Fluency Disorders Lecture Notes

Overview

• Focuses on stuttering and cluttering across the lifespan.
• Excludes acquired neurogenic and psychogenic stuttering.
• Fluency: Continuity, smoothness, rate, and effort in speech production.
• Fluency Disorder: Atypical rate, rhythm, disfluencies (e.g., repetitions, prolongations, blocks).
  • Psychological, emotional, social, and functional impacts.

Stuttering

• Most common fluency disorder.
• Characterized by:
  • Repetitions (sounds, syllables, words).
  • Prolongations (consonants not for emphasis).
  • Blocks (silent fixation or inability to initiate sounds).
• Accompanied by:
  • Negative reactions, avoidance, escape behaviors, physical tension.
• Psychological and social impacts include anxiety, negative self-perception, loss of control.
• Originates in childhood, often before age 4.
  • 88%-91% recover spontaneously.
• Co-occurs with disorders like ADHD, autism, intellectual disabilities.

Cluttering

• Characterized by rapid/irregular speech rate, atypical pauses, maze behaviors.
• Involves excessive disfluencies, collapsing or omitting syllables.
• Affects speech clarity and pragmatic skills.
• Co-occurs with disorders like learning disabilities, ADHD, Tourettes.
• Speech clarity improves with slowing down or focusing on speech.

Incidence and Prevalence

• Stuttering lifetime prevalence: 0.72%.
• Higher in children and preschoolers.
• Predominantly male (4:1 ratio in stuttering).
• Higher incidence with family history, first-degree relatives.
• Cluttering less researched, estimated at 1.1%-1.2% in school-age children.

Signs and Symptoms

Stuttering

• Core behaviors: repetitions, prolongations, blocks, tension.
• Secondary behaviors: facial grimaces, body movements.
• Avoidance or escape behaviors for covert stuttering.

Cluttering

• Coarticulation issues, atypical pauses, rapid or irregular speech.
• Unusual prosody due to pausing patterns.

Causes

Stuttering

• Multifactorial: genetic, neurophysiological factors.
• Emotional problems and parenting styles not causal.
• Genetic predispositions identified, some gene mutations linked.
• Neurophysiological differences in brain structure and function.

Cluttering

• Less known, some neurological overlaps with other disorders.
• Possible issues in self-regulation and speech production timing.

Roles and Responsibilities of SLPs

• Screening, assessment, diagnosis, and treatment.
• Educating and supporting individuals and families.
• Developing individualized, culturally relevant intervention plans.

Assessment and Treatment

• Comprehensive assessment includes history, speech samples, emotional and cognitive impacts.
• Treatment individualized for age, needs, and cultural context.
• Goals include increased fluency, self-acceptance, and reduced negative impacts.

Treatment Strategies

For Stuttering

• Indirect and direct approaches for preschool children.
• Speech modification and stuttering modification for older individuals.
• Cognitive restructuring, self-disclosure, and support groups.

For Cluttering

• Focus on regulating speech rate and increasing awareness.
• Use of pausing and self-monitoring strategies.

Cultural and Linguistic Considerations

• Bilingualism not directly linked to increased stuttering.
• Importance of culturally and linguistically adapted assessment and treatment.

Conclusions

• Fluency disorders are complex, multifactorial conditions impacting communication and quality of life.
• SLPs play a crucial role in identifying and treating these disorders, considering individual needs and cultural contexts.