typical disfluencies and the development of stuttering

there is not a clear mark between beginning stuttering and not

kids fluctuate based on presentation of behaviors

-there is always individual variability about when behaviors emerge

levels of stuttering include

-typical disfluency

-younger preschoolers: borderline stuttering

-older preschoolers: beginning stuttering

-school age: intermediate stuttering

-older teens and adults: advanced stuttering

subcategories of stuttering characteristics

-core behaviors

-secondary behaviors

-feelings and attitudes

-underlying processes

typical disfluency ages

1.5-6

-can extend into adulthood

younger preschoolers: borderline stuttering ages

1.5-3.5

older preschoolers: beginning stuttering ages

3.5-6

school age: intermediate stuttering ages

6-13

older teens and adults: advanced stuttering ages

>14

categories of typical disfluency

-multisyllable word repetition

-phrase repetition

-interjections

-revision-incomplete phrase

stuttering-like disfluencies

-part-word repetitions

-single-syllable/whole-word repetitions

-prolongations

-tense pauses

core behaviors typical disfluencies

frequency:

-6-10 dysfluencies for every 100 words spoken

-5 dysfluencies per 100 syllables

number of units per repetition:

-typical disfluencies and repetitions typically consist of only one extra unit

type of disfluency:

-interjections

-revisions

-whole-word repetitions

children who present with typical disfluencies generally do not present with

secondary behaviors

-no escape behaviors

-no avoidance behaviors

children who present with typical disfluencies rarely

-notice his/her disfluencies

-show evidence of frustration or embarrassment

factors that contribute to increases in typical disfluencies

-demands of language acquisition

-inefficient speech-motor control skills

-interpersonal family stress

-threats to security from such events as relocation, family breakup, or hospitalization

-ordinary daily pressures of competition and excitement while speaking

typical disfluencies summary

-no more than 10 disfluencies per 100 words

-typically one-unit repetitions: occasionally 2

-most common disfluency types are interjections, revisions, and word repetitions

-as children mature pat age 3, use of part-word repetitions will decline

younger preschool children borderline stuttering diagnosis

may be difficult at this age as the child may fluctuate between typical and borderline stuttering

borderline stuttering core behaviors

frequency:

-more than 10 disfluencies per 100 words

number of repetition units:

-more than one extra unit is a warning sign of borderline stuttering

types of disfluencies:

-sound and syllable reps

-single syllable word reps

-broken words

-prolonged sounds

in borderline stuttering the proportion of stuttering-like disfluencies relative to all disfluencies is

greater than half

there is no significant difference between children with typical disfluencies and borderline stuttering with respect to

the number of interjections, revisions, or incomplete phrases

broken words

when the phonation or airflow is abnormally stopped within a word

children who present with borderline stuttering generally do not present with

secondary behaviors

-no escape behaviors

-no avoidance behaviors

in children with borderline stuttering the degree of tension

may seem slightly greater than normal

borderline stuttering feelings and attitudes

children who present with typical disfluencies rarely:

notice them

show evidence of frustration/embarrassment

typical disfluencies and borderline stuttering have

a lot in common

-feelings and attitudes

-no secondary behaviors

factors that may contribute to the transition between typical disfluencies and borderline stuttering

neural speech and language-processing anomalies

-demands of speech and language development

-pressure from higher rates of speech

-more complex language

-competitive speaking symptoms

borderline stuttering summary

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 a child to react to their disfluencies

beginning stuttering core behaviors

qualitative changes

-repetitions begin to sound tense, rapid, and irregular

-increased tension

--marked by rising vocal pitch

types of disfluencies:

-blocks begin to replace repetitions and prolongations

rising pitch may first appear

towards the end of a string of repeated syllables

-over time will appear earlier in repetition

indications of increased tension include

intonation of speech

release of air

beginning stuttering secondary behaviors

earliest to emerge are escape behaviors

-maneuvers used to end a stutter and finish a word

-children may transition these maneuvers to before a moment of stuttering (avoidance behaviors)

-may include insertion of a filler

beginning stuttering feelings and attitudes

awareness of stuttering emerges

may be accompanied by feelings of:

-frustration

-fear

-helplessness

-lack of control

beginning stuttering underlying processes: classical conditioning

-when a child is disfluent they feel threatened, frustrated, or afraid which leads to rapid tense disfluencies that appear in beginning of stuttering

-with repeated pairings the disfluency results in increased tension and rate rather than the emotion

beginning stuttering underlying processes: operant conditioning

escape behaviors are

-negatively reinforced by reduction in frustration

-positively reinforced when the child is then able to complete their communication

this conditioning increases and maintains the use of escape behaviors

beginning stuttering underlying processes: avoidance conditioning

combines operant and classical conditioning

-using um or other filler or injector as a starter

-may emerge during beginning stuttering but becomes more evident in intermediate and advanced stuttering

beginning stuttering summary

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 muscles

4. escape behaviors are sometimes present in beginning stuttering (eye blinks, head nods, ums)

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

intermediate stuttering core behaviors

types of disfluencies

-repetitions and prolongations are still evident

--increased tension, rising pitch

-the frequency of blocks is a defining difference between beginning and intermediate stuttering

intermediate stuttering secondary behaviors

develop avoidances

-starters

-substitutions

-circumlocutions

-postponements

-antiexpectancy devices

-situation avoidance

intermediate stuttering feelings and attitudes

-children with intermediate stuttering have surpassed momentary frustrations and embarrassments

for children in the intermediate stuttering stage, stuttering is no longer an annoyance but

a serious problem

-has a seriously negative impact on children at this point

intermediate stuttering underlying processes

symptoms of intermediate stuttering result from the same conditioning processes that underlie those of beginning stuttering

-classically conditioned tension responses are more evident

-avoidance conditioning shapes stuttering behaviors

for intermediate stuttering, therapy must do two things to reduce avoidance

1. clinician must structure situations to help student learn that the moment of stuttering can be tolerated and fear can be reduced by resisting the impulse to push thru stutter

2. clinician should help student learn new behaviors to substitute for old avoidances

intermediate stuttering summary

1. 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

2. stuttering may be suppressed in some individuals through extensive avoidance behaviors

3. 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

4. emotions of fear, embarrassment, and shame are very strong. individual has negative feelings about themself

advanced stuttering

individuals whose stuttering has persisted into older adolescence and adulthood

-typically have a deeply ingrained pattern of core and secondary behaviors

-report that stuttering is a major player in their school, work, and social lives

advanced stuttering core behaviors

types of disfluencies

-repetitions, prolongations, and blocks all marked by tension

-blocks may be longer and display more struggle, associated with tremors

advanced stuttering secondary behaviors

many same word and situational avoidances in intermediate stuttering

-more extensive and refined

advanced stuttering feelings and attitudes

vary greatly

-for some negative feelings associated with advanced stuttering are exacerbated by their perceptions of how others view them

-for others they have become reconciled with stuttering

advanced stuttering underlying processes

older teen and adult stuttering is affected by higher-level, explicit learning

-individual has developed self-concept as an impaired speaker

advanced stuttering summary

1. most frequent core behaviors are longer tense blocks often with tremors of the lips, tongue, jaw. longer repetitions and prolongations

2. stuttering may be suppressed in some individuals with extensive avoidance behaviors

3. complex patterns of avoidance and escape behaviors characterize the stutterer. these may be very rapid and so well habituated that the stutter may not be aware of what he does

4. emotions of fear, embarrassment, and shame are very strong. individual who stutters has negative feelings