Treatment approaches are individualized based on the childs needs and family communication patterns. Journal of Speech, Language, and Hearing Research, 60(11), 30973109. Self-disclosure involves communicating to others information that reveals ones identity as a person who stutters. 115134). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Onslow, M., & Yaruss, J. S. (2007). https://doi.org/10.1080/2050571X.2016.1253533. Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). 157186). A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. International Journal of Speech-Language Pathology, 17(4), 367372. 7184). When a bilingual clinician is not available, using an interpreter is a viable option. Stuttering and its treatment in adolescence: The perceptions of people who stutter. St. Louis, K. O., & Rustin, L. (1996). These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). Individuals may exhibit pure cluttering or cluttering with stuttering (van Zaalen-Opt Hof et al., 2009). Defining cluttering: The lowest common denominator. You do not have JavaScript Enabled on this browser. 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). Adolescents also may be particularly susceptible to peer pressure and bullying at this time. reports changing conception of stuttering from exclusively negative to having positive features. Board Certified Specialists in Fluency are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with fluency disorders. The ASHA Action Center welcomes questions and requests for information from members and non-members. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). 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). https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Seminars in Speech and Language, 35(2), 6779. Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). 115134). Daniels, D. (2007). Desensitization strategies are strategies that help speakers systematically desensitize themselves to their fears about speaking and stuttering by facing those fears in structured, supportive environments. SIG 4 Perspectives on Fluency and Fluency Disorders. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). Numerous treatment approaches and strategies have been developed in an attempt to help speakers reduce the negative reactions associated with stuttering (e.g., W. P. Murphy et al., 2007a). American Journal of Speech-Language Pathology, 2(2), 6573. their reason for seeking treatment at the current time. Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Enhancing treatment for school-age children who stutter: II. Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). https://doi.org/10.1044/0161-1461(2012/11-0044), Yaruss, J. S., LaSalle, L. R., & Conture, E. G. (1998). Oxford University Press. 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. Speech modification approaches to stuttering treatment in schools. It is not appropriate to determine a standard score if the norming sample of the assessment is not representative of the individual being assessed. In D. Ward & K. Scaler Scott (Eds. There is a family history of stuttering or cluttering. Reduced perfusion in Brocas area in developmental stuttering. Advocating for individuals with fluency disorders and their families at the local, state, and national levels. ), Stuttering and related disorders of fluency (pp. 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). Seminars in Speech and Language, 35(2), 114131. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Fluency disorders can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). (1988). Psychology Press. 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). https://doi.org/10.1037/a0020113, Coleman, C., & Yaruss, J. S. (2014). discussing the rationale for treatment decisions, and. increasing self-confidence and self-efficacy. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. What is motivational interviewing? Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. Operant approaches operate within a framework of stuttering as a learned behavior (for a discussion, see Conture, 2001; de Sonneville-Koedoot et al., 2015, p. 334; Onslow & Yaruss, 2007). In D. Ward & K. Scaler Scott (Eds. Clinicians can help clients progress to active stages through building self-efficacy. Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs are obligated to provide culturally and linguistically appropriate services, regardless of the clinicians personal culture, practice setting, or caseload demographics. (2017). Other speech or language concerns are also present. I ran out of cheese and bread the other day while making sandwiches and now Im out so I need to go to the store), and/or. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. 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). Prins, D., & Ingham, R. J. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. The term overt stuttering is used when core speech behaviors are present. Evidence-based treatment and stutteringHistorical perspective. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). Psychology Press. Fluency refers to continuity, smoothness, rate, and effort in speech production. Self-help conferences for people who stutter: A qualitative investigation. Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016a; Coleman & Yaruss, 2014; Vanryckeghem & Kawai, 2015; WHO, 2001; Yaruss, 2007; Yaruss & Quesal, 2004, 2006), a comprehensive fluency assessment is conducted to identify and describe. seizure disorders (Briley & Ellis, 2018). Journal of Fluency Disorders, 36(2), 110121. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. https://doi.org/10.1016/j.jfludis.2010.04.003, Wagovich, S., & Hall, N. (2017). As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. 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. The plan outlines reasonable accommodations for speaking or reading activities to help ensure a students academic success and access to the learning environment in school. You do not have JavaScript Enabled on this browser. 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). perceived communication and job barriers. The purpose of the screening is to identify individuals who require further speech-language assessment. Typical childhood disfluencies may increase and decrease without any external influence. https://doi.org/10.1044/1092-4388(2008/07-0111), Prochaska, J. O., & DiClemente, C. C. (2005). To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. Wolk, L., Edwards, M. L., & Conture, E. G. (1993). Specifically, mutations to GNPTAB, GNPTG, and NAGPA have been found to disrupt the signal that directs enzymes to their target location in the lysosome of the cell (Drayna & Kang, 2011). 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. Palin ParentChild Interaction Therapy for early childhood stammering. Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. Below is a list of approaches commonly used with school-age children, adolescents, and adults who stutter. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Reeves, L. (2006). 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 should consider not just the overt stuttering behavior but also the affective and cognitive reactions to stuttering. Manning, W. H., & Quesal, R. W. (2016). Speech modification (including fluency shaping) strategies (Bothe, 2002; Guitar, 1982, 2019) include a variety of techniques aimed at making changes to the timing and tension of speech production or altering the timing of pauses between syllables and words. B. Onset may be progressive or sudden. See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Fluency: A review of developmental and remedial practices. Self-efficacy and quality of life in adults who stutter. 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). Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). https://doi.org/10.1044/2019_JSLHR-S-18-0225. See ASHAs Practice Portal page on Telepractice. Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. Social anxiety disorder in adults who stutter. Overheard: Bilingual and disfluent: A unique treatment challenge. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Journal of Communication Disorders, 44(3), 276293. Pediatrics, 144(4), Article e20190811. 1997- American Speech-Language-Hearing Association. Stuttering may influence an individuals perception of their career possibilities and professional limitations (Klein & Hood, 2004). NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. See ASHAs resource on assessment tools, techniques, and data sources. https://doi.org/10.1093/brain/awm241, Watson, J. 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). Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). The creative process in avoidance reduction therapy for stuttering. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). A thematic analysis of late recovery from stuttering. Assisting children who stutter in dealing with teasing and bullying. In fact, stuttering can affect all areas of academic competency, including academic learning, social-emotion functioning, and independent functioning (Ribbler, 2006, p. 15). Recurring themes of successful stuttering management in adults have been described as. Journal of Fluency Disorders, 40, 6982. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). ), Stuttering and related disorders of fluency (pp. Treatment outcomes for bilingual children who stutter do not appear to be different from those of monolingual children who stutter (Shenker, 2011). 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). The term atypical has been applied to rapid atrial tachycardias with ECG patterns differing from the typical and reverse typical flutter described above, and also to re-entrant tachycardias with circuit configuration different from the typical RA flutter circuit, even if they have an ECG pattern similar to typical flutter. 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. Therefore, when conducting an assessment with an adult, it is crucial to understand. 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. Intervention procedures for the young stutterer. 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). Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. Donaher, J., & Richels, C. (2012). Best practice for developmental stuttering: Balancing evidence and expertise. Expand Search Apply; Program Guide; BOBapp(2023) . (2018). Preus, A. Strategies for reducing impairment in body function have been separated into two categoriesspeech modification and stuttering modification, both of which are described below. 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. Scheduling concerns, cost, and insurance reimbursement also are likely to be factors affecting dosage. recognize physical concomitant behaviors, locate the point of physical tension and struggle during moments of disfluency, and. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy.