1. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 1 The Nature of Fluent and Nonfluent Speech: The Onset of Stuttering CHAPTER 2

2. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 2 Fluency, from Latin for “flowing” (Ongoing flow of information) Starkweather (1987) linguistic fluency—syntactic, semantic, phonologic, pragmatic speech fluency—continuity, rate, duration, coarticulation, effort Also: natural, some typical disfluencies, little cognitive effort by the speaker and listener, feeling good (or neutral) about speaking

3. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 3 Table 2-1Equivalent terms commonly used for describing stuttering StutteringStammering FluencyNormal Speech DisfluentDysfluent Primary BehaviorsCore BehaviorsAlpha Behaviors Secondary BehaviorsAccessory BehaviorsCoping Behaviors

4. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 4 Some definitions of stuttering Examples of definitions: Johnson et al. (1940s and 1950s) …anticipatory, hypertonic avoidance reaction Behavioral …conditioned negative emotion Psychogenic definitions …pregenital conversion neurosis

5. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 5 M. Wingate (1964) The term “stuttering” means: 1. (a) Disruption in the fluency of verbal expression, which is (b) characterized by involuntary, audible, or silent repetitions or prolongations in the utterance of short speech elements, namely: sounds, syllables, and words of one syllable. These disruptions (c) usually occur frequently or are marked in character and (d) are not readily controllable. 2. Sometimes the disruptions are (e) accompanied by accessory activities involving the speech apparatus, related or unrelated body structures, or stereotyped speech utterances.

6. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 6 M. Wingate (1964) (continued) These activities give the appearance of being speech- related struggle. 3. Also, there not infrequently are (f) indications or reports of the presence of an emotional state, ranging from a general condition of “excitement” or “tension” to more specific emotions of a negative nature such as fear, embarrassment, irritation, or the like. The immediate source of stuttering is some incoordination expressed in the peripheral speech mechanism; the ultimate cause is presently unknown and may be complex or compound. (p. 488)

7. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 7 Features on and under the surface The ABCs of stuttering Overt behaviors (struggle, escape, & avoidance) Covert/intrinsic features The speaker’s experience of Helplessness – lack of control – fear (fake vs. real stuttering; goals of therapy) *E. Cooper; W. Perkins, et al., and many others

8. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 8 A change in the WHO WHO 1980: Impairment (disruption), Disability (limitations), & Handicap (disadvantages) WHO/ICF (2001): no distinction between disability & handicap Considers environmental & unique response re. personal/cultural factors Includes less observable aspects of the disabilities Accesses & treats cognitive and affective behaviors (not only overt aspects)

9. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 9 The quality or form-types of disfluencies Distinguishing stuttering-like disfluencies from more typical fluency breaks

10. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 10 Table 2-3 Ways of categorizing disfluencies. Fluency breaks characteristic of individuals who do stutter are listed in the first column. Fluency breaks characteristic of individuals who do not stutter are listed in the second column. From Yaruss, 1997a. Within-Word Disfluencies Monosyllabic whole-word repetition Sound/syllable repetition Audible prolongation Inaudible prolongation Between-Word Disfluencies Phrase repetition Polysyllabic whole-word repetition Interjection Revision Stuttering-Like Disfluencies (SLD) Part-word repetition Monosyllabic word repetition Disrhythmic phonation Other Disfluencies Interjection Phrase repetition Revision/Incomplete phrase

11. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 11 Table 2-3 Ways of categorizing disfluencies. Fluency breaks characteristic of individuals who do stutter are listed in the first column. Fluency breaks characteristic of individuals who do not stutter are listed in the second column. From Yaruss, 1997a. (continued) Stutter-Type Disfluencies Part-word repetition Prolongation Broken word Tense pause Normal-Type Disfluencies Whole-word repetition Phrase repetition Revision Incomplete phrase Interjection Less Typical Disfluencies Monosyllabic word repetition (3 or more repetitions) Part-word syllable repetition (3 or more repetitions) Sound repetition Prolongation Block More Typical Disfluencies Hesitation Interjection Revision Phrase repetition Monosyllabic word repetition (2 or fewer repetitions: no tension) Part-word syllable repetition (2 or fewer repetitions: no tension)

12. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 12 Characteristics of early stuttering Yairi, E., Ambrose, N. (2005). Early Childhood Stuttering: For Clinicians by Clinicians, Austin TX: Pro-Ed Early disfluent speech is markedly different from that of normally fluent children. Stuttering does not appear to rise from normal disfluency. Parents who believe that their child has begun stuttering do not exercise erroneous judgment. Early in stuttering, disfluent speech has a complex pattern of disfluency types. Two-thirds of disfluencies of CWS are SLDs; two-thirds or disfluencies of NFC are other disfluencies (ODs). “As stuttering continues, the difficulty lies not in the correct diagnosis of stuttering, but in correct diagnosis of its recovery” (p. 139).

13. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 13 Age of onset (Yairi & Ambrose, 2005) Although stuttering may begin within a wide age range, it has been recognized for a long time that a large number of cases begin prior to age 6 or 7. Our own investigation was open to children up to 72 months of age but it was interesting to note that all onsets occurred between 16 and 60 months of age with a mean age of 33.38 months. Almost 85% of onsets occurred prior to three and - half years of age (42 months).

14. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 14 Age of onset (continued) (Yairi & Ambrose, 2005) The fact that the critical period for onset lies in close proximity to the emergence of complex language and articulatory skills, as well as fast anatomical changes of the speech systems, invites speculations that interference in maturational processes involves stuttering-language-articulation relations (in the broadest sense).

15. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 15 Table 2-4 Mean frequency and standard deviation (SD) of disfluencies per 100 syllables for experimental and control groups (Yairi & Ambrose, 2005) Experimental: 103 children, stuttering no longer than 6 months Control: 52 children, judged by parents and authors as normally fluent Disfluency TypeExperimental Control Frequency (SD) Stuttering-Like Disfluencies Part-Word repetitions5.64 (4.28)0.55 (0.43) Single-syllable word repetitions3.24 (2.01)0.79 (0.74) Disrhythmic phonations (prolongations & blocks) 2.42 (2.62)0.08 (0.12) Total11.30 (6.64)1.41 (0.96) Other Disfluencies5.79 (2.75)4.48 (2.41)

16. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 16 Characteristics of early stuttering There are many forms of onset including sudden (with slightly more children in this group), intermediate, and gradual (not primary followed by secondary stuttering). Only about 20% begin to stutter with unremarkable circumstances; most have at least some degree of physical, emotional, and language stresses. Repetitions of initial syllables and short words are typical, but may also include prolongations and fixations. About half of the children show tense movements in parts of the body, especially head, face, and neck.

17. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 17 Additional characteristics of stuttering Greater number of repetitions Faster repetitions Clustering of form-types Level of awareness depending on maturity & temperament (Ambrose & Yairi, 1994) Develop a negative attitude about speaking as young as 3–4 years (Vanryckeghem et al. (2005)

18. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 18 More influential factors related to onset Age: little risk after age 6, nil by age 12 Gender: 1:1 at onset, 3:1–4:1 by school age Genetics: implicated about 50% of time interaction of gender and genetics (Chapter 5) Twinning: More concordance with monozygotic (MZ) twins than dizygotic (DZ) twins Poorer cognitive & motor abilities result in higher occurrence of fluency problems Language: CWS tend to have expressive language abilities that equal or exceed their peers

19. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 19 More influential factors (continued) The phonological connection... not so much A weak and nonlinear connection of stuttering & phonological problems; but more boys than girls tend to have both. At onset, children who stutter tend to be behind normally fluent children in phonological development. Children who persist in stuttering are apt to be slower in phonological development than those who recover. Phonological skills alone are insufficient to predict the further course of stuttering. The phonological development of children who stutter is similar in order of progression and strategies to those used by normally fluent children.

20. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 20 More influential factors (continued) Over 40% of parents report emotional event prior to onset of stuttering (Yairi & Ambrose, 2005) No difference of persistent & recovered groups for anxiety (Yairi & Ambrose, 2005) Guitar (2006) – interaction of hemispheric functioning and a fragile speech production system with temperamental reactivity (especially time pressure) a reaction to novel or threatening stimuli with higher levels of physical tension

21. Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 21 By assuming the role of a moderately severe PWS the last two weeks... What have you observed? Positive/negative reactions? Did you get “The Look” ? Humorous responses? What have you learned?