Speech Therapy - Stuttering/Cluttering

How can a Speech-Language Pathologist Help?

Speech-language pathologists can assess and provide intervention for the following fluency disorders:

  • Developmental stuttering: Appears during the emergence of speech and language, typically between 2-4 years of age. Most (75-80% of) children who begin stuttering will spontaneously recover. If stuttering persists into the school-age years, it will likely be a chronic but manageable condition.
  • Acquired stuttering: May result from neurological injury or psychological trauma, and may occur at any stage of life.
  • Cluttering: Characterized by rapid or irregular speaking rate, excessive normal speech disfluencies and deletion of sounds and syllables resulting in speech that is difficult to understand. While stuttering cannot be cured, therapy can help decrease the impact of the communication disorder. Speech therapy for stuttering seeks to make speaking easier, but also fosters self-respect, freedom of speech and the conviction that what you want to say is worthwhile, stutter or not.

Clientele

Adults and children with fluency disorders (stuttering or cluttering)

Signs and Symptoms

Stuttering

Stuttering is a neuro-physiological communication disorder which impairs an individual’s ability to time and sequence the underlying movements necessary for speech. This can result in:

  • Involuntary, intermittent interruptions in an otherwise normal, automatic, effortless flow of speech. The characteristic stuttering behaviours are repetitions, prolongations & blocks.
  • A lack of confidence in one’s ability to effectively communicate and a sense of “losing control” due to the extreme variability in regard to occurrence and manner of stuttering.
  • The individual employing increased tension, struggle or pushing to try to force the words out, which can be expressed as facial tics, abnormal breathing and movements of the head, arms and legs.
  • The anticipation of future speech breakdowns causing the individual to avoid talking, switch words or do anything to hide the overt behaviors. Stuttering can inhibit the drive to communicate and participate in daily activities.

Cluttering

Cluttering is a fluency disorder that affect one’s ability to convey messages in a clear and concise manner. It is described as a torrent of half-articulated words, following each other like peas running out of a spout. It can result in:

  • Bursts of rapid speech
  • Rapid rate
  • Articulation errors: excessive co-articulation (also called telescoping), which leads to mumbled speech, dropped sounds, dropped syllables, lots of starts, hesitations and repetitions, and excessive non-stuttering disfluencies
  • Poor language organization
  • Abrupt pauses, or pauses in atypical places
  • Coordination, rhythm and prosody issues
  • Pragmatic difficulties (talking for too long in a conversation, difficulty with turn-taking)

Cluttering can often be found alongside other conditions, such as attention difficulties (ex: ADHD), motor coordination difficulties (ex: hand-writing difficulties), auditory perceptual difficulties, and stuttering.

People who clutter are often unaware of their difficulties. Unlike people who stutter, their speech is often at its best when monitored. This means they often are more intelligible during presentations or important conversations, and less intelligible in relaxed and comfortable environments/situations.

Assessment

Through interview, analysis of video-recordings of speech samples and completion of impact questionnaires, the speech-language pathologist will measure overt stuttering/cluttering behaviours as well as psycho-social impact on function, activity and community participation, in order to determine severity, establish client goals and decide best options for treatment.

With stuttering for preschool children, assessment seeks to answer two questions: is this stuttering (or normal speech disfluency) and is it likely to persist. Evaluation of normal speech & language development forms part of the assessment.

For cluttering, assessment seeks to answer a few questions: are the cluttering symptoms at the word level (phonological cluttering), at the sentence level (syntactic cluttering) or both? Is there stuttering present as well? 

Intervention

Treatment may consist of direct, one-on-one appointments for a block of sessions; group sessions or clinician-guided, parent-led therapy. Re-evaluation after each block will determine the need for further treatment. Speech-language pathologists work in collaboration with the client and his or her family, as well as with other service providers, teachers or employers to ensure consistency of approach and generalization of treatment.

Stuttering

Therapeutic goals may include increasing knowledge of speech production and stuttering to increase awareness; reduction of struggle associated with speaking; modification of stuttering and/or fluency-shaping to promote forward-moving speech; changing thoughts and emotions that may be interfering with communication; and addressing particular communication needs, such as interview skills, giving oral presentations, etc.

Preschool Children

Results of assessment may indicate a “watch and wait” approach or immediate therapy. The Lidcombe Program, a behavioural treatment for children under 6 years of age, is used. This approach, which trains parents to evaluate severity of stuttering and to provide daily therapy, has strong evidence base for efficacy.

School-age Children

Children and adolescents may be seen for a block of individual sessions.

Adults

Treatment options include one-on-one therapy; group therapy blocks of five weeks, offered once-per-week in the evenings; and twelve-day intensive group treatment clinics offered in the spring and summer.

Cluttering

Therapeutic goals may include increasing knowledge of speech production and cluttering, increasing self-awareness and self-monitoring, slowing rate, improving articulation/clarity/intelligibility, improving language organization, improving prosody, reducing disfluencies, and improving pragmatics/discourse management.

Helpful Resources

To learn more, please visit these additional resources:

Marie Poulous Fund

Purpose of the Fund

To enable qualified individuals who stutter access to financial assistance in order to attend stuttering treatment programs.The Bursary Fund was named in honour of Marie Poulos who worked at the Ottawa Hospital’s Rehab Centre Stuttering Treatment Clinic in the 80s and 90s until she was tragically killed in a car accident. Marie was much loved by her many clients and highly respected by her speech pathology peers.

Main Eligibility Requirements

Any person who stutters who can prove they would benefit from such treatment and who is financially unable to cover in whole or in part the costs of such treatments themselves.

Who is Eligible?

The applicant must be a resident of the National Capital Area (Ontario and Gatineau) or a student (including international) attending any National Capital school (universities and colleges in Ottawa and Gatineau). Applicants may access treatment in either English or French.

Summary of Eligibility Criteria

Proof of need for treatment

Applicant to submit document by a qualified professional indicating the results of an assessment that shows the individual can benefit from the proposed treatment program. Assessment may be done either by a speech language pathologist or another qualified individual (e.g. doctor, counselor, social worker).

Proof of financial need for treatment

Applicant to complete and submit the Request for Financial Assistance form and to provide written proof about not being able to access the treatment program without some financial assistance.