ASLP 5800 (fluency) exam 1

fluency disorder

interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors; and secondary mannerisms

fluent speech

• ease and ongoing flow of speech muscular movements and the resulting produced speech sounds

• elements of speech we recognize as rate, continuity, and tension effort

persistent stuttering

people who continue to present the characteristics of stuttering throughout their lifetime

physical tension in stuttering

• refers to the observable muscle tightness or strain that people who stutter often experience in their face, jaw, neck, and upper body when they are struggling to produce speech

• ex: facial grimace, rapid eye blinking, clenched fists, or head nodding

typical disfluencies

• no more than 10 disfluencies per 100 words

• typically one unit repetitions, occasionally two

atypical disfluencies

• when there are secondary behaviors

• 11 or more disfluencies per 100 words

predictors of stuttering

• family history (about 50% of PWS have relatives who do too)

• gender (male)

• age of onset

• trend of stuttering frequency and severity (someone who stutters more/more severe is more likely to persist)

• duration since onset

• duration of stuttering moments

• continued presence of sound prolongations and blocks

• phonological skills

prevalence

• proportion of a population who have a specific characteristic in a given time period

• estimated number of people who exhibit an identified trait or characteristic at any given time

prevalence of stuttering

• about 5% of kids go through a period of stuttering

• there are 3-4x as many boys who stutter as girls

• about half of kids who stutter have a family member who also stutters

• about 3.5% of preschoolers are reported to stutter

• about 1% of school ages kids are reported to stutter

• about 2% of kids ages 3-17 years stutter

• about 1% of adults are reported to stutter

incidence

• “the occurrence, rate, or frequency of a disease, crime, or something else undesirable”

• estimated chance or percentage of the occurrence of a specific disorder

incidence of stuttering

usually accepted that the overall incidence of stuttering in the US is about 1% but in the preschool and school populations it is around 4% and at all ages seem to be more common among males than females

familiality incidence

stuttering occurs more in people who have one or more family members who stutter concurrently or have stuttered in the past

age incidence

a large proportion of cases of stuttering begin during the preschool years (between 2-4)

gender incidence

stuttering is substantially more prominent in males vs. females

geography incidence

• worldwide incidence of stuttering appears to be about 5%

• most incidence info comes from North America, Europe, and Australia

culture incidence

no supported evidence that shows a significant difference in incidence rates of stuttering from one culture to the next

hearing impairment incidence

the incidence rate of people who have a hearing impairment and who stutter is very low

cleft palate incidence

low incidence rate of stuttering, which has brought about the idea of exploring the physiological considerations of stuttering and relationship of intraoral pressure and rate of verbalization

cognitive impairment incidence

• incidence rates in people with intellectual disabilities are higher than the incidence rates in the general population

• according to some studies the prevalence of stuttering is higher in groups with lower intellectual functioning

inconclusive incidence of stuttering correlation

• autism

• culture

• geography

• bilingualism

etiology

• cause of stuttering is unknown in its exact form

• the cause has started debates and continuous curiosity and research

blocks

inappropriate stoppage of the flow of air or voice, and often the movement of articulators as well

repetitions

• a sound, syllable, or single syllable words that is repeated several times

• the speaker is apparently “stuck” on that sound or syllable and continues repeating it until the following sound can be produced

prolongations

a disfluency in which sound or air flow continues but movement of the articulators is stopped

interjections

insertion of filler words like “um” into speech as a way to pause or gain time before a potentially difficult word

hesitations

noticeable pauses or delays in speech

filler words

word being used as placeholders during speech (ex: “uh” or “um”)

avoidance behaviors

a speaker’s attempt to change a word or topic to prevent a stuttering moment

escape behaviors

a speaker’s attempt to terminate a stutter and finish the word; occurs when the speaker is already in a moment of stuttering

environmental factors that impact the development of stuttering

• parents can be overbearing or the little things that they are doing to affect the child

• speech and language environments

• rate of speech, interruptions, asking questions

• environments that are better for the child can improve their stuttering

• life events - a family illness or a big move

social and emotional development related to stutering

• social growth and development occurs in stages

• kids who are predisposed to stuttering may be more affected by typical emotional conflicts - these events may trigger the onset of stuttering or may increase the frequency and severity

speech and language development factors related to stuttering

• guitar reports “early language learning can be the stress most frequently associated with the onset of stuttering”

• early language learner is learning new words, but also new articulatory patterns

sensorimotor factors

studies show one possible factor → people who stutter may have inherited a sensorimotor system that will not support fluent speech

diagnosogenic theory (semantogenic)

• stuttering is a learned response

• proposed that stuttering began when parents would “erroneously” assign the stuttering label to typical disfluency - reported that research indicated the parents from the study were “strict, perfectionist, demanding”

• proposes the child react tot he parental expectations and demands, the family became disappointed with more stuttering

• includes “the monster” study

psycholinguistic theories

• covert-repair hypothesis

  • strengths: identifying the breakdown and covert behaviors

  • weaknesses: PWS don’t make more phonological errors than others

• fault line hypothesis

  • strengths: execution of stress is a phonatory experience

  • weaknesses: not all stressed syllables are stuttered

• neuropsycholinguistic theory

  • strengths: stuttering is the speaker’s time and place holding activity until speech components are arranged and ready for execution

biological theories

• stuttering as a disorder of brain organizations

• disorder of timing, reduced capacity for internal modeling, language production deficit, multifactorial dynamic disorder

audition theory

• exploration to what are auditory and audition functions on how they help or hurt stuttering in general

• delayed auditory feedback (DAF) “magically cures” stuttering but it never lasts longer than 3 weeks

• what is different in hearing? does it have anything to do with stuttering?

two stage etiological model

• primary stuttering: repetition due to dys-synchrony and biology

• secondary stuttering: secondary behaviors appear as a result of the speakers constitutional factors

factors in stuttering onset

• competition of neurons may impact onset and development of stuttering

• early language learning can be the stress most frequently associated with the onset of stuttering

• emotional events may trigger the onset of stuttering or may increase the frequency and severity

most common types of typical disfluencies

• revisions are common and may account for a large number of the disfluencies counted

• interjections are common but will decline

• repetitions are common around age 2 and 3, starting with single syllable words and can gradually become phrase repetitions

4 stages of stuttering

• borderline stuttering

• beginning stuttering

• intermediate stuttering

• advanced stuttering

borderline stuttering

• typically begins between the ages of 2 and 3.5

• resembles typical disfluency but is usually more frequent - can exhibit typical disfluency periods and periods of borderline stuttering

• frequency: 6-10 or more disfluencies per 100 words

• proportion of repetitions: more than 2 units; more sound, syllable, and single syllable word reps and more prolongations

• little evidence of secondary behaviors or avoidance or reaction, momentary surprise or mild frustration

beginning stuttering

• beginning signs of muscular tightness, reps are rapid and irregular

• pitch rise toward the end of a repetition or prolongation

• fixed articulatory posture due to tension

• beginning awareness of difficulty of speaking and feelings of frustration, may verbalize frustration

intermediate stuttering

• frequent blocks, many repetitions, and prolongations

• escape behaviors are used to minimize or terminate blocks

• anticipation of blocks will increase avoidance behaviors in words and situations

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

advanced stuttering

• stuttering characteristics are longer, more tension, possible tremors in the articulators → will see repetitions and prolongations

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

• complex patterns of avoidance and escape behaviors usually rapid and habituated, sometimes the speaker may not be aware of his/her behaviors

• emotions of fear, embarrassment and shame are very strong

• negative feelings about self, feelings of hopelessness and ineptness

the stuttering “iceberg”

• representation depicting how a PWS might feel, what they might experience

• meant to be multifactorial

• not an individualized symbol, but addressing it should be individualized