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Fluency Disorders in ASD Population

Fluency Disorders in ASD Population. Jennifer Lozier M.S. CCC-SLP. What You Will Learn. Introduction and overview What we do and don’t know about the presence, causes, and treatment of fluency disorders in………. Cognitive features and potential contributors to disfluency in ASDs

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Fluency Disorders in ASD Population

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  1. Fluency Disorders in ASD Population Jennifer Lozier M.S. CCC-SLP

  2. What You Will Learn • Introduction and overview • What we do and don’t know about the presence, causes, and treatment of fluency disorders in………. • Cognitive features and potential contributors to disfluency in ASDs • Assessment and treatment

  3. Stuttering-Like Disfluencies (SLDs) • Repetitions of: • Single-Syllable whole words (with tension) • Sounds or syllables (part-word repetition) • Prolongations • Blocks/Tense Pauses • Broken Words • “I-I-I” • “d-d-uck” “Spi-spiderman” • “sssometimes” • “st---uck” • “bro—ken”

  4. Nonstuttering-Like Disfluencies • Repetitions of: • Multisyllable whole words Phrases • Revisions • Interjections/Fillers • “open-open” “I want—I want” • “I like unicorns, no, I mean dragons” • “um, uh, er, well, like, so”

  5. Cluttering • Cluttering is a fluency disorder wherein segments of conversation1 in the speaker’s native language2 typically are perceived as too fast overall3, too irregular4, or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (a) excessive “normal” disfluencies5; (b) excessive collapsing6 or deletion of syllables; and/or (c) abnormal pauses, syllable stress, or speech rhythm. • St. Louis and Schulte (2011)

  6. Atypical Disfluencies • Final sound and syllable repetitions • “light-t” “train-ain” • Between syllable insertions • “way-hay” • Within-word breaks • “op—en” • Final sound prolongations • “thissss”

  7. Disfluency Noted in Individuals with ASD • Simmons and Baltaxe (1975) documented “hesitations, repetitions, prolongations, nonfluencies” (SLDs and NSLDs) • Klin, Volkmar, Sparrow (2000): “Dysfluencies are...common” (p. 378) in Asperger Syndrome” (AS) • Shriberg et al. 2001: 67% male speakers with Asperger’s and 40% with High-functioning autism: “inappropriate or nonfluent phrasing on more than 20% of utterances” (p. 1109) • “These data suggest that many speakers with autistic syndromes produce notably disfluent speech” (p. 1109)

  8. Word Final Disluencies • Have been noted more in populations within a diagnostic category other than stuttering, such as children and adults with neurological insults • Commonly found in kids with other diagnoses, particularly those with autism, ADHD • Seems to be a growing consensus that regardless of diagnosis (or lack thereof), the kids with these issues also have other (sometimes subtle) pragmatic language issues

  9. What We Know So Far • Disfluency (more and less typical) and stuttering (more and less typical) happen in Autism Spectrum Disorders • The same patterns have been seen in different individuals in the contexts of reading, repetition tasks, and conversation but there are individual differences as well • Awareness seems to be on a continuum • Avoidance behavior – not aware at all

  10. Cognitive Features of Autism • Working memory • Williams et al. (2005): lack of deficits, more in processing complex tasks • Joseph et al. (2005): no use of verbal mediation to monitor goal-related information in working memory • Self-monitoring • Response inhibition (Agram et al., 2010) • Mixed findings for behavioral response inhibition • Consistent findings for difficulties with eye movement inhibition • Preservation ((Rehfeldt & Chambers, 2003) • Treatment of verbal perseveration in cognitive approach

  11. Cognitive Features That May Contribute to Disfluency • Typical Disfluency • Language factors? • Stuttering-like Disfluencies • Neurological factors • Atypical Disfluencies • Perseveration, pragmatic/perspective taking, language organization • Cluttering • Disinhibition, working memory

  12. Treatment of Fluency Disorders in Autism • Stuttering (Brundage et al. 2013) • Fluency Rules Program- dramatic reduction of stuttering • Someone on Spectrum is very rule-based • Speak slowly, don’t repeat a word more than once, put pauses in speech, say each sound short • Word Final Disfluencies • Sometimes go away without intervention (maturation and executive functioning) • Have client address them and suppress them (put in a pause or pause and visualize to give more time to formulate thoughts- language organization or working memory issue?)

  13. Application • Every case is an individual one, not every case is the same. • Be on the lookout for: • Types of disfluencies • Traditional stuttering or atypical • Negative feelings and attitudes by the student

  14. Application • Some children with ASD will not hear their disfluencies or want anything to do with treatment • On the other hand, some will understand once you bring it to their awareness

  15. Cluttering Treatment • Proactive • Use more pauses, emphasize sounds before communication breakdown happens • Reactive • Look for signs your communication partner has misunderstood you and revise your sentence

  16. References • “Fluency Disorders in the ASD Population” Presented by Kathleen Scaler Scott, Ph.D., CCC-SLP

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