Fluency Disorders

What is fluency disorder?

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

Fluency disorders may cause:

• Frequent pauses in speech
• Longer sounds than what’s considered normal
• Frequent repetitions of sounds, syllables or words
• Unusual rate or rhythm of talking

Disorders of fluency are common. But not everyone reports them, so researchers don’t know exactly how many people have them.

Fluency disorders often start in childhood. They can lead to challenges with making friends, learning and mental health. Treatment can teach you how to manage your symptoms.

Types of fluency disorders

There are two main types of fluency disorders:

• Stuttering. You’re trying to say a syllable or word, but it’s not coming out.
• Cluttering. You might speak quickly, combine words or cut off parts of words.

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

What are the symptoms of fluency disorders?

Stuttering and cluttering each involve specific types of interruptions that affect the flow of your speech.

Signs and symptoms of stuttering

If you have stuttering, there may be:

• Periods of silence when you’re trying to begin a sentence but can’t start the sound you 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

If you have a cluttering, you might:

• Collapse two words into one (for example, “Turn the televisoff”)
• Have a rate or rhythm of speech that sounds rapid, irregular or jerky
• Include excessive interruptions during speech (for example, “um,” “uh” and “you know”)
• Make changes to your speech in the middle of sentences (for example, “I would like to go can I go?”)
• Notice “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.”)
• Omit syllables or words (like “ferchly” instead of “fortunately”)
• Pause unexpectedly in the middle of sentences (for example, “Do you want to … come to the movies?”)

You may also adopt certain behaviors to try to cover up your fluency disorder. For example, you might:

• Avoid certain words that tend to cause stuttering or cluttering
• Cough, clear your throat or yawn to distract from your symptoms
• Cover your mouth, blink your eyes or nod your head
• Pretend to forget what you wanted to say
• Steer clear of situations where you might have to speak

What causes fluency disorders?

Scientists don’t know exactly what causes fluency disorders. But experts have identified some risk factors. A risk factor is something that increases your chance of getting a certain condition.

Risk factors

You might be more likely to develop a fluency disorder if:

• One or more of your biological family members have a speech disorder
• You have a developmental delay or learning disability
• You have a neurological disorder like ADHD or autism spectrum disorder
• You're male

These things don’t automatically mean you have a fluency disorder. If you think you or your child might have a speech issue, talk to your healthcare provider. They can help.

How are fluency disorders diagnosed?

Healthcare providers can usually diagnose fluency disorders based on signs and symptoms. They’ll ask you questions like:

• Does anyone in your biological family have a speech disorder?
• How do your speech issues impact your daily life?
• What are the specific challenges you’d like to address?
• What has your personal experience been like?

Your healthcare provider might refer you to a speech-language pathologist (SLP). SLPs specialize in treating speech, language and communication issues. They can tell the difference between fluency disorders and other types of speech disorders. That way, they can make a treatment plan tailored to you.

If you think your child could have a fluency disorder, your SLP may talk to your child’s teachers and other family members. This can help them check for challenges with learning, socialization or mental health (like anxiety). They may also recommend talk therapy to help your child process any difficult emotions that can come along with speech disorders.

How are fluency disorders treated?

Healthcare providers treat fluency disorders with speech therapy. Treatment involves practicing speech and developing strategies to use in conversations.

Fluency disorder treatment can help you:

• Control breathing to support your speech
• 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, like 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

Can fluency disorders be prevented?

You can’t prevent fluency disorders because experts don’t know what causes them. But treatment can help you improve the flow of your speech.

What can I expect if I have this condition?

Fluency disorders affect different people in different ways. Symptoms can range from mild to severe. Speech therapy can help you overcome all kinds of speech challenges, including stuttering or cluttering.

Signs and symptoms may reappear, particularly in times of stress. It’s helpful to continue practicing strategies you learned during speech therapy.

When should I see my healthcare provider?

If you have a speech issue that affects your confidence or daily life, tell your healthcare provider. They can talk with you about your personal goals and help you find a starting point.

If you think your child might have a speech issue, talk to their pediatrician. They can help determine whether your child’s speech is on track for their age. They can also refer you to an SLP for treatment.

What questions should I ask my doctor?

If you or your child has a fluency disorder, here are some questions you might want to ask your healthcare provider:

• What type of fluency disorder do I have?
• What kinds of triggers can make my symptoms worse?
• What treatment do you recommend?
• What can I expect during my speech therapy sessions?
• Are there resources or support groups available?

How can I help a loved one who has this condition?

If someone you know has a fluency disorder, here are some ways you can support them:

• Be kind and patient. Give them time to complete sentences and thoughts. Don’t make judgments or comments.
• Find resources that can help. For example, public schools provide special services 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.