Fluency Flashcards
stuttered speech is
effortful, halting and discontinuous, and slow from excessive disfluencies.
Secondary stutters: are
abnormal motor behaviors that accompany dysfluencies
defining fluency with non-speech behaviours
Basing it on variables that are not specific to speech, such as:
Stuttering is not = dysfluency
Stuttering begins when children anticipate trouble in speaking situations → become apprehensive about maybe speaking → become tense → avoid.
Due to parental disapproval of normal dysfluencies.
Based on this, stuttering diagnosis is based on consistent avoidance of speaking situations.
What a person does to avoid stuttering (“normal dysfluencies”) and their negative consequences. Diagnosis **based on presence of speech avoidance. **
The person has a **problem with playing certain social roles **
defining stuttering by types of dysfluencies
Basing it on which dysfluencies are present.
Van Riper: Stuttering occurs when the forward flow of speech is interrupted a motorically disrupted sound, syllable or word or by the speaker’s reaction”. Depending on the definition, some dysfluencies have clinical significance (e.g., part-word repetitions, sound prolongations) while others do not (e.g., whole word repetitions, interjections, pauses).
Van Riper’s definition includes the speaker’s reaction to the dysfluency
defining stuttering by all types of dysfluencies
All Types of Dysfluencies
Basing it on if any dysfluency present.
What gives it clinical significance is excessive (1) frequency, (2) duration.
defining stuttering by psychopathology
- based on a psychopathological cause or neurotic reaction (e.g. anxiety, frustration,, apprehension)
- not a foccus except for psychological reactions of PWS
Etiology theories
Sound prolongation and part-word repetitions are due to (Pavlovian) classically conditioned negative emotion and are therefore is considered stuttering (Brutten and Shoemaker).
All other dysfluencies are non-pathological=operantly conditioned-Skinner
Cerebral dominance theory: people who stutter are less likely to have developed unilateral cerebral dominance (often ambidextrous)
There is a certain percentage threshold of __ in speech that make a listener judge it as __; however, this differs based on __
%
%
dysfluencies ; “stuttered”; the type of dysfluency:
2% threshold for part-word repetitions and sound prolongations.
5% threshold for whole-word repetitions, schwa interjections
2% threshold for
part-word repetitions and sound prolongations.
5% threshold for
whole-word repetitions, schwa interjections
Natural Recovery.
Natural Recovery. Rate changes on the study (i.e. the longer the study, the greater the rate); generally believed to be 88% and persists in 12%. (This includes without any strategy/coping mechanism - with professional help or not).
incidence rate General Populations.
Approximately 8-10% lifetime incidence (i.e., at one point in their life), but less than a 1% prevalence.
Gender.
M > F, with a 3:1 ratio, and becomes larger with age (i.e., girls tend to have more spontaneous recovery).
Typically begins between
(however,
adult onset is
3-6Y
risk is generally over by 5Y);
rare, but could be neurogenic, psychogenic, or a reemergence of childhood stuttering.
At stuttering onset, children may be dysfluent on
adults are typically dysfluent on
function words (e.g. pronouns, conjunctions, articles) and content words (adjectives, nouns, verbs, adverbs)
on content words
normal fluency is
Speech that is effortless, flowing, smooth, continuous, relatively fast, rhythmic, and free from excessive disfluencies.
normal disfluency
disfluencies we all have
developmental dysfluency
dysfluencies during the developmental age range (2-4) as theyre rapidly developing their language
- esp part word repetitions and interjections
- Diagnosis of stuttering may be made by using one of the several diagnostic
criteria: - A dysfluency rate that exceeds 5% of spoken words when all kinds
of dysfluencies are counted - A certain frequency of part-word repetitions, speech-sound
prolongations, and broken words (at least 2% of the words spoken) - Excessive duration of dysfluencies (1 second or longer)
- Presence of stuttering-like dysfluencies, at least at 3% of syllables
produced
types of direct treatment
- Procedures to reduce frequency/severity of stuttering behaviours
a. Contingency Management Strategies
b. Fluency Shaping Strategies:
c. Anxiety Reduction Strategies
d. Stuttering Modification Strategies - Procedures to minimize or remove processes that may be maintaining stuttering behaviours
a. Identify and manage external factors that reinforce stuttering or
avoidance behaviours
b. Identify and manage external factors or situations that are associated
with increased stuttering - Procedures to facilitate transfer of new speech behaviours to daily
communication situations - Foster maintenance
Different Treatment of stuttering
- Psychological methods
- Fluent-stuttering method / stutter more fluently / stuttering modification
- Fluency shaping method / speak more fluently
- Fluency reinforcement method
- Masking and delayed auditory feedback techniques
- Direct stuttering reduction methods
Neurogenic/acquired stuttering:
- may happen after-
- happens when theres __ problems ___(where)__
- etiologies
○ Neurogenic stuttering may happen after a stroke or brain injury.
○ It happens when there are signal problems between the brain and
nerves and muscles involved in speech.
○ Etiologies
■ Cerebral vascular disorders that cause stroke
■ RHD
■ Extrapyramidal diseases - parkinson’s
■ Drug toxicity
Similarities between child onset and NG Stut.
disorders
- Resembles stuttering of early childhood onset but is associated with diagnosed neurological disorder(s)
Positive signs or symptoms of
neurogenic stuttering that contrast with
stuttering of childhood onset include:å
- Repetitions of medial and final syllable in words
- Dysfluent production of function words
- Disfluencies in imitated speech
- Rapid speech rate
- General symptoms of brain injury
Acquired psychogenic stuttering
○ Psychogenic stuttering is not common. It may happen after emotional
trauma. Or it can happen along with problems thinking or reasoning.
○ Categorized as a conversion reaction
Theories of stuttering
- Genetic
- Neurophysiological
- Brain dysfunction hypotheses
- Learning, conditioning, and related hypotheses
- Stuttering is a learned, operant behaviour
- Mismatch hypotheses - environmental demands placed on a child exceed their capacity of fluency
Cause & does Cluttering coexist with other disorders?
Often co-exists with stuttering, fluency disorder
○ The cause of cluttering seems to be largely unknown, however, cluttering co-occurs with various other conditions (e.g. learning disabilities, auditory processing disorders, Tourette’s syndrome, ASD,
ADHD)
○ assessment/treatment of cluttering
- what you look at
much like stuttering of early childhood onset with an emphasis on its special features
- (excessive rate and rate variations,
- articulatory breakdowns and speech intelligibility,
- prosodic variations,
- lack of concern, etc.
○ ellipse → omission of sounds, syllables and words
Cluttering characteristics
○ Rapid but disordered articulation → unintelligible speech
○ Rate variations
○ Impaired prosodic features with frequent pauses
○ Impaired fluency (often word and phrase repetitions, interjections and
revisions)
○ Omission and compression of sounds and syllables
○ Jerky/stumbling rhythm
○ Monotonous tone
○ Spoonerisms “hissed the mistory lectures”
○ Disorganized language production and thought process
○ Lack of concern/reduced awareness of difficulties → less anxiety
MEMORY TOOL: clutz, tripping over his words w/ a spoon in his hand and jerky in the other cz he’s going too fast, but doesn’t care, and ppl dont understand him but he doesnt care cz hes kinda a jerk[y] & monotone & unintellig
Cluttering vs Stuttering
Stuttering
- excessive frequency of part- and whole-word
repetitions
- active attempts to avoid or conceal communication difficulties
- use of word avoidance and circumlocution in
response to anticipated disfluency
Cluttering
- excessive frequency of revisions
- reduced intelligibility in conjunction with rapid rate
- misarticulating of multisyllabic words
- limited concern and awareness of communication deficits
Psychosocial, educational, and
vocational impact of fluency disorders
Social and Emotional
● expressing wants and needs
● having conversations or telling stories
● forming friendships
● regulating emotions
● showing confidence
● conveying truthfulness
Academic
● reading aloud
● answering questions in class
● giving class or work presentations
● participating in class discussions
Vocational
● “Results indicated that more than 70% of people who stutter agreed that stuttering decreases
one’s chances of being hired or promoted. More than 33% of people who stutter believed
stuttering interferes with their job performance, and 20% had actually turned down a job or
promotion because of their stuttering.”
● Limited career choices (e.g. may prefer a career that doesn’t require much interaction with
others)
Assessment fluency
Background information of client (case history)
○ Family history of stuttering
○ Frequency, type, duration and variability
○ Age and circumstances of onset of stuttering
○ Changes in stuttering over time (normal to have good and bad days)
○ Child’s awareness of and reactions to stuttering
○ Child’s temperament
○ Other coexisting speech, language or other developmental/ medical/ cognitive
issues
○ Parents’ concern about stuttering
○ Additional factors to consider for older children:
■ Motivation to seek therapy
■ Impact of stuttering on individual’s life
■ Discussion of escape and avoidance behaviours
■ Thoughts and feelings about communication
■ Any previous therapy experiences
■ Goals and expectations of therapy
