Royal College of Speech & Language Therapists Clinical Guidelines: 5.9 Disorders of Fluency
Taylor-Goh, S. (ed). (2005).
Bicester (United Kingdom): Speechmark Publishing Ltd., 73-82.
This evidence-based guideline provides recommendations for the assessment and management of fluency disorders in children and adults. This guideline is intended for speech-language pathologists.
Royal College of Speech & Language Therapists (United Kingdom)
<div>"A case history [associated with a fluency disorder assessment] should include details of the problem (e.g., onset details, family history of fluency problems, variability, speech behaviours, coping strategies, social environment, emotional responses, psychosocial impact)" (Grade C Evidence; p. 74).</div>
<div>For the adolescent, "therapy may be drawn from aspects of the child and adult therapies, but special consideration should be given to this stage of life and the impact that physiological, psychological, social and educational changes will be having on an individual's [stuttering] problem." The timing and type of therapy will need to be adjusted according to the needs and motivation of the individual (Grade B Evidence; p. 77).</div>
<div>Cluttering intervention may include work on "extending speech production and articulatory accuracy, prosody, and rhythm skills" (p. 82).</div>
<p>An cluttering evaluation should assess overt behavior and include an assessment of:</p>
<ul>
<li>speech rate during spontaneous speech and/or reading aloud;</li>
<li>voice;</li>
<li>language (including word-finding skills, narrative ability, and syntax/grammar);</li>
<li>pragmatic language;</li>
<li>written language skills; and</li>
<li>speech to determine if cluttering coexists with stuttering (Grade B Evidence).</li>
</ul>
<div>"[Standardized] speech and language assessments should be used as a screening procedure or in more depth as required. Coexisting speech and language difficulties may be present in half of children who [stutter]" (Grade B Evidence; p. 75).</div>
<div>"Children with [a fluency disorder and] additional speech, language or oro-motor difficulties should be offered therapy that addresses these problems either in parallel or sequentially to their [stuttering] therapy. The nature of the coexisting problems will determine the primary need of the child. Therapy for speech and language problems will focus initially on 'input' (e.g., phonological, word-finding) strategies rather than 'output’ strategies" (p. 77).</div>
<div>"A fluency disorder can be a part of a wider communication difficulty. [Therefore], it is necessary to consider speech, language, social and communication skills" (Grade C Evidence; p. 74).</div>
<div>During an assessment, clinicians should gather data (preferably with published measures) that help quantify the stuttering (e.g., frequency/severity of stuttering, associated behaviors), obtain details of previous treatment, determine how the child's stuttering is influenced by different situations or contexts, and identify the effects of speaking difficulties on the child's day-to day life and determine what strengths or resources are available that may influence the treatment process (Grade C Evidence).</div>
<div>Cluttering treatment may focus on rate-control strategies, awareness and self-monitoring, attention and listening skill development, language planning and formulation, the development of speech, prosody and rhythm skills, and the expansion of lexical abilities.</div>
<p>Grade B evidence indicates that the following key factors should be considered when assessing a child for a fluency disorder:</p>
<ul>
<li>The assessment procedure should be modified depending on the age of the child and the stage and nature of the child's stuttering.</li>
<li>Published questionnaires/scales should be used to assess the child's views and feelings about stuttering as well as the consequences of stuttering.</li>
<li>Since co-occurring speech and language difficulties are common in children who stutter, speech and language skills should be screened or assessed as needed.</li>
<li>Observations of the child interacting with others should be evaluated to determine if "changes in interaction styles would be beneficial to the child's fluency" (p. 75).</li>
<li>Information about the child's communication skills in other settings (e.g., school, day care) should be obtained to ascertain a comprehensive understanding of the child's skills and to determine what strategies others have employed to assist the child.</li>
</ul>
<p>A number of approaches are available to address fluency disorders in children. These include:</p>
<ul>
<li>The Demands and Capacities model is "based on the principle that child’s capacity for fluency can be enhanced naturally by reducing the internal and external demands that may be being placed on a vulnerable system" (Grade B Evidence; p. 76).</li>
<li>Integrated approaches are personalized programs that include the environmental factors that affect the child's fluency and also address the cognitive, affective, and behavioral components of stuttering.</li>
<li>Child (fluency) focused treatment typically employs a behavioral methodology to directly modify the child's stuttering and in some cases (e.g., Lidcombe program) may involve the child's parent or caregivers (Grade A Evidence).</li>
</ul>
