Diagnostic: 1. Parent-Child Interaction (PCI; 10 minute free play) Observe positive interactions

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1 Clients Initials: XX Age: 4 years, 0 months Gender: M Diagnostic Plan Concern(s) (Referral Questions): Is there anything that the parents can do to help XX? Are there any other underlying causes/diagnoses that we should know about? Grad Student Clinician Goal: I want to work on being more reflective within the context of the appointment (e.g., asking more follow-up questions to information presented during the appointment, and commenting on parent s interaction with child during the appointment). INPUTS PROCESS OUTCOME Family History: - no family history of speech, language, reading problems, or learning disabilities - maternal sister, uncle, and grandfather are left-handed - sister and father are artistic - paternal grandmother musical Medical History: - XX was born at 40 weeks and birth history is unremarkable - no chronic illnesses - hearing and vision reported to be normal Developmental History: - generally favors left hand for writing; favors right hand for other activities (noted that he switches hands often) - communicates with peers, but same-age peers appear frustrated at times, with XX s speech - enjoys school - no disabilities reported by mother Before Evaluation: Brief Phone Call-- 1. Confirm appointment 2. Briefly discuss diagnostic procedures 3. Ask about hearing screening 4. Ask parent to bring in/file transfer audio/video of home sample of spontaneous conversation (5-10 minutes) 5. Ask about favorite toys/interests for child interaction portion of Dx Diagnostic: 1. Parent-Child Interaction (PCI; 10 minute free play) Observe positive interactions 2. Simultaneously (a & b): a. In Treatment Room: Clinician-Child Interaction (10 minute video free play) b. In Observation Room with Parent: -- Review Positive PCI observations -- State-Trait Anxiety Inventory for Adults (STAI) to collect information about how stuttering is affecting the parent(s) H1: XX will present with a borderline stuttering. H2: XX will benefit from implementation of fluency intervention.

2 History of Stuttering: - started talking at <1 year - uses very advanced vocabulary in speech - first noticed at 3 years, 1-2 months by parents, and grandparents - no situations/conditions reported by mother to be associated with onset - reported that all family member speak rapidly - first signs of stuttering included first sound repetitions, and first-syllable repetitions - stuttering occurs during normal every day speech - stuttering severity reported in increase with fatigue, and excitement - unaware of stuttering - does not produce a great deal of fillers - no apparent avoidance of speaking - stuttering has waxed and waned over the past 10 months, but has not disappeared - no difficulty with singing - XX stutters in most situations, but is not reported to stutter when saying his name, answering direct questions, using new words, nor when talking to strangers - parents consulted with SLP at YYY Elementary - based on recommendations parents 3. Parent Interview (see questions below) a. Review SRs in different situations b. Stuttering Hierarchy 4. Supervisor/Clinician Meeting Make clean copy of 4 Circles and discuss recommendations while parent/child play or relax. 5. Exit Interview - 4 Circles Summary - Tx Recommendations - SR Sheets - PCI techniques 6. Hearing Screening (unless hearing was tested within past 6 mo.) SSI-4 (analyze later) -Spontaneous Sample a. home sample b. clinician-child sample (clinic) c. parent-child sample (clinic) -Intelligibility Rating -Speech Rate -Subjective Observation

3 have made sure to allow XX time and space to speak - SLP reports that she believes XX s stuttering is due to his advanced vocabulary and his less-developed motor planning/facial musculature - also produces distorted /ɹ/ (articulation challenge, likely unrelated to stuttering) Current Stuttering: - mother reports that it does not generally interfere with his life, though sameage peers sometimes appear frustrated by his speech - first-syllable, and first-sound repetitions - unaware of stuttering - does not display secondary behaviors, nor avoids speaking More information needed about: - certain words/speech sounds that are more troublesome for XX? - situations that induce stuttering (times of day) - frequency - interaction style of parents - interaction with siblings - peer interactions - XX s personality/temperament

4 Brief Phone Call Questions: 1. Confirm diagnostic appointment. 2. Ask parents if they need directions to Luse Center. 3. Who is coming to the evaluation? 4. Does XX need frequent breaks? Would this be beneficial during the evaluation (e.g., bring snack)? 5. Request audio/video sample of XX interacting with one or both of her parents (~10 mins). 6 Ask about favorite activities/interest. 7. Questions or concerns? Parent Interview Questions: THANK YOU FOR FILLING OUT THE CASE HISTORY FORM SO THROUGHLY-- VERY HELPFUL! 1. What brings you here today? 2. What do you hope to learn from this evaluation/what are your expectations of this evaluation session? 3. Have you been doing anything different at home, based on the school SLP s recommendations/consultation? What did you do, and what were the results? (Tell me more about ) 4. What is the dynamic at his preschool like? How does he interact with peers? 5. How would you describe XX s personality/temperament? 6. What is a typical day like for XX? (ask follow-up about parent/sibling interactions) 7. Just want to confirm that there is no diagnosis of ADHD or other speech-language concerns? Describe SR scale 1-10 (describe normal disfluencies, progression of severity, secondary behaviors using Stuttering Hierarchy) 8. What are characteristics of XX s stuttering? Has anything changed since the end of May, when you filled out the Case History form? a. Physical struggles (eye blinks, hand movements)? Any tension? b. Discuss repetitions vs. prolongations vs. blocks vs. avoidance vs. secondary behaviors. c. Collect SRs in different situations: Family at home With peers At school Most challenging Today Typically Phone?

5 Pockets of fluency? Other? d. What is XX s awareness of his stuttering? e. Is stuttering primarily at beginning of words (first-sound, first-syllable)? f. Any avoidance behaviors? 9. How does XX handle transitions? Beginning preschool? (Starting kindergarten this coming year?) Vacations? Moving? 10. What is your family s reaction to XX s stuttering? 11. How does stuttering affect XX at home and at school? How does he interact with peers? 12. Is there any other information about your child that you feel is important for us to know? 13. What other questions do you have for us? Any other important information you would like to share?