Fluency Midterm 2

3 categories of psychological theories of stuttering

1) psychoemotional

2) psychobehavioral

3) psycholinguistic

psychoemotional theories suggest…

stuttering is caused by psychological trauma or emotional disturbance

In the past, stuttering was thought to be due to a psychological disturbance and purposeful behavior.

it is a purposeful behavior that:

1. represents repressed hostility
2. satisfies oral and anal erotic needs
3. represents an unconscious desire to repress speech

t/f: adults and children who stutter are more likely to show anxiety and social difficulties compared to those who do not stutter.

true

t/f: parents and children who stutter are more likely to report separation anxiety, social phobia, and generalized anxiety

true

psychobehavioral theories propose….

stuttering is a learned behavior

avoidance behaviors

* learned behaviors
* AWS may avoid speaking situations, certain words by substitution or circumlocution
* approach-avoidance conflict and diagnosogenic theories

Approach-Avoidance Conflict theory

* occurs when an individual is attracted and repelled by the same goal
* stuttering is viewed as a consequence of the need to speak and desire to hold back from speaking

(approach-avoidance conflict theory)

if the avoidance is dominant, then AWS is ______

silent

(approach-avoidance conflict theory)

if the approach and avoidance drives are equally strong, then …

stuttering occurs

(approach-avoidance conflict theory)

once a moment of stuttering occurs, the fear response is ____ and thus the avoidance drive is _____ and the conflict is ________

reduced

reduced

resolved

Johnson’s Diagnosogenic theory

* the diagnosis of stuttering is the cause of stuttering/the disorder
* normal disfluencies are misdiagnosed as stuttering
* stuttering begins in the ears of parents when they overreact to their child’s normal disfluencies

Conditioned Anxiety Response theory

* agrees with Johnson that children react to parents reaction to disfluencies
* BUT he proposes children are NOT trying to avoid disfluencies but they are trying to avoid feelings of anxiety, hurt, and shame
* feelings of anxiety → change behavior (avoidance behavior)→ reduced anxiety

Anticipatory Struggle hypothesis

* suggests people who stutter tend to stutter when they expect to stutter
* PWS tend to talk fluently when they are not thinking about speech
* anticipation of stuttering → stuttering

Demands and Capacities model

* stuttering results when demands for fluency from the child’s social environment exceed their cognitive, linguistic, motor, or emotional capacities for fluent speech
* internal and external factors influence the production of fluent and non-fluent speech

(Demands and Capacities model)

capacities:

inherited tendencies, strengths, weaknesses, and perceptions that may influence the child’s ability to speak fluently

(Demands and Capacities model)

demands:

* may be from the child or other listeners
* rapid rate of speech or speech continuity
* demands may change over time

psycholinguistic theories suggests…

* stuttering is a consequence of speech-language encoding disorder
* speech and language processing in individuals who stutter are deficient in some way

Covert Repair Hypothesis

* individuals who stutter produce more disfluencies because they may..
* be slower in phonological encoding
* attempting to begin speaking too soon or try to speak too quickly for their impaired encoding mechanism to make accurate selections

(Covert Repair Hypothesis)

errors are detected _____ but the correction or repairs are done ______

covertly

overtly

(Covert Repair Hypothesis)

errors can be ___ or ________ but there is a higher rate of _______

real or perceived

corrections

(Covert Repair Hypothesis)

disfluencies are the result of ….

hyperactive self-monitoring and correction of speech

Neuropsycholinguistic Theory

* disfluency is a result of disruption in timing between various linguistic formulation and motor execution
* in abnormal disfluency there is an added component of time pressure and feeling loss of control

(Neuropsycholinguistic Theory)

time pressure:

loss of control:

sounds are not inserted into syllables at a timely fashion during speech production

\
some aspects of language formulation are accessible to conscious awareness while others are not

loss of control occurs when disruption takes place in an aspect of language that is not accessible to conscious awareness (ex: phonological encoding)

motor learning in stuttering

* motor skills can be improved with practice
* action learned in slow motion can be transferred to action in higher speeds
* motor skills can be improved with practice

with increased rehearsal, the frequency of stuttering _______

decreases

adaptation effect

stuttering decreases over repeated readings HOWEVER, if there is a pause between the readings, the frequency of stuttering increases when the reading resumes

differences of motor ability in AWS and controls in:

* fine and gross motor coordination
* bimanual coordination
* reaction time
* speech and motor coordination

fine and gross motor coordination in AWS

* AWS have reduced fine and gross motor coordination even in tasks NOT involving speech
* AWS are slower and less accurate than controls

finger tapping with either left of right hand (fine motor skills in AWS)

* right handed AWS were slower than right handed controls
* overall tapping rates were slower in __**right**__ handed AWS than left handed AWS

when asked to write concurrently with both hands, AWS:

* performed more poorly with their non-dominant hand
* made more mirror reversals compared to controls
* poor bimanual writing

bimanual crank task (AWS)

* AWS with persistent stuttering were the fastest
* AWS had the most errors
* AWS had most excess output

compared to controls, adults and children who stutter are:

* less coordinated at motor tasks
* show poorer performance (slower, less accurate) in bimanual tasks

in AWS, reaction time in speech tasks may be influenced by ________

secondary and avoidance behaviors

(reaction time tasks) AWS display slower:

* manual reaction
* vocal reaction

(during speech and non-speech tasks when compared to controls)

(speech motor coordination)

in both speech and non-sequences AWS:

* AWS take longer time to accomplish the task compared to controls
* AWS movement velocity was higher than controls
* AWS moved their mouths to a greater extent
* AWS were less coordinated (less lip coordination)

controls have larger _____ prefrontal lobe and larger _____ occipital lobe volume BUT, AWS did not show these asymmetries

right

left

AWS have extra gyri in the ……. close to….

superior bank of the Sylvian fissure

regions involved in speech and language processing

The larger left planum temporale (PT) in controls is assumed to be an indicator of the…. \n PT is part of ….

left hemisphere \n specialization for language

Wernicke’s area

in AWS, the planum temporal was larger on the _____ or equal in size

right

AWS have a larger _______ compared to controls

corpus callosum

AWS had more _____ in the rostrum of the corpus callosum → which connects the….

white matter

prefrontal and motor areas

AWS display atypical brain anatomy in…

gyrification, lobes, grey matter, white matter, and planum temporal

AWS display deficits in the….. but compensatory effects found in the….

left hemisphere

right hemisphere

AWS display less activity in the ______ hemisphere compared to controls during language processing

left hemisphere

During moments of stuttering, the right hemisphere motor cortex controlling the lips, and the \n supplementary motor area were ________ in AWS.

\n The motor regions were _______ during choral reading.

overactivated

not overactivated (fluent speech when choral reading)

Before treatment: _____ > _____

\n Immediately after treatment:_____>____ \n

One year after treatment: ___ >___

before: right > left

\
immediately after: Left > Right

\
One year after treatment: Left > right

Imagined stuttering produced activation…. \n Only small differences were found between the 2 conditions

similar to actual moments of stuttering

In general, most areas of the brain activated during overt stuttering were also activated during…

imagined stuttering

During moments of stuttering, _________

showed bilateral activation while ______ showed more right hemisphere \n activation.

females

males

In both males and females, the ……… was correlated with moments of stuttering. \n ________ is involved in speech planning and production.

anterior insula

During fluent speech (choral reading) ____ AWS showed more \n bilateral activation when compared to _____ AWS who showed \n right hemisphere lateralization.

female

male

The activation of ______ was \n only observed in AWS but not controls. \n ______ is the right hemisphere homologue of Broca’s area.

right frontal operculum (RFO)

In AWS , the ____ was only activated during the _______ task but not during passive reading and it was _____ correlated with \n stuttering.

\n This observation suggests that activation of the ____ \n may be a __________ to produce \n fluent speech.

right frontal operculum (RFO)

reading and semantic decision

negatively

compensatory mechanism

damage to the RFO has \n been linked to……

articulatory disorders

Fluent speech: associated with activation of the \n regions involved in…..

auditory processing

(STG and MTG)

During moments of stuttering: AWS were observed to overactivate regions of the….. (associated with speech production) in the ______ \n hemisphere and deactivate ________

motor cortex

right hemisphere

auditory regions

AWS: ______ motor activity even when speech is not required and during moments of stuttering

increased

AWS: Increased ____ hemisphere compensatory activation (related to the motor system and \n compensation-RFO)

right

Overall, people who stutter show _____ hemisphere dominance for speech-language processing

right

Sex differences: _____ AWS show more _____ activation than _____ AWS during speech and language processing

female, bilateral

male

other conditions that ameliorate stuttering:

* masking noise
* paced speech

core executive function skills:

* attention
* inhibitory control
* working memory

executive function underpins:

* self-control
* emotional regulation
* goal oriented behavior
* speech fluency

individuals with neurodevelpmental disorders have _____ executive function compared to typically developing children

ex:

lower

ADHD, ASD, SLI, and stuttering

Children who stutter (CWS) have _____ EF compared to children who do not stutter (CWNS)

lower

* Working memory
* Inhibitory control
* Attention

Children with ________ and children with ________ were more likely to \n stutter.

weaker EF and comorbid conditions

Children with comorbidity showed _____ EF than children without comorbidity and typically developing children

weaker

Prevalence of stuttering was ______ for children with comorbid conditions relative to children without comorbidity

higher (4.19%)

without comorbidity (1.02%)

CWS who recover show stronger ________ skills compared to those with persistent stuttering

working memory

types of acquired stuttering:

* neurogenic
* psychogenic

In _____ AS, stuttering onset is observed in adults following neurological disease, brain injury, stroke, etc

neurogenic

______ AS typically occurs after a period of prolonged stress or after a traumatic event. \n

________ stuttering can occur alone or together with other signs or psychological or neurological involvement

Psychogenic

_________ AS = acquired stuttering that starts in late adolescence or adulthood but the cause is unclear

idiopathic stuttering

t/f: Acquired stuttering may not develop immediately after the \n traumatic event but later on

true

most common etiology/causes of neurogenic AS:

* stroke
* head trauma
* tumor
* neurological disease (parkinson’s)
* drugs

Acquired stuttering may be more common in individuals with both _______ and ____________

brain trauma & post-traumatic stress disorder (PTSD)

t/f: onset of acquired stuttering can be sudden or gradual

true

t/f: Disfluencies observed in DS are also observed in AS

true

t/f: Adaptation and pacing effects rarely occur in AS.

true

in acquired stuttering, secondary behaviors….

are present but not as common

for acquired stuttering, repeated readings of the same material showed….

no adaptation effect

for acquired stuttering, choral reading did/did not increase fluency?

did NOT increase fluency

for acquired stuttering, reading under delayed auditory feedback did/did not increase fluency?

did NOT increase fluency

in acquired stuttering, physical concomitants are…

rare and less likely to be observed in AS compared to DS

Treatments used with DS have been used with patients with ______ AS. \n

Strategies include:

psychogenic

\
Easy onset, light contact and easy repetitions

additional treatments for AS:

* neurosurgery
* drugs

differences between DS and AS:

* AS speakers typically __**do not**__ **have the long-history of negative emotions** associated with speech
* **Repetitions, prolongations and blocks** (SLDs) do NOT occur only on initial syllables of words and utterances in AS
* **Secondary symptoms** such as facial grimacing, eye blinking, or fist clenching may be present but they are __**not as common in AS**__
* **adaptation effect** not commonly observed in AS
* **Stuttering occurs relatively consistently** across various types of speech task in AS (e.g. fluency inducing conditions such as __choralreading may not reduce disfluencies in AS__)

SAAND:

__**stuttering associated with acquired**__ __**neurological disorders**__: subtype of acquired stuttering; most general term to refer to dysfluency associated with acquired brain damage; can also be used in individuals with pre-existing stuttering

palilalia:

subtype of neurogenic stuttering characterized by the __**repetition of words or**__ __**phrases**__, often with __**increasing rapidity**__ and __**decreasing voice volume**__, and mostly at the __**end of**__ __**utterances**__. The number of repetitions may be impressive

thalamic stuttering:

possibly a distinct subtype of neurogenic stuttering due to thalamic brain damage

drug-induced stuttering:

subtype of acquired stuttering; dysfluency associated with the use of medication

connecting with your clients involves…

* Express empathy
* Show positive regard
* Have a collaborative relationship
* Collect and use feedback

assessments for presence of stuttering:

* %SLD (3% or higher)
* Stuttering Severity Instrument (SSI-4)
* Test of Childhood Stuttering (TOCS)

SSI-4

o Ages:

o Duration:

o Task:

o Measures:

* Normed and validated
* Ages: 2;10 months and older (for children and adults)
* Duration: 15 to 20 minutes
* Task: story telling, conversation, reading
* Measures:
* Frequency
* Duration
* Physical concomitants
* Natural of the individual’s speech

TOCS

o Ages:

o Duration:

o Task:

o Measures:

* Ages: 4 to 12 years
* Duration: 20-30 mins
* Task: picture naming, conversation, story telling
* Measures:
* frequency
* duration
* physical concomitants
* nature of the individual’s speech

assessments for looking at the impact of stuttering:

* Overall Assessment of the Speaker’s \n Experience of Stuttering (OASES)
* Communication Attitude Test for Preschool \n and Kindergarten Children Who Stutter
* KittyCAT (preschool)
* CAT (kindergarten)
* Spence Children’s Anxiety Scale

OASES \n Three different forms: \n Assesses:

* school-age (7-12 years)
* teens (13-17 years)
* adults (> 18)

\
* Information about self-perception of stuttering
* Reactions to stuttering
* Impact of stuttering on daily communication
* Impact of stuttering on quality of life

CAT and KiddyCAT \n assesses/involves:

* Questions related to perceptions of speaking
* Impact of stuttering on attitudes toward speech

Spence Anxiety Scale

involves/assesses:

* Self-report for children and parent report
* 44 items related to anxiety, social phobia, panic/agoraphobia, obsessive compulsive issues, fears of physical injury
* Children are asked to rate on a 4 point scale involving never (0), sometimes (1), often (2), and always (3), the frequency with which they experience each symptom