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How do I screen a preschooler or young school-age child who stutters?

How do I screen a preschooler or young school-age child who stutters?

Question: I’ve been asked to screen a preschool/young school-age child who stutters. What test should I use?!?

Answer: Often, clinicians are asked to look at a young child who stutters to see if he is stuttering. Parents, teachers, and others may observe disruptions in a child’s speech and wonder what should be done.

For preschool and young school-age children (between the ages of about 2 and 6), the question of whether or not they are stuttering is actually fairly straightforward to answer. We simply observe their speech behavior and see if they exhibit what we tend to call "stuttered" (or "stutter-like") disfluencies. These include part-word repetitions, prolongations, blocks, and any other indication that the child is stuck or struggling with speech (physical tension is a good indicator of this).

Almost any measure of surface speech behaviors can do this, though observation is also just fine. Tests such as the Stuttering Severity Instrument or a frequency count can give you some information about whether and how much the child is stuttering. (My personal preference for a test for 4- to 12-year-olds is the TOCS: Test of Childhood Stuttering, by Gillam, Logan, & Pearson, available from Pro-Ed.)

Note that the kids might not stutter much in the therapy/assessment room during your evaluation, so parental report is necessary here. And, I absolutely accept the parents' report if they say that the child is exhibiting those behaviors even if I don't see them.

Overall, though, I don't worry too much about the frequency count that I get. The reason for this is that assessment of the speech observable behaviors doesn’t really tell me anything meaningful about early childhood stuttering, because most preschool children who stutter actually recover from stuttering on their own! This is true even if the child stutters severely!

Once upon a time, our field believed that if a child stuttered more severely, then he was more at risk for continuing to stutter. Today, we know that for younger children (especially ages 3 and 4), the severity of stuttering does not help you predict the chronicity of stuttering (that is, the likelihood that the child will recover). So, simply asking whether a child is stuttering—or even asking how much he is stuttering—is not particularly valuable. What is more important is assessing whether the child is likely to *continue* stuttering, and answering that question has very little to do with the frequency of observable disfluencies. Thus, tests like the SSI and SPI, frequency counts, and even the TOCS aren't particularly helpful in making this determination.

Instead, we need to look toward factors that contribute to the likelihood that a child will continue to stutter. These so-called risk factors include whether there is a family history of stuttering (given the genetic aspects of stuttering, a family history indicates a risk for persistence), the length of time the child has been stuttering (the longer the child stutters, the greater the risk of persistence), the nature of the child’s speech and language development, the child’s and family’s reactions to stuttering, etc. Answering all of these questions is difficult to do in a simple screening. It will probably take a full evaluation to yield a good assessment of risk. And, of course, even then, it is just our best bet. The bottom line? The more at-risk a child is, the more confident we can be in our recommendation in favor of treatment.

At the level of screening, though, I would first confirm that the behaviors are indeed stuttering (and not so-called “non-stuttered” disfluencies like interjections or phrase repetitions) and I would ask about those risk factors that we can get through observation and discussion with the family: family history, time since onset, nature of the child’s overall development (and in particular, development speech skills, language skills, and temperament). By combining this information, I am able to make a reasonable decision about whether to intervene based on the likelihood that the child might continue stuttering without intervention.

For more details about how to conduct a comprehensive evaluation of speech fluency in young children, see Chapter 3 of Early Childhood Stuttering Therapy: A Practical Guide.