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.

This quiz covers the assessment techniques for stuttering and cluttering in speech therapy. It focuses on client history, observation methods, and analysis of signs and symptoms relevant to these speech disorders. Ideal for students and professionals in the field of speech-language pathology.