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Positive Regard
optimism, excitement in the process, confidence in knowledge, willingness to take risks, share ourselves, venture into unknown, focus on the client TERM 2
Characteristics of SLP communication style
DEFINITION 2 animated, attentive, friendly, contentious TERM 3
Successful Clinician Qualities
DEFINITION 3 empathy, warmth, genuineness, ability to listen, ability to adjust, ability to make correct observations TERM 4
Manning's important clinical success
DEFINITION 4 knowledge of characteristics of disorder, willingness to connect with the client, knowledge of treatment methods, ability to identify specific characteristics of a specific client TERM 5
competency
DEFINITION 5 open mindedness and flexibility, ability to admit errors, recognize strengths and weaknesses, demonstrate respect and compassion, learn from each new case, call on others for help and information
chances of not
stuttering
by 5 years 25% by 8 years 50% by 10 years 75% if they haven't started stuttering by 12, then they most likely will not (except neurogenic causes) TERM 7
operational definition
DEFINITION 7 tells what to look for during diagnosis this is the core behavior(s) TERM 8
Important aspects of Wingate's definition
DEFINITION 8 disruptions of fluency, disruptions occur in verbal expression, disruptions are involuntary, involve silent or audible repetitions, involve silent or audible prolongations, involve "broken" words, silent prolongations are called blocks, disruptions occur frequently, learned behaviors can accompany these disruptions (struggle), negative emotions accompany all of the above TERM 9
Root of Stuttering (according to Peters and
Guitar)
DEFINITION 9 neuromotor and complex language TERM 10
Conture's definition of Stuttering
DEFINITION 10 diagnostic label referring to a clinical syndrome with abnormal and persistent disfluencies accompanied by characteristic affective, behavioral, and cognitive patterns
3 Blind Men w/the elephant and Stuttering
the way in which you define depends on which part of the disorder you get a hold of and what it will consist of TERM 17
ABC's of Stuttering
DEFINITION 17 Affective- feelings and emotions Behavioral- observed characteristics Cognitive- attitudes about their stuttering (kind of overlaps with A) TERM 18
Prevalence and Incidence
DEFINITION 18 -generally accepted to be about 1% of the population at a given time -population that has stuttered at one time: 5%, 75% recover without intervention TERM 19
Sex Ratio
DEFINITION 19 3 males to each female (SA and Adult) 1 to 1 in preschool population TERM 20
Onset Age
DEFINITION 20 -coincides with multi-word utterances (18 months) -typically before puberty -mostly between 2 and 5 years of age
Predictability and Variability
-constantly variable but highly predictable -predictability may be a clue to the disorder -stuttering is individualized and inconsistent -there are aspects that are predictable across the disorder TERM 22
Where does Stuttering Occur?
DEFINITION 22 on consonants, initial sound of a word, contextual speech, nouns, verbs, adjectives, stressed syllables, NOT when swearing TERM 23
Are Interjections Stuttering?
DEFINITION 23 not agreed upon most frequent disfluency in all of us depends on frequency of occurrence 5% of spoken material is stuttering TERM 24
Multisyllabic word repetitions stuttering?
DEFINITION 24 like interjections- not agreed upon tend to occur with all of us depends on frequency 5% of spoken material is stuttering TERM 25
variability and
stuttering
DEFINITION 25 people who stutter are variable- -do not stutter on the same sounds, syllables, or words all the time
Sound repetition
s-s-s-s-s-s-s-sun TERM 32
syllable repetition
DEFINITION 32 trans-trans-transportation TERM 33
multisyllabic word repetition
DEFINITION 33 transport-transport-transportation TERM 34
single syllable word repetition
DEFINITION 34 sun-sun-sun-sun-sun TERM 35
prolongation
DEFINITION 35 audible prolongation: zzzzzzzzzzzzzzzz-zoom silent prolongation: assume articulatory posture for a sound but no acoustic output (a.k.a.: BLOCKS) broken word- special form of silent prolongation: begin to produce the word, part way through stop production and lose artic posture; resume word at point where artic posture was lost: bro.........ken
interjections
intrusions of verbal or vocal elements into running speech verbal: you know, ok, alright, etc vocal: um, uh, er, ah, etc TERM 37
struggle behaviors and accessory
features
DEFINITION 37 -struggle behavior: produced w/repetitions and prolongations; -listener perceives that the speaker is struggling to speak - tight, forceful muscles -accessory features: learned behaviors: -allows PWS to avoid, postpone or escape from stuttering -e.g.: finger popping, head turning, odd body postures TERM 38
Fluent Speech
DEFINITION 38 ability to move structures of vocal tract easily, rapidly, smoothly, and consistently with appropriate timing coordinated with other structures 8,000 muscles movements per minute to produce speech 175-275 words per minute (vs. PWS 75-175 words per min) TERM 39
Stuttered Speech
DEFINITION 39 inability to move structures of vocal tract easily rapidly smoothly with appropriate timing coordination TERM 40
Fluency vs. Disfluency
DEFINITION 40 -fluency is judged on rate and continuity -fluency is influenced by information load -ALL speakers experience decreased fluency at times -PWS vary in degree of fluency - PWS do not stutter at all times (actually more fluent than disfluent) -disfluencies reflect a disturbance in smooth transitioning between sounds, syllable, and words
Formulative vs. motor breaks
formulative (normal): breaks between words, phrases, larger syntactic units; lack of tension; interjections between words, phrases or larger syntactic units motoric: breaks between sound and syllables; tension in vocal tract; stoppages of airflow or voicing; prolongations of long duration TERM 47
Between word disfluencies (Conture)
DEFINITION 47 Normal: transition difficulties between words difficulties linking words together phrase repetitions: i want i want i want the red one interjections: i, ummmmmmmmmmmmmmm, i want the red one **can occur due to: cognitive processes, motoric processes, coordination issues, distraction, language issues, phonological issues TERM 48
Within Word Disfluencies (Conture)
DEFINITION 48 Stuttering: transitions within a word, difficulties linking components of words, disfluencies that break up the flow of words, repetitions, prolongations, blocks, broken words **can occur due to: cognitive processes, motoric processes, coordination issues, distraction, language issues, phonological issues TERM 49
Van Riper on Differentiation
DEFINITION 49 based on: -syllable repetitions (break up words): vocal tension, interrupted air -prolongations: more than 1 sec, rise in pitch, sudden termination -silent pauses: within word, long prior to speech initiation -phonation features (level of the larynx): inflections, vocal fry -artic postures: may be inappropriate -stress reaction: more broken words -evidence of awareness: frustration, eye contact may waiver TERM 50
Yairi on Differentiation
DEFINITION 50 based on: -part word and monolsyllabic repetitions - prolongations -dysrythmic speech -monosyllabic repetitions/pert word repetitions -sound repetitions -blocks
Influences on Stuttering
-NNF vs IS: degree of awareness -onset factors: sex ratio, 1: preschool 3 males to 1 females age- begin stuttering earlier, younger =greater chance of stutter genetic- tends to run in families twinning- identical= both probably will, fraternal= 1, not other brain injury- sometimes develop stuttering speech/lang development- one gets ahead of other= difficulties motor coordination- language made visible temperament- tends to be children who are criticized/uncomfortable TERM 52
Less influential Factors
DEFINITION 52 physical development illness imitation of someone else who is disfluent shock or fright (psychogenic group of stutters, not really kids) emotional/communicative conflicts socioeconomic factors nationality- universal behavior TERM 53
Van Riper Track System
DEFINITION 53 Track 1: gradual onset (2.5-4 years); irregular reps; stuttering Track 2: SA/adolescent; hurried dysrhytmic repetitions; few prolongations; awareness/emotional reactions; little avoidance Track 3: (not true stutterers- didn't progress through childhood phases); sudden onset following trauma (psychogenic); prolongations; laryngeal blocks; awareness and frustration; intense avoidance; stuttering Track 4: sudden onset (5 to 9 yrs); deliberate repetitions (consciously controlling repetitions; no change in types; no avoidance; appropriate eye contact; stuttering TERM 54
Conture's Development System
DEFINITION 54 4-way tract (more of a developmental scheme) ALPHA: brief, subtle disfluencies (more NNF); inefficiencies of speech production BETA: oscillatory repetitive movements; compensatory to alpha behaviors GAMMA: tense and fixed behaviors; compensatory to beta DELTA: verbal and non- verbal; Rxs to beta and gamma; pharyngeal TERM 55
Guitar's States of Stuttering
DEFINITION 55 *NNF: behaviors w/in normal limits (
assessment process
*asking questions and gaining info- creates more questions (for every question, 5 more from answer) *making observations- gathers info to answers *important terms- assessment (not a diagnosis); diagnosis (statement we make based on info obtained) GOAL 1: who is and who is not a stutterer at a young age GOAL 2: differentiate whether neurogenic or psychogenic TERM 62
adult assessment goals
DEFINITION 62 1- determine nature of disfluent speech (surface features) 2- info on history of problems 3-info on history of treatment 4- determine beliefs/attitudes about talking 5- what are their behavioral components 6- views of stuttering and what causes stuttering 7- views of self as stutterer 8- decisions made due to stuttering 9- avoidance behaviors 10- anticipation (what they do) 11- behaviors they're aware of 12- what they believe others think TERM 63
Molar Analysis
DEFINITION 63 gives single number summary of stuttering; i.e. duration of the 3 longest stutters, severity: mild/mod/severe frequency, duration, severity, speech rate TERM 64
Molecular Analysis
DEFINITION 64 takes stuttering apart into its constituent parts i.e.: certain % of prolongations, repetitions, broken words etc types of disfluencies, proportion of types, secondary behavior TERM 65
Child Assessment Goals
DEFINITION 65 1- determine nature of disfluent speech 2-assessment of speech/lang. level-most need work on more 3- info on history of problem (from child AND parent) 4- info on history of treatment 5- determine beliefs/attitudes about talking 6-listen to child's and parents' willingness to talk about stuttering 7- behavioral components 8-awareness of what stuttering is 9- thoughts/beliefs about why he/she stutters 10-awareness of anything s/he does to control or help 11- level of worry/distress 12- perception on parents' worry/distress
Info to gather from Interview/Case History
general development family history academic or work info presenting problem history of disorder reaction to problem precipitating factors (what situations give rise to stuttering) nature of disfluency (what does it consist of?) TERM 67
Emotions and Attitudes
DEFINITION 67 important to gather info: *affects choices made *may narrow options *impact on treatment success *indication of severity *increases client understanding of disorder *to assist client in acknowledging aspect THINGS TO ADDRESS: beliefs about stuttering, beliefs about ability to control/manage stuttering, beliefs about ability to change, fear/shame/embarrassment, TERM 68
Methods of Analysis (adults)
DEFINITION 68 1- Perceptions of Stuttering Inventory: determines attitude 2- Southern IL Uni Speech Situation Checklist: things to work in Tx 3- Stutters' Self-Rating Reactions to Speech Situations: use Tx 4-Self Efficacy Scale of Adult Stutterers: attitude/confidence/perform 5- Self Efficacy Scale for Adolescents: attitude/perform/confidence 6- Stuttering Problem Profile: help patient set Tx goals 7-Modified Erickson Scale of Comm Attitudes: patient's attitude 8-Locus of Control of Behavior Scales: attitudes/emotions TERM 69
Methods of Analysis (children)
DEFINITION 69 1-What's True For You: self awareness of stuttering 2-Worry Ladder: see how much stuttering is mentioned 3-Write a Picture Word: attitude (+)/(-) 4-My View of School: attitude 5-Here's What I think: attitude/emotions 6-Hands Down: self confidence 7- Important Stuff about Me: attitude 8-What Pops: attitude/emotions 9-Framing my Speech: attitude/emotion 10-Draw a Picture: attitude/emotion TERM 70
Speech Sample (children)
DEFINITION 70 *size: larger to represent behaviors (100-300 words/syllables) (Costello and Ingram): clinic: 10 min convo. w/parent, 10 min w/child; outside: 10 min w/parent; 10 min w/clinician; 10 min w/sibling/friend; 10 min in regular activity (Yarass): parent-child interaction; play interaction w/clinician- with and without stress; story retell; pic. description; reading (Hutchinson): convo w/clinician; convo w/parent; pic. description; story retell; reading; convo w/peer; convo w/teacher; convo about emotional topic
MOST LIKELY require treatment
total disfluencies= more than 10% sound prolongations= 30% disfluencies stuttering severity index score= more than 18 stuttering prediction index score= more than 16 majority of w/in word disfluencies= 65% or more clustered disfluencies duration= 0.5 to 1 sec awareness, concern, avoidance, expectancy associated behaviors TERM 77
MAY require treatment
DEFINITION 77 total disfluencies= more than 6-10% sound prolongations= 12-25% of disfluencies stuttering severity index score= between 12-18 stuttering prediction index score= between 10-16 w/in word disfluencies= 40-60% occasional clustered disfluencies duration= 0.25-0.5 seconds may have awareness and occasional associated behaviors no negative emotions TERM 78
who will NOT require treatment
DEFINITION 78 total disfluencies= less than 3-6% sound prolongations= less than 12% of disfluencies SSI score= less than 12 SPI score= less than 10 w/in word disfluencies= less than 40% typically no clustered disfluencies duration= TERM 79
Positive Prognosis
DEFINITION 79 Child needs to have: -no history of unsuccessful treatment - cooperative parents -less severe patterns -little avoidance - cooperative teacher/school support -no other significant problems -intensive therapy options (2-3 times per week) TERM 80
Diagnosis for Adolescents/Adults
DEFINITION 80 determine: -History of problem -Disfluency type -frequency - duration -associated behaviors -attitude and emotional info CONSIDER: predictability, persistence, consistency Benefit from: info on emotions/attitude, why seeking Tx?
Stuttering Therapy
1- stuttering modification- decrease fear/avoidance 2-learn "easy stuttering"- in a relaxed, easy way and feel OK about it 3-fluency shaping- learn to be fluent in an easy context (single word or phrase level); maintain fluency in more and more difficult situations TERM 82
Steps in Therapy
DEFINITION 82 Principles for working with fear: -fearless clinician - explore/approach feared object -maximize time in contact w/feared object- longer in stutter, more fear will decrease - explore beliefs in accepting way -explore what child feels he's doing when in a moment of stuttering, increase positive awareness TERM 83
Stuttering
Modification
DEFINITION 83 1-reduce avoidance 2-make therapy fun- be reinforcing and let them know they're doing great 3- reduce shame- want openness 4-stimulate approach, exploration, acceptance TERM 84
cancellations
DEFINITION 84 powerful, relaxed slow motion stutter -hold onto stutter, slow motion on non-feared words -pause, say it in slow motion TERM 85
pull outs
DEFINITION 85 you catch yourself IN the stutter and decide not to do that- - becomes just a "behavior" and have more control over it - facial expressions relax
