Fluency Disorders

Fluency:
- Speech is effortless in nature.
- Easy, rapid, rhythmical, even-flowing.
Disfluency:
- Marked by word or phrase repetitions, interjections, pauses, and revisions.
- Normal speakers produce disfluencies some of the time.

Stuttering:
- Unusual, tense disfluencies that interfere with communication.
- Most common form of fluency impairment.
Acquired/neurogenic stuttering:
- Adulthood, brain damage, or emotional trauma.
Cluttering:
- Rapid bursts of dysrhythmic, unintelligible speech.

Unusually high frequency or durations of repetitions, prolongations, and/or blocks (tense moments when voicing/air flow interrupted).
Excessive mental and physical effort to resume talking.
- Lose train of thought, focus on stuttering.
Negative perceptions of communication abilities.
- Low self-esteem.
- Internalize negative reactions of others.

Part-word repetitions:
- Syllables (with or without schwa vowel).
- Interjections (“uh”/ “um”).
- Phonemes (“baseb,b,b,ball”).
Prolongations:
- vvvvvvvvvvvan
Blocks:
- Silent prolongations.
- Get “stuck”.

Typical duration ~ 3 sec, can be longer.
Peaks and valleys of fluency --> frustration.
Pressure to be fluent --> greater dysfluencies.
May be fluent when:
- Singing.
- Using pretend voices.
- Talking to babies or animals.

Self-concept.
Language abilities.
Motor systems
- Voice Onset Time
Neurological differences:
- More activation in right hemisphere speech and language areas.
- More activation in the cerebellum.
- Less activation in left hemisphere speech and language areas.

Stuttering is a nervous reaction.
- General anxiety levels, relaxation therapies not effective.
- Increase anxiety may increase stuttering, not underlying cause.
Overly Sensitive Parents.
- Speech style and rate of speech.
- Parental anxieties, overprotectiveness.
- Overly critical?

Maintain reasonable eye contact.
Do not finish his or her words or sentences.
Do not interrupt.
Pay attention to what the person is saying, not how he or she is saying it.
Pause at least 1 second prior to responding.
Do not allow common stereotypes to override your opinion of the person who stutters.

Dynamic Relationships Between
- Inherited traits:
  - Temperament, cognitive abilities, language abilities, attention, perception, speech motor control.
- External conditions:
  - Parental Expectations, relationships with others, child-rearing practices, educational experiences.

Usually gradual - Sometimes develops suddenly.
Genetic predisposition - 15% first-degree relatives.
Balance between demands and capacities.
- Neurological development
- Language development
- Emotional constancy

An average of 3 or more sound repetitions, prolongations, or blocks per 100 words.
An average of 3 or more stuttering-like disfluencies (i.e., single-syllable-word repetitions, syllable repetitions, sound repetitions, prolongations, or blocks) per 100 words.
Seventy-two percent or more stuttering-like disfluencies per total disfluencies.
Twenty-five percent or more of the total disfluencies are prolongations or blocks.
Instances in which repetitions, prolongations, or blocks occur in adjacent sounds or syllables within a word.
Increases in the rate and irregularity of repetitions.
Signs of excess tension or struggle during moments of disfluency.
Secondary behaviors such as eye blinks, facial tics, or interjections immediately before or during disfluencies.
Feelings of frustration about disfluencies.

Chronic stuttering – continues from childhood into adolescence/adulthood.
Contributing factors:
- Negative feelings and attitudes (self-conscious, out of control).
- Avoidance (phonemes, situations).
- Difficulties with speech motor control (unusual breathing patterns).
- Difficulties with language formulation (phonology/semantics/syntax).

Non-stuttering disfluencies (phrase repetitions, revisions) vs stuttering disfluencies
Frequency of Stuttering
- 500 Total Words, 76 words were stuttered on. $(76/500) * 100 = 15.2$ %
Percentage of each disfluency type
- 76 words were stuttered on, 21 words contained sound prolongations. $(21/76) * 100 = 27.6$ % prolongations

Stuttering Modification
- Client is taught to stutter less and more easily.
- Speech is more natural.
- Considerable focus on attitudes and negative reactions to speaking situations.
Fluency Shaping
- Client is taught to have stutter-free speech.
- Loss of speech naturalness.
- Little to no attention given to attitudes, negative reactions, and so on.