Stuttering Severity Instrument 4th Edition (SSI-4)
The Stuttering Severity Instrument–Fourth Edition (SSI-4) is a reliable and valid norm-referenced stuttering
assessment that can be used for both clinical and search purposes. It measures stuttering severity in both
children and adults in the four areas of speech behavior: frequency, duration, physical concomitants, and
naturalness of the individual’s speech through reading tasks or picture description tasks, as well as a
conversational sample. Frequency is expressed in percent syllables stuttered and converted to scale scores
of 2-18. Duration is timed to the nearest one tenth of a second and converted to scale scores of 2-18. The
four types of Physical Concomitants are converted to scale scores of 0-20. The SSI-4 can also be used in
conjunction with the Stuttering Prediction Instruments for Young Children (SPI). Total score of severity is
gathered by averaging the frequency, duration, and physical concomitants scores and comparing to severity
equivalents. Total Score Ratings: 6-10 = Very Mild; 11-20 = Mild; 21-27 = Moderate; 28-35 = Severe; and 36+
= Very Severe. XXX’s scores are as follows:
Picture Description 1:
Number of Stuttering Events: XX
Total Number of Syllables: XX
Percent of Syllables Stuttered: XX%
Picture Description 2:
Number of Stuttering Events: XX
Total Number of Syllables: XXX
Percent of Syllables Stuttered: X%
Total Number of Syllables: XXX
Percent of Syllables Stuttered: XX%
Conversation Sample (Transcribed):
Number of Stuttering Events: XX
Average Number of syllables stuttered out of all 3 areas: XX%
Frequency Score: XX Duration Score: XX (X+ seconds) Physical Concomitants Score: X Total Severity:
XX/Mild/Moderate/Severe
XXX’s severity rating of XXX indicates fluency as an area of concern. During the communication assessments,
XXX was observed to have many secondary behaviors to assist him in getting out words and managing his
stuttering events. These secondary behaviors included: loud sniffing sounds, blowing, lip pressing, eye
closures, facial grimacing, jaw tension, turning away, poor eye contact, constant looking around, and hands
about the face. Out of the total number of stuttering events, 7% were phrase repetitions, 17% were word
repetitions, 28% were part-word repetitions, 11% were word or phrase revisions, and 37% were interjections
and fillers coupled with a secondary behavior. XXX also reports that he avoids reading aloud in class and
tends to cut his story/event telling short due to frustration with getting his words out fluently.
The Predictive Cluttering Inventory (PCI) is a frequently used, and helpful, tool for assisting clinicians in
making differential diagnostic discriminations among (1) people who clutter, (2) people who both clutter
and stutter, and (3) those who do not have a fluency problem like stuttering or cluttering. The checklist
is given to the childs teacher(s)to determine if (a) cluttering and/or stuttering is present and (b) if so,
does it have an educational impact that reflects a need for remediation (speech therapy). After
choosing the students level on each specific area, numbers are totaled at the bottom and referenced
with the following score ranges: a score of 120+ indicates a diagnosis of cluttering; scores between 80
and 120 indicate a diagnosis of cluttering-stuttering; and scores of 79 or less indicate normal fluency,
with no cluttering or stuttering observed.
Descriptive Number Ranges: 6= Always; 5=Almost Always; 4=Frequently; 3=Sometimes; 2=Infrequently;
1=Almost Never; 0=Never.
Four of XXX’s teachers were asked to fill out the check-list according to their own classroom
observations. XXX’s received the following scores:
NEW CHART:
Teacher#3:
Always:
Almost Always:
Frequently:
Sometimes:
Infrequently:
Almost Never:
Never:
PRAGMATICS:
1. Lack of effective self-monitoring skills
2.Lack of awareness of own communication errors or problems
3. Compulsive talker; verbose; tangential; word-finding problems
4. Poor planning skills; mis-judges effective use of time
5. Poor social communication skills; inappropriate turn-taking; interruptions
6. Does not recognize or respond to listener’s visual or verbal feedback
7. Does not repair or correct communication breakdowns
8. Little or no excessive effort observed during disfluencies
9. Little or no anxiety regarding speaking; unconcerned
10. Speech better under pressure (improves short-term with concentration)
SPEECH-MOTOR:
11. Articulation errors
12. Irregular speech rate; speaks in spurts or bursts
13. Telescopes or condenses words
14. Rapid rate (tachylalia)
15. Speech rate progressively increases (festinating)
16. Variable prosody; irregular melody or stress pattern
17. Initial loud voice trailing off to unintelligible murmur
18. Lack of pauses between words and phrases
19. Repetition of multi-syllablic words and phrases
20. Co-existence of excessive disfluencies and stuttering
1
2
3
4
LANGUAGE/COGNITION:
21. Language is disorganized; confused wording; word-finding problems
22. Poor language formulation; poor story-telling; sequencing problems
23. Disorganized language increases as topic becomes more complex
24. Many revisions; interjections; filler words
25. Seems to verbalize before adequate thought formulation
26. Inappropriate topic introduction, maintenance, or termination
27. Improper linguistic structure; poor grammar; syntax errors
28. Distractible; poor concentration; attention span problems
MOTOR COORDINATION-WRITING PROBLEMS:
29. Poor motor control for writing (messy)
30. Writing includes omission or transposition of letters, syllables, or words
31. Oral diadochokinetic coordination below expected normed levels
32. Respiratory dysrhythmia; jerky breathing pattern
33. Clumsy and uncoordinated; motor activities accelerated or impulsive
Total Score: