Stuttering

Stephen M. Tasko Ph.D. CCC-SLP Associate Professor Speech Pathology and Audiology Western Michigan University http://homepages.wmich.edu/~stasko/

Some questions

• What is stuttering?

• What is disfluency?

• Are they the same thing?

Disorders of fluency

•

(Developmental) Stuttering

• Neurogenic Stuttering • Psychogenic Stuttering • Cluttering

Features of Stuttering

Core Features • Repetitions of – Sounds – Syllables – Words – Phrases • Prolongation of – Sounds – Silence (blocks or tense pauses)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stuttering Treatment

There is no cure for stuttering

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

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

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

Stuttering Treatment

Issues for the child with beginning stuttering • Issues – 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

Stuttering Treatment

• Phases of treatment – Establishment of fluency – Transfer of fluency skills – Maintenance of fluency

Stuttering Treatment

Other approaches • Use of devices to alter auditory feedback • Medications • Self help groups

For more information

Helpful Websites • Stuttering Foundation of America – http://www.stutteringhelp.org/ • National Stuttering Association – http://www.nsastutter.org/