https://doi.org/10.1044/2017_AJSLP-17-0146, St. Louis, K. O., & Hinzman, A. R. (1986). Disclosure of stuttering and quality of life in people who stutter. Consequently, they may speak less to avoid being disfluent, and they may avoid social situations. (2003). Scaler Scott, K. (2010). Fluency disorders do not necessarily affect test scores or subject grades. 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. 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). Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. Journal of Fluency Disorders, 38(2), 6687. Crystal ball gazing: Research and clinical work in fluency disorders in 2026. Stuttering: An integrated approach to its nature and treatment. Journal of Speech, Language, and Hearing Research, 62(5), 13711372. 155192). Communication Disorders Quarterly, 39(2), 335345. Journal of Fluency Disorders, 35(4), 333354. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). An examination of various aspects of auditory processing in clutterers. Education, 136(2), 159168. Journal of Fluency Disorders, 49, 1328. https://doi.org/10.1044/2017_JSLHR-S-16-0343, Snsterud, H., Feragen, K. B., Kirmess, M., Halvorsen, M. S., & Ward, D. (2019). Genetic bases of stuttering: The state of the art, 2011. American Journal of Speech-Language Pathology, 7(4), 6276. These modifications are used regardless of whether a particular word is expected to be produced fluently. https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Allyn & Bacon. (2014). 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. See ASHAs Practice Portal page on Cultural Responsiveness. 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). https://doi.org/10.1044/1058-0360(2011/09-0102), Ntourou, K., Conture, E. G., & Walden, T. A. Section 504 of the Rehabilitation Act of 1973 also applies to individuals with disabilities in a work setting. Journal of Fluency Disorders, 43, 116. Advocating for individuals with fluency disorders and their families at the local, state, and national levels. Pro-Ed. Seminars in Speech and Language, 37(3), 145152. Estimates of incidence and prevalence vary due to a number of factors, including disparities in the sample populations (e.g., age), how stuttering was defined, and how stuttering was identified (e.g., parent report, direct observation). Sheehan, J. G. (1970). https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. https://doi.org/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. Journal of Speech, Language, and Hearing Research, 45(6), 10971105. These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. Clients often report successful stuttering therapy as a transformational experience progressing from avoidance to acceptance and openness, increasing self-confidence and self-efficacy (Plexico et al., 2005; Tichenor & Yaruss, 2019a). With this approach, parents are trained to provide verbal contingencies based on whether a childs speech is fluent or stuttered (M. Jones et al., 2005; Onslow et al., 2003). Onslow, M., Packman, A., & Harrison, E. Sadness/Depression, 6. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. For example, when selecting reading passages, it may be difficult to determine the linguistic complexity of a text in a language unfamiliar to the clinician. https://doi.org/10.1016/j.jfludis.2017.09.004, Cassar, M. C., & Neilson, M. D. (1997). Service delivery for fluency disorders encompasses, among other factors, treatment format, provider(s), dosage, timing, and setting. 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. One example of an approach that incorporates cognitive restructuring is Acceptance and Commitment Therapy (ACT; Beilby & Brynes, 2012; Beilby et al., 2012a; Palasik & Hannan, 2013). Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. Preschool children who stutter showed differences in event-related brain potentials used as indices of language processing. 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). The ASHA Leader, 11(10), 621. Van Borsel, J., Maes, E., & Foulon, S. (2001). Dosage refers to the frequency, intensity, and duration of treatment. Clinical implications of situational variability in preschool children who stutter. Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). Miller, W. R., & Rollnick, S. (2013). https://doi.org/10.1044/0161-1461.2602.162. Journal of Speech, Language, and Hearing Research, 60(9), 24832505. (2004). Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. (2009). 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. Reducing bullying through role-playing and self-disclosure. Harper & Row. 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). A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). St. Louis, K. O., & Flynn, T. W. (2018). https://doi.org/10.1044/cds20.1.15, Silverman, S., & Bernstein Ratner, N. (2002). These individuals are said to experience covert stuttering (B. Murphy et al., 2007). https://doi.org/10.1044/1058-0360(2003/070), Arenas, R. M., Walker, E. A., & Oleson, J. J. Cambridge University Press. Aphasia. When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. Sisskin, V. (2018). The term overt stuttering is used when core speech behaviors are present. Depression & Anxiety, 27(7), 687692. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. production of words with an excess of physical tension or struggle. Journal of Fluency Disorders, 61, 105713. https://doi.org/10.1016/j.jfludis.2019.105713, Douglass, J. E., Schwab, M., & Alvarado, J. Stuttering and cluttering. https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). explaining or interpreting symptoms of stuttering, providing advice on how to respond to someone who stutters, or. Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. Stuttering: Research and therapy. Such individuals may benefit from treatment strategies that focus on improving speech efficiency by reducing word avoidance and increasing spontaneity in communication. Cluttering treatment: Theoretical considerations and intervention planning. https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). Summary - Typical vs Atypical Pneumonia. typical vs atypical disfluencies asha. American Journal of Speech-Language Pathology, 12(2), 243253. Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). Building clinical relationships with teenagers who stutter. https://doi.org/10.1044/ffd22.2.51, Berquez, A., & Kelman, E. (2018). Perspectives on Fluency and Fluency Disorders, 23(2), 5469. Manning, W. H., & Quesal, R. W. (2016). Perspectives on Fluency and Fluency Disorders, 16(1), 1517. Fluency Disorders (Practice Portal). Other observable, secondary or concomitant, stuttering behaviors can include body movements (e.g., head nodding, leg tapping, fist clenching), facial grimaces (e.g., eye blinking, jaw tightening), and distracting sounds (e.g., throat clearing). Presence of stutteringAn estimated one third of people who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). For example, English language learners may have word-finding problems in the second language. Sheehan, V. M., & Sisskin, V. (2001). Higher incidence rates of stuttering have been reported in preschool-aged children (11.2%; Reilly et al., 2013), with prevalence estimates reported as 2.2%5.6% (Yairi & Ambrose, 2013). Bullying in adolescents who stutter: Communicative competence and self-esteem. Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. 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. Journal of Communication Disorders, 37(1), 3552. Nurturing a resilient mindset in school-aged children who stutter. Differentiating between typical disfluencies and stuttering (i.e., ambiguous and unambiguous moments of stuttering) is a critical piece of assessment, particularly for preschool children (see ASHAs resource on characteristics of typical disfluency and stuttering). Singular. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. In D. Ward & K. Scaler Scott (Eds. Seminars in Speech and Language, 23(3), 181186. Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency. Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their childs environment. Parents of Preschoolers Parents of school-age children Just for Kids Teens Adults Teachers SLPs Physicians Employers News and Blog February 7, 2023 Grace in Advocacy See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. 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). International Journal of Speech-Language Pathology, 17(4), 367372. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. https://doi.org/10.1002/hbm.23487, Dignazio, L. E., Kenny, M. M., Raj, E. X., & Pelkey, K. D. (2020). Perspectives on Fluency and Fluency Disorders, 11(1), 711. Anger/Resistance, 4. Signs and symptoms. B. gain insights from others who may be further along in treatment, have opportunities to gain self-confidence from mentoring others, and. Journal of Fluency Disorders, 13(5), 331355. 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). Self-disclosure involves communicating to others information that reveals ones identity as a person who stutters. Apply Now. 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). (2010). Enhancing treatment for school-age children who stutter: II. Journal of Speech, Language, and Hearing Research, 54(6), 14851496. I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike). For example, an individual might elect to self-disclose in a workplace and educate coworkers about fluency disorders via a group presentation followed by a question-and-answer period. The underlying relationship between stuttering and working memory is not fully understood but may be related to interruptions in sensorimotor timing for developmental stuttering and may involve both the basal ganglia and the prefrontal cortex (Bowers et al., 2018). educates the individual who stutters and their family members about stuttering and communication and. 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). Howell, P., & Davis, S. (2011). Thieme. 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). Temperament, emotion, and childhood stuttering. In E. G. Conture & R. F. Curlee (Eds. 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). Oral reading may not be a valid measure of reading fluency for children who stutter, as fluency breakdowns will slow reading rate. Brain, 136(12), 37093726. https://doi.org/10.1044/1092-4388(2011/10-0304), Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K. (2002). 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). Lippincott Williams & Wilkins. Wampold, B. E. (2001). https://doi.org/10.1176/appi.books.9780890425596, American Speech-Language-Hearing Association. 115134). Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). 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. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders. In B. J. Amster & E. R. Klein (Eds. They have long-held beliefs about stuttering that positively or negatively affect self-perceptions about their communication skills and their motivation for change (Daniels, 2007). 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. Technology has been incorporated into the delivery of services for fluency, including the use of telepractice to deliver face-to-face services remotely. Individuals may experience the impact of fluency disorders in social and emotional, academic, and vocational domains. The clutterer. Molt, L. F. (1996). https://doi.org/10.1016/j.jfludis.2008.01.001. 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. 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/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. https://doi.org/10.1002/mgg3.276, Frigerio-Domingues, C. E., Gkalitsiou, Z., Zezinka, A., Sainz, E., Gutierrez, J., Byrd, C., Webster, R., & Drayna, D. (2019). Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. Journal of Fluency Disorders, 26(3), 179206. In J. C. Norcross & M. R. Goldfried (Eds. https://doi.org/10.1016/j.jfludis.2007.02.001. https://doi.org/10.1016/j.jcomdis.2015.10.003. American Journal of Speech-Language Pathology, 27(3S), 11391151. In D. Ward & K. Scaler Scott (Eds. The clinical applications of Acceptance and Commitment Therapy with clients who stutter. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. modifying instructions to accommodate the home language, using exemplars in audio or video format in the home language, and. Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. In B. J. Amster & E. R. Klein (Eds. Traditional stuttering modification strategies (Manning & DiLollo, 2018) include the following: These strategies require an individual to identify a moment of disfluency before, during, or after it occurs and to make adjustments to reduce tension and struggle. Cluttering can co-occur with other disorders, including. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). 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). Journal of Speech, Language, and Hearing Research, 60(11), 30973109. Onslow, M., & Yaruss, J. S. (2007). https://doi.org/10.1016/0094-730X(88)90004-6, Onslow, M., & OBrian, S. (2012). See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 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. A study of pragmatic skills of clutterers and normal speakers. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). See the Assessment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0190. Changing adolescent attitudes toward stuttering. Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. 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). Daly, D. A., Simon, C. A., & Burnett-Stolnack, M. (1995). https://doi.org/10.1016/j.jfludis.2006.02.002. Quick: Talk fast & dont stutter! Counseling parents of children who stutter. The human capacity to thrive in the face of potential trauma. 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. Journal of Fluency Disorders, 58, 110. 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). is more open and willing to disclose and talk about their stuttering; experiences reduced impact from stuttering; generalizes attitudes, beliefs, and behaviors across contexts; reports feeling more authentic and enjoying social conversations; and. have a sense of belonging and experience less stigma. All speakers are disfluent at times. https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Scope of practice in speech-language pathology [Scope of practice]. Individuals who stutter consistently report experiencing limitations, discrimination, and glass ceilinglike effects at their jobs and within their careers (Bricker-Katz et al., 2013; Cassar & Neilson, 1997; Klein & Hood, 2004). American Psychiatric Association. Seminars in Speech and Language, 28(4), 312322. The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. increased social communication participation (Manning & DiLollo, 2018). van Zaalen, Y., & Reichel, I. K. (2014). A phenomenological analysis of the moment of stuttering. (2010). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Below is a list of approaches commonly used with school-age children, adolescents, and adults who stutter. For example, some children from bilingual or multicultural backgrounds may experience stuttering onset or a temporary increase in stuttering as result of being in new and unfamiliar situations, learning a new language, or being exposed to mixed linguistic input (Shenker, 2013). A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering. Scaler Scott, K. (2013). American Journal of Speech-Language Pathology, 26(4), 11051119. Specific standardized tests can be used to rule out word-finding difficulties. Conture, E. G. (2001). Clinical utility of self-disclosure for adults who stutter: Apologetic versus informative statements. Journal of Fluency Disorders, 36(4), 290295. Neurobiology of Disease, 69, 2331. learning disabilities (Wiig & Semel, 1984). minimizing the adverse impact of stuttering (Yaruss et al., 2012). Speech modification (including fluency shaping) strategies (Bothe, 2002; Guitar, 1982, 2019) include a variety of techniques aimed at making changes to the timing and tension of speech production or altering the timing of pauses between syllables and words. Stuttering More than 70 million people around the world struggle with stuttering, according to The Stuttering Foundation. The role of self-help/mutual aid in addressing the needs of individuals who stutter. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). (2010). 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). https://doi.org/10.1044/1058-0360.0202.65. https://doi.org/10.1044/cicsd_31_S_69, Blood, G. W., & Blood, I. M. (2016). These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). Assisting children who stutter in dealing with teasing and bullying. https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Prevalence of stuttering in primary school children in Cairo-Egypt. 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). Counseling begins with active listening and continues with microskills (Egan, 2013) that emphasize attending, showing empathy, demonstrating shared interest in the individual/family, and working to build trust. Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). SLPs can include teachers in the treatment process by educating them about fluency disorders, involving them in treatment sessions, and having them assist with assignments outside of treatment sessions. https://doi.org/10.1016/j.jfludis.2013.01.001. For some people, the use of these behaviors can result in little or no observable stuttering. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. if monitoring or treatment (direct or indirect) is recommended. Managing cluttering: A comprehensive guidebook of activities. Stuttering may influence an individuals perception of their career possibilities and professional limitations (Klein & Hood, 2004). https://doi.org/10.1016/j.jcomdis.2010.12.003. https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). An increase in observable disfluent behaviors may occur as the individual communicates more freely. 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). https://doi.org/10.1044/2018_JSLHR-S-17-0378, Byrd, C. T. (2018). Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). 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). These strategies help individuals learn about the speech mechanism and how it operates during both fluent and disfluent speech so they can modify it. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. ), The treatment of stuttering in the young school-aged child (pp. The impact of fluency disorders often extends to social and vocational aspects of the individuals life. For example, cluttering symptoms may decrease during a formal speech evaluationdue to increased self-monitoringbut increase in more comfortable situations where the person is less likely to self-monitor.