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Stuttering Lecture 2: Basic Facts & Information
Terms in this set (32)
Confusing Signs of Stuttering
"Always exceptions to any rule"
-when you are looking at a client
What do we know about Stuttering?
-When does it begin?
-How long does it last?
-How does it start?
-Who "get it"?
Defining It: What's In a Word?
Stuttering - Stammering ??
Dysfluency - Disfluency ??
Disfluency: Any disruption in the smooth, natural flow of speech
-we all have disfluencies
-there are disruptions in the natural flow of speech
Stuttering: An involuntary disfluency; a characteristic of disordered speech involving core behaviors
-involves core behaviors
-core behaviors= stuttering in US
-in UK and Australia: Stammering
Dysfluency: Used by some to indicate a disordered disfluency (or stuttering).
-used interchangeably with stuttering
Defining It: Core (Overt) Behaviors of Stuttering
-not whole world, repetitions of part of a word
-I wa-wa-wa-nt a cookie
-repeating whole world: usually young children and it is not stuttering
-part of word prolonged longer than normal
-i waaaaaaaaaaaaaant a cookie
-often a vowel is stretched out (hard to stretch out some consonants like stops)
-short or long
3. Blocks (where do they occur?)
-blockage of airflow, no sound
-they often are unique to person
-they will tell you where there blocks are (might not be where the literature says they commonly occur)
-lips, jaw, with these three
-not a core behavior, but occurs with these
-sometimes but sometimes not
Secondary Features (physical movements, sounds, etc.)
• Body movements: rolling eyes, tapping foot
• Interjections, extra sounds: um, uh, a way for them to try to get out of the stuttering moment
-my name is uh um uh um Sarah
-doesn't always mean avoidance behavior
• Avoidances, circumlocutions: talking around the word to avoid it
-my name is unusual, rhymes with....
• Loss of eye contact: look away, look up, close eyes
-a way to avoid or escape stuttering
-close eyes to push word out and concentrate
-roll eyes because it helps
• Patterned behaviors: cover mouth, tongue movements, roll heads, raise shoulders, etc.
-different from core because they are not the same for every person
The King's Speech: What core behaviors and secondary features do you think are present?
-close eyes, head down
-head out, moving forward
-interjections (insert vowel uh)
-tension in jaw and his body
-more confident in end
Defining It: The Stuttering Iceberg
• Core Behaviors
• Secondary Characteristics
-overt, what we see as the tip of the iceberg
-stuttering is far more complex and much bigger
-primary part of stuttering
-what is this person thinking about me?
-they are going to think im stupid, something is wrong with me, etc.
Affective components are covert (hidden, secretive)
What are examples?
Why do affective components occur?
-what the public has said and done to a person who is experiencing a stuttering moment
-imagination of the person who is stuttering or thinks they are going to stutter
-toward inward and believe negative reactions
-reinforced throughout their life
Stuttering Profiles: Components Multidimensional
1. Core Behaviors (tip)
2. Feeling, Emotions, & Beliefs (major part)
3. Reactions (person's reactions to behaviors and feelings)
-to define stuttering
-going to look different for different age groups
-example: preschooler will have a lot of overt behaviors but covert will be less
-adults will have emotions, beliefs, behaviors as the bigger part
Ways we react to stuttering
1. Escape Behaviors: Attempts to end a stutter
-react and want it to stop
-do whatever they can to end the stutter
-Stop talking, leave the situation
-throw head back, squeeze eyes (might see secondary behaviors)
2. Avoidance Behaviors: Attempts to avoid stuttering
-I know I'm going to stutter but I'm going to avoid
-circumlocution, interjections, try to say word different way
Both of these: Often develop into ritualistic patterns of behavior in response to stuttering and the fear of stuttering
-squeezing eyes, shrugging shoulders, constant avoidance behaviors all the time
-negatively impact peron's communication
3. Cognitive views of self: stupid, worthless, poor speaker, etc.
-no one will hire us, etc.
When Does It Begin?
•Can begin anytime in childhood, between 18 mo and 12 yrs of age
[most commonly between ages 2 and 5 years]
•Gradually or suddenly
-little bit more or all at once
•Continual or intermittant and sporadic
-once they start they never stop
-or one day, then a couple days without, and then it comes back
-terrible emotional experiences for families if they think it went away
-a lot of emotion around it
-child may not be able to monitor speech very well
-does not have capacity for smooth speech because of emotions going on
When Does it Begin? graph
Approx 70% of cases start by 3 ½ years old
-x: age in months
-between 24 (2 years) months to age 5 years
-more common in males
Frequency of Disfluencies
-y: SLD/100 syllables
-x: number of months
-red line = persistent
-blue line = recovered
-we cannot tell who is going to be a recovered stutterer versus who will be persistent stutterer
-around the time when identified, same frequency of disfluencies
-put them in therapy when they show signs early on, then watch them carefully in therapy and track their progress
-need 4 years or so, takes longer to make diagnosis sometimes
-these are generalities - always variability
-in general, persistent tended with time and therapy to reduce their frequency, but not as much as recovered
-therapy is impactful!
How Long Does it Last? [Amongst Children Who Recovered from Stuttering]
-76% develop normal speech fluency within 4 years of onset;
-vast majority of children recovered
-Other studies show variability in recovery (6%-94%).
-might seem like long time but over that 4 years, children are showing noticable gains before they reach the point where stuttering is no longer present
-24% become chronic
-persistent stutterers, long term help
-x: number of months
-tracked children who stuttered until they no longer stutterd
-males stuttered longer
Impact of Family History
-x: persistence/recovery from stuttering
-persistent stutterer: noticeably more people in family who were persistent than recovered
-recovered stutterer: more recovered stutterers in family
-family history can tell us who is more likely to be which, but is not done deal
-can have persistent stutterer family history, but don't assume they will be one too
Families of PWS (people who stutter)
•CWS had more stuttering relatives than CWDS; about 67% (really noticeable)
•Genetic basis in about half of those with persistent stuttering
-Predisposed or 'prevented' natural recovery???
•Predictors of Recovery: strong speech, language, nonverbal skills; family hx of recovery; early onset
-like psychological testing
-if stuttering earlier = more likely to recover
How Does It Start?
•1:3 sudden onset
-1 in every 3 have a sudden onset
•1:2 stressful event
-1 in 2 have a stressful event that triggers stuttering
What is happening in young children's lives that might "trigger" stuttering?
-Getting sent to foster care
-Family issues with parents
-death, losing a pet, losing a toy
Who "Gets" It?
•No different in intelligence, motor skills, or psychological function
-there are some differences in fine motor skill tasks
-more fearful, but generally, don't need more psychological help than typical non-stuttering person (e.g., medications)
•Prevalence (how common is it?)
-Preschoolers - 2.4%
-School age - 1%
-Adults - just less than 1% (.7%)
-About 5% of population has stuttering or gets stuttering every year
-not everyone is referred or identified
Who Gets It? cont.
Incidence of stuttering is consistent across...
-geographic (same here as it is in China)
-brain based disorder
-not something that people learn
Who Gets It? Gender Ratio
-Overall: Males about 4 times more often than females
-Females tend to recover more often and earlier than males
-30 months: about the same between them (at 1)
-60 months: ratio is now 5x more likely boys than girls
In Summary: How Many Recover?
•About 75-80% - usually by age 8 yrs (but can take longer), rate declines after puberty
•Usually within 12 to 24 months, but can take 4 years
-most likely 2 years
Predictive Factors of Recovery
•No family history of persistent stuttering
•Earlier age at onset - before 3.5 yrs
•Strong phonological & language skills
•Higher non-verbal IQ
Other Things Worth Knowing
•Neuroimaging data show:
-differences in brain structure and function for people who stutter
-it is a myth that people learn to stutter from other people (brain doesn't work this way!)
-decreases in white-matter in left superior longitudinal fasciculus
-Greater volume and activity on right side of brain
-speech activity (normally occurring on left) is on right side of brain
-when we do therapy = we can change structure of brain and how left side if being used in speech
•For some, stuttering "sets" and becomes chronic
•The handicap is not necessarily directly related to overt frequency of disfluencies
•Stuttering is quite predictable, but that knowledge is seldom used to one's advantage
•Emotional reactions to stuttering experiences result in bodily and behavioral changes
-decrease communicative effectiveness
-if someone has a lot of dysfluencies, it does not mean the person is more likely to be a persistent stutterer
-few disfluencies can be in the 24%!
What Is Your Confidence in Assessing and Treating PWS?
Activity: Do clinicians who stutter make better clinicians for people who stutter? Can a clinician who does not stutter work effectively with a person who stutters?
-more empathy with those who do stutter
-seeing someone else may decrease their anxiety
-no models of fluent speech though
-counsel in a way that we would not be able to
-not in this alone
-but a clinician who does not stutter can work effectively with them, may not understand as well
-can pseudostutter and show techniques
-stutter a little bit: people will know that you understand the emotional issues
-stutter obviously: some clients, like parents, are going to think if you can't overcome it how can you help my child
Behavioral Observations (besides escape and avoidance)
-Prediction of stuttered words
-What do you think happens?
-avoids it, circumlocute, interjection, change subject
-Stutter on same words in successive readings
-sometimes reading will increase or decrease stuttering
-if they had trouble with one word, will have trouble in second time
-Stutter less and less in successive readings
-eventually, stuttering moments will be adapted
-maybe not severely as stuttered
-Reduction in frequency, intensity, duration
-Often in first or second reading
WHY? We don't know...
-Less language demand?
Stuttering occurs more often on
-Consonants (but varies for person, sometimes vowels!)
-Word-initial position (rather than middle)
-Initial sentence position (first word of sentence)
-Contextual speech (vs. isolated words), speech in conversation
-Nouns, verbals, adjectives, adverbs
-Longer words (multisyllabic words)
-not mutually exclusive, depends on person
Fluency Phenomenon-These are NOT treatments!
•Choral speaking: speaking in unison
•Metronome effect: often used in music, keeps you in rhythm, tick tock
•Automatic speech: alphabet, counting to 10, days of week
•DAF: feedback coming into ears later than is normal, I'm hearing myself speak but speech is delayed and coming into ears later than typically
•Singing/rhythm: sing and not stutter at al
•Slow rate: tell them to slow down
•Shadowing: mouthing, seeing mouth move, then I'm more fluent (mimes in unison)
-we can use in treatment but they themselves are not typically treatments
-people who are fluent would have more trouble speaking with DAF, where it helps those who stutter
-doesn't change anything, but helps stuttering decrease
-treatment is more permanent
•383-322 BC: Pebbles in mouth (Demosthemes)
•1795-1847: tongue surgery (Dieffenbach)
•1817: golden or ivory fork in alveolar arch (Itard)
•1898: psychoanalysis and reduction of anxiety (psychological problem)
-difference between psychological problem and physiological problem
-stuttering is physiological problem (problem with anatomy and structure of brain)
-not a psychological problem, but people who stutter may have psychological issues
The Bogue Institute for Stammerers
-1920s schools for people who stutter
-was not successful
The Lewis School for Stammerers
Much of past research in stuttering....
•Didn't go deep enough
•Not able to replicate
•Lead to more questions and confusion
-current research helps!
As technology improves....
... our understanding of the mechanisms underlying stuttering will improve as well.
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