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). Peer support for people who stutter: History, benefits, and accessibility. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. 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). My client isn't fluent - but is it stuttering? continued management (Plexico et al., 2005). Depression & Anxiety, 27(7), 687692. 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. https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). University Park Press. These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). Singular. (1986). https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). 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. 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. typical vs atypical disfluencies asha - reflectionsgallery.ae (2006). (2013). Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. 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. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). (1979). See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. https://doi.org/10.1093/brain/awu400, Choi, D., Conture, E. G., Walden, T. A., Lambert, W. E., & Tumanova, V. (2013). Timing refers to the initiation of treatment relative to the diagnosis. Perspectives on Fluency and Fluency Disorders, 23(2), 5469. Acquired neurogenic and psychogenic stuttering are not covered. https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). Thieme. The role of effortful control in stuttering severity in children: Replication study. Onset may be progressive or sudden. Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Guitar, B. 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 individuals lived experiences with stuttering, the perceived impact of these experiences with stuttering, and. Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. 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). 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. In contrast, children with reading disorders are likely to have difficulty decoding the printed form, which, in turn, has a negative impact on oral reading fluency (Kuhn & Stahl, 2003). The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. Application of the ICF in fluency disorders. https://doi.org/10.1016/j.nbd.2014.04.019, Han, T.-U., Root, J., Reyes, L. D., Huchinson, E. B., du Hoffmann, J., Lee, W.-S., Barnes, T. D., & Drayna, D. (2019). Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. (2007). Thieme. Journal of Fluency Disorders, 29(4), 255273. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. Characteristics of Typical Disfluency and Stuttering - ASHA Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Fear of speaking: Chronic anxiety and stammering. discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting). 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. 233253). However, sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children. Cognitive restructuring can be combined with the desensitization strategies described above (W. P. Murphy et al., 2007a). When determining eligibility for speech and language services through the public school system, SLPs need to document the adverse educational impact of the disability using a combination of standardized test scores when available and a portfolio-based assessment (Coleman & Yaruss, 2014; Ribbler, 2006). Persons who clutter can experience the same affective, behavioral, and cognitive reactions as those with stuttering, including communication avoidance, anxiety, and negative attitudes toward communication (Scaler Scott & St. Louis, 2011). Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. 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). It is important to distinguish stuttering from other possible diagnoses (e.g., language formulation difficulties, cluttering, and reading disorders) and to distinguish cluttering from language-related difficulties (e.g., word finding and organization of discourse) and other disorders that have an impact on speech intelligibility (e.g., apraxia of speech and other speech sound disorders). 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 Fluency Disorders, 21(34), 215225. talking about stuttering or treatment of stuttering. Conture, E. G. (2001). https://doi.org/10.1016/0094-730X(88)90003-4. Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. 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). https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). Folia Phoniatrica et Logopaedica, 19. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). the asha leader; journals. Professional awareness of cluttering. Eventually, they disappear after a few . Seminars in Speech and Language, 35(2), 6779. SLPs also need to discuss with persons who stutter and their families how to evaluate the veracity and trustworthiness of sites claiming to cure stuttering that they may find on their own. Often, there are pivotal points during treatment that indicate progress (T. K. Anderson & Felsenfeld, 2003; Plexico et al., 2005). Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. (2018). Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Journal of Speech, Language, and Hearing Research, 62(12), 43354350. https://doi.org/10.1044/1058-0360.0202.65. Psychology Press. Folia Phoniatrica et Logopaedica, 64(1), 3447. In addition to being used for improving communication skills, pausing is also an effective method of rate control. 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). SIG 4 Perspectives on Fluency and Fluency Disorders. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). See ASHAs resource on assessment tools, techniques, and data sources. In D. Ward & K. Scaler Scott (Eds. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). 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. 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). Journal of Speech, Language, and Hearing Research, 61(12), 28952905. ), Controversies about stuttering therapy (pp. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). (2016a). Stuttering and work life: An interpretative phenomenological analysis. There is ongoing debate as to whether persons who stutter have language skills that are equivalent to those seen in well-matched comparison speakers. (2017). The scope of this page includes stuttering and cluttering across the life span. 2335). Multicultural issues in school settings. 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). International Classification of Functioning, Disability and Health. Early childhood stuttering and electrophysiological indices of language processing. Journal of Fluency Disorders, 58, 2234. Psychology Press. Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. We believe it is past time to standardize the symptom assessment for MI so that proper and rapid diagnostic testing can be undertaken; however, we cannot standardize . https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. Limited research is available that identifies the causes of cluttering. Potential risk factors for cluttering include the following: Information is varied and conflicting regarding the exact relationship between bilingualism and disfluencies (Tellis & Tellis, 2003; Van Borsel et al., 2001). Crystal ball gazing: Research and clinical work in fluency disorders in 2026. Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. 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. Cluttering and autism spectrum disorders. Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. This law also applies to organizations that receive financial assistance from any federal department or agency. https://doi.org/10.1016/S0094-730X(01)00098-5. Drayna and Kang (2011) found that gene mutations were present in close to 10% of cases of familial stuttering. American Journal of Speech-Language Pathology, 27(3S), 11111123. Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). 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). Typical vs Atypical Pneumonia in Tabular Form 6. Genetic contributions to stuttering: The current evidence. Recurring themes of successful stuttering management in adults have been described as. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. Childhood stuttering: Incidence and development. (2017). What do people search for in stuttering therapy: Personal goal-setting as a gold standard? Speech modification (including fluency shaping) strategies (Bothe, 2002; Guitar, 1982, 2019) include a variety of techniques aimed at making changes to the timing and tension of speech production or altering the timing of pauses between syllables and words. School Psychology Review, 30(1), 135141. In addition, clinicians need to avoid using religious or highly familiar texts that individuals may know by rote. The social and communication impact of stuttering on adolescents and their families. Studies in tachyphemia: III. Starkweather, Janice Westbrook. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). For an accurate evaluation, it is ideal to collect samples of speech across various situations and tasks, both inside and outside the clinical setting (Yaruss, 1997). Acceptance; Constantino et al., 2017. 9099). Anger/Resistance, 4. Journal of Speech, Language, and Hearing Research, 62(5), 13711372. A phenomenological understanding of successful stuttering management. American Journal of Speech-Language Pathology, 26(4), 11051119. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). B., & Al-Khamra, R. (2015). Plural. The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. Prevalence of anxiety disorders among children who stutter. Journal of Abnormal Psychology, 119(3), 479490. Egan, G. (2013). Journal of Speech, Language, and Hearing Research, 60(9), 24832505. Developmental Disfluency vs. Atypical Dysfluency/Stuttering: When to be American Journal of Speech-Language Pathology, 7(4), 6276. There are benefits of both individual and group treatment. Journal of Fluency Disorders, 33(2), 8198. Acceptance and Commitment Therapy for people who stutter. Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). Summary - Typical vs Atypical Pneumonia. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). The specific strategy they select will depend on when the client catches the disfluencyin anticipation of the moment of disfluency, in the moment, or following the moment (Van Riper, 1973). Journal of Speech, Language, and Hearing Research, 60(11), 30973109. Brain, 136(12), 37093726. SLPs can include teachers in the treatment process by educating them about fluency disorders, involving them in treatment sessions, and having them assist with assignments outside of treatment sessions. 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). American Journal of Speech-Language Pathology, 12(4), 425431. Hill, D. (2003). See ASHAs Practice Portal page on Telepractice. Operant treatment (e.g., Palin ParentChild Interaction Therapy, Kelman & Nicholas, 2020; Lidcombe Program, Onslow et al., 2003) incorporates principles of operant conditioning and uses a response contingency to reinforce the child for fluent speech and redirect disfluent speech (the child is periodically asked for correction). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. In D. Ward & K. Scaler Scott (Eds. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). Motivational interviewing: Helping people change. 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). 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). This relationship is recognized as one of the common factors that account for the effectiveness of counseling (common factors theory; Wampold, 2001). In B. J. Amster & E. R. Klein (Eds. https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). Testing, and 7. Cluttering treatment: Theoretical considerations and intervention planning. Reducing negative reactions through desensitization and cognitive restructuring. 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. https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. 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). ), The Cambridge handbook of communication disorders (pp. Clinicians do not have to choose one approach or the other. Distinguishing Cluttering from Stuttering - @ASHA The Differential Diagnosis of Disfluency - American Speech-Language Trichon, M., & Raj, E. X. Code of ethics [Ethics]. https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. Risk factors that may be associated with persistent stuttering include. Workplace in fluency management: Factoring the workplace into fluency management. Fluency shaping with young stutterers. Self-help and mutual aid groups. BMJ, 331(7518), 659661. increasing effective and efficient communication. ), Cluttering: A handbook of research, intervention and education (pp. (2001). Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016a; Coleman & Yaruss, 2014; Vanryckeghem & Kawai, 2015; WHO, 2001; Yaruss, 2007; Yaruss & Quesal, 2004, 2006), a comprehensive fluency assessment is conducted to identify and describe. 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. may show increased disfluency rates (decreased reading fluency) because they cannot change the words to avoid moments of stuttering as easily as they can in conversation, and. They may hesitate when speaking, use fillers (like or uh), or repeat a word or phrase. Bilingual SLPs who have the necessary clinical expertise to assess the childand are familiar with the languages they speakmay not always be available. In D. Ward & K. Scaler Scott (Eds. National Stuttering Association. Stuttering typically has its origins in childhood. Guilford Press. What is motivational interviewing? (2011). An examination of various aspects of auditory processing in clutterers. Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). Miller, W. R., & Rollnick, S. (2013). Daniels, D. (2007). 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). Approximately 88%91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013). As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs are obligated to provide culturally and linguistically appropriate services, regardless of the clinicians personal culture, practice setting, or caseload demographics. Counseling begins with active listening and continues with microskills (Egan, 2013) that emphasize attending, showing empathy, demonstrating shared interest in the individual/family, and working to build trust.