typical vs atypical disfluencies asha typical vs atypical disfluencies asha

Adolescents also may be particularly susceptible to peer pressure and bullying at this time. (2018). Journal of Fluency Disorders, 37(4), 242252. Journal of Fluency Disorders, 26(3), 179206. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. Reasonable accommodations would vary by work setting and type of work. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. https://doi.org/10.1016/S0094-730X(01)00098-5. (2011). Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. (1986). 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). Bargaining, 5. Whurr Publishers. The human capacity to thrive in the face of potential trauma. Breakdowns in fluency and clarity can result from. 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). Individuals may experience stuttering in different ways with siblings, their spouse, or other family members. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. (2018). https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). 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. (2003). The purpose of the screening is to identify individuals who require further speech-language assessment. Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. National Stuttering Association. There are several indicators of positive therapeutic change. if a child has typical disfluencies or a fluency disorder (see ASHAs resource on. There is a family history of stuttering or cluttering. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Effortful control, an aspect of temperament that supports self-regulation, may be predictive of stuttering severity and may facilitate positive change in treatment (Kraft et al., 2019). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199. 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). Prins, D., & Ingham, R. J. Individuals may exhibit pure cluttering or cluttering with stuttering (van Zaalen-Opt Hof et al., 2009). https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). Journal of Communication Disorders, 48, 3851. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Journal of Fluency Disorders, 58, 110. consultation with and referral to other professionals as needed. Seminars in Speech and Language, 18(4), 371389. Parents can also report if secondary behaviors are present in both languages. A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. These modifications are used to facilitate speech fluency and may include. I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike). 211230). 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). 3. 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). In fact, stuttering can affect all areas of academic competency, including academic learning, social-emotion functioning, and independent functioning (Ribbler, 2006, p. 15). https://doi.org/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. Language, Speech, and Hearing Services in Schools, 49(1), 13. https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). A meta-analysis did find differences in the receptive vocabulary, expressive vocabulary, and mean length of utterance between children who stutter and children who do not stutter, with children who stutter generally performing relatively weaker (Ntourou et al., 2011). discussion of personal issues (e.g., prior to, or in addition to, targeting generalization of skills in a group setting). Best practice for developmental stuttering: Balancing evidence and expertise. https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. (2014). Journal of Fluency Disorders, 38(2), 6687. (2014). minimizing the adverse impact of stuttering (Yaruss et al., 2012). https://doi.org/10.1044/ffd16.1.15. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). Journal of Neurodevelopmental Disorders, 3(4), 374380. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. Speech, Language and Hearing, 20(3), 144153. 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. american journal of audiology (aja) american journal of speech-language pathology (ajslp) journal of speech, language, and hearing research (jslhr) language, speech, and hearing services in schools (lshss) perspectives of the asha special interest groups; topics; special collections Journal of Speech, Language, and Hearing Research, 56(5), 15171529. Traditional stuttering modification strategies (Manning & DiLollo, 2018) include the following: These strategies require an individual to identify a moment of disfluency before, during, or after it occurs and to make adjustments to reduce tension and struggle. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). There may be a relationship between stuttering and working memory. Journal of Speech, Language, and Hearing Research, 62(12), 43354350. https://doi.org/10.1111/jpc.12034. A treatment plan that involves both speech and stuttering modification techniques may be necessary to achieve optimal outcomes. https://doi.org/10.1016/j.jfludis.2010.12.003. Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. In E. Conture & R. F. Curlee (Eds. Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. https://doi.org/10.1044/jshr.3103.377, Weber-Fox, C., Wray, A. H., & Arnold, H. (2013). In D. Ward & K. Scaler Scott (Eds. This approach to care incorporates individual and family preferences, priorities, and desired outcomes in the selection of treatment goals and treatment methods. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. Some examples of these are to openly discuss experiences with stuttering (from the client and the clinician with pseudostuttering or as described by previous clients who stutter) and model pseudostuttering and techniques, attitudes, and beliefs across speaking situations (Manning & Quesal, 2016; Watson, 1988). Self-efficacy and quality of life in adults who stutter. These are called typical disfluencies or nonfluencies. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. Operant approaches operate within a framework of stuttering as a learned behavior (for a discussion, see Conture, 2001; de Sonneville-Koedoot et al., 2015, p. 334; Onslow & Yaruss, 2007). Journal of Fluency Disorders, 38(2), 171183. In D. Ward & K. Scaler Scott (Eds. Journal of Fluency Disorders, 50, 7284. May 11, 2022 As a speech-language pathologist, you might often face the question of whether a young child is showing early signs of stuttering, or if those disruptions are simply typical speech disfluencies. (2004). School-age stuttering therapy: A practical guide. Language, Speech, and Hearing Services in Schools, 37(2), 118136. Despite these challenges, some of the therapy that applies to adults can be just as effective with teens/adolescents. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. Fluency refers to continuity, smoothness, rate, and effort in speech production. Dosage refers to the frequency, intensity, and duration of treatment. Journal of Fluency Disorders, 46, 114. https://doi.org/10.1044/1058-0360(2003/070), Arenas, R. M., Walker, E. A., & Oleson, J. J. Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. 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. https://doi.org/10.1136/bmj.38520.451840.E0, Kelman, R., & Nicholas, A. When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. https://doi.org/10.1044/ffd22.2.51, Berquez, A., & Kelman, E. (2018). Lower levels of overt stuttering do not directly relate to lower levels of psychological, emotional, social, or functional impacts experienced by the individual (Lucey et al., 2019; Tichenor & Yaruss, 2019a, 2020). The great psychotherapy debate: Models, methods, and findings. 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. Universitetsforlaget. Logos, 3, 8295. White matter neuroanatomical differences in young children who stutter. In R. Lees & C. Stark (Eds. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). www.asha.org/policy/. Academic Press. Stuttering in school-age children: A comprehensive approach to treatment. Limited research is available that identifies the causes of cluttering. https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). Conture, E. G. (2001). Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. (2016a). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). Workplace in fluency management: Factoring the workplace into fluency management. modifying instructions to accommodate the home language, using exemplars in audio or video format in the home language, and. Journal of Speech and Hearing Disorders, 49(1), 5358. https://doi.org/10.1016/j.jfludis.2006.12.003. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Strategies aimed at changing the timing and tension of speech production include. deletion and/or collapsing of syllables (e.g., I wanwatevision). Folia Phoniatrica et Logopaedica, 69, 180189. Scaler Scott, K., & St. Louis, K. O. Code of ethics [Ethics]. (2017). Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. They are likely to use interjections, repeat phrases, and revise what they are saying. reducing secondary behaviors and minimizing avoidances. 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). Singular. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. 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. slower rates of language development (Leech et al., 2017, 2019) or co-occurring speech and language impairment (Ntourou et al., 2011; Yaruss et al., 1998). Education, 136(2), 159168. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.1044/2018_JSLHR-S-17-0353, Guitar, B. Plural. (2010). Some of the most commonly prescribed typical or first-generation antipsychotics include: Haldol (haloperidol) Thorazine (chlorpromazine) Loxitane (loxapine) Moban (molindone) Mellaril (thioridazine) Serentil (mesoridazine) Navane (thiothixene) Trilafon (perphenazine) On the other hand, the following are atypical or second-generation antipsychotics: These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). In L. Cummings (Ed. These include when the individual who stutters. increasing effective and efficient communication. Journal of Fluency Disorders, 30(1), 122. Sisskin, V. (2018). For school-age children and adolescents, initiation of treatment depends, in large part, on their motivation, which, in turn, is dependent on factors such as their perceived needs, the degree of adverse impact they experience, and their previous treatment experiences. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. 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). 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. 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. 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 . In J. C. Norcross & M. R. Goldfried (Eds. https://doi.org/10.1017/CBO9781139108683.023. Traits of attention deficit/hyperactivity disorder in school-age children who stutter. Clinicians need to understand the interaction of symptoms and the strategies that are most effective for dealing with stuttering and cluttering when they occur together. their reason for seeking treatment at the current time. 187214). ), Stuttering and related disorders of fluency (pp. Adults who stutter may be dealing with years of shame or stigma (Boyle, 2013a), and they can experience elevated levels of negative mood states (e.g., interpersonal sensitivity and depressed mood) when compared to adults who do not stutter (Tran et al., 2011). https://doi.org/10.1044/2020_JSLHR-20-00096. Stuttering Therapy Resources. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Scope of practice in speech-language pathology [Scope of practice]. Posted at 23:22h . Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. https://doi.org/10.1044/1092-4388(2001/030), Finn, P. (2003). Childhood stuttering: Incidence and development. Moments of stuttering or disfluency may be difficult to distinguish from typical disfluency or reduced language proficiency, especially for a person unfamiliar with the language (Shenker, 2011). Oxford University Press. Thieme. (1982). Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. Journal of Fluency Disorders, 32(2), 139162. NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. (2003). An examination of various aspects of auditory processing in clutterers. Emotional reactivity, regulation and childhood stuttering: A behavioral and electrophysiological study. These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. Wampold, B. E. (2001). Journal of Speech, Language, and Hearing Research, 61(5), 12381250. (2009). The differences between disfluencies stemming from reduced language proficiency and stuttering are evident in lack of awareness, struggle, tension, blocking, and lack of self-concept as a person who stutter, which are not seen in typical second language learning profiles (Byrd, 2018). Setting refers to the location of treatment (e.g., home, community-based [including work settings], school environments, clinic room). increasing acceptance and openness with stuttering. Journal of Fluency Disorders, 53, 2640. Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. Journal of Communication Disorders, 80, 8191. Speaker and observer perceptions of physical tension during stuttering. ASHA also extends its gratitude to the following subject matter experts who were involved in the reviewand development of thispage: In addition, ASHA thanks the members of the Steering Committee of ASHAs Special Interest Division on Fluency and Fluency Disorders (Division 4) whose work preceded this content. Finding opportunities for social support for individuals with fluency disorders. Peer support for people who stutter: History, benefits, and accessibility. (1988). Perspectives on Fluency and Fluency Disorders, 22(1), 3446. For example, emotional reactivity/regulation and behavioral disinhibition may affect the childs ability to cope with disfluencies (Choi et al., 2013; Guttormsen et al., 2015; R. M. Jones, Conture, & Walden, 2014; Ntourou et al., 2013). Stuttering: Research and therapy. Cluttering and Down syndrome. Clinical characteristics associated with stuttering persistence: A meta-analysis. Other speech or language concerns are also present. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). talking about stuttering or treatment of stuttering. The social and communication impact of stuttering on adolescents and their families. International Classification of Functioning, Disability and Health. "I-I-I-I- want the ball") The utility of stuttering support organization conventions for young people who stutter. https://scholarworks.bgsu.edu/comm_disorders_diss/7/. Abou, E. M., Saleh, M., Habil, I., El Sawy, M., & El Assal, L. (2015). Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. Stuttering and cluttering. https://doi.org/10.1055/s-0034-1382151, Chang, S.-E., Garnett, E. O., Etchell, A., & Chow, H. M. (2019). The Neuroscientist, 25(6), 566582. Acceptance and Commitment Therapy for people who stutter. resilience building within the child and family (Berquez & Kelman, 2018). Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. Increasing the individuals awareness and self-monitoring skills helps to reduce unproductive behaviors that interfere with speech, and it may allow them to alter moments of stuttering so that they have decreased tension, are shorter, and are less disruptive to communication. 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).