Stuttering exam

fluency

effortless automatic uninterrupted expression of information via speech

disfluency

effortful non-automatic/interrupted expression of information via speech

stuttering and lack of fluency are not synonymous

what is the problem with the word fluency

typical disfluencies

polysyllabic whole-word & phrase documentaries, interjections, revisions, incomplete phrases

polysyllabic whole-word & phrase repetitions, revisions, interjections, incomplete phrases

typical disfluencies

atypical disfluencies

prolongations, blocks, part-word/monosyllabic whole word repetitions

prolongations, blocks, part-word/monosyllabic whole-word repetitions

atypical disfluencies

accessory behaviors

associated physical behaviors associated with stuttering moments

temporarily aligned movements, autonomic changes, vocal changes

three types of accessory behaviors

eye blinking, gaze aversion, head bobbing, chest tightening, fist clenching

examples of temporarily-aligned movements accessory behaviors

flushing, sweating, heart rate

examples of autonomic changes accessory behaviors

pitch, rate

examples of vocal changes accessory behaviors

we do not know

why do accessory behaviors typically occur

covert stuttering

A person tries to hide their stuttering by avoiding/replacing words, avoiding certain situations

affective, behavioral, cognitive

what do the ABCs of stuttering stand for

feelings

what does the affective component refer to

speech and non-speech behaviors

what does the behavioral component refer to

thoughts and feelings

what does the cognitive component refer to

stuttering anticipation

knowing that you are going to stutter before it happens

develops with age and stuttering experience

how does stuttering anticipation develop

stuttering variability

inconsistency of stuttering- some words are stuttered & some aren’t; stuttering in some contexts and not others

social-cognitive, linguistic, cognitive/attentional factors

factors that impact distribution of stuttering events (stuttering variability)

social-cognitive factors

social interaction between speaker & listener

talk-alone effect and communicative pressure

social-cognitive factors

talk-alone effect

people who stutter don’t stutter when they are talking to themself out loud even if there are others around (as long as there is no communicative exchange)

meaningfulness, talking to an authority figure, time pressure, listener reaction/social approval

parts of communicative pressure that increase stuttering

initial consonants, content words, words earlier in sentence, longer words

brown’s four factors part of linguistic factors of variability that are stuttered more

lower frequency words, words with lower neighborhood density, more syntactically complex words

words that are stuttered more frequently are… (linguistic factors)

novel conditions, engage in concurrent activities/dual tasks, intense/unusual stimuli

what is included under cognitive/attentional factors

singing, choral reading, talking to beat, speaking alone, swearing, talking to animals/infants, whispering, acting/accents

fluency enhancing conditions

consistency effect

stuttering on similar words over repeated readings

adaptation effect

stuttering decreases over repeated readings may be due to reduced anxiety, decreased fear, and motor rehearsal

more males than females

who stutters

5%

incidence rate of stuttering

1%

prevalence rate of stuttering

2-5 years old

when does stuttering typically emerge

family history, sex, age of onset

predicative factors of stuttering

stuttering

loss of control, emotional reactions, behavioral reactions, cognitive reactions, limitations and impact, perceived influence of listeners

non-verbal and verbal reactions

how do listeners impact stuttering experience

non-verbal reactions

facial expressions that are interpreted to reflect confusion, impatience, embarrassment, pity, shock

verbal reactions

finishing words and sentences, mocking

stigma

deeply discrediting attribute that reduces an individual from a whole and usual person to a tainted, discounted one

stereotypes, prejudice, discrimination

what is included under public stigma

public stigma and self-stigma

what are the two types of stigmas

awareness, agreement, application

what falls under self-stigma

stereotypes

beliefs about a group of people (can be negative, positive, or neutral)

that they are shy, anxious, introverted

what is a stereotype for PWS

preschool years

when might stereotyping begin occurring

prejudice

negative feelings/attitudes or physiological reactions to a group of people

discrimination

negative behaviors to a group of people based on their membership

stigma-awareness

degree PWS are aware of public stigmas associated with stuttering

stigma agreement

degree PWS believes negative stereotypes about stuttering are applied to others who stutter

stigma application

degree that a person believes negative stereotypes apply to themselves

stress, anxiety, depression

self-stigma is positively correlated with

communication participation, self-esteem, quality of life, physical health

self-stigma is negatively correlated with

coping

constantly changing cognitive and behavioral effects to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of a person

protect the self and others, approach the problem and achieve agency

two ways to cope with stuttering

protect the self and others

devote time and effort to strategizing ways to prevent aversive communication experiences; use methods of escape and avoidance which provides relief and control, but hazards risk of isolation, frustration, and emotional suffering

approach the problem and achieve agency

improve self-concept, PWS broaden their perspective of stuttering to recognize their capability, minimize escape/avoidance, recognize alternative coping choices; focus on own needs rather than listeners needs

passing as fluent

the ability to hide stuttering to an extent that others do not recognize it as stuttering; repression of authentic self in face of societal stigma and pathological levels of social anxiety and shame

grants access to privilege they would otherwise be denied

why do PWS try to pass as fluent

stuttering gain

what people gain from stuttering (the benefits, experiences that PWS have that others don’t); challenges deficit-based perspective

unknown

what is the cause of stuttering

logical coherence, consistent, parsimonious, real-world relevance, falsifiable

what makes a good theory

what causes stuttering, features of stuttering, variability, sudden onset before 2-4 years old, young children awareness of stuttering, natural recovery

a good stuttering theory must explain….

physiological, learning, speech/language encoding, multifactorial

categories of stuttering theories

cerebral dominance theory, current neuroanatomical models, genetic factors

physiological theories

cerebral dominance theory

children predisposed to stutter due to conflict between right & left hemispheres specifically with left-handed people forced to use their right hand (disproved)

current neuroanatomical models

stuttering as deficit in basal ganglia, dysfunction in basal ganglia thalamocortical motor circuits= impaired ability to regulate timing cues for speech initiation; another model suggests stuttering as failure of connectivity among brain regions, children who have persistent stuttering have less developed white-matter tracts

genetic factors

structure follows familial patterns, most cases have clear genetic contribution, strong family history is best predictor of persistence & recovery

diagnosogenic theory, approach-avoidance conflict, anticipatory struggle hypothesis, operant and classical conditioning

learning theories

diagnosogenic theory

based on observations of similarities in speech of young children, stuttering caused by diagnosis- begins when parents accidentally diagnose typical disfluencies as stuttering= child becomes self-conscious, child tries to avoid disfluencies stuttering is what happens when child tries to prevent disfluencies

diagnosogenic theory

what theory did the monster study disprove

monster study

labeled children at orphanage that did not stutter as stutterers to see if they start stuttering; showed that calling a kid a stutterer isn’t going to cause them to have stutter-like disfluencies

approach-avoidance conflict

desire to avoid speaking outweighs desire to speak= stuttering/silence; desire to speak outweighs desire to avoid speaking= fluent speech; clear that avoidance is central feature of stuttering but doesn’t explain the reason of the first stuttering event

anticipatory struggle hypothesis

stutterers interfere in some manner with way they’re talking because of learned belief that stuttering is difficult; child learns to anticipate disfluencies and struggles to avoid/escape; the anticipation leads to the stuttering; doesn’t explain first stuttering event; focuses on what happens before stuttering event

classical conditioning

child learns to associate speaking with emotional response; better account of onset (associate speaking with emotional response)

operant conditioning

fluency failures are shaped by responses they elicit; better account of development (negative responses from listeners to stuttering shapes stuttering experiences)

execution and planning model (EXPLAN), covert repair hypothesis, vicious cycle hypothesis

speech/language encoding theories

execution and planning model (EXPLAN)

stuttering from difficulties in execution and planning of speech movements; distinguish between linguistic planning, motor planning, and motor execution; planning difficulty= unavailability of motor execution plan= mismatch of timing of planning & execution= stuttering

covert repair hypothesis

adopts Leveit’s model of normal speech production, difficulty with phonological encoding = hypervigilant internal monitor - detects both poorly formed output & identifies well-formed utterances as poorly formed & tries to repair them= stutter-like disfluencies

vicious cycle hypothesis

combines elements of covert repair hypothesis and anticipatory struggle hypothesis; adds that internal monitor is hyperfunctional & overly scrutinizes well-formed output; CWS more prone to disfluencies because difficulty with linguistic skills (perceive own fluency more sensitively = cycle of flunecy failure)

demands & capacities model, multifactorial dynamic pathways

multifactorial theories

demands & capacities model

Stuttering emerges when linguistic, motor, social-emotional & cognitive capacities for fluency aren’t enough for communication

environmental & internal

demands for communication (demands & capacities model)

motoric capacity

ability to initiate and control movement of articulators (demands and capacities model)

linguistic capacity

ability to formulate sentences (demands and capacities model)

social-emotional capacity

ability to produce smooth speech movements under communicative/emotional stress (demands & capacities model)

cognitive capactiy

ability to use metalinguistic skills (demands & capacities model)

multifactorial dynamic pathways

stuttering emerges from complex, non-linear interaction of many biological-environmental factors during development

motor components

fluent speech of adults who stutter show atypical pattern, failure to form stable underlying motor programs for speech, instability=over-reliance on feedback systems, AWS have more variable articulatory coordination patterns, increasingly unstable with increased length and complexity (multifactorial dynamic pathways)

language components

stuttering onset typically occurs when language abilities are developing rapidly, happens on longer/more complex utterances, varies from child to child, neural patterns for semantic & syntactic processing subtly different in AWS (multifactorial dynamic pathways)

emotional component

disfluency associated with increased sympathetic arousal, AWS hearing & anticipatory overt disfluencies = increase sympathetic arousal, greater negative affect= greater cognitive load for emotional regulation, decreasing availability of resources from language development (multifactorial dynamic pathways)

anxiety is a trigger for stuttering not the cause

what is the relationship between stuttering & anxiety

temperment

Innate tendency that refers to an individual’s emotional reactivity & emotional regulation

pseudostuttering

fake stuttering, voluntary stuttering

desensitize, increase sense of control, set stage/tone to start interaction on own terms, improve communicative exchange, implement physical speaking strategies

why is pseudostuttering beneficial for clients who stutter

desensitize, clinical skill-modeling, build trust, build empathy

why is pseudostuttering beneficial for SLPs