Drayna and Kang (2011) found that gene mutations were present in close to 10% of cases of familial stuttering. Journal of Fluency Disorders, 35(4), 333354. See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Pro-Ed. continued management (Plexico et al., 2005). Measurement and modification of speech naturalness during stuttering therapy. Functional and neuroanatomical bases of developmental stuttering: Current insights. Journal of Paediatrics and Child Health, 49(2), E112E115. Another example is Cognitive Behavior Therapy (CBT; Menzies et al., 2019, 2009). Yaruss, J. S., & Reardon-Reeves, N. (2017). The impact of a stuttering disorder on Western Australian children and adolescents. Experiences with stuttering can affect an individuals employment, job satisfaction, personal and romantic relationships, and overall quality of life (Beilby et al., 2013; Blood & Blood, 2016). Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. The ASHA Leader, 11(10), 621. Following are descriptions of each of these forms of disfluency. Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. Early childhood stuttering for clinicians by clinicians. Psychology Press. Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. 2335). (2014). Clinicians need to be observant of indicators, such as stuttering avoidance or social isolation, that clients/patients/students may be internalizing negative stereotypes about stuttering (Boyle, 2013a). International Classification of Functioning, Disability and Health. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). Stuttering is often more severe when there is increased pressure to communicate (e.g., competing for talk time, giving a report at school, talking on the telephone/during a video chat, or interviewing for a job). Testing, and 7. Journal of Speech, Language, and Hearing Research, 56(5), 15171529. Persons who clutter can experience the same affective, behavioral, and cognitive reactions as those with stuttering, including communication avoidance, anxiety, and negative attitudes toward communication (Scaler Scott & St. Louis, 2011). Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. Preschool children who stutter showed differences in event-related brain potentials used as indices of language processing. (2014). Cambridge University Press. Van Riper, C. (1973). Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Methods in stuttering therapy for desensitizing parents of children who stutter. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. Journal of Fluency Disorders, 44, 3245. Advocating for individuals with fluency disorders and their families at the local, state, and national levels. production of words with an excess of physical tension or struggle. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. Perspectives on Fluency and Fluency Disorders, 4(6), 13161326. Journal of Educational Psychology, 95(1), 321. Enhancing treatment for school-age children who stutter: I. https://doi.org/10.1192/apt.12.1.63, Craig, A., & Tran, Y. The purpose of the screening is to identify individuals who require further speech-language assessment. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Estimates have reported the male-to-female ratio of individuals who stutter to be as large as 4:1; however, more recent studies in preschool children suggest that a younger age of onset has smaller ratios in gender differences (Yairi & Ambrose, 2013). https://doi.org/10.1016/j.jfludis.2017.06.001. Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. 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). (2011). Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). https://doi.org/10.1016/j.jfludis.2008.01.001. (2009). 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). Journal of Communication Disorders, 80, 8191. Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. What is motivational interviewing? Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. Helping individuals who stutter become more accepting and open about their stuttering may help them have workplace conversations about it, advocate for themselves, and build support systems within the workplace (Plexico et al., 2019). Communication Disorders Quarterly, 6(1), 5059. In D. Ward & K. Scaler Scott (Eds. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. (2014). Journal of Fluency Disorders, 29(4), 255273. language or learning disability (Ntourou et al., 2011). Psychology Press. https://scholarworks.bgsu.edu/comm_disorders_diss/7/. Finding the good in the challenge: Benefit finding among adults who stutter. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. 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. 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). Workplace in fluency management: Factoring the workplace into fluency management. 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). The American Board of Fluency and Fluency Disorders, under the auspices of ASHAs specialty certification program, offers clinical specialty certification in fluency and fluency disorders. 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). 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). Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. https://doi.org/10.1016/j.nbd.2014.04.019, Han, T.-U., Root, J., Reyes, L. D., Huchinson, E. B., du Hoffmann, J., Lee, W.-S., Barnes, T. D., & Drayna, D. (2019). Communication attitudes in children who stutter: A meta-analytic review. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. These include when the individual who stutters. 15). 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?). Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). Prins, D., & Ingham, R. J. In addition, clinicians need to avoid using religious or highly familiar texts that individuals may know by rote. Breakdowns in fluency and clarity can result from. Genetic bases of stuttering: The state of the art, 2011. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Parents of bilingual children easily can be trained to provide perceptual ratings of fluency in any language spoken by the child (Shenker, 2013). Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. (2011). Treatment approaches for adults should take into consideration career and workplace factors. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). When a bilingual clinician is not available, using an interpreter is a viable option. 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). Finding opportunities for social support for individuals with fluency disorders. https://doi.org/10.1044/0161-1461(2012/11-0044), Yaruss, J. S., LaSalle, L. R., & Conture, E. G. (1998). Their skills are developing in this area. Evaluation of speech-related attitude by means of the KiddyCAT, CAT, and BigCAT, within a larger behavior assessment battery framework for children and adults who stutter. Journal of Fluency Disorders, 35(3), 216234. https://doi.org/10.1016/0094-730X(86)90028-8, St. Louis, K. O., & Hinzman, A. R. (1988). Journal of Speech, Language, and Hearing Research, 60(9), 24832505. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). (2019). American Journal of Speech-Language Pathology, 27(3S), 11241138. The clinical process for an adult involves. Nurturing a resilient mindset in school-aged children who stutter. ), Cluttering: Research, intervention and education (pp. Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the Self-Stigma of Stuttering Scale (4S). Journal of Speech, Language, and Hearing Research, 46(5), 12211233. https://doi.org/10.1016/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Stuttering in school-age children: A comprehensive approach to treatment. Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. Healey, E. C., Reid, R., & Donaher, J. Ward, D. (2006). Typical adolescent experiences of emotional reactivity, resistance to authority, and social awkwardness may be exacerbated in adolescents who also experience stuttering (Daly et al., 1995; Zebrowski, 2002). Human Brain Mapping, 38(4), 18651874. Journal of Fluency Disorders, 27(4), 289304. American Journal of Speech-Language Pathology, 29(1), 201215. 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. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. intellectual disability (Healey et al., 2005). 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). Rehabilitation Act of 1973, Section 504. https://doi.org/10.1044/persp1.SIG4.55, Byrd, C. T., Croft, R., Gkalitsiou, Z., & Hampton, E. (2017). Posted at 23:22h . The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. 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). https://doi.org/10.1016/j.jcomdis.2014.02.001, Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Typical childhood disfluencies may increase and decrease without any external influence. Scaler Scott, K., & Ward, D. (2013). In contrast to adults who stutter, children who stutter did not show increases in white matter tracts in the right hemisphere (Chang et al., 2015). https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. 6396). Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. https://doi.org/10.1177/1073858418803594, Chang, S.-E., & Zhu, D. C. (2013). In K. O. Lewis (Ed. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. Journal of Speech, Language, and Hearing Research, 61(12), 28952905. Avoidance or escape behaviors may also be used and can temporarily conceal stuttering (Constantino et al., 2017; Douglass et al., 2019, 2018; B. Murphy et al., 2007; Starkweather, 1987; Tichenor et al., 2017; Tichenor & Yaruss, 2018, 2019a, 2019b, 2020). autism spectrum disorder (Briley & Ellis, 2018). See ASHAs Practice Portal resource on Transitioning Youth. Increasing the individuals awareness and self-monitoring skills helps to reduce unproductive behaviors that interfere with speech, and it may allow them to alter moments of stuttering so that they have decreased tension, are shorter, and are less disruptive to communication. https://doi.org/10.1016/j.jfludis.2018.10.003, Bray, M. A., & Kehle, T. J. A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. https://doi.org/10.1044/2017_JSLHR-S-16-0343, Snsterud, H., Feragen, K. B., Kirmess, M., Halvorsen, M. S., & Ward, D. (2019). Barnes, T. D., Wozniak, D. F., Gutierrez, J., Han, T. U., Drayna, D., & Holy, T. (2016). https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). information regarding family, personal, and cultural perception of fluency. Children with normal disfluencies have emergent fluency. Guilford Press. ), Stuttering and related disorders of fluency (pp. You do not have JavaScript Enabled on this browser. Scaler Scott, K., & St. Louis, K. O. https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O., Bavin, E., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). Depending on the country and methodology used, rates were estimated to range from 1.03% (Abou et al., 2015) to 1.38% (Al-Jazi & Al-Khamra, 2015), but could be as high as 8.4% (Oyono et al., 2018). Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. www.asha.org/policy/, American Speech-Language-Hearing Association. On the other hand, stuttering symptoms may decrease in more comfortable situations. Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. https://doi.org/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). Structural and functional abnormalities of the motor system in developmental stuttering. Denial, 3. Possible genetic factors in cluttering. There is a family history of stuttering or cluttering. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). Psychology Press. Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). typical vs atypical disfluencies asha. Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). Explore how typical and atypical disfluencies differ, and find resources for guidance and support. Some children who stutter or clutter may only experience symptoms situationally. Mis- and overidentification of stuttering in bilingual speakers may occur due to typical disfluencies observed in development, code switching, and wording changes to maintain the grammatical integrity of the dominant language. Stuttering and its treatment in adolescence: The perceptions of people who stutter. See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. Prevalence of stuttering in primary school children in Cairo-Egypt. Experts in the field of cluttering have consistently estimated that approximately one third of children and adults who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). Impact experienced from stuttering, or covert features of stuttering, may include. Stuttering Therapy Resources. Plural. In contrast, children with reading disorders are likely to have difficulty decoding the printed form, which, in turn, has a negative impact on oral reading fluency (Kuhn & Stahl, 2003). Language, Speech, and Hearing Services in Schools, 49(1), 13. may show increased disfluency rates (decreased reading fluency) because they cannot change the words to avoid moments of stuttering as easily as they can in conversation, and. 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. https://doi.org/10.1044/1092-4388(2001/030), Finn, P. (2003). Egan, G. (2013). Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. Harper & Row. Journal of Fluency Disorders, 54, 113. gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. Lippincott Williams & Wilkins. (1988). Covert stuttering: Investigation of the paradigm shift from covertly stuttering to overtly stuttering. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. How can you tell if childhood stuttering is the real deal? Seminars in Speech and Language, 28(4), 312322. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. https://doi.org/10.1044/1092-4388(2008/07-0111), Prochaska, J. O., & DiClemente, C. C. (2005). Language, Speech, and Hearing Services in Schools, 26(2), 162168. (2001). Sheehan, J. G. (1970). One example of a desensitization activity is pseudostutteringthe use of voluntary stuttering behaviorsin different, and increasingly more difficult, situations where the individual might fear the occurrence of real moments of stuttering (e.g., Reardon-Reeves & Yaruss, 2013; J. G. Sheehan, 1970). Educating other professionals about the needs of individuals with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders. Alm, P. A. In D. Ward & K. Scaler Scott (Eds. Prentice-Hall. Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. Peer support for people who stutter: History, benefits, and accessibility. Palin ParentChild Interaction therapy: The bigger picture. Seminars in Speech and Language, 37(3), 145152. In addition to stuttering-like disfluencies and other typical disfluencies, the children with ASD also produced atypical disfluencies, which usually are not observed in children with typically developing speech or developmental stuttering. Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. Available from http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/. The validity of reading assessment tools for children who stutter is questionable because it is difficult to differentiate the cause (decoding or stuttering) of oral reading fluency problems. Journal of Communication Disorders, 58, 4357. Understanding and treating cluttering. The scope of this page includes stuttering and cluttering across the life span. Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). Stuttering modification strategies, originated by Van Riper (1973), have four stages: (1) identification, (2) desensitization, (3) modification, and (4) generalization and aim to reduce associated physical tension and struggle by helping individuals. Journal of Communication Disorders, 80, 1117. https://doi.org/10.1016/j.jfludis.2013.09.003, Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). (2016). attention-deficit/hyperactivity disorder (Alm, 2011). Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). A phenomenological understanding of successful stuttering management. https://doi.org/10.1002/mgg3.276, Frigerio-Domingues, C. E., Gkalitsiou, Z., Zezinka, A., Sainz, E., Gutierrez, J., Byrd, C., Webster, R., & Drayna, D. (2019). Managing cluttering: A comprehensive guidebook of activities. The ASHA Action Center welcomes questions and requests for information from members and non-members. Stuttering and work life: An interpretative phenomenological analysis. Subjective distress associated with chronic stuttering. The presence of at least 1 disabling developmental condition was 5.5 times higher in CWS [children who stutter] when compared to children who do not stutter (Briley & Ellis, 2018, p. 2895). Journal of Fluency Disorders, 49, 1328. In L. Cummings (Ed. 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). Journal of Speech, Language, and Hearing Research, 61(7), 16491663. 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). Group experiences and individual differences in stuttering. In this way, positive reinforcement is used to increase or strengthen the response of fluency (the desired behavior). ), Cluttering: Research, intervention and education (pp. 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). Individuals may experience the impact of fluency disorders in social and emotional, academic, and vocational domains. Clinical implications of situational variability in preschool children who stutter.