Unit 3 – Theories About Stuttering

Theory

Explanation of some phenomenon, why one person stutters and another does not, why one child recovers and the other doesn't, why a person stutters on some words and not others, why a person stutters in certain situations, why a person does things when they stutter

Hypotheses

Derived from a theory, Explains the important causal relationships in a phenomenon, Tested theory

Stuttering as a disorder of brain organization; Orton & Travis (1920's)

Lack of hemisphere dominance, Conflicts in speech control due to handedness, Creating neuromotor disorganization/speech mistiming, thus stuttering

Stuttering as a disorder of brain organization; Geschwind & Galaburda (1985)

Delay in left-hemisphere growth/development, MAY AFFECT SPEECH/LANGUAGE skills showing right hemisphere dominance/Found overdeveloped right hemisphere has overtaken undeveloped left hemisphere functions resulting in poor timed speech resulting in stuttering

Stuttering as a disorder of brain organization; Webster (1993)

Overactive right hemisphere/Overflow of right hemisphere activation may disrupt the supplementary motor area functions

Stuttering as a disorder of timing

Deficit in temporal programming/ Inappropriate localization of speech+language functions to right hemisphere/ Poor programming+ sequenced motor commands/ Results in poorly timed speech w/ disruptions; stuttering/ Emotions may also play role in timing disruption; Van Riper (1982), Kent (1984)

Stuttering as reduced capacity for internal modeling

Repetitions of beginning stuttering are deficit in ability to create/use inverse internal models of speech production system; desired word/phrase relayed to speech production system's internal inverse model; desired output entered as expected auditory/kinesthetic sensory code results; then inverts to generate motor control output; Stuttering results from inadequate neuronal resources to make necessary sensory-motor transformation for fluent speech

Stuttering as a language production deficit; Kolk & Postma (1997)

overt repair hypothesis; Stuttering occurs when the internal feedback system detects an error and tries to repair it; Results in the core stuttering behaviors (repetitions, prolongations, blocks)

Stuttering as a language production deficit; Perkins, Kent, and Curlee (1991)

Disfluencies are attributed to dyssynchrony of the "paralinguistic" and the linguistic components

Stuttering as a Multifactorial Dynamic Disorder

Anne Smith; (Multifactorial)many factors can result in stuttering;(Dynamic) outward signs of stuttering events seen as surface manifestations of ever-changing neurophysiological process underlying disorder

the three theoretical perspectives on developmental and environmental factors

Diagnosogenic theory, communicative failure and anticipatory struggle, capacities and demands

Diagnosogenic theory

Wendel Johnson (1930); Proposed stuttering begins when parents mistakenly diagnose normal disfluency as stuttering

Communicative failure and anticipatory struggle

Oliver Bloodstein (1987, 1997, & 2008); Child's experience of frustration/failure when trying to talk results in stuttering behaviors; Difficulty communicating results in fear of having difficulty, causes tension/speech fragmentation

Communicative failure and anticipatory struggle; Negative experiences

makes speaking difficult for children; Normal disfluencies being criticized, Delay in speech and language development, Speech/language disorders, Difficulty/traumatic experience reading aloud in school, Cluttering, Emotionally traumatic events when speaking

Capacities and Demands

Sheehan (1970, 1975), Starkweather (1987), Stuttering results when demands put on child's speech are greater than child's capacity for fluency

Two-stage model of stuttering

Primary stuttering, secondary stuttering

A Perspective on Primary Stuttering

Early stuttering, Loose, easy repetitions, Not aware of their stuttering, Do not react to the stuttering, Thought to be a dyssynchrony of the speech and language process

A Perspective on Secondary Stuttering

Characterized by tension/struggle, Escape/avoidance behaviors, Reaction to primary stuttering, Child becomes self-conscious/frustrated, Thought as result of reactive temperament

Interactions with Developmental Factors

Demand of language development, brain maturation, Normal neural circuitry for spoken language, but has inhibited temperament

Interactions with Environmental Factors

Listeners responses to child's emerging speech/language skills, Family influence on temperament, Life events

Treatment for preschool children

Maximize fluent speech, Prevent defensive reactions

Maximize fluent speech

Provide an environment of slower speaking rate, Reduce pressure on the child's speech

Prevent defensive reactions

Education regarding the acceptance of the repetitive stuttering, Education regarding spontaneous recovery, Positive parent demeanor

Treatment for school age children

Assessment of tension; Reduce the fear of stuttering; Practice

Treatment for adolescents & adults

Diminish defensive reactions and fear; Confront and explore stuttering behaviors, attitudes, feelings; Education regarding listener reactions

List the various points of evidence for stuttering

in all cultures; low incidence; doesn’t begin with speech ; sometimes begins with tense blocks, often with repetitions; severity changes over time; appears as repetitions, prolongations, blocks; Not all have relative who stuttered; more common in boys ; Many conditions reduce/eliminate it; Person often has poorer performance on sensory/motor tasks; Other research finding/clinical observations should be accounted for