Scaler Scott, K. (2013). Guttormsen, L. S., Kefalianos, E., & Nss, K. A. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Potential risk factors for cluttering include the following: Information is varied and conflicting regarding the exact relationship between bilingualism and disfluencies (Tellis & Tellis, 2003; Van Borsel et al., 2001). Stuttering More than 70 million people around the world struggle with stuttering, according to The Stuttering Foundation. 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). omission of word endings (e.g., Turn the televisoff). Long-term follow-up of self-modeling as an intervention for stuttering. Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. Cluttering: A neurological perspective. https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Journal of Fluency Disorders, 44, 3245. Impact of stuttering severity on adolescents domain-specific and general self-esteem through cognitive and emotional mediating processes. Assessment of awareness in young children of disfluencies and difficulty in speaking. https://doi.org/10.1044/2017_JSLHR-S-16-0343, Snsterud, H., Feragen, K. B., Kirmess, M., Halvorsen, M. S., & Ward, D. (2019). Helping individuals who stutter become more accepting and open about their stuttering may help them have workplace conversations about it, advocate for themselves, and build support systems within the workplace (Plexico et al., 2019). https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. Measurement and modification of speech naturalness during stuttering therapy. 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). Apply Now. Fluency Disorders (Practice Portal). When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. American Psychiatric Association. 4. Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. The creative process in avoidance reduction therapy for stuttering. production of words with an excess of physical tension or struggle. Assessment of stigma associated with stuttering: Development and evaluation of the Self-Stigma of Stuttering Scale (4S). Journal of Speech, Language, and Hearing Research, 36(5), 906917. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). talking about stuttering or treatment of stuttering. Sheehan, V. M., & Sisskin, V. (2001). The Stuttering Foundation We provide free online resources, services and support to those who stutter and their families, as well as support for research into the causes of stuttering. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). There has been some documentation of the use of stuttering modification strategies to help those who clutter (Ward, 2006). The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. Communication Disorders Quarterly, 6(1), 5059. 155192). Stuttering and bilingualism: A review. Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. 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. For a review of temperament, emotion, and childhood stuttering, see R. M. Jones, Choi, et al. Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). Barnes, T. D., Wozniak, D. F., Gutierrez, J., Han, T. U., Drayna, D., & Holy, T. (2016). One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). Thieme. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Journal of Fluency Disorders, 54, 113. 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). Acquired neurogenic and psychogenic stuttering are not covered. Language, Speech, and Hearing Services in Schools, 49(1), 13. See ASHAs Practice Portal page on Cultural Responsiveness. These are called typical disfluencies or nonfluencies. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. 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., . The role of self-help/mutual aid in addressing the needs of individuals who stutter. ), Cluttering: A clinical perspective (pp. Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Neurobiology of Disease, 69, 2331. 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). 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). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. 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). 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). It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. For some people, the use of these behaviors can result in little or no observable stuttering. 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. The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. Children with normal disfluencies have emergent fluency. Appropriate roles for SLPs include the following: As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so. https://doi.org/10.1016/j.jfludis.2013.09.003, Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). Journal of Fluency Disorders, 21(34), 201214. (1981). St. Louis, K. O., Myers, F., Bakker, K., & Raphael, L. (2007). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199. Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words and interjections (such as um and well). Journal of Neurodevelopmental Disorders, 3(4), 374380. Enhancing treatment for school-age children who stutter: II. Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. A phenomenological analysis of the moment of stuttering. Stuttering and cluttering. 297325). Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). The social and communication impact of stuttering on adolescents and their families. the individuals lived experiences with stuttering, the perceived impact of these experiences with stuttering, and. Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency. https://doi.org/10.1016/j.jfludis.2007.02.001. A study of pragmatic skills of clutterers and normal speakers. Individuals and families may have a wide range of beliefs about the best way to treat fluency disorders, ranging from medical and therapeutic intervention to prayer. Mancinelli, J. M. (2019). Engaging parents in treatment helps to achieve carryover in the home environment and helps with treatment across languages (Shenker, 2013). excessive coarticulation resulting in the collapsing and/or deletion of syllables and/or word endings; excessive disfluencies, which are usually of the more nonstuttering type (e.g., excessive revisions and/or use of filler words, such as um); pauses in places typically not expected syntactically; unusual prosody (often due to the atypical placement of pauses rather than a pedantic speaking style, as observed in many with autism spectrum disorder). Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. 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 Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. The Neuroscientist, 25(6), 566582. Quick: Talk fast & dont stutter! Onslow, M., & Yaruss, J. S. (2007). Perspectives on Fluency and Fluency Disorders, 23(2), 5469. Evidence-based treatment and stutteringHistorical perspective. Stuttering in school-age children: A comprehensive approach to treatment. Perspectives on Fluency and Fluency Disorders, 11(1), 711. Treatment outcomes for bilingual children who stutter do not appear to be different from those of monolingual children who stutter (Shenker, 2011). Speech modification approaches to stuttering treatment in schools. Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). In E. G. Conture & R. F. Curlee (Eds. Other speech or language concerns are also present. Oxford University Press. Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. 147171). Treatment for adolescents who stutter poses a particular challenge because of the issues related to this developmental stage. https://doi.org/10.1016/j.jfludis.2016.07.002, Iverach, L., & Rapee, R. M. (2014). The role of effortful control in stuttering severity in children: Replication study. Approximately 88%91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013). 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. Disclosing a fluency disorder may be done a number of ways, such as verbally stating I stutter/have a speech disorder or by pseudostuttering or openly stuttering, while doing so confidently (McGill et al., 2018). Fluency: A review of developmental and remedial practices. 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. Application of the ICF in fluency disorders. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. https://doi.org/10.1044/2020_JSLHR-20-00096. In addition to being used for improving communication skills, pausing is also an effective method of rate control. Journal of Speech, Language, and Hearing Research, 61(12), 28952905. Prentice-Hall. Group experiences and individual differences in stuttering. https://doi.org/10.1192/apt.12.1.63, Craig, A., & Tran, Y. Fear of speaking: Chronic anxiety and stammering. Children who stutter may demonstrate poorer expressive lexical skills compared to their peers (Silverman & Bernstein Ratner, 2002). (2018). Seminars in Speech and Language, 35(2), 6779. (1979). https://doi.org/10.1016/j.jfludis.2017.06.001. Thieme. B. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). Some children who stutter or clutter may only experience symptoms situationally. American Journal of Speech-Language Pathology, 27(2), 721736. Journal of Fluency Disorders, 29(4), 255273. More recently, CBT and mindfulness have been applied to stuttering therapy and may support that CBT+mindfulness is more beneficial to clients who stutter than CBT alone (Gupta et al., 2016; Harley, 2018). https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). Clinicians do not have to choose one approach or the other. Behavioural and Cognitive Psychotherapy, 23(4), 325325. Yaruss, J. S., & Pelczarski, K. M. (2007). Evaluating stuttering in young children: Diagnostic data. Disclosure of stuttering and quality of life in people who stutter. Cluttering can co-occur with other disorders, including. In N. B. Ratner & J. Tetnowski (Eds. Pro-Ed. https://doi.org/10.1016/j.jfludis.2010.07.001. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/. (2015). Multilingual children who stutter: Clinical issues. Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. ASHA also extends its gratitude to the following subject matter experts who were involved in the reviewand development of thispage: In addition, ASHA thanks the members of the Steering Committee of ASHAs Special Interest Division on Fluency and Fluency Disorders (Division 4) whose work preceded this content. Alm, P. A. 157186). Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. https://doi.org/10.1055/s-0034-1371755, Jones, R. M., Conture, E. G., & Walden, T. A. Clinicians can help clients progress to active stages through building self-efficacy. Typical disfluencies often resolve by age five and tend to cycle, meaning they come and go. However, the clinician needs to consider the impact of disfluency on communication and quality of life as a whole. This results in less effective social interactions. https://doi.org/10.1016/S0094-730X(01)00098-5. Molecular Genetics & Genomic Medicine, 5(2), 95102. Donaher, J., & Richels, C. (2012). An introduction to camps for children who stutter: What they are and how they can help. See ASHAs resource on assessment tools, techniques, and data sources. Providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. Research updates in neuroimaging studies of children who stutter. Mild stuttering, on the other hand, tends to appear more regularly. Adolescents and young adults who stutter were found to have more white matter connections in the right hemisphere as compared with normally fluent controls (Watkins et al., 2008). Genetic approaches to understanding the causes of stuttering. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. (1984). Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering. In R. Lees & C. Stark (Eds. https://doi.org/10.1017/CBO9781139108683.023. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering. The presence of at least 1 disabling developmental condition was 5.5 times higher in CWS [children who stutter] when compared to children who do not stutter (Briley & Ellis, 2018, p. 2895). 9099). (1982). Typical childhood disfluencies may increase and decrease without any external influence. Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). Measuring lexical diversity in children who stutter: Application of vocd. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). Perspectives on Fluency and Fluency Disorders, 16(1), 1517. As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. For example, clinicians may use treatment strategies to reduce bullying through desensitization exercises and by educating the individuals peers about stuttering (W. P. Murphy et al., 2007a, 2007b). (2018). It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. Board Certified Specialists in Fluency are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with fluency disorders. A comprehensive fluency assessment typically includes the following: See ASHAs resource on assessment procedures: parallel with CPT codes for a breakdown of pre-evaluation, intra-service, and post-service procedures. Tallying has the client stop directly after a moment of stuttering to tally or bring awareness to it while not attempting to escape by continuing to talk. practice monitoring each others speech and secondary behaviors. Psychology Press. (1986). One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). Therefore, when conducting an assessment with an adult, it is crucial to understand. Prevalence of stuttering in primary school children in Cairo-Egypt. Denial, 3. Seminars in Speech and Language, 24(1), 2732. Scaler Scott, K., & Ward, D. (2013). Building clinical relationships with teenagers who stutter. However, fluency shaping approaches, such as easy onset or continuous phonation, may not be appropriate for the treatment of cluttering. Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. educates the individual who stutters and their family members about stuttering and communication and. https://doi.org/10.1016/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. Psychology Press. Perspectives on Fluency and Fluency Disorders, 4(6), 13161326. Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. It is not appropriate to determine a standard score if the norming sample of the assessment is not representative of the individual being assessed. Strategies for reducing impairment in body function have been separated into two categoriesspeech modification and stuttering modification, both of which are described below. 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. Clinical characteristics associated with stuttering persistence: A meta-analysis. Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. It is important that parents and clinicians acknowledge and respond to a childs verbal and nonverbal reactions in a supportive manner; this helps to minimize the likelihood that the child will develop negative reactions to stuttering. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). In addition, clinicians need to avoid using religious or highly familiar texts that individuals may know by rote. Seminars in Speech and Language, 28(4), 312322. Management of childhood stuttering. See ASHAs Practice Portal pages on Counseling For Professional Service Delivery and Cultural Responsiveness for more information related to counseling. The purpose of assessing fluency in a preschool child is to determine. Other identification strategies may include video or pseudostuttering analysis or tallying/freezing. The clutterer. Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery.
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