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Stuttering > Lectures 1 - 6 > Flashcards

Lectures 1 - 6 Flashcards

1
Q

Operational/symptomatic definition

A

Can be measured/counted
Used to diagnose
Used in research
Disruption in the fluency of verbal expression, characterised by INVOLUNTARY, audible OR silent repetitions or prolongations in utterances

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2
Q

Stuttering stages (What is affected first?)

A
  1. Whole word repetitions
  2. Syllable/part-word repetitions
  3. “Dragging stutter” - prolongations
  4. Blocking - silent repetitions
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3
Q

When does stuttering onset?

A

ALWAYS in childhood

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4
Q

Where in the word does stuttering occur?

A

Stuttering almost always occurs at the beginning of words

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5
Q

Internal/private definitions of stuttering

A

Definitions that focus on the internal/psychological components of stuttering
Used in clinic
“Temporary or covert loss of control of the ability to move forward in speech

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6
Q

Consensus definition

A

Whatever is perceived as stuttering by a reliable observer, who has relative agreement with others

  • Important to consult colleagues before beginning expensive and time-consuming treatment
  • Most reliable observer = patient/patient’s parents
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7
Q

Janet’s definition

A

Stuttering is a tendency in the speech motor system to destabilise more easily than another child. This tendency has a genetic basis, and can become highly emotional

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8
Q

Observable features of stuttering

A 
Whole word repetition
Repetitions of initial sounds and part words
Prolongations
Blocks
Non-verbal: facial and body movements
- jaw jerking, eye closure, shaking
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9
Q

What is the clinical importance of non-verbal features?

A

The level of intensity of non-verbal features can be indicative of a patient’s prognosis, or their attitude towards their stutter

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10
Q

Unobservable features of stuttering

A 
Negative emotions
- self confidence
- anxiety
Word avoidance
Word revision
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11
Q

Epidemiology

A

Rates of diseases in populations, which considers how these rates are affected by variables such as age, gender, social class

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12
Q

Importance of understanding stuttering epidemiology

A

Drives every clinical decision
Makes you accountable for taking on and treating clients - by knowing prognosis, what has been effective treatment in the past
Allows you to consider the need for treatment (given that you are using tax payers’ money)
Crucial for counseling caregivers/clients (sound knowledge of the nature of stuttering, prognosis, recovery rate etc.

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13
Q

What is the INCIDENCE of stuttering? (How many people will develop stuttering at some point in their lives?)

A

4-5% of the population (which is quite high- the same as epilepsy)

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14
Q

What is the PREVALENCE of stuttering? (What percentage of the population has a stutter at any given time?)

A

1% of the population

Therefore there are 27,000 people in WA at this time that stutter

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15
Q

What is the gender ratio of stutterers?

A

4: 1 ratio of males to females

- Boys have a slower myelinisation in early childhood, and are more prone to other speech and language disorders

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16
Q

The issues with “spontaneous recovery”?

A
  • Stuttering wasn’t defined properly
  • Measures weren’t frequent or rigorous enough to be valid
  • Can’t test spontaneous recovery anymore - ethical issues
  • Perhaps no such thing as “spontaneous recovery” - parents are ACTIVE CHANGE AGENTS
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17
Q

What is the usual age of onset for stuttering?

A

Between 2;6-3;6

  • At this age, children start to use more complex prosody, which places a greater demand on speech resources
  • E.g. “daddy gone” becomes “where’s my daddy gone mummy?” (phrased as question)
  • Approximately 1% of children have a speech motor system that will destabilise more easily with the demands of frequency, formants etc.
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18
Q

Factors that modify stuttering?

Mr Smith Always Marks Damn Rough

A 
Measurement Reactivity
Situational Reactivity
Adaptation Effect
Modified Vocalisation Hypothesis
Discriminative Stimuli
Response Contingent Stimulation
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19
Q

Measurement Reactivity

A

If the client suspects that their speech is being measured/analysed, then you won’t get a truly representative sample (especially if voice recording device is present)

  • Very important in setting goals, discharge criteria - you are RESPONSIBLE TO THE CLIENT
  • Measurement reactivity influences the speech samples you get, which in turn influences the type of therapy you give
  • Sample could either be artificially fluent or more stuttered
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20
Q

Situational Reactivity

A

Certain situations can be the most taxing for particular clients

  • Job interviews
  • Public speaking
  • Talking over the phone
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21
Q

Adaptation Effect

A

Practice effects - e.g. if you ask an adult to read the same passage twice, there will be a decrease in the occurrence of stuttering - therefore DONT use the same passage to assess the client’s speech each week

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22
Q

Modified Vocalisation Hypothesis

A

If you use your speech system differently, you can temporarily reduce your stutter - because they change the way the laryngeal system operates

  • Chorus reading (reading along with the clinician)
  • Speaking with an accent
  • Singing
  • Whispering
  • White noise masking/DAF (when adults can’t hear their own voice, they are perfectly fluent
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23
Q

Issues with white noise masking

A
  • The white noise needs to be at a level of 90dB which is loud enough for noise-induced hearing loss
  • Most adults who stutter are blocking - which precludes the use of these white noise devices because they require voicing for initiation
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24
Q

Advantages of data measurement

A

Contributes to ACCOUNTABILITY
Record the severity and extent of the client’s problem
Allows prescription of appropriate goals and duration of treatment
Every session is started by gathering baseline data - need to have a representative sample to show CHANGE

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25
Q

Within clinic measurement situations for children

A

Sharing a book, playing with toys, arts and craft, cooking

26
Q

Beyond clinic measurement situations for children

A

In free play, at meal times, in the bath - need to measure in a space/time that child is relaxed and confined

27
Q

Within clinic measurement situations for adults

A

Confrontational naming - picture description, reading passages, making a telephone call, ask their name and address (can’t avoid words)

COVERT measurements - assessing their speech without their knowledge. E.g. set up a marketing call, ask their spouse to record them when they don’t know (given Measurement Reactivity)

28
Q

Response Contingent Stimulation

A

The feedback you provide depends on the client’s response and level of success

  • If the client responds fluently, then give positive feedback
  • If the client stutters, clinician/parent should STOP the child, e.g. “careful darling”
  • This is to stop the NEUROLOGICAL MAPPING - i.e. stop the behaviour, not the child (don’t stop them from talking all together)
29
Q

What is the most important measure of stuttering? What kind of measure is it?

A

%SS - Molecular measure (objective)

30
Q

What is the normal/stuttered %SS?

A

Normal dysfluencies = 0-2%
Mild dysfluencies = 2-5%
Moderate = 5-10%
Severe = >10%

31
Q

What is the usefulness of SPM?

A

SPM = syllables per minute

  • Rate control = important part of fluency therapy
  • Consider ALONGSIDE %SS
  • If 25% of syllables are stuttered, and only 120 syllables are produced each minute, the client is likely to be blocking (the stutter takes up a greater amount of TIME than someone who scores 25%SS on an SPM of 180-200
32
Q

SMST

A

stutters per minute of speech time

- need to ensure that the clinician and parent are scoring the same

33
Q

Mean number of repetitions

A

Sometimes there is a qualitative shift in the nature of the stutter
- e.g. at the beginning of therapy, client may have produced 6-8 repetitions on each word to 2-3 repetitions

34
Q

Molar Measures

A

Perceptual internal threshold judgements

  • subjective
  • doesn’t involve counting speech events
  • Uses rating scales
  • Parent fills out graph/chart each day with SEVERITY RATING - gives clinician idea of how child copes with being tired/sick/on the weekend
35
Q

OASES

A
  • The severity of the stutter does NOT necessarily determine the ATTITUDE towards the stutter
  • Interested in internal/emotional dimensions of stuttering
36
Q

What is concordance and discordance?

A

CONCORDANCE: The occurrence of stuttering in both members of a pair of twins
DISCORDANCE: When only one twin has a stutter

Concordance occurs more in monozygotic twins

37
Q

Genetics vs Environmental Factors

A

Stuttering is a combination of genetic and environmental factors.
Genetics = 70%, Environmental = 30%
Concordance is not 100% - showing environmental factors
Adoption studies show that stuttering was more closely related to whether or not a child’s BIOLOGICAL parents (rather than adoptive parents) stuttered - genetic factors

38
Q

Stuttering as a complex trait

A

Stuttering is the result of complex genetic traits
A possible mutation in the major gene is reflected in the phenotype ONLY when certain environmental and other polygenetic factors are present

39
Q

Sex-Linked studies (gender ratios)

A
  • A mother who studies is more likely to pass it on to her SONS than her daughters (67% compared to 19%)
  • Girls need a higher ‘dosage’ of the genetic component of the vulnerability to stutter for the stutter to be realised
40
Q

Which chromosome?

A

Some researchers found chromosome 18 to be a strong marker - chromosome 18 is known to be associated with speech production in the brain

Other studies have shown links to chromosomes 9 and 12

This leads authors to suggest that stuttering can be caused by mutations at MANY different loci

41
Q

How do we know that stuttering is not a single-gene disorder?

A

Because NOT ALL children in the family will stutter

42
Q

Sib ship rankings

A

Many parents worry about mimicry - don’t want their child around other children who stutter

HOWEVER if there was an element of mimicry, then everyone younger than the proband would stutter - research shows that the position of a child who stuttered (in the family) was completely RANDOM

Kids don’t adopt habits that make life harder for them

43
Q

Clinical implications for genetic basis of stuttering

A
  • Inform parents that stuttering is a family disorder
  • Doesn’t require genetic counselling - because the child may not even develop the stutter (and if they do, then it can be treated)
  • Environmental influences can play a part in assisting recovery and help facilitate fluency
  • Emphasise the effectiveness of treatment in childhood if the stutter is identified EARLY
44
Q

What are the three types of aetiological theories of stuttering?

A

Psychogenic theories
Learning theories
Organicity theories

45
Q

What is a psychogenic theory?

A

Stuttering is the result of an abnormal personality or underling emotional and psychological issues - research “found” that children who stuttered were anxious and parents were overprotective - but these traits are likely to be the RESULT of the stutter - not the other way around

Recent studies found NO LINK between personality and stuttering severity

46
Q

Learning theory

A

Stuttering is a LEARNED behaviour from their parents’ NEGATIVE REACTIONS to normal childhood dysfluencies

  • If you pay attention to the stutter, then it will get worse
  • treatment encouraged parents to ignore the stutter
47
Q

Anticipatory Struggle Hypothesis (part of learning theory)

A

People stutter because of a learned BELIEF in the difficulty of speech and an ANTICIPATION of speech failure
- Child anticipates negative reactions from parents (facial expressions etc.) and blocks as a reaction

48
Q

Issues with learning theories

A
  • Not all children with stutters receive negative reactions from their parents
  • Children who stutter FLUCTUATE
  • There would not be such extreme gender imbalances if learning theories were true
49
Q

Operant Learning Theory

A

Body has learnt that EVENTUALLY they will get the word out after their stutter (and therefore they associate the motor characteristics of stuttering with the eventual successful output of the word)

50
Q

Demands and Capacities Hypothesis

A

Stuttering results when the demands of fluency from a child’s social environment exceed the child’s cognitive, linguistic, motor or emotional capacities for speech
- Doesn’t explain cause, but describes the fluctuation/impact of environmental factors

51
Q

Organicity Theories

CECLMSS

A 
Cerebral Dominance
EEG
Cybernetic Models of Stuttering
Laryngeal Reaction Times
Manual Reaction Times
Stuttering as Prosodic Disorder
Speech Motor Control Theory
52
Q

Cerebral dominance

A

Nervous system of people who stuttered had not yet matured enough to achieve left hemisphere dominance of speech movements - by investigating the handedness of individuals who stutter

53
Q

EEG studies

A

Researches used electroencephalography to compare the neural activity of stuttered v. non-stutterers
Abnormal alpha levels were detected during stuttering episode, and thought to cause stuttering
However the heightened motor responses, anxiety and effortful nature of the stuttering episode is likely to have caused the extra cortical activity - not the other way around

54
Q

Cybernetic Models of Stuttering

A

Servosystem feedback mechanisms were thought to be defective. This distorted feedback creates the misconception that an error has occurred and the speaker attempts to correct it over and over again

Studied by altering the feedback (by delaying it) - DAF
People who stutter became fluent using DAF, and were weaned off the system by decreasing the delay

55
Q

Laryngeal reaction times

A

Researchers found that people who stutter had a slower VOT
However, they weren’t born with anything different - studies show that children with and without stutters had the same VOT
Larynx develops a difference over time, as the result of the physical patterns developed by people who stutter

56
Q

Manual Reaction Times

A

There is no difference in the reaction times for button pressing and non speech vocalisation tasks

However, people with stutters had a slower VOT in speech tasks

57
Q

Stuttering as a PROSODIC Disorder

A

Stuttering was more common on specific loci of information units in speech e.g. nouns, adjectives and personal pronouns - all of which are stressed in English (by altering the laryngeal function)

58
Q

Speech Motor Control Theory

A

People who stutter have a neurophysical deficit that results in the inability to move their articulators as accurately or quickly as their non-stuttering counterparts

59
Q

The V model

A

Suggests reasons why people tend to stutter on stressed syllables

Stressed syllables = changes to frequency, duration and amplitude. The period from stressed to unstressed syllables is thus a period of EXTREME VARIABILITY

Proposes that people who stutter have a lower threshold of variability and hence are more prone to destabilisation of the speech motor system

Syllable repetitions are seen as an attempt to get over the variability of syllable stress. Prolongations/blocks are attempts to get over repetitions

60
Q

Effortful Control

A

Self regulatory trait representing voluntary and executive functions of temperament

  • Children with higher levels of EC display regulation of behaviour and attention, and have LOWER stuttering severity ratings
  • High EC means child has many more resources to focus on treatment
  • High EC = temperament allows child to respond to their speech with compensatory behaviour, attention and emotion
  • Children without high EC will be taxed more by changes in their environment (e.g. being sick, excited, tired, unhappy) resulting in more frequent breakdowns in their speech
61
Q

Therapy implications for EC

A

Therapy should be focus don building skills related to EC (i.e. attention, inhibitory control and perceptual sensitivity, as well as negative emotions, self-perception etc.)

Stuttering (6 decks)

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