#143: Assessing Stuttering: Speech Fluency

This Week’s Episode: Speech Fluency

The last episode, Stephen Groner started to share his knowledge and experience with stuttering. Stephen is an SLP who is super knowledgeable, has really great + relevant clinical experiences, is a research nerd like me, and his struggle with stuttering in the past means that he brings really helpful experience to the table — and I think that really shines through as we talk about navigating this evaluation.

Last week Stephen shared a really great framework for diving into stuttering evaluations (and he shared a 20% off coupon with SLP Now listeners. Yay!).

Today Stephen and I  discus standardized testing and fluency when he shared something that was surprising at face value but made so much sense after he explained it:

Disfluency counts aren’t the gold standard for assessing stuttering. 

And that wasn’t the only spice Stephen dropped on me during our conversation — he also let me in on a little secret…

You don’t need a standardized test to assess speech fluency.

This conversation was a great reflection of the way that things are constantly evolving in the field of speech pathology, and why that’s such a good thing. It’s all in pursuit of helping our students.
And don’t worry… you don’t have to throw your disfluency counts out with the assessment bathwater here — Stephen shares some great strategies for taking those evaluations from irrelevant to invaluable. Let’s dive in!

Topics Discussed:

📚The Weighted SLD Severity Score ✨free✨
📚The Test of Childhood Stuttering
📚Disfluency counts and variability
📚Coding for non-stuttering-like disfluencies
📚Assessing the length of a stutter without using a stopwatch
📚Measuring progress without standardized tests

Want to learn more about fluency therapy?

→ Hear more from Stephen on Instagram.

→ Print off Stephen’s one page Stuttering assessment  ✨For 20% off use code: MONEYROCKS ✨

→ Are you an SLP Now Member? Check out our Fluency Bootcamp in the SLP Now Academy.

→ Listen to this podcast: Tackling Stuttering Treatment with Special Populations

→ Check out the SLP Podcast with the Fluency Queen, Lauren LaCour Haines!

→ Discover how to make planning + prepping your fluency treatments a breeze with the SLP Now Membership.

Here’s what to expect this month:

Here’s what to expect this month:
November, 1: Assessing Stuttering: Getting Started
November, 8: Assessing Stuttering: Speech Fluency
November, 15: Assessing Stuttering: The Impact
November, 22: Assessing Stuttering: Making Recommendations

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Transcript

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.

Welcome back to The SLP Now Podcast. This week we are continuing the conversation with Stephen Groner, talking all things stuttering assessment. Today, we are diving into assessing speech fluency, but if you missed us last week, be sure to check out that episode because it gave an epic overview of how to start your evaluation. But now, let's chat about assessing speech fluency. Stephen, which tools do you like to use when you're assessing?

Stephen Groner: Yeah, so when it comes to stuttering assessment, there are a lot more tools for assessing speech fluency than assessing the myriad of other stuff that comes with stuttering, so I do think we have some great things to choose from. Probably the one that we're all probably most familiar with will be the Stuttering Severity Instrument, the SSI-4 by Riley and his buddies. That's the one that's most used and it does a pretty good job at assessing simply speech fluency. But I can let you in on a secret and that is you don't need a standardized test to assess speech fluency.

I know you might be saying, "Yeah, but we have to have some kind of a standardized score to qualify students in my district, or qualify them on their insurance," and you would be right. But there is a free standardized measure called the Weighted SLD Severity Score that was published and it's free to use. You don't have to buy any forms, you don't have to buy any manuals. You can use that score and it is a standardized score of speech fluency. Yes, while I have the SSI-4, I have the TOCS. I actually really like the TOCS as well. That's the Test of Childhood Stuttering. It actually is pretty great and it does assess more than just speech fluency. It's a little pricey, which I know can be kind of a deal breaker for some, but I really do like it, and I can talk more about that as well.

But what I tend to use, simply because it's the most efficient and free, is the Weighted SLD Severity Score. But before I could use that, we have to take a disfluency count. Now, disfluency counts in the past have been relied upon as if they are gold, and whatever it says is true about a client stuttering all of the time. That is not true. Stuttering we know is so variable. It can change. I mean, from when I talk to you on this podcast to if my wife were to walk in the door to, if I were to get a call from my mom, my stuttering could change vastly in about three minutes time based off the situation, so disfluency counts are not good, not good at all. Almost worthless. If you only take one in one speaking situation, you might as well throw it in the trash.

But disfluency counts also, I feel like in recent times have been marred of they are not good for anything. You should never take one, they're just so bad, and I don't think that that's true, either. I think if you take a disfluency count of a person who stutters of their stuttering in a number of different contexts, in baseline conversation with you, talking in class to their teacher, talking to their friends at lunch, talking on the playground, as they talk to mom, as they play a game with their sister.

I also love to ask for home video recordings of clients from mom and dad. I say, "Hey, what I see when we meet for your child's assessment, they may have a great day and their stuttering might not seem like what it is to you at home, so if you could send me two or three different recordings of their speech at home that you want me to see, I would love to have that," and boom, you can take a disfluency account from that as well. If you've got three, four, five, six different speech samples, got to have in total at least, at least 300 words or about 500 syllables at least. But I love to go for about three times that. Then you can feel more sure and certain that you have a solid disfluency count.

Then once you have that, that's only one part of your stuttering evaluation, so you need to have an expansive disfluency count for just a small part of your assessment. But on the backside of my one-page stuttering assessment, yes, it's really two pages, but I print mine out front and back, so it's just one sheet on the back, that's where I have my disfluency count sheet.

The way that I do it, and people have all different ways and that is just fine, you find the way that works for you so that you can do it quickly and efficiently 'cause I know that all of our time is limited, but essentially what I do is I have 100-word blocks and I put a dash if the word is fluent and I put a code to say that there has been some kind of a disfluency. My codes are this for stuttering-like disfluencies, so disfluencies that sound like stuttering, I put an "S" if it is a sound syllable repetition. I put a "W" if it is a whole word, repetition, I put an "A" if it's an audible sound prolongation and I put an "I" if it's an inaudible sound prolongation or a block.

If I hear those four, I put that little letter in the slot. Now, you can also have other kinds of disfluencies that don't sound like stuttering, but those of us who stutter can use to slyly mask a true stuck stuttering moment. The ones that I code for are interjects like "likes" and "ums," phrase repetitions where we say a phrase more than one time, or a revision where I think I want to get the chocolate ice cream. Okay, I was getting stuck on "vanilla," so I'll switch it and say "chocolate." I code for those as well.

There was a really great study done back in 2014, Tumanova and colleagues. They found that if you have 8% or more of your words are any kind of disfluency, whether stuttering-like or non-stuttering, then you can be reliably classified as someone who stutters, so if I masked all of my stuttering moments with an "um" or a "like," but I had 8% or more of my words were ums or likes, they found through their cool statistical modeling that you can still say that I have a stutter even if I have no stuttering-like disfluencies, which is pretty cool. I, of course, see if you have 3% or more of your words or 2% or more of your syllables are a stuttering-like disfluency, then that can be a marker for stuttering. Then if your total disfluency count, which is stuttering-like disfluencies plus non-stuttering-like disfluencies, if that's 8% or more, then you can also be reliably classified as someone who stutters.

But I don't just stop there. I have found that I used this next measure a whole lot in assessing treatment success, and that is the average length or duration of a client's stuttering. Now, yes, you probably should sit there with a stopwatch and time every single stutter to be the most reliable, but that is never going to happen in our clinical practices. But I like to make the determination at the end. What was the average length of their stutters? Was it half a second that was more like a full second. Was it a half a second? Was it a full second? Or was it three seconds in length?

You can really see with treatment, say that when somebody came to you, their average stuttering length was three and a half seconds. That is extremely noticeable. Then say that they still have the exact same number of stuttering-like disfluencies, but their average length or duration is now down to half a second. That is going to sound a lot smoother, a lot less stuckness, a lot less struggle. It's going to sound way more forward-moving and you can be sure that something that you've done has helped, even if they have the exact same number of stutters.

I also always do a speech naturalness score on a 10-point scale. Zero is extremely unnatural and 10 is perfectly natural. You can really see some changes there, too, after treatment. It's probably the quickest measure that you could take. Are they, ooh, wow, they had a lot of stuttering, they struggled for a long time with each one? They had so many secondaries, they were probably two out of 10 natural, and then six months later they're like seven or eight out of 10 natural. That is a huge, huge jump. We know if you make a two-point or more movement on a 10-point scale, then you have a clinically significant change, so even going from a two out of 10 when it comes to speech naturalness to a four is a clinically meaningful change, much less seven or eight. Speaking of which, I always list down any secondary behaviors that I see. I don't assign those a numerical score. I just like to list, "I saw a lot of X, Y, and Z," and then we see how that changes.

Okay, so that's my disfluency count, and now is when I would I do the calculation to get their Weighted SLD Severity Score. This is also probably if you are using the SSI-4, it's when you would score it all, and you would see where they fall in the percentiles. But the Weighted SLD Severity Score sounds and looks complex when you first see it, and it can be scary, although once you know it, it's really not.

But one of the things that I made so it wouldn't be so scary is I actually made an online calculator that is inside of my Fluency School Stuttering Toolbox, so if you get that inside of which is also my one-page stuttering assessment, I have a page where all you have to do is put in a couple of numbers, like the number of repetitions in the sample, the average number of how many repetition units that there were, so you could have just one, or you could have two, or you could have three, or you could have four. If you put in the number of repetitions and the average number of units that preceded the affluent word, the number of sound prolongations, whether audible or in audible, and the total number of syllables in the sample, it will spit out a number for you that's either mild, moderate, or severe stuttering, or normal speaking with no stuttering. But you can also do it by hand. That equation is also on the back page of my one-page stuttering assessment.

Essentially, what it is you'll get a score between zero and it can go up to 70, 80, or like 90, but the important thresholds are a score of zero to four is normal, a score of four up to 9.99 is mild stuttering. A score from 10 to 29.99 is moderate stuttering, and anything greater than 30 is severe stuttering. It can go up pretty high. But if you have that number, you have a standardized measure of speech fluency and it is completely free if you want to do it by hand. I love to use that just because it's so ding-dang fast and I don't have time, so I like to use that a lot. It's cool because it takes into account not just how many stutters that there were, but how severe were they are, so if I have a ton of repetitions for each of my repetition stutters, that should be weighted more than if I have just, well, one, right, hence the name: Weighted SLD Severity Score.

Then they also assign, they weight a higher score to prolongations because those do tend to be markers of more severe stuttering. If you're having a lot of prolongations and blocks like that, that tends to be more severe than a repetition, so it weights it based off of what kinds of stuttering that they have, and gives you a standardized numerical score, which I love to use. That's what I tend to use a lot. But you can also use a standardized assessment like the SSI-4 or the TOCS. I really like the TOCS a lot. I used it when I was doing research at Vanderbilt when I was in graduate school. I didn't have it at any of my jobs when I worked 9:00 to 5:00 and I don't have it for my private practice just because the kit costs like $220 and then you have to pay for all the booklets.

But if you can get it, I would choose the TOCS over any other box stuttering assessment kit, if you have the funds for it. What it does is it's so good at walking the child through a number of different speaking situations. They have to name pictures as fast as they can, which can be pretty stressful. They have to say sentences of increasing syntactic complexity, but it's in a structured way, which is really cool. Then it has them do, I think, conversation as well as they have to narrate a story, so you get a lot of different speaking situations all in one.

Then it has some of, in fact, the rating scales that they have inside of the TOCS for parents and teachers are actually what inspired me. That's what I've tried to sort of model my rating scales for that I use because they're so good, so if you have the funding, I would look at the TOCS, at the Test of Childhood Stuttering. But if you don't have it, no sweat. You can assess all of the things that you should for free or very close to it. I hope that was really helpful. I feel like that I lost a few IQ points as I went and I'm sorry. I talk a lot. I say since I stuttered for 17 years, very badly, I like to say that I'm trying to make up for lost time.

Speaker 1: No, that was incredible. What an amazing resource. If an SLT is like, they know that they have a stuttering evaluation coming up, and they feel like they don't know what to do, after listening to you for these 15 minutes or so, they're set. They know what to do.

Stephen Groner: Good.

Speaker 1: Thank you for breaking it down in such a-

Stephen Groner: I'm so glad. You're so welcome.

Speaker 1: ... That's a wrap on our discussion of assessing speech fluency, but we hope to see you next week when we chat about assessing the impact of stuttering.

Stephen Groner: Oh, and really, I love this the most, so I'm pumped to see you there.

Speaker 1: 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.

 

marisha-mets-about-mobile

Hi there! I'm Marisha. I am a school-based SLP who is all about working smarter, not harder. I created the SLP Now Membership and love sharing tips and tricks to help you save time so you can focus on what matters most--your students AND yourself.

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