1. Self Help and Support Groups Provides a supportive environment to discuss issues related to stuttering Common Goals – Emotional support – Opportunities to socialize – Education Stephen M. Tasko

2. National Stuttering Association Mission Statement The National Stuttering Association is a non-profit organization dedicated to bringing hope and empowerment to children and adults who stutter, their families, and professionals through support, education, advocacy, and research. Programs/Groups NSA Adult: adult groups TWST: Teens who Stutter NSA Kids: children and parents Stephen M. Tasko http://www.nsastutter.org/index.html

3. Acquired stuttering Stephen M. Tasko

4. Acquired Stuttering Neurogenic stuttering Psychogenic stuttering Stephen M. Tasko

5. Neurogenic Stuttering (NS) Relatively rare Separate from aphasia, dysarthria, apraxia Secondary to stroke, TBI, and progressive disorders NS observed following lesions to – Left and right hemisphere – All lobes except occipital lobe – Cortical and subcortical (BG; thalamus) structures Bilateral considered more likely to result in persistent stuttering Observations of – Lesions resulting in “recovery” of stuttering in developmental stutterers – Lesions resulting in re-emergence of stuttering in “recovered” stutterers NOTE: A sudden onset of stuttering that is inconsistent with the onset pattern of developmental stuttering should warrant further investigation for the possibility of a neurological event (i.e. referral). Stephen M. Tasko

6. Neurogenic Stuttering: Features Part-word or phoneme repetitions dominate No patterns related to word type Not restricted to initial words No syllable stress effect Lack of anxiety, tension or secondary symptoms Can exhibit very high frequency of disfluency Less responsive to fluency-enhancing conditions Stephen M. Tasko

7. Neurogenic Stuttering: Treatment Must consider co-existing speech and language disorders Spontaneous recovery does occur Traditional fluency treatment may assist some clients, but results are highly variable Stephen M. Tasko

8. Psychogenic Stuttering Stuttering secondary to emotional trauma or stress Characteristics 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 Mimed reading also shows stuttering Stephen M. Tasko

9. Cluttering Stephen M. Tasko

10. Definitions of Cluttering Weiss (1964) – “Cluttering is a speech disorder characterized by the clutterer’s unawareness of his disorder, by a short attention span, by disturbances in perception, articulation and formulation of speech and often by excessive speed of delivery.…It is a disorder of the thought processes preparatory to speech and based on a hereditary disposition. Cluttering is the verbal manifestation of Central Language Imbalance, which affects all channels of communication (e.g., reading, writing, rhythm, and musicality) and behavior in general.” Stephen M. Tasko

11. Definitions of Cluttering Tiger, Irvine, and Reis, 1980 Configuration of symptoms in 4 areas (not all have all symptoms in each area) 1.Language disorders: reading, writing, speaking, and auditory comprehension 2.Speech disorders: fluency, prosody, articulation 3.Perceptual problems: visual-motor, auditory- perceptual disabilities 4.Lack of complete awareness of the disorders Stephen M. Tasko

12. Definitions of Cluttering St. Louis, 1992 – “Cluttering is a speech-language disorder, and its chief characteristics are (1) abnormal fluency which is not stuttering and (2) a rapid and/or irregular speech rate.” Stephen M. Tasko

13. Definitions of Cluttering Daly, 1992 – “Cluttering is a disorder of speech and language processing resulting in rapid, dysrhythmic, sporadic, unorganized, and frequently unintelligible speech. Accelerated speech is not always present, but an impairment in formulating language almost always is.” Stephen M. Tasko

14. Ten Significant Features of Cluttering: Expert Opinion (Daly & Cantrell, 2006) Characteristic 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; circumlocutions Language disorganized; confused wording Seems to verbalize before adequate thought formulation Agreement (%) 93 90 83 82 80 78 75 Stephen M. Tasko

15. Ten Additional Features Important for Diagnosis (Daly & Cantrell, 2006) Excessive “normal” disfluencies Does not repair mistakes Difficulty with words of increasing length/complexity Disfluencies not related to specific sounds/situations Cluttering co-occurs with ADHD Greater difficulty discriminating vowels. Rapid fire with poor articulation Irregular fast speech rate with spurts Unaware when communication breakdown occurs Unwilling to change or believe treatment is necessary Stephen M. Tasko

16. Motor vs. Linguistic Components Motor Components (Ward, 2006) Tachylalia Excessive coarticulation Articulation errors Lack of speech rhythm Monotone Festinant (accelerated) speech Fluency disruptions (w/o blocks & prolongations) Stephen M. Tasko

17. Motor vs. Linguistic Components Linguistic Components (Ward, 2006) Grammar and syntax Lexical level problems Pragmatics Stephen M. Tasko

18. Stuttering vs. Cluttering Pure cluttering considered relatively rare – Is it rare or do pure clutterers not seek treatment? Cluttering-stuttering more common – Clinical reports of about 1/3 of youngsters who stutter show signs of cluttering http://associations.missouristate.edu/ICA/Resources/Resources%20and%20links%20pages/clinical_materials.htm http://associations.missouristate.edu/ica/Resources/cluttering_assessment.htm#Self-Assessment http://associations.missouristate.edu/ica/cluttering_assessment_program.htm Stephen M. Tasko

19. Cluttering Treatment (From D. Daly, U of M) Self-awareness Most clutterers are unaware of their repetitions, deletions, and transpositions. Audiotape and videotape them to teach self monitoring. Be patient, but direct. Stephen M. Tasko

20. Cluttering Treatment Adjusting Speech Rate Tachylalia is common. Instructions to “slow down” are not helpful Explicit rate reduction techniques such as finger tapping to teach syllable stress. One word at a time approach; reading with a paper covering all but target word (Froeschels, 1964) Model desired behavior. Clinician must slow rate too. Stephen M. Tasko

21. Cluttering Treatment Articulation Articulation errors are common Delayed auditory feedback may be used to help clients “over-articulate” their slower rate of speech. Encourage client to “feel” tactile cues. Stephen M. Tasko

22. Cluttering Treatment Memory Poor memory abilities are common Practice telling and retelling stories trying to include more and more details Use sequence picture cards if necessary Daly suggests that such abilities can be enhanced Stephen M. Tasko

23. Cluttering Treatment Attention/Impulsivity Relaxation and visual imagery exercises may be useful for reducing impulsivity and distractibility. Attention deficits are common. Auditory comprehension activities found useful for learning disabled students or aphasic adults may be most appropriate for cluttering clients. Stephen M. Tasko

24. Cluttering Treatment Speech Rhythm Some clutterers have motor coordination, rhythm, and speech melody impairments. Exaggeration of various rhythmic/prosodic patterns of speech prosodic patterns may be helpful. Stephen M. Tasko

25. Cluttering Treatment Language Formulation Reading and writing difficulties are typical Use written language to aid with language formulation Help clients write a one paragraph story. Assistance may be needed to follow a train of thought. Reinforce generously. Read and discuss the “story.” Then try for a one page story. Patience and persistence are needed. Examination of written work may understand the clutterer’s language confusion. Stephen M. Tasko