Developmental, environmental & learning factors in stuttering

Question 1

2 leading hypotheses:

Answer 1

1. Children w/ artic or lang impairments anticipate difficulty speaking.
2. Disorders result from common genetic/neural deficit

Question 2

From Gene to Phenotype
Genes
Cells
Systems
Behaviour

Answer 2

Serial model of how genes impact brain development
Genes-multiple alleles each of small effect
Cells-subtle molecular bottlenecks
Systems-variable development/info processing
Bevr-complex functional interactions and emergent phenomena

Question 3

Cognition

Answer 3

• stuttering onset coincides w/ rapid cognitive devt
• this leaves fewer neural resources for fluent speech production
• if cog deficits (e.g. Down Syndrome, TBI), higher incidence
• recovery may be associated w/ cog ability (persistent, lower on IQ- all w/in normal though)

Question 4

Family Environment

Answer 4

-Highly impactful for developmental stuttering
(interactionist theories)
-parental factors may favor devt of disorder (critical, greater senstivity to speech etc.)

Question 5

Diagnosogenic Theory of Developmental Stuttering

Answer 5

Wendell Johnson (1942)
Parents overreact to child's typical disfluencies, and child becomes stressed about it

Question 6

The Tudor Study (1939)

Johnson

Answer 6

Tested hypothesis that labeling a child as a stutterer would create MORE hesitancies
-many orphaned children exhibited stuttering-like bevrs

Question 7

Diagnosogentic Theory: Problems

Answer 7

Johnson misinterpreted data

• disfluencies were at word-repetition level (more typical)
• could have made this children more hesitant speakers

Question 8

Demands & Capacities Theory

Answer 8

disfluency = capacitiesm (inherited tendencies, strengths, weaknesses, perceptions) not equal to speech performance demands

Question 9

Demands/Supports

Answer 9

Demands: parents w/ high expectations & standards
-increasing complex thoughts, parental interactions that cause stress

Supports: love, care, encouragement

Question 10

D&C - Four Dimensions

Answer 10

1. motoric
2. linguistic
3. socio-emotional
4. cognitive

Question 11

Motoric

Answer 11

• *Motor demands defined by TIME PRESSURE
• negative listener reactions (interruptions, finishing child’s sentences)
• high emotion/excitement
• competition for conversational turns

Question 12

Motoric Demands

Answer 12

Speaking when someone is waiting, complex/long utterance, saying own name, telephone, repeating to clarify, speaking while rushed

Question 13

Linguistic

Answer 13

• semantic, syntactic, phonological, pragmatic aspects of lang use
• disfluent speech more prevalent when word-retrieval, sentence formulation, complex phono combos & social appropriateness imperative

Question 14

Socio-Emotional

Answer 14

• excitement & anxiety

- increase child’s oral motor muscle activity and reduce fluency (children regulate emotion differently than adults)

Question 15

Cognitive

Answer 15

-child’s ability to use metaling skills
-onset of stuttering, before meta skills developed
BUT communication is more natural w/ lessened cognitive effort

Question 16

D&C Strengths

Answer 16

• accounts for day-to-day stuttering variability

- accounts for individual variability

Question 17

D&C Limitations

Answer 17

• means limitless # of possible causes
• untestable b/c capacities not measurable
• no identifiable threshold where stuttering will occur (relation b/t D & C not distinguished)
• limited research

Question 18

Utilization of D&C Theory for Tx of developmental stuttering

Answer 18

• Basis for comprehensive & clear direction for treatment
• continual re-assessment needed
• Aim: Build capacity for fluent speech, controlling envtal demands
• *Parental involvement crucial
• early intervention (educate fam)
• lessen expectations for child in stressful activities
• reduce negative comments

Question 19

2 Categories of Stuttering brought out by significant life events:

Answer 19

1. Clients w/ predisposition for the disorder (Predisposition positive)
2. Clients without any evidence of a predisposition (predisposition negative)

Question 20

Predisposition Positive

Etiology & Xtics

Answer 20

Etiology: Ability to learn speech & lang is subtly compromised

• stress from life increases anxiety
• neg. emotions take resources for speech & lang learning, stabilization & fluency

Xtics: Typical developmental stuttering

Question 21

Psychogenic Stuttering

Etiology & Xtics

Answer 21

Etiology: traumatic life event leads to stuttering in a child or adult w/ no predisposition to disorder

Xtics: Atypical “atypical” disfluencies

Question 22

Learning

Define, List 3 types

Answer 22

=change that takes place in person as result of their experiences in the environment

1. classical conditioning
2. operant conditioning
3. avoidance conditioning

Question 23

Classical Conditioning & Stuttering

Answer 23

Pavlovs dogs

• can explain secondary behaviours (e.g., tension, anxiety, struggle)
• people can become conditioned stimuli (neutral stimuli can become conditioned)
• may play role in onset of stuttering and spread to many contexts

Question 24

Operant Conditioning & Stuttering

Answer 24

If bevr followed by REWARD it increases, and by an AVERSIVE consequence, it decreases
e.g., random struggle movements to escape stuttering rewarded with the removal/end of stuttering (negative reinforcement)
**Positive reinforcement as therapy tool (Lidcombe program)
**Mild punishment can be used (pointing out bumpy speech, asking child to practice using smooth speech)
-may increase escape bevrs
ENVIRONMENT IS KEY

Question 25

Avoidance Conditioning

Answer 25

• Bevr used to avoid stuttering when it is anticipated (e.g. adding interjection or starter prior to anticipated stuttering)
• avoiding speaking or words, substituting words, using extra sounds)
• often avoidance bevrs beings as ESCAPE behaviours (trying to get out of the stutter)