Notes for Chapter 8
Notes for Chapter 8 1230.0
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Date Created: 10/23/15
Chapter 8 Fluency Disorders Most children and adults speak with relatively little effort The term uency is used to describe speech hat is effortless in nature Speakers do not speak in a perfectly uent manner all the time however The term dis uency is used to describe speech that is marked by phrase repetitions interjections pauses and revisions An inaudible sound prolongation where the mouth is in position for the sound for an extended period of time but no sound is coming out is referred to as a block Stuttering is the most common form of uency impairment but it is not the only type of uency disorder There are two types Acquired neurogenic Developmental It is characterized by an unusually high frequency or duration of repetitions prolongations andor blockages The interruptions are often combined with excessive mental and physical effort to resume talking People who stutter sometimes lose their train of thought when they concentrate too much on ways to avoid stuttering Avoidance and escape behaviors that are meant to decrease speech dis uencies often have the opposite effect Some people who stutter develop unusually low selfesteem because they internalize the negative reactions of others Sometimes referred to as core behaviors which are the stutteringlike speech dis uencies People who stutter tend to have somewhat different kinds of speech dis uencies They may produce three or more rapid repetitions of sounds May produce prolongations in which they hold out a sound for an unusually long period of time They may also produce blocks or silent prolongations They are counterproductive adaptations that people who stutter make as they try to get through primary stuttering behaviors or to avoid them altogether Unfortunately as these compensations become more and more automatic they help less when trying to avoid stuttering These secondary behaviors can actually be more distracting than the primary stuttering behaviors Prevalence is the percentage of people who stutter at any given point in time Incidence is the percentage of people who report having stuttered at some point in their lives Across all ages of stutters there are approximately three male persons who stutter to every female person who stutters Not all individuals stutter in the same manner or with the same manner of frequency Some people who have mild stuttering only experience problems in stressful situations In people with severe stuttering the instances of speech dis uency can be much longer and more frequent Most individuals who stutter fall somewhere between those extremes The severity of their stutter can change over time Speech dis uency tends to be worse when the speaker puts pressure on themselves to be uent Stuttering tends to occur when speaking long and complicated utterances speaking with figures of authority or when the speaker is in a hurry Most people who stutter are notably uent when they sing use fake voices are engaged in choral reading or when talking to babies or animals Individuals who stutter may have more negative concepts of themselves as well as a higher concern for speech There are also subtle differences in the language abilities of people who do or do not stutter Such as difficulties formulating messages and organizing words and sentences This is especially true with children Stuttering tends to increase in relation to the importance and complexity of the information being expressed People who stutter use their brains a bit differently during speech production They have unusual neural activation in speech motor language processing and memory areas of the brains There have been findings of excess neural activity in the right hemisphere and in motor areas in individuals who stutter Decreased connectivity between auditory processing and motor speech areas could interfere with the intricate timing necessary for uent speech Some theories that seem to be reasonable have been proven false Current models of stuttering depict the disorder as arising from complex dynamic relationship between internal neurological and cognitive factors and external conditions While these factors may prompt the onset and development of stuttering it is not necessarily the cause for every single person The speech of preschool age children is often marked by phrase repetition interjections revisions and pauses For the majority of children the amount of dis uency declines over time However some children do increase in dis uency Children that stutter may show feelings of frustration about their speech They may also develop secondary stuttering behaviors For some children stuttering seems to develop over time before anyone even themselves notice it There is strong evidence for genetic in uences on the development of stuttering It appears that there are multiple genes that contribute to stuttering Four interrelated mechanisms contribute to the capacity for uency Neural development that supports sensorymotor coordination Language development Conceptual development Emotional development In a process known as neural plasticity neural circuits organize and reorganize themselves in response to interactions with the environment Slowed neurological development and less efficient patterns of neural activation could result in a diminished capacity for producing uent speech Children tend to be dis uent when they are not sure what to say or when they must expend a great deal of mental energy to solve a conceptual problem What matters most for the development of stuttering is the balance between children39s perception of the demands that are present in their environment and their motoric linguistic cognitive and emotional resources for meeting the demands they placed on themselves For some children demand and capacity imbalances that contribute to increased dis uency may occur in many circumstances with many different listeners In some instances children39s speech dis uencies may be more physically tense than they are in other instances Our brains work so efficiently that patterns of behavior even undesirable patterns such a stuttering can strengthen and stabilize rather quickly Fortunately stuttering resolves in 60 to 80 of individuals who stutter during childhood The resolution of stuttering is probably related to growth spurts and developmental domains such as speech motor control language cognition and temperament The term chronic stuttering is often used to refer to individuals who may stutter from childhood into adolescence and adulthood Genetics possibly in uence whether children will continue to start or after they begin People who stutter often report that they are frustrated and embarrassed by their inability to say what they want to say in the way they want to say it Individuals who stutter sometimes avoid stuttering by changing the words they plan to say as they talk Another way people who stutter keep from stuttering is to avoid speaking situations in which they believe they will stutter Some people who stutter simply refuse to answer the telephone introduce themselves ask questions or speak in front of groups of people Some people who stutter evidence unusual patterns of breathing vocalizing and speaking even when they39re not stuttering Although motors aspects of stuttering have received considerable attention research studies indicate that linguistic variables such as phonology semantic and syntax may also contribute childhood stuttering Evaluations of individuals Who are excessively dys uent are designed to determine Whether the person is a stutterer to describe the patterns of dys uency that are exhibited and determine What therapy procedures to use It is more and more common for clinicians to assess and treat clients and families Who are members of ethnic and cultural groups that differ from their own Clinicians should never assume that the communication traditions and patterns from one culture are more correct than those from another culture Typically if a person stutters in one language they Will stutter in both native language and second languages assessment and treatment should allow for evaluation in both languages Evaluations should begin With a thorough case history The case history should reveal information about environmental conditions reactions to speech dis uency the consistency of speech dys uency behaviors across situations and changes in dys uencies over time Clinicians often give standardized test to help them determine Whether children have a disorder or not The test of childhood stuttering provides an objective measure of the core dis uencies that characterize stuttering The stuttering severity instrument4 can help clinicians determine the severity of stuttering Stuttering evaluations should include the collection and analysis of speech samples from a variety of speaking contexts including dialogue monologue and oral reading Some clinicians ask individuals Who stutter to read a short passage over and over again People who stutter tend to stutter on the same words from the first reading of the passage to the second reading of the same passage However people who stutter who read the same passage beyond two times stutter less on successive readings As with every evaluation the clinician needs to ensure that hearing sensitivity is within normal limits and that the structure and function of the oral mechanisms are adequate to support speech Adults who receive treatment or not cured often but it does happen Unfortunately we do not know how often it happens The good news is that many children adolescents and adults who receive treatment become uent to the point where they can communicate effectively There are two types of treatment for stuttering Stuttering modification procedures help the stutterer change or modify his stuttering so that it is relaxed and easy Fluency shaping procedures establish a uent manner of speaking that replaces stuttering One of the main differences between those two approaches is focus on attitudes and emotions related to stuttering Stuttering modification therapy is used to teach the person who stutters to change the way he stutters This treatment uses the acronym MIDVAS which stands for motivation identification desensitization variation approximation and stabilization The primary goal of this therapy is to help stutters acquire a speech style they find to be acceptable Fluency shaping therapy is used to teach a new speech style that is free of stuttering Most procedures involve lower rates of speech relaxed breathing easy initiation of sounds and smoother transitions between words One of the major differences between stuttering modification and uency shaping methods is that in uency shaping the focus is only on speech production whereas in stuttering modification the focus is also on attitudes and beliefs about speech production For this reason many SLPs believe that it is best to combine stuttering modification and uency shipping techniques in therapy Therapy for children between three and eight years of age involves many of the basic concepts and procedures from stuttering modification and uency shaping approaches Most clinicians utilize uency shaping approaches somewhat more than stuttering modification Clinicians frequently use the term quotturtle talkquot to describe the slower and easier uency shaping speech styles It is critical that clinician to work with young children involved families in the therapy process as much as possible that way the families will know how to help the child