SLP10415_Nature of stuttering and Dysfluencies

pogi mo sir iric kahit kailan ???

fluentem

Latin word, meaning to flow

fluency

continuous and effortless flow of speech

continuity, smoothness, rate

typical disfluencies/nonfluencies

may hesitate when speaking, use fillers, repeat a word/phrase

Linguistic fluency

Syntactic, Semantic, Pragmatic, Phonologic fluency

Speech fluency

Continuity, Rate, Rhythm, Effort

Syntactic fluency

can use a variety of forms

Semantic fluency

have a large vocabulary repertoire

Pragmatic fluency

respond appropriately and in a timely manner in various contexts

Phologic fluency

can produce sequences of sounds of increasing length and complexity

Continuity

presence and absence of pauses

Pauses

Conventional, Idiosyncratic, Filled, Unfilled pauses

Rate

percentage to a number of syllables

Rhythm

patterns of stressed and unstressed syllables

Effort

most important dimension

effort = no smooth flow

Conventional Pauses

to signal a linguistically important event

Idiosyncratic pauses

hesitates or becomes uncertain about what is being said

Unfilled pauses

250 milliseconds between words

Filled pauses

• “ah”, “err”, “uh“, “um“

• disrupts flow of information

Effort associated with: Linguistic planning

effort in thinking about what to say next; thinking process

Effort associated with: Muscle planning

tension when talking and how articulators move; muscular exertion

Normally Fluent speech

natural, normal disfluencies

Fluency (ASHA)

interruption in the flow of speaking characterized by atypical rate, rhythm, disfluencies

Disfluency

• fluency breaks

• typical

• DIS - reversal, separation, or duplication

Dysfluency

• abnormal fluency breaks

• disordered

• DYS - difficult, impaired, painful, bad, or disordered

Primary behavior

• developed since childhood

• transient phenomenon

• “child’s easy repetition of syllables and words”

Secondary behavior

reactions developed from primary behaviors

Escape behavior

attempts to terminate the stutter and finish the word

Avoidance behavior

• attempt to prevent stuttering

• avoid where they repeat or stutter

Stuttering

• unusually high rates of repetition, prolongation, or blockage that interrupt the flow and rhythm of speech

• most of the time unpredictable

Equivalent terms: Fluency

normal speech

Equivalent terms: Stuttering

stammering

Equivalent terms: Disfluency

dysfluency

Equivalent terms: Primary behaviors

core behaviors = alpha behaviors

Equivalent terms: Secondary behaviors

accessory behaviors = coping behaviors

Normal Fluency Breaks

• interruption of speech in a typically developing individual

• result of “linguistic uncertainty“

  • interjections

Stuttering components: Core behaviors

• basic behaviors of stuttering

• speech disfluencies

repetitions, prolongations, blocks

What are the 3 core behaviors?

Repetitions

sound, syllable, or single-syllable words that is repeated several times

Prolongations

prolongations of voiced or voiceless sounds

Blocks

inability of the speaker to initiate speech, often signaled by a postural fixation

Stuttering components: Secondary Behaviors

• reaction to core behaviors

• developed in response to disfluencies

  • may be visible or hidden

Escape Behaviors

attempts to terminate the stutter and finish the word; eye-blinks, hair nods, and interjections of extra sounds like “uh“

Avoidance Behaviors

• attempt to prevent stuttering when they anticipate stuttering on a word or in a situation

• would say another word

  • would not involve themselves in the conversation

Feelings and Attitudes

cognitive and affective components

Feelings

• may precipitate stutters

  • become frustrated or ashamed because they can’t say what they want as smoothly and quickly as others

Attitudes

• feelings that have become a pervasive part of the person’s belief

• beliefs they have developed because of the behavior

Adding a sound or word (interjection)

“I um need to go home“

Repeating whole words

“cookie cookies and milk“

Repeating phrases

“He is—he is 4 years old“

Revision

“i had—i lost my tooth“

Not finishing a thought

“his name is… I can’t remember“

Part-word repetitions

“I w-w-w-w-w-want a drink“

One-syllable word repetitions

“go-go-go away“

Blocks or stops

“I want a (pause) cookie“

Continuum of Fluency Breaks

• Formulative Fluency Breaks

• Motoric Fluency Breaks

Formulative Fluency Breaks

• Breaks - usually in form of repetitions between whole words, phrases and larger syntactic units

• Interjections - between whole-word or larger syntactic units

• little to no effort or tension

• result of linguistic planning or uncertainty

• NORMAL disfluency

Motor Fluency Breaks

• breaks - part-word breaks

• Obvious Effort/Tension - focused but not limited to the vocal tract

• Pauses - with a possible cessation of airflow and voicing

• Excessive prolongation of sounds or syllables

Prevalence

indicates how widespread a disorder is

Incidence

index of how many people have stuttered at some time in their lives

Characteristics at the onset: Epidemiological attributes

• contributing to incidence and prevalence

• possibility of the problem remitting or becoming chronic

• changes in symptomatology and subtypes

• in the young, it is described in terms of the major factors that help to distinguish children experiencing the onset of stuttering from their normally fluent peers

Characteristic at the Onset of Stuttering

• Age & gender

• Rate & uniformity of onset

• Stuttering-like disfluencies

• Clustering of Disfluencies

• Awareness and reaction of the child to disfluency

Age & Gender

• stuttering usually starts 2-6 years of age

• rarely begins after the early childhood

• boys are more likely to continue stuttering than girls

Rate and Uniformity

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

• onset of developmental stuttering is not necessarily gradual or uniform

Stuttering-Like Disfluencies

• composed of:

  • Part-word repetitions

  • Single-syllable word repetitions

  • Dysrhythmic phonations (sound prolongations/blocks)

Clustering of Disfluencies

• produce a sequence of disfluencies in close proximity to one another

  • two or more consecutive disfluencies that occur within the same word, adjacent words, or a word and an adjacent between-word interval

Awareness and Reaction of Child to Disfluency

• how children are asked to indicate their awareness but when some children who have recently begun to stutter are aware of their situation and are beginning to react negatively