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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 l.jpg
The Assessment Process with Young Speakers: Preschool and School-Age Children

CHAPTER5

1

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


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  • Goals for the initial meeting School-Age Children

  • 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.


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The first meeting: School-Age ChildrenTake-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.


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Most children recover School-Age Children

  • 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.


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Severity of childhood stuttering School-Age ChildrenThe 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.


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The weighted SLD School-Age Children(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.


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Awareness & anxiety School-Age Children

  • 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.


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Awareness & anxiety (continued) School-Age Children

  • 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.


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Anxiety increases School-Age Children

following onset

9

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


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10 School-Age Children

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


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11 School-Age Children

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


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Additional characteristics School-Age Children(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.


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Other characteristics suggested by the component model School-Age Children(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.


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Summary of stuttering signs School-Age Children

  • 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.


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Table 5-1 School-Age ChildrenYairi & Ambrose (2005)

15

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


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Guessing about chronicity School-Age Children 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.


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Children likely to become fluent School-Age ChildrenGreen 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.


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Children likely to be chronic School-Age ChildrenRed 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.


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The School-Age Childrenbest 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.


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Table 5-2 School-Age ChildrenYairi & Ambrose (2005)

20

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


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Educational impact School-Age Children(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.


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Procedures for assessing children School-Age 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.


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Procedures for assessing children (continued) School-Age Children

  • 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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