Fluency Disorder

When a person has a fluency disorder it means the person has trouble speaking in a fluid, or flowing, way. The person may say the whole word or parts of the word more than once, or pause awkwardly between
words. This is known as stuttering. The person may speak fast and jam words together, or say "uh" often. This is called cluttering.
These changes in speech sounds are called "disfluencies." Many people have a few disfluencies in their speech. But people with a fluency disorder have many disfluencies when they talk. For them, speaking and
being understood may be a daily struggle.

Signs of a fluency disorder

A fluency disorder causes problems with the flow, rhythm, and speed of speech. A person with stuttering may have speech that's interrupted or blocked, as though the person is trying to say a sound but it doesn't
come out. The person may repeat part or all of a word as he or she tries to say the word. The person may drag out syllables. Or the person may talk breathlessly, or seem tense while trying to speak. A person with
cluttering often speaks fast and merges some words together or cuts off parts of them. The person may sound like he or she is slurring or mumbling. And the person may stop and start speech and say "um" or
"uh" often when talking.
Some people have both stuttering and cluttering. They may also have what are known as "accessory" or "secondary" behaviors. These are methods a person may use to try to avoid or cover up their disfluencies.
These behaviors can include:

Not speaking, even when the person wants or needs to

Pretending to forget what the person wanted to say

Covering his or her mouth or pretending to cough or yawn to cover up stuttering

Using "filler" sounds between words to make the rate of speech sound more normal

Not using certain words that seem to cause stuttering

Rearranging words in sentences

Children with fluency disorders also may develop beliefs that can hinder them later on. For example, a child who stutters may decide that speaking is difficult by nature. Fear, anxiety, anger, and shame involving
speaking are also common.

Fluency is the aspect of speech production that refers to continuity, smoothness, rate, and effort. Stuttering, the most
common fluency disorder, is an interruption in the flow of speaking characterized by repetitions (sounds, syllables, words,
phrases), sound prolongations, blocks, interjections, and revisions, which may affect the rate and rhythm of speech. These
disfluencies may be accompanied by physical tension, negative reactions, secondary behaviors, and avoidance of sounds,
words, or speaking situations (ASHA, 1993; Yaruss, 1998; Yaruss, 2004). Cluttering, another fluency disorder, is
characterized by a perceived rapid and/or irregular speech rate, which results in breakdowns in speech clarity and/or
fluency (St. Louis & Schulte, 2011).

Stuttering
Stuttering typically has its origins in childhood. Most children who stutter, begin to do so around 2 years of age (e.g.,
Mansson, 2007; Yairi & Ambrose, 2005; Yaruss, LaSalle, & Conture, 1998). Approximately 95% of children who stutter
start to do so before the age of 5 years (Yairi & Ambrose, 2005).
All speakers produce disfluencies, which may include hesitations, such as silent pauses, and interjections of word fillers
(e.g., "The color is like red") and nonword fillers (e.g., "The color is uh red"). Other examples include whole-word
repetitions (e.g., "But-but I don't want to go") and phrase repetitions or revisions (e.g., "This is a- this is a problem").
These are generally considered to be nonstuttered (typical) disfluencies (Ambrose & Yairi, 1999; Tumanova, Conture,
Lambert, & Walden, 2014). When a child uses a high number of nonstuttered (typical) disfluencies, differential diagnosis is
critical to distinguish between stuttering, avoidance, and a language disorder.
Less typical, stuttering-like disfluencies (Yairi, 2007) include part-word or sound/syllable repetitions (e.g., "Look at the b-bbaby"),prolongations (e.g., "Ssssssssometimes we stay home"), andblocks (i.e., inaudible or silent fixations or inability to
initiate sounds). In addition, compared with typical disfluencies, stuttering-like disfluencies are usually accompanied by
greater than average duration, effort, tension, or struggle. Aspects that factor into perception of severity include frequency
and type of stuttering and the ability of the person who stutters to communicate effectively.
Some young children go through a period of excessive disfluency, which does not persist for a large majority of these
children. Estimates of remission vary from 6.3% (Reilly et al., 2013) to 47% (Fritzell, 1976) to 89% (Yairi & Ambrose,
1992, 1999; Yairi, Ambrose, Paden, & Throneburg, 1996). The large variability in recovery estimates may be due to factors
such as the way the data were collected (e.g., individual, clinic, or community) and the age at which recovery was
determined (Reilly et al., 2013).

Stuttering can greatly interfere with school, work, or social interactions (Yaruss & Quesal, 2004). Children who stutter may
report fear or anxiety about speaking and frustration or embarrassment with the time and effort required to speak (EzratiVinacour, Platzky, & Yairi, 2001). Children who stutter may also be at risk for experiencing bullying (Blood & Blood, 2004;
Davis, Howell, & Cooke, 2002; Langevin, Bortnick, Hammer, & Wiebe, 1998).
Stuttering can co-occur with other disorders, such as speech sound disorders (St. Louis & Hinzman, 1988; Wolk, Edwards,
& Conture, 1993); intellectual disabilities (Healey, Reid, & Donaher, 2005); and language disorders (Ntourou, Conture, &
Lipsey, 2011). For example, although there is little systematic evidence describing disfluency in autism spectrum disorder
(ASD), increasing numbers of case reports indicate both stuttering-like disfluency and non-stuttered (typical) disfluency
(Scaler Scott, Tetnowski, Flaitz, & Yaruss, 2014) and atypical disfluency that is additionally distinguished by unusual
features, such as repetition of final segments of words (Paul et al., 2005; Shriberg et al., 2001; Sisskin & Wasilus, 2014).

Cluttering
In cluttering, the breakdowns in clarity that accompany a perceived rapid and/or irregular speech rate are often
characterized by deletion and/or collapsing of syllables (e.g., "I wanwatevision") and/or omission of word endings (e.g.,
"Turn the televisoff"). The breakdowns in fluency are often characterized by more typical disfluencies (e.g., revisions,
interjections) and/or pauses in places in sentences not expected grammatically, such as "I will go to the/store and buy
apples" (St. Louis & Schulte, 2011).
Although the current criteria for cluttering include only symptoms of speech rate and fluency, other disorders may co-occur.
For example, there is documentation of cluttered speech in children with learning disabilities (Wiig & Semel, 1984),
auditory processing disorders (Molt, 1996), Tourette's syndrome (see Van Borsel, 2011, for review), autism (see Scaler
Scott, 2011, for review), word finding/language organization issues (Myers, 1992) and attention deficit hyperactivity
disorder (ADHD; Alm, 2011). These disorders (and their features) may occur in addition to a diagnosis of cluttering (or
stuttering), and cluttering has been documented with none of these additional features or diagnoses.
A disorder that can be seen as a consequence of cluttering is that of pragmatic disorder; individuals with cluttering may not
attempt to repair breakdowns in communication, which may result in less than effective social interaction (Teigland, 1996).
What is a voice disorder?
A voice disorder can be defined as a problem involving abnormal pitch, loudness
or quality of the sound produced by the larynx, more commonly known as the
voice box. Almost every disorder may present in more than one symptom and
one cannot associate one single symptom with one specific voice disorder. For
example, hoarseness, increased vocal effort or limitations in pitch and loudness
may be a sign of any number of disorders. Severity of the voice symptoms varies
according to the disorder and the individual. Voice disorders may be present in
both adults and children.
What symptoms should I look out for?
Symptoms may include any of the following: hoarseness, shortness of breath,
harsh or rough voice, breathy voice, decrease in pitch range, decrease in
loudness, deterioration of the voice as the day goes by, loss of voice, increased
strain to speak, tension in neck muscles. If symptoms persist for more than three
weeks one should seek advice.

Psychotic disorders such as schizophrenia are a group of serious illnesses that affect the mind. These illnesses alter a person's ability to
think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. When
symptoms are severe, people with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary
demands of daily life. However, even severe psychotic disorders usually are treatable.

There are different types of psychotic disorders, including:

Schizophrenia: People with this illness have changes in behavior and other symptoms -- such as delusions and hallucinations -that last longer than six months, usually with a decline in work, school, and social functioning.

Schizoaffective disorder: People with this illness have symptoms of both schizophrenia and a mood disorder, such as depression
or bipolar disorder.

Schizophreniform disorder: People with this illness have symptoms of schizophrenia, but the symptoms last between one and six
months.

Brief psychotic disorder: People with this illness have sudden, short periods of psychotic behavior, often in response to a very
stressful event, such as a death in the family. Recovery is often quick -- usually less than a month.

Delusional disorder: People with this illness have a delusion (a false, fixed belief) involving real-life situations that could be true,
such as being followed, being conspired against, or having a disease. These delusions persist for at least one month.

Shared psychotic disorder (also called folie deux) : This illness occurs when one person in a relationship has a delusion that
the other person in the relationship adopts for him or herself.

Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from some substances, such as
hallucinogens and crack cocaine, that may cause hallucinations, delusions, or confused speech.

Psychotic disorder due to a medical condition: Hallucinations, delusions, or other symptoms may be the result of another illness
that affects brain function, such as a head injury or brain tumor.

Paraphrenia: This is a type of schizophrenia that starts late in life and occurs in the elderly population.

What Are the Symptoms of a Psychotic Disorder? continued...

Hallucinations are unusual sensory experiences or perceptions of things that aren't actually present, such as seeing things that aren't there,
hearing voices, smelling odors, having a "funny" taste in your mouth, and feeling sensations on your skin even though nothing is touching
your body.
Delusions are false beliefs that are persistent and organized, and that do not go away after receiving logical or accurate information. For
example, a person who is certain his or her food is poisoned, even if it has been proven that the food is fine, is suffering from a delusion.
Other possible symptoms of psychotic illnesses include:

Disorganized or incoherent speech

Confused thinking

Strange, possibly dangerous behavior

Slowed or unusual movements

Loss of interest in personal hygiene

Loss of interest in activities

Problems at school or work and with relationships

Cold, detached manner with the inability to express emotion

Mood swings or other mood symptoms, such as depression or mania

What Causes Psychotic Disorders?

The exact cause of psychotic disorders is not known, but researchers believe that many factors may play a role. Some psychotic disorders
tend to run in families, suggesting that the tendency, or likelihood, to develop the disorder may be partly inherited. Environmental factors may
also play a role in their development, including stress, drug abuse, and major life changes.
In addition, people with certain psychotic disorders like schizophrenia may have abnormalities in the functioning of pathways in the brain that
control thinking, perception, and motivation. In schizophrenia, it is thought that nerve cell receptors that interact with a brain chemical called
glutamate may not work properly in specific brain regions, and that this in turn may contribute to symptoms of abnormal thinking and
perception.

How Common Are Psychotic Disorders?

About 1% of the population worldwide suffers from psychotic disorders. These disorders most often first appear when a person is in his or her
late teens, 20s, or 30s. They tend to affect men and women about equally.

How Are Psychotic Disorders Diagnosed?

If symptoms of a psychotic disorder are present, the doctor will perform a complete medical history and physical exam to determine the
cause of the symptoms. Although there are no laboratory tests to specifically diagnose psychotic disorders -- except those that accompany a
physical illness, such as a brain tumor -- the doctor may use various tests, such as blood tests and brain imaging (e.g., MRI scans), to rule
out physical illness or intoxication with drugs like cocaine or LSD as the cause of the symptoms.
If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist, mental health
professionals who are trained to diagnose and treat mental illnesses. Psychiatrists use specially designed interview and assessment tools to
evaluate a person for a psychotic disorder.

Can Psychotic Disorders Be Prevented?

In general, there is no known way to prevent most psychotic disorders, but many of the related symptoms can be prevented with early
detection and treatment. Seeking help as soon as symptoms appear can help decrease the disruption to the person's life, family, and
friendships. Avoiding drugs and alcohol can prevent psychotic disorders associated with these substances.

How Are Psychotic Disorders Treated?

Most psychotic disorders are treated with a combination of medications and psychotherapy (a type of counseling).

Medication: The main medications used to treat psychotic disorders are called antipsychotics. These medicines do not cure the illnesses but are
very effective in managing the most troubling symptoms of psychotic disorders, such as delusions, hallucinations, and thinking problems. Antipsychotics
include medications such as Haldol, Thorazine, Loxapine, and Mellaril and other medications (often called atypical antipsychotics) such as Abilify, Clozaril,
Geodon, Invega, Latuda, Risperdal, Saphris, Seroquel, and Zyprexa. The atypical psychotics are often considered first-line treatments because they have
fewer and more tolerable side effects. Some of the medications are available by injection and only need to be taken once or twice a month. For patients this
can be easier to keep up with compared to a daily pill.

Psychotherapy: Various types of psychotherapy, including individual, group, and family therapy, may be used to help support the person with a
psychotic disorder.

Most patients with psychotic disorders are treated as outpatients. However, people with particularly severe symptoms, those in danger of
hurting themselves or others, or those unable to care for themselves because of their illness, may require hospitalization to stabilize their
condition.

Schizophrenia Types and Symptoms

Usually with schizophrenia, the person's inner world and behavior change notably. Behavior changes might include the following:

Social withdrawal

Depersonalization (a sense of being unreal, hazy and in a dreamlike state), sometimes accompanied by intense anxiety

Loss of appetite

Loss of hygiene

Delusions

Hallucinations (hearing or seeing things that aren't there)

The sense of being controlled by outside forces

Disorganized speech
A person with schizophrenia may not have any outward appearance of being ill. In other cases, the illness may be more apparent, causing
bizarre behaviors. For example, a person with schizophrenia may wear aluminum foil in the belief that it will stop one's thoughts from being
broadcast and protect against malicious waves entering the brain.
People with schizophrenia vary widely in their behavior as they struggle with an illness beyond their control. In active stages, those affected
may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. People with schizophrenia may also
experience relatively passive phases of the illness in which they seem to lack personality, movement, and emotion (also called a flat affect).
People with schizophrenia may alternate in these extremes. Their behavior may or may not be predictable.
In order to better understand schizophrenia, the concept of clusters of symptoms is often used. Thus, people with schizophrenia can
experience symptoms that may be grouped under the following categories:

Positive symptoms: Hearing voices, suspiciousness, feeling as though they are under constant surveillance, delusions, or making
up words without a meaning (neologisms).

Negative (or deficit) symptoms: Social withdrawal, difficulty in expressing emotions (in extreme cases called a flat affect), difficulty
in taking care of themselves, inability to feel pleasure. These symptoms cause severe impairment and are often mistaken for laziness.

Cognitive symptoms: Difficulties attending to and processing of information, understanding the environment, and remembering
simple tasks.

Affective (or mood) symptoms: Most notably depression, accounting for a very high rate of attempted suicide in people suffering
from schizophrenia. Anxiety can also be present and may be a direct result of the psychosis or come and go during a psychotic episode.