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Fluency Disorders

Fluency refers to the rate, rhythm, effort, continuity, prosody, and/or naturalness of a person’s speech. We all produce some “disfluencies”, such as occasional repetitions of words, filler words, and non-word fillers. Less commonly, individuals may produce part-word repetitions, multiple whole-word repetitions, phrase repetitions, prolongations, or feel like they are ‘stuck’ on a certain sound making it difficult or forceful to produce. The latter “dysfluent” productions are often consistent with fluency disorders, such as stuttering. Additionally, they are often accompanied by facial grimacing or other secondary behaviors.

The etiology of fluency disorders is complex in nature, and presentation often varies across speakers and situations. Through speech therapy, individuals learn how to control various aspects of their speech. In addition, speakers learn techniques to alleviate feelings of anxiety that are often associated with verbal communication among those with fluency disorders.

Stuttering is a disorder that disrupts an individual’s ability to speak fluently. While the symptoms of stuttering may present differently across individuals, common effects of stuttering include atypical dysfluencies such as part-word, whole-word, and phrase repetitions, prolongations, and blocks, as well as concomitant physical and emotional behaviors. A person who stutters is typically aware of his or her speech difficulties. Research has yet to determine the exact cause of stuttering, though genetic and neurological correlates have been discovered. Regardless of this unknown etiology, speech therapy has been shown as an effective management tool to either eradicate or control the stutter.

Like stuttering, cluttering is another disorder that affects an individual’s fluency. Cluttering is characterized by an excessive number of typical disfluencies, such as “um”, “like”, and “you know”. The rate of cluttered speech is incredibly rapid and its rhythm may be atypical, sounding “jerky” at times. Sentences may be frequently restarted. Language presents as disorganized and confusing for the listener to understand. Cluttered speech may be improperly articulated, sounding “sloppy” to the listener. A person who clutters is typically unaware that he or she does so, and typically does not experience secondary physical or emotional behaviors.

An individual’s dysfluencies may be exacerbated by feelings of anxiety in certain situations and contexts. An integral aspect of therapy involves addressing the underlying psychological components of communication. In therapy, the client and clinician will evaluate the situations and circumstances which lead to dysfluent episodes and work toward achieving fluency, even under duress. Appropriate respiratory patterns and breathing techniques may also be incorporated to address these emotional and psychological concerns.

At the preschool age, many children experience a period of dysfluency as part of typical development. Others exhibit dysfluencies in the form of mazing, which can co-occur with second language acquisition. An evaluation will allow us to distinguish between dysfluent episodes that are likely to resolve and atypical speech patterns that may persist to older ages. In either case, we are happy to provide materials and information to help you better understand your child’s speech and language development.

As with all speech therapy services, family and caretaker involvement is crucial to a child’s success. Parents and family members are encouraged to be involved in the therapeutic process, though this is certainly not mandated.

An initial consultation is warranted to determine the presence and severity of a fluency disorder. Assessment of speech during the evaluation will indicate whether or not the client’s speech patterns are consistent with atypical dysfluencies in type or frequency. The severity of a fluency disorder is determined by objective measures, such as the percentage of syllables stuttered, and the occurrence of secondary concomitant behaviors. In addition, subjective findings, including the client’s overall naturalness as perceived by the clinician, and client self or caretaker report, will be incorporated in the overall fluency analysis. A client and/or caregiver interview is included to gather relevant background information.

We also offer comprehensive evaluations for those who would like an extensive report beyond that of the initial consultation. In addition to the components of the initial consultation, each evaluation will include assessment of related communication domains, an extended case-history, and communication with other professionals when appropriate. Prior to an evaluation, we will conduct a free 15-minute phone conversation to determine the assessment methodologies appropriate for you or your child’s concerns.

After the initial consultation or evaluation, the clinician will provide you with a treatment plan including a recommended frequency and total number of sessions. However, the frequency of sessions is at your discretion and amenable based on progress. Though most clients are seen for treatment once per week, a handful prefer or are recommended to receive more frequent sessions depending on severity, type of condition/disorder, and urgency to remediate the issue. We are happy to work with you to determine how many sessions will fit your specific needs. This can be adjusted at any time.

Therapy differs between clients due to the differences in types of dysfluencies, severity of dysfluencies, and temperament of the client towards his or her fluency difficulties. Therapy may involve reconditioning the speaking mechanism, applying various techniques to combat dysfluent moments, and/or addressing the emotional and psychological aspects of the fluency disorder. Individual sessions and treatment plans are highly specialized for each client, depending on you or your child’s concerns and goals. We aim to help you achieve natural, fluent speech in a way that is most comfortable and appropriate for you!

Clients with fluency concerns are typically seen for therapy once per week for one hour. For young children, however, we recommend 30-minute sessions to maintain participation and satisfaction.