Semin Speech Lang 2007; 28(4): 312-322
DOI: 10.1055/s-2007-986528
© Thieme Medical Publishers

Application of the ICF in Fluency Disorders

J. Scott Yaruss1
  • 1Associate Professor, Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania; Associate Director, Audiology and Communication Disorders, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Further Information

Publication History

Publication Date:
12 October 2007 (online)


Stuttering is a complicated communication disorder that can affect many aspects of a speaker's life. In addition to exhibiting observable disruptions in speech (e.g., part-word repetitions, prolongations, blocks), many people who stutter also experience broader consequences in their lives because of their stuttering. Examples include difficulty with social communication (e.g., speaking with other people, making introductions) and job-related tasks (e.g., talking on the phone, participating in meetings). Because it incorporates these types of daily experiences, the World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides an ideal framework for considering the overall experience of the stuttering disorder. The purpose of this article is to highlight the ways in which the ICF can help clinicians, people who stutter, and the general public understand the multifaceted nature of stuttering. The article will also describe how clinicians can use the ICF as a framework for developing comprehensive evaluations and providing individualized treatment plans for people who stutter.


  • 1 Bloodstein O. A Handbook on Stuttering. 5th ed. San Diego, CA; Singular 1995
  • 2 Yaruss J S. Clinical implications of situational variability in preschool children who stutter.  J Fluency Disord. 1997;  22 187-203
  • 3 Bloodstein O. Stuttering: The Search for a Cause and Cure. Boston; Allyn & Bacon 1993
  • 4 Bothe A, Davidow J, Bramlett R, Ingham R J. Stuttering treatment research 1970-2005: I. Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches.  Am J Speech Lang Pathol. 2006;  15 321-341
  • 5 Ahlbach JM, Benson V To Say What Is Ours. Anaheim Hills, CA; National Stuttering Project 1994
  • 6 Hood SB Advice to Those Who Stutter. 2nd ed. Memphis, TN; Stuttering Foundation of America 1998
  • 7 St. Louis K O. Living with Stuttering. Morgantown, WV; Populore 2001
  • 8 Perkins W H. What is stuttering?.  J Speech Hear Disord. 1990;  55 370-382
  • 9 Van Riper C. The Nature of Stuttering. 2nd ed. Englewood Cliffs, NJ; Prentice-Hall 1982
  • 10 Murphy W P. A preliminary look at shame, guilt, and stuttering. In: Bernstein-Ratner N, Healey EC Stuttering Research and Practice: Bridging the Gap. Mahwah, NJ; Lawrence Erlbaum 1999: 131-143
  • 11 Reardon-Reardon N A, Yaruss J S. The Source for Stuttering: Ages 7-18. East Moline, IL; LinguiSystems 1999
  • 12 Yaruss J S. Describing the consequences of disorders: stuttering and the International Classification of Impairments, Disabilities, and Handicaps.  J Speech Lang Hear Res. 1998;  41 249-257
  • 13 Yaruss J S, Quesal R W. Stuttering and the International Classification of Functioning, Disability, and Health (ICF): an update.  J Commun Disord. 2004;  37 35-52
  • 14 Yaruss J S, Quesal R W. Overall Assessment of the Speaker's Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment.  J Fluency Disord. 2006;  31 90-115
  • 15 World Health Organization .International Classification of Impairments, Disabilities, and Handicaps: A Manual of Classification Relating to the Consequences of Disease. Geneva, Switzerland; World Health Organization 1980
  • 16 Curlee R F. Evaluating treatment efficacy for adults: assessment of stuttering disability.  J Fluency Disord. 1993;  18 319-333
  • 17 McClean M D. Neuromotor aspects of stuttering: levels of impairment and disability. In: J Cooper Research Needs in Stuttering: Roadblocks and Future Directions. Rockville, MD; American Speech-Language-Hearing Association 1990: 64-71
  • 18 Prins D. Theories of stuttering as event and disorder: implications for speech production processes. In: Peters HFM, Hulstijn W, Starkweather CW Speech Motor Control and Stuttering. Amsterdam; Elsevier Sciences Publishers 1991: 571-580
  • 19 Badley E M. The ICIDH: format, application in different settings, and distinction between disability and handicap. A critique of papers on the application of the International Classification of Impairments, Disabilities, and Handicaps.  Int Disabil Stud. 1987;  9(3) 122-125
  • 20 Brandsma J W, Lakerveld-Heyl K, Van Ravensberg C D, Heerkens Y F. Reflection on the definition of impairment and disability as defined by the World Health Organization.  Disabil Rehabil. 1995;  17(3-4) 119-127
  • 21 Schuntermann M F. The International Classification of Impairments, Disabilities and Handicaps (ICIDH)-results and problems.  Int J Rehabil Res. 1996;  19(1) 1-11
  • 22 Thuriaux M C. The ICIDH: evolution, status, and prospects.  Disabil Rehabil. 1995;  17(3-4) 112-118
  • 23 World Health Organization .International Classification of Functioning, Disability, and Health. Geneva, Switzerland; World Health Organization 2001
  • 24 Foundas A L, Bollich A M, Corey D M, Hurley M, Heilman K M. Anomalous anatomy of speech-language areas in adults with persistent developmental stuttering.  Neurology. 2001;  57(2) 207-215
  • 25 Sommer M, Koch M A, Paulus W, Weiller C, Büchel C. Disconnection of speech-relevant brain areas in persistent developmental stuttering.  Lancet. 2002;  360 380-383
  • 26 DeNil L. Neurogenic stuttering: its etiology, symptomatology, and treatment. In: Conture EG, Curlee RF Stuttering and Related Disorders of Fluency. 3rd ed. New York; Thieme 2007
  • 27 Manning W H. Clinical Decision Making in Fluency Disorders. 2nd ed. San Diego, CA; Singular 2001
  • 28 Cooper E B. Fluency disorders. In: Crowe TA Applications of Counseling in Speech-Language Pathology and Audiology. Baltimore; Williams & Wilkins 1997
  • 29 Zebrowski P M, Schum R L. Counseling parents of children who stutter.  Am J Speech Lang Pathol. 1993;  2 65-73
  • 30 Lass N J, Ruscello D M, Schmitt J F et al.. Teachers' perceptions of stutterers.  Lang Speech Hear Serv Sch. 1992;  23 78-81
  • 31 Blood G W, Blood I M. Bullying in adolescents who stutter: communicative competence and self-esteem.  Contemp Iss Comm Sci Disord. 2004;  31 69-79
  • 32 Davis S, Howell P, Cook F. Sociodynamic relationships between children who stutter and their non-stuttering classmates.  J Child Psychology Psychiatry. 2002;  43 939-947
  • 33 Langevin M. Teasing and Bullying: Unacceptable Behaviour. The TAB program. Edmonton, Alberta, Canada; Institute for Stuttering Treatment and Research 2000
  • 34 Hurst M I, Cooper E B. Employer attitudes towards stuttering.  J Fluency Disord. 1983;  8 1-12
  • 35 Yaruss J S. Current status of academic and clinical education in fluency disorders at ASHA-accredited training programs.  J Fluency Disord. 1999;  24 169-183
  • 36 Yaruss J S, Quesal R W. Academic and clinical education in fluency disorders: An update.  J Fluency Disord. 2002;  27 43-63
  • 37 Riley G. Stuttering Severity Instrument for Children and Adults. 3rd ed. Austin, TX; Pro-Ed 1994
  • 38 Yaruss J S. Real-time analysis of speech fluency: procedures and reliability training.  Am J Speech Lang Pathol. 1998;  7(2) 25-37
  • 39 Ammons R, Johnson W. Studies in the psychology of stuttering: XVIII. Construction and application of a test of attitude toward stuttering.  J Speech Disord. 1944;  9 39-49
  • 40 Andrews G, Cutler J. Stuttering therapy: The relation between changes in symptom level and attitudes.  J Speech Hear Disord. 1974;  39 312-319
  • 41 Erickson R. Assessing communication attitudes among stutterers.  J Speech Hear Res. 1969;  12 711-724
  • 42 Ornstein A, Manning W. Self-efficacy scaling by adult stutterers.  J Commun Disord. 1985;  18 313-320
  • 43 Watson J B. A comparison of stutterers' and nonstutterers' affective, cognitive, and behavioral self-reports.  J Speech Hear Res. 1988;  31 377-385
  • 44 Brutten G, Shoemaker D. Speech Situation Checklist. Carbondale, IL; Speech Clinic, Southern Illinois University 1974
  • 45 Riley J, Riley G, Maguire G. Subjective screening of stuttering severity, locus of control and avoidance: research edition.  J Fluency Disord. 2004;  29 51-62
  • 46 Wright L, Ayre A. The Wright & Ayre Stuttering Self Rating Profile (WASSP). Bicester, UK; Winslow Press 2000
  • 47 Yaruss J S. Evaluating treatment outcomes for adults who stutter.  J Commun Disord. 2001;  34 163-182
  • 48 Yaruss J S. Treatment outcomes in stuttering: finding value in clinical data. In: Cordes A, Ingham R Toward Treatment Efficacy in Stuttering: A Search for Empirical Bases. Austin, TX; Pro-Ed 1998: 213-242
  • 49 Manning W. Progress under the surface and over time. In: Bernstein Ratner N, Healey EC Stuttering Research and Practice: Bridging the Gap. Mahwah, NJ; Lawrence Erlbaum 1999: 123-130

J. Scott YarussPh.D. 

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