Stuttering Lecture #3-4: Preschool Assessment & Adolescent/Adult Eval

What are the main purposes of a preschool stuttering assessment?

1. Determine whether the child has true stuttering vs normal developmental disfluencies

2. Describe frequency, type, and severity of disfluencies

3. Identify risk factors for persistence

4. Understand the child’s awareness and emotional response

5. Understand family concerns and communication environment

6. Guide recommendations (therapy, monitoring, counseling)

What information should be gathered during a preschool stuttering case history?

• When parents first noticed stuttering

• Family history of stuttering

• Child’s interests

• Developmental milestones

• Previous SLP services

• Behaviors related to stuttering

• Parent concerns

• Communication environments (home/daycare)

What percentage of children who begin stuttering before age 3 recover naturally?

Approximately 80%

Why are cultural considerations important when assessing stuttering?

Different cultures may have different beliefs and reactions toward stuttering. Clinicians must understand the family’s perspective and provide culturally sensitive care.

What is an important consideration when assessing bilingual children who stutter?

Determine whether disfluencies represent true stuttering or are related to second-language proficiency/word retrieval difficulties.

Why should clinicians collect speech samples from multiple settings?

Because stuttering varies by situation. A sample in the clinic may not represent the child’s everyday communication.

What is the recommended speech sample for preschool stuttering assessment?

Approximately 100–200 words of conversational speech through play activities.

Why are play-based conversational samples preferred over reading samples for preschoolers?

Preschoolers may not be readers, and spontaneous conversation better represents natural communication.

When analyzing preschool speech samples, should clinicians select only certain words?

No. Analyze everything the child says to accurately represent their communication.

Why do clinicians usually count words instead of syllables with preschoolers?

Preschoolers often use shorter words, making word counts easier while remaining accurate.

What does the SSI-4 measure?

1. Frequency of stuttering

2. Duration of stuttering events

3. Physical concomitants

4. Overall severity rating

How is frequency measured on the SSI-4?

Percentage of syllables stuttered (%SS), converted into a frequency score.

How is duration measured on the SSI-4?

The average length of the three longest stuttering moments, measured in seconds.

What are physical concomitants measured on the SSI-4?

• Distracting sounds

• Facial grimaces

• Head movements

• Limb movements

Rated on a 0–5 scale.

What is a limitation of the SSI-4?

It only captures observable stuttering behaviors during a limited sample and may miss covert behaviors, avoidance, or the variability of stuttering.

Why might a covert stutterer score well on the SSI-4?

Because the SSI-4 measures observable behaviors, not hidden avoidance or emotional impact.

Why is frequency of stuttering important in assessment?

It helps distinguish normal developmental disfluency from possible stuttering.

How is frequency of stuttering commonly reported?

Percentage of syllables stuttered (%SS), though some clinicians use percentage of words stuttered or stutters per 100 words.

What are Stuttering-Like Disfluencies (SLDs)?

• Part-word repetitions

• Single-syllable word repetitions

• Blocks

• Prolongations

What are Typical Disfluencies (TLDs)?

• Phrase repetitions

• Interjections

• Revisions

• Whole-word repetitions

What did Yairi suggest regarding SLD frequency?

Children who stutter often produce more than 3 SLDs per 100 words, while typically developing children usually produce 2 or fewer.

Why do repetition units matter when analyzing stuttering?

More repetition units (ex: ba-ba-ba-ball) suggest greater likelihood of stuttering severity.

What aspects of duration are most important to measure?

Duration of blocks and prolongations, not usually repetition duration.

What secondary behaviors might be expected in preschoolers?

Younger children may show fewer avoidance behaviors. Older children are more likely to develop escape and avoidance behaviors.

Why is predicting stuttering severity difficult?

Stuttering is highly variable, and severity at one point does not predict future persistence.

What percentage of syllables stuttered corresponds with severity categories?

• <5% = mild

• 5–10% = mild-moderate

• 10–15% = moderate

• 15–20% = moderate-severe

• 20% + = severe

What factors increase risk for persistent stuttering?

• Family history

• Longer time since onset

• Male sex

• Speech/language concerns

What two criteria suggest a child may be at risk for stuttering?

1. Three or more within-word disfluencies per 100 words (sound/syllable repetitions, blocks, prolongations)
   AND

2. Concern expressed by parents or others in the child’s environment

Why are false negatives more concerning than false positives in stuttering identification?

Missing a child who needs support may delay treatment and negatively affect outcomes.

How can clinicians examine environmental influences on stuttering?

Observe responses to:

• Communication demands

• Language complexity

• Speech demands

• Structure/discipline

• Different speaking situations

Is temperament a cause of stuttering?

No. Temperament differences are not strongly associated with stuttering onset, but may influence coping and communication experiences.

What temperament factors are important to assess?

• Reactivity

• Emotionality

• Sociability

• Ability to regulate emotions

Why is resilience important in children who stutter?

Resilient children can regulate emotional reactions, recover from negative experiences, and participate more positively in therapy and communication situations.

What emotional responses might parents experience when their child stutters?

• Grief

• Guilt

• Anger

• Confusion

• Vulnerability

• Feelings of inadequacy

What is the role of the SLP when parents experience distress about stuttering?

Provide counseling, validate emotions, support reframing, and help parents understand they do not need to “fix” stuttering.

What is the biggest difference between preschool and adult stuttering evaluations?

Preschool: parents are the main informants and clinicians focus on persistence risk.
Adults: the client is the primary source and clinicians focus on lived experience and impact.

What are the ABCs of stuttering?

Affective: feelings about stuttering
Behavioral: observable stuttering behaviors
Cognitive: thoughts and beliefs about stuttering

What is covert stuttering?

When a person hides or avoids their stuttering through strategies such as word substitutions, avoiding speaking situations, or pretending not to struggle.

What is the difference between avoidance and escape behaviors?

Avoidance: occurs before stuttering happens (avoiding words/situations).
Escape: occurs during stuttering (ending a block through tricks or substitutions).

Why should adult stuttering goals not focus only on increasing fluency?

Fluency counts do not capture communication participation, emotional impact, or quality of life.

What are examples of appropriate adult stuttering goals?

• Reduce physical tension during stuttering

• Participate in avoided speaking situations

• Improve acceptance and reduce negative self-talk

What is the purpose of the OASES?

Measures the impact of stuttering on a person’s life, including emotions, communication, and quality of life.

Why was the OASES developed?

Because stuttering severity counts do not capture the emotional and functional impact of stuttering.

What are the four sections of the OASES?

1. General information

2. Reactions to stuttering

3. Communication in daily situations

4. Quality of life

Why should clinicians be cautious when interpreting stuttering assessments?

Stuttering changes from moment to moment and situation to situation, so a short sample may not represent the whole communication experience.

What three concepts summarize modern stuttering assessment?

1. Frequency, not type, distinguishes stuttering

2. Stuttering can hide through covert behaviors

3. Tension and struggle are important indicators

What should SLPs remember about stuttering treatment goals?

Goals should target the person’s experience with stuttering (communication, confidence, reduced struggle, acceptance), not just reducing stutter counts.