No access
Viewpoint
8 February 2022

A Point of View About Fluency

Publication: Journal of Speech, Language, and Hearing Research
Volume 65, Number 2
Pages 645-652

Abstract

Purpose:

This article presents several potential concerns with the common usage of the term fluency in the study of stuttering and people who stutter (or, as many speakers now prefer, stutterers). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended.

Method:

We begin by reviewing the history of the term fluency. We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition.

Results:

By highlighting current research and perspectives of stutterers, we conclude that the term fluency (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole.

Conclusions:

We recommend that researchers and clinicians cease referring to stuttering as a fluency disorder and simply refer to it as stuttering. Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition.

Get full access to this article

View all available purchase options and get full access to this article.

References

Adams, M. R., & Runyan, C. M. (1981). Stuttering and fluency: Exclusive events or points on a continuum? Journal of Fluency Disorders, 6(3), 197–218.
Ahlbach, J., & Benson, V. (1994). To say what is ours: The best of 13 years of letting go (2nd ed.). The National Stuttering Project.
Alpern, E. (2019). Why stutter more? In C. D. Constantino & S. Simpson (Eds.), Stammering pride and prejudice 2. J&R Press.
Armson, J., & Kalinowski, J. (1994). Interpreting results of the fluent speech paradigm in stuttering research. Journal of Speech and Hearing Research, 37(1), 69–82.
Arya, P., & Geetha, Y. V. (2013). Factors related to recovery and relapse in persons with stuttering following treatment: A preliminary study. Asia Pacific Disability Rehabilitation Journal, 24(1), 82–98.
Barzilai-Nahon, K. (2008). Toward a theory of network gatekeeping: A framework for exploring information control. Journal of the American Society for Information Science and Technology, 59(9), 1493–1512.
Blumgart, E., Tran, Y., & Craig, A. (2010). An investigation into the personal financial costs associated with stuttering. Journal of Fluency Disorders, 35(3), 203–215.
Boyle, M. P. (2013). Assessment of stigma associated with stuttering: Development and evaluation of the self-stigma of stuttering scale (4S). Journal of Speech, Language, and Hearing Research, 56(5), 1517–1529.
Boyle, M. P. (2015). Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the self-stigma of stuttering scale (4S). Journal of Fluency Disorders, 43, 17–27.
Boyle, M. P. (2018). Enacted stigma and felt stigma experienced by adults who stutter. Journal of Communication Disorders, 73, 50–61.
Boyle, M. P., & Blood, G. W. (2015). Stigma and stuttering: Conceptualizations, applications, and coping. In K. O. St. Louis (Ed.), Stuttering meets stereotype, stigma, and discrimination (pp. 43–70). West Virginia University Press.
Boyle, M. P., & Fearon, A. N. (2018). Self-stigma and its associations with stress, physical health, and health care satisfaction in adults who stutter. Journal of Fluency Disorders, 56, 112–121.
Campbell, P., Constantino, C. D., & Simpson, S. (2019). Stammering pride and prejudice. J&R Press.
Constantino, C. D. (2016). Stuttering gain. International Stuttering Association, International Stuttering Awareness Day Online Conference 2016. http://isad.isastutter.org/isad-2016/papers-presented-by-2016/stories-and-experiences-with-stuttering-by-pws/stuttering-gain-christopher-constantino/
Constantino, C. D. (2018). What can stutterers learn from the neurodiversity movement? Seminars in Speech and Language, 39(4), 382–396.
Constantino, C. D. (2019). Stutter naked. In P. Campbell, C. D. Constantino, & S. Simpson (Eds.), Stammering pride and prejudice (pp. 213–223). J&R Press.
Constantino, C. D., Eichorn, N., Buder, E. H., Beck, J. G., & Manning, W. H. (2020). The speaker's experience of stuttering: Measuring spontaneity. Journal of Speech, Language, and Hearing Research, 63(4), 983–1001.
Constantino, C. D., Leslie, P., Quesal, R., & Yaruss, J. S. (2016). A preliminary investigation of daily variability of stuttering in adults. Journal of Communication Disorders, 60, 39–50.
Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). Rethinking covert stuttering. Journal of Fluency Disorders, 53, 26–40.
Cooper, E. B. (1987). The chronic perseverative stuttering syndrome: Incurable stuttering. Journal of Fluency Disorders, 12(6), 381–388.
Cordes, A. K., & Ingham, R. J. (1996). Time-interval measurement of stuttering: Establishing and modifying judgment accuracy. Journal of Speech and Hearing Research, 39(2), 298–310.
Cordes, A. K., & Ingham, R. J. (1999). Effects of time-interval judgment training on real-time measurement of stuttering. Journal of Speech, Language, and Hearing Research, 42(4), 862–879.
Craig, A., & Hancock, K. (1995). Self-reported factors related to relapse following treatment for stuttering. Australian Journal of Human Communication Disorders, 23(1), 48–60.
Cream, A., Onslow, M., Packman, A., & Llewellyn, G. (2003). Protection from harm: The experience of adults after therapy with prolonged-speech. International Journal of Language & Communication Disorders, 38(4), 379–395.
Curlee, R. F. (1981). Observer agreement on disfluency and stuttering. Journal of Speech and Hearing Research, 24(4), 595–600.
Davis, S., Howell, P., & Cooke, F. (2002). Sociodynamic relationships between children who stutter and their non-stuttering classmates. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43(7), 939–947.
Dayalu, V. N., & Kalinowski, J. (2002). Pseudofluency in adults who stutter: The illusory outcome of therapy. Perceptual and Motor Skills, 94(1), 87–96.
Dayalu, V. N., Kalinowski, J., & Saltuklaroglu, T. (2002). Active inhibition of stuttering results in pseudofluency: A reply to Craig. Perceptual and Motor Skills, 94, 1050–1052.
Doody, I., Kalinowski, J., Armson, J., & Stuart, A. (1993). Stereotypes of stutterers and nonstutterers in three rural communities in Newfoundland. Journal of Fluency Disorders, 18(4), 363–373.
Douglass, J. E., Constantino, C. D., Alvarado, J., Verrastro, K., & Smith, K. (2019). Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Journal of Fluency Disorders, 61, 105713.
Ferguson, A. M., Roche, J. M., & Arnold, H. S. (2019). Social judgments of digitally manipulated stuttered speech: An evaluation of self-disclosure on cognition. Journal of Speech, Language, and Hearing Research, 62(11), 3986–4000.
Finn, P., & Ingham, R. J. (1989). The selection of “fluent” samples in research on stuttering. Journal of Speech and Hearing Research, 32(2), 401–418.
Foucault, M. (1994). The order of things: Am Archaeology of the human sciences. Random House.
Foucault, M. (2010). The archaeology of knowledge (A. M. S. Smith [Ed.]) . Vintage Books.
Gabel, R. M., Blood, G. W., Tellis, G. M., & Althouse, M. T. (2004). Measuring role entrapment of people who stutter. Journal of Fluency Disorders, 29(1), 27–49.
Geertz, C. (1973). The interpretation of cultures. Basic Books.
Gerlach, H., Hollister, J. E., Caggiano, L., & Zebrowski, P. M. (2017). Outcomes of attending a support organization convention for young people who stutter. The University of Iowa.
Gerlach, H., Totty, E., Subramanian, A., & Zebrowski, P. (2018). Stuttering and labor market outcomes in the United States. Journal of Speech, Language, and Hearing Research, 61(7), 1649–1663.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Simon and Schuster.
Guitar, B. (2013). Stuttering: An integrated approach to its nature and treatment (4th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
Healey, E. C. (1982). Speaking fundamental frequency characteristics of stutterers and nonstutterers. Journal of Communication Disorders, 15(1), 21–29.
Healey, E. C., & Ramig, P. R. (1986). Acoustic measures of stutterers' and nonstutterers' fluency in two speech contexts. Journal of Speech and Hearing Research, 29(3), 325–331.
Ingham, R. J. (1998). On learning from speech-motor control research on stuttering. In A. K. Cordes & R. J. Ingham (Eds.), Treatment efficacy for stuttering: A search for empirical bases (pp. 67–101). Singular.
Ingham, R. J., Bothe, A. K., Jang, E., Yates, L., Cotton, J., & Seybold, I. (2009). Measurement of speech effort during fluency-inducing conditions in adults who do and do not stutter. Journal of Speech, Language, and Hearing Research, 52(5), 1286–1301.
Ingham, R. J., Ingham, J. C., & Bothe, A. K. (2012). Integrating functional measures with treatment: A tactic for enhancing personally significant change in the treatment of adults and adolescents who stutter. American Journal of Speech-Language Pathology, 21(3), 264–277.
Ingham, R. J., Warner, A., Byrd, A., & Cotton, J. (2006). Speech effort measurement and stuttering: Investigating the chorus reading effect. Journal of Speech, Language, and Hearing Research, 49(3), 660–670.
Irani, F., Gabel, R., Daniels, D., & Hughes, S. (2012). The long term effectiveness of intensive stuttering therapy: A mixed methods study. Journal of Fluency Disorders, 37(3), 164–178.
Jackson, E. S., Quesal, R., & Yaruss, J. S. (2012). What is stuttering: Revisited [Paper presentation] . International Stuttering Awareness Day Online Conference, 2012.
Jackson, E. S., Rodgers, N. H., & Rodgers, D. B. (2019). An exploratory factor analysis of action responses to stuttering anticipation. Journal of Fluency Disorders, 60, 1–10.
Jackson, E. S., Tiede, M., Beal, D., & Whalen, D. H. (2016). The impact of social–cognitive stress on speech variability, determinism, and stability in adults who do and do not stutter. Journal of Speech, Language, and Hearing Research, 59(6), 1295–1314.
Jackson, E. S., Yaruss, J. S., Quesal, R., Terranova, V., & Whalen, D. H. (2015). Responses of adults who stutter to the anticipation of stuttering. Journal of Fluency Disorders, 45, 38–51.
Jancke, L. (1994). Variability and duration of voice onset time and phonation in stuttering and nonstuttering adults. Journal of Fluency Disorders, 19(1), 21–37.
Johnson, K. N., Karrass, J., Conture, E. G., & Walden, T. (2009). Influence of stuttering variation on talker group classification in preschool children: Preliminary findings. Journal of Communication Disorders, 42(3), 195–210.
Johnson, M., Baxter, S., Blank, L., Cantrell, A., Brumfitt, S., Enderby, P., & Goyder, E. (2016). The state of the art in non-pharmacological interventions for developmental stuttering. Part 2: Qualitative evidence synthesis of views and experiences. International Journal of Language & Communication Disorders, 51(1), 3–17.
Johnson, W. (1959). The onset of stuttering: Research findings and implications. University of Minnesota Press.
Klassen, T. (2002). Social distance and the negative stereotype of people who stutter. Journal of Speech-Language Pathology and Audiology, 26(2), 90–99. http://www.arts.yorku.ca/politics/tklassen/cv/Publications/Refereed_articles/Social_Distance_and_the_Negative_Stereotype_-_2002.pdf
Kully, D., & Boberg, E. (1988). An investigation of interclinic agreement in the identification of fluent and stuttered syllables. Journal of Fluency Disorders, 13, 309–318.
MacIntyre, S. (2012). Passing as fluent. In P. Reitzes & D. Reitzes (Eds.), Stuttering (Vol. 1, pp. 25–38). StutterTalk.
Martin, R., & Haroldson, S. K. (1981). Stuttering identification. Journal of Speech and Hearing Research, 24(1), 59–63.
Max, L., & Gracco, V. L. (2005). Coordination of oral and laryngeal movements in the perceptually fluent speech of adults who stutter. Journal of Speech, Language, and Hearing Research, 48(3), 524–542.
McAllister, J., Collier, J., & Shepstone, L. (2012). The impact of adolescent stuttering on educational and employment outcomes: Evidence from a birth cohort study. Journal of Fluency Disorders, 37(2), 106–121.
Millager, R. A., Gerlach, H., & Sepulveda, R. (2018). Impact of a group support program on the communication attitudes of children who stutter. The Stuttering Association for the Young.
Moore, S. E., & Perkins, W. H. (1990). Validity and reliability of judgments of authentic and simulated stuttering. Journal of Speech and Hearing Disorders, 55(3), 383–391.
Perkins, W. H. (1983). The problem of definition: Commentary on “stuttering.” Journal of Speech and Hearing Disorders, 48(3), 246–249.
Perkins, W. H. (1984). Stuttering as a categorical event. Journal of Speech and Hearing Disorders, 49(4), 431–434.
Perkins, W. H. (1990). What is stuttering? Journal of Speech and Hearing Disorders, 55(3), 370–382.
Perkins, W. H. (1992). Fluency controls and automatic fluency. American Journal of Speech-Language Pathology, 1(2), 9–10.
Ponterotto, J. (2015). Brief note on the origins, evolution, and meaning of the qualitative research concept thick description. The Qualitative Report, 11(3), 538–549.
Quesal, R. (1989). Stuttering research: Have we forgotten the stutterer? Journal of Fluency Disorders, 14(3), 153–164.
Reitzes, P., & Reitzes, D. (2012). Stuttering: Inspiring stories and professional wisdom. StutterTalk.
Saltuklaroglu, T., & Kalinowski, J. (2002). The end-product of behavioural stuttering therapy: Three decades of denaturing the disorder. Disability and Rehabilitation, 24(15), 786–789.
Smith, A., & Weber, C. (2017). How stuttering develops: The multifactorial dynamic pathways theory. Journal of Speech, Language, and Hearing Research, 60(9), 2483–2505.
Starkweather, C. W. (1987). Fluency and stuttering. Prentice-Hall.
Stewart, T., & Richardson, G. (2004). A qualitative study of therapeutic effect from a user's perspective. Journal of Fluency Disorders, 29(2), 95–108.
St. Pierre, J. S. (2012). The construction of the disabled speaker: Locating stuttering in disability studies. Canadian Journal of Disability Studies, 1(3), 9–23.
Tellis, G. M., Bressler, L., & Emerick, K. (2008). An exploration of clinicians views about assessment and treatment of stuttering. SIG 4 Perspectives on Fluency and Fluency Disorders, 18(1), 16–23.
Tichenor, S. E., & Yaruss, J. S. (2018). A phenomenological analysis of the experience of stuttering. American Journal of Speech-Language Pathology, 27(3S), 1180–1194.
Tichenor, S. E., & Yaruss, J. S. (2019a). Group experiences and individual differences in stuttering. Journal of Speech, Language, and Hearing Research, 62(12), 4335–4350.
Tichenor, S. E., & Yaruss, J. S. (2019b). Stuttering as defined by adults who stutter. Journal of Speech, Language, and Hearing Research, 62(12), 4356–4369.
Tichenor, S. E., & Yaruss, J. S. (2020). Recovery and relapse: Perspectives from adults who stutter. Journal of Speech, Language, and Hearing Research, 63(7), 2162–2176.
Tichenor, S. E., & Yaruss, J. S. (2021). Variability of stuttering: Behavior and impact. American Journal of Speech-Language Pathology, 30(1), 75–88.
Trichon, M., & Tetnowski, J. (2011). Self-help conferences for people who stutter: A qualitative investigation. Journal of Fluency Disorders, 36(4), 290–295.
Van Borsel, J., Brepoels, M., & De Coene, J. (2011). Stuttering, attractiveness and romantic relationships: The perception of adolescents and young adults. Journal of Fluency Disorders, 36(1), 41–50.
Van Riper, C. (1982). The nature of stuttering. Prentice Hall.
Vanryckeghem, M., Brutten, G. J., Uddin, N., & Van Borsel, J. (2004). A comparative investigation of the speech-associated coping responses reported by adults who do and do not stutter. Journal of Fluency Disorders, 29(3), 237–250.
Venkatagiri, H. S. (2009). What do people who stutter want—Fluency or freedom? Journal of Speech, Language, and Hearing Research, 52(2), 500–515.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends (1st ed.). Norton.
White, P. A., & Collins, S. R. (1984). Stereotype formation by inference. Journal of Speech and Hearing Research, 27(4), 567–570.
Wieneke, G., & Janssen, P. (1987). Duration variations in the fluent speech of stutterers and nonstutterers. In Speech motor dynamics in stuttering (pp. 345–352). Springer.
Williams, D. E. (1957). A point of view about stuttering. Journal of Speech and Hearing Disorders, 22(3), 390–397.
Wingate, M. E. (1964). Recovery from stuttering. Taylor & Francis.
Wingate, M. E. (1969). Sound and pattern in “artificial” fluency. Journal of Speech and Hearing Research, 12(4), 677–686.
Wingate, M. E. (1981). Knowing what to look for. Journal of Speech and Hearing Research, 24(4), 622–623.
Wingate, M. E. (1988). The structure of stuttering. R.R. Donnelley and Sons.
Wislar, E., & Gerlach, H. (2017). How to be a fluent ally to people who stutter (an illustrated guide). International Stuttering Association, International Stuttering Awareness Day Online Conference.
Yairi, E. (1982). Longitudinal studies of disfluencies in two-year-old children. Journal of Speech and Hearing Research, 25(1), 155–160.
Yairi, E., & Ambrose, N. (2005). Early childhood stuttering for clinicians by clinicians. Pro-Ed.
Yaruss, J. S. (1997). Clinical implications of situational variability in preschool children who stutter. Journal of Fluency Disorders, 22(3), 187–203.
Yaruss, J. S., Lee, J., Kikani, K. B., Leslie, P., Herring, C., Ramachandar, S., Tichenor, S., Quesal, R. W., & McNeil, M. R. (2017). Update on didactic and clinical education in fluency disorders: 2013–2014. American Journal of Speech-Language Pathology, 26(1), 124–137.
Yaruss, J. S., & Quesal, R. (2004). Stuttering and the international classification of functioning, disability, and health (ICF): An update. Journal of Communication Disorders, 37(1), 35–52.
Yaruss, J. S., Quesal, R., & Murphy, B. (2002). National stuttering association members' opinions about stuttering treatment. Journal of Fluency Disorders, 27(3), 227–242.
Yaruss, J. S., Quesal, R., Reeves, L., Molt, L. F., Kluetz, B., Caruso, A. J., McClure, J. A., & Lewis, F. (2002). Speech treatment and support group experiences of people who participate in the national stuttering association. Journal of Fluency Disorders, 27(2), 115–134.
Zimmermann, G. (1980a). Articulatory behaviors associated with stuttering. Journal of Speech and Hearing Research, 23(1), 108–121.
Zimmermann, G. (1980b). Articulatory dynamics of fluent utterances of stutterers and nonstutterers. Journal of Speech and Hearing Research, 23(1), 95–107.

Information & Authors

Information

Published In

Journal of Speech, Language, and Hearing Research
Volume 65Number 2February 2022
Pages: 645-652
PubMed: 34982943

History

  • Received: Jun 21, 2021
  • Revised: Sep 15, 2021
  • Accepted: Sep 28, 2021
  • Published online: Jan 4, 2022
  • Published in issue: Feb 9, 2022

Permissions

Request permissions for this article.

Authors

Affiliations

Florida State University, Tallahassee

Notes

Disclosure: The authors have declared that no competing financial or nonfinancial interests existed at the time of publication.
Correspondence to Seth E. Tichenor: [email protected]
Editor-in-Chief: Bharath Chandrasekaran
Editor: Julie D. Anderson

Metrics & Citations

Metrics

Article Metrics
View all metrics



Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Citing Literature

  • Repetitive Negative Thinking as a Mechanism of Stuttering Anticipation, Journal of Speech, Language, and Hearing Research, 10.1044/2025_JSLHR-24-00175, 0, 0, (1-23), (2025).
  • An active inference account of stuttering behavior, Frontiers in Human Neuroscience, 10.3389/fnhum.2025.1498423, 19, (2025).
  • Stuttering: Our Current Knowledge, Research Opportunities, and Ways to Address Critical Gaps, Neurobiology of Language, 10.1162/nol_a_00162, 6, (2025).
  • Holistyczno‑socjoekologiczny model profilaktyki giełkotu. Założenia – cele – wyzwaniaHolistic‑Socioecological Model of Cluttering Prevention. Assumptions – Goals – Challenges, Logopaedica Lodziensia, 10.18778/2544-7238.10.09, 10, (143-156), (2024).
  • Czas na zmianę podejścia do jąkania, Prace Językoznawcze, 10.31648/pj.10587, 26, 4, (53-67), (2024).
  • Critical Perspectives in Speech-Language Therapy: Towards Inclusive and Empowering Language Practices, Disabilities, 10.3390/disabilities4040062, 4, 4, (1006-1018), (2024).
  • Pseudostuttering Assignments Support Clinical Training and Develop Strong Stuttering Therapists: A Letter to the Editor Regarding Bortz (2024), Perspectives of the ASHA Special Interest Groups, 10.1044/2024_PERSP-24-00237, 10, 1, (179-185), (2024).
  • A Viewpoint on the Ethics of Pseudostuttering Assignments: Guidelines and Best Practices for Their Use, American Journal of Speech-Language Pathology, 10.1044/2024_AJSLP-24-00139, 34, 1, (428-436), (2024).
  • Exploring international advances and collaborative scholarship: A preface to the Special Issue of the 2022 Joint World Congress on Stuttering and Cluttering, Journal of Fluency Disorders, 10.1016/j.jfludis.2024.106049, 80, (106049), (2024).
  • Evaluation of an Integrated Fluency and Acceptance and Commitment Therapy Intervention for Adolescents and Adults Who Stutter, Journal of Speech, Language, and Hearing Research, 10.1044/2023_JSLHR-23-00252, 67, 4, (1003-1019), (2024).
  • See more

View Options

Sign In Options

ASHA member? If so, log in with your ASHA website credentials for full access.

Member Login

View options

PDF

View PDF

Full Text

View Full Text

Figures

Tables

Media

Share

Share

Copy the content Link

Share