Recommending related services when necessary for management and treatment in different settings (e.g., classroom, work, community). Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). Seminars in Speech and Language, 24(1), 2126. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). For students who stutter, the impact goes beyond the communication domain. Ward, D. (2006). Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). Fluency refers to continuity, smoothness, rate, and effort in speech production. 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). Manning, W. H., & DiLollo, A. 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. Pediatrics, 132(3), 460467. The imbalance of stuttering behavior in bilingual speakers. www.asha.org/policy/, American Speech-Language-Hearing Association. We often use the term "emergent" to describe skills that are developing, but have not fully emerged. Arnold, H. S., Conture, E. G., Key, A. P., & Walden, T. (2011). Measuring lexical diversity in children who stutter: Application of vocd. Fluency Disorders (Practice Portal). Ingham, R. J., & Onslow, M. (1985). Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). Finding opportunities for social support for individuals with fluency disorders. Dosage refers to the frequency, intensity, and duration of treatment. These strategies help individuals learn about the speech mechanism and how it operates during both fluent and disfluent speech so they can modify it. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). Journal of Speech, Language, and Hearing Research, 62(5), 13711372. Persons who stutter may appear friendlier when they self-disclose their stuttering, and self-disclosure may help put listeners more at ease (Healey et al., 2007). https://doi.org/10.1044/1058-0360.0704.62. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. Stuttering in school-age children: A comprehensive approach to treatment. Atypical disfluency has been documented through case studies and has been described as final part-word repetition or "rhyme repetition". Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). Research updates in neuroimaging studies of children who stutter. Temperamental characteristics of young children who stutter. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). Journal of Fluency Disorders, 44, 3245. In L. Cummings (Ed. https://doi.org/10.1017/CBO9781139108683.023. 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). Seminars in Speech and Language, 37(3), 145152. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. ), Cluttering: A clinical perspective (pp. The term overt stuttering is used when core speech behaviors are present. Perspectives on Fluency and Fluency Disorders, 16(1), 1517. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. 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). Signs and symptoms. modifying instructions to accommodate the home language, using exemplars in audio or video format in the home language, and. When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. information regarding family, personal, and cultural perception of fluency. https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Prentice-Hall. Avoidance can lead to less talking and reduced linguistic complexity. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). Journal of Speech and Hearing Disorders, 50(3), 261281. educates the individual who stutters and their family members about stuttering and communication and. 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). Palin ParentChild Interaction Therapy for early childhood stammering. However, as they learn to reduce reactivity (see below), they develop greater comfort while speaking, they assume more positive attitudes about their ability to communicate, and they are better able to accept and manage moments of disfluency as they occur. having flexibility based on individual needs and desired outcomes (Amster & Klein, 2018). Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). You do not have JavaScript Enabled on this browser. Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. Journal of Fluency Disorders, 38(1), 1429. Time and expense are considerations along with attention to generalization and treatment needs following an intensive program (Cooper, 1979). Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. https://doi.org/10.1044/2019_JSLHR-S-18-0225. Best practice for developmental stuttering: Balancing evidence and expertise. 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. Erickson, S., & Block, S. (2013). Fluency refers to continuity, smoothness, rate, and effort in speech production. 341358). Evaluating stuttering in young children: Diagnostic data. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. https://doi.org/10.1093/brain/awm241, Watson, J. Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. Egan, G. (2013). Emotional reactivity and regulation in preschool-age children who stutter. However, these disfluencies are typical and not indicative of a disorder (Shenker, 2013). https://doi.org/10.1044/2018_JSLHR-S-17-0353, Guitar, B. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). https://doi.org/10.1044/0161-1461(2012/11-0044), Yaruss, J. S., LaSalle, L. R., & Conture, E. G. (1998). https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. Journal of Fluency Disorders, 22(3), 219236. For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. International Classification of Functioning, Disability and Health. 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/10.1017/S135246580001643X. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. The impact of stuttering on employment opportunities and job performance. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). Changing adolescent attitudes toward stuttering. ), The atypical stutterer: Principles and practices of rehabilitation (pp. The ASHA Action Center welcomes questions and requests for information from members and non-members. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). Journal of Fluency Disorders, 34(4), 368381. https://doi.org/10.1016/j.jfludis.2014.01.001. When assessing fluency, it is important to consider the impact of fluency disorders on participation in everyday activities. See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Enhancing treatment for school-age children who stutter: I. avoidance behaviors (i.e., avoidance of sounds, words, people, or situations that involve speaking); escape behaviors, such as secondary mannerisms (e.g., eye blinking and head nodding or other movements of the extremities, body, or face); and. In E. G. Conture & R. F. Curlee (Eds. ), Stuttering therapy: Rationale and procedures (pp. The purpose of assessing fluency in a preschool child is to determine. University Park Press. 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). Journal of Abnormal Psychology, 119(3), 479490. Self-help and support groups for people with cluttering. Manning, W. H., & Quesal, R. W. (2016). https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). Acquired neurogenic and psychogenic stuttering are not covered. Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). Some children who stutter or clutter may only experience symptoms situationally. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Cengage Learning. Journal of Fluency Disorders, 38(2), 206221. Rethinking covert stuttering. 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). Language, Speech, and Hearing Services in Schools, 49(1), 13. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. Similarities - Typical and Atypical Pneumonia 5. Onset may be progressive or sudden. Parents of bilingual children easily can be trained to provide perceptual ratings of fluency in any language spoken by the child (Shenker, 2013). Journal of Fluency Disorders, 22(3), 187203. Signs and symptoms of stuttering include core speech behaviors, such as. Journal of Fluency Disorders, 26(3), 179206. There are benefits of both individual and group treatment. https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. Functional and neuroanatomical bases of developmental stuttering: Current insights. Individuals who stutter may report fear or anxiety about speaking and frustration or embarrassment with the time and effort required to speak (Ezrati-Vinacour et al., 2001). Logos, 3, 8295. ), Controversies about stuttering therapy (pp. (2019). Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). Clinical implications of situational variability in preschool children who stutter. https://doi.org/10.1016/0094-730X(88)90003-4. Clinicians can help clients progress to active stages through building self-efficacy. (2017). Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Myers, F. L. (1992). Stuttering Therapy Resources. Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. (2018). Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. 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). Enhancing treatment for school-age children who stutter: II. continued management (Plexico et al., 2005). Evidence-based treatment and stutteringHistorical perspective. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). In D. Ward & K. Scaler Scott (Eds. https://doi.org/10.1176/appi.books.9780890425596, American Speech-Language-Hearing Association. American Journal of Speech-Language Pathology, 28(1), 1428. 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. The purpose of assessing school-age children and adolescents for fluency disorders is to determine the presence, the extent, andmost importantlythe impact of the fluency disorder and the potential benefit from treatment. Neural network connectivity differences in children who stutter. minimizing the adverse impact of stuttering (Yaruss et al., 2012). The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. In fact, increased pausing alone may increase speech fluency and intelligibility for those who clutter (Scaler Scott & Ward, 2013). Language growth predicts stuttering persistence over and above family history and treatment experience: Response to Marcotte. 7). Yaruss, J. S., & Pelczarski, K. M. (2007). Individuals are referred to a speech-language pathologist (SLP) for a comprehensive assessment when disfluencies are noted and when one or more of the factors listed below are observed along with the disfluencies. Stuttering typically has its origins in childhood. ), Stuttering and related disorders of fluency (pp. https://doi.org/10.1016/j.jfludis.2013.03.001, Coifman, K. G., & Bonanno, G. A. Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. The ASHA Leader, 18(3), 1415. Defining cluttering: The lowest common denominator. Cognitive restructuring is a strategy designed to help speakers change the way they think about themselves and their speaking situations. The attitudes of high school peers toward stuttering and toward persons who stutter can be improved through education in the form of classroom presentations about stuttering (Flynn & St. Louis, 2011). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. Counseling parents of children who stutter. Perspectives on Fluency and Fluency Disorders, 11(1), 711. Psychology Press. A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. Language, Speech, and Hearing Services in Schools, 43(4), 536548. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. 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. Is parentchild interaction therapy effective in reducing stuttering? (2007). Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. American Journal of Speech-Language Pathology, 20(3), 163179. Bargaining, 5. American Journal of Speech-Language Pathology, 2(2), 6573. Psychology Press. One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). 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). Journal of Fluency Disorders, 50, 5971. Prevalence of stuttering in primary school children in Cairo-Egypt. In F. L. Myers & K. O. St. Louis (Eds. Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). increasing effective and efficient communication. Journal of Speech, Language, and Hearing Research, 61(5), 12381250. (2014). 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. The cost of such avoidance can be great because of the resulting impact on the persons ability to say what they want to say, when they want to say it. Pro-Ed. https://doi.org/10.1016/j.jfludis.2018.10.003, Bray, M. A., & Kehle, T. J. Please enable it in order to use the full functionality of our website. Early childhood stuttering for clinicians by clinicians. Other disorders, such as apraxia of speech and/or articulation and phonological disorders, can affect speech intelligibility; assessment of speech production can be used to rule out these causes of reduced speech intelligibility. 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). 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). 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). The skilled helper: A problem-management and opportunity-development approach to helping. Following are descriptions of each of these forms of disfluency. Timing refers to the initiation of treatment relative to the diagnosis. Video self-modeling as a post-treatment fluency recovery strategy for adults. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Therefore, clinicians may want to ask open-ended questions to assess communication across specific situations (e.g., How do you participate in class? How do you talk to strangers? Please describe a situation when you ordered food from a restaurant. How did it feel?). Journal of Fluency Disorders, 36(4), 290295. This relationship is recognized as one of the common factors that account for the effectiveness of counseling (common factors theory; Wampold, 2001). Approximately 95% of children who stutter start to do so before the age of 4 years, and the average age of onset is approximately 33 months. Amster, B. J., & Klein, E. R. (2018). Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). Clinical characteristics associated with stuttering persistence: A meta-analysis. Disfluent behavior becomes more complex as fear of speaking, anxiety, and resulting avoidance increase. The role of effortful control in stuttering severity in children: Replication study. Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). Wampold, B. E. (2001). American Journal of Speech-Language Pathology, 27(3S), 11801194. Remaining informed of research in the area of fluency disorders and advancing the knowledge base of the nature of the disability, screening, diagnosis, prognostic indicators, assessment, treatment, and service delivery for individuals with fluency disorders. https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. It is not possible to determine with certainty which children will continue to stutter, but there are some factors that indicate a greater likelihood that stuttering will become chronic. The purpose of CBT is to modify current negative thoughts, emotions, and/or behaviors and replace them with positive ones through identification of thought patterns and challenging cognitive distortions in real time. Traits of attention deficit/hyperactivity disorder in school-age children who stutter. The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). See ASHAs Practice Portal resource on Transitioning Youth. What we know for now IN BRIEF. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. https://doi.org/10.1016/S0094-730X(01)00098-5. It can also be challenging to assess the reading fluency of bilingual students who stutter. International Journal of Language & Communication Disorders, 49(1), 113126. https://doi.org/10.1111/1469-7610.00093, de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M. C. (2015). Universitetsforlaget. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). See ASHAs resource on assessment of fluency disorders in the context of the WHO ICF framework. Setting refers to the location of treatment (e.g., home, community-based [including work settings], school environments, clinic room). NonEnglish-speaking countries reported prevalence rates similar to those reported in English-speaking countries. Intervention procedures for the young stutterer. Parents can also report if secondary behaviors are present in both languages. reports changing conception of stuttering from exclusively negative to having positive features. Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. The neurological underpinnings of cluttering: Some initial findings. For preschool children who stutter, parent and family involvement in the treatment process is essential, as is a home component (Kelman & Nicholas, 2020). In D. Ward & K. Scaler Scott (Eds. Seminars in Speech and Language, 35(2), 6779. American Journal of Speech-Language Pathology, 26(4), 11051119. In K. O. Lewis (Ed. 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 . Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. Onslow, M., Packman, A., & Harrison, E. (2020). Adults with fluency disorders have likely experienced years of treatment with varied outcomes. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). 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). Through a process of identifying the assumptions underlying their thoughts, they can evaluate whether those thoughts are helpful (or valid) and ultimately adopt different assumptions or thoughts. Parental involvement is an integral part of any treatment plan for children who stutter. Cluttering treatment: Theoretical considerations and intervention planning. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Early childhood stuttering therapy: A practical guide. Journal of Fluency Disorders, 36(2), 122129. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. (2017). The individual learns strategies for generalization of skills to the classroom, workplace, and community. (2010). (2015). More recently, CBT and mindfulness have been applied to stuttering therapy and may support that CBT+mindfulness is more beneficial to clients who stutter than CBT alone (Gupta et al., 2016; Harley, 2018). 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). Psychosocial support for adults who stutter: Exploring the role of online communities. Breakdowns in fluency and clarity can result from. Prior to developing generalization activities, the SLP needs to consider the individuals profile. the impact of communication impairments on, Relevant case history (as appropriate for age), including. The specific strategy they select will depend on when the client catches the disfluencyin anticipation of the moment of disfluency, in the moment, or following the moment (Van Riper, 1973). Studies in tachyphemia: III. Code of ethics [Ethics]. 1997- American Speech-Language-Hearing Association. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. American Journal of Speech-Language Pathology, 11(1), 4149. Stuttering, the most common fluency disorder, is an interruption in the flow of speaking characterized by specific types of disfluencies, including, These disfluencies can affect the rate and rhythm of speech and may be accompanied by. Scaler Scott, K., & Ward, D. (2013). A clinicians first responsibility when treating an individual of any age is to develop a thorough understanding of the stuttering experience and a speakers successful and unsuccessful efforts to cope with his or her communication problem (Manning & DiLollo, 2018, p. 370). explaining or interpreting symptoms of stuttering, providing advice on how to respond to someone who stutters, or. Craig, A., Blumgart, E., & Tran, Y. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). B. Cluttering and autism spectrum disorders. Allyn & Bacon. Stuttering: Research and therapy. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. 9099). Structural and functional abnormalities of the motor system in developmental stuttering. Folia Phoniatrica et Logopaedica, 19. Educating other professionals about the needs of individuals with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders. Perspectives on Fluency and Fluency Disorders, 1(4), 5569. Motivational interviewing: Helping people change. https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. Nurturing a resilient mindset in school-aged children who stutter. How stuttering develops: The multifactorial dynamic pathways theory. https://doi.org/10.1044/1092-4388(2008/07-0111), Prochaska, J. O., & DiClemente, C. C. (2005). Symptoms and severity of stuttering and cluttering can vary (Davidow & Scott, 2017; St. Louis & Schulte, 2011). reducing secondary behaviors and minimizing avoidances. SIG 4 Perspectives on Fluency and Fluency Disorders. https://doi.org/10.1016/j.jfludis.2011.04.002, Foote, G. (2013). frequency of exposure to all languages used by the child and their proficiency (comprehension and production) in each language; family history of stuttering or cluttering; description of disfluency and rating of severity; age of onset of disfluency and patterns of disfluency since onset (e.g., continuous or variable); previous fluency treatment and treatment outcomes; exploration of parental reactions to the childs moments of disfluency or speaking frustration; and. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. 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).