Abou, E. M., Saleh, M., Habil, I., El Sawy, M., & El Assal, L. (2015). https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). Brain, 131(1), 5059. Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. Prentice-Hall. 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). (2011). Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Crystal Cooper, Diane L. Eger, and Nancy Creaghead served as monitoring vice presidents. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). Journal of Communication Disorders, 80, 1117. Cluttering: A handbook of research, intervention and education. (1988). 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). PLOS ONE, 10(7), Article e0133758. For example, individuals who clutter may not be aware of communication breakdowns and, therefore, do not attempt to repair them. (1993). 1997- American Speech-Language-Hearing Association. 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). Genetic approaches to understanding the causes of stuttering. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Rehabilitation Act of 1973, Section 504. In B. J. Amster & E. R. Klein (Eds. Cambridge University Press. Multilingual children who stutter: Clinical issues. Prevalence of anxiety disorders among children who stutter. 178196). https://doi.org/10.1044/sbi15.2.75, Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). (2016a). Journal of Fluency Disorders, 25(1), 4757. typical vs atypical disfluencies asha typical vs atypical disfluencies asha. The underlying relationship between stuttering and working memory is not fully understood but may be related to interruptions in sensorimotor timing for developmental stuttering and may involve both the basal ganglia and the prefrontal cortex (Bowers et al., 2018). minimizing the adverse impact of stuttering (Yaruss et al., 2012). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). The clutterer. American Journal of Speech-Language Pathology, 16(1), 6568. When a student stutters: Identifying the adverse educational impact. Contemporary Issues in Communication Science and Disorders, 31(Spring), 6979. Clinical decision making in fluency disorders. atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. Family historyAnecdotal reports indicating the presence of cluttering in more than one family member suggest that family history may be a risk factor. 211230). In D. Ward & K. Scaler Scott (Eds. SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. Journal of Communication Disorders, 48, 3851. Enhancing treatment for school-age children who stutter: II. 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. 157186). However, a preliminary prevalence study estimated the rate of cluttering to be between 1.1% and 1.2% of school-age children (Van Zaalen & Reichel, 2017). Journal of Fluency Disorders, 43, 1727. Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. Goals that focus on minimizing negative reactions to stuttering and difficulties communicating in various speaking situations may help the individual reduce the effort used to hide or avoid their disfluencies and communicate with more ease. https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Is parentchild interaction therapy effective in reducing stuttering? 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. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. Other strategies for treating cluttering include overemphasizing multisyllabic words and word endings, increasing awareness of when a communication breakdown occurs (e.g., through observation of listener reactions), and increasing self-regulation of rate and clarity of speech. The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker. For some people, the use of these behaviors can result in little or no observable stuttering. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Lyn Goldberg and Michelle Ferketic served as ex officios. Journal of Fluency Disorders, 27(4), 289304. Early childhood stuttering therapy: A practical guide. We often use the term "emergent" to describe skills that are developing, but have not fully emerged. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Brain, 138(3), 694711. The relationship of self-efficacy and depression to stuttering. There is ongoing debate as to whether persons who stutter have language skills that are equivalent to those seen in well-matched comparison speakers. Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. ), The atypical stutterer: Principles and practices of rehabilitation (pp. gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. Differences in fluency across languages may be due to the social context in which the language is used (Foote, 2013), as well as the proficiency of each language spoken. Measuring lexical diversity in children who stutter: Application of vocd. Speaker and observer perceptions of physical tension during stuttering. For bilingual individuals, it is important for the clinician to consider the language or languages used during intervention. Therefore, as with school-age children and adolescents, the purpose of the assessment for adults typically is not to diagnose stuttering. A phenomenological understanding of successful stuttering management. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). Effective counseling is important for encouraging individuals with a fluency disorder to share information in the affective, cognitive, and social domains. 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). https://doi.org/10.1016/j.jcomdis.2014.02.001, Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). See the Assessment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1044/1092-4388(2001/030), Finn, P. (2003). deletion and/or collapsing of syllables (e.g., I wanwatevision). Adjustments can include. 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. Building clinical relationships with teenagers who stutter. Donaher, J., & Richels, C. (2012). Consequently, they may speak less to avoid being disfluent, and they may avoid social situations. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Counseling persons with communication disorders and their families. Folia Phoniatrica et Logopaedica, 64(1), 3447. Given that cluttering may co-occur with other disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder), having any of these disorders may be a risk factor; however, not all individuals with these disorders also exhibit cluttering. Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. The most common atypical disfluency of concern is word-final . Scaler Scott, K. (2011). The SLP works with parents and families to create an environment that facilitates fluency and that helps them develop healthy and appropriate communication attitudes (Onslow et al., 2003; Yaruss & Reardon-Reeves, 2017). 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. Some individuals develop speech habits to escape or avoid moments of overt stuttering, such as changing words or using interjections (e.g., um, uh), and they may become so skilled at hiding stuttering that their speech appears to be fluent (covert stuttering; B. Murphy et al., 2007). Smith, A., & Weber, C. (2017). Some people who clutter tend to decrease volume at the ends of sentences or phrases and, therefore, can benefit from learning to keep a steady volume throughout their utterances. Journal of Speech, Language, and Hearing Research, 62(8), 26912702. Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O., Bavin, E., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). Palin ParentChild Interaction Therapy for early childhood stammering. Parents can also report if secondary behaviors are present in both languages. As suggested earlier, normal disfluencies will appear for a few days and then disappear. Psychology Press. (2006). https://doi.org/10.1080/2050571X.2016.1253533. Stuttering: Research and therapy. Systems that govern self-regulation may underlie cluttering; qualitative interviews with those who clutter suggest that thoughts emerge before they are ready (Scaler Scott & St. Louis, 2011). https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. 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). Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. These are called typical disfluencies or nonfluencies. Treatment for adolescents who stutter poses a particular challenge because of the issues related to this developmental stage. This model describes stages in the process of behavioral change, and it can be used to determine an individuals readiness to make a change. https://doi.org/10.1192/apt.12.1.63, Craig, A., & Tran, Y. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. continued management (Plexico et al., 2005). 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. Reducing bullying through role-playing and self-disclosure. Subjective distress associated with chronic stuttering. Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. American Journal of Speech-Language Pathology, 28(1), 1428. Seminars in Speech and Language, 28(4), 312322. Cluttering and autism spectrum disorders. Cluttering treatment: Theoretical considerations and intervention planning. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. Brain, 136(12), 37093726. Coworkers may have negative attitudes toward individuals who stutter, and the individual may feel excluded because of this. Tourettes syndrome (see Van Borsel, 2011, for a review). A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Stuttering impact: A shared perception for parents and children. In E. Conture & R. F. Curlee (Eds. Both procedures help the client decrease the sense of loss of control experienced during moments of stuttering by demonstrating their ability to stop and modify moments of stuttering, anxiety, and other emotional reactivity. 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. Childhood stuttering: Incidence and development. https://doi.org/10.1044/1092-4388(2011/10-0304), Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K. (2002). In B. J. Amster & E. R. Klein (Eds. Stuttering in school-age children: A comprehensive approach to treatment. Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. EBP Briefs, 2(4), 18. In D. Ward & K. Scaler Scott (Eds. This approach to care incorporates individual and family preferences, priorities, and desired outcomes in the selection of treatment goals and treatment methods. https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). Best practice for developmental stuttering: Balancing evidence and expertise. Available 8:30 a.m.5:00 p.m. Journal of Fluency Disorders, 36(4), 290295. https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). Advance online publication. Most individuals who stutter demonstrate both observable disfluency and negative life impact (Beilby et al., 2012b; Ribbler, 2006; Tichenor & Yaruss, 2019a; Yaruss et al., 2012). 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/10.1044/ffd16.1.15. Treatment approaches for adults should take into consideration career and workplace factors. Evaluation of speech-related attitude by means of the KiddyCAT, CAT, and BigCAT, within a larger behavior assessment battery framework for children and adults who stutter. https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). increasing the time provided for an oral reading or presentation, providing an alternative assignment to oral reading, and. Individuals may experience the impact of fluency disorders in social and emotional, academic, and vocational domains. I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike). Nurturing a resilient mindset in school-aged children who stutter.
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