Assessment of Stuttering

Question 1

Why do we assess?

Answer 1

Get useful info
Understand the history and development of their disorder
To get a starting point
Set goals

Question 2

What are the Principles of Assessment?

Answer 2

• Explore the impact that stuttering has had
• Explore the impact of previous intervention
• Identify the outcomes the person hopes for
• Create an agreement/contract about what
  outcomes are attainable

Question 3

What are the consensus guidelines for assessment? (Brundage et al, 2021)

Answer 3

• Stuttering related background
  information
• Speech, language ,
  Temperament, and related
  background information
• Speech Fluency and Stuttering
  behaviour
• Speaker’s reactions to
  stuttering
• Reactions to stuttering within
  the Environment
• Adverse Impact associated
  with Stuttering

Question 4

ICF (International Classification of Functioning and Health - Yaruss & Quesal, 2004)

Answer 4

• Shift towards creating a distinction between aetiology and consequences
• Distinction between cause and results
• Impact on daily life

Question 5

Reducing Negative Reactions (Murphy and Yaruss, 2007):

Answer 5

• Strategies to overcome children’s negative reactions to their stuttering
• Talking about thoughts and feelings about stuttering
• Understanding the nature of the problem

Question 6

OASES (Overall Assessment of the Speaker’s Experience of Stuttering - Yaruss & Quesal, 2006)

Answer 6

• Quality of lifw
• Thoughts and feelings behind stutter
• Focuses on the speaker’s experience of stuttering as defined by the ICF

Question 7

WASSP (Wright-Ayre Stuttering Self-Rating Profile):

Answer 7

Based on the ICF framework
Understand how individuals who stutter see and feel about their stuttering
How they avoid certain speaking situations
Whether they feel like stuttering puts them at a disadvantage in any way
Their personal feelings and perspectives on stutterin

Question 8

Observations during Assessment:

Answer 8

• Frequency of stuttering is most commonly reported as % of syllables stuttered
• Variety of samples, ideally video with written consent
• Average the duration of the 3 longest stutters in a sample
• Secondary behaviors: physical movements/extra sounds/pitch rise

Question 9

Discrepancies:

Answer 9

• Disagreements between people who stutter, professionals, and authorities on what constitutes stuttering
• Research into outcomes has focused on quantifiable behaviors
• Consistency in measuring stuttering events is essential

Question 10

Persistence and Recovery:

Answer 10

Rates of recovery differ across studies
- recovery occurs between the ages of two and half and four and a half years (Bernstein Ratner,
2010)
- spontaneous recovery may
occur up to five years post onset (Baxter, 2015; Bernstein
Ratner, 2005; Curlee & Yairi, 1997; Blomgren, 2013).

Approximately 70-80% of children who begin to stutter will spontaneously recover
Factors influencing persistence and recovery

Question 11

Predicting persistence and recovery

Answer 11

Walsh et al (2018)
Provide supplemental evidence of the role of known predictive
factors (e.g., sex and family history of persistent stuttering).
Provide evidence that
*early delays in basic speech motor processes (especially in boys),
* poor performance on a non word repetition test,
*stuttering severity at the age of 4 to 5 years,
*and delayed or atypical functioning in central nervous system
language processing networks are predictive of persistent
stuttering.

Question 12

Onset, development and recovery

Answer 12

Longitudinal study by Yairi & Ambrose (2005)

• Identifies cognitive abilities for CWS are no different to CWNS
• Expressive language skills are average or above average close
  to onset, although children who persist in stuttering tend to be
  slower in phonological development than those who recover
• Approximately 70-80% of children who begin to stutter will
  spontaneously recover from symptoms within one to two
  years post-onset (Bernstein Ratner, 2005; Curlee & Yairi,
  1997)

Question 13

What are you assessing?

Answer 13

• Family history of stuttering
• Language development
• Phonological development
• Motor development
• Temperament

Question 14

Assessing feelings and attitudes:

Answer 14

• The need to work with the whole person
• Instruments such as OASES and WAASP
• The impact of self-stigma on self-esteem and self-efficacy

Question 15

Key elements in Assessment/Therapy?

Answer 15

• Identification
• Desensitization
• Stigma and Stereotyping
• The importance of addressing the whole person

Question 16

Goals of assessment may include:

Answer 16

Assessing confidence and participation in communication
Understanding self-perception as a communicator
Evaluating support systems
Gathering input from various sources
Handling questions, teasing, bullying, and reactions when talking

Question 17

Behaviours to assess:

Answer 17

• Avoidance: the degree to which the PWS
  successfully use avoidance behaviours in order
  to give the appearance of a person with mild or
  even no stuttering
• Postponement: as the PWS approaches a
  feared word there is often a moment of
  hesitation or the speaker may use a serious of
  sounds e.g. um/ah/let me see/you know
• Substitution: substitution of words
• Loss of control: speaker identifies

Question 18

Normal non fluency vs stuttering

Answer 18

Normal non fluency:
- part/whole word repetitions (<3)
- phrase repetitions
- single syllable word repetitions

Stuttering:
- Part/whole word repetitions (>3)
- Phoneme/syllable repetitions
- prolongations/blocks
- tension
- incresed awareness
- secondary behaviours

Question 19

When might stuttering be more likely to persist?

Answer 19

• Family history of persistent stuttering
• Relatives continue to stutter
• Male
• Stable or increasing number of SLDs (stutter-like dysfluencies) within one year of
  onset
• Stable or increasing severity rating by parents/clinicians
• Few repetitions (more blocks and prolongations than reps)
• Strong reactions to stuttering by parents/child
• Later onset of stuttering (4 years up)
• Concomitant (co-occurring) learning or communication problems

Question 20

When is stuttering less likely to persist? (Manning, 2010)

Answer 20

• No relatives who stutter
• Female
• Within one year of onset
• Decreasing pattern of SLDs within one year of
  onset
• Few reactions to stuttering by child or parents
• Early onset of stuttering (2-3 years)
• Decreasing severity ratings by parents and
  clinicins

Question 21

Cluttering severity instrument

Answer 21

Eight dimensions:
1. Overall intelligibility
2. Speech rate regularity
3. Speech rate
4. Articulatory precision
5. Typical disfluency
6. Language disorganisation
7. Discourse management
8. Use of prosody (tone and rhythm)

Question 22

Cluttering Assessment

Answer 22

• Monologue
• Reading
• Story retelling

a person who stutters doesn’t slow down their speech for the more complicated parts, which leads to more typical speech difficulties like repeating words or phrases and making sentence structure mistakes. (Van Zaalen, 2009)

6.4 times more normal disfluencies in
spontaneous speech and retelling

• Speech motor coordination (10 repetitions of
  puhtukkuh) judging articulatory accuracy and
  smooth flow (co-articulation, flow and sequencing)
  and rate
• Skills in oral motor coordination in multisyllabic
  words (Van Zaalen, 2009)

Question 23

Evidence-Based Practice (EBP) in Speech-Language Pathology:

Answer 23

EBP emphasizes the importance of clinicians documenting intervention results and choosing treatment approaches based on a substantial body of literature. This is particularly relevant in the field of fluency disorders.

Question 24

Stuttering as More Than Surface Features:

Answer 24

Stuttering involves not only observable behaviors but also intrinsic aspects that profoundly affect individuals. These “under the surface” aspects include emotional reactions, cognitive responses, and the overall impact on a person’s life.

Question 25

Sheehan’s “Iceberg” Analogy:

Answer 25

Sheehan’s analogy illustrates that much of the experience of stuttering occurs below the surface, encompassing more than just observable speech disfluencies.

Question 26

Challenges in Studying Intrinsic Aspects of Stuttering:

Answer 26

Research on the less-observable components of stuttering is limited. Various factors may contribute to this gap, such as the difficulty of defining and measuring intrinsic aspects and skepticism regarding their significance.

Question 27

Need for Comprehensive Treatment Outcomes Research:

Answer 27

There is a pressing need for research on the outcomes of treatment that extends beyond the surface speech behaviors to address the full scope of the stuttering disorder.

Question 28

Measurement of Intrinsic Aspects:

Answer 28

Instruments for measuring less-observable components of stuttering exist, but they have not been widely used in treatment outcomes research. These instruments can provide insights into a speaker’s fluency, confidence, emotional reactions, attitudes, and more.

Question 29

clinical implications of OASES

Answer 29

Clinicians should recognize that the effects of stuttering extend beyond the observable behaviors and consider the intrinsic aspects of the disorder.

Utilizing instruments like the OASES can help clinicians and researchers comprehensively assess the experiences and outcomes of stuttering treatment.

A broader understanding of stuttering and its impact on individuals can guide evidence-based practice, enabling more informed treatment decisions and improving the overall quality of care

Question 30

Initial Trial Instruments: SRS, FCS, and QOL-S

Answer 30

The OASES consists of three initial trial instruments designed to target specific components of the stuttering disorder defined by the WHO model.
These components include the speaker’s reactions to stuttering (SRS), functional communication and stuttering (FCS), and quality of life and stuttering (QOL-S).

Question 31

Speaker’s Reactions to Stuttering (SRS)

Answer 31

SRS was designed to gather information about how speakers felt about their speech, the actions they engaged in due to stuttering, and their thoughts and perceptions about communication difficulties.
The SRS addressed affective, behavioral, and cognitive reactions, including negative emotions like embarrassment and anxiety.
Focus groups and specialists provided input to refine the SRS, which initially contained 100 items.

Question 32

Functional Communication and Stuttering (FCS)

Answer 32

FCS focused on the disability of stuttering and the impact of the environment on communication by examining difficulties in relevant life situations.
It contained 35 items and examined challenges in general communication, work-related communication, and social interaction.
Input from focus groups and specialists was used to refine the FCS

Question 33

Quality of Life and Stuttering (QOL-S)

Answer 33

QOL-S assessed the potential disadvantages experienced due to stuttering, including its impact on overall quality of life.
It included 30 items and was based on items from other quality of life instruments but modified for stuttering.
Focus groups and specialist reviews were used for refinement.

Question 34

Initial Pilot Studies: Item Analysis

Answer 34

The early drafts of SRS, FCS, and QOL-S were tested in two pilot studies, involving participant feedback and analysis.
Item distributions were analyzed to avoid floor or ceiling effects and ensure appropriate variability.
Pairwise correlations were conducted to eliminate redundant items and maintain reliability.

Question 35

Initial Pilot Studies: Validity and Reliability

Answer 35

The S-24 was used for concurrent validity assessment.
Content validity was ensured through focus groups, participant feedback, and specialist input.
Preliminary test-retest reliability was assessed, with the majority of items showing high reliability.

Question 36

First Integrated Instrument: CASES

Answer 36

The three initial instruments (SRS, FCS, QOL-S) were combined into CASES to address the WHO’s ICF framework and WHO terminology.
A general information section was added, making it a “Comprehensive Assessment of the Speaker’s Experience of Stuttering” (CASES) instrument.

Question 37

Additional Pilot Analyses and Final Revisions

Answer 37

A larger sample was used for further pilot analyses, involving a broad cross-section of people who stutter.
Data quality checks were performed, and sections with incomplete or uniform responses were excluded.
Detailed item analyses were conducted for item distributions, correlations, and internal reliability.
The resulting integrated instrument was named OASES, with minor wording changes.

Question 38

OASES contains:

Answer 38

General Information (Section I):
Reactions to Stuttering (Section II):
Communication in Daily Situations (Section III):
Quality of Life (Section IV):

Question 39

General Information

Answer 39

Focuses on the speaker’s perceived fluency and speech naturalness.
Assesses the speaker’s knowledge about stuttering and stuttering therapy.
Explores overall perceptions about stuttering.

Question 40

Reactions to Stuttering

Answer 40

Examines the speaker’s affective, behavioral, and cognitive reactions to stuttering.
Evaluates how the speaker responds emotionally and behaviorally to stuttering experiences.

Question 41

Communication in Daily Situations

Answer 41

Assesses the degree of difficulty speakers have when communicating in various situations, including work, social settings, and home.
Focuses on communication difficulties rather than fluency in these situations.

Question 42

Quality of Life

Answer 42

Focuses on how much stuttering interferes with the speaker’s satisfaction with their ability to communicate, relationships, ability to participate in their lives, and overall well-being.

Question 43

Scoring procedures for OASES

Answer 43

Response scales are organized so that higher scores indicate a greater degree of negative impact associated with stuttering.
Scores are based on the calculation of an “impact score,” which involves the ratio of the total number of points in the respondent’s answers to the total number of possible points for the items that were completed.
Impact scores range from a minimum of 20 to a maximum of 100, regardless of the number of items a speaker might skip

Question 44

Impact ratings of OASES

Answer 44

Impact ratings are analogous to traditional severity ratings and provide an indication of the impact of stuttering.
The impact scores are divided into different categories representing varying degrees of stuttering impact: mild, mild-to-moderate, moderate, moderate-to-severe, and severe

Question 45

Final Evaluation of Reliability of OASES

Answer 45

Test-retest reliability was examined by distributing the OASES to 20 adults who stutter, with 14 of them completing the instrument on two occasions separated by 10-14 days.
Point-to-point agreement for individual items was high, with strong consistency between test administrations.
Impact scores showed a high degree of test-retest reliability, with Pearson product–moment correlations ranging from 0.90 to 0.97.
Impact ratings remained stable between the first and second administrations of the instrument, confirming strong reliability.

Question 46

What is the Palin PRS?

Answer 46

It is designed for parents or guardians to rate their child’s therapy sessions.
Parents use a 0-10 scale to rate nineteen statements.
Provides valuable insights into the parent or guardian’s viewpoint on their child’s stammering therapy.
It is used by The Michael Palin Centre and their therapists.
The measure was created at The Michael Palin Centre using a Delphi approach. Parents of children who stammer were involved in defining important therapy outcomes. Statements rated highly by a majority of respondents were incorporated into the Palin PRS.
Over time, data has been collected to assess the validity, internal reliability, component factors, and normative scores of the Palin PRS.