Test 3 Flashcards
Assessment
the identification of a specific condition usually not apparent at the beginning; leads to differential dx, and then either tx or no tx/monitor
dx objectives
establish rapport, observe speech, describe speech, identify variables that affect, understand impact, provide information, recommend plan of action (7)
dx adults vs. school-age children
adults: background hx (home/social/work), info. for selecting tx (onset, severity, variables affecting speech, who referred, encourage questions); school-age: background hx, family reactions, CAT-R, interview parent alone, speech/lang. eval
pre-school dx
incipient or persistent?, parent as informant, test hearing, lang., phonology, motor, cognitive, elicit speech sample (is today a good/normal/bad day?); talk to teacher (also school-age) to determine if interferes with academic behavior, teased, teacher’s reaction
speech sample
minimum 200 syllables, 300 or more better; if severe, consider stuttering events per minute; count frequency and type of stuttering, describe methods; for children, 500-1000 syllables (20 min. x 2) if possible from parent recording at home (note head and neck movements
observation
videotape; do conversation, reading, phone or other (with monologue, easier, but also more uniform)
transcription
verbatim without disfluency first, then color code and put behaviors in brackets; note % syllables stuttered as a whole
transcription counting
count stuttered and non-stuttered; count expressions/names/ritual reduplications as one word; exclude direct quotes, serial speech (1,2,3), automatic or sung words, isolated single words (yes), unintelligible words
Yairi and iterations
2 or more iterations per 100 for CWS (3.12) vs. .19 (CWNS); CWNS virtually never have more than 2
Guitar’s suggested adult assessment questions
initial interview/small talk: history, nature of stuttering (situational?), attitudinal, wrap up
SSI-4: stuttering severity instrument
one of the most popular for calculating severity; note frequency, duration, intensity of secondaries; scoring for pre-school, school, adults; version 4 added naturalness of speech; 3 SLDs needed to diagnose stuttering condition; can also measure speaking rate in syllables/min. with reading, conversation, picture description–FDIN
OASES: overall assessment of speaker’s experience of stuttering
100 questions in 4 sections: general information, impact rating for reactions to stuttering, communication in daily situations, quality of life; mild = 1, severe = 3.75–GICQ
ASHA’s stance on EBP for stuttering
entirely empirical evidence too restrictive, so common practice also
efficacy vs. effectiveness
in a lab vs. less stringent in clinical setting
tx objectives
impact on communicative effectiveness, decrease on communicative stress, appropriate for client’s needs/desires, and everything must be done to avoid interfering with natural recovery and instead to facilitate it; who will do what to what degree of accuracy and under what conditions (John will independently apply a slow, easy speech initiation strategy on 100 utterances with 95% accuracy during spontaneous conversation with peers across 2 consecutive group sessions in tx room); include clear description of targets, feedback from you and client, and less practice per time but more days a week better for tx
two primary fluency tx approaches
fluency shaping (naturally or deliberately fluent–100% is goal, then shape to natural speech; little or no attention to fear and avoidance); stuttering modification (reduced abnormality and frequency, but not 100%)
PFS: precision fluency shaping (Hollis)
2 week residential program for 10+ y.o.: 1. full breath target (correct, natural airflow), 2. stretched syllable (KEY: slow motion speech extending duration of syllables for 2 seconds), 3. smooth transition (move slowly from syllable to syllable, flow)
PFS transfer
=learning to use targets in spite of emotionality; overlearn, practice with internal voice using key words with vowels, do NOT target anxiety bc not determinant of stuttering;
ELU: extended length of utterance (Costello Ingham)–still fluency shaping
6 steps with 50 picture cards; apply reinforcement (token) when good fluency; 20 steps: 1-6=monosyllabic to 6-syllable utterances; 7-10: 3-20 sec. monologue; 11-16: 30 sec. to 5 min. monologue; 17-20: 2-5 min. conversation; hierarchy of difficulty, with increasing demands
Guitar’s procedures (stuttering modification)
help fam. deal with emotions, reduce frequency, abnormality, negative attitudes, avoidance, improve communication skills, create fluency-friendly environment
Guitar’s advice to parents about home environment
decrease pressures, emotional and physical excitement, more relaxed, slow-paced activities, and model speaking slowly, promote child’s self-confidence–5
Guitar’s advice to parents about handling stuttering
listen patiently, repeat stuttered word stretched a bit, “say this easily again,” reinforce fluency (this was easy), show empathy (speech can be difficult)–5
indirect therapy (stuttering modification)
involve others (parents, etc.) or don’t directly treat condition: parent education, counseling, training; Guitar suggests trying indirect for 6 weeks, and then moving to direct if unsuccessful
indirect therapy: interaction therapy
deals with parental anxiety and child’s self confidence, but not stuttering; both parents is best; develop and refine constructive behaviors; parent/child support groups (UK)
