Fripty Study Bundle SLP Set 11 - Student Developed - Fripty Approved

What is the Hodson Cycles Approach for SSD?

For severe kids. No drill.

Each sound is targeted for a set time, then next week another sound is targeted.

In a session, you review the previous sound, do auditory bombardment, activities with new words, play break, more activities, auditory bombardment.

What is fluent speech characterized by?

It's produced with relative ease, easy flowing, smooth, continuous, relatively rapid, normally rhythmic, free from excessive amounts of disfluencies

How is stuttering defined in terms of non speech behaviors? (3)

It is defined as anticipatory, apprehensive and hypertonic avoidance reactions (when a child learns to avoid speaking or avoids certain audiences). Anticipating struggles and becoming apprehensive.

It is also defined by what a person does to avoid stuttering.

It is also defined by a conflict with social roles. These individuals feel comfortable speaking with pets or children, but get nervous talking to their boss, for example.

How is stuttering defined in terms of unspecified behaviors?

This definition defines stuttering as a moment or event that is recognized by an expert. It does' specify behaviors or actions.

How is stuttering defined when limited by certain types of disfluencies?

Some people define stuttering as only part word repetitions and prolongations and not interjections or pauses.

How is stuttering defined in terms of psychopathology?

Some believe that stuttering is a result of a neurotic reaction.

How is stuttering defined based on all types of disfluencies?

Some people define stuttering by frequency and duration of disfluencies, and they include all disfluencies.

How is stuttering defined based on etiology?

Some say that stuttering is the result of fluency failure that is a result of classically conditioned negative emotions.

Some also say that stuttering is the result of cerebral dominance theory, which states that those who stutter are less likely to have developed unilateral cerebral dominance.

What are repetitions?

part, whole, phrase. ---Part: s-s-s-s-s-saturday

Whole: could-could-could

Phrase: I am-i am-i am

What are sound prolongations?

llllllllllike mmmmmmmmmommy

What are silent prolongations?

An articulatory posture that is held for a duration longer than average but with no vocalization

What are interjections? sound/syllable, word, phrase

um

like

you know

What are broken words?

silent intervals within a word. be [pause] fore

What percentage of disfluencies must there be in speech for it to be considered dysfluent?

about 5%

Incidence vs prevalence

Incidence is the rate of occurrence in a specified group of people. usually studied in longitudinal method

Prevalence is determined by counting the number of individuals who currently have it. usually done by cross-sectional.

What is the general prevalence of stuttering in the US?

around 1%

What is the gender ratio of stuttering?

More common in males.

What is the family prevalence of stuttering?

Family prevalence is higher than in the general population.

What is the prevalence and concordance rates in twins for stuttering?

Concordance rate is higher for identical twins. About 30-80%

What two factors play a role in the etiology of stuttering?

genetic factors predispose individuals to stutter and environmental factors may trigger the disorder

What is natural recovery in terms of stuttering?

When it disappears without professional help.

What does the onset of stuttering look like?

---At the onset, repetition of whole words and syllables is common. Children are usually dysfluent on function and content words. As the child develops they'll shift to mainly stuttering on content words. In later childhood and adolescence, situational fears and avoidance and increased muscular tension emerge.

What are some secondary behaviors/associated motor behaviors with stuttering?

Excessive muscular effort

Various facial grimaces

Various hand/foot movements

Rapid eye blinking

Knitting of the eyebrows

Lip pursing

Rapid opening and closing of the mouth

Tongue clicking

The type and amount varies

What are some associated breathing abnormalities with stuttering?

Speaking on inhalation

Holding breath before talking

Continued attempts to speak even when air supply is exhausted

Interruptions of inhalations by exhalations

Rapid and jerky breathing

Tensed breathing

Exhaling puffs of air during speech

What are some negative emotions/avoidance behaviors associated with stuttering?

Anxiety

Apprehension about stuttering

Fear of certain speaking situations

Frustrations in efforts to communicate

Sense of humiliation

Avoidance

What does the loci of stuttering refer to?

It refers to the locations in a speech sequence where stuttering are typically observed

What loci of stuttering are most likely to occur?

With consonants rather than vowels.

On first sound/word.

On longer words.

On less frequently used words.

On content words.

What's the big difference between adults and preschoolers who stutter in terms of when they stutter?

Preschoolers stutter more on function words because at that age, that's typically how they start their sentences.

What is the adaption effect in stuttering?

Controlling the stimulus can help promote fluency. Reading a passage over and over limits stuttering. Limiting the time between reading the passage also limits stuttering. Silent reading does not help with adaption.

What is the consistency effect in stuttering?

It refers to the occurrence of stuttering on the same words upon repeated reading. The consistency effect is presumed to be an indicator of the strength of the stimuli that evoke stuttering.

What is the adjacency effect in stuttering?

It refers to the occurrence of new stuttering on words that surround previously stuttered words. For example, have the individual read a passage, then conceal the words they stutter on, and have them read it again. They will most likely stutter on words that are adjacent to those blotted out.

What is the audience size effect in stuttering?

It refers to increased frequency of stuttering with an increase in audience size. There is a marked decrease in stuttering when there is no audience and when an individual is talking to themselves.

What has research found in terms of people who stutter and their families?

There is no distinct personality related to stuttering

They are not clinically maladjusted

They are not clinically anxious

Their parents don't have any distinct personality traits, but may exhibit somewhat higher standards of behavior and be somewhat more critical, but not clinical significant.

What is the genetic hypothesis of stuttering?

There is a higher prevalence in persons with persistent stuttering than in those who recover from it. There is a well established gender ratio. Higher concordance rate in identical vs fraternal twins. Some genes found that are linked to stuttering, but no consensus. There is no evidence for a simple inheritance, but its suggested that there may be some genes that predispose you.

What is the neurophysiological hypothesis of stuttering?

Basically states that people who stutter have an abnormal neuromotor organization. Under this hypothesis is the laryngeal dysfunction hypothesis, which states that there is something aberrant with laryngeal functions.

What evidence supports the laryngeal dysfunction hypothesis of stuttering?

slightly delayed voice onset time

increased tension in the laryngeal muscles

aberrant muscle behavior (simultaneous activation of adductors and abductors)

excessive laryngeal muscle activity

What evidence supports the notion that there is potential brain dysfunction in people who stutter?

They don't have a dominant hemisphere which causes confused neuromotor control

Electrocephalographic studies show some abnormal brain waves (but some don't. so weak evidence)

Central auditory function may be a factor. weak evidence.

Auditory feedback problems

What is the stuttering as operant conditioning belief?

Believe that frequency of disfluencies may be reduced or altered by consequences

What is the stuttering as avoidance behavior belief?

Johnson. When disfluencies are punished, they develop anticipatory, apprehensive and hypertonic avoidance reactions. Stutters are normals but negative behaviors turn them into true stutters. This theory is not supported though.

What is the stuttering as approach-avoidance belief?

Sheehan. People want to approach speaking situations but have an equally strong desire to avoid them. When the want to speak is stronger, they speak fluently. When the want to avoid is stronger, they don't speak at all. When it's equal, they stutter.

What is the stuttering as a reaction of tension and fragmentation belief?

Bloodstein believes that stuttering is a response to tension and fragmentation in speech. Believes it comes from severe communication pressure that leads to repeated communicative failures. AKA anticipatory struggle hypothesis

What is the stuttering due to demands that exceed capacities belief?

The belief that stuttering results when a child faces demands for communication that they cannot meet because of limited capacities.

What is the stuttering as a form of psychoneurosis belief?

The belief that stuttering is due to an underlying psychopathology.

How do you conduct a stuttering assessment?

Do the basics:

Hearing screening

Orofacial exam

Detailed case history

-onset of stuttering and the context

-familial prevalence

-earliest stuttering behaviors

-prior services

-prior treatments/how effective

-current education/occupation

-general health

-language and speech development

Assessment of frequency and types of disfluencies

-Record conversation

-Record oral reading sample

Assessment of variability of stuttering

-Have client or caretaker rate different speaking situations

-Obtain reports from parents

-Obtain speech samples from different settings

Assessment of motor behaviors

-Taking notes/observation

-Ask parent

Assessment of avoidance behaviors

-Taking notes/observations

-Ask client/family

Assessment of rate

-count number of words per minute in various samples

Assessment of negative emotional reactions

-Have client list them out

-Administer S-Scale and Behavior Assessment Battery

-Ask family

Assessing severity

-Calculating percentage

-SSI

What are some comprehensive assessment instruments for individuals who stutter?

Behavior Assessment Battery for School-Age Children Who Stutter

Overall Assessment of the Speaker's Experience of Stuttering

How do you diagnose stuttering?

Disfluency rate of more than 5%

A certain frequency of part word, prolongations and broken words (about 2%)

Excessive duration of stutter (1 second or longer)

What are psychological methods of treatment for stuttering?

Discuss the psychological problems associated with stuttering

Discuss feelings, emotions, and attitudes

What are fluent stuttering methods of treatment for stuttering?

Van Riper. Aka "stutter-more-fluently" approach. Goal is not achieving normal fluency, but less abnormal stuttering.

1. Teaching stuttering identification: client identifies their stutter and associated problems

2. Desensitizing: the client is encouraged to be open and honest about stuttering. do voluntary stuttering to desensitize.

3. Modify stuttering: face feared words/situations without fear, use cancellations (pausing and saying again), pull outs and prepatory sets (changing manner of stutter)

4. Stabilize treatment gains: encouraged to use strategies in all situations

5. Counseling the client: gaining realistic and accepting views

What are fluency shaping methods of treatment for stuttering?

Aka "speak-more-fluently" approach. It teaches strategies to achieve fluency. Different programs emphasize different aspects.

Teach airflow management

Teach gentle, soft, relaxed, easy onset beginning after exhalation

Reduced rate of speech through syllable prolongation with continuous phonation

After stutter-free speech is stabilized, introduce normal intonation, rate and intensity to normalize speech

Teach maintenance strategies

What is the fluency reinforcement method for stuttering treatment?

Generally for young children.

1. Arrange a relaxed therapy setting

2. Evoke speech with books, toys, materials, etc

3. Positively reinforce child for fluent utterances

4. Frequently model slow,

relaxed speaking

5. Reshape normal prosody

What are masking and delayed auditory feedback techniques for stuttering treatment?

When a person who stutters hears their speech with a fraction speech delay, several disfluencies are reduced. Similarly with masking.

What is the pause-and-talk method for stuttering?

Also called time-out. Pause after each disfluency and then resume talking.

The clinician says stop when they stutter and avoids eye contact for 5 seconds. Then they reestablish and maintain eye contact, smiling for fluent speech

What is the response cost method for stuttering?

For every instance of stuttering, the clinician takes away a token. Bunches are given beforehand or they get it for every fluent production.

What do you do to generalize and maintain stuttering strategies?

Introduce unfamiliar people into the session

Family members can be involved in therapy to help reinforce

strategies at home

Client taken out of clinic

Self monitoring skills

What are some common etiologies for neurogenic stuttering?

CVA

Extrapyramidal disease, like Parkinsons

Drugs

What are some characteristics of neurogenic stuttering?

Evidence of neuropathology

Adult onset of stuttering

An increased rate of stuttering

Repetitions on medial, final syllables (unlike childhood)

Few motor behaviors

No adaption

Minimal effects with delayed onset, masking, choral reading, shadowing, rhythmic speech

No anxiety or word fears

How do you assess neurogenic stuttering?

Assess potentially coexisting aphasia, apraxia, dysarthria or dementia

Stuttering assessment for normal stutters

Differential evaluation of features seen in early childhood stuttering vs neurogenic

What is cluttering?

A disorder of fluency characterized by rapid but disordered articulation, with possibly high rates of disfluencies and impaired prosodic features

unintelligible speech

excessive amounts of disfluencies

improved articulation and intelligible with slower rate

omission and compression of sounds and syllables

jerky or stumbling rhythm

monotonous tone

spoonerisms (many thinkle peep)

disorganized language production

lack of anxiety or negative feelings