When the Diagnosis Is Dual Fluency disorders affect nearly 1% of the population, with a range of 0.3% to 2.12% (Bloodstein & Bernstein Ratner, 2008), yet when it comes to treatment, they are one of the least understood areas of speech-language pathology (Brisk, Healey, & Hux, 1997). One reason for this uncertainty may be the ... Features
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Features  |   February 01, 2012
When the Diagnosis Is Dual
Author Notes
  • John A. Tetnowski, PhD, CCC-SLP, is Ben Blanco Memorial/BORSF Endowed Professor in Communicative Disorders at University of Louisiana-Lafayette and a member of ASHA Special Interest Group 4, Fluency and Fluency Disorders. Contact him at tetnowski@louisiana.edu.
    John A. Tetnowski, PhD, CCC-SLP, is Ben Blanco Memorial/BORSF Endowed Professor in Communicative Disorders at University of Louisiana-Lafayette and a member of ASHA Special Interest Group 4, Fluency and Fluency Disorders. Contact him at tetnowski@louisiana.edu.×
  • Corrin Richels, PhD, CCC-SLP, is assistant professor of communication disorders and special education at Old Dominion University and a member of ASHA Special Interest Groups 4 and 10, Issues in Higher Education. Contact her at crichels@odu.edu.
    Corrin Richels, PhD, CCC-SLP, is assistant professor of communication disorders and special education at Old Dominion University and a member of ASHA Special Interest Groups 4 and 10, Issues in Higher Education. Contact her at crichels@odu.edu.×
  • Rosalee Shenker, PhD, CCC-SLP, is executive director of the Montreal Fluency Centre. Contact her at rosalee.shenker@mcgill.ca.
    Rosalee Shenker, PhD, CCC-SLP, is executive director of the Montreal Fluency Centre. Contact her at rosalee.shenker@mcgill.ca.×
  • Vivian Sisskin, MS, CCC-SLP, is an instructor in the Department of Hearing and Speech Sciences at the University of Maryland and a member of ASHA SIG 4. Contact her at vsisskin@umd.edu.
    Vivian Sisskin, MS, CCC-SLP, is an instructor in the Department of Hearing and Speech Sciences at the University of Maryland and a member of ASHA SIG 4. Contact her at vsisskin@umd.edu.×
  • Lesley Wolk, PhD, is associate professor of education at Long Island University-C.W. Post. Contact her at lesley.wolk@liu.edu.
    Lesley Wolk, PhD, is associate professor of education at Long Island University-C.W. Post. Contact her at lesley.wolk@liu.edu.×
Article Information
Speech, Voice & Prosodic Disorders / Fluency Disorders / Special Populations / Cultural & Linguistic Diversity / Autism Spectrum / Attention, Memory & Executive Functions / Speech, Voice & Prosody / Features
Features   |   February 01, 2012
When the Diagnosis Is Dual
The ASHA Leader, February 2012, Vol. 17, 10-13. doi:10.1044/leader.FTR1.17022012.10
The ASHA Leader, February 2012, Vol. 17, 10-13. doi:10.1044/leader.FTR1.17022012.10
Fluency disorders affect nearly 1% of the population, with a range of 0.3% to 2.12% (Bloodstein & Bernstein Ratner, 2008), yet when it comes to treatment, they are one of the least understood areas of speech-language pathology (Brisk, Healey, & Hux, 1997). One reason for this uncertainty may be the unclear terminology related to fluency disorders (see sidebar, p. 12). Another may be the comorbidity of fluency disorders with other disorders and conditions.
Stuttering and other fluency disorders often co-occur with other conditions and disorders. For example, Arndt and Healey (2001) discovered that as many as 44% of children who stutter have a concomitant speech or language disorder. Additional research found that other disorders, such as attention deficit hyperactivity disorder (ADHD), also run concomitant with stuttering at a greater level than in the general population (e.g., Healey & Reid, 2003). Add to that other issues, such as autism spectrum disorders (ASDs), and the likelihood of concomitance is extremely high.
Earlier research indicates that as many as 68% of children who stutter have at least one other speech, language, learning, reading, neurological, or other disorder (Blood & Seider, 1981). The same researchers found that as many as 24% of their sample had more than one disorder.
Given these high rates of co-occurrence, much research that lists “stuttering” participants as “free of other major speech, language, learning, and other disorders” does not reflect many clients we see in our practice. To help shed more light on how to handle concomitant disorders, we present four case studies involving a fluency disorder co-occurring with either Tourette syndrome (TS), an ASD, ADHD, or a phonological disorder. We also present a case on stuttering in a bilingual client.
Case One: + Tourette Syndrome
TS is characterized by multiple motor tics and one or more vocal tics that cause distress or impairment in social, occupational, or other important areas of functioning. The vocal tics often present in the form of nonfluent speech, including “non-stuttering” disfluencies and “stuttering-like disfluencies” (e.g., Tetnowski & Donaher, 2003; Van Borsel & Vanryckeghem, 2004). Stuttering in general is quite common in TS (15.3%: Pauls, Leckman, & Cohen, 1993; 31.3%: Comings & Comings, 1993; 50%: Abwinder et al., 1998). The prevalence of TS is estimated between 0.03% and 1% (Cardoso, Veado, & Teotonio de Oliveira, 1996; Van de Wetering, Cath, & Buitelaar, 1996).
This case involves an 11-year-old girl. Initial symptoms included eye twitching, head and neck jerking, and shoulder shrugging. Later symptoms included abdominal jerking and flexing, mouth grimacing, lip popping, eye twitching, nose twitching, finger smelling, clapping, jumping, and leg tensing. Verbal symptoms included throat clearing, interjections, broken words, and vocal tics.
Because these symptoms were having a negative effect on the child’s social life—she lost friends and endured teasing—the mother requested a fluency evaluation.
The evaluation assessed speech and language behaviors across various settings and revealed a stuttering rate between 1% and 2% and overall nonfluency levels of 10% to 12%. Fluency induction strategies had little impact on stuttering, and the Overall Assessment of the Speaker’s Experience of Stuttering for School Children showed “mild impact.” The most common significant nonfluency was interjections—short, audible laryngeal tics described as abnormal or unnatural sounding. Often accompanied by finger and eye movements, the interjections were sometimes word final or word medial in nature (e.g., dog-g-g-g).
The case was referred for intervention, with goals emphasizing stuttering modification tasks. We identified fluency breakdowns through videotape and audiotape review and taught self-regulatory control through pull-outs and preparatory sets. This approach might appear to be simplistic; however, Raz et al. (2009) found increased activation in frontostriatal areas of the brain by TS participants during a task that required concentrated cognitive attention and regulation of tics. It is possible that some clients with TS are able to regulate behaviors.
After four months (two sessions a week), the child was dismissed from treatment. The child was able to decrease overall disfluency levels (vocal tics) to less than 2% in monologue and dialogue tasks. Education, identification, and modification were all key to controlling the child’s nonfluencies. Specifically, she noted, “I know when I am going to do it (vocal tics) and I can control it, but I feel better when I just let them come out.”
Case Two: + Autism Spectrum Disorder
ASD symptoms include social deficits, communication difficulties, and stereotyped or repetitive behaviors. Children with Asperger syndrome, specifically, often have adequate structural language skills, but demonstrate difficulties with social or pragmatic aspects of communication. Speech nonfluencies have been noted in children with ASDs, but there are no published estimates of prevalence. Descriptions in the literature have included:
  • Stuttering-like disfluencies, described as part-word repetition, whole-word repetition, prolongation, and silent blocks.

  • Other disfluencies, described as interjections, revisions, multi-syllabic word repetition, and phrase repetition.

  • Atypical disfluencies, described as final part-word repetition (“his-is-is”), mid-syllable insertion (“we-hee”), and final sound prolongation (Paul et al., 2005; Plexico, Cleary, McAlpine, & Plumb, 2010; Scaler Scott, Grossman, Abendroth, Tetnowski, & Damico, 2006; Shriberg et al., 2001; Sisskin, 2006). Atypical disfluencies have been documented in typically developing children as well as in children with ASDs (McAllister & Kingston, 2005; Van Borsel, Geirnaert, & Van Coster, 2005).

This case study reports results of a single treatment trial aimed to reduce the frequency of atypical disfluency—specifically, final part-word repetition (“man-an-an-an”) and final phrase repetition (“You keep on –eep on swinging-ing back-ackwards -ackwards cause I –ause I –ause I”)—in a 7-year-old boy with Asperger syndrome.
The child demonstrated superior vocabulary skills, average structural language skills, mild pragmatic language deficits, and mild articulation disorder. Speech prosody was poor and accompanied by monotone voice quality, over-exaggerated articulation, and pedantic communication style. Over eight weeks, a single clinician provided 13 treatment sessions of 50 minutes each. Methods included elements from stuttering modification treatment, including identification and correction (Van Riper, 1973), with session design and teaching strategies catering to the cognitive learning style of children with ASDs (Mesibov, Shea, & Adams, 2001).
Post-treatment measures indicated a reduction in frequency and duration of the two atypical behaviors targeted. Efficiency of communication improved, as measured by a gradual increase in speech rate over time between pre- and post-treatment samples.
The nature of the atypical disfluencies documented and treated in this study remains unclear. They do not appear to represent a form of developmental stuttering, but did respond to self-monitoring strategies often associated with stuttering modification treatment. One possibility is that the disfluencies are a verbal form of high-level restricted repetitive behavior, perhaps compensating for poor executive function (Turner, 1999). It is clear that the child’s atypical disfluencies were reduced through a form of self-regulation training (Singer & Bashir, 1999) in which he learned self-monitoring, self-evaluation, and behavioral adjustment.
Case Three: + ADHD
ADHD is a neurological disorder that impairs a person’s ability to regulate attention and/or behavior efficiently. ADHD affects approximately 6%–8% of children (DSM-IV-TR, 2000). There are three subtypes of ADHD:
  • ADHD predominantly inattentive type (ADHD-IA). Inattentive symptoms include difficulties with basic organization (e.g., loses and forgets items); avoidance of tasks that require sustained attention or mental effort, such as reading; and high levels of distractibility—noticing small noises, for example. Children with ADHD–IA may talk excessively, fidget and move continuously, or generally have difficulty waiting for anything, such as taking a turn or letting a teacher finish speaking before asking a question.

  • ADHD predominantly hyperactive-impulsive type (ADHD-HI). Children with this form of ADHD are often described as being “on the go” or “driven by a motor.” They tend to talk excessively, fidget with their hands or feet, squirm in their seats, and run or climb excessively when not appropriate. They tend not to engage in quiet leisure activities.

  • ADHD combined type (ADHD-C; DSM-IV-TR, 2000). Children with this type display both inattentive and hyperactive traits.

The presence of ADHD traits in people who stutter has been shown to have a negative effect on their treatment outcomes and their ability to manage their speech (Riley & Riley, 1979, 2000). This situation is likely due to the unique deficits seen in the various subtypes of ADHD and variable impacts of ADHD medications on frequency of stuttering in children. That is, methylphenidate (e.g., Ritalin) has been associated with stuttering in some people with ADHD (Lavid, Franklin, & Maguire, 1999).
This case involves a 10-year-old boy being treated with stimulant medication for ADHD–C. Assessment indicated speech skills within normal limits, and mild stuttering characterized by sound-syllable and whole-word repetitions. He received group treatment once a week, for 50 minutes, with four other same-age peers who stuttered. Treatment targeted increasing awareness of and identification of moments of stuttering as well as rate reduction.
The child struggled to identify his stuttering in conversational speech, but his inability to do so made it nearly impossible to teach stuttering-management strategies such as change-outs, stretched speech, and gentle onsets. To help focus the child’s attention on stuttering moments, the clinician showed the group video recordings of each group member speaking. Children also participated in turn-taking games in which they had to “catch” instances of stuttering in the speech of their peers and the clinician. The group also practiced speaking at an appropriate rate using varying rates of “slow” speech such that the faster rate was still slow-normal.
Over the course of 16 weeks of treatment, the boy’s stuttering was reduced to within normal limits, and he was able to reduce his speech rate by identifying the accelerated rate and accompanying increase in stuttering. Treating a client with ADHD who also stutters is a challenge that requires focusing the child on the speech difficulty before teaching any fluency-enhancing techniques.
Case Four: + Bilingualism
Given that about a fifth of school-age children speak a language other than English at home (U.S. Census Bureau, 2007), speech-language pathologists often encounter bilingual children who have a fluency disorder. The following case highlights treatment issues that can emerge.
David, a 4-year-old with severe stuttering, is the child of immigrants from Sri Lanka and Malaysia and lives in a family where Tamil is the home language. David’s father speaks a bit of English and French, but his mother cannot. David’s parents have been advised by the SLP involved to speak English at home to expose David to his second language.
Is this a sensible, realistic recommendation for this family? The short answer is—no. ASHA guidelines indicate that SLPs need to respect families’ use of both languages. A rigorously controlled study found stuttering incidence rates in a multilingual population to be approximately the same as those for monolingual populations (Mansson, 2000), so there is no evidence-based justification for counseling multilingual families to choose a single language. Also, case studies of preschool bilingual children indicate that stuttering is reduced or eliminated in the same time frame as it is for monolingual children (Roberts & Shenker, 2007).
Clinicians with bilingual or multicultural clients who stutter must identify stuttering/disfluency in an unfamiliar language, evaluate linguistic proficiency, and adjust treatment to cultural beliefs and expectations. There are few guidelines for identifying stuttering in an unfamiliar language. Some suggestions for improving reliability include rating short (five-second) intervals, achieving consensus with the parent on what is an unambiguous moment of stuttering, or using any combination of methods that is feasible.
In evaluating linguistic proficiency, it is advisable to look for over-identification of stuttering or misdiagnosis of delayed language. Bilingual children often have uneven development across all languages spoken and may have increased ambiguous nonfluencies as a result. Code mixing or changing the word order to preserve the grammatical rules of the stronger language is common and should not be labeled as avoidance behavior. Some suggestions for assessment include taking a detailed language history of all languages spoken using a perceptual rating scale to rate proficiency for comprehension and expression.
Cultural diversity adds another dimension of complexity for clinicians. One way to understand the cultural beliefs of the family is to ask the family to tell stories of shared experiences. Such stories help to identify culturally determined behaviors and rules, and may reveal parents’ concerns over the loss of cultural identity, values, and beliefs. These stories can be embedded in free play or interview sessions with the family. Before we can draw conclusions about the treatment of bilingual children who stutter, we will need, among other things, more clinical studies with larger numbers of children, and comparisons of languages with different structures such as Chinese and Urdu.
Case Five: + Phonological Disorder
Over the past two decades there has been increasing interest in the relationship between stuttering and phonological disorders, in terms of coexistence and phonological planning (Bloodstein, 1995; Byrd, Wolk, & Davis, 2007; Louko, Conture, & Edwards, 1999; Nippold, 2002; Wolk, Edwards, & Conture, 1993). Studies have shown that children who persist with stuttering may have more phonological difficulties. Also, subtle phonological differences may exist in children with stuttering, even if they do not show disordered phonology (Conture, 2001; Howell, 2011). These differences may contribute to the children’s inability to produce and/or maintain fluent speech.
The following case describes 5-year-old Adam, who was being treated for a moderate phonological disorder and a concomitant severe disfluency, mostly involving sound syllable repetitions and sound prolongations. During treatment for the phonological and language deficits, it became apparent that the stuttering was exacerbated by the increased linguistic demands of attempting to correct phonological and fluency mistakes in his speech.
The clinician discussed two possible intervention approaches with the parent: sequential and concurrent treatment. She explained that with a sequential approach that treats the stuttering first, fluency is facilitated, but phonological errors will become more apparent. If, however, the phonological disruptions are treated first, articulation and phonological accuracy improve, but stuttering may worsen (Byrd, Wolk, & Davis, 2007).
The clinician then described a concurrent approach, which may be discrete or blended. In a discrete approach, the clinician devotes half the treatment session to fluency facilitation tasks and the other half to phonological tasks.
A blended approach, by comparison, involves simultaneously introducing phonological targets and fluency-facilitation techniques. Its key feature is an indirect phonological treatment program that does not draw attention to the child’s speech errors. The clinician models slow, physically relaxed speech. Fluency skill practice is introduced within a context of lowest phonological and linguistic demand and increasing linguistic complexity. The notion of contrasts is highlighted in both phonological and fluency treatment tasks using all modalities. Group intervention may be useful, and parent involvement is critical (Bernstein Ratner & Guitar, 2006; Byrd, Wolk, & Davis, 2007; Guitar & McCauley, 2010).
In Adam’s case, the parents and clinician selected a blended approach focused on indirect phonological remediation along with fluency-enhancing skills. Intervention was successful after one year of treatment. Further research is needed to improve the understanding of the relationship between stuttering and phonological development. Because these disorders frequently appear together in young children, more rigorous studies of long-term treatment outcomes on which to base clinical decisions is needed.
The Take-Away
These case studies involve children who have fluency disorders and at least one other accompanying condition or unusual circumstance. The symptoms are varied and may include stuttering-like disfluencies and other types of nonfluencies. Therefore, clinicians should be aware of the following issues when treating this population:
  • Assessment should gauge the range of nonfluent behaviors. Treatment goals should be clear about aims to eliminate or reduce these behaviors, or to at least to help children learn to identify and cope with them.

  • Traditional stuttering treatment will likely need to be modified or combined with other approaches.

  • Terminology must be looked at cautiously and used consistently to prevent inaccurate transmission of data.

  • Larger cohort studies are needed. For now, research is limited to case studies and small “n” studies.

Fluency Disorders Glossary

Understanding fluency disorders means getting to know an array of associated terms.

Stuttering: Part-word repetitions, single-syllable word repetitions, prolongations, and blocks. Typically, stuttering occurs at the beginning of words, beginning of linguistic units, during stressed syllables, and during more linguistically complex utterances.

Atypical stuttering: Stuttering that occurs outside the above parameters. An example is a word-final repetition, such as “dog-g-g-g.”

Cluttering: Disruptions in speech flow associated with problems with speech planning, not knowing what to say, or talking too rapidly.

Fluency disorders: A group of disorders that includes, but is not limited to, stuttering. The most common “other” fluency disorder is cluttering.

Disfluencies: Nonfluencies that are not stuttering, including interjections, phrase repetitions, rephrasings, broken words, and multi-syllable word repetitions. These are present in the speech of typical speakers, but may be elevated in certain conditions or disorders.

Nonfluencies: Breakdowns in fluency that include the speech behaviors typically defined as stuttering, or stuttering-like disfluencies, but can include other types of disfluencies.

Sources
Abwender, D. A., Trinidad, K. S., Jones, K. R., Como, P. G., Hymes, E., & Kurlan, R. (1998). Features resembling Tourette’s syndrome in developmental stutterers. Brain and Language, 62, 455–464. [Article] [PubMed]
Abwender, D. A., Trinidad, K. S., Jones, K. R., Como, P. G., Hymes, E., & Kurlan, R. (1998). Features resembling Tourette’s syndrome in developmental stutterers. Brain and Language, 62, 455–464. [Article] [PubMed]×
Arndt, J., & Healey, E. C. (2001). Concomitant disorders in school-age children who stutter. Language, Speech, and Hearing Services in Schools, 32, 68–78. [Article]
Arndt, J., & Healey, E. C. (2001). Concomitant disorders in school-age children who stutter. Language, Speech, and Hearing Services in Schools, 32, 68–78. [Article] ×
Bernstein Ratner, N., & Guitar, B. (2006). Treatment of very early stuttering and parent administered therapy: The State of the Art. In Bernstein Ratner, N. & Tetnowski, J. A. (Eds.), Current Issues in Stuttering Research and Practice (pp. 99–124). Mahlwah, New Jersey: Lawrence Erlbaum Associates.
Bernstein Ratner, N., & Guitar, B. (2006). Treatment of very early stuttering and parent administered therapy: The State of the Art. In Bernstein Ratner, N. & Tetnowski, J. A. (Eds.), Current Issues in Stuttering Research and Practice (pp. 99–124). Mahlwah, New Jersey: Lawrence Erlbaum Associates.×
Blood, G., & Seider, R. (1981). The concomitant problems of young stutterers. Journal of Speech and Hearing Research, 46, 31–33. [Article]
Blood, G., & Seider, R. (1981). The concomitant problems of young stutterers. Journal of Speech and Hearing Research, 46, 31–33. [Article] ×
Bloodstein, O. (1995). A Handbook on Stuttering (5th Ed.). San Diego, CA: Singular.
Bloodstein, O. (1995). A Handbook on Stuttering (5th Ed.). San Diego, CA: Singular.×
Bloodstein, O. & Bernstein Ratner, N. (2008). A Handbook on Stuttering (6th Ed.). Clifton Park, NY: Thomson Delmar.
Bloodstein, O. & Bernstein Ratner, N. (2008). A Handbook on Stuttering (6th Ed.). Clifton Park, NY: Thomson Delmar.×
Brisk, D. J., Healey, E. C., & Hux, K. A. (1997). Clinicians’ training and confidence associated with treating school-age children who stutter: A national survey. Language Speech and Hearing Services in Schools, 28(2), 164–176. [Article]
Brisk, D. J., Healey, E. C., & Hux, K. A. (1997). Clinicians’ training and confidence associated with treating school-age children who stutter: A national survey. Language Speech and Hearing Services in Schools, 28(2), 164–176. [Article] ×
Byrd, C., Wolk, L., & Davis, B. (2007). Phonological considerations in developmental stuttering. In Conture, E. & Curlee, R. (Eds.), Stuttering and related fluency disorders (pp. 163–182). New York: Thieme Medical.
Byrd, C., Wolk, L., & Davis, B. (2007). Phonological considerations in developmental stuttering. In Conture, E. & Curlee, R. (Eds.), Stuttering and related fluency disorders (pp. 163–182). New York: Thieme Medical.×
Cardoso, F., Veado, C., & Teotonio de Oliveira, J. (1996). A Brazilian cohort of patients with Tourette’s syndrome. Journal of Neurology, 60, 209–212.
Cardoso, F., Veado, C., & Teotonio de Oliveira, J. (1996). A Brazilian cohort of patients with Tourette’s syndrome. Journal of Neurology, 60, 209–212.×
Comings, D., & Comings, B. (1993). Comorbid behavioral disorders. In Kurlan, R., (Ed.), Handbook of Tourette’s syndrome and related tic and behavioral disorders. New York: Dekker.
Comings, D., & Comings, B. (1993). Comorbid behavioral disorders. In Kurlan, R., (Ed.), Handbook of Tourette’s syndrome and related tic and behavioral disorders. New York: Dekker.×
Conture, E. G. (2001). Stuttering: Its nature, diagnosis, & treatment. Needham Heights, MA: Allyn & Bacon.
Conture, E. G. (2001). Stuttering: Its nature, diagnosis, & treatment. Needham Heights, MA: Allyn & Bacon.×
Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition-Text Revision (2000). Washington DC: American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition-Text Revision (2000). Washington DC: American Psychiatric Association.×
Guitar, B., & McCauley, R. (2010). Treatment of stuttering: Established and merging interventions. Baltimore, MD: Lippincott Williams & Wilkins.
Guitar, B., & McCauley, R. (2010). Treatment of stuttering: Established and merging interventions. Baltimore, MD: Lippincott Williams & Wilkins.×
Healey, E. C., & Reid, R. (2003). ADHD and stuttering: A tutorial. Journal of Fluency Disorders, 28, 79–94. [Article] [PubMed]
Healey, E. C., & Reid, R. (2003). ADHD and stuttering: A tutorial. Journal of Fluency Disorders, 28, 79–94. [Article] [PubMed]×
Howell, P. (2011). Recovery from stuttering. New York: Psychology Press.
Howell, P. (2011). Recovery from stuttering. New York: Psychology Press.×
Lavid, N., Franklin, D. L. & Maquire, G. A. (1999). Management of child and adolescent stuttering with olanzapine: Three case reports. Annals of Clinical Psychiatry, 11(4), 233–236. [Article] [PubMed]
Lavid, N., Franklin, D. L. & Maquire, G. A. (1999). Management of child and adolescent stuttering with olanzapine: Three case reports. Annals of Clinical Psychiatry, 11(4), 233–236. [Article] [PubMed]×
Louko, L., Conture, E., & Edwards, M. L. (1999). Treating children who exhibit co-occurring stuttering and disordered phonology. In Curlee, R. (Ed.), Stuttering and related disorders of fluency (2nd ed.; pp. 124–138). New York: Thieme Medical.
Louko, L., Conture, E., & Edwards, M. L. (1999). Treating children who exhibit co-occurring stuttering and disordered phonology. In Curlee, R. (Ed.), Stuttering and related disorders of fluency (2nd ed.; pp. 124–138). New York: Thieme Medical.×
Månsson, H. (2000). Childhood stuttering: Incidence and development. Journal of Fluency Disorders, 25(1), 47–57. [Article]
Månsson, H. (2000). Childhood stuttering: Incidence and development. Journal of Fluency Disorders, 25(1), 47–57. [Article] ×
McAllister, J., & Kingston, M. (2005). Final part-word repetitions in school-age children: two case studies. Journal of Fluency Disorders, 30, 255–267. [Article] [PubMed]
McAllister, J., & Kingston, M. (2005). Final part-word repetitions in school-age children: two case studies. Journal of Fluency Disorders, 30, 255–267. [Article] [PubMed]×
Nippold, M. (2002). Stuttering and phonology: Is there an interaction? American Journal of Speech-Language Pathology, 11, 99–110. [Article]
Nippold, M. (2002). Stuttering and phonology: Is there an interaction? American Journal of Speech-Language Pathology, 11, 99–110. [Article] ×
Paul, R., Shriberg, L. D., McSweeny, J., Cicchetti, D., Klin, A., & Volkmar, F. (2005). Brief report: Relations between prosody performance and communication and socialization ratings in high functioning speakers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 35, 861–869. [Article] [PubMed]
Paul, R., Shriberg, L. D., McSweeny, J., Cicchetti, D., Klin, A., & Volkmar, F. (2005). Brief report: Relations between prosody performance and communication and socialization ratings in high functioning speakers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 35, 861–869. [Article] [PubMed]×
Pauls, D., Leckman, J., & Cohen, J. (1993). Familial relationship between Gilles de la Tourette syndrome, attention deficit disorder, learning disability, speech disorders and stuttering. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1044–1050. [Article] [PubMed]
Pauls, D., Leckman, J., & Cohen, J. (1993). Familial relationship between Gilles de la Tourette syndrome, attention deficit disorder, learning disability, speech disorders and stuttering. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1044–1050. [Article] [PubMed]×
Plexico, L., Cleary, J., McAlpine, A., & Plumb, A. (2010). Disfluency characteristics in young children with autism spectrum disorders: A preliminary report. Perspectives on Fluency and Fluency Disorders, 20, 42–50. [Article]
Plexico, L., Cleary, J., McAlpine, A., & Plumb, A. (2010). Disfluency characteristics in young children with autism spectrum disorders: A preliminary report. Perspectives on Fluency and Fluency Disorders, 20, 42–50. [Article] ×
Raz, A., Zhu, H., Yu, S., Bansal, R, Wang, Z, Alexander, G. M., … Peterson, B. S. (2009). Neural substrates of self-regulatory control in children and adults with Tourette syndrome. Canadian Journal of Psychiatry, 54, 579–588.
Raz, A., Zhu, H., Yu, S., Bansal, R, Wang, Z, Alexander, G. M., … Peterson, B. S. (2009). Neural substrates of self-regulatory control in children and adults with Tourette syndrome. Canadian Journal of Psychiatry, 54, 579–588.×
Riley, G., & Riley, J. (1979). A component model for diagnosing and treating children who stutter. Journal of Fluency Disorders, 4, 279–293. [Article]
Riley, G., & Riley, J. (1979). A component model for diagnosing and treating children who stutter. Journal of Fluency Disorders, 4, 279–293. [Article] ×
Riley, G. D., & Riley, J. (2000). A revised component model for diagnosing and treating children who stutter. Contemporary Issues in Communication Sciences and Disorders, 27, 188–199.
Riley, G. D., & Riley, J. (2000). A revised component model for diagnosing and treating children who stutter. Contemporary Issues in Communication Sciences and Disorders, 27, 188–199.×
Roberts, P. M., & Shenker, R. C. (2007). Assessment and treatment of stuttering in bilingual speakers. In Conture, E. G. & Curlee, R. (Eds.), Stuttering and related disorders of fluency (3rd ed., pp. 183–210). New York, NY: Thieme Medical.
Roberts, P. M., & Shenker, R. C. (2007). Assessment and treatment of stuttering in bilingual speakers. In Conture, E. G. & Curlee, R. (Eds.), Stuttering and related disorders of fluency (3rd ed., pp. 183–210). New York, NY: Thieme Medical.×
Scaler Scott, K., Grossman, H. L., Abendroth, K. J., Tetnowski, J. A., & Damico, J. S. (2006). Asperger Syndrome and Attention Deficit Disorder: Clinical disfluency analysis. Proceedings of the 5th World Congress on Fluency Disorders, Dublin, Ireland: International Fluency Association.
Scaler Scott, K., Grossman, H. L., Abendroth, K. J., Tetnowski, J. A., & Damico, J. S. (2006). Asperger Syndrome and Attention Deficit Disorder: Clinical disfluency analysis. Proceedings of the 5th World Congress on Fluency Disorders, Dublin, Ireland: International Fluency Association.×
Shriberg, L. D., Paul, R., McSweeny, J. L., Klin, A., Cohen, D. J., & Volkmar, F. R. (2001). Speech and prosody characteristics of adolescents and adults with high-functioning autism and Asperger syndrome. Journal of Speech, Language, and Hearing Research, 44, 1097–115. [Article]
Shriberg, L. D., Paul, R., McSweeny, J. L., Klin, A., Cohen, D. J., & Volkmar, F. R. (2001). Speech and prosody characteristics of adolescents and adults with high-functioning autism and Asperger syndrome. Journal of Speech, Language, and Hearing Research, 44, 1097–115. [Article] ×
Singer, B., & Bashir, A. (1999). Clinical forum. What are executive functions and self-regulation and what do they have to do with language-learning disorders? Language, Speech, and Hearing Services in Schools, 30(3), 265. [Article]
Singer, B., & Bashir, A. (1999). Clinical forum. What are executive functions and self-regulation and what do they have to do with language-learning disorders? Language, Speech, and Hearing Services in Schools, 30(3), 265. [Article] ×
Sisskin, V. (2006). Speech disfluency in Asperger’s Syndrome: Two cases of interest. Perspectives of Fluency and Fluency Disorders, 16(2), 12–14. [Article]
Sisskin, V. (2006). Speech disfluency in Asperger’s Syndrome: Two cases of interest. Perspectives of Fluency and Fluency Disorders, 16(2), 12–14. [Article] ×
Tetnowski, J. A., & Donaher, J. (2003). Disfluency associated with Tourette’s syndrome: Two case studies. ISAD On-Line. Available: www.mnsu.edu/comdis/isad6/papers/tetnowski6.html
Tetnowski, J. A., & Donaher, J. (2003). Disfluency associated with Tourette’s syndrome: Two case studies. ISAD On-Line. Available: www.mnsu.edu/comdis/isad6/papers/tetnowski6.html×
Turner, M. A. (1999). Generating novel ideas: Fluency performance in high-functioning and learning disabled individuals with autism Journal of Child Psychology and Psychiatry, 40, 189–201. [Article] [PubMed]
Turner, M. A. (1999). Generating novel ideas: Fluency performance in high-functioning and learning disabled individuals with autism Journal of Child Psychology and Psychiatry, 40, 189–201. [Article] [PubMed]×
U.S. Census Bureau (2007). American Community Survey: Avalable at: http://www.census.gov/hhes/socdemo/language/data/acs/ACS-12.pdf [PDF]. Accessed January 13, 2012.
U.S. Census Bureau (2007). American Community Survey: Avalable at: http://www.census.gov/hhes/socdemo/language/data/acs/ACS-12.pdf [PDF]. Accessed January 13, 2012.×
Van Borsel, J., Geirnaert, E., & Van Coster, R. (2005). Another case of word-final disfluencies. Folia Phoniatrica et Logopaedica, 57, 148–162. [Article] [PubMed]
Van Borsel, J., Geirnaert, E., & Van Coster, R. (2005). Another case of word-final disfluencies. Folia Phoniatrica et Logopaedica, 57, 148–162. [Article] [PubMed]×
Van de Wetering, B., Cath, D., & Buitelaar, J. (1996). Klinische presentatie, epidemiologie en comorbitditeit. In : Buitelaar, J. and Van de Wetering, B. (Eds.) Syndroom van Gilles de la Tourette. Een leidraad voor diagnostiek en behandeling (pp. 6–13), Assen, the Netherlands: Van Gorcum.
Van de Wetering, B., Cath, D., & Buitelaar, J. (1996). Klinische presentatie, epidemiologie en comorbitditeit. In : Buitelaar, J. and Van de Wetering, B. (Eds.) Syndroom van Gilles de la Tourette. Een leidraad voor diagnostiek en behandeling (pp. 6–13), Assen, the Netherlands: Van Gorcum.×
Wolk, L., Edwards, M. L., & Conture, E. G. (1993). Coexistence of stuttering and disordered phonology in young children. Journal of Speech and Hearing Research, 36, 906–917. [Article] [PubMed]
Wolk, L., Edwards, M. L., & Conture, E. G. (1993). Coexistence of stuttering and disordered phonology in young children. Journal of Speech and Hearing Research, 36, 906–917. [Article] [PubMed]×
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FROM THIS ISSUE
February 2012
Volume 17, Issue 2