1.  Fluency Disorders in ASD Population Jennifer Lozier M.S. CCC-SLP

2. What You Will Learn  Introduction and overview  What we do and don’t know about the presence, causes, and treatment of fluency disorders in……….  Cognitive features and potential contributors to disfluency in ASDs  Assessment and treatment

3. Stuttering-Like Disfluencies (SLDs)  Repetitions of:  Single-Syllable whole words (with tension)  Sounds or syllables (part-word repetition)  Prolongations  Blocks/Tense Pauses  Broken Words  “I-I-I”  “ d-d -uck” “ Spi-spi derman”  “ sss ometimes”  “st---uck”  “bro—ken”

4. Nonstuttering-Like Disfluencies  Repetitions of:  Multisyllable whole words Phrases  Revisions  Interjections/Fillers  “open-open” “I want—I want”  “I like unicorns, no, I mean dragons”  “um, uh, er, well, like, so”

5. Cluttering  Cluttering is a fluency disorder wherein segments of conversation1 in the speaker’s native language2 typically are perceived as too fast overall3, too irregular4, or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following : (a) excessive “normal” disfluencies5 ; (b) excessive collapsing6 or deletion of syllables ; and/or (c ) abnormal pauses, syllable stress, or speech rhythm.  St. Louis and Schulte (2011)

6. Atypical Disfluencies  Final sound and syllable repetitions  “light-t” “train-ain”  Between syllable insertions  “way-hay”  Within-word breaks  “op—en”  Final sound prolongations  “thissss”

7. Disfluency Noted in Individuals with ASD  Simmons and Baltaxe (1975) documented “hesitations, repetitions, prolongations, nonfluencies” (SLDs and NSLDs)  Klin, Volkmar, Sparrow (2000): “Dysfluencies are...common” (p. 378) in Asperger Syndrome” (AS)  Shriberg et al. 2001: 67% male speakers with Asperger’s and 40% with High-functioning autism: “inappropriate or nonfluent phrasing on more than 20% of utterances” (p. 1109)  “These data suggest that many speakers with autistic syndromes produce notably disfluent speech” (p. 1109)

8. Word Final Disluencies  Have been noted more in populations within a diagnostic category other than stuttering, such as children and adults with neurological insults  Commonly found in kids with other diagnoses, particularly those with autism, ADHD  Seems to be a growing consensus that regardless of diagnosis (or lack thereof), the kids with these issues also have other (sometimes subtle) pragmatic language issues

9. What We Know So Far  Disfluency (more and less typical) and stuttering (more and less typical) happen in Autism Spectrum Disorders  The same patterns have been seen in different individuals in the contexts of reading, repetition tasks, and conversation but there are individual differences as well  Awareness seems to be on a continuum  Avoidance behavior – not aware at all

10. Cognitive Features of Autism  Working memory  Williams et al. (2005): lack of deficits, more in processing complex tasks  Joseph et al. (2005): no use of verbal mediation to monitor goal-related information in working memory  Self-monitoring  Response inhibition (Agram et al., 2010)  Mixed findings for behavioral response inhibition  Consistent findings for difficulties with eye movement inhibition  Preservation ((Rehfeldt & Chambers, 2003)  Treatment of verbal perseveration in cognitive approach

11. Cognitive Features That May Contribute to Disfluency  Typical Disfluency  Language factors?  Stuttering-like Disfluencies  Neurological factors  Atypical Disfluencies  Perseveration, pragmatic/perspective taking, language organization  Cluttering  Disinhibition, working memory

12. Treatment of Fluency Disorders in Autism  Stuttering (Brundage et al. 2013)  Fluency Rules Program- dramatic reduction of stuttering  Someone on Spectrum is very rule-based  Speak slowly, don’t repeat a word more than once, put pauses in speech, say each sound short  Word Final Disfluencies  Sometimes go away without intervention (maturation and executive functioning)  Have client address them and suppress them (put in a pause or pause and visualize to give more time to formulate thoughts- language organization or working memory issue?)

13. Application  Every case is an individual one, not every case is the same.  Be on the lookout for:  Types of disfluencies  Traditional stuttering or atypical  Negative feelings and attitudes by the student

14. Application  Some children with ASD will not hear their disfluencies or want anything to do with treatment  On the other hand, some will understand once you bring it to their awareness

15. Cluttering Treatment  Proactive  Use more pauses, emphasize sounds before communication breakdown happens  Reactive  Look for signs your communication partner has misunderstood you and revise your sentence

16. References  “Fluency Disorders in the ASD Population” Presented by Kathleen Scaler Scott, Ph.D., CCC-SLP