Voice and Fluency: CSAD 123 - EXAM 1

Exam 1 – Fluency (75mins) -- Covering Guitar Chapters 1 – 7 (multiple choice exam)

Based on 4 variables: What is Stuttering?

—Continuity

—Effort

—Rate

—Rhythm

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What causes stuttering?

No known cause, can run in family.

—Developmental influences

—Environmental influences

Developing stuttering: stuttering - at ages 2-5

* Rapid speech and language development

* Growth & change

Core behaviors of stuttering

1. REPETITIONS

2. Prolongations

3. Blocks

Core behavior #1: Repetitions

• Observed most frequently at onset of stuttering

• Sound, syllable, or single-syllable word repeated several times

• may be single-syllable word or part-word

  repetitions

  • Word or syllable repeated more than two times, li-li-li-like this.

Core behaviors #1: Prolongations

• Voiced or voiceless sounds

• Usually appear somewhat later than repetitions

• Airflow continues but movement of articulators appears to be stopped

• Duration: 0.5 seconds – several minutes

Core behavior #2: Blocks

When seeing someone trying to push the sound but ends up stuck.

• Typically last to emerge

• Pause in flow of air as well as movement of articulators

• May be a learned behavior in response to fear of stuttering (increased

pressure in mouth and jaw)

• inappropriate stoppage of airflow or voicing;

movement of articulators may be stopped

• Blocks may occur at any level—respiratory, laryngeal, and/or

articulatory.

• Blocks may be accompanied by tremors of lips, tongue, jaw,

and/or laryngeal muscles.

• On average, stutterers stutter on about 10% of words while

reading.

• On average, stutters last about 1 second.

Major categories of secondary stuttering behaviors (behavior acquired as a attempt not to stutter

1. Avoidance: can be movement that occurs before an anticipated stutter

• Eye blinks, fillers (uh, etc) postponements, starters, substitutions, timing

  devices (i.e., hand movements times with the word)

1. Escape: occurs after the moment of stuttering.

• Small visible movements afterwords

• Eye blinks, fillers (uh, etc.), head nods, etc.

World Health Organization: ICF Perspective

Function and disability: includes anatomical structures that cause

the impairment (for stuttering, cortical and subcortical structures,

such as white matter tracts)

Activity and Participation: Stuttering can affect basic human

activities, such as speaking and conversing

Environment: Stuttering is influenced both by home environment, as

well as personal factors

Prevalence (picture of population)

How widespread a disorder is among the entirety of the population, at any given moment

• “Snapshot”

• For stuttering, prevalence is about 1%

Incidence

Measures how many people hace stuttered at some point in their lives (possibly not currently)

• For stuttering, incidence is about 5% of the population

Recovery in children

The most reliable studies show that about 80% of early stutterers recover naturally (i.e., without intervention)

• “Early stuttering:” generally refers to children between ages 3 -5

• Inability to naturally recover is called “persistence

(persitance-: ability to naturally overcome stuttering)

Factors that contribute to recovery

— Family history

— Gender

— Age at onset

— Trend of stuttering frequency and severity

— Duration since onset

— Duration of stuttering moments

— Continued presence of prolongations and blocks

—Phonological skills

Gender ratio in school Population

• Within the population: 3:1

• Within younger populations: 1:1

WHY??

• Sex-linked patterns of genetic

transmission

• Differences in constitution

• Physical maturation

• Nurture factors/gender expectations

Anticipation

an individual’s ability to predict the words or sounds

on which they will stutter

Consistency

Stutterer’s tendency to stutter on the same words when they read a passage multiple times

Adaption

Tendency for speakers to stutter less and less each time they read the same passage

Stuttering and language: Brown’s FINDINGS for “Occurrence of Stutter”:

• Consonants

• Sounds in word-initial position

• Speech in a larger context (ongoing speech)

• Nouns, verbs, adj, and adverbs (in more experienced speakers); pronouns and conjunctions (in less experienced speakers)

• Longer words

• Words at the beginning of sentences

• Stressed syllables

• Patterns are more variable and less stable as language matures

Fluency-Inducing Conditions (END OF LECTURE 1)

• When a speaker is alone or relaxed

• In unison with another speaker

• Speaking to an animal or infant

• In time with a rhythmic stimulus

• When singing

• In different dialect

• While simultaneously writing

• When swearing

Fluency

The effortless flow of speech.

Disfluency

An interruption of speech that can occur in both typical speakers and those who stutter

=either normal or abnormal

is preferable to “dysfluency”

Starkweather (1980,1990)

suggests that rate and effort are

critical to fluency.

• Thus, a fluent speaker effortlessly

produces speech at a rate

comfortable to listeners

Secondary Behaviors

• Learned behaviors triggered by the experience of stuttering or

anticipation of it

—Avoidance behavior

—Escape behaviors

Feelings and Attitudes

• The experience of stuttering often creates feelings of

embarrassment and frustration in a speaker.

• Feelings become more severe as the speaker has more

stuttering experiences.

• Fear and shame may develop and may contribute to the

frequency and severity of stuttering.

• Attitudes are feelings affect the person’s beliefs.

• Beliefs may be about oneself or listeners.

Functioning, Disability and Health

THE HANDICAP IS THE LIMITATION IT PUTS ON INDIVIDUALS’S LIVES

Feelings and attitudes

• The disability of stuttering is the limitation it puts on individuals’

ability to communicate.

• This limitation is affected by the severity of stuttering as well as

feelings and attitudes that people who stutter have about

themselves and about how listeners have reacted to them.

• The handicap is the limitation it puts on individuals’ lives.

• This refers to the lack of fulfillment they have in social life,

school, job, and community

Stuttering and their implications for the nature of stuttering #1

Onset: • May start as gradual increase in normal childhood disfluencies or may start as

sudden appearance of prolongations or blocks.

• Often sporadic at outset, coming and going for periods of days or weeks before

becoming persistent.

• Onset may occur between 18 months and 12 years but most often between 2

and 3.5 years (average 2.8 years).

Prevalence: A measure of how many people stutter at any given time.

• Prevalence is 2.4% in kindergarten, about 1% in school-age children, and

slightly less than 1% in adults.

Stuttering and their implications for the nature of stuttering #2

Incidence: A measure of how many people have stuttered at some point in their lives

• About 5%

Recovery from stuttering: Somewhere between 70% and 80% of children who begin to stutter recover without treatment

Stuttering and their implications for the nature of stuttering #3

Children with these attributes have less likelihood of spontaneous (Yairi & Ambrose, 2005):

• Having relatives who were persistent stutterers

• Being male

• Onset after 3.5 years

• Stuttering not decreasing during first year after onset

• Stuttering persisting beyond 1 year after onset

• Multiple unit repetitions (li-li-li-li-like this)

• Continued presence of prolongations and blocks

• Below normal phonological skills

Stuttering and their implications for the nature of stuttering #4

Evidence that recovery is associated with:

—Right-handed

—Growing up in a home with a mother who is nondirective (reduces demand?)

—Having a slower speech rate and more mature speech motor system

Stuttering and their implications for the nature of stuttering #5

Influencing persistence versus recovery:

—Mothers of children who recovered used simpler language when talking to their children

—White matter tracts in brain of children who recovered may be more developed/ mature than those who persisted

—Duration of breastfeeding was longer for children who recovered than for persistent children

Continuity: Characteristic of Fluent Speech

Smooth & continuous production of intended words without interruption

Continuity: Characteristic of disfluent speech

Choppy flow of speech, marred by (1) inappropriate pauses; (2) repetitions of sounds, syllables, words, or phrases; (3) prolongations of sounds; and/or (4) moments of being unable to finish words that were started (blocks)

Effort: Characteristic of Fluent Speech

Ordinary, expected movements to produce speech that do not distract

from the message

Effort: Characteristic of disfluent speech

Moments when the exertion or struggle of speaking interrupts the smooth flow of speech and may distract from the message

Rate: Characteristic of Fluent Speech

Speed of speaking that matches listener’s comprehension and expectation, and sounds natural

Rate: Characteristic of disfluent speech

Speaking too fast, especially in bursts or speaking too slowly in an unnatural way that may be the speaker’s attempt to avoid a stutter

Rhythm: Characteristic of Fluent Speech

Speaking with the stress pattern that is natural for the language

Rhythm: Characteristic of disfluent speech

Speaking in a monotone so that each word has equal stress. This may serve to avoid stuttering, but it distracts from the speaker’s message

Do All Cultures Have Stuttering?

• Stuttering is found in all parts of the world and in all cultures and

races.

• Indiscriminate of occupation, intelligence, and income.

• Affects both sexes and people of all ages, from toddlers to the

elderly.

What Causes People to Stutter?

• The causes of stuttering are not completely understood, but

scientists believe these are important factors:

• Genetic and congenital influences

• Developmental influences

• Environmental influences

• Repeated negative emotional experiences with stuttering lead

to negative feelings and attitudes.

What is Stuttering?

• Abnormally high frequency and/or duration of stoppages in the

flow of speech

• Includes speakers’ reactions to stoppages

• Reactions are behavioral, emotional, and cognitive responses

to repeated experiences of getting stuck while talking

• Must distinguish between stuttering and typical disfluencies, as

well as from neurogenic and psychogenic stuttering

Secondary Behaviors: Escape behaviors

attempts to terminate the stutter and finish

the word (eg, eye blinks and head nods)

Secondary Behaviors: Avoidance behaviors

anticipation of a stutter and attempts to

avoid it by, for example, changing the word or saying “uh” just

before the word

The Human Face of Stuttering

• Case examples of individuals who stutter are presented in the

Chapter 1 videos.

• These examples include individuals at these developmental

levels:

• Borderline stuttering—young preschool age

• Beginning stuttering—older preschool age

• Intermediate stuttering—school age

• Advanced stuttering—teens and adults

Sex Ratio

• The sex ratio is almost even (1:1) at the onset of stuttering.

• However, girls start to stutter earlier than boys and recover

more frequently so that by the time they are of school age, the

ratio becomes three boys to every girl who stutters and

continues at a 3:1 ratio.

• Girls begin to stutter earlier than boys and recover earlier and

more frequently.

Variability and Predictability of Stuttering

• In the 1930s, interest in stuttering turned from its medical or

organic aspects to social, psychological, and linguistic aspects

such as these:

• Anticipation: People who stutter can predict which words they

will stutter on in a reading passage.

• Consistency: People who stutter tend to stutter on the same

words each time they read a passage.

• Adaptation: People who stutter less each time they read a

passage up to about six readings

Language Factors #1

• Brown showed that adults stutter more frequently on:

• Consonants

• Sounds in word-initial position

• Sounds in contextual speech

• Nouns, verbs, adjectives, and adverbs

• Longer words

• Words at beginnings of sentences

• Stressed syllables

Language Factors #2

• Loci and frequency of stuttering are different in preschool children

than in older individuals.

• Stuttering in preschool children occurs most frequently on pronouns

and conjunctions.

• Stuttering appears most frequently as repetitions of parts of words

and single-syllable words in sentence-initial position.

• The trigger seems to be linguistic planning and preparation.

Fluency-Inducing Conditions #1

• Many conditions have been found which reduce or eliminate

stuttering. These include speaking:

• When alone, when relaxed

• In unison with another speaker

• To an animal or infant

• In time or a rhythmic stimulus or when singing, in a different dialect

• While simultaneously writing, while swearing

• In a slow, prolonged manner

• Under loud masking noise, while listening to delayed auditory feedback

• When shadowing another speaker, when reinforced for fluent speech

Fluency-Inducing Conditions #2

• Fluency-inducing conditions result from reduced demands on

speech motor control and language formation.

• Recent brain imaging studies have showed that cortical and

subcortical networks are impaired in people who stutter.

• Fluency-inducing conditions may work because they help

individuals compensate for the deficits in neural systems by:

• Providing timing cues

• Slowing the rate of speech production

• Allowing the person who stutters to focus total attention on producing

fluent speech

An Integration #1

• Stuttering is a neurodevelopmental disorder that usually

appears in the preschool years when language development or

the child’s environment create enough stress to trigger speech

production discoordination that results in an excess of

disfluencies.

An Integration #2

—The child may regain fluency when stresses are reduced or the child learns to compensate. Some children recover completely

—Other children persist in stuttering, because their neutral pathways remain inadequate for fluency and/or because they react negatively to their early stuttering

—Children who persist usually develop learned behaviors, making their stuttering more conspicuous

What Do We Know About Constitutional Factors in

Stuttering?

—Factors inside the person—aspects of their constitutional makeup—influence their stuttering.

—Knowing this will help you counsel people who stutter and reassure parents of children who stutter to help them understand that stuttering is not their fault.

Information about the biological or constitutional factors of

stuttering collected through:

—Family studies

—Twin studies

—Adoption studies

—Genes

Family Studies: Findings

—Stuttering appears to be inherited

—Stuttering best explained as interaction of several genes and the environment, including effect of epigenetics

—Children from families with persistent stuttering themselves

Clinical Implications #1

— Parents should be told that stuttering is often inherited, not a result of bad parenting

—Prognosis for natural recovery is related to number of recovery factors

Twin Studies: Findings

—Stuttering in identical and fraternal twins

—Greater concordance among identical twins

—Twin studies confirm that genetic influence in stuttering is a major factor, with environmental influence being importance being important but having a little less influence.

Clinical Implications #2

—Environment should be made as fluency facilitating as possible, because it decreases any negative influence of environment and will help children who are genetically predisposed to stuttering.

Adoption Studies: Findings

—Research on families of stutters who were adopted soon after birth

—Adoption studies provide evidence for both genetic and environmental factors, with the influence of genetic factors being greater

Clinical Implication #3

—Fact that a relative has persistent stuttering does not assure that stuttering will occur.

—Environment should be made as fluency-friendly as possible

Gene Studies: Findings #1

• Looking for genes and the chromosomes on which they are

located.

• Genes associated with stuttering have been found on

chromosomes 1, 2p, 3q, 3p, 7, 9, 12, 13, 14q, 15q, 16, and 18.

• Persistent and recovered stuttering is associated with

chromosome 9; persistent stuttering is only associated with

chromosome 15