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Practical Thoughts Blog

Is it “developmental stuttering” or “normal disfluency” or “true stuttering” or what?!?!?

Is it “developmental stuttering” or “normal disfluency” or “true stuttering” or what?!?!?

Our field has long struggled with the definitions of stuttering, particularly in young children. All children (indeed, all people) are disfluent—disfluency is a normal part of learning to speak, and even adults are disfluent due to commonly occurring slips or glitches in the process of planning or producing speech. Common non-stuttered or typical disfluency types include phrase repetitions, revisions, or interjections. These disfluencies may arise as we plan what we want to say. Thus, we can say that everyone is disfluent, that is, we all exhibit non-stuttered disfluencies or disruptions in their speech.

It is also well-known that many children go through a period of stuttering during their development. These stuttering behaviors, which are different from so-called non-stuttered disfluencies, include part-word repetitions, monosyllabic whole-word repetitions, prolongations, blocks, or other kinds of disfluencies with tension. The common experience for stuttered types of disfluencies is a sensation of being “stuck” or unable to move forward in speech.

Finally, we also know that the vast majority of those children who start to stutter in the preschool years also recover from stuttering—that is, they go on to develop typical speech fluency, and many never even recall that they once stuttered. This is good news—except that it can lead to confusion for clinicians who may be trying to determine whether or when to recommend therapy for young children who stutter.

One way that the field has tried to cope with this challenge is to use different labels to reflect speech disfluency behavior that is not stuttered vs. speech disfluency behavior that is stuttered but is likely to diminish vs. speech disfluency behavior that is stuttered and is likely to persist. A set or terms that has traditionally been used includes “developmental disfluency” (referring to non-stuttered disfluencies), “developmental stuttering” (referring to stuttering behaviors that are likely to resolve), “real stuttering” (referring to stuttering behaviors that are likely to continue), or even "normal dysfluency" (which doesn't make sense, really, because the "dys" prefix is supposed to indicate something that is not normal!)

Unfortunately, these terms only introduce more confusion. Clinicians are constantly wondering whether a child who stutters is exhibiting “real” stutteringbut the traditional definitions inherently require us to predict the future . The idea seems to be that the child’s stuttering isn’t “real” unless it continues, and that we’ll only know if it continues by waiting to see what happens. If the child recovers, then it must not have been “true” stuttering but only “developmental” stuttering. To me, this makes no sense. It would be like asking a physician if my arm is broken only to have her tell me that we can only wait to see what happens, and we’ll only know if it was truly broken if it heals or not.

To simplify this, my colleagues and I have been encouraging clinicians to move away from the confusing “developmental vs. true” stuttering debate and instead simply label the behavior as we see it at the time, like this: If we see that a young child is exhibiting stuttering behavior (as opposed to non-stuttered disfluencies only), then we will determine that the child is indeed stuttering at that time. We don’t use a modifier like “developmental” or “normal” or “abnormal” or anything like that. We simply call it stuttering, because that’s what the behavior is.

We can then ask a second, separate question about whether the child’s stuttering is likely to continue. We do that by considering various risk factors that I have discussed in other blog posts. If the child is likely to recover from stuttering, then we would say that he stutters but is likely to recover (rather than trying to call it normal nonfluency or normal disfluency or normal stuttering or whatever); if he is likely to continue, we say that he stutters but is at risk for persistence.

Simplifying the terminology in this way can help us ensure that we are not caught up in trying to decide if a child’s stuttering is normal or not. Put simply, stuttering is not a normal part of developmentthere is no such thing as "normal" stuttering, and it is not correct to say that "all children go through a normal period of stuttering." So, if we see stuttering behavior, then we are alerted to the fact that we need to look more carefully at the child’s speech and overall development to see if there is a risk that the child might continue to stutter. If there is, we treat; if not, then we might not need to be as urgent about recommending treatment.

I know that this represents a shift in how people have traditionally thought about stuttering, but my hope is that getting away from the confusing “developmental stuttering” or “normal stuttering” terminology will help us better serve children who are actually stuttering and who might need our services due to a risk that their stuttering might persist.

I talk more about those services in other blog postsand, of course, there's a ton of information about this in Early Childhood Stuttering Therapy: A Practical Guide.