What are "fluency disorders"?
Most of the fluency disorders that are evaluated and treated
in our clinic are stuttering. Stuttering is a disorder
that results in the uncontrolled interruption of the normal rate
and pattern of speech. Stuttering is usually first noticed in
early to middle childhood and often persists into adolescence
and adulthood. The cause of this kind of stuttering is unknown,
but it is assumed to be due to an interaction between a physiological
predisposition that children are born with and their environmental
experiences. Often there are other family members who also stutter,
or stuttered when they were children. Sometimes stuttering begins
in adulthood as the result of a stroke, brain injury, or emotional
trauma. This kind of stuttering is called adult onset stuttering.
Another kind of fluency disorder is called cluttering.
Cluttering results in speech that is difficult to understand
because it is too fast and many sounds of speech are left out.
Sometimes there are accompanying language and organization problems.
Two disorders that are sometimes confused with stuttering, but
are really quite different, are Tourette's syndrome and
spasmodic dysphonia.
Why don't I know more people who stutter?
There are probably about 2.5 to 3 million people in the United
States who stutter. That means that only one person out of every
700 to 1000 persons experiences this problem. That makes stuttering
infrequent enough so that most people do not personally know
a person who stutters. However, most people have at least met
or observed someone who stutters. Other fluency disorders, such
as adult onset stuttering and cluttering occur even less frequently.
Why do I (or my child) need to be evaluated?
All candidates for the fluency treatment program go through
a thorough speech and language evaluation (diagnostic evaluation).
One reason for this evaluation is to find out which of the types
of fluency disorders described above is present and how severe
it is. Sometimes fluency problems occur along with other speech
and language problems. We need to find out if that is the case
and how these problems influence each other. We also need to
distinguish between common fluency disorders and other less common
but related problems. The main purpose of this careful evaluation
is to make certain that we are treating the problem in the most
effective way possible.
What should I expect from therapy?
That depends on how old you are or how old your child is.
My child is preschool age or younger.
Therapy with very young children involves work with parents
as well as the child. In fact, in some cases we may only work
with parents to help them create conditions that are most likely
to encourage fluent speech for their children. We watch the child
carefully over a period of time to see if stuttering stops or
is significantly reduced with this indirect treatment. If necessary,
we will work directly with your child in a play setting, showing
your child how to speak more easily. Parents are involved in
this activity so that they can continue the procedures at home.
My child is school aged.
School aged children are usually aware of their stuttering
and have begun to react to their experiences with it. Therapy
with this age group involves exploration of the physical dynamics
of the stuttering behavior as well as the social and emotional
effects. Children are taught to experience their dysfluencies
or blocks with less tension and to convert the way in which they
stutter to a pattern that is more easy and effortless. As with
preschool children, it is important for the parents of school
aged children to be involved in their children's treatment. We
want parents to understand our objectives and to help monitor
and praise the accomplishments of their children. We also want
parents to be knowledgeable advocates for their children with
other family members and with school personnel.
I am a teenager.
If you are a teenager, your therapy will be very much like
that described below for adults. The difference is that you are
probably still living at home and also having to deal with the
reactions of family members as well as those of friends and acquaintances
at school. We will help you find ways of dealing with the everyday
problems that come up when you are a person who stutters, as
well as someone that is experiencing the other problems common
to the teen age years.
I am an adult.
There are several clearly defined parts to the process of
treating stuttering. The first involves careful observation and
description of the stuttering behavior. You need to become an
expert about your own particular pattern of stuttering. Although
there are common elements among all people who stutter, there
are also very definite individual differences. The second element
involves exploring the impact of stuttering on your life, and
how you have learned to adjust and accommodate to it. Often the
learned responses to stuttering get in the way of successful
treatment. One of the goals of this phase of therapy is to become
less reactive and more accepting of your own disfluencies and
to return to a pattern of stuttering that was more like the easier
stuttering that you did as a young child. When these first two
goals have been achieved, you will learn various techniques that
will make your disfluencies less tense and more manageable. The
longer-term goal is to achieve speech that moves forward with
a minimum of tension and disruption. A related objective is to
reduce your apprehension and fear of speaking situations and
the prospect of stuttering in them.
How is therapy conducted?
After a thorough evaluation, clients are assigned to a therapist
for treatment. Your student therapist is likely to change from
quarter to quarter, but continuity of therapy is maintained by
weekly case management conferences and through ongoing supervision
by permanent, professional clinic staff. There is always someone
who is following your situation and who knows the nature of your
treatment from quarter to quarter.
Both individual and group therapy is provided. Sometimes you
may receive a combination of both. The placement of a client
in a group or in individual treatment is based on the treatment
needs and goals of each client. In many instances group therapy
is more effective than individual therapy, or individual therapy
alone.
Therapy sessions typically are scheduled twice weekly for
8 weeks of each academic quarter.
How long will treatment take?
There is no easy answer to this question. It depends in part
on your age and the severity of the problem. There is a controversy
about whether or not stuttering can be completely cured. We know
that there is a better chance that children who are treated as
young as possible will have the best chance for cure. If you
are a school aged child, a teenager, or an adult, there is a
greater chance that stuttering is something that you will need
to learn to live with, although it is very likely that you will
be able to co-exist with your stuttering more easily after therapy.
Often, people who have had successful therapy in the past find
that they need to return for a "refresher". Sometimes
people who have had limited success with therapy in the past
find that they are more able to benefit from additional therapy
later on in their lives. In our treatment program, the decision
to continue with or to terminate therapy is a decision that is
made by the client with the best recommendations possible from
the therapy staff.
Who does the therapy?
The Speech, Language and Hearing Clinic at California State
University, East Bay, is a teaching clinic, where Master's level
graduate students are training to become licensed and certified
speech-language pathologists. The Fluency Treatment Program is
conducted by these students under the direct supervision of licensed
and certified speech-language pathologists who have extensive
experience in the management of fluency disorders.
Resources:
Much has been written about stuttering (and other fluency
disorders) and periodically the media reports what are represented
as new breakthroughs or exceptional treatment programs. Like
much that is reported in the media, you need to evaluate carefully
what you read or hear. We have listed below several resources
that we believe to be reliable and ethical. You should discuss
the appropriateness of these resources with your therapist.
