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2. STUTTERING

3. What is Fluency Disorder?
Some questions
What is Fluency Disorder?
What is stuttering? 3

4. Two essential characteristics:
Fluency Disorders
Two essential characteristics:
Disturbance in the normal fluency and timing patterns of speech
Disturbance in social communication, academic performance, or occupational achievement

5. What Is Stuttering?
An impairment of speech and language production, typically characterized by interruptions in the forward flow of speech (“speech disfluencies”)

6. (Developmental) Stuttering Neurogenic Stuttering
Type of Stuttering
(Developmental) Stuttering
Neurogenic Stuttering
Psychogenic Stuttering 6

7. Features of Stuttering
Core Features
Repetitions of
Sounds
Syllables
Words
Phrases
Prolongation of
Silence (blocks or tense pauses) 7

8. 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 8

9. 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 9

10. How Does Stuttering Develop?
Typically begins between ages 3 and 5
As the disorder progresses, children are likely to develop reactions to stuttering...
Tension and struggle in their speech musculature
More advanced types of speech disfluencies
Concern or anxiety about their speaking abilities
These reactions can have profound social, emotional, and educational consequences

11. 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 11

12. Psychogenic Stuttering
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
Stuttering in response to emotional trauma or stress 12

13. Prevalence: 1 in 100 persons
Prevalence and Incidence
Incidence: 5 in 100 persons
Males are affected at a higher rate than females (approximately 3:1)
Prevalence: 1 in 100 persons
Affect children between the ages of two and 10 years at the highest rates

14. Causes and Risk Factors
For the majority of children, stuttering begins for no apparent reason
Hard to identify, because results from complex interaction of two types of factors:
Predisposing: individual’s constitutional factors that make him susceptible to a fluency disorder (70% of likelihood)
Precipitating: developmental and environmental factors that can worsen stuttering (30%)

15. Family history: tendency to run in families, and genetic link seen in twin studies
Gender: boys are more likely to develop a fluency disorder and slower to recover
Processing ability: underlying problem with linguistic processing (demand and capacity model)
Motor-speech coordination: difficulty in coordinating and timing the motor activities required for fluent speech
Predisposing Factors

16. Precipitating Factors
Age: average age of emergence is 3 years for boys and 2.5 years for girls
Development stressors:
Stressful adult speech models: children exposed to adult speech not appropriate for their own speech, language, and cognitive abilities
Stressful speaking situations for children: competing or hurrying to speak, having too many things to say
Stressful life events: moving, divorce of parents, loss of family member, illness, or accident
Self awareness: atypically high awareness of own disfluencies
Precipitating Factors

17. Who Is At Risk for Chronic Stuttering?
Much greater frequency of disfluencies
Who Is At Risk for Chronic Stuttering?
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)
- Selected aspects of the communicative environment
- Selected aspects of the child’s overall speech/language development
Lack of rhythm in disfluency
More “adult-like” patterns that include increased level of awareness, fear and frustration

18. 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 18

19. How does we assess stuttering?
Referral
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 19

20. Important for other professionals to recognize warning signs and make referrals to SLPs
Warning signs for developmental fluency disorders:
Repetition of words or parts of words that involve 3 or more repetitions, prolongation of a sound, feelings of frustration or embarrassment towards communication
Warning signs for acquired fluency disorders:
“stuttering-like” or “cluttering-like” disfluencies, inability to effectively communicate
Referral

21. How are Fluency Disorders Identified?
Determine if the quality and/or quantity of disfluencies significantly differ from normal
Quantity: two common metrics
Average # of disfluencies per 100 words
Average # of disfluencies per 100 syllables
Quality:
Normal: interjection and revisions predominate
Disordered: repetitions, prolongations, and blocks predominate

22. Diagnosis
More likely to be diagnosed if the following ??? are observed during assessment:
At least 10 total disfluencies per 100 words
At least 3 total “stuttering-like” disfluencies per 100 words
Physical escape behaviors
Verbal avoidance behaviors
Also need to determine the severity, prognosis, and treatment recommendations

23. Recovery from Stuttering
Difference between prevalence and incidence rates indicate that the majority of persons (perhaps 80%) who exhibit fluency disorders do recover
Raises question concerning need for treatment (i.e., to treat or to wait and see)

24. Early intervention vs. “wait and see” approach
Three reasons why treatment is necessary:
Children who recover from stuttering often do experience stuttering for a relatively long time
No way to know whether children will eventually recover or not
Relatively high rate of co-occurring speech and language problems that exist beyond fluency disorder

25. A Critical Period for Recovery from Stuttering
If children do not recover by age 6 or 7, they are likely to develop chronic stuttering
Older children rarely achieve normal fluency, and the negative consequences increase over time
Negative social and emotional consequences can be minimized with appropriate early intervention

26. Treatment Approaches
Speech therapy
medication

27. Speech therapy Helping children learn to speak more fluently
Changing the timing and tension of speech production
Helping parents learn to facilitate children’s fluency in everyday speaking situations
Parents can change their own speech and manage children’s speaking situations to help them speak fluently

28. Medication Theoretical Rationale
Studies have shown that the use of medication is effective in reducing stuttering due to dopamine blocking medications
Reduction of stuttering results in decreased anxiety which lessens the amount of medication needed

29. Medications/Drug Treatments
Risperidone
Olanzapine
Pagoclone
Alprazolam
Citalopram
Haloperidol
Appear to make some PWS more fluent, but most eventually discontinue because of unacceptable side effects such as drowsiness and nausea

30. Recommend? We do NOT recommend this approach
Lack of research on effectiveness
Long-term side effects are unknown
Medications are costly
Generalization is unknown

31. Reference
Stuttering. American Speech-Language-Hearing Association. Accessed July 21, 2014.
Childhood-onset fluency disorder (stuttering). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; Accessed July 21, 2014
The facts. Stuttering Foundation of America. Accessed July 21, 2014