In a majority of cases the stuttering disorder is response pattern that develops over time and with continued experience or expectancy of getting physically stuck on sounds or words. Presented below is an outline that describes some of the more salient characteristics of a developing stuttering response. While presented in four phases the clinician should consider these as general boundaries of development. Children are very individualistic in the characteristics and development of their stuttering problem, often with overlap from one phase to another.

Each phase is divided into four primary components of the communication system, speech production, cognition (thoughts), emotional arousal, and coping strategies. During an evaluation of a non-fluent child or adult the clinician should identify those characteristics that indicate the client is speaking, thinking, feeling, or coping with speech and communication in an ineffective manner.

PHASE I: A distinguishing characteristic of this phase is a total lack of awareness or concern about talking or talking mistakes by the child. There is little or no overt or covert reaction to disfluency.

Speech Production
1. Intermittent periods of disfluency. These periods can vary substantially in duration. Tendency to come and go.
2. Disfluency typically emerges after onset of connected speech. Most will experience a period of fluent connected speech before disfluency emerges.
3. Most common segmental characteristics of disfluency:

revisions
false starts
phrase and word repetitions
interjections

4. Most common non-segmental characteristics of speech and disfluency:

Continuity and underlying speech rhythm is maintained during fluent and disfluent episodes
No indication of change in movement speed or force in during speech and non-speech movements
No evidence of variation or cessation of air flow during speech.
No evidence of variation or cessation of continuous movement during speech.
Blending, sequencing, force, and speed generally appropriate during fluent episodes

Cognition
1. No evidence that the child is aware of disfluencies
2. No evidence that the child anticipates future speech difficulties

Emotional Arousal
1. No evidence of changes in arousal before, during, or after disfluencies occur
2. No evidence of fear or apprehension of speaking

Coping Strategies
1. No evidence of avoidance behaviors by the child
2. No evidence of attempts to vary the speech act or the message
3. No evidence of changes in interaction frequency or style

PHASE II: The child begins to exhibit awareness of some difficulty talking, primarily getting "stuck on words". All thoughts and reaction patterns are related solely to occurrence of the disruption itself.

Speech Production
1. Disfluency becomes more chronic and occurs more frequently in response in cognitive, linguistic, social, and emotional distracters/demands.
2. Intermittent periods of fluency and disfluency are common
3. Segmental features of disfluency:

Same features as PHASE I
Evidence of fragmentation of speech
Often includes part-word repetitions, hesitations, prolongations, and dysrhythmic phonation

4. Non-segmental features of speech and disfluency:

Continuity is disrupted by hesitation, prolongation, and/or complete cessation of movement
Increased evidence of disrupted air flow and sound during disfluent episodes
Evidence of involuntary "pushing" of speech structures during disfluency
Some involuntary variation in tension in speech musculature
Little evidence of pre-disruption variation in speech behavior

Cognition
1. Verbal or non-verbal signs that child is aware of speaking difficulty

Emotional Arousal
1. Some evidence of increased arousal reactions to extended disfluency may be observed. This occurs during disfluency only.
2. No evidence of strong panic or fear related reaction to anticipation of disfluent episodes or speaking in general.

Coping Strategies
1. Child may verbalize concern about speaking difficulty
2. Some evidence of emerging avoidance behaviors observed in some children. The child may talk less often.

PHASE III: The individual is now aware of and reacts emotionally and cognitively to speaking difficulty. This is combined with perceptual-physical reactions to being out of control. Concerns focus not only on actual stuttering episodes, but anticipation of stuttering during fluent periods as well.

Speech Production
1. Chronic episodes of disruption. Less frequent extended periods of fluency. Disfluency generalized to specific speaking situations.
2. Segmental features of disfluency:

Fragmentation of speech units. Part-word/sound repetitions,
Extended prolongations, dysrhythmic phonation are common
Interjections used to postponement/avoid disfluency
Hesitation/pauses observed prior to actual disruption
Some evidence of speech "starters"

3. Non-segmental features:

Disruption in air flow and structural movement observed at one or more valving points
Evidence of involuntary and voluntary struggle behavior in the speech structures
Increase in force in speech musculature and speeding of movement during disfluent episodes
Involuntary and voluntary changes in movement sequence, force, and/or speeding prior to disfluent episodes
Release from disfluent episodes are often abrupt and forceful
Evidence of struggle-type behavior in the non- speech muscles

Cognition
1. Verbal and non-verbal evidence that the child is aware of inability to "get words out". Might call themselves a "stutterer"
2. Focus of attention prior to and during talking shifts to anticipation of impending disruptions
3. Focus of attention shifts to negative feelings, thoughts, and images about stuttering

Emotional Arousal
1. Increase in overt signs of fear and panic during disfluencies. This is associated with perception of being out of control (see "Window of Acceptability")
2. Overt and covert signs of anticipation of disfluencies and the emotional reactions that accompany them. Verbal/non-verbal signs of fear of talking in certain situations.
3. Verbal and non-verbal signs of frustration, embarrassment, and confusion about getting stuck on sounds and words

Coping Strategies
1. Evidence of intentional or unintentional attempts to "fix" speech or avoid fear associated with talking and being disfluent. These are associated with attempts to avoid, postpone, escape, or hide disruptions.
2. Speech avoidance:

Recoil from onset of disfluencies
Use of interjections to postpone disfluency
Excessive use of "pushing/forcing" in speech structures
Covert attempts to hide disfluency while talking ("holding back")
Avoids using certain sounds or words
Changes words while talking (circumlocution)

3. Situation avoidance:

Decrease in attempts to talk in specific speaking situations

PHASE IV: This phase is characterized by a fully developed stuttering response pattern. A bond is created between emotional cues and arousal, feelings of being out of control of speech, and physical struggle/avoidance behaviors. In actuality, the stuttering response is the "normal" or most "natural" communication pattern for the speaker.

Speech Production
1. Chronic disruptions. Generalization of disruption to talking in general.
2. Segmental features: same as Phase III but increased in frequency and severity
3. Non-segmental features: same as Phase III but increased in frequency and severity.
4. Decrease in the rhythm, sequence, and timing of fluent utterances. This is associated with anticipation and prevention of impending stuttering

Cognition
1. Focus of attention prior to and during talking is on anticipation of disruptions. The client feels that stuttering can occur at any time and they are unable to prevent getting stuck.
2. Primary motivation is typically on hiding, preventing, or rapidly escaping from stuttering moments
3. There is a marked increase in anticipatory "scanning" of the utterance for potential danger words, often resulting in attempts to change or avoid them.
4. The individual also attends to emotional cues prior to and during stuttering moments and on the embarrassment of being "a stutterer"
5. Specific attitudes and perceptions begin to develop about what it means to be a stuttering and the consequences this brings.

Emotional Arousal
1. A strong bond is created between the anticipation and occurrence of stuttering and the emotional reactions of fear and panic they bring
2. There is an increase in emotional arousal prior to and during moments of stuttering, much of which is associated with anticipatory fear and feelings of being out of control

Coping Strategies
1. The client continues to develop individualistic strategies to prevent, hide, minimize, or rapidly escape from moments of stuttering.
2. The client is often motivated to keep others from knowing they stutter.
3. Coping strategies can be overt (visible on the surface) and/or covert (not visible on the surface).