The DSM-5 reclassifies stuttering as an early childhood fluency disorder. About 5% of children in the US are diagnosed with a fluency disorder before age 6. Of that 5 percent, 75% recover by their teens to which many believe is attributed to early intervention programs such as working with a speech pathologist or literacy personnel in elementary and junior high school. The other 25% carry this fluency disorder into adulthood. These cases could be described from mild, moderate to severe. Fluency disorders can be broken down into stuttering, stammering, word blocks, difficulties with producing sound, and cessation of speaking midpoint due to pausing (and trying to complete the word). As the child grows older, this fluency disorder can be associated with anxiety. Children begin to notice how their speech is different from others, or perhaps when called to read aloud they stammer or stutter which causes an internal sense of shame and embarrassment. Speaking with folks who have dealt with such, they have also commented that they felt labeled or judged “as stupid…” The rationale behind this stems from ignorance when one assumes that the student
1. Does not know how to read, and
2. The student does not comprehend pronunciation.
In fact, this is the total opposite. The student knows how to read and can pronounce the words when they are reading silently to themselves. It is the fear and anxiety attached to reading aloud and being judged that causes further hesitation and doubt.
Here’s the story of Leidy.
Leidy was 7 when she realized her speech was a bit different from her classmates. She was an avid reader at home, attended multiple school book fairs, and like all other children her age she liked cartoons. She lived with her mom, aunt and grandmother, who encouraged her to read daily and communicate. In her communication with her family, there was no stutter or a very little stutter that would present itself during the use of certain words. However, when at school she felt tremendous anxiety when asked to read aloud. She would feel her heart race, legs and feet begin to shake, and palms get sweaty. She had a classmate, Johnny, who also had a stutter, except his was more pronounced. Leidy felt that her stuttering was less noticeable because most people paid attention to Johnny. Johnny also went to speech therapy. One day, the speech therapist came to class to pick up Johnny and asked if anyone else wanted to come along…Leidy stayed quiet, despite this desire to run to the speech therapist and ask for help.
For the next 2 years Leidy coasted, as she would describe it. She passed all classes with A’s and would read material ahead of time to practice just in case she was called on in class. When the class had to read aloud from the text, Leidy would either count how many paragraphs before it was her turn and read the paragraph that would be assigned to her about 5 times to practice. Or, she would choose a paragraph and read it in her head a few times and volunteer to read the rehearsed paragraph.
In 4th grade, a literary instructor came to class and divided the class into 4 sections, the 1st Group was for students that had difficulties reading and needed major assistance with reading for comprehension; the 2nd Group was for students who needed general help with reading comprehension and answering questions about the content read, the 3rd group was for students who read well but could use pointers on the state exams and lastly the 4th group was for stellar readers with great diction and use of vocabulary. Students were asked to read aloud and due to Leidy’s nervousness, she paused frequently when reading to catch her breath and not wanting to stutter in front of others. She was placed in group 1. After reading aloud again and answering some questions Leidy was moved to group 2, and lastly group 3. In spite of finally being placed in the group she belonged; Leidy recognized that people thought she couldn’t read rather than understand the fluency issues. As years passed, Leidy continued to read additional chapters in advance and practice pronunciation in the mirror. She would read books that her aunt was assigned in college and practice reading from her mother’s psychology textbooks. In high school, Leidy did what she defined as the unthinkable and joined the debate team. She traveled with the team and learned the art of debate while trying to practice her pronunciation.
She admitted the following “joining the debate team was probably my biggest mistake as well as my greatest lesson…I was scared out of mind and fumbled so much, I practiced day and night and the words would never flow right, but it was also my best experience being from the inner city and traveling to colleges and universities to practice the art of debate. It wasn’t until college that I learned most of it came from my nerves, I wanted to do well, and be like everyone else, meaning I just wanted to talk regularly. I wanted to get my point across without messing up, and when I couldn’t I just stopped talking. I passed every class in college with an A. I joined sports where I didn’t have to talk much, I ran track, you just run…release whatever you’re feeling and apply pressure and speed…athleticism helped with the anxiety. Whenever I had a presentation, I would volunteer to go first or second so I could practice and get it out of the way. The anxiety of waiting to go last was worse than the anxiety of potentially stuttering. I noticed that I had created these goals of being perfect at everything because of this one debilitating factor in my life. I acquired good ole perfectionism and that anxiety was stressful as I grew up. I was trying to make up for what I could not fix in one area, I overcompensated…”
Like many, avoidance is a typical characteristic of fluency disorders. Leidy often avoided situations where she had to speak unless she had absolutely no choice. She utilized athleticism as a positive coping skill and practiced speaking aloud in her mirror. Leidy’s story is still being written, and she is successful in her career and commented that stuttering still “shows its face from time to time but has diminished over the years…I also learned how to recognize when I feel anxious about speaking in public or having to read aloud in front of others, I just slow down, take a breath and embrace the fact that I will always have those jitters, and rather than fighting against them and making myself feel more nervous, I accept it and practice meditation…”
The DSM-5 has now added the addition of anxiety and avoidance to the criteria for childhood fluency disorder diagnosis, as this has been noted to be a major issue for Leidy and many others. Childhood-onset fluency disorder usually consists of reiterations of words or sections of words, in addition to prolongations of speech sounds. While this is seen in the general population with the use of words such as as “umm…” it is more common in those who stutter; however, “umm” may be replaced with complete silence or repetition of the word. Sometimes it may appear as if the person is experiencing shortness of breath while talking. In some cases, even when the mouth appears to be in the process of formulating a sound, nothing may come forth for a few seconds. The individual may require some effort in order to complete the pronunciation of the word.
If you notice that your child has a fluency disorder, it is most helpful to be supportive, identify creative ways to practice deep breathing, meditation, and practicing words, sounds, and reading aloud in the presence of supportive family. In addition, getting the child’s school involved to establish services with a speech pathologist and literacy coach. The idea is to access early intervention, boost your child’s self-esteem and confidence, and work on relaxation techniques to assist with anxiety. Always assess for depression, as therapy is an invaluable resource for confidence building and addressing depression.
In adulthood, fluency disorders can prevent an individual from applying for higher ranking positions, front facing positions that require speaking to the public or a large internal team, or even being a supervisor. There are virtual support groups and therapy that would help with these areas.