Stuttering Final

stuttering sex ratio

Sex ratio beings at 1:1 at onset, by school age reaches 3:1 (male:female)

Typical onset of stuttering

• Between 2-3.5 years

• Gradual increase in normal disfluencies

• Sudden appearance of severe block 

• Between 70-80% of children who begin to stutter recover without treatment

• If they persist past about 8 yrs old, it is likely they will persist for their entire life

Developmental factors of stuttering

• Limited speech motor skills

• Increases emotional reactivity

• Decreases in emotional regulation

• Rapidly developing motor cognitive, and speech and language skills may compete for neural resources so that language and speech production are affected

• Stuttering onset often coincides with complex language development (Evaluation of young children who stutter should include all components of language)

secondary behaviors

Learned behaviors that are triggered by the experience of stuttering or the anticipation of it.

escape behaviors in stuttering

to actions or strategies that a person who stutters might use to avoid or get out of a difficult speaking situation. These behaviors typically happen when the individual is experiencing a moment of stuttering and feels anxious or unable to complete their speech fluently. Escape behaviors can help them temporarily avoid the stuttering moment, but they don't resolve the underlying speech difficulty.

Example: A common escape behavior is eye blinks or head jerks. When a person feels that they are about to stutter on a word, they might quickly blink their eyes or jerk their head to distract from the stutter or to "break" the stuttering moment, allowing them to move past it more quickly. While this might help in the short term, it can contribute to the persistence of stuttering over time if used frequently.

avoidance behaviors in stuttering

the actions a person takes to prevent situations where they might stutter. These behaviors are typically driven by fear or anxiety about stuttering in certain situations and can involve avoiding specific words, people, or speaking scenarios altogether.

Example: A common avoidance behavior is avoiding certain words. For instance, a person might steer clear of words they know are likely to cause stuttering, such as difficult consonant clusters or longer words, by substituting them with simpler words or rephrasing their sentences. This avoidance can lead to reduced fluency in everyday conversations and may limit communication opportunities. Another example may be someone avoiding certain social situations, which may be very isolating for the individual.

Listeners tend to…

• Feelings of discomfort

• Avoid eye contact

• Help finish utterance

• Interrupt when there is a pause

• Try to help by saying phrases such as “it’s olay, take your time” “slow down”

genetic influences

• when one twin stutters, the other often stutters as well (but not always, shows there are biological and environmental influences)

• No single gene or mutation has been shown to be associated with stuttering

• Relieve parent’s guilt about “causing” their child’s stutter

• Just because a relative has persistent stuttering does not assure that stuttering will occur

• the hereditary factors that may contribute to the likelihood of developing stuttering. Research indicates that stuttering can run in families, suggesting a genetic component, but it also involves complex interactions with environmental factors.

brain structure differences- white matter tracts

Density of white matter tracts in areas of left operculum were less dense in PWS. information flow between brocas and wenicke’s area may be affected with this less myelinated white matter

brain structure differences- overactivation

•  increased brain activity in the right hemisphere

• PWS are using less efficient side of the brain for speech 

• Compensation for deficient left hemisphere

brain structure difference- deactivation

decreased brain activity in left hemisphere

Underactivity in auditory areas used to monitor one’s own speech output. Delayed auditory feedback 

Children and adults who stutter show reduced connectivity within brain regions associated with speech motor control

environmental influences

• Behaviors, attitudes, events at home

• Family’s anxiety about child’s speech

  • Conversational style in home

    • Rapid rate

    • Complex syntax

    • More than 1 language in home

    • Polysyllabic vocab

    • Competition for speaking

    • Frequent interruptions

    • Demand for display speech

    • Loss of listener attention

    • Hurried when speaking

    • Frequent questions

    • Excited when speaking

    • Many things to say

  • Peer/family reactions to stuttering

  • Parenting style

  • Life changes

    • Moving

    • Parent separation/divorce

    • Death in family

    • Hospitalization (family member or child)

    • Parent loss of job

    • New person in house

    • Parents leaving frequently or long-term

    • Holidays, changes in routine, etc.

    • Discipline issues with kid

speech motor skills approach

• (Van Lieshout, Hulstijn, Peters)

• Stuttering result of limited speech motor skills

• PWS have less efficient, less flexible, less adaptive speech motor system; increasing demands of speech motor system may destabilize motor control

• PNS start to receive benefits from motor practice, PWS have more difficulty and motor practice does not improve

multifactorial dynamic pathway theory

• Smith and Weber

• Constellation of stuttering

• There is no one cause of stuttering

• Many factors interact to result in stuttering

  • Psychosocial/emotional stress

  • Linguistic stress

  • Cognitive stress

• Unique to the individual 

• The 80% of children who recover experience brain adaptations, allows them to compensate for the atypical neural activity underlying the stuttering disfluencies

• The 20% of children who don't recover dont have adequate brain adaptations

capacities and demands

• Stuttering exacerbated by demands from attention, language, emotion, motoric processes (Chang, Sheehan, Andrews, Starkweather)

• Capacities:

  • Ability to plan and program for language while making fast, coordinated movements for speech

• Demands:

  • Advanced conceptual and linguistic abilities: attempting to model rapid and complex speech and language in environment; emotionally stressful situations

2-stage theory of stuttering

• Primary stuttering

  • Occurs because neural circuits for speech and language may be:

    • Working in an “underdeveloped” area

    • Reorganized and moved to an area not naturally suited to rapid speech and language functions (e.g. right hemisphere)

    • Reorganized so that major functions are at some distance from each other

    • Slower in processing because of less dense pathways

• Secondary stuttering

  • Some kids may be more reactive temperamentally

  • Reactivity causes responses to unpleasant/threatening stimuli such as

    • Increasing tension

    • Speeding up

    • Escaping

    • Avoiding

  • Reactive temperament causes emotional arousal, events causing the emotion are more deeply engrained (learning enhances emotion)

  • Emotional conditioning may result in cognitive changes

2-stage theory of stutterin for dummies

In the primary stage, stuttering happens because the brain’s neural circuits for speech and language may not be fully developed or may not be in the ideal areas for smooth speech. For example, the circuits might be working in an “underdeveloped” part of the brain or be reorganized to a less efficient area (like the right hemisphere), making it harder for the person to speak quickly and smoothly. The pathways for speech might also be less dense, leading to slower processing of language.

In the secondary stage, the stuttering becomes more pronounced because of a child’s emotional reactions. Some children may have a temperament that makes them more sensitive or reactive to stress, and this can lead to feelings of anxiety or frustration when they try to speak. This emotional reaction often increases tension, causes them to speed up their speech, or leads them to use escape and avoidance behaviors (like avoiding certain words or situations). Over time, these emotional responses become deeply ingrained, and they can make stuttering worse, creating a "fear" pattern that leads to persistent difficulties.

In simple terms, stuttering doesn't have just one cause. Biological differences in the brain can make speech less efficient, and emotional reactions to stuttering can create a cycle of fear and avoidance that makes the problem worse over time.

normal disfluencies

Ages 2-5

• Part word repetition

• Single-syllable word repetitions

• Multisyllabic word repetition

• Phrase repetition “I wanna I want a ice-cream

• Interjection “uh”

• Revision-incomplete phrase- “I lost my…where’s mommy going”

• Repetitions are more common in younger children, revisions are more common in older children

• Most children have these at these ages

how to differentiate normal disfluencies

1. No more than 10 disfluencies per 100 words

2. Typically one-unit repetition

3. Most common disfluency types are interjections, revisions, and word repetitions. 

Normal/other disfluencies- fillers, interjections, revisions, multisyllabic word repetitions 

• Children with normal disfluencies don't react to them, they seem unaware of them

younger preschool: borderline stuttering

• More than 10 disfluencies per 100 word

• Often more than two units in repetition

• More repetitions and prolongations than revisions or incomplete phrases

• Disfluencies loose and relaxed, no frustration/embarrassment, moves through quicker

• Rare for child to react to disfluencies

olderpreschool children: beginning stuttering

• signs of muscle tension and hurry

• pitch rise may be present some escape behaviors emerging

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

school aged: intermediate stuttering

• most frequent core behaviors are blocks, repetitions, and prolongations

• uses escape behaviors to terminate blocks

• can anticipate block, and will engage in avoidance behaviors

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

word avoidance techniques

• Starters

• Substitutions

• Circumlocutions

• Postponements- waiting a few beats or putting in a filler before starting a word on which stuttering is expected 

• Anti-expectancy devices- using an odd manner or funny voice to avoid stuttering (whispering, accents)

adults/adolescents: advanced stuttering

• longer, tense blocks

• stuttering may be suppressed through extensive avoidance behaviors

• fear, embarassment, shame feelings are very strong

• have negative feelings of self

A married couple come to you for advice. They tell you they are thinking of having a child but are worried because each has a relative who stutters. What would you tell them about the likelihood that they would have a child who stutters and whether they should be concerned?

Stuttering can have a genetic component, as research shows it sometimes runs in families, suggesting that inherited factors may increase a child's risk. However, no single gene has been identified as solely responsible, indicating that stuttering is likely polygenic, with multiple genes contributing to the risk. Given that both individuals in the couple have relatives who stutter, their child may have a slightly higher chance of stuttering, but genetic predisposition alone doesn’t guarantee it. Stuttering can also arise from complex interactions between genetic, neurophysiological, developmental, and environmental factors, as outlined by the Multifactorial Dynamic Pathway Theory (Smith & Weber, 2017).

The theory emphasizes that while genetics may contribute to susceptibility, stuttering is influenced by a variety of forces, including developmental milestones, brain function, and environmental stressors. Even if a child is genetically predisposed, stuttering may not manifest unless specific developmental or environmental factors trigger it. Moreover, early intervention and a supportive environment can significantly help a child manage or overcome stuttering. I would reassure the couple that, while their family history may slightly raise the likelihood of stuttering, many children with a family history of stuttering do not develop it, and supportive, low-stress environments can mitigate any challenges.

Why do you think it is important for you to understand genetic and brain differences in people who stutter?

By understanding the neurological and genetic factors involved, we can better support clients and their families, offering strategies that account for both the speech production process and potential cognitive or emotional influences.

Research has shown that individuals who stutter may have differences in brain hemisphere activation, particularly when it comes to speech and language processing. Typically, the left hemisphere is dominant for language, but in people who stutter, there can be altered activation patterns, with both hemispheres being involved in speech production. This could lead to difficulties in coordinating the motor and cognitive aspects of speech. Additionally, the amygdala, which is involved in processing emotions like anxiety and fear, may be more activated in people who stutter, contributing to the emotional and social challenges they experience. Finally, differences in white and gray matter have been observed, particularly in areas related to speech motor control. These structural differences may impact the efficiency and coordination of speech movements. By understanding these brain-based differences, we can adopt more personalized, neurodevelopmentally informed approaches to therapy, addressing not just the speech itself, but also the emotional, cognitive, and developmental aspects of stuttering.

Knowing some of the developmental and environmental pressures that impact stuttering in young children, how might you counsel a parent to promote a supportive environment?

When counseling a parent, it's crucial to acknowledge the complexity of environmental and developmental factors that contribute to stuttering in young children. In homes with rapid speech, complex syntax, and multiple languages, it's essential to slow down communication, provide ample time for the child to respond, and create an atmosphere where the child feels relaxed and unpressured. Avoiding frequent interruptions and competition for speaking space can help reduce anxiety and promote more fluent speech. Also, parents should be mindful of their reactions to the child's stuttering, ensuring that they remain calm and supportive rather than correcting or drawing attention to the stutter, which may increase stress for the child. If there are multiple changes in the home, such as moving or family illness, these stressors should be addressed in a sensitive, open manner, as the child’s environment plays a key role in their speech development.

Additionally, ensuring a stable and predictable routine can help reduce pressure around speaking. If the child is excited, hurried, or feeling rushed when speaking, it’s important to encourage slow, relaxed conversation and avoid demanding overly formal or display-like speech. Parents should prioritize listening attentively, even if the child’s speech is disfluent, and reassure the child that their thoughts and words are valued. In situations where there are significant life changes, like a divorce or family death, the child may need extra emotional support to cope, which can, in turn, alleviate the impact of stress on their speech. Parenting styles that are warm, patient, and understanding, combined with a calm, structured environment, can significantly reduce stuttering-related anxiety and foster a supportive atmosphere for the child’s speech development.

Explain to a parent, using a classical conditioning approach, why their child’s stuttering has changed from easy, loose repetitions, to tightly squeezed blocks?

When a child starts stuttering, it may initially appear as easy, loose repetitions without much tension. However, through classical conditioning, these disfluencies can become associated with negative responses from others, such as a frown, mocking, or stern correction. Over time, these reactions (unconditioned stimuli, or UCS) trigger a stress response (unconditioned response, or UCR), which creates tension during stuttering. As this pattern repeats, the child begins to associate certain words, sounds, people, or situations (previously neutral stimuli) with the uncomfortable feelings of tension and pressure, turning them into conditioned stimuli (CS). This repeated pairing leads to a shift in how the child stutters, causing the once easy repetitions to become tighter and more blocked as the conditioned response intensifies.

What are two indicators that point to developmental stuttering vs normal disfluency?

• Presence of secondary behaviors

• any sort of tension

• a child being aware of stutters

• any sort of negative feelings about talking

• Part-word, syllable, and word repetitions, prolongations, blocks

empathetic response

I hear/it sounds like you feel (this way) about (experience)  because (experience)

deep listening

• Listening posture

• “Mmhmm” “That sounds hard” “tell me more”

• Resist right reflex, understand patient’s motivations, listen with empathy,

bommerng

• Send question back to client: don’t be the expert yourself

• Open-ended questions

  • “What is your instinct on that?”

  • “What are your thoughts on..?”

• Summarizing

  • “Tell me if I got this right…”

  • “I hear you saying…”

• Reflecting/validating

  • “That sounds…”

choice point

thoughts and feelings that push us and pull us from our goals

defusion activities

• “I hear you saying…”, “Your brain is telling you…”

• Make it into shape, color, texture, where in body

• Practice “and, can, try” instead of “always, never, should have”

• Glitter jar [kids]

  • Colors for different aspects: thoughts, feelings, urges

  • Jar is settled after time, but can swirl around = can’t see clearly. What do we need to do? Be still.

• Worry Dial [kids]

• Calming hands [kids]

ABCs of stuttering

ABCs of stuttering

• Affective: feelings

• Behavioral: Stuttering Behavior

• Cognitive: thoughts and attitudes

• Social: Impact 

3 tracts of treatment

Fluency shaping

• Teaching strategies that prevent or eliminate stuttering

Stuttering modification

• Modifying stuttering behaviors

• Work with the stutter they already have, so it's not so struggled, less tense

Acceptance based or stuttering affirming

• Focuses on acceptance of stuttering and reducing escape/avoidance behaviors 

RESTART- DMC

(demands and capacities model of treatment)

• Indirect 

• SLP give feedback 

• Starts with weekly parent-only coaching sessions, transitions to parent-child sessions with SLP observing to give feedback

• Don’t have any frustrations or avoidance

• RESTART is a therapy approach for young children who stutter, based on the Demands and Capacities Model. It helps reduce stuttering by decreasing environmental and communicative demands while supporting the child’s speech and language capacities through parent-led changes at home.

Indirect treatments are effective

• Mothers slowing speech affects child’s fluency

• When parents change interactions, child becomes fluent

• RESTART-DCM is an effective treatment, they have tested for efficacy

approaches for preschool

• Fluency shaping

  • Turtle talk [direct]

  • Lidcombe [direct]

    • That was bumpy/smooth

  • Cheryl Gottwald’s Approach [direct]

    • Parent counseling/ed, change to environment

  • Resilience/self-regulation [direct]

  • Palin Parent-child interaction (PCI) [indirect]

    • Lower conversational stress - examine with family, make changes

  • Monitoring (stuttering, family interaction patterns, etc.) [indirect]

  • RESTART-DCM [indirect]

    • Reduce demands/stressors: motoric, linguistic, cognitive, emotional

Common Factors in Direct Behavioral Approaches

• Slow, smooth, relaxed pattern of speech by modeling

• Reducing communicative stressors

• Parent counseling

• Direct fluency work 

Lidcombe

• Preschool and school age (4-10)

  • Parent delivered

  • Based on operant conditioning

• Not a great program choice for highly sensitive child, use indirect 

• Works best in children older than 3.5 year old

• Acknowledgement of fluent speech and also brings attention to stutters and requests self-correction

• Controversial- some AWS don’t like it as it is a “punitive” form of treatment 

What should goal be for school aged stutterer?

• Help child manage, cope with, accept stuttering to be effective communicators

• How to handle moments of stuttering with less fear and more confidence

• Identify and reduce barriers and facilitate supports

• Use ABCS as a guide 

Stutter Modification core behaviors

• Education

• Exploration

• Identification

• Staying in the stutter

• Modifying the stutter

stutter modification: education

• How our voices work

• Learning about the speech machine, draw the speech machines or speech helpers

• Explore the history and myths about stuttering

• Learn about famous people who stutter (ed sheeran, emily blunt, darth vader), creates some distance

stuttering modification: exploring and identification

• Explore the child’s stutter: learning the pattern, becoming a “speech detective”

• Exploring the child’s stuttering pattern, promotes desensitization

• Activity: playing with our voices: (low, high, bumpy, stretchy, loud, tight, loose, baby, animal, follow child’s lead 

• Clinician models stutters neutrally and describes what’s happening

• Activities: play “catch me”: lift a finger or have a signal for catching a stutter. LOTS of positive reinforcement

modifying the stutter

• pull-out, slide out, ease out

• catch and release, fist technique

• The more time the child is able to spend in the moment of the stuckness of the stutter, the more his fear will reduce. Clinician remains calm, good eye contact, positive reinforcement

rationale for voluntary stuttering

• Reduce or minimize tension that mights build to harder, more tense stuttering (chinese finger trap example)

• Reduce fear of stuttering in specific situations

• Shows the stutter who is “boss” 

fluency shaping

• Techniques that will change timing or tension

• Most people do a blend of this with stuttering modification with school aged. Don’t use JUST fluency shaping 

• Use with low-fear child (preschool), before secondary behaviors

• Should be used cautiously with highly sensitive CWS and those with high hear, avoidance, or secondary behaviors

Pausing and phrasing 

• Stretchy speech may be diff to maintain for children

• Teach where and how to take natural pauses 

Light Contact

• Also called light touch

• Touch or brush articulators together with less physical force

Theoretical model of change

• Pre-contemplation- i don't see a problem

• Contemplation- i don't feel good but something is still holding me back

• Preparation- I’m ready to work on this

• Action- making the changes

• Maintenance- i’ve been making changes for a while and feel confident that I can stick to them

• Relapse 

Rogers guiding framework for treatment of adolescents

making changes to talk and stutter more eaily

• learning about speech mechanism

• identify moments of stuttering

• holding, tolerating, and easing out

developing more positive feelings and attitudes about stuttering

• education

• reframing success

• identifying thinking traps

• accepting and letting go of difficult thoughts and emotions

• finding community

reducing avoidance of sounds, words, and situations

• disclosure

• expanding the comfort zone

• voluntary stuttering/open stuttering

guitar framework for adults

• Tx should be tailored to each clients needs

• Increase approach behaviors and reducing avoidance

• Goals: 

  • focus of therapy is on stuttering (not fluency)

  •  reduce negative emotions

  • teach client to stay in stutter while remaining calm, being comfortable in stutter

  • Natural eye contact maintained

  • Need to reduce fear, need to reduce shame, need to reduce neg thoughts

voluntary stuttering

• Considered challenging at first, but can have sig cognitive, affective, and behavioral benefits

• A personal sense of freedom, taking back control

• Cognitive relief, not needing to anticipate a reaction (eliminated surprise from listener)

• Sig gains in quality of life after using voluntary stuttering provided that it was similar to their actual moments of stuttering and in real contexts of their life

• Don’t push through resistance. But a good resource for when they’re ready: Byrd et al., 2016

ARTS Outcomes

• Help strip away habitual hiding behaviors to move towards comfortable, joyful communication

• Reducing avoidance

outcomes

• Efficiency in communication

• Comfort

• Confidence

• Spontaneity

• Joy

• Authenticity

not valued

• Fluency

• Control

• Hiding stuttering well

• Practice

• Protecting others from discomfort 

high values of ARTS

• Fluency

• Control

• Hiding stuttering well

• Practice

• Protecting others from discomfort 

dopamine and movement

• Plays a role in regulating movement

• Depletion of dopamine is associated with tourette's and parkinsions

• Larger levels of dopamine have been found in adults who stutter resulting in uncontrolled, unnecessary, repetitive movements 

• Haloperidol (D2 receptor blocker) has been shown to decrease in stuttering in some AWS

• Not enough studies to show that these medications are actually effective in reducing stuttering

• Most studies are case studies (not randomized, not controlled, worked for this one person)

• A lot of bad side effects 

assistive devices

Delayed auditory feedback

• Reproduce an acoustic signal with a small time delay, typically between 20-200ms, in effect producing an echo of the own speaker’s voice

Frequency altered feedback

speech easy device

• places in the ear like a hearing aid, DAF and FAF

• Recommended for child 11 and older

• Choral reading effect

• Does not cure or eliminate stuttering 

• Drastic initial improvement but effects diminish over time 

• No long-term treatment outcome studies have been reported

This is where ARTS and Stuttering Modification take different paths in regards to the stuttering moment. What are some similarities? What are some differences? What is a potential pro and a potential con of using Stuttering Modification versus ARTS for school-age kids?

similarities

• Both address the moment of stuttering rather than aiming solely for fluency.

• Both aim to reduce fear and avoidance around stuttering.

• Both focus on improving communication and self-acceptance, not just fluent speech.

differences

• primary techniquess: cancelations, pull-outs vs reducing avoidances, speaking openly.

• goals: easier controlled stuttering vs reduced fear/avoidance, openness/joy/spontaneity

nemo (9 yr old) case study

Given Nemo’s age, advanced language skills, and strong self-awareness of his stuttering, a Stuttering Modification approach would be well-suited to his needs. He is already able to describe the strategies he uses to avoid stuttering—such as fillers, word substitutions, and avoiding participation in class—which suggests he is cognitively and emotionally ready to explore his speech more deeply. This approach would begin with education about the speech mechanism and the difference between core and secondary stuttering behaviors, helping Nemo better understand what’s happening when he stutters. Through exploration and identification, he would learn to recognize his specific stuttering patterns, including his inaudible blocks, physical tension, and secondary behaviors like eye blinks and head jerks. From there, modifying the stutter would involve teaching him strategies such as easing out of blocks and reducing physical struggle, with the goal of increasing his comfort and confidence while speaking, rather than avoiding stuttering altogether.

three aspects of a student’s profile to consider when choosing between fluency shaping and stuttering modification?

When choosing between stuttering modification and fluency shaping, I would consider the student's temperament (e.g., comfort with risk-taking and emotional resilience), linguistic abilities (ability to understand and apply speech strategies), and social supports (encouragement from family, teachers, and peers), as these factors impact their readiness for self-awareness, tolerance of stuttering, and success with either approach.

Write one long-term goal and a corresponding short-term goal that targets one of the ABCS (affective, behavioral, cognitive, and social) using Dr. Rodger’s approach.

Long-Term Goal (Affective/Cognitive):
The student will develop increased self-acceptance and reduced negative emotions related to stuttering by learning to talk and stutter more easily, reframing success, and letting go of difficult thoughts and feelings.

Short-Term Goal:
The student will identify at least two common thinking traps they experience related to stuttering and practice reframing those thoughts using positive self-talk strategies in structured speaking tasks with 80% accuracy over three consecutive sessions.

Long-Term Goal (Behavioral/Social):
The student will reduce avoidance behaviors and increase participation in speaking situations by using open stuttering and voluntary stuttering to expand their comfort zone.

Short-Term Goal:
The student will use voluntary stuttering in at least one planned speaking situation (e.g., reading aloud, answering a question in class) per session and reflect on the experience with support from the clinician in 4 out of 5 sessions.

Long-Term Goal (Cognitive/Education):
The student will increase understanding of their stuttering by learning about the speech mechanism and identifying personal moments of stuttering to support greater self-awareness and self-advocacy.

Short-Term Goal:
The student will accurately identify and describe at least two personal stuttering behaviors (e.g., blocks, repetitions, physical tension) during recorded speech tasks in 3 out of 4 sessions.

A parent tells you that they heard of a drug that cures stuttering, how would you respond? talk about lack of evidence and and controlled studies. but feel free to add other stuff

I would respond by acknowledging the parent’s hope and interest, then gently clarify: “I understand why the idea of a medication that could ‘cure’ stuttering is appealing, and it's great that you're staying informed. Right now, there’s no scientifically proven drug that cures stuttering. While there have been some small studies or claims about medications reducing stuttering, none have consistently shown strong, long-term benefits in well-controlled clinical trials. Most of these studies either lack rigorous design or haven't been replicated reliably. Stuttering is a complex neurodevelopmental condition that involves much more than just speech fluency—it also includes emotional, cognitive, and behavioral components. That’s why treatment typically focuses on helping people manage stuttering effectively and improve communication confidence, rather than trying to eliminate it entirely. If you ever come across a treatment that sounds too good to be true, I’d be happy to look into the research with you

How would you explain delayed auditory feedback and its effects to a stuttering client or family? What might be some pros and cons?

Delayed auditory feedback is a tool that changes how we hear our own voice. When someone uses a DAF device, they hear their speech with a slight delay—like an echo. For some people who stutter, this delay can help slow down their speech and make it feel easier to talk fluently. It’s kind of like how some people sing more fluently than they speak—hearing your voice differently can affect how your brain controls speech."

Pros might include:

• It can help some people speak more fluently, especially in the short term.

• It’s non-invasive and easy to use.

• It may boost confidence in certain speaking situations.

Cons might include:

• The effects vary widely—some people see improvement, others don’t.

• It doesn’t address the emotional or cognitive parts of stuttering, like fear or avoidance.

• Relying on a device may reduce independence or lead to frustration if it doesn’t always work.

• It can feel distracting or uncomfortable for some users.

characteristics of cluttering

• sudden bursts of rapid speech

• difficult to understand and somewhat disfluent

• Abnormal sound, syllable, phrase and pausing patterns

• Speech-motor disorder

• NOT REACTIVE

• Cluttering must occur in naturalistic conversation and is random

• Syllables are omitted, sounds slurred, or syllables are collapsed

• Syllable rate can be rapid with misarticulations and disfluencies

• Speech may appear as jerky

• Collapsing includes excessive shortening or “over-coarticulating” various syllables, especially multisyllabic words

• Normal disfluencies are most prevalent, often frequent, and include the following

  • Repetitions= multisyllabic, phrases

  • Revisions

  • Interjections/fillers

• Rate problems are central to the disorder

• Word finding problems, lack of background info, difficulty sequencing

cluttering treatment

• Proprioceptive activities

• fluency shaping is more warranted

• they don’t have the negative reactions that people who stutter do

• Increase client’s knowledge and awareness of cluttering

  • Educate

  • Encourage to transcribe their own speech

  • Help client to become aware of this thought process while speaking in rapid bursts

  Modification to speech

  • Increase natural pauses

  • Sounds or syllables deleted and/or collapsed= emphasize all sounds and syllables 

behavioral characteristics of acquired stuttering

• Sound, syllable, word reps more common

• Prolongations and blocks are less common (less reactivity, don’t have the negative reactions)

• Secondary behaviors are less common for the same reason as above

• % syllable stuttered remain relatively consistent across speaking conditions (which is diff than dev stuttering)

• No effects of fluency enhancing conditions like singing or clapping

• Less likely to show an adaptation effect- stutter more at the beginning of an interaction or reading

treatment for acquired stuttering

• ½ recover on their own

• Fluency shaping work due to less reactivity

• timing/pace

• Self advocacy may be important for those who persist (greater than 6 months)

functional acquired stuttering (conversion stutter)

• Cause: Linked to psychological or emotional factors, often triggered by trauma, extreme stress, or underlying mental health conditions.

• Onset: Often sudden, without a clear neurological cause.

• Speech Characteristics: Disfluencies can appear atypical or inconsistent; sometimes unusual patterns not seen in developmental stuttering (e.g., rapid syllable repetition, bizarre prosody).

• Awareness: The person may or may not show concern; some show indifference or seem unaware of the severity.

• Consistency: Stuttering can be highly variable, often disappearing during distraction or automatic speech (e.g., singing).

neurogenic vs functional acquired stuttering

• both are formsof acquired stuttering

• Neurogenic stuttering stems from brain-based damage with more predictable patterns, while functional stuttering arises from emotional or psychological causes and tends to be more inconsistent and unusual in presentation.

functional acquired stuttering treatment

• Combined psychotherapy with fluency shaping

• Not consciously doing these things, treatment is real and it needs to be treated as such

• Enhancing fluency- slow/relax speech

• Relaxing muscles and also, easy speech starting at the sound level

• Delay aud feedback

• Emotional coping skills 

3 fluency shaping techniques

• Easy starts/onset

  • Start with continuous airflow sounds: /m, n, w, j, l, r/; words to phrases, etc.

  • Mmmmmy cat is named Apple.

• Pausing and phrasing

  • Brief pause between words/phrases: controls conversational pace

  • Our cohort // is the most talented cohort // the world has ever seen.

• Light contact/touch

  • Brush articulators together with less physical tension; prevents fixed position

stuttering and medication

Medications that have been studied for stuttering mostly target dopamine, a neurotransmitter involved in motor control, reward, and speech regulation. Research suggests that people who stutter may have increased dopamine activity in certain brain regions, which could interfere with the smooth coordination of speech.

Here’s how these medications work:

• Dopamine antagonists (like risperidone, olanzapine, and haloperidol) reduce dopamine activity by blocking dopamine receptors in the brain. This is thought to help reduce the "overactivity" that may contribute to stuttering.

• side effects: drowsiness, weight gain, or emotional blunting, especially with older medications.

• medications don’t cure stuttering and are not a first-line treatment