Stuttering Case Study

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Background
Accurate assessment of a person with stutter (PWS) is crucial in selecting the most effective relevant therapy and achieving successful outcomes. (Tarkowski, 2010). In particular it is important to assess whether a person has a normal disfluency or a stutter (Curlee & Perkins, 1985; Andrew & Ingham,1971). Diagnosis can be challenging due to the occurrence of disfluent speech at early age which appears and disappears in some situations and can be missed in others (Tarkowski, 2010). Nor should a parent’s input be overlooked as it may provide a clinician with essential information on their children’s speech (Einarsdo & Ingham,2008).

There are variety of symptoms that associated with stuttering, both overt and covert, also recognizable speech components that are consistent with stuttering, namely repetitions of parts of words, single-syllables or sounds and prolongations and blocks (Yairi & Sheery, 2011; Conture, 1990; Andrews & Ingham, 1971). Additionally, repetitions and blocks are easily identified whereas drawling, revisions and pauses are less noticeable (Tarkowski,2010). Covert behaviours include avoiding words they find difficult or substitution of another word. The feelings, emotions, and beliefs can accompany their stuttering which more likely to complicate the situation (Yairi & Sheery,2011; Conture,1990).

Measuring the Severity of Stuttering
Stuttering Severity Instrument (SSI) developed by Riley in 1972. According to Riley (1972) the SSI consists of three parameters which is also used to measure stuttering severity. The first parameter measures frequency of sound/syllables repetitions & prolongations, the second is an estimation of the duration of the three longest stutters and the third records observable physical concomitants such as head movement and facial grimacing. The mean of the overall score permits identifying severity from very mild to severe. However, he has not classified age groups into children and adults. The same score will correspond to a different severity in children and adults, such as moderate or mild (cited by Guitar, 1998 & Healey, 1991). Healey listed the strengths of the instrument as being simple, easy to obtain, widely used by clinicians and highly reliable for measuring stuttering frequency and duration. It is also time efficient and easy to score. However, content validity was noted as a limitation by Healey. Alternatively, the Wright and Ayre Stuttering Self Rating Scale can be used with PWS but not for CWS (Ayre & Wright, 2000).

Analyses and Diagnosis
According to Riper (1982) it is important to get an adequate speech sample in length for measuring frequency of the stuttering. Too small and it may not allow the SLT to record stutters; too large and it may become tiring. 400 words or 10 stutter moments can provide efficient data. The SLT also ought to identify whether they are repetitions, prolongations or tense pauses. The frequency of stuttering behaviour, define by Riper (1982, p21) as “…disrupted sound, syllables and words or reacts to them by obvious struggle or avoidance.” is the determining factor when making a clinical diagnosis. Making differential diagnosis can be difficult in young children as even normally developing children can stutter from time to time.

Based on speech profile (SP) data Danny is diagnosed with moderate stutter (5.58% SS, Andrews & Harris, 1964) – see analysis in the appendix –He primarily displays single syllable repetitions (Wingate, 2001). Although articulation is clear, Danny’s speech rate is slower than normal for his age. He also manifested repetitions, most commonly at the beginning of the sentences and particularly on consonants e.g. “what, do, you and rubber”. He got frustrated during play when his mother did not follow his lead and his speech became even less clear. Since he is not facing the camera it is difficult to see any secondary characters such as jaw thrust or eye blinking although he occasionally...
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