FLUENCY Flashcards
articulation
movement of articulators to produce sounds of language
voice
carrier signal underlying many speech sounds
prosody
rate
stress
intonation
fluency
smooth, forward flow of communication
fluency dimensions
continuity
rate
rhythm
effort
naturalness
T/F: stuttering is the only fluency disorder
false
T/F: to be diagnosed w/ stuttering, children must develop symptoms during childhood
false
stuttering definition
speech hesitations that keep a speaker from moving forward
not related to the speaker being unclear about their message
composed of affective, behavioral, & cognitive components of stuttering (ABCs)
stuttering-like disfluencies
repetitions of sounds or syllables – most commonly word-initially
whole word repetitions – single syllable
prolongations of sounds – word initial & medial
blocks
non stuttering-like disfluencies
interjections
revisions
phrase repetitions
not finishing a thought
cluttering LCD definition
segments of speech are too fast overall, too irregular, or both too fast & too irregular
the segments of rapid &/or irregular speech rate must be accompanied by 1+ of the following:
- excessive non-SLDs
- excessive collapsing (coarticulation) or deletion of syllables
- abnormal pauses, syllable stress, or speech rhythm
cluttering associated w/
difficulty in written communication / illegible handwriting
disordered thoughts/ideas in their speech
difficulties w/ self monitoring / awareness, perceiving nonverbal cues from convo partner
neurodiversity
differences in cognition & brain function are natural variations of human biology vs pathological conditions
ableism
direct / indirect discrimination towards impairment sustained by stereotypes / stigma
disorder
a group of symptoms that disrupt normal functions in the body or cause significant impairment
disability
any condition / group of conditions of the body or mind (impairment)
that makes it more difficult for a person w/ the condition to engage in certain activities (activity limitations)
& interact w/ the world around them (participation restrictions)
medical perspective
assess, diagnose, & treat impairment
social perspective
change an unaccommodating society / reduce ableism
rigidity of society leads to activity limitations & participation restrictions
covert stuttering
all the things a person is doing to hide their stutter
cause of affective + cognitive factors
overt stuttering
when a person isn’t hiding their stutter
affective components of stuttering
feelings & emotions that accompany stuttering
shame, guily, embarrassment, anger, frustration, etc.
cognitive components of stuttering
negative thoughts & beliefs that perpetuate the problem of stuttering
behavioral components
observable behaviors of stuttering
physical symptoms - SLDs
secondary behaviors
secondary behaviors
tension or struggle behaviors that become paired w/ stuttering moments
learned behavior
classically conditioned to avoid or escape a moment of stuttering
stomping, blinking, clearing throat
types of stuttering
developmental
acquired
acquired types of stuttering
neurogenic
drug induced
psychogenic
characteristic of acquired stuttering
usually not as much tension
less blocks & prolongations, more repetitions
less secondary behaviors
developmental stuttering onset
preschool years (~2-4 yrs)
can be sudden / progressive / start & stop
treatment often initiated by age 6
cluttering onset
age of onset similar to developmental stuttering
usually treated around agee 8
why is cluttering treated later
increasing complexity of sentences
early childhood stuttering remission
resolves in 80% of children within 12-24 mos of onset — regardless of treatment
persistent stuttering risk factors
family history
boys
co-occurring condition (ADHD, ASD)
more complex stuttering moments & secondary behaviors
prevalence vs incidence
prevalence = fixed point in time
incidence = long span of time
stuttering prevalence
1%
stuttering incidence
5-8% in early childhood
stuttering eliminated w/
chorus reading
singing
delayed auditory feedback
behavior outside speech that stuttering affects
playing instruments
manual tasks (typing, piano)
adaptation in stuttering
~5 readings of the same passage, stuttering reduced by 50%
consistency in stuttering
tends to occur on the same words during repeated passages
adjacency
when stuttered words are removed, stuttering occurs on words located near removed ones
packman & attansio model
multi factorial model because stuttering is not just 1 thing
speech motor system prone to perturbation
linguistic variability / situational complexity increase demands
threshold for moments of stuttering are different for each inidividual
demands & capacities model
demands for a child’s fluency exceed language, motor, social-emotional, & cognitive capacity
parental pressure
not true
covert repair hypothesis
stuttering is a covert attempt to repair Phonological coding (speech sound selection) errors
incorrect phonological planning leads to incorrect speech motor planning
doesn’t cover secondary behaviors or genetics
EXPLAN theory
breakdown in linguistic planning leads to delayed motor execution
developmental stuttering NOT caused by
anxiety
trauma
parents
what % of PWS report family history
70%
have any genes been identified to cause stuttering
4, but not everyone has them
identical twins & stuttering
80% chance both twins will stutter
male vs female & stuttering
relatively even at onset
persistent stuttering higher in males
3-5 males for every 1 female
reduced brain function w/ stuttering
corpus callosum
arcuate fasiculus
white matter tracts
greater activity in right hemisphere than controls
assessment goals
document nature & severity of the IMPACT of stuttering (abcs)
establish rapport & clear communication
develop & state treatment goals –> quantifiable & measurable
comprehensive assessment
case history, file review, medical history, educational record
parent / teacher / client interview
analysis / assessment of live & recorded speech samples demonstrating representative disfluencies
comprehensive assessment components
review of previous fluency evals
awareness & adverse impact –> ABCs & attitude towards stuttering
formal test of other dimensions of speech –> may be co-occurring w/ other language disorder
strengths & coping strats
stimulability testing
diagnostic cut offs
3% SS or more = stutter
10% SS or more could be stuttering or cluttering
cluttering diagnosis
SLDs under 3% SS & NSLDs would primarily contribute to 10% SS
stuttering diagnosis
72% of total disfluencies would be SLDs
which of the following supports a prognosis for stuttering remission
relatives who stuttered & recovered
this causal theory of stuttering specifies factors that are necessary (must apply to all persons who stutter) & sufficient (all those who stutter may have it) for stuttering to occur at any given moment
packman & attansio model
validity limitations of %SS / NSLDs
doesn’t capture variability of stuttering
some SLDs perceived by listener & speaker as more severe
reliability limitations of %SS / NSLDs
subjectivity inherent to quantifying %SS
dependent on clinician experience
severity rating
person listens to sample of speech & uses scale to rate overall severity
SR strengths
anyone can complete it, anywhere
simple, valid, & covert
correlated w/ %SS
reliability typically greater between raters than %SS
SR weakness
cannot characterize number of disfluencies
speech rate
words / syllables per minute
less stuttering = faster rate
avg speech rate for someone who does NOT stutter
200 SPM
avg speech rate for someone who stutters severely
50 SPM
intelligibility
how well a speaker’s message can be understood
open set measures
listening & writing down what is heard
generate %
closed set measures
comparing what was heard to preset list of options
generate %
rating scale
listener assigns a number as to how intelligible the message is
not super valid or reliable
stuttering severity instrument (SSI)
normed & validated measure
qualifies:
- %SS
- duration of 3 longest stuttering moments
- verbal & nonverbal behaviors
- speech naturalness
time consuming
what does OASES measure
self awareness & attitude towards stutter / clutter
assessment results in
diagnosis
features & severity
impact
recs for treatment
counseling
referral
treatment formats
individual therapy
group therapy
intensive intervention
residential / camp programs
support groups / conventions
direct stuttering treatment options
fluency shaping
stuttering modification
other – operant approaches, cognitive restructuring etc
indirect support for communicative effectiveness
model reduced speaking rate, relaxed demeanor
provide time for speaker to get message out
listen
avoid rapid fire questions
take turns
positive feedback
maintain eye contact
why might treatment goals for children under 6 appear more fluency-centric than treatment goals after that age?
before 6 –> caregivers usually making goals which tend to rely more on fluency
after 6 –> persistent stutter = more coping & less “fixing”
Lidcombe Program
direct
based on response contingent stimulation
- remove desirable stimulus to decrease a behavior (puppet)
parents trained to give verbal contingencies during practice sessions & naturalistic conversations
goal of fluency treatment in school age children
avoid overemphasizing or placing high value on the achievement of fluency as the ultimate or only goal of therapy
focus on effective communication
the goal of fluency treatment in adults
often fluency is primary goal requested by clients at start of therapy
help clients shift towards communication vs fluency centric goals
tools for change
fluency shaping (change the way we talk)
stuttering modification (change the way we stutter)
voluntary stuttering (change the way we think/react to stuttering)
self advocacy, disclosure, education (change others’ thoughts, reactions, & behaviors)
fluency shaping
rate control
continuous phonation
prolonged syllables
easy onsets
light articulatory contact
abdominal breathing
when is a fluency shaping approach a good move
stutters openly
doesn’t avoid speaking
positive self image as a communicator
positive response to fluency shaping trial therapy
stuttering modification
identification - what we do, how we feel
desensitization
variation
modification (prep set, cancellation, pull out)
stabilization
stuttering modification primary goal
achieve desensitization to the stuttering experience & gradually change stuttering into less effortful
give client sense of control
voluntary stuttering
client stutters on purpose - chooses when & how
builds awareness about what happens when we speak & stutter
desensitization
variation
speak:
tight vs loose
slow vs fast
eyes closed vs open
cancellations
finish the stuttered word
pause for a moment to plan stutter on the word again in an easier way
client learns to cancel out or replace hard stuttering w/ looser, easier, & more controlled stuttering
pull outs
hold onto moment of stuttering & stay w/ it
focus on where tension is & where movement is stopped
change the stutter by reducing tension & moving ahead slowly
reinforces a loose way of stuttering
prep sets
when speaker anticipates a stuttering moment, begin word w/ a smooth form of stuttering
full breath, air flow, gradual onset, constant phonation, light articulation
when to do stuttering modification
speaker hides stutter
avoids speaking
negative self image regarding communication
positive response to trial
disclosure
letting conversation partner that you have a stutter & what they can do to make you feel more comfortable
will usually practice it in therapy
