Chapter 1 Introduction to Stuttering

1. Chapter 1Introduction to Stuttering

2. The Words We Use • “People who stutter” preferable to: • Stutterer • PWS • Disfluency • “Disfluency” = either normal or abnormal • “Disfluency” is preferable to “dysfluency”

3. Do All Cultures Have Stuttering? • Yes. Stuttering is ancient and universal.

4. What Causes People to Stutter? • The causes of stuttering are not completely understood, but scientists believe these are important factors: • Genetic and congenital influences • Developmental influences • Environmental influences • Repeated negative emotional experiences with stuttering lead to negative feelings and attitudes.

5. Factors Contributing to Stuttering

6. Definitions • Fluency versus disfluent speech

7. Definitions (cont.) • Starkweather (1980, 1987) suggests that rate and effort are critical to fluency. • Thus, a fluent speaker effortlessly produces speech at a rate comfortable to listeners.

8. Stuttering: General Description • Stuttering = abnormally high frequency and/or duration of stoppages in the flow of speech • Stuttering also includes speakers’ reactions to stoppages • These reactions include behavioral, emotional, and cognitive responses to repeated experiences of getting stuck while talking • Need to distinguish between stuttering and typical disfluencies, as well as from neurogenic and psychogenic stuttering

9. Core Behaviors of Stuttering • Repetitions: may be single-syllable word or part-word repetitions • Word or syllable may be repeated more than two times, li-li-li-like this. • Prolongations: sound or airflow continues but movement of articulators is stopped • Prolongations as short as one-half second may be perceived as abnormal.

10. Core Behaviors of Stuttering (cont.) • Blocks: inappropriate stoppage of airflow or voicing; movement of articulators may be stopped • Blocks may occur at any level—respiratory, laryngeal, and/or articulatory. • Blocks may be accompanied by tremors of lips, tongue, jaw, and/or laryngeal muscles. • On average, people who stutter, stutter on about 10 percent of the words while reading. • On average, stutters last about 1 second.

11. Secondary Behaviors • Secondary behaviors are learned behaviors that are triggered by the experience of stuttering or the anticipation of it. • Escape behaviors occur when the speaker is stuttering and attempts to terminate the stutter and finish the word (e.g., eye blinks and head nods). • Avoidance behaviors occur when the speaker anticipates a stutter and tries to avoid it by, for example, changing the word or saying “uh” just before the word.

12. Feelings and Attitudes • The experience of stuttering often creates feelings of embarrassment and frustration in a speaker. • Feelings become more severe as the speaker has more stuttering experiences. • Fear and shame may develop eventually and may contribute to the frequency and severity of stuttering. • Attitudes are feelings that have become more permanent and affect the person’s beliefs. • Beliefs may be about oneself or listeners.

13. Functioning, Disability, and Health • The disability of stuttering is the limitation it puts on individuals’ ability to communicate. • This limitation is affected by the severity of stuttering as well as feelings and attitudes that people who stutter have about themselves and about how listeners have reacted to them. • The handicap is the limitation it puts on individuals’ lives. • This refers to the lack of fulfillment they have in social life, school, job, and community.

14. The Human Face of Stuttering • Case examples of individuals who stutter are presented in the Chapter 1 videos on thepoint.lww.com • These examples include individuals at these developmental levels: • Borderline stuttering—young preschool age • Beginning stuttering—older preschool age • Intermediate stuttering—school age • Advanced stuttering—teens and adults

15. Basic Facts and Their Implications • Onset • May start as gradual increase in normal childhood disfluencies or may start as sudden appearance of prolongations or blocks • Often sporadic at outset, coming and going for periods of days or weeks before becoming persistent • Onset may occur between 18 months and 12 years but most often between 2 and 3.5 years (average 2.8 years) • Prevalence • A measure of how many people stutter at any given time • Prevalence is 2.4 percent in kindergarten, about 1 percent in school-age children, and slightly less than 1 percent in adults

16. Basic Facts and Their Implications (cont.) • Incidence • A measure of how many people have stuttered at some point in their lives • About 5 percent • Recovery from stuttering • Somewhere between 70 and 80 percent of children who begin to stutter recover without treatment

17. Basic Facts and Their Implications (cont.) • Children with these attributes have less likelihood of spontaneous recovery (Yairi & Ambrose, 2005): • Having relatives who were persistent stutterers • Being male • Onset after 3.5 years • Stuttering not decreasing during first year after onset • Stuttering persisting beyond 1 year after onset • Multiple unit repetitions (li-li-li-li-like this) • Continued presence of prolongations and blocks • Below normal phonological skills

18. Basic Facts and Their Implications (cont.) • There is also evidence that recovery is associated with: • Being right-handed • Growing up in a home with a mother who is nondirective • Having a slower speech rate and more mature speech motor system

19. Basic Facts and Their Implications (cont.) • Some evidence of other factors influencing persistence versus recovery: • Mothers of children who recovered used simpler language when talking to their children. • White matter tracts in brains of children who recovered may be more developed/mature than those who persisted. • Duration of breastfeeding was longer for children who recovered than for persistent children.

20. Sex Ratio • The sex ratio is almost even (1:1) at the onset of stuttering. • However, girls start to stutter earlier than boys and recover more frequently so that by the time they are of school age, the ratio becomes three boys to every girl who stutters and continues at a 3:1 ratio. • Girls begin to stutter earlier than boys and recover earlier and more frequently.

21. Variability and Predictability of Stuttering • In the 1930s, interest in stuttering turned from its medical or organic aspects to social, psychological, and linguistic aspects such as these: • Anticipation: People who stutter can predict which words they will stutter on in a reading passage. • Consistency: People who stutter tend to stutter on the same words each time they read a passage. • Adaptation: People who stutter less each time they read a passage up to about six readings.

22. Language Factors • Brown showed that adults who stutter do so more frequently on: • Consonants • Sounds in word-initial position • Sounds in contextual speech • Nouns, verbs, adjectives, and adverbs • Longer words • Words at beginnings of sentences • Stressed syllables

23. Language Factors (cont.) • Loci and frequency of stuttering are different in preschool children than in older individuals. • Stuttering in preschool children occurs most frequently on pronouns and conjunctions (these occur frequently at the beginning of utterances in young children). • Stuttering appears most frequently as repetitions of parts of words and single-syllable words in sentence-initial position. • In summary, because stuttering in preschoolers tends to occur at beginning of syntactic units, the trigger seems to be linguistic planning and preparation.

24. Fluency-Inducing Conditions • Many conditions have been found which reduce or eliminate stuttering. These include speaking: • When alone, when relaxed • In unison with another speaker • To an animal or infant • In time or a rhythmic stimulus or when singing, in a different dialect • While simultaneously writing, while swearing • In a slow, prolonged manner • Under loud masking noise, while listening to delayed auditory feedback • When shadowing another speaker, when reinforced for fluent speech

25. Fluency-Inducing Conditions (cont.) • Fluency-inducing conditions have been explained as resulting from reduced demands on speech motor control and language formation (Andrews et al., 1982). • In addition, recent brain imaging studies have made it clear that cortical and subcortical networks are impaired in people who stutter. • Thus, fluency-inducing conditions may work because they help individuals compensate for the deficits in neural systems, by providing timing cues, slowing the rate of speech production, and/or allowing the person who stutters to focus total attention on producing fluent speech.

26. A Model of Stuttering • Stuttering is a neurodevelopmental disorder that usually appears in the preschool years when language development or the child’s environment create enough stress to trigger speech production discoordination that results in an excess of disfluencies.

27. A Model of Stuttering (cont.) • The child may regain fluency when stresses are reduced or the child learns to compensate. Some children recover completely. • Other children persist in stuttering, because their neural pathways remain inadequate for fluency and/or because they react negatively to their early stuttering. • Children who persist usually develop learned behaviors, making their stuttering more conspicuous.

28. Class Activity • Students work singly or in small groups to develop an explanation of stuttering that would be easy to understand when a parent asks. • “What causes stuttering?” • In pairs or groups of three, students role-play a clinician and a parent, answering the parent’s question about the cause of stuttering.