Connections: Speech and Language Therapy

Fluency

Speech-language pathologists (SLPs) use the term fluency to describe the qualities of typical, undisrupted speech production—smooth, continuous, steady, and effortless.

Everyone has trouble with fluency sometimes, like when you are nervous or stressed; you might hesitate, use filler words like "um," or repeat words/phrases while you speak. Those are examples of what we call "typical disfluencies," or disruptions in fluency that do not result from a primary speech, language, or fluency disorder.

There are many different types of fluency disorders, but they all cause disruptions in the flow of a person's speech due to irregularities in rate, rhythm, or effort. People often use the word stuttering or "stammering" to describe any disfluencies they hear, but it actually refers to a specific type of fluency disorder.

Continue reading below to learn more about stuttering and how we can help.

Stuttering is a type of fluency disorder characterized by three main speech behaviors: repeating single sounds or parts of words (repetitions), stretching sounds out (prolongations), or getting "stuck" and having trouble getting a word out (blocks). That said, there is more to stuttering than just interruptions in a person's speech.

Talking is hard work for a person who stutters; it can cause physical strain and tension and be mentally draining. People who stutter often associate negative emotions—like anxiety—with speaking and might avoid events or scenarios in which they will need to speak or those they know will trigger their stuttering.

There is more than one type of stuttering:

Developmental stuttering–this is the most common type of stuttering. It is set apart because it appears during childhood, typically between ages 2 and 6. For some, it can gradually worsen and continue into adolescence and adulthood.
Acquired fluency disorders– this is an umbrella term for rare types of stuttering that develop outside of childhood due to neurological or psychological factors.

Signs & Symptoms

Stuttering disorders can vary by type—classified by distinct speech characteristics—and severity, ranging from mild to profound. It is also important to note that stuttering is not constant; the severity of symptoms often fluctuates throughout the day or across different situations. Below is a list of speech characteristics and other behaviors associated with stuttering:

Speech characteristics:
- Repetitions of single sounds and syllables, or one-syllable words– "th-th-th-thank you."
- Prolongations of single sounds– "I'm ssssssssorry
- Blocks (or stops) before or between words- "I c- (pause) can't go."
Other Behaviors:
- Escape behaviors are habits that people who stutter form while trying to stop, or escape, a stutter and finish a word.
  - They might blink their eyes, nod their head, shift their body weight, or more.
- Avoidance behaviors are habits that people who stutter form by trying to anticipate when they will stutter and avoid it.
  - They might choose words that won't trigger their stuttering, frequently use filler words like "uh," or avoid speaking altogether.
- Physical tension and strain while speaking
- Negative feelings and emotions about speaking and stuttering.

Causes

Despite decades of research, there is still a lot we do not know about the nature of stuttering. In particular, we have yet to uncover what exactly happens in the brain– what causes the breakdown– during the act of stuttering. Because of such knowledge gaps, we do not fully understand the causes of fluency disorders. That said, the research does indicate some possible causes, as well as potential risk factors for stuttering:

Possible Causes

Developmental stuttering–instead of having a single root cause, developmental stuttering is likely caused by a combination of genetic factors and differences in brain structure. It is also associated with risk factors that seem to increase the likelihood that stuttering will persist past childhood.
Acquired Fluency Disorders– Unlike developmental stuttering, acquired fluency disorders are symptoms of other conditions; however, we do not know why only some individuals with those conditions start to stutter while others do not. Here are some examples:
- Neurogenic stuttering– occurs as a symptom of brain diseases or damage, including head trauma, stroke, tumors, drug toxicity, and degenerative diseases like dementia.
- Psychogenic stuttering– occurs due to prolonged stress, a psychologically traumatic event, or other psychological conditions, including post-traumatic stress disorder (PTSD).

Risk Factors

As mentioned, certain factors might increase the likelihood that developmental stuttering will emerge or persist past childhood; they include:

Family history– people who stutter often have family members who also stutter; their risk of persistent stuttering increases if those relatives stuttered past childhood.
Sex- male children are more likely to start stuttering and continue stuttering into adolescence or adulthood.
Age of onset- or the age at which a child begins to stutter. If the onset of stuttering occurs at age 3½ or older, it is more likely to persist.

How We Help

Diagnosis

Only a qualified speech-language pathologist (SLP) can diagnose fluency disorders, but a medical doctor or psychologist must determine the underlying cause of an acquired fluency disorder. That said, you do not need a referral from a doctor to request an appointment with us. Our licensed SLP can conduct a free screening to check your speech fluency, then help you make an appointment with a doctor if needed.

A screening will also help the SLP decide if she needs to complete a full diagnostic examination, which could include the following:

Questions about your developmental, medical, and family histories
Recording audio or video speech samples for analysis
Instrumental assessments of stuttering to observe the frequency, type, and duration of disfluencies in your speech
Questionnaires regarding your feelings and emotions towards stuttering and the impacts of stuttering on your daily life

The SLP will also ask you questions about the problems you encounter, the areas you feel you need to work on, the goals you would like to accomplish in therapy, and more. She will combine all that information and use it to help determine a diagnosis, as well as recommendations for treatment and care.

Treatment

There are many ways to approach stuttering therapy, and the treatment you need will depend on the type and severity of stuttering you have. At Connections: Speech and Language Therapy, our SLP will customize your treatment according to your preferences, goals, and areas of concern. After completing a comprehensive evaluation, she will create and provide you with a personalized treatment plan that best addresses your fluency disorder.

During therapy, our SLP will guide you through tasks, activities, and exercises carefully designed to target and help you overcome the challenges of stuttering. She will also provide instructions for exercises, strategies, and modifications that you, or your loved ones, can use at home to help reduce problems that occur in daily life.

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