Exploring Fluency and its Perceptions

Hello! I’m Kasey, a therapist here at Team Chatterboxes. I am an avid reader & crafter, and I have a passion for language learning. The term fluency first came up in my life under the lens of world languages. “Are you fluent?” is the question I heard most often when I told others that my area of focus was Spanish language and literature. Not, “do you like it?” or “what are you reading?” but are you able to speak in a way that others would deem “fluent”. Now, as a speech therapist, I play a role in working with people who don’t have fluent speech. When working with clients, I aim to shift the focus from external perceptions on the smooth flow of speech, to internal perceptions on comfort, communication, and connection.

Redefining Fluency and Acceptance
At Chatterboxes, we know that there is nothing wrong with dysfluent and stuttered speech with the exception of when it impedes communication. We take a radically accepting perspective and encourage you to do the same. That means that we recognize the impact that stuttering has on the individual, and how it shapes the individual’s life experience. Speech therapists have a unique opportunity to engage with people who stutter to facilitate comfortable communication, social engagement, and building positive self identities with our clients. We, as speech language pathologists, are licensed to treat speech, language, and swallowing disorders. One of the most well known, but maybe the least understood, domains is fluency and its disorders. Disfluencies can go by many names: stuttering, cluttering, and stammering to name a few. They can be labeled as normal, developmental, disordered, atypical, or unusual. But, specifically, what are we discussing? What goes into fluent speech and what makes it disfluent? When is it “normal” and when is it “disordered”? Furthermore, what should we do about it as therapists, parents, and community members?

Understanding the Dynamics of Fluent and Disfluent Speech
Let’s start by defining some of the terms that come up when discussing measurable aspects of speech. Fluent speech is forward moving, like water flowing undisrupted. Disfluent speech, on the other hand, is sometimes disrupted and turbulent. It lacks the smooth characteristic of its reciprocal, and like a jazz piece, is unpredictable. And for whatever reason, it tends to put listeners on edge. In fact, Weidner, St. Louis & Glover (2018) demonstrate that children as young as three years old begin to identify disfluent speech as “different” and “worrisome”. As children age, this disquietude around aberrant speech characteristics tends towards harsh, sometimes even cruel, responses.

Promoting Positive Listener Attitudes
In their article about changing listener attitudes, Weidner, St. Louis & Glover discuss a program designed to change listener attitudes and teach children how to interact with people with differences, specifically stuttering. Their pre- and post-test comparisons showed promising results for fostering a change in perspective in children in the preschool age group. Educating caregivers, family, and peers can put them at ease and prepare them to respond compassionately. Boyce et. al. (2022) discuss self-reported impacts of stuttering across the lifespan. They found that 80% of participants believed that stuttering was a barrier to their educational and vocational pursuits. Negative attitudes and thoughts about stuttering arise early in childhood; it is important to be proactive in fostering a positive sense of self.

Chatterboxes’ Approach to Preschool Fluency
At Chatterboxes, we take a 3 phase approach to preschool fluency. It first aims to adjust the environment rather than the child’s speech behaviors, then to reinforce the child’s speech and language abilities, and finally to work directly on a comfortable way of speaking. Throughout this process, we collaborate with parents and caregivers to tailor the program to fit the family. For older clients, we take a personalized, client centered approach, based on current research findings and client preferences.

A Multidisciplinary Approach to Stuttering
It is important to note that even though stuttering falls under the umbrella of speech and language, it is not just SLPs who work with stuttering. Psychosocial therapists are members of the multidisciplinary treatment team. Collaborating with these professionals is particularly beneficial when the presence of stuttering yields social communication anxiety. In many cases, internal perceptions of communication failure and anxiety need to be addressed.

Prioritizing the Individual in the Treatment Process
Coming to terms with a stutter can be a long, emotional process. Parents, caregivers, and clinicians need to remember that the individual is at the core of any treatment plan. The individual’s goals should be the focus of therapy. Hilda Sonsterud et. al. discuss the importance of a collaborative alliance between the client and clinician in the 2019 article, The working alliance in stuttering treatment: a neglected variable? When the client reports feeling heard, connected, and respected, they also reported feeling more motivated to participate in therapy and reported significantly better outcomes following treatment. This research tells us that the client needs to be involved in goal setting, rather than the clinician proposing a treatment plan with generic goals. In the case that a child is too young to be making these decisions, their parents and caregivers will be making the decisions alongside clinicians.

Tailoring Speech Intervention to Individual Goals
Some may choose to focus on effortless communication. They may have goals for self-advocacy and educating others on stuttering facts and myths. In this case, we may give the client permission to stop thinking about their speech. We know that people living with fluency disorders are taught to self-monitor and assess their own fluency.  While this may be helpful to some, others find this to be an exhausting, anxiety inducing task. For someone working on effortless communication, speech intervention will focus on repairing communication breakdowns and functional communication across a variety of settings. Others may strive for minimizing moments of disfluency and to target fluency enhancing strategies.

Supporting Your Journey towards Fluency
Whatever your and your child’s goals are, we will be here to support you!