Theme - Fluency Disorders (General Overview)
Definition/Description
As defined on the ASHA website, Fluency is the aspect of speech production that refers to continuity, smoothness, rate, and effort. Stuttering, the most common fluency disorder, is an interruption in the flow of speaking characterized by repetitions (sounds, syllables, words, phrases), sound prolongations, blocks, interjections, and revisions, which may affect the rate and rhythm of speech. These disfluencies may be accompanied by physical tension, negative reactions, secondary behaviors, and avoidance of sounds, words, or speaking situations (ASHA, 1993; Yaruss, 1998; Yaruss, 2004). Cluttering, another fluency disorder, is characterized by a perceived rapid and/or irregular speech rate, which results in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011).
All speakers have disfluencies. One typical disfluency is the insertion of the word "uh" in sentences (i.e. - I think uh it's a lion). Another typical disfluency is a whole word repetition like in this phrase "But, but it is not time to go to school" Phrase repetitions are also common disfluency errors that typical speakers may produce (I will eat, I will eat my vegetables later). An excessive number of typical disfluencies can often be associated with word finding difficulties.
Less typical fluency errors are part-word repetitions or syllable sound repetitions (i.e. - I-I-I want to g-g-go to the store today). Another less typical error is called a prolongation like in the following example (S-s-s-s-s-so many people like to go to amusement parks). Finally, the use of an inaudible block is an atypical fluency error. It can present itself when a person tries to start a conversation. Stuttering behaviors are accompanied with more stress, tension and effort.
Signs and Symptoms
Signs and symptoms of stuttering include primary behaviors, such as
These signs and symptoms are consistent with the diagnostic criteria for childhood-onset fluency disorder (stuttering) listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013).
Frequency and severity of stuttering may fluctuate from day to day and in relation to the speaking situation. Stuttering is often more severe when there is increased pressure to communicate (e.g., competing for talk time, giving a report at school, interviewing for a job).
Secondary, avoidance, or accessory behaviors that may impact overall communication include
Role of a Speech Language Pathologist
Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders in children. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), advocacy, education, administration, and research.
How a parent can help
The Stuttering Foundation (September 2018) recommends seven things parents can do to help their child who stutters.
Referrals to a SLPASHA (September 2018) stated that “Individuals suspected of having a fluency disorder are referred to a speech-language pathologist (SLP) for a comprehensive assessment. A thorough assessment focuses on components known to accompany fluency disorders (e.g., affective, behavioral, cognitive, and others). When in doubt about the severity, causes, types of interventions, and how to help your child, please contact a licensed Speech Language Pathologist.
As defined on the ASHA website, Fluency is the aspect of speech production that refers to continuity, smoothness, rate, and effort. Stuttering, the most common fluency disorder, is an interruption in the flow of speaking characterized by repetitions (sounds, syllables, words, phrases), sound prolongations, blocks, interjections, and revisions, which may affect the rate and rhythm of speech. These disfluencies may be accompanied by physical tension, negative reactions, secondary behaviors, and avoidance of sounds, words, or speaking situations (ASHA, 1993; Yaruss, 1998; Yaruss, 2004). Cluttering, another fluency disorder, is characterized by a perceived rapid and/or irregular speech rate, which results in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011).
All speakers have disfluencies. One typical disfluency is the insertion of the word "uh" in sentences (i.e. - I think uh it's a lion). Another typical disfluency is a whole word repetition like in this phrase "But, but it is not time to go to school" Phrase repetitions are also common disfluency errors that typical speakers may produce (I will eat, I will eat my vegetables later). An excessive number of typical disfluencies can often be associated with word finding difficulties.
Less typical fluency errors are part-word repetitions or syllable sound repetitions (i.e. - I-I-I want to g-g-go to the store today). Another less typical error is called a prolongation like in the following example (S-s-s-s-s-so many people like to go to amusement parks). Finally, the use of an inaudible block is an atypical fluency error. It can present itself when a person tries to start a conversation. Stuttering behaviors are accompanied with more stress, tension and effort.
Signs and Symptoms
Signs and symptoms of stuttering include primary behaviors, such as
- monosyllabic whole-word repetitions (e.g., "Why-why-why did he go there?"),
- part-word or sound/syllable repetitions,
- prolongations of sounds,
- audible or silent blocking (filled or unfilled pauses in speech),
- words produced with an excess of physical tension or struggle.
These signs and symptoms are consistent with the diagnostic criteria for childhood-onset fluency disorder (stuttering) listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013).
Frequency and severity of stuttering may fluctuate from day to day and in relation to the speaking situation. Stuttering is often more severe when there is increased pressure to communicate (e.g., competing for talk time, giving a report at school, interviewing for a job).
Secondary, avoidance, or accessory behaviors that may impact overall communication include
- distracting sounds (e.g., throat clearing, insertion of unintended sound);
- facial grimaces (e.g., eye blinking, jaw tightening);
- head movements (e.g., head nodding);
- movements of the extremities (e.g., leg tapping, fist clenching);
- sound or word avoidances (e.g., word substitution, insertion of unnecessary words, circumlocution);
- reduced verbal output due to speaking avoidance;
- avoidance of social situations;
- fillers to mask moments of stuttering.
Role of a Speech Language Pathologist
Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders in children. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), advocacy, education, administration, and research.
How a parent can help
The Stuttering Foundation (September 2018) recommends seven things parents can do to help their child who stutters.
- Speak with your child in an unhurried way, pausing frequently. Wait a few seconds after your child finishes speaking before you begin to speak. Your own slow, relaxed speech will be far more effective than any criticism or advice such as "slow down" or "try it again slowly.
- Reduce the number of questions you ask your child. Children speak more freely if they are expressing their own ideas rather than answering an adult's questions. Instead of asking questions, simply comment on what your child has said, thereby letting him know you heard him.
- Use your facial expressions and other body language to convey to your child that you are listening to the content of her message and not to how she's talking.
- Set aside a few minutes at a regular time each day when you can give your undivided attention to your child. During this time, let the child choose what he would like to do. Let him direct you in activities and decide himself whether to talk or not. When you talk during this special time, use slow, calm, and relaxed speech, with plenty of pauses. This quiet, calm time can be a confidence-builder for younger children, letting them know that a parent enjoys their company. As the child gets older, it can be a time when the child feels comfortable talking about his feelings and experiences with a parent.
- Help all members of the family learn to take turns talking and listening. Children, especially those who stutter, find it much easier to talk when there are few interruptions and they have the listeners' attention.
- Observe the way you interact with your child. Try to increase those times that give your child the message that you are listening to her and she has plenty of time to talk. Try to decrease criticisms, rapid speech patterns, interruptions, and questions.
- Above all, convey that you accept your child as he is. The most powerful force will be your support of him, whether he stutters or not.
Referrals to a SLPASHA (September 2018) stated that “Individuals suspected of having a fluency disorder are referred to a speech-language pathologist (SLP) for a comprehensive assessment. A thorough assessment focuses on components known to accompany fluency disorders (e.g., affective, behavioral, cognitive, and others). When in doubt about the severity, causes, types of interventions, and how to help your child, please contact a licensed Speech Language Pathologist.
