Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). Building clinical relationships with teenagers who stutter. 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. American Journal of Speech-Language Pathology, 27(3S), 12351243. https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). Numerous treatment approaches and strategies have been developed in an attempt to help speakers reduce the negative reactions associated with stuttering (e.g., W. P. Murphy et al., 2007a). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Journal of Speech, Language, and Hearing Research, 62(5), 13711372. (1996). Reducing bullying through role-playing and self-disclosure. Limited research is available that identifies the causes of cluttering. Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. Fluency refers to continuity, smoothness, rate, and effort in speech production. Enhancing treatment for school-age children who stutter: II. Subjective distress associated with chronic stuttering. Assessment of awareness in young children of disfluencies and difficulty in speaking. There may be a relationship between stuttering and working memory. 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). Treatment for adolescents who stutter poses a particular challenge because of the issues related to this developmental stage. The American Board of Fluency and Fluency Disorders, under the auspices of ASHAs specialty certification program, offers clinical specialty certification in fluency and fluency disorders. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. One example of a desensitization activity is pseudostutteringthe use of voluntary stuttering behaviorsin different, and increasingly more difficult, situations where the individual might fear the occurrence of real moments of stuttering (e.g., Reardon-Reeves & Yaruss, 2013; J. G. Sheehan, 1970). 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. Therefore, when conducting an assessment with an adult, it is crucial to understand. These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). This list is not exhaustive, and not all factors need to be present for a referral to an SLP (e.g., Guitar, 2019; Yaruss et al., 1998). https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Journal of Fluency Disorders, 43, 116. 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. Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. These strategies, like speech modification strategies, are introduced along a hierarchy of speaking situations that varies both with linguistic demands and with the stressors of the environment. Prevalence of stuttering in African American preschool children. using fillers (e.g., like, um, uh, you know); avoiding sounds or words (e.g., substituting words, inserting unnecessary words, circumlocution); and. Molecular Genetics & Genomic Medicine, 5(2), 95102. Avoidance can lead to less talking and reduced linguistic complexity. The individual who stutters becomes desensitized to their fears by performing activities (e.g., self-disclosing, going to a place where they fear speaking) using a fear hierarchy. This hierarchy represents situations or activities that range from low risk to high risk. Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. Code of ethics [Ethics]. (1981). There is not enough epidemiological research to state specific risk factors for cluttering. Scope of practice in speech-language pathology [Scope of practice]. 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). 115134). These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. https://doi.org/10.1016/0094-730X(86)90028-8, St. Louis, K. O., & Hinzman, A. R. (1988). talking about stuttering or treatment of stuttering. 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). Menu. It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). attention-deficit/hyperactivity disorder (Donaher & Richels, 2012; Lee et al., 2017). Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. Clinical characteristics associated with stuttering persistence: A meta-analysis. Fluency refers to continuity, smoothness, rate, and effort in speech production. All speakers are disfluent at times. Increasing fluency may not be a goal for an adult or may be only one aspect of a comprehensive and multidimensional approach (Amster & Klein, 2018). Journal of Fluency Disorders, 58, 110. (2001). The interview process and work environment can be challenging for individuals who stutter. https://doi.org/10.1044/2020_JSLHR-20-00096. 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). Journal of Fluency Disorders, 49, 1328. They are likely to use interjections, repeat phrases, and revise what they are saying. reducing secondary behaviors and minimizing avoidances. Specifically, mutations to GNPTAB, GNPTG, and NAGPA have been found to disrupt the signal that directs enzymes to their target location in the lysosome of the cell (Drayna & Kang, 2011). Folia Phoniatrica et Logopaedica, 19. Journal of Speech, Language, and Hearing Research, 61(7), 16491663. These individuals are said to experience covert stuttering (B. Murphy et al., 2007). Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O., Bavin, E., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). American Journal of Speech-Language Pathology, 27(3S), 11801194. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). Professional awareness of cluttering. The perils of oral-reading fluency assessments for children who stutter led a group of SLPs to investigate the issue and call on colleagues to change their school districts policies. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. Speaker and observer perceptions of physical tension during stuttering. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. SLPs counseling skills should be used specifically to help speakers improve their quality of life by minimizing the burden of their communication disorder. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. 1-888-266-0574. These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). https://doi.org/10.1016/j.jfludis.2015.08.001, Han, T.-U., Park, J., Domingues, C. F., Moretti-Ferreira, D., Paris, E., Sainz, E., Gutierrez, J., & Drayna, D. (2014). Journal of Fluency Disorders, 40, 3543. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). Depending on the country and methodology used, rates were estimated to range from 1.03% (Abou et al., 2015) to 1.38% (Al-Jazi & Al-Khamra, 2015), but could be as high as 8.4% (Oyono et al., 2018). See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their childs environment. The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. https://doi.org/10.1192/apt.12.1.63, Craig, A., & Tran, Y. https://doi.org/10.1016/j.jfludis.2016.09.005, Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). Some adults lack communication confidence as a result of negative self-perceptions about their stuttering (Beilby et al., 2012a) or due to repeated exposure to people holding stereotypes about stuttering, which, in turn, may create self-stigmatization (Boyle, 2013a). Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). 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. https://doi.org/10.1016/S0094-730X(01)00098-5. 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). Journal of Speech, Language, and Hearing Research, 52(1), 254263. Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. Multicultural issues in school settings. https://doi.org/10.1044/leader.FTR2.19072014.44, American Speech-Language-Hearing Association. American Journal of Speech-Language Pathology, 27(2), 721736. Approximately 95% of children who stutter start to do so before the age of 4 years, and the average age of onset is approximately 33 months. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Cluttering and autism spectrum disorders. BMJ, 331(7518), 659661. Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. ), Current issues in stuttering research and practice (pp. Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. Genetic factors and therapy outcomes in persistent developmental stuttering. A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. Craig, A., Blumgart, E., & Tran, Y. Teigland, A. Clinicians can help clients progress to active stages through building self-efficacy. Coexistence of stuttering and disordered phonology in young children. For example, some children from bilingual or multicultural backgrounds may experience stuttering onset or a temporary increase in stuttering as result of being in new and unfamiliar situations, learning a new language, or being exposed to mixed linguistic input (Shenker, 2013). Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. Bowling Green State University Archive. A phenomenological analysis of the moment of stuttering. Neural network connectivity differences in children who stutter. have a sense of belonging and experience less stigma. https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. Psychology Press. https://doi.org/10.1016/j.jfludis.2013.01.001. Erickson, S., & Block, S. (2013). Please enable it in order to use the full functionality of our website. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. (2017). ), Cluttering: Research, intervention and education (pp. https://doi.org/10.1044/2017_LSHSS-17-0028. by ; 2022 June 3; barbara "brigid" meier; 0 . (2004). Self-regulation and the management of stuttering. (2017). Consistent with a person- and family-centered approach to stuttering treatment, the SLP. American Journal of Speech-Language Pathology, 29(1), 201215. The SLP can use audio- or videoconferencing to augment this type of treatment. 233253). Journal of Fluency Disorders, 26(3), 179206. 178196). Psychology Press. 1997- American Speech-Language-Hearing Association. 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. Developmental stuttering in children who are hard of hearing. https://doi.org/10.3109/17549507.2015.1010583, Adriaensens, S., Beyers, W., & Struyf, E. (2015). 187214). https://doi.org/10.1044/2017_JSLHR-S-16-0371, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2019). It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. (2005). 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). These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. 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. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. deletion and/or collapsing of syllables (e.g., I wanwatevision). These modifications are used regardless of whether a particular word is expected to be produced fluently. https://doi.org/10.1136/bmj.38520.451840.E0, Kelman, R., & Nicholas, A. 142185). On the surface, this can be a difficult question, as many studies show up to 80% of children might recover from early speech disfluencies. Peer support for people who stutter: History, benefits, and accessibility. Miller, W. R., & Rollnick, S. (2013). Prentice-Hall. Guttormsen, L. S., Kefalianos, E., & Nss, K. A.
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