Palin ParentChild Interaction Therapy for early childhood stammering. https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). Typical childhood disfluencies may increase and decrease without any external influence. Genetic approaches to understanding the causes of stuttering. Stuttering and cluttering. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). Review of previous fluency evaluations and educational records. Measuring lexical diversity in children who stutter: Application of vocd. Individuals who stutter consistently report experiencing limitations, discrimination, and glass ceilinglike effects at their jobs and within their careers (Bricker-Katz et al., 2013; Cassar & Neilson, 1997; Klein & Hood, 2004). Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. Code of ethics [Ethics]. Psychology Press. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). Rehabilitation Act of 1973, Section 504. Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. School Psychology Review, 30(1), 135141. These simulations and applications of strategies might be most likened to cancellation and pull-out techniques used in stuttering. the asha leader; journals. Some children who stutter or clutter may only experience symptoms situationally. They also can benefit from groups and intensive programs (Fry et al., 2014). 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. Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. Journal of Fluency Disorders, 38(4), 311324. American Journal of Speech-Language Pathology, 26(4), 11051119. See the Assessment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Manning, W. H., & DiLollo, A. Persons who stutter may appear friendlier when they self-disclose their stuttering, and self-disclosure may help put listeners more at ease (Healey et al., 2007). Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Technological advances and the expansion of social media outlets have increased opportunities for adults who stutter to connect, share, and gain information through the Internet (Fuse & Lanham, 2016; Raj & Daniels, 2017) and stuttering-related podcasts (Dignazio et al., 2020). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. 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. altering the size of the group or audience. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. American Journal of Speech-Language Pathology, 28(1), 1428. They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. Language, Speech, and Hearing Services in Schools, 43(4), 536548. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). The skilled helper: A problem-management and opportunity-development approach to helping. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. 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). https://doi.org/10.1016/j.cub.2016.02.068, Beilby, J. M., & Byrnes, M. L. (2012). typical vs atypical disfluencies asha. Denial, 3. Journal of Fluency Disorders, 54, 1423. reports changing conception of stuttering from exclusively negative to having positive features. (1996). See ASHAs Practice Portal page on Cultural Responsiveness. Genetic factors also may play a role in predicting the likelihood of persistence or recovery and, possibly, treatment outcomes (Frigerio-Domingues et al., 2019; Han et al., 2014). https://doi.org/10.1016/j.jfludis.2016.09.005, Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. However, fluency shaping approaches, such as easy onset or continuous phonation, may not be appropriate for the treatment of cluttering. Academic Press. 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/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. Van Borsel, J. One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). With adults, initiation of treatment depends on the individuals previous positive or negative intervention experiences and current needs pertaining to their fluency and the impact of their fluency disorder on communication in day-to-day activities and participation in various settings (e.g., community or work). Sheehan, J. G. (1970). Prentice-Hall. 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. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). educates the individual who stutters and their family members about stuttering and communication and. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. You do not have JavaScript Enabled on this browser. Avoidance Reduction Therapy for Stuttering (ARTS). Long-term follow-up of self-modeling as an intervention for stuttering. ), Stuttering therapy: Rationale and procedures (pp. Reeves, L. (2006). https://doi.org/10.1044/2017_JSLHR-S-16-0371, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2019). 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). Stuttering and labor market outcomes in the United States. 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). Palin ParentChild Interaction therapy: The bigger picture. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). Journal of Fluency Disorders, 22(3), 219236. B. 9099). Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199. Their description details the characteristics of each stage, along with treatment goals and processes appropriate for each stage. Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Seminars in Speech and Language, 35(2), 6779. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). other developmental disorders (Briley & Ellis, 2018). American Journal of Speech-Language Pathology, 27(2), 721736. monosyllabic whole-word repetitions (e.g., Why-why-why did they go there?), part-word or sound/syllable repetitions (e.g., Look at the, prolongation of consonants when it isnt for emphasis (e.g., , blocking (i.e., inaudible or silent fixations or inability to initiate sounds), and. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. The SLP works with parents and families to create an environment that facilitates fluency and that helps them develop healthy and appropriate communication attitudes (Onslow et al., 2003; Yaruss & Reardon-Reeves, 2017). Approximately 88%91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013). Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). 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 can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). The underlying relationship between stuttering and working memory is not fully understood but may be related to interruptions in sensorimotor timing for developmental stuttering and may involve both the basal ganglia and the prefrontal cortex (Bowers et al., 2018). Stuttering and its treatment in adolescence: The perceptions of people who stutter. 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). Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. The plan outlines reasonable accommodations for speaking or reading activities to help ensure a students academic success and access to the learning environment in school. One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). 341358). https://doi.org/10.1093/med:psych/9780195165791.003.0007, Proctor, A., Yairi, E., Duff, M., & Zhang, J. Bilingual SLPs who have the necessary clinical expertise to assess the childand are familiar with the languages they speakmay not always be available. Stuttering Therapy Resources. Trichon, M., & Tetnowski, J. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). Breakdowns in fluency and clarity can result from. Journal of Fluency Disorders, 50, 5971. Journal of Fluency Disorders, 36(2), 122129. https://doi.org/10.1044/ffd22.2.51, Berquez, A., & Kelman, E. (2018). Moments of stuttering or disfluency may be difficult to distinguish from typical disfluency or reduced language proficiency, especially for a person unfamiliar with the language (Shenker, 2011). Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). American Journal of Speech-Language Pathology, 27(3S), 11241138. https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). In E. Conture & R. F. Curlee (Eds. Perspectives on Fluency and Fluency Disorders, 11(1), 711. https://doi.org/10.1016/S0094-730X(01)00098-5. In D. Ward & K. Scaler Scott (Eds. In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). The purpose of CBT is to modify current negative thoughts, emotions, and/or behaviors and replace them with positive ones through identification of thought patterns and challenging cognitive distortions in real time. Neural network connectivity differences in children who stutter. B. You do not have JavaScript Enabled on this browser. White matter neuroanatomical differences in young children who stutter. auditory processing disorders (Molt, 1996). Journal of Fluency Disorders, 58, 94117. 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. 15). Journal of Fluency Disorders, 43, 116. What do people search for in stuttering therapy: Personal goal-setting as a gold standard? Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. Characteristics of Typical Disfluency and Stuttering - ASHA To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. Acceptance and Commitment Therapy for people who stutter. Other speech or language concerns are also present. Prevalence of anxiety disorders among children who stutter. Impact experienced from stuttering, or covert features of stuttering, may include. What is motivational interviewing? 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Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. Some adults lack communication confidence as a result of negative self-perceptions about their stuttering (Beilby et al., 2012a) or due to repeated exposure to people holding stereotypes about stuttering, which, in turn, may create self-stigmatization (Boyle, 2013a). When a bilingual clinician is not available, using an interpreter is a viable option. Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. Appropriate roles for SLPs include the following: As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis. Bilingual children are assessed in both languages to determine stuttering profiles in both (Finn & Cordes, 1997). These strategies help individuals learn about the speech mechanism and how it operates during both fluent and disfluent speech so they can modify it. https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). Behavioural and Cognitive Psychotherapy, 23(4), 325325. The term overt stuttering is used when core speech behaviors are present. 157186). https://doi.org/10.1016/j.jfludis.2010.04.003, Wagovich, S., & Hall, N. (2017). attention-deficit/hyperactivity disorder (Alm, 2011). The SLP can use audio- or videoconferencing to augment this type of treatment. In B. J. Amster & E. R. Klein (Eds. Although cluttering has been reported in children as young as 4 years of age, the diagnosis is more commonly made at about 8 years of age (Ward, 2006), when a childs language becomes lengthy and/or complex enough for symptoms to manifest themselves. 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. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Shock, 2. Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their childs environment. Signs and symptoms of stuttering include core speech behaviors, such as. 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). (2010). Journal of Fluency Disorders, 29(4), 255273. 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). This list is not exhaustive, and not all factors need to be present for a referral to an SLP (e.g., Guitar, 2019; Yaruss et al., 1998). Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Other observable, secondary or concomitant, stuttering behaviors can include body movements (e.g., head nodding, leg tapping, fist clenching), facial grimaces (e.g., eye blinking, jaw tightening), and distracting sounds (e.g., throat clearing). Finding the good in the challenge: Benefit finding among adults who stutter. Fluency Disorders - ASHA An examination of various aspects of auditory processing in clutterers. A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. 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). There is ongoing debate as to whether persons who stutter have language skills that are equivalent to those seen in well-matched comparison speakers. https://doi.org/10.1111/jpc.12034. Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). using fillers (e.g., like, um, uh, you know); avoiding sounds or words (e.g., substituting words, inserting unnecessary words, circumlocution); and. The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. (Eds.). The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. Providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk. 178196). Evidence-based treatment and stutteringHistorical perspective. Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). Mancinelli, J. M. (2019). https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. The utility of stuttering support organization conventions for young people who stutter. 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.2011.06.001. These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). An effective clientclinician relationship facilitates the identification of potential roadblocks (Plexico et al., 2010). https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). Parents of bilingual children easily can be trained to provide perceptual ratings of fluency in any language spoken by the child (Shenker, 2013). 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). https://doi.org/10.1055/s-0034-1371755, Jones, R. M., Conture, E. G., & Walden, T. A. https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). Journal of Fluency Disorders, 44, 3245. The ASHA Leader, 11(10), 621. gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. Eventually, they disappear after a few . Craig, A., Blumgart, E., & Tran, Y. Efforts to conceal stuttering may adversely affect quality of life (Boyle et al., 2018). Journal of Fluency Disorders, 31(2), 90115. https://doi.org/10.1044/1092-4388(2013/12-0280), Boyle, M. P. (2013b). In D. Ward & K. Scaler Scott (Eds. Clinicians may start with the client observing videos of others who stutter (or a puppet for children) to help them identify patterns, attitudes, and beliefs about communication and stuttering. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.1016/j.jcomdis.2015.10.003. Assessment of awareness in young children of disfluencies and difficulty in speaking. With regard to cluttering, research is not far enough along to identify causes.
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