Skip to main content. Seminars in Speech and Language, 24(1), 2126. Please enable it in order to use the full functionality of our website. Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. Clinical decision making in fluency disorders. Clinicians may provide education about the speech systems and processes (e.g., respiratory system, phonatory, articulation/resonance, and nonverbal features) and that communication includes both verbal and nonverbal aspects, pragmatics, senderreceiver dynamics, and interpersonal relational features, which may be a target in treatment. World Health Organization. Persons who stutter may appear to have expressive language problems because of a tendency to avoid speaking or speak in a way thats unclear to the listener. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. reports changing conception of stuttering from exclusively negative to having positive features. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. 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. ), Stuttering and related disorders of fluency (pp. typical vs atypical disfluencies asha. Prevalence of stuttering in primary school children in Cairo-Egypt. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. All speakers are disfluent at times. Recommending related services when necessary for management and treatment in different settings (e.g., classroom, work, community). Cluttering: A neurological perspective. Genetics and neurophysiology appear to be related to the underlying causes of stuttering. The individual who stutters becomes desensitized to their fears by performing activities (e.g., self-disclosing, going to a place where they fear speaking) using a fear hierarchy. This hierarchy represents situations or activities that range from low risk to high risk. Journal of Fluency Disorders, 34(4), 368381. https://doi.org/10.1016/S0094-730X(01)00098-5. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. discussing the rationale for treatment decisions, and. the asha leader; journals. 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). Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. (2006). ), Handbook of psychotherapy integration (pp. Differential treatment of stuttering in the early stages of development. Daly, D. A. Defining cluttering: The lowest common denominator. The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. https://doi.org/10.1044/persp1.SIG4.55, Byrd, C. T., Croft, R., Gkalitsiou, Z., & Hampton, E. (2017). The individual learns strategies for generalization of skills to the classroom, workplace, and community. omission of word endings (e.g., Turn the televisoff). https://doi.org/10.1055/s-0034-1371755, Jones, R. M., Conture, E. G., & Walden, T. A. Bowling Green State University Archive. Journal of Paediatrics and Child Health, 49(2), E112E115. Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). Wiig, E. H., & Semel, E. M. (1984). Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. In contrast to adults who stutter, children who stutter did not show increases in white matter tracts in the right hemisphere (Chang et al., 2015). 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. Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). https://doi.org/10.1177/152574018200600106. The transtheoretical approach. Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. 233253). These modifications are used regardless of whether a particular word is expected to be produced fluently. Structural and functional abnormalities of the motor system in developmental stuttering. Atypical Disfluency: What Is It and What Can I Do About It? A treatment plan that involves both speech and stuttering modification techniques may be necessary to achieve optimal outcomes. typical vs atypical disfluencies asha Journal of Fluency Disorders, 36(3), 186193. However, these disfluencies are typical and not indicative of a disorder (Shenker, 2013). On the surface, this can be a difficult question, as many studies show up to 80% of children might recover from early speech disfluencies. Bilingual myth-busters series when young children who stutter are also bilingual: Some thoughts about assessment and treatment. More recently, CBT and mindfulness have been applied to stuttering therapy and may support that CBT+mindfulness is more beneficial to clients who stutter than CBT alone (Gupta et al., 2016; Harley, 2018). Emotional problems and parenting style do not cause stuttering. https://doi.org/10.1016/j.jfludis.2014.12.002, Boyle, M. P., Beita-Ell, C., & Milewski, K. M. (2019). Yaruss, J. S., & Pelczarski, K. M. (2007). by ; 2022 June 3; barbara "brigid" meier; 0 . Psychology Press. In D. Ward & K. Scaler Scott (Eds. https://doi.org/10.1016/j.jfludis.2012.12.001, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012a). winery in maryland with igloos; thick peeling skin around fingernails; holiday inn st pete beach revolving restaurant; metro approved housing in norwalk ohio https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. Amster, B. J., & Klein, E. R. (2018). Pediatrics, 121(2), 369375. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). 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). Parents can also learn about how to help their child generalize skills from the treatment room to different settings and with different people. 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). https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). Routledge. Stuttering: An integrated approach to its nature and treatment. 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. Pro-Ed. Cluttering, another fluency disorder, is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). 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). Counseling parents of children who stutter. In B. J. Amster & E. R. Klein (Eds. Word-finding problems can also result in an increase in typical disfluencies that are similar to those observed in cluttering. Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. The human capacity to thrive in the face of potential trauma. The skilled helper: A problem-management and opportunity-development approach to helping. In this way, positive reinforcement is used to increase or strengthen the response of fluency (the desired behavior). Journal of Speech, Language, and Hearing Research, 44(2), 368380. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Barnes, T. D., Wozniak, D. F., Gutierrez, J., Han, T. U., Drayna, D., & Holy, T. (2016). An effective clientclinician relationship facilitates the identification of potential roadblocks (Plexico et al., 2010). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Psychology Press. Such individuals may benefit from treatment strategies that focus on improving speech efficiency by reducing word avoidance and increasing spontaneity in communication. Another example is Cognitive Behavior Therapy (CBT; Menzies et al., 2019, 2009). Children with language difficulties at the sentence, narrative, or conversational discourse level may exhibit increased speech disfluencies. Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. There is not enough epidemiological research to state specific risk factors for cluttering. https://doi.org/10.1044/2017_AJSLP-17-0146, St. Louis, K. O., & Hinzman, A. R. (1986). Starkweather, C. W. (1987). As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. Typical pneumonia is a form of community-acquired pneumonia that tends to have more serious symptoms. To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. In E. Conture & R. F. Curlee (Eds. Journal of Fluency Disorders, 37(4), 289299. The International Journal of Indian Psychology, 3(3), 7887. The purpose of assessing school-age children and adolescents for fluency disorders is to determine the presence, the extent, andmost importantlythe impact of the fluency disorder and the potential benefit from treatment. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. Logos, 3, 8295. https://doi.org/10.1371/journal.pone.0133758, Desai, J., Huo, Y., Wang, Z., Bansal, R., Williams, S. C., Lythgoe, D., Zelaya, F. O., & Peterson, B. S. (2016). Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. typical vs atypical disfluencies asha Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Journal of Fluency Disorders, 27(4), 289304. Journal of Abnormal Psychology, 119(3), 479490. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). Speech, Language and Hearing, 20(3), 144153. See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 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). https://doi.org/10.1016/j.jfludis.2006.12.003. Van Borsel, J., Maes, E., & Foulon, S. (2001). National Stuttering Association. In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). Journal of Fluency Disorders, 40, 3543. Neurobiology of Disease, 69, 2331. Available 8:30 a.m.5:00 p.m. Operant treatment (e.g., Palin ParentChild Interaction Therapy, Kelman & Nicholas, 2020; Lidcombe Program, Onslow et al., 2003) incorporates principles of operant conditioning and uses a response contingency to reinforce the child for fluent speech and redirect disfluent speech (the child is periodically asked for correction). For school-age children and adolescents, initiation of treatment depends, in large part, on their motivation, which, in turn, is dependent on factors such as their perceived needs, the degree of adverse impact they experience, and their previous treatment experiences. Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words and interjections (such as um and well). (2020). Parental involvement is an integral part of any treatment plan for children who stutter. Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. other developmental disorders (Briley & Ellis, 2018). Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. In F. L. Myers & K. O. St. Louis (Eds. minimizing the adverse impact of stuttering (Yaruss et al., 2012). Journal of Speech, Language, and Hearing Research, 52(1), 254263. Journal of Fluency Disorders, 22(3), 187203. How can you tell if childhood stuttering is the real deal? Testing, and 7. https://doi.org/10.1044/ffd22.1.34, Beilby, J. M., Byrnes, M. L., Meagher, E. L., & Yaruss, J. S. (2013). Journal of Fluency Disorders, 58, 2234. The Journal of Child Psychology and Psychiatry, 43(7), 939947. 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). See ASHAs Practice Portal page on Cultural Responsiveness. Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their childs environment. These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. https://doi.org/10.1044/1092-4388(2001/030), Finn, P. (2003). Depending on the country and methodology used, rates were estimated to range from 1.03% (Abou et al., 2015) to 1.38% (Al-Jazi & Al-Khamra, 2015), but could be as high as 8.4% (Oyono et al., 2018). Through a process of identifying the assumptions underlying their thoughts, they can evaluate whether those thoughts are helpful (or valid) and ultimately adopt different assumptions or thoughts. 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. Reducing bullying through role-playing and self-disclosure. A thematic analysis of late recovery from stuttering. https://doi.org/10.1002/mgg3.276, Frigerio-Domingues, C. E., Gkalitsiou, Z., Zezinka, A., Sainz, E., Gutierrez, J., Byrd, C., Webster, R., & Drayna, D. (2019). 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. Typical vs. Atypical Disfluencies: What Are the Differences? https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). Fluency Disorders - ASHA (n.d.). 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/10.1542/peds.2019-0811, Zebrowski, P. M. (2002). A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. Individuals may exhibit pure cluttering or cluttering with stuttering (van Zaalen-Opt Hof et al., 2009). The clutterer. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Their skills are developing in this area. using fillers (e.g., like, um, uh, you know); avoiding sounds or words (e.g., substituting words, inserting unnecessary words, circumlocution); and. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Alm, P. A. Education, 136(2), 159168. Measuring lexical diversity in children who stutter: Application of vocd. 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. However, fluency shaping approaches, such as easy onset or continuous phonation, may not be appropriate for the treatment of cluttering. International Journal of Language & Communication Disorders, 49(1), 113126. 4566). Plural. ), Cluttering: Research, intervention and education (pp. Support (both giving and receiving) can be valuable for improving attitudes, boosting self-confidence, and reducing feelings of isolation (Yaruss et al., 2007). https://doi.org/10.1044/sbi15.2.75, Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). https://doi.org/10.1044/ffd16.1.15. 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). Journal of Fluency Disorders, 22(3), 219236. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). https://doi.org/10.1044/gics4.2.57, Van Zaalen, Y., & Reichel, I. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. 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. https://doi.org/10.1044/0161-1461(2012/11-0044), Yaruss, J. S., LaSalle, L. R., & Conture, E. G. (1998). Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). 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. 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. . Erickson, S., & Block, S. (2013). 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?). Plural. Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. Tourettes syndrome (see Van Borsel, 2011, for a review). Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). typical vs atypical disfluencies asha typical vs atypical disfluencies asha. Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering. attention-deficit/hyperactivity disorder (Donaher & Richels, 2012; Lee et al., 2017). 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). Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. Sisskin, V. (2018). Human Brain Mapping, 38(4), 18651874. One of the core principles of ACT is mindfulness. deletion and/or collapsing of syllables (e.g., I wanwatevision). Preus, A. Diagnostic and statistical manual of mental disorders (5th ed.). Strategies aimed at altering the timing of pausing are used to increase the likelihood of fluent speech production and to improve overall communication skills (e.g., intelligibility, message clarity). Stuttering: Research and therapy. In B. J. Amster & E. R. Klein (Eds. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). https://doi.org/10.1037/a0020113, Coleman, C., & Yaruss, J. S. (2014). Psychology Press. language or learning disability (Ntourou et al., 2011). Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). Psychology Press. Fear of speaking: Chronic anxiety and stammering. Early Childhood Stuttering: Is it Stuttering or Typical Disfluency? - @ASHA Time pressures for verbal communication and requirements to use the telephone may lead to stress and discomfort. Journal of Fluency Disorders, 53, 2640. Journal of Speech, Language, and Hearing Research, 62(5), 13711372. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/. Journal of Communication Disorders, 80, 1117. Acquired neurogenic and psychogenic stuttering are not covered. perceived communication and job barriers. Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. The attitudes of high school peers toward stuttering and toward persons who stutter can be improved through education in the form of classroom presentations about stuttering (Flynn & St. Louis, 2011). Journal of Fluency Disorders, 37(4), 242252. Engaging parents in treatment helps to achieve carryover in the home environment and helps with treatment across languages (Shenker, 2013). Early childhood stuttering therapy: A practical guide. Journal of Fluency Disorders, 50, 5971. Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. 115134). Multicultural identification and treatment of stuttering: A continuing need for research. Ingham, R. J., & Onslow, M. (1985). Long-term follow-up of self-modeling as an intervention for stuttering. In addition to the challenges associated with typical adolescent experiences, treatment may not be a priority for some adolescents because of other academic and social demands, denial of a speech problem, and concern about the stigma of seeking treatment. Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A.
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