Referral to another helping professional should be made if a condition or situation falls outside of the SLPs scope of practice. 4566). 2335). This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. 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). https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. Children who stutter also may be at risk for experiencing bullying (Blood & Blood, 2004; Davis et al., 2002; Langevin et al., 1998). EBP Briefs, 2(4), 18. Miller, W. R., & Rollnick, S. (2013). In H. Gregory (Ed. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). altering the size of the group or audience. Brain, 136(12), 37093726. Another example is Cognitive Behavior Therapy (CBT; Menzies et al., 2019, 2009). bringing peers into the treatment setting; planning strategies to use in the classroom, cafeteria, or playground or at work; taking outings to stores and other businesses; and. Thieme. Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). explaining or interpreting symptoms of stuttering, providing advice on how to respond to someone who stutters, or. https://doi.org/10.1016/j.jfludis.2006.12.003. Fear of speaking: Chronic anxiety and stammering. Reducing bullying through role-playing and self-disclosure. https://doi.org/10.1073/pnas.1901480116, Harasym, J., Langevin, M., & Kully, D. (2015). Limited research is available that identifies the causes of cluttering. To foster generalization, assignments adhere to a hierarchy of linguistic skills and environmental stressors. Epidemiology of stuttering in the community across the entire life span. 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. Daly, D. A., Simon, C. A., & Burnett-Stolnack, M. (1995). https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). Perspectives on Fluency and Fluency Disorders, 23(2), 5469. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Possible genetic factors in cluttering. Wampold, B. E. (2001). Aphasia. Journal of Speech, Language, and Hearing Research, 62(8), 26912702. Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. Impact of social media and quality of life of people who stutter. When determining eligibility for speech and language services through the public school system, SLPs need to document the adverse educational impact of the disability using a combination of standardized test scores when available and a portfolio-based assessment (Coleman & Yaruss, 2014; Ribbler, 2006). typical vs atypical disfluencies asha typical vs atypical disfluencies asha. Bakker, K., Myers, F. L., Raphael, L. J., & St. Louis, K. O. One of the core principles of ACT is mindfulness. SLPs also need to discuss with persons who stutter and their families how to evaluate the veracity and trustworthiness of sites claiming to cure stuttering that they may find on their own. Language intervention from a bilingual mindset. 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). Allyn & Bacon. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Areas of the brain that were studied and the technologies used to conduct the research (e.g., PET, MEG, MRI, fMRI, NIRS, DCS) also varied widely. It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. Multilingual children who stutter: Clinical issues. (2007). 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). Our primary goals were to identify patterns in overt features of WFDs and to extend our understanding of this clinical profile by focusing on aspects of . Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. Pro-Ed. Overheard: Bilingual and disfluent: A unique treatment challenge. the impact of communication impairments on, Relevant case history (as appropriate for age), including. https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). Self-regulation and the management of stuttering. (2011). Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). A study of pragmatic skills of clutterers and normal speakers. increasing self-confidence and self-efficacy. https://doi.org/10.1044/2017_AJSLP-17-0146, St. Louis, K. O., & Hinzman, A. R. (1986). Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). Dosage refers to the frequency, intensity, and duration of treatment. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). Review of previous fluency evaluations and educational records. Management of childhood stuttering. Ward, D. (2006). 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). The ASHA Leader, 18(3), 1415. SIG 4 Perspectives on Fluency and Fluency Disorders. practice monitoring each others speech and secondary behaviors. Maintenance of improved attitudes toward stuttering. Sadness/Depression, 6. 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. Journal of Fluency Disorders, 21(34), 215225. recognize physical concomitant behaviors, locate the point of physical tension and struggle during moments of disfluency, and. 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. Journal of Speech, Language, and Hearing Research, 60(9), 24832505. Neural network connectivity differences in children who stutter. Often, there are pivotal points during treatment that indicate progress (T. K. Anderson & Felsenfeld, 2003; Plexico et al., 2005). discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting). Video self-modeling as a post-treatment fluency recovery strategy for adults. The creative process in avoidance reduction therapy for stuttering. Emotional problems and parenting style do not cause stuttering. When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. A comprehensive view of stuttering: Implications for assessment and treatment. (2006). Cluttering may have an effect on pragmatic communication skills and awareness of moments of disruption (Teigland, 1996). (Eds.). https://doi.org/10.1044/2020_JSLHR-20-00096. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. (2009). I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike). St. Louis, K. O., & Flynn, T. W. (2018). Speech clarity and fluency may temporarily improve when the person is asked to slow down or pay attention to their speech. If treatment is currently not warranted, the SLP educates the family about how to monitor the childs fluency to determine if and when the child should be reevaluated. Journal of Fluency Disorders, 30(1), 122. Methods in stuttering therapy for desensitizing parents of children who stutter. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). SLPs counseling skills should be used specifically to help speakers improve their quality of life by minimizing the burden of their communication disorder. (1993). Journal of Fluency Disorders, 35(3), 216234. 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). 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). The goals of treatment may be (a) to eliminate, greatly reduce, or help the child manage their stuttering and (b) to help them not develop negative emotional reactions related to their stuttering (H. S. Arnold et al., 2011; Yaruss et al., 2006). Individuals and families may have a wide range of beliefs about the best way to treat fluency disorders, ranging from medical and therapeutic intervention to prayer. (1979). These symptoms come suddenly and do need hospitalization. Evidence-based treatment and stutteringHistorical perspective. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. Journal of Speech, Language, and Hearing Research, 62(5), 13711372. Higher incidence rates of stuttering have been reported in preschool-aged children (11.2%; Reilly et al., 2013), with prevalence estimates reported as 2.2%5.6% (Yairi & Ambrose, 2013). Journal of Communication Disorders, 80, 1117. Howell, P., & Davis, S. (2011). https://doi.org/10.1542/peds.2019-0811, Zebrowski, P. M. (2002). Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Journal of Fluency Disorders, 49, 1328. (2013). Young children may or may not verbalize their reactions to stuttering. https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). winery in maryland with igloos; thick peeling skin around fingernails; holiday inn st pete beach revolving restaurant; metro approved housing in norwalk ohio https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). Perspectives on Fluency and Fluency Disorders, 22(1), 3446. Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). https://doi.org/10.1044/1058-0360.0202.65. 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. Bargaining, 5. Stuttering and reading fluency: Information for teachers [Brochure]. Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Strategies for reducing impairment in body function have been separated into two categoriesspeech modification and stuttering modification, both of which are described below. The SLP can use audio- or videoconferencing to augment this type of treatment. (2018). Brain, 138(3), 694711. Advance online publication. However, even when children show little observable disfluency, they may still need treatment because of the negative impact of stuttering or cluttering on their lives. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. 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. Section 504 of the Rehabilitation Act of 1973 (United States Department of Labor, n.d.) protects qualified individuals from discrimination based on their disability via a 504 plan. (2010). There are two predominant types of atypical disfluencies: stuttering and cluttering. Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016a; Coleman & Yaruss, 2014; Vanryckeghem & Kawai, 2015; WHO, 2001; Yaruss, 2007; Yaruss & Quesal, 2004, 2006), a comprehensive fluency assessment is conducted to identify and describe. Timing refers to the initiation of treatment relative to the diagnosis. For example, individuals who clutter may not be aware of communication breakdowns and, therefore, do not attempt to repair them. Journal of Fluency Disorders, 38(2), 206221. 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. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Journal of Speech, Language, and Hearing Research, 51(6), 14651479. The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. 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). Journal of Fluency Disorders, 34(3), 187200. Journal of Abnormal Psychology, 119(3), 479490. Journal of Fluency Disorders, 61, 105713. https://doi.org/10.1016/j.jfludis.2019.105713, Douglass, J. E., Schwab, M., & Alvarado, J. https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. 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. NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. 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. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. 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). https://doi.org/10.1044/persp1.SIG4.55, Byrd, C. T., Croft, R., Gkalitsiou, Z., & Hampton, E. (2017). The relationship of self-efficacy and depression to stuttering. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. Risk factors that may be associated with persistent stuttering include. Please enable it in order to use the full functionality of our website. Similarities - Typical and Atypical Pneumonia 5. School-age stuttering therapy: A practical guide. American Journal of Speech-Language Pathology, 29(1), 201215. 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). typical vs atypical disfluencies asha. Self-efficacy is a positive belief in ones own ability to successfully accomplish a set goal that is task dependent, which comes from (a) past experiences of mastery, (b) vicarious experiences, (c) verbal persuasion, and (d) emotional/physical states (Boyle, 2013a, 2013b, 2015; Boyle et al., 2018; Carter et al., 2017). 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. St. Louis, K. O., & Rustin, L. (1996). https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. (2004). A comprehensive assessment for persistent stuttering should include a self-assessment of the experience of stuttering. Despite these challenges, some of the therapy that applies to adults can be just as effective with teens/adolescents. The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). The scope of this page includes stuttering and cluttering across the life span. However, as they learn to reduce reactivity (see below), they develop greater comfort while speaking, they assume more positive attitudes about their ability to communicate, and they are better able to accept and manage moments of disfluency as they occur. It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. Counseling is an integral part of the assessment and treatment of individuals who stutter or clutter. https://doi.org/10.1017/S135246580001643X. Although cluttering and stuttering can co-occur, there are some important distinctions between the two (see Scaler Scott, 2010). Prentice-Hall. For example, an individual might elect to self-disclose in a workplace and educate coworkers about fluency disorders via a group presentation followed by a question-and-answer period. (2011). Seminars in Speech and Language, 28(4), 312322. 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). Studies in tachyphemia: III. Journal of Fluency Disorders, 44, 3245. Whurr Publishers. The person is experiencing negative reactions from others (e.g., peers, classmates, coworkers, family members). Increasing fluency may not be a goal for an adult or may be only one aspect of a comprehensive and multidimensional approach (Amster & Klein, 2018). Effectiveness of intensive, group therapy for teenagers who stutter. Journal of Fluency Disorders, 32(2), 95120. In D. Ward & K. Scaler Scott (Eds. Donaher, J., & Richels, C. (2012). Application of the ICF in fluency disorders. Stuttering in school-age children: A comprehensive approach to treatment. The Lidcombe Program of early stuttering intervention: A clinicians guide. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). Psychology Press. Denial, 3. https://doi.org/10.1044/leader.OV.18032013.14, Freud, D., & Amir, O. In D. Ward & K. Scaler Scott (Eds. Genetics and neurophysiology appear to be related to the underlying causes of stuttering. Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. Journal of Speech and Hearing Disorders, 50(3), 261281. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Fluency Disorders (Practice Portal). Some children who stutter or clutter may only experience symptoms situationally. A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. Journal of Fluency Disorders, 62, 105762. https://doi.org/10.1016/j.jfludis.2019.105726. Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. Smith, A., & Weber, C. (2017). Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/. Direct treatment approaches can also target resilience and effort control in the child and family (Caughter & Crofts, 2018; Druker et al., 2019; Kraft et al., 2019). https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). Language, Speech, and Hearing Services in Schools, 37(2), 118136. Folia Phoniatrica et Logopaedica, 64(1), 3447. Journal of Fluency Disorders, 11(2), 131149. Temperamental characteristics of young children who stutter. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). Providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk. Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. https://doi.org/10.1044/ffd16.1.15. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). Cluttering and Down syndrome. Perspectives on Fluency and Fluency Disorders, 11(1), 711. Language, Speech, and Hearing Services in Schools, 49(1), 13. See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. language or learning disability (Ntourou et al., 2011). providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Journal of Fluency Disorders, 36(2), 110121. 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. ), Cluttering: Research, intervention and education (pp. Journal of Fluency Disorders, 38(4), 311324. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). Children who stutter typically know how to read (decode) the printed form of words, but they may not be able to speak the printed form fluently. An examination of various aspects of auditory processing in clutterers. To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. Fluency disorders can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). This law also applies to organizations that receive financial assistance from any federal department or agency. For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. Molt, L. F. (1996).