stuttering definition
disorder of speech fluency that interrupts the forward flow of speech
disfluencies heard in the speech of typical speakers
fillers (um, ah)
hesitations
whole word and phrase repetitions or revisions
no tensions or tremors
normal rhythm and stress patterns
stuttering like disfluencies
repetitions
prolongations
blocks
broken words
repetitions
part word or whole word repeated
of sounds
syllables
prolongations
unnatural stretching out of sounds or syllables
blocks
sounds get stuck and can't come out
tense pauses, hesitations, and/or no sound starting words or within words
broken words
get stuck in the middle of a word
a percentage of disfluency =
the number of disfluencies in 100 words
the average speaker has up to ____ disfluencies
7% (7/100 words)
stuttering: ____ and up -- longer pauses and accompanied by ________
10%, tension
components of stuttering
core behaviors
secondary behaviors
feelings and attitudes
related behaviors/secondaries
reactions that accompany stuttering such as:
tense muscles in the lips, jaw, and/or neck
tremor of the lips, jaw, and/or tongue during attempts to speak
foot tapping, eye blinks, head turns
There are learned responses to stuttering that become...
habitual
feelings and attitudes toward stuttering
avoidance and escape behaviors
word and sound fears/avoidance
situation fears/avoidance
loss of control
sound and word fears, situational fears, anticipation of stuttering, embarrassment, and sense of shame
certain sounds or words or speaking situations may be...
avoided
words may be _______ for one another
substituted
The "loss of control" factors have to be addressed in a...
complete assessment protocol
There is great variability in stuttering behavior depending on the...
speaking situation
communication partner-s
speaking task
speaking situation
home vs. office vs. classroom vs. out with friends vs. job interview vs. telephone
communication partner-s
conversation with a friend/spouse may be easier, and more fluent, than with a boss, for example
speaking task
a person may be completely fluent when singing, but stutter on the phone.. or fluent in easy conversation, but stutter during more difficult conversation
variability causes...
frustration
variability makes the disorder....
difficult to manage
what causes stuttering?
not fully understood
may be different factors for different people
many theories
factors of stuttering
predisposing
precipitating
perpetuating
predisposing factors
those agents that incline a person to stutter and causes one person to be at a greater risk than another for beginning to stutter
genetic predisposition
underlying neurological differences
language and speech right brain centered
slower motor reactions
ce
precipitating factors
those factors thought to have made stuttering surface or those that brought it to its present state
may or may not be operating at time of evaluation
developmental and environmental
perpetuating factors
those variables that are continuing or maintaining the stuttering at the present time
attitudes of family members
environmental and physical factors that may be reinforcing stuttering
unrealistic expectations
feelings and attitudes about stuttering
antici
development of stuttering
some children are born with a predisposition for stuttering but that the stuttering only emerges if certain developmental and/or environmental factors are present
three factors interact to result in stuttering
constitutional (predisposing factors)
developmental (precipitating)
environmental (precipitating)
About ____ of those who stutter will have a relative who stutters
2/3rds
who is more at risk for stuttering? males or females?
males
_____________ who stutter are more likely to have relatives who stutter
females
_____________ runs in families. children who continue to stutter typically have relatives who continued to stutter.
persistence
predisposing factor
speech and language
children who stutter have a higher probability of also having a...
they are _________________ to grow out of stuttering
speech and/or language deficit
less likely
predisposing factor
arousal
Speech production systems are _____________ to the effects of high arousal
more vulnerable
higher arousal is associated with __________________ and the occurrence of stuttering migh precipitate even greater arousal
speaking
predisposing factor
sensitivity
those who stutter have a more sensitive temperament
more likely to react negatively to criticism and for it to have an impact on their speaking
predisposing factor
sensory motor coordination
those who stutter were significantly slower than the control
predisposing factor
temporal processing of speech
those who stutter perform poorly on central auditory processing tests
have difficulty discriminating small time differences in the speech signals
predisposing factor
central dominance
those who stutter tend to rely on their right hand hemisphere for linguistic processing rather than the left
which hemisphere cannot handle the linguistic information as efficiently?
right
right hemisphere
where negative emotions are processed
negative emotions might interfere with the processing of speech in the right hemisphere which would make disfluency even more likely to occur
those who stutter use this hemisphere more-however this hemisphere is not s
speech and language networks appear to be vulnerable to disruption during...
moments of growth and neural reorganization
precipitating factor
physical development
child is growing rapidly- as child is focuses on other tasks, fluency suffers
other motor tasks compete with fluency
precipitating factor
cognitive development
processes of perceiving, reasoning, imagining, and problem solving
children with cognitive deficits have a higher incidence of stuttering
may not have as good of an ability to recover from stuttering
precipitating factor
social and emotional development
crosstalk
issues of security, self consciousness, and sensitive impairment- life events
self consciousness can begin around the ages of...
3-4
if children develop maladaptive emotional responses to disfluencies, it may lead to...
increased tension and escape/avoidance behaviors as well as persistent stuttering
decrease in fluency when there is a growth in...
language
stuttering typically begins when...
speech and language are developing most rapidly
parents (environmental influence)
parents standards may influence fluency however there is no evidence that the tendencies of the parents cause stuttering
speech and language environment
speech and language usage is influenced by models that child hears
as he tries to imitate models he hears his system may not be capable of the performance
stressful adult speech models
rapid rate of speech
polysyllabic vocabulary
complex syntax
use of two languages in home
stressful speaking situations for child
competition for speaking
frequent interruptions
demand for display of speech
loss of listener attention
hurried when speaking
frequent questions
excited when speaking
many things to say
life events...
influence child's stability and security
normal non-fluency/typical disfluency
go through this between ages 2-5 years old
whole word or phrase repetitions and interjections
repeated just once or twice and is repeated easily
flow of speech not interrupted
no tension in their speech; kid often unaware of it
Why do children go through typical disfluencies?
language demands, motor control demands, cognitive demands, family demands
Why don't some children "outgrow" disfluencies?
predisposing, precipitating, and perpetuating factors
the onset of stuttering usually occurs before the age of...
6
case history
hereditary factor
developmental history- motor, speech, language
health/neurological
psychological/behavioral
family- how does child react? how do parents feel? what triggers stuttering?
speech and language assessment
identify phonological/articulation issues
identify any language issues
difficulties/delays in speech and language development could lead to a diagnosis of __________ instead of _________
cluttering
stuttering
speech sample
gathered from more than one session and more than one setting
ask parents or client to record samples for analysis
Why do you need a representative sample in as many settings as possible?
because stuttering is variable
analysis of a speech sample
total number of disfluencies
frequencies of different types of disfluencies
disfluency index
duration of individual instances of disfluency
speech rate
types and frequencies of secondary behaviors
disfluency indexes
% of disfluent speech present in the sample
determine in several different environments with different speech modes (reading, spontaneous speech, etc.)
to calculate the total disfluencies index:
1. count the total # of words in speech sample
2. count the total # of disfluencies
3. divide the total disfluencies by the total words
4. change to percentage
two basic measures of behaviors
frequency of disfluencies
types of disfluencies
frequency of disfluencies
how often disfluencies occur in a sample
typically represented as the percentage (out of 100) of disfluent words or syllables
types of disfluencies
helps distinguish "normal" interruptions from "stuttered" interruptions
provides indication of the development of the disorder (especially in preschool children)
duration of disfluencies
measures in terms of the numbers of seconds a repetition, prolongation, or block lasts
can also describe the number of iterations in a repetition
measured with a stopwatch, by averaging the samples or by selecting the longest examples of disfluencies to i
severity of disfluencies
describes the physical concomitant behaviors during stuttering (tension, struggle)
combine several aspects of behavior into a single number or score
assessing secondary behaviors
note all unusual movement the client exhibits
note abnormal physiological behaviors-these may affect respiratory, phonatory, articulatory, and prosodic aspects of speech production
primary avoidances
starters
postponments
retrials
circumlocutions
antiexpectancies- speech with accent, etc.
secondary avoidances
reduced verbal output or not taking at all
rely on others to communicate for them
speech rate
want to know overall speech rate
difference of speech rate of fluent segments versus overall rate
a standardized assessment to evaluate stuttering looks at:
frequency
duration
physical concomitants
frequency scale scores
expressed in percent syllables stuttered and converted to scale score of 2-18
duration scale scores
timed to the nearest one tenth of a second and converted to scale scores of 2-18
physical concomitants scale scores
converted to scale scores of 0-20
SSI-4
tally the number of disfluencies in speech and in reading
tallies these at the syllable level, not the word level
SSI-4
obtain the _______ for the three longest disfluencies
mean time
assessing feelings and attitudes
helpful for making treatment decisions
different types of checklists, questionnaires
assess stimulability
assess child's ability to produce fluent speech
use the same techniques that are used in treatment
treatment options
fluency enhancing techniques
modification techniques
combined approach
fluency enhanced on...
operant conditioning
some form of fluency is first established in a...
controlled stimulus situation
reinforced and modified to normal conversational speech in clinic setting, then this speech is generalized to a person's daily speaking situation
fluency enhancing is most effective with those who do NOT have...
strong negative emotions associated with stuttering
fluency enhancing techniques/ fluency shaping
flexible rate
easy onset
light contacts
reduced effort/tension- proprioception
stuttering modification therapy
reduce...
avoidance behaviors, speech related fears, and negative attitudes
stuttering modification therapy
help the client learn to...
modify the form of his stuttering
stuttering modification therapy
great deal of emphasis upon...
reducing the fear of stuttering and eliminating avoiding behaviors
combined approach
combine fluency shaping and stuttering modification
fluency shaping is more efficient than...
stuttering modification for changing speech patterns
stuttering modification is more effective in...
reducing speech fears and improving speech attitudes
do they grow out of stuttering?
some do some don't
approaches to stuttering, depending on the case
education about stuttering
language/articulation therapy
parent counseling
direct fluency work
therapy
much depends on...
age, awareness, severity, etc.