Fluency

Question 1

stuttered speech is

Answer 1

effortful, halting and discontinuous, and slow from excessive disfluencies.

Question 2

Secondary stutters: are

Answer 2

abnormal motor behaviors that accompany dysfluencies

Question 3

defining fluency with non-speech behaviours

Answer 3

Basing it on variables that are not specific to speech, such as:

Stuttering is not = dysfluency
Stuttering begins when children anticipate trouble in speaking situations → become apprehensive about maybe speaking → become tense → avoid.

Due to parental disapproval of normal dysfluencies.

Based on this, stuttering diagnosis is based on consistent avoidance of speaking situations.

What a person does to avoid stuttering (“normal dysfluencies”) and their negative consequences. Diagnosis **based on presence of speech avoidance. **

The person has a **problem with playing certain social roles **

Question 4

defining stuttering by types of dysfluencies

Answer 4

Basing it on which dysfluencies are present.
Van Riper: Stuttering occurs when the forward flow of speech is interrupted a motorically disrupted sound, syllable or word or by the speaker’s reaction”. Depending on the definition, some dysfluencies have clinical significance (e.g., part-word repetitions, sound prolongations) while others do not (e.g., whole word repetitions, interjections, pauses).
Van Riper’s definition includes the speaker’s reaction to the dysfluency

Question 5

defining stuttering by all types of dysfluencies

Answer 5

All Types of Dysfluencies
Basing it on if any dysfluency present.

What gives it clinical significance is excessive (1) frequency, (2) duration.

Question 6

defining stuttering by psychopathology

Answer 6

• based on a psychopathological cause or neurotic reaction (e.g. anxiety, frustration,, apprehension)
• not a foccus except for psychological reactions of PWS

Question 7

Etiology theories

Answer 7

Sound prolongation and part-word repetitions are due to (Pavlovian) classically conditioned negative emotion and are therefore is considered stuttering (Brutten and Shoemaker).

All other dysfluencies are non-pathological=operantly conditioned-Skinner

Cerebral dominance theory: people who stutter are less likely to have developed unilateral cerebral dominance (often ambidextrous)

Question 8

There is a certain percentage threshold of __ in speech that make a listener judge it as __; however, this differs based on __

%
%

Answer 8

dysfluencies ; “stuttered”; the type of dysfluency:

2% threshold for part-word repetitions and sound prolongations.
5% threshold for whole-word repetitions, schwa interjections

Question 9

2% threshold for

Answer 9

part-word repetitions and sound prolongations.

Question 10

5% threshold for

Answer 10

whole-word repetitions, schwa interjections

Question 11

Natural Recovery.

Answer 11

Natural Recovery. Rate changes on the study (i.e. the longer the study, the greater the rate); generally believed to be 88% and persists in 12%. (This includes without any strategy/coping mechanism - with professional help or not).

Question 12

incidence rate General Populations.

Answer 12

Approximately 8-10% lifetime incidence (i.e., at one point in their life), but less than a 1% prevalence.

Question 13

Gender.

Answer 13

M > F, with a 3:1 ratio, and becomes larger with age (i.e., girls tend to have more spontaneous recovery).

Question 14

Typically begins between

(however,

adult onset is

Answer 14

3-6Y

risk is generally over by 5Y);

rare, but could be neurogenic, psychogenic, or a reemergence of childhood stuttering.

Question 15

At stuttering onset, children may be dysfluent on

adults are typically dysfluent on

Answer 15

function words (e.g. pronouns, conjunctions, articles) and content words (adjectives, nouns, verbs, adverbs)

on content words

Question 16

normal fluency is

Answer 16

Speech that is effortless, flowing, smooth, continuous, relatively fast, rhythmic, and free from excessive disfluencies.

Question 17

normal disfluency

Answer 17

disfluencies we all have

Question 18

developmental dysfluency

Answer 18

dysfluencies during the developmental age range (2-4) as theyre rapidly developing their language
- esp part word repetitions and interjections

Question 19

• Diagnosis of stuttering may be made by using one of the several diagnostic
  criteria:
• A dysfluency rate that exceeds 5% of spoken words when all kinds
  of dysfluencies are counted
• A certain frequency of part-word repetitions, speech-sound
  prolongations, and broken words (at least 2% of the words spoken)
• Excessive duration of dysfluencies (1 second or longer)
• Presence of stuttering-like dysfluencies, at least at 3% of syllables
  produced

Question 20

types of direct treatment

Answer 20

1. Procedures to reduce frequency/severity of stuttering behaviours
   a. Contingency Management Strategies
   b. Fluency Shaping Strategies:
   c. Anxiety Reduction Strategies
   d. Stuttering Modification Strategies
2. Procedures to minimize or remove processes that may be maintaining stuttering behaviours
   a. Identify and manage external factors that reinforce stuttering or
   avoidance behaviours
   b. Identify and manage external factors or situations that are associated
   with increased stuttering
3. Procedures to facilitate transfer of new speech behaviours to daily
   communication situations
4. Foster maintenance

Question 21

Different Treatment of stuttering

Answer 21

• Psychological methods
• Fluent-stuttering method / stutter more fluently / stuttering modification
• Fluency shaping method / speak more fluently
• Fluency reinforcement method
• Masking and delayed auditory feedback techniques
• Direct stuttering reduction methods

Question 22

Neurogenic/acquired stuttering:
- may happen after-
- happens when theres __ problems ___(where)__
- etiologies

Answer 22

○ Neurogenic stuttering may happen after a stroke or brain injury.
○ It happens when there are signal problems between the brain and
nerves and muscles involved in speech.
○ Etiologies
■ Cerebral vascular disorders that cause stroke
■ RHD
■ Extrapyramidal diseases - parkinson’s
■ Drug toxicity

Question 23

Similarities between child onset and NG Stut.
disorders

Answer 23

• Resembles stuttering of early childhood onset but is associated with diagnosed neurological disorder(s)

Question 24

Positive signs or symptoms of
neurogenic stuttering that contrast with
stuttering of childhood onset include:å

Answer 24

• Repetitions of medial and final syllable in words
• Dysfluent production of function words
• Disfluencies in imitated speech
• Rapid speech rate
• General symptoms of brain injury

Question 25

Acquired psychogenic stuttering

Answer 25

○ Psychogenic stuttering is not common. It may happen after emotional trauma. Or it can happen along with problems thinking or reasoning. ○ Categorized as a conversion reaction

Question 26

Theories of stuttering

Answer 26

- Genetic - Neurophysiological - Brain dysfunction hypotheses - Learning, conditioning, and related hypotheses - Stuttering is a learned, operant behaviour - Mismatch hypotheses - environmental demands placed on a child exceed their capacity of fluency

Question 27

Cause & does Cluttering coexist with other disorders?

Answer 27

Often co-exists with stuttering, fluency disorder ○ The cause of cluttering seems to be largely unknown, however, cluttering co-occurs with various other conditions (e.g. learning disabilities, auditory processing disorders, Tourette’s syndrome, ASD, ADHD)

Question 28

○ assessment/treatment of cluttering - what you look at

Answer 28

much like stuttering of early childhood onset with an emphasis on its special features - (excessive rate and rate variations, - articulatory breakdowns and speech intelligibility, - prosodic variations, - lack of concern, etc. ○ ellipse → omission of sounds, syllables and words

Question 29

Cluttering characteristics

Answer 29

○ Rapid but disordered articulation → unintelligible speech ○ Rate variations ○ Impaired prosodic features with frequent pauses ○ Impaired fluency (often word and phrase repetitions, interjections and revisions) ○ Omission and compression of sounds and syllables ○ Jerky/stumbling rhythm ○ Monotonous tone ○ Spoonerisms "hissed the mistory lectures" ○ Disorganized language production and thought process ○ Lack of concern/reduced awareness of difficulties → less anxiety MEMORY TOOL: clutz, tripping over his words w/ a spoon in his hand and jerky in the other cz he's going too fast, but doesn't care, and ppl dont understand him but he doesnt care cz hes kinda a jerk[y] & monotone & unintellig

Question 30

Cluttering vs Stuttering

Answer 30

Stuttering - excessive frequency of part- and whole-word repetitions - active attempts to avoid or conceal communication difficulties - use of word avoidance and circumlocution in response to anticipated disfluency Cluttering - excessive frequency of revisions - reduced intelligibility in conjunction with rapid rate - misarticulating of multisyllabic words - limited concern and awareness of communication deficits

Question 31

Psychosocial, educational, and vocational impact of fluency disorders

Answer 31

Social and Emotional ● expressing wants and needs ● having conversations or telling stories ● forming friendships ● regulating emotions ● showing confidence ● conveying truthfulness Academic ● reading aloud ● answering questions in class ● giving class or work presentations ● participating in class discussions Vocational ● “Results indicated that more than 70% of people who stutter agreed that stuttering decreases one's chances of being hired or promoted. More than 33% of people who stutter believed stuttering interferes with their job performance, and 20% had actually turned down a job or promotion because of their stuttering.” ● Limited career choices (e.g. may prefer a career that doesn’t require much interaction with others)

Question 32

Assessment fluency

Answer 32

Background information of client (case history) ○ Family history of stuttering ○ Frequency, type, duration and variability ○ Age and circumstances of onset of stuttering ○ Changes in stuttering over time (normal to have good and bad days) ○ Child’s awareness of and reactions to stuttering ○ Child’s temperament ○ Other coexisting speech, language or other developmental/ medical/ cognitive issues ○ Parents’ concern about stuttering ○ Additional factors to consider for older children: ■ Motivation to seek therapy ■ Impact of stuttering on individual’s life ■ Discussion of escape and avoidance behaviours ■ Thoughts and feelings about communication ■ Any previous therapy experiences ■ Goals and expectations of therapy