Fluency Disorders

Question 1

Stuttering

Answer 1

Involuntary repetitions of sounds and syllables, sound prolongations, blocks

Question 2

Determining Stuttering

Answer 2

• Stuttering frequency by itself is not a definitive clinical measure for stuttering.
• More than two repetitions of a sound or word is considered a stuttering moment.
• One or two repetitions of an interjection is generally considered a normal dysfluency, but more than two repeats of an interjection is equated with stuttering.
• “Clustered disfluencies” (more than one dysfluency in a word) are common in young children who stutter and may indicate incipient stuttering (just beginning).

Question 3

Nonverbal Components of Stuttering

Answer 3

Secondary behaviors or accessory characteristics may accompany speech disfluencies.
* Include eye blinking, facial grimacing or tension, and exaggerated movements of the head, shoulders, and arms.
* Exaggerated movements are used to keep listeners engaged and to distract speakers from their speech.
* Interjected speech fragments (e.g., “…that is to say…” “…like…”) are also considered secondary characteristics.
* Secondary behaviors are adopted in an effort to reduce instances of stuttering. * Some behaviors are so habituated that they are permanently associated with stuttering. The more someone stutters, the more these behaviors occur.

Question 4

Neurogenic Stuttering

Answer 4

Typically associated with neurological disease or trauma and is acquired after childhood. Usually seen in adults.
* Neurogenic stuttering does not improve with repeated readings or singing.
* Prognosis for neurogenic stuttering is usually poor.

Question 5

Developmental Stuttering

Answer 5

The most common form of stuttering; begins in the preschool years.
* Developmental stuttering usually occurs on content words, whereas they can occur on function words in neurogenic stuttering.
* People who have developmental stuttering frequently exhibit secondary behaviors and fear and anxiety about speaking, whereas individuals with neurogenic stuttering do not.
* Developmental stuttering occurs on the initial syllables of words, whereas neurogenic stuttering can be more widely dispersed throughout the utterance.
* Onset of developmental stuttering is between 2 and 5 years of age and is gradual with severity increasing with age.
The developmental framework has age groups.

Question 6

Younger Preschool Years 2-3

Answer 6

• Periods of stuttering are followed by periods of relative fluency.
• The child will stutter most when upset or excited, or under pressure.
• Sound and syllable repetitions are the dominant feature.
• Stuttering occurs at the beginning of sentences, clauses, and phrases on both content and function words.
• Most children are unaware or are not bothered by disfluencies and do not exhibit secondary behaviors. Many children speak like this, so secondary behaviors are not yet there. Child does not feel that speech isn’t normal yet.

Question 7

Older Preschool Years 4-6

Answer 7

• Stuttering may begin to sound rapid and irregular.
• Blocks may begin to appear, and increased tension of the speech mechanism may be observed.
• Stuttering is more widely dispersed throughout the child’s utterances.
• Secondary behaviors may appear; the child has conscious awareness of his/her stuttering and may become frustrated.

Question 8

School-Age

Answer 8

• Fear and avoidance of stuttering begin to emerge. May isolate and have fear of talking over the phone.
• Stuttering seems to be in response to specific situations.
• Certain words are regarded as more difficult than others and such words may be avoided.
• Blocks are more common than repetitions and prolongations and characterized by excessive muscular tension.

Question 9

Older Teens and Adults

Answer 9

• Stuttering is in its most advanced form.
• The individual has developed a self-concept as a person who stutters.
• A primary characteristic is vivid and fearful anticipation of stuttering.
• Certain sounds, words, and speaking situations are feared and avoided.
• Longer, tense blocks are the most frequent core stuttering behavior; repetitions still occur but they are more rapid and irregular and may co-occur with blocks.
• Secondary behaviors and circumlocution continue.
• There is evidence of embarrassment, helplessness, fear, and shame.

Question 10

Organic Theory

Answer 10

Physical cause for stuttering

Question 11

Behavioral Theory

Answer 11

Stuttering is a learned response to conditions external to the individual.

Question 12

Diagnosogenic Theory

Answer 12

Overly concerned parents react negatively to a child’s normal speech hesitations and repetitions, causing anxiety in the child and increased stuttering.

Question 13

Psychological Theory

Answer 13

Stuttering is a neurotic symptom treated appropriately by psychotherapy. Stuttering is highly related to emotions because anxiety can create disfluency which may cause more anxiety.

Question 14

Covert Repair Hypothesis

Answer 14

Stuttering is a reaction to a flaw in the speech production plan. Poorly developed phonological encoding skills cause errors in the speech plan. Stuttering is a “normal” repair reaction to an abnormal phonetic plan.

Question 15

Demands and Capacities

Answer 15

Stuttering develops when the demands to produce fluent speech exceed the child’s physical and learned capacities. Fluency depends on motor skills, language production, maturity, and cognitive development. Children who stutter presumably lack one or more of these capacities. The DCM is a tool for understanding the forces that contribute to stuttering. More demands, less abilities.

Question 16

The Packman and Attanasio 3-Factor Model

Answer 16

Suggests that there are three factors that cause moments of stuttering: a deficit in the neural processing of language and inherent instability of the speech production system; triggers, or certain features of spoken language that are associated with greater speech motor demands that negatively affect an already unstable speech production system; and modulating factors, such as physiological arousal in an individual that can alter the threshold at which a stuttering moment occurs. Processing of language, motor abilities, physiological arousal.