St. Louis, K. O., & Flynn, T. W. (2018). A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). Overheard: Bilingual and disfluent: A unique treatment challenge. 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. 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). (2013). Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). Coexistence of stuttering and disordered phonology in young children. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). https://doi.org/10.1016/j.jfludis.2010.07.001. Hill, D. (2003). (2001). the diagnosis of a fluency disorder (stuttering, cluttering, or both); a differential diagnosis between fluency disorders and reading disorders, language disorders, and/or speech sound disorders; descriptions of the characteristics and severity of the fluency disorder; judgments on the degree of impact the fluency disorder has on verbal communication and quality of life; a determination if the person will benefit from treatment; a determination of adverse educational, social, and vocational impact; parent or family counseling to determine optimal responses to the childs speech and stuttering; and. These should be considered during differential diagnosis but should not be the sole therapeutic strategies. In addition to being used for improving communication skills, pausing is also an effective method of rate control. Journal of Fluency Disorders, 61, 105713. https://doi.org/10.1016/j.jfludis.2019.105713, Douglass, J. E., Schwab, M., & Alvarado, J. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). However, a school-age child or adolescent who stutters may not report their experience accurately, possibly due to a lack of awareness or a desire to appease the clinician (Adriaensens et al., 2015; Erickson & Block, 2013). ), Controversies about stuttering therapy (pp. The SLP can use audio- or videoconferencing to augment this type of treatment. Journal of Speech and Hearing Disorders, 50(3), 261281. Parental involvement is an integral part of any treatment plan for children who stutter. Journal of Fluency Disorders, 22(3), 219236. advertising through a classroom presentation with the guidance of the SLP or classroom teacher in the case of school-age children (W. P. Murphy et al., 2007b). Assisting children who stutter in dealing with teasing and bullying. Journal of Fluency Disorders, 43, 1727. However, even when children show little observable disfluency, they may still need treatment because of the negative impact of stuttering or cluttering on their lives. One example of an approach that incorporates cognitive restructuring is Acceptance and Commitment Therapy (ACT; Beilby & Brynes, 2012; Beilby et al., 2012a; Palasik & Hannan, 2013). https://doi.org/10.1044/1058-0360.0202.65. The ASHA Leader, 11(10), 621. Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). (2017). ), Cluttering: Research, intervention and education (pp. Early childhood stuttering for clinicians by clinicians. For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Emotional reactivity, regulation and childhood stuttering: A behavioral and electrophysiological study. This results in less effective social interactions. American Journal of Speech-Language Pathology, 28(1), 1428. This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. These include when the individual who stutters. 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). Stuttering: Its nature, diagnosis, and treatment. The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. Plural. Self-efficacy is a positive belief in ones own ability to successfully accomplish a set goal that is task dependent, which comes from (a) past experiences of mastery, (b) vicarious experiences, (c) verbal persuasion, and (d) emotional/physical states (Boyle, 2013a, 2013b, 2015; Boyle et al., 2018; Carter et al., 2017). ), Stuttering and related disorders of fluency (pp. https://doi.org/10.1016/j.jfludis.2010.12.003. Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. Dosage refers to the frequency, intensity, and duration of treatment. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Stuttering and speech naturalness. The assignments begin in supportive, low-fear situations and slowly evolve to more challenging situations and settings as the individual demonstrates the ability to accept or tolerate potential negative reactions. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). may show increased disfluency rates (decreased reading fluency) because they cannot change the words to avoid moments of stuttering as easily as they can in conversation, and. Person- and family-centered practice offers a range of services, including counseling and emotional support, procuring information and resources, coordinating services, teaching specific skills to facilitate communication, and advocating for or with the individual and their family. With this approach, parents are trained to provide verbal contingencies based on whether a childs speech is fluent or stuttered (M. Jones et al., 2005; Onslow et al., 2003). See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. Direct treatment approaches may include speech modification (e.g., reduced rate of speech, prolonged syllables) and stuttering modification strategies (e.g., modifying a stuttered word, pulling out of a stuttered word) to reduce disfluency rate, physical tension, and secondary behaviors (Hill, 2003). https://doi.org/10.1111/jpc.12034. Bilingual children are assessed in both languages to determine stuttering profiles in both (Finn & Cordes, 1997). 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). In addition, clinicians need to avoid using religious or highly familiar texts that individuals may know by rote. Understanding and treating cluttering. BMJ, 331(7518), 659661. Estimates have reported the male-to-female ratio of individuals who stutter to be as large as 4:1; however, more recent studies in preschool children suggest that a younger age of onset has smaller ratios in gender differences (Yairi & Ambrose, 2013). Efforts to conceal stuttering may adversely affect quality of life (Boyle et al., 2018). https://doi.org/10.1016/j.jfludis.2006.12.003. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). 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. Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. Introduction: The importance of the social, emotional, and cognitive dimensions of stuttering. Atypical disfluency has been documented through case studies and has been described as final part-word repetition or "rhyme repetition". ), Cluttering: Research, intervention and education (pp. Although cluttering has been reported in children as young as 4 years of age, the diagnosis is more commonly made at about 8 years of age (Ward, 2006), when a childs language becomes lengthy and/or complex enough for symptoms to manifest themselves. Language, Speech, and Hearing Services in Schools, 43(4), 536548. I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. St. Louis, K. O., Myers, F., Bakker, K., & Raphael, L. (2007). Miller, W. R., & Rollnick, S. (2013). "I-I-I-I- want the ball") 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). Individuals may experience the impact of fluency disorders in social and emotional, academic, and vocational domains. World Health Organization. https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). Children who stutter also may be at risk for experiencing bullying (Blood & Blood, 2004; Davis et al., 2002; Langevin et al., 1998). A study of pragmatic skills of clutterers and normal speakers. https://doi.org/10.1016/j.jfludis.2013.09.001, Boyle, M. P. (2015). ), Cluttering: A handbook of research, intervention and education (pp. Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Smith, A., & Weber, C. (2017). There is a family history of stuttering or cluttering. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). Bilingual myth-busters series when young children who stutter are also bilingual: Some thoughts about assessment and treatment. https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). One example of a desensitization activity is pseudostutteringthe use of voluntary stuttering behaviorsin different, and increasingly more difficult, situations where the individual might fear the occurrence of real moments of stuttering (e.g., Reardon-Reeves & Yaruss, 2013; J. G. Sheehan, 1970). typical vs atypical disfluencies asha. Differentiating between typical disfluencies and stuttering (i.e., ambiguous and unambiguous moments of stuttering) is a critical piece of assessment, particularly for preschool children (see ASHAs resource on characteristics of typical disfluency and stuttering). In D. Ward & K. Scaler Scott (Eds. Seminars in Speech and Language, 24(1), 2126. reports changing conception of stuttering from exclusively negative to having positive features. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. Speech, Language and Hearing, 20(3), 144153. For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. An increase in observable disfluent behaviors may occur as the individual communicates more freely. All speakers are disfluent at times. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. 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. Bargaining, 5. seizure disorders (Briley & Ellis, 2018). Mindfulness is an intentional awareness of the present moment (e.g., through meditation) to help disengage from automatic thoughts and redirect attention, de-escalate emotions, and increase self-acceptance (Boyle, 2011; Harley, 2018). Studies in tachyphemia: III. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. 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. Coleman, C. (2013). Yaruss, J. S., & Quesal, R. W. (2004). Stages of change and stuttering: A preliminary view. 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. See the Assessment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 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. Journal of Communication Disorders, 37(1), 3552. social anxiety disorder (Brundage et al., 2017; Craig & Tran, 2014; Iverach et al., 2018), speech sound disorders (St. Louis & Hinzman, 1988; Wolk et al., 1993), and. Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.4324/9781351122351, Klein, J. F., & Hood, S. B. Singular. Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. Preliminary research suggests adults who clutter demonstrate differences in cortical and subcortical activity compared to controls (Ward et al., 2015). B., & Al-Khamra, R. (2015). One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Research updates in neuroimaging studies of children who stutter. Evidence-based treatment and stutteringHistorical perspective. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. 15). Drayna, D., & Kang, C. (2011). Communication Disorders Quarterly, 39(2), 335345. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). In N. B. Ratner & J. Tetnowski (Eds. www.asha.org/policy/. Typical vs Atypical Pneumonia in Tabular Form 6. (2010). Therefore, clinicians may want to ask open-ended questions to assess communication across specific situations (e.g., How do you participate in class? How do you talk to strangers? Please describe a situation when you ordered food from a restaurant. How did it feel?). Fluency Disorders (Practice Portal). Scientific Reports, 7(1), 118. https://doi.org/10.1111/1469-7610.00093, de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M. C. (2015). https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). american journal of audiology (aja) american journal of speech-language pathology (ajslp) journal of speech, language, and hearing research (jslhr) language, speech, and hearing services in schools (lshss) perspectives of the asha special interest groups; topics; special collections Journal of Fluency Disorders, 27(4), 289304. The social and communication impact of stuttering on adolescents and their families. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. The clinical applications of Acceptance and Commitment Therapy with clients who stutter. autism spectrum disorder (Briley & Ellis, 2018). https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). Adolescents also may be particularly susceptible to peer pressure and bullying at this time. These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering. https://doi.org/10.1177/152574018200600106. Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Starkweather, Janice Westbrook. In addition to stuttering-like disfluencies and other typical disfluencies, the children with ASD also produced atypical disfluencies, which usually are not observed in children with typically developing speech or developmental stuttering. B. 7). 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). Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. In J. C. Norcross & M. R. Goldfried (Eds. Arnold, G. E. (1960). auditory processing disorders (Molt, 1996). Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. Helping adolescents who stutter focus on fluency. Starkweather, C. W. (1987). Pro-Ed. Genetic approaches to understanding the causes of stuttering. 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). (2010). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). https://doi.org/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. 157186). (1979). Maintenance of improved attitudes toward stuttering. Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. Psychology Press. Pro-Ed. 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. 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). Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. Empirical research on whether bilingual individuals who stutter are more disfluent in one language than the other is sparse and based on small case studies (Tellis & Tellis, 2003), but many bilingual individuals who stutter report this to be the case (Nwokah, 1988). Factors that contribute to the perception of overt stuttering severity include frequency, duration, effort, naturalness, and the ability of the person who stutters to communicate effectively and efficiently. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Luterman, D. M. (2006). In F. L. Myers & K. O. St. Louis (Eds. 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). Yairi, E., & Ambrose, N. (2013). Drayna and Kang (2011) found that gene mutations were present in close to 10% of cases of familial stuttering. practice monitoring each others speech and secondary behaviors. Children with language difficulties at the sentence, narrative, or conversational discourse level may exhibit increased speech disfluencies. 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). ), The treatment of stuttering in the young school-aged child (pp. Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. Erickson, S., & Block, S. (2013). Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). 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. https://doi.org/10.1080/2050571X.2016.1253533. Individuals may experience stuttering in different ways with siblings, their spouse, or other family members. Language, Speech, and Hearing Services in Schools, 48(4), 234248. Fluency disorders can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). Clinical decision making in fluency disorders. However, the clinician needs to consider the impact of disfluency on communication and quality of life as a whole. Finding the good in the challenge: Benefit finding among adults who stutter. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). To foster generalization, assignments adhere to a hierarchy of linguistic skills and environmental stressors. EBP Briefs, 2(4), 18. When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Word-finding problems can also result in an increase in typical disfluencies that are similar to those observed 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. The Journal of Child Psychology and Psychiatry, 43(7), 939947. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). Reardon-Reeves, N., & Yaruss, J. S. (2013). Plural. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019.