Assessment of Stuttering, Cluttering, and Fluency Disorders in the Context of the WHO ICF Framework

The World Health Organization, International Classification of Functioning, Disability and Health (WHO ICF 2014) framework may be used to describe the following comprehensive set of assessment features for stuttering (Coleman & Yaruss, 2014; Tichenor & Yaruss, 2019; Yaruss, 2007; Yaruss & Quesal, 2004, 2006). The terminology used on this page is based on the WHO ICF framework. Individuals may prefer different designations for stuttering that are more neuroaffirming rather than “impairment.” We suggest goals within the WHO ICF framework because of its wide use and recognition of the importance of function and context.

Brundege et al. (2021), identified six core areas that a consensus of experts determined should be included in an assessment of fluency disorders:

stuttering-related background information;
speech, language, and temperament development (especially for younger clients);
speech fluency and stuttering behaviors;
reactions to stuttering by the speaker;
reactions to stuttering by people in the speaker’s environment; and
adverse impact caused by stuttering

The WHO ICF framework captures the six core consensus areas for assessment.

Impairment In Body Function

Examples of specific assessment areas that relate to physiological and psychological function include:

determining speech efficiency and spontaneity in communication,
assessing speech fluency (including the sensation of being stuck, feeling unable to continue speaking, or losing control; Tichenor & Yaruss, 2019),
assessing physical concomitant behaviors and learned escape/avoidance behaviors,
assessing tension and effort in communication (during both fluent and disfluent speech).

Activity Limitations and Participation Restrictions

The impact of stuttering or cluttering on the speaker's life. Examples of specific assessment areas that relate to the ability of the person to participate in life activities include:

determining if the speaker is able to communicate effectively in various speaking situations (e.g., at school, in social settings, at home);
assessing the impact of stuttering or cluttering on the speaker's ability to achieve educational objectives and interact with others;
assessing the impact of stuttering or cluttering on the speaker's perceived quality of life (e.g., satisfaction with communication and impact of stuttering or cluttering on life as a whole);
determining comfort, spontaneity, and naturalness in functional communication across a range of situations.

Personal and Environmental Context

Personal factors include, per Tichenor & Yaruss (2019)

coping styles
responses to perceptions
experiences
behavioral, affective, and cognitive reactions

Environmental factors include, per Tichenor & Yaruss (2019)

external influences on functions
reactions and attitudes of listeners
stigma, and
the influence of speaking situations and real-world experiences

Assessment areas within the personal and environmental context framework include the speaker’s internal reactions and the effect of others’ negative responses.

Examples of specific assessment areas include:

negative internal reactions, including emotional responses to stuttering or cluttering and to communication in general (e.g., anxiety, shame, frustration, fear, and apprehension);
self-confidence and participation in and enjoyment of communication;
attitudes about stuttering and self-perception as a competent communicator;
knowledge about stuttering or cluttering, initiative in educating others, and advocacy for appropriate accommodations;
support systems, including family involvement, support groups, teachers, mentors, and peers;
response to questions about stuttering or cluttering and managing teasing/bullying and other listener reactions;
effectiveness of self-therapy, self-management, and problem-solving skills.

References

Coleman, C., & Yaruss, J. S. (2014). A comprehensive view of stuttering: Implications for assessment and treatment. SIG 16 Perspectives on School-Based Issues, 15(2), 75-80.

Tichenor, S. E., & Yaruss, J. S. (2019). Stuttering as defined byadults who stutter. Journal of Speech, Language, and Hearing Research, 62(12), 4356–4369. https://doi.org/10.1044/2019_JSLHR-19-00137

World Health Organization. (2014). International Classification of Functioning, Disability and Health. Geneva, Switzerland: Author. Retrieved from https://www.who.int/classifications/international-classification-of-functioning-disability-and-health

Yaruss, J. S. (2007). Application of the ICF in fluency disorders. Seminars in Speech and Language, 28(4), 312-322.

Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update. Journal of Communication Disorders, 37(1), 35-52.

Yaruss, J. S., & Quesal, R. W. (2006). Overall Assessment of the Speaker's Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Journal of Fluency Disorders, 31(2), 90-115.