Increasing fluency may not be a goal for an adult or may be only one aspect of a comprehensive and multidimensional approach (Amster & Klein, 2018). Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). 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). This list is not exhaustive, and not all factors need to be present for a referral to an SLP (e.g., Guitar, 2019; Yaruss et al., 1998). The person is experiencing negative reactions from others (e.g., peers, classmates, coworkers, family members). Evidence-based treatment and stutteringHistorical perspective. The International Journal of Indian Psychology, 3(3), 7887. Differences in fluency across languages may be due to the social context in which the language is used (Foote, 2013), as well as the proficiency of each language spoken. 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. (2010). Stuttering and bilingualism: A review. Their description details the characteristics of each stage, along with treatment goals and processes appropriate for each stage. Assessing bilingual children: Are their disfluencies indicative of stuttering or the by-product of navigating two languages? Expand Search Apply; Program Guide; BOBapp(2023) . providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. 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). Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. production of words with an excess of physical tension or struggle. Overheard: Bilingual and disfluent: A unique treatment challenge. ), The atypical stutterer: Principles and practices of rehabilitation (pp. Journal of Speech, Language, and Hearing Research, 54(6), 14851496. In D. Ward & K. Scaler Scott (Eds. Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. using indirect prompts rather than direct questions, recasting/rephrasing to model fluent speech or techniques (Millard et al., 2008; Yaruss et al., 2006), and. What is motivational interviewing? Clinical utility of self-disclosure for adults who stutter: Apologetic versus informative statements. The utility of stuttering support organization conventions for young people who stutter. Sex of childIt appears that the disorder is more common in males than in females; the male-to-female ratio for cluttering has been reported to range from 3:1 to 6:1 (G. E. Arnold, 1960; St. Louis & Hinzman, 1986; St. Louis & Rustin, 1996). Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization., Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). Enhancing treatment for school-age children who stutter: II. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Genetic factors and therapy outcomes in persistent developmental stuttering. Cluttering and Down syndrome. Mild stuttering, on the other hand, tends to appear more regularly. Motivational interviewing is a person-centered approach that can be useful in developing functional goals and enhancing readiness for change (Miller & Rollnick, 2013; Rollnick & Miller, 1995)., Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). SLPs can include teachers in the treatment process by educating them about fluency disorders, involving them in treatment sessions, and having them assist with assignments outside of treatment sessions. black quartz metaphysical properties; car accident woodbury, mn today; it severely reduces carb intake crossword clue their disfluencies may be accompanied by physical tension and secondary behaviors. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. Self-efficacy and quality of life in adults who stutter. Journal of Fluency Disorders, 21(34), 215225. Prevalence of stuttering in primary school children in Cairo-Egypt., Boyle, M. P. (2015). A phenomenological analysis of the moment of stuttering., Van Zaalen, Y., & Reichel, I. Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. Typical pneumonia is a form of community-acquired pneumonia that tends to have more serious symptoms. (2014)., Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). resilience building within the child and family (Berquez & Kelman, 2018). Denial, 3., Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Menzies, R. G., Onslow, M., & Rapee, R. M. (2016). Mis- and overidentification of stuttering in bilingual speakers may occur due to typical disfluencies observed in development, code switching, and wording changes to maintain the grammatical integrity of the dominant language. 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)., American Speech-Language-Hearing Association. 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. Journal of Fluency Disorders, 38(4), 342355. Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018)., Wagovich, S., & Hall, N. (2017). Therefore, clinicians may want to ask open-ended questions to assess communication across specific situations (e.g., How do you participate in class? How do you talk to strangers? Please describe a situation when you ordered food from a restaurant. How did it feel?). Journal of Fluency Disorders, 59, 120. Journal of Fluency Disorders, 62, 105724., Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). Thieme. Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process., St. Louis, K. O., & Hinzman, A. R. (1988). Effectiveness of intensive, group therapy for teenagers who stutter. (2011). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Folia Phoniatrica et Logopaedica, 69, 180189. autism spectrum disorder (Briley & Ellis, 2018)., Ribbler, N. (2006). The presence of at least 1 disabling developmental condition was 5.5 times higher in CWS [children who stutter] when compared to children who do not stutter (Briley & Ellis, 2018, p. 2895). Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). Anger/Resistance, 4. Examples of support groups and activities include FRIENDS: The National Association of Young People Who Stutter, the National Stuttering Association, and SAY: The Stuttering Association for the Young; online groups (e.g., online chats); and social media (e.g., blogs; Reeves, 2006). Journal of Fluency Disorders, 22(3), 219236., Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). Bilingual children are assessed in both languages to determine stuttering profiles in both (Finn & Cordes, 1997). The attitudes of high school peers toward stuttering and toward persons who stutter can be improved through education in the form of classroom presentations about stuttering (Flynn & St. Louis, 2011). These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. 6396). For bilingual individuals, it is important for the clinician to consider the language or languages used during intervention. Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. 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. SIG 16 Perspectives on School-Based Issues, 15(2), 7580. Reducing negative reactions through desensitization and cognitive restructuring. A clinicians first responsibility when treating an individual of any age is to develop a thorough understanding of the stuttering experience and a speakers successful and unsuccessful efforts to cope with his or her communication problem (Manning & DiLollo, 2018, p. 370). Maintenance of improved attitudes toward stuttering. (2017). A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. 4566). While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. ), Cluttering: Research, intervention and education (pp. Counseling helps an individual, a family member, or a caregiver of a person of any age who stutters move from the current scenario to a preferred scenario through an agreed-upon action plan (Egan, 2013). Bullying in adolescents who stutter: Communicative competence and self-esteem. Erlbaum. Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. They may hesitate when speaking, use fillers (like or uh), or repeat a word or phrase. Clinical characteristics associated with stuttering persistence: A meta-analysis., Beilby, J. M., & Byrnes, M. L. (2012). Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services., Briley, P. M., & Ellis, C. (2018). Whurr Publishers. Impact experienced from stuttering, or covert features of stuttering, may include. These individuals are said to experience covert stuttering (B. Murphy et al., 2007). Multicultural identification and treatment of stuttering: A continuing need for research. 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). These modifications are used regardless of whether a particular word is expected to be produced fluently. discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting)., McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. Application of the ICF in fluency disorders. Reducing bullying through role-playing and self-disclosure. Journal of Fluency Disorders, 36(2), 110121. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). Scope of practice in speech-language pathology [Scope of practice]. Some adults lack communication confidence as a result of negative self-perceptions about their stuttering (Beilby et al., 2012a) or due to repeated exposure to people holding stereotypes about stuttering, which, in turn, may create self-stigmatization (Boyle, 2013a). (2007). Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). 115134). Adults are likely to have been living with stuttering for a long time. More recently, CBT and mindfulness have been applied to stuttering therapy and may support that CBT+mindfulness is more beneficial to clients who stutter than CBT alone (Gupta et al., 2016; Harley, 2018). Journal of Communication Disorders, 58, 4357. Clinical implications of situational variability in preschool children who stutter. National Stuttering Association., Finn, P. (2003). Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. Reduced perfusion in Brocas area in developmental stuttering. Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). Typical childhood disfluencies may increase and decrease without any external influence. Stuttering and work life: An interpretative phenomenological analysis. Human Brain Mapping, 38(4), 18651874. social anxiety disorder (Brundage et al., 2017; Craig & Tran, 2014; Iverach et al., 2018), speech sound disorders (St. Louis & Hinzman, 1988; Wolk et al., 1993), and. Scaler Scott, K. (2010). Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. Teigland, A. Limited research is available that identifies the causes of cluttering. Languages differ with regard to developmental milestones, and direct comparison of scores across languages can be misleading, even if the assessments appear similar (Thordardottir, 2006). 115134). If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. 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). Seminars in Speech and Language, 35(2), 6779. Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. Bilingual myth-busters series when young children who stutter are also bilingual: Some thoughts about assessment and treatment., Shenker, R. C. (2013). Acceptance and Commitment Therapy for people who stutter. Neurobiology of Disease, 69, 2331. Reeves, L. (2006). Journal of Speech, Language, and Hearing Research, 62(8), 26912702. Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering., Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2019). Bargaining, 5. A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. This law also applies to organizations that receive financial assistance from any federal department or agency. Stuttering in school-age children: A comprehensive approach to treatment. Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering., Davis, S., Howell, P., & Cooke, F. (2002). 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. In E. Conture & R. F. Curlee (Eds., Menzies, R. G., OBrian, S., Packman, A., Jones, M., Helgadttir, F. D., & Onslow, M. (2019). Psychology Press. Journal of Speech, Language, and Hearing Research, 52(1), 254263. Speech, Language and Hearing, 20(3), 144153. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. For school-age children and adolescents, initiation of treatment depends, in large part, on their motivation, which, in turn, is dependent on factors such as their perceived needs, the degree of adverse impact they experience, and their previous treatment experiences. Luterman, D. M. (2006). Differential treatment of stuttering in the early stages of development. Persons who stutter may appear to have expressive language problems because of a tendency to avoid speaking or speak in a way thats unclear to the listener. Resilience in people who stutter: Association with covert and overt characteristics of stuttering. SLPs also need to discuss with persons who stutter and their families how to evaluate the veracity and trustworthiness of sites claiming to cure stuttering that they may find on their own. Other strategies for treating cluttering include overemphasizing multisyllabic words and word endings, increasing awareness of when a communication breakdown occurs (e.g., through observation of listener reactions), and increasing self-regulation of rate and clarity of speech. van Zaalen, Y., & Reichel, I. K. (2014). Individuals who stutter are more likely to be self-aware about their disfluencies and communication, and they may exhibit more physical tension, secondary behaviors, and negative reactions to communication. The social and communication impact of stuttering on adolescents and their families., Boyle, M. P., & Gabel, R. (2020). 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. Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. For example, individuals who clutter may not be aware of communication breakdowns and, therefore, do not attempt to repair them. The SLP works with parents and families to create an environment that facilitates fluency and that helps them develop healthy and appropriate communication attitudes (Onslow et al., 2003; Yaruss & Reardon-Reeves, 2017). As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. The Journal of Child Psychology and Psychiatry, 43(7), 939947. However, their disfluencies are not likely to involve prolongations, blocks, physical tension, or secondary behaviors that are more typical for children who stutter (Boscolo et al., 2002). Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility., Flynn, T. W., & St. Louis, K. O. Natural history of stuttering to 4 years of age: A prospective community-based study. American Journal of Speech-Language Pathology, 27(2), 721736. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Daly, D. A., Simon, C. A., & Burnett-Stolnack, M. (1995). Journal of Speech, Language, and Hearing Research, 36(5), 906917. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Journal of Communication Disorders, 80, 1117., American Speech-Language-Hearing Association. Stimulability testing (e.g., person is asked to increase pausing and/or decrease speech rate in some other way)a reduction of overall speech rate typically helps in reducing cluttering symptoms. sex of childboys are at higher risk for persistence of stuttering than girls (Craig et al., 2002; Yairi & Ambrose, 2013); family history of persistent stuttering (Kraft & Yairi, 2011); time duration of greater than 612 months since onset or no improvement over several months (Yairi & Ambrose, 2005); age of onsetchildren who start stuttering at age 3 years or later (Yairi & Ambrose, 2005); and. ), Cluttering: A clinical perspective (pp. Parental involvement is an integral part of any treatment plan for children who stutter. Stuttering in animal models, such as zebra finches (Chakraborty et al., 2017) and mice (Barnes et al., 2016; Han et al., 2019), has also been investigated, including how the expression of stuttering influences social behaviors of mice (Han et al., 2019). School Psychology Review, 30(1), 135141. Fluency treatment can occur at any point after the diagnosis. 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). Is parentchild interaction therapy effective in reducing stuttering?, Lucey, J., Evans, D., & Maxfield, N. D. (2019). Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. International Journal of Language & Communication Disorders, 49(1), 113126. Methods in stuttering therapy for desensitizing parents of children who stutter. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). Journal of Fluency Disorders, 38(2), 171183., Zebrowski, P. M. (2002)., Cassar, M. C., & Neilson, M. D. (1997). Communication Disorders Quarterly, 6(1), 5059. Perspectives on Fluency and Fluency Disorders, 23(2), 5469. Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Strategies aimed at altering the timing of pausing are used to increase the likelihood of fluent speech production and to improve overall communication skills (e.g., intelligibility, message clarity). American Journal of Speech-Language Pathology, 7(4), 6276. Journal of Fluency Disorders, 43, 116. Psychology Press. Speaker and observer perceptions of physical tension during stuttering. Pro-Ed. Journal of Fluency Disorders, 32(2), 121138. B. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. 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). Sadness/Depression, 6. For example, cluttering symptoms may decrease during a formal speech evaluationdue to increased self-monitoringbut increase in more comfortable situations where the person is less likely to self-monitor. In D. Ward & K. Scaler Scott (Eds. Molecular Genetics & Genomic Medicine, 5(2), 95102. 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). Stuttering Therapy Resources. Enlisting the help of a person familiar with the language and rating fluency in short speech intervals also may help to accurately and reliably judge unambiguous stuttering (Shenker, 2011). Scaler Scott, K. (2011). Clinicians and parents also look for reactions, such as avoidance of words or speaking situations, increased physical tension or secondary behaviors, reduced utterance length, or slight changes in pitch or loudness during stuttering episodes. However, these disfluencies are typical and not indicative of a disorder (Shenker, 2013). Folia Phoniatrica et Logopaedica, 19. Prevalence of speech disorders in elementary school students in Jordan. Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. In D. Ward & K. Scaler Scott (Eds., Freud, D., & Amir, O. Psychology Press. Estimates of incidence and prevalence vary due to a number of factors, including disparities in the sample populations (e.g., age), how stuttering was defined, and how stuttering was identified (e.g., parent report, direct observation). 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). Emotional reactivity, regulation and childhood stuttering: A behavioral and electrophysiological study. We believe it is past time to standardize the symptom assessment for MI so that proper and rapid diagnostic testing can be undertaken; however, we cannot standardize . (2016b). The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. wandering womb handmaid's tale; ismackzi gta 5 mods; katherine stinney age. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). First, let's clarify the types of disfluencies we are discussing as atypical: BSI: Sound Insertion (in-word or between-words) [be-uh-come] FSR: Final Sound (or syllable) Repetition [become-m-m] [become-ome-ome] Next, let's be clear that these types of disfluencies seem to occur predominantly in children on the . Family historyAnecdotal reports indicating the presence of cluttering in more than one family member suggest that family history may be a risk factor. St. Louis, K. O., & Schulte, K. (2011). Van Borsel, J. Journal of Fluency Disorders, 54, 1423.