Dana Lynn Miller, MA, CCC-SLP - Speech-Language Pathologist

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Fluency

What is stuttering?

Stuttering is a disorder of speech fluency that interrupts the forward flow of speech. All individuals are disfluent at times, but what differentiates the person who stutters from someone with normal speech disfluencies is the kind and amount of the disfluencies.

Characteristics

Repetition of sounds (e.g., b-b-b-ball), syllables (e.g., mo-mo-mommy), parts of words (e.g., basket-basket-basketball), whole words, and phrases
Prolongation, or stretching, of sounds or syllables (e.g., r-----abbit)
Tense pauses, hesitations, and/or no sound between words
Speech that occurs in spurts, as the client tries to initiate or maintain voice
Related behaviors: reactions that accompany stuttering such as tense muscles in the lips, jaw, and/or neck; tremor of the lips, jaw, and/or tongue during attempts to speak; foot tapping. eye blinks, head turns, etc. [to try to escape from the stuttering]; etc. There are many related behaviors that can occur and vary from person to person.
Variability in stuttering behavior, depending on the speaking situation, the communication partner(s), and the speaking task. A person who stutters may experience more fluency in the speech-language pathologist' s office than in a classroom or workplace. There may be no difficulty making a special dinner request at home, but extreme difficulty ordering a meal in a restaurant. Conversation with a spouse may be easier, and more fluent, than that with a boss. A person may be completely fluent when singing, but experience significant stuttering when talking on the telephone.
A feeling of loss of control. The person who stutters may experience sound and word fears, situational fears, anticipation of stuttering, embarrassment, and a sense of shame. Certain sounds or words may be avoided. One word may be substituted for another that is thought to be harder to say. Or, certain speaking situations may be avoided altogether. For example, a person who stutters may always wait for someone else to answer the phone. Or, he or she may walk around a store for an hour rather than ask sales staff where an item can be found. These reactions to stuttering occur in more advanced stages.

Repetitions and prolongations are essential features of stuttering. The presence of the other listed behaviors varies from person to person.

Normal Disfluencies

Every one is disfluent at times and may sometimes have repetitions and prolongations. However, the disfluencies of people who do not stutter are not as frequent as those who do. The kind of disfluencies are also generally different. Normal disfluencies tend to be a repetition of whole words or the interjection of syllables like um and er. while stuttering tends to be repetition and prolongation of sounds and syllables.

Disfluencies in Children

Almost all children go through a stage of frequent disfluency in early speech development, usually between the ages of 2 and 5. Speech is produced easily in spite of the disfluencies. As children mature and sharpen their communication skills, these disfluencies typically disappear, but not always.

Stuttering usually starts during this same time period, but may occasionally appear for the first time in a school-age child and, more rarely, in an adult. As a parent, seek the advice of an ASHA-certified speech-language pathologist if:

you or your child are concerned about his or her speech
disfluencies begin to occur more often
disfluencies begin to sound effortful or strained.

Early treatment of stuttering is generally more effective than waiting until a child is in school.

Treatment

The goals of speech-language pathology treatment are improved fluency and success in communication. There are a variety of successful approaches for accomplishing these goals. There are no published scientific data that indicate the general superiority of any one approach.

Prior to treatment, the speech-language pathologist will conduct a detailed evaluation. This assessment may include:

a developmental and behavioral history of speech and language by interviewing family members and/or the person who stutters
a structured speech sample (e.g., a recording of the person describing a picture, reading a passage aloud, or describing a job or favorite activity)
speech samples in different everyday communication situations
determination of variables that may affect speech fluency through interviews and review of video- and/or audiotapes
experimentation with different fluency strategies to assess how they may improve speech
observation of articulation, expressive and receptive language skills, cognitive skills, voice, hearing and vision
information from other professionals, as necessary, to help plan treatment.

Fluency strategies may include:

reducing the rate of speech and using slow, smooth speech movements
easing into voicing of speech sounds
voicing continuously during utterances
articulating lightly
starting air flow for speech before any other muscle movement
other techniques

Special equipment or a computer may be used to teach these strategies or give immediate feedback on how well these strategies are being used.

The person who stutters may also be taught different things to do when he or she has a stuttering block or feels that one is about to occur. Reducing tension in specific muscle groups and substituting a bouncing kind of speech are examples of this kind of strategy.

The speech-language pathologist may also provide suggestions and counseling on modifying the speaking situation. Parents and other communication partners may be asked to modify their behaviors by talking more slowly or not interrupting. The person who stutters may want to tell a stranger, "I stutter. It may take me longer to say a sentence than what you are used to." Such a statement reduces the time pressure to speak and makes it easier to use slower, more relaxed speech. In general, the speech-language pathologist and the person who stutters will discuss different speaking situations and determine together the best way to handle them, even those that are feared or have been avoided by the person who stutters.

Causes

We still do not know what causes stuttering. It may be caused by different factors for different people, or it may occur when a combination of elements comes together. Furthermore, what causes stuttering may be very different from what makes the behavior continue or get worse. Possible conditions that may cause stuttering are incoordination of the speech muscles, the way people talk to a child, the rate of language development, and life stresses.

We do know that children who stutter are no more likely to have psychological problems than children who do not stutter. In general, there is no reason to believe that emotional trauma causes stuttering.

Talking to People Who Stutter

Try not to finish sentences or fill in words. No one likes words put in his or her mouth. Problems can also multiply if you guess wrong.
Avoid suggestions such as "Slow down," "Relax," of "Take a Breath." If these suggestions worked, the person wouldn't stutter.
Wait patiently until your conversational partner is finished speaking. Maintain eye contact and try not to look embarrassed or alarmed.
Talk about stuttering openly. It should not be a taboo subject. Your friend or family member will appreciate your interest in the subject.
Do not be afraid to say, "I'm sorry, I didn' t understand what you said." No matter how much of a struggle your communication partner had with stating a point or idea, it is preferable to say something rather than to guess what you think was being said.
Talk in a relaxed, slower than normal manner.
Try not to interrupt.
Do not criticize or correct the speech.

Links

Dana Lynn Miller, MA, CCC-SLP
Speech-Language Pathologist

13702 Ginkgo Terrace
Rockville, MD 20850
(240) 731-0747
dana@danalynnmiller.com