[Overton]Early Identification of Stuttering: The Physician's Role

by Valerie Johnston, MS, CCC-SLP

Physicians are often the first professionals to whom parents express concerns about their child's speech and language development. Knowing the early warning signs of the various speech and language disorders helps physicians make appropriate referrals. One concern frequently mentioned by parents regarding their children between the ages of two and five is stuttering. This article provides guidelines for determining when it is appropriate to refer a child for a stuttering evaluation.

Deciding when to make a referral for stuttering is not simple. Young children typically go through a period of normal disfluency, during which they often hesitate, repeat words and sounds, and pause to formulate their thoughts. This usually occurs between the ages of two and five when their speech and language abilities are growing very rapidly. Unfortunately, stuttering also develops during this same time period. The child who is normally disfluent will outgrow his disfluencies; the child who is actually stuttering most likely will not.

Fortunately, recent research has shown that these two groups of children can be differentiated. This makes early referral and intervention much easier. An article based on this research, which describes the common behaviors of young stutterers, was recently published in the Journal of Fluency Disorders (Riley and Riley, 1989). This article presented a screening protocol (see below) to be used by physicians as a guideline for determining if a referral for a stuttering evaluation is warranted.

The decision regarding referral is based on data from six parameters, listed on the left-hand side of the screening form. Ratings of normal, borderline, abnormal, and very abnormal are assigned to each behavior in a given parameter along the top of the form. It is important to note that the last five parameters refer only to the abnormal disfluencies identified in the first parameter. It is recommended that a child be referred for a stuttering evaluation if there are three or more symptoms in the abnormal and very abnormal columns.

A growing body of evidence has provided support for managing children's disfluencies as soon as they become clearly abnormal. This same literature states that the prognosis for successful treatment of stuttering decreases as the child's age increases. The included protocol is designed to help physicians counsel concerned parents about stuttering and make appropriate referrals when warranted.

Physician's Screening Procedure for Children Who May Stutter





Very Abnormal

Types of disfluencies

Repeats phrases or whole words

Interjects "uh" while thinking

Repeats the first sound of a word 2 or 3 times without tension

Repeats sound four or more times before getting the word out

Has tense voice during the repetitions

Has "hard" blocks

Gets stuck on words

Other behaviors during abnormal disfluencies




Tries to change words for fear of stuttering

Struggles to get word out as seen in facial grimaces and/or hand, arm or foot movements

Frequency of abnormal disfluencies


Infrequent (less than 2%)

Frequent (one in every 2-3 sentences)

Very frequent (one or more per sentence)

Child's reaction to the abnormal disfluencies

None - seems unaware of them


Just keeps on trying

Gives up trying to say the sentence or asks, "Why can't I talk right?"

Other people's reaction to the normal disfluencies

No one is bothered by the disfluencies


Parents are afraid he/she will not outgrow the stuttering

Child is very upset by teasing or other listener reactions

How long since the abnormal disfluencies were first noticed?


Began less than four months ago

Began 4 to 12 months ago

Began more than 12 months ago


Note the number of "Abnormal" and "Very Abnormal" symptoms. Monitoring is indicated if one or two symptoms are present. For three or more symptoms referral is indicated.

Reference: Riley, G. and Riley, J., Physician's Screening Procedure for Children Who May Stutter. Journal of Fluency Disorders, 1989, 14, 57-66.

If you have questions or need more information you can contact me at:

Overton Speech & Language Center, Inc.
Fort Worth, TX
(817) 294-8408


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Copyright 2001-2003 Overton Speech & Language Center, Inc.
Last revised: March 24, 2003