https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. Effective counseling is important for encouraging individuals with a fluency disorder to share information in the affective, cognitive, and social domains. 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). Peer support for people who stutter: History, benefits, and accessibility. In E. Conture & R. F. Curlee (Eds. Long-term follow-up of self-modeling as an intervention for stuttering. 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). 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). This results in less effective social interactions. Journal of Fluency Disorders, 11(2), 131149. Sociodynamic relationships between children who stutter and their non-stuttering classmates. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). minimizing the adverse impact of stuttering (Yaruss et al., 2012). Scope of practice in speech-language pathology [Scope of practice]. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. Dosage depends largely on the nature of the treatment (e.g., direct, indirect), age group, and the task level (e.g., learning basic skills requires more clinic room practice than does generalization). Support (both giving and receiving) can be valuable for improving attitudes, boosting self-confidence, and reducing feelings of isolation (Yaruss et al., 2007). The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). 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). increasing acceptance and openness with stuttering. 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. Stuttering in relation to lexical diversity, syntactic complexity, and utterance length. ), Stuttering and related disorders of fluency (pp. ), Cluttering: A clinical perspective (pp. Journal of Fluency Disorders, 27(4), 289304. The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. Potential risk factors for cluttering include the following: Information is varied and conflicting regarding the exact relationship between bilingualism and disfluencies (Tellis & Tellis, 2003; Van Borsel et al., 2001). The use of counseling in other areas of the speakers lifethat is, those not directly related to communicationis outside the scope of practice for SLPs (ASHA, 2016b). www.asha.org/policy/. If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. Differences between children and adults should also be considered when interpreting data from neurological studies. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. https://doi.org/10.1044/jshr.3103.377, Weber-Fox, C., Wray, A. H., & Arnold, H. (2013). School Psychology Review, 30(1), 135141. As children who stutter get older, they may become adept at word and situational avoidances that result in a low frequency of overt stuttering. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Children who stutter also may be at risk for experiencing bullying (Blood & Blood, 2004; Davis et al., 2002; Langevin et al., 1998). Journal of Speech, Language, and Hearing Research, 60(9), 24832505. They are likely to use interjections, repeat phrases, and revise what they are saying. As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs are obligated to provide culturally and linguistically appropriate services, regardless of the clinicians personal culture, practice setting, or caseload demographics. Bulletin of the Center for Special Needs Education Research and Practice, 13, 19. The lowest prevalence rates of stuttering were reported in adults aged 2150 years (0.78%) and adults aged 51 years or older (0.37%; Craig et al., 2002). 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). (2003). In L. Cummings (Ed. 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). See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 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. Allyn & Bacon. The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. avoidance behaviors (i.e., avoidance of sounds, words, people, or situations that involve speaking); escape behaviors, such as secondary mannerisms (e.g., eye blinking and head nodding or other movements of the extremities, body, or face); and. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Fear of speaking: Chronic anxiety and stammering. We believe it is past time to standardize the symptom assessment for MI so that proper and rapid diagnostic testing can be undertaken; however, we cannot standardize . 178196). 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. Adolescents also may be particularly susceptible to peer pressure and bullying at this time. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). the diagnosis of a fluency disorder (stuttering, cluttering, or both); a differential diagnosis between fluency disorders and reading disorders, language disorders, and/or speech sound disorders; descriptions of the characteristics and severity of the fluency disorder; judgments on the degree of impact the fluency disorder has on verbal communication and quality of life; a determination if the person will benefit from treatment; a determination of adverse educational, social, and vocational impact; parent or family counseling to determine optimal responses to the childs speech and stuttering; and. Hill, D. (2003). Journal of Communication Disorders, 48, 3851. 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. 233253). https://doi.org/10.1044/2018_AJSLP-17-0097, Kraft, S. J., & Yairi, E. (2011). It is important that parents and clinicians acknowledge and respond to a childs verbal and nonverbal reactions in a supportive manner; this helps to minimize the likelihood that the child will develop negative reactions to stuttering. Seminars in Speech and Language, 24(1), 2126. All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. Psychology Press. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. Erickson, S., & Block, S. (2013). Counseling persons with communication disorders and their families. Treatment approaches for adults should take into consideration career and workplace factors. International Journal of Speech-Language Pathology, 17(4), 367372. When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). The ASHA Action Center welcomes questions and requests for information from members and non-members. American Journal of Speech-Language Pathology, 27(3S), 11801194. Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. World Health Organization. A comprehensive view of stuttering: Implications for assessment and treatment. See ASHAs Practice Portal page on Telepractice. Traits of attention deficit/hyperactivity disorder in school-age children who stutter. Structural and functional abnormalities of the motor system in developmental stuttering. American Journal of Speech-Language Pathology, 27(3S), 11111123. Referral to another helping professional should be made if a condition or situation falls outside of the SLPs scope of practice. 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. PLOS ONE, 10(7), Article e0133758. (2013). Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. 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). https://doi.org/10.1016/j.jfludis.2006.12.003. Reduced perfusion in Brocas area in developmental stuttering. Parents can also learn about how to help their child generalize skills from the treatment room to different settings and with different people. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. (1988). Approximately 88%91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013). Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. Psychology Press. Journal of Fluency Disorders, 29(4), 255273. gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. American Psychiatric Association. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Stuttering severity may vary dramatically by speaking situation. learning disabilities (Wiig & Semel, 1984). Speech modification (including fluency shaping) strategies (Bothe, 2002; Guitar, 1982, 2019) include a variety of techniques aimed at making changes to the timing and tension of speech production or altering the timing of pauses between syllables and words. 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). ), Cluttering: Research, intervention and education (pp. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. For example, emotional reactivity/regulation and behavioral disinhibition may affect the childs ability to cope with disfluencies (Choi et al., 2013; Guttormsen et al., 2015; R. M. Jones, Conture, & Walden, 2014; Ntourou et al., 2013). https://doi.org/10.1016/j.jfludis.2018.09.004, Menzies, R. G., OBrian, S., Packman, A., Jones, M., Helgadttir, F. D., & Onslow, M. (2019). Perspectives on Fluency and Fluency Disorders, 22(2), 5162. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). Bullying in adolescents who stutter: Communicative competence and self-esteem. Persons who stutter may appear to have expressive language problems because of a tendency to avoid speaking or speak in a way thats unclear to the listener. 155192). Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. 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. The interview process and work environment can be challenging for individuals who stutter. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). Below is a list of approaches commonly used with school-age children, adolescents, and adults who stutter. https://doi.org/10.1044/2018_JSLHR-S-17-0378, Byrd, C. T. (2018). Individuals learn to identify the thoughts underlying their negative attitudes and emotional reactions and examine the link between these thoughts, attitudes, and emotional reactions and their speech. (2010). Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. Prins, D., & Ingham, R. J. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders. For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. These include when the individual who stutters. Epidemiology of stuttering in the community across the entire life span. Singular. The neurological underpinnings of cluttering: Some initial findings. 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. Stuttering and its treatment in adolescence: The perceptions of people who stutter. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. An examination of various aspects of auditory processing in clutterers. Family historyAnecdotal reports indicating the presence of cluttering in more than one family member suggest that family history may be a risk factor. University Park Press. Some examples of these are to openly discuss experiences with stuttering (from the client and the clinician with pseudostuttering or as described by previous clients who stutter) and model pseudostuttering and techniques, attitudes, and beliefs across speaking situations (Manning & Quesal, 2016; Watson, 1988). Other speech or language concerns are also present. https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). Determination of individual strengths and coping strategies. 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. Seminars in Speech and Language, 35(2), 114131. https://doi.org/10.1044/ffd23.2.54, Plexico, L. W., Hamilton, M. B., Hawkins, H., & Erath, S. (2019). Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. Brain, 138(3), 694711. Journal of Speech, Language, and Hearing Research, 61(7), 16491663. the impact of communication impairments on, Relevant case history (as appropriate for age), including. St. Louis, K. O., & Schulte, K. (2011). See ASHAs resource on person- and family-centered care. Motivational interviewing: Helping people change. This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. 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). Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering. https://doi.org/10.1044/2019_PERS-SIG4-2019-0024, Boyle, M. P., & Gabel, R. (2020). 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).
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