CDS 526 Stuttering Chapter 8

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Diagnosis

Defined: “the identification of a specific condition usually not
apparent at the beginning”

Differential Diagnosis - discerning the nature of a disorder as
different from other disorders

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Differential Diagnosis: Examples

▪
Stuttering vs. Normal Disfluencies

▪
Early Stuttering vs. Advanced Stuttering

▪
Stuttering that will Recover vs. Stuttering that will Persist

▪
Stuttering vs. Cluttering

▪
Stuttering (Developmental) vs. Neurogenic Stuttering

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Assessment Objectives

•Establish rapport

•Obtain background/case history

•Describe speech characteristics

•Consider home/social/work environments

•Note conditions affecting speech

•Understand the impact on the client’s life

•Provide info. about stuttering and therapy

•Recommend a plan of action

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Case History Areas (pp. 182-183 )

I.
History of Stuttering (client and family)

II.
Treatment History

III. Current Speech Description

IV. Environmental Variables Affecting Speech

V.
Impact on Quality of Life

VI. Other Relevant Case History

VII. Client’s Perspective

VIII. Identifying Information

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Interviewing School-Age Children

What grade in school?

Which subjects liked most? Least?

After-school activities? Skills/Hobbies?

What do you like to do best? Why?

Tell me about things you do well.

Like talking? When/Where/How much?

Peers’ response? Teachers’ response?

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Interviewing Parents

•Does stuttering affect the child in school?

•Is it the same at school and at home?

•Describe the child’s typical day.

•Besides speech, any other trouble areas?

•Is playing or socializing affected?

•Any other impact on the family?

•Is speech important to your child?

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Speech Analysis Decisions

After speech sample collection, determine:

•behaviors of interest:

–Examples: Disfluency types? Stuttering events? Fluent
words?

•units to be analyzed:

–Examples: Stuttered syllables? Stuttered words? Time
intervals?

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Disfluency analysis: Initial analysis

Disfluency Type

No. in sample

Per 100 words

Part-word repetition

____

____

Monosyllab. word repet.

____

____

Dysrhythmic phonation

____

____

Total SLD

____

____

Interjection

____

____

Revision

____

____

Phrase repetition

____

____

Total Other disfluency

____

____

Grand total

____

____

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Example of Disfluency Analysis

(566-word sample)

Type of Disfluency

Per 100 words

Part-word repetitions (45)

7.95

Whole-word repetitions (19)

3.36

Dysrhythmic Phonations (33)

5.83

SLD Subtotal (97)

17.14

Phrase repetitions (12)

2.12

Interjections (34)

6.01

Revisions (4)

0.71

OD Subtotal (50)

8.83

Disfluency Total (147)

25.97

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Metrics: stuttering/disfluency counts

Percent of words stuttered

Percent of syllables stuttered

Number of disfluencies per 100 words or per 100 syllables

Repetition Units

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Speech Analysis: Fluency Measures

Type of Measure

Target

Sampling Unit

Formula

Number of
disfluencies per 100
syllables

Disfluency
Types

Syllables

# disfluencies x 100

# syllables

in the sample

Percent Words
Stuttered

Perceived
Stuttering

Words

# stuttered words x 100 # words in
the sample

Number of Stuttered
Intervals

Perceived
stuttering

5-s. periods

# stuttered intervals x 100 # of
intervals

Fluency Index

Perceived
Fluency

Words

# fluent words x 100

# of words

in the sample

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Formula for stuttering/disfluency counts per 100

words or syllable

No. stuttered words X 100 = XYZ

No. of words in sample

52 X 100 = 11.3

467

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Stuttering Severity

“the level of disruption in the delivery of continuous speech” (p. 194)

Severity may not correspond to the impact or experience of the
disorder

Stuttering can be severe, but cause minimal concern or social
impact

Stuttering can be mild, but cause deep concern and negative social
impact

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Severity Rating Scale

Overall Rating

Stuttering Frequency

Effort

Secondary Behaviors

Very Mild

3/100 (3%)

No visible tension

No noticeable movements

Mild

1/20 (5%)

Minimal visible
tension

Barely noticeable movements

Moderate

1/10 (10%)

Moderate visible
tension

Noticeable movements

Severe

1/5 (20%)

Severe visible
tension

Very distracting movements

Very Severe

1/4 (25%)

Very severe visible
tension

Painfully agitated movements

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Situational Rating Protocols

➢ Stutterer’s Self-Ratings of Reactions to Speech Situations (SSR)

➢ Southern Illinois University Speech Situation Checklist

➢ Reactions to Selected Speaking Situations

➢ Self-Efficacy Scales (SESAS & SEA Scale)

➢ Individualized situation hierarchy

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Attitude Rating Scales

o
Modified Erickson Scale (S-24)

o
Communication Attitude Test (CAT-R)

o
Overall Assessment of the Speaker’s Experience of Stuttering
(OASES)

o
Individualized interview regarding attitudes and emotional
reactions