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291 terms

Fluency Unit 1

STUDY
PLAY
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•One school of thought has been replaced by another.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
Ways to change normal speaking patterns in order to decrease stuttering (4)
a. Suggestion (hypnotic)
b. Playing a role.
c. Talking to a pet, baby, small child.
d. Speaking with a foreign accent.
What is the most beneficial way to reduce stuttering? Why is this so effective?
Chorus reading (with another person or with auditory feedback). Reduces pressure because they are not the only one speaking & it gives them a model.
What is an Invariant?
The entity that is "necessary" and "sufficient" for a disorder to be there.
Why is the presence (or lack thereof) of an invariant such an big concern in stuttering?
a. We are treating something that we see and hear - these are symptoms not causes.
b. We treat proximal events and yet do not understand the distal events.
Things we can see and hear.
proximal
Things that cause the proximal events that we can't see.
distal
Purpose of Speech Motor Dynamics Paradigms.
looking for an organic cause
Three questions speech motor dynamics paradigms seek to answer:
1. Is stuttering working in an invariantly different manner?
2. Are all forms of stuttering common in some overt way that signals an etiologic agent?
3. Are there acoustic and kinematic differences between the fluent speech of people who stutter and the fluent speech of non-stuttering individuals?
Is usually referred to as the interval between the onset of the (acoustic or visual) stimulus and the initiation of phonation. Synonyms: Laryngeal reaction time (LRT), phonatory reaction time (PRT), and voice initiation time (VIT).
Vocal Reaction Time
The temporal interval between the release of a voiced (e.g., /b,d,g/) or voiceless (/p,t,k/) stop consonant and the onset of phonation.
Voice Onset Time (VOT)
T/F It was thought that any differences found in fluent speech between people who stutter and those who do not might indicate an underlying invariant.
True
Acoustic measures of speech (2)
1. Vocal reaction time: initiating phonation, pause time, segment duration
2. Voice onset time: articulation rates.
Kinematic measures
Times to reach peak velocity (in jaw and lip movements), coordination between respiration and phonation at the onset of phonation during an acoustic reaction time task (Watson and Alfonso- PWS showed initiated the process of exhalation prior to the adduction of the vocal folds.)
Results of studies employing "treated" PWS: (3)
1. Reversals in articulatory sequencing relative to fluent speakers.
2. Longer reaction times in reaching peak velocity in the movements of the upper lip, lower lip and jaw during the productions of the word "sapapple" (McClean).
3. Lower velocities in articulator movement in fluent VCV productions (Pindzola).
Results of acoustic and kinematic studies of speech motor dynamics paradigms provided what type of results? Results were dependent on what four factors?
equivocal- probably related to the following
a. Sample context: is the fluent speech surrounded by stuttering?
b. Treatment history: therapeutic "fluent speech" is different from true fluent speech!
c. Stuttering severity: more severe stutterers are more likely to show greater acoustic and kinematic differences in their fluent speech productions.
d. Developmental history: adults are more likely than children to show greater acoustic and kinematic differences in their fluent speech productions.
Separation of Cause & Effect- Speech Motor Dynamics Paradigms
1. What do acoustic and kinematic differences in fluent speech mean?
2. Are they causes or effects of stuttering?
Acoustic and kinematic characteristics of stuttering in perceptually fluent speech:
Subperceptual stuttering:
a. Not evident to listener.
b. May be felt by person who stutters ("microstuttering")
c. Detected using sensitive instrumentation.
Eliminates differences of subpercpetual stuttering (?)
choral speech
Is the most powerful "inhibitor" of stuttering.
Choral speech
With use of choral speech, stuttering symptoms are ____ inhibited and fluent speech occurs immediately and effortlessly.
95-100%
Emulate the effects of choral speech. (3)
FAF, DAF and the SpeechEasy
Types of altered feedback (2)
1. Delayed auditory feedback (DAF)
a. Temporal shift (echo)
b. 50 - 200 ms
c. "induces prolonged speech" - Drandy
d. May result in prolongation - which may not be a bad thing!
2. Frequency altered feedback (FAF)
a. Shift frequency up or down; "Darth Vader" or "Mickey Mouse"
How does AAF reduce stuttering?
Most studies show that both DAF and FAF reduce stuttering in reading by about 70-80% ( but don't work as well with hard laryngeal blocks)
Effect of AAF in conversations & monologues (2)
a. Fewer studies done than reading but improvements found to be 60-75%.
b. Stuttering occurs the most on the initial syllable.
Why is "playing a role" successful in decreasing stuttering?
When we "act", we change our volume & cadence. This is used in therapy; makes sense that playing a role would be effective.
Drandy's explanation of why AAF work.
PWS may be too reliant on their own auditory feedback; have insufficient internal models.
Results of studies employing "treated" PWS
Treatment doesn't cure these organic things
Have acoustic & kinematic measure revealed the cause of stuttering?
No, the results more than likely revealed symptoms, not a cause.
Why would you expect differences between stuttering in reading and conversation?
What is more difficult about implementing in natural settings?
In reading, the speaker knows what's coming next. This reduces anxiety. Every conversation of the day cannot be planned.
T/F When testing the effects of AAF, make sure you use both reading and conversation testing.
True
Emotional Reactions to Stuttering
On speaking tasks PWS and controls are not different on measures of autonomic arousal (Weber et al., 1998).
Relationship between emotional reactions & dysfluent speech.
a. Weak correlation.
b. Complex relationship not 1-to-1 relationshipbut may have some influence
Temperament of people who stutter (3)
1. Little evidence that people who stutter have a more reactive temperament.
2. Physiological studies are equivocal
3. PWS may have social anxiety (Messenger)
Brain areas that are important in fluency (3)
a. Broca's Area
b. Wernicke's Area
c. Arcuate Fasiculus
Wernicke's Model
Broca's and Wernicke's are connected and are important to one another
Who's brain model of stuttering?
a. Decreased blood flow in Broca's and Wernicke's areas
b. Decreased blood flow in left caudate (i.e., "tail") region within the basal ganglia (related to motor control, for example).
Wu
Who's brain model of stuttering?
a. Right hemisphere (RH) overactivation of motor system areas in both cerebrum and cerebellum.
b. Underactivation of left hemisphere (LH) auditory areas (related to self monitoring during speech production)
i. Left temporal lobe areas tend to be underused in PWS which makes sense because language is left localized
Fox
Conclusion of brain anatomy investigations (Wu & Fox)
Stuttering results from both these over- and underactivations of these areas!
Conclusion from the following study by Braun:
a. Activation patterns observed in fluent speakers are absent, bilateral or lateralized to the RH even during perceptually fluent speech.
b. Activation of anterior areas
c. Underactivation of posterior areas associated with auditory perception and processing.
The right hemisphere (RH) might take a compensatory role in stuttering.
Conclusion from the following study: DeNil, Kroll, Kapur, and Houle: found an increased activation in the left anterior cingulated cortex (ACC), even during silent reading (also in Braun), which is associated to selective attention and covert articulation practice.
PWS actively planned speech to avoid anticipated fluency breakdown.
Guitar- describe right hemisphere relapse (this goes w/ the grid picture in the notes)
a. Right Hemisphere relapse (2 years after therapy this RH activity tends to come back)
b. (Under choral speech, this RH Blob shifts back to the left)
c. Right hemisphere activity is thought to be compensatory
d. Seems to be associated with severity of stuttering
e. "Black blob" on left is the homologous area to Broca's on the right
(See picture in Guitar)
Brown's description of brain systems involved in stuttering.
a. Overactivation in right frontal operculum
b. Absence of activation in auditory areas bilaterally
c. Overactivation in vermal lobule III of the cerebellum
d. Don't suggest cause
e. Systems are somehow involved in stuttering.
f. There is something wrong with sensory motor integration (There is something "noisy" in there.)
Brain morphology studies of PWS show that, instead of the motor planning areas (Rolandic operculum) lighting up first then the central sulcus (execution area), what happens?
Central sulcus lights up first
A neuron that fires both when an animal acts and when the animal observes the same action performed by another.Thus, the neuron "mirrors" the behaviour of the other, as though the observer were itself acting.
mirror neuron
Describe the suspected role of mirror neurons in stuttering (5)
1. Motor resonance
2. PWS are deficient in FoxP2 gene which is thought to be important for mirror neurons
3. Some people think that mirror neurons are represented through internal models
Purpose of Internal Model
Integrating psycholinguistic and motor control approaches to speech production resulting in a neuroanatomically grounded, hierarchical state feedback control model of speech production.
Describe the internal model shown in class
Motor controller sends commands to motor effector, which in turn results in a change of state. State changes are detected by sensory systems (somatosensory & temporal lobe). Also includes internal forward model that receives a copy of the motor command that is issued by the controller and generates a prediction of the sensory consequences of the command that can be compared against the measured sensory consequences. The difference between the predicted and measured sensory consequences is used as a motor correction signal that relays to the controller.
"Controller" in internal models
Broca's & precentral gyrus
Describe an example of an internal model "break down".
a. When there is no efference copy - there wouldn't be any sensory predicted consequences. Only feedback would be from physical movement (knowing you moved your articulators) and vocal feedback. Could = stuttering.
-PWS are activating their effector first, there is something wrong with their internal model.
T/F Hickcock's Internal Model follows the Law of Parsimony.
True (explains the widest amount of problems with the least number of assumptions)
T/F Time is very important in Hickcock's internal model.
True
There is a suspicion that PWS have problems with the ______ so that Wernicke's and Broca's are not communicating properly.
1. Maybe a neural bottle neck
2. But it is not "cut" because they don't have conduction aphasia (characterized by poor repetition skills)
arcuate fasciculus
High temporal (time; fast) resolution. Might be used as a kind of neuromodulatory feedback.
Electroencephlagraphy
1. PWS are judged to be more tense, quiet, guarded, reticent, afraid, passive, and self-derogatory relative to PWS
2. .....This is despite little evidence of broad-based personality differences
- Why might this happen?
a. Maybe do to people projecting their own feelings on PWS
b. Stereotypes about PWS are pervasive and usually negative
a. People react by changing their engagement patterns
b. PWS react to _____ because it is a visual reaction (of the listener).
where the listener is looking
What did we learn from the table that showed stimulus condition on the x-axis (stuttering or non-stuttering) and sweat on the y-axis?
PWS have a higher autonomic response then normal people.
Model of Stuttering based in part on Sheehan's Model
Level 1
Central Compensatory Strategies
Examples of central compensatory strategies
1. Avoidance
2. Expectancy
3. Covert Struggle
Model of Stuttering based in part on Sheehan's Model
Level 2
Subperceptual stuttering
Examples of subperceptual stuttering
Struggle behaviors at neuromuscuclar level.
Model of Stuttering based in part on Sheehan's Model
Level 3
Overt Perceptible Struggle Behaviors
Examples of overt perceptible struggle behaviors
1. Repetitions
2. Prolongations
3. Ancillary behaviors
Model of Stuttering based in part on Sheehan's Model
What levels are covert?
1: Central Compensatory Strategies
2: Subperceptual stuttering
Model of Stuttering based in part on Sheehan's Model
What levels are overt?
3: Overt Perceptible Struggle Behaviors
Model of Stuttering based in part on Sheehan's Model
Purpose of acoustic compensations
Release of central block by engaging mirror neurons.
Model of Stuttering based in part on Sheehan's Model
Relationship between covert & overt behaviors
Compensations for central block manifest outward from the CNS
What is the distal event of stuttering?
Think back to development: incipient part-word repetitions. Not sure about cause, could be environment & genes
What is the proximal event of stuttering?
Moment of stuttering; involuntary block that occurs somewhere in CNS, most likely a break down in internal model.
What is the necessary and sufficient entity for producing overt stuttering behaviors?
No "invariant" we don't know the cause of distal or proximal stuttering.
What is the necessary and sufficient entity for reducing stuttering?
We can come pretty close w/ choral speech but not all people who stutter respond to choral speech. Still alot of challenges to understanding stuttering.
Importance of Van Riper's Track II:
1. Cases: children beginning late to talk.
2. Symptoms: 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. Generally mild and late developing word and sound fears.
Van Riper may have identified subgroup -> cluttering
Working definition of cluttering (St. Louis)
1. Syndrome characterized by a rate which is either abnormally fast, irregular, or both. Speech is affected by one or more of the following:
(1) failure to maintain normally expected sound, syllable, phrase, and pausing patterns;
(2) evidence of greater than expected incidents of disfluency, the majority of which are unlike those typical of people who stutter.
Name 5 Cluttering Symptoms
1. Slurring or omitting syllables of longer words
2. Lack of awareness = major characteristic
3. Family history of fluency disorders
4. Poor handwriting;
5. Confusing, disorganized language or conversational skills
6. Temporary improvement when asked to "slow down" or "pay attention"
7. Misarticulations
8. Poor intelligibility
9. Social/ vocational problems;
10. Distractibility/ Hyperactivity
11. Auditory perceptual difficulties
12. Learning disabilities
13. Apraxia.
What is the cluttering invariant?
There is no agreement on the necessary and sufficient symptoms of cluttering..
Age of onset for cluttering
As in stuttering, usually in preschool years. children who stutter are typically late in achieving linguistic milestones (i.e., onset of babbling, single words and two-word phrases) (Ward).
Differences between cluttering & stuttering
a. Stuttering: breakdown occurs in units smaller than the word, e.g., sound prolongation, sound/syllable repetition.
vs. Cluttering at the phrase level.
b. Stuttering shows effort or physiologic tension in an attempt to coordinate the gestures of a intended word, thereby disrupting or prolonging rate of speech.
vs. Cluttering = no signs of tension/struggle
c. Stuttering presents a degree of awareness, if not a sense of loss of control.
vs. Cluttering= no signs of awareness
Characteristics of Cluttering
1. Little physiologic struggle at the within-word level.
2. Near nonexistence of prolongations and tense pauses.
3. Breakdowns involve units larger than the sound or syllable (e.g., words and phrase repetitions, incomplete phrases, and revisions).
4. A fast and/or spurty speaking rate.
5. Linguistic encoding difficulties leading to poor cohesion and coherence in discourse.
T/F Prolongations like silent postural fixations may occur on any speech-sound.
False
Which of the following are assumptions of Diagnosogenic theory:
a. Stuttering is caused by an underlying organic disorder
b. Stuttering is caused by the equal drive to speak and remain silent
c. Parents had little role in causing the disorder
d. Stuttering begins as normally nonfluent speech
e. A and D
e. both A & D
Please select the best answer: According to the lectures Joseph Sheehan...
a. suggested that stuttering results from a conflict between the drive to speak and the drive to refrain from speaking.
b. suggested that the stuttering problem originates from "bad speaking habits".
c. compared stuttering to an iceberg with only 20% exposed and 80% of the pathology beneath the surface.
d. A and C only.
d. A & C only
According to the lectures, Starkweather:
a. explained that stuttering could be caused only by an approach-avoidance conflict
b. thought that stuttering was caused only by the diagnosis of stuttering itself
c. identified external and internal demands that may exceed a child's speech-motor capacities
d. A and C
c. identified external and internal demands that may exceed a child's speech-motor capacities
5. According to Andrews (1983):
a. 25% of four-year-olds will recover from stuttering
b. 75% of six-year-olds will recover from stuttering
c. 50% of six-year-olds will recover from stuttering
d. A larger percentage of four-year-olds recover than 10 year olds who recover from stuttering
e. Both c and d
e. Both c and d
T/F The perceptually fluent speech of those who stutter is acoustically and kinematically the same as those who are normally fluent.
False
Which of the following is true regarding Bloodstein's developmental phases:
a. In phase one, dysfluencies become chronic
b. In phase two, children who stutter (CWS) consciously anticipate stuttering
c. In phase four, stuttering occurs more on function as opposed to content words
d. Bloodstein's developmental phases overlap in time and do not represent discrete developmental phases
e. All of the above (are true)
d. Bloodstein's developmental phases overlap in time and do not represent discrete developmental phases
8. According to the lectures, a number of conditions that decrease the occurrence of stuttering have which of the following in common:
a. Hypnosis
b. Changing normal speaking patterns
c. Role conflicts
d. Higher autonomic arousal
e. None of the above
b. Changing normal speaking patterns
According to the lectures, core overt stuttering behaviors include:
a. Part word repetitions
b. Prolongations
c. Whole word repetitions
d. Interjections
e. A & B only
e. A & B only
According to the lectures, traditional stuttering therapies have been found to show relapse rates of about:
a. 80%
b. 5%
c. 1%
d. 70%
e. None of the above
d. 70%
11. According to the lectures, what reason was offered for why a higher proportion of stuttered syllables might be observed on the first syllable (i.e. initial syllable) of an utterance under conditions of delayed auditory feedback (DAF):
a. DAF simply doesn't reduce overt symptoms
b. DAF only works for some PWS
c. Choral speech works better than DAF
d. DAF is received following the onset of voicing
d. DAF is received following the onset of voicing
Which of the following statements about stuttering is true:
a. Few cultures have people who stutter (PWS)
b. All PWS have relatives who stutter
c. Number of years in therapy predicts severity of stuttering
d. Stuttering is a categorical phenomenon
e. ~80% of children who stutter spontaneously recover
e. ~80% of children who stutter spontaneously recover
Which of the following is not true regarding Brown's factors:
a. Adults stutter more on content as opposed to function words
b. Stuttering occurs more often on the second syllable of a word
c. Stuttering occurs more often on words that occur with less frequency in the language
d. Brown's theory was based on Sheehan's role conflict theory
e. b & d
e. b & d
T/F Most recovery from stuttering occurs within 6 months post onset.
False
T/F The proportion of cases with persistent stuttering is higher in families with a history of persistent stuttering and higher in cases with a family history of recovery.
False
What? Maybe sounds like Wernicke's Aphasia
Cluttering
A multifaceted assessment protocol for cluttering should include measures of ... (9)
1. Fluency
2. Rate
3. Language
4. Articulation
5. Hearing
6. Psychoeducational & academic skills
7. Auditory and visual perception
8. Fine motor coordination (handwriting)
9. Cognitive/intellectual functioning
T/F (Considering stuttering) There seem to be no established norms for comparing speakers and speech across differences in age, task, familiarity with content, length of utterance, and effectiveness of monitoring.
True
______ is the most commonly used measure of cluttering.
syllables per minute (SPM)
Average conversational rate for normal preschoolers in SPM.
110-180
Average conversational rate for normal elementary aged children in SPM.
140-200
Average conversational rate for adults in SPM.
180-220
Clinicians interested in fluent speech will find "_________" computed in syllables per second (SPS) to be appropriate. SPS rates are usually reported for standard diadochokinetic tasks, that is, rapidly alternating productions of syllables such as "puh-tuh-kuh."
articulatory rate; Typical adult artic rates range from 6-7 SPS in convesation
Effect of suggested "synergistic framework" treatment for cluttering as suggested by Myers.
This would be expected to lead to changes in other domains as a result of the change in one domain. Slowing speech rate would thus lead to fewer sound and syllable deletions and thus to higher speech intelligibility.
3 pillars of St. Louis and Myer's synergistic framework for treating cluttering.
1. Slowing down the rate
2. Heightening Monitoring
3. Improve Encoding of Propositions
Considerations when working with what population using what technique?
1. It is much more difficult to achieve and maintain a slow rate than for a normal speaker.
2. Simply nagging a client to "slow down" is not helpful and perhaps detrimental.
3. Speech rate often increases as the degree of emotionality of the topic increases
4. Clinicians can give "speeding tickets" to help clients to remember to use a slower rate. Rapid, cluttered speech segments can be tape recorded and then transcribed in written form—with no spaces between the words—to highlight the need to pause between phrases and between some words.
5. Slower speech may easily be achieved by matching the duration of his production of a sentence to a prerecorded sentence model on a device that can record and display electronically frequency and/or intensity tracings over several seconds.
6. By superimposing his frequency or intensity tracing on that of the clinician, the client can approximate the clinician's slow or normal rate (ex. Visipitch)
Clutterers, synergistic framework
How can you help clutterers slow their speech rate. (5)
1. Fluency-shaping
2. DAF
3. Clinician-client imitation
4. Rhythmic speech
5. Read orally and pause at commas and periods
How can you help clutterers heighten their speech monitoring? (4)
1. Video-feedback
2. Turn-taking conversational exercise pragmatic difficulties are associated - the client learns.
3. Audiotaping worst, questionable, and best
4. Improve encoding of propositions
Examples of how to help clutterers improve their encoding of propositions: (2)
1. outlining a telegram to facilitate the organization of thought and language;
2. exercises on synonyms and antonyms, denotations, connotations, and semantic relationships to stimulate lexical retrieval, (if found to be a problem).
(Besides the 3 pillars) other synergistic framework suggestions to reduce cluttering
1. Using clear articulation (can treat misarticulations traditionally).
2. Using acceptable, organized language (can treat language problems traditionally).
3. Interacting with listeners (training, turn-taking, checking-in)
4. Speaking naturally (imitating clinician or Visi-Pitch)
5. Reducing excessive disfluencies (shaping strategies)
Organic cause (injury or insult) to arcuate fasiculus or basal ganglia. Characteristics include part-word repetitions.
neurogenic stuttering
Problems with Diagnosing stuttering (2)
1. No good definition (do you count just core behaviors? Duration? Ancillary behaviors? Feelings and attitudes?)
2. Most likely the cause of the moment of stuttering: Central involuntary block (in the brain) which is very hard to diagnose
Barry's two levels of assessment for stuttering:
o Careful planning, observation, and analysis
o Trying to understand the whole person or family
Client needs in the assessment of stuttering (3)
1. Open perspective:
-Don't be blinded by your past experience.
-Don't be limited by expectations created by case history and referral information.
2. Understand the client's goals.
3. Accept client as (s)he is.
The clinician reflects her expertise to the client through her: (3)
1. Empathic comments.
2. Display of comfort with stuttering and its associated emotions.
3. Effectiveness in conducting evaluation.
Is stuttering observable? (2)
1. Manifestations are conspicuous and highly noticeable.
2. Qualitative and quantitative differences in fluency levels make stuttering a highly observable disorder.
T/F Investigation of stuttering gave rise to the field of speech language pathology.
True
The following behaviors should be counted as stutters: (according to Barry) (5)
1. Part-word repetitions
2. Monosyllabic whole-word repetitions
3. Sound prolongations
4. Blockages of sound or airflow
5. Unequivocal sound or word avoidances
Dr. Andy's issues w/ Barry's stuttering behaviors to be counted (2)
1. Whole-word repetitions b/c this overlaps with normal disfluency.
2. Unequivocal sound or word avoidances b/c you have to ask them or guess and it reduces your reliability.
Who defined stuttering as "elementary repetitions and prolongations", which has been a standard definition of stuttering for almost 40 years.
Wingate
Does Wingate's definition of stuttering as elementary repetitions and prolongations allow us to count "stuttering"? What behaviors are counted?
Yes; those that are observable
Van Riper's version of Wingate's definition of stuttering:
Called these repetitions and prolongations the 'core behaviors' and applied "stuttering modification" techniques to treat them. Also, blocks (silent postural fixations?)
Means of counting primary speech behaviors: (5)
1. Frequency counts - a measure of stuttered speech as a proportion of the total speech output.
2. Stutters / minute (No longer used)
3. Stutters / utterance (Problem: How do you define an utterance?)
4. % stuttered words (One word may have more than one stutter)
5. % stuttered syllables (Dr. Andy likes this one)
Why does Dr. Andy prefer to use % stuttered syllables as a measure of stuttering? (2)
1. The syllable is the basic physiologically unit of speech
2. Can be converted to words with an constant (average # of syllable per word)
Stated the syllable is the basic physiological unit of speech and should be used when assessing fluency.
Perkins
Most common measure for assessing frequency of stuttering (2)
1. Percentage syllables stuttering (%SS) = total stutters/total syllables
2. When counting stutters, each syllable can only be stuttered once.
-Example: "n-n-n-n-nuh-nuh ...(silent block)...name" = 1 stutter
3. If client has obvious avoidance behavior without stutter, count as stutter.
-Example: "My name is uh...uh...uh...uh...Barry."
May be important in distinguishing normally-disfluent children from those who stutter
Assessing types of stutters
Stutter-like or normal disfluency: part-word and single-syllable whole-word repetitions, tense pauses, and dysrhythmic phonations.
Stutterlike
Most Important: Part-word and Single-syllable Repetitions
Stutter-like or normal disfluency: multi-syllable word repetitions, phrase repetitions, interjections, & revisions.
normal
If child has more than __% stutter-like disfluencies, more likely to be stuttering than normally disfluent
50
If child has more than __ stutter-like disfluencies per __ words, more likely to be stuttering
3/100
After age __, typical children show decrease in part-word repetitions. If child is showing plateau or increase in part-word repetitions after __, more likely to be stuttering
4
Common practice when assessing duration of stutterers is to average the duration of the ___ longest stutters. This is a component of severity assessment.
3
According to Barry, what type of secondary behaviors?
Behaviors occur after stutter has started.
-They are an attempt to stop a stutter and produce a word.
-Examples = head nod, eye blink.
escape
According to Barry, what type of secondary behaviors?
Behaviors occur before stutter has begun.
-They are an attempt to keep from stuttering.
- Examples = saying extra sound, changing word.
avoidance
T/F Severity assessments often include measures of secondary behaviors.
True
Assessment of severity is a clinically relevant measure because it...
captures what listeners experience
Good for measuring progress in treatments that reduce abnormality of stuttering but don't eliminate stuttering altogether
assessing severity
Goal is to get rid of stuttering altogether
Fluency shaping (vs. stuttering modification)
The ___ of a measurement generally refers to its "truthfulness" (Shaughnessy) and can be defined as the degree to which a measurement measures what is supposed to measure (e.g., Kerlinger & Lee).
validity
_____ refers to the degree up to which one can depend on a measurement.
Reliability (Repeatability, precision, accuracy)
Reliability between observers
interjudge
Reliability within observers
intrajudge
Found inter-judge reliability at 9 major treatment centers to be extremely low.
kully & boberg
What has a large affect on the reliability of counting stuttering behaviors?
Human error - attention, motivation, cognition