Differentiating typical disfluencies and stuttering is a critical piece of assessment, particularly for preschool children. advertising through a classroom presentation with the guidance of the SLP or classroom teacher in the case of school-age children (W. P. Murphy et al., 2007b). Proceedings of the National Academy of Sciences of the United States of America, 116(35), 1751517524. (2014). The utility of stuttering support organization conventions for young people who stutter. Ward, D. (2006). Explore how typical and atypical disfluencies differ, and find resources for guidance and support. Journal of Fluency Disorders, 31(2), 90115. Allyn & Bacon. B., & Al-Khamra, R. (2015). Evidence-based treatment and stutteringHistorical perspective. Journal of Speech, Language, and Hearing Research, 54(6), 14851496. Self-efficacy is a positive belief in ones own ability to successfully accomplish a set goal that is task dependent, which comes from (a) past experiences of mastery, (b) vicarious experiences, (c) verbal persuasion, and (d) emotional/physical states (Boyle, 2013a, 2013b, 2015; Boyle et al., 2018; Carter et al., 2017). Cultural diversity should also be considered in the discussion of stuttering, as it can have an impact on assessment and treatment of stuttering. Language assessment and intervention for the learning disabled. Guitar, B. (1981). Perspectives on Fluency and Fluency Disorders, 1(4), 5569. Differential treatment of stuttering in the early stages of development. Differences in fluency across languages may be due to the social context in which the language is used (Foote, 2013), as well as the proficiency of each language spoken. monosyllabic whole-word repetitions (e.g., Why-why-why did they go there?), part-word or sound/syllable repetitions (e.g., Look at the, prolongation of consonants when it isnt for emphasis (e.g., , blocking (i.e., inaudible or silent fixations or inability to initiate sounds), and. https://doi.org/10.1016/j.jfludis.2013.06.002, Nwokah, E. E. (1988). 115134). ), Stuttering and related disorders of fluency (pp. Languages differ with regard to developmental milestones, and direct comparison of scores across languages can be misleading, even if the assessments appear similar (Thordardottir, 2006). Repetitive negative thinking, temperament, and adverse impact in adults who stutter. Experiences with stuttering can affect an individuals employment, job satisfaction, personal and romantic relationships, and overall quality of life (Beilby et al., 2013; Blood & Blood, 2016). https://doi.org/10.1044/2018_AJSLP-ODC11-17-0189, Chakraborty, M., Chen, L.-F., Fridel, E. E., Klein, M. E., Senft, R. A., Sarkar, A., & Jarvis, E. D. (2017). Journal of Fluency Disorders, 21(34), 201214. ), Cluttering: A clinical perspective (pp. Bray, M. A., Kehle, T. J., Lawless, K., & Theodore, L. (2003). American Journal of Speech-Language Pathology, 29(1), 201215. Healey, E. C., Reid, R., & Donaher, J. https://doi.org/10.1016/j.jfludis.2017.09.001, Byrd, C. T., & Donaher, J. Children with normal disfluencies have emergent fluency. 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). 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. Individuals with disfluencies are seen in all of the typical speech-language pathology service settings, including private practices, university clinics, hospitals, and schools. Resilience and stuttering: Factors that protect people from the adversity of chronic stuttering. In general, the earlier preschool stuttering is addressed (relative to its onset), the easier it is to manage (Onslow & OBrian, 2012). The epidemiology of cluttering with stuttering. Stuttering: Research and therapy. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Atypical disfluencies are generally not seen in the majority of children with developmental stuttering (child onset fluency disorder). Adults who stutter also may experience job discrimination and occupational stereotyping, including an earnings gap, especially for females (Gerlach et al., 2018). 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. Consistent with treatment approaches for children and adolescents, treatment for adults needs to be individualized, dynamic, and multidimensional. Screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation. Consequently, they may speak less to avoid being disfluent, and they may avoid social situations. Goals that focus on minimizing negative reactions to stuttering and difficulties communicating in various speaking situations may help the individual reduce the effort used to hide or avoid their disfluencies and communicate with more ease. You do not have JavaScript Enabled on this browser. Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in stuttering (Singer et al., 2020). A comprehensive treatment approach for preschoolers includes both parent- and child-focused strategies. United States Department of Labor. The individual who stutters becomes desensitized to their fears by performing activities (e.g., self-disclosing, going to a place where they fear speaking) using a fear hierarchy. This hierarchy represents situations or activities that range from low risk to high risk. However, the clinician needs to consider the impact of disfluency on communication and quality of life as a whole. Summary - Typical vs Atypical Pneumonia. As children who stutter get older, they may become adept at word and situational avoidances that result in a low frequency of overt stuttering. As is the case with any communication disorder, language differences and family/individual values and preferences are taken into consideration during assessment. https://doi.org/10.1044/1092-4388(2008/046, Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Code of ethics [Ethics]. Board Certified Specialists in Fluency are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with fluency disorders. (2020). Motivational interviewing is a person-centered approach that can be useful in developing functional goals and enhancing readiness for change (Miller & Rollnick, 2013; Rollnick & Miller, 1995). Bowling Green State University Archive. The incidence of pediatric fluency disorder refers to the number of new cases identified in a specific time period. ), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. https://doi.org/10.1044/1092-4388(2002/088), Craig, A., & Tran, Y. https://scholarworks.bgsu.edu/comm_disorders_diss/7/. Academic Press. https://doi.org/10.1037/0022-0663.95.1.3, Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Language, Speech, and Hearing Services in Schools, 37(2), 118136. Bullying in adolescents who stutter: Communicative competence and self-esteem. Clinicians can help clients progress to active stages through building self-efficacy. Although cluttering has been reported in children as young as 4 years of age, the diagnosis is more commonly made at about 8 years of age (Ward, 2006), when a childs language becomes lengthy and/or complex enough for symptoms to manifest themselves. Apply Now. Teigland, A. Other treatment approaches described below also may be incorporated as part of a comprehensive treatment approach. School Psychology Review, 30(1), 135141. See ASHAs Practice Portal page on Telepractice. Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as. Preliminary research suggests adults who clutter demonstrate differences in cortical and subcortical activity compared to controls (Ward et al., 2015). Psychology Press. https://doi.org/10.1016/j.jfludis.2007.02.002, Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007b). (2011). ASHA also extends its gratitude to the following subject matter experts who were involved in the reviewand development of thispage: In addition, ASHA thanks the members of the Steering Committee of ASHAs Special Interest Division on Fluency and Fluency Disorders (Division 4) whose work preceded this content. In contrast to adults who stutter, children who stutter did not show increases in white matter tracts in the right hemisphere (Chang et al., 2015). Although cluttering and stuttering can co-occur, there are some important distinctions between the two (see Scaler Scott, 2010). ), Cluttering: Research, intervention and education (pp. Arnold, H. S., Conture, E. G., Key, A. P., & Walden, T. (2011). When a student stutters: Identifying the adverse educational impact. Increasing fluency may not be a goal for an adult or may be only one aspect of a comprehensive and multidimensional approach (Amster & Klein, 2018). Palin ParentChild Interaction therapy: The bigger picture. Although some people with cluttering are not aware of their communication difficulties, many are aware that others have difficulty understanding them. Coworkers may have negative attitudes toward individuals who stutter, and the individual may feel excluded because of this. See the Fluency Disorders Evidence Map for summaries of the available research on this topic. Scheduling concerns, cost, and insurance reimbursement also are likely to be factors affecting dosage. https://doi.org/10.1044/2017_AJSLP-16-0079, Davis, S., Howell, P., & Cooke, F. (2002). Sociodynamic relationships between children who stutter and their non-stuttering classmates. https://doi.org/10.1016/j.jfludis.2016.09.005, Gerlach, H., Hollister, J., Caggiano, L., & Zebrowski, P. M. (2019). Trichon, M., & Raj, E. X. Fear of speaking: Chronic anxiety and stammering. ), Cluttering: Research, intervention and education (pp. Symptoms have been observed in individuals with autism spectrum disorder as well as in neurotypical individuals. See ASHAs Practice Portal pages on Counseling For Professional Service Delivery and Cultural Responsiveness for more information related to counseling. Plural. (1979). (2019). For example, counseling an individual to accept or tolerate embarrassment can facilitate desensitization. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders. See ASHAs resource on treatment goals for fluency disorders in the context of the WHO ICF framework. https://doi.org/10.1055/s-0036-1583549, Martin, R. R., Haroldson, S. K., & Triden, K. A. As fear reduces, physical tension and struggle decrease, fluency is enhanced, and the individual is better able to communicate effectively. Stuttering and speech naturalness. (2014). Yaruss, J. S., & Pelczarski, K. M. (2007). ), Current issues in stuttering research and practice (pp. Van Borsel, J. For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, learning disability, or seizures have higher odds of 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). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. https://doi.org/10.1002/hbm.23487, Dignazio, L. E., Kenny, M. M., Raj, E. X., & Pelkey, K. D. (2020). Journal of Fluency Disorders, 30(1), 122. The great psychotherapy debate: Models, methods, and findings. bringing peers into the treatment setting; planning strategies to use in the classroom, cafeteria, or playground or at work; taking outings to stores and other businesses; and. 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. 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). In B. J. Amster & E. R. Klein (Eds. However, a preliminary prevalence study estimated the rate of cluttering to be between 1.1% and 1.2% of school-age children (Van Zaalen & Reichel, 2017). 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). In B. J. Amster & E. R. Klein (Eds. Scaler Scott, K. (2010). Mild stuttering, on the other hand, tends to appear more regularly. A range of studies support a genetic predisposition for stuttering, but no definitive findings have been made regarding which transmission model, chromosomes, genes, or sex factors are involved in the expression of stuttering in the population at large (Kraft & Yairi, 2011, p. 34). Recommending related services when necessary for management and treatment in different settings (e.g., classroom, work, community). "Atypical" disfluencies include: sound repetitions ("s-s-s-so"); syllable repetitions ("be-be-be-be-because"); prolongations ("Aaaaaaaaaaaaand"); and Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. Journal of Fluency Disorders, 49, 1328. Treatment for fluency disorders helps the individual make changes that will facilitate communication in a variety of settings. Peer support for people who stutter: History, benefits, and accessibility. The American Board of Fluency and Fluency Disorders, under the auspices of ASHAs specialty certification program, offers clinical specialty certification in fluency and fluency disorders. American Journal of Speech-Language Pathology, 20(3), 163179. Cluttering treatment: Theoretical considerations and intervention planning. See the Service Delivery section of the Fluency Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Perspectives on Fluency and Fluency Disorders, 22(2), 5162. Symptoms and severity of stuttering and cluttering can vary (Davidow & Scott, 2017; St. Louis & Schulte, 2011). There may be a relationship between stuttering and working memory. B. Multicultural identification and treatment of stuttering: A continuing need for research. Technological advances and the expansion of social media outlets have increased opportunities for adults who stutter to connect, share, and gain information through the Internet (Fuse & Lanham, 2016; Raj & Daniels, 2017) and stuttering-related podcasts (Dignazio et al., 2020). Journal of Communication Disorders, 85, 105944. https://doi.org/10.1016/j.jcomdis.2019.105944. 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). Stuttering and work life: An interpretative phenomenological analysis. When being spontaneous and saying all they want to say, individuals may exhibit more surface-level stuttering. Journal of Fluency Disorders, 59, 120.https://doi.org/10.1016/j.jfludis.2018.11.003. Features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g., autism spectrum disorder, Tourettes syndrome, and attention-deficit/hyperactivity disorder). Determination of individual strengths and coping strategies. Parent involvement may be a beneficial approach for addressing fluency issues in a bilingual child. Journal of Speech, Language, and Hearing Research, 61(12), 28952905. Journal of Fluency Disorders, 58, 94117. 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). https://doi.org/10.1044/2018_JSLHR-L-16-0400, Palasik, S., & Hannan, J. https://doi.org/10.1055/s-2003-37384, Finn, P., & Cordes, A. K. (1997). 9099). Methods in stuttering therapy for desensitizing parents of children who stutter. Cluttering: A synergistic framework. Allyn & Bacon. Estimates of incidence and prevalence vary due to a number of factors, including disparities in the sample populations (e.g., age), how stuttering was defined, and how stuttering was identified (e.g., parent report, direct observation). Journal of Fluency Disorders, 13(5), 357373. Freezing is similar to tallying but has the client/clinician stop, freeze, during a moment of stuttering to perform a self-scan. Neurobiology of Disease, 69, 2331. Children who stutter may demonstrate decreased performance for phonological tasks such as nonword repetition (Wagovich & Anderson, 2010). Van Borsel, J., Maes, E., & Foulon, S. (2001). Journal of Educational Psychology, 95(1), 321. Consultation with family members, educators, and other professionals regarding fluency variability (when disfluencies are noticed most and least) and the impact of disfluency. Language, Speech, and Hearing Services in Schools, 48(4), 234248. Defining cluttering: The lowest common denominator. Overall, the lifetime prevalence of stuttering was estimated to be 0.72% (Craig et al., 2002). Most individuals who stutter demonstrate both observable disfluency and negative life impact (Beilby et al., 2012b; Ribbler, 2006; Tichenor & Yaruss, 2019a; Yaruss et al., 2012). An increase in observable disfluent behaviors may occur as the individual communicates more freely. https://doi.org/10.1016/j.jcomdis.2010.12.003. Journal of Fluency Disorders, 58, 2234. American Journal of Speech-Language Pathology, 27(2), 721736. Prevalence and trends of developmental disabilities among children in the United States: 20092017. This perceived rapid rateand the resulting breakdown in speech clarityis thought to be because speakers with cluttering speak at a rate that is too fast for their systems to handle (Myers, 1992; St. Louis et al., 2007; Ward, 2006). Resilience in people who stutter: Association with covert and overt characteristics of stuttering. A preliminary comparison of speech rate, self-evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. 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). Folia Phoniatrica et Logopaedica, 69, 180189. (2011). https://doi.org/10.1044/1058-0360(2002/005), Bothe, A. K. (2002). (2010). https://doi.org/10.1016/j.jcomdis.2014.02.001, Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Professional awareness of cluttering. Scope of practice in speech-language pathology [Scope of practice]. Effective counseling is important for encouraging individuals with a fluency disorder to share information in the affective, cognitive, and social domains. Indicators of positive therapeutic change may include. Seminars in Speech and Language, 39(4), 324332. https://doi.org/10.1044/1092-4388(2008/07-0111), Prochaska, J. O., & DiClemente, C. C. (2005). Motivational interviewing may be used to help individuals who stutter better understand the thoughts and feelings associated with their stuttering and make positive changes to improve communication. Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches. Daniels, D. (2007). Adults are likely to have been living with stuttering for a long time. Nurturing a resilient mindset in school-aged children who stutter. There has been some documentation of the use of stuttering modification strategies to help those who clutter (Ward, 2006). Some families may decide to send children to live with relatives or ask children not to speak in public (Shenker, 2013). Stuttering impact: A shared perception for parents and children. https://doi.org/10.1055/s-2008-1064082, Caughter, S., & Crofts, V. (2018). Some children who stutter or clutter may only experience symptoms situationally. Stuttering and cluttering. the asha leader; journals. Journal of Speech, Language, and Hearing Research, 51(3), 636650. Bulletin of the Center for Special Needs Education Research and Practice, 13, 19. Journal of Fluency Disorders, 36(2), 122129. Journal of Fluency Disorders, 35(3), 216234. For stuttering, the assessment will identify risk factors associated with stuttering, the severity of stuttering, and the presence of other speech and language concerns. Journal of Neurodevelopmental Disorders, 3(4), 374380. Psychology Press. Advance online publication. Often, the main reason for seeking advice from an SLP and initiating services is to eliminate or greatly reduce disfluent speech. production of words with an excess of physical tension or struggle. provide and receive support from others who share the experience of stuttering. https://doi.org/10.1016/j.jfludis.2018.08.006, Boyle, M. P. (2011). In E. Conture & R. F. Curlee (Eds. Cumulative incidence estimates of stuttering in children range from 5% to 8% (Mnsson, 2000; Yairi & Ambrose, 2013). American Psychiatric Association. For a review of temperament, emotion, and childhood stuttering, see R. M. Jones, Choi, et al. Clinicians also should attempt to better understand how the person experiences the moments before, during, and after stuttering. Given these potential issues, determining dosage often comes down to the professional opinion of the SLP and the needs of the individual. One example of a desensitization activity is pseudostutteringthe use of voluntary stuttering behaviorsin different, and increasingly more difficult, situations where the individual might fear the occurrence of real moments of stuttering (e.g., Reardon-Reeves & Yaruss, 2013; J. G. Sheehan, 1970). increasing the time provided for an oral reading or presentation, providing an alternative assignment to oral reading, and. autism spectrum disorder (Briley & Ellis, 2018). Greater abnormality of cerebral blood flow in the posterior language loop, associated with processing words that we hear, correlates with more severe stuttering. All speakers are disfluent at times. (2019). Yaruss, J. S., & Reardon-Reeves, N. (2017). Journal of Fluency Disorders, 27(4), 289304. Understanding and treating cluttering. Clinical utility of self-disclosure for adults who stutter: Apologetic versus informative statements. https://doi.org/10.1044/jshr.3605.906. Cambridge University Press. https://doi.org/10.1044/sbi15.2.75, Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). Universitetsforlaget. Prentice-Hall. Content for ASHAs Fluency Disorders Practice Portal pagewas developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. wandering womb handmaid's tale; ismackzi gta 5 mods; katherine stinney age. EBP Briefs, 2(4), 18. if monitoring or treatment (direct or indirect) is recommended. People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a). Thieme. practice monitoring each others speech and secondary behaviors. Starkweather, Janice Westbrook. Pro-Ed. Anger/Resistance, 4. Integrated treatment focused on parental involvement, self-regulation, and fluency may also be beneficial (Druker et al., 2019). have a sense of belonging and experience less stigma. 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. (2020). Measuring lexical diversity in children who stutter: Application of vocd. social anxiety disorder (Brundage et al., 2017; Craig & Tran, 2014; Iverach et al., 2018), speech sound disorders (St. Louis & Hinzman, 1988; Wolk et al., 1993), and. https://doi.org/10.1016/S0021-9924(03)00052-2, Yaruss, J. S., & Quesal, R. W. (2006). See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). 4566). Yairi, E., & Ambrose, N. (2013). Social anxiety disorder and stuttering: Current status and future directions. https://doi.org/10.1044/1092-4388(2008/07-0057), Raj, E. X., & Daniels, D. E. (2017). Higher incidence rates of stuttering have been reported in preschool-aged children (11.2%; Reilly et al., 2013), with prevalence estimates reported as 2.2%5.6% (Yairi & Ambrose, 2013). Cluttering and stuttering do not need to occur in all situations or even a majority of the time to be diagnosable disorders. Journal of Fluency Disorders, 40, 3543. Stuttering Therapy Resources. Risk factors that may be associated with persistent stuttering include. https://doi.org/10.1044/cicsd_25_S_8, Leech, K. A., Bernstein Ratner, N., Brown, B., & Weber, C. M. (2017). SIG 16 Perspectives on School-Based Issues, 15(2), 7580. When speakers are able to participate in decisions about treatment goals and select goals they consider important, they may be more motivated to take part in therapy (Finn, 2003; Snsterud et al., 2019). Education, 136(2), 159168. Avoidance can lead to less talking and reduced linguistic complexity. Seminars in Speech and Language, 24(1), 2126. Strategies aimed at changing the timing and tension of speech production include. The neurological underpinnings of cluttering: Some initial findings. www.asha.org/policy/, American Speech-Language-Hearing Association. https://doi.org/10.1044/2017_LSHSS-17-0089, Carter, A., Breen, L., Yaruss, J. S., & Beilby, J. These individuals are said to experience covert stuttering (B. Murphy et al., 2007). Communication Disorders Quarterly, 39(2), 335345. Please enable it in order to use the full functionality of our website. Time pressures for verbal communication and requirements to use the telephone may lead to stress and discomfort. American Journal of Speech-Language Pathology, 12(2), 243253. https://doi.org/10.1016/j.jfludis.2013.08.003, Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). Communication attitudes in children who stutter: A meta-analytic review. https://doi.org/10.1016/j.jfludis.2013.09.001, Boyle, M. P. (2015). Sex of childIt appears that the disorder is more common in males than in females; the male-to-female ratio for cluttering has been reported to range from 3:1 to 6:1 (G. E. Arnold, 1960; St. Louis & Hinzman, 1986; St. Louis & Rustin, 1996). These are called typical disfluencies or nonfluencies. Journal of Fluency Disorders, 38(2), 206221. In addition, clinicians need to avoid using religious or highly familiar texts that individuals may know by rote. Stuttering in relation to lexical diversity, syntactic complexity, and utterance length. https://doi.org/10.1111/1469-7610.00093, de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M. C. (2015). (2018). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.
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