A fluency disorder, which is often referred to as “stuttering”, is characterized by primary (core) and secondary behaviours. Primary behaviours may include repetitions of sounds, syllables, or whole words; prolongations of single sounds; or blocks of airflow or voicing during speech. Secondary behaviours develop over time as learned reactions to the core behaviours and are categorized as avoidance behaviours. They may include hesitations, interjections of sounds, syllables, or words; word revisions or complete changes in words; or motor movements associated with stuttering (such as eye blinking, loss of eye contact, extraneous movements, to name a few). Stuttering is often confused with a period of “normal disfluency”, which typically emerges when children are learning to combine words and speak in short sentences (18 months of age) and can continue into their early school years when they learn to read (7 years of age). Disfluent speech seems to typically “peak” between 2 and 5 years of age. Controversy exists in the research about the number of children who “spontaneously recover” from stuttering without treatment, with some figures as high as 80%.
However, the question becomes which children won’t’ recover and who among them are at risk for the development of chronic stuttering? Speech-language pathologists (SLPs) rely on many factors in making a differential diagnosis, including the consideration of certain risk factors and warning signs that point to which clients would benefit from treatment. Many theories have been proposed regarding the cause of stuttering. It is probable that a combination of factors (i.e., neurological, psychological, social, and linguistic) impact the onset and development of fluency disorders. Those factors form the bases for treatment and treatment is rightfully designed to address each client’s unique needs. Some therapy approaches are indirect, where the SLP works with parents and adjustments are made in the home that facilitate fluent speech. Other therapy approaches are direct in nature, where clients may be instructed in fluency-shaping or stuttering modification techniques or a combination of the two. Finally, in cases of moderate-to-severe stuttering, clients’ feelings and attitudes towards their speech are also addressed in a comprehensive therapy approach.