Stuttering: Physical, Motor, Cognitive, Social, and Emotional Development; Conditioning; Theories

Physical and Motor Development

  • Competition between language and physical motor abilities exists.
  • Motor and neural resources interfere with cognitive resources needed for fluency.
  • Children learn to crawl and sit before speaking meaningful words.
  • Vocal tract changes occur every 2-5 years, requiring adaptation.
  • Infants' oral mechanism primarily sustains life (breathing, eating).
  • Poor speech motor development and auditory motor learning can cause delays.
  • Children need time to master each skill (walking, talking).

Speech and Language Development

  • Children may be predisposed to speech difficulties (e.g., parent with cognitive impairment).
  • Rapid speech and language development can lead to stuttering.
  • Language delays are associated with stuttering in some cases.

Cognitive Development

  • Cognition competes with fluency.
  • Poor cognitive skills lead to an inability to recover from disfluencies.
  • Normal cognitive level can increase negative attitudes about speech when disfluency awareness arises.

Social and Emotional Development

  • Emotional stress worsens stuttering.
  • Sensitive temperaments increase vulnerability to stuttering.
  • Individuals may have normal psychosocial traits.
  • Research on environmental factors is mixed.
  • Anxious parents may correlate with children's stuttering.
  • Vulnerable temperaments can be inherited, leading to anxious, perfectionist children.
  • Stressful life events can trigger stuttering.
  • Reference table 4.3 for more information.

Learning and Unlearning

Classical Conditioning

  • Classical and operant conditioning are critical in stuttering causes and treatment.
  • Classical conditioning involves conditioned and unconditioned responses.
  • Overbearing parents with high expectations can impact a child's speech.
  • Increased tension in a child's speech increases repetitions or the conditioned emotional state (CES).
  • Tension elicits a response before disfluencies occur.
  • Stuttering frequency increase leads to the spread of conditioning to more stimuli.
  • Therapists desensitize clients to their stuttering.
  • Early intervention can stop negative emotions and behaviors.
  • Adults struggle more due to a strong connection between stuttering and negative feelings.
  • Classical conditioning can involve body responses like facial tension or extremity movements.

Operant Conditioning

  • Secondary behaviors are associated with operant conditioning.
  • Secondary behaviors may initially occur by accident (e.g., closing eyes to get a word out).
  • Positive reinforcement increases the behavior that preceded it.
  • Negative reinforcement involves unpleasant experiences that reinforce behaviors, leading to withdrawal.
  • Punishment decreases the behavior.
  • Escape behaviors become part of the stuttering response.

Avoidance Conditioning

  • Avoidance behaviors include extra sounds, fillers, avoiding speaking situations, or changing words.
  • These behaviors are triggered by nonconscious and conscious cues, based on fear.
  • Avoidance behaviors are secondary characteristics that appear after stuttering is learned.
  • Extreme behaviors (arm or leg jerking) may develop if they work for the individual.

Unlearning Classical Conditioning

  • Decouple the link between the response and behaviors.
  • Younger children: Increased fluency reduces or stops escape behaviors.
  • Older children and adults: Acceptance of stuttering, education, slow/easy release of stuttered words, fluency shaping strategies.

Unlearning Avoidance Conditioning

  • Don't take away avoidance behaviors before helping the individual deal with stuttering through counseling.
  • Reduce negative emotions.
  • Work with families to change the environment (e.g., slower rate of speech, pauses).
  • Provide direct instruction and education for adults to desensitize them.
  • Hierarchy of desensitization is used for adults.

Theories About Stuttering

Capacities and Demands

  • Stuttering occurs when a child's capacities are less than their speech demands.
  • Capacities fluctuate, explaining fluent and disfluent periods.
  • Demands: Rapid language development (ages 3-7), fast-talking parents, high expectations, frequent interruptions, complex sentences/vocabularies, impatience.

Two-Stage Model

  • Primary Stuttering:
    • Left hemisphere deficits for language processing.
    • Underdeveloped or slower processing.
    • Repetitions: Waiting for brain to fire.
    • Prolongations: Waiting for element to fire.
    • Blocks: Attempting to say the next thing.
    • Begins with repetitions and little awareness or reaction.
  • Secondary Stuttering:
    • Result of awareness and reaction to disfluencies.
    • Temperament: Fearful (increased tension, escape/avoidance) or nonchalant.
    • Reactive children can continue behaviors long term.
    • Highly emotional children are more aware, leading to more secondary behaviors.

Stuttering as a Disorder of Timing

  • Temporal disruption of muscular movements to produce speech (Van Riper, 1982).
  • Left hemisphere less developed than the right (Kent, 1994).
  • Emotion can affect timing.
  • Inability to process rapid speech for normal fluency.

Stuttering as a Disorder of Brain Organization

  • Lack of left hemisphere dominance causes mistiming of muscle activation (Orton & Travis, 1931).
  • Underdevelopment of the left hemisphere leads to right hemisphere dominance (Geschwind & Galaburda, 1985).
  • Supplementary motor area vulnerable to disruptions of other brain activity (Webster, 1983).
  • Right hemisphere is overdeveloped and compensates for the left side.