The Role of Speech Therapy in Fluency Disorders

Statistics from the National Institute on Deafness and Other Communication Disorders (NIDCD) reveal that roughly 3 million Americans stutter and approximately 5 to 10 percent of all children will stutter at some point in their lives.

Fluency is the facet of speech production that refers to smoothness, rate, effort, and continuity. The two, major fluency disorders include stuttering and cluttering.

Causes of stuttering and cluttering are generally multifactorial and usually include genetic and neurophysiological factors. Environmental factors and temperament often influence how individuals handle stuttering and cluttering.

A number of risk factors have been identified for persistent fluency disorders:

• Gender – Boys are at a higher risk for stuttering persistence than girls.
• Family history
• Time duration/age of onset – Individuals who started to stutter at age 3 ½ or later or those who show no improvement over several months.
• The presence of other speech and language disorders

Gaining a Better Understanding of Stuttering and Cluttering

Speech-language pathologists (SLPs) specializing in fluency disorders treat people of all ages who suffer from stuttering and cluttering:

Stuttering Fluency Disorder

Stuttering, the most common fluency disorder, is marked by persistent interruptions in the flow of speaking. Individuals who stutter may repeat sounds, syllables, words, and phrases, prolong specific sounds, or block sounds. For many, stuttering is accompanied by physical and mental tension, avoidance of situations where they may be expected to speak, and even avoidance of speech altogether.

Stuttering can greatly interfere with social, school, and work interactions. Children and adults who suffer often report anxiety and fear when speaking, and frustration with the time and effort required to communicate with others.

While all speakers produce some disfluencies in speech, including hesitations, silent pauses, and whole-word repetitions, those with a stuttering disorder produce a high number of disfluencies that inhibit their ability to communicate effectively.

Stuttering occurs most often in children; about 95 percent of all children who stutter started before the age of 5.

Cluttering Fluency Disorder

Cluttering involves a breakdown in clarity, usually as a result of rapid or irregular speech patterns. It is often characterized by omitting parts of words (usually the end of words) and pausing in places in sentences not expected grammatically.

Cluttering often occurs with children and adults with learning disabilities, auditory processing disorders, Tourette’s syndrome, autism, and ADHD.

Working as a Speech-Language Pathologist Specializing in Fluency Disorders

Speech-language pathologists focus on the assessment, screening, diagnosis and treatment of fluency disorders in children and adults. Their roles include:

• Clinical/Educational Services: Diagnosing, planning, and treatment
• Advocacy
• Education
• Administration
• Research

The roles and responsibilities of SLPs specializing in fluency disorders:

• Educating individuals and groups (and those working with these individuals and groups) at risk for fluency disorders
• Performing assessment and screening activities as part of a comprehensive speech-language evaluation or when a fluency disorder is suspected
• Diagnosing fluency disorders
• Facilitating access to other services/professionals to rule out other conditions and determine the cause of the disorder
• Developing intervention plans focused on achieving fluent speech and providing treatment
• Documenting progress of treatment
• Counseling individuals with fluency disorders to prevent other complications related to the disorders
• Consulting and collaborating with families, support personnel, peers, and other professionals regarding intervention plans focused on functional outcomes
• Advancing the knowledge base of the nature of the fluency disorder and remaining informed of the latest research in the screening, diagnosis, assessment, and delivery of therapeutic services
• Advocating for individuals with fluency disorders and their families at the local, state, and national levels

How to Become a Speech-Language Pathologist Focused on Fluency Disorders

The path to becoming a speech-language pathologist specializing in fluency disorders involves the following steps:

Step 1. Complete an entry-level master’s degree (MA, MS, MEd) from a communicative sciences and disorders/speech-language pathology program accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA)

You can choose elective courses in fluency disorders to specialize your speech-language master’s degree program.

Step 2. Complete a post-graduate fellowship of at least 36 weeks. A post-graduate fellowship allows you to begin gaining real-world experience working with clients with fluency disorders.

Step 3. Pass the Praxis II: Subject Assessment in Speech-Language Pathology and earn state licensure as a speech-language pathologist.

Step 6. Earn ASHA’s Speech-Language Pathology Certificate of Clinical Competence (CCC-SLP).

Step 7. Earn the Board Certified Specialist in Fluency and Fluency Disorders designation through the American Board of Fluency and Fluency Disorders.

Earning Board Certification as a Fluency Disorder Specialist

Board Certified Specialists in Fluency and Fluency Disorders (BCS-F) have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with fluency disorders.

To earn the BCS-F designation, you must meet two standards:

Standard A: Eligibility for Application

You must meet certain eligibility requirements before submitting an application to become a candidate for Board Certification:

• Hold ASHA’s CCC-SLP certification
• Be employed as an SLP for at least 5 years after obtaining the CCC-SLP designation
• Document at least 450 hours of direct clinical contact in fluency disorders; direct clinical contact must include:
  • Providing services involved with prevention, identification, intervention, and assessment
  • Obtaining at least 25 hours across each of the following three age ranges:
    • 2-6 years of age (preschool)
    • 7-15 years of age (school-age)
    • 16 (adolescent/adult)
  • Document at least 10 CEUs (or 100 hours) of intermediate to advanced training in fluency disorders

Once you have completed all application materials, you must submit an Application Form for Board Certified Specialist – Fluency, which includes the four components:

• Application and required fee
• Completion and documentation of required clinical hours
• Three letters of recommendation confirming your knowledge and skills in fluency disorders
• Copy of CEU transcripts from ASHA and a completed BCS-F Application Continuing Education form

Standard B: Portfolio Submission

Once your application has been approved (about 30 days), you must submit for Board review a portfolio of case studies that demonstrates your ability to apply knowledge and understand research and clinical experience in fluency disorders.

The portfolio must contain three cases, one in each of the age ranges:

• 2-6 years of age (preschool)
• 7-15 years of age (school-age)
• 16 (adolescent/adult)

The Board will notify you within 60 days of your approval.

The BCS-F designation is valid for 5 years. Renewal is based on current CCC-SLP certification, documented evidence of the completion of at least 100 hours of clinical activity in fluency disorders, and at least 10 CEUs (100 hours) in fluency disorders.

Clinical activity may include both direct and indirect contact, such as:

• Serving as a supervisor
• Serving as a consultant
• Teaching
• Program development
• Publications

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