Diagnosis and Treatment of Childhood Stuttering and Disordered Phonology

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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
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Purpose

• To discuss recent advances in the diagnosis and
  treatment of children exhibiting both stuttering
  (S) and disordered phonology (DP)
• How can SDP 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?

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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
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Interaction Between S and DP

• There are differences in the basic fluency and
  phonology behaviors exhibited by SDP and SNP
  children
• Interaction may affect diagnosis and treatment of
  SDP 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)

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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 childrens sensitivity to speaking
  difficulties

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Diagnosing StutteringandDisordered Phonology
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Diagnosing Stuttering

• Purpose Determine whether treatment is necessary
  to overcome stuttering
• Components of a Diagnostic
• interview childs parents
• evaluate childs speech fluency
• evaluate oral motor skills
• evaluate other aspects of speech and language

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Interviewing Parents

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

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Evaluating Fluency

• Frequency of Disfluencies
• Childrens 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

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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

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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)

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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)

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Treating Stutteringand Phonological Disorders
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Options for Treating SDP 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

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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.

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Simultaneously Treating Stuttering and Disordered
Phonology

• Combines indirect therapy techniques for treating
  stuttering
• with
• phonological therapy techniques for treating
  speech sound problems

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Indirect Therapy

• Definition Technique that does not specifically
  correct or modify the childs speech
• Principle Model desired behaviors, but do not
  require child to produce them
• Benefits
• Does not draw attention to childs 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

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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