6. Fluency and Its Disorders

Question 1

The Loci of Stuttering

Answer 1

Definition: locations in a speech sequence where stutterings are typically observed
Stuttering is more likely to occur:
*with consonants vs vowels
*on the first sound or syllable of a word
*on the first word in a phrase or sentence
*on longer words
*with less frequently used words, which also tend to be longer

Question 2

Stimulus Control in Stuttering (4)

[Patterns of variation suggest a strong environmental control, called stimulus control]

Answer 2

4 important phenomena that suggest a strong stimulus control of stuttering include:

• Adaption effect: reduction in stuttering when a short printed passage is repeatedly read aloud
• Consistency effect: occurance of stuttering on the same word or loci when a passage is read aloud repeatedly; In a sense, it is the opposite of the adaption effect
• Adjacency effect: new stuttering on words that surround previously stuttered words
• Audience size effect: stuttering increases with increase in audience size

Question 3

Theories of Stuttering

Answer 3

• There are environmental, genetic, and neurophysiological theories of stuttering. However, no theory explains all aspects of stuttering
• Theories are likely to remain incomplete until the nature of causation is determined. Existing theories are at best hypotheses; Hence, none are universally accepted as explanations

Question 4

Stuttering: Genetic Hypothesis

Answer 4

• Potential genetic basis based on: a) stuttering has a high familial incidence, b) well-established gender ratio in prevalence (boys>girls), and c) higher concordance rate among identical twins
• However, no gene/chromosomal abnormality and no particular mechanism of inheritance has been identified; Also, in about ½ the cases, familial incidence may be negative

Question 5

Stuttering: Neurophysiological Hypothesis

Answer 5

• Position that PWS have an abnormal neurophysiological or neuromotor organization
• ”Laryngeal dysfunction hypothesis” (etiology of aberrant laryngeal function may be defective neuromotor control of laryngeal mechanism as no local laryngeal pathology has been noted)
• Evidence supporting laryngeal dysfunction hypothesis include: a) slightly delayed VOT in some PWS, b) increased tension in laryngeal muscles in stuttered speech, c) abberant muscle behavior during stuttered speech, and d) excessive laryngeal muscle activity in stuttered speech

Question 6

Stuttering: Learning, Conditioning, and Related Hypotheses (6)
(Environmental)

Answer 6

• Stuttering as an operant behavior
• Stuttering as speech disruption due to classically conditioned negative emotion
• Stuttering as avoidance behavior
• Stuttering as approach avoidance
• Stuttering as a reaction of tension and fragmentation (anticipatory struggle hypothesis: severe communicative pressure leads to repeated failures)
• Stuttering due to demands exceeding capacities
• Stuttering as a form of psychoneurosis

Question 7

Stuttering: Assessment

Answer 7

• Detailed case hx
• Measurement of type and frequency of dysfluencies in conversational speech and oral reading
• Evaluation of the variability of dysfluencies
• Assessment of negative emotions
• Avoidance reactions
• Associated motor behaviors
• Measure of speech and articulatory rates
• Application of a chosen diagnostic criterion

Question 8

Behavior Assessment Battery

Answer 8

Assesses negative emotions and attitudes associated with speech, speaking situations and avoidance behaviors of adults and children who stutter

Question 9

Stuttering: Treatment Methods (6)

*Traditional and **Behavioral

Answer 9

• Psychological methods (Freudian psychoanalysis, nonFreudian psychotherapy, and counseling)
• Van Riper’s Fluent stuttering method AKA stutter-more-fluently approach (stuttering identification, desensitization, modification, stabalizing tx gains, counseling)
• Fluency shaping method AKA speak-more-fluently approach (establish normal fluency not fluent stuttering via airflow management, slower rate, and easy onset)
• *Fluency reinforcement method (young kids; reinforces fluent speech in naturalistic conversational contexts)
• Masking and delayed auditory feedback techniques
• *Direct stuttering reduction methods (time-out/pause-and-talk and response cost)

Question 10

Van Riper’s Fluent Stuttering Method: Techniques of Stuttering Modification (3)

Answer 10

• Cancellations: pausing after a stuttered word and saying word again w/ easy and more relaxed stuttering
• Pull-outs: changing stuttering mid-course (e.g., by slowing down and using soft articulatory contacts)
• Preparatory sets: e.g., changing manner of stuttering so that the client produces less abnormal stuttering

Question 11

Neurogenic Stuttering

Answer 11

• Associated with neuropathology; other neurogenic speech disorder (e.g., apraxia or dysarthria) or lang disorder (e.g., aphasia) may or may not be evident
• Assessed and treated within context of existing neurological disorders

Common etiologic factors include:

• Cerebral vascular disorders –> strokes/head trauma
• Extrapyramidal diseases (esp. Parkinson’s), brain tumors, brain surgery, seizure disorders, dementia
• Drug toxicity (esp. drugs for asthma, depression, schizophrenia, and anxiety)
• Bilateral brain damage is associated with persistent neurogenic stuttering; multiple lesions of a single hemisphere or some drug toxiity is associated with transient neurogenic stuttering
• Different neuropathological conditions may produce the same symptom complex

Question 12

Cluttering: Definition

Answer 12

• DIsorder of fluency characterized by rapid but disordered articulation, possibly combined with a high rate of dysfluencies and disorganized thought and lang
• Tends to coexist with stuttering, but no strong tendency for stuttering to coexist with cluttering
• Characterized by rapid, jerky, and disorganized speech
• Reduced awareness of one’s speech problem
• Tx: Reducing sp. rate and increasing self-awareness
• Etiology/cause: unknown