COMPS Exam Study Guide: Stuttering

This study guide will be used to study all of the material from my stuttering courses

A mother comes into your office and asks, “Why is my child stuttering?” Using a model/theory/framework explain to this mother why her child might be stuttering. Be thorough as we discussed in class.

Stuttering is a multifactorial condition influenced by speech production, gender differences, linguistic factors, genetics, emotional sensitivity, environmental influence, neurological aspects, motor skills, and secondary behaviors. Primary stuttering occurs when children produce speech differently, while gender differences contribute to girls outgrowing stuttering. Linguistic complexity can also affect fluency. Genetics play a significant role, with about half of all cases having a family history. Emotional sensitivity can exacerbate stuttering, and environmental factors can lead to anxiety and secondary behaviors. Neurological aspects, motor skills, and secondary behaviors can also affect stuttering. Understanding these factors can help create a tailored support plan for a child's speech, emotional, and social needs.

Speech

Children who stutter often produce their speech differently, which can lead to what we call primary stuttering (Smith & Weber, 2016). This means their speech patterns might not flow as smoothly as those of non-stutterers.

Gender Differences

Research shows that girls are generally more likely to outgrow their stutter compared to boys. This is often attributed to girls maturing faster than boys at a young age (Manning & DiLollo, 2018).

Linguistic Factors

The complexity of what a child is trying to say can affect their fluency. The longer and more complex the words or sentences, the harder it may be for them to speak fluently (Smith & Weber, 2016).

Genetics

Stuttering often has a familial component; about half of all cases have a family history of stuttering (Smith & Weber, 2016). This suggests that genetics play a significant role.

Emotional Sensitivity

Some children may be more sensitive to their surroundings and stressful situations, which can exacerbate their stuttering (Smith & Weber, 2018). Events like moving, parental divorce, or new siblings can be particularly challenging.

Environmental Influence

A child's environment matters greatly. If they grow up in a setting that views stuttering negatively, they may develop anxiety about speaking, leading to secondary behaviors like avoidance or tension (Manning & DiLollo, 2018).

Neurological Aspects

There are differences in brain processing between individuals who stutter and those who do not. This can affect their ability to speak fluently (Manning & DiLollo, 2018).

Motor Skills

Children who stutter may show slower reaction times when speaking and can experience motor instability during tasks that require quick responses (Manning & DiLollo, 2018).

Secondary Behaviors

When children become aware of their stuttering and fear it, they often develop secondary behaviors, such as tensing up or avoiding certain words (Jackson et al., 2015). These behaviors can make stuttering more persistent over time.

What evidence can you suggest from your readings or class discussions that “Stuttering More” or practicing pseudo stuttering actually creates more efficient neurophysiological patterns, which in turn might create spontaneity or fluency inducing moments?

In the study "Responses of adults who stutter to the anticipation of stuttering," seven participants reported using pseudo-stuttering when they anticipated stuttering on a word. This strategy helped them avoid actual stuttering because pseudo-stuttering is perceived as less severe (Jackson et al., 2015). When children who stutter become self-conscious, they often try to control or stop their stuttering, which can actually make it worse. Instead, allowing themselves to stutter can lead to smoother speech and less tension (Jackson et al., 2015). Using pseudo-stuttering helps individuals become less sensitive to their stuttering and shifts their view from seeing it as a disorder to recognizing it as a unique trait. This perspective encourages them to embrace their stuttering rather than hide it, helping them identify and reduce avoidance behaviors (Jackson et al., 2015).

You are working in a school and a child comes in to see you for stuttering therapy, yet you are unsure if the child is stuttering or having normal disfluency patterns.  Tell me 10 tasks/questions/behaviors, with a brief justification, you might perform in order to differentially diagnose between beginning stuttering and normal disfluency. 

Ex: You would ask the question, “is there is a family history of stuttering” because we know there is a strong genetic component to stuttering…………..

• Family History

• Patterns of Stuttering

• Reactions to Stuttering

• Awareness of Stuttering

• Speech Sample

• Narrative/Storytelling Task

• Introduce Mild Communicative Stressors

• Read Book Passage

• Look for any Disfluencies and SLDs

Family History

I will ask the parents about any family history of stuttering, as genetic factors play a significant role—50% to 70% of stuttering cases are linked to family members who also stutter (Manning & DiLollo, 2018). I’d like to know if family members fully recovered or if they still stutter, as children often mimic the behaviors of relatives when stuttering.

Patterns of Stuttering

I will inquire about the patterns of stuttering the child displayed in the year following onset. Research shows that a decrease in stuttering-like disfluencies (SLDs) during this time indicates a higher chance of recovery, while stable or increasing SLDs suggest persistence into adulthood (Manning & DiLollo, 2018).

Reactions to Stuttering

I’ll also ask how the child reacts when they don’t get their way. Children who stutter may be more sensitive and less adaptable to changes, which can increase their risk of stuttering (Manning & DiLollo, 2018).

Awareness of Stuttering

It's important to ask the parents if they are aware of their child’s stuttering. Young children often show secondary behaviors, such as tense movements, in response to their stuttering, indicating their awareness of it (Manning & DiLollo, 2018).

Speech Sample

I’ll request a speech sample from the child in their natural environment, observing interactions with family. Parents will record clips during different situations to capture typical behavior (Manning & DiLollo, 2018).

Narrative/Storytelling Task

Given that narrative tasks yield more SLDs than structured conversations, I will ask the child to tell a story, as this can elicit more complex speech and reveal stuttering patterns (Manning & DiLollo, 2018).

Introduce Mild Communicative Stressors

Throughout the evaluation, I will introduce mild communicative stressors, such as looking away while the child speaks. This can help identify fluency breaks when demands exceed their speaking abilities (Manning & DiLollo, 2018).

Read Book Passage

I will have the child read a passage from a book, allowing me to observe stuttering without the influence of avoidance strategies (Manning & DiLollo, 2018).

Look for any Disfluencies and SLDs

Finally, I will look for any disfluencies. While typically fluent children have normal disfluencies, children who stutter show more SLDs and often exhibit tense movements (Manning & DiLollo, 2018). I will also assess the rate of repetitions, noting that children who stutter tend to have faster rates and shorter intervals between repetitions compared to fluent peers (Manning & DiLollo, 2018).

Think about how you define stuttering and defend the argument why early intervention is key in treating stuttering.  Remember stuttering is a multifactorial disorder.

Stuttering is a neurodevelopmental disorder that affects brain systems involved in speech production, including emotional, motor, and linguistic networks. A child's genetic makeup plays a significant role in their likelihood of stuttering. Their individual experiences also influence this risk. For children to learn fluent speech, their brains must develop and connect various neural circuits accurately. Stuttering often begins in childhood, suggesting that some brain circuits may not be functioning properly. The wiring of a child's brain can be shaped by their experiences, highlighting the importance of early intervention. The longer stuttering persists, the harder it may be for clinicians to change these neural pathways, increasing the chances that stuttering will become a lifelong issue (Smith & Weber, 2016).

“Stuttering is what we do when we try not to stutter.” Make the argument why avoidances, escapes, and other patterns of behaviors are stuttering. (Two articles should drive this response)

Stuttering often occurs when children try to avoid stuttering. Those who fear it may look for ways to escape situations that trigger their stuttering. Children with more reactive temperaments might tighten their bodies, speak faster, or try to avoid stuttering altogether to cope with negative feelings (Jackson et al., 2015). Emotional experiences are deeply learned, especially for reactive children, as their emotions can influence their learning. These emotions activate the right side of the brain, which is already managing various factors related to speech. This can make fluent speaking even harder (Constantino et al., 2017). As a result, children may develop tension, escape, and avoidance behaviors in response to stuttering, which can become ingrained patterns over time (Constantino et al., 2017).

Why is fostering the therapeutic alliance such a pivotal part of stuttering management? Be thorough.

A strong and cooperative relationship between a person who stutters and their speech-language pathologist (SLP) is essential for effective stuttering management. This therapeutic alliance creates a safe and supportive environment where the individual can share their thoughts and experiences about stuttering openly (Manning & DiLollo, 2018). Such a partnership fosters honest communication, self-acceptance, and trust, which are important for exploring different therapy options. When individuals feel understood and valued by their SLP, they are more motivated to participate actively in treatment and work towards their goals. The therapeutic alliance also helps SLPs tailor treatment plans to each person's unique needs and preferences. By focusing on this relationship, SLPs can provide effective, person-centered therapy that improves communication and overall well-being (Manning & DiLollo, 2018).

A) Create a role play (script) with SLP and client (counseling chapters illustrate this) and illustrate the use of 3 counseling responses. This should be a page or so.

Role-Play Script:

SLP: Good morning! I’m glad you could join me today. How have things been since our last meeting?

Client: It’s been tough. I felt really nervous and ashamed about my stuttering during a work presentation, and it’s affecting my confidence.

SLP: That sounds challenging. Many people who stutter face similar issues at work. Let’s reframe this situation. Can you share any moments during the presentation when you felt in control or when your message was well received?

Client: I did manage to make eye contact and emphasize my points with gestures. Some coworkers seemed engaged.

SLP: That’s impressive! You communicated well through nonverbal cues. Let’s explore ways to boost your confidence in future presentations. How can you use your nonverbal communication to enhance your overall presentation skills?

Client: I think I can focus on making expressive gestures and maintaining eye contact. That might help me feel less focused on my stuttering and more connected to my audience.

SLP: Great plan! It’s encouraging to see you thinking about how to improve your communication skills. I want to share that I’ve worked with many clients who stutter. I understand some of your challenges, and it’s important to know you’re not alone in this journey.

Client: Thank you for sharing that. It’s comforting to know you have experience with stuttering clients. It gives me hope.

SLP: Absolutely, you can improve! Remember, everyone’s progress is unique. I’d like to ask you about a recent time when you felt particularly self-conscious about your stuttering. What thoughts and feelings were you experiencing?

Client: Last week, I struggled to introduce myself at a social event. I felt embarrassed and feared being judged for my speech. I wanted to avoid social gatherings.

SLP: That must have been tough. It’s normal to feel self-conscious in situations like that. How have these feelings affected your social relationships? Have you tried any coping strategies?

Client: I’m not great at introducing myself. I’ve tried deep breathing to relax, but it doesn’t always help.

SLP: Thank you for sharing that. Understanding your coping strategies is valuable. We can discuss other techniques in our next session that might work better for you. Remember, improvement takes time, and we’ll find the best strategies for you together.

In this script, the SLP uses three counseling strategies: sharing personal experiences, reframing the situation, and asking open-ended questions. These techniques help shift focus from the client’s struggles to their strengths, creating a supportive environment and facilitating deeper conversations about coping with stuttering (Luterman, 2008).

B) Defend your role play on why it operates under a narrative-based intervention.

This role play uses key concepts from the narrative-based intervention approach, including open-ended questions, a person-centered approach, collaborative storytelling, and externalization of stuttering. By focusing on the client’s experiences and feelings, the SLP empowers them to engage actively in their therapy (Manning & DiLollo, 2018). The role play promotes collaborative storytelling, where the SLP and client work together to create a new narrative. The SLP helps reframe negative experiences and highlight the client's strengths, fostering a sense of personal agency (Manning & DiLollo, 2018). By discussing how stuttering affects different situations, the SLP helps the client externalize their stutter. This approach treats stuttering as a separate issue, allowing the client to share their frustrations without tying their identity to the stutter. This aligns with narrative-based interventions that aim to provide perspective on personal challenges. The role play also seeks to deconstruct and reconstruct the meaning of the client’s stuttering experiences. The SLP encourages the client to challenge negative views and consider alternative perspectives through self-reframing (Manning & DiLollo, 2018). Open-ended questions are used to promote self-reflection and deeper understanding, which are essential for creating new narratives in narrative-based therapy (Manning & DiLollo, 2018).

A) Explain the relevance between the thin vs thick descriptions. Clinical implications.

Thin descriptions are surface-level observations about a person's experiences, providing basic information without the depth needed for full understanding. Relying on these can limit a therapist's ability to explore underlying feelings and thoughts (Manning & DiLollo, 2018). In contrast, thick descriptions delve deeper into clients' feelings and the contexts that shape their stories, allowing therapists to grasp unique perspectives and tailor therapy more effectively (Manning & DiLollo, 2018). The distinction between thin and thick descriptions has important clinical implications. Encouraging detailed accounts enhances the therapist's understanding, promotes self-reflection, and builds a stronger therapeutic alliance. This deeper exploration helps uncover meanings in clients' narratives (Manning & DiLollo, 2018). Thick descriptions increase clients’ self-awareness, enabling them to understand their thoughts and emotions better, leading to meaningful changes (Manning & DiLollo, 2018). By using thick descriptions, therapists can foster a compassionate environment and help clients reinterpret their experiences, ultimately improving therapy outcomes (Manning & DiLollo, 2018).

B) List 3 counseling responses and explain why they can be used in helping clients move from thin to thick descriptions.

• Reframing

• Open-Ended Questions

• Sharing of Self

By using reframing, open-ended questions, and sharing of self, counselors can create a therapeutic environment that encourages clients to move beyond surface-level descriptions. These techniques foster deeper reflection and understanding of clients' thoughts, feelings, and behaviors (Luterman, 2008).

Reframing

Reframing is a therapeutic technique that helps change a client's perspective on a problem. By encouraging clients to see situations from different viewpoints, counselors can help them move from thin to thick descriptions. This deeper understanding of their thoughts and feelings can lead to richer accounts of their experiences (Luterman, 2008).

Open-Ended Questions

Open-ended questions prompt clients to provide detailed answers rather than simple "yes" or "no" responses. These questions encourage clients to explore their feelings and share specific examples, allowing for a more thorough examination of their experiences. This results in a clearer and more nuanced understanding of their issues (Luterman, 2008).

Sharing of Self

Sharing relevant personal experiences or feelings by the counselor helps build rapport and support. This creates a safe environment where clients feel comfortable sharing more deeply. When counselors open up, clients are more likely to provide fuller, more detailed accounts of their experiences (Luterman, 2008).

Explain how you would foster a culture of “stuttering modification”. Using the acronym (MIDVaS) discussed in class how can this be accomplished?

• Motivation

• Desensitization

• Variation/Modification

• Approximation

• Stabilization

Discuss the different theoretical frameworks that explain the nature of stuttering. How do these frameworks inform our understanding of its etiology and characteristics?

• Diagnosogenic Theory

• Anticipatory Struggle Hypothesis

• Approach-Avoidance Conflict Theory

• Covert Repair Hypothesis (CRH)

• EXPLAN Theory

• Multifactorial Dynamic Pathways Theory

Diagnosogenic Theory

Proposed by Wendell Johnson, this theory argues that stuttering starts when parents mistakenly label a child's normal speech hesitations as stuttering. This can make the child self-conscious and actually cause them to stutter (Johnson, 1959). It highlights how negative reactions to a child's speech can lead to learned stuttering behaviors.

Anticipatory Struggle Hypothesis

This theory by Oliver Bloodstein suggests that stuttering happens because people believe speaking is hard. This fear of difficulty creates tension and interruptions in their speech (Bloodstein, 1958). Stuttering results from trying to avoid expected disfluencies, which makes the struggle worse.

Approach-Avoidance Conflict Theory

Developed by Joseph Sheehan, this theory sees stuttering as a conflict between wanting to speak and fearing the anxiety that comes with it. When the desire to talk is blocked by fear, it leads to disfluencies and avoidance behaviors (Sheehan, 1953).

Covert Repair Hypothesis (CRH)

This theory suggests that stuttering occurs when speakers try to fix mistakes in their speech before they say them. It involves internal monitoring, where the speaker detects errors and attempts to correct them (Postma & Kolk, 1993). Stuttering happens as a byproduct of these correction efforts.

EXPLAN Theory

This theory proposes that stuttering arises from a timing mismatch between planning speech and actually speaking. When the planning doesn't keep up with speaking, it causes repetitions and prolongations (Howell, 2004).

Multifactorial Dynamic Pathways Theory

This perspective suggests that stuttering results from a mix of many factors, including genetics, brain function, language, and environment. It sees stuttering as the outcome of these various influences interacting over time (Bloodstein & Ratner, 2008).

Analyze the cultural factors that affect the experience of stuttering in bilingual and multilingual individuals. What specific challenges do these individuals face in different cultural contexts?

Attitudes and Stigma

• Cultural Views

• Negative Stereotypes

Communication Styles

• Normal and Expectations

• Oral Ability Pressure

Linguistic Factors

• Language Proficiency

• Code-Switching

Diagnostic and Treatment Issues

• Misdiagnosis

• Cultural Bias

Socioeconomic Factors

• Access to Resources

• Acculturation

Recommendations

• Cultural Sensitivity

• Family Involvement

Attitudes and Stigma

• Cultural Views: Different cultures have varying attitudes toward stuttering. In some cultures, it may be seen as a shameful condition, leading to stigma and isolation (Craig et al., 2009).

• Negative Stereotypes: People who stutter often face misunderstandings and assumptions about their abilities, which can increase stress and anxiety.

Communication Styles

• Norms and Expectations: Cultural norms influence how people communicate. For example, eye contact may be encouraged in some cultures but viewed as disrespectful in others, affecting how stuttering is perceived (Gonzalez et al., 2018).

• Oral Ability Pressure: In cultures that value speaking skills highly, individuals who stutter may feel extra pressure, which can worsen their stuttering.

Linguistic Factors

• Language Proficiency: Bilingual individuals might stutter more in their less proficient language due to increased difficulty in finding words (Manning, 2001).

• Code-Switching: Switching between languages is common but can sometimes lead to more disfluencies.

Diagnostic and Treatment Issues

• Misdiagnosis: Clinicians who aren't familiar with a client's language might misinterpret normal speech patterns as stuttering (Yairi & Ambrose, 2005).

• Cultural Bias: Clinicians' assumptions can affect how they treat stuttering, so understanding the client's background is important.

Socioeconomic Factors

• Access to Resources: Economic challenges can impact language development and access to treatment (Yairi & Ambrose, 2005).

• Acculturation: How well individuals adapt to a new culture can influence their experience with stuttering.

Recommendations

• Cultural Sensitivity: Speech-language pathologists should consider the client's cultural and linguistic background in assessments and treatments (Gonzalez et al., 2018).

• Family Involvement: Engaging families in the treatment process is essential to respect their beliefs and preferences.

Explain the psychosocial effects of stuttering on an individual's daily life. What predictive factors are associated with recovery, and how do they differ among individuals?

Psychosocial Effects of Stuttering

• Children

• Adolescents

• Adults

Predictive Factors Associated with Recovery

• Gender

• Age of Onset

• Family History

• Severity of Stuttering

• Trend in Severity

• Language Skills

Differences Among Individuals

• Complex Nature of Stuttering

• Coping Strategies

• Access to Therapy

Psychosocial Effects of Stuttering

Stuttering can greatly impact an individual's daily life, affecting emotional well-being, social interactions, and overall quality of life.

• Children often face teasing and bullying, leading to low self-esteem, anxiety, and social withdrawal (Bloodstein & Ratner, 2008; Craig et al., 2009). They may avoid speaking in class and feel isolated, which can hurt their education (Yairi & Ambrose, 2005).

• Adolescents experience increased pressure for social acceptance, which can make stuttering more distressing. They often deal with social anxiety and difficulties in communication (Beilby et al., 2012).

• Adults may struggle with job opportunities and social relationships, leading to frustration and low self-esteem (Manning, 2001). Many develop avoidance behaviors to cope with social situations, resulting in a lower quality of life (Stewart et al., 2020).

Overall, stuttering is linked to significant emotional challenges, including anxiety, depression, and impaired self-image (Yairi & Ambrose, 2005).

Predictive Factors Associated with Recovery

Several factors can predict recovery from stuttering, though they vary among individuals:

• Gender: Females tend to recover more often and earlier than males (Yairi & Ambrose, 2005).

• Age of Onset: Children who start stuttering before age 3.5 are more likely to recover (Yairi & Ambrose, 2005).

• Family History: A family history of recovery from stuttering increases the likelihood of a child's recovery (Yairi & Ambrose, 2005).

• Severity of Stuttering: Children with milder stuttering are more likely to recover (Bloodstein & Ratner, 2008).

• Trend in Severity: A decrease in stuttering severity over time is a strong predictor of recovery (Yairi & Ambrose, 2005).

• Language Skills: Better speech and language skills are associated with higher chances of recovery (Yairi & Ambrose, 2005).

Differences Among Individuals

These factors can differ from person to person due to:

• Complex Nature of Stuttering: Stuttering is influenced by genetics, environment, and personal circumstances (Yairi & Ambrose, 2005).

• Coping Strategies: Some individuals develop effective ways to manage their stuttering, while others may struggle more (Beilby et al., 2012).

• Access to Therapy: Availability and effectiveness of speech therapy can significantly impact recovery outcomes (Stewart et al., 2020).

Understanding these psychosocial effects and recovery factors is essential for providing effective support to those who stutter.

Describe two competing assessment methods for stuttering. What theoretical positions support each method, and how do they influence treatment planning?

• Stuttering Severity Instrument-Fourth Edition (SSI-4)

• Comprehensive Assessment with OASES

• Competing Aspects

Stuttering Severity Instrument-Fourth Edition (SSI-4)

A tool that measures how severe stuttering is by looking at how often it happens, how long it lasts, and any physical movements that go with it (Riley, 1994). It focuses on observable stuttering behaviors (Speech and Language Kids, 2024). It helps determine how severe the stuttering is and track progress in treatment (Riley, 1994). However, some suggest using it to describe stuttering rather than relying on the score (SLP Now, 2025).

Comprehensive Assessment with OASES

This method combines measuring stuttering behaviors with the Overall Assessment of the Speaker's Experience of Stuttering (OASES), which looks at the emotional and cognitive impact of stuttering (SLP Now, 2025). It recognizes that stuttering affects emotions, thoughts, and social life, not just speech (World Journal of Advanced Research and Reviews, 2025). It informs treatment by addressing both stuttering behaviors and the speaker's feelings and attitudes (SLP Now, 2025).

Competing Aspects

The SSI-4 focuses primarily on the what and how of stuttering behaviors, while the comprehensive assessment with OASES also explores the why and so what by examining the speaker's experience (Stuttering Therapy Resources, 2024). While the SSI-4 provides a standardized measure of stuttering severity, the OASES offers a more in-depth understanding of the impact of stuttering on the individual's life (Global Scientific Journal, 2021). By integrating both types of assessment, clinicians can develop more effective and personalized treatment plans that address the multifaceted nature of stuttering (World Journal of Advanced Research and Reviews, 2025).

Reflect on an in-class role-playing session focused on stuttering intervention. What theoretical perspectives did you apply, and what insights did you gain about effective intervention strategies?

The author applied cognitive-behavioral therapy (CBT), narrative therapy, and person-centered therapy to address stuttering. CBT focused on reducing anxiety by reframing negative perceptions and encouraging positive self-talk. Narrative therapy encouraged clients to share their experiences, separating their identity from speech difficulties. Person-centered therapy fostered a supportive environment by actively listening and validating clients' feelings. Effective intervention strategies included empathy, open-ended questions, reframing, gradual exposure, and collaborative storytelling. Empathy helped clients feel understood and supported, while open-ended questions facilitated in-depth conversations. Reframing helped clients view their stuttering from a different perspective, and gradual exposure helped clients face fears in a supportive setting. These insights will inform future practice and enhance the author's approach to working with stuttering clients.

Cognitive-Behavioral Therapy (CBT)

This approach was applied by addressing the thoughts and beliefs clients have about their stuttering. By reframing negative perceptions and encouraging positive self-talk, we aimed to reduce anxiety associated with speaking situations.

Narrative Therapy

We utilized narrative therapy principles by encouraging clients to share their personal stories about stuttering. This helped in externalizing their experiences, allowing them to separate their identity from their speech difficulties.

Person-Centered Therapy

This perspective was crucial in creating a safe and supportive environment. By actively listening and validating clients' feelings, we fostered a therapeutic alliance, which is essential for effective intervention.

Importance of Empathy

Building rapport through empathy was vital in helping clients feel understood and supported. This approach encouraged deeper sharing of their experiences, leading to richer descriptions of their feelings and challenges.

Value of Reframing

Reframing negative experiences into more positive narratives helped clients view their stuttering from a different perspective. This strategy not only empowered them but also encouraged resilience.

Gradual Exposure

Discussing gradual exposure techniques for desensitization revealed how important it is to help clients face their fears in a supportive setting. This approach built their confidence in handling speaking situations.

Collaborative Storytelling

Engaging in collaborative storytelling with clients allowed us to co-create narratives that emphasized their strengths and capabilities. This process fostered a sense of agency and ownership over their speech journey.

How can the ICF framework be utilized to create a comprehensive intervention plan for a person who stutters? Discuss the key factors that need to be integrated into the plan.

The International Classification of Functioning, Disability and Health (ICF) framework provides a comprehensive approach to creating intervention plans for people who stutter. [1] It moves beyond just addressing the impairment (stuttering) to considering the whole person within their environment (WHO, 2001; Yaruss & Quesal, 2004). By using the ICF, clinicians can develop holistic plans that target not only fluency but also the individual's attitudes, feelings, and coping strategies (ASHA, 2023; Coleman & Yaruss, 2014; Yaruss, 2007; Yaruss & Quesal, 2004, 2006).

Body Functions and Structures

Focus on the physical parts of speech, like how the mouth and vocal cords work (Yaruss, 2007. Check speech fluency and any extra movements made while stuttering (Yaruss, 2007). Therapy can help improve speech control.

Activities and Participation

Look at how stuttering affects daily activities, like talking in class or ordering food (Yaruss, 2007). Identify tough situations and work on communicating better in those moments, building confidence, and reducing avoidance (Yaruss, 2007).

Environmental Factors

Consider outside influences, like family support, school environment, and how society views stuttering (Yaruss, 2007). See how the environment affects stuttering and educate family, teachers, and peers. Advocate for support and understanding (Yaruss, 2007).

Personal Factors

Think about internal factors like age, coping skills, and self-esteem (Yaruss, 2007). Acknowledge feelings about stuttering and work on self-esteem, reducing anxiety, and developing healthy coping strategies (Yaruss & Quesal, 2004; Tichenor & Yaruss, 2019).

How the ICF helps

Looks at the whole picture, not just the stuttering itself (Yaruss, 2007). Focuses on the client's needs and daily life. Improves communication among healthcare providers and people who stutter. Leads to more effective therapy and improved confidence. By using the ICF, therapists can create personalized plans that address all aspects of stuttering and improve overall well-being (WHO, 2001; Yaruss & Quesal, 2004).

Present a hypothetical case where ethical dilemmas arise in assessing a person who stutters. How would you apply ethical principles and the ICF framework to resolve these dilemmas?

Hypothetical Case: An SLP evaluates a 6-year-old girl, Sarah, who stutters. Although her stuttering frequency is 2% (below the school’s 3% threshold for services), her parents report that she avoids speaking in certain situations, indicating that her stuttering affects her quality of life. The school administrator is hesitant to provide services based solely on the percentage.

Ethical Dilemmas

• Client Needs vs. Policy: The SLP must balance Sarah's needs for support with the school’s strict eligibility criteria.

• Beneficence and Non-Maleficence: The SLP needs to consider whether denying services would harm Sarah by allowing her avoidance behaviors to worsen.

• Justice: The SLP should question if the %SS criterion is fair, as it may not fully capture the impact of stuttering on Sarah’s life.

• Veracity: The SLP has a duty to accurately report Sarah’s stuttering and its effects, even if it contradicts the school’s policy.

Ethical Dilemmas: Client Needs vs. Policy

The SLP must balance Sarah's needs for support with the school’s strict eligibility criteria.

Ethical Dilemmas: Beneficence and Non-Maleficence

The SLP needs to consider whether denying services would harm Sarah by allowing her avoidance behaviors to worsen.

Ethical Dilemmas: Justice

The SLP should question if the %SS criterion is fair, as it may not fully capture the impact of stuttering on Sarah’s life.

Ethical Dilemmas: Veracity

The SLP has a duty to accurately report Sarah’s stuttering and its effects, even if it contradicts the school’s policy.

Ethical Principles

• Beneficence: The SLP should prioritize Sarah’s well-being by considering long-term effects of both providing or denying services.

• Justice: Advocate for equitable access to services that reflect Sarah's actual needs, not just numerical criteria.

• Integrity: Maintain honesty in assessments and recommendations, challenging policies that may harm the child.

• Autonomy: Involve Sarah's parents in the decision-making process, respecting their concerns and perspectives.

Ethical Principles: Beneficence

The SLP should prioritize Sarah’s well-being by considering long-term effects of both providing or denying services.

Ethical Principles: Justice

Advocate for equitable access to services that reflect Sarah's actual needs, not just numerical criteria.

Ethical Principles: Integrity

Maintain honesty in assessments and recommendations, challenging policies that may harm the child.

Ethical Principles: Autonomy

Involve Sarah's parents in the decision-making process, respecting their concerns and perspectives.

ICF Framework

• Body Functions: Document Sarah’s speech disfluencies and any tension or struggle behaviors (Yaruss & Quesal, 2004).

• Activities and Participation: Assess how Sarah’s stuttering affects her communication in different settings (Yaruss & Quesal, 2004).

• Environmental Factors: Evaluate the attitudes of Sarah's family and teachers towards her speech (Yaruss & Quesal, 2004).

• Personal Factors: Consider Sarah’s emotional state and self-perception regarding her stuttering (Yaruss & Quesal, 2004).

ICF Framework: Body Functions

Document Sarah’s speech disfluencies and any tension or struggle behaviors (Yaruss & Quesal, 2004).

ICF Framework: Activities and Participation

Assess how Sarah’s stuttering affects her communication in different settings (Yaruss & Quesal, 2004).

ICF Framework: Environmental Factors

Evaluate the attitudes of Sarah's family and teachers towards her speech (Yaruss & Quesal, 2004).

Personal Factors

Consider Sarah’s emotional state and self-perception regarding her stuttering (Yaruss & Quesal, 2004).

Resolution

• Comprehensive Documentation: The SLP should record all relevant findings, including the impact of stuttering on Sarah’s life (SAC, 2016).

• Advocate for Holistic Assessment: Present a complete picture to the school administrator, emphasizing that the %SS alone does not capture Sarah’s struggles (WHO, 2001).

• Explore Alternatives: If services are denied, consider indirect therapy, parent and teacher training, and regular monitoring (ASHA, 2023).

• Seek Support: Collaborate with other professionals or advocacy groups to support Sarah’s needs (Speech Pathology Australia, 2020).

• Prioritize Well-being: The goal is to ensure Sarah receives the necessary support for effective communication, regardless of strict eligibility criteria (ResearchGate, 2020).

Comprehensive Documentation

The SLP should record all relevant findings, including the impact of stuttering on Sarah’s life.

Advocate for Holistic Assessment

Present a complete picture to the school administrator, emphasizing that the %SS alone does not capture Sarah’s struggles.

Explore Alternatives

If services are denied, consider indirect therapy, parent and teacher training, and regular monitoring.

Seek Support

Collaborate with other professionals or advocacy groups to support Sarah’s needs.

Prioritize Well-Being

The goal is to ensure Sarah receives the necessary support for effective communication, regardless of strict eligibility criteria.

Discuss how evidence-based practice informs ethical decision-making in the assessment and treatment of stuttering. Provide examples from current literature.

How EBP Guides Ethical Decisions

• Choosing Assessments

• Selecting Treatments

• Considering Client Value

• Monitoring Progress

• Addressing Ethical Issues

Examples from Research

• Therapeutic Relationship

• Early Intervention

• Comprehensive Assessment

How EBP Guides Ethical Decisions: Choosing Assessments

Use reliable and valid tools to measure stuttering. Include measures like the SSI-4 (Riley, 1994) for severity and the OASES (Yaruss & Quesal, 2006) to understand the client's experience. This ensures a comprehensive and ethical assessment.

How EBP Guides Ethical Decisions: Selecting Treatments

Stay updated on research and use proven interventions. Effective treatments include the Demands and Capacities Model (Yairi & Ambrose, 2005) and CBT for adults (Mongia et al, 2019).

How EBP Guides Ethical Decisions: Considering Client Values

Treatment should align with the client's goals and cultural background (Haynes et al., 2002). Focus on communication effectiveness and quality of life.

How EBP Guides Ethical Decisions: Monitoring Progress

Continuously track progress and adjust treatment as needed. Be ready to change approaches if necessary.

How EBP Guides Ethical Decisions: Addressing Ethical Issues

Use evidence to advocate for clients when policies are too restrictive.

Examples from Research: Therapeutic Relationship

A strong clinician-client relationship improves outcomes (Plexico et al., 2010).

Examples from Research: Early Intervention

Early treatment is important to minimize the potential negative long-term consequences (Yairi & Ambrose, 2005) but avoid over-diagnosis and should carefully consider the child's individual risk factors and the impact of labeling.

Comprehensive Assessment

Assess both stuttering behaviors and the emotional, social. And cognitive impact. This comprehensive approach ensures that treatment targets all relevant aspects of the client's experience.

Choose a recent research study on stuttering intervention. Summarize its findings and critique the methodology. What implications do these findings have for clinical practice?

• Title: The Utility of Cinematherapy for Stuttering Intervention: An Exploratory Study

• Research Study Summary: Azios et al., 2020 conducted a study to explore the use of cinematherapy (movie therapy) for addressing the cognitive and emotional effects of stuttering in adults. The study involved four participants in a 4-week program.

• Key Findings

• Critique of Methodology

• Implications for Clinical Practice