Introduction

Question 0

How is stuttering recognised medically?

Answer 0

By the WHOICD-10 as a disease state…
F98.5
Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence

As a DSM-IV-TR Axis I disorder
Diagnostic Statistical Manual of Mental Disorders
307.0
Communication Disorders

Question 1

What does fluency overarch?

Answer 1

1. Persistent developmental stuttering
2. Acquired neurogenic stuttering
3. Acquired psychogenic stuttering
4. Cluttering
5. Rate and general prosodic disorder

Question 2

What are the core stuttering behaviours?

Answer 2

Repetitions: of individual sounds, part words or whole words.
Prolongations: Stretching out of a sound or syllable.
Blocking: on sound or words. The airflow is physically stopped at some point in the speech mechanism. Often there is a forced and audible release of the sound, although sometime blocking can be silent. Blocks are associated with increased muscle tension.

Question 3

What are verbal coping stuttering behaviours?

Answer 3

Verbal behaviours:
- Interjections/intrusions: of extraneous sounds, words, syllables or phrases at an inappropriate point in the utterance. (Can occur in non-stutters as well).
Intrusions and restarts are thought to assist in ‘priming the verbal pump’. Allowing time for the individual to plan what is to be said next, help motor planning.
- Restarts: involve two or more words which are repeated unchanged.
Restarts also facilitate ideational, word and motor retrieval, but the ‘run-up’ additionally provides a layer of semi –automaticity to ain in the retrieval process.
Revisions - Two or three words repeated but changed slightly eg. I like…I love…

Question 4

What are non-verbal coping behaviours?

Answer 4

• Word avoidance: avoidance of a word that the person fears they will stutter on. Word is replaced by another word. Stutter may have not said what they wanted to entirely.
• Facial contortions: often accompany blocking and indicate tension and struggle especially around mouth and neck.
• Loss of eye contact while stuttering.
• Associated body movements: shifting of body positions, tense arms or hands. Usually distracting to listener.

Question 5

What are some of the emotional reactions caused by stuttering?

Answer 5

Anxiety
Avoidance of situations.
Loss of self-esteem.

Question 6

What are normal disfluencies vs dysfluencies?

Answer 6

Normal disfluencies involve hesitations, repetitions, revisions, interjections etc.
These can progress to dysfluencies as the disfluencies increase and reactions to these get worse, tension or struggles increase.

Question 7

What is the iceberg of stuttering?

Answer 7

An analogy that shows that only small part of stuttering is seen above the surface.
Above the surface: core speech features (blocking, prolongations, repetitions) and secondary behavioural features (escape, avoidance).
Below the surface: attitudes and feelings (anxiety, fear, shame, guilt).

Question 8

What is a definition of stuttering?

Answer 8

Stuttering is a disorder in the rhythm and timing of speech such that the person knows exactly what they want to say, but at the time is unable to move forward in their speech due to involuntary repetition, blocking or prolongation of sounds or words.

Question 9

How does stuttering present on the ICF?

Answer 9

Impairment: in body function that affects their ability to produce fluent speech.
Activity limitation - Engaging in verbal communications whenever they so desire
Participation/restriction - Social, vocational, educational, ADL (eg. telephone, requests).
Environmental Factors: Other’s negative reactions, discrimination, fast world
Personal Factors: avoidance, anxiety, fear, embarrassment, shame

Question 10

What is the incidence and prevalence of stuttering?

Answer 10

Incidence: approx 1-2% of adults and 4-5% of children.

Prevalence is around 1%

Question 11

What are the gender ratios for stuttering?

Answer 11

1:2 females to males (early)

Increase 1:4, 1:5 in adulthood.

Question 12

What is the age of onset?

Answer 12

Earliest onset in around 18 months.
Average is 30 months.
Risk mostly outgrown by 3.5 years.
Can emerge again around 7-11 years.

Adult onset of stuttering is usually due to acquired neurological damage or psychological trauma and conversion.

Question 13

What are Bloodstein’s phases of developmental stuttering?

Answer 13

Phase One - preschool years (the ages of 2 - 6)

• Episodic
• Sound and syllable repetitions, but there is a tendency to repeat whole words
• Most are unaware of the interruptions in their speech

Phase Two - children of early school age

• Chronic or habitual
• Few intervals of fluent speech
• Child has developed a self-concept as a person who stutterers
• Occurs primarily on content words

Phase three - from about 8 years to young adulthood

• Stuttering is in response to specific situation fears
• Certain words as more difficult than others
• Word substitutions and circumlocutions to avoid feared words
• Person will not avoid specific speaking situations

Phase Four - most advanced form

• Anticipation of stuttering
• Certain sounds, words and speaking situations are feared and avoided
• Word substitutions and circumlocutions are frequent
• Secondary symptoms may be present at its onset

Question 14

What are the family factors for stuttering?

Answer 14

70-80% of PWS have a known family history.
Risk of stuttering x3 if you have a direct family member who stutters.
Same gender sibling -> 18% chance of stuttering.
Females more likely to pass down.
Twins: monozygotic 77% chance, dizygotic 32% chance.

Question 15

What are the facts about recovery?

Answer 15

Girls grow out of it.
About 65-75% of preschoolers who stutter recover spontaneously in first two years.
About 74% of children who stutter recover by their early teens with the majority recovering by 8.
Only 18% of children who are still stuttering five year after onset recover spontaneously.
If family history and secondary behaviours are present then the prognosis should be more guarded.
There is a known relationship between the persistence of stuttering (or remission) and a family history of these.

Question 16

What are signs for concern?

Answer 16

Males
Family history of persistence and recovery
Time since onset
Age at onset (over 36 months)
Relatively poor speech and language skills (precocious MLU and expressive language has also been linked).

Question 17

What are some other problems for stutterers?

Answer 17

More likely to have had language, phonological and phonological awareness difficulties.
Three times risk of phonological disorders.
Online semantic processing is slower
Poorer nonword repetition skills in CWS
Slower phoneme monitoring and encoding of segmental phonological units during silent naming.

No real difference in intelligence.
No real difference in personality.

Slower manual reaction times

Question 18

What is the stuttering moment influenced by?

Answer 18

Genetics
Environment
Organics of neural wiring and biochemistry

Question 19

How does stuttering vary?

Answer 19

Over time (adults) - no significance 3-18 months apart (untreated)
Across situations - many differences within individuals
Language factors - stressed syllables, initial words/sounds, emotional content, linguistic complexity.

Question 20

What conditions reduce stuttering?

Answer 20

Conditions that immediately reduce stuttering by 90-100%
Lipped speech
Prolonged speech/smooth speech
Rhythmic speech
Shadowing
Singing
Slowing rate
Chorus reading

Conditions that immediately reduce stuttering by 50-80%
Speaking alone
Speaking in time to rhythmical movements
DAF of 50-150 msec
Masking
Changing pitch or accents
Whispering

Conditions that gradually reduce stuttering
Response contingent stimulation (operant conditioning)
EMG feedback
Drugs (Haloperidol, Risperdal, Pagocione)
Rehearsal, Adaptation effect