Fluency and Fluency Disorders

Disfluency

Disruption in the forward flow of speech (can be normal or abnormal)

Fluency Disorder

Abnormal disfluencies (i.e., stuttering or cluttering)

Normal Disfluencies

• Whole word: “My, my ball went under the couch.”

• Whole Phrase: “I want, I want some ice cream.”

• Interjections: “er, uhm, uh” (not very frequent)

Atypical Disfluencies

• Sound prolongations: “Sssssally took my ball.”

• Unfilled pause/block: “I want (block) ice cream.”

• Part word/syllable repetition: “My i-i-i-ice cream”

• Incomplete/broken phrases; frequent interjections

Stuttering

• A disruption in the forward flow of speech, can take any forms and may be accompanied by . . .

  • physical tension and secondary behaviors

  • Negative thoughts/emotions

  • decreased communication skills

  • involuntary breakdowns affects all communication

    • e.g., respiration, phonation, articulation

Cluttering

• Fluency disorder; irregular speaking rate, excessive normal disfluencies, and excessive repetitions

  • may result in decreased speech intelligibility

  • may occur with and without stuttering

  • co-occur with: 

    • language and articulation disorders

    • attention problems and other disorders

Types of Stuttering

1. Childhood Onset Stuttering (most common type)

2. Psychogenic Stuttering (associated psych disorder)

3. Neurogenic Stuttering (nervous system damage)

Stuttering Etiology

unknown cause, multiple systems play a role (i.e., genetic, environmental, abnormal phonation system, etc.)

Stuttering Treatment

• many young children will recover from normal disfluencies on their own without treatment

• children under 6 years old - treatment outcomes are very good

• for children 7+ treatment shifts to more about management of symptoms and less about elimination

Young Children

• Parent education: reduce rate, use prompts rather than direct questions, reduce time pressures, and increase recasting and rephrasing

• Indirect strategies: changes made to the environment, not child’s speech (i.e., indirectly)

• Direct strategies: more direct and specific activities to change and help reduce the stutter

• Overall communication and speech therapy

Older Children

• Parent education

• Strategies: quality and quantity

• Stuttering modification: changing the way one stutters; modifying the stutter (i.e., quality)

  • identification, desensitization, modification, and stabilization

• Speech modification: changing the way one speaks; modifying speech (i.e., quantity)

• Overall communication and speech therapy