typical vs atypical disfluencies asha

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). Language, Speech, and Hearing Services in Schools, 48(4), 234248. If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. Perspectives on Fluency and Fluency Disorders, 23(2), 5469. Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. Rethinking covert stuttering. Brain, 131(1), 5059. (2018). 115134). recognize physical concomitant behaviors, locate the point of physical tension and struggle during moments of disfluency, and. Persons who clutter can experience the same affective, behavioral, and cognitive reactions as those with stuttering, including communication avoidance, anxiety, and negative attitudes toward communication (Scaler Scott & St. Louis, 2011). Methods in stuttering therapy for desensitizing parents of children who stutter. Mild stuttering, on the other hand, tends to appear more regularly. The effects of self-disclosure and non-self-disclosure of stuttering on listeners perceptions of a person who stutters. Referral to another helping professional should be made if a condition or situation falls outside of the SLPs scope of practice. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Fluency of school-aged children with a history of specific expressive language impairment: An exploratory study. The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. SIG 16 Perspectives on School-Based Issues, 15(2), 7580. When developing treatment goals, the clinician takes a holistic approach and considers the extent to which stuttering affects the individuals entire communication experience. 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/10.1044/2018_AJSLP-17-0097, Kraft, S. J., & Yairi, E. (2011). Board Certified Specialists in Fluency are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with fluency disorders. Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). Coleman, C. (2013). intellectual disability (Healey et al., 2005). See ASHAs Practice Portal page on Cultural Responsiveness. ; American Psychiatric Association, 2013). https://doi.org/10.1111/1460-6984.12051, Fuse, A., & Lanham, E. A. 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. 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). https://doi.org/10.1017/CBO9781139108683.023. Such strategies include simulating a fast rate of speech and applying pausing and/or simulating overarticulated speech and applying increased emphasis to increase intelligibility. These simulations and applications of strategies might be most likened to cancellation and pull-out techniques used in stuttering. Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. In B. J. Amster & E. R. Klein (Eds. Stuttering in animal models, such as zebra finches (Chakraborty et al., 2017) and mice (Barnes et al., 2016; Han et al., 2019), has also been investigated, including how the expression of stuttering influences social behaviors of mice (Han et al., 2019). Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. Research updates in neuroimaging studies of children who stutter. https://doi.org/10.1016/j.jfludis.2012.11.002, Yaruss, J. S. (1997). Other identification strategies may include video or pseudostuttering analysis or tallying/freezing. Erlbaum. Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. Assessing organization of discourse also can help rule out verbal organization problems that might be mistaken for cluttering (van Zaalen-Opt Hof et al., 2009). Psychology Press. International Classification of Functioning, Disability and Health. Available 8:30 a.m.5:00 p.m. Contemporary Issues in Communication Science and Disorders, 31(Spring), 6979. https://doi.org/10.1016/j.jcomdis.2014.02.001, Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). 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: A study of pragmatic skills of clutterers and normal speakers. Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. They are likely to use interjections, repeat phrases, and revise what they are saying. For some people, the use of these behaviors can result in little or no observable stuttering. In contrast, children with reading disorders are likely to have difficulty decoding the printed form, which, in turn, has a negative impact on oral reading fluency (Kuhn & Stahl, 2003). These may include stuttering modification (described above) in addition to awareness, desensitization, cognitive restructuring, self-disclosure, and support. These are called typical disfluencies or nonfluencies. Scaler Scott, K. (2011). 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). https://doi.org/10.1111/1469-7610.00093, de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M. C. (2015). As suggested earlier, normal disfluencies will appear for a few days and then disappear. (2014). ), Stuttering and related disorders of fluency (pp. Avoidance can lead to less talking and reduced linguistic complexity. Journal of Fluency Disorders, 38(4), 342355. Journal of Educational Psychology, 95(1), 321. ), Cluttering: Research, intervention and education (pp. See ASHAs resource on assessment of fluency disorders in the context of the WHO ICF framework. Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. 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. 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. https://doi.org/10.1044/2019_PERS-SIG4-2019-0024, Boyle, M. P., & Gabel, R. (2020). https://doi.org/10.1016/j.jfludis.2009.09.002, Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Although cluttering and stuttering can co-occur, there are some important distinctions between the two (see Scaler Scott, 2010). https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Palin ParentChild Interaction therapy: The bigger picture. Stuttering: Its nature, diagnosis, and treatment. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. The person is having difficulty communicating messages in an efficient, effective manner. typical vs atypical disfluencies asha. The epidemiology of cluttering with stuttering. Folia Phoniatrica et Logopaedica, 64(1), 3447. 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). Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. Wiig, E. H., & Semel, E. M. (1984). Without proper intervention, children who exhibit signs of early stuttering are more at risk for continued stuttering. Skip to main content. American Journal of Speech-Language Pathology, 27(2), 721736. Journal of Speech, Language, and Hearing Research, 61(5), 12381250. 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. However, there is no evidence to support the idea that stuttering is caused by, or more prevalent in, bilingual or multilingual speakers or that exposure to a second language increases the risk for developing stuttering (Byrd, 2018). https://doi.org/10.1016/j.jfludis.2010.12.003. Stuttering may influence an individuals perception of their career possibilities and professional limitations (Klein & Hood, 2004). Language, Speech, and Hearing Services in Schools, 43(4), 536548. Consistent with a person- and family-centered approach to stuttering treatment, the SLP. 7). Alm, P. A. https://doi.org/10.1016/j.jfludis.2013.01.001. 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). This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. They may hesitate when speaking, use fillers (like or uh), or repeat a word or phrase. excessive levels of typical disfluencies (e.g., revisions, interjections), maze behaviors or frequent topic shifting (e.g., I need to go toI mean Im out of cheese. van Zaalen, Y., & Reichel, I. K. (2014). Whurr Publishers. https://doi.org/10.1044/1092-4388(2011/10-0304), Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K. (2002). https://doi.org/10.1044/ffd22.1.34, Beilby, J. M., Byrnes, M. L., Meagher, E. L., & Yaruss, J. S. (2013). In D. Ward & K. Scaler Scott (Eds. American Journal of Speech-Language Pathology, 7(4), 6276. Differences between children and adults should also be considered when interpreting data from neurological studies. 9099). To foster generalization, assignments adhere to a hierarchy of linguistic skills and environmental stressors. ), Handbook of psychotherapy integration (pp. Areas of the brain that were studied and the technologies used to conduct the research (e.g., PET, MEG, MRI, fMRI, NIRS, DCS) also varied widely. Psychology Press. https://doi.org/10.1016/j.jcomdis.2015.10.003. Guitar, B. Clinical characteristics associated with stuttering persistence: A meta-analysis. In D. Ward & K. Scaler Scott (Eds. Evaluating stuttering in young children: Diagnostic data. Evidence-based practice for school-age stuttering: Balancing existing research with clinical practice. (2010). 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). They also can benefit from groups and intensive programs (Fry et al., 2014). International Journal of Speech-Language Pathology, 17(4), 367372. 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). https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). (2011). https://doi.org/10.1044/2020_JSLHR-20-00096. Journal of Fluency Disorders, 43, 1727. Preliminary research suggests adults who clutter demonstrate differences in cortical and subcortical activity compared to controls (Ward et al., 2015). The ASHA Leader, 19(7), 4448. https://doi.org/10.1044/2018_JSLHR-S-17-0378, Byrd, C. T. (2018). https://doi.org/10.1044/2018_JSLHR-S-17-0353, Guitar, B. Sadness/Depression, 6. Journal of Fluency Disorders, 32(2), 139162. https://doi.org/10.3109/17549507.2015.1010583, Adriaensens, S., Beyers, W., & Struyf, E. (2015). 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). American Journal of Speech-Language Pathology, 26(4), 11051119. The clinical applications of Acceptance and Commitment Therapy with clients who stutter. Atypical disfluency has been documented through case studies and has been described as final part-word repetition or "rhyme repetition". increasing self-confidence and self-efficacy. (2014). Journal of Fluency Disorders, 30(1), 122. Often referred to as advertising in the stuttering community, self-disclosure can involve. 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). 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). Fear of speaking: Chronic anxiety and stammering. Functional and neuroanatomical bases of developmental stuttering: Current insights. It is important to distinguish stuttering from other possible diagnoses (e.g., language formulation difficulties, cluttering, and reading disorders) and to distinguish cluttering from language-related difficulties (e.g., word finding and organization of discourse) and other disorders that have an impact on speech intelligibility (e.g., apraxia of speech and other speech sound disorders). Coexistence of stuttering and disordered phonology in young children. Scaler Scott, K. (2013). Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Early childhood stuttering and electrophysiological indices of language processing. Psychology Press. https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). 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). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Journal of Fluency Disorders, 62, 105762. https://doi.org/10.1016/j.jfludis.2019.105726. In D. Ward & K. Scaler Scott (Eds. It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. https://doi.org/10.1044/2020_PERSP-20-00014. (2011). Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. (2017). Testing, and 7. 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. Journal of Neurodevelopmental Disorders, 3(4), 374380. In F. L. Myers & K. O. St. Louis (Eds. It can also be challenging to assess the reading fluency of bilingual students who stutter. In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). reducing secondary behaviors and minimizing avoidances. Often, there are pivotal points during treatment that indicate progress (T. K. Anderson & Felsenfeld, 2003; Plexico et al., 2005). A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). The coexistence of disabling conditions in children who stutter: Evidence from the National Health Interview Survey. 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. You do not have JavaScript Enabled on this browser. https://doi.org/10.1044/2017_JSLHR-S-16-0343, Snsterud, H., Feragen, K. B., Kirmess, M., Halvorsen, M. S., & Ward, D. (2019). If treatment is currently not warranted, the SLP educates the family about how to monitor the childs fluency to determine if and when the child should be reevaluated. 157186). Parents can also report if secondary behaviors are present in both languages. Cambridge University 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). American Journal of Speech-Language Pathology, 27(3S), 12351243. EBP Briefs, 2(4), 18. Teasing/bullying experienced by children who stutter: Toward development of a questionnaire. Journal of Communication Disorders, 80, 1117. 4566). Prins, D., & Ingham, R. J. (n.d.). Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). The International Journal of Indian Psychology, 3(3), 7887. These should be considered during differential diagnosis but should not be the sole therapeutic strategies. Disclosure of stuttering and quality of life in people who stutter. Yairi, E., & Ambrose, N. (2013). Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering. The frequency and severity of overt stuttering may fluctuate from day to day and in relation to the speaking situation. Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. ), Current issues in stuttering research and practice (pp. Bakker, K., Myers, F. L., Raphael, L. J., & St. Louis, K. O. https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). 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. Helping adolescents who stutter focus on fluency. American Journal of Speech-Language Pathology, 2(2), 6573. 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). 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). Assessment and treatment of stuttering in bilingual speakers. The impact of stuttering on employment opportunities and job performance. 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). the individuals lived experiences with stuttering, the perceived impact of these experiences with stuttering, and. 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 In B. J. Amster & E. R. Klein (Eds. 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). Journal of Fluency Disorders, 38(2), 6687. Journal of Communication Disorders, 44(3), 276293. https://doi.org/10.1016/j.jfludis.2013.08.001, Briley, P. M., & Ellis, C. (2018). Journal of Fluency Disorders, 36(3), 186193. Temperamental characteristics of young children who stutter. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). American Journal of Speech-Language Pathology, 27(3S), 11111123. https://doi.org/10.1044/2019_AJSLP-19-00077, Tran, Y., Blumgart, E., & Craig, A. Reducing negative reactions through desensitization and cognitive restructuring. Journal of Speech, Language, and Hearing Research, 44(2), 368380. Stuttering and labor market outcomes in the United States. The Journal of Child Psychology and Psychiatry, 43(7), 939947. What we know for now IN BRIEF. The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. Journal of Fluency Disorders, 34(4), 368381. (2004). 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. https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). 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). Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. https://doi.org/10.1044/leader.FTR1.11102006.6, Tichenor, S. E., Leslie, P., Shaiman, S., & Yaruss, J. S. (2017). The ASHA Action Center welcomes questions and requests for information from members and non-members. 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). Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their childs environment. Journal of Communication Disorders, 80, 8191. Social anxiety disorder and stuttering: Current status and future directions. Treatment for adolescents who stutter poses a particular challenge because of the issues related to this developmental stage. Stuttering: Research and therapy. Diagnostic and statistical manual of mental disorders (5th ed.). Treatment should consider not just the overt stuttering behavior but also the affective and cognitive reactions to stuttering. Bargaining, 5. 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). Fluency and stuttering. Crystal ball gazing: Research and clinical work in fluency disorders in 2026. ), Cluttering: A clinical perspective (pp. typical vs atypical disfluencies asha. This approach to care incorporates individual and family preferences, priorities, and desired outcomes in the selection of treatment goals and treatment methods. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). Counseling helps an individual, a family member, or a caregiver of a person of any age who stutters move from the current scenario to a preferred scenario through an agreed-upon action plan (Egan, 2013). Singular. Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. https://doi.org/10.1016/j.jfludis.2018.10.003, Bray, M. A., & Kehle, T. J. (2013). Section 504 of the Rehabilitation Act of 1973 (United States Department of Labor, n.d.) protects qualified individuals from discrimination based on their disability via a 504 plan. 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). https://doi.org/10.1044/0161-1461(2006/014), Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). 6989). Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. A comprehensive assessment for persistent stuttering should include a self-assessment of the experience of stuttering. See ASHAs Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Miller, W. R., & Rollnick, S. (2013). https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). Journal of Fluency Disorders, 33(2), 8198. Reeves, L. (2006). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use https://doi.org/10.1044/2018_AJSLP-ODC11-17-0192, Tichenor, S. E., & Yaruss, J. S. (2019a). https://doi.org/10.1017/S135246580001643X. Journal of Fluency Disorders, 38(2), 171183. information regarding family, personal, and cultural perception of fluency. 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). Genetic bases of stuttering: The state of the art, 2011. discussing the rationale for treatment decisions, and. Clinical utility of self-disclosure for adults who stutter: Apologetic versus informative statements. Part of the diagnostic process is also to distinguish between stuttering disfluencies and disfluencies that occur when learning a new language. Therefore, as with school-age children and adolescents, the purpose of the assessment for adults typically is not to diagnose stuttering. Children who stutter (ages 39 years) have reduced connectivity in areas that support the timing of movement control. 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). Hill, D. (2003). There may be a relationship between stuttering and working memory. Journal of Speech, Language, and Hearing Research, 45(6), 10971105. Perspectives on Fluency and Fluency Disorders, 22(1), 3446. https://doi.org/10.1044/1058-0360.0704.62. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 1523. SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. Journal of Speech, Language, and Hearing Research, 51(6), 14651479. The Present Levels of Academic Achievement and Functional Performance statements are based on objective data. 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).