Diagnosing Childhood
Stuttering: Results from
100 Clinical Evaluations
J. Scott Yaruss, PhD, CCC-SLP
Speech Fluency Laboratory
University of Pittsburgh
Purpose
• To present results from the diagnostic
evaluations of 100 children who stutter
– To evaluate trends in the data that might
shed light on the underlying nature of
childhood stuttering
– To present clinical benchmarks that can
be used to help clinicians evaluate their
treatment recommendation decisions
Background
• Considerable research on childhood
stuttering has been conducted in
recent years regarding
– The developmental course of stuttering
– The frequency and types of disfluencies
exhibited by children who stutter
– The speech and language abilities of
children who stutter
Background (cont.)
• Still, the diagnosis of young children
who stutter remains less than an
exact science (to put it mildly…)
– Stuttering is a multifaceted disorder
that manifests itself in different ways
– Clinicians are not clear which variables
(from a host of possible options)
should be targeted in a diagnostic
evaluation
Many Variables
• When diagnosing children at risk for
stuttering, clinicians must consider
many variables, including:
– Observable characteristics of stuttering
– Psychosocial factors
– Psycholinguistic factors
– Physiological factors
– Other Variables (?)
Some Problems
• Many of the variables may not be
directly related to speech fluency
– Phonological development
– Lexical access / Word-finding
– Speech/language development
• Variables interact and manifest
themselves differently in different
children who stutter
Another Problem:
Recommending Treatment
• Not all children need to be referred
for formal treatment
– Many children “outgrow” their disfluencies,
so it is not necessary to treat everyone
– There are not sufficient resources to treat
all disfluent children
• PROBLEM: It is not always clear who
does need treatment and who does not
Some Important
Questions
• Which variables should be considered?
• How do children who stutter perform
on commonly administered tests of
stuttering and other aspects of
speech/language development?
• What are the characteristics of those
children referred for treatment?
Developing Solutions
• It would be helpful for clinicians to have
access to a database of diagnostic
information to guide decision-making
– Data collected in a consistent fashion
– Using a standard battery of commonly used
tests and measures
– Based on clinical data similar to what is
collected in the “real world”
The “100 Kids” Project
• Conture, EG, Yaruss, JS, & LaSalle, LR (1990, Nov.).
One-hundred young stutterers: Making sense of their
clinical records. Miniseminar presented at the Annual
ASHA Convention, Seattle, WA.
• Yaruss, JS, LaSalle, LR, & Conture, EG (1995, Nov.).
One-hundred children who stutter: Revisiting their
clinical records. Seminar presented at the Annual
ASHA Convention, Orlando, FL.
• Yaruss, JS, LaSalle, LR, & Conture, EG
(submitted*). Evaluating stuttering in young
children: Diagnostic data. Manuscript submitted
for publication.
for publication.
General Purpose
• To describe the speech and language
behaviors of 100 children, age two to six,
referred for evaluation of their fluency
– To examine relationships between fluency and
other aspects of development
– To examine differences in testing results
for children recommended for:
•
- treatment
•
- re-evaluation
•
-neither treatment nor re-evaluation
Method
• Subjects
– 85 boys, 15 girls
– Mean age=54.7 mos. (SD=12.2 mos.)
– Referred to university clinic for initial
diagnostic evaluation of speech fluency
based on parents’ concern re stuttering
• Analyses based on retrospective
analysis of detailed diagnostic reports
Diagnostic Procedures
• Based on a standard battery of tests
(Conture, 1990; Conture & Caruso, 1987;
Conture & Yaruss, 1993).
• 3-hour evaluation, including:
– Detailed Parent Interview
– Informal Observation of Child’s Speech
– Direct Speech-Language Testing
Measures of
Fluency I
• Commonly assessed observable
characteristics of stuttering
– Average Frequency of Disfluency
– Average Duration of Disfluency
– Most common Types of Disfluency
• Within-word disfluencies
• Between-word disfluencies
– Sound Prolongation Index
Measures of
Fluency II
• Commonly used tests of stuttering
– Stuttering Severity Instrument (Riley, 1980)
– Iowa Scale for Rating the Severity
of Stuttering (Johnson et al., 1963)
– Stuttering Prediction Instrument (Riley,
1981)
– Stocker Probe Technique (Stocker, 1980)
Measures of Speech and
Language Development
• Phonological Development
– Picture naming task (GFTA, Weiss, Hodson)
– Phonological processes analysis (Edwards)
• Receptive Vocabulary (PPVT)
• Expressive Language
–
-- MLU, Grammatical Morphemes
–
-- Standardized Test (TELD,PLS-3,CELF)
–
-- Informal play-based assessment
“Other” Measures
• Child’s Diadochokinetic Rates
– Based on rapid repeated production of
“puh-tuh-kuh” following a model and
compared to available norms
• Parents’ Articulatory Speaking Rates
– Since parents are often told to change their
speaking rates during treatment
Diagnostic Decisions
• Treatment: Treatment in a parent/ child
fluency group involving weekly group
and individual sessions
• Re-evaluation * : Re-evaluation 3 to 6
months following initial evaluation
• No treatment *: Neither treatment nor
re-evaluation at time of evaluation
* Parents received extensive counseling
Selected Results
•
•
•
•
Basic measures of fluency
Speech/language development
Other Measures (DDK)
Interactions between variables
Basic Measures of Fluency
N= 100
Prolongation Index (%)
Duration (ms)
Frequency (%)
• Frequency, Duration, and Type of
Speech Disfluencies
N= 94
Most Common
Disfluency Type
(In)audible Sound
Prolongation
26%
Other
7%
3
 2 4
N= 90

Whole-Word
Repetition
20%
1
Sound/Syllable
Repetition
47%
Basic Measures of Fluency
SPI
SSI
Iowa Scale
• Measures of Severity and Chronicity
N= 100
N= 81
N= 76
Speech and Language
Development
Exp. Language
Phonology
Below Above
Normal Normal
Limits Limits
25%
26%
Within
Normal
Limits
49%
Normal
Phonology
63%
Disordered
Phonology
37%
Speech and Language
Development
• No significant differences in fluency of
children with normal vs. disordered
25.00 phonology (similar findings for language)
20.00
Disordered Phonology
Normal Phonology
15.00
10.00
5.00
0.00
Frequency
SPI Score
Iowa Score
Duration
SSI Score
No. of Children Exhibiting Process
Speech and Language
Development
• Patterns of phonological errors
GL
35
30
25
20
15
10
5
0
ST
SCR
Disordered Phonology
Normal Phonology
(based on guidelines of Edwards
& Shriberg, 1983; Grunwell,
1982; McReynolds & Elbert,
1981; Stoel-Gammon & Dunn,
1985)
Other Measures
DDK Rates
Above
Normal
Limits
Below 14%
Normal
Limits
42%
Within
Normal
Limits
44%
Treatment Recommendations
8%
43%
TREATMENT
49%
RE-EVALUATION
NO TREATMENT
Relationships Between
Stuttering and Child’s Age
• No significant relationships between
speech fluency and chronological age
r = .18
p = .12
Age
Age
r = .07
p = .47
Frequency
Severity
Percent of Subjects
Relationship between Fluency
and Time Since Onset
• Children stuttering longer more likely
to produce sound prolongations
60
50
40
30
20
10
0
Short-TSO
Long-TSO
Whole-word
Sound/Syllable Sound Prolongations
Repetitions
repetitions
Relationships Between
Measures of Stuttering
• Expected strong correlations between
basic measures (frequency, duration,
type) and derived measures of
severity and chronicity (SSI, SPI, etc.)
• Also, expected strong correlations
between measures of severity (SSI)
and measures of chronicity (SPI)
Relationships between
Stuttering and Language
• No relationship between measures
of stuttering behaviors and...
– overall language development
– phonological development
– DDK rates
• No apparent differences in fluency of
children with normal vs. disordered
speech/language development
Relationships Between
Language Measures
• In these children who stutter, there
was a significant co-occurrence of:
– below-normal DDK rates
– below-normal language
– disordered phonology
• Interesting interactions between
language, phonology, motor
production and stuttering
65
Stuttering and Treatment
Recommendations
Treatment
No Treatment / Reevaluation
45
40
No Treatment / No Reevaluation
35
30
25
20
15
10
5
0
Frequency
Prolongation Iowa SSI
SPI Stocker
Duration
Probe
Index
Scale
Discussion
• Results provide data about how
children perform on commonly used
measures of stuttering and speech/
language development during a
diagnostic evaluation
• Results also provide a means for
evaluating the diagnostic practice
utilized by the clinicians in this clinic
Stuttering and Speech/
Language Development
• Present findings support prior reports
that children who stutter are more likely
to exhibit disordered phonology
• Findings also suggest that some
children who stutter may have
difficulty with diadochokinetic rates
• Interaction between DDK, language,
and phonology should be examined
Uses of the Data Set
• Data provide indication of factors that
might be involved in onset of stuttering
• Clinicians can use these data as a
reference to determine how their clients
compare to other children who stutter
• Results provide information about the
characteristics of children referred for
treatment by this set of clinicians
Diagnostic Benchmarks
• Data-based benchmarks for comparing
treatment recommendations
Likelihood that
Total
Sound Iowa Stuttering Stuttering
child may require Freq. of
ProScale Severity Prediction
treatment
Disfl. longation
Instrument Instrument
Index
Most likely to
> 10% > 30%
require treatment
6% - 10% 12% May require
30%
re-evaluation
>3
> 18
> 16
23
12 18
10 16
Least likely to
require treatment
<2
< 12
< 10
< 6%
< 12%
Future Directions
• Replicate and extend findings using
children evaluated at NU
– Standardize diagnostic battery
• Develop templates based on results of
these children that can facilitate
comparison to other datasets
• Examine relationships between
language, phonology, and motor
development in children who stutter