Assessment of Stuttering in Adults: The 6 Steps

How do you assess stuttering in adult speech therapy patients? Do you need special technology? Standardized tests? Where do you even begin?

In this article, you’ll learn how to do an assessment of stuttering with adults. You’ll get:

• A step-by-step guide
• Interview questions
• Links to evidence-based assessments

Visit our shop for a print-and-go fluency assessment template!

What Should Be In A Stuttering Assessment?

Many speech-language pathologists aren’t comfortable assessing and treating stuttering (Crichton-Smith et al., 2003).

In fact, because of their differing philosophies on stuttering, even the stuttering textbooks give conflicting recommendations, making it that much harder for clinicians to feel confident (Brundage et al., 2021).

To solve this problem, researchers collected feedback from 12 expert stuttering clinicians and researchers. Their goal was to develop a consensus on how to assess stuttering.

The researchers found 6 common areas that an assessment of stuttering should cover: 

1. Background information about the patient’s stuttering
2. Development of speech, language, and temperament (only as needed for adults)
3. Speech fluency and stuttering behaviors
4. Patient’s reactions to their stutter
5. Other people’s reactions to their stutter
6. Negative effects of stuttering

(Brundage et al, 2021).

How To Do A Stuttering Assessment

Here is a step-by-step guide to comprehensive stuttering assessments. It includes the factors listed above, plus helpful interview questions, links, and tips. 

1. Case History & Interview

Ask questions about their stuttering background:

• When did your stutter begin?
• Did your stutter develop suddenly or gradually?
• Has it gotten better, worse, or stayed the same?
• Do you have family members who stutter?
• How do you react to your stutter?
• Is there anything you do that makes the stutter get better or go away?
• Are there any physical sensations that warn you that you’re about to stutter? Describe them.
• In what situations or settings do you stutter more or less?
• How do people react to your stutter?
• How does stuttering affect your life? (Work, family, social life, etc.)

If your patient is working or plans to return to work, be sure to ask how stuttering impacts them on the job. Your treatment can include ways to improve their support systems and ability to self-advocate (Plexico et al, 2019).

2. Collect Objective Data

Next, assess if and how severely the patient stutters and what they do when they stutter. 

• Include a self-rating severity scale. Here are 3 evidence-based examples:
  • The Stuttering Severity Scale. A 9-point scale where 0 = no stuttering, 1 = extremely mild stuttering, and 8 = extremely severe stuttering
  • Satisfaction with Communication in Everyday Speaking Situations (SCESS). Ask, “Considering all the issues associated with your stuttering, how satisfied are you with your communication in everyday speaking situations at the present time?” A 9-point scale where 1 = extremely satisfied as the most positive response and 9 = extremely dissatisfied as the most negative response (Karimi et al, 2018).
  • Overall Assessment of the Subjective Experience of Stuttering (OASES) (Horton et al., 2023). 
• And a norm-referenced evaluation, like the Stuttering Severity Instrument (SSI-4).

3. Speech Sample

Record a voice sample. Obtain the appropriate permissions before recording the patient.

Listen and make note of disfluencies and behaviors.

4. Conversational Speech

Converse with your patient. This may include conversations to build rapport, small talk, discussing recent hospitalizations, etc.  

Listen and make note of disfluencies and behaviors.

5. 5-Minute Monologue

Ask the patient about their career, hobbies, family, etc. They might also describe a visual scene, like the Cookie Theft Picture. The goal is 100 words; 200 is even better.

Analyze the type and frequency of disfluencies in the patient’s speech sample:

• Percent of stuttering disfluencies (SD): Divide the # of SD by the # of meaningful words (i.e. 100).
• Percent of normal disfluencies (NE) Divide the # of ND by the # of meaning words (i.e. 100).

You may also use a Monologue Sample Disfluency Grid or Molecular Analysis. See the Evaluation Pack for these resources.

6. Read Aloud

Ask the patient to read a paragraph aloud, like the Rainbow Passage.  Measure vocal quality using the Consensus Auditory-Perceptual Evaluation of Voice.  

Listen and make note of their disfluencies and behaviors.

You can download fluency assessment templates and treatment guides designed for speech therapy patients on our shop.

If you need more guidance on how to work with people with stutter, see The Adult Speech Therapy Roadmap Course.

References

• American Speech-Language-Hearing Association (n.d.). Fluency Disorders (Practice Portal). Retrieved August, 2024, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/.
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• 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, 30(6), 2379–2393. https://doi.org/10.1044/2021_AJSLP-21-00107
• Crichton-Smith, I. , Wright, J. , & Stackhouse, J. (2003). Attitudes of speech and language therapists towards stammering: 1985 and 2000. International Journal of Language & Communication Disorders, 38(3), 213–234. https://doi.org/10.1080/1368282031000086282 
• Horton, S., Jackson, V., Boyce, J., Franken, C., Siemers, S., John, M. S., Hearps, S., Braden, R., Parker, R., Vogel, A. P., Eising, E., Amor, D. J., Irvine, J., Fisher, S. E., Martin, N. G., Reilly, S., Bahlo, M., Scheffer, I., & Morgan, A. (2023). Self-Reported Stuttering Severity Is Accurate: Informing Methods for Large-Scale Data Collection in Stuttering. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2023_JSLHR-23-00081
• Karimi, H., Onslow, M., Jones, M., O’Brian, S., Packman, A., Menzies, R., Reilly, S., Sommer, M., & Jelčić-Jakšić, S. (2018). The Satisfaction with Communication in Everyday Speaking Situations (SCESS) scale: An overarching outcome measure of treatment effect. Journal of Fluency Disorders, 58, 77-85. https://doi.org/10.1016/j.jfludis.2018.10.002
• Plexico, L. W., Manning, W. H., & DiLollo, A. (2005). A phenomenological understanding of successful stuttering management. Journal of Fluency Disorders, 30(1), 1–22. https://doi.org/10.1016/j.jfludis.2004.12.001
• Van Riper, C. (1973). The treatment of stuttering. Prentice-Hall.