Fluency and Stuttering: A Brief Overview

First, what is stuttering?  

Stuttering is a multi-dimensional fluency disorder that disrupts the natural flow of speech. The exact causes of stuttering are unknown and the range of severity is wide, with characteristics varying from person to person. Stuttering can essentially be broken down into three major components: core behaviors, secondary behaviors, and negative feelings/attitudes.  

Core Behaviors 

The core behaviors of stuttering consist of the observable, uncontrollable disfluencies that a person makes when speaking. These include repetitions, prolongations, and blocks. Repetitions involve repeating a sound, syllable, or single syllable word (ex: “I want to p-p-p-play” or “I wa-wa-want to play” or “I want-want-want to play”). Prolongations involve holding out a sound for an extended time (ex: “I waaaaaaaant to play”). Blocks are silent and occur when a sound gets “stuck” or cannot be initiated, like an unwanted, tense pause (ex: “I w——-ant to play”).  

Secondary Behaviors 

Secondary behaviors may develop as children get older and become more aware of their own stuttering. They also tend to increase with severity. These behaviors can be physical, including eye blinking, tics, lip tremors, facial tremors, jerking of the head, breathing movements, or fist clenching. A person may also demonstrate avoidance or escape behaviors to prevent stuttering in fear of certain sounds, words, speaking partners, or situations.  

Negative Feelings and Attitudes  

If stuttering persists into adolescence and adulthood, a person may begin to associate past negative experiences with speaking and consequently develop negative reactions toward stuttering and communication. This can include feelings of fear, shame, guilt, embarrassment, and frustration. It is just as important to address the inner, personal aspects of stuttering as it is to acknowledge the outer, surface aspects.  

Indirect Techniques for Childhood Stuttering 

Usually, in early childhood, we mainly see the core behaviors or disfluencies of stuttering. Indirect therapy methods may be used by parents at home to help reduce the occurrence of stuttering. This includes asking fewer questions, using a slower rate of speech, and increasing pause time during conversation. These methods aim to reduce communicative stress during conversation, which in turn will indirectly target your child’s fluency.  

Ideas for at Home 

Join your child in play with his or her favorite toys (e.g., racetrack, stuffed animals, etc.). Try not to ask too many questions or speak too quickly, and give your child plenty of time to respond to you so he or she doesn’t feel rushed to communicate. The mood should be relaxed and positive for communication. You may self-monitor your own rate of speech, pause time, and amount of questions asked by making a tally mark each time you ask a question or notice yourself speaking in a hurried manner.  

I think my child may be stuttering. What should I do?  

Mild disfluencies in very young children may be normal and occur at times when they learning language. However, if you notice your child has been exhibiting the behaviors described above for more than three months, or if the disfluencies appear to be more than just mild, you should seek the help of a speech-language pathologist right away. Treatment approaches vary depending on age, severity, impact, and emotional components that may be involved. A speech-language pathologist will be able to complete an evaluation and develop an individualized treatment program that is appropriate for your child. Treatment options are available to older children, adolescents, and adults as well! 

-Ashley Cochran, M.S. CCC-SLP 

Helpful Links:

http://www.asha.org/public/speech/disorders/stuttering.htm

http://www.stutteringhelp.org/content/parents-pre-schoolers

http://www.stutteringhelp.org/content/stuttering-and-your-child-help-parents

Phonological Processes

When a child receives treatment from a speech-language pathologist in order to remediate speech sound errors, these errors can actually be divided into two groups: articulation errors and phonological process errors. Articulation errors are what typically come to mind first when anyone thinks of a “speech error”. These are the errors that result from a child’s impaired ability to produce sounds due to issues with coordinating the movements of our articulators: the lips, teeth, tongue, palate and jaw, to produce a clear speech sound. When a child has articulation errors, the speech language pathologist uses therapy sessions to teach the child how to make the correct sound by showing them how to move their articulators, and helping them to understand what type of sound they are making. This way, the child can learn to self-monitor their speech to correct errors as they work from practicing at sound isolation, to words, phrases, sentences, and ultimately conversational level speech. 

The second group of errors can be referred to as the phonological process errors. Some children who appear to have many “articulation” errors, or are very difficult to understand may have more than an articulation delay; these children may have a phonological delay. A phonological delay is distinguished by the presence of what we call phonological processes, which can effect a wide variety of sounds in the child’s speech. 

What are Phonological Processes? 

A phonological process is a pattern that young children adapt to simplify adult speech sounds. All children use these processes at some point in time while their speech and language skills are still developing because they don’t have to ability to coordinate the articulators for clear “adult-like” speech. Due to this, children will simplify words in predictable ways until they develop the skills required to produce them clearly. A familiar example of this might be a 2-year-old child saying “wa-wa” for “water” or “nana” for “banana”. 

While these are common in younger children, normally developing children will have stopped using all phonological processes by the age of 5. Children that may have a phonological delay or disorder produce these processes beyond the age that they are expected to disappear, and may produce additional “abnormal” processes that are not commonly seen in development. As children with phonological delays continue to use these phonological processes, they develop a different organization of patterns of sounds in their brains that do not match that of most of their same-aged peers, or adults. As you can see, unlike articulation errors, phonological errors involve remediating more than just the coordination of the articulators, which is why these errors are treated differently than articulation errors. Treatment for children with phonological errors usually involves targeting the phonological processes in error rather than targeting each individual sound. When phonological errors are present, therapy time will typically also involve recognition and discrimination of correct sounds as the first step to re-wiring the child’s patterns to match those of a normally developing child or adult.

Some signs of phonological delays: 

* Child is very difficult to understand, especially when the context is unknown 

* You can recognize more than one sound that is not produced correctly 

* Child is “deleting” sounds, multiple sounds, or parts of words 

For reference to this information regarding phonological processes, here is a chart below including several of the more commonly seen patterns:

Phonological ProcessesExamplesAge Mastered
“Fronting”When “back” sounds, like /k/ and /g/ are replaced by “front” sounds like /t/ and /d/. “tandy” for “ candy” “dod” for “dog” Age 3.5
“Cluster Reduction”When a consonant cluster is simplified to one consonant “pane” for “plane” “sot” for “spot” Age 4-5

“Final Consonant Deletion”When the final consonant in a sound is left off “ca” for “cat” “we” for “web” Age 3

“Reduplication”When a complete or incomplete part of the word is repeated “baba” for “bottle” “wawa” for “water” Age 3
“Gliding” When /r/ becomes a /w/, and /l/ becomes a /w/ or /y/ sound “wabbit” for “rabbit” “yeyo” for “yello” Age 6
“Prevocalic Voicing”When a “voiceless” consonant in the beginning of the word like /k/, /p/, /f/, or /t/ is replaced with a “voiced” consonant like /g/, /b/, /v/, or /d/. “gomb” for “comb” “big” for “pig” Age 6

If you suspect that your child may have a phonological delay or are concerned about their speech, please contact our office. We would love to work with you and set up an evaluation with a speech-language pathologist! 

-Emily Hamm, M.A., CCC-SLP 

References: 

Bauman-Waegner, J. (2016). Diagnosis: Articulation- versus Phonemic-Based Speech Sound Disorders. In Articulation and Phonology in Speech Sound Disorders: A Clinical Focus(5th ed., pp. 177-210). Boston, MA: Pearson Education.