Stuttering Assessment: A Guide for School-Based SLPs

Marisha (00:01.358)

Hello and welcome to the SLP Now podcast. I'm really excited to be chatting about stuttering assessment today. Our guest is Victoria Dertouzos. She is the owner and lead therapist at Speech and Stuttering Therapy of New Jersey. So she has a private practice. She also worked as a school-based SLP for five years and obviously managing all the school-based things.

So she has a really cool set of experiences, just starting with a very broad practice space and now specializing in stuttering. And I'm really excited to learn more about assessments with her. But before we dive into all things assessments, first of all, hello, Victoria.

Victoria Dertouzos (Giacalone) (00:53.071)

Hi Marcia, thanks for having me.

Marisha (00:56.844)

Really looking forward to diving in. But before we do all that, would you mind telling us just a little bit more of your story? The bio I shared obviously doesn't do you justice. But what led you to specialize in stuttering and kind of the road to your own practice?

Victoria Dertouzos (Giacalone) (01:15.653)

Yeah, I would love to talk about that. I think stuttering itself kind of fell into my lap. After going into speech therapy, I ended up in an undergraduate college that didn't actually provide a major for speech therapy. So I kind of had to go out and find my own experiences. And I think it was just kind of by chance I found a board certified specialist in stuttering. And through my time observing with her,

It was just kind of something that hit me where like when she was working with her patients, I could tell it was a little bit more than what I thought speech was. She was really connecting with them and I could see how she was really changing that quality of life and how, you know, the difficulty they were coming to her with was really, really negatively impacting their life in a way that I didn't really think about with other, you know, speech knowledge that I had previously. So.

I kind of had the seed planted from college and then as I continued to go to grad school and go out into the field, you know, there were so many clients and kids and adults that I saw that I was like, okay, this is what I need to do because it's such a passion project for me. So it kind of led me to make all the decisions I've made up until this point. And ultimately I'm thrilled with where I'm at now and very

feel very lucky that I can work with the clients that I do now.

Marisha (02:48.314)

I love that. And I think, I don't know, there's just something really cool about all of our journeys because I feel like the types of students or patients or clients that we're meant to have just kind of, they just end up on your caseload. because like some SLPs have like, they might have one start like student on their caseload who stutters or I don't know. It's just funny how that variation happens and how, I don't know.

Victoria Dertouzos (Giacalone) (03:02.871)

Yes.

Marisha (03:18.958)

Some weird stuff at play, I guess.

Victoria Dertouzos (Giacalone) (03:21.337)

I agree. think I'm a person that thinks you kind of end up where you're supposed to and the people that need to find you find you for whatever reason. So I think that happened.

Marisha (03:29.388)

Yeah, I love that. Okay, so now let's dive into assessment. I, throughout this whole series that we've been like, we're releasing a bunch of episodes on stuttering, because there's been a lot of changes in the field, and just kind of some shifts from what we might have learned in grad school. So that's why we're talking about assessment again.

But what, from your perspective, what are the current best practices in terms of an effective assessment? What do we want to be thinking about?

Victoria Dertouzos (Giacalone) (04:09.101)

Yes, it's a great question and something I just want to comment on too while you mentioned it is that like there's a shift, right? And I think of course best practice always in our field is to use the research and the data that's there. I just want to note that this research has actually been around for a while, like even dating back to like the mid 1900s. That sounds really far away, you know? Everyone knows what I mean by that.

So yeah, just keeping that in mind when we're talking about this. So when we're looking at assessment, there's definitely key pieces. First, as always, getting a really good intake from the parents or from the person if it's an adult. And that not only includes the medical history and all of the basic things that we usually collect, but it actually is really important to include information about the temperament and the personality of the person if there's any

additional anxieties that are present or any emotional challenges that are present. And the reason for that is because stuttering is pretty sensitive to nervous system changes. So when you hear people say misconceptions like, they're stuttering because they're nervous, right? It's not because they're nervous, but maybe when they're nervous, you see it a little bit more. So trying to take those things into account, not just for stuttering frequency, because we care a little bit less about that.

but just for helping the person understand why it's happening, when it's happening, and maybe helping them to, and even the parent, to manage those situations to see if it can support them a little bit better. And again, in the intake, we're always kind of getting the parent, if it is for a child, we're getting the parent's view because they're filling it out usually or they're speaking with us, but something really important to get from them is also what they understand about stuttering at the start.

and then what their view of their child's stutter is. So if they're viewing it as a problem, if they're viewing it as something they're just really worried about, if they know or if they believe that the stutter is going to go away through the speech therapy process, these are all things that we want to kind of inventory so that we can either educate appropriately or continue to support their views of stuttering as the therapy process goes on.

Victoria Dertouzos (Giacalone) (06:36.835)

And then within the assessment, I think it's pretty easy to digest when you split it into two sections. So the first one that maybe SLPs are a little bit more familiar with would be the behavioral assessment. So that is actually talking about the concrete aspects of stuttering that you hear most frequently, right? Like those stuttering-like disfluencies, are there blocks? Are there prolongations? Are there repetitions, right?

And the testing, right, because we're usually looking for a test to use that usually comes along with that is the SSI-4. That's the most up-to-date one right now. However, the difficulty with the SSI is that it's only based on what we are hearing as the clinician or we are seeing as the clinician and our judgment. So something that is

different about stuttering is that there's also another side to this. There is the person's experience of the stutter. And believe it or not, that can actually be different than what we are hearing. So the person might be either feeling a block and we're perceiving it as a pause. So we're not actually noting it as a stutter. A little bit, something that can be a little more hidden or hard to kind of realize is that the person may also be using an avoidance strategy. So maybe they know the block is gonna come.

And they're actually adding the pause in to try to move past the block or they're adding in a word to switch it around. And, you know, even kids can be really adept at these coping strategies that can even become automatic. They may not even know that they're doing them, but it's something that their body is doing to manage the stutter, make it feel a little bit better for them. So personally, I, I still use the, pieces of the SSI, but I never score it.

So the reason for that is that I wanna be describing what I'm hearing. Always in the narrative, I'll explain that, you know, I cannot completely judge the stuttering severity because of the experience of the person as well that has to be involved, but I do wanna note like some of the pieces that I'm hearing. And then to also account for what I might not be hearing, I'm always asking the child as well. Like if I have a little bit of a suspicion, you know, I...

Victoria Dertouzos (Giacalone) (09:04.421)

I'm doing a lot of listening to stuttering. So I feel like my ear has gotten tuned just like anything, right? As speech therapists, we have to tune our ear to certain things. But I might ask, like, did you feel a stutter there? Or when they do the reading sample, I might say, like, I'm just wondering, did you notice if you stuttered in there or not? Never with a judgment, never to point it out to them, but just to see what they're aware of and to see if they feel something that I didn't hear, because that's important information, too.

So yeah, not scoring that also helps the parent not to hang on to something. Because a lot of times we'll get a question from parents that is, okay, well, how bad is it, right? They're using these judgmental words too. But if we tell them, the stutter is moderate or the stutter is very mild, right? It actually says nothing about how the stutter is impacting the child. And that's going to be the next part that

is the most important that I'm going to talk about now. But lastly, I just want to note about the SSI is that just another piece of why we're not scoring it why we're not giving it a severity is because stuttering at its core is variable. So parents and kids who stutter need to understand that their stutter is going to change depending on different factors, depending on the day, depending on the week. And that's actually just part of the experience.

So it kind of comes along with the acceptance piece of knowing, you know, that it's going to change. So if we're giving them this clear cut number or this clear cut word for it, then we're kind of setting them up for failure if it changes, if it gets the frequency increases or decreases.

So that next piece right I'm splitting it kind of into two behavioral we just talked about and then effective Which is the experience of the person? There are a bunch of different inventories out there to kind of survey how the person feels about their stutter and what their experience of it is like My favorite one is the Oasis so There are different age groups or different Oasis for different age groups

Victoria Dertouzos (Giacalone) (11:18.917)

starting at age seven and then going up to adult. And that's gonna give you a really good picture of how this center is impacting the child. So if we're kind of talking about the schools, right? We're looking to figure out, you know, what are really the areas of need? I know you talked about goals with Nina, but you know, the assessment always drives the treatment. So this test survey questionnaire, right?

Is really where personally I pull my goals from because it's telling me all that I need to know about how it's affecting the child And just to kind of note on something that I think school SLPs, especially are always looking for is how do I justify services? This is where you justify services At least in my state there's still a stuttering percentage a number of stutters that they're looking for unfortunately to qualify

However, your way around that is to show, hey, this is having an educational impact. They're not comfortable raising their hand in class, or it's having a social impact. They are feeling completely too nervous to even initiate conversations with their peers. And to me, that is just as good as giving a concrete number. And the OASIS does give you a number. It gives you an impact score at the end too. So you're still getting that.

that quantitative information. Yeah. So that's kind of like the overview, you know, including the screening parts and everything else that comes with being an SLP, right? If there are language difficulties that you see or speech difficulties that you see, just using your clinical judgment to figure out, is the language impacting the stutter? Is the stutter impacting the language?

speech, vice versa, and deciding what you're prioritizing in therapy. Sometimes you have a student where they're not very intelligible, and that's impacting them a little bit more at the time. But again, I keep using the word impact, and that's really the most important piece is figuring out how is this affecting, how is the stutter affecting the child.

Marisha (13:36.406)

Yeah. Wow. This was such a great overview of just like, yeah, what to consider when looking at an assessment. we're looking just a quick recap. We're looking at, we're doing a thorough intake, looking at medical history, temperament, personality, anxiety, emotional aspects. and then checking in with the parents on like perspectives and beliefs, because that can really impact.

how we set up therapy too, or at least how we communicate it with them. And then also looking at the behavioral and effective aspects. And you gave some great examples of things to consider in both of those areas. So yeah, this is awesome. And then I wanna ask this just because I know SLPs are always like, but how do I write the goals? So would you?

Like, would you be open to giving an example of how, like, how you would look at the oasis to, like, kind of navigate your goal writing?

Victoria Dertouzos (Giacalone) (14:41.529)

Yeah, 100%. So I think like anything, once you kind of shift your mindset on it and you look at it through a new lens, it actually becomes really easy. So you can take it pretty literally. So let's just say there's one item on the Oasis, right? And I'll just use feeling confident in your abilities as a speaker, right? That's the first one that comes to mind. So that's almost, we're very close to word for word, kind of what it says in the Oasis.

And they can choose, you know, always to never. And you can tell if they have like a pretty low view or a low confidence level. So what we want to do is we want to raise their confidence in their ability as a speaker. So we're going to put that as the goal. Now, the part that I think gets SLPs tripped up is, well, how do I make that 80 % accuracy? How do I make that one out of 10 opportunities, right?

And what you can do is, again, simple. You can use that same rating scale and the same way that you collected that information from the child, which was having the child decide, you're actually going to have them rate it again whenever you want. So now you have a progress measurement whenever you want and you have a measurement for your reevaluation or whatnot. So the goal might look like

the student will self-rate their confidence and speaking ability at a four out of five, maybe when the baseline was a two out of five. So really, whether you want something to go down or you want something to go up, you still have a measurement of it. And to me, it's actually more accurate in a way than the SLP judging something. Because technically, it's pretty subjective when you're when you're saying, OK,

the sound is being produced with 80 % accuracy, right? But when you're actually asking the person who's experiencing it, you're getting the information like straight from the horse's mouth. And it also helps to really encourage the fact that we wanna be listening to what they are feeling versus kind of just telling them, hey, we're gonna practice this thing today.

Marisha (17:04.066)

Yeah. And that's the, I think that's the overarching theme that we've been seeing in a lot of these episodes too, is that it's really, it's really like, and like you've been mentioning this whole episode, it's really all about the impact. And our goal is for our students to be confident communicators and what better way to measure that than by asking them. And because like, we, if we collect a language sample, it's so incredibly variable. It's not.

a good data point anyway, even if it might feel better of like, using our clicker to track these occurrences. if we ask them, even the context of what we ask them could significantly impact the, yeah. So I love that. again, you're so skilled at just giving really clear and practical examples. So thank you for that.

Victoria Dertouzos (Giacalone) (18:01.093)

Yeah, of course. If you don't mind, I want to touch on something you mentioned, the language sample. Again, I think that's something else that SLPs can get bogged down on. But if we're thinking about shifting, and we're thinking about communication effectiveness and communication competence, maybe when the child starts out, that language sample is going to look like a ton of avoidance strategies.

Marisha (18:03.08)

okay.

Victoria Dertouzos (Giacalone) (18:27.885)

repeating or going back and starting the sentence over because they want to rewrite over the stutter to fix it. We're adding in lot of ums, right? And in reality, if the child just stutters and lets it out and doesn't use any of those things, the language sample is going to look different, but it's actually not going to change how many stutters are in it. But you'll probably increase confidence, you'll increase communication effectiveness, and things like that. So.

That's kind of what we're looking for.

Marisha (18:59.139)

Yeah, now that makes so much sense. Okay, so, and this feels like what you outlined feels super doable. But I'm just curious, especially since you've had like five years in the schools and most people listening to this are school-based SLPs. But do you have any tips or strategies for SLPs who are juggling a bunch of different things in just making sure that they're able to

actually implement this. Like it feels really practical, but do you have any like tips or strategies that might make it a little bit easier?

Victoria Dertouzos (Giacalone) (19:39.181)

Yeah, I totally understand the feeling of having to have a million balls in the air and maybe, you know, feeling like your job isn't understood completely, the responsibilities and all that kind of goes into just being an SLP in the school. I think that thinking about the whole picture, right, we talk about that with like any student, just trying to keep the mindset that you're

you're treating the whole child. So keeping that open mind when you're going into the assessment, like I mentioned, when you're talking with the parents, even when you're talking with the teacher, that's an important part I missed in the intake, just seeing how the child functions in the classroom and what they notice. And again, of course, hearing from the child. But functionally, I think if you kind of keep that lens,

It'll just naturally help you gather the information a little bit more because ultimately again, we're looking for increasing the wellbeing of the child. We're not looking for, you know, parents maybe asking, okay, how can we practice or how are we going to make him more fluent? If that doesn't feel right to you and it probably shouldn't, I'll erase probably, then go with that, right? Anything that you think is going to increase his wellbeing in school, outside of school.

go there. But I think it is tough to juggle, right? You may have a group that you need to see and you have the one kid who stutters in there and you're trying to figure out how do I make this work? Talking about stuttering is also going to help making it not the elephant in the room. Again, kind of just another simple thing. know, kids can feel how you feel about things. So.

even if they are in the articulation group, it's okay if they're talking about stuttering, as long as you notice that they're comfortable. But I think, I know I'm kind of going broader instead of specific, but I think that's kind of what will help the most. But I know it's tough, like, I think a lot of SLPs have heard this message of like, not using fluency shaping strategies, right, not encouraging fluency, but

Victoria Dertouzos (Giacalone) (22:02.287)

They're not really sure what to replace it with. I think that's where the difficulty lies. So I guess I'll just give kind of one more thing. When you're in treatment, right, or you're in therapy and you're thinking about the stutter, we have this lens of strategies, right? So shifting away from those and into something else, what you can replace that with is all of your knowledge of being an SLP, everything else that you know about voice.

Everything else you know about articulation. Within the lens of stuttering, it falls under this idea of tension, really. So how can you help the child with the underlying message of, your stutter's not gonna go away, it's gonna be there, but let's work and play with your speech system so that we can make it feel better. And it doesn't need to be called an easy onset. It doesn't need to be called stretchy speech, right? You can let the child come up with something and just figure out.

Let them have the ownership over like, it feels better when I stutter a little bit easier and let them call it whatever that is. So I think just that lens, again, you're looking at the whole child and you're trying to make it feel better for them, whether that's emotionally or physically. Yeah.

Marisha (23:22.358)

that's great. was there anything else that you wanted to like wrap up with? I mean, I feel like we did, you did a phenomenal job kind of going through assessment and I feel like SLPs will have, if you check out the show notes, anyone listening, there's a link.

In the episode description, you'll find just like a quick outline of what we talked about. So you can use that to create your like your own little assessment checklist, as well as links to some of the assessments and all of that. But yeah, was there anything you wanted to add Victoria?

Victoria Dertouzos (Giacalone) (23:59.845)

I think I touched on a lot, but I guess just to kind of leave everyone with like the messaging that you're sending to both the child and the parents and the teachers and the staff in the school, right? Understanding that a stutter is part of the way this child communicates. So using that as the foundation for all of the rest of the things that you're doing. And assessment's a really good place to start because it kind of sets the tone for

working with the child and the whole speech therapy process.

Marisha (24:31.628)

Yeah, that is so true because if like based on the types of questions we're asking and just what the assessment looks like and also how we report it, that'll really shift how like parents and teachers and the student are kind of being introduced to the intervention too. So yeah, this is where it all starts.

Victoria Dertouzos (Giacalone) (24:40.794)

Yes.

Victoria Dertouzos (Giacalone) (24:52.141)

Yes, 100%.

Marisha (24:54.38)

Amazing. Well, thank you so much, Victoria. This was super helpful. And thank you to everyone who listened.

Victoria Dertouzos (Giacalone) (25:02.637)

I'm so glad. Thank you for having me.