CHAPTER 8 FLUENCY DISORDERS Fluent Speech Versus Stuttering 1 Fluent Speech a Consistent ability to move speech production apparatus in an effortless smooth rapid manner resulting in a continuous uninterrupted forward flow of speech 2 Stuttering a b Involuntary repetitions of sounds and syllables sound prolongations and broken words Incidence is about 1 3 Some children naturally recover 4 May be genetically linked 5 Children typically exhibit a Hesitations b Revisions c Interruptions 6 7 Normal Disfluencies a Age 2 b Age 3 Increase in disfluent speech beginning around age 2 improving after age 3 8 Stuttered Disfluencies i Whole word repetitions interjections syllable repetitions i Revisions are the dominant disfluency type c Persist throughout life d Fluent speakers may repeat whole multisyllabic words interject a word or phrase repeat phrases or revise sentences a Audible or silent repetitions and prolongations b Tense pauses and hesitations within and between words c Within word and between word disfluencies d Young children i Monosyllabic whole word repetitions sound repetitions syllable repetitions audible and inaudible prolongations e Clustered disfluencies are common f Secondary characteristics or accessory behaviors i Eye blinking facial grimacing or tension exaggerated movements of head shoulders arms interjected speech fragments Onset and Development of Stuttering 1 Developmental stuttering a Most common form of stuttering b Begins in the preschool years c Onset gradual increasing severity d Usually occurs on content words initial syllables 2 Neurogenic stuttering a Typically associated with neurological disease or trauma b Usually occurs on function words widely dispersed through utterance c No secondary characteristics d No improvement with repeated readings or singing 3 Developmental Framework a Phase one 2 6 years i Sound syllable repetitions most common ii Generally not aware or not bothered b Phase two elementary school i Stuttering on content words more habitual ii Child refers to self as stutterer c Phase three 8 years young adulthood i Stuttering in response to situations ii Little fear avoidance embarrassment d Phase four i Most advanced ii Fearful anticipation avoidance of words situations iii Embarrassment The effects of Stuttering Through the Lifespan 1 Considered handicap 2 Children may withdraw refuse to speak 3 Adults may seek professions that require little oral communication 4 Poorer in educational adjustment 5 Employers view stuttering negatively but seeking treatment positively 6 Successful treatment improves social interactions Theories and Conceptualizations of Stuttering 1 Organic Theory a Proposes an actual physical cause b Many have been proposed i All have failed to explain stuttering satisfactorily c Renewed interest in cerebral dominance theory i Structural and functional differences in the brains of adults with chronic developmental stuttering ii Neither the right or left hemisphere in a person who stutters is 2 Behavioral theory responsible a Stuttering is a learned response b Diagnosogenic theory i Overly concerned parents react negatively to normal speech hesitations and repetitions causing anxiety in the child and increased stuttering ii There is contrary evidence to this theory iii Natural recovery may actually be due in part to parents explicitly telling their child to slow down sop and start again or think before speaking 3 Psychological theory a Contends stuttering is a neurotic symptom i Treated most appropriately by psychotherapy b Research indicates psychotherapy is not an effective treatment of stuttering c Psychogeneric stuttering when someone has had a traumatic event and someone begins to stutter 4 Current Conceptual models of Stuttering a Covert repair hypothesis i Stuttering is a reaction to a flaw in the speech production plan b Demands and capacities model i Stuttering develops when demands to produce fluent speech exceed child s physical and learned capacities c EXPLAN model i Fluency failures occur when linguistic plans are sent too slowly to the motor system 1 EX Execution 2 PLAN Speech planning Therapeutic Techniques used with Young Children 1 The Evaluation of Stuttering a Detailed analysis of speech behaviors b Average number of each type of disfluency c Duration of disfluencies d Standardized tests may be used i Also used for adults e Therapy may be recommended if two or more i Sound prolongations more than 25 of total disfluencies ii Sound syllable reps or sound prolongations on first syllables iii Loss of eye contact on more than 50 of utterances iv A score of 18 or more on the SPI v At least one adult expressing concern about speech fluency 2 Indirect Approaches a For children just beginning to stutter mild b Provide a slow relaxed speech model c Play oriented activities d Goal i Facilitate fluency through environmental manipulation ii Needs to be natural 3 Direct Approaches a For children stuttering at least a year mod severe b Explicit attempts to modify speech c d Strategies to increase easy speech and change from hard to easy Hard and easy speech speech Therapy Techniques with Older Children and Adults 1 Fluency shaping techniques a Prolonged speech b Light articulatory contacts and gentle voicing onsets c Pausing phrasing d Response contingent stimulation 2 Stuttering Modification a Cancellation phase b Pull out phase c Preparatory sets 3 Prolonged Speech a Speech slowed involuntarily under delayed auditory feedback b Substantially decreases stuttering 4 Light articulatory contacts and GVOs a Reduced tension prevents prolonged articulatory postures that interfere with smooth articulatory transitions b GVOs gentle voice onsets tension free onsets of voicing 5 Pausing Phrasing a Gradual increase in length and complexity of UTTerance program i Effective in reducing or eliminating stuttering school age 6 Response contingent stimulation a Response contingent time out from speaking i Requires pausing briefly after stuttering ii The pause serves as the consequence for stuttering b Lidcombe Program i Parent administered treatment ii Positive reinforcement for fluency correction following stuttering iii Praise and reinforcement five times more often 7 Cancellation Phase a Completes stuttered word and then pauses b Then produce stuttered word slowly 8 Pull out Phase 9 Preparatory sets a Modifies stuttered word during stuttering b Slowing down sequential movements a Prepare to use strategies before attempting word b