Exam 5 Study Guide Chapter 8 Fluency Disorder Fluent Speech Versus Stuttering o Fluent Speech o Stuttering Consistent ability o move speech production apparatus in effortless smooth rapid manner resulting in a continuous uninterrupted forward flow of speech Little interruptions Generally have normal rate to speech production Involuntary repetitions of sounds and syllables sound prolongations and broken words Sound prolongation extending length of syllable or phoneme Effects about 1 Some children naturally recover from disfluency Start in early childhood 65 75 of children that have disfluency will recover in the first two years 85 recover before the age of 6 May be genetically linked Familiar instances Tend to run in families Twins studies reveal that identical twins have a higher prevalence rate Children typically exhibit Hesitation o Pauses Revisions Interruptions o Insertion of words of vocalizations Increase in disfluent speech beginning around age 2 improving after age 3 Because speech and language system has gone through developmental growth changes 3 to every 4 boys stutter for every one girl o Normal Disfluencies Not true stuttering Age 2 25 37 months Whole word repetitions interjections syllable repetition Age 3 Revisions are the dominant disfluency type o Repair a sentence while speaking Persist throughout life Fluent speakers may repeat whole multisyllabic words interject a word or phrase repeat phrases or revise sentences Everyone has moments of Disfluencies o Stuttered Disfluencies o Mostly revisions Red flags someone may be a true stutter Audible or silent repetitions and prolongations Tense pauses and hesitations within and between words Within word and between word Disfluencies o Sound repetition within word disruption o Revision interjections between word Disfluencies Yong children o Monosyllabic whole word repetition sound repetitions syllable repetitions audible and inaudible prolongations Clustered Disfluencies are common o Multiple types of Disfluencies occur Secondary characteristics or accessory behavior biggest red flag o Eye blinking facial grimacing or tension exaggerated movements of head shoulders arms interjected speech fragments Accessory behaviors develop to help figure away to move beyond the disfluent moment that becomes a habit and draws more attention to disfliuent moments Theories and Conceptualization of Stuttering o Organic Theory Biological theories Proposes an actual physical cause gene Many have been proposed All have failed to explain stuttering satisfactorily o Certain situations create Disfluencies Renewed interest in cerebral dominance theory Stutters have brain with no dominant hemisphere for speech and language production o Behavioral Theory Stuttering is a learned response Environmental or external conditions Diagnosogenic theory why people stutter Overly concerned parents react negatively to normal speech hesitations and repetitions causing anxiety in the child and increased stuttering There is contrary to this theory o Natural recovery may actually be due in part to parents explicitly telling their child to slow down stop and start again or think before speaking o Psychological Theory Contends stuttering is a neurotic symptom Resolved through psychotherapy rather than speech and language pathologist Believes there are advisor behaviors that attribute to stuttering Phobia of talking anxiety away for gaining attention covert expression of hostility and aggression and abnormal fear of disapproval o Current Conceptual Models of Stuttering Evidence from computer based models Covert Repair Hypothesis Demands and Capacities Model Stuttering is a reaction to a flaw in the speech production plan o Speech is disrupted before stuttering moment and person tries to self repair which disrupts speech production Stuttering develops when environmental demands to produce fluent speech exceed child s physical and learned capacities o Limited cognitive capacity and language Periods of instabilities in processes Fluency failures occur when linguistic plans are sent too slowly to the motor system o EX Motor execution o PLAN speech planning For typical and stutters Linguistic process necessary Discounting signal from brain to linguistic EXPLAN model Therapeutic Techniques Used with Young Children process o The evaluation of stuttering Assessment in two portions Parent interview o Talk about concerns sense of developmental milestones family history related to speech and language specific questions on speech and language developments history and description of problem and daily family interactions Analysis of speech o Detailed analysis of speech behaviors o Average number of each type of Disfluencies red flags o Duration of Disfluencies biggest red farm o Standardized tests may be used Show the severity of stuttering Used more on kids Use the stuttering predicting instrument o Therapy may be recommended if two or more are true Sound prolongation more than 25 of total Disfluencies Sound syllable reps or sounds prolongation on first syllable Loss of eye contact on more than 50 of utterances A score on 18 or more on stuttering predicting instruments At least one adult expressing concern about speech fluency o Indirect Approaches Analysis on in word and between word Disfluencies o Average number of each Spontaneous speech sounds Differ based on age Don t explicitly trying to change or modify child s speech Focus on child parents and environment o Teach adults on providing a slow and relaxed speech mode when they talk Don t need feedback on child s speech Works well with children just beginning to stutter or have mild severity phase 1 Provide a slow relaxed speech model Play oriented activities games Goal o Facilitate fluency through environmental manipulation o Direct Approaches Explicit attempt For children stuttering at least a year moderate severity Hard and easy speech Hard speech rapidly produced and tense Easy speech slow and relaxed speech Strategies to increase easy speech and change from hard to easy speech Therapy Techniques with older children and adults o Fluency shaping techniques Primary focus speech comes across fluent even if there are moments of disfluency Prolonged speech Speech slowed involuntarily under delayed auditory feedback Substantially decreases stuttering Reducing speech rates o Delayed auditory feedback one on one settings o Recognize instances and move into reducing speaking rate o Impacts future moments as well Light