5

Category / Minimal Success
1 / Emerging
2 / Expanding
3 / Mastered
4 / Notes
Awareness of Stuttering / No awareness / Some awareness / Expanding awareness / Within normal limits
Understanding Of Stuttering / Complete lack of understanding / Some understanding / Expanding understanding / Within normal limits
Understanding of How Others
View His/Her Stuttering / Complete lack of understanding / Some understanding / Expanding understanding / Within normal limits
Understanding of His/Her Own Stuttering / Complete lack of understanding / Some understanding / Expanding understanding / Within normal limits
Column Totals
Category / Minimal Success
1 / Emerging
2 / Expanding
3 / Mastered
4 / Notes
Perceptions of Self / Extremely negative perception of self / Negative perception of self / Some acceptance of self / Acceptance of self / Feeling(s): (circle all that apply)
helpless angry ashamed lonely anxious depressed defensive embarrassed guilty frustrated
Attitudes and Feelings About Communication / Extremely negative perception of self / Negative perception of self / Some acceptance of self / Acceptance of self / Feeling(s): (circle all that apply)
helpless angry ashamed lonely anxious depressed defensive embarrassed guilty frustrated
Attitude About His/her Stuttering / Extremely negative perception of self / Negative perception of self / Some acceptance of self / Acceptance of self / Feeling(s): (circle all that apply)
helpless angry ashamed lonely anxious depressed defensive embarrassed guilty frustrated
Feelings and Emotions About Stuttering / Extremely negative perception of self / Negative perception of self / Some acceptance of self / Acceptance of self / Feeling(s): (circle all that apply)
helpless angry ashamed lonely anxious depressed defensive embarrassed guilty frustrated
Feelings About Others’ Reactions to His Stuttering / Extremely negative perception of self / Negative perception of self / Some acceptance of self / Acceptance of self / Feeling(s): (circle all that apply)
helpless angry ashamed lonely anxious depressed defensive embarrassed guilty frustrated
Column Totals
Category / Minimal Success
1 / Emerging
2 / Expanding
3 / Mastered
4 / Notes
Length and Complexity of Utterances / Poor
> 2 SD below norm / Emerging
1.5-2.0 SD below norm / Expanding
1-1.5 SD below norm / Within normal limits
<1 SD below norm / Degree of Stuttering during: naming; sentence
repetition, picture descriptions, story retelling,
discourse skills, etc.
Overall Language Abilities / Poor
> 2 SD below norm / Emerging
1.5-2.0 SD below norm / Expanding
1-1.5 SD below norm / Within normal limits
<1 SD below norm / Clinical Impression/Formal Assessment: i.e. CELF 3
Articulation and Phonological Abilities / Poor
> 2 SD below norm / Emerging
1.5-2.0 SD below norm / Expanding
1-1.5 SD below norm / Within normal limits
<1 SD below norm / Clinical Impression/Formal Assessment
Word Finding/
Receptive and Expressive Language / Poor
> 2 SD below norm / Emerging
1.5-2.0 SD below norm / Expanding
1-1.5 SD below norm / Within normal limits
<1 SD below norm / Clinical Impression/Formal Assessment
Column Totals
Category / Minimal Success
1 / Emerging
2 / Expanding
3 / Mastered
4 / Notes
Types of dysfluencies
1. Repetitions
2. Prolongations
3. Blocks
4. Other (Please list) / Significant
1.
2.
3.
4. / Frequent
1.
2.
3.
4. / Mild
1.
2.
3.
4. / Within normal limits
1.
2.
3.
4. / (Other includes hesitation,
interjections, etc.)
Characteristics of Dysfluencies / Very effortful/tense / Frequent / Mild / Within normal limits / (i.e. number of units per repetition, rhythmicity, effort, tension)
Frequency of Stuttering with Various Partners
1.  Teacher
2.  Parent
3.  Siblings
4.  Peers
5.  Clinician
6.  Unfamiliar listener
  1. Other
/ Severe
1.
2.
3.
4.
5.
6.
7. / Frequent
1.
2.
3.
4.
5.
6.
7. / Mild
1.
2.
3.
4.
5.
6.
7. / Within normal limits
1.
2.
3.
4.
5.
6.
7.
Secondary Coping Behaviors/Characteristics
1.  Overt-Physical Concomitants
2.  Covert / Very Distracting / Somewhat Distracting / Mildly Distracting / Within Normal Limits / (Overt-Distracting sounds, facial
grimaces, head movements, eye
contact, movements of extremities,
etc.)
(Covert-circumlocution, etc.)
Frequency of Stuttering
1.Reading
2. Spontaneous Speech / Significant - 12% or more of words
1.
2. / Frequent - 5-11%
1.
2. / Mild - 2-4%
1.
2. / Within Normal Limits (less than 2%)
1.
2.
Duration of Dysfluent Moments / Significant
10 sec or more / Frequent
3-9 sec / Mild
.5-2 sec / Within Normal Limits
Clinical Impression of Overall Motor Control / Significant Difficulties / Frequent Difficulties / Mild Difficulties / Within Normal Limits
Column Totals
Category / Minimal Success
1 / Emerging
2 / Expanding
3 / Mastered
4 / Notes
Avoidance of Speaking Situations
1. Student/Client’s View
2. Parent’s View
3. Teacher’s View
4. SLP’s View
5. Other / Debilitating
(Circle all that apply)
1.
2.
3.
4.
5. / Frequent
1.
2.
3.
4.
5. / Mild
1.
2.
3.
4.
5. / Within normal
limits/minimally impacted
1.
2.
3.
4.
5. / Do you:
…Leave a situation where you
fear you may stutter?
…Not say what you want to say?
…Let others speak for you?
…Avoid situations such as
using the phone?
…Change words (circumlocution)?
Degree of Stuttering in Various
Situations
1.Academic Subjects
2. Non-academic subjects
3.Extra Curricular Activities
4.Other / Debilitating
(Circle all that apply)
1.
2.
3.
4. / Frequent
1.
2.
3.
4. / Mild
1.
2.
3.
4. / Within normal
limits/minimally impacted
1.
2.
3.
4.
Ability to Meet Curriculum
Objectives/Job Demands / Severely Impacted / Moderately Impacted / Mildly Impacted / Within normal
limits/minimally impacted
Impact of Peer/Social Relations / Severely Impacted / Moderately Impacted / Mildly Impacted / Within normal
limits/minimally impacted
Column Totals

Adapted from CALMS Rating Scale for School-Age Children Who Stutter, Healey, Scott-Trautman, and Susca, 2002