Stuttering Therapy: Older Speakers & Covert Features

Factors for Older Speakers

• Stuttering has variability
• Explore the reasons for seeking assistance at this time
• Assess the person's level of motivation
• Stuttering frequency is a relatively minor severity indicator
• Identify specific situations or reasons that trigger stuttering

Stuttering Cover-Up Effects

• The better a PWS can conceal their stuttering, the more challenging it becomes to release coping responses.
• Can lead to desensitization.
• Requires experimenting with different treatment options.

Surface vs Intrinsic Features

• Only about 10% of stuttering is overtly observed.
• Listeners tend to concentrate on frequency, duration, tension, and effort
• Speakers sometimes use dramatic accessory features to postpone or escape stuttering
• A full problem assessment involves looking beyond the surface.

Determining Desire for Change

• A speaker's desire for change is a challenging covert aspect to quantify
• Assess a person's commitment to change and growth before and throughout therapy
• Commitment declarations help provide progress indications

Desire for Change Considerations

• Speakers might expect clinicians to "fix" or "cure" stuttering
• Realistic expectations and activity examples will help
• Motivation level provides information regarding level of motivation
• Knowing a PWS's stage in the change process is critical for intervention.

Impact of Self-Directed Change

• A person's continuum location that ranges from self-reevaluation, contemplation of change, action, and maintenance are powerful factors in predicting a successful treatment outcome.

General Motivation

• The client's readiness for change is an important determination of motivation.
• Transitional periods occur throughout a PWS's life
• Early 20s are a major period
• Missed assistance opportunities during this stage can lead to less satisfactory communication and Quality of Life (QOL)
• Reassessment and change opportunities also occur at middle age

Essential Structure of Unsuccessful Stuttering Management

• Experience might be characterized by dominated story and suffering.
• A struggle to cope with the difficulties that the stuttering poses.
• PWS tend to lead a restrictive lifestyle
• Dominated by stuttering avoidance and world revealing.
• Struggles + negative reactions from family members and failure associated with inadequate therapy.
• Some struggles can also lead to emotions of helplessness, anxiety, low self-worth, embarrassment, and disapproval and suffering.

Take Home Messages

• Strategies and persistence will improve fluency and QOL
• Dedicated clinician and support of others will increase enjoyment and confidence when communicating with others.

Mapping Surface Features - Frequency

• Frequency of stuttering may not correspond with the individual
• Measured in %SS or %SW
• Shorter time intervals creates better inter-rater reliability
• The assessment involves reading vs. extemporaneous speech

Mapping Surface Features - Tension and Duration

• Tension and duration are closely related
• Greater tension or effort is associated with stuttering
• Resulting in long duration
• Muscular tension
• Degree to which a word is fragmented
• Greater tension can indicate a stuttering "block."
• Tension can be measured with EMG

Subtle Surface Features - Avoidance

• People can appear as if their stuttering is nonexistent
• Also referred to as “covert” or “internalized” stutterers.
• Avoidance of feared stimuli such as; sounds, words, people and time pressure environments
• Affects: Daily activities and choices
• Can lead to exhaustion and frustration

Subtle Surface Features - Word Substitution

• Word substitution is a form of avoidance
• Change meaning only a little (dog/poodle; white/vanilla)
• Or dramatic (tea/coffee; no/yes)

Subtle Surface Features - Postponement

• Postponement can also be referred to as moment of hesitation that leads to difficulty.
• "ah" "you know"
• It involves the filler words
• Words that can't be avoided (such as names and addresses)

Severity Assessment - Locus of Control of Behavior

• Internal control: Does PWS perceive stuttering as behavior consequence?
• Indicates the ability for person to take responsibility in maintaining desired behaviors
• External control: behavior is beyond control

Severity Assessment - Stuttering Severity Instrument

• Frequency of stuttering
• Duration of longest blocks
• Concomitant behaviors

Discovering Intrinsic Features (A, B, C)

• Affective: Anxiety, fear, worry
• Behavioral: Avoidance/escape
• Cognitive: Negative thinking, attitude, helplessness, shame
• Assess Speaker's Decision Making
• It is important to identify and acknowledge that choice that will foster denial or avoidance of stuttering
• Awareness can decrease frequency
• Important of desensitization

Measuring Tools

• Self-Efficacy Scale for Adult Stutterers (SESAS)
• Self-Efficacy for Adolescent Scale (SEA-Scale)
• Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
• Wright & Ayre Stuttering Self-Rating Profile (WASSP)
• Erickson S-24
• Behavior Assessment Battery (BAB) sub-tests

Adult Behavior Assessment Battery (BAB; Vanryckeghem & Brutten, 2018)

• Speech Situation Checklist – Emotional Reaction (SSC-ER)
• Speech Situation Checklist – Speech Disruption (SSC – SD)
• Behavior Checklist (BCL)
• Communication Attitude Test for Adults who Stutter (BigCAT)