Differential Diagnosis of Stuttering

Differential Diagnosis of Stuttering

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According to Ambrose and Yairi, the purpose of this report is to provide such a reference. To develop, refine, and answer theoretical questions concerning stuttering characteristics at early stages of the disorder, and to provide a basis for clinical needs of differential diagnosis of stuttering from normal disfluency, their objective was to obtain data from sample size, representing population variability of very early stuttering for preschool-age children. Ambrose and Yairi have questions in addition to providing normative data for dysfluency types for early stuttering and normal disfluencies, regarding possible gender and discrete age differences with the preschool range were addressed.

In this study there are two groups, the experimental group and the control group. The experimental group consisted of 90 preschool aged children who exhibited stuttering, and the control group consisted of 54 normally fluent children. The Independent variables were how many stuttering syllables per words read or spoken. This is a non-manipulated variable in the study. The manipulated independent variable was the score test to determine the severity of the fluency disorder. The Dependent manipulated variable was the authors, the speech pathologists, and the parents in the case study. They were able to influence the test by controlling certain aspects of the test. Subjects from the experimental group were referred to the University of Illinois Stuttering Research Project for speech evaluation on the resourcefulness of their parents, physicians, nurses, speech-language clinicians, and day care personal. All children in the stuttering group (experimental) met the following multiple objective and subjective criteria: (a) age 60 months or under, (b) regarded by parents as having a stuttering problem, (c) regarded by the two authors (certified speech pathologists with extensive experience with fluency disorders) as having a stuttering problem, (d) stuttering severity rated by parents as greater than 1 on an 8-point scale (0= normal; 1 = borderline; 2 = mild; 7 = very severe), (e) severity rating greater than 1 assigned by the two authors, (f) exhibiting at least three stuttering-like disfluencies (SLD, or part- and single-syllable word repetitions and blocks/sound prolongations) per 100 syllables, (g) stuttering histories of no longer than 6 months, and (h) no obvious neurologic disorders or abnormalities. Subjects from the normal fluency group (controlled) were (a) age 60 months or under, (b) reported by their parents as not having a history of stuttering, (c) regarded by the investigators

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as not exhibiting stuttering, (d) severity rated by parents as less than 1 on the 8-point scale described above, (e) severity rating of less than 1 assigned by the two authors, (f) exhibiting less than three stuttering-like disfluencies (SLD) per 100 syllables, and (g) not regarded as having histories of neurological disorders or abnormalities. These children were recruited from day cares in the same geographical location as the children in the experimental group.

A weighted SLD was created to score the frequency of repetitions, the extent of repetitions (number of iterations), and the presence and duration of disrhythmic phonation. It is calculated by adding together part- and single-syllable word repetitions per 100 syllables (pw + ss) and multiplying by the mean number of repetition units (ru). This yields the mean number per 100 syllables of extra productions of sounds, syllables, or single syllable words. This accounts for frequency and extent of repetitions. To account for the presence and duration of disrhythmic phonation (dp), its frequency is weighted and then added to the number above. The numerical amplification of disrhythmic phonation is justified because not only are these infrequent in early stuttering and rare in normally fluent children (Johnson et al., 1959; Yairi & Lewis, 1984), but they have traditionally been considered an advanced symptom. In addition, they make a considerable contribution to the perception of severity (Costello & Ingham, 1984; Zebrowski & Conture, 1989). Disrhythmic phonation might be weighted by a factor of 1; noticeable, more tense, by a factor of 2; and obvious or distracting, by a factor of 3. To avoid the necessity of actual time measurements, the middle factor of 2 was chosen. The resulting equation is: [(pw + ss) ´ ru] + (2 ´ dp). Differences of the six different dysfluency types (part-word repetition, single syllable word repetition, disrhythmic phonation, interjection, revision, and phrase repetition) and repetition units performed were evaluated by using a MANOVA. The MANOVA for the six disfluency types plus repetition units with respect to participant classification (experimental or control), gender, and age (2-year-olds, 3-year-olds, and 4 and up). The design used was intercept + group + gender + age + group ´ gender + group ´ age. The group factor was significant (F = 12.62, df 7, 130, p < .001) but gender and age factors were not (respectively, F = 1.68, df 7, 130, p = .12, power = .67; F = 1.30, df 14, 262, p = .21, power = .77). Neither of the interactions tested were significant (group ´ gender, F = 2.00, df 7, 130, p = .06, power = .76; group ´ age, F = 1.25, df 14, 262, p = .24, power = .75).

The data that was collected was presented in a logical way. The only way the data was easy to understand for myself involved taking notes in order to keep up with the way the author explained the data. After the chart was revealed the items stated were more clearly presented. Although severe early stuttering is not common, at 16% it cannot be considered rare and only 37% of the children in this study presented with mild stuttering. The data also provide strong support for the distinction between the two global measures of SLD and other disfluencies. Type by type, each of the three components of the SLD measure indicated sharp group difference in spite of the large standard deviations for both groups. Although syllable and word repetition is also found in the speech of children regarded as normally fluent, such repetitions are few in number and short in extent. The present data strongly support the conclusion that, although repetition is normal, its occurrence with any substantial frequency should not be conceived of as typical of normal speech. One can break the categories or levels of stuttering down into five different levels as follows: Normal, Borderline, Beginning, Intermediate, and lastly Advanced stuttering. The speech-language pathologist will help the individual to learn techniques that allow them to stutter in an easier manner. They will not focus on helping the individual to speak fluently, but focus the person to change their speech movements. These procedures require a large amount of practice and develop new speech patterns.

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