12/20/14. Nina Reeves, A bit of housekeeping. Assessment of Stuttering: Disclosures

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1 Assessment of Stuttering: Nina Reeves, M.S. CCC-SLP BRS-FD Board Certified Specialist-Fluency Disorders Fluency Specialist: Frisco ISD Fluency Specialist Consultant: San Diego Unified School District What are we looking for? Disclosures Financial I have received a speaker s fee for this presentation School Age Stuttering Therapy: A Practice Guide and Minimizing Bullying for Children who Stutter: A Practical Guide for SLPs, Stuttering Therapy Resources (Royalties & Ownership) Non-financial Advisory Board, National Stuttering Association Past volunteer author, Stuttering Foundation A bit of housekeeping REMINDERS Photos or Recordings of this presentation (in whole or in part) are prohibited No distribution of this presentation or its contents is permitted without express permission of the author Nina Reeves,

2 I know that I cannot possibly present everything you want or need to know about assessing children who stutter in the span of 3 hours, So, I will attempt to address the major points of assessment WHILE Also providing you with resources for further education and activities What s the Primary GOAL of Assessment for Children Showing Signs of Stuttering? To collect information that will help us to determine the most appropriate course of action in each individual case! Nina Reeves,

3 Questions to Consider in Assessment Where has the child been? Case History Where is the child now? What are the parent/family perspectives and concerns? Is this child truly stuttering? Is he reacting to stuttering? What are his risk factors? Where is the child going? Does he need therapy? Does he need therapy NOW? The WHO s (World Health Organization) ICF (International Classification Framework) Applied to Stuttering Personal Factors / Reactions Affective Presumed Etiology Impairment in Body Function (Observable Stuttering Behaviors) Behavioral Cognitive Activity Limitation Participation Restriction Environmental Factors (adapted from Yaruss, 1998, 2007; Yaruss & Quesal, 2004, 2006) So, for the our time today Function: Observable/surface speech behaviors Reactions: child s behaviors in reaction to stutters, child s thoughts about self and communication, child s feelings about self and stuttering Environment: How others perceive/react to stuttering Impact: Participation & Activity Limitations Nina Reeves,

4 Truths about Stuttering Let s talk causes Complex interaction of a variety of factors related to child s development Neurological Disorder HIGHLY variable between and within people who stutter In both severity & impact Talking about stuttering in supportive, matter-of-fact ways does NOT make things worse It s NOT about how it sounds! It IS about how it feels! The more one fights and tries to hide stuttering, the harder handling it becomes! Assessment Overview Multifactorial Surface stuttering behaviors (observable) Not just the frequency count look at the pattern! Feelings/Beliefs/Struggle & Avoidance Behaviors Influence of Environment Impact on overall communication NOTE: VIDEO, VIDEO, VIDEO your assessments! Assessment: Pre-Referral Informal observations Gathering of initial info from all concerned What areas may need to be evaluated? Concomitant Issues Referral for full evaluation, if appropriate Let s Talk RTI! Nina Reeves,

5 Assessment: Overview Case History Previous assessments/therapy Speech/language skills Medical history Academic & social history & skills Can be found... Textbooks Clinical manuals Websites: And many other places! ASSESSMENT: Back to the WHO Assessment-Environment Assessment of other people s reactions to stuttering Environmental impact Adults: Parents & Teachers Children: Peers & Siblings Do they hold beliefs that impact progress in therapy? Nina Reeves,

6 Sample Section from a Case History Reardon-Reeves & Yaruss, 2013 School-Age Stuttering Therapy: A Practical Guide Sample Parent Questionnaire Reardon-Reeves & Yaruss, 2013 School-Age Stuttering Therapy: A Practical Guide Sample Teacher Questionnaire Reardon-Reeves & Yaruss, 2013 School-Age Stuttering Therapy: A Practical Guide Nina Reeves,

7 Assessment-Reactions Assessment of Child s Reactions to Stuttering Affective (feelings) Behavioral (tension, struggle, avoidance) Cognitive (thoughts/beliefs, self-esteem, self-confidence) Assessment: Beliefs and Feelings Impairment: Surface Behaviors Reactions Limitations Environmen t A visual representation of Joseph Sheehan's Iceberg Of Stuttering ( 70) Assessment-Reactions (cont.) Talking together WITH the child About the child, interests, talking & communication Talking about Talking (Williams, 85) & stuttering Normed-Referenced Behavioral Assessment Battery (BAB) [Kiddy-Cat, CAT-R] Portfolio-Based Reflective writings/drawings Journal entries Questionnaires/checklists Documentation of observations (SLP s & others ) Samples upcoming: For further information, See Chmela & Reardon: The School Age Child who Stutters: Working Effectively with Attitudes and Emotions, Stuttering Foundation, 2001 Nina Reeves,

8 ISBN / ' : 12/20/14 What do we want to know about this child? Specifically Does this child have awareness of stuttering? Can the child describe/discuss speaking differences? How does the child think/feel about what is going on with speech? Are there any covert behaviors occurring? What is the impact of stuttering on the child s communication? How do we find out? General Questions More Specific Questions Pencil & Paper Tasks For further information, See Chmela & Reardon: The School Age Child who Stutters: Working Effectively with Attitudes and Emotions, Stuttering Foundation, 2001 IWHAT'S TRUE FOR YOU? I Date: :5('0/ Age: '1, 1 Read each statement. Circle the number that best describes what's true for you. 1. I wish I could talk like other kids. NoWay 4 Sometimes ~ 2. Some people are hard to talk to. ~~~~ ~l ~7 Y" No Way Sometimes I totally agree 3. I talk openly about my speech with my parents. CSlo Way 4 Sometimes 4. I am a good talker ,.-, ~~~71 4 NoWay Sometimes I totally agree 5. I like to talk. +; (2)--+7 No Way Sometimes I totally agree 6. Sometimes I do things so I won't have trouble talking (like not talking or changing words or thoughts). - 01'1.6 1 VI\.~ o Way Sometimes I totally agree %h.oj'.f Copyright e 2001 by Stuttering Foundation of America. All rights reserved.i \)) 0 Sample WTFY Chmela/Reardon (Reeves) 2001 for SFA 26 Nina Reeves,

9 12/20/14 7. 'I have sounds that arehardfor me to say. ~o Way C;Sometimes 7) 1totally agree..-ap,l e" q[oway --n~lb~~l- Jo VJ:::; 10. 1don't like having trouble talking. ~ ~ NoWay Sometimes 4 Sometimes want to improve the way I talk. 1 NoWay 4 Sometimes C1totally agree Sample WTFY Chmela & Reardon (Reeves) 2001 for SFA Appropriate for ages 8 years and older Copyright 2001 by Stuttering Foundation of America. All rights reserved. I' ISBN / i 27 _J An example of reflective writing/acrostic poem Reardon, N Reeves, 2007 This is a sample of Ways our voice works from School Age Stuttering Therapy: A Practical Guide Nina Reeves,

10 Ways Our Voice Works: In Assessment-Probing To Do: Co-develop (with the child) a list of ways our voices can work Be certain to include words related to the 3 types of stutters I usually include a foil type of voice to assure the child understands the activity Demonstrate each kind of voice, and have child discriminate whether they recognize this in own speech Reasons: Diagnostic of awareness does the child report any bumpy or stuck speech? Desensitization/normalization (Yaruss) Bumpy (etc) is just another way our voice works sometimes. Sample Reflective Drawing (younger child) For further information, See Chmela & Reardon: The School Age Child who Stutters: Working Effectively with Attitudes and Emotions, Stuttering Foundation, 2001 An example of Reflective Drawing For further information, See Chmela & Reardon: The School Age Child who Stutters: Working Effectively with Attitudes and Emotions, Stuttering Foundation, 2001 Nina Reeves,

11 An example of reflective drawing : Ongoing assessment For further information, See Chmela & Reardon: The School Age Child who Stutters: Working Effectively with Attitudes and Emotions, Stuttering Foundation, 2001 Assessment- Impairment/ Function Assessment of speech fluency Observable characteristics/speech disfluencies Non-stuttered (unless produced with tension) Phrase repetitions Revisions Interjections Stuttered Repetitions of multisyllabic words/sounds/syllables Prolongations Blocks VIDEO VIDEO VIDEO Just curious what do you use for assessment? "Non-Stuttered" Disfluencies Hesitations (pause) Interjections (um, uh, er) Revisions ("I want-i need that") Repetitions of phrases ("I want- I want that") Disfluencies occur more frequently Understanding Different Types of Speech Disfluencies Repetitions of multisyllabic whole words ( mommymommy-mommy let s go. ) Reactions to disfluencies increase Repetitions of monosyllabic whole words ( I-I-I want to go. ) Tension or struggle increases Tension during "nonstuttered" disfluencies Duration (length) of disfluencies increases NOTE: "Non-stuttered" disfluencies Secondary characteristics can be used to avoid or postpone (eye blinks, head stuttering (e.g., I um, you know, uh movements, etc.) I want to um, g-g-g-o with you. ) From Yaruss & Reardon (2010), Young Children Who Stutter: Information and Support for Parents. New York: National Stuttering Association (NSA). "Stuttered" Disfluencies Repetitions of sounds or syllables ("li-li-like this") Prolongations ("llllllike this") Blocks ("l---ike this") Reeves & Yaruss, 2013 School Age Stuttering Therapy: A Practical Guide Nina Reeves,

12 Assessment: Speech Disfluencies MEASURE Types Repetitions Prolongations Blocks Report Frequency Duration Severity DON T Forget! Clusters (more than one type of stuttering in one moment of stuttering) Avoidances/Reactions Secondary Behaviors (Visual & Auditory) Circumlocution, escapes, starters, postponement, withdrawal Assessment: Speech Disfluencies Sample Assessments Video Language Samples: Complete transcriptions of NSD/SD and other observations SSI-4 TOCS Others??? Remember: Surface behaviors are highly VARIABLE Measuring disfluencies provides a snapshot of overall disfluency patterns Samples need to be large enough and representative enough! Vary in type/situation/time/size We need to practice transcriptions to increase our reliability of measurements What you see may not be what you get! WATCH carefully for avoidance patterns Nina Reeves,

13 Assessment-Impact Assessment of adverse impact of stuttering on child s life Functional communication Quality of life OASES and others Interviews Checklists Self-Observation Portfolio Documentation And there is more Assessment of speech/language skills Vocab, word retrieval/lexical access, syntax, oral motor, artic/phono, voice, Expressive/receptive language Putting it all together Let s talk briefly about Interpreting findings Report writing Determination of eligibility (or not) Conferences Development of IEP Nina Reeves,

14 Remember: Surface behaviors are highly VARIABLE Measuring disfluencies provides a snapshot of overall disfluency patterns Samples need to be large enough and representative enough! Vary in type/situation/time/size We need to practice transcriptions to increase our reliability of measurements What you see may not be what you get! WATCH carefully for avoidance/frustration patterns Yes, even young children can exhibit these TIMING is EVERYTHING: Need therapy? Ready for therapy? Is there likely benefit? Willingness, what are the child s goals? What about eligibility? Negative Impact academic, functional, social Timing is everything Ready for what goals? When is a break the right thing? Other than & in addition to therapy Support organizations & Self-study Selected Resources Websites: Chmela & Reardon, 2001: The School Age Child who Stutters: Working Effectively with Attitudes and Emotions, Stuttering Foundation Reardon-Reeves & Yaruss, 2013 School-Age Stuttering Therapy: A Practical Guide, Stuttering Therapy Resources, Inc: McKinney, TX Nina Reeves,

15 References Sheehan, J. (1970). Stuttering; research and therapy. New York: Harper & Row. Yaruss, J. S. (1998). Describing the consequences of disorders: Stuttering and the International Classification of Impairments, Disabilities, and Handicaps. Journal of Speech, Language, and Hearing Research, 41(2), Yaruss, J. S. (2007). Application of the ICF in fluency disorders. Seminars in Speech and Language, 28(4), Yaruss, J. S. (2010). Evaluating and treating schoolaged children who stutter. Seminars in Speech and Language,31(4), Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health: An update. Journal of Communication Disorders, 37(1), Assessments Mentioned Brutten, E. J., & Vanryckeghem, M. (2006). The Behavior Assessment Battery for school-age children who stutter. San Diego, CA: Plural Publishers. Gillam, R., Logan, K. J., & Pearson, N. (2009). Test of Childhood Stuttering (TOCS). Austin, TX: Pro-Ed. Riley, G. (2009). Stuttering Severity Instrument (4th ed.). Austin, TX: Pro-Ed. Yaruss, J.S., & Quesal, R.W. (2010). Overall Assessment of the Speaker's Experience of Stuttering (OASES). Bloomington, MN: Pearson Assessments. Summary Comments Nina Reeves,