Exam of Preschool Stuttering Assessment

Question 1

1. What brings you here today?

• Onset - “When did it begin?” (and how long ago was that?) “Did the stuttering start gradually, or quite suddenly? Over what time period?” [In combination with age may give indication of possibility of natural recovery].

Answer 1

• Variability - [becoming more severe over time or “good” episodes are increasing/decreasing. Can get some hints about what is happening for a child by parent’s indication of how frequently the cycles occur. If parents says originally cycles happened every week (good) and otherwise moderate, if changed and good cycles now only happen once per month, even though severity is not increasing, the fact that the cycles are getting further apart (fewer good times) is an indicator of overall increasing severity. OR if good cycles are increasing could be an indicator of maybe natural recovery (anecdotal)]. Even in kids who we expect to have natural recovery (even though we can’t know) we STILL have to consider mental health issues.

Question 2

• Family Hx of stuttering? “Does anybody else in your family stutter?” (May not be correct - mother may not know about stuttering in Father’s family history. Also, if natural recovery (ie for grandparents) younger family members may not know about it).

Answer 2

• Hx of natural recovery in family?… if ‘yes’ to family Hx “Does that person still stutter?’ if no “Did they have treatment for stuttering? Or did the stuttering go away by itself?”

Question 3

• Any major trauma? (associated with onset?) “Was the onset of stuttering related to any event?” [RULE out neurological stuttering from brain injury  refer to neurologist - esp. with adult who starts stuttering suddenly]  even with trigger, the child would probably have started stuttering around that time anyway. Can help you understand parent guilt around onset, and reassure them of genetic nature.

Answer 3

• Avoidance or shyness - indications of social anxiety? “Does your child avoid certain situations, or avoid speaking or playing with others?” (to goal-set with family re: anxiety, or even refer to paed. Psych.).

Question 4

• Other speech or language issues? Developmental language history? [what to prioritise?  if within age window treat whatever is having their biggest impact on socialising, communication, intelligibility, mental health…]

Answer 4

• How aware is the child about their own stutter? (thoughts about how to do treatment? Is the child in distress from it? Some kids may be anxious about it, even if they’re not aware. Other kids might interact differently with stuttering issues).

Question 5

• Ask about the validity (representativeness) of the samples “Are they a good representation of child’s normal speech and severity of stuttering?”
• Of the samples taken, which is the most representative? Is he ever more severe? Is he ever less severe?

Answer 5

• What situations does he speak in? Who are his typical conversation partners? (know what speech samples to get, later).
• Explain severity rating score 0-9 and get parent consensus.

Question 6

• Is stuttering worse in certain situations/times/conversation partners? [idea of variability and severity in different contexts].

Answer 6

• What are his interactions like at preschool? (any teasing, bullying…)
• Things that will impact on treatment decisions? (Moving house, time availability, goals with treatment etc…)

Question 7

Teens /ADULTS
• How does your stuttering impact on your socialisation? (word it better?)
• Impact (career attainment, avoiding certain jobs etc)
• What are your goals? (if they say ‘get rid of my stuttering’  if adult/teen CAN’T get rid of it, but can learn to control it. Will they modify their goal, or choose not to go ahead?).

Answer 7

• Situation of time of day impact on stuttering?
• Impact on activity and participation?
• Gather information to make recommendations for treatment.

Question 8

Describe stuttering using Lidcombe Behavioural Data Language (Packman + Onslow, 1998)

Answer 8

*Overview descriptor (ie mild-moderate)
*Features in sample (ie fixed postures with audible airflows, 3 repetitions in 10 min sample)
Why: people reading file have a ‘picture’ of client’s stuttering.

Question 9

Stuttering and its treatment: Eleven lectures. Onslow (2021)

Answer 9

Lidcombe Behavioural Data Language (Packman + Onslow, 1998)

Question 10

BL = Baseline
•	
$ = stutters
•	
◊ = cumulative speaking time of client
•	
BC = beyond clinic --> speech sample taken somewhere other than clinic (should be in an environment typical for the client, with a typical conversation partner).

Answer 10

WC = within clinic

%SS = percent of syllables stuttered. For every 100 syllables, that many were stuttered.
•
SPM = syllables per minute. Syllables spoken/time

Question 11

Something we must avoid, if a child doesn’t stutter during assessment?

Answer 11

AVOID FALSE NEGATIVE - the parents brought their child in because they thought the child was stuttering. Child needs to be put on a monitoring program if no evidence of stuttering can be found (could be in a ‘good cycle’ of variablility BUT check samples are representative and sufficient.

Question 12

Stuttering treatment in one language will often generalise to the other, and the clinician may monitor the language they don’t speak, and treat in the one they do.

Answer 12

True

Vong, Wilson + Lincoln, 2011. p 139

–> Good idea for the caregiver to be trained, and collect severity ratings in all languages.