Speech behavior you may see or hear:

• Occasional (less than once every 10 sentences), brief (less than 1/2 second), repetitions of sounds, syllables, or short words li-like this. Sounds, syllables, or words only repeated once or twice, for example hey-hey, ca-ca-can.

• Frequent (3 or more every 10 sentences), long (longer than 1/2 second) repetitions of sounds, syllables, and some short words, li-li-li-like this. Sounds, syllables, and short words usually repeated 3 or more times, f-f-f-f-for ex-ex-ex-example. Occasional prolongation of sounds lllllike this, or blockages.

Other behavior you may see or hear:

• Occasional pauses, hesitations in speech, or fillers such as "uh," "er," or "um," usually noticed when the child is changing words or thoughts.

• Repetitions and prolongations may be associated with eyelid closing and blinking, looking away, and some muscle tension in and around the mouth. May also hear changes in pitch or loudness as child struggles to say word. Child may say extra sounds or words as starters, e.g., "Well it's well it's I-I-I-I need a crayon."

When problem is most noticeable:

• Tends to come and go when child is: tired, excited, talking about complex or new topic, asking or answering questions, or talking to unresponsive listeners.

• May come and go in similar situations, but is more often present than absent. If noticed in most speaking situations and is consistent, problem may be more severe.

Child reaction:

• None apparent

• May show concern, embarrassment, frustration, fear of speaking. May be reluctant to participate in classroom activities such as show-and-tell, reading aloud, or raising hand during question-answer periods.

Peer reactions:

• None apparent

• Peers may ask questions, comment on, or imitate child's speech. Teasing may be present.

Parent reactions:

• None to a great deal.

• Some degree of concern.

Referral decision:

• No referral

• Refer for screening.