Fluency

"Stuttering" is a term applied to an interruption in the fluent flow of speech. While we all have dysfluencies (i.e., non-fluent speech moments) from time to time, some individuals have a more persistent struggle in this area. In most cases, dysfluencies first occur in young children between the ages of two and five years, as they learn and refine their speech. At this age, the dysfluencies may be considered "developmental" or a normal part of the "speech-learning" process. The young child may repeat words or phrases once or twice as he attempts to gather his thoughts for self expression (e.g., "Mommy, mommy, mommy." "Guess what, guess, guess what?") These repetitions are usually effortless and easy. Frequent insertions of "filler" sounds may also be heard as the child searches for the right words to use (e.g., "I saw...um...uh...it was um...like a big...uh... balloon!") Often, children will outgrow such "normal nonfluencies" with little to no intervention. However, some dysfluencies present more of a concern, as they may worsen or become a more persistent problem. In particular, a speech-language pathologist should be contacted if a child, adolescent, or adult exhibits one or more of the following:

• A worsening of the dysfluencies in terms of frequency (i.e., it is happening more often), duration (e.g., the dysfluencies have gone from lasting a half-second to several seconds, and/or the number of repetitions have increased), or severity (i.e., the dysfluencies have proceeded from phrase or whole-word repetitions to part-word repetitions, such as “ba-ba-baby”, or prolongations, such as “Wh-->y?”)
• Observable struggle when attempting to get the word out, as evidenced by signs such as a tightening of the muscles around the face and neck or the word seeming to “get stuck” in the throat or mouth
• Any avoidance of particular “feared” words and/or speaking in general

Stuttering often affects an individual’s self-esteem as a communicator, causing him to shy away from situations and opportunities.

This is a common question among parents, and the answer is that no one can target one exact cause. Many theories exist about the cause of stuttering, but there may be some individuals who are predisposed to stuttering and certain triggers may result in the onset of stuttering. One trigger for stuttering may be genetics, as it tends to run in families. Another trigger may be language development. Stuttering occurs around the age when children are transitioning from one- and two-word utterances to more mature sentence structure. Dysfluent speech may result because of this increase in expressive language. Some children who stutter will become fluent without therapy intervention and some will need speech therapy to learn strategies to increase fluency.

The speech-language pathologist will first want to know the history of the individual’s stuttering problem (i.e., when it began, how it has changed, what affect it has had). A sample of the person’s speech will be taken through conversation, and older children and adults may also be asked to read a passage in order to obtain another speech sample. These samples will later be analyzed by the speech-language pathologist in order to determine the frequency, severity, and characteristics of the fluency problem, and a rating score will be applied.

The nature of stuttering therapy is dependent upon many factors, including the age of the individual, the severity of the problem, and the person’s motivation to improve his speech. For young children, parents are provided with suggestions for the appropriate handling of the child’s dysfluent moments and for helping the child become a more fluent speaker. During therapy sessions, specific techniques will be employed while engaging the child in fun, language-based activities. As an older child becomes more understanding and aware of his difficulties, he can be instructed in ways to achieve greater fluency and will learn how to prevent and work through moments of stuttering. Likewise, an adolescent or adult will learn to analyze factors affecting his fluency and will practice achieving fluent speech in a variety of communicative situations.

While it can be uncomfortable watching a child or any individual struggle with a fluency problem, it is important to maintain your eye contact with him and convey your patience. Allow the person as much time as is needed to express himself without interruption. By keeping your speech relatively slow and using frequent pauses, you will help relax the person, set a slower pace for the conversation, and alleviate a sense of time pressure. As always, make sure that what the person says is more important to you than how fluently he says it.

Card Games

Playing Memory or Go Fish with your child can be a great way to practice fluent speech. It is important for your child to feel successful and experience fluency. These cards games can be adapted depending on the child. For example, you may start at a level where the child only speaks with one word responses (naming cards turned over in a memory game). If the child is fluent with this task, have him say a phrase (e.g., “I found a dog.” “I found a flower.”) As the child maintains fluent speech, encourage an expanded response into sentence form (e.g., “I found a dog and flower, and that is not a match.”)

Mr. Potato Head

This fun-loving spud can be a great tool for fluency practice. Have the child request each part. Start with one word responses (e.g., “hat”) and gradually move into sentence level responses if fluency can be maintained (e.g., “I want the yellow hat.”)

Board Games

Using commercial board games can be a motivating way to practice fluent speech. Games such as “Guess Who” and “Battleship” can be functional for older children, whereas “Candyland” may be used for preschool aged children. These games can be used to achieve a varying complexity of responses. For instance, “Battleship” is a great game to use initially, because the speech demand is low since only numbers and letters are needed as responses. “Guess Who” requires sentence level speech (“Does your person have blonde hair?”) and should be used with children who can be successful at this level.