Fluency Disorders

Fluency is the smoothness, rate, and effort of speech. Fluency disorders occur when there is an interruption in any of those aspects of fluency. The most common fluency disorder is stuttering. Stuttering disrupts the fluency of speech in the form of repetitions, blocks, and prolongations. Repetitions can be at the sound level (e.g., P-p-p-please…), syllable level (e.g., Take a pic-pic-picture… ), word (e.g., “I got-got-got water…), or phrase level (I want- I want- I want some…). Blocks are the sensation of words getting stuck and the inability to make any sound. Prolongations are when a sound is held out longer than typical (e.g., Mmmmmy name is…). Physical behaviors in the body can also occur during stuttering. Some examples of physical (or secondary) behaviors include blinking eyes, clenching fists, and jerking of the head.  

Another fluency disorder is cluttering, which is disruption of the rate of speech. People with cluttered speech will use a rapid or irregular rate of speech which can greatly impact how well they are understood by others. People who clutter may leave out syllables or the ends of words (e.g., “I wanplayoputer” for “I want to play on the computer”). People who clutter may also pause during a sentence in a place that is not grammatically appropriate. 

What causes Fluency Disorders? 

Stuttering typically starts between the ages of 2 to 6 years old. Stuttering is most likely caused by family history/genetics, child development, brain differences, or neurophysiology. Many people who stutter have a family member who also stutters. Stuttering is more common in boys than in girls. Child development refers to any other underlying speech or language delays or disorders. Some studies suggest that there may be slight differences in the way the brain is wired in people who stutter. Stuttering can also occur due to damage to the brain, such as a stroke.  

The cause of cluttering is not yet known due to limited research. Cluttering can sometimes co-occur with neurological disorders such as Autism Spectrum Disorder, Tourette’s, and ADHD. 

When is speech therapy recommended for Fluency Disorders? 

Speech therapy can start as young as the age of two or three; however, it should be noted that developmentally typical dysfluencies can occur around this age due to the rapid growth of language skills. If these dysfluencies persist in young children longer than six months, therapy is recommended. If children start having blocks (words that get stuck and inability to get any sound out) or significant tension during stuttering events, then an evaluation is recommended. Speech therapy for stuttering and cluttering is also appropriate for older children and adults who are impacted by dysfluencies in their school, work, and/or social aspects of life 

What does therapy for Fluency Disorders involve? 

Your Speech-Language Pathologist will teach you or your child strategies for avoiding stuttering and getting out of a stutter when dysfluencies occur. These strategies are practiced at the word, phrase, sentence, and conversational level to ensure the strategies are understood and can be carried out outside of the therapy room. Therapy targets identifying and relaxing any tension that occurs during dysfluent speech. Speech therapy also involves pinpointing and discussing any emotions or behaviors that arise due to stuttering, such as avoiding or feeling anxious about certain social interactions.  

Therapy for cluttering involves regulating the rate and clarity of speech using various strategies. Therapy may also focus on volume, inclusion of all sounds and syllables, and increasing awareness of when communication breakdowns occur.