This document contains confidential information about a 14-year-old boy named Ali Jawaid who is being evaluated for possible autism spectrum disorder or Asperger syndrome. It includes his birth and medical history, developmental milestones, education history, and assessments of his oral structures, physiological speech factors, and associated motor behaviors. The forms were completed by his mother and provide background for his evaluation.

1. All the information in this form is confidential and will not be made public to any
persons without the consent of the child’s parent or legal guardian.
STUTTERING
CASE PRACTICAL
BY
FOUZIA REHMAN
Date:

2. 2
CHILD CASE HISTORY Form # 1
BASIC INFORMATION
Name: Ali Jawaid Birth Date 2/june/2000 Age: 14
Home Language Urdu Tel# ---- School/ Preschool. Dewa Academy
Home Address: Nazimabad Father Name: Jawaid Ahmed
Father Occupation Banker Phone #: _----_____- E-mail Id ___----
Mother Name: Nida Jawaid Mother Occupation: House wife
Date of Evaluation: 18/2/2015 Referred By: -------
Problem Statement: . Autistic spectrumdisorder possible Asperger syndrome
Identifying Information of Child
Please fill in the form as accurately and complete as possible. If there are any questions regarding the information asked, those sections will
be filled in with the therapist during the parental interview.
PRENATAL AND BIRTH HISTORY:
How was the mother’s general health during the pregnancy? (Illnesses, accidents, medications used, complications,
procedures performed?) Normal
Duration of pregnancy: Normal Duration of labor: Normal
Birth weight: Normal Was your child placed in an incubator? No
If yes why and for how long? -
CIRCLE APPLICABLE BIRTH:
Head first Feet first Bridge Planned C-section Unplanned C-section
Was your child breastfed and for how long? 8th
Months
Until when was your child bottle fed? After 8th
Months
MEDICAL HISTORY:
Provide approximate ages at which the child suffered from following illnesses & conditions:
Allergies
Asthma
Chicken Pox
Colds
Convulsions
Croup
Dizziness
Ear Infections
Encephalitis
German measles
Headaches
High fever
Influenza
Mastoiditis
Mumps
Pneumonia
Seizures
Sinusitis
Ringing in ear
Tonsillitis
Other
Where any procedures or surgery done to improve any of the above conditions. If yes Please describe
Does your child use any chronic medication? If yes please specify. Retalin
GENERAL INFORMATION:
Brothers and sisters (include names and ages). Zeeshan is elder brother Age: 18 years
What languages does your child speak? English Primary language: Urdu
What languages are spoken at home? Both Other:
With whom does child spend most of his time? Mother
How does your child usually communicate? [Gestures, single words, short phrases, sentences (how many words in a
sentence)] sentences
When the problem was first noticed? Mother
What do you think may have caused the problem? Asperger Syndrome
Has the problem changed since it was first noticed? yes
Have any other speech-language therapists or audiologists seen your child? No
Have any other professionals seen your child? If yes, who?
Physician yes
Pediatrician yes
Psychologists yes
Optometrist orOphthalmologist
Specialeducation teachers' yes
Neurologist’s
Ear nose and throatspecialist
Physiotherapist
Are there any speech, language, hearing or cognitive (brain related) problems in your family? If
Yes please describe. No
DEVELOPMENTALHISTORY:
Please provide the approximate ages at which your child mastered the following milestones (if applicable):
Crawl 10th
months Sit 1 year Stand 1 1/5 years
Walk 2 years Feed self 2 1/5years Dress self 3 1/5 years Use toilet 2 years

3. Speech / Language Assessment
3
Use single words (e.g., no, mom, doggie, etc.) 4 years
Combine words (e.g., me go, daddy shoe, etc.) 6years
Name simple objects (e.g., dog, car, tree, etc.)
Does your child have difficulty walking, running, or participating in other activities, which require small or large
muscle coordination? clumsy -
Are there or have there ever been feeding problems (e.g. problems with sucking, swallowing, drooling, chewing, reflux
etc.) if yes, please describe No
Describe the child’s response to sound (e.g. responds to all sounds, responds to loud sounds only, or inconsistently
responds to sounds). yes
EDUCATIONAL HISTORY:
School: DEWA Academy Grade: learner
How is the child performing academically (or pre-academically)? Does the teacher have any concerns? If yes please
specify. He has behavior issuse , he doesnot develop interest in academics although he is good in
extra curricular activities
How does your child interact with others (e.g., shy, aggressive, uncooperative etc.)? Sometime
aggressive, but mostly in a friendly way, but he did not listen to other he speaks only has a short temperament of
listening
Provide any additional information that might be helpful in the evaluation or remediation of your child’s problem. He
ilike to make friends, he like cartoon movies and games , he like to prank others that also cause problems for peoples
specially in school.
ORAL-FACIAL EXAMINATION Form # 2
Evaluation of Face Comments
_______ symmetry: normal/droops on right/droops on left
_______ abnormal movements: none/grimaces/spasms
_______ mouth breathing: yes/no
Evaluation of Jaw and Teeth
Tell client to open and close mouth.
_______ range of motion: normal/reduced
_______ symmetry: normal/deviates to right/deviates to left
_______ movement: normal/jerky/groping/slow/asymmetrical
_______ TMJ noises:absent/grinding/popping
Observe dentition.
_______ occlusion (molar relationship): normal/neutroclusion (Class I)/ distoclusion (Class II)/ mesioclusion
(Class III)/
_______ occlusion (incisor relationship): normal/overbite/underbite/crossbite
_______ teeth:all present/dentures/teeth missing (specify)
_______ arrangement of teeth: normal/jumbled/spaces/misaligned
_______ hygiene:
Evaluation of Lips
Tell client to pucker.
_______ range of motion: normal/reduced
_______ symmetry: normal/droops bilaterally/droops right/droops left
_______ strength (press tongue blade against lips): normal/weak
Tell client to smile.
_______ range of motion: normal/reduced
_______ symmetry: normal/droops bilaterally/droops right/droops left
Tell client to puff cheeks and hold air.
_______ lip strength:normal/reduced
_______ nasalemission: absent/present
Evaluation of Tongue
_______ surface color: normal/abnormal (specify)
_______ abnormal movements: absent/jerky/spasms/writhing/fasciculations
_______ size: normal/small/large
_______ frenum: normal/short
Tell client to protrude the tongue.
_______ excursion: normal/deviates to right/deviates to left
_______ range of motion: normal/reduced
_______ speed ofmotion: normal/reduced
_______ strength (apply opposing pressure with tongue blade): normal/reduced
Tell client to retract tongue.

4. 4
_______ excursion: normal/deviates to right/deviates to left
_______ range of motion: normal/reduced
_______ speed ofmotion: normal/reduced
Tell client to move tongue tip to the right.
_______ excursion: normal/incomplete/groping
_______ range of motion: normal/reduced
_______ strength (apply opposing pressure with tongue blade): normal/reduced
Tell client to move the tongue tip to the left.
_______ excursion: normal/incomplete/groping
_______ range of motion: normal/reduced
_______ strength (apply opposing pressure with tongue blade): normal/reduced
Tell client to move the tongue tip up.
_______ movement: normal/groping
_______ range of motion: normal/reduced
Tell client to move the tongue tip down.
_______ movement: normal/groping
_______ range of motion: normal/reduced
Observe rapid side-to-side movements.
_______ rate: normal/reduced/slows down progressively
_______ range of motion: normal/reduced on left/reduced on right
Evaluation of Pharynx:
_______ color: normal/abnormal
_______ tonsils:absent/normal/enlarged
_______ other:
Evaluation of Hard and Soft Palates:
_______ color: normal/abnormal
_______ rugae: normal/very prominent
_______ arch height: normal/high/low
_______ arch width: normal/narrow/wide
_______ growths:absent/present (describe)
_______ fistula: absent/present (describe)
_______ clefting: absent/present (describe)
_______ symmetry at rest: normal/lower on right/loweron left
_______ gag reflex: normal/absent/hyperactive/hypoactive
_______ other:
Tell client to phonate using /ɑ/.
_______ symmetry of movement: normal/deviates
right/deviates left
_______ posteriormovement: present/absent/reduced
_______ lateral movement: present/absent/reduced
_______ uvula: normal/bifid/deviates right/deviates left
_______ nasality: absent/hypernasal
ASSESSMENT OF PHYSIOLOGICAL FACTORS ASSOCIATED WITH STUTTERING
Form # 3
Respiratory Factors
_____ normal respiration at rest
_____ normal respiration during speech
_____ shallow breathing
_____ audible inhalation
_____ prolonged inhalation
_____ audible exhalation (nonspeech)
_____ gasping
_____ arhythmical breathing
_____ other(describe)
Phonatory Factors
_____ normal phonatory functions
_____ delays of phonatory onset
_____ hard glottal attacks
_____ pitch breaks
_____ excessive pitch variations
_____ too loud
_____ too soft
_____ alternating loudness
_____ arhythmical breathing
_____ other(describe)
Articulatory Factors
_____ normal articulatory contacts
_____ easy articulatory contacts
_____ hard articulatory contacts

5. Speech / Language Assessment
5
_____ normal articulation (place, manner)
_____ other(describe)
Prosodic Factors
_____ normal prosody
_____ prolonged sound productions
_____ excessive stressing
_____ atypical stressing
_____ other(describe)
Rate When Fluent
_____ appropriate
_____ excessively fast
_____ excessively slow
FINDINGS:
ASSESSMENT OF ASSOCIATED MOTOR BEHAVIORS # 4
Instructions: Check all associated motor behaviors theclient exhibits. Use blank to describe behaviors or record frequency counts.
Eyes
blinking
shutting
Upward movement
Downward movement
Vertical movement present .
Nose
flaring
Dilation
wrinkling
Leg
tensing
kicking
Rapid movement
Tongue
clicking
Extraneous movement
Head
shaking
upward movement
downward movement
lateral movement to right
lateral movement to left
Lips
quivering.
pursing
Invert lower lip
Hands
Fist clenching
wringing
splaying
Teeth
clenching
grinding
clicking
Jaw
clenching
Opening
Closing
Fingers
Tapping
rubbing
clenching
Excessive movement
clicking
Neck
tightening
twitching
Upward movement
downward movement
Lateral movement to the right
Lateral movement to left
Arms
Excessive movement
banging against side
banging against leg
Jerky movement
tensing
Forehead
wrinkling/creasing
Breathing
speaking on little air
Unnecessary inhalation
Jerky breathing
Audible inhalation
Audible exhalation
Dysrhythmic
THE S/Z RATIO # 5
Instructions: Say to the client, “Takea breathandmake the longest /s/ youcan, like this, /s---s/” (model the target response).Time thedurationof the client’s
productionis in seconds. Repeat the instructions, replacing /s/ with /z/. Complete at least 2 trials of each phoneme, recording seconds per trial below:
To determine the s/z ratio, divide the longest /s/ production by the
longest /z/ production
Interpretation:
 A 1.0 ratio with normal duration on productions of /s/ and /z/ (approximately 10 seconds for children and 20–25 seconds for adults) suggests
normal respiratory ability and the absence of vocal cord pathology.
 A 1.0 ratio with reduced duration of /s/ and /z/ indicates possible respiratory inefficiency. The patient may have a reduced vital capacity or
poor control of expiration.
Trial in Sec /S/ /Z/
Trial 1
Trial 2
Trial 3
Total
Total Average
Longest /S/
Longest /Z/
S/Z Ratio

6. 6
 An s/z ratio of 1.2 or greater with normal duration of the /s/ production indicates possible vocal cord pathology. Unlike /s/, the voiced /z/
requires phonation. Therefore, unequal phonatory control of the /s/ and /z/ is indicative of a laryngeal pathology rather than a respiratory
problem. The higher the s/z ratio is above 1.0, the greater the likelihood of laryngeal pathology.
FREQUENCY CONT FOR DYSFLUENCIES Form # 6
Speech sample duration:
REPETITIONS: Part-word (PWR)
Whole-word (WWR
phrases
PROLONGATION: Sound (SoPr)
Silent (SPr)
INTERJECTIONS: Sound/Syllable (I)
Whole-Word
Phrase
SILENT PAUSES (SP)
BROKEN WORDS (B)
INCOMPLETE PHRASES (Inc)
REVISIONS (x)
BLOCKS (B)
FLUENCY CHARTING GRID FORM # 7
Instructions:Make an appropriatemark in each square for every word uttered using thesuggested symbols or make up your own to
indicate typeof dysfluency present. Themajor categories of dysfluencies are in bold print
CODE:
 (R) = repetition
 (*) = no dysfluency
 (I) = Interjection
 (SP) = Silent Pause
 (BW) = Broken words
 (Inc) = Incomplete Phrases
 (SPr) = Silent prolongation
 (SoPr) = Sound Prolongation
 (P) = prolongation
 (B) = block
 (x) = revision
 (F) = filler/starter
 (PWR) = Part word repetition
 (WWR) = Whole-word repetition
 (PR) = Phrase repetition
Steps in the Frequency Count Assessment
1. Prepare eithera video oraudio tape recorder
2. Assessthefrequencyofstuttering in each caseusingthe following
No. of syllables stuttered * 100 = * 100 = %Syllable stuttered
No of syllables spoken
CALCULATING THE DYSFLUENCY INDEX # 8
Instructions: Transfer your findings fromthe Fluency ChartingGridto the appropriate blanks below and calculate dysfluency indexes for general or
specific dysfluency types. E.g., Repetitions are general fluency types which consist of specific types: Part -word, Whole-word, and Phrase Repititions.
Total Number of Words:
No# of Dysfluencies Dysfluency Index Dysfluency Acc. To Type
Repetitions (R)
Part-Word (PWR)
Whole-Word (WWR)
Phrases (RP)
Prolongation (P)
Sound Pro (SoP)
Silent-Pro (SP)
Interjections (I)
Sound/Syllable (SS)
Whole-word (WWI)
Phrases (PI)

7. Speech / Language Assessment
7
Silent Pauses (SPh)
Broken Words (BW)
Incomplete Phrase (InP)
Revisions (Rev)
TOTALNUMBER OF DYSFLUENCIES:
THE MODIFIED S-SCLAE # 9
Instruction:Answer the following by circling 'T' if the stutteringis generally true for you or tick 'F' if the statement is generally false
for you. If the situation is unfamiliar or rare, judge it on a "if it was familiar.." basis.
1. I usually feelthat I am making a favorable impressionwhen Italk. T F
2. I find it easy to talk with almost anyone. T F
3. I find it very easy to lookat my audience while talking in a group. T F
4. A person who is my teacherormy boss is hard to talkto. T F
5. Even the idea of giving a talk in public makes me afraid. T F
6. Some words are harder than others for me to say. T F
7. I forget all about myselfshortly afterIbegin to give a speech. T F
8. I ama good mixer. T F
9. People sometime seemuncomfortable when Iamtalking to them. T F
10. I dislike introducing one person to another. T F
11. I often ask questions in group discussion. T F
12. I find it easy to keep controlofmy voice when speaking. T F
13. I don’t mind speaking before a group. T F
14. I don’t talkwell enough to do thekind ofwork I would really like to do. T F
15. My speakervoice is ratherpleasant&easy to listen to. T F
16. I amsometimes embarrassed by the way I talk. T F
17. I face most speaking situationswith complete confidence. T F
18. There are few people I can talk with easily. T F
19. I talk better than I write. T F
20. I often feel nervous while talking. T F
21. I often find it hard to talk when I meet new people. T F
22. I feel pretty confident about my speaking abilities. T F
23. I wish I could say things as clearly as others do. T F
24. Even though Iknewthe right answer,Ihave often failed to give it because T F
I was afraid to speakout.
Diadochokinetic Syllable Rates Worksheet # 10
Instructions: Time the number of seconds it takes your client to complete each task the prescribed number of times. The average number
of seconds for children 6 to 13 years of age is reported in the right-hand side of the table. The standard deviation (SD) from the norm (mean
or average) is also found in the table. Subtract the SD from the norm to determine each SD interval. For example, using the /puh/ norm with
a 6-year-old, 3.8 (4.8 - 1.0) is one SD, 2.8 (4.8 - 2.5) is two-and-a-half SDs, etc. Therefore, a 6-year-old child who needed the 2.6 seconds
to complete the /puh/ sequence would be two SDs below the mean.
Norms in seconds for Diadochokinetic syllable rates
Task Repetitions Seconds 6 7 8 9 10 11 12 13
puh 20 . 4.8 4.8 4.2 4.0 3.7 3.6 3.4 3.3
tuh 20 . 4.9 4.9 4.4 4.1 3.8 3.6 3.5 3.3
kuh 20 . 5.5 5.3 4.8 4.6 4.3 4.0 3.9 3.7
1.0 1.0 .7 .7 .6 .6 .6 .6
Standard deviation: σ2
= Σ x /n – (Σx /n)
Task Repetitions Time (Sec) x X2
Mean = ∑x/n σ 2
= Σ x2
/n – (Σ x /n)2
puh 20
tuh 20
kuh 20 σ 2
=
Total 60 σ =
Task Repetitions Seconds 6 7 8 9 10 11 12 13
puhtuhkuh 10 ______ 10.3 10.0 8.3 7.7 7.1 6.5 6.4 5.7
SDs 2.8 2.8 2.0 2.0 1.5 1.5 1.5 1.5

8. 8
EVALUATION BY DDK:
ASSESSING INTELLIGIBILITY WORKSHEET # 11
Instruction Write out each word in each utterance (use phonetics if possible), Use a dash (----) to indicate each unintelligible word, An
utterance is considered intelligible only if the entire utterance can be understood, & Calculate intelligibility for words and utterances
 Intelligible Word = X 100 = % .
Total Word
Serial
#
UTTERANCES # of
Intelligible
Words
Total
Words
# of
Intelligible
Utterances
Total
Utterances
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

9. Speech / Language Assessment
9
 UnIntelligible Word = X 100 % .
Total Word
MEAN LENGTH of UTTERANCE (MLU) # 12
Mean length of utterance (MLU) is the average number of morphemes per utterance. It is an index of expressive language development
used beyond the stage of single words, when a child uses two or more words together in an utterance. It is calculated in 50 or 100
utterances by counting the number of morphemes in each utterance divided by the total number of utterances. MLU is used as a benchmark
to assess individual differences and developmental changes in grammatical development in children in the early stages of language
acquisition. The mean length of children’s utterances is a valuable estimate of their early language acquisition. A child’s MLU typically
corresponds closely to their age. Roger Brown described five stages of language development based on MLU.
MLU for the child by the formula
Total No. of Words = = MLU
Total No. of utterances
Table shows MLU in normal individuals (1 to 4 years)
COMMENTS on MLU & WPM
ASSESS OVERALL SPEAKING RATE or WPM # 13
NOTE; Speech rate is the term given to the speed at which you speak. It's calculated in the number of words spoken in a minute. A normal
number of words per minute (wpm) can vary hugely. The average speaking rate for people who don't stutter is 167 words per minute, 1st
grade child’s WPM is about 125 and 5th
grade child has 142 WPM (Darley, 1940). Generally people are not conscious of their habitual
speaking speed and if they are understood by those listening there is little reason to change. Their speech could be considered too slow or
too fast by people outside of their normal environment but if they are not routinely communicating with them it doesn't really matter.
Total words =
Word per minute = total number of words / time in seconds X 60
WPM = ( / 20) x 60 = wpm
COMMENTS
Phase MLU Approximate age
1
2
3
4
5
1.0 – 2.0
2.0 – 2.5
2.5 – 3.0
3.0 – 3.75
3.75 – 4.5
1 – 2.5 years
2 – 2.5 years
2.5 – 3 years
3 – 3.5 years
3.5 – 4 years

10. 10
EVALUATION REPORT of sadia arshad
Name: Birth Date: Age:
Home Language Tel# Date of Evaluation:
School/ Preschool.
Home Address:
Father Name: Father Occupation Phone #:
E-mail Id Mother Name: Mother Occupation: