Fluency

---

Definition of Stuttering

In science, one often uses a norm from which to measure changes. Stuttering is a change from one norm, fluency. Despite our use of fluency as a norm in research and therapy, there is no clear definition of fluency. Still, people seem to know it when they experience it or hear it. Frequently, fluency is defined within the context of or as a comparison to stuttering, disfluency or some other non‐fluent behavior. It is rare that fluency is defined or studied only in the normally fluent population. Many fluency‐inducing conditions have been described (Andrews, Howie, Dozsa, & Guitar,1982), but the absence of stuttering does not mean fluency in the broadest sense. Automaticity, naturalness, tension‐free, and effortless flow have also been attached to our understanding of fluency. Other forms of fluency, such as “fluent stuttering” and “fragile fluency” (Manning, 2001) have been embraced. The termfluency may also encompass communicative clarity, competency, efficiency or effectiveness (ASHA, 2016)

The cause of stuttering remains elusive. As such, treatment is generally directed at alleviating symptoms of the disorder. Stuttering treatment outcomes are typically focused at reducing the overall number of stuttering episodes; producing natural and automatic sounding speech and speech rate; normalizing abnormal speech attitudes; and reducing the duration of stuttering episodes (Bloodstein, 1995).

Recent studies suggest that genetics plays a role in the disorder. It is thought that many, if not most, individuals who stutter inherit traits that put them at risk to develop stuttering. The exact nature of these traits is presently unclear. Whatever the traits are, they obviously impair the individual's ability to string together the various muscle movements that are necessary to produce sentences fluently (ASHA, 2016).
Not everyone who is predisposed to stutter will develop the disorder. For many, certain life events are thought to "trigger" fluency difficulty. One of the triggers for developmental stuttering may be the development of grammar skills. Between the ages of 2 and 5 years, children learn many of the grammatical rules of language. These rules allow children to change immature messages ("Mommy candy") into longer sentences that require coordination to produce fluently ("Mommy put the candy in my backpack"). A child who is predisposed to stutter may have no difficulty speaking fluently when sentences are only one or two words long. However, when the child starts trying to produce longer, more complex sentences, he or she may find himself or herself not quite up to the challenge-and disfluent speech results.

Types of Stuttering Patterns

• W- W- W- Where are you going?" (Part-word repetition: The person is having difficulty moving from the "w" in "where" to the remaining sounds in the word. On the fourth attempt, he successfully completes the word.)
• "SSSS ave me a seat." (Sound prolongation: The person is having difficulty moving from the "s" in "save" to the remaining sounds in the word. He continues to say the "s" sound until he is able to complete the word.)
• "I'll meet you - um um you know like - around six o'clock." (A series of interjections: The person expects to have difficulty smoothly joining the word "you" with the word "around." In response to the anticipated difficulty, he produces several interjections until he is able to say the word "around" smoothly.) (ASHA, 2016)

Cluttering 

The definition of cluttering adopted by the fluency disorders division of the American Speech-Language-Hearing Association is: Cluttering is a fluency disorder characterized by a rapid and/or irregular speaking rate, excessive disfluencies, and often other symptoms such as language or phonological errors and attention deficits. To identify cluttering, you must listen to nonstuttered speech of the speaker. Evidence for a fluency disorder (one that is not stuttering) and excessive disfluencies, would be present in a speaker who meets all of the following:

• Does not sound "fluent," that is, does not seem to be clear about what he or she wants to say or how to say it.
• Has excessive levels of "normal disfluencies," such as interjections and revisions.
• Has little or no apparent physical struggle in speaking.
• Has few if any accessory (secondary) behaviors.

A rapid and/or irregular speaking rate would be present in a speaker who has any or all of the following:

• Talks "too fast" based on an overall impression or actual syllable per minute counts.
• Sounds "jerky."
• Has pauses that are too short, too long, or improperly placed. (ASHA,2016)

Stuttering and ADHD

It has been estimated that as many as 45% of children with ADHD have some form of speech and language impairment (Tirosh & Cohen, 1998). The most common deficits include: impaired social skills, reduced ability to problem solve, auditory processing issues, limited ability to extract detailed information, and becoming fixated on specific topics (Michon, 1999).
Many other disorders that are linked to ADHD can have a significant effect on one's ability to organize and formulate thoughts and ideas. These include: anxiety disorders, major depression, and conduct disorder.