COMDIS415 FLUENCY Flashcards
Characteristics of typical disfluencies
Phrase repetitions (“I want I want to go”)
Interjections (uhm, uh)
Revisions (“I want to go – I want to buy something at the store”)
Typical disfluencies reflect physical maturation and language development
All speakers show fluctuations in fluency
Core Features
Primary speech characteristics that result in disfluent speech
A. Repetition
Sound Repetition (p-p-p-p-paper)
Syllable repetition (pa-pa-pa-pa-paper)
Monosyllabic word repetition (cat cat cat)
B. Prolongation (ssssssave me a seat)
Held for long periods of time
C. Block
Complete blockage somewhere in vocal tract, articulators in fixed position, but nothing is coming out
Secondary Features
Non-speech characteristics that occur alongside core features
Emerge with increased severity, age, and awareness
Might be more obvious than the core feature and more difficult to treat
Used to escape or avoid a stuttering moment
Can include feelings and attitudes about stuttering
a. Escape
Physical body movement (reinforcing behaviors: hand flapping, rocking)
Eyes close
Eyes roll back
b. Avoidance: if they have trouble with certain phoneme, they’ll change the phoneme
Sound/word/situational avoidances
Circumlocution (gives description so that they can avoid using a certain phoneme, clinician fills in the blanks based on description)
E.G “I went to that big city that everyone wants to live in with the big rats (NEW YORK CITY) because client can’t say “city” without stuttering
Reduced verbal output
Fillers
What speaking situations are typically most challenging for a person who stutters
a. public speaking
b. on the phone
c. ordering food at a restaurant
d. talking to people you don’t know
How do we distinguish typical disfluencies from atypical disfluencies?
Stuttering-like disfluencies (SLD) ~ core features *Frequency matters
Typical disfluencies (TD) ~ interjections, revisions, phrase repetitions
Neurogenic
A stutter caused by a stroke
Psychogenic
Emotional Trauma, Counseling is needed, not therapy
Developmental
No pinpointed cause, but genetic mutation/neurophysiological factors likely involved
Not induced by parents
Environmental factors may exacerbate
Fast-paced lifestyle, stress, anxiety, family dynamics
Emerges between ages 2- and 3.5-years
Transient or lifelong (persistent stuttering)
70-80% of cases will resolve within 1 year of onset
What are the components of a stuttering assessment
A. Naturalistic speech samples across contexts
- Frequency of disfluencies across 300 syllables
- Secondary behaviors (motor behaviors that happen during moment of disfluency)
- Questionnaires
>10% disfluency
>30% of disfluencies are ‘stuttering-like’ core behaviors like repetition, block
Indirect Parent Implemented
one, two visit session, teach parent communication strategies, speaking at slow pace
giving child time to respond, minimizing distractions, have them come back to update
if getting worse, time for active treatment
Best for young children who have a mild disfluency
Parent counseling
Model good speaking and listening
Clinician may check in on a regular basis to re-assess
(70-80% that might resolve naturally qualify for this)
Direct Parent Implemented: (e.g Lidcombe program)
3 main strategies:
Prompt for correction of disfluent speech / praise fluent speech
Clinic visits
Structured activities
Unstructured activities
teaching parent every week to implement programs at home, helps with generalization
getting treatment everyday in a natural context, successful with few challenges
backlash for parents (why am i paying all this money if i’m doing the work?)
Clinician Directed
Stuttering modification: teaches a person how to manage a moment of stuttering
Controlled fluency
One on one with a child
working on the disfluent speech and teach them how to speak with controlled fluency
maximum parts of speech that are fluent
Fluency Shaping: teaches a person how to produce more fluent speech
Fluency shaping techniques
Rate control
Continuous phonation (cursive talking – prevent starting and stopping between sounds)
Easy onset (“hi” “horse” h allows for air to come out)
Light articulatory contact (“paper”)
Airflow management (diaphragmatic breathing)
Age of onset for developmental stuttering. Why does stuttering occur during this period?
2-3.5
Fast-paced lifestyle, stress, anxiety, family dynamics
What percentage of stuttering cases resolve naturally within 12 months of onset
70-80% of cases will resolve within 1 year of onset
