Fluency, Incidence, and Prevalence

• Fluency is the effortless flow of human speech.
• Normal fluency includes temporal aspects (speech rate), prosodic aspects (very little intonation), and a lack of stuttering events.
• Universality indicates that nearly all cultures and languages have a word to describe stuttering.
• Aron (1958) described stuttering in Bantu and Zulu children.
• Universality might hold some clues to the origins and nature of stuttering.
• Factors affecting perceptions of disfluency include sound repetitions, syllable repetitions, word repetitions, phrase repetitions, sound prolongations, interjections, revisions, and blockage.
• Incidence is the probability that new cases of a disorder will develop over time.
• Prevalence is the estimated proportion of all cases of a disorder at a given time.
• Prevalence is generally less than incidence.
• Incidence and prevalence are important in guiding clinical decision-making and determining who to serve, when to serve them, and how long to serve them.

Incidence vs. Prevalence:

• Spontaneous recovery is the major distinction between incidence and prevalence.
• Spontaneous recovery does not mean sudden recovery.
• Incidence includes those who once stuttered.
• Prevalence is determined mostly through cross-sectional studies and surveys.
• Prevalence ranges from 0.7% to 2.1%.
• The Stuttering Foundation of America estimates that the prevalence of stuttering is 1% across all age groups.

Prevalence & Incidence Variability:

• Stuttering prevalence decreases with age.
• Prevalence remains relatively steady between 1st and 8th grade.
• If a child stutters at age 12, it is likely they will continue stuttering as an adult.

Factors Affecting Spontaneous Recovery:

• No family history of stuttering is a good sign.
• A family history of persistent stuttering is the worst sign.
• A family history of recovered stuttering is neither overtly good nor bad.
• Male gender is considered a negative prognostic factor.
• Female gender is considered a positive prognostic factor.

Severity:

• Increased severity on the sliding scale is less likely to lead to recovery.
• The presence of secondary behaviors diminishes the likelihood of recovery.
• More stimulable individuals have a better prognosis.
• A boy with a severe family history may get treatment at age 3, whereas a girl with a less severe family history may not get treatment until age 6.

Age of Onset:

• Typically begins in early childhood, when anatomical structures are growing and language and phonology systems are expanding.
• The range is from 18 months to the teenage years.
• Onset after age 9 is rare.
• The average range for onset is 30 to 60 months.

Age Distribution:

• 59% begin stuttering between 24 & 36 months.
• 85% begin by 42 months.
• 95% begin by 48 months.

Loci Factors:

• Loci refers to the place where stuttering is most likely to occur in the speaker's speech.
• Stuttering loci are specific sounds or words on which stuttering behaviors are more likely to occur.
• Research often looks at specific characteristics and places of stuttered words, syllables, and sounds.
• Some factors that influence the locations of stuttering in people who stutter are individualized.

Locational aspects:

• Distinctive features of speech sounds/words can lead to stuttering
• Position of the sound/word in an utterance
• The loci of stuttering may depend more on factors other than word features, such as learned fear.
• First words in utterances tend to be stuttered more often than others, potentially due to situational fears focused on the beginning of utterances.
• Most stuttering begins at the beginnings of words, specifically 92-97%

Phonemic Characteristics:

• People who stutter have trouble on some sounds.
• There is a tendency to stutter on voiced sounds.
• Longer words and novel words are frequently stuttered.
• Propositional speech yields more stuttering than nonsense speech.

Issues with Loci Studies:

• Reading differs from speaking.
• People have different fluency patterns in each setting.
• Those with word avoidances might stutter more in reading because they cannot skip words.
• If good readers, people might stutter more when speaking because there are less cognitive processes involved.
• Studying repeated readings are difficult to compare.
• Potential differences exist for prosody, reading/speaking rate, reading proficiency and anxiety level.

Physicality :

• During silence and rest, a person who stutters appears similar to people who don't stutter in muscle activity, audition, vision and touch.
• Differences may exist and the presence and role of neuroactivity and/or auditory feedback in stuttering remains conflicted.

Personality of PWS:

• Overall adjustment rating of people who stutter tend to score lower than people who do not stutter.
• May not be co-morbid with other diagnostic criteria and tend to score within the average range.
• A person can be maladjusted, but that maladjustment is due to communication challenges.
• People who stutter tend to exhibit caution or even adopt defeatist views.
• They also demonstrate lower goal-setting behaviors, yet simultaneously exhibit a higher drive for achievement.
• People who stutter exhibit a greater fear of failure in adulthood and equal fear of failure as children.
• Handwriting of people who stutter tends to be untidy, clumsy, obstructed in fluency & continuity, and marked by interruptions & repetition.
• People who stutter tend to have smaller type-token ratios.
• Language might reveal an adjustment to stuttering.
• Questionnaires indicate a higher level of anxiety in adults who stutter.
• Projective measures show higher anxiety.
• Physiological measures show no difference.
• Behavioral measures show higher levels of anxiety.
• Overall people who stutter do not appear to belong in the group of people classified maladjusted or neurotic.
• There isn't a broad set of characteristics that can encompass people who stutter.
• Some evidence suggests that these people are less well adjusted than people who do not stutter.
• The tendency is for people who stutter to score lower than people who do not stutter, but within the normal range.

Defining Stuttering

• Setting boundaries clarifies who should be treated.

• Quantifying and justifying treatment and guide subsequent treatment.

• Progress can be measured.

• Verb is the stuttering event and Noun is the disorder.

• The verb defines stuttering as the stuttering event, including part-word repetitions, whole-word repetitions, prolongations, silent postural fixations, circumlocutions, interjections, and struggle behaviors.

• Overt stuttering events are open to view of knowledge, not concealed or secret and includes Repetitions, prolongations, interjections, silent postural fixations, struggle behaviors.

• Covert stuttering events are concealed, secret, and disguised.

• These include circumlocutions, avoidances, and subperceptual forms.

• Inadequacies of event-only definition: is the event a cause or an effect, can describing the event describe what it is like to be a person who stutters

• Expands upon overt symptomatology consisting of overt speech characteristics, physical concomitants, physiological activity, affective features, cognitive processes, social dynamics

• Defining stuttering as a noun (disorder) can lead to Inadequacies of disorder-only definitions: is cause important in a definition; what weights "assigned” in a definition; when you are defining with lists, are you including other disorders as well

• Assumes that all human behavior is under voluntary control, the goal is to unlearn bad speech habits & learn good speech habits. Current prevailing explanatory theory

• Shaping is highly embraced by speech language pathologists mostly in Step by step programs and states speech can be taught just like any other motor skill and the ultimate GOAL is NO STUTTERING

• Is a neuromotor disorder that can be brought under voluntary control and one of the earlier advocates was Charles Van Riper who advocated for “stuttering modification"

• Is a neuromotor disorder that can be brought under voluntary control and one of the earlier advocates was Charles Van Riper who advocated for “stuttering modification" and the Goal must be to STUTTER FLUENTLY

• Shulthess (1830) coined the tern lalophobia: fear of producing certain sounds and Merkel 1842 noted a failure in confidence to speak

• Beesel 1845 noted struggles represent an effort to overcome an imagined difficulty and Wyneken 1869 created the term sphrachzweifler

• There was significant importance in the identification of all these people who stuttered and was later supplemented in the work by Slide 20 which started to focus on the emotional aspect and not just the physical

• Orton & Travis proposed those who stutter were more apt to be left handed or ambidextrous and that Stuttering is caused by a lack of sufficient dominance of one half of the brain over the other Treatment:

• Propose the use of a belt to strap down left hand so they can only use the right hand which would control left hemisphere

• Stated by Johnson in organic etiology and that Stuttering is defined by those who listen to it

• Stuttering is a result of parents placing unrealistic demands on their child's speech

• The lasting impact is there is A Lot of parental blame and that Didn't publish because it didn't work

Issues with Behavioral Approaches:

• May not work in the long-term
• Remission has is shown to be as high as 70%
• Assumes that all human behavior is under voluntary control
• How many motoric skills require relearning & retratining?
• We don't actively learn how to talk
• It is still not determined whether stuttering is infact voluntary even when ○ Speech is voluntary, stuttering is not

Model (level 1-3): Central Involuntary Block:

• Responsible for all overt manifestations of stuttering and that All manifestation s of stuttering (stuttering events) is compensatory strategies for the block The purpose of the stuttering event is to relieve the block Stuttering is a form of medicine to clear the block Waiting doesn't clear the block away.

Level one

• Central compensatory strategies occurs when All stuttering behaviors are not observable by the eye or ear People are not capable of identifying where others are avoiding certain words And most likely occur due to:
• The block itself, Disruptive to the Speech Pattern, the Anticipations and reactions to stuttering
• Includes Avoidance: of: Sounds, Words, People, Places, Situations
• Results in Circumlocutions: talking around words

Level two

• Is defined SubPerceptual forms of stuttering, Struggle behaviors at the neuromuscular leve
• Represents transition between the covert level 1 and overt level 3 as well Acoustic and kinematic phenomena that are invisible with sensitive equipment

Level Three

• Represents: IMPORTANCE OF LEVEL 2: the attempt to describe the cascading effects the central neural block has and how it affects recognition and behavior

Overt signs:

• Stuttering Behaviors: reps, prolongations, Silent postural fixations, Ancillary behaviors
• All three levels occur in order to avoid or release the central involuntary block in which can be Voluntary through: word avoidance or Involuntary

Overt vs Covert Stuttering

• Overt: open to view or knowledge; not concealed or secret and can be visually represented through many repetitions, prolongations, interjections, silent postural fixations, & struggle behaviors
• Covert as concealed, secret, disguised using Circumlocutions, avoidances, sub perceptual forms

Explore speech fluency, its characteristics, and stuttering across cultures. Understand factors affecting disfluency perception. Learn about incidence and prevalence in guiding clinical decisions for speech disorders.