Stuttering Therapy Resources. The clinical applications of Acceptance and Commitment Therapy with clients who stutter. Journal of Fluency Disorders, 40, 3543. Plural. Referring to other health care professionals when outside support is needed to facilitate treatment goals for interfering behaviors (e.g., anxiety, depression). Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). In E. Conture & R. F. Curlee (Eds. The primary provider of fluency treatment is the SLP. A phenomenological understanding of successful stuttering management. Seminars in Speech and Language, 35(2), 114131. Seminars in Speech and Language, 24(1), 2732. 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. 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. 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. The young childs awareness of stuttering-like disfluency. (2006). 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. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. www.asha.org/policy/, American Speech-Language-Hearing Association. 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). Peer support for people who stutter: History, benefits, and accessibility. Epidemiology of stuttering in the community across the entire life span. 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). Some children who stutter or clutter may only experience symptoms situationally. Stuttering severity may vary dramatically by speaking situation. The term atypical has been applied to rapid atrial tachycardias with ECG patterns differing from the typical and reverse typical flutter described above, and also to re-entrant tachycardias with circuit configuration different from the typical RA flutter circuit, even if they have an ECG pattern similar to typical flutter. Journal of Fluency Disorders, 36(2), 122129. Palin ParentChild Interaction therapy: The bigger picture. American Journal of Speech-Language Pathology, 29(1), 201215. Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. Symptoms and severity of stuttering and cluttering can vary (Davidow & Scott, 2017; St. Louis & Schulte, 2011). These are called typical disfluencies or nonfluencies. Self-help and support groups for people with cluttering. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). Journal of Fluency Disorders, 29(4), 255273. Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. For example, English language learners may have word-finding problems in the second language. typical vs atypical disfluencies asha. Another example is Cognitive Behavior Therapy (CBT; Menzies et al., 2019, 2009). american journal of audiology (aja) american journal of speech-language pathology (ajslp) journal of speech, language, and hearing research (jslhr) language, speech, and hearing services in schools (lshss) perspectives of the asha special interest groups; topics; special collections https://doi.org/10.1016/S0094-730X(01)00098-5. deletion and/or collapsing of syllables (e.g., I wanwatevision). increased social communication participation (Manning & DiLollo, 2018). https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. (2010). Resilience has been examined in the stuttering literature as one factor that may protect people from the adverse effects of chronic stuttering (Craig et al., 2011; Freud & Amir, 2020). https://doi.org/10.1017/S135246580001643X. A thematic analysis of late recovery from stuttering. Scaler Scott, K. (2011). See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016a; Coleman & Yaruss, 2014; Vanryckeghem & Kawai, 2015; WHO, 2001; Yaruss, 2007; Yaruss & Quesal, 2004, 2006), a comprehensive fluency assessment is conducted to identify and describe. Self-efficacy and quality of life in adults who stutter. Genetic contributions to stuttering: The current evidence. Journal of Speech, Language, and Hearing Research, 62(8), 26912702. Skip to main content. Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). https://doi.org/10.1055/s-2007-986528, Yaruss, J. S., Coleman, C., & Hammer, D. (2006). Operant treatment (e.g., Palin ParentChild Interaction Therapy, Kelman & Nicholas, 2020; Lidcombe Program, Onslow et al., 2003) incorporates principles of operant conditioning and uses a response contingency to reinforce the child for fluent speech and redirect disfluent speech (the child is periodically asked for correction). American Journal of Speech-Language Pathology, 27(3S), 11801194. Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. Prevalence of speech disorders in elementary school students in Jordan. The social and communication impact of stuttering on adolescents and their families. Typical disfluencies often resolve by age five and tend to cycle, meaning they come and go. Other speech or language concerns are also present. 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. This law also applies to organizations that receive financial assistance from any federal department or agency. Journal of Fluency Disorders, 54, 1423. Plural. Cluttering: A synergistic framework. These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). Journal of Communication Disorders, 80, 8191. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. (2011). Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Communication Disorders Quarterly, 39(2), 335345. Some children go through a disfluent period of speaking. Teasing/bullying experienced by children who stutter: Toward development of a questionnaire. Donaher, J., & Richels, C. (2012). (2018). 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). may show increased disfluency rates (decreased reading fluency) because they cannot change the words to avoid moments of stuttering as easily as they can in conversation, and. Journal of Fluency Disorders, 50, 7284. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. ), The treatment of stuttering in the young school-aged child (pp. https://doi.org/10.1055/s-0034-1371755, Jones, R. M., Conture, E. G., & Walden, T. A. Mis- and overidentification of stuttering in bilingual speakers may occur due to typical disfluencies observed in development, code switching, and wording changes to maintain the grammatical integrity of the dominant language. https://doi.org/10.1016/j.jfludis.2014.01.001. Psychology Press. (2018). One example of a desensitization activity is pseudostutteringthe use of voluntary stuttering behaviorsin different, and increasingly more difficult, situations where the individual might fear the occurrence of real moments of stuttering (e.g., Reardon-Reeves & Yaruss, 2013; J. G. Sheehan, 1970). Advances in Psychiatric Treatment, 12(1), 6368. Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. Mild stuttering, on the other hand, tends to appear more regularly. 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. EBP Briefs, 2(4), 18. https://doi.org/10.1016/j.jfludis.2006.02.002. Fluency disorders do not necessarily affect test scores or subject grades. https://doi.org/10.1044/1058-0360(2003/070), Arenas, R. M., Walker, E. A., & Oleson, J. J. 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). https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). Desensitization can help decrease word avoidance and reduce fear. Journal of Speech, Language, and Hearing Research, 63(9), 29953018. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. Technological advances and the expansion of social media outlets have increased opportunities for adults who stutter to connect, share, and gain information through the Internet (Fuse & Lanham, 2016; Raj & Daniels, 2017) and stuttering-related podcasts (Dignazio et al., 2020). 115134). There may be a relationship between stuttering and working memory. Whurr Publishers. if monitoring or treatment (direct or indirect) is recommended. Cengage Learning. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). Repetitive negative thinking, temperament, and adverse impact in adults who stutter. Discussions about the physical experience of anxiety and ways to reduce it and the sense of loss of control and time pressure may be of further benefit (e.g., mindfulness and grounding; Beilby et al., 2012a; Boyle, 2011; Harley, 2018). When a bilingual clinician is not available, using an interpreter is a viable option. Languages differ with regard to developmental milestones, and direct comparison of scores across languages can be misleading, even if the assessments appear similar (Thordardottir, 2006). 147171). Journal of Communication Disorders, 37(1), 3552. American Journal of Speech-Language Pathology, 27(3S), 11111123. Seminars in Speech and Language, 23(3), 181186. In addition, some persons who stutter substitute words, omit words, or use circumlocution to hide stuttering symptoms (B. Murphy et al., 2007). Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 61, 105713. https://doi.org/10.1016/j.jfludis.2019.105713, Douglass, J. E., Schwab, M., & Alvarado, J. Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. Code of ethics [Ethics]. 6396). Clinical characteristics associated with stuttering persistence: A meta-analysis. B. These modifications are used regardless of whether a particular word is expected to be produced fluently. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. https://doi.org/10.1044/cicsd_25_S_8, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2017). It is not appropriate to determine a standard score if the norming sample of the assessment is not representative of the individual being assessed. Parents can also report if secondary behaviors are present in both languages. Signs and symptoms. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. Stuttering and reading fluency: Information for teachers [Brochure]. Palin ParentChild Interaction Therapy for early childhood stammering. Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. Multicultural issues in school settings. The clutterer. Journal of Speech, Language, and Hearing Research, 61(5), 12381250. Disclosing a fluency disorder has many benefits on both the speaker (Boyle & Gabel, 2020; Boyle et al., 2018; Mancinelli, 2019) and the listener (Byrd, Croft, et al., 2017; Byrd, McGill, et al., 2017; Ferguson et al., 2019; Healey et al., 2007). (2018). Teigland, A. 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). (2014). B., & Al-Khamra, R. (2015). Disfluent behavior becomes more complex as fear of speaking, anxiety, and resulting avoidance increase. the diagnosis of a fluency disorder (stuttering, cluttering, or both); a differential diagnosis between fluency disorders and reading disorders, language disorders, and/or speech sound disorders; descriptions of the characteristics and severity of the fluency disorder; judgments on the degree of impact the fluency disorder has on verbal communication and quality of life; a determination if the person will benefit from treatment; a determination of adverse educational, social, and vocational impact; parent or family counseling to determine optimal responses to the childs speech and stuttering; and. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. Sociodynamic relationships between children who stutter and their non-stuttering classmates. https://doi.org/10.1016/j.jfludis.2012.12.001, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012a). Counseling individuals with fluency disorders and their families and providing education aimed at self-acceptance and reducing negative reactions (see ASHAs Practice Portal page on, Consulting and collaborating with individuals with fluency disorders, families, other professionals, peers, and other invested parties to identify priorities and build consensus on an intervention plan focused on functional outcomes (see ASHAs resources on. Despite these challenges, some of the therapy that applies to adults can be just as effective with teens/adolescents. Strategies aimed at altering the timing of pausing are used to increase the likelihood of fluent speech production and to improve overall communication skills (e.g., intelligibility, message clarity). Support (both giving and receiving) can be valuable for improving attitudes, boosting self-confidence, and reducing feelings of isolation (Yaruss et al., 2007). https://scholarworks.bgsu.edu/comm_disorders_diss/7/. 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). 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). Recommending related services when necessary for management and treatment in different settings (e.g., classroom, work, community). Guitar, B. Given that cluttering may co-occur with other disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder), having any of these disorders may be a risk factor; however, not all individuals with these disorders also exhibit cluttering. Stuttering-related podcasts: Audio-based self-help for people who stutter. A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. Enlisting the help of a person familiar with the language and rating fluency in short speech intervals also may help to accurately and reliably judge unambiguous stuttering (Shenker, 2011). https://doi.org/10.1044/1092-4388(2013/12-0280), Boyle, M. P. (2013b). "Atypical" disfluencies include: sound repetitions ("s-s-s-so"); syllable repetitions ("be-be-be-be-because"); prolongations ("Aaaaaaaaaaaaand"); and SIG 4 Perspectives on Fluency and Fluency Disorders. ), Current issues in stuttering research and practice (pp. Reardon-Reeves, N., & Yaruss, J. S. (2013). A comprehensive treatment approach for school-age children, adolescents, and adults includes multiple goals and considers the age of the individual and their unique needs (e.g., communication in the classroom, in the community, or at work). American Journal of Speech-Language Pathology, 16(1), 6568. 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: Prevalence and trends of developmental disabilities among children in the United States: 20092017. Journal of Fluency Disorders, 58, 110. https://doi.org/10.1016/j.cub.2016.02.068, Beilby, J. M., & Byrnes, M. L. (2012). For students who stutter, the impact goes beyond the communication domain. Limited research is available that identifies the causes of cluttering. The speakers measured speech rate is not always greater than average, but the listener perceives it as rapid. We often use the term "emergent" to describe skills that are developing, but have not fully emerged. Approximately 88%91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013). 7184). https://doi.org/10.1044/leader.OV.18032013.14, Freud, D., & Amir, O. Adults also may want to involve family members, friends, or coworkers as part of a treatment plan. Managing cluttering: A comprehensive guidebook of activities. Disclosing a fluency disorder may be done a number of ways, such as verbally stating I stutter/have a speech disorder or by pseudostuttering or openly stuttering, while doing so confidently (McGill et al., 2018). 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). See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Journal of Fluency Disorders, 26(3), 179206. https://doi.org/10.1055/s-0034-1382151, Chang, S.-E., Garnett, E. O., Etchell, A., & Chow, H. M. (2019). One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). the individuals lived experiences with stuttering, the perceived impact of these experiences with stuttering, and. Persons who stutter may appear to have expressive language problems because of a tendency to avoid speaking or speak in a way thats unclear to the listener. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. Journal of Fluency Disorders, 34(3), 187200. https://doi.org/10.1016/0094-730X(88)90003-4. Wampold, B. E. (2001). Journal of Fluency Disorders, 11(2), 131149. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). 297325). What do people search for in stuttering therapy: Personal goal-setting as a gold standard? Family historyAnecdotal reports indicating the presence of cluttering in more than one family member suggest that family history may be a risk factor. 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. There are two predominant types of atypical disfluencies: stuttering and cluttering. 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). Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. 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). https://doi.org/10.1016/j.jfludis.2018.10.003, Bray, M. A., & Kehle, T. J. Individuals may experience stuttering in different ways with siblings, their spouse, or other family members. 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. Timing refers to the initiation of treatment relative to the diagnosis. You do not have JavaScript Enabled on this browser. See ASHAs resource on person- and family-centered care. Journal of Fluency Disorders, 49, 1328. Workplace in fluency management: Factoring the workplace into fluency management. In B. J. Amster & E. R. Klein (Eds. American Journal of Speech-Language Pathology, 11(1), 4149. Current Biology, 26(8), 10091018. The epidemiology of cluttering with stuttering. https://doi.org/10.3109/17549507.2015.1010583, Adriaensens, S., Beyers, W., & Struyf, E. (2015). Adolescents also may be particularly susceptible to peer pressure and bullying at this time. As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. (2011). https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). Increasing fluency may not be a goal for an adult or may be only one aspect of a comprehensive and multidimensional approach (Amster & Klein, 2018). Empirical research on whether bilingual individuals who stutter are more disfluent in one language than the other is sparse and based on small case studies (Tellis & Tellis, 2003), but many bilingual individuals who stutter report this to be the case (Nwokah, 1988). Speech modification approaches to stuttering treatment in schools. Available 8:30 a.m.5:00 p.m. Singular. https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. The utility of stuttering support organization conventions for young people who stutter. 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). Areas of the brain that were studied and the technologies used to conduct the research (e.g., PET, MEG, MRI, fMRI, NIRS, DCS) also varied widely. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Cluttering can co-occur with other disorders, including. See the Assessment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. In D. Ward & K. Scaler Scott (Eds. See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. (2005). In E. G. Conture & R. F. Curlee (Eds. Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). Social anxiety disorder in adults who stutter. An increase in observable disfluent behaviors may occur as the individual communicates more freely. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. In B. J. Amster & E. R. Klein (Eds. consultation with and referral to other professionals as needed. being more comfortable and open with stuttering and pseudostuttering; reporting experiencing decreased anxiety while communicating; reporting less adverse psychological, emotional, social, and functional impacts; reporting enjoying social communication, including with strangers; and. (2007). In L. Cummings (Ed. American Journal of Speech-Language Pathology, 27(2), 721736. Prior to developing generalization activities, the SLP needs to consider the individuals profile. A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. ), Cluttering: Research, intervention and education (pp. Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Egan, G. (2013). 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. 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). Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders. See also ASHAs resources titled Person-Centered Focus on Function: Preschool Stuttering [PDF], Person-Centered Focus on Function: School-Age Stuttering [PDF], and Person-Centered Focus on Function: Adult Stuttering [PDF] for examples of treatment goals consistent with the ICF framework. (2013). In N. B. Ratner & J. Tetnowski (Eds. International Journal of Language & Communication Disorders, 49(1), 113126. Developmental stuttering in children who are hard of hearing. In H. Gregory (Ed. I ran out of cheese and bread the other day while making sandwiches and now Im out so I need to go to the store), and/or. A comprehensive assessment for persistent stuttering should include a self-assessment of the experience of stuttering. 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). 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). Available 8:30 a.m.5:00 p.m. Merrill. 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). Conture, E. G. (2001). Language abilities of children who stutter: A meta-analytical review. Luterman, D. M. (2006). Language assessment and intervention for the learning disabled. 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 Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). ), Stuttering and related disorders of fluency (pp. (2007) for a description of how the stages of change model can be applied to fluency therapy.
