Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. Parents can also report if secondary behaviors are present in both languages. Multicultural issues in school settings. https://doi.org/10.1055/s-0034-1371755, Jones, R. M., Conture, E. G., & Walden, T. A. Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). Workplace in fluency management: Factoring the workplace into fluency management. International Classification of Functioning, Disability and Health. 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). Stimulability testing (e.g., person is asked to increase pausing and/or decrease speech rate in some other way)a reduction of overall speech rate typically helps in reducing cluttering symptoms. School-age stuttering therapy: A practical guide. Communication Disorders Quarterly, 39(2), 335345. Title: The Differential Diagnosis of Disfluency Created Date: 7/18/2007 3:15:45 PM These modifications are used regardless of whether a particular word is expected to be produced fluently. Fluency treatment can occur at any point after the diagnosis. 6989). Mindfulness is an intentional awareness of the present moment (e.g., through meditation) to help disengage from automatic thoughts and redirect attention, de-escalate emotions, and increase self-acceptance (Boyle, 2011; Harley, 2018). Assessment of stigma associated with stuttering: Development and evaluation of the Self-Stigma of Stuttering Scale (4S). Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 36(1), 1726. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). Journal of Fluency Disorders, 54, 113. Amster, B. J., & Klein, E. R. (2018). Disclosing a fluency disorder may be done a number of ways, such as verbally stating I stutter/have a speech disorder or by pseudostuttering or openly stuttering, while doing so confidently (McGill et al., 2018). Neural network connectivity differences in children who stutter. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. In K. O. Lewis (Ed. (2019). Clinical decision making in fluency disorders. One example of an approach that incorporates cognitive restructuring is Acceptance and Commitment Therapy (ACT; Beilby & Brynes, 2012; Beilby et al., 2012a; Palasik & Hannan, 2013). gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. Educating other professionals about the needs of individuals with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders. 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. Providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk. Lyn Goldberg and Michelle Ferketic served as ex officios. A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. These signs and symptoms are consistent with the diagnostic and associated features of childhood-onset fluency disorder (stuttering) listed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. https://doi.org/10.1093/brain/awm241, Watson, J. auditory processing disorders (Molt, 1996). Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. Nurturing a resilient mindset in school-aged children who stutter. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). Features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder). Fluency Disorders (Practice Portal). Often, there are pivotal points during treatment that indicate progress (T. K. Anderson & Felsenfeld, 2003; Plexico et al., 2005). Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). Scope of Practice in Speech-Language Pathology, Counseling For Professional Service Delivery, interprofessional education/interprofessional practice [IPE/IPP], American Board of Fluency and Fluency Disorders, assessment tools, techniques, and data sources, assessment of fluency disorders in the context of the WHO ICF framework, assessment procedures: parallel with CPT codes, characteristics of typical disfluency and stuttering, Collaborating With Interpreters, Transliterators, and Translators, ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter, Speech Sound Disorders: Articulation and Phonology, treatment goals for fluency disorders in the context of the WHO ICF framework, What To Ask When Evaluating Any Procedure, Product, or Program, Counseling For Professional Service Deliver, Cognitive Distortions and Fluency Examples, Characteristics of Typical Disfluency and Stuttering, Early Identification of Speech, Language, and Hearing Disorders, How Can You Tell if Childhood Stuttering is the Real Deal, Assessment of Fluency Disorders In the Context of the WHO ICF Framework, Treatment Goals For Fluency Disorders in the Context of the WHO ICF Framework, Assessment Procedures: Parallel With CPT Codes, Private Health Plans: Tips and strategies for ensuring that speech and hearing services are covered, FRIENDS: The National Association of Young People Who Stutter, International Cluttering Association (ICA), SAY: The Stuttering Association for the Young, https://doi.org/10.1371/journal.pone.0133758, https://doi.org/10.1044/2020_PERSP-20-00014, https://doi.org/10.1016/j.jfludis.2019.105713, https://doi.org/10.1044/2018_AJSLP-17-0097, https://doi.org/10.1044/2017_JSLHR-S-16-0371, https://doi.org/10.1044/1092-4388(2008/046, https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199, https://doi.org/10.1044/1058-0360(2011/09-0102, https://doi.org/10.1044/1092-4388(2008/07-0057, www.asha.org/practice-portal/clinical-topics/fluency-disorders/, Connect with your colleagues in the ASHA Community, repetitions of sounds, syllables, and monosyllabic words (e.g., Look at the, prolongations of consonants when it isnt for emphasis (e.g., . The impact of a stuttering disorder on Western Australian children and adolescents. 115134). Bowling Green State University Archive. Journal of Communication Disorders, 37(1), 3552. if monitoring or treatment (direct or indirect) is recommended. Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. The purpose of assessing school-age children and adolescents for fluency disorders is to determine the presence, the extent, andmost importantlythe impact of the fluency disorder and the potential benefit from treatment. Understanding and treating cluttering. There is a family history of stuttering or cluttering. The underlying relationship between stuttering and working memory is not fully understood but may be related to interruptions in sensorimotor timing for developmental stuttering and may involve both the basal ganglia and the prefrontal cortex (Bowers et al., 2018). Self-regulation and the management of stuttering. https://doi.org/10.1044/2017_AJSLP-17-0146, St. Louis, K. O., & Hinzman, A. R. (1986). Measurement and modification of speech naturalness during stuttering therapy. The ASHA Leader, 18(3), 1415. Journal of Communication Disorders, 58, 4357. Resilience has been examined in the stuttering literature as one factor that may protect people from the adverse effects of chronic stuttering (Craig et al., 2011; Freud & Amir, 2020). Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. 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). https://doi.org/10.1016/j.jfludis.2011.06.001. The primary provider of fluency treatment is the SLP. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. Aphasia. In D. Ward & K. Scaler Scott (Eds. https://doi.org/10.1016/j.jfludis.2013.01.001. Bakker, K., Myers, F. L., Raphael, L. J., & St. Louis, K. O. Such individuals may benefit from treatment strategies that focus on improving speech efficiency by reducing word avoidance and increasing spontaneity in communication. Typical disfluencies often resolve by age five and tend to cycle, meaning they come and go. Journal of Fluency Disorders, 32(1), 5169. Journal of Speech, Language, and Hearing Research, 61(5), 12381250. It is helpful to know that typical bilingual or multilingual children tend to produce higher rates of monosyllabic word repetitions, sound repetitions, and syllable repetitions than monolingual speakers. The person is experiencing negative reactions from others (e.g., peers, classmates, coworkers, family members). 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. Routledge. The clinician (a) considers the degree to which the individuals disfluent behaviors and overall communication are influenced by a coexisting disorder (e.g., other speech or language disorders, Down syndrome, autism spectrum disorder, attention-deficit/hyperactivity disorder) and (b) determines how treatment might be adjusted accordingly. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use United States Department of Labor. There is very little genetic information on cluttering, except for anecdotal reports that the speech characteristics have been found to be present in more than one member of a family (Drayna, 2011). The relationship of self-efficacy and depression to stuttering. Journal of Fluency Disorders, 46, 114. 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). 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). Traditional stuttering modification strategies (Manning & DiLollo, 2018) include the following: These strategies require an individual to identify a moment of disfluency before, during, or after it occurs and to make adjustments to reduce tension and struggle. Referring to other health care professionals when outside support is needed to facilitate treatment goals for interfering behaviors (e.g., anxiety, depression). (2008). https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). https://doi.org/10.1044/jshr.3103.377, Weber-Fox, C., Wray, A. H., & Arnold, H. (2013). (2017). The cost of such avoidance can be great because of the resulting impact on the persons ability to say what they want to say, when they want to say it. Their description details the characteristics of each stage, along with treatment goals and processes appropriate for each stage. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Psychology Press. Some people who clutter tend to decrease volume at the ends of sentences or phrases and, therefore, can benefit from learning to keep a steady volume throughout their utterances. Guilford Press. The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). ), Cluttering: A handbook of research, intervention and education (pp. The impact of stuttering on employment opportunities and job performance. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Reardon-Reeves, N., & Yaruss, J. S. (2013). A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. Seminars in Speech and Language, 35(2), 6779. American Journal of Speech-Language Pathology, 12(2), 243253. Prior to developing generalization activities, the SLP needs to consider the individuals profile. Support activities can be incorporated into group treatment and through participation in self-help groups (Trichon & Raj, 2018), attendance at self-help conferences (Boyle et al., 2018; Gerlach et al., 2019; Trichon & Tetnowski, 2011), and participation in summer camp programs (Byrd et al., 2016). their reason for seeking treatment at the current time. altering the size of the group or audience. 147171). Stuttering impact: A shared perception for parents and children. These include when the individual who stutters. Seminars in Speech and Language, 24(1), 2732. Current Biology, 26(8), 10091018. Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. Adults with fluency disorders have likely experienced years of treatment with varied outcomes. Individuals may experience the impact of fluency disorders in social and emotional, academic, and vocational domains. 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). https://doi.org/10.1016/j.jfludis.2014.12.003. Through a process of identifying the assumptions underlying their thoughts, they can evaluate whether those thoughts are helpful (or valid) and ultimately adopt different assumptions or thoughts. Stuttering-related podcasts: Audio-based self-help for people who stutter. Clinicians can help clients progress to active stages through building self-efficacy. Journal of Speech, Language, and Hearing Research, 44(2), 368380. 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. (n.d.). Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. American Journal of Speech-Language Pathology, 27(3S), 12351243. 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. Harper & Row. Stuttering Therapy Resources. Disclosure of stuttering and quality of life in people who stutter. Preliminary research suggests adults who clutter demonstrate differences in cortical and subcortical activity compared to controls (Ward et al., 2015). In D. Ward & K. Scaler Scott (Eds. Referral to another helping professional should be made if a condition or situation falls outside of the SLPs scope of practice. 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. Journal of Speech, Language, and Hearing Research, 60(11), 30973109. The frequency and severity of overt stuttering may fluctuate from day to day and in relation to the speaking situation. http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/, Multisyllabic whole-word and phrase repetitions, Secondary behaviors (e.g., eye blinks, facial grimacing, changes in pitch or loudness), Avoidance behaviors (e.g., reduced verbal output or word/situational avoidances). Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. Starkweather, C. W. (1987). Remaining informed of research in the area of fluency disorders and advancing the knowledge base of the nature of the disability, screening, diagnosis, prognostic indicators, assessment, treatment, and service delivery for individuals with fluency disorders. Journal of Fluency Disorders, 13(5), 357373. Journal of Fluency Disorders, 38(2), 6687. 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. autism (see Scaler Scott, 2011, for a review), word-finding/language organization difficulties (Myers, 1992), and. https://doi.org/10.1016/j.jcomdis.2014.02.001, Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Genetic contributions to stuttering: The current evidence. https://doi.org/10.1044/0161-1461.2602.162. Perspectives on Fluency and Fluency Disorders, 4(6), 13161326. https://doi.org/10.1016/S0094-730X(01)00098-5. A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. These are called typical disfluencies or nonfluencies. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. 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, 50, 7284. https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). Van Riper, C. (1973). Acquired neurogenic and psychogenic stuttering are not covered. https://doi.org/10.1044/ffd22.2.51, Berquez, A., & Kelman, E. (2018). The purpose of CBT is to modify current negative thoughts, emotions, and/or behaviors and replace them with positive ones through identification of thought patterns and challenging cognitive distortions in real time. https://doi.org/10.1016/j.jfludis.2006.02.002. The utility of stuttering support organization conventions for young people who stutter. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. Al-Jazi, A. Parents can also learn about how to help their child generalize skills from the treatment room to different settings and with different people. Journal of Fluency Disorders, 62, 105762. https://doi.org/10.1016/j.jfludis.2019.105726. However during treatment and forming a new, more congruent identity, clients may progress through some of the stages of grief (e.g., 1. recognize physical concomitant behaviors, locate the point of physical tension and struggle during moments of disfluency, and. 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). Yaruss, J. S., & Reardon-Reeves, N. (2017). 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. (2019). When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. (2013). Cluttering may have an effect on pragmatic communication skills and awareness of moments of disruption (Teigland, 1996). American Journal of Speech-Language Pathology, 29(1), 201215. For example, cluttering symptoms may decrease during a formal speech evaluationdue to increased self-monitoringbut increase in more comfortable situations where the person is less likely to self-monitor. Screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation. https://doi.org/10.1016/j.jfludis.2013.09.003, Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. https://doi.org/10.1044/leader.OV.18032013.14, Freud, D., & Amir, O. Covert stuttering. Wiig, E. H., & Semel, E. M. (1984). World Health Organization. Regional cerebral blood flow is reduced in Brocas area, the region in the frontal lobes of the brain linked to speech production, and an inverse relationship was noted between the severity of stuttering and the rate of blood flow (Desai et al., 2016). Setting refers to the location of treatment (e.g., home, community-based [including work settings], school environments, clinic room). The ASHA Action Center welcomes questions and requests for information from members and non-members. . Stuttering and cluttering: Frameworks for understanding and treatment. Stuttering as defined by adults who stutter. Treatment approaches for preschool children who stutter include the following. (2016). (2019). https://doi.org/10.1044/1092-4388(2011/10-0304), Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K. (2002). In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. Sheehan, J. G. (1970). An introduction to camps for children who stutter: What they are and how they can help. https://doi.org/10.1044/gics4.2.57, Van Zaalen, Y., & Reichel, I. When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. www.asha.org/policy/, American Speech-Language-Hearing Association. https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. Measuring lexical diversity in children who stutter: Application of vocd. Psychosocial support for adults who stutter: Exploring the role of online communities. 297325). The role of self-help/mutual aid in addressing the needs of individuals who stutter. Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). Fluency refers to continuity, smoothness, rate, and effort in speech production. Potential neurological underpinnings of cluttering include dysregulation of the anterior cingulate cortex and the supplementary motor area (Alm, 2011) as well as increased activity in the basal ganglia and premotor cortex (Ward et al., 2015). ASHA also extends its gratitude to the following subject matter experts who were involved in the reviewand development of thispage: In addition, ASHA thanks the members of the Steering Committee of ASHAs Special Interest Division on Fluency and Fluency Disorders (Division 4) whose work preceded this content.

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