They are likely to use interjections, repeat phrases, and revise what they are saying. Parents can also learn about how to help their child generalize skills from the treatment room to different settings and with different people. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. There are limited data on the age of onset of cluttering; however, the age of onset of cluttering appears to be similar to that of stuttering (Howell & Davis, 2011). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. 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. 4566). Onslow, M., & Yaruss, J. S. (2007). The impact of stuttering on employment opportunities and job performance. This perceived rapid rateand the resulting breakdown in speech clarityis thought to be because speakers with cluttering speak at a rate that is too fast for their systems to handle (Myers, 1992; St. Louis et al., 2007; Ward, 2006). Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. School-age stuttering therapy: A practical guide. Molt, L. F. (1996). Clients often report successful stuttering therapy as a transformational experience progressing from avoidance to acceptance and openness, increasing self-confidence and self-efficacy (Plexico et al., 2005; Tichenor & Yaruss, 2019a). Yaruss, J. S., & Pelczarski, K. M. (2007). The clutterer. Speech clarity and fluency may temporarily improve when the person is asked to slow down or pay attention to their speech. These should be considered during differential diagnosis but should not be the sole therapeutic strategies. Adults with fluency disorders have likely experienced years of treatment with varied outcomes. Treatment for fluency disorders is highly individualized and based on a thorough assessment of speech fluency, language factors, emotional/attitudinal components, and life impact (Byrd & Donaher, 2018). However, the clinician needs to consider the impact of disfluency on communication and quality of life as a whole. https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). Yairi, E., & Ambrose, N. (2005). The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. provide and receive support from others who share the experience of stuttering. Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). Language, Speech, and Hearing Services in Schools, 49(1), 13. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). Smith, A., & Weber, C. (2017). The purpose of assessing fluency in a preschool child is to determine. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). Educating other professionals about the needs of individuals with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders. Specific standardized tests can be used to rule out word-finding difficulties. excessive levels of typical disfluencies (e.g., revisions, interjections), maze behaviors or frequent topic shifting (e.g., I need to go toI mean Im out of cheese. Journal of Fluency Disorders, 40, 3543. The term overt stuttering is used when core speech behaviors are present. (2016b). It can also be challenging to assess the reading fluency of bilingual students who stutter. The assignments begin in supportive, low-fear situations and slowly evolve to more challenging situations and settings as the individual demonstrates the ability to accept or tolerate potential negative reactions. Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. Sex of childIt appears that the disorder is more common in males than in females; the male-to-female ratio for cluttering has been reported to range from 3:1 to 6:1 (G. E. Arnold, 1960; St. Louis & Hinzman, 1986; St. Louis & Rustin, 1996). Journal of Fluency Disorders, 36(4), 290295. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter Assisting children who stutter in dealing with teasing and bullying. 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). Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. Rehabilitation Act of 1973, Section 504. Thieme. 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. Journal of Fluency Disorders, 34(4), 368381. (1996). https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). Ward, D., & Scaler Scott, K. (2011). Self-help and support groups for people with cluttering. EBP Briefs, 2(4), 18. Singular. 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). have a sense of belonging and experience less stigma. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0189, Chakraborty, M., Chen, L.-F., Fridel, E. E., Klein, M. E., Senft, R. A., Sarkar, A., & Jarvis, E. D. (2017). In L. Cummings (Ed. Communication Disorders Quarterly, 39(2), 335345. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). However, increased mean length of utterance, more diverse vocabulary, and greater syntactic complexity have also been noted (Wagovich & Hall, 2017). Starkweather, Janice Westbrook. Measuring lexical diversity in children who stutter: Application of vocd. It is not possible to determine with certainty which children will continue to stutter, but there are some factors that indicate a greater likelihood that stuttering will become chronic. (2010). Fluency shaping with young stutterers. (1979). https://doi.org/10.1044/ffd16.1.15. Risk factors that may be associated with persistent stuttering include. Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. https://doi.org/10.1016/j.jfludis.2015.01.003, Harley, J. In D. Ward & K. Scaler Scott (Eds. Clinicians do not have to choose one approach or the other. Stuttering: An integrated approach to its nature and treatment. 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/10.1016/j.jfludis.2018.09.004, Menzies, R. G., OBrian, S., Packman, A., Jones, M., Helgadttir, F. D., & Onslow, M. (2019). Seminars in Speech and Language, 24(1), 2732. Stuttering Therapy Resources. Stuttering: Research and therapy. It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. Journal of Speech, Language, and Hearing Research, 45(6), 10971105. 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). (2010). Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. American Journal of Speech-Language Pathology, 27(3S), 12111223. Journal of Fluency Disorders, 37(4), 289299. Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. 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). Impact experienced from stuttering, or covert features of stuttering, may include. Lyn Goldberg and Michelle Ferketic served as ex officios. (2011). Bullying in adolescents who stutter: Communicative competence and self-esteem. Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. Trichon, M., & Tetnowski, J. Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). Yaruss, J. S., & Quesal, R. W. (2004). For an accurate evaluation, it is ideal to collect samples of speech across various situations and tasks, both inside and outside the clinical setting (Yaruss, 1997). Perspectives on Fluency and Fluency Disorders, 17(2), 49. Cooper, E. B. Strategies aimed at changing the timing and tension of speech production include. Journal of Speech, Language, and Hearing Research, 56(5), 15171529. Seminars in Speech and Language, 39(4), 324332. American Journal of Speech-Language Pathology, 29(1), 201215. Emotional problems and parenting style do not cause stuttering. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). 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). A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. When a student stutters: Identifying the adverse educational impact. 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). (2003). A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. Group experiences and individual differences in stuttering. Denial, 3. 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). For some people, the use of these behaviors can result in little or no observable stuttering. (2014). Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. The perils of oral-reading fluency assessments for children who stutter led a group of SLPs to investigate the issue and call on colleagues to change their school districts policies. It is helpful to know that typical bilingual or multilingual children tend to produce higher rates of monosyllabic word repetitions, sound repetitions, and syllable repetitions than monolingual speakers. Peer support for people who stutter: History, benefits, and accessibility. American Journal of Speech-Language Pathology, 27(3S), 11241138. Coworkers may have negative attitudes toward individuals who stutter, and the individual may feel excluded because of this. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. The transtheoretical approach. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. slower rates of language development (Leech et al., 2017, 2019) or co-occurring speech and language impairment (Ntourou et al., 2011; Yaruss et al., 1998). Bowling Green State University Archive. Apply Now. Avoidance Reduction Therapy for Stuttering (ARTS). These strategies, like speech modification strategies, are introduced along a hierarchy of speaking situations that varies both with linguistic demands and with the stressors of the environment. 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. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). The scope of this page includes stuttering and cluttering across the life span. Acceptance and Commitment Therapy for people who stutter. Journal of Abnormal Psychology, 119(3), 479490. Typical pneumonia is a form of community-acquired pneumonia that tends to have more serious symptoms. Psychology Press. 1997- American Speech-Language-Hearing Association. 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. 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. Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). 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). Journal of Speech, Language, and Hearing Research, 51(6), 14651479. Section 504 of the Rehabilitation Act of 1973 also applies to individuals with disabilities in a work setting. 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). Desensitization can help decrease word avoidance and reduce fear. Journal of Fluency Disorders, 38(3), 260274. Arnold, H. S., Conture, E. G., Key, A. P., & Walden, T. (2011). In B. J. Amster & E. R. Klein (Eds. The neurological underpinnings of cluttering: Some initial findings. Summary - Typical vs Atypical Pneumonia. Self-regulation and the management of stuttering. (1988). sex of childboys are at higher risk for persistence of stuttering than girls (Craig et al., 2002; Yairi & Ambrose, 2013); family history of persistent stuttering (Kraft & Yairi, 2011); time duration of greater than 612 months since onset or no improvement over several months (Yairi & Ambrose, 2005); age of onsetchildren who start stuttering at age 3 years or later (Yairi & Ambrose, 2005); and. Recommending related services when necessary for management and treatment in different settings (e.g., classroom, work, community). Guttormsen, L. S., Kefalianos, E., & Nss, K. A. Yaruss, J. S., & Reardon-Reeves, N. (2017). 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. Counseling parents of children who stutter. Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). Perspectives on Fluency and Fluency Disorders, 23(2), 5469. Atypical disfluency has been documented through case studies and has been described as final part-word repetition or "rhyme repetition". Similarities - Typical and Atypical Pneumonia 5. In B. J. Amster & E. R. Klein (Eds. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Teigland, A. Stuttering severity may vary dramatically by speaking situation. Counseling individuals with fluency disorders and their families and providing education aimed at self-acceptance and reducing negative reactions (see ASHAs Practice Portal page on, Consulting and collaborating with individuals with fluency disorders, families, other professionals, peers, and other invested parties to identify priorities and build consensus on an intervention plan focused on functional outcomes (see ASHAs resources on. In N. B. Ratner & J. Tetnowski (Eds. Language abilities of children who stutter: A meta-analytical review. 4. Assessment of awareness in young children of disfluencies and difficulty in speaking. 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).