Approx number of syllables needed for a speech sample in conversation
300-400
Approx number of syllables needed for a reading sample
200
Describe assessment goals for preschool children
Goal is to identify:
- Is tx needed? (abnormal vs normal disfluencies)
- Likelihood of spontaneous recovery?
Describe assessment goals for school-age children
- Gather comprehensive information on the impact of the disorder
- Identify readiness + desire for therapy
- Include observation in classroom
- May need to develop IEP
With children, we may have them describe images, name images, repeat non-words, or conduct other standardized items.
For school-age children, what are some important areas to consider during assessment?
- Reading sample
- Questionnaire to the teacher
- Interview the child without their parent to understand their feelings
- Observation in classroom
- Story telling
- Therapeutic trials before analysis + interpretation
Examples of direct intervention for stuttering
Lidcombe
Syllable Timed Speech (Westmead)
Examples of indirect intervention for stuttering
Palin PCI
DCM
RESTART
Sarah is 30 months old. For the last 2 months, she has been repeating some words and revises utterances. Her parents aren’t too worried about her disfluencies but want to know if she’ll need therapy.
Where does she fall on the risk of persistency of stuttering? What should you suggest?
Lowest tier - education and information only
- Can provide a screening and risk ax
- Child under 3 years old with onset below 3 months
- Inform parents that may recover naturally
- Provide counselling on the environment
Lucas is 3.5 years old and has had jumbled speech for about 5 months. His parents don’t seem too concerned, and neither does he. He doesn’t show signs of speech or language concerns.
Where does he fall on the risk scale and what should you suggest to parents?
Monitoring
- Child is under 4
- Onset of stuttering over 3 months
- Child not showing signs of distress
-
At what age do we typically shift to direct tx strategies for children?
5 years old
4 elements typically included in direct treament
1) Procedures to REDUCE the Frequency and/or Severity of stuttering
2) Procedures to MINIMIZE or remove factors that may be MAINTAINing stuttering
3) Procedures to facilitate GENERALIZATION of new speech behs to daily comm
4) Procedures that foster MAINTENANCE of fluency
General treatment for cluttering
- Reduce speech rate
- Increase awareness of rate with recordings
- Improve pragmatics + linguistic skills (turn taking, staying on topic, using complex sentences)
- Increase pauses for intelligibility
Potential factors causing stuttering
- Genetic/congenital e.g. a trauma - neuronal connections are less developed or dense (predisposed)
- Physiological/devleopmental characteristics (e.g. growth spurt in syntax/language development)
- Environmental characteristics - e.g. change in family structure, moving, reaction from others + reaction of the own child
**The child’s own response to the stuttering (negative attitudes, escape behaviours) can contribute to increased severity
Risk factors for a more persistent stutter
- A member of their family had a persistent stutter
- Male
- Female who does not recover shortly after installation
- 3;6 or older at the moment of installation
- Frequency/severity does not decrease during the year following installation
- Continues to stutter one year post-installation
- Repetitions are at a high # of iterations
- Repetitions are fast
- Presence of prolongations and blocks do not decrease with time
- Phonological abilities are below the norm
Diagnosogenic Theory
Begins when parents/adults mistakenly label normal disfluencies as stuttering.
Being labelled as a stutterer causes them anxiety/anticipation and leads to actual stuttering or avoidance
Widely refuted –> lack of empirical evidence; overly simplistic explanation; places blame on parents; does not explain persistence
Communicative Failure and Anticipatory Struggle Theory
Van Riper
- Communication breakdown btwn speaker and listener (e.g. linguistic complexity, increased rate)
- As this continues to occur, speakers develop anticipatory anxiety about negative reactions - increased avoidance
- Vicious cycle - struggle causes tension and exacerbates stuttering which reinforces fear of speaking
Covert repair hypothesis
We have external and internal monitoring of our phonological plans
Covert would be the internal monitoring and changes we make before the chosen sounds are articulated
Demands and Capacities Theory
Expectations for the child’s performance are too high for their abilities
E.g. child’s own expectations as in having complex ideas; environment asking many questions instead of commenting; impatient during moments of stuttering.
vs.
Abilities –> motor control, linguistic planning; cognitive abilities, socio-emotional
What are stuttering-type disfluencies?
- Part-word Repetitions
- Audible prolongations
- Blocks
- Repeating monosyllabic words twice (3 iterations) without indication of word retrieval problem
What are normal disfluencies?
Fewer than 10 per 100 words, avg.
- Revisions
- Interjections
- Repetitions of polysyllabic words
- Repetitions of groups of words
- Repetition of a monosyllabic word once (2 iterations) without any signs of tension/fast rate/secondary behaviour)
What characterizes borderline stuttering?
Amount and type of disfluencies beyond normal (11 or more per 100, 3+ iterations of reps);
no secondary beh’s;
sometimes surprised by stuttering or shows momentary mild frustration but generally not aware
What type of disfluency/patterns would Barry Guitar use to identify intermediate stuttering?
Blocks in which sound and air are shut off; escape AND avoidance present
List stuttering type disfluencies from most to least severe.
1 - Blocks and prolongations
2 - Part-word repetitions
3 - Whole-word repetitions (monosyllabic)
Percentage of disfluencies that should be stuttering-type disfluencies to be considered a person who stutters
66%
