Assessing a stutter
Speech pathologists interact with a wide range of disorders throughout their careers. Some disorders seem more apparent than others, which a speech pathologist may diagnose. How hard is it to diagnose a child with a stuttering disorder? Is there a criteria they have to meet or is the assessment dependent on the speech pathologist’s own opinion of the child’s speaking ability?
Hi!
In most cases, both informal and formal evaluations are required. I would underline the importance of collecting information from the children themselves, as well as from related persons (ex. parents, teachers) in the child’s contexts. Since we have access to several great comprehensive assessments, and since we are including parents in the evaluation procedures, as well as in the therapy, we usually have access to the necessary information. I would consider diagnosing a child who stutters as relatively easy. Just recently, a very solid paper on stuttering assessments was published in the American Journal of Speech-Language Pathology, and I can recommend this paper. Several authors were involved (Shelley Brundage, Nan B. Ratner, Michael P. Boyle, Scott Yaruss, among others). The paper is entitled ‘Consensus Guidelines for the Assessments of Individuals who Stutter Across the Lifespan’. The authors were identifying six core areas as common components of a comprehensive evaluation of stuttering. According to the authors, a thorough evaluation is required to better be prepared to provide personalized therapy, and I very much support this statement.
Hello! Thanks so much for asking a question to the professional panel. I second my dear colleague Hilda in saying that collecting information from a child in diagnosing stuttering is so important and I also recommend checking out that article she mentioned- it is amazing! The reference for the article she mentioned is:
Brundage, S. B., Ratner, N. B., Boyle, M. P., Eggers, K., Everard, R., Franken, M. C., Kefalianos, E., Marcotte, A. K., Millard, S., Packman, A., Vanryckeghem, M., & Yaruss, J. S. (2021). Consensus Guidelines for the Assessments of Individuals who Stutter Across the Lifespan. American journal of speech-language pathology, 1–15. Advance online publication. https://doi.org/10.1044/2021_AJSLP-21-00107
Stuttering is an individualized experience, that may include overt (seen/heard/obvious) characteristics and/or covert (felt/unseen by listeners such as communication avoidance and emotional results of stuttering) characteristics. It is important that both the overt (sound repetitions, prolongations, for example) and covert aspects of stuttering are assessed when diagnosing stuttering. With that, however, stuttering is not defined by fluency counts. Some years ago, we used to rely heavily on fluency counts (i.e. the number of times a person had stuttering moments within a given sample in either syllables or words and the percentage of syllables or words stuttered within a given sample or samples) in the diagnosis of stuttering. Depending on the researcher(s) that you follow, then one used to be inclined to say (for example), “this person stuttered 10% or greater on words within the contexts that were sampled and therefore this individual is a person who stutters.” In more recent years, however, we have seen a big shift from data-driven and fluency-count driven assessment to more humanistic, experience-based assessment. Data assessment (via some kind of syllable or word count) within stuttering diagnosis is often still common practice, however it is not the sole basis of diagnosis. Nowhere, within the textbook definition of stuttering, does it say that stuttering is defined as, “ten percent stuttered words”, for example. 🙂 We must supplement data counts (if we use them- which a lot of us still do, but not all of us) with covert assessment, parent/guardian interview questions, teacher (if a child) questions, other assessment tools that can let us in on a person’s lived stuttering experience and how stuttering has an effect on their life. There are characteristics of stuttering that we know set stuttering apart from other entities and we also must be highly trained and aware of those prior to doing an assessment on a person that may or may not stutter. Also, we have also started to shift to a different therapeutic mindset which is that the individual who stutters, within their own stuttering experience, guides their own therapeutic goals. Differing therapeutic goals across people we serve may even cause us to gather differentiating information or ask varying interview questions during the initial assessment when doing our evaluation with different individuals depending upon their goals/what they want out of the speech therapy experience.
With young children we do get a lot of individuals referred for potential stuttering diagnosis (this actually is probably the most common) who have what we call, “developmental disfluencies”. Developmental disfluencies, are typical (“within normal limits”) disfluencies experienced by children as they are developing language skills, usually between the ages of 3-6 or so. Overt characteristics of developmental disfluencies are often interjections (“um”, “uh”), whole word repetitions (“hey hey hey” or “mom mom mom”) and phrase repetitions (“guess what guess what”); some prolongations can be included as a child is processing/thinking and telling a story as well (as in, “ummmmmm, well the other day….”. Basically, a child is trying to formulate what they want to say and they are developing so much language during those given ages, that it causes some disfluencies. I mean, kids don’t really develop the ability to tell a cohesive narrative (story) until around the ages of 8-10 years, so this makes sense. One of the most challenging things for new SLPs entering the field coming out of graduate school is to differentially diagnose true child-onset stuttering from these developmental disfluencies (which do not need therapy and are typical within language development of a child). True child-onset stuttering can also have these disfluencies seen as I listed within developmental disfluencies, but stuttering presents rather differently than developmental disfluencies. First, at times (but not always) child-onset stuttering may come with visible tension (in the face, blinking of the eyes during stuttered moments, etc) while developmental disfluencies will not. Stuttering may display part-word repetitions, and sound repetitions, while developmental disfluencies will not. There is a difference between seeing a child produce, for example, “Mom mom guess what guess what I saw a frog in the park.” (developmental disfluencies) and “M-m-m-m-mom g-g-g-g-guess what I sssssssssssaw a ffffffrog (with visible tension) in the p-p-p-p-park” (stuttering). I thought that I would explain those two entities to you as those are probably the two most common diagnoses that we differentially diagnose in small children.
I hope that this helps you, and thanks so much again for asking this engaging question of the professional panel.
Take Care,
Steff
Hello – in addition to what my esteemed colleagues have shared above, one other aspect we need to consider when assessing a child for stuttering is whether the child is multilingual. We do not yet know much about normal fluency development and stuttering in multilingual stuttering but the fewer articles we have show that they experience more disfluencies than their monolingual counterparts (see the review of types provided by Steff – thank you Steff!). For multilingual kids we should extend the assessment process to all languages and proceed from there on a case-by-case basis.
Farzan