FLUENCY Normal Fluency and Development of Stuttering

Core behaviors

• Describe the basic speech behaviors of stuttering: repetitions, prolongations and blocks

• Behaviors that seem involuntary to the person who stutters, as if out of their control

Secondary behaviors

• A speaker's reactions to his or her repetitions, prolongations, and blocks, in an attempt to end them quickly or avoid them altogether 

• These reactions may begin as random struggle but soon turn into well-learned patterns

• Can be divided into two broad classes: escape and avoidance behaviors

Feelings and attitudes

• Feelings may precipitate stutters, just as stutters may create feelings

• Attitudes are feelings that has become a pervasive part of a person’s beliefs

• for every developmental stage, may pagbabago in terms of behaviors

• Feelings may precipitate stutters, just as stutters create feelings 

Underlying processes

• These are speculations about the process that may cause disfluencies or stuttering at each developmental level.

• These processes explain why symptoms may change from level to level. Why stuttering often changes from borderline to beginning to intermediate to several levels

• Help us understand the nature of the symptoms, as well as the rationales for the treatment for stuttering

• probable reason bakit nagkakaroon ng developmental stage—-

Repetitions

• Core behavior

• mostly observed most frequently among children who are just beginning to stutter and are simply a sound, syllable, or single-syllable word that is repeated several times

• Speaker is “stuck” on a sound and continues repeating it until the following sound can be produced

• for early stutterers, mas common and single syllable repetitions and part word

• advanced stutters, sa isang word, lahat ng syllables nagsstutter - multisyllable repetitions

Prolongations

• Core behaviors

• Usually appear later than repetitions; although may be present at onset (Johnson et al, 1959; Yairi, 1997a)

  • Wait a little until they finish

• Denote stutters in which sound or airflow continues but movement of the articulators is stopped

• differs from repetitions (airflow is continuous)

• as short as half a second may be perceived as abnormal, but in core cases, they may last as long as several minutes (Van Riper, 1982)

  • need to wait a little before they finish

  • time how long nangyayari ang stutter

• Older writers include stutters with no sound or airflow as well as stopped movement of the articulators in their definitions of prolongations

Blocks

• Typically the last core behavior to appear; as with some (Johnson et al, 1959; Yairi, 1997a), blocks may be observed at or close to stuttering onset

  • Articulators stop or freeze, the airflow also stops 

• Occur when a person inappropriately stops the flow of air or voice and often the movement of articulators, as well

• May involve any level of the speech production mechanism – respiratory, laryngeal, or articulatory

• As stuttering persists, blocks grow longer and more tense, and tremors may become evident

  • the individual closes off the airway 

  • kaya nagsstop ang flow ng air

Escape behavior

• Secondary behaviors

• speakers attempt to terminate stutter and finish the word

  • Happens during the stutter

• occurs when speaker is already in the moment of stuttering

• Common examples are eye blinks, head nods and interjections of extra sounds, such as “uh” which are often followed by the termination of a stutter and are therefore reinforced

  • reinforced - since it's their mechanism to terminate, if they see it as successful, uulitin ang behavior

  • everytime they do an escape behavior, it is reinforced

Avoidance behavior

• Secondary behaviors

• A speaker’s attempt to prevent a stuttering when he or she anticipates stuttering on a word or in a situation 

  • To avoid the stuttering event

  • It usually happens before the stutter

• Word-based avoidances are commonly eye blinks, interjections of extra sounds, like “uh,” said before the word on which stuttering is expected

• Changing the word PWS was planning to say

Feelings and attitudes

1. emotions they would feel because of stuttering; shame, embarrassment

2. A feeling that has become a pervasive part of a person’s beliefs

   • Adolescents and adults usually have negative attitudes about themselves that are derived from years of stuttering experiences

   • nag-iba ang pananaw sa buhay

     • negative attitude towards speech or communication - assosicated with stuttering

   • A person who stutters often projects his attitudes on listeners; sometimes, listeners may contribute to the person’s attitudes

     • because of our negative responses/reactions towards stuttering

Developmental Levels of Stuttering

• Normal disfluency

• Younger preschool children - Borderline stuttering

• Older Preschool Children: Beginning Stuttering

• School age - intermediate stuttering

• Older Teens and Adults: Advanced stuttering

Normal Disfluency

• 8 common categories:

• Part-word repetition (ex. “mi-milk”)

• Single-syllable word repetition (ex. “I… I want that”) 

• Multisyllabic Word Repetition (ex. “Lassie… Lassie is a good dog”) 

• Phrase Repetition (”I want a… I want ice ceem comb”)

• Interjection (ex. “He went to the… Uh… circus”) 

• Revision-incomplete phrase (ex. “I lost my… Where’s my mommy going?”)

  • replace with another thought

• Prolongation (ex. “I’m Tiiiiiiimmy Thompson”)

  • Can be an example of normal disfluency

• Tense Pause (”Can I have some more [lips together, no sound] milk?”)

Core behaviors of normal disfluency

• Distinguishing features: amount of disfluency, number of units of repetitions and interjections, and the type of disfluency, especially in relation to the age of the child

  • usually kapag nasa normal disfluency, we do not treat them as core behaviors

  • but we need to take note that the child has disfluencies

• Amount of disfluency – often measured as the number of disfluencies per 100 words or syllables, rather than “percent disfluency”

  • Less amount of disfluency during core behaviors 

  • Example 1:

    • “Mommy, can you… can you… can you buy me that?”

      • 2 disfluencies (repetition, interjection)

• measured per number of words spoken vs. per number of syllables spoken

  • Example 2: 

    • S-s-s-s-sept-t-t-tember

      • 2 disfluencies (single sound repetition for /s/ and /t/)

  • d-dinosa- sa- saur

    • 2 disfluencies (d-d, sa-sa)

• Yairi (1997a) noted that as children get older, they are more likely to use multisyllable words–

• To keep the count equitable between younger and older children, Yairi has assessed disfluencies in children as the number per 100 syllables attempted (Hubbard & Yairi, 1988; Yairi & Ambrose, 1996; Yairi & Lewis, 1984)

  • when you count disfluencies, it is number of disfluencies in a 100 word

• Estimated that normally speaking preschool children have an average of about 7 disfluencies for every 100 words spoken

• Six disfluencies per 100 syllables

• Number of units that occur in each repetition or interjection - Yairi’s data in 1981 suggest that normal reps typically consist of only one extra unit. Instances of multiple repetitions were occasionally observed but were exceptional

  • Example: 

    • “That my-my ball” 

    • Typical kasi isang beses lang niya inulit

  • “I want som Uh.. juice”

• typical kasi may interjection + revision

• Rule: one and sometimes two units per repetition or interjection

• Average children have one- or two- unit repetitions (Johnson and associates, 1959)

• Type of disfluency – interjections, revisions and whole-word repetitions were the most common disfluency types (Johnson and associates, 1959)

• Yairi’s (1981) study found that there were two clusters of common disfluency types:(1) repetitions of speech segments of one syllable or less (one-syllable words or part of words were repeated); (2) interjections and revisions

• Revisions are more common for normal children and may continue to account for a major portion of their disfluencies as they grow older

• Interjections are also common, but usually decline after 3 years of age

• Repetitions may also be a frequent type of disfluency around 3 years of age, esp. single-word repetitions having fewer than 2 extra units. Repetitions are also more likely to involve longer segments (eg. phrases) as a child grows older

  • are part-word repetitions common? no, mas common ang whole word

Secondary behaviors of normal disfluency

• Generally has no secondary behaviors

• Some studies suggest some “tense pauses” but not as a reaction to their disfluencies  

• hindi pa aware, kaya walang reactions

• None at this age

Feelings and attitudes of normal disfluency

• Rarely notices their disfluencies; not aware, no concern

• A typically developing child who repeats, interjects or revises usually continues talking after a disfluency without evidence of frustration or embarrassment

• None at this age

Underlying processes of normal disfluency

• Stresses of speech/language and psychosocial development

  • age where speech and language develops

• Summary: 

  • Between ages 2 and 5 many children pass through periods of increased disfluency. Repetitions, interjections, revisions, prolongations, and pauses are commonly heard during this period

  • Between 2 and 3.5, disfluencies reach 7 per 100 words spoken and may be even more frequently in some normally disfluent children

  • Repetitions are most probably the most common type of normal disfluency in younger children, whereas revisions are more common normal disfluencies in older children 

  • Normally disfluent children seem generally unaware of the disfluencies in their own speech and don’t react to them or engage in secondary behaviors to escape or avoid them as consequence

Borderline stuttering

Younger preschool children

Core behaviors of borderline stuttering

• 11 or more disfluencies per 100 words

• Often more than 2 units in repetitions

• more repetitions and prolongations than revisions or interjections

  • more revisions and interjections for normal disfluency

• Disfluencies loose and relaxed 

• No tension during stuttering

• nagsstutter pero hindi naninigas

Secondary behaviors of borderline stuttering

• None at this age

• Rare for child to react to disfluencies

• No secondary behaviors observed

• sometimes nagugulat when it happens

Feelings and attitudes of borderline stuttering

• None at this age 

• Generally not aware of stutter

• may occasionally show momentary surprise or mild frustration

  • it does not affect the feelings and attitudes

Underlying processes of borderline stuttering

• Stresses of speech/language and psychosocial development interacting with constitutional predisposition

• Summary:

• Usually exhibit a greater amount of disfluency than do normal children - more than 7 dysfluencies per 100 words

• Proportion of SLDs may be greater than half of all disfluencies

• Likely to repeat units more than once in many of their part-word and monosyllabic word repetitions and prolongations than multisyllabic word and phrase repetitions, revisions and interjections

Beginning stuttering

Older preschool children

Core behaviors of beginning stuttering

• Rapid, irregular and tense repetitions may have fixed articulatory posture in blocks

• Repetitions become more rapid and tensed

Secondary behaviors of beginning stuttering

• Escape behaviors such as eye blinks, increases in pitch, or loudness as disfluency progresses

Feelings and attitudes of beginning stuttering

• Aware of disfluency, may express frustration

• Presence of tension

Underlying processes of beginning stuttering

• Conditioned emotional reactions causing excess tension; increase in muscle tension and tempo

  • They start to anticipate the difficulty

1. Reflect the extra muscular effort that emerges when they anticipate difficulty 

2. As a child’s attempt to control sound-syllable repetitions 

• Conditioned emotional reactions causing excess tension; increase in muscle tension and tempo

  • Response to frustration 

• Major factor underlying beginning stuttering appears to be child’s sensitivity to stress, which may result to frustration, triggering tension responses

• Instrumental conditioning resulting in escape behaviors; effects of learning on stuttering

• Summary

  • Signs of muscle tension and hurry appear in stuttering

  • Repetitions are rapid and irregular with abrupt terminations of each element

  • Pitch rise may be present toward the end of a repetition or prolongation

  • Fixed articulatory postures, apparently as a result of muscle tension in speech musculature

  • Escape behaviors are sometimes present

  • Awareness of difficulty, but there are no strong negative feelings about self as a speaker

Intermediate stuttering

School age

Core behaviors of intermediate stuttering

• Blocks in which sound and airflow are shut off (most prominent feature)

  • May repetitions and prolongations but not that prominent

• Stopping airflow

Secondary behaviors of intermediate stuttering

• Presence of both escape and avoidance behaviors

  • Because of the increase of cognitive development 

  • Aware na what’s happening 

  • dahil nacocompare na niya ang sarili niya sa iba

Feeling and attitudes of intermediate stuttering

• feelings of fear frustration embarrassment and shame

• Fear happens: before 

• Frustration: During

• Embarrassment and shame : after 

Underlying processes of intermediate stuttering

• Conditioned emotional reactions causing excess tension

  • They would encounter bullies, classmates who would react negatively

• Instrumental conditioning resulting in escape behaviors

• Plus avoidance conditioning

  • see an avoidance behavior as effective, then reinforced, then conditioned

  • mas lalong gagawin kasi everytime he does it, hindi siya nagsstutter

• Summary:

• Most frequent core behaviors are blocks in which PWS shuts off sound or voice 

• may also have repetitions and prolongations

• PWS uses escape behaviors to terminate blocks

• Stutterers appear to anticipate blocks, often using avoidance behaviors prior to feared words

• Fear before stuttering, embarrassment during stuttering, and shame after stuttering characterize this level

• Especially characterized by fear

Advanced stuttering

Older teens and adults

Core behavior of advanced stuttering

• Long, tense blocks

  • May blocks but more disturbing

  • More tensed and mahirap panoorin

• Some with tremors

Core behavior of advanced stuttering

• Long, tense blocks

  • May blocks but more disturbing

  • More tensed and mahirap panoorin

• Some with tremors

Secondary behaviors of advanced stuttering

• Presence of both escape and avoidance behaviors

  • very habitual na hindi mo manonotice na escape and avoidance behavior

  • if not keen on observing, hindi mapapansin

Feelings and attitudes of advanced stuttering

• Feelings of fear, frustration, embarrassment and shame

  • May nadagdag na BELIEF 

• Negative self-concept 

  • Treat themselves as dumb and incompetent 

Underlying Processes

• Conditioned emotional reactions causing excess tension

  • There are conditioned responses 

• Instrumental conditioning resulting in escape behaviors

• Plus cognitive learning 

• Summary:

• Most frequent core behaviors are longer, tense blocks, often with tremors of the lips, tongue or jaw

• Will also probably have repetitions and prolongations

• Stuttering may be suppressed in some individuals through extensive avoidance behaviors

• Complex patterns of avoidance and escape behaviors (very rapid and well habituated)

• Emotions of fear, embarrassment and shame are very strong

• PWS has negative feeling about himself as a person who is helpless and inept when he stutters