Nature of Stuttering; Theories Tagged PDF

Stuttering Theories of Stuttering 1 Today’s Learning Outcomes To understand the primary theories of stuttering origin and development To demonstrate ability to answer client questions about stuttering origin/devel...

Stuttering Theories of Stuttering 1 Today’s Learning Outcomes To understand the primary theories of stuttering origin and development To demonstrate ability to answer client questions about stuttering origin/development To identify principles on which to base assessment and therapy decisions To understand why a ‘one size approach’ does not fit all at any age 2 Exercise 1 In groups, discuss the findings of this meta-analysis and identify the key clinical characteristics associated with stuttering persistence. 3 Question Why is it important for us to understand the nature, models and theories of stuttering? It improves our clinical observations It improves the comprehensiveness and sensitivity of our analysis It informs our differential diagnostic skills It supports the validity of our management It supports our ability to answer client/family questions 4 Theories of Stuttering Aetiology (Manning 2009 p95) Theories explaining the onset and development of stuttering Physiological Cerebral Asymmetry Temporal Processing Linguistic Processing Genetic Factors Psychological Psychosexual Repressed Need Learning Diagnosogenic Anticipatory Struggle Classical and Operant Conditioning 5 Cerebral Asymmetry Stuttering is a result of a failure to develop a dominant speech hemisphere (required for timing of motor movements) (Orton 1928) Additionally, forced change in ‘handedness’ (left to right) would interfere with speech development and potentially cause stuttering (Orton) Delay in left hemisphere development (1960s) Research by Webster (1993) indicated that despite similar dominance for people who stutter, their supplementary motor area SMA (plans, initiates and sequences speech motor output) is more likely to be affected by brain activity elsewhere. Additionally, Webster (1993) suggested that right hemisphere activity including negative emotions (fear) potentially impacts on the functioning of the SMA. Atypical cerebral asymmetries in AWS (Foundas et al 2001; Foundas et al 2003. (? Cause of stuttering or result of stuttering) 6  Kent (1984) Inability to perform precise timing functions due to left hemisphere being less developed Issues with processing (fine motor control of verbal Temporal output) Suggested that emotion may play a role in timing processing disruption For individuals who stutter, when there is an increase of stress there is more likely to be cross-hemispheric interference (Peters and Guitar, 1991) Vulnerable to interference by right hemisphere activity (stress, high emotions) 7  Linguistic Processing The basic deficit is in the sensori-motor control of speech (De Nil, 2004) When language demands are high, the speech systems for people who stammer are more likely to breakdown (Kleinow and Smith, 2000). Stutterers have limited extra Increased Increased neuronal speech rate distributed resources Increased brain activity required to (Johnson & Increased linguistic (due to compensate for Rosen, 1937) Stuttering complexity increased s/m defect (Starkweather, language 1981) complexity) (De Nil & Bosshardt, 2001) Clinical implications indicate that a decrease in linguistic complexity may decrease stuttering in children. 8  The neurotic/psycho-analytic explanation of stuttering Repressed- Seen as a neurosis – result of repressed need and symptom of conflict need and Source of conflict posited to be psycho-sexual (oral/anal stage of infant sexual development Glauber, 1982) Psycho- Result of inadequate interpersonal relationships (Barbara sexual 1965, 1982; Wyatt 1969). Other suggestions: to gain attention, sympathy or to avoid hypothesis responsibilities Freud, 1966 – himself did not believe in effectiveness of psycho-analytical approach with stuttering 9 Insufficient evidence for psychogenic stuttering onset in children (Bloodstein & Bernstein Ratner 2008) “It is clearly time to declare that the belief that parents’ personalities or attitudes are causally related to stuttering is null and void for purposes of counselling and treatment” (Yairi 1997 p 44) 10 Learning: Classical Classical conditioning: provokes development of negative emotional response (Pavlov’s dog) Conditioning The repeated association between a neutral stimulus (phone) and another stimulus (dysfluency) that through learning consistently evokes a response (emotional arousal) The repeated associations result in the neutral stimulus (phone) evoking the emotional response associated with stuttering even if stuttering hasn’t yet happened. The emotional response may actually trigger stuttering. Clinical Implications: A child may learn that certain speaking situations are challenging. The unlearning of these associations has a potential for change in therapy e.g. avoidance reduction therapy, family communication skills 11  Operant conditioning: The association between a behaviour and a consequence (Skinner 1953)  Positive reinforcement=increase in behaviour  Negative reinforcement=decrease in behaviour Learning:  Disfluency is shaped by the response it elicits. Operant  Listeners’ responses to child’s disfluencies reinforces their occurrences. conditioning  Disfluencies are shaped into greater abnormality with associated struggle and secondary characteristics. Theory better at explaining how stuttering evolves (avoidance and escape behaviours) rather than explaining onset of stuttering. 12 The Diagnosogenic Theory “Stuttering begins with its diagnosis”/misdiagnosis (Guitar 2006 p.116) Premise: negative reactions from those around children experiencing normal disfluency that caused these to become a stutter Invalid: both stutter-like and normal disfluencies occur at stuttering onset (Van Riper 1982, Yairi 1997, Yairi and Ambrose 1999) 13 Let’s remind ourselves of the people behind the theories…. https://www.youtube.com/watch?v=0dz FY2VeHvg 14  Attempt to describe the variety of intrinsic and extrinsic factors affecting the ability to produce fluent speech Multi- Numerous factors Factorial Complex Difficult to understand and test Models (Manning, 2010) It explains variability in each individual It provides an accessible explanation for clients and/or the parents/families (Curlee, 2000; Gottwald and Starkweather, 1999) 15 Palin Multifacto rial Model 16 Updat ed Model 17  Palin Multifactorial Model: Factors Physiological Speech and Language Genetics Time of onset: 2-5 years (Rapid language Neurology expansion) Gender (Child: 1.5:1; Adult 4:1) Delayed/advanced/uneven profile Phonological factors (high incidence of phon Rate of speech problems and stuttering: Yaruss et al 1995) Psychological/ Emotional Environmental CWS are more emotionally reactive (Rocha et Family interaction styles al 2019) Emotional arousal affects speech (excitability, Daily life demands anxiety) Environmental changes Speech-related anxiety evident at young age (Vanryckeghem et al 2005) 18 DCM Model Considers both the capacities of the individual and the effects of both internal and environmental demands A decrease in fluency is explained as reflecting an imbalance between the child’s current capacities or abilities for producing fluent speech and the demands placed on the child 19  DCM Model: some examples Demands: environmental (external) Capacities: inherent tendencies, and self-imposed (internal) strengths, weaknesses and perceptions that influence fluency Motoric External demands Ability to initiate and control co-articulatory Fast speaking rate by others movements smoothly, rapidly and with Time pressure to respond quickly minimal effort Competition to speak Linguistic Internal demands Ability to formulate sentences Reactive temperament Socioemotional Over-stimulation of language centres Ability to produce smooth movements when under communicative or emotional Excitement/anxiety stress Cognitive demands Cognitive Ability to use metalinguistic skills  DCM Model Demands Capacities When capacities outweigh demands, Motoric and fluency is more possible but when Linguistic demands outweigh capacities, External Socioemotional disfluency is more possible Internal Cognitive (Starkweather and Gottwald, 2000) 21  Note: capacities and demands are both dynamic and changing at any given moment Clinical Implications? Variability Change with general development Therapy and therapy decisions Reminds us of the necessity of ongoing assessment/clinical observations 22 Multifactorial Dynamic Pathways Theory of Stuttering: Smith and Weber 2017 23 24 Exercise 2 Group discussion What are the basic similarities and differences in the multifactorial models? What are the advantages of M/F models when talking to parents? What are the potential vulnerabilities/threats? 25 Exercise 3 In Groups… What answer would you give parents of a child experiencing stuttering to questions such as: ‘Why is my child stuttering?’ ‘Will she grow out of it?’ ‘Was it because his dog died suddenly?’ 26  Social versus Medical Models of Disability (Constantino 2018) Social Model Medical Model  Impairment is a medical or physical condition and disability is a social condition. Individual who  Disability is imposed on top of stutters has a deficit impairment by way of discrimination, in functioning that stigma, and prejudice can, and should, be  People are disabled by society and not their bodies. researched,  Individuals who stutter are disabled identified, modified, by expectations of fluency, by and cured. discrimination against nonstandard speech, and by speaking time constraints. Deficit is within the person Deficit is within society 27  Emphasises natural variation and the unique skills, experiences, and traits of Neurodiversity neurodivergent individuals. (Constantino 2018) This movement suggests that bodies are neither healthy nor pathological but diverse and variable. Neurodiversity rejects the medical model’s Reading to support understanding claim that stuttering is a pathology and the of terms: social model’s claim that it is an impairment. https://neuroqueer.com/neurodiversity- terms-and-definitions/ Rather, there is a mismatch between stuttering and an environment not designed for them. Natural Variation 28 Social model of Disability 29  Resources StutterTalk podcast: StutterTalk : Changing how you think about stuttering - Film: When I Stutter Play: Unspoken: Watch the play 'Unspoken' online | STAMMA Spotify: ‘Vivian Sisskin’ 30 What is your key take home message from today’s lecture? 31 What was the muddiest/ most confusing points in today’s lecture? 32 Additional Resources to Reading List Campbell, P., Constantino, C. & Simpson, S.(2019). Stammering pride and prejudice: Difference not defect. J&R Press. Constantino, C. (2018). What can stutterers learn from the neurodiversity movement? Seminars in Speech and Language, 39(4). Dr Soo-Eun Chang interview on StutterTalk: https://stuttertalk.com/what-causes-stuttering-with-dr-soo-eun-ch ang-568/ (5.30-8.10) Cluttering: https://www.youtube.com/watch?v=LfXgh3dQH1M Singer, C. et al. (2020). Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis. Journal of Speech, Language, and Hearing Research, (63) 2995–3018. 33