Education, 136(2), 159168. Journal of Fluency Disorders, 38(2), 6687. Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. Fear of speaking: Chronic anxiety and stammering. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Defining cluttering: The lowest common denominator. Bilingual children are assessed in both languages to determine stuttering profiles in both (Finn & Cordes, 1997). Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Genetics and neurophysiology appear to be related to the underlying causes of stuttering. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. https://doi.org/10.1002/da.20657, Bonanno, G. A., & Mancini, A. D. (2008). In D. Ward & K. Scaler Scott (Eds. The transtheoretical approach. Preschool children who stutter showed differences in event-related brain potentials used as indices of language processing. American Journal of Speech-Language Pathology, 29(1), 201215. B., & Al-Khamra, R. (2015). Maintenance of improved attitudes toward stuttering. ), Controversies about stuttering therapy (pp. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. The social and communication impact of stuttering on adolescents and their families. (2011). Avoidance or escape behaviors may also be used and can temporarily conceal stuttering (Constantino et al., 2017; Douglass et al., 2019, 2018; B. Murphy et al., 2007; Starkweather, 1987; Tichenor et al., 2017; Tichenor & Yaruss, 2018, 2019a, 2019b, 2020). American Journal of Speech-Language Pathology, 20(3), 163179. Davidow, J. H., & Scott, K. A. Available 8:30 a.m.5:00 p.m. (1982). (2018). 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). Higher incidence rates of stuttering have been reported in preschool-aged children (11.2%; Reilly et al., 2013), with prevalence estimates reported as 2.2%5.6% (Yairi & Ambrose, 2013). Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. The great psychotherapy debate: Models, methods, and findings. The ASHA Leader, 11(10), 621. EBP Briefs, 2(4), 18. Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. deletion and/or collapsing of syllables (e.g., I wanwatevision). https://doi.org/10.1016/j.jfludis.2010.07.001. Epidemiology of stuttering: 21st century advances. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). Brain, 131(1), 5059. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Scaler Scott, K. (2013). National Stuttering Association. Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. (1996). See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1044/jshr.3605.906. https://doi.org/10.1093/brain/awm241, Watson, J. Brain, 136(12), 37093726. Children with persistent stuttering showed deficiencies in left gray matter volume with reduced white matter integrity in the left hemisphere. Fluency treatment can occur at any point after the diagnosis. Journal of Fluency Disorders, 35(3), 216234. Effortful control, an aspect of temperament that supports self-regulation, may be predictive of stuttering severity and may facilitate positive change in treatment (Kraft et al., 2019). Neural network connectivity differences in children who stutter. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. Journal of Fluency Disorders, 30(1), 122. Assessment of stigma associated with stuttering: Development and evaluation of the Self-Stigma of Stuttering Scale (4S). A comprehensive fluency assessment typically includes the following: See ASHAs resource on assessment procedures: parallel with CPT codes for a breakdown of pre-evaluation, intra-service, and post-service procedures. Treatment outcomes for bilingual children who stutter do not appear to be different from those of monolingual children who stutter (Shenker, 2011). Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. Natural history of stuttering to 4 years of age: A prospective community-based study. Journal of Communication Disorders, 44(3), 276293. Stages of change and stuttering: A preliminary view. These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). Yaruss, J. S., & Pelczarski, K. M. (2007). (2019). https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). Thieme. Menu. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. https://doi.org/10.1037/a0020113, Coleman, C., & Yaruss, J. S. (2014). Prevalence of stuttering in primary school children in Cairo-Egypt. Persons who stutter may appear friendlier when they self-disclose their stuttering, and self-disclosure may help put listeners more at ease (Healey et al., 2007). SLPs also need to discuss with persons who stutter and their families how to evaluate the veracity and trustworthiness of sites claiming to cure stuttering that they may find on their own. Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. Presence of stutteringAn estimated one third of people who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). https://doi.org/10.1016/j.jfludis.2013.08.001, Briley, P. M., & Ellis, C. (2018). Peer support for people who stutter: History, benefits, and accessibility. Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. However, their disfluencies are not likely to involve prolongations, blocks, physical tension, or secondary behaviors that are more typical for children who stutter (Boscolo et al., 2002). Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). Language, Speech, and Hearing Services in Schools, 48(4), 234248. Journal of Communication Disorders, 80, 8191. American Journal of Speech-Language Pathology, 12(2), 243253. For example, English language learners may have word-finding problems in the second language. Communication Disorders Quarterly, 39(2), 335345. "I-I-I-I- want the ball") (2019). autism spectrum disorder (Briley & Ellis, 2018). https://doi.org/10.1111/jpc.12034. Epidemiology of stuttering in the community across the entire life span. (2010). Language, Speech, and Hearing Services in Schools, 49(1), 13. attention-deficit/hyperactivity disorder (Alm, 2011). (2008). In R. Lees & C. Stark (Eds. https://doi.org/10.1016/S0094-730X(01)00098-5. (2014). Cluttering treatment: Theoretical considerations and intervention planning. These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering. Prentice-Hall. Differences between children and adults should also be considered when interpreting data from neurological studies. Often, there are pivotal points during treatment that indicate progress (T. K. Anderson & Felsenfeld, 2003; Plexico et al., 2005). Sheehan, V. M., & Sisskin, V. (2001). https://doi.org/10.1016/j.jfludis.2011.06.001. 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). 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). Universitetsforlaget. Journal of Fluency Disorders, 54, 113. Review of previous fluency evaluations and educational records. Stuttering: Its nature, diagnosis, and treatment. Fluency refers to continuity, smoothness, rate, and effort in speech production. Miller, W. R., & Rollnick, S. (2013). Developmental stuttering in children who are hard of hearing. They have long-held beliefs about stuttering that positively or negatively affect self-perceptions about their communication skills and their motivation for change (Daniels, 2007). There may be a relationship between stuttering and working memory. Communication attitudes in children who stutter: A meta-analytic review. Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. Journal of Fluency Disorders, 38(1), 1429. 211230). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. (2014). https://doi.org/10.1176/appi.books.9780890425596, American Speech-Language-Hearing Association. Onslow, M., Packman, A., & Harrison, E. Reasonable accommodations would vary by work setting and type of work. Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. The relationship of self-efficacy and depression to stuttering. A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. Daly, D. A. Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). Social anxiety disorder and stuttering: Current status and future directions. Reeves, L. (2006). ), The atypical stutterer: Principles and practices of rehabilitation (pp. Cluttering and autism spectrum disorders. The purpose of assessing fluency in a preschool child is to determine. Desensitization can help decrease word avoidance and reduce fear. Manning, W. H., & Quesal, R. W. (2016). In addition, clinicians need to avoid using religious or highly familiar texts that individuals may know by rote. Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. (2017). Merrill. Following are descriptions of each of these forms of disfluency. 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 Enhancing treatment for school-age children who stutter: I. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). (2011). Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. https://doi.org/10.1055/s-2003-37447, Thordardottir, E. (2006). Unlike stuttering, there are no data regarding age since onset and long-term outcomes of cluttering. (2017). Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). talking about stuttering or treatment of stuttering. Toward a better understanding of the process of disclosure events among people who stutter. Journal of Fluency Disorders, 13(5), 357373. https://doi.org/10.1016/j.jfludis.2014.12.003. In E. G. Conture & R. F. Curlee (Eds. Arnold, G. E. (1960). Journal of Fluency Disorders, 36(2), 122129. Neurobiology of Disease, 69, 2331. Psychology Press. The person is having difficulty communicating messages in an efficient, effective manner. https://doi.org/10.1044/1092-4388(2011/10-0304), Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K. (2002). The utility of stuttering support organization conventions for young people who stutter. The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker. It is incumbent upon the SLP to help the individualized education program (IEP) team determine the academic and social impacts of stuttering on students in the school setting. 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). Seminars in Speech and Language, 24(1), 2126. ), Cluttering: A handbook of research, intervention and education (pp. Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Daniels, D. (2007). Professional awareness of cluttering. ), Stuttering and related disorders of fluency (pp. 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. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. Moments of stuttering or disfluency may be difficult to distinguish from typical disfluency or reduced language proficiency, especially for a person unfamiliar with the language (Shenker, 2011). Speech, Language and Hearing, 20(3), 144153. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). https://doi.org/10.1044/leader.OV.18032013.14, Freud, D., & Amir, O. Intervention procedures for the young stutterer. To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. SLPs can include teachers in the treatment process by educating them about fluency disorders, involving them in treatment sessions, and having them assist with assignments outside of treatment sessions. Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). It may occur only in specific situations, but it is more likely to occur in these situations, day after day. In addition to being used for improving communication skills, pausing is also an effective method of rate control. 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). 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. BMJ, 331(7518), 659661. Rehabilitation Act of 1973, Section 504. On the surface, this can be a difficult question, as many studies show up to 80% of children might recover from early speech disfluencies. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. Stuttering and cluttering: Frameworks for understanding and treatment. practice monitoring each others speech and secondary behaviors. Assessment of speech fluency (e.g., frequency, type, and duration of disfluencies), speech rate, speech intelligibility, and the presence of secondary behaviors in a variety of speaking tasks (e.g., conversational and narrative contexts). Covert stuttering: Investigation of the paradigm shift from covertly stuttering to overtly stuttering. (1984). These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). (2018). Journal of Fluency Disorders, 58, 2234. Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). Yaruss, J. S., & Quesal, R. W. (2004). Counseling is an integral part of the assessment and treatment of individuals who stutter or clutter. Understanding that awareness and concern about stuttering may vary across individuals and cultures and conducting a culturally and linguistically relevant comprehensive assessment. typical vs atypical disfluencies asha. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). Repetitive negative thinking, temperament, and adverse impact in adults who stutter. These are called typical disfluencies or nonfluencies. Arnold, H. S., Conture, E. G., Key, A. P., & Walden, T. (2011). Assessing bilingual children: Are their disfluencies indicative of stuttering or the by-product of navigating two languages? The neurological underpinnings of cluttering: Some initial findings. A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. auditory processing disorders (Molt, 1996). The frequency and severity of overt stuttering may fluctuate from day to day and in relation to the speaking situation. Cluttering: A synergistic framework. The scope of this page includes stuttering and cluttering across the life span. Lippincott Williams & Wilkins. 341358). Developing culturally and linguistically relevant intervention plans focused on helping the individual achieve more fluent speech and self-acceptance of disfluency, providing treatment, documenting progress, and determining appropriate dismissal criteria. St. Louis, K. O., Myers, F., Bakker, K., & Raphael, L. (2007). resilience building within the child and family (Berquez & Kelman, 2018). The individual learns strategies for generalization of skills to the classroom, workplace, and community. Stuttering in school-age children: A comprehensive approach to treatment. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). Areas of the brain that were studied and the technologies used to conduct the research (e.g., PET, MEG, MRI, fMRI, NIRS, DCS) also varied widely. School Psychology Review, 30(1), 135141. Pediatrics, 132(3), 460467. (2014). https://doi.org/10.1044/2017_JSLHR-S-16-0343, Snsterud, H., Feragen, K. B., Kirmess, M., Halvorsen, M. S., & Ward, D. (2019). When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. Drayna and Kang (2011) found that gene mutations were present in close to 10% of cases of familial stuttering. Fluency Disorders (Practice Portal). 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). 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). 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. Journal of Fluency Disorders, 44, 3245. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. 187214). Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). 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). SIG 4 Perspectives on Fluency and Fluency Disorders. increased social communication participation (Manning & DiLollo, 2018). https://doi.org/10.1044/persp1.SIG4.55, Byrd, C. T., Croft, R., Gkalitsiou, Z., & Hampton, E. (2017). https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). Shock, 2. 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). The ASHA Leader, 19(7), 4448. Skip to main content. Wiig, E. H., & Semel, E. M. (1984). Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Bulletin of the Center for Special Needs Education Research and Practice, 13, 19. 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). Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. Discussions about the physical experience of anxiety and ways to reduce it and the sense of loss of control and time pressure may be of further benefit (e.g., mindfulness and grounding; Beilby et al., 2012a; Boyle, 2011; Harley, 2018). https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). The Journal of Child Psychology and Psychiatry, 43(7), 939947. Roberts, P., & Shenker, R. (2007). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. https://doi.org/10.1016/j.nbd.2014.04.019, Han, T.-U., Root, J., Reyes, L. D., Huchinson, E. B., du Hoffmann, J., Lee, W.-S., Barnes, T. D., & Drayna, D. (2019). Sadness/Depression, 6. Resilience has been examined in the stuttering literature as one factor that may protect people from the adverse effects of chronic stuttering (Craig et al., 2011; Freud & Amir, 2020). Journal of Fluency Disorders, 58, 110. 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. increasing acceptance and openness with stuttering. B. Regional cerebral blood flow is reduced in Brocas area, the region in the frontal lobes of the brain linked to speech production, and an inverse relationship was noted between the severity of stuttering and the rate of blood flow (Desai et al., 2016). (2014). https://doi.org/10.1055/s-2008-1064082, Caughter, S., & Crofts, V. (2018). How can you tell if childhood stuttering is the real deal? The specific strategy they select will depend on when the client catches the disfluencyin anticipation of the moment of disfluency, in the moment, or following the moment (Van Riper, 1973). Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. Rethinking covert stuttering. Disclosure of stuttering and quality of life in people who stutter. ), Cluttering: A handbook of research, intervention and education (pp. (Eds.). Yairi, E., & Ambrose, N. (2005). Erickson, S., & Block, S. (2013). Harper & Row. Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. Technological advances and the expansion of social media outlets have increased opportunities for adults who stutter to connect, share, and gain information through the Internet (Fuse & Lanham, 2016; Raj & Daniels, 2017) and stuttering-related podcasts (Dignazio et al., 2020).