stammering assessment

1. ST
AMMERINGASSESSMENT&
MANAGEMENT
Presented by
Ms. Fouzia Saleemi
SpeechLanguage P
athologist
/Pediatric Psychologist
B.S(BioMedicals)
M.Phil. (SpeechLanguage P
athology)
M.A (Special Ed), ABS(T
rainer), B
.ED
,
PGD (SL
T)

2. OBJEC
T
IV
E
1. Introduction of Stammering
2
. T
ypesof Stammering
3. Phase of Stammering
4. Informal and formal Assessment
5. Portfolio/Griding
6. Management

3. IN
T
R
ODU
C
T
IONOFST
AMMER
IN
G
 Stammering is a neurological
condition that makes it
physically hard to speak.
Someone who stammers will
repeat, prolong or get stuck
on sounds or words. There
might also be signs of visible
tension as the person
struggles to get the word out.

4.  Stuttering — also called
stammering or childhood-onset
fluency disorder — is a
speech disorder that involves
frequent and significant
problems with normal fluency
and flow of speech.

5. DIFFERENCEB
E
T
W
E
E
NSTUTTERINGAND
ST
AMMERING
The Difference between Stuttering and
Stammering is like a funny English in
which two different words represent the
same meaning like football also known
as soccer.

6. SYMPT
OMS
Stuttering signs and symptomsmay include:
Difficulty starting a word, phrase or sentence
Prolonging a word or sounds within a word
R
epetition of a sound, syllable or word
Brief silence for certain syllables or words, or pauses within a word (broken
word)
Addition of extra words suchas "um" if difficulty moving to the next word is
anticipated
Excess tension, tightness, or movement of the face or upper body to produce
a word
Anxiety about talking
Limited ability to effectively communicate

8. A. Etiology-Focused Classification
Developmental Disorder of Fluency:
🢝
Emergesinearly childhood (2-5 years) and usually at theage of 30 mons.It is
diagnosed if the symptoms consisted for 6mons.
🢝
Characterized by stuttering-like dysfluencies (SLDs): part- and single-syllable word
repetitions, prolongations, and blocks
Acquired Disorder of Fluency:
🢝
Dramaticonsetanytimeinlifespan, resulting from illness,trauma, accident,or
psychological trauma
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.

9. T
YPESOFST
AMMER
IN
G
There are several types of stammering:
Developmental.: Thisisthemostcommontype of stuttering inchildren. It
usually happens when a child is between ages 2 and 5. It may happen
when a child’s speechand language development lags behind what he or
she needs or wants to say.
Neurogenic.:Neurogenicstuttering mayhappen after a strokeor brain
injury. It happens when there are signal problems between the brain and
nerves and musclesinvolved in speech.
Psychogenic.: Psychogenic stuttering is not common. It may happen after
emotional trauma. Or it can happen along with problems thinking or
reasoning.

10. PH
ASEOFST
AMMERIN
G
There are four phases of stammering:
1. Specific
2. Episodic
3. Chronic
4. Anticipatory

11. DEV
EL
OPMEN
T
ALLEV
ELSOFDISFL
U
EN
C
Y
Level of
Dysfluency
Core Behaviors Secondary
Behaviors
Feelings and
Attitudes
Underlying Processes
Normal
Disfluency
Disfluency less than
10% of the time 1 to 2
repetitions per instance
Slow, even
behaviors
None None Developing
language
Pragmatics
Speech/ motor control
Environmental
stress
Borderline
Stuttering
Frequencyof dissiliency
increases to more
than 10%. Repetitions
increase to more than 2
per instance.
Repetitions remain
loose and relaxed.
None
Little awareness
Little concern
Same as above

12. Beginning Stuttering Tense, abrupt
multiple part-word
repetitions. Tense
prolongations
Pitch rise
Articulatory
posturing with
increased tension
Difficulty initiating
airflow and voicing
Escape behaviors
Awarenes
s Early
fear
Anticipati
on
Frustration
Response to
awareness
Intermediate
Stuttering
Blocks
Repetitions
and
prolongations continue
Avoidance of words and
situations
Starters
Fear
Shame Embarrassment
Classically conditioned
tension
Classically conditioned
fear
Avoidance conditioning
Advanced Stuttering Blocks
Stoppage of air flow
Tremors from
increased duration
of blocks
Avoidance of words and
situations
Scanning (i.e.,
thinking ahead to
identify potentially
difficult or feared
words or sounds)
Helplessn
ess
Anger
Frustration
Strong negative feelings
about self
Stronger conditioning
Developed sense of
self as a stutterer

13. ASSESSMENT/FORMAL/INFORMAL
Stammering Assessment can be divided into two types
Screening
Diagnostic
1. Screening identifies if there is a problem
2. Diagnostic identifies what the problem is.

14. Core features:primary characteristics of a fluency disorder
🢝
R
epetitions
🢝
Prolongations
🢝
Blocks
Secondary features: emerge in response to the core behaviors
🢝
Avoid and escape momentsof disfluency, suchas
🢝
eye blinks, head jerks, pauses, fillers
🢝
Negative feelings and attitudes, such as worrying about speaking, viewing speaking
as difficult
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by PearsonE
ducation, Inc.
Upper Saddle R
iver, New Jersey 07458
All rights reserved.

15. Informal Observations
They start the minute the client enters and include
observations of
▣ Posture
▣ Social skills
▣ The way in which a person speaks
▣ The way in which a person stutters
▣ etc.
▣Case History

16. ▣ developmental milestones
▣ history of speech complaint
▣ current management of speech problems
▣ other speech /language problems
▣ familial history of stuttering
▣ relationships within the family
▣ emotional development
▣ school details

17. • previousspeech therapy and / or other therapy
• relationship status
• job
• client's ideas about onset and cause
• views on responsibility for stutter
• changes in stuttering over the years
• best/worst occasions for stutter
• expectations of present therapy
• model of therapy (doctor/patient, student/teacher,
partnership)
• type of therapy desired (group or individual, intensive or
weekly).

18. ▣ Speech Profile which assesses the overt
symptoms of stuttering and the
▣ Attitude Assessments which are the most
frequently usedtoolsby whichcovert features
are assessed.
Real-Time Analysis of Speech Fluency (Yaruss,Journal of Speech-Language Pathology, 1998)

19. ASSESSMEN
TDESC
RIPT
ION
A multifactorial model for understanding the complexity and diversity of
child/adult dysfluency that includes:
1. Physiological
2. Linguistic
3. Psychological
4. Environmental factors

20. Speech Profile(Portfolio/ Griding)

21. ESSEN
T
IALSKILLS
1. General behavior
2. Cognitive skills
3. Receptive, expressive and pragmatic language(Verbal
Comprehension)
4. Social skills
5. Dysfluency
6. Attitudes

22. General behavior
1. SEPARATION
2. CO-OPERATION
3. MANNER
4. ANXIETY/TENSION
5. ATTENTIONS
6. FIDGETING
Cognitive skills
1. ORGANISATIONAL SKILLS
2. DRAWING
3. PLAY

23. Verbal Comprehension
1
. T
wo word level
2. Three word level
3. Four word level
Linguistic analysis
1. Word finding ability(Vocabulary –
Lexicon)
2. Phonology( Intelligibility-
delayed/deviant)
3. Prosody(volume-intonation-voice
quality)

24. SOC
IALSKILLS
1. Observation &eye contact
2. Listening skills
3
. T
urn taking
4. Position
5. Facial expression
6. Gesture

25. DYSFLUENCY
1. Assessmentof fluency determine thenature and severity of the
presenting problems
2. Observation of dysfluency (2 min)
Video-recording –Parent child interaction
Pragmatics categories
Facial &body tension
1. Transcription
(Part-word repetition, prolonged sound-struggling behavior)

26. D
YSFL
U
EN
C
YMEASU
RE
When the therapist has completed the transcription the following fluency
measure are taken and recorded in dysfluency section i.e
1. Dysfluent words (DW)
2. Fluent words spoken (FWS)
3
. T
otal words spoken (TWS)
4. Length of prolongation
5. Time

27.  Typeof errors:(no.of-----------------struggling behaviors)Locusof errors:(
words-syllable)
 Percentage of DW:(DW*100/TWS
 Articulatory rate:(FWS*X/100)
 Occurrence in pragmatics categories:(initiation-centre-final)
 Secondary behaviors
 AvoidanceAwareness

28. 100 syllable stammer minimum
SS%-- syllable stuttered percentage
Repetition, blocking and prolongation no
matter done multiple times in one syllable
will be counted as 1 SS
SS%=No.SS/total Syllable X 100
Real-Time Analysis of Speech Fluency (Yaruss, Journal of Speech-Language Pathology, 1998)

29.  Below 3% isnon-fluency 3-5---low
 5-8---mild
 8-12---moderate
 12-more– severe
 Real-TimeAnalysis of Speech Fluency (Y
aruss,Journal of Speech-Language Pathology,1998)

30. • Do refer to a speech and language therapist.
• Do look and listen carefully -listen with interest to what the child is saying, rather than how they are saying it.
• Do slow down your own rate of speech.
• Do ensure you use a level of language that the child understands.
• Do have a regular routine.
• Do discuss any future events so that the child is prepared for them.
• Do give the child regular periods of uninterrupted time with you.
• Do try to maintain eye contact with them while they are speaking -lack of eye contact can signal boredom or impatience.
• Do give them time to say what they have to say.
• Do encourage a calm and relaxed atmosphere.
• Do acknowledge their difficulties and give them reassurance and encouragement in a
Stammering: How to Help
Do
visit twinkl.com

31. • Don’t finish off sentences for them.
• Don’t mimic them.
• Don’t interupt them.
• Don’t insist on making them speak when they do not want to.
• Don’t speak for them.
• Don’t make comparisons to other children.
• Don’t hurry them.
• Don’t tell them to start again.
Stammering: How to Help
Don’t
visit twinkl.com

32. Yaruss,J.S.(1998), “Real-Time Analysis of SpeechFluency: Proceduresand Reliability Training.” AJSLP,Vol. 7, No.@, pp25-37.
Yaruss,J.S., Max, M., Newman, R.and Cambell, J.H. (1998). “Comparing Real-Time and Transcript-Based Techniques For Measuring
Stuttering”, Journal of Fluency Disorders, 23, pp. 137-151.
Onslow, M., Packman, A. & Harrison, E.(2003) The Lidcombe Program of Early Stuttering Intervention: A Clinician’s Guide. Austin, Tx.
Pro-Ed.
Peters,T.J.& Guitar, B.(1991). Stuttering: An Integrated Approach to Its nature and Treatment. Williams and Wilkins, Baltimore, Md.
Shapiro, D. A.,(1999), Stuttering Intervention: Collaborative Journey to Fluency Freedom. Austin, Tx. Pro-Ed.
Quesal,R.and Yaruss,J.S.Assessmentof ChildsExperienceof Stuttering(ACES).www.stutteringcenter.org.(2005).
Reardon, N. and Yaruss,J.S.(2004). The Sourcefor Stuttering: Ages 7-18. Chicago, Ill. Linguisystems.