Fluency disorders are a relatively common issue, affecting around 1% of the adult population, and occurring in 5% of children. Despite this, many people are unaware of what they are or how they can be managed. For those who struggle with fluency disorders, it can be a source of frustration and embarrassment.
In this article, we'll explore...
- what fluency disorders are
- how they can be diagnosed and
- different approaches on how it can be managed
What are Fluency Disorders?
When someone has difficulty speaking in a smooth and flowing way, it is called a fluency disorder. People with fluency disorders have issues with speech rate, rhythm, and disfluencies, such as repeating words or sounds. It can make it challenging for individuals to speak and be understood in their daily lives.
This speech disorder can make communication difficult and lead to tension and anxiety. Because of these physical tensions, they may have more hesitations, or repetitions when speaking. These occur even if they don’t necessarily point to a fluency disorder.
Individuals with fluency disorders may experience psychological, emotional, social, and functional impacts. These impacts can affect their self-esteem, and ability to take part in everyday activities.
There are two common types of fluency disorders: stuttering and cluttering. Let’s learn about how they differ and how they can affect the way you speak.
Stuttering is when people repeat words, sounds when they talk. It may also cause someone to pause their flow of speech, as if their speech is blocked.
It usually starts when they are kids, before they turn 4 years old. For many, stuttering can be a part of learning how to speak, also known as developmental stuttering. Most kids who have this type of stuttering will get better on their own without any help. However, it’s possible for stuttering to return in certain situations during adulthood.
Stuttering shouldn’t be confused with normal disfluencies. Some unique signs of stuttering include:
- Long or stuck letters (“I m-m-m-made a drawing.”)
- Repetitions of sounds and monosyllabic words (“I li-li-like apples.”)
- Long pauses or silent fixations in speech (“Can I have *long pause* my blankie?”)
- Physical tension or struggle when trying to make speech sounds
People who stutter may have more trouble speaking on some days than on others, and this can depend on the situation they’re in. For example, it can be harder for them to talk when they feel anxious and stressed, like when giving a presentation or job interview.
Evaluating the severity of stuttering is based on how often it happens, how long it lasts, how much effort it takes to speak, and how easy it is to understand what the person is saying.
It’s also possible for other disorders like ADHD and Autism Spectrum Disorders to have co-occurring signs of stuttering. Further diagnosis is needed to determine what is causing the stutter at all.
Cluttering is when the words seem to blend into each other when speaking. It can also be described with an irregular rate of speech. Individuals who clutter may also repeat words or phrases frequently and use unusual intonation patterns. They may also talk with disorganized thought processes.
It’s also possible for cluttering to co-occur in disorders like ASD or Tourette’s. Individuals with cluttering typically aren’t diagnosed. If they are, they usually do not start treatment until 8 years of age or into adolescence/adulthood.
Some common behaviours associated with cluttering include:
- removing syllables between words
- switching between ideas and topics when speaking
- frequent use of filler words
- irregular speed of speech
- random pauses in speech
Cluttering may occur independently of stuttering, in which case it is known as ‘pure cluttering’. Speech therapy can help someone who clutters by reintroducing a natural flow of speech, and more.
Why is Stuttering / Cluttering so Challenging?
Physical tension and discomfort behind fluency disorders can be its own struggle. But the impact is greater when you consider the secondary behaviors that come with cluttering and stuttering.
To divert attention away from their speech, people who stutter might try speaking faster. They may avoid certain words and sounds that they think will be hard to say. Some body movements, like jerking their head, tapping their hands or feet, or sticking out their lips or tongue may also occur.
People who clutter also do the same, along with other techniques like pretending to forget what they were trying to say. While these secondary behaviors satisfy in the short term, these techniques can’t address the emotional, social, psychological effects that come with fluency disorders.
People with fluency disorders may feel more ashamed or embarrassed and think stuttering should be kept secret. They might limit their self-expression, making them less likely to socialize or communicate. Making relationships becomes difficult when their confidence stays low.
Strategies That Can Help
1) Learning More and Being Aware
Being aware of how communication, speech, and stuttering are connected is key to understanding them better. A speech-language pathologist may be able to explain the different elements that make speech happen.
With the understanding of how speech works, someone with fluency disorders can make sure that each component works properly. Learning about nonverbal communication also plays an important role.
Some cognitive restructuring can also go a long way. Spending time understanding what contributes to the fear and stress can help them think differently of social situations they participate in. Changing how they think about speech can help reduce anxiety over it and build their confidence over time.
Importance of a Supportive Environment
Support can come in various ways, may it be in the form of a partner, family, or friends. They can help create a more comforting environment and build confidence. If you are in a position to support someone who has fluency disorders, here are a few key things to remember.
- Practice Patience – Communicating can get frustrating both ways for you and the person experiencing these challenges. Listen, be patient, and let the person work through their speech without rushing them.
- Be Kind – Admonishing someone who stutters or clutters will not help them overcome its difficulties. Expressing kindness can be one of the best ways to support their self-expression.
- Include Them – When they are comfortable, include them in conversations. You can also help them enter stuttering and fluency support groups, where they can safely practice speaking.
2) Real Life Practice and Application
Putting strategies learned in therapy in real-life practice is the best way to get results faster. There are two key approaches: desensitization and generalization.
Desensitization will help a person be more comfortable with the speaking situations they fear the most. Generalization will involve the practice of learned techniques in real life settings.
Before taking any action, the speech therapist will assess the individual’s personal comfort and stress. They will also determine what level of exposure they would be ready to approach. Overtime, the levels will increase according to progress until they learn to speak comfortably and confidently.
3) Communicating the Difficulty
By talking openly about stuttering, the speaker can help to dispel any myths that others may have about stuttering. It also gives those who listen a better understanding of how to interact with the speaker.
Developing a self-disclosure script can help. The speaker should be prepared to talk about their stuttering and practice the script in various settings. Additionally, it is important for the person to remember that they can choose when and how they disclose their identity as a person who stutters.
Treatment and Management
An evaluation from a speech-language pathologist can go a long way in determining the presence of a fluency disorder. It will also help parents identify if their child is experiencing developmental stuttering, or if the fluency disorder is a long-term concern.
Working with a speech-language pathologist can help them be more aware of speech patterns and processes that affect speech fluency. The SLP can also help them practice the words they have the most trouble with, slowing down speech and using natural pauses more effectively.
Co-occurring disorders such as Autism Spectrum Disorders may also contribute to the difficulty. The SLP can factor that into the personalized treatment plans they will provide. If needed, they may also recommend cognitive behavioral therapy to address the accessory behaviors associated with fluency disorders.
Overtime, it’s important to also gain the confidence to use speech in real life. A speech therapist can also provide some key strategies to help them get comfortable as they practice this way. They may also provide ways to communicate with loved ones to help them understand the challenges.
If you’re interested in overcoming stuttering whether for you or a loved one, start the journey and get in touch today.