Chapter 8: Fluency Disorders

fluency

speech is effortless in nature

easy, rapid, rhythmical, and even-flowing

disfluency

marked by word or phrase repetitions; interjections, pauses, and revisions

normal speakers produce disfluencies some of the time 

stuttering

unusual, tense disfluencies that interfere with communication

most common form of fluency impairment

aquired/neurogenic stuttering - adulthood, brain damage, or emotional trauma

cluttering

rapid Burts of dysrhythmic, unintelligible speech

what is stuttering

unusually high frequency or durations of repetitions, prolongations, and/or blocks

excessive mental and physical effort to resume talking - lose train of thought 

negative perceptions of communication abilities - low self-esteem internalized negative reaction of others 

core stuttering behaviors

part word repetitions - syllables, interjections, and phonemes

prolongations - vvvvvan

blocks - silent prolongations - gets stuck

secondary stuttering behaviors

looking away, open jaw, purse lips

becomes automatic

more distracting than primary behaviors 

how often does stuttering occur

ratio of male stutters: females stutters is 3:1 - women develop lang abilities sooner

prevalence - 1-2%

incidence - 5%

Individual variability

typical duration - 3 sec, can be longer

peaks and valleys of fluency - frustration 

pressure to be fluent - greater disfluencies 

may be fluent when - singing, pretend voices, talking to babies 

differences between stutterers and non stutters 

self concept - view not as smart 

language abilities - grammatically complex/more words

motor system - voice onset time

neurological differences 

• more activation in right hemisphere speech and language areas 

• more activation in the cerebellum

• left activation in left hemisphere speech and language areas 

myths

stuttering is a nervous reaction

• general anxiety levels

• relaxation therapies not effective

• increase in anxiety may increase stuttering

overly sensitive parents 

• speech style and rate of speech

• parental anxieties and over protectiveness 

• overly critical 

current thinking about etiology

dynamic relationships between

inherited traits

• temperament, cognitive abilities, language abilities, attention, perception, speech motor control

external conditions

• parental expectations, relationship with others, child rearing practices 

development

usually gradual

• sometimes develops suddenly 

genetic predisposition 

• 15% first-degree relatives 

balance between demands and captivities 

• neurological, language, and emotional 

chronic stuttering

continues from childhood into adolescence/adulthood

contributing factors to chronic stuttering

negative feelings and attitudes

avoidance

difficulties with speech motor control

difficulties with language formulation 

assessment

interviews, speech samples, language development, consistency, adaptation, feeling and attitudes, and trial therapy 

measures

disfluency, percentage, and percentage of the kind

treatment

stuttering modification and fluency shaping

stuttering modification

MIDVAS- van Riper

motivation indentification, desensitization, variation, approximation, and stabilization 

modifying the stuttering

fluency shaping 

changing the way people talk so they do not stutter at all

control rate, onset, transitions, phrasing

airflow therapy 

gradual increase in length and complexity of utterances