#145: Assessing Stuttering: Making Recommendations

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. We are continuing this month's series on stuttering assessment with Stephen Groner, and today we're chatting about making recommendations.

So Stephen, you shared such amazing tips in terms of gathering a case history, assessing speech fluency, the impact of stuttering. How do we tie that all together to start making recommendations?

Stephen Groner: That is a great question, and if you do a great job at assessing all these threads but don't really feel like that you know how to then make some kind of a recommendation, then you might as well not work so hard to get all of those threads, because what we want to do is make right judgements based off of the data that we have.

And I am just going to say, you do not have to put as much pressure on yourself as you think you have to, because it's pretty simple if you go with the client's values. If you go with what they want, then you can never be wrong.

Now, I know, of course, in some of our settings that we work in, we have to have numbers, we have to make some kind of recommendation, and I get that we will have to use our clinical expertise to do that.

But what I'm saying is have all of your knowledge and recommendations. Be colored by what does the client or their parent want?

So let's dive into what I do.

First of all, I split this up into two camps. If the child is not seven yet, if they're two, three, four, five, or six, then all that you really have to do is look at a few things.

You have to look at do they have a lot of risk factors for stuttering? Have they been stuttering for six months or longer? Is mom or dad really concerned, and are they as the child aware of or frustrated by stuttering?

If it's been longer than six months, then you should start therapy, especially if it's been longer than 12 months, you for sure should start therapy.

If they have a lot of risk factors for persisting in stuttering or even just one or two of the top two, which if you recall, are having any family history of stuttering or being male, you should start therapy now.

And if they're aware of their stuttering and frustrated by it, then you should just start therapy.

And also take into account parents' concern as well. If mom or dad are super concerned but their child has been stuttering for three months, she's a girl and there's no family history, she's not aware of it and is not frustrated by it, you might say, "Well, let's just wait and see."

But if mom or dad are really concerned, you could do a super short course of therapy, train mom and dad up on some really helpful ways to respond to stuttering when it comes up, and you have just relieved them and done a lot of good for that child who will then get all that really good input when they stutter. That could be done in four to six weeks.

So if they're younger than seven, just look at those few things and you can essentially say, "If you should start therapy now, wait until six months, or not do therapy at all."

But if they're seven years old or older, this is where it gets muddy, and that is because after the age of seven, we know from Yury and Ambrose that there is a very low likelihood that their stuttering will fully and completely resolve on its own.

So a child who is seven years old or older who is still stuttering, will likely stutter in some form or fashion for the rest of their life.

Now while there are some good treatment, there are some adequate treatments for stuttering in the age range between seven and 12, I would say it's the weakest age span that we have.

Before age seven, we have Palin PCI therapy, we have the Lidcombe program, and we have syllable time speech or beat speech. Those work wonders for that age range.

And then we have some really good therapies for age 12 and up.

But the age seven to 12 is really tricky, and I'm sure as I say that you will think to yourself, "Gosh, yeah. That is the most difficult age range to treat," and you would be right.

But almost any and all change that you will see in a child's communication who is age seven to 12 will have to come from some conscious effortful work on their part to change thoughts, to change physical things that they're doing, to try to reframe feelings, and to walk into perhaps stressful situations.

So if they don't want to change, if they are not bothered by stuttering, if they are fine with the way that they talk and their friends are too, then you could start stuttering therapy, but you likely wouldn't see the outcomes that you want even if you have mom and dad breathing down your neck. Which makes it hard because a lot of times, you'll see a client who's eight. Mom is like, "They are stuttering all day long and I want it fixed by next week." And they're like, "I don't give a flying whoop about my stuttering."And then it's really tough because it feels like that you're caught between a rock and a hard place.

So if they're seven years old or older and they want help, of course, for stuttering, then you should start therapy.

What I like to do in this age range is at the end of my assessment, I like to see if they're stimulable for certain stuttering therapy approaches. So I might teach them how to feel when their voice is turned on and how to extend or expand how long that they voice for, and do that in a few simple sentences. And then I have them rate on a 10 point scale how much that helped.

Or we could do some kind of a tension shifting approach where instead of focusing on the fear that you might stutter, you focus the beam of your attention somewhere else, and that helps your words to just flow more automatically. And then I have them rate how much that helped them.

Or we can work on just saying the fact that they stutter and that they want help for their speech. Does that help some of the fear to dissipate when you just say, "My name is Sam and I stutter, and I'd like to find some things that help."

And then you can take their ratings of some different therapy approaches and you go with the one that got the highest rating. Then you know where to start in stuttering therapy.

So if they're not into therapy, then now might not be the best time.

But at the same time, if they get some good education about stuttering and about ways that you can help, maybe you'll get more buy-in. But if they do want help, then of course, they should start and then you can recommend a course of therapy based off of then what you trialed to see if it helped them, and they can tell you how much it helped. Then you can start to plan a course of therapy and recommend a course of therapy that takes those client values into consideration.

But what I do at the end of my one page stuttering assessment, when I try to wrap up in the assessment portion of my, evaluation is I essentially give each of the three Fs, so fluency, feelings, and familiar people ratings.

I put those, each one of those on a scale from zero to four.

So say that a child's weighted SLD severity score was in the moderate range, so maybe they have a 16, I would rate from zero to four what their fluency is, and it would be moderate, which would be three out of four. Zero is none, one is minimal, two is mild, three is moderate, and four is severe.

So if they got a moderate score when I took into account all of their fluency data, I would give them a moderate or a three for their fluency scale score.

Say that when it comes to their feelings about stuttering and all of the data that I took, whether it be a standardized test or a 10 point scale, say that they had severe negative feelings or impact from their stuttering, I would give them a four out of four on their feelings scale score.

And then I take into account the ratings that I got from parents and, or teachers of what they see in the client who stutters when it comes to how frustrated that they get, how much they clam up and don't participate in speaking situations, how severe they would rate the client's stuttering. And I put it on that zero to four point scale.

And then all I do is I take the average of those three scores, fluency, feelings, and familiar people, and I get an average score.

So you can do three for fluency, four for feelings, so that's seven. We could do three moderate when it came to familiar people, which would give you 10.

So then all you would do is do 10 divided by three, which, of course is 3.33. So they have a moderate overall functional impact of stuttering on their life. And that's the number and verbiage that I use to tie up the bow on my assessment portion before I then go into what I recommend for stuttering treatment.

So, that's the way that I do it. I try to take all the threads and tie them into a beautiful bow and then get a really good course of treatment plan, taking into account the values of the client sitting in front of me, and then we're off to the races.

Speaker 1: What an epic overview on assessment. You're such an incredible teacher, and we're so lucky to have all of this content for free on the podcast. It's so big.

Stephen Groner: Thank you.

Speaker 1: I can also attest to the fact that Stephen does a really great job of breaking down treatment as well. He created a video course for SLP Now and some like materials to go with it, but he also has the Epic Fluency School Stuttering Toolbox that walks you through all of the things.

Stephen Groner: All of the things.

Speaker 1: Yeah. We'll put a link to that toolbox in the show notes as well, if you want to check it out.

Stephen Groner: I'll slide a 20% discount code in there as well.

Speaker 1: Awesome. Good, good, good.

But that's a wrap. Thank you so much, Stephen. This was incredibly helpful.

Stephen Groner: You're so welcome. It was my pleasure, and I hope to be back again very soon.

Speaker 1: Less than three years this time.

Stephen Groner: Yes. Less than three years this time.

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.