Fluency 5542-15

What is the age range for Borderline stuttering?

1.5-6 yrs

What is the age range for Normal disfluency?

1.5-6 yrs

What is the age range for Advanced stuttering?

14 yrs +

How many words are in the following? I'm gonna get uhm de de de dem too. A____nd dis one. A ape. Ge ge get Ste____vy down. You are ih ih ih in the way.

18

What is the age range for beginning stuttering

2-8 yrs

How many syllables are in the following: I'm gonna get uhm de de de dem too. A____nd dis one. A ape. Ge ge get Ste____vy down. You are ih ih ih in the way.

21

Calculate the % stuttered syllables (stuttering events/#of syllables * 100) in the following: I'm gonna get uhm de de de dem too. A____nd dis one. A ape. Ge ge get Ste____vy down. You are ih ih ih in the way.

23.8%

The prevalence of stuttering is:

30 million people in the US; about 1%

How many stuttered events are in the following? I'm gonna get uhm de de de dem too. A____nd dis one. A ape. Ge ge get Ste____vy down. You are ih ih ih in the way.

5

What is the age range for Intermediate stuttering?

6-13 yrs

Language Sampling Procedures in the TSHA Eligibility document (e.g., Stocker Probe technique). Is it x or y (either / or)? What is it (simple wh)? Where would you keep one (creative wh)? Tell me everything you know about it (descriptive question) Make up a story about it (creative, open ended - APPLY PRESSURE) SLP Observation Checklists (in the TSHA fluency template) Parent and Teacher Checklists (in the TSHA fluency template) Hearing and Vision screening Language / Articulation tests

Additional data that you should obtain in an assessment

We need to demonstrate an understanding and knowledge of stuttering and be accepting of the clients point of view. 1. Modified Erickson Scale of Communication Attitude (S-24) Normed on both stuttering and non stuttering individuals. It is predictive of relapse 2. Stutterers self rating of reaction to speech situations (SSRSS): Assess clients tendency to avoid speak 3. Overall Assessment of Speakers Experience of Stuttering (OASES): To be discussed in class. 4. Perception of Stuttering Inventory (PSI):PSI looks into behaviors such as perception of struggle, avoidance and anticipation of stuttering behaviors Clients can view their problem objectively by completing this form. 5. Locus of Control of Behavior Scale: Can predict long-term outcome (relapse). Also assess the extent to which client believes he/she can control his speech behavior with and without external support.

Adults and Adolescents rating scales

11 or more disfluencies per 100 words More than 2 units of repetition t-t-t table Rapid, irregular and tense repetitions Blocks - airway is shut off Secondary behaviors Aware -frustrated - embarrassed - avoidance Long tense blocks with tremors Escape avoidance behaviors -yes! Fear, shame, negative self concept

Advanced Stuttering

Good for collecting baseline data and assigning a subjective rating or judgment of severity. Measures (a)Behavioral components of stuttering: frequency (percentage of repetitions, prolongations, and blocks), duration, and secondary behaviors; (b)Naturalness rating and self report. Used with preschool through adult students; readers and non readers. With the exception of the reading passages, may be used with ELL students. Can support eligibility in the public schools or to obtain funding for services in the private sector.

Advantages of the SSI-4

No reported history of fluency disorders Evidence of neurological (CNS) problems: Associated with neurological conditions (left & right hemisphere lesions, basal ganglia, thalamus, brainstem lesions, cerebellar lesions) Neurodegenerative diseases, meningitis, Parkinson's, head trauma, stroke, cryosurgery, drug usage, anoxia. Not readily localized to any one region in the CNS

Aquired stuttering (Neurological) Adult onset

GrimaceMuscular effortHand-foot movementEye blinkNostril flaringTongue clickOpening -closing mouthKnitting eyebrowsLip pursingHead nodding Tension

Associated motor behaviors

Communication Attitude Test-Revised (CAT-R) Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT) Overall Assessment of the Speaker's Experience of Stuttering (OASES)

Attitudinal, Quality of life, Emotional scales/Self reports

What is the secondary characteristic where the PWS avoids certain words or situations to prevent stuttering?

Avoidance Behaviors

__________________________ aspects of the environment that limit or hinder a person's functioning by creating or exacerbating disability.

Barriers

11 or more disfluencies per 100 words More than 2 units of repetition t-t-t table Rapid, irregular, tense repetitions Blocks- may be Secondary behaviors: eyeblinks, increases in pitch Aware -frustrated - Tension

Beginning Stuttering

GenesInherited - runs in the familyIdentical twins have stuttering more often compared to fraternal twinsChromosomes 1, 7, 9, 12, 13, 15, 16 and 18 are implicated in stutteringPersistent stuttering associated with Chromosome 15 Brain structure and functions Brain structure: Planum temporale (PT) is ~ same size in PWS on both L and R hemispheres. In individuals without stuttering, left PT is larger than right PT. White matter fiber tracts in left operculum are less dense in PWS compared to normal controls.

Biological factors

I like b___________ananas

Blocks

What is it called If speech sounds appear: "frozen"/ "locked", "stuck" / "fixed articulatory posture" with no audible sound and accompanied by physical tension and/or tremor. Also called "prolonging and blocking" as the Consonant or vowel is produced for an unusually long duration

Blocks

11 or more total disfluencies per 100 words More than 2 units of repetition t-t-t table Rhythmic and regular repetitions Generally unaware, but may be express surprise or frustrations No secondary behaviors

Borderline stuttering

What is a multidimensional assessment that assesses: 1. Cognitive2. Affective3. Linguistic4. Motoric5. Social

CALMS

Norm-referenced test for children between 6-15 years (CAT) and for children 3-6 years (Kiddy CAT) Self report Provides multidimensional how children are affected by how they feel, react to, and think about their speech Helpful in developing goals and monitoring progress.

CAT/ KIDDY CAT

Which model is for School-age children with stuttering (2nd grade-high school) 23-items in five domains: Cognitive, affective, linguistic, motor & social 5-point rating scale Provides treatment activities that reflect multidimensional approach to stuttering

CAlMS

Generally, disfluencies will decrease speaking rate. Gives us an idea of how much stuttering interferes with speech Speaking rate can be computed as words per minute or # of syllables per minute Count ONLY those words that would have been said if the client hadn't stuttered

Calculating rate of speech

_____________________ refers to "the highest probable level of functioning that a person may reach."

Capacity

Mostly sound/ part word repetitions, occasional prolongations/ Disfluencies occur on medial and final syllables; doesn't vary depending on situation or context. Fluency is not different with automatic vs non-automatic speech Absence of struggle and secondary behaviors Relatively little fear or anxiety Quiet Mild Little or no adaptation with repeated readings

Characteristics of Neurological Stuttering

repeated association between stimulus and stutter leads to the response (stuttering).

Classical conditioning

Which portion of the SSI-4 is used for monitoring the efficacy of therapy?

Clinical use of self rating / Speech naturalness PORTION OF SSI-4

Less common than stuttering Etiology unknown - may be neurological ? Basal ganglia, Supplementary motor area Generally starts in preschool years More common in males than in females Often accompanied by Stuttering; sometimes learning disability, ADHD, CAPD, ASD Poor handwriting Language disturbances No anxiety or avoidance or secondaries Generally unaware PWS knows what to say - PWC - may not know what to say.

Cluttering

________is a disorder of speech and language processing resulting in rapid, dysrhythmic, sporadic, unorganized, and frequently unintelligible speech. Accelerated speech is not always present, but an impairment in formulating language almost always is. (Daly 1992).

Cluttering

Rapid speech; variable intensity Spoonerisms: "You missed my history lecture -- You hissed my mystery lecture" or "queer old dean" for "dear old queen" Excessive normal disfluencies (interjections, false starts / revisions) Slurred syllables Omission of syllables (collapsing) during rapid bursts. Abnormal pause locations, syllable stress and speech rhythm Articulation errors, cluster reductions, vowel neutralizations, excessive coarticulation resulting in unintelligible Speech

Cluttering characteristics

What does the CALMS Assessment stand for?

Cognitive, Affective, Linguistic, Motor, and Social

(a) there are no known objective, listener-independent criteria for identifying instances of stuttering or classifying children as stutterers versus normally fluent speakers and(b) there is no consensus among experienced clinicians and researchers regarding behavioral definitions of stuttering in childhood or classification of children as stutterers." (c) What this means is that the clinician must exercise informed, professional judgment, yet be flexible to further information and alternative interpretations regarding clients who exhibit "stuttering" behavior.

Conture (1990)

"...Stuttering is a diagnostic label referring to a clinical syndrome characterized most frequently by abnormal and persistent dysfluencies in speech accompanied by characteristic affective, behavioraland cognitive patterns..."

Cooper's definition of stuttering

Predictive Cluttering Inventory (PCI) Cognitive, Affective, Linguistic, Motor, & Social (CALMS) Rating Scale

Criterion referenced fluency tests

Onset most often between 18mos - puberty Most often onset if between 2 - 5yrs; rare after 12.

Developmental Stuttering

Motor development• Speech-Language development• Cognitive development• Social-emotional development

Developmental factors that may influence stuttering

Generally PWS are not more anxious than individuals who do not stutter. But, autonomic arousal is associated during the moment of stuttering. Sensitive, inhibited temperament in PWS

Emotional factors of stuttering

Communication style in the home environment; Life events

Environmental factors that may influence stuttering

What is the secondary characteristic where the PWS is in a moment of stuttering and they attempt to stop stuttering & finish the word. Such as, eyeblinks, eyebrow twitching, head nods, hand movement, Tongue clicks, interjection of extra sounds, etc.

Escape Behavior

The following are physical concomitant/escape behaviors:

Eye blinks, avoiding eye contact, arm movements, and tension in the laryngeal area Tongue clicks, facial grimace, and foot-tapping

___________ can be either intrinsic or extrinsic to the speaker.

Facilitators

A mother's rate of speech is a solid indicator of the degree of severity of stuttering in children.

False

We know what causes a stutter.

False

The ICF model encompasses only three following elements: (1) body function/ structures, (2) activity limitations, (3) personal factors.

False, environmental factors; participation restrictions are missing from the model

The sample does not have to be representative of the client's typical stuttering.

False, it does

More stuttering occurs when: Choral reading, repeating, shadowing Singing The listener already knows the information - rehearsed

False, less stuttering occurs

Less stuttering occurs when: Stressed Rushed Authority figures Important communication

False, more stuttering occurs

Interjections are counted (toward syllable count) even if they are used as postponements or as starters.

False, they are not counted if they are used as postponements or as starters.

If the student is not exhibiting disfluencies on some of the simpler linguistic tasks, you do NOT move along the continuum until you observe the fluency breakdowns.

False, you do

In obtaining a language sample, it is necessary to do all activities listed below: 1. Student Interview 2. Play a Game 3. Provide Descriptions 4. Compare/Contrast 5. Explain a procedure 6. Tell/retell a story 7. Reading sample 8. Talk on the phone

False, you do not

the ability to speak effortlessly and with normal rate, intonation, rhythm, and with appropriate pauses is called

Fluent Speech

____________ describes what a person does during daily activities.

Functioning

Primary Stuttering: is a result of genetic inheritance or early brain damage. Poor myelination Individuals who stutter have differences in the way their brains process sensory information and produce motor output. Poor sensory motor modeling Compensatory activity in homologous areas of the right hemisphere for speech and language functions. Rapid information flow between sensory and motor areas is critical for accurate and fluent speech. Delays or dys-sychrony in assembly of components ( motor plans and execution) may lead to repetitions. Secondary stuttering: is the reaction to stutters by tensing articulators, speeding up, struggle, escape, and avoidance behaviors.

Guitar's view of the two-stage model

Theorists believe that the problem is not really one that concerns speech execution. The issue lies in planning and assembly of language units such as phonemes. Internal monitoring process that monitor and check for the accuracy of the phonetic plan without being aware of it.Repetitions, prolongations and blocks are the result of correcting or repairing the phonological errors detected in the phonetic plan before they are spoken.

Herman Kolk & Albert Postma (1997) - Covert repair hypothesis.

Less stuttering when:Talking to self; animalsOther people can't hear even if they can seeListener is wearing earphones, masking More stuttering when:Number of listeners increasesListener can hear

How audience size and variety effects the stutter

Stutters per 100 words % of stuttered syllables - better approach as some clients may stutter on more than one syllable of a word.

How to assess the frequency of a stutter

More than 10 total disfluencies in 100 words 3 or more stuttering-like disfluencies (SLD) per 100 words More than 5 % disfluencies per 100 syllables (# of SLD / total # disfluencies)*100 = <50% for normal disfluences and about 2/3 (66%) for PWS (Yairi, 1997) Physical escape behaviors (associated motor, secondary characteristics) Verbal avoidance behaviors - e.g. word substitutions. More than two repeated units - e.g. s-s-s-s-snow Disfluencies : Keep in mind- phrase reps, multisyllable whole-word repetitions, interjections, and revisions in an incomplete phrase are NOT core stuttering behaviors

If the client uses one or more of these, they are a PWS

11 or more disfluencies per 100 words More than 2 units of repetition t-t-t table Rapid, irregular and tense repetitions Blocks - airway is shut off Secondary behaviors Aware -frustrated - embarrassed - avoidance

Intermediate Stuttering

Contains: Health conditions, bodily structures and functions, activities, participation, environments factors and personal factors.

International Classification of Functioning, Disability & Health - ICF model by WHO

Stuttering onset typically coincides during language development phase (2-5 yrs)More disfluencies on linguistically complex sentences and longer utterances

Language aspect of stuttering

Classical conditioning• Operant conditioning• Avoidance conditioning

Learning factors that may influence stuttering

Fear Words - specific sounds or wordsSituations - telephone, audience, Listeners - strangers, boss, large #sAnger at listenersFrustrationAnxiety

Negative emotions that l/t avoidance

Little or no reduction in stuttering in a variety of fluency inducing conditions pacing (rhythmic), DAF, and masking May not warrant treatment most often Slow rate and easy onset techniques are useful.

Neurogenic Stuttering

Stuttering Severity Instrument, 4th Edition (SSI-4) Test of Childhood Stuttering (TOCS) Stuttering Prediction Instrument (SPI)

Norm-referenced fluency tests

A three-year-old girl is brought to a clinic by her parents with the complaint of stuttering. Parents report that the problem began approximately 6 months ago but their daughter is unaware of her stuttering problem. Background information did not reveal any family history of stuttering problems. The analyses revealed that the child demonstrates mostly polysyllabic whole word repetitions, phrase repetitions, and interjections. The total number of disfluencies per 100 words was 9. Additionally, assessment revealed 1-2 units of repetitions. Articulation and language abilities were within normal limits. This child most likely demonstrates:

Normal Disfluency

Designed to gather information on the entire breadth of the disorder. It is designed to measure the effect of stuttering on a person's life. Appropriate for students aged 7-years through adult and is divided by groups: ages 7-12, 13-17, and 18+ Is helpful for establishing a baseline and for identifying therapy goalsand documenting changes in the student's experience of stuttering over time. Can support eligibility in the public schools and provide further opportunities to measure progress at benchmark or reporting increments. Is a good supplement to norm-referenced tests

OASES benefits

Students may not always be honest in their responses. Does not measure the behavioral components of the disorder. May not be recognized as a valid assessment tool by some healthcare providers or individuals unfamiliar with fluency disorders.

OASES weaknesses

If rewarded (positive reinforcement) frequency of stuttering decreases, if punished, it increases Example : Head jerking during moments of stuttering. If head jerk helps in getting out of the block, then head jerk is used all the time.

Operant conditioning

Many Left handed individuals have stuttering Right hemisphere retains some language functions. Over activation of the right hemisphere / less developed left hemsiphere Geshwind - delay in left hemisphere growth Mutated Gene (2010)

Orton and Travis - Cerebral dominance theory- lack of hemisphere dominance

Concomitant behaviorsAssociated motor behaviorsEscape behaviorsPhysical concomitants

Other terms for motor/secondary characteristics

"...Stuttering is characterized by an abnormally high frequency and/or duration of stoppages in the forward flow of speech. These stoppages usually take the form of: (a) repetitions of sound, syllables, or one-syllable words, (b) prolongations of sounds, or "blocks" or airflow and/or voicing in speech. Individuals who stutter are usually aware of their stuttering and are often embarrassed by it. Moreover, they often use abnormal physical and mental effort to speak..."

Peters's and Guitar's definition of stuttering

Gestures coinciding with release of disfluencies Extra noises during disfluencies are

Physical Concomatants

While not many are available for this age group, there are options: 1. Kiddy CAT: Communication Attitude Test 2. Behavioral style questionnaire Administered to parents It helps us in identifying children with inhibited or more sensitive temperaments

Preschool age rating scales

This is my ssssssssssssssister

Prolongations

Acquired; Adult onset History of emotional problems (personality disorders, post-traumatic stress, drugs, anxiety or depression) Give the impression of "holding on" to stuttering. Fluency inducing strategies don't seem to help. Worsening of symptoms in less difficult speaking tasks Disfluencies increase with repeated readings of a passage Bizarre struggle behaviors and signs of anxiety not associated with periods of disfluencies Situation specific episodes of stuttering

Psychogenic stuttering

Rapid and favorable response to trial therapy Psychotherapy Fluency shaping Strategies to reduce tension

Psychogenic stuttering

Research studies investigating brain structure and functions have shown

Reduced volume of grey matter and delay in myelination Deficits in the white matter, underactivity in the left auditory areas

(sound, syllable (part-word), mono-syllabic whole word) "I-I-I-I want water"

Repetitions

What is used to: Evaluate temperamen Distinguish PWS from PWNS Tool to evaluate efficacy of treatment Predict relapse Situations that are avoided

Scales

**Most of these scales must be administered once the therapist has established rapport with the client. Can repeat after 10 weeks of therapy. A-19 Scale ? May distinguish children with and without stuttering Perhaps more useful to see if attitudes change pre and post treatment 2. CAT: Communication Attitude Test Can reliably differentiate children with and without stuttering 3. TASCC: Teacher's Assessment of Students Communicative Competence One subtest of this test looks at class participation and voluntary communication at school 4. OASES: Overall Assessment of Speaker's Experience withStutterin

School Aged rating scales

What are LEARNED reactions of a person to their repetitions, prolongations, blocks.

Secondary characteristics

Unstable speech-motor controlSequencing for non-speech stimuli are also affectedSlower reaction times for speech and non-speech tasksFluent speech in PWS is slower: longer VOT, longer durations of consonants and vowels

Sensory-Motor control

The types of stuttering-like disfluencies (core disfluencies) in this sample are: Y y y yesterday uh... I wen wen wen went to the uh uh d d d doctor

Sound repetition and syllable or part-word repetition

Adult models Parents or adults may have rapid rate of speech, use complex multisyllabic vocabulary & complex syntax. Life eventsHospitalization, divorce, excessive discipline, death, move Stressful situationsCompetition for speaking, frequent interruptions, frequent questions, loss of attention, hurried when speaking, excitement, demand for public speaking

Speech and Language events that affect a stutter

Many preschoolers who begin to stutter stop within the first year or two of onset without having received any professional treatment. This is called:

Spontaneous Recovery

Abrupt onset and offset of words Fixed articulatory postures Jerky transitions

Starting and sustaining airflow and phonation

Children between ages of 3 - 8.9 years Helps to determine whether a child should be scheduled for therapy or not. ? May aid in predicting the chronicity of the disorders Best if used in conjunction with other tests Five components used in calculating a total score 1. History (background / family) 2. Reaction towards disfluencies[10 minutes of speech sample - At least 100 words] 3. Part-word repetitions (scored for how many units of repetition and the degree of abnormality) 4. Prolongations (duration) 5. Frequency (%)

Stuttering Prediction Instrument (SPI)

Frequency: Scoring is slightly different for readers versus non-readers Note you can choose to get 2 or 3 samples. Add the corresponding task score to get a Frequency score Duration: Observe the 3 longest stutters and get an average. Enter the scale score Physical concomitant: Add all the ratings to get a total physical concomitant score Total score: Add scores for frequency, duration, physical concomitants subtests. Consult tables 2.2/2.3/2.4 to get Percentile ranks and severity

Stuttering Severity Instrument (SSI-4)

Difficulty developing mental model of relationship between speech sounds and motor commands. Difficulty in sensory to motor and motor to sensory transformation because of reduced functional neural capacity. Max et al., (2004): unstable or insufficiently activated internal model Predisposition to stutter may be due to the difficulty learning the relationships between their motor commands and the desired acoustic output. This leads to an inaccurate inverse internal model of the speech production system Generation of output that may not match the desired perceptual consequences. The production system "resets" itself to try again, producing repetitions. This resetting continues until output matches the consequences.

Stuttering as a disorder of reduced capacity for internal modeling Neilson & Neilson, (1987)

Disfluencies are a result of repairing these internal inconsistencies or phonological errors in the phonetic plan. If an error is detected in the final part of the word, initial syllable is repeated until the plan is corrected A sound is prolonged if the sound preceding the error is a continuant If the error is in the initial sound, it results in a block

Stuttering as a language production deficit

Capacities and Demands: Disfluencies and stuttering emerge when a child's capacities for fluencies are not equal to speech performance demands. Rapid development of language from 3-7 yrs. Demands from the environment (e.g., Fast talking parents). High expectation with a physiological predisposition for stuttering (Sheehan 1975) Demands from within the child - mind racing a million miles -complex thoughts - limited capacities for rapid speech (Starkweather 1987; Adams,1990) Child's capacities develop in spurts and environmental demands fluctuate - explains why stuttering may wax and wane in cycles.

Stuttering due to environmental and developmental factors

For children 4 -12 years of age 20-30 mins of administration time Provides severity of stuttering, standard scores, and percentile ranks Three components: 1. Standardized speech fluency measures: rapid picture naming, modeled sentences, structured conversation, and narration 2. Observational rating scales: use information provided by parent/caregiver and teacher 3. Supplemental clinical assessments: interview, fluency analysis, speech rate, duration of disfluencies, repetition length, associated behaviors, speech naturalness

Test of Childhood Stuttering (TOCS)

Developmental history: Motor, language, cognitive, speech, situation, home environment Stuttering onset & progression: Life events Family history Home environment Social-emotional development; during (pre)school years: friendships, bullying, communication attitude, temperament Medical history drugs, surgery, injury, seizures, tremors/tics Speech, Language, and Hearing history Stuttering-related queriesTypes of disfluencies, secondaries, durationNature of the problem: word finding, organization of thoughtsAvoidances: situations, contexts, persons, wordsTherapy history: tools used in the past and present. Which one is least/most effective?

The case history

Speech on inhalationHolding breath before speechSpeaking on expiratory reserveInterruption of speech with inhalationRapid/jerky breathing NOT a respiratory problem

These are characteristics of speech breathing

Part-word, syllable, or sound repetition More than 2 units of repetitions s-s-s-small ; ba-ba-ba-ball Mostly rapid and jerky. Blocks Prolongations Secondaries Avoidance

These are core behaviors

Revisions or False starts or restart-revise (" I want - I need juice") Interjections ("um", "er", "uh") Pauses (filled or unfilled or tense, vary in duration) Phrase repetitions - I want I want juice Part-word (syllable) repetition ("I wa wa want juice") Repetitions of speech sounds ("w-w-want juice") Prolongations ("wwwwant juice") - also known as tense pauses, inaudible prolongations Blocks ("w—ant juice")- [fixed articulatory postures - airflow stops] - most severe form of disfluency and last one to emerge. Inaudible prolongations. Advanced stuttering. Often associated with physical behaviors (muscle tension, blinking)

These are examples of Primary (involuntary) characteristics

Multisyllable word repetition is more likely [tomorrow...tomorrow is a holiday) Repetitions are rhythmic and regular No more than 1-unit of repetition butterfly-butterfly Phrase repetition [she wants a..she wants a puppy] Interjections [I cannot.. uh.. Skate] Revision-incomplete phrase [false start) i.e. abort and restart: He jumped in the ..... he dived in the pool Generally no avaoidance, tension in the speech mechanism ?Prolongation [she is my sisssssster] ?Tense pauses [I saw this on (tensed tongue palate contact) TV). ?Single-syllable word repetition [He.. he went away]

These are examples of normal disfluency

Consonant versus Vowels First versus 2nd or 3rd syllable Longer (polysyllabic) or shorter words Infrequent or frequent words Content or functional words (preschool children - function words ; adults and school age children - content words)

These are when the stutter is more likely to occur

Poor central auditory processing (temporal info) EEG: Longer latencies and lower amplitudes when listening to complex linguistic stimuli ? Poor processing abilities for visual and tactile information Altered auditory feedback leads to reduced disfluencies

This is evidence of a sensory processing disorder

The more a PWS reads a passage the more fluent they become. Works better with milder stuttering. Works with kids and adults. May not last or transfer!

This is the adaptation effect

The same words are stuttered on in a passage read weeks later. A PWS tends to stutter on the same sounds, words, situations.

This is the consistency effect

(T/F) Frequency of disfluencies - fewer than 11 total disfluencies per 100 words are considered as normal disfluencies

True

A person that demonstrates 11 or more disfluencies per 100 words, shows more than 3 stuttering like disfluencies per 100 words, exhibits 3 or more units of repetitions, and shows avoidance/escape behaviors is most likely to be a person with stuttering.

True

A reading sample should contain 200 syllables, approximately 150 words and the reading material should be below the client's reading level.

True

According to Guitar's two-stage model, constitutional factors contribute to primary stuttering; whereas, developmental, learning, environmental and emotional factors may precipitate secondary stuttering

True

Bruten and Shoemaker 1967 had a two-factor theory for Stuttering, that it is caused by a classically conditioned negative emotion and shaped by operant conditioning

True

Competition for neural resources is one of the suggested reasons for the onset of disfluencies.

True

For a multidimensional assessment, It is important to gather Audio and VIDEO data, Complete attitude scales in addition to formal measures Client's point of view

True

For the population of those who stutter the developmental manifestation of anxiety is an effect of stuttering.

True

For the population of those who stutter, unusual temperament is a causal factor for the development of the disorder and its later association with anxiety.

True

Goals should have action/behavior (locate tension) + context/condition (while reading a list of 10 sentences) + criterion (9 out of 10 trials) + quality (with minimal ques)

True

If there is no evidence of avoidance behavior or stuttering didn't interfere with the utterance - then it is counted

True

It is important to assess limitations on a person's involvement in verbal communication.

True

Lt auditory cortex inactivation during stuttering? Not using auditory feedback

True

Phrase repetitions, multisyllable whole-word repetitions, interjections, and revisions in an incomplete phrase are not marked as stutter-like disfluencies (SLD, or core stuttering behaviors)

True

Planum temporale (PT) is ~ same size in PWS on both L and R hemispheres. In individuals without stuttering, left PT is larger than right PT.

True

Polysyllabic word repetitions, phrase repetitions and interjections are considered to be normal disfluencies.

True

Research studies suggest that in individuals with stuttering there is a possibility of left hemisphere underactivation and over activation of right hemisphere for speech and language functions.

True

The CALMS model has both Standardized & Non-standardized approaches gives a Baseline and Treatment

True

The Rt hemisphere over activation (frontal operculum, insula)

True

The demands and capacities model proposes that children with stuttering do not have capacities (linguistic, motor) to meet either external demands (e.g. from parents) or internal demands (e.g., complex thoughts)

True

White matter fiber tracts in left operculum are less dense in PWS compared to normal controls.

True

bilingual PWS will have the stutter in all languages but the cultural rate/pauses/ can make the stutter easier or harder.

True

pauses longer than 250 ms -3000 ms and if occurrence is in an unexpected location - then considered atypical

True

Fluent production involves integration of the brief, rapid, left hemisphere-generated speech segments with the slower prosodic elements of speech that are generally functions of the right hemisphere. Sequential events are not planned perhaps because of less well developed left hemisphere Speech of people who stutter may be vulnerable to interference by right-hemisphere activity during increased emotion.

Van Riper / Kent : Deficits in temporal programming.

"...Stuttering occurs when the forward flow of speech is interrupted by a motorically disrupted sound, syllable, or word or by the speaker's reaction thereto."

Van Riper's definition of stuttering

Provides a limited speaking sample that may not be indicative of the true severity of the fluency disorder. Only takes into account the behavior components of the disorder during a specific timeframe. Does not provide a standard score.

Weaknesses of the SSI-4

Case History Formal Tests Norm-referenced, criterion-referenced, and rating scales Informal Analyses Speech and language samples Disfluency analyses Differential Diagnosis Goals / Lesson plan Report Writing

What is needed for an assessment

(a) Disruption in the fluency of verbal expression, which is (b) characterized by involuntary, audible or silent, repetitions or prolongations in the utterance of short speech elements, namely: sounds, syllables, and words of one syllable. These disruptions (c) usually occur frequently or are marked in character and (d) are not readily controllable. 2. Sometimes the disruptions are (e)accompanied by accessory activities involving speech apparatus, related or unrelated body structures, or stereotyped speech utterances. These activities give the appearance of being a speech-related struggle. 3. Also, there are not infrequently (f) indications or report of the presence of an emotional state, ranging from a general condition of "excitement" or "tension" to more specific emotions of a negative nature such as fear, embarrassment, irritation, or the like. (g) The immediate source of stuttering is some incoordination expressed in the peripheral speech mechanism; the ultimate cause is presently unknown and may be complex or compound.

Wingate's definition of stuttering

These avoidances suggest stuttering not normal disfluencies

Word avoidances

A sample conversation should contain: 300-400 syllables of conversation Approx. 250 words Interject with questions, comments, and mild disagreements to simulate pressures faced during normal conversations.

Yes

If associated motor behaviors are present, does it almost assure the diagnosis of a stutter?

Yes

Is the prognosis good if the client Decrease in stuttering after first 12 months of onset Female No family history Good nonverbal intelligence scores Outgoing carefree temperament

Yes

Should you use topics of interest and open-ended questions in the language sample?

Yes

Should you video record at least two samples in the clinic? and request a home recording.

Yes

The incidence of stuttering is:

about 8%

-sudden, post head trauma, tumer, disease, drug toxicity, stroke -secondary characteristics are uncommon -normal eye contact -disfluencies throughout utterances avoidance/anxiousness absent -constant across situations -mostly normal disfluencies

acquired/Neurogenic stuttering

avoidance of people, situation, words or substitution of words.This increases behaviors that a PWS uses to evade or postpone expected stutters. Conflict - to speak versus to refrain

avoidance conditioning

Stuttering severity rating scale (SSRS) Scale of 0-7 : no stuttering to very severe stuttering LIDCOMBE Program's Severity Rating Scale Scale 0-9 ; No stuttering to extremely severe stuttering

commonly used severity scales

Core disfluencies - SLD Sound / syllable repetition Sound prolongation Blocks Secondaries Rate of speech Breathing Pitch changes Speech and language issues Knowledge about speech and stuttering Socio-emotional well being FEELINGS AND ATTITUDES about communication

considerations of developmental stuttering

Sound repetitions Syllable rep /part-word repetitions Monosyllabic word repetition Prolongations Blocks

core/Stuttering like Disfluency

-Gradual onset -Secondaries are common -limited eye contact -disfluencies on the initial postion of words/utterances -avoidance behaviors are common -situation dependent -varied disfluencies

development stuttering

Adaptation effect suggest that with repeated readings of a passage, the disfluencies tend to increase.

false, it decreases

(T/F) The client is more likely to be stuttering if-no avoidance or fear-only whole word repetitions or schwa - no secondary characteristics

false, less

Stuttering is more common in females

false, males

To elicit conversations, you should select topics that are emotional in nature

false, not emotional

A person who comes into the clinic has a stutter that Resolves by itselfUnawarePartial grasp of language False starts, interjections, whole word or phrase repetitions dominate exhibit

normal disfluency

Phrase repetition Multi-syllabic word rep Interjections Long pauses Revise-restarts

normal disfluency

___________ is assessed to determine how a person performs in a variety of settings

performance

(T/F) It is important to determine the types of communication activities a patient is able to perform and which they avoid

true

60-70% of PWS spontaneously recover

true

It is hypothesized that stuttering is due to weak or unstable internal models.

true

is the prognosis better if there are not as many secondary characteristics?

yes