by Janice B. Westbrook, Ph.D.

A - Indicative of "mild" stuttering; B - Indicative of "moderate" stuttering; C - Indicative of "severe" stuttering

Circle A, B, or C according to which most closely describes the
answers given by parents. Add clinician observations if they are
in the direction of greater severity. Never rank an item as
less severe than parent perceives it.
At the end. summarize
and discuss results with parents.

1. Tell me what concerns you about your child's speech.

A. - They repeat, start over
- They sound like they might be starting to stutter
B. - They stutter
- They talk too fast
- I don't want them to be teased
C. - I'm afraid they will start stuttering and won't stop
- Stuttering will handicap them
- It worries, frightens me

2. When did you first notice this problem?

A. - Less than I month ago
B. -1 to 3 months ago
C. - Longer than 3 months ago

3. Does the stuttering come and go, or has it been persistent
since you first noticed it? A. - 1 to 2 episodes, less than 1 to 2 weeks in length, with
fluent interludes between B. - 3+ episodes, less than 2 to 4 weeks in length, with fluent interludes between C. - Periods without stuttering are less than 1 day in length consistently over a period of more than1 month 4. Is there a history of stuttering in your family? A. - No B. - Yes, distant relatives __maternal grandparents __paternal grandparents __maternal aunts, uncles etc. __paternal aunts, uncles etc. C. - Yes, immediate family __mother __father __brothers __sisters 5. Has your child had any unusual medical problems? A. - Normal problems B. - Serious illnesses, but unrelated to speech C. - Serious illnesses which could be related to speech 6. Have you had any unusual family Problems lately? A. - Normal problems that are being managed and do not disturb consistency and security of the family B. - Some problems which interrupt routines necessary for linguistic and emotional development C - Serious problems which may damage the child's social, emotional, or linguistic growth (e.g. punishment, ridicule for stuttering) 7. How does your child get along with other children? A. - They have other children to play with and only have normal problems occasionally B. - They have no other children to play with or have some difficulty getting along with playmates C. - They are extremely shy when around other children or have a lot of difficulty getting along with them 8. Is your child difficult to discipline? A. - No, just normal B. - They are sometimes a little more difficult to handle than other children in the family C. - They are very difficult to handle 9. When did your child first begin to talk? A. - Between 1 year and 18 months of age B. - Between 18 months and 2 years of age C. - After age 2 10. Tell me about the way your child gets you to do what they want. A. - They tell me, or point - They persist until they get what they want B. - They point or start fussing - Sometimes I can't tell what they want C. - They seldom ask for anything - They just cry, and won't say what they want 11. How often does your child ask questions? A. - Very often B. - Not very often C. - Hardly ever 12. Describe your child's favorite play activity. A. - They have a favorite activity - Description of play is normal B. - They either don't have (or parents do not know) about a favorite play activity - description of play is restricted C. - Description of play activities suggests language delay - Description of deprived environment for language development 13. Does your child start activities or conversations with others? A. - Yes, often B. - Not very often C. - Hardly ever 14. If strangers have trouble understanding your child, do you think it is because of the stuttering? A. - No B. - Sometimes C. - Yes 15. When does your child communicate best? A. -When they are relaxed and comfortable -When they are not hurried B. -When they are alone with someone -When they have someone's complete attention C. -When they are by themselves -When they are playing with a pet 16. When does your child have the most trouble communicating? A. - When they are anxious - When they talk to a stranger - When they are in a hurry B. - When several people are around - When they don't have someone's complete attention - When they are explaining something - When they have to ask for something they want - When they ask questions - When they have trouble thinking of what to say, or how to say it 17. Do you think your child is bothered by the stuttering? A. -No, I don't think they are aware of it -They do not seem to be B. -Sometimes I think it does, but they do not say anything about it C. -Yes, they have told me that it bothers them -Yes, I can see that it bothers them 18. How does your child normally react to their stuttering? A. - They just keep on talking, with no comment about it B. - They sometimes start over, or took frustrated C. - They give up talking - They look away - They use unusual ways of speaking - They use movements/sounds to start speech - They express frustration, cry 19. Has anything happened which makes you think the stuttering is keeping your child from talking? A. - No B. - I think it may be C. - Yes 20. What worries you most about your child's speech? A. - That they am having trouble, and I wish I could help B. - That I am having trouble understanding what they say C. - That their stuttering (or talking) gets on my nerves, worries, or embarrasses me - That I believe the stuttering makes them feel bad 21. Has anyone ever teased your child about stuttering? A. No B. This may have happened a few times, but not very often C. Yes. This has happened often (or several times) 22. Has anyone ever called your child a stutterer"? A. - Yes B. - This may have happened a few times, but not very often C. - Yes. This has happened often (or several times) 23. When you watch your child stutter, how does it make you feel? A. - I feel sorry for them, and wish I could help them B. - I feel frustrated, anxious or worried C. - I feel angry - I think they are doing it out of habit or to get attention 24. Tell me some things that you have done which seem to help your child when they stutter. A. -I look at them when they speak, and wait for them to finish -I tell them to slow down B. -I tell them to think about what they are going to say -I help them say the word C. -I tell them to take a deep breath before talking -I tell them to wait, relax, or quit being nervous -I tell them not to talk like that 25. Have you ever known a person who stutters? A. - Yes. We have a family member who stutters - Yes. I've known a few people who stutter B. - I've only seen people who stutter, I've never really known them C. - I've never even seen a person who stutters At this point in the interview, the clinician should demonstrate different types of disfluencies to parents, and allow them to report which their child has exhibited. The clinician should begin with more severe behaviors so parents can, hopefully, have the relief and joy of reporting "Oh no! We've never seen anything like that." In this way, the clinician educates parents about stuttering, and models objectivity, openness and confidence - attitudes she will want to help them adopt. 26. Let me describe to you some kinds of disfluencies. Tell me if any of these are similar to your child's disfluencies. (Demonstrate) - Silent posturing with lip pursing - Silent posturing with open mouth, ending in abrupt voice onset - Prolongations with pitch rise - Tense, disrhythmic part-word repetitions with use of schwa vowel - Tense pauses - Combination of part-word, whole-word, and phrase repetitions - Easy, rhythmic part-word repetitions without use of schwa vowel - Easy, whole-word repetitions - Phrase repetitions A. Disfluencies will be characterized as follows: No struggle No awareness 1-2 Repetitions per instance .5 to 1 second in length Even and rhythmic ___Phrase Revisions ___Phrase Repetitions ___Interjections ___Word Revisions ___Word Repetitions ___Syllable Revisions ___Syllable Repetitions B. Disfluencies will be characterized as follows: No snuggle No awareness 3+ Repetitions per instance I- 1.5 seconds in length Even and rhythmic ___Interjections ___Word Repetitions ___Syllable Repetitions ___Pauses at ungrammatical junctures ___Easy prolongations ___"Runs" of disfluencies 3+ types per instance (e.g. "uh I I d-don't I don't want to.") C. Disfluencies will be characterized as follows: - Struggle - Awareness - Uneven, disrhythmic (with or without struggle) - 1.5+ seconds in length (with or without struggle) Respiratory disruptions ___Vowel glide ___Vocal fry ___Intensity/pitch disruptions ___Aphonia ___Insertion of schwa vowel ___Facial tension/grimacing ___Fixed articulatory posturing ___Body/limb movements SUMMARY OF RELATED ASSESSMENT PROCEDURES: 27. Parental speech models: A. - Parents use a slow rate and simple language B. - Parents use a fast rate and complex language C. - Parents' speech is difficult to understand 28. Oral peripheral examination: A. -Normal for age B. - Mild-moderate problems C. - Severe probe 29. Respiration: A. -Abdominal, rhythmic B. - Thoracic, rhythmic C. - Thoracic or clavicular, disrhythmic 30. Receptive language proficiency: A. - Within 6 months of chronological age B. - 6-9 month delay C. - 9+ month delay 31. Expressive language proficiency: A. - Within 6 month of chronological age B. - 6-9 month delay C. - 9+ month delay 32. Articulation/phonological proficiency: A. - Normal forage B. - 6-9 month delay C. - 9+ month delay 33. Rate of speech- A. 4-5 syllables/second B. 4-5 syllables/second (plus or minus one) C. 4-5 syllables/second (plus or minus two or more) 34. Connected speech: A. Intelligible, smooth, phrasing coordinated with breathing B. Intelligibility somewhat impaired jerky, short phrases with mild breath discoordination C. Intelligibility seriously impaired, serious disruptions of smoothness, short phrases with serious breath discoordination 35. Voice: A. Normal for age B. Disorders of quality, pitch, or resonance C. Cleft palate, vocal nodules