https://doi.org/10.1016/j.jcomdis.2015.10.003. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. They are likely to use interjections, repeat phrases, and revise what they are saying. Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. Stuttering and its treatment in adolescence: The perceptions of people who stutter. Lippincott Williams & Wilkins. (2019). ), Cluttering: Research, intervention and education (pp. St. Louis, K. O., & Rustin, L. (1996). Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Effortful control, an aspect of temperament that supports self-regulation, may be predictive of stuttering severity and may facilitate positive change in treatment (Kraft et al., 2019). Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. Differential treatment of stuttering in the early stages of development. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. It is not appropriate to determine a standard score if the norming sample of the assessment is not representative of the individual being assessed. Sociodynamic relationships between children who stutter and their non-stuttering classmates. American Journal of Speech-Language Pathology, 28(1), 1428. (2006). Sadness/Depression, 6. It is not possible to determine with certainty which children will continue to stutter, but there are some factors that indicate a greater likelihood that stuttering will become chronic. 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. https://doi.org/10.1044/leader.FTR2.19072014.44, American Speech-Language-Hearing Association. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). ), Stuttering and related disorders of fluency (pp. SIG 16 Perspectives on School-Based Issues, 15(2), 7580. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. The individual who stutters becomes desensitized to their fears by performing activities (e.g., self-disclosing, going to a place where they fear speaking) using a fear hierarchy. This hierarchy represents situations or activities that range from low risk to high risk. Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. For example, English language learners may have word-finding problems in the second language. seizure disorders (Briley & Ellis, 2018). https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. Journal of Communication Disorders, 80, 8191. Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). 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). National Stuttering Association. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). (2010). ), Current issues in stuttering research and practice (pp. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. However, fluency shaping approaches, such as easy onset or continuous phonation, may not be appropriate for the treatment of cluttering. Seminars in Speech and Language, 24(1), 2732. Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Disclosing a fluency disorder has many benefits on both the speaker (Boyle & Gabel, 2020; Boyle et al., 2018; Mancinelli, 2019) and the listener (Byrd, Croft, et al., 2017; Byrd, McGill, et al., 2017; Ferguson et al., 2019; Healey et al., 2007). https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. Seminars in Speech and Language, 35(2), 6779. (1979). https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). altering the size of the group or audience. https://doi.org/10.1016/j.jfludis.2014.12.002, Boyle, M. P., Beita-Ell, C., & Milewski, K. M. (2019). Support (both giving and receiving) can be valuable for improving attitudes, boosting self-confidence, and reducing feelings of isolation (Yaruss et al., 2007). The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). They also can benefit from groups and intensive programs (Fry et al., 2014). A range of studies support a genetic predisposition for stuttering, but no definitive findings have been made regarding which transmission model, chromosomes, genes, or sex factors are involved in the expression of stuttering in the population at large (Kraft & Yairi, 2011, p. 34). Clinical implications of situational variability in preschool children who stutter. Barnes, T. D., Wozniak, D. F., Gutierrez, J., Han, T. U., Drayna, D., & Holy, T. (2016). The specific strategy they select will depend on when the client catches the disfluencyin anticipation of the moment of disfluency, in the moment, or following the moment (Van Riper, 1973). The ASHA Action Center welcomes questions and requests for information from members and non-members. These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). reports changing conception of stuttering from exclusively negative to having positive features. The Lidcombe Program of early stuttering intervention: A clinicians guide. Genetics and neurophysiology appear to be related to the underlying causes of stuttering. As children who stutter get older, they may become adept at word and situational avoidances that result in a low frequency of overt stuttering. Evidence-based treatment and stutteringHistorical perspective. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). It is important to distinguish stuttering from other possible diagnoses (e.g., language formulation difficulties, cluttering, and reading disorders) and to distinguish cluttering from language-related difficulties (e.g., word finding and organization of discourse) and other disorders that have an impact on speech intelligibility (e.g., apraxia of speech and other speech sound disorders). https://doi.org/10.1016/j.jfludis.2016.09.005, Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). International Classification of Functioning, Disability and Health. Journal of Fluency Disorders, 25(1), 4757. the asha leader; journals. Application of the ICF in fluency disorders. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. (2017). 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). https://doi.org/10.1542/peds.2019-0811, Zebrowski, P. M. (2002). 178196). University Park Press. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Children with normal disfluencies have emergent fluency. 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 Menu. Section 504 of the Rehabilitation Act of 1973 (United States Department of Labor, n.d.) protects qualified individuals from discrimination based on their disability via a 504 plan. Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Yaruss, J. S., & Pelczarski, K. M. (2007). Journal of Communication Disorders, 37(1), 3552. 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). https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). (2014). https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. In F. L. Myers & K. O. St. Louis (Eds. Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). (2018). Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Human Brain Mapping, 38(4), 18651874. Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering. The creative process in avoidance reduction therapy for stuttering. Empirical research on whether bilingual individuals who stutter are more disfluent in one language than the other is sparse and based on small case studies (Tellis & Tellis, 2003), but many bilingual individuals who stutter report this to be the case (Nwokah, 1988). The Journal of Child Psychology and Psychiatry, 43(7), 939947. This model describes stages in the process of behavioral change, and it can be used to determine an individuals readiness to make a change. 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). https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). Journal of Fluency Disorders, 54, 113. Fluency disorders do not necessarily affect test scores or subject grades. International Journal of Language & Communication Disorders, 49(1), 113126. One example of an approach that incorporates cognitive restructuring is Acceptance and Commitment Therapy (ACT; Beilby & Brynes, 2012; Beilby et al., 2012a; Palasik & Hannan, 2013). https://doi.org/10.1002/mgg3.276, Frigerio-Domingues, C. E., Gkalitsiou, Z., Zezinka, A., Sainz, E., Gutierrez, J., Byrd, C., Webster, R., & Drayna, D. (2019). For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). Childhood stuttering: Incidence and development. the impact of communication impairments on, Relevant case history (as appropriate for age), including. Counseling begins with active listening and continues with microskills (Egan, 2013) that emphasize attending, showing empathy, demonstrating shared interest in the individual/family, and working to build trust. Cognitive restructuring can be combined with the desensitization strategies described above (W. P. Murphy et al., 2007a). Plural. However during treatment and forming a new, more congruent identity, clients may progress through some of the stages of grief (e.g., 1. increased social communication participation (Manning & DiLollo, 2018). https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). 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. The Neuroscientist, 25(6), 566582. 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 . 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. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). 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. slower rates of language development (Leech et al., 2017, 2019) or co-occurring speech and language impairment (Ntourou et al., 2011; Yaruss et al., 1998). Avoidance or escape behaviors may also be used and can temporarily conceal stuttering (Constantino et al., 2017; Douglass et al., 2019, 2018; B. Murphy et al., 2007; Starkweather, 1987; Tichenor et al., 2017; Tichenor & Yaruss, 2018, 2019a, 2019b, 2020). This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). American Journal of Speech-Language Pathology, 26(4), 11051119. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Onslow, M., Packman, A., & Harrison, E. Journal of Fluency Disorders, 29(4), 255273. Journal of Fluency Disorders, 38(1), 1429. Testing, and 7. Communication Disorders Quarterly, 39(2), 335345. Thieme. May 11, 2022 As a speech-language pathologist, you might often face the question of whether a young child is showing early signs of stuttering, or if those disruptions are simply typical speech disfluencies. (2018). 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). Differing perspectives on what to do with a stuttering preschooler and why. These simulations and applications of strategies might be most likened to cancellation and pull-out techniques used in stuttering. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). https://doi.org/10.1044/2020_JSLHR-20-00096. The individual learns strategies for generalization of skills to the classroom, workplace, and community. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. Some children who stutter or clutter may only experience symptoms situationally. "Atypical" disfluencies include: sound repetitions ("s-s-s-so"); syllable repetitions ("be-be-be-be-because"); prolongations ("Aaaaaaaaaaaaand"); and https://doi.org/10.1016/j.jfludis.2006.12.003. The scope of this page includes stuttering and cluttering across the life span. Journal of Speech, Language, and Hearing Research, 45(6), 10971105. Screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation. Bilingual SLPs who have the necessary clinical expertise to assess the childand are familiar with the languages they speakmay not always be available. Avoidance can lead to less talking and reduced linguistic complexity. https://doi.org/10.1016/j.jfludis.2014.12.003. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). Individuals may experience stuttering in different ways with siblings, their spouse, or other family members. 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. American Psychiatric Association. (2016a). Van Borsel, J. (2013). It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. typical vs atypical disfluencies asha 24 Jun. Journal of Speech, Language, and Hearing Research, 52(1), 254263. reducing secondary behaviors and minimizing avoidances. 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). 255279). 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). If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. Treatment approaches are individualized based on the childs needs and family communication patterns. Identifying subgroups of stutterers (No. Communication Disorders Quarterly, 6(1), 5059. The ASHA Action Center welcomes questions and requests for information from members and non-members. Stuttering Therapy Resources. In B. J. Amster & E. R. Klein (Eds. 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. Signs and symptoms of stuttering include core speech behaviors, such as. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). Prior to developing generalization activities, the SLP needs to consider the individuals profile. There may be a relationship between stuttering and working memory. Starkweather, C. W. (1987). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. This perceived rapid rateand the resulting breakdown in speech clarityis thought to be because speakers with cluttering speak at a rate that is too fast for their systems to handle (Myers, 1992; St. Louis et al., 2007; Ward, 2006). Howell, P., & Davis, S. (2011). These are called typical disfluencies or nonfluencies. These modifications are used to facilitate speech fluency and may include. The social and communication impact of stuttering on adolescents and their families. See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Technological advances and the expansion of social media outlets have increased opportunities for adults who stutter to connect, share, and gain information through the Internet (Fuse & Lanham, 2016; Raj & Daniels, 2017) and stuttering-related podcasts (Dignazio et al., 2020). Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). Journal of Paediatrics and Child Health, 49(2), E112E115. https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). Journal of Fluency Disorders, 32(2), 121138. Consider the individuals age, preferences, and needs within the context of family and community when selecting and adapting treatment approaches and materials. Breakdowns in fluency and clarity can result from. American Journal of Speech-Language Pathology, 29(1), 201215. School-based SLPs and IEP teams should resist pressure to minimize the impact of stuttering on educational achievement for the purpose of disqualifying students from speech-language pathology services.