SLP10415_NATURE OF STUTTERING AND DYSFLUENCIES

Fluency

• Describes what the listener perceives when listening to someone who is truly adept at producing speech.

• Refers to the continuity, smoothness, rate, and effort in speech production.

Fluentem

The word fluency came from the Latin word _______ meaning to “flow.”

Continuous and effortless; movement and information

Fluency refers to the _______ and _______ flow of both _______ and _______.

Linguistic fluency and speech fluency

What are the two types of fluency?

Syntactic, semantic, pragmatic, phonologic fluency

What are the 4 components of linguistic fluency?

Syntactic fluency

Refers to being able to use a variety of forms in order to put together increasingly complex sentence structures.

Semantic fluency

Refers to having a large vocabulary repertoire and intact concepts.

Pragmatic fluency

Refers to being able to respond appropriately and in a timely manner in various contexts.

Phonologic fluency

Refers to being capable of producing sequences of sounds of increasing length and complexity in languages that are both familiar and unfamiliar.

Continuity, rate, rhythm, effort

What are the 4 components of speech fluency?

Continuity

• Refers to the logical sequencing of syllables and words where logical “flow” of information is smooth.

• Refers to the presence and absence of pauses, which are said to mark the disruption of the flow of sound.

Pauses

Refers to the disruption in the flow of sound.

Conventional, idiosyncratic; filled, unfilled

Pauses can be characterized as _____ or _____, and _____ or _____.

Conventional pauses

Used by a speaker in order to signal a linguistically important event.

Idiosyncratic pauses

Speaker hesitates or becomes uncertain about what is being said.

Filled pauses

Marked by words such as “ah,” “err,” “uh,” and “um” are used to make a continuous flow of sound but essentially disrupts the flow of information.

Unfilled pauses

This is identified by a normal silent interval of 250 milliseconds found between words.

250 milliseconds

How many milliseconds is considered an unfilled pause?

Rate

Refers to the percentage to the number of syllables that a speaker produces per second.

Formality, time pressure, background noise/competing messages, and lengthy utterance

Variations of rate are seen due to these 4 factors:

Slower

The more formal the speaking situation is, the _____ the rate.

Faster

The more time pressure during speaking, the _____ the rate.

Slower

The more interference from background noise/competing messages, the _____ the rate.

Faster

The lengthier the utterance, the _____ the rate.

Rhythm

• Refers to the patterns of stressed and unstressed syllables, which contributes to the overall flow and naturalness of speech.

• This influences how listeners perceive and understand spoken language, and its disruption can lead to difficulties in comprehension.

Effort

• It is the most important dimension of fluency.

• It is closely related to the force of contact between opposing articulators.

Effort

The listener’s perception of _____ is the most sensitive indicator of fluency.

Linguistic planning, articulatory planning

Fluent speech is effortless in two distinct ways: it requires little thought (_____ _____) and requires little muscular exertion (_____ _____).

Cognitive effort, muscular effort

Effort is viewed as both the _____ _____ necessary for concentrating on the message and the _____ _____ necessary for producing speech.

Effort associated with linguistic planning

Refers to the thought processes that govern the way a person constructs sentences.

Effort associated with muscle planning

Refers to muscle exertion, which includes the amount of attention an individual accords to speech production, as well as the “automaticity” of producing speech.

Normally fluent speech

• Sounds natural

• Contains normal disfluencies

• Faster speech rates within the normal range

• Less cognitive effort

• Faster rather than slower and less natural speech

• Feeling good or neutral about speaking

• Focused on communicating a message

Interjections, revisions, whole-word repetitions

Normal disfluencies include:

Interjections

“Uhm” and “like”

Revisions

Repeating or changing what the speaker said

Whole-word repetitions

“Yung ano kase, yung kase”

ASHA definition of fluency

• Refers to an interruption in the flow of speaking characterized by an atypical rate, rhythm, and disfluencies, which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms.

• People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder.

Disfluency

• Refers to the fluency breaks of normal speakers.

Dysfluency

• Describe the abnormal fluency breaks of people who stutter.

Dis

Means reversal, separation, or duplication.

Dys

Means difficult, impaired, painful, bad, or disordered.

Disfluency

• Are interruptions that disrupt the natural flow and rhythm of speech.

• It includes:

  • Phrase repetitions

  • Gap fillers

  • Phrases

  • Sentence repetitions

  • False starts

Primary behavior

• Are disfluencies developed since childhood.

• It was thought of as a transient phenomenon characterized by a child’s easy repetition of syllables and words, which are typical in childhood.

• A child is typically unaware of these events and displays no special effort or tension during speaking.

• Initial motoric behaviors taking place in the speech mechanism have been referred to as core, alpha, and pure behaviors.

Secondary behavior

• Are reactions that have developed from other behaviors.

• These may begin as random struggles but soon turn into well-learned patterns resulting from the child’s attempt to cope with the initial breaks in speech flow.

• Begins when the speaker becomes aware of and responds to these core behaviors that “real” or “secondary stuttering” began.

Escape behavior and avoidance behavior

What are the two types of secondary behavior?

Escape behavior

• A speaker’s attempts to terminate a stutter and finish the word.

• Occurs when the speaker is already in the moment of stuttering.

  • E.g., closing eyes or blinking

Avoidance behavior

• A speaker’s attempt to prevent stuttering when he or she anticipates stuttering on a word or in a situation.

• Avoid where they repeat or block/stutter.

  • E.g., I live in…the big apple (New York)

Stuttering

Stammering is an equivalent term for

Fluency

Normal speech is an equivalent term for

Disfluency

Dysfluency is an equivalent term for

Primary behaviors

Core behaviors/Alpha behaviors is an equivalent term for

Secondary behaviors

Accessory behaviors/coping behaviors is an equivalent term for

Normal fluency breaks

• An interruption of speech in a typically developing individual.

• More likely to be considered normal or non stuttered if it is the result of “linguistic uncertainty” in planning and formulating a way to express themselves.

Stuttering

• A type of speech disorder characterized by unusually high rates of repetition, prolongation, or blockage that interrupt the flow and rhythm of speech.

• Most of the time they are unpredictable but have normal cognition and are aware of their stuttering.

  • May head nod or eye blink to stop or keep from stuttering.

  • May also avoid using certain words or use different words to keep from stuttering.

Core behaviors, secondary behaviors, feelings and attitudes

Components of stuttering includes:

Core behaviors

• Basic speech behaviors of stuttering including:

  • Repetitions

  • Prolongations

  • Blocks

• Also referred to as speech disfluencies.

Repetitions

• Can be sound, syllable, or single-syllable words that is repeated several times.

  • E.g., a…a…a…pple

Prolongations

• Lengthened voiced or voiceless sounds.

  • E.g., aaaaaapple

Blocks

• Inability of the speaker to initiate speech, often signaled by a stop in airflow and postural fixation of the articulators.

  • E.g., a……pple

Secondary behaviors

• Reaction to core behaviors

• Are developed in response to disfluencies.

• May be visible or hidden.

Escape behaviors

• Attempts to terminate the stutter and finish the word such as eye blinks, head nods, and interjections of extra sounds such as “uh.”

Avoidance behaviors

• A speaker’s attempt to prevent stuttering when he or she anticipates stuttering on a word or in a situation.

Avoidance behaviors

Substituting another word with a synonym in anticipation of stuttering is an example of _____ _____.

Avoidance behaviors

A person with stuttering does not involve themselves in social situations and conversations is an example of _____ _____.

Feelings and attitudes

Are referred to as cognitive and affective components of stuttering.

Feelings

• May precipitate stutters, just as stutters may create feelings.

• May become frustrated or ashamed because they cannot say what they want to say as smoothly and quickly as others.

Attitudes

• Feelings that have become a pervasive part of the person’s beliefs.

  • E.g., feeling dumb or thinking that other people think they are dumb

Typical disfluencies

Adding a sound or interjection is a characteristic of _____ _____.

Typical disfluencies

Repeating whole words is a characteristic of _____ _____.

Atypical disfluencies

Part-word repetitions is a characteristic of _____ _____.

Typical disfluencies

Repeating phrases is a characteristic of _____ _____.

Atypical disfluencies

Prolonged sounds is a characteristic of _____ _____.

Typical disfluencies

Revision is a characteristic of _____ _____.

Typical disfluencies

Not finishing a thought (e.g., I can’t remember) is a characteristic of _____ _____.

Atypical disfluencies

One-syllable word repetitions is a characteristic of _____ _____.

Atypical disfluencies

Blocks or stops is a characteristic of _____ _____.is a characteristic of _____ _____.

Formulative fluency breaks and motoric fluency breaks

Manning and Shirkey (1981) suggested the use of two categories in describing the continuum of fluency breaks among speakers. This includes:

Breaks and interjections

Formulative fluency breaks include:

Formulative fluency breaks

• Characterized by little or no effort or tension.

• Result of linguistic planning or uncertainty and may provide the speaker time to organize the remainder of the sentence.

• Considered a normal disfluency.

Breaks, effort/tension, pauses, excessive prolongation of sounds/syllables

Motor fluency breaks include:

Motor fluency breaks

Are more typical of speakers who stutter but may occur in normally fluent speakers during conditions of communicative or emotional stress.

Formulative fluency breaks: Breaks

Usually in the form of repetitions between whole words, phrases, and larger syntactic units.

Interjections

Addition of a sound or word between whole-word or larger syntactic units.

Motor fluency breaks: Breaks

Addition of sounds between sounds or syllables (part-word breaks).

Obvious effort/tension

Are observable physical qualities that are focused in but not limited to the vocal tract.

Pauses

With a possible cessation of airflow and voicing.

Prevalence

A term used to indicate how widespread a disorder is.

Incidence

An index of how many people have stuttered st some time in their lives.

Epidemiological attributes

• The factors contributing to the incidence and prevalence of a problem.

• The possibility of the problem remitting or becoming chronic and;

• Changes in symptomatology and subtypes.

Epidemiological attributes of stuttering onset in preschool children

Are described in terms of the major factors that help distinguish children who are experiencing the onset of stuttering from their normally fluent peers.

Characteristics at the onset of stuttering

• Age and gender

• Rate & uniformity of onset

• Stuttering-like disfluencies (SLD)

• Clustering of disfluencies

• Awareness and reaction of the child to disfluency

2, 6

Stuttering usually starts between _ and _ years of age.

Less than 6 months

Many children go through normal periods of disfluency lasting ______ ______ _ _____.

Early childhood years

Stuttering rarely begins after the ______ ______ _____.

Boys, girls

______ are more likely to continue stuttering than ______.

Rate and uniformity of onset

• The nature of fluency characteristics at onset is closely related to the rate of onset.

  • In the 19th century, stuttering was viewed to develop gradually and followed a uniform pattern of development.

• The onset of developmental stuttering is not necessarily gradual or uniform.

  • The gradual and linear development of stuttering is associated with the description of primary and secondary stuttering.

• Studies noted that children sometimes experienced sudden onset and presented with what had been previously considered to be advanced (secondary) behaviors.

3 ½

Children who start stuttering at age _ or later are more likely to continue stuttering.

Stuttering like disfluencies (SLD)

• Are composed of three basic types of disfluencies:

  • Part-word repetitions

  • Single-syllable word repetitions

  • Dysrhythmic phonations (sound prolongations, blocks)

• Another important issue at onset is whether or not some disfluencies are particularly unique to young children who stutter.

  • Normally speaking children rarely repeated a part-word repetition more than once (range of 1-2)

  • Stuttering children typically repeated a portion of the word two or more times (range of 1-11)

Long disfluencies

Yairi and Ambrose (2005) conclude by stating their conviction that “a large number of _____ _____ (e.g., repetitions containing two or more iterations) plays a major role in parents’ decisions that their child has begun stuttering.

Clustering of disfluencies

• Several researchers have noted the tendency for children with stuttering to produce a sequence of disfluencies in close proximity to one another.

• Two or more consecutive disfluencies that occur within the same word, on adjacent words, or on a word and an adjacent between word interval.