Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. their reason for seeking treatment at the current time. Summary - Typical vs Atypical Pneumonia. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). Journal of Fluency Disorders, 38(1), 1429. language or learning disability (Ntourou et al., 2011). their disfluencies may be accompanied by physical tension and secondary behaviors. 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. https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. Limited research is available that identifies the causes of cluttering. Journal of Speech, Language, and Hearing Research, 62(5), 13711372. Assessment of speech fluency (e.g., frequency, type, and duration of disfluencies), speech rate, speech intelligibility, and the presence of secondary behaviors in a variety of speaking tasks (e.g., conversational and narrative contexts). Singular. Assessment of awareness in young children of disfluencies and difficulty in speaking. Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). What we know for now IN BRIEF. Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. Reeves, L. (2006). Cluttering and autism spectrum disorders. Luterman, D. M. (2006). In R. Lees & C. Stark (Eds. 328). When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. The speaker is thought to be talking at a rate that is too fast for their system to handle, resulting in breakdowns in fluency and/or intelligibility (Bakker et al., 2011). Rather, the purpose is to determine the extent and impact of the fluency disorder on the individual, the potential benefit from treatment, and the individuals desire and willingness to change. Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). Drayna, D. (2011). 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). typical vs atypical disfluencies asha typical vs atypical disfluencies asha. 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). Van Riper, C. (1973). These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. (1988). typical vs atypical disfluencies asha. Psychology Press. Manning, W. H., & DiLollo, A. Journal of Fluency Disorders, 58, 2234. Differing perspectives on what to do with a stuttering preschooler and why. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/. In L. Cummings (Ed. How can you tell if childhood stuttering is the real deal? American Journal of Speech-Language Pathology, 29(1), 201215. Available 8:30 a.m.5:00 p.m. Brain, 138(3), 694711. Advance online publication. Emotional problems and parenting style do not cause stuttering. In K. O. Lewis (Ed. www.asha.org/policy/, American Speech-Language-Hearing Association. Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. https://doi.org/10.1044/1058-0360(2011/09-0102), Ntourou, K., Conture, E. G., & Walden, T. A. (2011). 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). See ASHAs resource on person- and family-centered care. https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). Clinicians need to understand the interaction of symptoms and the strategies that are most effective for dealing with stuttering and cluttering when they occur together. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. 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. See What To Ask When Evaluating Any Procedure, Product, or Program. Stages of change and stuttering: A preliminary view. Education, 136(2), 159168. 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). other developmental disorders (Briley & Ellis, 2018). 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). This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Journal of Fluency Disorders, 54, 113. The term overt stuttering is used when core speech behaviors are present. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). 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). The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. For school-age children and adolescents, initiation of treatment depends, in large part, on their motivation, which, in turn, is dependent on factors such as their perceived needs, the degree of adverse impact they experience, and their previous treatment experiences. https://doi.org/10.1044/2017_AJSLP-17-0146, St. Louis, K. O., & Hinzman, A. R. (1986). The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. https://doi.org/10.1177/152574018200600106. autism (see Scaler Scott, 2011, for a review), word-finding/language organization difficulties (Myers, 1992), and. Treatment for fluency disorders is highly individualized and based on a thorough assessment of speech fluency, language factors, emotional/attitudinal components, and life impact (Byrd & Donaher, 2018). Fluency treatment can occur at any point after the diagnosis. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). https://doi.org/10.1044/1058-0360.0202.65. discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting). Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. Journal of Fluency Disorders, 32(2), 95120. ), Cluttering: Research, intervention and education (pp. (2010). Folia Phoniatrica et Logopaedica, 64(1), 3447. In H. Gregory (Ed. Rehabilitation Act of 1973, Section 504. Journal of Fluency Disorders, 25(1), 4757. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. Parental involvement is an integral part of any treatment plan for children who stutter. https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). https://doi.org/10.1044/2020_PERSP-20-00014. Apply Now. The neurological underpinnings of cluttering: Some initial findings. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Discussions about the physical experience of anxiety and ways to reduce it and the sense of loss of control and time pressure may be of further benefit (e.g., mindfulness and grounding; Beilby et al., 2012a; Boyle, 2011; Harley, 2018). The person exhibits negative reactions (e.g., affective, behavioral, or cognitive reactions) to their disfluency. ), Cluttering: Research, intervention and education (pp. Crystal ball gazing: Research and clinical work in fluency disorders in 2026. 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). Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. (2017). https://doi.org/10.1044/2020_JSLHR-20-00096. B. Definitions of communication disorders and variations [Relevant paper]. 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. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Subjective distress associated with chronic stuttering. "Atypical" disfluencies include: sound repetitions ("s-s-s-so"); syllable repetitions ("be-be-be-be-because"); prolongations ("Aaaaaaaaaaaaand"); and The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). International Classification of Functioning, Disability and Health. Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. Language, Speech, and Hearing Services in Schools, 48(4), 234248. Available 8:30 a.m.5:00 p.m. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Avoidance Reduction Therapy for Stuttering (ARTS). Counseling allows the clinician who works with those who stutter or clutter to practice within the ICF framework by targeting all aspects of the disordernot just the surface behaviors. https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). For students who stutter, the impact goes beyond the communication domain. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. Prevalence of speech disorders in elementary school students in Jordan. Starkweather, Janice Westbrook. Journal of Communication Disorders, 48, 3851. A thematic analysis of late recovery from stuttering. Acceptance and Commitment Therapy for people who stutter. Trichon, M., & Raj, E. X. Often, there are pivotal points during treatment that indicate progress (T. K. Anderson & Felsenfeld, 2003; Plexico et al., 2005). Long-term follow-up of self-modeling as an intervention for stuttering. Treatment approaches for adults should take into consideration career and workplace factors. Expand Search Apply; Program Guide; BOBapp(2023) . Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. There has been some documentation of the use of stuttering modification strategies to help those who clutter (Ward, 2006). It is incumbent upon the SLP to help the individualized education program (IEP) team determine the academic and social impacts of stuttering on students in the school setting. (1996). https://doi.org/10.1016/0094-730X(88)90004-6, Onslow, M., & OBrian, S. (2012). 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). A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. Journal of Speech, Language, and Hearing Research, 60(9), 24832505. 7). 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. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Journal of Fluency Disorders, 36(4), 290295. https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. Fluency: A review of developmental and remedial practices. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). (2009). https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker. Acquired neurogenic and psychogenic stuttering are not covered. 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). Seminars in Speech and Language, 18(4), 371389. https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. 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. Childhood stuttering: Incidence and development. 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. https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis. Journal of Fluency Disorders, 29(4), 255273. https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). National Stuttering Association. Their skills are developing in this area. See ASHAs Practice Portal page on Telepractice. Journal of Fluency Disorders, 34(3), 187200. Thieme. 2335). Cluttering: A neurological perspective. United States Department of Labor. Specific standardized tests can be used to rule out word-finding difficulties. Human Brain Mapping, 38(4), 18651874. Stuttering: Its nature, diagnosis, and treatment. It can also be challenging to assess the reading fluency of bilingual students who stutter. Allyn & Bacon. As children who stutter get older, they may become adept at word and situational avoidances that result in a low frequency of overt stuttering. Self-report of self-disclosure statements for stuttering. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. ), Cluttering: A clinical perspective (pp. 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. In B. J. Amster & E. R. Klein (Eds. Plural. There may be a relationship between stuttering and working memory. 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). Clinical implications of situational variability in preschool children who stutter. https://doi.org/10.1044/1058-0360(2007/008), Oyono, L. T., Pascoe, M., & Singh, S. (2018). 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. Stuttering More than 70 million people around the world struggle with stuttering, according to The Stuttering Foundation. B., & Al-Khamra, R. (2015). https://doi.org/10.1044/2017_JSLHR-S-16-0371, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2019). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). (1981). Stuttering as defined by adults who stutter. typical vs atypical disfluencies asha 24 Jun. 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. excessive coarticulation resulting in the collapsing and/or deletion of syllables and/or word endings; excessive disfluencies, which are usually of the more nonstuttering type (e.g., excessive revisions and/or use of filler words, such as um); pauses in places typically not expected syntactically; unusual prosody (often due to the atypical placement of pauses rather than a pedantic speaking style, as observed in many with autism spectrum disorder). Behavioural and Cognitive Psychotherapy, 23(4), 325325. van Zaalen, Y., & Reichel, I. K. (2014). Therefore, a comprehensive assessment for fluency disorders should include assessment of both overt and covert features. https://doi.org/10.1016/j.jfludis.2008.01.001. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Wolk, L., Edwards, M. L., & Conture, E. G. (1993). What is motivational interviewing? One study showed that children who clutter had 7.6 times more normal disfluencies compared to "atypical" disfluencies when they retold a story (van Zaalen et al., 2009). https://doi.org/10.1044/2019_JSLHR-S-18-0225. Assessing bilingual children: Are their disfluencies indicative of stuttering or the by-product of navigating two languages? Harper & Row. Tourettes syndrome (see Van Borsel, 2011, for a review). Prentice-Hall. EBP Briefs, 2(4), 18. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. advertising through a classroom presentation with the guidance of the SLP or classroom teacher in the case of school-age children (W. P. Murphy et al., 2007b). Evidence-based treatment and stutteringHistorical perspective. A clinicians first responsibility when treating an individual of any age is to develop a thorough understanding of the stuttering experience and a speakers successful and unsuccessful efforts to cope with his or her communication problem (Manning & DiLollo, 2018, p. 370). 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). attention-deficit/hyperactivity disorder (Donaher & Richels, 2012; Lee et al., 2017). The model describes the following stages of behavioral change: See Manning and DiLollo (2018) and Floyd et al. 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). Shock, 2. This results in less effective social interactions. Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). Some children who stutter or clutter may only experience symptoms situationally. However, a school-age child or adolescent who stutters may not report their experience accurately, possibly due to a lack of awareness or a desire to appease the clinician (Adriaensens et al., 2015; Erickson & Block, 2013). These symptoms come suddenly and do need hospitalization. With regard to cluttering, research is not far enough along to identify causes. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. A comprehensive fluency assessment typically includes the following: See ASHAs resource on assessment procedures: parallel with CPT codes for a breakdown of pre-evaluation, intra-service, and post-service procedures. have a sense of belonging and experience less stigma. Journal of Fluency Disorders, 49, 1328. 297325). It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). Drayna and Kang (2011) found that gene mutations were present in close to 10% of cases of familial stuttering. Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering.
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