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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. 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

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  1. The Assessment Process with Young Speakers: Preschool and School-Age Children CHAPTER5 1 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

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

  10. 10 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

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

  12. 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.

  13. 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.

  14. 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.

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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

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

  21. 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.

  22. 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.

  23. 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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