Chapters 3 & 4 Flashcards
Questions regarding stuttering onset
When does it happen?
Who is affected?
How does it happen?
What happens?
When: Age at onset
Range: 16 - 60 months
Mean: 33.40 months
for boys: 33.60
for girls: 32.95
Average age they begin to stutter- 2 ½ years
*It is very rare for children to begin stuttering after 5 years of age. There are acquired and psychogenic stuttering disorders
When
56% of onsets occur between 24 to 36 months of age;
84% from 18 to 42 months
What: Nature of onset period
Sudden (1-3 days) 40%
Intermediate (1-2 weeks) 33%
Gradual (>2 weeks) 27%
Most cases are sudden or intermediate onset- troubling for the child if they are aware and for the parents
How: Manner of onset
30% the onset happens in one day
Majority of onsets are not gradual
What happens?
Disfluencies near onset
Stuttering-Like
Disfluencies (per 100 syllables)
Stuttering Children Normal Children
10.37 1.33
Stuttering-like disfluencies: Part-word repetitions Prolongations Blocks Monosyllabicword repetition
What: Secondary Characteristics
52% of children exhibit at least one: Facial contortions Eye closing Head tilting Respiratory irregularities Others
*Concomitant/accessory behaviors
Over half (52%) exhibit at least on secondary behavior when they begin stuttering
What: Stuttering severity at onset
Severity Mild
Clinicians 35%
Parents 45%
Severity Moderate
Clinicians 45%
Parents 27%
Severity Severe
Clinicians 20%
Parents 28%
Some kids do onset with severe stuttering, not always gradual or mild at onset
What: Reported stress at onset
Illness 14% Emotional upset 40% Behavioral stress 36% Rapid lang. develop. 40% Word finding problems 43%
*Rapid language development: they have a lot of internal drive to put new language together and may not be able to so there are breakdowns
What: Child’s Awareness & Reactions. Assessed through:
Parents’ reports
Children’s response to clinician probing
Puppet task: Child’s identification with fluent or non-fluent puppet
*Puppet task: one fluent one disfluent, ask child: which one is more like you?
What: Awareness
Some children exhibit awareness of, and reactions to, their stuttering soon after onset. Studies with the puppet method have indicated sharp rise in awareness between ages 4 and 5.
Development of Stuttering
Natural recovery
80% will recover even without treatment
Persistency
20% will persist
*In some cases, natural recovery trends occur soon after onset.
When was the onset? How long has this been going on?
80% chance of recover at onset, but if 2 years go by it is 57% chance of recovery
Persistence and Recovery: Gender
Males
Persistent 30%
Recovered 70%
Females
Persistent 18%
Recovered 82%
Male/female ratio
- 67m/f
- 89 m/f
*4:1 Males to females for the persistent people who stutter, not true for the recovered
Risk for persistency: Primary factors
Family History (#1 risk factor) Gender (boys) Stuttering trends Duration of stuttering (years stuttered) Age at onset (younger=better prognosis) Disfluency length Disfluency type; Prolongations/blocks
Risk for Persistency: Lesser factors
Secondary Severity Secondary characteristics. Phonology Expressive language Acoustic features
Tertiary
Concomitant disorders.
Awareness; Emotional reactions
*Severity has to be factored in but is not always predictive of persistency
Secondary characteristics- negative sign
Other disorders- worse prognosis
Analyze risk factors to get a sense of severity and prognosis for persistence but we ever really know
A family history of persistency gives a child a ____% chance of following the same trend.
A family history of recovery gives a child a ____% chance for the same trend.
65%
65%
The development of stuttering
Red flags
- Multiple small unit repetitions
- Prolongation, consistent sound
- Blocks, laryngeal tension- no air
- Respiratory irregularities
- Secondary behaviors
- Excess muscular tension, push harder and the whole system shuts down at the level or the larynx or the articulators
Disfluency Types
Part-word repetitions: a-ai; f-five; ba-baby
Single-syllable word repetitions: but-but; and-and
Multiple-syllable word repetitions (Typical): Because – because
Phrase repetitions (Typical): I was - I was going; Once up - once upon
Prolonged sounds: a»»ai like to go; S»»ometimes
Blocks & broken words: C (silence)–ake; The ta (silence)–able
Tense pause: I like to (silence)——go home (between words)
Interjections (Typical): um; uh; er; hmmm
Revisions (Typical): I like – I want this ball (same thought)
Incomplete utterance (Typical): The baby – let’s do…(change in thought
Stuttering-Like Disfluency
- Part-word-repetition
- Single-syllable word repetiton
- Disrhythmic phonation (prolongations and blocks)
Other disfluencies
Interjection
Multi-syllable word and phrase
Revision
Incomplete sentence
Why the term:Stuttering Like Disfluencies?
Two reasons:
SLD are much more typical and much more frequent in the speech of PWS
Listeners show a strong inclination to perceive these disfluencies as “stuttering.”
Sound prolongations: Duration tends to ______with age in PWS
Increase
Non-stuttering preschool 1.16 units Stuttering preschool 1.53-1.70 units Stuttering, school-age 2.45 units
Physical Concomitants
Head jerks Head turns (side; down) Forehead tension Nostrils flaring/constricted Eyes closed; squinting Eyes widely open Facial contortions Lips pressured Jaw closed tightly Teeth grinding Jaw wide open Sideways jaw movement Tongue protrusion Throat tightened Body swaying Hand/ arm movements Irregular exhalation (blowing) during speech Irregular inhalations (gasping) in the midst of speaking
*Can target reduction of secondary behaviors as a goal – need to learn tools to use then reduce behaviors utilizing tools
Emotional Reactions Vary in Time Relative to the Stuttering Event
Prior- Fear, dread, anxiety
During- blankness, trapped, panic, frustration
After- Shame, humiliation, anger, resentment
