Fluency Disorder

What is a fluency disorder?

Having a fluency disorder means you have trouble speaking in a fluid or flowing way. You may say the whole word or parts of the word more than once. Or you may pause awkwardly between words. This is called stuttering. You may speak fast and jam words together, or say "uh" often. This is called cluttering.

These changes in speech sounds are called disfluencies. Many people have a few disfluencies in their speech. But if you have a fluency disorder, you will have many disfluencies when you talk. Speaking and being understood may be a daily struggle.

What causes a fluency disorder?

Experts don’t know the exact causes of fluency disorders. They may be genetic and run in families. They can happen at the same time as another speech disorder. The symptoms of a fluency disorder can be made worse by emotions such as stress or anxiety.

Who is at risk for a fluency disorder?

Theories have included organic, behavioral, and psychological causes of fluency disorders. If members of your family have a fluency disorder, you may be at higher risk to develop one.

What are the symptoms of a fluency disorder?

A fluency disorder causes problems with the flow, rhythm, and speed of speech. If you stutter, your speech may sound interrupted or blocked. It may sound as if you're trying to say a sound, but it doesn't come out. You may repeat part or all of a word as you to say it. You may drag out syllables. Or you may talk breathlessly, or seem tense while trying to speak.

A different type of fluency disorder is called clutter. If you clutter, you often speak fast and blend some words together or cut off parts of them. You may sound like you're slurring or mumbling. And you may stop and start speech and say "um" or "uh" often when talking.

Some people use accessory or secondary behaviors to prevent or hide disfluencies. These can include:

Covering your mouth or pretending to cough or yawn to cover up stuttering
Not speaking, even when you want to or need to
Not using certain words that seem to cause stuttering
Pretending to forget what you wanted to say
Changing the order of words in sentences
Using "filler" sounds between words to make the rate of speech sound more normal

Children with fluency disorders also may develop beliefs that can hurt them later on. For instance, a child who stutters may decide that speaking is too hard. Feeling fear, anxiety, anger, and shame about speaking are also common.

How is a fluency disorder diagnosed?

Experts feel it's important to assess and address speech disorders early. Children who struggle with speech can find school and community activities challenging or painful. They can't communicate their thoughts. They may also have problems making friends.

A fluency disorder can be diagnosed by a speech-language pathologist (SLP). An SLP will ask about your health history and listen to you speak. You may have an oral-mechanism exam and have your speech-language skills tested.

How is a fluency disorder treated?

Once you're diagnosed, an SLP can use exercises and strategies to help you speak more fluently. A fluency disorder can't be cured. But an SLP uses different methods to help you manage speech day-to-day. These methods can reduce the number of disfluencies in your daily speaking.

An SLP can help you lower your own stress around moments of fluency problems. The SLP will work on changing your negative feelings, thoughts, and beliefs about your speech. They will help you reduce the use of accessory behaviors. You will learn strategies such as speaking in shorter sentences, and controlling your breathing and how fast you speak. An SLP will often talk with family, caregivers, and teachers about the disorder and how to help.

Living with a fluency disorder

If someone you know has a fluency disorder:

Use available resources. Public schools are required to assess children with communication disorders. If the child meets certain criteria, the school must provide treatment services. If you have a child as young as age 3 with communication problems, contact your local public school’s office. Talk with the principal about assessment options.
Be patient and supportive. It's frustrating to try to understand someone with a fluency disorder. But it can be much more frustrating for the person who has it. Be as patient as you can while the person works on their speech.
Be kind. Making fun of a person with a fluency disorder is a form of bullying. It's destructive and may take away the person’s desire to communicate.
Join a support group. Many fluency disorders, such as stuttering, have support groups. Spending time with other families coping with fluency disorders can be helpful.

When should I call my healthcare provider?

Call your healthcare provider if you have:

Symptoms that get worse
New symptoms

Key points about fluency disorders

A fluency disorder causes problems with the flow, rhythm, and speed of speech.
Stuttering is 1 example. Another type is cluttering. That's when you speak fast and jam words together or say “uh” often.
It's important to assess and address speech disorders early.
A fluency disorder can be diagnosed by a speech-language pathologist (SLP).
A fluency disorder can’t be cured. But an SLP can use exercises and strategies to help you speak more fluently.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.