https://doi.org/10.1044/2019_PERS-SIG4-2019-0024, Boyle, M. P., & Gabel, R. (2020). Motivational interviewing is a person-centered approach that can be useful in developing functional goals and enhancing readiness for change (Miller & Rollnick, 2013; Rollnick & Miller, 1995). Psychology Press. 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. 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). Finding the good in the challenge: Benefit finding among adults who stutter. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. https://doi.org/10.1093/brain/awu400, Choi, D., Conture, E. G., Walden, T. A., Lambert, W. E., & Tumanova, V. (2013). Testing, and 7. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Breakdowns in fluency and clarity can result from. Trichon, M., & Raj, E. X. The Lidcombe Program of early stuttering intervention: A clinicians guide. https://doi.org/10.1044/1092-4388(2008/07-0111), Prochaska, J. O., & DiClemente, C. C. (2005). 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). 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). https://doi.org/10.1044/jshr.2804.495, Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Menzies, R. G., Onslow, M., & Rapee, R. M. (2016). Prevalence of speech disorders in elementary school students in Jordan. https://doi.org/10.1073/pnas.1901480116, Harasym, J., Langevin, M., & Kully, D. (2015). 211230). https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). 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). BMJ, 331(7518), 659661. 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. 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. Onslow, M., Packman, A., & Harrison, E. Seminars in Speech and Language, 37(3), 145152. Other disorders, such as apraxia of speech and/or articulation and phonological disorders, can affect speech intelligibility; assessment of speech production can be used to rule out these causes of reduced speech intelligibility. The clinical process for an adult involves. 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). This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). See What To Ask When Evaluating Any Procedure, Product, or Program. Language intervention from a bilingual mindset. In B. J. Amster & E. R. Klein (Eds. Language, Speech, and Hearing Services in Schools, 26(2), 162168. 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). Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. The term overt stuttering is used when core speech behaviors are present. Counseling persons with communication disorders and their families. Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. The utility of stuttering support organization conventions for young people who stutter. Harper & Row. talking about stuttering or treatment of stuttering. It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. World Health Organization. Scaler Scott, K., & Ward, D. (2013). Parental involvement is an integral part of any treatment plan for children who stutter. Rethinking covert stuttering. American Journal of Speech-Language Pathology, 29(1), 201215. 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. Symptoms and severity of stuttering and cluttering can vary (Davidow & Scott, 2017; St. Louis & Schulte, 2011). Available 8:30 a.m.5:00 p.m. Avoidance can lead to less talking and reduced linguistic complexity. Journal of Speech and Hearing Disorders, 49(1), 5358. Disclosure of stuttering and quality of life in people who stutter. Al-Jazi, A. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). What is motivational interviewing? Some individuals develop speech habits to escape or avoid moments of overt stuttering, such as changing words or using interjections (e.g., um, uh), and they may become so skilled at hiding stuttering that their speech appears to be fluent (covert stuttering; B. Murphy et al., 2007). For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. In E. Conture & R. F. Curlee (Eds. Journal of Neurodevelopmental Disorders, 3(4), 374380. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). All speakers are disfluent at times. Language, Speech, and Hearing Services in Schools, 48(4), 234248. The Present Levels of Academic Achievement and Functional Performance statement, which serves as the baseline for the IEP, refers to other areas that are not necessarily academic and can include information about communication skills, social skills, and other activities of daily living. Multicultural identification and treatment of stuttering: A continuing need for research. Counseling individuals with fluency disorders and their families and providing education aimed at self-acceptance and reducing negative reactions (see ASHAs Practice Portal page on, Consulting and collaborating with individuals with fluency disorders, families, other professionals, peers, and other invested parties to identify priorities and build consensus on an intervention plan focused on functional outcomes (see ASHAs resources on. There are limited data on the age of onset of cluttering; however, the age of onset of cluttering appears to be similar to that of stuttering (Howell & Davis, 2011). 328). https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Craig, A., Blumgart, E., & Tran, Y. (Eds.). Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. Effectiveness of intensive, group therapy for teenagers who stutter. https://doi.org/10.1055/s-2008-1064082, Caughter, S., & Crofts, V. (2018). ), Current issues in stuttering research and practice (pp. Self-disclosure involves communicating to others information that reveals ones identity as a person who stutters. See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1016/j.jfludis.2010.12.003. Erickson, S., & Block, S. (2013). https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. Estimates of incidence and prevalence vary due to a number of factors, including disparities in the sample populations (e.g., age), how stuttering was defined, and how stuttering was identified (e.g., parent report, direct observation). Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. (2011). Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. See ASHAs resource on assessment tools, techniques, and data sources. Signs and symptoms. https://doi.org/10.1044/1058-0360(2011/09-0102), Ntourou, K., Conture, E. G., & Walden, T. A. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. International Journal of Speech-Language Pathology, 17(4), 367372. Perspectives on Fluency and Fluency Disorders, 23(2), 5469. However, sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children. 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). Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O., Bavin, E., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Perspectives on Fluency and Fluency Disorders, 1(4), 5569. 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). reducing secondary behaviors and minimizing avoidances. Journal of Fluency Disorders, 13(5), 331355. Journal of Fluency Disorders, 36(3), 186193. The goal of Avoidance Reduction Therapy for Stuttering is to decrease fear of stuttering that leads to struggle. Disfluencies are not directly targeted; however, the frequency and intensity of disfluencies decrease as struggle is reduced. https://doi.org/10.1044/ffd16.1.15. Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). Fluency refers to continuity, smoothness, rate, and effort in speech production. (2004). Some children who stutter or clutter may only experience symptoms situationally. Journal of Fluency Disorders, 46, 114. Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. One of the core principles of ACT is mindfulness. The assignments begin in supportive, low-fear situations and slowly evolve to more challenging situations and settings as the individual demonstrates the ability to accept or tolerate potential negative reactions. https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & 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. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. The speakers measured speech rate is not always greater than average, but the listener perceives it as rapid. Drayna, D., & Kang, C. (2011). https://doi.org/10.1044/1058-0360.0704.62. Language abilities of children who stutter: A meta-analytical review. Psychology Press. Journal of Speech, Language, and Hearing Research, 61(5), 12381250. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. 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). 1997- American Speech-Language-Hearing Association. Increased incidence of stuttering has been noted among those with a first-degree relative (e.g., parent, sibling) who stutters and an even greater likelihood if that relative is an identical twin (Kraft & Yairi, 2011). https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. https://doi.org/10.1177/152574018200600106. ), Cluttering: A handbook of research, intervention and education (pp. Hearne, A., Packman, A., Onslow, M., & Quine, S. (2008). Bullying in adolescents who stutter: Communicative competence and self-esteem. Social anxiety disorder in adults who stutter. Conture, E. G. (2001). 341358). In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). Prevalence of cluttering in two European countries: A pilot study. In F. L. Myers & K. O. St. Louis (Eds. Measurement and modification of speech naturalness during stuttering therapy. Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization.