https://doi.org/10.4324/9781351122351, Klein, J. F., & Hood, S. B. 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. The imbalance of stuttering behavior in bilingual speakers. In D. Ward & K. Scaler Scott (Eds. Journal of Speech, Language, and Hearing Research, 62(12), 43354350. Diagnostic and statistical manual of mental disorders (5th ed.). Communication Disorders Quarterly, 39(2), 335345. Long-term follow-up of self-modeling as an intervention for stuttering. Journal of Speech, Language, and Hearing Research, 60(11), 30973109. https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). Parents of bilingual children easily can be trained to provide perceptual ratings of fluency in any language spoken by the child (Shenker, 2013). Clinicians need to be observant of indicators, such as stuttering avoidance or social isolation, that clients/patients/students may be internalizing negative stereotypes about stuttering (Boyle, 2013a). What is motivational interviewing? American Journal of Speech-Language Pathology, 16(1), 6568. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. The SLP can use audio- or videoconferencing to augment this type of treatment. Tourettes syndrome (see Van Borsel, 2011, for a review). frequency of exposure to all languages used by the child and their proficiency (comprehension and production) in each language; family history of stuttering or cluttering; description of disfluency and rating of severity; age of onset of disfluency and patterns of disfluency since onset (e.g., continuous or variable); previous fluency treatment and treatment outcomes; exploration of parental reactions to the childs moments of disfluency or speaking frustration; and. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). https://doi.org/10.1044/ffd17.2.4, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007a). Approximately 95% of children who stutter start to do so before the age of 4 years, and the average age of onset is approximately 33 months. Acceptance and Commitment Therapy for people who stutter. Roberts, P., & Shenker, R. (2007). Journal of Fluency Disorders, 37(4), 242252. Singular. if monitoring or treatment (direct or indirect) is recommended. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). American Journal of Speech-Language Pathology, 20(3), 163179. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). Dosage depends largely on the nature of the treatment (e.g., direct, indirect), age group, and the task level (e.g., learning basic skills requires more clinic room practice than does generalization). https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. American Journal of Speech-Language Pathology, 27(3S), 11801194. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Journal of Fluency Disorders, 36(2), 110121. For bilingual individuals, it is important for the clinician to consider the language or languages used during intervention. The great psychotherapy debate: Models, methods, and findings. https://doi.org/10.1044/2018_JSLHR-S-17-0353, Guitar, B. Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. Unlike stuttering, there are no data regarding age since onset and long-term outcomes of cluttering. Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Stuttering: Research and therapy. (1979). 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). 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). Folia Phoniatrica et Logopaedica, 69, 180189. Tallying has the client stop directly after a moment of stuttering to tally or bring awareness to it while not attempting to escape by continuing to talk. Palin ParentChild Interaction therapy: The bigger picture. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Fear of speaking: Chronic anxiety and stammering. ASHA thanks the following individuals,who, in 2014, made significant contributions to the development of this content. Structural and functional abnormalities of the motor system in developmental stuttering. 157186). Cluttering and Down syndrome. International Journal of Language & Communication Disorders, 49(1), 113126. Because the theory behind cluttering is that speakers are talking at a rate that is too fast for their systems to handle, techniques that help regulate speech rate, such as increased pausing, often are helpful. Neural network connectivity differences in children who stutter. A thematic analysis of late recovery from stuttering. Resilience in people who stutter: Association with covert and overt characteristics of stuttering. It is helpful to know that typical bilingual or multilingual children tend to produce higher rates of monosyllabic word repetitions, sound repetitions, and syllable repetitions than monolingual speakers. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Hearne, A., Packman, A., Onslow, M., & Quine, S. (2008). https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). 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. Yaruss, J. S., & Reardon-Reeves, N. (2017). Fluency shaping with young stutterers. Motivational interviewing: Helping people change. Treatment for fluency disorders is highly individualized and based on a thorough assessment of speech fluency, language factors, emotional/attitudinal components, and life impact (Byrd & Donaher, 2018). Journal of Paediatrics and Child Health, 49(2), E112E115. There are several indicators of positive therapeutic change. Fluency disorders do not necessarily affect test scores or subject grades. The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). american journal of audiology (aja) american journal of speech-language pathology (ajslp) journal of speech, language, and hearing research (jslhr) language, speech, and hearing services in schools (lshss) perspectives of the asha special interest groups; topics; special collections Brain, 138(3), 694711. their disfluencies may be accompanied by physical tension and secondary behaviors. Numerous treatment approaches and strategies have been developed in an attempt to help speakers reduce the negative reactions associated with stuttering (e.g., W. P. Murphy et al., 2007a). Plural. Stuttering impact: A shared perception for parents and children. See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. 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). Psychology Press. Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. Language intervention from a bilingual mindset. Treatment approaches are individualized based on the childs needs and family communication patterns. ), Cluttering: Research, intervention and education (pp. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Seminars in Speech and Language, 24(1), 2732. Sisskin, V. (2018). Journal of Fluency Disorders, 46, 114. See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. Assisting children who stutter in dealing with teasing and bullying. https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. Cluttering treatment: Theoretical considerations and intervention planning. Genetic approaches to understanding the causes of stuttering. their reason for seeking treatment at the current time. The person exhibits negative reactions (e.g., affective, behavioral, or cognitive reactions) to their disfluency. 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). Clinicians do not have to choose one approach or the other. Differing perspectives on what to do with a stuttering preschooler and why. https://doi.org/10.1016/j.jfludis.2016.07.002, Iverach, L., & Rapee, R. M. (2014). Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. Clinical characteristics associated with stuttering persistence: A meta-analysis. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Rather, the purpose is to determine the extent and impact of the fluency disorder on the individual, the potential benefit from treatment, and the individuals desire and willingness to change. Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. Journal of Fluency Disorders, 29(4), 255273. National Stuttering Association. American Journal of Speech-Language Pathology, 7(4), 6276. Group experiences and individual differences in stuttering. We often use the term "emergent" to describe skills that are developing, but have not fully emerged. (2011). Erlbaum. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. Journal of Fluency Disorders, 35(3), 216234. Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. A study of pragmatic skills of clutterers and normal speakers. Similarities - Typical and Atypical Pneumonia 5. Regional cerebral blood flow is reduced in Brocas area, the region in the frontal lobes of the brain linked to speech production, and an inverse relationship was noted between the severity of stuttering and the rate of blood flow (Desai et al., 2016). https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). The Present Levels of Academic Achievement and Functional Performance statement, which serves as the baseline for the IEP, refers to other areas that are not necessarily academic and can include information about communication skills, social skills, and other activities of daily living. The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. https://doi.org/10.1177/1525740117702454. Building clinical relationships with teenagers who stutter. https://doi.org/10.1016/j.jfludis.2018.09.004, Menzies, R. G., OBrian, S., Packman, A., Jones, M., Helgadttir, F. D., & Onslow, M. (2019). https://doi.org/10.1136/bmj.38520.451840.E0, Kelman, R., & Nicholas, A. reports changing conception of stuttering from exclusively negative to having positive features. https://doi.org/10.1044/1058-0360.0202.65. https://doi.org/10.1044/1058-0360(2003/070), Arenas, R. M., Walker, E. A., & Oleson, J. J. https://doi.org/10.1016/0094-730X(88)90003-4. Howell, P., & Davis, S. (2011). Clinical decision making in fluency disorders. Presence of stutteringAn estimated one third of people who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Stuttering and labor market outcomes in the United States. Understanding and treating cluttering. Consider the individuals age, preferences, and needs within the context of family and community when selecting and adapting treatment approaches and materials. 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). Cambridge University Press. 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). 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). Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). An introduction to camps for children who stutter: What they are and how they can help. Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). However, sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children. 256276). 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. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). The ASHA Action Center welcomes questions and requests for information from members and non-members. Language, Speech, and Hearing Services in Schools, 49(1), 13. Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). How can you tell if childhood stuttering is the real deal? As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs are obligated to provide culturally and linguistically appropriate services, regardless of the clinicians personal culture, practice setting, or caseload demographics. Typical childhood disfluencies may increase and decrease without any external influence. Some examples of these are to openly discuss experiences with stuttering (from the client and the clinician with pseudostuttering or as described by previous clients who stutter) and model pseudostuttering and techniques, attitudes, and beliefs across speaking situations (Manning & Quesal, 2016; Watson, 1988). Defining cluttering: The lowest common denominator. Identifying subgroups of stutterers (No. The impact of stuttering on employment opportunities and job performance. Molt, L. F. (1996). Journal of Speech, Language, and Hearing Research, 62(12), 43564369. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). In H. H. Gregory, J. H. Campbell, C. B. Gregory, & D. G. Hill (Eds. Finding the good in the challenge: Benefit finding among adults who stutter. Traditional stuttering modification strategies (Manning & DiLollo, 2018) include the following: These strategies require an individual to identify a moment of disfluency before, during, or after it occurs and to make adjustments to reduce tension and struggle. https://doi.org/10.1016/j.jfludis.2014.12.002, Boyle, M. P., Beita-Ell, C., & Milewski, K. M. (2019). Journal of Fluency Disorders, 62, 105762. https://doi.org/10.1016/j.jfludis.2019.105726. Strategies for reducing impairment in body function have been separated into two categoriesspeech modification and stuttering modification, both of which are described below. Time and expense are considerations along with attention to generalization and treatment needs following an intensive program (Cooper, 1979). Other identification strategies may include video or pseudostuttering analysis or tallying/freezing. Epidemiology of stuttering in the community across the entire life span. (2017). 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. Journal of Fluency Disorders, 50, 7284. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). https://doi.org/10.1016/j.jfludis.2011.04.002, Foote, G. (2013). https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). Following are descriptions of each of these forms of disfluency. Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). The transtheoretical approach. Psychology Press. Quick: Talk fast & dont stutter! Van Borsel, J. Language, Speech, and Hearing Services in Schools, 43(4), 536548. The differences between disfluencies stemming from reduced language proficiency and stuttering are evident in lack of awareness, struggle, tension, blocking, and lack of self-concept as a person who stutter, which are not seen in typical second language learning profiles (Byrd, 2018). Psychosocial support for adults who stutter: Exploring the role of online communities. The role of effortful control in stuttering severity in children: Replication study. The human capacity to thrive in the face of potential trauma. Time pressures for verbal communication and requirements to use the telephone may lead to stress and discomfort. Engaging parents in treatment helps to achieve carryover in the home environment and helps with treatment across languages (Shenker, 2013). Self-efficacy and quality of life in adults who stutter. The role of self-help/mutual aid in addressing the needs of individuals who stutter. https://doi.org/10.1016/j.jcomdis.2015.10.003. Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. Journal of Fluency Disorders, 21(34), 201214. Yaruss, J. S., & Pelczarski, K. M. (2007). See ASHAs Practice Portal page on Cultural Responsiveness. Journal of Fluency Disorders, 58, 2234. Timing refers to the initiation of treatment relative to the diagnosis. Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). In J. C. Norcross & M. R. Goldfried (Eds. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. The Journal of Child Psychology and Psychiatry, 43(7), 939947. For example, English language learners may have word-finding problems in the second language. Temperamental characteristics of young children who stutter. 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. Ingham, R. J., & Onslow, M. (1985). (2011). information regarding family, personal, and cultural perception of fluency. It is important that parents and clinicians acknowledge and respond to a childs verbal and nonverbal reactions in a supportive manner; this helps to minimize the likelihood that the child will develop negative reactions to stuttering. (2019). Wolk, L., Edwards, M. L., & Conture, E. G. (1993). https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). In D. Ward & K. Scaler Scott (Eds. Assessment of awareness in young children of disfluencies and difficulty in speaking. discussing the rationale for treatment decisions, and. With regard to cluttering, research is not far enough along to identify causes. International Journal of Speech-Language Pathology, 17(4), 367372. Prevalence of anxiety disorders among children who stutter. 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?). Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. Journal of Fluency Disorders, 44, 3245. Social anxiety disorder in adults who stutter. Features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder). 3. Stuttering typically has its origins in childhood. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). seizure disorders (Briley & Ellis, 2018). (2003). Stuttering Therapy Resources. Rethinking covert stuttering. See ASHAs resource on assessment of fluency disorders in the context of the WHO ICF framework. (2010). Drayna, D. (2011). Education, 136(2), 159168. (2003). typical vs atypical disfluencies asha. Factors that contribute to the perception of overt stuttering severity include frequency, duration, effort, naturalness, and the ability of the person who stutters to communicate effectively and efficiently. Fluency refers to continuity, smoothness, rate, and effort in speech production. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. other developmental disorders (Briley & Ellis, 2018). American Journal of Speech-Language Pathology, 27(3S), 11391151. Measuring lexical diversity in children who stutter: Application of vocd. https://doi.org/10.1044/jshr.2804.495, Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Menzies, R. G., Onslow, M., & Rapee, R. M. (2016). ), Stuttering and related disorders of fluency (pp. Neurobiology of Disease, 69, 2331. Typical pneumonia is a form of community-acquired pneumonia that tends to have more serious symptoms. Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). There are two predominant types of atypical disfluencies: stuttering and cluttering. Journal of Communication Disorders, 44(3), 276293.
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