Stuttering Stephen M. Tasko Ph.D. CCC-SLP Associate Professor Speech Pathology and Audiology Western Michigan University http://homepages.wmich.edu/~stasko/ 1

Some questions What is stuttering? What is disfluency? Are they the same thing? 2

Disorders of fluency (Developmental) Stuttering Neurogenic Stuttering Psychogenic Stuttering Cluttering 3

Features of Stuttering Core Features Repetitions of Sounds Syllables Words Phrases Prolongation of Silence (blocks or tense pauses) 4

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 5

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 6

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 7

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 8

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 9

HOWEVER, A LARGE PERCENTAGE DO NOT FALL INTO ANY OF THESE GROUPS 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 10

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 11

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 12

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 13

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 14

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 15

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 16

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 17

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 18

There is no cure for stuttering Stuttering Treatment There is no cure for stuttering 19

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 20

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 21

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 22

Stuttering Treatment Issues for the child with beginning stuttering 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 23

Stuttering Treatment Phases of treatment Establishment of fluency Transfer of fluency skills Maintenance of fluency 24

Stuttering Treatment Other approaches Use of devices to alter auditory feedback Medications Self help groups 25

For more information Helpful Websites Stuttering Foundation of America http://www.stutteringhelp.org/ National Stuttering Association http://www.nsastutter.org/ 26