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The focus of clinical activities

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1. Diagnosis and 2. Therapy/Intervention

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Diagnosis

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Identification of a disorder by analyzing symptoms present distinguishing a persons particular problem from the many possibilities available -concerned with understanding client's communication disorder

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Differential diagnosis

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distinguishing between two conditions that appear similar by discovering a significant symptom in one condition but not the other

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Evaluation

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the process of arriving at a diagnosis through interview, informal and formal assessments, etc

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Diagnosis and evaluation are

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ongoing, we administer assessments, arrive at an initial diagnosis and continue to conduct assessment activities during intervention activities

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Two major goals of evaluation tasks

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1. To understand/diagnose client's problem 2. Monitor client's progress in treatment/intervention & describe changes in communication

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From a broader perspective diagnosis and evaluation ranges from

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diagnosis--> baseline data--> measure progress

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The three levels of diagnosis and evaluation on continuum

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1. diagnosis 2. moving through establishing baseline performance data 3. measurment of treatment progress diagnosis--> baseline data--> measure progress

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Process of understanding a communication disorder

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1. Determining a complaint-what led a person to see you 2. Existence of communication disorder- deciding if there is a disorder and what areas are affected 3. Family attitudes and reactions- Responses to client's communication 4. Associated Problems - (e.g. vision problems for stroke victim)

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Process of understanding a communication disorder (con't)

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5. Possible causes of the problem/what increases it (if vocal nodules..could be sign of cancer and needs medical diagnosis) 6. hearing loss must be ruled out 7. Prognosis (course of problem or progress of it, will it get better?) How effective will treatment be?

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3 important influences in the field of Speech Pathology

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1. Evidence-based=practice 2. Dynamic Assessment 3. RTI Response to intervention

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Clinicians should consider factors such as

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1. Age- the earlier the intervention the more progress that can be made 2. Length of time impairment has existed- habitual activities more difficult to change 3. Existence of other problems 4. Reaction of significant others 5. Client motivation

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When determining treatment activities

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whether to start or continue intervention

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The most important tool is the

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clinician/diagnostician

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Schools make decisions based on ________ rather than ________________________

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administrative criteria; professional criteria

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Current trends in assessment include

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Evidence-based practice; Response to Intervention; Dynamic assessment

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2 major implications of Evidence Based Practice

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-Must select diagnostic procedure and measures that have most scientific support and psychometric adequacy -evaluate effectiveness of and efficiency of protocols for prevention, intervention and enhancement using criteria recognized in evidence based literature

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What did Haynes & Pindzola (1998) point out about the diagnosis benefiting the client?

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The diagnosis could benefit the client utmost only when it is goal-oriented & would provide logical suggestions for treatment. -Its process should be "dynamic" by nature and therefore allow the clinician to gain some insight into clients tendencies and preferences

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Through assessment, the clinician should accomplish these goals:

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1. gain knowledge of etiology &/or cause- effect of the problem 2. establish a trustful rapport with the client 3. provide some info, education, &/or counseling 4. decide treatment direction & made appropriate recommendation

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Case History interview

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1. explore the 3 p's 2. establish the client-clinician rapport 3. obtain speech & lg sample of various speaking conditions - a variety of speech tasks (reading, monologue, telephone) - across different situations (clinic, home) & time/ dates

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Speech and Language assessment involves:

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1. differential diagnosis 2. evaluation of oral-motor coordination 3. analysis of speech/ verbal samples 4. evaluation of speech, lg, and communication abilities 5. individual vulnerability & psycho-sociological impact 6. environmental factors and support systems

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Differential diagnosis

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-onset and development of stuttering -fluency-inducing conditions -adaptation effect -speech (motoric) vs. lg (formulative) disfluency

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Evaluation of oral-motor coordination

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a) oral motor examination b) diadockokinesis (DDK) task : tests strength, accuracy, speed, regularity, sequence & coordination of articulatory movements c) OMAS (oral motor assessment scale)

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Analysis of speech/verbal samples

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1. dysfluency index- total & subtotal 2. syllable stuttered (%SS) 3. duration of stuttering moment 4. duration on prolongation 5. unit of repetition 6. rate of speech

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Analysis of speech/verbal samples (con't)

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7. tension of blocks 8. mental efforts 9. naturalness of speech 10. communication effectiveness 11. physical concomitant behaviors 12. diversion of eye contact 13. escape & avoidance behaviors

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Evaluation of speech, lg, and communication abilities

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a. speech and/ or lg sample b. standardization tests: artic and or lg

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Examples of formal tests and informal behavioral checklists or scales

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-Stuttering Prediction Instrument (SPI) -Stuttering Severity Instrument (SSI-3) -Locus of Control - Erickson S-24 -Communication Attitude -A-19 Scale for Children Who Stutter -Situational Ratings -Severity of Stuttering

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Individual vulnerability and pyscho-sociological impact

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-individuals own perception, feelings, and attitudes, self-esteem, confidence, etc -individuals temperament -sensitivity and perfectionism -impact on individuals life

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Environmental factors and support systems

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-childs reactions to his environment, & interactions with parents, siblings, teachers, and peers -perception and or reaction of the individuals significant other -parental/ mother-child interaction, childs daily routine, and family interaction style -issues of concern when assessing different age groups

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Issues of concern when assessing pre-schoolers

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a. normal disfluency or at risk to developing stuttering? b. mother-child interaction style c guideline/ advice/ education/ counseling for parents regarding "dos and donts"

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Issues of concern when assessing school age children

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-criteria and qualification for receiving speech service -reactions to his/ her stuttering or ways to deal w/ teasing and frustration -behavior, perception and support system -being an advocate to the child -other speech services needed

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Issues of concern when assessing Teens

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-self-identification, self-esteem/self-acceptance, and self-confidence -social relationship with self, others, and the world -frustration threshold and tolerance level -talent, strengths, or hobbies

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Issues of concern when assessing Adults

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-impacts on life -motivation and readiness - expectation for tx - belief system and attitude toward therapy -commitment to change

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Normal disfluency

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-the momentary repetitions, revisions, and pauses in the speech of most normal adults, when the speaker is in a hurry or uncertain -normal children who are developing speech and lg may show repetitions, revisions, and pauses- which are not stuttering

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Developmental stuttering

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-typical stuttering -the disfluency symptoms usually appear gradually, during the period of greatest speech and lg development

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Potential explanations for connection between fluency & speech/lg development

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a. neurological maturation and competition among motoric, cognitive, emotional, social behaviors, and speech & lg abilities b. trade-off between speech & lg, and between fluency & speech c. Mismatch between demands and capacities

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Major features that distinguish normal disfluency from developmental stuttering

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a. the amount of disfluency b. the number of units in repetitions and interjections c. types of disfluency in related to the childs age d the duration of the prolongation e. the presence of secondary behaviors f. the awareness, feelings, attitudes

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The Amount of disfluency the # of disfluencies per 100 word

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-It may not apply to revisions, interjections, or phrase repetition associated w/ more than one word

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Wendell Johnson's (1959) findings on the amount of disfluencies

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68 male stuttering vs 68 male nonstuttering children (2:6 - 8yrs) - the stutters had more than twice the amount of disfluency = 18 disfluencies/ 100 words for stutters vs 7 disfluencies/ 100 words for nonstutters -estimated that the average normally disfluent preschooler may have 10 disfluencies or less in every 100 words

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The Number of Units in repetitions and interjections

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typicall y normal repetitions consist of at most one or two extra units, instead of multiple units of repetitions

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The Type of disfluency in related to the child's age

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-Johnson & Associates (1959) found the most frequent disfluency types among the 68 nonstuttering males were: interjections, revisions, and word reps -In Yairi's (1981) study, one syllable word, and interjections and revisions were the common disfluency types.

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The Duration of the prolongation

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-Van Riper and others consistently reported of no longer than 1 sec of duration -Riley indicated prolongation lasting for more than 2 secs equals a good predictor of chronicity

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The presence of secondary behaviors

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-normallly disfluent children have no secondary behaviors (regardless of some displaying "tense pauses". -If the child displays reactions frequently to his normal disfluencies by pauses or interjections immediately before or during the disfluencies,he may require careful evaluation

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The awareness, feelings, and attitudes

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The normally disfluent child does not notice his disfluencies. He/ she will usually continue talking after disfluency, without frustration or embarrassment

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Riley's Stuttering Prediction Instrument (SPI) 5 Sections

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Section I: A brief case history Section II: Parental reaction to stuttering Section III: Frequency of part-word res & other abnormalities Section IV: Prolongations, phonatory arrest, & articulatory posturing Section V: Dysfluency index

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Stuttering Prediction Instrument with a score of 9 or less

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a very high probability of outgrowing stuttering

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Stuttering Prediction Instrument with a score of 10 to 13

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a borderline case, In this case, family history is key to the prediction of recovery or chronicity

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Stuttering Prediction Instrument with a score of 14 or more

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stuttering may become chronic, higher the score the greater is probability of chronicity

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Riley's research on Stuttering Predication instrument shows

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-excellent predictors of chronicity are phonatoy arrest & articulatory posturing -good predictors of chronicity are prolongation lasting for more that 2 seconds -poor predictors of chronicity are frequency of total disfluencies and parents negative reaction to the child's disfluencies

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Contour's (1997) indicated:

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-that a child can be meaningfully classified as a stutterer &/or at risk for continuing to stutter

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