stuttering final

fluency

continuity, smoothness, rate, and effort in speech production

stuttering

most common fluency disorder, is an interruption in the flow of speaking characterized by specific types of dysfluencies, including repetitions of sounds, syllables and monosyllabic words, prolongations of sounds when it isn’t for emphasis and blocks

onset

betweem 2 and 4 years, by age 3.5 , most children who stutter will begin

prevalence

around 1%

indicidence

5-15%

spontaneous recovery

occurs in about 80% of cases
• wide variations in reports on spontaneous recovery
• predictors of recovery: sex, family history, age at onset, duration since onset, language skills

anticipation

ability to predict occurance of stuttering

consistency

tendency to stutter on the same words during repeated readings of same text

adaptation

decrease in stuttering frequency during repeated readings of the same text

fluency enhancing conditions

when alone, reduced rate, rthymically , to an animal or infant, different dialect, reading, singing, whispering , altered auditory feedback

overt

primary/core, secondary/accessory

covert

feelings and attitudes ( towards speech, speaking situtations)

stuttering speech interruptions

(part-word) sound repetitions: “I n-n-need that”
• (part-word) syllable repetitions: “I nee-nee-need that”
• monosyllabic whole-word repetitions: “I need need that”
• audible prolongations: “I nnnnneed that”
• inaudible prolongations: “I˽need that”
• broken words: “I n˽eed tha

non-fluent speech interruptions

• phrase repetitions: “I need I need that”
• interjections: “I need ... uh ... that”
• revisions: “I want – I need that”
• multisyllabic word repetitions: “I really really need that”

secondary symptoms

• escape behaviors, avoidance behaviors

• distracting sounds

• facial grimaces

• head movements

• movements of the extremities

distracting sounds

noisy breathing, sniffling, clicking sounds

facial grimaces

jaw jerking, tongue protruding, lip pressing

head movements

back/forward, poor eye contact

movements of the extremities

arm/hand movement, foot tapping

feeling and attitudes

negative emotions and attitudes develop early, equally if not more important to address in treatment

preschool children main assessment goal

stuttering it typical nonfluencies, risk factors dor persistent stuttering

school age children, adolescents, adults main assessment goal

readiness for treatment

case history

btain relevant background information
a) description of problem (onset, duration, etc.)
b) family history
c) speech/language development
d) academic performance
e) additional case hx (speech-related anxiety, situational
hierarchy)
f) previous treatment

overt stuttering analysis

in the clinic: spontaneous speech sample, reading sample. observe secondary behaviors, analyze stuttering

data to collect from recorded samples

stuttering frequency (percent stuttered syllables PSS)

frequency-by-type analysis

average duration of 3 longest stuttering moments

number of repetitions for repetitions

speech rate

secondary characteristics

preschool children covert symptoms

kiddyCAT

school age children covert symptoms

A-19, communication attitude test, OASES

adolescents and adults covert symptom

modified erickson scale of communication attitudes, OASES

preschool recommendations

monitor or start treatment depending on evaluation findings

school age children, adolescent, adult recommendations

start treatment

report writing

evaluation of all information, history , evaluation method, evaluation results, interpretation, and recommendations

Cluttering

fluency disorder wherein segments conversation in the speaker’s native language typically are perceived as too fast overall, too irregular or both. The segments of rapid and/or irregular speech rate must further be. accompanied by one of or more of the following a. excessive normal disfluencies, b. excessive collapsing or deletion of syllables, and c. abnormal pauses, syllable stress or speech rhythm

acquired stuttering

onset of the dysfluent speech must occur in adulthood in the absence of a childhood history of developmental stuttering

cluttering time of onset

preschool years, may remain undiagnosed until it starts interfering with academic performance

etiology of childhood onset stuttering

genetics, neurophysiological factors

etiology of cluttering

neurological?, involves aspects of learning, verbal and written expression, and perception

etiology of neurogenic stuttering

CVA, TBI, brain tumor, degenerative neurological disease

etiology of psychogenic stuttering

conversion disorder(loss or alteration of physical functioning caused by psychological factors

cluttering overt characteristics

excessive whole word and phrase repetitions, rapid articulation rate, lack of intelligibility, slurring or/and omission of syllables, mazes(repeated false starts, hesitations, and revisions)

additional cluttering characteristics

receptive or expressive language difficulties, central auditory processing difficulties, reading problems, learning disabilities, limited attention span, and hyperactivity

neurogenic stuttering overt charcateristics

primary behaviors only

neurogenic place of stuttering

not limited to initial syllables and more on function than content words

phenomena observed in neurogenic stuttering

spontaneous recovery

no adaptation effect

fluency enhancing conditons ineffective in reducing stuttering frequency

psychogenic stuttering overt characteristics

primary dysfluency is rapid initial syllable repetition

phenomenon observed in psychogenic stuttering

fluency-enhancing condition ineffective in reducing stuttering frequency

childhood onset stuttering treatment

preschool children: fluent speech
• school-age children: controlled fluency
• adolescents and adults: modified stuttering

cluttering treatment

speech rate reduction
• overarticulation
• increase awareness

neurogenic stuttering treatment

techniques that facilitate fluency: pacing, masking, slow rate
• differentiate fluency, speech, language components

psychogenic stuttering treatment

symptoms may dramatically improve with trial therapy

indirect

no direct manipulation/modification of child’s dysfluencies

direct

explicit instructions to modify speech

preschool children

children 2 to 6 years old
• in some children, beginning stuttering emerges gradually,
after a period of repetition that are relatively free of
tension
• few negative emotions (e.g., occasional frustration)
• fear or avoidance of stuttering has not yet developed
• feeling and attitudes affected by family
• treatment goal: fluent speech
• treatment approach: direct and/or indirect
• participation in maintenance program following treatmen

fluency shaping based on operant conditioning

5:1 ratio of verbal responses for fluency to verbal responses for stuttering

verbal responses

praise, acknowledgement of fluency, request for self evaluation, acknowledgement of stuttering, request for self correction

school age children

• typical symptoms:
- tense repetitions and prolongations
- use of escape devices (e.g., “uh”)
- secondary characteristics
- avoidance strategies (e.g., word substitutions)
- frustration
- embarrassment
- anticipation of stuttering on specific sounds/words/speaking
situations

treatment working with child

direct approach

treatment goal- controlled fluency (fluency mixed with very mild/mild stuttering)

stuttering modification

fluency shaping conditions

environment modification

reduce negative feelings and atttitudes

reduce avoidance behaviors with regard to sounds/words/situations

stuttering modification

cancellations, pullouts, preparatory sets

fluency modification

flesible rare, easy start, light contacts

treatment working with parents

explain treatment program and parents role in it

discuss possible causes of stuttering

identify and reduce fluency

eliminate teasing