Fluency Final

What is Intermediate Stuttering?

- Blocks that cut off airflow - Escape and avoidance behaviours - Fear, frustration, embarrassment and shame - Avoidance

What is Advance Stuttering?

- Leads to advance stuttering - Long, tense blocks - Tremor → (like tensing any muscle → you tend to shake) - The muscles in the jaw, lips, tongue etc.

Why is stuttering often compared to an iceberg and how would that impact your assessment and treatment approach?

- There is a part that sticks out of the water, but there is a section underneath the water - The tip of the iceberg = the core and observable secondary behaviors - Observable behaviour such as speech disfluencies and some coping behaviours - If you only pay attention to that part, you ignore everything else that is underneath - Not (or less) visible behaviour such as, some avoidance, escape and struggle behaviour, anxiety, frustration, guilt, shame, isolation, etc. - we miss the internal struggles and secondary characteristics such as anxiety and isolation - You need to work with what is underneath the water too - That is where the eclectic approach comes in. - As future clinicians, we need to dive deeper and consider all of the behaviours associated with fluency disorders in order to properly assess and treat our clients - We should not only be assessing and treating the observable, core behaviours but also the secondary behaviours

Which of these is NOT a critical phase(s) of the Fluency Plus treatment program a) Establishment of Targets b) Desensitization c) Transfer and Cognitive Restructuring d) Maintenance e) B and D

b) Desensitization Rationale: The 3 phases of Fluency Plus therapy are 1. Establishment of Targets, 2. Transfer and Cognitive Restructuring, and 3. Maintenance. Desensitization is from Van Riper's approach.

Describe the key features that distinguish direct treatment from indirect treatment of stuttering?

*Direct treatment* - Is specifically targeting the stutter and working towards fluency - Reducing the frequency/severity of the stutter - Removing or monitoring underlying factors - Teaching the individual to fluently communicate *Indirect treatment* - Is working to help the mindset or create an environment in which the individual will be more likely to succeed in producing more fluent speech, or be more comfortable with their stutter - Working not only with the client but with family and friends as well

What is the difference between involuntary and voluntary stuttering?

*involuntary stuttering* - a stutter that cannot be controlled - more tension is apparent *voluntary stuttering* - a type of strategy to overcome the tension of stuttering - person controls how often their repeat the sound, syllable, prolongation, or block - approach the word in a more relaxed manner

What are the 5 steps to gentle onset target?

- 5 Steps to the Gentle Onset Target - Take a slow full breath in - Let the air out and begin voicing very gently/softly/quietly - Gradually increase your loudness level (without increasing pitch) - Reach your full loudness level - Gradually decrease your loudness level à Practices, slow, gradually and systematically

Jacob, a 35-year-old male, comes to you because he is embarrassed about his stutter. He tells you that he "just wants to be like everyone else". You decide to start a stuttering modification intervention as described by Van Riper. Initially, Jacob is really motivated to succeed in therapy, however, after a couple sessions, you notice Jacob is frustrated and he tells you that he wants to stop treatment. When you ask Jacob why he wants to terminate the treatment, he tells you that you're making his stutter worse. What would you say to Jacob?

- According to Van Riper, people become so use to stuttering that do not notice all of the times that they stutter. - That is the purpose of the Identification phase of Van Riper's Stuttering Modification approach. - Jacob was likely making progress in this stage and was becoming increasingly aware of his stutter. As a result, he accused you of making his stutter worse - I would explain to Jacob the purpose of identification (you cannot modify your speech unless you know what to modify) and that this is the natural progression of this type of therapy. - I would tell Jacob that it may feel worse before it gets better and explain the trajectory of treatment and the theory behind the next stages so that he knows that to expect. - Facing a stutter head on can be an overwhelming experience and I would stress the bravery and proactiveness Jacob has for wanting to face this challenge. - Jacob likely has never put so much focus into the core behaviors, secondary behaviors, and emotions/attitudes of stuttering, so, identification (and the beginning stages of desensitization) are likely contributing to his decreased motivation and desire to terminate treatment.

What is the amplitude contour target?

- Amplitude Contour Target: Variation of loudness and blending of syllables within the speech chain. - For blending of sounds within a syllable, they practice with people on the amplitude contour target. - People have a tendency to speak very choppy. You want to make sure that they contour of speech is preserved/created/maintained - The purpose is to facilitate the initiation of syllables embedded within words and phrases, and improve speech flow and prosody. (New Normal)

Briefly summarize how the field of epigenetics could describe the interaction between genetic makeup and environmental factors in the development of and recovery from stuttering.

- Epigenetics strives to move beyond a clean dichotomy between nature and nurture in order to explore the complex interactions of the two. - Just because someone has a gene for something, it doesn't mean they will develop it; just means they have a higher likelihood of developing it. - Epigenesis refers to the way in which genes are expressed, including both the timing and intensity of their expression. - The ultimate phenotype stuttering/not stuttering is a product of genetic and environmental interactions. Epigenesis is influenced by environmental factors, and therefore epigenetic processes provide the bridge between genes and environment. - Next step is looking at what are the trigger factors that will lead to the manifestation of stuttering - Example: if a child carries the genes for stuttering, they are more likely to express its phenotype if they are raised in a family with negative perceptions of stuttering, attitudes that regard stuttering as a "bad omen," or caregivers who regard the child's stuttering as something that will forever limit their potential to thrive in the society. If the same child is brought up in a more accepting environment wherein the caregivers regard conditions more as differences rather than disorders, the child might not show the same expression of phenotype for stuttering. In other words, the gene for stuttering is more likely to express itself if the environmental factors trigger it.

What is the full articulatory movement target?

- Full Articulatory Movement: The full and deliberate movement of the articulators from sound to sound within syllables - It is important in the fluency plus program to have good sensory feedback (needed for fluent speech) → do large movements without overdoing it so that they can feel what's happening and allow for greater feedback. à this is called full articulatory movement - The purpose is to decrease physical tensioning in jaw and neck areas and to facilitate kinesthetic perception of other target behaviors

What is Full breath target?

- Full breath target: A full inhalation and exhalation cycle. Breathing comes from the diaphragm and is controlled. The purpose is to correct incorrectly learned breathing patterns

What is Gentle Onset?

- Gentle Onset (This is very important in the Fluency Plus program): An initial low amplitude vibration of the vocal folds followed by a steady and gradual increase in the strength of these vibrations - Primarily on initial vowels sounds - The purpose is to facilitate proper phonatory onsets and to reduce the abrupt, excessive tensioning of the vocal folds and the forceful expulsion of air characteristic of laryngeal block

You are a speech-language pathologist working with children and adults who stutter. Your friend, is concerned that her daughter, 3-year old Sarah, may be developing stuttering. She calls you for advice. She says that she has noticed the stuttering in the last 2 months and is feeling helpless watching Sarah become increasingly frustrated whenever she stutters. She feels upset that she can't seem to do anything to help her daughter. She also tells you that she is not in favour of starting speech treatment at this time. What would you say to your friend?

- I would ask my friend my she was against going to speech therapy - To see if it was based of Johnson's Diagnosogenic theory. If this was her concern. I would explain the falsehood of this theory - If she is worried about being stigmatized and labeled, I would send a stuttering assessment so that she can "diagnose" her child herself. - I would explain that the label isn't to stigmatize them, rather, a tool to know what the child needs - I would explain the importance of being seen by an SLP early. - Take the perspective of the child. Sarah is the one that is frustrated and at the end of the day, she will be the one that suffers. - If she does not want someone else facilitating her child's treatment, I would recommend RESTART, Lidcombe or Palin Parent-Child Interaction à If you don't want to bring your child for therapy, they you become your child's therapist - Lidcombe - specifically lays out how to address moments of stuttering - RESTART - instead of addressing everything your child says and trying to account for every production, your control of your own responses can help your child - Palin PCI- similar to RESTART but a little more go with the flow and individual

Explain the Diagnosogenic Theory of stuttering proposed by Johnson (1959).

- It grew out of psychodynamic - A strong theory at this time was that things exist because they were being named. If you don't have a name for it, it doesn't exist for you. (e.g. colours on a spectrum à we categorize them, we don't notice the gradients between the clear colours) - People (anthropologists) visited the native groups in the US and asked about stuttering. 1 community, when they spoke to the elders there, they said that they don't have that. They were imitating stuttering, asked about stuttering, and the anthropologists said that "Indians don't have a word for it" → it doesn't exist because they don't have a word for it - Diagnosogenic theory of stuttering → stuttering starts when parents notice typical disfluencies in their child (things all children have) and label those disfluencies as stuttering. Johnson said that tt's when the parents diagnose the child as having a stutter, that's what then stuttering starts. When they put a label to it. - 'what appears to have been crucial was the fact that the parents were motivated to evaluate the nonfluencies as unacceptable, or distressing, to classify them as "stuttering" and to react, nonverbally as a rule but verbally in some cases, to them and to the child accordingly." - That is why it is called the diagnosogenic theory of stuttering (diagnose = cause of the issue) - When parents diagnose disfluencies as stuttering, they are communicating to the child (verbally and non-verbally) that what they are doing is wrong à you're not supposed to do that. The child then start to struggle to prevent those disfluencies and in the process, develop secondary behaviours. He said that stuttering is struggling against typical disfluencies

What are Borderline Disfluencies?

- More frequent disfluencies - Repetitions tend to be longer - In typical disfluencies, you don't hear such long repetitions. - Don't think they don't talk well (I think) - Underlying processes (diathesis stress model)

Explain the Demands-Capacity model of stuttering. What are the strengths of the model and what are its limitations?

- People stutter because there is a discrepancy of demands and capacity for fluent speech - Demands are cognitive, emotional, motor and linguistic - Demands can come from the environment (parents, siblings, peers), or from themselves (e.g. if they are perfectionist and have an innate drive to preform higher than their developmental capacity) - Capacities are cognitive motor linguistic and emotional

Differences in the structure and function of brain areas have been found in people who stutter. List and briefly describe three research findings that support this

- People who stutter (PWS) have structural differences in the left inferior frontal gyrus, which roughly corresponds to Broca's area, as well as in the middle temporal gyrus and other brain areas that assist in language production compared to people who do not stutter. - A cross-sectional study found that the left pars opercularis does not undergo pruning with age in PWS. The means that the area is thicker and that the area functions less efficiently compared to people who do not stutter. - PWS have atypical connections between the brain areas and networks that contribute to attention, motor control, perception, and emotion→ may influence whether a child persists or recovers from stuttering - Stuttering is associated with lesions in the cortical-striatal-cortical loop, as seen in stroke patients. - Increased activity in right hemisphere in speech and language areas for people who stutter, both during stuttering and fluent speech. - The more severe the stuttering, the more activation.

What is reduced air pressure target?

- Reduced Air Pressure Target: reducing airflow through the vocal tract. - When you use stretched syllables and break up the syllables and focus on inhalation/exhalation and gentle onset, there is a tendency to break up the sounds individual. To reduce the tendency of choppy/jerky speech. There is a continuous flow - The purpose is to stop excessive air loss on voiceless fricative sounds (otherwise there is a risk of a prolongation) and to correctly start the voicing of following sounds. - You don't want them to run out of air prematurely

What is the reduced articulatory pressure target?

- Reduced Articulatory Pressure Target: Light contacts of the articulators (similar to easy onset but applies to consonants, not so much to the vowels) - The purpose is to prevent excessive lip and tongue pressure build-up on plosive sounds and to ensure correct initiation of voicing on subsequent sounds

What are slow change targets?

- Slow Change Target: Maintaining voicing between sounds and easy transitions of the articulators from sound to sound within syllables - The purpose is to slow the movements from one sound to the next within syllables, reducing the tendency to have choppy or jerky speech

What are the Strengths of the demand-capacity model?

- Strengths: Clinicians love this because it provides a clear guideline of what needs to be done in treatment and what needs to change. - Look for the capacities and the demands and work with the discrepancies - If their environment is too busy - If the language used is too complex - If the child is in a high stress environment, reduce the stress

What are stretched syllables?

- Stretched syllable target: each syllable and sounds (except for stops and fricatives) are elongated beyond normal - The purpose is to help the client become aware of the motor movements they are doing when speaking. It provides a basis for fluent speech upon which other targets can be applied, and it can then be shaped towards more typical patterns of speech.

Explain the general differences between stuttering modification and fluency shaping approaches to stuttering treatment.

- Stuttering modification focuses on the stutter; training the person to stutter more fluently. There is an emphasis on self-perception and working on the attitude that surrounds the stutter, and to improve the overall confidence level surrounding the person's communication ability. In stuttering modification, the clinician also works to eliminate any secondary behaviors that may exist. - Fluency shaping focuses on eliminating stutters entirely and places emphasis on teaching the person to talk fluently. The clinician will teach techniques in therapy in order to achieve fluent speech, and the individual's speech is gradually shaped to approximate normal sounding speech. There is no emphasis on fear or avoidance behavior reduction as the idea is that in learning to produce fluent speech through this treatment, the fluent speech will lead to a reduction in such behaviors.

Explain the Multifactorial Dynamic Pathway theory proposed by Smith and Weber (2017).

- The mechanism that produces stuttering is a failure of the CNS to generate patterns of motor commands necessary for fluent speech to continue → there is underlying weakness at the motor level - Neural systems (for speech, language, and emotional functions) interact with unstable speech motor networks → places pressure on the collective system and pushes it outside the boundaries of fluent speech production - Too many demands placed on motor capacity = unstable control signals = pushed beyond normal function = stuttering - Responses to these unstable control signals may either be adequate and result in recovery or less adequate and result in chronicity of stuttering - Recovery: 80% - Persistence: 20% - Innate predisposition (genes) - Epigenetics → environmental influences that trigger activation of stuttering - Not just a single factor→ not just genetics, environment, temperament but the interaction. - Dynamic because it changes over time. Interactions that lead to the initial onset of stuttering may not be the same ones that lead to chronic stuttering.

Briefly describe two possible reasons for increased activation in the right hemisphere in the brains of people who stutter.

- There has been a lot of research on brain activation and PWS vs. PNS. - Previous research explains that the brain is supposed to be lateralized so that one hemisphere can minimally control the other hemisphere. Since children were forced to use their right hands, even though they were left handed, that lateralization did not form and the hemispheres of the brain did not have a sergeant to organize fluent movement (including speech). This reason has been disproven - Current thought it that there is reduced density of white matter, grey matter volume, and cortical thickness found in people who stutter which is believed to compromise the function of the left inferior frontal gyrus. It is possible that increased activation in the right hemisphere serves to compensate for this insufficiency in the left hemisphere. - Increased activation in the right hemisphere may result in interference with functions normally controlled by the left hemisphere. - As well, the right hemisphere is more responsible for consciously doing something (PWS focus more on what they are saying), while the left hemisphere is more autopilot (PNS do not need to put so much conscious thought in their speech) à When you ask adults to do voluntary stuttering, there was increased right hemisphere activation → similar to the activation seen in the other studies of people who stutter. - This was confirmed when clients were scanned pre and post treatment. - PNS: Stronger left than right - PWS: Stronger right than left; following treatment even MORE right

Compare the Lidcombe treatment program vs. the RESTART program for young children who stutter. What do these program have in common? What are the main differences?

- They are 2 ends of a continuum: - Lidcombe - specifically lays out how to address moments of stuttering - Based on Operant Conditioning: Positive and Negative reinforcement and "punishment"/correction - Both direct and indirect: You as the SLP are directly with the child, but you are teaching the parents to directly work with the child - RESTART - instead of addressing everything your child says and trying to account for every production, your control of your own responses can help your child - Didn't want stuttering to be the focus. Don't create an environment in which stuttering is always pointed out. - RESTART is based on demands capacity model - Work more on acceptance of stuttering (want to avoiding the need for secondary behaviours) - Indirect treatment à SLP works with the parents to reduce motor, linguistic, emotional, cognitive demands - Motor: Insert pauses in your speech (relax and reflect, don't interrupt; reduced speech rate, maintain eye contact, slower paced environment) - Linguistic: Use age-appropriate utterance complexity and length (Good turn-taking, parallel talk (child says something and you repeat what they said), follow child's initiative, Use closed-end questions rather than open ended ones) - Emotional: Prevent/reduce strong emotional reactions, Prepare child for exciting events, Do not advise different ways of talking - Cognitive: Ask age-appropriate questions, 1 question at a time) - More direct treatment for increasing capacities - Model shorter and relaxed disfluencies - Modify their stuttering - The child is present, but once every couple weeks, the parent meets with the clinician without the child - Long term results are similar, as they decrease stuttering. However, the lidcombe program decreases stuttering faster in the short term.One or the other is no better in their final outcome. - Both are indirect - Lidcombe is indirect-direct because you're working with parents but parents are working directly with kids - Direct à teach skills directly to kids. - "Direct treatment decreased stuttering more quickly during the first 3 months of treatment for Lidcombe" - seeing it as direct - Indirect approach = restart because decreasing demands, not working directly on it, you're working with the environment?

What is Beginning Stuttering?

- They are trying to get them out - The tension starts to come out in the speech - Prolongations and blocks are more apparent - Increases in pitch - They are really trying to push the word out - No avoidance behaviors yet. - May be more frustration and a general frustration - They might say they don't talk well. No fear and avoidance - This is where the learning (associations between the situation and the stutter - Leads to the next stage of escape of avoidance behaviours) - Some escape behaviours (eye blinking), frustration and negative self-talk (I don't talk well) à but there aren't avoidance behaviours

You are a SLP working at the Speech and Stuttering Institute. A woman calls the Institute and requests that her child be assessed as she is concerned about his stuttering. The child's mother claims that her son, Tommy, who is 4 years old, has recently started stuttering. She states that Tommy speech is disfluent and that he often fumbles over his words when speaking to strangers. However, she tells you that she only notices Tommy stuttering when they meet new people but that this never happens at home or when he's around close friends or family members. She also tells you that he sometimes does not stutter for days at a stretch. Do you think that Tommy may be developing stuttering? If so why? If not, why? What would you tell Tommy's mother?

- Tommy is most likely shy and nervous around strangers which explains why he may be fumbling over his words but comfortable speaking to people he knows - I would be interested as to what Tommy's mother is referring when she mentions that Tommy's speech is disfluent. I would want to do if he is experiencing core disfluencies (prolongations, blocks and repetitions (or sounds or syllables) or typical disfluencies (revisions, interjections, phrase repetitions etc.) - It is therefore impossible to say based on the description alone and I would recommend Tommy comes in for an assessment and is monitored. I would also be interested in finding out any family history of stuttering. - Tommy is a male, and while not all males who are disfluent fit the description of someone who stutters, it can provide some information regarding perceptibility to stuttering - Stuttering can be exacerbated by stress and anxiety provoking situations; however, it is unlikely that these situations would be exclusive - Stuttering varies over time and across situations

In the Yairi and Ambrose paper Epidemiology of Stuttering: 21st Century Advances (2012), the authors note that "the incidence and prevalence of [stuttering] in the general population can vary greatly, depending on the time-window observed". Briefly explain what the authors mean by this statement and how the said time-window affects the outcome of reports

- Various studies calculating Incidence and prevalence rates of stuttering yield different percentages - There are a variety of reasons as to why this might be - specifically, Variability may be due to (subjectivity in) how you collect your data. - parents may think something is stuttering when it's typical disfluency or not think it's stuttering when it is; Are you doing direct observation or surveys - depends on who and how you are sampling and the age of the individuals (still) stuttering - there is an 80% spontaneous recovery rate, so the percentage of individuals stuttering decrease as they get older - There is also a difference in gender - There is a Difference between incidence (only new cases of stuttering) and prevalence (stuttering at the time of the survey/report) - The emerging new cases of stuttering are balanced by existing cases of people who recover naturally. - Reportedly, a 24-month-window between the 2nd and 4th birthday best captures the peak of both stuttering onsets and natural recovery. - Explaining why surveys that cover this age range provide a better indication of life-time stutter incidence than those that begin coverage at more advanced ages. - Second example: A 24-month window between 15th and 17th birthdays, prevalence of stuttering exceeds its incidence because new onsets are minimal for that time-window. There are, then, several ways of investigating or analyzing incidence and prevalence.

What are weaknesses of the Demand capacity model?

- Weaknesses Researchers don't like this model because it is a theory that cannot be proven wrong. It cannot be proven wrong because it is circular reasoning - There is a discrepancy - How do you know? - Because the child stutters. - If you look at the capacity and the demands and there is not a discrepancy, you are told to look again. - Why look again? - Because the child stutters so there must be a discrepancy. --> You can never look at everything!! That is why it is impossible to prove wrong it is also overly simplistic

What is the definition of concordance rate as used in genetics research for stuttering? Compare the concordance rate for stuttering in monozygotic twins and dizygotic twins and explain the significance of this comparison

- When looking at monozygotic and dizygotic twins, Concordance is the likelihood that both twins will stutter - Monozygotic twins have a higher concordance rate than dizygotic twins - But its not a perfect correlation #epigenetics - Stuttering is affected by both genetics (71%) and the environment (29%) - Stuttering has a strong genetic component, but genetics aren't everything

According to CASLPO's Practice Standards and Guidelines for Developmental Stuttering, what are the associated risks associated with intervention and how do clinicians account for these risks?

1. Risks associated with identification 2. Risks of delayed or inappropriate intervention 3. Risk of increased anxiety 4. Risk of associating fluency solely with the clinical environment

Describe three different speech skill targets used in the Fluency Plus program and their intended purposes/goals.

1. Stretched Syllable (SS) 2. Full Breath (FB) 3. Gentle Onset (GO) 4. Slow Change (SC) 5. Reduced Air Pressure (RAP I) 6. Reduced Articulatory Pressure (RAP II) 7. Amplitude Contour (AC) 8. Full Articulatory Movement (FAM)

What are the steps for full breath?

3 Steps to the Full Breath 1) Take a slow breath in while the stomach moves out. 2) Do not pause or hold your breath in between inhaling and exhaling. 3) Let the air out passively (do not push your stomach back in).

According to Nippold, SLPs should do the following when working with a child who stutters: a) The SLP should treat stuttering as a language delay and should bolster the child's language development through utterance expansions and modelling of syntactically complex sentences. b) The SLP should treat stuttering as a speech motor disorder unless child also has a language delay or disorder. c) The SLP should recommend that the family encourage the child's efforts to speak in more complicated ways as this reflects normal language development d) A and C e) All of the above

Either b) or e) All of the above NOBODY KNOWS...

What are normal disfluencies

No secondary behaviours --> They are not away of the disfluencies. Mostly repetitions, interjections and revisions

List and briefly explain the 3 different main stutter modification techniques used during the modification phase of Van Riper's treatment approach to stuttering.

Phase 3 is the modification phase and its goal is to elicit easier stuttering and as well as learn to use modification techniques: - → cancelations -Complete the stuttered word --> pause. Then, either finish the sentence or say the word a second time in a modified manner (easy stutter) - The logic is that the fluent speech following the stutter is a reinforcement to the stutter. The pause cancels that reinforcement. You reflect on the stuttering and turn it into an easy stutter - → pull-outs - Identify the stutter as you say it --> no pausing --> complete the word using modifications (east stutter) - As people get good at this, they use the easy stuttering right away. - → preparatory sets - this steps involves anticipating a stutter and then modifying the word to prevent stuttering - Anticipate a stutter --> modify the word to prevent stuttering - If it works well, then it's a natural progression form cancellation --> pull-outs --> preparatory sets.

According to CASLPO's Practice Standards and Guidelines for Developmental Stuttering, what is "risk of increased anxiety"?

SLPs must understand the relationship between anxiety and stuttering to inform interventions. The SLPs goal is to try and find ways to minimize the patient's anxiety in relation to stuttering.

Name and briefly describe the 5 stages of stuttering development proposed by Barry Guitar.

Stage 1 - Norma Disfluency (1.5 - 6 years) Stage 2 - Borderline disfluencies (1.5 - 3.5 years) Stage 3- Beginning stuttering (3.5 - 6 years) Stage 4- Intermediate stuttering (6 - 13 years) Stage 5 - Advance stuttering (16+ years) --> This is not a linear model. You can jump around. Skip stages, come back etc. It's flexible/fluid. It's a continuum. The child can move around. But generally, you wouldn't see borderline stuttering in a 16-year-old. More common in children

According to CASLPO's Practice Standards and Guidelines for Developmental Stuttering, what is "risks associated with identification"?

There is a risk of false identification resulting in unnecessary concern for the patient/client while a lack of identification could have detrimental effects as well. To account for this, SLPs must sample a broad variety of speaking situations before coming to a conclusion regarding the presence or absence of stuttering.

According to CASLPO's Practice Standards and Guidelines for Developmental Stuttering, what is "risks of delayed or inappropriate intervention"?

This can result in increased frequency and severity of stuttering behaviours as well as developing inappropriate compensatory strategies. To account for this, SLPs must respond to referrals in a timely manner and consider all factors before selecting and starting a treatment approach.

According to Andrews, et al. (1991), the contribution of genetic vs. environmental influences is: a) 71% and 29% b) 50% and 50% c) 29% and 71% d) 1% and 99% e) None of the above

a) 71% and 29% Rationale: 71% of variance due to genetic factors; 29% of variance due to environmental influences

What is the characteristic of trait stuttering as summarized in the meta-review by Belyk, et al. (2015)? a) Increase in right hemisphere activation b) Increase in left hemisphere activation c) Decrease in right hemisphere activation d) Decrease in left hemisphere activation e) A and B f) B and C

a) Increase in right hemisphere activation

Which of the following statements is not true? a) Males are more likely to develop a stutter than females. b) Monozygotic twins are less likely to both develop a stutter than dizygotic twins. c) Developmental stuttering is likely caused by a combination of genetics and environmental factors. d) Stuttering can be characterized by articulatory discoordination. e) B and D

b) Monozygotic twins are less likely to both develop a stutter than dizygotic twins.

According to the research findings summarized by De Nil and Mersov (2020), which of the following statements regarding the sensory-motor aspects of stuttering is false? a) People who stutter tend to have slower reaction times on both speech and non-speech movement tasks. b) People who stutter have an increased proprioceptive sensitivity. c) People who stutter tend to have significantly higher articulatory discoordination during oro-motor movements. d) People who stutter have greater difficulty attaining a high degree of movement automaticity. e) None of the above f) All of the above

b) People who stutter have an increased proprioceptive sensitivity. Rationale: proprioceptive sensitivity is decreased

Which of the following is NOT typical of Phase 2 stuttering according to Bloodstein & Bernstein-Ratner (2008) a) Self-concept as a person who stutters, but little fear b) Stuttering is episodic c) Stuttering is mostly on content words d) More severe when excited or under pressure e) All of the above

b) Stuttering is episodic Rationale: Phase 2 is characterized by A, C, and D. Episodic stuttering occurs in Phase 1 according to Bloodstein.

What is the difference between incidence and prevalence? a) Incidence and prevalence are the same b) Incidence is the number of current cases in a given time-window while prevalence is the number of new cases in a given time-window c) Incidence is the number of new cases in a given time-window while prevalence is the number of current cases in a given time-window d) Incidence has to do with how many people are affected while prevalence has to do with where the affected people are e) None of the above

c) Incidence is the number of new cases in a given time-window while prevalence is the number of current cases in a given time-window

Which of the following do not reflect a core behaviour associated with stuttering? a) Layla, who often times prolongs the onset of her words, especially the /m/ sounds. b) John, whose speech is involuntarily interrupted by blocks and pauses. c) Merriam, who usually comes up with a synonym in order to replace a word that is hard for her to pronounce. d) Samuel, who has a tendency to repeat the pronoun "I" multiple times before proceeding with the rest of his sentence. All of the above

c) Merriam, who usually comes up with a synonym in order to replace a word that is hard for her to pronounce. Rationale: Coming up with synonyms is an avoidance behaviour and a typical disfluency

Which of the following is NOT an example of typical disfluencies? a) Revisions b) Interjections c) Prolongations d) Phrase repetitions e) All of the above

c) Prolongations Rationale: Almost non-existent in non-stutterers

Which of the following is NOT a target(s) of the Fluency Plus treatment program? a) Stretched Syllable (SS) b) Slow Change (SC) c) Reducing Conversational Demands (RCD) d) Reduced Articulatory Pressure (RAP II) e) B and D f) All of the above

c) Reducing Conversational Demands (RCD) Rationale: The Fluency Plus program targets include: stretched syllable, slow change, reduced articulatory pressure, full breath, gentle onset, reduced air pressure, amplitude contour, and full articulatory movement

Stuttering is most likely to occur at: a) The end of a word b) The end of a syllable within the word c) The beginning of a word d) In short simple sentences e) A and B f) All of the above

c) The beginning of a word Rationale: Stuttering is most likely to occur at the beginning of a word, the beginning of a syllable within a word, the beginning of a sentence, on longer words, on long/complex sentences, or on content words/less familiar words.

What does a stuttering modification program attempt to modify? a) environment b) parents' feedback on stuttering c) moments of stuttering d) linguistic demands e) A and D f) All of the above

c) moments of stuttering Rationale: Three objectives are to modify moments of stuttering, decrease speech anxiety, and eliminate avoidance behaviours

Current brain imaging research has generally shown that PWS have: a) structurally similar brains compared to people who do not stutter, but functionally different brains b) structurally different brains and functionally similar brains, compared to people who do not stutter c) structurally different and functionally different brains, compared to people who do not stutter d) structurally the same and functionally the same brains, compared to people who do not stutter e) None of the above

c) structurally different and functionally different brains, compared to people who do not stutter

Stroke-related acquired neurogenic stuttering is associated with lesions in which of the following brain area(s)? a) Cerebellum b) Broca's area c) Corpus callosum d) Cortico-striatal-cortical feedback loop e) A and C f) None of the above

d) Cortico-striatal-cortical feedback loop

Why are there fewer cases of stuttering identified as age increases? a) Natural recovery b) Older children and adults are less willing to get treatment and so it goes unidentified c) Less new onsets occur during late childhood and adulthood d) A and C e) All of the above

d) Natural recovery and Less new onsets occur during late childhood and adulthood

What are some well-known predictors of persistence of stuttering? a) Family history of stuttering b) Later age of onset c) Sex—boys are more likely to persist d) A and C e) All of the above

e) All of the above

What are the main features of cluttering? a) a rapid and/or irregular articulatory rate b) a higher than average frequency of disfluencies c) reduced intelligibility due to exaggerated co-articulation (deletion of syllables or sounds in multi-syllabic words) and indistinct articulation d) B and C e) all of the above

e) all of the above Rationale: These are the three main features of cluttering; a rapid and/or irregular articulatory rate, a high number of disfluencies, and co-articulation/ indistinct articulation

According to CASLPO's Practice Standards and Guidelines for Developmental Stuttering, what is "risk of associating fluency solely with the clinical environment"

there is a risk of the patient/client depending on the clinician and the clinical environment to maintain fluency. To account for this, the SLP should focus on the transfer of fluency and generalizing treatment environments as much as possible.