Stuttering is a fluency disorder. It affects the rhythm, rate, and smoothness of a person’s speech. It is characterized by disfluencies or the “stutter.” While it is normal for all persons to have disfluencies in their speech, stuttering has disfluencies which occur at a higher frequency and are more noticeable because of the type of disfluencies present.
While the following chart is not a diagnostic tool, it can help you know if disfluencies that you are hearing might be typical disfluencies or actual stuttering:
| Typical Disfluencies | Stuttering | |
| Behavior | Whole word repetitions (And and then it…) Phrase repetitions (It was it was going…) Sentence Revisions (I seen… I saw the..) Interjections (It was ahh… green.) | Part word repetitions (J,j,j,just pa,pa,part) Prolongations (It sooooooounds long) Blocks (The air sto—–ops). |
| Location of disfluency | Between words (e.g., It happens it happens between the words). | Within the words (e.g., I-i-it ha-ha-happens within the words themselves. |
| Frequency | Typically, less than 10% of syllables are stuttered. | Variable, but it usually becomes noticeable when passing 10% of the syllables, but can be as low as 4% of the time in some situations. When it happens twice as often as same aged peers. |
| Duration | 1-2 repetitions (e.g., I want I want to go [1 rep], or And and and then we… [2 reps]) | 3 or more repetitions (e.g., A-a-a-and [3 reps] then w-w-w-w-we [4 reps] saw it) |
| Reaction | The person usually shows no reaction. | Secondary behaviors are present such as eye blinking, throat clearing, changing the word mid-word, and using lots of interjections or fillers like “uh.” Young children who are not yet aware of their speech patterns will likely have not developed secondary behaviors yet. |
When atypical disfluencies are present, it is more likely that recovery without intervention will not happen and that it is an actual disorder. All disfluencies will be worked on in therapy, both atypical and typical, as the frequency of disfluencies often increases as a child progresses through the stuttering “levels” and even typical disfluencies can become atypical due to the frequency at which they start to occur. Again, these include sound/syllable/whole word repetitions, blocks of airflow/ voicing/ articulation movements and prolongations and/or muscle tension.
To start therapy or to not start therapy? Sometimes stuttering resolves without therapy, so how do you know when to seek out therapy?
There are risk factors that increase the chances that stuttering will persist. These include being male, the stuttering starting at age 4 or above, the length of time since it started (if 3 or more years, there is only a 15% spontaneous recovery rate), if there is a family history of stuttering, if there has been slight or no decrease in stuttering for 12 months, if there is a higher frequency of part-word or single syllable repetitions, having longer lengths of repetitions (3 or more at a time), having speech that is very fast or irregular in its speed, and/or if the child is already aware of their stutter and has started to develop feelings about it.
When I evaluate a child for a fluency disorder, part of my evaluation is always to find out if they are aware of their speech patterns or not. I start playing with them and ask about regular stuff (family, pets, activities, etc) and when comfortable, I ask things like: Do you like talking? What do you like to talk about the most? Is talking usually easy for you? If you could change something about your talking, what would it be?
If there is no awareness of the diffluent speech, I don’t question further. If they do indicate that they are aware they speech differently, then I ask a little more about their answers: What does that mean? Can you show me? What does it look like/sound like? When does that happen? How did you get so smart about this?
I ask these questions to guide me on what interventions I recommend for a child. If a child is already aware that they speak differently, you can start introducing ways to help make it easier. If the child isn’t aware, it’s the parents call to make them aware in direct treatment or try an indirect approach first.
In therapy, the child will learn about how talking actually happens and what stuttering is. They will learn strategies to use to eliminate their stutter or to make their stuttering sound easy and even so that it sounds more like typical disfluencies in speech rather than stuttered speech. They will also learn about people who are famous/successful who are also people that stutter so they they can know they aren’t alone and won’t be held back just because they have some bumps in their speech.
Room to Talk Speech Therapy 