Fluency

Question 1

types of stuttering

Answer 1

• Repeated movements including –
o Complete syllable repetition eg.“But, but, but, but”
o Incomplete syllable repetitioneg.“Mmmmmmmm-more”
o Multisyllable repetition eg.“I want, I want, I want, I want”
• Fixed postures –
o With audilble airflow ie. Freezing of air for several seconds with phonation/fricatives
o Without air flow
• Superfluous behaviours –
o Verbal eg. Umm, you what I mean, and yeah
o Nonverbal behaviours eg. Grimaces, eye closing

Question 2

measures of stuttering

Answer 2

• Connected speech samples in multiple contexts

Stuttering behaviours
• Percentage of syllables stuttered = %SS
• Syllable per minute = SPM
• Severity rating scales (perceptual)
o 0-9 point scale for children (Lidcombe program)
o 0-8 point scale for adults (Camperdown program)

Anxiety about stuttering
• Spence Children’s Anxiety Scale (SCAS) (St. Clare et al, 2009)
• Adult anxiety: Unhelpful Thoughts and Beliefs about Stuttering (UTBAS) (Spence, 1998)

Question 3

What to consider before starting intervention(possible natural recovery)

Answer 3

• Age – by 6yo
• Family history
• Phonological skill
• Gender
o Equivalent statistics for children between male and female children with stuttering
o Adult males are more likely to experience stuttering behaviours than female

Question 4

why is it important to have early intervention?

Answer 4

• Significantly more hours of treatment needed to manage advanced stuttering than early stuttering
• Stuttering can be variable over time – consider whether it is recovery or a period of no stuttering behaviours
• Early stuttering is more responsive to treatment. Advanced stuttering is more prone to relapse
• Consider the family context, including the parent’s views on commencing treatment
• Social anxiety level is a good indicator to start treatment
• Early intervention is critical ie. Treatment before 6yo.
• Severity is not a predictor of natural recovery. Ie. “mild” stuttering is not more likely to resolve naturally than a severe stutter

• Conclusion: can safely delay treatment in children by 12 months from onset, as long as there is enough time to deliver the Lidcombe program

Question 5

how can stuttering be monitored

Answer 5

Delayed treatment = Monitoring:
• Caregiver completes daily severity ratings to monitor progression of the stutter
• Check in every 4-6 weeks to assess whether treatment is required
• Face to face visits every 2-3 months

Question 6

Cause - Theories

Answer 6

Speech motor control theories
• Stuttering as a problem of planning or execution of speech motor control function. Ie. Speech production is the problem.
• Speech motor control deficit needs to be present for stuttering to occur

Variability model – “unstable speech motor system”
• The idea is a speech motor control deficit plus oral language demands cause stuttering
• Linguistic task demands and variation of stress, prosody etc leads to stuttering. Eg. The word photograph and photography are pronounced with different stress
• This leads to stuttering moments
P&A model
• Extends Vmodel further
• 3 factors to cause and all need to be activated for stuttering to be present:
1. Underlying deficit in neural processing for spoken language
2. Features of spoken language provide triggers for stuttering
3. Modulating factors influence whether or not stuttering occurs

Anticipatory struggle theories
• Stuttering as non-organic ie. Not a physical condition.
• It is more a perception/belief within the person that speech is difficult
• Underlying psychological/emotional belief that speech is difficult which generates the stutter and then reinforces the stuttering behaviour
• It has been discredited by the rise of contingent-response treatment
• Speech pressures/demands on the speaker
• Can explain some of the consistency and adaptation effects ie. The psychological effects of stuttering but there are more limitations than strengths to this theory.

Multifactorial theories of stuttering
• Caused and maintained by an interaction of innate and environmental factors
• Unqualified model – cause could be different for all people who stutter

Question 7

multilingualism and stuttering

Answer 7

• Stuttering occurs across all languages and cultures
• If stuttering is the focus of treatment, attainable treatment goals must be set for bilingual children.
• Treatment decisions include:
o a) which language to treat in,
o b) how will that language be target, ie. Through parents, one on one with clinician,
o c) parent’s goals and wishes and
o d) the treatment with the best evidence for treatment of bilingual children.
• Providing stuttering treatment to bilingual children may necessitate some adjustments to traditional treatments including:
o Choosing which language to target
o Using culturally appropriate stimuli
o Modifying instructions to accommodate the second language of the parent
o Using exemplars in audio or video format of the home language of the child
o Structuring treatment to provide opportunities for practicing fluency in relevant contexts and activities