psychological report based on a videotape analysis
Dear Mrs. NN.
You requested to review the videotape
of your prospective child.
The intent of my report is to interpret
and explain developmental data as they appear in the video and written
files that you provided.
Let me briefly comment on the accuracy
of translation of the medical documentation, available for my
review, and recorded interview depicted in the last section of the
videotape. Basically, this is a complete and accurate translation
with one, but significant, exception. Medical diagnosis under the
rubric current diagnoses and under specialists:
neurologist, psychiatrist: was translated as mild developmental
delays. In fact, the correct translation should be: mental
retardation, moderate degree. I suggest that you downloaded
my article Oligophrenia from the BGCenter website www.bgcenter.com
to read more on this diagnosis.
Most of the comments on the backdrop
of the tape were unremarkable in terms of any additional information,
not contained in the medical records. It is always a problem to
determine to which extent the taped behavior is typical for a child
in question. Please remember that videotaping by itself was rather
emotionally charged, uneasy, and at times intimidating situation
Date of Birth: 00/00/00
Chronological age at the time of being videotaped: 12 years and
Physical appearance: Olga is a
proportionally developed, normally nourished, and well-groomed child.
Her body coordination, balance, and gross-motor proficiency appeared
normally developed in those physical activities displayed on the
tape (walking, dancing, running, etc.). Her fine motor skills cannot
be comprehensively evaluated from the tape, but appeared within
normal limits in what was indeed displayed on the tape. Her overall
physical development was described in Russian medical record as
average. She received all immunizations on time, which
is a sign of a generally good health.
Speech and language: Language
delays or disorders are the most common deficits in children from
Eastern European orphanages. The common picture for many orphanage-raised
children at the age of 3 is incomprehensible speech with only a
few phrases used, very limited vocabulary, poor understanding of
what is said, and slowness in learning new words. According to some
research data, at the age of 4 only 14% orphanage raised children
use two-words sentences. By age 7, about half of all orphanage raised
children have clinically significant speech (articulation) and language
delays and disorders. Please refer to my website www.bgcenter.com
to find more information about language development in internationally
Articulation: Olga showed significantly
distorted articulation. Just based on this tape alone I would not
hesitate to diagnose her with what is known in this country as dyslalia
which means impairment of the ability to speak (e.g. articulate
sounds of the speech). Dyslalia results in an inability of the child
to pronounce vowels and sounds correctly. Therefore, speech is characterized
by omissions, replacements, inversions, and additions, which make
speech difficult to understand. The time limit to detect dyslalia
is the child's 6th birthday. From that point onwards, all pronunciation
mistakes must be eliminated and the child must pronounce words correctly.
Olga is 12 and at her age this is a serious speech disorder, not
just a developmental delay, as stated by a speech pathologist in
Russia,. I cannot say if Olgas condition is due to organic
impairment/weakness of speech producing organs, or it has a developmental
etiology or environmentally-induced nature, but I see an urgent
need for thorough assessment and immediate remediation.
Another issue is the fluency of speech
production, which is not mentioned at all in her Russian evaluation.
Olga hesitated on many occasions, especially with several specific
sounds. Based on this tape alone, I cannot determine the degree
of her fluency issues, but suspect some problems here as well.
Receptive language: On the tape,
Olga demonstrated an ability to follow the flow of the conversational
speech provided by adults in the background, but she got completely
lost during the rapid exchange of remarks. Her responses showed
that she was capable of following up to three-step instructions.
Her reaction speed to the verbal stimuli was somewhat delayed for
her age expectations, but still within the normal limits (that is,
her movements were synchronized with the verbal instructions, given
to her). There were two episodes when she obviously misunderstood
the question, but she corrected herself after receiving clarification
in the form of a second question. In general, her receptive language
appears functional for easy (undemanding) social interactions and
Expressive language: Olgas
oral expressive communication skills are barely functional
this is her major weakness. All her verbalization was in response
to stimulation from the adults on the tape: I observed practically
no spontaneous speech to make a judgment. The length of sentences
used (only a few), syntax, and vocabulary were very immature. She
kept using a diminutive form of words and immature verbal mannerisms
that are normally observed in much younger children. Her distortion
of words structure (described in the speech therapy report and observed
on a number of occasions on the tape) constitutes serious language
impairment. Olga demonstrated word retrieval difficulties, as well
as difficulties in modifying nouns and verbs, in conjugating numerals,
nouns, and verbs. I observed that the more open-ended the question
was, the harder it was for her.
Pragmatics of speech (ability
to use language for social purposes, e.g. to participate in conversation
and joint/shared activity) was limited, but functional. In one-to-one
interview (the last taped segment) Olga demonstrated an application
of pragmatic conversational features such as turn taking and sticking
to the topic; she was able to sustain conversation and to respond
properly to questions. On the other hand, her pragmatics skills
were less effective in a more advanced stage of spontaneous shared/joint
activities during her trip to the amusement park. Thus, it was more
difficult for Olga to engage in goal-directed dialogue in more than
three to four exchanges in object-related activity that
required her to initiate, maintain, and terminate joint interactions
through proper language application.
Behavior and adaptive/social skills:
Olga appeared somewhat tense and nervous on the tape, probably due
to the stressed situation of this tape recording. However, no unusual
or bizarre behaviors or mannerisms were observed (e.g. rocking,
breaks in receptivity, etc.). She was fully oriented in place, time,
and activity. She was alert and attentive all the time. She demonstrated
understanding of and responsiveness to social cues. She did not
appear as a despondent, sad, and withdrawn child, just an extremely
timid and hesitant. No hyperkinetic and/or repetitive movements
were observed, although she was obviously high-strung at the moment.
It seemed as if she anxiously tried to conform to what was expected
from her and this may have caused some rigidity in her movements
and body posture. She accepted praise and encouragement well. There
was no avoidance or negativism in her interaction.
Cognitive functioning: I understand
that this is your major concern. Unfortunately, I do not have enough
data to answer the question if the diagnosis of mental retardation
is correct. In a child who has severe speech and language impairments,
many behavior patterns may look similar to what is usually observed
in children with mental retardation. Olgas current level of
cognitive functioning, described in her Russian documents and in
part observed on the tape, suggests significant delays, but these
all may well be due to a combination of organically-based speech
defect and educational neglect/deprivation. At the age of 5, Olga
was placed in a special orphanage for children who could
not cope in a regular Children Homes. This placement by itself may
inhibit her potential for development. Based on the documents I
reviewed, I can estimate her academic readiness close to 2nd grade
in regular Russian school. Her current academic-related skills must
be carefully evaluated to determine the degree of a remedial help
she needs to benefit from the English language academic curriculum.
I have to tell you that on the tape Olga appeared, cognitive-wise,
in a better state that one can suggest based on her medical record.
Nevertheless, I do not rule out her major diagnosis: I would be
able to do this only based on my own hands-on comprehensive
Conclusion: Based on the limited
information given to me, I came to the conclusion that Olga demonstrates
identifiable psychological/developmental handicapping condition:
speech and language impairment. I can conclude that her current
level of cognitive skills and academic readiness are well below
age expectations, but I cannot rule in or rule out mental retardation
as educational handicapping condition just based on the information
given to me.
You have to realize that Olga is a child
with special needs and prepare yourself for a difficult task of
remediation. You have to consult your school district prior to your
trip to Russia to create a plan that should include assessment,
special education placement, and remediate/supportive services.
Boris Gindis, Ph.D.