Fluency

Definition

The following information is remixed from ASHA:

A “fluency disorder” refers to the intrusion or repetition of sounds, syllables, and words; prolongations of sounds; avoidance of words; silent blocks; or inappropriate inhalation, exhalation, or phonation patterns. These patterns may also be accompanied by facial and body movements associated with the effort to speak. Fluency patterns that are attributed only to dialectical, cultural, or ethnic differences or to the influence of a foreign language must not be identified as a disorder.

Cluttering is another form of fluency disorder less commonly identified. Cluttering is perceived as a rapid/irregular rate of speech containing unnatural pauses, difficulties with pragmatics and straightforward expression of information, limited awareness of disfluencies, breakdown of multisyllabic words, and difficulty with clarity and fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). Individuals may experience cluttering exclusively, or along with another fluency disorder (van Zaalen-Opt Hof et al., 2009).

Eligibility Criteria

The following criteria are taken from the Minnesota Department of Education and Legislature (Minnesota Revisor, 2007).

A pupil has a fluency disorder and is eligible for speech or language special education when:

1. the pattern interferes with communication as determined by an educational speech language pathologist and either another adult or the pupil; and
2. disfluent behaviors occur during at least five percent of the words spoken on two or more speech samples.

Characteristics

A variety of disfluencies can be present in any speaker’s messages. There are two types of disfluencies: Typical Type disfluencies, which are typical in the speaker’s messages, and Stuttering Type disfluencies, which are atypical in conversation. Throughout the disfluency types listed below, the phrase “I’m going” will be used as the example phrase.

The following disfluencies are categorized as Typical Type disfluencies:

• Hesitations (silent pauses)
• Interjections of sounds, syllables, or words (i.e., “um,” “like”)
• Revisions of phrases or sentences (i.e., “I’m going… I went…”)
• Phrase repetitions (i.e., “I’m going I’m going”)
• Monosyllabic word repetitions – two or fewer (i.e., “I’m I’m”)
• Part-word syllable repetitions – two or fewer (i.e., “go-going”)

The following disfluencies are categorized as Stuttering Type disfluencies:

• Monosyllabic word repetitions — three or more (i.e., “I’m I’m I’m…”)
• Part-word syllable repetitions (“I’m go-go-going”)
• Sound repetitions (i.e., “g-g-going”)
• Prolongations (i.e., “I’mmm going”)
• Blocks (i.e., “I’m – going”)
• Interjections — three or more (i.e., “Um um um I’m going”)
• Phrase repetitions — three or more (i.e., “I’m going I’m going I’m going)
• Increased tension noted (i.e., tremor of lips or vocal tension)
• Other

Stuttering-type disfluencies may also be accompanied by secondary behaviors, which are subconscious acts performed by the speaker to help aide in their fluency. This can be experienced as physical changes such as a hard eye-blink, a deep breath, or a snap of the fingers.

Higher frequency of stuttering may occur when the student is experiencing heightened emotions (i.e., anger, excitement, stress) or when experiencing self-consciousness or pressure.

The following information is remixed from the Stuttering Foundation:

It is found that stuttering begins during heightened periods of speech-language development, typically between ages two to five. As children are growing in their verbal output, their efforts combined with the normal stresses of growing up may be antecedents to brief repetitions, hesitations, and other characteristics of early stuttering and typical disfluency. For most children, stuttering qualities will gradually disappear, but for some, their stuttering will continue. If the child begins to demonstrate physical exertion during speech or frustration with their fluency, it is recommended that an SLP be sought out.

There are several types of stuttering that an SLP will consider during an evaluation, including Developmental stuttering, Neurogenic stuttering, Psychogenic stuttering, and Cluttering.

• Developmental stuttering occurs during periods of rapid brain growth, as there is a higher likelihood of experiencing stuttering while speaking. Often, students between the ages of two and five will experience heightened disfluencies that will fade over time. As a child grows in their language skills, they are interested in producing sentences that may be more advanced than what they have mastered. Therefore, their message may lag behind the speed of their speaking rate.
• Neurogenic stuttering – This form of stuttering occurs following a significant physical change to the brain (i.e., stroke, brain injury). This occurs due to a motor planning impairment.
• Psychogenic stuttering – This form of stuttering is associated with trauma and other mental health disorders. This often appears as rapid repetition of initial words in a message.
• Cluttering – This form of stuttering is perceived as fast, unclear, and disorganized. The speaker’s messages may have atypical or excessive breaks in their flow of speech and seem as though the speaker is having difficulty formulating their thoughts.

Stuttering Foundation

Etiology and Risk Factors

For many people who struggle with fluency, the etiology is unknown. It has, however, been found that there is a genetic component to stuttering, which is more commonly found in males than females. Stuttering has also been linked to congenital brain damage.

There are various factors that may negatively impact someone’s fluency in speech.

• Fast-paced/high pressure environments
• Fast-paced conversation and frequent interruptions
• Traumatic experiences such as death, family conflict, bullying, etc.
• Major life changes such as moving homes, new school, etc.
• High expectations by oneself, a teacher, parent, etc.
• Heightened sensitivity and/or competitiveness
• Performance anxiety
• Temperament that easily becomes frustrated or upset

(Yaruss, J.L., Coleman, C., & Hammer, D., 2006)

In 2018, Brinley and Ellis found that stuttering has also been found to co-occur with other disorders, including the following:

• Attention-deficit/hyperactivity disorder (Donaher & Richels, 2012; Lee et al., 2017)
• Autism spectrum disorder (Briley & Ellis, 2018)
• Intellectual disability (Healey et al., 2005)
• Language or learning disability (Ntourou et al., 2011)
• Seizure disorders (Briley & Ellis, 2018)
• Social anxiety disorder (Brundage et al., 2017; Craig & Tran, 2014; Iverach et al., 2018)
• Speech sound disorders (St. Louis & Hinzman, 1988; Wolk et al., 1993)
• Other developmental disorders (Briley & Ellis, 2018)

(ASHA, n.d.)

Bilingual Considerations

For students learning two languages, disfluencies can occur in a variety of ways, which are considered as more typical-type disfluencies:

• Switching vocabulary in a sentence is typical; however, it may cause an increase in disfluencies temporarily.
• Having word-finding difficulties can increase typical speech disfluency.

It is important to note that having two languages in the home does not cause stuttering. Often, if the student is expressing stuttering-type disfluencies in the second language, it is likely that they are also expressing stuttering-type disfluencies in their first language. If you suspect that your student is stuttering, reach out to your SLP for resources and consideration of next steps.

Special Considerations

Often, team members such as the school counselor, social worker, speech-language pathologist, and parents will be involved to consider the child’s emotions, as negative emotions can frequently be experienced. The goal is to continue supporting the child in a positive way and to keep them talking. Classroom education can occur as necessary to support the child and their social-emotional well-being.

Team Interventions and Support

There are several ways to support your student outside the speech room. This could be provided by any adult who works with the student.

• Wait time – Do not finish their sentences for them.
• Visuals for fluency strategies
• Model slow speech.
• Provide pressure-free opportunities for the student to speak.