typical vs atypical disfluencies asha

), The Cambridge handbook of communication disorders (pp. 256276). Limited research is available that identifies the causes of cluttering. Available 8:30 a.m.5:00 p.m. Ward, D., & Scaler Scott, K. (2011). Children and adults who stutter also frequently experience psychological, emotional, social, and functional consequences from their stuttering, including social anxiety, a sense of loss of control, and negative thoughts or feelings about themselves or about communication (Boyle, 2015; Craig & Tran, 2014; Iverach et al., 2016; Iverach & Rapee, 2014). 328). Journal of Fluency Disorders, 50, 5971. 211230). 1-888-266-0574. The ASHA Leader, 11(10), 621. Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders, 58, 94117. These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering. https://doi.org/10.1016/j.jcomdis.2015.10.003. SLPs counseling skills should be used specifically to help speakers improve their quality of life by minimizing the burden of their communication disorder. Clinical characteristics associated with stuttering persistence: A meta-analysis. Purpose Disfluencies associated with stuttering generally occur in the initial position of words. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Journal of Fluency Disorders, 32(1), 5169. 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). Given that cluttering may co-occur with other disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder), having any of these disorders may be a risk factor; however, not all individuals with these disorders also exhibit cluttering. In N. B. Ratner & J. Tetnowski (Eds. "I-I-I-I- want the ball") Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. 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. Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. Journal of Fluency Disorders, 54, 113. "Atypical" disfluencies include: sound repetitions ("s-s-s-so"); syllable repetitions ("be-be-be-be-because"); prolongations ("Aaaaaaaaaaaaand"); and https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). However, the clinician needs to consider the impact of disfluency on communication and quality of life as a whole. 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). Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). 157186). In E. G. Conture & R. F. Curlee (Eds. It is important that parents and clinicians acknowledge and respond to a childs verbal and nonverbal reactions in a supportive manner; this helps to minimize the likelihood that the child will develop negative reactions to stuttering. Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. It is incumbent upon the SLP to help the individualized education program (IEP) team determine the academic and social impacts of stuttering on students in the school setting. Acquired neurogenic and psychogenic stuttering are not covered. https://doi.org/10.1177/152574018200600106. 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). Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Experts in the field of cluttering have consistently estimated that approximately one third of children and adults who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). Experiences with stuttering can affect an individuals employment, job satisfaction, personal and romantic relationships, and overall quality of life (Beilby et al., 2013; Blood & Blood, 2016). The SLP works with parents and families to create an environment that facilitates fluency and that helps them develop healthy and appropriate communication attitudes (Onslow et al., 2003; Yaruss & Reardon-Reeves, 2017). Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. 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. https://doi.org/10.1044/1058-0360(2007/008), Oyono, L. T., Pascoe, M., & Singh, S. (2018). 7). On the other hand, stuttering symptoms may decrease in more comfortable situations. https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Assisting children who stutter in dealing with teasing and bullying. https://doi.org/10.1055/s-2008-1064082, Caughter, S., & Crofts, V. (2018). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). Psychology Press. Counseling parents of children who stutter. Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). The purpose of the screening is to identify individuals who require further speech-language assessment. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Journal of Fluency Disorders, 43, 116. The clinical applications of Acceptance and Commitment Therapy with clients who stutter. https://doi.org/10.1016/j.jfludis.2012.12.001, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012a). For example, English language learners may have word-finding problems in the second language. 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. Fluency refers to continuity, smoothness, rate, and effort in speech production. Reducing negative reactions through desensitization and cognitive restructuring. Fluency Disorders (Practice Portal). Definitions of communication disorders and variations [Relevant paper]. Section 504 of the Rehabilitation Act of 1973 (United States Department of Labor, n.d.) protects qualified individuals from discrimination based on their disability via a 504 plan. Smith, A., & Weber, C. (2017). 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). Brain, 131(1), 5059. Self-report of self-disclosure statements for stuttering. Desensitization strategies are strategies that help speakers systematically desensitize themselves to their fears about speaking and stuttering by facing those fears in structured, supportive environments. Onslow, M., Packman, A., & Harrison, E. intellectual disability (Healey et al., 2005). Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. (2018). https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). 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). https://doi.org/10.1044/ffd16.1.15. 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. Available from http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/. omission of word endings (e.g., Turn the televisoff). 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. However, these compensations may compound the negative experience of stuttering over time. provide and receive support from others who share the experience of stuttering. https://doi.org/10.1176/appi.books.9780890425596, American Speech-Language-Hearing Association. Their skills are developing in this area. Reasonable accommodations would vary by work setting and type of work. See ASHAs Practice Portal pages on Counseling For Professional Service Delivery and Cultural Responsiveness for more information related to counseling. Journal of Fluency Disorders, 58, 110. Advance online publication. The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. 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). Bowling Green State University Archive. 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). As suggested earlier, normal disfluencies will appear for a few days and then disappear. Identifying subgroups of stutterers (No. reducing secondary behaviors and minimizing avoidances. They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. https://doi.org/10.1044/sbi15.2.75, Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). 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. Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. Workplace in fluency management: Factoring the workplace into fluency management. Psychology Press. You do not have JavaScript Enabled on this browser. American Journal of Speech-Language Pathology, 26(4), 11051119. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). Cluttering may have an effect on pragmatic communication skills and awareness of moments of disruption (Teigland, 1996). Maintenance of improved attitudes toward stuttering. Clinicians do not have to choose one approach or the other. Yairi, E., & Ambrose, N. (2005). Daly, D. A. 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). ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. Bakker, K., Myers, F. L., Raphael, L. J., & St. Louis, K. O. https://doi.org/10.1016/j.jfludis.2007.02.001. Tourettes syndrome (see Van Borsel, 2011, for a review). Journal of Communication Disorders, 80, 1117. Explore how typical and atypical disfluencies differ, and find resources for guidance and support. Individuals who stutter are more likely to be self-aware about their disfluencies and communication, and they may exhibit more physical tension, secondary behaviors, and negative reactions to communication. Other strategies for treating cluttering include overemphasizing multisyllabic words and word endings, increasing awareness of when a communication breakdown occurs (e.g., through observation of listener reactions), and increasing self-regulation of rate and clarity of speech. Other speech or language concerns are also present. Folia Phoniatrica et Logopaedica, 19. https://doi.org/10.1017/CBO9781139108683.023. Children with persistent stuttering showed deficiencies in left gray matter volume with reduced white matter integrity in the left hemisphere. The presence of at least 1 disabling developmental condition was 5.5 times higher in CWS [children who stutter] when compared to children who do not stutter (Briley & Ellis, 2018, p. 2895). Treatment outcomes for bilingual children who stutter do not appear to be different from those of monolingual children who stutter (Shenker, 2011). Best practice for developmental stuttering: Balancing evidence and expertise. auditory processing disorders (Molt, 1996). In K. O. Lewis (Ed. Sociodynamic relationships between children who stutter and their non-stuttering classmates. Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. Following are descriptions of each of these forms of disfluency. Roberts, P., & Shenker, R. (2007). Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. What is motivational interviewing? https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Cengage Learning. Teigland, A. Fluency refers to continuity, smoothness, rate, and effort in speech production. Speech, Language and Hearing, 20(3), 144153. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. With regard to cluttering, research is not far enough along to identify causes. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). Plural. (2019). The attitudes of high school peers toward stuttering and toward persons who stutter can be improved through education in the form of classroom presentations about stuttering (Flynn & St. Louis, 2011). https://doi.org/10.1016/0094-730X(88)90003-4. Van Borsel, J., Maes, E., & Foulon, S. (2001). Children who stutter typically know how to read (decode) the printed form of words, but they may not be able to speak the printed form fluently. Crystal ball gazing: Research and clinical work in fluency disorders in 2026. Clinicians can help clients progress to active stages through building self-efficacy. Stuttering and reading fluency: Information for teachers [Brochure]. Journal of Fluency Disorders, 43, 1727. For students who stutter, the impact goes beyond the communication domain. Self-help and mutual aid groups. (2017). https://doi.org/10.1542/peds.2012-3067, Ribbler, N. (2006). ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. 147171). Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. 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. Journal of Fluency Disorders, 30(1), 122. Prevalence and trends of developmental disabilities among children in the United States: 20092017. Stuttering: Research and therapy. https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). https://doi.org/10.1044/2018_JSLHR-S-17-0378, Byrd, C. T. (2018). Self-regulation and the management of stuttering. (2016). have a sense of belonging and experience less stigma. Childhood stuttering: Incidence and development. Genetic contributions to stuttering: The current evidence. 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). Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. Stuttering Therapy Resources. The person is having difficulty communicating messages in an efficient, effective manner. Stuttering and work life: An interpretative phenomenological analysis. Eventually, they disappear after a few . Erickson, S., & Block, S. (2013). Finding opportunities for social support for individuals with fluency disorders. Menu. Screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation. I ran out of cheese and bread the other day while making sandwiches and now Im out so I need to go to the store), and/or. Journal of Fluency Disorders, 36(1), 1726. https://doi.org/10.1002/hbm.23487, Dignazio, L. E., Kenny, M. M., Raj, E. X., & Pelkey, K. D. (2020). American Journal of Speech-Language Pathology, 27(3S), 11241138. Long-term follow-up of self-modeling as an intervention for stuttering. When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. Understanding and treating cluttering. Journal of Speech, Language, and Hearing Research, 60(11), 30973109. Genetic bases of stuttering: The state of the art, 2011. This results in less effective social interactions. 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. Is parentchild interaction therapy effective in reducing stuttering? Treatment approaches for adults should take into consideration career and workplace factors. Social anxiety disorder in adults who stutter. Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. For bilingual individuals, it is important for the clinician to consider the language or languages used during intervention. Singular. their reason for seeking treatment at the current time. 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). https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). 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). These are called typical disfluencies or nonfluencies. the impact of communication impairments on, Relevant case history (as appropriate for age), including. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). https://doi.org/10.1073/pnas.1901480116, Harasym, J., Langevin, M., & Kully, D. (2015). Journal of Fluency Disorders, 36(2), 122129. Parental involvement is an integral part of any treatment plan for children who stutter. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). Evaluating stuttering in young children: Diagnostic data. The Journal of Child Psychology and Psychiatry, 43(7), 939947. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. 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). Assessing bilingual children: Are their disfluencies indicative of stuttering or the by-product of navigating two languages? perceived communication and job barriers. Brain, 138(3), 694711. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Journal of Fluency Disorders, 44, 3245. https://doi.org/10.1016/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. Scaler Scott, K., & St. Louis, K. O. Manning, W. H., & Quesal, R. W. (2016). Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). 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). Perspectives on Fluency and Fluency Disorders, 1(4), 5569. Assessing organization of discourse also can help rule out verbal organization problems that might be mistaken for cluttering (van Zaalen-Opt Hof et al., 2009). American Journal of Speech-Language Pathology, 28(1), 1428. Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). 7184). Journal of Fluency Disorders, 31(2), 90115. https://doi.org/10.1016/j.jfludis.2011.06.001. 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. Differences between children and adults should also be considered when interpreting data from neurological studies. It is not possible to determine with certainty which children will continue to stutter, but there are some factors that indicate a greater likelihood that stuttering will become chronic. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). 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). Treatment for fluency disorders is highly individualized and based on a thorough assessment of speech fluency, language factors, emotional/attitudinal components, and life impact (Byrd & Donaher, 2018). It may occur only in specific situations, but it is more likely to occur in these situations, day after day. Parents can also learn about how to help their child generalize skills from the treatment room to different settings and with different people. A range of studies support a genetic predisposition for stuttering, but no definitive findings have been made regarding which transmission model, chromosomes, genes, or sex factors are involved in the expression of stuttering in the population at large (Kraft & Yairi, 2011, p. 34). Young children may or may not verbalize their reactions to stuttering. Early childhood stuttering for clinicians by clinicians. Professional awareness of cluttering. See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). Toward a better understanding of the process of disclosure events among people who stutter. https://doi.org/10.1016/j.cub.2016.02.068, Beilby, J. M., & Byrnes, M. L. (2012). The ASHA Action Center welcomes questions and requests for information from members and non-members. 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. Journal of Fluency Disorders, 32(2), 95120. There are benefits of both individual and group treatment. Assessment of stigma associated with stuttering: Development and evaluation of the Self-Stigma of Stuttering Scale (4S). Arnold, G. E. (1960). Journal of Fluency Disorders, 36(3), 186193. The relationship of self-efficacy and depression to stuttering. (2018). 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). (2016b). 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). All speakers are disfluent at times. Guilford Press. 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).

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