Stuttering

1. Stuttering • Stephen M. Tasko Ph.D. CCC-SLP • Associate Professor • Speech Pathology and Audiology • Western Michigan University • http://homepages.wmich.edu/~stasko/

2. Some questions • What is stuttering? • What is disfluency? • Are they the same thing?

3. Disorders of fluency • (Developmental) Stuttering • Neurogenic Stuttering • Psychogenic Stuttering • Cluttering

4. Features of Stuttering Core Features • Repetitions of • Sounds • Syllables • Words • Phrases • Prolongation of • Sounds • Silence (blocks or tense pauses)

5. Features of Stuttering Additional Features • Frequent use of interjections (e.g. ‘um’,’ah’,etc) • Unwanted movements of the body e.g. • Facial grimaces • Eye blinking • Jaw jerking • Head movement • Muscle contractions • Arm and foot movements

6. Features of Stuttering Additional Features • Feelings of • Fear • Embarrassment • Shame • Avoidance of • Feared words • Difficult speaking situations (telephone, public speaking) • Social interactions • Certain types of employment, recreation, etc

7. Neurogenic Stuttering Follows a identified neurologic event • Stroke • Head injury • Onset of neurological disease Some Features • Part-word or phoneme repetitions • No patterns related to word type • Not restricted to initial words • No syllable stress effect • Lack of anxiety or secondary symptoms • Less responsive to fluency-enhancing conditions

8. Psychogenic Stuttering • Stuttering in response to emotional trauma or stress Some Features • Sudden onset, typically related to some event • Repetition of initial or stressed word • Fluency enhancing effects not observed • No periods of stutter free speech • Initially no interest in problem

9. Ten Significant Features of Cluttering: Expert Opinion (Daly & Cantrell, 2006) Telescopes or condenses words Lack of effective self-monitoring skills Lack of pauses between words; run-on sentences Lack of awareness Imprecise articulation Irregular speech rate Interjections; revisions; filler words Compulsive talker; verbose; ‘talks in circles’ Language disorganized; confused wording Seems to verbalize before adequate thought formulation Cluttering

10. Who tends to stutter? • Those with a family history of the disorder • Those with slower developing/disordered speech and language • Boys more likely to stutter than girls • Those with significant motor and/or cognitive delays • Children who are “vulnerable” to stress HOWEVER, A LARGE PERCENTAGE DO NOT FALL INTO ANY OF THESE GROUPS

11. Natural History of Stuttering • Begins in early childhood • ~ 3.5 years with a rather wide range of onset • Stuttering does not typically begin when children first speak, it typically begins when speech/language demands increase • Recovery is not uncommon • 1% of population have persistent stuttering • 4-5 % of population report stuttering at some point • Reports of up to 80% recover - for those who do not, stuttering typically persists through life • Features of stuttering tend to change over time • In developed form, expectancy, fear and avoidance play significant roles

12. Common observations in normally developing children • Whole-word repetition • Limited to sentence initiation • Normal speech tempo • Lack of awareness or concern • Evidence that it is related to language formulation • Episodic

13. Indications of potential stuttering • Much greater frequency of disfluencies • Longer duration disfluencies • Change in disfluency type • Shift away from word/phrase repetition to sound/syllable repetitions and prolongations and blocks/tense pauses • Evidence of struggle (not easy disfluency) • Lack of rhythm in disfluency • More “adult-like” patterns that include increased level of awareness, fear and frustration

14. Factors known to influence stuttering • Stuttering tends to increase • At the beginning of a sentence/clause • For words beginning with pressure consonants • For longer words • For words with greater information load • For multisyllabic words

15. Factors known to influence stuttering • Stuttering tends to decrease • During repeated readings of material • During certain speaking activities • Singing • Shadowed or choral speech • Slowed rate of speech • Chanting or changing ‘melody’ of speech • When exposed to noise or altered feedback • When performing concurrent activities

16. Theories of stuttering • Stuttering as a neurotic behavior • Stuttering arises from its diagnosis • Stuttering as a learned behavior • Stuttering as a physical disorder • Motor control problem • Linguistic formulation problem • Genetic disorder • Abnormal brain development

17. Recent Evidence from Brain Imaging • Persons who stutter show anatomical differences in key speech areas of the brain • However, most studies performed on adults who have been stuttering their whole life • Are the brains differences the cause of stuttering or the effect of a lifetime of stuttering? • New evidence suggests even young children who stutter show brain differences

18. How does we assess stuttering? • Case History • Careful observation of speech behavior • Collect speech samples • Measure frequency and type of stuttering • Collect information about attitudes toward speaking • Plan treatment • Prognosis

19. Stuttering Treatment There is no cure for stuttering

20. Stuttering Treatment Fluency Shaping Approaches • Modify the way the person speaks all of the time to reduce the chance that stuttering will occur • May be considered a preventative approach • Initially speech is often slow and very deliberate • Over time and practice speaking becomes more natural

21. Stuttering Treatment Stuttering Modification Approaches • Client focuses on changing the way he/she stutters so that it is less severe, and easier • Emphasizes that stuttering should not be avoided since it creates more fear/anxiety about speaking • Over time stuttering events may not be perceptible to the listener as client gains control over stuttering events • Emphasis on • client’s attitudes and feelings about speech • Reducing sensitivity to concerns about stuttering

22. Stuttering Treatment Issues for the person with chronic stuttering • Typically need to address • accessory behaviors (head movements, eye blinking etc) • Attitudes and feelings about communication • Avoidance issues

23. Stuttering Treatment Issues for the child with beginning stuttering • Issues • Determining the likelihood of recovery or persistence • Addressing speech problems without creating increased concern, embarrassment etc • Creating a communicative environment that does not create excessive pressures • Direct vs. Indirect models of intervention

24. Stuttering Treatment • Phases of treatment • Establishment of fluency • Transfer of fluency skills • Maintenance of fluency

25. Stuttering Treatment Other approaches • Use of devices to alter auditory feedback • Medications • Self help groups

26. For more information Helpful Websites • Stuttering Foundation of America • http://www.stutteringhelp.org/ • National Stuttering Association • http://www.nsastutter.org/