Fluency Notes from Hayes 3/17/25
fluency: latin word for flowing, uninhibited, easy smoothly moving along
fluency requires both language and speech aspects
language= must be competent. in all subsystems
speech= rate, duration, pausing
if someone’s vocab is not where it should be, that can look like a disfluency when they find words but it does not mean so, does not mean they are a stutterer. they just are stressed or does not know what to say
stuttering= disruptions which are considered abnormal in the flow of speech
overt charavteristics of stuttering may be accompanied by covert
types of abnormal disfluencies: blocks, SLDs etc. google
overt= types of disfluencies. these characteristics that you can typically hear. stuttering-like disfliuencies (SLDs) are considered true stuttered moments. these include part word repetitions, this means they repeat a sound or syllable of the word. also monosyllabic word repetitions. prolongations: the sssssun is shining today. sound being held out, some sounds like b cant be held out. know diff. between prolongations and repetitions.
blocks- happen when there is a ceasing of air flow. happens at vocal folds. or within oral cavity. pay attention to where you see the block. VFs= glottal fry. oral cavity= you will see that they have the artic posture to try to get word out but can’t
single syllable can be a disfluencies or not, I I am doing this is not a dysfluency, but 2 or more repetitions fall under a disfliuent category
OD (other dusfluencies)= include phrase repetitions, like I came I came to school. 2 words repeating.
other ODs are interjections like uh, um. can be interfering but in general they are not counted as abnormal.
other ODs are revisions= we start a sentence and come back and revise it. we all do this but not too often that it is abnormal. can also be indicative of language disorder syntactically or semantically
secondary= behaviors that typically go along or show up at the same moment as the stuttered moment. facial characteristics like lack of eye contact, facial grimacing, little noises like tics, facial tension and neck tension. eye contact: look away or shut eyes bc of embarrassment maybe. also limbs like arms and feet can also be part of 2 behaviors like wringing hands, tapping foot, swinging leg. secondary behaviors can range from subtle to obvious. also head jerk, jaw jerk
covert= charactersistics that don’t show up as easily as the others. these have to do with the attitude of the person toward their stutter, emotions they carry bc of stutter. look to see how this emotional part can handicap them. can be. on a continuum
a great attitude can be soooo great for them. it is what it is type of ppl
other side can be very angry and grieving the loss of their communication skills; could have been bullied too. think of Bill from It!
a bad attitude can change the whole situation sometimes = impactful
this negative attitude can also keep them from working as hard in therapy
you will look at types and number of disfluencies.
types of fluency disorders:
1. developmental stuttering: occurs or begins during the time the person is developing language like as a baby. between 2-5 years old there is a whole lotta language going on. kids can stutter as early as 2 and a half. between 3-5 it can show up to an SLP. sometimes language learning period can show up later too. can be very normal, typically these kids will have lots of normal disfluencies like phrase repetitions, single word being repeated, no tension, lack of awareness that usually goes away by 6-8 months after they start. goes from normal too abnormal disfluencies start to be aware and show tension= likely will become true stutterer
DF= disfluency
developmental= started as a child
levels of dev. stuttering= look at frequency and types of disfluencies. borderline stutterer= has some normal and abnormal DFs, low awareness so they are not frustrated. DFs can go away or turn into a beginning dev. stutterer
beginning dev. stutterer= far more DFs than normal, show frustration, say nevermind when they start to talk. can also show secondary behaviors. mostly exhibiting part word or whole word repetitions but also prolongations and fleeting blocks. types are increasing. from there is they do not get theraoy, the number and frequency of DFs will go up with their level of frustration, secondary behaviors will be included. in that. increases severity level of fluency disorder. consistency can vary from task to task, day to day. task= we assess them at varying linguistic levels like can they count 1-10, name days of week, recite a nursery rhyme like something they know well. then we go to naming picture cards and then to tasks that require 2-3 words, then a sentence to connected speech sample. Linguistic Levels are increasing and so will stutter. they will stutter at beginning of the word, but once their severity level increases, they may stutter at the medial and final position of the word too. they never know if it will come out smoothly, like day to day they may have a stutter free day and then a bad one the next. they may not always know why their days are good and bad with stutter.
neurogenic stuttering= began with or is maintained as a result of a specific identifiable neurological insult or disorder. can come on suddenly or slowly. stroke or head trauma, drug usage, some meds too. slow onset can be due to degenerative disease or vascular disease, dementia, dialysis dementia. some of these disorders can also result in other problems like aphasia that the stutter can co-occur with. some stuttering characteristics= repetition but no prolongations or blocks. the neurogenic stutterer can exhibit secondary behaviors, fear and anxiety but these are not typically present at the very beginning but they will be if they stutter long enough. they stutter on initial position but can also be on M/F position. they tend to be very consistent on their stutter moments like across all tasks like naming days of the week to connected speech.
psychogenic stuttering= onset is usually sudden with no history of stuttering in the past. adult can be hard to discern if they are psycho or neuro. begins due to some life happening like some event like stress can inflict on your body. like stress can cause stomach aches, it can also cause stuttering for some. does not mean they are mentally off. always have compassion for people who go through stuff you think is easy. hallmark= once you start to talk to them about what happened, their stuttering goes away within 1-2 sessions. not true for other two types. ask lots of questions to find out more. psychogenic stutterers are both men and women but there are not a lot of them. we can counsel them on their life issues and we can help them!!! refer them if they have life issues outside of communication like our realm. characteristics= starts out severe often, DF moments are mostly repetitions, can exhibit prolongations and blocks but not as likely. will not show frustration toward stutter at the same level as the developmental. their life experience may still be top priority so their frustration lies within the life experience not with stutter. they tend to stutter consistently across linguistic levels. secondary behaviors= may exhibit some but they are not ass. with stuttered moment like with the other types
developmental stutters can have odd respiratory patterns
Assessment:
first thing: get a thorough case history of them: 3 major ?s
1. when did stuttering begin?
2. did it start after stroke, how long after stroke?
3. what is your level of awareness/ Tell me about your stuttering. like where are they emotionally. for a child, ask mom this question. not aware= good thing
4. ask what their feelings and attitudes are about the stuttering. could be bad or good. always empathize with them!!!!!!! be careful when syaing I understand bc you truly do not bc you do not have a stutter
second thing: determine the most appropriate fluency test. SSI= stuttering severity instrument. get spontaneous fluency sample or a reading sample. also looks at the secondary behaviors and how distracting they are. gets average of stuttered moments. this is a normed test for children and adults
also Cooper= not normed test for children and adults, can be used with SSI. counts stuttered words not syllables. has various lingusitic tasks like reciting responding repeating reading naming pictures. has child and adolescent/adult version.
also TOCS= assessing language aspects also, has rapid naming, narration, structured sentences. for ages 4-12, normed test.
if you are going to do attitudinal test to test their attitude and emotions, the Oasis has forms from 7-12, 13-17, 18+.
look at email from 3/15 for sample forms to look at
ALWAYS GET a sample and write it out verbatim, count number of spoken syllables and stuttered syllables. helps with severity and compare types of disfluencies you see.
age ranges:
preschoolers: get a sample of some type with SSI or Cooper, but test their language also bc language difficulties may contribute to disfluencies. may need to hit language first or at least at the same time.
do not give an attitudinal scale to the child
if child has a Fluency disorder, always recommended therapy if they have any abnormal DFs in case they do not remediate on their own
school age: if i think language may be a problem, definitely test language bc it may also contribute to fluency. do not give attitudinal scale to school age child unless you get to know them well to make sure it is accurate. not always necesary to give this scale tho. put them in therapy immediately if they have abnormal stutters, but if kid is not motivated or does not want to, they will not succeed
adult: case by case. if they are dev. stutterer with job, military, etc. if they are functioning well, do not test language unless you see something that triggers disfluencies. something has happened that they want to do something in their future that stuttering will prevent so that is why they are in therapy. they come to you not for the first time but now they need more help moving forward. always plan to do language if they have had a stroke. eventually do an attitude scale on an adult. 100% rec therapy for an adult bc they want this and they want to make a change.