1. Stuttering Stephen M. Tasko Ph.D. CCC-SLP Associate Professor
Speech Pathology and Audiology
Western Michigan University 1

2. Some questions What is stuttering? What is disfluency?
Are they the same thing? 2

3. Disorders of fluency (Developmental) Stuttering Neurogenic Stuttering
Psychogenic Stuttering
Cluttering 3

4. Features of Stuttering
Core Features
Repetitions of
Sounds
Syllables
Words
Phrases
Prolongation of
Silence (blocks or tense pauses) 4

5. 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 5

6. 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 6

7. Neurogenic Stuttering
Follows a identified neurologic event
Stroke
Head injury
Onset of neurological disease
Some Features
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 7

8. 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 8

9. 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 9

10. HOWEVER, A LARGE PERCENTAGE DO NOT FALL INTO ANY OF THESE GROUPS
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 10

11. 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 11

12. Common observations in normally developing children
Whole-word repetition
Limited to sentence initiation
Normal speech tempo
Lack of awareness or concern
Evidence that it is related to language formulation
Episodic 12

13. 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 13

14. 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 14

15. Factors known to influence stuttering
Stuttering tends to decrease
During repeated readings of material
During certain speaking activities
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 15

16. Theories of stuttering
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 16

17. 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 17

18. 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 18

19. There is no cure for stuttering
Stuttering Treatment
There is no cure for stuttering 19

20. 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 20

21. 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 21

22. 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 22

23. Stuttering Treatment Issues for the child with beginning stuttering
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 23

24. Stuttering Treatment Phases of treatment Establishment of fluency
Transfer of fluency skills
Maintenance of fluency 24

25. Stuttering Treatment Other approaches
Use of devices to alter auditory feedback
Medications
Self help groups 25

26. For more information Helpful Websites Stuttering Foundation of America
National Stuttering Association 26