256276). One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). Journal of Paediatrics and Child Health, 49(2), E112E115. Advocating for individuals with fluency disorders and their families at the local, state, and national levels. https://doi.org/10.1044/1058-0360(2007/008), Oyono, L. T., Pascoe, M., & Singh, S. (2018). Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. Routledge. Counseling helps an individual, a family member, or a caregiver of a person of any age who stutters move from the current scenario to a preferred scenario through an agreed-upon action plan (Egan, 2013). Other speech or language concerns are also present. Counseling persons with communication disorders and their families. Distinguishing Cluttering from Stuttering - @ASHA Journal of Fluency Disorders, 35(3), 216234. Journal of Fluency Disorders, 38(2), 206221. See What To Ask When Evaluating Any Procedure, Product, or Program. https://doi.org/10.3109/17549507.2015.1010583, Adriaensens, S., Beyers, W., & Struyf, E. (2015). 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 disfluencies are typical and not indicative of a disorder (Shenker, 2013). seizure disorders (Briley & Ellis, 2018). Prins, D., & Ingham, R. J. Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. Language, Speech, and Hearing Services in Schools, 43(4), 536548. Mancinelli, J. M. (2019). https://doi.org/10.1016/j.jfludis.2007.02.001. The person is experiencing negative reactions from others (e.g., peers, classmates, coworkers, family members). Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. It can also be challenging to assess the reading fluency of bilingual students who stutter. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). (2018). BMJ, 331(7518), 659661. Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. Bilingual children are assessed in both languages to determine stuttering profiles in both (Finn & Cordes, 1997). 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. Journal of Fluency Disorders, 54, 1423. 211230). Toward a better understanding of the process of disclosure events among people who stutter. https://doi.org/10.1017/S135246580001643X. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Palin ParentChild Interaction therapy: The bigger picture. (2005). Some adults lack communication confidence as a result of negative self-perceptions about their stuttering (Beilby et al., 2012a) or due to repeated exposure to people holding stereotypes about stuttering, which, in turn, may create self-stigmatization (Boyle, 2013a). https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. In addition to being used for improving communication skills, pausing is also an effective method of rate control. B. Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. 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. Limited research is available that identifies the causes of cluttering. The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. https://doi.org/10.1044/1092-4388(2013/12-0280), Boyle, M. P. (2013b). Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. 6989). Human Brain Mapping, 38(4), 18651874. Language assessment and intervention for the learning disabled. Molecular Genetics & Genomic Medicine, 5(2), 95102. https://doi.org/10.1002/da.20657, Bonanno, G. A., & Mancini, A. D. (2008). 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). Building clinical relationships with teenagers who stutter. The clinician (a) considers the degree to which the individuals disfluent behaviors and overall communication are influenced by a coexisting disorder (e.g., other speech or language disorders, Down syndrome, autism spectrum disorder, attention-deficit/hyperactivity disorder) and (b) determines how treatment might be adjusted accordingly. Cluttering treatment: Theoretical considerations and intervention planning. consultation with and referral to other professionals as needed. These strategies help individuals learn about the speech mechanism and how it operates during both fluent and disfluent speech so they can modify it. Cluttering can co-occur with other disorders, including. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). How Can You Tell if Childhood Stuttering is the Real Deal? - @ASHA Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Journal of Fluency Disorders, 37(4), 242252. https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Ward, D. (2006). 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/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). Children who stutter also may be at risk for experiencing bullying (Blood & Blood, 2004; Davis et al., 2002; Langevin et al., 1998). https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). 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. 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. 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). They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. Overheard: Bilingual and disfluent: A unique treatment challenge. Journal of Communication Disorders, 44(3), 276293. This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. https://doi.org/10.1044/ffd11.1.7, Shenker, R. C. (2011). The creative process in avoidance reduction therapy for stuttering. 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. Genetic factors and therapy outcomes in persistent developmental stuttering. Posted at 23:22h . Myers, F. L. (1992). Journal of Communication Disorders, 58, 4357. 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. For example, stuttering has been associated with higher levels of social anxiety in adults who stutter (Blumgart et al., 2010), and this can lead to fear and avoidance of social interaction (see Craig & Tran, 2006, for a review research on this topic). https://doi.org/10.1016/S0094-730X(97)00008-9, Floyd, J., Zebrowski, P. M., & Flamme, G. A. Assessment of awareness in young children of disfluencies and difficulty in speaking. Children with language difficulties at the sentence, narrative, or conversational discourse level may exhibit increased speech disfluencies. Emotional problems and parenting style do not cause stuttering. Journal of Fluency Disorders, 38(4), 311324. 142185). Often referred to as advertising in the stuttering community, self-disclosure can involve. Evaluating stuttering in young children: Diagnostic data. Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. Intervention procedures for the young stutterer. ), Current issues in stuttering research and practice (pp. Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. Psychology Press. A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. Journal of Speech, Language, and Hearing Research, 61(7), 16491663. Cognitive restructuring can be combined with the desensitization strategies described above (W. P. Murphy et al., 2007a). Prior to developing generalization activities, the SLP needs to consider the individuals profile. However, sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children. The validity of reading assessment tools for children who stutter is questionable because it is difficult to differentiate the cause (decoding or stuttering) of oral reading fluency problems. Crystal Cooper, Diane L. Eger, and Nancy Creaghead served as monitoring vice presidents. ), Cluttering: Research, intervention and education (pp. Perspectives on Global Issues in Communication Sciences and Related Disorders, 4(2), 5762. Sheehan, J. G. (1970). (2017). Psychology Press. Psychology Press. Therefore, when conducting an assessment with an adult, it is crucial to understand. (1988). They are likely to use interjections, repeat phrases, and revise what they are saying. School-age stuttering therapy: A practical guide. Pediatrics, 144(4), Article e20190811. Journal of Communication Disorders, 80, 1117. Craig, A., Blumgart, E., & Tran, Y. excessive coarticulation resulting in the collapsing and/or deletion of syllables and/or word endings; excessive disfluencies, which are usually of the more nonstuttering type (e.g., excessive revisions and/or use of filler words, such as um); pauses in places typically not expected syntactically; unusual prosody (often due to the atypical placement of pauses rather than a pedantic speaking style, as observed in many with autism spectrum disorder).
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