Chapters 3 & 4 Flashcards
Questions regarding stuttering onset
When does it happen?
Who is affected?
How does it happen?
What happens?
When: Age at onset
Range: 16 - 60 months
Mean: 33.40 months
for boys: 33.60
for girls: 32.95
Average age they begin to stutter- 2 ½ years
*It is very rare for children to begin stuttering after 5 years of age. There are acquired and psychogenic stuttering disorders
When
56% of onsets occur between 24 to 36 months of age;
84% from 18 to 42 months
What: Nature of onset period
Sudden (1-3 days) 40%
Intermediate (1-2 weeks) 33%
Gradual (>2 weeks) 27%
Most cases are sudden or intermediate onset- troubling for the child if they are aware and for the parents
How: Manner of onset
30% the onset happens in one day
Majority of onsets are not gradual
What happens?
Disfluencies near onset
Stuttering-Like
Disfluencies (per 100 syllables)
Stuttering Children Normal Children
10.37 1.33
Stuttering-like disfluencies: Part-word repetitions Prolongations Blocks Monosyllabicword repetition
What: Secondary Characteristics
52% of children exhibit at least one: Facial contortions Eye closing Head tilting Respiratory irregularities Others
*Concomitant/accessory behaviors
Over half (52%) exhibit at least on secondary behavior when they begin stuttering
What: Stuttering severity at onset
Severity Mild
Clinicians 35%
Parents 45%
Severity Moderate
Clinicians 45%
Parents 27%
Severity Severe
Clinicians 20%
Parents 28%
Some kids do onset with severe stuttering, not always gradual or mild at onset
What: Reported stress at onset
Illness 14% Emotional upset 40% Behavioral stress 36% Rapid lang. develop. 40% Word finding problems 43%
*Rapid language development: they have a lot of internal drive to put new language together and may not be able to so there are breakdowns
What: Child’s Awareness & Reactions. Assessed through:
Parents’ reports
Children’s response to clinician probing
Puppet task: Child’s identification with fluent or non-fluent puppet
*Puppet task: one fluent one disfluent, ask child: which one is more like you?
What: Awareness
Some children exhibit awareness of, and reactions to, their stuttering soon after onset. Studies with the puppet method have indicated sharp rise in awareness between ages 4 and 5.
Development of Stuttering
Natural recovery
80% will recover even without treatment
Persistency
20% will persist
*In some cases, natural recovery trends occur soon after onset.
When was the onset? How long has this been going on?
80% chance of recover at onset, but if 2 years go by it is 57% chance of recovery
Persistence and Recovery: Gender
Males
Persistent 30%
Recovered 70%
Females
Persistent 18%
Recovered 82%
Male/female ratio
- 67m/f
- 89 m/f
*4:1 Males to females for the persistent people who stutter, not true for the recovered
Risk for persistency: Primary factors
Family History (#1 risk factor) Gender (boys) Stuttering trends Duration of stuttering (years stuttered) Age at onset (younger=better prognosis) Disfluency length Disfluency type; Prolongations/blocks
Risk for Persistency: Lesser factors
Secondary Severity Secondary characteristics. Phonology Expressive language Acoustic features
Tertiary
Concomitant disorders.
Awareness; Emotional reactions
*Severity has to be factored in but is not always predictive of persistency
Secondary characteristics- negative sign
Other disorders- worse prognosis
Analyze risk factors to get a sense of severity and prognosis for persistence but we ever really know
A family history of persistency gives a child a ____% chance of following the same trend.
A family history of recovery gives a child a ____% chance for the same trend.
65%
65%
The development of stuttering
Red flags
- Multiple small unit repetitions
- Prolongation, consistent sound
- Blocks, laryngeal tension- no air
- Respiratory irregularities
- Secondary behaviors
- Excess muscular tension, push harder and the whole system shuts down at the level or the larynx or the articulators
Disfluency Types
Part-word repetitions: a-ai; f-five; ba-baby
Single-syllable word repetitions: but-but; and-and
Multiple-syllable word repetitions (Typical): Because – because
Phrase repetitions (Typical): I was - I was going; Once up - once upon
Prolonged sounds: a»»ai like to go; S»»ometimes
Blocks & broken words: C (silence)–ake; The ta (silence)–able
Tense pause: I like to (silence)——go home (between words)
Interjections (Typical): um; uh; er; hmmm
Revisions (Typical): I like – I want this ball (same thought)
Incomplete utterance (Typical): The baby – let’s do…(change in thought
Stuttering-Like Disfluency
- Part-word-repetition
- Single-syllable word repetiton
- Disrhythmic phonation (prolongations and blocks)
Other disfluencies
Interjection
Multi-syllable word and phrase
Revision
Incomplete sentence
Why the term:Stuttering Like Disfluencies?
Two reasons:
SLD are much more typical and much more frequent in the speech of PWS
Listeners show a strong inclination to perceive these disfluencies as “stuttering.”
Sound prolongations: Duration tends to ______with age in PWS
Increase
Non-stuttering preschool 1.16 units Stuttering preschool 1.53-1.70 units Stuttering, school-age 2.45 units
Physical Concomitants
Head jerks Head turns (side; down) Forehead tension Nostrils flaring/constricted Eyes closed; squinting Eyes widely open Facial contortions Lips pressured Jaw closed tightly Teeth grinding Jaw wide open Sideways jaw movement Tongue protrusion Throat tightened Body swaying Hand/ arm movements Irregular exhalation (blowing) during speech Irregular inhalations (gasping) in the midst of speaking
*Can target reduction of secondary behaviors as a goal – need to learn tools to use then reduce behaviors utilizing tools
Emotional Reactions Vary in Time Relative to the Stuttering Event
Prior- Fear, dread, anxiety
During- blankness, trapped, panic, frustration
After- Shame, humiliation, anger, resentment
Phenomena of Advanced Stuttering
Adaptation
Consistency
Adjacency
Expectancy
Adaptation
Stuttering declines with each successive rereading of a passage
Other conditions of adaptation:
- increased fluency with each successive restating of a word or phrase
- talking or reading words that are always changing (but far less adaptation)
Typically, 50% decline by the 5th reading Greatest reduction the 2nd reading Both frequency and severity decline Improvement is only temporary Not all clients show the effect
Consistency
stuttering tends to occur on words previously stuttered
Adjacency
if words are removed, stuttering tends to occur on words near those previously stuttered
Expectancy
stuttering tends to occur on words the speaker predicts will be stuttered
Brown’s 4 Factors of Stuttering Loci
Adult stuttering events tend to occur on:
- words beginning with consonants rather than vowels
- long words rather than short ones
- content words rather than function
- sentence-initial (early) words rather than later words
*Children- it is usually flipped
Vowels more than consonants
Function words more than content words
Conditions that Diminish Stuttering
Manner of Talking
Singing In rhythm (e.g., to a metronome beat) In a monotone Imitating a dialect Acting Whispering Speaking slowly
Conditions that Diminish Stuttering
Context of Talking
To an animal To an infant In unison With DAF With masking noise With response contingent stimuli
*Propositionality- no social demand when speaking to an animal or infant
