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When stuttering severity doesn’t show significant change, then one should consider measuring something that will. According to Yaruss & Quesal (2008, 2010), measuring the impact of stuttering on a person’s life is just the thing to do.

Last Friday (10/22/10) was International Stuttering Awareness Day–but just like any other day, we all need to keep learning about what it means to be a person who stutters.

Enter Yaruss and Quesal‘s (in collaboration with Craig Coleman) latest effort for children who stutter–the Overall Assessment of the Speaker’s Experience of Stuttering (OASES) forms for children ages 7-17. How does stuttering impact a young person’s life–at home, at school, out on the playground or at practice? This new self-report does just that in a few minutes. Who better to tell professionals how to support a person who stutters than the people who stutter themselves?

The new forms of the OASES make perfect partners on multiple levels:

1. As a partner to the measurement of stuttering severity (a la the SSI-4, for example)
2. As a partner to the planning of intervention–focusing where the impact on life is the greatest or most valued
3. As a partner to the person who stutters–providing young children (in this case) with a vehicle for communicating complex and often emotional details about their speaking.

The number of stutters a person “speaks” in a particular situation may be variable on any given day, but reducing the negative impact of those stutters consistently in the middle of a particular situation may be the best thing that ever happened to someone who stutters–and now you can quantitatively and qualitatively measure it.

That’s significant, don’t you think?

Reference:
Yaruss, J. S. & Quesal, R. W. (2010). Overall Assessment of the Speaker’s Experience of Stuttering. Bloomington, MN: NCS Pearson, Inc.

"Leaving Las Vegas" by pyth0ns on Flickr.com

If you can’t stand the heat, get inside. Luckily, the 119 degree heat in Las Vegas at the ASHA Schools conference in mid-July kept people indoors and for many, at a session on school-age stuttering by Nina Reeves, MS, CCC-SLP, BRS-FD. If you look at the ASHA data, most SLPs see children who stutter, but not very many in number. So it seems that continuing education on stuttering assessment and intervention is especially critical to maintain a high standard of evidence-based practice and confidence in this part of the SLP scope of practice. Nina’s presentation did just that…with plenty of great energy and passion on behalf of children who stutter.

Two (of many) key insights from Nina’s presentation:

1. Look beyond the stutter—As we all know, while frequency counts and descriptions of stuttering are important, they are not the whole story. In addition, children who continue to stutter well into elementary school and beyond often have long-term effects of stuttering in their lives. In ongoing assessment and intervention, Nina emphasized the cognitive/affective and environmental aspects of the child’s life as they address their own stuttering. The literature on any chronic communication disorder may be a good area of ongoing reading for even more insights into our role as SLPs and supportive guides to children who stutter.
2. Jump in yourself—If you want to teach a technique to someone who stutters, you’d better be willing to demonstrate both the technique AND the stuttering event with them. Trust and authenticity is paramount in any therapeutic partnership; stuttering assessment/intervention is no different. Nina encouraged all of us who work with children who stutter to take our turn and learn to pseudo-stutter with our students in the same contexts that they do. Scary? Sure. But just imagine being someone who stutters—not able to turn stuttering “off.”

Want more from Nina? See her 2006 ASHA Leader article for starters.

One final thought: if you’re looking for an assessment tool that measures “beyond the stutter,” check out our soon-to-publish record forms for ages 7-17 of the OASES: Overall Assessment of the Speaker’s Experience of Stuttering by J. Scott Yaruss, Robert Quesal, and Craig Coleman. In just 10-15 minutes, your student who stutters can complete a self-report of the impact stuttering has on his or her life across contexts. While the frequency of stuttering may not change much over time, the OASES can give you a quantifiable measure of progress (i.e., an impact score) that the impact of stuttering is going down.

Have your own story about stuttering assessment and intervention? Share it below!

June is National Aphasia Awareness Month. In that spirit, we’ve been thinking about quick tips for you related to aphasia assessment and treatment. Most of us who have worked clinically in the area of aphasia likely would agree that a combination of formal and informal assessment procedures balances an approach to assessment at any stage. Of course, when the patient or client is in the acute phase of a neurological event, brevity is a partner to a broad survey of communication skills.

1. Enter the Bedside Record Form (BRF) of the Western Aphasia Battery-Revised (WAB-R). In just 15 minutes or less, you can get a broad survey of typically assessed language skills with a few items in each area. That’s the formal part of the evaluation—listening, speaking, reading, writing, and apraxia, in a quick, standardized nutshell.
2. Then, consider using some of the tasks (or similar tasks) dynamically. In just seconds, you can informally assess “what works” in terms of viable communication strategies beyond the formal procedure. Tools required? Blank paper and Sharpies. Here’s an example: The patient scores 0 on the Spontaneous Speech: Content section of the BRF. After you complete the administration, you might say to the patient, “Let’s try this again.” Readminister the same four items from that section, but offer written choices you’ve created with your Sharpie and paper. Read through each of the choices aloud, pointing as you go, and then hand the Sharpie to the patient. What happens next may surprise you! Picture drawing, pointing to written choices, gesturing—all are viable dynamic options to follow a quick, formal assessment.

“I’m an SLP; I was told there would be no math.”

I don’t exactly remember the first time I heard someone say something to this effect—grad school at the earliest, I’m sure—but it has certainly stayed with me and keeps me chuckling as I occasionally think the same thing myself. Ironically, I ended up in a role in the professions where I deal with math and statistics constantly every day in business, development and clinical contexts. Over the years, I also have come to appreciate that there are plenty of places where math and statistics are rightfully embedded in the professions. So where did the “no math” notion come from, I’ve wondered? It certainly isn’t left out of our standard masters-level curriculum.

Lest any young (or seasoned) professional feel encouraged, prodded, or outright pushed into the world of math and statistics against their will, I’d like to call your attention to one of the many critical ways math and statistics need to be on our collective radar as we work daily to improve communication skills in individuals of all ages.

The term of the day is psychometrics. No, it’s not a compound word combining a “psycho” concept with a “metrics” concept exactly! Psychometrics, a subspecialty of psychology, is a discipline that deals with the measurement of human behaviors and/or traits. For our purposes in this article, psychometrics is the discipline of valid and reliable test development.

Excellent test development means you have tools that you can stand behind confidently in your work. The psychometric effort that goes into building a test, among many other areas of expertise, is straightforward yet creative, analytical yet fluid. Psychometricians evaluate the needs that the test fills. They use their knowledge of math and statistics, but their expertise when working with content types (like us) is to provide insight on how to best capture the variability of human behavior.

You may be able to define the terms standard score, percentile, or stanine, but can you articulate the rationale behind the norming process of your favorite standardized test? Can you accurately describe the math and statistics-based validity, reliability, and evidence-based properties of your favorite non-standardized assessment tools? In any assessment tool choice you make, you are responsible for the appropriate application of that tool—to the right person, for the right reason(s), in the right place, at the right time. Our Code of Ethics requires it.

If you’ve read this far, you may be reaching for a paper sack right now to help with your breathing or needing someone to elbow you to remain upright and awake. I can’t hand you that type of support in this article, but I do have something that hopefully will be even more helpful. With the integration of the Pearson and PsychCorp businesses, we’re just beginning to enjoy all the things we can share across the Minnesota and Texas campuses. One very special document that our colleagues in Texas have created is called a “Psychometrics Primer.”

View the Psychometrics Primer.

It’s a way of looking at psychometrics from an SLP’s perspective. I’d call it “required reading” for every student in the professions as well as a great reference and a helpful reference for every professional in practice today.

With all the questions we receive at Pearson from professionals who use our products, we know that we can’t say enough about what goes into putting a tool like the CELF, PLS, PPVT, or GFTA together. It’s more than numbers and pretty colors on the packaging, to be sure (although we do like how our products look). As you read, share, and ponder the attached document, please email us as you have questions about how our tools are created and how they apply to the work you do, individually and collectively.

Oh, and do keep in mind—math is a language too!

These days, making statements about progress are increasingly important as we seek to document our efforts in each and every practice setting where SLPs and audiologists serve individuals with communication disorders. To that end, using scores that are sensitive to smaller changes in performance over time are critical. There are a number of Pearson products that currently have growth scores:

• PPVT™-4
• EVT™-2
• PLS-4 Measure of Progress
• CELF Preschool-2 Spanish

But what exactly is a growth score, and how is it used? Using the PPVT-4 test as an example, you can read a brief excerpt from the test manual for a definition below. In the case of the PPVT-4 and EVT-2, the growth score is titled “Growth Scale Value” or GSV:

The GSV score is useful for measuring change in…performance over time. The GSV is not a normative score, because it does not involve comparison with a normative group. Rather, it is a transformation of the raw score and is superior to raw scores for making statistical comparisons (p.18).

For a little more background on growth scores, you can read another set of comments in the PPVT-4 test manual regarding the GSV:

The GSV scale was developed so that vocabulary growth could be followed over a period of years on a single continuous scale. Standard scores, percentiles, stanines, and NCEs compare an examinee’s vocabulary knowledge with that of a reference group representing all individuals of the same age or grade. In contrast, the GSV measures an examinee’s vocabulary with respect to an absolute scale of knowledge. The test performance of any examinee…can be placed on a [single] GSV scale. As an examinee’s vocabulary grows, the GSV will increase.

The GSV is an equal-interval scale. Therefore, GSV scores can be added, subtracted, or averaged. Furthermore, the fact that GSVs can be averaged makes this scale a useful one for tracking the progress of groups.

Standard scores and percentiles are less useful than GSVs for measuring growth, because the reference norm group changes as the examinee moves into a higher age or grade level. If a person’s vocabulary increases at the average rate, his or her standard score and percentile would stay the same, whereas the GSV score would increase (p.21).

In addition, each test manual should offer you the number of growth points needed to show statistically significant change at a particular age level. For example, 8 GSV points of change from one test administration to another is statistically significant on the PPVT-4 for individuals age 2:6-12. For children in this age range, if they increase 8 points on the GSV scale, you can be confident that the child’s vocabulary has truly increased.

A caveat: Using growth scores for measuring progress doesn’t mean standard scores are not important. Standard scores serve a very clear purpose and can be used reliably with growth scores. You can think of a growth score as a complementary tool to a standard score; each score tells you something different about the individual’s performance and creates a clearer picture of change over time. The growth score indicates whether there has been improvement, and the standard score indicates whether the rate of improvement has been above or below the average rate for the child’s peers.

So, as you consider the need to demonstrate growth in an individual you serve, do consider using the growth scores available in the above tests as well—and make your work easier!

Reference

Dunn, L. M. & Dunn, D. M. (2007). PPVT-4 Manual. Bloomington, MN: NCS Pearson, Inc.

Why do some tests have small samples, and others have huge samples; why is that OK? When talking about sample sizes in test development the conversation could quickly go statistical. That won’t happen here. Rather, this explanation is intended to be general in nature, and touch on some of the basic considerations for determining how sample sizes are determined for norm-referenced tests.

Several considerations go into determining sample size selection. These are:

• The type of scores to be reported, whether
  • in broad ranges (e.g., below average, average, above average), or
  • on a continuum (e.g., age and grade equivalents)
• The breadth of the scale, determined by the degree of behavioral variation seen in the population (i.e., low variation, high variation)
• How the scores will be used (screener vs. placement; high stakes vs. low stakes)

In general, it’s preferable to have at least 100 persons contributing to each characteristic that defines the norm group (such as age, grade level, gender, race, SES, etc.) particularly when measuring constructs that are developmentally sensitive. As age increases variations in population become more stable, so fewer persons are required to obtain a statistically stable sample.

Let’s use two recently introduced Pearson tests as examples: the PPVT™-4 test and the OASES™ test. These products are quite different in their uses of scores and designs. The PPVT-4 is a vocabulary test, normed by age, and by grade in the spring and fall. It is intended primarily for use with children in early grades, but is also normed through age 81+ years. Scores are reported in standard score metric. The OASES is a product for adults who stutter, and is a self-rated survey. It has a criterion-referenced norm basis, meaning that scores fall into several (5) broad ranges of severity.

The PPVT-4 has a total sample size of 3540. The sample is broken out into many demographic variables, all of which closely mirror the U.S. population as a whole. There are 26 groupings by grade and 28 groupings by age. The age groups average126 persons. This many subjects was preferable because of the many combinations of age, grade, and demographic variables being considered, and the fact that the PPVT-4 measures abilities in children, which vary considerably particularly in the early grades. In addition, the PPVT-4 is often used to determine programming for children in schools.

In contrast, the OASES test has a total sample size of 173, which range more or less equally in age between 18 and 73. Why is this OK? Isn’t a bigger sample always better?

The OASES reports scores within broad ranges (Mild, Mild/Moderate, Moderate, Moderate/Severe, Severe). It is measuring a relatively narrow band of human behavior and reactions to those behaviors (stuttering), although variations among people who stutter can be large. The test is intended to be informative rather than diagnostic. The stakes associated with receiving one score or another on the OASES do not lead directly to a classification or impose life changes on the person. Additionally, stuttering is not an age-based or developmentally sensitive disorder. It affects adults of all races, gender, religious beliefs, geographic areas and socio-economic backgrounds more or less equally. So, these differences did not need to be accounted for in the sample. The OASES sample can be characterized as a clinical sample of adults who stutter, where age and clinical membership were the only variables that really mattered. So, a sample of 173 was sufficient, because the OASES is a “low stakes” kind of test, providing scores within broad ranges, and the scores on the test are relatively low in variation.

What does all of this mean for your practice? The sample sizes of quality testing tools can vary depending upon how the test’s scores will be used, and the variations in the population it measures. When the range of scores is expected to be wide within the population being measured, especially for children, a larger sample size is necessary. A test that is more focused, where people are expected to score within a narrower range, such as a screening test, may show very good validity and reliability results with a relatively small sample size. In all cases, the publisher should explain the reasons for their sample selection clearly, and with simple tables, in the test manual.

I hope this brief introduction helps you understand some basics of how norm sample sizes are determined for the tests you use. You should be able to find detailed information about sample size in the tables of your test manual (see http://www.speechandlanguage.com/cafe/june2007.asp).

The next level of detail about sample size in tests includes concepts like: standard distributions, confidence intervals, confidence levels, statistical significance, standard deviation, mean scores. But let’s save that for another day!

Do you ever wonder about test forms when you pick up a test? Why does it matter if a test has two (or more) forms? Is it really worth the effort to figure out what to do with Form A and Form B? Does it really matter if a test has two forms?

Short answer: Yes, it matters, and yes, it’s worth the effort.

We’ll help you through the basics of test forms in this Clinical Cafe. We’ll explain the differences between forms, how to use Forms A and B, and what they can mean for your clinical practice.

Parallel forms of a test are statistically equal (or as equal as they possibly can be) in their ability to measure the target content area. “Alternate forms reliability” refers to the correlation between Form A and Form B; that is, how closely your results from each form would match if you gave them to the same person. The correlation (written as a decimal between .00 and 1.00) should be as close to 1.00—a perfect correlation—as possible; for high quality tests like the PPVT-4™ test and EVT-2, the correlation is 0.89 across all ages. Therefore, you should be able to give a student Form A or Form B from the same test and get very nearly the same score using either form.

So what is the difference whether you have Form A or Form B or both? Your options for timely and accurate evaluation expand when you own both forms. All you need to decide is which form to use first. If they are truly equivalent, or “parallel,” it won’t matter which one you choose. If you want to test the same student again in the same content area within a short timeframe (several weeks), as in the case of progress monitoring, use the alternate form. If you wait longer (months) before testing the same student again, you may be safe to use the same form again.

We’ve covered the development and appropriate use of parallel forms. But what is the value of parallel forms in your clinical work? You get more flexibility. You can get more frequent use out of the quality test you purchased. Consider just two scenarios: special client needs; and progress monitoring. You may have a student who you know to be bright, precocious, with a good memory. If you need to test this child again you could expect him/her to recall items, particularly pictures; possibly even perseverate on a particular picture. This is the time to use your alternate form.

Use of alternate forms for progress monitoring opens new horizons for your practice. Now you can use a test such as the PPVT-4™ or the EVT-2 for progress monitoring, without concern that your student will learn the test and invalidate the scores. Form B contains a different set of items, with scores on the same scale as Form A, and the scores can be compared equally. You can monitor the progress of your student’s ability more often, and be accurate and reliable in your measurement by using Form A and Form B. This can enhance your use of response-to-intervention (RTI) procedures. A test such as PPVT-4™ with Forms A and B becomes a Tier 2, and a Tier 3 RTI tool, using the alternate forms.

So, is it worth the effort to figure out what to do with Form A and Form B? And does it really matter if a test has two forms? It certainly is worth the effort, because it allows you to work smarter, and be more accurate in your assessment of children.

This month’s Clinical Café is a “back to the basics” discussion of common and often-discussed test types as well as the important concepts of reliability and validity. For new and veteran test users alike, you may find easy ways below to describe these ideas to others…and to refresh your own memory!

To begin, a standardized test is a test administered and scored in a standard manner. These tests are designed in such a way that the questions, conditions for administering, scoring procedures, and interpretations are consistent and are administered and scored in a predetermined, standard manner. “Standardized” may also refer to the reference of the score that a test-taker receives (i.e., a standard score).

Generally, there are two types of standardized tests: norm-referenced tests and criterion-referenced tests, resulting in a norm-referenced score or a criterion-referenced score, respectively. Norm-referenced scores compare test-takers to a group of same-age or same-grade peers. Criterion-referenced scores compare test-takers to a content performance level (i.e., a criterion), and may also be described as standards-based or curriculum-based assessment. Norm-referenced tests measure success by rank ordering students, while standards-based assessments allow that all students may score highly if they meet stated standards. Let’s look at each in a more in-depth way.

Norm-Referenced Tests (NRTs)

A norm-referenced test (NRT) compares an individual to a sample of his or her peers, referred to as a “normative sample.” NRTs compare test takers to each other. NRTs are designed to “rank-order” test takers—that is, to compare students’ scores. A norm-referenced test does not compare all the students who take the test in a given year. Instead, test developers select a subset of individuals (e.g., 50 ninth graders in 30 different states) from the target population (i.e., all ninth graders in the nation). The test is “normed” on this subset to fairly represent the entire target population—that is, the full range of “normal students.” The scores that you generate from individuals you test (e.g., ninth graders at your local high school) are then reported in relation to the scores of this “norming” group.

To make comparing scores easier, test developers often want results that look somewhat like a bell-shaped curve (i.e., the “normal” curve, shown in the diagram below). Most students will score near the middle, and some will score low (the left side of the curve) or high (the right side of the curve). Scores are usually reported as percentile ranks or standard scores. The scores range from 1st percentile to 99th percentile, with the average student score set at the 50th percentile. For example, if Steve scored at the 63rd percentile, it means he scored higher than 63% of the test takers in the norming group. It would also mean that Steve’s 63rd percentile rank equals a standard score of 105.  With standard scores average, or 50th percentile, always equals 100.  Scores also can be reported as “grade equivalents,” “stanines,” or “normal curve equivalents.” Some scores are derived from raw scores, and others are derived from standard scores.

Source: Dunn, L. M., Dunn, D. M. (2007). Manual: Peabody Picture Vocabulary Test, fourth edition. Bloomington, MN: Pearson Assessments.

Criterion-referenced tests (CRTs)

A criterion-referenced test is intended to measure how well a person has learned a specific body of knowledge and associated skills. Multiple-choice tests most people take to get a driver’s license and on-the-road driving tests are both examples of criterion-referenced tests. As on most other CRTs, it is possible for everyone to earn a passing score (e.g., 90% or better) if they know about driving rules and if they drive reasonably well.  Educators are concerned with students achieving passing scores on statewide standards.  In these kinds of tests there is an agreed upon set of criteria, and students are expected to score at a specified minimum level to pass.  Curriculum performance goals are another kind of CRT. To advance to the next learning packet, for example, the student must achieve 70% or better on the post test.

Testing with Reliability and Validity

Test reliability refers to the degree to which a test is consistent and stable in measuring what it is intended to measure. Reliability is a statistical estimation.  Most simply put, a test is reliable if it is consistent within itself and across time. To understand the basics of test reliability, think of a bathroom scale that gave you drastically different readings every time you stepped on it regardless of whether your had gained or lost weight. If such a scale existed, it would not be considered reliable.

Test validity refers to the degree to which the test actually measures what it claims to measure. Test validity is also the extent to which inferences, conclusions, and decisions made on the basis of test scores are appropriate and meaningful.

See the September 2006 Clinical Café article “The Validities” for some great examples of test validity.

The relationship of reliability and validity is straightforward. Test validity is required for a test to be considered reliable. If a test is not valid, then it cannot be reliable. And the converse is also true; if a test is not reliable it is also not valid.

All This Science…

Those of us who entered into a profession that favors highly verbal characteristics in people sometimes struggle with the quantitative aspects of research science.  We desire success in the clinical setting and over time we realize that art and science seem to meld together in practice. We are partly scientists! So, boring as it seems sometimes, stats and test theory are good for us to review; hopefully this refresher is useful for your practice.

References

Dunn, L. M., Dunn, D. M. (2007). Manual: Peabody Picture Vocabulary Test, fourth edition. Bloomington, MN: Pearson Assessments.

Being seated at a good table in a cafe is important to some people. To them, the ambiance is an important part of the meal. Other cafe patrons could care less about their table; they’re there for the food.

How about when you open the manual of your test? Are the tables important? Absolutely. The purpose of tables is to present test-related data to you in a clear and unambiguous manner. The presence and quality of tables offer you clues to the quality of the data and the quality of the entire test product. Obscured or missing data do and should raise red flags.

Standardization Sample Tables

The normative sample is the part of the population used to standardize a test. The normative sample should consist of a sufficiently large and random sample taken from the target population. If a test publisher has done an excellent job gathering a normative sample, the publisher will want you to know that. The simplest way to bring this information to your attention is a well-designed table. A table should highlight what is relevant and present the data in a format that is easy to understand. After all, the purpose of a table is to present complex information in a tidy format so you can further analyze what the author is saying.

What if there is no table in your test manual that shows the information you need to know? Maybe the statistical information you need is in the text, but chances are, if the data are not represented clearly in a table, they simply are not there. In this case, what is absent may speak as loudly as what is present.

One-Way versus Two-Way Tables

Here is a simple example of a one-way table. This is the simplest method for analyzing categorical (or nominal) data. It shows one kind of information about one variable. This kind of table is often used to explore data, for an initial look at what has been found. It is sometimes called a frequency table.

Here is a simple example of a two-way table. This is a combination of two (or more) one-way tables arranged such that each cell in the table represents a unique combination of information derived from the variables. Two-way tables allow examination of categories by frequencies of observations on more than one variable. By examining these frequencies, we can identify relationships between the variables.

Two Examples

Here is an example of a two-way table from the PPVT-4 manual. It is actually a composite of four one-way tables. There is a wealth of information presented about the ethnic breakdown of the PPVT-4 norming sample in this table. In this example the sample population is described by four broad ethnic groups, and the table clearly indicates where each portion of the sample was drawn from by region of the USA. Plus, how that portion of the sample compares to US demographics overall.

Here is another example of a 2-way table from the Comprehensive Assessment of Spoken Language (CASL). The table clearly reports the number (N) and percentage of females and males in the sample at each age range, with a comparison between the sample and the U.S. population as a whole at each age range. You can see clearly that the sample size was sufficiently large to be statistically reliable. Also the percentage of subjects in each age and gender group closely matched the percentage of persons in that category in the U.S. population. For example, 50.7 percent of the 14-15 year olds in the sample were female, which closely matched the Bureau of the Census figure of 50.9 percent of 14-15 year olds in the U.S. population. So this table shows the closeness of the normative population on age and sex, simultaneously, rather than just one or the other.

In Closing

Next time you shop for a test, look at the tables in the manual. The strength of the product should be easily seen in them. Look for the data in plain view. If it isn’t easy to find in a simple clear format, you should ask why.

Good tables may not be important to everyone in a restaurant, but good tables are paramount for everyone who evaluates, chooses and uses tests. It is also paramount in serving your clients.

References

Carrow-Woolfolk, E. (1999). Comprehensive Assessment of Spoken Language, Manual. Minneapolis, MN: Pearson Assessments.

Dunn, L.M., Dunn, D. M. (2007). Peabody Picture Vocabulary Test fourth edition, Manual. Minneapolis, MN: Pearson Assessments.

A perspective from author Kathy Swiney, MA, CCC/SLP, BRS-FD, ASHA Fluency Specialist

Having a special interest in stuttering, I see a number of children and young adults who stutter (CWS). Clinical observations indicate, not unexpectedly, that these young speakers often have situational speaking fears associated with their fluency disorder. What was not expected, however, is the frequency that these same speakers exhibit pragmatic weakness as well. A simple but functional definition of pragmatic skills is knowing “when to speak, … what to talk about with whom, where, and in what manner” (Hymes, 1971, p. 277). The challenge is how to differentiate these intertwined conditions. Unfortunately, there isn’t a wealth of information available to assist the clinician with this task. Weiss (2004) is particularly helpful on this topic and every clinician working with children and young adults who stutter is encouraged to read this work.

It is not surprising that CWS often exhibit pragmatic language disorders (PLD) that either influence or complicate their speaking fears. Reports by Blood and Seider (1981) indicate that 68% of CWS have at least one concomitant disorder. Therefore, it is highly probable most clinicians have or will have at least one CWS with a concomitant pragmatic language disorder. The demands and capacities model, as explained by Starkweather (1987), indicates that a decrease in fluency can occur when speech demands exceed a child’s motor, linguistic and/or emotional capacities. Under this model, it is easy to understand how the linguistic and cognitive demands of dealing with the spontaneity of pragmatics, the most complex of language tasks, can increase disfluency in CWS.

Weiss (2004) suggests that the first step in defining the role pragmatics training should play in stuttering therapy is to establish the client’s current level of language competence. The author (Swiney, 2006) examined seven case studies to determine how PLD might be distinguished from speaking fears. Two tools were used in addition to a standard stuttering assessment. As measure of language competency, the Comprehensive Assessment of Spoken Language (Carrow-Woolfolk, 1999) was administered to each subject. The CASL battery provides a great deal of detail on lexical/semantic, syntactic, and supralinguistic skills, along with data from a standardized test of pragmatic language skills (Pragmatic Judgment). Checklists from Chmela, Reardon, and Scott (2005) were used as informal measures of speaking fears.

Data gathered from these three sources was extremely helpful in determining what part pragmatic skills played in these clients’ fluency and in setting remediation targets. Interestingly, in the seven case studies (Swiney, 2006), the CWS with the most severe stuttering as measured by the Stuttering Severity Instrument for Children and Adults – 3rd Edition (Riley, 1994), were not always the children with the most significant speaking fears or pragmatic weaknesses. Clinicians are encouraged to include some measure of pragmatic competency in their fluency assessments and provide specific training in these skills as part of their therapy plan. Weiss (2004) reports that increasing a client’s pragmatic skills also improves narratives and expository discourse and points out that all fluency therapy eventually covers these types of conversational interactions.

Article reprinted with author approval.

References:

Blood, G. & Seider, R. (1981). The concomitant problems of young stutterers. Journal of Speech and Hearing Research 46, 31-33.

Chmela, K.A., Reardon, N. & Scott, L. (Eds.) (2005). The school-age child who stutters: Working effectively with attitudes and emotions…a workbook. Memphis, TN: Stuttering Foundation of America.

Carrow-Woolfolk, E. (1999) Comprehensive assessment of spoken language. Circle Pines, MN: American Guidance Service.

Hymes, D. (1972). On communicative competence. In J. Pride & J. Holmes (Eds.) Sociolinguistics (pp.269-293). Harmondsworth, England: Penguin.

Riley, G. D. (1994). Stuttering severity instrument for children and adults (3rd ed.) Austin, TX: PRO-ED.

Swiney, K. A. (2006). Differentiating speaking anxiety from pragmatic language disorder in children who stutter. A paper presented to the annual convention of the Texas Speech-Language-Hearing Association (Grapevine, TX).

Weiss, A. L. (2004). Why we should consider pragmatics when planning treatment for children who stutter. Language, Speech, and Hearing Services in Schools. 35, 34 – 45.