[SLP10415] Normal Fluency and Development of Stuttering

Core behaviors

• Describe the basic speech behaviors of stuttering: repetitions, prolongations and blocks

• Behaviors that seem involuntary to the person who stutters, as if out of their control

Secondary behaviors

• A speaker's reactions to his or her repetitions, prolongations, and blocks, in an attempt to end them quickly or avoid them altogether 

• These reactions may begin as random struggle but soon turn into well-learned patterns

• Can be divided into two broad classes: escape and avoidance behaviors

Feelings and attitudes

• Feelings may precipitate stutters, just as stutters may create feelings

• Attitudes are feelings that has become a pervasive part of a person’s beliefs

• For every developmental stage, there are changes in terms of behaviors

• Feelings may precipitate stutters, just as stutters create feelings 

Underlying processes

• These are speculations about the process that may cause disfluencies or stuttering at each developmental level.

• These processes explain why symptoms may change from level to level. Why stuttering often changes from borderline to beginning to intermediate to several levels

• Help us understand the nature of the symptoms, as well as the rationales for the treatment for stuttering

Repetitions

• mostly observed most frequently among children who are just beginning to stutter and are simply a sound, syllable, or single-syllable word that is repeated several times

• Speaker is “stuck” on a sound and continues repeating it until the following sound can be produced

Single syllable repetitions and part word repetitions

More common core behaviors in early stutterers

Multisyllable repetitions

More common core behaviors in advance stutterers

Prolongations

• Usually appear later than repetitions; although may be present at onset

  • Wait a little until they finish

• Denote stutters in which sound or airflow continues but movement of the articulators is stopped

• As short as half a second may be perceived as abnormal, but in core cases, they may last as long as several minutes (Van Riper, 1982)

Blocks

• Typically the last core behavior to appear; as with some, blocks may be observed at or close to stuttering onset

• Occur when a person inappropriately stops the flow of air or voice and often the movement of articulators, as well

• May involve any level of the speech production mechanism – respiratory, laryngeal, or articulatory

Longer and more tense

As stuttering persists, blocks grow ____ and ___ _____

Escape behaviors

• speakers attempt to terminate stutter and finish the word

• Happens during the stutter

• Common examples are eye blinks, head nods and interjections of extra sounds, such as “uh” which are often followed by the termination of a stutter and are therefore reinforced

  • reinforced - since it's their mechanism to terminate, if they see it as successful, uulitin ang behavior — everytime they do an escape behavior, it is reinforced

Avoidance Behavior

• A speaker’s attempt to prevent a stuttering when he or she anticipates stuttering on a word or in a situation 

• To avoid the stuttering event

• It usually happens before the stutter

• Word-based avoidances are commonly eye blinks, interjections of extra sounds, like “uh,” said before the word on which stuttering is expected

• Changing the word PWS was planning to say

Feelings

Emotions they would feel because of stuttering

Attitudes

• A feeling that has become a pervasive part of a person’s beliefs

• Adolescents and adults usually have negative ____ about themselves that are derived from years of stuttering experiences

• A person who stutters often projects his attitudes on listeners; sometimes, listeners may contribute to the person’s attitudes

Normal Disfluency, Borderline Stuttering, Beginning Stuttering, Intermediate Stuttering, Advanced Stuttering

Developmental Levels of Stuttering

Part-word repetition, single-syllable word repetition, phrase repetition, interjection, revision-incomplete phrase, prolongation, tense pause

8 common core behaviors in normal disfluency

Amount of disfluency

•  often measured as the number of disfluencies per 100 words or syllables, rather than “percent disfluency”

• number of units of repetitions and interjections, and the type of disfluency, especially in relation to the age of the child

Average number of disfluencies in normal disfluency stage

7 to 10 disfluencies per 100 syllables

One extra unit

Number of units that occur in each repetition in normal disfluency stage

Core behaviors: Normal disfluency stage

Interjections, revisions, whole-word repetitions

After 3 years of age

Interjections usually decline at what age?

Secondary behaviors: Normal disfluency stage

• Generally has no secondary behaviors

• Some studies suggest some “tense pauses” but not as a reaction to their disfluencies  

• No awareness = no reactions

Feelings and attitudes: Normal disfluency stage

• Rarely notices their disfluencies; not aware, no concern

• A typically developing child who repeats, interjects or revises usually continues talking after a disfluency without evidence of frustration or embarrassment

• None at this age

Underlying processes: Normal disfluency stage

Stresses of speech/language and psychosocial development

Core behaviors: Borderline stuttering

• 11 or more disfluencies per 100 words

• Often more than 2 units in repetitions

• more repetitions and prolongations than revisions or interjections

• Disfluencies are loose and relaxed 

• No tension during stuttering

Secondary behaviors: Borderline stuttering

• None at this age

• Rare for child to react to disfluencies

• No secondary behaviors observed

Feelings and attitudes: Borderline stuttering

• None at this age 

• Generally not aware of stutter

• May occasionally show momentary surprise or mild frustration

• It does not affect the feelings and attitudes

Underlying processes: Borderline stuttering

Stresses of speech/language and psychosocial development interacting with constitutional predisposition

Average mount of disfluencies in borderline stuttering

11 or more disfluencies

Repetitions in borderline stuttering

Likely to repeat units more than once in many of their part-word and monosyllabic word repetitions and prolongations than multisyllabic word and phrase repetitions, revisions, and interjections

Core behaviors: Beginning stuttering

• Rapid, irregular and tense repetitions may have fixed articulatory posture in blocks

• Repetitions become more rapid and tensed

Secondary behaviors: Beginning stuttering

• Escape behaviors such as eye blinks, increases in pitch, or loudness as disfluency progresses

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

Feelings and attitudes: Beginning stuttering

• Aware of disfluency, may express frustration

• Presence of tension

• No strong negative feelings about self as a speaker

Underlying processes: Beginning stuttering

• Conditioned emotional reactions causing excess tension; increase in muscle tension and tempo

  • They start to anticipate the difficulty

• Reflect the extra muscular effort that emerges when they anticipate difficulty 

• As a child’s attempt to control sound-syllable repetitions 

• child’s sensitivity to stress, which may result to frustration, triggering tension responses

• Instrumental conditioning resulting in escape behaviors; effects of learning on stuttering

Core behaviors: Intermediate stuttering

• Most prominent feature are blocks, in which sound and airflow are shut off

  • May repetitions and prolongations but not that prominent

• Stopping airflow

Secondary behaviors: Intermediate stuttering

• Presence of both escape and avoidance behaviors

  • Because of the increase of cognitive development 

  • Aware na what’s happening

• compares self with peers

Feelings and attitudes: Intermediate stuttering

feelings of fear frustration embarrassment and shame

When feelings and attitudes occur

• Fear happens: before 

• Frustration: During

• Embarrassment and shame : after

Underlying processes: Intermediate stuttering

• Conditioned emotional reactions causing excess tension

  • They would encounter bullies, classmates who would react negatively

• Instrumental conditioning resulting in escape behaviors

• Avoidance conditioning

  • see an avoidance behavior as effective, then reinforced, then conditioned — does it more often because they know it’s effective

Avoidance conditioning

See an avoidance behavior as effective, then reinforced, then conditioned — does it more often because they know it’s effective

Core behaviors: Advanced stuttering

• Long, tense blocks

  • May blocks but more disturbing

  • More tensed and mahirap panoorin

• often with tremors of the lips, tongue, and jaw

• will also probably have repetitions and proongations

Secondary behaviors: Advanced stuttering

• Presence of both escape and avoidance behaviors

  • very habitual that is not noticeable

  • if not keen on observing, it’s not noticeable

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

Feelings and attitudes: Advanced stuttering

• Feelings of fear, frustration, embarrassment and shame are very strong

  • May nadagdag na BELIEF 

• Negative self-concept 

  • Treat themselves as dumb and incompetent

  • Negative feeling of self who is helpless and inept when he stutters

Underlying processes: Advanced stuttering

• Conditioned emotional reactions causing excess tension

• Instrumental conditioning resulting in escape behaviors

• Plus cognitive learning

Psychogenic stuttering

Presence of psychological trauma

Neurogenic stuttering

Acquired stuttering

Developmental stuttering

Stuttering during the early childhood