Evaluation

1. Evaluation • Purposes of an evaluation • determine if a problem exists • determine the cause, if possible • determine the need for treatment • determine the course of treatment

2. Stuttering Evaluation Considers Dysfluent Behavior and Language • Stuttering Evaluation is divided into • 1. Eliminating other communication factors, such as language and motor speech • 2. Specifying OVERT characteristics • visible behaviors stutterer displays • measurable • pre-post measure • 3. Specifying COVERT characteristics • attitudes • anxieties • belief system

3. Evaluation Considerations • In clinic • 1. Clinician-client sample • 3 modes • other language tasks • varying listener (your) reaction • 2. Child-parent • playing • construction task not seen before • narrative task

4. Out of Clinic • Out of Clinic • most critical measure, besides parent-child • baseline for transfer and maintenance • various locations • school settings such as classroom, bus, lunchroom • shopping • walk around and sit outside • talking with others • at home • with parents • with siblings • friends

5. Evaluating the Young Child • Article: Onslow, M., “Identification of Early Stuttering: Issues and Suggested Strategies.” 1992, AJSLP • consensus that stuttering should be treated when it first appears • effective early identification would enable clinicians to monitor very young children at risk for developing stuttering

6. Gordon, P & Luper H, 1992. The Early Identification of Beginning Stuttering II: Problems AJSLP, September • Protocols differ in the number, type of speech and non-speech criteria • All use frequency and/or % criteria • Differences in weighting of the criteria • Lack of agreement on which behaviors are crucial and what amount of dysfluency should be given categorical label of stuttering • variation creates clinician uncertainty

7. Gordon and Luper continued, #2 • Difficulties in using behavioral signs as a basis for categorical markers • clinician assigns to 1 of 3 categories: stutterer, nonstutterer, potential stutterer • problem • overlaps in classification • subjective • weighting of continues variables clinician attempts to evaluate • need to look for • 1. need to look for predominant type • 2. overall frequency and proportion of types remain distinguishing characteristic • 3. degree of effort • 4. reaction to dysfluency

8. Gordon and Lure continued, #2 • Van Riper in 1982 stated: • When stuttering behaviors occur frequently and are severe, the clinician has little difficulty in recognizing that a disorder exists. More advanced stutterers, by their struggle or avoidance reactions and emotionality, show that they have a serious fluency problem. However, in young children, the differential diagnosis is more difficult

9. Possible solutions • 1. Decrease the possibility of diagnostic errors • PROBLEM: CHILD INCORRECTLY DIAGNOSED AS HAVING NORMAL DYSFLUENCIES • Solutions • continued monitoring • enroll in short-term diagnostic treatment • individualized treatment for all

10. 2. Role of Spontaneous Recovery • rate of spontaneous recovery: 40%-80% • problem: rate is exaggerated • research by Curlee, Ingam, Martin & Lindammod in the ‘80’s

11. 3. Consider importance of Language Sample • need standardization of sample size • range: Riley’s 100 word to Miller & Cahpman’s 100 utterances • # of settings • Always include home or parents in sample

12. 4. Consider Clinician Quantification Issue • quantification is variable • clinician judgements form the basis of several quantitative measures • issues of frequency, typography and severity measures

13. Article Summary • Early detection provides an opportunity for early treatment • Early treatment holds a promise of preventing the young incipient stutterers from having to undergo many distressful experiences

14. End of Lecture Notes