Onset/development of stuttering
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Gender ratio
ages 2-5 yrs
at ages of 2-3
2.1 males, 1 female
at 1st grade
3 males, 1 female
5th grade
5 males, 1 female
General ratio: 4-5;1
sex ratio increases with age and may be a consequence of girls beginning to stutter earlier and tend to recover earlier and mor
prevalence/ incidence
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language factors
prevalence: 1%, degree to which a disorder is widespread or currently exists (2.4% for kindergarten, 1% for school age, less than 1% for adults)
incidence: 5%, an index of how many people have stuttered at some time in their lives (15% CWS for a prd, 5% a
position of words/ sentences
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abstract vs. concrete words
position: PWS typically do so on initiation
-children on spectrum at the end
concrete vs. abstract: kids below 7 stutter on abstract, adults on concrete
analysis of stuttered speech
duration, number of rep., and frequency
mean duration of sound/syllable repetition and sound prolongation
mean number of repeated units per instance of sound/syllable and whole-word repetition
various related measures of the frequency of all between- and
variables when assessing stuttering problems
#NAME?
possible methodological problems
-assessing in different contexts
-speech tasks (structured and unstructured)
-communication partners are used in obtaining speech samples
-that % syllables stuttered is not sufficient for rating (must impact AEI)
-definitions of block
-pause duration
3Ps
a roadmap to get to know the client, from how their stutter possibly developed to where they are now
use in assessment to provide education counseling and to direct and focus our treatment
used to "explore, analyze, and manage the stuttering"
"predisposin
predisposing factors
factors that cause one person to be at a greater risk.
biologically inherited, medical development and status, family history of speech, language, cognitive, emotion, or neurological disorders
SLPs cannot fix this factor
precipitating factors
factors that cause a person to begin to stutter
the "triggers"
those agents thought to have made stuttering surface or those that brought it to its present state
may be able to help with early intervention
perpetuating factors
factors that cause a person to continue to stutter after the stuttering has begun
those variables that are continuing or maintaining the stuttering at the present time
reinforcing factors
SLPs can helpt these
factors that may be associated with increased likelihood of recover from stuttering WITHOUT treatment
-decrease in disfluencies during 12 mo. after onset (important when predicting recovery)
-female
-no relatives
-good language and articulation skills
-good nonverbal intelligence scores
-outgoing and carefree temperament
potential fluency disrupting factors for children
Child Related
..speech and language skills/styles
...low tolerance frustration
..behavioral characteristics
Environmentally Related
...communicative stress
...interpersonal stress
... life situations imposing stress
Bill of rights (2000)
people who stutter have the right to...
1. stutter or be fluent
2. communicate and be listened to regardless of ones severity
3. be treated with dignity and respect
4. publicly available and accurate information of stuttering
5. equal protection under the
Do No Harm
ASHA code of ethics require clinicians "hold paramount the welfare of persons"
-carry out regiment for the benefit of the impaired according to my ability and judgment
-keep them from harm and injustice
-keep them from harm and injustice
Zebrowski's decision streams for intervention
Stream 1, 2, 3, & 4
based on the likelihood of children recovering without therapy, the clinician may want to consider one of several "decision streams" according to the characteristics of the child and the family
used to establish recovery based on the c
stream 1
time since onset: 0-6 mo.
recovery factors:
1. evaluation ages between 18 mo.-3 yrs
2. no family history
3. female
4. few to none associated behaviors
5. no co-existing phono/lang/cog issues
recovery probability: HIGH
Service plan:
score of 5: Plan A-educ
stream 2
time since onset: 6-12 mo.
recovery factors:
1. evaluation age of 2-4 years
2. began prior to 3 years
3. decrease in stuttering behavior patterns
-no family history, female, few to none associated behaviors, no co-existing phono, lang, cog. issues
recover
Stream 3
time since onset: 12-24 months.
1. evaluation age of 2-5 yrs
same as stream 2.. the differences are the time since onset and evaluation age.
recovery probability: may not recover
service plan: score of 6 or less
Plan D: everything applicable from Plan C p
Stream 4
time since onset: 24-36 mo.
recovery factors: eval age of 3.4-5 yrs
no family history
few to non associated behaviors
no co-existing phono/lang/cog
score of 4 or less:
Plan E: all plans plus direct intervention
CALMS (2004)
lifelong model
Cognitive, Affective, Linguistic, Motor, and Social Scale
multidimensional, integrative, and dynamic model used for the differential diagnosis of stuttering
beneficial because it presents a snapshot of where an individuals stuttering is in terms of the 5
Cognitive, affective, & linguistic
Cognitive: thoughts, perceptions, awareness, and understanding
affective: feelings, emotions, and attitudes
linguistic: language skills, language formulation demands, discourse
motor and social
motor: sensori-motor control of speech movements
social: effects of type of listener and speaking situation
Etiologies of developmental stuttering and cluttering
devel. stuttering:
probably neurophysiological and exacerbated by temperament and environment
ONSET: 2-5 yrs or school-age
-frustrated and embarrassed and fear of speaking
cluttering: probably neurobiological... dysfunction in the basal ganglia
ONSET: pre
etiologies of neurogenic and psychogenic
neurogenic:
stroke, head trauma, tumor, drug toxicity, dementia, seizure disorder, and/or tumors
-annoyed and frustrated but not scared to speak
psychogenic:
prolonged stress, psychological conflict, psych. traumatic event, emotional arousal or conflict i
speech characteristics of devel. stuttering and cluttering
devel. stuttering:
-single syllable whole word repetitions
-part word repetitions
-prolongations
-blocks
-frequency usually more than 3%
-syllables stuttered
-secondary behaviors (Escape and avoidance)
-pattern varies
cluttering:
-excess of normal disflue
speech characteristics for neurogenic and psychogenic
neurogenic:
-stuttering on function and content words
-no secondary behaviors
-little adaptation in repeated readings
-no markedly reduced in fluency-inducing conditions
psychogenic:
-constant or increased while speaking under fluency-inducing conditions
treatment of devel. stuttering & cluttering
devel. stuttering:
-integration of behavioral, affective, and cognitive focus of stuttering therapy
cluttering:
increase awareness of cluttering, help self-regulate speech rate and fluency, improve expressive language
treatment for neurogenic and psychogenic
neurogenic:
Pacing, masking, DAF, slow rate, and easy onset
psychogenic:
fluency shaping, tension reduction
Riley's Stuttering prediction instrument spa
excellent predictors of chronicity are phonatory arrest and articulatory posturing
good predictors are prolongation lasting more than 2 secs, abnormality of repeated syll., child's negative reactions to his/her disfluencies, and family history of stutteri
Contour's criteria or indicators for incipient stuttering (beginning stuttering)
can be classified based on the following:
-stuttering frequency
-prolongation
-mother-child speaking behaviors
-clusters
-selected non-speech behaviors
common indicators
amount of disfluencies (%)
number of units repeated
type of stuttering
duration of prolongation/stuttering moment
feelings/attitudes
Ambrose & Yairi (1999)
no stat. significant overall differences were found for either gender of age