Disfluency or word finding?

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I’ve recently begun to see a child who is having a great deal of difficulty expressing himself in the classroom.  The big question is: Is this child stuttering?  Or does he have word finding difficulties? Even a thorough speech and language assessment left the examiner and his parents confused.  I went to the practice portal on the ASHA website and also googled “word finding and stuttering,” where I found an excellent article by Nancy E. Hall:

“Subtle differences in language skills, or mismatches between lexical abilities and other aspects of linguistic development, may set the stage for breakdowns in fluency in youngsters who are predisposed to stuttering.”  Lexical Development and Retrieval  in Treating Children Who Stutter, by Nancy E. Hall ..p.66  LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS • Vol. 35 • 57–69 • January 2004.

I’m still stymied. This is a child who has adequate receptive and expressive language skills and a weak Test of Word Finding quotient. I think it will take a few sessions of close observation to tease out the various difficulties that are contributing to his disfluency.  In our initial session, I observed several instances that I would label a “hard block.”  He himself states that he has the word in his head, and that “When I get past the first letter I can easily say the rest of the word.”

What diagnostic criteria do I use?  If the child can consistently repeat words with no tension when they are modeled for him, I lean toward word finding.  If a child can fluently state the correct word given a multiple choice, I lean toward word finding.  If he/she has initial sound repetitions and blocks, I lean toward stuttering.  So now I am encountering a very bright little boy with excellent receptive and expressive language skills who seems to experience both word finding difficulties and stuttering. I am going to proceed as though the source of his difficulty is both.  I welcome any of your ideas!

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