The SLP’s checklist for completing a stuttering assessment

A thorough stuttering assessment does more than count disfluencies. It builds a picture of how a person communicates across settings, how they feel about speaking, and what support will make everyday interactions easier. For speech-language pathologists, the process should be structured enough to guide clinical decisions while remaining flexible for each child, teenager or adult.

This checklist is designed for Australian SLPs, students and families who want a practical way to organise a fluency evaluation. It covers case history, speech sampling, communication impact, differential considerations, documentation and feedback, with room for clinical judgement throughout.

Prepare the referral and case history

Start by clarifying why the person has been referred and what the family, teacher or adult client hopes to understand. Record when the stuttering began, whether it has changed over time, and whether there is a family history of persistent stuttering. Ask about previous speech therapy, hearing assessments, developmental milestones, languages spoken and any relevant medical or educational history.

A detailed case history should include more than the speaker’s observable behaviours. Explore avoidance, word substitutions, reluctance to answer questions, frustration, teasing, bullying and concerns about participating in class or social activities. For adults, ask about workplace communication, presentations, phone calls and important conversations. For university students in Melbourne or Sydney, speaking demands may include tutorials, placements and group assessments; for a school-aged child, the pressure may centre on oral presentations, roll call or playground conversations.

Use language that separates the person from the difficulty. “What happens when talking feels hard?” is generally more supportive than describing a child as “a stutterer”. Ask the speaker what they notice and what they would like adults to understand. If the person uses Aboriginal English, a dialect other than mainstream Australian English, or more than one language, gather culturally and linguistically relevant information before interpreting fluency patterns.

Collect representative speech samples

Plan samples across different speaking tasks rather than relying on a short conversation in the clinic. Include spontaneous conversation, a personal narrative, picture description, reading when developmentally appropriate, and a structured interaction with a parent or familiar communication partner. For preschoolers, play-based observation can reveal more than formal questioning. For adolescents and adults, consider a sample involving a real-life task such as explaining a process or making a phone enquiry.

Document the context of every sample: who was present, the topic, the activity, the communication partner and the level of support provided. Fluency can vary considerably between a quiet therapy room and a busy classroom in Brisbane, a family barbecue or a football club. If possible, obtain a brief recording from home or school, with appropriate consent and secure handling of the file. A teacher’s observation during group work may reveal avoidance that does not appear during one-to-one assessment.

Analyse speech behaviours carefully. Note repetitions, prolongations and blocks, along with secondary behaviours such as eye blinking, facial tension, body movements or changes in pitch. Record typical and atypical disfluencies, but avoid treating every pause or repetition as stuttering. Revisions, hesitations and phrase repetitions are common in developing language. Consider speech rate, utterance length, intelligibility, language formulation and whether the speaker appears rushed or physically tense.

Measure impact alongside frequency

Frequency measures can be useful, particularly when comparing samples over time, but they should never stand alone. Depending on the client’s age and goals, calculate or estimate stuttering-like disfluencies, total disfluencies, syllables spoken and speaking rate. Be consistent in how samples are selected and analysed, and state the limits of the data. A single percentage cannot capture the full experience of stuttering.

Explore the emotional and cognitive effects of communication difficulty. Ask about fear, shame, anticipation, confidence and beliefs such as “people will think I am not smart”. Children may communicate this through drawings, rating scales or play. Teenagers may disclose that they avoid ordering at a café, answering in class or speaking to unfamiliar peers. Adults may have developed elaborate strategies to hide stuttering, including avoiding names, changing words or declining career opportunities.

Self-report tools can add valuable information when selected for the person’s age, language and needs. Combine formal questionnaires with open conversation and observations from people who know the client well. A parent’s view, a teacher’s report and the speaker’s own perspective may differ, and those differences are clinically meaningful. If executive functioning affects planning, turn-taking or self-monitoring, consider how broader language supports may fit into the assessment; language therapy strategies can help frame these needs without treating fluency in isolation.

Consider development, diagnosis and context

For a preschool child, determine whether the profile is consistent with typical developmental disfluency, emerging stuttering or a more persistent pattern. Consider duration, family history, age of onset, changes over time, physical tension, the child’s reactions and the family’s concern. A child who appears unconcerned may still benefit from support if the stuttering is increasing or participation is narrowing. Conversely, frequent repetitions do not automatically indicate a severe or persistent disorder.

For school-aged children, teenagers and adults, examine the interaction between stuttering and the communication environment. Classroom expectations, teacher responses, peer reactions and family communication styles can either reduce or increase pressure. During an assessment in an Australian school, ask how speaking tasks are handled during assemblies, oral presentations, sports training and parent-teacher communication. Reasonable adjustments may be appropriate even when therapy is not delivered at school.

Check for co-occurring needs without assuming that every communication difference is caused by stuttering. Consider speech sound difficulties, language disorder, literacy challenges, autism, attention differences, anxiety, hearing loss and motor speech concerns. A bilingual speaker should not be judged against monolingual norms, and an interpreter may be needed for an accurate case history. Cultural safety matters when discussing eye contact, turn-taking, family roles and expectations around speaking.

For families accessing support through the NDIS, document functional communication needs and participation goals in clear everyday language. Eligibility, funding and reporting requirements can change, so avoid promising a particular pathway. Some clients may receive services through private practice, schools, community health or hospital clinics, while others may combine options. Recording the practical effect of stuttering helps families explain why support matters within their actual routines.

Develop a useful clinical formulation

After gathering information, bring the findings together in a formulation rather than simply assigning a severity label. Describe the observable speech features, the speaker’s reactions, communication partners, environmental demands and areas of strength. Explain how these factors interact. For example, a child may have mild physical tension but significant avoidance during classroom speaking, while another child may stutter frequently and remain highly engaged.

Separate assessment findings from assumptions. State what was directly observed, what was reported by the family or teacher, and what remains uncertain. If the sample was short, the client was tired, or the clinic context reduced natural stuttering, note that limitation. A clear record might include frequency estimates, speech characteristics, emotional impact, participation restrictions, protective factors and priorities identified by the speaker.

Recommendations should be specific and achievable. They may include education about stuttering, parent coaching, teacher guidance, direct therapy, monitoring, counselling referral or collaboration with other professionals. Avoid advising people to slow down, take a breath or “think before speaking” as universal solutions. Instead, recommend communication environments that allow time, attentive listening and comfortable turn-taking.

For children who need help understanding other people’s reactions, carefully chosen social communication resources can support discussion without implying that the child is responsible for managing everyone else’s behaviour. perspective-taking scenarios may be useful when adapted to the individual’s age, culture and communication goals. Always keep the focus on inclusion, self-advocacy and respectful communication.

Share findings and plan follow-up

Set aside enough time to explain the results in plain English. Begin with strengths: the person’s ideas, humour, willingness to communicate, relationships, interests or successful strategies. Then describe the fluency profile without exaggeration or blame. Families often need reassurance that stuttering is not caused by poor parenting, nervousness, laziness or a lack of intelligence.

Invite the speaker to participate in the feedback conversation as much as possible. A young child may choose pictures or demonstrate what talking feels like; an older student may identify classroom adjustments; an adult may prioritise workplace or social goals. Discuss what therapy could address, what it cannot guarantee and how progress will be measured. Stuttering may change across situations, so success should include participation, confidence and reduced avoidance, not just fewer disfluencies.

Provide practical recommendations for communication partners. Encourage natural eye contact, attentive listening, allowing the person to finish, reducing interruptions and avoiding time pressure. Teachers can offer alternative ways to demonstrate knowledge while maintaining access to meaningful speaking opportunities. Families preparing for the next school term can share a concise support plan with relevant staff rather than asking the child to explain everything repeatedly.

Finish the assessment record with a review plan. State when the client will be contacted, what information will be monitored and which changes should prompt earlier review. For a preschooler, this might involve regular parent check-ins; for a teenager, it may involve tracking participation across school and social settings. Keep reports useful for the next professional, whether that is an SLP in Perth, a school team in Adelaide or a private clinician supporting a family through telehealth.

A well-organised stuttering assessment gives the client more than a label: it gives them a clearer path towards confident, meaningful communication. Use this checklist alongside professional standards, current evidence and the speaker’s own goals. Explore practical fluency assessment resources and therapy materials in the Let’s Talk Speech Therapy shop, then adapt each tool so it reflects the person, their community and the conversations that matter most.