Bilingual + Fluency Plus

What is the difference between simultaneous and sequential bilingualism?

• Simultaneous bilingualism: Both languages are learned from birth.

• Sequential bilingualism: A second language is learned after the first.

• Bilingualism exists on a continuum rather than being all-or-none.

Does bilingualism cause stuttering?

No. There is no evidence that bilingualism causes stuttering or that dropping one language prevents or resolves it.

Why has bilingualism sometimes been mistakenly considered a risk factor for stuttering?

Because monolingual English assessment guidelines have often been applied to bilingual children, increasing the risk of false-positive diagnoses.

What three key features help distinguish true stuttering from second-language learning?

1. Stuttering occurs in both languages.

2. The child demonstrates awareness of the stuttering.

3. Secondary behaviors accompany the stuttering.

How should bilingual children be assessed for stuttering?

• Collect speech samples in both languages

• Measure frequency and duration as usual

• Obtain language history

• Compare to bilingual peers (not monolingual norms)

• Use an interpreter or bilingual SLP when needed

Why can bilingual children be misdiagnosed with stuttering?

Normal second-language learning includes revisions, fillers, repetitions, and silent periods that can resemble stuttering

Should clinicians ever recommend dropping one language to reduce stuttering?

No. Support the child's ability to communicate in both languages and counsel families accordingly.

What is the biggest treatment consideration for bilingual children?

Therapy techniques (fluency shaping, stuttering modification, desensitization) require explicit practice and generalization in both languages

Why may generalization be difficult in bilingual children?

Skills learned in one language often do not automatically transfer to the other language.

How should clinicians counsel bilingual families?

Use the family's preferred language, address misconceptions about bilingualism and stuttering, and never blame bilingualism for the disorder.

What are executive functions (EF)?

Cognitive skills that allow a person to:

• Plan

• Organize

• Execute

• Stay focused

• Problem solve

• Persist through challenges

Which executive function skills are especially important in stuttering?

• Working memory

• Self-monitoring

• Self-awareness

• Attention

• Goal setting

• Response inhibition

Do executive function differences cause stuttering?

No. Research shows group-level differences in attention, inhibition, and working memory, but these do not cause stuttering, and many children who stutter have intact executive functioning

Why does executive functioning matter in therapy?

Many fluency strategies rely on working memory, inhibition, self-monitoring, and emotional regulation, so clinicians should reduce cognitive load before increasing demands

True or False: Speech sound therapy causes stuttering.

False. There is no evidence that articulation therapy triggers stuttering. Stuttering is multifactorial

What challenge exists when treating SSDs and stuttering together?

SSD therapy often emphasizes strong articulatory placement, whereas stuttering therapy emphasizes light contacts and gentle onsets, so techniques may conflict.

How does ADHD affect stuttering therapy?

ADHD-related challenges (impulsivity, attention, working memory, language organization) may interfere with learning and carrying over fluency strategies.

What therapy supports are helpful for clients with ADHD?

• Visual reminders

• Organizers

• Timers

• External strategy cues

• Emphasizing "extra effort saves me time"

Myth or Fact: Individuals with intellectual disability do not experience frustration about stuttering.

Myth. They experience frustration and avoidance even if they cannot verbalize those feelings

What should clinicians differentiate before planning treatment in clients with learning disabilities?

Differentiate cluttering, stuttering, and language formulation difficulties before selecting treatment targets

What is the initial therapy priority for clients with selective mutism who also stutter?

Help the client become comfortable speaking first before focusing on fluency strategies

What counseling approach is helpful for both selective mutism and stuttering?

Cognitive Behavioral Therapy (CBT) to address anxiety and cognitive misperceptions.

What are the four biggest principles of bilingual fluency assessment and treatment?

1. Children who truly stutter will stutter in both languages.

2. Assess across both languages and multiple environments.

3. Treat both languages, not just one.

4. Never recommend eliminating a language