Fluency Disorders

Understanding Fluency Disorders

Speech tasks that we take for granted every day - ordering from a restaurant, introducing ourselves, or reading aloud - can sometimes be challenging for individuals dealing with fluency disorders such as stuttering and cluttering.

Fluency disorders are more common in toddlers and youth, but can affect individuals at any stage of life [1].

There are several factors that are thought to be main contributors to disfluent speech - (a) family genetics, (b) the functioning of several areas of the brain, namely the basal ganglia, (c) co-occurring language or developmental disorders, and (d) high-pressure family dynamics.

The term 'fluency disorders' represents a group of speech disorders that interfere with the smooth flow of speech. The two most well-known fluency disorders are stuttering (also known as stammering) and cluttering. These conditions can profoundly affect an individual's ability to communicate, sometimes leading to frustration, stress, anxiety, and in severe cases, social isolation.

Stuttering

Stuttering is a well-known fluency disorder characterized by disruptions in the flow of speech. This disruption manifests as repetition, prolongation, or complete stoppage of sounds, syllables, or words, causing an irregular speech pattern [4]. “Extra” words, sometimes called interjections, can also be a characteristic of stuttering.

Individuals who stutter may find themselves stuck on a particular sound or word, unable to push forward smoothly. This block in speech flow often results in various physical behaviours, otherwise known as secondary characteristics. These could include eye blinking, tense mouth, looking away, or avoiding eye contact [4].

Stuttering can vary in intensity among individuals and may change in response to certain situations or emotional states. It's worth noting that the impact of stuttering extends beyond the obvious speech disruptions, often affecting an individual's self-confidence, social interactions, and emotional well-being [4].

Cluttering

Cluttering, although less recognized than stuttering, is another impactful fluency disorder. It is characterized by a rapid or irregular speaking rate, excessive disfluencies, and irregular speech rhythms [3].

These disfluencies could include skipping or omitting parts of words, irregular pitch or intonation, or even repeating words or phrases unnecessarily. A fast and irregular speech rate often results in a "clutter" of words, making it difficult for listeners to follow [3].

Moreover, cluttering isn't solely about speech; it can also affect an individual's ability to organize their thoughts verbally. This aspect can compound communication difficulties, making it even harder for listeners to understand the speaker [3].

Assessment & Intervention

Correctly diagnosing fluency disorders is the first crucial step towards effective management. This task typically lies in the hands of a Speech-Language Pathologist (SLP), a professional trained to identify and treat a broad spectrum of speech, language, and communication disorders [1].

The diagnostic process involves a comprehensive evaluation of the child's speech patterns and behaviours. The SLP begins by collecting relevant medical and family history and conducting interviews with parents, caregivers and educators to understand the child's speech development and daily speech behaviours. They then evaluate the child's speech in various situations and contexts, enabling the SLP to gauge the severity of the disorder and how it affects the child's ability to communicate [1].

It is also important to understand the individual’s own perception of their fluency disorder, including their level of awareness, how impactful they feel it is in their life, and their desire and expectations for change, if appropriate.

The management of fluency disorders requires an individualized approach, as each child presents a unique set of symptoms and challenges. The treatment plan should address these individual needs and include realistic, achievable goals.

The Role of Speech Therapy

Speech therapy serves as the primary form of treatment for stuttering and cluttering. This involves working closely with an SLP, who guides the child through various techniques to improve their speech fluency [5].

In stuttering, the therapy aims to help children slow down their speech and develop an awareness of when they stutter [5]. The children learn to identify their unique stuttering patterns and apply techniques to decrease disfluencies. With time and practice, these techniques can substantially improve speech fluency and overall communication [5]. Speech therapy can also help individuals to stutter with more control, to gain a better understanding of their own speech and fluency, and to feel more comfortable speaking about their speech with others, such as when disclosing to an employer, if desired.

For children with cluttering, the therapy approach shifts focus towards self-monitoring. The SLP works to help the child recognize their own rapid speech rate and learn how to regulate it [2]. The first phase often involves building awareness of their speech difficulties, followed by learning strategies to improve fluency [3]. With consistent practice, these techniques can help children slow their speech, reduce disfluencies, and improve their overall communication.

Fluency Disorders and Neurodiversity

It is also important to understand that not all people who stutter feel the desire or need to speak fluently. Embracing a social model and neurodiversity lens, we affirm stuttering or stammering as a natural variant of human communication, an authentic and valuable form of expression. Rather than viewing it as a deficiency, we can recognize it as a unique and valid difference which contributes to the richness of human diversity [6].

From this perspective, speech therapy may focus more on helping an individual stutter with more control, educating the individual and their social circle to better understand fluency disorders and helping them to feel more comfortable disclosing their diagnosis when desired and appropriate.