Case Studies

The following case studies illustrate three recent examples of private therapy Gillian Hart has recently been involved with:

'Callum' - Age 2.5 years, referred with delayed speech and language

'Kirsty' - Age 5 years, referred with disordered articulation

'Mary' - Age 18 months, referred with severe feeding difficulties including reflux

'Callum' Age 2.5 Yrs, referred with delayed speech and language

Initial presentation
On first meeting 'Callum' I observed: Poor eye contact, frequent destructive behaviour with objects and toys, very poor concentration, delayed expressive language and poor speech intelligibility.
He was very dependent on his bottle.

Approach and treatment carried out
Following initial assessment, 6 sessions were undertaken. The main emphasis of the sessions was to use the principles of non-directive communication / play therapy, with full parent participation. The sessions were carried out in the child's home. It was also recommended that 'Callum' was weaned off the bottle on to a trainer cup as soon as possible.

Post treatment presentation
'Callum''s parents made the following observations:

Improved eye contact
Improved concentration span
Reduced frustration and agressive behaviour
Increased spoken language (expressive language)
Improved clarity of speech (intelligibilty of speech)

'Kirsty' Age 5 Yrs, referred with disordered articulation

Initial Presentation
'Kirsty' was starting to feel very shy about speaking in class, her peers were aware that her speech sounded different. Her parents were anxious.
'Kirsty' presented with delayed and deviant articulation

Approach and Treatment Carried Out
Following initial assessment, specifically regarding her articulation and listening skills, 'Kirsty' was seen for 8 sessions for Phonological therapy. 'Kirsty' was seen in my home, as this was felt to be more suitable for 'Kirsty''s parents. Exercises were given for her to practice at home.

Post Treatment Presentation
'Kirsty' was able to make accurate productions for her deviant sounds, 80% of the time. She had an increased awareness of 'mistakes' made and was starting to self-correct.

'Kirsty' still has a few immature sounds which will probably be resolved in the course of normal development, however her parents know that they can contact me if they are concerned about this in the future.

'Mary'; - Age 18 months, referred with severe feeding difficulties including reflux

Initial Presentation.

'Mary' presented with Cerebral Palsy - Classification: Dystonic athetoid quadriplegia. She had marked oro-motor difficulties which made it very difficult for her to control liquids, and to cope with foods other than puree. There was a great deal of stress related to feeding. Furthermore 'Mary' showed clinical signs of reflux during and after a meal.

Approach and Treatment carried out:

Preparation prior to feeding was crucial in order to 'inhibit' abnormal patterns of movement seen especially in 'Mary''s trunk, hips, shoulders, head and neck (these abnormal patterns of movement were due to her Cerebral Palsy)
Positioning for feeding was explored and optimised for safety and comfort.
Techniques of 'oral control' appropriate spoon feeding and open cup drinking with thickened liquids were gradually introduced.
'Mary' was fed smaller meals, more frequently, and kept in an upright position for at least 20 minutes after her meals.

Observations made after first six week block of treatment:

Reduced stress during feeding situations
Reduced clinical evidence of reflux, during and after meals
Increased fluid intake -> decreased constipation
Progression from puree to mashed food with small lumps