Ax of school-age children and adults

General considerations for school-age CWS

• parental concern about stuttering = reliable indicator of presence of stuttering in children

• little justification for “wait-and-see” - typically beyond age of spontaneous recovery

• increase in 2ndary bxs, coping & concealment strategies with increased self-awareness of stuttered speech, avoidance bxs

• significant % have concomitant SSD, expressive or receptive language difficulties

General considerations for ax of school-age CWS + adults

• Ax is multidimensional - not only speech but comprehensive ax necessary e.g. OASES & CALMS

• Variability - exposed to many different contexts

• Needs to be within ICF framework

Background & Case history

• stuttering history

• treatment history

• current speech description - has severity changed? awareness of speech, can they describe it?

• environmental influences on speech

• stuttering impact on QOL

• other relevant case history - e.g. languages spoken

• client’s perspective - important to talk about expectations and readiness for treatment

School-age children background & case history

Interview with parent - address parents concerns about child’s stuttering

Interview with child

• Tell me about some things you are good at?

• Do you like talking?

• Do you participate in class discussions? Answer questions?

• Do other children make fun of your stuttering?

Use alternate wording if diagnosis is uncertain

Children may downplay stuttering severity or impact on QOL due to shame, anxiety etc - remove from talking about themselves, ask about more general perceptions

Adolescents and adults background & case history

Focus on overt stuttering bxs, often secondary in ax & tx

Provide info about stuttering & tx:

• unlikely to completely recover will experience some amount of stuttering for rest of lives, regardless of tx

• manage expectations: controlled fluency, less effortful stuttering or managed stuttering - can teach strategies for these

Observations and Examinations

1. speech examination

2. situation rating scales

3. emotions & attitudes rating scales

4. tests for overall stuttering severity

Speech examination

• 2 ideally 3 separate speech contexts (conversational or monologue, reading, speaking context relevant for individual)

• obtain speech sample with full extent of severity

• comparison to normative dataset - to get idea of severity

Speech sample size

Conversation/monologue: >300 syllables, >600 better to identify blocks & longer repetitions

Oral reading: ~200 syllables

Disfluency measures

Stuttering frequency - syllables or words

Percent syllables stuttered

Stuttering severity

Based on speech characteristics:

• how often is speech disrupted

• how long is speech disrupted

• secondary bxs associated with disruptions

Tools: SSI-4, TOCS, 8 or 10-point rating scale

may not reflect impact of total stuttering disorder - social, emotional impacts

Speaking effort increases as children age

Increases in both:

Physical effort

• extraneous movements, excessive physical tension, atypical speech breathing, atypical phonation during speech etc

Mental effort

• increased awareness of stuttering

• linked with increase in responses to stuttering with self-devised management strategies that require substantial mental effort to implement e.g. word substitution, avoidance, stalling

Situation rating scales

Become more important with longer stuttering experience

Use to collect info on variability of stuttering across situations and contexts

Rapport necessary before asking these q’s

Situation rating scales Instruments

Speech Situation Checklist (SSD) - how disrupted speech is in certain situations

Individualised Situation Hierarchy - identify which situations are the easiest, more difficult

Emotions & Attitudes Rating Scales

Consider attitudes about stuttering, speaking, self, other people etc

Can be challenging for individual - be respectful and sensitive

Emotions & Attitudes Rating Scales Instruments for adults

• Individualised interview about emotions & attitudes

• OASES

• BAB-A

• UTBAS

• Erickson S-24

• PSI

• LCB

Emotions & Attitudes Rating Scales Instruments for children

For children 6+:

BAB-S - bx ax battery for school-age CWS

• CAT - communication attitude test

• SSC - speech situation checklist

• BC - behaviour checklist

For children under 6:

• KiddyCAT

Interpretations & Recommendations

Differential diagnosis

• usually pretty clear, rare instances of feigned stuttering

Differences across clients

• very mild stuttering but high impact

• lots of avoidance

• lots of tension in articulators

• lots of secondary characteristics