UNIVERSITY OF WISCONSIN-STEVENS POINT SPEECH-LANGUAGE EVALUATION

UNIVERSITY OF WISCONSIN-STEVENS POINT SPEECH-LANGUAGE EVALUATION Karla Steif & Jena Weiler IDENTIFYING INFORMATION Name: XX Date of Birth: XX-XX-XXXX Parent: XX and Dad Age: 5;10 Address: 1426 Ellis Street Stevens Point, WI 54481 Date of Evaluation: 09/24/2013 Phone Number: 715-313-2853 Length of Evaluation: 100 minutes STATEMENT OF PROBLEM XX was referred to the University of Wisconsin Stevens Point Center for Communicative Disorders (UWSP-CCD) with concerns in regard to his speech fluency by his mother and the speech-language pathologist Mrs. XX XX at XX Elementary School in XX, XX. XX was evaluated by school psychologist Mrs. XX XX in May 2013. Mrs. XX determined that XX did not qualify for services in the school at that due to the lack of severity of a communication problem and because the family was not enrolled in public education. BACKGROUND INFORMATION Mrs. XX reported that XX achieved all developmental milestones at expected ages and reported that compared to his siblings, XX began to speak early. XX performed well on his well-baby checks. XX s health history was unremarkable until occurrence of a grand mal seizure in January 2013. XX s current health history is normal. Mrs. XX stated that XX began stuttering in March of 2013. Characteristics at onset of stuttering included whole word repetitions (e.g. my my my) and sound syllable repetitions (e.g. mmmmmy). She also said that stuttering frequency has increased gradually in the past seven months and the types of stuttering have also changed. Mrs. XX states that the disfluencies occur daily but vary in severity. Two weeks prior to the evaluation, Mrs. XX reports disfluency types have changed to include repetitions of interjections (e.g. uh uh uh) and starting the utterance with the phrase first off. Mrs. XX reports that XX is aware of his stuttering but is not self-conscious and does not avoid speaking. Other communication partners noted to Mrs. XX that they notice XX s stuttering, however it does not negatively impact his intelligibility. Mrs. XX indicated that when XX begins to stutter tension can be seen on his face in the form of eye squinting and rate and depth of breathing increases. Mrs. XX also reported that XX s maternal grandmother stuttered in her childhood years. EXAMINATION AND RESULTS Mrs. XX accompanied XX to the evaluation and provided background information about her son and his history of stuttering. The evaluation consisted of the following tasks: Communication sample of XX and his mother Communication sample of XX with the clinicians Communication Attitudes Test for Preschool and Kindergarten Children Who Stutter Phonological Awareness Screening Hearing Screening Test of Childhood Stuttering (TOCS) Communication Samples Two communication samples were collected: one of XX playing with his mother, and one of XX interacting with the clinicians. The following chart represents a detailed analysis of XX s stuttering behaviors. Stutter-like Disfluencies Interaction with Mother Interaction with Clinicians Total Syllables: 328 366 Part-word repetition (2) 0.6% (1) 0.27% Single syllable word repetition (3) 0.9% (2) 0.55% Sound prolongation (0) 0.0% (2) 0.55% Tension -- -- Total stutter-like disfluencies (5) 1.5% (4) 1.4%

Other Disfluencies Interaction with Mother Interaction with Clinicians Multiple syllable word and phrase (2) 0.6% (3) 0.82% repetition Interjections ( uh ) ( first off ) N/A N/A Revisions (2) 0.6% (2) 0.55% Total Other Disfluencies (4) 1.2% (5) 1.37% Total Disfluencies (9) 2.7% (9) 2.8% During the interaction with Mrs. XX, XX displayed disfluency in 2.7% of 328 total syllables counted. These disfluencies included part word repetitions, single syllable repetitions, multiple syllable word and phrase repetitions, and revisions. Additionally, XX used interjections in 62% (44/ 71) of total utterances. Although interjections were not accounted for in the overall syllable count as they did not contribute to the overall intended message, interjection-like stuttering was the most prevalent form of disfluency observed. The average duration of stuttering events including events with interjections was 5.05 seconds. During the interaction with clinicians, XX displayed disfluency in 2.8% of 366 total syllables counted. These disfluencies included part word repetitions, single syllable repetitions, sound prolongations, multiple syllable word and phrase repetitions, and revisions. In this sample, XX used interjections in 61.76% (42/68) of total utterances. Interjection-like stuttering was the most prevalent form of disfluency observed in this sample as well. The average duration of these stuttering events in the interaction with the clinicians was 3.93 seconds. This data in conjunction with data observed in the interaction with Mrs. XX including percentage of total utterances including stuttering events and duration of stuttering events are characteristic of a severe developmental stuttering disorder. According to the Illinois Clinician Stuttering Severity Scale, severity of stuttering can be determined by rating three characteristics (frequency, duration/repetitions, and tension) on a scale of zero to six, 0 being the least severe and 6 being the most severe. The fourth characteristic measured is the existence of secondary characteristics, such as jerking, clenching, tremor, avoidance, etc., ranges from 0 being the least severe and 6 being the most severe. The results of the analysis are presented below: Characteristic Score (0-6) Frequency of SLD 0 Duration/Repetition of SLD 6 Tension 0 Secondary Characteristics.25 Subscore= 2.00 Total= 2.25 A total severity score based on the above was 2.25, which is considered to be a mild stuttering severity level. XX s Mean Length of Utterance (MLU), the average number of words and/or morphemes used in sentences was calculated from his conversation sample. XX s MLU was found to be 4.72. According to the Language Sample Analysis; The Wisconsin Guide, XX s MLU is within 1 standard deviation of the mean (M = 5.71, SD = 0.99). Communication Attitudes Test for Preschool and Kindergarten Children Who Stutter The Communication Attitudes Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT) was partially administered. XX demonstrated signs of anxiety and discomfort, including deep breathing and avoidance of clinicians when he was asked the stimulus questions. Therefore, the test was terminated. Phonological Awareness Screen XX correctly demonstrated the ability to segment sentences into words, and words into syllables. This was done by instructing XX to point to a different block for each word in a sentence (e.g. I like to swim) and by point to a different block for each syllable in a word that was given (e.g. Wisconsin).

Hearing Screening A hearing screening was conducted to assess XX s hearing acuity. XX raised his hand to indicate when he heard a tone. His hearing was tested at 20 db at 1000 Hz, 2000 Hz, and 4000 Hz. XX s hearing acuity was judged to be within functional limits. Test of Childhood Stuttering The Test of Childhood Stuttering (TOCS), a set of formal speaking tasks designed to obtain a representative sample of a child s speech, was conducted to quantify XX s descriptive severity of stuttering. XX scored into the severe disfluency category. This test uses tasks of rapid naming, modeled sentences, structured conversation and narration. The following chart represents XX s results across the four subtests: Task Raw score Percentage of stuttered trials Rapid Naming 14 35% Modeled Sentences 17 89% Structured Conversation 28 88% Narration 5 63% Total 64 65% A combined raw score of 64 based on the above subtests is indicative of a severe stuttering severity level. SUMMARY AND IMPRESSIONS XX was cooperative and enjoyable throughout the duration of the evaluation. He sustained attention across all tasks and interacted with clinicians appropriately. XX s language abilities appeared to be age appropriate, despite his disfluencies. Disfluencies included part word repetitions, single syllable repetitions, sound prolongations, multiple syllable word and phrase repetitions, revisions, and interjections, with a vast majority being interjections. Results obtained from his interactions during the evaluation were characteristic of a severe developmental stuttering disorder. RECOMMENDATIONS Based on the results of our assessment, it is considered unlikely that XX will naturally recover from stuttering without intervention. This was determined as males are less likely to naturally recover from stuttering, XX has been stuttering for more than six months, the severity of his stuttering has increased and changed since onset, and XX has a family history of stuttering. Prognosis for improvement with intervention is probable due to XX s awareness of his disfluency, supportive family, strong language skills, strong social skills, young age, and high levels of awareness and motivation. Charlie Osborne, M.A., CCC-SLP Clinical Supervisor Jena Weiler, B.S. Graduate Student Clinician Karla Steif, B.S. Graduate Student Clinician

PROJECT REFLECTION This assignment was extremely valuable to our future careers as speech-language pathologists. During my undergraduate career at the University of Wisconsin Eau Claire we did an assignment similar to this; however this assignment was different in the type and length of the sample used. It is valuable to have this type of assignment so that as emerging clinicians, we are aware of what is available and at least have the opportunity to get our feet wet in analyzing the material. This is also a good opportunity to ask questions of our professor and of our other classmates before we are out on our own in the real world. I also found it beneficial to be able to use the information we are learning in class. It is one thing to have a lecture and study information from a book, and another thing entirely to have the chance to be able to apply the information and use it in a meaningful way. I enjoyed the aspect of collaboration brought by this project as well as it gave Karla and I the opportunity to work through it together both when we agreed and when we did not. It was a good opportunity to get to use the TOCS and the Illinois to expose us to these types of evaluations and how to score them. Even taking all of our successes into consideration, there were a few times that completing this project was difficult. When listening to the sample for the purposes of transcription, there were many times that Karla and I did not agree upon what we heard. At these junctures, we agreed to every time, no matter what, go back and re-listen to what we had heard until we reached consensus on what was said. This open mindedness benefitted us greatly as it became more of a curiosity of what was actually said than a you were wrong, I was right situation. This outlook will be beneficial in our careers as Speech Language Pathologists as with perceptual judgments such as these it is vital to keep an open mind, especially when working within a team setting with various team members. Another challenge we encountered was the transcription itself. I personally found it difficult to know and write down exactly how many times the individual stuttered and then categorize this information into what type of stutter it was. This was especially difficult as the classification system we used in Eau Claire is different than the type we learned here in Stevens Point, resulting in some initial confusion of how to delineate which type of stutter corresponded with each utterance. In terms of analyzing the sample and writing our report, Karla and I came to consensus more often than not. There were several times that we listened to a sample over and over to reach inter-rater reliability, however generally we agreed upon what was said and also agreed on how to categorize the stutter. When counting syllables and morphemes within each of the samples we split up for the initial counting, and then came back together to discuss and re-analyze our findings as a team. Even during this process we rarely disagreed and it was easy to discuss the few discrepancies we had. In my opinion, one advantage of completing this assignment was that we may not all have a fluency client in a clinical setting during our graduate career. This assignment gave us the chance to analyze a sample, do an assessment, and write up a report for a fluency client in a very realistic way. Since fluency is one of the ASHA Big 9, I feel that this assignment will give us an application foundation on which to build our further education in the realm of fluency. One of the disadvantages of doing this assignment was the threat of inaccuracy posed by the poor audio/video quality of the sample. Even though Karla and I may have agreed upon what was said, we may have heard something incorrectly because of this, therefore throwing off our analyses.

Child Mother Conversational Sample Utterance # Utterance Syllables Morphemes Comments 1 Uh first off I do know how to play this game 8 2 uh uh uh first off its kind of too hard and first off I don t really like it 12 3 First off I did play this before 6 4 Uh uh uh uh uh uh uh uh I, no, I got it at good will 8 5 Uh uh uh sure 1 6 w-w-wait 1 7 Sure 1 8 First off you know if you set this thing 7 9 And I know 3 10 Uh uh uh yeah we did 3 11 First off I picked it out at good will 7 12 uh uh uh uh uh uh uh uh uh uh so pick a color uh yellow, green, blue or red 11 13 Okay now 3 14 Uh then you go 3 15 Then you go this hand 5 16 First off I think I will pick blue 6 17 first off fo firs four people have to play 6 18 First off it really doesn t care 6 19 Uh then you have to fling it uh in to the frogs mouth 11 20 Uh you turn it on 4 21 Uh uh uh you do this 3 22 Uh uh yeah it kind of comes over here and opens 11 23 Don t need to give up 5 24 So I m uh turn this the the the other way 8 25 You missed it 3 26 No 1 27 Wasn t even close 5 28 Uh uh uh uh first off probly uh uh I give up 5 29 Ooh you got it 3 30 Uh uh no 1 31 First off this game is too hard 5 32 First off I ve never tried this one 6 33 Would you help me? 4 34 Ooh uh first off this looks k too hard 4 35 This looks too hard 4 36 Uh uh uh yeah 1 37 Uh uh uh first off battery games are dumb 6 38 Come out 2 39 Yeah 1 8:36 40 Uh uh uh uh uh first off the bees come out this hole 6 41 So can we try one 5 42 Uh uh uh okay just Uh uh mom Uh it s not yet 7 43 Wait uh uh uh uh uh uh first off first off whatever hole it comes out 8 44 Uh uh see this is the best place 6 45 Uh uh see one two three four 5 46 It s the highest 4 47 One 1 48 Uh uh uh first off that was just one hole 5 49 So that doesn t count? 5 50 Uh uh uh mom uh uh uh uh uh see uh uh uh see no hole uh uh no hole I mean no hole 11 51 sure 1 52 First off its not done 3 53 When are they going to be back? 8 54 First off I do like this game 5 55 They re they are here 4

56 yeah 1 11:10 57 Uh uh uh uh one more leaf left 4 58 One more leaf left 4 59 Uh uh mom uh mom 2 60 Uh uh yeah 1 61 It probly goes g-g-goes up to like twenty 9 62 Uh uh uh your turn 2 63 Ooh come in 2 13:29 64 Uh uh uh not trying to get the bees out 8 65 The holes 2 66 Uh uh uh First off I was just starting over 7 67 Yeah 1 68 You have to put them in 6 69 Oh it shows in the constructions 7 70 Oh there s sixteen bees! 4 71 Shows right here 3 Child Clinician Conversational Sample Utterance # Utterance Syllables Morphemes Comments 1 Uh uh uh uh not yet 2 18:32 2 Uh what does this do? 4 3 Oh I see what it does 6 4 Sure 1 5 We need some gas 4 6 No 1 7 Ooh yeah I see 4 8 Uh uh uh uh first off I know that 3 9 Uh yeah 1 10 Sure 1 11 Uh uh uh yeah I see 3 12 Oh yeah I think you re right 6 13 Yeah 1 14 Uh uh uh it s supposed to be big s- it s supposed to be bigger rocks 8 15 It s supposed to be big boulders 8 16 Sure 1 17 First off I don t really knew 5 22:10 18 First off I do like playing bowling ball 8 19 First off I kind of like this game 6 20 What does this do? 4 21 It s supposed to be like a slide 8 22 No they can t 3 23 Oh yeah Oh now I see what s falling 9 24 Is this the right thing? 5 23:41 25 Hey does this do anything? 7 26 Uh yeah 1 27 Uh uh uh yes uh uh uh a dog uh a cat goldfish and chickens 10 24:32 28 Uh uh yeah 1 29 Oliver 1 30 But first off he gets to live in the house 8 31 Uh uh uh uh sometimes he goes outside uh to go pee 9 32 Yeah 1 33 No no Uh uh he is a kitten 6 34 Uh uh his name is Leo 5 35 uh mom named him that 4 36 Uh uh w-w-what are names? 3 37 Is the William is a boy? 4 38 Uh not that much 3

39 Uh uh uh uh because dogs uh uh uh and cats don t get along very good 12 40 Uh uh big brain 2 41 uh uh uh uh first off I do have two goldfish uh uh uh one of them uh is a sucker fish 14 42 Uh uh yeah it s like this big 5 43 Uh uh black with white spots 4 44 Um uh he doesn t have a name 6 45 A little bit 4 46 A little sometimes 6 47 Oh Legos here? 4 48 Uh uh just one 2 49 Uh first off I do have lots of Legos 7 50 Uh uh yeah yeah at my house 4 51 Yes 1 52 Uh uh uh uh uh first off mostly uh first off mostly I I first off mostly I just kind of go like robots uh and Lego guys 14 28:00 53 This big 2 54 Yeah uh first off he s eight 3 55 Uh uh uh yeah 1 56 Yeah 1 57 Um uh uh uh he likes to be mean to me and first off tha- first off that s like the only thing I know 16 58 Uh uh uh uh uh yeah 1 59 First off I m five and he s eight 5 60 So they re older than you? 6 61 First off I don t only have like a yard anyways 10 62 Uh uh uh First off we do have a basement 6 63 Uh well we have screen time on there and on the laptop too uh well we mostly play sport on the laptop uh uh sport is a really fun game 30 29:35 64 See you get to like make your own guy 8 65 Uh uh uh uh uh yeah uh like an alien uh uh by level five uh uh uh is the best 12 66 Yeah 1 67 Uh lots 1 68 Uh uh first off our dad even plays it too s- uh sometimes well at night he does 14