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. Atrial Flutter, Typical and Atypical: A Review | AER Journal Pediatrics, 132(3), 460467. Myers, F. L. (1992). Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. https://doi.org/10.1016/j.jfludis.2013.09.003, Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). Journal of Fluency Disorders, 61, 105713. https://doi.org/10.1016/j.jfludis.2019.105713, Douglass, J. E., Schwab, M., & Alvarado, J. For school-age children and adolescents, initiation of treatment depends, in large part, on their motivation, which, in turn, is dependent on factors such as their perceived needs, the degree of adverse impact they experience, and their previous treatment experiences. Scaler Scott, K. (2013). These individuals are said to experience covert stuttering (B. Murphy et al., 2007). ), Cluttering: Research, intervention and education (pp. Many clinicians use an integration of approaches to achieve optimal outcomes. Characteristics of Typical Disfluency and Stuttering Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. 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 . Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). Management of childhood 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. Plural. https://doi.org/10.1016/S0094-730X(96)00024-1, Murphy, B., Quesal, R. W., & Gulker, H. (2007). Psychology Press. typical vs atypical disfluencies asha. The role of effortful control in stuttering severity in children: Replication study. https://doi.org/10.1002/hbm.23487, Dignazio, L. E., Kenny, M. M., Raj, E. X., & Pelkey, K. D. (2020). https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. https://doi.org/10.1177/1525740117702454. Stuttering modification strategies, originated by Van Riper (1973), have four stages: (1) identification, (2) desensitization, (3) modification, and (4) generalization and aim to reduce associated physical tension and struggle by helping individuals. This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. https://doi.org/10.1044/1092-4388(2008/07-0111), Prochaska, J. O., & DiClemente, C. C. (2005). Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. Individuals who stutter may report fear or anxiety about speaking and frustration or embarrassment with the time and effort required to speak (Ezrati-Vinacour et al., 2001). https://doi.org/10.1044/ffd16.1.15. Self-efficacy is a positive belief in ones own ability to successfully accomplish a set goal that is task dependent, which comes from (a) past experiences of mastery, (b) vicarious experiences, (c) verbal persuasion, and (d) emotional/physical states (Boyle, 2013a, 2013b, 2015; Boyle et al., 2018; Carter et al., 2017). Prevalence of speech disorders in elementary school students in Jordan. (2003). Therefore, as with school-age children and adolescents, the purpose of the assessment for adults typically is not to diagnose stuttering. Perspectives on Fluency and Fluency Disorders, 16(1), 1517. Differing perspectives on what to do with a stuttering preschooler and why. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. https://doi.org/10.1371/journal.pone.0133758, Desai, J., Huo, Y., Wang, Z., Bansal, R., Williams, S. C., Lythgoe, D., Zelaya, F. O., & Peterson, B. S. (2016). Journal of Fluency Disorders, 49, 1328. Whurr Publishers. Estimates have reported the male-to-female ratio of individuals who stutter to be as large as 4:1; however, more recent studies in preschool children suggest that a younger age of onset has smaller ratios in gender differences (Yairi & Ambrose, 2013). Avoidance Reduction Therapy for Stuttering (ARTS). 3. Motivational interviewing may be used to help individuals who stutter better understand the thoughts and feelings associated with their stuttering and make positive changes to improve communication. Specific standardized tests can be used to rule out word-finding difficulties. Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. (2014). Sheehan, V. M., & Sisskin, V. (2001). Journal of Fluency Disorders, 32(2), 95120. https://scholarworks.bgsu.edu/comm_disorders_diss/7/. https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). www.asha.org/policy/, American Speech-Language-Hearing Association. Section 504 of the Rehabilitation Act of 1973 also applies to individuals with disabilities in a work setting. Efforts to conceal stuttering may adversely affect quality of life (Boyle et al., 2018). The epidemiology of cluttering with stuttering. Seminars in Speech and Language, 24(1), 2732. ), Cluttering: Research, intervention and education (pp. 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). https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. Educating families about local support organizations for people who stutter and their families. 157186). The Neuroscientist, 25(6), 566582. Coleman, C. (2013). https://doi.org/10.1016/j.jfludis.2016.09.005, Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). Children with language difficulties at the sentence, narrative, or conversational discourse level may exhibit increased speech disfluencies. Treatment approaches for adults should take into consideration career and workplace factors. ASHA also extends its gratitude to the following subject matter experts who were involved in the reviewand development of thispage: In addition, ASHA thanks the members of the Steering Committee of ASHAs Special Interest Division on Fluency and Fluency Disorders (Division 4) whose work preceded this content. 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. 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. Typical Disfluencies vs. Stuttering in Children. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. american journal of audiology (aja) american journal of speech-language pathology (ajslp) journal of speech, language, and hearing research (jslhr) language, speech, and hearing services in schools (lshss) perspectives of the asha special interest groups; topics; special collections Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. https://doi.org/10.1044/jshd.4901.53, Mnsson, H. (2000). Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. (2016a). https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Childhood stuttering: Incidence and development. Manning, W. H., & Quesal, R. W. (2016). Self-help conferences for people who stutter: A qualitative investigation. Fear of speaking: Chronic anxiety and stammering. The relationship of self-efficacy and depression to stuttering. https://doi.org/10.1016/j.jfludis.2013.01.001. Developmental stuttering in children who are hard of hearing. Scientific Reports, 7(1), 118. Technological advances and the expansion of social media outlets have increased opportunities for adults who stutter to connect, share, and gain information through the Internet (Fuse & Lanham, 2016; Raj & Daniels, 2017) and stuttering-related podcasts (Dignazio et al., 2020). (1996). 15). Available 8:30 a.m.5:00 p.m. Referring the individual to other professionals to rule out other conditions and facilitate access to comprehensive services. Bilingual children are assessed in both languages to determine stuttering profiles in both (Finn & Cordes, 1997). Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). Best practice for developmental stuttering: Balancing evidence and expertise. Clinicians need to be mindful of different beliefs and the stress imposed on the individual and family during treatment. Journal of Speech, Language, and Hearing Research, 51(3), 636650. In J. C. Norcross & M. R. Goldfried (Eds. Differential Diagnosis | Stuttering Foundation: A Nonprofit As suggested earlier, normal disfluencies will appear for a few days and then disappear. (2013). Genetic contributions to stuttering: The current evidence. Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. (2005). Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). Acquired neurogenic and psychogenic stuttering are not covered. These feelings may come from having a positive perception about the ability to face challenges (Boyle et al., 2019). Journal of Communication Disorders, 58, 4357. Language abilities of children who stutter: A meta-analytical review. Stuttering and bilingualism: A review. https://doi.org/10.3109/17549507.2015.1010583, Adriaensens, S., Beyers, W., & Struyf, E. (2015). Aphasia. winery in maryland with igloos; thick peeling skin around fingernails; holiday inn st pete beach revolving restaurant; metro approved housing in norwalk ohio Stuttering as defined by adults who stutter. https://doi.org/10.1044/ffd17.2.4, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007a). Ward, D., Connally, E. L., Pliatsikas, C., Bretherton-Furness, J., & Watkins, K. E. (2015). What are typical disfluencies? - Golderkey - Live News Breaking An introduction to camps for children who stutter: What they are and how they can help. https://doi.org/10.1136/bmj.38520.451840.E0, Kelman, R., & Nicholas, A. In D. Ward & K. Scaler Scott (Eds. 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. The influence of workplace discrimination and vigilance on job satisfaction with people who stutter. reducing secondary behaviors and minimizing avoidances. 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. Journal of Fluency Disorders, 54, 1423. Persons who stutter may appear to have expressive language problems because of a tendency to avoid speaking or speak in a way thats unclear to the listener. 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). Journal of Speech, Language, and Hearing Research, 60(11), 30973109. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. Clinicians need to be familiar with various counseling principles and approaches (Luterman, 2006; Zebrowski & Schum, 1993). 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). (1982). National Stuttering Association. https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). SLPs counseling skills should be used specifically to help speakers improve their quality of life by minimizing the burden of their communication disorder. American Journal of Speech-Language Pathology, 27(3S), 12111223. Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). Stages of change and stuttering: A preliminary view. Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). Journal of Fluency Disorders, 26(3), 179206. Speech, Language and Hearing, 20(3), 144153. However, sensitive temperament (individual behavioral characteristics or reactions) and emotion are commonly seen as traits associated with stuttering in young children. This includes the impact on functional communication in key school situations and on quality of life (Beilby et al., 2012b; Yaruss et al., 2012). Acceptance; Constantino et al., 2017. Prentice-Hall. Guitar, B. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. 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). 297325). Perspectives on Fluency and Fluency Disorders, 22(1), 3446. 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). 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). People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). (2011). https://doi.org/10.1044/cicsd_25_S_8, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2017). There are benefits of both individual and group treatment. https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). Temperamental characteristics of young children who stutter. American Journal of Speech-Language Pathology, 27(3S), 11241138. The ASHA Leader, 19(7), 4448. Journal of Communication Disorders, 37(1), 3552. 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. See What To Ask When Evaluating Any Procedure, Product, or Program. 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). Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. Coworkers may have negative attitudes toward individuals who stutter, and the individual may feel excluded because of this. resilience building within the child and family (Berquez & Kelman, 2018). Title: The Differential Diagnosis of Disfluency Created Date: 7/18/2007 3:15:45 PM https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). (2019). 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. 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). Journal of Fluency Disorders, 38(1), 1429. Menu. https://doi.org/10.1016/j.cub.2016.02.068, Beilby, J. M., & Byrnes, M. L. (2012). 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. 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). Journal of Fluency Disorders, 53, 2640. This relationship is recognized as one of the common factors that account for the effectiveness of counseling (common factors theory; Wampold, 2001). Recurring themes of successful stuttering management in adults have been described as. Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). Lippincott Williams & Wilkins. Behavioral inhibition and childhood stuttering. Singular. On the surface, this can be a difficult question, as many studies show up to 80% of children might recover from early speech disfluencies. Stuttering More than 70 million people around the world struggle with stuttering, according to The Stuttering Foundation. Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). Seminars in Speech and Language, 39(4), 324332. ), The treatment of stuttering in the young school-aged child (pp. The SLP can instruct parents in how to modify the environment to enhance fluency and reduce communication pressure. 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). See the Treatment section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Genetic factors also may play a role in predicting the likelihood of persistence or recovery and, possibly, treatment outcomes (Frigerio-Domingues et al., 2019; Han et al., 2014). Human Brain Mapping, 38(4), 18651874. Differentially diagnosing fluency disorders from disfluencies stemming from language encoding difficulties such as language delay or second language learning. Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Additionally, the affective, behavioral, and cognitive features of stuttering are important components of the assessment (Vanryckeghem & Kawai, 2015). Changing adolescent attitudes toward stuttering. Because the theory behind cluttering is that speakers are talking at a rate that is too fast for their systems to handle, techniques that help regulate speech rate, such as increased pausing, often are helpful. Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency. The term overt stuttering is used when core speech behaviors are present. Quick: Talk fast & dont stutter! Self-help and support groups for people with cluttering. A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. Seminars in Speech and Language, 37(3), 145152. Tourettes syndrome (see Van Borsel, 2011, for a review). https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. 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. Thieme. See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. autism (see Scaler Scott, 2011, for a review), word-finding/language organization difficulties (Myers, 1992), and. The validity of reading assessment tools for children who stutter is questionable because it is difficult to differentiate the cause (decoding or stuttering) of oral reading fluency problems. 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). https://doi.org/10.1017/S135246580001643X. United States Department of Labor. Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). What we know for now IN BRIEF. See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Acceptance and Commitment Therapy for people who stutter. Early Childhood Stuttering: Is it Stuttering or Typical Disfluency? - @ASHA Disfluent behavior becomes more complex as fear of speaking, anxiety, and resulting avoidance increase. https://doi.org/10.1055/s-2003-37447, Thordardottir, E. (2006). Journal of Speech, Language, and Hearing Research, 46(5), 12211233. Enhancing treatment for school-age children who stutter: I. ), Handbook of psychotherapy integration (pp. An examination of various aspects of auditory processing in clutterers. Psychology Press. Therefore, a comprehensive assessment for fluency disorders should include assessment of both overt and covert features. Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. University Park Press. Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). Multilingual children who stutter: Clinical issues. https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). 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). https://doi.org/10.1044/leader.FTR2.19072014.44, American Speech-Language-Hearing Association. Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. It is helpful to know that typical bilingual or multilingual children tend to produce higher rates of monosyllabic word repetitions, sound repetitions, and syllable repetitions than monolingual speakers. Journal of Fluency Disorders, 33(2), 8198. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). (2014). 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). www.asha.org/policy/, American Speech-Language-Hearing Association. Some people who clutter tend to decrease volume at the ends of sentences or phrases and, therefore, can benefit from learning to keep a steady volume throughout their utterances. They are likely to use interjections, repeat phrases, and revise what they are saying. Fluency disorders can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). Journal of Speech, Language, and Hearing Research, 56(5), 15171529. - Speech & Language Parent Support - SPSD https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). (2015). 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. 211230). https://doi.org/10.1037/a0020113, Coleman, C., & Yaruss, J. S. (2014). The clutterer. Fluency treatment can occur at any point after the diagnosis. Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Advocating for individuals with fluency disorders and their families at the local, state, and national levels. 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. Other speech or language concerns are also present. Amster, B. J., & Klein, E. R. (2018). Communication Disorders Quarterly, 6(1), 5059. These are called typical disfluencies or nonfluencies. B. https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). The young childs awareness of stuttering-like disfluency. Cambridge University Press. American Journal of Speech-Language Pathology, 16(1), 6568. 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). Fluency shaping with young stutterers. 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). The frequency and severity of overt stuttering may fluctuate from day to day and in relation to the speaking situation. Assessment and treatment of stuttering in bilingual speakers. Stuttering in school-age children: A comprehensive approach to treatment. One example of a treatment approach that incorporates desensitization is Avoidance Reduction Therapy for Stuttering (Sisskin, 2018). Journal of Fluency Disorders, 40, 6982. Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). 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). American Journal of Speech-Language Pathology, 11(1), 4149. Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. Avoidance or escape behaviors may also be used and can temporarily conceal stuttering (Constantino et al., 2017; Douglass et al., 2019, 2018; B. Murphy et al., 2007; Starkweather, 1987; Tichenor et al., 2017; Tichenor & Yaruss, 2018, 2019a, 2019b, 2020). (1993). attention-deficit/hyperactivity disorder (Alm, 2011). 155192). Peer support for people who stutter: History, benefits, and accessibility. Genetic approaches to understanding the causes of stuttering. van Zaalen, Y., & Reichel, I. K. (2014). (Eds.). It may occur only in specific situations, but it is more likely to occur in these situations, day after day. Maintenance of improved attitudes toward stuttering. It is also not unusual for disfluencies to be apparent and then seem to go away for a period of weeks or months only to return again. Family historyAnecdotal reports indicating the presence of cluttering in more than one family member suggest that family history may be a risk factor.
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