Stuttering and Fluency

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, tumours, 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 behaviours in facial or unrelated body structures, by frequent interjections, or by stereotyped speech utterances. These secondary characteristics add to the impression of speechrelated struggle or excessive effort. Other correlates of stuttering may include: unhelpful or negative cognitive and emotional reactions; and avoidance behaviours (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 complex verbal or written messages; and unhelpful or negative cognitive and emotional reactions, including possible avoidance and reduced confidence, surrounding specific speaking contexts.

Assessment

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

Treatment for fluency disorders is tailored to each client’s goals and preferences for their speech and communication, following a comprehensive evaluation.