Ch. 6: Fluency & Its Disorders

Question 1

Fluent Speech

Answer 1

Type of speech that is produced with relative ease (less effort and tension), that is flowing, smooth, continuous, relatively rapid, normally rhythmic, and free from an excessive amount or duration of dysfluencies.

Question 2

Stuttered Speech

Answer 2

Type of speech that is produced with greater than normal amount of effort. It is halting, does not have flow, is discontinuous, not smooth, and may be slow with abnormal rhythm.

Question 3

Moment

Answer 3

The act of stuttering that is observed in a time duration.

Question 4

Event

Answer 4

The act of stuttering that is observed in a time duration.

Question 5

Cerebral Dominance Theory

Answer 5

According to this theory, persons who stutter (as a group) are less likely than their fluent peers to have developed unilateral cerebral dominance. They are often ambidextrous. Thus, these people stutter because of their lack of unilateral dominance. Known to be questionable.

Question 6

Repetitions

Answer 6

Saying the same element of speech more than once.

Question 7

Part-Word Repetitions

Answer 7

Also known as sound or syllable repetitions. Repetition of a part of a word or a sound or syllable. E.g., “S-S-S-Saturday” or “Sa-Sa-Sa-Saturday”

Question 8

Whole-Word Repetitions

Answer 8

Repetition of an entire word more than once. Word repeted may be single or multiple syllables. E.g., “I-I-I-I am fine” or “could-could-could-could not do it”

Question 9

Phrase Repetitions

Answer 9

Repetition of more than one words. E.g., “I am-I am-I am fine” or “could not-could not-could not do it”

Question 10

Sound Prolongations

Answer 10

Sounds produced for a duration longer than typical. E.g., “Lllllike it” or “Mmmmmommy”

Question 11

Silent Prolongations

Answer 11

An articulatory posture held for a duration longer than average but with no vocalization. E.g., the articulatory position for producing the /p/ sound in the word ‘pot’ may be held too long. Such postures are usually associated with increased muscular tension.

Question 12

Interjections

Answer 12

Extraneous elements introduced into the speech sequence. These may be:

• Sound or syllable interjections (e.g., “um” and /schwa/)
• Word interjections (e.g., “like,” “okay,” “well”)
• Phrase interjections (e.g., “You know,” “I mean”)

Question 13

Pauses

Answer 13

Silent intervals in the speech sequence at inappropriate junctures or of unusually long duration.

Question 14

Broken Words

Answer 14

Silent intervals within words, also known as intralexical pauses. E.g., “Be [pause] fore you say it.”

Question 15

Incomplete Sentences

Answer 15

Often described as incomplete phrases, these are grammatically incomplete productions. E.g., “Last summer I was… Last summer… we went to Paris this time.”

Question 16

Revisions

Answer 16

Changes in wording that do not change the overall meaning of an utterance. E.g., “Let me have coffee, maybe tea.”

Question 17

Incidence

Answer 17

The rate of occurrence in a specified group of people. Predictive statement. More expensive and time consuming.

Question 18

Prevalence

Answer 18

Determined by counting the number of individuals who currently have a disease or disorder. Involves a head count at any given point in time. Does not make a predictive statement. Less expensive and time consuming. Head counting often underestimates this by missing those who have not received clinical services.

Question 19

Stuttering

Answer 19

Begins as an increase in the frequency of dysfluencies (may be sudden or gradual). Typically judged to be 5+% of speech as dysfluent to be considered this. Typically begins in early childhood (3 – 6 years). Adult onset is rare. Lifetime expectancy is 5%. Incidence is 1%. Prevalence is higher in African Americans. Occurs more commonly in males (3:1 ratio in younger grades, 4:1 ratio in higher grades). Familial prevalence is estimated to be 3x higher than the general population. Prevalence is higher in people with developmental disabilities and people with neurological impairment (especially brain injury or epilepsy). Lower prevalence in the D/HOH community.

Question 20

Familial Prevalence

Answer 20

The frequency with which a given condition appears in successive generations of blood relatives.

Question 21

Concordance

Answer 21

The occurrence of the same clinical condition (or normal trait) in both members of a twin pair.

Question 22

Spontaneous Recovery from Stuttering

Answer 22

Disappearance of stuttering without professional help. May be associated with an inadvertent use of certain techniques. Some studies suggest that the rate of this is 60%, others believe it is 30 – 35%. It is not possible to predict whether this phenomenon will occur in a particular child.

Question 23

Stuttering Associated Motor Behaviors

Answer 23

Number and severity of these behaviors may vary. May be accidentally reinforced. Not crucial for diagnosis. Include:

• Excessive muscular effort
• Various facial grimaces
• Various hand and foot movements (e.g., wringing the hands, tapping the foot)
• Rapid eye blinking
• Knitting of the eyebrows
• Lip pursing
• Rapid openings and closings of the mouth
• Tongue clicking

Question 24

Stuttering Associated Breathing Abnormalities

Answer 24

May be part of the stuttering symptom process. Not crucial to diagnosis. Do not suggest an inherent respiratory disorder. Include:

• Attempts to speak on inhalation
• Holding breath before talking
• Continued attempts to speak even when the air supply is exhausted
• Interruption of inhalations by exhalations and vice versa
• Speaking without first inhaling a sufficient amount of air
• Rapid and jerky breathing during speech
• Exhaling puffs of air during stuttered speech
• Generally tensed breathing

Question 25

Negative Emotions Associated with Stuttering

Answer 25

Are not necessary for diagnosis, but may help process. Include:

• Anxiety and apprehension about stuttering
• Fear of certain speaking situations
• Frustration in efforts to communicate
• Possibly a sense of humiliation in certain difficult speaking situations or some hostility toward certain speakers

Question 26

Difficult Speaking Situations

Answer 26

• Speaking with strangers and formal audiences
• Speaking with people at counters where services or products are bought
• Speaking on the telephone
• Ordering in restaurants
• Speaking to authority figures
• Self-introductions
• Introductions of other people

Question 27

Loci of Stuttering

Answer 27

Refers to the locations in a speech (or oral reading) seqeucne where stutterings are typically observed. In the speech of adults and school-age children who stutter, stuttering is more likely to occur:
- With consonants than with vowels
- On the first sound or syllable of a word
- On the first word in a phrase or sentence
- On the first word in a grammatical clause
- On longer words
- With less frequently used words
- On content words
For preschool children, loci are the same as for adults, but with one exception: Tends to occur most on function words (especially pronouns, conjunctions, and prepositions). This contrasts with the adults and school-age children who typically stutter more often on content words than on function words. Preschool children also tend to use whole-word repetitions.

Question 28

Stimulus Control

Answer 28

Most variations found in stuttering are due to variations in stimuli. Such patterns suggest a strong environmental control. A few important phenomena that suggest strong stimulus control are adaptation, consistency, adjacency, and audience size.

Question 29

Adaptation Effect

Answer 29

Systematic reduction in the frequency of stuttering when a short printed passage is repeatedly read aloud. The amount of reduction in stuttering is the greatest during the first few oral readings. The magnitude of reduction is progressively less on subsequent readings of the same passage until the amount of reduction is negligible. The greater the time interval between readings, the less the degree o adaptation. No transfer of adaptation from one passage to another. A temporary pheonomenon. Silent reading of a passage does not produce greater adaptation when the same passage is subsequently read orally. Lipped or whispered reading may reduce stuttering to some extent. Less severe stuttering tends to adapt more than severe stuttering. Both children and adults, those who stutter and those who do not, show adaptation. Great deal of individual difference. Due to a deconfirmation of the expectancy of stuttering, a reactive inhibition (fatigue), fear reduction, and to the rehearsal effect.

Question 30

Consistency Effect

Answer 30

The occurrence of stuttering on the same word or loci when a passage is read aloud repeatedly. Opposite of the adaptation effect, in a sense. About 65% of stuttering in given individuals may be consistent (stuttering tends to occur on the same words or loci in repeated readings). Consistency remains when subjects reread a passage after weeks of interval.

Question 31

Adjacency Effect

Answer 31

The occurrence of new stuttering on words that surround previously stuttered words. A striking phenomenon of stimulus control. This effect is studied by having a subject read a passage aloud multiple times, blotting out or otherwise concealing the words on which stuttering occurs, and then having the subject read the passage again to note the occurrence of new stuttering. In several subjects, words that were fluently read during earlier readings were eventually stuttered. The newly stuttered words were often adjacent to those blotted out (previously stuttered words). This effect is evident in adults and children who stutter. May be horizontal or vertical.

Question 32

Audience Size Effect

Answer 32

Refers to the observation that the frequency of stuttering increases with an increase in audience size. Characterized by:

• A marked decrease in stuttering when there is no audience and the person is speaking to themselves (monologue)
• A corresponding increase in the amount of stuttering with a systematic increase in the number of listeners
• A reduced amount of stuttering when a listener’s hearing is visibly masked
• A greater amount of stuttering when listeners can hear the person who stutters than when they can only see the person who stutters.

Question 33

Laryngeal Dysfunction Hypothesis

Answer 33

States that suttering is due to aberrant laryngeal functions. Etiology may be defective neuromotor control of the laryngeal mechanism, as no local laryngeal pathology has been documented in people who stutter. Evidence for this hypothesis includes:

• Slightly delayed voice onset time (VOT)
• Increased tension in the laryngeal muscles
• Aberrant muscle behavior during stuttered speech
• Excessive laryngeal muscle activity during stuttered speech

Question 34

Voice Onset Time (VOT)

Answer 34

Measured by giving a visual or auditory signal to produce a simple vocal response (e.g., saying “ahhh”) and measuring the time between the offset of the stimulus and the onset of the vocal response. Documented delay is in milliseconds and fades with repeated trials.

Question 35

Operant Behaviors

Answer 35

A behavior that can be changed by changing its consequences. Learned behaviors.

Question 36

Diagnosogenic Theory of Stuttering

Answer 36

States that when parents punish a child’s normal nonfluencies, the child develops anticipatory, apprehensive, and hypertonic avoidance reactions that are indeed stutterings.

Question 37

Brutten and Shoemaker (1967)

Answer 37

Proposed that stuttering consists of fluency disruption due to classically conditioned negative emotion.

Question 38

Johnson (1959)

Answer 38

Viewed stuttering as an avoidance behavior. Proposed the diagnosogenic theory. Asserted that stuttering is a cultural phenomenon. Believe that people did not stutter in cultures that did not emphasize fluency.

Question 39

Sheehan (1970)

Answer 39

Viewed stuttering as approach avoidance. Believed that a person’s stuttering person’s hesitations and repetitions indicate a conflict between a desire to approach speaking situations and an equally strong desire to avoid them. Difficult to measure. Fluent speech is possible when the drive or desire to speak is stronger than the drive to avoid speech. When the drive to avoid speech is the stronger of the two, the person does not talk at all. However, when the two rives are at equal strengths, stuttering results.

Question 40

Bloodstein (1995)

Answer 40

Proposed that stuttering is essentially a response of tension and fragmentation in speech. Stuttering is not unlike normal dysfluency, though it is typically greater in quantity and more disruptive in quality. Such a response of tension and fragmentation may come about because of a child’s belief that speech is a difficult task. Thinks that stuttering may have many origins, most of them related to various kind of severe communication pressure that leads to repeated communicative failures (anticipatory struggle hypothesis).

Question 41

Anticipatory Struggle Hypothesis

Answer 41

Hypothesis proposed by Bloodstein (1995), stating that stuttering may have many origins, most of them related to various kinds of severe communicative pressure that leads to repeated communicative failures.

Question 42

Demands and Capacities Model

Answer 42

States that stuttering can result when a child faces demands for communication that he or she cannot meet because of limited capacities.

Question 43

Psychological Methods of Treatment for Stuttering

Answer 43

Methods involve the assumption that stuttering is a psychological disorder with underlying unconscious psychological conflicts or that stuttering and psychological problems coexist. No strong evidence that this kind of counseling, offered exclusively, is effective. SLPs often use this in conjunction with other treatment methods. Psychological treatment consists of attempts to solve those problems. The somewhat varied methods of treatment include:

• Discussion of psychological problems associated with stuttering
• Discussion of feelings, emotions, and attitudes associated with stuttering
• Discussion and resolution of potential psychological conflicts, unconscious psychosexual conflicts, and various kinds of negative reactions
• Reeducation of the client about a more realistic and rational approach to the stuttering problem

Question 44

Fluent Stuttering Method/Stutter-More-Fluently Approach

Answer 44

Stuttering treatment approach developed by Van Riper (1973). The goal is to obtain more fluent (less abnormal) stuttering. Rarely establishes normal fluency, but does modify stuttering. Relapse of stuttering may be a problem. This method involves the following steps:

1) Teaching stuttering identification
2) Desensitizing the client to his or her stuttering
3) Modifying stuttering (cancellations, pull-outs, preparatory sets)
4) Stabilizing the treatment gains
5) Counseling the client

Question 45

Cancellations

Answer 45

Pausing after a stuttered word and saying the word again with easy and more relaxed stuttering.

Question 46

Pull-Outs

Answer 46

Change in stuttering midcourse. E.g., by slowing down and using soft articulatory contacts instead of blocking on sounds or words)

Question 47

Preparatory Sets

Answer 47

Changing the manner of stuttering so that the client produces less abnormal stuttering.

Question 48

Fluency Shaping/Speak-More Fluently Approach

Answer 48

This approach to stuttering aims to establish normal fluency (not fluent stuttering). Teaching the various skills of fluency (e.g., appropriate management of airflow to produce and sustain fluent speech, slower rate of speech, and gentle onset of phonation) is the main treatment task. Can generate slow, deliberate, and somewhat unnatural-sounding speech. Relapse is common. Treatment targets include:

• Teach airflow management
• Teach gentle, soft, relaxed, and easy onset of phonation, beginning after the initiation of exhalation
• Teach a reduced rate of speech through syllable prolongation with no pauses
• Implement maintenance strategies (e.g., teaching self-monitoring skills and training family and friends to monitor and reinforce fluency in natural settings over time)
• Reshape normal prosodic features

Question 49

Fluency Reinforcement Method

Answer 49

A simple method that works with many young children is to positively reinforce fluent speech in naturalistic conversational contexts. This method can be combined with such targets as reduced speech rate. In this method, the clinician:

• Aranged a pleasant and relaxed therapeutic setting
• Evokes speech with the help of picture books, toys, and other play materials
• Positively reinforces the child for fluent utterances with verbal praise, tokens, or both
• Frequently models a slow, relaxed speaking rate that assures stutter-free speech
• Reshapes normal prosody if a slower rate is an added target

Question 50

Delayed Auditory Feedback Treatment

Answer 50

When a stuttering person hears his or her own speech with a fraction of a second’s delay, most of the dysfluencies are reduced. Main advantage of this technique is its capacity to induce a slower rate of speech. In this method:

• Clinician uses DAF machine that allows for variable delays
• Determines a client-specific duration of delay that assures stutter-free speech
• Has the client practice stutter-free speech for varying lengths of time to eliminate stutterings
• Fades the delay in gradual steps to reshape the normal prosody while maintaining fluency

Question 51

Masking + DAF Treatment

Answer 51

Method of treatment for stuttering. Used has decreased over the years. Patients may adapt to noise. Treatment includes:

• Clinician determines a minimum level of auditory masking that induces stutter-free speech
• Has the client practice stutter-free speech for variable lengths of time, depending on the client’s progress
• Fade the masking noise to reshape normal prosody while maintaining fluency

Question 52

Direct Stuttering Reduction Methods

Answer 52

Methods of treatment that seek to reduce stuttering directly, without teaching specific fluency skills or modifying stuttering into less abnormal forms. To reduce stuttering directly, behavioral methods of time-out or response cost may be used.

Question 53

Time-Out/Pause-and-Talk

Answer 53

In this method, the person who stutters is taught to pause after each dysfluency and then resume talking. Can establish natural-sounding fluency. Preferred for older children and adults. The specific procedures include the clinician:

• Saying “stop” or giving other signals (e.g., a light that comes on) to pause after each dysfluency is observed and making sure that the client completely ceases talking
• Avoiding eye contact with the client for 5 seconds
• Reestablishing eye contact after the time-out duration and letting the client continue his or her speech
• Maintaining eye contact, smiling, and employing other social reinforcers for fluent speech

Question 54

Response Cost

Answer 54

In this method, for every instance of stuttering, the clinician takes away a token, that is being awarded for every fluent production. There is a variation of this procedure in which a bunch of tokens are initially given to the client, and a single token is withdrawn for each dysfluent production; this variation is not recommended. Most of the positive evidence is related to the classic procedure of giving tokens for fluency and taking it away for dysfluency. Can establish natural-sounding fluency. Preferred for preschoolers and younger children. The specific procedure includes:

• Reinforcing the client for every fluently spoken word, phrase, or sentence with a token that is backed up with other kinds of reinforcers; the client exchanges the tokens for another reinforcer at the end of the session
• Taking a token away in a matter-of-fact manner immediately following a stuttering or at the earliest sign of it
• Progressing from words and phrases to conversational speech
• Fading the tokens when fluency is sustained at 98% or better across three or four sessions and maintaining frequency with verbal praise alone

Question 55

Neurogenic Stuttering

Answer 55

A form of fluency disorder associated with documented neuropathology. Other neurogenic speech disorders (e.g., apraxia or dysarthria) or language disorders (e.g., aphasia) may or may not be present. Common etiological factors include bilateral brain damage, cerebral vascular disorders that cause strokes and head trauma, extrapyramidal diseases (especially Parkinson’s), progressive supranuclear palsy, brain tumors, brain surgery (including bilateral thalamotomy), seizure disorders, dementia, and drug toxicity (especially from drugs prescribed for asthma, depression, schizophrenia, and anxiety). Characteristics include evidence of neuropathology, adult onset of stuttering, and a generally increased rate of dysfluencies is common. Not associated with social/emotional/self-esteem issues, as is common in childhood-onset stuttering. Signs include repetitions of medial and final syllables in words, dysfluent production of function words, dysfluencies in imitated speech, and rapid speech rate.

Question 56

Cluttering

Answer 56

A disorder of fluency characterized by rapid but disordered articulation, possibly combined with a high rate of dysfluencies and disorganized thought and language. Tends to coexist with stuttering. Causes are unknown. Reducing rate of speech usually improves clarity and fluency. Increasing awareness via audio is helpful. Very little research on this topic. Maintenance is a prominent problem after therapy. Characteristics include:

• Impaired fluency with excessive amounts of dysfluencies
• Rapid repetition of syllables, along with other forms of dysfluencies
• Rapid but disordered articulation resulting in indistinct (unintelligible) speech
• Clearer articulation and improved intelligibility at a slower rate of speech
• Omission and compression of sounds and syllables
• Jerky or stumbling rhythm
• Monotonous tone
• Spoonerisms
• Reportedly, a lack of personal concern about or reduced awareness of one’s speech problem

Question 57

Spoonerisms

Answer 57

Unintentional interchanges of sounds in a sentence. E.g., many thinkle peep so instead of many people think so)

• Lack of anxiety about or negative reactions to one’s speech difficulties
• Disorganized thought processes (a controversial feature)