Stutter 1.4

Assessment and Diagnosis: School-Age

Introduction

This section provides an in-depth overview of assessing and diagnosing stuttering specifically in school-age children, emphasizing the importance of a comprehensive evaluation to understand the severity and impact of stuttering on a child's life.

Stuttering Severity Instrument- 4 (SSI-4)

The SSI-4 is a standardized tool used to assess stuttering in school-aged children. It evaluates three primary components:

• Frequency: This is assessed as the percentage of syllables stuttered relative to the total number of syllables spoken. A significant frequency may indicate a higher severity of stuttering.

• Duration: This refers to the average length of the three longest stuttering occurrences, measured in seconds. It is vital as longer stutters can impact communication effectiveness. A stopwatch is employed to measure duration accurately to the nearest half-second, and specialized SSI-4 software can further assist in this measurement.

• Secondary Behaviors: This component assesses physical concomitants that often accompany stuttering, rated based on four categories such as facial grimaces, head movements, and other escape behaviors (e.g., eye blinking), to provide insights into the psychological burden of stuttering.

The overall score is calculated by summing these three components, yielding a total severity rating that aids in intervention planning.

Assessing Duration

• The standard practice involves averaging the duration of the three longest stutters. Duration is crucial as it reflects the severity and frequency of the child’s stuttering episodes.

Assessing Secondary Behaviors

• Escape Behaviors: These physical actions occur when stuttering has commenced, aimed at curtailing the stutter (e.g., nodding, tapping).

• Avoidance Behaviors: These actions happen before stuttering begins, reflecting the child's attempts to prevent stuttering (e.g., substituting words or using fillers).

Including secondary behaviors in severity assessments provides a fuller picture of the student's experiences and coping mechanisms related to stuttering.

Assessing Severity

Severity assessments are critical for understanding teachers' and listeners' perceptions of the child's stuttering, which can vary. They serve a dual purpose: monitoring progress based on the client’s individual goals and guiding intervention strategies. Severity is classified into five categories:

• Very Mild

• Mild

• Moderate

• Severe

• Very Severe

Assessing Speaking and Reading Rate

It's crucial to recognize that severe stuttering often results in decreased speaking rates, which can hinder effective communication. Conversely, both stuttering and another fluency disorder known as cluttering can lead to rapid speech rates, which may result in unintelligibility. Rates are typically calculated by measuring syllables per second, utilizing both manual timing methods (stopwatch and counter) and computerized devices. Reading rates can be assessed through timed readings of standardized passages.

Speaking Rates for Different Ages

Assessing School-Age Children

Preassessment Considerations

An effective assessment begins with understanding the specific characteristics of the child’s stuttering and includes the following considerations:

• Evaluate the characteristics of the student’s stuttering.

• Understand the student’s feelings and attitudes toward speaking, which can significantly influence their willingness to participate in communication.

• Assess the emotional and social impact of stuttering in school and home environments, including academic performance and peer interactions.

• Ensure all evaluations comply with eligibility for services as mandated by state regulations.

• Identify the individual priorities of the student regarding communication and engagement.

Speaking Samples

Data collection can be achieved through a variety of methods:

• Classroom Observations: Collecting data in natural settings, particularly during speaking activities.

• Clinician-Client Interactions: Utilizing tools like SSI-4 pictures to provoke speech and observe stuttering in a controlled context.

• Video Samples: Recording interactions in various settings, including at home, to analyze a wider range of behaviors.

• Reading Samples: Providing insights into the child’s fluency in more structured tasks.

Teacher Interviews

• Conduct interviews to gather detailed information on the teacher's perspective regarding stuttering, including:

• Interest in understanding stuttering further and its educational impact.

• The student’s participation levels and characteristics observed in class.

• Incidence of peer teasing and its effects on the child’s social experiences.

• The teacher's emotional response and support strategies for students who stutter.

Classroom Observation

• Organize observations around periods of active class participation while maintaining an unobtrusive presence. Key areas of focus include:

• Observing the child’s engagement in discussions.

• Identifying signs of avoidance or distress during speaking tasks.

• Understanding peer dynamics, such as reactions to the child’s stuttering and teacher responses.

Public School Considerations

• Begin by considering the Individuals with Disabilities Education Act (IDEA) and state regulations relevant to evaluation and treatment processes.

• Speech-Language Pathologists (SLPs) should conduct classroom observations discreetly and in collaboration with teachers to ensure a supportive evaluation environment.

• All evaluations must secure parental consent, and treatment options should involve discussions among the SLP, teachers, special education administrators, and parents.

Assessing Feelings and Attitudes for School-Age Children

To gauge attitudes toward stuttering, several tools can be employed:

• A-19 Scale (Guitar & Grims, 1977)

• Communication Attitude Test (CAT) (Brutten & Dunham, 1989)

• Teachers' Assessment of Student Communicative Competence (TASCC)

• Overall Assessment of Speaker’s Experience of Stuttering (OASES)

Communication Attitude Test Examples

Form A Questions could include:

• "I don't talk right" (True/False)

• "I don't mind asking the teacher a question in class" (True/False)Other similar questions will address feelings surrounding stuttering, helping uncover the emotional responses associated with speech challenges.

Methods of Assessing Feelings and Attitudes

• Conduct informal assessments through observation and discussion, allowing for a natural understanding of the child’s emotions towards stuttering.

• Use creative tools, such as drawing activities or a "worry ladder," to allow children to express their feelings about stuttering visually.

• Formal assessments can be coupled with guided discussions, utilizing instruments like CAT, A-19, or OASES, to document and analyze the child's perspectives.

Other Concerns

It is crucial to evaluate additional aspects that may co-occur with stuttering, such as:

• Physical Concerns: Assess for motor issues or delays that could influence communication.

• Cognitive Concerns: Explore any learning disabilities or attention difficulties that may be present alongside stuttering.

• Social-Emotional Concerns: Consider the child's ability to make and maintain friendships and their capacity to manage anxiety and stress.

• Academic Adjustment Issues: Identify any problems the child faces in terms of academic performance, particularly in reading tasks.