Fluency Exam 1

Repetition

sound, syllable, or single word repeated several times

Prolongation

Sound or air flow continues but movement of articulators is stopped

Block

Airflow and movement of articulators stop

1. Tonic: continuous, inappropriate contraction of articulatory musculature (everything freezes)

2. Clonic block: Alternating cycles of tension and release of articulatory musculature

2 types of blocks

Modern Disorder

Stuttering is NOT a

Epidemiology

Cluster of characteristics that help define a disorder

70%

Percent of people who stutter with family history

30%

People who stutter with no family history

Incidence

Amount of people who ever have

Prevalence

Amount of people who currently have

Overt: can see from the outside

Covert: feelings/attitude on the inside

Overt vs. Covert

“Neurotic disorder; personality disturbance”

“epileptic and neuromotor disorder”

Early definitions of stuttering

• we don’t know cause

• every case different

• lack of cause, cure, & diff subgroups

Why is it so difficult to define stuttering?

Fluency

Effortless flow of speech

Fluency Disorder

Abnormal fluency, rate, rhythm of speech

Stuttering and Cluttering (handwriting mirrors their speech)

Two main types of disfluencies

Wendell Johnson

who had the early theory that stuttering is an anticipatory apprehensive hypertonic avoidance reaction

• circumlocution

• changing their name

• substituting different words for ones they stutter on

Coping mechanisms for PWS

Van Riper

Said “Stuttering occurs when the forward flow of speech is interrupted by a motorically disrupted sound, syllable, or word or by the speaker’s reaction thereto”

Wingate

Said “a disruption in fluency of verbal expression characterized by involuntary, audible, or silent, repetitions or prolongations, which may be accompanied by accessory activities and emotional states such as excitement, tension, fear or embarrassment”

IS NOT: a speech problem

IS: a communication problem

Stuttering is NOT ____________ but IS

The first one — all others will follow

Which behavior do you treat first in secondary behaviors?

• socially (takes 2 people)

• Vocationally

• Psychologically

3 ways stuttering is a communication disorder

Etiology (cause)

impairment (event of stuttering)

disability (education)

handicap (limitation to fulfill life roles)

How does the world health organization describe stuttering?

Secondary Behaviors - begin as random but turn into learned patterns

Exist because of stuttering

Visible/Audible: pitch/loudness variation, visible tension, body movements

Non-visible: increased blood flow, increased heart rate, stomach clenching

Reactive features: psychological adjustment (I am a PWS), emotional states

Types of secondary behaviors

Escape Behaviors

Occur when speaker is stuttering and attempts to stop the stuttering event and finish the word

Avoidance Behaviors

• Learned when a speaker anticipates stuttering and recalls the negative experiences he has had when stuttering

changing the word they were planning to say or stop talking

Top: core/secondary behaviors

Bottom: emotions/ cognitive/ axiety - fear

Iceberg of stuttering

Attitudes

Feelings that become pervasive or part of a person’s belief system. As they stutter more, they begin to believe they are a person who generally has trouble speaking

SLD: suttering-like disfluencies (part word reps, whole word reps, dysrhythmic fluencies - blocks, prolongations, repetitions )

OD: Other disfluencies (saying wrong word, interjections)

Disfluency types

• Part word repetitions

• Whole word repetitions - single syllable

• Dysrhythmic phonation - blocks/prolongations

Types of Stuttering like disfluencies (SLD)

Repetition Units

Number of EXTRA times a sound, syllable, or word is repeated

• Interjections: um, like, uh

• Revisions: changing the word

• Phrase repetitions

Types of OD’s - Other disfluencies

• No single cause/cure

• All groups/cultues

• Incidence: 5%

• Prevalence: 1%

General epidemiological findings of stuttering

Natural Recovery

Definition: Prognostic decisions of how many might recover without therapy

Near onset (age 2-3) = 2:1 (males to females)

Later onset (age 5) = 4/5:1 (males to females)

Gender ratio (near onset vs. late onset)

approximately 75%

About ____% of all children who ever stutter will recover naturally w/out formal treatment

If mom/dad stuttered, but stopped

What is one of the most important signs that an individual will have a natural or spontaneous recovery?

Most: 25 - 36 months (2-3yrs) - lang, fine, gross motor dev

Can happen from 16-60 months (1.5 - 5 years)

Most cases have an onset at what age

36 mo

5 years

Majority of recover occurs w/in ______ months of stuttering onset, some continue up to _____ years post onset

1 year

A marked decrease in stuttering (PW reps, Dysrhythmic phonations) occur w/in _____ of onset for those who recover

25%

Of all those who ever begin stuttering, about _______% continue to stutter beyond 4/5 yrs past onset

• male

• family history of persistence

• later onset

• stuttering not stopped by 6mo-year after onset

• dysrhythmic phonations continue

• other communication problems

Early prediction of possible persistency: RED FLAGS

• female

• no family history/history of recovery

• early onset

• stuttering significantly dropped by a year after onset

• Dysrhythmic phonations drop to norm

Early predictions of possible persistency: GREEN FLAGS

Immediate/extended family 68%

immediate family 39%

parents 27%

Percentage of children who stutter w relatives who stutter

1. structural anomalies (brain differences)

2. Brain processing

3. Motor skills

4. Temperament

If someone is predisposed to stuttering, what is transmitted?

3

66% of risk over by age 3

85% of risk over by age 3.5

Greatest risk for stuttering is prior to age _____

2 and 4

• speech, lang, motor system, socially developing

Critical period for onset lies between ages ___ and _____

• He stutters when excited

• His mind moves faster than mouth

• He is nervous

• Trauma/stress

Common parental explanations

Theory: an explanation of a phenomenon that has been supported by consistent, repeated experimental results (testable)

Model: Verbal, mathematical, or visual representation of phenomenon which allows scientists to explain, construct, and test theories (not testable)

Theory vs. Model

Correlation: a relationship

Causality

Correlation does not mean causality

Correlation and Causality

Bloodstein - Influenced by Zeitgeist (predominant thinking of the time)

Said “Theories of stuttering are seldom disproved. Most often we just get tired of them”

believed that stuttering resulted from changing the handedness of children

- left handed children that were forced to switch hands stuttered more

Theory of Incomplete Cerebral Dominance

Hemispheral Confusion

Theory of Incomplete cerebral dominance hypothesis:

Since the brain’s L hemisphere controls the muscles of the R side of the body and vice versa, to force a L handed child to be R handed could conceivably cause ___________… with stuttered speech as the result

Stuttering was an overt symptom of conscious conflict btwn child and parent

• treated the parents not the child (believed mom caused it)

• children had repressed needs that weren’t being satisfied so they stuttered

Freud’s belief on stuttering - psychoanalysis

Behaviorism theory - Wendell Johnson

Stuttering began, not in the mouth of the child, but in the ear of the parent

• misdiagnosis made by parents

Diagnosogenic theory

Wendell Johnson - performed the monster study

Godfather of Stuttering

Wendell Johnson

• tudor attempted to infect orphans with stuttering

• studied effect of verbal labeling on the frequency of disfluency

The monster study (evaluative labeling of stuttering )

Oliver Bloodstein

• stuttering results from early experiences w speech and child is convinced speech is a difficult thing to do

• PWS anticipate difficulty w a sound/word, leading them to struggle

Anticipatory-Struggle Hypothesis

Joseph Sheehan

• Desire to communicate collides w the drive to avoid speech anxiety (ex. hungry rat experiment)

• They want to communicate, they stutter, run the other direction, but still go back to communication, eventually they just stop

Approach-Avoidance Theory

PWS who is fluent vs. PWS who stutters

Approach-avoidance theory — Inside all PWS are 2 people ..

When comm demands from child’s social env are larger than their comm capacity, disfluencies are the result (fast talkers, time, genetics, etc.)

Capacity and Demands

1. Speech-motor skills

2. Linguistic skills

3. Affective & emotional control

4. Cognitive skills

Each child has a certain capacity level in any of the following domains:

capacity; demands

The development of fluent speech is maximized by supporting _________ development and temporarily decreasing ____________

not by 1 gene; several genes

• More often than not, it’s a predisposition

Genetic complications - stuttering is more likely to be controlled _______________________ but by ______________ interacting simultaneously

“stuttering gene”

Unlike other disorders with a genetic etiology, researchers in stuttering have not located a ________________

regional cerebral blood flow

• looked at 20 PWS - less blood flow overall in both hemispheres

• reduction greater in the L hemisphere (speech)

PET studies - does blood flow increase or decrease in people who stutter?

May be involved in coordination and timing of complex movements as well as processor of complex sensory info - playing key role in fluent utterances of PWS

PET studies - cerebellum (balance and coordination)

No diff in Broca’s area - in Wernicke’s, planum temporale was significantly larger

Also found:

• extra gyri

• more variability in gyral patterns

MRI brain imaging results

Children deficiencies (more global) in L hemisphere gray matter with reduced white matter

Adolescents and young adults more white matter connections in R hemisphere

Gray and white matter differences in PWS

Stuttering

1. Physiological

2. Speech and Language (linguistic)

3. Personality (emotional)

4. Environment

Multifactorial model - Stuttering Flower

1. loss of an existing normal function (fluency)

2. The appearance of unusual speech characteristics (secondary characteristics)

Onset of stuttering: stuttering is marked by 2 definite changes

• early stuttering = MILD

• early symptoms = EASY repetitions

• NO TENSION

• GRADUAL

• NO AWARENESS

Johnsonian trend/ traditional view of stuttering onset

3-6 weeks GRADUAL

1-2 weeks INTERMEDIATE

1-3 days SUDDEN

Manner (time) of stuttering onset

5

Normally fluent children show consistent awareness of fluency by age

distinct

Stuttering is ___________ from normal disfluency even at onset

Uniformity in…

1. GRADUAL APPEARANCE

2. EFFORTLESS REPETITIONS OF SYLLABLES/WORDS

3. LACKING IN PHYSICAL TENSION

4. LACKING AWARENESS AND AFFECTIVE REACTIONS

Early on, stuttering onset and development was characterized by 4 features

Primary to —> secondary when kid becomes aware

Primary = pure speech disorder w mild repetitions of syllables and words

(no tension, awareness, reaction)

Secondary = begins when child becomes more aware

Bleumel’s primary and secondary stuttering

early symptoms of stuttering are essentially normal disfluency or develop out of normal disfluency

• turn into “real” stuttering through parent-child interaction and/or other env influences

Bleumel and Froeschel assumed

• all children DO NOT go through period of stuttering

• Stuttering does not arise out of normal disfluency

• internal/external env factors do contribute to onset

• early severe symptoms close to onset are not unusual

What we know now about stuttering

attempted to show progression of stuttering across phases (stuttering as a continuum)

Phase 1: age 2-6; stuttering episodic, no awareness

Phase 4: adults; avoidance, word/sound fears

Bloodstein’s Phases

• Idea that everyone progresses through the stages

• cross sectional study

Problems with Bloodstein’s phases

Orton and Travis

Who was responsible for the theory of cerebral dominance

Not aware 120 (79%)

Aware 31 (21%)

Parent report of awareness at onset percentage