Fluency refers broadly to the percussion elements of speech: the rate rhythm and flow. A bit like the drumbeat holds the rhythm and beat of music, fluency sets the pace, rhythm and beat of speech. Dysfluency refers to the disruptions of rate rhythm and flow in speech. Stuttering is simply the most commonly known term for dysfluency and is known typically as repetitions of sounds or words. Stuttering is otherwise referred to by speech pathologists as a motor speech problem, difficulty controlling the ‘motor’ aspect of speech. Every person’s stuttering difficulty is unique to them, a combination of pauses, hesitations, characteristic speed (often fast measured in syllables per minute), sound word or phrase repetitions. The features and severity of dysfluency can be measured, assessed and diagnosed by an experienced Speech Pathologist. Other descriptors for stuttering may include: prolongations of sounds, excessive use of pause fillers (ums, ers…), circumlocutions or blocks and secondary behaviours.
Stuttering can be classified as mild, moderate or severe. Whilst many toddlers in the 2-4 year age group pass through a phase of stuttering when learning to talk, it is difficult to know which children will ‘grow out of it’, so early intervention, seeking the advice of an experienced Speech Pathologist, with the aim of correcting before school starts, is advised.
Anxiety can become an integral part of a stuttering pattern and its effect on communication and attitudes to talking can be profound. Studies show that anxiety can develop quite quickly in some children who are stuttering.
A decision about treating very young children or waiting for them to grow out of it is an important one and may depend on factors like family history, how long the child has been stuttering and the severity of the stuttering and other concomitant life events.
The recommended treatment for children before they commence school is a parent-training program that teaches delivery of positive rewards during play and in the everyday home environment. Therapy is fun and can involve the whole family.
Stuttering in school age children is sometimes more complex and can take longer to treat than the ‘littlies’. As children get older they are more likely to have developed entrenched stuttering habits, and possible anxiety around speaking. The rule of thumb is the younger the better when treating childhood stuttering. The younger a child learns the easier it is for them, and the less likely they develop negative attitudes or fears around speaking situations.
For school age children a more direct therapy approach using ‘Smooth Speech’ may be required, in combination with a positive reward system. There are many different names used for smooth speech programs e.g. Turtle Talk. Kids like being able to win their very own (toy) turtle when they master it!
A tricky aspect of therapy with school age children is the requirement that they develop the skills to self-monitor their speech when learning to use smooth speech in everyday speaking situations, even when they are in the grip of emotional states like excitement. It is a work in progress and takes time as they encounter new situations and challenges in daily life, and as they grow and mature. Fluency therapy is not an overnight fix, but a process of skill acquisition.
Not only that, one of the biggest challenges for parents is that they want to help their child overcome stuttering, but their child simply does not care. This is a challenging situation for parents and speech pathologists which requires ‘careful managing’.
Adults and adolescents who are stuttering, have often had a lifetime of talking experiences that may shape the way they feel about their speech. It is unlikely but not unheard of, that stuttering will commence in the teenage or adult years.
The ideal therapy for this age group is intensive style over a period of 2-3 months, including assessment treatment and progress reviews. Treatment in a group forum is ideal, allowing individuals to share their experiences with others who also stutter, which can be a great comfort and support.
Treatment involves learning techniques for controlling fluency and decreasing stuttering, including management of emotions, anxiety and unhelpful communication habits which may have been present for many years as part of dealing with stuttering in everyday life.