comd 475 PP5a Differential Diagnosis: Stuttering, Cluttering & Other Types of Fluency Disorders

Types of Fluency Disorders 

• Normal disfluencies

• Developmental stuttering

• Acquired stuttering

• Other types of Stuttering

Normal adult disfluency

This is momentary repetitions, revisions, and pauses in the speech, especially when the speaker is in a hurry or uncertain

Normal childhood disfluency

These are still developing speech and language and may show repetitions, revisions, and pauses, which are not stuttering.

Developmental stuttering

This refers to typical stuttering. The disfluency symptoms usually appear gradually, during the period of greatest speech and language development

Major features for assessment

1. The amount (frequency, %) of disfluency

2. The number of units in repetitions and interjections

3. The type of disfluency in relation to the child’s age (Danger signs: excessive repetition, prolongation, blocks; schwa vowels, dysrhythmic, etc. ) 

4. The duration of prolongation (1 second or longer)

5. The presence of secondary behaviors

6. The awareness, feelings, and attitudes

Predictors of Chronicity (Riley, 1991)

• Excellent predictors

• Good predictors

• Poor predictors

Excellent predictors of chronicity

These are are phonatory arrest and articulatory posturing

Good predictors of chronicity

These are prolongations lasting for more than 2 seconds

Poor predictors of chronicity

These are the frequency of total disfluencies and parents’ negative reactions to the child’s disfluencies.

Stuttering

Cluttering

Neurogenic stuttering

Onset/development of psychogenic stuttering

This begins late, is sporadic, and has a history of fluency

Psychogenic stuttering

This comes about due to some sort of unclear emotional trauma and is not speech or language based.

Cognitive and emotional aspects of psychogenic stuttering

The client seems to be highly aware and may not be bothered

Speech abilities, language processing, and behavioral characteristics of psychogenic stuttering

These are uneventful and have little knowledge

Manual/sign language stuttering

These are repetition and prolongation while signing (sign language)

Flute/horn/trumpet stuttering

(Musical Instrument ) - getting stuck in a certain part of the music. 

(Meltzer, 1992; Silverman & Bohlman,1988)

Characteristics of stuttering in sign language

1. Inconsistent interruptions in sign and finger-spelling.

2. Stuttering symptoms most often occur at the initiation of a gesture.

3. Hesitation of sign movement.

4. Repetition of sign movement while keeping the original handshape.

5. Exaggerated Signs / "Prolonged" Signs.

6. Unusual body movements completely unrelated to linguistic communication.

7. Poor fluidity of the sign.

8. Inappropriate muscular tension (in the arms and hands) associated with signing.