Fluency Disorder

What is a fluency disorder?

Fluency is the flow of a person’s speech. A person is fluent when they speak continuously and smoothly. A fluency disorder involves chronic and repeated interruptions to speech flow.

A fluency disorder may cause frequent:

• Pauses in speech.
• Longer sounds than what’s considered normal.
• Repetitions of sound, syllables or words.
• Unusual rate or rhythm of talking.

Fluency disorders can lead to problems with socialization, learning and mental health.

What are the types of fluency disorders?

There are two main types of fluency disorders: stuttering and cluttering.

If you stutter, you may sound like you’re trying to say a syllable or word, but it’s not coming out. If you clutter, you may speak quickly, merging words or cutting off parts of words.

Stuttering is more common than cluttering. A person can experience both at the same time.

Who might experience stuttering or cluttering?

Fluency disorders can affect anyone, but they often begin in childhood. They’re more common in children assigned male at birth than children assigned female at birth.

They appear to be more common in people with:

• Auditory processing disorder, a type of hearing problem.
• Attention-deficit/hyperactivity disorder.
• Autism spectrum disorder.
• Learning disabilities.
• Tourette syndrome.

How common are fluency disorders?

Fluency disorders are common. Scientists don’t know how many people they affect because they aren’t often reported.

What causes fluency disorders?

Scientists are still studying what causes fluency disorders. Some studies have shown that genetic and neurological factors may be involved.

What are the signs and symptoms of a fluency disorder?

Stuttering and cluttering each involve particular types of interruptions in the flow of speech.

Signs and symptoms of stuttering

• Periods of silence when a person is trying to begin a sentence but can’t start the sound they want to make.
• Sounds that are held too long (for example, “I sssssss-see what you mean.”).
• Syllables or words that are repetitive (for example, “Hand me that b-b-b-b-b-book” or “Who-who-who-who called?”).

Signs and symptoms of cluttering

• Collapsing two words into one (for example, “Turn the televisoff”).
• Excessive interruptions to speech (for example, “um,” “uh” and “you know”).
• Frequent revisions to speech right in the middle of sentences (for example, “I would like to go can I go?”).
• “Maze patterns” of speech, which take multiple turns to get to the point (for example: “I have to go buy a dress … I’m going out on Friday and have nothing to wear … I’m going shopping to buy something for this date I have.”).
• Omissions of syllables or words (such as “ferchly” instead of “fortunately”).
• Rate or rhythm of speech that sounds rapid, irregular or jerky.
• Unexpected pauses in the middle of sentences (for example, “Do you want to … come to the movies?”).

A person with a fluency disorder also might adopt certain behaviors to try to cover up the problem, such as:

• Avoiding certain words that tend to cause stuttering or cluttering.
• Coughing, clearing their throat or yawning to distract from the disorder.
• Covering their mouth, blinking their eyes or nodding their head.
• Frequently pretending to forget what they wanted to say.
• Not speaking or avoiding situations where they might have to speak.

How is a fluency disorder diagnosed?

Your healthcare provider can usually diagnose a fluency disorder based on a discussion of the signs and symptoms. This may include other medical conditions, family history of speech disorders and the effects of fluency problems on your life.

Your healthcare provider might consult a speech-language pathologist (SLP), an expert in speech, language and communication problems. They can help differentiate a fluency disorder from other speech disorders, such as articulation disorder.

Your healthcare provider or SLP may also talk to your child’s teachers and other family members. This can help them assess any associated problems with learning, socialization or mental health (such as anxiety). If your provider or SLP believes your child could benefit from additional support, they may refer you to behavioral therapy (counseling).

What’s the treatment for a fluency disorder?

To treat a fluency disorder, your SLP will recommend speech therapy. Therapy involves working on speech and strategies to practice at home and in social situations.

During speech therapy, your SLP uses a variety of activities and exercises to help you:

• Control your breathing to improve your speech.
• Learn to insert natural pauses when you talk, which can help you move to the next part of a word or sentence.
• Lessen other behaviors associated with the fluency disorder, such as coughing and blinking.
• Reduce stress and negative feelings related to speaking.
• Slow down and concentrate on individual sounds, syllables and words.
• Speak more fluently and smoothly.
• Talk to others about how they can help you communicate better (for example, giving you time to complete sentences).
• Use shorter, clearer sentences.

How can I prevent fluency disorder?

Because scientists aren’t sure what causes fluency disorders, there currently aren’t any strategies to prevent them.

What’s the outlook for a person with fluency disorder?

Many people with fluency disorders find that speech therapy helps them improve their fluency or overcome stuttering or cluttering.

Even after therapy, signs and symptoms of a fluency disorder can reappear, particularly in times of stress. It’s helpful to continue practicing strategies you learned during speech therapy.

How can I best learn to cope with a fluency disorder?

If someone you know has a fluency disorder, try these strategies to help them better cope:

• Be kind, patient and supportive. Give the person time to complete sentences and thoughts. Don’t make judgments or comments.
• Find resources that can help. For example, public schools must provide special services and accommodations to students with diagnosed speech disorders.
• Look for support, in person or online. Fluency disorders are common, and there are support groups for people who stutter or clutter, as well as their loved ones.

A note from Cleveland Clinic

Problems with fluency, such as stuttering or cluttering, interrupt the natural flow of speech. If you, or your child, have signs of a fluency disorder, talk to your healthcare provider. Speech therapy can help you communicate better and have less anxiety about speaking.