Test of Childhood Stuttering (TOCS)

Administration the TOCS

To prepare for administration of the TOCS, therapists should first familiarize themselves with the test manual, protocols, and scoring procedures. Before administering the assessment, it’s important to establish a positive, supportive environment for the client.

To conduct the assessment, the SLP completes the 4 subtests within the Standardized Speech Fluency Measure.

• Rapid Picture Naming: The child is asked to name a series of 40 pictures as quickly as they can.

• Modeled Sentences: The clinician presents the child with 2 pictures that differ in one important detail. The SLP will say a sentence regarding one of the pictures, and the child is asked to produce sentences that consist of the same sentence structure as what the examiner has modeled.

• Structured Conversation: The child is shown a sequence of 8 pictures and is asked to answer a series of open ended questions about them.

• Narration: The examiner shows the child the picture cards that are used in the Structured Conversation subtest and the child is asked to generate a story based on the pictures.

The Observational Rating Scales are also completed as part of the TOCS. The examiner completes the Speech Fluency Rating Scale and the Disfluency-Related Consequences Rating Scale with input from the child’s parents, teachers, and other individuals who are familiar with the child.

The SLP can also complete the 8 supplementary fluency-related assessments. These provide additional information about the child’s speech and fluency, such as the duration of dysfluencies, associated behaviors such as concomitant behaviors, and the naturalness of their speech.

It’s important to be aware of some potential challenges that can arise while administering the TOCS. Some clients may experience anxiety or resistance surrounding speech related tasks. SLPs can attempt to offset these challenges by establishing rapport with the client and creating a comfortable testing environment.

Interpreting TOCS results

The TOCS provides quantitative data that assists speech-language pathologists in identifying the presence of stuttering and analyzing the severity of a client’s fluency disorder. The clinician uses the scores obtained from each subtest to obtain an overall measure of the client’s speech fluency.

The examiner can look at the results of the Observational Rating Scales and analyze the results to determine the types of dysfluencies the client demonstrates, how often he or she stutters, and when the student is more likely to be dysfluent.

Both the Speech Fluency Measure and the Observational Rating Scales yield index scores, percentile ranks, and descriptive terms that can be analyzed to characterize the child’s speech fluency. These scores can also be analyzed by the SLP to quantify the severity of this child’s stuttering (ex: mild, moderate, or severe).

The results of the Test of Childhood Stuttering influence treatment planning by highlighting specific areas that indicate the need for intervention. Therapists can analyze and consider these areas when developing therapy goals and selecting individualized treatment techniques.

Using TOCS in treatment planning

The TOCS results provide valuable information that can be used in treatment planning. The SLP can identify the specific areas that require intervention. For example, a child may benefit from working on production of fluent speech in a specific speaking situation, such as when answering a direct question.

In addition to aiding in setting therapy goals, the SLP can also use the TOCS results to select specific fluency-shaping strategies to use with the child during intervention. If the child uses a fast rate of speech that appears to be contributing to his or her stuttering, for example, the SLP may teach the strategy of using a slow rate of speech.

The TOCS can also be used as a tool for progress monitoring. Speech-language pathologists can complete periodic re-assessments that include administration of the TOCS. By comparing and analyzing the results over time, therapists can evaluate the effectiveness of intervention strategies being used, and make adjustments to a child’s intervention plan to ensure they make optimal progress.

Training and Professional Development for TOCS

SLPs can enhance their skills for administering the TOCS by utilizing various resources. Workshops, online courses, and seminars are available that focus specifically on developing techniques for assessing stuttering.

Continuing education opportunities in the area of fluency are also valuable in helping therapists stay up to date on current research, assessment tools, and treatment techniques.

Ethical and Cultural Considerations of TOCS

As with any standardized assessments, there are certain ethical guidelines and cultural considerations that should be made when using the TOCS in clinical practice.

The test should be administered by a licensed speech-language pathologist who is knowledgeable and experienced in administering standardized assessments and working with clients who stutter.

SLPs should strive to ensure cultural sensitivity and inclusivity when administering and interpreting the TOCS. It’s important to consider the cultural background of the child and their family, understanding and respecting their unique values, beliefs, and practices.

Clinicians should consider potential differences in communication styles, attitudes towards stuttering, and the perception of speech fluency. It’s also important to consider the child’s dominant language and dialect, and his or her exposure to multiple languages. This can help the SLP differentiate between a language difference versus disorder.

Stuttering can have potential impacts on several areas of a child’s life, including social skills, academic performance, and emotional wellbeing. Through intervention that begins with a comprehensive, accurate assessment, Speech therapists play a critical role in improving speech fluency for children who stutter. One reliable tool that can be used to identify the presence and severity of stuttering in children is The Test of Childhood Stuttering (TOCS).

The TOCS provides a measurement of a child’s speech fluency in single words, sentences, conversation, and narration. Observational rating scallions provide information about the child’s stuttering and related behaviors from those who are most familiar with them. And 8 supplementary assessments provide additional fluency-related data that can assist with a comprehensive assessment and intervention plan.

Resources

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References

Engelen, M. M., Franken, M. C. J., Stipdonk, L. W., Horton, S. E., Jackson, V. E., Reilly, S., ... & Eising, E. (2024). The association between stuttering burden and psychosocial aspects of life in adults. Journal of Speech, Language, and Hearing Research.

Guttormsen, L. S., Yaruss, J. S., & Næss, K. A. B. (2021). Parents' perceptions of the overall impact of stuttering on young children. American Journal of Speech-Language Pathology, 30(5), 2130-2142.

Shipley, K. G., & McAfee, J. G. (2023). Assessment in speech-language pathology: A resource manual. Plural Publishing.