Stuttering Quiz 1

Dis

typical

Dys

disordered (dysphagia, dysarthria)

Fluency

the ability to speak easily and smoothly

Disfluency

• interruption of the flow of speech

  • non-stuttering like disfluencies

  • stuttering-like disfluencies

Non-Stuttering Like Disfluencies

• Repetitions:

  • Single-syllable words (without tension): “I-I think I want a snack.”

  • Multisyllabic whole words: “Open - open the door.”

  • Phrases: “I want - I want a cookie.”

• Revisions:

  • “I like unicorns, no, I mean dragons.”

  • Interjections: “Um, uh, er, well, like, so”

Stuttering - Like Disfluencies

• Repetitions:

  • Single-syllable words (with tension): “I-I think I want a snack.”

  • Sounds of syllables (part-word repetitions): “I see a d-d-duck” or I love Spid-Spiderman”

• Prolongations: “I ssssssssee you”

• Broken Words: “This is an ex-ample.”

Stuttering is made up of:

• core behaviors

• feelings and attitudes

• secondary behaviors

Core Behaviors of Stuttering

• Repetitions

  • Part-word repetitions

    • Sound repetitions: b-b-b-banana

    • Syllable repetitions: ba-ba-ba-banana

  • Whole word repetitions: I-I-I-I

• Prolongations

  • Involuntary lengthening or prolonging of voiced (rrrrrrunning, aaaaple) or voiceless (ssssseven, fffffourteen) speech sounds

  • Usually occur at beginning or in the middle of words; RARE to occur at the end of words

  • Can occur on consonants or vowels

• Blocks

  • Audible blocks: ba ———nanna

  • Inaudible blocks: “I would like to buy a ——- banana.”

  • Hallmark: a temporary breakdown in respiration

Things to consider

• types of disfluencies

• amount of disfluencies

• duration of disfluencies

• affective components

• cognitive components

• secondary behaviors

Affective components

• guilt

• shame

• embarrassment 

• fear

• frustration

Secondary Behaviors

• Escape Behaviors:

  • Speaker attempts to terminate the moment of stuttering and finish the word

  • Examples: physical concomitants such as movement of the extremities, eye blinks, facial grimaces

• Avoidance behaviors

  • speaker tries to avoid a disfluency and the negative feelings that accompany disfluencies

  • Examples: changes the word, does not enter certain situations, has someone else speak for them

Cognitive Components

• Someone’s interpretation about stuttering and how it affects their life

  • Preschool: “I can’t talk”

  • School-age: “I can’t say my name.”

  • Adolescent: “I have to work in a profession that I don’t have to talk a lot.”

  • Adult: “I won’t get a promotion if I stutter.”

Cognitive Components (This leads to):

• Avoidance of communication

  • With certain people

  • In certain situations

  • Using certain words

• Not meeting true potential

  • Academically

  • Professionally

Types of Disfluencies

• Typical developmental disfluencies — NOT a fluency disorder

• Neurogenic stuttering

• Psychogenic stuttering

• Covert stuttering

Typical Developmental Disfluencies

• Occur most often between 1.5 - 5 years old

• Tend to wax and wane/develop and change over time

• No link to psychological or organic trauma

• Typically no more than 10 disfluencies per 100 words

• Typically signs that a child is learning to use language in new ways

• Generally no signs of tension or struggle

Normal vs. Abnormal

• Must consider:

  • Amount of disfluency: less than 1% of syllables stuttered

  • Type of disfluency: multisyllabic whole-word repetitions, phrase repetitions, interjections, revisions

  • Number of iterations of repetitions or interjections: 1-2

Treat or not to treat

• Borderline Behaviors

  • Single syllable/whole world repetitions: I-I, you-you

  • Part word repetitions of two or three iterations: w-w-water

  • Prolongations

  • No struggle or tension

• Indicators that treatment is warranted!

  • Increased iterations of repetitions: w-w-w-w-w-water

  • Prolongations with pitch and/or loudness changes

  • Blocks

  • Struggle, tension, word avoidance

Preschool Risk Factors

• sex

• time since onset

• family history of persistence and recovery

• age of onset

• phonological skills

• pattern of development

Beginning stuttering

• stuttering may still come and go, but periods of fluency may last only a few days

• number of repetitions increases

• tension increases and struggle is evident

• feelings and attitudes: because stuttering is episodic, child doesn’t feel that they are a “defective speaker” — just that sometimes they have trouble talking

Intermediate stuttering

• two characteristics to distinguish between intermediate and beginning stuttering:

  • fear of stuttering (situations and words) emerges

    • shifts from frustration/surprise/annoyance

  • reacting to stuttering with regular avoidance and struggle/tension

• scanning ahead when reading

Advanced stuttering

• pertains to older adolescents and adults (although not all progress to this stage)

• client can take more responsibility for work in therapy, BUT

  • ineffective communication patterns and misperceptions are well-established at this point and difficult to change

  • do not always accept stuttering and some do not use the word

Covert stuttering

• “I will hide my stuttering at all costs.”

• “You may never hear me stutter.”

• Most difficult to treat! Why?

• Fear needs to be addressed

• Support groups are important

Neurogenic stuttering

• an acquired fluency disorder resulting from neurological trauma/pathology

• commonly results following CVA but can be associated with a range of etiologies:

  • brain tumor

  • degenerative disease

  • TBI

  • dementia

  • parkinson’s disease

  • drug use

  • renal disease

• main characteristics:

  • sound and syllable repetitions

  • no secondary behaviors

• little consensus among researches to the reliability of these “distinguishing features”

Psychogenic Stuttering

• onset of stuttering is sudden and can be associated with significant trauma or event

• causes vary widely but include:

  • significant loss (e.g., death, end of a relationship)

  • personal health concerns

  • physical or sexual violence/abuse

• consistent factor among triggers: high levels of stress, anxiety, or both

What causes stuttering?

• there are many theories that attempt to explain the development and persistence of stuttering 

• only a few have stood the test of time

• most likely explanations are:

  • multifactorial

  • polydimensional

Multifactorial-Polydimensional Model

• these models assume that stuttering is the result of the complex interaction of numerous individualized factors like:

  • genetic composition

  • neurogenic conditions

  • psychological/emotional factors

  • environmental circumstances 

Breakdown Theories

• believe that stuttering is likely a motor disorder - - one of the parts involved in speech production encounters a struggle leading to the breakdown in production

  • “a momentary failure of the complicated coordination required among the systems involved in speech production”

• 1. Cerebral Dominance Hypotheses

• 2. Psycholinguistic Models

• 3. Demands and Capacities Model

Cerebral Dominance Theory: Then

• Orton-Travis theory

  • people who stutter had discoordination in lateralization

    • speech processing and production are L hemisphere dominant

    • PWS believed to have a dominance or lateralization shift, using more of the R hemisphere for speech

    • thought to be related to handedness (L handed/ambidextrous people)

Cerebral Dominance Theory: Now

• Forster-webster Hypothesis

  • brain imaging showed that PWS have more R hemisphere activity during speech production tasks

• DeNil et al.

  • PET scans showed the PWS show atypical lateralization during speech tasks

  • CAUTION: is it cause or consequence?

• Chang et al.

  • included 9-12 YOs who never stuttered, those who recovered from stuttering, and those with persistent stuttering

  • failed to confirm lateralization differences between the groups

  • reduced grey matter volume in stuttering groups

  • decreased left white matter integrity for both groups

• fNIRS and lateralization

  • with children (Sato et al)

    • again found discoordination in lateralization as compared to controls-even at preschool age

  • with adults (Tellis et al.,): in agreement with above-just with adults

Psycho-Linguistic Theories

• encoding

  • developing a linguistic (what you say) and motor (how you say it) plan for speech

• covert repair hypothesis

  • internal over-monitoring for errors in speech results in different types of stuttering

  • as errors are detected, the planning sequence is interrupted to correct it

Demands and Capacities Model

• stuttering occurs when the speaking demands on a child exceed the child’s capacities in one or more of the following areas:

  • motoric

  • linguistic

  • cognitive

  • socioemotional

Older Theories-Anticipatory Struggle Theory

• original theory: stuttering is a learned behavior

  • child has difficulty with speech (not necessarily stuttering) and experiences communication failure

  • child anticipates difficulty speaking next time

  • child reacts to speaking with tension and struggle, which causes stuttering

• updated theory: still a learned behavior

  • child has genetic predisposition to stutter and starts stuttering

  • child anticipates difficulty speaking next time

  • child reacts to speaking with tension and struggle which maintains the stuttering

Older Theories-Diagnosogenic Theory of Stuttering

• stuttering is caused by its diagnosis by parents or others

  • child hesitates, pauses, has normal disfluency

  • parent reacts to it as if it is stuttering and labels it as such

  • child then becomes a PWS

  • has been disproven

Multifactorial theory of stuttering development

• several factors act in combination in an individual to cause and/or maintain stuttering

• initial cause

  • genetics (predisposition for stuttering)

  • neurological differences (NOT brain damage or intelligence)

  • environmental stressors