W2/3 - Developmental Stammering Flashcards
What is developmental stammering?
Stammering can be defined as:
‘an abnormally high frequency and/or duration of stoppages in the forward flow of speech’ (Guitar, 2014).
It initially occurs in childhood, and can start in different ways: sudden, gradual or intermediate onset. It typically occurs during rapid language development (2>3.5yo), and it varies in its severity.
What are the core behaviours of developmental stammering?
Repetitions - at sound, syllable, word or phrase level
Prolongations - a sound being stretch out - can be with consonants or vowels
Blocks - the word seemingly being stuck
What are the 2 types factors in the Multifactorial Model of Developmental Stammering?
Ref - Kelman and Nicholas, 2008
Yellow – Causal/Predisposing Factors
Blue – Maintaining/Contributing Factors
What are the significance of the factors in the multifactorial model?
Physiological and linguistic factors are likely to be significant in the onset and development of the stammer.
The way these factors interact with psychological and environmental aspects contributes to the severity and the persistence of the stammer, and the impact it has on the child and the family.
What are the environmental factors in the Multifactorial Model of Developmental Stammering?
Environmental Factors are Maintaining Factors.
- Communicative Environment/Communication Style of adults around CWS
- Parental Anxiety
What are the psychological factors in the Multifactorial Model of Developmental Stammering?
Psychological factors are maintaining factors.
- Temperament
- Child’s Awareness
What are the physiological factors in the Multifactorial Model of Developmental Stammering?
Physiological factors are predisposing factors.
- Genetics
- Neurological
- Auditory Feedback Loop
- Increased Incidence in specific conditions
- Speech Motor Skills
What are the Speech and Language factors in the Multifactorial Model of Developmental Stammering?
S&L factors are predisposing factors.
- Language Skills
- Phonological Skills
- Linguistic Context
- Bilingualism
What are the impact of neurological factors on stammering in terms of the Multifactorial Model of Developmental Stammering?
Neurological Factors are physiological, predisposing/causal factors.
In CWS, we consistently see:
- Overactivation of many areas of the right hemisphere during speech.
- Differences in white matter in the left hemisphere in comparison to CWNS.
- Reduced gray matter in the brains subcortical centres in children with persistent and transient stammering.
What are the impact of genetic factors on stammering in terms of the Multifactorial Model of Developmental Stammering?
Genetic factors are physiological, predisposing/causal factors.
In CWS, we consistently see:
- Hereditary Component
- Between 30-60% of those who stammer have a family history
- Many genes have been found to be related to stammering, with chromosome 12 being particularly significant
What is the impact of the Auditory Feedback Loop on stammering in terms of the Multifactorial Model of Developmental Stammering?
The auditory feedback loop is a physiological, predisposing/causal factor.
In CWS, we see that:
- Altered, auditory feedback helps - the feedback that the ears get could alter the pitch or delay the feedback
- Listening to music, reading in unison with someone else or delayed auditory feedback (DAF) all alters the AFL, and reduces or removes a persons stammering
- Stammering is less prevalent in the deaf population
*This technique is best in the short term - not practical for conversations.
What are the impact of Speech Motor Skills on stammering in terms of the Multifactorial Model of Developmental Stammering?
Spech Motor Skills are physiological, predisposing/causal factors.
In CWS, we see:
- Reduced oro-motor skills (subtle but present difference, noticeable at clinical level, not everyday).
- Slower response times for vocal and manual tasks.
- Slower consonant-vowel transitions (subtle but present difference, noticeable at clinical level, not everyday).
- Impacted laryngeal control
What is the impact of other conditions on stammering in terms of the Multifactorial Model of Developmental Stammering?
Causal/previous conditions are physiological, predisposing/causal factors.
There is an increased incidence in CWS with:
- Some degree of brain damage
- Down syndrome
- Premature birth
What is the impact of language skills on stammering in terms of the Multifactorial Model of Developmental Stammering?
Language skills are a speech and language, predisposing/causal factor.
We see that:
- The onset of a developmental stammer is linked to a period of rapid speech and language development
- Some studies suggest above average language skills in CWS, whilst other studies suggest CWS have less developed language skills than CWNS.
- CWS may have mismatches in their linguistic skills - they have an uneven profile.
What are the impact of phonological skills on stammering in terms of the Multifactorial Model of Developmental Stammering?
Phonological skills are a speech and language, predisposing/causal factor.
We see that:
- Some studies suggest there is a relationship between persistant stammering and having phonological difficulties.
- Some studies show a higher proportion of CWS have speech sound difficulties than CWNS.
What is the impact of linguistic context on stammering in terms of the Multifactorial Model of Developmental Stammering?
Linguistic context is a speech and language, predisposing/causal factor.
We see that:
- Stammering often occurs at the start of an utterance, clause boundaries and on function words rather than content words.
- Stammering increases on lengthy utterances, and utterances with increased syntactic complexity.
What is the impact of bilingualism on stammering in terms of the Multifactorial Model of Developmental Stammering?
Bilingualism is a speech and language, predisposing/causal factor.
We see that:
- Some studies suggest bilingual speakers are more likely to stammer and have lower chance of recovery
- More recent research does suggest that stammering is not more prevalent in bilingual speakers
What is the impact of the communicative environment on stammering in terms of the Multifactorial Model of Developmental Stammering?
The communicative environment is an environmental, maintaining/contributing factor.
We see that:
- There is no evidence of parental communication/interaction styles being different between CWS and CWNS, or being responsible for the onset of stammering
- however, stammering can cause a change in the interaction style of the parents due to anxiety associated with the child’s stammer
What is the impact of parental anxiety on stammering in terms of the Multifactorial Model of Developmental Stammering?
Parental anxiety is an environmental, maintaining/contributing factor.
We see:
- There’s limited research on the impact of parental anxiety on stammering
- Parents are more anxious when interacting with a CWS
- Children can pick up on this and respond to it
What is the impact of a child’s temperament on stammering in terms of the Multifactorial Model of Developmental Stammering?
The temperament of the child is a psychological, maintaining/contributing factor.
We see that:
- Emerging evidence suggests CWS are less adaptable to change and new situations
- CWS who have a more reactive temperament may be more aware/concerned about their periods of dysfluency
- CWS may find it hard to ‘move on’ or ‘let it go’ when stammering presents.
What is the impact of the child’s own awareness on stammering in terms of the Multifactorial Model of Developmental Stammering?
A child’s self awareness is an psychological, maintaining/contributing factor.
We see that:
- From 3yo+, children can identify differences in stammered v fluent speech
- Young CWS are more likely to have a negative attitude towards their speech, which becomes increasingly negative as they get older
What are the two parts of Sheehan’s Iceberg?
Overt Symptoms - Characteristics of speech
Covert Symptoms - Avoidance behaviour, feelings & thoughts about stammering
What are the overt symptoms in Sheehan’s Iceberg Model?
Repetitions - at sound, syllable, word or phrase level
Blocks - the word seemingly being stuck
Prolongations - stretching out a sound
What are the covert symptoms in Sheehan’s iceberg model?
Hiding negative feelings - fear, anxiety, shame, embarassment, self hatred, etc.
Avoidance behaviours - talking, specific situations, certain words, phone calls, etc.
