https://doi.org/10.1016/j.jfludis.2018.10.003, Bray, M. A., & Kehle, T. J. sex of childboys are at higher risk for persistence of stuttering than girls (Craig et al., 2002; Yairi & Ambrose, 2013); family history of persistent stuttering (Kraft & Yairi, 2011); time duration of greater than 612 months since onset or no improvement over several months (Yairi & Ambrose, 2005); age of onsetchildren who start stuttering at age 3 years or later (Yairi & Ambrose, 2005); and. Mindfulness is an intentional awareness of the present moment (e.g., through meditation) to help disengage from automatic thoughts and redirect attention, de-escalate emotions, and increase self-acceptance (Boyle, 2011; Harley, 2018). The skilled helper: A problem-management and opportunity-development approach to helping. Cluttering: A handbook of research, intervention and education. Children and adolescents with fluency disorders may qualify for accommodations whether or not they have an active individualized education program (IEP). typical vs atypical disfluencies asha typical vs atypical disfluencies asha. (2013). (2011). (2018). 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). Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). Menu. Journal of Fluency Disorders, 38(2), 171183. Folia Phoniatrica et Logopaedica, 64(1), 3447. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). Communication Disorders Quarterly, 6(1), 5059. blocks (i.e., inaudible or silent fixation or inability to initiate sounds). Stuttering: Its nature, diagnosis, and treatment. However, a school-age child or adolescent who stutters may not report their experience accurately, possibly due to a lack of awareness or a desire to appease the clinician (Adriaensens et al., 2015; Erickson & Block, 2013). Craig, A., Blumgart, E., & Tran, Y. (1982). Measuring lexical diversity in children who stutter: Application of vocd. Another example is Cognitive Behavior Therapy (CBT; Menzies et al., 2019, 2009). Van Borsel, J. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. monosyllabic whole-word repetitions (e.g., Why-why-why did they go there?), part-word or sound/syllable repetitions (e.g., Look at the, prolongation of consonants when it isnt for emphasis (e.g., , blocking (i.e., inaudible or silent fixations or inability to initiate sounds), and. The Neuroscientist, 25(6), 566582. To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. the individuals lived experiences with stuttering, the perceived impact of these experiences with stuttering, and. 4566). A comprehensive fluency assessment typically includes the following: See ASHAs resource on assessment procedures: parallel with CPT codes for a breakdown of pre-evaluation, intra-service, and post-service procedures. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. having flexibility based on individual needs and desired outcomes (Amster & Klein, 2018). We often use the term "emergent" to describe skills that are developing, but have not fully emerged. EBP Briefs, 2(4), 18. https://doi.org/10.1017/CBO9781139108683.023. Both procedures help the client decrease the sense of loss of control experienced during moments of stuttering by demonstrating their ability to stop and modify moments of stuttering, anxiety, and other emotional reactivity. 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. 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). reducing secondary behaviors and minimizing avoidances. 142185). With adults, initiation of treatment depends on the individuals previous positive or negative intervention experiences and current needs pertaining to their fluency and the impact of their fluency disorder on communication in day-to-day activities and participation in various settings (e.g., community or work). Measurement and modification of speech naturalness during stuttering therapy. American Journal of Speech-Language Pathology, 27(3S), 12351243. Yaruss, J. S., & Pelczarski, K. M. (2007). omission of word endings (e.g., Turn the televisoff). For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). https://doi.org/10.1044/1058-0360.0704.62. SLPs may want to relate personal experiences when asking clients to share such vulnerable information. Journal of Speech, Language, and Hearing Research, 63(9), 29953018. 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). Journal of Speech, Language, and Hearing Research, 62(12), 43354350. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. ), Stuttering and related disorders of fluency (pp. https://doi.org/10.1002/hbm.23487, Dignazio, L. E., Kenny, M. M., Raj, E. X., & Pelkey, K. D. (2020). The impact of fluency disorders often extends to social and vocational aspects of the individuals life. (2001). Prior to developing generalization activities, the SLP needs to consider the individuals profile. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). (2007). Covert stuttering. Journal of Fluency Disorders, 37(4), 242252. American Journal of Speech-Language Pathology, 27(2), 721736. https://doi.org/10.1016/j.jfludis.2013.09.001, Boyle, M. P. (2015). In N. B. Ratner & J. Tetnowski (Eds. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). https://doi.org/10.1016/j.jfludis.2016.07.002, Iverach, L., & Rapee, R. M. (2014). 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). There may be a relationship between stuttering and working memory. The primary provider of fluency treatment is the SLP. Pro-Ed. The young childs awareness of stuttering-like disfluency. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). Individuals who clutter may exhibit more errors related to reduced speech intelligibility secondary to rapid rate of speech. These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). 115134). Seminars in Speech and Language, 35(2), 6779. The assignments begin in supportive, low-fear situations and slowly evolve to more challenging situations and settings as the individual demonstrates the ability to accept or tolerate potential negative reactions. Estimates report that 1.5% of school-age children who are hard of hearing also stutter, which is similar to the estimates of older elementary students who stutter (Arenas et al., 2017). Application of the ICF in fluency disorders. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. https://doi.org/10.1016/j.jfludis.2013.01.001. Journal of Communication Disorders, 80, 1117. Many clinicians use an integration of approaches to achieve optimal outcomes. Emotional problems and parenting style do not cause stuttering. Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). Depression & Anxiety, 27(7), 687692. https://doi.org/10.1044/cicsd_29_S_91, Zebrowski, P. M., & Schum, R. L. (1993). Fear of speaking: Chronic anxiety and stammering. (1986). Testing, and 7. 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. Perspectives on Fluency and Fluency Disorders, 23(2), 5469. Journal of Fluency Disorders, 13(5), 331355. When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. The impact of a stuttering disorder on Western Australian children and adolescents. 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). Impact of stuttering severity on adolescents domain-specific and general self-esteem through cognitive and emotional mediating processes. 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. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). Plural. https://doi.org/10.1016/S0094-730X(02)00162-6, Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). ), Cluttering: A clinical perspective (pp. The purpose of CBT is to modify current negative thoughts, emotions, and/or behaviors and replace them with positive ones through identification of thought patterns and challenging cognitive distortions in real time. Assessing bilingual children: Are their disfluencies indicative of stuttering or the by-product of navigating two languages? The ASHA Action Center welcomes questions and requests for information from members and non-members. Appropriate roles for SLPs include the following: As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so. 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). Other speech or language concerns are also present. Prevalence of anxiety disorders among children who stutter. Drayna and Kang (2011) found that gene mutations were present in close to 10% of cases of familial stuttering. Journal of Fluency Disorders, 43, 116. 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). https://doi.org/10.1044/2018_JSLHR-S-17-0353, Guitar, B. 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). Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. 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). Adults with fluency disorders have likely experienced years of treatment with varied outcomes. Following are descriptions of each of these forms of disfluency. ), The atypical stutterer: Principles and practices of rehabilitation (pp. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). Some adults lack communication confidence as a result of negative self-perceptions about their stuttering (Beilby et al., 2012a) or due to repeated exposure to people holding stereotypes about stuttering, which, in turn, may create self-stigmatization (Boyle, 2013a). Overheard: Bilingual and disfluent: A unique treatment challenge. Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. An effective clientclinician relationship facilitates the identification of potential roadblocks (Plexico et al., 2010). https://doi.org/10.1016/0094-730X(88)90004-6, Onslow, M., & OBrian, S. (2012). https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. Perspectives on Fluency and Fluency Disorders, 4(6), 13161326. https://doi.org/10.1016/0094-730X(88)90003-4. Abou, E. M., Saleh, M., Habil, I., El Sawy, M., & El Assal, L. (2015). You do not have JavaScript Enabled on this browser. Such individuals may benefit from treatment strategies that focus on improving speech efficiency by reducing word avoidance and increasing spontaneity in communication. Journal of Fluency Disorders, 27(4), 289304. School Psychology Review, 30(1), 135141. https://doi.org/10.1016/j.jcomdis.2015.10.003. Journal of Fluency Disorders, 40, 3543. Seminars in Speech and Language, 24(1), 2126. (2014). Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. Behavioural and Cognitive Psychotherapy, 23(4), 325325. Journal of Speech, Language, and Hearing Research, 62(5), 13711372. Treatment should consider not just the overt stuttering behavior but also the affective and cognitive reactions to stuttering. Screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation. 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 The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. https://doi.org/10.1044/jshr.3103.377, Weber-Fox, C., Wray, A. H., & Arnold, H. (2013). 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). Drayna, D., & Kang, C. (2011). Referring to other health care professionals when outside support is needed to facilitate treatment goals for interfering behaviors (e.g., anxiety, depression). Desensitization can help decrease word avoidance and reduce fear. Journal of Speech and Hearing Disorders, 50(3), 261281. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Self-report of self-disclosure statements for stuttering. Treatment for adolescents who stutter poses a particular challenge because of the issues related to this developmental stage. Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. Journal of Speech, Language, and Hearing Research, 56(5), 15171529. Helping adolescents who stutter focus on fluency. autism (see Scaler Scott, 2011, for a review), word-finding/language organization difficulties (Myers, 1992), and. https://doi.org/10.1177/152574018200600106. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Psychology Press. https://doi.org/10.1044/2017_LSHSS-17-0028. Bowling Green State University Archive. Fluency refers to continuity, smoothness, rate, and effort in speech production. resilience building within the child and family (Berquez & Kelman, 2018). They are likely to use interjections, repeat phrases, and revise what they are saying. Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). 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). Children who stutter may demonstrate poorer expressive lexical skills compared to their peers (Silverman & Bernstein Ratner, 2002). Journal of Educational Psychology, 95(1), 321. facilitates conversations between the individual and their family about the experience of stuttering, the individuals communication expectations, their life goals, and how to holistically support communication (see, e.g., Berquez & Kelman, 2018; Millard et al., 2018; Rocha et al., 2019). Resilience in people who stutter: Association with covert and overt characteristics of stuttering. However, even when children show little observable disfluency, they may still need treatment because of the negative impact of stuttering or cluttering on their lives. Language, Speech, and Hearing Services in Schools, 37(2), 118136. Individuals learn to identify the thoughts underlying their negative attitudes and emotional reactions and examine the link between these thoughts, attitudes, and emotional reactions and their speech. typical vs atypical disfluencies asha. Drayna, D. (2011). As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. Experts in the field of cluttering have consistently estimated that approximately one third of children and adults who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). American Journal of Speech-Language Pathology, 28(1), 1428. 187214). https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). It can also be challenging to assess the reading fluency of bilingual students who stutter. 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). Coexistence of stuttering and disordered phonology in young children. The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). Pro-Ed. In fact, stuttering can affect all areas of academic competency, including academic learning, social-emotion functioning, and independent functioning (Ribbler, 2006, p. 15). See ASHAs resource on person- and family-centered care. Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. Time and expense are considerations along with attention to generalization and treatment needs following an intensive program (Cooper, 1979). https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. https://doi.org/10.1055/s-2002-33751, Bowers, A., Bowers, L. M., Hudock, D., & Ramsdell-Hudock, H. L. (2018). American Journal of Speech-Language Pathology, 2(2), 6573. Tallying has the client stop directly after a moment of stuttering to tally or bring awareness to it while not attempting to escape by continuing to talk. Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. https://doi.org/10.1016/j.jfludis.2016.10.002, Blumgart, E., Tran, Y., & Craig, A. In this way, positive reinforcement is used to increase or strengthen the response of fluency (the desired behavior). American Journal of Speech-Language Pathology, 27(3S), 11801194. Unlike stuttering, there are no data regarding age since onset and long-term outcomes of cluttering. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. https://doi.org/10.1016/0094-730X(86)90028-8, St. Louis, K. O., & Hinzman, A. R. (1988). Efforts to conceal stuttering may adversely affect quality of life (Boyle et al., 2018). 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). Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. Mild stuttering, on the other hand, tends to appear more regularly. Studies in tachyphemia: III. Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. (2005). This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. St. Louis, K. O., & Schulte, K. (2011). Prevalence of speech disorders in elementary school students in Jordan. the asha leader; journals. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). Educating other professionals about the needs of individuals with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders. 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). 328). https://doi.org/10.1044/1092-4388(2013/12-0280), Boyle, M. P. (2013b). Wampold, B. E. (2001). Course: #10096 Level: Intermediate 1 Hour 2233 Reviews. Temperamental characteristics of young children who stutter. Available 8:30 a.m.5:00 p.m. See an article by ASHAs Ad Hoc Committee on Reading Fluency For School-Age Children Who Stutter (ASHA, 2014). See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. The role of effortful control in stuttering severity in children: Replication study. ), Cluttering: A handbook of research, intervention and education (pp. American Journal of Speech-Language Pathology, 27(3S), 11391151. You do not have JavaScript Enabled on this browser. https://doi.org/10.1044/ffd16.1.15. (1993). The SLP works with parents and families to create an environment that facilitates fluency and that helps them develop healthy and appropriate communication attitudes (Onslow et al., 2003; Yaruss & Reardon-Reeves, 2017). These include when the individual who stutters. Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. Potential risk factors for cluttering include the following: Information is varied and conflicting regarding the exact relationship between bilingualism and disfluencies (Tellis & Tellis, 2003; Van Borsel et al., 2001). Human Brain Mapping, 38(4), 18651874. https://doi.org/10.3109/17549507.2015.1010583, Adriaensens, S., Beyers, W., & Struyf, E. (2015). Acceptance; Constantino et al., 2017. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. The Lidcombe Program of early stuttering intervention: A clinicians guide. Sex of childIt appears that the disorder is more common in males than in females; the male-to-female ratio for cluttering has been reported to range from 3:1 to 6:1 (G. E. Arnold, 1960; St. Louis & Hinzman, 1986; St. Louis & Rustin, 1996). Reeves, L. (2006). https://doi.org/10.1016/S0094-730X(97)00008-9, Floyd, J., Zebrowski, P. M., & Flamme, G. A. 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. Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. https://doi.org/10.1016/j.jfludis.2006.12.003. Prentice-Hall. https://doi.org/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. https://doi.org/10.1177/1073858418803594, Chang, S.-E., & Zhu, D. C. (2013). The ASHA Leader, 19(7), 4448. First, let's clarify the types of disfluencies we are discussing as atypical: BSI: Sound Insertion (in-word or between-words) [be-uh-come] FSR: Final Sound (or syllable) Repetition [become-m-m] [become-ome-ome] Next, let's be clear that these types of disfluencies seem to occur predominantly in children on the . 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. American Journal of Speech-Language Pathology, 11(1), 4149. These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). Adults are likely to have been living with stuttering for a long time. 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. Most individuals who stutter demonstrate both observable disfluency and negative life impact (Beilby et al., 2012b; Ribbler, 2006; Tichenor & Yaruss, 2019a; Yaruss et al., 2012). In contrast to adults who stutter, children who stutter did not show increases in white matter tracts in the right hemisphere (Chang et al., 2015). Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). https://doi.org/10.4324/9781351122351, Klein, J. F., & Hood, S. B. https://doi.org/10.1055/s-2008-1064082, Caughter, S., & Crofts, V. (2018). Building trust by following the students lead, finding out what experiences may be motivating, and bringing together peers for support are treatment options to consider (Hearne et al., 2008). Speech clarity and fluency may temporarily improve when the person is asked to slow down or pay attention to their speech. Apply Now. Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. https://doi.org/10.1044/0161-1461.2602.162. There is a family history of stuttering or cluttering. Speech modification approaches to stuttering treatment in schools. bringing peers into the treatment setting; planning strategies to use in the classroom, cafeteria, or playground or at work; taking outings to stores and other businesses; and. Journal of Paediatrics and Child Health, 49(2), E112E115. Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. Journal of Abnormal Psychology, 119(3), 479490. Group experiences and individual differences in stuttering. The model describes the following stages of behavioral change: See Manning and DiLollo (2018) and Floyd et al.