Fluency Unit 1

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Give a brief overall definition of fluency.

Speak/write smoothly, readily, effortlessly or easily.

Define oral fluency.

Production of continuous speech at a relatively rapid rate w/ optimum effort.

What causes people to stutter?

Traumatic event, genetics (FOXP2)

Can stuttering be cured?

70-80% of children spontaneously recover; most adults don't spontaneously recover.

Is stuttering voluntary or involuntary?

we don't know

Is stuttering controllable?

yes; context dependent

What are some overt signs of stuttering?

grimaces, flailing, repetitions, prolongations, postural fixations

Why do we stutter?

No purpose; possible that its a way of reinstating fluency or caused by a blockage somewhere in the speech stream (central originating disorder)

___ percent of people who stutter relapse.

70

Is dysfluency a categorical or continuous phenomena?

Continuous - the number of dysfluencies; Categorical - Mild, Moderate, Severe

Proximal events

what we can see, hear, touch, ... often related to the symptoms

Distal events

unseen, often related to deeper causal events in the pathology.

What are our current goals when dealing with stuttering?

Successful management of symptoms; both overt & covert.

What does the successful management of stuttering entail?

Varies; one size does not fit all.

Scientific theories change by a series of _____ _____

paradigm shifts

Paradigm shifts a complete ________, a shift in the _____ idea of how we view something.

change of perspective, "gestalt"

T/F Scientists become heavily invested in their causes and fight to defend them.

True

The effects of paradigm shifts:

-Scientific advancement, new technologies
-How do we communicate nowadays?

Stuttering has undergone a series of shifts in thought.
•One school of thought has been replaced by another.
•Ideas about stuttering have been heavily influenced by the field of ________.

psychology

Theory: ______believed that when
people stammer it is due, not to an
affection of the veins, but to the
movement of the tongue; for they find
difficulty in changing the position of
the tongue when they have to utter the next sound.

Aristotle

Treatment: ______ is reported to have used "pebble" therapy to train his "tangled tongue".

Demosthenes

An experienced German surgeon and pioneer in the field of skin transplantation and cosmetic surgery.
Theory: He believed that the tongue was too large and would thus disrupt fluency in speech.
Treatment: He surgically cut out portions of the tongues of people who stuttered to cure them started this "triangular wedge" procedure in 1841 without anesthesia.

Johann Frederick Dieffenbach

Describe this "treatment":
Cured Stutterers Pass It On..

Stutterers who felt they had been successful in overcoming their own stuttering and offered to share their "secret" for doing so (for a price) with others.

One of the most infamous of these was the Bogue Institute in Indianapolis. Such schools, most of which used "secret methods" and were residential, offered a "guaranteed cure" for a fairly high tuition that was usually payable in advance.

Commercial Stuttering Schools

What is the problem w/ commercial stuttering schools?

If the school guaranteed a cure & the client continued to stutter, who was to blame? (the client)

Background: Findings of Paul Broca indicate that the left hemisphere is dominant for speech and language. I.e., the left hemisphere gives the timing of nerve impulses associated with speech and language for right handed individuals.

Orton and Travis

Who's Theory?
•Broca's aphasia (Greek 'a' = 'not'; 'phasia' = 'speech'): failure to produce any connected speech, nor any other words than 'tan'- other symptoms:
•paralyzed right arm
Cause: a lesion on the third convolution of the frontal lobe (Broca's area)
Theory: The third convolution of the frontal lobe of the left hemisphere would be the primary responsible structure for the control of speech production.

Orton & Travis's

Who? Observations: Cases with defective speech, including stuttering, were also found to be left handed.
Theory: Being left handed or ambidextrous reflects an incomplete dominance and thus indicates a danger to develop communication disorders.

Orton & Travis's handedness theory

Orton & Travis's treatment according to their handedness theory.

Treatment: Use a cast and bind a limb to counteract an incomplete dominance, which is responsible for stuttering.

Evidence that contradicts Orton & Travis's handedness theory.

Findings of Wingate of children beginning to stutter after switching to their non-dominant right hand and later becoming fluent after switching back to their dominant left hand.

T/F Stuttering shows opercular right hemisphere invovledment; whether its a cause or compensatory result is unknown.

True

Problems w/ Orton & Travis's theory: (3)

(1) Because of spontaneous recovery in children, it could not predict which individuals would stutter and which wouldn't.
(2) Their treatment did not yield significant reductions in stuttering.
(3) Children, whose handedness was changed, did not stutter.

What do we know about the brains of stutterers (Orton & Travis)? (3ish)

Brains of stutterers are different:
-Both functionally: stuttering shows more right hemispheric involvement.
-Structurally (in adults): differences in cerebral morphology in temporal lobe areas.

Background: Freudian _____ gained popularity in the early part of the 20th century
Observations: probably some similarity between stuttering and other behaviors classified as "neurotic" during that time.

psychoanalysis

Give some examples theories that base stuttering on neurosis:

1. A defence mechanism where the personality is disturbed and speech reverts to its earlier lalling pattern" Glauber
2. "A compulsion neurosis where there is a fixation at one stage which never develops" Stein
3. "A pregenital conversion neurosis where an inner conflict is converted to the external" Fenichel
4. "The stutterer cannot speak because he has unspeakable feelings" Travis
5. "Stuttering is a psychoneurosis caused by the persistence into later life of early pregenital oral nursing, oral sadistic and anal sadistic components" Coriat

Psychoanalysis: Freud's 'structural theory' divided the human psyche in 3 components:

super-ego = internalization of norms and moral rules of the society (as well as taboos); represented by the parents; stood in opposition to the id
ego= mediating component of the mind
id = natural drives and wishes; responsible for our basic drives such as food, sex, and aggressive impulses.

Who's theory?
Theory on stuttering: stuttering emanates from a either oral or anal needs, a covert expression of hostility, or an unconscious suppression of speech that originates during childhood, or
"a pregenital conversion neurosis where an inner conflict is converted to the external"

Psychoanalysts; (Fenichel).

According to psychoanalysts, Stuttering is a ______ activity motivated by ______ needs e.g., a hostile and aggressive impulses that the person fears to speak openly.

purposeful, unconscious

Psychoanalysts treatment for stuttering

1. Treatment: emotional 'catharsis effect' should resolve the deep-rooted conflict causing stuttering behaviors.
2. Anomalies: few patients were effectively treated with this approach; Abraham Brill reported being able to help only 4 out of 69 patients treated.

Problems w/ psychoanalysts' theory

no scientific theory which is thus neither to be proven nor refuted; circularity of argument

Who?
Background: psychoanalytic
theory
Observations: children who stutter and their over-concerned parents; some children presenting dysfluencies at one time tend to recover during the later years, while others continue to stutter.

Johnson?

What theory?
(1) no underlying organic disorder was assumed for stuttering;
(2) normally non-fluent speech (e.g., tension-free word repetitions, interjections or revisions) could be turned to stuttering when parents placed "unrealistic" demands on the child's speech;
(3) stuttering was defined as an "anticipatory, apprehensive hypertonic, avoidance reaction".
(4) stuttering is an emotional disorder, a reaction motivated by fear to avoid stuttering.

Diagnosogenic or Semantogenic Theory; Johnsonian Theory

Johnsonian Theory treatment

(1) parents were taught to stop labeling the child as a "stutterer" and to ignore stutters
(2) stuttering is an emotional disorder, a reaction motivated by fear to avoid stuttering -> therapeutic approach oriented towards dealing with the fear of stuttering: "bouncing", i.e., easy, tension-free, voluntary syllabic repetitions; the technique, a similar version of which was employed by Van Riper, produced some inhibition of stuttering, which were attributed to a fear-reduction; slowed speech models;
(3) reinforcement of a loving, caring environment; direct therapy was avoided until the client was confirmed to be a "stutterer".

Monster study, what is it & who done it?

The "monster studies" in 1939 revealed no significant differences between those children abused by Johnson and his student and those who were spared.

Problems w/ Johnsonian theory

circularity of argument when trying to explain therapy outcomes.

Who?
Background: psychoanalysis and Johnsonian approaches
Observations: avoidance behaviors in those who stutter.

Joseph Sheehan

What theory? stuttering resulted from an equal drive to speak and to remain silent. The drive to avoid speech includes learned fears of words, situations, interpersonal relationships, emotional content and one's own ego

Role Conflict Theory (Joseph Sheehan)

Possible reasons for the need to remain silent from a psychoanalytic point of view: (Role Conflict Theory)

1. not to reveal shame
2. what speech means to them: e.g., aggressive
acts which are retaliated by others (fear)
3. ego-defense need to avoid competition posing "threat of failure or threat of success"

Treatment, Role Conflict Theory

Treatment: group therapy aimed at confrontation, openness and acceptance of stuttering by exposing the hidden pathology

Describe the "Iceberg Analogy"

Can see the core behaviors, but not the secondary behaviors beneath the surface.

Explain how theorists thought stuttering become "conditioned".

• Brutten and Shoemaker say that normal non fluency (NNF) reflects an AUTONOMIC reaction to stress.
• When this arousal becomes conditioned to words, listeners and situations, stuttering begins.
• Therefore, stress equals autonomic arousal which in turn causes the disruption of fine motor co-ordinations like those used in speech.

_________ theorists state that speech in stutterers is never "normal" and that stuttering is not just an extension of normal non fluency.
They also feel that the antecedents to the moment of stuttering are just as important as the consequences i.e. that there is conditioned negative emotion.

Classical conditioning

Problems with the classical conditioning approach to stuttering: (4)

a) There is little evidence of a consistent relationship between variations in the amount of stuttering and measures of autonomic arousal
b) Much initial stuttering is not reported to have started with emotional upheaval
c) We cannot produce stuttering by threat in the clinic
d) There should be more people who stutter if this were to be happening.

Assumed that all behaviors can be shaped by using
appropriate schedules of reinforcement;undesirable behaviors can be extinguished or eliminated and replaced with desirable counterparts by systematic reinforcement or punishment.

B.F. Skinner

What theory?
As stuttering was found to be reduced when the manner of speaking was modified, a SLOWER SPEECH RATE became the cornerstone in stuttering therapies.

Behaviorism

2 most common behavioral approaches:

1. Van Riperian: stuttering modification
2. Fluency Shaping: training smooth, fluent speech, teaching people to talk.

Assumes that we can retrain speech & teach fluency.

behaviorism

slow, smooth and "easy" speech was taught, sometimes with help of computer biofeedback

fluency shaping

Advantages of fluency shaping

1. easy to learn and administer
2. short-term fluency enhancement

Disadvantage of fluency shaping

Disadvantages: relapse up to 70%

What theory: Stuttering is a failure of the coordination of respiration, phonation and articulation to be brought under voluntary control. Once the client has overcome his fear of stuttering, the new techniques should be learned and applied more effectively.

Charles Van Riper: Stuttering Modification

4 stages of Stuttering Modification (Van Riper)

1. Identification: identify every minute stuttering as well as the negative emotions
2. Desensitization: Reduction of negative emotional reactions
3. Modification: Modify/shape the stuttering moments into milder forms through voluntary repetitions and prolongations.
4. Stabilization: generalization

Stuttering Modification- shortcomings (3)

1.Non-standardized form of therapy, which could not be followed without many hours of specialized training.
2.Extremely long duration
3.Emotionally draining

What?
1. Empirical: They are based on actual experience.
2. Rational: It follows the rules of logic (e.g.,
avoiding tautologies and vague statements) and is consistent with known facts.
3. Testable: You can know if they confirm your expectations by putting them to experimentation.
4. Parsimonious: They tend to be simple by involving fewer assumptions.
5. General: They work for a relatively wide range of phenomena.
6. Tentative: You are willing to give them up if they prove wrong.
7. Rigorously evaluated: They are continually evaluated for consistency with available data, for parsimony, and for generality.

Scientific Explanations

Science progresses, not only with new inventions, but also --and especially-- with new ideas.
•Often, these ideas are part of a larger belief system that provides the theoretical framework, i.e., the questions and tools to conduct research and do therapy.
•Such belief system we know as a

paradigm

what proportion of population is afflicted at some point in their life

incidence

incidence of stuttering

5%

what proportion of the population is currently afflicted.

prevalence

prevalence of stuttering

1%

How many people recover from stuttering?

4 our of every 5 = ~80%

Gender ratio for stuttering

Gender ratio 3 : 1 (males : female)

-Silverman & Silverman collected reports from teachers at residential schools for persons affected by hearing loss in the United States regarding stuttering-like dysfluencies produced during manual communication
(i.e., signing and fingerspelling).
-The dysfluencies included: (4)

- repetitions of signs
- repetitions of initial letters in fingerspelling
- involuntary interjections fingerspelling
- hesitations during fingerspelling.
- 13 out of 78 teachers gave positive responses.

Survey on stuttering in a hearing impaired school age population by Montgomery and Fitch found of 12 individuals who stuttered:

3 in the oral mode only, 6 in the manual communication model only, and 3 in both modes.

What is the prevalence of stuttering in the hearing impaired community?

0.12%
8 times more prevalent in the hearing
-Perceived manual dysfluency was found to be more prevalent than oral dysfluency

Stuttering generally starts between the ages of __ and __.

2 & 4

Why is it difficult to determine the exact age of onset of stuttering?

Stuttering generally starts between the ages of 2 and 4.

T/F The onset of stuttering can be gentle or abrupt.

T; Generally starts as mild, easy stuttering but can change rapidly.
-Reports exist of children whose incipient stuttering patterns are more severe.

Compare the number of cases of recovered & persistent stuttering in the population to that of "cases affected by stuttering"

1.In families of persistent probands there is a higher proportion of persistent stuttering than in the population.
2.In families of recovered probands the proportion of recovered stuttering is much greater than in the population.
3.The proportion of recovered stuttering is greater than in the population, but to a lesser degree than persistent stuttering.
*probands = cases affected by stuttering

T/F
-In the first six months, it is often difficult to tell whether a child persistently stutter.
-Initial level of severity is not informative of this.

True

Yairi's studies tell us that a conservative estimate of natural recovery is __
-Most recovery occurs within__years post onset. (window closes w/ age)

74%, 4

Describe the genetic predisposition that that may predict a child will recover from stuttering.

parents recovered

Andrews et al. found people who stutter were_ times more likely to have an immediate family member who stuttered than those who did not.

3

A ______ model may be more appropriate than a single gene explanation.

polygenic (FOXP2)

Why is the genetic pattern of stuttering unclear?

-May skip generations
-May be observed in a child without any previous history of stuttering.

Describe condordance of fluency in twin studies. What does this mean?

There is not 100% concordance in identical twins.
- Concordance is higher in identical than in fraternal twins.
- Genetics are obviously implicated, but other factors probably come into play also. (environmental)

Stuttering can exist independently or concomitantly with other disorders (5)

Down's syndrome, Tourette's, ADD, phonological disorders, other neurological conditions (e.g., cerebral palsy).

probability of phenotypic expression in both twins, given the phenotypic expression of one twin.

Concordance

Who's theory?
Simply put, a child may begin to stutter when the demands placed upon their speech motor system outweigh the systems capacities for speech and language.
-If the demands continue to outweigh capacities, stuttering can become ingrained and permanent.
-This is a model that is often used to describe stuttering to parents.

Starkweather's demands & capacities (DCM)

Starkweather's internal demands:

1. Speech: muscular strength and coordination.
2. Linguistic: semantics, grammar, syntax, turn-taking, conversation initiation, articulation, phonology.
3. Others: cognitive abilities, anxiety levels.

Starkweather's external demands:

1. rate and prosody
2. production of accurate linguistic forms.
3. Stress, teasing etc.

Describe the 3 core stuttering behaviors

1. Part-word or syllable repetitions:
◦E.g., ba-ba-ba-baloon
◦Muh, muh, muh, my
◦Can occur on all types of speech sounds.
2. Prolongations:
◦E.g., mmmmmmmilk, llllllunch, oooover
◦Can only occur on continuants.
3. Silent postural fixations
◦Usually represents the most severe form of stuttering.
◦Speech flow stops and the system freezes.
◦Can occur on any type of sound.

Describe the "other" speech characteristics of stuttering (6)

1. Tense pauses
2. Incomplete phrases
3. Interjections
4. Revisions
5. Abnormal speech rate
6. Abnormal loudness or pitch

Abnormally long pauses between words during which the sound caused by tensing of muscles of the speech mechanism, particularly the larynx, is perceptually evident.

Tense pauses

The utterances are initiated but not completed:
- "I want a... never, mind" or just silences.
- Automatic responses are fluency but extemporaneous generations of utterance (i.e., spoken without preparation) are difficult. Sometimes this occurs when substitutions, avoidances and circumlocutions have failed.
- Giving up is the ultimate avoidance!!!

incomplete phrases

Sounds, Syllables --'um', "er"... "filled pauses"- "uh-uh"
- Words- "and"
- Phrases- the ubiquitous "you know"

interjections

changed and utterance change the word that was stuttered or avoided.

revisions

Slow rate- typical for some severe stutterers
Fast rate- Mild Stutterer--- like a burglar trying to escape through a windows before it is slammed closed on their shirt tail. The shirt tail "here" is speech and the stutterer is trying to get as much speech out as possible in the shortest period of time before the stuttering starts. Or before they get caught on the word.

abnormal speech rate

These are strong signals of struggle behavior in an attempt to avoid "core stuttering behavior".

abnormal loudness or pitch

Besides those related to speech, what other muscle groups are tensed in stuttering? (5)

1. Arm tension
2. Lip biting
3. Leg tensing
4. Pinching
5. Head jerking

What type of behaviors?
1. Looking away-eye contact.
2. Jerking or other movements of the head,
3. Blinking
4. Distortions of the Mouth
5. Quivering of the nostrils
6. Abnormal variation in speech rate, pitch, and or loudness.
7. Interjections (Primary-Secondary)
8. Breathing abnormalities during stuttering, especially upper chest tension; clavicular breathing.
9. Laryngeal blocks, spasms, tension, dysphonia, which intermittently terminates airflow.
10. Articulation problems, including tension in the lips, jaw and tongue, and prolonged or repeated sounds.

Secondary behaviors

What is this describing?
Linguistic development is a time of trial and error...children make mistakes and correct them.
Changes in vocabulary, syntax, semantics, etc.
Growth rate is very rapid...it is not surprising that some children make mistakes and speech fluency is compromised.

Normal nonfluency (NNF)

Lists some behaviors that are considered NNFs

1. Word and phrase repetitions
2. Interjections.
3. Revisions
4. No struggle or frustration.
5. Does not seem to get worse.
6. Do we see part-word repetitions?
◦ Perhaps....

Is NNF categorical or continuous?

continuous

Big difference between NNF & Stuttering.

NNF: whole word repetitions
Stuttering: part word repetitions

Quantitative criteria to be considered "stuttering" and not just NNF.

1. 10+ dysfluencies/100words
2. 3+ repetitions on part word

Qualitative criteria to be considered "stuttering" and not just NNF.

1. Part word repetitions & prolongations (Adams)
2. Insertion of schwa

Development of Stuttering

1. Syllable Repetitions (first & mildest symptom)
2. Prolongations & Silent Blocking

Silent blocking is...

often evidence of more severe behaviors, especially if the blocks are longer in duration.

Development of stuttering may ...

stop anywhere...some people who stutter just stay mild...others get worse.

Bloodstein provided some guidelines for development...

1. Four Phases that are general milestones
2. Do not apply to everyone who stutters
3. Are the standard in the field
4. Tend to overlap

Bloodstein's Phase 1

1. Episodic and Exacerbated when upset or excited.
2. Dominant symptoms are repetitions.
3. At beginning of sentences.
4. Function words: pronouns, conjunctions, articles, prepositions. ( just now acquiring these words)
5. Preschool years (i.e., 2-6).

Bloodstein's Phase 2

1. Chronic
2. Full awareness of being stutterer
3. Content words (nouns, verbs, adjectives)
4. Exacerbated when upset or excited or when speaking rapidly.
5. Lack of conscious anticipation
6. Elementary school years.

Phase 2- Additional Reflections by Bloodstein

1. Stutter chiefly when they "talk fast and get excited", even though they may long since have past the age limits of phase 1.
2. Individuals of this phase have been found as early as age 4 and as late as adulthood.

Bloodstein's Phase 3

1. Situation exacerbated: More severe in "stressful" situations (e.g., classroom recitations, talking on the phone).
2. Beginning of association of stuttering with "difficult" words or sounds.
3. Substitutions, circumlocutions
4. No avoidance of speech situations and little or no evidence of fear or embarrassment.
5. Late childhood to early adolescence.

Phase 3- Additional Reflections by Bloodstein

1. Speak freely in virtually all situations despite the fact that the person may be stuttering severely.
2. Reactions likely to be irritation rather than of shame and anxiety.
3. Has been found in ages 8 to adulthood.

Bloodstein's Phase 4

1. Vivid, fearful, anticipations of stuttering.
2. Feared words, feared sounds
3. Frequent word substitutions and circumlocutions.
4. Avoidance of speech situations, and other evidence of fear and embarrassment.
5. Ability to read other people's facial expressions and reactions to their speech = fear.
6. Late adolescence and adulthood.

Phase 4- Additional Reflections by Bloodstein

1. Also in children as young as 10 years of age.
2. Distinctive emotional reactions -> serious personal problem.
3. May be victimized by a tendency to exaggerate and misinterpret reactions of others.
4. Unusually sensitive to the stigma as astutterer, to shrink from discussing their speech difficulty in front of others, and to go to extreme lengths to maintain the pretense as a normal speaker.

Use caution with Bloodstein's phases

1. Bloodstein's phase 1 stuttering does not differentiate from normal non-fluency!
-- Can they be truly differentiated?
2. These are rough guidelines...
-- Some PWS move through these stages much faster.
-- Not everyone goes through all the stages.

1. Description scheme stressing on the developmental variability of stuttering.
2. Based on 44 cases he observed longitudinally, he came up with 4 possible paths of how stuttering appeared to have developed.

Van Riper's Four Tracks

Track I

1. Majority (van riper)
2. Effortless, unhurried repetitions of syllables and words, marked by extreme fluctuations and long remissions.
3. Gradual onset.
4. Progression: more rapid and irregular repetitions, prolongations, tension and forcing with intermittent concern by the child, associated movements, word and situation fears, and avoidance.

Track II

1. Cases: children beginning late to talk.
2. Rapid, irregular syllable and word repetition from the beginning, followed in time by silent intervals, revisions and interjections, in addition to similar patterns of cluttering.
3. Mild and late developing word and sound fears.

Track III

1. Cases: children who began to stutter with sudden inability to speak, or complete blockage.
2. Progression into severe forcing and struggle, breathing abnormalities, signs of frustration, associated facial and other tensions, fear and avoidance.
3. In most cases the severe struggle reactions abated after a while and were followed first by prolongation and then by syllable repetition.

Track IV

1. Cases: children who were reported to suddenly begin to stutter with repetition of phrases, words, and later syllables.
2. Few avoidances and little change of stuttering over the years.

Individual Patterns of Stuttering

1. People don't stutter in the same way.
2. Different combinations
3. Behaviors are difficult to categorize
4. Differences in other speech/ ancillary behaviors.
5. Unique patterns = Stuttering "fingerprint"
6. Patterns can be dynamic and change over time.

How do stuttering patterns develop?

1. Often no patterns at first.
2. Develop as children start to feel reactions.
3. Often related to classes of sounds.

The Development of Stuttering: An Alternative Explanation

1. Overt symptoms: Not a problem, but a solution to stuttering:
Repetitions may serve the speech mechanism as a release-function from the neural block in the brain, in order to reinstate fluent speech.
- This mechanism may have contributed to the 80% recovery seen in children.

Increase in Symptoms Severity: Prolongations

1. 20% of children not recovering naturally may have become more severe.
2. Repetitions may be accompanied by prolongations, in order to compensate with "a more potent dose of Mother Nature's self-healing medicine" (p.63).

Repetitions and Prolongations

1. Compare these symptoms to volitional analogs of stuttered speech: "bouncing" (voluntary repetitions, Johnson), "pseudostuttering" (Van Riper), "prolonged speech" (Bothe, Onslow).

Postural Fixations or "Silent Blocking"

Possible combination of 2 factors:
1. Build-up of acoustic energy which produces an explosion when the block is released.
2. In relation to covert behaviors, may reduce the acoustically conspicuous repetitions and prolongations. Tension and struggle can be less visible during silent blockages.

Adaptation and Consistency Effects:

1. Adaptation: Upon consecutive readings of the same passage, stuttering frequency is reduced.
-- Adaptation effect diminishes when material is altered, or even when punctuated differently to produce different meanings.
2. Consistency: Even though stuttering is reduced, there is a tendency to stutter on the same words.

Brown's Factors (PRAXIS QUESTION)

1. Based on Johnson's Anticipatory Struggle Hypothesis
2. "anticipatory, apprehensive, hypertonic avoidance reaction" meaning stuttering is what happens when a person anticipates stuttering, dreads it, and becomes tense in the attempt to avoid it.
3. When person expects to have an interruption in speech and are anxious about it.
3. Analyzed 10,000 words of oral reading produced by 32 adults who stuttered & arrived at 4 linguistic factors affecting stuttering.

Brown's 4 Factors:

1. The Grammatical Factor
2. Length of Word
3. The Phonetic Factor
4. Position Effect
(5.) Linguistic/Syllable Stress

1. The Grammatical Factor

• Lexical or content words: nouns / verbs / adverbs/ adjectives (According to Brown, meaning is most important, thus anticipated as stuttered words.)
• Function: pronouns / prepositions / conjunctions etc.

2. Length of word:

The longer the word, the more likely it is to be stuttered. This has also been related to frequency in the English language (Newman & Bernstein Ratner), longer words are typically less frequent than shorter words - compare to adaptation effect!

3. The phonetic factor:

For PWS, as a group, initial consonants have shown to be more difficult than initial vowel.

4. Position effect of words within the sentence

Such an effect has also been found in phrases, phonemic clauses and random sequences of words. 90% of stutterings occur on the initial sound or syllable of the word while seldom on the last sound of the word (Bloodstein & Bernstein Ratner).

5. Linguistic / Syllable stress within the word (additional factor found by Brown but not added to his list, as he was interested in the properties of stuttered words, not syllables).

Accented syllables tend to be stuttered more frequently than unaccented syllables. (Interaction with the grammatical function of a word: I.e., function words receive little stress as opposed to content words)

Content vs. Function Words

1. At early stages, function words.
2. At later stages, content words.
3. Adaptation effect taking place, more familiar (function) words being produced more fluently than newly learned (content) words.

Covert Behaviors

(Lie beneath the surface)
Core covert behaviors:
1. Avoidances
2. Silence- the ultimate avoidance
3. Substitutions of words.
4. Circumlocutions.
5. Other covert symptoms:
-- Anxiety, stress, anticipatory fear, discomfort
-- Approach-avoidance "mind games"
-- Escape mechanisms

The game of stuttering

1. About to speak, "scan ahead", gamble:
-- How important is my message?
-- Will I stutter?
-- Will it interfere badly with communication?
-- Will the person/ people react negatively?
-- How can I say what I want to say without stuttering? What covert strategies will increase my odds of sounding fluent?
2. If I choose to talk, I am rolling the dice.
-- Do I feel lucky?
-- How does confidence level affect the chances of rolling the dice?

Cost-benefit analysis (5ish)

Every time they talk:
-- For me to talk and risk stuttering the possible benefit must outweigh the cost.

Results of Covert Behaviors & mind games (3)

1. Often shorten conversations; try to get to the point.
2. Discomfort around people, especially unfamiliar.
3. Discomfort and avoidance of social or vocational settings.

Impact of Stuttering (8ish)

All aspects of life:
1. School
2. Vocational
3. Romance
4. Friendships
5. Personality
6. Anxiety
7. Day to day functioning.

Conditions that may increase stuttering (9)

1. Saying name
2. Jokes
3. Repeating misunderstood messages
4. Waiting to Speak
5. Speaking to Authority Figures
6. Speaking to an Audience
7. Desire to Avoid Stuttering
8. Using the phone
9. Emotional Arousal

Conditions that may decrease stuttering (7)

1. Adaptation.
2. Not trying to hide.
3. Not Thinking.
4. Suggestion.
5. Playing a role.
6. Talking to a pet, baby, small child.
7. Speaking with a foreign accent.

Conditions that reduce stuttering (8) (more related to Tx)

1. Chorus reading
2. Singing
3. Shadowing
4. DAF (Delayed Audi Feedback), MAF (Masked AF), FAF (Frequency Altered Feedback)
5. Reducing Speech Rate
6. Lipped Speech
7. Metronome
8. Prolonged Speech

Stutters are only (according to Drandy)

a. Part-word/syllable repetitions
b. Prolongations
c. Postural Fixations

T/F Anytime a PWS changes the way they talk, it seems to make them more fluent.

True

Ways to reduce cognitive load in order to decrease stuttering (3)

a. Adaptation
b. Not trying to hide stuttering
c. Not thinking

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