Comprehensive ExaminationsText Box:



Fluency and Stuttering




The Turtle  Wins By A Hare





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Section I.  Essay

Answer ONE ( 1 ) of the following two questions.


NOTE:        Feel free to use a combined narrative and outline format for answering this question if you wish to do so.


1.         Billy and Bobby Keaton, age four, are fraternal twins who have been referred to you by the parents who are extremely worried that both boys are stuttering.  This is particularly troublesome to the parents because the boys have a paternal uncle and maternal grandmother who stuttered severely as children.  After a comprehensive evaluation of the boys you conclude that Billy is developing fluency that is well within normal limits.  You determine that Bobby is showing significant danger signs, and conclude that he is a │borderline stutterer.▓


A.   What behavioral and emotional similarities and differences would have led you to make your final diagnosis?


B.    What would you anticipate being some of the recommendations that would be made to Mr. and Mrs. Keaton regarding things that they might be able to do to optimize the home environment?




2          Ted Neill, age 22, and his brother Stanley Neill, age 25, both stutter.  After an exhaustive evaluation you conclude that both Ted and Stan have a moderately severe stuttering problem, and you recommend that they be enrolled for a combination of individual and group therapy.  You recommend that the primary focus of Ted╣s therapy should be on │fluency shaping▓ and that the major focus for Stan╣s therapy should be on │stuttering modification.▓


A.        What behavioral and emotional factors might have led you to believe that Ted should receive │fluency shaping therapy▓ and that Stan should receive │stuttering modification therapy?▓


B         What would be some of the major area(s) in which their therapy would be similar, and different?


                                                Comprehensive Examinations


                                                    Fluency and Stuttering


The Turtle is Still Winning By A Hare


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SECTION II.  Multiple Choice.


_____ 1.          Which of the following would NOT be considered │stutter-like-disfluencies▓ (SLD╣s?)      


            a          audible-vocalized sound prolongations

            b           tense pauses/hard contacts

            c.         interjections such as │well▓ and │ya╣ know.▓

            d.         audible-nonvocalized sound repetitions                      

            e.         silent blocks


____2.             The shaping of normally fluent speech would include all of the following EXCEPT:


            a.         establishing normal sounding prosody                       

            b.         establishing normal breath flow

            c.         establishing a normal rate                               

            d.          establishing normal sounding melody

            e.         establishing normal sounding preparatory sets and pull-outs.


____3.             Voluntary stuttering can be helpful for accomplishing which of the following:


            a          advertising                  

            b.         desensitizing               

            c.         providing a safety margin

            d.         two of the above         

            e.         all of the above


____4.             A child says "I am ssssssix years old."  This is an example of what type of prolongation?


            a.         vocalized-audible                    

            b.          non-vocalized-audible                

            c.          vocalized-inaudible

            d.          non-vocalized-inaudible        

            e.         Prolongation of blocked articulatory posture.


____5.             Which of the following statements if FALSE?


            a.         the incidence of stuttering is approximately 5%         

            b.         the prevalence of stuttering is approximately 1%

            c.         the average duration of a moment of stuttering is approximately 1 second

            d.         normal nonfluencies occur on approximately 5-8 % of the words spoken during conversational speech.

            e.         persons who stutter have a particularly difficult time saying rote, automatic things such as counting to twenty, of reciting the days of the week or months of the year.


____6.             Which of the following factors is LEAST likely to contribute to the etiology/cause/onset of stuttering?


            a          Genetic predisposition

            b.         The child╣s temperament and sensitivity

c.           Delays in phonological and/or language development

d.           Childhood fears and phobias

e.           Family history of stuttering


_____ 7.          The nonprofit, charitable organization dedicated to the prevention and treatment of stuttering is the:


            a.         National Stuttering Association      

            b.         National Stuttering Project        

            c.         Stuttering Foundation of America

            d.         Foundation for Fluency                

            e.         United States Fluency Association



_____8.           Tommy speaks 100 meaningful words in 45 seconds.  What is his rate of speech?


            a.         75 words per minute

            b.         110 words per minute

            c.         125 words per minute

            d.         133 words per minute

            e.         150 words per minute


____ 9.            Clinicians who model │Turtle Talk▓ ---

            a.         use slow speech         

            b.         pause between phrases     

            c.         use slightly exaggerated melody and inflection

            d.         TWO of the above      

            e.         ALL of the above


____10.           Which of the following is arranged from least to most severe?


a.         phrase repetitions, whole word repetitions, part-word repetitions

b.         whole word repetitions, silent blocks, audible-vocalized prolongations

c.         prolongations, repetitions, blocks

d.         repetitions and prolongations, avoidances, tremors


____11.           Which of the following would not be considered a │core feature▓ of stuttering?


            a          sound and syllable repetitions

            b.         escapes and avoidances

c.           silent blocks

d.           tense pauses/hard contacts

e.           vocalized and nonvocalized sound prolongations


_____12.         The essential components of │stuttering modification therapy▓ include:


a.         reducing of fear, and reducing the avoidances associated with fears

b.         teaching behavioral coping skills to alter the form of the stuttering

c.         learning the speech skills and targets that are necessary to be fluent

d.         A and B

e.         B and C


____13.           The essential components of │fluency shaping therapy▓ include:


a.         reducing of fear, and reducing the avoidances associated with fears

b.         establishing normal sounding fluency in the clinical setting

c.         transferring and generalizing normal sounding fluency to every day speaking situations

d.         A and C

e.         B and C


____14.           Which of the following goals/procedures would most likely be used by clinicians who engage in "fluency shaping" for an adult client who is in the advanced stages of stuttering:


            a.         reducing the frequency of stuttering to less than 1 stuttered word per minute

            b.         developing the ability to discuss stuttering openly and objectively

            c.         learning to stutter openly, honestly and easily

            d.         two of the above

            e.         three of the above


___15.             Modification techniques should be taught to the client in the following order:


            a.         Cancellation --> Pull-Out --> Preparatory Set     

            b.         Pull-Out --> Preparatory Set --> Cancellation

            c.         Preparatory Set --> Cancellation --> Pull Out     

            d.         Cancellation --> Preparatory Set --> Pull Out

            e.         Pull-Out --> Cancellation --> Preparatory Set



___16.             Mr. and Mrs. Pompous are extremely proud of their child's precocious development and "brag" about him by being able to recite things that he has learned: e.g., the 23rd Psalm and Pledge of Allegiance, etc.  This is referred to as:


a.         Verbal Display           

            b.         Verbal Demand          

            c.         Verbal Time-Pressure

            d.         Verbal Sharing           

            e.         Verbal Competition    


____17.           Which of the following would be the most appropriate show for a young child who is beginning to stutter to watch on television?


            a.         Judge Judy     

            b.         Mr. Rogers       

            c.         Sesame Street 

            d.         Saturday Night Live

e.         Law and Order


____18.           A four year old child is brought to you for an evaluation.  You conclude that he exhibits "Borderline Stuttering."  Which of the following would NOT be exhibited by the child?


            a.         disfluencies are rhythmic                    

            b.         the child is unaware                

            c.         stuttering comes and goes in cycles or episodes

            d.         the child is susceptible to communicative stress         

            e.         disfluencies are often accompanied by increased pitch or loudness


____19.           Which of the following could NOT be an example of avoidance?


            a.         struggle and escape    

            b.          starters           

            c.          circumlocutions

            d.          postponement

            e.          all of the above are avoidances


_____20.         Which of the following is arranged from least to most severe?


            a.          repeating, blocking, fixating              

            b.          repeating, blocking, prolonging

            c.          fixating, repeating, prolonging                      

            d.         repeating, prolonging, blocking

            e.          repeating, avoiding, struggling



Section III.  True False


____21.           Clinicians who teach stuttering modification seek primarily to reduce the severity of stuttering.  Fluency shaping clinicians seek to teach fluency enhancing skills


____22.           Desensitization generally begins with situations that are most aversive and stressful, then gradually works backward to situations that are least aversive and stressful.


____23.           Voluntary stuttering can be useful in desensitization both to the actual stuttering behavior and to aversive listener reactions.


____24.           For young children who are just beginning to stutter it is important to provide speech models that are unhurried, and contain correct but simple patterns of speech and language.


____25.           Children who stutter often have concurrent problems with articulation.


____26.           Children tend to learn to talk at their own particular rate of speech.  This is why the rate of speaking of close relatives is relatively unimportant in the modeling of optimum speaking rate(s).


____27.           When trying to model a reduced speaking rate for young children, it is better to do so by pausing in between words, rather than stretching out the syllables within words.


____28.           Parents of young children who are beginning to stutter should reduce the number of questions they ask their children. 


____29.           The │secondary features of stuttering▓ include escape, avoidance and emotions.


____30.           Although we do not believe that there is a specific gene that causes stuttering, there is reason to believe that there may be genetic influences that result in some children being │at risk▓ and more vulnerable to developing a stuttering problem.


____31.           Linguistic demands can occur at four levels: phonologic, syntactic, semantic and pragmatic.


____32            Three year old children are more at risk for stuttering if they exhibit │within-word disfluencies▓ than if they exhibit │between-word disfluencies.▓


____33            Five year old children are more at risk for stuttering if they exhibit │within-word disfluencies▓ than if they exhibit │between-word disfluencies.▓


____34.           Speech rate is expressed in words or syllables spoken per minute and includes time spent stuttering, pausing and formulating language.  Articulation rate is expressed in fluent syllables spoken per second, and does not count time spent stuttering, pausing and formulating language.


____35.           In the development of stuttering, escape behaviors are developed (learned) before avoidance behaviors.


____36.           Struggle and escape behaviors are easier to distinguish than avoidance behaviors.


____37.           When trying to model a reduced speaking rate for young children, it is better to do so by pausing in between words, rather than by pausing in between phrases.


____38.           The onset of stuttering usually occurs between the ages of 2 and 5.


____39.           The onset of stuttering symptoms in adults can be caused by organic and/or emotional trauma


____40.           Diagrams, pictures and cartoons of turtles and rabbits, as on page one of this exam, can be helpful adjuncts to therapy with preschool and elementary school aged children who stutter.





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