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From: Steve Hood
Date: 10/15/02
Time: 9:31:57 AM
Remote Name: 199.33.133.50
Hello, J.L.
I assume from your description that this youngster has made progress with artic and that this is not a major issue. (If not, correct me on this.) If he has significant artic. or phonology problems, then this may be a different issue. I'll limit my comments to the stuttering.
If this child is 98-100 fluent in clinic, then this is even more fluent than would normally be expected, so frequency appears not to be an issue. But above and beyond the frequency, I would be interested in knowing the characteristics of the 2% disfluencies he does have. If they are short-element repetitions like sounds and syllables, and "stutter-like disfluencies" also including sound prolongations, or tense pause/hard contact elements, then this could possible be significant.
Would it be possible for the parents to audio or video tape the child in the home situation? I would be interested to know what he is doing in terms of frequency. But above and beyond just the frequency, I would also be very much interested in knowing the types of behavaviors: repetitions of sounds, or syllables, or words (single syllable whole words, or words of more than one syllable,) or multiple words--- prolongations, tense pauses, etc. What about interjections, revisions? Do these seem to be "normal nonfluencies" or "stutter-like disfluencies" or discontinuities related to language formulation?
Are there any signs of effort/struggle? Or are disflluencies easy and effortless? Are there increases in pitch or loudness associated with disfluencies? When he repeats, are they single unit repetitions ("ca-can he do it")or multiple reiterations ("li-li-li-like this one.") Are they rhythmic or disrhythmic?
What is going on at home when he is disfluent? Are things cool, calm and relaxed, or is there a lot of communicative stress? Is there good turn taking between the talkers, or a lot of interruption and verbal competition? Is he being bombarded with multiple questions, expected to give lots of answers? Are there lots of language demands being placed on him - e.g., are his sentences lengthy and complex?
I think it would be helpful for you to learn more about what his talking is like in the home situation.
In terms of your therapy with him, are you in a situation where family member(s) can participate in your therapy with him in the clinic? Maybe you can have activities where a parent (and sibling, if appropriate) can do activities with you and the child where you can work on pragmatic issues such as turn taking, reducing verbal competition, etc. Board games (shoots and ladders) or activities where you take turns rolling the dice, etc, can sometimes be good for this. Work to establish baserates of easy fluency (people talking slowly, with turn taking,etc) and then slowly and gradually introduce some mild fluency disruptors (talk faster, ask questions) to help desensitize him to these types of stresses.
Maybe some others will also reply to your question. You asked a good one.