Valerie. Valerie was diagnosed with Prader – Willi syndrome at 3 months of age. She had a limited sound repertoire that mainly consisted of vowels, nasals, and several stop sounds. Most of her sound combinations were inconsistent and consisted of consonant vowel (CV) combina- tions; she had approximately 10 intelligible words. Valerie had poor oral-motor skills, includ- ing poor motor programming and muscle weakness. Valerie demonstrated receptive lan- guage delays. Expressively, Valerie used gestures, speech approximations, signs, and a voice output system to communicate.