Transcript 5% - School Based Behavioral Health

Understanding Stuttering
in Children
“If knowledge can create problems,
it is not through ignorance
that we can solve them.”
Isaac Asimov*
Anna Birstein
University of Pittsburgh
Stuttering is:
Stuttering is “a marked impairment in speech
fluency, that reflects an underlying problem with
speech production rather than a language
problem” (Weis, 2013, p. 150).
The Diagnostic and Statistical Manual of Mental
Disorders Fifth Edition, edited by American
Psychiatric Association, DSM –V (2013), gives this
communication disorder a new name:
“Childhood-Onset Fluency Disorder” (APA, 2014).
.
Diagnostic Criteria (DSM-V)
Childhood-Onset Fluency Disorder (Stuttering)
• Is a condition characterized by disturbances in the
normal fluency and time patterning of speech that
are inappropriate for the individual’s age and
language skills, and persist over time.
• Is an impairment in speech fluency that is not
attributable to another developmental disorder, a
mental disorder, or a medical condition (like stroke).
• The onset of symptoms is usually in the early
developmental period (i.e., prior to the age 5).
• The disturbance [in speech fluency] causes anxiety
about speaking, limitations in effective
communication, social participation, and academic
performance or occupational performance (APA , 2013,
pp. 45-46).
Symptoms
The disturbances in the normal fluency of speech may be
characterized by one or more of the following:
 Sound and syllable repetitions (part-word repetitions):
“ba – ba — baby”
 Sound prolongations: “S>>>>sometimes”
 Broken words (pauses within a word): “Ta – table”
 Audible or silent blocking (filled or unfilled pauses
in speech): “I like to – go home”
 Monosyllabic whole-word repetitions: “I-I-I see him”
 Circumlocutions (word substitutions to avoid a
problematic word)
 Words pronounced with an excess of physical tension
(APA, 2013, pp. 45-46; Weis, 2013, p. 151)
Eligibility for Services:
• A child who stutters may be eligible to
receive speech therapy under a federal
law, the Individuals with Disabilities
Improvement Act of 2004 (IDEA, P.L. 108446, Part 300 / A / 300.8 / c / 11 )*
• IDEA’s definition of a Speech-Language
Impairment includes communication
disorders, such as stuttering, impaired
articulation, language impairment, or
voice impairment, “that adversely affects
a child’s educational performance.”*
*(U.S. Department of Education , n. d.)
Early Identification
The following signs may help to distinguish between stuttering and
developmentally appropriate disfluencies.
Many preschool-age children demonstrate age-appropriate
disfluencies, which do not appear often, and may include whole
word repetitions, pauses in speech, and relaxed hesitations.
“The warning signs that should alert parents and teachers are:
1. Frequent part-word repetitions rather than word
repetitions , more likely ‘B-b-but’ than ‘but, but.’
2. Repetition of a part of a word more than 2 times
3. ‘ba-ba-ba-ba-ball.’
4. Repetitions having an irregular rhythm ‘b-ba--b-ball.’
5. A sound held longer than normal (more than 1 second)
‘Mmmmmy ball.’
6. Excessive tension in the speech muscles (in the neck and
face).
7. Fear of speaking in public.” *
*(Haynes, Moran, & Pindzola, 2006, p 28)
Age of Onset and Recovery
• An onset of stuttering is usually between ages
3 and 6 with almost no new cases being
reported after age 12.
• Boys are 2 to 5 times more likely to exhibit
stuttering than girls.
• Boys begin stuttering, on average, 5 months
• later than girls.
Recovery:
• 5% of preschool children are affected, but by
adolescence this percentage drops to 1%.
• the highest rate (70% or higher) of recovery
exists during the first 15 months post-onset.*
*(Dworzynski, at al., 2007)
Causes and Treatment
• The exact causes of stuttering are
unknown.*
• There are strong genetic influences
in the etiology of stuttering (family
history of disorder).**
• No single treatment or strategy will
work for each and every child who
stutters**
• Behavioral intervention strategies
are most effective before age 8.**
*(Dworzynski, et al., 2007, Nye, at al., 2013, Weis, 2013)
**(Nye, at al., 2013)
Stuttering Stereotype
• Many myths and
misconceptions about
stuttering exist in the
society.
• Examine your own
perceptions toward
people who stutter
through the “Myth vs.
Truth” activity.
Myth OR Truth?*
1. There is exactly the same range of intelligence among
children who stutter as there is among non-stuttering
children.
2. Parents, their behaviors, or parental practices do not
cause stuttering.
3. Stuttering is caused by nerves (children may stutter
because they are nervous or anxious).
4. Stuttering is caused by an event in life.
5. Children who stutter are usually shy and lack confidence.
6. Children who stutter need help to speak (to finish their
sentences).
7. Children who stutter experience reduction in stuttering
when they sing, speak to an infant or a pet, or read aloud
the passage in unison with a large group.
*This activity is based on the information from Kelman and Whyte (2012, pp. 38-40) and Weis (2013, p. 152)
Myth OR Truth?
• 1 truth
• 2 myth
• 3 truth
• 4 truth
• 5 myth
• 6 truth
• 7 truth
Suggestions for Teachers: “PRIME”
speech
• P - Create pauses (silences) in
interactions.
• R - Reduce your rate of speech.
• I - Show your interest in what the child
•
expresses, rather than how it is said.
M - Model simple vocabulary and
normal non-fluencies in your speech
• E - Do not reduce your expectations
(treat the child who stutters as any other
student in the class)*
*LaBlance, Steckol, and Smith (1994)
Suggestions for Teachers: Do’s
• Listen attentively.
• Give him/her opportunities to talk.
• Praise the student for sharing his/her
ideas.
• Prepare the student for the upcoming
events.
• Have a one-on-one conversation with the
student about needed accommodations.
• Acknowledge disfluencies.
• Let the student who stutters know it’s OK
to stutter.
From: LaBlance, Steckol, and Smith (1994) and Stuttering Foundation (2015)
Suggestions for Teachers: Do’s
Create a comfortable speaking
climate in the classroom:
•
•
•
•
Educate your students about
stuttering.
Establish the “conversational rules”
(together with your students).
Model and reinforce your students
to follow those rules.
(LaBlance, Steckol, & Smith, 1994)
Suggestions for Teachers: Don’ts
• Do not interrupt the student who
stutters.
• Do not finish his or her sentences.
• Do not tell the student to “relax” or
to “take a deep breath.”
• Don’t make stuttering something to
be ashamed of. Talk about stuttering
just like any other matter.*
* (Stuttering Foundation, 2015)
Implications from Research
1. Be aware that a child may be prone to
stuttering when there is a strong family
tendency.
2. Consult with the child’s Speech and
Language clinician (SLP) to learn about
the course and current treatment.
3. Address anxiety early. Proper
intervention may prevent many
negative consequences of stuttering.
1. (Dworzynski et al., 2007).
2. (Nye, et al., 2013).
3. (Iverach & Rapee, 2013, p. 220).
Implications from Research
4. Establishing a comprehensive bullying
prevention program can effect positive
changes in peer attitudes toward children
who stutter and toward bullying in
general.
5. Advise a student who stutter to join
support groups to connect to others who
share similar emotional experiences.
6. Help him or her find local support
groups in your area.
4. (Langevin & Prasad, 2012)
5, 6. (Guntupalli et al., 2006).
A Case Study
• Meet Davis, a 4-year-old boy.*
What would you recommend the parents of
Davis if they asked your advice as a teacher
of their child, or as a family friend who works
on the field of education?
*A Case Study from the Chapter 5 “Communication Disorders in Children” of the
book Introduction to Abnormal Child and Adolescent Psychology by Robert Weis
(2013, pp. 150-151)
References:
APA (2014) A new name for stuttering in DSM-5 Retrieved from: http://www.apa.org/monitor/2014/07-08/stuttering-dsm.aspx
APA (2013) Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)
Dworzynski, K., Remington, A., Rijsdijk, F., Howell, P., & Plomin, R. (2007). Genetic etiology in cases of recovered and persistent
stuttering in an unselected, longitudinal sample of young twins. American Journal of Speech-Language Pathology, 16(2), 169-178.
Flynn, T. W., & Louis, K. O. S. (2011). Changing adolescent attitudes toward stuttering. Journal of fluency disorders, 36(2), 110-121.
Haynes, W. O., Moran, M., & Pindzola, R. (2006). Communication disorders in the classroom: An introduction for professionals in
school settings. P 28. Jones & Bartlett Learning.
Howell, P., Davis, S., & Williams, R. (2008). Late childhood stuttering. Journal of Speech, Language, and Hearing Research, 51(3),
669-687.
Kelman E., Whyte, A (2012) Understanding Stammering or Stuttering. A Guide for parents, teachers, and other professionals, pp.
38-40. Jessica Kingsley Publishers: London, UK
LaBlance, G. R. (1994). Stuttering: The Role of the Classroom Teacher.Teaching Exceptional Children, 26(2), 10-12.
Stuttering Foundation (2015) Special education law & children who stutter. web. Retrieved from:
http://www.stutteringhelp.org/special-education-law-children-who-stutter
Langevin, M., & Prasad, N. N. (2012). A stuttering education and bullying awareness and prevention resource: A feasibility study.
Language, speech, and hearing services
in schools, 43(3), 344-358.
Guntupalli, V. K., Kalinowski, J., Nanjundeswaran, C., Saltuklaroglu, T., & Everhart, D.
E. (2006). Psychophysiological responses of adults who do not stutter while listening to stuttering. International journal of
psychophysiology, 62(1), 1-8.
Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of fluency
disorders, 40, 69-82.
Stuttering Foundation (n. d.) Special Education Law and Children Who Stutter. Retrieved from:
http://www.stutteringhelp.org/special-education-law-children-who-stutter
Weis, R. (2013). Introduction to abnormal child and adolescent psychology, pp 150-152
Sage Publications.
U.S. Department of Education (n. d.) Building the Legacy :IDEA 2004. ED.GOV Website. Retrieved from:
http://idea.ed.gov/explore/view/p/%2Croot%2Cregs%2C300%2CA%2C300%252E8%2Cc%2C11%2C
*Quotation of Isaac Asimov as it cited in Liebersoh, A (2009) World Wide Agora p. 160. Publisher: Lulu Enterprises, UK Ltd
The background image was created: March, 2015, by Anna Birstein (using the PickArt software).