Speech Therapy: Stuttering and Cluttering Assessment

Speech Therapy - Assessment of Stuttering and Cluttering

• Stuttering Assessment:
  • Client history: Obtain written case history, conduct an interview, gather information from other professionals (signs & symptoms).
  • Contributing factors: Medical/neurological factors, family history, sex, motivation, and level of concern.
• Observation/Assessing Stuttering and Cluttering:
  • Screening: Assess speech sampling in various speaking situations (e.g., oral reading, dialogue, different audiences).
  • Speech sampling: Use representative samples (e.g., pictures, narratives, reading, syllable-by-syllable stimulus phrases) to evaluate speech in various conditions.
• Analysis of Signs and Symptoms:
  • Disfluency index: A way to quantify the ratio of stuttering to total syllables.
  • Associated motor behaviors: These indicate severity of stuttering.
  • Psychological factors: Feelings and reactions to speech (e.g., avoidance).
  • Rate of speech: Rate of speech can indicate higher or lower severity of stuttering.
• Orofacial Examination: Examination of the mouth, face, and related structures.
• Speech and Language Assessment: Evaluate speech and language skills.
• Hearing Assessment: Evaluate hearing ability.
• Determining Diagnosis of Stuttering:
  • A diagnosis of stuttering is made if one or more of the following criteria are met:
    • Total disfluency index of 10% or greater.
    • Disfluency indexes (for repetitions, prolongations, and intralexical pauses) greater than 3%.
    • Duration of disfluencies is 1 second or more.
    • Frequent incidence of part-word repetitions, whole-word repetitions, sound prolongations, silent pauses, or broken words.
    • Significant concerns of the client or parent.
  • Identify that normally developing children from 2-5 years experience periods of non-fluent speech. A diagnosis may be made if these instances cause long-term concern.
• Providing Information in a Written Report: Summarize assessment findings and recommendations.

Types of Disfluencies

• Repetition: Part-word or whole-word repetitions, as well as phrase repetitions.
• Prolongations: Sound or syllable prolongations when struggling to say a word.
• Interjections: meaningless sound/syllable or whole-word interjections.
• Silent pauses: pauses in speech when trying to finish a word or sentence.
• Broken words: silent pauses within a word.
• Incomplete phrases: grammatically incomplete phrases.
• Revisions: changing words or ideas mid-utterance.
• Disfluencies: abnormal speech instances. Some mild instances are considered normal.

Defining Stuttering

• Fluency disorder characterized by involuntary repetitions or prolongations of sounds/words.
• It develops for no apparent reason.
• More common among boys than girls.
• More common among highly sensitive children.
• Some people are genetically prone to stuttering.
• Onset commonly occurs before the age of 6, but fluency disorders may be observed in children between 2-5 years old.
• Stuttering is variable, often exhibiting fluency in some situations and disfluency in others.
• Disfluency types can be more indicative of a fluency disorder than others.
• Stuttering causes personal grief, fear, and frustration.

Disfluency Indexes

• Total disfluency index: A measure of all disfluencies.
• Individual disfluency types/percentage: Breakdown of the different forms of disfluencies observed.

Determining Diagnosis of Stuttering (additional criteria)

• Total disfluency index is 10% or greater.
• Client's disfluency index for repetitions, prolongations, and intralexical pauses is 3% or greater.
• Disfluency duration is one second or longer.
• Most prevalent disfluency types: are part-word repetitions, monosyllabic whole word repetitions, sound prolongations, silent pauses, or broken words.
• Secondary accessory behaviors are present.
• Significant degree of concern for the client, parent(s).

Accessory Behaviors

• Behaviors that develop and are reinforced in response to stuttering.
• Become habitual when speaker gains perceived success in avoiding stuttering.
• Examples include oral-facial, or motor behaviors (ex. eye blinks, facial grimaces, head/arm/leg movements).

Avoidance

• Learned in response to stimuli or specific sounds/words/topics/people/situations.
• Strategies (to avoid speaking) include:
  • Starting utterances with ease
  • Using easy words
  • Using gestures/rituals to initiate speaking.
  • Postponements (silences/pauses/elipses).
  • Using circumlocutions (substituting words).
  • Rebrials (repetitions).

Expectancy

• Anticipation of a disfluency before it occurs.
• Reaction may be stopping to speak, or avoiding speaking entirely.