Stuttering Chapter Questions (1,2,4,6,7)
compare the feelings and attitudes of the borderline, beginning and intermediate stutterers.
- borderline: little awareness and therefore no concern or embarrassment... if anything they may feel surprised/frustrated when caught on a word -beginning stutterers have an awareness of the difficulty and feelings of frustration are present, but there are no strong negative feelings about self as a speaker -intermediate are well beyond the momentary frustration and mild embarrassment, its no longer an annoyance but a serious problem. Still has fear, embarrassment and shame (school shows him he's markedly different from his peers)
Johnson and associates (1959) revised view of stuttering suggested that it results from and interaction b/w three factors (a) the extent of the child's disfluency (b) the listener's sensitivity to that disfluency and (c) to the listener's to his own disfluency and to the listener's reaction. relate these factors to constitutional, developmental and environmental factors in stuttering.
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describe the core behaviors of the beginning of a stutter
1. repetitions begin to sound rapid and irregular. the final segment of a repeated syllable often sounds abrupt... 2. also tension in speech mechanism, may be rise in vocal pitch 3. and prolonging first/middle sounds. 4. 1st signs of blockages appear
at what ages is normal disfluency likely to be most frequent?
1.5-6 years, although a small amount of normal disfluency continues in mature speech (revisions, interjections, repetitions on single-syllable word repetitions having fewer than 2 extra units)
compare kent's (1984) view of stuttering as a disorder of timing with Geschwind and Galabura (1985) theory.
G&G suggest that a delay in left hemisphere growth and development effect nerve cells that do not properly migrate to the left side, and receive signals from the right and migrate there instead, resulting in right hemisphere dominance. However, because the right hemisphere is not designed for this function, speech and lang operate inefficiently. Kent suggested the inability to perform precise timing (muscular movements) may stem from a stutter's left hemisphere being less well developed than the right. Left hemisphere is specialized for processing brief, rapidly changing events like speech.
describe the role of the listener in the development of the advanced stutter's self-concept.
Looker's reactions look overwhelmingly negative, even when they say nothing their face says everything. Such experiences gradually shape advanced stutterers attitudes toward feelings of helplessness, frustration, anger and hopelessness.
Both Nielson and Nielson's view of stuttering and one of Max and coulleages (2004) hypotheses about stuttering suggest that repetitions occur because of a problem with the internal modes used for speech production. what is the difference b/w the cause of repetitions in each view?
Nielsens: A child develops a mental model of the relationship between speech sounds (what they hear) and motor commands (try to recreate it). repetitions may occur if a speaker it attempting to push ahead with speech while his brain is still planning the syllable that follow and how to link them with the initial sound. Have difficulty with sensory-motor planning and bc their brain does not have functional capacities in speech and language areas (left brain) and are focused on language tasks and cannot be accomodated and repititons occur. Max team: difficulty between motor commands and desired output would cause the speech production system to "reset" itself to try again, producing repetitions.
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?
Yes because the age (2-5) is when vocabulary is rapidly expanding and demanding on the child, and also when most begin to stutter. If they have a language delay they may begin to stutter and then have 2 deficits to deal with.
what is the relationship between a sensitive temperament and a high-level of conditionability?
a sensitive temperament means they may be more likely to increase their laryngeal tension in response to primary stuttering which they experience as threatening because it seems out of their control.This may be the reason many children's disfluencies change from easy, relaxed repetitions to tense repetitions and more involved secondary behaviors. Because they have a more reactive limbic system and strong emotional memories,bad interaction trigger tense reactions. The secondary behaviors learned through this fear conditioning is not easy to unlearn, and new behaviors will have to be learned as a new response.
how to studies provide evidence that stuttering is a product of both hereditary and environment?
a study that investigated both hereditary and adoptive families found that although both hereditary and environment plays a role, hereditary plays a stronger role (hereditary- concordance in identical twins). BUT some adoptive siblings may both stutter (environment)
why would children's speech and lang development be likely to put greater pressure on fluency than would their physical or cognitive development?
as language rapidly develops, the increasing length and complexity of the child's utterances may sometime exceed speech production abilities. selecting words, encoding phonology, planning syntax, and working on the complex prosody for an entire utterance all occur just as the child is starting to speak... both use left side of brain
what are the differences between core and secondary behaviors in stuttering?
core behaviors are the basic speech behaviors of stuttering; repetitions, prolongations, and blocks. The secondary behaviors are the acquired behaviors the stutterer learns as reactions to the basic core behaviors (escape or avoid)
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? Explain how you would do this.
cpacities include the potential for rapid movement of speech structures in well-planned rhythmic movements. To increase capacity, you can reduce the demands (parent pressure, cognitive demands, etc.) ... build their confidence of their stuttering and reduce fear of public speaking --> reading becomes more automatic and increased the available capacity for speech processes.
what are some feelings and attitudes PWS might have, and what is their origin? Do non-stutterers ever have these feelings?
feelings: frustration, shame , fear, guilt and hostility attitude: may begin feeling they are stupid, nervous, or someone who generally has trouble speaking most people stereotype stutterers as being tense, insecure, and fearful
how would you describe the etiology of stuttering to a parent who has has limited education and is not used to discussing abstract concepts?
i would explain it is something in their genetics, a random occurrence, that is not anyones fault
there is a high incidence of stuttering among individuals with cognitive impairment. What might this suggest about the relationship between cognition and fluency?
learning to think may make great demands on cognitive-linguistic abilities, leaving fewer resources available for rapid production of fluent speech. May also provide the intellectual ability for a child to compare herself with others, which may lead to shame + embarrassment about stuttering.
what is the major secondary behavior that differentiates the intermediate from the beginning stutterer?
more complex escape behaviors (combination of eye blink and head nod). - also develops word and situation avoidances. If he knows he has trouble with a certain word, he has learned how to take evasive action before he has to say it. (uses starters, substitutions, circumlocutions, postponments and antiexpectancy devices) - these techniques are becoming more rapid and subtle from experience
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?
neurological maturation may provide more "functional cerebral space" that supports fluency, nut it also spurs development of other motor behaviors that may compete with fluency. competition for resources, learning to walk leaves great demands on motor-sensory abilities, making fewer resources available for fluency.
what is the age range for the onset of stuttering (the youngest and oldest age at which onset is commonly reported)? why might it occur at that time?
onset typically occurs between ages 2 and 3.5 years, (typically just before 3 years). some older children - up to age 12 may begin to stutter. 18 months - puberty. may be due to continuing development of the language center, they are just learning to talk and demands are high, dramatic growth in vocab.
explain how deficits in sensory processing in people who stutter could be related to the actual behaviors of stuttering?
patients with various injuries and diseases have taught us normal speech depends on intact auditory and tactile feedback. studies have found reduced density in stutter's white matter fibers that support sensory-motor integration in speech production.
what are the differences between sensory processing and sensory-motor control?
sensory processing is how the individual hears/feels their own voice or others, while sensory-motor control is the muscles that move speech structures to produce airflow, voicing and articulation in a coordinated fashion.. stuttering is therefore a disruption in the sequenced muscle contractions
what aspects of social and emotional development might threaten fluency?
some stages of these developments may be more stressful than others.. for example the stages of separation (independent preschooler) and individuation (mother may be restraining child which frustrates child). disfluency may result in those interaction in which such emotional ambivalence and conflict affect motor control of speech. --- normal nerves/inability to control speech during emotional states (excitement) are exacerbated for those who stutter b/c right side has centers of emotion
why is it difficult to answer the question "what is the cause of stuttering"?
strong evidence of a genetic basis, (brain development and neural pathways for speech and language), environmental stressors may precipitate the onset of stuttering for a child who has a neurophysiological predisposition for stuttering.
how would you summarize the brain imaging studies to someone who is not a professional in our field?
stutterers have more activity in the right hemisphere of their brain as opposed to the left, during both fluent and stuttered speech. The language center is on our left hemisphere so the goal of intervention is to activate the left hemisphere and improve fluency
how does each of the areas - family studies, twin studies, and adoption studies - provide evidence that stuttering is inherited?
stuttering appears to have a genetic basis in many individuals (family studies) however, twin and adoption studies confirm that genes must interact with environmental factors for stuttering to appear.
the study by Kelly, Smith, and Goffman (1955) reviewed in this chapter suggest that tremors don't appear in younger children who stutter but do appear in older children. Why would this be?
such tremors may appear in the stuttering of only those individuals who have stuttered for some time and have developed maladaptive reactions. It is also possible that these tremors are evoked or magnified by autonomic arousal or the emotion that arise in response to expectation of speech difficulties ( older more aware of it)
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? (end of 6)
the 70% who don't recover, they have a second predisposition, a reactive temperament, which leaves them prone to the tension, escape and avoidance behaviors that characterize secondary stuttering. this can be from genetic factors or environmental (such as changes in temperament due to brain injury)
what problems do researchers encounter when they try to determine how many stutterers recover without treatment?
there is a variety in 1. the accuracy with which stuttering is differentiated with normal disfluency, 2. whether the study is retrospective or longitudinal, 3. and the size of the group studied.
describe why an escape behavior is used by a stutterer. Give examples
they may nod their head, blink their eyes, or squint right before they try to push a word out and for the moment, they escape from the punishing repetition, prolongation, or block.
identify several characteristics of parents' speech that may create difficult models for a disfluent child to emulate.
using longer words, less frequently occurring words, more information-bearing words, speaking fast, and longer sentences that are more linguistically complex may influence a child to use this more advanced language that is too demanding and cause them to stutter more.