Fluency Test 1 (UCA)

Use person ____ terminology

-first

-person is not defined by stuttering:it's only one aspect of their life

____% of SLPs see fluency cases

65%

in school settings, _______ of SLP's see fluency cases

78%

Where is stuttering found? (3 topics)

history, cultures, races

-it's NOT a modern disorder

-all socio economic groups!

________ isn't affected by stuttering, but stuttering can affect _________

occupation

Who can stuttering affect?

-both genders

-all ages

Stuttering is most commonly a disorder of ______ ______

early childhood

Stuttering is considered a _______ disorder (timeline)

lifespan

Stuttering definitions in the 1920's & who was associated?

-neurotic disorder, personality disturbance

-Glauber

Stuttering definitions in the late 20s/early 30s & who was associated?

-epileptic and neuromotor disorder

-West

Why do we not have one simple definition for stuttering?

-differences in each person who stutters

- no one known cause

To understand the ______ we must first understand the ________

abnormal, normal

Fluency

-effortless flow of speech

-taking into account rhyme, rate, intonation, stress

Fluency disorder

abnormal fluency, rate, and rhythm of speech

-stuttering and cluttering

Wendell Johnson definition of stuttering

-stuttering is an anticipatory apprehensive hypertonic avoidance reaction

-speaker does this when he expects it to happen, dreads it, tenses, tries to avoid

-mild w/ no awareness until parents drew attention

Wingate (1964) definition of stuttering

-disruption in fluency of verbal expression characterized by involuntary, audible, or silen repetitions or prolongations which may be accompanied by accessory activities and emotional states (excitement, tension, fear, or embarassment)

dysrhythmic phonations

blocks or prolongations

Van Riper definition of stuttering

-stuttering occurs when the forward flow of speech is interrupted by a motorically disrupted sound, syllable, or word by the speaker's reaction

Stuttering is not just a ______ problem, it is a _______ problem

speech, communication

When stuttering is chronic, it affects a person ______, ______, and _______

socially, vocationally, psychologically

-takes a social interaction for it to occur

-may affect job choice

-takes a toll on speaker

WHO definition by Yaruss: etiology

cause

WHO definition by Yaruss: impairment

stuttering itself, the stuttering event

-blocks, prolongations, repetitions

WHO definition by Yaruss: disability

limitations in the ability to communicate

WHO definition by Yaruss: handicap

limitations in an individual's abilities to fulfill roles in life events

Core behaviors definition

the basic behaviors of stuttering (repetitions, prolongations, blocks)

Repetitions

A sound, syllable, or single word repeated several times

Repetitions normally occur...

-initial sound

-single word

CWS frequently repeat a word or syllable more than ___ per instance

twice

Prolongations

sound or air flow continues but movement of the articulators stops; voiced or voiceless

Blocks

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

What levels of the speech-mechanism can blocks occur at?

ALL: respiratory, laryngeal, articulatory

Two types of blocks

tonic and clonic

Tonic blocks

-result of continuous, inappropriate contraction of articulatory musculature

-person exerts too much pressure/ tone in the articulatory structure affected

Clonic blocks

characterized by alternating cycles of tension and release of articulatory musculature

-ex. starting a lawnmower-repeated blocks

Secondary behaviors

reactions by PWS to repetitions, prolongations, and blocks

-trying to escape the stuttering event or avoid it altogether

Secondary behaviors begin as a ________ and turn into _________

struggle, well-learned pattern

overt characteristics

-visible/ audible

-pitch/loudness, tension, tremor, body movements (blinking, facial grimace, etc.)

covert characteristics

-non visible

-increased blood flow, heart rate, stomach clenching, face flush

Both visible and non visible are ______

physiological

Reactive features

-physiological adjustment to the stuttering

-variety of emotional states

Escape behaviors

occur when speaker is stuttering and attempts to stop the stuttering event/ finish the word

-eye blinks, head nods, interjections of extra sounds

-often followed by termination of stuttering

Avoidance

when a speaker anticipates stuttering and recalls negative experiences

-changes word they planned to say or cease talking altogether

-circumlocution, postponements, starters, etc.

-may temporarily prevent stuttering

stuttering is like an _______

-iceberg

-lot more than meets the eye

Feelings

-feelings may precipitate stuttering, stuttering may create feelings

-PWS stuttering on their name and feeling shame that they can't do the simple task

Attitudes

-feelings that have become more pervasive or part of the person's belief system

-years of stuttering can lead to negative attitudes

affective reactions

anxiety, fear, embarrassment, shame, loneliness, frustration, depression, anger

-feelings

cognitive reactions

low self-esteem, lack of confidence

-eventually become beliefs

In the case of _________ in stuttering, we are talking about ________ that develops over a long period of time, that is most likely difficult for the stutterer to ________, and is probably not _______ to rapid change

attitudes, affect, trace, amendable

Feelings of PWS

-beginning: may have little awareness

-more frequent stuttering: may become frustrated or embarrassed because they're aware they can't say what they want

ABCs of stuttering

-Affect (feelings/emotions)

-Behavior (stuttering)

-Cognitive reactions (self esteem/ confidence)

-A+B=C

2 main types of disfluency categories

-stuttering like disfluencies (SLD), -other disfluencies (OD)

Stuttering-like disfluencies

part word repetitions, single syllable word repetitions, dysrhythmic phonations (blocks, prolongations)

Why are SLDs SLDs?

Occur much more often in PWS (they do still happen in normal speakers)

Other disfluencies

interjections, revisions, phrase repetitions

Epidemiology

the study of an epidemic

Epidemiology covers...

-How many people were affected?

-What segments of the population are affected?

-When does the disorder strike, and how long does it last?

-Is the disorder familial? (yes)

-What are signs and symptoms?

When does stuttering strike, and how long does it last

-Childhood (generally ages 2-5 16-60months)

-16 months is early

-60 months is late

-duration varies

T/f: There is no single cause to stuttering?

True

Incidence of stuttering

5%

-how many people have ever stuttered

Prevalence of stuttering

1%

-how many people currently stutter

What is the middle ground between incidence and prevalence?

-spontaneous recovery

Regional estimates of stuttering

-LR area Incidence:30k, prevalence: 6,000

-Arkansas incidence 135,000, prevalence 27,000

Gender ratio of stuttering

-2:1 males to females near onset

-4-5:1 later on males to females

Approximately ____% recover naturally

75%

-no formal therapy

Majority of recovery occurs within ___ months of onset

36

-second and third year

-can continue up to 5 years

Marked decrease in stuttering occurs within about _____ of onset for those who recover

1 year

_____ recover more often (boys or girls)

girls

_______ recover sooner (boys or girls)

girls

Most cases of stuttering occur between ___ and __ months of age

25-36 ages 2-4

-critical period

The earlier the onset...

-better chance for recovery

-later the onset... bigger chance of persistence

Continuing ______ ______ could be an indicator of persistence

dysrhythmic phonations

Of all who begin stuttering, about ____% continue to stutter past 4-5 years of onset

25%

Red flags for persistence

male, family hx, later onset (over 3.5), still stuttering after 6 months- 1yr of onset, DR continue, other comm. problems (phonological disorder)

Strongest predictor of persistence or recovery?

Family history of persistence or recovery

____% of children have someone in their immediate and extended family who stutters

68

__________% of children who stutter have someone in their immediate family who stutters

39

________ % of children who stutter have a parent/parents who stutter

27

Genes/collection of genes may cause what traits to be transmitted? (Yairi)

structural anomalies, motor skills, brain processing, temperament

Greatest risk to stuttering is prior to age ___; 66% of risk is over by that age

3

Onset rarely occurs before age _____ and only occasionally after age ____

2, 4

Theory of Incomplete Cerebral Dominance (biological)

Orton & Travis (1920-1930s)

-PWS were left handed and forced to change

-neither hemisphere fully takes charge of speech motor functions, resulting in competition between two sides

-Tx= retraining left dominance

Psychological Causes

-Stuttering as a neurotic symptom rooted deeply in unconscious needs

-Freud: Psychoanalysis=stuttering was an overt symptom of conscious conflict between child and parent

-Tx= treat parents (repressed needs, neurotic personality of mom)

Diagnosogenic Theory (behaviorism and learning)

-Wendell Johnson

-Stuttering began, not in the mouth of the child but in the ear of the parent (when they overreact to their child's normal disfluencies)

-stuttering is learned

Tudor Study (1939)

-AKA monster study

-Tudor used orphans as subjects and attempted to "infect" them with stuttering

-Studied the effect of verbal labeling on the frequency of disfluency

-hypothesis FAILED

Anticipatory Struggle Hypothesis

-bloodstein

-Past experience with bumpy speech causes anticipatory difficulty which leads to stutter

Approach-avoidance theory

Joseph Sheehan

-Desire to communicate collides with the drive to avoid speech anxiety

Capacity and Demands Model

-Imbalance between a child's linguistic capacities and the demands for fluent speech production

-Stuttering occurs when the demands for fluency from the child's social environment exceed the cognitive, linguistic, motor, or emotional capacities for fluent speech.

-NOT A THEORY

-Tx= support capacity, reduce demands

Every child has a certain capacity in:

-Speech motor skills

-Linguistic skills

-Affective and emotional control

-Cognitive skills

Each child may have demands in

-Parent speech-lang behaviors

-Family interaction patterns

-Family reactions to stuttering (verbal, nonverbal, sibling, parental)

-Family lifestyle characteristics (lessons, sports, schooling, etc. where can you power down and give them extra time?)

-Uneven capacity development (where do articulation and phonology fall?)

What age group is c&d relevant for?

Preschool!

Theory

An explanation of a phenomenon that has been supported by consistent, repeated, experimental results.

Model

A verbal, mathematical, or visual representation of a phenomenon that allows scientists to explain, construct, and test theories

Etiological theories are often influenced by the ________ of the times

Zeitgeist; the predominant thinking of the time, reflecting the prevailing thought of the time

Bloodstein "Theories of stuttering are seldom disproved, most often we ______ ____ ______ ___ _____"

just get tired of them

T of F:The transmission of stuttering in families follows simple, single-gene genetics.

False: stuttering is likely caused by several genes interacting, there is no "stuttering gene"

True or False: FEW studies have focused on the associated environmental factors of stuttering

True

Stuttering is _______ and _______ (2 characteristics)

multifactorial, polygenetic

PET scan

positron emission tomography

Regional cerebral blood flow

-PWS have less blood flow overall in both hemispheres

-greater reduction in left hemisphere temporal (speech hemisphere)

-less blood flow in cerebellum

MRI

magnetic resonance imaging