second and third lecture (week 2)

the number of all cases currently identified (even if they did not begin recently)

prevalence

Ex. Ear infections – the current number of 6 month old babies that have ear infections within a certain facility at a certain point in time

prevalence

Prevalence data will shift with _____ and ____

age of the population being surveyed and time

Ex. Ear infections are more prevalent in younger vs. older children AND ear infections are more prevalent in the winter months than in the summer months.

prevalence shifting with age and time

the probability that new cases of any disorder will develop over a period of time…

incidence

Ex. Most people have had at least one ear infection in their life…

incidence

the number of all cases ever exhibited of a disorder whether currently or in the past (even if they recovered).

lifetime incidence

how are the terms incidence and prevalence problamatic

even in the literature authors confuse the two terms and use them incorrectly…authors have used the word incidence when they really mean prevalence…..yes nice and confusing for all……

they can be inaccurate becuase of how they measure the data

The TRUE frequency of incidence and prevalence data for stuttering cannot be appreciated unless what?

all cases that exhibit properly diagnosed stuttering even if for a short time are counted

Which one is greater? I or P?

Sample of 100 children – includes CWS and NFC

duration (Ex. A one year span between the ages of 5 and 6 years old)

If you measure I and P between year 6 and 7 of life for a sample, the likelihood that only new stuttering cases would develop within that one year span (incidence) would be lower than the prevalence of the disorder found in your sample (the number of cases of stuttering currently in your sample) – in this case P would be greater then I

Which one is greater? I or P?

Sample of 100 children – includes CWS and NFC

Incidence of stuttering over the lifespan

If you measure the chance the sample of 100 could develop stuttering at some point in life that would be greater than the number of cases of stuttering you measure in the 100 children sample. In this case I would be greater than P.

Why is I and P data important for theory and research?

it is critical to design research studies

ex. when making a study, there should be more males because it is more representative of the gender ratio

Why is I and P data important for professional training?

curriculum for CSD is impacted because of the relatively small size of stuttering population

Why is I and P data important for clinical service delivery?

data more services are planned for younger children than adults

Why is I and P data important for public awareness and zoning?

diminished the public’s concern for fluency disorders and even contributed to ASHA’s temporary deemphasis of the disorder.

The risk of developing stuttering is __% over by the age of __ years old. (new dx of stuttering)

What is the chance of developing a stutter after the age of 4?

90%; 4

10%

Lifetime I estimate of __% - newborn risk of stuttering is __ in ___babies born

5%; 5 in 100

the gender data of stuttering across the lifespan

4:1 in favor of males

Stuttering is most prevalent in newborn boys, or girls? ( ____ in 100)

BOYS - 8 in 100 babies born

(girls- 2 in 100)

What is the chance of recovery, soon after stuttering onset?

75-80

If the child has been stuttering for two + years the chance of recovery falls to ___%

47%

Stuttering occurs more often in families who…

have a history of stuttering

What percentage of PWS have familial stuttering?

30-60

Family members have a ____ times higher risk of developing stuttering

3-4

Risk is higher for which relatives?

males

What percentage of NFS have familial stuttering?

10%

What is the strongest risk factor for developing stuttering?

AGE, stuttering tends to erupt during the preschool years

Why does stuttering prevalence decline with age?

As age increases, natural recovery does too

New stuttering onsets (acquired), however, are less frequent as age increases

Who stutters: The gender factor (ratios)

Childhood (near onset): 2.1 males to 1 female

Adulthood: 4 males to 1 female

Differences in brain regions between males and females who stutter (insula is correlated with stuttering unilaterally in males and bilaterally in females)

Stuttering has been documented in nearly all geographic areas of the world

Strong genetic factors in stuttering so there are higher prevalence data in certain sub populations where original founders exhibited stuttering – for example the Hutterites are a group where there is high intermarriage so a higher reported cases of stuttering (runs in the familiy)

Cross-culture stuttering findings are questionable due to “methodological problems” (what are these problems)

Certain cultures/geographic regions have been studied more than others

The ways in which disfluencies/multilingual characteristics have been documented or identified may not be consistent across studies

A common belief: higher incidence of stuttering among which ethnicity because of some published studies?

African Americans

Recent research of preschoolers: no significant difference between which two ethnicities?

African Americans and European Americans

Currently there does not appear to be enough evidence to support that _______ tend to exhibit more stuttering than _______

African Americans; non African Americans

Fluency norms in other languages

To date few to none exist…

Difference between Spanish and ENG speaking stutterers

Spanish speaking children exhibited more polysyllabic word repetitions than what has been seen in ENG speakers (in spanish we doon’t count it as stuttering like, the children are doing this from emphasis not from a stutter)

is bilingualism a risk for stuttering

NO, No scientific evidence to date has found that bilingualism causes stuttering nor does it hinder chances for improvement during stuttering therapy.

We can differentiate typical vs. atypical disfluencies from paying attention to what? this is true for who as well?

tension and the presence of secondary behaviors (very physical)– true for bilinguals that stutter as well

how is bilingualism and fluency complicated in our job?

we have to parse apart language dominance and observe how and how frequent a bilingual speaker is disfluent in each of their languages

the literature has found conflicting results for differences between rates of stuttering in either the dominant vs non-dominant language

It is believed that stuttering like disfluencies occur more in the dominant language or the non-dominant language?

non-dominant language

Latino cultures tend to view stuttering as a product of __________

studies surveying Latino parents have shown that they are less likely to be…

psychological maladjustment

actively involved in home programming because they feel it is the school’s responsibility to treat such issues

assessment considerations

• Take disfluency counts in both languages

• Evaluate and differentiate non-stuttering like vs stuttering like disfluencies to see if you see any patterns, look for secondary behaviors

• If evaluating a SPN-ENG speaking child, PSW’s (polysyllabic words) may appear more as repetitions

• Consider language dominance – some feel strongly that more stuttering like disfluencies occur in the non dominant language

• Oral narrative samples, conversation samples, parent interaction samples if possible

Is there a link between audition and fluency issues?

Yes, there is a low incidence of stuttering among the hearing impaired

Informal reports for stuttering and hearing impairment: more ______ than _______ among the deaf

manual disfluency (ASL); oral disfluency

Stuttering occurs infrequently in the literature in individuals that have _______ and/or ______ speech

a cleft lip/palate and hypernasal speech.

Stuttering occurs infrequently in individuals with a cleft lip/palate and hypernasal speech, this can be due to..?.

Slower speech induced by these physiological challenges. Slower speech is related to more fluent speech.

a high incidence of stuttering among those with ______ impairments

cognitive

Children with Down syndrome have a higher ______, but show low ______ to their stuttering

disfluency level; emotional reactivity

When someone is dx with stuttering, commonly, questions surrounding the onset of stuttering will arise.

When did the stuttering start?

How did it start?

Why is it important to consider the onset of stuttering?

Important to consider WHEN and HOW b/c:

1. children are influenced by their immediate environment

2. anatomical structures for speech are developing

3. speech and language skills are developing rapidly (for most children)

SO is it a true stutter? These considerations can help with dx and tx >>> speech therapy vs play based psychotherapy

Due to _____ during this sensitive time period, it is important for these to be taken into consideration into the possible role they play in the ______

caregiver roles; onset of stuttering.

In considering these 3 factors, theories regarding the ________ etc. as playing a part in the onset of stuttering are given a lot of attention.

home environment/parental demands on the child

These factors also contribute to theories regarding how stuttering may arise when demands ___ and ___ to the child exceed their developing _____, _____, and ______ capacities to produce fluent speech

internal and external; motor, linguistic and cognitive

Manner of onset questions

Does the stuttering occur quickly?

from one day to the next?

Or does it develop over time?

Quick duration?, duration in bursts? or does it persist?

Consideration of these factors is important tx selection..

Develop over time, persistent symptoms vs From 1 day to the next? Run a short course?

Develop over time, persistent symptoms: speech therapy

sudden onset: play based psychotherapy

Other developmental communication disorders such as ____ or ____, the child has not developed the skills they are “missing” or have not previously shown mastery of these skills yet.

DLD or phonological issues

There is often a significant ____ reaction to this loss as well as a reaction by the ____.

parent/caregiver; child

With stuttering, children often develop stuttering _____ they have shown the capacity for fluent speech – SO, there is often a significant change in their _____ and the LOSS of the ability to produce ______

AFTER; speech pattern; fluent speech.

Before the age of what does most stuttering start?

Most stuttering will start before the age of 5 years old.

What is the average range for the onset of stuttering?

16-60 months

What is the average range in months that children acquire stuttering

33.40 months

After what age is the onset of stuttering low?

9 yrs

Stuttering onset in adults is _____

RARE

Stuttering onset in adults is usually linked to a clear origin (what are the two reasons?

either an emotional trauma or brain damage.

Adult onset stuttering is distinguished from ______________ as the stutter developed in an adult likely has a different _______

developmental stuttering (stuttering that developed in childhood); etiology/cause.

TRUE/FALSE: Research shows that there is a greater gap in stuttering-like behavior between CWS and NFC than there is a gap between CWS and NFC producing typical disfluencies

True

in other words typical disfluencies appear in both. Atypical disfluencies not so common

What amount of repetitions are considered stuttering and not typical disfluencies?

Anything >2

About __ out of _ children that begin stuttering ( %) recover!!

4 out of 5 (80%)

what do you report?

number, type of dysfluency and extend (how many times it was repeated)

criteria for natural recovery

1) No stuttering present for a minimum of 12 months as judged by parent and clinician

2) Parental rating of stuttering severity of less than 1 on a 8 point case

3) Clinician rating stuttering severity less than 1

4) Stuttering like disfluencies to be less than 3 per 100 syllables

5) Maintain no stuttering for 4 years to demonstrate stability recovery

Risk for persistency: Primary factors

• Family History

• Gender

• Stuttering trends

• Duration of stuttering

• Age at onset

• Disfluency length

• Disfluency type; Prolongations/blocks

Family persistency/recovery percentage rates

65%

-children will follow the same trend

Which gender has a higher recovery rate?

Females

How is stuttering different from other clinical disorder that we may encounter as SLPs?

Stuttering is different from other disorders in that you have developed full fluent speaking abilities that are then lost due to the stutter whereas, with other disorders children still HAVEN'T developed the skills they are missing and therefore it's not as emotionally impacting because you don't realize what is missing.