typical vs atypical disfluencies asha

https://doi.org/10.1016/j.jfludis.2004.08.001, Kraft, S. J., Lowther, E., & Beilby, J. 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. their reason for seeking treatment at the current time. Drayna, D. (2011). Journal of Fluency Disorders, 58, 94117. https://doi.org/10.1016/j.jfludis.2014.12.002, Boyle, M. P., Beita-Ell, C., & Milewski, K. M. (2019). Available 8:30 a.m.5:00 p.m. 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). https://doi.org/10.1016/S0094-730X(97)00009-0, Yaruss, J. S. (2007). https://doi.org/10.1044/persp2.SIG17.42, Vanryckeghem, M., & Kawai, M. (2015). (2011). It incorporates techniques such as open-ended questions, feedback, reflective listening, affirmations, and summarizing to resolve resistance or ambivalence to therapy. Disfluencies noted in bilingual children and adults are similar to those found for monolingual speakers (Shenker, 2013). See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. B., & Al-Khamra, R. (2015). other developmental disorders (Briley & Ellis, 2018). ), Cluttering: A handbook of research, intervention and education (pp. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0183, Blood, G. W., & Blood, I. M. (2004). It is important that parents and clinicians acknowledge and respond to a childs verbal and nonverbal reactions in a supportive manner; this helps to minimize the likelihood that the child will develop negative reactions to stuttering. Perspectives on Fluency and Fluency Disorders, 4(6), 13161326. In D. Ward & K. Scaler Scott (Eds. Anderson, J. D., Pellowski, M. W., Conture, E. G., & Kelly, E. M. (2003). 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). Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. https://doi.org/10.1038/s41598-017-00519-8, Chang, S.-E. (2014). language or learning disability (Ntourou et al., 2011). The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. Long-term follow-up of self-modeling as an intervention for stuttering. Alternative measures of reading fluencysuch as tests of silent reading fluencymay be more valid measures for children who stutter. Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. The International Journal of Indian Psychology, 3(3), 7887. Speech modification (including fluency shaping) strategies (Bothe, 2002; Guitar, 1982, 2019) include a variety of techniques aimed at making changes to the timing and tension of speech production or altering the timing of pauses between syllables and words. Journal of Fluency Disorders, 29(4), 255273. 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). https://doi.org/10.1093/brain/awm241, Watson, J. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Daniels, D. (2007). Journal of Fluency Disorders, 40, 6982. Typical childhood disfluencies may increase and decrease without any external influence. Stuttering: An integrated approach to its nature and treatment. Consequently, they may speak less to avoid being disfluent, and they may avoid social situations. Ingham, R. J., & Onslow, M. (1985). Oxford University Press. Stuttering and work life: An interpretative phenomenological analysis. Dysfluency is a term used for the impairment of the ability to produce smooth, fluent speech. Thieme. 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. Bargaining, 5. Environmental factors include family dynamics, fast-paced lifestyle, and stress and anxiety (J. D. Anderson et al., 2003). Davidow, J. H., & Scott, K. A. (2019). Cluttering and Down syndrome. Helping adolescents who stutter focus on fluency. Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. All speakers are disfluent at times. https://doi.org/10.1016/j.nbd.2014.04.019, Han, T.-U., Root, J., Reyes, L. D., Huchinson, E. B., du Hoffmann, J., Lee, W.-S., Barnes, T. D., & Drayna, D. (2019). Journal of Fluency Disorders, 32(2), 95120. Singular. https://doi.org/10.1159/000504221, Rollnick, S., & Miller, W. R. (1995). 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). (2020). (Eds.). Journal of Fluency Disorders, 35(4), 333354. Measuring lexical diversity in children who stutter: Application of vocd. Starkweather, Janice Westbrook. The purpose of assessing fluency in a preschool child is to determine. https://doi.org/10.1044/1092-4388(2008/07-0111), Prochaska, J. O., & DiClemente, C. C. (2005). A comparison of stutterers and nonstutterers affective, cognitive, and behavioral self-reports. I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike). (1996). There has been some documentation of the use of stuttering modification strategies to help those who clutter (Ward, 2006). Journal of Speech, Language, and Hearing Research, 61(12), 28952905. It discusses types of atypical dysfluency as well as application of current findings to assessment and treatment, including treatment strategies. Individuals typically arent diagnosed or do not start treatment until 8 years of age or into adolescence/adulthood (Ward & Scaler Scott, 2011). For a discussion of a process for selecting evidence-based approaches based on individual needs, see Yaruss and Pelczarski (2007). Time and expense are considerations along with attention to generalization and treatment needs following an intensive program (Cooper, 1979). 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. Timing refers to the initiation of treatment relative to the diagnosis. Emotional problems and parenting style do not cause stuttering. The role of self-help/mutual aid in addressing the needs of individuals who stutter. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. Assessment of other communication dimensions, including speech sound production, receptive and expressive language, pragmatic language, voice, hearing, and oralmotor function/structure. https://doi.org/10.1177/1525740117702454. Drayna, D., & Kang, C. (2011). There is not enough epidemiological research to state specific risk factors for cluttering. 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. Reduced perfusion in Brocas area in developmental stuttering. Journal of Fluency Disorders, 38(2), 6687. Journal of Fluency Disorders, 32(2), 139162. https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. Typical vs Atypical Pneumonia in Tabular Form 6. Journal of Speech, Language, and Hearing Research, 46(5), 12211233. Fluency treatment can occur at any point after the diagnosis. 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. https://doi.org/10.1176/appi.books.9780890425596, American Speech-Language-Hearing Association. Person- and family-centered practice is a collaborative approach that fosters an alliance-style partnership among individuals, families, and clinicians. B. https://doi.org/10.1016/j.jfludis.2010.12.003. 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). Self-disclosure involves communicating to others information that reveals ones identity as a person who stutters. Journal of Speech, Language, and Hearing Research, 63(9), 29953018. practice monitoring each others speech and secondary behaviors. Scaler Scott, K. (2013). Prevalence of speech disorders in elementary school students in Jordan. autism spectrum disorder (Briley & Ellis, 2018). Impact of stuttering severity on adolescents domain-specific and general self-esteem through cognitive and emotional mediating processes. https://doi.org/10.1016/j.jfludis.2010.04.003, Wagovich, S., & Hall, N. (2017). Yaruss, J. S., & Quesal, R. W. (2004). 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.2018.10.003, Bray, M. A., & Kehle, T. J. Presence of stutteringAn estimated one third of people who stutter also present with at least some components of cluttering (Daly, 1986; Preus, 1981; Ward, 2006). For example, some children from bilingual or multicultural backgrounds may experience stuttering onset or a temporary increase in stuttering as result of being in new and unfamiliar situations, learning a new language, or being exposed to mixed linguistic input (Shenker, 2013). https://doi.org/10.1055/s-2007-986528, Yaruss, J. S., Coleman, C., & Hammer, D. (2006). The epidemiology of cluttering with stuttering. Pro-Ed. Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the Self-Stigma of Stuttering Scale (4S). https://doi.org/10.1016/S0094-730X(96)00023-X, Tellis, G. M., & Tellis, C. M. (2003). The ASHA Leader, 19(7), 4448. Watkins, K. E., Smith, S. M., Davis, S., & Howell, P. (2008). What we know for now IN BRIEF. Their description details the characteristics of each stage, along with treatment goals and processes appropriate for each stage. 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). Language, Speech, and Hearing Services in Schools, 26(2), 162168. Menu. (2011). 256276). ), The Cambridge handbook of communication disorders (pp. https://doi.org/10.1016/j.jfludis.2017.06.001. https://doi.org/10.1016/j.jfludis.2006.12.003. typical vs atypical disfluencies asha. Journal of Paediatrics and Child Health, 49(2), E112E115. Stuttering in school-age children: A comprehensive approach to treatment. Folia Phoniatrica et Logopaedica, 69, 180189. Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O., Bavin, E., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). Teigland, A. Individuals who stutter are more likely to be self-aware about their disfluencies and communication, and they may exhibit more physical tension, secondary behaviors, and negative reactions to communication. These findings suggest the presence of atypical lateralization of speech and language functions near the onset of stuttering. Typical pneumonia is a form of community-acquired pneumonia that tends to have more serious symptoms. Operant treatment (e.g., Palin ParentChild Interaction Therapy, Kelman & Nicholas, 2020; Lidcombe Program, Onslow et al., 2003) incorporates principles of operant conditioning and uses a response contingency to reinforce the child for fluent speech and redirect disfluent speech (the child is periodically asked for correction). With adults, initiation of treatment depends on the individuals previous positive or negative intervention experiences and current needs pertaining to their fluency and the impact of their fluency disorder on communication in day-to-day activities and participation in various settings (e.g., community or work). Prentice-Hall. Cluttering, another fluency disorder, is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. Al-Jazi, A. Journal of Fluency Disorders, 22(3), 187203. reducing secondary behaviors and minimizing avoidances. A recent U.S. study estimated that approximately 2% of children ages 317 years stutter (Zablotsky et al., 2019). Stuttering and its treatment in adolescence: The perceptions of people who stutter. Approaches may vary by therapeutic philosophy, goals and activities, duration and intensity, and age of the individual. Studies have shown both structural and functional neurological differences in children who stutter (Chang, 2014; Chang et al., 2019). providing opportunities to practice fluency in linguistically and culturally relevant contexts and activities. by ; 2022 June 3; barbara "brigid" meier; 0 . 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. These brain differences have previously been observed in adults who stutter (Weber-Fox et al., 2013). 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). Evidence-based treatment and stutteringHistorical perspective. Although cluttering and stuttering can co-occur, there are some important distinctions between the two (see Scaler Scott, 2010). Identifying subgroups of stutterers (No. The prevalence refers to the number of individuals who are living with fluency disorders in a given time period. (2010). Bullying in adolescents who stutter: Communicative competence and self-esteem. https://doi.org/10.1044/2019_JSLHR-19-00137, Tichenor, S., & Yaruss, J. S. (2020). Expand Search Apply; Program Guide; BOBapp(2023) . In N. B. Ratner & J. Tetnowski (Eds. Recovery rates were estimated to be approximately 88%91% by Yairi and Ambrose (2013). A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. The term overt stuttering is used when core speech behaviors are present. The ultimate goal is for individuals to understand these interactions and how they can manage the disfluencies and their reactions. International Journal of Language & Communication Disorders, 49(1), 113126. American Psychiatric Association. Stuttering and cluttering. A thematic analysis of late recovery from stuttering. Therefore, a comprehensive assessment for fluency disorders should include assessment of both overt and covert features. In addition to the challenges associated with typical adolescent experiences, treatment may not be a priority for some adolescents because of other academic and social demands, denial of a speech problem, and concern about the stigma of seeking treatment. Journal of Speech, Language, and Hearing Research, 54(6), 14851496. Atypical Disfluencies are more concerning and are an indicator that stuttering may not necessarily resolve without some type of intervention. consultation with and referral to other professionals as needed. 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. Journal of Speech and Hearing Disorders, 50(3), 261281. Following are descriptions of each of these forms of disfluency. The imbalance of stuttering behavior in bilingual speakers. educates the individual who stutters and their family members about stuttering and communication and. The treatment of stuttering. https://doi.org/10.1016/0094-730X(88)90003-4. Testing, and 7. The individual learns strategies for generalization of skills to the classroom, workplace, and community. In fact, increased pausing alone may increase speech fluency and intelligibility for those who clutter (Scaler Scott & Ward, 2013). (2017). The model describes the following stages of behavioral change: See Manning and DiLollo (2018) and Floyd et al. (2006). The impact of stuttering on employment opportunities and job performance. Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. ), Current issues in stuttering research and practice (pp. https://doi.org/10.1037/a0020113, Coleman, C., & Yaruss, J. S. (2014). Recounting the school experiences of adults who stutter: A qualitative analysis [Doctoral dissertation, Bowling Green State University]. Scaler Scott, K., & Ward, D. (2013). These simulations and applications of strategies might be most likened to cancellation and pull-out techniques used in stuttering. Potential risk factors for cluttering include the following: Information is varied and conflicting regarding the exact relationship between bilingualism and disfluencies (Tellis & Tellis, 2003; Van Borsel et al., 2001). Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Enhancing treatment for school-age children who stutter: I. Smith, A., & Weber, C. (2017). Molecular Genetics & Genomic Medicine, 5(2), 95102. Thieme. B. See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. Arnold, H. S., Conture, E. G., Key, A. P., & Walden, T. (2011). Psychology Press. Communication apprehension, loss of control, and shame may also develop as individuals experience greater difficulty with communication. Language, Speech, and Hearing Services in Schools, 43(4), 536548. ), Cluttering: Research, intervention and education (pp. minimizing the adverse impact of stuttering (Yaruss et al., 2012). https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). Journal of Fluency Disorders, 54, 1423. This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. See ASHAs Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Apply Now. 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). Recurring themes of successful stuttering management in adults have been described as. Acquired neurogenic and psychogenic stuttering are not covered. 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. Journal of Fluency Disorders, 38(4), 311324. Not all of these approaches are appropriate for the treatment of cluttering (see Cluttering Treatment below). Behavioural and Cognitive Psychotherapy, 23(4), 325325. How can you tell if childhood stuttering is the real deal? https://doi.org/10.1044/2019_PERS-SIG4-2019-0024, Boyle, M. P., & Gabel, R. (2020). Daly, D. A., Simon, C. A., & Burnett-Stolnack, M. (1995). 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). Students who improve their attitudes toward stuttering tend to maintain these views years later (St. Louis & Flynn, 2018). https://doi.org/10.1016/j.jcomdis.2010.12.003. These are called typical disfluencies or nonfluencies. For preschool children who stutter, parent and family involvement in the treatment process is essential, as is a home component (Kelman & Nicholas, 2020). Prevalence of cluttering in two European countries: A pilot study. 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. A comprehensive treatment approach for school-age children, adolescents, and adults includes multiple goals and considers the age of the individual and their unique needs (e.g., communication in the classroom, in the community, or at work). Sociodynamic relationships between children who stutter and their non-stuttering classmates. Screening is conducted whenever a fluency disorder is suspected or as part of a comprehensive speech and language assessment. Psychology Press. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). These should be considered during differential diagnosis but should not be the sole therapeutic strategies. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). Multicultural identification and treatment of stuttering: A continuing need for research. https://doi.org/10.1055/s-0034-1382151, Chang, S.-E., Garnett, E. O., Etchell, A., & Chow, H. M. (2019). Journal of Fluency Disorders, 38(3), 260274. Journal of Fluency Disorders, 31(2), 90115. 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). International Journal of Speech-Language Pathology, 17(4), 367372. Preus, A. Resilience in people who stutter: Association with covert and overt characteristics of stuttering. Disclosing a fluency disorder has many benefits on both the speaker (Boyle & Gabel, 2020; Boyle et al., 2018; Mancinelli, 2019) and the listener (Byrd, Croft, et al., 2017; Byrd, McGill, et al., 2017; Ferguson et al., 2019; Healey et al., 2007). Pro-Ed. Consider the individuals age, preferences, and needs within the context of family and community when selecting and adapting treatment approaches and materials. ; American Psychiatric Association, 2013). B. 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). Building clinical relationships with teenagers who stutter. Shock, 2. 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). They also can benefit from groups and intensive programs (Fry et al., 2014). Differences between children and adults should also be considered when interpreting data from neurological studies. Miller, W. R., & Rollnick, S. (2013). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use (2019). The primary provider of fluency treatment is the SLP. Teasing/bullying experienced by children who stutter: Toward development of a questionnaire. Journal of Communication Disorders, 80, 8191. (2016b). When a bilingual clinician is not available, using an interpreter is a viable option. Journal of Fluency Disorders, 36(2), 110121. (2020). 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. excessive coarticulation resulting in the collapsing and/or deletion of syllables and/or word endings; excessive disfluencies, which are usually of the more nonstuttering type (e.g., excessive revisions and/or use of filler words, such as um); pauses in places typically not expected syntactically; unusual prosody (often due to the atypical placement of pauses rather than a pedantic speaking style, as observed in many with autism spectrum disorder). Journal of Speech, Language, and Hearing Research, 62(5), 13711372. https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). In D. Ward & K. Scaler Scott (Eds. Donaher, J., & Richels, C. (2012). For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering. St. Louis, K. O., & Flynn, T. W. (2018). 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). Bilingual clinicians who have the necessary clinical expertise to treat the individual may not always be available. https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Assessment of the impact of stuttering or clutteringincluding assessment of the emotional, cognitive, and attitudinal impact of disfluency. ), Cluttering: Research, intervention and education (pp. 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. Approximately 88%91% of these children will recover spontaneously with or without intervention (Yairi & Ambrose, 2013). Desensitization strategies are strategies that help speakers systematically desensitize themselves to their fears about speaking and stuttering by facing those fears in structured, supportive environments. Motivational interviewing: Helping people change. The clutterer. Academic Press. Partners may be sources of support for treatment of stuttering (Beilby et al., 2013). Children who stutter may demonstrate poorer expressive lexical skills compared to their peers (Silverman & Bernstein Ratner, 2002). 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). Perspectives of the ASHA Special Interest Groups 4:4 (615-623) 15 Aug 2019. 178196). ), Stuttering and related disorders of fluency (pp. There is ongoing debate as to whether persons who stutter have language skills that are equivalent to those seen in well-matched comparison speakers. 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). However, several likely gene mutations have been linked to stuttering (Frigerio-Domingues & Drayna, 2017).

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