Part 1: Fluency Disorders

Fluency

Describes the flow of speech during communication

Smooth, effortless, and automatic

Fluent speech is…

Disfluency

A speech behavior that disrupts the forward flow of speech

rate, rhythm, smoothness, effort, and/or automaticity

Disfluencies disrupt…

Pauses, interjections, revisions

Three examples of disfluencies

True

True or false: some types of disfluencies are typical in nature

Word repetition

Describe the type of disfluency based on the example: “I like that…that book” 

Phrase repetitions

Describe the type of disfluency based on the example: “I want a…want a big one” 

Sentence repetitions

Describe the type of disfluency based on the example: “Watch me! Watch me! Watch me!”

Hesitations

Describe the type of disfluency based on the example: “He took…my juice”

Interjections

Describe the type of disfluency based on the example: “We, um, got to go too”

1. Word repetition

2. Phrase repetitions

3. Sentence reptitions

4. Hesitations

5. Interjections

List types of disfluencies that can be normal

Normal disfluencies do not affect communication

What is the difference between a normal disfluency and a fluency disorder? 

prolongations

Describe the type of disfluency based on the example: “I sssssee a rainbow”

Blocks

Describe the type of disfluency based on the example: “I………….see a rainbow

Sound repetitions

Describe the type of disfluency based on the example: “I s s see a rainbow” 

Syllable reptitions

Describe the type of disfluency based on the example: “I see a rain, rainbow”

Word repetitions

Describe the type of disfluency based on the example: “I see, see a rainbow”

1. Prolongations

2. Blocks

3. Sound repetitions

4. Syllable repetitions

5. Word repetitions

List types of dysfluencies that do not usually occur in typical speech

• Disfluency = normal non-fluency

• Dysfluency - disordered fluency

Difference between disfluency and dysfluency

speech

Fluency disorders are________disorders

• Abnormally high frequency

• Duration of disfluencies

Fluency disorders are characterized by…

1. Inappropriate for the speaker’s age, culture, linguistic background (dialect)

2. Significant - affects social communication and educational/occupational performance

3. Struggle and tension

Components disfluencies must meet to be considered a fluency disorder

developmental, acquired

Fluency disorders can be _______ or ________.

• Emerges in childhood

• Cause is unknown (functional) 

• Most common type 

Describe the components of a developmental fluency disorder

• Neurological in nature

  • Adult w/ TBI, stroke

Describe the components of an acquired fluency disorder

core, secondary

Stuttering is characterized by ________and ________ behaviors

• Disfluent speech patterns

• Stuttering-like (SLDs) and non stuttering-like disfluencies

Core behaviors

• Responses to core behaviors

• Behaviors and attitudes resulting from disfluencies experienced

Secondary behaviors

core

Secondary behaviors are responses to ______ behaviors

• Physical: facial or body movements

• Verbal: interjections, circumlocution 

Secondary escape behaviors 

• Avoiding sounds, words, or speaking

• Avoiding situations

Secondary avoidance behaviors

blinking, flaring nostrils, licking lips, clicking tongue, clenching jaw, nodding head, tapping foot

Examples of secondary escape behaviors

disfluencies 

Negative feelings and attitudes are secondary responses to _______

• Affect participation and achievement in school, home, and work environments

• Can affect quality of life

Psychological affect of stuttering

Predisposing, precipitating

________ and _______ factors cause stuttering

Predisposing

Factors that make a person susceptible to stuttering

family history/genetic predisposition, sex, differences in brain morphology and neural physiology, differences in motor speech coordination

Examples of predisposing factors 

Precipitating factors

Factors that make a person’s stuttering appear or worsen

age, communicative stressors, interpersonal stressors, other child factors

Examples of precipitating factors

50%

________ of PWS have an immediate family member who stutters

70%

______ of PWS have an extended family member who stutters

3,4

Stuttering affects _______or _____males for every female 

• Differences in brain shape and connections

• Differences in motor speech coordination

Brain differences as predisposing factors that make a person susceptible to stuttering

2-10

Stuttering mostly affects children between the ages of _________years old

3-5

Age of onset for stuttering is usually _______years old

3 years old 

Mean age of onset for boys

2.5 years old

Mean age of onset for girls

2-4

Rapid speech/language growth occurs at ages ______

Fast rate, complex language, interruptions, overuse of questions, short wait time following questions

Examples of communicative stressors that precipitate stuttering

Competing to speak, hurrying when speaking, having many things to say

Examples of interpersonal stressors that precipitate stuttering

True

True or false: Children who stutter are more aware of disfluencies in their speech.

cluttering

Rapid or unusual rates of speech that result in dysfluencies, frequent and unusual pauses in speech, a blending of sounds in words

• Fewer repetitions (whole word, initial sound)

• Frequent errors due to increased rate of speech

• No awareness of errors - no signs of struggle, tension, or avoidance

Cluttering vs stuttering 

• Referral

• Case hx and interview

• Observation

• Questionnaire and survey

• Direct testing

Assessment of fluency disorders may include…

core, secondary

Assessment of fluency disorders should examine _____ AND ________ behaviors

core behavior analysis

Analysis to examine core behaviors of fluency disorders

Determining the percentage of syllables stuttered (# of dysfluent syllable divided by total syllables)

What does a core behavior analysis entail?

30 dysfluent syllables/300 total syllables = 10%

If a person stutters 30 syllables out of 300, what percentage of syllables were stuttered?

1. 10% syllables stuttered or more

2. 3% or more SLDs

3. Physical behaviors

4. Verbal avoidance behaviors

A fluency disorder is more likely to be diagnosed when the following are observed

18, 3

Typical disfluencies begin around ____months to _____ years

3-5 years

In typical disfluencies, what age may children have repetition of words and phrases

True 2

True or false: in typical disfluencies, children remain unaware of their disfluency

True

True or false: children who stutter are often aware of their disfluency

early intervention (EI)

Current evidence argues that ___________should be implemented to prevent/treat stuttering. They argue it will prevent children from progressing to more advanced levels of stuttering

direct

Approach used in treating fluency disorders where a clinician provides therapy

indirect

Approach used in treating fluency disorders that involves a clinician guiding the parent or teacher

• Parents use “easy talking”

• Reduce stressful activities

• Teachers avoid putting child “on the spot”

Examples of indirect treatment

Fluency shaping and stuttering modification

Two approaches used in direct treatment

• Fluency shaping: not to stutter

• Stuttering modification: to stutter more fluently

Goal of fluency shaping vs stuttering modification

• Teaches to modify speech in certain ways so that dysfluencies don’t occur

• Strategies include slow rate of speech, easy onsets, light articulatory movements

• Does not focus on feelings/emotions

What does fluency shaping teach and what strategies does this approach include? 

• Teaches to manage and modify the dysfluency in the moment

• Strategies include pulling out, cancellations.

• Counseling is an important part

What does stuttering modification teach and what strategies does this approach include? 

• Don’t finish sentences/fill in words

• Don’t make remarks like “slow down,” “take a breath,” or “relax”

• Set a relaxed pace - use a moderate rate of speech

• Show them that you’re listening to what they say (not how they’re saying it)

List tips for working with people who stutter