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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

MS

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

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