V&F Ch 7: Typical Disfluency and the Development of Stuttering

age range for typical disfluency development/treatment level (years)

1.5-6^a (small amount of typical disfluency continues in mature speech)

age range for “younger preschoolers: borderline stuttering” development/treatment level

1.5-3.5 years

age range for “older preschoolers: beginning stuttering” development/treatment level

3.5-6 years

age range for “school age: intermediate stuttering” development/treatment level

6-13

age range for “older teens and adults: advanced stuttering” development/treatment level

≥ 14

T/F Stuttering levels of development are very clear cut and have no exceptions

FALSE-→ many exceptions

• ex: children will show borderline stuttering and then show signs of beginning stuttering for several days and then return to borderline stuttering

• others will retain milder level of stuttering even as they grow up

How many levels of development are there to determine treatment approach

4

What type of typical disfluency is this “mi-milk”

part-word repetition

What type of typical disfluency is this “I…I want that”

single-syllable word repetition

What type of typical disfluency is this “Lassie…Lassie is a good dog”

multisyllabic word repetition

What type of typical disfluency is this “I want a…I want ice-ceem comb”

phrase repetition

What type of typical disfluency is this “He went to the…uh…circus”

interjection

What type of typical disfluency is this “I lost my…Where’s mommy going?”

revision-incomplete phrase

What type of typical disfluency is this “I’m Tiiiiiiiimy Thompson”

prolongation

What type of typical disfluency is this “Can I have some more (lips together, sound) milk?”

tense pause

Between ages ____ and _____ , most children have typical repetitions, prologonations, and pauses

2 and 6

3 Characteristics of Typical Disfluency in a Nonstuttering Child:

1. No more than ____ disfluencies per ____ words

2. typically, ___ -___ _____ ; occasionally ____

3. most common disfluency types are ______ , ______ , and ___ -____ ______

   1. as children mature past age ___ , use of ___ -___repetitions will decline

1. No more than 10 disfluencies per 100 words

2. typically, one-unit repetitons; occasionally two

3. most common disfluency types are interjections, revisions, and whole-word repetitions

   1. as children mature past age 3, use of part-word repetitions will decline

T/F typically disfluent children don’t react to their disfluencies; they seem unaware of them

true

Typically disfluencies may be caused by:

• demands on _______ _____

• delayed ____ _______skills

• what emotion?

• ________ and _______ when speaking

  • someone might interrupt you

• demands on language acquisition

• delayed speech motor skills

• stress

• competition and excitement when speaking

  • someone might interrupt you

characteristics of Borderline stuttering in a younger preschool child

1. more than ___ - _____disfluencies per _____ words

2. often more than _____ units in ______

3. more _______ and _______ than revisions or ______ phrases

4. disfluencies ______ and ______

5. rare for child to _____ to their ______

1. more than 6-10 disfluencies per 100 words

2. often more than two units in repetition

3. more repetitions and prolongations than revisions or incomplete phrases

4. disfluencies loose and relaxed

5. rare for child to react to their disfluencies

Borderline Stuttering Underlying Processes: Constitutional

• Speech and Language Development

  • some _____ and _____ skills may be more ________ than others

  • ________ in some language production processes

• Speech and Language Development

  • some language and speech skills may be more advanced than others

  • inefficiencies in some language production processes

Borderline Stuttering Underlying Processes: Environmental

• Communication Stress

  • models of ____ talking/few ____

  • interruptions, ____, etc

  • models of advanced ____ and ____

  • _________ to be heard

• Communication Stress

  • models of fast talking/few pauses

  • interruptions, questions, etc

  • models of advanced vocab and syntax

  • competition to be heard

Borderline Stuttering Underlying Processes: Environmental pt 2

• psychosocial stress

  • conflicts in ___

  • birth of new ____

  • changes in home, moving, etc

• psychosocial stress

  • conflicts in family

  • birth of new siblings

  • changes in home, moving, etc

“Outgrowing” Borderline Stuttering

• _____ reallocation to _____

• ____ and ______ systems mature

• _____ resolve

• resource reallocation to compensate

• speech and language systems mature

• conflicts resolve

Characteristics of Beginning Stuttering in an Older Preschool Child pt 1

• signs of _____ tension and ____ appear in stuttering

  • repetitions are ____ and _____ with abrupt _________ of each element

• pitch ____ may be present toward the ____ of a ____ or ______

1. signs of muscle tension and hurry appear in stuttering

   1. repetitions are rapid and irregular with abrupt terminations of each element

2. pitch rise may be present toward the end of a repetition or prolongation

Characteristics of Beginning Stuttering in an Older Preschool Child pt 2

• fixed ______ postures are sometimes evident when the child is momentarily unable to ____ a word, apparently as a result of ______ in speech _______

• _______ behaviors are sometimes present in beginning stuttering

  • eye blinks, head nods, “ums”, etc

• awareness of _______ and feelings of ______ are present, but there are no strong negative feelings about ____ as ______

• fixed articulatory postures are sometimes evident when the child is momentarily unable to begin a word, apparently as a result of tension in speech musculature

• escape behaviors are sometimes present in beginning stuttering

  • eye blinks, head nods, “ums”, etc

• awareness of difficulty and feelings of frustration are present, but there are no strong negative feelings about self as speaker

Underlying Processes #1 of “Older Preschool Children: Beginning Stuttering”

• Increases in ____ tension and t____

  • ______ are seen as a sign that stuttering is worsening

  • these changes may be attempts to ____ or ______ from stutters

• Increases in muscle tension and tempo

  • increases are seen as a sign that stuttering is worsening

  • these changes may be attempts to control or escape from stutters

_____ conditioning spreads emotion associated with stuttering to more situations

• this means more ______ and faster ____

classical

• tension and faster tempo

______ conditioning increases frequency of _____ behaviors

• this means more eye blinks, head nods, etc

operant

• escape

blocks in which the child shuts off sound or voice

• probably will also have many repetitions and prolongations

what level do these occur in?

frequent core behaviors

Characteristics of Intermediate Stuttering in a School-Age Child

what level of stuttering occurs when child uses escape behaviors to terminate blocks

Characteristics of Intermediate Stuttering in a School-Age Child

what level of stuttering is this

• child appears to anticipate blocks, often using avoidance behaviors prior to feared words

  • anticipate difficult situations and sometimes avoids them

Characteristics of Intermediate Stuttering in a School-Age Child

what level of stuttering is this

• fear before stuttering, embarrassment during stuttering, and shame after stuttering

  • especially fear

Characteristics of Intermediate Stuttering in a School-Age Child

________ conditioning creates more and more tension in stuttering in more situations

classical

______ conditioning creates a more complex array of escape behaviors

operant

______ conditioning creates extra sounds and behaviors before the feared word and causes child to avoid more and more words and situations

• my name is uh uh uh barry

avoidance

what level is this

more frequent core behaviors are longer, tense blocks, often with tremors of the lips, tongue, or jaw

• individual will also probably have repetitions and prolongations

Older teens and adults: advanced stuttering

what level is this

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

Older teens and adults: advanced stuttering

what level is this

• complex patterns of avoidance and escape behaviors characterize the stutterer

  • may be very rapid and so well habituated that the stutterer may not be aware of what they do

Older teens and adults: advanced stuttering

what level is this

• fear, embarrassment, and shame are very strong

  • negative feelings about themselves as a person who is helpless and inept when they stutter

    • self-concept may be pervasive

Older teens and adults: advanced stuttering

what level is this

• minimal influence of original constitutional, developmental and environmental factors

• learning and experience changed brain structure and function

• ______ learning has created enduring stuttering patterns

Older teens and adults: advanced stuttering

• avoidance

what level is this

• _____ learning creates negative-self concept

• comes from listener reactions from childhood and later

  • stutters also project their own negative feelings about stuttering onto others

Older teens and adults: advanced stuttering

• cognitive

borderline stuttering

beginning stuttering

intermediate stuttering

advanced stuttering

an unusual way of speaking or acting that seems to reduce stuttering, like laughing and pretending that most things said were a joke

• ex: speaking with an accent that the speaker pretends to have

antiexpectancy devices

rather than stuttering on a word, person might use a different way of saying something

• “my father was in the N..n…he served aboard ships in the armed forces

circumlocutions

stuttering that the indiv. hides from listeners, usually by avoiding sounds, words, and situations that might precipitate stuttering

• typically associated with deep shame

covert stuttering

sound prolongation, broken word, or other instance of ongoing phonation being stopped, extended, or distorted

dysrhythmic phonation

this is like a starter, but usually it just involves waiting a few beats before saying a feared word as in “Back then I use to drink a lot of…soda”

• an avoidance

postponements

words or sounds used by someone who stutters to get started speaking when blocked or when anticipating a block

• ex: “My name is, uh, Barry”

• type of avoidance behavior bc used before indiv. is in a moment of stuttering

starters

short segmented repetitions, as well as sound prolongations and blocks

• disfluencies typically judged by listeners as stuttering

stuttering like disfluencies

disfluencies in the speech of individuals who do not stutter

• more prevalent in younger children (2-4 years)

typical disfluency

speculations about the process that may cause disfluencies or stuttering at each developmental level

• help us understand why stuttering often changes from borderline to beginning to intermediate to advanced levels

underlying processes

disfluencies that occur within a word boundary such as repetitions of parts of words, prolongations, or blocks

• stuttered speech is said to contain higher proportion of within-word disfluencies (as opposed to disfluencies that happen between/across words, such as hesitations, fillers, and repetitions of whole words)

within-word disfluencies