Fluency

Speech is fluent when words are produced easily, effortlessly, smoothly, quickly, and in a forward flow. Speech is disfluent when one word does not flow smoothly and quickly into the next (Haynes, Pindzola, pg. 189).

SYMPTOMS:

Core Behaviors of Stuttering:

  • repetitions (part-word, whole word)
  • prolongations
  • hesitations (blocks)
  • interjections

Accessory Behaviors (secondary behaviors)

  • struggle reactions (visible struggle as they try to get a sound out)
  • irrelevant sounds and movements (movements unrelated to the words- i.e. foot stomping; extra sounds as a part of the word)

Covert Behaviors

  • negative emotions and self-image
  • fear
  • avoidance

ASSESSMENT:

Assessment Areas

  • speech, language, hearing
  • home environment
  • description of stuttering behaviors
  • classroom demands
  • overt behavior features of speech disfluency
  • covert struggle features

Interview Questions

  • When did the client begin exhibiting disfluencies?
  • What were the circumstances under which the disfluencies were noted?
  • How long has the client been exhibiting the disfluencies?
  • What changes have been noted in the frequency or form of the disfluencies?
  • What factors seem to increase or decrease the client’s disfluency?
  • In what ways has the family tried to help the client?
  • What is the client’s reaction to the family’s efforts to help?

Formal Tests

  • Stuttering Severity Instrument for Children and Adults (SSI-4)
  • A Protocol for Differentiating the Incipient Stutterer
  • A Stuttering Chronicity Prediction Checklist
  • Assessment of Child’s Experience of Stuttering (ACES)
  • Stuttering Attitudes Checklist
  • Speech-Related Anxiety Questionnaire

Alternative Assessment Measures

  • behavioral observations
  • observe client in natural settings (school, home, etc.)
  • language sample (play, reading, conversation)

Initial Treatment Goals

  • The client will demonstrate the ability to reduce physical tension during stuttering using the “pull-out” technique, for 70% of the disfluencies during conversational situations.
  • The client will decrease avoidance behaviors associated with his/her stuttering by entering 3 specific situations where he/she previously avoided because of stuttering.

CLIENT & FAMILY EDUCATION:

  • http://www.cincinnatichildrens.org/health/s/stuttering/
    • This site defines fluency disorders, or stuttering. The cite provides information about the possible causes of stuttering, common characteristics, and what treatment for stuttering looks like. It also provides information for parents on how to help their child you stutters.
  • http://stavishclan.com/2013/01/what-every-parent-should-know-about-stuttering.html
    • This blog provides parents information about stuttering. It describes normal disfluencies that are seen in most children, but it also addresses abnormal disfluencies that children may experience. The blog outlines some potential risk factors. The page also provides additional resources for parents.
  • Raz, M.G. (2014). Preschool stuttering: what parents can do. Gertenweitz Publishing
    • This book provides a framework for parents to understand stuttering. It provides charts, strategies, and tips for parents to utilize. The book include’s “dos and dont’s” for parents to use in everyday life with their children. Areas addressed in the book include: understanding stuttering, viewpoints and reactions, stuttering and emotions, different environments, events, and people, professional help, and questions and answers.

PROFESSIONAL MATERIALS & RESOURCES:

  • Wall, M.J. & Myers, F.L. (1995). Clinical management of childhood stuttering. (2nd ed.). Austin, TX: PRO-ED, Inc.
    • This text includes theories of the causes of stuttering. It provides the symptoms, psycholinguistics, psychosocial, and physiological aspects of childhood stuttering. Ideas for assessment and therapy are also included.
  • Reardon-Reeves, N. & Yaruss, S.J. (2004). School-age stuttering therapy: a practical guide. Austin, TX: LinguiSystems.
    • This text teaches SLPs to successfully work with school-age children and adolescents who stutter. The information provided includes practical knowledge for the intervention process, including the assessment, treatment, and follow-up.
  • Reitzes, P. (2006) 50 great activities for children who stutter: lessons, insights, and ideas for therapy success.  Austin, TX: PRO ED. Inc
    • The text is a manual for SLPs working with school-age children who stutter. The book includes activities that are divided into five categories: identifying and exploring stuttering, practicing speech tools, learning the facts, uncovering feelings, targeting language and stuttering goals. It also includes basic information about stuttering and tools needed for successful therapy.

REFERENCES:

Haynes, W. O., & Pindzola, R. H. (2012). Diagnostics and evaluation in speech pathology (8th ed., pp 215-237). Pearson.

(1997–2014) American Speech-Language-Hearing Association (ASHA)

SPAUD 501: Diagnostics notes; Heather Koole (Calvin College)

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