Is parentchild interaction therapy effective in reducing stuttering? Some individuals develop speech habits to escape or avoid moments of overt stuttering, such as changing words or using interjections (e.g., um, uh), and they may become so skilled at hiding stuttering that their speech appears to be fluent (covert stuttering; B. Murphy et al., 2007). Journal of Fluency Disorders, 36(1), 1726. 142185). Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. (2018). The term overt stuttering is used when core speech behaviors are present. Reardon-Reeves, N., & Yaruss, J. S. (2013). When a bilingual clinician is not available, using an interpreter is a viable option. The individual learns strategies for generalization of skills to the classroom, workplace, and community. A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). www.asha.org/policy/, American Speech-Language-Hearing Association. 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). Psychology Press. Individuals are referred to a speech-language pathologist (SLP) for a comprehensive assessment when disfluencies are noted and when one or more of the factors listed below are observed along with the disfluencies. Stuttering and cluttering. Purpose Disfluencies associated with stuttering generally occur in the initial position of words. Thieme. For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. In L. Cummings (Ed. In K. O. Lewis (Ed. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Pro-Ed. See also ASHAs resources titled Person-Centered Focus on Function: Preschool Stuttering [PDF], Person-Centered Focus on Function: School-Age Stuttering [PDF], and Person-Centered Focus on Function: Adult Stuttering [PDF] for examples of assessment data consistent with the ICF framework. https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). Rocha, M., Yaruss, J. S., & Rato, J. R. (2019). Journal of Speech, Language, and Hearing Research, 61(5), 12381250. Healey, E. C., Reid, R., & Donaher, J. intellectual disability (Healey et al., 2005). (2017). Stuttering in relation to lexical diversity, syntactic complexity, and utterance length. B. Available from http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/. On the surface, this can be a difficult question, as many studies show up to 80% of children might recover from early speech disfluencies. 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). 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?). Yairi, E., & Ambrose, N. (2005). Assessment and treatment of stuttering in bilingual speakers. increasing acceptance and openness with stuttering. https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). altering the size of the group or audience. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. Fluency Disorders (Practice Portal). A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. (2015). In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). 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). In D. Ward & K. Scaler Scott (Eds. Nurturing a resilient mindset in school-aged children who stutter. 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). https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). 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). Howell, P., & Davis, S. (2011). Fluency shaping with young stutterers. 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. Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. Finding the good in the challenge: Benefit finding among adults who stutter. Psychology Press. https://doi.org/10.1016/j.jfludis.2013.09.003, Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). Some children who stutter or clutter may only experience symptoms situationally. 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). Evaluating stuttering in young children: Diagnostic data. Social anxiety disorder and stuttering: Current status and future directions. Psychology Press. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. 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). Seminars in Speech and Language, 39(4), 324332. Journal of Abnormal Psychology, 119(3), 479490. Neurobiology of Disease, 69, 2331. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). For example, some children from bilingual or multicultural backgrounds may experience stuttering onset or a temporary increase in stuttering as result of being in new and unfamiliar situations, learning a new language, or being exposed to mixed linguistic input (Shenker, 2013). 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). Consequently, they may speak less to avoid being disfluent, and they may avoid social situations. 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. (2010). Stuttering and work life: An interpretative phenomenological analysis. The clinical applications of Acceptance and Commitment Therapy with clients who stutter. Prevalence of speech disorders in elementary school students in Jordan. Guitar, B. Preus, A. A comprehensive assessment for persistent stuttering should include a self-assessment of the experience of stuttering. The social and communication impact of stuttering on adolescents and their families. Fear of speaking: Chronic anxiety and stammering. Children who stutter may demonstrate poorer expressive lexical skills compared to their peers (Silverman & Bernstein Ratner, 2002). Individuals may experience the impact of fluency disorders in social and emotional, academic, and vocational domains. The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). Stuttering and its treatment in adolescence: The perceptions of people who stutter. https://doi.org/10.1044/2017_JSLHR-S-16-0371, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2019). Journal of Fluency Disorders, 25(1), 4757. See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Journal of Fluency Disorders, 35(3), 216234. A study of pragmatic skills of clutterers and normal speakers. Disclosing a fluency disorder has many benefits on both the speaker (Boyle & Gabel, 2020; Boyle et al., 2018; Mancinelli, 2019) and the listener (Byrd, Croft, et al., 2017; Byrd, McGill, et al., 2017; Ferguson et al., 2019; Healey et al., 2007). Routledge. Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. University Park Press. 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). Hill, D. (2003). ), Cluttering: A handbook of research, intervention and education (pp. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). Covert stuttering: Investigation of the paradigm shift from covertly stuttering to overtly stuttering. Prevalence of stuttering in African American preschool children. (1988). https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). The ASHA Leader, 19(7), 4448. https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. Direct treatment approaches may include speech modification (e.g., reduced rate of speech, prolonged syllables) and stuttering modification strategies (e.g., modifying a stuttered word, pulling out of a stuttered word) to reduce disfluency rate, physical tension, and secondary behaviors (Hill, 2003). The Stuttering Foundation We provide free online resources, services and support to those who stutter and their families, as well as support for research into the causes of stuttering. Group experiences and individual differences in stuttering. Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. School-age stuttering therapy: A practical guide. Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. https://doi.org/10.1177/152574018200600106. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. 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). Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). For bilingual individuals, it is important for the clinician to consider the language or languages used during intervention. Adults with fluency disorders have likely experienced years of treatment with varied outcomes. See ASHAs resource on person- and family-centered care. Application of the ICF in fluency disorders. Goals that focus on minimizing negative reactions to stuttering and difficulties communicating in various speaking situations may help the individual reduce the effort used to hide or avoid their disfluencies and communicate with more ease. These signs and symptoms are consistent with the diagnostic and associated features of childhood-onset fluency disorder (stuttering) listed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. However, as they learn to reduce reactivity (see below), they develop greater comfort while speaking, they assume more positive attitudes about their ability to communicate, and they are better able to accept and manage moments of disfluency as they occur. The impact of a stuttering disorder on Western Australian children and adolescents. Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. It can also be challenging to assess the reading fluency of bilingual students who stutter. 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. increasing self-confidence and self-efficacy. 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). The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. Erlbaum. 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. increased social communication participation (Manning & DiLollo, 2018). Section 504 of the Rehabilitation Act of 1973 also applies to individuals with disabilities in a work setting. Differences in fluency across languages may be due to the social context in which the language is used (Foote, 2013), as well as the proficiency of each language spoken. https://doi.org/10.1055/s-2008-1064082, Caughter, S., & Crofts, V. (2018). Individuals learn to identify the thoughts underlying their negative attitudes and emotional reactions and examine the link between these thoughts, attitudes, and emotional reactions and their speech. 7184). 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). https://doi.org/10.1044/jshr.3605.906. 4. Stuttering, the most common fluency disorder, is an interruption in the flow of speaking characterized by specific types of disfluencies, including, These disfluencies can affect the rate and rhythm of speech and may be accompanied by. (2014). (2018). typical vs atypical disfluencies asha. production of words with an excess of physical tension or struggle. B., & Al-Khamra, R. (2015). Molecular Genetics & Genomic Medicine, 5(2), 95102. One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). https://doi.org/10.1093/brain/awm241, Watson, J. When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. ), Cluttering: Research, intervention and education (pp. https://doi.org/10.1016/j.jfludis.2016.09.005, Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). Onset may be progressive or sudden. Perspectives on Fluency and Fluency Disorders, 4(6), 13161326. American Journal of Speech-Language Pathology, 16(1), 6568. This may progress to the client analyzing the clinicians or their own pseudostuttering, to analyzing a video of their own stuttering to real-time analysis (Bray & Kehle, 2001; Bray et al., 2003; Cream et al., 2010; Harasym et al., 2015; Prins & Ingham, 2009). https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. Journal of Fluency Disorders, 54, 113. Motivational interviewing: Helping people change. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency. Emotional reactivity, regulation and childhood stuttering: A behavioral and electrophysiological study. In B. J. Amster & E. R. Klein (Eds. Journal of Fluency Disorders, 38(2), 206221. Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. Self-help conferences for people who stutter: A qualitative investigation. ), The treatment of stuttering in the young school-aged child (pp. 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. 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. Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. See What To Ask When Evaluating Any Procedure, Product, or Program. 297325). This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. (2014). 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). ASHA thanks the following individuals,who, in 2014, made significant contributions to the development of this content. https://doi.org/10.1044/2019_JSLHR-S-18-0225. Barnes, T. D., Wozniak, D. F., Gutierrez, J., Han, T. U., Drayna, D., & Holy, T. (2016). The interview process and work environment can be challenging for individuals who stutter. (2001). https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). 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). In H. Gregory (Ed. Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. Journal of Fluency Disorders, 40, 3543. Seminars in Speech and Language, 35(2), 114131. Professional awareness of cluttering. 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. Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Sadness/Depression, 6. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). 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). Fluency disorders do not necessarily affect test scores or subject grades. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). 1-888-266-0574. The lowest prevalence rates of stuttering were reported in adults aged 2150 years (0.78%) and adults aged 51 years or older (0.37%; Craig et al., 2002). Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). Pro-Ed. Reducing bullying through role-playing and self-disclosure. Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis. To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. Rehabilitation Act of 1973, Section 504. https://doi.org/10.1093/med:psych/9780195165791.003.0007, Proctor, A., Yairi, E., Duff, M., & Zhang, J. Cengage Learning. Treatment should consider not just the overt stuttering behavior but also the affective and cognitive reactions to stuttering. Stuttering-related podcasts: Audio-based self-help for people who stutter. When determining eligibility for speech and language services through the public school system, SLPs need to document the adverse educational impact of the disability using a combination of standardized test scores when available and a portfolio-based assessment (Coleman & Yaruss, 2014; Ribbler, 2006). Onslow, M., Packman, A., & Harrison, E. Motivational interviewing may be used to help individuals who stutter better understand the thoughts and feelings associated with their stuttering and make positive changes to improve communication. They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. Individuals may experience stuttering in different ways with siblings, their spouse, or other family members. As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. The ASHA Leader, 18(3), 1415. the asha leader; journals. https://doi.org/10.1044/jshr.2804.495, Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Menzies, R. G., Onslow, M., & Rapee, R. M. (2016). Journal of Speech, Language, and Hearing Research, 62(5), 13711372. https://doi.org/10.1044/leader.OV.18032013.14, Freud, D., & Amir, O. However, fluency shaping approaches, such as easy onset or continuous phonation, may not be appropriate for the treatment of cluttering. Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. When a bilingual SLP is not available, using an interpreter is a viable option. Referring to other health care professionals when outside support is needed to facilitate treatment goals for interfering behaviors (e.g., anxiety, depression). Adolescents and young adults who stutter were found to have more white matter connections in the right hemisphere as compared with normally fluent controls (Watkins et al., 2008). practice monitoring each others speech and secondary behaviors. Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. 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). Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. practice treatment targets with more listeners. Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. https://doi.org/10.1016/0094-730X(88)90004-6, Onslow, M., & OBrian, S. (2012). Overheard: Bilingual and disfluent: A unique treatment challenge. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. 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. Individuals who stutter may report fear or anxiety about speaking and frustration or embarrassment with the time and effort required to speak (Ezrati-Vinacour et al., 2001). Treatment is sensitive to cultural and linguistic factors and addresses goals within WHOs ICF framework (ASHA, 2016a; Coleman & Yaruss, 2014; WHO, 2001; Yaruss, 2007; Yaruss & Quesal, 2004, 2006). https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. Self-regulation and the management of stuttering. One of the core principles of ACT is mindfulness. Scope of Practice in Speech-Language Pathology, Counseling For Professional Service Delivery, interprofessional education/interprofessional practice [IPE/IPP], American Board of Fluency and Fluency Disorders, assessment tools, techniques, and data sources, assessment of fluency disorders in the context of the WHO ICF framework, assessment procedures: parallel with CPT codes, characteristics of typical disfluency and stuttering, Collaborating With Interpreters, Transliterators, and Translators, ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter, Speech Sound Disorders: Articulation and Phonology, treatment goals for fluency disorders in the context of the WHO ICF framework, What To Ask When Evaluating Any Procedure, Product, or Program, Counseling For Professional Service Deliver, Cognitive Distortions and Fluency Examples, Characteristics of Typical Disfluency and Stuttering, Early Identification of Speech, Language, and Hearing Disorders, How Can You Tell if Childhood Stuttering is the Real Deal, Assessment of Fluency Disorders In the Context of the WHO ICF Framework, Treatment Goals For Fluency Disorders in the Context of the WHO ICF Framework, Assessment Procedures: Parallel With CPT Codes, Private Health Plans: Tips and strategies for ensuring that speech and hearing services are covered, FRIENDS: The National Association of Young People Who Stutter, International Cluttering Association (ICA), SAY: The Stuttering Association for the Young, https://doi.org/10.1371/journal.pone.0133758, https://doi.org/10.1044/2020_PERSP-20-00014, https://doi.org/10.1016/j.jfludis.2019.105713, https://doi.org/10.1044/2018_AJSLP-17-0097, https://doi.org/10.1044/2017_JSLHR-S-16-0371, https://doi.org/10.1044/1092-4388(2008/046, https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199, https://doi.org/10.1044/1058-0360(2011/09-0102, https://doi.org/10.1044/1092-4388(2008/07-0057, www.asha.org/practice-portal/clinical-topics/fluency-disorders/, Connect with your colleagues in the ASHA Community, repetitions of sounds, syllables, and monosyllabic words (e.g., Look at the, prolongations of consonants when it isnt for emphasis (e.g., .
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