Factors to Consider when assessing
- client’s needs/ clinician expertise
- genetic/constitutional
- developmental
- speech & language
- home environment
- stuttering behaviour
Client Needs
- Genuine interest/empathy from clinician
- acceptance as a whole person
- celebrate tx victories
- recieve understanding in backslides
- assisted in accepting self
- **heard w/ respect to assessment and treatment goals
Procedure
- preassessment info
- parent-child observations
- clinician-child observation
- case history/interview
- counselling
- speech tasks
Preassessment info
Initial contact Questionnaires Case History Forms Referral Letter Teacher Information
Parent-Child Observation
- Frequency/types of disfluencies
- struggle and secondary behaviour
- situational variability/consistency
- phonetic variability/consistency
- parents’ speech (rate, disfluencies)
- verbal/non-verbal interactions
- personalities of child and parent (ask about development)
- other speech-lang variables
Clinician-child observation
- Changes in speech fluency, interaction style, etc?
- High pressure conditions (time pressure, questions, interruptions)
- Low pressure conditions
- Child’s awareness
- can child talk about stuttering?
Case History
Typical one but with:
- parent description of child’s problem
- family history of speech/lang/stuttering
- onset
- who first notices?
- changes in speech patterns over time
- child’s awareness
- struggle, escape, or avoidance behaviours?
- situation or sound specific
- parents reactions
- **Previous/current therapy
- previous advice
Other Components
OME speech/lang tests artic language screen hearing screen consult w/ other professionals
Ax of Speech Rate
- Count syllables PER MINUTE
- Only syllables client would have said if no stuttering was present
- Only meaningful speech units (e.g. not interjections)
- exclude long pauses (>2 sec) unless silent blocks
Ax Instruments
Dx:
- Stuttering Severity Instrument - 4th Edition (SSI4)
- Stuttering Prediction Instrument
Attitudes:
- Children’s Attitude Test (CAT)
- S-24
- Locus of Control Behaviour (LOCB)
- Perceptions of Stuttering Inventory (PSI)
- Speech Situation Checklist (SSC)
- Overall Assessment of Speaker’s Experience of Stuttering (OASES)- assesses how stuttering affects person’s daily life
Interview: Behavioural
- How does client describe speech problem?
- What secondary behaviours used? (Avoidance, Escape)
- How aware is client of secondary behaviours?
Interview: Developmental
When did it start? Who noticed? Changes over time? Easy vs. hard situations? How do you cope when difficult? Easy vs hard sounds/words, why? How does client cope?
Interview: Psychological-Social
Can client anticipate stuttering?
What does client do when anticipating?
What effect on school, friends, work, social etc.
How do others react?
Interview: Neurological
Family history of stuttering?
Other speech, language, motor or health concerns?
Drug use (affects dopamine)
Interview: Previous Treatment
Received tx?
Type, techniques, why was it terminated, seeking ax now?
Seeing other health professionals?
Speech Tasks
Reading Task
-single words, sentences of ^ length, paragraph, adaptation (does it occur?)
Monologue (more fluent) vs. Convo
-300 syllables each
Automatic speech
-Count 1-20, days of week
Fluency Enhancing Techniques
- Altered auditory feedback during reading (doesn’t work for psychogenic)
- Masking
- *Slowed speech (word level, sentence level)
- Choral reading
Counseling
- 1st impression of ax results
- stuttering or not
- need for therapy?
- format of therapy (parent’s role, practical arrangements, homework)
- questions/concerns
- referrals
Developmental Levels of Stuttering (Guitar)
Normal disfluency Borderline stuttering Beginning stuttering Intermediate stuttering Advanced stuttering
Normal Disfluency
Core Behaviours
- 10 or FEWER disfluencies/100 words
- Single unit repetitions
- Repetitions, interjections, revisions
Secondary Behaviours
-NONE
Feelings/Attitudes
-Child not aware/concerned
Hypothesis
-Stresses of speech, lang and devt
Borderline Stuttering
Core Behaviours
- 11 or MORE disfluencies/100 words
- More than two units in repetitions
- More repetitions & prolongations than interjections & revisions
Secondary Behaviours
-NONE
Feelings/Attitudes
- Child generally not aware
- Sometimes surprised or mildly frustrated
Hypothesis
-Genetic predisposition interacting w/ stresses of speech, lang & devt
Beginning Stuttering
Core Behaviours
-Rapid, irregular & tense repetitions may have fixed artic posture in blocks
Secondary Behaviours
-Escape behaviours (e.g. eye blinks, increases in pitch/loud)
Feelings/Attitudes
- Child generally aware
- frustrated
Hypothesis
-Conditioned emotional reactions cause excess tension & conditioning of escape behaviours
Intermediate Stuttering
Core Behaviours
-Blocks where sound/airflow cut off
Secondary Behaviours
-Escape and avoidance behaviours
Feelings/Attitudes
-Fear, frustration, anger, shame
Hypothesis
-Those from borderline & beginning stuttering plus AVOIDANCE CONDITIONING
Advanced Stuttering
Core Behaviours
-Long tense blocks including tremor
Secondary Behaviours
-Escape and avoidance
Feelings/Attitudes
-Fear, frustration, anger, shame, negative self-concept
Hypothesis
-Those from earlier stages plus cognitive learning
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Genetic Contributions to Stuttering32
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Neurodevelopmental Contributions to Stuttering14
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Sensorimotor Contributions to Stuttering19
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Developmental, environmental & learning factors in stuttering25
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Identifying & Counting Stuttering Moments5
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Assessment30
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Preschool Assessment13
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Ax & Tx - School Aged16
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Comprehensive Stuttering Program for School-Aged Children (7-11/12 years)39
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CSP-CS + Down Syndrome19
