FLUENCY & STUTTERING DISORDERS

Disclaimer: I’ve incorporated and edited content pulled directly from the ASHA (American Speech-Hearing Association). My goal is to give parents a resource to use as a guide to determine if their child’s speech development is standard, or if they might need to consider hiring a Speech Therapist. Please visit this link for more detailed information.

Elyssa using toys for speech therapy

A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). 

Stuttering, the most common fluency disorder, is an interruption in the flow of speaking characterized by specific types of disfluencies such as: 

  • repetitions of sounds, syllables, and monosyllabic words (e.g.,
    “Look at the d-d-dog,” “Let’s go out-out-out”);

  • prolongations of consonants when it isn’t for emphasis (e.g.,
    “Ssssssstop doing that please”); and

  • blocks (i.e., inaudible or silent fixation or inability to initiate sounds).

These disfluencies can affect the rate and rhythm of speech, and may also be accompanied by

  • negative reactions to speaking

  • avoidance behaviors (i.e., avoidance of sounds, words, people, or situations that involve speaking)

  • escape behaviors, such as secondary mannerisms (e.g., eye blinking and head nodding or other movements of the extremities, body, or face)

  • physical tension

*Approximately 95% of children who stutter start to do so before the age of 4 years, and the average age of onset is approximately 33 months. Onset may be progressive or sudden. Approximately 88%–91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013).

Cluttering, another fluency disorder, is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). Individuals may exhibit pure cluttering or cluttering with stuttering (van Zaalen-Op’t Hof et al., 2009).

Breakdowns in fluency and clarity can result from

  • atypical pauses within sentences that are not expected syntactically (e.g., “I will go to the / store and buy apples”; St. Louis & Schulte, 2011),

  • deletion and/or collapsing of syllables (e.g., “I wanmilk”),

  • excessive levels of typical disfluencies 

  •  frequent topic shifting (e.g., “I need to go to...I mean I’m out of cheese. I ran out of cheese and bread the other day while making sandwiches and now I’m out so I need to go to the store”), and/or

  • omission of word endings (e.g., “Turn the televisoff”).

*Importance of Intervention:

The impact experienced from stuttering, or features of stuttering, may include

  • a sense of loss of control/cognitive dissociations

  • increased social anxiety

  • shame and guilt

  • negative thoughts/feelings about oneself and one’s communication abilities

  • feelings of perceived communication failures

  • decreased self-confidence/self-efficacy

  • a decreased sense of self-worth 

  • depression

  • avoidance of words/sounds, speaking, and social interactions

  • perceived judgment of communication by others 

  • perceived negative effects on social/romantic relationships

  • perceived communication and job barriers

Disclaimer: The communication milestones included in ASHA's "How Does Your Child Hear and Talk" products are currently being revised and will be published in 2023. Changes include (a) shorter timeframes and (b) evidence regarding the percentage of children demonstrating specific milestones.