FLUENCY DISORDERS Flashcards
Phenomena Associated with stuttering
Conditions of speaking in which
stuttering is suddenly reduced or
absent
Situations where stuttering increases
Occurs much more in males than
females
More often in children who are twins
Onset usually begins in early childhood
between the ages of 2 and 5
40-60 percent of cases has paternal or maternal relative who stutters
More in children who are bilingual
Fluent Speech
Consistent ability to move speech production apparatus in an
effortless, smooth, rapid manner resulting in a continuous,
uninterrupted, forward flow of speech
Stuttering
Disruption in the fluency of verbal expression
Characterized by involuntary, audible repetitions of sounds
and syllables (b-b-b-ball), whole word repetitions (I, I, I, want), phrase repetitions (why are you, why are you, why are
you) or prolongations of sounds (mmmmmmall), syllables, and monosyllabic words, and silent blocks, broken words (b— oy), interjections of sounds, syllables, words, phrases (uh, um, well, you see)
Sometimes accompanied by secondary features such as
groping, grimacing, blinking, stomping/kicking
Incidence is about 1 %.
Type of dysfluencies
Repetitons
Part Word repetitions “What t-t-t-time is it?”
Whole word repetitions “What-what-what are you doing?”
Phrase repetitions “I want to-I want to- I want to do it”
Prolongations
Sound/syllable prolongations “Lllllet me do it”
Silent prolongations A struggle to say a word when there is no
sound
Interjections
Sound syllable interjections “um…um I had a problem today”
Whole word interjections “I had well a problem today”
Phrase Interjections “I had you know a problem today”
Silent Pauses A silent duration between words and sentences
considered to be too long “I was going to the
(pause) store.”
Broken Words A silent pause within words: “It was won(pause)derful.
Some facts on stuttering
Some children naturally recover
May be genetically linked
Children typically exhibit
◦ Hesitations
◦ Revisions
◦ Interruptions
Increase in disfluent speech beginning around age 2,
improving after age 3
Normal Disfluencies
Age 2
Whole-word repetitions ( I-I-I-want a cookie), interjections (Can
we-uhm-go now?), syllable repetitions (I like ba-baseball)
◦ Age 3
Revisions are the dominant disfluency type (“He can’t-he won’t
play baseball.”)
◦ Normal disfluencies persist throughout life.
◦ Fluent speakers may repeat whole multisyllabic words (I
really-really like hockey) interject a word or phrase (He will,
uhhh, you know, not like the idea),repeat phrases (Will you,
will you please stop that) or revise sentences (She can’t-She
didn’t do that).
Stuttered Disfluencies
Audible or silent repetitions and prolongations
◦ Tense pauses and hesitations within and between words
◦ Within-word and between-word disfluencies
◦ Young children
monosyllabic whole-word repetitions, sound repetitions, syllable
repetitions, audible and inaudible prolongations.
◦ Clustered disfluencies are common
◦ Secondary characteristics or accessory behaviors
Eye blinking, facial grimacing or tension, exaggerated movements of
head/shoulders/arms, interjected speech fragments
Stuttering behavior hierarchy
1 Accessory or secondary behaviors: abnormal body
movements, avoidance, and revisions
Excitement, tension, fear, embarrassment, and
shame
2 Disruptions are frequently
occurring marked in character
and difficult to control
Reactions to stuttering
3 Disruption in the fluency
of verbal expression
Involuntary, audible or
silent repetitions or
prolongations
Loci of stuttering
Loci of stuttering refers to the locations in the speech
sequence where stutterings are typically observed.
Stuttering in more likely on the initial word or phrase
of a sentence.
The very first word or few words are more likely
repeated than the last (“Let-let-let me do it.”
compared to “Let me do it-it-it-it”).
Initial syllables are more likely to be repeated than
the last (“Pro-pro-probably than probably-bly-bly).
More likely on consonants than vowels, although
some people stutter predominately on vowels.
Greater difficulty with longer than shorter words
Words that are used more frequently in the language
are stuttered less often.
Cluttering
Less common than stuttering
A complex disorder of communication with impaired fluency
characterized by rapid but disordered articulation, possibly combined
with disorganized thought and language production.
Usually begins in childhood
Often, but not always, cluttering coexists with stuttering.
Rhythm is jerky and stumbling and tone is monotonous because they
speak without much variation in pitch and stress.
Impairment in formulating language not always rapid speech
Can articulate speech sounds when they speak at a slower rate, but, they
cannot speak at slower rates.
Have greater difficulty self monitoring their speech than a person who
stutters.
Are usually not concerned about their speech problem like a stutterer
and are perplexed that the listener does not understand them.
Research on treating cluttering is lacking.
Developmental Stuttering
Most common form of stuttering
◦ Begins in the preschool years
◦ Onset gradual, increasing in severity
◦ Usually occurs on content words, initial syllables
Neurogenic Stuttering
Typically associated with neurological disease or trauma
◦ Usually occurs on function words, widely dispersed through
utterance
◦ No secondary characteristics
◦ No improvement with repeated readings or singing
Developmental Framework
Phase One (2-6 years)
Sound/syllable repetitions most common
Generally not aware or not bothered
◦ Phase Two (elementary school)
Stuttering on content words, more habitual
Child refers to self as stutterer
◦ Phase Three (8 years – young adulthood)
Stuttering in response to situations
Little fear, avoidance, embarrassment
◦ Phase Four
Most advanced
Fearful anticipation, avoidance of words/situations
Embarrassment
onset and developmental stuttering
Considered a handicap
Children may withdraw/refuse to speak
Adults may seek professions that require little oral
communication
Poorer in educational adjustment
Employers view stuttering negatively, but seeking
treatment positively
Successful treatment improves social interactions
Organic Theory
Proposes an actual physical cause
◦ Many have been proposed
All have failed to explain stuttering satisfactorily
◦ Renewed interest in cerebral dominance theory
Structural and functional differences in the brains of adults
with chronic developmental stuttering
Child is predisposed to stuttering because neither side
of the brain is dominant in controlling the motor
activities involved in talking
Recently PET scans have revealed differences in the
brain activity of persons who stutter as compared to
normal speakers
Cerebral Dominance theory
Child is predisposed to stuttering because
neither side of the brain is dominant in
controlling the motor activities involved in
talking
Recently PET scans have revealed differences
in the brain activity of persons who stutter as
compared to normal speakers
New interest in this theory
Behavioral Theory
Stuttering is a learned response
◦ Diagnosogenic theory
Overly concerned parents react negatively to normal speech
hesitations and repetitions, causing anxiety in the child and
increased stuttering
There is contrary evidence to this theory
Natural recovery may actually be due in part to parents explicitly
telling their child to slow down, stop and start again, or think
before speaking
Diagnosogenic theory
Overly concerned parents react negatively to normal speech
hesitations and repetitions, causing anxiety in the child and
increased stuttering
There is contrary evidence to this theory
Natural recovery may actually be due in part to parents explicitly
telling their child to slow down, stop and start again, or think
before speaking
Diagnosogenic theory history
From 1940-1970
Wendell Johnson
Also called a developmental theory
The initial diagnosis by the parents create an environment of
difference and handicap. The child soon begins to speak
abnormally in response to the parents anxieties, pressures
criticism etc
Research shows that parents of persons who stutter are
sometimes anxious and perfectionist and have high standards
for their child or those that do not understand that all
children exhibit disfluencies.
Wendall Johnson said “the origin of stuttering is its parental
diagnosis and that stuttering is not in the mouth of the child
but in the ear of the listener” (Johnson & Associate, 1959
Anticipatory struggle theory
Oliver Bloodstein (1984, 1995)
A theory that states that stuttering is a reaction
of tension and speech fragmentation.
Child may acquire the belief that speech is a
difficult task for many reasons (ie some children
have problems with language acquisition and
articulation later develop stuttering)
Learning a language or the sound system of
language, combined with the usual pressure to
communicate, are likely to instill the belief that
speech and language is a difficult task.
Psychological Theory
Contends stuttering is a neurotic symptom
Treated most appropriately by psychotherapy
◦ Research indicates psychotherapy is not an effective treatment
of stuttering
Current Conceptual Models of Stuttering
Covert Repair Hypothesis
Demands and Capacities Model (DCM)
EXPLAN Model
EXPLAN Model
Fluency failures occur when linguistic plans are sent too slowly to the
motor system
EX: Execution
PLAN: Speech planning
Demands and Capacities Model (DCM)
Stuttering develops when demands to produce fluent speech exceed
child’s physical and learned capacities
Covert Repair Hypothesis
Stuttering is a reaction to a flaw in the speech production plan
assessment of stuttering
Case History-history of the client, family and disorder
Interview with the client, family members, or both
Orofacial Examination
Hearing Screening
Speech and Language Sampling
Assessment of stuttering and related behaviors
A. Measurement of dysfluencies in conversational speech
B. Measurement of dysfluencies in oral reading
C. Measurement of dysluencies in home and other situations
D. Assessment of associated motor behaviors and emotions
E. Assessment of avoidance words and speaking situations
F. Measurement of speech rate
Recommendations
Report Writing
The Evaluation of Stuttering
Detailed analysis of speech behaviors
◦ Average number of each type of disfluency
◦ Duration of disfluencies
◦ Standardized tests may be used
◦ Therapy may be recommended if two or more
Sound prolongations more than 25% of total disfluencies
Sound/syllable reps or sound prolongations on first syllables
Loss of eye contact on more than 50% of utterances
A score of 18 or more on the SPI
At least one adult expressing concern about speech fluency
Indirect Approaches
For children just beginning to stutter; mild
◦ Provide a slow, relaxed speech model
◦ Play-oriented activities
◦ Goal
Facilitate fluency through environmental manipulation
Direct Approaches
For children stuttering at least a year; moderate-severe
◦ Explicit attempts to modify speech
◦ “Hard” and “easy” speech
◦ Strategies to increase easy speech and change from hard to easy
speech
Fluency-Shaping Techniques
Prolonged speech
◦ Light articulatory contacts and gentle voicing onsets
◦ Pausing/Phrasing
◦ Response-contingent stimulation
Stuttering Modification
Cancellation phase
◦ Pull-out phase
◦ Preparatory sets
Prolonged Speech
Speech slowed involuntarily under delayed auditory
feedback
◦ Substantially decreases stuttering
Light articulatory contacts and GVOs
Reduced tension prevents prolonged articulatory postures
that interfere with smooth articulatory transitions
◦ GVOs: tension-free onsets of voicing
Pausing/Phrasing
Gradual Increase in Length and Complexity of Utterance program
Effective in reducing or eliminating stuttering (school-age)
Response-Contingent Stimulation
◦ Response-contingent time-out from speaking
Requires pausing briefly after stuttering
The pause serves as the consequence for stuttering
Lidcombe Program
Parent-administered treatment
Positive reinforcement for fluency, correction following stuttering
Praise and reinforcement five times more often
Cancellation Phase
Completes stuttered word and then pauses
◦ Then produce stuttered word slowly
Pull-Out Phase
Modifies stuttered word during stuttering
◦ Slowing down sequential movements
Preparatory Sets
Prepare to use strategies before attempting word
◦ Goal is to initiate the word in a more fluent manner
Efficacy of Intervention
Efficacy of Intervention with Preschool Children
◦ Up to 91% maintain fluent speech up to 5 years
◦ Those in parent-directed programs maintained fluent speech
up to 7 years
Efficacy of Intervention with School-Age Children
◦ 61% average decrease in stuttering over 9 studies
Efficacy of Intervention with Adolescents and Adults
◦ Little is known about treatment in adolescents
◦ 60-80% improvement in adults regardless of treatment
