What is 3 factors causal model of moments of stuttering?
Three factors:
- A deficit in the neural processing underpinning spoken language which renders the speech production system unstable.
- Triggers which are some inherent features of spoken language that increase the motoric task demands on that system. (Variable syllabic stress, complexity).
- Modulating factors which determine the triggering threshold.
Review
- Severity range varies within individuals. Eg. young children cyclical or episodic comes and goes over days and months.
- Cause unknown.
- Appears to be a problem with neural processing of speech related to genetics.
- Kids with first degree relatives who stutter are 3 times more likely to stutter.
- Twin studies and adoption studies suggest genetic factors interact with environment.
- 40% of stutters have no family history
- Clear evidence that there are structural and functional differences in the brains of stutterers.
- Stuttering is less prevalent in deaf and hard of hearing. Therefore auditory processing may be a cause.
- Myelinization: time when myelin covers the axon and expedites transmission of neural impulses in a predetermined pattern - happens around age 7.
What is distinct about early stuttering?
Stuttering affects 5% of children before age of 5.
Early stuttering refers to children who have begun to stutter in the preschool years.
Responds to intervention.
There can be recovery without formal intervention.
Early stuttering occurs in episodes and is variable.
Stuttering oscillates from one level of severity to another.
May be fluent for days.
Bad studies about stuttering
Yairi - Proposed that stuttering was always gradual and occurred under uneventful circumstances and that parents helped create the problem.
Stuttering VS non-stuttering children
Stuttering:
More dysfluencies than non stuttering counterparts
10 or more dysfluencies in every 100
Part word repetitions of sounds and syllables, sound prolongations
More clusters of dysfluencies.
head, body movements.
Non stuttering:
Not as frequent
Repetitions of whole words, phrases or interjections of um uh similar filler.
No secondary movements.
What are the predictors of chronic stuttering?
Poor performance in phonological tests - presence of phonological difficulties.
Precocious language development.
Discuss the emergence of the behavioural approach
Concerned with present aspects not historical aspects of human problems and overt behavioural change.
Clinicians began committing themselves to the notion of immediate and direct attention to stuttered speech.
Lectures, text and treatment in Australia reflect the influence of behaviourism.
Speech measurement and accountability are emphasised.
Do parents speech behaviours contribute to children’s stuttering?
LIttle support that modifying a parent’s speech behaviours facilitates children’s fluency.
Little evidence that parents of stutterers and non-stutterers talk to their children differently.
What is the concept that stuttering is a behaviour?
See stuttering as a problem behaviour to be eliminated.
Therapy with early stutterers can be seen as a process of skill acquisition.
But early stuttering is not a just a simple skill deficit. Advanced stuttering can be thought of as a skills deficit as the person is incapable of producing stutter free speech.
Therapy choices should contain techniques that parents generally use to manage behaviour eg. The lidcombe program.
What is the variability model (v-model)?
A theoretical perspective on the cause and nature of stuttering developed by some of the authors of the lidcombe program.
Explains the growing body of evidence that the program works.
V model explains the nature of early stuttering by linking the onset of the disorder to development of variable syllabic stress. Provides early management guidelines.
Suggests that neuromotor systems involved in applying stress (respiration, phonation, articulation) are destabilised by the variability of movement required.
Linguistic stress varies across syllables and is achieved by changing pitch, duration and/or loudness.
Stuttering involves difficulty in syllable initiation. (syllable initiation theory which is based on vmodel).
Therefore stuttering is a problem at the interfacing of speech and language at the syllable.
What are the management guidelines suggested by the vmodel?
V model explains the nature of early stuttering by linking the onset of the disorder to development of variable syllabic stress.
Current research suggests that waiting 6-12 months may not effect the outcome of treatment. If a child a has been stuttering for less than 6 months, intervene depending on: consistency, severity, family history and child or parental concerns.
What are the 5 ways to describe treatments?
- Simple or complex (changing existing behaviour vs replacing speech pattern).
- Direct or indirect (target the stuttering vs the environment)
- Programmed (pre determined steps) or non programmed (loosely prescribed principles eg. lidcombe).
- Theoretical vs atheoretical (lidcombe).
- Standardised vs individualised (lidcombe).
What are two indirect treatment approaches?
- The lidcombe program
2. Parent child group approach
What are two direct treatment plans?
- Extended length of utterance program
2. Fluency rules program (physiological concepts)
What is the multifactorial treatment model?
Suggests that three treatment factors have an impact on the speech neuromotor system
- Treatment agents that reduce the demands of language on speech motor control
- Incorporate procedures intended to offset instability of speech system by having the child practise motor skills
- Targets possible disruptive effects of emotional states on the unstable speech.
How do you calculate % syllables stuttered?
number of stutters / number of syllables x 100
What is the difference between trait anxiety and state anxiety?
Trait anxiety is considered to be a stable predisposition to perceive environmental threats.
State anxiety is a temporary experience that is situation specific and its severity can fluctuate over time for an individual.
What is temperament?
An innate tendency to react or to interact with daily environments in certain ways. This can be a risk factor for developing anxiety.
How can a behavioural checklist be helpful in assessment?
For stuttering children during the preschool years there may be some association between temperament and stuttering.
It’s possible that the child was born with a temperament that predisposes them to anxiety which influences stuttering.
Behavioural inhibition, characterised by reluctance to explore and an avoidance of new experiences has been identified as the amin temperament characteristic involved.
What are the guidelines for dealing with a bilingual stuttering child?
- Advise parents to continue to speak in home language
- Caution parents to refrain from using code mixed utterances
- Only in severe cases when it is clear the phonological or language disorder is present would you advise parents to reduce the number of languages a child is exposed to.
- Where each parent speaks a different language: the treatment is given in the language of the parent who comes to therapy. If both come then 50/50.
- Measurement of severity ratings overall global measurement taken in each language.
What are the steps in assessment?
- Case history
- Obtain within clinic speech sample - is this typical?
- Identify types of stutters and measurements (%SS, SPM)
- Demonstrate simple therapy techniques
- EG unaided self control
- Self-monitoring - if you $ just stop and try again.
- Rewards for $ free speech
- Response cost - use tokens
- Positive verbal stimulation
- ELU
- Reduced speech rate
- Smooth speech etc.
- Discuss with parents about involvement, rationale, maintenance etc.
How do you calculate rate (SPM)?
syllables / time in secs x 60
