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What is the primary characteristic of stuttering according to the integrated definition?
Which of the following categories is NOT part of Johnson’s Disfluency Categories?
Which type of stuttering is characterized by static movements of speech organs?
What distinguishes secondary stuttering behaviors from primary stuttering behaviors?
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In the context of assessment, which factor can influence the reliability of identifying stuttering?
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What is the primary difference between core and secondary behaviors in stuttering?
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Which aspect of stuttering involves the feelings surrounding the speech disruption?
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What is an essential consideration when differentiating between stuttering and normal disfluency?
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What is the age range for the 'Borderline' stage of stuttering according to Barry Guitar’s Approach?
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Which of the following is NOT a feature considered for determining the stages of stuttering?
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During the Iowa Study, what percentage of disfluencies was observed in fluent children?
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Which method is NOT a valid type of speech sample collection?
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What is the primary focus when working with clients from different cultures?
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Stuttering-like disfluencies (SLD) frequency in children who stutter (CWS) compared to fluent children is approximately what?
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What is a characteristic of 'Normal Disfluency' as opposed to stuttering?
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Which of the following is the correct abbreviation for the Percentage of Syllables Stuttered?
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When assessing language in a bilingual person who stutters (PWS), which factor is essential?
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What defines an 'Unambiguous Stuttering Moment'?
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Which factor is important for differential diagnosis of stuttering?
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Which of the following is NOT typically considered during speech contexts?
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How should stuttered syllables be counted according to the percentage syllables stuttered rules?
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Which behavior tends to decrease in frequency as children grow according to the studies?
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Which equipment is appropriate for assessing speech fluency?
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What should be confirmed with the client or their parents/carers during assessments?
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What is the primary purpose of the Pre-school Anxiety Scale – Revised (PASR)?
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Which of the following is NOT a subscale of the Pre-school Anxiety Scale – Revised?
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According to the findings, how does the mental health group respond to treatment compared to those without mental health disorders?
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What is suggested about the relationship between stuttering severity and psychological variables?
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What is essential for the psychological management of people who stutter?
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Which component of Cognitive Behavioural Therapy (CBT) involves gradual exposure to feared situations?
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What impact might social anxiety have on individuals who stutter?
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What is a potential strategy employed in CBT to manage anxiety in people who stutter?
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What is a common finding regarding the prevalence of stuttering in bilingual versus monolingual speakers?
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In research by Au-Yeung et al (2000), which age range did the participants fall into?
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What did the findings from Shafer & Robb (2012) indicate about stuttering in bilingual individuals?
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Which of the following factors did Lim et al. find to affect stuttering frequency?
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According to the discussed studies, where do bilingual individuals typically show more stuttering?
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What did Woumans et al. (2021) conclude about stuttering in bilinguals?
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What is a noted characteristic of stuttering behavior in bilingual people who stutter?
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What might contribute to an increase in stuttering under dual task situations according to Woumans et al.?
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Study Notes
Stuttering
- Stuttering is defined as "temporary overt or covert loss of control of the ability to move forward fluently in the execution of linguistically formulated speech.”
- Only the person who stutters (PWS) truly knows whether he/she is experiencing stuttering
- Stuttering involves a constellation of experiences beyond speech behaviours, including:
- Sensation of anticipation, stuck, loss control
- Affective and emotional reactions; behaviour reactions; cognitive reactions
- Impact in real‐world/life
- Potential issues with this definition:
- Describes the nature rather than behaviours of stuttering
- Differential diagnosis between stuttering and normal disfluency
- Clinical threat
- Ability to and reliably identify the moments of stuttering (short vs later times)
Integrated Definition of Stuttering
- Preferred definition of stuttering because it considers both internal and objective factors
- Internal definition (Optional):
- Based on the individual's own experience and perception of stuttering.
- Perceptual definition (Experts can help, you may ask other expert to help)
- Based on the perception of stuttering by trained professionals.
- Objective definition (Collecting supportive evidences i.e.different symptoms by professional observation):
- Based on the observable speech characteristics and behaviors.
Factors Influencing Stuttering Definition
- Experience and skills of clinician
- Purpose of visits / diagnosis
- Assessment scheme / tool used
- Age of client
Features of Stuttering
- Stuttering Taxonomies are used to classify different types of stuttering.
- Johnson’s disfluency categories
- Eight categories:
- Word repetition
- Sound/syllable repetition
- Phrase repetition
- Interjection
- Revision
- Incomplete phrase
- Broken word
- Prolongation
- Applicable to stuttering and non-stuttering children
- Eight categories:
- Clonic and Tonic
- Based on medical terminology of muscle activity
- Kinematic status of speech mechanism in stuttering
- Clonic stuttering:
- Repetitive movements
- Tonic stuttering:
- Static speech organs
- Primary (Core) and Secondary Stuttering
- Primary stuttering / Core Behaviours
- Simple disturbance of speech
- Mostly at the beginning of the sentence
- Repetitions, prolongations, and blocks
- Secondary stuttering / Secondary Behaviours:
- Conscious of stuttering, attempts to control or conceal stuttering
- Struggling behaviours involving mouth, head, limbs, respiration, use of fillers etc
- Avoidance e.g.Syllable repetition and fixed postures with audible airflow
- Primary stuttering / Core Behaviours
Considerations For Choosing a Stuttering Taxonomy
- Descriptive Power
- Consistent and precise terminology
- Reliability
- Facilitates communication
- Clinically meaningful
- Knowledge / Skills
- Training
Stages of Stuttering
- Early and Advanced Stuttering:
- No consensus on age cut-off
- Based on a number of features:
- Age
- Dysfluency types
- Frequency
- Psychosocial responses
- Loci of stuttering
- Barry Guitar’s Approach
- Borderline: 1.5 – 3.5 years old
- Beginning: 3.5 – 6 years old
- Intermediate: 6 – 13 years old
- Advanced: 14 years old and above
Stuttering & Normal Disfluency
- Normal Disfluency (it happens to everyone):
- Difficult to differentiate between normal disfluency and stuttering
- Degree of disfluencies varies between and within child
- Maybe associated with language development, motor learning, other developmental, environmental or interpersonal influences
- Differential diagnosis criteria between Stuttering and Normal Disfluency:
- Frequency
- Types of stuttering
- Speed of repetition
- Number of repetitions
- Distribution/cluster of stuttering
Studies on Normal Disfluency
- The Iowa Study (data from fluent children)
- Frequency of behaviours:
- Less disfluencies (Approximately 7 per 100 words; 6 per 100 syllables)
- Less units of repetitions (1 or 2 units)
- Type of behaviours:
- Interjections, revisions, and easy whole word repetitions
- No secondary behaviours
- As the children grow:
- Interjections and part‐word repetitions decreases
- Revisions and phrase repetitions increases
- Rarely aware about their disfluencies
- Frequency of behaviours:
- The Illinois Study (data from fluent children)
- Stuttering‐like disfluencies (SLDs)
- Frequency of behaviours:
- Less SLD (Approximately 1.5 per 100 words)
- Less units of repetition (Approximately 1 unit)
- Types of behaviours:
- Interjection, revision/abandoned utterances, multisyllable/phrase repetition – Lower proportion of SLD to other disfluencies
- Children who stutter (CWS): Approximately 66%
- Fluent children: Approximately 28%
Unambiguous Stuttering Moments
- Refers to moments during speech that are clearly stuttering rather than normal disfluency, as judged by the observer
- Particularly useful concept in clinical settings, especially with young children and parent training.
Important Issues in Assessment
- Get to know client as individual
- Build relationship with client
- Understand their point of view
- Develop skills and sensitivities in working with clients from other cultures
Interview Considerations
- Who is/are your client(s)?–
- Parent
- Child
- Client’s age:
- Preschooler
- Schoolage
- Adolescent
- Adult
- Use appropriate language, ask relevant questions
Equipment and Materials
- Equipment:
- Speech fluency rating machine
- Calculator, pen and paper
- Stopwatch
- Software:
- Stuttering Measurement System (SMS)
- Online Syllable Counter
- Smart phone apps: Fluency Calculator
- Recording system
Speech Samples
- Sampling method
- Within‐clinic
- Beyond‐clinic recordings
- Types of speech samples:
- Reading
- Story telling
- Monologue
- Conversational speech
- Situation specific samples
- Length of sample
- Time‐based
- Word / Syllable‐based:
- 300 syllables – Basic information
- 600 syllables
- 1200 syllables – Comprehensive sample
Speech Contexts
- Best, usual and worst speaking situations
- Confirm ratings with client or parents/carers
- Individual reaction and performance to various situations
- Environments:Clinic,home,work or community
- Tasks:Conversation,phone calls,presentations
- People:Spouse/partner,friends,family,co‐workers,authority
Clinical Reasoning in Bilingual Stuttering
- Which language would you assess in a bilingual PWS?
- What are the causes of stuttering?
- Language dominance
- Linguistic factors and triggers of stuttering
- Client factor and language uses in everyday life
Frequency, Severity and Types of Stuttering
- Percentage Syllables Stuttered (%SS):
- Percentage of spoken syllable that are stuttered
- Identification of unambiguous stuttering moments
- May adopt the perceptual definition of stuttering
- Stuttered syllable is only counted a “one syllable” regardless of types or number or repetitions
- Limitations of percentage syllables stuttered
- Not Viable For Self‐assessment
- Reliability
Psychological Measures: PASR
- Pre-school Anxiety Scale – Revised (PASR):
- Parent report measure for children under 6 years of age
- Not a diagnostic instrument but identifies elevated anxiety symptoms
- Not specific for communication or stuttering
- 4 subscale:
- Social anxiety
- Generalised anxiety
- Separation anxiety
- Specific fears
Psychological Management of PWS
- Treatment Outcome and Mental Health
- 64 adults with speech restructuring treatment
- 2/3 with one or more mental health disorders
- Mental health group has higher pre-treatment severity
- Mental health group has lower treatment gain
- High treatment relapse in mental health group
- Psychological Management
- No clear relationship between stuttering severity and psychological variables
- Impede treatment progression and outcome
- Multidisciplinary approach to management:
- Clinical psychologist
- Psychiatrist
- Speech‐language pathologist
- Conflicting principles between direct stuttering therapy and social-anxiety treatment
- Induce and increase Self‐focused attention
- Promote use of safety Behaviour
- Stuttering therapy becomes a safety behaviour
- No strong evidence on the order of treatment
- Psychological treatment first or speech therapy first
- May need a detailed assessment to evaluate the most impacting issue
- Psychological treatment reduces social anxiety but NOT stuttering severity
Counseling People who Stutter
- Integral part of treatment
- More likely for adults, but also important school-aged or preschool-aged children who stutter as well as parents
- Basic counseling skills is required
- Consider referral to professionals, if appropriate
Cognitive Behavioral Therapy (CBT)
- Strong evidence of CBT in managing social anxiety, and especially in PWS
- Hopefully prevent relapse
- Reduce negative evaluation and stereotyping experienced by PWS
- Social anxiety may worsen stuttering
- In-person and online standalone treatment available
- Four Components of CBT
- Exposure:
- Gradually expose to fearful / anxious situations
- Practice fluency in increasingly difficult and feared situations
- Develop fear hierarchy
- Counter threat‐related experience (e.g.people will laugh at me)
- Evaluate and justify expectancies of harm
- Exposure:
Stuttering in Multilingual PWS
- Stuttering Prevalence
- Conflicting findings in the literature
- Bilingual speakers are more likely to stutter and are less likely to recover naturally
- No difference in the likelihood of stuttering between monolingual and bilingual
- Many methodological flaws
- Au-Yeung et al (2000)
- Online survey of 794 Individuals
- 40 countries;L1=52andL2=70
- Participants Age:3‐80 years of age
- Same prevalence in monolingual and bilingual,especially in early bilingual groups
Convergent Findings in Stuttering
- Monolingual and multilingual children who stutter:
- Similar Male‐to‐female ratio
- Onset Age
- Higher Recovery Rates In Female
- Positive Family History Of Stuttering
- Stuttering Frequency:
- Stutter in all the languages they speak
- Findings in the literature are controversial:
- Stutter More In Less Proficient Language
- Stuttermoreinmore Proficient Language
- Balanced Bilinguals Stutter more in one language
- With Many Methodological Flaws
Studies on Bilingual Stuttering
- Shafer & Robb (2012)
- 15 German‐English bilinguals (Age10–59;Meanage=25)
- More stuttering in L2 than L1
- L1:More Stuttering On Content Than Function Words
- L2:Similar stuttering frequency on content than function words
- Maruthy, Raj, Geetha and Priay (2015)
- 25 Kannada‐English Bilinguals(Age16–28;Meanage=22.5)
- More stuttering in L2 than L1
- L1:More stuttering on content than function words
- L2:More stuttering on function words
- Woumans, Van der Linden, Hartsuiker et al.(2021)
- 28 Dutch‐FrenchandDutch‐English Bilinguals(Age19‐53)
- More SLD in L2 than L1
- Krawczyk, Vanryckeghem, Wesierska, Kong and Xu (2023)
- 7 Polish‐English Bilinguals(Age20–31;Meanage=25;8)
- More stuttering in L2 than L1 in speech tasks (dialogue, monologue and reading)
- More typical disfluencies in English
- Lim, Lincoln, Chan and Onslow (2008)
- 30 Mandarin‐English Speakers Between 12‐44 years‐old
- 15 English‐dominant; 4 Mandarin‐dominant; 11balanced
- Significantly More Stuttering In Less Dominant Language, but marginal clinical difference
Why More Stuttering in the Less Dominant Language?
- Linguistic Demands
- Cognitive Demands (Dual Tasking)
- Woumans, Van der Linden, Hartsuiker et al.(2021)
- Bilinguals produced both SLD and OD in all languages spoken
- BPWS produce more SLD than typical disfluencies in both languages but more typical disfluencies in L2
- Lim et al showed no differences between each stutter behaviour
- However, under dual task situations...Woumans, Van der Linden, Hartsuiker et al.
- More SLD in L2 during dual task conditions
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Description
This quiz explores the complexities of stuttering, including its definitions, internal and external factors, and the experiences of those who stutter. It will delve into the differences between stuttering and normal disfluency, addressing potential clinical implications. Prepare to enhance your knowledge about this speech disorder and its wide-ranging impacts on individuals.
