SLP Praxis Practice (Form 2)

A 65-year-old patient is transferred from another facility with a diagnosis of aphasia. The patient's symptoms, however, appear more consistent with apraxia. Which of the following tasks for the patient is most appropriate when assessing verbal apraxia of speech?

A.Repeating words of increasing length

B.Recalling three common items

C.Performing voluntary oral movements

D.Following two-step commands

Option (A) is correct. Inability to repeat two-syllable words is a clear indicator of apraxia of speech.

Oropharyngeal dysphagia in a child with Down syndrome is most likely caused by which of the following factors?

A.Hypotonia

B.Digestive problems

C.Pneumonia

D.Aversive feeding behaviors

Option (A) is correct. Hypotonia is the leading cause of swallowing disorders in children with Down syndrome.

Which of the following recommendations to a parent of an infant with cleft lip and palate should an SLP make to best optimize feeding for adequate nutrition and appropriate growth?

A.Providing a bottle rather than breast-feeding the infant

B.Positioning the infant in a supine position during feeding times

C.Allowing the infant to take as much time as needed to feed

D.Using a bottle with a modified nipple during feedings

Option (D) is correct. A bottle with a modified nipple allows for greater control over the quantity of liquid expressed and the pacing of feeding.

The head lift exercise published by Shaker et al. (2002) was designed to produce which of the following changes in swallow biomechanics?

A.Increase in laryngeal closure duration

B.Strengthening of the base of the tongue

C.Increase in diameter and duration of the upper esophageal sphincter (UESU E S) opening

D.Prolonged relaxation of the cricopharyngeal portion of the inferior constrictor muscle

Option (C) is correct. The results of Shaker et al. (2002) demonstrated a significant (p<.01p left angle bracket period zero one) increase in the opening duration of the UESU E S.

Which of the following sounds are typically mastered by the time a child turns 3?

A./k/ and /g/forward slash k forward slash and forward slash g forward slash

B./p/ and /b/forward slash p forward slash and forward slash b forward slash

C./l/ and /s/forward slash l forward slash and forward slash s forward slash

D./ch/ and /sh/

Option (B) is correct. /p/ and /b/forward slash p forward slash and forward slash b forward slash should be mastered by age 3 in a typically developing child.

When assessing the ability of a student with cerebral palsy to access an augmentative and alternative communication device, which of the following physical factors must be evaluated first?

A.Upper extremity range of motion

B.Lower extremity strength

C.Trunk stability and control

D.Fine motor dexterity

Option (C) is correct. Trunk stability will guide the clinician in making an appropriate recommendation for the type of device a client can access as it influences more distal movements.

A school-based SLP wants to discharge a fifth-grade student. The student has mastered all his goals except /r/forward slash r forward slash in conversational speech. The SLP worked with the student for the entire school year, and the student is able to use /r/forward slash r forward slash accurately 75 percent of the time. However, the goal is to reach 90 percent accuracy. Because the student worked on the skill all year and still has not met the established goal, the SLP feels the student performs at his highest possible level. The SLP does not think it is in the student's best interest to continue pulling the student out of class to address the goal. The parents are upset and are questioning the SLP's decision.

Which of the following statements from the American Speech-Language-Hearing Association (ASHA) Code of Ethics can be used to back up the SLP's decision?

A.Individuals who hold the Certificate of Clinical C

Option (A) is correct. According to ASHA, it is important that SLPs remember to provide services when a benefit can be expected. The SLP has exhausted all treatment options and a benefit for this student is no longer expected.

Put in order of acquision: p, k, dj, th

/p/forward slash p forward is first because this phoneme is developed between ages 1 and 3. /k/forward slash k forward slash is second because this is developed by age 3 1/2. /θ/forward slash omega forward slash is third because this is developed between ages 3 and 8. /ʒ/forward slash ezh forward slash is last because this is developed between ages 6 and 8. ((P, K, TH, J))

An 81-year-old female presents to a rehabilitation hospital following a severe L MCA stroke. The patient has poststroke right-sided weakness, right neglect, and suspected nonfluent aphasia. Receptive language appears to be mildly impacted. The patient has a complex medical history, including TBI following a car accident two years ago, obesity, diabetes, seizure disorder, congestive heart failure, and hypertension. Socially, the patient has lived alone for the past three years following her husband's death. Since her car accident she mainly watches TV at home and leaves her house only for dialysis. She has meals on wheels and home health aides to assist her with showering. Because of her TBI, her behavior is often variable and erratic. The highest level of education she attained was seventh grade. She stayed home to take care of her children and did not have a career.

1-Which of the following medical conditions, in

1- are more likely to have metacognitive problems in addition to the aphasia, thus impacting their ability to improve.

2-Option (C) is correct. When an SLP assesses phrase length, it is important to task the patient with open-ended questions to assess the patient's ability to spontaneously produce speech.

3-Option (B) is correct. Information about the severity of the patient's stroke is necessary to estimate the patient's chance of recovery.

Inhalation during respiration is primarily carried out through the movement of which of the following muscles or muscle groups?

A.Diaphragm

B.Internal intercostals

C.External intercostals

D.Scalenes

Option (A) is correct. The diaphragm is the muscle that creates the most volume in the lungs.

An SLP receives a referral from an audiologist for a 72-year-old woman who demonstrates a moderate to severe bilateral sensorineural hearing loss preventing her from participating in social activities. Which of the following best identifies the SLP's role?

A.Training in speech reading

B.Prescribing hearing aids

C.Performing an auditory evaluation

D.Using auditory integration training

Option (A) is correct. Providing speech-reading therapy is a primary role for SLPs as it enhances the overall communicative competency for the client.

An SLP provides home practice for a patient with aphasia as part of discharge plans. The patient is approximately six-months post left-hemisphere stroke that resulted in aphasia. Verbal output has improved significantly since the stroke; however, the patient is still very concerned that written expression is moderately impaired at the single-word level. The homework assignment is to implement copy-and-recall treatment to improve written expression, which involves practicing writing target words (from photographs) and then copying those words multiple times. However, during a follow-up phone call, the SLP determines that the patient is struggling to write the assigned target words because the patient "can't think of the correct letters." Although a model is provided on the back of each target photograph, the patient wants to find a way to practice without looking at the answer. The SLP's best course of action is to su

Option (A) is correct. This approach would give the client the best access to completing the homework. The letter tiles would provide a support for the client to complete the homework and are a regular part of this treatment approach.

Which of the following instruments is often used to document stages of recovery after traumatic brain injury (TBIT B I) ?

A.Glasgow Coma Scale

B.Scale of Executive Function

C.Sequenced Inventory of Communication Development

D.Rancho Los Amigos Scales of Cognitive Function

Option (D) is correct. The Rancho Los Amigos Scales of Cognitive Function is the only truly "scaled" instrument developed specifically for rehabilitation documentation following TBIT B I.

A large metropolitan school district wants to determine the prevalence of developmental stuttering among all enrolled students during the past year. Which of the following approaches is most appropriate for accomplishing the task?

A.Dividing the total number of students who currently stutter by the total number of students who were enrolled during the past year

B.Subtracting the total number of students who received treatment for stuttering during the past year from the total number of students who currently stutter

C.Multiplying the total number of students who currently stutter by the total number of students enrolled during the past year

D.Dividing the total number of newly identified students who stutter by the total number of students enrolled during the past year

Option (A) is correct. The prevalence of stuttering is the percentage found by dividing the number of students who currently stutter by the number of students enrolled in school.

An SLP uses evidence-based practice by integrating the perspectives and values of the client, patient, or caregivers into the treatment plan. Which of the following best reflects simultaneous incorporation of the host culture's perspectives and values and maintenance of the native culture's perspectives and values?

A.Acculturation

B.Assimilation

C.Enculturation

D.Ethnocentrism

Option (A) is correct. Acculturation is the incorporation of the host culture's perspective and the native culture's perspective and values.

The commonly used chin-down posture was initially developed to eliminate thin-liquid aspiration in people with delayed pharyngeal stage onset after having a stroke, and when its efficacy was investigated, it was found to be 50% effective. For whom is the chin-down posture ineffective at eliminating thin-liquid aspiration?

A.People who have cricopharyngeal dysfunction

B.People who aspirate residue from the pyriform sinuses

C.People who have impaired lingual function

D.People who aspirate residue from the valleculae

Option (B) is correct. Shanahan et al. (1993) found that 50 percent of people with stroke- and swallowing-related aspiration due to delayed onset of the pharyngeal response continued to aspirate from the pyriform sinuses using the chin-down posture. Moreover, Eisenhuber et al. (2002) found that people with a pyriform sinus residue with a height that was less than 50 percent of the pyriform sinus height aspirated significantly more than those with less or no pyriform sinus residue.

Which of the following strategies to treat compensatory articulation errors is most appropriate for a child with hypernasality and glottal stop substitutions following surgery for velopharyngeal insufficiency?

A.Using oral motor exercises

B.Using a straw to elicit /s/forward slash s forward slash

C.Using tactile cues to elicit phonemes

D.Using negative practice

Option (C) is correct. Tactile cues are used to elicit correct articulation placement.

Which of the following neuroimaging studies specifies which artery or arteries is/are occluded in a patient with a stroke?

A.Electroencephalography

B.Magnetoencephalography

C.Evoked-response potentials

D.CT or MR angiography

Option (D) is correct. These studies will give results which specify which artery is occluded.

Which of the following statements best indicates a screening tool with high sensitivity?

A.The majority of the children who passed the screening were found to have a communication disorder.

B.Many of the children who passed the screening did not have a communication disorder.

C.All of the children who failed the screening were found to have a communication disorder.

D.Most of the children who failed the screening did not have a communication disorder.

Option (C) is correct. Sensitivity is the success rate in identifying all of the children who truly have a disorder.

A 72-year-old right-handed female is evaluated following a left-hemisphere stroke. Findings reveal a moderate Broca's aphasia. Which of the following is the primary goal of intervention for the client?

To improve the client's pragmatics skills and abilities

To increase the client's ability to express functional comprehension abilities

To improve the client's ability to express production of syntactically appropriate sentences

To enable the client's ability to use a digital augmentative communication system

Option (C) is correct. Improvement of expression, particularly syntax, is the most appropriate focus of treatment for Broca's aphasia.C-

An SLP tries to elicit correct production of the target sound /s/forward slash s forward slash. Which of the following words provides the best coarticulatory conditions to meet the SLP's goal?

A.Spoon

B.Sea

C.Sob

D.Soup

Option (B) is correct. The target sound /s/forward slash s forward slash and the vowel /i/forward slash i forward slash that follows it both require lip spreading. The vowel /i/forward slash i forward slash is high and front.

Management of which one of the following examination observations alone will produce the best improvement in the pneumonia risk of an adult patient with chronic dysphagia?

A.Poor oral bolus control and containment

B.Poor oral hygiene and dependence for oral care

C.Delayed onset of the pharyngeal stage of swallowing

D.Impaired distension of the upper esophageal sphincter

Option (B) is correct. Studies have identified poor oral hygiene (including presence of decayed teeth) and dependency for oral care as significant independent predictors of pneumonia in people with chronic dysphagia.

Which of the following is a distinguishing characteristic of articulation therapy for a 2-year-old patient with a repaired cleft palate and compensatory errors?

A.Cycling through multiple speech goals in a given session

B.Having a play-based learning approach to address goals

C.Focusing on carryover of speech productions

D.Addressing speech targets with high frequency and intensity

Option (B) is correct. Based on the age of the child, the only appropriate treatment listed is a play-based approach. All other treatments listed are inappropriate for the age of the child.

Early intentional communication typically emerges in the months leading up to a child's first birthday. Which of the following communicative functions typically emerges first in this period?

A.Requesting

B.Commenting

C.Protesting

D.Greeting

Option (C) is correct. Early intentional communication develops around 8 to 10 months of age, and the first function that emerges is protesting.

An SLP plans to give Cody, an 8-year-old boy with autism spectrum disorder, tangible reinforcement in conjunction with the use of manual signs during an object labeling task. At first, reinforcement will be presented every time Cody produces a sign correctly. After several sessions, however, reinforcement will be given after every third instance of correct labeling. Which of the following choices best describes the SLP's reinforcement schedule?

A.Fixed-ratio schedule followed by variable-ratio schedule

B.Fixed-ratio schedule followed by continuous schedule

C.Continuous-ratio schedule followed by fixed-interval schedule

D.Continuous-ratio schedule followed by fixed-ratio schedule

Option (D) is correct. At first the desired behavior is reinforced every time it occurs followed by a fixed ratio of every third time.

Alternation Attention?

Sustained Attention?

Selective Attention?

Working Memory?

Match the action with the correct term listed above.

Focusing on hearing a person speaking while the television is on?

Listening to a list of spoken words for a target word

Sorting playing cards by color, then by number, and then by color again

Mentally solving a complex math problem

-Alternating Attention—Sorting playing cards by color, then sorting by number, and then sorting by color again.

-Sustained Attention—Focusing on hearing a person speaking while the television is on. -Selective Attention—Listening to a list of spoken words for a target word over a 3-minute period. -Working Memory—Solving a complex math problem in your head. Any other order is incorrect because as Sohlberg and Mateer (2010) lay out the types of attention, their descriptions match the assessment tasks described below. That is, sustained attention involves maintaining attention over a period of time (3 minutes); selective attention involves a distraction (television); working memory involves holding information in your head and manipulating that information (math problem); and alternating attention involves switching between two tasks or two parts of a task (sorting by color and then by number).

An SLP assesses a 3-year-old child with poor intelligibility. The SLP attempts to determine whether the child has a severe phonological disorder or childhood apraxia of speech (CASC A S). Which TWO of the following characteristics are primarily indicative of CASC A S?

A.Presenting with decreased strength and muscle coordination

B.Displaying inconsistencies in articulation performance

C.Making the same errors independent of length of speech utterance

D.Speaking with a disrupted rate, rhythm, and stress of speech

Options (B) and (D) are correct. Children with CASC A S struggle to make consistent productions of speech sounds. Children with CASC A S speak with a rate, rhythm, and stress of speech that can be disrupted, and sometimes they can appear to be groping for placement.

A 6-year-old child has difficulty producing both regular and irregular plural forms. Intervention for this problem would best target language at the level of

A.syntax

B.phonology

C.morphology

D.semantics

Option (C) is correct. Regular and irregular plural forms are morphological markers.

A patient is referred to speech therapy after a total laryngectomy. The SLP teaches the patient to speak by taking air in through the mouth, trapping it in the throat, and then releasing it. Which of the following treatments is the SLP primarily implementing with the patient?

A.Tracheoesophageal puncture

B.Esophageal speech

C.Neck electrolarynx

D.Intraoral artificial larynx

Option (B) is correct. Esophageal speech focuses on using the esophagus to provide speech, and no devices are used.

Questions 33-35 refer to the following information.

A 72-year-old male presents to a skilled nursing facility (SNF) following a complicated hospital stay. The patient is morbidly obese and has a history of COPD, depression, hypertension, diabetes, Bell's palsy, encephalopathy, and congestive heart failure. During his stay, he was not intubated but became very weak as a result of extended time in bed. In the hospital, he was placed on an NDD Level 2 diet with nectar-thick liquids due to aspiration of thin liquids and poor oral control of regular solids. The patient worked until he was 50 years old, but his health conditions led to his early retirement. Before his hospitalization, the patient did not leave his house very often, and his wife helped him with all ADLs.

While evaluating the patient at the SNF, the SLP noticed that the patient was disoriented and confused, appeared to be hallucinating, grunted loudly when

2- Option (C) is correct. Once the patient understands that he is in control and can use his voice, he will be more likely to use his voice consistently.

1- Option (A) is correct. Depression can lead to psychogenic disorders and given what this patient has been through, it is very likely that his depression has deepened during his hospital stay.

3-Option (B) is correct. Involving the professional who is treating the psychological piece of the disorder will hopefully lead to success for the patient.

Which of the following is generally considered most effective and appropriate for viewing the vocal folds during phonation?

A.Stroboscopy

B.Endoscopy

C.Fluoroscopy

D.Laryngeal mirror examination

Option (A) is correct. Stroboscopy is generally the most efficient and effective instrumentation for viewing the vocal folds during phonation.

An SLP administers a language test to all kindergarten children in a particular school and finds that 40 percent fall below the tenth percentile of the normative sample. Which of the following is the most reasonable interpretation of this finding?

A.Forty percent of the kindergarten children in the school have language disorders.

B.The school's kindergarten population differs from the standardization population in the language skills measured.

C.The SLP administered the test incorrectly.

D.The standardization population is not representative of the nation as a whole.

Option (B) is correct. If disparities exist between examinees and the norm group in terms of skills and experiences, the conclusions based on the examinees' test performance may be misleading.

A fourth-grade student presents to a school SLP with receptive-expressive language disorder. The student has difficulty with asking "wh-" questions. Specifically, the student tends to ask only "who" and "what" questions. When probed, the student will ask "why" and "when" questions but often uses the terms incorrectly.

When writing the annual Individualized Education Program for the student, which of the following goals is most appropriate and measurable?

A.The student will ask six related "wh-" questions with 100% accuracy.

B.The student will ask six related "wh-" questions with minimal cueing in two out of three tries.

C.The student will ask six related "wh-" questions with no cueing and with 100% accuracy.

D.The student will ask six related "wh-" questions with no cueing in one out of three tries.

Option (B) is correct. The goal is specific, measurable, realistic, and time limited and addresses the student's specific needs.

Which of the following is an example of a reversible passive?

A.The balloon was broken by the pin.

B.The kite was flown by Ben Franklin.

C.Jared was bullied by Michael.

D.The girl put her doll by her friend.

Option (C) is correct. In reversible passive constructions, participants can fit into either role.

Which of the following benchmarks best aligns with current research on typical communication development for 3-year-old children?

A.Understanding approximately 1,000 words

B.Using irregular third-person-singular verb forms

C.Having a mean length of utterance (MLUM L U) in morphemes of six

D.Producing approximately ten consonant phonemes accurately

Option (A) is correct. Receptive vocabulary is reported at approximately 1,000 words for 3-year-old children.

The Family Educational Rights and Privacy Act (FERPA) guarantees parents access to their child's educational records. However, this mandate does not apply to the daily records kept by an SLP working in a school setting if these records

A.are not used for treatment-related reimbursement from state or local government

B.remain within the school district in which the SLP works

C.are kept in the sole possession of the SLP

D.are not distributed to anyone outside of the child's school

Option (C) is correct. FERPA states that daily notes can be kept in the sole possession of an SLP as long as the purpose is to serve as a "memory jogger" for the creator of the record.

Which of the following will most effectively decrease the fundamental frequency?

A.Increasing the mass of the vocal folds

B.Increasing the subglottal pressure

C.Raising the position of the larynx within the neck

D.Lengthening the vocal folds

Option (A) is correct. Frequency is inversely proportional to mass. As the mass of the vocal folds increases, fundamental frequency decreases.

Which of the following speech-sampling contexts best assesses hyponasality?

A.Producing sentences with oral sonorants

B.Counting in numerical order from 60 to 70

C.Saying single words with nasal consonants

D.Repeating words with oral-pressure consonants

Option (C) is correct. Hyponasality (too little nasal resonance) is most easily detected during the production of nasal consonants.

An SLP designs a series of treatment activities for Jake, a 4 year old who presents with severely delayed phonological development. During one of the activities, the SLP asks Jake to say various word pairs in which two phonologically dissimilar target sounds, both of which are absent from the child's phonetic inventory, are contrasted (for example, "chip" and "rip"). Which of the following choices best describes the treatment approach that is being used?

A.Multiple-oppositions approach

B.Minimal-pairs approach

C.Maximal-oppositions approach

D.Metaphonological approach

Option (C) is correct. The maximal-oppositions approach contrasts two errored sounds differing across place, manner, and voicing to gain the greatest amount of generalization.

A clinician is starting treatment with a new client with specific language impairment (SLIS L I). Which of the following is the most appropriate source of information for the SLP to use in developing the treatment plan?

A.Advice from a senior colleague in the speech clinic

B.An all-day seminar presented by a leading clinician in the area of SLIS L I

C.A peer-reviewed article describing a large-scale study comparing several methods of treatment for SLIS L I

D.A conference presentation of unpublished cutting-edge research comparing several methods of treatment for SLI

Option (C) is correct. When an SLP is looking for information to develop a lesson plan for a client with SLIS L I, the best source of information is a peer-reviewed article that focuses on a large-scale study and compares several treatment methods.

Which of the following statements about dysphagia screening and assessment/evaluation is true?

A.Screening identifies the likelihood of dysphagia and the need for further assessment.

B.Screening identifies the nature and severity of dysphagia and enables treatment planning.

C.Assessment/evaluation is a pass-fail procedure that determines whether or not a patient is aspirating.

D.Assessment/evaluation can be performed by non-SLP observers.

Option (A) is correct. Screening is a method that allows for the identification of dysphagia and determines the need to assess the condition further.

Infants with cleft lip and palate are susceptible to middle ear disease because which of the following muscles is commonly impaired?

A.The superior constrictor muscle

B.The levator veli palatini muscle

C.The palatopharyngeus muscle

D.The tensor veli palatini muscle

Option (D) is correct. The tensor veli palatini muscle when contracted opens the auditory tube, equalizing middle ear pressure. When the tensor is not functioning properly, the auditory tube is not opened, pressure is not equalized, and fluid may accumulate in the middle ear. The tensor veli palatini travels around the hamulus of the sphenoid bone, where it has a fanlike appearance, and becomes the palatine aponeurosis, extending from the hard palate to the free border of the soft palate.

Two months after undergoing surgery to improve velopharyngeal function, a client continues to exhibit nasal airflow only on the production of /s/ and /sh/forward slash s forward slash and forward slash s h forward slash, and also exhibits glottal stops for several pressure consonants. The most appropriate next action for the SLP to take is to

A.request consideration of prosthetic management

B.request a nasoendoscopic study

C.inform the surgeon that the client is not making satisfactory progress

D.provide speech treatment to correct compensatory articulation errors

Option (D) is correct. It would be appropriate to provide speech-language services with the objective of reducing and eliminating the speech-production errors evidenced by the patient.

Following placement of a tracheostomy tube, a patient recovering from cardiothoracic surgery is successfully weaned from mechanical ventilation. A day later the SLP receives a consult to assess patient candidacy for using a one-way tracheostomy valve. Which of the following observations is the most important contraindication for safe and successful patient tolerance of the one-way valve?

A.Oxygen saturation below 95%

B.Ability of patient to pass air to the oral cavity while exhaling with the tube cannula occluded by the SLP

C.Patient ability to expectorate lung secretions without suctioning

D.Patient tolerance of the deflated cuff

Option (B) is correct. Inability to pass air to the oral cavity with expiratory occlusion represents an upper-airway obstruction, which is a contraindication for use of a one-way tracheostomy valve.

Dysarthria in a patient with lower motor neuron damage generally manifests as

A.spastic dysarthria

B.flaccid dysarthria

C.ataxic dysarthria

D.hyperkinetic dysarthria

Option (B) is correct. Flaccid dysarthria is the only choice that correlates to lower motor neuron damage.

Which of the following is an example of a modeled trial?

A."This is the opposite of a cat. What is this?"

B."What animal is this a picture of?"

C."This is a dog. Can you say the word 'dog'?"

D."This is a picture of a /da.../.forward slash d a ellipses forward slash"

Option (C) is correct. A modeled trial consists of the client's being told the correct answer (This is a dog) and then the client's being asked to imitate the answer.

Discriminative stimulus is associated with Skinner. Zone of proximal development is associated with Vygotsky. Language generativity is associated with Chomsky. Object permanence is associated with Piaget. Any other pairings would be incorrect.

A 62-year-old male presents to an outpatient SLP following an extended stay at a rehabilitation facility. He had a left-hemisphere stroke three months ago and currently has moderate Broca's aphasia and severe apraxia of speech. It is difficult for him to participate in conversation because of the combination of his word-finding deficits and apraxia of speech. The patient's normal speech pattern consists of one- to two-word phrases, at times including paraphasias. He is able to write but often misspells words. During evaluation, the SLP finds the patient is able to initiate communication, recognize and categorize picture symbols, and comprehend familiar words and phrases. In general, his communication is fragmented and inefficient, but he will try anything to get his message across. Which of the following AAC treatment strategies would be most appropriate for the patient to start with?

A.Accessing stored messages in

Option (A) is correct. Accessing stored messages with a device can ease the burden of communication and assist the patient in answering simple questions.

Which of the following strategies is most appropriate for an SLP to try in an effort to minimize the perception of mild nasal emission in a patient?

A.Increasing fundamental frequency

B.Using light articulatory contacts

C.Reducing mouth opening

D.Increasing rate of speech

Option (B) is correct. Using light articulatory contacts can help decrease perception of nasal emissions.

To compensate for the effects of normal aging on cognitive functions, older adults will naturally demonstrate

A.greater amounts of bilateral activation of prefrontal brain regions

B.significant reduction in the activation of the hippocampus

C.increased activation in areas of the cortex responsible for visual-spatial processing

D.an increase in semantic abilities that do not rely on long-term memory abilities

Option (A) is correct. Alterations in the prefrontal areas in particular are some of the changes seen in normal aging, in part to compensate for reduced frontal activation.

A 90-year-old female patient residing in a long-term care facility is referred to the facility SLP for a swallow evaluation. The patient has advanced dementia, is under hospice care, and is currently on a pureed diet with nectar-thick liquids. During the evaluation, the SLP finds that the patient is showing signs and symptoms of aspiration on all consistencies, including pudding-thick liquids. The patient's cognitive condition makes an instrumental exam inappropriate. The SLP's recommendation is nothing by mouth (NPON P O) except for pleasure. The family and patient have decided against feeding-tube placement.

Which of the following is a primary ethical responsibility of the SLP in this situation?

A.Asking the family what diet level they would like the patient to consume

B.Making a recommendation based on clinical judgment

C.Deferring to a doctor or nurse to help with the decision

D.Refusing to write diet orders for

Option (B) is correct. In this situation the role of the SLP is to keep the patient as safe as possible. Because the family does not want to pursue a feeding tube, the SLP has to choose the diet that is most appropriate for the patient.

For a patient's use of consonant cluster reduction, the SLPS L P would most appropriately recommend intervention, including words such as

A.knight

B.laugh

C.stop

D.wish

Option (C) is correct. The /st/forward slash s t forward slash in "stop" is the only cluster occurring in the word choices.

Esophageal and tracheoesophageal (TEPT E P) techniques for producing alaryngeal voice are similar in that both

A.redirect expiratory airflow from the lungs to the esophagus

B.result in a vocal fundamental frequency similar to that of laryngeal phonation

C.require the speaker to occlude the stoma with either a thumb or a valve

D.depend on adequate vibration of the pharyngoesophageal (P EP E) segment

Option (D) is correct. Both esophageal speech and tracheoesophageal speech require vibration of the P EP E segment. Esophageal speech uses air from stomach/lower esophagus to upper esophagus/pharynx, where it vibrates the wall. TEPT E P speech requires the patient to cover the stoma to redirect air and initiate vibration. Fundamental frequency is different than that of laryngeal phonation (e.g.for example, variability and prosody).

For a patient with potential pharyngeal phase dysphagia and pooling of secretions following open-heart surgery with suspected recurrent laryngeal nerve damage, which of the following instrumental examinations for swallowing provides the most direct view for evaluating the patient based on history and suspected difficulties?

A.Upper gastrointestinal (GIG I) series

B.Fiberoptic endoscopic evaluation of swallowing (FEESF E E S)

C.Videofluoroscopic swallowing study (VFSS)

D.Videostroboscopic examination of vocal folds

Option (B) is correct. Recurrent laryngeal nerve damage during open-heart surgery would only involve the left vocal fold. This swallowing instrumental examination allows for both assessment for pharyngeal phase dysphagia, by presenting foods and liquids during the assessment procedure, and a direct view of the functioning of both vocal folds, as well as determining the pooling of secretions.

Which THREE of the following are included in a pragmatic language assessment during conversation?

A.New topic initiation

B.Speech intelligibility

C.Discourse cohesion

D.Repair strategies

E.Type-token ratio

Options (A),(C) and (D) are correct. Initiating new topics is an important piece when conversing with another person. A pragmatic assessment would analyze this area of conversation. Discourse cohesion shows a child's understanding of not interrupting and responding when appropriate. Using repair strategies will provide the assessor with data related to the child's ability to respond based on what the conversational partner said.

Which of the following is characteristic of a mild traumatic brain injury?

A.Long-term memory loss

B.Onset of frequent seizures

C.Memory loss of events immediately preceding or following the trauma incident

D.Extensive and permanent neurological impairments

Option (C) is correct. Loss of memory of events immediately preceding or following the traumatic incident is a characteristic of a mild traumatic brain injury.

As part of a study, the speech of several subjects with Wilson's disease is evaluated using an acoustic analysis system. The same subjects are assessed again, but with a different system from another manufacturer. Which of the following can be assessed by comparing the two data sets?

A.Content validity

B.Concurrent validity

C.Test-retest reliability

D.Interjudge reliability

Option (B) is correct. Concurrent validity refers to the extent to which the results of a particular test, or measurement, correspond to those of a previously established measurement for the same construct.

n Bloom and Lahey's model, morphology is considered

A.form

B.content

C.use

D.semantics

A- FORM

A 7-month-old infant presents to an SLP for a swallow evaluation prompted by parental concerns related to the child coughing and choking frequently when swallowing thin liquids. The parents have attempted to feed the child small amounts of pureed foods, but the child spits them out.

Which of the following developmental milestones is a typically developing 7 month old most likely to demonstrate during a swallow evaluation?

A.Showing the ability to manipulate food

B.Creating vertical jaw movements

C.Using the rooting reflex when food is seen

D.Engaging tongue elevation patterns

Option (B) is correct. Using jaw movements to initiate chewing begins to emerge around 5 to 7 months, and it would be appropriate for the SLP to assess whether the child has begun to use this skill.

It is most appropriate for a SLP to treat hyperadduction of the vocal folds by having the client

A.increase muscular effort through pushing or lifting while vocalizing

B.use light and gentle vocal-fold contacts

C.attempt quick onset of phonation

D.use drills with exaggerated contrastive stress on words

Option (B) is correct. Having the client use light and gentle vocal-fold contacts will help to reduce tension and thus would be effective in treating hyperadduction of the vocal folds. All of the other answer choices listed would serve to increase tension.

An SLP works with a patient who has severe dysphagia. The patient is on a pureed diet and honey-thick liquids. During treatment, the patient becomes tearful and expresses frustration. The patient says, "I feel like I'm not making any progress and I'm never going to eat normal food again. I hate this diet, and I hate doing therapy. I just want to give up." The SLP responds by saying, "What you're feeling is normal, and I understand. You're doing everything you can right now to get better, and giving up isn't the answer." The SLP reaches across the table and places a comforting hand on the patient's arm and has a caring facial expression.

Which of the following principles of counseling is the SLP primarily demonstrating?

A.Showing congruence

B.Having unconditional positive regard

C.Offering the patient sympathy

D.Providing emotional suppor

Option (A) is correct. The SLP is demonstrating congruence by using words and body language that match.

A transfer student is referred for a language evaluation. The student has spoken English for less than a year, and English is not the primary language used at home. To provide the student with culturally and linguistically appropriate service delivery, the student should be evaluated

A.using norms for standard English speakers

B.in the student's native language

C.with the student's parents present

D.based on formal assessments

Option (B) is correct. Assessment should be administered in the student's native language for accurate results and appropriate service delivery.

Which of the following muscles is responsible for changing vocal pitch?

A.Posterior cricoarytenoid

B.Thyroarytenoid

C.Lateral cricoarytenoid

D.Cricothyroid

Option (D) is correct. The cricothyroid is responsible for changes in vocal fold pitch as it tenses the vocal folds.

Sensorineural hearing loss resulting from Ménière's disease causes

A.a sudden hearing loss without warning

B.fluctuating levels of hearing loss

C.complete hearing loss at all frequencies

D.bilateral progressive hearing loss

Option (B) is correct. Ménière's disease is a disorder of the inner ear and causes fluctuating hearing loss.

An SLP is evaluating a preschool child referred for concerns regarding stuttering. In which of the following areas is performance likely to be weaker in a preschooler who stutters than in a typical preschooler?

A.Hearing acuity

B.Voice

C.Language

D.Swallowing

Option (C) is correct. Some young children who stutter present with concomitant language delay/disorder. School-based SLPs report that among the children to whom they provide stuttering services, a significant percentage are also receiving language services. Some studies with preschoolers and children in early elementary grades who stutter have shown evidence of group-level deficits in various aspects of language functioning. Thus, in a number of studies, a significant subset of children who stutter have shown language skills that are weaker than those of typical children.

Children with semantic-pragmatic language disorders often have difficulty learning deictic words because such terms

A.require an understanding of indirect directives

B.take the perspective of the communication partner

C.refer to object permanence

D.have many alternate forms

Option (B) is correct. Deictic terms are words whose meaning shifts depending on the point of view of the speaker; difficulties with such terms is a core feature of semantic-pragmatic language disorders.

How many continuing education hours are required across a three-year certification renewal period to maintain a Certificate of Clinical Competence in Speech-Language Pathology?

A.10 contact hours

B.20 contact hours

C.30 contact hours

D.40 contact hours

Option (C) is correct. ASHA Certification Maintenance Standards require that all certificate holders (CCC-A and CCC-SLP) must accumulate 30 Certification Maintenance Hours (CMHs) of professional development during each three-year certification maintenance interval in order to maintain their ASHA Certificates of Clinical Competence.

During an evaluation, a 2½‑year‑old boy exhibits a lack of social reciprocity, an averted eye gaze, and repetitive motor mannerisms. The child's behavior is most typical of which of the following?

A.Social‑pragmatic disorder

B.Autism spectrum disorder

C.Generalized developmental delay

D.Rett syndrome

Option (B) is correct. Autism spectrum disorder is the only one that includes all three of the characteristics described. The others may have one or another but not all three.

Mr. Greene recently sustained a cerebrovascular accident (CVAC V A), which impaired his communication. An SLP asked him to describe the illustration above. He said, "Well, it's a black-and-white drawing on heavy paper. There's a window with blinds and a driveway or sidewalk going off into the distance."

Mr. Greene's response is most characteristic of which type of language disorder?

A.Right-hemisphere language impairment

B.Broca's aphasia

C.Global aphasia

D.Anomia

Option (A) is correct. Right hemisphere dysfunction (RHD) often manifests with a left visual field cut or neglect. The client description only discusses items in the right visual field of the picture. For this reason, RHD the best answer.

A patient is diagnosed with a cerebrovascular accident of the temporal lobe. The patient exhibits deficits in repetition, written expression, and auditory comprehension. In addition, literal paraphasias are noted. These findings are consistent with what type of aphasia?

A.Broca's

B.Conduction

C.Anomic

D.Globa

Option (B) is correct. A temporal lobe stroke and the symptoms described are typical of a patient with conduction aphasia.

Alan, a 62-year-old, right-handed African American male, sustained a traumatic brain injury mostly affecting his right hemisphere and bi-lateral frontal lobes. Alan was hospitalized for 24 days before being discharged to an inpatient brain injury rehabilitation program. His spouse attends his initial evaluation sessions. The SLP reports impairments in memory, poor awareness of deficits, and some changes in his communication skills.

The SLP already has current information about Alan's performance on a standardized language battery suggesting minimal impairments. Therefore, the SLP completes an evaluation of Alan's functional communication skills. The SLP's assessment involves testing his functional use of humor, facial expressions, nonverbal communication strategies, and understanding functional written materials. The SLP hopes to use this information to determine the impact of Alan's impairments on his daily life.

Option (D) is correct. Anosognosia, the reduced awareness of deficits, is common after right hemisphere disorder.

Option (B) is correct. The CADL-2 is the best tool for evaluating functional communication skills in people with neurological communication disorders. It measures receptive and expressive language, as well as social use of language, gestures, and humor.

Option (A) is correct. The most appropriate practice for the clinician to use in this instance is errorless learning.

An elderly patient with multiple diagnoses including Parkinson's disease (PD) presents to a home health SLP for treatment. The SLP recommends that the patient follow a mechanical soft diet with thin liquids, alternate bites and sips, take small bites, and have supervision when eating. Throughout the course of treatment, the patient exhibits a 12 percent weight loss with variable intake levels. To which of the following professionals is it most appropriate for the SLP to refer the patient?

A.A gastroenterologist, for possible feeding tube placement

B.A dietitian, for nutrition management

C.An ENTE N T specialist, for possible esophageal deficits

D.A neurologist, for assessment of progression of PD

Option (B) is correct. A dietitian will be able to assess caloric intake and recommend supplements and other ways for the patient to maintain a healthy weight.

A 6-year-old child who is a bilingual English-Spanish speaker produced the following statements during a speech-language assessment.

I cutted the finger.

I played with her yesterday.

She eated too much candy.

You like ice cream?

Maria is going?

Father is happy. Buy a new car.

Based on the sample, the speech-language pathologist should begin remediation by focusing on

A.adjectives and imperatives

B.irregular verbs

C.prepositional phrases

D.conjunctions and embedding

Option (B) is correct. Given the language sample, the child incorrectly recognizes the past tense forms of irregular verbs.

To best facilitate the functional and meaningful use of linguistic forms, a language-intervention program for a child with language impairments should

A.focus on comprehension tasks that are just above the child's linguistic level

B.stress structured, game-like situations that use imitative tasks

C.present and elicit the forms in naturalistic contexts

D.stress imitation of the forms to be learned

Option (C) is correct. Naturalistic contexts—everyday situations—provide opportunities for the use of functional and meaningful linguistic forms.

An SLP working with a 45-year-old patient with acquired expressive communication deficits is emphasizing reengagement by focusing on realistic short-term goals of the patient's choice. The SLP is primarily using which of the following approaches to therapy?

A.Life Participation Approach to Aphasia (LPAAL P A A)

B.Visual Action Therapy (VATV A T)

C.Supported Communication Intervention (SCIS C I)

D.Prompts for Reconstructing Oral Muscular Phonetic Targets (PROMPTP R O M P T)

Option (A) is correct. The Life Participation Approach to Aphasia (LPAAL P A A) has the overriding philosophy to maximize clients' re-engagement in life and bases all decision making on the life concerns identified by the clients and their families.

Mr. Lewis, a fourth-grade teacher, has referred a 9-year-old student to the school speech-language pathologist (SLP) because he is concerned that the student's speech is interfering with spelling performance. The SLP observes that the student substitutes the voiceless labiodental fricative for the voiceless interdental fricative in the word-final position and that the student reverses /s/ and /k/forward slash s forward slash and forward slash k forward slash in words such as "ask." Which of the following areas needs to be considered first?

A.Auditory discrimination

B.Dialectal differences

C.Disordered phonological system

D.Dyslexia

Option (B) is correct. An f/"th"f forward slash t h substitution as well as the reversal of "sk"s k in "ask" are common characteristics of a dialectal difference.

Of the following, which is generally the most appropriate treatment goal for clients who have had a laryngectomy?

A.Acceptance of the alaryngeal status

B.Production of an esophageal voice

C.Use of a voice prosthesis

D.Restoration of oral communication

Option (D) is correct. The ultimate treatment goal for clients who have had a laryngectomy is the restoration of oral communication, no matter how it is addressed.

Which of the following sets of minimal pair words best targets the phonological patterns of stopping of fricatives?

A.Sun and ton

B.Sip and ship

C.Star and tar

D.Shoe and shoot

Option (A) is correct. "Sun" and "ton" are minimal pair words, and substituting /t/forward slash t forward slash for /s/forward slash s forward slash is an example of the phonological process of stopping of fricatives.

Which dental condition is most likely to have a negative effect on articulation?

A.Class II malocclusion

B.Class III malocclusion

C.Missing maxillary lateral incisors

D.Missing mandibular central incisors

Option (B) is correct. A class III malocclusion has the most negative effect on articulation, as it can affect all anterior sounds.

The acoustic reflex is triggered in a person with typical hearing when the listener is exposed to a sound above approximately

A.85 dB HTL

B.130 dB HTL

C.1000 Hz

D.6500 Hz

Option (A) is correct. The acoustic middle ear reflex in a person with typical hearing usually occurs at about 85 dB HL.

Which of the following structures is a relay center for sensory information?

A.The reticular formation

B.The thalamus

C.The putamen

D.The hippocampus

Option (B) is correct. The thalamus is the major relay system for sensory information.

An SLP is working with a 30-month-old child who is at the one-word production level. The goal of treatment is to facilitate growth in play as a precursor to the acquisition of two-word semantic relationships. To achieve the goal, the SLP can best begin by facilitating

A.the use of pretend play, such as brushing a doll's hair or feeding a doll with a bottle

B.the purposeful exploration of toys

C.exploration, by mouthing of toys

D.mean-end behaviors, such as pulling a string to get a toy

Option (A) is correct. The child needs to be encouraged to proceed to the two-word production stage, and the use of pretend play will encourage action/object two-word phrases such as "Feed baby" and "Brush hair." All of the other answer choices involve behaviors that do not necessarily promote linguistic behaviors.

During a clinical swallow assessment by an SLP, a patient was noted to have the following symptoms.

An immediate cough after swallowing thin liquids

Prolonged mastication with regular-consistency foods

No coughing when fed thickened liquids

Postswallow residue

Which of the following recommendations is most appropriate for the patient in this situation?

A.Neuromuscular electrical stimulation

B.Modified barium swallow study

C.High-resolution pharyngeal manometry

D.Cervical auscultation of swallowing

Option (B) is correct. When reasonable suspicion of clinically significant dysphagia is present after a clinical examination and the cause is potentially undefinable without imaging, an imaging study is necessary; a modified barium swallow study is the only imaging study in the list.

Which of the following best describes the speech reception threshold (SRT)?

A.It is the intensity level at which spondee words are recognized at or near 100% of the time.

B.It is the lowest intensity level at which spondee words can be detected and recognized as speech.

C.It is the intensity level at which spondee words are recognized at least 50% of the time.

D.It is the lowest intensity level at which spondee words can be discriminated from one another.

Option (C) is correct. It includes the use of spondee words and recognition 50% of the time. Recognition 100% of the time is unrealistic and the reference to the lowest intensity level is too vague.

During an examination of his oral mechanism, an adult male is asked to pucker his lips and then to spread them into a wide smile.

This ability depends on the bilateral integrity of which of the following cranial nerves?

A.CN Vroman numeral 5?

B.CN VIIroman numeral 7?

C.CN IXroman numeral 9?

D.CN XII

Option (B) is correct. CN VIIroman numeral 7 (the facial nerve) is the major nerve innervating the described physiological action of the lips.

Which of the following conditions is primarily characterized by premature closure of the sutures of the skull?

A.Craniosynostosis

B.Craniopharyngioma

C.Deformational plagiocephaly

D.Positional plagiocephaly

Option (A) is correct. Craniosynostosis is a premature closure of one or more of the cranial sutures of the skull and can be associated with a cleft palate.

A 2-year-old child pronounces "bottle" as [baba]. Which of the following best describes the speech simplification process evident in this utterance?

A.Gliding

B.Stopping

C.Reduplication

D.Devoicing

Option (C) is correct. Reduplication is a multisyllable production different from the target (bottle) where the syllables are phonetically identical [baba].

Compensatory swallowing maneuvers and interventions are designed to mitigate a biomechanical impairment during the swallow; however, some of them have unintended consequences that have been documented in scientific literature. Which of the following swallow maneuvers has been found to produce cardiac arrhythmia (irregular heartbeat) in patients with stroke or cardiovascular diseases?

A.Mendelsohn maneuver

B.Chin-down posture

C.Supraglottic swallow maneuver

D.Head rotation toward the weak side

Option (C) is correct. Chaudhuri et al. (2002) found that 86 percent of people with history of stroke and/or cardiovascular disease developed cardiac arrhythmias while performing the supraglottic or super-supraglottic swallow, including supraventricular tachycardia and premature atrial and/or ventricular contractions.

Mr. Aviz, a 62-year-old chemist, is recovering from hip-replacement surgery following a spontaneous fracture. The surgery was completed without complications. He is now in his second postoperative day, and his wife reports alterations in his memory and some confusion not previously noted. Which of the following is the most reliable screening instrument for the SLP to use in this case?

A.The Mini-Mental State Examination (MMSEM M S E)

B.The Test of Problem Solving (TOPS-3)

C.The Cognitive Linguistic Quick Test (CLQT)

D.The Global Deterioration Scale (GDS)

Option (A) is correct. The MMSEM M S E is the only screening tool in the list appropriate for the age and condition described.

Which of the following signs of dysphagia is the most common oral-stage observation when assessing a patient with Parkinson's Disease?

A.Repeated nonpropulsive lingual movements

B.Eating quickly and impulsively

C.Spilling liquids out of mouth because of poor labial seal

D.Holding food in mouth because of poor sensation

Option (A) is correct. Lingual festination is very characteristic of patients with PD and does not manifest in many other disorders.

Which of the following techniques is most effective when treating phonation in a patient with spastic dysarthria?

A.Completing head and neck relaxation exercises

B.Engaging in lip-stretching exercises

C.Providing instruction in phonetic placement

D.Working on pitch-range exercises

Option (A) is correct. Head and neck relaxation exercises assist in reducing hyperadduction of the vocal folds.

Minimal word pairs are typically used in phonological treatment in order to

A.stabilize phonological patterns in a system

B.build awareness of the phonetic realizations of phonological contrasts

C.probe generalization of taught sound patterns to words that have not been used in instruction

D.facilitate automatic production of words

Option (B) is correct. The erroneous sound is contrasted with the correct sound to encourage the contrasting of the sound production and word meaning or homonym.

Patient is a 77-year-old female with a left hemisphere stroke. Sensorimotor clinical examination revealed right lower facial droop, impaired oral sensation, absence of dentition, need for frequent prompts to engage the patient in evaluation procedures, and aphasia. Bedside swallow evaluation with pureed food and nectar-thick liquids revealed food remnants in right lateral sulcus, drooling from the right oral cavity, and intermittent cough that was not present before the swallow evaluation. Prior medical history includes COPDC O P D, diabetes, and congestive heart failure. Patient does not want an instrumental examination.

Based on the data above, which of the following is most likely to lead to a clinically significant dysphagia-related adverse event?

A.Impaired oral sensorimotor function

B.Prior medical history

C.Impaired level of alertness

D.Aphasia

Option (C) is correct. It is extremely important that the patient is alert and as upright as possible when addressing swallowing and trying out different foods.

Which of the following instrumental assessment tools provides the most direct dynamic view of velopharyngeal movement during speech?

A.Nasopharyngoscopy

B.Lateral-view x-ray

C.Nasometry measurements

D.Aerodynamics

Option (A) is correct. Nasopharyngoscopy is an example of a direct instrumental assessment tool that provides a dynamic (moving) view of the velopharyngeal movements.

A 23-year-old client recently completed an intensive 3-week-long summer program for stuttering and now exhibits stuttering symptoms on fewer than 3 percent of syllables during both in-clinic conversations with the SLP and beyond-clinic conversations with family members. The SLP is concerned that the client might relapse now that intervention has ended and wishes to enact a plan to help the client maintain fluency gains. Which of the following plans is the most likely to result in maintenance of the fluency gains?

A.Recommending that the client participate in an annual intensive review of stuttering management skills

B.Recommending that the client practice fluency management skills during monthly telephone calls with the SLP

C.Ensuring the client understands the need for continued use of stuttering management techniques and referring to a local SLP for ongoing treatment

D.Scheduling the client for reenrollment in the

Option (C) is correct. Continuing to regularly participate in scheduled intervention activities under the direction or supervision of an SLP is essential to maintaining fluency gains. It provides a client with the opportunity to address ongoing fluency challenges or new ones that may arise after completion of the intensive intervention program. This type of continued treatment does not necessarily imply that the client must participate in ongoing weekly or intensive intervention.

Which of the following best distinguishes a dialect from an accent?

A.Differences in language as well as in pronunciation

B.Differences in pronunciation only

C.Differences due to the influence of a second language

D.Differences that are unique to a particular speake

Option (A) is correct. A dialect involves differences in language and pronunciation.

Place the following aspects of phonological awareness in developmental order starting with the earliest skill to emerge.

Listing words that start with the same sound

Recognizing words that rhyme

Counting syllables in single words

Creating words by blending onset and rime

Recognizing words that rhyme is first because this occurs between 30 and 36 months of age. Counting syllables in single words is next because this occurs by 4 years of age. Blending words into rime is third because this occurs near 5 years of age. Listing words that start with the same sound is last because this occurs between 6 and 7 years of age. Any other order is incorrect because phonological awareness builds on itself and it is necessary to master each area prior to moving on to the next.

According to empirical research with people who stutter, which TWO of the following are true regarding the age of symptom onset for most cases?

A.It is usually earlier for girls than for boys.

B.It is similar for girls and boys.

C.It most often occurs in the range of 2 to 5 years old.

D.It most often occurs in the range of 6 to 9 years old

Options (A) and (C) are correct. Research findings indicate that the age of onset for stuttering symptoms is somewhat earlier for girls than for boys, and in most cases, symptom onset occurs in the preschool years.

Which of the following should an SLP recommend to best help a patient who has advanced to late stages of dementia of the Alzheimer's type?

A.Group treatment to improve the patient's conversational intelligibility

B.Individual treatment to improve the patient's recall of salient vocabulary words

C.Individual treatment to improve the patient's comprehension during social discourse

D.Assistance from caregivers to improve the patient's communication skills

Option (D) is correct. In the late stages of dementia of the Alzheimer's type the most appropriate intervention is to engage caregivers as facilitators of clients' communication of wants and needs. Restorative treatment is not a goal at this stage.

Six months ago, an SLP evaluated 4-year-old Molly's speech fluency during conversation. At that time, she displayed physically relaxed repetitions of words and phrases (occurring at a frequency of 2 per 100 words), and interjections such as "um" (occurring at a frequency of 1 per 100 words). She did not display any sound prolongations or facial grimaces; she did not produce any pitch rises or phonatory breaks; and she did not appear to avoid any sounds or words. Results from several formal tests suggested that her articulation and language development were within normal limits. Molly reportedly began producing repetitions and interjections at age 24 months, and the frequency of these disfluency types reportedly has remained stable since then. The SLP did not recommend speech-language intervention following the previous evaluation; however, she did provide the parents with information about fluency development, sympto

Option (B) is correct. Molly's fluency development was within normal limits at the previous evaluation, and, based on the parents' report, it also seemed to be within normal limits at age 2. Further, no other concerns about Molly's communication development were mentioned in the scenario. Thus, it appears that Molly has never stuttered and her communication skills have been and continue to be within normal limits. Therefore, it is unnecessary to reevaluate her speech or enroll her in fluency therapy.