Part 1

Question 1

What are some rules for communication etiquette?

Answer 1

Do not finish sentences or interrupt

Maintain posture, facial expression, eye contact and focus on what person is saying to de-focus from stuttering bx

Question 2

Why do SLPs report lack of confidence with fluency?

Answer 2

Low prevalence
ASHA deregulation of clinical experience and coursework
Counseling component
High rate of relapse

Question 3

Where can patient look after treatment has begun?

Answer 3

ASHA, stuttering foundation for self-help literature

Question 4

What is the clinician’s role?

Answer 4

Induce initial changes and coach speech-motor programming
Counsel and empower client to become their own clinician
Calibrate to client and notice details of stutter, anxieties…
Become less inhibited by practicing voluntary stuttering and modeling risk taking bx

Question 5

What is the client’s role?

Answer 5

Main agent to sustain change!

Question 6

What is the nature of stuttering?

Answer 6

Occurs in presence of perceived other, and likely to occur under high pressure, including conversation (bidirectional comm)
Often brought on when person is not talking yet, but knows they will have to…

Question 7

How is stuttering different and distinct from typical dysfluency?

Answer 7

Typical dysfluency is tension free, rythmic, brief and without secondary bxs.

Stuttering is involuntary with environmental and neurochemical triggers, difficulty initiating and moving across syllables
Variable and cyclical

Question 8

When are dysfluencies counted as SLDs?

Answer 8

Sound repetitions with more than 2 units per repetition… are they dysrythmic?

Variety of atypical dysfluencies (prolongations, blocks, repetitions, and clusters)

Pitch or loudness increase is sign of laryngeal tension/pushing

Evidence of struggle bxs

More than 10 words per 100 stuttered

Question 9

When is onset of stuttering? Why?

Answer 9

2-7 is likely, 2-5 is typical!

There is an increase in lexicon and grammaticality

There’s only a 50% chance that if child has not stuttered at age 4 they will stutter after…

Question 10

What is the incidence? Prevalence?

Answer 10

Incidence is new cases over time period: 5%

Prevalence is % at any given time: 1%

Question 11

Preschool is a time of great…

Answer 11

Vulnerability- parents have large influence, resources scarce
Potential- plasticity, lack of experience with stuttering, high self efficacy
High stakes- most natural stuttering will resolve within a year

Question 12

How often do children recover from stuttering?

Answer 12

32-85% will recover on own

Spontaneous recovery ends at age 5

Question 13

What is the issue with existing explanations for stuttering?

Answer 13

Some account for etiology, and others for moments of stuttering

Question 14

What are some research strides in last 30 years?

Answer 14

Predictors of natural recovery v chronicity

Neuromotor bases of stuttering in adults

Response to altered auditory feedback conditions

Question 15

What are research needs?

Answer 15

Neuromotor bases among children?

Multicultural/multilingual contexts

Question 16

What are the biological bases of stuttering?

Answer 16

Genetic links!- 1/3-1/2 report family history. Males greater risk than females. Severity not familial, just presence. Greater rate with mono than dizygotic twins, with bio than adopted parent, and with males than with females (esp with recovery). Male from mothers who stutter at greatest risk!

Atypical neurology- atypical cerebral dominance, now, irregular neural organization due to reduced lh white matter, myelin covering, rh hyperactivity, reduced grey matter in subcortical areas, and atypical dopamine levels.

Auditory dysfunction- altered feedback causes improvement, difficulties with sound localization

Speech motor discoordination- slower and less coordinated speech motor execution

Question 17

What are the implications and issues of atypical neurology?

Answer 17

Pharmacological treatment

Neurological evidence suggests link- but causal or adaptive??

Question 18

What are the implications and issues of auditory dysfunction?

Answer 18

AAF was used to augment therapy, now used as an alternative to therapy as well

Neuro underpinnings not totally understood, not sure of clinical efficacy of AAF devices

Question 19

What are the implications and issues of genetic links?

Answer 19

Close monitoring of children of parents who stutter, counseling…

Could it be genetically based even without family history?

Question 20

What are the implications and issues of speech motor discoordination?

Answer 20

Evaluate speech motor function

Is is due to inherent capacity or learned response to stuttering?

Question 21

What are some critiques of biological perspective research?

Answer 21

Small number participants, few replicated studies, and most with adults!

Doesn’t fit one physiological explanation!

Question 22

What is the diagnosogenic semantic theory?

Answer 22

Stuttering is a maladaptive learned response!

Most kids go through periods of normal disfluency, child learns to approach talking with apprehension, tension…

Aberrant speech bx ID’d as stuttering after parents say it is. Clinical implication is “hands off” approach and not calling attention to it by calling it stuttering. Caused loss of research on bio basis, and parent guilt for causing.

Overall undermined by genetic involvement. BUT communicative environment was brought into focus.

Question 23

What is the two factor theory?

Answer 23

One factor suggests explained by classical conditioning

Another is development of secondary bx are explained with operant conditioning (he agrees with this)

Application of contingent stimuli (aversive or not) appears to create a state in which stuttering tends to diminish

Question 24

Summarize stuttering as a unidimensional d/o

Answer 24

Nature (bio) or nurture (bx explanations)

Counseling- develop skepticism for unidimensional explanation, gauge parents beliefs about stuttering, refer to contributive factors–> predisposing genetics, precipitating trigger (stage, phase, env), perpetuating (what makes it worse, environment, push/avoid)

Question 25

Summarize stuttering at a multidimensional d/o

Answer 25

Fluency breakdown that suggests reduced capacity to respond to internal and external demands:

Demands on motor system language system emotional system, self imposed…

Capacities motoric linguistic affective, cognitive social…

Can be mismatched! Capacities typical demands high, or capacities limited, demands typical… etc.

Provides framework, but does not explain why fluency breaks down under heightened demands– do parents communication bxs impact children’s fluency?

Question 26

What does the research on speech characteristic of parents of CWS say?

Answer 26

they don’t speak faster, reduction in mothers speech rate positively influences fluency, interuptive bx increases with severity, reduction in stuttering in turn taking tasks, little evidence that question asking causes pressure

Question 27

What is a defense of the demands capacity model?

Answer 27

Not held up in research but difficult to generalize, collective influence of parent talk characteristics make difficult to measure, stuttering varies across partners/situations…