1. fluency introduction

Fluency- definition, factors effecting,
development & dimensions of fluent
speech

Fluency,
Disfluency
Dysfluency

Introduction
The term fluency means non-stuttered
and forward moving speech in regards
to both content and production (Stark
weather, 1987).

Fluency is the effortless production of
long continuous utterance at a rapid
rate. These 3 elements of fluency are
related to each other.
The pauses and hesitations break up to
the smooth continuous flow of speech,
and this determines the length and
influences the rate of each utterance.
These slow down the rate at which
words are produced (stark weather
1987).

Factors influences fluency are
1. Stress which depend upon language
and environment.
2. duration of sound
3. co articulation
4. effort
1. Muscular
2. Mental effort
5. Anatomical and physiological
constraints also.

Disfluency refers to normal, non-stuttered
interruptions of speech and Dysfluency
refers to stuttered interruptions of speech
(Stark weather, 1987; Manning, 2001).

A Dysfluency is anything that disrupts the
smooth flow of speech. this would include
word finding problems found in aphasia
and groping behaviors characteristic of
apraxia
Shipley & McAfee 1992

Fluency
The term fluency is derived from the Latin
word ‘flure’ – flowing, describes what the
listener perceives when listening to some
one who is truly adept at producing
speech. The speech flows easily and
smoothly in terms of both sound and
information.

There is no disruption of the stream and
the listener can attend to the message
the overall effect of the performance-
rather than considering how it was
produced.
We use the speech mechanism to
produce speech and some people
produce speech more easily smoothly
and rapidly than others.

The ease with which some people speak
may result from characteristics present in
the mechanism they use (Stark weather
1987).
The speech flows easily and smoothly in
terms of both sound and information.

The effect is similar to observing any
accomplished athletic performance that
requires complicated sequential
movements, such as gymnastics, i.e.
skating, diving or swimming. The
impression when observing such athletes
in one of smoothness and ease.

Fluency requires facility at a minimum of
two levels of production: language and
speech. Filmore (1979) described the
three types of language fluency, which are
interpreted by Stark Weather (1987) as
syntactic, semantic, and pragmatic
fluency. Stark Weather adds 4th
components which he describes as
phonologic fluency.

Speakers who are syntactically fluent
are able to construct highly complex
sentences. Speakers who are
semantically fluent possess and able to
access large vocabularies.

Speakers who are pragmatically fluent
are adept at verbal response in a variety
of speaking situations. Stark weather’s
term phonologically fluent describes
those speakers who are able to
pronounce long and complicated
sequences of sounds and syllables
including nonsense and foreign words.

Although language fluency is a pre
requisite for the production of fluent
speech
It is not the case that individuals who
stutter are deficient in these aspects of
language competence or ability. People
who stutter do however, exhibit difficulties
in speech fluency.

Stark Weather’s Definitions of
Fluency
Fluency: “Facility of speech and
language performance. People who are
fluent are so skilled in the performance of
speech and language behaviours that
they don’t need to put much thought or
energy into talking.” (C.W. Stark weather,
1987, p.11).

The coordination and timing of speech
segments can affect the articulation which
in turn affects fluency. Others such as
reaction time for speech changes in the
feedback during speech can also affects
fluency. Certain anatomical constraints on
the child’s vocal system may also
influence fluency.

Younger children shows
a smaller vocal tract
Less coordination
Less control of the movement of vocal
tract
Coordination
Planning
Execution
This all disrupts fluency.

Acoustic basis of fluency includes rhythm
some language are syllable timed and
some language and some are time where
some kind of a rhythm is maintained.
Hence this should also be considered
while evaluating fluency.

Children’s speech becomes increasingly
fluent as they become mature when
children are first begin to use speech to
convey ideas their speech lacks fluency.
It is produced slowly and many of the
features of normal rhythm are missing .
As their fluency increases children also
learn to read to deal with lapses of fluency
such as discontinuities in a more
sophisticated way. Stark weather 1987).

Some children do not develop the capacity
for fluent made by their environment are
too much for them to handle.
Since their environment demands are
greater than their capacity to produce, the
child lacks fluency in speech.
Conditions that arise as a result of fluency
disruptions include stuttering and
cluttering.

FEW STUDIES
Few studies (Branscom et al 1955,
Silverman 1972,1973 Helmrich and
Bloodstein 1973, Kowal et al 1975,
Haynes & hood 1977, Suzan, Zunkerman
1980 and Dejoy & Gregory 1983)have
been conducted to explore fluency
development in children .

Of these that by Kowal et al 1975 illustrates
some aspects of fluency development. They
asked 168 children 24 children at each of 7
different age levels to describe a series of
cartoons. They considered 5 categories of non
fluent
unfilled pauses
filled pauses
Repetition
false starts
Parenthetical remarks.

Their study indicated that vocal
hesitations, in general do not decreases
with age but fluctuate with development
increasing between kindergarten and
fourth grade, then declining by 6 th grade
increasing again through 8 th grade and
then declining at senior year to the same
level as kindergarten.

In the early ages children exhibit more of
unfilled pauses, filled pauses and
repeats which predominate which
decreases in frequency which increasing
age.
However an increase in false starts and
parenthetical remarks is noticed in the
older age groups.

Aspect of fluency
There are several dimensions of speech
fluency .
Stark weather (1987) discusses speech
fluency in terms of
continuity,rate,duration,coarticulation
and effort.
The coordination of timing of speech
segments can effect the articulation which
in turn affects fluency.

Continuity refers to speech that flows
without hesitation or stoppage.
It relates to the degree to which syllables
and words are logically sequenced as well
as the presence or absence of pauses.

If the semantic unit follows one another in
a continuant flow of information, the
speech is interpreted as fluent.
If the units of speech fail to flow in a
logical sequence, information does not
flow.

Another aspect of continuity has to do
with a disruption in the flow of sound in
the form of pauses i.e. filled and unfilled
pauses (lasting longer than
approximately 250 milliseconds (ms).
(Goldman – Eisler,1958) .

Clarke (1971).
Conventional pauses idiosyncratic pauses
Signals linguistically
important
Aspects of performance
reflecting hesitations of
uncertainty over word
choice. Single or syntax
style.

Rate refers to the speed in which the
words are spoken.
Rate of speech also signals the perception
of fluency.
Most people talk about as fast as they can,
as indicated by Tiffany(1980), who noted
that the maximum and ordinary rates tend
to be similar.

According to speaking task, there is
considerable variability in rate in terms of
such factors as
formality of speaking situation,
time pressure,
interference from background noise
or competing message.
These appear to be a reasonably wide
rage of acceptable rates in the judgment of
fluency.

It is well known that if communication
failure is likely, such as when speaking
in a noisy environment, speakers are
likely to slow down (Long Hurst &
Siegel, 1973).
Likewise if a speaker is producing a
lengthy utterance, the rate of speech is
likely to be more rapid (Malecot,
Johnson & Kizzear, 1972).

Rate is typically measured in terms of
words or syllables per minute.
Stark weather notes that as children
mature their syllable rate increase while
rate variability decreases.
For English-speaking adults, the mean
overall speaking rate is 170 words per
minute (w/m), substantially quicker
than the approximately 120 w/m that
stutterers produce.

Although the rate of speech production
is obviously one aspect of fluency, it
does not appear to be a primary
dimension.
The flow of speech and information is
based not only on rate but on a
combination of many factors,
particularly the ease of production.

Effort refers to the ease with which an
act is performed.
Stark weather (1987) distinguishes 2
types of effort:
• Effort associated with linguistic planning
(mental)
• Effort associated with muscle movement
(physical)
Effort can be neuromuscular in the
timing and co-ordination of respiration,
phonation, and articulation.

Effort can also be mental in terms of
formulating the content of a response
and arranging content in an appropriate
syntactic sequence.

Ease of speaking refers to the amount
of effort being expanded to produce
speech.
Fluent speakers put very little muscular
or physical effort into the act of
speaking, while stutterers exert a
relatively large amount of muscular
effort to produce the same speech.

In addition to the physical effort
involved in producing speech, the
mental effort is usually much greater in
stutterers than non-stutterers.

Duration of speech segments relates
closely to the co articulation of the
segments.
The duration of the consonants and
vowels of a language varies
considerably with speech rate and
phonetic and linguistic context.
For example, stressed syllables are
longer than unstressed ones (Umeda,
1975).

Sound segments are longer at the
initiation and termination of syllables,
words and phrases (Fowler, 1978).
Much of what occurs in terms of the
duration of individual sound segments
and words appears to be related to the
speaker’s anticipated flow of
information during an utterance (Stark
weather, 1978).

That is, the speaker may not need to
plan all aspects of the upcoming
utterances in terms of the necessary
respiratory, phonatory and articulatory
events.
Rather the speaker would only need to
have some idea about the amount of
information the utterances would
contain.

Co articulation: The co articulatory
effects are greater when the speech
rate is increased (Gay, 1978; gay
&Hirose 1973; Gay Ushijima, Hirose &
Cooper 1974).

co articulatory effects contribute to the
timing and smoothness of speech. In
fluent speech articulatory movement
between the sounds, syllables, and
words are done with ease. The
transitions are smooth and there is a
continuous flow of overlapping
sounds.

Rhythm rather than being a dimension
of fluency, it seems to promote or
enhance fluency.
Specifically, it seems that speech
rhythm serves fluency by making it
easier for us to talk faster.
It does this in several ways. Unstressed
syllables are shorter and thus require
less time.

In addition rhythm assists in rapid
speech production by providing a
means for us to anticipate upcoming
movements. There is certain rhythm to
speech.

Allen, 1968 theorizes that rhythm is
imposed on speech for the same
reasons that any movement might be
organized temporarily, to facilitate
execution.
Martin, 1972 however says that
“rhythmic patterning carries a heavy
information load in ordinary connected
speech”.

Classification of disfluencies:
Johnson 1961
1. Interjections of sounds , syllables,
words, phrases extraneous sounds
such as uh, er, hmmm, extraneous
words such as well which are distinct
from sounds and words associated
with the fluent text or with phenomena,
included in other categories.

2. part word repetition
3. word repetitions
4. phrase repetition

5. Revision
6. Incomplete phrases
7. Broken words
8. Prolonged sounds.

William, Silverman & Kools
(1968)
Revised version of Johnson’s
Disfluency classification system they
include
Part word repetition
Whole word repetition
Phrase repetition
Interjection
Revision

Tense pauses: (the occurrence of a
tense pauses is indicated by the
presence of audible manifestation of
heavy breathing or muscle tension)

Disrhythemic phonations: It is with in a
word event that may constitute a
prolonged sound an accent or timing.
it is notably un usual an improper
stress, a break, or any other speaking
behavior not compatible with fluent
speech and not included in another
category.

Yairi (1981) Disfluency in 8
categories:
Part word, phrase repetition,
interjection, revision, disrhythmic
phonation, tense pauses, word
repetition (single syllable word, multi
syllable word repetition).

Compound disfluencies:
Two or more types of disfluencies can
occur successively.
Clustering: term used by Silverman
(1969) to describe the occurrence of
more than one Disfluency on the same
word or consecutive words or both.

Oscillation: a term used by Mysak 1978
to describe the no of repetition instance
of Disfluency.
Silverman (1969)refers to the oscillation
phenomenon as duration of fluency.

Characteristics of stuttering
Stuttering disrupts the fluency of
speech. Hence, “stutters” are often
referred to as “dysfluencies” or
“nonfluencies”.
They may be in the form of
prolongations, blocks or repetitions.
One or any combination of these
features may be present, consistently
or variably.

Disfluency in speech, including
repetitions and prolongations, is
normal for all speakers, but stuttering
is distinct from normal Disfluency in
that it occurs with greater frequency
and severity – the disfluencies occur
much more often and tend to last
longer with more strain.

The types of disfluencies are also
markedly different: normal disfluencies
tend to be a repetition of whole words
or the interjection of syllables like “um”
and “er,” .

while stuttering tends to be repetition
and prolongation of sounds and
syllables.
The various behaviors that can
disrupt the smooth flow of speech
include repetition, prolongations, and
pauses.

Repetition occurs when a unit of
speech, such as a phrase, word, or
syllable, is superfluously repeated.
Examples:
Phrasal repetition would be, “I want... I
want. to go... I want to go to the store,
“or, “I want to go to the – I want to go to
the store”.

A word repetition would often
resemble, “I want to-to-to go to the
store,” and a syllable or sound
repetition being, “I wa-wa want to go to
the store” or, “I w-w- want to g-go to
the store”.

Repetition occurs in the speech of both
stutterers and non-stutterers, but non-
stutterers are less likely to repeat
shorter units of speech, mainly
repeating phrase and sometimes words
but rarely syllables.

Non-stutterers will also, in the majority
of cases, repeat the unit once or twice
as opposed to the 6 or so times
common from stutterers.

Prolongations are one of the least
typical behaviors exhibited by
stutterers. Prolongations normally
happen with child stutterers and with
the sounds /θ/, /∫/, /v/, and any other
fricative consonant or vowel.

With stutterers, prolonging a sound
sometimes leads to a pitch and volume
increase.

Pauses: are a common source of
Disfluency in both stutterers and non-
stutterers.
Most pauses can be dividing into two
categories:
filled pauses unfilled
pauses
Pauses

Unfilled pauses are extraneous
portions of silence in the ongoing
stream of speech.
These pauses differ from the pauses
that punctuate normal speech, where
they reflect common sentence structure
or are used to add a particular rhythm
or cadence to speech.

Unfilled pauses by stutterers are
usually unintentional and may cause
the larynx to close, restricting the flow
of air necessary for speech. Stutterers
refer to this as “blocking”.

Filled pauses are interjections typical in
normal speech like “um”, “uh”, “er”,
and so on.
In speech these serve as a kind of
place-holder – a way a speaker lets
listeners know that he or she still has
the floor and is not finished speaking.

In addition to being used as a way of
preempting interruption, they are also
used by stutterers as a way of easing
into fluency or deflecting
embarrassment when they cannot
speak fluently.

Development of fluency:
The findings related to fluency
development make it clear that
children’s speech becomes
increasingly fluent as they mature.
When children first begin to produce
speech to convey ideas, it is produced
slowly, and many of the features of the
rhythm are missing.

As their fluency increases, children
also learn to deal with lapses of
fluency in more sophisticated ways.

Why do we know about the dimensions of
fluent speech?
In order to appreciate the nature of non
fluent speech production, it is
necessary to understand the
dimensions of fluent speech.
Even the best of speakers speaking
under ideal conditions are apt to
produce breaks in the flow of words.

Language and speech production is a
complex task.
It takes many years of experience to
do it well, especially under conditions
of stress.

Demands and Capacities
Model of Fluency
Development:
Growth in the capacity for fluency
speech comes from several areas.
There is increasing control over the
movements of the vocal tract.

Another capacity for fluency comes
from rhythm.
The sense of rhythm makes it easier for
a child to anticipate movements of
speech production, and as a result it
will give him a motoric confidence for
fluency.

The increased demand for fluency also
comes from the child’s development of
language skills.
Increased syntactic, semantic,
phonologic and pragmatic knowledge
all contribute to this demand for
fluency.

The people with whom children
communicate – also place demands on
them.
According to Stark weather, the
increasing fluency is accompanied by
an increasing demand for fluency from
the environment, or even from within
the child.

Development – Speech
Continuity
Findings
From 29 mths – 33 mths – 37 mths,
discontinuities decline from 6.5% to 5.10%
to 4.10% (Yairi, 1981)
Discontinuities decline from 14.6% to 9.1%
from ages 2-4 but then remain the same
from 4-6 yrs (Wexler & Mysak, 1982)

From 3 ½ - 5 yrs, discontinuities decline
from 11.9 – 9.5% (Dejoy & Gregory,
1975). Kindergarten and first grade
children’s speech is approximately 2%
and more discontinuities than that of
high school children (Kowal, O’Connell
& Sabin, 1975)

Two types dominate the
discontinuities of 2 yr olds
• Repetitions of small units (parts of words…)
• Interjections and revisions (Yairi, 1981)

Development of rate
The rate at which speech is
produced is an important aspect of
fluency and it shows clear development
trends.
These trends are evident in several
different measures – pause duration,
length of utterance, syllables / sec and
segment.

Pause duration:
Several of Kowal, O'Connell & Sabin's
observations suggest that the duration
of unfilled pauses is an excellent
measure of fluency development.
It directly influences the rate of speech
It shows strong development trends
that parallel another fluency measure of
known clinical importance – part word
repetitions

It shows a clinically important
difference between the sexes – unfilled
pause duration presents one difficulty
as a measure of speech fluency – it is
not independent of language fluency.
Children with abnormally long unfilled
pauses may be using the extra time to
plan language, not speech.

Speech has many levels of organization
– words are nested within utterances,
syllables within words, sounds within
syllables, and individual gestures
within sounds.
The rate of speech is seen a little
different at each of these levels of
organization.

The most complex level is the
utterance, and the length of an
utterance is related to the rate at which
it is produced.
This relation seems to be determined
by the amount of speech produced.
This relation seems to be determined
by the amount of information the
utterance contains.

Although a longer utterance typically
contains more information than a short
one, the amount of information in each
word of a longer utterance is less than
that in a shorter utterance because of
the additional redundancy of the
context.
One can supply the missing item more
readily in a longer utterance because of
the additional context.

Context is redundancy, so there is less
information in each word of a longer
utterance than there is in a shorter one.
It may be for this reason that the rate
of speech in syllables / sec is faster in
longer than in shorter utterance
(Malecot, Johnston et al 1972)

The rate can be assessed in word and
syllable levels also.
Simth, 1978 compared the duration of 9
words in the speech in 2 and 4 yr
children with that of adults.
The duration of words was a direct
function of the subject’s age.

It is evident that, the speech of
children gets faster and faster with
age.

The next level is syllable. Utterance
duration and word duration seem to
depend heavily on the amount of
information contained in the
utterances, but syllable/sec seems
independent of content, as long as the
sample is large enough to contain a
large variety of syllables.

For this reason, the number of
syllables/sec is the most common
measure of speech production rate.
The rate of speech in adults is 5-6
syllables/sec.

Development of speech
rhythm:
Findings:
Young children (18-36 months) are
unable to imitate sentences lacking
normal rhythm (Eilers, 1975)
2 year olds tends to use far fewer
reduced syllables than do adults, so
that their speech rhythm has fewer
syllables per foot, or more beats per
utterance, in short, it sounds more
syllable timed (Allen and Hawkins,
1980).

Syllables are totally reduced (deleted)
by 2-3 yr olds in two phonetic
environments,
• world initial
• next to another light (unstressed) syllable
(Hawkin, 1979)
The rhythm of speech is an important
perceptual cue to our recognition of
speech has meaningful stimuli.

The very 1st words, children produce,
do not show has much stress contrast
as in adult speech (Ingram, 1974, Allen
and Hawkins, 1980).
The adult rhythm of language is not as
easily discerned in the speech of
children in the one and two word
stages of development.

Two syllable word containing one
heavy (stressed) and one light
(unstressed) syllable are typically
produced as if they were spondees,
with both syllables being given full
vowel, color and duration.
The only indication of stress is in the
raised.
Fo of the stressed syllable.

Furthermore, many of the sounds in the
unstressed syllable may be lost, and
instead the child produces a nearby,
usually adjacent, stress syllable.
Typically, a child’s reduplication
consists of one heavy accented syllable
followed by a heavy unaccented
syllable (Hawkins, 1979).
E.g. “ray-ray” for “raisin” or “bebe” for
“betty”

Development of ease in
speech:
We have no direct measures of the
effort children expend in the
production in the speech, either
muscular effort or mental effort, and
thus no findings on this topic.

Anyway, some thought is required
before an utterance to plan its
execution, but once this planning is
accomplished the utterance is executed
automatically.

When this conclusion is put together
with the data reported earlier on the
length of unfilled pauses in children’s
speech which tend to shorten as the
child grows, it appears that young
children spend more time planning an
utterance, and that the planning time
decreases as the child develops.

Since the rate of speech increases as
the children grow, once can conclude
that acquire the ability to talk with less
muscular effort.

CONTINUM OF DISFLUENT SPEECH
BEHAVIOURS. From R.Curlee, Stuttering
and related disorders of fluency.
(1999) .More usual: typical dis fluencies
in pre school children. More unusual: A
typical disfluencies that are very in
frequent in the speech of children

INDIAN STUDIES:
SOME ASPECTS OF FLUENCY IN CHILDREN
4-5 YEARS 1990
INDU .V.
197
Subjects: 12 Kannada speaking children, from
middle socio economic status.
Task: conversation, rhymes, picture description
& story telling.
Descriptive analyses were done.
Kinds of disfluencies includes: filled pauses,
unfilled pause, parenthetical remarks, false
starts, prolongation, and audiable inspiration.

Results show that children in the age group 4-5
year had more filled pauses followed by
repetition and parenthetical remarks.
More Disfluency occurred before the content
words especially (nouns) than before functional
words. More Disfluency occurred on the initial
part of the utterance than in the medial and final
part. On the basis of result a test has been
proposed using picture description task and a
cut off scores and ranges for different
disfluencies at each group been given.

Study 2
Differential diagnosis of stuttering and
normal non fluency.
Soumya srinivasan
May 1992
Subjects : 25 children
Age: 3-7 years
Belonging to middle socio economic
status

Task :
picture description task
Connected pictures
Cartoons
Panchatantra story

Age range was divided in to
3-4
4-5
5-6
6-7 year old children

Responses were recorded. Speech samples
were transcribed verbation and analyzed for
the following disfluencies.
Unfilled pauses
Filled pauses
Repetition
Prolongation
Audiable inspiration
Parenthetical remarks
False starts
Part question
repetition
Broken word
hesitations

Data compared with the normative data
given by Nagapoornima , Indu, Yamini,
(1990) Rajendraswamy (1991) for the
diagnosis of stuttering or normal non
fluency.
Also a comparison of the diagnosis of
the child on the basis of the fluency
test was made with that of a speech
pathologist.

Pearson correlation test was
performed.
Results indicated that repeats unfilled
pauses and filled pauses to a greater
extent and prolongation and audiable
inspiration to a lesser extent seem to
guide in the diagnosis of the child as a
stutterer.
Unfilled & filled pauses in the younger
rage group.
Repeats and filled pauses in the older

It was observed that strict and uniform
measure was to be followed by the
speech pathologist to diagnose a case
as stutterer or normally non fluent.
Based on this results the test was
found to be valid and clinically useful in
differentiating young stutterers from
their normal nonfluent peers

Fluency test provides a set criteria
which could be used as a diagnostic
tool.
How ever the fluency test needs
modification in the terms of reduced
length of testing ,decrease in the no of
picture description task deletion of
parenthetical remarks ,false starts from
list of disfluencies.
Validated modified form of the fluency
test may be used by SLP tp ve
uniformity in their diagnosis.

Fluency test .
Study given by nagapoornima1990,indu
1990,yamini 1990,rajendraswamy 1991
Were conducted to analyze the
percentage of disfluencies of normal
kannada speaking children in the age
range of 3-7 years.
Based on this test was proposed .
Validity of this test was not established.

Disfluency types
in %
3-4y 4-5y 5-6y 6-7y
Filled
Unfiled
Repetition
Parenthetical remarks
False starts
Sound prolongation
Part question repetition
Audiable inspiration
Broken words
Hesitation
total
9.6
8-6
4.0
2.5
0.16
-
-
-
-
-
24.86
12
1.52
0.69
5.27
0.39
0.13
-
0.18
-
-
20.18
7.66
9.2
3.21
7.49
6.51
1.11
0.04
5.38
-
-
35.60
7.4
1.53
6.37
6.54
2.88
1.84
-
2.79
0.19
0.13
29.67

Epidemiology of Stuttering
in the Community Across
the Entire Life Span
Ashley Craig ,Karen Hancock ,Yvonne
Tran& Magali Craig .
Journal of Speech, Language, and
Hearing Research Vol.45 1097-1105
December 2002.

A randomized and stratified investigation
was conducted into the epidemiology of
stuttering in the community across the
entire life span. Persons from households
in the state of New South Wales, Australia,
were asked to participate in a telephone
interview. Consenting persons were given
a brief introduction to the research, and
details were requested concerning the
number and age of the persons living in
the household at the time of the interview.

Interviewees were then given a
description of stuttering. Based on this
description, they were asked if any
person living in their household
stuttered (prevalence).
If they answered "yes," a number of
corroborative questions were asked,
and permission was requested to tape
over the telephone the speech of the
person who stutters.

Confirmation of stuttering was based
on (a) a positive detection of stuttering
from the tape and (b) an affirmative
answer to at least one of the
corroborative questions supporting
the diagnosis.

Results showed that the prevalence of
stuttering over the whole population
was 0.72%, with higher prevalence
rates in younger children (1.4–1.44) and
lowest rates in adolescence (0.53).
Male-to-female ratios ranged from 2.3:1
in younger children to 4:1 in
adolescence, with a ratio of 2.3:1
across all ages.

The household member being
interviewed was also asked whether
anyone in the household had ever
stuttered.
If the answer was “yes," the same
corroborative questions were asked.

These data, along with the prevalence
data, provided an estimate of the
incidence or risk of stuttering, which
was found to range from 2.1% in adults
(21–50 years) to 2.8% in younger
children (2–5 years) and 3.4% in older
children (6–10 years).
Implications of these results are
discussed.

Clinical implications of
situational variability in
preschool children who
stutter
J. Scott Yaruss.
Journal of Fluency Disorders
Volume 22, Issue 3, 1997, Pages 187-
203

Abstract
Variability is one of the hallmarks of
stuttering. Nevertheless, differences in
children's frequency of stuttering in
different speaking situations have not
been thoroughly investigated.

This study examined variability in the
frequency of disfluencies produced by
45 preschool children who stutter
(mean age = 42.3 months) in five
different speaking situations (parent-
child interaction, play with clinician,
play with pressures imposed, story
retell, and picture description).

Significant differences were found in
the frequency of disfluencies between
these situations, and the variability
between situations was significantly
greater than the variability seen within
a single speaking situation.

In general, the “play with pressure”
situation elicited the highest frequency
of disfluencies from many subjects,
though subjects exhibited highly
individualized patterns of variability.

Finally, children with a higher average
frequency of “less typical” disfluency types
exhibited a significantly higher degree of
variability.
Results highlight the importance of
evaluating more than one speaking situation
when diagnosing a child who stutters both to
obtain a better understanding of the nature of
the child's stuttering disorder and to ensure
that the true extent of the child's stuttering is
not overlooked.

Syntactic Complexity,
Fluency, and Accuracy of
Sentence Imitation in
Adolescents
Stacy W. Silverman
Nan Bernstein Ratner.
Journal of Speech, Language, and
Hearing Research Vol.40 95-106
February 1997.

The majority of work that suggests a
relationship between syntactic complexity
and the frequency of stuttering has been
carried out with young children.
In this paper, they investigate whether or
not syntactic complexity exerts an
influence on the frequency of stuttering in
adolescent speech.

Fourteen adolescents, 7 of whom
stuttered, and 7 of whom were normally
fluent, ages 10–18 years, participated in a
sentence imitation task in which stimuli
were divided into three classes of
grammatical complexity.

Results indicated that for both groups
of speakers, normal disfluencies and
errors in repetition accuracy increased
as syntactic complexity increased.
However, stuttering frequency did not
appear to be affected by changes in the
syntactic complexity of the target
stimuli.

Such findings suggest either a diminution of
the effects of syntactic complexity on
stuttering over the course of language
acquisition or changes in the mix of chronic
and nonchronic stuttering speakers from
those used in earlier studies of the effects of
linguistic structure on stuttering in children.

Relationship between Language and
Fluency in Children with
Developmental Language Disorders
Nancy E. Hall ,Toyoko S. Yamashita ,Dorothy
M. Aram
Journal of Speech and Hearing Research
Vol.36 568-579 June 1993

The present investigation addresses
two primary hypotheses:
(a) that a subset of children with
developmental language disorders
exhibits significantly more disfluencies
than other children with language
disorders and
(b) that differences between the
disfluent and non disfluent groups
observed in fluency may be related to
differences in language deficits.

Spontaneous language samples from
60 preschool children with
developmental language disorders
were analyzed for frequency and type
of disfluencies.

Comparisons of the frequency of
disfluencies across subjects revealed
that a subset of 10 subjects exhibited
significantly more disfluencies than the
other subjects with language disorders.
Demographic, intelligence, and
language variables were compared
across the two groups to determine
whether such factors could account for
the differences in fluency.

The subjects with greater percentages
of disfluencies were found to be
significantly older and demonstrated
significantly higher scores on two
standard measures of vocabulary.

These findings were interpreted in light
of two models of disfluencies: the
neuro psycholinguistic (Perkins, Kent,
& Curlee, 1991) and Demands and
Capacities (Adams, 1990; Starkweather,
1987).

This suggests that some children with
language disorders are at risk for
fluency breakdown because of
dysynchronies in the development of
lexical and syntactic aspects of
language or as a result of mismatches
between speaking demands and
capacities

Articulation, Language, Rate,
and Fluency Characteristics
of Stuttering and Non
stuttering Preschool Children
Bruce P. Ryan 1 Journal of Speech and
Hearing Research Vol.35 333-342 April
1992.

Articulation (Arizona Articulation
Proficiency Scale), language (TOLD,
Peabody Picture Vocabulary Test), and
fluency (Fluency Interview) tests were
given to 20 stuttering and 20
nonstuttering male and female preschool
children to examine potential
performance differences between the two
groups. Speaking rate was also
measured.

There were several significant but minor
differences between the two groups. The
stuttering children scored lower on seven
out of eight language measures than the
non stuttering children and slightly lower
than the average score for their age
group when compared with the tests'
normative samples. Girls demonstrated
higher language scores and faster
speaking rates.

There were no differences between the
stuttering and non stuttering groups on
articulation proficiency, although 25%
of the stuttering group (all boys) later
required articulation treatment.

There were few statistically significant
correlations between measures of stuttering
rate, speaking rate, and language
performances within each of the two groups
of children, although there were consistent,
low-to-moderate negative correlations
between stuttering rate and language
measures and low positive correlations
between speaking rate and language
measures.

A stepwise regression analysis
suggested that selected variables of
language proficiency combined with
speaking rate were at best moderately
predictive (R=.52) of stuttering
behaviour for the total group of
children.

Reference :
1. Hugo H.Gregory., Stuttering therapy
rationale and procedure 2003.
2. Walter .H. Manning., Clinical decision
making in fluency disorders .second
edition.
3. Stark weather W. Fluency and
stuttering.1987
4. Dissertation – Indu .V. 1990 (197)
5. Journal of Fluency disorders.
6. Journal of speech and hearing

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