Lecture 6 Flashcards
(32 cards)
What are the language issues as related to childhood stuttering?
- stuttering onset occurs between 2 and 5 years of age during period of great language growth
- stut. typically develops during a period of significant language growth- exemplified by mastery of morphologic, and syntactic forms, and vocab development
- some CWS exhibit co-occurring lang disorders
What are the lang issues as related to childhood suttering? part 2
- effective communication takes place within the context of lang-cant ignore the context in which stuttering takes places
- earliest onset stut reported as being 8 mos
What about linguist demand related to stutter?
“…longer and developmentally more complex utterances are more likely to be stuttered than shorter utterances with simpler syntax”
- Gianes,runyan, and myers
How about mean length of utterance (MLU) compared to disfluency rate?
- rate of disfluencies in spontaneous utterances that were above the child’s mean length of utterance (MLU) compared with the disfluency rate in utterances identified as shorter than MLU. “
- The results indicated that utterances above the MLU were more likely to be produced disfluently…”
- Increased linguistic complexity relative to overall language proficiency (as measured by MLU) may set the stage for fluency breakdown.”
What about overall linguistic proficiency?
fluency is more likely to be compromised when children both children who stutter (CWS) and children who do not stutter (CWNS) attempt to produce language that is more advanced relative to their own overall linguistic proficiency
What are the implications for fluency assessment?
- A comprehensive lang assessment is an important part of an assessment for young ch. who are being assessed for stuttering/fluency issues.
- lang sample other assessments: receptive and expressive
What are the fluency therapeutic ramifications (consequence) based on language development difficulties?
- targets for fluency therapy need to chosen with care, initially to maximize the potential for fluent production and over time to gradually challenge child’s mastery of fluency skills through a hierarchy of successively more demanding utterances.”
- berstain, ratner
What significant aspects of language development are evident for ch who recovered vs those who persisted with stuttering? (Watkins and Yairi)
- even though it seems the recovered and persistent groups did not show language differences, the persistent group did display increased variability in their performances on measures of expressive language compared with those children who recovered. (Watkins and Yairi)
- The children who persisted in their stuttering did not show such a pattern, maintaining a more stable above average expressive language profile. This finding is in contrast with those presented above and may be suggestive of language effects on stuttering, such that the children’s attempts to produce developmentally more challenging utterances have the potential to adversely affect their ability to be fluent
What are the stuttering assessment components for children?
- Extensive case history including familial history
- speech/ lang assessment
- nature of disfluencies/ other factors/ counting disfluencies/ observations/videotaping/other assessments
Extensive case history including familial history
- Parent /Client concerns
- Parent/ Client description of disfluencies
- When did parent first notice disfluency?
- Have the disfluencies changed since they began?
- If so, in what way?
- Why seeking evaluation/treatment now?
- How does client react to stuttering? If a child, is he/she aware?
- Does client struggle or abandon?
- Does the client have strategies they use that help
- Situations in which client is most fluent? Most disfluent?
- Family history?
- Previous treatment?
- Is client’s speech during evaluation representative of disfluent patterns?
- Anything we need to know, that didn’t ask?
- Client/parent questions?
What are Frequently Asked Questions?
- What causes stuttering?
- Can it be Cured?
- Why does it seem to come and go?
- Should we discuss the stuttering with our child?
- Why does singing or talking in a funny voice seem to help?
Speech/Language Assessment
- articulation/ phonologic
- receptive/expressive langugae
Nature of disfluencies
- identify specific vowel/ consonant patterns
- loci of disfluencies (initial words, final words, etc.)
- core features
- sounds, syllable, words, phrases
- severity- frequency of the disfluencies- how often/how long
- secondary behaviors
- presence of struggle
- accessory behaviors
ch. reaction to disfluencies(embarrassment abandoning utterances)
other factors (stuttering assessment components for ch)
- social/emotional/academic aspects - how handicapping is stuttering?
- parent reaction to disfluencies
- motivation: attention span, stimulability and compliance
- older children: reading/ monologue sample
counting disfluenices:
a. obtain 300- word sample consider mean:
- frequency of all speech disfluencies
- frequency of each disfluency type
- duration from onset to offset of 10 randomly selected speech disfluencies
- number of iterations (repetitions) per sound syllable repetition for 10 randomly selected disfluencies
- rate of speech in words or syllables per minute
other possible assessments
SSI-3/4: Stuttering Severity Instrument For Children and Adults
OASES: Overall assessment of the speakers experience of stuttering
SSI-3 and SSI-4 Stuttering Severity Instrument
- ages: 2-10 yrs. and up
- measures frequency, duration, and physical concomitants of stuttering
- converted to numerical rating corresponding to the severity of stuttering
OASES (overall assessment of the speakers experience of stuttering)
- ages: 7 yrs. to adult
- Examines:
1) the speaker’s perception of the stuttering impairment;
2) the speaker’s affective, behavioral, and cognitive reactions to stuttering
3) the speaker’s limitations when communicating in daily activities
4) the impact of stuttering on the speakers overall participation in life
Methods of counting disfluencies
Procedure “A”
- “count each syllable or word as either fluent or disfluent”
- each syllable or word should be counted only once
- calculate the percentage of words or syllables that were disfluent.
Also:
- Count number of stuttering-like disfluencies (SLDs): each word or syllable is counted as either fluent or involving an SLD- (ie. “ Within-word repetition; monosyllabic word repetitions; sound prolongations….; tense pauses; or any other type of disfluency that is perceived to involve excessive muscle tension or effort…..” )
- then calculate the percentage of syllables or words with SLDs
Observations and other suggested assessments
- Videotaping of child with one/more parents in therapy room playing game etc.. Familiarize child with therapy room as well as observe parent/child interactions. Parent videotape at home.
- Speech/Language assessment/alternate with game or other activity
- Videotaping of child and clinician during unstructured play activities (compare to parent home videotaping)
- Different speaking tasks such as:
- retelling a familiar story
- sometimes interrupting, disagreeing, or saying we need to “hurry and finish” to see how this may affect fluency
- Hearing screening/ oral peripheral assessment
At risk signs for child developing chronic stuttering: Factors depend on
- Nature of childs disfluencies
- Frequency of disfluencies
- situational variability
- presence of struggle/ secondary behaviors
- childs reaction to disfluencies
- familial history
- childs gender
Possible outcomes of child stuttering evaluation
- no at risk stuttering behaviors present
- inconsistent signs/not quite sure
- child is at risk/ stuttering present at times
- stuttering evident including secondary behaviors
- No at Risk Stuttering Behaviors present
a. disfluencies present but more related to “linguistic encoding
process” – interjections, repetitions or words/phrases
b. no muscle tension/ no effort/ no secondary behaviors observed
c. speech and language age appropriate
Next Steps: affirm parent concerns/ praise them for bringing in child; encourage them to make contact again immediately if there is any change in nature or frequency of disfluencies
- Inconsistent signs/not quite sure
a. Inconsistent signs of stuttering present, but need more information- observation/assessment
b. Affirm parents concerns/parents to track
disfluencies; day to day; situations good/bad; possible videotaping; follow up evaluations
d. Parents to note any changes in disfluency
e. Re- contact in approximately 2 months or sooner if there is marked change in nature or frequency of disfluency
