Diagnosis and Treatment of Childhood Stuttering and Disordered Phonology

1. Diagnosis and Treatment ofChildhood Stuttering andDisordered Phonology J. Scott Yaruss, Ph.D., CCC-SLP University of Pittsburgh Presentation at Western Illinois University Macomb, IL February 7, 1997

2. Purpose • To discuss recent advances in the diagnosis and treatment of children exhibiting both stuttering (S) and disordered phonology (DP) • How can S+DP children be better diagnosed and treated in real-world public school settings? • Should children exhibiting S and DP be treated differently from children exhibiting S or DP?

3. Co-Occurrence of S and DP • Children who stutter are more likely than children who do not stutter to exhibit phonological concerns Disordered Phonology Phonology Normal phonology Normal phonology Children who stutter Children who do not stutter

4. Interaction Between S and DP • There are differences in the basic fluency and phonology behaviors exhibited by S+DP and S+NP children • Interaction may affect diagnosis and treatment of S+DP children • Stuttering onset occasionally follows treatment for phonological concerns (Comas, 1974; Hall, 1977) • Phonological disorders may increase risk of chronic stuttering (St. Louis, 1991) or affect courseof treatment (Conture et al., 1993)

5. What Is the RelationshipBetween S and DP ?!? • The precise relationship is not known • Disordered phonology does not cause stuttering • Many children who stutter exhibit normal phonology • Disordered phonology may exacerbate stuttering • Associated difficulties with intelligibility may increase children’s sensitivity to speaking difficulties

6. Diagnosing StutteringandDisordered Phonology

7. Diagnosing Stuttering • Purpose: Determine whether treatment is necessary to overcome stuttering • Components of a Diagnostic: • interview child’s parents • evaluate child’s speech fluency • evaluate oral motor skills • evaluate other aspects of speech and language

8. Interviewing Parents • Perhaps the most difficult to get in schools, but it may be possible to obtain information from a brief phone interview • Child’s speech behaviors at home • Situations which affect child’s fluency • History of prior therapy • Change in fluency since onset • Child’s level of concern about speech/fluency

9. Evaluating Fluency • Frequency of Disfluencies • Children’s speech fluency differs with situation, so obtain several speech samples • monologue, dialogue, play with peers, play with parents • Types of Disfluencies • May provide the best diagnostic indicator of likelihood that child will continue stuttering • Physical Tension/ Nonspeech Behavior

10. Oral Motor Skills • Stuttering is, in the end, a motor activity, so it is important to evaluate oral motor skills • Diadochokinetic Rates(maximum rate of production of puh-tuh-kuh) • Rate of Speech in Conversation • Oral Peripheral Examination

11. Other Aspects of Speech and Language • Word-finding abilities • Word-finding problems may co-occur with stuttering just like phonological disorders, but empirical research has yet to be conducted • Syntactic formulation abilities • Structural analysis from conversational sample • Receptive and Expressive Vocabulary • Oral Reading Skills (for older children)

12. L D Ï ¿ Diagnosing Phonology • Purpose: Determine whether phonological system is typical, delayed, or atypical, and whether treatment is indicated • Components of Evaluation: • Speech Samples • Conversation • Picture-naming • Speech Error Analysis • Describe patterns of errors (phonological processes)

13. Treating Stutteringand Phonological Disorders

14. Options for Treating S+DP Children • Treat Disordered Phonology ONLY • Pro: Treating disordered phonology is often easier, shows faster success • Con: Stuttering fluctuates; severity may increase • Treat Stuttering ONLY • Pro: Reduces likelihood of “flare-up” • Con: Child may still be unintelligible, perhaps increasing sensitivity to speaking situations

15. L D Ï ¿ Options for Treatment (cont.) • Treat BOTH Stuttering and Disordered Phonology SIMULTANEOUSLY • Pros: Reduces likelihood of “flare-up” while improving intelligibility. Improves generali-zation since child addresses fluency and phonology goals in the same context. • Con: Child may show slower progress, especially in the beginning.

16. Simultaneously Treating Stuttering and Disordered Phonology Combines indirect therapy techniques for treating stuttering with phonological therapy techniques for treating speech sound problems

17. Indirect Therapy • Definition:Technique that does not specifically correct or modify the child’s speech • Principle:Model desired behaviors, but do not require child to produce them • Benefits: • Does not draw attention to child’s speech problems • Reduces likelihood that therapy will increase self-consciousness or sensitivity to speech or stuttering • Setting:Can be used with any activity or setting

18. Phonological Therapy • Definition:Technique designed to address error patterns rather than individual sounds • Principle:Highlights distinctions,similarities between sounds child knows and error sounds • Benefits: • Fosters generalization by changing error patterns • can easily be combined with indirect techniques • Setting/Population: children with many errors or who are unintelligible