Treatment Goals For Stuttering, Cluttering, and Fluency Disorders in the Context of the WHO ICF Framework

The World Health Organization, International Classification of Functioning, Disability and Health (WHO ICF 2014) framework may be used to describe the following comprehensive set of treatment goals for stuttering (Coleman & Yaruss, 2014; Tichenor & Yaruss, 2019; Yaruss, 2007; Yaruss & Quesal, 2004, 2006).

Terminology used on this page is based on the WHO ICF framework. Individuals may prefer different designations for stuttering that are more neuroaffirming rather than “impairment.” We suggest goals within the WHO ICF framework because of its wide use and recognition of the importance of function and context.

Impairment In Body Function

Examples of specific treatment goals that relate to physiological and psychological function include:

reducing the sensation of being stuck, feeling unable to continue speaking, or losing control (Tichenor & Yaruss, 2019; 2019a)
reducing physical concomitant behaviors and learned escape/avoidance behaviors;
reducing tension and effort in communication (during both fluent and disfluent speech).

Activity Limitations and Participation Restrictions

Examples of specific treatment goals that relate to the person’s ability and willingness to function and participate in various activities include:

ensuring that the speaker is able to communicate effectively in various speaking situations (e.g., at school, in social settings, at home);
increasing the speaker's ability to achieve educational/vocational objectives and interact with others.
improving the speaker's perceived quality of life (e.g., by improving satisfaction with communication, reducing concerns about the impact of stuttering or cluttering on life as a whole);
habituating and generalizing new behaviors for increased comfort, spontaneity, and naturalness in functional communication across a range of situations.

Personal and Environmental Context

Personal factors include “coping styles, responses to perceptions, and experiences” and include behavioral, affective, and cognitive reactions; environmental factors pertain to “external influences on functions” and include “reactions and attitudes of listeners, stigma, and the influence of speaking situations and real-world experiences” (Tichenor & Yaruss, 2019). Treatment goals within this framework relate to improving the speaker’s positive internal reactions and managing emotions when met by others' negative responses.

Examples of specific treatment goals include:

reducing negative emotional responses (e.g., anxiety, shame, frustration) to stuttering or cluttering and to communication in general;
increasing self-confidence and participation in communication;
increasing knowledge about stuttering or cluttering, educating others, and advocating for appropriate accommodations;
developing and maintaining support systems (e.g., family involvement, support groups);
increasing confidence in responding to questions about stuttering or cluttering and managing teasing/bullying and other listener reactions;
developing self-therapy, self-management, and problem-solving skills.

References

Coleman, C., & Yaruss, J. S. (2014). A comprehensive view of stuttering: Implications for Assessment and Treatment. SIG 16 Perspectives on School-Based Issues, 15(2), 75-80.

Tichenor, S. E., & Yaruss, J. S. S. (2019a). Group experiences and individual differences in stuttering. Journal of Speech, Language, and Hearing Research, 62(12), 4335–4350. https://doi.org/10.1044/2019_JSLHR-19-00138

Tichenor, S. E., & Yaruss, J. S. (2019). Stuttering as defined by adults who stutter. Journal of Speech, Language, and Hearing Research, 62(12), 4356–4369. https://doi.org/10.1044/2019_JSLHR-19-00137

World Health Organization. (2014). International Classification of Functioning, Disability and Health. Geneva, Switzerland: Author. Retrieved from www.who.int/classifications/icf/en/

Yaruss, J. S. (2007). Application of the ICF in fluency disorders. Seminars in Speech and Language, 28(4), 312-322.

Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update. Journal of Communication Disorders, 37(1), 35-52.

Yaruss, J. S., & Quesal, R. W. (2006). Overall Assessment of the Speaker's Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Journal of Fluency Disorders, 31(2), 90-115.