Lost in the literature, but not the caseload: working with atypical disfluency from theory to practice

Atypical disfluency is a frustrating but little addressed clinical problem. The purpose of this article and case study was to summarize what is known about atypical fluency profiles and to describe the presenting behaviors and successful treatment of an unusual fluency profile (numerous word-final syllable repetitions) in a school-aged child. To this end, we describe the speech fluency and associated communication characteristics of a young boy diagnosed with Asperger disorder who was between 7;2 and 8;0 when seen for evaluation and treatment. We describe a therapy protocol that was successful in nearly eliminating these atypical disfluencies. The protocol emphasized self-monitoring and was integrated with other goals to improve the child's communication, which had features consistent with mild autism spectrum disorder (ASD). Following an 8-week treatment, the child significantly reduced his percent stuttered syllables of atypical disfluencies (word-final repetition and phrase-final repetition), resulting in significant qualitative improvements to his speech. This case study demonstrates that traditional stuttering modification treatment can be successful in reducing atypical and typical disfluencies in a child with concomitant social language impairment consistent with ASD. The therapy approach reported here may be useful in treatment of other cases having symptoms similar to the child we treated.