The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. 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). https://doi.org/10.1017/S135246580001643X. (2011). Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. ASHA thanks the following individuals,who, in 2014, made significant contributions to the development of this content. See ASHAs resource on assessment of fluency disorders in the context of the WHO ICF framework. https://doi.org/10.1016/j.jfludis.2006.12.003. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. (2018). (2018). Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). Scaler Scott, K., & Ward, D. (2013). Stuttering: Research and therapy. Summary - Typical vs Atypical Pneumonia. https://doi.org/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. (2005). Journal of Fluency Disorders, 32(1), 5169. the impact of communication impairments on, Relevant case history (as appropriate for age), including. 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). 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). With regard to cluttering, research is not far enough along to identify causes. https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). (2011). https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). Evaluation of speech-related attitude by means of the KiddyCAT, CAT, and BigCAT, within a larger behavior assessment battery framework for children and adults who stutter. Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. Children with normal disfluencies have emergent fluency. In E. Conture & R. F. Curlee (Eds. ), Stuttering and related disorders of fluency (pp. However, there is no evidence to support the idea that stuttering is caused by, or more prevalent in, bilingual or multilingual speakers or that exposure to a second language increases the risk for developing stuttering (Byrd, 2018). seizure disorders (Briley & Ellis, 2018). The clinical applications of Acceptance and Commitment Therapy with clients who stutter. Advocating for individuals with fluency disorders and their families at the local, state, and national levels. Stuttering in animal models, such as zebra finches (Chakraborty et al., 2017) and mice (Barnes et al., 2016; Han et al., 2019), has also been investigated, including how the expression of stuttering influences social behaviors of mice (Han et al., 2019). See ASHAs Practice Portal pages on Counseling For Professional Service Delivery and Cultural Responsiveness for more information related to counseling. 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. Fluency and stuttering. perceived communication and job barriers. Pediatrics, 121(2), 369375. https://doi.org/10.1016/j.jfludis.2014.01.001. Journal of Neurodevelopmental Disorders, 3(4), 374380. Rethinking covert stuttering. In contrast to adults who stutter, children who stutter did not show increases in white matter tracts in the right hemisphere (Chang et al., 2015). 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. 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). (2018). (Eds.). Traits of attention deficit/hyperactivity disorder in school-age children who stutter. Journal of Communication Disorders, 58, 4357. Parents of Preschoolers Parents of school-age children Just for Kids Teens Adults Teachers SLPs Physicians Employers News and Blog February 7, 2023 Grace in Advocacy https://doi.org/10.1016/j.jfludis.2013.08.001, Briley, P. M., & Ellis, C. (2018). Please enable it in order to use the full functionality of our website. 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). production of words with an excess of physical tension or struggle. It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Emotional problems and parenting style do not cause stuttering. 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. The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). In F. L. Myers & K. O. St. Louis (Eds. Prins, D., & Ingham, R. J. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. 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). See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. Evaluating stuttering in young children: Diagnostic data. https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). (2017). Journal of Abnormal Psychology, 119(3), 479490. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). 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). https://scholarworks.bgsu.edu/comm_disorders_diss/7/. Yaruss, J. S., & Pelczarski, K. M. (2007). Contemporary Issues in Communication Science and Disorders, 29(Spring), 91100. being more comfortable and open with stuttering and pseudostuttering; reporting experiencing decreased anxiety while communicating; reporting less adverse psychological, emotional, social, and functional impacts; reporting enjoying social communication, including with strangers; and. https://doi.org/10.1055/s-2003-37447, Thordardottir, E. (2006). This relationship is recognized as one of the common factors that account for the effectiveness of counseling (common factors theory; Wampold, 2001). Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. 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). (2017). Measurement and modification of speech naturalness during stuttering therapy. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). Brain, 138(3), 694711. Journal of Fluency Disorders, 32(2), 95120. Speech, Language and Hearing, 20(3), 144153. https://doi.org/10.1016/j.jfludis.2013.09.001, Boyle, M. P. (2015). 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). Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. Communication Disorders Quarterly, 6(1), 5059. https://doi.org/10.1371/journal.pone.0133758, Desai, J., Huo, Y., Wang, Z., Bansal, R., Williams, S. C., Lythgoe, D., Zelaya, F. O., & Peterson, B. S. (2016). The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). https://doi.org/10.1016/j.jfludis.2013.01.001. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Preschool children who stutter showed differences in event-related brain potentials used as indices of language processing. Atypical disfluency has been documented through case studies and has been described as final part-word repetition or "rhyme repetition". Multicultural issues in school settings. See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). Perspectives on Fluency and Fluency Disorders, 11(1), 711. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). Psychology Press. https://doi.org/10.1016/j.jcomdis.2010.12.003. (2008). 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. Prevalence of anxiety disorders among children who stutter. https://doi.org/10.1016/j.jfludis.2011.04.002, Foote, G. (2013). Onset may be progressive or sudden. https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). Journal of Fluency Disorders, 36(3), 186193. Sociodynamic relationships between children who stutter and their non-stuttering classmates. American Journal of Speech-Language Pathology, 7(4), 6276. One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. 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). 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. When a bilingual clinician is not available, using an interpreter is a viable option. (1996). Strategies aimed at changing the timing and tension of speech production include. Avoidance can lead to less talking and reduced linguistic complexity. Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Changing adolescent attitudes toward stuttering. The relationship of self-efficacy and depression to stuttering. Psychology Press. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. ), Controversies about stuttering therapy (pp. Yairi, E., & Ambrose, N. (2005). Assessment of awareness in young children of disfluencies and difficulty in speaking. Professional awareness of cluttering. Healey, E. C., Reid, R., & Donaher, J. Some children who stutter or clutter may only experience symptoms situationally. Seminars in Speech and Language, 24(1), 2126. World Health Organization. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. Journal of Fluency Disorders, 22(3), 219236. Dosage refers to the frequency, intensity, and duration of treatment. Genetic bases of stuttering: The state of the art, 2011. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. American Journal of Speech-Language Pathology, 27(3S), 11391151. https://doi.org/10.1016/j.jfludis.2010.07.001. Journal of Fluency Disorders, 54, 1423. An effective clientclinician relationship facilitates the identification of potential roadblocks (Plexico et al., 2010). 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). SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. 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/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). information regarding family, personal, and cultural perception of fluency. Journal of Communication Disorders, 48, 3851. Stuttering in relation to lexical diversity, syntactic complexity, and utterance length. have a sense of belonging and experience less stigma. 297325). Developing culturally and linguistically relevant intervention plans focused on helping the individual achieve more fluent speech and self-acceptance of disfluency, providing treatment, documenting progress, and determining appropriate dismissal criteria. (1982). ), Cluttering: A handbook of research, intervention and education (pp. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. https://doi.org/10.1044/1058-0360(2003/088), Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. 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). When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. 142185). Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). Language, Speech, and Hearing Services in Schools, 49(1), 13. 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). resilience building within the child and family (Berquez & Kelman, 2018). Neural network connectivity differences in children who stutter. Languages differ with regard to developmental milestones, and direct comparison of scores across languages can be misleading, even if the assessments appear similar (Thordardottir, 2006). Thieme. Enhancing treatment for school-age children who stutter: II. Building clinical relationships with teenagers who stutter. There are benefits of both individual and group treatment. Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). B., & Al-Khamra, R. (2015). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). https://doi.org/10.1044/1092-4388(2013/12-0280), Boyle, M. P. (2013b). https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Miller, W. R., & Rollnick, S. (2013). See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Management of childhood stuttering. https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. Clinicians need to be observant of indicators, such as stuttering avoidance or social isolation, that clients/patients/students may be internalizing negative stereotypes about stuttering (Boyle, 2013a). Psychology Press. Stuttering and its treatment in adolescence: The perceptions of people who stutter. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. Most individuals who stutter demonstrate both observable disfluency and negative life impact (Beilby et al., 2012b; Ribbler, 2006; Tichenor & Yaruss, 2019a; Yaruss et al., 2012). Educating other professionals about the needs of individuals with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders. In K. O. Lewis (Ed. 15). 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. language or learning disability (Ntourou et al., 2011). https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). In L. Cummings (Ed. Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). (1988). 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).