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In addition, some persons who stutter substitute words, omit words, or use circumlocution to hide stuttering symptoms (B. Murphy et al., 2007). Stuttering in relation to lexical diversity, syntactic complexity, and utterance length. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). "Atypical" disfluencies include: sound repetitions ("s-s-s-so"); syllable repetitions ("be-be-be-be-because"); prolongations ("Aaaaaaaaaaaaand"); and Motivational interviewing is a person-centered approach that can be useful in developing functional goals and enhancing readiness for change (Miller & Rollnick, 2013; Rollnick & Miller, 1995). Remaining informed of research in the area of fluency disorders and advancing the knowledge base of the nature of the disability, screening, diagnosis, prognostic indicators, assessment, treatment, and service delivery for individuals with fluency disorders. Healey, E. C., Reid, R., & Donaher, J. The ASHA Leader, 18(3), 1415. Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to https://doi.org/10.1111/jpc.12034. 3. Neural network connectivity differences in children who stutter. Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). Identifying subgroups of stutterers (No. These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). Disfluency Characteristics Observed in Young Children With - ASHA Wire have a sense of belonging and experience less stigma. Cengage Learning. Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. Estimates report that 1.5% of school-age children who are hard of hearing also stutter, which is similar to the estimates of older elementary students who stutter (Arenas et al., 2017). https://doi.org/10.1016/j.jfludis.2018.10.003, Bray, M. A., & Kehle, T. J. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Evaluating stuttering in young children: Diagnostic data. https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Testing, and 7. Advocating for individuals with fluency disorders and their families at the local, state, and national levels. Stuttering and speech naturalness. ), Stuttering and related disorders of fluency (pp. Merrill. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). Journal of Fluency Disorders, 50, 7284. typical vs atypical disfluencies asha 24 Jun. 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 Acceptance and Commitment Therapy for people who stutter. Self-regulation and the management of stuttering. Journal of Fluency Disorders, 21(34), 201214. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. The Present Levels of Academic Achievement and Functional Performance statement, which serves as the baseline for the IEP, refers to other areas that are not necessarily academic and can include information about communication skills, social skills, and other activities of daily living. The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Communication Disorders Quarterly, 6(1), 5059. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Folia Phoniatrica et Logopaedica, 64(1), 3447. Journal of Fluency Disorders, 31(2), 90115. ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. Specific standardized tests can be used to rule out word-finding difficulties. Journal of Communication Disorders, 48, 3851. BOBapp(2023) https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. These modifications are used regardless of whether a particular word is expected to be produced fluently. 328). However, sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children. (2017). In addition to being used for improving communication skills, pausing is also an effective method of rate control. The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. van Zaalen, Y., & Reichel, I. K. (2014). https://doi.org/10.1016/S0094-730X(97)00008-9, Floyd, J., Zebrowski, P. M., & Flamme, G. A. 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. https://doi.org/10.1044/2018_AJSLP-17-0097, Kraft, S. J., & Yairi, E. (2011). 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). Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. deletion and/or collapsing of syllables (e.g., I wanwatevision). Journal of Speech, Language, and Hearing Research, 62(5), 13711372. 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). Professional awareness of cluttering. American Journal of Speech-Language Pathology, 27(3S), 11241138. Reducing bullying through role-playing and self-disclosure. https://doi.org/10.1542/peds.2012-3067, Ribbler, N. (2006). https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). https://doi.org/10.1044/0161-1461.2602.162. Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their childs environment. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). American Journal of Speech-Language Pathology, 28(1), 1428. Fluency refers to continuity, smoothness, rate, and effort in speech production. It is not possible to determine with certainty which children will continue to stutter, but there are some factors that indicate a greater likelihood that stuttering will become chronic. Timing refers to the initiation of treatment relative to the diagnosis. https://doi.org/10.1177/152574018200600106. Journal of Fluency Disorders, 25(1), 4757. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. Journal of Fluency Disorders, 34(3), 187200. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). - Speech & Language Parent Support - SPSD For example, English language learners may have word-finding problems in the second language. 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. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). American Journal of Speech-Language Pathology, 12(2), 243253. 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, 53, 2640. Journal of Fluency Disorders, 58, 94117. (2018). Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). Clinicians need to understand the interaction of symptoms and the strategies that are most effective for dealing with stuttering and cluttering when they occur together. The Differential Diagnosis of Disfluency - American Speech-Language This results in less effective social interactions. All speakers are disfluent at times. Plural. 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. 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. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. ), Current issues in stuttering research and practice (pp. Other speech or language concerns are also present. Perspectives on Fluency and Fluency Disorders, 1(4), 5569. See the Assessment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. School-age stuttering therapy: A practical guide. The purpose of CBT is to modify current negative thoughts, emotions, and/or behaviors and replace them with positive ones through identification of thought patterns and challenging cognitive distortions in real time. Some children who stutter or clutter may only experience symptoms situationally. Epidemiology of stuttering: 21st century advances. The speakers measured speech rate is not always greater than average, but the listener perceives it as rapid. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. 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). Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. Individuals may experience stuttering in different ways with siblings, their spouse, or other family members. excessive levels of typical disfluencies (e.g., revisions, interjections), maze behaviors or frequent topic shifting (e.g., I need to go toI mean Im out of cheese. 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). Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. Following are descriptions of each of these forms of disfluency. Word-finding problems can also result in an increase in typical disfluencies that are similar to those observed in cluttering. using indirect prompts rather than direct questions, recasting/rephrasing to model fluent speech or techniques (Millard et al., 2008; Yaruss et al., 2006), and. It is also not unusual for disfluencies to be apparent and then seem to go away for a period of weeks or months only to return again. One study showed that children who clutter had 7.6 times more normal disfluencies compared to "atypical" disfluencies when they retold a story (van Zaalen et al., 2009). The individual learns strategies for generalization of skills to the classroom, workplace, and community. Time pressures for verbal communication and requirements to use the telephone may lead to stress and discomfort. Studies in tachyphemia: III. See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Journal of Fluency Disorders, 32(1), 5169. Adults who stutter may be dealing with years of shame or stigma (Boyle, 2013a), and they can experience elevated levels of negative mood states (e.g., interpersonal sensitivity and depressed mood) when compared to adults who do not stutter (Tran et al., 2011). 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. EBP Briefs, 2(4), 18. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). "I-I-I-I- want the ball") 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). A study of pragmatic skills of clutterers and normal speakers. http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/, Multisyllabic whole-word and phrase repetitions, Secondary behaviors (e.g., eye blinks, facial grimacing, changes in pitch or loudness), Avoidance behaviors (e.g., reduced verbal output or word/situational avoidances). 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). American Journal of Speech-Language Pathology, 27(3S), 11111123. Temperament, emotion, and childhood stuttering. https://doi.org/10.1177/1525740117702454. Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. The speaker is thought to be talking at a rate that is too fast for their system to handle, resulting in breakdowns in fluency and/or intelligibility (Bakker et al., 2011). www.asha.org/policy/, American Speech-Language-Hearing Association. Anger/Resistance, 4. https://doi.org/10.1016/j.jfludis.2016.09.005, Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). ), Cluttering: A handbook of research, intervention and education (pp. American Journal of Speech-Language Pathology, 27(3S), 12111223. https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). See What To Ask When Evaluating Any Procedure, Product, or Program. Academic Press. 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). Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. Strategies aimed at changing the timing and tension of speech production include. A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering. Perspectives on Fluency and Fluency Disorders, 17(2), 49. Journal of Fluency Disorders, 26(3), 179206. www.asha.org/policy/, American Speech-Language-Hearing Association. However during treatment and forming a new, more congruent identity, clients may progress through some of the stages of grief (e.g., 1. (2013). See ASHAs resource on assessment tools, techniques, and data sources. Desensitization can help decrease word avoidance and reduce fear. 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. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. How can you tell if childhood stuttering is the real deal? https://doi.org/10.1044/ffd22.1.34, Beilby, J. M., Byrnes, M. L., Meagher, E. L., & Yaruss, J. S. (2013). ), Cluttering: A handbook of research, intervention and education (pp. Stuttering in animal models, such as zebra finches (Chakraborty et al., 2017) and mice (Barnes et al., 2016; Han et al., 2019), has also been investigated, including how the expression of stuttering influences social behaviors of mice (Han et al., 2019). Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. https://doi.org/10.1016/j.jfludis.2013.08.001, Briley, P. M., & Ellis, C. (2018). The impact of fluency disorders often extends to social and vocational aspects of the individuals life. Language, Speech, and Hearing Services in Schools, 26(2), 162168. 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/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). Luterman, D. M. (2006). The young childs awareness of stuttering-like disfluency. A comprehensive view of stuttering: Implications for assessment and treatment. Children who stutter typically know how to read (decode) the printed form of words, but they may not be able to speak the printed form fluently. Journal of Speech, Language, and Hearing Research, 62(12), 43354350. B., & Al-Khamra, R. (2015). Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter Below is a list of approaches commonly used with school-age children, adolescents, and adults who stutter. Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. Psychology Press. For example, an individual might elect to self-disclose in a workplace and educate coworkers about fluency disorders via a group presentation followed by a question-and-answer period. Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Children with language difficulties at the sentence, narrative, or conversational discourse level may exhibit increased speech disfluencies. 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). (2014). Stuttering impact: A shared perception for parents and children. Journal of Fluency Disorders, 11(2), 131149. (2020). The skilled helper: A problem-management and opportunity-development approach to helping. 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. See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. discussing the rationale for treatment decisions, and. Journal of Fluency Disorders, 32(2), 121138. Journal of Fluency Disorders, 13(5), 357373. What do people search for in stuttering therapy: Personal goal-setting as a gold standard? https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). Clinicians and parents also look for reactions, such as avoidance of words or speaking situations, increased physical tension or secondary behaviors, reduced utterance length, or slight changes in pitch or loudness during stuttering episodes. 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. Scientific Reports, 7(1), 118. provide and receive support from others who share the experience of stuttering. Family historyAnecdotal reports indicating the presence of cluttering in more than one family member suggest that family history may be a risk factor. The social and communication impact of stuttering on adolescents and their families. Psychology Press. https://doi.org/10.1176/appi.books.9780890425596, American Speech-Language-Hearing Association. Efforts to conceal stuttering may adversely affect quality of life (Boyle et al., 2018). Estimates of incidence and prevalence vary due to a number of factors, including disparities in the sample populations (e.g., age), how stuttering was defined, and how stuttering was identified (e.g., parent report, direct observation). Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). Title: The Differential Diagnosis of Disfluency Created Date: 7/18/2007 3:15:45 PM Pro-Ed. Individuals who stutter are more likely to be self-aware about their disfluencies and communication, and they may exhibit more physical tension, secondary behaviors, and negative reactions to communication. https://doi.org/10.1044/ffd16.1.15. American Journal of Speech-Language Pathology, 16(1), 6568. (2009). Journal of Fluency Disorders, 36(3), 186193. International Classification of Functioning, Disability and Health. In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. https://doi.org/10.1044/2017_LSHSS-17-0028. 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. Brain, 136(12), 37093726. https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). 115134). In H. H. Gregory, J. H. Campbell, C. B. Gregory, & D. G. Hill (Eds.