Stuttering/Dysfluency Disorders

Stuttering presents as speech that does not flow smoothly and is interrupted by sound, syllable or word repetitions, prolongations of certain sounds, frequent use of interjections (“um”, “uh”) in utterances, all of which may be accompanied by behaviors such as grimacing, stomping feet, head movements or other body movements or avoidance of speaking in certain situations.  Increased stuttering often is related to stress or anxiety producing speaking situations.

Stuttering is a speech disorder characterized by dysfluencies, or interruptions in the flow of speech. All people produce dysfluencies sometimes, but these dysfluencies differ in quality, quantity, and duration in people who stutter. People who stutter may also have physical tension, secondary behaviors (see below), and/or negative emotions about their speech. They feel like they do not have control over their speech, and this can interfere with their communication and their participation in daily life activities.

Stuttering typically develops in early childhood between the ages of 2-4 years old. In some children, the stuttering goes away on its own, and some recover only after having speech therapy. For some, the condition may continue into adulthood, although typically they learn to manage their stuttering better.

Stuttering may begin in people of any age after injuries to the brain. Much more commonly, though, stuttering starts in childhood from unknown causes. Research has shown that the brain structure and function of people who stutter is different from those who do not. Genetics are known to play a role; children with a family history of stuttering are at greater risk to develop stuttering. Environmental factors, like family’s and friends’ reactions and the child’s temperament, can influence the child’s reactions to his stuttering and may aggravate the symptoms.

Symptoms of Stuttering

A person’s stuttering may vary from day to day and situation to situation. Certain conditions like talking on the phone, talking to strangers, public speaking, feeling rushed, or being very tired may increase the severity of stuttering.

Examples of stuttering symptoms include:

  • Multiple repetitions of sounds, syllables, words or phrases (My name is T-t-t-tomor My name, my name, my name is Tom.)
  • Prolongations of sounds (My name is Sssssss-ara.)
  • Interjections (My name is…um…well…you know…Tom.)
  • Blocks, where the mouth is in position to say a sound but no sound comes out
  • Secondary behaviors that may accompany the dysfluencies; examples include tension in the upper body and face, rapid blinking, higher pitch, or louder voice

Assessing and Treating Stuttering

The speech-language pathologist (SLP) may use a variety of formal and informal tests to evaluate the client’s fluency. She will measure how often and what types of dysfluencies and secondary behaviors occur in different speech tasks and situations. She will also watch for coping strategies the client might be using (e.g., avoiding certain words, changing rate) and the reactions of the client to the dysfluencies. She will take a thorough history and may interview the client and/or family about when and how the issue developed, stuttering behaviors at home, factors in the environment, and the impact of stuttering on communication, emotions, and daily activities. Testing of other speech and language skills may also be completed.

In very young children, the SLP will try to predict the risk of continued stuttering in order to decide if therapy should be started. She may opt to begin treatment, or may give the family tips about dealing with the stuttering and just occasionally follow up to monitor the child’s fluency. With older children and adults, the SLP will want to assess both the severity of the disorder and its impact on the client’s life, to create an appropriate treatment plan.

Treatment for stuttering is designed to promote more fluent speech and to lessen the negative effects of stuttering on overall communication and participation in daily activities. The SLP may teach strategies for improving fluency, such as slowing rate of speech, using less tension in the voice and mouth movements, controlling breathing, and easing out of moments of stuttering. These strategies are practiced in gradually more complex utterances and more difficult situations. The SLP will also educate the client about stuttering so that he understands it better, and work to desensitize him to his stuttering and minimize negative reactions. In young (preschool) children, therapy may simply focus on teaching parents to model slow, smooth speech and provide feedback to children about their fluency.