My Son Has Difficulties Retelling a Story and Organizing Spoken Language

Question

When my son was 4-1/2 yrs old, I thought he was 'behind' in speech development compared to other kids his age. He wasn't forming his sentences as well and had a hard time explaining himself. I had his hearing tested, took him to an occupational therapist,

Answer

Your questions are very valid and tell me a lot about you and your understanding of your son's deficits. However, I am missing a lot of information about him, beginning with his age. I am assuming that he is probably in the second-third grade in school, judging by the fact that you ask him to write down his responses to the questions.
So I may run a few scenarios of possible difficulties your son may have in terms of language processing and production and give you some suggestions for helping him along the way.

1. You mentioned that your son has difficulties retelling a story, that he normally remembers the ending and some parts of it. There are developmental milestones in retelling a story. If your child is a kindergartener, he is doing what is developmentally appropriate. Retelling a story requires good sequential abilities, where one can put the entire plot into specific time and place frame, and that requires working memory capacity; good ability to take another person's perspective, and good ability to use specific language "devices", like conjunctions, to make the story cohesive. All these skills begin to develop in grade one and up. The building of narrative skills progress as the child acquires more and more language and cognitive skills. If your child is older, then few things may prevent him from being able to retell a story:
   
   a) he has difficulties sequencing - that is a deficit in executive function, or difficulties processing information in sequential manner;
   
   b) he may have limited working memory capacity, that does not allow him to integrate previous and new information;
   
   c) he may not have specific linguistic terms that allow us to sequence a story, such as "and then", "although", "after that", "first", "in the end"
   
   What you may want to do is to provide him with these "devices" - be it in the form of printed cards or just as cuing when you listen to him and see that he may be stumbling. You can make it a game, where you ask your son to retell a story within a frame, beginning with the words/card like "first" or "in the beginning" and continuing with other cohesion devices. That way you can also monitor if he understood the meaning of the story. And start small until he has a good grasp of what is required in retelling a story.
   
   
2. You mentioned that your son received occupational therapy for 3 months to improve hand/eye coordination. Does he have any difficulties: using scissors? holding pen/pencil? staying within the lines when he is writing? having problems writing cursive letters and preferring to "print" instead? If the answers are "yes" to some or all of these questions, I would suspect that some deficits are still unresolved and you may ask for another evaluation. And what are his reading skills? Does he like to read and has good decoding skills? Can he read any words, including non-words, or is he better at reading words that he learned and has problems decoding new ones? Can he rhyme? Do "pig latin"? If you answer "no" to all or some of these questions - I would urge you to do reading evaluation, where you will start with a good assessment of phonological processes. Children with reading disabilities often start as children with oral language deficits.
   
   
3. Not to confuse you completely, but there may be another possibility here: word finding difficulties. It can occur at a word and discourse level, and has specific characteristics: "tip of the tongue" phenomenon where a person my struggle to find the correct word, or the "slip of the tongue" phenomenon where a person may produce the word that has some but not all elements of the target word. At the discourse level, there may be instances of low or high language productivity, when a child may struggle to retrieve correct word and will take a long time to produce it, or may say "I know it, but cannot remember the word", will repeat the word or phrase preceding the word they try to retrieve, as if holding "place". It is also possible with word finding deficit to have difficulties retrieving the schema for a narrative (setting, initiating event, internal response, consequences, ending, etc.) When he tells you a story, does he use gestures to fill in the gaps, does he have any other behaviors that show frustration, like finger snapping? Again, if the answers are "yes" to some of these questions - you need to request an evaluation. You can also visit www.wordfinding.com for more information. This is the website created by Dr. D. J. German, an expert in word finding deficits.

Meanwhile, you can help your child by asking him specific, rather than open-ended questions: it is easier to tell about favorite activity on a playground than try to provide a recount of what he did in school. When you read together - stop often and ask him questions about just read paragraph and try to tie the story and characters in the story to his own experiences. There is nothing better than to be able to connect one's background knowledge with new information.

Dr. Elena Zaretsky, Ph.D., CCC-SLP, is an Assistant Professor in the Department of Communication Disorders at UMass, Amherst. She is part of the team of professors in that department who received a four-year DOE grant to better educate and train graduate students to work with children with Autism Spectrum Disorders (ASD). Her other interest include language learning disabilities and reading acquisition, as well as issues in bilingualism.