typical vs atypical disfluencies asha

Whurr Publishers. These symptoms come suddenly and do need hospitalization. Journal of Fluency Disorders, 38(4), 342355. In D. Ward & K. Scaler Scott (Eds. Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. The influence of workplace discrimination and vigilance on job satisfaction with people who stutter. Language, Speech, and Hearing Services in Schools, 37(2), 118136. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. These signs and symptoms are consistent with the diagnostic and associated features of childhood-onset fluency disorder (stuttering) listed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. Psychology Press. The clutterer. Following are descriptions of each of these forms of disfluency. (2011). Self-help and mutual aid groups. ), Handbook of psychotherapy integration (pp. In D. Ward & K. Scaler Scott (Eds. Title: The Differential Diagnosis of Disfluency Created Date: 7/18/2007 3:15:45 PM The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Adolescents and young adults who stutter were found to have more white matter connections in the right hemisphere as compared with normally fluent controls (Watkins et al., 2008). Other identification strategies may include video or pseudostuttering analysis or tallying/freezing. https://doi.org/10.1016/j.jfludis.2015.08.001, Han, T.-U., Park, J., Domingues, C. F., Moretti-Ferreira, D., Paris, E., Sainz, E., Gutierrez, J., & Drayna, D. (2014). Stuttering: Its nature, diagnosis, and treatment. Differential treatment of stuttering in the early stages of development. Speech clarity and fluency may temporarily improve when the person is asked to slow down or pay attention to their speech. https://doi.org/10.1542/peds.2012-3067, Ribbler, N. (2006). https://doi.org/10.1016/j.jfludis.2006.02.002. In K. O. Lewis (Ed. Psychology Press. If treatment is currently not warranted, the SLP educates the family about how to monitor the childs fluency to determine if and when the child should be reevaluated. Smith, A., & Weber, C. (2017). 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. Universitetsforlaget. https://doi.org/10.1016/j.jfludis.2012.11.002, Yaruss, J. S. (1997). Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). Typical childhood disfluencies may increase and decrease without any external influence. Estimates have reported the male-to-female ratio of individuals who stutter to be as large as 4:1; however, more recent studies in preschool children suggest that a younger age of onset has smaller ratios in gender differences (Yairi & Ambrose, 2013). Finding the good in the challenge: Benefit finding among adults who stutter. https://doi.org/10.1111/jpc.12034. Journal of Fluency Disorders, 43, 1727. Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. These modifications are used to facilitate speech fluency and may include. 9099). The ability to use speech strategies; to make choices to speak and participate, regardless of the level of fluency; and to take risks is greatly reduced outside of the treatment setting when time pressure and conditioned negative feelings may trigger fear and old behaviors. Shock, 2. These should be considered during differential diagnosis but should not be the sole therapeutic strategies. Bargaining, 5. Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. In J. C. Norcross & M. R. Goldfried (Eds. Possible genetic factors in cluttering. modifying instructions to accommodate the home language, using exemplars in audio or video format in the home language, and. 6396). https://doi.org/10.1177/1073858418803594, Chang, S.-E., & Zhu, D. C. (2013). typical vs atypical disfluencies asha 24 Jun. Typical adolescent experiences of emotional reactivity, resistance to authority, and social awkwardness may be exacerbated in adolescents who also experience stuttering (Daly et al., 1995; Zebrowski, 2002). The speech-language pathologist (SLP) uses linguistically and culturally appropriate stimuli and is sensitive to the unique values and preferences of each individual and their family to create a treatment plan (Sisskin, 2018). https://doi.org/10.1016/j.jcomdis.2014.02.001, Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Journal of Communication Disorders, 37(1), 3552. Clinicians may start with the client observing videos of others who stutter (or a puppet for children) to help them identify patterns, attitudes, and beliefs about communication and stuttering. Arnold, G. E. (1960). 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). Prentice-Hall. 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. 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). 157186). Application of the ICF in fluency disorders. Referring to other health care professionals when outside support is needed to facilitate treatment goals for interfering behaviors (e.g., anxiety, depression). (2017). the impact of communication impairments on, Relevant case history (as appropriate for age), including. However, these disfluencies are typical and not indicative of a disorder (Shenker, 2013). Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. A treatment plan that involves both speech and stuttering modification techniques may be necessary to achieve optimal outcomes. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). www.asha.org/policy/. Ingham, R. J., & Onslow, M. (1985). This includes the impact on functional communication in key school situations and on quality of life (Beilby et al., 2012b; Yaruss et al., 2012). using fillers (e.g., like, um, uh, you know); avoiding sounds or words (e.g., substituting words, inserting unnecessary words, circumlocution); and. The speakers measured speech rate is not always greater than average, but the listener perceives it as rapid. Journal of Neurodevelopmental Disorders, 3(4), 374380. Therefore, when conducting an assessment with an adult, it is crucial to understand. 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). Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). 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). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. For example, English language learners may have word-finding problems in the second language. Emotional problems and parenting style do not cause stuttering. Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. Enhancing treatment for school-age children who stutter: II. Trichon, M., & Raj, E. X. As suggested earlier, normal disfluencies will appear for a few days and then disappear. autism (see Scaler Scott, 2011, for a review), word-finding/language organization difficulties (Myers, 1992), and. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). Early childhood stuttering and electrophysiological indices of language processing. Donaher, J., & Richels, C. (2012). It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. Psychology Press. Pro-Ed. https://doi.org/10.1016/j.jfludis.2006.12.003. information regarding family, personal, and cultural perception of fluency. If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. 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). ), Stuttering therapy: Rationale and procedures (pp. NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. They have long-held beliefs about stuttering that positively or negatively affect self-perceptions about their communication skills and their motivation for change (Daniels, 2007). Summary - Typical vs Atypical Pneumonia. minimizing the adverse impact of stuttering (Yaruss et al., 2012). Mild stuttering, on the other hand, tends to appear more regularly. (2016a). Video self-modeling as a post-treatment fluency recovery strategy for adults. ), Cluttering: A clinical perspective (pp. Typical vs Atypical Pneumonia in Tabular Form 6. Subjective distress associated with chronic stuttering. Brain, 136(12), 37093726. Journal of Fluency Disorders, 58, 2234. Nurturing a resilient mindset in school-aged children who stutter. For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. https://doi.org/10.1002/mgg3.276, Frigerio-Domingues, C. E., Gkalitsiou, Z., Zezinka, A., Sainz, E., Gutierrez, J., Byrd, C., Webster, R., & Drayna, D. (2019). 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). ), Cluttering: Research, intervention and education (pp. https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). 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. The plan outlines reasonable accommodations for speaking or reading activities to help ensure a students academic success and access to the learning environment in school. Folia Phoniatrica et Logopaedica, 69, 180189. Education, 136(2), 159168. The goals of treatment may be (a) to eliminate, greatly reduce, or help the child manage their stuttering and (b) to help them not develop negative emotional reactions related to their stuttering (H. S. Arnold et al., 2011; Yaruss et al., 2006). See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. American Journal of Speech-Language Pathology, 7(4), 6276. American Journal of Speech-Language Pathology, 20(3), 163179. Psychology Press. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. https://doi.org/10.1044/persp1.SIG4.55, Byrd, C. T., Croft, R., Gkalitsiou, Z., & Hampton, E. (2017). World Health Organization. Stuttering: An integrated approach to its nature and treatment. Journal of Fluency Disorders, 53, 2640. An effective clientclinician relationship facilitates the identification of potential roadblocks (Plexico et al., 2010). https://doi.org/10.1093/brain/awm241, Watson, J. Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). 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). ASHA thanks the following individuals,who, in 2014, made significant contributions to the development of this content. The International Journal of Indian Psychology, 3(3), 7887. Mis- and overidentification of stuttering in bilingual speakers may occur due to typical disfluencies observed in development, code switching, and wording changes to maintain the grammatical integrity of the dominant language. Posted at 23:22h . discussing the rationale for treatment decisions, and. Language assessment and intervention for the learning disabled. https://doi.org/10.1080/2050571X.2016.1253533. Communication attitudes in children who stutter: A meta-analytic review. 3. The impact of stuttering on employment opportunities and job performance. Stuttering and cluttering. 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). (2013). (2019). 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. https://doi.org/10.1044/1058-0360.0202.65. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Yaruss, J. S., & Pelczarski, K. M. (2007). The term overt stuttering is used when core speech behaviors are present. https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). Identifying subgroups of stutterers (No. The ASHA Leader, 19(7), 4448. 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). https://doi.org/10.1044/1058-0360.0704.62. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). Available 8:30 a.m.5:00 p.m. (2017). See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). The relationship of self-efficacy and depression to stuttering. Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering. Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. https://doi.org/10.1044/jshr.3103.377, Weber-Fox, C., Wray, A. H., & Arnold, H. (2013). Journal of Communication Disorders, 58, 4357. Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. the asha leader; journals. Journal of Speech, Language, and Hearing Research, 61(7), 16491663. Children who stutter also may be at risk for experiencing bullying (Blood & Blood, 2004; Davis et al., 2002; Langevin et al., 1998). Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. Advances in Psychiatric Treatment, 12(1), 6368. Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. Palin ParentChild Interaction therapy: The bigger picture. Bulletin of the Center for Special Needs Education Research and Practice, 13, 19. 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). Cooper, E. B. ), Stuttering and related disorders of fluency (pp. Singular. https://doi.org/10.1044/2020_PERSP-20-00014. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.1044/ffd16.1.15. Seminars in Speech and Language, 28(4), 312322. Perspectives on Fluency and Fluency Disorders, 11(1), 711. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. Best practice for developmental stuttering: Balancing evidence and expertise. Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words and interjections (such as um and well). In D. Ward & K. Scaler Scott (Eds. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). Fluency refers to continuity, smoothness, rate, and effort in speech production. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. See ASHAs resource on assessment of fluency disorders in the context of the WHO ICF framework. Speech, Language and Hearing, 20(3), 144153. (2017). (2003). See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Disfluent behavior becomes more complex as fear of speaking, anxiety, and resulting avoidance increase. 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). Early childhood stuttering for clinicians by clinicians. https://doi.org/10.1016/0094-730X(88)90003-4. Journal of Fluency Disorders, 38(4), 311324. Arnold, H. S., Conture, E. G., Key, A. P., & Walden, T. (2011). Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. Cluttering: A synergistic framework. Communication Disorders Quarterly, 6(1), 5059. SLPs may want to relate personal experiences when asking clients to share such vulnerable information. These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). Please enable it in order to use the full functionality of our website. The purpose of assessing fluency in a preschool child is to determine. The clinical applications of Acceptance and Commitment Therapy with clients who stutter. Conture, E. G. (2001). Psychology Press. Fluency disorders can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). In addition to being used for improving communication skills, pausing is also an effective method of rate control. However during treatment and forming a new, more congruent identity, clients may progress through some of the stages of grief (e.g., 1. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. 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). Perspectives on Fluency and Fluency Disorders, 17(2), 49. Format refers to the manner in which a client receives treatmentindividually, as part of a group, or both. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). In L. Cummings (Ed. In R. Lees & C. Stark (Eds. 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). (2014). St. Louis, K. O., & Schulte, K. (2011). Journal of Abnormal Psychology, 119(3), 479490. https://doi.org/10.1002/da.20657, Bonanno, G. A., & Mancini, A. D. (2008). Stuttering may influence an individuals perception of their career possibilities and professional limitations (Klein & Hood, 2004). (2018). Lyn Goldberg and Michelle Ferketic served as ex officios. Journal of Fluency Disorders, 33(2), 8198. 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. https://doi.org/10.4324/9781351122351, Klein, J. F., & Hood, S. B. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders. Although cluttering has been reported in children as young as 4 years of age, the diagnosis is more commonly made at about 8 years of age (Ward, 2006), when a childs language becomes lengthy and/or complex enough for symptoms to manifest themselves. Plural. ), Cluttering: A handbook of research, intervention and education (pp. This law also applies to organizations that receive financial assistance from any federal department or agency. Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. 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). It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. Diagnostic and statistical manual of mental disorders (5th ed.). Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. Often, there are pivotal points during treatment that indicate progress (T. K. Anderson & Felsenfeld, 2003; Plexico et al., 2005). See the Fluency Disorders Evidence Map for summaries of the available research on this topic. Neurophysiological factors that are thought to contribute to stuttering include the following: These neurophysiological findings should be interpreted with caution due to the small number of subjects and the heterogeneity of the methodologies used. Higher incidence rates of stuttering have been reported in preschool-aged children (11.2%; Reilly et al., 2013), with prevalence estimates reported as 2.2%5.6% (Yairi & Ambrose, 2013). A phenomenological analysis of the moment of stuttering. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. Drayna, D. (2011). Onset may be progressive or sudden. https://doi.org/10.1044/leader.FTR2.19072014.44, American Speech-Language-Hearing Association. 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. In F. L. Myers & K. O. St. Louis (Eds. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Stages of change and stuttering: A preliminary view. Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions.

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