SHS 716 Exam 2

Repetitions

Typically the first sign of stuttering in a young child

Learning

After stuttering begins, this has a major impact on the form the stutter takes

Classical Conditioning, Operant Conditioning, and Avoidance Conditioning

3 types of learning that impact the form of a stutter

Classical Condition

Begins with two things being naturally associated, a neutral stimulus is added, and after repeated association a previously neutral stimulus elicits a response.

Stages of Classical Condition Stuttering

Disfluencies become noticeable to child or parent, and child can feel unconsciously or consciously threatened by it; child tries to stop disfluency, and increases tension in laryngeal and articulatory muscles; repetition of these behaviors allow disfluencies to become conditioned stimulus that elicits a conditioned response which is tension.

Disfluency

In classical conditioning this becomes a conditioned stimulus when a child repeatedly notices their disfluency and feels threatened by it, resulting in tension in the laryngeal and articulatory muscles.

Tension

In classical conditioning this becomes a conditioned response when a child repeatedly notices their disfluency and feels threatened by it, resulting in tension in the laryngeal and articulatory muscles.

Classical Conditioning

A listener who previously associated with only easy stuttering, later becomes associated with struggle and tension because stutters themselves (CS) become cues for tension response (CR) is an example of what kind of learning?

T

T/F: Easy stutters become hard stutters in classical conditioning learning because all stutters have been conditioned to elicit tension and struggle.

Classical Conditioning

If stuttering occurs repeatedly when the PWS is on the phone, and the phone now elicits dread and muscle tension, this is an example of what type of learning?

Operant Conditioning

This type of learning deals with a behavior and its consequence

Positive Reinforcer

Giving praise (or a prize) following a behavior will cause it to increase in frequency. The praise or Candy is a:

Negative Reinforcer

Stopping an unpleasant experience following a behavior will also cause a behavior to increase in frequency. The stopping of the unpleasant experience is a:

Punishment

An event following a behavior (typically negative event) will cause a behavior to decrease in frequency. This event, i.e. something like a shock, is a:

Secondary Behaviors

These behaviors are most seen in operant conditioning (eye blinks, head nods)

Core Behaviors

These behaviors are most seen in classical conditioning (blocks, repetitions, and prolongations).

Negative

If a child is stuck in a stutter and nods his head or blinks his eyes to release the stutter, the head nod or eye blink will increase in frequency when child is stuck in the stutter. this is an example of what type of reinforcement?

Increase

In terms of operant conditioning, the unpleasantness of being stuck in a stutter being relieved by a head nod or eye blink will cause them to increase or decrease in frequency?

T

T/F: If a behavior reduces negative stimulation, it is "negative reinforcement" or escape, and it increases the behavior.

Avoidance Behavior

This type of learning can best be described combination of classical and operant conditioning

Avoidance Behavior

putting in extra sounds just before saying a word they anticipate stuttering on is an example of:

Avoidance Behavior

Anticipating a stutter and doing something to keep it from happening is an example of:

Deconditioning

associating a behavior with neutral stimulus and having a client keep stuttering until fear is gone (no negative stimulus) is an example of what in unlearning classical conditioning

counterconditioning

associating a behavior with positive stimulus (what has been classically conditioned) and having a client stutter and receive praise for keeping stutter going and ending it easily (positive stimulus) is an example of what in classical conditioning

True

T/F: When the clinician asks client to stay in the stutter and she praises him as he holds onto the stutter, counterconditioning results in a reduction of fear, which makes the stutter relax and feel to the client that it's under control.

Operant Conditioning

Stopping a reward for unwanted behavior or starting a reward for wanted behavior is an example of unlearning what?

Avoidance behavior

Decreasing fear of stuttering or rewarding nonavoidance are examples of dealing with unlearning what?

Theory

a systematic assembly of research findings that enable scientists to explain a phenomenon

T

T/F: In stuttering, we don't yet have well-established and widely accepted theories to explain and predict all aspects of the disorder.

Theoretical perspective

less formal, but do suggest why and when stuttering occurs

Disorder of Brain Organization

Orton and Travis (1931); Geschwind and Galaburda (1985); Webster (1983) are all researchers who have theoretical perspectives that stuttering is caused by:

Orton and Travis (1931)

Believe lack of hemispheric dominance leads to mistiming of muscle activation = stuttering

Geschwind and Galaburda (1985)

Believe left-hemisphere delay leads to right-hemisphere dominance inefficient for speech = stuttering

Webster (1983)

Believes left-hemisphere SMA, responsible for initiation, planning, and sequencing of movement, is vulnerable to disruption = stuttering

True

T/F: In stuttering Right hemisphere (RH) may be over developed to compensate for a less well-developed left hemisphere.

Disorder of Timing

Van Riper (1982); Kent (1994) believe that stuttering is caused by

Van Riper (1982)

Believes a disruption of timing of muscle sequencing = stuttering

Kent (1994)

Believes a deficit in central timing that regulates speech production and integrates left brain segmental and right brain suprasegmental aspects of speech production; this deficit produces stuttering.

Reduced Capacity for Internal Modeling

Neilson and Neilson (1987) believe stuttering is caused by a:

T

T/F: Children learn to talk by hearing the sounds of their language and developing a "model" of how to move their articulators to make the sounds they desire.

Neilson and Neilson (1987)

Believe Stuttering is thought to result from a weakness in using the internal model to transform the child's plans for the sounds of a word into motor commands leading to movements producing speech

Language Production Deficit

Wingate (1988); Perkins, Kent, and Curlee (1991); and Kolk and Postma (1997) suggest stuttering is a result of:

Kent

theorized that emotions located in the brain's right hemisphere might interfere with the timing of speech production in PWS.

Covert Repair Hypothesis

Curated by Kelly and Postma as an explanation of stuttering as the result of the brain's stopping production of speech when it detects an error in the plan that the brain has made to produce a word

Multifactorial, Dynamic Disorder

Anne Smith and colleagues believe stuttering is a:

Dynamic

Anne Smith et al. see stuttering as _____________ because behaviors (repetitions, prolongations, blocks) are only surface features of an ever-changing process.

Underlying Factors

linguistic load, speech motor instability, emotional stress, etc. are all ___________ ______________ of stuttering

Smith and Weber (2017)

suggest that multiple stresses (that are different for different individuals) interact to result in stuttering.

Tremors

Fibiger, 1971; Smith, 1989; Van Riper, 1982, conclude ____________ are an important element in more advanced stuttering

Kelly, Smith, and Goffman (1995)

found tremors in older children who stuttered, but not younger children

T

T/F: research by Kelly, Smith, and Goffman (1995) further suggested that tremors may be evoked or amplified by emotion.

Diagnosogenic Theory

Perspective from Wendell Johnson that stuttering may result when parents misdiagnose their child's normal disfluencies as stuttering

Wendell Johnson

thought children who were misdiagnosed by their parents or other listeners developed tension and hesitation in their speech in an effort to avoid disfluencies.

Wendell Johnson

Directed a master's thesis by Mary Tudor that used children at an orphanage to test the hypothesis that normal-speaking children who were misdiagnosed as stutterers would develop stuttering

Oliver Bloodstein (1987; 1997)

proposed that in many cases, stuttering begins when a child finds talking difficult.

True

T/F: Anticipated difficulty in talking produces tension and fragmentation of speech.

This leads to more frustration and failure in communication, which increases anticipation of difficulty.

Fluency; Demands

Sheehan (1970, 1975), Andrews et al. (1982), and Starkweather (1987) suggest stuttering may emerge when child's capacities for ________ are overwhelmed by ___________.

Capacities

Child's ability to plan and program for language while making fast, coordinated movements for speech are examples of

Demands

Some children's advanced conceptual and linguistic abilities; models of rapid and complex speech and language in environment; emotional stress on child from environment are examples of

Capacity and Demands Theory

leads to treatment based on reducing demands and, when possible, increasing capacities.

True

T/F: A reactive temperament may cause a child to increase tension when stuttering, creating secondary stuttering characterized by struggle, escape, and avoidance behaviors that make stuttering more likely to persist.

Primary

simpler disfluencies that are the result of how the brain handles speech and language production is what stage of stuttering?

Secondary

A more complex pattern that is the result of the child's and environment's reaction to disfluencies is what stage of stuttering?

Left Hemisphere

stuttering often emerges from deficits in in what hemisphere responsible for processing for speech and language

Deficits in Primary Stuttering

Results of neural circuits for speech and language may be:

1. Working in an "underdeveloped" area

2. Reorganized and moved to an area not naturally suited to rapid speech and language functions (e.g., right hemisphere)

3. Reorganized so that major functions are at some distance from each other

4. Slower in processing because of less dense pathways

Thus being the results of:

Repetitions, prolongations, or blocks

Kent, 1984; Perkins, Kent, & Curlee, 1991; Webster, 1997; Van Riper, 1982 suggest dyssynchrony at some level is responsible for:

dyssynchrony

may mean that units for rapid speech and language production are not assembled accurately or rapidly enough.

Repetitions

may result from repeated utterance of unit that is ready, while waiting for next (transitional) element that is not ready.

Prolongations

may result from maintaining voice or airflow of first unit while waiting for next (transitional) element that is not ready.

Blocks

may result from attempt to go ahead despite next (transitional) element not being ready.

temperament

______________ may make them acutely experience the loss of control (cf. Perkins et al., 1991) accompanying stuttering as threatening (nonconscious) or fearful (conscious).

T

T/F: fearful or threatening temperaments may cause PWS to respond by increasing tension, speeding up, escaping, and/or avoiding (cf. Gray, 1987, re: behavioral inhibition).

T

T/F: Because a reactive temperament causes emotional arousal, events that caused the emotion will be more deeply learned

A

Brutten & Shoemaker, 1969 suggest, children who react to primary stuttering with increased tension, escape, and avoidance behaviors will be more likely to continue these secondary behaviors

A. Long Term

B. Short Term

Permanently

Ayres, 1998 suggests that behaviors associated with high emotion are likely to be retained ____________.

T

T/F: treatment of those with secondary stuttering may be most effective if coping skills are taught

Cognitive Therapy

Emotional conditioning may result in cognitive changes so that ___________ _____________ (examining habitual thought patterns) may be a useful adjunct to behavioral therapy.

Primary Stuttering

may be the result of an anomalous organization of speech and language networks in the brain, which can resolve via maturation or reorganization.

Secondary Stuttering

may be the result of additional factors— perhaps a predisposition for a reactive temperament.

T

T/F: Persistent and recovered stutterers have similar genetic makeup

T

T/F Ambrose, Cox, & Yairi, 1997 suggest it is possible that persistent stutterers have some additional genetic predisposition

Low; strong

Child with primary stuttering may be able to recover if speech and language demands are _____ or language ability is _______.

High; Speech and Language; Temperament

Another child with primary stuttering may not recover so easily if language development demands are ________, child is not strong in ____________ and __________, and child has a reactive ____________.

Neural Plasticity

Some individuals will recover early from stuttering because they have greater

Females

_____________ have greater organizational plasticity and more widely distributed language centers

Speech

As social-emotional development creates stress on children, those with more inhibited temperaments may be more likely to have more negative reactions to difficulty with

Social Emotional

Children who manifest primary stuttering may develop secondary stuttering as ______-_________ pressures increase (e.g., beginning school).

Fast-Paced; Demanding

An environment that is ______-________ and _______ may be more likely to delay recovery.

Slow-Paced; Accepting

An environment that is _______-_________ and _________ may be more likely to give children freedom to develop fluency at their own pace.

Rate; Pausing

Models of speech and language with slow ______ and _________ may facilitate fluency in child with primary stuttering (Guitar et al., 1992).

Repetitions

more common in younger children

Revisions

revisions are more common in older children.

True

T/F: Typically disfluent children don't react to their disfluencies; they seem unaware of them.

Normal Disfluencies

Demands on language acquisition

Delayed speech motor skills

Stress

Competition and excitement when speaking

These all may increase:

2; 6

Between __ and __ children have typical repetitions, prolongations, and pauses.

Characteristics of Typical Disfluencies

1. No more than 10 disfluencies per 100 words

2. Typically one-unit repetitions; occasionally two

3. Most common disfluency types are interjections,

revisions, and word repetitions. As children mature

past age 3, use of part-word repetitions will decline

Characteristics of Borderline Stuttering

More than 6-10 disfluencies per 100 words

2. Often more than two units in repetition

3. More repetitions and prolongations than revisions or

incomplete phrases

4. Disfluencies loose and relaxed

5. Rare for child to react to his or her disfluencies

2 to 3.5

Younger preschool children experience borderline stuttering in these years

Constitutional Factors

Speech and language development

Some language and speech skills may be more advanced than others.

Inefficiencies in some language production processes

These are all _________ ____________ of borderline stuttering

Environmental factors

Communication stress

Models of fast talking/few pauses

Interruptions, questions, etc.

Models of advanced vocabulary and syntax

Competition to be heard

Psychosocial stress

Conflicts in family

Birth of new sibling

Changes in home, moving, etc.

These are all ____________ _____________ of borderline stuttering