Quiz 1, Quiz 3, Quiz 4, Quiz 5, Quiz 7, Quiz 8, Quiz 9

Why start the case history interview with "tell me about X's speech?"

-As broad as possible -You want their main concerns first

Why is reading difficult to use in an assessment for fluency?

If a person has an avoidance behavior won't see that

Do you allow any disfluencies in treatment?

No, because you don't want revisions (which happen in normal speech) hiding core behaviors of stuttering

What type of task should be used when eliciting language from bilingual kids?

Narrative tasks

Why is speaking with loud masking noise a fluency inducing condition?

Not able to listen to yourself

What is the concern about mazes vs. stuttering for bilingual kids?

Overlap between types of disfluencies that are considered to be mazes and those that are typically defined as stuttering -Reported high rate of maze production in Spanish-English speakers -Risk for false positive identification of stuttering in Spanish-English speakers

What do you want to observe while the parent and child are playing during a fluency eval?

Parent reaction to stutter

What type of repetition is most disruptive to motor planning?

Part word repetitions (not syllables) because speech is programmed into chunks of syllables.

What is easier to listen to, part word/whole word repetition or initial phoneme repetition?

Part/Whole Word Repetition is easier to listen to

What are some examples of autonomic nervous system responses?

Perspiration Becoming flush or pale Palpitations Shortness of breath

What are some examples of escape behaviors?

Physiological things... -Eye blinks -Head nods

True/False: Children who recover naturally show steady decline in amount of stuttering in first 12 months after stuttering onset.

True

True/False: Communicative stress may or may not manifest as changes in fluency.

True

True/False: Fixations/sound prolongations predict persistent stuttering.

True

True/False: Norms for monolingual children on stuttering assessments are not applicable to bilingual kids.

True

True/False: Some adolescents and adults who stutter will not progress to the advanced stuttering stage.

True

True/False: Stuttering in adults typically means they didn't have EI or, if they did, it was unsuccessful.

True

True/False: Stuttering is more common in males.

True

True/False: Stuttering occurs in all cultures, in both men and women, across all ages and SES levels.

True

True/False: The age of onset of stuttering is critical for intervention.

True

True/False: The younger the child, the more appropriate indirect treatment is.

True

True/False: Stuttering is not common.

True, it only occurs in 1% of the population

What are prolongations?

Voiced or voiceless sounds Airflow continues, articulatory movement stops e.g. mmmmmmy name is vs. my name is.

What are fixations or blocks?

-Airflow stops, articulatory movement stops -Any physiological system may be involved (respiratory, laryngeal, articulatory) -Often excessive laryngeal muscle activity leading to breath holding

What stuttering characteristics in preschoolers appeared to elicit negative peer responses?

-Behaviorally complex (repetition + prolongation + fixation) -Long duration -Utterances where you can't understand what they're saying

What are some characteristics of advanced stuttering?

-Characterized primarily by age (14 yrs and up) -Extensive avoidance behaviors -Fear, embarrassment, shame

What are some characteristics of intermediate stuttering?

-Child starts to develop fear of stuttering, more emotional than just frustrated/surprised -Child reacts to this fear by trying to avoid sounds or speaking situations that might cause stuttering -Fixations very noticeable -Excessive tension in laryngeal area, lips, tongue, holding breath

What is the challenge when assessing bilingual kids for stuttering?

-Distinguishing bilingual children who do and do not stutter from their monolingual fluent and disfluent peers. -Distinguishing a stuttering disfluency from a linguistic disfluency -Mazes vs. Stuttering

What are the two main types of secondary behaviors?

-Escape behaviors -Avoidance behaviors

What are some examples of avoidance behaviors?

-Fillers (um, you know) -Starters (My name is...) -Substitutions/circumlocutions - talking around a problem word -Timing hand movements to saying a word -Avoiding situations where they're likely to stutter

What is the empathy response?

-First acknowledge how someone is feeling and make a statement that indicates your understanding of the reason for feeling that way. -Then WAIT for them to respond before you make suggestions.

What are some examples of quantifiable parent behaviors you may observe and need to change?

-High rates of parental speech -Rapid fire conversational pace (lack of pauses between speakers) -Interruptions -Frequent Questions -Critical comments -Tone of voice -Inadequate or inconsistent listening to what child says -Vocabulary far above child's level -Advanced levels of syntax

What are some reasons a child may not spontaneously outgrow borderline stuttering?

-Home environment -Limitations in expressive language skills -Low frustration tolerance for repetitions -Developmental stressors do not diminish

What are some examples of mazes?

-Lexical revison -Grammatical revision -Phonological revision -Repetition

What are some things to do when you make initial contact with a parent about their child with dysfluency?

-Listen to concerns -Get a sense of urgency -Give them something to do until you can see them (forms) -Provide reasonable reassurance

In bilingual English-Spanish children, why do they typical produce more disfluencies in Spanish vs. English?

-More morphosyntactic elements to revise (e.g. gender of words) -Nouns less frequent than verbs in Spanish

What are some characteristics of borderline stuttering?

-Mostly linguistic formulation/normal developmental disfluencies -Look for increased # of disfluencies -Child has infrequent reactions to disfluencies -Few secondary behaviors -No tension

What decisions do you need to make at the end of a fluency assessment?

-No treatment -Watchful waiting -Parent delivered tx -Clinic based tx -Other referrals needed -Child WNL for language, artic, voice

How do you begin indirect treatment for preschool stuttering?

-Parents complete Stuttering Severity Rating Scale -Obtain baseline sample of child's speech in clinic -Compare your rating to parents' rating

What are some characteristics of beginning stuttering?

-Rapid and irregular repetitions -Increased tension -Pitch rise (due to laryngeal tension) -Awareness and feelings of frustration but no strong negative feelings about self yet -Some secondary escape behaviors

What are some other secondary behaviors, aside from escape and avoidance behaviors?

-Revision/incomplete phrase -Disrhythmic phonations/altered prosody -Autonomic nervous system response -Visceral nervous system

What should be completed before the initial visit for a fluency evaluation?

-Scale for rating severity of stutter -Case history form -Early childhood behavior questionnaire -Video request of child speaking in typical home situation

How will you use the info gained from the video of the child at home combined with the info gained from watching the child play with the parent in the eval?

-See if there is variability in stutter across people (parent vs. clinician) -Is the parent calm/caring or stressful

What are some types of repetitions?

-Sounds (part word) e.g. t-t-table -Syllables e.g. di-di-di-disect -Whole word (includes 1 syllable words such as a/the, but excludes words repeated for emphasis such as very very big) -Phrase (repetition of two or more words at a time e.g. I was I was going)

What are some examples of formal fluency assessments for pre-school children?

-Stuttering Severity Instrument (SSI-3) -Speaking Rate -Impact of Stuttering on Preschoolers and Parents Questions -KiddyCAT

What is the general progression from normal disfluency to advanced stuttering?

1. Borderline Stuttering 2. Beginning Stuttering 3. Intermediate Stuttering 4. Advanced Stuttering

What two things might persuade the listener that what they are hearing is stuttering and not normal disfluency?

1. If it distracts from the speaker's message. 2. If it makes the listener uncomfortable.

What are three types of core behaviors?

1. Repetitions 2. Prolongations 3. Blocks/Fixations

What three things are important for differential diagnosis of bilingual children?

1. Tension 2. Fixations 3. Parental Concern

What do we care about most when deciding if a child is truly stuttering or if it's developmental?

1. Tension 2. Reactions to disfluencies

The percentage of children who stutter between the ages of 3 and 5 who will live fluent lives...

75%

By what age do developmental stressors contributing to stuttering typically taper off for most children?

Age 4 - 5

What is the difference between a fixation/block and a prolongation?

Airflow (There is airflow in a prolongation but not in a block)

What is a repetition?

And [they] they were all looking

What is communicative stress?

Any force causing strain/tension in the communicative process

What does Van Riper consider significant landmarks in the development of true stuttering?

Any indication that a child is stopping the flow of air or voice at one or more places -Laryngeal Tension -Laryngeal Fixation

Why might bilingual children experience more linguistic uncertainty?

Because they don't have enough practice in one language, their resources are divided

What part of an utterance is the locus of greatest uncertainty?

Beginning. That's where stutter most likely.

What is the typical age of onset for people who stutter?

Between 2-5 years old

Stuttering is... A) Psychological B) Behavioral C) Neurological

C) Neurological

What is a core behavior?

Characteristic of the disfluent speech itself

What is the impact of an increased parental speech rate on a child who stutters?

Child uses that speech rate as a model for their own speech. They try to talk too fast. This leads to tension.

What are the clinical implications of the negative peer responses to preschool stuttering?

Children identified at risk for negative social consequences of stuttering may need to be treated sooner rather than later

What phonemes are prolongations common on?

Continuants (m, f, s)

What is a grammatical revision?

Correction of over grammatical errors (e.g. He was wearing the jar [in] on his head)

What is a lexical revision?

Correction of over word choice errors (e.g. his [frog] dog came along)

What is a phonological revision?

Correction of phonological errors (e.g. Squeak went the [saxalone] saxophone)

What are oscillations?

Count of how many repetitions of sounds, words, etc. occur during a stuttering event

What are the potential negative impacts of peer responses to preschool stuttering?

Difficulty resolving conflicts, unable to use words could lead to child who stutters getting hit or being held responsible for conflict if can't explain self

What is the difference between dys and dis when speaking about disfluency?

Dis = not Dys = abnormal or bad

What is stuttering?

Disruption in the fluency of verbal expression

What is a maze?

Disruption in the forward flow of speech by the production of a string of words, initial parts, or unattached fragments of words that do not in and of themselves contribute to the message (e.g. linguistic disfluency)

What is stuttering?

Disruption in the forward flow of speech that includes repetitions of sounds and syllables as well as audible and inaudible sound prolongations

In what part of child development are disfluencies normal?

During periods of intense language acquisition

Why is swearing a fluency inducing condition?

Emotion

With indirect treatment, what are you modifying?

Environment

What is a secondary (accessory) behavior?

Extraneous physical behaviors associated with disfluent speech. They are initially deliberate and then become involuntary.

True/False: Neurotypical adults are always fluent.

False

The presence of what specific behavior indicates likely stutter in a bilingual child?

Fixations/sound prolongations Tensions

Why is speaking in a slow, prolonged manner a fluency inducing condition?

Gives articulators time to reach their targets

What is anticipation?

In a reading passage, many PWS are able to predict the words they will stutter on

What are some examples of fluency inducing conditions (situations in which a child is fluent)?

LOW PRESSURE SITUATIONS -Speaking alone -Speaking when relaxed -Speaking in unison with another speaker -Speaking to an animal -Speaking to an infant -Singing -Speaking in another dialect -Speaking while simultaneously writing -Swearing -Speaking in a slow, prolonged manner -Speaking with loud masking noise -Speaking with DAF -Shadowing another speaker

How is the Impact of Stuttering on Preschoolers and Parents Questions structured?

Indirect questionnaire

Stuttering is characterized by...

Involuntary, audible or silent, repetitions, prolongations or fixations in the utterance of speech elements (sounds, syllables, words, phrases)

What is the most common type of stuttering in bilingual children?

Monosyllabic word repetitions

How is the KiddyCAT structured?

More direct questions for child, assessment of child's attitude, e.g. Do you think that Mom & Dad like the way you talk? -Assess in play environment

How is the SSI-3 structured?

Percent of syllables stuttered in speaking and reading (if a non-reader, speaking task score doubles) -Based on at least 2 conversational speech samples (e.g. at home and in clinic) -Determine duration of 3 longest stutters -Calculate mean -Convert to scaled score -Add scaled value of each subcomponent

What does PWS stand for?

Person Who Stutters

What would you do if the child is fluent in an eval but the parent says they stutter at home?

Put some pressure on during the eval and see if you can elicit the stutter (e.g. ask lots of questions and interrupt the child)

Why is singing a fluency inducing condition?

Right hemisphere involvement (melody line)

What do you treat first when working with a PWS - core behaviors or secondary behaviors?

Secondary behaviors. Get rid of those to get at the core behaviors.

How would you explain "why does my child stutter" to a parent?

Some children have slight differences in their neurological organization for speech, which may emerge as stuttering during the normal stresses and strains of growing up and learning to talk

What is adaptation?

Stuttering frequency decreases for most when they read a passage over many times

What is consistency?

Stuttering tends to occur on many of the same words each time in repeated readings of a passage

Why is speaking in a different dialect a fluency inducing condition?

Taking on a different persona

What advice would you give to parents whose children are in the "beginning stuttering" stage?

Tell them to compare the child's difficulty with speaking to other things the child is learning how to do. Eg. "When you first learned to walk you fell down a lot. Sometimes we need to practice physical things to get them right."

Why get a video of child speaking in typical home situation?

Tells you what situations have more disfluency

What is the most concerning behavior for parents of bilingual children?

Tension/timing/arrhythmic speech

Secondary behaviors, or accessory behaviors, include all of the following except... a) prolongations b) eye blinks c) gasping d) head jerks

a) prolongations

Core behaviors include all of the following except... a) part word repetitions b) whole word repetitions c) grimacing d) laryngeal fixation (block)

c) grimacing