Section 11: Fluency and Fluency Disorders

Normal vs. Disordered, Stuttering and Cluttering

Disfluency

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

Fluency Disorder

Abnormal disfluencies (i.e., stuttering, 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: ssssssally took my ball.

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

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

• Incomplete/broken phrases; frequent interjections

Stuttering

• A disruption in the forward flow of speech

  • 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

• Excessive repetitions

  • May result in decreased speech intelligiblity

  • May occur with and without stuttering

  • Co-occurs with:

    • Language and articulation disorders

    • Attention problems and other disorders

Types of Stuttering

• Childhood onset stuttering (most common type)

• Psychogenic stuttering (associated psych disorder)

• 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

  • 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

  • Modify 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