Cole's NU speech disfluency (stuttering) evaluation

We started to notice last Thanksgiving that Cole had developed a bit of a stutter. It started out as simple sylable repitition (e.g. I-I-I want to go.., Wha-wha-what are you doing) but progressed into a full blown communication problem (e.g. out of breath, full stops, frustration) by January. I did my undergraduate work in a Human Communication Sciences major which combined audiology, speech language pathology and learning disabilities into one curriculum. One of the main things that I got out of the coursework was that parents often let speech and language problems fester for too long before seeking help. We weren't going to let that happen.

Research

The first step in pretty much everything we do is a bit of research. We have a friend who got the same undergraduate degree as I and actually turned into a speech language pathologist. She pointed us to the Stuttering Foundation of America. The site was pretty helpful. In particular the articles on risk factors, if you think your child is stuttering and 7 ways to help a suttering child were particularly insightful.

Action Plan

In January, I started keeping a daily log of his stuttering on a scale from 1 to 10. It is attached below. It was during the early part of January when Cole was really struggling. I called the speech clinic at Northwestern and setup an appointment. Since I had read the risk factors document, I knew that the time since onset that we needed to worry about was after 6 months. It has only been a couple of months but we thought an evaluation couldn't hurt things. Michelle Jones, the scheduling coordinator at Northwestern reiterated this point and thought we should make the appointment for the end of February (a month and a half away at the time). She told me that kids at Cole's age (3 years old in April) sometimes fix things themselves by the time the appointment comes around. This wasn't the case with us. By the end of February, he had gone through another bout of stuttering but the severity was not as high.

Evaluation

The evaluation spanned two, two-hour sessions. The clinic really seemed to have its stuff together. Since it is a university, each team is a combination of a certified pathologist and four to five graduate students. The crew which handles preschool aged children was waiting for us at the front desk when we arrived. This impressed me because we were early. The evaluation was two pronged: an oral history/interview from a parent, and a clinical evaluation of the child.

The interview questions were about our observations and Cole's milestones. The only tricky thing that we had to look up (beforehand) was the age at which he had: started babbling, spoken his first word, sat up on his own, etc. The idea was to assess his overall development and get a context which could be used to frame the evaluation. While I was being interviewed Cole was being evaluated.

The clinicians needed to assess Cole's ability to express and understand language, his fluency, and his physical mouth structure.

The first two parts were done with a flip book and props. In the flip book, each page had a bunch of pictures on it (four or five). There was also an age range at the bottom of the page. The clinician would ask Cole a question which could be answered by one of the pictures (either by pointing at it or talking about it). When Cole would get a question right or wrong (within his age range), it would reflect in his percentile ranking. They also wanted to find out Cole's top or maximum level. The maximum is defined by a child getting five wrong answers in a row. The benchmark for a problem is the 30th percentile.

It was strange to see Cole being evaluated. I really wanted him to do well. I also thought.. how are they going to get a 2 year old to sit and answer random questions about a flip book ?!? They made a deal with him.. answer three cards, then play with some toys. This went on for two hours in the first session and one hour in the second. I couldn't believe he participated so well.

He definitely made me proud. He would examine each picture and actually think before answering. By the second appointment, he was all business and seemed to enjoy answering the questions. Whenever he would get bored with things, he would get contrary. For instance, one of the scenarios was trying to get Cole to fill in the blank on a sentence. The clinician would take a teddy bear and say could you please get me a cup of water I'm really -------, to which Cole replied, the bear isn't thirsty he's hungry, could you give me the spoon?-- classic.

Results

Cole did well on his tests: he scored 75th percentile on expression and understanding, they couldn't find a max (he answering the five year old cards when they stopped), and his physical mouth structure/tongue movement was just fine. Ok so what's next? The six month litmus seems to be holding true; we are going back in three months. In the meantime, the clinicians are preparing a detailed write-up that we should receive in a week or two. Lynda Thill (the certified clinician) thought that Cole had just gone through a language explosion (common at 2.5 years) and had a large vocabulary. She thinks that it is possible that he just needs a little bit of time to sort all of that out (hence the three months). In the meantime, we are still logging his fluency and practicing the 7 ways to help a suttering child. More to come...