CSD 453 Exam 1

Defining Fluency & Stuttering, Terminology, Variability and Predictability of Stuttering, Fluency Enhancing Conditions, Theories & Models of Stuttering, Onset Characteristics, Evolution of Stuttering

T/F: A fluency disorder is not necessarily a speech disorder.

True

what is fluent speech?

speech that does not contain unnecessary words or pauses, stoppages or blocks

effortless, easy flow, natural pausing, no unnecessary sounds or words

fluency is defined in terms of… by Starkweather

rate: syllables/words per minute

continuity: how continuous is the speech production? sequencing of syllables and words in relation to pauses

effort: physical and cognitive effort

what is stuttering?

involuntary disruption in fluency of verbal expression that includes audible or silent repetitions and prolongations of sounds, syllables and words and is sometimes accompanied by tension and effort

what is the prevalence of stuttering?

1% of the population stutters right now

what is the incidence of stuttering?

5-10% of the population ever stuttered

T/F: when a person stutters, it feels uncontrolled.

True

T/F: most people who stutter will show only one type of disfluency

false

what behaviors would you look for in a stuttering assessment?

pauses

revisions

interjections

speaking rate

movement on nonspeech structures

PRISM

define stammering

same as stuttering

geographical difference in terminology

define dysfluency

atypical speaking that results in prolongations, blocks, etc.

stuttering

define disfluency

typical disfluencies in general population

phrase repetitions, revisions, multisyllable word repetitions

mostly refer to people who stutter having disfluency

define PWS, CWS, AWS

PWS: person who stutters

CWS: child who stutters

AWS: adult who stutters

define stutterer

prior to 1990s, term used to PWS

not that big of an issue in the field

define primary/core behaviors

repetitions, prolongations, blocks

define secondary behaviors/secondaries

other behaviors that go along with stuttering

the older people get, the more secondary behaviors they usually have

eye closure, head movement, swallowing, movement of extremities

why do secondary behaviors occur?

1. learned response to get out of a moment of stuttering
2. used to avoid a moment of stuttering they anticipate

what are examples of secondary behaviors to get out stuttering?

use different words, interjections, circumlocution, avoid certain people/situations

the more open a person stutters, the ______ secondary behaviors they have.

less

define developmental stuttering

child who stutters

define developmental disfluency

NOT stuttering, typical disfluency in children

define childhood onset fluency disorder

diagnostic code name for typical child who stutters

seen in current literature

define cluttering

fluency disorder characterized by an issue with speech intelligibility, fast speaking or irregular rate, can’t understand what they are saying and don’t know they are doing it

may take syllable or sound out of word

define acquired stuttering

stuttering that begins in teenagers or adults

have to rule out stuttering as a child

define neurogenic acquired stuttering

stuttering caused by head injury- aphasia, TBI, neurotoxins, etc.

define psychogenic acquired stuttering

stuttering during panic attack or caused by trauma

resolves quicker, not common

what are elements of stuttering definitions that are seen across many definitions?

repetitions of phonemes and syllables

prolongations of phonemes

difficulty in beginning to say words (initiating consonants and voicing)

why are there so many definitions on what stuttering is?

those defining stuttering focus on different aspects. some investigate certain parts of stuttering and revolve their definition around that. need to combine all perspectives

etiology vs behaviors

covert vs overt

define overt

what can be observed

define covert

what occurs but can’t be observed

what is the current etiology definition of stuttering?

neurodevelopmental disorder of speech fluency with genetic influences

what is Sheehan’s definition of stuttering (iceberg)?

overt behaviors: behaviors we can see

covert behaviors: behaviors we can’t see- thoughts and feelings

conflict of identity because they want to portray themselves as a fluent speaker but it is not who they are

more popular now and acknowledges the importance of identity

What are the key parts to Johnson’s learned response definition of stuttering?

individual does it, it doesn’t happen to them

anticipatory: person expects it to happen

apprehensive: fear

hypertonic: tension

avoidance: person tries to keep it from happening

what is the frequently cited definition of stuttering (Wingate)?

focuses on perceptual characteristics of stuttering

disruption in fluency of verbal expression and is involuntary, audible or silent repetitions, prolongations… of sounds, syllables, words sometimes accompanied by physical effort, excitement, tension, fear, etc.

what is impairment under the WHO definition and how does it relate to stuttering?

any sort of physiological, psychological, anatomical, structural or function difference

audible behaviors of stuttering

what is disability under the WHO definition and how does it relate to stuttering?

restriction or lack of ability to certain activity within certain range that is typical of most individuals

very specific tasks person who stutters cannot or will not do

what is handicap under the WHO definition and how does it relate to stuttering?

roles a person cannot fulfill in their life because of their condition

disadvantages person who stutters has because of their stuttering

what is the purpose of the Yaruss (2004) ICF model of stuttering?

describe consequences of stuttering in broader context

determine what other factors influence stuttering

what are the different parts of the Yaruss (2004) ICF model of stuttering?

presumed etiology: genetic mutation, neurological difference

impairment in body function: overt characteristics, fluency of speech

personal factors/reactions: who person is and how their stuttering affects them, certain feelings, emotions, beliefs about self

environmental factors: what environment person is in and how it reacts to stuttering

activity limitation and participation restriction: what activities are they limited in and what participation they are restricted in (economic, social, educational impact)

how does stuttering vary on a person level?

person to person

throughout person’s life

day to day

within an interaction

what is the variability in duration of stuttering?

on average 1 second long but can be 0.5s to 30s

what is the variability in frequency of stuttering?

0% to 30% of words/syllables affected

on average 5-10% words/syllables

how does stuttering vary in terms of overt/covertness?

overt: how much, how often, etc.

covert: feelings about stuttering- fear, embarrassment, shame

how does stuttering vary in terms of secondary behaviors?

some openly stutter without any secondary behaviors

others close their eyes, move their head or arms, etc.

what is the variability in severity of stuttering?

mild, moderate, severe

what is the variability in type of stuttering?

blocks, prolongations, repetitions, etc.

how does stuttering vary in personal, environmental and situational areas of one’s life?

personal: cognitive/affective reactions

environmental: react differently in different environments

situational: react differently in different situations- public speaking, talking on the phone, etc.

what is the predictability of stuttering? more likely to be on…

location: first word/sound of utterance

word class: content words

word length: longer words

phoneme type: consonants and especially plosive sounds

word frequency: unfamiliar words

syllable stress: stressed syllables

syllable/phoneme position: initial sounds

what are contexts for decreased stuttering?

adapting a new way of speaking (new rate, pitch, whisper, accent)

speaking to a metronome (tapping leg)

masking with other auditory input (music, white noise)

delayed auditory feedback

reduced speaking rate

choral reading/unison speech

singing

when speaking alone or to animals or young children

using lipped speech

speaking in monotone voice

disclosing stuttering

not attending to speech (emergency situation)

acting

adaptation effect

ASMDRCSWUSDNAA

what is delayed auditory feedback and how does it relate to stuttering?

person speaks into microphone and voice is played back to them at slightly reduced rate

specific speaking tasks caused 100% fluency

What is choral reading/unison speech and how does it relate to stuttering?

reading along with someone else and stuttering stops completely

could be happening because of distraction, following other person’s pace, listening to other voice not yours, change in communicative responsibility

what is the adaptation effect?

decrease in frequency of stuttering after repeated oral readings of same material in short amount of time

as their fluency increases, they continue to stutter on the few same words

most significant change between readings 1 and 2

how can the adaptation effect be used in speech therapy?

can figure out etiology because it is not seen as much with acquired stuttering

see if their stuttering is typical

have client experience fluent speech

what are contexts for increased stuttering?

telephone, speaking to authority figures, own name, anticipating negative reaction, telling jokes, speaking to audience, repeating misunderstood message, trying to avoid/hide stuttering, waiting to respond, excitement

how might you implement your knowledge of contexts for increased/decreased stuttering in therapy?

if they don’t stutter in front of you, adding in some more challenging contexts and use those to initiate change

help them identify things to work on

make some contexts easier or harder

What is the ABC model of stuttering?

affective, behavioral, cognitive

what is the affective part of the ABC model of stuttering?

affective: relating to, arising from or influencing feelings or emotions

feelings are result of emotions and are preceded by physiological reaction to environmental stimuli, response to living with stuttering

increase in heart rate or sweat response, feelings of anger, fear, guilt, shame, etc.

what is the behavioral part of the ABC model of stuttering?

core behaviors: repetitions, prolongations, blocks

secondary behaviors: reactions to core behaviors (escape and avoidance)

what is a prolongation?

when sound or air flow continues but movement of articulators stops

what are blocks?

respiratory, laryngeal or articulatory stops in speech

what is the cognitive part of the ABC model of stuttering?

act or process of knowing that involves both awareness, judgment and beliefs about self

if they don’t have a good understanding of when they stutter and why it happens, it is a mystery and can’t focus on things to change it

beliefs and attitudes about stuttering, communication and themself

can impact quality of life

what are the two historical theories of etiology and therapy of stuttering?

structural problems caused by tongue or mouth issues\\therapy: dry out tongue, put pebbles in mouth, smoking, piercing nerves, surgery

symptom of psychological pathology (1920-1960)

etiology: psychosexual conflict, repressed need\\therapy: talk about childhood

when thinking about etiology, ask yourself these questions?

What causes some people to be at greater risk for stuttering than others?

What causes a person to begin stuttering?

What causes a person to continue to stutter? (focus on these factors as an SLP)

Theories of stuttering can focus on etiology (explaining why this stuttering occurs altogether) or _______________.

stuttering moments (explaining this particular moment of stuttering)

a complete theory of stuttering must account for…

stuttering from normal nonfluency

patterns near stuttering onset and during development

conditions where stuttering is lessened and worsened

onset between 2 and 4

spontaneous recovery

what are the organic/biologic theories to explain stuttering?

cerebral dominance

genetic

neurophysiologic

what is the cerebral dominance theory?

believed there was lack of speech and language dominance in the left hemisphere

thought this was because of changing handedness causing disorganization in neural impulses but fell out of favor in 1940s

overall theory about language dominance continued on

what is the genetic theory?

believes environment doesn’t matter and we are our genes

unable to identify single gene but 5 gene mutations have been identified to be related to stuttering

stuttering may be attributable to genetic factors 50% of the time

higher concordance of stuttering in identical vs fraternal twins

T/F Children learn to stutter from their parents who stutter.

False

what is the neurophysiologic breakdown theory?

shows there are functional and structural differences in people who stutter- don’t know if they are at birth or if they are present because it is a person who has lived with stuttering

what are the functional differences in the brains of people who stutter compared to those who don’t?

increase right hemisphere activation and decreased left hemisphere activation

less activation in Broca’s area

more activation in right SMA, left primary auditory cortex, cerebellum

what are the structural differences in the brains of people who stutter compared to those who don’t?

integrity of white matter tracts different between those who stutter and those who don’t

How do the learning theories explain stuttering?

stuttering is learned behavior caused by the environment

brain changes based on what you experience

classical conditioning: phone ringing causes stuttering

operant conditioning: secondary behavior gets you out of the stutter

what are the learning theories that explain stuttering?

diagnosogenic

anticipatory-struggle hypothesis

what is the diagnosogenic theory?

believe children learn to have anticipatory struggle reactions to their speech by the overreaction of their parents

stuttering is in the ear of the parents

caused by parents inaccurate labeling of child’s normal nonfluencies as stuttering

theory persists when parents/SLPs think they are going to make it worse or feel guilty they did something to cause it

what is the anticipatory-struggle hypothesis?

believe stuttering develops when child experiences frustration and failure when trying to talk leading to struggle behaviors

reaction to stuttering makes it worse and more severe

external environment not considered

what are the neuropsycholinguistic theories?

covert repair hypothesis

How do the neuropsycholinguistic theories explain stuttering?

believes there is an underlying deficit in language production

subtle linguistic processing differences

stuttering emerges between 3-5 years which is when they are developing language

A complex linguistic task results in ________ disfluencies.

more

what is the covert repair hypothesis?

belivies stuttering and normal disfluencies result from errors in internal monitoring process to check what we are about to say is what we intend to say

causes pre-articulatory, syntactic, lexical and phonological errors they are attempting to repair covertly

prior to output, brain is trying to correct the error

prolongations: phonological, repetitions: syntactic, blocks: lexical

what are the multifactorial theories to explain stuttering?

demands and capacities model

what is the demands and capacities model?

believes capacities of individual and internal and external demands impacts the development of stuttering

helps to explain and predict cycles of fluency

demand high + capacity low = stuttering

demand low + capacity high = no stuttering

demand = capacity = no stuttering

what are capacities in the demands and capacities model?

inherent characteristics of individuals that influences how they respond to different situations

linguistic, motoric, emotional, cognitive capacities

what are demands in the demands and capacities model?

external and internal environmental demands

internal demand for perfectionism, need to say complex thought, interaction style

what factors influence onset and recovery?

age, gender, family history

T/F: general physical development/milestones influences stuttering recovery.

false

T/F: severity at onset is not related to recovery.

true

how is age related to onset and recovery?

onset occurs between 2-4

75-80% will recover between 2-4

older child gets, less likely they will recover

spontaneous recovery/transient stuttering happens with young children

how is gender related to onset and recovery?

in general, more males stutter than females

over time, more females recover from stuttering

how is family history related to onset and recovery?

about 50% of CWS have family member(s) who stutter

those with family history more likely to continue to stutter and especially more likely if family history is of persistent stuttering

how is language development/ability related to onset and recovery?

onset usually during rapid language development (could be related)

language abilities do not predict recovery

how is speech sound production related to onset and recovery?

stuttering preschooler with delayed speech sound production is at greater risk for persistent stuttering

how is time since onset related to onset and recovery?

longer child stuttered for, less chance they will recover

if stuttering for more than 6 months, clinicians become concerned

what are typical reactions from parents?

may think it is associated with shock or fright/emotional or communicative conflicts

may ignore it

may communicate embarrassment and influence their child

may give advice to child that is harmful

continuum of emotions- concerned vs not concerned

what would you tell a parent who’s child is stuttering?

pay attention to what they are saying not how they are saying it

monitor how you react to their speech and try to maintain neutral demeanor

If a child has delayed language, they are likely to have __________ disfluences.

more

not stuttering

increases in typical disfluencies happen around ages

2-5

what are characteristics of typical disfluency?

effortless repetitions of words and syllables

no tension

not aware of disfluencies

when do changes in disfluencies occur?

18 months-3 years: repeating sounds, syllables, words, part words, no blocks or prolongations

3-7 years: part words repetitions decrease, repeating words and phrases increases

When differentiating normal disfluency from stuttering, think about…

types of disfluency, frequency and duration