The Assessment Process with Young Speakers: Preschool and School-Age Children CHAPTER 5 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 1

Goals for the initial meeting Map surface features— sample Indicators of awareness Two basic decisions Chronicity v. Recovery Eliciting fluency breaks Related problems Assessment Measures Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 2

The first meeting: Take-home messages for parents Demistify the phenomenon—stuttering is not a bad word Demistify the phenomenon—stuttering is not a bad word Decrease guilt and shame—it’s nobody’s fault Decrease guilt and shame—it’s nobody’s fault Explain onset and development—DC/Component models Explain onset and development—DC/Component models Inform about the future of their child Inform about the future of their child Explain the treatment process Explain the treatment process What they can do What they can do Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 3

Most children recover Incidence about 4 – 5% Incidence about 4 – 5% Prevalence about 0.5 – 1.0% Prevalence about 0.5 – 1.0% Onset usually at 2 – 4 years (mean of 33 m.) Onset usually at 2 – 4 years (mean of 33 m.) Recovery 75% – 85% by age 6 Recovery 75% – 85% by age 6 Remission especially high first 6 months Remission especially high first 6 months Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 4

Severity of childhood stuttering The weighted SLD Add together the number of part-word and single- syllable word repetitions per 100 syllables (PW + SS) Add together the number of part-word and single- syllable word repetitions per 100 syllables (PW + SS) Multiply that sum by the mean number of repetition units (RU) (Repetition units are the number of times a sound, syllable, or word is repeated prior to saying the word, divided by the number of words where this occurred.) (RU/n) Multiply that sum by the mean number of repetition units (RU) (Repetition units are the number of times a sound, syllable, or word is repeated prior to saying the word, divided by the number of words where this occurred.) (RU/n) (PW + SS) x RU Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 5

The weighted SLD (continued) Add to the above total twice the number of disrhythmic phonations (DP, blocks and prolongations) per 100 syllables (2 x DP) Add to the above total twice the number of disrhythmic phonations (DP, blocks and prolongations) per 100 syllables (2 x DP) Disrhythmic phonations are absent or rare in fluent speakers and are a strong indicator of stuttering. The resulting formula is [(PW + SS) x RU] + (2 x DP) [(PW + SS) x RU] + (2 x DP) A weighted SLD of 4 or above and associated nonspeech and psychosocial characteristics (e.g., awareness, negative attitude about communicating, struggle and escape behavior) are indicative of stuttering. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 6

Awareness & anxiety No clear differences in anxiety at outset (NFC v CWS); anxiety tends to increase over time (Yairi & Ambrose, 2005) No clear differences in anxiety at outset (NFC v CWS); anxiety tends to increase over time (Yairi & Ambrose, 2005) Puppet Study (Ambrose & Yairi, 1994) Puppet Study (Ambrose & Yairi, 1994) Temperament Temperament More sensitive, inhibited, and reactiveMore sensitive, inhibited, and reactive Inhibited with strangers, low tolerance for disfluencyInhibited with strangers, low tolerance for disfluency Fertile ground where stuttering will grow?Fertile ground where stuttering will grow? A contribution to or a consequence of stuttering?A contribution to or a consequence of stuttering? Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 7

Awareness & anxiety (continued) Head and eye movements (Conture and Kelly, 1991 ) Head and eye movements (Conture and Kelly, 1991 ) Pitch rise, schwa substitutions, fear, avoidance behaviors, decreased speaking—electively mute Pitch rise, schwa substitutions, fear, avoidance behaviors, decreased speaking—electively mute Results with KiddyCAT (Vanryckeghem, Brutten, & Herandez, 2005; Behavior Assessment Battery (BAB) Results with KiddyCAT (Vanryckeghem, Brutten, & Herandez, 2005; Behavior Assessment Battery (BAB) CWS = 4.36 v. NFC − 1.79CWS = 4.36 v. NFC − 1.79 Using projective drawings (DeVore, Nandur, & Manning, 1984) Using projective drawings (DeVore, Nandur, & Manning, 1984) smaller drawings, lower-left quadrant pre-txsmaller drawings, lower-left quadrant pre-tx Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 8

Anxiety increases following onset Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 9

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Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 11

Additional characteristics (Yairi & Ambrose, 2005) Cognitive ability within or above normal range Cognitive ability within or above normal range Speech system may be less stable & more easily perturbed (slower phone production, more shimmer, limited articulatory movement) Speech system may be less stable & more easily perturbed (slower phone production, more shimmer, limited articulatory movement) Expressive language at or above norm Expressive language at or above norm Phonological ability likely to be lower (especially following onset; may predict chronicity) Phonological ability likely to be lower (especially following onset; may predict chronicity) Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 12

Other characteristics suggested by the component model (Riley & Riley, 1979, 1984, 2000) Physical Attributes Attending Disorders: 36% (moderate & severe) Speech Motor Coordination: 68% Temperamental Factors High Self-Expectations: 70% Overly Sensitive: 73% Listener Reactions Disruptive Communication Environment: 61% occurrence Secondary Gains: 35% Teasing/bullying: 31% Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 13

Summary of stuttering signs Occurrence of stuttering in nuclear or extended family * Occurrence of stuttering in nuclear or extended family * Parents identify child as stuttering Parents identify child as stuttering Weighted SLD score of 4 or greater Weighted SLD score of 4 or greater SLDs increase when communicating under pressure SLDs increase when communicating under pressure SLDs accompanied by tense movements of head, face, & neck SLDs accompanied by tense movements of head, face, & neck Behavioral or formal indicators of negative psychosocial reactions to stuttering Behavioral or formal indicators of negative psychosocial reactions to stuttering The child self-restricts communication and social interaction The child self-restricts communication and social interaction The child is easily upset by changes in routine or inhibited with strangers The child is easily upset by changes in routine or inhibited with strangers Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 14

Table 5-1 Yairi & Ambrose (2005) Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 15

Guessing about chronicity Yairi & Ambrose (1999, 2005) Recovery and persistency are inherited. Recovery and persistency are inherited. Children who stutter and have a familial history of chronic stuttering would tend to follow that same pattern, whereas children who stutter but have a familial history of recovery would tend to follow that pattern.Children who stutter and have a familial history of chronic stuttering would tend to follow that same pattern, whereas children who stutter but have a familial history of recovery would tend to follow that pattern. Children who stutter are more likely to recover if they have mild v. severe phonological scores Children who stutter are more likely to recover if they have mild v. severe phonological scores Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 16

Children likely to become fluent Green flags Female Female Less than three years old Less than three years old Few relatives who stuttered Few relatives who stuttered Relatives who did, recovered Relatives who did, recovered May be severe at onset May be severe at onset Rapid decrease in severity Rapid decrease in severity Fewer stuttering-like disfluencies (SLDs) Fewer stuttering-like disfluencies (SLDs) Normal expressive language Normal expressive language Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 17

Children likely to be chronic Red flags Male Male Family history of persistence Family history of persistence Little or no decrease in weighted SLD by 12 months post onset Little or no decrease in weighted SLD by 12 months post onset Phonological skills decrease after onset Phonological skills decrease after onset 2–3 times more SLDs: 2–3 times more SLDs: Children Who Stutter (CWS): SLD = 66%Children Who Stutter (CWS): SLD = 66% Normally Fluency Children (NFC): SLD = 28%Normally Fluency Children (NFC): SLD = 28% Clustering of fluency breaks Clustering of fluency breaks 2+ part-word repetitions 2+ part-word repetitions Faster repetitions Faster repetitions More head & eye movements More head & eye movements Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 18

The best estimates of chronicity? (Yairi & Ambrose, 2005) A strong family history is the single most reliable predictor of persistence and remission A strong family history is the single most reliable predictor of persistence and remission Boys > girls Boys > girls Decrease in SLDs first year following onset Decrease in SLDs first year following onset A flat or inclining function suggests chronicityA flat or inclining function suggests chronicity Onset later than typical 33 months Onset later than typical 33 months Longer strings of part-word repetitions Longer strings of part-word repetitions Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 19

Table 5-2 Yairi & Ambrose (2005) Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 20

Educational impact (N. Ribbler, 2006) academic competency academic competency academic learning academic learning social-emotional social-emotional independent functioning independent functioning quality of life issues quality of life issues Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 21

Procedures for assessing children Decision Streams (Zebrowski-1997-revised)—Figure 5-3 Decision Streams (Zebrowski-1997-revised)—Figure 5-3 Cooper Chronicity Prediction Checklist—Figure 5-4 Cooper Chronicity Prediction Checklist—Figure 5-4 Stuttering Prediction Instrument—Figure 5-5 Stuttering Prediction Instrument—Figure 5-5 A-19 Scale—Figure 5-6 A-19 Scale—Figure 5-6 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 22

Procedures for assessing children (continued) Behavior Assessment Battery (BAB) Behavior Assessment Battery (BAB) Speech Situation Checklist—Emotional Reaction (SSC- ER)Speech Situation Checklist—Emotional Reaction (SSC- ER) Communication Attitude Test (CAT)Communication Attitude Test (CAT) Speech Situation Checklist—Speech Disruption (SSC-SD)Speech Situation Checklist—Speech Disruption (SSC-SD) Behavior Checklist (BCL)Behavior Checklist (BCL) KiddyCATKiddyCAT Responsibilities of the IEP team (Ramig and Dodge, 2005) Responsibilities of the IEP team (Ramig and Dodge, 2005) Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 23