STUTTERING

1. STUTTERING

2. WARNING SIGNS FIRST THREE INDICATORS-disturbance in speech production -Multiple repetitions, especially parts of words or first syllables -Use of schwa vowel that delays or disrupts flow of speech -prolongations- especially first sound LAST FIVE INDICATORS WHEN CHILD REACTS TO INTERRUPTIONS IN THEIR SPEECH -tremors -rise in pitch and loudness -struggle and tension with lips and throat -moment of fear when the child can’t say a word correctly -avoidance of a word the child cannot say without stuttering

3. CAUSES • Cerebral dominance theory: predisposition to stutter; neither side of the brain is dominant in controlling motor activities involved in talking • Biochemical/Physiological Theories: Inherited predisposition and Physiological related to epilepsy problems with phonation, respiration, and articulation

4. Cont. • Approach-avoidance conflict: stutterer desires to talk and be silent; anxiety builds up and conflict is manifested in stuttering • Anticipatory-struggle theory: diagnosis of “stuttering” is made by the parents based on normal developmental dysfluencies which creates an environment of “difference”; child begins to speak abnormally in response to the parents’ anxieties, help, and corrections

5. Cont. • Auditory Monitoring Theory: stutterers hear themselves differently • Psychoneurotic theory: stutterer has some unconscious need that he/she has difficulty expressing, therefore represses; creates conflict which results in stuttering • Learning theory: operant conditioning-as a reaction to other people’s reaction, frustration builds effort to decrease dysfluent behavior and creates child to become a stutterer

6. PHASES OF STUTTERING • Stage 1 (preschool years 2-6) • Most dysfluent at age 3-4 • Dysfluencies usually begin with initial sound/syllable repetition, word repetitions, and pauses • Chis is usually not aware of the dysfluency and not bothered by it • Stuttering usually occurs at the beginning of a sentence, clause, or phrase on both content and function words • Stage 2 (elementary school age) • Core behavior is established • Begin to see “struggle behavior • Speech is forced and prolonged • Child is still not avoiding talking • Stuttering is more chronic, less periods of fluent speech • Occurs primarily on content words and increases under periods of excitement

7. Stage 3 (8- young adult) • Avoidance of stuttering • Child is aware of dysfluent behavior • Begins to build up strong aversions to certain words (certain words are regarded as more difficult than others) • Anticipate trouble; attempt to circumlocute, delay, or put off words • Begin to have difficulty speaking with certain people (e.g. teachers, parents, people with authority) • Stage 4 (most advanced form) • Associate feelings • Self-esteem decreases • Fear and anxiety • Child now identifies him or herself as a stutterer

8. TREATMENT AND THERAPY • Fluency Shaping Techniques • Goal is to reduce or eliminate stuttering • Change speed/timing patterns • Light articulatory contact • Pausing/phrasing Examples: Response contingent Stimulation, Gradual Increase in Length of Complexity of Utterance program, Lidcombe Program

9. Cont. • Stuttering Modification Techniques • Goal is to change type of disfluency while teaching one to react to his or her own stuttering calmly • 3 techniques • Cancellations: stutter word, pause 3 seconds and repeat again slowly • Pullouts: once criterion for cancellations met, do this during actual stutter • Preparatory Sets: once pullout criterion met, do this in anticipation of stutter