other developmental disorders (Briley & Ellis, 2018). Stuttering and reading fluency: Information for teachers [Brochure]. School Psychology Review, 30(1), 135141. https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). A study of pragmatic skills of clutterers and normal speakers. Rehabilitation Act of 1973, Section 504. (2019). https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. Please enable it in order to use the full functionality of our website. Journal of Fluency Disorders, 26(3), 179206. Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. The treatment of stuttering. Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. American Journal of Speech-Language Pathology, 27(2), 721736. Clients often report successful stuttering therapy as a transformational experience progressing from avoidance to acceptance and openness, increasing self-confidence and self-efficacy (Plexico et al., 2005; Tichenor & Yaruss, 2019a). if a child has typical disfluencies or a fluency disorder (see ASHAs resource on. These modifications are used to facilitate speech fluency and may include. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. https://doi.org/10.1044/2018_JSLHR-S-17-0353, Guitar, B. Journal of Fluency Disorders, 38(2), 6687. https://doi.org/10.1016/j.cub.2016.02.068, Beilby, J. M., & Byrnes, M. L. (2012). The perils of oral-reading fluency assessments for children who stutter led a group of SLPs to investigate the issue and call on colleagues to change their school districts policies. It is not appropriate to determine a standard score if the norming sample of the assessment is not representative of the individual being assessed. Children who stutter may demonstrate poorer expressive lexical skills compared to their peers (Silverman & Bernstein Ratner, 2002). These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). Journal of Fluency Disorders, 38(2), 171183. Parents can also report if secondary behaviors are present in both languages. Guttormsen, L. S., Kefalianos, E., & Nss, K. A. Journal of Speech and Hearing Disorders, 50(3), 261281. Unlike stuttering, there are no data regarding age since onset and long-term outcomes of cluttering. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. The utility of stuttering support organization conventions for young people who stutter. The impact of stuttering on employment opportunities and job performance. The influence of workplace discrimination and vigilance on job satisfaction with people who stutter. deletion and/or collapsing of syllables (e.g., I wanwatevision). https://doi.org/10.1016/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. (2008). SIG 4 Perspectives on Fluency and Fluency Disorders. Journal of Speech and Hearing Disorders, 49(1), 5358. The person is having difficulty communicating messages in an efficient, effective manner. American Journal of Speech-Language Pathology, 27(3S), 12351243. https://doi.org/10.1002/da.20657, Bonanno, G. A., & Mancini, A. D. (2008). (2006). Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. In addition to being used for improving communication skills, pausing is also an effective method of rate control. https://doi.org/10.1044/2020_PERSP-20-00014. Natural history of stuttering to 4 years of age: A prospective community-based study. https://doi.org/10.1016/j.jfludis.2017.06.001. Signs and symptoms. Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). (2019). The Stuttering Foundation We provide free online resources, services and support to those who stutter and their families, as well as support for research into the causes of stuttering. Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Advances in Psychiatric Treatment, 12(1), 6368. Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. Menu. In D. Ward & K. Scaler Scott (Eds. When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). Universitetsforlaget. Journal of Fluency Disorders, 29(4), 255273. https://doi.org/10.1016/j.jcomdis.2014.02.001, Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). American Journal of Speech-Language Pathology, 29(1), 201215. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. being more comfortable and open with stuttering and pseudostuttering; reporting experiencing decreased anxiety while communicating; reporting less adverse psychological, emotional, social, and functional impacts; reporting enjoying social communication, including with strangers; and. https://doi.org/10.1044/ffd22.1.34, Beilby, J. M., Byrnes, M. L., Meagher, E. L., & Yaruss, J. S. (2013). Psychology Press. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Emotional problems and parenting style do not cause stuttering. Journal of Fluency Disorders, 22(3), 187203. excessive coarticulation resulting in the collapsing and/or deletion of syllables and/or word endings; excessive disfluencies, which are usually of the more nonstuttering type (e.g., excessive revisions and/or use of filler words, such as um); pauses in places typically not expected syntactically; unusual prosody (often due to the atypical placement of pauses rather than a pedantic speaking style, as observed in many with autism spectrum disorder). Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. See ASHAs Practice Portal page on Cultural Responsiveness. The underlying relationship between stuttering and working memory is not fully understood but may be related to interruptions in sensorimotor timing for developmental stuttering and may involve both the basal ganglia and the prefrontal cortex (Bowers et al., 2018). In N. B. Ratner & J. Tetnowski (Eds. Coleman, C. (2013). Journal of Fluency Disorders, 63, 105746. https://doi.org/10.1016/j.jfludis.2020.105746, Boyle, M. P., Milewski, K. M., & Beita-Ell, C. (2018). autism (see Scaler Scott, 2011, for a review), word-finding/language organization difficulties (Myers, 1992), and. Fluency treatment can occur at any point after the diagnosis. Journal of Speech, Language, and Hearing Research, 61(5), 12381250. Journal of Communication Disorders, 48, 3851. The impact of stuttering on adults who stutter and their partners. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). https://doi.org/10.1016/j.jfludis.2014.01.001. Word-finding problems can also result in an increase in typical disfluencies that are similar to those observed in cluttering. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). https://doi.org/10.1044/2017_LSHSS-17-0028. Journal of Fluency Disorders, 50, 5971. https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. In this way, positive reinforcement is used to increase or strengthen the response of fluency (the desired behavior). Stages of change and stuttering: A preliminary view. It is incumbent upon the SLP to help the individualized education program (IEP) team determine the academic and social impacts of stuttering on students in the school setting. (2005). a sense of loss of control/cognitive dissociations; negative thoughts/feelings about oneself and ones communication abilities; rumination on perceived communication failures; a decreased sense of self-worth (report feeling less than human); avoidance of words/sounds, speaking, and social interactions; perceived judgment of communication by others (e.g., being mocked, laughed at, made fun of, pitied, talked over/for, ignored, or hung-up on); perceived negative effects on social/romantic relationships; and. However, as they learn to reduce reactivity (see below), they develop greater comfort while speaking, they assume more positive attitudes about their ability to communicate, and they are better able to accept and manage moments of disfluency as they occur. Communication Disorders Quarterly, 39(2), 335345. Psychology Press. Their skills are developing in this area. The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. 233253). https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). Acquired neurogenic and psychogenic stuttering are not covered. Parents of Preschoolers Parents of school-age children Just for Kids Teens Adults Teachers SLPs Physicians Employers News and Blog February 7, 2023 Grace in Advocacy production of words with an excess of physical tension or struggle. Journal of Fluency Disorders, 34(4), 368381. There are two predominant types of atypical disfluencies: stuttering and cluttering. Stuttering Therapy Resources. Multilingual children who stutter: Clinical issues. Luterman, D. M. (2006). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use
Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Increased incidence of stuttering has been noted among those with a first-degree relative (e.g., parent, sibling) who stutters and an even greater likelihood if that relative is an identical twin (Kraft & Yairi, 2011). https://doi.org/10.1016/S0094-730X(97)00008-9, Floyd, J., Zebrowski, P. M., & Flamme, G. A. American Journal of Speech-Language Pathology, 27(3S), 11241138. Journal of Speech, Language, and Hearing Research, 31(3), 377385. Daly, D. A. https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). Roberts, P., & Shenker, R. (2007). The clinician (a) considers the degree to which the individuals disfluent behaviors and overall communication are influenced by a coexisting disorder (e.g., other speech or language disorders, Down syndrome, autism spectrum disorder, attention-deficit/hyperactivity disorder) and (b) determines how treatment might be adjusted accordingly. It applies protections to ensure that programs and employment environments are accessible and to provide aids and services necessary for effective communication in these settings. Adolescents and young adults who stutter were found to have more white matter connections in the right hemisphere as compared with normally fluent controls (Watkins et al., 2008). Language, Speech, and Hearing Services in Schools, 49(1), 13. https://doi.org/10.1055/s-0034-1382151, Chang, S.-E., Garnett, E. O., Etchell, A., & Chow, H. M. (2019). Support activities can be incorporated into group treatment and through participation in self-help groups (Trichon & Raj, 2018), attendance at self-help conferences (Boyle et al., 2018; Gerlach et al., 2019; Trichon & Tetnowski, 2011), and participation in summer camp programs (Byrd et al., 2016). A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. ASHA also extends its gratitude to the following subject matter experts who were involved in the reviewand development of thispage: In addition, ASHA thanks the members of the Steering Committee of ASHAs Special Interest Division on Fluency and Fluency Disorders (Division 4) whose work preceded this content. Starkweather, Janice Westbrook. continued management (Plexico et al., 2005). https://doi.org/10.1016/j.nbd.2014.04.019, Han, T.-U., Root, J., Reyes, L. D., Huchinson, E. B., du Hoffmann, J., Lee, W.-S., Barnes, T. D., & Drayna, D. (2019). https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). Application of the ICF in fluency disorders. (2015). https://doi.org/10.1044/2018_AJSLP-17-0097, Kraft, S. J., & Yairi, E. (2011). (2009). Stuttering and its treatment in adolescence: The perceptions of people who stutter. Journal of Fluency Disorders, 32(2), 95120. A comprehensive treatment approach for school-age children, adolescents, and adults includes multiple goals and considers the age of the individual and their unique needs (e.g., communication in the classroom, in the community, or at work). Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. The ASHA Leader, 11(10), 621. 9099). For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. American Journal of Speech-Language Pathology, 12(2), 243253. 6989). Finding opportunities for social support for individuals with fluency disorders. Journal of Fluency Disorders, 58, 110. Prevalence of stuttering in African American preschool children. (2003). These strategies help individuals learn about the speech mechanism and how it operates during both fluent and disfluent speech so they can modify it. Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. Stuttering and bilingualism: A review. (2011). However, the clinician needs to consider the impact of disfluency on communication and quality of life as a whole. https://doi.org/10.1016/j.jfludis.2013.09.003, Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). The interview process and work environment can be challenging for individuals who stutter. These are called typical disfluencies or nonfluencies. (1981). https://doi.org/10.1044/2019_JSLHR-S-18-0225. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. Journal of Speech, Language, and Hearing Research, 54(6), 14851496. When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Seminars in Speech and Language, 35(2), 6779. Areas of the brain that were studied and the technologies used to conduct the research (e.g., PET, MEG, MRI, fMRI, NIRS, DCS) also varied widely. International Classification of Functioning, Disability and Health. Stuttering, the most common fluency disorder, is an interruption in the flow of speaking characterized by specific types of disfluencies, including, These disfluencies can affect the rate and rhythm of speech and may be accompanied by. Other speech or language concerns are also present. Scheduling concerns, cost, and insurance reimbursement also are likely to be factors affecting dosage. Purpose Disfluencies associated with stuttering generally occur in the initial position of words. Sadness/Depression, 6. Contemporary Issues in Communication Science and Disorders, 29(Spring), 91100. Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. Other observable, secondary or concomitant, stuttering behaviors can include body movements (e.g., head nodding, leg tapping, fist clenching), facial grimaces (e.g., eye blinking, jaw tightening), and distracting sounds (e.g., throat clearing). Therefore, a comprehensive assessment for fluency disorders should include assessment of both overt and covert features. Covert stuttering. Referring to other health care professionals when outside support is needed to facilitate treatment goals for interfering behaviors (e.g., anxiety, depression). Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. Social anxiety disorder and stuttering: Current status and future directions. Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis. Given that cluttering may co-occur with other disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder), having any of these disorders may be a risk factor; however, not all individuals with these disorders also exhibit cluttering. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. See ASHAs Practice Portal page on Telepractice. An introduction to camps for children who stutter: What they are and how they can help. Brain, 131(1), 5059. Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. bringing peers into the treatment setting; planning strategies to use in the classroom, cafeteria, or playground or at work; taking outings to stores and other businesses; and. We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). Speech clarity and fluency may temporarily improve when the person is asked to slow down or pay attention to their speech. Journal of Fluency Disorders, 54, 113. University Park Press. Workplace in fluency management: Factoring the workplace into fluency management. https://doi.org/10.1080/2050571X.2016.1253533. (2001). talking about stuttering or treatment of stuttering. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). Measuring lexical diversity in children who stutter: Application of vocd. This approach to care incorporates individual and family preferences, priorities, and desired outcomes in the selection of treatment goals and treatment methods. 297325). (2011). Clinicians do not have to choose one approach or the other. Molecular Genetics & Genomic Medicine, 5(2), 95102. Seminars in Speech and Language, 23(3), 181186. For example, English language learners may have word-finding problems in the second language. may show increased disfluency rates (decreased reading fluency) because they cannot change the words to avoid moments of stuttering as easily as they can in conversation, and. Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. The lowest prevalence rates of stuttering were reported in adults aged 2150 years (0.78%) and adults aged 51 years or older (0.37%; Craig et al., 2002). Fear of speaking: Chronic anxiety and stammering. PLOS ONE, 10(7), Article e0133758. If treatment is currently not warranted, the SLP educates the family about how to monitor the childs fluency to determine if and when the child should be reevaluated. Rocha, M., Yaruss, J. S., & Rato, J. R. (2019). Al-Jazi, A. Individuals may exhibit pure cluttering or cluttering with stuttering (van Zaalen-Opt Hof et al., 2009). The ASHA Action Center welcomes questions and requests for information from members and non-members. A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). Sheehan, V. M., & Sisskin, V. (2001). using indirect prompts rather than direct questions, recasting/rephrasing to model fluent speech or techniques (Millard et al., 2008; Yaruss et al., 2006), and. 255279). Journal of Fluency Disorders, 34(3), 187200. See What To Ask When Evaluating Any Procedure, Product, or Program. Anger/Resistance, 4. The speaker is thought to be talking at a rate that is too fast for their system to handle, resulting in breakdowns in fluency and/or intelligibility (Bakker et al., 2011). https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). One of the core principles of ACT is mindfulness. Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. Typical adolescent experiences of emotional reactivity, resistance to authority, and social awkwardness may be exacerbated in adolescents who also experience stuttering (Daly et al., 1995; Zebrowski, 2002). In R. Lees & C. Stark (Eds. Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. Preus, A. facilitates conversations between the individual and their family about the experience of stuttering, the individuals communication expectations, their life goals, and how to holistically support communication (see, e.g., Berquez & Kelman, 2018; Millard et al., 2018; Rocha et al., 2019). Cluttering, another fluency disorder, is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). if monitoring or treatment (direct or indirect) is recommended. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). typical vs atypical disfluencies asha. Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. An increase in observable disfluent behaviors may occur as the individual communicates more freely. Differential treatment of stuttering in the early stages of development. Strategies for reducing impairment in body function have been separated into two categoriesspeech modification and stuttering modification, both of which are described below. Stuttering: Its nature, diagnosis, and treatment. Journal of Fluency Disorders, 25(1), 4757. Therefore, when conducting an assessment with an adult, it is crucial to understand. Journal of Speech, Language, and Hearing Research, 56(5), 15171529. They are likely to use interjections, repeat phrases, and revise what they are saying. Stuttering impact: A shared perception for parents and children. Bargaining, 5. Disclosing a fluency disorder may be done a number of ways, such as verbally stating I stutter/have a speech disorder or by pseudostuttering or openly stuttering, while doing so confidently (McGill et al., 2018). 15). Some individuals develop speech habits to escape or avoid moments of overt stuttering, such as changing words or using interjections (e.g., um, uh), and they may become so skilled at hiding stuttering that their speech appears to be fluent (covert stuttering; B. Murphy et al., 2007). Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. As suggested earlier, normal disfluencies will appear for a few days and then disappear. Journal of Fluency Disorders, 38(4), 342355. https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). avoidance behaviors (i.e., avoidance of sounds, words, people, or situations that involve speaking); escape behaviors, such as secondary mannerisms (e.g., eye blinking and head nodding or other movements of the extremities, body, or face); and. 178196). Parental involvement is an integral part of any treatment plan for children who stutter. The prevalence rate of stuttering in African American children (25 years of age) was estimated to be 2.52%, but was not reported to not be significantly different from that reported for European American children in the same age group between 2- to 5-year-old African American children and European American children (Proctor et al., 2008). https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). Available 8:30 a.m.5:00 p.m. Assisting children who stutter in dealing with teasing and bullying. See the Fluency Disorders Evidence Map for summaries of the available research on this topic. There has been some documentation of the use of stuttering modification strategies to help those who clutter (Ward, 2006). gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. A comprehensive view of stuttering: Implications for assessment and treatment. Journal of Fluency Disorders, 33(2), 8198. Crystal Cooper, Diane L. Eger, and Nancy Creaghead served as monitoring vice presidents. Typical Disfluencies vs. Stuttering in Children. Psychology Press. https://doi.org/10.1016/j.jcomdis.2010.12.003. The use of counseling in other areas of the speakers lifethat is, those not directly related to communicationis outside the scope of practice for SLPs (ASHA, 2016b). A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. Understanding that awareness and concern about stuttering may vary across individuals and cultures and conducting a culturally and linguistically relevant comprehensive assessment.
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