Chapter 9: Preschool-age Flashcards
Evaluation: Objectives
Case and family history Quantified disfluent speech Other domains & contributing factors Prognosis and recommendations Initial parent counseling Child’s reactions Other domains
Case history: Important information
Exact time of onset Manner of onset (gradual-sudden) Circumstances of onset Initial stuttering; changes over time (features and severity) Family’s stuttering history
Ask parent which speech disfluencies were observed near onset and now
-Disfluency--> Onset vs. Now Repeating short words (and-and) Repeating sound/syllable (ba-ba-baby) Prolonging vowels (aaaall) Prolonging consonants (sssso, mmmy) Silent blocks (b-aby) Incomplete words (ba-) Repeating phrases / longer words (going to-going to) Revisions (it was, it went) Interjecting (ah, um)
Secondary characteristics: onset and now
Onset vs. now Facial grimaces Eyes closing/blinking Lip tension Tongue tension Mouth wide open Throat tension Respiratory irregularities Upward swings in vocal pitch Head tilting Arm/leg movement/tension
Parent: Compare overall stuttering severity at onset and now (may select midpoints)
Onset
0-Normal
7- very severe
Now
0-Normal
7- very severe
Minimal diagnostic criteria for stuttering (per 100 syllables) ages 2 to 5. Need at least 3
Part-word repetition (PW) 1.5
Single–syllable word repetition (SSW) 2.5
Disrhythmic phonation 0.5
Total SLD 3.0
Weighted SLD* 4.0
Mean repetition units 1.5
PW + SSW with 2 or more extra units 2.0
- Reflects reflects three dimensions of disfluency:
frequency, type, and extent in a single score.
Risk prediction near onset:Primary factors
Family History Gender Stuttering trends Duration of stuttering history Age at onset Disfluency type Disfluency length
Family history
Persistency and natural recovery tend to go in the family.
A child with familial history of persistent stuttering has a 65% chance to follow same pattern
A child with familial history of recovered stuttering has a 65% chance to follow same pattern
Persistence and recovery by gender
Males
30% persistent
70% recovered
Females 18% persistent
82% recovered
Male/female ratio
- 67 m/f persistent
- 89 m/f recovered
Risk prediction near onset: Secondary and Tertiary factors
Severity. Not a factor during first 8-12 months
Age at Onset. Somewhat greater risk for later onset (age 4-5)
Phonology. Poor scores indicate risk only close to onset.
Language (expressive). Not clear; continuous high scores may indicate risk.
2ndary characteristics. Presence may indicate greater risk.
2nd formant. Not clear. Limited transition may indicate risk.
Concomitant disorders; Awareness; Emotional reactions.
-Not risk predictors. Their presence complicating the stuttering problem should be considered.
Parent Counseling
Summary of findings
Considerations for intervention
Information about stuttering
Advice to parents:
a. Home environment
b. Handling stuttering eventsAdvice to parents: Home environment
Decrease various pressures Decrease emotional and physical excitement More relaxed, slow paced activities Speak slower, especially to child Promote child’s self confidence.
Advice to parents: Handling Stuttering
Listen patiently as child stutters
Repeat child’s stuttered word: easily and stretched a bit
More direct suggestion: “say this easily again”; “let’s say it easily together”
Reinforce fluency: “this was easy”
Show empathy: “Sometimes speech is difficult”
New from Stuttering Foundation of America
Slower rate Fewer questions Full listening Turn taking Building confidence Special times Normal rules apply
