Stuttering
What is Stuttering?
Stuttering is a speech disorder where the smooth flow of speech is disrupted. This dysfluency may interfere with the ability to be clearly understood.
- Repetitions of sounds, syllables or words e.g. “M-m-m-mummy” or bu-bu –bubbles or ‘I want- I want-I want a pear”.
- Blockings that are silence as the person tries to speak.
- Prolongations e.g. “Where is the c-o-o-o-w?”
- Verbal disruptions may be accompanied by body, head and facial movements such as eye-blinking or other signs of struggle and tension.
What Causes Stuttering?
The causes of stuttering are multifactorial. Stuttering has been strongly linked to a genetic basis. Stuttering also affects more males than females, with reported rations varying from 3:1 to 5:1 (Onslow, 1998). In addition, brain studies have also shown differences in the brains of people who stutter, compared to the normal individuals.
Stuttering may also be influenced by environmental factors and may worsen in situations that produce anxiety or stress.
Onset Of Stuttering
The onset of stuttering typically occurs in the early years of life, between 2 to 5 years old or as soon as a child starts putting words together into short sentences. Sometimes, stuttering may be ‘acquired’ in late childhood or early adulthood. “Acquired” stuttering may occur due to psychogenic reasons or neurological trauma such as a head injury or stroke.
What happens in Stuttering Therapy?
Parents may be concerned that stuttering therapy will increase the child’s awareness of his or her speech dysfluencies and have a negative effect. On the contrary, early intervention is important because studies have shown that as a child enters formal schooling, children can be bullied and teased in school because of their stuttering.
In addition, once stuttering persists past 7 years of age and into the formal schooling years, it becomes less tractable. Deciding to bring your child for treatment is an important step towards helping your child.
Stuttering therapy allows children to successfully speak fluently, resulting in:
- Increased confidence
- Stuttering with less tension
- Increased eye contact
Stuttering Treatment
Preschool children (from 2 to 6 years) are treated using the Lidcombe Program. The Lidcombe Program is an evidence-based, behavioural treatment for early stuttering. Parents are trained to help their child to control their stutter. Results from the Lidcombe Program show that the majority of children are able to maintain fluent speech during conversations or social interactions. Randomised controlled trials and scientific studies (Arnott et al, 2014) have shown that the Lidcombe Program is best practice for treating stuttering in the preschool years.
Some preschool children may benefit from Syllable Timed Speech which has also shown promising results.
For school aged children, there are different treatment approaches available to reduce the stuttering severity. This includes:
- Fluency shaping treatment aimed at controlling the stutter (e.g. phrasing and pausing, easy onsets and light contacts).
- Fluency modification treatment aimed at reducing tension (e.g. cancellations, pull-outs).
- Cognitive Behavioural Therapy such as restructuring negative thought patterns as well as desensitizing the stuttering itself are also helpful. Narrative therapy may be helpful in shifting negative thoughts and/or beliefs to a healthier place, thereby decreasing anxiety and fear surrounding the stuttering.
For adolescents and adults, Prolonged Speech or Smooth speech techniques are used. Clients are taught specific strategies to improve their fluency and control the stutter. Treatment is conducted on an individual basis and tailored to suit the client’s needs. This may include reading, presentations, speaking engagements, job interviews, or other social situations.
Australian Stuttering Research Centre : http://www.fhs.usyd.edu.au/asrc/
Latrobe University : http://www.latrobe.edu.au/istutter/
Arnott, S., Onslow, M., O’Brian, S., Packman, A., Jones, M., & Block, S. (2014). Group Lidcombe Program treatment of early stuttering: a randomized controlled trial. Journal of Speech, Language and Hearing Research, 57, 1606–1618.
Cluttering
What is Cluttering?
Cluttering is a fluency disorder that is characterized by an irregular or rapid speech rate which results in a breakdown in speech clarity. Prosody (speech rhythm) and articulation may also be affected. For instance, an individual may display articulation difficulties, such as saying “buttercup” as “tuttertup”, or omit word endings.
Other Symptoms Of Cluttering Include:
- Deletion of syllables in a word (e.g. “television” as “tevision”, “crocodile” as “crodile”).
- Collapsing of syllables where sounds and syllables are blended together too much (e.g. “ferchly” for “fortunately”).
- Dysfluencies, such as sound repetitions (“b-b-b-ball”); syllable repetitions (“di-di-di-di-dinner”), prolongations (“waaaaant ”), or blocks (where the person tensely pauses while trying to speak but no sound comes out).
- Excessive use of interjections (e.g. um, uh, er) and revisions (e.g. “um, I really um, like to um, — I was um, thinking of watching, um, a movie).
- Unusual prosody or irregular speech patterns - Speaking too quickly and/or irregularly; such as abnormal pauses in places not expected grammatically, often making the speech sound “jerky” or abrupt.
- Difficulty planning what to say next, which can lead to disruptions in the flow of speech.
Differences between Stuttering and Cluttering
| Symptom | Stuttering | Cluttering |
| What gets stuck | Word, sound, syllable | Message |
| Know what want to say? | Yes | No (or less clear; know but the person gets derailed in mazes) |
| Awareness | Typically yes | Yes and No |
| Rate differences | Can be a secondary strategy (i.e. person who stutters may speak quickly to avoid stuttering), but is not central to stuttering itself | Yes; mandatory for a diagnosis of cluttering (note that rate has to be rapid OR irregular, but does not have to be both) |
| Dysfluences | Mostly stuttering-like disfluencies (SLDs), such as repetitions, prolongations, blocks | Mostly non- stuttering- like disfluencies (NSLDs), such as interjections / filler words, phrases repetitions, revisions |
| Examples of dysfluencies: | Repetitions of sounds of syllables: y-y-you, wa-wa-watermelon Prolongations: sssso; thiiiis Blocks: sound gets stuck and person has difficulty moving forward to nextsound: p---eople | Interjections/ filler words: um, uh. Phrase repetitions: I love, I love NSA. Revisions: I would like ice cream, no, please make that a shake. |
| Articulation difficulties (i.e. difficulties pronouncing sounds in words) | Not in pure stuttering (i.e. stuttering without any additional communication disorders). | Collapsing or deleting of syllables (e.g. escalator as "eslator"). |
| Prosody (i.e. the rhythm and melody of one’s speech) | Typically normal. | Irregular speech rate with jerky speaking patterns - incorrect use of pauses, syllable stress and volume. |
| How it sounds | Repetitions, prolongations, blocks. | Rushes of speech; lots of restarts. |
| Affective and cognitive components | May be affected. | Negative reactions and communication avoidance. |
| Pragmatics (i.e. social aspects of language) | Typically okay. | A secondary consequence to decreased communication effectiveness. |
Irregular speec speaking patterns,
Reference: National Stuttering Association, 2010