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From: Mark Irwin
Date: 18 Oct 2008
Time: 21:18:46 -0500
Remote Name: 203.192.86.115
Hello Carla, Glad you’ve enjoyed the debates! Thanks for your question, you’ve stimulated my thinking in an area I admit to not being previously experienced. I believe only a comprehensive assessment ensures the consistent possibility of comprehensive functioning-related therapy. (This, of course, is the ideal therapy and the reason the DSM exists). This comprehensiveness necessitates the existence of distinct labels (diagnostic terms) as provided by DSM. Such labels and associated codes also assist with 3rd party reimbursement schemes. So using DSM criteria I would list the principal diagnosis as the presenting condition. As my paper highlights, stuttering may be associated with social anxiety disorder, and if so a new specific diagnostic label (Stuttered Speech Syndrome) is needed for the DSM. In this way immediate recognition is given as to whether the stuttering is related to habituated responses with often minimal impact on function, or whether it is related to social anxiety disorder and significant role-functioning impairment. I have no experience with ASD but I imagine that even though SAD has been implicated in ASD, that high functioning ASD clients have less SAD (if any) than low functioning. However if their stuttering is associated with SAD I suggest Stuttered Speech Syndrome is a more appropriate label for the reasons explained in my paper. I would imagine that stuttering would be the presenting symptom and that your assessment (or that of the referring psychologist) would include possibility of associated social anxiety disorder. Re Your therapy: It sounds like you are using a CBT approach. This seems logical for both the ASD and the SSS. As an SLP have you received specific training in this area? Do you use the DSM when making your assessment? mirwin@cobweb.com.au