Stuttering Exam 1

Within word disfluencies

(break rhythm of speech) -Sound/syllable repetitions (s s s something)=ssr -Sound prolongations /disrhythmic phonation=asp or Isp (audible and inaudible/block) (ssss something, or inaudible-nothing comes out) -Monosyllabic whole-word repetitions (I I I I I like toys) These are all stuttered

How a CS-CR response becomes unlearned

-External inhibition: present novel stimulus at same time C.S. is presented, individual "orients" towards novel stimulus reducing C.S. ability to arouse C.R. (e.g., metronome). If u distract a person when the conditioned stimulus is presented, they will orient themselves to that novel stimulus •Internal inhibition: present C.S. (bell) repeatedly without U.C.S (food)...C.S. gradually, over time, loses ability to elicit C.R. (e.g., telephone without fear)

between word disfluencies

-Interjections (I um like pizza) -Revisions (I like hot no iced coffee) -Phrase repetitions (I like, I like, cinnamon) •These are all normal

The Monster Study (1939)

-Wendell Johnson and grad student Mary Tudor, 5 month study -22 orphans, ages 5-16 into two groups normal speakers and stutterers -5 stutter children told fluent -5 stuttering children where stuttering verbally reinforced -6 fluent children told they stuttered and should avoid it -6 normal children told they had good speech -Many of them suffered negative psychological effects and speech problems throughout life.

loci of stuttering for preschoolers

-occurs most frequently on pronouns and conjunctions (these occur frequently at the beginning of utterances in young children) -Function words: pronouns, conjunctions, articles -Words at beginning of sentence •The trigger seems to be linguistic planning and preparation -Tend to start sentences with I, mine, she/he, you (functional words also). Our brain plans and coarticulates to make speech easier

threshold for stuttering diagnosis

3% of speech is stuttered disfluencies. Therefore 97% of speech is fluent. Parents at 3% typically report concern with child's speech From 3-10% (mild range) for kids For adults: 20% maybe, but this is a lot, very severe stuttering, like every word is being stuttered. Adults however may be avoiding and substituting words more. About 1% of adults stutter

brain structure

Anatomy of the brain. Stuttering is neurodevelopmental. Primary motor cortex: motor homunculus At end of motor cortex is the ventral frontal cortex, it houses broca's area which is important for language expression, programming for linguistic gestures In brocas aphasia, comprehension is relatively unaffected Inferior parietal cortex-temporal lobe and wernickes area Pathways connecting wernickes and brocas These are important language areas. There are similarities of these areas in adults with stutter -Density of white matter tracks examined in left operculum region. These fibers are thought to connect sensory planning and motor areas for speech -Bundles of myelinated axons in cns are called tracts, are like highways in brain that connect to other areas so that we can function. In PWS, the density of these tracts were not as dense as ppl who don't stutter -The superior longitudinal fasciculus is less dense in the left hemispheres of people who stutter •This is a bidirectional pathway between sensory integration and motor planning areas. Brain areas used for sensory integration are not efficiently connected to motor planning and motor execution areas in PWS

Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis

Children with chronic stuttering •were older at stuttering onset and •exhibited higher frequency of stuttered disfluencies, •lower speech sound accuracy, and •lower expressive and receptive language skills than recovered children, •had a family history of stuttering •Males were also more likely to develop chronic stuttering.

attributes

Children with these attributes have less likelihood of spontaneous recovery (Yairi & Ambrose, 2005): Having relatives who were persistent stutterers Being male Onset after 3.5 years Stuttering not decreasing during first year after onset Stuttering persisting beyond one year after onset Multiple unit repetitions (li-li-li-li-like this) Continued presence of prolongations and blocks Below normal phonological skills

types of stuttering

Developmental stuttering starts in early preschool years around 2.5-4, affects most people Neurogenic Psychogenic These other two types are way less common compared to developmental. Could be due to trauma that triggers stuttering again

behavioral stuttering

Disfluency and Stuttering reflect a disruption in the smooth transitioning between sounds, syllable, and words (rhythm of speech)

other classical conditioning examples (for stuttering)

Fear of: reading, speaking in large groups (public speaking), introducing yourself to new people, ordering at a restaurant, leaving voicemails on phone -Reactions by listeners that may have caused fear and anxiety: Laughed, stared, made a face, people asked them confusedly, time restraint, communication breakdown causing awkwardness, make a rude comment -With repeated pairings of these reactions after someone stuttered this will cause the learned negative emotion of fear

life events

Stressful life events may precipitate or worsen stuttering in some children The child's family moves to a new house, a new neighborhood or a new city. The child's parents separate or divorce. A family member dies. A family member is hospitalized. The child is hospitalized. A parent loses his or her job. An additional person comes to live in the house. One or both parents go away frequently or for a long period of time. Holidays or visits occur which cause a change in routine, excitement, or anxiety. A discipline problem involving the child.

twin studies

Stuttering in identical and fraternal twins Greater concordance among identical twins Twin studies show that whether stuttering occurs is 2/3 genetics and 1/3 environment clinical implications of this: Parents should be told that stuttering is often inherited, not a result of bad parenting -Tell parents: stuttering is genetic, neurodevelopmental Parents often think they are the cause-the way they breast fed, the way they went about their childs education. Make sure to tell them this is not true.

Diagnosogenic Theory

a belief that stuttering is caused by the misdiagnosis of typical disfluencies as stuttering -•Stuttering is caused by parental tendency to label 'normal' disfluency as 'stuttering'. •"Stuttering develops from the avoidance of normal disfluency." -Wendell johnson was one of the first slp researchers in 1940s-50s. He researched if stuttered is caused by parents labelling normal disfluencies as stuttering, looked into if letting kids just be disfluent, this would lessen stuttering, this is not true! •Johnson thought children, who were misdiagnosed by their parents or other listeners, developed tension and hesitation in their speech in an effort to avoid disfluencies. -Disfluency types (at onset) of children thought to be normally disfluent versus children thought to be stuttering

cognitive behavior therapy

a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

stuttering

a speech disorder that disrupts the flow of words with repeated or prolonged sounds and involuntary pauses. •disorder of communication •observable behavior A FORM OF SPEECH DISFLUENCY CHARACTERIZED BY A RELATIVELY HIGH PROPORTION OF WITHIN-WORD SPEECH DISFLUENCIES AND ASSOCIATED BEHAVIORS Rhythm disrupted, involuntary, and the PWS know what they want to say!, not a word finding difficulty -most important aspects of stuttering definition

stuttering in preschoolers vs adults

adults have way more secondary/learned behaviors than preschoolers, more tension can be developed

internal exhibition

better to use in exposure therapy for classical conditioning: gradually exposing u to the thing you fear in a controlled environment where you are guaranteed not to experience fear (show them nice cartoon snakes, watch a video of a snake bing peaceful on a tree) Examples: -If a person has fear of public speaking, have them speak in front of a group repeatedly with people who don't have negative reactions or respond positively by smiling -Fear of speaking on phone: give them a phone and pretend they are talking to a stranger but really it is a controlled person, who doesn't have a negative reaction to their stutter. Set up controlled conversations, no one says something unpleasant or hangs up after they stutter. Have them on the phone with a familiar speaker, parent, the clinician, have a script, give them encouragement during conversation

Disfluent Behaviors

between word and within word disfluencies

factors of stuttering

constitutional, developmental, learning, environmental

Ivan Pavlov

discovered classical conditioning; trained dogs to salivate at the ringing of a bell Russian physiologist (1849 - 1936); Awarded Nobel in 1904 for study of digestive tract; his theory, for him, was NOT to explain behavior but to explain CNS activity; as had others before him, he had noticed that by merely showing a dog food, animal would begin to salivate...

origins of stuttering

dna, and environment can trigger it. is neurological in nature, has to do with brain structure and function

linguistic information (information value of a word)

e.g. "Today is Tuesday, tomorrow is?" -you know the answer has to be wednesday vs."the next president of the USA will be ? "-you cannot guess this answer -We communicate NO information when our responses are completely predictable, and maximum information when our responses are unpredictable (high ambiguity) -Introducing yourself can be difficult because informational value is high. cannot predict as a listener what their name will be •Stuttering tends to occur at those places in utterances or passages that carry the highest information load(Content words have a high informational load, you cannot get rid of them to convey a message whereas function words you can) -Content words: convey meaning, nouns, verbs, adjectives, adverbs •Places within an utterance where stutterings occur are NOT determined by chance...Stuttering is not random, its locus is predictable

classical conditioning

emotional, called exposure therapy. Whatever you are afraid of you are exposed to in therapy 3 steps: -Begins with two things naturally associated -Then a neutral stimulus is added. -After repeated associations, previously neutral stimulus elicits response You can learn to be afraid of certain situations because of classical conditioning (C.S.) Conditioned Stimulus (light/bell): (U.C.S.) Unconditioned Stimulus (meat): (U.C.R.) Unconditioned Response (salivation):

loss of control

equals stuttering •Helplessness •Characterizes stuttering as opposed to normally disfluent speech

brain function

how the brain is working during a task •EEG studies showed more right-brain activity during speech compared to normally fluent people •Overactivation in right hemisphere areas that are homologous to left hemisphere areas active for speech production •Overactivation in left hemisphere areas related to motor control of speech •Deactivation of left auditory cortex during stuttering -Right hemisphere used to compensate! Typically when learning a skill not as well, there is more activation in the brain, so wont be as skilled. Similar to PWS. -Early studies showed activity during speech shifted to left brain after treatment •After therapy, right-brain overactivations are reduced; left-brain speech, language, and auditory areas are more activated •Two years after therapy, some right-brain overactivation has returned -implications: •Evidence that treatment changes neurological function •May suggest that treatments restore effective sensory-motor control of speech -Stuttering is neurodevelopmental, not caused by anxiety Some studies show that group therapy and speech therapy can help with differences in activation of the brain

woods & williams (1976)

investigated how various groups rated hypothetical individuals who stutter on a semantic differential scale compared to hypothetical individuals who did not stutter. These perceptions were all negative but definitely not true. Some pws may be outgoing and be okay with their stutter This is why we must get to know our clients. Don't assume they will be a certain way just because they stutter

planum temorale

is the cortical area just posterior to the auditory cortex. •It is a triangular region which forms the heart of Wernicke's area •Is associated with higher level auditory processing (detecting sound/speech) •is known as one of the most asymmetric regions in the brain, with this area being up to ten times larger in the left cerebral hemisphere than the right •Also differences found in gyri (folds) in speech-language areas •It is thought that this bias for right hemisphere could be interrupting or impeding information flow between Wernicke's and Broca's areas

secondary behaviors of stuttering

learned reactions/patterns to core behaviors: - escape behaviors (e.g. eye blinks, head nods, restarting a sentence, etc.) - avoidance (e.g. circumlocution). -sort of acquired or more of a reaction to, learned behaviors •Attempt to end or avoid stuttering •To control ones speech in a certain way •Escape (you already started stuttering and trying to end it) and avoidance Typically reaction to core speech features of stuttering, typically not seen in very young kids who just started stuttering. They typically will openly stutter Operant conditioning: we seek reward, if something is rewarding, we will do it again. If you happened to blink twice and was able to get out of stuttering, will start to keep doing this -often not something that speakers (pws) are aware of. Listeners will see these though. Want to work on these behaviors since they stand out, not typical -The way you do this is by helping people control their speech in a better more productive way (do this instead). Not telling them to stop doing it, just what they can do instead when they think they may get stuck during speech

clinical implications of avoidance conditioning

need to: -Decrease fear of stuttering •If client avoids by using "um" as in "My name is um...um...um Tom," have client practice staying in stuttering on "Tom" (reward this) and also learn to reduce tension and release word easily -Reward non-avoidance •Have client practice saying "My name is Tom" without the "um" but with an easier stutter on "Tom" (reward this) -Teach the client what to do when he thinks he'll stutter, instead of teaching him what not to do (=avoidance behaviors)

Core behaviors of stuttering

repetitions, prolongations, blocks. Hearing audible disruptions to the rhythm of speech •Within-word disfluencies aka -"stuttered disfluencies" or "stuttering-like disfluencies" used interchangeably •They are involuntary, out of the PWS's control •Therapy goal: to control speech, not to eliminate moments of stutter, just more control over speech

fluency

smoothness of speech. Disfluency is moments when rhythm/smoothness is broken down

flexible rate

spending longer time articulating on each sound, so another way to slow down that can be taught by slps because people wld not normally do this. -Would not work well with a preschooler since not cognitively aware of speech sounds. Most kids middle school and up are more aware and can take advantage of this technique.

Speculation (about some variables causing stress for vulnerable children)

stressful Adult Speech Models Rapid speech rate Complex syntax Polysyllabic vocabulary Use of two languages in home Stressful Speaking Situations for Children Competition for speaking Hurried when speaking Frequent interruptions Frequent questions Demand for display speech Excited when speaking Loss of listener attention Many things to say -She basically refuted stressful adult speech models and Speaking 2 languages-no evidence that these cause stuttering Important for children to continue with the languages they speak, even if severe and stuttering is in both languages, do not have them stop language because they stutter especially cuz no evidence Work with the caregiver and make sure their language is not hurried and directions are slowed and clear

onset of stuttering

typically between 2-4 years of age •Probability of stuttering onset decreases with age •Lifetime incidence (in USA and Western Europe) approximately 4-5% of the population -Incidence is an index of how many people have stuttered at some time in their lives •Prevalence ranges from 0.5% to 1% -Prevalence indicates how wide-spread the disorder is (how many people currently stutter) -Higher prevalence in preschool-age children -Lower prevalence in older children and adults

Feelings and attitudes

we cannot ignore the ones that are more disruptive to them than the actual stutter they have-this is why counseling is crucial •Initially when excited (either good or bad), a child (pre-k) may stutter more •When a child stutters often, he/she may become frustrated, ashamed Those feelings may impede fluency -Their speech is associated with difficulty. When we think something is difficult it may impede our performance on it -Speaking is a skill, and so if you are thinking people are gonna laugh at you, it will prevent you from speaking well -Frustrated: I would like this to be easy but its not, young children report this. "my words are stuck" "cant say it" -Shame: feel something is wrong with you and you want to hide it: may develop this with age as we compare ourselves with others -Let parents and caregivers know that they should tell their kids they shouldn't stutter because its not something they can control. •Attitudes are feelings that became a pervasive part of a person's beliefs •I am not a good communicator •I can't talk •People think I am stupid

atypical disfluencies

will whisper or stutter at the ends of words

Yairi and Ambrose (2005)

•"Early childhood stuttering" book •Gathered longitudinal data on 146 CWS and 59 CWNS •Onset -Sudden 40% -Intermediate (over 1-2 weeks) 30% -Gradual (3 or more weeks) 27% • First disfluencies -Only 35% of parents described their child's disfluencies as easy repetitions -More iterations per instance of repetition -Rapid rate of iterations -Disfluency clusters

Frequency

•% Total Words Disfluent (% TD) = 38/300*100 = 12.67% •% Total Words Stuttered (%SD) = 36/300*100 = 12% •% SD/TD= 36/38*100 = 94.74% •Sound prolongation Index = 14/36*100 = 38.89 %

assessing frequency

•% words stuttered= #of SDs/number of words spoken •When counting SDs, each word can only be stuttered once (ex. N-n-n-n-n-nuh-nuh...[silent block]...name" = one stutter) •% syllables stuttered= number of SDs/number of syllables spoken •each syllable can only be stuttered once •If client has obvious avoidance behavior without stutter, may count as stutter (ex. "My name is uh...uh...uh...uh...Ben") -Multisyllabic word: most probable syllable to be stuttered on is the first syllable (which is usually stressed but not always) -For preschoolers, Multiply words by 1.15 to get number of syllables cuz too hard to count all the syllables. So if 100 words, 115 syllables. -For adults, conversion is 1.5, so 150 for 100 words since adults have more complex speech

avoidance conditioning

•Anticipating a stutter and doing something to keep it from happening "I went to um...um...um...New York." •In this case, he avoids stuttering on the feared word, "New York," by saying "um" several times.

reinforcement

•Anything that increases response frequency •Learn what your client likes •REINFORCING STIMULI = environmental events following a particular behavior...if behavior INCREASES, it was REINFORCED •POSITIVE reinforcement: PRESENTATION of this reinforcer leads to INCREASE in behavior NEGATIVE reinforcement: TERMINATION of this reinforcer leads to INCREASE in behavior •negative reinforcement does not ( = ) equal punishment because reinforcement inherently increases targeted behavior and punishment inherently decreases targeted behavior. •In this context, positive means to present a stimulus (+) and negative means to terminate (-) a stimulus. Be careful not to confuse positive with pleasant and negative with noxious/unpleasant.

duration

•Average Duration of 3 longest SDs = (2.78+2.64+2.10)/3 = 2.51 seconds -Frequency and duration contribute to how severe a person's stutter is

loci of stuttering

•Based on the work by Brown in 1930's/1940's with adults who stuttered •The characteristics of sounds, syllables, and words that are consistently stuttered on: -Initial consonant sounds -Stressed syllables -Longer words -Content words: Nouns, verbs, adjectives, adverbs -Words at beginning of sentence -Words in sentences of increased length and complexity •Those are linguistic influences -which places in an utterance are typically stuttered on. Things/words that "attract" stuttering. People dont stutter as much on function words

constitutional factors

•Basic physiological tendencies, inherent to the makeup of individual •Are thought to contribute to personality, temperament and the etiology of the specific disorder •May lead to disturbances of function, structure or both Temperament-more primary/biologically based features of a person. Does not usually change over the course of your life, but your personality can change based off of environmental factors. •Genes or Hereditary factors •Stuttering often runs in families •30 to 60% of PWS have family histories of stuttering •Research is underway to identify genes associated with stuttering •Twin studies, adoption studies provide evidence that environmental factors are also important -Could be due to someone in your extended family also has a stutter, which makes it difficult to track down. Family may think there is no family history. Neurological in nature, has to do with someone's brain structure and function

Onset of stuttering study (Johnson and associates)

•Broken words-ISP Similarities vs differences: Similarities: Incomplete phrases, phrases repetitions, were similar between experimental and control. Even kids who don't stuttered showed disfluencies Differences: more revisions and interjections for control group (kids who don't stutter). The main difference is type of disfluency produced between control and experimental group. Control group had less stuttered disfluencies and more non-stuttered.

developmental factors

•Changes that occur in human beings over the course of their life •Some important ones in child's development are Emotions and Language

clinical implications (of speech and language environment)

•Children who stutter may be helped by making communication easier. -More one-on-one time when parent can listen -Slower speech rate -Language complexity not too far above child's level

key factors (for classical conditioning)

•Conditioned Stimulus (neutral stimulus) must be: -paired correctly in time and -paired together enough times with Unconditioned Stimulus •Learning is thought to take place when C.S. elicits a C.R. independently from U.C.S. It is the C.S.-C.R. bond that is LEARNED

basic phenomena of stuttering

•Consistency •Locus/Loci •Adaptation

Giolas & Williams (1958)

•How specific kinds of disfluency influence child's preference for a (1) particular story or (2) particular person telling story •120 Kindergarten and 2nd grade children listened to 3 passages, produced by 3 female speakers: •fluent •10% Interjections inserted into the sampe (um, well, idk, typical disfluencies) •10% Repetitions of initial part of words (s s s something) results:takeaway •"Listen closely cause you'll have to name the story you like the best" •1st story most preferred & speaker has no influence on story; •"You will hear 3 ladies, and you will be asked to decide which lady you would like for a teacher" Speaker with fluent pattern most desired, speaker with repetition pattern least desired -Speech fluency influences child's preferences for speakers but not stories. Children reflect, at a relatively early age, society's critical attitude/appraisal toward speech disfluencies, particularly in reference to repetitions.

operant conditioning and escape behaviors

•If a behavior reduces negative stimulation, it is "negative reinforcement" or escape, and it increases the behavior "I went to N-N-N...the Big Apple" In this example, the speaker" escapes from the stutter on "N-N-N" by substituting "the Big Apple" for "New York;" head nod is also an escape

take aways (from The Young Child's Awareness of Stuttering-Like Disfluency)

•If an SLP is unaware that he/she stereotypes people who stutter, expect all of them to have similar personality traits, •Then the SLP may never see the individual who stutters, instead conduct therapy with an abstraction, a mythical person who may never be in the therapy room with the clinician Instead of dealing with the people as they are, we are dealing with people as we assume they are...

operant conditioning

•If behavior is followed by reward, it increases -Example: Parent says "good talking" after child says five fluent sentences; child's fluency will increase •If behavior is followed by punishment, it decreases -Example: Parent says "Can you say 'truck' again?" after child stutters; child's stuttering will decrease Reinforcers: more likely youll do something again Punishment: makes u less likely to do something •Is a type of learning where individual's behavior is modified by its consequences • a particular behavior that is initially spontaneous (NOT a response to a prior stimulus), but whose consequences may reinforce or inhibit recurrence of that same behavior -made by B.F. Skinner: American psychologist (1904 - 1990), professor of psychology at Harvard University, introduced "principles of reinforcement"

what affects behavior reinforcement

•Immediacy: After a response, how immediately a consequence is then felt determines the effectiveness of the consequence. More immediate feedback will be more effective than less immediate feedback. •Contingency: If a consequence does not contingently (reliably, or consistently) follow the target response, its effectiveness upon the response is reduced.

how a behavior becomes unlearned

•Lack of reinforcement •Reinforcement of behavior, once learned, does not have to be constant, but it must occur, at least on occasion

learning factors

•Learning is a process leading to changes in a person/animal as a result of their experiences •Learning does NOT have to be -Conscious -"Correct", "good for you" or adaptive -Any overt or behaviorally apparent act •Types of learning -Classical conditioning (Ivan Pavlov) -Operant conditioning (B.F. Skinner) -Avoidance conditioning

woods and williams (1971)

•Most traits listed deemed undesirable by college student judges •Term "stutterer" has certain traits attached to it and most of these traits are unwanted ones •Perhaps the person who stutter's intense desire to hide his/her stuttering reflects an attempt to avoid the stereotype Use "person who stutters" even if the person themselves call themselves stutterer.

sex ratio

•Nearly even (1:1 to 1.65:1) male:female sex ratio among very young children (3 yrs) close to the onset of stuttering •However, girls recover more frequently so that by the time children are of school age, the ratio becomes 3 boys to 1 girl who stutters and continues at a 3:1 ratio •More boys than girls develop chronic stuttering problems (3:1) Girls begin to stutter earlier than boys and recover earlier and more frequently CM shared about her Camp SAY experience that out of 100 children (9 to 18) there were 80 boys and 20 girls who stutter.

Operant conditioning example (negative)

•Negative reinforcement (terminate noxious stimulus to increase a behavior): if child demonstrates 30 min of on-task behavior, the therapy worksheet assignment (noxious stimulus) is taken away (-, terminated), increasing (reinforcing) on-task behavior. •Negative punishment (terminate pleasant stimulus to decrease a behavior): if child demonstrates off-task behavior (rowdy, talkative) the movie/film (pleasant stimulus) is terminated (-), decreasing (punishing) rowdy behavior.

how PWS are perceived

•Nervous, tense, shy, quiet, reticent, guarded, avoiding, introverted, afraid, passive, self-derogatory and sensitive •These negative attributes given to hypothetical individuals who stutter were robust and found in many groups: •students •parents •speech-language clinicians •teachers and professors •special educators vocational rehabilitation counsellors

The Young Child's Awareness of Stuttering-Like Disfluency (Ezrati-Vinacour, Platzky, & Yairi (2001))

•Normally fluent preschool and first-grade children watched videos of two puppets speaking fluently and disfluently •Which one speaks like you? •Whose speech do you like better? The emergence of awareness of stuttering has been an important factor in theoretical and clinical considerations for early childhood stuttering. results •It was found that from age 3, children show evidence of awareness of disfluency, but most children reached full awareness at age 5. •Negative evaluation of disfluent speech is observed from age 4.

spontaneous recovery predictors

•Onset before age 3 •Female •Measurable decrease in sound/syllable and word repetitions, and sound prolongations, overtime, observed relatively soon (6-12 mos) post-onset •No coexisting phonological problems (and possibly language and cognitive problems) •No family history of stuttering or a family history of recovery from stuttering •***All are probability indicators***

Tumanova, Conture, Walden, 2014, study

•Overall frequency of disfluencies in CWS and CWNS -How disfluent are preschool-age children? •Parental concern and frequency of disfluency for preschool-age children -When do parents become concerned about their child's fluency?

punishment

•PUNISHING STIMULI = environmental events following a particular behavior...if behavior DECREASES, it was PUNISHED •POSITIVE punishment: PRESENTATION of this punisher leads to DECREASE in behavior NEGATIVE punishment: TERMINATION of this punisher leads to DECREASE in behavior

patterns of recovery

•Period of recovery marked by steady decrease in sound/syllable and word repetitions and prolonged sounds over time, beginning shortly after onset •Subgroup of children presenting with "severe" stuttering at onset, with frequency of behaviors peaking at 2-3 months post onset and full recovery seen by 6-12 months

Operant conditioning example (positive)

•Positive reinforcement (present pleasant stimulus to increase a behavior): when child produces /r/ correctly, clinician presents (+) a smile, increasing (reinforcing) correct /r/ production. Positive punishment (present noxious stimulus to decrease a behavior): when child produces /r/ incorrectly, clinician presents (+) a frown to decrease incorrect /r/,decreasing (punishing) incorrect /r/.

avoidance

•Produced in anticipation of stuttering •Used to stay away from stuttering (before) •Same behaviors used to Escape moments of stuttering could be used as this •Example: changing a word you were going to say •Initially these behaviors may prevent stuttering, but they soon become strong habits that are resistant to change -Adults who stutter report knowing that they are about to stutter/get stuck/may soon occur-anticipation

criteria for stuttering

•Produces THREE (3) or more Stuttered (WITHIN-WORD) disfluencies per 100 words of conversational speech •Parents and/or other people in the child's environment express concern that the child stutters.

adaptation

•Progressive decrease in the number of disfluencies during successive readings of the same material •Typically 5 readings lead to most gain in fluency frank and bloodstein: -Reading aloud is a fluency-inducing condition -When people are reading alone, they stutter a lot (50% of words stuttered), ended at 30% for condition 1 -this is adaptation process -For condition 2, first 5 readings they barely stuttered, for the 6th they jumped to around 28. -they found it was not significantly different, so it does not matter whether you read/practiced this text and are fluent or read and experience moments of stuttering for a person to get benefits from this

environmental factors

•Qualities of someone's environment including Stress level, diet, physical and mental abuse, exposure to toxins, pathogens, chemicals •Environmental factors may determine the development of disease in those genetically predisposed to a particular condition •If a disorder thought to be the result of a combination of genetic and environmental influences, its etiology can be referred to as multifactorial Allergy example You may be predisposed to an allergy and then the environment can trigger it

spontaneous recovery

•Recovery from stuttering without treatment •Estimates of unassisted recovery or remission range from 32%-80% •Best estimate is 75% •Probability of recovery highest from 6-12 months post onset •Majority of children recover within 12-24 months post onset

fluency inducing conditions

•Singing (even just rhythm), classical music •Talking to beat of metronome -syllable timed speech •Talking in unison with another speaker (choral reading) •Talking in a slow prolonged manner •Whispering-not likely used clinically •Delayed auditory feedback-a person will talk slower cause of this since you are trying to ignore what you hear and focus on the movements) •Talking in presence of noise-will cause us to talk louder and slow down •Talking in a different accent ("acting")-really have to think about every sound •Talking alone, talking to animals, babies-no social aspect of communication and decreased linguistic demands -resulting from reduced demands on speech-motor control and language formation (Andrews et al., 1982) -Can make slowed speech more natural by speeding it up a little and adding more natural intonation-flexible rate. Use slow prolonged speech and make more desirable to speakers which is called flexible rate. Also strategically stress the sounds they know they will stutter on. This can be used to practice while reading To slow down speech rate, people usually take pauses. -Flexible rate

different levels of observation

•Sound and syllable repetitions and sound prolongations •Dis-coordination of respiratory and laryngeal behaviors prior to speech initiation •Negative emotion associated with communication and speaking •Avoidance behaviors •Social context •Listener response •An increase in heart rate prior to speech •Tremor in muscle activity during speech •Eye blinks and head movement during instances of stuttering •Linguistic context-there are typical places and features that attract stuttering "Stuttering 'is' all these phenomena and exists at all these levels"

escape

•Speaker is stuttering and attempts to terminate the stutter and finish the word •Eye blinks •Head nods •Interjections ('uh') •Initially these behaviors may be random but they quickly turn into learned patterns

classical conditioning of stuttering

•Stuttering elicits feelings of dread and tightening of speech muscles •Stuttering (with accompanying dread and muscle tension) occurs repeatedly on the phone (previously neutral) •Phone elicits dread and muscle tension

classical conditioning example

•Talking on the phone and stuttering -Ringing of telephone (C.S.) -"Spit it out, I don't have all day" (U.C.S.) -Fear, anxiety, worry in reaction (U.C.R.) -Fear of phone (C.R.) •What is learned? -C.S.(phone ring) bonded to C.R. (fear of phone) -Fear disrupts speaking

consistency

•Tendency to stutter on the same words or sounds during successive readings or repetitions of the same material. •As a general rule, 60-70% of stutterings occur on the same word, from Reading A of a passage to Reading B of the same passage •People who stutter "know" when they will stutter on a word •They anticipate stuttering on the important, most salient aspects of speech, that is, content words such as nouns, verbs, adverbs, or adjectives. •SLP may want to discuss this with the client to help him/her identify words that are being reacted to.

assessment of stuttering behaviors

•The following behaviors should be counted as stutters: -Part-word repetitions -Monosyllabic whole-word repetitions -Sound prolongations (audible sound prolongations) -Blockages of sound or airflow (inaudible sound prolongations, broken words) •If you see many sound and word avoidances - you may choose to count those as stutters (if in doubt, count as fluent words) -Unequivocal sound or word avoidances -goal in this instance: the client will avoid less and openly stutter

clinical implications of classical conditioning

•To deal with classical conditioning, you need to: -Decondition (associate behavior with neutral stimulus) and •Have client keep stuttering until fear is gone (no negative stimulus) •Desensitize - reduce emotional response to stuttering (e.g. fear, frustration) -Counter-condition (associate behavior with positive stimulus) what has been classically conditioned •Have client stutter and receive praise for keeping it going (positive stimulus)

clinical implications of operant conditioning

•To deal with operant conditioning, you need to: -Stop reward for unwanted behavior •Have client not release (reward denied) word immediately after tense squeeze, head nod, eye blink, or other escape behavior -Start reward for wanted behavior •Have client stutter to easy prolongation before release (reward given)

Yairi & Williams (1970)

•What are speech-language pathologists conceptions of boys and men who stutter? •What are general public's conceptions of boys and men who stutter? •Asked public school clinicians to list 5 or more adjectives describing the male person who stutters...choice the 5 most relevant and then rate in terms of relevance (very much....slightly) •Adults: Top five adjectives: Nervous, shy, withdrawn, tense and anxious •Boys: Nervous & fearful, shy or insecure, good citizens, emotional concerns Important to note: Only 31% of SLPs mentioned abnormalities of speech

frank & bloodstein (1971)

•is Adaptation related to simple rehearsal of the motor plan...repeated readings rather than repeated stutterings needed for adaptation to occur...? -Rehearsal gives people benefit and advantage to stutter less. They are able to practice the motoric movement before the final reading -NOT the fact that they stuttered previously and are afraid of the word -Speaking is complex high speed movement (5/6 sounds a second), is high precision, and you need to think about voicing, linguistic messages sent back and forth -The readings have to be read back to back to back for adaptation to work -Not really helpful for practicing what you are going to say because you cannot really plan this -So the results are not really clinically relevant, but scientifically can help to know

listening to PWS

•listeners became much less mobile, lost eye contact, and reduced their speech output when confronted with a person who stutters •listeners expressed sympathy, embarrassment, curiosity and surprise when talking to a person who stutters Pws usually know how to say the sounds, so not just that they cannot say the speech sounds