A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. 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). Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. Limited research is available that identifies the causes of cluttering. 6396). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Psychology Press. Starkweather, C. W. (1987). (2011). 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). Language abilities of children who stutter: A meta-analytical review. Education, 136(2), 159168. Young children may or may not verbalize their reactions to stuttering. Time and expense are considerations along with attention to generalization and treatment needs following an intensive program (Cooper, 1979). Temperamental characteristics of young children who stutter. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). https://doi.org/10.1111/1469-7610.00093, de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M. C. (2015). Advances in Psychiatric Treatment, 12(1), 6368. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). (2013). These simulations and applications of strategies might be most likened to cancellation and pull-out techniques used in stuttering. The prevalence rate of stuttering in African American children (25 years of age) was estimated to be 2.52%, but was not reported to not be significantly different from that reported for European American children in the same age group between 2- to 5-year-old African American children and European American children (Proctor et al., 2008). School-age stuttering therapy: A practical guide. (2001). One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). In J. C. Norcross & M. R. Goldfried (Eds. https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). language or learning disability (Ntourou et al., 2011). Empirical research on whether bilingual individuals who stutter are more disfluent in one language than the other is sparse and based on small case studies (Tellis & Tellis, 2003), but many bilingual individuals who stutter report this to be the case (Nwokah, 1988). increasing self-confidence and self-efficacy. Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. 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). increasing effective and efficient communication. Research updates in neuroimaging studies of children who stutter. The relationship of self-efficacy and depression to stuttering. Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. They are likely to use interjections, repeat phrases, and revise what they are saying. https://doi.org/10.1044/jshr.3605.906. Journal of Fluency Disorders, 38(3), 260274. In R. Lees & C. Stark (Eds. This perceived rapid rateand the resulting breakdown in speech clarityis thought to be because speakers with cluttering speak at a rate that is too fast for their systems to handle (Myers, 1992; St. Louis et al., 2007; Ward, 2006). American Journal of Speech-Language Pathology, 27(2), 721736. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). See the Fluency Disorders Evidence Map for summaries of the available research on this topic. Journal of Fluency Disorders, 13(5), 331355. In D. Ward & K. Scaler Scott (Eds. There is a family history of stuttering or cluttering. Children and adolescents with fluency disorders may qualify for accommodations whether or not they have an active individualized education program (IEP). Scaler Scott, K., & St. Louis, K. O. Contemporary Issues in Communication Science and Disorders, 31(Spring), 6979. Journal of Fluency Disorders, 37(4), 242252. Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. These symptoms come suddenly and do need hospitalization. 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. Often referred to as advertising in the stuttering community, self-disclosure can involve. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. Fear of speaking: Chronic anxiety and stammering. Rethinking covert stuttering. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. Counseling parents of children who stutter. https://doi.org/10.1055/s-2003-37447, Thordardottir, E. (2006). However, several likely gene mutations have been linked to stuttering (Frigerio-Domingues & Drayna, 2017). The epidemiology of cluttering with stuttering. Measurement and modification of speech naturalness during stuttering therapy. Adjustments can include. Seminars in Speech and Language, 23(3), 181186. Preschool children who stutter showed differences in event-related brain potentials used as indices of language processing. School Psychology Review, 30(1), 135141. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). Parents can also report if secondary behaviors are present in both languages. American Psychiatric Association. The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. 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). Avoidance Reduction Therapy for Stuttering (ARTS). Sisskin, V. (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). Reduced perfusion in Brocas area in developmental stuttering. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Time pressures for verbal communication and requirements to use the telephone may lead to stress and discomfort. frequency of exposure to all languages used by the child and their proficiency (comprehension and production) in each language; family history of stuttering or cluttering; description of disfluency and rating of severity; age of onset of disfluency and patterns of disfluency since onset (e.g., continuous or variable); previous fluency treatment and treatment outcomes; exploration of parental reactions to the childs moments of disfluency or speaking frustration; and. (2011). Journal of Communication Disorders, 80, 8191. American Journal of Speech-Language Pathology, 7(4), 6276. https://doi.org/10.1016/j.jfludis.2010.04.003, Wagovich, S., & Hall, N. (2017). Clinical implications of situational variability in preschool children who stutter. https://doi.org/10.1044/1092-4388(2011/10-0304), Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K. (2002). Some of the most commonly prescribed typical or first-generation antipsychotics include: Haldol (haloperidol) Thorazine (chlorpromazine) Loxitane (loxapine) Moban (molindone) Mellaril (thioridazine) Serentil (mesoridazine) Navane (thiothixene) Trilafon (perphenazine) On the other hand, the following are atypical or second-generation antipsychotics: Genetic factors and therapy outcomes in persistent developmental stuttering. The clutterer. A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. Indicators of positive therapeutic change may include. https://doi.org/10.1055/s-0034-1371755, Jones, R. M., Conture, E. G., & Walden, T. A. Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Stuttering is often more severe when there is increased pressure to communicate (e.g., competing for talk time, giving a report at school, talking on the telephone/during a video chat, or interviewing for a job). What do people search for in stuttering therapy: Personal goal-setting as a gold standard? https://doi.org/10.1044/ffd22.1.34, Beilby, J. M., Byrnes, M. L., Meagher, E. L., & Yaruss, J. S. (2013). 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). other developmental disorders (Briley & Ellis, 2018). https://doi.org/10.1044/1058-0360(2011/09-0102), Ntourou, K., Conture, E. G., & Walden, T. A. These are called typical disfluencies or nonfluencies. Egan, G. (2013). The role of self-help/mutual aid in addressing the needs of individuals who stutter. typical vs atypical disfluencies asha 24 Jun. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Clinicians can help clients progress to active stages through building self-efficacy. (2006). 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). As children who stutter get older, they may become adept at word and situational avoidances that result in a low frequency of overt stuttering. sex of childboys are at higher risk for persistence of stuttering than girls (Craig et al., 2002; Yairi & Ambrose, 2013); family history of persistent stuttering (Kraft & Yairi, 2011); time duration of greater than 612 months since onset or no improvement over several months (Yairi & Ambrose, 2005); age of onsetchildren who start stuttering at age 3 years or later (Yairi & Ambrose, 2005); and. Operant approaches operate within a framework of stuttering as a learned behavior (for a discussion, see Conture, 2001; de Sonneville-Koedoot et al., 2015, p. 334; Onslow & Yaruss, 2007). 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). Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. Journal of Fluency Disorders, 33(2), 8198. Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). Journal of Fluency Disorders, 38(2), 171183. In E. Conture & R. F. Curlee (Eds. https://doi.org/10.1093/brain/awm241, Watson, J. Wolk, L., Edwards, M. L., & Conture, E. G. (1993). Yaruss, J. S., & Quesal, R. W. (2004). Epidemiology of stuttering in the community across the entire life span. Factors that contribute to the perception of overt stuttering severity include frequency, duration, effort, naturalness, and the ability of the person who stutters to communicate effectively and efficiently. Universitetsforlaget. Diagnostic and statistical manual of mental disorders (5th ed.). Preus, A. Prior to developing generalization activities, the SLP needs to consider the individuals profile. (2018). B. The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. American Journal of Speech-Language Pathology, 16(1), 6568. Current Biology, 26(8), 10091018. Ward, D., & Scaler Scott, K. (2011). Clinical characteristics associated with stuttering persistence: A meta-analysis. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. Crystal ball gazing: Research and clinical work in fluency disorders in 2026. Differences in fluency across languages may be due to the social context in which the language is used (Foote, 2013), as well as the proficiency of each language spoken. See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Examples of support groups and activities include FRIENDS: The National Association of Young People Who Stutter, the National Stuttering Association, and SAY: The Stuttering Association for the Young; online groups (e.g., online chats); and social media (e.g., blogs; Reeves, 2006). atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. www.asha.org/policy/, American Speech-Language-Hearing Association. Clinicians may provide education about the speech systems and processes (e.g., respiratory system, phonatory, articulation/resonance, and nonverbal features) and that communication includes both verbal and nonverbal aspects, pragmatics, senderreceiver dynamics, and interpersonal relational features, which may be a target in treatment. World Health Organization. Acceptance; Constantino et al., 2017. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). In addition to the challenges associated with typical adolescent experiences, treatment may not be a priority for some adolescents because of other academic and social demands, denial of a speech problem, and concern about the stigma of seeking treatment. (2010). (1986). The clinical process for an adult involves. Adolescents also may be particularly susceptible to peer pressure and bullying at this time. 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. Children who stutter may demonstrate poorer expressive lexical skills compared to their peers (Silverman & Bernstein Ratner, 2002). https://doi.org/10.1093/med:psych/9780195165791.003.0007, Proctor, A., Yairi, E., Duff, M., & Zhang, J. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. ), Cluttering: A handbook of research, intervention and education (pp. In D. Ward & K. Scaler Scott (Eds. With this approach, parents are trained to provide verbal contingencies based on whether a childs speech is fluent or stuttered (M. Jones et al., 2005; Onslow et al., 2003). ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. What we know for now IN BRIEF. For some people, the use of these behaviors can result in little or no observable stuttering. Speech clarity and fluency may temporarily improve when the person is asked to slow down or pay attention to their speech. https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). Self-help conferences for people who stutter: A qualitative investigation. In D. Ward & K. Scaler Scott (Eds. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. is more open and willing to disclose and talk about their stuttering; experiences reduced impact from stuttering; generalizes attitudes, beliefs, and behaviors across contexts; reports feeling more authentic and enjoying social conversations; and. Fluency: A review of developmental and remedial practices. https://doi.org/10.1016/0094-730X(88)90004-6, Onslow, M., & OBrian, S. (2012). Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. Cluttering treatment: Theoretical considerations and intervention planning. Stuttering as defined by adults who stutter. See also ASHAs resources titled Person-Centered Focus on Function: Preschool Stuttering [PDF], Person-Centered Focus on Function: School-Age Stuttering [PDF], and Person-Centered Focus on Function: Adult Stuttering [PDF] for examples of treatment goals consistent with the ICF framework. 2335). https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. The young childs awareness of stuttering-like disfluency. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). ), The atypical stutterer: Principles and practices of rehabilitation (pp. The impact of a stuttering disorder on Western Australian children and adolescents. Journal of Abnormal Psychology, 119(3), 479490. (2011). Fluency treatment can occur at any point after the diagnosis. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). Journal of Speech, Language, and Hearing Research, 62(8), 26912702. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words and interjections (such as um and well). gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Chronic problems associated with illness, injury, or other traumatic events can have a negative impact on an individuals emotional health and quality of life (e.g., Bonanno & Mancini, 2008). Yairi, E., & Ambrose, N. (2005). Other identification strategies may include video or pseudostuttering analysis or tallying/freezing. (2001). 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. Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). Fluency of school-aged children with a history of specific expressive language impairment: An exploratory study. perceived communication and job barriers. Professional awareness of cluttering. ), The Cambridge handbook of communication disorders (pp. Scaler Scott, K. (2010). Journal of Fluency Disorders, 36(4), 290295. PLOS ONE, 10(7), Article e0133758. Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. Plural. Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). Disfluent behavior becomes more complex as fear of speaking, anxiety, and resulting avoidance increase. Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). https://doi.org/10.1016/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. Workplace in fluency management: Factoring the workplace into fluency management. Thieme. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. 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. In fact, increased pausing alone may increase speech fluency and intelligibility for those who clutter (Scaler Scott & Ward, 2013). learning disabilities (Wiig & Semel, 1984). We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). See ASHAs resource on person- and family-centered care. Bargaining, 5. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Perspectives on Fluency and Fluency Disorders, 22(1), 3446. Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. Motivational interviewing may be used to help individuals who stutter better understand the thoughts and feelings associated with their stuttering and make positive changes to improve communication. Specific standardized tests can be used to rule out word-finding difficulties. Just as individuals may experience feelings of shame or fear associated with showing stuttering, individuals also may experience negative feelings associated with using speech modification strategies, which often make their speech sound different from natural speech (Ingham & Onslow, 1985; Martin et al., 1984). Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. How can you tell if childhood stuttering is the real deal? Prins, D., & Ingham, R. J. The ASHA Action Center welcomes questions and requests for information from members and non-members. SLPs may want to relate personal experiences when asking clients to share such vulnerable information. https://doi.org/10.3109/17549507.2015.1010583, Adriaensens, S., Beyers, W., & Struyf, E. (2015). A phenomenological understanding of successful stuttering management. These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). ), The treatment of stuttering in the young school-aged child (pp. Journal of Fluency Disorders, 54, 1423. Below is a list of approaches commonly used with school-age children, adolescents, and adults who stutter. The most common atypical disfluency of concern is word-final . Journal of Fluency Disorders, 38(1), 1429. Stuttering Therapy Resources. https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. This approach to care incorporates individual and family preferences, priorities, and desired outcomes in the selection of treatment goals and treatment methods. Human Brain Mapping, 38(4), 18651874. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). https://doi.org/10.1016/j.jfludis.2010.07.001. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J.
