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). Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. Journal of Fluency Disorders, 61, 105713. https://doi.org/10.1016/j.jfludis.2019.105713, Douglass, J. E., Schwab, M., & Alvarado, J. Research updates in neuroimaging studies of children who stutter. Setting refers to the location of treatment (e.g., home, community-based [including work settings], school environments, clinic room). Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). These modifications are used regardless of whether a particular word is expected to be produced fluently. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. Wampold, B. E. (2001). https://doi.org/10.1016/j.jfludis.2011.06.001. Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. 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. ), Handbook of psychotherapy integration (pp. 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. Prevalence of anxiety disorders among children who stutter. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. having flexibility based on individual needs and desired outcomes (Amster & Klein, 2018). In this way, positive reinforcement is used to increase or strengthen the response of fluency (the desired behavior). Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). This approach to care incorporates individual and family preferences, priorities, and desired outcomes in the selection of treatment goals and treatment methods. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. Fluency refers to continuity, smoothness, rate, and effort in speech production. (1988). Psychology Press. Thieme. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. These individuals are said to experience covert stuttering (B. Murphy et al., 2007). In J. C. Norcross & M. R. Goldfried (Eds. Children with normal disfluencies have emergent fluency. International Classification of Functioning, Disability and Health. Self-efficacy and quality of life in adults who stutter. practice treatment targets with more listeners. When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. (1979). The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. Overheard: Bilingual and disfluent: A unique treatment challenge. Professional awareness of cluttering. 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. Counseling allows the clinician who works with those who stutter or clutter to practice within the ICF framework by targeting all aspects of the disordernot just the surface behaviors. 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. American Journal of Speech-Language Pathology, 29(1), 201215. Wolk, L., Edwards, M. L., & Conture, E. G. (1993). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Mancinelli, J. M. (2019). Please enable it in order to use the full functionality of our website. An effective clientclinician relationship facilitates the identification of potential roadblocks (Plexico et al., 2010). Journal of Fluency Disorders, 36(2), 110121. Current Biology, 26(8), 10091018. Neural network connectivity differences in children who stutter. 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). The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. https://doi.org/10.1044/ffd23.2.54, Plexico, L. W., Hamilton, M. B., Hawkins, H., & Erath, S. (2019). https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). typical vs atypical disfluencies asha typical vs atypical disfluencies asha. Reduced perfusion in Brocas area in developmental stuttering. provide and receive support from others who share the experience of stuttering. Desensitization can help decrease word avoidance and reduce fear. ), The Cambridge handbook of communication disorders (pp. The treatment of stuttering. The skilled helper: A problem-management and opportunity-development approach to helping. Journal of Fluency Disorders, 38(3), 260274. Differing perspectives on what to do with a stuttering preschooler and why. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. (1996). 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). Bullying in adolescents who stutter: Communicative competence and self-esteem. 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). Prevalence of stuttering in primary school children in Cairo-Egypt. (2010). Please enable it in order to use the full functionality of our website. Craig, A., Blumgart, E., & Tran, Y. With this approach, parents are trained to provide verbal contingencies based on whether a childs speech is fluent or stuttered (M. Jones et al., 2005; Onslow et al., 2003). 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. Perspectives on Fluency and Fluency Disorders, 17(2), 49. The social and communication impact of stuttering on adolescents and their families. (2006). It is important to distinguish stuttering from other possible diagnoses (e.g., language formulation difficulties, cluttering, and reading disorders) and to distinguish cluttering from language-related difficulties (e.g., word finding and organization of discourse) and other disorders that have an impact on speech intelligibility (e.g., apraxia of speech and other speech sound disorders). 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). This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). https://doi.org/10.1016/j.jcomdis.2010.12.003. van Zaalen, Y., & Reichel, I. K. (2014). Increased incidence of stuttering has been noted among those with a first-degree relative (e.g., parent, sibling) who stutters and an even greater likelihood if that relative is an identical twin (Kraft & Yairi, 2011). 256276). Tallying has the client stop directly after a moment of stuttering to tally or bring awareness to it while not attempting to escape by continuing to talk. Impact of stuttering severity on adolescents domain-specific and general self-esteem through cognitive and emotional mediating processes. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. 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). See ASHAs Practice Portal page on Cultural Responsiveness. (2001). Sociodynamic relationships between children who stutter and their non-stuttering classmates. 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. The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). Stuttering: Its nature, diagnosis, and treatment. The utility of stuttering support organization conventions for young people who stutter. https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. continued management (Plexico et al., 2005). See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). The great psychotherapy debate: Models, methods, and findings. Journal of Fluency Disorders, 21(34), 201214. American Journal of Speech-Language Pathology, 16(1), 6568. Journal of Fluency Disorders, 38(1), 1429. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). They are likely to use interjections, repeat phrases, and revise what they are saying. Apply Now. Natural history of stuttering to 4 years of age: A prospective community-based study. The model describes the following stages of behavioral change: See Manning and DiLollo (2018) and Floyd et al. Contemporary Issues in Communication Science and Disorders, 31(Spring), 6979. (2014). Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. Cluttering: A synergistic framework. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. Drayna, D., & Kang, C. (2011). (2011). The most common atypical disfluency of concern is word-final . https://doi.org/10.1542/peds.2019-0811, Zebrowski, P. M. (2002). Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting).
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