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Still other clinicians diagnose stuttering on the basis of excessive duration of dysfluencies. That is, if the speaker's dysfluencies are excessively long, then stuttering may be diagnosed. If the speaker's dysfluencies are predominantly part-word repetitions and sound prolongations, stuttering may be diagnosed even if the rate is less than 5%. If a speaker's dysfluencies exceed 5% of the words spoken, stuttering may be diagnosed. If one rule fails, the other rule may be applied to evaluate whether a speaker stutters. A clinician may consider the three criteria as a set of rules to use in diagnosing stuttering. In essence, stuttering is diagnosed when the durations are brief but the frequency of dysfluencies is high or when the frequency is low but the durations are long. When the durations are noticeably long, the frequency of dysfluencies may be ignored. When the durations are very brief, the frequency may be important in the diagnosis of stuttering. The durational criterion may or may not use the frequency criterion as well. Most clinicians diagnose stuttering if the duration of dysfluencies is 1 second or longer. Accordingly, stuttering may be diagnosed if a speaker's dysfluencies are abnormal durations. A dysfluency may be so brief that only an expert would notice it, or it may be so long that no one could miss it. Therefore, some clinicians use the criterion 5% or more dysfluencies to distinguish people who stutter from those who do not. Accordingly, any type of dysfluency is a stutter if it produced with tension and struggle. In fact, some clinicians place a heavy emphasis on tension and struggle, along with abnormal breathing patterns associated with certain types of dysfluencies. Word repetitions or interjections often are produced without much struggle or muscular tension. Most experts think that part-word repetitions and prolongations are more likely to be associated with muscular tension and struggle. The presence of part-word repetitions or prolongations may be sufficient to diagnose stuttering. The diagnosis of stuttering based on the types of dysfluencies may not have a quantitative criterion. Therefore, some clinicians diagnose stuttering only on the basis of part-word reptitions and sound prolongations. However, these types of dysfluencies are heard quite frequently in the speech of people who stutter. Part-word repetitions and speech sound prolongations are not as frequent as interjections and word or phrase repetitions. Although all kinds of dysfluencies are present in typical speakers, some types are infrequent. Some clinicians believe that typical and stuttered speech should be distinguished not by the amount of dysfluencies but by the types of dysfluencies. In using this criterion, the clinician counts all types of dysfluencies because there is evidence that listeners judge a speech sample negatively if it includes an excessive amount of such common types of dysfluencies interjections and word repetitions.
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