Stuttering

The most common fluency disorder, is an interruption in the flow of speaking characterized by specific types of disfluencies, including

• repetitions of sounds, syllables, and monosyllabic words (e.g., “Look at the b-b-baby,” “Let’s go out-out-out”);

• prolongations of consonants when it isn’t for emphasis (e.g., “Ssssssssometimes we stay home”); and

• blocks (i.e., inaudible or silent fixation or inability to initiate sounds).

These disfluencies can affect the rate and rhythm of speech and may be accompanied by

• negative reactions to speaking;

• avoidance behaviors (i.e., avoidance of sounds, words, people, or situations that involve speaking);

• escape behaviors, such as secondary mannerisms (e.g., eye blinking and head nodding or other movements of the extremities, body, or face); and

• physical tension.

Can Co-occur with

• Attention-deficit/hyperactivity disorder

• Autism spectrum disorder

• Intellectual disability

• Language or learning disability

• Seizure disorders

• Social anxiety disorder

• Speech sound disorders

• Other developmental disorders

Cluttering

Characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency

• Individuals may exhibit pure cluttering or cluttering with stuttering

Breakdowns in fluency and clarity can result from

• atypical pauses within sentences that are not expected syntactically (e.g., “I will go to the / store and buy apples”; St. Louis & Schulte, 2011),

• deletion and/or collapsing of syllables (e.g., “I wanwatevision”),

• excessive levels of typical disfluencies (e.g., revisions, interjections),

• maze behaviors or frequent topic shifting (e.g., “I need to go to...I mean I’m out of cheese. I ran out of cheese and bread the other day while making sandwiches and now I’m out so I need to go to the store”), and/or

• omission of word endings (e.g., “Turn the televisoff”).

Can Co-occur with

• Learning disabilities

• Auditory processing disorders

• Tourette’s syndrome

• Autism

• Word-finding/language organization difficulties

• Attention-deficit/hyperactivity disorder

Stuttering

Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence

Environmental factors and speaking demands may exacerbate disfluency and influence a person’s negative reactions to stuttering. Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety

Sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children.

Genetic Factors

A range of studies support a genetic predisposition for stuttering, but “no definitive findings have been made regarding which transmission model, chromosomes, genes, or sex factors are involved in the expression of stuttering in the population at large” (Kraft & Yairi, 2011, p. 34).

Neurophysiological Factors

factors that are thought to contribute to stuttering include the following:

• Gray and white matter differences

  • Children with persistent stuttering showed deficiencies in left gray matter volume with reduced white matter integrity in the left hemisphere. In contrast to adults who stutter, children who stutter did not show increases in white matter tracts in the right hemisphere (Chang et al., 2015).

• Neural network connectivity differences

  • Children who stutter (ages 3–9 years) have reduced connectivity in areas that support the timing of movement control. These differences may affect speech planning needed for fluency (Chang & Zhu, 2013).

• Atypical lateralization of hemispheric functions

  • Preschool children who stutter showed differences in event-related brain potentials used as indices of language processing. These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013).

• White matter connections

  • Adolescents and young adults who stutter were found to have more white matter connections in the right hemisphere as compared with normally fluent controls (Watkins et al., 2008).

• Reduced Blood Flow

  • Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering.

  • Regional cerebral blood flow is reduced in Broca’s area, the region in the frontal lobes of the brain linked to speech production, and an inverse relationship was noted between the severity of stuttering and the rate of blood flow (Desai et al., 2016).

***These neurophysiological findings should be interpreted with caution due to the small number of subjects and the heterogeneity of the methodologies used ***

Attention/Phonological Working Memory and Stuttering

There may be a relationship between stuttering and working memory. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition.

The underlying relationship between stuttering and working memory is not fully understood but may be related to interruptions in sensorimotor timing for developmental stuttering and may involve both the basal ganglia and the prefrontal cortex

Risk factors that may be associated with persistent stuttering include

• sex of child—boys are at higher risk for persistence of stuttering than girls

• family history of persistent stuttering

• time duration of greater than 6–12 months since onset or no improvement over several months

• age of onset—children who start stuttering at age 3½ years or later

• slower rates of language development or co-occurring speech and language impairment

Typical disfluencies/ non-fluencies characteristics:

• Hesitate when speaking

• Use of fillers (“like” or “uh”)

• Word or phrase repetitions

A fluency disorder is an interruption in the flow of speaking.

Characteristics:

• Atypical rate

• Atypical rhythm

• Atypical disfluencies

  • • Repetitions of sounds syllables, words, and phrases

    • Sound prolongations

    • Blocks

May also be accompanied by:

• Excessive tension

• Speaking avoidance

• Struggle behaviors

• Secondary mannerisms

Stuttering characteristics:

• Monosyllabic whole-word repetitions

  • • “Why-why-why did he go there?”)

• Part-word or sound/syllable repetitions

  • • “Look at the b-b-boy”

• Prolongations of consonants when it isn’t for emphasis

  • • “Ssssssssometimes we stay home”)

• Blocks

  • • inaudible or silent fixation or inability to initiate sounds

• Production of words with an excess of physical tension or struggle

Observable, secondary or concomitant, stuttering behaviors:

• Body movements

  • • Head nodding, leg tapping, fist clenching

• Facial grimaces

  • • Eye blinking, jaw tightening

• Distracting sounds

  • • Throat clearing

Secondary, avoidance behaviors:

• Using fillers

  • • “like,” “um,” “uh,” “you know”

• Avoiding sounds or words

  • • • Substituting words, inserting unnecessary words, circumlocution)

• Altering rate of speech

(ASHA; Fluency Disorders, 2021)

Characteristics of stuttering:

1. Repeated sounds or syllables

2. Extended consonants when it isn't needed for emphasis

3. Reading is less fluent than spontaneous speech

4. Avoidance of difficult sounds or words/diminished interest in speaking

5. Physical tension and behaviors such as eye blinking or nodding

Characteristics of cluttering:

1. Rapid production of speech

2. Spoken sentence structure which lacks fluency, has unexpected pauses

3. Syllable collapsing or deletion

4. Spontaneous speech is less fluent t than reading

5. Exhibits multiple errors in articulation

• Diagnosis of Fluency Disorders (Stuttering, Cluttering, or both) and Characteristics of severity levels.

• Determination if person will benefit from treatment or if any adverse educational, social and vocational impact exist.

• What are the negative reactions (e.g., affective, behavioral, or cognitive reations) to their disfluency assessed?

• Any environmental concerns of negative reactions from others (e.g., peers, classmates, family, community members)

• If client exhibits physical tension or secondary behaviors and the severity observed.

• Are there any co-occuring language or speech disorders

• Are their any impairments in body stucture or function: including frequency and severity of disflencies,

• The limitations the client may have in terms of activity level and participation their of.

• Contextual (environemental and personal factors)

• Any Quality of Life (QoL) evaluation results and the affects on treatment

• Recommendation for treatment

• Prognosis