I find this too distracting, so I uncheck " Speak typed characters" and check " Speak typed words".
By default, NVDA reads every character as you type. If you are going to use a laptop, check " Use CapsLock as an NVDA modifier key". I often change the rate based on the complexity of the webpage. I typically hover around the 80-90, but it took me some time to be comfortable at that speed. The voice I use is Microsoft Zira because I find it a natural sounding voice at lower speeds, but still understandable at higher speeds. The default synthesizer is not the easiest to understand, so the first thing I do is change the default voice. Preferences > Synthesizer and then Preferences > Voice Setting > Voice. However, I do make a few changes that I feel make the experience more pleasant and efficient without altering the information that is presented. I want my testing experience to be as ‘typical’ as possible, so I try not to configure my screen reader too heavily. While you can argue the merit of one approach over another for the end user, this ‘literal’ presentation is excellent for accessibility evaluation. Literal: Some screen readers will attempt to fill in accessibility gaps, for example, by guessing at a label for an unlabeled form control. Always up to date: Updates are regular and I have always found them seamless. 
Free: I am not faulting companies that charge for their product, but it is much harder to justify the hefty price tag if you are using it for evaluation purposes only. Other screen readers take too long to start up and tend to crash, especially JAWS. I need a screen reader that can keep up with me. Lightweight: I am constantly turning my screen reader on and off, switching browsers, etc. I have access to full versions of JAWS and Window-Eyes and while they are both capable screen readers, the screen reader I use most often is NVDA. I spend a significant amount of time evaluating website accessibility and a large percentage of that time is spent using a screen reader. 
For a more detailed guide on using this screen reader, see our NVDA tutorial. Note: This is a piece about how I configure and use NVDA.
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