SHS 616 Ch. 5-7

repetitions

• The first signs of stuttering in a young child are usually ___ (but sometimes prolongations or blocks).

• These behaviors appear to be the result of the anomalies in the way the child’s brain is developing.

learning

Very soon after onset of stuttering, ____ has a major impact on the form that stuttering takes. This is especially true for struggle, escape, and avoidance behaviors.

classical conditioning, operant conditioning, and avoidance conditioning.

The major forms of learning are ___

• Disfluencies become noticeable to child or parent, and child is consciously or nonconsciously “threatened” by them.

• Child tries to stop disfluencies, and as a result, she increases tension in laryngeal and/or articulatory muscles.

• When this happens again and again, disfluencies become a conditioned stimulus (CS) that elicits the tension response that is then the conditioned response (CR).

the stages that a child may go through as classical conditioning affects their stuttering:

• tension

• stimulus

• Stages in the development of stuttering

  • As child begins to react to her stuttering and to her mother’s alarm, her ___ increases.

  • The ___ of her disfluency elicits more and more tension.

• CS: struggle and tension because stutters themselves

• CR: struggle and tension because stutters themselves become cues for tension response

• example of classical conditioning:

  • A listener who previously associated with only easy stuttering, later becomes associated with struggle and tension because stutters themselves become cues for tension response.

  • That is, behaviors that were easy stutters, now become hard stutters, because all stutters have been conditioned to elicit tension and struggle.

• What is the conditioned stimulus and what is the conditioned response?

• threat and tightening of speech muscles (CS + CR).

• repeatedly on the phone (previously neutral)

• elicits dread and muscle tension (spread of conditioning)

• Classical Conditioning of Stuttering Beyond Childhood

  • Stuttering elicits feelings of ___

  • Stuttering (with accompanying dread and muscle tension) occurs ___.

  • Phones now regularly ____.
    
    

behavior and its consequences

Operant conditioning deals with a ____.

• positive

• negative

• punishment

operant conditioning

• A ___ reinforcer (praise, candy) following a behavior will cause that behavior to increase in frequency.

  • Adding

• A ___ reinforcer (stopping an unpleasant experience) following a behavior will also cause a behavior to increase in frequency.

  • Taking away

• A ____ (an electric shock) following a behavior will cause a behavior to decrease in frequency

• If a child is stuck in a stutter and nods his head or blinks his eyes to release the stutter, the head nod or eye blink will increase in frequency when child is stuck in the stutter.

• This is the result of the unpleasantness of being stuck in a stutter being terminated by the nod or eye blink. These behaviors increase because they are negatively reinforced.

• That is, the unpleasantness of being stuck in a stutter is relieved by the nod or eye blink. Thus, they increase in frequency in that situation.

• If a behavior reduces negative stimulation, it is “negative reinforcement” or escape, and it increases the behavior.

• In this example, the young man “escapes” from the stutter on “N-NNN” by substituting “the Big Apple” for “New York;” head nod is also an escape that is rewarded.

• “I went to N-N-N…the Big Apple”

give an example of Operant Conditioning and Stuttering

• combination of classical and operant conditioning

Avoidance behavior is best understood as a __.

avoidance behaviors

Starting when they are children, individuals who stutter learn to avoid the threat and fear associated with moments of stuttering by using ___

• putting in extra sounds just before saying a word they anticipate stuttering on.

  • Those extra sounds give the person a feeling that they will be able to say the feared word after a few repetitions of the extra sound.

Examples of avoidance behaviors are ___

• reduces

avoidance behavior

• Putting in extra sounds is negatively reinforced because it ___ the fear experienced when a stutter may be coming up

• Anticipating a stutter and doing something to keep it from happening

• Anticipating a stutter and doing something to keep it from happening

  • “I went to um…um…um…New York.”

• In this case, he avoids stuttering on the feared word, “New York,” by saying “um” several times

example of avoidance conditioning

• Decondition (associate behavior with neutral stimulus) and

  • Have client keep stuttering until fear is gone (no negative stimulus)

• OR

• Countercondition (associate behavior with positive stimulus) what has been classically conditioned

  • Have client stutter and receive praise for keeping stutter going and ending it easily (positive stimulus)

  • Client is also rewarded by the feeling of “being in control” when he ends the stutter loosely and easily with good eye contact

To deal with classical conditioning, you need to:

associate behavior with neutral stimulus

what is deconditioning

associate behavior with positive stimulus

what is Counterconditioning

reduction

Example of unlearning classical conditioning responses:

• When the clinician asks client to stay in the stutter and she praises him as he holds onto the stutter, counterconditioning results in a __ of fear, which makes the stutter relax and feel to the client that it’s under control.

• Stop reward for unwanted behavior

  • Have client not release (reward denied) word immediately after tense squeeze, head nod, eye blink, or other escape behavior

• Start reward for wanted behavior

  • Have client stutter to easy prolongation before release (reward given)

To deal with operant conditioning, you need to:

• Decrease fear of stuttering

  • If client avoids by using “um” as in “My name is um…um…umBarry,” have client practice staying in stutter on “Barry” (reward this) and also learn to let tension reduce and release word slowly and easily

• Reward nonavoidance

  • Have client practice saying “My name is Barry” without the “um” but with an easier stutter on “Barry” (reward this emphatically!)

To deal with avoidance conditioning, you need to:

theory

a systematic assembly of research findings that enable scientists to explain a phenomenon (like tsunamis) and be able to predict the future occurrence of the event.

No, we have “theoretical perspectives” about stuttering that are less formal, but do suggest why and when stuttering occurs.

do we have well-established and widely accepted theories to explain and predict all aspects of the disorder?

anomalies in the central nervous system

Some theoretical perspectives focus on ___ that result in a vulnerable speech production system.

• Orton and Travis (1931): lack of hemispheric dominance leads to mistiming of muscle activation = stuttering

• Geschwind and Galaburda (1985): left hemisphere delay, right hemisphere dominance  inefficient for speech = stuttering

• Webster (1983): left hemisphere supplementary motor area, responsible for initiation, planning, and sequencing of movement, is vulnerable to disruption, resulting in stuttering

Who had theories about brain disorganization (3)

disruption of timing of muscle sequencing = stuttering

Van Riper (1982) theory states:

• deficit in central timing that regulates speech production and integrates left brain segmentala and right brain suprasegmental aspects of speech production

• this deficit produces stuttering

Kent (1994) theory states:

• not designed for rapid sequencing of movement

• emotion

• Speech motor control may have shifted to right hemisphere (RH), which is __.

• The speech motor control is thus awry. Also, RH __ may disrupt timing.

• a reduced capacity for internal modeling

• Children learn to talk by hearing the sounds of their language and developing a “model” of how to move their articulators to make the sounds they desire.

• They use auditory feedback as they babble and talk to update their internal model as their speech mechanism changes size as they grow.

• Stuttering is thought to result from a weakness in using the internal model to transform the child’s plans for the sounds of a word into motor commands leading to movements producing speech

Neilson and Neilson (1987) theory states:

• deficits in planning and assembling the units for language production.

• Kent theorized that emotions located in the brain’s right hemisphere might interfere with the timing of speech production in PWS.

Wingate (1988); Perkins, Kent, and Curlee (1991); and Kolk and Postma (1997) have suggested that stuttering results from

• Covert Repair Hypothesis

  • Language production is monitored internally.

  • If problem in phoneme plan is in error, production halts.

  • Repetitions, prolongations, and blocks can all be explained by different responses to an error.

Kolk and Postma very specific model:

• no one cause of stuttering but an array of factors contributing to it

• “dynamic”

• linguistic load, speech motor instability, emotional stress

• multiple stresses

• A Multifactorial, Dynamic Disorder

  • Anne Smith and her colleagues (e.g., Smith & Weber, 2017) suggest there is ___

  • They see stuttering as___ because behaviors (repetitions, prolongations, blocks) are only surface features of an ever-changing process

  • Examples of the underlying factors are ___, etc

  • Smith and Weber (2017) suggest that ___ (that are different for different individuals) interact to result in stuttering.

Physiological tremor

a factor that may make the initial disorder more severe

• tremors are an important element in more advanced stuttering (adolescents and adults)

• tremors in older children who stuttered, but not younger children.

• Tremors

  • A number of researchers (Fibiger, 1971; Smith, 1989; Van Riper, 1982) conclude that ____

  • Kelly, Smith, and Goffman (1995) found ___

    • They further suggested that tremors may be evoked or amplified by emotion.

emotion

tremors may develop when speech or stuttering is associated with___. This may occur when stuttering has been associated with fear, embarrassment, or other negative emotions

•  diagnosogenic thoery

• stuttering may result when parents misdiagnose their child’s normal disfluencies as stuttering.

• Johnson thought children who were misdiagnosed by their parents or other listeners developed tension and hesitation in their speech in an effort to avoid disfluencies.

• Collected data to try to prove his theory:

  • Directed a master’s thesis by Mary Tudor that used children at an orphanage to test the hypothesis that normal-speaking children who were misdiagnosed as stutterers would develop stuttering (Tudor, 1939).

  • Interviewed parents of normally disfluent children and parents of stuttering children to show that their first disfluencies (at onset) were very similar.

  • Other researchers (e.g., McDearmon, 1969) interpreted the same data to suggest normally disfluent children and stuttering children had very different disfluencies at onset

• Disfluency types (at onset) of children thought to be normally disfluent versus children thought to be stuttering

what does Wendell Johnson (Johnson et al., 1942) theory state

• Communicative Failure and Anticipatory Struggle

• proposed that in many cases, stuttering begins when a child finds talking difficult.

• Anticipated difficulty in talking produces tension and fragmentation of speech.

• This leads to more frustration and failure in communication, which increases anticipation of difficulty.

what does Oliver Bloodstein (1987; 1997) theory state

• normal disfluencies criticized by significant listeners

• delay in speech or language development

• speech or language disorders, including articulation problems, word finding difficulty, cerebral palsy, and voice problems

• difficult or traumatic experience reading out loud in school

• cluttering, especially if listeners frequently say “slow down” or “what”

• emotionally traumatic events during which child tries to speak

experiences that may make some children believe speaking is difficult:

• Capacities and Demands

• stuttering may emerge when child’s capacities for fluency are overwhelmed by demands

• Capacities and demands theory leads to treatment based on reducing demands and, when possible, increasing capacities.

what does Sheehan (1970, 1975), Andrews et al. (1982), and Starkweather (1987) theory state

Child’s ability to plan and program for language while making fast, coordinated movements for speech

what are capacities related to speech

• Some children’s advanced conceptual and linguistic abilities

• models of rapid and complex speech and language in environment

• emotional stress on child from environment

what are demands related to speech

• Inheritance or brain injury

• Primary

• ___ leads to a vulnerable speech production mechanism.

• __ stuttering results.

• reactive

• secondary

a __ temperament may cause a child to increase tension when stuttering, creating _ stuttering characterized by struggle, escape, and avoidance behaviors that make stuttering more likely to persist

• primary stage

• secondary stage

Stuttering may often develop in two stages:

simpler disfluencies that are the result of how the brain handles speech and language production.

what is the primary stage

more complex pattern that is the result of the child’s and environment’s reaction to disfluencies.

what is the secondary stage

left-hemisphere processing for speech and language

Evidence reviewed in Chapter 2 suggests that stuttering often emerges from deficits in __

• primary

  • Working in an “underdeveloped” area

  • Reorganized and moved to an area not naturally suited to rapid speech and language functions (e.g., right hemisphere)

  • Reorganized so that major functions are at some distance from each other

  • Slower in processing because of less dense pathways

• deficits in the left hemisphere processing for speech and language may result in __ stuttering because neural circuits for speech and language may be:

  • (4)

Dyssynchrony

__ may mean that units for rapid speech and language production are not assembled accurately or rapidly enough.

• Repetitions may result from repeated utterance of unit that is ready, while waiting for next (transitional) element that is not ready.

• Prolongations may result from maintaining voice or airflow of first unit while waiting for next (transitional) element that is not ready.

• Blocks may result from attempt to go ahead despite next (transitional) element not being ready.

2-6

normal disfluency age range

2 - 3.5

Younger Preschool Children: Borderline Stuttering age range

3.5 - 6

Older Preschool Children: Beginning Stuttering age range

6 - 13

School-Age Children: Intermediate Stuttering age range

13+

School-Age Children: Intermediate Stuttering age range

• Between 2 and 6, most children have typical repetitions, prolongations, and pauses.

• Repetitions are more common in younger children; revisions are more common in older children.

• Typically disfluent children don’t react to their disfluencies; they seem unaware of them.

• Factors that may increase normal disfluencies:

  • Demands on language acquisition

  • Delayed speech motor skills

  • Stress

  • Competition and excitement when speaking

normal disfluency characteristics

1. no more than 10 disfluencies per 100 words

2. typically one-unit repetitions; occasionally 2

3. most common disfluency types are interjections, revisions, and word repetitions. As children mature past age 3, use of part-word repetitions will decline

3 typical disfluency characteristics in a non stuttering child

• Speech and language development

  • Some language and speech skills may be more advanced than others.

• Inefficiencies in some language production processes

Underlying Constitutional Processes of a Younger Preschool Children: Borderline Stuttering

• Communication stress

  • Models of fast talking/few pauses

  • Interruptions, questions, etc.

  • Models of advanced vocabulary and syntax

  • Competition to be heard

• Psychosocial stress

  • Conflicts in family

  • Birth of new sibling

  • Changes in home, moving, etc.

Underlying Environmental Processes of a Younger Preschool Children: Borderline Stuttering

• Resource reallocation to compensate

• Speech and language systems mature

• Conflicts resolve

“Outgrowing” Borderline Stuttering

1. more than 6-10 disfluencies per 100 words

2. often more than 2 units in repetition

3. more repetitions and prolongations than revisions or incomplete phrases

4. disfluencies loose and relaxed

5. rare for child to react to his or her disfluencies

5 characteristics of borderline stuttering in younger preschool children

• Increases in muscle tension and tempo

  • These increases are seen as a sign that stuttering is worsening.

  • These changes may be attempts to control or escape from stutters.

• Effects of learning on stuttering

  • Classical conditioning spreads the emotion associated with stuttering to more situations; this means more tension and faster tempo.

• Operant conditioning increases frequency of escape behaviors; this means more eye blinks, head nods, etc.

Underlying Environmental Processes of Older Preschool Children: Beginning Stuttering

1. Signs of muscle tension and hurry appear in stuttering. Repetitions are rapid and irregular with abrupt terminations of each element.

2. Pitch rise may be present toward the end of a repetition or prolongation.

3. Fixed articulatory postures are sometimes evident when the child is momentarily unable to begin a word, apparently as a result of tension in speech musculature.

4. Escape behaviors are sometimes present in beginning stuttering. These include, among other things, eye blinks, head nods, and “ums.”

5. Awareness of difficulty and feelings of frustration are present, but there are no strong negative feelings about self as speaker.

5 characteristics of beginning stuttering in an older preschool child

• Classical conditioning creates more and more tension in stuttering in more situations.

• Operant conditioning creates a more complex array of escape behaviors.

• Avoidance conditioning creates extra sounds and behaviors before the feared word and causes child to avoid more and more words and situations.

underlying processes in school age children: intermediate stuttering

1. Frequent core behaviors are blocks in which the child shuts off sound or voice. He or she will also probably have many repetitions and prolongations.

2. Child uses escape behaviors to terminate blocks.

3. Child appears to anticipate blocks, often using avoidance behaviors prior to feared words. He or she also anticipates difficult situations and sometimes avoids them.

4. Fear before stuttering, embarrassment during stuttering, and shame after stuttering characterize this level, especially fear.

4 characteristics of intermediate stuttering in school-aged child

• Minimal influence of original constitutional, developmental, and environmental factors.

• Learning and experience, however, have changed brain structure and function.

• Avoidance learning has created enduring stuttering patterns.

• Cognitive learning creates negative self-concept.

• This comes from listener reactions from childhood and later.

• Stutterers also project their own negative feelings about stuttering onto others.

underlying processes in older teens and adults: advanced stuttering

• Most frequent core behaviors are longer, tense blocks, often with tremors of the lips, tongue, or jaw. Individual
  will also probably have repetitions and prolongations.

• Stuttering may be suppressed in some individuals through extensive avoidance behaviors.

• Complex patterns of avoidance and escape behaviors characterize the stutterer. These may be very rapid and so well habituated that the stutterer may not be aware of what he does.

• Emotions of fear, embarrassment, and shame are very strong. Individual has negative feelings about himself as a person who is helpless and inept when he stutters. This self-concept may be pervasive.

4 characteristics of advanced stuttering in older teens and adults