CHAPTER2 The Nature of Fluent and Nonfluent Speech: The Onset of Stuttering
Fluency, from Latin for “flowing” (Ongoing flow of information) Starkweather (1987) linguistic fluency—syntactic, semantic, phonologic, pragmatic speech fluency—continuity, rate, duration, coarticulation, effort Also: natural, some typical disfluencies, little cognitive effort by the speaker and listener, feeling good (or neutral) about speaking
Some definitions of stuttering Examples of definitions: • Johnson et al. (1940s and 1950s) …anticipatory, hypertonic avoidance reaction • Behavioral …conditioned negative emotion • Psychogenic definitions …pregenital conversion neurosis
M. Wingate (1964) The term “stuttering” means: 1. (a) Disruption in the fluency of verbal expression, which is (b) characterized by involuntary, audible, or silent repetitions or prolongations in the utterance of short speech elements, namely: sounds, syllables, and words of one syllable. These disruptions (c) usually occur frequently or are marked in character and (d) are not readily controllable. 2. Sometimes the disruptions are (e) accompanied by accessory activities involving the speech apparatus, related or unrelated body structures, or stereotyped speech utterances.
M. Wingate (1964) (continued) These activities give the appearance of being speech-related struggle. 3. Also, there not infrequently are (f) indications or reports of the presence of an emotional state, ranging from a general condition of “excitement” or “tension” to more specific emotions of a negative nature such as fear, embarrassment, irritation, or the like. The immediate source of stuttering is some incoordination expressed in the peripheral speech mechanism; the ultimate cause is presently unknown and may be complex or compound. (p. 488)
Features on and under the surface The ABCs of stuttering • Overt behaviors (struggle, escape, & avoidance) • Covert/intrinsic features • The speaker’s experience of Helplessness – lack of control – fear (fake vs. real stuttering; goals of therapy)*E. Cooper; W. Perkins, et al., and many others
A change in the WHO • WHO 1980: Impairment (disruption), Disability (limitations), & Handicap (disadvantages) • WHO/ICF (2001): no distinction between disability & handicap • Considers environmental & unique response re. personal/cultural factors • Includes less observable aspects of the disabilities • Accesses & treats cognitive and affective behaviors (not only overt aspects)
The quality or form-types of disfluencies Distinguishing stuttering-like disfluencies from more typical fluency breaks
Table 2-3 Ways of categorizing disfluencies. Fluency breaks characteristic of individuals who do stutter are listed in the first column. Fluency breaks characteristic of individuals who do not stutter are listed in the second column. From Yaruss, 1997a.
Table 2-3 Ways of categorizing disfluencies. Fluency breaks characteristic of individuals who do stutter are listed in the first column. Fluency breaks characteristic of individuals who do not stutter are listed in the second column. From Yaruss, 1997a. (continued)
Characteristics of early stutteringYairi, E., Ambrose, N. (2005). Early Childhood Stuttering: For Clinicians by Clinicians, Austin TX: Pro-Ed • Early disfluent speech is markedly different from that of normally fluent children. • Stuttering does not appear to rise from normal disfluency. • Parents who believe that their child has begun stuttering do notexercise erroneous judgment. • Early in stuttering, disfluent speech has a complex pattern of disfluency types. • Two-thirds of disfluencies of CWS are SLDs; two-thirds or disfluencies of NFC are other disfluencies (ODs). • “As stuttering continues, the difficulty lies not in the correct diagnosis of stuttering, but in correct diagnosis of its recovery” (p. 139).
Age of onset(Yairi & Ambrose, 2005) • Although stuttering may begin within a wide age range, it has been recognized for a long time that a large number of cases begin prior to age 6 or 7. Our own investigation was open to children up to 72 months of age but it was interesting to note that all onsets occurred between 16 and 60 months of age with a mean age of 33.38 months. Almost 85% of onsets occurred prior to three and - half years of age (42 months).
Age of onset (continued)(Yairi & Ambrose, 2005) The fact that the critical period for onset lies in close proximity to the emergence of complex language and articulatory skills, as well as fast anatomical changes of the speech systems, invites speculations that interference in maturational processes involves stuttering-language-articulation relations (in the broadest sense).
Table 2-4 Mean frequency and standard deviation (SD) of disfluencies per 100 syllables for experimental and control groups(Yairi & Ambrose, 2005) Experimental: 103 children, stuttering no longer than 6 months Control: 52 children, judged by parents and authors as normally fluent
Characteristics of early stuttering • There are many forms of onset including sudden (with slightly more children in this group), intermediate, and gradual (not primary followed by secondary stuttering). • Only about 20% begin to stutter with unremarkable circumstances; most have at least some degree of physical, emotional, and language stresses. • Repetitions of initial syllables and short words are typical, but may also include prolongations and fixations. • About half of the children show tense movements in parts of the body, especially head, face, and neck.
Additional characteristics of stuttering • Greater number of repetitions • Faster repetitions • Clustering of form-types • Level of awareness depending on maturity & temperament (Ambrose & Yairi, 1994) • Develop a negative attitude about speaking as young as 3–4 years (Vanryckeghem et al. (2005)
More influential factors related to onset • Age:little risk after age 6, nil by age 12 • Gender:1:1 at onset, 3:1–4:1 by school age • Genetics:implicated about 50% of time • interaction of gender and genetics (Chapter 5) • Twinning:More concordance with monozygotic (MZ) twins than dizygotic (DZ) twins • Poorer cognitive & motorabilities result in higher occurrence of fluency problems • Language:CWS tend to have expressive language abilities that equal or exceed their peers
More influential factors (continued)The phonological connection . . . not so much • A weak and nonlinear connection of stuttering & phonological problems; but more boys than girls tend to have both. • At onset, children who stutter tend to be behind normally fluent children in phonological development. • Children who persist in stuttering are apt to be slower in phonological development than those who recover. • Phonological skills alone are insufficient to predict the further course of stuttering. • The phonological development of children who stutter is similar in order of progression and strategies to those used by normally fluent children.
More influential factors (continued) • Over 40% of parents report emotional event prior to onset of stuttering (Yairi & Ambrose, 2005) • No difference of persistent & recovered groups for anxiety (Yairi & Ambrose, 2005) • Guitar (2006) – interaction of hemispheric functioning and a fragile speech production system with temperamental reactivity (especially time pressure) • a reaction to novel or threatening stimuli with higher levels of physical tension
By assuming the role of a moderately severe PWS the last two weeks . . . What have you observed? • Positive/negative reactions? • Did you get “The Look” ? • Humorous responses? • What have you learned?