Chapter 1: Intro to Stuttering Therapy
Dimensions of Normal Speech Fluency and Characteristics of Disfluency
Dimensions of Normal Speech Fluency:
Rate: Refers to the appropriate timing of speech delivery.
Continuity: The presence of smooth connections between speech sounds, syllables, and words.
Tension Effort: The utilization of appropriate muscular force during the production of speech.
Definition of Disfluency:
Observable interruptions occurring within on-going speech.
Refers collectively to all speech interruptions, whether they are considered normal/typical or not.
Disfluency is a universal Phenomenon; it occurs in the speech of everyone, including People Who Stutter (PWS) and those who do NOT stutter.
Detailed Taxonomy of Disfluency Types
Part-word Repetitions: Examples include "a-ai," "f-five," or "ba-baby."
Single-syllable Word Repetitions: Examples include "but-but" or "and-and."
Multiple-syllable Word Repetitions: Examples include "Because—because."
Phrase Repetitions: Examples include "I was—I was going" or "Once up—once upon."
Prolonged Sounds: Examples include "a>>>>ai like to go" or "S>>>>ometimes."
Blocks and Broken Words: Characterized by silence within a word, such as "C (silence)--ake" or "The ta (silence)--able."
Tense Pause: Silent intervals occurring between words, such as "I like to (silence)------go home."
Interjections: Common fillers such as "um," "uh," "er," or "hmmm."
Revisions: Modifying the phrasing while maintaining the same thought, such as "I like—I want this ball."
Incomplete Utterance: A change in thought mid-sentence, such as "The baby—let’s do…"
Classification: Stuttering-Like Disfluencies (SLD) vs. Other Disfluencies (OD/TD)
Stuttering-Like Disfluencies (SLD):
Part-Word Repetition: "Bu-bu-but."
Single Syllable Repetition: "And-and-and."
Dysrhythmic Phonation: "Mo------mmy."
Rationale for SLD Classification: These are much more typical and frequent in the speech of PWS, and listeners have a strong inclination to perceive these specific disfluencies as "stuttering."
Other Disfluencies (OD/TD):
Phrase Repetition: "I like to—I like to…"
Multiple Syllable / Word Repetition: "Summer—summer—summertime."
Revision: "It was, I mean…"
Interjection: "Uhm, well, er."
The ABCs of Stuttering and Affective Dimensions
Multidimensional Components: Represents a mix of involuntary speech events and learned behaviors, including avoidance and escape mechanisms.
Affective Factors (Emotions):
Prior to Stuttering: Fear, dread, anxiety, and panic.
During Stuttering: A sense of blankness, feeling trapped, panic, and frustration.
After Stuttering: Shame, humiliation, anger, and resentment.
Cognitive and Internal Factors: Often invisible to others, these include feelings regarding self-worth, confidence, acceptance, courage, worry, despair, concern, and guilt.
Secondary Behaviors and Multidimensional Aspects
Secondary Behaviors: These physical concomitants contribute to the effect of tense, struggled speech. They increase the perception of stuttering severity and the overall degree of abnormality. Examples include squeezing hands or eyes and moving feet.
Six Multidimensional Aspects of Stuttering:
Overt speech characteristics.
Physical concomitants.
Physiological activity.
Affective features.
Cognitive processes.
Social dynamics.
Conditions Affecting Speech Behavior
Ameliorating Conditions (Factors that may improve fluency):
Manner: Singing, speaking in rhythm (e.g., to a metronome beat), speaking in a monotone, imitating a dialect, whispering, or speaking slowly.
Context: Speaking to an animal, speaking to an infant, or speaking in unison with others.
Inducing Conditions (Communicative Pressures):
Environmental/Internal: Time pressure, the meaningfulness of the message, language complexity, the size of the audience or number of communication partners, the gender or attraction of the communication partner, and situations involving authority.
Communicative Pressures: Use of Delayed Auditory Feedback (DAF), masking noise, or response contingent stimuli.
Defining and Diagnosing Stuttering
Two Meanings of Stuttering:
Overt speech events: Momentary, disrupted events like repetitions. This refers to disordered speech phenomena and "what the person is doing" when talking. Example: "He stuttered a lot this morning."
Complex disorder: A condition including speech, physiological, emotional, and cognitive factors lasting over time. This refers to "what a person is or has." Example: "Her stuttering has affected her social life."
Definition vs. Diagnosis:
Definition: Delineates meaning and describes the fundamental properties and limits unique to the phenomena. It should be free from opinion, theory, or explanation.
Diagnosis: Determines whether the presenting patterns represent a clinical problem or a risk for developing one.
Clinical Importance of Definitions:
Research: Determines who qualifies as a person who stutters versus a control subject and what changes should be measured.
Practice: Determines who should enter therapy and establishes the measurement of progress to justify termination of therapy.
Incidence and Prevalence
Incidence: Measures the magnitude of the disorder, its causes, and dynamics.
Lifetime Incidence: Traditionally cited as . Recent findings suggest it may be as high as or higher.
The 16-Year Span: Considered sufficient for "lifetime" incidence of developmental stuttering because the condition typically starts and resolves for most before age 16.
Prevalence: Provides guidance for clinical practice, prognosis, counseling, and treatment recommendations.
Rate: Lower than the traditionally accepted level; likely closer to .
Impacted Areas: Incidence and prevalence data affect professional training, service delivery, public awareness/knowledge, funding, and research.
The Presumed Relationship Between Disfluency Types
Nonstuttered Disfluency Hierarchy:
Hesitation (pause)
Interjection
Revision
Phrase Repetition
Multisyllabic Whole-Word Repetition (e.g., "Mommy-mommy-mommy let's go.")
Progression Toward Stuttered Disfluencies: As disfluencies move from nonstuttered to stuttered types, the following typically occur:
Disfluencies occur more frequently.
Reactions to disfluencies increase.
Physical tension or struggle increases.
Physical tension during nonstuttered disfluencies may appear.
Duration (length) of disfluencies increases.
Stuttered Disfluency Types:
Monosyllabic Whole-Word Repetition (e.g., "I-I-I want to go.")
Sound or Syllable Repetition (e.g., "li-li-like this.")
Prolongation (e.g., "!!!!!!like this.")
Block (e.g., "---ike this.")
Note on Avoidance: Nonstuttered disfluencies are sometimes used strategically to avoid or postpone stuttering (e.g., "I um, you know, uh, I want to um, g-g-go with you.")
Development and Resources
Stuttering Development: Focuses on natural recovery versus persistency and the identification of predictive factors. Key questions include when it happens, how it happens, what happens, and who is affected.
Key Literature and Authors:
J. Scott Yaruss, PhD and Nina Reardon-Reeves, MS.
Early Childhood Stuttering Therapy: A Practical Guide.
School-Age Stuttering Therapy: A Practical Guide.
Reference to the 8th edition of Young Children Who Stutter: Information and Support for Parents (2013), published by the National Stuttering Association (NSA).
Questions & Discussion
What you know and what you want to know: Students are encouraged to jot down their current knowledge and goals for the course.
Clinically Speaking: Why might there be so many definitions of stuttering, and when might you use different definitions?
Slide authorship/attribution: The name Jens Martensson appears throughout the presentation, leading to the closing question: "But who is Jans?"