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DYSFLUENCY NOTES 2: THE ASSESSMENT OF STUTTERING |
CONTENTS:
Introduction
General guidelines
to assessment
The process of assessment
The speech profile
Attitude assessments
Psychological investigations
LEARNING
OBJECTIVES
Students
should be able to:
Perceive
and count overt stuttering symptoms
Carry
out and interpret selected attitude assessments
Describe
and discuss the controversies about stuttering assessment
Consider
the person who stutters as a whole and begin to see how therapy must be designed
for the individual
Compare,
contrast and critically evaluate the various models of stuttering assessment
Key Text: Chapter 7 Stuttering: an integrated approach to
its nature and treatment Guitar
1998
Introduction
Assessing stuttering is possibly one of the most
contentious issues in the whole field of disfluency because the disorder is so
variable. As Sheehan (1970) says
"it is not a unitary problem". Also the type of assessment which
might be done is dependent upon the theoretical standpoint of the clinician.
For example those therapists who follow the belief that stuttering is a learned
behaviour will assess it from this point of view.
The role of assessment must be strongly related
to outcome measures in the current climate of service provision. Purchasers of
our services have a right to see how effective we have been and think we might
be in future but this always been considered difficult in the area of
stuttering because change is difficult to measure and customer satisfaction is
not always related to a reduction in dysfluency. A good overview can be found
in the paper by DesForges and Rowley
(1994 unpublished but in tied articles)
which discusses this issue for
A further major ethic is that we should not just
be assessing the disorder but should be evaluating the person with the disorder. If we do not do this our assessment will
bear no relationship to the needs of the individual. However, once we try to do
it the number of variables we try to include tend to create confusion. It is
still better, however to look at the person as a whole than to simplify the
situation but it may help to alleviate the anxiety of the therapist to know
that the procedure is complex.
General
Guidelines for Assessment
WHO
should be assessed
Anyone who is referred
or refers themselves, at whatever age. It is vital that children are seen as
young as possible i.e. as soon as a parent/ other carer feels any alarm.
WHY
assess stuttering (especially if it is so difficult!):
a) differential diagnosis i.e. between
stuttering and non stuttering and
between subgroups of stuttering
b) obtain base measurements,
c) observe & record change,
d) plan effective therapy,
e) predict outcome of therapy,
f) evaluate treatment and make changes
g) provide outcome
measures for purchasers
h) find out more about the nature of
stuttering i.e. are there subgroups.
Hayhow (1983)
WHEN
to assess stuttering
at initial visit
post - treatment
follow-up (this has more
often than not been omitted from efficacy of therapy studies)
N.B. because stuttering
is so variable even throughout a single day it is hard to find a reliable time
WHERE
to assess.
There are major problems
in getting representative samples of speech as stuttering often improves in a
clinic environment out of all proportion to what it is like outside.
Some authors suggest
that there should be covert (secret) assessment but these are suspect on
ethical grounds.
WHAT
to assess
This refers to both
overt and covert characteristics although whether one deals with psychological
areas depends on one's theoretical viewpoint. Learning theorists say that
people who stutter do not have primary covert problems but only have
psychological difficulties resulting from the overt problem. Others feel there
is a strong, primary, psychological problem.
There are also different
viewpoints as to whether we should assess the ‘moment’ of stuttering (Johnson)
or view the total speech behaviour as disordered.
Overt features
The
main ones are repetitions, prolongation and blocks. Others include facial
grimacing and body movements, body tension and tremor, vocal fry, repositioning
of the articulators, interruptor devices, speaking on complemental air,
speaking on inhalation. Reaction to the fear of stuttering include avoidance,
postponement, timing devices e.g. several "run - ups" to the word,
trigger postures, disguise reactions (laughing it off) and finally a whole
history of accessory reactions. Van
Riper (1982)
Covert features
The
responses to the experience of stuttering in terms of feelings reactions and
attitudes. The basis of all these covert features is fear including fear of
loss of self control, fear of listener reaction and fear of revealing the
stutter. Causes of fears include situations, conditions of communication,
communicative content, linguistic precipitants, phoneme fears and word fears.
Other covert reactions
are frustration, hostility and guilt. Any or all of these are at the root of avoidance which is why the perpetuation
of avoidance is so harmful. Van Riper (1982)
Bloodstein
(1970) said that "If the stutterer were to forget
he is a stutterer he would have no further problem." When he does forget,
through distraction, fear or anger, for example, he often appears improved.
Sheehan in particular felt that the whole problem is one of
attitude. Indeed, a speech technique could produce a kind of avoidance
behaviour.
One
of the most useful ways of analysing the relative proportion of overt and
covert symptoms is to ask the client to draw his or her own "iceberg"
(Sheehan 1970) and Byrne (1992) gives a good description
in "Lets Talk about Stuttering".
This analogy refers to
how the major portion of the problem may lie hidden well below the surface or
may be visible above. Sheehan stated that the stutterer needs to convert the
concealed behaviour into more open behaviour so that this can be reconditioned.
Individuals differ
enormously in the amount/severity of these symptoms and the relative degree of
overt/covert qualities. This is obviously of prime importance in planning
therapy and most of the assessment procedures are devoted to it as listed
below.
Not only do we want to
know what someone is doing but also how severe they are and how remediable the
problem is.
Assessment of related areas (these tend to be assessed in children
rather than adults)
phonology
language
hearing
reading
education
i.e. knowledge of
client’s whole world
HOW to assess.
The usual protocol and a
selection of some of the methods are as follows:
The Process of
Assessment
Referral
All therapy must begin with an assessment of the
person with the problem. This actually starts with the form of referral e.g.
from employer, self referral, from teacher, from parent themselves. All will
have different implications for therapy in terms of type of therapy, motivation
and outcome.
Initial
appointment
This should be offered during working hours or
school time unless one is specifically working in evenings. If the individual
is unable to attend because of the time this must say something about their
future commitment to therapy. (Evening classes can always be offered later for
therapy). It is very important to stress the level of commitment the
professional expects from the client. Some people who stutter do hope for the
instant cure and need to adjust to the knowledge that a great deal of time and
effort will need to be invested in this change.
The initial appointment can only begin a process
of investigation, which should then continue throughout contact. It is
important that the therapist is able to adjust style to suit the client
involved. Some people have a great deal to say, some stutter too severely and
are unable to impart a great deal and young children ought not be conscious of
assessment at all.
Informal Observations
They
start the minute the client enters and include observations of
posture
social
skills
the way in which a
person speaks
the way in which a
person stutters
etc.
Case
History
This should give us a very full overview of the
person and cannot be completed quickly. All professionals will complete a
history whatever their beliefs but they might stress different questions. The
information about the past and present of an individual takes time to build so
that the professional can see the problem from the point of view of the
complainant and the relative importance of each fact examined. In order to do this one needs to take the credulous listening approach (Kelly
1955).This approach is basically one where one accepts what the client says and
does not reject those facts (neither silently nor to their faces) which do not
fit in with one's own picture. The sort of information one needs to gather and
prioritise depends on, for example, he age of the person and their experience
of life. It is not until one is better
able to subsume the problems of the person in the present that any change for
the future can be planned. In the Case History one should try to ask questions
that help the client elaborate what they are saying rather than interrogating
them. For example it may be useful to follow suggestions made by Hayhow and Levy 1990 , one of which is not to ask the
question "Why". but rather
"What" and "How" as these "encourage clients to focus
on specific behaviours and questions rather than abstract aspects of the
problem". Also, always supply what information you can to clarify the
picture for them. A useful model to keep
in mind is that while you are the expert
on the theory of stuttering the client is the expert on themselves.
Authors have devised their own Case History
protocols and indeed there are different procedures in different clinic
environments. General areas of questioning are as follows:
When dealing with children the history is obtained from the parents paying
particular attention to the following:
developmental milestones
history of speech complaint
current management of speech problems
other speech /language problems
familial history of stuttering
relationships within the family
emotional development
school details
When dealing with adults knowledge about the onset and development of
stuttering is not as vital unless it is
sudden. Other details as they relate to
the stuttering problem include:
previous speech therapy and /or other therapy
relationship status
job
client's ideas about onset and cause
views on responsibility for stutter
changes in stuttering over the years
best/worst occasions for stutter
expectations of present therapy
model of therapy (doctor/patient,
student/teacher, partnership)
type of therapy desired (group or individual,
intensive or weekly).
The therapist notes how the information gained
by asking these questions relates to their knowledge base about stuttering.
Rustin
(1987), in her Assessment and Therapy Programme for Young
Children stresses that an in-depth parental interview should take place
covering general health, eating sleeping and elimination, muscular system and
concentration, speech family structure and history, home circumstances, family
life and relationships, child's developmental history and temperamental or
personality attributes.
The City Lit suggests Case History questions for
adults. They say it is useful to follow a "reasonably uniform approach to
our first encounter with a client".
Another way to find out more about the client
and their world is to ask them to complete a questionnaire. This can be similar to or different from questions
asked in the interview but it allows some clients more time to think and add to
information at home.
Procedures
These tend to be a mixture of both formal and
informal methods.
The following section presents the
Speech Profile which assesses
the overt symptoms of stuttering and the
Attitude Assessments
which are the most frequently used tools by which covert features are assessed.
THE SPEECH PROFILE
The way this is done differs depending on the
reasons for doing it. Some reasons are:
·
for differentiating incipient
stuttering (Riley & Riley 1981/84)
(see Onset and Development notes)
·
solely for gaining a measure of overt severity
·
for deciding upon the type of therapy
which should be undertaken (results examined in conjunction with results of covert tests)
The speech profile looks at the overt
characteristics of the client and those professionals who feel that stuttering
is basically a more psychological problem sometimes do not conduct the
frequency count of stuttering in the speech profile. Indeed some therapists
feel that a frequency count lacks
predictive efficiency and too lengthy an assessment is not useful.
The Frequency Count
The way to conduct this has been described countless times by
different authors. They all have much in common but there are several areas of
disagreement. Hayhow 1983 in Approaches to the treatment of stuttering gives
a full picture of the points of disagreement outlined below and which are still
true today:
1. What to count as stuttering behaviour. How do
we know what is a normal non fluency and what is a stutter
2. How to count stutters e.g. is s-s-s-stutter
three stutters or one? Stutters differ hugely in their manifestation, the
simple distinction being between blocks, repetitions and prolongations. Should
we differentiate them or should we group them all together?
3. When working out the percentage of stuttering
should we use the syllable or word as the unit of measurement? The syllable
tends to be used more often as a) words
vary in length, b) the rhythm of speech is built around the syllable, not the
word and c) it solves the problem of more than one stutter in a word.
4. We cannot be sure that our result is
representative of the person's problem
(see where and when).
5. Does frequency really
indicate severity (frequent small repetitions vs infrequent massive blocks).
6. How do we decide what
is a normal non fluency and what is stuttering?
7. If therapy is not geared towards the
elimination of overt factors (as in the case of covert stuttering) then is a frequency count useful?
To reduce unreliability professionals should
ensure that their own assessment of individuals is CONSISTENT.
Steps in the Frequency Count Assessment
1. Prepare
either a video or audio tape recorder
2. Explain what you will be doing to your client
3 Reading a passage of
about 200 words out loud (Rainbow
Passage or Arthur the Young Rat). The reason for including reading (in those
who can), is that one can then detect the tendency to avoid.
4. Monologue for 2 - 3 minutes using the topics
of e.g. job, school or stuttering
5. Dialogue for 2 - 3 minutes on any topic
6. Phone or speak to another person in the
clinic who is a stranger to them.
7. Assess the frequency of stuttering in each
case using the following
No.
of syllables stuttered * 100 =
%Syllable stuttered
No
of syllables spoken
(N.B. either words or syllables can be used as the
unit of measurement but one should be
consistent)
What to count as stutters: Repetitions (R)
for the equation Prolongations (P)
Blocks
(B)
(see Onslow below for alternative)
8. In order to assist in conveying the
perception of severity, time the duration of the longest stutter.
9. Assess overall speaking rate:
Syllables (SPM) = no. of sylls. spoken in 2
mins
per minute 2
Normal speech rates in syllables range from 162
– 230 spm, with a mean of 196 (Andrews
and Ingham 1971) . Normal reading rates are about 210 – 265 spm.
Different authors define different frequency
measures and if a therapist is following one of these programmes it is
essential that those measures are used. Examples are Onslow (1996/9) and Rustin
(1987).
Recently, for example, (Onslow & Packman 1999) suggest that ‘scientists within the
field may not be communicating with each other as effectively as they might’
and that ‘the source of this disarray is in the nature of the data language
which is inconsistent, illogical, and imprecise and frequently does not portray
the behavioural characteristics of the disorder.’
They suggest a data language which will be valid
and reliable in describing behavioural features but caution that it is not to
be used for differential diagnosis nor as a severity instrument.
STUTTERING
Repeated movements Fixed
Postures Superfluous
Behaviours
Syllable repetition with
audible airflow verbal
Incomplete syllable repetition without
audible airflow nonverbal
Multisyllable unit repetition
The Lidcombe behavioural data language of stuttering
Evaluating
severity
The frequency count gives a picture of the raw
data but this needs to be translated into a picture of severity of stuttering
for the individual. The main problem
with this, however is that many minor stutters will always appear, on paper, as
more severe than the infrequent long contorted stutters which will appear more
severe perceptually.
The assessment of frequency and rate together is
one of the main methods for assessing severity. There is said to be a
correlation between frequency and listener judgements of severity but it is not
particularly high (between .41 and .71 Aron
1971).
Other (numerous) semi - formal and formal ways
of assessing severity are:
1.
2.
Andrew's & Harris 1964. Although this is one of the oldest it remains
one of the quickest and most used, offering communication between therapists.
It uses a grade system:
Grade 0 - stutter
not heard at interview
Grade 1 Mild stutter
Communication
unimpaired
0-5%
words stuttered
Grade 2 Moderate stutter
Communication
slightly impaired
6-20%
words stuttered
Grade 3 Severe stutter
Communication
definitely impaired
over
20% words stuttered
Their codings for symptoms were:
A: simple repetitions
B: Prolongations and hard blockings
C: Associated facial and body movements.
They also feel that the rate of speech
correlates highly with severity and their percentage calculation takes this
into account. Below the rate of 140 = or - 24 wpm speech sounds abnormal.
3.
4.Revised
5. Stuttering
Severity Instrument - Riley 1972. Yields a single numerical representation
of severity within a range of 0 -45 and has three parameters:
a) frequency of repetitions and prolongations
b) estimated duration of longest blocks
c) observable physical concomitants.
A useful tool.
6. Standard
Talking Samples - Costello & Ingham 1985. Assessed in terms of
frequency, duration, speed, length of stutter-free speech, speech quality and
speech behaviour under different "probe" conditions e.g. reduced
rate, prolonged speech, rhythmic speech, shadowing, verbal punishment,
self-recording, time-out and chorus reading. They use ABAB designs. They do not
describe the nature of the moment of stuttering as Costello & Hurst (1981) found that these divisions were not
clinically meaningful.
Further points for the Speech Profile
Other factors apart from frequency and rate are
usually assessed these days as they are useful for the selection of therapy and
give a more complete picture of the whole person.. They include:
1. Consistency of stutters i.e. are they always
blocks, repetitions or prolongations? Do they occur at the same valve
regardless of the articulation (more severe if so). Is there difficulty
starting and a tendency to "runaway blocks" or tension?
2. What is the reaction to stuttering (the
person who stutters and listeners)?
3. What are the concomitant or secondary
behaviours?
4. What is the fluency like i.e. rate, breathing
pattern, accent variation, syllable stress. Does fluency feel easy or
"tenuous" and how natural does it sound?
5. What is the average length of non- stuttered
intervals?
6. What is the intonation and prosody like?
7. What is the general communicative style like?
Other Assessments
Luper & Mulder 1964 provide
a checklist for child and adult stutterers and Cooper 1982 in his "Disfluency descriptor digest for clinical
use" assesses which of a set of fluency eliciting techniques might be used
most advantageously.
Designing
a Situation Hierarchy
Because stuttering is so variable it is useful
to ask a client to list their situations in order of most to least difficult.
Reasons for difficulty can be discussed and the assessment is used when
transferring fluency from the clinic to outside. An example might be:
talking on the phone most difficult
talking
to a group
talking to strangers
talking
to the boss
talking
to friends
talking
to family least difficult.
ATTITUDE
ASSESSMENTS
Hayhow
(1983) notes that there is a controversy about whether
or not to assess attitudes. The
differences of opinion relate to beliefs about the nature and cause of
stuttering and to one's persuasion about the form of therapy that should be
given (fluency shaping versus behaviour modification).
Current attitude assessments are unsatisfactory
because their reliability and validity are virtually untested and there is
always confusion about what the scales measure.
Attitudes are assessed in three main ways:
Questionnaires
Specific
attitude assessments
Psychological
investigations.
Questionnaires
Can be for parents, children and adults and ask
direct questions about fears, avoidance, situations and relationships etc.
The Situation Questionnaire was
developed from Shumak's self ratings
for reactions to speech situations and quantifies the amount of avoidance and
reaction to these.
Attitude Assessments
These are many, varied and largely,
unstandardised. The two commonest are described below:
The S24
Andrews and Cutler 1974 JHSD 39 p315
(Adapted from Erikson's 1969 S39 Scale)
Originally the S39 scale was used to compare
stutterers' and nonstutterers' attitudes towards communication but was adapted
by Andrews and Cutler in 1974 to
select those items which
a) discriminated between the two groups
b) show a strong bias towards normalcy when
administered to stutterers improving in treatment and
c) proved reliable when repeatedly administered
to stutterers in treatment.
Clients do tend to fill the form in honestly
although Preus (1981) said his
subjects were inconsistent or failed.
Basically, the higher the score the more
disordered the attitude to communication is said to be.
There is a problem relating the results of this
assessment to severity in that Andrews
and Cutler (1974) and Guitar and Bass (1978) failed to find a correlation.
This is probably because those persons skilled at avoidance would have low
severity but a high S24. Those with overt symptoms can sometimes have a less
"disordered attitude" conversely and there may be different cases for
different subgroups. Helps (1975) found
that those stutterers who see themselves as like other stutterers have a high
S24. Certainly the result is obviously important when choosing therapy i.e.
5% stuttering and more than 9 scored on the S24
equals more concentration on attitudes than on technique and
20% stuttering and less than 9 scored on S24
equals greater concentration on technique than attitude.
Guitar
and Bass (1978) say that stutterers who do not show a
normalisation of communication attitudes on the S24 by the end of treatment
will have a poorer long term prognosis.
Children’s
Attitude Test Brutten (1985)
Similar to the S24 and again quite widely researched.
Fewer implications noted.
The Perception of Stuttering Woolf (1967)
Asks the person who stutters to evaluate dysfluent behaviour in terms of struggle (20 Y/N statements), avoidance (20) and expectancy (20). It does reflect his attitudes and provide a means of understanding his overt behaviour but it is rather subjective. It cannot be used to determine general communication attitudes or any changes that may occur and it is not useful for reassessment if the individual is using a technique. Here one might expect the expectancy scores to rise.
Locus
of Control
Craig, Franklin
& Andrews 1984
Craig et al developed the scale to measure locus
of control of behaviour. What this
does is to
assess the extent to which people feel they can
influence what happens to them
External - helpless in controlling life
Internal
- empowered to influence the course of
life events
In their study to measure the extent to which
stuttering subjects perceive responsibility for their personal problem
behaviour they found that:
·
a reduced internal locus of control is
associated with less chance of relapse
·
an increased external locus of control is
associated with greater chance of relapse
PSYCHOLOGICAL INVESTIGATIONS
Sheehan's Levels of Avoidance
Through discussion, the therapist discovers at which of the five levels the person is avoiding. The deeper the level the greater is the need for a desensitisation and counselling approach.
The levels are:
word
situation
feeling
relationship
ego-protective
or "self" level.
Some of the most widely used psychological
investigations of attitudes and the meaning of stuttering and change for the
individual may be found in the area of Personal Construct Psychology. They
include:
The self characterisation
Repertory Grids
Self evaluation Grid
Happy and Sad faces (children)
Troubles at school
Personal Construct Psychology and therapy and
its application to stuttering will be covered in the Developmental Studies
Course.
Outcome
measures
Rowley
and DesForges 1994
Look at the different types of outcome measures
in disorders of fluency and conclude that “there are a number of approaches
....the key issue is deciding which is the most appropriate. The variability of
clients with dysfluency in terms of age and severity alone ensures that it is
very difficult to decide upon a single measure which is guaranteed to provide
clinicians and managers with what they want - a single reliable, valid, easy to
use and understandable measure”. Three areas need to be tapped:
“1. The therapists perception of outcome
2. The client’s perception of outcome
3. The client’s satisfaction”
Some measurement scales in use are appended to
their paper
The Wright and Ayre Stuttering Self-rating
Profile (WASSP) (Wright & Ayre 2000) is a comprehensive outcome measure for
adults for before and following therapy. It examines behaviours, thoughts,
feelings about stuttering, avoidance and disadvantage.
The
following synopses have been drawn from other texts. Students are advised to go
to the Guitar 1998 reference in its entirety
GUITAR
AND PETERS 1994 (an earlier edition of the Guitar 1988)
Chapter
6 Assessment & Diagnosis
They set up components of diagnosis: background information
observation
of behaviour and feelings
diagnosis
proposal
for intervention or not
Keep in mind when seeing new client:
every
client is different
consider
the person as well as the problem
diagnosis
is an ongoing process
For
adults and adolescents they have:
pre-assessment information to be collected: a case history form
attitude
questionnaires: S24
Avoidance
Scales
PSI
interview data to be collected:
·
the speech sample using Riley’s 1972
Stuttering severity instrument plus speech rate
·
comprehension and production of language,
articulation and voice and screen hearing
intelligence, academic adjustment, psychological
adjustment and vocational adjustment - factors which can affect treatment
Data from parents if dealing with an adolescent
get a picture of how the young client functions
within the family and how everyone feels.
The next stage is to determine the
developmental/treatment level. This depends largely on age and is determined by
how much the client can accept responsibility for self-therapy.
The
pre-school child
a case history form is sent out
In the interview:
parent-child interaction is observed
a parent interview is conducted - appears fairly
information based and informal
a clinician-child interaction:
talking about stuttering - if the child is unaware then only use
non-directive play to
assess
speech
if
s/he is aware then how able are they to talk about stuttering
how
to deal with a child who won’t talk or who is entirely
fluent.
Analysis
of speech sample:
Pattern of dysfluencies: frequency
type
nature
of repetitions & prolongations
starting
and sustaining airflow and phonation
physical
concomitants
word
avoidances
SSI
Speech
rate
Feelings and attitudes: ask
parents if child is:
unaware
of dysfluencies
occasionally
aware but not really bothered
aware and frustrated by
dysfluencies
highly
aware, frustrated and afraid
Other speech and language behaviours as
in adult section but age appropriate
Other factors e.g.
physical
development
cognitive
development
social-emotional
development
speech/language
environment
he
next stage is to determine the developmental/treatment level
·
normal disfluency
·
borderline stuttering
·
beginning stuttering
·
intermediate stuttering
Information
is fed back to the parents at the end of assessment
Elementary school child
Case
history
Parent interview
Teacher interview
Classroom observation
Child interview to get:
speech
sample
Feelings
& attitudes A-19 scale (Guitar
& Grims 1977)
Children’s
Attitude Test (Brutten 1985)
Similar stages to other two groups thereafter
CONTURE
1990
Assessment
and evaluation
Has three beliefs that influence assessment and
evaluation:
1. “Stuttering relates to a complex interaction
between the stutterer’s environment and the skill and abilities that stuttering
brings to that environment”
2.”Stuttering rarely operates in a vacuum but
many times relates to subtle and not so subtle difficulties in other areas”.
3. “Individuals who stutter are individuals
first and stutterers second - there is more to their lives than stuttering”.
It is a good chapter on: first impressions as an assessor
facilities
equipment
informed
consent
the
intake form
the
interview: structured round styles of questioning:
a)
direct - open
closed
b)
open ended questions
c)
leading questions - loaded
requiring a yes/no response
d)
non-directive questioning a) mirroring
b) verbal probes
standardised
and nonstandardised assessment and evaluation of
communicative
and related skills
written
documentation of findings
His data is summarised in a single sheet copied
at the end.
WALL
& MYERS 1995
Their chapter concentrates on differentiating
NNF from stuttering and also considers stuttering assessment from the
three-factor model they propose. They use a matrix of stuttering behaviours to
detail what is actually occurring in speech and have diagnostic questions
within each factor but stresses that a gestalt approach to assessment is
paramount.
Psychosocial:
1. Does the child know he or she sometimes has
fluency disruptions?
2. If the child knows, how does he or she react?
3. How does the fluency behaviour affect the
parents and other family members?
4. How do the parents’ communication behaviours
influence the child?
5. What situations appear to provoke or to
ameliorate the fluency breakdowns?
6. How is the child’s adjustment to his/her
speech and to the reactions of others?
Physiological
questions involve:
1. Respiration
2. Phonation
3. Coarticulatory and aerodynamic factors
4. Summary remarks
Psycholinguistic
1. Syntax
2. Semantics
3. Pragmatics
Associated or secondary characteristics are also
important as are situational factors.
They advocate the use of other scales and
protocols.
References
Andrews
and Cutler The Relationship between changes in symptom
level and attitude JHSD 39 312 - 319 1974
Andrews
and Ingham Stuttering: Considerations in the evaluation of
treatment BJDC 6 129 - 138 1971
Bernstein
Ratner N Language and Stuttering (in press) (kept in tied
articles)
Conture
Stuttering (1995)
Cooper
A disfluency Descriptor Digest for Clinical Use JSHR 7 1982
Costello
and Hurst An analysis of the relationship among
stuttering behaviours JSHR 24 247 - 256 1981
Craig,
Franklin & Andrews 1984
A scale to measure locus of control of behaviour B J of Medical Psychology 57 173-180
DesForges
& Howell An overview of outcome measures (1994) (tied
articles)
Guitar
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