Stuttering in school-age children: A comprehensive approach to treatment. typical vs atypical disfluencies asha - letsgokaigai.jp These are called typical disfluencies or nonfluencies. https://doi.org/10.4324/9781351122351, Klein, J. F., & Hood, S. B. Allyn & Bacon. Potential neurological underpinnings of cluttering include dysregulation of the anterior cingulate cortex and the supplementary motor area (Alm, 2011) as well as increased activity in the basal ganglia and premotor cortex (Ward et al., 2015). The ASHA Leader, 11(10), 621. An examination of various aspects of auditory processing in clutterers. https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Journal of Speech, Language, and Hearing Research, 45(6), 10971105. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). SLPs may want to relate personal experiences when asking clients to share such vulnerable information. Journal of Fluency Disorders, 63, 105746. https://doi.org/10.1016/j.jfludis.2020.105746, Boyle, M. P., Milewski, K. M., & Beita-Ell, C. (2018). information regarding family, personal, and cultural perception of fluency. https://doi.org/10.1044/persp1.SIG4.55, Byrd, C. T., Croft, R., Gkalitsiou, Z., & Hampton, E. (2017). language or learning disability (Ntourou et al., 2011). Genetic bases of stuttering: The state of the art, 2011. Palin ParentChild Interaction Therapy for early childhood stammering. 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/10.1044/leader.FTR2.19072014.44, American Speech-Language-Hearing Association. When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. Journal of Fluency Disorders, 22(3), 219236. The young childs awareness of stuttering-like disfluency. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). 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. Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their childs environment. The role of self-help/mutual aid in addressing the needs of individuals who stutter. Bilingual SLPs who have the necessary clinical expertise to assess the childand are familiar with the languages they speakmay not always be available. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. 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). https://doi.org/10.1016/j.jfludis.2011.04.001, Shenker, R. C. (2013). Manning, W. H., & Quesal, R. W. (2016). (2018). Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. Journal of Fluency Disorders, 37(4), 242252. The purpose of the screening is to identify individuals who require further speech-language assessment. Developing culturally and linguistically relevant intervention plans focused on helping the individual achieve more fluent speech and self-acceptance of disfluency, providing treatment, documenting progress, and determining appropriate dismissal criteria. (2011). The utility of stuttering support organization conventions for young people who stutter. Children who stutter also may be at risk for experiencing bullying (Blood & Blood, 2004; Davis et al., 2002; Langevin et al., 1998). Mancinelli, J. M. (2019). increasing acceptance and openness with stuttering. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). typical vs atypical disfluencies asha. Defining cluttering: The lowest common denominator. Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). Another example is Cognitive Behavior Therapy (CBT; Menzies et al., 2019, 2009). Early childhood stuttering and electrophysiological indices of language processing. Brain, 131(1), 5059. (2006). Prins, D., & Ingham, R. J. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). Self-help and support groups for people with cluttering. Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. increased social communication participation (Manning & DiLollo, 2018). 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). One of the most widely used models of change is the transtheoretical or stages of change model (Prochaska & DiClemente, 2005). Language, Speech, and Hearing Services in Schools, 43(4), 536548. There are two predominant types of atypical disfluencies: stuttering and cluttering. https://doi.org/10.1093/brain/awu400, Choi, D., Conture, E. G., Walden, T. A., Lambert, W. E., & Tumanova, V. (2013). Stuttering-related podcasts: Audio-based self-help for people who stutter. The primary provider of fluency treatment is the SLP. Reducing negative reactions through desensitization and cognitive restructuring. Stuttering and labor market outcomes in the United States. BOBapp(2023) Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). Below is a list of approaches commonly used with school-age children, adolescents, and adults who stutter. Some example of stuttering (or atypical dysfluencies) would be: Monosyllabic whole word repetitions: (e.g. Unlike stuttering, there are no data regarding age since onset and long-term outcomes of cluttering. Journal of Fluency Disorders, 13(5), 357373. BMJ, 331(7518), 659661. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). 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. Molt, L. F. (1996). The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. 15). May 11, 2022 As a speech-language pathologist, you might often face the question of whether a young child is showing early signs of stuttering, or if those disruptions are simply typical speech disfluencies. Davidow, J. H., & Scott, K. A. Clinicians can help clients progress to active stages through building self-efficacy. Understanding and treating cluttering. Long-term follow-up of self-modeling as an intervention for stuttering. You do not have JavaScript Enabled on this browser. Counseling is an integral part of the assessment and treatment of individuals who stutter or clutter. Consider the individuals age, preferences, and needs within the context of family and community when selecting and adapting treatment approaches and materials. Stuttering and its treatment in adolescence: The perceptions of people who stutter. They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. (2019). Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. Epidemiology of stuttering: 21st century advances. Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. These should be considered during differential diagnosis but should not be the sole therapeutic strategies. They also can benefit from groups and intensive programs (Fry et al., 2014). 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. These simulations and applications of strategies might be most likened to cancellation and pull-out techniques used in stuttering. Understanding that awareness and concern about stuttering may vary across individuals and cultures and conducting a culturally and linguistically relevant comprehensive assessment. Shock, 2. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). Peer support for people who stutter: History, benefits, and accessibility. Differences in fluency across languages may be due to the social context in which the language is used (Foote, 2013), as well as the proficiency of each language spoken. Avoidance Reduction Therapy for Stuttering (ARTS). 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). 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). Childhood stuttering: Incidence and development. Adolescents also may be particularly susceptible to peer pressure and bullying at this time. What about those "atypical disfluencies?" - Stuttering Therapy Resources The person is having difficulty communicating messages in an efficient, effective manner. There are benefits of both individual and group treatment. Available 8:30 a.m.5:00 p.m. https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Children who stutter typically know how to read (decode) the printed form of words, but they may not be able to speak the printed form fluently. American Journal of Speech-Language Pathology, 11(1), 4149. Fluency treatment can occur at any point after the diagnosis. Drayna, D. (2011). 9099). 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). 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. See ASHAs Practice Portal pages on Counseling For Professional Service Delivery and Cultural Responsiveness for more information related to counseling. The presence of at least 1 disabling developmental condition was 5.5 times higher in CWS [children who stutter] when compared to children who do not stutter (Briley & Ellis, 2018, p. 2895). Stuttering Therapy Resources. Journal of Speech, Language, and Hearing Research, 31(3), 377385. 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). All speakers are disfluent at times. In J. C. Norcross & M. R. Goldfried (Eds. Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Journal of Fluency Disorders, 36(2), 122129. Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the Self-Stigma of Stuttering Scale (4S). See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). ; American Psychiatric Association, 2013). https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. https://doi.org/10.1055/s-2007-986528, Yaruss, J. S., Coleman, C., & Hammer, D. (2006). Scope of practice in speech-language pathology [Scope of practice]. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). Seminars in Speech and Language, 39(4), 324332. Overheard: Bilingual and disfluent: A unique treatment challenge. 6396). Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. having flexibility based on individual needs and desired outcomes (Amster & Klein, 2018). Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). The purpose of assessing fluency in a preschool child is to determine. Impact of stuttering severity on adolescents domain-specific and general self-esteem through cognitive and emotional mediating processes. Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. Differential treatment of stuttering in the early stages of development. (2019). The treatment of stuttering. 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). Assessment of speech fluency (e.g., frequency, type, and duration of disfluencies), speech rate, speech intelligibility, and the presence of secondary behaviors in a variety of speaking tasks (e.g., conversational and narrative contexts). The speakers measured speech rate is not always greater than average, but the listener perceives it as rapid. https://doi.org/10.1044/gics4.2.57, Van Zaalen, Y., & Reichel, I. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). Stuttering: Research and therapy. The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. https://doi.org/10.1016/j.jfludis.2014.12.002, Boyle, M. P., Beita-Ell, C., & Milewski, K. M. (2019). 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. For example, individuals who clutter may not be aware of communication breakdowns and, therefore, do not attempt to repair them. (2005). Psychology Press. atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. https://doi.org/10.1073/pnas.1901480116, Harasym, J., Langevin, M., & Kully, D. (2015). Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. (2011). 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. Emotional problems and parenting style do not cause stuttering. Structural and functional abnormalities of the motor system in developmental stuttering. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). Often referred to as advertising in the stuttering community, self-disclosure can involve. Temperamental characteristics of young children who stutter. Cluttering, another fluency disorder, is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). Journal of Communication Disorders, 58, 4357. (2011). Preschool children who stutter showed differences in event-related brain potentials used as indices of language processing. Effortful control, an aspect of temperament that supports self-regulation, may be predictive of stuttering severity and may facilitate positive change in treatment (Kraft et al., 2019). See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Stuttering and reading fluency: Information for teachers [Brochure]. Logos, 3, 8295. Journal of Fluency Disorders, 36(2), 110121. The scope of this page includes stuttering and cluttering across the life span. Journal of Fluency Disorders, 35(3), 216234. The Lidcombe Program of early stuttering intervention: A clinicians guide. Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. the asha leader; journals. 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). When a bilingual clinician is not available, using an interpreter is a viable option. In N. B. Ratner & J. Tetnowski (Eds. Explore how typical and atypical disfluencies differ, and find resources for guidance and support. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. These strategies, like speech modification strategies, are introduced along a hierarchy of speaking situations that varies both with linguistic demands and with the stressors of the environment. Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). The International Journal of Indian Psychology, 3(3), 7887. 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). The clutterer. Building clinical relationships with teenagers who stutter. (2016). A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. Erickson, S., & Block, S. (2013). Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. American Journal of Speech-Language Pathology, 26(4), 11051119. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. https://doi.org/10.1192/apt.12.1.63, Craig, A., & Tran, Y. Numerous treatment approaches and strategies have been developed in an attempt to help speakers reduce the negative reactions associated with stuttering (e.g., W. P. Murphy et al., 2007a). Eventually, they disappear after a few . Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. The individual learns strategies for generalization of skills to the classroom, workplace, and community. A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. 211230). The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Fluency: A review of developmental and remedial practices. https://doi.org/10.1016/S0021-9924(03)00052-2, Yaruss, J. S., & Quesal, R. W. (2006). Purpose Disfluencies associated with stuttering generally occur in the initial position of words. Children with persistent stuttering showed deficiencies in left gray matter volume with reduced white matter integrity in the left hemisphere. 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). ), Stuttering therapy: Rationale and procedures (pp. University Park Press. Daniels, D. (2007). https://doi.org/10.1044/1092-4388(2001/030), Finn, P. (2003). Hill, D. (2003). Characteristics of Typical Disfluency and Stuttering Title: The Differential Diagnosis of Disfluency Created Date: 7/18/2007 3:15:45 PM Adults are likely to have been living with stuttering for a long time. Journal of Fluency Disorders, 13(5), 331355. However, several likely gene mutations have been linked to stuttering (Frigerio-Domingues & Drayna, 2017). Typical vs. Atypical Antipsychotics: Main Differences and Effectiveness https://doi.org/10.1044/2019_JSLHR-S-18-0225. Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. For some people, the use of these behaviors can result in little or no observable stuttering. Journal of Fluency Disorders, 36(4), 290295. Psychology Press. (2020). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0190. Characteristics of Typical Disfluency and Stuttering - ASHA Journal of Fluency Disorders, 43, 1727. 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). Pro-Ed. Characteristics of Typical Disfluency and Stuttering Bakker, K., Myers, F. L., Raphael, L. J., & St. Louis, K. O. American Journal of Speech-Language Pathology, 27(3S), 11391151. Self-regulation and the management of stuttering. https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). https://doi.org/10.1002/da.20657, Bonanno, G. A., & Mancini, A. D. (2008). (2016a). Distinguishing Cluttering from Stuttering - @ASHA ), Cluttering: A clinical perspective (pp. reports changing conception of stuttering from exclusively negative to having positive features. Functional and neuroanatomical bases of developmental stuttering: Current insights. For students who stutter, the impact goes beyond the communication domain. Brain, 138(3), 694711. Journal of Fluency Disorders, 33(2), 8198. Typical childhood disfluencies may increase and decrease without any external influence. For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). The neurological underpinnings of cluttering: Some initial findings. Sisskin, V. (2018). 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. Pediatrics, 121(2), 369375. The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. Young children may or may not verbalize their reactions to stuttering. The epidemiology of cluttering with stuttering. The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker. Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). 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). 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. All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. Conture, E. G. (2001). Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). Genetic contributions to stuttering: The current evidence. Other identification strategies may include video or pseudostuttering analysis or tallying/freezing. Language abilities of children who stutter: A meta-analytical review. What is Typical Pneumonia? https://doi.org/10.1177/1073858418803594, Chang, S.-E., & Zhu, D. C. (2013). Early childhood stuttering therapy: A practical guide. Journal of Fluency Disorders, 32(2), 121138. Journal of Fluency Disorders, 35(4), 333354. Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Early childhood stuttering for clinicians by clinicians. https://doi.org/10.1542/peds.2012-3067, Ribbler, N. (2006). 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. When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. Individuals may experience stuttering in different ways with siblings, their spouse, or other family members. Clinical utility of self-disclosure for adults who stutter: Apologetic versus informative statements. Pro-Ed. Stuttering is often more severe when there is increased pressure to communicate (e.g., competing for talk time, giving a report at school, talking on the telephone/during a video chat, or interviewing for a job). Developmental Disfluency vs. Atypical Dysfluency/Stuttering: When to be In addition, some persons who stutter substitute words, omit words, or use circumlocution to hide stuttering symptoms (B. Murphy et al., 2007). 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). See ASHAs resource on assessment tools, techniques, and data sources. https://doi.org/10.1016/j.jfludis.2012.11.002, Yaruss, J. S. (1997). Journal of Speech, Language, and Hearing Research, 46(5), 12211233. Some examples of these are to openly discuss experiences with stuttering (from the client and the clinician with pseudostuttering or as described by previous clients who stutter) and model pseudostuttering and techniques, attitudes, and beliefs across speaking situations (Manning & Quesal, 2016; Watson, 1988). https://doi.org/10.1055/s-0034-1371755, Jones, R. M., Conture, E. G., & Walden, T. A. Yaruss, J. S., & Pelczarski, K. M. (2007). Nurturing a resilient mindset in school-aged children who stutter. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. Adjustments can include. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. 7). Perspectives on Fluency and Fluency Disorders, 22(1), 3446. With regard to cluttering, research is not far enough along to identify causes. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. (2009). Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/. Children and adolescents with fluency disorders may qualify for accommodations whether or not they have an active individualized education program (IEP). https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000).