will
not provide information regarding his communicative interactions with others.
2. Based on the information reported earlier, what is the best
treatment approach to use with this TB?
a) Improve narrative skills.
b) Improve discourse management skills.
c) Improve communicative intent.
d) a and b.
e) All of the above.
Answer: d is correct. See explanations in a and b below.
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a is partially correct. Testing revealed deficits in narrative
production. Much of communication requires being able to tell
a story.
b is partially correct. Informal measures revealed weak conversation skills. Thus, discourse management must be targeted
for this client to meet his goals of forming relationships and
improved job retention.
c is incorrect. Communicative intent is typically targeted in
young children with ASD.
e is incorrect. a and b are the most appropriate skills to target.
3. Why would an observational rating scale be useful in this
type of case?
a) It is a norm-referenced method.
b) Observational rating scales can be used to evaluate con-
versational or narrative skills.
c) It is a way to measure your own interactions with the cli-
ent.
Answer: b is correct. Observational rating scales can help identify areas of disordered behavior.
a is incorrect. Typically, norms for these instruments are not
provided. Their purpose is not to compare to typical development.
c is incorrect. Observational rating scales are typically clientcentered.
4. What would be considered a negative prognostic indicator
in TB’s case?
a) Client motivation.
b) Current level of cognitive functioning.
c) Severity of disorder.
Answer: c is correct. Autism is defined as an impairment in
social communication and interaction.
a is incorrect. TB was highly motivated to improve his communication skills.
b is incorrect. TB did not display any cognitive deficits that
may contribute to his communication difficulties. His nonverbal
intelligence score was considered average.
80.5 Description of Problem and
Recommended Treatment
TB presented with a severe impairment in pragmatic language
skills characterized by deficits in making inferences, understanding nonliteral language, gathering meaning from context,
responding appropriately to various social scenarios, and
understanding ambiguous statements. Treatment was recommended twice a week for 1-hour sessions. TB’s program specifically targeted his ability to produce a cohesive narrative (see
▶ Table 80.2 for suggested scoring r ubric) as well as the social
use of language in conversation, including correctly interpreting supralinguistic aspects of communication. Improved job
interview skills and the use of appropriate language in the
workplace were also recommended. Participation in an adult
social skills group was also discussed. Prognosis for improvement of these skills was judged to be guarded; however, positive prognostic indicators included TB’s willingness to participate in treatment, as well as his motivation to improve these
skills.
Table 80.2 Scoring rubrics for narratives
Weak: Narrative consists of descriptions and poorly organized,
uninteresting stories.
Adequate: Stories take one of four forms:
a) An account of events without a high point or climax.
b) A minimal narrative without elaboration.
c) A story without a resolution.
d) A confusing narrative with some strong descriptive elements.
Good: Narratives are captivating stories that contain problems and
resolutions, but they may contain organizational weaknesses.
Strong: Narratives are easily understood and contain clear, integrated
story lines; elaboration; interesting word choices; and some captivating
features, such as a climax or plot twist or compelling personal voice.
Adapted from Paul R, Norbury C. Language Disorders from Infancy to
Adolescence. 4th ed. St. Louis, MO: Elsevier Mosby; 2012:444.
80.6 Outcome
TB spent a total of four consecutive semesters in treatment. He
made progress across goals targeting facial expression identification and rationale, identifying appropriate interview behaviors, and improved awareness of nonverbal communication
behaviors in multiple partners. However, TB continued to demonstrate difficulties managing his role throughout conversational exchanges. He was often rated as overly talkative, producing out-of-sync content, confusing accounts, topic perseveration, providing insufficient background information, inadequate clarification, and scripted/stereotyped sentences/discourse. TB’s intonation was judged to be unusual and his eye
gaze rarely assisted his communicative attempts.
Across the targeted goals, TB displayed weaknesses demonstrating reciprocity in conversational exchanges, generalizing
nonliteral concepts, and initiating greetings with familiar and
unfamiliar partners. Cueing was often required to assist with
goal completion. Repetitions, providing binary choices, and
modeling proved to be the most effective.
Throughout treatment, TB required operational definitions
regarding friendship (e.g., acquaintance vs. best friend) and dating. The PEERS (Program for the Education and Enrichment of
Relational Skills) curriculum was then introduced to assist TB in
making and maintaining relationships. He did not readily
accept these skills based on previous failed relationships and,
thus, cognitive behavior therapy was recommended to identify
and address dysfunctional thoughts about interacting with
others that may be inhibiting progress. TB had weekly appointments at the university counseling center. Treatment was discontinued at the request of the client once he obtained a fulltime job.
80.7 Key Points
●
New diagnostic criteria for ASD were provided by the Diagnostic and Statistical Manual of Mental Health Disorders-Fifth
Edition (DSM-5).
●
Know the difference between the diagnostic criteria for
autism and social (pragmatic) communication disorder.
●
For treatment, rating forms must be developed to track and
measure progress regarding conversation skills. Landa et al.’s
pragmatic rating scale is incredibly useful.
1
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Targeting Social Communication Skills for an Adult Client with ASD
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
●
Homework should include real-world applications. Clients
should rate their use of pragmatic skills targeted in treatment.
Suggested Readings
[1] McPartland JC, Klin A, Volkmar FR. Asperger Syndrome. 2nd ed. New York,
NY: Guilford Press; 2014
[2] Gantman A, Kapp SK, Orenski K, Laugeson EA. Social skills training for young
adults with high-functioning autism spectrum disorders: a randomized controlled pilot study. J Autism Dev Disord. 2012; 42(6):1094–1103
References
[1] Landa R, Piven J, Wzorek MM, Gayle JO, Chase GA, Folstein SE. Social language
use in parents of autistic individuals. Psychol Med. 1992; 22(1):245–254
315
Index
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
Note: Page numbers set bold or italic indicate headings or figures, respectively.
7
7q11.23 duplication syndrome, see
apraxia of speech
– clinical history 148
– clinical testing 148, 148
– communication sample analy-
ses 148–149
– outcome 149, 150
– treatment 149
1
10-20 International EEG place-
ment 300, 301
A
AAC, see augmentative/alternative
communication
AAC Evaluation Genie 36
abdominal muscles 200
accent modification
– multimodality cueing/feedback 249
– Thai
–– clinical history 246
–– clinical testing 246
–– language differences 246–247, 247
–– outcome 248
–– syllable stress differences 247
–– treatment 246–247, 247, 248, 249
–– voiced/voiceless consonants 247
– Ukrainian
–– clinical history 190
–– clinical testing 190, 191
–– diagnosis 192
–– discharge criteria 191–192
–– outcome 192, 192
–– phoneme errors in 190, 192
–– prognosis formulation 190, 192
–– therapy recommendation 192, 193
–– treatment plan development 190–
191
acquired brain injury
– cognitive-linguistic deficits
–– attention types 118
–– clinical history 117, 118
–– clinical testing 117, 117
–– consciousness disorders 118
–– inpatient rehabilitation 117–118
–– outcome 118, 119
–– treatment 118
– differential diagnosis 227
– dysphagia in 228
– PICA
aneurysm/TBI
–– clinical history 226, 226
–– clinical testing 226, 227
–– differential diagnosis 227
–– outcome 228
–– treatment 228
– VFSS studies 227–228
– vocal fold hemorrhages 227
ADHD 41advocacy/service coordina-
tion 9
affricate consonants 247
airway-protection deficits rehabilitation 266
allophonic pair instruction, cleft pal-
ate 3
ALS Functional Rating Scale-Revised
(ALSFRS-R) 194
altered auditory feedback 91–92, 94
Alzheimer's dementia
– clinical history 296, 298
– clinical testing 296, 296, 297
– diagnosis of 230
– differential diagnosis 297
– interdisciplinary collaboration 297
– outcome 298
– swallowing function assessment 297
– treatment 298
amyotrophic lateral sclerosis (ALS)
– AAC/cognitive status
–– AAC options 195–196, 198
–– clinical history 194
–– clinical testing 194, 194, 195, 195,
196
–– informational counseling 197
–– mobile tablets 197–198
–– outcome 197
–– treatment 197
– characterization 174, 176, 197
– differential
– dysarthria
–– AAC strategies 174–176
–– clinical history 173
–– clinical testing 173, 176
–– effortful exercises in 173
–– intelligibility, course of 174–175
–– outcome 175, 175
–– treatment 174
anomic aphasia 282
aphasia, see augmentative/alternative
communication
– AAC usage in
–– clinical course of action 208
–– clinical history 207
–– clinical testing 207
–– informal assessment 208, 208
–– outcome 209, 210
–– patient selection 208
–– treatment 209, 209, 210, 210
– classification of 212, 214, 282
– differential diagnosis 230
– functional rehabilitation
–– clinical history 212
–– clinical testing 212, 212, 213–214,
–– informal assessments 215
–– outcome 214, 215
–– treatment 214, 215
– primary progressive, script training,
see script training/nonfluent aphasia
– speec
–– aphasia type determination 282
–– clinical history 280
–– clinical testing 280, 280, 281–282
–– outcome 283, 284
–– prognostic indicators 282
diagnosis 227
215
h therapy telepractice
–– treatment 282–283, 283
aphasia/dysphagia
– skilled facility resident
–– characterization 223
–– clinical history 221
–– clinical testing 221
–– dietary recommendations 222
–– expressive language 222
–– language goals 223
–– nectar-thickened liquids toler-
ance 222–223
–– outcome 224
–– receptive language 221
–– rehabilitation settings effects 224
–– treatment 223, 223
– stroke-induced
–– caregiver education 289, 291
–– clinical history 288, 288
–– clinical testing 288, 288, 289, 291
–– clinical vs. anticipated findings 289
–– oral intake diet 289
–– outcome 290, 290
–– subacute facility discharge 289
–– treatment 290
Applied Behavior Analysis (ABA) 9, 131
apraxia of speech, see 7q11.23 duplica-
tion syndrome
– Broca's aphasia comorbid 203–204
– characterization 202
– childhood-onset
–– clinical
–– clinical testing 8, 66
–– DDK rates 66
–– outcome 68, 68
–– treatment 67, 67,68
– diagnosis 202, 205
– differential diagnosis 52, 66–68,
– insurance reimbursement 204
– stroke-induced
–– characterization 202, 204
–– clinical history 202, 205
–– clinical testing 202, 203
–– outcome 204
–– treatment 204, 205
Apraxia of Speech Rating Scale
ASHA Code of Ethics 240
ASHA Scope of Practice 30
assistive technology for cognition
asthma, differential diagnosis 242, 244
ataxic dysarthria 234
athletes, see concussions, multiple, par-
attention process training (APT) 166,
attention types 118
auditory discrimination tasks 133
augmentative/alternative communica-
– Broca's aphasia, see under Broca's
– family member/close friend
– high-technology supports 308
history 66, 151
134, 145, 149, 204
(ASRS) 204
(ATC) 162–163
adoxical vocal fold motion
167
tion
aphasia
roles 308
– implementation timing 308
– in ALS, see under amyotrophic lateral
sclerosis (ALS)
– informational counseling 197
– iPad/AssistiveChat app 195–196
– iPad/Verbally app 195–196
– Lightwriter 194–196
– low-technology supports 307
– MessageMate 197
– mobile
tablets 197–198
– persons with aphasia
–– clinical course of action 208
–– clinical history 207
–– clinical testing 207
–– informal assessment 208, 208
–– outcome 209, 210
–– patient selection 208
–– treatment 209, 209, 210, 210
– picture-based communication 196
– porencephaly, congenital
–– assessment of 131, 142
–– caregiver training 38
–– clinical history 36
–– clinical testing 36,37
–– eye-tracking systems 196
–– feature matching 38–39
–– indications 37–38
–– outcomes 38, 39
–– therapeutic intervention strat-
egies 37
–– treatment 38
– ProLoQuo2Go 129, 131
– SGD (speech-generating device) 36–
38
– two-switch step-scanning train-
ing 38
autism spectrum disorder
– characterization 81
– clinical history 8
– clinical testing 8
– communication profile assessment 8
– diagnosis of 88–89, 314
– eye contact 89
– language impairment (global)
–– age-equivalent scores 81
–– clinical history 80
–– clinical
–– joint attention 80–82, 89
–– outcome 82
–– reassessment 81
–– social skills instruction 81
–– treatment 81, 82, 82
– minimal verbal skills, see under lan-
– narrative skills assessment 313–314
– outcome 10
– parental roles in intervention 9
– peer interactions 81
– pragmatic language 116
– referrals 8
– self-stimulatory behavior 89
– social communication intervention
–– clinical history 59, 313
–– clinical testing 59, 62, 313, 313
–– evidence-based practices 60
testing 80,82
guage impairment
316
Index
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
–– expressive language 59
–– observational rating scale 314
–– outcome 61, 314
–– self-talk 60
–– sibling interaction 59–62
–– treatment 60, 61, 313–314, 314
– speech/language intervention strat-
egies 9
– treatment 9
– word associations
–– clinical history 88
–– clinical testing 88
–– outcome 89
–– treatment 89
autoimmune encephalopathies
– characterization 286
– clinical history 285
– clinical testing 285, 286
– cognition/memory effects 286
– demographics 286
– outcome 287
– treatment 286
– types of 285–286
B
barium sulfate (BaSo4) 170
Bayley Scales of Infant Development, 3/
e1
Beck Depression Inventory-II (BDI-
II) 300
behavioral training 159
bilateral cerumen impaction 182
bilateral sequential CI
– clinical history 257
– clinical testing 257, 257
– errors typically observed 258
– outcome 259, 259, 260, 260
– performance, factors influenc-
ing 258
– treatment 258, 258
bilingual children
– clinical decision-making/converging
information
–– clinical history 11
–– clinical testing 11, 11,13
–– language impairment in 12
–– monolingualism development
vs. 12–13
–– outcome 13
–– treatment 12,13
–– vocabulary items generation 12
–– vocabulary skills assessment 11–12
– dynamic assessment, see dynamic
assessment
– dysphagia, post-CVA, see dysphagia,
post-CVA
– interpreter, assessment by 188
– language delay in
–– age-appropriate development 14
–– clinical history 14
–– clinical testing 14,15–16
–– language comprehension 14
–– language transfer/influence 15
–– morphosyntactic usage 14–16
–– outcome 16
–– pragmatic language ability 14
–– treatment 15,16
–– treatment, in-home 15
–– v
ocabulary skills 14–15
– narrative assessment, see dynamic
assessment
– native language assessment 187–
189
Bilingual English Spanish Assessment
(BESA) 11
Boston Naming Test (BNT) 162
botulinum toxin 218, 236, 243
brainstem encephalitis
– clinical history 233, 234, 235
– clinical testing 233
– dysarthria type determination 233–
234, 236, 237
– hyperkinetic dysarthria 233, 236–
237
– outcome 237
– outpatient therapy 235–236
– spastic dysarthria 234, 236
– treatment 236, 236
Brief Cognitive Assessment Tool
(BCAT) 297
Broca's aphasia
– AAC usage
–– clinical history 307
–– clinical testing 307, 309
–– family member/close friend
roles 308
–– implementation timing 308
–– outcome 309
–– selection of 307–308
–– treatment 309
– apraxia symptoms comorbid 203–
204
– characterization 282
C
CAS, see under apraxia of speech
Chapel Hill Multilingual Intelligibility
Test (CHMIT) 202
chelation therapy 9
childhood dysarthria 149, 151
childhood-onset fluency disorder, see
under stuttering
cleft palate
– feeding/swallowing impairment
–– clinical history 95
–– clinical testing 95
–– medical/surgical interventions 96–
97
–– nutrition/hydration 96, 98
–– oral skills development 96
–– outcome 97
–– treatment 97, 97,98
– normal speech attainment
–– clinical history 1
–– clinical testing 1, 1
–– outcomes 4
–– treatment 2, 3
–– velopharynx assessment 1–2
–– vowel inventory, factors affecting 2
–– vowel inventory, intelligibility
and 2
–– [p, b], intelligibility and 2
– Pierre Robin sequence 96, 97
– speech rehabilitation
–– /p/ sound production 51–52
–– clinical history 51
–– clinical testing 51, 51
–– incorrect articulatory placement 52
–– outcome 54
–– secondary repair rationale 52–53
–– speech therapy, presurgery 53
–– treatment 53, 53
– speech therapy hierarchy 53, 53
clinical
decision making
– communication facilitation 156
– concussions, multiple 165
– in bilingualism, see bilingual children
– MCA CVA
–– clinical history 152, 152, 153–154,
156
–– clinical testing 152
–– outcome 156
–– treatment 156, 156
– NIHSS score 155
– priority determination 155, 155
– swallow study 155
Clinical Evaluation of Language Funda-
mentals, 4/e Spanish (CELF-4) 14–15
Clinical Evaluation of Language Funda-
mentals, Preschool, 2/e (CELF-P2) 10
cluttering
– described 40–41
– diagnosis 41
– treatment 41
– treatment plan impacts 41
CMV/TBI, feeding/swallowingimpair-
ment
– clinical history 129
– clinical testing 129, 129, 131
– language therapy 131
– outcome 131
– ProLoQuo2Go 129, 131
– stage assessment 130
– treatment 130, 131
coarticulatory influences in accent
modification 190
cochlear implants, see bilateral sequen-
tial CI
code-switching 15
cognitive apprenticeship model 78–79
cognitive behavior therapy 100
Cognitive Linguistic Quick Test
(CLQT) 207
cognitive-communication ther-
apy 162–163
Combined Aphasia and Apraxia of
Speech Treatment (CAAST) 204–205
combined modality therapy
– altere
d auditory feedback 91–92, 94
– clinical history 91
– clinical testing 91
– outcome 93
– treatment 92, 92
– word substitution/circumlocu-
tion 92
Common Core Standards 65, 100
Communication and Symbolic Behavior
Scales (CSBS) 27
communication device program-
ming 44
Communication Matrix Profile 27, 139,
139, 143
communication partner instruction 38
communication sample analyses 148–
149
communication supports model
– clinical history 43
– clinical testing 43
– expressive communication 43,44
– IEP revision 44
– outcomes 45
– receptive skills 43
– strategies 43
– treatment 44
comparative inventories in accent mod-
ification 191
Comprehensive Aphasia Test (CAT) 207
concussions, mild, see under traumatic
brain injury (TBI)
concussions, multiple
– characterization 166
– clinical decision making 165
– clinical history 164, 164
– clinical testing 164–165
– follow-up evaluation 166, 166
– gender differences 166
– outcome 167, 168
– protective equipment 166
– risk factors 166, 168
– symptoms of 165
– treatment 166, 167, 168
conductive loss distortions 52
congenital porencephaly
– See
also augmentative/alternative
communication
congestive heart failure 298
consciousness disorders 118
Consensus Auditory Perceptual Evalua-
tion of Voice (CAPE-V) 32, 34,84
converging information in bilingualism,
see bilingual children
conversation training therapy
– benefits of 252
– clinical history 250
– clinical testing 250, 250, 251
– outcome 251–252, 252, 253
– patient selection 251–252
– treatment 251
– vocal fold paralysis evaluation 251
conversion disorder 254–255
core vocabulary therapy 131, 145
cricoarytenoid muscles 200
CTT, see conversation training therapy
Cystografin 170
cytomegalovirus, see CMV/TBI
38
D
daily schedule cue cards 183–184
decoding
– language-based learning disabil-
ity 76–78
– reading comprehension 63
deep brain stimulation (DBS)
– Parkinson's disease 265
– progressive generalized dystonia, see
progressive generalized dystonia
delayed auditory feedback 91
dementia, reading impairment in, see
reading impairment/dementia
depression 298
depression, post-stroke 216
diaphragm 200
DIBELS probes 135
DIGEST tool 169
disability evaluation
– clinical history 55
– clinical testing 55, 55, 56
– differential diagnosis 55–56, 58
– language acquisition 56–57
– metalinguistics 56–57
– misdiagnosis factors 57
– outcome 58
– television shows, understanding
of 56
– treatment 58
dolphin-assisted therapy 9
Down syndrome 44
driver's assessment 162
317
Index
Branski and Molfenter, Speech-Language Pathology Casebook (ISBN 978-1-62623-487-1),
copyright © 2020 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
drooling 9
dynamic assessment
– benefits, limitations of 18–19
– clinical history 17
– clinical testing 17,18
– language ability 19
– language impairment (global) 81
– MLE sessions 17, 19–20
– treatment 19,20
dynamic temporal and tactile cueing
(DTTC) 67
dysarthria, see under amyotrophic lat-
eral sclerosis (ALS), under Parkinson's disease
– ALS-associated 175
– differential diagnosis 66, 233–234,
236, 237
– hyperkinetic 233, 236–237
–– See also brainstem encephalitis
– hypokinetic 234, 236
– spastic 234
dyslexia 63
dysphagia, post-CVA
– aphasia/dysphagia, see aphasia/dys-
phagia
– clinical history 187
– clinical testing 187
– interpreter, assessment by 188
– native language assessment 187–
189
– neuroimaging benefits 188–189
– outcome 189
– treatment 188, 189
dysphonia
– complex medical history
–– clinical history 32
–– clinical testing 32, 33–34
–– outcome 34,87
–– post-airway reconstruction, see
v
oice disorder, post-airway recon-
struction
–– treatment 33, 33,34
–– vocal fold mobility 32
–– voice disorder impacts/class-
room 32–33
– lifestyle factors 273
– muscle tone assessment 217–218
– muscle-tension vs. spasmodic
–– characterization 218
–– clinical history 217
–– clinical testing 217, 217, 219
–– differential diagnosis 217–219
–– outcome 219
–– treatment 218
– vocal quality 218–219
E
early intervention, speech sound disor-
ders
– clinical history 108
– clinical testing 108, 109–110
– consonants analysis 108, 110
– DSM-V definition 111
– eligibility criteria 111
– KLPA-3 summary 108, 110
– outcome 112, 112
– phonetic inventory 108, 110
– phonological approach to 111–113
– screening recommendations 110,
113
– treatment 111
end of life
– clinical history 303, 303, 304, 304
– decision making 305
– enteral feeding 305–306
– FTT defined 305
– outcome 306
– PEG tube feeding 305
– treatment 305
errorless learning 166, 181
esophageal stage, swallowing 130, 278
expressive language delay 70
expressive language disorder 145, 147
Expressive One-Word Picture Vocabu-
lary Test, 2000 Edition (EOWPVT-
2000) 18
external intercostals 200
F
facial nerve 228
feature matching 38–39
feeding skills evaluation 104–105, 107,
139
feeding/swallowing impairment
– aphasia/dysphagia, see aphasia/dys-
phagia
– cleft palate
–– clinical history 95
–– clinical testing 95
–– medical/surgical interventions 96–
97
–– nutrition/hydration 96, 98
–– oral skills development 96
–– outcome 97
–– treatment 97,98
– CMV/TBI
–– clinical history 129
–– clinical testing 129, 129, 131
–– language therapy 131
–– outcome 131
–– ProLoQuo2Go 129, 131
–– stage assessment 130
–– treatment 130, 131
– communication, augmentative
means of 140
– dysphagia, post-CVA, see dysphagia,
post-CVA
– family education/counseling 140–
141
– medical/surgical interventions 96
– Moebius syndrome
–– clinical history 103
–– clinical testing 103, 107
–– feeding skills evaluation 104–105,
107
–– outcome 106
–– swallowing/feeding plan implemen-
tation 104, 105, 106, 107
– neurogenic syndrome
–– clinical history 139
–– clinical testing 139, 139
–– outc
ome 141
–– treatment 140, 141
– orocutaneous fistula
–– adjuvant radiotherapy effects 170
–– clinical history 169
–– clinical testing 169
–– contrast material selection 169–
170
–– outcome 171, 172
–– speech deficits associated with 170
–– treatment 170, 171
–– videofluoroscopic swallow study
timing 169
– Parkinson's disease dysphagia/dys-
tussia, see under Parkinson's disease
– stage assessment 130
– therapy, sensory approach to 130
– therapy, singular approach to 130
– treatment 97
fetal alcohol spectrum disorder
– articulation/phonology 47–49
– attention 47
– clinical history 46
– clinical testing 46,48–49
– diagnosis 49
– expressive language 46–48
– fluency 47
– language disorder diagnosis 49
– literacy 47, 49
– narrative retell 47
– outcomes 50
– receptive language 47
– sentence complexity 48
– social communication 47
– treatment 49
fistula, postoperative, see orocutaneous
fistula
f
luency intervention
– assessment, outside interviews 6,
122
– childhood-onset, see under stutter-
ing
– clinical history 5, 22
– clinical testing 5, 22,23
– combined modality therapy, see
under stuttering
– holistic therapy, see holistic therapy
– outcome 7, 24, 24, 24
– parent-directed treatment 6–7
– stuttering severity/impact assess-
ment 6
– stuttering, persistent risk factors 5–
6, 23
– treatment 6, 6, 7, 23, 23
– treatment ethics 7
frequency-altered feedback 91
fricative consonants 247
G
G-tube 96
gastrografin 170
gender agreement 12
gender dysphoria 158
getting to know you game 40
global aphasia 282, 290
glossopharyngeal nerve 228
Goldman-Fristoe Test of Articula-
tion 143
Guillain-Barré syndrome 227
H
Haddon matrix 270–271
Haddon's countermeasures 273–274
Hashimoto's encephalopathy 285
Helen sentence test 257
Hodson's cycles approach 145
holistic therapy
– assessment, outside interviews 122
– language formulation disfluen-
cies 122
– stuttering
–– clinical history 120
–– clinical testing 120, 121, 124
–– outcome 123
–– reassessment 123–124
–– treatment 123
hormone replacement therapy 159
hyperkinetic dysarthria 233, 236–237
hypoglossal nerve 32, 228
hypokinetic dysarthria 234, 236
I
IEP referral reassessment
– clinical history 40
– clinical testing 40,41
– cluttering
–– described 40–41
–– diagnosis 41
–– treatment plan impacts 41
– outcomes 42
– treatment 41
illusory recovery 64–65
Individuals with Disabilities Education
Act (IDEA) 30, 81
instrumental analysis in accent modifi-
cation 190
intellectual disabilities
– communication supports
–– clinical history 43
–– clinical testing 43
–– expressive communication 43,44
–– IEP revision 44
–– outcomes 45
–– receptive skills 43
–– strategies 43
–– treatment 44
– severe
–– clinical history 26
–– clinical testing 26
–– Communication Matrix vs. CSBS 27
–– Down syndrome comorbid 44
–– MacArthur CDI 27
–– nonsymbolic communication 26
–– outcome 28
–– preassessment staffing 27
–– treatment 27
–– tri-focused framework 27
intelligibility, factors affecting 146–
147
intentional nonsymbolic communica-
tion 143
intentional symbolic communica-
tion 142
interviews, methodology 6
iPad/AssistiveChat app 195–196
iPad/Verbally app 195–196
J
joint attention 80–82, 89, 143
K
Khan-Lewis Phonological Analysis-3/e
(KLPA-3) 108, 108, 109–110
L
Landau-Kleffner syndrome
– capacity assessment 125, 126
– clinical history 125
– clinical testing 125
318
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