Chapter 8: Fluency Disorders

Fluency - speech that is effortless, easy, rhythmical, evenly flowing
Disfluency - speech with phrase repetitions, interjections (fillers in speech), pauses, revisions

Fluency Disorders

Speech disfluencies - interfere with the ability to communicate effectively and may cause the speakers to have negative emotional reactions

Stuttering

Stuttering - high number or duration of repetitions, prolongations, and/or blockages that interrupt speech
Stuttering is often combined with - excessive mental and physical effort to resume talking (struggle)
Stutters may have a - Negative perception of their communication abilities, low self-esteem

Primary Stuttering

Core behaviors of primary stuttering - repetitions, prolongations, blocks * Repetitions - ex. bbbbasebbball * Prolongations - stretch out a sound for the long period of time ex. vvvvvvan * Blocks - silent prolongations (car, hold tongue tightly in the /k/ positions)

Secondary Stuttering Behaviors

Secondary stuttering behaviors - counterproductive adaptations that started out as a way to help the stutterer * Blink eyes, open jaw, flap arms * Become more automatic, less successful in escaping the stutter

Individual Variability

Stuttering is worse when * Pressure * Content words * Long and complex sentences * Authority figures * Hurry
Stutterers could become fluent when * Sing * Use pretend voices * Choral reading * Talk to babies/animals
Severity of stuttering may change over time

Differences Between Individuals Who Do and Do Not Stutter

Person who stutters has - more negative concepts about themselves, high levels of concerns regarding their speech
Subtle differences in the language abilities of people who do and do not stutter
Less efficient motor systems - may contribute to stuttering
People who stutter use their brains a little differently during speech production
Decreased neural fibers between the auditory processing and motor speech areas * Transition between Wernicke’s and Broca’s not quite working right

Myths

Stuttering is not that result of a nervous condition
Parent’s reaction to their child’s disfluencies do not cause stuttering

The Etiology of Stuttering

Complex relationships between * internal (neurological and cognitive) factors * external factors
Currently the etiology of stuttering remains unknown

The Development of Stuttering

Early Stuttering
Normal speech in not completely fluent
Most pre-school children are “dysfluent” * Phrase repetition * Interjections * Revisions * Pauses
Few kids * Speech disfluencies increase in % * Exhibit sound repetitions, prolongations, and blocks
Stuttering-like disfluencies: 3/100 words
Feelings of frustration

Genetic Influences

Strong evidence for genetic influences on the development of stuttering
Relatives of people who stutter are generally at greater risk for stuttering then relatives of people who do not stutter

Environmental Demands and the Capacity for Fluency

Demands and Capacity Model (DCM) - disfluencies are likely to occur in children’s speech when there is an imbalance between the demands for fluency and the child’s capacity to produce fluent speech
4 interrelated mechanisms contribute to the capacity for fluency * Neural development that supports sensory-motor coordination * Language development * Conceptual development * Emotional development

The Influence of Learning

When multiple experiences occur over time as might happen during repeated instances of speech disfluency
New neural groups that are related to speech disfluency may form, grow, and strengthen
Children may likely recognize subtle similarities in speaking context that induce more emotion and more tense disfluencies
Anticipate difficulties, heighten muscle tension, which increase the likelihood of disfluencies

Factors that Contribute to Chronic Stuttering

Stuttering resolves in 65-80% of the individuals who stutter in childhood
Growth spurt - motor speech control, language, cognition and temperament
Chronic stuttering - used to refer to individuals who stutter into adulthood

Contributing Factors

Genetics - natural recovery is more likely in children who do not have relatives who stutter
Negative Feelings and Attitudes - feeling that stuttering controls the person
Avoidance - avoid certain sounds/words/speaking situations
Difficulties with Speech Motor Control - evidence of unusual patterns of breathing, vocalizing, and speaking even when they are not stuttering; variance of rate
Difficulties with Language Formation - linguistic variables such as phonology, semantics, and syntax may contribute to stuttering

How to Interact with a Person Who Stutters

Maintain reasonable eye contact
Do not finish his words or sentences
Do not interrupt
Pay attention to what the person is saying, not how he is saying it
Pause at least 1 second prior to responding
Do not allow common stereotypes to override your opinion of the person who stutters

Assessment Procedures

Interviews and Case Histories * Other family members that stutter * Changes in the disfluency over time? * Perceptions about the person’s fluency * Perceptions of others regarding the person’s fluency

Tests of Stuttering

The Test of Childhood Stuttering * Name pictures as rapidly as possible * Produce sentences with complex grammar * Answer questions about a series of pictures * Tell a story that corresponds to the pictures * Determine if a child is stuttering (compares # and types of disfluencies to normal)
Stuttering Severity Instrument
Determine the severity of the stuttering
Speech samples in reading and conversation contexts
Speech Samples
100 word sample * Calculate * Total number of words * Count number of words that contain non-stuttering like disfluencies (phrase repetition, revisions, interjections) * Count number of words that contain stuttering like disfluencies (sound/word repetitions, prolongations, blocks)
Screening - hearing, OME, voice quality
Speech/Language Testing - receptive and expressive vocabulary/language skills, articulation
Feelings and Attitudes - Scales that patients self-report

Treatment

There are two types of treatment * Stuttering Modification - helps the stutterer change his stuttering so that it is relaxed and easy * Fluency Shaping - establish a fluent manner of speaking that replaces stuttering

Stuttering Modification Therapy

“change the way he stutters”
Charles Van Riper (1960s) - a founding father of speech pathology, specifically articulation and stuttering
Client is taught to stutter less and more easily
Speech is more natural
Considerable focus on attitudes / negative reactions to speaking
Motivation, Identification, Desensitization, Variation, Approximation, Stabilization

Stuttering Modification: Approximation

Cancellations - stuttering is modified after a stuttered word is completed * taught to stop as soon as a stuttered word is completed, pause, and then say the word again in an easy manner
Pull outs - stuttering is modified within the moment of stuttering * ease their way out of repetitions, prolongations, and blocks
Preparatory Set - modify the stuttering before it occurs * anticipate stuttering on an upcoming words or sound and form a preparatory set in which they ease their way into the word

Fluency Shaping Therapy

Neilson and Andrews (1992)
Client is taught to have stutter-free speech
Focus on speech naturalness
Little to no attention given to attitudes/negative reactions
Techniques involve: * slower rates of speech * relaxed breathing * easy initiation of sounds * smooth transitions between words

Integration of Stuttering Modification and Fluency Shaping Techniques

Best to combine the 2 methods
Therapy for children who stutter (3-8 years old)
Most clinicians use fluency shaping approaches
“Turtle talk” – slow easy onset
Involve the family

Cluttering

Cluttering - rapid bursts of dysrhythmic, unintelligible speech