Question
Do you have any recommendations for an adult who has never received treatment for a nonverbal language disability? How are services covered and what is the prognosis?
Answer
For an adult who has never really received treatment, one thing I recommend is getting a good neuropsychiatric assessment so you have an idea of that individual’s strengths in working memory, nonverbal working memory, speed of processing, intellectual basis and attention. Then in terms of best treatment, there are several things I recommend. I do believe that individual speech therapists who have a lot of experience working with traumatic brain injury are very good working with adults, even if that individual’s executive function is not from an acquired brain-based injury. Those therapists seem to have a lot of rehab skill on how to get people more functional in their home, community, and work environments. In terms of getting services covered, it can be tricky in that health insurance often will not cover it unless it is deemed medically necessary. You must identify in your goals the language-based skills you will be working on such as working on language to build nonverbal imagery, language to build verbal working memory towards task execution, etc. If you include and define this as cognitive, many insurance companies will not pay for it. I find prognosis is difficult as it depends upon the severity of the nonverbal language disability and the characteristics of the neuropsychological assessment. I will say that we defined what the executive functions skills were in the last 5 to 10 years or have really understood it. However in the last 2 to 3 years, we have seen a huge increase in really good strategies. I think prognosis is better as we are getting better at treating it.
Sarah Ward, M.S., CCC/SLP has over 16 years of experience in diagnostic evaluations, treatment and case management of children, adolescents and adults with language learning disabilities, nonverbal learning disabilities, attention deficit disorder, executive dysfunction, Asperger’s disorders and social pragmatics. Ms. Ward holds a faculty appointment at the Massachusetts General Hospital Institute of Health Professions where she provides instruction to graduate level students in the assessment and treatment of individuals with traumatic brain injury and other cognitive communication disorders.
