United States Department of Labor. Cambridge University Press. Journal of Abnormal Psychology, 119(3), 479490. Al-Jazi, A. "I-I-I-I- want the ball") Stuttering and labor market outcomes in the United States. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). Journal of Speech, Language, and Hearing Research, 61(5), 12381250. Journal of Speech and Hearing Disorders, 49(1), 5358. Coexistence of stuttering and disordered phonology in young children. Covert stuttering. (2014). As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs are obligated to provide culturally and linguistically appropriate services, regardless of the clinicians personal culture, practice setting, or caseload demographics. Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. 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). (2016a). Journal of Speech, Language, and Hearing Research, 62(5), 13711372. Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). ), Cluttering: Research, intervention and education (pp. Journal of Fluency Disorders, 11(2), 131149. 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. (2004). Academic Press. They may hesitate when speaking, use fillers (like or uh), or repeat a word or phrase. The goal of Avoidance Reduction Therapy for Stuttering is to decrease fear of stuttering that leads to struggle. Disfluencies are not directly targeted; however, the frequency and intensity of disfluencies decrease as struggle is reduced. Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. https://doi.org/10.1016/j.jfludis.2015.01.003, Harley, J. Self-help conferences for people who stutter: A qualitative investigation. Contemporary Issues in Communication Science and Disorders, 25(Spring), 820. (2011). Temperament, emotion, and childhood stuttering. Emotional problems and parenting style do not cause stuttering. Differential treatment of stuttering in the early stages of development. (2006). 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. 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. Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. 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. Recurring themes of successful stuttering management in adults have been described as. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. by ; 2022 June 3; barbara "brigid" meier; 0 . Journal of Fluency Disorders, 36(1), 1726. One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). 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). 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). Abou, E. M., Saleh, M., Habil, I., El Sawy, M., & El Assal, L. (2015). Fluency Disorders (Practice Portal). https://doi.org/10.1016/j.jcomdis.2010.12.003. (1982). Journal of Fluency Disorders, 40, 6982. It is important to distinguish stuttering from other possible diagnoses (e.g., language formulation difficulties, cluttering, and reading disorders) and to distinguish cluttering from language-related difficulties (e.g., word finding and organization of discourse) and other disorders that have an impact on speech intelligibility (e.g., apraxia of speech and other speech sound disorders). increasing self-confidence and self-efficacy. 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). Cooper, E. B. excessive levels of typical disfluencies (e.g., revisions, interjections), maze behaviors or frequent topic shifting (e.g., I need to go toI mean Im out of cheese. Reducing negative reactions through desensitization and cognitive restructuring. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. Journal of Speech, Language, and Hearing Research, 60(9), 24832505. The plan outlines reasonable accommodations for speaking or reading activities to help ensure a students academic success and access to the learning environment in school. Journal of Fluency Disorders, 33(2), 8198. Daly, D. A. Resiliencethe ability to adjust and cope in the face of adversitycan help lessen the negative impact (e.g., Coifman & Bonanno, 2010). Journal of Fluency Disorders, 36(4), 290295. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. 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 Neuroscientist, 25(6), 566582. Video self-modeling as a post-treatment fluency recovery strategy for adults. Providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk. (2013). Journal of Fluency Disorders, 30(1), 122. 1-888-266-0574. Journal of Fluency Disorders, 13(5), 357373. Clinicians need to be observant of indicators, such as stuttering avoidance or social isolation, that clients/patients/students may be internalizing negative stereotypes about stuttering (Boyle, 2013a). Sisskin, V. (2018). National Stuttering Association. The lowest prevalence rates of stuttering were reported in adults aged 2150 years (0.78%) and adults aged 51 years or older (0.37%; Craig et al., 2002). https://doi.org/10.1044/2017_JSLHR-S-16-0371, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2019). The interview process and work environment can be challenging for individuals who stutter. SIG 16 Perspectives on School-Based Issues, 15(2), 7580. omission of word endings (e.g., Turn the televisoff). Journal of Speech, Language, and Hearing Research, 46(5), 12211233. https://doi.org/10.1093/brain/awu400, Choi, D., Conture, E. G., Walden, T. A., Lambert, W. E., & Tumanova, V. (2013). Journal of Fluency Disorders, 38(2), 206221. Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. Psychology Press. 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). Starkweather, Janice Westbrook. All speakers are disfluent at times. Arnold, G. E. (1960). ASHA thanks the following individuals,who, in 2014, made significant contributions to the development of this content. (2013). Psychology Press. https://doi.org/10.1055/s-2003-37447, Thordardottir, E. (2006). Seminars in Speech and Language, 37(3), 145152. Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. Speech modification approaches to stuttering treatment in schools. St. Louis, K. O., Myers, F., Bakker, K., & Raphael, L. (2007). (2001). talking about stuttering or treatment of stuttering. The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). See ASHAs Practice Portal resource on Transitioning Youth. Please enable it in order to use the full functionality of our website. (2017). have a sense of belonging and experience less stigma. Assessment of awareness in young children of disfluencies and difficulty in speaking. ; American Psychiatric Association, 2013). Onslow, M., & Yaruss, J. S. (2007). Journal of Fluency Disorders, 54, 1423. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. For bilingual individuals, it is important for the clinician to consider the language or languages used during intervention. Available 8:30 a.m.5:00 p.m. The perils of oral-reading fluency assessments for children who stutter led a group of SLPs to investigate the issue and call on colleagues to change their school districts policies. Journal of Fluency Disorders, 34(4), 368381. Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. Early childhood stuttering for clinicians by clinicians. Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). Neurophysiological factors that are thought to contribute to stuttering include the following: These neurophysiological findings should be interpreted with caution due to the small number of subjects and the heterogeneity of the methodologies used. International Journal of Language & Communication Disorders, 49(1), 113126. Scope of practice in speech-language pathology [Scope of practice]. black quartz metaphysical properties; car accident woodbury, mn today; it severely reduces carb intake crossword clue Folia Phoniatrica et Logopaedica, 64(1), 3447. 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. Chronic problems associated with illness, injury, or other traumatic events can have a negative impact on an individuals emotional health and quality of life (e.g., Bonanno & Mancini, 2008). deletion and/or collapsing of syllables (e.g., I wanwatevision). Journal of Fluency Disorders, 58, 110. However, these disfluencies are typical and not indicative of a disorder (Shenker, 2013). Impact experienced from stuttering, or covert features of stuttering, may include. Mild stuttering, on the other hand, tends to appear more regularly. Motivational interviewing: Helping people change. There is not enough epidemiological research to state specific risk factors for cluttering. Posted at 23:22h . Fluency refers to continuity, smoothness, rate, and effort in speech production. Parental involvement is an integral part of any treatment plan for children who stutter. (2005). https://doi.org/10.1016/j.jcomdis.2019.03.007, Fry, J., Millard, S., & Botterill, W. (2014). Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). In fact, stuttering can affect all areas of academic competency, including academic learning, social-emotion functioning, and independent functioning (Ribbler, 2006, p. 15). Guilford Press. The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. 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). In D. Ward & K. Scaler Scott (Eds. Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). Stuttering: Research and therapy. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). Onslow, M., Packman, A., & Harrison, E. Toward a better understanding of the process of disclosure events among people who stutter. (2009). Typical disfluencies often resolve by age five and tend to cycle, meaning they come and go. Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. Epidemiology of stuttering: 21st century advances. Miller, W. R., & Rollnick, S. (2013). 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). Reducing bullying through role-playing and self-disclosure. Seminars in Speech and Language, 28(4), 312322. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. (n.d.). Emotional reactivity and regulation in preschool-age children who stutter. These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. https://doi.org/10.1044/2020_PERSP-20-00014. A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. A meta-analysis did find differences in the receptive vocabulary, expressive vocabulary, and mean length of utterance between children who stutter and children who do not stutter, with children who stutter generally performing relatively weaker (Ntourou et al., 2011). These modifications are used regardless of whether a particular word is expected to be produced fluently. Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. The ability to use speech strategies; to make choices to speak and participate, regardless of the level of fluency; and to take risks is greatly reduced outside of the treatment setting when time pressure and conditioned negative feelings may trigger fear and old behaviors. https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Journal of Speech, Language, and Hearing Research, 52(1), 254263. The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. Scaler Scott, K. (2013). Neurobiology of Disease, 69, 2331. Apply Now. These modifications are used to facilitate speech fluency and may include. a sense of loss of control/cognitive dissociations; negative thoughts/feelings about oneself and ones communication abilities; rumination on perceived communication failures; a decreased sense of self-worth (report feeling less than human); avoidance of words/sounds, speaking, and social interactions; perceived judgment of communication by others (e.g., being mocked, laughed at, made fun of, pitied, talked over/for, ignored, or hung-up on); perceived negative effects on social/romantic relationships; and. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. A thematic analysis of late recovery from stuttering. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). Studies in tachyphemia: III. 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). A range of studies support a genetic predisposition for stuttering, but no definitive findings have been made regarding which transmission model, chromosomes, genes, or sex factors are involved in the expression of stuttering in the population at large (Kraft & Yairi, 2011, p. 34). Journal of Fluency Disorders, 36(2), 110121. Children and adolescents with fluency disorders may qualify for accommodations whether or not they have an active individualized education program (IEP). B. (2014). typical vs atypical disfluencies asha 24 Jun. Similarities - Typical and Atypical Pneumonia 5. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. 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. See ASHAs Practice Portal pages on Counseling For Professional Service Delivery and Cultural Responsiveness for more information related to counseling. https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Prevalence of cluttering in two European countries: A pilot study. Moments of stuttering or disfluency may be difficult to distinguish from typical disfluency or reduced language proficiency, especially for a person unfamiliar with the language (Shenker, 2011). 115134). https://doi.org/10.1016/j.jfludis.2006.02.002. The imbalance of stuttering behavior in bilingual speakers. 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 Communication Disorders, 44(3), 276293. 6396). https://doi.org/10.1016/j.jfludis.2010.12.003. Cluttering can co-occur with other disorders, including. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Understanding and treating cluttering. This list is not exhaustive, and not all factors need to be present for a referral to an SLP (e.g., Guitar, 2019; Yaruss et al., 1998). Depression & Anxiety, 27(7), 687692. Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O., Bavin, E., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Natural history of stuttering to 4 years of age: A prospective community-based study. 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. 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?). Language, Speech, and Hearing Services in Schools, 49(1), 13. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. Code of ethics [Ethics]. Communication Disorders Quarterly, 39(2), 335345. Stuttering and its treatment in adolescence: The perceptions of people who stutter. Stuttering in school-age children: A comprehensive approach to treatment. Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). Journal of Fluency Disorders, 21(34), 201214. 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. https://doi.org/10.1044/2019_JSLHR-S-18-0225. Starkweather, C. W. (1987). Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency. Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). 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. (2016). Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). Prevalence of anxiety disorders among children who stutter. Stuttering and cluttering. Adults who stutter may be dealing with years of shame or stigma (Boyle, 2013a), and they can experience elevated levels of negative mood states (e.g., interpersonal sensitivity and depressed mood) when compared to adults who do not stutter (Tran et al., 2011). learning disabilities (Wiig & Semel, 1984). Stuttering severity may vary dramatically by speaking situation. ), Cluttering: A clinical perspective (pp. Support activities can be incorporated into group treatment and through participation in self-help groups (Trichon & Raj, 2018), attendance at self-help conferences (Boyle et al., 2018; Gerlach et al., 2019; Trichon & Tetnowski, 2011), and participation in summer camp programs (Byrd et al., 2016). Bargaining, 5. Denial, 3. 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). Maintenance of improved attitudes toward stuttering. https://doi.org/10.1016/j.jfludis.2012.05.003, Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012b). Journal of Communication Disorders, 58, 4357. https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. 142185). The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker. Journal of Speech, Language, and Hearing Research, 62(12), 43354350. 115134). https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). 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. American Journal of Speech-Language Pathology, 12(2), 243253. St. Louis, K. O., & Flynn, T. W. (2018). 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. Van Borsel, J. Indicators of positive therapeutic change may include. https://doi.org/10.1016/j.jfludis.2014.12.003. The model describes the following stages of behavioral change: See Manning and DiLollo (2018) and Floyd et al. Stuttering and reading fluency: Information for teachers [Brochure]. 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). having flexibility based on individual needs and desired outcomes (Amster & Klein, 2018). Advocating for individuals with fluency disorders and their families at the local, state, and national levels. For students who stutter, the impact goes beyond the communication domain. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). https://doi.org/10.1044/1058-0360(2007/008), Oyono, L. T., Pascoe, M., & Singh, S. (2018). Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. Clinical characteristics associated with stuttering persistence: A meta-analysis. Brain, 136(12), 37093726. increasing the time provided for an oral reading or presentation, providing an alternative assignment to oral reading, and. There may be a relationship between stuttering and working memory. There is a family history of stuttering or cluttering. Prentice-Hall. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). 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). Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). 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. (2020). https://doi.org/10.1016/j.jfludis.2016.07.002, Iverach, L., & Rapee, R. M. (2014). 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. Structural and functional abnormalities of the motor system in developmental stuttering. On the surface, this can be a difficult question, as many studies show up to 80% of children might recover from early speech disfluencies. https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. Young children may or may not verbalize their reactions to stuttering. It can also be challenging to assess the reading fluency of bilingual students who stutter. St. Louis, K. O., & Schulte, K. (2011). Mancinelli, J. M. (2019). Cengage Learning. Prins, D., & Ingham, R. J. Adults with fluency disorders have likely experienced years of treatment with varied outcomes. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. 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. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. Helping adolescents who stutter focus on fluency. In addition to stuttering-like disfluencies and other typical disfluencies, the children with ASD also produced atypical disfluencies, which usually are not observed in children with typically developing speech or developmental stuttering. Erickson, S., & Block, S. (2013). https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). The prevalence rate of stuttering in African American children (25 years of age) was estimated to be 2.52%, but was not reported to not be significantly different from that reported for European American children in the same age group between 2- to 5-year-old African American children and European American children (Proctor et al., 2008). Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). Pro-Ed. Referral to another helping professional should be made if a condition or situation falls outside of the SLPs scope of practice. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. 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). The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. practice treatment targets with more listeners. Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. Yairi, E., & Ambrose, N. (2005). All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering.
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