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

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

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

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

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

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

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

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

• 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

• 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

• 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

• 4. Consider Clinician Quantification Issue– quantification is variable

• clinician judgements form the basis of several quantitative measures

• issues of frequency, typography and severity measures

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

End of Lecture Notes