Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. (2009). American Journal of Speech-Language Pathology, 27(3S), 12351243. Stuttering and speech naturalness. What do people search for in stuttering therapy: Personal goal-setting as a gold standard? Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. https://doi.org/10.1044/ffd22.1.34, Beilby, J. M., Byrnes, M. L., Meagher, E. L., & Yaruss, J. S. (2013). https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). Video self-modeling as a post-treatment fluency recovery strategy for adults. Timing refers to the initiation of treatment relative to the diagnosis. Journal of Fluency Disorders, 58, 94117. https://doi.org/10.1093/brain/awm241, Watson, J. 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). It is helpful to know that typical bilingual or multilingual children tend to produce higher rates of monosyllabic word repetitions, sound repetitions, and syllable repetitions than monolingual speakers. A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. See ASHAs Practice Portal resource on Transitioning Youth. Strategies for reducing impairment in body function have been separated into two categoriesspeech modification and stuttering modification, both of which are described below. Typical childhood disfluencies may increase and decrease without any external influence. These individuals are said to experience covert stuttering (B. Murphy et al., 2007). language or learning disability (Ntourou et al., 2011). In N. B. Ratner & J. Tetnowski (Eds. Journal of Educational Psychology, 95(1), 321. International Journal of Speech-Language Pathology, 17(4), 367372. 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). Stuttering and labor market outcomes in the United States. Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. Please enable it in order to use the full functionality of our website. 7184). When speakers are able to participate in decisions about treatment goals and select goals they consider important, they may be more motivated to take part in therapy (Finn, 2003; Snsterud et al., 2019). Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). Journal of Fluency Disorders, 54, 113. 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). (2017). Erlbaum. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.1016/j.jfludis.2015.01.003, Harley, J. How can you tell if childhood stuttering is the real deal? Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. 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. 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. Yairi, E., & Ambrose, N. (2005). World Health Organization. Possible genetic factors in cluttering. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. 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). (2001). (2019). Journal of Fluency Disorders, 35(3), 216234. (2005). (1984). https://doi.org/10.1044/2017_JSLHR-S-16-0343, Snsterud, H., Feragen, K. B., Kirmess, M., Halvorsen, M. S., & Ward, D. (2019). Treatment should consider not just the overt stuttering behavior but also the affective and cognitive reactions to stuttering. In H. Gregory (Ed. 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). Yaruss, J. S., & Pelczarski, K. M. (2007). Language, Speech, and Hearing Services in Schools, 49(1), 13. These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). The relationship of self-efficacy and depression to stuttering. Understanding and treating cluttering. Professional awareness of cluttering. Lyn Goldberg and Michelle Ferketic served as ex officios. Impact of social media and quality of life of people who stutter. 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). Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. 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. 297325). Disfluent behavior becomes more complex as fear of speaking, anxiety, and resulting avoidance increase. Psychology Press. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). Direct treatment approaches can also target resilience and effort control in the child and family (Caughter & Crofts, 2018; Druker et al., 2019; Kraft et al., 2019). minimizing the adverse impact of stuttering (Yaruss et al., 2012). https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). In D. Ward & K. Scaler Scott (Eds. These strategies, like speech modification strategies, are introduced along a hierarchy of speaking situations that varies both with linguistic demands and with the stressors of the environment. Journal of Communication Disorders, 58, 4357. https://doi.org/10.1044/ffd23.2.54, Plexico, L. W., Hamilton, M. B., Hawkins, H., & Erath, S. (2019). The impact of stuttering on adults who stutter and their partners. 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. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Fluency Disorders (Practice Portal). Some children go through a disfluent period of speaking. Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering. The Journal of Child Psychology and Psychiatry, 43(7), 939947. Journal of Fluency Disorders, 34(3), 187200. (Eds.). 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). See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Self-efficacy and quality of life in adults who stutter. A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). Healey, E. C., Reid, R., & Donaher, J. 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). Enlisting the help of a person familiar with the language and rating fluency in short speech intervals also may help to accurately and reliably judge unambiguous stuttering (Shenker, 2011). Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. Contemporary Issues in Communication Science and Disorders, 31(Spring), 6979. 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). Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). The ASHA Leader, 11(10), 621. Sheehan, V. M., & Sisskin, V. (2001). Journal of Fluency Disorders, 43, 116. 15). Young children may or may not verbalize their reactions to stuttering. Increasing the individuals awareness and self-monitoring skills helps to reduce unproductive behaviors that interfere with speech, and it may allow them to alter moments of stuttering so that they have decreased tension, are shorter, and are less disruptive to communication. Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. ), Stuttering and related disorders of fluency (pp. Manning, W. H., & Quesal, R. W. (2016). https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Summary - Typical vs Atypical Pneumonia. 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. 328). Prevalence of speech disorders in elementary school students in Jordan. When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. Thieme. Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. practice monitoring each others speech and secondary behaviors. However, there is no evidence to support the idea that stuttering is caused by, or more prevalent in, bilingual or multilingual speakers or that exposure to a second language increases the risk for developing stuttering (Byrd, 2018). 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. United States Department of Labor. 147171). Seminars in Speech and Language, 28(4), 312322. Individuals may exhibit pure cluttering or cluttering with stuttering (van Zaalen-Opt Hof et al., 2009). (2019). Onset may be progressive or sudden. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). Strategies aimed at changing the timing and tension of speech production include. You do not have JavaScript Enabled on this browser. (1981). Journal of Fluency Disorders, 43, 1727. Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). Journal of Fluency Disorders, 27(4), 289304. Review of previous fluency evaluations and educational records. The role of self-help/mutual aid in addressing the needs of individuals who stutter. https://doi.org/10.1044/2018_JSLHR-S-17-0378, Byrd, C. T. (2018). Identifying subgroups of stutterers (No. https://doi.org/10.1044/1058-0360.0704.62. Palin ParentChild Interaction therapy: The bigger picture. (1982). (2019). reports changing conception of stuttering from exclusively negative to having positive features. facilitates conversations between the individual and their family about the experience of stuttering, the individuals communication expectations, their life goals, and how to holistically support communication (see, e.g., Berquez & Kelman, 2018; Millard et al., 2018; Rocha et al., 2019). This model describes stages in the process of behavioral change, and it can be used to determine an individuals readiness to make a change. Parents can also learn about how to help their child generalize skills from the treatment room to different settings and with different people. Donaher, J., & Richels, C. (2012). Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Prins, D., & Ingham, R. J. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). monosyllabic whole-word repetitions (e.g., Why-why-why did they go there?), part-word or sound/syllable repetitions (e.g., Look at the, prolongation of consonants when it isnt for emphasis (e.g., , blocking (i.e., inaudible or silent fixations or inability to initiate sounds), and. Seminars in Speech and Language, 23(3), 181186. increasing acceptance and openness with stuttering. Guilford Press. Distinguishing Cluttering from Stuttering - @ASHA Bowling Green State University Archive. Communication Disorders Quarterly, 6(1), 5059. American Journal of Speech-Language Pathology, 12(4), 425431. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research.
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