Evaluate for stuttering vs. Not
Hey! My name is Michalla Silvey and I am a second year graduate student at Stephen F. Austin State University perusing my degree to become a speech-language pathologist. This semester I am at my school-based placement working with children with a variety of communication disorders, one being stuttering. I have one student on my caseload that frequently has stuttering moments of mostly part-word repetitions and word repetitions. He also produces typical disfluencies such as interjections and phrase repetitions. We are currently working on speech sound errors, but I brought my concerns to my supervisor about his disfluencies. She was not concerned about his disfluencies. I am currently taking a fluency course and I think we should evaluate him because I believe it is impacting his speech. He is school age and has some physical tension during those dis fluent moments. My question is when do you determine between evaluating him for stuttering as opposed to not. Since, my supervisor is not as concerned I’m just wondering if I shouldn’t be as well. Any insight on the little bit of information I have shared is appreciated.
Thank you,
Michalla Silvey
Michalla,
Hello! Thank you for posting to the professionals panel, and I wish you the best in your graduate studies. This is such a good question- and a question that even clinicians that have done this for years have- so you are in good company! This is also a personal/individualized question. For example, my brother stutters and is in his 40s and never had speech therapy- and it’s one of my favorite things about him even though I am a speech therapist (it does surprise some people when I say that!)- because our parents gave him a say on whether he wanted therapy intervention or not. In the United States, the public school setting requires there to be an “academic need” for speech therapy services- meaning that the entity we are treating has to have an effect on access to the general education curriculum. So, in the school setting, we don’t just treat the kiddo because they stutter- but we treat the kiddo based on how it affects their education since that’s the setting you are seeing this kiddo in. How we define “academic need” isn’t just grades, but it’s holistic development including social, emotional… and we look at things like participation in the classroom, participation with peers during lunchtime or PE and other activities to see if there is an educational need. This may sound odd- but I have dismissed kiddos in third or fourth grade who stutter… because they were fully participating, and didn’t have any academic need in terms of their stuttering, but also- they were requesting to be done, or no longer wished to have further therapy or generally didn’t need it… Therapy for stuttering is often intermittent across the lifespan. I always tell new clinicians and students, “if we qualified a person who stutters and continues to stutter for therapy strictly based on the fact that they stutter- they’d be in speech therapy until they are 80 years old” if that helps frame it for you a bit. So I encourage you to look holistically at this kiddo and how stuttering comes into play in their life, specifically within the setting you are providing services. 🙂 I hope that helps! Also, reach out to your professor at SFA if you need further guidance or have a chat with your supervisor about your concerns as well. Take care!
Hey Michalla,
Thanks for your question. For me, I would be wanting to support a child who stutters if their stutter was impacting on them in a negative way – socially, emotionally, or cognitively. Are they struggling physically or emotionally? Is the child aware he is stuttering, are they reacting to their stutter, are they upset, concerned, bothered about stuttering, are they participating and doing the things they want? Do they comment on their stutter? Do they have any struggle behaviours? (You mentioned there is some tension. Are there any other things he is doing such as running out of breath, closing his eyes, stamping his foot, nodding his head, etc)? Are they trying to conceal/hide/mask/avoid stuttering? Do they give up talking, change words, say less, pretend not to know for example? I think if the child/his caregiver was mentioning these things, then I would be wanting to chat to him some more, providing he wanted this too. Good luck, and enjoy the rest of your course – particularly the stuttering components!!!!! Nic
Hi Michalla,
Thank you for your thoughtful question! I’m so happy to see great colleagues like you taking initiative and advocating for your students. I’d like to add a few thoughts that might help.
One of my mentors always says, “If a child shows physical tension, that means the child is aware that something is going on while speaking.” In those cases, it’s better to move forward with an assessment rather than wait until the child expresses discomfort or frustration.
When I was in my master’s program, I sometimes had supervisors who preferred to wait before evaluating a child for stuttering. I learned that it helps to kindly share your perspective, explaining that early assessment can guide appropriate support and prevent the development of negative emotions or avoidance behaviors around speaking. Once I provided a clear rationale and explained what might happen if we delay intervention, supervisors were more open to the idea.
Based on what you described, it does sound appropriate to conduct an assessment or collect some baseline data. This way, you can better understand what is happening and monitor any changes over time.
You’re doing a wonderful job noticing and questioning these important details, it’s a key part of becoming a skilled clinician 🙂 Thank you so much !!
Angelica