Fluency Condition Flashcards
These are disruptions to fluency
Dysfluency
What is fluent?
Fluency is entirely dependent on the listener’s perception
“Flows” easily for sound and information
Listener attends to the message and NOT how it is produced
Continual end effortless of movement and information–no disruptions.
Fluency has a _________ and __________ component
Language and speech component
Linguistics: Syntactic, semantics, phonological, pragmatic
Speech: continuity, rate and duration, effort
What is continuity?
Logical sequence of words and syllables, presence/absence of pauses
What is rate?
Most people talk as fast as they can (max and ordinary rate are similar)
There is wide range of acceptable rates
What are the (4) normal fluency pauses?
Conventional pause
Idiosyncratic pause
Unfilled pause
Filled pause
What is a conventional pause?
These are part of a linguistically important event (junctures)–punctuations
What are idiosyncratic pauses?
Hesitation or uncertainty on speaker’s part
What is an unfilled pause?
Silence longer than 250 ms–Normal silent intervals
What is a filled pause?
“Fillers” such as um, er, ah, um
What is normal fluency in terms of effort?
Linguistic planning
Muscle movement
What is effort (linguistic planning)
Effortless speech = little thought + little muscular exertion
“Automaticity” of speech
What is effort (muscle movement)
Little articulatory contact–usually in the OPM may be in the chest/abdomen
There should me minimal effort in the chest/abdomen
Little constriction of airflow
What are the other characteristics of normal fluency?
Natural to listeners
With normal disfluencies
Faster > slower
Less cognitive effort (speaker and listener)
Good or neutral feeling for speakers
Communication focused > paying attention to speaking
What is stuttering?
Wingate (1964)
Involuntary – audible or silent – repetitions or prolongations in the utterance of short speech elements that occur frequently and are not readily controllable
Emotional state ranging from a general condition of excitement or tension to more specific negative emotions
Bloodstein (1987)
stuttering is whatever is perceived as stuttering by a reliable observer who has relatively good agreement with others
Perkins et al (1991), disruptions of speech experienced by the speaker as loss of control
According to DSM V, there are frequent and marked occurrence of one (or more of the following:
Core behaviors
(1) sound and syllable repetitions,
(2) sounds prolongations of consonants as well as vowels;
(3) broken words (e.g., pauses within a word); (
4) audible or silent blocking (filled or unfilled pauses in speech);
(5) circumlocutions (word substitutions to avoid problematic words);
(6) words produced with an excess of physical tension, monosyllabic whole-word repetitions (e.g., I-I-I-I see him)
Secondary
- Causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance–individually or in any combination
Does dysfluency mean stuttering?
No
What are disfluencies? Is an individual diagnosed with stuttering if they have disfluencies?
Typical dysfluency - present for children and adults
Characteristics: Interjections, repetitions, revisions, etc.,
Distinct from stuttering
Both disfluencies and stuttering interrupt communication flow.
Stuttering should not rely only on observable behavior → low reliability
Disfluencies alone is not sufficient for a stuttering diagnosis, because it should involve covert behaviors–feelings and attitudes
What are the typical dysfluency?
Whole word repetitions → monosyllabic and polysyllabic
Multiple word repetition
Phrase repetition
Phrase revision
Filled and unfilled pauses
Typical disfluencies occur frequently at
Pre unfamiliar words
Syntactic boundaries
Complex and longer sentences
What are the primary behaviors of stuttering?
Syllable repetitions - frequency per word would me more than two, frequency for 100 words would be more than two, the tempo is faster than normal, regularity is irregular, airflow is often interrupted, vocal tension is often apparent (monosyllabic words are often repeated for stuttering)
Prolongations - tension → important when present (absent for dysfluency)
Gaps - within the word boundary, this may be present (this is absent for disfluency), prior to speech attempt is unusually long (not marked for dysfluency), and after the disfluency gaps may be present which is absent for dysfluency
What are the ABCs of stuttering?
Affective
Behavior
Cognitive
Note: These are negatively developed thoughts (1) frustration when speaking (2) feeling of muscular tension (3) emotional and cognitive reactions
What are the affective aspects of stuttering?
Occur conjunction with stuttering:
- Fear and anxiety - listener reactions, “poor” communicators
- Guilt and shame - inherently bad, uncontrollable factors
What is the meaning of cognitive aspects of stuttering?
Thoughts or beliefs about stuttering, speaking, and communicating
What is anticipation stuttering?
Anticipation stuttering - person with stuttering can accurately anticipate where they can stutter . 96% of the predictions were followed by stuttering, 94% of stuttering events occurred on anticipated words
Associated with loss of control over speaking and “feeling stuck”
Predicting that a word/sound will be difficult
Pws predict san sila magstutter and most of the time tama sila
What are the cognitive aspects of stuttering?
- Anticipation
- Avoidance - anticipation leads to avoidance (e.g., feared words, feared situations, persons)
- Attitudes about communication - even young children exhibit negative attitudes regarding communication, understands that their speech is different from peers which leads to negative attitudes
What are the secondary behaviors?
Visible reactions accompanying speech interruptions
Function to conceal or avoid stuttering
Attempts to minimize stuttering
Feature in the stuttering severity instrument
Can be any part of the voluntary musculature–may be independent from observable interruptions (eye blinking, etc.,)
Secondary Behaviors (Van Riper)
- Avoidance - feared words are avoided altogether (e.g., word substitution, circumlocutions)
- Postponement - delaying the attempt of feared word which may come by using strategic pauses (Example: “you know” “well”)
- Starting tricks - tricks to make the first sounds easier (“uh”, grimacing)
- Escape behavior - attempt to terminate a block (e.g., head jerk, gasp) interjection
- Anti expectancy - distracting attention from fear, preventing fear
Which of the following best defines fluency in speech?
a. Listener focuses on both the message and how it is produced
b. The ability to produce speech without any pauses
c. The listener attends to the message, not how it is produced
d. The use of fillers like “um” and “ah” is required for fluent speech
Answer: c. The listener attends to the message, not how it is produced
Which of the following pauses is characterized by silence longer than 250 ms and occurs normally during speech?
a. Filled pause
b. Conventional pause
c. Idiosyncratic pause
d. Unfilled pause
Answer: d. Unfilled pause
Stuttering, according to Wingate (1964), can be best described as:
a. Involuntary repetitions or prolongations in speech that are difficult to control
b. A voluntary attempt to avoid specific words
c. The use of speech strategies to ease communication
d. A normal disruption in communication flow
Answer: a. Involuntary repetitions or prolongations in speech that are difficult to control
Rationale: Wingate (1964) describes stuttering as involuntary and uncontrollable disruptions.
Which of the following is NOT considered a primary behavior of stuttering?
a. Syllable repetitions
b. Word substitutions
c. Prolongations
d. Gaps within words
Answer: b. Word substitutions
Rationale: Word substitutions are an avoidance strategy, not a primary behavior of stuttering.
What is the meaning of “automaticity” in normal fluency?
a. Speech requires cognitive effort but minimal muscular effort
b. Speech flows without thought or excessive muscular exertion
c. Speech that requires rehearsing and planning
d. The presence of pauses during speech for clarity
Answer: b. Speech flows without thought or excessive muscular exertion
Rationale: Automaticity in speech refers to the effortless and fluid nature of communication.
Select all the typical disfluencies that occur in both children and adults:
a. Phrase repetition
b. Word substitution
c. Monosyllabic whole-word repetitions
d. Filled pauses like “um” or “uh”
e. Syllable prolongations
Answer: a, c, d
Rationale: Typical disfluencies include phrase repetition, monosyllabic whole-word repetitions, and filled pauses.
The “ABC” model of stuttering refers to:
a. Articulation, Behavior, and Cognitive strategies
b. Affective, Behavioral, and Cognitive aspects of stuttering
c. Anticipation, Blocking, and Circumlocutions
d. Auditory, Body language, and Cognitive aspects
Answer: b. Affective, Behavioral, and Cognitive aspects of stuttering
Rationale: The ABC model refers to emotional, behavioral, and cognitive components of stuttering.
A 6-year-old child demonstrates sound repetitions (e.g., “b-b-ball”) at a frequency of more than 2 times per word, and his speech often appears tense. His parents are concerned because these behaviors have persisted for over a year. Based on this information, which condition is most likely?
a. Typical disfluency
b. Childhood-onset fluency disorder (stuttering)
c. Phonological disorder
d. Apraxia of speech
Answer: b. Childhood-onset fluency disorder (stuttering)
Rationale: Persistent sound repetitions with tension are signs of stuttering in children.
You are working with a 10-year-old who frequently avoids using words that begin with the letter “s.” He anticipates stuttering and substitutes these words with easier alternatives. This is an example of:
a. Escape behavior
b. Postponement behavior
c. Avoidance behavior
d. Starting tricks
Answer: c. Avoidance behavior
Rationale: Avoiding feared words is a cognitive response to anticipated stuttering.
A 28-year-old client reports that he frequently feels anxious when speaking in front of a group and often resorts to using filler words like “um” and “uh” to ease the tension. He also demonstrates head jerking and blinking when attempting to speak during a block. These behaviors are classified as:
a. Anticipation
b. Secondary behaviors
c. Primary stuttering symptoms
d. Cognitive responses
Answer: b. Secondary behaviors
Rationale: Secondary behaviors, such as head jerking, are learned reactions to stuttering.
According to DSM V, which of the following behaviors are indicative of stuttering? (Select all that apply)
a. Sound and syllable repetitions
b. Broken words (e.g., pauses within a word)
c. Word substitutions
d. Audible or silent blocking
e. Speaking without pauses
Answer: a, b, d
Rationale: These behaviors align with DSM V criteria for stuttering.
Which of the following are characteristic of normal fluency pauses? (Select all that apply)
a. Filled pauses like “um”
b. Unfilled pauses longer than 500 ms
c. Conventional pauses used at syntactic boundaries
d. Hesitations due to speaker uncertainty
Answer: a, c, d
Rationale: These are types of pauses
What is the key difference between dysfluency and stuttering, and how does this impact diagnosis?
a. Dysfluency involves more severe interruptions of speech flow compared to stuttering
b. Dysfluency alone is sufficient for a stuttering diagnosis, without the need for covert behaviors
c. Dysfluency may include typical interruptions, but stuttering includes loss of control and covert reactions
d. Stuttering and dysfluency are the same and should be treated similarly
Answer: c. Dysfluency may include typical interruptions, but stuttering includes loss of control and covert reactions
Rationale: Stuttering is distinguished by loss of control and emotional reactions.
A person exhibits anticipation stuttering and avoids specific words in social situations. Which cognitive and affective factors are most likely influencing their stuttering?
a. Frustration due to difficulty in articulation
b. Positive attitudes toward communication
c. Fear of listener reactions
d. Overconfidence in their ability to communicate fluently
Answer: c. Fear of listener reactions
Rationale: Cognitive and affective factors like fear play a role in anticipation stuttering.
What is the primary purpose of secondary behaviors in stuttering?
a. To assist in fluid communication by promoting relaxed speech
b. To avoid and conceal moments of stuttering
c. To make the stuttering event more noticeable to others
d. To reduce speech tempo and improve clarity
Answer: b. To avoid and conceal moments of stuttering
Rationale: Secondary behaviors are used to minimize the occurrence of stuttering.
What are stuttering tracks?
Van Riper
These are four alternate paths or “tracks” which stuttering appeared to develop
What is Track I stuttering?
Stuttering is initially effortless, unhurried repetitions, extreme fluctuations and long remissions (there are long periods of good fluency and long periods of stuttering)
What is Track II stuttering?
Children who were late in beginning to talk → Language delay
Rapid, irregular syllable
Word repetition from the beginning.
What is track III stuttering?
Sudden inability to speak/complete blockage
Soon following by severe forcing and struggle, breathing abnormalities, frustration
Fear and avoidance
What is Track IV stuttering?
Sudden onset of stuttering
Repetition of phrases, words, and syllables
Stutter openly with few avoidances (
Little change in their stuttering over the years
What is the age range of the first phase according to Bloodstein and Guitar?
Bloodstein: Ages: 2-6
Guitar: 3.5 - 6 years
What are the characteristics of the first phase according to Bloodstein and Guitar?
Bloodstein: Episodic stuttering, appears when emotional, repetitions predominant, low concerns
Guitar: Part word repetitions, tensions, prolongations, frustrations but not full awareness, pitch rise post pre/pro
What is the age range of phase ii according to Bloodstein and Guitar?
Bloodstein: Elementary age
Guitar: 6-14 years old
What are the characteristics of phase II according to Bloodstein and Guitar?
Bloodstein: Chronic phase, self-concept developing but no concern regarding difficulty, occurs for nouns, verbs, adjectives and adverbs (content words)
Guitar: Full range of stuttering behaviors, avoidance, avoidance strategies, avoidance of situations prep behaviors, shame, embarrassment, emerging fear
What is the age range of phase III according to Bloodstein and Guitar?
Bloodstein: 8-adulthood
Guitar: Adulthood
What are the characteristics of phase III according to Bloostein and Guitar?
Bloodstein: In response to situations, there are certain words that are more difficult, noi avoidance, no fear, rather irritation, anticipation is developing
Guitar: Advanced stuttering, all of the features and impacts of stuttering (primary and secondary)
What is phase IV according to Bloodstein?
Late adolescent and adulthood
Fearful anticipation
Feared sounds and words
Conscious of other reactions
Avoidance of situations
What is covert stuttering?
Core behaviors are not readily observable
Affective and cognitive impacts amplified
Interiorized stuttering
Rarely appeared to block at all
Anticipation and avoidance are most difficulty
What is the word final disfluency?
Word initial seen in typical childhood fluency disorder
Less common than typical stuttering
Repetitions of the syllables or consonants
Middle (e.g., oliv-viv-ver) and end (e.g., oliver-er-er
What is acquired stuttering (neurogenic stuttering)
Stuttering begins in adulthood–no stuttering in childhood
Late onset stuttering, organic stuttering
Acquired stuttering is quite rare
Causes head trauma, stroke, etc.,
What are the unique presentations of neurogenic stuttering?
Content and function words equally likely
Annoyance no anxiety
Primary behaviors not only in the initial position
Secondary behaviors are rare
No “adaptation effect”
Stuttering regardless of task (e.g., imitation, conversations, reading)
What is psychogenic stuttering?
This is another acquired stuttering
Also adult onset
Absence of neurological pathology
Evidence of stress or other psychological factors
What is cluttering?
It is also a fluency disorder
Segments are too fast overall, too irregular, or both
Imprecise articulation → articulation errors
Excessive normal disfluencies
Excessive collapsing or deletion of syllables and or
Abnormal pauses, syllable stress, or speech rhythm
Difference between cluttering and stuttering
1. Speaking rate?
2. Articulation?
3. Disfluencies?
4. Self perception?
5. Expressive Language?
Speaking rate
- Cluttering is irregular +300 syllables per minutes
- Stuttering is regular: 240 syllables per minute
Speech articulation
- Cluttering - slurred and/or omission
- stuttering: normal
Speech disfluencies
- Cluttering is primarily other disfluencies
- stuttering is primarily stuttering-like disfluencies
Self perception/anxiety
- cluttering may be unaware of disfluent speech/no anxiety,
- stuttering may be aware of disfluent speech/anxious
Expressive language
- cluttering, EL is disorganized
- stuttering it is organized
What is stress/trauma response?
Freudian basis that stuttering happen to fulfill erotic need
Lost appeal in modern speech pathology
Not much research support
What are constitutional abnormalities/psychological incoordination?
Momentary failure of physiological coordination among speech subsystems.
What is dysphemia?
Inherited predispositions of persons → speech production breakdown
West’s theory viewed the moment of stuttering as a kind of miniature seizure
Affects the speech-motor system
Precipitated by emotional stress
What is perseverative theory?
Constitutional predisposition to motor and sensory perseveration
Similar to the perseverative behavior or person’s with aphasia “being stuck”
Characteristics: failure of coordination → stuttering as the result of a failure of coordination of respiration, phonation, and articulation
What is Brainstem reflex theory?
Reflexes abnormally triggered when OPM movement exceed ranges of velocity, displacement, or positioning
What is aberrant cerebral dominance?
Conflict between the cerebral cortices
For control of the activity of the speech production system
Research has failed to show convincingly who stutter are distinguished either by left-handedness or ambidexterity
Conflict kung anong hemisphere ba yung in charge with speech production
What are basal ganglia circuits?
Dysfunction in basal-ganglia-thalamocortical motor circuits
Key role in stuttering
Impairing the ability of BG to regulate timing cues for speech initiation
If there is a dysfunction of basal ganglia = unwanted movements
What is the DIVA model theory?
Weakness in the feedforward system
PWS inappropriately dependent on auditory and somatosensory feedback
Leads to speech errors
What is failure of connectivity among brain regions?
Pre-supplementary motor area, basal ganglia and cerebellum
Pacing the temporal sequences in articulation
Identified tracts which appear to be less well-developed in children
Difference in connectivity among brain regions
Yung mga brain regions na in charge sa speech ay hindi nagcoconnect ng maayos
What is operant conditioning?
Maintained by positive and negative reinforcements on complex multiple schedules
Changing the form of nonfluency to struggle or silence
The termination of aversive stimuli from the listener or the speaker’s own negative reactions to their speech
Nonfluency yung reinforcement nagusto nila matanggal (or yung negative feeling nila about doon) kaya nagaavoid sila
What is classical conditioning?
Stuttering as a disruption of fluency
Causes is the emotional arousal (bell) associated with speech and speech-related stimuli
Stuttering block (salivation) represents not operant but respondent behavior
Based on typically fluent speakers, stress may produce autonomic reactions capable of disrupting speech fluency
Stress ang trigger for stuttering
What is anticipatory struggle?
Learned belief that speaking is difficult → conscious interference with the way they speak
Analogous to playing sports or playing an instrument in public (shooting in front of the crowd will be more difficult, likewise with speaking)
Iniisip mo na mahirap magsalita so nahihirapan ka talaga
What is diagnosogenic theory?
Parent feedback for child’s “aberrant speech” (typical dysfluency) → child learns that their speech is aberrant → anticipatory struggle
Wrong diagnosis from the part of the parents
Dahil lumaki bata na timgin nila mali pagsasalkta nila, inaanticipate nila na kadamagttry silang magsalita is mali na hence anticipatory struggle
Mild tension and fragmentation are normal speech characteristics. These are magnified by communicative pressures and failures. Can be from the child’s own ears or other listeners vs diagnosogenic (parent’s feedback)
Continuity hypothesis
Yung mga normal na tension or pag utal lumalala dahil sa pressure and failure to communicate effectively
What is covert repair?
Hypothesized that the speech-planning process of people who stutter is impaired and tends to result in the production of phonetic plans that contain an abnormally large number of errors.
Errors in the phonetic plan
What is explan?
It is an autonomous model of the production of spontaneous speech that applies to speakers who stutter and fluent speakers. Planning and execution are independent processes that reflect the linguistic and motor levels, respectively. Failures in the normal mode of interaction between the plan and ex processes can lead to fluency failures when plans are too late in being supplied to the motor plan system.
Generally, fluency failure arises whenever there is this underlying problem but, according to explan, there are two distinct.
Late yung pagpasa ng plano sa motor aspect (execution) so nagkakadysfluency
True or False. More men than women stutter into adulthood
True
True or False. Girls recover from early stuttering much more often than boys
True
True or False. Small proportion of persons with stuttering will spontaneously recover when they reach adulthood
False. Large proportion of persons with stuttering will spontaneously recover when they reach adulthood
True or False. Mothers of stutters made more judgements of stuttering than non stutterers’ mothers in response to most disfluency types
t
This refers to the number of new cases of a disease that occur in a specific population during a defined time period. It tells you about the risk of developing a disease.
Incidence
This refers to the total number of cases of a disease, both new and pre-existing, in a specific population at a given time. It reflects how widespread the disease is.
Prevalence
General estimate of the prevalence in stuttering
0.01
The start of stuttering behaviors show up at around
2.5 years (around 30 months
What are the characteristics of stuttering in terms of syllable repetition?
- Frequency per word?
- Frequency per 100 words?
- Tempo?
- Regularity?
- Presence of schwa?
- Airflow?
- Vocal tension
- More than 2 syllables
- More than 2 words
- Faster than normal
- Irregular
- Often present
- Often interrupted
- Often apparent
What are the characteristics of stuttering in terms of prolongations?
1. Duration?
2. Frequency?
3. Regularity?
4. Tension?
5. When voiced?
6. When unvoiced?
7. Termination?
- Longer than 1 second
- More than 1 per 100 words
- Uneven or interrupted
- Important when present
- May show rise in pitch
- Interrupted airflow
- Sudden
