Teacher Checklist-Fluency

The following form contains a checklist and questionnaire which is designed to increase awareness of the teacher of a child who stutters.

THIS FORM IS TO BE COMPLETED BY SCHOOL PERSONNEL BASED UPON OBSERVATIONS IN THE CLASSROOM

Student’s Name _______________________________________________

B. D. ________________ Age _________ Date ______________________

Teacher/Support Staff___________________________________________

School ____________________________ Grade______________________

Your observations of this student’s ORAL COMMUNICATION SKILLS will help determine if there is a fluency problem which adversely affects the student’s ability to communicate effectively in school learning and/or social situations.

Fluency refers to the typical rate and rhythm of connected speech. When disruption occurs, this is known as disfluency and/or stuttering.

1. Check any of the following behaviors that you have noticed in this student’s speech:
   
   

   Revisions (starting and stopping and starting over again	( )
   Frequent interjections (um, like, you know)	( )
   Phrase repetitions (and then, and then)	( )
   Pauses or hesitate while speaking (“He … went away.”	( )
   Word repetitions (we-we-we)	( )
   Part word repetitions (t-t-t-take; mo-mo-mom)	( )
   Prolongations (no____body)	( )
   Blocks (noticeable tension/no speech comes out)	( )
   Unusual face or body movements (head nods, eye movement)	( )
   Abnormal breathing patterns	( )
   Other _______________________________________________________ _______________________________________________________

   
   
   

2. Answer the following questions with YES or NO.
   • Do you listen to HOW the student is speaking rather than WHAT he/she is saying ?
     
     
   • Does this student avoid speaking in the classroom ?
     
     
   • Do classmates react to this student when he/she is stuttering ?
     
     
   • If so, does this student have negative responses to the peers’ reactions?
     (stops talking, more stuttering, withdraws, etc.)
     
     
   • Do you feel uncomfortable when you try to communicate with this student?
     
     
   • Do you think this student is aware of his/her fluency problem?
     
     
   
   

3. Information questions
   • How long have you observed the problem?
     
     
   • How long have you been concerned about the disfluencies in this student’s speech?
     
     
   • Has the disfluency been consistent or intermittent?
     
     
   • Can you recall any unusual event near the onset of the problem?
     (child, family, environment)
     
     
   • Have the parent(s)/caregivers ever mentioned the student’s fluency problems?
     If yes, what was discussed?
     
     
   • Is there a history of stuttering in the biological family?
     
     
   • Has the student ever talked to you about his/her speech problem?
     If yes, what was discussed?
     
     
   • What other information might be helpful in looking at this student’s fluency skills?
     
     
   • Do you have any other concerns regarding this student’s speech and language skills, academic functioning, or social appropriateness ?

Thank you for taking time to share this helpful information.

Source: Judith Eckardt, SLP, Board Recognized Fluency Specialist, USA, 8/03

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