Fluency Disorders
Fluency disorders (disruptions/interruptions in the "smoothness" of speech production) can affect individuals of any age and may result from a number of different causes. Mild fluency disruptions (disfluencies) are fairly common in the speech of young children and may not reflect any type of disorder. It is vital, however, to seek professional assistance in determining if the disfluencies reflect a normal pattern or instead are characteristic of stuttering or other disorders of fluency.top
Fluency Disorders in Young Children
Normal Disfluency: Most children go through a period where the fluency (smoothness) of their speech undergoes a marked change. For most children this occurs between two and a half and five years of age. Previously easily produced utterances now are characterized by repetitions of words or phrases, sometimes several times, within the sentence. Occasionally the first part of a word (the first sound or first syllable) may be repeated several times). Parents quickly notice these errors, and become concerned – often wondering if their child has begun to stutter. Some children may be unaware of their errors; others may comment on them to their parents. Fortunately, for the majority of children, they are experiencing a very normal phase of language development – what researchers and clinicians often refer to a period of "normal disfluency". The phase often appears when they have moved from producing "baby talk" – short 2-3 word utterances, to producing complex statements, questions, or demands. The pauses and repetitions in their speech may indicate uncertainty in selecting the appropriate word, or confusion in putting his or her thoughts into a grammatically correct sentence. Most children will progress out of this phase within a relatively short period, generally 1-3 months. There are key signs that separate this period of "normal disfluency" from stuttering. Generally, the disfluencies appear to be produced with little or no effort or struggle, and disfluencies appear in less that 10% of the children’s words. In normal disfluency, the majority of the child’s errors consist of:
- interjections of sounds or words between words ("uh", "you know")
- revisions of the utterance ("Johnny went- Johnny ran back home")
- repetitions of phrases ("we are going, we are going to the store")
- repetitions of words ("Pick-Pick-Pick me up")
Stuttering: In some children, the initial stage of normal disfluency continues beyond the average 3 month period and worsens noticeably, becoming much more effortful. Other children may not experience the symptoms of normal disfluency, but instead show clear difficulty getting sentences or words begun. They may struggle to get the sounds out, and may repeat the first part of a word 5 to 10 times. Danger signs for stuttering include:
- disfluencies occurring in more than 10% of the child’s words
- sound or syllable repetitions ("I wa-wa-wa-wa-want to go outside"), sound prolongations (do you sssssssssssssee the ssssssscissors?), or silent speech postures (the lips, tongue, jaw are held as if ready to speak, and the child may appear to be attempting to speak, however no sound comes out) are now the predominant types of disfluency
- the child may appear distressed by the disruptions in his or her speech, and may avoid saying words they feel they’ll have difficulty producing
- visible effort is seen in attempts to speak during disfluencies, and the child struggles to produce certain sounds or words; other body parts (eyes opening wide, head movements, arm movements) may appear during the child’s struggles to produce speech
If left untreated, some children will outgrow their stuttering, but for most children exhibiting the signs of stuttering given above, it is the beginning of what can be a lifelong struggle to produce speech, and a serious problem affecting school, employment, and even social interaction with other people. Prompt treatment may prevent of development of more severe symptoms and reverse the progress of the disorder. Generally, the longer the disorder continues to develop without treatment, the more habituated and automatic the symptoms, perceptions, and fears involving speech difficulty become, and the more resistant to change.
Assessment of Fluency Disorders in Young Children
In a two hour assessment of fluency in a child of pre-school to early elementary school age, the following areas are typically addressed
- Case History and Interview: A detailed case history will be mailed to the parents for completion prior to the interview. We are especially interested if there is any family history of stuttering or other communication disorders, in the child’s pattern and progress in language development, the presence of other communication disorders, the child’s medical history, and the effect his disfluency is having on his communication. Past experiences with therapy are also reviewed.
- Standardized Testing: Because stuttering is often accompanied by other communication disorders, we generally will employ standardized tests to examine the child’s receptive and expressive language skills, speech sound repertoire (articulation/phonological skills), and fluency.
- Oral Mechanism Examination: The clinician will make sure that the child has the appropriate oral structures and movement ability necessary to produce normal speech.
- Speech/Language Sampling: The child’s conversational interaction patterns will be examined in conversation and play with the clinician, the parent(s), and possibly others. For children who can read, their fluency will also be assessed during reading tasks.
- Hearing Screening: Fluency evaluations generally include a hearing screening to rule out the possibility of hearing loss as a contributing factor.
After the evaluation the student clinician and supervisor will meet with the parent(s) and possibly the child to talk about preliminary results of the assessment. Tests and videotaped conversational samples must be scored for more specific results, but parents can expect to be given a general idea about the nature and severity of any communication disorders noted and preliminary recommendations about how to deal with them. A detailed report will be written and mailed to the parents, and, if authorized, to appropriate educational institutions or clinicians. The report will include detailed recommendations for treatment, if necessary.
Assessment of Fluency Disorders in Older Children and Adolescents
In a two-hour assessment of fluency in a child of late elementary to high school age, the following areas are typically addressed
- Case History and Interview: A detailed case history will be mailed to the parents for completion prior to the interview. We are especially interested if there is any family history of stuttering or other communication disorders, in the child’s pattern and progress in language development, the presence of other communication disorders, the child’s medical history, and the effect his disfluency is having on his communication. Past experiences with therapy are also reviewed.
- Screening for Other Communication Disorders: Because stuttering is often accompanied by other communication disorders, we generally will employ screening tests to examine the individual’s receptive and expressive language skills, speech sound repertoire (articulation/phonological skills), oral mechanism, and fluency.
- Speech/Language Sampling: The individual’s conversational interaction patterns will be examined in conversation, oral reading, and other speaking activities with the clinician, the parent(s), and possibly others.
- Attitudinal/Perceptual Measures: Standardized tests to examine the individual’s attitudes towards communication in general, perception of stuttering, and perceptions of how stuttering affects his or her life are often utilized. These measures help to determine the direction that therapy should take.
After the evaluation the student clinician and supervisor will meet with the parent(s) and the child/adolescent to talk about preliminary results of the assessment. Tests and videotaped conversational samples must be scored for more specific results, but parents can expect to be given a general idea about the nature and severity of any communication disorders noted and preliminary recommendations about how to deal with them. A detailed report will be written and mailed to the parents, and, if authorized, to appropriate educational institutions or clinicians. The report will include detailed recommendations for treatment, if necessary.
Assessment of Stuttering in Adults
In a two-hour assessment of fluency in an adult, the following areas are typically addressed
- Case History and Interview: A detailed case history will be mailed to the individual for completion prior to the interview. We are especially interested if there is any family history of stuttering or other communication disorders, the presence of other disorders, the effect his or her disfluency is having on his communication and past experiences with therapy.
- Speech/Language Sampling: The individual’s fluency and conversational interaction patterns will be examined in conversation, oral reading, and other speaking activities with the clinician and possibly others.
- Attitudinal/Perceptual Measures: Standardized tests to examine the individual’s attitudes towards communication in general, perception of stuttering, and perceptions of how stuttering affects his or her life are often utilized. These measures help to determine the direction that therapy should take.
After the evaluation the student clinician and supervisor will meet with the individual to talk about preliminary results of the assessment. Tests and videotaped conversational samples must be scored for more specific results, but patients can expect to be given a general idea about the nature and severity of the stuttering noted and preliminary discussions about options for treating the disorder. A detailed report will be written and mailed to the patient and, if authorized, to other agencies. The report will include detailed recommendations for treatment.