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Stuttering is one of the most extensively studied yet
poorly understood communicative disorders.
Authorities in fluency disorders do not agree on a
universal definition or on an etiology.
The disagreements about causation do not significantly
influence the assessment process because it is possible
to validly detect and assess stuttering without knowing
the etiology.
HISTORY OF CLIENT:
 Procedures
• Written case history
• Information-getting interview
• Information from other professionals
 Contributing
Factors
• Medical or neurological factors
• Family history
• Sex, motivation, and levels of concern
ASSESSMENT OF FLUENCY
 Procedures
• Screening
• Speech sampling
• Stimulability
 Analysis
• Dyfluency indexes
• Associated motor behaviors
• Other physiological factors
• Rate of speech
• Feelings, Attitudes, and Reactions to Speech
ORAL-FACIAL EXAMINATION
HEARING ASSESSMENT
DETERMING THE DIAGNOSIS
PROVIDING INFORMATION
Written report
Interview
Community resources
Support Groups
 Important
for risk factors
 finding triggers (ex: adult who goes in
and out of fluency at different points in
his life)
 differential diagnosis
• Ex: Child with Tourette's and chronic stutterer;
tick disorder—research now shows that ADD
medication may worsen or trigger ticks.
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Screening
• The most important procedure for a stuttering evaluation is a
speech sample
• Obtaining speech samples for more than one session and
setting is recommended.
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Clinic/testing site
Outside the assessment area
Home
Classroom
Playground
Work
• Obtain the most representative sample possible
 Fewest dysfluencies
 Most dysfluencies
 Typical # of dysfluencies
 Important
because it will be the primary
basis on which most analyses and
judgments about fluency are made
 Establish
a positive rapport prior to
collecting sample
 Strive for a long sample ( 200+
utterances)
 Alter the contexts
• Conversation/ conversational starters
• Narratives (for reading aloud)
• Response/description of pictures (have the child
describe what’s going on in picture)
 Avoid
yes/no questions
 Be willing to WAIT for the client to talk
 Use a good quality recorder/video
 Preselect materials and topics that will
be interesting to the client
 Determine
• Total # of dysfluencies
• Frequencies of different types of dysfluencies
• Dysfluency indexes
• Duration of individual instances of dysfluency
• Types and frequencies of associated motor
behaviors
 Repetitions
• Part word repetitions “What t-t-t time is it?”
• Whole word repetitions “What what what are
you doing?”
• Phrase repetitions “ I want to- I want to- I want to
do it.”
 Prolongations
• Sound/syllable prolongations “Llllllet me do
it”
• Silent prolongations A struggling attempt to
say a word when there is no sound
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Interjections
• Sound/syllable interjections “um….um…I had
a problem this morning”
• Whole word interjections “ I had a well
problem this morning.”
• Phrase interjections “ I had a you know
problem this morning.”
 Silent
Pauses
• A silent duration within speech considered
abnormal “ I was going to the (pause) store.”
• Awkward sounding to a normal conversation;
usually placed randomly in sentences
 Broken Words
• A silent pause within words “ It was
won(pause)derful.
 Incomplete
Phrases
• Grammatically incomplete utterances “I don’t
know how to….Let us go, guys”
• Complete stoppage of phrase and then
moving on to something else (like
circumlocution).
 Revisions
• Changed words, ideas “ I thought I will write a
letter, card”
 Dysfluency
Indexes refer to percentages
of dysfluent speech present in the speech
sample.
 Index
grids are helpful in identifying and
quantifying dysfluencies
 Examples
of Indexes
• Form 9-1: The fluency Charting Grid
• Form 9-2: Frequency Count for dysfluencies
• Form 9-3: Calculating the Dysfluency Index
 Example:
• When determining a dysfluency index, count
each repetition of a sound, part of a word, whole
word, or phrase only ONCE.
 ba ba ba ba ball
 I want I want I want a ball
 The
total dysfluency index reflects ALL
dysfluencies produced by the client.
• 500 word sample: 75 repetitions
50 pauses
25 sound prolongations
150 total dysfluencies
 Count
total number of words in speech
sample (500)
 Count total dysfluencies (150)
 Total dysfluencies/total words
(150/500=.30)
 30% TDI
 Specific
dysfluencies
• Total # of specific dysfluencies/total # of words
• Total repetitions
 75/500=.15 (15%)
 Percentage
of each dysfluency type
• Total # of specific dysfluencies/total # of
dysfluencies
 75/150=.50 (50% of dysfluencies present were
repetitions)
 Time
each dysfluency with a stopwatch.
 Pauses and prolongations are the most
commonly timed
 10 dysfluencies resulting in a total of 42
seconds yields an average duration of 4.2
seconds
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Extraneous motor body movements in association with
dysfluencies
Usually involve parts of the oral facial mechanism: eye
blinking, wrinkling of the forehead, sudden exhaustive
exhaling, frowning, distorting the mouth, moving the head
and quivering the nostrils.
Can involve arms, hands, legs, feet or torso
Form 9-4
Identify and chart the frequency of motor behaviors
 Respiratory
 Phonatory
 Articulatory
 Prosodic
 Note
aspects
if these features are present during
fluent or dysfluent speech
 Assessing
speech rate is an especially
important element of the evaluation
 Determine what you want to evaluate:
• Overall rate:
• Normal rate:
 S-Scale: assesses
stutterers’ attitudes
about various speaking situations.
 Form 9-6
 Understanding
a client’s feelings and
attitudes about his or her stuttering
behavior may be helpful for making
decisions about the client’s care.
 Parental
Concern:
• Particularly for children who stutter
• Important to assess parental fears, anxieties and
concerns that they have surrounding their child’s
stuttering
 Two
specific responses to negative
feelings about stuttering are
AVOIDANCE and EXPECTANCY
 Sounds
 Words
 Topics
 People
(employer, teacher, strangers)
 Situations (ordering in a restaurant)
 Communicative Events (public speaking)
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Primary Avoidances
• Starters
• Postponements
• Retrials
• Circumlocutions
• Antiexpectancies
Secondary Avoidances
• Reducing verbal output or not talking at all
• Relying on others to communicate for them
 The
expectation of the stutter before it
occurs
 Some stutterers will push through the
stutter when it occurs and others will
avoid that situation
 Assess this by observing and listening
during speech tasks and through
interviews.
 You can “suspect” expectancy, but can
only confirm this by asking the client
Clinicians must use their professional judgment and experience to make
an appropriate diagnosis.
1.
The total dysfluency index: must be 5% or greater is usually
considered a fluency disorder
2.
The dysfluency indexes for repetitions, prolongations and pauses
between words is 3% or greater is usually considered a fluency
disorder
3.
The duration of dysfluencies are 1 second or longer usually
warrant a diagnosis of a fluency disorder
4.
The presence of associated motor behaviors
5.
The client or caregivers degree of concern about dysfluency
 Differentiate
between children with
normal dysfluency and stuttering
disorders?
 Research
shows that a child is more likely
to outgrow stuttering if:
• The child is a girl
• The onset is fairly recent (spontaneous recovery usually
happens within 12-14 months of initial onset)
• The onset of stuttering occurred after the child’s 3rd birthday
• The prevalence of sound/syllable or word repetitions declines
quickly after onset
• The child demonstrates few to no associated motor behaviors
and no articulation or language problems
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Diagnosis of stuttering if any one of these
behaviors are present:
• Total % of dysfluencies is greater than 10% of all words or
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syllables uttered.
Prolongations longer than 1 second on 2% or more of the words
uttered. Increases in loudness, pitch rises, and abrupt termination
of prolongations are additional indicators of a fluency disorder
Part-word repetitions of two or more units per repetition on more of
the words uttered.
Involuntary blockings or hesitations that last longer than 2 seconds
Signs of struggle
Noticeable emotional reactions
Complaints of being unable to perform satisfactorily bc of speech
Obvious variations in the frequency or severity of speech
disruptions with changes in speaking situations
Mild, Moderate, Severe
 Stuttering Severity Instrument for
Children and Adults : SSI (Riley 1994)
 Based on four major measures:
frequency, duration, concomitant
behaviors and overall severity
 Used for all ages and yields a quick
estimate for severity
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Rate speaker on 10 pt. scale (1 is no stutter;10 is most
severe)
 Would it be possible for a clinician to rate an entire
days worth of disfluencies? No
 It’s important to get parents and friends to use the
rating scale for x amount of time as well.
 Very subjective measure—measures disfluencies
over time
 Gives clear parameters of what to look for in each
level (1-10) unlike SSI
 For this form, ‘Very Severe’ is stuttering on 25% or
more of words.
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• As a clinician you would have to calculate this via language
sample, a parent would just estimate.
 Questions
for child to answer (Yes or No
format)
 Taps into emotional based questions
without directly using word stutter
 Be careful not to put ideas into the
patients head
 For
adults
 Answer questions based on avoidance,
reactions, and stuttering itself
 Helps determine which core behaviors
are more dominant