• 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