Stuttering

Question 1

Define Stuttering

Answer 1

Stuttering is a disruption in the fluency of verbal expression which is characterised by involuntary audible or silent repetitions or prolongations in the utterance of short speech elements. Namely sounds, syllables or words of one syllable.

Question 2

What are the observable features of stuttering

Answer 2

• Repetitions of whole words, initial sounds and part words
• Prolongations
• Blocks
• Non Verbal: Facial and Body movements

Question 3

What are the unobservable features of stuttering

Answer 3

• Negative emotions
• Word Avoidance
• Word Revision

Question 4

What is the Epidemiology of Stuttering

Answer 4

Study of Rates of diseases in populations and the consideration of how these rates are affected by variables such as age, gender and social class- Allows for accountability and planning caseload of management decisions

Question 5

Incidence?

Answer 5

Number of New cases of disorder (4-5%)

Question 6

Prevalence?

Answer 6

Percentage of cases at any given time: One percent of the population

Question 7

Gender?

Answer 7

4:1 ratio males to females

Question 8

Spontaneous Recovery

Answer 8

10% recovery

Question 9

Age of Onset

Answer 9

Onset between 2.6 and 3.6 years of age

Question 10

Episodic Nature

Answer 10

Fluctuate significantly in preschool years, 10% sudden onset

Question 11

Factors that Modify stuttering

Answer 11

Situational Reactivity (changes due to situation- occupation and socialising
Measurement Reactivity:
Assessment trigger/ recording device
Discriminative Stimuli
Adaptation effect: Repetition
Response Contingent Stimulation
Modified Vocalisation Hypothesis: Chorus Reading/Shadowing, speaking with an accent, singing, whispering, white noise/ delayed auditory feedback

Question 12

Measurement Situations

Answer 12

Beyond clinic measurements
Within clinic Measurements
Covert Measurement (reactive to assessment, reduced or increased by discriminative stimuli- important to consider ethics and informed consent)

Question 13

Molecular Measures (objective)

Answer 13

%SS- no of stutter/no of syllables
SPM no of stutters/time
SMST stutters per min of speech time
Mean number reps
Mean duration of stuttered episodes

Question 14

Molar Measures (subjective)

Answer 14

Severity rating scale
Speech naturalness
(Internal perceptual threshold judgement)

Question 15

Family Aggregation Studies

Answer 15

Yale Study Demonstrates “Single major locus vs polygenic transmission’
High Density families (30-60%) of pro bands have a positive family history
-Gender issues
-Sib Ship rankings (inherited dispositions no mimicry/environmental causes)

Question 16

Twin Studies

Answer 16

Increased Concordance in monozygotic twins compared to dyzygotic indicates increase strength of genetic factors

• 10/16 monozygotic pairs
• 3/14 dyzyogotic pairs both stuttered

Question 17

Sex Linked Studies

Answer 17

Males have a higher probability when linked to affected female parent (67%) , questions regarding transient recovery vs persisted stuttering is genetically linked

Question 18

Linkage Analysis

Answer 18

Methodology determines the location of a specific causative gene on a known chromosome- very complex patterns of inheritance (chromosome 9 and 15 emerged strongly)

Question 19

Biological Genetics

Answer 19

Attempt to find a gene relationship trait
Candidate gene analysis uses smaller location identified on genes known to have similar characteristics- larger amount of chromosomes to be analysed at once

Question 20

Association Studies

Answer 20

International collaborative DNA research grant “in search of genes for stuttering”
Aim: To identify genetic variation affecting susceptibility to stuttering through association functional mapping
-Genes are yet to be identified though studies confirm genetic trends in transmission among family members

Question 21

Clinical Implications to genetic research

Answer 21

Inform parents stuttering is familial disorder
Does not require genetic counselling offered for serious diseases
environmental influences can play a part in assisting recovery, reducing symptoms and facilitating fluency
Emphasise effectiveness of treatment in childhood as close to onset as possible

Question 22

What are the three Aetiological hypotheses

Answer 22

Psychogenic Theory
Learning Theory
Organicity Theory

Question 23

What is the Psychogenic Theory

Answer 23

Stuttering is the breakdown in normal ongoing psychological function, resultant from abnormal personality
-Research investigated parent aspirations (Over-protectivness) and anxiety in children and adults
Did not find significant patterns

Question 24

What is the learning theory

Answer 24

Stuttering as a learned Behaviour resulting from negative reactions to normal childhood disfluencies

Question 25

What are the components of the learning Theory?

Answer 25

Diagnosogenic Theory
Anticipatory Theory
Operant or Instrumental Learning theory
Demands and capacity hypothesis

Question 26

What is the diagnosogenic theory?

Answer 26

Stuttering begins not in the child’s mouth but in the parents ear- stuttering avoidance reactive motivated by anxious anticipation of speech interruption by the child and negative labelling by the parent

Question 27

What is the Anticipatory Theory?

Answer 27

People who stutter interfere with speech patterns because of a learned belief in difficult of speech and anticipation of speech failure

Question 28

What is the operant or Instrumental learning theory?

Answer 28

Stuttering is learned and maintained under reinforcement schedule in child environment

Question 29

What is the demands and capacity hypothesis?

Answer 29

Stuttering results when demands of fluency from social environment exceed cognitive, linguistic, motor or emotional capacity for speech

Question 30

What are the components of Organicity theory?

Answer 30

Cerebral Dominance
EEG
Cybernetic models of stuttering
Laryngeal Reaction Time
Manual Reaction times 
Stuttering as a prosodic disorder
Speech motor control theory

Question 31

Cerebral Dominance?

Answer 31

Confused cerebral dominance and handedness

Question 32

EEG?

Answer 32

Abnormal alpha rhythms and electrical activity were thought to cause stuttering; no differences found at rest.. EFFORT?

Question 33

Cybernetic models of stuttering?

Answer 33

Servo system feedback mechanisms were though to be defective, experiments were conducted with masking noise and delayed auditory feedback

• Edinburgh masker: Stuttering decrease under high level of white noise (50-60db)
• DAF and found under specified delay periods (150-200) milliseconds people who stuttered increased loudness, used monotone, prolonged rate, increased pitch became fluent- effects persisted after delay was eliminated (normal speakers under DAF displayed disfluencies

Question 34

Laryngeal Reaction time

Answer 34

Slower vocalisation onset time in individuals who stuttered in response to auditory signal

Question 35

Manual Reaction time

Answer 35

No difference in button pressing and non speech vocalisation times

Question 36

Stuttering as a prosodic disorder

Answer 36

Stuttered episodes on specific loci of information units in speech e.g. nouns adjective and personal pronouns
-These word classes received stress in english stressed syllables are achieved by changes in vocal control and laryngeal functioning

Question 37

Speech Motor Control Theory?

Answer 37

Investigation of velocity, displacement and duration of movement and coordination of timing between articulatory events specifically: physiological conditions associated with speech breakdown and condition which make people who stutter vulnerable to speech breakdowns

Question 38

What is effortful control?

Answer 38

Self regulatory trait representing voluntary and executive functions of temperament
^ displays regulation of behaviour attention have lower stuttering severity ratings
less have a high stuttering severity rating
teach parents to increase resilience and self regulation in children.