increasing acceptance and openness with stuttering. The goals of treatment may be (a) to eliminate, greatly reduce, or help the child manage their stuttering and (b) to help them not develop negative emotional reactions related to their stuttering (H. S. Arnold et al., 2011; Yaruss et al., 2006). There are several indicators of positive therapeutic change. Language, Speech, and Hearing Services in Schools, 48(4), 234248. 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. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). The role of self-help/mutual aid in addressing the needs of individuals who stutter. https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Is parentchild interaction therapy effective in reducing stuttering? https://doi.org/10.1016/0094-730X(86)90028-8, St. Louis, K. O., & Hinzman, A. R. (1988). Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. Journal of Speech, Language, and Hearing Research, 36(5), 906917. Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). Sheehan, J. G. (1970). Language, Speech, and Hearing Services in Schools, 43(4), 536548. Emotional problems and parenting style do not cause stuttering. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. Multicultural issues in school settings. Human Brain Mapping, 38(4), 18651874. altering the size of the group or audience. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. Journal of Speech, Language, and Hearing Research, 62(12), 43354350. American Journal of Speech-Language Pathology, 26(4), 11051119. In addition to stuttering-like disfluencies and other typical disfluencies, the children with ASD also produced atypical disfluencies, which usually are not observed in children with typically developing speech or developmental stuttering. Please enable it in order to use the full functionality of our website. Operant treatment (e.g., Palin ParentChild Interaction Therapy, Kelman & Nicholas, 2020; Lidcombe Program, Onslow et al., 2003) incorporates principles of operant conditioning and uses a response contingency to reinforce the child for fluent speech and redirect disfluent speech (the child is periodically asked for correction). In E. Conture & R. F. Curlee (Eds. have a sense of belonging and experience less stigma. See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 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). See also ASHAs resources titled Person-Centered Focus on Function: Preschool Stuttering [PDF], Person-Centered Focus on Function: School-Age Stuttering [PDF], and Person-Centered Focus on Function: Adult Stuttering [PDF] for examples of assessment data consistent with the ICF framework. Scope of practice in speech-language pathology [Scope of practice]. Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.1044/sbi15.2.75, Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). https://doi.org/10.1044/2020_PERSP-20-00014. 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. St. Louis, K. O., Myers, F., Bakker, K., & Raphael, L. (2007). 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. Workplace in fluency management: Factoring the workplace into fluency management. Methods in stuttering therapy for desensitizing parents of children who stutter. Genetics and neurophysiology appear to be related to the underlying causes of stuttering. increasing self-confidence and self-efficacy. https://doi.org/10.1016/j.jfludis.2013.01.001. These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). Journal of Speech, Language, and Hearing Research, 61(5), 12381250. In H. H. Gregory, J. H. Campbell, C. B. Gregory, & D. G. Hill (Eds. Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). See ASHAs Practice Portal resource on Transitioning Youth. Scientific Reports, 7(1), 118. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. Through a process of identifying the assumptions underlying their thoughts, they can evaluate whether those thoughts are helpful (or valid) and ultimately adopt different assumptions or thoughts. the impact of communication impairments on, Relevant case history (as appropriate for age), including. However, these disfluencies are typical and not indicative of a disorder (Shenker, 2013). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. 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?). https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. For some people, the use of these behaviors can result in little or no observable stuttering. For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. other developmental disorders (Briley & Ellis, 2018). Cognitive restructuring can be combined with the desensitization strategies described above (W. P. Murphy et al., 2007a). Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). Features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder). typical vs atypical disfluencies asha. Childhood stuttering: Incidence and development. Measurement and modification of speech naturalness during stuttering therapy. Journal of Fluency Disorders, 53, 2640. Perspectives on Fluency and Fluency Disorders, 11(1), 711. Stuttering: An integrated approach to its nature and treatment. (2017). learning disabilities (Wiig & Semel, 1984). Journal of Fluency Disorders, 50, 7284. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. In fact, increased pausing alone may increase speech fluency and intelligibility for those who clutter (Scaler Scott & Ward, 2013). Journal of Fluency Disorders, 38(4), 311324. For a review of temperament, emotion, and childhood stuttering, see R. M. Jones, Choi, et al. Apply Now. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk. 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). 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). (2015). Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. Conture, E. G. (2001). Psychology Press. (2018). Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. Pediatrics, 121(2), 369375. Hearne, A., Packman, A., Onslow, M., & Quine, S. (2008). Parents can also learn about how to help their child generalize skills from the treatment room to different settings and with different people. Thieme. Journal of Fluency Disorders, 34(3), 187200. 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). 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. 1997- American Speech-Language-Hearing Association. Counseling persons with communication disorders and their families. Journal of Fluency Disorders, 29(4), 255273. Code of ethics [Ethics]. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). The impact of stuttering on employment opportunities and job performance. Time pressures for verbal communication and requirements to use the telephone may lead to stress and discomfort. You do not have JavaScript Enabled on this browser. 297325). https://doi.org/10.1044/gics4.2.57, Van Zaalen, Y., & Reichel, I. 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. Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. However, increased mean length of utterance, more diverse vocabulary, and greater syntactic complexity have also been noted (Wagovich & Hall, 2017). Brain, 131(1), 5059. 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). Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. 6989). Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Parents of bilingual children easily can be trained to provide perceptual ratings of fluency in any language spoken by the child (Shenker, 2013). discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting). In N. B. Ratner & J. Tetnowski (Eds. Perspectives on Fluency and Fluency Disorders, 16(1), 1517. Finding opportunities for social support for individuals with fluency disorders. (2019). Systems that govern self-regulation may underlie cluttering; qualitative interviews with those who clutter suggest that thoughts emerge before they are ready (Scaler Scott & St. Louis, 2011). Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. Universitetsforlaget. Journal of Fluency Disorders, 40, 6982. Parents can also report if secondary behaviors are present in both languages. Therefore, as with school-age children and adolescents, the purpose of the assessment for adults typically is not to diagnose stuttering. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). https://doi.org/10.1016/j.cub.2016.02.068, Beilby, J. M., & Byrnes, M. L. (2012). Early childhood stuttering therapy: A practical guide. Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. Journal of Fluency Disorders, 46, 114. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Specifically, mutations to GNPTAB, GNPTG, and NAGPA have been found to disrupt the signal that directs enzymes to their target location in the lysosome of the cell (Drayna & Kang, 2011). Effectiveness of intensive, group therapy for teenagers who stutter. (1979). Counseling individuals with fluency disorders and their families and providing education aimed at self-acceptance and reducing negative reactions (see ASHAs Practice Portal page on, Consulting and collaborating with individuals with fluency disorders, families, other professionals, peers, and other invested parties to identify priorities and build consensus on an intervention plan focused on functional outcomes (see ASHAs resources on. (1988). In D. Ward & K. Scaler Scott (Eds. They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. Stuttering is often more severe when there is increased pressure to communicate (e.g., competing for talk time, giving a report at school, talking on the telephone/during a video chat, or interviewing for a job). Psychology Press. Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. Acceptance and Commitment Therapy for people who stutter. In D. Ward & K. Scaler Scott (Eds. ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. (2011). Psychology Press. Pediatrics, 132(3), 460467. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. Stuttering Therapy Resources. Emotional reactivity and regulation in preschool-age children who stutter. Prevalence of speech disorders in elementary school students in Jordan. advertising through a classroom presentation with the guidance of the SLP or classroom teacher in the case of school-age children (W. P. Murphy et al., 2007b). It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. American Journal of Speech-Language Pathology, 27(3S), 11241138. https://doi.org/10.1542/peds.2019-0811, Zebrowski, P. M. (2002). Davidow, J. H., & Scott, K. A. (2019). Folia Phoniatrica et Logopaedica, 64(1), 3447. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use (2018). For students who stutter, the impact goes beyond the communication domain. See What To Ask When Evaluating Any Procedure, Product, or Program. St. Louis, K. O., & Flynn, T. W. (2018). Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Purpose Disfluencies associated with stuttering generally occur in the initial position of words. There is not enough epidemiological research to state specific risk factors for cluttering.

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