Stuttering 49Clinicians want to make correct diagnoses at all times, but sometimes errors occur. In diag-
nosing stuttering in children, the false- positive error is more detrimental than the false- negative
one. Clinicians should attempt to be error free, but if an error is made, it is better to make a false-
negative diagnosis than to diagnose a normally f luent child as one who is stuttering. The reasoning
behind this princi ple is discussed next.
As noted earlier, a false- negative diagnosis suggests that the child is not stuttering when, in fact,
he or she is. Consequently, a child who needs therapy does not receive it. The negative effects of
this error include lost treatment time, and the stuttering is likely to get worse. However, eventually
the abnormal dysf luencies will be correctly evaluated and the child placed in therapy. Sometimes a
false- positive diagnosis is more detrimental than a false- negative one. A normally f luent child with
excessive repetitions, prolongations, and hesitations may be regularly pulled from the classroom
and taken to speech therapy. As a result, he or she may become unduly self- conscious about speech
f luency, which can contribute to the development of stuttering. The theory that misdiagnosis can
contribute to stuttering development is a long- standing clinical concept known as the diagnoso-
genic theory of stuttering (Johnson, 1938).
The frequency and types of dysf luencies displayed by the child can indicate whether he or she
is normally nonfluent or stuttering. A diagnostic gray area is called incipient or developmental
stuttering because it may not be clear that a par tic u lar child is or is not stuttering. Table 3-1 shows
some speech and ancillary be hav iors that separate normally nonf luent children from those who
may be stuttering (Tanner, 1990). Strug gle with speech, airf low disruptions within words, and the
excessive use of the schwa vowel /uh/ are impor tant signs of stuttering. Unfortunately, because of
the wide variety of symptoms, no reliable and valid diagnostic tests can be administered to show
definitively which children are stuttering and which ones are normally nonf luent. Diagnosing
stuttering in children is an ongoing clinical judgment based on observations, test scores, parental
interviews, and direct assessment.