Myers, F. L. (1992). 328). seizure disorders (Briley & Ellis, 2018). In D. Ward & K. Scaler Scott (Eds. Cluttering: A neurological perspective. This perceived rapid rateand the resulting breakdown in speech clarityis thought to be because speakers with cluttering speak at a rate that is too fast for their systems to handle (Myers, 1992; St. Louis et al., 2007; Ward, 2006). Journal of Speech, Language, and Hearing Research, 61(7), 16491663. Dosage refers to the frequency, intensity, and duration of treatment. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). PLOS ONE, 10(7), Article e0133758. Maintenance of improved attitudes toward stuttering. There are several indicators of positive therapeutic change. their reason for seeking treatment at the current time. Temperament, emotion, and childhood stuttering. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. 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). Stuttering as defined by adults who stutter. Singular. 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. Avoidance or escape behaviors may also be used and can temporarily conceal stuttering (Constantino et al., 2017; Douglass et al., 2019, 2018; B. Murphy et al., 2007; Starkweather, 1987; Tichenor et al., 2017; Tichenor & Yaruss, 2018, 2019a, 2019b, 2020). American Journal of Speech-Language Pathology, 7(4), 6276. Bilingual SLPs who have the necessary clinical expertise to assess the childand are familiar with the languages they speakmay not always be available. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. Journal of Communication Disorders, 80, 8191. The great psychotherapy debate: Models, methods, and findings. Sociodynamic relationships between children who stutter and their non-stuttering classmates. The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). Journal of Speech, Language, and Hearing Research, 62(12), 43564369. Egan, G. (2013). For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. In addition to being used for improving communication skills, pausing is also an effective method of rate control. 115134). These signs and symptoms are consistent with the diagnostic and associated features of childhood-onset fluency disorder (stuttering) listed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). The interview process and work environment can be challenging for individuals who stutter. https://doi.org/10.1044/1058-0360(2011/09-0102), Ntourou, K., Conture, E. G., & Walden, T. A. EBP Briefs, 2(4), 18. Brain, 138(3), 694711. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. Coleman, C. (2013). Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. ), Cluttering: A clinical perspective (pp. Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. A treatment plan that involves both speech and stuttering modification techniques may be necessary to achieve optimal outcomes. Journal of Fluency Disorders, 40, 3543. Journal of Fluency Disorders, 38(2), 6687. 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). Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. Journal of Fluency Disorders, 27(4), 289304. Early childhood stuttering for clinicians by clinicians. It applies protections to ensure that programs and employment environments are accessible and to provide aids and services necessary for effective communication in these settings. 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. Just as individuals may experience feelings of shame or fear associated with showing stuttering, individuals also may experience negative feelings associated with using speech modification strategies, which often make their speech sound different from natural speech (Ingham & Onslow, 1985; Martin et al., 1984). Wolk, L., Edwards, M. L., & Conture, E. G. (1993). https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. Treatment approaches are individualized based on the childs needs and family communication patterns. Examples of support groups and activities include FRIENDS: The National Association of Young People Who Stutter, the National Stuttering Association, and SAY: The Stuttering Association for the Young; online groups (e.g., online chats); and social media (e.g., blogs; Reeves, 2006). Rehabilitation Act of 1973, Section 504. Risk factors that may be associated with persistent stuttering include. Cluttering and autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Peer support for people who stutter: History, benefits, and accessibility. Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. (2017). 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. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Sheehan, J. G. (1970). ), Stuttering and related disorders of fluency (pp. Reducing negative reactions through desensitization and cognitive restructuring. 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. Perspectives on Fluency and Fluency Disorders, 23(2), 5469. The Lidcombe Program of early stuttering intervention: A clinicians guide. (1979). talking about stuttering or treatment of stuttering. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). In D. Ward & K. Scaler Scott (Eds. There is not enough epidemiological research to state specific risk factors for cluttering. 1997- American Speech-Language-Hearing Association. These symptoms come suddenly and do need hospitalization. https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). 142185). https://doi.org/10.1044/0161-1461.2602.162. Prevalence and trends of developmental disabilities among children in the United States: 20092017. (2011). Stuttering modification strategies, originated by Van Riper (1973), have four stages: (1) identification, (2) desensitization, (3) modification, and (4) generalization and aim to reduce associated physical tension and struggle by helping individuals. For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. They also can benefit from groups and intensive programs (Fry et al., 2014). Coworkers may have negative attitudes toward individuals who stutter, and the individual may feel excluded because of this. (2019). Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. https://doi.org/10.1016/S0094-730X(97)00008-9, Floyd, J., Zebrowski, P. M., & Flamme, G. A. Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. information regarding family, personal, and cultural perception of fluency. Screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation. 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). Differing perspectives on what to do with a stuttering preschooler and why. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). https://doi.org/10.1016/j.jfludis.2006.02.002. Universitetsforlaget. How Can You Tell if Childhood Stuttering is the Real Deal? - @ASHA White matter neuroanatomical differences in young children who stutter. When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Parental involvement is an integral part of any treatment plan for children who stutter. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. One of the core principles of ACT is mindfulness. increased social communication participation (Manning & DiLollo, 2018). (2018). Stuttering in relation to lexical diversity, syntactic complexity, and utterance length. using fillers (e.g., like, um, uh, you know); avoiding sounds or words (e.g., substituting words, inserting unnecessary words, circumlocution); and. Psychology Press. (2013). Trichon, M., & Tetnowski, J. Wampold, B. E. (2001). https://doi.org/10.4324/9781351122351, Klein, J. F., & Hood, S. B. 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). NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. Dosage depends largely on the nature of the treatment (e.g., direct, indirect), age group, and the task level (e.g., learning basic skills requires more clinic room practice than does generalization). (2011). increasing effective and efficient communication. Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. Language assessment and intervention for the learning disabled. Hearne, A., Packman, A., Onslow, M., & Quine, S. (2008). 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). Behavioural and Cognitive Psychotherapy, 23(4), 325325. Atypical disfluency has been documented through case studies and has been described as final part-word repetition or "rhyme repetition". Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Journal of Fluency Disorders, 43, 1727. Determination of individual strengths and coping strategies. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). 2335). https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. This relationship is recognized as one of the common factors that account for the effectiveness of counseling (common factors theory; Wampold, 2001). B. Setting refers to the location of treatment (e.g., home, community-based [including work settings], school environments, clinic room). 9099). Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. Counseling persons with communication disorders and their families. Epidemiology of stuttering in the community across the entire life span. What are typical disfluencies? - Golderkey - Live News Breaking 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. https://doi.org/10.1016/j.jfludis.2013.08.001, Briley, P. M., & Ellis, C. (2018). avoidance behaviors (i.e., avoidance of sounds, words, people, or situations that involve speaking); escape behaviors, such as secondary mannerisms (e.g., eye blinking and head nodding or other movements of the extremities, body, or face); and. Posted at 23:22h . 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. Social anxiety disorder in adults who stutter. Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). 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 . There may be a relationship between stuttering and working memory. ), Cluttering: Research, intervention and education (pp. Journal of Fluency Disorders, 25(1), 4757. Howell, P., & Davis, S. (2011). Methods in stuttering therapy for desensitizing parents of children who stutter. Journal of Fluency Disorders, 63, 105746. https://doi.org/10.1016/j.jfludis.2020.105746, Boyle, M. P., Milewski, K. M., & Beita-Ell, C. (2018). Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. Journal of Fluency Disorders, 32(2), 95120. https://doi.org/10.1055/s-2007-986528, Yaruss, J. S., Coleman, C., & Hammer, D. (2006). Guitar, B. Counseling is an integral part of the assessment and treatment of individuals who stutter or clutter. One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). These modifications are used regardless of whether a particular word is expected to be produced fluently. https://doi.org/10.1016/j.jfludis.2011.04.002, Foote, G. (2013). Van Borsel, J. Functional and neuroanatomical bases of developmental stuttering: Current insights. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Preus, A. A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). Genetic bases of stuttering: The state of the art, 2011. Van Borsel, J., Maes, E., & Foulon, S. (2001). What we know for now IN BRIEF. (2016b). Numerous treatment approaches and strategies have been developed in an attempt to help speakers reduce the negative reactions associated with stuttering (e.g., W. P. Murphy et al., 2007a). Adolescents also may be particularly susceptible to peer pressure and bullying at this time. is more open and willing to disclose and talk about their stuttering; experiences reduced impact from stuttering; generalizes attitudes, beliefs, and behaviors across contexts; reports feeling more authentic and enjoying social conversations; and. Clients often report successful stuttering therapy as a transformational experience progressing from avoidance to acceptance and openness, increasing self-confidence and self-efficacy (Plexico et al., 2005; Tichenor & Yaruss, 2019a). 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. Research updates in neuroimaging studies of children who stutter. Communication Disorders Quarterly, 6(1), 5059. Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. 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/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. An introduction to camps for children who stutter: What they are and how they can help. Acceptance; Constantino et al., 2017. Erickson, S., & Block, S. (2013). Evaluating stuttering in young children: Diagnostic data. 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. Thieme. Perspectives on Fluency and Fluency Disorders, 17(2), 49. 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. Psychology Press. by ; 2022 June 3; barbara "brigid" meier; 0 . Journal of Fluency Disorders, 38(4), 342355. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. 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). Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). Typical Disfluencies vs. Stuttering in Children. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. Shock, 2. https://doi.org/10.1044/cicsd_25_S_8, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2017). https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Therefore, when conducting an assessment with an adult, it is crucial to understand. Possible genetic factors in cluttering. frequency of exposure to all languages used by the child and their proficiency (comprehension and production) in each language; family history of stuttering or cluttering; description of disfluency and rating of severity; age of onset of disfluency and patterns of disfluency since onset (e.g., continuous or variable); previous fluency treatment and treatment outcomes; exploration of parental reactions to the childs moments of disfluency or speaking frustration; and. https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). Avoidance can lead to less talking and reduced linguistic complexity. 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). Perspectives on Fluency and Fluency Disorders, 11(1), 711. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). Assisting children who stutter in dealing with teasing and bullying. American Journal of Speech-Language Pathology, 26(4), 11051119. Abou, E. M., Saleh, M., Habil, I., El Sawy, M., & El Assal, L. (2015). Journal of Fluency Disorders, 36(4), 290295. Routledge. Daly, D. A. On the other hand, stuttering symptoms may decrease in more comfortable situations. 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). Donaher, J., & Richels, C. (2012). Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). Journal of Fluency Disorders, 36(1), 1726. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). SLPs counseling skills should be used specifically to help speakers improve their quality of life by minimizing the burden of their communication disorder. Individuals who stutter consistently report experiencing limitations, discrimination, and glass ceilinglike effects at their jobs and within their careers (Bricker-Katz et al., 2013; Cassar & Neilson, 1997; Klein & Hood, 2004). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). https://doi.org/10.1016/j.jfludis.2014.12.003. 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). Davidow, J. H., & Scott, K. A. Depression & Anxiety, 27(7), 687692. The SLP can use audio- or videoconferencing to augment this type of treatment. Prentice-Hall. Treatment approaches for preschool children who stutter include the following. 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. Perspectives on Fluency and Fluency Disorders, 1(4), 5569. Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). 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). ), Stuttering and related disorders of fluency (pp. Journal of Fluency Disorders, 49, 1328. Journal of Fluency Disorders, 53, 2640. When determining eligibility for speech and language services through the public school system, SLPs need to document the adverse educational impact of the disability using a combination of standardized test scores when available and a portfolio-based assessment (Coleman & Yaruss, 2014; Ribbler, 2006). autism spectrum disorder (Briley & Ellis, 2018). increasing the time provided for an oral reading or presentation, providing an alternative assignment to oral reading, and. (2005). Contemporary Issues in Communication Science and Disorders, 29(Spring), 91100. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. ), Controversies about stuttering therapy (pp. Journal of Fluency Disorders, 36(2), 122129. Psychology Press. (n.d.). For students who stutter, the impact goes beyond the communication domain. 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). Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. Genetic approaches to understanding the causes of stuttering. As children who stutter get older, they may become adept at word and situational avoidances that result in a low frequency of overt stuttering.
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