Understanding Stuttering

• Stuttering is an integrated approach to viewing its nature and possible treatments. It’s the fifth edition.

Chapter Objectives

• Why using "person who stutters" is better than "stutterer"
• Factors that may predispose, precipitate, or make stuttering persistent
• The core behaviors of stuttering
• Name the two main types of secondary stuttering behaviors
• List different feelings and attitudes that can come with stuttering
• Describe the parts of the International Classification of Functioning, Disability, and Health (ICF) that matter most to stuttering
• Tell the age range and onset types of stuttering, and the challenges of pinpointing the actual onset
• Explain the terms "prevalence" and "incidence," and give current best estimates for each
• Estimate the number of children who recover without help, and describe factors that predict this recovery

Key stuttering terms

• Adaptation: Speakers stutter less when repeatedly reading a passage.
• Anticipation: The ability to predict which words or sounds a person will stutter on.
• Attitude: A belief that has become part of a person.
• Avoidance behavior: Attempting to prevent stuttering when anticipation of it occurs.
• Block: A disfluency that is an inappropriate pause in airflow/voice with articulator movement.
• Consistency: Stuttering on the same words when reading a passage multiple times.
• Core behaviors: Repetition, prolongation, and block.
• Developmental stuttering: The most common form, develops during childhood.
• Disfluency: An interruption of speech that may occur in both typical and atypical speakers whether it be a repetition, hesitancy, or prolongation.
• Escape behavior: An attempt to terminate stutter finish the word.
• Fluency: The effortless flow of speech.
• Heterogeneity: Differences among various types of a disorder.
• Incidence: How many people have stuttered at some point in their lives.
• Normal disfluency: An interruption of speech in a typically developing speaker.
• Prevalence: How widespread a disorder is over a limited time.
• Prolongation: When sound/airflow continues, but movement of articulators is stopped.
• Repetition: A sound, syllable, or single-syllable word repeated multiple times.
• Secondary behaviors: Reactions to repetitions, prolongations, and blocks (escape and avoidance).

Perspective

• Stuttering is an age-old problem potentially rooted in brain evolution and speech production.
• It surfaces when children use emerging language skills.
• Variations are determined by brain structure, learning, personality, and temperament.
• Different cultures have varying responses to it.

Words used

• Using "person who stutters" is preferred over "stutterer" to emphasize that stuttering is just one facet of who they are.
• "Disfluency" denotes interruptions of speech in both normal and abnormal speech.
• "Typical disfluency" is for speech hesitancies that are unequivocally not stuttering and instead are normal.

Overview of the disorder

• Stuttering exists worldwide, regardless of culture, race, or socioeconomic status.
• Genes play a role as there may be something neurological that is inherited that causes issues with neural pathways for speech and language.
• Stuttering commonly starts between ages 2 and 5, often triggered by typical early childhood stresses, either alone or together.
• When it worsens it may have learned reactions such as playmates at schools or adults who don't provide correct responses.
• Once fully developed, an adult who stutters may limit several situations such as, work, friends, and general fun.

Can stuttering be cured

• Many children recover without help.
• Early intervention is needed; concerted treatment is needed when stuttering becomes ingrained. Some achieve partial recovery through techniques such as speaking slower.

Definition of fluency

• Speakers include many elements in the flow of speech.
• Frieda Goldman-Eisler showed that typical speech is always filled with hesitations.
• Dalton and Hardcastle distinguished types of speech with the differences listed, variables such as rhythmic patterning in speech, intonation and stress are included in the list.
• Temporal aspects such as pauses, rhythm, intonation, stress, and rate are controlled by speech structures.
• Starkweather noted that the rate of information flow, not just sound flow, is a key aspect.

Stuttering general description

• It is like cell phone problems that causes frustration, dread, and limitations in life .
• It can also include forcing words out, using extra sounds/words/movements to become unstuck/avoid getting stuck and sometimes giving up altogether.

Stuttering specifics

• It is important to distinct it from normal hesitations.
• Children often display repetitions, revisions, and pauses.
• Stuttering also differs from other speech disorders as well as cluttering, which is fast, unintelligible speech.

Core behavior in depth

• These come across involuntary to those who happen to the disorder.
• Repetitions are what is noticed in children, and consist of sounds, syllables, or single-syllable words.
• They're stuck and continue until they make the following sound.
• Prolongations of sounds also appear, those are stutters where the sound is continuous.
• Short pauses sound abnormal, lengthy pauses may occur in adults.
• Blocks are the last and it occurs when a person stops the flow of air or voice and they also stop movement of the articulators.
• Those can grow and get tense or even appear with tremors.
• It happens at 10% of words while reading aloud, though individuals vary. Durations usually average around 1 second.

Secondary behaviors in depth

• Stutterers dislike stuttering and will react by repetitions, prolongations and blocks.
• Can either be reactions to end quickly or actions to altogether avoid the moment to end quickly.

Feelings and attitudes in depth

• Feelings may precipitate stutters, and stutters may create feelings.
• A child's feelings such as fear can cause more and more stutters.
• Feelings may also include fear, guilt, and hostility towards others because of the disorder.
• Attitudes are feelings that become pervasive parts of a person
• Adolescents often may obtain negative attitudes because of the disorder and may project their issues onto others as a form of coping
• People generally may think stereo typically of the the person who stutters with their own perspective which may not be true at all.

Functioning, disability & health

• The World Health Organization (WHO) uses the International Classification of Impairment, Disabilities, and Handicaps.
• It begins as body functions and structures where things can all have issues.
• It then helps consider the "Activity and Participation" or the individuals which include speaking and general conversations.
• Can have an impairment in speaking and conversation which can limit the amount in which someone will partake.
• Finally "Environmental" which includes a supportive and unsupportive family. Includes a "Personal" attribute like their general personality.

Human face of stuttering

• Several examples of stuttering
• Individuals accommodate in different ways to help over come.

Facts and implications

• "Heterogeneity" is a fact about stuttering and that that stuttering is not just one disorder.
• It begins during childhood where it can gradually be easier or harder.

Onset

• The average age for onset is generally before age 3 and most often it will occur somewhere between the age of 2 years to 3.5 years old, even though this can vary some.
• Simple and relaxed repetitions happen to the first signs of stuttering at the beginning.
• "I-I-I-I-I-I-I don't want that" has an excessive amount of syllable repetitions.
• The first is not the sudden onset or is it an intermediate, instead some comes to more often and some come on overnight getting worse quickly.
• The others tend to tiptoe in with sore throats and cough.

Prevalence

• The measurement is how widespread the disorder is.
• Prevalence information generally let's the amount of people that are stuttering.
• It is not common to find an up-to-date data on the prevalence due to differing reports, studies, and methodology.
• Prevalence of stuttering has been measured with care for kindergarten which ended at 2.4%.
• Recoveries between K-12 grade can allow for certain numbers to have a greater increase to enter the upper side of grades.

Incidence

• The amount of how many people have stuttered in their lives.
• Different researchers have used different methods for this measure.
• Estimates may vary.

Recovery from stuttering

• This is a puzzle and why it occurs.
• Results are from 20-80% to have a positive outcome.
• The reviews are difficult to tell what is wrong and what would be the correct answer.

Persistance of stuttering

• Several studies are compared with the people who persisted which will give the general detail.
• Family history can be one if anyone else in the family is suffering from the ailment.
• Gender is another factor.
• The age as well

Sex Ratio

• Three males to every one female is the usual ratio of the disorder
• Nearly even sex ratio among very young children who stutter gradually increases the ratio to be a larger gap between ages.

Variability & predictablity

• There is some what, there is and some what, there isn't is important to understand the disorder overall and fully.
• 1930 study was done by Lee Edward Travis which thought it was a result of an irregular and/or inefficient organization of the brain's two cerebral hemispheres
• Brain waves, heart rates and breathing problems were looked at.

Anticipation, consistancy & adaption

• Someone who is reading a passage several times has to anticipate certain words or sounds.
• Reading it more than once results in stuttering the same words
• Gradual reading will give stutterers the less and less they will have any issues over the reading by several times.
• These studies were given to those to mark any issues.
• The result of these was that the new learning helps clients to be able to acquire fluent speech from the issues or none.

Language Factors

• Spencer Brown the researcher pushed to get predictions into what and how a language goes about it.
• Several studies were based on 7 correlations between stuttering and 10 gramatial things.
• The overall results were strongly saying, "stuttering is highly influenced by these linguistic factors."