The goals of the evaluation are to obtain information that help the clinician determine (1) whether the client exhibits behaviors, attitudes, and/or perceptions of a communication problem, and (2) whether these symptoms are consistent with the presence or development of a fluency problem. The following questions are designed to obtain information that allows for reasonable clinical decision. The topic questions under the Broad Goals heading are intended to determine if a communication problem exists. The topic questions under the Narrow Goals heading are intended to assess the presence and nature of a fluency disorder that is characteristic of a stuttering response. The information obtained from both the general and specific be used as a guideline for developing an evaluation protocol and making assessment-diagnostic decisions.

The clinician is encouraged to obtain corroborating information from a variety of sources to address each of the issues below.

BROAD GOALS: Identification of a Communication Disorder

Determine if the client exhibits behaviors, attitudes, and/or perceptions that indicate a communication problem or disorder. Specifically, the clinician should address the following questions.

1. Does the client's communication pattern interfere with the ability or desire to communicate with others?

2. Does the client's communication pattern interfere with the ability to be understood by others?

3. Does the client's communication pattern interfere with social, educational, or vocational development?

4. Does the client's communication pattern call attention to itself so as to interfere with effective communication?

NARROW GOALS: Identification and Analysis of Fluency/Stuttering Problems

The purpose is to determine if the client exhibits behaviors, attitudes, or emotions consistent with the onset, development, or maintenance of a stuttering response and/or other fluency disorders. The following is an outline of primary topic areas and questions that should be addressed and answered.

Features of Speech Fluency and Disfluency

1. Does the client exhibit segmental speech behaviors that interfere with the natural continuity, rhythm and/or pace of speech?

2. Does the client exhibit speech movement behaviors preceding or during fluent and/or nonfluent utterances that interfere with the natural continuity, rhythm, pace, and force of speech?

3. Does the client exhibit atypical behaviors in the non-speech structures that precede or accompany disfluent episodes?

Attitudes and Perception About Talking

4. Does the client exhibit covert or overt behaviors, attitudes, or perceptions that reflect concern about talking or the occurrence of disruptions in speech fluency?

5. Does the client exhibit covert or overt behaviors, attitudes, or perceptions about themselves that interfere with social, educational, or vocational development and activities?

Awareness, Anticipation, and Expectancy Reactions

6. Is the client aware of how they talk and the occurrence of talking mistakes (e.g. disfluencies, etc.)?

7. Does the client exhibit covert or overt features of anticipation/expectancy about speech or disfluency?

Changes in Emotional Arousal

8. Does the client exhibit emotional arousal to talking that interferes with normal communication?

9. Does the client exhibit emotional arousal to the anticipation of speech disfluencies?

10. Does the client exhibit emotional arousal to the occurrence of speech disfluencies?

Use of Adjustment/Coping Behaviors

11. Does the client exhibit speech behaviors that reflect voluntary or involuntary attempts to postpone, avoid, hide, or escape from speech disfluencies?

12. Does the client exhibit non-speech behaviors that reflect voluntary or involuntary attempts to postpone, avoid, hide, or escape from speech disfluencies?

Possible Contributing Factors

The goal here is to identify any factors that might contribute to the predisposition, precipitation, or perpetuation of a stuttering response. The clinician should be aware that many of the features overlap. The following are general guidelines of factors known to influence in some individuals the onset, development, and maintenance of a stuttering problem. These should not be associated with causation, since stuttering is a complex, multidimensional problem.

• Predisposing Factors

  Diminished cognitive and learning development
  Problems with language development or usage
  Problems with phonological development
  Medical development and status, pregnancy, and birth
  Neurological development and status
  Motor development and status
  Familial history of speech, language, cognitive, emotional, or neurological disorders

• Precipitating Factors

  Delayed onset and development of speech and language
  Accelerated onset and usage of speech and language
  Speech-linguistic expectations and model from parents or others
  Performance expectations and models from self and others
  Emotional/psychological stress or uncertainty
  Physical stress, illness, or fatigue
  Environmental pressures
  Rapid communication pace/speech rate

• Perpetuating Factors

  Negative attitudes about self, talking, mistakes, or occurence of disfluency
  Negative attitudes and reactions to talking and disfluency from parents, peers, etc.
  Fear of talking or making talking mistakes
  Voluntary or involuntary strategies to postpone, avoid, hide or escape disfluency
  Use of excessively rapid or slow communication pace or speaking rate