However, fluency shaping approaches, such as easy onset or continuous phonation, may not be appropriate for the treatment of cluttering. 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. Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. https://doi.org/10.1044/2017_LSHSS-17-0028. Features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder). ), Controversies about stuttering therapy (pp. (2018). Testing, and 7. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. Counseling is an integral part of the assessment and treatment of individuals who stutter or clutter. Journal of Fluency Disorders, 36(1), 1726. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. https://doi.org/10.1017/CBO9781139108683.023. Journal of Fluency Disorders, 38(4), 311324. Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). Traits of attention deficit/hyperactivity disorder in school-age children who stutter. Motivational interviewing may be used to help individuals who stutter better understand the thoughts and feelings associated with their stuttering and make positive changes to improve communication. https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). Journal of Speech, Language, and Hearing Research, 56(5), 15171529. Journal of Speech, Language, and Hearing Research, 61(5), 12381250. (2004). (2010). They may hesitate when speaking, use fillers (like or uh), or repeat a word or phrase. St. Louis, K. O., Myers, F., Bakker, K., & Raphael, L. (2007). Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. provide and receive support from others who share the experience of stuttering. ), Cluttering: A handbook of research, intervention and education (pp. 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). Treatment for adolescents who stutter poses a particular challenge because of the issues related to this developmental stage. Journal of Speech, Language, and Hearing Research, 62(12), 43564369. The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. Presence of stutteringAn estimated one third of people who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). Characteristics of Typical Disfluency and Stuttering - ASHA (2010). https://doi.org/10.1002/da.20657, Bonanno, G. A., & Mancini, A. D. (2008). Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). It applies protections to ensure that programs and employment environments are accessible and to provide aids and services necessary for effective communication in these settings. 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). Allyn & Bacon. 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. Direct treatment approaches can also target resilience and effort control in the child and family (Caughter & Crofts, 2018; Druker et al., 2019; Kraft et al., 2019). https://doi.org/10.1044/0161-1461(2012/11-0044), Yaruss, J. S., LaSalle, L. R., & Conture, E. G. (1998). increasing self-confidence and self-efficacy. Available 8:30 a.m.5:00 p.m. Such individuals may benefit from treatment strategies that focus on improving speech efficiency by reducing word avoidance and increasing spontaneity in communication. 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). Both procedures help the client decrease the sense of loss of control experienced during moments of stuttering by demonstrating their ability to stop and modify moments of stuttering, anxiety, and other emotional reactivity. Davidow, J. H., & Scott, K. A. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. Consider the individuals age, preferences, and needs within the context of family and community when selecting and adapting treatment approaches and materials. increasing acceptance and openness with stuttering. Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. (1993). https://doi.org/10.1044/2018_AJSLP-17-0097, Kraft, S. J., & Yairi, E. (2011). An effective clientclinician relationship facilitates the identification of potential roadblocks (Plexico et al., 2010). Temperamental characteristics of young children who stutter. Indicators of positive therapeutic change may include. Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. having flexibility based on individual needs and desired outcomes (Amster & Klein, 2018). Structural and functional abnormalities of the motor system in developmental stuttering. Our primary goals were to identify patterns in overt features of WFDs and to extend our understanding of this clinical profile by focusing on aspects of . See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Stuttering and its treatment in adolescence: The perceptions of people who stutter. (2018). Emotional reactivity and regulation in preschool-age children who stutter. 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). While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. Long-term follow-up of self-modeling as an intervention for stuttering. 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). https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). auditory processing disorders (Molt, 1996). Sex of childIt appears that the disorder is more common in males than in females; the male-to-female ratio for cluttering has been reported to range from 3:1 to 6:1 (G. E. Arnold, 1960; St. Louis & Hinzman, 1986; St. Louis & Rustin, 1996). ; American Psychiatric Association, 2013). Stuttering impact: A shared perception for parents and children. Self-help and support groups for people with cluttering. https://doi.org/10.1111/jpc.12034. The scope of this page includes stuttering and cluttering across the life span. American Psychiatric Association. Differences between children and adults should also be considered when interpreting data from neurological studies. The use of counseling in other areas of the speakers lifethat is, those not directly related to communicationis outside the scope of practice for SLPs (ASHA, 2016b). The most common atypical disfluency of concern is word-final . Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. 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. Egan, G. (2013). practice monitoring each others speech and secondary behaviors. The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker. Cluttering treatment: Theoretical considerations and intervention planning. 256276). https://doi.org/10.1080/2050571X.2016.1253533. An introduction to camps for children who stutter: What they are and how they can help. Mancinelli, J. M. (2019). Self-help conferences for people who stutter: A qualitative investigation. is more open and willing to disclose and talk about their stuttering; experiences reduced impact from stuttering; generalizes attitudes, beliefs, and behaviors across contexts; reports feeling more authentic and enjoying social conversations; and. However, their disfluencies are not likely to involve prolongations, blocks, physical tension, or secondary behaviors that are more typical for children who stutter (Boscolo et al., 2002). Cluttering: A neurological perspective. The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. Speaker and observer perceptions of physical tension during stuttering. A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). seizure disorders (Briley & Ellis, 2018). Scaler Scott, K. (2010). ), The treatment of stuttering in the young school-aged child (pp. Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. Managing cluttering: A comprehensive guidebook of activities. Similarities - Typical and Atypical Pneumonia 5. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. Changing adolescent attitudes toward stuttering. 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). Ingham, R. J., & Onslow, M. (1985). https://doi.org/10.1093/brain/awm241, Watson, J. Dosage refers to the frequency, intensity, and duration of treatment. A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199. Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. In E. Conture & R. F. Curlee (Eds. Depression & Anxiety, 27(7), 687692. https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. Therefore, a comprehensive assessment for fluency disorders should include assessment of both overt and covert features. Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. However, a preliminary prevalence study estimated the rate of cluttering to be between 1.1% and 1.2% of school-age children (Van Zaalen & Reichel, 2017). https://doi.org/10.1044/jshr.3605.906. Psychology Press. ), Cluttering: Research, intervention and education (pp. Technological advances and the expansion of social media outlets have increased opportunities for adults who stutter to connect, share, and gain information through the Internet (Fuse & Lanham, 2016; Raj & Daniels, 2017) and stuttering-related podcasts (Dignazio et al., 2020). Seminars in Speech and Language, 39(4), 324332. Atypical Disfluency: What Is It and What Can I Do About It? Self-disclosure involves communicating to others information that reveals ones identity as a person who stutters. Journal of Speech and Hearing Disorders, 50(3), 261281. https://doi.org/10.1044/2017_JSLHR-S-16-0343, Snsterud, H., Feragen, K. B., Kirmess, M., Halvorsen, M. S., & Ward, D. (2019). 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). The Stuttering Foundation We provide free online resources, services and support to those who stutter and their families, as well as support for research into the causes of stuttering.
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