increasing acceptance and openness with stuttering. Other speech or language concerns are also present. https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). https://doi.org/10.1044/1058-0360.0202.65. The impact of stuttering on employment opportunities and job performance. https://doi.org/10.1044/ffd22.2.51, Berquez, A., & Kelman, E. (2018). 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. Stuttering and bilingualism: A review. Thieme. These disfluencies do not appear to be symptoms of stuttering (child onset fluency disorder). Pro-Ed. 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). educates the individual who stutters and their family members about stuttering and communication and. Reducing bullying through role-playing and self-disclosure. Journal of Fluency Disorders, 43, 116. International Journal of Speech-Language Pathology, 17(4), 367372. Sisskin, V. (2018). 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. https://doi.org/10.1044/leader.FTR2.19072014.44, American Speech-Language-Hearing Association. However, several likely gene mutations have been linked to stuttering (Frigerio-Domingues & Drayna, 2017). https://doi.org/10.1016/j.jcomdis.2019.04.003, Menzies, R. G., Onslow, M., Packman, A., & OBrian, S. (2009). Time pressures for verbal communication and requirements to use the telephone may lead to stress and discomfort. However, their disfluencies are not likely to involve prolongations, blocks, physical tension, or secondary behaviors that are more typical for children who stutter (Boscolo et al., 2002). Best practice for developmental stuttering: Balancing evidence and expertise. American Journal of Speech-Language Pathology, 2(2), 6573. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. attention-deficit/hyperactivity disorder (Alm, 2011). A phenomenological analysis of the moment of stuttering. Palin ParentChild Interaction Therapy for early childhood stammering. American Journal of Speech-Language Pathology, 20(3), 163179. Awareness and identification helps speakers better understand communication, speech, and stuttering along with their attitudes, beliefs, and behaviors. 341358). As suggested earlier, normal disfluencies will appear for a few days and then disappear. The treatment of stuttering. 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). 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). https://doi.org/10.1044/1058-0360.0704.62. Repetitive negative thinking, temperament, and adverse impact in adults who stutter. 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). 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. . Erlbaum. Overall Assessment of the Speakers Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. their disfluencies may be accompanied by physical tension and secondary behaviors. Sheehan, V. M., & Sisskin, V. (2001). The young childs awareness of stuttering-like disfluency. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). 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. What is motivational interviewing? Journal of Fluency Disorders, 50, 5971. Therefore, when conducting an assessment with an adult, it is crucial to understand. 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: 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. They may hesitate when speaking, use fillers (like or uh), or repeat a word or phrase. Stuttering impact: A shared perception for parents and children. Speech clarity and fluency may temporarily improve when the person is asked to slow down or pay attention to their speech. Al-Jazi, A. The person exhibits negative reactions (e.g., affective, behavioral, or cognitive reactions) to their disfluency. 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). ), Stuttering and related disorders of fluency (pp. having flexibility based on individual needs and desired outcomes (Amster & Klein, 2018). Seminars in Speech and Language, 28(4), 312322. How Can You Tell if Childhood Stuttering is the Real Deal? - @ASHA See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. Cluttering: A handbook of research, intervention and education. intellectual disability (Healey et al., 2005). Preus, A. Journal of Fluency Disorders, 38(4), 311324. https://doi.org/10.1055/s-0034-1382151, Chang, S.-E., Garnett, E. O., Etchell, A., & Chow, H. M. (2019). Members were Gordon Blood, Eugene Cooper, Hugo Gregory, John Hanley, Charles Healey, Stephen Hood, Kenneth S. Louis, Theodore Peters, C.W. The chart below describes some characteristics of "typical disfluency" and "stuttering" (Adapted from Coleman, 2013). BOBapp What are typical vs. atypical disfluencies in speech? Fluency Disorders - ASHA Many clinicians use an integration of approaches to achieve optimal outcomes. Fluency and stuttering. Luterman, D. M. (2006). 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). For an accurate evaluation, it is ideal to collect samples of speech across various situations and tasks, both inside and outside the clinical setting (Yaruss, 1997). Davidow, J. H., & Scott, K. A. See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Temperamental characteristics of young children who stutter. 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. Clinicians can help clients progress to active stages through building self-efficacy. Search Evidence Maps - American Speech-Language-Hearing Association https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. 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). "I-I-I-I- want the ball") typical vs atypical disfluencies asha When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Normal and atypical speech disfluencies - Banter Speech 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. 178196). See ASHAs resource on assessment tools, techniques, and data sources. Universitetsforlaget. 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). In D. Ward & K. Scaler Scott (Eds. In K. O. Lewis (Ed. Developing culturally and linguistically relevant intervention plans focused on helping the individual achieve more fluent speech and self-acceptance of disfluency, providing treatment, documenting progress, and determining appropriate dismissal criteria. Journal of Fluency Disorders, 62, 105725. https://doi.org/10.1016/j.jfludis.2019.105725, Plexico, L. W., Manning, W. H., & DiLollo, A. There is very little genetic information on cluttering, except for anecdotal reports that the speech characteristics have been found to be present in more than one member of a family (Drayna, 2011). ), The treatment of stuttering in the young school-aged child (pp. Typical vs Atypical Pneumonia in Tabular Form 6. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. Desensitization strategies are strategies that help speakers systematically desensitize themselves to their fears about speaking and stuttering by facing those fears in structured, supportive environments. Definitions of communication disorders and variations [Relevant paper]. 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. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. In fact, stuttering can affect all areas of academic competency, including academic learning, social-emotion functioning, and independent functioning (Ribbler, 2006, p. 15). Unlike stuttering, there are no data regarding age since onset and long-term outcomes of cluttering. SIG 4 Perspectives on Fluency and Fluency Disorders. Treatment approaches that incorporate support activities also can provide venues to practice learned strategies in a safe environment and help promote generalization. These should be considered during differential diagnosis but should not be the sole therapeutic strategies. https://doi.org/10.1016/j.jfludis.2017.06.001. Emotional reactivity, regulation and childhood stuttering: A behavioral and electrophysiological study. Teigland, A. Their skills are developing in this area. (1979). As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). The goals of treatment may be (a) to eliminate, greatly reduce, or help the child manage their stuttering and (b) to help them not develop negative emotional reactions related to their stuttering (H. S. Arnold et al., 2011; Yaruss et al., 2006). Self-report of self-disclosure statements for stuttering. Therefore, a comprehensive assessment for fluency disorders should include assessment of both overt and covert features. increased social communication participation (Manning & DiLollo, 2018). Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. Disfluent behavior becomes more complex as fear of speaking, anxiety, and resulting avoidance increase. Psychology Press. Treatment approaches are individualized based on the childs needs and family communication patterns. https://doi.org/10.1542/peds.2012-3067, Ribbler, N. (2006). Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. typical vs atypical disfluencies asha. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Journal of Fluency Disorders, 29(4), 255273. You do not have JavaScript Enabled on this browser. As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. Journal of Communication Disorders, 37(1), 3552. The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. Speech, Language and Hearing, 20(3), 144153. Onset may be progressive or sudden. Bilingual children who stutter typically do so in both languages (Nwokah, 1988; Van Borsel et al., 2001). Characteristics of Typical Disfluency and Stuttering This includes the impact on functional communication in key school situations and on quality of life (Beilby et al., 2012b; Yaruss et al., 2012). Psychology Press. In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). 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). 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. Stuttering: Research and therapy. Van Borsel, J., Maes, E., & Foulon, S. (2001). On the other hand, stuttering symptoms may decrease in more comfortable situations. These behaviors often are used unsuccessfully to stop or avoid stuttering (Guitar, 2019; Van Riper, 1973). https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). Logos, 3, 8295. continued management (Plexico et al., 2005). https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). Thieme. 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/jshd.4901.53, Mnsson, H. (2000). They may hesitate when speaking, use fillers ("like" or "uh"), or repeat a word or phrase. 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). Journal of Fluency Disorders, 54, 113. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. Identifying subgroups of stutterers (No. 115134). 6396). https://doi.org/10.1159/000331073, Kuhn, M. R., & Stahl, S. A. Word-Final Disfluencies in a School-Age Child: Beneath the Tip of the The primary provider of fluency treatment is the SLP. Parents of bilingual children easily can be trained to provide perceptual ratings of fluency in any language spoken by the child (Shenker, 2013). Assessment and treatment of stuttering in bilingual speakers. (2014). Stuttering and cluttering. https://doi.org/10.1016/j.jfludis.2011.04.005, Boyle, M. P. (2013a). Cooper, E. B. Wiig, E. H., & Semel, E. M. (1984). 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). Smith, A., & Weber, C. (2017). B., & Al-Khamra, R. (2015). Lyn Goldberg and Michelle Ferketic served as ex officios. Crystal Cooper, Diane L. Eger, and Nancy Creaghead served as monitoring vice presidents. Stuttering and cluttering: Frameworks for understanding and treatment. The ASHA Leader, 18(3), 1415. Such individuals may benefit from treatment strategies that focus on improving speech efficiency by reducing word avoidance and increasing spontaneity in communication. The role of effortful control in stuttering severity in children: Replication study. 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). Group experiences and individual differences in stuttering. 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). Journal of Fluency Disorders, 54, 1423. For example, clinicians may use treatment strategies to reduce bullying through desensitization exercises and by educating the individuals peers about stuttering (W. P. Murphy et al., 2007a, 2007b). Guilford Press. 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). Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the Self-Stigma of Stuttering Scale (4S). Rather, the purpose is to determine the extent and impact of the fluency disorder on the individual, the potential benefit from treatment, and the individuals desire and willingness to change. 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. (2017). Adults with fluency disorders have likely experienced years of treatment with varied outcomes. Journal of Fluency Disorders, 38(1), 1429. This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. the asha leader; journals. 115134). Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Stuttering in relation to lexical diversity, syntactic complexity, and utterance length. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). 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). 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). Genetic approaches to understanding the causes of stuttering. 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. Treatment approaches for adults should take into consideration career and workplace factors. An increase in observable disfluent behaviors may occur as the individual communicates more freely. Bilingual myth-busters series when young children who stutter are also bilingual: Some thoughts about assessment and treatment. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). Cluttering and Down syndrome. Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. 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). Plural. The epidemiology of cluttering with stuttering. 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. Their description details the characteristics of each stage, along with treatment goals and processes appropriate for each stage. Fluency disorders can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). 155192). 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). Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). The ASHA Leader, 11(10), 621. Myers, F. L. (1992). Increased incidence of stuttering has been noted among those with a first-degree relative (e.g., parent, sibling) who stutters and an even greater likelihood if that relative is an identical twin (Kraft & Yairi, 2011). 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 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). The scope of this page includes stuttering and cluttering across the life span. Reduced perfusion in Brocas area in developmental stuttering. recognize physical concomitant behaviors, locate the point of physical tension and struggle during moments of disfluency, and. Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). The great psychotherapy debate: Models, methods, and findings. Prevalence of cluttering in two European countries: A pilot study. talking about stuttering or treatment of stuttering. One of the core principles of ACT is mindfulness. Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). ), Cluttering: A handbook of research, intervention and education (pp. their reason for seeking treatment at the current time. (2001). Journal of Speech, Language, and Hearing Research, 61(5), 12381250. The influence of workplace discrimination and vigilance on job satisfaction with people who stutter. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. Seminars in Speech and Language, 24(1), 2126. Impact of social media and quality of life of people who stutter. Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. Please enable it in order to use the full functionality of our website. Similarities - Typical and Atypical Pneumonia 5. 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. Stuttering typically has its origins in childhood. 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). Contemporary Issues in Communication Science and Disorders, 31(Spring), 6979. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Yaruss, J. S., & Reardon-Reeves, N. (2017). Short-term intensive treatment programs have been used for some individuals to reduce disfluency and address negative attitudes. Assessment of awareness in young children of disfluencies and difficulty in speaking. Prevalence of stuttering in African American preschool children. Folia Phoniatrica et Logopaedica, 69, 180189. Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). Epidemiology of stuttering in the community across the entire life span. Environmental factors and speaking demands may exacerbate disfluency and influence a persons negative reactions to stuttering. https://doi.org/10.1016/j.jfludis.2012.11.002, Yaruss, J. S. (1997). Neurobiology of Disease, 69, 2331. World Health Organization. https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. The dysfluencies that render concerns of Childhood Onset Stuttering are different than typical disfluencies. 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). Miller, W. R., & Rollnick, S. (2013). Structural and functional abnormalities of the motor system in developmental stuttering. Following are descriptions of each of these forms of disfluency. Disclosure of stuttering and quality of life in people who stutter. 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). School-based SLPs and IEP teams should resist pressure to minimize the impact of stuttering on educational achievement for the purpose of disqualifying students from speech-language pathology services. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. Clinicians and parents also look for reactions, such as avoidance of words or speaking situations, increased physical tension or secondary behaviors, reduced utterance length, or slight changes in pitch or loudness during stuttering episodes. Improvements in fluency may generalize spontaneously from a treated language to an untreated language in bilingual speakers (Roberts & Shenker, 2007). ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. See ASHAs Practice Portal page on Cultural Responsiveness. How stuttering develops: The multifactorial dynamic pathways theory. A study of pragmatic skills of clutterers and normal speakers. Roberts, P., & Shenker, R. (2007). https://doi.org/10.1093/brain/awm241, Watson, J. Seminars in Speech and Language, 23(3), 181186. information regarding family, personal, and cultural perception of fluency. A descriptive study of speech, language, and hearing characteristics of school-aged stutterers. (2007). https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. (2016b). Psychology Press. 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). Potential neurological underpinnings of cluttering include dysregulation of the anterior cingulate cortex and the supplementary motor area (Alm, 2011) as well as increased activity in the basal ganglia and premotor cortex (Ward et al., 2015).

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