FLUENCY - INTRO TO STUTTERING

Fluency

• From the latin word of flowing (fluentem)

• describes what the listener perceives when listening to someone who is truly adept at producing speech

• continuous and effortless flow of both movement and information; effortless flow of speech

• No disruptions in the sequence of sounds and words and the listener can attend to the message rather than considering how the message is being produced

Fluentem

• latin word of flowing

Continuity, Smoothness, Rate, Effort

• Four words that describe fluency in speech production

• All speakers are disfluent at times, They may hesitate when speaking, use fillers (“like” or “uh”).

Linguistic Fluency

• Syntactic, Pragmatic, Phonologic, Pragmatic Fluency

Syntactic Fluency

• Ca use variety of forms in order to put together increasingly complex sentence structures

Semantic Fluency

• Have a large vocabulary repertoire

Phonologic Fluency

• Capable of producing sequencing of sounds of increasing length and complexity in language that are both familiar and unfamiliar

Pragmatic Fluency

• Able to respond appropriately in a timely manner in various contexts

Speech Fluency

• Components: Continuity, Rate, Effort

Continuity

• Logical sequencing of syllables and words, where a logical “flow” of information is established during speaking. It also refers to the presence and absence of pauses, which are said to mark the disruption of the flow of the sound

Pauses

Another aspect of continuity which refers to disruption by a speaker in order to signal a linguistically important event

Conventional, Idiosyncratic, Unfilled, Filled

TYPES OF PAUSES

1. Type of pause is used by a speaker in order to signal a linguistically important event

2. Speaker hesitates or becomes uncertain about what is being said

3. Characterized as silence lasting longer than approximately 250 milliseconds

4. Fillers such as “ah”, “err”, “uh”, and “um” are used to make a continuous flows of speech but essentially disrupts the flow of information

Rate

• The number of syllables that a speaker produces per second

  • How many syllables can be said in one minute

• Wide range of acceptable rates in the judgement of fluency 

• When speaking in a noisy environment, speakers are likely to slow down

Formality, Time Pressure, Interference from Background Noise

Factors that affect rate (3)

Effort

• Most important dimension of fluency

• The listener’s perception of effort is the most sensitive indicator of fluent

• The perception of effort is closely related to the force of contact between opposing articulators

  • Little sensation of opposition of the articulators, or constriction of airflow

    • Some people may have sudden blocks of airflow

  • On the other hand, people who stutter are typically at the opposite end of the effort

• Both the cognitive effort necessary

Effort associated with linguistic planning, Effort associated with muscle movement

2 types of effort

1. Effort in thinking what to say next

2. Tension when talking and how to move articulators

Normally fluent speech

• Sounds natural to listeners

• Contains normal disfluencies (interjections, revisions, whole-word repetitions)

• Associated by listeners with faster speech rates within the normal range

• Perceived by speakers to be associated with less cognitive effort

• Associated by speakers with faster rather than slower and less natural speech

• Associated by speakers with feeling good or neutral about speaking

• Associated with speakers who are focused on communicating a message rather than paying attention to the process of speaking

Fluency Disorder

• An interuption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies (e.g. repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors and secondary mannerisms (ASHA)

• They also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder

  • Less participation in school

Disfluency

• Used in literature to refer to the fluency breaks of normal/typical speakers

• dis - = reversal, separation or duplicaton

Dysfluency

• Describe the abnormal fluency of breaks of people who stutter (PWS) 

• Dys- means difficult, impaired, painful, bad, or disordered

Disfluency

• Interruptions that disrupt the natural flow and rhythm of speech

• Includes:

  • Phrase repetitions

  • Gap fillers

Stuttering

• A type of speech disorder characterized by unusually high rates of repetition, prolongation, and/or blockage that interrupt the flow and rhythm of speech

• Sometimes people who stutter exhibit behaviors like head nodding or eye blinking to stop or keep from stuttering

• May also avoid using certain words or use different words to keep from stuttering

• Can be: Unnatural, avoiding words,

• Most of the time, it is unpredictable

  • Some phonemes or the start of words can possibly make you stutter, but it does not guarantee that you will stutter or not  

  • But there are indicators

• Typical cognitive level and high level of awareness → instead of stuttering, they won’t talk → affects their activities of daily living

• Stuttering can affect feelings and attitudes

  • Feeling of frustration, fear, embarrassment

  • A person who stutters may also stutter more if others tease them or bring attention to their speech

  • Stuttering may cause a person to be embarrassed and make them feel nervous about talking

Primary Behaviors

• Disfluencies developed since childhood

• Thought of as a transient phenomenon characterized by a child’s easy repetitions of syllables and words

• Child is typically unaware of these events and displays no special effort or tension during speaking

• Initial motoric behaviors taking place in the speech production mechanism have been refered to as core, alpha, or pure fluency disruptions

Repetition, Prolongation, Blocks

3 types of primary/core behaviors

1. Sound, syllable, or single-syllable word repeated several times

2. Prolongations of voiced or voiceless sounds

3. Inability of the speaker to initiate speech, often signaled by a postural fixation

   • Articulators stay in the posture where sound is meant to be produced

   • Airflow stops/blocks

   • Referred as speech disfluencies

Secondary Behaviors

• Reactions developed from primary behaviors

• Developed in response to disfluencies; may be visible or hidden

Escape behavior, Avoidance Behaviors

Types of secondary behaviors

1. Attempt to terminate a tutter and finish the word. Occurs when the speaker is already in a moment of stuttering (eye blinking, head nodding)

2. Speaker’s attempt to prevent stuttering when he or she anticipates stuttering on a word or in a situation. Does not say the word because of awareness of stuttering: uses another word

Equivalent terms

Stuttering - stammering

Fluency - Normal speech

Disfluency - Dysfluency

Normal Fluency Breaks

• An interruption of speech in  a typically developing individual

• More likely to be considered normal or nonstutered if it is the result of linguistic uncertainty planning – speaker is hesitating because he has not yet formulated how to express himself

  • Uncertain or thinking about what to say next

• Interjection: adding a sound or word

  • I um need to go home

• Repeating whole words

  • Cookies cookies and milk

  • Especially in children, not because they want to correct their production

• Repeating phrases

  • He is - he is 4 years old

• Revisions

  • changing the words in a sentence

    • I had-I lost my tooth

Feelings, attitudes

• Cognitive and affective components

  1. May precipitate stutters, just as stutters may create feelings. They become frustrated or ashamed because they can’t say what they want to say as smoothly and quickly as others

  2. Feelings that have become a pervasive part of a person’s beliefs (ex. Feel dumb). Beliefs that were developed due to the behavior

Formulative Fluency Breaks

• Breaks (usually in the form of repetitions) between whole words, phrases, and larger syntactic units and interjections between whole-word or larget

• Little or no effort or tension

• Result of linguistic planning or uncertainty and may provide the speaker time to organize the 

• TYPICAL DISFLUENCY

Motoric Fluency Breaks

• Characterized by:

  • Breaks

    • Between sounds or syllables (part-word breaks)

  • Obvious Effort/ Tension

    • Often focused in but not limited to the vocal tract

  • Pauses

    • With a possible cessation of airflow and voicing

  • Excessive prolongation of sounds or syllables

Prevalence

A term used to indicate how widespread a disorder is

Incidence

An index of how many people have stuttered at some time in their lives

Epidemiological attributes

• The factors contributing to the incidence and prevalence of a problem;

• The possibility of the problem remitting or becoming chronic and;

• Changes in symptomatology and subtypes

• The factors contributing to the incidence and prevalence of a problem;

• The possibility of the problem remitting or becoming chronic and;

• Changes in symptomatology and subtypes

Age & Gender, Rate & Uniformity of Onset, Stuttering-Like Disfluencies (SLD), Clustering of Disfluencies, Awareness and Reaction of the Child to Disfluency

Characteristics at Onset (5)

Age & Gender

• Stuttering usually starts between 2 and 6 years of age. 

• Many children go through normal periods of disfluency lasting less than 6 months. 

  • Stuttering lasting longer than this may need treatment

• Stuttering rarely begins after the early childhood years

• Boys are more likely to continue stuttering than girls. 

  • Data are currently limited to individuals who identify as male or female

Rate and Uniformity of Onset

• The nature of the fluency characteristics at onset is closely related to the rate of onset.

  • Dating back to the 19th century, the long-held view was that stuttering developed gradually and followed a uniform pattern of development

• The onset of developmental stuttering is not necessarily gradual or uniform (Yairi et al.). 

  • The gradual and linear development of stuttering is associated with the description of primary and secondary stuttering.

• A few investigators had noted that children sometimes experienced sudden onset and presented with what had been previously considered to be advanced (secondary) behaviors. 

• In some instances, children began stuttering within a single day, demonstrating at the outset disfluencies that were unusual and obviously different to the more common fluency breaks of other young, normally fluent speakers.

• Children who start stuttering at age 3½ or later are more likely to continue stuttering

Stuttering-Like Disfluencies (SLDs)

• Stuttering-like disfluencies are composed of three basic types of disfluencies:

  • Part-word repetitions 

  • Single-syllable word repetitions 

  • Disrhythmic phonations

    • Includes sound prolongations or blocks of airflow and voicing

Clustering of Disfluencies

• Several researchers have noted the tendency for children who stutter to produce a sequence of disfluencies in close proximity to one another

• Two or more consecutive disfluencies that occur within the same word, on adjacent words, or on a word and an adjacent between-word interval

Awareness and Reaction of Child to Disfluency

Yairi and Ambrose (2005) have also studied this issue and point out that because fluency is highly variable and the child’s awareness of his or her disfluencies is momentary, it depends not only on how children are asked to indicate their awareness but when some children who have recently begun to stutter are aware of their situation and are beginning to react negatively

More Influential Factors

Conditions Contributing to Onset

• Age

• Gender

• Twinning

• Genetic factors

• Cognitive Abilities

• Motor Abilities

• Speech and Language Development 

• Response to Emotional Events

Less Influential Factors

Conditions Contributing to Onset

• Physical development and Illness 

• Culture, nationality and Socioeconomic Status

• Bilingualism

• Imitation