Understanding Stuttering Disfluencies

Stuttering-like Disfluencies (SLD)

• Characterized by disruptions in the flow of speech, impacting communication.
• Includes various types of disfluencies that can affect both speech production and fluency.

Types of Stuttering-like Disfluencies

• Part-word Repetitions: Involves repeating sounds or syllables within words, affecting overall fluency.
• Monosyllabic Word Repetition: Repeating a one-syllable word, which may indicate difficulty in word retrieval or production.
• Disrhythmic Phonation: Atypical rhythm or pitch in voice production, often observed during speech interruptions.
• Prolongations: Lengthening of sounds, either vowels or consonants, which disrupts normal speech patterns.
• Blocks: Occur at word boundaries, marked by a pause (#) where the speaker struggles to produce the sound.
• Broken Words: Indicated by a # within words, reflecting significant disruptions in speech flow, leading to incomplete word utterances.

Weighted SLD Equation

• The equation for assessing stuttering severity is given by: [(PWR + SSWR) x RU + (2 x DP)].
• Variables defined:
  • PWR: Part-word repetitions.
  • SSWR: Single syllable word repetition.
  • RU: Ratio of repeated sounds, syllables, or words to total words spoken.
  • DP: Dysrhythmic phonation, which reflects variations in speech rhythm.

Checklist for Coping Strategies

• Utilizes a checklist with 50 behaviors to identify coping mechanisms.
• Children respond "yes" or "no" to whether they engage in each behavior to manage sounds or words.

Stuttering Severity Ranges

• Normally Fluent: Score between 0-3.99 indicates typical fluency.
• Mild Stuttering: Score between 4.00 and 9.99 suggests mild difficulties with fluency.
• Moderate Stuttering: Score ranged from 10.00 to 29.99 indicates moderate stuttering issues.
• Severe Stuttering: Score greater than 30.00 represents severe stuttering challenges.

Fluency Sample Overview

• Informal assessment tool typically requires two samples: conversation and reading.
• Reading samples show avoidance of specific words, highlighting stuttering patterns.

Sample Length Guidelines

• Standard sample length is 300-500 words or syllables for general cases.
• Less frequent stutterers should provide samples of 600-1200 words or syllables.
• Some sources suggest a minimum of 200 syllables for samples.

Diagnostic Criteria for Stuttering

• Minimum stuttering diagnosis criteria: 2-3% of syllables must be stuttered.
• Percentage of stuttered syllables (%SS) is calculated from stuttering-like disfluencies (SLD) divided by total syllables.
• Percentage of stuttered words (%SW) calculated from SLD divided by total words.

Calculating Stuttering Metrics

• Focus on intended words only; ignore repetitions and word revisions for total word count.
• Count each stuttering moment only once, regardless of severity; e.g., ‘P-P-P-P-Pan’ counts as one stuttering moment.

Stuttering-like Disfluencies (SLD)

• Types of SLD include:
  • Part-word repetitions (sound or syllable)
  • Monosyllabic word repetition
  • Disrhythmic phonation
  • Prolongations of vowels and/or consonants
  • Blocks, marked by '#' in word boundaries
  • Broken words, marked by '#' within words

Non Stuttering-like Disfluencies (NSLD)

• Includes interjections (e.g., 'um'), revision or abandoned utterances, and multisyllabic phrase repetition.
• NSLD and other disfluencies are not included in %SS or %SW calculations.

Weighted SLD Score

• Equation: [(PWR + SSWR) x RU] + (2 x DP)
  • PWR: Part-word repetitions
  • SSWR: Single syllable word repetitions
  • RU: Average repetitions per word
  • DP: Dysrhythmic phonation
• Required to assess severity of stuttering, categorized as follows:
  • Normally Fluent: 0-3.99
  • Mild Stuttering: 4.00-9.99
  • Moderate Stuttering: 10.00-29.99
  • Severe Stuttering: >30.00

Additional Considerations

• It’s advisable to record %SS and %SW in both conversational and reading contexts.
• Variability of percentages due to anticipatory and avoidance behaviors is common and may differ based on circumstances and content.

Impact of Avoidance in Stuttering

• Avoidance behaviors can adversely affect an individual’s lifestyle more than the stuttering itself.
• Signs of avoidance include hesitation before a feared word and thinking of similar words or circumlocutions.

Starting Tricks

• Individuals may use sounds (e.g., "ah") or fillers (e.g., "you know, let me see") to delay speech initiation, known as starting tricks.

Assessment of Stuttering Behavior

• An equal-interval scale is utilized to evaluate the current, average, and range of stuttering behavior, especially during assessments of adolescents and adults.

Loss of Control

• Empirical evidence for identifying loss of control in speakers is lacking, but experienced clinicians may discern such moments through calibration with clients.

A19 Questionnaire

• A formal 19-item questionnaire measures children's attitudes toward communication, indicating that higher scores correlate with more negative attitudes.
• Mean score for K through 4th grade stutterers is 9.07 (SD = 2.44), compared to matched controls with a mean of 28 (SD = 1.80).

S-24 Scale

• Developed by Erickson in 1969, this formal tool consists of 39 true-false items that assess attitudes toward verbal communication in adults, differentiating between persons who stutter (PWS) and those who do not (PWNS).

OASES Tool

• The OASES (Yaruss & Quesal, 2016) evaluates the impact of stuttering on various life aspects, including affective, behavioral, and cognitive factors, applicable to both adults and children.

CAT and BigCAT

• CAT and BigCAT are adult versions of the Communication Attitude Test (Vanryckeghem and Brutten, 2011; 2018).
• Comprised of 35 self-report items, these tools are normed on adults who stutter (AWS) and those who do not (AWNS), aimed at assessing perceptions about speech and speaking abilities.

Factors Affecting Stuttering in School Age to Adults

• White Noise/Masking

  • Stuttering frequency decreases in the presence of loud background noise (e.g., ocean surf, waterfalls, trains).
  • Individuals who stutter may not hear their own speech when loud noise is present.
  • Reduced anxiety from stuttering cues contributes to this phenomenon.
  • Inference indicates that hearing one's own speech may hinder fluency, rather than distraction alone.
  • This effect has been extensively verified through repeated studies.

• Delayed Auditory Feedback (DAF)

  • Speaking with DAF can help many individuals who stutter reduce their stuttering frequency.
  • In contrast, DAF may increase disfluencies in those who are typically fluent.
  • Current research is ongoing to determine if DAF can lead to long-lasting improvements in spontaneous speech fluency outside clinical settings.

• Video Self-Modeling

  • Involves exposing individuals to edited videos depicting their error-free speech patterns.
  • By focusing on desired performances, it aims to improve fluency and decrease stuttering instances.

Low Evidence Interventions

• Hypnosis & Suggestion

  • Limited evidence supports the effectiveness of hypnosis or suggestion as standalone treatments for stuttering.

• Psychotherapy Alone

  • Psychotherapy without adjunct therapies has shown no dramatic improvement in achieving fluency for individuals who stutter.

• Pharmaceutical Therapy

  • Recent reviews indicate that responses to medication among people who stutter (PWS) can vary significantly.
  • No pharmacological agents have been conclusively shown to eliminate stuttering symptoms.
  • To achieve meaningful fluency improvements, any effective pharmacological treatment should ideally be combined with a behavioral treatment regimen.

This quiz explores the concept of stuttering disfluencies, including their types, causes, and impact on communication. Test your knowledge on the complexities of speech patterns and how they affect individuals in different contexts.