Dillon was a bright, normally developing child with no apparent illnesses or language delays. At about age 3.5 his preschool teachers reported to his parents that he was not responding when he was called and seemed to "get lost in the group." Although results of an audiological evaluation were normal, his teachers continued to suspect problems. Social skills began to deteriorate, and when his parents observed him in the classroom, he was not playing with other children and had poor eye contact. They were surprised because these problems were not seen at home or in a one-on-one situation.
The school district evaluated Dillon at age 4.1, but he was not recommended for speech-language services because of high scores on standardized language tests. His nursery school teachers were surprised and concerned because the test scores did not reflect what they saw in the classroom. He did qualify for occupational therapy because of delays in fine motor skills, such as copying shapes, cutting, drawing a person, and completing puzzles.
Almost a full year after problems were first noticed, Dillon experienced a severe regression in language functioning. The first neurologist he was taken to suggested that he had pervasive developmental disorder or autism spectrum disorder (ASD). A copy of a video taken by his parents at age 4.4 during the most severe phase of his regression illustrates why either hearing loss or ASD might have been suspected (see video).
In the first and second clips, he seems to be in his own world. He barely acknowledges his mother and demonstrates little eye contact or joint attention. He seems to be singing repetitively to himself.
The third clip demonstrates that he had some contextually appropriate language but incorrect word order ("I'm pizza eating."). He seems confused when he says, "I wanna bigger bigger piece," but then points to his own piece and says, "This one I want."
Dillon's father reacts to him as if he cannot hear in the fourth clip. He calls, "Dillon, Dillon" louder and louder until Dillon finally responds. The final clip demonstrates Dillon's emotional lability. He has just finished playing a board game with his mother and sister. On the video we see him shout, "I won I won. Megan lost," after which he starts to cry because now he thinks he lost.
The day after this video was taken, Dillon was taken to the emergency room where he experienced a myoclonic seizure. He was placed on Depakote (Valproic Acid) to control the seizures, but Dillon responded poorly to the medication. The parents then consulted with a different neurologist who placed Dillon in the hospital for three to five days for overnight EEG assessments. On the fourth night, frequent seizures were observed, and Landau-Kleffner Syndrome was confirmed. His parents did not want to treat Dillon with high-dose steroids because they were concerned about behavioral and other side effects. Instead they opted for intravenous immunoglobulin (IVIG) treatments. Dillon had two more courses of two-day drips in the following two months and was placed on Keppra to control his seizures.
Within two weeks of the IVIG treatments, Dillon's communication and other behaviors began to return to previous levels. However, the school district recommended Dillon receive speech-language intervention due to subtle remaining deficits. For example, Dillon did not elaborate on responses, and when retelling a story, he wandered off-topic or focused on unimportant details. Pronoun confusion, word finding deficits, and phonemic paraphasias also were noted. Dillon was not very verbal in a group setting and was somewhat slower than other children to follow directions in both pre-kindergarten and summer camp programs, according to observations.
After one year of individual intervention, Dillon was placed in a collaborative kindergarten class where speech-language intervention and occupational therapy were provided in the classroom. Speech-language services were discontinued by the middle of the school year. By first grade, he was functioning at or above grade level in reading and math. Areas of continued weakness included fine motor skills such as writing and cutting, listening skills such as responding to stories, and the ability to work independently. Five years have passed with no relapse of language loss. Dillon is functioning well in a general education classroom although difficulties with attention, executive function, and emotional sensitivity persist. For a more detailed discussion of Dillon's case, see Alpern (2008).
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