Fluency Disorders - Types, Causes And Symptoms
Author: Roselyn Mathew, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, July 10, 2024
Table of Contents
Introduction
Fluency is an important component of speech. As defined by American Speech- Language – Hearing Association “fluency refers to continuity, smoothness, rate and effort in speech production. All speakers are disfluent at times. They may hesitate when speaking, use fillers (um, uh), or repeat a word or phrase. These are called typical disfluencies or nonfluencies”.
The definition of fluency disorder according to ASHA in 1993 is- “an interruption in the flow of speaking characterized by atypical rate, rhythm and disfluencies (eg. Repetitions of sounds, syllables, words and phrases; sound prolongations and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviours and secondary mannerisms” (ASHA, 1993).
Although fluency disorder is commonly known as a disruption in the speech fluency, they can be classified into different types based on the type of the fluency disruption. There are different ways a fluency disorder can be classified. In this article we will be focusing on classification of fluency disorder based on the type of disruptions in the flow of speech.
Stuttering
Stuttering is a fluency disorder where there are repetitions, prolongation, or blocks during speech. The duration of blocks and prolongations vary according to the severity of stuttering. Repetitions are usually sound repetitions, although syllable repetitions, words repetitions and multiword repetitions have been reported.
In some parts of the world the word “stammering” is used instead of stuttering. There is no difference between these two. The term stuttering is generally used in countries like Australia, Canada and the United States of America; whereas the term stammering is used in the United Kingdom.
What causes stuttering?
Although stuttering is a disorder that has been researched since 1800s, the exact cause of stuttering has not been identified till date. A lot of theories regarding the cause of stuttering have been proposed but none has been proven so far.
Some of the theories about the cause of stuttering are:
Genetics
It is proposed that stuttering can be hereditary and a child could develop stuttering if their family members have stuttering. Even though there have been studies showing individuals with stuttering whose parents or close family members stutter, there are
also studies showing cases where there are individuals with stuttering whose family members do not stutter or have no history of stuttering.
Presence of another speech or language disorder
It has also been theorized that stuttering might develop due to any other speech and language issues that went unresolved but there are minimal evidences to support this theory.
Subconsciously imitating a person with stuttering due to being influenced by them
According to this theory, a person can develop stuttering while they are being influenced by another person with stuttering. It could be a friend, relative, a role model or even with someone whom they spent a lot of time talking.
Brain structure differences/neurological
A couple of studies have shown that the left hemisphere of a person with stuttering is different from a person who does not have stuttering. This has led to the theory that the cause of stuttering is purely neurological. No clear evidence supporting this has been found so far.
Psychological trauma
Another theory is that stuttering might develop due to any sort of psychological trauma or shock that had happened in childhood. Although a few cases have been reported, it is still not yet proven as a cause.
History of being overcorrected
An experiment was done during the 1800s where it was shown that children who are overcorrected at a young age tend to develop less confidence regarding their speech and might develop stuttering. Again, this was the only experiment supporting this theory and has not been proven.
Extreme anxiety and stress
Although it is seen that people with stuttering have anxiety and stress while speaking, it is not clear whether they actually develop anxiety and stress due to stuttering.
Symptoms of stuttering
Some of the common symptoms of stuttering are:
Repetitions of mostly sounds, but also syllables or words
Prolongation of sounds
Unable to move articulators and freezing during the stuttering episode
Other behaviours like eye clenching, frequent eye blinking, foot tapping, raising eyebrows, nose flaring etc.
Increased disfluencies while speaking with higher authorities and strangers and reduced disfluencies while speaking with family, friends or people with whom the person is comfortable with.
Avoid speaking situations and sometimes social situations
Excessive tension on the jaw, tongue, lips, mouth, throat or neck muscles while the person is speaking
Having higher disfluencies for a specific sound/sounds or word/words
Being stressed and anxious while facing a speaking situation or even while thinking of a speaking situation
Fast speech which happens intermittently in order to complete the speech faster
Using filler sounds or interjections like ‘um’, ‘uh’ and ‘ah’ while speaking
Cluttering
Cluttering can be defined as “a fluency disorder and is characterized by a perceived rapid and / or irregular speech rate, atypical pauses, maze behaviours, pragmatic issues, decreased awareness of fluency problems or moments of dysfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and /or fluency” (St. Louis & Schulte, 2011; van Zaalen-Opt Hof and Reichel, 2014).
Cluttering may have an effect on pragmatic communication skills and awareness of moments of disruptions (Teigland, 1996).
Causes of cluttering
It is hard to pinpoint the exact cause of cluttering. It has been proposed that since people with cluttering are not aware of the issue most of the time, cluttering could be caused due to a faulty or disrupted auditory feedback system. It means that generally when we speak, we listen to our own speech and can identify if we have any speech issues like a lisp, disfluencies or when we speak at a faster pace. We understand this because we get feedback of our own speech to our ears to analyze and understand the things we say and the way that we speak. If this feedback or understanding is disrupted, we won’t be able to understand if our speech is fluent or meaningful or any other issues in our speech.
One of the most popular theories regarding the cause of cluttering is that cluttering might be caused due to mild or soft neurological impairments in the brain.
Symptoms of cluttering
The most commonly seen symptoms of cluttering are:
The rate of speech is fast. For some individuals it might be extremely fast that the speech becomes unintelligible.
There would be repetitions of mostly syllables, single words, multiple words and sometimes only sound repetitions.
People with cluttering are mostly unable to understand that they have cluttering and that they are going fast unless they get some feedback about their speech from another person.
They find it difficult to slow down while speaking even when asked to do so • Deleting of sounds and syllables from speech (especially middle and end part of longer words)
Merging of 2 or more words together without leaving gaps between each word • Speaking and writing without organizing thoughts appropriately
Mostly having a messy handwriting and having a tendency to write fast • Having a tendency to constantly interrupt others during conversations • Inconsistent use of atypical pauses within a sentence
Finding it difficult to express thoughts and ideas clearly
As stated by ASHA, cluttering can co-occur with other disorders, including
Learning disabilities (Wiig & Semel, 1984)
Auditory processing disorders (Molt, 1996)
Tourette’s syndrome (Van Borsel, 2011)
Autism (Scaler Scott, 2011)
Word –finding/language organization difficulties (Myers, 1992)
Attention deficit/hyperactivity disorder (Alm, 2011)
Neurogenic stuttering
Neurogenic stuttering is an acquired form of stuttering where stuttering develops after a neurological damage. People with neurogenic stuttering typically have a fluent speech before the neurological damage occurs.
Causes of Neurogenic stuttering
The main cause of Neurogenic stuttering is neurological damage to the brain or any other areas in the central nervous system. It can be sudden or slowly progressive.
Some examples are:
Stroke
Side effects of prescribed drugs which might be either permanent or temporary and goes away once the person stops taking those drugs
Tumors or cysts affecting the nervous system
Brain trauma
Degenerative disorders like Multiple Sclerosis and Parkinson’s disease - Brain infections like meningitis and encephalitis
Drug abuse
Symptoms of Neurogenic Stuttering
Some common symptoms of Neurogenic Stuttering are:
Having rapid bursts of speech that are often not intelligible
Having repetitions or prolongations of sounds, syllables, single words or multiple words - Ending a sentence without using adequate words to complete it which might making the listener confused
Having atypical pauses or hesitations in between a sentence
Groping or posturing of tongue, lips and jaws while speaking
Conclusion
Fluency disorders are of different types based on the cause and symptoms. The treatment plan for fluency disorders depends on their type and symptoms. It is important to consult a trained Speech Language Pathologist to get adequate treatment in order to improve communication skills and have confidence during speaking situations.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
