Chapter 8: Assessment Adults/School-age Flashcards
Diagnostic
A) attitudes, feelings emotions about stuttering,
B) speech behavior,
C) cognitions, thinking, beliefs about stuttering, and
perceived “loss of control” will be conducted
*Affective (emotional)
Behavioral, physical speech aspects (e.g. blocks)
Cognitive
Diagnosis
Defined: “the identification of a specific condition usually not apparent at the beginning” (p. 199)
Differential Diagnosis - discerning the nature of a disorder as different from other possible clinical entities
Differential Diagnosis – Examples
Stuttering vs. Normal Disfluencies
Early Stuttering vs. Advanced Stuttering
Stuttering that will Recover vs. Stuttering that will Persist
Stuttering vs. Cluttering
Stuttering (Developmental) vs. Neurogenic Stuttering
*Preschool- stuttering vs. normal disfluencies
Developmental- from childhood
OR
Neurogenic- acquired
Assessment Objectives
Establish rapport Obtain background/case history Describe speech characteristics Consider home/social/work environments Note conditions affecting speech Understand the impact on the client’s life Provide info. about stuttering and therapy Recommend a plan of action
*Rapport- very important especially with young children. If they aren’t comfortable may not be honest or open with you.
Case History Areas (pp. 204-206)
Stuttering (including family) History Treatment History Current Speech Description Environmental Variables Affecting Speech Impact of Stuttering on Quality of Life Other Relevant Case History Client’s Perspective Identifying Information
Interviewing School-Age Children
What grade in school? Which subjects liked most? Least? After-school activities? Skills/Hobbies? What do you like to do best? Why? Tell me about things you do well. Like talking? When/Where/How much? Peers’ response? Teachers’ response?
Interviewing Parents
Does stuttering affect the child in school? Is it the same at school and at home? Describe the child’s typical day. Besides speech, any other trouble areas? Is playing or socializing affected? Any other impact on the family? Is speech important to your child?
Speech Analysis Decisions
After sample collection, determine:
behaviors of interest:
Examples: Disfluency types? Stuttering events? Fluent words?
units to be analyzed:
Examples: Syllables? Words? Time intervals?
*Get person to talk using open-ended questions
Record the session, ideally with video (to see behaviors, secondary or physical)
Video ideally head to waist to see secondary behaviors
Audio only, you hear pauses- block or distraction?
Metrics of stuttering / disfluency counts
Percent of words stuttered Percent of syllables stuttered Number of disfluencies per 100 words or per 100 syllables Repetition Units
Formula for stuttering/disfluency counts per 100 words or syllable
No. stuttered words X 100 = XYZ
No. of words in sample
52 X 100 = 11.3
467
Also important to measure…
Physical concomitants
Speaking rate
Communication skills in general
Other speaking conditions
Analyzing the Speech Sample
SSI-4: Stuttering Severity Instrument – Fourth Edition is a reliable and valid norm-referenced stuttering assessment that can be used for both clinical and search purposes.
It measures stuttering severity in both children and adults in the four areas of speech behavior:
(1) frequency,
(2) duration,
(3) physical concomitants, and
(4) naturalness of the individual’s speech.
*Looks only at speech aspects (focuses on B of our ABC of assessment)
Long block vs. short block must be measured because frequency of blocks is going to be the same. brief= more mild
Analyzing the Speech Sample
Mean Duration of the 3 longest stuttering behaviors
3 longest stuttering disfluencies
3
5 + 6 + 8 = 20/3 = 6.7 seconds
*Find 3 longest stuttering events (e.g. blocks) and average
It tells you information you can’t get from just frequency counts
Analyzing the Speech Sample
For instance, the client says
buh-buh-buh-aseball with tension.
This would be evaluated as a sound syllable repetition (part-word) and block (tense pause).
The coding procedure consists of underlining the word(s) where the disfluency occurred, and then placing the letters from the disfluency categories above the word in a transcript. In this case, it is a cluster.
Analyzing the Speech Sample
In this example the letters Rss and B would be placed above the word “baseball” in the transcription.
CL [Rss(2) + B]
This is a baseball. It is really easy to throw.
This means that two types of disfluencies (This would be evaluated as a sound syllable repetition (part-word) and block (tense pause) occurred on that one word. You would record this as a cluster.
Stuttering Severity
“the level of disruption in the delivery of continuous speech” (p.219)
Severity may not correspond to the impact or experience of the disorder
Stuttering can be severe, but cause minimal concern or social impact
Stuttering can be mild, but cause deep concern and negative social impact
*Very mild person comes in, you may not hear any stuttering events but the impact is substantial vocationally, socially, etc..
Severity- not just the outward manifestation, outward manifestation + impact (there is debate)
For us: severity- outward manifestation and does not include life impact
Situational Rating Protocols
Stutterer’s Self-Ratings of Reactions to Speech Situations (SSR)
Southern Illinois University Speech Situation Checklist
Reactions to Selected Speaking Situations
Self-Efficacy Scales (SESAS & SEA Scale)
Individualized situation hierarchy
Attitude Rating Scales
Modified Erickson Scale (S-24)
Communication Attitude Test (CAT-R)
Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
Self-Stigma of Stuttering Scale (4S)
Individualized interview regarding attitudes and emotional reactions
Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
- Yaruss & Quesal adapted the World Health Organization’s (2001) International Classification of Functioning, Disability, Health (ICF)
- The ICF model describes disorders in terms of:
a) Impairment in body function or structure (observable stuttering behavior)
b) Contextual Factors (personal and environmental reactions to stuttering)
c) Limitations or restrictions in ability to participate in daily activities
Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
“The scope of practice in speech-language pathology encompasses all components and factors identified in the WHO framework…That is, speech-language pathologists work to improve quality of life by reducing impairments in body functions and structures, activity limitations, participation restrictions, and environmental barriers…”
– ASHA (2007) Scope of Practice
Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
100 items in 4 sections, each on a 5-point scale
Sections are closely related to the ICF Model
Section I: General Information about Stuttering
Speaker’s perception of the Impairment and general knowledge and perception of the stuttering disorder
Section II: Affective, Behavioral, Cognitive Reactions
Section III: Communication in Daily Situations
Activity Limitation / Environmental Factors
Section IV: Impact of Stuttering on Quality of Life
Participation Restriction Environmental Factors
ANALYSIS of ASSESSMENT TOOLS
Age Administration Time Manual Case History Obtained Audio recording required Video recording required Verbatim Transcript required Number of samples obtained Monologue sample analyzed Dialogue sample analyzed Parent-child interaction Reading sample obtained Rate of speech calculation Duration measures % of stuttered words % of stuttered syllables Stuttered words/minute Stuttered syllables/minute Physiological factors Secondary behaviors Attitudes Personality factors Severity ratings Language factors Parent interview Teacher interview Client self-evaluation Therapy IEP information Normative data provided
So, back to diagnosis…
Even more important to describe, quantify and assess aspects of it
Remember to consider “life impact”
There is often “more than meets the eye”
Importance of multiple samples
Tx Recommendations
Need tx? What type? Client’s goals? What kind of speech change needed? Deal with attitudes/avoidances, coping mechanisms, etc.? Work on basic communication skills? Deal with secondary behaviors?
