Fluency in speech refers to how smoothly someone forms sounds, words, and phrases when communicating. Maintaining a high level of fluency is crucial to conveying one’s thoughts and needs clearly when speaking. That makes speech fluency an important part of social and professional interactions. However, sometimes people have disfluencies, or confluences, in their speech, such as adding pauses, sounds, or words, or repeating themselves. These disfluencies are common, particularly for young children who are mastering language.
Persistent problems with fluency, however, can indicate a fluency disorder. Understanding what are typical vs. atypical disfluencies is an important step in tackling communication problems before they lead to negative outcomes that can range from learning difficulties to social anxiety disorders.
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What Are Speech Disfluencies? Typical vs. Atypical Disfluencies
Most people occasionally struggle with speech fluency, especially when they’re feeling anxious, experiencing stress, or trying to convey a complex concept. These infrequent interruptions in fluency, known as typical disfluencies, can include adding or repeating words or fillers such as “like” or “uh.” They also can include prolonged sounds or blocks in which the individual seemingly cannot speak. Young children commonly exhibit speech disfluencies, with the most prevalent symptoms shifting according to age.
- Children between 18 months and 3 years old typically exhibit speech disfluencies about once every 10 sentences as they learn to talk. They repeat sounds, syllables, and words, particularly when starting sentences.
- Children older than 3 are less likely to repeat sounds or syllables. Instead, as they work to rapidly develop their speech abilities, they may use filler words and sounds, switch topics midsentence, shift the order of a sentence, or leave a thought unfinished.
Most children can easily use language by age 5. Typical disfluencies can continue to occur at any time, however, particularly for children who are experiencing feelings such as fatigue, excitement, or unhappiness, or if they are rushed. These disfluencies may occur regularly for days or weeks and then decrease or disappear, returning later. Typical disfluencies generally are not a cause for concern and don’t signal a need for an intervention from a speech-language pathologist, a professional who treats communication and swallowing problems.
Typical vs. Atypical Disfluencies
When disfluencies include frequent interruptions that cause a person’s speech to have an abnormal rate and rhythm, or they’re accompanied by certain behaviors, they are atypical disfluencies. When these disfluencies have a significant impact on how the individual interacts with others, it can represent a fluency disorder. People with atypical disfluencies may react through behaviors such as:
- Blinking or shutting their eyes, looking to the side, or tensing their mouths when they speak
- Avoiding speaking or pretending to forget what they were going to say
- Covering their mouth or pretending to cough or yawn to mask the disfluency
- Not using words that trigger the disfluency
- Adding filler sounds to disguise disfluencies
Unlike typical disfluencies, atypical disfluencies generally require assistance, such as therapy from a speech-language pathologist, to correct them. Without early intervention, those with atypical disfluencies in their speech can find school, work, and social activities difficult. Children who do not receive treatment may find making friends challenging.
They may experience bullying, struggle with learning, and suffer from anxiety issues. To help ensure they are taking the appropriate course of action related to their loved one’s speech disfluency, individuals should explore resources about fluency disorders and learn about the types of speech disfluency.
Types of Speech Disfluencies
As speech-language pathologists evaluate individuals who have speech disfluencies, they consider a variety of factors to determine whether they are typical or atypical disfluencies. The American Speech-Language-Hearing Association (ASHA) and the Eyes Landing clinic note some characteristics that can indicate an atypical speech disfluency:
- Age of onset — Atypical disfluencies often begin after age 3 1/2.
- Frequency of disfluency — Disfluencies that occur more than once per 100 words typically require treatment
- Family history — Stuttering, for example, is more common in individuals who have a family member with speech disfluency issues.
- How long the disfluency persists — Speech disfluencies that are atypical frequently last six months or longer.
- Gender — For stuttering, males are three to four times more likely to experience long-term concerns.
- Behaviors — Individuals with atypical disfluencies often exhibit negative reactions or physical responses to the issue.
Brain changes are believed to be a contributing factor in atypical disfluency, according to research — including that referenced in a 2022 Frontiers in Human Neuroscience article about stuttering.
Most Common Forms of Atypical Disfluency
There are two predominant types of atypical disfluencies: stuttering and cluttering. Following are descriptions of each of these forms of disfluency.
More than 70 million people around the world struggle with stuttering, according to The Stuttering Foundation. People with this type of atypical disfluency, also called stammering, have speech that’s broken by repetitions, prolongations, or abnormal silence. The Stuttering Foundation provides the following examples for these interruptions:
- Repetition — “li-li-like this”
- Prolongations — “lllllike this”
- Abnormal stoppages — No sound
Unusual facial and body movements often accompany this speech disfluency.
People with the atypical disfluency known as cluttering rarely recognize that they have the condition. Instead, others often report that they can’t understand the speaker. Cluttering is commonly described as talking too fast, or someone’s brain going faster than their mouth. Cluttering is believed to be less prevalent than stuttering.
Symptoms of cluttering in speech include:
- Speaking rapidly
- Omitting word endings
- Deleting syllables (“probly” instead of “probably,” for example)
- Collapsing syllables (“pleece” instead of “police,” for example)
- Unusual pauses
About a third of people who clutter also stutter, according to Speech IRL speech therapy. But the conditions are different in their speech characteristics and other symptoms. Unlike stuttering, those who clutter rarely exhibit behaviors and movements associated with their condition, for example, and they often aren’t aware of the disfluency. Additionally, cluttering typically appears later than stuttering, with most cases occurring in those age 8 or older.
Stuttering and Cluttering vs. Typical Disfluencies
The characteristics of stuttering and cluttering differ from those that represent typical disfluencies. Following are some disfluencies that are typical and usually don’t point to a speech disorder:
- Adding a sound or word, called an interjection
- Repeating whole words or phrases
- Changing a sentence’s wording midway through it
- Taking pauses while thinking
Assessment and Treatment of Typical and Atypical Disfluencies
When speech-language pathologists assess and treat speech disfluencies, they begin by considering some key factors related to the issue. As they evaluate the individual’s health history and listen to them speak, they note the following issues:
- Level of impairment — Ability to speak with efficiency, frequency of interruptions, presence of disfluency-linked behaviors, and amount of effort required for speaking
- Limitations on activity — Impact on participating in school, work, and social and at-home activities; on progressing at school; and on enjoying life
- Attitudes about the disfluency — Emotional and behavioral responses of the individual exhibiting disfluency as well as those who interact with them
Specific issues related to the language an individual speaks as well as an individual’s family communication preferences also are important factors for speech-language pathologists to consider as they assess people with disfluencies. Speech disfluency assessments also may include an oral mechanism exam, which focuses on how an individual’s tongue, jaw, throat, teeth, tonsils, and top of the mouth work during speech.
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Assessment of Disfluencies by Age
Speech-language pathologists consider specific sets of issues depending on the age of the individuals who are exhibiting speech disfluencies. When it comes to typical vs. atypical disfluencies, the areas of focus change according to whether the person is a preschool-age child, a school-age child, or an adult.
Speech Disfluency Assessment for Preschool Children
For preschool children, assessment of speech fluency concerns focuses on whether the disfluency is typical or atypical and whether the issue warrants treatment. Speech-language pathologists work with families to develop plans for treatment and reevaluation.
Speech Disfluency Assessment for School-Age Children
For speech disfluency concerns in school-age children, the most important concern is the impact of the issue on the individual’s interactions — and life. Speech-language pathologists typically start by asking these children and adolescents to assess themselves. Because older children might have learned to mask their disfluencies, speech-language professionals may pose open-ended questions to get honest answers about how the child is participating in class, ordering food in a restaurant, or taking part in other types of interactions.
Speech Disfluency Assessment for Adults
Adults with speech disfluencies often have exhibited the issue for a long time. As with older children, the main goal of assessment is to determine the extent of the impact the disfluency has had on the individual’s life. By determining the depth of the individual’s concern about the issue, speech-language pathologists can gauge that person’s willingness to make changes to address it as well as the potential benefits for doing so.
Diagnosing Different Speech Impairments
In addition to evaluating whether a disfluency is typical or atypical, speech-language pathologists also must determine whether the concern is a speech disfluency at all. The issue could instead be related to a reading disorder, challenges in learning a new language, or a different type of disorder. Movements that could be tied to stuttering, for example, might instead be the result of apraxia, a disease that causes an inability to control or coordinate one’s movements.
Treatments for Disfluencies
There’s no cure for disfluency disorders. But speech-language pathologists can use exercises and other techniques to help the individual decrease the number of speech interruptions, limit disfluency-related behaviors and movements, and lessen the stress and other negative feelings associated with the issue. Speech-language pathologists address disfluencies through direct and indirect techniques.
Direct Treatments for Disfluencies
Direct techniques for treating speech disfluencies focus on the individual making changes to their own speech and attitudes. Following are some commonly used direct approaches to treating speech disfluencies:
- Self-monitoring exercises — The individual focuses on their own speech and messages in the therapy setting, increasing their awareness of their speech patterns and building their ability to control their fluency.
- Cancellation technique — After stuttering or cluttering occurs, the speaker pauses to consider the word or phrase and then makes adjustments that make fluency easier.
- Pausing exercises — To make their communication clearer and to encourage appropriate pacing, the individual changes the timing of pauses in their speech.
Indirect Treatments for Disfluencies
Indirect treatments call on the individual’s loved ones to make changes to facilitate speech improvements for the person struggling with a disfluency disorder. Among the steps that families can take to help someone manage a disfluency disorder are:
- Changing the conditions that can worsen disfluencies by refraining from prompting the person to speak in front of others or correcting their speech
- Listening closely, maintaining eye contact, and ensuring people take turns speaking
- Modeling fluent speaking, using slower speech with more pauses, and talking throughout daily activities to encourage communication in an informal environment
Families should work closely with speech-language pathologists to support efforts to decrease the rate of disfluencies and facilitate treatment plans.
Resources for Addressing Disfluencies and Fluency Disorders
A variety of organizations and publications provide valuable information to help people identify typical vs. typical disfluencies, learn about types of disfluencies, and find support. Following are resources to help individuals, families, and speech-language pathologists take prompt action to address these disorders.
Fluency Disorder Organizations
Many groups offer support to individuals with fluency disorders and to the family members and speech-language professionals who assist them. These groups provide resources such as assessment tools, articles, training materials, and therapy kits. They include:
- American Board of Fluency and Fluency Disorders — Seeks to promote high standards of practice in the treatment of fluency disorders, providing professional certification, discussions, helpful links, and lists of certified speech-language professionals
- ASHA — Provides publications and research as well as information about events and jobs for speech-language professionals
- Friends — Supports young people who stutter as well as their families and those who treat stuttering, providing activities targeting different ages as well as events and a newsletter
- International Fluency Association (IFA) — Advances science, education, treatment, and advocacy related to stuttering and cluttering
- International Cluttering Association (ICA) — Connects speech-language professionals, researchers, and those who clutter and their families by offering conferences, a newsletter, and assessment information
- National Stuttering Association (NSA) — Supports those who stutter and their loved ones as well as speech-language professionals through local chapters, a newsletter, events, and a tool for finding specialists
- The SLP Solution — Assists speech-language pathologists through therapy guides, e-books, continuing education, and expert advice
- The Stuttering Association for the Young (SAY) — Provides camps, therapy, and creative arts programs for children age 3 to 18 who stutter
- The Stuttering Foundation — Offers articles, podcasts, and videos for people who stutter and their loved ones as well as support for research about the disorder
- Stutter Talk — Hosts a podcast about stuttering and provides a newsletter and links to information about the disfluency
- Stuttering Therapy Resources — Offers therapy guides, handouts, videos, and a newsletter targeting professionals who treat stuttering
Fluency Disorder Publications
Books and professional journals can provide speech-language pathologists and students — as well as individuals with fluency disorders and their families — with in-depth information about disfluencies, assessments, and treatments. Following are some publications about fluency disorders:
- Fluency Disorders: Stuttering, Cluttering, and Related Fluency Problems, Second Edition — Details fluency disorders as well as treatments that meet ASHA standards, focusing on the impact that fluent communication has on quality of life
- Journal of Fluency Disorders — Features research and clinical reports as well as articles that examine the latest fluency disorder treatments
- Stuttering as a Mind body Disorder: How and Why Expressiveness and Assertiveness Promote Fluency — Examines the role that stress and tension play in stuttering
- Stuttering, Fifth Edition — Provides an overview of stuttering and how to assess and address it, including case studies and videos on treatment techniques
Find the Resources You Need to Tackle Disfluencies
While occasional disfluencies in speech are common, especially for young children, certain patterns in speech and behavior can indicate a fluency disorder. Because these disorders can have serious implications for individuals’ quality of life, promptly determining whether they are typical or atypical disfluencies is critical.
Connecting with resources that educate and support individuals with disfluencies — as well as their families and speech-language pathologists — can help put those with fluency disorders on a path to effective communication, successful learning, and positive family and social interactions.