Speech Disorders Quiz 4: Stuttering + Cluttering

Stuttering

A deviation in the ongoing fluency of speech due to a neurodevelopmental disorder

disturbances in the forward flow of speech/inappropriate stop/flow of voice

How many children stutter?

5% - 8%

How much of the General Population/World stutter?

1% - 3%

Transient Stuttering

People who stopped stuttering

Acquired Stuttering/Neurogenic Stuttering

not true stuttering

acquired later, did not have in childhood

• Ex) someone has a stroke —> acquires stutter

Psychogenic Stuttering

better suited to be treated psychologically than by SLP

trauma-induced

• Ex) trauma goes away —> stutter does too

Stuttering looks like…

• Repetitions

• Blocks

• Prolongations

“Fluent Speech”

consistent ability to move the speech production apparatus in an effortless, smooth, rapid manner

results in continuous uninterupted forward flow of speech

Stuttering

involuntary repetitions of sound and syllables, sound prolongations, blocks

cause in unknown

lifetime incidence is as high as 8%

~70% of children stop stuttering within the first 2 years after onset 85% will stop stuttering within the next few years

T/F: not well understood why some childrne sto stuttering and some continue

True

___ appear to stop stuttering more frequently and quickly

Females

Family history of stuttering…

increases risk that stuttering will persist

Later onset of stuttering (after 3.5 years of age) or a child who continues to stutter more than a year post-onset is at greater raks for persistent stuttering

longer you stutter/older you are when you start stuttering increases, the higher risk you are at to continue stuttering

Children usually start to stutter…

age 2-3 years (when they start to produce 2-3 word utterances)

incidence of stuttering is 1-3% and affects males more than females

2 boys for every 1 girl (children)

4-5 males for every 1 female (adults)

__________ likely play a role in stuttering

genetics and environmental factors

Characterizations of stuttering (what do you notice?)

Part-Word (M-M-M-Mick)/Full Word repetition (Mick-Mick-Mick)

More blinking/Reduced Blinking

Blocks (no air) (M———-ick)

Prolongations (Mmmmmmick)

Pause/Hesitate

Head Movement

Facial Grimace

Swapping Words

Filler Words (uh, um, etc.)

Laryngeal Tension

tnesion

Irregular Breathing

Clicking

Reduced Eye-Contact

Extra Movement elsewhere (Ex. extremities)

Tongue Protrusion

single syllable whole wrords SSWWR

Part word repetitions

1/SLD

secondary:

blinking looking away

movement

grimace

extra sounds

tention

breathing laryngeal tension

3 Types of Stuttering

Developmental

Acquires

Psychogenic

People who stutter have a higher rate of _____

Phonological disorders

Children exhibits…

hesitations, revisions, interruptions

Increase disfluent speech ~age 2, improve after age 3

Typical Disfluenceies

2 years:

whole word repititions, intergections

3years:

Primary Stuttering

repetitions of sounds syllables or single syllable words

prolongations of sounds or blocks

Frequency alone is NOT a…

definitive clinical measure

Dysrhythmic Phonation

prolongation

block

THREE OR MORE repetitions of a sound or word is considered a…

stuttering moment

1 or 2 repetitions of an interjection is generally considered a…

typical disfluency

more than one dysfluency in a word are common in young children and may indicate incipient stuttering

Clustered disfluencies

interjected speech fragments

adopted to reduce instances of stuttering

become permanently associated w/ stuttering

Developmental Stuttering

Child onset fluency disorder

begins until preschool (when they been 2-3 word utterances) (2-5 years of age)

gradual or sudden

severity increases w/ age

OCCURS ON CONTENT WORDS, not function words

in initial syllables of words

exhibit secondary behaviors and fear/anxiety about speaking pecificially

Neurogenic Stutteriing

associated w neurological disease

acquired AFTER childhood

occurs on FUNCTION WORDS

can be more widely diseresed through utterance

does not improve w/ repeated readings or singing

no secondary behaviors, no fear/anxiety directly from/about speaking

no “below the iceberg”

Psychogenic Stuttering

Associated w/ TRAUMA

UNIQUE AND NOT TRUE STUTTERING

no secondary behaviors, no fear/anxiety directly from/about speaking

typically resolves after trauma is solves w/ therapist (not SLP)

Younger preschool years (2-3 years of age)

periods of stuttering are followed by periods of less stuttering (relative fluency)

children stutter most when excited, upset, under pressure

sound and syllable repetitions are dominant

stuttering occurs at beginning of: sentences, clauses, phrases

occurs on content and function words

do not exhibit secondary behaviors

most not bothered or aware of disfluencies

Older preschool years (4-6 years of age)

stuttering may sound rapid and irregular

blocks may begin

secondary characteristics appear

increased tension

more widely dispersed through utterance

kids aware of stutter (TELL THEM they have one)

may become frustrated

School-age

fear and avoidance of stuttering begin (for some)

stuttering appears to be in response to specific situations

certain words regarded as more difficult and are avoided

blocks are more common that repetitions + prolongations (for most)

Older teens and adults

Stuttering in most advanced form

– Individual has developed a self-concept as a person who stutters

– Vivid and fearful anticipation of stuttering (not all people)

– certain sounds, words, and speaking situations are feared/avoided

– Longer, tense blocks are the core stuttering behavior

– Repetitions still occur but are more rapid and irregular and may co-occur w/ blocks

– Secondary behaviors and circulocution (talking around topic) continue

– Evidence of (for some) of embarrassment, helplessness, fear and shame

Theories of Stuttering

Behavioral

Organic

Phychological

Theories should propose…

Etiology

Persistent vs. Transient

• “Risk Factors’

When/Why is/does onset happen

• “Risk Factors’

locus (location) of stuttering/type of stutter (SLD)

• location in word/phrase, lexical complexity, frequency of word/sound, content (typically stutter here) vs function

• define 1, 2, 3 behaviors

Prognostic factor

Treatment/therapy options

Genetics

Variance (why diff day to day, moment to moment, etc)

SLD

Stuttering-like disfluencies

Organic Theories

proposes actual physical cause

all fail to explain stuttering satisfactorily

renewed interest in the theory of cerebral dominance due to findings of structural and functional differences in the brains of adults w/ chronic developmental stuttering

Incorrect

Behavioral theories

stuttering is a learned response to conditions external to the individual

Diagnostic Theory: overly concerned parents react negatively to a child’s normal speech hesitations, causing anxiety in the child and increased stuttering

contrary evidence + no supporting evidence

INCORRECT

Psychological Theories

contends stuttering is a “neurotic” symtom

• treated most appropriately by psychotherapy

doesn’t really explain underlying cause of stuttering

Typical Models of Stuttering

Linguistic

• language deficit/diff

• planning/programming issue

Cognitive/Neuro (middle of linguistic + motor)

• Defiict/Difference in neuro/executive function

• ability to coordinate

Motor

• motor abilities

• programming/control

Current Models of Stuttering

Covert repair hypothesis

Demands and capacities model

The Packman and Attansio 3-factor model

Covert repair hypothesis

stuttering is a reaction to a less effective speech production plan

unstable phonological encoding skills cause errors in speech plan

stuttering is. anormal repair reaction to an abnormal phonetic plan

Demands and capacities model

stuttering develops when the demands to produce non-stuttered speech exceed the child’s physical and learned capacities

dr spray’s fav model

speech depends on motor skills, language production, maturity (age), cognitive development

kids who stutter presumably have reduced ability to maintain 1+ of these capacities

The Packman and Attansio 3-factor model

3 factors that cause moment sof stuttering

• deficit in neural processing of language and inherent instability of speech production mech

• triggers or certain features of spoken language that are associated w/ greater speech motor demands that negatively affcect an already unstable speech production system

• modulating factors such as physiological arousal in an individual that can alter teh threshold at which a stutteing momen occurs

Direction Into Velocity of Articulators (DIVA) model

Computer simulation models provide evidence for disrupted speech motor control systems

Feed forward control(Speech) system vs feedback control system (Sense/Hearing) + how they work together to tell when something is wrong

doesn’t mention treatment

not heavy on linguistic aspect

psycholinguistic

Fault line hypothesis - speech encoding is delayed

Cover Repair Hypothesis

BEhavioral

starkweather -

DIVA -

Demands and Capacities model - no actual “flaw” in systems, structures exceed child’s abilities and cause speech failure

• cognitive

• motor

• linguistic

• emotional state/maturaity

Multi-Factorial Dynamic Pathways (MDP) Model of Stuttering

most current/accepted theory

Ties together these aspects:

• Motor

• linguistic

• neuro/cognitive

• emotional

which aspects do we notice deficits in

doesn’t really go into therapy

stuttering onset

2-4 years of age

Evaluation of Stuttering

2 components:

• observations of the child speaking

• detailed parent interview

Primary component is a detailed analysis of the child’s speech behaviors

Determine the average # of each type of disfluency

Measure # of units that occur in each repetition or interjection

Standardized tests may be used

Determine feelings and attitudes about stuttering

Behaviors generally associated w/ decreased likelihood of persistent stuttering

Read ch 8

Theories

background

little about assessment

NOT treatments

What is stuttering?

interruptions in the normal flow of speech.

Common Characteristics of Stuttering

• Repetitions

• Prolongations

• Blocks

Repetitions

repeating sounds/syllables

• Example: “b-b-b-ball”

Prolongations

stretching a sound

• Example: “ssssun”

Blocks

getting “stuck” with no sound coming out

Fluent Speech is speech that is…

• Smooth

• Effortless

• Rapid/continuous

• Uninterrupted

• Involves smooth movement of the speech production system

About ____% of people stutter at some point in their lives?

5-8%

What % of children stop stuttering within 2 years of onset?

70%

(about 85% stop in the following years)

What % of the general population continues to stutter throughout life?

1-3%

Factors associated with persistent stuttering

• Male sex → males are more likely to continue stuttering.

• Family history → increases risk of persistent stuttering.

• Later onset → onset after 3.5 years increases risk.

• Continued stuttering >1 year after onset → greater risk of persistence.

• Genetic + environmental factors likely contribute.

Females are more likely to naturally…

stop stuttering/recover more quickly than males

Stuttering ultimately affects more…

males than females

“Tip of the iceberg” vs “below the surface” in stuttering

Above = observable speech behaviors

Below = everything else that may come with stuttering

The Disfluency is…

the observable stuttering event

the actual speech event/things we can hear/observe

Things we can hear/observe

Part-word repetitions

• “M-m-m-my name…”

Prolongations

• “Mmmmmmy name…”

Blocks

• “My name is ___ Mic.”

• No sound comes out temporarily

T/F: having a disfluency doesn't automatically mean someone has a stuttering disorder

True

• everyone has disfluencies sometimes

A Dysfluency is…

the whole stuttering condition

entire iceberg, not just the speech behaviors

6 Parts of the stuttering iceberg

Speech (repetitions, prolongations, blocks)

Physical Concomitants (movements, grimacing, blinking, etc.)

Physiological Activity (feelings, anxiety, awareness, tension, etc.)

Affect (emotions and attitudes related to stuttering)

Cognitive Processes (what the person thinks about)

Social Dynamics (how stuttering affects social life)

Common disfluencies at age 2

• Whole-word repetitions → “I-I-I want it.”

• Interjections → “Um, I want…”

• Syllable repetitions

Common disfluencies at age 3

Revisions

• Ex) “I want the— I mean, I need the blue one.”

Stuttering-Like Disfluencies (SLDs)

primary stuttering behaviors

Ex)

• broken words

• sound repetitions

• syllable repetitions

• monosyllabic word repetitions

• Prolongations

• Blocks

Clustered Disfluencies

more than one disfluency occurs within the same word

Other Disfluencies (ODs) are…

common in ALL children (stuttering or not)

Ex)

• Multisyllabic whole-word repetitions

• Phrase repetitions

• Interjections

• Revisions

What else should you consider to determine that someone stutters other than how often they are disfluent

• What their stuttering sounds like

• Their experience of stuttering

• Their feelings/reactions toward stuttering

• Their behaviors surrounding moments of stuttering

T/F: A child who has more disfluencies is automatically a child who stutters.

False

Secondary Stuttering Behaviors

• Eye blinking

• Facial grimacing/tension

• Head movements

• Shoulder movements

• Arm movements

• Other exaggerated movements

• interjecting speech

Why might ppl develop secondary stuttering behaviors?

person's attempt to escape or avoid stuttering

• become associated with moments of stuttering

Stuttering onset + characteristics differ depending on 2 types:

Developmental Stuttering

Neurogenic Stuttering

Developmental Stuttering

most common type

usually begins gradually btwn 2-5 years

• can be sudden in 36%

increases in severity w/ age

cause = unknown

What words are most commonly impacted in developmental stuttering?

Content words

Where does Developmental Stuttering occur in utterance?

initial syllable

What is the occurrence of secondary behaviors in developmental stuttering?

Frequent

Is fear/anxiety about speaking present in Developmental Stuttering?

it can be

Does developmental stuttering improve w/ singing/reading?

can show improvement

Neurogenic Stuttering

less common

onset is after childhood

associated w/ neurological disease/trauma

What word types are most commonly impacted in Neurogenic Stuttering?

Function words (the, is, and, etc.)

Where does Neurogenic Stuttering occur in utterance?

Dispersed throughout utterance

What is the occurrence of secondary behaviors in Neurogenic Stuttering?

Infrequent

Is fear/anxiety about speaking present in Neurogenic Stuttering?

less typical

Does Neurogenic stuttering improve w/ singing/reading?

usually does not

Stuttering at age 2-3 years

stuttering comes and goes

increases when child is upset, excited, or angry

most children are unaware of their stutter/not bothered by it

not usually any secondary behaviors

What are the most common stuttering behaviors in ages 2-3?

sound and syllable repetitions

Where does stuttering occur in utterances in ages 2-3?

Usually at beginning of:

• Sentences

• Clauses

• Phrases

Can occur on both:

• Content words

• Function words

Stuttering at ages 4-6 years

Stutter more noticeable (speech = rapid/irregular)

more tension

awareness increases

secondary behaviors might appear