I recently had a request for an evaluation of a 6th grade student for stuttering. I have not observed any disfluencies or acceptable disfluencies that are observed in everyone's speech during conversation. When she reads she has a lot of disfluencies - h
Thank you for submitting your question. It is true that it can be difficult, at times, to differentially diagnose reading difficulties from stuttering when the speech disfluencies are primarily or only observable during reading tasks. I would like to offer some questions that you might consider in order to find an answer to your question:
First, stuttering typically starts in the preschool years, so a child in 6th grade would likely have a history of stuttering that you would be able to discern through an interview with parents, teachers, and the child herself. Absent that history, it is less likely that we would truly be looking at a case of stuttering. Of course, stuttering can and occasionally does arise in somewhat older children, so the lack of a history of stuttering does not rule out the possibility of recent onset stuttering.
Second, you will want to be absolutely certain that stuttering behaviors are not observed in other communication situations. While some children may stutter mostly during reading, it is nevertheless likely that you will see some indication of their speaking difficulties in other settings. That said, some children can become quite adept at hiding their stuttering. They may use "tricks" like selecting only the words they think they will be able to say fluently (circumlocution) or simply avoiding sounds, words, or situations when they think they might stutter. Children who use such strategies can often be identified when they are asked to read, for they cannot employ their avoidance tactics when faced with a passage that they must read as it is written.
Third, to determine whether reading may indeed be at the root of her difficulties, you or the reading specialist should conduct a formal reading assessment. Reading deficits are detected by means other than observing the production of speech disfluencies, so the results of the reading battery will yield important information about the cause of the child's difficulties. You can also give the child the opportunity to read a passage that is well below her reading level (i.e., very easy for her) to see if the stuttering behaviors are still present. If they are not, then this would point toward reading ability as the source of the difficulty.
In sum, I believe you will need to collect a bit more information before you can determine whether the child's difficulties stem from stuttering or from reading difficulties or both. By following the suggestions outlined above, you should be able to complete the differential diagnosis process and use the added information you gain as the basis for developing your treatment plan.
J. Scott Yaruss, PhD, CCC-SLP is Associate Professor in the Department of Communication Science and Disorders at the University of Pittsburgh and Associate Director of the Department of Audiology and Communication Disorders at Children's Hospital of Pittsburgh. A Board-Recognized Specialist and Mentor in Fluency Disorders, Dr. Yaruss also co-directs the Stuttering Center of Western Pennsylvania. He has served on the board of directors for the National Stuttering Association and as Associate Coordinator for the American Speech-Language-Hearing Association Special Interest Division for Fluency Disorders.