Stuttering Assessment Notes

Pre-Assessment

  • Begins with gathering necessary information.
  • Ensure appropriate clinical questions are asked.
  • Identify family concerns regarding the child's speech.
  • Understand their feelings about the child's speech.
  • Explore their thoughts and potential reservations about treatment.

Initial Contact

  • Obtain case history.
  • Request a 5-10 minute video recording of play for natural interaction analysis (more likely in clinic settings).
  • Analyze the video prior to the visit.
  • Avoid giving parents too much information or showing concern to maintain neutrality.
  • Neutrality encourages transparent interaction and prevents parents from trying to elicit stutters.

Assessment - Observing Parent-Child Interaction

  • Observe parent-child interaction (formal or informal) to understand their natural dynamic.
  • Observe the child's stuttering behaviors.
  • Observe parent interactions:
    • Do they interrupt the child?
    • Do they finish the child's sentences?
    • Do they speak too fast?
    • Are their utterances too complex?
    • Is their vocabulary too advanced for the child?
  • Paying attention to these details reveals the home environment dynamics.

Parent Interview

  • Ask open-ended questions to avoid directing answers.
  • Refer to textbooks for examples of interview questions.

Clinician-Child Interaction

  • Record interactions for later analysis or take notes during audio-only interactions.
  • Clinician mirrors the child's speech style:
    • If the child stutters, maintain the same speech style.
    • If the child speaks rapidly without stuttering, adjust the rate and ask questions to potentially elicit stutters.
  • Always consider the parent's report, even if you don't observe the same behaviors in the clinic.
  • Use age-appropriate vocabulary when discussing stuttering with the child (e.g., "getting stuck" instead of "block").
  • Avoid forcing verbal interactions to reduce anxiety.
  • Multiple interactions may be necessary to gather sufficient information.

Practical Considerations

  • Consider billing limitations for assessment sessions.
  • Establish rapport with the child to encourage openness.
  • Recognize the challenge of one-time assessment settings.
  • School settings offer more opportunities for engagement with the child.

Speech Sample Analysis

  • Collect multiple speech samples, each between 150-500 syllables.
  • For young children, samples may be closer to 150 syllables.
  • Analyze disfluencies and their patterns.
  • Analyze speech rate.
  • Use formal tools like the SSI (Stuttering Severity Instrument) or the TOCS (Test of Childhood Stuttering).
  • Note types and number of iterations of disfluencies.
  • Assess difficulties with sustained airflow, tension, physical concomitants, and avoidance behaviors.

Feelings and Attitudes

  • Feelings and attitudes are not commonly observed in this population; gather parent perspectives through case history, interviews, and interactions.
  • Use questionnaires like the "Impact of Stuttering on Preschoolers."
  • Determine the child's awareness level:
    • Unaware.
    • Occasionally aware, seldom bothered.
    • Aware and frustrated.
    • Highly aware, frustrated, and afraid of speaking.

Other Speech and Language Behaviors

  • Assess risk factors for persistent stuttering.
  • Consider parent history, the child's gender (male being a higher risk), stuttering onset, and duration.
  • Include this information in reports to aid in determining the risk of persistent stuttering.

Diagnosis, Prognosis, and Treatment Planning

  • Typical disfluencies: fewer than 10 per 100 words.
  • Stutter-like disfluencies: less than 50% is still considered typical.
  • Borderline stuttering: greater than 10 disfluencies per 100 words; disfluencies are loose and relaxed.
  • Beginning stuttering (3.5 to 6 years): rises in pitch, repetitions, prolongations, subtle awareness, facial tension, gentle head nods, blinks, and blocks.

Risk Factors

  • (List of risk factors mentioned earlier).

Recommendations

  • After assessment, consider:
    • Postponing treatment.
    • Providing indirect treatment to modify the child's environment.
    • Pursuing direct therapy.
  • Closing interview to discuss recommendations:
    • Typical disfluencies: create an accepting environment and consider family counseling.
    • Postponing treatment: monitor for spontaneous improvement over time with check-ins.
    • Borderline or beginning stuttering: provide indirect treatment, working with the family to modify the environment.
    • Older Preschoolers:generally a direct approach is taken.

Factors that Influence Treatment Decision

  • Direct vs. Indirect therapy really depends on the child's temperament. Is the child participatory? Or should the SLP work with the family first?

Assessment of School-Age Children, Adolescents, and Adults Who Stutter

  • Pre-assessment with Individuals with Disabilities Education Act (IDEA) considerations.
  • Initial contact with parents before connecting with the child.
  • Gather case history.
  • Request video or audio recordings (with release).

Observation and Interviews

  • Observe parent-child interaction in a clinic.
  • Conduct parent interviews to explore disfluency onset, family history, etc.
  • Conduct teacher interviews (if in a school setting) or send interview worksheets to school.
  • Classroom observations are crucial for natural setting insights.
  • Conduct student interviews for older children, adolescents, and adults.

Speech Samples

  • Speech samples of 300-400 syllables.
  • Reading sample of at least 200 syllables appropriate for the client's reading level.
  • Use stuttering severity instrument 4 (SSI-4), which has reading passages at the third, fifth, and seventh-grade levels.
  • Analyze patterns of disfluencies and speech rate.

Trial Therapy

  • Trial therapy to see how easily they're able to talk about stuttering and their feelings.
  • If there are no negative feelings, try strategies.

Feelings and Attitudes

  • Communication Attitude Test (CAT).
  • A-19 Scales.
  • KittyCAT (Communication Attitude Test for Young Children).
  • Using measures determine if there are negative self perceptions of their communication.

Continuing Assessment

  • Check for other speech and language disorders or comorbidities.

Closing Interview

  • Diagnosis is provided to client.
  • Summarize findings and make treatment recommendations.

Adolescents (Ages 13-19)

  • Assessments are similar to other age groups.
  • Form based on WHO classification of functioning (WHO 2011) - The Overall Assessment of the Speaker’s Experience of Stuttering(OASES).
  • The OASIS is a formal measure of feelings and attitudes for this age group and adults.
  • Assess situational types of interactions and feelings about way they speak.

Advanced Stuttering

  • More often escape and avoidance behaviors.
  • More tension on blocks, prolongations, and repetitions.

Considerations

  • Determine if there are other comorbidities, including ADHD.
  • Closing interview with parents and the client is important.

Adults

  • Assessments are similar to adolescents.
  • Audio/video recordings, speech samples, SSI-4, patterns of disfluencies, speech rate, trial therapy, and comorbidity checks.
  • Determine the type of stuttering through differential diagnosis to assess severity.
  • In a closing interview with recommendations for treatment are given.

Typical Disfluencies

  • Less than 10 disfluencies for 100 words
  • Stutter like disfluencies are less than 50 percent.

Borderline Stuttering

  • Greater than 10 disfluencies per 100 words.
  • Most of these are loose and relaxed.

Beginning Stuttering

  • Age Range: 3 1/2 to 6 years.
  • Rises in pitch and repetitions and prolongations.
  • Awareness may be subtle, maybe some facial tension, and then maybe escape behavior, some gentle head nods, maybe some blinks, and even some blocks.