1. STUTTERING

2. WARNING SIGNS FIRST THREE INDICATORS-disturbance in speech production -Multiple repetitions, especially parts of words or first syllables -Use of schwa vowel that delays or disrupts flow of speech -prolongations- especially first sound LAST FIVE INDICATORS WHEN CHILD REACTS TO INTERRUPTIONS IN THEIR SPEECH -tremors -rise in pitch and loudness -struggle and tension with lips and throat -moment of fear when the child can’t say a word correctly -avoidance of a word the child cannot say without stuttering

3. CAUSES Cerebral dominance theory: predisposition to stutter; neither side of the brain is dominant in controlling motor activities involved in talking Biochemical/Physiological Theories: Inherited predisposition and Physiological related to epilepsy problems with phonation, respiration, and articulation

4. Cont. Approach-avoidance conflict: stutterer desires to talk and be silent; anxiety builds up and conflict is manifested in stuttering Anticipatory-struggle theory: diagnosis of “stuttering” is made by the parents based on normal developmental dysfluencies which creates an environment of “difference”; child begins to speak abnormally in response to the parents’ anxieties, help, and corrections

5. Cont. Auditory Monitoring Theory: stutterers hear themselves differently Psychoneurotic theory: stutterer has some unconscious need that he/she has difficulty expressing, therefore represses; creates conflict which results in stuttering Learning theory: operant conditioning-as a reaction to other people’s reaction, frustration builds effort to decrease dysfluent behavior and creates child to become a stutterer

6. PHASES OF STUTTERING Stage 1 (preschool years 2-6) Most dysfluent at age 3-4 Dysfluencies usually begin with initial sound/syllable repetition, word repetitions, and pauses Chis is usually not aware of the dysfluency and not bothered by it Stuttering usually occurs at the beginning of a sentence, clause, or phrase on both content and function words Stage 2 (elementary school age) Core behavior is established Begin to see “struggle behavior Speech is forced and prolonged Child is still not avoiding talking Stuttering is more chronic, less periods of fluent speech Occurs primarily on content words and increases under periods of excitement

7. Stage 3 (8- young adult) Avoidance of stuttering Child is aware of dysfluent behavior Begins to build up strong aversions to certain words (certain words are regarded as more difficult than others) Anticipate trouble; attempt to circumlocute, delay, or put off words Begin to have difficulty speaking with certain people (e.g. teachers, parents, people with authority) Stage 4 (most advanced form) Associate feelings Self-esteem decreases Fear and anxiety Child now identifies him or herself as a stutterer

8. TREATMENT AND THERAPY Fluency Shaping Techniques Goal is to reduce or eliminate stuttering 1. Change speed/timing patterns 2. Light articulatory contact 3. Pausing/phrasing Examples: Response contingent Stimulation, Gradual Increase in Length of Complexity of Utterance program, Lidcombe Program

9. Cont. Stuttering Modification Techniques Goal is to change type of disfluency while teaching one to react to his or her own stuttering calmly 3 techniques 1. Cancellations: stutter word, pause 3 seconds and repeat again slowly 2. Pullouts: once criterion for cancellations met, do this during actual stutter 3. Preparatory Sets: once pullout criterion met, do this in anticipation of stutter