Fluency Disorders: Cluttering & Stuttering
Working definition: "Cluttering is a fluency disorder disorder wherein segments of conversation in the speaker's native language typically are percdeived as too fast overall, too irregular or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (a) excessive "normal" disfluencies; (b) excessive collapsing or deletion of syllables; and/or (c) abnormal pauses, syllable stress, or speech rhythm."
-St. Louis and Schulte
Some hallmarks of cluttering:
Speech sounds fast, but in inconsistent bursts
Speech sounds "jerky" or "sprayed"
Longer words are shortened; syllables get "stacked" on top of each other
Normal disfluencies (such as interjections, fillers and phrase repetitions) occur more frequently than in the average speaker.
Cluttering occurs in conversation, but not consistently.
Speech phrasing and rhythm are irregular and unpredictable.
Stuttering is a complex, multi-factorial disorder of speech in which the forward motion of speech is disrupted. The National Library of Medicine's definition is: “Stuttering is a speech disorder in which sounds, syllables, or words are repeated or last longer than normal. These problems cause a break in the flow of speech (called disfluency).”
Breaks in the flow of speech can be:
· Repetitions of sounds, syllables or whole words. e.g., “Wa wa wa wa walk the dog.”
· Prolongations of sounds: e.g., “Mmmmy mommy is late.”
· Blocks: e.g., “I d………on’t know.”
Stuttering can also include extraneous or “secondary” behaviors such a facial grimaces, head turns, eye blinks, silent blocks and other gestures. Individuals who stutter react emotionally to their speech in varying degrees, ranging from total acceptance to fear, anxiety and avoidance of speaking.
Speech therapy can help. The following is a brief description of how we provide speech therapy for children who stutter:
The place to start is with a comprehensive speech and language evaluation. The Speech-Language Pathologist (SLP) will watch and often videotape a person who stutters. The SLP will make note of the types and frequency of stuttering and secondary behaviors if any. In addition, the SLP will check the person’s receptive and expressive language skills. During the evaluation, the person who stutters may be asked to count, describe pictures, read a short paragraph and converse with the speech clinician. The SLP might ask the person who stutters to rate his or her experience of stuttering using standardized surveys. For children, parents will participate in the evaluation process and complete detailed speech histories. When the initial evaluation is complete, the patient and family will receive a formal diagnosis and recommendations. Speech therapy for stuttering is completely individualized. Below are very general descriptions of what speech therapy for stuttering may encompass:
Stuttering and Preschool Children: It can be tricky to figure out whether a young child is going through a period of “normal disfluency” or whether s/he will develop stuttering. Here are several risk factors or “red flags”that signal that the problem may be more serious. When a child has one or more of these risk factors, s/he is less likely to grow out of “normal disfluency”:
· Family (genetic) history of stuttering
· Child is aware that speech is difficult
· Child is reluctant to talk
· Child avoids eye contact or has secondary symptoms
· Child uses a neutral vowel (“uh” ) rather than the correct vowel in repeated words: (e.g., “ I see a buh-buh-buh-buh boat over there.”)
· There is a large gap between a child’s language skills and his speech skills.
Treat Street Therapy uses an eclectic approach that is family focused. For young children, we do not usually do direct speech correction initially. During speech therapy sessions, parents are taught how to use several specific techniques that will foster healthy relationships, decrease anxiety and focus on the developing child as a whole person. Each family can expect to learn a new technique at each visit. Subsequent visits will focus on observing (possibly videotaping) and coaching the parents use each skill with the child.
One of the most important skills families learn is how to talk openly about speech so that the child does not try to hide her/her disfluencies. Later in treatment the SLP may also use child strategies, in order to teach her how to make talking easier.
Stuttering and School-Age children: It can be a delicate matter deciding whether to use direct or indirect approaches with school age children who stutter. If the child can talk openly about his speech, the SLP will teach him about the speech mechanism and about stuttering. The child will learn to identify the types of stuttering and to talk about how his speech system feels during moments of stuttering and how this is different from regular speech.
I use play, games, artwork, story-telling, journals, question-of-the week, books and videos in order to demystify speech and stuttering. We talk about feelings. I consult with the child’s teacher and school SLP. If needed, I teach the childspecific techniques so that she will learn how to stutter in a better way (stuttering modification therapy) and to improve speech fluency (fluency enhancement therapy). As with preschool children, parents will learn right along with their child in order to support the work we do in speech therapy.
Adults who Stutter: You can expect a comprehensive evaluation of your speech, which includes history, self-rating scales, interview and various speech tasks (e.g., reading aloud, describing pictures and conversation.) The SLP will videotape your speech in order to count and categorize the stuttering and note any secondary symptoms.
Most adults who come to speech therapy have a long history of ups and downs with stuttering.
My approach with adults is eclectic and individualized. I do not use biofeedback or DAF. I teach stuttering modification techniques immediately so that you will leave my office knowing how to stutter in a better way. I also teach you how to improve your speech using specific fluency shaping strategies.
My work with adults also includes Cognitive Behavioral Therapy (CBT). We will explore how your thoughts, emotions, physiological responses and behaviors are impacting speech. We will work on the phone and in the community in order to generalize your improved speech outside of the clinic.
As you make progress with your speech, we will use avoidance reduction activities. These are graded steps toward using your speech in more challenging or feared situations. You will uncover and work with your own “mental gymnastics” that you have been using to avoid certain situations. You will be able to disclose your stuttering to others, become a stuttering expert and possibly a mentor to other people who stutter.
5 things to think about before you call:
1. Why is now a good time to work on your speech?
2. How do your lips, tongue, teeth, chest and throat feel when you speak fluently?
3. Can you feel what you are doing differently when you stutter?
4. On a scale of 1-10, where 1 = severe stuttering and 10 = fluent speech, how would you rate your own speech on your worst and best days?
5. Using the same scale, what is your best hope for your speech in the future?
DID YOU KNOW?
Adults: approximately 1%
Children: approximately 5%
As children are learning to speak, their listening comprehension and desire to communicate may develop ahead of expressive speech and language. This can cause a temporary “normal disfluency”, which is common from age 31/2 - 4/1/2. The above statistic reveals that most children grow out of this type of stuttering.
Males are 4 times more likely to stutter than females.
Many famous people stuttered, including Marilyn Monroe, James Earl Jones, Winston Churchill, and Michael Palin
· The Stuttering Foundation; 1-800-992-9392
· American Speech, Language and Hearing Association
· The Michael Palin Centre for Stammering Children
7 tips for talking with your child
from the Stuttering Foundation of America
Complied in 2010 by: Barry Guitar, Ph.D., University of Vermont and Edward G. Conture, Ph.D.,
1. “Speak with your child in an unhurried way, pausing frequently. Wait a few seconds after your child finishes speaking before you begin to speak. Your own slow, relaxed speech will be far more effective than any criticism or advice such as “slow down” or “try it again slowly.”
2. “Reduce the number of questions you ask your child. Instead of asking questions, simply comment on what your child has said, thereby letting him know you heard him. Children speak more freely if they are expressing their own ideas rather than answering adult’s questions.”
3. “Use your facial expressions and other body language to convey to your child that you are listening to the content of her message and not how she’s talking.”
4. “Set aside a few minutes at a regular time each day when you can give your undivided attention to your child. When you talk during this special time, use slow, calm, and relaxed speech, with plenty of pauses. this quiet, calm time can be a confidence-builder for younger children, letting the know that you enjoy their company.”
5. “Help all members of the family learn to take turns talking and listening. Children, especially those who stutter, find it much easier to talk when there are few interruptions and they have the listeners’ attention.”
6. “Observe the way you interact with your child. Try to increase those times that give your child the message that you are listening to her and she has plenty of time to talk. Try to decrease criticisms, rapid speech patterns, interruptions and questions.”
7. “Above all, convey that you accept your child as he is. The most powerful force will be your support of him, whether he stutters or not.”
Suggested readings for adults who stutter:
Self Therapy for the Stutterer, 11th edition by Malcolm Fraser
Publication # 00112
The Stuttering Foundation