Allyn & Bacon. Allyn & Bacon. https://doi.org/10.1044/2019_PERS-SIG4-2019-0024, Boyle, M. P., & Gabel, R. (2020). Depending on the country and methodology used, rates were estimated to range from 1.03% (Abou et al., 2015) to 1.38% (Al-Jazi & Al-Khamra, 2015), but could be as high as 8.4% (Oyono et al., 2018). Seminars in Speech and Language, 37(3), 145152. See the Assessment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Erlbaum. Motivational interviewing: Helping people change. Direct treatment approaches can also target resilience and effort control in the child and family (Caughter & Crofts, 2018; Druker et al., 2019; Kraft et al., 2019). Repetitive negative thinking, temperament, and adverse impact in adults who stutter. 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. https://doi.org/10.1044/2017_JSLHR-S-16-0371, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2019). 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). Stuttering impact: A shared perception for parents and children. Multicultural identification and treatment of stuttering: A continuing need for research. Explore how typical and atypical disfluencies differ, and find resources for guidance and support. Education, 136(2), 159168. In contrast to adults who stutter, children who stutter did not show increases in white matter tracts in the right hemisphere (Chang et al., 2015). Journal of Fluency Disorders, 46, 114. My client isn't fluent - but is it stuttering? ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. Seminars in Speech and Language, 28(4), 312322. Desensitization strategies are strategies that help speakers systematically desensitize themselves to their fears about speaking and stuttering by facing those fears in structured, supportive environments. Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. In D. Ward & K. Scaler Scott (Eds. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Engaging parents in treatment helps to achieve carryover in the home environment and helps with treatment across languages (Shenker, 2013). Our primary goals were to identify patterns in overt features of WFDs and to extend our understanding of this clinical profile by focusing on aspects of . Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. Despite these challenges, some of the therapy that applies to adults can be just as effective with teens/adolescents. Fluency refers to continuity, smoothness, rate, and effort in speech production. Journal of Abnormal Psychology, 119(3), 479490. https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). Folia Phoniatrica et Logopaedica, 19. Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Scaler Scott, K. (2010). (2009). United States Department of Labor. Motivational interviewing may be used to help individuals who stutter better understand the thoughts and feelings associated with their stuttering and make positive changes to improve communication. by ; 2022 June 3; barbara "brigid" meier; 0 . Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). Neurophysiological factors that are thought to contribute to stuttering include the following: These neurophysiological findings should be interpreted with caution due to the small number of subjects and the heterogeneity of the methodologies used. 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. Ward, D., & Scaler Scott, K. (2011). Journal of Fluency Disorders, 38(4), 342355. 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). Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). Prior to developing generalization activities, the SLP needs to consider the individuals profile. Seminars in Speech and Language, 24(1), 2732. Clinical decision making in fluency disorders. Hill, D. (2003). This includes the impact on functional communication in key school situations and on quality of life (Beilby et al., 2012b; Yaruss et al., 2012). Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. Journal of Communication Disorders, 37(1), 3552. For example, when selecting reading passages, it may be difficult to determine the linguistic complexity of a text in a language unfamiliar to the clinician. American Journal of Speech-Language Pathology, 26(4), 11051119. Journal of Speech, Language, and Hearing Research, 62(5), 13711372. Cengage Learning. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Natural history of stuttering to 4 years of age: A prospective community-based study. Timing refers to the initiation of treatment relative to the diagnosis. Bowling Green State University Archive. For an accurate evaluation, it is ideal to collect samples of speech across various situations and tasks, both inside and outside the clinical setting (Yaruss, 1997). Language, Speech, and Hearing Services in Schools, 43(4), 536548. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Fluency and stuttering. The American Board of Fluency and Fluency Disorders, under the auspices of ASHAs specialty certification program, offers clinical specialty certification in fluency and fluency disorders. https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). https://doi.org/10.1016/S0021-9924(03)00052-2, Yaruss, J. S., & Quesal, R. W. (2006). Differences between children and adults should also be considered when interpreting data from neurological studies. Advances in Psychiatric Treatment, 12(1), 6368. https://doi.org/10.1044/2020_PERSP-20-00014. Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Language intervention from a bilingual mindset. ), The atypical stutterer: Principles and practices of rehabilitation (pp. In B. J. Amster & E. R. Klein (Eds. Atrial Flutter, Typical and Atypical: A Review | AER Journal 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). Scientific Reports, 7(1), 118. Journal of Fluency Disorders, 58, 94117. Fluency shaping with young stutterers. The great psychotherapy debate: Models, methods, and findings. However, even when children show little observable disfluency, they may still need treatment because of the negative impact of stuttering or cluttering on their lives. Assessment of awareness in young children of disfluencies and difficulty in speaking. Daly, D. A. 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. 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). In D. Ward & K. Scaler Scott (Eds. Pediatrics, 121(2), 369375. Treatment approaches for preschool children who stutter include the following. However, there is no evidence to support the idea that stuttering is caused by, or more prevalent in, bilingual or multilingual speakers or that exposure to a second language increases the risk for developing stuttering (Byrd, 2018). Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). https://doi.org/10.1542/peds.2012-3067, Ribbler, N. (2006). School Psychology Review, 30(1), 135141. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. Increasing the individuals awareness and self-monitoring skills helps to reduce unproductive behaviors that interfere with speech, and it may allow them to alter moments of stuttering so that they have decreased tension, are shorter, and are less disruptive to communication. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). 142185). Although cluttering and stuttering can co-occur, there are some important distinctions between the two (see Scaler Scott, 2010). Yaruss, J. S., & Quesal, R. W. (2004). 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. Neurobiology of Disease, 69, 2331. The Lidcombe Program of early stuttering intervention: A clinicians guide. 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. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). (2018). See What To Ask When Evaluating Any Procedure, Product, or Program. (1986). 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. Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. Managing cluttering: A comprehensive guidebook of activities. increasing acceptance and openness with stuttering. Routledge. Seminars in Speech and Language, 35(2), 6779. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Sheehan, V. M., & Sisskin, V. (2001). Understanding that awareness and concern about stuttering may vary across individuals and cultures and conducting a culturally and linguistically relevant comprehensive assessment. (2019). auditory processing disorders (Molt, 1996). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0189, Chakraborty, M., Chen, L.-F., Fridel, E. E., Klein, M. E., Senft, R. A., Sarkar, A., & Jarvis, E. D. (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?). This model describes stages in the process of behavioral change, and it can be used to determine an individuals readiness to make a change. Direct treatment approaches may include speech modification (e.g., reduced rate of speech, prolonged syllables) and stuttering modification strategies (e.g., modifying a stuttered word, pulling out of a stuttered word) to reduce disfluency rate, physical tension, and secondary behaviors (Hill, 2003). Rethinking covert stuttering. Advance online publication. 1997- American Speech-Language-Hearing Association. The ability to use speech strategies; to make choices to speak and participate, regardless of the level of fluency; and to take risks is greatly reduced outside of the treatment setting when time pressure and conditioned negative feelings may trigger fear and old behaviors. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. attention-deficit/hyperactivity disorder (Donaher & Richels, 2012; Lee et al., 2017). Nurturing a resilient mindset in school-aged children who stutter. The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. How stuttering develops: The multifactorial dynamic pathways theory. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. Journal of Speech, Language, and Hearing Research, 62(8), 26912702. https://doi.org/10.1044/2020_JSLHR-20-00096. When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. Counseling persons with communication disorders and their families. Temperamental characteristics of young children who stutter. For example, English language learners may have word-finding problems in the second language. Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). increasing the time provided for an oral reading or presentation, providing an alternative assignment to oral reading, and. Human Brain Mapping, 38(4), 18651874. SLPs may want to relate personal experiences when asking clients to share such vulnerable information. Palin ParentChild Interaction therapy: The bigger picture. The transtheoretical approach. https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. Limited research is available that identifies the causes of cluttering. 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. Thieme. In D. Ward & K. Scaler Scott (Eds. Symptoms and severity of stuttering and cluttering can vary (Davidow & Scott, 2017; St. Louis & Schulte, 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). These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). St. Louis, K. O., & Flynn, T. W. (2018). seizure disorders (Briley & Ellis, 2018). Impact experienced from stuttering, or covert features of stuttering, may include. (1982). (2011). Self-help and mutual aid groups. Self-report of self-disclosure statements for stuttering. Goals that focus on minimizing negative reactions to stuttering and difficulties communicating in various speaking situations may help the individual reduce the effort used to hide or avoid their disfluencies and communicate with more ease. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). There is ongoing debate as to whether persons who stutter have language skills that are equivalent to those seen in well-matched comparison speakers. For example, emotional reactivity/regulation and behavioral disinhibition may affect the childs ability to cope with disfluencies (Choi et al., 2013; Guttormsen et al., 2015; R. M. Jones, Conture, & Walden, 2014; Ntourou et al., 2013). Counseling is an integral part of the assessment and treatment of individuals who stutter or clutter. provide and receive support from others who share the experience of stuttering. Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. 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). Peer support for people who stutter: History, benefits, and accessibility. continued management (Plexico et al., 2005). 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). In D. Ward & K. Scaler Scott (Eds. (2010). What we know for now IN BRIEF. Effective counseling is important for encouraging individuals with a fluency disorder to share information in the affective, cognitive, and social domains. https://doi.org/10.1016/j.jfludis.2013.09.001, Boyle, M. P. (2015). Stuttering and cluttering. Psychology Press. Both procedures help the client decrease the sense of loss of control experienced during moments of stuttering by demonstrating their ability to stop and modify moments of stuttering, anxiety, and other emotional reactivity. (2016). Lower levels of overt stuttering do not directly relate to lower levels of psychological, emotional, social, or functional impacts experienced by the individual (Lucey et al., 2019; Tichenor & Yaruss, 2019a, 2020). Van Borsel, J., Maes, E., & Foulon, S. (2001). SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. (Eds.). Covert stuttering: Investigation of the paradigm shift from covertly stuttering to overtly stuttering. Starkweather, C. W. (1987). Lyn Goldberg and Michelle Ferketic served as ex officios. Genetics and neurophysiology appear to be related to the underlying causes of stuttering. Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. Self-help and support groups for people with cluttering. The individual learns strategies for generalization of skills to the classroom, workplace, and community. https://doi.org/10.1044/0161-1461(2012/11-0044), Yaruss, J. S., LaSalle, L. R., & Conture, E. G. (1998). Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. Perspectives on Fluency and Fluency Disorders, 11(1), 711. The ASHA Action Center welcomes questions and requests for information from members and non-members. 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. The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. A comprehensive assessment for persistent stuttering should include a self-assessment of the experience of stuttering. 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 . (2010). https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. A thematic analysis of late recovery from stuttering. Hearne, A., Packman, A., Onslow, M., & Quine, S. (2008). Menu. Depression & Anxiety, 27(7), 687692. Operant approaches operate within a framework of stuttering as a learned behavior (for a discussion, see Conture, 2001; de Sonneville-Koedoot et al., 2015, p. 334; Onslow & Yaruss, 2007). Erickson, S., & Block, S. (2013). Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders. Treatment should consider not just the overt stuttering behavior but also the affective and cognitive reactions to stuttering. 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). https://doi.org/10.1044/1092-4388(2013/12-0280), Boyle, M. P. (2013b). There is not enough epidemiological research to state specific risk factors for cluttering. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). All speakers are disfluent at times. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). minimizing the adverse impact of stuttering (Yaruss et al., 2012). Plural. (1981). Stuttering-related podcasts: Audio-based self-help for people who stutter. Counseling allows the clinician who works with those who stutter or clutter to practice within the ICF framework by targeting all aspects of the disordernot just the surface behaviors. Cluttering may have an effect on pragmatic communication skills and awareness of moments of disruption (Teigland, 1996). 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). 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).
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