#142: Assessing Stuttering: Getting Started

Speaker 1: Hello there and welcome to the SLP NOW Podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back, as we dive into this week's episode. Hello there, and welcome to the SLP Now Podcast. This month we are diving into all things assessment for stuttering, and we have a very special guest, Stephen Groner, you might recognize this name. He's got an epic Instagram account, and he was on the podcast three years ago, which is insane, over three years.

He did a really epic episode on tackling stuttering treatment with special populations. So, head back to 15 if you want to hear that. But I'm especially excited for today's episode, because Stephen has such a great framework for diving into stuttering evaluations and navigating that. I really appreciate his perspective, because he's super knowledgeable, he's got really great relevant clinical experiences, and he's a research nerd like me, which research nerds unite. But he also has struggled with stuttering in the past and he now speaks very fluently, but I think it's so cool that he has that perspective and he brings that to the table and I think that'll really shine through as we talk about navigating this evaluation. So, without further ado, hello, Stephen.

Speaker 2: Hey, it is so good to be back. I'm so glad to get to spend some time with you all today.

Speaker 1: Awesome. Okay, so let's just dive right in.

Speaker 2: Let's do it, let's just jump into the deep end.

Speaker 1: Yes, so we just got a new stuttering evaluation or you [inaudible 00:01:50] got a first one. So other than panic, what's the first thing we're going to do?

Speaker 2: Don't do that. Okay, first off, it is normal to sort of panic if you're not really sure what to do. But the goal is to know what you can do, so then there'll be no panic. Here's what I do, the very first thing that I do is I print off my one-page stuttering assessment and my 10 point stuttering scales. That's not a plug to go by my stuff, those are just the things that I love to use, because I think that they're the most comprehensive while being the most efficient with my time, and I know that we all need that. The first things first, I print those two things out and get them in front of me, but I also see value in a number of standardized assessments as well, which I will use too. I get that all in front of me and then I am ready for them to walk through the door.

Speaker 1: Awesome, can you walk us through a little? Because I think we'll walk through the components of the one-page stuttering assessment, but just to get a sneak peek?

Speaker 2: Okay, so definitely, of course, need a thorough case history, if they're younger than seven years old. If they haven't had their seventh birthday, you have to look at risk factors for persistent stuttering. We know from Yairi and Ambrose that almost all children who will see their stuttering resolve will do so by their seventh birthday. If they're past that, then they likely will stutter in some way for the rest of their lives, although there are some late recovery cases. If they're younger than seven, I always then look at risk factors for persistent stuttering. Definitely want to screen for articulation, language, voice, all of those things, and dive in and go ahead and assess those, if there are any concerns. Got to get my disfluency count out, although that's not the entirety of a stuttering eval.

It's a great place to start. Then of course I'm thinking I have to assess fluency in some way, I have to assess their feelings in some way. I really like to get an assessment of familiar listeners, like mom and dad or teachers, and get their take on things. Then I know that I have to wrap it up in a pretty bow of okay, what is the overall functional impact of stuttering on this child at this time, and what are we going to do about it? That's what's going through my head, then that's what I use my one-page stuttering assessment for, as well as my 10 point stuttering scales, as well as some surveys, and some other standardized tests as well that look at some of those things.

Speaker 1: We'll dive into some of the options in the next episode, but that's all on your one page?

Speaker 2: Technically, if one page if you print it out front and back, so it's two pages.

Speaker 1: That sounds cool.

Speaker 2: But it can be on one sheet of paper, which is helpful. That just came about because I wasn't satisfied with the stuttering's verity instrument, which I think we'll talk about that next week. It's great for what it does, but it can't capture everything, and so how do we capture as much as we can about stuttering? Which if you know the iceberg, there can be a lot that's not on the surface that you can't see, so how do you capture as much as you can in the most efficient amount of time? That's where I was like, "Well, I need to make my own thing," because I didn't really feel like that there was something out there, so that's what I did. I can walk you through step by step how I do what my thorough case history would look like. I'm sure that I've missed some things that you might hit, but it seems to work for me, and we can go from there.

Speaker 1: Yeah, let's talk more about the case history, that sounds great.

Speaker 2: Okay, so I know that we're all like, "It's boring, you're just doing a case history." You're like, "I know how these are done." But there are some specific things when it comes to stuttering that I always want to make sure that I get when it comes to a case history. First things first, I want to know why the client or their parent, if they're younger than seven, why they came to see me today, why am I seeing them? What's the general concern? I always get it down in their words, because it feels really good at the end to then say, "Okay, you came to me because X, I found Y. Here's Z, how we're going to tackle it," makes them feel heard. Then I've got to know about the onset of stuttering, how it started. Especially if they're younger than seven, I need to know as close as we can to the exact time when it started.

Some parents you will find will know the date down to the day and time of day, they will know it. Then some will say, "It's been a few years," and you're like, "That doesn't help me so much." But what you can do is ask about what were some other life events that were going on when it started? They just started preschool, so he was three and a half years whenever he started preschool, so it was around there, or it was at Christmas with Grandma June, and all of a sudden he was just stuttering. You're like, "Okay, so it was Christmas of maybe 2019 or something like that," to really try and drill down to what was the time of onset. Then from that, of course you can do some math, which I know that we aren't always great at in the speechy field, at least I am not.

Then you can get the time since onset, and that used to be a lot more important I think, than the field thinks today. It used to be you had to wait a full 12 months or one year before you started therapy to see if it would go away on its own. But people like me, and I'm not a researcher, but some big names like Scott Yaruss, they now say, "Maybe don't even wait as long as six months, maybe even sooner than that, you should just start therapy." Because, of course, we know that 80 to 90% of children will see their stuttering resolve, but we don't know who the 15% of kids are who won't. Although, we are getting some pretty good measures or we're getting better ones that we can tell at a young age. It used to be you really did want to know, has it been a year since they started stuttering?

Now, it's like, "If it's been six months and they're still stuttering, I would start treatment."If it's been less than six months, but the child is aware of it and frustrated by it, you should just go ahead and start therapy. Or if the parents are extremely concerned or if they have some of the big risk factors for persisting in stuttering, I would just go ahead and start it." It's not as important as it used to be, but still good to have. Then I like to know what has the change been since stuttering started? Has it gotten better? Has it gotten a lot worse? Has it stayed the same? Has it come and gone in waves? It was gone for six months and now it's back? Which by the way is very common at a very young age. Have you had any other previous therapy and what did they do? What did you learn? What did you take from it? What was the most helpful thing? I want to know when stuttering started, how it's changed since then and what they've done so far to try to help it.

Okay, then I want to know let's look at the whole child, in the whole family. Were there any events in their birth or developmental histories that could be contributing to stuttering or is there any family history? Does dad or grandpa or auntie, do they stutter as well? Because then boom, you have family history, which is one of the big risk factors for persisting in stuttering. Are there any learning abilities? Are there any behavioral problems as well? Riley and Colleagues in 2018, we don't have time to really get into it, but they did a great study. Riley and colleagues in 2018 looked at the percentage of Children who stutter, who have concomitant health problems. While children who stutter and people who stutter are on average just as intelligent and psychologically stable as those who don't stutter, they do tend to have more health problems.

You have a higher chance of having a second disorder, be it ADHD, or autism, or down syndrome, or a whole host of things if you stutter, so it's good to know about those. I also love to know what are their strengths and what are some weaknesses? It can be really helpful as you're tailoring treatment if you have a kid and mom says, "Man, they are just off the wall, they just don't slow down or stop at all." You're going to want to know, so they have a lot of energy, how do I harness that to do really good therapy, instead of trying to force them sit in this chair for an hour while we try and do stuttering therapy? That can be super helpful. I also love to, love to, love to gather things that they're into, things that they're interested in.

I'll ask a number of questions. What do you like to do? Is a great one to start with. If you get some blank stares, you can be like, "If you had the whole day off and you could do whatever you wanted to, what would you do? Or what do you do on Saturdays when you're not at school? Or anything, to how do you spend your free time?" That always gives me so much meat of things to talk about and or do in my stuttering therapy sessions, so that I don't feel like I'm having to pull teeth to get them to buy in and participate, because we're doing something that they've told me that they love. I always, always, always ask that. Now, let's talk a little bit about the top risk factors for children who are under the age of seven.

There were some really great studies, Singer in 2020, Walsh in 2021, there were a lot that just came out in the last two years that have really looked at and did some impressive meta analyses of risk factors for persisting in stuttering. How can we tell if the child in front of me has a high risk of being in that 15% of children who will not see their stuttering resolve? They have some pretty cool findings, so the top risk factor for persisting in stuttering is having any family history of stuttering, whether or not they still stutter or if they recovered as a child. If you have a family history, that means that you have a strong genetic component, and that is going to put you more at risk of persisting. Number two, being of the male sex. Those two, those two, by and far, by large effect size, predict persisting in stuttering.

If a child is one or both of those, even if it's been less than six months since stuttering started, I just go ahead and start therapy, I tend to. The third most important one is having poor phonological or articulation abilities. The fourth one is having a higher percentage of stuttering-like disfluency, so just having a ton of stuttering. Then five and six are having poor receptive language skills and poor expressive language skills. Now, when it comes to poorer artic and language skills, that does not mean so bad that they are disordered. It just means that as compared to peers who do not stutter, they have depressed scores, but not to the point of you too have a language disorder or a phonological disorder. Those studies rate the threshold cutoff scores that they found from their samples.

Then of course, if they've been stuttering for longer than one year, we know from Yairi and Ambrose that most children will recover within one year, and then almost all within three to four years post-onset, which is that seventh birthday. Those are the biggest risk factors. I always check off how many of those that a child younger than seven has. But if they're older than seven, I essentially know that they have/are persisting, and so I don't have to look at those if they're above seven. That's my word vomit for the first part of my assessment that I do. Anything that you want to hear more about or have questions about, because I wasn't clear, which is very probable?

Speaker 1: That was incredible. I just feel like I gained 50 IQ points, that was so good. But no, I think that's super helpful, and this might be an episode that people want to listen to a couple of times in case you missed anything. But no, it was super clear, and I'll put some of the highlights in the show notes as well. If you all need a quick recap of some of this, check the show notes. I'll also link Stephen's one page stuttering assessment and everything in there, too.

Speaker 2: Yeah, and you do not have to go and buy mine, it's just what I use because I know that I have to have it all down in front of me or I will forget things. I do have a 20% off code if your listeners would like it, if not, I'll gladly zip my lips.

Speaker 1: Yeah, I'll put that in the show notes, so then they can just click and access it.

Speaker 2: Awesome.

Speaker 1: Awesome, this is so good. That's a wrap on this first episode, and [inaudible 00:16:11] be back next week talking about assessing speech fluency. Thanks for listening to the SLP Now Podcast, if you enjoyed this episode, please share with your SLP friends, and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.