**Bolded Terms/Definitions and Lilac Boxes in Each ChapterChapter 8-FluencyPrevalence and Incidence Rates for StutteringStuttering is involuntary repetitions of sounds and syllables, sound prolongations, and broken words.Stuttering incidence rate is about 1%The number of adults who report that they had stuttered at some time in their life is 5%. However, this 5% incidence rate includes the high percentage of children who naturally recover from the disorder before the age of 6. Relatively new information indicates that 65% to 75% of children will recover within the next few years.Females appear to recover from stuttering more frequently than males. The reported sex ratio difference ranging from 2.3 to 1 to 3.0 to 1 more males than females.Stuttering has a high degree of familial incidence – 50% of people who stutter report that they have a relative who stuttered at some time in his/her life. 15% of 1st degree relatives of people who stutter are current or recovered stutterers.Types of Normal (Within word) vs Stuttered (Between Word) Disfluencies and Recognize Examples of each typeThe type of disfluency exhibited by the normally developing child changes between the ages of 25 and 37 months. At approximately 2 years of age, typical disfluencies are whole word repetitions – i.e. I-I-I want a banana, syllable repetitions – i.e. I like ba-baseball, and interjections – i.e. Can we-uhm-go now?At age 3, revisions are the dominant disfluency typeNormal Disfluences persist throughout life. Fluent speakers may repeat whole multisyllabic words, interject a word or phrase, repeat phrases, or revise sentences.Stuttered speech involves audible or silent repetitions and prolongations. Tense pauses and hesitations within and between words may also be regarded as stuttering. Within word and some between word disfluencies are believed to be the universal features of stuttering.DISFLUENCY TYPEWITHIN-WORDBETWEEN WORDEXAMPLESSound/syllable repetitionsXHe’s a b-b-boy.G-g-g-go awaySound prolongationXSsssssee me swing!Broken wordXBase-(pause)-ballMonosyllablic whole-word repetitionsXXI-I-I hit the ball.Multisyllablic whole-word repetitionsXI’m going-going homePhrase repetition/interjectionXShe hit- she hit meRevisionsXI like, uh, ya know, big boats.Developmental vs Neurogenic StutteringDevelopmental stuttering is whole word repetitions and other self conscious nonfluency that is apparent in many young children.Most common form of stutteringBegins in the preschool yearsExhibit secondary characteristics such as anxietyOnset gradual, increasing in severityUsually occurs on content words (nouns, verbs), initial syllablesNeurogenic stuttering is disorder of fluency associated with some form of brain damage.Typically associated with neurological disease or traumaUsually occurs on function words (conjunctions, prepositions), widely dispersed through utteranceNo secondary characteristicsNo improvement with repeated readings or singingSummary of Bloodstein’s four phases of the onset and development of stutteringPhase 1 – 2-6 yearsStuttering is episodic.Most stuttering occurs when the child is upset or excitedSound/syllable repetitions are dominant speech featureChild seems unaware of the stutteringPhase 2 – Elementary school ageStuttering is chronicStuttering occurs on content words (nouns, verbs)Child regards himself or herself as a stuttererPhase 3 – 8 years to adulthoodStuttering is situational (speaking on the telephone, speaking to large groups)Certain words are regarded as more difficult than othersCircumlocutions (roundabout or indirect ways of speaking) and word substitutions are frequentPhase 4 – 8 years to adulthoodStuttering is at its apex of developmentThere is fearful anticipation of stutteringCertain sounds, words, and speaking situations are avoidedIncreased circumlocutions and word substitutions are presentTheories and conceptualizations of StutteringEtiological theories of stuttering can be classified into three categories: organic, behavioral, and psychologicalOrganic theoryProposes an actual physical causeMany have been proposed – all have failed to explain stuttering satisfactorilyRenewed interest in cerebral dominance theory – structural and functional differences in the brains of adults with chronic developmental stutteringi.e. theory of cerebral dominance assumed that when neither cerebral hemisphere was dominant, both would send competing neural impulses to their respective muscles of speech, resulting in discoordinationBehavioral theoryStuttering is a learned responseDiagnosogenic theoryOverly concerned parents react negatively to normal speech hesitations and repetitions, causing anxiety in the child and increased stutteringThere is contrary evidence to this theoryNatural recovery may actually be due in part to parents explicitly telling her child to slow down, stop and start again, or think before speakingPsychological theoryContends stuttering is a neurotic symptom with ties to unconscious needs and internal conflictsTreated most appropriately by psychotherapyResearch indicates psychotherapy is not an effective treatment of stutteringCurrent Conceptual Models of StutteringCovert Repair Hypothesis – stuttering is a reaction to a flaw in the speech production plan. Stuttering is not the error rather stuttering is a “normal” repair reaction to an abnormal phonetic planDemands and Capacities Model – stuttering develops when environmental demands to produce fluent speech exceed child’s physical and learned capacities.DCM is not a theory of stuttering and it doesn’t suggest a cause, rather it is a useful tool that helps clinicians to understand the dynamics of forces that contribute to the development of stutteringEXPLAN Model – fluency failures occur when linguistic plans are sent too slowly to the motor system (EX – execution; PLAN – speech planning)An account of the production of spontaneous speech that applies to both fluent speaker and speakers who stutter.In this model, speech planning is the linguistic process of language formulation and execution is the motor activity related to the production of the language formulation.Stuttering results from a failure in normal interactions between the PLAN and EX processes.Therapeutic Techniques with young childrenThe Evaluation of StutteringDetailed analysis of speech behaviorsAverage number of each type of disfluency (e.g. within word repetitions, sound prolongations)3 or more within word