Exam 2

Question 1

Normal disfluencies ages

Answer 1

1 1/2 to 6 years old

Question 2

Borderline stuttering ages

Answer 2

1 1/2 to 3 1/2

Question 3

Beginning stuttering ages

Answer 3

3 1/2 to 6

Question 4

Intermediate stuttering ages

Answer 4

6 to 13

Question 5

Advanced stuttering ages

Answer 5

14+

Question 6

Do all PWS pass through every stuttering level?

Answer 6

No. Can be at any level and advance. May move in and out or skip around.

Question 7

To determine normal disfluencies vs stuttering

Answer 7

Look at frequency, duration, and type of disfluencies as well as the individual’s awareness

Question 8

Van Riper track 1

Answer 8

Exhibit core behaviors between ages of 2-4

May progress on to disfluencies with more tension (maybe more blocks?)

Question 9

Van Riper Track 2

Answer 9

Later onset of stuttering 3 1/2 - 4
Artic/Lang issues - more concomitant areas of concern

This may be the most common one that we see.

Question 10

Van Riper Track 3

Answer 10

Come on with very severe blocks, a lot of tensions, secondary behaviors - no ease into it, comes on very suddenly - does not happen often

Question 11

Van Riper Track 4

Answer 11

Psychogenic onset - traumatic experiences triggering onset of stuttering

Question 12

Normal disfluencies are a part of development as children try to master speech and language. Examples of normal disfluencies…

Answer 12

Part word 
Whole word 
Phrase repetitions 
Interjections 
May see some prolongations but these could also be a red flag for concern - look at frequency and duration to determine

Question 13

Distinguishing features between normal disfluencies and stuttering

Answer 13

Amount of disfluencies - 1% usually ok, 15% red flag
Number of unit repetitions - more = more likely stuttering
Type of disfluencies - part word repetitions, prolongations, blocks are more indicative of stuttering

Question 14

Normal disfluencies

Answer 14

Single - syllable word repetition 
Multisyllabic word repetition 
Phrase repetition 
Interjection 
Revision - incomplete phrase

Question 15

Atypical disfluencies

Answer 15

Part-word repetition 
Prolongation 
Tense pause (blocks)

Question 16

Do no stuttering children exhibit secondary characteristics

Answer 16

No.

Question 17

Why are increases and decreases in disfluencies common throughout childhood?

Answer 17

Language acquisition demands
Pragmatics - social interaction with peers
Environmental stress - parents, moving, preschool demands

Question 18

What kind of stuttering may be difficult to diagnose because the child will exhibit normal disfluencies and stuttering

Answer 18

Borderline stuttering

Question 19

Children with borderline stuttering may exhibit…

Answer 19

Part word repetitions 
Whole word repetitions 
Prolongations 
Frequency is 10% 
Stuttering behavior consist of more within word disfluencies

Question 20

Does a child with borderline stuttering exhibit secondary characteristics?

Answer 20

No

Question 21

Underlying processes to borderline stuttering include

Answer 21

Resource allocation - a lot of development happening at the same time, where are the brain resources being placed?
Capacity to handle demands
Potential increasing frustration with communication

Question 22

Child with Beginning stuttering exhibits what types of behaviors? (Not their speech characteristics)

Answer 22

Increased tension during stuttering moments
Less patience and tolerance for stuttering moments
Development of escape behaviors may occur

Question 23

Beginning stuttering core behaviors

Answer 23

Repetitions sound more rapid and irregular
During repetition a schwa may be inserted
Prolongations may be a second or longer
Increased tension present - may be fleeting

Question 24

Do children with beginning stuttering exhibit secondary behaviors?

Answer 24

Pitch rise
Head turns
Eye closure

Question 25

Are children at the beginning stuttering level aware of the stuttered moments?

Answer 25

Yes. | Frustration is common and may question inability to get a word out

Question 26

In beginning stuttering, what is increased tension attributed to?

Answer 26

Anticipation of the stuttering event - tension helps brace the individual's body for the stuttering moment

Question 27

In beginning stuttering, what is the increase in speed of repeated behaviors attributed to?

Answer 27

The child's recognition in the delay to communicate the intended message

Question 28

In beginning stuttering, what is responsible for the increase in frequency of escape behaviors?

Answer 28

Conditioning Ex. Child thinks, every time I squeeze my fist when I get stuck, then the word comes out better so I am going to do that - it doesn't work and will have to also be addressed in therapy

Question 29

At what level to children begin to develop fear of stuttering as well as develop avoidance behaviors?

Answer 29

Intermediate

Question 30

At what level are core behaviors still present and more blocking is involved?

Answer 30

Intermediate

Question 31

With this level, use of escape behaviors are more prevalent than beginning stuttering and this time of avoidance behaviors occur.

Answer 31

Intermediate Word and situation avoidance behaviors

Question 32

What are Van Riper's 3 different word avoidance categorized.

Answer 32

Substitutions - Say a different word than what they want to say - come up with a different word to avoid the stutter Circumlocutions - Talking around the word but never actually saying it Postponements - A little pause before they say the word the are intending to say - getting themselves ready to say the word successfully or they know they have to say the word and that it will be problematic

Question 33

At what level to children begin to feel fear, embarrassment, and shame with stuttering?

Answer 33

Intermediate

Question 34

In intermediate stuttering, how are the escape behaviors changed?

Answer 34

Escape behaviors transform into avoidance behaviors ex. I don't want to raise my hand in class, I will not participate I won't order, my parents have to do it for me Child starting to shut down a little bit in various situations

Question 35

At what level do treatment responsibilities fall on the client and beliefs about stuttering can be distorted?

Answer 35

Advanced

Question 36

What type of stuttering is common in the advanced level?

Answer 36

Core speech behaviors consist typically of blocks, with the blocking being more pronounced and include more struggle behavior as well

Question 37

How is the advanced level of stuttering characterized? What makes a person be placed in this level?

Answer 37

Age - older adolescents and adults

Question 38

Why are those is the advanced stage of stuttering more adept to control the environment to avoid stuttering?

Answer 38

Their fears and attitudes have been shaped by years of conditioning

Question 39

People in this level have developed a self-concept as an impaired speaker. Why?

Answer 39

Advanced Self-concept is formed by perceptions of listeners' reactions

Question 40

Stuttering assessment is a multi level process that includes..

Answer 40

Information gathering and personal encounter Display your knowledge about stuttering and listen to the family/client concerns

Question 41

All client's have a right to privacy and confidentiality. Why is this especially important for school aged children?

Answer 41

They have to trust you to be able to move forward in therapy. Even have to be careful when talking to parents - you tell the parents something that was said in therapy and then the child does not trust you anymore and no longer wants to share with you

Question 42

Clinicians need to develop a multicultural view on stuttering assessment and treatment including...

Answer 42

Becoming sensitive to communicative style differences | Learning how other cultures view speech and language disorders

Question 43

What are some multicultural issues related to stuttering?

Answer 43

Eye contact - ex. May be offensive to have eye contact with authority figures Family interaction style - family may value their interaction style like a fast speaking rate Physical touch - ex. Personal space! - Ask them and explain before you do it Voluntary stuttering - may help with control, able to practice techniques ex. Some client's may find this unacceptable. Client may think - Why are you making me do this when I already stutter?

Question 44

What is the purpose of a preschool assessment? And what purpose does the initial evaluation serve?

Answer 44

To clarify observations of disfluencies by parents or others. Is the child stuttering or is it just normal disfluencies? Also, parents may need information and reassurance from the clinician. Initial evaluation will serve as the beginning point of the decision making process

Question 45

What are the preschool assessment procedures?

Answer 45

- Obtain a good audio and video recording - at the very least have to audio but it is best to have both - have toys that are age appropriate - first part of the assessment should be free play. This allows time to observe and record disfluencies types and frequency, observe parent-child interaction, look at how the parent reacts when the child stutters, Speaking rate of the parent and child,Types of questions/vocab that the parent is asking - cognitive load, and Does the parent interrupt the child? Frequency? - provide structured speech tasks that slowly increase in difficulty - interview parents - clinician-child interaction - talk about stuttering - determine the child's awareness - if aware, ask them why they are here today - calculate speech rate - find out about feelings and attitudes - may have to be from parent interview

Question 46

How do you do an assessment with a child who won't talk?

Answer 46

Bring the parent in for the evaluation - rely on parent-child interaction

Question 47

Preschool assessment diagnosis: Normal Borderline Beginning

Answer 47

Normal - less than 10 disfluencies per 100 words - most disfluencies are normal like (normal like disfluencies (NLD) or other disfluencies (OD) - Phrase reps, whole word reps, maybe some part word reps, interjections) Borderline - more than 10 disfluencies per 100 words - exhibits core stuttering behaviors Beginning - presence of tension in the child's speech - Likely see awareness, pitch rising, prolongations of 1 second or longer

Question 48

Preschool recommendations: Normal Borderline/beginning

Answer 48

Normal - greater emphasis placed on parental concern's than child's disfluencies - educate parents about stuttering development in conjunction with other aspects of child development - offer strategies for interaction with their child Borderline/beginning - have parents keep note of fluency changes in children - continue to educate parents - parent directed therapies are good for this age