Term
What are some things we look at to distinguish fluency vs stuttering?
They relate to the surface features of stuttering. |
|
Definition
1. presence of extra sounds in speech (repetitions, prolongations)
2. degree of interjections and revisions
3. rate of speech (too fast, too slow)
4. intonation & stress
5. rhythmic patterning of speech
6. location and frequency of pauses |
|
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Term
| How can we define stuttering? |
|
Definition
It can be defined based on:
1. etiology
2. symptomology
3. personal experience
4. psychological aspect
Lack of consistency in definitions; can't solely go by core features |
|
|
Term
Which definition of stuttering is this?
“Stuttering is defined as any disruption in the forward flow of speech characterized by repetitions, prolongations, blocks, hesitations, and interjections, that are perceived by the speaker as being out of control.” |
|
Definition
ASHA's
based on Van Riper's definition |
|
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Term
| Symptom-Oriented Definitions |
|
Definition
Focuses on stuttering – what you can see/hear
Defined in terms of it’s essential clinical features
Implies that stuttering is composed of specific types of dysfluencies which are quantifiable (eg, avoidance)
Provides logical targets for therapy
Ignores the personal experience of stuttering |
|
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Term
| Loss of Control Definitions? |
|
Definition
Stuttering is defined in terms of the PWS private, personal experience of stuttering
Takes into account the PWS feeling of being “blocked” or “out of control”
Includes the person who rarely stutters overtly (internalized stuttering) |
|
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Term
| symptomology of core stuttering behaviors? |
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Definition
Result from motor mistiming of respiration, phonation, and articulation, or the inability to program appropriate co-articulation features. Reflect physiologic components of stuttering. Physical disruption in 1+ areas of speech. We need to consider the production of speech at the respiratory, phonatory and articulatory levels. core behaviors can vary even in themselves.
repetitions, prolongations, blocks |
|
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Term
| symptomology of secondary behaviors? |
|
Definition
Result from reactions to stuttering
may be overt or covert – what really lead to the complicated nature of stuttering. People really respond to secondary behaviors. Eg, word avoidance, substitutions, etc.
RESPONSE to stuttering
It can release person from moment of stuttering. Many times person doesn’t realize they are doing it. Therefore, ID of behaviors is a huge part of Tx. Can occur before, during, or in place of the moment of the stuttering.
2 kinds = escape and avoidance |
|
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Term
| characteristics of repetitions (AKA Oscillations) |
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Definition
PW, WW, PR
vary in rate and rhythm, even or uneven in tempo
Repetitions reflect a searching for appropriate co-articulatory transitions – not able to get to the next sound or part of word.
Often the schwa or part of the attempted vowel are used in place of the correct vowel
Can be abrupt with cessation of voicing between iterations
** presence of schwa vowel and faster and more uneven tempo can indicate more severe stuttering. |
|
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Term
| characteristics of prolongations |
|
Definition
Vary in loudness, tension, airflow, and pitch
Reflect searching movements
May be considered a “fixation” of movement. “fixed” on a sound, cannot find the next sound/articulatory movement.
Consider articulatory position
Silent prolongations = silent block |
|
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Term
| characteristics of blocks |
|
Definition
Laryngeal vs. articulatory
Articulatory – tongue has stopped. Blocking is in the oral cavity somewhere. Most often w/ plosives.
Reflects a complete cessation of airflow resulting in an inability to produce speech
Varies in duration and tension – can measure progress by the duration of the blocking. Is it getting shorter? |
|
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Term
| Characteristics of escape behaviors? |
|
Definition
part of secondary behaviors.
Those behaviors which allow the person who stutters to “escape” or get out of a moment of stuttering
Physical behaviors which ultimately add to the complexity and severity of the stuttering
Idiosyncratic to the client
function to take a person from a moment of stuttering --> moment of fluency
Occur during a moment of stuttering |
|
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Term
| what are some times of escape behaviors? |
|
Definition
1. tremors - most significant. severe stuttering. result from tension. can be anywhere in body. contraction of antagonistic muscles.
2. vocal fry - attempts to start voicing
3. speaking on complemental air. don't want to stop talking b/c it's hard to reinitiate voicing
4. interruption reaction - attempts to terminate blocks. idiosyncratic. (eye closure, tongue clicks, hand mm, etc)
6. gasping - attempts to interrupt closure |
|
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Term
| types of avoidance behaviors = avoidance behaviors occur before a moment of stuttering. |
|
Definition
word/sound avoidance
circumlocutions - talking around word
postponements - interjections, repetitions
situational avoidance
timing devices - foot tapping
starters - "well, you know..."
trigger positions
disguise reactions - yawning, laughing |
|
|
Term
1. what is one of the most prevalent feelings in stuttering?
2. one of the most pervasive feelings? |
|
Definition
1. fear.
situational fears, phonemic/word fears, time pressure fear, conditioned fear responses, importance of communicative message
2. shame |
|
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Term
what is the prevalence (extent to which disorder is widespread)?
What is incidence (number of people who have stuttered in their lifetime)? |
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Definition
Prevalence = >1%
Incidence = 5% |
|
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Term
| talk a/b the onset of stuttering |
|
Definition
* gradual or sudden (usually gradual)
* may be severe, but severity not indicative of recovery patterns
* usually happens alongside intensive lang growth period
* cyclic, episodic
* onset around 2-5 years of age
* mean onset 38 mons (~ 3yrs)
* very early onset better prognostically for recovery
* can see onset b/t 2 yrs - puberty |
|
|
Term
|
Definition
3:1 (at 5 yrs)
1:1 (at 2-3 yrs)
greater # of females spontaneously recover by 3 yrs. |
|
|
Term
| what contributes to the variability and predictability of stuttering? |
|
Definition
1. anticipation = whenever someone anticipates that they will stutter, they will usually stutter. Can become a cue for stuttering. Need to know what creates cue for stuttering (eg, phoneme?, phone call?, certain situation? , reading?)
2. adaptation effect – the more you have someone who stutter reread a passage several times, the passage becomes more fluent; easier to read. Clinician can have PWS read the passage/presentation to themselves several times before they give the presentation.
3. consistency – PWS will stutter on the same word/sound. Consistency w/in person w/ the things they stutter on. Younger and school-aged children tend to have more randomness to their stuttering than adults who stutter. Innate awareness that something will be hard. |
|
|
Term
What are 5 conditions under which stutter varies predictably?
(has an effect on increasing/decreasing stuttering)? |
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Definition
1. comm pressure
2. attention to what you're going to say
3. suggestion to self that something will be hard
4. tension, stress, anxiety
5. presence or absence of cues that trigger stuttering |
|
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Term
| what things can help increase fluency temporarily? |
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Definition
speaking alone and in unison (choral)
singing
speaking in time to a rhythmic stimulus
talking while writing
automatic speech
prolonged speech
speaking w/ masking noise
using delayed AUD feedback |
|
|
Term
what are the background factors that contribute to stuttering?
why do these factors contribute to stuttering? |
|
Definition
1. congenital abnormalities - down syndrome, closed head TBI
2. early childhood trauma
3. heredity/genetics
the influence of brain structure and function may make a child more vulnvernable to speech breakdowns. |
|
|
Term
| what predisposes a child to stuttering? |
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Definition
both congenital and genetic factors.
"constitutionality" of stuttering. Any factor that makes child more vulnerable to speech breakdowns. |
|
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Term
| what are some physical or psychological traumas that contribute to congenital/early childhood factors of constitutionality? |
|
Definition
infectious diseases (meningitis)
anoxia
CP, Downs
head injury |
|
|
Term
how does brain structure and function affect/influence stuttering vulnerability?
Contribute to constitutionality? |
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Definition
May result in a delay or disruption in the normal neural processing for speech and language
Brains of PWS may be different thus influencing sensory motor control.
Considered a “bridge” between etiology and behavior - NOT causal |
|
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Term
| How are the brains of PWS different than PWDS? |
|
Definition
1. diff in gray matter volume around Broca's and bilateral temporal lobes (AUD processing) (signal origination). Structural abnormality
2. reduced density of white matter tracts connecting PHON representations to speech motor execution areas (transmission of signal). reduced sensory-motor integration
3. underactivation of LH and overactivation of RH (adaptation feature?). Homologous centers in RH "take over" S/L functions. Not as efficient. RH also in charge of emotions. |
|
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Term
| Sensory and Sensory-motor factors? |
|
Definition
Affect the onset and development of stuttering because they limit how well the individual can produce rapid and fluent speech.
1. sensory processing
2. Central AUD processing
3. Sensory-motor control |
|
|
Term
| what are some systems that can be affected in sensory processing for speech? |
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Definition
We need intact feedback system to produce fluent speech.
1. Auditory system - AUD cortex
2. proprioceptive feedback system- feeling positioning and mm of articulators
3. tactile system - feeling of touch cues |
|
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Term
| central AUD processing & PWS |
|
Definition
PWS are poorer at processing AUD signals
May not hear more subtle things in speech/artic
interruption of AUD feedback can help mostly orient PWS to the feeling of speaking. Developing proprioception of speech. |
|
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Term
| Sensory motor control and PWS |
|
Definition
speech-motor control breaks down in stuttering.
Speech motor control depends in part on sensory input.
Lack of sensory input |
|
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Term
| how do language factors influence stuttering? |
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Definition
Important to consider because they affect the primary deficit of sensory motor control.
1. development of lang places high demands on child's cog resources
2. delays in lang may affect stuttering
advanced or delayed lang
3. Complexity of lang - HUGH factor. Stressor b/c the planning and formulation piece of lang. More lang complexity = greater possibility of speech break downs. |
|
|
Term
| how do emotional factors influence stuttering? |
|
Definition
stuttering causes anxiety; not other way around.
temperament is HUGH factor. biologically determined. CWS are born with more sensitive or inhibited temperaments. major factor in counseling parents. CWS are more emotionally reactive and less able to regulate emotional responses. Temperament/emotionality may compete for resources in RH of PWS. |
|
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Term
| what is role of heredity? |
|
Definition
2/3 genetic (63.4%); 1/3 enviro
Stuttering runs in families suggesting a familial link Studies suggest genetic influences may predispose a person to stutter There is widespread agreement that stuttering can be inherited. Trying to find gene or mult genes that may cause stuttering. 30-60% family inheritance estimation Severity NOT related to inheritance persistence runs in families
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|
|
Term
Who conducted "1000 families study"?
what did they find? |
|
Definition
Andrews & Harris, 1964
more males stuttered and males more at risk, CWS had more stuttering relatives, females who stuttered more likely to have stuttering relatives, stuttering may be passed from female side |
|
|
Term
| what are some factors that help predict recovery? |
|
Definition
1. Good scores/skills w/ PHON, language, and non-verbal skills
2. family history of recovery
3. early age of onset |
|
|
Term
| we can say that stuttering is: more likely a combination of physical, physiological, or cognitive-emotional characteristics that interact with developmental and environmental factors that set the stage for stuttering” |
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Definition
|
|
Term
| how did researchers investigate familial inheritance of stuttering? |
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Definition
1. 1000 family study
2. genetics/chromosome studies
3. twin studies
4. adoption studies |
|
|
Term
| How do people who stutter differ from fluent speakers? |
|
Definition
Laterality and Brain Function
Auditory Skills
Sensory-Motor Control
Motor Abilities
Temporal Characteristics
Speech and Language Skills
Emotion
Intelligence |
|
|
Term
| Laterality/Brain Function b/t PWS and PWDS? |
|
Definition
PWS are less left hemisphere dominant for speech/language than NS
right hemisphere or bilateral dominance for speech/language for PWS
* Overactivation of RH; homologous centers in RH either by rewiring during fetal period or adaptation
atypical cortical activation, localization, and lateralization patterns during speaking and listening for PWS
* Left AUD cortex inactivity. PWS do not use auditory feedback as efficiently to monitor and control speech. Evidence of AUD dysfunction.
"wired differently"
CAPACITY for fluency is determined by these kinds of factors. |
|
|
Term
|
Definition
PWS are inferior in complex auditory perception /discrimination tasks
Limited evidence that randomly selected PWS have slightly worse hearing acuity than NS |
|
|
Term
| how does AUD feedback influence fluency? |
|
Definition
masking noise may be a distraction, causes PWS to change how they speak, or compensates for deficits in auditory processing
May increase activation in AUD areas |
|
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Term
| Sensory feedback factors in stuttering? |
|
Definition
PWS may have reduced oral sensation
PWS have reduced sensory-motor control for minimal movements of the jaw and tongue
PWS have difficulty using auditory, touch and movement feedback to control speech |
|
|
Term
| sensory-motor control factors for fluent speech? |
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Definition
Fluent speech production uses sensory information about where a structure is and where it is going
Brain plans movements, stores memories of past movement, and how to produce acoustic (auditory) and perceptual (kinesthetic) results. |
|
|
Term
PWS have irregular aerodynamic control - Imprecise control of air pressure and airflow during speech
Think "airplane" vs. "rocketship" voice. Airplane - smooth, more controlled, gradual onset of airflow |
|
Definition
PWS also have irregular articulatory mms.
1. inappropriate co-articulation (Schwa insertion)
2. slower and reduced mm of articulators
3. reduced sensory input b/c of reduced mm
4. difficulty achieving accurate artic targets (transitional mm) |
|
|
Term
| PWS have irregularities in: |
|
Definition
1. aerodynamic processes
2. articulation
3. breathing
4. temporal characteristics of speech |
|
|
Term
| Which researcher found diff in the articulatory mm b/t PWS and PWDS? |
|
Definition
Zimmermann (1980)
* Reduction of mm w/in oral cavity; enviro for mm becomes smaller --> reduced artic mm & reduced sensory input. LANDMARK study
* PWS have reduced and slower mm of articulation
* Increasing jaw angle helps PWS get out of moment of stuttering. |
|
|
Term
| what kind of breathing irregularities are there in PWS? |
|
Definition
1. Inspiratory gaps
2. antagonistic thoracic mm
3. shallow/clavicular breathing |
|
|
Term
| what are some abnormal temporal characteristics for PWS? |
|
Definition
1. significantly more pauses of longer duration - pauses that last longer b/c of blocking
2. Slower diadokokinesis (esp. w/ plosives)
3. less regularity of rate of repeated utterances
4. a reduced ability to generate temporal patterns, both sensory and motor
5. lack the ability to smoothly sequence movements for speech
All about mismanaging the air stream |
|
|
Term
| Speech-lang skills of PWS? |
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Definition
1. other s/l disorders more common
2. 2x more likely artic and PHON impairment
3. may see lower scores on expressive/receptive lang, first word/sentence, MLU |
|
|
Term
| How does emotion affect stuttering? |
|
Definition
1. can be a trigger
2. can worsen stuttering
3. stuttering generates strong emotional responses |
|
|
Term
|
Definition
PWS may have esp. sensitive temperaments
more likely to react to new people/situations
more sensitive to enviro changes and stimuli
PWS have high expectations, very hard on selves, more perfectionistic
upset at changes in routine
diff regulating emotion |
|
|
Term
| what are the contributing factors to stuttering causality? |
|
Definition
1. genetics
2. neurophysiology (anatomy and function)
3. child development - lang growth
4. family dynamics (life events, etc) |
|
|
Term
| stuttering is triggered by an interaction of what factors? |
|
Definition
| physiological, environmental, and developmental |
|
|
Term
|
Definition
Stuttering is not caused by emotional problems
Stuttering is not a nervous disorder
Stuttering is not the fault of the family or the person who stutters |
|
|
Term
| Elements of the cerebral dominance theory? |
|
Definition
created by Orton-Travis in 20's
L-handedness
lack of dominant hemisphere created disorganization and mistiming for speech
atypical cerebral localization in RH for s/l
More RH activity |
|
|
Term
| Stuttering as a disorder of timing theory? |
|
Definition
Based on inappropriate localization of speech language functions in the right hemisphere
Lack of efficiency:
1. in processing temporal features of speech necessary to monitor speech
2. regulating speech breakdowns, esp during stress
3. reduced ability to generate temporal patterns, whether sensory or motor” to smoothly sequence the movements necessary for fluent speech |
|
|
Term
| Ray Kent's (1983)basic principles of stuttering as timing disorder |
|
Definition
theory is looking at temporal processing speed and efficiency and RH interruption of that process.
LH superior to RH in processing rapid AUD and motor patterns
more boys than girls have problems in LH processing
reduced abilities to generate temporal patterns
emotion disrupts timing (b/c of RH) |
|
|
Term
| Stuttering as lang production deficit theory |
|
Definition
"Covert Repair Hypothesis"
production deficit can be in lexical, semantic, syntactic areas
deficit exists in planning and assembly of lang units (phonemes and words)
(Typical) Dysfluencies are the result of “correcting or repairing” detected errors
* PWS less efficient at checking and correcting speech |
|
|
Term
Reduced capacity for internal modeling
(More sensory-motor feedback loop theory) |
|
Definition
Neilson & Neilson
motor control problem
motor commands --> sensory consequence (perceptual feedback)
Looks at problem w/ motor output and how it is related to sensory input.
Has to do w/ how children learn and store speech patterns.
reduced capacity for generating and comparing expected with actual sensory consequences
weakness in learning the relationship between the sounds they want to say and movements required to say them
repetitions & prolongations result as the speaker is pushing ahead with speech while his brain is still planning motor mm |
|
|
Term
| Stuttering as a Physiological Tremor theory |
|
Definition
Accounts for the more severe stuttering behaviors
Occurs in more persistent, advanced stuttering
Tremors may be evokes or intensified by autonomic arousal or negative emotion
Explains how easier repetitions evolve into more tense, struggle behaviors
Tremor behaviors seen in more advanced stuttering that comes from antagonistic muscles working at same time
neuromuscular instability
VF tremor, jaw tremor, etc |
|
|
Term
| emergence of dysfluency is considered to be the result of ________________? |
|
Definition
resource depletion
esp. seen in kids w/ lang delays or big spurts in lang growth.
Fluency breakdown – brain’s resources are depleted to support fluency; in young children really limited sharing of resources. |
|
|
Term
| what kind of physical developmental factors can pull away resources for fluency? |
|
Definition
1. growth factors - maturation of nervous system, speech mechanism, and improved perceptual/motor skills
2. development of sensory integration skills
3. motor tasks compete with speech resources |
|
|
Term
| Cognitive development factors in stuttering? |
|
Definition
1. complex relationship b/t cog and lang
2. people w/ ID can have higher incidence of stuttering
3. Cognition may be related to slower speech language acquisition time |
|
|
Term
| how do social-emotional factors of development affect stuttering? |
|
Definition
1. Fluency suffers during emotional arousal
2. "cross talk" b/t areas of emotion and s/l (in RH)
3. development of self-consciousness is stressful
4. temperament and perfectionistic attitudes can contribute to emotional arousal |
|
|
Term
| how does S/L development influence stuttering/fluency? |
|
Definition
1. interaction b/t S/L development and stuttering is considerable
2. can be a significant trigger for stuttering
3. onset typically occurs during s/l growth spurt
4. s/l growth shares resources w/ fluency in child's system
5. both advanced and delayed s/l skills can negatively impact fluency |
|
|
Term
| what are some enviro factors that can affect fluency? |
|
Definition
1. enviro plays a part in both triggering and worsening stuttering
2. we want to look at: parental behavior, s/l enviro, communicative stressors, and life events. |
|
|
Term
| what are some factors in the s/l enviro that stress fluency? |
|
Definition
1. rapid speech from parents
2. use of more complex syntax
3. use of multisyllabic words (from a motor planning aspect)
4. intro of L2
5. use of longer/more complex sentences |
|
|
Term
| How might the communicative enviro stress fluency? |
|
Definition
competition for speaking
frequent interruptions
demand or display speech (telling a child to say something)
loss of listener attention
time pressure to speak
excessive questioning and requests for corrections |
|
|
Term
| what influence does major life events have on fluency? |
|
Definition
they can stress fluency; decrease child's capacity for fluency
eg, moving, birth of new sibling, divorce, death in family, holidays, change in caregiver, starting school, etc |
|
|
Term
|
Definition
Wendall Johnson
1930
"Stuttering borne in ear of listener"
theory placed blame on parents
Monster study - Mary Tudor
REVISED in 50s. |
|
|
Term
| Present Day Implications of Wendall Johnson’s Theory |
|
Definition
1. influences what docs tell parents
2. continued belief that we shouldn't discuss stuttering
3. delays timing of intervention
4. continued belief that if we ignore it, it will go away |
|
|
Term
| Communicative Failure and Anticipatory struggle theory |
|
Definition
Bloodstein
1987, revised 1997
Stuttering can develop when a child experiences frustration and failure when trying to talk
Children perceive talking is difficult, anticipate difficulty and respond with increased tension
Speech problems may be in other areas first, which teaches child that talking can be hard -> can facilitate stuttering |
|
|
Term
|
Definition
it's multi-factorial; dynamic
stuttering emerges b/c internal capacity of child to be fluent doesn't equal demands in their enviro
Demands may come from rapidly developing language, from within the child or from the environment
explains the cyclic nature of stuttering
capacity for fluency is influenced by constitutional factors in child (eg, genetics, brain physiology) which interact w/ enviro factors
In most cases, both components appear to be necessary for the problem to develop
contributes to variability of stuttering
Maturation increases capacity |
|
|
Term
| variability in stuttering result from what specific factors? |
|
Definition
1. capacity vs. demand factors
2. competing motor, cognitive and emotional activities
3. growth factors and resource depletion |
|
|
Term
| what are the tx implications of developmental and environmental factors in stuttering? |
|
Definition
1. controlling S/L demands can help rewire circuitry for S/L skills in brain
2. parents' use of more pauses, less complex lang, slower speech can help facilitate fluency
3. families can help children develop less inhibited temperaments by reinforcing positive and assertive behaviors.
4. increase mouth opening and sensation in child
5. managing enviro stressors |
|
|
Term
| _______________ factors may play more of a role in onset of stuttering whereas ____________ may play more of a role in development/persistence. |
|
Definition
1. physiological
2. conditioning processes/learning behaviors |
|
|
Term
| conditioning - the stimulus and response to stuttering both contribute to the development of stuttering. classical and instrumental conditioning. |
|
Definition
|
|
Term
1. what is "borderline stuttering"?
2. when does it shift to beginning stuttering? |
|
Definition
1. characterized by length and frequency of stuttering. easy stuttering. no learned behaviors.
2. shifts when child starts to become aware of their speech breakdowns; arousal of negative emotions. |
|
|
Term
|
Definition
conditioning is an active and continuing process
adds layers to the 2nd behaviors; adds layers to "onion"
stimulus and response can bleed into diff sounds/words, situations, places, topics, listeners, etc
spread results in changes in stuttering --> becomes more tense. Freq and duration of stutter may increase |
|
|
Term
| __________________ should be a part of every tx plan. associating fluency with situations that trigger dysfluencies, we can counteract previous conditioning |
|
Definition
counter-conditioning
removal of conditioned response to stuttering triggers. |
|
|
Term
| ___________________ is also called "operant" conditioning. It's a major force in the devel of stuttering and is an important tx tool. Human behaviors are shaped by this. Includes positive and negative reinforcements. |
|
Definition
| instrumental conditioning |
|
|
Term
| _____________________ process through which a behavior can be unlearned. |
|
Definition
|
|
Term
Begin to see in school age children
Arises from the combined effect of instrumental and classical conditioning
Take the place of escape behaviors
Results in behaviors so well learned they are difficult to unlearn
Relief from avoidance use results in conditioning to use behaviors again |
|
Definition
|
|
Term
| _______________ where a neutral stimulus evolves into a conditioned stimulus and becomes a conditioned response over time |
|
Definition
|
|
Term
| secondary behaviors are developed via __________________ conditioning |
|
Definition
|
|
Term
| _____________ conditioning contributes to the development of primary behaviors (increase tension and tempo) |
|
Definition
|
|
