Stuttering Goals: Fluency is Not the Master of All

In the May 2018 edition of the ASHA Leader, speech-language pathologist Rebecca Moore highlights the need to move beyond "80 percent accuracy" in writing and measuring goals. We agree that this is a critical concept, especially for children who stutter. In the article (Moore, 2018), a sample goal is provided that utilizes a rating scale for children who stutter. The goal reads as follows (p. 7).:

"Alice's teacher will rate her fluency daily on a scale of 1 to 5-in which 1 is completely fluent and 5 is severely disfluent- for one week each month. By her next IEP date, Alice will receive an average rating >2 for two-plus consecutive months."

Another sample goal provided is:

"In a 30-minute session, Tami will use her strategies to speak with no more than one instance of blocking for two-plus sessions."

While these goals may be reflective of how some SLPs target stuttering, they are very one-dimensional. 

Let's begin with Tami. If Tami blocks one time during a session, Tami now knows that she will not meet her goal if she blocks again. So, Tami could start avoiding works and speaking so that she still meets her goal. What if Tami blocks more than once but talks openly with others, doesn't let stuttering interfere with her communication, and decides to practice giving a presentation on stuttering during the session? There is no question Tami would be demonstrating progress on important functional measures, rather than a random number of blocks. After all, who decides how many blocks is appropriate for a person who stutters during a session?

Now, let's return to Alice. First, the way the goal is written seems to reflect that the goal is any number greater than 2 on the scale, so a 5 (severely disfluent) would be as acceptable as a 2. Second, there are many more appropriate goals that could be targeted to help Alice from and academic and social standpoint. For example, the number of times Alice participates in class could be measured. A rating scale could also be used to assess the impact of Alice's stuttering on her ability to participate in social situations in the classroom or other school activities. For a more complete list of possible goals see (https://lshss.pubs.asha.org/article.aspx?articleid=2669930). 

When working with people who stutter, it is important to target all aspects of stuttering, not just the number of disfluencies. Goals should reflect that surface-level disfluencies are only one small part of stuttering. Too often, we project fluency-only goals onto children (because administrators or third-party payers may ask for those types of goals) instead of setting functional goals that impact quality of life and overall communication skills.