Free Stuttering Evaluation Template
Stuttering Evaluation
[YOUR COMPANY NAME]
Date: May 12, 2056
Introduction: This guide provides a structured framework for evaluating stuttering behaviors for clinical diagnosis and therapeutic interventions.
Overview: The assessment focuses on various aspects such as frequency, types, and severity of stuttering to influence therapy planning and progress monitoring.
Evaluation Criteria:
This evaluation employs an integrated approach which hones in on the following indicators:
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Frequency of Stuttering: This reflects the regularity of occurrence of stuttering behaviors during verbal communication.
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Type of Stuttering: This identifies specific forms of stuttering experienced such as repetitions, prolongations, and blocks.
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Severity of Stuttering: This measures the impact of stuttering on the overall speech quality.
Instructions:
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Use the provided criteria table to evaluate each aspect of stuttering behavior.
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Enter evidence supporting the evaluation, such as speech samples or observer reports.
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For each criterion, mark the appropriate rating based on your assessment. Place a checkmark (✓) in the corresponding box with the appropriate rating (1 to 5) to indicate the severity level.
Rating Scale:
1: Minor/Barely Noticeable - Minimal impact on communication.
2: Mild - Noticeable but not significant.
3: Moderate - Moderately impactful.
4: Severe - Significant impact on communication.
5: Very Severe - Speech severely disrupted.
Stuttering Evaluation
|
Criteria |
Description |
Evidence |
1 |
2 |
3 |
4 |
5 |
|---|---|---|---|---|---|---|---|
|
Frequency of Stuttering |
The count of stuttering events during speech |
Speech Samples, Observer Reports |
|
|
|
|
|
|
Type of Stuttering |
Specific forms of stuttering such as repetitions, prolongations, blocks |
Speech Samples, Observer Reports |
|
|
|
|
|
|
Severity of Stuttering |
The extent to which stuttering affects the verbal communication quality |
Speech Samples, Self-reports, Observer Reports |
|
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|
|
Additional Comments and Notes:
|
Additional Comment/Notes |
|---|
