Child Onset Fluency Disorder Study Guide for Nursing Students

Week 8;

Please utilize your syllabus and/or Rubric so your assignment(s) can be completed appropriately.  The information I provide here is not all inclusive of your assignment.  Please make sure you are reading each module in detail and completing assignment appropriately. 

The Assignment

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5 but also supported by at least three other scholarly resources.(Child Onset Fluency Disorder Study Guide for Nursing Students)

You will need to submit your Assignment to two places: the Week 8 Study Guide discussion forum as an attachment and the Week 8 Assignment submission link. Although no responses are required in the discussion forum, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Please complete your assignment on Child- Onset Fluency Disorder (Stuttering)

Irritability in autism

Attention-deficit/hyperactivity disorder

aripiprazolerisperidone

amphetamine IR, XR, and ERdextroamphetamine atomoxetine

clonidine hydrocholoride ERDexmethylphenidate IR and XRguanfacine hydrocholride ERlisdexamfetaminemethylphenidatemethylphenidate hydrocholoride IR and ER, transdermal

Creating Study Guides

The purpose of study guides is to organize lecture notes and textbook material so that you can increase your comprehension and memory of large amounts of information. Preparing study guides that are visual is even more effective, as the visual organization helps you see related concepts and make meaningful connections with the material, thus acquiring the higher levels of learning expected by many of your professors.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Study Guides and Learning Levels

Preparing for tests often involves more than knowing facts, figures, formulas, and definitions. Many professors expect you to demonstrate critical thinking, which involves more than rote memorization. Therefore, you must organize and process course materials so that you can increase your comprehension and ability to think critically.

Examples of Learning Levels

Review the following examples of test questions from a sociology class. The first question only requires that you recall a definition, which you can do well through rote memorization techniques, such as flash cards. The remaining questions require you to make connections or conclusions that may not have been directly presented by your professor or your text book.(Child Onset Fluency Disorder Study Guide for Nursing Students)

• Question 1: A group of relatives by marriage constitutes a) a conjugal family b) an extended family c) a nuclear family d) none of the above
• Question 2: Describe the similarities and differences of these societal forms: matriarchal, neolocal, and patriarchal societies…
• Question 3: Illustrate the economic flow and functions of a neolocal society.

To correctly answer test questions like those in the example, you must create study guides that will help you:

• Condense course material into smaller amounts of information that are easier to remember.
• Visualize, understand, and demonstrate relationships among concepts and ideas.
• Create examples and apply information to “real world” situations.

Common Types Of Study Guides

Within this Idea Sheet are examples of common types of study guides or “visual organizers”.

These study guides can be adapted based on your personal learning style and the information you need to organize. Experiment with these, as well as using other study guide formats that you have found to be effective. Remember, the purpose for study guides is to organize information so that you can demonstrate your knowledge at the critical thinking level your professor expects.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Concept Map and Branching Diagram

Many students benefit when information is presented visually. Concept maps and branching diagrams allow you to organize information spatially versus in a linear outline format. However, you still organize information from the general to the specific. You can then add details and examples that help you apply the information. Concept maps and branching diagrams are useful for classes in any subject area.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Comparison Chart

A comparison chart allows you to organize information visually so that you can see relationships among categories or characteristics. It is a very effective format when you need to be able to understand the differences or similarities among facts, theories, theorists, processes, etc.(Child Onset Fluency Disorder Study Guide for Nursing Students)

How to Create a Comparison Chart

Information you are comparing

Characteristics you are comparing

Transmission

Vaccine

Symptoms

Hepatitis A

Hepatitis A

Hepatitis A

Example (from Psychology class)

Type of memory

Information stored

Capacity

Duration of info.

Format

Sensory

temporary; senses

high

<1 sec. (vision) few seconds (hearing)

literal

short-term

brief; info, currently being used

limited

<20 seconds

auditory & verbal

long-term

relatively permanent

unlimited (?)

long or perm. (?)

semantic

Example (from a Chemistry class)

Name of organic compound

Functional group

Structure

1. Alkane

Concept Card

Concept cards are “flash cards on steroids”, and you create them using index cards that are 3×5 or larger. On the front of the card, you write the:

1. key idea or concept you want to learn
2. organizing term or phrase (upper right-hand corner). This is the category or term that allows you to see how your key ideas or concepts are organized.
3. source of the information (textbook page, date of lecture, etc.

On the back of the card, you write what is most important to know and learn about the concept, in your own words. To ensure you do more than just memorize the information, include examples, summaries, and synthesis of main points as well as definitions. Include diagrams, time lines, or other visuals that will help you understand the information at the level your professor expects.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Example 1: Back of Card

Example 2: Back of Card

Example 3: Front

Example 3: Back

Diagram

Diagrams allow you to visually represent dynamic information such as a process, procedure, stages, and steps. For example, in a geology class, you could create a diagram to describe how rock layers are formed. In a political science class, a diagram can help you understand and learn the process for how a bill is passed into law.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Example 1: physical geography class

Example 2: note-taking cycle

Time Line

A time line allows you to organize information chronologically. You are able to review information that must be understood and remembered in sequence. Time lines would be effective for classes in which you are presented:

• historical developments: history, anthropology, political science, music, art 
• biological developments: biology, anatomy, physiology(Child Onset Fluency Disorder Study Guide for Nursing Students)
• human or other developments: psychology, biology, natural resources

Example 1: Development of an embryo

Example 2: Major Civil War Battles 1861-1863

NRNP_6665_Week8_Assignment_Rubric

NRNP_6665_Week8_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeCreate a study guide, in outline form with references, for your assigned disorder. Incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards.

30to >26.0 pts

Excellent

The response is in a well-organized and detailed outline form. Informative and well-designed visual elements are incorporated….Followed directions correctly by uploading assignment to Gradebook and submitted to the discussion forum area.(Child Onset Fluency Disorder Study Guide for Nursing Students)

26to >23.0 pts

Good

The response is in an organized and detailed outline form. Appropriate visual elements are incorporated….Partially followed directions by uploading assignment to Gradebook but did not submit to the discussion forum area.

23to >20.0 pts

Fair

The response is in outline form, with some inaccuracies or details missing. Visual elements are somewhat vague or inaccurate….Partially followed directions by submitting to the discussion forum area but did not upload assignment to Gradebook.(Child Onset Fluency Disorder Study Guide for Nursing Students)

20to >0 pts

Poor

The response is unorganized, not in outline form, or is missing. Visual elements are inaccurate or missing….Did not follow directions as did not submit to discussion forum area and did not upload assignment to gradebook per late policy.

30 pts

This criterion is linked to a Learning OutcomeContent areas of importance you should address, but are not limited to, are:• Signs and symptoms according to the DSM-5-TR• Differential diagnoses• Incidence• Development and course• Prognosis• Considerations related to culture, gender, age• Pharmacological treatments, including any side effects• Nonpharmacological treatments• Diagnostics and labs• Comorbidities• Legal and ethical considerations• Pertinent patient education considerations(Child Onset Fluency Disorder Study Guide for Nursing Students)

50to >44.0 pts

Excellent

The response throughly addresses all required content areas.

44to >39.0 pts

Good

The response adequately addresses all required content areas. Minor details may be missing.

39to >34.0 pts

Fair

The response addresses all required content areas, with some inaccuracies or vagueness. No more than one or two content areas are missing.(Child Onset Fluency Disorder Study Guide for Nursing Students)

34to >0 pts

Poor

The response vaguely or inaccurately addresses the required content areas. Or, three or more content areas are missing.

50 pts

This criterion is linked to a Learning OutcomeSupport your guide with references to the DSM-5-TR and at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines. Be sure they are current (no more than 5 years old).(Child Onset Fluency Disorder Study Guide for Nursing Students)

10to >8.0 pts

Excellent

The response is supported by the DSM-5 and at least three current, evidence-based resources from the literature.

8to >7.0 pts

Good

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

7to >6.0 pts

Fair

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.(Child Onset Fluency Disorder Study Guide for Nursing Students)

6to >0 pts

Poor

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.

10 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation

5to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4to >3.5 pts

Good

Contains one or two grammar, spelling, and punctuation errors

3.5to >3.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors

3to >0 pts

Poor

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The guide follows correct APA format for parenthetical/narrative in-text citations and reference list.(Child Onset Fluency Disorder Study Guide for Nursing Students)

5to >4.0 pts

Excellent

Uses correct APA format with no errors

4to >3.5 pts

Good

Contains one or two APA format errors

3.5to >3.0 pts

Fair

Contains several (three or four) APA format errors

3to >0 pts

Poor

Contains many (five or more) APA format errors

5 pts

Total Points: 100

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Child Onset Fluency Disorder Study Guide for Nursing Students

The most prevalent type of stuttering, childhood-onset fluency disorder, is a neurologic impairment caused by an underlying brain defect resulting in dysfluent speech. Subsequent effects of stuttering include a negative perception of oneself and judgmental comments by others, anxiety, and, in rare cases, depression (Maguire et al., 2020). Patients diagnosed with stuttering tend to develop verbal or situational avoidance and involuntary movements over time. Stuttering that is pervasive into adulthood can significantly restrict or impact an individual’s quality of life, including social engagement and professional growth and development (Maguire et al., 2020). Identifying stuttering early can help with early intervention intending to initiate compensatory changes in the brain, which are possible in the early stages of development, to minimize consequences such as social anxiety, limited social skills, negative attitudes towards communication, and maladaptive compensatory behaviors. (Child Onset Fluency Disorder Study Guide for Nursing Students)

Signs and Symptoms

Patients with childhood-onset fluency disorder are marked by normal fluency and time patterning of speech disturbance unrelative to an individual’s age or development stage. Patients often repeat or prolong sounds or syllables (Maguire et al., 2020). Additionally, patients demonstrate speech deficits, including broken-up single words like pauses within a word, audible or silent blocks like speech with filled or unfilled pauses, circumlocutions like substituting words to avoid problematic ones, producing words with excess physical tension, and use of monosyllabic whole-word repetitions like “she-she-she-she is there.”(Child Onset Fluency Disorder Study Guide for Nursing Students)

DMS-5 Criteria

DMS-5 Criteria for Stuttering
Criteria A	Criteria B	Criteria C	Criteria D
Repetition of sounds and syllables	The disturbance leads to anxiety regarding speaking or ineffective communication, social engagement, or academic or occupation performance, individually or combined. (Child Onset Fluency Disorder Study Guide for Nursing Students)	Symptoms begin in the early childhood development period.	The disturbance is not linked to any speech-motor or sensory deficit., disfluency related to neurological insults like stroke or trauma, or any medical condition, and is not better demonstrated by another mental disorder. (Child Onset Fluency Disorder Study Guide for Nursing Students)
Prolonging consonants and vowels
Broken words
Audible or silent blocking
Producing words with excessive physical tension
Repeating whole monosyllabic words like he, she, and I

Etiology

The origin of stuttering is attributed to genetic and epigenetics and neural and motor correlates. Studies have indicated that stuttering is typical in some families because of a gene linked to stuttering transmission, which can be established using a family tree with a high density of people who stutter (Smith & Weber, 2019). The gene can vary from family to family; hence stuttering is not attributed to a single genetic basis. Studies have also used epigenetics to understand stuttering. Epigenesis is based on environmental influences, linking the bridge between genetic and environmental factors. More recent studies have focused on neural and motor correlates to understanding the etiology of stuttering. These studies have investigated the difference in brain sections between stuttering and fluent individuals (Smith & Weber, 2019). The commonality in the investigations indicates atypical connectivity and functioning in the left inferior frontal areas typically specialized for speech production and other sections related to auditory and linguistic processing.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Epidemiology

Stuttering is a common disorder across all age groups. In 80-90% of people who stutter, it begins by age 6. Most people averagely develop stuttering between 2 and 7 years. Stuttering affects 5% to 10% of kindergarten children (Sjøstrand et al., 2019). About 5.2% of children aged 3 to 5 years and 8.4% of those aged 2 to 7 years stutter (Sjøstrand et al., 2019). Stuttering is common among persons with intellectual disabilities, affecting 0.8% to 20.3% per different reports. Persistent stuttering affects about 1% of the population (Sommer et al., 2021). Males develop stuttering four times more than females.   (Child Onset Fluency Disorder Study Guide for Nursing Students)

Prognosis

Individuals can recover from stuttering, although it can be life-long. About 65%-85% of stuttering children recover (Sommer et al., 2021).(Child Onset Fluency Disorder Study Guide for Nursing Students)

Pharmacological Treatment

There is no FDA-approved medication to treat stuttering. However, patients can be prescribed medications with a dopamine-blocking activity that has proved effective and efficient (Maguire et al., 2020). However, it is fundamental to limit medication after reviewing side-effects profiles. A dopamine-blocking antipsychotic, haloperidol, can be prescribed as it has proven its efficiency in improving brain activity in speech areas.  (Child Onset Fluency Disorder Study Guide for Nursing Students)

Non-Pharmacological Treatment

Non-pharmacological treatments are the first line of treatment for stuttering. Common non-pharmacological treatments include speech therapy, cognitive behavioral therapy, and electronic delayed auditory feedback tools (Maguire et al., 2020).

1. Speech therapy promotes slow and effective speaking(Child Onset Fluency Disorder Study Guide for Nursing Students)
2. Cognitive behavioral therapy can be adopted together with speech therapy to identify undesired thought patterns that worsen stuttering and help the patient develop coping strategies to manage the stress associated with stuttering.
3. Electronic delayed auditory feedback tools are adopted to help people slow down their speech to enhance effectiveness.

Diagnostic and Labs

Family physicians are the first contact during patient assessment and diagnosis because of their broad knowledge of individual disfluencies. After collecting subjective data, various tests can be done to ascertain the diagnosis. The practitioner can test phonological skills and syntactic and morphosyntactic proficiency using SPELT-3 (Smith & Weber, 2019). The test of Childhood Stuttering (TOCS) can help determine speech fluency. It adopts standardized speech measures like rapid picture naming, modeled sentences, narration, and structured conversation. The Behavior Assessment Battery for School-Age Children (BAB) can help identify disfluencies. A norm references stuttering assessment like Stuttering Severity Instrument (SSI-4) is also helpful in ascertaining the diagnosis.(Child Onset Fluency Disorder Study Guide for Nursing Students)

Differential Diagnosis

1. Sensory deficits
2. Normal Speech dysfluencies
3. Medication side effects(Child Onset Fluency Disorder Study Guide for Nursing Students)
4. Adult-Onset Dysfluencies

Patient Education

• Educate the patient to speak slowly and calmly with frequent pauses.
• Advise the parent to spend quiet, uninterrupted time with the child daily.
• Ask the parent to be polite when the child speaks,(Child Onset Fluency Disorder Study Guide for Nursing Students)
• Educate the parent on using positive affirmations and reinforcement.

References

Maguire, G. A., Nguyen, D. L., Simonson, K. C., & Kurz, T. L. (2020). The Pharmacologic Treatment of Stuttering and Its Neuropharmacological Basis. Frontiers in neuroscience, 14, 158. https://doi.org/10.3389/fnins.2020.00158

Sjøstrand, Å., Kefalianos, E., Hofslundsengen, H., Guttormsen, L. S., Kirmess, M., Lervåg, A., Hulme, C., & Næss, K. A. B. (2019). Non‐pharmacological interventions for stuttering in children aged between birth and six years. The Cochrane Database of Systematic Reviews, 2019(11), CD013489. https://doi.org/10.1002/14651858.CD013489

Smith, A., & Weber, C. (2019). Childhood Stuttering: Where Are We and Where Are We Going? Seminars in speech and language, 37(4), 291–297. https://doi.org/10.1055/s-0036-1587703

Sommer, M., Waltersbacher, A., Schlotmann, A., Schröder, H., & Strzelczyk, A. (2021). Prevalence and Therapy Rates for Stuttering, Cluttering, and Developmental Disorders of Speech and Language: Evaluation of German Health Insurance Data. Frontiers in human neuroscience, 15, 645292. https://doi.org/10.3389/fnhum.2021.645292

Frequently Asked Questions

What are the criteria for childhood-onset fluency disorder?

Childhood-Onset Fluency Disorder, commonly known as stuttering, is characterized by disruptions in the normal flow of speech, such as repetitions, prolongations, or blocks of sounds or words. The disorder typically begins during early childhood and is accompanied by anxiety or avoidance behaviors related to speaking situations. Diagnosis requires the presence of these speech disruptions for at least six months and the impact on daily communication or social functioning.(Child Onset Fluency Disorder Study Guide for Nursing Students)

What is the treatment plan for childhood-onset fluency disorder?

The treatment plan for childhood-onset fluency disorder, commonly known as stuttering, typically involves a combination of speech therapy techniques tailored to the individual’s needs. Therapists may employ strategies such as slow and rhythmic speech, controlled breathing, and desensitization to reduce stuttering and improve communication fluency. Early intervention, family involvement, and ongoing support are key components of an effective treatment approach for children with fluency disorder.(Child Onset Fluency Disorder Study Guide for Nursing Students)

What is the coping mechanism of a stutter?

A common coping mechanism for stuttering involves employing techniques such as speech modification, slow and deliberate speech, breathing exercises, and mindfulness to manage and reduce the frequency of stuttering episodes. Additionally, individuals may engage in self-acceptance and self-confidence-building strategies to navigate social interactions and communication challenges more comfortably. Speech therapy and support groups often play a crucial role in developing effective coping strategies for individuals who stutter.(Child Onset Fluency Disorder Study Guide for Nursing Students)

What are the three types of stuttering?

The three main types of stuttering are developmental stuttering, neurogenic stuttering, and psychogenic stuttering. Developmental stuttering typically begins in childhood as a part of speech development. Neurogenic stuttering can result from brain injuries or neurological conditions. Psychogenic stuttering is linked to psychological factors and may appear suddenly in response to stress or trauma.(Child Onset Fluency Disorder Study Guide for Nursing Students)