Differentiating between typical disfluencies and stuttering (i.e., ambiguous and unambiguous moments of stuttering) is a critical piece of assessment, particularly for preschool children (see ASHAs resource on characteristics of typical disfluency and stuttering). The clinical applications of Acceptance and Commitment Therapy with clients who stutter. https://doi.org/10.1017/CBO9781139108683.023. American Journal of Speech-Language Pathology, 11(1), 4149. See the Fluency Disorders Evidence Map for summaries of the available research on this topic. They are likely to use interjections, repeat phrases, and revise what they are saying. language or learning disability (Ntourou et al., 2011). Language, Speech, and Hearing Services in Schools, 43(4), 536548. https://doi.org/10.1044/0161-1461.2602.162. Measurement and modification of speech naturalness during stuttering therapy. Despite these challenges, some of the therapy that applies to adults can be just as effective with teens/adolescents. Stuttering: An integrated approach to its nature and treatment. Cluttering may have an effect on pragmatic communication skills and awareness of moments of disruption (Teigland, 1996). Typical vs. Atypical Antipsychotics: Main Differences and Effectiveness ), Stuttering and related disorders of fluency (pp. https://doi.org/10.1016/j.jfludis.2015.01.003, Harley, J. Neural network connectivity differences in children who stutter. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. Journal of Fluency Disorders, 58, 94117. Psychology Press. The treatment of stuttering. Other strategies for treating cluttering include overemphasizing multisyllabic words and word endings, increasing awareness of when a communication breakdown occurs (e.g., through observation of listener reactions), and increasing self-regulation of rate and clarity of speech. Onset may be progressive or sudden. These individuals are said to experience covert stuttering (B. Murphy et al., 2007). atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. Group experiences and individual differences in stuttering. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. Counseling helps an individual, a family member, or a caregiver of a person of any age who stutters move from the current scenario to a preferred scenario through an agreed-upon action plan (Egan, 2013). ), Cluttering: A clinical perspective (pp. Prevalence of speech disorders in elementary school students in Jordan. Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. St. Louis, K. O., & Flynn, T. W. (2018). https://doi.org/10.1044/ffd23.2.54, Plexico, L. W., Hamilton, M. B., Hawkins, H., & Erath, S. (2019). These include when the individual who stutters. 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. 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. Prevalence of cluttering in two European countries: A pilot study. Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. Folia Phoniatrica et Logopaedica, 19. Journal of Fluency Disorders, 36(2), 110121. Clinicians and parents also look for reactions, such as avoidance of words or speaking situations, increased physical tension or secondary behaviors, reduced utterance length, or slight changes in pitch or loudness during stuttering episodes. 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. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. May 11, 2022 As a speech-language pathologist, you might often face the question of whether a young child is showing early signs of stuttering, or if those disruptions are simply typical speech disfluencies. Acquired neurogenic and psychogenic stuttering are not covered. A meta-analysis did find differences in the receptive vocabulary, expressive vocabulary, and mean length of utterance between children who stutter and children who do not stutter, with children who stutter generally performing relatively weaker (Ntourou et al., 2011). American Journal of Speech-Language Pathology, 7(4), 6276. 155192). Pro-Ed. Seminars in Speech and Language, 35(2), 114131. Journal of Paediatrics and Child Health, 49(2), E112E115. In K. O. Lewis (Ed. 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). Ward, D., & Scaler Scott, K. (2011). 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). National Stuttering Association. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. Van Riper, C. (1973). For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). production of words with an excess of physical tension or struggle. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). 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. facilitates conversations between the individual and their family about the experience of stuttering, the individuals communication expectations, their life goals, and how to holistically support communication (see, e.g., Berquez & Kelman, 2018; Millard et al., 2018; Rocha et al., 2019). Typical disfluencies often resolve by age five and tend to cycle, meaning they come and go. (2019). Genetic approaches to understanding the causes of stuttering. Temperamental characteristics of young children who stutter. 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). In D. Ward & K. Scaler Scott (Eds. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). 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. Treatment should consider not just the overt stuttering behavior but also the affective and cognitive reactions to stuttering. information regarding family, personal, and cultural perception of fluency. When speakers are able to participate in decisions about treatment goals and select goals they consider important, they may be more motivated to take part in therapy (Finn, 2003; Snsterud et al., 2019). Counseling parents of children who stutter. Professional awareness of cluttering. 2335). Stuttering typically has its origins in childhood. This relationship is recognized as one of the common factors that account for the effectiveness of counseling (common factors theory; Wampold, 2001). Advance online publication. Given that cluttering may co-occur with other disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder), having any of these disorders may be a risk factor; however, not all individuals with these disorders also exhibit cluttering. An increase in observable disfluent behaviors may occur as the individual communicates more freely. 1997- American Speech-Language-Hearing Association. (2001). 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. 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). The impact of stuttering on employment opportunities and job performance. (n.d.). In E. G. Conture & R. F. Curlee (Eds. How can you tell if childhood stuttering is the real deal? 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). See ASHAs Practice Portal page on Cultural Responsiveness. You do not have JavaScript Enabled on this browser. See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. Cluttering treatment: Theoretical considerations and intervention planning. 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. Manning, W. H., & DiLollo, A. https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). American Journal of Speech-Language Pathology, 20(3), 163179. Efforts to conceal stuttering may adversely affect quality of life (Boyle et al., 2018). Prentice-Hall. Self-help conferences for people who stutter: A qualitative investigation. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. www.asha.org/policy/, American Speech-Language-Hearing Association. Journal of Fluency Disorders, 13(5), 331355. Roberts, P., & Shenker, R. (2007). Systems that govern self-regulation may underlie cluttering; qualitative interviews with those who clutter suggest that thoughts emerge before they are ready (Scaler Scott & St. Louis, 2011). Journal of Communication Disorders, 37(1), 3552. PLOS ONE, 10(7), Article e0133758. ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. Early childhood stuttering therapy: A practical guide. Reeves, L. (2006). Stuttering as defined by adults who stutter. Managing cluttering: A comprehensive guidebook of activities. Approximately 88%91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013). Language intervention from a bilingual mindset. Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. 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). ), Cluttering: A clinical perspective (pp. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). Stuttering in school-age children: A comprehensive approach to treatment. modifying instructions to accommodate the home language, using exemplars in audio or video format in the home language, and. https://doi.org/10.1044/1058-0360.0202.65. https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). Evaluating stuttering in young children: Diagnostic data. Stuttering and cluttering: Frameworks for understanding and treatment. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. 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). 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).
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