EVALUATING FLUENCY AND
STUTTERING IN CHILDREN
AND ADULTS
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I. RATIONALE AND GOALS of the fluency evaluation provides an overview of the Systems Model upon which the evaluation of fluency disorders is based. A description of the stuttering response as well as four principle phases of development. Each phase provides a description of the thoughts (cognition), emotions (arousal), and speech/non-speech behaviors (actions) that typically emerge or change as development of an anticipitory response pattern progresses. A checklist of "warning signs" is provided that aids the clinician in determining whether a client is exhibiting communication patterns that are consistent with developing or chronic stuttering problems. Caution is given about relying on singular symptoms to make a diagnosis of developmental stuttering. The purpose of the evaluation is not to make a binary diagnosis of "stutterer" or "non-stutterer". A set of both broad and narrow goals of the evaluation are provided that guide the clinician in determining whether the client is exhibiting thoughts, emotions, or behaviors that interfere with effective and comfortable communication, and if so, what patterns are contributing to the problem.

II. METHODS AND PROCEDURES provides a structure for evaluating fluency in both children and adults.This includes a detailed outline for interviewing the fluency client. Two different outlines are presented, one for the preschool and school-age child and a different one for the adult client. Specific attention is given to topics that help identify overt and covert patterns that indicate possible development of a stutter-like response pattern. A non-inclusive list of speech samples that vary in cognitive/linguistic, social/emotional, and speech movement complexity is provided to help the clinician obtain a representative speech sample. In addition, a variety of evaluation and rating forms are provided to analyze the speech and non-speech behavior patterns of the client. Specifically, the clinician is provided the procedures for performing a traditional segmental analysis of fluency/disfluency. The segmental analysis is based on calculating a "disfluency index" that categorically divides the total words attempted in a sample (or syllables if desired) into proportions of fluent versus disfluent utterances. Disfluent utterances are then subdivided by proportion according to "type" or "category" (part-word repetitions, prolongations, revisions, etc.). Calculation of duration of disfluencies as well as speaking rate are also provided.

The Systems Approach to Stuttering Therapy focuses heavily on describing what the client is actually doing with their speech system that interferes with fluid speech movements. Original rating scales and other are provided that help the clinician (and the client) identify what they might be doing at each of five phases of an utterance that inhibits fluid sequencing of movement. Specific attention is given to the features of movement sequence, force, speed, rhythm, and prosody at different phases of the utterance sequence and in different portions of the speech mechanism (respiration, phonation, and articulation). Separate rating procedures for identifying patterns of communication pace are introduced.

III. INTEGRATION, DIAGNOSIS, AND REPORTING provides links that aid the clinician in organizing information obtained and integrating that information into a clinical impression. This includes the client's speech behaviors and the thoughts, emotions, and coping/adjustment strategies that might be a part of the total response pattern. The Communication/Fluency Profile helps the clinician integrate the overt and covert symptoms observed and determine whether the patterns warrant attention in therapy. Finally, a format for reporting the results of the fluency evaluation and making recommendation is provided.