Childhood Stuttering Screening for Physicians (CSS-P™)

Stuttering Therapy Resources Childhood Screening Physicians CSS-P
Stuttering Therapy Resources Childhood Physician Screening CSS-P

What Is the Childhood Stuttering Screening for Physicians (CSS-P™)?

  • The CSS-P is a data-based screening tool for Childhood-Onset Fluency Disorder (ICD-10: F80.81) that indicates when physicians should refer children who stutter, ages 2 to 5, to a speech-language pathologist (SLP) for evaluation and possible treatment.

Why Screen Young Children Who Stutter?

  • Many young children ages 2 to 5 exhibit stuttering behaviors as they are learning to speak.
  • Although most stop stuttering, roughly 20-25% may continue to stutter into the school-age years and beyond.
  • Continued stuttering is associated with negative consequences, including reduced quality of life.
  • Early intervention increases the likelihood that a child will overcome stuttering and its negative impact.
  • Decades of research have identified risk factors that predict whether a child is likely to continue stuttering.
  • Children who exhibit these risk factors should be evaluated by an SLP to determine if they need treatment to support their speech fluency, general language development, and overall communication abilities.

What Is Stuttering?

  • All speakers exhibit disruptions in their speech. These disruptions are known as speech disfluencies. Some speech disfluencies reflect stuttering behavior, but some do not.
  • Stuttering behaviors are speech disfluencies that occur when people know what they want to say but cannot say it in that moment. This is different from what people experience when they are thinking about what they want to say.
  • Common stuttering behaviors include repetitions, prolongations, blocks, and other indicators that speakers feel “stuck” when talking. Moments of stuttering may involve physical tension or struggle as speakers try to force their words out.
  • Stuttering is uncomfortable for speakers. They may try to avoid words or not talk when they think they might stutter. Although this may hide stuttering for the moment, it increases the overall negative impact of the condition.
  • Without appropriate early intervention, young children are more likely to continue stuttering and experience these and other adverse consequences. Early intervention can diminish the risk of the negative sequelae of stuttering.

Administering the CSS-P

  • The CSS-P should be used anytime a caregiver or other observer expresses concern that a child may be stuttering.
  • The CSS-P is designed for use with electronic medical record-gathering software so that it can be administered, as needed, during the intake and assessment process. It can be administered to caregivers or other adults familiar with the child by physicians, physician assistants, nurse practitioners, nurses, or support staff.
  • The first question asks if the child has any family history of stuttering. If so, the child should be referred to an SLP for evaluation without further screening, due to the well-documented genetic predisposition for stuttering.
  • The numbered questions gather information about the caregivers’ and child’s concerns about stuttering; specific types of disfluencies and stuttering behaviors exhibited; time since onset of stuttering, changes in observable stuttering behavior over time; physical tension or struggle; and whether or not caregivers have other concerns about the child’s speech.
  • If the number of “Yes” responses is 4 or more, then referral to an SLP is indicated. Otherwise, the child should be rescreened every 3 months until the child and caregivers no longer express concern about stuttering.

Reliability and Validity of the CSS-P

  • The CSS-P is based on research about stuttering risk factors and affirmed by the clinical judgments of more than 40 SLPs who specialize in the evaluation and treatment of stuttering.
  • Comparison of CSS-P scores with SLP judgments yielded 100% agreement regarding the need for referral.

To Use the CSS-P in Your Practice

  • The CSS-P is designed to be entered into electronic medical record-gathering or screening software. It can also be administered via tablet (iPad/Android) or paper forms.
  • Contact Stuttering Therapy Resources at / 844-4-STUTTER (844-478-8883) for pricing and additional information.

About the Authors

  • Loryn McGill, MS, ASHA-certified SLP 
    Owner, OC Stuttering Center
    Adjunct Faculty, University of Southern California
  • Helen Chambers, MS, ASHA-certified SLP
    School-based clinician focused on stuttering and autism spectrum
  • Tayler Thompson, MS, ASHA-certified SLP
    Private practice clinician specializing in early intervention
  • J. Scott Yaruss, PhD, ASHA Fellow, ASHA-certified SLP, Board-certified specialist in stuttering
    Professor, Communicative Sciences and Disorders, Michigan State University
    President, Stuttering Therapy Resources, Inc.

Selected References

  • McGill & Yaruss (2021) Childhood-onset fluency disorder: “Wait and see” or “refer for revaluation?” Poster. American Academy of Pediatrics.
  • Yaruss & McGill (2022) Childhood Stuttering Screening for Physicians (CSS-P): Supporting accurate referral of young children who stutter. Paper. American Speech-Language-Hearing Association Convention; Proceedings, Joint World Congress on Stuttering and Cluttering.