What are Fluency Disorders?
Stuttering is a type of fluency disorder. Another type of fluency disorder is called cluttering.
These disorders can occur in conjunction or in isolation of one another. Our recent post, What is Stuttering? covers these types of speech-language disorders and how they may present across individuals.
When an individual stutters, they have stuttering-like disfluencies (we will cover below), and often have secondary behaviors related to stuttering. This may include a physical behavior like overemphasized blinking or clenching their fist during moments of stuttering. Their rate of speech is typically adequate, though may be slightly slower due to the type of disfluency they are experiencing. Individuals who stutter are usually aware of their disfluencies. They may also have negative feelings related to their stuttering, such as anxiety in or avoidance of certain situations, like talking in class or going through a drive-thru.
When an individual stutters, they have stuttering-like disfluencies and often have secondary behaviors related to stuttering. This may include a physical behavior like overemphasized blinking or clenching their fist during moments of stuttering.
Individuals who clutter often have interruptions in their speech related to speaking very quickly or irregularly (e.g., sometimes faster, sometimes slower), irregular pauses, and less awareness of their disfluencies. They may also change topics quickly or omit syllables when speaking, which can make it hard to be understood by others. An individual speaking irregularly or omitting syllables may sound like: “Let’s go get I really like I want ice cre- chocolate!”
With both stuttering and cluttering, it is typical for anyone to have disfluencies at times, but when it is more than expected and consistently disrupts the flow of speech, it is considered a disorder.
Generally speaking, a fluency disorder is diagnosed when an individual’s interruptions, or disfluencies, are present in more than 10% of one’s words.
The 3 main types of stuttering-like disfluencies include: repetitions, blocks, and prolongations.
Who Needs Fluency Goals?
Usually if a fluency disorder is diagnosed, it is because the individual who is going to receive therapy underwent a formal evaluation and results indicated that intervention was warranted based on results and/or additional clinical observations. The speech-language pathologist (SLP) performing the evaluation may have the individual complete a language sample and record the disfluencies they hear. There are formal stuttering assessments, including the Stuttering Severity Instrument and Test of Childhood Stuttering. Individuals who are older may also complete the Overall Assessment of a Speaker’s Experience of Stuttering (OASES). The OASES is a questionnaire, which measures the life impact an individual’s stuttering has, and looks at areas such as reactions to stuttering and communication in daily life.
Writing Fluency Goals
As seen above, speech goals should be written with 3* components in mind: the DO statement, the CONDITION statement, and the CRITERION statement.
*Also commonly included is consistency (we incorporate this!). Aka does the individual have to meet a specific criterion more than once? A common example of this may include across 3 consecutive sessions. This is usually something understood by the therapy organization/service provider and is sometimes/sometimes not included in the written goal itself. This is to ensure that the skill has been generalized and provides more reliable data that the skill has been properly mastered.
What the client is actually going to DO and the specific skill they will be working towards.
Example: use 1 learned fluency shaping strategy (e.g., slowed speech)
The specific setting and/or context your client will work on this skill.
Example: within a 5-minute timed reading task
How the client’s performance will be measured.
Example: in 75% of opportunities
DO + CONDITION + CRITERION
Example: [Client] will use 1 learned fluency shaping strategy (e.g., slowed speech), within a 5-minute timed reading task, in 75% of opportunities.
There you have it! An example using our Goal Writing Formula containing the DO + CONDITION + CRITERION (don’t forget to think about consistency!) for increasing fluent speech.
Fluency Goal Bank
Our fluency goal bank is organized based on the most common treatment approaches to stuttering therapy: fluency shaping, fluency modification, avoidance reduction, and acceptance commitment. It should be noted that there are some treatment strategies that are more preferred for younger individuals who stutter, as compared to adolescents and/or adults who stutter. The personal perceptions and feelings of the person who stutters should also be taken into account as well and may influence whether you move forward with a direct or indirect treatment approach.
Fluency Shaping Strategies
Promote fluency enhancing techniques. Common types include slowed speech, light contacts, easy onset, relaxed breathing, stretched speech/continuous phonation, pausing/chunking.
Example #1: [Client] will use the easy onset fluency shaping strategy, during a 5 minute conversational treatment task, in 80% of opportunities.
Example #2: [Client] will use 2 fluency shaping strategies (i.e., relaxed breathing, slowed speech), during a timed structured treatment task, with 80% accuracy.
Example #3: [Client] will use the continuous phonation strategy, during presentations to unfamiliar individuals, in 75% of opportunities.
Example #4: [Client] will use the light contact fluency shaping strategy in words and phrases, in structured language tasks, in 90% of opportunities, across 3 sessions.
Stuttering Modification Strategies
Designed to reduce tension and modify moments of stuttering. Common types include pull-outs, relaxed stuttering, intentional stuttering, preparatory sets, cancellations.
Example #1: [Client] will use the cancellation stuttering modification strategy, following self-identified disfluencies, throughout the duration of the treatment session, with 80% accuracy.
Example #2: [Client] will use preparatory sets, prior to moments of anticipated stuttering within a conversational treatment task, in 75% of opportunities.
Example #3: [Client] will use pull-out strategies, during a structured reading aloud task, with 80% accuracy.
Example #4: [Client] will use the 3 stuttering modification strategies, in words and sentences, during structured language tasks, in 8 out of 10 trials, across 2-3 consecutive sessions.
Avoidance Reduction & Acceptance Commitment
Focus of reducing avoidant behaviors and/or fears relating to stuttering; promotes positive attitudes, beliefs, and emotions about stuttering. Often considered to be more of a counseling/cognitive behavioral approach.
Example #1: [Client] will self-identify avoidant behaviors secondary to his/her/their stuttering, during natural and structured treatment tasks, with 90% accuracy.
Example #2: [Client] will decrease social avoidance by participating in novel social activities/events, within community-based settings, for 3 separate events per treatment quarter.
Example #3: [Client] will introduce themselves to novel individuals by using their full name, within various academic and/or community settings, in 8 out of 10 opportunities.
If you are looking for more goal-related posts (with goal banks), check out some others we have posted:
- How to Write Pragmatic Language Goals
- How to Write Receptive Language Goals
- How to Write AAC Goals
- How to Write Articulation Goals
- How to Write Expressive Language Goals
- How to Write Play Skills Goals