Chapters 5 & 6

Question 1

What is a theory?

Answer 1

A proposed explanation, framework, or model of a natural or social phenomenon or set of phenomena.
(Yairi & Seery, 2015)

*Model is more specific, includes discrete variables that relate to each other in certain ways
Model is the prototype for how all of the variables interact with eachother

Question 2

What is a model?

Answer 2

An ideal prototype of the major parts of a complex phenomenon or system.
Proposes a set of variables and the relationships among them.
(Yairi & Seery, 2011, 2015)

*They help explain how a system works.

Question 3

Ancient Stuttering Treatments(Limited Evidence of Improvement)

Answer 3

Talking with pebbles in the mouth (Demosthenes, ancient Greece)
Surgical resections of the tongue (Germany, 1840s)
Prosthetic devices (U.S.; France, 1800’s)

*In ancient times:
Slow tongue, faulty tongue, demonic possession, not knowing how to pronounce sounds
Chopping of the tongue, supportive arches at the bottom of tongue to support a lazy or weak tongue

King’s Speech: marbles in the mouth, playing music

Question 4

Stuttering theories: The blind men and the elephant

Answer 4

Six blind men encountered an elephant for the first time. Each touched the elephant and arrived at a different impression – like a wall, like a fan, like a spear, like a tree, like a snake, etc. Each was correct, but they needed to combine their knowledge to understand the elephant.

*Limited perspective, not getting the full picture

Question 5

We don’t have a good solid theory that can explain everything. This is a complicated, ____________disorder

Answer 5

multidimensional

Question 6

Types of Causal Factors

Answer 6

Predisposing - sets up a vulnerability
Precipitating - triggers episodes or events
Perpetuating - aggravates or maintains

*Predisposing: Family history, genetics, temperament
Precipitating: Environment, prenatal and perinatal factors, trauma, emotional stressors, illnesses, speaking context
Perpetuating: Emotional reaction (linked with temperament), tense emotions, secondary behaviors (begins as repetitions and turns into blocks with many secondary behaviors and interjections), parent pressure
“Genetics loads the gun, environmental factors pull the trigger”

Bi-directional cause: the cause may be genetic, neurological and predisposing factors along with negative emotional reactions.

The negative reactions my exacerbate the cause of stuttering.

Question 7

Risk factors

Answer 7

biological or behavioral aspects associated with a disorder; but they do not cause it (e.g., male)

*Male: risk factor
Age is a risk factor: older than 5 the risk factor decreases

Question 8

Protective factors

Answer 8

biological or behavioral aspects associated with not having a disorder, but they do not cure it (e.g., female)

Question 9

Superstition or Science?

Answer 9

How do we decide what to believe?

How do we test the many theories of stuttering that arise?

Question 10

Criteria for Strong Theories and Models

Answer 10

Valid
It fits the observed phenomena
Exhaustive
It explains all associated phenomena
Elegant
It is succinct
Parsimonious
It uses the least ideas to explain the most facts
Exclusive
It does not overlap with other explanations
Testable
Its essence or parts can be proved or disproved
Predictive
It makes predictions about future observations
Consistent
Its components do not contradict each other
Flexible
It can easily be adapted with new information
Explanatory
It serves to explain, not merely describe

Question 11

STUTTERING IS ___________:

Answer 11

VARIABLE

*not constant, changes across time, situations, speaking partners
The only real constant is how much it varies.

Question 12

Testing Theories and Models

Answer 12

Multiple observations needed as a basis for evidence
To establish a causal relationship:
Mere correlation or association of variables is not sufficient.
Manipulation is needed. Repeatedly create and remove a condition to show that change occurs only with the variable being altered with that condition.

*Correlation is not causation
We need research and manipulation of variables to isolate certain variables

Question 13

Challenges to Stuttering Research

Answer 13

Difficult to observe its onset - how can we catch the first time it appears? Parents often wait, it is difficult to catch at onset for research
Characteristics change with age – is it the same disorder?
Inconsistent occurrence – why are stuttering events and their conditions so variable?
Ethical limitations – is it moral to create conditions that may induce stuttering?

*Variable: even if someone knows the tools and is competent at using them, sometimes they just have a bad day

Is stuttering just stuttering? Or are there subtypes? Etiology can be different, responses to treatments can be different, types of stutters can be different. *This is an area of research to be pursued! Right now we assess and treat is as one disorder, we don’t have a good categorization at this point.

Question 14

Types of Psychological Theories Causes of stuttering:

Answer 14

Psychoemotional – emotional trauma or personality conflict

Psychobehavioral – a learned behavior reinforced by environmental variables

Psycholinguistic – a breakdown in the processes for generating language

Question 15

Examples of Psychoemotional Theories

Answer 15

Stuttering is a symptom of repressed unconscious conflicts or urges
Stuttering is a symptom of a personality disorder or neurosis
Stuttering is a symptom of maladjustment following a psychological trauma

Question 16

What evidence would support a psychoemotional cause?

Answer 16

1. Onsets coincide with traumatic events
2. Sudden onsets far more frequent than gradual onsets
3. Recovery coincide with improved emotional adjustment
4. Onset age evenly distributed across the lifespan

Note: none of these are supported facts

Question 17

Adult Personality and Stuttering

Answer 17

Inconsistent findings across studies
Personality characteristics of PWS likely reflecting the impact of stuttering, not its cause
Trait anxiety may be a contributing predisposing factor (but not, by itself, a cause)

*Personality disorders are claimed to be more prevalent among people who stutter; however, some say personality disorders come as a result of stuttering

Today, nobody is proposing the core cause of stuttering is psychological
Psychological/psychoemotional: emotions
Psychobehavioral: learned
Psycholinguistic: language

Question 18

Examples of Psychobehavioral Theories

Stuttering is acquired :

Answer 18

by a child who tries to avoid unacceptable speech behavior
when a child has learned to be anxious and tense about speaking
after environmental stimuli have reinforced the behavior
when environmental demands exceed the speaker’s capacities for fluent speech

Question 19

Diagnosogenic Theory (Johnson)

Answer 19

Diagnosogenic: the diagnosis causes the problem
Stuttering occurs when a speaker tries to avoid normally disfluent speech events
Parents disapprove and show concern over disfluency, and then the child struggles to avoid it

*Wendell Johnson: Monster study

Very important theory, not because it’s right. Pediatricians still tell parents this today: “ignore it, don’t make a big deal out of it, it will go away, calling attention to it could make it worse.”

Question 20

Negating Johnson’s Theory

Answer 20

Notable differences do exist in the speech of CWS. Parents are not reacting to normal disfluency
Improvement occurs in some cases despite calling attention to stuttering
Stuttering improves when aversive stimuli (e.g., electric shock) were the consequence of stuttering

*Parents are reacting to something that is not normal, there are observable stutters and parents have reason to be concerned.

There is documented improvement when calling attention to the stuttering occurs

Negative consequences to a child following a pediatrician’s advice: “don’t talk about it, there will be negative emotional consequence,” but if they are not allowed or open to talking about it they may become shameful of their stuttering “I’m struggling and no body is saying anything or helping me, this must be really bad.”

Question 21

REVIEW OF Classical Conditioning:

Answer 21

If a neutral stimulus (bell) is paired with a naturally-occurring stimulus (food) it can develop the power to trigger the same response (saliva)
Example: Pavlov’s dog salivates when a bell rings
Neutral stimuli evokes salivation response over time

Question 22

REVIEW OF Operant Conditioning:

Answer 22

The consequence (food) of a response (standing) can change the response frequency. 
Example: When the rat stands up, food is delivered. Because the behavior was positively reinforced, the rat stands up more times.
*Train an animal=operant conditioning
Go to the bathroom outside, sit, stay – reinforce with praise/treats so they will keep doing it
Things you don’t want them to do- discipline

Question 23

Two-Factor Theory (Brutten & Shoemaker, 1967)

Answer 23

Stuttering results from conditioned negative emotion
Two factors, classical and operant conditioning play a role
Factor I: various cues evoke feelings that disrupt speech movements
Factor 2: secondary behaviors are reinforced because they deter stuttering

*Factor 1: classical conditioning
Factor 2: operant conditioning

Question 24

Anticipatory-Struggle Hypothesis (Bloodstein, 1997)

Answer 24

A child struggles to speak and finds it difficult
Frustration and repeated failure lead to a belief that talking is hard to do
Believing speech is difficult, the child adds undue tension to the act
Talking triggers the anticipation of stuttering and struggle (tension) reactions.

Question 25

Demands-Capacities Model (Starkweather & Gottwald, 1990)

Answer 25

Stutter events arise when various demands exceed the speaker’s capacities for fluent speech. For example, a child attempts speech performance beyond his/her abilities.

Capacities vs. demands differ across children (cognitive, linguistic, motor, etc.)
A child may have no deficits, but demands still exceed capacities
An advanced capacity may be a demand For example: new vocabulary knowledge (demand) may exceed oral motor abilities (capacity) for producing the words

*Decrease demands:
Talking in shorter sentences
Talking slower
Not interrupting child
Use familiar/more simple vocabulary

Bottom line of this model:
Stuttering can be learned from emotions/anxiety, anybody can learn stuttering
Stuttering can be unlearned (reinforcement, praise, punishment)

Problem with this approach:
There is an inherent component
If this model fails, they will feel incompetent

This is a neurodevelopmental disorder a person is born with and can be managed over their lifetime. Cannot claim a cure.

There are not cures for most medical conditions, they are managed.

Question 26

Examples of Psycholinguistic Theories Stuttering results from:

Answer 26

An effort to correct a speech planning error before it surfaces (Covert Repair Hypothesis)
A defect in central processes responsible for uniting sound elements into syllables (fault line hypothesis)
A mistimed arrival of either the sound fillers or the syllable frames essential to execution of speech (neuropsycholinguistic theory)

*Defect in ability to correct the errors in a timely fashion, late in correcting phonological errors it results in stutters according to this theory

Fault –line: real problem with stuttering lie in the transitions between consonants and vowels and syllables
Voiceless consonant to a vowel- turning the voice on

Not a problem in terms of articulation/motor speech production, it is more of a problem in language and encoding of language