CONFIDENTIAL CONFIDENTIAL

SPEECH AND LANGUAGE EVALUATION REPORT

Name: XXX XXX             Date of Evaluation: X/X/XXXX

Date of Birth: X/XX/XXXX                      Evaluator Name(s): XXX & XXX
Age:  X; X           Evaluator Title: Graduate Student Clinician
Speech Language Pathologist
Grade: X                                           School: XXX XXX
Student ID #: XXXXXX                           Teacher: XXX XXX

REASON FOR REFERRAL AND RELEVANT BACKGROUND

INFORMATION
At a student study meeting held in X/XX/XXXX, XXX’s educational team recommended, and
parents agreed to speech and language testing to determine eligibility for special education
services. XXX was informally screened in XXX of XXX and passed all portions of the screener.
It was noted by the Speech Therapist that XXX presented with some part-word repetitions,
whole word repetitions and phrase repetitions in his spontaneous speech. She reported that the
repetitions observed during the screener were primarily non-stuttering like disfluencies. Per
teacher report, XXX’s vocabulary is age appropriate. She reported that he does have a
significant stutter while in the classroom, but it does not appear to keep him from participating in
whole group and small group discussions. Per parent report, XXX’s stuttering progressed
throughout the summer, but parents still notice concerns with fluency.

Relevant Background Information (can include but not limited to)

XXX is X-year and X-month old predominately English-speaking student, with exposure to
Spanish, who presents with an unremarkable medical history. XXX passed his hearing
screening on X/XX/XXXX.

BEHAVIORAL OBSERVATIONS
XXX came willingly with the examiners to the testing environment without incident and
immediately began conversation. He demonstrated appropriate attention and focus throughout
the evaluation. Overall, XXX attempted all portions of the assessment and was a pleasure to
work with. Results are believed to be a true estimate of his speech and language abilities.

ASSESSMENT PROCEDURES
 Stuttering Severity Instrument-4 (SSI-4)
 Speech-Language-Voice Screening
 Clinical Observations

RESULTS AND INTERPRETATION

RECEPTIVE/EXPRESSIVE LANGUAGE:
XXX’s receptive and expressive language skills were formally assessed through a Speech-
Language-Voice Screener.  He appeared to demonstrate age-appropriate understanding and
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use of language.  XXX followed all given directions, answered a variety of simple and complex
WH-questions, engaged appropriately in conversations with complete sentences, and used age-
appropriate sentence length. Per the Screener, XXX demonstrated appropriate knowledge of
prepositions (i.e. inside, on top, next to, under), opposites (i.e. girl/boy, little/big, day/night),
verbal reasoning, word retrieval, functional use of items (i.e. what do you do with a cup/ ball/
pencil), and story comprehension along with narrative skills. He provided personal narratives
with a beginning, middle and end as well as adequate detail.  At this time, teachers and parents
do not have concerns with listening comprehension and oral communication.

ARTICULATION:
Per speech sample, XXX demonstrated appropriate production of speech sounds at the
conversational level. He was judged to be 90% intelligible to the examiner when the context was
both known and unknown. It should be noted that XXX presents with a developmental frontal
lisp while speaking, but this did not impact his intelligibility during conversation.

VOICE
Informal observations during conversation revealed that XXX’s voice (i.e. pitch/intonation) was
within normal limits for his age and gender.

FLUENCY
SSI-4
Stuttering Severity Instrument for Children and Adults-Fourth Edition (SSI-4)
XXX was administered the Stuttering Severity Instrument - Fourth Edition (SSI-4). The SSI-4
evaluates frequency, duration, and physical concomitants of fluency, and was used to assess
the severity of XXX’s stuttering. Since XXX is below the third-grade level in reading abilities, the
non-readers portion of the SSI-4 was administered. Pictures were presented to XXX which
included some things that are wrong or out of place (i.e. farm animals wearing sunglasses and
hats), and the clinician engaged with XXX in a discussion of the pictures. The clinician
measured three separate conversational samples, which are reported below.

The frequency score of the SSI-4 represents the percentage of stuttered syllables (%SS) in
normal speech. The %SS was calculated for each speech sample (three total samples), and
then the scores were averaged. XXX received a score of 14/18 for frequency which indicates
that XXX demonstrated 9.7% of stuttered syllables out of an average of 249 syllables. The
duration score of the SSI-4 represents the average duration of the three longest stuttered
syllables noted during the assessment. XXX received a duration score of 6/18, which indicates
that the average duration of his stutters was around 1 second long. The physical concomitants
score was based on observations noted during the assessment. Physical concomitants are
described as physical or secondary behaviors observed during stuttering moments. These can
be classified as postural (i.e. moving hands, head turning, swinging legs), facial grimaces (i.e.
eye blinking, jaw jerking, muscle tension), head movements (poor eye contact, looking around
the room, turning away), or distracting sounds (noisy breathing, blowing, clicking sounds). XXX
received a score of 4/20 in this portion, which indicates that there were some notable physical
concomitants during the assessment, and that they were not noticeable unless the listener was
looking for them. The total score was obtained by adding the scores for frequency, duration,
and physical concomitants together. A total score of 24 indicates that XXX’s severity is judged
to be in the moderate range.

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The following table displays XXX’s current overall scores:

Stuttering Severity Instrument for Children and Adults-Fourth Edition (SSI-4)

Behavior Measure Score Score

Frequency 14

Duration 6

Physical concomitants 4

Total Score 24

Sample 1
In the first conversational sample, XXX had a total of 21 stuttering moments. Typical
disfluencies that were noted were revisions, whole-word repetitions, and phrase repetitions.
Atypical disfluencies noted in the sample were prolongations, part-word repetitions, and
secondary behaviors. All of the stuttering moments mentioned resulted in a 9.7 percent of
stuttered syllables. Disfluencies noted during the first conversational sample are reported below.

Typical Disfluencies Atypical Disfluencies

Revisions (ex. uh, um) Prolongations* (ex. whhhhy)
Whole-word repetitions* (ex. these-these, I-I) Sound syllable/ Part-word repetitions
(ex. wh-why)
Phrase repetition (ex. look see - look see) Disfluencies with secondary behaviors*
(ex. poor eye contact, kicking legs, jaw
gliding)
* = commonly seen throughout this sample

Sample 2
In the second conversational sample, XXX had a total of 27 stuttering moments.  Typical
disfluencies that were noted were revisions, whole-word repetitions, and phrase repetitions.
Atypical disfluencies noted in the sample were prolongations, part-word repetitions, and
secondary behaviors. All of the stuttering moments resulted in a 10.9 percent of stuttered
syllables. Disfluencies noted during the second conversational sample are reported below.

Typical Disfluencies Atypical Disfluencies

Revisions (ex. uh, um) Prolongations*
(ex. junnngle, chicaaaago)
Whole-word repetitions* (ex. not-not) Sound syllable/ Part-word repetitions
(ex. or-order)
Phrase Repetitions (ex. and then - and then) Disfluencies with secondary behaviors*
(ex. poor eye contact, kicking legs, jaw
gliding)
* = commonly seen throughout this sample

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Sample 3
In the third conversational sample, XXX had 24 stuttering moments. Typical disfluencies noted
in the sample were revisions, phrase repetitions, and whole-word repetitions. Atypical
disfluencies noted during the sample were prolongations and secondary behaviors. All of the
stuttering moments resulted in an 8.5 percent of stuttered syllables. Disfluencies noted during
the second conversational sample are reported below.

Typical Disfluencies Atypical Disfluencies

Revisions (ex. uh, um) Prolongations*
(ex. barrrking, dropppping)
Whole-word repetitions* (ex. I-I, no-no) Disfluencies with secondary behaviors*
(ex. poor eye contact, kicking legs, jaw
gliding)
Phrase Repetition (ex. a rat - a rat)
* = commonly seen throughout this sample

Based on the conversational samples, XXX presents with typical and atypical disfluencies
characterized by revisions, whole-word repetitions, phrase repetitions, prolongations, part-word
repetitions and secondary behaviors such as: poor eye contact, kicking legs, and jaw gliding.
Rate of speech was considered to be excessive when sharing information and making
commentary about the visual stimuli presented during testing and also during conversation.
Although secondary behaviors were present, they were not distracting to the listener. Per
fluency assessment, XXX presents with disfluencies that are deemed moderate in severity when
compared to peers of the same age and grade level. It should be noted that although
disfluencies were present throughout testing, XXX did not appear to be withdrawn and/or
frustrated when a stuttering moment would occur.

ORAL MOTOR SKILLS

Informal observation of the oral mechanism showed all structures and functions satisfactory for
speech production.

PRAGMATICS
Per informal observation, XXX is a very sweet, outgoing, funny student. He was able to
demonstrate facial regard, joint attention, and participate in several back-and-forth social
exchanges with the clinician while staying on-topic. XXX did a nice job sharing personal stories
and was able to provide details about his interests (i.e. XXX). XXX was able to communicate for
numerous pragmatic purposes such as but not limited to commenting, requesting, turn-taking,
protesting, answering/asking WH-questions, and terminating. Overall, pragmatic abilities were
deemed typical for his age.

HEARING
Please refer to school nurse report.

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SUMMARY
Based on current data including formal/informal assessments and information available, XXX
appears to demonstrate age-appropriate receptive and expressive language skills for his age.
Relative weaknesses were noted in his fluency abilities during conversational speech. XXX
presents with moderate disfluencies characterized by typical and atypical disfluencies such as:
revisions, whole-word repetitions, phrase repetitions, audible sound prolongations, part-word
repetitions and secondary behaviors (i.e. poor eye contact, kicking legs). It should be noted that
although disfluencies were present, XXX did not appear withdrawn from participation and/or
frustrated during times of stuttering. Although secondary behaviors were present, they were not
distracting to the examiner. Voice, oral-motor abilities and social communication skills are all
warranted within normal limits at this time when compared to peers of the same age and grade
level.

EDUCATIONAL CONSIDERATIONS
Although XXX presents with moderate typical and non-typical disfluencies, per teacher report,
he is performing similarly to peers in the general education classroom and does not avoid
speaking situations.

RECOMMENDATIONS
It is recommended that the committee use this information in conjunction with other components
to determine eligibility for special education services.

_______________________________ ___________________
XXX XXX Date of Report
Graduate Student Clinician

XXX XXX, M.S., CCC-SLP

XXX XXX, M.S., CCC-SLP                              
Speech-Language Pathologist

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