Avoidance Reduction Therapy for School-Age Children Who Stutter

Sisskin, Vivian; Goldstein, Benjamin I.

doi:10.1055/s-0042-1742695

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…Furthermore, the excessive cognitive control required for success in fluency shaping may increase cognitive conflict, leading to relapse and sense of failure. In contrast, treatment approaches that emphasize communicative competence (Byrd et al, 2021) and acceptance of stuttering (Sisskin, 2018) may reduce motivational conflict over the long-term by increasing approach motivation and decreasing avoidance motivation. These types of treatment approaches are best positioned to reduce cognitive conflict in people who stutter and are thus most congruent with the theoretical account proposed here.…”

Section: What Explains Variability In Treatment Effectiveness For Peo...mentioning

confidence: 98%

“…Nearly 70 years ago, Joseph Sheehan proposed that stuttering behaviors are elicited by a conflict between simultaneous motivations to approach and avoidance of a speaking situation (Sheehan, 1953). Since that time, the explanatory power of this assumption has driven the increasing use of psychotherapeutic approaches (i.e., cognitive-behavioral) to improve psychological well-being by increasing communicative competence (Byrd et al, 2021) and reduce avoidance behaviors (Sisskin, 2018) in people who stutter. Despite the growing popularity of these treatment approaches, motivational conflict in stuttering has largely not been empirically investigated.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

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Why Stuttering Occurs

Usler¹

2022

Topics in Language Disorders

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The purpose of this article is to provide a theoretical account of the experience of stuttering that incorporates previous explanations and recent experimental findings. According to this account, stuttering-like disfluencies emerge during early childhood from excessive detection of cognitive conflict due to subtle limitations in speech and language processes. For a subset of children who begin to stutter, the development of approach-avoidance motivational conflict likely contributes to a chronic reliance on cognitive control processes during speech. Consequently, maladaptive activation of right hemisphere inhibitory cortices to the basal ganglia via a hyperdirect pathway results in involuntary, episodic, and transient freezing of the motor system during speech initiation. This freeze response, consistent with defensive behavior in threatening situations, may lead to stuttering persistence, tension and struggle, maladaptive speech physiology, and feelings of anxiety and loss of control.

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Section: What Explains Variability In Treatment Effectiveness For Peo...mentioning

confidence: 98%

Section: Limitations and Future Directionsmentioning

confidence: 99%

Why Stuttering Occurs

Usler¹

2022

Topics in Language Disorders

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“…A common associated characteristic of (persistent) DS is the development of social anxiety, social phobia, and avoidance behaviors ( Menzies et al, 1999 ; Iverach et al, 2011 ; Iverach and Rapee, 2014 ). PWS may also develop a stigmatized identity that contributes to avoidance, shame, and fear of speaking ( Sisskin and Goldstein, 2022 ) which, in turn, might considerably impact their quality of life ( Craig et al, 2009 ; Nang et al, 2018 ). It is now quite clear that an emotive/emotional difference is not the fundamental driving force behind development of stuttering in children ( Reilly et al, 2009 ; Alm, 2014 ; Park et al, 2021 ; Delpeche et al, 2022 ).…”

Section: Interactions Between Atypical Neural Systems In Ds and Assoc...mentioning

confidence: 99%

Psychedelics in developmental stuttering to modulate brain functioning: a new therapeutic perspective?

Pasculli,

Busan,

Jackson

et al. 2024

Front. Hum. Neurosci.

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Developmental stuttering (DS) is a neurodevelopmental speech-motor disorder characterized by symptoms such as blocks, repetitions, and prolongations. Persistent DS often has a significant negative impact on quality of life, and interventions for it have limited efficacy. Herein, we briefly review existing research on the neurophysiological underpinnings of DS -specifically, brain metabolic and default mode/social-cognitive networks (DMN/SCN) anomalies- arguing that psychedelic compounds might be considered and investigated (e.g., in randomized clinical trials) for treatment of DS. The neural background of DS is likely to be heterogeneous, and some contribution from genetically determinants of metabolic deficiencies in the basal ganglia and speech-motor cortical regions are thought to play a role in appearance of DS symptoms, which possibly results in a cascade of events contributing to impairments in speech-motor execution. In persistent DS, the difficulties of speech are often linked to a series of associated aspects such as social anxiety and social avoidance. In this context, the SCN and DMN (also influencing a series of fronto-parietal, somato-motor, and attentional networks) may have a role in worsening dysfluencies. Interestingly, brain metabolism and SCN/DMN connectivity can be modified by psychedelics, which have been shown to improve clinical evidence of some psychiatric conditions (e.g., depression, post-traumatic stress disorder, etc.) associated with psychological constructs such as rumination and social anxiety, which also tend to be present in persistent DS. To date, while there have been no controlled trials on the effects of psychedelics in DS, anecdotal evidence suggests that these agents may have beneficial effects on stuttering and its associated characteristics. We suggest that psychedelics warrant investigation in DS.

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Disfluency-Affirming Therapy for Young People Who Stutter: Unpacking Ableism in the Therapy Room

Sisskin

2023

LSHSS

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Purpose: Ableist messages are conveyed early in the life of a stutterer and are amplified throughout the school-age years. Increased recognition of the benefits of acceptance-based therapies for positive long-term outcomes has changed the narrative about stuttering and stutterers. Speech-language therapists are resonating with the ideas that “it is okay to stutter,” socioemotional aspects of stuttering must be considered, and support and community are valuable. Despite the shift in understanding, messages conveyed to students and parents commonly encourage suppression of stuttering and masking of one's stuttering identity. The purpose of this article was to (a) expose unintentional ableist messages that perpetuate stigma and feeling “othered” in the therapy relationship and (b) offer suggestions for congruent messaging in stuttering therapy. Conclusions: Ableism in stuttering therapy contributes to the physical struggle and socioemotional challenges experienced by stutterers. The author offers ideas for revisioning therapy outcomes, language, and messaging to students to encourage a congruent, disfluency-affirming culture in schools and community. Introspection and advocacy by both therapists and the broader professional community, in collaboration with young people who stutter, will serve to reduce the stigma that fuels many of the daily challenges faced by school-age children who stutter.

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Avoidance Reduction Therapy for School-Age Children Who Stutter

Cited by 6 publications

References 24 publications

Why Stuttering Occurs

Why Stuttering Occurs

Psychedelics in developmental stuttering to modulate brain functioning: a new therapeutic perspective?

Disfluency-Affirming Therapy for Young People Who Stutter: Unpacking Ableism in the Therapy Room

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