The term “speech fluency” refers to the overall flow of your speech. When we have interruptions in our speech, we call that dysfluency, stuttering, or stammering. People who stutter know what they want to say, but the message doesn’t come out as smoothly as they intended. Often, a fluency disorder comes with negative feelings and attitudes, causing a person who stutters to try to hide their stutter, avoid certain words, or avoid talking in general. A speech-language pathologist (SLP) helps people who stutter to recognize their strengths and use strategies to control their fluency.
In this blog post, we’ll focus on childhood stuttering. Information about acquired neurogenic and psychogenic stuttering can be found on ASHA’s website search.
Defining fluency and fluency disorders
According to the American Speech-Language and Hearing Association (ASHA), fluency refers to continuity, smoothness, rate, and effort in speech production. All speakers are disfluent at times. They may hesitate when speaking, use fillers (“like” or “uh”), or repeat a word or phrase. These are called typical disfluencies or nonfluencies.
A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (ASHA, 1993). People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a).
Technically stuttering is just one type of disfluency, and it’s the most common one. Stuttering varies from person to person, and can include things like:
Sound repetitions (e.g., “do you like comic b-b-books?”)
Word (or part-word) repetitions (e.g., “My my my my favorite is Black Panther.”)
Prolongations (e.g., “What time does the mmmmmovie start?”)
Blocks (e.g., “I don’t kn….…ow if I can make it there.”)
Cluttering is a less-common type of disfluency. It centers on irregular speaking rhythm, rapid or atypical speaking speed, and excessive breakdowns in speech clarity and fluency. Additional characteristics of cluttering include:
Pauses within sentences that are not expected (e.g., “I will go to the… store and buy apples”)
Deletion and/or collapsing of syllables (e.g., “I wan-wat-evision” instead of “I want to watch television”)
Excessive levels of typical disfluencies such as revisions, interjections, filler words
Maze behaviors or frequent topic shifting (e.g., “I need to go to...I mean I’m out of cheese. I ran out of cheese and bread the other day while making sandwiches and now I’m out so I need to go to the store”)
Omission of word endings (e.g., “Turn the televis-off”)
Recognizing fluency and fluency disorders
When is stuttering considered disordered? There are a few things to consider when determining if a person’s disfluencies are typical or something a little more disruptive.The age when stuttering began, how long the person has been stuttering, and how frequently stuttering happens are important factors.
Other reasons to consider consulting with a speech-language pathologist regarding stuttering include, but are not limited to:
There is a family history of stuttering or cluttering.
There is parent/individual concern.
The person shows negative reactions to their disfluency.
The person is experiencing negative reactions from others (e.g., peers, classmates, family members).
The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency.
The person is having difficulty communicating messages in an efficient, effective manner.
Other speech or language concerns are also present.
This YouTube video is geared towards kids, but it contains a lot of useful information to give viewers an understanding of stuttering and what may cause it.
Treating fluency disorders
Speech-Language Pathologists (SLPs) conduct thorough evaluations before diagnosing and treating fluency disorders. A typical fluency evaluation should include the following:
Formal and informal testing to evaluate fluency
Measurement of type, frequency, and duration of the disfluencies
Observation of secondary characteristics and coping strategies (such as avoiding certain words, changing rate, decreased eye contact or engagement)
Input from the person who stutters on their feeling/attitude toward their disfluencies
Thorough case history and interview with the person who stutters and/or family
Testing of additional speech/language skills if more difficulties are suspected
Depending on the results of the evaluation and the initial reasons for evaluating (see previous section), the SLP may or may not recommend therapy. Therapy may not be recommended if:
The person who stutters is young (less than 5 years old) and stuttering recently began (within the last 6 months)
The disfluencies are mild and the person has no negative or adverse feelings about their stutter
The impact on the person’s life is minimal
Stuttering can be improved through monitoring (e.g., parent coaching, tips/tricks to deal with stuttering, infrequent consultations and follow-ups with the SLP)
Therapy may be warranted if:
The child or adult is older and stuttering has persisted for several months to years
The person shows negative feelings toward their stutter or avoids certain speaking situations, topics, words, and/or groups of people
General tricks and strategies have not worked to improve stuttering
Stuttering impacts the person’s ability to effectively communicate and be understood
Some of the goals of stuttering treatment include:
Increasing overall speech fluency
Improving the person’s understanding of their fluency and disfluencies
Lessening negative effects of stuttering on the person’s daily life
Recognizing when and where to use learned strategies to communicate effectively in all speaking situations
SLPs teach strategies for improving fluency, such as slowing rate of speech, using less tension in the voice and mouth movements, controlling breathing, easing out of moments of stuttering, etc. These strategies are practiced in gradually more complex utterances and more difficult situations. SLPs also educate about stuttering to improve understanding, and work to desensitize the person who stutters to their disfluencies and minimize negative reactions.
In some situations, SLPs may also use assistive devices that play noise or play back the speaker's voice in the ear with a slight delay. These devices have been shown to help some, but not all, people who stutter to speak more fluently. In young children, therapy may simply focus on teaching parents to model slow, smooth speech and provide feedback to children about their fluency.
If you have more questions about fluency disorders or suspect your child might have one, reach out to the Magic Speech Bus and I’d be happy to see how I can help you!