Exam 2 Flashcards
Normal disfluencies ages
1 1/2 to 6 years old
Borderline stuttering ages
1 1/2 to 3 1/2
Beginning stuttering ages
3 1/2 to 6
Intermediate stuttering ages
6 to 13
Advanced stuttering ages
14+
Do all PWS pass through every stuttering level?
No. Can be at any level and advance. May move in and out or skip around.
To determine normal disfluencies vs stuttering
Look at frequency, duration, and type of disfluencies as well as the individual’s awareness
Van Riper track 1
Exhibit core behaviors between ages of 2-4
May progress on to disfluencies with more tension (maybe more blocks?)
Van Riper Track 2
Later onset of stuttering 3 1/2 - 4
Artic/Lang issues - more concomitant areas of concern
This may be the most common one that we see.
Van Riper Track 3
Come on with very severe blocks, a lot of tensions, secondary behaviors - no ease into it, comes on very suddenly - does not happen often
Van Riper Track 4
Psychogenic onset - traumatic experiences triggering onset of stuttering
Normal disfluencies are a part of development as children try to master speech and language. Examples of normal disfluencies…
Part word Whole word Phrase repetitions Interjections May see some prolongations but these could also be a red flag for concern - look at frequency and duration to determine
Distinguishing features between normal disfluencies and stuttering
Amount of disfluencies - 1% usually ok, 15% red flag
Number of unit repetitions - more = more likely stuttering
Type of disfluencies - part word repetitions, prolongations, blocks are more indicative of stuttering
Normal disfluencies
Single - syllable word repetition Multisyllabic word repetition Phrase repetition Interjection Revision - incomplete phrase
Atypical disfluencies
Part-word repetition Prolongation Tense pause (blocks)
Do no stuttering children exhibit secondary characteristics
No.
Why are increases and decreases in disfluencies common throughout childhood?
Language acquisition demands
Pragmatics - social interaction with peers
Environmental stress - parents, moving, preschool demands
What kind of stuttering may be difficult to diagnose because the child will exhibit normal disfluencies and stuttering
Borderline stuttering
Children with borderline stuttering may exhibit…
Part word repetitions Whole word repetitions Prolongations Frequency is 10% Stuttering behavior consist of more within word disfluencies
Does a child with borderline stuttering exhibit secondary characteristics?
No
Underlying processes to borderline stuttering include
Resource allocation - a lot of development happening at the same time, where are the brain resources being placed?
Capacity to handle demands
Potential increasing frustration with communication
Child with Beginning stuttering exhibits what types of behaviors? (Not their speech characteristics)
Increased tension during stuttering moments
Less patience and tolerance for stuttering moments
Development of escape behaviors may occur
Beginning stuttering core behaviors
Repetitions sound more rapid and irregular
During repetition a schwa may be inserted
Prolongations may be a second or longer
Increased tension present - may be fleeting
Do children with beginning stuttering exhibit secondary behaviors?
Pitch rise
Head turns
Eye closure
Are children at the beginning stuttering level aware of the stuttered moments?
Yes.
Frustration is common and may question inability to get a word out
In beginning stuttering, what is increased tension attributed to?
Anticipation of the stuttering event - tension helps brace the individual’s body for the stuttering moment
In beginning stuttering, what is the increase in speed of repeated behaviors attributed to?
The child’s recognition in the delay to communicate the intended message
In beginning stuttering, what is responsible for the increase in frequency of escape behaviors?
Conditioning
Ex. Child thinks, every time I squeeze my fist when I get stuck, then the word comes out better so I am going to do that - it doesn’t work and will have to also be addressed in therapy
At what level to children begin to develop fear of stuttering as well as develop avoidance behaviors?
Intermediate
At what level are core behaviors still present and more blocking is involved?
Intermediate
With this level, use of escape behaviors are more prevalent than beginning stuttering and this time of avoidance behaviors occur.
Intermediate
Word and situation avoidance behaviors
What are Van Riper’s 3 different word avoidance categorized.
Substitutions - Say a different word than what they want to say - come up with a different word to avoid the stutter
Circumlocutions - Talking around the word but never actually saying it
Postponements - A little pause before they say the word the are intending to say - getting themselves ready to say the word successfully or they know they have to say the word and that it will be problematic
At what level to children begin to feel fear, embarrassment, and shame with stuttering?
Intermediate
In intermediate stuttering, how are the escape behaviors changed?
Escape behaviors transform into avoidance behaviors
ex. I don’t want to raise my hand in class, I will not participate
I won’t order, my parents have to do it for me
Child starting to shut down a little bit in various situations
At what level do treatment responsibilities fall on the client and beliefs about stuttering can be distorted?
Advanced
What type of stuttering is common in the advanced level?
Core speech behaviors consist typically of blocks, with the blocking being more pronounced and include more struggle behavior as well
How is the advanced level of stuttering characterized? What makes a person be placed in this level?
Age - older adolescents and adults
Why are those is the advanced stage of stuttering more adept to control the environment to avoid stuttering?
Their fears and attitudes have been shaped by years of conditioning
People in this level have developed a self-concept as an impaired speaker. Why?
Advanced
Self-concept is formed by perceptions of listeners’ reactions
Stuttering assessment is a multi level process that includes..
Information gathering and personal encounter
Display your knowledge about stuttering and listen to the family/client concerns
All client’s have a right to privacy and confidentiality. Why is this especially important for school aged children?
They have to trust you to be able to move forward in therapy. Even have to be careful when talking to parents - you tell the parents something that was said in therapy and then the child does not trust you anymore and no longer wants to share with you
Clinicians need to develop a multicultural view on stuttering assessment and treatment including…
Becoming sensitive to communicative style differences
Learning how other cultures view speech and language disorders
What are some multicultural issues related to stuttering?
Eye contact - ex. May be offensive to have eye contact with authority figures
Family interaction style - family may value their interaction style like a fast speaking rate
Physical touch - ex. Personal space! - Ask them and explain before you do it
Voluntary stuttering - may help with control, able to practice techniques ex. Some client’s may find this unacceptable. Client may think - Why are you making me do this when I already stutter?
What is the purpose of a preschool assessment? And what purpose does the initial evaluation serve?
To clarify observations of disfluencies by parents or others. Is the child stuttering or is it just normal disfluencies? Also, parents may need information and reassurance from the clinician.
Initial evaluation will serve as the beginning point of the decision making process
What are the preschool assessment procedures?
- Obtain a good audio and video recording - at the very least have to audio but it is best to have both
- have toys that are age appropriate
- first part of the assessment should be free play. This allows time to observe and record disfluencies types and frequency, observe parent-child interaction, look at how the parent reacts when the child stutters, Speaking rate of the parent and child,Types of questions/vocab that the parent is asking - cognitive load, and Does the parent interrupt the child? Frequency?
- provide structured speech tasks that slowly increase in difficulty
- interview parents
- clinician-child interaction
- talk about stuttering - determine the child’s awareness - if aware, ask them why they are here today
- calculate speech rate
- find out about feelings and attitudes - may have to be from parent interview
How do you do an assessment with a child who won’t talk?
Bring the parent in for the evaluation - rely on parent-child interaction
Preschool assessment diagnosis:
Normal
Borderline
Beginning
Normal
- less than 10 disfluencies per 100 words
- most disfluencies are normal like (normal like disfluencies (NLD) or other disfluencies (OD) - Phrase reps, whole word reps, maybe some part word reps, interjections)
Borderline
- more than 10 disfluencies per 100 words
- exhibits core stuttering behaviors
Beginning
- presence of tension in the child’s speech - Likely see awareness, pitch rising, prolongations of 1 second or longer
Preschool recommendations:
Normal
Borderline/beginning
Normal
- greater emphasis placed on parental concern’s than child’s disfluencies
- educate parents about stuttering development in conjunction with other aspects of child development
- offer strategies for interaction with their child
Borderline/beginning
- have parents keep note of fluency changes in children
- continue to educate parents
- parent directed therapies are good for this age
