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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