Her early formal language profile showed substantial strengths.
At approximately three years six months, the CELF Preschool–3 produced broadly average composite scores:
At approximately age three, receptive vocabulary was 114, or the 83rd percentile, and expressive vocabulary was 121, or the 92nd percentile. Speech intelligibility was 89.7%, mean length of utterance was 3.79, and pragmatic skills were considered age appropriate once her attention was secured. Following Directions and Word Structure were relative weaknesses at approximately the 16th percentile.
In 2024, the Preschool Language Assessment Instrument placed Matching and Selective Analysis at the 75th percentile, Reordering at the 37th percentile, and Reasoning at the 50th percentile. The evaluator explicitly stated that recommendations were offered because the family wanted useful targets, not because that observation demonstrated a broad language deficit.
The family’s summary provides the following 2024 TAPS-4 results:
The family’s summary describes substantial variation within those composites. Phonological Deletion was at the 2nd percentile, with the evaluator noting difficulty understanding the word “without.” Word Memory was at the 16th percentile and Sentence Memory at the 37th, suggesting stronger performance when information had meaningful linguistic context. Longer passages, inference, implied meaning, and integration of information were harder than short, concrete material.
By the final 2025 school speech-language report, the more specific higher-level and pragmatic difficulties were clearer. Her CELF-5 Pragmatic Profile scaled score was 5, below average. Areas of difficulty included:
- maintaining a topic;
- entering and leaving interactions;
- participating in unstructured groups;
- making introductions or giving advice;
- responding to teasing or failure;
- interpreting nonverbal social and emotional information;
- using greetings consistently; and
- judging interpersonal distance.
The same report documented real progress in peer play, turn-taking, flexibility, pretend play, reporting experiences, and labeling emotions. Remaining challenges included transitions, moments of freezing or eye aversion, and communicating with less-familiar partners. Speech-language therapy one to two times weekly was recommended.
At the latest family update, she remained conversational and socially interested but continued to have word-finding difficulty, mid-sentence reformulation, deeper semantic and higher-level language challenges, perspective-taking and inferencing difficulty, and trouble organizing explanations. Executive-function demands—planning, starting, sequencing, holding several steps in mind, and following through—can further restrict access to skills she possesses. Letter reversals and reading difficulties have also been noticed. A comprehensive neuropsychological evaluation was completed in summer 2026, with the final report issued in September. It identified a Language Disorder and Specific Learning Disorders in Reading, Written Expression, and Mathematics, as detailed below.
Her family does not identify childhood apraxia of speech as her communication profile. A 2022 speech-language history records that neurology did not find that she met autism criteria and instead described complex motor stereotypies unrelated to autism. Her family later reiterated that she did not clearly meet autism or ADHD criteria. The 2026 neuropsychological evaluation subsequently identified provisional Unspecified ADHD, with mixed findings and language and motor demands affecting interpretation. The report did not add an autism diagnosis. The ASH1L result should not itself be treated as an autism diagnosis.
A comprehensive speech-language evaluation in spring 2026 identified a mixed receptive-expressive language disorder with particular difficulty in higher-level processing. The neuropsychologist reviewed that evaluation and described weaknesses in narrative organization, inferencing, semantic flexibility, and expressive formulation. Receptive language was relatively stronger but became less reliable as complexity increased.
Her family describes the following results from the spring 2026 speech-language evaluation:
Scroll horizontally to review every column.
Average single-word retrieval did not capture her difficulty finding and organizing words in connected speech. Her family describes pauses, starts and restarts, mid-sentence reformulation, difficulty organizing explanations, and challenges producing age-appropriate written narratives. Their summary states that the speech-language evaluator understood pragmatic difficulty primarily in relation to higher-order language processing rather than a primary lack of social knowledge. The family reports that she was in a post-illness flare during this assessment. That context is relevant to interpretation without canceling the documented language needs.
Completed neuropsychological evaluation
The neuropsychological evaluation was completed over summer 2026, with the final report issued in September. It incorporated direct testing, parent interviews and questionnaires, clinical observations, and review of prior evaluations and IEPs. Direct testing took approximately eight hours across four sessions. She wore her glasses throughout, worked persistently, and responded well to structure and individualized pacing. The evaluator considered the results a valid estimate of her current functioning.
The report identified:
The evaluator described Unspecified ADHD as provisional because findings were mixed, symptom criteria were subclinical, and language and motor demands could affect performance. Teacher rating scales were not obtained during the summer evaluation. Parent attention and hyperactivity ratings were within expected limits, although parents described functional difficulties and prior school evaluations documented distractibility, frequent movement, and inconsistent engagement.
The evaluation did not diagnose intellectual disability. It also did not add an autism diagnosis. Earlier history records a neurology assessment that did not find she met autism criteria, and the 2026 parent autism-rating scales were within expected limits. An ASH1L result is not itself an autism diagnosis.
Cognitive strengths, working memory, and processing speed
The WISC-V results show a markedly uneven profile:
Scroll horizontally to review every column.
The evaluator explicitly considered the Full Scale IQ non-cohesive and not clinically meaningful as an overall description because of substantial differences among the contributing subtests.
Figure Weights, a quantitative-reasoning subtest, was a strength at scaled score 13, the 84th percentile. Other reasoning tasks were less consistent: Matrix Reasoning was scaled score 5, the 5th percentile, while Visual Puzzles was scaled score 8, the 25th percentile. The quantitative-reasoning strength therefore describes a particular task, rather than every form of nonverbal reasoning or mathematics.
Short-term memory and mental manipulation were more difficult. Digit Span was scaled score 4, the 2nd percentile, and Picture Span was scaled score 6, the 9th. Digit Span Forward was at the 5th percentile, Backward at the 9th, and Sequencing at the 2nd. The evaluator noted that she did not understand the instructions to at least one working-memory task. These results describe performance under those language and task demands; they do not establish a progressive memory disorder.
Coding and Symbol Search were each scaled score 5, the 5th percentile. Both processing-speed tasks included visual and graphomotor demands, which the evaluator identified as relevant to interpretation.
On NEPSY-2, Auditory Attention and Response Set were each scaled score 2, below the 1st percentile. Inhibition naming speed was scaled score 7, the 16th percentile, while inhibition speed was 5, the 5th, and total errors 6, the 9th. Performance became slower and less accurate as demands on attention and inhibition increased.
These difficulties were visible alongside sustained effort. She became more distractible as sessions progressed but responded to prompts, movement breaks, sensory tools, and predictable routines. She returned to tasks with little prompting and independently put away materials after breaks.
Language, phonological processing, and social communication in 2026
The completed neuropsychological evaluation confirmed that foundational language strengths coexist with specific higher-level needs.
Scroll horizontally to review every column.
Sound blending was a relative strength, with CTOPP-2 Blending Words at scaled score 10, the 50th percentile. Elision and Phoneme Isolation were each scaled score 6, the 9th percentile. Memory for Digits was scaled score 3, the 1st percentile, and Nonword Repetition was 6, the 9th. Rapid digit and letter naming were within the average range. The most pronounced phonological difficulty involved holding speech-based information in memory.
Social-language testing also varied by task:
She performed better recognizing emotional information in structured tasks than generating gestures, explaining social situations, or making inferences. Overall facial-affect recognition was average, although the evaluator’s error analysis identified particular difficulty with sad and neutral expressions.
During conversation, she sometimes had difficulty sustaining a back-and-forth exchange or answering open-ended questions, even while remaining polite and interested. She connected through shared activities, offered practical help, and showed her artwork. Her social motivation remained evident when spontaneous language was harder to organize.
Reading, written expression, and mathematics
The family’s account describes an uneven academic profile before the neuropsychological evaluation. A spring 2025 mathematics assessment found secure early number concepts, with emerging difficulty writing teen numbers, identifying patterns and sequences above ten, and organizing more complex work.
Their summary of the November 2025 WIAT-4 evaluation reports Reading 93, Written Expression 88, Mathematics 75, and Total Achievement 82. Word Reading and Reading Comprehension were each 95, Spelling 91, Sentence Composition 79, Numerical Operations 78, Math Problem Solving 76, Math Fluency 79, and Oral Expression 97. The neuropsychologist’s review independently describes the same broad pattern of stronger reading alongside more substantial mathematics and sentence-composition difficulty.
The completed 2026 WIAT-4 results were:
On the GORT-5 oral-reading measure, rate was scaled score 6, the 9th percentile; accuracy 7, the 16th; and fluency and comprehension each 8, the 25th. The Oral Reading Index was standard score 89, the 23rd percentile.
The evaluator diagnosed a reading disorder from the combined literacy, phonological-processing, developmental, and educational findings. Some individual reading scores remained in the low-average or average range. Those scores coexist with difficulty developing sufficiently efficient reading to support comprehension and learning from text.
Written expression was affected by language formulation and fine-motor demands. She had difficulty creating and combining complete sentences despite trying multiple items and receiving repeated explanations. Writing samples showed inconsistent letter formation, sizing, spacing, and alignment, as well as spelling errors and an occasional reversal.
In mathematics, timed retrieval of basic addition and subtraction facts was particularly difficult. The evaluator also identified gaps in number sense and ordering numbers. These findings coexisted with her strength on the quantitative-reasoning task, supporting instruction that develops foundational number understanding and fluency while recognizing her reasoning potential.
These evaluations describe performance at different times and under different conditions. Differences between scores do not by themselves demonstrate loss of acquired skills. The 2026 findings identify more specific learning needs as academic expectations increase.