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Certain breathing abnormalities also may be associated with stuttering. The case history and interview also are the most commonly used methods to assess negative emotions and avoidance reactions. The types and frequency of dysfluencies are measured in both conversational speech and oral reading, if the client is old enough to read. A major task of assessment is to observe the types and frequency of dysfluencies. By taking a case history and interviewing the client, the parents, or both, the clinician seeks to understand the individual and his or her stuttering. Consistent stuttering on certain words and in certain speaking situations creates apprehension and anxiety about speaking and speaking situations. The emotional responses may get stronger as the person who stutters gets older, especially when stuttering severity increases. People who stutter carefully avoid many speaking situations. Circumlocution is another strategy that people who stutter use. Repeated stutterings on certain words or in certain words or in certain speaking situations eventually lead to the avoidance of those words and speaking situations. The negative feelings and the eventual avoidance behaviors the person who stutters develops may have an origin in this awareness of being different in speech. A person who stutters is bound to experience certain emotional and behavioral effects of this profound speech difficulty. Breathing patterns of people who stutter may be jerky and arrhythmic during stuttered speech. Whereas typical speakers stop and breathe every so often during speech, a person who stutters may try to keep talking, although the air supply is exhausted. Pauses of varying durations are equally common, especially in young children whose language skills are still developing. Most people who stutter report a tightness in their throat, jaw, chest, shoulder, and stomach muscles while producing dysfluent speech. Muscular tension associated with speech also is significant. 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. Most clinicians diagnose stuttering if the duration of dysfluencies is 1 second or longer. Still other clinicians diagnose stuttering on the basis of excessive duration of dysfluencies. 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. 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. Some clinicians believe that typical and stuttered speech should be distinguished not by the amount of dysfluencies but by the types of dysfluencies. The variability found in the amount dysfluencies of typical speakers also is found in people who stutter. Both typical speakers and those who stutter vary a great deal in the amount of dysfluencies.
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