Cognitive restructuring can be combined with the desensitization strategies described above (W. P. Murphy et al., 2007a). The International Journal of Indian Psychology, 3(3), 7887. Miller, W. R., & Rollnick, S. (2013). 1-888-266-0574. Evidence-based treatment and stutteringHistorical perspective. I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike). Self-help conferences for people who stutter: A qualitative investigation. 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. 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. This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. Universitetsforlaget. Journal of Fluency Disorders, 37(4), 289299. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. The primary provider of fluency treatment is the SLP. In B. J. Amster & E. R. Klein (Eds. https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. 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). The impact of stuttering on employment opportunities and job performance. The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. Rocha, M., Yaruss, J. S., & Rato, J. R. (2019). Lippincott Williams & Wilkins. Seminars in Speech and Language, 24(1), 2732. Perspectives on Fluency and Fluency Disorders, 17(2), 49. 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). In D. Ward & K. Scaler Scott (Eds. Journal of Fluency Disorders, 40, 6982. American Journal of Speech-Language Pathology, 26(4), 11051119. Psychology Press. International Journal of Language & Communication Disorders, 49(1), 113126. Journal of Fluency Disorders, 35(3), 216234. https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. using indirect prompts rather than direct questions, recasting/rephrasing to model fluent speech or techniques (Millard et al., 2008; Yaruss et al., 2006), and. ; American Psychiatric Association, 2013). Journal of Fluency Disorders, 46, 114. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). 2335). Myers, F. L. (1992). Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. Research updates in neuroimaging studies of children who stutter. Mancinelli, J. M. (2019). In addition to being used for improving communication skills, pausing is also an effective method of rate control. It is also not unusual for disfluencies to be apparent and then seem to go away for a period of weeks or months only to return again. Early childhood stuttering for clinicians by clinicians. ASHA thanks the following individuals,who, in 2014, made significant contributions to the development of this content. With regard to cluttering, research is not far enough along to identify causes. Howell, P., & Davis, S. (2011). 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). American Journal of Speech-Language Pathology, 27(2), 721736. Stuttering: An integrated approach to its nature and treatment. One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). Guitar, B. Journal of Communication Disorders, 48, 3851. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199. Breakdowns in fluency and clarity can result from. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. ), Cluttering: A handbook of research, intervention and education (pp. Disclosure of stuttering and quality of life in people who stutter. Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Journal of Communication Disorders, 58, 4357. Sadness/Depression, 6. Impact of social media and quality of life of people who stutter. Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. A phenomenological analysis of the moment of stuttering. The person exhibits negative reactions (e.g., affective, behavioral, or cognitive reactions) to their disfluency. Journal of Speech, Language, and Hearing Research, 61(12), 28952905. School-age stuttering therapy: A practical guide. Reducing bullying through role-playing and self-disclosure. The plan outlines reasonable accommodations for speaking or reading activities to help ensure a students academic success and access to the learning environment in school. Prentice-Hall. The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. 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). https://doi.org/10.1016/j.jfludis.2006.02.002. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). Stuttering and speech naturalness. https://doi.org/10.1044/2019_JSLHR-S-18-0225. Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. Assessment of speech fluency (e.g., frequency, type, and duration of disfluencies), speech rate, speech intelligibility, and the presence of secondary behaviors in a variety of speaking tasks (e.g., conversational and narrative contexts). Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. Wiig, E. H., & Semel, E. M. (1984). For example, stuttering has been associated with higher levels of social anxiety in adults who stutter (Blumgart et al., 2010), and this can lead to fear and avoidance of social interaction (see Craig & Tran, 2006, for a review research on this topic). Journal of Communication Disorders, 80, 1117. However, increased mean length of utterance, more diverse vocabulary, and greater syntactic complexity have also been noted (Wagovich & Hall, 2017). Journal of Speech, Language, and Hearing Research, 61(5), 12381250. 147171). Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. The transtheoretical approach. Support (both giving and receiving) can be valuable for improving attitudes, boosting self-confidence, and reducing feelings of isolation (Yaruss et al., 2007). Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). 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). Scientific Reports, 7(1), 118. if monitoring or treatment (direct or indirect) is recommended. 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). Scope of practice in speech-language pathology [Scope of practice]. 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. their reason for seeking treatment at the current time. attention-deficit/hyperactivity disorder (Alm, 2011). Drayna, D. (2011). See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Erickson, S., & Block, S. (2013). Cluttering can co-occur with other disorders, including. There has been some documentation of the use of stuttering modification strategies to help those who clutter (Ward, 2006). (2020). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Young children may or may not verbalize their reactions to stuttering. . Long-term follow-up of self-modeling as an intervention for stuttering. https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). I ran out of cheese and bread the other day while making sandwiches and now Im out so I need to go to the store), and/or. Is parentchild interaction therapy effective in reducing stuttering? Social anxiety disorder and stuttering: Current status and future directions. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. intellectual disability (Healey et al., 2005). https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). Plural. https://doi.org/10.1055/s-2008-1064082, Caughter, S., & Crofts, V. (2018). Covert stuttering. (2004). Prevalence and trends of developmental disabilities among children in the United States: 20092017. Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). For example, an individual might elect to self-disclose in a workplace and educate coworkers about fluency disorders via a group presentation followed by a question-and-answer period. What do people search for in stuttering therapy: Personal goal-setting as a gold standard? Individuals who stutter are more likely to be self-aware about their disfluencies and communication, and they may exhibit more physical tension, secondary behaviors, and negative reactions to communication. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). 211230). typical vs atypical disfluencies asha typical vs atypical disfluencies asha. Journal of Fluency Disorders, 11(2), 131149. 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 . 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.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). Language intervention from a bilingual mindset. increasing acceptance and openness with stuttering. https://doi.org/10.1044/cicsd_25_S_8, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2017). On the other hand, stuttering symptoms may decrease in more comfortable situations. 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). Psychology Press. Journal of Fluency Disorders, 62, 105762. https://doi.org/10.1016/j.jfludis.2019.105726. Journal of Speech, Language, and Hearing Research, 56(5), 15171529. Aphasia. As children who stutter get older, they may become adept at word and situational avoidances that result in a low frequency of overt stuttering. 6396). Journal of Fluency Disorders, 36(2), 110121. https://doi.org/10.1016/j.jfludis.2012.11.002, Yaruss, J. S. (1997). Other disorders, such as apraxia of speech and/or articulation and phonological disorders, can affect speech intelligibility; assessment of speech production can be used to rule out these causes of reduced speech intelligibility. https://doi.org/10.1044/ffd16.1.15. The speech-language pathologist (SLP) uses linguistically and culturally appropriate stimuli and is sensitive to the unique values and preferences of each individual and their family to create a treatment plan (Sisskin, 2018). Journal of Fluency Disorders, 54, 113. deletion and/or collapsing of syllables (e.g., I wanwatevision). These modifications are used regardless of whether a particular word is expected to be produced fluently. Scaler Scott, K., & St. Louis, K. O. (2011). Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. 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). https://doi.org/10.1016/0094-730X(88)90004-6, Onslow, M., & OBrian, S. (2012). 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. When a bilingual clinician is not available, using an interpreter is a viable option. Self-help and mutual aid groups. 256276). The skilled helper: A problem-management and opportunity-development approach to helping. 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. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). These strategies help individuals learn about the speech mechanism and how it operates during both fluent and disfluent speech so they can modify it. https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). ), Cluttering: A clinical perspective (pp. Cluttering may have an effect on pragmatic communication skills and awareness of moments of disruption (Teigland, 1996). Building trust by following the students lead, finding out what experiences may be motivating, and bringing together peers for support are treatment options to consider (Hearne et al., 2008). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0190. With adults, initiation of treatment depends on the individuals previous positive or negative intervention experiences and current needs pertaining to their fluency and the impact of their fluency disorder on communication in day-to-day activities and participation in various settings (e.g., community or work). Clinical decision making in fluency disorders. Testing, and 7. Scope of Practice in Speech-Language Pathology, Counseling For Professional Service Delivery, interprofessional education/interprofessional practice [IPE/IPP], American Board of Fluency and Fluency Disorders, assessment tools, techniques, and data sources, assessment of fluency disorders in the context of the WHO ICF framework, assessment procedures: parallel with CPT codes, characteristics of typical disfluency and stuttering, Collaborating With Interpreters, Transliterators, and Translators, ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter, Speech Sound Disorders: Articulation and Phonology, treatment goals for fluency disorders in the context of the WHO ICF framework, What To Ask When Evaluating Any Procedure, Product, or Program, Counseling For Professional Service Deliver, Cognitive Distortions and Fluency Examples, Characteristics of Typical Disfluency and Stuttering, Early Identification of Speech, Language, and Hearing Disorders, How Can You Tell if Childhood Stuttering is the Real Deal, Assessment of Fluency Disorders In the Context of the WHO ICF Framework, Treatment Goals For Fluency Disorders in the Context of the WHO ICF Framework, Assessment Procedures: Parallel With CPT Codes, Private Health Plans: Tips and strategies for ensuring that speech and hearing services are covered, FRIENDS: The National Association of Young People Who Stutter, International Cluttering Association (ICA), SAY: The Stuttering Association for the Young, https://doi.org/10.1371/journal.pone.0133758, https://doi.org/10.1044/2020_PERSP-20-00014, https://doi.org/10.1016/j.jfludis.2019.105713, https://doi.org/10.1044/2018_AJSLP-17-0097, https://doi.org/10.1044/2017_JSLHR-S-16-0371, https://doi.org/10.1044/1092-4388(2008/046, https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199, https://doi.org/10.1044/1058-0360(2011/09-0102, https://doi.org/10.1044/1092-4388(2008/07-0057, www.asha.org/practice-portal/clinical-topics/fluency-disorders/, Connect with your colleagues in the ASHA Community, repetitions of sounds, syllables, and monosyllabic words (e.g., Look at the, prolongations of consonants when it isnt for emphasis (e.g., . Onset may be progressive or sudden. Potential neurological underpinnings of cluttering include dysregulation of the anterior cingulate cortex and the supplementary motor area (Alm, 2011) as well as increased activity in the basal ganglia and premotor cortex (Ward et al., 2015). The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). (2019). Folia Phoniatrica et Logopaedica, 64(1), 3447. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. This may progress to the client analyzing the clinicians or their own pseudostuttering, to analyzing a video of their own stuttering to real-time analysis (Bray & Kehle, 2001; Bray et al., 2003; Cream et al., 2010; Harasym et al., 2015; Prins & Ingham, 2009). Seminars in Speech and Language, 18(4), 371389. bringing peers into the treatment setting; planning strategies to use in the classroom, cafeteria, or playground or at work; taking outings to stores and other businesses; and. https://doi.org/10.1093/med:psych/9780195165791.003.0007, Proctor, A., Yairi, E., Duff, M., & Zhang, J. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). Enhancing treatment for school-age children who stutter: II. Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/, Multisyllabic whole-word and phrase repetitions, Secondary behaviors (e.g., eye blinks, facial grimacing, changes in pitch or loudness), Avoidance behaviors (e.g., reduced verbal output or word/situational avoidances). See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). 233253). Workplace in fluency management: Factoring the workplace into fluency management. Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. The ASHA Leader, 11(10), 621. Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. Cluttering and Down syndrome. In E. Conture & R. F. Curlee (Eds. In D. Ward & K. Scaler Scott (Eds. See ASHAs resource on assessment of fluency disorders in the context of the WHO ICF framework. Fluency: A review of developmental and remedial practices. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. 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. https://doi.org/10.1111/jpc.12034. 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. (2010). https://doi.org/10.1044/ffd22.1.34, Beilby, J. M., Byrnes, M. L., Meagher, E. L., & Yaruss, J. S. (2013). 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 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. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. https://doi.org/10.1044/ffd22.2.51, Berquez, A., & Kelman, E. (2018). The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. 187214). Journal of Fluency Disorders, 34(3), 187200. Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech.
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