Transcript SPPA 2000 Stuttering slides

Stuttering
Stephen M. Tasko Ph.D. CCC-SLP
Associate Professor
Speech Pathology and Audiology
Western Michigan University
http://homepages.wmich.edu/~stasko/
Some questions
• What is stuttering?
• What is disfluency?
• Are they the same thing?
Disorders of fluency
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(Developmental) Stuttering
Neurogenic Stuttering
Psychogenic Stuttering
Cluttering
Features of Stuttering
Core Features
• Repetitions of
– Sounds
– Syllables
– Words
– Phrases
• Prolongation of
– Sounds
– Silence (blocks or tense pauses)
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
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
Neurogenic Stuttering
Follows a identified neurologic event
– Stroke
– Head injury
– Onset of neurological disease
Some Features
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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
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
Cluttering
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
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
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
Common observations in normally
developing children
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Whole-word repetition
Limited to sentence initiation
Normal speech tempo
Lack of awareness or concern
Evidence that it is related to language
formulation
• Episodic
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
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
Factors known to influence stuttering
• Stuttering tends to decrease
– During repeated readings of material
– During certain speaking activities
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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
Theories of stuttering
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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
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
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
Stuttering Treatment
There is no cure for stuttering
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
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
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
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
Stuttering Treatment
• Phases of treatment
– Establishment of fluency
– Transfer of fluency skills
– Maintenance of fluency
Stuttering Treatment
Other approaches
• Use of devices to alter auditory feedback
• Medications
• Self help groups
For more information
Helpful Websites
• Stuttering Foundation of America
– http://www.stutteringhelp.org/
• National Stuttering Association
– http://www.nsastutter.org/