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Stuttering. Stephen M. Tasko Ph.D. CCC-SLP Associate Professor Speech Pathology and Audiology Western Michigan University http://homepages.wmich.edu/~stasko/. Some questions. What is stuttering? What is disfluency? Are they the same thing?. Disorders of fluency.

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Stuttering l.jpg

Stuttering

  • Stephen M. Tasko Ph.D. CCC-SLP

  • Associate Professor

  • Speech Pathology and Audiology

  • Western Michigan University

  • http://homepages.wmich.edu/~stasko/


Some questions l.jpg
Some questions

  • What is stuttering?

  • What is disfluency?

  • Are they the same thing?


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Disorders of fluency

  • (Developmental) Stuttering

  • Neurogenic Stuttering

  • Psychogenic Stuttering

  • Cluttering


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Features of Stuttering

Core Features

  • Repetitions of

    • Sounds

    • Syllables

    • Words

    • Phrases

  • Prolongation of

    • Sounds

    • Silence (blocks or tense pauses)


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Features of Stuttering

Additional Features

  • Frequent use of interjections (e.g. ‘um’,’ah’,etc)

  • Unwanted movements of the body

    e.g.

    • Facial grimaces

    • Eye blinking

    • Jaw jerking

    • Head movement

    • Muscle contractions

    • Arm and foot movements


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Features of Stuttering

Additional Features

  • Feelings of

    • Fear

    • Embarrassment

    • Shame

  • Avoidance of

    • Feared words

    • Difficult speaking situations (telephone, public speaking)

    • Social interactions

    • Certain types of employment, recreation, etc


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Neurogenic Stuttering

Follows a identified neurologic event

  • Stroke

  • Head injury

  • Onset of neurological disease

    Some Features

  • Part-word or phoneme repetitions

  • No patterns related to word type

  • Not restricted to initial words

  • No syllable stress effect

  • Lack of anxiety or secondary symptoms

  • Less responsive to fluency-enhancing conditions


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Psychogenic Stuttering

  • Stuttering in response to emotional trauma or stress

    Some Features

    • Sudden onset, typically related to some event

    • Repetition of initial or stressed word

    • Fluency enhancing effects not observed

    • No periods of stutter free speech

    • Initially no interest in problem


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Ten Significant Features of Cluttering: Expert Opinion (Daly & Cantrell, 2006)

Telescopes or condenses words

Lack of effective self-monitoring skills

Lack of pauses between words; run-on sentences

Lack of awareness

Imprecise articulation

Irregular speech rate

Interjections; revisions; filler words

Compulsive talker; verbose; ‘talks in circles’

Language disorganized; confused wording

Seems to verbalize before adequate thought formulation

Cluttering


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Who tends to stutter? & Cantrell, 2006)

  • Those with a family history of the disorder

  • Those with slower developing/disordered speech and language

  • Boys more likely to stutter than girls

  • Those with significant motor and/or cognitive delays

  • Children who are “vulnerable” to stress

    HOWEVER, A LARGE PERCENTAGE DO NOT FALL INTO ANY OF THESE GROUPS


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Natural History of Stuttering & Cantrell, 2006)

  • Begins in early childhood

    • ~ 3.5 years with a rather wide range of onset

    • Stuttering does not typically begin when children first speak, it typically begins when speech/language demands increase

  • Recovery is not uncommon

    • 1% of population have persistent stuttering

    • 4-5 % of population report stuttering at some point

    • Reports of up to 80% recover - for those who do not, stuttering typically persists through life

  • Features of stuttering tend to change over time

  • In developed form, expectancy, fear and avoidance play significant roles


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Common observations in normally developing children & Cantrell, 2006)

  • Whole-word repetition

  • Limited to sentence initiation

  • Normal speech tempo

  • Lack of awareness or concern

  • Evidence that it is related to language formulation

  • Episodic


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Indications of potential stuttering & Cantrell, 2006)

  • Much greater frequency of disfluencies

  • Longer duration disfluencies

  • Change in disfluency type

    • Shift away from word/phrase repetition to sound/syllable repetitions and prolongations and blocks/tense pauses

  • Evidence of struggle (not easy disfluency)

  • Lack of rhythm in disfluency

  • More “adult-like” patterns that include increased level of awareness, fear and frustration


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Factors known to influence stuttering & Cantrell, 2006)

  • Stuttering tends to increase

    • At the beginning of a sentence/clause

    • For words beginning with pressure consonants

    • For longer words

    • For words with greater information load

    • For multisyllabic words


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Factors known to influence stuttering & Cantrell, 2006)

  • Stuttering tends to decrease

    • During repeated readings of material

    • During certain speaking activities

      • Singing

      • Shadowed or choral speech

      • Slowed rate of speech

      • Chanting or changing ‘melody’ of speech

    • When exposed to noise or altered feedback

    • When performing concurrent activities


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Theories of stuttering & Cantrell, 2006)

  • Stuttering as a neurotic behavior

  • Stuttering arises from its diagnosis

  • Stuttering as a learned behavior

  • Stuttering as a physical disorder

    • Motor control problem

    • Linguistic formulation problem

    • Genetic disorder

    • Abnormal brain development


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Recent Evidence from Brain Imaging & Cantrell, 2006)

  • Persons who stutter show anatomical differences in key speech areas of the brain

  • However, most studies performed on adults who have been stuttering their whole life

  • Are the brains differences the cause of stuttering or the effect of a lifetime of stuttering?

  • New evidence suggests even young children who stutter show brain differences


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How does we assess stuttering? & Cantrell, 2006)

  • Case History

  • Careful observation of speech behavior

    • Collect speech samples

    • Measure frequency and type of stuttering

  • Collect information about attitudes toward speaking

  • Plan treatment

  • Prognosis


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Stuttering Treatment & Cantrell, 2006)

There is no cure for stuttering


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Stuttering Treatment & Cantrell, 2006)

Fluency Shaping Approaches

  • Modify the way the person speaks all of the time to reduce the chance that stuttering will occur

  • May be considered a preventative approach

  • Initially speech is often slow and very deliberate

  • Over time and practice speaking becomes more natural


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Stuttering Treatment & Cantrell, 2006)

Stuttering Modification Approaches

  • Client focuses on changing the way he/she stutters so that it is less severe, and easier

  • Emphasizes that stuttering should not be avoided since it creates more fear/anxiety about speaking

  • Over time stuttering events may not be perceptible to the listener as client gains control over stuttering events

  • Emphasis on

    • client’s attitudes and feelings about speech

    • Reducing sensitivity to concerns about stuttering


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Stuttering Treatment & Cantrell, 2006)

Issues for the person with chronic stuttering

  • Typically need to address

    • accessory behaviors (head movements, eye blinking etc)

    • Attitudes and feelings about communication

    • Avoidance issues


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Stuttering Treatment & Cantrell, 2006)

Issues for the child with beginning stuttering

  • Issues

    • Determining the likelihood of recovery or persistence

    • Addressing speech problems without creating increased concern, embarrassment etc

    • Creating a communicative environment that does not create excessive pressures

    • Direct vs. Indirect models of intervention


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Stuttering Treatment & Cantrell, 2006)

  • Phases of treatment

    • Establishment of fluency

    • Transfer of fluency skills

    • Maintenance of fluency


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Stuttering Treatment & Cantrell, 2006)

Other approaches

  • Use of devices to alter auditory feedback

  • Medications

  • Self help groups


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For more information & Cantrell, 2006)

Helpful Websites

  • Stuttering Foundation of America

    • http://www.stutteringhelp.org/

  • National Stuttering Association

    • http://www.nsastutter.org/


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