Nature of Stuttering PDF

Stuttering and Cluttering Introduction Definitions, presentations & impact 1 Today’s learning outcomes To understand the experience of stuttering for children and adults To understand the impact of stuttering on an individual’s life To...

Stuttering and Cluttering Introduction Definitions, presentations & impact 1 Today’s learning outcomes To understand the experience of stuttering for children and adults To understand the impact of stuttering on an individual’s life To distinguish typical disfluencies from stuttering in children To identify the risk factors for persistent stuttering in children 2  James Earl Jones (1931-2024) “You become a good listener... You appreciate the written word. You appreciate the sound. I did communicate with the animals quite freely. They don't care how you sound, they just want to hear your voice”. 3 Exercise 1 Consider a 6-year old boy who is referred to you due to parental concerns with stuttering. 1. What do you know about stuttering? 2. What clinical questions do you have? 3. How will you gather data to answer those questions? 4 Task cont. How competent or confident do you feel in answering the following questions: Why is my child stuttering? Will she grow out of it? Was it because I sent her to preschool too early? 5  Disfluency Stuttering Stammering/ Disfluency/ Childhood Cluttering Onset Fluency Disorder (DSM V) Psychogenic/ Functional Developmental Acquired Stuttering Pharmacogenic Neurogenic 6 Cluttering Characterized by a fast and/or irregular speech rate accompanied by at least one out of three The breakdowns in fluency are often main communicative characteristics: characterized by more typical (a) a high frequency of typical disfluencies, disfluencies (e.g., revisions, Prevalence of approx. 1% (b) errors in word structure e.g. errors in interjections) and/or pauses in places (Van Zaalen and Reichel 2017) syllable sequencing, omission of syllables in sentences not expected and/or grammatically, such as "I will go to (c) abnormal pausing the/store and buy apples" (St. Louis, Myers, Bakker, & Raphael, 2007; St. Louis & Schulte, 2011). (St. Louis & Schulte, 2011) 7 Cluttering: Joseph Dewey's s eries https://www.youtube.com/watch?v=qs vtBKSIiTY&list=PL0QPIVEOKyiD7bXhT1v PzO4j0PlcSXD9H&index=1 8 Acquired Disfluency of non developmental origin Stuttering Neurogenic Psychogenic Pharmacogenic 9 Neurogenic Stuttering Stuttering that appears to be caused or exacerbated by neurological disease/damage (Guitar, 2006; p435) For example: traumatic brain injury, stroke, and neurodegenerative disease (Onslow, 2021) Sudden onset in adulthood Published reports of neurogenic stuttering describe that the frontal lobe, the thalamus, and the basal ganglia are frequently involved (Alm, 2004) Clients typically show additional signs of aphasia, dysarthria and word finding difficulties (Theys, Van Wieringen, and De Nil ,2008) Secondary behaviours appear to be rare (Onslow, 2021) Minimal fear/anxiety associated with stuttering (may have frustration/annoyance) (Guitar, 2006; Onslow, 2021) Important to explore the client’s case history during assessment in order to exclude any chance of neurogenic stuttering being mistaken for developmental stuttering 10 Psychogenic/Functional Stuttering Disfluency associated with a psychological difficulty or an emotional trauma Can emerge after periods of acute or sustained psychological stress, or in association with a psychiatric disorder Onset is often sudden and linked to a specific event or history of stress Late onset Typically commences following a prolonged period of stress or a traumatic event Core behaviours are similar to developmental stuttering Diagnosis excludes those cases in which past resolved developmental stuttering has reoccurred May result in increased anxiety for client 11 Pharmacogenic Stuttering Drug-induced stuttering i.e. the effects of medication E.g. Antiepileptics, antidepressants, antipsychotics Few reports in the literature and mostly single case studies 12  Multi-faceted Exact cause is not yet known No single theory for the origin or experience No cure – therapy facilitates change Nature of Variable in origin, presentation and individual’s reactions Stuttering Fluency Bank: https://fluency.talkbank.org/teaching/AWS.ht ml 13 Patrick Campbell, individual who stutters 14 Nature of Stuttering Stuttering as Defined by Adults Who Stutter Tichenor & Yaruss (2019) Impairment in Body Use of an impaired system Structure and Function (differences in motoric, linguistic and emotional processes) Sensation of being stuck/losing control/ feeling unable to continue speaking =primary symptom P(187): …The ability to know exactly what you want to say, when you want to say it, and how you want to say it, but having little to no control on how it will come out. (Tichenor and Yaruss 2019) 16  1) Behavioural Factors: Overt and Covert Speech Disfluencies: Repetitions e.g. Where-where-where-where is my p-p- pencil gone? Personal One syllable whole word repetitions (WWR) and part word repetitions (PWR) Prolongations e.g. The w:ind is s:trong today Factors Blocking – silent or audible e.g. (M)y head is thumping. Tension/Struggle: physical tension, struggle, or bodily movements. Avoidance: choosing not to speak, avoiding situations, substituting feared sounds/words. 17  https://www.youtube.com/watch?v=je7ml AzyD7A What stuttering behaviours can you observe? 18 2) Affective/Emotional 3) Cognitive Reactions Reactions  Reaction to sensation of being  Reaction to sensation of being stuck/loss of control stuck/loss of control  Impact of stuttering on self  Including shame, guilt, worry, identity and self-esteem anxiety, embarrassment,  Anticipation=thought emotional pain, hopelessness, that stuttering may emotional exhaustion, and soon occur fear 19 Exercise 2: Stuttering Impact List the activity limitations and participation restrictions that people who stutter may experience (children and adults). How might this knowledge effect our assessment and intervention for children and adults who stutter? 20 21  The following are not considered to be types of stuttering but typical disfluencies.  Interjections e.g. ‘..am...um...eh..’ Typical  Phrase repetitions e.g. ‘Mammy, David took Disfluencies my-took my-took my DS’  Multi-syllabic whole word repetitions e.g. ‘because-because’, ‘walking-walking’  Phrase revisions/abandoned utterances e.g. ‘The DS with the blue-with the pink Pokémon is mine’ Still important to note (Guitar, 2006; Yairi & Ambrose, 2005) Clinical Implications Language formulation difficulties of Typical E.g. Word finding difficulties Disfluencies 23 Exercise 3 Step 1 Write 3 sentences about what you were doing during the last few weeks. Step 2 Circle all p, b, m, s sounds Underline all t, d, w sounds Step 3 (Do individually or with a friend/family member/) Now, read the sentences while stuttering: repetitions at every circled sound and blocking at every underlined sound. HOW DID YOU FEEL? 24 Risk Factors: Persistent Stuttering or Extended Treatment (Guitar, 2014) Factors within child Factors within Environment Family history of persistent stuttering Other’s reactions: e.g. impatience, critical. More (Ambrose, Coz, Yairi; 1997) sensitive temperament is more affected Gender: if a boy, persistent stuttering is more Family Communication Style: parent’s likely (male/female ratio is approx 1.5:1 at language more complex (Rommel, Hage, preschool age (Yairi & Ambrose 2005, 2013); Kalehne and Johannsen, 2000) M:F ratio for teenagers/adults is 4:1. Speech and Language Skills: language, Family Expectations: high expectations phonological skills or N/V intelligence are (academic, athletic, social or verbal performance) below normal (Yairi et al, 1996); if disparity between vocabulary and syntax (Conture, 2001) Sensitivity/temperament: inhibited/sensitive Life Events: may precipitate temperament (Richels and Conture, 2010; or perpetuate stuttering Rocha et al 2019) Exercise 4 Watch the Irish Stammering Association Youth international Theatre clip https://www.youtube.com/watch?v=s1NOLh4 ctYA (16 minutes) Consider: 1. Did this clip reinforce anything? 2. Anything new? 3. Anything unexpected? 4. Any other clinical observations? 26 Life of Privilege: Any similarities to stuttering? https://www.youtube.com/watch?v=7vR3Oovhi1Q 27 Intersectio nality of Disability and Race https://open.spotify.com/episode/5scnZnU78BCkTfWWoN5Hu6 28 What is your key take home message from today’s lecture? 29 What was the muddiest/ most confusing points in today’s lecture? 30