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). The cost of such avoidance can be great because of the resulting impact on the persons ability to say what they want to say, when they want to say it. www.asha.org/policy/, American Speech-Language-Hearing Association. Pediatrics, 144(4), Article e20190811. Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). Yairi, E., & Ambrose, N. (2013). 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. In E. Conture & R. F. Curlee (Eds. 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. Language assessment and intervention for the learning disabled. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. Journal of Fluency Disorders, 21(34), 201214. Below is a list of approaches commonly used with school-age children, adolescents, and adults who stutter. Finding opportunities for social support for individuals with fluency disorders. 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). Journal of Speech, Language, and Hearing Research, 36(5), 906917. Brain, 131(1), 5059. 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). (n.d.). Typical disfluencies often resolve by age five and tend to cycle, meaning they come and go. Wolk, L., Edwards, M. L., & Conture, E. G. (1993). The interview process and work environment can be challenging for individuals who stutter. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. Building trust by following the students lead, finding out what experiences may be motivating, and bringing together peers for support are treatment options to consider (Hearne et al., 2008). https://doi.org/10.1016/j.jfludis.2015.08.001, Han, T.-U., Park, J., Domingues, C. F., Moretti-Ferreira, D., Paris, E., Sainz, E., Gutierrez, J., & Drayna, D. (2014). There may be a relationship between stuttering and working memory. Coexistence of stuttering and disordered phonology in young children. These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). Behavioural and Cognitive Psychotherapy, 23(4), 325325. (2010). These modifications are used to facilitate speech fluency and may include. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. Yaruss, J. S., & Reardon-Reeves, N. (2017). Available from http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/. A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. Research updates in neuroimaging studies of children who stutter. A range of studies support a genetic predisposition for stuttering, but no definitive findings have been made regarding which transmission model, chromosomes, genes, or sex factors are involved in the expression of stuttering in the population at large (Kraft & Yairi, 2011, p. 34). Adolescents also may be particularly susceptible to peer pressure and bullying at this time. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. https://doi.org/10.1016/j.jfludis.2011.06.001. All speakers are disfluent at times. 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. American Journal of Speech-Language Pathology, 12(2), 243253. Stimulability testing (e.g., person is asked to increase pausing and/or decrease speech rate in some other way)a reduction of overall speech rate typically helps in reducing cluttering symptoms. https://doi.org/10.1016/j.jfludis.2018.10.003, Bray, M. A., & Kehle, T. J. increasing self-confidence and self-efficacy. Counseling helps an individual, a family member, or a caregiver of a person of any age who stutters move from the current scenario to a preferred scenario through an agreed-upon action plan (Egan, 2013). https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). Journal of Fluency Disorders, 13(5), 331355. The ASHA Action Center welcomes questions and requests for information from members and non-members. Bilingual myth-busters series when young children who stutter are also bilingual: Some thoughts about assessment and treatment. Sisskin, V. (2018). https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). 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). 115134). ), Cluttering: Research, intervention and education (pp. Overheard: Bilingual and disfluent: A unique treatment challenge. 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). resilience building within the child and family (Berquez & Kelman, 2018). In H. H. Gregory, J. H. Campbell, C. B. Gregory, & D. G. Hill (Eds. ), Controversies about stuttering therapy (pp. Donaher, J., & Richels, C. (2012). The SLP can use audio- or videoconferencing to augment this type of treatment. typical vs atypical disfluencies asha. Finding the good in the challenge: Benefit finding among adults who stutter. Stuttering and cluttering. Stuttering Therapy Resources. Journal of Fluency Disorders, 50, 7284. Coleman, C. (2013). Thieme. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). Thieme. The International Journal of Indian Psychology, 3(3), 7887. Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. Some people who clutter tend to decrease volume at the ends of sentences or phrases and, therefore, can benefit from learning to keep a steady volume throughout their utterances. The individual learns strategies for generalization of skills to the classroom, workplace, and community. See ASHAs Practice Portal page on Cultural Responsiveness. The utility of stuttering support organization conventions for young people who stutter. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). BMJ, 331(7518), 659661. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. Individuals who stutter are more likely to be self-aware about their disfluencies and communication, and they may exhibit more physical tension, secondary behaviors, and negative reactions to communication. Cluttering: A synergistic framework. talking about stuttering or treatment of stuttering. Anger/Resistance, 4. (2018). Perspectives on Fluency and Fluency Disorders, 11(1), 711. In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). 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. 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). For example, clinicians may use treatment strategies to reduce bullying through desensitization exercises and by educating the individuals peers about stuttering (W. P. Murphy et al., 2007a, 2007b). A meta-analysis did find differences in the receptive vocabulary, expressive vocabulary, and mean length of utterance between children who stutter and children who do not stutter, with children who stutter generally performing relatively weaker (Ntourou et al., 2011). 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/10.1016/j.jfludis.2016.07.002, Iverach, L., & Rapee, R. M. (2014). https://doi.org/10.1044/1058-0360(2011/09-0102), Ntourou, K., Conture, E. G., & Walden, T. A. For a review of temperament, emotion, and childhood stuttering, see R. M. Jones, Choi, et al. Stuttering and cluttering: Frameworks for understanding and treatment. A comprehensive treatment approach for school-age children, adolescents, and adults includes multiple goals and considers the age of the individual and their unique needs (e.g., communication in the classroom, in the community, or at work). altering the size of the group or audience. autism spectrum disorder (Briley & Ellis, 2018). This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. We often use the term "emergent" to describe skills that are developing, but have not fully emerged. Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. 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. being more comfortable and open with stuttering and pseudostuttering; reporting experiencing decreased anxiety while communicating; reporting less adverse psychological, emotional, social, and functional impacts; reporting enjoying social communication, including with strangers; and. Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. Plural. (2016a). explaining or interpreting symptoms of stuttering, providing advice on how to respond to someone who stutters, or. Communication Disorders Quarterly, 39(2), 335345. 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. https://doi.org/10.1016/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. SIG 4 Perspectives on Fluency and Fluency Disorders. https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). 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).
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