SHS 716: Stuttering Final

Which spelling is preferred: disfluency or dysfluency?

disfluency

What refers to an interruption of normal speech?

disfluency

What three factors distinguish normal disfluencies from stuttering-like disfluencies?

the type of disfluencies, frequency (less than or more than 10), number of units of repetitions

What are the three core behaviors of stuttering?

repetitions, prolongations, blocks

Which core behavior involves the sound or airflow continuing, but the moment of the articulators stopping?

prolongations

Which core behavior is when the single-syllable or part-word repetitions occur?

repetitions

Which core behavior is the inappropriate stoppage of airflow or voicing? movement of articulators may also be stopped)

blocks

What is the sex ratio of stuttering?

1:1 at onset, 3:1 later (more common in boys; girls are more likely to recover)

Stuttering most frequently occurs in which parts of speech in preschoolers? (locus of stutter)

pronouns and conjunctions

How does the locus of stuttering differ for people diagnosed with neurogenic stuttering?

stuttering occurs on function words as well as content works, and is not restricted to initial syllables in words

What are examples of fluency inducing conditions/situations?

talking to animals or babies, talking alone, singing or talking with a rhythmic tone

What are examples of a fluency inducing environment?

using a slow rate of speech, using non-directive speech, using simple syntax

What are the 8 factors of stuttering?

1. developmental

2. genetic/hereditary

3. environmental

4. congenital

5. sensorimotor

6. emotional

7. language

8. brain structure and function

What are some predictors of early recovery?

being female, being right-handed, having relatives who recovered from stuttering, having a more advanced speech motor system

What attributes can cause a child to have a smaller chance of recovery?

having relatives with a persistent stutter, being male, onset happening after 3.5 years, stuttering not decreasing during first year, multiple unit repetitions, continued presence of prolongations and blocks, and below normal phonological skills

Children who stutter are more likely to have ______________.

relatives who stutter

What did we discover from twin studies?

that genetics play a big role in stuttering: identical twins had a greater concordance of stuttering

What did we discover from adoption studies?

that environments also have a role in stuttering

Does delayed auditory feedback help or hinder people who stutter?

help: auditory feedback integrated with proprioceptive and other muscle feedback helps pws discover errors in their motor commands and adjust to the new dimensions of the speech tract

Does delayed auditory feedback help or hinder typically fluent people?

hinder: it can create an artificial stutter

What age does the onset of stuttering usually occur?

2-3.5 years old

During what period of development does the onset of stuttering usually occur?

during periods of rapid language acquisition

Who theorized that emotions located in the brain's right hemisphere might interfere with the timing in the left brains of people who stutter?

Kent

Who theorized that stuttering is a disruption of timing of muscle sequencing?

Van Riper

Which theorist suggests that in many cases stuttering begins when a child finds talking difficult (communicative failure and anticipatory struggle theory)?

Oliver Bloodstein

Which theorist suggested that stuttering is caused by parents overreacting to normal disfluencies? (diagnosogenic)

Wendell Johnson

What is Sheehan, Andrews, and Starkweather's theory of capacities and demands?

the theory that stuttering emerges when the child's capacities for fluency are overwhelmed by demands (motor skills, demands from parents, teachers, or even oneself)

What is an example of classical conditioning?

associating stuttering with talking in front of a crowd

What are the components of classical conditioning?

unconditioned stimulus, unconditioned response, conditioned stimulus, conditioned response

What is an example of operant conditioning?

associating a secondary behavior (like eye blinks) with getting out of a stutter

What are the components of operant conditioning?

positive reinforcement, negative reinforcement, and punishment (reinforcement causes an increase in the target behavior, while punishment causes a decrease in the target behavior)

What is avoidance conditioning?

a mixture of both classical and operant conditioning

Trying to eliminate a learned fear is the basis for what?

avoidance conditioning

What differentiates stuttering from typical disfluencies?

-typical disfluency: no more than 10 disfluencies per 100 words, typically one-unit repetitions, most common are interjections, revisions, and whole word repetitions

-stuttering: more than 10 disfluencies per 100 words, multiple unit repetitions, most common are part-word repetitions (initial syllable)

What is a sign of stuttering that includes tension in reaction and pauses before the disfluencies occur?

secondary behaviors

What are the types of secondary behaviors?

escape and avoidance

What are possible feelings and attitudes that can accompany stuttering?

feelings of fear, embarrassment, or shame, as well as attitudes of an overall negative feeling about oneself

What are characteristics that a clinician should have?

empathetic, positive, genuine, charismatic

What are the two levels of good assessment?

1. careful planning, observation, and analysis

2. trying to understand the whole person or family

What are the components/goals of assessment?

collecting objective data, reaching subjective conclusions, addressing emotions and attitudes

How do we count stutters?

divide the total number of stutters by the total number of syllables

How do we record speech/language samples of people who stutter?

video and audio

How many syllables are required in a speech-language sample for a person who stutters?

300-400 conversationally, at least 200 reading (passage must be below clients reading level)

How do we assess stuttering severity?

- it is a reflection of the overall perception by listeners

-take into account frequency, duration, physical reactions, secondary behaviors

-tools used: SSI-4, Scale for Rating Severity of Stuttering, Severity Rating Scale for Parents of Preschoolers, and Test of Childhood Stuttering

What are the 4 features of the SSI-4?

1. frequency

2. duration

3. secondary behaviors

4. scores from these three components are summed to produce total overall score

When do we interview and do trial therapy for school-aged children?

during assessment

What can trial therapy during a student interview consist of?

-have student catch the clinicians pretend stutters

-have student put in pretend (or real) stutters, and have clinician catch student and reward them

-have student control the length of clinician's pretend stutters

-roles reverse: clinician signals student to make stutter longer and end it slowly and loosely

-can student hold onto stutter, reduce tension, and release stutter slowly with the clinician's coaching? on their own?

What is the purpose of an interview for an adult client who stutters?

figuring out why they are here

What is important during an evaluation of an adolescent?

-parents do not have to be involved in child's interview

-convey sincere acceptance of family's viewpoint and concerns

-give family opportunity to express their concerns and emotions and to get their view of the adolescent's stuttering

-give some time for adolescent to express views and feelings privately

What are the possible outcomes of a preschool assessment?

-watchable waiting

-indirect or direct treatment

-no treatment

When analyzing a preschool speech sample, what are we looking for?

-tension

-frequency of stutter

-type of stutter

-typical disfluency vs stuttering

What is cluttering?

rapid bursts of dysrhythmic, unintelligible speech

What typically causes neurogenic stuttering?

neurological disease or damage (TBI, tumors, Parkinson's disease, drug toxicity)

How is neurogenic stuttering different from developmental stuttering?

-different locus (final parts of words instead of initial)

-later age of onset

-few secondary symptoms (if they do show secondary behaviors it is usually mild)

How is psychogenic stuttering different from developmental stuttering?

-later onset (typically teens or later)

-typically appears after stress or trauma

-may be accompanied with unusual secondary behaviors

How do people with psychogenic stuttering react to fluency inducing conditions/environments?

it has the reverse effect: causes them to stutter more

How do people with psychogenic stuttering typically react to direct trial therapy?

it is very effective

What is the Lidcombe Program?

-a fluency shaping program

-ages 3-6

-goal is to eliminate stuttering

-focuses on behavioral feedback provided in response to a child's fluent speech (5 praises to every 1 criticism)

-parent provides therapy

-severity scale is used

-therapist teaches parent to calibrate ratings so that they are similar