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 reactionto 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