Fluency Disorders

Stuttering is a speech disorder characterized by interruptions to the smooth flow of speech.  These interruptions can come in the form of repetitions (e.g., “D-d-d-d-do you like animals?”), prolongations (e.g., “I nnnnnnnnnnneed some help.”), blocks (sounds like the person is having a hard time getting the word out; they may pause for a long time, e.g. “See you t……….omorrow.”), and interjections (e.g., “That’s, uh, my favorite, uh, song.”).  Everyone experiences speech that isn’t perfectly smooth sometimes, but for stutterers, these disfluencies occur often and can be very disruptive.

The intensity of stuttering can change day to day or even moment to moment.  A person may stutter a lot all day at school and then speak fluently at home.   Also, energy level and emotional state can affect how much a person stutters.  Stress, nervousness, excitement, and fatigue can make stuttering temporarily worse.  It is also common for stuttering to disappear for a while and then return after several weeks or even months.

Stuttering often includes negative feelings about speech.  It is common for people who stutter to wish to avoid situations that tend to make them stutter more.  For example, many stutterers do not make phone calls and may rely heavily on texting because speaking on the phone is difficult and stressful for them.  Children who stutter may not raise their hands to contribute to discussions in class.  They may also dread given presentations and oral reports.  Some stutterers feel the need to try to hide their stuttering from others.

How speech therapy helps:

People who stutter often benefit from speech therapy aimed at reducing negative feelings and attitudes about speech, teaching techniques that decrease stuttering, and ultimately equipping them to “be their own therapist,” that is, continue to  practice and use the strategies they’ve learned independently after completing the treatment program.  We use an integrated approach including both fluency shaping and stuttering modification techniques to reduce the frequency and abnormality of stuttering behaviors.  Fluency shaping aims to reduce the frequency of stuttering by providing a “tool box” of techniques that can produce instant fluency (such as noticing the position of the jaw, tongue, and lips while speaking) and learning to use them in increasingly challenging speaking situations.  Stuttering modification focuses on reducing the abnormality of stuttering by training the stutterer first 1) to correct a stutter immediately after it happens by repeating the word in an easier fashion, then 2) to change stutters into easier productions while they are still going on, and finally 3) to anticipate stutters, beginning words which they expect to be difficult in a slow and relaxed way, resulting in a stutter that is very mild.  Stuttering therapy also focuses on helping stutterers overcome the habit of avoiding feared speaking situations.  The ultimate goal of speech therapy for a person who stutters is to increase overall communication abilities: we want them to feel confident to say what they want, when they want, and to whom they want.

Measureable success:

One of my former clients was a 13-year-old boy who stuttered.  He was confident, outgoing, and not at all self-conscious about his speech problem; however, his stutter did make certain interactions with family members difficult for him.  He would often get “stuck” when talking to his dad or older brother, especially during heated conversations.  Therapy focused on educating his family members about changes they could make to support his efforts to improve his speech, as well as providing him with strategies to avoid getting “stuck.”  Both fluency shaping and stuttering modification techniques proved to be very effective in enabling him to express himself with confidence and clarity.  He frequently came to speech therapy proudly reporting that he had volunteered to give a toast at a wedding or answer a question in class.  As is often the case, his stuttering seemed to disappear during certain times of the year, only to return when school work got stressful or his family schedule became busy.  By the end of his treatment program, he was equipped to “be his own therapist” and independently practice and use the techniques he had learned in speech therapy.

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