You’ve probably heard that our field is moving away from using stuttering frequency counts as a way of measuring stuttering. In our opinion, this is a very good development—it is something that we have been encouraging for quite a while now, and it is increasingly important as we come to view stuttering as an example of Verbal Diversity™. (For more discussion of stuttering as Verbal Diversity, visit www.VerbalDiversity.com.)
A change as big as this doesn’t come without challenges, however. Many clinicians—and many work settings—are still tied to the old way of doing things, that is, counting moments of apparent stuttering and using the results of that count as a means of diagnosing stuttering, determining eligibility, assessing “progress” in therapy, providing reimbursement for services, and even planning for dismissal.
What if I told you that it is possible to do all of those things – and more – without ever counting how many times a child appears to stutter and without ever evaluating “stuttering severity” as perceived by a listener.
Crazy, huh?
It’s true, though. I myself haven’t done a formal stuttering frequency count in the clinical setting in years. Why not? Because doing so never gives me the information that I need!
Put simply, observing the number of times a speaker appears to stutter during a particular evaluation session tells me absolutely nothing about whether they need therapy, how any therapy should be structured, how that speaker is doing in therapy, or whether they are ready to be dismissed from therapy. Moreover, because of the inherent variability of stuttering, I know that the amount of stuttering that I think I see in one situation is not necessarily the same amount of stuttering that I will think I see in another situation.
In other words, I find stuttering frequency counts to be basically useless for clinical purposes. There, I said it, and I’m glad.
What do I do instead?
What I really want to know when I’m assessing a person who stutters is whether they are facing any difficulties in life associated with stuttering. That is, I want to know whether they are experiencing “adverse impact.”
If they are experiencing adverse impact at that time, then I want to recommend therapy. If they are not experiencing adverse impact at that time, then they don’t need therapy!
(Of course, this can change over time, so we want to be sure that we understand their experience of stuttering and know how to evaluate and document that over time.) So, what I do instead is measure adverse impact!
Personally, I do that using the Overall Assessment of the Speaker’s Experience of Stuttering (OASES)™ . In fact, that’s one of the many reasons that I developed the OASES—to measure the adverse impact of stuttering.
The results that I get from the OASES not only give me the information that I need to qualify a person for therapy; they also help me plan that therapy by giving me a more complete understanding of the person’s experience of stuttering.
Specifically, the OASES helps me learn about:
- The speaker’s feelings, actions, and thoughts related to stuttering
- The communication difficulties the person is experiencing in real-world situations (including school or work setting)
- The impact of stuttering on the person’s overall quality of life.
Knowing this information helps me understand whether the person is actually experiencing a disorder related to stuttering (and can therefore benefit from stuttering therapy).
What if my employer requires frequency counts?
Let me first state that I don’t want to get you into any trouble. If your district or clinic or administrator requires you to collect frequency counts, then you will certainly want to do so in order to avoid problems.
Along the way, however, let’s acknowledge that requiring frequency counts is not consistent with IDEA 2004, so frequency counts aren’t supposed to be required in schools. Nowhere in IDEA does it say that we need to count (apparent) moments of stuttering in order to qualify children for therapy.
Instead, IDEA requires us to recommend therapy based on whether or not a student experiences adverse impact in their lives as a result of their communication issues. Likewise, insurance companies and other third-party payers are increasingly focused on the impact of communication and other issues on a person’s life. So, again, frequency counts aren’t really helpful or necessary.
The common practice of trying to count stutters stems from older views of stuttering that focused primarily on what listeners could observe about stuttering rather than focusing on what speaker experience, as we seek to do today. (For more thoughts on shifting our perspectives from listeners’ views to speakers’ views, visit this blog post: Shifting Perspectives about Stuttering.
Therefore, in addition to doing any required frequency counts, you will also want to gather other measures of stuttering to ensure that you have the the information that you really need in order to make appropriate clinical decisions.
What other measures? Well, measures of adverse impact, of course!
By assessing adverse impact, you are not only following the requirements of IDEA and third party payers, you are also keeping your focus on what really matters to people who stutter—the impact that stuttering has on their lives.
What if I still need some type of “severity measure?”
Even when districts, payers, administrators recognize the importance of measuring adverse impact, they may still require an assessment of stuttering severity. In fact, many people who stutter (and their caregivers) want to know about severity, too. So, you may still find yourself in situations in which you want to measure stuttering severity.
Unfortunately, the existing stuttering severity measures suffer from relatively low reliability. Plus, they’re focused on counting moments of stuttering, which is exactly the type of thing that the field is moving away from.
Don’t worry, though. STR has you covered. In future blog posts, I will talk about our new, forthcoming stuttering severity assessment which supplements observer-based measures of stuttering with speaker-based measures in order to give you a more complete understanding of a person’s experience of stuttering.
Stay tuned for more! And please be sure to share these thoughts with your friends and colleagues who want to learn more about stuttering.
