Unit Six Stuttering Copyright 2008 Delmar All rights

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Unit Six Stuttering Copyright © 2008 Delmar. All rights reserved.

Unit Six Stuttering Copyright © 2008 Delmar. All rights reserved.

Chapter 23 Foundational Information about Stuttering Copyright © 2008 Delmar. All rights reserved.

Chapter 23 Foundational Information about Stuttering Copyright © 2008 Delmar. All rights reserved.

What Is Stuttering? • Disturbance in the normal flow and time patterning of speech

What Is Stuttering? • Disturbance in the normal flow and time patterning of speech 3 Copyright © 2008 Delmar. All rights reserved.

Characteristics of Stuttering • Stuttering is characterized by one or more of the following:

Characteristics of Stuttering • Stuttering is characterized by one or more of the following: – Audible or silent blocking – Sound, syllable, or word repetitions – Sound prolongations 4 Copyright © 2008 Delmar. All rights reserved.

Characteristics of Stuttering • • Interjections Broken words Circumlocutions Sounds and words produced with

Characteristics of Stuttering • • Interjections Broken words Circumlocutions Sounds and words produced with excessive tension 5 Copyright © 2008 Delmar. All rights reserved.

Normal Disfluency • • • Pauses Repetitions Incomplete phrases Revisions Interjections and prolongations that

Normal Disfluency • • • Pauses Repetitions Incomplete phrases Revisions Interjections and prolongations that are typical in speech 6 Copyright © 2008 Delmar. All rights reserved.

Definitions of Stuttering • There are multiple definitions of stuttering – No one definition

Definitions of Stuttering • There are multiple definitions of stuttering – No one definition is agreed upon by all 7 Copyright © 2008 Delmar. All rights reserved.

Overt Audible Behaviors • • Part-word repetitions Whole-word repetitions Phrase repetitions Interjections of sounds,

Overt Audible Behaviors • • Part-word repetitions Whole-word repetitions Phrase repetitions Interjections of sounds, syllables, words, and phrases 8 Copyright © 2008 Delmar. All rights reserved.

Overt Audible Behaviors • Revisions of phrase and sentences • Blocks • Disrhythmic phonations

Overt Audible Behaviors • Revisions of phrase and sentences • Blocks • Disrhythmic phonations 9 Copyright © 2008 Delmar. All rights reserved.

Overt Audible Behaviors • Part-word repetitions are most common in preschoolers’ disfluency • Disrhythmic

Overt Audible Behaviors • Part-word repetitions are most common in preschoolers’ disfluency • Disrhythmic phonations are most common disfluency in school age children • Interjections are most common for adults 10 Copyright © 2008 Delmar. All rights reserved.

Overt Visible Behaviors • There may be body movements that accompany the speech –

Overt Visible Behaviors • There may be body movements that accompany the speech – Facial tension, jerking the head, tension in shoulders 11 Copyright © 2008 Delmar. All rights reserved.

“Iceberg” of Stuttering • Visible and audible behaviors represent the upper one-third of the

“Iceberg” of Stuttering • Visible and audible behaviors represent the upper one-third of the iceberg • Invisible lower two-thirds of the iceberg – Includes emotions of people who stutter and their tricks to try and be more fluent 12 Copyright © 2008 Delmar. All rights reserved.

Covet Reactions to Stuttering • Feelings and thoughts about stuttering – Frustrations, shame, anxiety,

Covet Reactions to Stuttering • Feelings and thoughts about stuttering – Frustrations, shame, anxiety, expectations of difficulty talking 13 Copyright © 2008 Delmar. All rights reserved.

General Information about Stuttering • Incidence of 1 percent in general population • Age

General Information about Stuttering • Incidence of 1 percent in general population • Age of onset typically in childhood • Male-to-female ratio: 3 or 4 to 1 • Tendency to run in families 14 Copyright © 2008 Delmar. All rights reserved.

Stuttering and Other Communication Disorders • Children who stutter are more likely to reach

Stuttering and Other Communication Disorders • Children who stutter are more likely to reach speech milestones later • May have poorer articulation skills • Stuttering occurs less frequently in the deaf and hard of hearing population 15 Copyright © 2008 Delmar. All rights reserved.

Brain Function and Stuttering • Neural system of stuttered speech can be distinguished from

Brain Function and Stuttering • Neural system of stuttered speech can be distinguished from normal speech • No one structure or neural pathway associated with stuttering • Stuttering is associated with hemispheric asymmetry 16 Copyright © 2008 Delmar. All rights reserved.

Psychological Characteristics • Those who stutter are within normal range for intelligence and emotional

Psychological Characteristics • Those who stutter are within normal range for intelligence and emotional adjustment 17 Copyright © 2008 Delmar. All rights reserved.

Theories of the Etiology of Stuttering • Breakdown theories • Repressed need theories •

Theories of the Etiology of Stuttering • Breakdown theories • Repressed need theories • Anticipatory struggle theories 18 Copyright © 2008 Delmar. All rights reserved.

Breakdown Theories • Stuttering is due to early environmental stress • Neurological predisposition is

Breakdown Theories • Stuttering is due to early environmental stress • Neurological predisposition is also important 19 Copyright © 2008 Delmar. All rights reserved.

Repressed Need Theories • Stuttering is a symptom of repressed needs 20 Copyright ©

Repressed Need Theories • Stuttering is a symptom of repressed needs 20 Copyright © 2008 Delmar. All rights reserved.

Anticipatory Struggle Theories • Stuttering is a learned behavior • Precipitated by anticipating and

Anticipatory Struggle Theories • Stuttering is a learned behavior • Precipitated by anticipating and fearing the stuttering and struggling to avoid it 21 Copyright © 2008 Delmar. All rights reserved.

Etiology of Stuttering • Most professionals consider stuttering multifactorial – One or more potential

Etiology of Stuttering • Most professionals consider stuttering multifactorial – One or more potential causes 22 Copyright © 2008 Delmar. All rights reserved.

Conditions that Decrease Stuttering • • • Read in unison with someone Shadow someone’s

Conditions that Decrease Stuttering • • • Read in unison with someone Shadow someone’s speech Sing Speak to a metronome or beat Delayed auditory feedback 23 Copyright © 2008 Delmar. All rights reserved.

Conditions that Increase Stuttering • Saying specific words – I, person’s name • Reading

Conditions that Increase Stuttering • Saying specific words – I, person’s name • Reading aloud in a group • Speaking to authority figures • Talking on the telephone 24 Copyright © 2008 Delmar. All rights reserved.

Cluttering • Speech is abnormally fast, irregular, or both • Language is also affected

Cluttering • Speech is abnormally fast, irregular, or both • Language is also affected 25 Copyright © 2008 Delmar. All rights reserved.

Chapter 24 Working with Children Who Stutter Copyright © 2008 Delmar. All rights reserved.

Chapter 24 Working with Children Who Stutter Copyright © 2008 Delmar. All rights reserved.

Multidimensional Evaluation • Capacities-demand model is a framework for the evaluation – SLPs explore

Multidimensional Evaluation • Capacities-demand model is a framework for the evaluation – SLPs explore the capacity of the child for fluent speech – SLPs explore the demands being placed on the child by others 27 Copyright © 2008 Delmar. All rights reserved.

Preschool Children • Parent interview and case history are very important • Evaluation typically

Preschool Children • Parent interview and case history are very important • Evaluation typically done in a play atmosphere • Standardized speech assessment, Stuttering Severity Inventory – Three may be completed 28 Copyright © 2008 Delmar. All rights reserved.

Preschool Children: Parent Interview Categories • • Motivation Family background Characteristics of stuttering Developmental

Preschool Children: Parent Interview Categories • • Motivation Family background Characteristics of stuttering Developmental course 29 Copyright © 2008 Delmar. All rights reserved.

Preschool Children: Parent Interview Categories • • • Communication abilities/style Degree of awareness Environmental

Preschool Children: Parent Interview Categories • • • Communication abilities/style Degree of awareness Environmental influences Parent/child relationship Skills, interests, and locus of control 30 Copyright © 2008 Delmar. All rights reserved.

School-Age Children • Parent interview • May want to interview child directly as well

School-Age Children • Parent interview • May want to interview child directly as well • Assess all speech systems 31 Copyright © 2008 Delmar. All rights reserved.

Prevention • Not all children who stutter need therapy • Three levels of prevention:

Prevention • Not all children who stutter need therapy • Three levels of prevention: – Primary – Secondary – Tertiary 32 Copyright © 2008 Delmar. All rights reserved.

Primary Prevention • Provide educational information to parents – How to support development of

Primary Prevention • Provide educational information to parents – How to support development of communication skills – Language stimulation 33 Copyright © 2008 Delmar. All rights reserved.

Secondary Prevention • Parent counseling – Provide information – Teach appropriate interaction styles –

Secondary Prevention • Parent counseling – Provide information – Teach appropriate interaction styles – Assist parents with monitoring child's stuttering 34 Copyright © 2008 Delmar. All rights reserved.

Tertiary Prevention • For parents of children who are mild stutterers • Goal is

Tertiary Prevention • For parents of children who are mild stutterers • Goal is to prevent stuttering from becoming more severe – Child receive individual therapy – Parents attend weekly discussion groups 35 Copyright © 2008 Delmar. All rights reserved.

Principles of Therapy: Preschool • Therapy will be a dynamic process • Fluency shaping

Principles of Therapy: Preschool • Therapy will be a dynamic process • Fluency shaping focuses on increasing and maintaining fluent speech • Stuttering modification focuses on improving overall communication 36 Copyright © 2008 Delmar. All rights reserved.

Goals of Therapy: School Age • Reduce severity of stuttering • Reduce negative attitudes

Goals of Therapy: School Age • Reduce severity of stuttering • Reduce negative attitudes to stuttering • Increase motivation 37 Copyright © 2008 Delmar. All rights reserved.

Multicultural Considerations • Determine if child is really stuttering or struggling in development of

Multicultural Considerations • Determine if child is really stuttering or struggling in development of two languages • Compare disfluencies across languages • If child is in therapy, treat the stronger language 38 Copyright © 2008 Delmar. All rights reserved.

Chapter 25 Working with Adolescents and Adults Who Stutter Copyright © 2008 Delmar. All

Chapter 25 Working with Adolescents and Adults Who Stutter Copyright © 2008 Delmar. All rights reserved.

Evaluation • Client interview • Direct assessment of speech 40 Copyright © 2008 Delmar.

Evaluation • Client interview • Direct assessment of speech 40 Copyright © 2008 Delmar. All rights reserved.

Principles of Therapy • Developing insights into attitudes about stuttering • Increasing awareness of

Principles of Therapy • Developing insights into attitudes about stuttering • Increasing awareness of muscle tension • Speech analysis and modification • Building new speech skills 41 Copyright © 2008 Delmar. All rights reserved.

Principles of Therapy • Group therapy may be used in conjunction with one-on-one therapy

Principles of Therapy • Group therapy may be used in conjunction with one-on-one therapy • Therapy needs to be long-term 42 Copyright © 2008 Delmar. All rights reserved.

Chapter 26 Emotional and Social Effects of Stuttering Copyright © 2008 Delmar. All rights

Chapter 26 Emotional and Social Effects of Stuttering Copyright © 2008 Delmar. All rights reserved.

Emotional Adjustment • Most stutterers are as well adjusted as those who do not

Emotional Adjustment • Most stutterers are as well adjusted as those who do not stutter • Stutterers may be reluctant to speak publicly and avoid social situations 44 Copyright © 2008 Delmar. All rights reserved.

Emotional Effects of Stuttering • • • Anxiety and fear Perfectionism Excessive need for

Emotional Effects of Stuttering • • • Anxiety and fear Perfectionism Excessive need for approval Low self-esteem Reluctance to take risks 45 Copyright © 2008 Delmar. All rights reserved.