ASSESSMENT. ASHA Guidelines: Assessment Goals (p. 524 Shapiro) 1. Obtain a speech sample that is as representative as possible of the client’s speech

ASSESSMENTASSESSMENT

ASHA Guidelines: ASHA Guidelines: Assessment Goals Assessment Goals

(p. 524 Shapiro)(p. 524 Shapiro) 1. Obtain a speech sample that is as 1. Obtain a speech sample that is as

representative as possible of the representative as possible of the client’s speech in everyday use.client’s speech in everyday use.

Obtain a sample of the client’s Obtain a sample of the client’s speech under circumstances that are speech under circumstances that are constant from one client to anotherconstant from one client to another

Generate, from obtained speech Generate, from obtained speech samples & incidental observations, samples & incidental observations, quantitative & qualitative (and quantitative & qualitative (and accurate) descriptions of the client’s accurate) descriptions of the client’s fluent & disfluent speech behaviors fluent & disfluent speech behaviors that can be related where applicable that can be related where applicable to vocal tract physiology, and that to vocal tract physiology, and that are communicable to other are communicable to other interested professionals.interested professionals.

ASHA Guidelines: ASHA Guidelines: Assessment GoalsAssessment Goals

Obtain information about variables Obtain information about variables that affect client’s fluency level and that affect client’s fluency level and apply this to treatment planning.apply this to treatment planning.


Obtain information about person’s Obtain information about person’s early social, physical and behavioral early social, physical and behavioral and speech development, including and speech development, including information about variables that information about variables that might be related to the origin of the might be related to the origin of the disorder or it’s course of disorder or it’s course of development, and apply this development, and apply this information to treatment planning.information to treatment planning.


Obtain information about variables Obtain information about variables that might influence clinical outcome that might influence clinical outcome and/or the prognosis for treatment and/or the prognosis for treatment and apply this to treatment planning.and apply this to treatment planning.


Obtain information about other communicative problems Obtain information about other communicative problems or disorders that may not be related to fluency.or disorders that may not be related to fluency.

Generate descriptions of the results of assessment that Generate descriptions of the results of assessment that are communicable to other professional and lay persons.are communicable to other professional and lay persons.


ASHA: Clinician ASHA: Clinician competencies related to competencies related to

assessmentassessment Can differentiate between a child’s normally Can differentiate between a child’s normally

disfluent speech, language based disfluency, disfluent speech, language based disfluency, the speech of a child who has already begun the speech of a child who has already begun to stutter.to stutter.

Can distinguish cluttered from stuttered Can distinguish cluttered from stuttered speech and understands the potential speech and understands the potential relationship between these 2 disorders.relationship between these 2 disorders.

Can relate the findings of language, Can relate the findings of language, articulation, voice and hearing tests to the articulation, voice and hearing tests to the development of stuttering.development of stuttering.

Can obtain a thorough case history from Can obtain a thorough case history from an adult client or the family of a child an adult client or the family of a child client.client.


assessmentassessment

Can obtain a useful speech sample Can obtain a useful speech sample and evaluate it for stuttering severity and evaluate it for stuttering severity both informally by subjective both informally by subjective impression and formally by calculating impression and formally by calculating relevant measures such as the relevant measures such as the frequency of dysfluency, duration of frequency of dysfluency, duration of dysfluency, speaking rate.dysfluency, speaking rate.



Is familiar with the available Is familiar with the available diagnostic tests for stuttering that diagnostic tests for stuttering that serve to objectify aspects of the serve to objectify aspects of the client’s communication pattern client’s communication pattern (secondary features, avoidance (secondary features, avoidance patterns, attitudes, etc. ) that may patterns, attitudes, etc. ) that may not be readily observed.not be readily observed.



Is able to identify & measure, Is able to identify & measure, where feasible, environmental where feasible, environmental variables that may be related to variables that may be related to the onset, development & the onset, development & maintenance of stuttering and to maintenance of stuttering and to fluctuations in the severity of fluctuations in the severity of stuttering.stuttering.



Can identify dysfluencies by type Can identify dysfluencies by type and, in addition, can describe and, in addition, can describe qualitatively the fluency of a qualitatively the fluency of a person’s speech.person’s speech.



Can relate to the extent possible Can relate to the extent possible what stuttered speech sounds like what stuttered speech sounds like to the vocal tract behavior that is to the vocal tract behavior that is producing itproducing it



Can, in appropriate consultation with Can, in appropriate consultation with the client or parents, construct a the client or parents, construct a treatment program, based on the treatment program, based on the results of comprehensive testing, on results of comprehensive testing, on the client’s personal emotional and the client’s personal emotional and attitudinal development, and on past attitudinal development, and on past treatment history that fits the unique treatment history that fits the unique needs of each client’s disorders.needs of each client’s disorders.



Can administer predetermined Can administer predetermined programs in a diagnostic way so programs in a diagnostic way so that decisions with regard to that decisions with regard to branching and repeating of parts branching and repeating of parts of the program reflects the unique of the program reflects the unique needs of each client’s disorder(s).needs of each client’s disorder(s).



Can explain clearly to clients or their Can explain clearly to clients or their families/significant others what treatment families/significant others what treatment options, including the various types of options, including the various types of speech treatment, medication, devices speech treatment, medication, devices self-help groups, and other forms of self-help groups, and other forms of treatment are available, why they may or treatment are available, why they may or may not be appropriate to a specific case, may not be appropriate to a specific case, and what outcomes can be expected and what outcomes can be expected from each, based on knowledge of the from each, based on knowledge of the available literature.available literature.



Diagnosis of Diagnosis of Stuttering in Stuttering in

ChildrenChildren

Goals of the Goals of the Assessment ProcessAssessment Process

1. Assess child’s capacities for 1. Assess child’s capacities for fluencyfluency

2. Identify potential demands on 2. Identify potential demands on child’s capacities for fluencychild’s capacities for fluency

3. Assess child’s response to 3. Assess child’s response to fluency enhancement and fluency enhancement and disruptions.disruptions.

4. Assess needs of family and of 4. Assess needs of family and of school personnelschool personnel

5. Assess child’s awareness of, 5. Assess child’s awareness of, response to, attitude towards fluency response to, attitude towards fluency problemsproblems

Goals of the Assessment Goals of the Assessment ProcessProcess

Steps in Steps in assessment assessment

processprocess Prior to evaluationPrior to evaluation

– Telephone contactTelephone contact

– Send forms homeSend forms home

– Schedule evaluationSchedule evaluation

– Family/teacher interviewsFamily/teacher interviews

Case History/Parent Case History/Parent InterviewInterview

Give the parents an opportunity to Give the parents an opportunity to voice their worries/concernsvoice their worries/concerns

Issues most commonly reportedIssues most commonly reported

Helpful informationHelpful information

How parent perceives dysfluencyHow parent perceives dysfluency How parent reacts/handles How parent reacts/handles

dysfluencydysfluency Family home profile/child’s behavior Family home profile/child’s behavior

at homeat home

EvaluationEvaluation A. Collect speech & interaction A. Collect speech & interaction

samplesample B. direct manipulation of child’s B. direct manipulation of child’s

fluencyfluency C. Additional testingC. Additional testing D. Family/teacher feedbackD. Family/teacher feedback

Analyze fluency, language, Analyze fluency, language, interaction behaviors of interaction behaviors of significant adults in child’s life. significant adults in child’s life. a. Continuity and speech ratea. Continuity and speech rate

measures. measures. b. MLU/TTR.b. MLU/TTR.c. Syntactic complexity measurec. Syntactic complexity measure

performance.performance.

EvaluationEvaluation

Analyze fluency, language, interaction behaviors Analyze fluency, language, interaction behaviors

of significant adults in child’s life.of significant adults in child’s life.

d. Number and nature of d. Number and nature of questions.questions.

e. Topic initiations and changes.e. Topic initiations and changes.

f. Interruptions/talking timef. Interruptions/talking time

overlap.overlap.


g. Request for verbal performance.g. Request for verbal performance.

h. Amount of time significanth. Amount of time significant others spend talking vs. amountothers spend talking vs. amount of time child spends talking.of time child spends talking.

i. Ability to structure and i. Ability to structure and

participate in child’s play.participate in child’s play.


Analyze fluency, language, interaction behaviors of significant Analyze fluency, language, interaction behaviors of significant

adults in child’s life.adults in child’s life.

j. Verbal/nonverbal reactions toj. Verbal/nonverbal reactions to child’s speech and stuttering.child’s speech and stuttering.k. Behavior management style.k. Behavior management style.l. Level of acceptance of child’sl. Level of acceptance of child’s behavior and choices.behavior and choices.




m. Positive and negative commentsm. Positive and negative comments

made to the child.made to the child.

n. Characteristics and quality ofn. Characteristics and quality of

sibling interactions.sibling interactions.




D. Analyzing the child’s fluency D. Analyzing the child’s fluency samplesample

1. Measures of Fluent Speech1. Measures of Fluent Speech

a) continuity of speecha) continuity of speech

b) ease of speechb) ease of speech

c) ratec) rate

Direct manipulation Direct manipulation of child’s fluencyof child’s fluency

Utilize fluency enhancement methods Utilize fluency enhancement methods during play (interrupt,talk fast, etc)during play (interrupt,talk fast, etc)

Manipulate variables suspected to be Manipulate variables suspected to be demandingdemanding

Explore child’s awareness of and Explore child’s awareness of and reaction to stuttering/reaction to stuttering/

speakingspeaking

– Hearing acuityHearing acuity– Fine motor skillsFine motor skills– Cognitive developmentCognitive development– Social-emotional developmentSocial-emotional development

–Voice productionVoice production

Assessing Child/Environment MatchAssessing Child/Environment Match– compare child’s capacity levels compare child’s capacity levels

with adult models*with adult models* relative speech raterelative speech rate relative MLU/TTR measuresrelative MLU/TTR measures relative syntactic complexity relative syntactic complexity measuremeasure

relative talking timerelative talking time relative topic initiation measurerelative topic initiation measure

Evaluate child’s response to Evaluate child’s response to environmental variableenvironmental variable

– reactions to levels of structure & reactions to levels of structure & disciplinediscipline

– reactions to demands on linguistic reactions to demands on linguistic abilitiesabilities

– reactions to demands on speech, reactions to demands on speech, articulatory abilitiesarticulatory abilities

Evaluate child’s response to Evaluate child’s response to environmental variablesenvironmental variables

– reactions to dysfluency & listener reactions to dysfluency & listener

reactionsreactions– reactions to expectations of reactions to expectations of

performanceperformance

Summary WheelSummary Wheel

Feedback Feedback sessionsession

Describe the child’s speech and language Describe the child’s speech and language skillsskills

Summarize the theory of capacity and Summarize the theory of capacity and demands and discuss where demands are demands and discuss where demands are placed on the child which may affect placed on the child which may affect speech fluency.speech fluency.

Discuss when the child is likely to be Discuss when the child is likely to be fluent/disfluentfluent/disfluent

Identify short-term strategiesIdentify short-term strategies Provide practical, easily applied Provide practical, easily applied

suggestionssuggestions Answer questionsAnswer questions Give a prognosis based on treatment Give a prognosis based on treatment

and support availableand support available Offer appropriate reading materialOffer appropriate reading material

Feedback Feedback sessionsession

Making the Making the diagnosis:diagnosis:

Is it stuttering?Is it stuttering? Must integrate all information and Must integrate all information and

answer 3 questions:answer 3 questions: is stuttering the problem?is stuttering the problem? if so, what should be done?if so, what should be done? if something is done, what is the if something is done, what is the

prognosis?prognosis?

1. Is stuttering 1. Is stuttering the problem? the problem?

Draw conclusionsDraw conclusions If fluency is not age-appropriate, If fluency is not age-appropriate,

make a differential diagnosismake a differential diagnosis If the disfluencies are If the disfluencies are

developmental, decide if it’s developmental, decide if it’s -borderline (counseling or monitoring)-borderline (counseling or monitoring)-stuttering (direct therapy)-stuttering (direct therapy)

Handout: Normal Handout: Normal Nonfluency vs. Nonfluency vs.

StutteringStuttering

Computer Computer technology technology

assessment updateassessment update The Computerized Scoring of the The Computerized Scoring of the

Stuttering SeverityStuttering Severity Bakker and Riley (1997), Pro-Ed PublishersBakker and Riley (1997), Pro-Ed Publishers

CASS-C Cooper Assessment for CASS-C Cooper Assessment for Stuttering Syndromes (Children’s Stuttering Syndromes (Children’s Version)Version)

Cooper and Cooper, The Psychological Corp Cooper and Cooper, The Psychological Corp (1996)(1996)

A programmed protocol that enables the A programmed protocol that enables the SLP to complete fluency assessments of SLP to complete fluency assessments of children while simultaneously preparing children while simultaneously preparing an assessment report and analysis.an assessment report and analysis.

Computer technology Computer technology assessment updateassessment update

Stuttering Stuttering Measurement Measurement

TrainingTrainingJ. Costello InghamJ. Costello Ingham

Roger InghamRoger Ingham

Stuttering Stuttering Measurement Measurement

ModuleModuleRichard a. MogliaRichard a. Moglia

Childhood Childhood Stuttering: A Stuttering: A

Second OpinionSecond OpinionE. G. ContureE. G. Conture

J. Scott YarussJ. Scott Yaruss

Creative Productions of OhioDr. Anthony Caruso

Speech RateSpeech Rate

Common Sense About Common Sense About StutteringStuttering

ID StutteringID Stuttering

Documents

ASSESSMENT. ASHA Guidelines: Assessment Goals (p. 524 Shapiro) 1. Obtain a speech sample that is as representative as possible of the client’s speech