Fluency (Stuttering)

Stuttering, or dysfluent speech, is characterized by disruptions in normal speech flow. Speech is often halting and can include repetitions, interjections/fillers and prolongation of speech sounds. The onset of stuttering usually occurs between 2-5 years of age. Two main categories of behaviors are associated with stuttering:

Core behaviors are the basic manifestations that seem beyond the voluntary control of the stutterer, and may include repetitions of sounds, syllables, words or phrases, prolongations of single sounds and/or inappropriate stoppage of air or voice during speech (blocks). Secondary behaviors develop over time as learned reactions to the core behaviors and are characterized as escape or avoidance behaviors and may include head nods, eye blinks, foot taps and/or jaw tremors

Evaluating the child with a fluency disorder incorporates both standardized measurement as well as observational measures.

The speech-language pathologist will observe and document all aspects of the child’s overall experience of stuttering. This is accomplished by collecting information about factors such as the child’s use of avoidance strategies, the child’s self-reported feelings about his or her speaking difficulties, and other factors that reflect the consequences of stuttering. Interviewing the parents, teachers and other people in the child’s environment, as well as the child, will provide a comprehensive picture of the child’s fluency experiences.

lipsOur treatment approach to Fluency / Stuttering begins with a comprehensive assessment which includes a baseline frequency count, formal assessment, and parent interview.

The speech-language pathologist will develop a comprehensive treatment program according to assessment findings. The goal of fluency therapy is for the child to reduce the frequency of stuttering, decrease the tension and struggle of stuttering movements and decrease word or situation avoidances. Successful therapy is therapy that helps a child communicate freely and participate fully in his/her daily life.

The Fluency Therapy Protocol at Suburban Speech Center includes assessment, as well as indirect and direct therapy approaches in accordance with the Preferred Practice Patterns of the American Speech-Language and Hearing Association, as well as the philosophies of The National Stuttering Association and the Stuttering Foundation of America.

Indirect Approach is a family focused treatment plan for preschool age children (ages 2-6).

The treatment includes teaching parents specific strategies and providing suggestions to facilitate their child’s fluency and to promote a healthy speaking environment. The speech-language pathologist addresses the young child’s dysfluency symptoms without calling further attention to them. This may include parental style adjustments such as rate, turn-taking latencies, interrupting behaviors and parental language style changes. Parents may also be instructed to directly model fluency enhancing techniques.

Counseling is utilized as part of this treatment approach to help parents reduce their anxiety about stuttering, and employ child-focused strategies to aid the child in modifying his behaviors and communication attitudes as well as the child’s environment.

Direct Approaches target the child’s individual speech behaviors.

Direct therapy is implemented when the child is aware of and/or frustrated by his stuttering, as well as when secondary behaviors are exhibited. At Suburban Speech Center, we use Stuttering Modification, Fluency Shaping and Hierarchical approaches.

Fluency Shaping is based on the assumption that stuttering is a learned behavior. This approach focuses on teaching the child to speak more fluently. The goal of fluency shaping is to work with the child’s motor speech control capabilities and to apply various approaches to facilitate new speech production patterns.

  • Easy onset/prevoice exhalation: The speaker is taught to exhale slightly before beginning phonation and reaches conversational loudness gradually.
  • Decreased speaking rate: The speaker is trained to stretch out the sounds (primarily vowels) in his speech and produce words at a slower-than-normal speaking rate while maintaining normal stress and intonation.
  • Light articulatory contacts: The speaker is taught to move the articulators in a loose and relaxed manner.
  • Continuous phonation: The speaker is trained to reduce all breaks between words by maintaining voicing continuously until he naturally needs to take a breath.

The ultimate aim of programs based on a fluency shaping philosophy is to completely change speech behavior by teaching the child to use these techniques at all times, not just during disfluent moments. These techniques are designed to interfere with the stuttering behaviors, thus reducing them. Therapy sessions focus solely on acquisition of these behaviors and generally do not address secondary behaviors or the negative feelings and attitudes that may be associated with the stuttering.

Stuttering Modification is based on the premise that stuttering may involve a physiological predisposition. The primary goals of stuttering modification are to modify each disfluent moment by stuttering more easily and to eliminate struggle and avoidance behaviors. This approach aims to reduce speech-related avoidance behaviors, fears and negative attitudes. The goal of stuttering modification therapy is to modify stuttering moments by decreasing the tension so the stuttering is less severe and the fear or avoidance behaviors of stuttering are eliminated. These goals are accomplished through the use of a combination of the following techniques:

  • Self-Analysis is the increased understanding by the child about his speech mechanism, as explained by the speech-language pathologist. Through self-modeling, a child learns the target behaviors by observing himself engaging in positive behaviors from audio recordings and videotapes. This approach increases the child’s awareness of the type, severity, and loci of disfluencies as well as any accompanying secondary behaviors. Attention also may be given to increasing the client’s self-awareness of the characteristics of his nonstuttered speech and monitoring his proprioceptive awareness of the oral musculature.
  • Desensitization reduces negative emotions and fears associated with stuttering by decreasing sensitivity to core behaviors and listener reactions. This also is effective at reducing anxiety relating to any potential teasing or bullying situations.
  • Environmental Modification targets child, parent and teacher understanding of the fluency disorder and includes techniques to incorporate into the child’s environment.
  • Interactive skill development is essential to incorporate into the therapy regimen. It is important for the child to develop good eye contact that is age appropriate and socially acceptable.
  • Resisting time pressure is an important skill that the child needs. Proper turn taking, on the part of the listener can decrease the number of times a child’s speech is interrupted and can reduce the time pressure a child may feel. Parents, siblings and other people in the child’s environment are included in this process.
  • Fluency Enhancing Techniques include cancellations, pull-outs, and preparatory sets.
  • Role Playing is effective at reducing anxiety relating to any potential teasing or bullying situations. Teachers and parental input are also used to create and monitor these situations.
  • Charting is used to help the child label positive and negative attributes to help improve self confidence and self-esteem. The speech-language pathologist helps the child to identify and chart the child’s emotions regarding stuttering situations.

Structured Hierarchies is an effective way to monitor therapy progress. Once the child learns strategies to facilitate fluency, the speech-language pathologist will help him develop a scale of fluency difficulties. Environmental settings will be charted starting with the child’s most fluent speaking situations and progressing to the more challenging speaking environments. The use of hierarchies enhances the child’s chances of success. For example, if a child is using voluntary stuttering as a way of desensitizing himself to stuttering, then it needs to be introduced in a comfortable and supportive setting such as the therapy room. It can then move to harder situations such as the playground and with the family. The use of structured hierarchies facilitates generalizations between the therapy room and the outside environment

At Suburban Speech Center, our comprehensive treatment approach is individualized to each child’s needs. As a result of therapy, some children are able to eliminate stuttering completely, others will learn to use strategies to help them stutter less, while still others will learn to speak in a manner that is less tense, even though some dysfluency may still be present, while maintaining a more positive outlook on their fluency.

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