Quiz 1 - Intro to Stuttering, Theories, and History

stuttering

no single definition!!!!

-disruption of fluency

-ability to talk with normal levels of continuity, rate, and effort

-fluency broken by repetitions, prolongations, or abnormal stoppages

overt symptoms

what can be heard or is apparent/visable

overt symptoms of stuttering

-effortful and involuntary issues with speech that breaks fluencies

-repetitions, prolongations, blocks

covert symptoms

hidden/concealed symptoms or secondary behaviors

covert symptoms of stuttering

avoidance, escape behaviors, circumlocutions, replace/substitute, anticipate

physical concomitants

-non-speech behaviors in other areas of the face/body

-distracting noises/sounds, facial grimaces, head movement, movement of the extremities

typical dysfluencies

interjections, repeating whole words, repeating phrases, revision, not finishing a thought

atypical dysfluencies

repetitions, prolongations, blocks/stops/postural fixations

repetitions

-multiple repetitions of sounds or syllables in words

-part-word (b-but; thi-thi-this) or one-syllable (go-go-go)

-usually at beginning of words

iterations

number of times a sound or syllable is repeated

prolongations

-disturbances in normal rhythm of words

-length of prolongation can be recorded

-mmmmmy; coooookie

blocks/stops/postural fixations

-pauses between words, part-words, and interjections in which PWS has barely audible manifestations of heavy breathing or muscle tightening

-almost never occurs in the speech of a normal speaker

-I want a [pause] cookie

What are the 4 factors/causes of stuttering?

-genetics

-child development

-neurophysiology

-environmental

What percentage of PWS have a family member who does also?

60%

early/developmental stuttering

-2-6 years old

-chance recovery will naturally occur

persistent stuttering

-beyond 6 years old and 6+ months of covert and overt symptoms of atypical moments of stutter

-no reasonable chance of recovery

benefits of therapy

-reduce stutter frequency

-decrease tension and struggle during stuttering moments

-decrease word or situation avoidances

-learn more about stuttering

-use effective communication

-determine whether goals relate to long-term or short-term needs

-provide support, counseling, and guidance

intervention for AWS

motoric/fluency shaping, sensory, medications, cognitive/psychosocial/counseling

What type of intervention is the auditory feedback device?

sensory

intervention for CWS

direct treatment (motoric) and indirect treatment (environmental changes)

How would you respond to the question - "Why is my child stuttering?"

We don't really know! Share risk factors, types of typical vs atypical stutters child presents with, provide counseling (not the family's fault)

effects of stuttering on PWS

-reduced verbal output

-word avoidance

-grammatical constraints

-quality o life impact

-occupational impact

-educational impact

-anticipation of stuttering

-social anxiety

What are the 4 main models/perspectives of stuttering?

psychological theories, learning theories, physiological theories, multifactorial model

psychological theories of stuttering

stuttering is a symptom of underlying psychological or emotional neurotic conflict

THEORIES: repressed need/internal conflict hypothesis, influence of parents, personality disorders and stuttering

repressed-need/internal conflict hypothesis

stutter is a psychopathological symptom of repressed internal conflict

personality disorders and stuttering

PWS also present with personality disorder

learning theories of stuttering

near the onset of stuttering the speaker learns that speaking is difficult and learns to anticipate stuttering

TYPES: diagnosogenic theory, anticipatory-struggle model, continuity hypothesis, operant conditioning models, two-factor approach

diagnosogenic theory

a belief that stuttering is caused by the misdiagnosis of typical disfluencies as stuttering so the person learns and begins to stutter

anticipatory-struggle model

child believes speech/communication is difficult and fears of communicating which causes them initiate speech with excessive tension (self-fulfilling prophecy)

continuity hypothesis

tension and fragmentation of fluency breaks in normal disfluencies is increased by communicative pressure and causes the stutter

operant conditioning models

fluency breaks are shaped by responses they elicit from listeners

two-factor approach

combining perspectives of classical and operant conditioning to suggest that initial fluency breaks occur as a result of classical conditioning (negative emotion + automatic nervous system response) and continued stutter result in the child avoiding communicating

Tudor study/Monster study

unethical study that looked at diagnosogenic theory and found stuttering is innate and cannot be caused by labeling a child as a PWS

physiological theories of stuttering

speaker's ability to produce fluent speech breaks down in response to various forms of stress

TYPES: cerebral dominance theory, covert repair hypothesis, cognitive/linguistic motor sequencing, genetics, EXPLAN model, structural and functional neurological differences, cybernetic and feedback models

cerebral dominance theory

-lack of dominance in LH results in decreased organization and language management

-Originally it was believed this occurred in lefties who were forced to be righties and therefore neither LH or RH dominated in speech

covert repair hypothesis

disfluencies are the result of correcting phonological errors in phonetic plan before they are spoken

cognitive/linguistic motor sequencing

stuttering results from combinations of inefficient higher level linguistic processing and lower level production of language and speech so it's difficult to generate temporal motor patterns for sequencing speech

genetics

genes interact with environmental factors to cause stuttering

EXPLAN model

Fluency failures occur when linguistic plans are sent too slowly to the motor system

EX: Execution

PLAN: Speech planning

structural and functional neurological differences

there are specific brain regions associated with stuttering

cybernetic and feedback models

disruption in feedback accuracy causes stuttering

multifactorial model of stuttering

most relevant in research today - considers combinations of factors that result in the onset and development of stuttering

TYPES: demands and capacities model, neurophysiological model

demands and capacities model

disfluencies and real stutters emerge when a child's capacities for fluency are not equal to speech performance demands, so child attempts speech beyond their abilities

neurophysiological model

dynamic interplay among processing, output, and contextual/environmental influences