1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1 Introduction to Stuttering

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Words We Use “People who stutter” preferable to: –Stutterer –PWS Disfluency –“Disfluency” = either normal or abnormal –“Disfluency” is preferable to “dysfluency”

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Do All Cultures Have Stuttering? Yes. Stuttering is ancient and universal.

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins What Causes People to Stutter? The causes of stuttering are not completely understood, but scientists believe these are important factors: –Genetic and congenital influences –Developmental influences –Environmental influences Repeated negative emotional experiences with stuttering lead to negative feelings and attitudes

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Contributing to Stuttering

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions Fluency versus disfluent speech

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions (cont’d) Starkweather (1980, 1987) suggests that rate and effort are critical to fluency Thus, a fluent speaker effortlessly produces speech at a rate comfortable to listeners

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stuttering: General Description Stuttering = abnormally high frequency and/or duration of stoppages in the flow of speech Stuttering also includes speakers’ reactions to stoppages These reactions include behavioral, emotional, and cognitive responses to repeated experiences of getting stuck while talking Need to distinguish between stuttering and typical disfluencies, as well as from neurogenic and psychogenic stuttering

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Core Behaviors Repetitions: May be single-syllable word or part-word repetitions –Word or syllable may be repeated more than two times, li-li-li-like this Prolongations: Sound or airflow continues but movement of articulators is stopped –Prolongations as short as one-half second may be perceived as abnormal

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Core Behaviors (cont’d) Blocks: inappropriate stoppage of airflow or voicing; movement of articulators may be stopped –Blocks may occur at any level – respiratory, laryngeal, and/or articulatory –Blocks may be accompanied by tremors of lips, tongue, jaw, and/or laryngeal muscles –On average, stutterers stutter on about 10 percent of the words while reading –On average, stutters last about one second

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Secondary Behaviors Secondary behaviors are learned behaviors that are triggered by the experience of stuttering or the anticipation of it Escape behaviors occur when the speaker is stuttering and attempts to terminate the stutter and finish the word (ex. Eye blinks and head nods) Avoidance behaviors occur when the speaker anticipates a stutter and tries to avoid it by, for example, changing the word or saying “uh”

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Feelings and Attitudes The experience of stuttering often creates feelings of embarrassment and frustration in a speaker Feelings become more severe at the speaker has more stuttering experiences Fear and shame may develop eventually and may contribute to the frequency and severity of stuttering Attitudes are feelings that have become more permanent and affect the person’s beliefs Beliefs may be about oneself or listeners

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Disability and Handicap The disability of stuttering is the limitation it puts on individuals’ ability to communicate This limitation is affected by the severity of stuttering as well as stutterers’ feelings and attitudes about themselves and how listeners have reacted to them The handicap is the limitation it puts on individuals’ lives This refers to the lack of fulfillment they have in social life, school, job, and community

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Facts and Their Implications Onset –May start as gradual increase in normal childhood disfluencies or may start as sudden appearance of severe blocks –Often sporadic at outset, coming and going for periods of days or weeks before becoming persistent –Onset may occur between 18 months and 12 years but most often between 2 and 3.5 years (average 2.8 years) Prevalence –A measure of how many people stutter at any given time –Prevalence is 2.4 percent in kindergarten, about 1 percent in school-age children and slightly less than 1 percent in adults

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Facts and Their Implications (cont’d) Incidence –A measure of how many people have stuttered at some point in their lives –About 5 percent Recovery without treatment –Somewhere between 70 and 80 percent of children who begin to stutter recover without treatment

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Facts and Their Implications (cont’d) Children with these attributes have less likelihood of spontaneous recovery (Yairi & Ambrose, 2005): –Having relatives who were persistent stutterers –Being male –Onset after 3.5 years –Stuttering not decreasing during first year after onset –Stuttering persisting beyond one year after onset –Multiple unit repetitions (li-li-li-li-like this) –Continued presence of prolongations and blocks –Below normal phonological skills

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Facts and Their Implications (cont’d) There is also evidence that recovery is associated with: –Being right-handed –Growing up in a home with a mother who is non-directive and uses less complex language when speaking to child –Having a slower speech rate and more mature speech motor system

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sex Ratio The sex ratio is almost even (1:1) at the onset of stuttering However, girls start to stutter earlier than boys and recover more frequently so that by the time they are of school age, the ratio becomes three boys to every girl who stutters and continues at a 3:1 ratio Girls begin to stutter earlier than boys and recover earlier and more frequently

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Variability and Predictability of Stuttering In the 1930s, interest in stuttering turned from its medical or organic aspects to social, psychological, and linguistic aspects Anticipation: Stutterers can predict which words they will stutter on in a reading passage Consistency: Stutterers tend to stutter on the same words each time they read a passage Adaptation: Stutterers stutter less each time they read a passage up to about six readings

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Language Factors Brown showed that adults who stutter do so more frequently on: –Consonants –Sounds in word-initial position –Sounds in contextual speech –Nouns, verbs, adjectives, and adverbs –Longer words –Words at beginnings of sentences –Stressed syllables

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Language Factors (cont’d) Loci and frequency of stuttering are different in preschool children Stuttering in preschool children occurs most frequently on pronouns and conjunctions (these occur frequently at the beginning of utterances in young children) Stuttering most frequent as repetitions of parts of words and single-syllable words in sentence-initial position In summary, because stuttering in preschoolers tends to occur at beginning of syntactic units, the trigger seems to be linguistic planning and preparation

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fluency-Inducing Conditions Many conditions have been found which reduce or eliminate stuttering. These include speaking: –When alone, when relaxed –In unison with another speaker –To an animal or infant –In time or a rhythmic stimulus or when singing, in a different dialect –While simultaneously writing, while swearing –In a slow, prolonged manner –Under loud masking noise, while listening to delayed auditory feedback –When shadowing another speaker, when reinforced for fluent speech

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fluency-Inducing Conditions (cont’d) Fluency-inducing conditions have been explained as resulting from reduced demands on speech-motor control and language formation (Andrews et al., 1982)

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Facts about Stuttering Imply the Following Stuttering is an inherited or congenital disorder It first appears when children are learning the complex coordinations of spoken language It emerges in those children whose speech production system is vulnerable to disruption by competing demands of language, cognition, and emotion After it emerges, it becomes persistent in some children – perhaps those whose stuttering arouses substantial negative emotion which leads to a variety of learned behaviors

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins A Model of Stuttering Disorder of neuromotor control of speech Influenced by language production Perpetuated by temperament and complex learning, and the response of their environment to their speech