Disfluency

Dysfluencies are disruptions or breaks in the normal flow of speech.

They occur in everyone's speech to some degree and can include various phenomena, such as:

• Repetitions: This can be a repetition of sounds (e.g., "s-s-soup"), syllables (e.g., "ba-ba-ball"), words (e.g., "and-and-and"), or phrases (e.g., "I want-I want-I want")^[1].

• Prolongations: These are the lengthening of sounds, like "ssssoup" or "ffflower"^[1].

• Interjections: Filler words or sounds that disrupt the flow of speech, such as "uh," "um," "like," "you know," etc.^[2].

• Revisions: Changing the wording or structure of a phrase or sentence partway through^[1].

• Blocks: A stoppage of airflow or voicing during speech^[3].

In typical speech, dysfluencies are common and normal. We all use them when we're thinking of what to say, trying to say something complex, or are tired or stressed.

However, if dysfluencies become frequent and disruptive enough to significantly impact communication, social interaction, academic performance, or emotional well-being, they may be classified as a speech disorder that needs treatment. This includes conditions like stuttering and cluttering.

Stuttering is characterized by frequent and significant problems with the normal fluency and time patterning of speech. Stuttering is often more than just the presence of dysfluencies, it may also involve struggle behaviors, negative feelings about speaking, and avoidance of certain words or speaking situations^[4].

Cluttering is a speech and communication disorder characterized by a rapid rate of speech, erratic rhythm, and poor syntax or grammar, often seen alongside excessive "normal" dysfluencies, like interjections and revisions^[5].

The difference between normal dysfluencies and those requiring treatment usually depends on a few factors:

• Frequency: People who stutter, for example, typically have a higher frequency of certain types of dysfluencies, such as part-word repetitions and prolongations^[6].

• Duration: Dysfluencies in speech disorders may last longer. For instance, someone might prolong a sound for several seconds or struggle to start a word^[7].

• Associated behaviors: People with speech disorders may show physical signs of struggle, like facial grimacing or tension. They may also avoid speaking situations out of fear of stuttering, which can affect their quality of life^[8].

• Reactions: A speaker's feelings and attitudes about their speech can also be important. People with normal dysfluencies usually don't worry about them, while those with a speech disorder might feel frustration, embarrassment, or anxiety about speaking^[9].

A speech-language pathologist should determine whether dysfluencies represent a normal aspect of speech development or a speech disorder that requires intervention. They can guide decisions about treatment, which might include speech therapy to develop fluency or strategies to manage stuttering.