Stuttering / Dysfluency

What is Developmental Stuttering? Developmental stuttering is disruption to the flow of speech that may include repetition of sounds and syllables, prolongation of sounds, and blocks in speech that initiates during childhood.

What Causes Stuttering? There is no known cause. However, there are some factors that may contribute to the developing stuttering: 

1. Genetics (about 60% of people who stutter have a family member who does also)
2. Childhood development 
3. Neurophysiology 
4. Family dynamics 

Goals of Treatment

1. Learn how to control stuttering behaviors (such as involuntary repetitions and blocking on syllables and words, along with high levels of associated muscle tension)
2. Gain control of any social and speech related fears and anxieties
3. Enhance social skills related to speaking and interaction with others

What is Neurogenic Stuttering? Neurogenic stuttering is characterized by disruption to the flow of speech that may include interjections, revisions, sound repetitions, syllable repetitions, word repetitions,  prolongations of sounds, hesitations and pauses, excess oral movements,  rapid bursts of speech that are unintelligible, or  unnecessary additional sounds. 

What Causes Neurogenic Stuttering? Neurogenic stuttering may occur following injury or disease to the central nervous system. Examples of injury or disease that may cause neurogenic stuttering include:

• Stroke
• Brain Injury
• Tumors
• Degenerative disease such as Parkinson’s disease or Multiple Sclerosis
• Drug-related/medication side-effects 
• And more—some cases are also unexplainable

Neurogenic vs. Developmental Stuttering

• In neurogenic stuttering, the dysfluency may occur in any part of a word rather than at the beginning.
• Neurogenic stuttering often occurs on any type or class of word anywhere in a sentence rather than primarily content words such as nouns, verbs, adjectives and adverbs.
• Neurogenic stuttering may occur in any type of vocal behavior, including singing and repeating rehearsed passages. 
• Choral reading, singing, repeated oral reading, and delayed auditory feedback are often not effective treatments for neurogenic stuttering. 
• Individuals with neurogenic stuttering often don’t have as many fears/negative feelings towards disfluencies as in developmental stuttering.

Strategies for Fluency:

Fluency Shaping: (Manning, 2001) Stuttering is viewed as a physical phenomenon. If the speaker follows the rules of speech mechanics, his speech will be fluent: if he violates these rules, his speech will not be fluent. As incorrect and distorted muscle movements are altered, the speaker is able to achieve fluent speech. The client is carefully taken through gradations of muscle movements associated with sounds and sound sequences which are less and then gradually more complex.

• Stretching: Slightly stretch the beginning of a sound to ease into speech production. 
• Light contacts: Transition between speech sounds “lightly” and “softly”.
• Pausing and Chunking: group words together and add pauses when appropriate in connected speech. 
• Gentle Onset: The goal of this technique is to address the harsh, abrupt start to phonation by providing a full breath before initiating speech. 
• Movement Target: The goal of this technique is to have a smooth transition from sound to sound and word to word. You may start with vowels at the beginning of therapy and move up the hierarchy of speech to voice consonants, voiceless consonants and plosives. 

Stuttering Modification: The goal of this technique is to reduce the avoidance and fear associated with stuttering. This involves focusing on desensitization and assertiveness training. (Manning, 2001). 

• Cancellation: Person who stutters will wait a few seconds and then produce the word again in an easier manner. 
• Pullout: Person who stutters “catches” themselves about to stutter and will “pull out” of the stuttering event and try producing the word/phrase in an easier, more controlled manner. 
• Preparatory set: Person who stutters will anticipate the word that’s going to be stuttered and will intentionally use a slower rate and light articulatory contacts/transitions before he/she begins the first sound of the word slowly and smoothly (adapted from Zebrowski & Kelly, 2002)
• Stuttering on Purpose: “Easy Stuttering” involves the person who stutters to feel less anxious and more at ease with his/her stuttering rather than avoiding and fighting the stuttering in speaking situations. 
• Pausing and Phrasing: Targets management of breathing and applying strategies mid-way during speech output. Person who stutters learns to breath up sentences or utterances into smaller units. 
• Bouncing: Person who stutters will repeat a sound or word in an easy way avoiding excessive muscle tension during stuttering. 

Additional Resources:

• http://www.mnsu.edu/comdis/kuster/therapy.html

• Stuttering Foundation: http://www.stutteringhelp.org/

• ASHA: http://www.asha.org/public/speech/disorders/stuttering/

• NIDCD: https://www.nidcd.nih.gov/health/stuttering

• Stuttering Related Web Pages: http://www.speakingofspeech.com/uploads/Stuttering_Web_Sites.pdf

• Bloodstein, O. (1995). A handbook on stuttering. (5^th ed.). San Diego, CA: Singular Publishing Group. 
• Van Riper, C. (1973). The treatment of stuttering. Englewood Cliffs, NJ: Prentice-Hall.
• Wall, M., J. & Myers, F. L. (1995). Clinical management of childhood stuttering. Austin, TX: Pro-Ed.