1. Etiologies of Stuttering

2. Three Ps of Etiology Predisposing factors Precipitating factors
Perpetuating factors

3. Predisposing Factors
“What factors cause one person to be at greater risk than another for beginning to stutter?” (i.e., genetics)
“Nature vs. Nurture”

4. Precipitating Factors
Those agents thought to have made stuttering surface or those that brought it to its present state
Rapid growth in speech-language skills during the preschool years
Competition among siblings for attention and conversational turns
Social adjustments necessary when entering school settings

5. Identification and Interaction of Predisposing and Precipitating Factors
Factors are not static/rather are dynamic and changing
Do not always know the causal link between predisposing and precipitating factors and the occurrence of stuttering

6. Interactions Cont’d.
Child presents with a family history of stuttering (predisposing factor), stuttering began around the age of 3 years when his speech-language skills were growing rapidly, whose home routine was busy as both parents worked outside, and who was beginning preschool (precipitating factors)

7. Perpetuating Factors
variables that are continuing/maintaining stuttering
Certain environmental/physical factors may reinforce/perpetuate stuttering
Need to identify perpetuating factors
Criticism of speech
Inappropriate linguistic models
Unrealistic expectations
Experience of fluency failure
Negative feelings and attitudes
Vary with each individual
Simple or complex/ Subtle or obvious
Malleable or resistant to change

8. Stuttering as an Emotional or Psychological Problem
Neurotic Theories
Psychoanalytic explanations of stuttering held that stuttering satisfies oral or anal erotic needs or represents repressed hostility.
Stuttering is an attempt to suppress speech and is a symptom of a deep neurotic conflict.

9. Neurotic Theories Cont’d.
Flexible interpretation:
If the stutterer admits to, or is assessed as having personal problems, it is quickly assumed that his stuttering is a manifestation of these problems.
If the stutterer gives all appearance of being normal and well-adjusted, his “symptoms” (stuttering) can be interpreted as representing his “solution” to inner conflicts

10. Neurotic Theories Cont’d.
Clinical and research data do not provide strong support for the conclusion that stuttering is usually a symptom of a neurosis or other type of emotional disorder.
But they do not rule out the possibility that it is a symptom of such a disorder for some persons who stutter
Results of most studies indicate that stutterers are as well adjusted as their non-stuttering peers.
Stutterers are more similar to their non-stuttering peers than they are to persons who are known to be emotionally disturbed.

11. Factors contributing to Stutterers seeming less well adjusted
1. Attitudes toward speaking
2. less well adjusted as a consequence of living with stuttering.
3. not as outgoing.
4. avoid talking on the telephone.
5. Unwilling to express anger openly when doing so would be appropriate
6. may be depressed bc they’re trying to cope with stuttering.
7. Self persecution: failure to overcome stuttering viewed as their fault
8. They may over react to stuttering.
9. They may feel guilty about stuttering.
10. They may experience anxiety about speaking.

12. Characteristics of Stuttering and Non-stuttering Children
No significant difference in degree of
Dependency
Sensitivity
Shyness
Fears
Enuresis
Disturbing dreams
Ability to form relationships with peers
Mother-child relationships
Father-child relationships

13. Related Theories
Stuttering as communicative failure and anticipatory struggle behavior
Diagnosogenic theory-semantic theory-states that stuttering is caused by the parent’s or care giver’s misdiagnosis of and inappropriate reaction to normal disfluencies in a child’s speech, followed by the child’s attempts to avoid the disfluencies that are mistakenly assumed to render the child’s speech as abnormal.

14. Related Theories Cont’d.
The Continuity Hypothesis-proposed by Bloodstein-suggests that stuttering develops from normal disfluency that becomes tense and fragmented as the child experiences frustration and failure in attempts to talk.
Experiences that increase difficulty with speech
Criticism of normal disfluencies
Delay in speech-language development
Traumatic experience in oral reading
Cluttering
Reminders to “slow down”

15. Related Theories Cont’d.
Preparatory Set-Van Riper-stuttering emerges gradually from a child’s normal hesitations and repetitions.
Become chronic when the child begins to:
Anticipate, avoid and fear speech
Stuttering originates from environmental, organic, emotional sources

16. Stuttering as Learned Behavior
Stuttering as an avoidance response
Conflict theory of stuttering and avoidance reduction
Operant conditioning
Classical conditioning
Eclectic conditioning
Vicarious conditioning

17. Avoidance Reduction
Sheehan-viewed stuttering as resulting from a double approach-avoidance conflict between speaking and not speaking and between being silent and not being silent.
Stuttering is the result of “speech vs. silence”

18. Operant Conditioning
Speech is a behavior subject to operant control of positive and negative reinforcements and punishments.
Stuttering begins as “normal disfluencies” which are natural and understandable.
Initially, these disfluencies are reinforced through some schedule of positive reinforcement.

19. Operant Cont’d.
These conditions recur and become discriminative cues which control disfluencies
Positive reinforcement is replaced with punishment by the parent or significant someone when they begin to disapprove of the disfluencies.
The child develops negative emotions about speaking and begins to struggle with the nonfluencies

20. Classical Conditioning
Fluency failure explained by Brutten and Shoemaker
Stage 1-the speech features of stuttering are a “form of fluency failure” which is believed to be associated with a negative emotional state. (negative emotion causes initial fluency failure)
Stage 2-negative emotion and resulting fluency failure become linked to certain external stimuli through associative learning
Stage 3-there is an extension of the range of stimuli to which the negative emotional response becomes associated.

21. Classical Cont’d.
1. Does not assume that the original stuttering behavior was normal. Original disfluent behaviors are not normal.
2. Original fluency breaks consist of disorganized forms of previously integrated behaviors
3. Antecedents of stuttering are considered to be as important as its consequences

22. Eclectic Conditioning
Any combination of learning theories can be operating for the individual simultaneously

23. Vicarious Conditioning
The behavior of the person becomes conditioned as that person watches someone else being conditioned.

24. Organic Theories
Referred to as “Breakdown Theories” characterize the moment of stuttering as an indication of failure or breakdown in the complex coordination required for speech.

25. Breakdown Theories Cont’d.
Dysphemia-the stutterer is believed to be inherently different from the non-stutterer.
Stuttering is the joint product of hereditary predisposition and precipitating factors in the environment
Shock
Fright
Illness
Injury

26. Organic Theories Cont’d.
Cerebral dominance theory-Travis-postulated that a conflict exists between the two halves of the cerebrum for control of the activity of the speech organs
Also known as handedness theory
20’s and 30’s changed children’s handedness to correct stuttering

27. Cerebral Dominance Theory Cont’d.
Travis (1978) indicated “I have never disavowed the cerebral dominance theory as an explanation of the underlying basis of stuttering. I have; however, acknowledged publicly the futility of shifting handedness in its management.”
The conflict between the two hemispheres for the control of speech resulted in neuromotor disorganization and mistiming resulting in stuttering

28. Biochemical Theory
Adheres to the belief that the basic difference between stutterers and non-stutterers rests in metabolic factors and tissue chemistry.
West (1958)-concept of stuttering as a convulsive disorder related to epilepsy-called “pyknolepsy”

29. Perseveration Theory
Persons who stutter have an organic predisposition to motor and sensory perseveration of which stuttering is an outward manifestation.
Eisenson-stuttering is a transient disturbance in propositional language usage.

30. Stuttering –Brain Lesion
Stuttering involves changes in the interaction of laryngeal, supra-laryngeal, and respiratory reflexes
Implicates the brainstem as the site of lesion
Stuttering is the consequence of disruption of motor organization, timing, and control

31. Stuttering as a Result of Disturbed Feedback
Auditory function-questions regarding the basic integrity of the auditory system of stutterers have had a long history
Areas investigated
Dichotic listening-to determine hemispheric specialization for speech

32. Auditory Function Cont’d.
Acoustic reflex
Phase disparity
Central auditory function
All have been investigated to assess the effects of auditory feedback
Clinical results indicate that disruption in the auditory channel of a stutterer while speaking produces fluent speech

33. Cybernetic Theory
Closed-loop systems-behavior and physiological control interpret activity and learning as self-regulated processes rather than a series of stimulus-controlled reflexes or discrete stimulus-response units.

34. Closed loop systems cont’d.
Error sensitive, error measuring, self adjusting, goal-directed mechanisms which employ feedback of the output to the place of control

35. Feedback Model Ear=the sensor
Vocal organs + motor innervations=the effectors
Brain=the control

36. Feedback Systems
Speech-When errors occur, the system corrects itself by searching for the appropriate output until it is achieved
Stuttering-The feedback system used to monitor speech has too much distortion, interference, and overload.

37. Demands and Capacities Model
Child’s capacity-Fluent speech characterized by continuous production, without effort at an appropriate rate
Demands-pressure imposed on the child by listeners and himself
When the demands exceed the child’s capacities for fluent speech stuttering occurs

38. Capacities Capacities for fluent speech
1. speech motor control-rate of syllable production and coordination of movement
2. language formulation-word finding, formulation of grammatical sentences, and knowledge of conversational rules
3. social-emotional maturation
4. cognitive skill-general intelligence and metalinguistic skill

39. Demands
Those conditions that impose a pressure perceived by the child to speak at greater rate (i.e., faster) or with greater continuity (i.e., smoothness)
Demands increase with maturity and include time pressure, uncertainty, and avoidance

40. Linguistic Considerations
Research about linguistic aspects of stuttering and stutterers has contributed to concern over language development

41. Language-Stuttering Relationship
1. Some stutterers acquire language more slowly
2. Poorer auditory recall of linguistic information
3. Higher number of grammatical errors
4. Increased word length/increased stuttering
5. Stuttering occurs more on words of importance
6. Less stuttering with high word frequency
7. Repeating prosodic patterns reduces amount of stuttering

42. Summary and Synthesis
Factors increasing risk or predisposition for stuttering:
Gender
Age (majority between 2 and 5 years)
Family history
Socioeconomic status and nationality- middle and upper- middle class families and certain groups from Canada, Korea, and West Africa show greater risk
Twins
Mental retardation
Brain injury
bilingualism

43. Group Differences between Stuttering/Non-stuttering children
Greater likelihood to have a history of delayed articulation or language development
Poorer performance on verbal and motor tests of intelligence
Poorer school performance
Less left-hemisphere dominance for speech
Slower reaction times
Poorer recognition and recall of competing messages
Slower speech movements even during fluent speech

44. References Shapiro, D.A. Stuttering Intervention. Texas: Pro Ed., 1999
Gregory, H. H. Stuttering Therapy: rationale and procedures. Boston: Pearson Education, 2003