The onset of stuttering is influenced by:
the development of children’s communication skills, and their emotions and cognitions.
The many variations and manifestations of stuttering are determined by:
- individual learning patterns,
used to denote behaviors that are an aspect of the disorder
interruptions of speech that may be either normal or abnormal.
-Can be natural pauses, repetitions, and other hesitancies that occur in individuals with normal speech
- -Can also apply to stuttering
Stuttering is found in all parts of the world, in all cultures, in all races. It affects...
- -All occupations
- -Both sexes
- -All ages
- -Traced back 40 centuries
What causes stuttering?
- It's a mystery, but...
- Genetic base – gentetics make it more likely the child will stutter (Dr. Allison)
- Many think it is the way the child’s brain is organized for S and L
- Neural pathways less developed OR more easily disrupted by overflow of emotional activity in the brain.
When does stuttering typically begin?
most stuttering begins between 2 and 5 years – the same time that typical stresses of early childhood occur (new baby, move, period of rapid growth in vocabulary and Syntax
Many factors may PRECIPITATE the onset of stuttering in a child who has a:
neurological PREDISPOSITION for stuttering
Once stuttering begins:
it may disappear- or it may get worse
- if individuals in the stutterers environment respond in negative ways, it can cause the child to:
- be self conscious
- develop a secondary characteristics (blink)
- have anticipation/anxiety
- try to avoid or escape interaction with others
By adulthood a stutterer may cope by:
- limiting friends
- fun and social situations- they will stick with no demand speaking situations
Once stuttering is firmly established, and the child has learned reactions, treatment is needed. Therapy has lasting results unless:
- the individual is fatigues, ill, stressed.
- or...if Wait too long (after puberty) get only partial recovery.
Stuttering is characterized by:
an abnormally high frequency and/or duration of stoppages in the forward flow of speech
Stoppages take the form of:
- Repetitions of sounds, syllables, or one syllable words
- Prolongations of sounds
- Blocks of airflow, voicing, movement of the articulators in speech
Stutterer beings to react to repetitions, prolongations or blocks by:
- Trying to force the words out
- Using extra sounds or movements
Stutterer is first surprised, followed by:
It's important to REMEMBER – children with normal S and L development often:
- exhibit repetitions, revisions and pauses – NOT STUTTERING.
- Same for adults in a hurry – caught off guard – politicians on the spot.
Van Riper described core speech behaviors of stuttering as:
- – repetitions, prolongations and blocks.
- These behaviors seem INVOLUNTARY
“Secondary behaviors” or characteristics are:
learned reactions to the CORE behaviors. Such as blinking.
Repetitions are observed most frequently among children just beginning to stutter.
Repetition can be in a:
Sound syllable or single-syllable word repeated several times.
the sound or air flow continues but movement of the articulators is stopped.
BLOCKS appear last – but may see early in some children
Blocks may involve any level of the speech production mechanism including:
- Respiratory, laryngeal, articulatory
- Perkins thought inappropriate muscle activity at laryngeal level
As stuttering persists,
blocks last longer and > more tense and may see TREMORS
People who stutter do not enjoy stuttering
They react by trying to:
end or avoid >
ESCAPE BEHAVIORS and AVOIDANCE BEHAVIORS (Guitar uses these rather than starters or postponements.
- try to finish the word
- Eye blinks, head nods, interjections of sounds, hit self
- They work > reinforcement
- in attempt to avoid, uses escape mechanisms –
- Say something different. Avoidance behaviors can become a habit
FEELINGS AND ATTITUDES that a stutterer may have:
- Have negative attitudes about themselves
- Project their attitudes on listeners (believe they think he is stupid or nervous)
- Research has shown most people stereotype people who stutter as tense, insecure, fearful.
- These stereotypes affect the way stutterers feel about themselves
The DISABILITY of stuttering is:
the limitation it puts on an individual’s ability to communicate. Refers only to the limitations on communication.
The HANDICAP that may result from stuttering is:
the limitation on a person’s life.
Stuttering may start:
gradually – or suddenly. Appear, disappear, reappear.
Occurs generally between 2 and 5 – therefore not just disorder of making sounds but a problem related to:
USING SPOKEN LANGUAGE TO COMMUNICATE.
The prevalence of stuttering is:
less than 1%
Incidence – how many people have stuttered at one time in their lives?
About 5% according to Guitar
Difference between incidence (5%) and prevalence (1% in school=age
children and less in adults) suggests that most people who stutter at
some time in their lives recover from it AND prevalence declines after
Therefore – there is some aspect of:
growth or maturation that allows many individuals to recover from stuttering.
Recovery without treatment is referred to as:
“spontaneous” or “natural”
In studies that showed recovery,
what made a difference for the children who recovered?
- Child had no relatives who ever stuttered – or who if stuttered, recovered
- Showed earlier age of onset
- Demonstrated stronger phonological and other language skills
- Scored higher on tests of nonverbal IQ
- More like to be girls
Kloth study on children who recovered:
- Had a more mature speech motor system (less variable)
- Had mother whose interaction style was non-directive and whose language was less complex (LESS STRESS, LESS NEED TO PERFORM, EASIER MODEL TO EMULATE – my points) Rommel et al – the moms had less complex syntax and used a smaller number of different words when talking to the child
- MODEL WHAT YOU WANT THE CHILD TO DO I was influenced by Lenneberg via Wood
Factors associated with recovery: (THINK ABOUT FOR COUNSELING AND TX)
- Speaking more slowly
- Having a more stable speech-motor system
- Having a mother who has a non-directive interaction style and uses less complex language when speaking to the child
- Being right-handed
- Having less severe stuttering
- Having relatives who recovered from stuttering or no relatives who stuttered
- Having good phonological, language and nonverbal skills
- Being female
Lee Edward Travis – first Ph.D. SLP Iowa
stuttering was the result of an inefficient organization of the brain’s two cerebral hemispheres.
Before Lee Edward Travis – first Ph.D. SLP Iowa hypothesized the following was considered regarding stuttering:
- Before the 30’s stuttering considered a medical disorder
- Variability of stuttering behaviors was seen as part of an organic disorder (not really important)
- IMPORTANT PART was stutterers’ brain waves, heart rate and breathing pattern (USC)
- Research then moved in the direction of social, psychological and linguistic factors (until recently with new medical tools)
Operant Conditioning –
- the frequency at which a behavior occurs is related to the consequences that follow.
- If a behavior is followed by a reward, it increases
- If it is followed by an aversive consequence, it decreases.
- ESCAPE BEHAVIORS are learned through operant conditioning
- POSITIVE REINFORCEMENT is a type of operant conditioning.
- PUNISHMENT is another type
- NEGATIVE REINFORCEMENT – occurs whenever a behavior is followed
- by the termination of an unpleasant situation
Classical Conditioning occurs when there is a repeated association between a neutral stimulus and another stimulus that naturally and consistently evokes a response
Studied conversations between mothers and stutterers showed:
- Mothers spoke more rapidly (child must speak faster)
- Frequency of interrupting their children when disfluent > increase in tension
- Studied parents asking questions
- Researchers believe that it is helpful therapeutically for parents to slow their speech rate and speak in shorter sentences when talking to their children who stutter.
Johnson found the mothers of stutterers to be:
More critical, more protective and more domineering toward their children
Darley found parents had:
- higher expectations – especially with speech –
- greater sensitivity to speech deviations and believed in early intervention
Parents Wendell Johnson “diagnosogenic” theory of stuttering:
- Parents misdiagnose normal disfluencies as stuttering
- Their reaction then causes the child to try to avoid disfluencies
Developmental and environmental factors precipitate stuttering.
Environmental factors such as more achievement and conformity-oriented culturesDo not know for sure the exact environmental factors
LANGUAGE – remember Guitar noted that:
- Evidence indicates that onset of stuttering generally occurs at ages when language growth is greatest
- Studies indicate that disfluencies increase when speakers produce longer, more linguistically complex sentencesWhen and where stuttering is likely to occur in spoken language is influenced by such linguistic factors as the lexical class of a word, its length and it location in a sentence
Control of smooth movements of speech depends in part on:
sensory input as well as motor output.
SENSORY-MOTOR CONTROL – Van Riper called:
“a temporal disruption of the simultaneous and successive programming of muscular movements”
Auditory processing tasks and sensory feedback (touch and movement) tasks show that:
As a group, individuals who stutter have some difficulty using auditory, touch, and movement information to control speech.
Studies in neuroanatomical differences in individuals who stutter indicate:
that stutterers left hemisphere structures for speech and language have anomalies or differences from those in normal speakers
Left hemisphere inactivity –
suggesting that when individuals stutter, they are NOT using auditory feedback to monitor and control their speech And research has shown stutterers have trouble with auditory processing tasks. ALSO can change fluency by changing the way stutterers hear their own speech (DAF)
ADULT ONSET of stuttering also related to:
- Head injury
- Neurological disease
- Intense fear
Looked at case histories – what occurred just prior to stuttering onset
- Infectious diseases
- Diseases of the nervous system
- Brain damage at birth (24% developed stuttering)
- Premature birth
- Childhood surgery (risks of anesthesia remember)
- Head injury
- Mild cerebral palsy
- Mild retardation
- Experiencing intense fear
Guitar thinks there are several genetic pathways that lead to stuttering.
Difficulty with speech motor control Language and learning ability Sensory processing – and the interactions of difficulties in these areas Vulnerable temperament IN COMBINATION WITH environmental factors
Stuttering appears to have a genetic basis in many individuals However, the studies of twins and adoption studies confirm that genes must:
must INTERACT with the environmental factors for stuttering to appear.
– not genes alone – but a combo of heredity and the environ-ment – with element of chance thrown in. (DR. ALLISON)
Guitar’s model of stuttering is that it is:
- Inherited or congenital disorder that First appears when a child is learning the complex and rapid coordination of speech and language production Children who do not recover but persist in stuttering are those who learn maladaptive responses to their disfluencies. This learning is influenced by:
- Their biological temperament
- Developing social and cognitive awareness
- And the response of the environment to their speech
Back to Travis:
Stuttering is a problem of coordinating the two sides of the brain for speech HAS NOW LED TO view of stuttering as a problem of coordinating multiple brain networks for speech with those for language, cognition, and emotion. This juggling act breaks down in all speakers when the resources needed to process language, cognition, or emotion momentarily drain available CNS capacities leaving too little attention for the intricacies of rapid, smooth speech production. THE RESULT?????? NORMAL DISFLUENCY Individuals who stutter appear to have trouble allocating resources to speech production under conditions of high demand. They have inherited or acquired a more vulnerable speech production system – one less able to deal with the norm of rapid, smooth speech under a variety of conditions
Why would a metronome help a stutterer?
EX: speaking in time to metronome decreases the demans on both linguistic and motor systems to generate the prosody for speech (ALSO DISTRACTING)
Also Speaking slowly reduces the demands on language formulation and motor coordination functions. Goes to brain organization and less need for rapid processing of motor speech and language functions.
CONDITIONS FOR FLUENT SPEECH:
- Speaking alone
- When relaxed
- In unison
- To an animal or infant
- In time to rhythmic stimulus (METRONOME) or when
- In a different dialect
- While simultaneously writing (DISTRACTION)
- When swearing (AUTOMATIC – JOHN HUGHLINGS JACKSON)
Language Factors – Brown found correlations between stuttering and seven grammatical factors – linguistic
Adults who stutter, do so more frequently on
- On sounds in word-initial position
- In contextual speech (versus isolated words)
- On nouns, verbs, adjectives, and adverbs (versus articles, prepositions, pronouns, and conjunctions)
- THINK ABOUT – importance or these words to the message,
- Small number used frequently
- On longer words
- On words at the beginnings of sentences
- On stressed syllables
Anticipation, Consistency and Adaptation
- Research showed predictability
- Stutterers knew when it would occur – consistently, and decreases with repetition Now stuttering not just neurophysiological but LEARNED BEHAVIOR > New ways of TREATING
All children speak more disfluently during periods of tension – moving, changing schools, divorce, death
Guitar notes however, the children who do are often:
PREDISPOSED Ex; learning disability and vulnerable temperament