Symptoms and severity of stuttering and cluttering can vary (Davidow & Scott, 2017; St. Louis & Schulte, 2011). See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. Speech modification approaches to stuttering treatment in schools. https://doi.org/10.1044/ffd23.2.54, Plexico, L. W., Hamilton, M. B., Hawkins, H., & Erath, S. (2019). (1996). In E. G. Conture & R. F. Curlee (Eds. Stuttering typically has its origins in childhood. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). The ASHA Leader, 11(10), 621. This relationship is recognized as one of the common factors that account for the effectiveness of counseling (common factors theory; Wampold, 2001). These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. 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). Reducing negative reactions through desensitization and cognitive restructuring. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Strategies aimed at changing the timing and tension of speech production include. Erickson, S., & Block, S. (2013). It may occur only in specific situations, but it is more likely to occur in these situations, day after day. All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. Finding opportunities for social support for individuals with fluency disorders. American Journal of Speech-Language Pathology, 27(3S), 11111123. What are typical disfluencies? - Golderkey - Live News Breaking Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. Developing culturally and linguistically relevant intervention plans focused on helping the individual achieve more fluent speech and self-acceptance of disfluency, providing treatment, documenting progress, and determining appropriate dismissal criteria. Drayna, D., & Kang, C. (2011). Journal of Fluency Disorders, 11(2), 131149. (1993). These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. Sheehan, V. M., & Sisskin, V. (2001). 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. Journal of Fluency Disorders, 21(34), 201214. 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). St. Louis, K. O., & Flynn, T. W. (2018). Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). Prentice-Hall. Resilience has been examined in the stuttering literature as one factor that may protect people from the adverse effects of chronic stuttering (Craig et al., 2011; Freud & Amir, 2020). (2014). 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. https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). 1997- American Speech-Language-Hearing Association. discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting). Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). This law also applies to organizations that receive financial assistance from any federal department or agency. (2007). Bilingual myth-busters series when young children who stutter are also bilingual: Some thoughts about assessment and treatment. Wolk, L., Edwards, M. L., & Conture, E. G. (1993). Social anxiety disorder and stuttering: Current status and future directions. Journal of Speech, Language, and Hearing Research, 54(6), 14851496. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). Acquired neurogenic and psychogenic stuttering are not covered. The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. Cluttering: A synergistic framework. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. The ASHA Action Center welcomes questions and requests for information from members and non-members. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. Desensitization can help decrease word avoidance and reduce fear. Typical vs. Atypical Disfluencies: What Are the Differences? PLOS ONE, 10(7), Article e0133758. Counseling persons with communication disorders and their families. Journal of Fluency Disorders, 34(3), 187200. There is not enough epidemiological research to state specific risk factors for cluttering. Scope of practice in speech-language pathology [Scope of practice]. 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. ), Controversies about stuttering therapy (pp. https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. However, a preliminary prevalence study estimated the rate of cluttering to be between 1.1% and 1.2% of school-age children (Van Zaalen & Reichel, 2017). 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. What about those "atypical disfluencies?" - Stuttering Therapy Resources 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). https://doi.org/10.1080/2050571X.2016.1253533. 187214). What we know for now IN BRIEF. information regarding family, personal, and cultural perception of fluency. For students who stutter, the impact goes beyond the communication domain. We often use the term "emergent" to describe skills that are developing, but have not fully emerged. 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 treatment goals consistent with the ICF framework. A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. American Journal of Speech-Language Pathology, 26(4), 11051119. Similarities - Typical and Atypical Pneumonia 5. 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. Prevalence of speech disorders in elementary school students in Jordan. increasing the time provided for an oral reading or presentation, providing an alternative assignment to oral reading, and. Individuals who stutter may report fear or anxiety about speaking and frustration or embarrassment with the time and effort required to speak (Ezrati-Vinacour et al., 2001). https://doi.org/10.1044/2020_JSLHR-20-00096. 211230). 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). Genetic approaches to understanding the causes of stuttering. Their description details the characteristics of each stage, along with treatment goals and processes appropriate for each stage. https://doi.org/10.1016/j.jcomdis.2015.10.003. Pro-Ed. Journal of Fluency Disorders, 40, 3543. Stuttering-related podcasts: Audio-based self-help for people who stutter. Journal of Communication Disorders, 80, 1117. Mancinelli, J. M. (2019). Cengage Learning. BOBapp(2023) Counseling parents of children who stutter. Psychology Press. 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). consultation with and referral to other professionals as needed. Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Indicators of positive therapeutic change may include. Daly, D. A. Individuals are referred to a speech-language pathologist (SLP) for a comprehensive assessment when disfluencies are noted and when one or more of the factors listed below are observed along with the disfluencies. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Journal of Fluency Disorders, 37(4), 242252. Typical pneumonia is a form of community-acquired pneumonia that tends to have more serious symptoms. All speakers are disfluent at times. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). Barnes, T. D., Wozniak, D. F., Gutierrez, J., Han, T. U., Drayna, D., & Holy, T. (2016). 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). Psychology Press. For preschool children who stutter, parent and family involvement in the treatment process is essential, as is a home component (Kelman & Nicholas, 2020). Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. The term atypical has been applied to rapid atrial tachycardias with ECG patterns differing from the typical and reverse typical flutter described above, and also to re-entrant tachycardias with circuit configuration different from the typical RA flutter circuit, even if they have an ECG pattern similar to typical flutter. This model describes stages in the process of behavioral change, and it can be used to determine an individuals readiness to make a change. Brain, 136(12), 37093726. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. (2011). https://doi.org/10.1044/1058-0360(2003/070), Arenas, R. M., Walker, E. A., & Oleson, J. J. 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). Cluttering: A handbook of research, intervention and education. Journal of Fluency Disorders, 62, 105762. https://doi.org/10.1016/j.jfludis.2019.105726. Stuttering and work life: An interpretative phenomenological analysis. However, as they learn to reduce reactivity (see below), they develop greater comfort while speaking, they assume more positive attitudes about their ability to communicate, and they are better able to accept and manage moments of disfluency as they occur. 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. 3. https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. Roberts, P., & Shenker, R. (2007). 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. It is important to note that there are more clinical anecdotes than data to support this statement; further research on the incidence and prevalence of cluttering is needed (Scaler Scott, 2013). Assessment of stigma associated with stuttering: Development and evaluation of the Self-Stigma of Stuttering Scale (4S). (1988). 6396). Stuttering and bilingualism: A review. Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. (2001). (2019). Seminars in Speech and Language, 24(1), 2732. Many clinicians use an integration of approaches to achieve optimal outcomes. 1-888-266-0574. Posted at 23:22h . Evidence-based treatment and stutteringHistorical perspective. Maintenance of improved attitudes toward stuttering. In addition to being used for improving communication skills, pausing is also an effective method of rate control. Journal of Neurodevelopmental Disorders, 3(4), 374380. 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). Journal of Abnormal Psychology, 119(3), 479490. 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. Prior to developing generalization activities, the SLP needs to consider the individuals profile. Sheehan, J. G. (1970). These symptoms come suddenly and do need hospitalization. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). 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). You do not have JavaScript Enabled on this browser. https://doi.org/10.1016/0094-730X(88)90003-4. Reeves, L. (2006). (2013). Drayna and Kang (2011) found that gene mutations were present in close to 10% of cases of familial stuttering. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Journal of Fluency Disorders, 38(4), 311324. It is not appropriate to determine a standard score if the norming sample of the assessment is not representative of the individual being assessed. Atypical disfluency has been documented through case studies and has been described as final part-word repetition or "rhyme repetition". Conture, E. G. (2001). https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). 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. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. (2018). Individuals may exhibit pure cluttering or cluttering with stuttering (van Zaalen-Opt Hof et al., 2009). intellectual disability (Healey et al., 2005). Journal of Speech, Language, and Hearing Research, 60(9), 24832505. Clinicians may start with the client observing videos of others who stutter (or a puppet for children) to help them identify patterns, attitudes, and beliefs about communication and stuttering. Journal of Fluency Disorders, 32(2), 95120. 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). One study showed that children who clutter had 7.6 times more normal disfluencies compared to "atypical" disfluencies when they retold a story (van Zaalen et al., 2009). Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. Singular. Children with persistent stuttering showed deficiencies in left gray matter volume with reduced white matter integrity in the left hemisphere. Menu. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). 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. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Skip to main content. 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 . Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. ), Cluttering: Research, intervention and education (pp. typical vs atypical disfluencies asha. Van Borsel, J. 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). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. Differential treatment of stuttering in the early stages of development. Journal of Communication Disorders, 37(1), 3552. Evaluating stuttering in young children: Diagnostic data. The validity of reading assessment tools for children who stutter is questionable because it is difficult to differentiate the cause (decoding or stuttering) of oral reading fluency problems. https://doi.org/10.1016/j.jfludis.2015.08.001, Han, T.-U., Park, J., Domingues, C. F., Moretti-Ferreira, D., Paris, E., Sainz, E., Gutierrez, J., & Drayna, D. (2014). https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). See ASHAs resource on assessment tools, techniques, and data sources. (2016b). Time and expense are considerations along with attention to generalization and treatment needs following an intensive program (Cooper, 1979). Chronic problems associated with illness, injury, or other traumatic events can have a negative impact on an individuals emotional health and quality of life (e.g., Bonanno & Mancini, 2008). 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). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. Word-Final Disfluencies in a School-Age Child: Beneath the Tip of the https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). Adults who stutter may be dealing with years of shame or stigma (Boyle, 2013a), and they can experience elevated levels of negative mood states (e.g., interpersonal sensitivity and depressed mood) when compared to adults who do not stutter (Tran et al., 2011). These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). Human Brain Mapping, 38(4), 18651874. Language, Speech, and Hearing Services in Schools, 48(4), 234248. American Journal of Speech-Language Pathology, 28(1), 1428. Brain, 138(3), 694711. 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. Pro-Ed. The purpose of the screening is to identify individuals who require further speech-language assessment. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199. Treatment outcomes for bilingual children who stutter do not appear to be different from those of monolingual children who stutter (Shenker, 2011). Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. Genetic factors also may play a role in predicting the likelihood of persistence or recovery and, possibly, treatment outcomes (Frigerio-Domingues et al., 2019; Han et al., 2014). typical vs atypical disfluencies asha - giclee.lt Harper & Row. 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. Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). perceived communication and job barriers. Self-help and support groups for people with cluttering. ), Cluttering: A clinical perspective (pp. St. Louis, K. O., & Rustin, L. (1996). In J. C. Norcross & M. R. Goldfried (Eds. practice treatment targets with more listeners. Individuals may experience the impact of fluency disorders in social and emotional, academic, and vocational domains. the asha leader; journals. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Stuttering and reading fluency: Information for teachers [Brochure]. Stuttering More than 70 million people around the world struggle with stuttering, according to The Stuttering Foundation. Ingham, R. J., & Onslow, M. (1985). Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). Oxford University Press. Stuttering: Research and therapy. The primary provider of fluency treatment is the SLP. Signs and symptoms. Acceptance and Commitment Therapy for people who stutter. In contrast, children with reading disorders are likely to have difficulty decoding the printed form, which, in turn, has a negative impact on oral reading fluency (Kuhn & Stahl, 2003). Despite these challenges, some of the therapy that applies to adults can be just as effective with teens/adolescents. Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. Treatment is sensitive to cultural and linguistic factors and addresses goals within WHOs ICF framework (ASHA, 2016a; Coleman & Yaruss, 2014; WHO, 2001; Yaruss, 2007; Yaruss & Quesal, 2004, 2006).
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