thespeechsource.com
Fort Worth, TX · Private Pay Clinic
Sample 1 Play Activity
Engage the child in a structured play activity (e.g., blocks, farm set, dollhouse). Tally each disfluency type and each fluent syllable as you listen.
Disfluency typeCountSound/syllable repetitions e.g. "b-b-ball"
0
Word repetitions e.g. "I-I want"
0
Sound prolongations e.g. "ssssun"
0
Blocks / hard stops airflow stops
0
Phrase repetitions e.g. "I want-I want"
0
Revisions / interjections e.g. "um", "uh"
0
Fluent syllables
Tap for each syllable spoken without disfluency
0
% Stuttered syllables
—
Sample 2 Conversation
Have a naturalistic conversation with the child (e.g., talk about a favorite show, pet, or recent event). Tally each disfluency type and each fluent syllable as you listen.
Disfluency typeCountSound/syllable repetitions
0
Word repetitions
0
Sound prolongations
0
Blocks / hard stops
0
Phrase repetitions
0
Revisions / interjections
0
Fluent syllables
Tap for each syllable spoken without disfluency
0
% Stuttered syllables
—
Sample 3 Reading / Retell
For readers: ask the child to read aloud a short passage. For pre-readers: use a wordless picture book and ask for a story retell. Tally each disfluency type and each fluent syllable as you listen.
Disfluency typeCountSound/syllable repetitions
0
Word repetitions
0
Sound prolongations
0
Blocks / hard stops
0
Phrase repetitions
0
Revisions / interjections
0
Fluent syllables
Tap for each syllable spoken without disfluency
0
% Stuttered syllables
—
Secondary Physical & Secondary Behaviors
Observe and check any secondary behaviors present during the assessment. These are physical movements or sounds that occur alongside stuttering and are important for severity determination.
Facial
Body / Extremities
Respiratory
Clinician notes on secondary behaviors
Total secondary behaviors observed
0
Summary & Severity
Total disfluencies
0
Total syllables
0
Overall % SS
—
0%5%10%15%20%+
Within normal
Mild
Moderate
Severe
Very severe
Severity classification: Within normal limits
Enter sample data above to generate a summary for families.
Clinical disclaimer: This is an informal clinical screening tool, not a standardized or norm-referenced assessment. It is intended for use by licensed speech-language pathologists as a supplement to — not a replacement for — a comprehensive fluency evaluation. Results must be interpreted in the context of a complete case history, clinical observation, and professional judgment. Severity ranges are adapted from the Stuttering Severity Instrument, 4th Edition (SSI-4) and ASHA fluency disorder guidelines.
