Assessment of Adolescents & Adults
Describe the role of anticipation and variability in evaluation.
Adult stutterers are adept at anticipating stuttering events -- have a multitude of strategies to disguise or hide a stuttering event.
Adolescents and adults are highly variable in how they stutter (across individuals) and when they stutter (within individuals, context plays a role). Hard to characterize the stuttering upon initial meeting.
What are the 5 stages of Stuttering Modification?
1. Identification
2. Desensitization
3. Variation
4. Modification
5. Stabilization
What are the two primary goals of assessment for preschoolers who stutter?
1. Determine if it is actually stuttering
2. Determine if the child will recover or persist
Describe the difference between indirect and direct intervention approaches.
Indirect approaches target the environment. Direct approaches target the speech behaviors.
Describe the Stages of Change Model.
2. Contemplation
3. Preparation/Determination
4. Action
5. Maintenance
Describe technical vs. adaptive challenges.
Technical challenges: overt stuttering
Adaptive challenges: covert stuttering
What is the goal of Fluency Shaping?
100% fluency
What does the Puppet Study tell us about CWS vs. CWNS?
CWS identify with the puppet that stutters. CWS and CWNS judge the puppet that stutters more negatively.
Children are aware of stuttering and hold specific attitudes about it.
Why is preschool treatment different from adolescent/adult treatment?
Role of the parent and other adults in the therapeutic process; possibility of natural recovery; issue of awareness
What are the "Common Factors" that are necessary and sufficient for therapeutic change?
1. Therapeutic alliance
2. A therapy environment in which the client feels safe and comfortable confiding in the clinician.
3. A clinician who provides a psychologically derived and culturally appropriate approach to therapy.
4. An explanation of the problem and treatment approach that is viable and believable, and is accepted by the client.
5. A set of procedures that leads the client to positive, helpful, or adaptive outcomes.
What are the components of adolescent and adult assessment?
1. Case History
2. Diagnostic Interview
3. Adaptive Measures
4. Technical Measures
5. Closing Interview
What is the primary difference between Stuttering Modification and Fluency Shaping?
Stuttering modification addresses both technical and adaptive challenges, while fluency shaping addresses only the technical.
What does the KiddyCAT assessment tell us about CWS?
CWS are aware of stuttering and hold specific attitudes about speaking.
What does the diagnosogenic theory posit?
Define cluttering.
A fluency disorder wherein segments of a conversation in the speakers native language are typically perceived as too fast overall, too irregular, or both. The segments of rapid and/or irregular speech must further be accompanied by one or more of the following: excessive "normal" disfluencies, excessive collapsing or deletion of syllables, and/or abnormal pauses, syllable stress, or speech rhythm.
What is the primary goal of assessment?
Prioritizing impact, not frequency
Briefly describe Johnson's view of stuttering (1961).
Stuttering = what the speaker does to avoid it (accessories)
What are the components of an evaluation for preschoolers who stutter?
1. Case History
2. Brief Parent Interview
3. Observe child/caregiver interactions
4. Assess overt stuttering behaviors
5. Assess covert stuttering behaviors
6. Screen for other speech and language areas as necessary
7. Risk factor analysis (green vs. red flags and decision streams)
No one approach is better than another -- has to be tailored to the individual.
There is always a possibility of natural recovery.
Describe 3 key differences between psychogenic and neurogenic stuttering.
1. Psychogenic stuttering develops are an acceptable solution to an unacceptable problem, while neurogenic stuttering develops because of something that happened (TBI, stroke, drug use, etc.)
2. Different concomitants: psychogenic stuttering can occur with neurologic disease, while neurogenic stuttering can occur with aphasia, apraxia, etc.
3. Neurogenic stuttering does not respond to fluency-inducing conditions, while psychogenic stuttering may respond to these conditions.
What do the SSI-IV and OASES tell us in assessment?
Severity and impact
Briefly describe Williams' view of stuttering (1957).
Stuttering is a learned behavior.
Name 3 green flags and 3 red flags.
Green flags: female, no family history, slower rate of repetitions
Red flags: male, family history of persistence, stable or increasing pattern of SLDs within 1 year of onset
Why might one consider preschool stuttering therapy controversial?
There is no sufficient evidence that preschool stuttering treatment has an impact.
Describe 3 key differences between stuttering and cluttering.
1. Stutterers know what they want to say; clutterers don't always know all of what they want to say but say it anyway.
2. Clutterers do not exhibit SLDs (unless they also stutter).
3. Stuttering features awareness; cluttering does not.