Case Studies in Fluency Disorders

Background: Bright social grader referred due to increased quietness and avoidance of speaking in group activities.
Speech Behaviors:
- Part-word repetitions and prolongations with increasing pitch and tension.
- Examples: "sometimes I want."
- Secondary behaviors: blinking, head nodding, word substitutions (e.g., "same bike" instead of "scooter").
Avoidance: Avoids speaking in situations where he anticipates stuttering.
Impact: Class participation is significantly impacted.
Emotional State: Expresses embarrassment and helplessness.
Level: Intermediate stuttering.

Background: Talkative, curious three-year-old with recent "bumpy speech."
Speech Behaviors:
- Occasional part-word repetitions (e.g., "mum mum mummy").
- Interjections (e.g., "um").
- Revisions (e.g., "I want I want the red one").
- Frequency: 5-7 disfluencies per 100 words, especially when excited or tired.
Secondary Behaviors: None observed.
Awareness: Generally relaxed, confident, and unaware of any difficulty.
Teacher Report: No concerns reported.
Language Skills: Expressive language within age expectations.
Parental Concern: Parents are more concerned than Ava or her teacher.
Level: Normal fluency/typical disfluencies.

Background: Student seeking help due to stuttering limiting opportunities, particularly in formal settings.
Speech Behaviors:
- Sound and syllable repetitions, prolongations, and tense blocks lasting 3-5 seconds.
- Subtle tremors in jaw and lips during emotional topics.
Covert Strategies:
- Scanning ahead for "safe words."
- Avoiding his name.
- Rarely initiating speech in class.
Secondary Behaviors:
- Blinking, throat clearing, jaw shifting, finger tapping during blocks.
Avoidance: Avoids situations like ordering food or talking on the phone.
Emotional State: Deep shame, anxiety, and frustration; feels like his voice disappears when needed.
Motivation: Motivated to work on his speech to achieve his goals.
Self-Concept: Strong negative self-concept.
Age Range (Inferred): Late teens.
Level: Advanced stuttering.

Background: Four and a half years old, previously an eager talker, now with more effortful speech.
Speech Behaviors:
- Rapid, tense repetitions (e.g., "banana").
- Abrupt syllable repetitions with a schwa vowel (e.g., "open").
- Tension in face and around mouth during disfluency.
Secondary Behaviors:
- Frequent eye blinks and squeezing.
- Slight head nods.
Awareness: Appears aware of difficulty; says "I can't say it" or changes topic.
Language Skills: Age-appropriate language skills.
Level: Beginning stuttering.

Background: Three and a half years old, referred by pediatrician after parents reported fluency concerns.
Speech Behaviors:
- Frequent part-word and whole-word repetitions (e.g., "I I want that and").
- Repetitions are loose and relaxed, without physical tension.
- Disfluency rate: High, around $23$ disfluencies per 100 words, varying with topic and excitement.
Secondary Behaviors: None noted.
Awareness: Does not blink or show visible physical effort; seems unaware of disfluencies.
Fluency Variation: Disfluencies come and go; some days fluent, others not, especially when excited or tired.
Development: Language, articulation, and cognitive development are age-appropriate; socially engaged and outgoing.
Level: Borderline stuttering.

Number of Disfluencies: Nora exhibits a significantly higher number of disfluencies compared to Ava.
Recent Onset: Nora's disfluencies have appeared more recently.