1. Copyright © 2008 Delmar. All rights reserved. Unit Six Stuttering

2. Copyright © 2008 Delmar. All rights reserved. Chapter 23 Foundational Information about Stuttering

3. Copyright © 2008 Delmar. All rights reserved. 3 What Is Stuttering? Disturbance in the normal flow and time patterning of speech

4. Copyright © 2008 Delmar. All rights reserved. 4 Characteristics of Stuttering Stuttering is characterized by one or more of the following: –Audible or silent blocking –Sound, syllable, or word repetitions –Sound prolongations

5. Copyright © 2008 Delmar. All rights reserved. 5 Characteristics of Stuttering Interjections Broken words Circumlocutions Sounds and words produced with excessive tension

6. Copyright © 2008 Delmar. All rights reserved. 6 Normal Disfluency Pauses Repetitions Incomplete phrases Revisions Interjections and prolongations that are typical in speech

7. Copyright © 2008 Delmar. All rights reserved. 7 Definitions of Stuttering There are multiple definitions of stuttering –No one definition is agreed upon by all

8. Copyright © 2008 Delmar. All rights reserved. 8 Overt Audible Behaviors Part-word repetitions Whole-word repetitions Phrase repetitions Interjections of sounds, syllables, words, and phrases

9. Copyright © 2008 Delmar. All rights reserved. 9 Overt Audible Behaviors Revisions of phrase and sentences Blocks Disrhythmic phonations

10. Copyright © 2008 Delmar. All rights reserved. 10 Overt Audible Behaviors Part-word repetitions are most common in preschoolers’ disfluency Disrhythmic phonations are most common disfluency in school age children Interjections are most common for adults

11. Copyright © 2008 Delmar. All rights reserved. 11 Overt Visible Behaviors There may be body movements that accompany the speech –Facial tension, jerking the head, tension in shoulders

12. Copyright © 2008 Delmar. All rights reserved. 12 “Iceberg” of Stuttering Visible and audible behaviors represent the upper one-third of the iceberg Invisible lower two-thirds of the iceberg –Includes emotions of people who stutter and their tricks to try and be more fluent

13. Copyright © 2008 Delmar. All rights reserved. 13 Covet Reactions to Stuttering Feelings and thoughts about stuttering –Frustrations, shame, anxiety, expectations of difficulty talking

14. Copyright © 2008 Delmar. All rights reserved. 14 General Information about Stuttering Incidence of 1 percent in general population Age of onset typically in childhood Male-to-female ratio: 3 or 4 to 1 Tendency to run in families

15. Copyright © 2008 Delmar. All rights reserved. 15 Stuttering and Other Communication Disorders Children who stutter are more likely to reach speech milestones later May have poorer articulation skills Stuttering occurs less frequently in the deaf and hard of hearing population

16. Copyright © 2008 Delmar. All rights reserved. 16 Brain Function and Stuttering Neural system of stuttered speech can be distinguished from normal speech No one structure or neural pathway associated with stuttering Stuttering is associated with hemispheric asymmetry

17. Copyright © 2008 Delmar. All rights reserved. 17 Psychological Characteristics Those who stutter are within normal range for intelligence and emotional adjustment

18. Copyright © 2008 Delmar. All rights reserved. 18 Theories of the Etiology of Stuttering Breakdown theories Repressed need theories Anticipatory struggle theories

19. Copyright © 2008 Delmar. All rights reserved. 19 Breakdown Theories Stuttering is due to early environmental stress Neurological predisposition is also important

20. Copyright © 2008 Delmar. All rights reserved. 20 Repressed Need Theories Stuttering is a symptom of repressed needs

21. Copyright © 2008 Delmar. All rights reserved. 21 Anticipatory Struggle Theories Stuttering is a learned behavior Precipitated by anticipating and fearing the stuttering and struggling to avoid it

22. Copyright © 2008 Delmar. All rights reserved. 22 Etiology of Stuttering Most professionals consider stuttering multifactorial –One or more potential causes

23. Copyright © 2008 Delmar. All rights reserved. 23 Conditions that Decrease Stuttering Read in unison with someone Shadow someone’s speech Sing Speak to a metronome or beat Delayed auditory feedback

24. Copyright © 2008 Delmar. All rights reserved. 24 Conditions that Increase Stuttering Saying specific words –I, person’s name Reading aloud in a group Speaking to authority figures Talking on the telephone

25. Copyright © 2008 Delmar. All rights reserved. 25 Cluttering Speech is abnormally fast, irregular, or both Language is also affected

26. Copyright © 2008 Delmar. All rights reserved. Chapter 24 Working with Children Who Stutter

27. Copyright © 2008 Delmar. All rights reserved. 27 Multidimensional Evaluation Capacities-demand model is a framework for the evaluation –SLPs explore the capacity of the child for fluent speech –SLPs explore the demands being placed on the child by others

28. Copyright © 2008 Delmar. All rights reserved. 28 Preschool Children Parent interview and case history are very important Evaluation typically done in a play atmosphere Standardized speech assessment, Stuttering Severity Inventory –Three may be completed

29. Copyright © 2008 Delmar. All rights reserved. 29 Preschool Children: Parent Interview Categories Motivation Family background Characteristics of stuttering Developmental course

30. Copyright © 2008 Delmar. All rights reserved. 30 Preschool Children: Parent Interview Categories Communication abilities/style Degree of awareness Environmental influences Parent/child relationship Skills, interests, and locus of control

31. Copyright © 2008 Delmar. All rights reserved. 31 School-Age Children Parent interview May want to interview child directly as well Assess all speech systems

32. Copyright © 2008 Delmar. All rights reserved. 32 Prevention Not all children who stutter need therapy Three levels of prevention: –Primary –Secondary –Tertiary

33. Copyright © 2008 Delmar. All rights reserved. 33 Primary Prevention Provide educational information to parents –How to support development of communication skills –Language stimulation

34. Copyright © 2008 Delmar. All rights reserved. 34 Secondary Prevention Parent counseling –Provide information –Teach appropriate interaction styles –Assist parents with monitoring child's stuttering

35. Copyright © 2008 Delmar. All rights reserved. 35 Tertiary Prevention For parents of children who are mild stutterers Goal is to prevent stuttering from becoming more severe –Child receive individual therapy –Parents attend weekly discussion groups

36. Copyright © 2008 Delmar. All rights reserved. 36 Principles of Therapy: Preschool Therapy will be a dynamic process Fluency shaping focuses on increasing and maintaining fluent speech Stuttering modification focuses on improving overall communication

37. Copyright © 2008 Delmar. All rights reserved. 37 Goals of Therapy: School Age Reduce severity of stuttering Reduce negative attitudes to stuttering Increase motivation

38. Copyright © 2008 Delmar. All rights reserved. 38 Multicultural Considerations Determine if child is really stuttering or struggling in development of two languages Compare disfluencies across languages If child is in therapy, treat the stronger language

39. Copyright © 2008 Delmar. All rights reserved. Chapter 25 Working with Adolescents and Adults Who Stutter

40. Copyright © 2008 Delmar. All rights reserved. 40 Evaluation Client interview Direct assessment of speech

41. Copyright © 2008 Delmar. All rights reserved. 41 Principles of Therapy Developing insights into attitudes about stuttering Increasing awareness of muscle tension Speech analysis and modification Building new speech skills

42. Copyright © 2008 Delmar. All rights reserved. 42 Principles of Therapy Group therapy may be used in conjunction with one-on-one therapy Therapy needs to be long-term

43. Copyright © 2008 Delmar. All rights reserved. Chapter 26 Emotional and Social Effects of Stuttering

44. Copyright © 2008 Delmar. All rights reserved. 44 Emotional Adjustment Most stutterers are as well adjusted as those who do not stutter Stutterers may be reluctant to speak publicly and avoid social situations

45. Copyright © 2008 Delmar. All rights reserved. 45 Emotional Effects of Stuttering Anxiety and fear Perfectionism Excessive need for approval Low self-esteem Reluctance to take risks