Stuttering 1

Normal Disfluencies & Developmental Stuttering: Part 2

CDS 6330 Class SummariesQuestions for David

Learning Factors: Review

Classical Conditioning:

• Children Who Stutter (CWS) experience increased tension as stuttering is perceived as a threatening situation.

• A tension response develops during stuttering attempts, which may manifest as physical tension or anxiety.

• The perception of stuttering can spread to various cues such as certain sounds, specific words, particular people, and certain situations, increasing the focus and pressure on the stuttering behavior.

Operant Conditioning:

• Escape behaviors develop, like squeezing eyes shut or using other physical actions to escape the feelings associated with stuttering.

• These escape behaviors can provide temporary relief from emotional pain linked to stuttering, including feelings of frustration and embarrassment.

• The reinforcement of these escape behaviors contributes to establishing a consistent stuttering pattern, where the child creates a repertoire of techniques to avoid or manage stuttering, sometimes referred to as a "museum of tricks."

Avoidance Conditioning:

• Children may develop avoidance behaviors due to the anticipation of being "trapped" in a stutter, leading to behaviors such as adding sounds before a word or substituting words entirely to prevent stuttering.

Think, Pair, Share

• Engage students in explaining how classical conditioning might cause a child's stuttering patterns to evolve from easy, loose repetitions to tightly squeezed blocks as their speech difficulties manifest.

Developmental/Treatment Levels

Normal Disfluencies: Ages 2-5

Categories of Normal Disfluencies:

• Part-word repetition: e.g., “mi-milk”

• Single-syllable repetition: e.g., “I…I want that”

• Multisyllabic word repetition: e.g., “Lassie…Lassie is a good dog”

• Phrase repetition: e.g., “I want a…I want a ice-cream cone”

• Interjection: e.g., “He went to the…uh…circus”

• Revision-incomplete phrase: e.g., “I lost my…where’s Mommy going?”

• Prolongation: e.g., “I’m Tiiiiiiiiimmy Thompson”

• Tense pause: e.g., “Can I have some more (lips together, no sound) milk?”

Characteristics of Normal Disfluency in Average Nonstuttering Child:

• Typically exhibits no more than 10 disfluencies per 100 words spoken.

• Often consists of one-unit repetitions, with occasional two-unit repetitions.

• The most prevalent types of disfluencies are interjections, revisions, and word repetitions, characterized by a relaxed and typical speech flow.

• Notably, part-word repetitions tend to decrease significantly after the age of 3.

Younger Preschool Children: Borderline Stuttering (Ages 2-3.5)

Characteristics of Borderline Stuttering:

• May exhibit more than 10 disfluencies per 100 words.

• Frequently displays more than two units in repetition patterns.

• Repetitions and prolongations are notable, often pronounced more strongly than revisions or incomplete phrases.

• Disfluencies appear relaxed and loose, and reactions from children in such cases are rare.

Core Stuttering Behavior Includes:

• Part-word repetitions (PW)

• Syllable repetitions (SR)

• Word repetitions (WR)

• Phrase repetitions (PR)

• Prolongations (P)

• Blocks (B)

"Outgrowing" Borderline Stuttering

• Children develop capacities to handle various stressors and experience maturation of their speech and language systems would often lead to a natural resolution of disfluencies.

• Even in supportive environments, persistent stuttering may arise in children with a predisposition, especially when accompanied by other disorders.

Older Preschool Children: Beginning Stuttering (Ages 3.5-6)

Characteristics of Beginning Stuttering:

• Manifestations of muscle tension and hurried repetitions become evident.

• Discoverable pitch rises, particularly towards the conclusion of repetitions or prolongations.

• Fixed articulatory postures indicative of tension become apparent, suggesting discomfort during speech.

• Emergence of escape behaviors, such as eye blinks and head nods, pointing to attempts at managing speech difficulty.

• Awareness of challenges and frustration surfaces, although children experience little to no strong negative self-perception at this stage.

Early Signs of Stuttering Awareness

• Children begin to recognize their stuttering, leading to the development of frustration feelings, but negative feelings about their identity as speakers remain marginal.

Underlying Processes

• Increased muscle tension and tempo may foreshadow exacerbation of stuttering, often tied to efforts made to control or escape stutters.

• Learning mechanisms such as classical and operant conditioning significantly influence stuttering patterns and behaviors.

School-Age Children: Intermediate Stuttering (Ages 6-13)

Characteristics of Intermediate Stuttering:

• Core behaviors involved often include blocks, repetitions, and prolongations, presenting challenges in fluent speech.

• Escaping behaviors may be employed to mitigate blocks, pointing to learned behaviors to manage difficulties.

• Anticipatory behaviors regarding blocks can lead to avoidance strategies, potentially avoiding feared words or high-pressure situations.

• Emotional responses are characterized by fear, embarrassment, and shame, creating additional barriers for these children.

Van Riper’s Word Avoidance Techniques:

• Starters: using alternative or simpler sounds/words to initiate speech.

• Substitutions: replacing challenging words with easier alternatives.

• Circumlocutions: employing descriptions around difficult words rather than saying the word directly.

• Postponements: delaying the use of particular words with fillers or occasions of hesitation.

• Anti-expectancy devices: using humor or unusual intonations to deflect potential stuttering.

Feelings and Attitudes

• Recognition of feelings such as helplessness during blocks and overwhelming repetitions.

• Fear of stuttering builds through anticipation, fostering negative emotional experiences of embarrassment and increased avoidance behaviors.

• Treatment and support may instill feelings of hope and resilience, helping children cope with their speech challenges.

Quotes from Children

• "When I talk, a really mean monster sneaks up on me and shoves a rock in my throat. Everything gets tight and I can’t talk..."

• "No one understands what I’m saying."

Older Teens and Adults: Advanced Stuttering (Ages 13+)

Characteristics of Advanced Stuttering:

• Advanced stuttering presents frequent occurrences of longer and tense blocks, often accompanied by tremors in the lip, tongue, or jaw.

• There might be extensive patterns of avoidance behaviors, which can serve to suppress stuttering in some instances.

• The development of complex avoidance and escape behaviors may become habitual, to the extent that individuals may be unaware of their responses.

• Strong emotions such as fear and shame contribute to a pervasive negative self-concept, which can hinder communication and social interactions.

Underlying Processes (cont’d)

• Cognitive learning aspects often generate negative self-concepts, influenced by listener reactions and individual self-perception.

Exit Card

• Identify two indicators that distinguish developmental stuttering from normal disfluency.

• Reflect on one significant takeaway from David’s narrative and perspective, emphasizing lessons learned about managing stuttering and advocating for understanding.