ASHA CCC Certificate of Clinical Competence Exam — Questions and Answers

Question 1: Aided Language Stimulation (ALS) in AAC intervention involves:

Administering standardized assessments using aided AAC symbols as response options
Training caregivers and partners to model language by pointing to AAC symbols during natural interactions (Correct answer)
Using hearing amplification devices to stimulate early language development
Providing neuromuscular electrical stimulation to the speech production muscles

Correct answer: Training caregivers and partners to model language by pointing to AAC symbols during natural interactions

ALS involves communication partners simultaneously speaking and pointing to symbols on an AAC system to model language use during natural interactions.

Question 2: Narrative macrostructure refers to which aspect of storytelling ability?

Vocabulary diversity within stories
Overall story organization including story grammar elements (Correct answer)
Sentence length in narratives
Grammatical accuracy of sentences

Correct answer: Overall story organization including story grammar elements

Narrative macrostructure refers to the overall organization and completeness of story grammar elements such as setting, problem, and resolution.

Question 3: Semantic paraphasias involve substituting a target word with a word that is:

A perseverative error
A made-up word (neologism)
Semantically related (Correct answer)
Phonologically similar

Correct answer: Semantically related

Semantic paraphasias are word substitutions based on meaning, such as saying 'chair' for 'table'.

Question 4: Which acoustic parameter most directly reflects vocal fold vibratory frequency and is perceived as pitch?

Signal-to-noise ratio
Intensity (dB SPL)
Formant frequencies
Fundamental frequency (F0) (Correct answer)

Correct answer: Fundamental frequency (F0)

Fundamental frequency (F0) is the rate of vocal fold vibration and is the primary acoustic correlate of perceived pitch.

Question 5: Anomia refers to difficulty with which language task?

Sentence comprehension
Reading aloud
Word retrieval or naming (Correct answer)
Repetition

Correct answer: Word retrieval or naming

Anomia is the inability or reduced ability to retrieve words, commonly manifested as difficulty naming objects or pictures.

Question 6: Pediatric feeding disorders differ from dysphagia in that feeding disorders more often involve which component?

Aspiration without behavioral factors
Pharyngeal phase deficits only
Behavioral and sensory aversions in addition to motor deficits (Correct answer)
Esophageal dysmotility exclusively

Correct answer: Behavioral and sensory aversions in addition to motor deficits

Pediatric feeding disorders frequently involve behavioral refusal, sensory sensitivities, and anxiety around food in addition to any motor or structural swallowing issues.

Question 7: Central auditory processing disorder (CAPD) is characterized by difficulty processing auditory information despite:

Normal peripheral hearing sensitivity (Correct answer)
Normal cognitive ability
Normal reading ability
Normal language skills

Correct answer: Normal peripheral hearing sensitivity

CAPD involves deficits in processing, interpreting, or using auditory information even when peripheral hearing thresholds are within normal limits.

Question 8: Which assessment tool is widely used to classify aphasia type based on fluency, comprehension, and repetition?

Western Aphasia Battery (WAB) (Correct answer)
MMSE
Token Test
Boston Naming Test (BNT)

Correct answer: Western Aphasia Battery (WAB)

The Western Aphasia Battery assesses fluency, comprehension, repetition, and naming to classify aphasia type and severity.

Question 9: Frontotemporal dementia (FTD) primarily affects which cognitive-behavioral domains first?

Visuospatial processing and memory
Behavior, personality, and language (Correct answer)
Attention and working memory
Sensory processing and motor function

Correct answer: Behavior, personality, and language

FTD predominantly affects the frontal and temporal lobes, causing early changes in behavior, personality, and language.

Question 10: Which morpheme is typically among the first 14 acquired according to Brown's sequence?

Third-person regular -s
Articles 'a' and 'the'
Contractible copula
Present progressive -ing (Correct answer)

Correct answer: Present progressive -ing

The present progressive morpheme -ing is among the earliest morphemes acquired, appearing in Brown's Stage I–II.

Question 11: Although computer programs are created in a high-level programming language, the human-readable version is referred to as _____________

Word size
Source code (Correct answer)
None of the above
Instruction set
Cache

Correct answer: Source code

Source code is the original, human-readable set of instructions written by a programmer in a high-level programming language. Before a computer can execute these instructions, the source code must be translated into machine language by a compiler or interpreter. It represents the fundamental blueprint of a software program.

Question 12: Which approach provides additional instructional support to at-risk children before a formal special education referral is made?

Response to Intervention (RTI) (Correct answer)
IEP development
Functional behavioral assessment
Ecological assessment

Correct answer: Response to Intervention (RTI)

RTI is a tiered prevention model that provides increasingly intensive instruction to at-risk children prior to special education eligibility determination.

Question 13: Which population is at highest risk for aspiration pneumonia secondary to dysphagia?

Adults with voice disorders
Elderly patients with neurological conditions in care facilities (Correct answer)
School-age children with DLD
Healthy young adults

Correct answer: Elderly patients with neurological conditions in care facilities

Elderly individuals with neurological conditions (stroke, dementia, Parkinson's) in institutional settings have the highest aspiration pneumonia risk.

Question 14: The Participation Model for AAC assessment, developed by Beukelman and Mirenda, primarily focuses on:

Assessing motor skills needed for physical access to AAC devices
Identifying the single most appropriate AAC device for each individual
Analyzing communication participation patterns of AAC users compared to same-age peers without disabilities (Correct answer)
Measuring receptive vocabulary size in individuals who use AAC

Correct answer: Analyzing communication participation patterns of AAC users compared to same-age peers without disabilities

The Participation Model analyzes the participation patterns of peers without disabilities to identify opportunity and access barriers limiting AAC users.

Question 15: Which of the following is a device for generating output?

Mouse
A and B both (Correct answer)
Monitor
None of the above
Printer

Correct answer: A and B both

Output devices are components that display or present information processed by a computer to the user. A monitor provides visual output, while a printer produces physical hard copies of documents or images. Both devices serve the function of generating output from the computer system.

Question 16: Which cognitive domain is most critical for assessing a patient's ability to profit from aphasia therapy?

Working memory and attention (Correct answer)
Visual-spatial processing
Executive inhibition only
Long-term semantic memory

Correct answer: Working memory and attention

Working memory and attention are essential for learning and retaining new information, directly affecting rehabilitation potential.

Question 17: Which treatment for stuttering teaches clients to initiate phonation gently and manage airflow to produce fluent speech?

Acceptance and commitment therapy
Easy onset only
Fluency shaping therapy (Correct answer)
Stuttering modification therapy

Correct answer: Fluency shaping therapy

Fluency shaping therapy uses targets like easy onset, light articulatory contacts, and slow rate to establish fluency from scratch.

Question 18: Coursework for the CCC must cover the basic science areas of:

Only anatomy and physiology
Business administration
Biological, physical, statistical/mathematical, and behavioral/social sciences (Correct answer)
Pharmacology and surgery

Correct answer: Biological, physical, statistical/mathematical, and behavioral/social sciences

ASHA standards require coursework across biological, physical, statistical, and social/behavioral sciences.

Question 19: Which approach to dysphagia management focuses on modifying the swallowing physiology itself through exercise rather than working around the deficit?

Diet modification only
Environmental modification
Rehabilitative (restorative) approach (Correct answer)
Compensatory approach

Correct answer: Rehabilitative (restorative) approach

The rehabilitative approach uses exercises (e.g., Mendelsohn, effortful swallow, Shaker) to strengthen and retrain swallowing musculature.

Question 20: The CCC is best described as which type of credential?

A hospital privilege
A state-issued license
A federal government permit
A voluntary national professional certification (Correct answer)

Correct answer: A voluntary national professional certification

The CCC is a voluntary national certification, distinct from state licensure to practice.

Question 21: Which best describes the relationship between the Praxis exam and the CCC?

The CCC is awarded before taking the Praxis
The Praxis replaces the Clinical Fellowship
Passing the Praxis is one required component of earning the CCC (Correct answer)
The Praxis is only for licensure and unrelated to the CCC

Correct answer: Passing the Praxis is one required component of earning the CCC

The Praxis is one of several requirements—alongside degree, practicum, and CF—needed for the CCC.

Question 22: Traumatic brain injury (TBI) most commonly results in which type of communication disorder?

Classical aphasia syndromes
Selective mutism
Cognitive-communication disorder (Correct answer)
Motor speech disorder only

Correct answer: Cognitive-communication disorder

TBI often causes diffuse damage resulting in cognitive-communication disorders affecting attention, memory, organization, and social communication.

Question 23: What does the abbreviation 'SGD' stand for in AAC?

Speech Generating Device (Correct answer)
Supported Gestural Dialogue
Sequential Grid Design
Symbol Guided Display

Correct answer: Speech Generating Device

SGD stands for Speech Generating Device, a category of high-tech AAC systems that produce electronic voice output.

Question 24: A/an ____________ is a piece of text that you'd like to appear at the bottom of the page.

Endnote
Header
Footer (Correct answer)
Footnote
None of the above

Correct answer: Footer

A footer is a section of text or graphics that appears consistently at the bottom of every page in a document. It is commonly used for elements like page numbers, document titles, or author names to provide consistent information throughout the document. In contrast, a header appears at the top, and footnotes are specific references at the bottom of a page.

Question 25: Which of the following statements concerning segments is accurate in Oracle?

A segment is created every time an extent is created, extended or altered (Correct answer)
None of the above
An index segment is created every time a table is created.
A segment is deleted whenever a table is truncated.
Each table has its own segment.

Correct answer: A segment is created every time an extent is created, extended or altered

In Oracle, a segment is a logical storage unit that contains all the data for a specific database object, such as a table or an index. Segments are composed of one or more extents, which are contiguous blocks of data. As data grows or shrinks, segments are dynamically managed by creating, extending, or altering extents to accommodate the changes.

Question 26: Which term describes a speech error that is inconsistent across repeated productions of the same word?

Assimilation error
Consistent error
Variable error (Correct answer)
Phonological delay

Correct answer: Variable error

Variable (inconsistent) errors occur when a child produces the same word differently across multiple trials, which may indicate childhood apraxia of speech.

Question 27: Which federal law mandates free appropriate public education (FAPE) and related services, including speech-language pathology, for children with disabilities?

NCLB
IDEA (Correct answer)
ADA
Section 504

Correct answer: IDEA

The Individuals with Disabilities Education Act (IDEA) ensures FAPE and related services, including SLP services, for eligible children.

Question 28: Phonological awareness intervention is particularly important for children at risk for which academic difficulty?

Math disabilities
Social-emotional problems
Writing mechanics difficulties
Reading disabilities (Correct answer)

Correct answer: Reading disabilities

Phonological awareness is a critical predictor of reading acquisition, and deficits are strongly linked to reading disabilities like dyslexia.

Question 29: The Shaker exercise (head-lifting exercise) targets strengthening of which muscle group to improve swallowing?

Suprahyoid and infrahyoid muscles to improve laryngeal elevation and UES opening (Correct answer)
Cricopharyngeus muscle directly
Tongue intrinsic muscles
Pharyngeal constrictors only

Correct answer: Suprahyoid and infrahyoid muscles to improve laryngeal elevation and UES opening

The Shaker exercise strengthens suprahyoid muscles to improve hyolaryngeal excursion, which aids upper esophageal sphincter (UES) opening.

Question 30: The OSHA permissible exposure limit (PEL) for occupational noise is 90 dB SPL for how many hours per day?

8 hours (Correct answer)
4 hours
2 hours
12 hours

Correct answer: 8 hours

OSHA sets the PEL at 90 dB SPL for an 8-hour workday, with a 5 dB exchange rate for each halving of duration.

Question 31: Natural recovery from stuttering without treatment occurs in approximately what percentage of children?

90–95%
25–35%
10–15%
50–80% (Correct answer)

Correct answer: 50–80%

Research indicates that 50–80% of children who stutter will naturally recover, often before puberty.

Question 32: Which instrumental assessment is used to visualize velopharyngeal function during speech by inserting a scope through the nose?

Electropalatography
Nasopharyngoscopy (Correct answer)
Videostroboscopy
Modified barium swallow

Correct answer: Nasopharyngoscopy

Nasopharyngoscopy uses a flexible endoscope passed transnasally to provide a direct view of the velopharyngeal mechanism during speech.

Question 33: Which term describes the perception of sound (ringing, buzzing, hissing) in the absence of an external sound source?

Diplacusis
Hyperacusis
Auditory hallucinations
Tinnitus (Correct answer)

Correct answer: Tinnitus

Tinnitus is the subjective perception of sound without an external acoustic stimulus, often associated with cochlear damage.

Question 34: Which amplification fitting approach is most commonly used as the prescriptive target for adult hearing aid fittings?

NAL-NL2 (Correct answer)
Mirror gain prescription
CROS fitting
BICROS fitting

Correct answer: NAL-NL2

NAL-NL2 (National Acoustic Laboratories Non-Linear fitting procedure) is a widely adopted prescriptive target for optimizing speech intelligibility in hearing aid fittings.

Question 35: Which disfluency types are considered 'stuttering-like disfluencies' (SLDs)?

Part-word repetitions, prolongations, and blocks (Correct answer)
Interjections, revisions, and phrase repetitions
Revisions and abandoned utterances only
Filled pauses and multisyllabic word repetitions

Correct answer: Part-word repetitions, prolongations, and blocks

SLDs include part-word repetitions, prolongations, and blocks, which are more closely associated with developmental stuttering.

Question 36: When it comes to computer input and output, input refers to_____________

retrieval of data or information that has been input into the computer
data or information that has been entered into the computer
Both (A) and (C) (Correct answer)
any data processing that occurs from new data input into the computer
the transmission of data that has been input to the computer

Correct answer: Both (A) and (C)

Input in computing refers to both the data or information that is entered into the computer system and the process of transmitting that data into the system. This means that anything fed into the computer, whether it's text from a keyboard or a file from a drive, along with its transmission, constitutes input. Both aspects are crucial for the computer to receive and process information.

Question 37: Vocal nodules most commonly develop in which population due to vocal overuse or misuse?

Elderly men
Professional singers and heavy voice users (Correct answer)
Infants
Individuals post-laryngectomy

Correct answer: Professional singers and heavy voice users

Vocal nodules are callous-like lesions on the vocal fold edges commonly caused by chronic vocal overuse and poor vocal hygiene, often in singers and heavy voice users.

Question 38: Which resonance disorder is characterized by insufficient nasal resonance on nasal phonemes /m/, /n/, and /ŋ/?

Mixed resonance
Hyponasality (Correct answer)
Hypernasality
Cul-de-sac resonance

Correct answer: Hyponasality

Hyponasality results from obstruction of the nasal passage, reducing nasal resonance on nasal consonants.

Question 39: Continuing education for CCC maintenance must be relevant to:

Foreign language study
Any topic the clinician chooses
Only management skills
The science and contemporary practice of the profession (Correct answer)

Correct answer: The science and contemporary practice of the profession

Maintenance hours must relate to the science and current practice of speech-language pathology or audiology.

Question 40: Which evidence-based aphasia treatment focuses on restoring word retrieval through repeated naming practice with feedback?

Supported Conversation for Adults with Aphasia (SCA)
Semantic Feature Analysis (SFA) (Correct answer)
Melodic Intonation Therapy (MIT)
Treatment of Underlying Forms (TUF)

Correct answer: Semantic Feature Analysis (SFA)

Semantic Feature Analysis targets word retrieval by activating semantic networks through systematic feature generation.

Question 41: Which medical condition in premature infants directly causes disorganized suck-swallow-breathe coordination?

Cleft lip only
Gastroesophageal reflux disease (GERD)
Cerebral palsy confirmed at birth
Respiratory distress syndrome (RDS) and chronic lung disease (Correct answer)

Correct answer: Respiratory distress syndrome (RDS) and chronic lung disease

Respiratory conditions in premature infants impair the coordination of the suck-swallow-breathe sequence, leading to oral feeding difficulties.

Question 42: Which type of dementia is the most common and is associated with amyloid plaques and neurofibrillary tangles?

Lewy body dementia
Alzheimer's disease (Correct answer)
Frontotemporal dementia
Vascular dementia

Correct answer: Alzheimer's disease

Alzheimer's disease is the most common dementia, characterized pathologically by amyloid-beta plaques and tau neurofibrillary tangles.

Question 43: Which condition is associated with the language profile of hyperlexia, relatively strong decoding, but poor reading comprehension?

ADHD
Dyslexia
DLD
Autism spectrum disorder (ASD) (Correct answer)

Correct answer: Autism spectrum disorder (ASD)

Hyperlexia, characterized by early word decoding with poor comprehension, is frequently observed in children with ASD.

Question 44: Which ethical principle guides the SLP to respect a patient's right to refuse texture-modified diets or thickened liquids despite aspiration risk?

Beneficence
Justice
Autonomy (Correct answer)
Non-maleficence

Correct answer: Autonomy

Autonomy respects the patient's right to make informed decisions about their care, including accepting risk of aspiration for quality of life.

Question 45: Hypernasality is most directly associated with inadequate function of which structure?

Tongue
Velopharyngeal mechanism (Correct answer)
Lips
Larynx

Correct answer: Velopharyngeal mechanism

Inadequate velopharyngeal closure allows excessive nasal resonance, causing hypernasality.

Question 46: Cricopharyngeal dysfunction (CP dysfunction) refers to impairment of which structure's ability to open during swallowing?

Epiglottis
Velopharyngeal port
Upper esophageal sphincter (Correct answer)
Glottis

Correct answer: Upper esophageal sphincter

Cricopharyngeal dysfunction involves failure of the cricopharyngeus muscle (main component of the UES) to relax and open during swallowing, causing bolus retention in the pharynx.

Question 47: Broca's aphasia is characterized by which pattern of language deficits?

Fluent paraphasic speech with poor repetition
Non-fluent speech with relatively preserved comprehension (Correct answer)
Fluent speech with comprehension deficits
Non-fluent speech with severely impaired comprehension

Correct answer: Non-fluent speech with relatively preserved comprehension

Broca's aphasia is marked by effortful, non-fluent speech with relatively preserved auditory comprehension.

Question 48: Which body verifies that submitted CCC maintenance hours meet requirements?

The employer's HR department
ASHA's Certification Maintenance / audit process (Correct answer)
The IRS
The state board of education

Correct answer: ASHA's Certification Maintenance / audit process

ASHA tracks and may audit certificate holders to confirm maintenance compliance.

Question 49: A child who uses fewer than 50 words and no word combinations by age 24 months is classified as a:

Late talker (Correct answer)
Late bloomer
Child with DLD
Child with autism

Correct answer: Late talker

A 'late talker' is a toddler between 18–24 months with limited expressive vocabulary without other developmental concerns.

Question 50: During the Clinical Fellowship, what percentage of time must be spent in direct clinical contact?

At least 80% (Correct answer)
At least 50%
At least 25%
At least 10%

Correct answer: At least 80%

At least 80% of the CF must involve direct clinical activities such as assessment and intervention.

Question 51: Videostroboscopy evaluates vocal fold function primarily by observing:

Vocal fold mucosal wave and closure patterns (Correct answer)
Subglottal pressure
Resonance characteristics
Respiratory support for speech

Correct answer: Vocal fold mucosal wave and closure patterns

Videostroboscopy uses a strobe light synchronized to vocal fold vibration to visualize the mucosal wave and vibratory characteristics.

Question 52: The acoustic stapedial reflex is elicited by loud sounds and involves contraction of which muscle?

Tensor veli palatini
Tensor tympani
Levator veli palatini
Stapedius muscle (Correct answer)

Correct answer: Stapedius muscle

The acoustic reflex involves reflexive contraction of the stapedius muscle in response to loud sounds, stiffening the ossicular chain.

Question 53: Which surgical procedure involves injecting material into a paralyzed vocal fold to improve glottic closure?

Thyroplasty Type I only
Vocal fold augmentation injection (Correct answer)
Arytenoidectomy
Laser cordectomy

Correct answer: Vocal fold augmentation injection

Vocal fold augmentation involves injecting materials (e.g., collagen, fat, Radiesse) to medialize a paralyzed or atrophic vocal fold for improved closure.

Question 54: The graduate program a CCC candidate attends must be accredited by:

ABET
LCME
CAA (Council on Academic Accreditation) (Correct answer)
CCNE

Correct answer: CAA (Council on Academic Accreditation)

Programs must be accredited by ASHA's Council on Academic Accreditation in Audiology and Speech-Language Pathology.

Question 55: Which aphasia type features fluent speech, impaired comprehension, and impaired repetition with paraphasias?

Transcortical motor aphasia
Wernicke's aphasia (Correct answer)
Broca's aphasia
Conduction aphasia

Correct answer: Wernicke's aphasia

Wernicke's aphasia is characterized by fluent, paraphasic speech with poor comprehension and poor repetition.

Question 56: Tympanometry assesses the function and compliance of which structure?

Cochlea
Tympanic membrane and middle ear system (Correct answer)
Eustachian tube only
Auditory nerve

Correct answer: Tympanic membrane and middle ear system

Tympanometry measures tympanic membrane compliance and middle ear pressure to assess middle ear function and pathology.

Question 57: Which distinctive feature differentiates /p/ from /b/?

Manner of articulation
Voicing (Correct answer)
Nasality
Place of articulation

Correct answer: Voicing

/p/ is voiceless and /b/ is voiced; they share the same bilabial place and stop manner.

Question 58: Which structure is primarily responsible for velopharyngeal closure during speech?

True vocal folds
Velum (soft palate) (Correct answer)
Epiglottis
Tongue dorsum

Correct answer: Velum (soft palate)

The velum elevates and retracts to contact the posterior pharyngeal wall, closing the velopharyngeal port during oral speech production.

Question 59: The Brown's Stages of morphological development are tracked using which measurement?

Lexical diversity index
Mean length of utterance (MLU) (Correct answer)
Type-token ratio (TTR)
Percentage of grammatical sentences

Correct answer: Mean length of utterance (MLU)

MLU (Mean Length of Utterance) in morphemes is used to track syntactic and morphological development according to Brown's Stages.

Question 60: What is 'feature matching' in the AAC assessment process?

Selecting AAC symbols that visually resemble real objects as closely as possible
Matching AAC device costs to an individual's insurance coverage specifications
Matching AAC device features to an individual's communication needs, motor abilities, and environments (Correct answer)
Pairing communication partners with AAC users based on shared personality traits

Correct answer: Matching AAC device features to an individual's communication needs, motor abilities, and environments

Feature matching involves identifying an individual's needs, skills, and environments, then selecting an AAC system whose features best align with that profile.

Question 61: Silent aspiration is defined as aspiration that occurs without which response?

Esophageal peristalsis
Laryngeal elevation
Tongue retraction
Cough or throat clear (Correct answer)

Correct answer: Cough or throat clear

Silent aspiration occurs when material enters the airway below the vocal folds without triggering a cough or throat-clearing response.

Question 62: Noise-induced hearing loss (NIHL) preferentially affects which frequency region on the audiogram?

All frequencies equally
4000 Hz (4 kHz notch) (Correct answer)
250–500 Hz low frequencies
Only high frequencies above 8000 Hz

Correct answer: 4000 Hz (4 kHz notch)

NIHL characteristically produces a 'noise notch' at 4000 Hz (4 kHz) due to the resonance properties of the ear canal and mechanical vulnerability of that cochlear region.

Question 63: When a user clicks on a word on a web page, it opens a new document.

None of the above
URL
Anchor
Hyperlink (Correct answer)
Reference

Correct answer: Hyperlink

A hyperlink is an interactive element on a web page or digital document that, when clicked, navigates the user to another location. This location can be a different part of the same document, another document, or an entirely different website. It provides a direct and convenient way to access related information.

Question 64: Dynamic assessment in language evaluation differs from standardized testing because it:

Uses only norm-referenced scores
Measures the child's response to mediated instruction (Correct answer)
Only assesses expressive language
Requires no clinician involvement

Correct answer: Measures the child's response to mediated instruction

Dynamic assessment follows a test-teach-retest model to measure the child's learning potential and responsiveness to scaffolding.

Question 65: Cognitive-communication disorders following right hemisphere brain damage commonly include deficits in:

Phonological processing
Pragmatics, discourse, and prosody (Correct answer)
Reading decoding
Syntactic comprehension

Correct answer: Pragmatics, discourse, and prosody

Right hemisphere damage frequently causes deficits in pragmatic communication, discourse organization, prosodic interpretation, and inferencing.

Question 66: Which phonological process involves moving a back consonant to a more anterior position, such as saying 'tat' for 'cat'?

Fronting (Correct answer)
Vocalization
Backing
Stopping

Correct answer: Fronting

Fronting occurs when velar or palatal sounds are replaced by alveolar or dental sounds.

Question 67: Failing to complete CCC maintenance requirements can result in:

A warning letter only
An automatic one-year extension
Reduced dues
Loss of certification (Correct answer)

Correct answer: Loss of certification

Certificate holders who do not meet maintenance standards risk losing their CCC.

Question 68: Which population would most benefit from a low-tech, alphabet-based AAC system such as a letter board?

An adult with acquired aphasia following stroke who retains functional literacy skills (Correct answer)
An individual with profound hearing loss who primarily communicates using American Sign Language
A young child with severe intellectual disability and complex communication needs who is preliterate
A toddler at risk for communication delays due to early language exposure deficits

Correct answer: An adult with acquired aphasia following stroke who retains functional literacy skills

Adults with acquired aphasia who retain literacy can use alphabet boards for spelling and partner-assisted scanning to communicate efficiently without high-tech devices.

Question 69: A device that connects to a network without using cables is known as _____________

distributed
centralized
open source
wireless (Correct answer)

Correct answer: wireless

Wireless technology enables devices to connect and communicate without the need for physical cables. Instead, it uses radio waves, infrared, or other electromagnetic signals to transmit data. Common examples include Wi-Fi for internet access and Bluetooth for short-range device connections.

Question 70: Percentage of consonants correct (PCC) is a metric used to quantify which aspect of speech?

Voice quality
Prosody
Articulation accuracy (Correct answer)
Intelligibility

Correct answer: Articulation accuracy

PCC measures the proportion of consonants produced correctly in a speech sample, reflecting articulation accuracy.

Question 71: FEES (Fiberoptic Endoscopic Evaluation of Swallowing) is advantageous over MBSS in which clinical situation?

When fluoroscopy is available and preferred
When esophageal phase must be visualized
When radiation exposure must be minimized and bedside evaluation is needed (Correct answer)
When the oral preparatory phase is the primary concern

Correct answer: When radiation exposure must be minimized and bedside evaluation is needed

FEES is portable, radiation-free, and can be performed at bedside, making it preferable when fluoroscopy is unavailable or radiation is contraindicated.

Question 72: Which approach uses personally relevant materials and life history to support communication and quality of life in individuals with dementia?

PECS
Errorless learning
Reminiscence therapy (Correct answer)
Response elaboration training

Correct answer: Reminiscence therapy

Reminiscence therapy uses personally meaningful memories, photographs, and life history materials to engage individuals with dementia and support communication.

Question 73: Word finding difficulties in school-age children are most directly associated with deficits in which language domain?

Phonology
Pragmatics
Semantics and lexical access (Correct answer)
Syntax

Correct answer: Semantics and lexical access

Word finding difficulties reflect problems with semantic organization and lexical retrieval from long-term memory.

Question 74: Spasmodic dysphonia (adductor type) is characterized by which voice quality?

Breathy, aphonic breaks
High-pitched tremulous voice
Monopitch with reduced loudness
Strained, strangled voice with voice breaks (Correct answer)

Correct answer: Strained, strangled voice with voice breaks

Adductor spasmodic dysphonia involves involuntary spasms that close the vocal folds during voiced speech, causing a strained, strangled quality with voice breaks.

Question 75: Beginning in recent ASHA standards, at least one maintenance hour must address which topic?

Grant writing
Billing codes
Marketing
Ethics (Correct answer)

Correct answer: Ethics

ASHA now requires that at least one professional development hour per interval cover ethics.

Question 76: A child consistently omits the past tense -ed morpheme in obligatory contexts. This is an example of a deficit in which language domain?

Pragmatics
Semantics
Morphosyntax (Correct answer)
Phonology

Correct answer: Morphosyntax

Omission of grammatical morphemes in obligatory contexts is a morphosyntactic deficit affecting grammar production.

Question 77: Augmentative and Alternative Communication (AAC) should be introduced for adults with aphasia:

Only in end-stage disease
As early as appropriate to support communication participation (Correct answer)
Only after all restorative treatments have failed
Only when the patient requests it

Correct answer: As early as appropriate to support communication participation

AAC should be introduced early to maximize communicative participation and does not interfere with natural speech recovery.

Question 78: A Clinical Fellowship for the CCC-SLP must total at least how many hours of supervised work?

1,000 hours
2,000 hours
640 hours
1,260 hours (Correct answer)

Correct answer: 1,260 hours

The CF requires a minimum of 1,260 hours completed over at least 36 weeks of full-time work.

Question 79: The Lee Silverman Voice Treatment (LSVT LOUD) is an evidence-based voice treatment specifically designed for patients with:

Spasmodic dysphonia
Parkinson's disease (Correct answer)
Unilateral vocal fold paralysis
Vocal nodules

Correct answer: Parkinson's disease

LSVT LOUD targets the hypokinetic dysarthria of Parkinson's disease by training patients to use increased vocal effort and loudness.

Question 80: A child with cleft palate who undergoes palatoplasty may still require speech therapy primarily because of residual issues with which aspect of speech?

Hearing
Fluency
Phonation
Velopharyngeal function and compensatory articulation errors (Correct answer)

Correct answer: Velopharyngeal function and compensatory articulation errors

Even after surgical repair, children may retain compensatory articulation errors and residual velopharyngeal insufficiency requiring speech therapy.

Question 81: The _____________ specifies the maximum amount of data that a storage medium can hold.

access
memory
storage
capacity (Correct answer)
None of the above

Correct answer: capacity

Capacity, in the context of computer storage, refers to the maximum amount of data that a storage medium can hold. It quantifies the total storage space available on devices like hard drives, USB drives, or solid-state drives. For example, a 1 terabyte hard drive has a storage capacity of 1 terabyte.

Question 82: A Type B tympanogram with no peak indicates which middle ear condition?

Normal middle ear function
Eustachian tube dysfunction with negative pressure
Ossicular discontinuity
Middle ear fluid (otitis media with effusion) (Correct answer)

Correct answer: Middle ear fluid (otitis media with effusion)

A Type B (flat) tympanogram indicates reduced tympanic membrane mobility, most commonly due to middle ear effusion.

Question 83: Which assessment approach samples a child's phoneme production across a variety of contexts using real words?

Nonsense syllable probe
Single-word articulation test (Correct answer)
Stimulability testing
Connected speech sample

Correct answer: Single-word articulation test

A single-word articulation test elicits target phonemes in a standardized set of real words across various positions.

Question 84: Which term describes the ability of a child to correctly produce a sound when given a model or cue?

Coarticulation
Automaticity
Generalization
Stimulability (Correct answer)

Correct answer: Stimulability

Stimulability refers to the child's ability to produce a sound correctly when provided with auditory and/or visual cues.

Question 85: The CCC-A credential is specifically for which profession?

Occupational therapy
Audiology (Correct answer)
Respiratory therapy
Speech-language pathology

Correct answer: Audiology

CCC-A designates the Certificate of Clinical Competence in Audiology.

Question 86: Which service delivery model places the SLP directly in the classroom to support language learning within the curriculum?

Pull-out model
Telehealth model
Collaborative classroom model (Correct answer)
Consultative model

Correct answer: Collaborative classroom model

The collaborative classroom (integrated) model embeds speech-language services within the general education setting.

Question 87: The Stuttering Severity Instrument (SSI-4) rates severity based on which three components?

Avoidance, anticipation, and struggle
Frequency, avoidance, and attitude
Frequency, duration, and physical concomitants (Correct answer)
Rate, intelligibility, and tension

Correct answer: Frequency, duration, and physical concomitants

The SSI-4 measures stuttering frequency, average duration of the three longest stuttering events, and physical concomitants.

Question 88: Several computers are connected to a server in order to share applications and storage space—

Integrated System
Library
Network (Correct answer)
Grouping

Correct answer: Network

A network is a system of interconnected computers and other devices that can communicate with each other and share resources. When several computers are connected to a server to share applications and storage space, they form a network. This setup allows for centralized data management and efficient resource utilization among users.

Question 89: The Cycles Approach was developed primarily to treat which type of disorder?

Stuttering
Highly unintelligible phonological disorders (Correct answer)
Apraxia of speech
Voice disorders

Correct answer: Highly unintelligible phonological disorders

The Cycles Approach, developed by Hodson and Paden, targets children with highly unintelligible speech due to multiple phonological process errors.

Question 90: Which standardized exam must candidates pass to earn the CCC?

Praxis examination in the area of certification (Correct answer)
GRE Subject Test
USMLE
NCLEX

Correct answer: Praxis examination in the area of certification

Candidates must pass the Praxis exam in speech-language pathology or audiology.

Question 91: Which intervention approach uses naturalistic contexts and child-initiated interactions to facilitate language targets?

Drill-based practice
Naturalistic developmental behavioral intervention (NDBI) (Correct answer)
Discrete trial training
Structured language stimulation

Correct answer: Naturalistic developmental behavioral intervention (NDBI)

NDBIs use natural, play-based interactions following the child's lead to embed language targets within meaningful contexts.

Question 92: Otoacoustic emissions (OAEs) measure the function of which structure?

Auditory cortex
Middle ear ossicles
Outer hair cells of the cochlea (Correct answer)
Auditory nerve (CN VIII)

Correct answer: Outer hair cells of the cochlea

OAEs are sounds generated by the outer hair cells of the cochlea and are measured to assess cochlear (outer hair cell) integrity.

Question 93: Real-ear measurement (REM) in hearing aid fitting verifies that the aid provides the prescribed gain by measuring sound at which location?

In a 2cc coupler
At the level of the tympanic membrane in the ear canal (Correct answer)
Outside the ear canal at the aid microphone
At the hearing aid speaker output only

Correct answer: At the level of the tympanic membrane in the ear canal

REM uses a probe microphone placed near the tympanic membrane to measure the actual sound pressure level delivered by the hearing aid in the individual's ear.

Question 94: Spaced retrieval training (SRT) is an evidence-based technique used with dementia patients to:

Improve swallowing safety
Reduce agitation with music
Teach and maintain functional information through graduated practice intervals (Correct answer)
Improve phonological awareness

Correct answer: Teach and maintain functional information through graduated practice intervals

SRT uses progressively longer intervals between retrieval attempts to help individuals with dementia learn and retain functional information.

Question 95: Adherence to which document is a condition of holding the CCC?

The ASHA Code of Ethics (Correct answer)
The Affordable Care Act
The DSM-5
OSHA regulations

Correct answer: The ASHA Code of Ethics

CCC holders must comply with the ASHA Code of Ethics to retain certification.

Question 96: The IDDSI (International Dysphagia Diet Standardisation Initiative) framework provides standardized terminology for:

Oral motor treatment approaches
Texture-modified food and thickened liquid levels (Correct answer)
Instrumental assessment procedures
Swallowing exercise protocols

Correct answer: Texture-modified food and thickened liquid levels

IDDSI defines eight standardized levels (0–7) of texture-modified foods and thickened liquids to improve communication and safety in dysphagia management.

Question 97: Presbyphonia refers to age-related voice changes that include which acoustic characteristic?

Improved mucosal wave in older speakers
Increased fundamental frequency in men, bowing of vocal folds, and reduced loudness (Correct answer)
Increased vocal intensity with aging
Decreased fundamental frequency in women

Correct answer: Increased fundamental frequency in men, bowing of vocal folds, and reduced loudness

Presbyphonia involves vocal fold bowing, atrophy, and stiffness leading to a higher, weaker voice in men and lower in women, with increased breathiness.

Question 98: Which evidence-based approach uses minimal pairs to contrast error and target sounds to facilitate phonological change?

Minimal opposition contrast therapy (Correct answer)
Nuffield dyspraxia programme
DTTC
Cycles approach

Correct answer: Minimal opposition contrast therapy

Minimal opposition contrast therapy pairs words that differ by only one phoneme to highlight the communicative impact of the error.

Question 99: Glottal stop substitutions in children with cleft palate are considered which type of errors?

Developmental phonological errors
Compensatory articulation errors (Correct answer)
Motor programming errors
Resonance errors

Correct answer: Compensatory articulation errors

Glottal stop substitutions are compensatory articulation errors developed to manage air pressure given inadequate velopharyngeal closure.

Question 100: What is the purpose of language sample analysis (LSA) in evaluating a child's language?

To assess phonological awareness only
To describe naturalistic language in terms of complexity and accuracy (Correct answer)
To measure hearing thresholds
To obtain a standardized norm-referenced score

Correct answer: To describe naturalistic language in terms of complexity and accuracy

Language sample analysis provides a descriptive, naturalistic measure of a child's spontaneous language use across multiple domains.

Question 101: Universal newborn hearing screening (UNHS) in the US uses which two primary technologies?

OAE and ABR (Correct answer)
Tympanometry and OAE
Behavioral audiometry and OAE
Pure tone audiometry and ABR

Correct answer: OAE and ABR

UNHS programs use OAE and/or ABR testing because both are objective, require no behavioral response, and can be performed on sleeping newborns.

Question 102: Which language component involves understanding and applying rules for combining words into sentences?

Pragmatics
Morphology
Syntax (Correct answer)
Phonology

Correct answer: Syntax

Syntax refers to the rules governing sentence structure, including word order and grammatical relationships.

Question 103: Which aphasia syndrome is characterized by relatively preserved repetition with non-fluent output and poor comprehension?

Global aphasia
Transcortical motor aphasia
Mixed transcortical aphasia (Correct answer)
Transcortical sensory aphasia

Correct answer: Mixed transcortical aphasia

Mixed transcortical aphasia features poor fluency, poor comprehension, but preserved repetition, often due to watershed lesions.

Question 104: Laryngeal penetration during swallowing is defined as bolus material entering which structure without passing below the vocal folds?

Valleculae
Pyriform sinuses
Laryngeal vestibule above the vocal folds (Correct answer)
Esophagus

Correct answer: Laryngeal vestibule above the vocal folds

Penetration occurs when material enters the laryngeal vestibule (above the vocal folds) but does not pass below them into the trachea.

Question 105: Is the CCC by itself sufficient to legally practice speech-language pathology in most US states?

No, a state license is also required (Correct answer)
Yes, it replaces all state requirements
No, a medical degree is required
Yes, but only in hospitals

Correct answer: No, a state license is also required

Legal practice in most states requires state licensure in addition to the voluntary CCC.

Question 106: Which SLP role in dementia care involves training care partners to use strategies that enhance communication?

Feeding tube placement
Care partner coaching and education (Correct answer)
Diagnostic workup only
Pharmacological management

Correct answer: Care partner coaching and education

SLPs train care partners in communication strategies such as simplified language, visual cues, and validation to optimize interactions with individuals with dementia.

Question 107: Which audiological test assesses the integrity of the auditory brainstem pathway by measuring electrical responses to sound?

Otoacoustic emissions (OAE)
Pure tone audiometry
Acoustic reflex threshold testing
Auditory brainstem response (ABR) (Correct answer)

Correct answer: Auditory brainstem response (ABR)

The ABR records electrical responses from the auditory nerve and brainstem to click or tone-burst stimuli, assessing neural pathway integrity.

Question 108: Which term describes a language disorder with no known etiology and no other co-occurring condition?

Developmental language disorder (DLD) (Correct answer)
Language learning disability
Specific reading disorder
Secondary language impairment

Correct answer: Developmental language disorder (DLD)

Developmental Language Disorder (DLD) is the current preferred term for persistent language difficulties without a known cause.

Question 109: Which process describes a child replacing a fricative with a stop, such as saying 'tun' for 'sun'?

Assimilation
Fronting
Gliding
Stopping (Correct answer)

Correct answer: Stopping

Stopping is a phonological process where fricatives or affricates are replaced by stop consonants.

Question 110: Which phase of swallowing involves the bolus being moved from the anterior to the posterior oral cavity by the tongue?

Oral transport phase (Correct answer)
Oral preparatory phase
Esophageal phase
Pharyngeal phase

Correct answer: Oral transport phase

The oral transport (propulsion) phase involves the tongue propelling the bolus posteriorly toward the pharynx.

Question 111: A speech-language pathologist selects intervention targets using a complexity approach. Which sounds are prioritized?

Early-developing sounds the child inconsistently produces
Late-developing sounds the child does not produce (Correct answer)
Sounds the child produces correctly in isolation
Sounds with the highest stimulability

Correct answer: Late-developing sounds the child does not produce

The complexity approach targets late-developing, non-stimulable sounds to promote system-wide generalization.

Question 112: Posterior tongue tie (posterior ankyloglossia) in infants is associated with difficulty in which feeding aspect?

Esophageal motility
Creating adequate suction and cupping during breastfeeding (Correct answer)
Pharyngeal swallow triggering
Liquid thickening tolerance

Correct answer: Creating adequate suction and cupping during breastfeeding

Posterior tongue tie restricts tongue elevation and cupping, impairing the suction and compression mechanics needed for efficient breastfeeding.

Question 113: Which standardized test assesses language comprehension and production in children ages 3–21 and yields an overall Language Score?

PPVT-5
CELF-5 (Correct answer)
EVT-3
CASL-2

Correct answer: CELF-5

The Clinical Evaluation of Language Fundamentals–Fifth Edition (CELF-5) assesses multiple language domains and yields a Core Language Score.

Question 114: Which communication characteristic is most prominent in the early stages of Alzheimer's disease?

Severe phonological errors
Fluent jargon aphasia
Complete mutism
Word finding difficulty and topic maintenance problems (Correct answer)

Correct answer: Word finding difficulty and topic maintenance problems

Early Alzheimer's disease typically presents with anomia and difficulty maintaining conversational topics due to memory and semantic deficits.

Question 115: Melodic Intonation Therapy (MIT) is primarily indicated for which aphasia profile?

Conduction aphasia
Non-fluent aphasia with relatively preserved comprehension (Correct answer)
Global aphasia with severe comprehension deficit
Fluent aphasia with comprehension deficits

Correct answer: Non-fluent aphasia with relatively preserved comprehension

MIT uses melodic, rhythmic speech to leverage right hemisphere processing in individuals with non-fluent aphasia and preserved comprehension.

Question 116: A child who consistently omits final consonants (e.g., 'ca' for 'cat') is demonstrating which phonological process?

Epenthesis
Weak syllable deletion
Cluster reduction
Final consonant deletion (Correct answer)

Correct answer: Final consonant deletion

Final consonant deletion is the omission of the final consonant in a syllable or word.

Question 117: Which evidence-based technique involves repeating a child's utterance with a corrected or expanded grammatical form?

Modeling
Prompting
Recasting (Correct answer)
Scaffolding

Correct answer: Recasting

Recasting repeats the child's utterance with a grammatical or semantic correction without explicitly marking the error.

Question 118: At what age is the phoneme /r/ typically acquired by most children?

Age 4
Age 5
Age 7 (Correct answer)
Age 3

Correct answer: Age 7

The phoneme /r/ is one of the latest to be acquired, typically mastered by age 7.

Question 119: Which instrumental assessment uses fluoroscopy to evaluate all phases of swallowing in real time?

High-resolution manometry
Modified barium swallow study (MBSS) (Correct answer)
Ultrasound imaging
Fiberoptic endoscopic evaluation of swallowing (FEES)

Correct answer: Modified barium swallow study (MBSS)

The Modified Barium Swallow Study uses dynamic fluoroscopy with barium-coated boluses to visualize swallowing physiology across all phases.

Question 120: A_____________ is the smallest unit in a digital system.

Word
Character
Byte
bit (Correct answer)
Kilobyte

Correct answer: bit

In a digital system, a bit (binary digit) is the smallest unit of data. A bit can represent one of two states, typically 0 or 1, corresponding to electrical on/off signals. These bits are the fundamental building blocks from which all other digital information, like bytes, kilobytes, and words, are constructed.

ASHA CCC Certificate of Clinical Competence Exam

The ASHA Certificate of Clinical Competence (CCC) Exam assesses speech-language pathology knowledge across speech sound disorders, language disorders in children and adults, fluency and voice disorders, swallowing and feeding disorders, and audiology and hearing sciences.

120

Questions

150 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds