Diagnosing Childhood Stuttering: Results from 100 Clinical Evaluations

1
Diagnosing Childhood Stuttering Results from100
Clinical Evaluations

• J. Scott Yaruss, PhD, CCC-SLP
• Speech Fluency LaboratoryUniversity of
  Pittsburgh

2
Purpose

• To present results from the diagnostic
  evaluations of 100 children who stutter
• To evaluate trends in the data that might shed
  light on the underlying nature of childhood
  stuttering
• To present clinical benchmarks that canbe used
  to help clinicians evaluate their treatment
  recommendation decisions

3
Background

• Considerable research on childhood stuttering has
  been conducted in recent years regarding
• The developmental course of stuttering
• The frequency and types of disfluencies exhibited
  by children who stutter
• The speech and language abilities of children who
  stutter

4
Background (cont.)

• Still, the diagnosis of young children who
  stutter remains less than an exact science (to
  put it mildly)
• Stuttering is a multifaceted disorder that
  manifests itself in different ways
• Clinicians are not clear which variables (from a
  host of possible options) should be targeted in a
  diagnostic evaluation

5
Many Variables

• When diagnosing children at risk for stuttering,
  clinicians must considermany variables,
  including
• Observable characteristics of stuttering
• Psychosocial factors
• Psycholinguistic factors
• Physiological factors
• Other Variables (?)

6
Some Problems

• Many of the variables may not be directly related
  to speech fluency
• Phonological development
• Lexical access / Word-finding
• Speech/language development
• Variables interact and manifest themselves
  differently in different children who stutter

7
Another ProblemRecommending Treatment

• Not all children need to be referredfor formal
  treatment
• Many children outgrow their disfluencies, so it
  is not necessary to treat everyone
• There are not sufficient resources to treat all
  disfluent children
• PROBLEM It is not always clear who does need
  treatment and who does not

8
Some Important Questions

• Which variables should be considered?
• How do children who stutter performon commonly
  administered tests of stuttering and other
  aspects of speech/language development?
• What are the characteristics of thosechildren
  referred for treatment?

9
Developing Solutions

• It would be helpful for clinicians to have access
  to a database of diagnostic information to guide
  decision-making
• Data collected in a consistent fashion
• Using a standard battery of commonly used tests
  and measures
• Based on clinical data similar to what is
  collected in the real world

10
The 100 Kids Project

• Conture, EG, Yaruss, JS, LaSalle, LR (1990,
  Nov.). One-hundred young stutterers Making sense
  of their clinical records. Miniseminar presented
  at the Annual ASHA Convention, Seattle, WA.
• Yaruss, JS, LaSalle, LR, Conture, EG (1995,
  Nov.). One-hundred children who stutter
  Revisiting their clinical records. Seminar
  presented at the Annual ASHA Convention, Orlando,
  FL.
• Yaruss, JS, LaSalle, LR, Conture, EG
  (submitted). Evaluating stuttering in young
  children Diagnostic data. Manuscript submitted
  for publication. for
  publication.
  

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General Purpose

• To describe the speech and language behaviors of
  100 children, age two to six, referred for
  evaluation of their fluency
• To examine relationships between fluency and
  other aspects of development
• To examine differences in testing resultsfor
  children recommended for
• - treatment
• - re-evaluation
• -neither treatment nor re-evaluation

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Method

• Subjects
• 85 boys, 15 girls
• Mean age54.7 mos. (SD12.2 mos.)
• Referred to university clinic for initial
  diagnostic evaluation of speech fluency based on
  parents concern re stuttering
• Analyses based on retrospective analysis of
  detailed diagnostic reports

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Diagnostic Procedures

• Based on a standard battery of tests (Conture,
  1990 Conture Caruso, 1987 Conture Yaruss,
  1993).
• 3-hour evaluation, including
• Detailed Parent Interview
• Informal Observation of Childs Speech
• Direct Speech-Language Testing

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Measures of Fluency I

• Commonly assessed observable characteristics of
  stuttering
• Average Frequency of Disfluency
• Average Duration of Disfluency
• Most common Types of Disfluency
• Within-word disfluencies
• Between-word disfluencies
• Sound Prolongation Index

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Measures ofFluency II

• Commonly used tests of stuttering
• Stuttering Severity Instrument (Riley, 1980)
• Iowa Scale for Rating the Severityof Stuttering
  (Johnson et al., 1963)
• Stuttering Prediction Instrument (Riley, 1981)
• Stocker Probe Technique (Stocker, 1980)

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Measures of Speech and Language Development

• Phonological Development
• Picture naming task (GFTA, Weiss, Hodson)
• Phonological processes analysis (Edwards)
• Receptive Vocabulary (PPVT)
• Expressive Language
• -- MLU, Grammatical Morphemes
• -- Standardized Test
  (TELD,PLS-3,CELF)
• -- Informal play-based
  assessment

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Other Measures

• Childs Diadochokinetic Rates
• Based on rapid repeated production
  ofpuh-tuh-kuh following a model and compared
  to available norms
• Parents Articulatory Speaking Rates
• Since parents are often told to change their
  speaking rates during treatment

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Diagnostic Decisions

• Treatment Treatment in a parent/ child fluency
  group involving weekly group and individual
  sessions
• Re-evaluation Re-evaluation 3 to 6 months
  following initial evaluation
• No treatment Neither treatment nor
  re-evaluation at time of evaluation
• Parents received extensive counseling

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Selected Results

• Basic measures of fluency
• Speech/language development
• Other Measures (DDK)
• Interactions between variables

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Basic Measures of Fluency

• Frequency, Duration, and Type of Speech
  Disfluencies

Most CommonDisfluency Type
Frequency ()
Duration (ms)
Prolongation Index ()
Other
7
(In)audible Sound
Prolongation

• 3

Whole-Word
26
Repetition

• 2

• 4

20

• 1

N
100
N
90
N
94
Sound/Syllable
Repetition
47
21
Basic Measures of Fluency

• Measures of Severity and Chronicity

Iowa Scale
SPI
SSI
N
100
N
81
N
76
22
Speech and Language Development

• Exp. Language Phonology

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Speech and Language Development

• No significant differences in fluency of children
  with normal vs. disordered phonology (similar
  findings for language)

25.00
20.00
Disordered Phonology
Normal Phonology
15.00
10.00
5.00
0.00
Frequency
Iowa Score
SPI Score
Duration
SSI Score
24
Speech and Language Development

• Patterns of phonological errors

• GL

35
Disordered Phonology
30

• ST

No. of Children Exhibiting Process
Normal Phonology
(based on guidelines of Edwards Shriberg, 1983
Grunwell, 1982 McReynolds Elbert, 1981
Stoel-Gammon Dunn,
1985)
25

• SCR

20
15
10
5
0
VOC
DP
LAB
DA
FCD
LCR
ALV
INT
IV
ID
WSD
FDV
GL
ST
VF
PAL
GR
VEL
SCR
LAT
AFF
25
Other Measures

• DDK Rates

26
Treatment Recommendations
27
Relationships Between Stuttering and Childs Age

• No significant relationships between speech
  fluency and chronological age

r .18p .12
r .07p .47
Age
Age
Severity
Frequency
28
Relationship between Fluency and Time Since Onset

• Children stuttering longer more likely to produce
  sound prolongations

60
50
Percent of Subjects
40
30
20
10
0
Whole-word
Sound/Syllable
Sound Prolongations
Repetitions
repetitions
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Relationships Between Measures of Stuttering

• Expected strong correlations between basic
  measures (frequency, duration, type) and derived
  measures of severity and chronicity (SSI, SPI,
  etc.)
• Also, expected strong correlations between
  measures of severity (SSI) and measures of
  chronicity (SPI)

30
Relationships between Stuttering and Language

• No relationship between measures of stuttering
  behaviors and...
• overall language development
• phonological development
• DDK rates
• No apparent differences in fluency of children
  with normal vs. disordered speech/language
  development

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Relationships Between Language Measures

• In these children who stutter, there was a
  significant co-occurrence of
• below-normal DDK rates
• below-normal language
• disordered phonology
• Interesting interactions between language,
  phonology, motor production and stuttering

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Stuttering and Treatment Recommendations
65
Treatment
45
No Treatment / Reevaluation
40
No Treatment / No Reevaluation
35
30
25
20
15
10
5
0
StockerProbe
Frequency
Prolongation
Iowa Scale
SSI
SPI
Duration
Index
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Discussion

• Results provide data about howchildren perform
  on commonly used measures of stuttering and
  speech/ language development during a diagnostic
  evaluation
• Results also provide a means for evaluating the
  diagnostic practice utilized by the clinicians in
  this clinic

34
Stuttering and Speech/ Language Development

• Present findings support prior reports that
  children who stutter are more likely to exhibit
  disordered phonology
• Findings also suggest that some children who
  stutter may havedifficulty with diadochokinetic
  rates
• Interaction between DDK, language, and phonology
  should be examined

35
Uses of the Data Set

• Data provide indication of factors that might be
  involved in onset of stuttering
• Clinicians can use these data as a reference to
  determine how their clients compare to other
  children who stutter
• Results provide information about the
  characteristics of children referred for
  treatment by this set of clinicians

36
Diagnostic Benchmarks

• Data-based benchmarks for comparing treatment
  recommendations

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Future Directions

• Replicate and extend findings using children
  evaluated at NU
• Standardize diagnostic battery
• Develop templates based on results of these
  children that can facilitate comparison to other
  datasets
• Examine relationships between language,
  phonology, and motor development in children who
  stutter