What are Fluency Disorders?
Fluency disorders refers to a category of speech disorders that includes stuttering, most commonly, and cluttering. Both disorders typically begin in childhood, although later onset in school-age years or adolescence is also possible. More rarely, disruptions in fluency may be acquired after specific injury or disease to the central nervous system (e.g. stroke, head injury, tumors, degenerative disease, etc.) or as a side-effect of some medications.
Stuttering involves a disruption in the fluency (smooth, forward flowing movements) of speech, and is characterized by involuntary, audible or silent repetitions or prolongations when producing short elements of speech, such as sounds, syllables, and words of one syllable. These disruptions usually occur frequently or are marked in character and are not readily controllable. Sometimes the disruptions are accompanied by secondary behaviors in facial or unrelated body structures, by frequent interjections, or by stereotyped speech utterances. These secondary characteristics add to the impression of speech-related struggle or excessive effort. Other correlates of stuttering may include: unhelpful or negative cognitive and emotional reactions; and avoidance behaviors (including avoidance of sounds, words, and specific speaking situations), which may lead to participation restrictions and adverse impact on social, academic, and professional spheres.
Cluttering may lead to breakdowns in a speaker’s speech fluency and intelligibility due to a perceived rapid and/or irregular speech rate and any of the following characteristics: an excessive number of ‘typical’ disfluencies such as interjections, hesitations, or revisions; irregular prosody; reduced articulatory accuracy (particularly in multisyllabic words). Other correlates of cluttering may include: difficulty slowing down or changing one’s speech to be more intelligible, despite requests from listeners to do so; difficulty organizing comp lex verbal or written messages; and unhelpful or negative cognitive and emotional reactions, including possible avoidance and reduced confidence, surrounding specific speaking contexts.
Assessment of fluency disorders includes a comprehensive evaluation of speech fluency, motor and language factors, and emotional or attitudinal reactions. Client and family interviewing and self-report measures are utilized to determine the degree of potential impact on social relationships, academic participation, and job performance. Throughout the assessment process and when planning treatment, adjustments are made to ensure the use of linguistically and culturally appropriate stimuli that respect the capacities and values of the individual or family. Differential diagnosis helps determine the presence of co-existing disorders, and considers how these may influence the client’s fluency and communication as well.
Treatment for fluency disorders is tailored to each client’s goals and preferences for their speech and communication, following a comprehensive evaluation.
Treatment for preschool children is designed to reduce the frequency and severity of stuttering or cluttering behaviors, and prevent the development of a persistent fluency disorder. The early intervention treatment approach is based on evidence-based practices that consider current research, family values, and clinician expertise. All treatment plans for preschoolers utilize parent involvement in weekly sessions with home carryover activities, and may include subsequent specialized home maintenance programs.
Recommended treatments approaches for preschoolers may include:
- the Lidcombe Program of Early Stuttering Intervention;
- a Demands-Capacities Model based treatment;
- parent education;
- individualized treatment planning to meet the unique needs of the child and family.
School-age and adolescent treatment is aimed at reducing the severity of the speech impairment, while helping the child develop positive attitudes and feelings surrounding their speech and stuttering in order to prevent or ameliorate feelings of stigma and the potential for social and academic challenges.
Treatment for adults who stutter and clutter is similarly dynamic and multidimensional. The areas of treatment focus are largely determined by the client’s preferences and goals for their speech and communication. Possible goals for treatment may include improving speech fluency and reducing tension and struggle associated with stuttering, improving rate control and comprehensibility of speech, reducing the impact of stuttering or cluttering on the client’s life, improving communicative effectiveness, and encouraging self-supportive cognitive and emotional reactions.
Treatment methods for school-agers, adolescents, and adults will be adjusted for the age and maturity of the client, and may include:
- education about normal speech processes and physical aspects associated with stuttering or cluttering;
- exploration of physical, cognitive, and emotional reactions to stuttering or cluttering and identification of maladaptive or unhelpful responses;
- desensitization to stuttering or cluttering sensations and development of more helpful thoughts/feelings/physiological responses/communication behaviors;
- reduction of avoidances in social, academic, or professional speaking situations
- individualized teaching and generalization of speech management techniques (including individual fluency-shaping components, ERA-SM or PSP speech restructuring patterns, and modification skills);
- discussions and problem-solving surrounding speech related topics (such as bullying/teasing; self-advocacy with teachers, co-workers, and significant others in environment; dealing with relapse; oral reading assessments; giving presentations; etc).
- parent, family, and teacher involvement as appropriate.
An additional opportunity for teenagers who stutter and clutter is the Summer Intensive Workshop, which is a 1-week individual and group therapy intensive offered annually. See Special Programs for further details about this workshop.
Melissa Kokaly, MS, CCC-SLP - Lecturer and Supervisor, Fluency Unit Coordinator
Marty Nevdahl, MS, CCC-SLP - Senior Lecturer; Director of Clinical Education
Ludo Max, PhD, CCC-SLP - Associate Professor and Researcher
National Stuttering Association - information on local chapters; NSA workshops