CD 466 QUIZ

There is a high incidence of stuttering among individuals with cognitive impairment. What might this suggest about the relationship between cognition and fluency?

A child's cognitive development may not only compete with speech production for resources but may also provide the intellectual ability for a child to compare herself with others, which may lead to embarrassment and shame about stuttering. Someone with cognitive impairment may not be aware or self conscious of their stuttering as someone who has a more advanced cognitive development and will become embarrassed

Describe why an escape behavior is used by a stutterer. Give examples.

A stutterer would use an escape behavior to momentarily relieve him or herself from a frustrating and fearful speaking situation. In order to avoid embarrassing oneself if caught in a block, stutterers most often try to add filler words before getting to the word that they struggle the most. Some examples of escape behaviors include: substituting a word when stuttering is expected, postponing before approaching a word, and using antiexpectancy devices such as speaking in an accent to speak more fluently. Other types of escape behaviors are physical. The stutterer may show signs of agitation by either eye-blinking or nodding when attempting to get past a repetition or a block.

Compare the feelings and attitudes of the borderline, beginning, and intermediate stutterers.

Borderline stutterers (younger preschool children) have little awareness of their stutters and do not show any concern or embarrassment. Sometimes they show brief alarm or surprise when they are unable to finish a word, but in general they are not aware of their disfluencies. Beginner stutterers (older preschool children) are aware of stuttering when it happens. Strong feelings of frustration, fear, helplessness are present, in addition to the feeling of being out of control. They are conscious that they have difficulties talking, but sometimes they forget. Intermediate stutterers (school-age children) are well beyond momentary frustration and mild embarrassment. They feel helpless, fear, embarrassment and shame when stuttering. They have an increasingly negative self-awareness and negative feelings about their speech.

Johnson and associates' (1959) revised view of stuttering suggested that it results from an interaction among the following three factors: (a) the extent of the child's disfluency, (b) the listener's sensitivity to that disfluency, and (c) the child's sensitivity to his own disfluency and to the listener's reaction. Relate these factors to constitutional, developmental, and environmental factors in stuttering.

Constitutional factors in stuttering directly relate to point a, which refers to the extent of the child's disfluency. Constitutional differences such as inheritance or congenital injury causes stuttering, amongst other developmental delays most often influences the extent of the child's disfluency. Developmental and environmental factors directly relate to point b and c, the listener's sensitivity to that disfluency and the child's sensitivity to his own disfluency and to the listener's reaction. Environmental factors include pressure that typically result from attitudes, behaviors, or events that occur in their homes. Developmental factors refer to the individual's physical and motor skill development, speech and language development, and cognitive development. Some stages of development may provide more social and emotional stress than others. For example, the processes of separation and individuation are known to be periods of stress. the transition from a dependent infant to an independent preschooler may occur too rapidly for a parent or a child. If the child is pushed toward independence faster than he wants, he may feel frustrated and insecure because his mother seems less nurturing. the child cannot easily express these feelings to someone he depends on so much, and disfluency may result in those interactions in which such emotional ambivalence and conflict affect motor control of speech (Lidz, 1968).

Explain how the deficits in sensory processing in people who stutter could be related to the actual behaviors of stuttering?

Experiments that have altered sensory processing, such as delayed auditory feedback, have resulted in behaviors in stuttering, such as repetitions, prolongations, and blocks in normal speakers.

What are some feelings and attitudes people who stutter might have, and what is their origin? Do non-stutterers ever have these feelings?

Feelings and attitudes can also be important components of stuttering that reflect the stutterer's emotional reactions to the experience of being unable to speak fluently and to listener responses to her stuttering. Feelings are immediate emotional reactions and include fear, shame, and embarrassment. Attitudes crystallize more slowly from repeated negative experiences associated with stuttering. An example is a stutterer's belief that listeners think she is stupid when they hear her stuttering.

How would you summarize the brain imaging studies to someone who is not a professional in our field?

First, I would explain to them Broca's area and how it is an area in the left side of their brain that is important for the articulation of speech and then I would explain how there is also a part in the brain that is responsible for listening to and understanding other peoples speech. After, I would tell them that the person who stutters has a reduction of grey matter in these areas and that we were able to see them from the image when compared to a picture of a person who doesn't stutters brain. The person who stutters right side of the brain is working harder than the left.

How would you describe the etiology of stuttering to a parent who has had limited education and is not used to discussing abstract concepts?

I would describe to a parent that stuttering just happens and can affect any gender, race, and age. There is no known cause of stuttering but some scientists have theorized that stuttering is linked to genetics. I would explain to the parent that sometimes stuttering can just happen and try to keep my explanation simple by describing that with early intervention, and continuing to work on strategies, stuttering can be kept to a minimum. There is no cure but there are ways to help hide the stutter.

I have suggested there may be two predispositions for persistent stuttering—one for primary stuttering and one for secondary stuttering. How, according to this view, would primary stuttering lead to secondary stuttering?

It is possible for a child's primary stuttering to continue into adulthood and for secondary behaviors in response to their primary stuttering, and I would hypothesize that these children have the second predisposition, a reactive temperament, which leaves them prone to the tension, escape, and avoidance behaviors that characterize secondary stuttering.

The study by Kelly , Smith, and Goffman (1995) reviewed in this chapter suggested that tremors don't appear in younger children who stutter but do appear in older children. Why would this be?

Kelly, Smith, and Goffman discuss how tremors are magnified or evoked by the emotion that arises in response of speech difficulties. Emotional responses may lead to explain the abnormal cases of severe blocks at the initial stages of stuttering, particularly when stuttering is more likely to occur during conditions of stress and strong emotion. With that being said, one could infer that tremors don't appear in younger children who stutter but do appear in older children because of the increased stress and emotional baggage one carries from early to late childhood due to the demands of school and natural life events that take place as one ages.

Compare Kent's (1984) view of stuttering as a disorder of timing with the Geschwind and Galaburda (1985) theory.

Kent (1984), Perkins, Kent, and Curlee 1991), and Wingate (1988) suggested that a major source of breakdown is in timing linguistic and paralinguistic components. This demand for complex prosody at the multiword stage at the same time that phonological, syntactical, and lexical demands are added is likely to be a time when an inefficient speech and language system cannot keep up with the demands for rapid and complex speech production. Geschwind and Galaburda's theory suggests that a delay in left-hemisphere growth and development may affect speech and language for the following reasons. Various left-hemisphere structures that evolve during embryonic development appear to be especially suited for speech and language functions. As these structures develop, specialized nerve cells that are genetically programmed to sprout the neural connections for speech and language processes disperse from their point of origin in the "neural tube," where the central nervous system is formed. These nerve cells normally migrate to previously developed structures in the left hemisphere that are appropriate for their specialized functions. But if development of left-hemisphere structures is delayed, cells migrating from the neural tube may not receive the "homing beacon" they need to reach the left hemisphere. Instead, these specialized cells receive signals from the more developed right hemisphere and migrate there instead. These specialized cells then organize themselves as "networks" of neural activity in the right hemisphere for processing of speech and language. However, because the right hemisphere is not designed by its architecture and interconnections for this function, speech and language operate inefficiently there, like the Internet search engine Google trying to access information through the postal service.

Why would children's speech and language development be likely to put greater pressure on fluency than would their physical or cognitive development?

Most stuttering begins between ages 2-4, when a child is acquiring mew sounds and learning new words at a rapid pace. In general, research has shown that speech and language delays are more common among children who stutter than those who don't. There are several possible relationships between speech and language and stuttering. One is that children with language development delays may become more frustrated at their difficulty speaking and then start to stutter as an anticipatory avoidance response. Stuttering seems to be or could be a result of speech and language delays whereas once the child stutters their cognitive development might make it worse because the child is thinking about how they are different, possibly making the stutter worse.

At what ages is normal disfluency likely to be most frequent?

Normal disfluency occurs throughout childhood and adulthood. It may begin earlier than 18 months of age and peak between ages 2 and 3.5 years. It slowly diminishes, thereafter, but also change in form. Some types of disfluency, such as repetitions, decrease after 3.5 years, but other types, such as revisions, may increase. Episodic increases and decreases in disfluency are also common throughout childhood

Identify several characteristics of parents' speech that may create difficult models for a disfluent child to emulate.

Rapid speech rate, polysyllabic vocabulary, complex syntax and use of two languages in home are stressful adult speech models that may be difficult for children who are disfluent to emulate. Speech rates of parents of children who stutter may be faster, and this may be more reliably so for parents of children who are severe stutterers. Mothers of stutterers and even mothers of nonstutterers who interacted with children who stuttered interrupted the stuttering children more frequently when these children were stuttering than when they were fluent; additionally, the durations of the mothers' interruptions may be related to the severity of the child's stuttering. Parents of children who stutter may ask about the same number of questions as parents of nonstuttering children, but when children give longer answers to questions, they stutter more. For children who began to stutter, the more complex the mothers' language, the less likely the children are to recover naturally.

What problems do researchers encounter when they try to determine how many stutterers recover without treatment?

Reviews of early research report findings that range from 20 percent to 80 percent natural recovery (Bloodstein & Ratner, 2008; Andrews et al., 1983). This wide range may be from different methodologies used by different studies. Some asked large numbers of adults if they ever stuttered when they were children. This method, which is called "retrospective" may be affected by faulty memories, poor definitions of stuttering, and the inclusion of individuals who may have stuttered for only brief periods

What are the differences between sensory processing and sensory-motor control?

Sensory-motor control refers to the manipulation of the muscles that move speech structures to produce airflow, voicing, and articulation in a coordinated manner to produce fluent speech. For example, compared to nonstutters, stutterers' reaction times are slower, especially when linguistically meaningful stimuli are used. Sensory processing refers to the processes relating to the senses such as auditory feedback. For example, stutterers have poorer central auditory processing than nonstutterers, especially with regard to temporal information.

What is the relationship between a sensitive temperament and a high level of conditionability?

Some children seem to be born with sensitive or inhibited temperaments and are more likely to react to new people and novel situations with increased muscle tension and physiological signs of stress (Kagan, Reznick, & Snidman, 1987). Rather than using the term "temperament," they referred to "individual differences in conditionability and autonomic reactivity." They suggested that some individuals have predispositions to stutter because they are constitutionally more likely to have an anxiety-based speech breakdown under stressful conditions. Moreover, these individuals are also thought to be more conditionable, making it more likely that initial breakdowns under stress will escalate into highly learned stuttering behaviors.

What aspects of social and emotional development might threaten fluency?

Some stages of development may provide more social and emotional stress than others. These include separation and individuation. For example, after age 2 a child battles with his parents for separation. Parents may try to limit his freedom in order to keep him safe. Conversely, for some children, the transition from dependent infant to independent preschooler may cause stress. Both of these scenarios cause stress for both parent and child. The child may feel angry and frustrated and be unable to express his feelings. This may cause disfluency because emotional ambivalence can affect motor control of speech.

How do studies provide evidence that stuttering is a product of both heredity and environment?

Studies show that stuttering in most people is hereditary but sometimes never shows up because the environment they are put in doesn't allow for it. For example, a child who is predisposed to stutter lives in a household of slow speakers who don't stutter, his stuttering may never develop. On the other hand, a child who is also predisposed to stuttering may live in a hectic household of fast - talkers, we could expect to see stuttering in this individual.

What is the age range for the onset of stuttering (the youngest and oldest ages at which onset is commonly reported)? Why might it occur at that time?

Stuttering begins between 18 months of age and puberty, but most often between ages 2 and 5 years, with a peak just before age 3. Its first appearance may be either a gradual increase in easy repetitions of words and sounds or a sudden onset of multiple repetitions, sometimes with prolongations or blocks as well.

Why is it difficult to answer the question, "What is the cause of stuttering?"

Stuttering is idiopathic so there is no direct cause. Scientist have yet to discover a cause of stuttering. There is strong evidence that stuttering has a genetic component.

Do you think difficulty with language processing may be a cause of stuttering for some individuals? Why or why not? How might language deficits be related to stuttering?

Stuttering onset is often associated with language development. Children who stutter appear to have slightly less robust language processing abilities, and therefore may be a factor for stuttering seen in some individuals. Furthermore, it has been found that individuals who stutter have weaker auditory processing abilities and have less accuracy with word identification compared to those who do not stutter. Language deficits are related to stuttering in the following ways: (1) more stuttering occurs in more complex sentences. (2) stuttering is influenced by linguistic factors such as lexical class of word, length, and location in a sentence. (3) more linguistically complex stimuli result in poorer performances by stuttering on many performance tasks.

Describe the role of the listener in the development of the advanced stutterer's self-concept.

The advanced stutterer's (older teens and adults) self-concept is developed through the reactions of significant listeners such as parents, peer group, and other adults. An advanced stutterer's self-concept can become filled with enduring negative perceptions as a result of the listener's impatience and rejection. A negative self-concept is formed not only by the perceptions of listeners' reactions, but it also affects those perceptions (they are likely to project their own rejections of stuttering onto listeners). Therefore, listeners should show non-judgment and patience during the development of the advanced stutterers self-concept.

Both Neilson and Neilson's view of stuttering and one of Max and colleagues' (2004) hypotheses about stuttering suggest that repetitions occur because of a problem with the internal models used for speech production. What is the difference between the cause of repetitions in each view?

The cause of repetition for the Neilson's view is that stutterers have a hard time learning the relationships between sounds and concluded that the stuttering was a result of the neural capacity one has for sensory-to-motor demands. The cause of repetitions is due to their neural capacity. Max and colleagues theory stated that the cause of repetitions was the brain's way of "resetting" itself until the right production came out (Guitar, 2014).

Describe the core behaviors of the beginning stutterer.

The core behaviors of a beginning stutter include whole or part word repetitions occuring 3 time or more, prolongation of words or sounds, and blockages or stops in speech

What is the major secondary behavior that differentiates the intermediate from the beginning stutterer?

The major secondary behaviors that differ the intermediate from the beginning stutterer are demonstrating word and situational avoidance techniques both swiftly and sneakily. The intermediate stutterer already plans out what evasive action to take before saying a disfluent sound. At this point, the intermediate stutterer is afraid and ashamed of his or her disfluent speech in addition to feeling frustrated and embarrassed. Therefore, the stutterer finds ways to avoid situations where they are put on the spot, such as being called to answer a problem in class or having to make an order at a restaurant. One example of escaping a situation is making up an excuse to use the restroom.

How does each of the areas—family studies, twin studies, and adoption studies— provide evidence that stuttering is inherited?

Through the research of family trees, scientists gathered evidence of the inheritance of stuttering by doing a study on those who stutter and those who don't. The scientists look for patterns of the occurrence of stuttering throughout the family tree of stutters. They found that this family study provided strong evidence that there may be a genetic predisposition in the individuals who stutter. They found that males were more at risk to develop stuttering than females. In the twin studies, the scientists found that in either identical, same-sex, or fraternal twins that if one twin stutters, the other one does too. However, the second thing they found was that there were cases in that with identical twins, one stuttered and one did not. They came to the conclusion that the genes do play a factor but the environment also can determine their behavior. In the adoption study, the scientists had mixed results in that those who were adopted versus those who weren't still developed a stutter. Even though hereditary and environmental factors play a part, hereditary plays a bigger role in the occurrence of stuttering.

A capacities and demands view of stuttering in children would lead to a therapy strategy of enhancing a child's capacities. What are some examples of what capacities in a child you could strengthen to reduce stuttering? Describe how you would do this.

Treatment based on this model would start with an evaluation of the demands of the environment and the child's capacity. Through this evaluation, therapy would be designed to decrease demands, enhance capacities, and provide support for the child. This view of stuttering onset proposes that if the demands are are greater than the child's capacity, stuttering occurs. However, stuttering is diminished if demands are lessened, even if the child's capacity remains the same. Some examples of strengthening capacities in a child in order to reduce stuttering is speaking slower so that the child has more time to process what is being said. Slower speech allows for corrections while a syllable is being produced rather than after it is completed. Another example of strengthening capacities in a child, is providing encouragement. If a child is fearful of reading because he or she thinks it's hard, then their capacities will remain the same as the demands for school continues to increase. It is important to be patient and provide support so the child becomes willing to read and changes their perspective of reading. Soon, the child won't think of reading as something intimidating or scary, but will able to read comfortably and be exposed to increasing syntax and vocab through the years, therefore strengthening their capacity.

It has been said that children usually do not learn to walk and talk at the same time. What does this suggest about how motor development might affect fluency?

When babies develop spoken language they temporarily postpone mastery of new motor skills. Speech development in children draws on a number of anatomical, motor sensory, and cognitive resources.