Stuttering Severity Calculator (SSI-4)
Assess stuttering severity using SSI-4 (Stuttering Severity Instrument - version 4).
Important Medical Disclaimer
This calculator is an educational and clinical decision support tool. Results DO NOT replace professional medical evaluation, laboratory tests, or clinical judgment. Always consult a qualified healthcare professional for diagnosis, treatment, and clinical decisions. Calculations are based on scientifically validated formulas but may not be applicable to all patients.
SSI-4 Assessment
Note: SSI-4 is an assessment tool. Complete analysis by speech-language pathologist is essential for diagnosis and treatment.
What is SSI-4?
SSI-4 (Stuttering Severity Instrument - 4th edition) is a standardized instrument to assess stuttering severity in children and adults. Developed by Glyndon Riley, SSI-4 evaluates three dimensions: 1) Frequency - number of disfluencies per 100 words, 2) Duration - average time of the 3 longest blocks, 3) Physical concomitants - muscle tension and associated movements (facial, head, limbs). Total score (0-46) classifies stuttering into 5 severity levels. SSI-4 is the most widely used instrument worldwide for stuttering assessment, with high test-retest reliability and validity. It is used for initial diagnosis, therapeutic monitoring, and research.
Scoring System
Total Score: 0-46
- 0-10: Very Mild
- 11-21: Mild
- 22-30: Moderate
- 31-36: Severe
- 37-46: Very Severe
Frequently Asked Questions
What causes stuttering?
Stuttering is a multifactorial fluency disorder. Genetic factors: 60-80% of cases have family history. Studies identified associated genes (GNPTAB, GNPTG, NAGPA). Neurological factors: Differences in brain areas of speech motor processing (inferior frontal gyrus, basal ganglia). Neuroimaging shows hyperactivity in right hemisphere and hypoactivity in left motor areas. Developmental factors: Typical developmental stuttering begins between 2-5 years, coinciding with language explosion and complex motor demand. 75-80% of children recover spontaneously by age 7. Environmental factors: Communication pressure, parents' fast speech rate, criticism or teasing can worsen but DO NOT cause stuttering.
What is the difference between developmental and neurogenic stuttering?
Developmental stuttering: Childhood onset (2-5 years), gradual evolution, typical patterns (repetitions, prolongations, blocks), variable awareness, often presents physical concomitants, responds well to fluency therapy. Neurogenic stuttering: Sudden onset after brain injury (stroke, TBI, tumor, Parkinson's), any age, atypical patterns (disfluencies in function words, without adaptation), little initial awareness, fewer concomitants, variable response to traditional therapy. Psychogenic stuttering: Rare, sudden onset in adults, related to psychological trauma, bizarre patterns (same disfluencies in every word), improves in distraction situations, may disappear abruptly.
Should young children start therapy immediately?
Depends on risk factors for persistence. Wait for 'spontaneous recovery': If <6 months onset, no family history, child not concerned, mild disfluencies (syllable/word repetitions without tension). Monitor every 3 months. Early intervention indicated: If >6-12 months of stuttering, strong family history (especially female), child shows frustration/avoidance, severe disfluencies (blocks, prolongations with tension), evident physical concomitants, male gender (3-4x higher persistence risk). Lidcombe Approach (children 2-6 years): Parents trained as co-therapists, high efficacy (70-90% of children achieve natural fluency). Earlier is better prognosis.
Can adults who stutter improve?
Yes, although complete 'cure' is rare, significant improvement and quality of life are achievable. Therapeutic approaches: 1) Fluency techniques (fluency shaping): Prolonged speech, easy onset, light contact, diaphragmatic breathing. Goal: Replace stuttering motor patterns with fluent speech. 2) Stuttering modification (Van Riper): Cancellation, pull-out, preparation. Goal: Stutter with less tension and effort. 3) Cognitive-behavioral therapy: Reduce fear and avoidance, improve self-esteem, face feared situations. 4) Technological devices: Delayed auditory feedback (DAF), frequency altered feedback (FAF). Variable efficacy. Prognosis: Highly motivated adults with good adherence can achieve 70-90% fluency in controlled environments. Maintaining fluency in stressful situations is challenging. Support groups (e.g., NSA - National Stuttering Association) are valuable.
Is there a cure for stuttering? Do medications help?
There is no 'cure' in the sense of permanent and total elimination of stuttering in most adults. Fluency therapy can lead to prolonged periods of fluency, but maintenance requires continuous practice. Medications: No medication specifically approved for stuttering. Some studies tested: Haloperidol, risperidone (dopamine antagonists): Showed disfluency reduction, but severe side effects (parkinsonism, tardive dyskinesia) limit use. Not recommended. Pagoclone (GABAergic modulator): Phase 2 studies showed modest benefit, but development discontinued. Ecopipam (D1 antagonist): Ongoing studies, preliminary positive results. Off-label use: Anxiolytics (alprazolam, clonazepam) may help in specific high-anxiety situations, but dependence risk. Don't treat stuttering itself. Focus should be speech-language therapy, not medication.
Scientific References
- 1. Riley GD. Stuttering Severity Instrument for Children and Adults (SSI-4). 4th ed. Austin, TX: Pro-Ed; 2009.
- 2. Yairi E, Ambrose N. Epidemiology of stuttering: 21st century advances. J Fluency Disord. 2013;38(2):66-87.
- 3. Guitar B. Stuttering: An Integrated Approach to Its Nature and Treatment. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.