Week #1 Intro to Stuttering

Introduction to Stuttering

  • Course Code: CDS 6330

The Words We Use

  • Preferred terminology: "People who stutter"

    • Avoid terms: stutterer, PWS (people who stutter), disfluency

  • Definition of Disfluency

    • "Disfluency" defined as developmental or abnormal.

    • Note: "Disfluency" is preferable to the term "dysfluency."

Historical Context of Stuttering

  • Evidence of stuttering found across various cultures:

    • Dates back approximately 40 centuries in both Chinese and Egyptian cultures.

    • Large populations of African tribes exhibit stuttering.

  • Historical treatment methods documented:

    • Talking with pebbles in the mouth (utilized by Greek orator Demosthenes).

    • Use of profanity (example: Samuel L. Jackson).

    • Tongue cutting (performed by surgeon Dieffenbach in the 1800s).

    • Boiling animal parts and consuming them (often seen in traditional African cultures).

Causes of Stuttering

  • Current understanding of stuttering causation:

    • Not fully understood, though several factors are believed to contribute:

      • Genetic and congenital influences.

      • Developmental influences.

      • Environmental influences.

      • Repeated negative emotional experiences linked to stuttering can lead to unfavorable feelings and attitudes.

      • Precipitating factors may contribute to the development of stuttering.

Developmental Stuttering

  • Key characteristics:

    • Represents a heterogeneous population.

    • Symptoms typically emerge before age 6.

    • Emergence is gradual, particularly notable during significant speech and language acquisition.

    • No attributable link to psychological or organic trauma.

Basic Facts about Stuttering

  • Findings from Yairi & Ambrose (2005):

    • Factors associated with children who persist in stuttering:

      • Family history of persistent stuttering.

      • Male gender.

      • Onset occurring after age 3.5 years.

      • Lack of decrease in stuttering during the initial year following onset.

      • Persistence of stuttering beyond one year since onset.

      • Presence of multiple unit repetitions (e.g., "li-li-li-li-like this").

      • Continuation of prolongations and blocks.

Onset of Stuttering

  • Onset may vary:

    • Can start as a gradual increase in normal disfluencies or manifest as a sudden appearance of severe blocks.

    • Stuttering may be sporadic at onset, fluctuating over days or weeks before becoming consistent.

    • Typical age of onset ranges from 18 months to 12 years, with most frequent onset between 2 and 3.5 years (average being 2.8 years).

Prevalence and Incidence of Stuttering

  • Prevalence Definition: Indicates the percentage of individuals stuttering at any given time.

    • 2.4% prevalence in kindergarten-aged children.

    • Approximately 1% in school-aged children.

    • Slightly less than 1% in adults.

  • Incidence Definition: Indicates the percentage of individuals who have experienced stuttering at some point in their lives.

    • Roughly 5% incidence rate.

  • Recovery Statistics:

    • Between 70% and 80% of children who begin to stutter will recover without treatment.

    • Approximately 1% of children will continue to stutter into adulthood.

Sex Ratio in Stuttering

  • Ratio observed at onset:

    • Nearly even (1:1) across genders at onset.

    • Assigned females at birth begin to stutter earlier than assigned males at birth but tend to recover more frequently.

    • By school age, the ratio changes to 3:1, favoring assigned males at birth who stutter.

Precipitating Factors for Stuttering

  • Developmental influences:

    • Emotional, cognitive, or motoric developmental pressures that may trigger stuttering.

  • Environmental influences:

    • Negative feedback or criticism of speech from peers or adults (listener's negative reactions).

    • Stressful environments at home or school.

    • Exposure to significant stressful events.

Core Behaviors Defining Stuttering

  • Repetitions:

    • Whole word repetitions (e.g., "I – I – I want to go").

    • Syllable repetitions (e.g., "I want choc-choc-chocolate ice cream").

    • Sound repetitions (e.g., "I w-w-want chocolate").

  • Prolongations:

    • Defined as when sound or airflow continues but the movement of articulators is halted.

    • Even prolongations as short as one-half second can be perceived as abnormal (e.g., "IIIIIIIII want to go").

  • Blocks:

    • Involves an inappropriate stoppage of airflow or voicing; articulatory movement may be halted.

    • Blocks can occur at various levels: respiratory, laryngeal, and/or articulatory.

    • May present with tremors of the lips, tongue, jaw, and/or laryngeal muscles.

The Iceberg Analogy of Stuttering

  • Stuttering is depicted metaphorically as an iceberg:

    • Visible effects on the surface (stuttering).

    • Profound emotional consequences deep beneath:

      • Fear, shame, guilt, anxiety, hopelessness, and isolation.

      • Development of negative feelings, attitudes, and perspectives regarding speaking and life.

      • Significant impact on the speaker’s daily routine and long-term goals.

Secondary Behaviors

  • Secondary behaviors are learned responses triggered by stuttering experiences or anticipation of stuttering.

    • Escape behaviors:

      • Occur during stuttering attempts aimed at completing words (e.g., eye blinks, head nods).

    • Avoidance behaviors:

      • Utilized when anticipating a stutter; the speaker may change words or use fillers (e.g., saying "uh").

Feelings and Attitudes Toward Stuttering

  • The experience of stuttering can evoke a range of emotions:

    • Feelings of embarrassment and frustration that intensify with additional stuttering instances.

    • Development of fear and shame, contributing to increased frequency and severity of stuttering.

  • Attitudes:

    • Develop as feelings become more entrenched, influencing beliefs about oneself and perceptions of listeners.

Covert Stuttering

  • Definition: Some speakers attempt to pass as fluent by employing secondary behaviors to mask or suppress stuttering.

  • Role conflict and Use of Suppression Hypothesis (Sisskin, 2012):

    • The act of suppressing stuttering may exacerbate the issue, creating a more severe disorder.

Personal Reflection

  • Anecdote - "Setting My Words Free" by Vince Markowsky:

    • Discusses the journey of finding a satisfying career in relation to speech challenges.

    • Reflects on making job choices based on comfort in speaking situations.

    • Acknowledges daydreaming about true aspirations and feeling frustrated with speech difficulties in the process.

Listener's Perceptions of Stuttering

  • Non-stuttering individuals often hold negative stereotypes regarding PWS:

    • Associations with emotional, intellectual, and developmental challenges.

    • Negative personality traits, such as shyness or insecurity.

  • Common behaviors exhibited by listeners:

    • Avoiding eye contact, finishing utterances for the speaker, interrupting pauses, or providing unsolicited advice like "it's okay, take your time" or "slow down."

Conclusion on Facts about Stuttering

  • The following implications about stuttering are summarized:

    • Stuttering is primarily an inherited or congenital disorder.

    • First appears during children's complex speech development stages.

    • Emerges in children whose speech production system is susceptible to interference from competing demands of language, cognition, and emotion.

    • Once stuttering begins, it becomes persistent in certain children, potentially those experiencing strong negative emotions related to their stuttering, resulting in various learned behaviors.