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The Assessment Process with Young Speakers: Preschool and School-Age Children. CHAPTER 5. 1. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. Goals for the initial meeting Map surface features— sample Indicators of awareness Two basic decisions

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the assessment process with young speakers preschool and school age children
The Assessment Process with Young Speakers: Preschool and School-Age Children

CHAPTER5

1

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

slide2

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

2

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

the first meeting take home messages for parents
The first meeting: Take-home messages for parents
  • Demistify the phenomenon—stuttering is not a bad word
  • Decrease guilt and shame—it’s nobody’s fault
  • Explain onset and development—DC/Component models
  • Inform about the future of their child
  • Explain the treatment process
  • What they can do

3

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

most children recover
Most children recover
  • Incidence about 4–5%
  • Prevalence about 0.5–1.0%
  • Onset usually at 2–4 years (mean of 33 m.)
  • Recovery rate @ 75%–85% by age 6
  • Remission especially high first 6 months

4

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

severity of childhood stuttering the weighted sld
Severity of childhood stutteringThe weighted SLD
  • 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)

(PW + SS) x RU

5

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

the weighted sld continued
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)

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)

A weighted SLD of 4or above and associated nonspeech and psychosocial characteristics (e.g., awareness, negative attitude about communicating, struggle and escape behavior) are indicative of stuttering.

6

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

awareness anxiety
Awareness & anxiety
  • No clear differences in anxiety at outset (NFC v CWS); anxiety tends to increase over time (Yairi & Ambrose, 2005)
  • Puppet Study (Ambrose & Yairi, 1994)
  • Temperament
    • More sensitive, inhibited, and reactive
    • Inhibited with strangers, low tolerance for disfluency
    • Fertile ground where stuttering will grow?
    • A contribution to or a consequence of stuttering?

7

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

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

8

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

slide9

Anxiety increases

following onset

9

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

slide10

10

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

slide11

11

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

additional characteristics yairi ambrose 2005
Additional characteristics(Yairi & Ambrose, 2005)
  • Cognitive ability within or above normal range
  • Speech system may be less stable & more easily perturbed (slower phone production, more shimmer, limited articulatory movement)
  • Expressive language at or above norm
  • Phonological ability likely to be lower (especially following onset; may predict chronicity)

12

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

other characteristics suggested by the component model riley riley 1979 1984 2000
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%

13

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

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

14

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

table 5 1 yairi ambrose 2005
Table 5-1Yairi & Ambrose (2005)

15

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

guessing about chronicity yairi ambrose 1999 2005
Guessing about chronicity Yairi & Ambrose (1999, 2005)
  • 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 are more likely to recover if they have mild v. severe phonological scores

16

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

children likely to become fluent green flags
Children likely to become fluentGreen flags
  • Female
  • Less than three years old
  • Few relatives who stuttered
  • Relatives who did, recovered
  • May be severe at onset
  • Rapid decrease in severity
  • Fewer stuttering-like disfluencies (SLDs)
  • Normal expressive language

17

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

children likely to be chronic red flags
Children likely to be chronicRed flags
  • Male
  • Family history of persistence
  • Little or no decrease in weighted SLD by 12 months post onset
  • Phonological skills decrease after onset
  • 2–3 times more SLDs:
    • Children Who Stutter (CWS): SLD = 66%
    • Normally Fluency Children (NFC): SLD = 28%
  • Clustering of fluency breaks
  • 2+ part-word repetitions
  • Faster repetitions
  • More head & eye movements

18

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

the best estimates of chronicity yairi ambrose 2005
The best estimates of chronicity?(Yairi & Ambrose, 2005)
  • A strong family history is the single most reliable predictor of persistence and remission
  • Boys > girls
  • Decrease in SLDs first year following onset
    • A flat or inclining function suggests chronicity
  • Onset later than typical 33 months
  • Longer strings of part-word repetitions

19

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

table 5 2 yairi ambrose 2005
Table 5-2Yairi & Ambrose (2005)

20

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educational impact n ribbler 2006
Educational impact(N. Ribbler, 2006)
  • academic competency
  • academic learning
  • social-emotional
  • independent functioning
  • quality of life issues

21

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

procedures for assessing children
Procedures for assessing children
  • Decision Streams (Zebrowski-1997-revised)—Figure 5-3
  • Cooper Chronicity Prediction Checklist—Figure 5-4
  • Stuttering Prediction Instrument—Figure 5-5
  • A-19 Scale—Figure 5-6

22

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

procedures for assessing children continued
Procedures for assessing children (continued)
  • Behavior Assessment Battery (BAB)
    • Speech Situation Checklist—Emotional Reaction (SSC-ER)
    • Communication Attitude Test (CAT)
    • Speech Situation Checklist—Speech Disruption (SSC-SD)
    • Behavior Checklist (BCL)
    • KiddyCAT
    • Responsibilities of the IEP team (Ramig and Dodge, 2005)

23

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

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