Chapter 12: Fluency Disorders

• Stuttering is also known as disfluency.
• Fluency is the continuity, smoothness, rate, and effort in speech production.
• Normal Disfluency: the repeating, pausing, incomplete phrasing, revising, interjecting, and prolonging of sounds that are typical in the speech of young children
• Secondary (overt, concomitant) stuttering behaviors: extraneous sounds and facial and body movements a person who stutters uses during moments of stuttering ("uh" or "um" repetitions, eye blinks, unusual head/hand/other body part movement)
• Audible Overt Behaviors

  1. Blocks: Inappropriate timing in initiation of sound w/ tension
  2. Dysrhythmic Phonations: disturbances in normal rhythm of speech (break between syllable, unusual timing)
  3. Interjections of sounds, syllables, words, and phrases
  4. Part-word repetitions: sound or syllable repetitions (m-m-mommy's home)
  5. Phrase repetitions: repetitions of units consisting of 2 or more words
  6. Prolongations of sounds & syllables
  7. Revisions of phrases & sentences:
  8. Whole-word repetitions
• Stuttering-like disfluencies: disfluencies that are qualitatively different from normal disfluencies and may include sound or syllable repetitions, tense pauses, and dysrhythmic phonations (behaviors that disrupt or distort flow)
• Covert reactions: feelings & thoughts such as frustration, anxiety, anger, and expectations of difficulty talking, which lead to inhibitory and avoidance behaviors.
• 2% of children ages 3-17 years old stutter
• 2.2-5.6% of preschool kids stutter
• Family history of stuttering = twice as likely
• Males are 1.5x more likely than females to stutter
• 90% of stuttering begins between 2 to 6 years old
• Stuttering associated with hemispheric asymmetry (increased motor activity in motor centers in nondominant hemisphere, usually right)
• Most challenging words for stutterers: their own name & I
• Cluttering characteristics:

  • Rapid rate of speech
  • sound or syllable deletion
  • inappropriate word segmentation
  • excessively dysrhythmic or monotone speech
  • excessively garbled or ungrammatical syntax
  • insertion of a very high number of inappropriate words or sounds
• proprioceptive: sense of the relative position of parts of the body and strength of effort being used in movement
• Delayed Auditory Feedback (DAF): system used for some stuttering or cluttering treatments in which person's voice is recorded and played back thru earpiece with a fraction of a second time delay. Distraction caused by altered auditory feedback increases fluency and slows speech rate
• Family systems therapy: models of counseling and service delivery that focus on variables regarding family unit as a whole. The system is interdependent.
• Cognitive behavioral therapy: model of counseling designed to help individuals recognize and examine problematic beliefs and replace them with more adaptive and flexible ways of thinking
• affective: relating to, arising from, or influencing feelings/emotions. Affect is revealed by facial expressions, body postures/gestures, tone of voice, choice of words
• Primary prevention: the involvement of an SLP in the elimination or diminishment of the onset and development of stuttering by changing the susceptibility of children in environments
• fluency shaping: a therapy approach for children and adult stutterers that attempts to directly train individuals to speak with relaxed respiration, relaxed vocal folds, and relaxed articulation muscles to help with fluency
• stuttering modification: therapy approach for kids & adult stutterers that requires them to recognize and confront fears, avoidances, and struggles to escape stuttering
• internal motivation - motivation that is self-generated or intrinsic in which a person decides what is important and needed
• external motivation - motivation that is provided by the encouragement of someone else, often family or an employer
• biofeedback: process of becoming aware of various physiological functions of the body using instruments that provide information on the activity of muscles or systems being monitored, with goal of being able to control or manipulate those muscles or systems voluntarily
• trait anxiety: consistent tendency to respond with anxiety in the anticipation of threatening situations
• social anxiety: fear of social situations and the interaction with other people