resilience building within the child and family (Berquez & Kelman, 2018). Fluency of school-aged children with a history of specific expressive language impairment: An exploratory study. (1979). https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). https://doi.org/10.1016/j.jfludis.2011.04.002, Foote, G. (2013). In F. L. Myers & K. O. St. Louis (Eds. Prentice-Hall. Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. In D. Ward & K. Scaler Scott (Eds. International Journal of Language & Communication Disorders, 49(1), 113126. Genetic factors also may play a role in predicting the likelihood of persistence or recovery and, possibly, treatment outcomes (Frigerio-Domingues et al., 2019; Han et al., 2014). - Speech & Language Parent Support - SPSD 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. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. Parental involvement is an integral part of any treatment plan for children who stutter. Psychology Press. These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. https://doi.org/10.1044/2017_AJSLP-17-0146, St. Louis, K. O., & Hinzman, A. R. (1986). However, increased mean length of utterance, more diverse vocabulary, and greater syntactic complexity have also been noted (Wagovich & Hall, 2017). 341358). While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. Early childhood stuttering for clinicians by clinicians. St. Louis, K. O., & Flynn, T. W. (2018). For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. Goals that focus on minimizing negative reactions to stuttering and difficulties communicating in various speaking situations may help the individual reduce the effort used to hide or avoid their disfluencies and communicate with more ease. www.asha.org/policy/, American Speech-Language-Hearing Association. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). ), Stuttering and related disorders of fluency (pp. Trichon, M., & Tetnowski, J. Erickson, S., & Block, S. (2013). The impact of a stuttering disorder on Western Australian children and adolescents. Children and adolescents with fluency disorders may qualify for accommodations whether or not they have an active individualized education program (IEP). https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Fluency Disorders - ASHA https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. Acceptance and Commitment Therapy for people who stutter. https://doi.org/10.1044/cicsd_25_S_8, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2017). When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). social anxiety disorder (Brundage et al., 2017; Craig & Tran, 2014; Iverach et al., 2018), speech sound disorders (St. Louis & Hinzman, 1988; Wolk et al., 1993), and. information regarding family, personal, and cultural perception of fluency. Stuttering may influence an individuals perception of their career possibilities and professional limitations (Klein & Hood, 2004). Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). The role of effortful control in stuttering severity in children: Replication study. One of the core principles of ACT is mindfulness. Self-regulation and the management of stuttering. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). Journal of Communication Disorders, 80, 8191. 142185). Self-efficacy is a positive belief in ones own ability to successfully accomplish a set goal that is task dependent, which comes from (a) past experiences of mastery, (b) vicarious experiences, (c) verbal persuasion, and (d) emotional/physical states (Boyle, 2013a, 2013b, 2015; Boyle et al., 2018; Carter et al., 2017). 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). (2014). You do not have JavaScript Enabled on this browser. Helping adolescents who stutter focus on fluency. Impact of social media and quality of life of people who stutter. Just as individuals may experience feelings of shame or fear associated with showing stuttering, individuals also may experience negative feelings associated with using speech modification strategies, which often make their speech sound different from natural speech (Ingham & Onslow, 1985; Martin et al., 1984). The skilled helper: A problem-management and opportunity-development approach to helping. Children with normal disfluencies have emergent fluency. learning disabilities (Wiig & Semel, 1984). Journal of Fluency Disorders, 13(5), 357373. Current Biology, 26(8), 10091018. Similarities - Typical and Atypical Pneumonia 5. https://doi.org/10.1044/0161-1461.2602.162. To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. Mild stuttering, on the other hand, tends to appear more regularly. Word-finding problems can also result in an increase in typical disfluencies that are similar to those observed in cluttering. (2011). The term overt stuttering is used when core speech behaviors are present. Journal of Speech and Hearing Disorders, 49(1), 5358. ), Cluttering: Research, intervention and education (pp. Journal of Speech, Language, and Hearing Research, 54(6), 14851496. (2014). They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. (2017). https://doi.org/10.1016/j.jfludis.2013.09.003, Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). Psychology Press. Journal of Communication Disorders, 58, 4357. Rehabilitation Act of 1973, Section 504. National Stuttering Association. 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. Psychology Press. increasing the time provided for an oral reading or presentation, providing an alternative assignment to oral reading, and. Clinical decision making in fluency disorders. Indicators of positive therapeutic change may include. Person- and family-centered practice offers a range of services, including counseling and emotional support, procuring information and resources, coordinating services, teaching specific skills to facilitate communication, and advocating for or with the individual and their family. (2013). Journal of Fluency Disorders, 38(2), 6687. Subjective distress associated with chronic stuttering. Seminars in Speech and Language, 35(2), 6779. Journal of Fluency Disorders, 58, 2234. The epidemiology of cluttering with stuttering. Signs and symptoms. A comprehensive fluency assessment typically includes the following: See ASHAs resource on assessment procedures: parallel with CPT codes for a breakdown of pre-evaluation, intra-service, and post-service procedures. Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. ), Stuttering and related disorders of fluency (pp. Maintenance of improved attitudes toward stuttering. https://doi.org/10.1016/j.jfludis.2006.02.002. https://doi.org/10.1093/brain/awm241, Watson, J. Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. 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. production of words with an excess of physical tension or struggle. https://doi.org/10.1093/med:psych/9780195165791.003.0007, Proctor, A., Yairi, E., Duff, M., & Zhang, J. Journal of Fluency Disorders, 35(4), 333354. One study showed that children who clutter had 7.6 times more normal disfluencies compared to "atypical" disfluencies when they retold a story (van Zaalen et al., 2009). Palin ParentChild Interaction Therapy for early childhood stammering. 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). A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. Factors that contribute to the perception of overt stuttering severity include frequency, duration, effort, naturalness, and the ability of the person who stutters to communicate effectively and efficiently. Screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation. B. advertising through a classroom presentation with the guidance of the SLP or classroom teacher in the case of school-age children (W. P. Murphy et al., 2007b). The ASHA Leader, 11(10), 621. Providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk. This may progress to the client analyzing the clinicians or their own pseudostuttering, to analyzing a video of their own stuttering to real-time analysis (Bray & Kehle, 2001; Bray et al., 2003; Cream et al., 2010; Harasym et al., 2015; Prins & Ingham, 2009). Whurr Publishers. Assessment of awareness in young children of disfluencies and difficulty in speaking. 9099). (2010). The prevalence rate of stuttering in African American children (25 years of age) was estimated to be 2.52%, but was not reported to not be significantly different from that reported for European American children in the same age group between 2- to 5-year-old African American children and European American children (Proctor et al., 2008). For example, individuals who clutter may not be aware of communication breakdowns and, therefore, do not attempt to repair them. Sheehan, J. G. (1970). https://doi.org/10.1016/j.jfludis.2017.06.001. Temperamental characteristics of young children who stutter. Treatment for adolescents who stutter poses a particular challenge because of the issues related to this developmental stage. The Journal of Child Psychology and Psychiatry, 43(7), 939947. 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. See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Application of the ICF in fluency disorders. https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Journal of Fluency Disorders, 21(34), 215225. Typical vs. Atypical Disfluencies: What Are the Differences? American Journal of Speech-Language Pathology, 27(3S), 11801194. 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). Journal of Speech, Language, and Hearing Research, 56(5), 15171529. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). Stuttering typically has its origins in childhood. There are limited data on the age of onset of cluttering; however, the age of onset of cluttering appears to be similar to that of stuttering (Howell & Davis, 2011). typical vs atypical disfluencies asha typical vs atypical disfluencies asha. 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. Measuring lexical diversity in children who stutter: Application of vocd. Genetic contributions to stuttering: The current evidence. Systems that govern self-regulation may underlie cluttering; qualitative interviews with those who clutter suggest that thoughts emerge before they are ready (Scaler Scott & St. Louis, 2011). Thieme. Typical vs. Atypical Antipsychotics: Main Differences and Effectiveness https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). However, even when children show little observable disfluency, they may still need treatment because of the negative impact of stuttering or cluttering on their lives. Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Cluttering treatment: Theoretical considerations and intervention planning. A treatment plan that involves both speech and stuttering modification techniques may be necessary to achieve optimal outcomes. Journal of Fluency Disorders, 38(4), 311324. 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). For example, English language learners may have word-finding problems in the second language. In fact, stuttering can affect all areas of academic competency, including academic learning, social-emotion functioning, and independent functioning (Ribbler, 2006, p. 15). This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). https://doi.org/10.1016/j.jcomdis.2015.10.003. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). Folia Phoniatrica et Logopaedica, 64(1), 3447. Cluttering and autism spectrum disorders. (2018). The lowest prevalence rates of stuttering were reported in adults aged 2150 years (0.78%) and adults aged 51 years or older (0.37%; Craig et al., 2002). Children with persistent stuttering showed deficiencies in left gray matter volume with reduced white matter integrity in the left hemisphere. 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). The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. Speech, Language and Hearing, 20(3), 144153. The imbalance of stuttering behavior in bilingual speakers. Ward, D. (2006). Acquired neurogenic and psychogenic stuttering are not covered. White matter neuroanatomical differences in young children who stutter. Self-report of self-disclosure statements for stuttering. Preliminary research suggests adults who clutter demonstrate differences in cortical and subcortical activity compared to controls (Ward et al., 2015). 1997- American Speech-Language-Hearing Association. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0189, Chakraborty, M., Chen, L.-F., Fridel, E. E., Klein, M. E., Senft, R. A., Sarkar, A., & Jarvis, E. D. (2017). https://doi.org/10.1044/leader.OV.18032013.14, Freud, D., & Amir, O. (n.d.). They also can benefit from groups and intensive programs (Fry et al., 2014). minimizing the adverse impact of stuttering (Yaruss et al., 2012). Journal of Fluency Disorders, 33(2), 8198. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. Building clinical relationships with teenagers who stutter. https://doi.org/10.1044/jshr.2804.495, Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Menzies, R. G., Onslow, M., & Rapee, R. M. (2016). (1988). 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). Other identification strategies may include video or pseudostuttering analysis or tallying/freezing. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. 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: It is also not unusual for disfluencies to be apparent and then seem to go away for a period of weeks or months only to return again. 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). Crystal ball gazing: Research and clinical work in fluency disorders in 2026. Strategies aimed at changing the timing and tension of speech production include. 328). Nurturing a resilient mindset in school-aged children who stutter. These are called typical disfluencies or nonfluencies. https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). Wiig, E. H., & Semel, E. M. (1984). 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. 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. Language, Speech, and Hearing Services in Schools, 48(4), 234248. Education, 136(2), 159168. 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). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). ), The treatment of stuttering in the young school-aged child (pp. Identifying subgroups of stutterers (No. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. Thieme. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Explore how typical and atypical disfluencies differ, and find resources for guidance and support. (2003). 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). Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). American Journal of Speech-Language Pathology, 27(3S), 12111223. 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). Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. Temperament, emotion, and childhood stuttering. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). Although cluttering and stuttering can co-occur, there are some important distinctions between the two (see Scaler Scott, 2010). https://doi.org/10.1111/jpc.12034. typical vs atypical disfluencies asha - giclee.lt 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. Coworkers may have negative attitudes toward individuals who stutter, and the individual may feel excluded because of this. When speakers are able to participate in decisions about treatment goals and select goals they consider important, they may be more motivated to take part in therapy (Finn, 2003; Snsterud et al., 2019). https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). Rethinking covert stuttering. Following are descriptions of each of these forms of disfluency. Structural and functional abnormalities of the motor system in developmental stuttering. 187214). attention-deficit/hyperactivity disorder (Alm, 2011). The utility of stuttering support organization conventions for young people who stutter. 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. Workplace in fluency management: Factoring the workplace into fluency management. This perceived rapid rateand the resulting breakdown in speech clarityis thought to be because speakers with cluttering speak at a rate that is too fast for their systems to handle (Myers, 1992; St. Louis et al., 2007; Ward, 2006). https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. American Journal of Speech-Language Pathology, 26(4), 11051119. Individuals learn to identify the thoughts underlying their negative attitudes and emotional reactions and examine the link between these thoughts, attitudes, and emotional reactions and their speech. Genetic approaches to understanding the causes of stuttering. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. The relationship of self-efficacy and depression to stuttering. Stuttering Therapy Resources. http://blog.asha.org/2013/09/26/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/, Multisyllabic whole-word and phrase repetitions, Secondary behaviors (e.g., eye blinks, facial grimacing, changes in pitch or loudness), Avoidance behaviors (e.g., reduced verbal output or word/situational avoidances). https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). Understanding and treating cluttering. Journal of Abnormal Psychology, 119(3), 479490. The person is having difficulty communicating messages in an efficient, effective manner. Self-disclosure involves communicating to others information that reveals ones identity as a person who stutters. Examples of support groups and activities include FRIENDS: The National Association of Young People Who Stutter, the National Stuttering Association, and SAY: The Stuttering Association for the Young; online groups (e.g., online chats); and social media (e.g., blogs; Reeves, 2006). Reardon-Reeves, N., & Yaruss, J. S. (2013). https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). Emotional reactivity, regulation and childhood stuttering: A behavioral and electrophysiological study. (2017). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Possible genetic factors in cluttering. 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. 7). Plural. Long-term follow-up of self-modeling as an intervention for stuttering. (2010). (2018). 178196). See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1176/appi.books.9780890425596, American Speech-Language-Hearing Association. Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. Scaler Scott, K. (2010). 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). Pro-Ed. sex of childboys are at higher risk for persistence of stuttering than girls (Craig et al., 2002; Yairi & Ambrose, 2013); family history of persistent stuttering (Kraft & Yairi, 2011); time duration of greater than 612 months since onset or no improvement over several months (Yairi & Ambrose, 2005); age of onsetchildren who start stuttering at age 3 years or later (Yairi & Ambrose, 2005); and. However, sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children. Journal of Speech, Language, and Hearing Research, 62(12), 43564369. Treatment is sensitive to cultural and linguistic factors and addresses goals within WHOs ICF framework (ASHA, 2016a; Coleman & Yaruss, 2014; WHO, 2001; Yaruss, 2007; Yaruss & Quesal, 2004, 2006). Pro-Ed. typical vs atypical disfluencies asha. Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). Referring to other health care professionals when outside support is needed to facilitate treatment goals for interfering behaviors (e.g., anxiety, depression). https://doi.org/10.1016/j.jfludis.2010.12.003. ), Controversies about stuttering therapy (pp. The International Journal of Indian Psychology, 3(3), 7887. Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. consultation with and referral to other professionals as needed. Daly, D. A. 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). increased social communication participation (Manning & DiLollo, 2018). How stuttering develops: The multifactorial dynamic pathways theory. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. 255279). Fluency treatment is a dynamic process; service delivery may change over time as the individuals needs change. https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). 6396). In J. C. Norcross & M. R. Goldfried (Eds. Journal of Speech, Language, and Hearing Research, 31(3), 377385. Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency.

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