Fluency and Stuttering

Christy H. Collins, M.Ed., CCC-SLP

Stuttering Defined

Stuttering is a speech fluency disorder characterized by disruptions in the production of speech sounds that impedes communication when the speaker produces too many of them. The disruptions of speech are also referred to as “dysfluencies”. Dysfluencies occur as repeated words, phrases, or preceded by “um” or “uh”. Onset begins during childhood and may last throughout life.

A technical definition of stuttering: The inability to move forward in the forward flow of speech (Moore, 1987). Stuttering may involve getting stuck, hesitating, repeating, or tensing in some way while speaking.

Levels of Speech Fluency

Stuttering

Dysfluent speech:

•Blocks, hesitations

•Discoordination of jaw, lips, and tongue

•Poor rhythm, timing, stress, and intonation

•Poor breath support

Secondary characteristics:

•Facial grimaces, inappropriate body movements

•Using fillers, starters, and avoidance of certain sounds

•Lack of eye contact

Controlled Speech

Levels of Speech Fluency

Full breath

Breath and speech together

Talking in breath groups

Stretchy onset/loose contact

Regulated rate

Continuous vocal phonation

Pause often

Minimizing consonants

Maximizing vowels

Reduced loudness and effort

Block corrections

Eye contact

Body still/Hands in lap

Correct proxemics

Levels of Speech Fluency

Fluent Speech

Regular speech

Automatic smooth speech with minimal disruptions

Absence of timing, stress, intonation, or rhythm difficulties in speech

Coordination of language and motor speech

Risk Factors

A family history of stuttering

Stuttering that has continued for 6 months or longer

Presence of other speech or language disorders

Strong fears or concerns about stuttering on the part of the child or the family

Stuttering Diagnosed

Case history

Interview

Assess the number and types of speech dysfluencies produced in various situations

Assess the reaction and coping methods with dysfluencies

Gather information about factors that make stuttering worse

A variety of other assessments (e.g., speech rate, language skills)

Stuttering Diagnosed

Perceptions of Stuttering Inventory developed by Dr. Gerald Woolf. British Journal of Disorders of Communication, 1967, 2, 158-177.

Fluency Assessment Checklist. David A. Daly. LinguiSystems, Inc., 1996.

Stuttering Prediction Instrument, Ages 3-8 (SPI). Glyndon D. Riley.

Stuttering Severity Instrument for children and Adults, Third Edition (SSI-3). Glyndon D. Riley.

Tips for SLPs

1. Maximize the involvement of parents and teachers through education, modeling and direct practice.

2. Collect baseline stuttering data. It may be necessary for the parent or teacher to provide taped speech samples.

3. Require the student to exaggerate and use target speech both inside and outside the therapy setting.

4. The stutterer must practice any newly learned speech pattern conscientiously, with deliberation and awareness so that it becomes automatic.

5. Validate the aspects of the student’s “normal” speech and language such as, grammar, articulation, voice quality, “manners”, etc. so the student’s perception of his/her communication pattern is not “stuttering skewed”. Fluency is only one parameter of the speaking pattern.

Tips for SLPs

6. Set up reinforcement and rewards schedules

7. Be patient with the student who stutters. Changing fluency patterns is hard work.

8. Strive to maintain a “fluency friendly” environment. Reduce excessive noise and overstimulation.

9. Provide models of rhythmic speech even if the student is speaking well.

10. Know that you are a significant mentor for the student who stutters. Often, just knowing that there is a place to go to talk freely is gratifying for the student. The majority of some sessions may involve listening and supporting the student!

Stuttering Resources

•American Speech-Language Hearing Association

•National Stuttering Association

•Stuttering Home Page Chat Room

•University of Wisconsin Family Village Stuttering Page

•Stuttering Home Page

•Stuttering Foundation of America

•International Stuttering Association

References

American Speech-Language Hearing Association (ASHA). Stuttering. Characteristics, causes, and treatment of stuttering. Includes information on normal dysfluencies and links to further information on stuttering.http://www.asha.org/public/speech/disorders/stuttering.htm - 16.1KB - ASHA Web Site 27 Jun 07

Moore, S. (1987). Effects of Echoic, Short-Term and Long-Term Memory on Validity and Reliability of Self-Identification of Authentic and Simulated Stuttering. Unpublished doctoral dissertation, University of Southern California, Los Angeles.

Farley, Alice Anne G., M.Ed., CCC-SLP, BRS-FD (2006). Color Me Fluent Fluency Program. Super Duper Publications.