Assessment of speech fluency (e.g., frequency, type, and duration of disfluencies), speech rate, speech intelligibility, and the presence of secondary behaviors in a variety of speaking tasks (e.g., conversational and narrative contexts). Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. 147171). St. Louis, K. O., Myers, F., Bakker, K., & Raphael, L. (2007). https://doi.org/10.1044/ffd17.2.4, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007a). https://doi.org/10.1044/persp1.SIG4.55, Byrd, C. T., Croft, R., Gkalitsiou, Z., & Hampton, E. (2017). Plural. 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/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). The presence of at least 1 disabling developmental condition was 5.5 times higher in CWS [children who stutter] when compared to children who do not stutter (Briley & Ellis, 2018, p. 2895). For students who stutter, the impact goes beyond the communication domain. Journal of Fluency Disorders, 32(2), 121138. The American Board of Fluency and Fluency Disorders, under the auspices of ASHAs specialty certification program, offers clinical specialty certification in fluency and fluency disorders. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. Cluttering: A handbook of research, intervention and education. Pediatrics, 144(4), Article e20190811. Brain, 136(12), 37093726. Davidow, J. H., & Scott, K. A. The person exhibits negative reactions (e.g., affective, behavioral, or cognitive reactions) to their disfluency. The interview process and work environment can be challenging for individuals who stutter. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). Erickson, S., & Block, S. (2013). Early childhood stuttering therapy: A practical guide. 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. Strategies for reducing impairment in body function have been separated into two categoriesspeech modification and stuttering modification, both of which are described below. Fluency treatment can occur at any point after the diagnosis. Yairi, E., & Ambrose, N. (2005). These include when the individual who stutters. Maintenance of improved attitudes toward stuttering. See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. When a bilingual clinician is not available, using an interpreter is a viable option. Cognitive restructuring can be combined with the desensitization strategies described above (W. P. Murphy et al., 2007a). Evaluating stuttering in young children: Diagnostic data. Journal of Speech, Language, and Hearing Research, 44(2), 368380. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). See also ASHAs resources titled Person-Centered Focus on Function: Preschool Stuttering [PDF], Person-Centered Focus on Function: School-Age Stuttering [PDF], and Person-Centered Focus on Function: Adult Stuttering [PDF] for examples of assessment data consistent with the ICF framework. Starkweather, C. W. (1987). Scaler Scott, K. (2011). Language abilities of children who stutter: A meta-analytical review. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. 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: Pro-Ed. A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. https://doi.org/10.1055/s-2003-37447, Thordardottir, E. (2006). If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. St. Louis, K. O., & Flynn, T. W. (2018). However, fluency shaping approaches, such as easy onset or continuous phonation, may not be appropriate for the treatment of cluttering. Reduced perfusion in Brocas area in developmental stuttering. More recently, CBT and mindfulness have been applied to stuttering therapy and may support that CBT+mindfulness is more beneficial to clients who stutter than CBT alone (Gupta et al., 2016; Harley, 2018). The human capacity to thrive in the face of potential trauma. 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. 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). However, increased mean length of utterance, more diverse vocabulary, and greater syntactic complexity have also been noted (Wagovich & Hall, 2017). Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). Self-help and mutual aid groups. Amster, B. J., & Klein, E. R. (2018). 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). 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/10.1044/2018_AJSLP-ODC11-17-0190. Many clinicians use an integration of approaches to achieve optimal outcomes. (2003). American Psychiatric Association. Typical childhood disfluencies may increase and decrease without any external influence. their reason for seeking treatment at the current time. A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). by ; 2022 June 3; barbara "brigid" meier; 0 . Identifying subgroups of stutterers (No. Oxford University Press. The speakers measured speech rate is not always greater than average, but the listener perceives it as rapid. 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 . Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words and interjections (such as um and well). "Atypical" disfluencies include: sound repetitions ("s-s-s-so"); syllable repetitions ("be-be-be-be-because"); prolongations ("Aaaaaaaaaaaaand"); and 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. Journal of Speech, Language, and Hearing Research, 62(12), 43354350. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). the asha leader; journals. 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/10.1016/j.jfludis.2012.11.002, Yaruss, J. S. (1997). Some persons who stutter report psychosocial benefits, including personal and relationship benefits and positive perspectives about stuttering and life. There is not enough epidemiological research to state specific risk factors for cluttering. Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. For preschool children who stutter, parent and family involvement in the treatment process is essential, as is a home component (Kelman & Nicholas, 2020). Direct treatment focuses on changing the childs speech, attitudes, and beliefs in order to manage stuttering or facilitate fluency (Yaruss et al., 2006). BMJ, 331(7518), 659661. 255279). Increasing the individuals awareness and self-monitoring skills helps to reduce unproductive behaviors that interfere with speech, and it may allow them to alter moments of stuttering so that they have decreased tension, are shorter, and are less disruptive to communication. Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. 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. Journal of Speech, Language, and Hearing Research, 51(3), 636650. 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. wandering womb handmaid's tale; ismackzi gta 5 mods; katherine stinney age. Scaler Scott, K., & Ward, D. (2013). This may progress to the client analyzing the clinicians or their own pseudostuttering, to analyzing a video of their own stuttering to real-time analysis (Bray & Kehle, 2001; Bray et al., 2003; Cream et al., 2010; Harasym et al., 2015; Prins & Ingham, 2009). (2018). The attitudes of high school peers toward stuttering and toward persons who stutter can be improved through education in the form of classroom presentations about stuttering (Flynn & St. Louis, 2011). Males were reported to be 1.48 times more likely to persist in stuttering than females (Singer et al., 2020). Journal of Speech, Language, and Hearing Research, 62(12), 43564369. increasing self-confidence and self-efficacy. https://doi.org/10.1016/S0094-730X(99)00023-6, McGill, M., Siegel, J., Nguyen, D., & Rodriguez, S. (2018). Journal of Fluency Disorders, 49, 1328. Experiences with stuttering can affect an individuals employment, job satisfaction, personal and romantic relationships, and overall quality of life (Beilby et al., 2013; Blood & Blood, 2016). Erlbaum. (2017). Daly, D. A., Simon, C. A., & Burnett-Stolnack, M. (1995). 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). Possible genetic factors in cluttering. In D. Ward & K. Scaler Scott (Eds. Time and expense are considerations along with attention to generalization and treatment needs following an intensive program (Cooper, 1979). The specific strategy they select will depend on when the client catches the disfluencyin anticipation of the moment of disfluency, in the moment, or following the moment (Van Riper, 1973). In B. J. Amster & E. R. Klein (Eds. Stuttering and labor market outcomes in the United States. It may occur only in specific situations, but it is more likely to occur in these situations, day after day. https://doi.org/10.1177/1073858418803594, Chang, S.-E., & Zhu, D. C. (2013). You do not have JavaScript Enabled on this browser. Genetic approaches to understanding the causes of stuttering. Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). practice monitoring each others speech and secondary behaviors. Journal of Fluency Disorders, 62, 105724. https://doi.org/10.1016/j.jfludis.2019.105724, Gerlach, H., Totty, E., Subraminian, A., & Zebrowski, P. (2018). Advances in Psychiatric Treatment, 12(1), 6368. Reducing negative reactions through desensitization and cognitive restructuring. Psychology Press. https://doi.org/10.1044/sbi15.2.75, Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). (2013). The primary provider of fluency treatment is the SLP. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. ), Controversies about stuttering therapy (pp. Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). (2017). Avoidance Reduction Therapy for Stuttering (ARTS). A phenomenological understanding of successful stuttering management. Causes of stuttering are thought to be multifactorial and include genetic and neurophysiological factors that contribute to its emergence (Smith & Weber, 2017). https://doi.org/10.1044/1058-0360(2007/008), Oyono, L. T., Pascoe, M., & Singh, S. (2018). Stuttering and work life: An interpretative phenomenological analysis. Psychosocial support for adults who stutter: Exploring the role of online communities. Assessment and treatment of stuttering in bilingual speakers. Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. ), The treatment of stuttering in the young school-aged child (pp. Harper & Row. Direct treatment approaches may include speech modification (e.g., reduced rate of speech, prolonged syllables) and stuttering modification strategies (e.g., modifying a stuttered word, pulling out of a stuttered word) to reduce disfluency rate, physical tension, and secondary behaviors (Hill, 2003). Cluttering treatment: Theoretical considerations and intervention planning. Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. B., & Al-Khamra, R. (2015). Journal of Fluency Disorders, 62, 105762. https://doi.org/10.1016/j.jfludis.2019.105726. https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Bowling Green State University Archive. Introduction: The importance of the social, emotional, and cognitive dimensions of stuttering. Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. https://doi.org/10.1542/peds.2019-0811, Zebrowski, P. M. (2002). https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). These differences may affect speech planning needed for fluency (Chang & Zhu, 2013). https://doi.org/10.1016/S0021-9924(03)00052-2, Yaruss, J. S., & Quesal, R. W. (2006). The scope of this page includes stuttering and cluttering across the life span. Emotional reactivity, regulation and childhood stuttering: A behavioral and electrophysiological study. Trichon, M., & Raj, E. X. Onslow, M., & Yaruss, J. S. (2007). They have long-held beliefs about stuttering that positively or negatively affect self-perceptions about their communication skills and their motivation for change (Daniels, 2007). 178196). A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. Journal of Fluency Disorders, 32(1), 5169. Educating other professionals about the needs of individuals with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders. Traits of attention deficit/hyperactivity disorder in school-age children who stutter. See ASHAs Practice Portal page on Telepractice. The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. Prentice-Hall. Cluttering and Down syndrome. However, several likely gene mutations have been linked to stuttering (Frigerio-Domingues & Drayna, 2017). Journal of Fluency Disorders, 13(5), 357373. 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). Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. Language, Speech, and Hearing Services in Schools, 48(4), 234248. Reading slowly may be perceived as a reading problem, even though the underlying cause is stuttering. The epidemiology of cluttering with stuttering. While uncommon, more and more cases are being reported through online communities by speech-language pathologists seeking guidance for treatment. See What To Ask When Evaluating Any Procedure, Product, or Program. Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. Recommending related services when necessary for management and treatment in different settings (e.g., classroom, work, community). An increase in observable disfluent behaviors may occur as the individual communicates more freely. Anger/Resistance, 4. Seminars in Speech and Language, 18(4), 371389. Speech modification approaches to stuttering treatment in schools. Fluency and stuttering. atypical pauses within sentences that are not expected syntactically (e.g., I will go to the. Provider refers to the person providing treatment (e.g., SLP, trained volunteer, family member, or caregiver). Acceptance and Commitment Therapy for people who stutter. Other strategies for treating cluttering include overemphasizing multisyllabic words and word endings, increasing awareness of when a communication breakdown occurs (e.g., through observation of listener reactions), and increasing self-regulation of rate and clarity of speech. Through a process of identifying the assumptions underlying their thoughts, they can evaluate whether those thoughts are helpful (or valid) and ultimately adopt different assumptions or thoughts. providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. https://doi.org/10.1016/j.jfludis.2018.09.004, Menzies, R. G., OBrian, S., Packman, A., Jones, M., Helgadttir, F. D., & Onslow, M. (2019). https://doi.org/10.1044/0161-1461.2602.162. Journal of Fluency Disorders, 54, 1423. Fluency disorders can interfere with play, school, work, or social interactions (Yaruss & Quesal, 2004). https://doi.org/10.1016/j.jfludis.2016.07.002, Iverach, L., & Rapee, R. M. (2014). https://doi.org/10.1016/0094-730X(88)90004-6, Onslow, M., & OBrian, S. (2012). 211230). Yaruss, J. S., & Reardon-Reeves, N. (2017). One study showed that children who clutter had 7.6 times more normal disfluencies compared to "atypical" disfluencies when they retold a story (van Zaalen et al., 2009). 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. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Quick: Talk fast & dont stutter! Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. BOBapp What are typical vs. atypical disfluencies in speech? https://doi.org/10.1044/2018_AJSLP-17-0097, Kraft, S. J., & Yairi, E. (2011). Perspectives on Fluency and Fluency Disorders, 17(2), 49. 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. https://doi.org/10.1044/cicsd_25_S_8, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2017). Journal of Paediatrics and Child Health, 49(2), E112E115. Typical pneumonia is a form of community-acquired pneumonia that tends to have more serious symptoms. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0189, Chakraborty, M., Chen, L.-F., Fridel, E. E., Klein, M. E., Senft, R. A., Sarkar, A., & Jarvis, E. D. (2017). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). https://doi.org/10.1044/2018_JSLHR-S-17-0378, Byrd, C. T. (2018). Treatment approaches for preschool children who stutter include the following. The International Journal of Indian Psychology, 3(3), 7887. St. Louis, K. O., & Schulte, K. (2011). Clinical implications of situational variability in preschool children who stutter. ), Stuttering and related disorders of fluency (pp. if monitoring or treatment (direct or indirect) is recommended. 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). Seminars in Speech and Language, 24(1), 2126. Disclosing a fluency disorder may be done a number of ways, such as verbally stating I stutter/have a speech disorder or by pseudostuttering or openly stuttering, while doing so confidently (McGill et al., 2018). 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). Genetic contributions to stuttering: The current evidence. https://doi.org/10.1016/0094-730X(88)90003-4. Features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder). Is parentchild interaction therapy effective in reducing stuttering? Yaruss, J. S., Quesal, R. W., & Reeves, L. (2007). Early childhood stuttering and electrophysiological indices of language processing. For bilingual individuals, it is important for the clinician to consider the language or languages used during intervention. The model describes the following stages of behavioral change: See Manning and DiLollo (2018) and Floyd et al. Stuttering and its treatment in adolescence: The perceptions of people who stutter. 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. https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). 115134). Apraxia of Speech (Adults) Apraxia of Speech (Childhood) Attention Deficit Hyperactivity Disorder (ADHD) Auditory Neuropathy Spectrum Disorder (ANSD) Augmentative and Alternative Communication (AAC) Autism. Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. One example of an approach that incorporates cognitive restructuring is Acceptance and Commitment Therapy (ACT; Beilby & Brynes, 2012; Beilby et al., 2012a; Palasik & Hannan, 2013). (2013). It is important for clinicians to verify online sites and virtual support groups recommended to clients and their families. Journal of Fluency Disorders, 61, 105713. https://doi.org/10.1016/j.jfludis.2019.105713, Douglass, J. E., Schwab, M., & Alvarado, J. https://doi.org/10.1016/0094-730X(86)90028-8, St. Louis, K. O., & Hinzman, A. R. (1988). Rehabilitation Act of 1973, Section 504. recognize physical concomitant behaviors, locate the point of physical tension and struggle during moments of disfluency, and. 1-888-266-0574. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. B. Journal of Abnormal Psychology, 119(3), 479490. https://doi.org/10.1080/2050571X.2016.1253533. Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. Speech, Language and Hearing, 20(3), 144153. (Eds.). altering the size of the group or audience. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Studies in tachyphemia: III. Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the Self-Stigma of Stuttering Scale (4S). Peer support for people who stutter: History, benefits, and accessibility. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. 4566). Singular. 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. Journal of Fluency Disorders, 38(1), 1429. Plural. Journal of Fluency Disorders, 31(2), 90115. Journal of Speech, Language, and Hearing Research, 63(9), 29953018. seizure disorders (Briley & Ellis, 2018). Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). https://doi.org/10.1044/2019_JSLHR-S-18-0318, Lucey, J., Evans, D., & Maxfield, N. D. (2019). Journal of Fluency Disorders, 32(2), 95120. Treatment may include strategies to reduce negative reactions to stuttering in the individual and others (Yaruss et al., 2012). These individuals are said to experience covert stuttering (B. Murphy et al., 2007). Individuals are referred to a speech-language pathologist (SLP) for a comprehensive assessment when disfluencies are noted and when one or more of the factors listed below are observed along with the disfluencies. All approaches should include a plan for generalization and maintenance of skills involved in activities of daily living. Explore how typical and atypical disfluencies differ, and find resources for guidance and support. https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. SIG 16 Perspectives on School-Based Issues, 15(2), 7580. 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. Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). 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). Current Biology, 26(8), 10091018. Strategies aimed at changing the timing and tension of speech production include. Bilingual children are assessed in both languages to determine stuttering profiles in both (Finn & Cordes, 1997). Dosage depends largely on the nature of the treatment (e.g., direct, indirect), age group, and the task level (e.g., learning basic skills requires more clinic room practice than does generalization).
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