Fluency & Stuttering on the Praxis SLP: The Complete Review

Fluency disorders are one of the ASHA Big 9 and show up reliably on the Praxis 5331 — usually 4–7 items across differential diagnosis, evidence-based intervention, and counseling. Here's the focused review.

Stuttering vs. cluttering — nail this distinction first

• Stuttering: repetitions (part-word, sound), prolongations, blocks. Awareness present. Secondary behaviors (eye blinks, facial tension). Often anxiety-linked.
• Cluttering: rapid or irregular rate, excessive disfluencies (whole-word, phrase repetitions, revisions), reduced awareness, disorganized language. Often co-occurs with ADHD or learning disabilities.

Developmental stuttering — the key numbers

• Onset: typically ages 2–5.
• Lifetime incidence: ~5–8%.
• Persistent prevalence: ~1% (most children recover).
• Male:female ratio: ~4:1 in school-age children.
• Strongest recovery predictors: female, family history of recovery, onset before age 3.5, decreasing severity over 6–12 months.
• Refer immediately if: family history of persistent stuttering, stuttering > 6–12 months without decrease, child shows awareness/frustration, secondary behaviors emerging.

Neurogenic vs. psychogenic stuttering

• Neurogenic: post-stroke, TBI, degenerative disease. Disfluencies on function AND content words, minimal anxiety, no adaptation effect.
• Psychogenic: sudden onset following psychological trauma. Unusual patterns, often improves with counseling.
• Developmental: disfluencies mostly on content words, adaptation effect present (fluency improves on repeated readings), anxiety/avoidance features.

Evidence-based interventions

Preschool (early intervention)

• Lidcombe Program: parent-delivered, response- contingent praise for fluency + gentle correction. Strong evidence for preschoolers.
• RESTART-DCM / Demands-Capacities Model:indirect approach; modify environmental demands.

School-age

• Fluency shaping: easy onset, light articulatory contact, continuous phonation, slowed rate. Aim = fluent speech.
• Stuttering modification (Van Riper):identification → desensitization → modification (cancellations, pull-outs, preparatory sets) → stabilization. Aim = easier stuttering, not eliminating it.
• Integrated approaches combine both, plus counseling and self-advocacy.

Adults

• Same techniques, with heavier emphasis on cognitive-behavioral components — avoidance reduction, self-disclosure, acceptance.
• Support groups (NSA, FRIENDS) are part of evidence-based practice.

What NOT to say to a person who stutters (counseling)

• "Slow down."
• "Take a breath."
• "Think about what you want to say."
• Finishing their sentences.

Do: maintain eye contact, wait, model unhurried turn-taking, ask what listener strategies help them.

Exam-style question pattern

Watch for cases contrasting a 3-year-old with 2 months of easy part-word repetitions (usually monitor / parent education) vs. a 4-year-old with 12 months of increasingly tense blocks and secondary behaviors (usually direct intervention). The clock matters more than the age.