SHS402-M5-Fluency Disorders

Introduction to Fluency Disorders

  • Speaker: Joshua Gregor, Clinic Director at ASU Speech & Hearing Clinic, Clinical Professor
  • Focus: Fluency disorders (e.g., stuttering & cluttering)

Defining Fluency

  • Fluency: Natural flow of speech; defined by:
    • Continuity: Seamless speech without interruptions.
    • Naturalness: Speech resembling natural speech patterns akin to water flow.
  • Fluency Disorders: Disruptions in fluency due to blocks or repetitions.

Types of Fluency Disorders

  • Stuttering:
    • Characterized by blocks, repetitions, and prolongations.
    • May involve physical tension, fear, and anxiety.
  • Cluttering:
    • Involves interjections, revisions, false starts (e.g., "um", "uh").
    • Features rapid speech and impaired rhythm; lacks awareness.

Subtypes of Stuttering

  • Neurodevelopmental Stuttering (Childhood Onset):
    • Common form starting around 30-38 months of age.
  • Acquired Stuttering (Neurogenic Stuttering):
    • Results from brain trauma or injury, less common than childhood onset.
  • Psychogenic Stuttering: Rare and often linked to trauma (e.g., PTSD).

Incidence and Prevalence

  • Incidence: 5% of the population has stuttered in their lifetime.
  • Prevalence: Roughly 1% currently stutter; often resolves naturally within 24 months post-diagnosis.
  • Gender Influence: More prevalent in males; male-to-female ratio increases with age (up to 4:1 in older children).

Causes of Stuttering

  • Unknown Etiology; however, four contributing factors identified:
    1. Genetic Predisposition: Higher familial incidence.
    2. Environmental Factors: Stress and anxiety play roles but uncertain.
    3. Neurodevelopmental Factors: Other communication disorders may co-occur but do not directly cause stuttering.
    4. Psychological Aspects: Increased anxiety correlates with stuttering severity, yet causality is debated.

Disfluencies

  • Typical Disfluencies:
    • Include repetitions, interjections, revisions (e.g., saying "I I forgot the toothpaste").
  • Stutter-Like Disfluencies:
    • More severe forms, including sound repetitions (e.g., "Can I can I can I go outside?").
    • Prolongations and blocks are additional severe forms.

Secondary Characteristics of Stuttering

  • Frequently co-occur with stuttering; can include:
    • Eye blinking, facial tension, and other movements when stuttering occurs.

Developmental Stages of Stuttering

  • Progression from normal disfluencies to advanced stages characterized by:
    • Increased frequency of disfluencies and the emergence of emotional responses like fear and anxiety as awareness of stuttering grows.

Acquired Stuttering vs. Developmental Stuttering

  • Acquired Stuttering:
    • Results from brain injuries (e.g., strokes) & affects any speech segment.
    • Stuttering remains during non-communication activities (e.g., singing).
  • Example: Drew Lynch, a comedian who developed stuttering after a sports injury, showcasing no early childhood stuttering.

Assessment and Treatment of Stuttering

  • Holistic Assessment: Includes relevant medical/family history, speech fluency, and impact on communication.
  • Formal Assessment Tools: SSI (Stuttering Severity Instrument) commonly used at ASU clinic.
  • Impact Assessment Tools: Oasis, CAT (Communication Attitude Test) evaluate the emotional aspects related to stuttering.

Intervention Focus

  • Goals: Improve both speech fluency and the overall life impact of stuttering.
  • Fluency Treatment Approaches:
    • Fluency Shaping: Modifying speech to reduce stuttering (e.g., deep breathing, slowing down).
    • Stuttering Modification: Techniques taught during stuttering events (e.g., cancellations, pullouts).
  • Addressing Impact: Important to reduce anxiety and encourage desensitization (e.g., pseudo-stuttering).

Importance of Counseling in Treatment

  • Counsel patients about their stuttering to improve self-acceptance and manage emotions effectively.
  • Self-disclosure: Patients informing others about their stuttering can reduce social pressure.

Summary of Key Points

  • Fluency disorders are complex, with multifactorial etiology - genetic, environmental, neurodevelopmental, and psychological influences.
  • Focus on person-centered, evidence-based approaches to therapy.
  • Treating the impact of stuttering is often a priority, especially with adults.

Closing

  • Stuttering is a rewarding area within speech pathology, emphasizing the importance of helping individuals communicate with confidence.