CMD460 Quiz 6 Stuttering

stuttering

fluency disorder involving interruptions in speech flow, including:

• repetitions of sounds/ words

• prolongations

• blocks

guitars 3 part definition of stuttering

1. unusually high frequency/ duration of repetitions, prolongations, and/or blocks that interrupt speech

2. excessive mental and physical effort to resume talking

3. negative perceptions about their communication abilities

stuttering facts

-PWS often experience psychological, social, and emotional consequences

-onset can be sudden or progressive

-can co-occur with other disorders (ADHD, ASD)

-88-91% of children can recover spontaneously

boys

is stuttering more common in boys or girls?

age 4

95% of children who stutter start before what age?

incidence and prevalence

-US study showed about 2% of children ages 3-17 yrs stutter

-higher incidence if first degree relative stutters

-family history= 1.89 times more likely to persist

whole word repetition, interjections- (“um, uh”), syllable repetition, revisions (“he cant..—he wont play”)

what are the 4 typical disfluencies at age 2/3

early stuttering

speech of preschoolers often marked by disfluencies due to difficult motor patterns that get refined during speech development

• repetition of 1st word in sentences is most common form

• predisposition of stuttering may be inherited

• some children show increases disfluencies with atypical disfluency types

warning signs of early stuttering

3 or more within-word disfluencies per 100 words

• might show frustration and begin to develop secondary stuttering behaviors

monosyllabic whole word repetition, sound/syllable repetition, prolongations, blocking, producing words with tension/struggle, clustered disfluencies

what are the 6 core speech stuttering behaviors?

monosyllabic whole word repetition

“why why why did he go?”

sound/syllable repetition

“look at the ba-ba-ba-baseball”

prolongations

“sssssssssometimes”

blocking

inaudible/ silent fixations/ inability to initiate sounds

clustered disfluencies

contains more than 1 disfluency, “m-m-m-mmmmommy”

avoidance/ escape behaviors

secondary characteristics or accessary behaviors used to stop/ avoid stutter

• often used unsuccessfully

individual variability

the manner, frequency, and context one stutters might be different from another stutterer

have negative views of themselves as a communicator (emotional), stutter on words in long, complex sentences, and/or words critical to context (linguistic), and have difficulty in motor system that interferes with ability to react

what is the emotional, linguistic, and motor characteristic that stutteres as group have in common?

stuttering and language development

stuttering often begins when child’s language skills are rapidly growing

they start to produce longer, complex sentences= higher brain demand which can affect motor control

• when language system moves faster than motor system= stuttering can occur

• negative emotions add cognitive load —— more stuttering

genetic factors

-some studies support genetic contribution

-no specific gene, but multiple mutations linked (ex- NPTAB)

-genetics help predict persistence, recovery, and possibly treatment

neurophysiological factors

-reduced L gray matter volume and white matter integrity in L hemisphere

-reduced neural network connectivity in areas that support timing of movement control- affecting speech planning

-more R hemisphere activity in parents with child who stutters

-reduced blood flow in Broca’s area

factors that may lead to chronic stuttering

negative feelings and attitudes

• frustration or embarrassment about their communication abilities

avoidance of difficult words/ situations

speech motor control difficulties

• unusual patterns of breathing, vocalizing, speaking

assessment components

-relevant case history

-consultations with family and educators

-speech fluency, rate, intelligibility

-secondary behaviors

-emotional, cognitive, attitudinal impact

-stimulability testing

measures of stuttering

frequency of stuttering (# of within word disfluencies per # of words) and frequency of each type of disfluency

-consistency and adaptation

-feelings and attitudes

-diagnosis and recommendation during conference

consistency

stuttering on same words during multiple readings

adaptation

overall reduced stuttering across multiple readings

preschool children who stutter considerations

treatment is individualized based on child’s needs and family communication patterns

• includes both family and child based strategies

• family involvement is essential

goals=

• eliminate, greatly reduce, or help stuttering

• prevent negative emotions about stuttering

indirect and direct treatment approaches

indirect treatment

focuses on counseling families how to make changes in the child’s environment

• reduce communication rate, indirect prompts, rephrasing to model fluent speech

direct treatment

focus on changing child’s speech, attitude, beliefs to manage stutter

• speech/ stutter modifications strategies to reduce disfluency rate, tension, and secondary behaviors

treatment considerations for adolescents

more challenging due to issues in this developmental stage such as:

• emotional reactivity, authority resistance, social awkwardness, peer pressure/bullying

treatment considerations for adults

they have long-held beliefs that positively or negatively affect self perception about communication skills and motivation to change

• impact often affects social and vocational aspects, so SLP needs to consider how disfluency impacts quality of life

increasing speech efficiency and strategies reducing negative reactions

what are speech and stuttering modifications aimed to do? (at all ages)

speech modification strategies

techniques aimed to change timing and tension of speech production or timing of pauses between syllables and words

• common for younger children

techniques=

-easy/gentle onset

-light articulatory contact

-continuous phonation

-prolonged syllables

-rate control

easy/gentle onset- speech mod

gradual onset of voicing

light articulatory contact- speech mod

using easy articulatory gestures

continuous phonation- speech mod

voicing throughout utterance

prolonged syllables- speech mod

“stretching” each syllable in words/utterances

rate control- speech mod

slowing speech

stuttering modification strategies

changing only the stuttering behaviors and reduce physical tension by helping PWS locate point of struggle during moments of disfluency

• goal= help stutters acquire speech style they find acceptable

techniques:

-cancellation

-pull out

-prepatory set

cancellation- stuttering mod

after word stuttered, speaker pauses to examine features and adjusts to produce easy version

pull out- stuttering mod

during stuttered word, speaker ‘slides out’ of word by adjusting airflow to stutter smoothly

prepatory set- stuttering mod

PWS anticipates stutter before and uses modification to manage moment of stutter

disrupt the forward flow of speech

typical fluencies DO NOT ____________

using fillers (um, uh), avoiding sounds/words, altering rate of speech

what are the secondary characteristics (escape/avoidance)

more R hemisphere, gray and white matter integrity in the L hemisphere

stutters have more __________ activity during speech and reduced _________ in the ____________

childs language skills grow= brain has higher demand, affecting motor control needed in speech. motor pathway cant keep up with language= stuttering can occur

simply explain how language development affects stuttering

risk factors of persistent stuttering

-time greater than 6-12 months since onset and no improvement

-children who start stuttering at age 3 ½ or older

-boys

-family history

-slower language development

assessment may result in=

-diagnosis of a fluency disorder

-differential b/t fluency disorder and other speech/language disorders

-characteristics and severity of stutter

-impact on communication and quality of life

-will the person benefit from treatment?

-parent/family counseling

through education in the form of class presentations

how can attitudes of adolescents towards stuttering and PWS be improved?