Stuttering: an overview

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Stuttering an overview
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Parameters of Speech FluencyStarkweather (1987)

• Continuity
• Logical sequence
• Pausing
• Rate
• Duration and Coarticulation
• Effort
• Linguistic planning
• Muscle movement

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Distinguishing disfluency from dysfluency

• Normal disfluency can be distinguished from
  dysfluency on the bases of
• Frequency
• Quality
• Accompanying features (overt and covert)

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Normal disfluencies

• Normal disfluencies include
• Repetitions (of sounds, syllables, words and
  phrases)
• Prolongations (of syllabic elements, usually for
  emphasis, or to gain planning time)
• Unfilled pauses or hesitations
• Filled pauses
• Revisions

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Fluency and dysfluency

• A. There is a noticable lack of fluency in normal
  speech production. Goldman-Eisler (1968)
  estimated that filled and unfilled pause time
  averaged 40-50 of overall speaking time in
  picture description tasks.
• B. There is some evidence that these disfluencies
  are necessary to allow on-line speech production.
• 1. Beattie Bradbury (1979). When subjects
  paused for more than 600 msec. in story-telling,
  a light went on. Subjects were told that it
  indicated poor story-telling. Pauses decreased by
  35, but repetitions of words and syllables went
  up 104, while the narrative quality declined as
  well.
• 2. Lindsley (1976). It took his subjects reliably
  longer to initiate a noun-verb sequence than a
  simple noun when describing pictures. Subjects
  need to plan ahead a certain distance, and need
  planning time to accomplish this.

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Fluency and disfluency (continued)

• 3. Beattie (1983) has noted gaze aversion during
  disfluencies, suggesting that the speaker is
  preoccupied with planning and cannot be
  distracted by eye contact.
• 4. Eye gaze patterns in normal speech In most
  American dialects, speakers may look away, while
  listeners should look at the speaker (Mayo,
  1967). What are the ramifications for variations
  in this pattern?

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Fluency and disfluency (continued)

• C. Patterns of pauses and disfluencies (loci
  studies)
• 1. They are quite reliably located a major
  constituent boundaries, with the exception of
  those occurring before abstract or infrequent
  lexical items. Some have suggested that filled
  pauses are usually used for syntactic planning,
  while unfilled pauses usually precede lexical
  search. (Maclay Osgood)
• 2. Beattie (1983) suggests that the macro-unit
  for discourse processing may be as large as eight
  clauses in length, because disfluencies tend to
  rise and fall in about eight-clause cycles.

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Fluency and disfluency (continued)

• 3. Factors which tend to aggravate normal
  fluency
• a. stress
• b. high cognitive loading
• c. increased linguistic/syntactic demand -
  especially true in children
• d. fatigue
• e. speed

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Cardinal features of stuttering

• Part-word repetitions
• In normally fluent speech, incidence of lt2, lt10
  of all disfluencies
• In stuttering gt2 incidence, and 50-75 of
  disfluencies
• In normally fluent speech, lt2 repetitions in
  stuttered speech gt2 repetitions
• Repetitions accompanied by tenseness, rapidity,
  disrhythmia, schwa vowel, awareness

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Cardinal features (continued)

• Prolongations
• Longer in stuttered speech
• On elements not typically prolonged in fluent
  speech
• Not used for planning or emphasis
• Blocking (virtually unique to stuttering)

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Stuttering DEVELOPS and changes over time

• Stuttering at onset may be very different from
  what it becomes as the child grows and develops
  coping strategies to deal with stuttering and the
  reactions s/he gets when talking

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Exercise comparing normal and stuttered
disfluencies

• Listen to the following samples and follow along
  on the transcripts
• What features are common to both speakers?
• What features distinguish the two speakers?

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Mike

• Interviewer What do you think the Presidents
  top priority should be this year?
• M Uh, the economy. I think if uh the -- I think
  if you solve a lot of the uh economic problems
  youll solve a lot of other problems, you know
  uhyou know, when economics or when the when
  people are out of work, dont have money, crime
  goes up, drug use goes up. Uh I think you have
  you know a psychological type of disorders go
  up..You know, people become a little bit
  anxious, and I think..if you solve that if you
  can help rel uh resolve that problem I mean
  youll help solve a lot of other problems. You
  know, we we wont be as tight with other people.
  I n- not tight, tight in the sense of money,
  you know, youyou know, people areright now, you
  know, why give money to this country why do
  this you know for these people why do this for
  that? And you know, I- its the reason is
  because they dont have a job or theyre afraid
  theyll lose their job and there wont be money
  for them if they have to collect or you know,
  that that type of uh anxiety.

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Tom

• That's possible, yeah.
• But I've gone through all kinds of programs and
• I've read up on what I think that how stuttering
  can sometimes be cured through psychological
  counseling.
• So when I read that it's like , 'Oh yeah that's
  the new hope
• I'm just that way because of my past failures.
• I know, but it's just that I tend to look forward
  rather than dwell in the present which isn't
  always good.
• Well, let's see
• I would say being called on in class or being
  where a teacher would say, 'Let's go in a circle
  for group discussion'
• And he starts on the opposite side of the room
• and I just happen to be the last one.
• That's the worst case.

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Accessory behaviors (secondaries)

• Usually appear later in development
• Appear learned and reactive
• Differ from PWS to PWS
• May include
• Physical concomitants
• Tension and tremor
• Anticipatory behaviors, postponements
• Timing devices
• Escape behaviors
• Breathing irregularities
• Circumlocutions

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How do secondary behaviors develop?

• Classical conditioning
• Operant conditioning

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Classical conditioning
Unconditioned stimulus (UCS) Exs
Food Frustration, Critical Listener
Unconditioned response (UCR) Exs
salivation Tension response
Conditioned stimulus (CS) Exs bell, easy
stuttering
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Chaining of stimuli in stuttering
CR Tension response, tense stuttering
CS Easy stuttering
Tension on initiation of utterance
CS Sounds Words People Situations, etc.
Silent blocks
Anticipation
Fear, physiological correlates
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Instrumental conditioning
(Increases response)
Stimulus Sit!
Response (Dog sits)
Consequence Treat
Secondaries Loss of eye contact Head
nod Filler Word substitution
Struggle, tension
Escape Release from the moment of stuttering
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Combining classical and instrumental conditioning
in stuttering
S
R
C
CS Sound, Word, Situation. people
Escape from negative emotion
Avoidance Behavior (ex word substitutions,
silence)
CR Fear
Instrumental conditioning
Classical conditioning
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Covert features

• Speaking fears (including fears of situations,
  addressees, targets)
• Fear of stuttering
• Avoidance
• Shame, guilt
• Belief systems

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What is stuttering? The ABCs
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The As and Cs of stuttering in pictures
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What does stuttering sound like, look like, feel
like?

• See some examples of what stuttering
• Sounds like
• Looks like
• Feels like
• At the StutteringHomePage
• http//www.mankato.msus.edu/dept/comdis/kuster/aud
  io.html

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Impairment, disability and handicap in stuttering
(ICIDH Yaruss Quesal)

• Impairment any loss or abnormality of
  psychological, physiological, or anatomical
  structure or function.
• In stuttering interruptions in the flow of
  speech
• Disability any restriction or lack of ability
  to perform an activity in the normal manner
• In stuttering limitations on the individuals
  ability to communicate or engage in social or
  vocational activities
• Handicap a disadvantage for an individual,
  resulting from and I or D that limitsthe
  fulfillment of a role that is normal..for that
  individual.
• In stuttering disadvantages experienced by the
  PWS that limits his/her ability to fulfill
  social, vocational or economic roles.

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Stuttering Impairment, Disability and Handicap
(Yaruss)
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Stuttering doesnt have to handicap some famous
examples
For more examples of PWS who have made a
difference, go to the Stuttering Home Page.
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Exercise Observing stuttering

• Making behavioral observations
• Actions or speech that are directly observed
• Observations should not reveal judgments,
  interpretations or opinions
• Examples
• The client repeated the /t/ sound three times on
  the word time.
• The client stated that her father stutters but
  that the subject of stuttering was not discussed
  at home.
• The client grimaced and said, This is boring.

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• Making inferences
• The observers interpretation of the observation.
• These may vary from observer to observer and will
  be influenced by the observers beliefs, past
  experiences, values, culture, training, etc.
• Examples
• The client demonstrated a core stuttering
  behavior
• The clients father experiences guilt and shame
  regarding his stuttering
• The clinicians materials and pacing were not
  appropriate to the clients age.

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Observations and inferences

• What core and secondary behaviors did you
  observe?
• What feelings and attitudes were expressed? How?
• What other aspects of the nature of stuttering
  were revealed in the video clips?

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The typical typology of stuttering symptoms

• Where stutters are typically found
• On utterance-initial syllables
• Initial consonants
• Words earlier in the utterance
• Longer, less frequent words of the language
  (adults)
• Shorter, function words (children)
• The consistency effect
• The adaptation effect

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Conditions which reduce the frequency of
stuttering

• Delayed auditory feedback (DAF)
• Frequency altered feedback
• Slowed speech
• Shadowing
• Singing
• Rhythmic speech
• Choral reading
• Lipped speech
• Whispering
• Why do you think these reduce stuttering? What
  are some common features of these adjustments to
  normal speech style?
• Question can these be used as therapy techniques?

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Conditions which tend to INCREASE stuttering

• Fear of stuttering/speaking
• Expectancy
• Time pressure
• Status gap/number of addressees
• Propositionality, linguistic and cognitive load
• Learned associations
• Other listener reaction variables
• What do these have in common with conditions that
  aggravate normal disfluency?

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Specific examples of conditions that tend to
increase stuttering severity

• Speaking on the telephone
• Saying ones own name
• Telling jokes
• Repeating a misunderstood message
• Waiting to speak
• Speaking in front of authority figures, audiences
• Hiding/avoiding stuttering (trying to be fluent)

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Stuttering Incidence and prevalence

• Incidence is 4, prevalence is 1
• Implications for recovery
• Implications for treatment
• Most common type is developmental and ideopathic,
  beginning between 2-4 years of age
• Later or adult onset is rare, usually accompanied
  by neurological insult or psychological trauma
  however, some late childhood onsets are
  unexplained.
• Newer data (Yairi, et al., 1996 Kloth, et al.,
  1995) suggest median onset age of 30-38 mos.

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Gender and fluency

• Boys are 3-4 times more likely to stutter than
  girls this imbalance increases with age
• Gender differences are less at onset, but girls
  appear to recover more frequently (Yairi, et al.,
  1996)

Yairi and the UI,U-C Research team
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Genetics and stuttering

• First degree relatives of PWS more than 3x more
  likely to stutter than general population
• 35 of sons of female PWS will stutter
• 17 of daughters of female PWS will stutter
• 22 of sons of male PWS will stutter
• 9 of daughters of male PWS will stutter
• Patterns of chronicity and recovery also appear
  to be inherited (Yairi, et al.), although
  severity and typology are not.

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Twin studies

• There is 77 concordance between monozygotic
  twins for stuttering
• Lack of full concordance does suggest possible
  environmental contributions
• What is environmental?
• Dizygotic twins have a 32 concordance rate,
  while non-twin siblings have an 18 concordance
  rate.

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Recovery from stuttering

• 80 of stuttering spontaneously resolves before
  age 16 however,
• The window for recovery appears best within 2
  years of symptom onset (Yairi, et al., 1996)
• Recovery at older ages diminishes in frequency,
  to less than 20 by age 10 (Andrews, et al.,
  1983) Ramig (1993) suggests this rate is even
  lower after age 8.

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Stuttering terminology

• Stuttering has an extensive lexicon to describe
  symptoms, features, theoretical models, treatment
  approaches, etc.
• See an online listing, with definitions

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Keeping up with the stuttering literature

• To search the latest developments In stuttering,
  or research your project/paper, go to
• http//www.ncbi.nlm.nih.gov/PubMed/
• (PubMed)
• Remember that ASHA journals are now on-line! (If
  you are not a NSSHLA member, join now!)
• Remember to distinguish between information found
  on the web, and peer-reviewed data.
• Do statistics confuse you? Here is a readable
  tutorial on how to read the stats in research
  articles
• Good lay sites to introduce yourself and your
  clients to information about stuttering
• http//www.stutteringhomepage.com
• NSA and SFA websites
• http//www.nspstutter.org/
• http//www.stuttersfa.org