ASSESMENT OF STUTTERING

 Assessment of children

Assessment pertains to finding out the following:

-severity of the problem

-differential diagnosis

-nature of stuttering and recommendation for treatment

Purpose of assessment includes:

1. The reason to evaluate stuttering ie to identify stuttering, to describe the nature and
severity, differential diagnosis and determine prognosis (why)

2. Evaluation of the description of dysfluencies ie type of dysfluencies, frequency and

duration of blocks and secondary behaviours.(what)

3. To evaluate as soon as the concern arises (when)

4. To use both formal and informal way of assessment.(how)

Detailed Assessment includes the following:

 Background information

 Clinician and child interview.

 Assessment of child’s speech sample for speech rate and stuttering.

 Assessment of parent–child interaction.

 Assessment of other aspects

 Formal tests

1. Background information: Includes the case history, developmental history, speech and
language development, development of dysfluencies and the environment details.
2. Clinician and child interview: This is where the clinician has a chance to see at first hand,
the issues which have come to light in the case history.

 The clinician uses age-appropriate play materials to engage the child’s interest

 An important objective is to ascertain whether the child is aware of his stuttering.

 Similarly, the clinician must be sensitive and adjust any terminology appropriately.

 The clinician will also use this opportunity to note the child’s motor speech and non-
speech motor control, as well as whether phonological and language skills appear age
appropriate.

 It is important to videotape (preferably) or audiotape this session. Video recordings

often reveal significant but fleeting behaviours

 On the basis of the clinician–child assessment, the clinician may feel that further
(formal) assessments are warranted.

 Receptive and expressive language: Poor language skills may be associated with
stuttering behaviour (Starkweather, 1997; Yaruss, 1999).

 Phonology: Some researchers and clinicians believe there is a link between

disordered and delayed phonology and stuttering (Bloodstein, 1995; Louko, et al.,
1990; Kolk and Postma, 1997), although the evidence at present seems equivocal
(Nippold, 1990).

 Motor control: The clinician should observe the child’s ability to control at both fine
and gross motor levels.

3. Assessment of child’s speech sample for speech rate and stuttering:

The most commonly used method for collecting objective data on stuttering severity
is the stuttering frequency count.

This involves collecting a speech sample from the client, ascertaining the number of
syllables or words spoken within the sample and then calculating the number of
syllables or words which are stuttered.
 It is commonly expressed as a percentage of stuttered syllables, or stuttered words
(%SS; %WS) and usually accompanied by an analysis of speech rate expressed in the
number of syllables or words spoken per minute (SPM, WPM).

Speaking rate refers to speech rate calculated from the total number of syllables
spoken within a minute, whereas articulatory rate refers to the number of nonstuttered
syllables spoken over the same time period.

FORMULA:

1. Percentage of stuttered syllables (%SS)

Total number of stuttered syllables / Total number of syllables spoken x 100

2. Speaking rate (in syllables per minute SPM)
Total number of all syllables spoken/ Total length in time (seconds) x 60
3. Articulatory rate(in syllables per minute SPM)
Total number of non stuttered syllables/ total length of time (seconds)x60

Assessing the type, frequency and duration of stuttering is important.

-Type of dysfluencies to look for are repetitions (syllable repetition, part word
repetition, whole word repetition and phrase repetition.), prolongations, pauses (filled
and unfilled) and interjections.

-Frequency of a stuttering event describes the number of stuttered words in the

analysed speech sample. Sound and syllable repetitions within a multisyllabic word
would be counted as iterations of a single repetition. Eg: pe pe pe pe:na will be
counted as one repetition and three iterations.

-An average of the duration of three longest blocks is a fair representation of the
duration of the block. (Riley, 1994)

1. Assessment of parent child interaction: Erickson and Block (2013) found that 69%
of parents reported that stuttering had at least a moderate impact on their family, with
almost one-third of participants indicating an “extreme impact. On the other hand
studies on the feelings of children who stutter revealed that they had lower perceived
 parental attachment scores and lower perceived parental trust scores than did their
fluent peers, and majority of stuttered children reported feeling frustrated with their
parents’ attempts to assist during stuttering moments. Hence, assessing the parent
child interaction is an important aspect during assessment since it plays a major role
in therapy and prognosis of the child.

2. Assessment of other aspects: This includes assessing respiration, secondary

behaviours, language aspects, psychological aspects and differentially diagnosing
stuttering from NNF.

INTRUMENTS USED IN ASSESSMENT / FORMAL TESTS

1. The Stuttering Severity Instrument (SSI):

 The SSI (Riley, 1972, 1994)

 It can be used with adults and children and has been validated for use with both.

 The SSI breaks stuttering down into three components: frequency, duration,
physical concomitants. Within each category, task scores are given to raw data,
which are eventually totalled to give a single score.

 FREQUENCY:

 A speech sample of at least 200 words is needed for analysis. Depending on

age, the client either reads aloud or interprets a story from a cartoon.

 They then either talk about their job or school.

 The clinician then makes frequency counts of each of the speech samples, and
under category 1 on the form translates these into the task score.

 DURATION:

 Duration is assessed by finding the three longest stuttering moments and then
calculating the mean length of time of these three.

 Like the raw figures on frequency of stuttering, this time, calculated in seconds
regardless of the stuttering subtype, is then converted to a total duration score.
  PHYSICAL CONCOMITANTS:

 This third section has the clinician evaluate a range of secondary stuttering
behaviours, grouped into four subcategories on a scale of 0 (none) to 5 (severe
and painful looking).

 The scores for each subcategory are then added together to make the physical
concomitants score.

 The frequency task score, duration score and physical concomitants scores are
then totalled to give the total overall score. This score can then be measured
against the severity ratings, ranging from 0 (very mild) to 45 (very severe)
which are included in the SSI test.

Stuttering Prediction Instrument (SPI) (RILEY 1980)

 This test has 6 criteria

 Simple to be used by trained clinician

 Quantifies behavior that are identified as abnormal

 Good reliability and validity

 Standardized

 Yields data for developing and monitoring treatment goals.

 This also is able to predict chronicity of stuttering

Description

SPI test is divided into 5 major sections

Section 1 History

Section 2 Reaction

Section 3 Part word repetition

 Section 4 Prolongation

Section 5 Frequency

Administrative procedures

It involves three procedures:

 Parent interaction observation

 Tape recording child’s speech

 Analysis of recorded speech.

 SECTION 1: HISTORY

 It is divided into two parts

 background information

 family history of stuttering

 This is part of the examiners qualitative analysis

 SECTION 2: REACTION

 Parent’s reaction

 0 – unconcerned

 1 – concerned

 2 – very concerned

 Children's reaction to dysfluency

 0 – never observed

 1 – observed to mild degree

 2 – observed to moderate to severe degree

SECTION 3 – PART WORD REPETITION

 Scored with regard to the number and quantity of repeated sounds or syllable. Number
of repeated syllable.

 0 - none

 1 = 1-3 repetition

 2 = 4 more repetitions

 Distortion in several ways

 0 = vowel changed so that it does not make the target sound – normal

 1 = repeated syllable may be hurried

 2 = syllable may be abruptly separated – moderate

 3 = accompanied by tension – severe

SECTION 4: PROLONGATIONS

 There are three types of prolongations

 Vowel prolongations

 Phonatory arrests

 Articulatory posturing

SECTION 5: FREQUENCY

 About 100 words are to be analyzed

 Number of stage events are divided by the number of words analyzed

 The percentage of the scores are taken

 All the scores are added and maximum score is 40

 Assessment in adults
Assessment is required for:
-Differentiating stuttering from other forms of stuttering like the neurogenic
stuttering.
-Differentiating stuttering from other types of fluency disorders like cluttering.
- Arriving at a severity index in order to monitor pre and post therapy status of the
client.
-Helping to choose proper client specific counselling which could be done.

Detailed assessment includes the following:

1. Case History
2. Measurement of speech rate and speech fluency
3. Attitudinal Assessment
4. Assessment of prosodic features
5. Formal assessment
6. Counselling

1. Case history: The clinician has to ask the client the past and present difficulties of the
client. Open ended questions are useful because they give the client an opportunity to
state his or her concerns and provide information in his own words.

2. Measurement of speech rate and speech fluency:

Frequency count:
 The most commonly used method for collecting objective data on stuttering severity
is the stuttering frequency count.

 This involves collecting a speech sample from the client, ascertaining the number of
syllables or words spoken within the sample and then calculating the number of
syllables or words which are stuttered.

 This figure is most commonly expressed as a percentage of stuttered syllables, or

stuttered words (%SS; %WS) and usually accompanied by an analysis of speech rate
expressed in the number of syllables or words spoken per minute (SPM, WPM).
 The fluency count

 The fluency count is most commonly used as part of the information gathering
process at assessment and at post-clinic and follow-up sessions, although it may be
used throughout the therapeutic process to continuously monitor the client’s progress.

 Most clinicians advocate that the speech sample comprises a minimum of two minutes
of the clients talking time, excluding pauses.

 To accurately analyse the time taken during speaking, the talking time must be
calculated using a stopwatch, which should be stopped when the client is either
listening or considering a reply, as well as during pauses, but not where there is
silence due to stuttering (for example, during a silent block).

Speech rate
 Speaking rate can be as revealing of a person’s communication problem as the
percentage of syllables which are stuttered, and it is important that these data are
recorded accurately.

Articulatory rate and speaking rate

 As we have seen earlier, speaking rate refers to speech rate calculated from the total
number of syllables spoken within a minute, whereas articulatory rate refers to the
number of nonstuttered syllables spoken over the same time period.

Formula for calculating the same as discussed earlier

The following parameters can be calculated once the speech sample is collected:

Dysfluency index (DI) = Total number of dysfluencies / Total number of words x 100

Total repetition index (TRI) = Total repetition /Total number of words x 100 (similar indices
can be obtained for prolongations, pauses etc.)

Baker (1997) breaks the overall sample duration into

 Pause time (PT) = Time when speech is not attempted / Total time of speech x 100
 Total articulatory time (TAT)= Time when speech is audible /Total time x100

 Fluent articulatory time (FAT)= Time when fluent speech is audible /TATx100

 Stuttering time (ST) = Total time when stuttering occurs/TATx100

These indices help in tabulating individual stuttering behaviours & determining

severity of stuttering.

To categorize stutterers into different severity groups Jayaram and Savithri (1993)
gave the stuttering severity index (SSI).The SSI includes the following factors

o Average syllable emission rate (ASER)

SER= total number of syllables uttered/Time taken to utter ,expressed as

syllables/min

The SER during the dysfluent phase is known as DSER and the SER during
fluent phase is known as FSER

Hence, ASER= FSER-DSER

o Percentage of stuttering Instances(PSI)=

Total stuttering moments/Total syllables uttered x100

o Product of multiple repetitions (PMR)= occurrence of multiple repetitions

(OMR)x Average number of iterations( AI)

OMR= Total number of multiple repetitions / Total number of syllables

spoken x100

AI= Total number of iterations/Total number of multiple repetitions

o Duration of stuttering instances (ADS)=

Duration of all stuttering instances/Total number of stuttering instances

Hence, the SSI can be calculated as:

SSI= ASER+PSI+PMR+ADS
 3.Attitudinal assessments:

 It is quite common, most notably in adulthood but also during adolescence, for the
client’s perception of and reactions to his problem to form the most significant part of
the disorder.

 The fear of stuttering can actually present a greater difficulty and barrier to fluency
than overt stuttering itself. If these aspects are to be dealt with, they first need to be
properly identified at assessment.

Perceptions of Stuttering Inventory (PSI)

 This questionnaire was developed by Woolfe (1967) and characterizes cognitive and
affective components of stuttering in terms of struggle, avoidance and expectancy.

 This is one of the earliest examples of a way of measuring the effect of stuttering
from the individual’s perspective rather than that surmised by the clinician.

 PSI scores and levels of severity

Below 7 mild

8-11 moderate

12-15 moderate-severe

16-20 severe.

4. Assessment of prosodic features:

Stuttering is considered to be a disorder of rhythm. They are known to either

excessively stress on the speech units or show atypical stress patterns.

The Tennessee test of rhythm and intonation patterns (T-TRIP) by Kazunari and Carl
(1981) can be used to analyse respiration, phonation and articulation

5. Formal assessment/ Instruments:

Stuttering Severity Instrument by Riley (1972) - discussed in the previous section.

 6. Counselling:

Client centred counselling should be done regarding the intervention and prognosis.

Overall Assessment of the Speaker’s Experience of Stuttering (OASES) –

Yaruss&Quesal,2002

 The purpose of this instrument is to assess the overall impact of stuttering on both
teens and adults who stutter, and to provide an outcome measurement system that
allows comparison between different treatments across several relevant dimensions.

 This describes disorders under three headings: (a) impairment in body function or
structure; (b) contextual factors; (c) limitations or restrictions.

 The questionnaire comprises four parts: general information (total of 25 questions);

your reactions to stuttering (25 questions); communication in daily situations (25
questions); quality of life (25 questions).

 Participants have to circle a number on a five-point Likert scale. (1- lowest impact, 5-
greatest negative impact)