CDIS 290: Stuttering

Extra Video Notes:

• 3 different types of stutters: repetitions, prolongations, blocks

Part 1:

Stuttering:

• involuntary, choppy, interrupted speech

• developmental

• covert stuttering

  • conceal stuttering

• overt stuttering

  • does not attempt to conceal

Primary characteristics:

• 3 types of disfluencies

  • repetitions: repeating a sound or monosyllabic word

    • “I want want a turn”

  • prolongations: saying a sound for an extended period of time

    • “I wwwwant a turn”

  • blocks: stoppages of airflow or sound production

    • “I……want a turn”

Secondary characteristics:

• throat clearing

• eye blinking

• foot stomping

• interjections

• sentence revisions

• word substitutions

• increased rate of speech

Causes:

• unknown

• family history

• brain difference

• diagnosed between 2 and 6 (typical stuttering period)

• lifelong

Acquired stuttering:

Variability:

• children (3-10)

  • onset

  • spontaneous recovery (no intervention and one day they just stopped stuttering)

  • high prevalence

• adolescents (10-19)

  • social difficulties

  • reduced signs and symptoms

  • low prevalence

• adults (19+)

  • acquired

  • reduced signs and symptoms

  • management

Impact of stuttering:

• social

  • express wants and needs

  • confidence

  • relationships

  • engaging in conversations

• emotional

  • confidence

  • social anxiety

  • avoidance

  • depression

• academic

  • read aloud

  • answering questions

  • presentations

  • participation

• occupational

  • interacting with colleagues and supervisors

  • career responsibilities (emails, calls, meetings, etc)

Part 2:

Diagnosogenic theory:

• Wendell Johnson

• parents cause stuttering

  • label typical dysfluencies as stuttering

• child attempts to avoid stuttering

Communicative failure aka Anticipatory struggle:

• Oliver Bloodstein

• child’s frustration and difficulty cause stuttering

  • speech and language delay

  • traumatic events

  • typical disfluencies criticized

• frustration leads to anticipation

  • tension

Demands and Capacities Model:

• child’s capacity does not equal demands on the child

• capacities

  • articulation

  • motor speech

  • neurological development

  • social-emotional skills

• demands

  • environmental reactions

  • adult speech

  • linguistic complexities and processing

Interaction theory:

• cause of stuttering is unknown

• children inherit a tendency to stutter: a person could maybe stutter, but it depends on the environment

• stuttering depends on environment

  • birth to 4 years old

Multifactorial model:

• stuttering is triggered by several factors

  • hereditary

  • motor speech

  • language

  • emotions

  • cognition

  • environment

  • communicative context

• stuttering is complex

Part 3:

Measures:

• case history and interview

• standardized assessments

  • 2 communication samples

• questionnaires

• observations

Family history and interview:

• risk factors

  • age of onset

  • time since onset

  • family history

    • was there recovery

• speech and language skills

• phonological skills

• cognitive skills

Standardized assessments:

• stuttering severity instrument 4th edition (SSI-4)

• 2 communication samples

• if stuttering occurs in at least 5% of their speech, they meet the stuttering eligibility

• analysis of stuttering

  • frequency of disfluencies

  • types of disfluencies

  • longevity of disfluencies

Questionnaires:

• parent/caregiver

• student/client

• feeling

• attitudes

Observation:

• primary characteristics

• secondary characteristics

• impact

  • social

  • emotional

  • academic

  • occupational

Interpret results:

• identify all difficulties

• identify areas of need (what you are going to work on right away)

• identify goals

• identify accommodations and modifications

Part 4:

Goal:

• increase ability to communicate

• stuttering acceptance

  • feelings

  • attitudes

  • confidence

  • learn about stuttering

• holistic

  • communication and quality of life

Indirect treatment:

• parent-child interactions

  • reduce rate of communication

  • recasting/rephrasing

  • indirect prompting

• manipulate environment

  • reduce pressure

  • include caregivers and other family members

  • address emotions and attitudes about stuttering

  • 3-6 year olds

  • play based

  • 6-8 weeks

Direct treatment:

• specific approaches to address stuttering

  • counseling

  • speech modification

  • stuttering modification

  • other strategies

Counseling:

• quality of life

• empowerment

• reduce negative thoughts and emotions

Speech modification:

• change time and tension

  • easy onset

  • light articulatory contact

  • continuous phonation

  • prolonged syllables

  • rate control

• change frequency and placement

  • increase fluency

  • improve communication

Stuttering modification:

• anticipate moments of stuttering    

  • before, during, and after occurrence

• reduce tension

  • preparatory sets

  • pull-out

  • cancellation

• 4 phases of stuttering modification: identification, desensitization, modification, stabilization

  

Strategies:

• reduce word avoidance

• cognitive restructuring

• self-disclosure

• reduce negative reactions