), Stuttering and related disorders of fluency (pp. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. The model describes the following stages of behavioral change: See Manning and DiLollo (2018) and Floyd et al. Prentice-Hall. Children who stutter may demonstrate poorer expressive lexical skills compared to their peers (Silverman & Bernstein Ratner, 2002). Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators. Persons who stutter may appear friendlier when they self-disclose their stuttering, and self-disclosure may help put listeners more at ease (Healey et al., 2007). https://doi.org/10.1159/000486032, Tichenor, S. E., & Yaruss, J. S. (2018). https://doi.org/10.4324/9781351122351, Klein, J. F., & Hood, S. B. 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). Cluttering: A handbook of research, intervention and education. Seminars in Speech and Language, 23(3), 181186. Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency. (2007) for a description of how the stages of change model can be applied to fluency therapy. https://doi.org/10.1016/j.jfludis.2007.02.001. Brain, 131(1), 5059. Behavioral treatments that address improved speech fluency appear to be effective across a range of cultures and languages (Finn & Cordes, 1997). Sheehan, V. M., & Sisskin, V. (2001). Systems that govern self-regulation may underlie cluttering; qualitative interviews with those who clutter suggest that thoughts emerge before they are ready (Scaler Scott & St. Louis, 2011). Studies in tachyphemia: III. Craig, A., Blumgart, E., & Tran, Y. https://doi.org/10.1017/CBO9781139108683.023. You do not have JavaScript Enabled on this browser. Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). https://doi.org/10.1007/s11689-011-9090-7, Druker, K., Mazzucchelli, T., Hennessey, N., & Beilby, J. language or learning disability (Ntourou et al., 2011). Journal of Speech, Language, and Hearing Research, 61(12), 28952905. https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). Genetic factors and therapy outcomes in persistent developmental stuttering. Prevalence of anxiety disorders among children who stutter. Signs and symptoms of stuttering include core speech behaviors, such as. (1984). Menu. Cluttering: A neurological perspective. https://doi.org/10.1016/j.jfludis.2014.12.003. (2008). https://doi.org/10.1044/ffd23.2.54, Plexico, L. W., Hamilton, M. B., Hawkins, H., & Erath, S. (2019). See ASHAs resource on assessment tools, techniques, and data sources. Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. Plural. The epidemiology of cluttering with stuttering. their reason for seeking treatment at the current time. Allyn & Bacon. Self-efficacy and quality of life in adults who stutter. These simulations and applications of strategies might be most likened to cancellation and pull-out techniques used in stuttering. 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). Van Borsel, J., Maes, E., & Foulon, S. (2001). Neural network connectivity differences in children who stutter. Journal of Fluency Disorders, 30(1), 122. https://doi.org/10.1055/s-2007-986528, Yaruss, J. S., Coleman, C., & Hammer, D. (2006). ), The atypical stutterer: Principles and practices of rehabilitation (pp. Onset may be progressive or sudden. (2011). Clinicians may start with the client observing videos of others who stutter (or a puppet for children) to help them identify patterns, attitudes, and beliefs about communication and stuttering. The assignments begin in supportive, low-fear situations and slowly evolve to more challenging situations and settings as the individual demonstrates the ability to accept or tolerate potential negative reactions. Adolescents also may be particularly susceptible to peer pressure and bullying at this time. These are called typical disfluencies or nonfluencies. using indirect prompts rather than direct questions, recasting/rephrasing to model fluent speech or techniques (Millard et al., 2008; Yaruss et al., 2006), and. 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. 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. (n.d.). Journal of Fluency Disorders, 31(2), 90115. Genetics and neurophysiology appear to be related to the underlying causes of stuttering. Harper & Row. For a child with normal disfluencies, a "wait and see" approach is much more acceptable than for a child with early stuttering. https://doi.org/10.1016/0094-730X(88)90003-4. 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). Journal of Fluency Disorders, 34(3), 187200. Journal of Speech, Language, and Hearing Research, 60(9), 24832505. https://doi.org/10.1044/2019_JSLHR-19-00138, Tichenor, S. E., & Yaruss, J. S. (2019b). It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. https://doi.org/10.1044/2019_JSLHR-S-18-0225. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0196, Healey, E. C., Gabel, R. M., Daniels, D. E., & Kawai, N. (2007). Genetic contributions to stuttering: The current evidence. 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). 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). Professional awareness of cluttering. 255279). Teigland, A. A mutation associated with stuttering alters mouse pup ultrasonic vocalizations. Effective counseling is important for encouraging individuals with a fluency disorder to share information in the affective, cognitive, and social domains. Intrajudge and interjudge reliability of the Stuttering Severity InstrumentFourth Edition. Tellis and Tellis (2003) caution clinicians not to confuse these word-finding problems with stuttering. 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. perceived communication and job barriers. 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. Reeves, L. (2006). Stuttering and labor market outcomes in the United States. Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. There are benefits of both individual and group treatment. Additionally, there is no documented recovery from cluttering; therefore, duration since onset does not seem to apply as a risk factor. Pro-Ed. The prevalence of speech and language disorders in French-speaking preschool children from Yaound (Cameroon). Evidence-based treatment and stutteringHistorical perspective. Engaging parents in treatment helps to achieve carryover in the home environment and helps with treatment across languages (Shenker, 2013). Crystal Cooper, Diane L. Eger, and Nancy Creaghead served as monitoring vice presidents. SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 2(17), 4249. https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. Treatment approaches are individualized based on the childs needs and family communication patterns. Pro-Ed. This course presents the most up-to-date evidence regarding the identification and management of atypical disfluency. Palin ParentChild Interaction therapy: The bigger picture. The primary provider of fluency treatment is the SLP. https://doi.org/10.1016/j.jfludis.2017.06.001. Journal of Speech, Language, and Hearing Research, 44(2), 368380. seizure disorders (Briley & Ellis, 2018). Children who stutter also may be at risk for experiencing bullying (Blood & Blood, 2004; Davis et al., 2002; Langevin et al., 1998). The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. https://doi.org/10.1542/peds.2007-1648, Boscolo, B., Ratner, N. B., & Rescorla, L. (2002). Clinicians can help clients progress to active stages through building self-efficacy. Defining cluttering: The lowest common denominator. SLPs may want to relate personal experiences when asking clients to share such vulnerable information. School-age stuttering therapy: A practical guide. Seminars in Speech and Language, 35(2), 114131. information regarding family, personal, and cultural perception of fluency. Tourettes syndrome (see Van Borsel, 2011, for a review). Donaher, J., & Richels, C. (2012). 328). We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). Definitions of communication disorders and variations [Relevant paper]. (2020). (2016). Overall, these indicators demonstrate progression from avoidance and negative impact to acceptance, openness, and increased socialization (V. M. Sheehan & Sisskin, 2001). An introduction to camps for children who stutter: What they are and how they can help. Journal of Fluency Disorders, 37(4), 242252. The ASHA Leader, 18(3), 1415. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). 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. If treatment is warranted, it is necessary to determine the timing for intervention and to set out a plan for parent education and counseling. 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. Examples of support groups and activities include FRIENDS: The National Association of Young People Who Stutter, the National Stuttering Association, and SAY: The Stuttering Association for the Young; online groups (e.g., online chats); and social media (e.g., blogs; Reeves, 2006). (2005). The utility of stuttering support organization conventions for young people who stutter. 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. Functional and neuroanatomical bases of developmental stuttering: Current insights. These modifications are used to facilitate speech fluency and may include. See What To Ask When Evaluating Any Procedure, Product, or Program. Ward, D., & Scaler Scott, K. (2011). Thieme. https://doi.org/10.1044/2019_PERS-SIG4-2019-0024, Boyle, M. P., & Gabel, R. (2020). See ASHAs Practice Portal pages on Childhood Apraxia of Speech and Speech Sound Disorders: Articulation and Phonology. (2020). ), Cluttering: A handbook of research, intervention and education (pp. 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). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199. All speakers are disfluent at times. Journal of Fluency Disorders, 54, 113. https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. 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). Typical adolescent experiences of emotional reactivity, resistance to authority, and social awkwardness may be exacerbated in adolescents who also experience stuttering (Daly et al., 1995; Zebrowski, 2002). being more comfortable and open with stuttering and pseudostuttering; reporting experiencing decreased anxiety while communicating; reporting less adverse psychological, emotional, social, and functional impacts; reporting enjoying social communication, including with strangers; and. 7). Fluency Disorders (Practice Portal). 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. modifying instructions to accommodate the home language, using exemplars in audio or video format in the home language, and. 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). 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). Strategies aimed at altering the timing of pausing are used to increase the likelihood of fluent speech production and to improve overall communication skills (e.g., intelligibility, message clarity). Fluency: A review of developmental and remedial practices. For a review of temperament, emotion, and childhood stuttering, see R. M. Jones, Choi, et al. Stuttering and the International Classification of Functioning, Disability and Health (ICF): An update. Current Biology, 26(8), 10091018. Real-time analysis or analysis based on an audiovisual recorded speech sample demonstrating representative disfluencies beyond the clinic setting. Limited research is available that identifies the causes of cluttering. Onslow, M., & Yaruss, J. S. (2007). 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. Possible genetic factors in cluttering. discussing the rationale for treatment decisions, and. Daly, D. A., Simon, C. A., & Burnett-Stolnack, M. (1995). Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Journal of Communication Disorders, 80, 8191. A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. https://doi.org/10.1016/j.jfludis.2007.03.001, Flynn, T. W., & St. Louis, K. O. Treatment for all communication disorders, including fluency disorders, may necessitate adjustments to protocols, processes, and approaches for bilingual individuals. Folia Phoniatrica et Logopaedica, 64(1), 3447. https://doi.org/10.15027/36895, Wagovich, S., & Anderson, J. Stimulability testing (e.g., person is asked to increase pausing and/or decrease speech rate in some other way)a reduction of overall speech rate typically helps in reducing cluttering symptoms. Neurobiology of Disease, 69, 2331. BOBapp(2023) Traits of attention deficit/hyperactivity disorder in school-age children who stutter. Manning, W. H., & DiLollo, A. Understanding and treating cluttering. For example, English language learners may have word-finding problems in the second language. Finding opportunities for social support for individuals with fluency disorders. omission of word endings (e.g., Turn the televisoff). 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). In E. Conture & R. F. Curlee (Eds. https://doi.org/10.1044/ffd22.2.51, Berquez, A., & Kelman, E. (2018). ), Cluttering: Research, intervention and education (pp. "I-I-I-I- want the ball") The speaker is thought to be talking at a rate that is too fast for their system to handle, resulting in breakdowns in fluency and/or intelligibility (Bakker et al., 2011). 157186). 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). Journal of Fluency Disorders, 49, 1328. There are limited data on the age of onset of cluttering; however, the age of onset of cluttering appears to be similar to that of stuttering (Howell & Davis, 2011). Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter. Journal of Fluency Disorders, 36(4), 290295. Journal of Fluency Disorders, 58, 110. Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. Stuttering and work life: An interpretative phenomenological analysis. Family historyAnecdotal reports indicating the presence of cluttering in more than one family member suggest that family history may be a risk factor. Psychology Press. https://doi.org/10.1044/2017_LSHSS-17-0028. https://doi.org/10.1016/j.jfludis.2012.11.002, Yaruss, J. S. (1997). Counseling parents of children who stutter. https://scholarworks.bgsu.edu/comm_disorders_diss/7/. Multicultural issues in school settings. their disfluencies may be accompanied by physical tension and secondary behaviors. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. 115134). Speaker and observer perceptions of physical tension during stuttering. (2019). frequency of exposure to all languages used by the child and their proficiency (comprehension and production) in each language; family history of stuttering or cluttering; description of disfluency and rating of severity; age of onset of disfluency and patterns of disfluency since onset (e.g., continuous or variable); previous fluency treatment and treatment outcomes; exploration of parental reactions to the childs moments of disfluency or speaking frustration; and. The neurological underpinnings of cluttering: Some initial findings. Stuttering More than 70 million people around the world struggle with stuttering, according to The Stuttering Foundation. Direct treatment approaches can also target resilience and effort control in the child and family (Caughter & Crofts, 2018; Druker et al., 2019; Kraft et al., 2019). Journal of Speech, Language, and Hearing Research, 61(5), 12381250. https://doi.org/10.1016/j.jfludis.2008.01.001. Prentice-Hall. (2011). Myers, F. L. (1992). Consistent with a person- and family-centered approach to stuttering treatment, the SLP. Toward a better understanding of the process of disclosure events among people who stutter. Prevalence of speech disorders in elementary school students in Jordan. https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). In D. Ward & K. Scaler Scott (Eds. In E. Conture & R. F. Curlee (Eds. Children with language difficulties at the sentence, narrative, or conversational discourse level may exhibit increased speech disfluencies. Journal of Fluency Disorders, 22(3), 219236. Symptoms and severity of stuttering and cluttering can vary (Davidow & Scott, 2017; St. Louis & Schulte, 2011). Typical vs. Atypical Antipsychotics: Main Differences and Effectiveness 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. Impact of social media and quality of life of people who stutter. See ASHAs Practice Portal resource on Transitioning Youth. Unlike stuttering, there are no data regarding age since onset and long-term outcomes of cluttering. 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. 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). 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). Sadness/Depression, 6. 297325). Bowling Green State University Archive. A phenomenological understanding of successful stuttering management. Parents can also report if secondary behaviors are present in both languages. SLPs also need to discuss with persons who stutter and their families how to evaluate the veracity and trustworthiness of sites claiming to cure stuttering that they may find on their own. Assessment and treatment of stuttering in bilingual speakers. The person exhibits physical tension or secondary behaviors (e.g., eye blinking, head nodding) associated with the disfluency. Journal of Fluency Disorders, 29(4), 255273. To facilitate generalization of skills, the clinician can help the individual use a variety of therapeutic activities outside of the treatment room, such as. Developmental Disfluency vs. Atypical Dysfluency/Stuttering: When to be Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. Roberts, P., & Shenker, R. (2007). Journal of Speech, Language, and Hearing Research, 63(9), 29953018. Seminars in Speech and Language, 39(4), 324332. 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). Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition. The ability to use speech strategies; to make choices to speak and participate, regardless of the level of fluency; and to take risks is greatly reduced outside of the treatment setting when time pressure and conditioned negative feelings may trigger fear and old behaviors. https://doi.org/10.1044/leader.OV.18032013.14, Freud, D., & Amir, O. Recurring themes of successful stuttering management in adults have been described as. Individuals and families may have a wide range of beliefs about the best way to treat fluency disorders, ranging from medical and therapeutic intervention to prayer. 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. Douglass, J. E., Constantino, C., Alvarado, J., Verrastro, K., & Smith, K. (2019). Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. https://doi.org/10.1044/1092-4388(2003/095), Anderson, T. K., & Felsenfeld, S. (2003). - Speech & Language Parent Support - SPSD 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. Fluency and stuttering. Characteristics of Typical Disfluency and Stuttering - ASHA (2018). Cambridge University Press. 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). In B. J. Amster & E. R. Klein (Eds. How stuttering develops: The multifactorial dynamic pathways theory. Journal of Speech and Hearing Disorders, 50(3), 261281. https://doi.org/10.1055/s-0038-1667161, Byrd, C. T., Chmela, K., Coleman, C., Weidner, M., Kelly, E., Reichhardt, R., & Irani, F. (2016). It is not appropriate to determine a standard score if the norming sample of the assessment is not representative of the individual being assessed. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. 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). https://doi.org/10.1016/j.jfludis.2015.08.001, Han, T.-U., Park, J., Domingues, C. F., Moretti-Ferreira, D., Paris, E., Sainz, E., Gutierrez, J., & Drayna, D. (2014). Journal of Fluency Disorders, 21(34), 215225. In D. Ward & K. Scaler Scott (Eds. Title: The Differential Diagnosis of Disfluency Created Date: 7/18/2007 3:15:45 PM Experts in the field of cluttering have consistently estimated that approximately one third of children and adults who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). ), Cluttering: Research, intervention and education (pp. In L. Cummings (Ed. Conture, E. G. (2001). https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). Erickson, S., & Block, S. (2013). Counseling allows the clinician who works with those who stutter or clutter to practice within the ICF framework by targeting all aspects of the disordernot just the surface behaviors. Their skills are developing in this area. (2019). https://doi.org/10.1093/brain/awt275, Chang, S.-E., Zhu, D. C., Choo, A. L., & Angstadt, M. (2015). American Journal of Speech-Language Pathology, 27(3S), 12351243. Journal of Fluency Disorders, 64, 105761. https://doi.org/10.1016/j.jfludis.2020.105761, Frigerio-Domingues, C. E., & Drayna, D. (2017). https://doi.org/10.1016/j.jfludis.2004.12.001, Plexico, L. W., Manning, W. H., & DiLollo, A. 147171). hurricane elizabeth 2015; cheap houses for sale in madison county; stifel wealth tracker login; zadna naprava peugeot 206; 3 days a week half marathon training plan; Persons who stutter also may experience psychological, emotional, social, and functional reactions to stuttering (anxiety, embarrassment, avoidance, tension and struggle, low self-esteem). Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. Efforts to conceal stuttering may adversely affect quality of life (Boyle et al., 2018). Resilience in people who stutter: Association with covert and overt characteristics of stuttering. Audiovisual recordings of speech can provide useful information to supplement direct clinical observations. It is not possible to determine with certainty which children will continue to stutter, but there are some factors that indicate a greater likelihood that stuttering will become chronic. The individual learns strategies for generalization of skills to the classroom, workplace, and community. Multicultural identification and treatment of stuttering: A continuing need for research. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). However, as they learn to reduce reactivity (see below), they develop greater comfort while speaking, they assume more positive attitudes about their ability to communicate, and they are better able to accept and manage moments of disfluency as they occur. Journal of Fluency Disorders, 43, 116. Reardon-Reeves, N., & Yaruss, J. S. (2013). Self-help conferences for people who stutter: A qualitative investigation.