Diagnosis and Treatment of
Childhood Stuttering and
Disordered Phonology
J. Scott Yaruss, Ph.D., CCC-SLP
University of Pittsburgh
Presentation at Western Illinois University
Macomb, IL
February 7, 1997
Purpose
• To discuss recent advances in the diagnosis
and treatment of children exhibiting both
stuttering (S) and disordered phonology (DP)
– How can S+DP 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?
Co-Occurrence of S and DP
• Children who stutter are more likely than
children who do not stutter to exhibit
Disordered
phonological concerns
Disordered
Disordered
Phonology
Phonology
Phonology
Phonology
Normal
Normal
phonology
Phonology
Normal
Normal
Phonology
phonology
Children
who stutter Children who
notnot
Stutter
whododo
stutter
Children who Stutter Children
Interaction Between S and DP
• There are differences in the basic fluency and
phonology behaviors exhibited by S+DP and
S+NP children
• Interaction may affect diagnosis and treatment of
S+DP 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 course
of treatment (Conture et al., 1993)
What Is the Relationship
Between 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
children’s sensitivity to speaking difficulties
Diagnosing
Stuttering
and
Disordered
Phonology
Diagnosing Stuttering
• Purpose: Determine whether treatment
is necessary to overcome stuttering
• Components of a Diagnostic:
– interview child’s parents
– evaluate child’s speech fluency
– evaluate oral motor skills
– evaluate other aspects of speech and
language
Interviewing
Parents
• Perhaps the most difficult to get in
schools, but it may be possible to obtain
information from a brief phone interview
– Child’s speech behaviors at home
– Situations which affect child’s fluency
– History of prior therapy
– Change in fluency since onset
– Child’s level of concern about speech/fluency
Evaluating Fluency
• Frequency of Disfluencies
– Children’s 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
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
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)
L
D

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)
Treating
Stuttering
and
Phonological
Disorders
Options for Treating S+DP
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
Options for Treatment (cont.)
L
D

• Treat BOTH Stuttering and Disordered
Phonology SIMULTANEOUSLY
– Pros: Reduces likelihood of “flare-up” while
improving intelligibility. Improves generalization since child addresses fluency and
phonology goals in the same context.
– Con: Child may show slower progress,
especially in the beginning.
Simultaneously Treating
Stuttering and Disordered
Phonology
Combines indirect therapy
techniques for treating stuttering
with
phonological therapy techniques for
treating speech sound problems
Indirect Therapy
• Definition: Technique that does not specifically
correct or modify the child’s speech
• Principle: Model desired behaviors, but do not
require child to produce them
• Benefits:
– Does not draw attention to child’s speech problems
– Reduces likelihood that therapy will increase selfconsciousness or sensitivity to speech or stuttering
• Setting: Can be used with any activity or setting
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