SID4 Clinician Competencies - Assessment and Treatment of Stuttering

1. Can differentiate between a child's normally disfluent speech, language-based disfluency, the speech of a child at risk for stuttering, and the speech of a child who has already begun to stutter.

2. Can distinguish cluttered from stuttered speech and understands the potential relations between these two disorders.

3. Can relate the findings of language, articulation, voice, and hearing tests to the development of stuttering.

4. Can obtain a thorough case history from an adult client or parents of a child client.

5. Can obtain a useful speech sample and evaluate it for stuttering severity both informally by subjective impression and formally by calculating relevant measures such as the frequency of dysfluency, duration of dysfluency, speaking rate, etc.

6. Is familiar with the available diagnostic tests for stuttering that serve to objectify aspects of the client's communication pattern (secondary features, avoidance patterns, attitudes, etc.) that may not be readily observed.

7. Is able to identify, and measure where feasible, environmental variables (i.e., aspects such as time pressure, emotional reactions, interruptions, nonverbal behavior, demand speech, or the speech of significant others) that may be related to the onset, development, and maintenance of stuttering and to fluctuations in the severity of stuttering.

8. Can identify dysfluencies by type (prolongation, repetition, etc.) and, in addition, can describe qualitatively the fluency of a person's speech.

9. Can relate, to the extent possible, what stuttered speech sounds like to the vocal tract behavior that is producing it (for example, recognizing the subtle acoustic cues that signal vocal straining).

10. Can, in appropriate consultation with the client or parents, construct a treatment program, based on the results of comprehensive testing, on the client's personal emotional and attitudinal development, and on past therapeutic history, that fits the unique needs of each client's problem(s).

11 Can administer predetermined programs in a diagnostic way so that decisions with regard to branching and repeating of parts of the program reflect the unique needs of each client's problem(s).

12. Can explain clearly to clients or their parents what treatment options, including the various types of speech therapy, medication, devices, self-help groups, and other forms of therapy are available, why they may or may not be appropriate to a specific case, and what outcomes can be expected from each, based on knowledge of the available literature.

13. Is familiar with the appropriate goals of therapy and the processes for achieving them and can engage these processes, choosing techniques that are best for the client, and administer them with an attitude that balances the goal of normal speech with a tolerance for abnormal speech.

14, Has flexibility in choosing and changing the level of difficulty of tasks based on fluency level of the client.

15. Can teach clients to produce vocal tract behaviors that result in normal sounding speech production.

16. Has sufficient counseling skills so as to interact with clients of all ages and develop a reasonable set of expectations in the client.

17. Has a thorough understanding of, and knows how to put into practice, the principles of conditioning and learning so as to achieve a successful and appropriate modification of speech behavior.

18. Understands the relations between stuttering and other related disorders of fluency, such as cluttering, neurogenic, and psychogenic stuttering, as well as disorders of language articulation, learning, etc., and can with flexibility identify sequences and combinations of treatment options that are helpful to the client.

19. Understands the dimensions of normal fluency and the relation of normal fluency to the speech situations and is able to work toward normal speech, with an awareness of the compromises among effort, fluency, and natural- sounding communication.

20. Understands that some stuttering behaviors may be reactions to other stuttering behaviors and knows how to plan treatment so as to account for this.

21. Can evaluate available therapy programs with regard to therapeutic application for a wide variety of clients.

22. Is able to decide, based on objective progress, motivational level, and cost in time and money, when it is appropriate to terminate therapy.

23. Is aware of the continuous nature of fluency and can identify subtle changes in speech or other behaviors related to therapeutic change and explain their importance to the client.

24. Can explain stuttering and therapy for stuttering to lay persons, such as day-care workers, teachers, baby-sitters, grandparents, etc., who may influence the life of stuttering children.

25. Knows how to develop a plan for assessing objectively the efficacy of treatment during therapy in an ongoing way.

26. Can recognize problems that are treated by professionals other than speech-language pathologists and can guide a client to acceptance of an appropriate referral.

27. Is aware of the principles of stimulus generalization and response transfer.

28. Has knowledge of, and can implement a variety of procedures to achieve transfer and maintenance of behavior changes achieved in the clinical setting.

29. Can, through guidance and counseling, help clients develop an attitude toward maintenance that includes an understanding of their own responsibility for their speech yet permits occasional booster session (e.g., the dental model) and that tolerates failure yet appreciates success.

30. Can help the client develop an awareness of the subtler forms of (returning) abnormality and know how to deal with them in a variety of ways, such as the use of home practice, graded hierarchical practice in social situations, and support groups.

31. Knows how to counsel parents regarding changes they can make at home that will facilitate their child's fluency development or encourage the generalization of gains made in treatment.

from SID 4 Guidelines for Practice in Stuttering Treatment, in Starkweather and Givens-Ackerman (1997) Stuttering, Austin, Texas: Pro-ed