stuttering final exam

Assessment procedure: preschool child: pre-assessment contains

Clinical questions

Determining if child is stuttering or normal disfluency

Case history form

Assessment procedure: preschool child: assessment

Parent interview: for example, any problems at birth, family history, first notice child’s disfluency, compare to siblings etc.

parent-child interview: observe caregivers interacting w child.

Is child aware of stutter, do parents listen, look, let child talk? Etc.

What are 2 assessment tools to use for assessment for preschool children

SSI (stuttering severity instrument)

OASES (overall assessment of the speaker’s experience of stuttering)

What does a speech sample look like for an assessment for a preschool child

Samples should include 200 syllables

Obtain reading sample

As child talks, clinician should interject questions, interruptions, and mild disagreements to stimulate pressure of normal convo at home and elsewhere (Riley)

Assessment for preschool child: Written transcript

Include all words, even those non meaningful utterances

Note where stutters are, details of how they stuttered

Identify and describe escape/avoidance behaviors

Analysis of speech sample for preschool child (6)

1. Frequency of disfluencies - total #

2. Severity

3. Frequencies of diff types of dysfluencies

4. Nature of repetitions and prolongations - duration of individual instances of dysfluencies

5. Starting and sustaining airflow and phonation

6. Types of frequencies of concomitant/associated behaviors

Borderline stuttering

More than 10 disfluencies per 100 words, loose and relaxed

Beginning stuttering

Occurs in children 3.5-6y

Presence of tension and hurry in child’s stuttering

Assessment procedure: school age child: preassessment

Clinical questions:

What is stuttering like

Severity?

Emotions

Attitudes

Observations

School age child: assessment

Parent interview

School experiences

Teacher interview

Classroom observation

Child interview: awareness? When does it happen? Any tricks to get words out? How do u feel ab ur speech? Ever get teased?

School age child assessment speech sample

Should include 300-400 syllables

Observe amount of tension, escape behaviors, avoidance behaviors

SSI-4 (stuttering severity instrument) assesses

Frequency

Duration

Physical concomitants

Most schoolchildren are at ___ or ___ levels of stuttering

Beginning or intermediate

Beginning level stuttering is most likely to occur in younger school age children characterized by

Physical tension, hurry, escape behaviors, awareness of difficulty, feelings of frustration, lack of avoidance

Intermediate level school age children characterized by

Tension, hurry, escape, frustration, notable avoidance as a result of fear and anticipation of stuttering

Adolescent/adult preassessment

Case history, attitude questionnaires (OASES)

Adolescent/adult interview assessment

When did u begin to stutter

What do u believe caused it

Any family history

Therapy received?

Stuttering changed or caused more problems recently?

What situations cause u to stutter more? Less? Why?

Avoid speaking situations?

Avoid certain words?

Relationships affected?

Adolescent/ adult assessment speech sample

Use SSI-4

Talk about familiar topics, work, school, hobbies, vacations

Get at least 300 syllables

Ask them to read a sample aloud for about 3 minutes to get 200 syllables or more of reading

What is the normal speaking rates of adults range from

From 115-165 words per minute, 162-230 syllables per minute, mean of 196 syllables per minute

Adults normal rates for reading aloud are

Faster, ranging from 150-190 words per minute, 210-265 syllables per minute

Adolescent/ adults assessment patterns of stuttering

Proportions of core behaviors

Escape and avoidance behaviors

End stutter quickly w pushing and tension?

Able to tolerate blocks or speak vaguely to avoid stuttering?

Adolescent/ adult stimulability

Encourage them to stutter, then ask them to freeze during the moment but maintain level of physical tension and posture (catch a stutter then prolong it)

Easier with a continuing sound like mmm

Identify exact posture associated with moment of stutter and hold on to it

Finish word slowly and easily ask them to do later

Have client become aware of what they are doing right when they get into the stutter (where are they holding back sound or airflow?, lips? Tongue? Larynx? All 3?)

Borderline stuttering: indirect approach

Aim in treatment is to prevent stuttering from becoming more severe and maximize the likelihood that recovery will take place

Borderline stuttering: indirect approach focuses on these goals:

Facilitate fluency by having family members:

Speak slowly with pauses

Change questions into comments

Listen attentively to their child

Borderline stuttering direct approach stages of therapy

Stages of therapy- to help individual reduce negative emotion:

1. Explore beliefs about stuttering

2. Explore feelings about stuttering

3. Explore their own stuttering

4. Explore and change core behaviors

Lidcombe program

Fluency shaping approach

Stuttering modification approach

Acceptance based approaches

Borderline stuttering: Fluency shaping/enhancing approach

Focuses in the way a person speaks to promote more fluent speech

Borderline stuttering: Fluency shaping/enhancing approach Goals

To increase overall fluency

Reduce stuttering behaviors

Use learned fluency techniques in everyday communication

4 fluency shaping techniques

Flexible/controlled rate: speaking at a slower rate to increase fluency

Pausing: use pausing to reduce muscle tension and allow the brain to stay at a processing speed that is comfortable

Easy onsets: initiating speech with a light, relaxed airflow to reduce tension

Light contacts: using light articulatory contact to prevent speech blocks

Stuttering modification approach(stutter fluently) - van riper

Focuses on reducing the struggle and avoid avoidance behaviors associated with stuttering

Stuttering modification approach goals

Reduce avoidance and fear of stuttering

Makes stuttering less tense, and more controlled

Increase comfort and confidence in speaking situations

Stuttering modification stages (4)

Identification: recognizing stuttering behaviors and feelings

Desensitization: reduce fear and avoidance

Modification: learn techniques like cancellations, pullouts, and preparatory sets

Stabilization: practice and generalize new stuttering behaviors

Stuttering, modification techniques: cancellation/timeout

After experiencing a moment of stuttering, the individual pauses briefly and then repeats the stuttered word or phrase in a more fluent manner

Stuttering modification techniques: pull-out

Easing out of a stuttered word rather than forcing it out

Stuttering modification techniques: preparatory sets

Anticipating a stutter and using techniques beforehand to say the word more easily

Stuttering modification techniques: voluntary stuttering

Individuals intentionally introduce controlled stuttering into their speech (reducing the fear/anxiety associated with stuttering and increasing fluency and confidence)

Acceptance based approaches: acceptance and commitment therapy

Acceptance: things are beyond your control

Commitment: actions that improve your life

Acceptance and commitment therapy goals

Accepting stuttering as part of communication

Reducing avoidance behaviors (word substitution, silence)

Building self-esteem and communication resilience

Mindfulness and emotional regulation

6 core principles of acceptance commitment therapy

Contact with present moment

Acceptance

Thought diffusion

Self as a context

defining values

And committed actions

Clinical procedures: working with teachers goals

Explain the treatment program and the teachers role in it

Facilitate the teacher talking with the student about their stuttering

Help the student and teacher work out the child’s class participation

Help the teacher eliminate teasing

Clinical procedures: working with parents goals

Explain the treatment program and the parents role in it

Discuss the possible causes of stuttering

Identify and reduce fluency disrupters

Identify and increase fluency enhancing situations

Connect them to stuttering support organizations (SAY)

Neurogenic acquired stuttering

Stuttering that appears to be caused or exacerbated by neurological disease or damage

Typically acquired after childhood

Etiology may be stroke, head trauma, Parkinson’s, drug toxicity

Neurogenic stuttering impatience may be an early diagnostic sign of a neurological problem

Functional/psychogenic acquired stuttering

Stuttering onset that occurs in late adolescence or adulthood

Typically begins after a prolonged period of stress or traumatic event

Stuttering symptoms are stable

Stuttering pattern of the disorder resembles developmental stuttering in terms of core behaviors

Frequency varies a lot- can stutter on every word and then long period of fluency

Lack of secondary behaviors

No improvement with fluency inducing conditions

Malingering

Onset- adulthood, sometimes after an accident to claim compensation or after a crime to claim innocence

Attempt to gain benefit by appearing to stutter

Stereotype and very severe types of stuttering

Lack of secondary behavior behaviors

Cluttering

Rapid speaking that is difficult to understand- can be situational

Words may be collapsed, syllables may be omitted, sounds may be slurred

Reduced intelligibility

Language is often disorganized

Fluency shaping technique

Flexible/controlled rate

Client will use a controlled speaking rate during classroom speaking tasks, as evidenced by producing speech in short phrase units, at least once per class across 3 out of 4 class sessions, measured by clinician observation

Fluency shaping technique

Pausing goal example

Client will intentionally pause within a sentence to reduce muscle tension during classroom speaking tasks at least once per class across 3 out of 4 class sessions, as measured by clinician observation

Fluency shaping techniques

Easy onset goal example

Client will initiate speech with a light, relaxed airflow to reduce tension, once per class in 3 out of 4 class sessions

Stuttering modification techniques

Cancellation strategy goal example

Client will incorporate the cancellation technique following a stuttering moment in 8 out of 10 opportunities

Stuttering modification techniques

Pull out strategy goal example

Client will incorporate the pull out method and ease out of a stuttered word in 8 out of 10 opportunities

Stuttering modification techniques

Voluntary stuttering goal example

Client will voluntarily stutter at least 4 times during a structured conversational activity

Stuttering accepting techniques goal examples (3)

Client will use a mindfulness strategy before feared speaking tasks in 4 out of 5 opportunities

Client will voluntarily participate in meetings one time in 3 out of 4 opportunities accepting the presence of their stutter

Client will identify and name 3 stuttering related thoughts during sessions and practice decision strategies across 3 sessions