MODULE #2 (1.1). Comprehensive Introduction to Stuttering and Fluency Disorders

Language and Terminology in Fluency Disorders

• Person-First Language vs. Identity-First Language:     * Person-First Language: Primarily utilizes terms such as "People who stutter" or "Person who Stutters" (commonly abbreviated as PWS). This approach emphasizes the person before the disability.     * Identity-First Language: The term "Stutterer" is becoming more frequently adopted by individuals within the stuttering community to reclaim the identity.     * Acronyms Frequently Used in Professional Literature:         * PWS: Person who Stutters.         * AWS: Adult who Stutters.         * CWS: Child who Stutters.     * Professional Consideration: Yaruss (2018) argues that referring to individuals by a series of letters can be more dehumanizing than using labels like "stutterer." Practitioners are encouraged to remember they are treating a person, not a set of acronyms.     * Style Guide Resource: The National Center on Disability and Journalism (NCDJ) provides a style guide ( https://ncdj.org/style-guide/ ) for appropriate terminology usage.

Etiology of Stuttering

• Conceptual Understanding: While the exact causes are not fully understood, scientists generally agree that stuttering results from a complex combination of factors:     * Genetic and Congenital Influences: Hereditary factors and biological predispositions present at birth.     * Developmental Influences: Challenges arising during the rapid growth of speech and language skills in childhood.     * Environmental Influences: External pressures or reactions from the surroundings that may exacerbate disfluencies.     * Emotional Reinforcement: Repeated negative experiences related to stuttering can lead to the development of deep-seated negative feelings and attitudes.

Prognosis and Recovery Factors

• The Possibility of a Cure: Outcomes vary significantly based on several variables:     * Independent Recovery: Some children will recover from stuttering naturally without formal intervention.     * Early Intervention: Others require professional speech-language therapy to achieve fluency.     * Mild to Moderate Cases: Preschool and early elementary children with mild to moderate stuttering often respond well to intervention. However, traces of stuttering may persist during periods of illness, fatigue, or high stress.     * Severe or Post-Puberty Onset: Individuals with severe stuttering or those who do not receive treatment until after puberty typically achieve only partial recovery.     * Persistent Stuttering: Some individuals will not experience significant improvement despite intervention.

The Nature and Definition of Stuttering

• Formal Definition: Stuttering consists of abnormally high frequency and/or duration of stoppages in the forward flow of speech.
• Metaphorical Description: Stuttering can be compared to a car that suddenly stops working in the middle of traffic or is constantly breaking down.
• Categorization of Stoppages:     * Repetitions: Sounds, syllables, or single words that are repeated more than two times (e.g., "Li, Li, Li, Like this…").     * Prolongations: The sound or airflow continues while the movement of the articulators has stopped. A duration as short as $0.5\,s$ may be perceived as abnormal (e.g., "I'm Tiiiiiiiiiiiiiiiimmy Thompson").     * Blocks: The inappropriate stoppage of airflow or voicing where articulatory movement is halted.         * Blocks can occur at the respiratory, laryngeal, or articulatory levels.         * They are often accompanied by tremors in the lips, tongue, jaw, or laryngeal muscles.         * Blocks are typically the last of the core behaviors to appear in the progression of the disorder.

Research Statistics Related to Core Behaviors

• Average Fluency in PWS: Individuals who stutter will, on average, stutter on $10\%$ of words while reading aloud.
• Mild Stuttering Threshold: Those with mild stuttering will stutter on fewer than $5\%$ of words spoken or read.
• Severe Stuttering Threshold: Individuals with severe stuttering can stutter on up to $50\%$ of their words.

Secondary Behaviors

• Definition: These are learned behaviors triggered by the immediate experience of a stutter or the anticipation of one.
• Escape Behaviors: Attempting to terminate an active moment of stuttering to finish a word.     * Examples: Head nods, interjections of sounds (e.g., "uh"), and eye blinks.
• Avoidance Behaviors: Attempts to prevent a stutter from occurring when it is anticipated or when recalling past negative experiences.     * Starters: Using a sound or word to get a "running start" on a difficult word.     * Postponements: Waiting or pausing before attempting a feared word.     * Circumlocution: Talking around a word by using different phrasing to avoid a difficult sound.     * Substitution: Replacing a feared word with a different word entirely.
• Critical Distinction: Escape behaviors occur after a stutter has started; avoidance behaviors occur before it starts.

Feelings, Attitudes, and Beliefs

• Feelings: Initial emotional reactions often include embarrassment and frustration. These feelings become more severe as a individual has more negative stuttering experiences.
• Fear and Shame: These may develop over time and contribute directly to increased frequency and severity of the disorder.
• Attitudes: Feelings that have become permanent and ingrained, shaping the individual's belief system.
• Beliefs: These can involve perceptions of oneself as a communicator or perceptions of how listeners view them.

Basic Facts: Onset, Prevalence, and Incidence

• Onset (When stuttering begins):     * It may start as a gradual increase in normal disfluencies or a sudden appearance of severe blocks.     * It is often sporadic initially, appearing for days or weeks before becoming persistent.     * Range: Between $2$ to $5$ years of age.     * Average Age of Onset: $33\,\text{months}$.
• Prevalence (How many people stutter at any given time):     * Kindergarten: $2.4\%$.     * School-age children: Approximately $1\%$.     * Adults: Slightly less than $1\%$.
• Incidence: The measure of new cases identified in a specific timeframe. These numbers vary based on risk factors.

Predictors and Risk Factors for Persistence

• Key Predictors:     * Family history of stuttering.     * Gender (higher prevalence in males).     * The trend of stuttering frequency and severity over time.     * The duration of individual stuttering moments.     * The continued presence of sound prolongations and blocks.     * The level of phonological skills.
• Specific Risk Factors for Lack of Spontaneous Recovery:     * Relatives who were persistent stutterers.     * Being male.     * Onset occurring after the age of $3.5\,\text{years}$.     * Stuttering that does not decrease during the first year after onset.     * Stuttering persisting beyond one year after onset.     * Presence of multiple unit repetitions (e.g., "li-li-li-li-like this").     * Phonological skills that are below the normal range.

Gender Disparities in Stuttering

• Initial Ratio: At the onset of stuttering, the sex ratio is nearly even at $1:1$.
• Changing Ratios: Because girls tend to start stuttering earlier and recover more frequently and sooner than boys, the ratio shifts over time.     * School age: $2:1$ (two boys for every one girl).     * Adulthood: Approximately $4:1$ (four males for every one female).

Variability and Linguistic Predictability

• Shift in Research Focus: In the 1930s, the field shifted from looking at medical/organic aspects to social, psychological, and linguistic factors.
• Three Key Phenomena:     * Anticipation: The ability of many who stutter to predict exactly which words in a reading passage they will stutter on.     * Consistency: The tendency to stutter on the same specific words each time a passage is read.     * Adaptation: The phenomenon where stuttering frequency decreases over repeated readings of the same passage (up to approximately six readings).

Language Factors and Triggers

• Preschool Children:     * Stuttering occurs most on pronouns and conjunctions (often found at the beginning of utterances).     * Most frequent disfluencies are part-word repetitions and single-syllable word repetitions at the start of sentences.     * Trigger: Likely linguistic planning and preparation at the beginning of syntactic units.
• Adults:     * Adults stutter more frequently on consonants, word-initial positions, and in contextual speech (rather than isolated words).     * Higher frequency on nouns, verbs, adjectives, and adverbs.     * Higher frequency on longer words, words at the start of sentences, and stressed syllables.