Heterogeneity: Differences among various types of a disorder

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1 1 Fluency SPE2104

2 Disfluency: An interruption of speech such as repetition, hesitancy, or prolongation of sound (this may occur in both developing individuals and those who stutter) Normal Disfluency: An interruption of speech in a typically developing individual Fluency: The effortless flow of speech Repetition: A sound, syllable or singlesyllable word that is repeated several times. The speaker is apparently stuck on that sound and continues repeating it until the following sound can be produced. Prolongation: A stutter in which sound or airflow continues but movement of the articulators is stopped. Block: A stutter that is an inappropriate stoppage of flow of air or voice and often the movement of articulators as well Core Behaviour: The basic speech behaviour of stuttering repetition, prolongation and block Secondary Behaviour: A speaker s reaction to his or her repetitions, prolongations, and blocks in an attempt to end them quickly or avoid them altogether. Such as reactions may begin as random struggle but soon turn into welllearned patterns Escape & Avoidance Behaviours (Escape Behaviours Speaker tries to terminate stuttering and finish word, physical movement (Eye blinks, foot tapping or head nods), adding extra phrases, words or sounds (Interjections of uh, ummm, you know etc), way word is produced (eg. Pitch rise). Avoidance Behaviours Anticipates the stutter and recalls ve experience. Resorts to previous escape behaviours, situation avoidance, word avoidance ( substituting words, rephrasing sentences, not entering certain speaking situations, pretending not to know answers). Postponement (pausing before a hard word, repeating a word/phrase) & use of a starter word or an interjection (ummm, arrrr). Escape Behaviours: A speaker s attempt to terminate their stutter to finish a word occurs when the speaker is already in a moment of stuttering Avoidance Behaviours: A speaker s attempt to prevent stuttering when they anticipate stuttering on a word or in a situation where the speaker will inject extra sounds i.e. uh before the word on which stuttering is expected Attitude: A feeling that has become a pervasive part of a person s belief Heterogeneity: Differences among various types of a disorder Developmental Stuttering: A term used to denote the most common form of stuttering that develops during childhood (contrast to stuttering that develops in response to a neurological event or trauma)

3 3 Prevalence: How widespread a disorder is Incidence: How many people have stuttered at some time in their lives Anticipation: An individual s ability to predict on which words or sounds he or she will stutter Consistency: The tendency for speakers to stutter on the same words when reading a passage several times Adaption: The tendency for speakers to stutter less and less when repeatedly reading a passage. SPE2104

4 Why do we assess stuttering? Diagnosis Establish extent of problem Informing clinical decision making (assessment and monitoring) Specifying treatment goals Quantifying treatment outcomes To facilitate communication Apply a model/theoretical framework for assessment of communication impairment or disorder A theoretical model: Provides a framework to evaluate a person s communication. Is necessary to interpret a person s communicative ability and how the underlying cognitive system is operating. Provides a starting point for therapy, however is not the only information you will need to develop an effective plan for treatment. Examine Levelt s theory in detail Levels of Processing Conceptualiser: Generates preverbal messages. Formulator: Grammatical encoder and phonological encoder. Articulator: Unfolds and executes the phonetic plan as a series of neuromuscular instructions. More detail Conceptualisation Transforms the communicative intent into a form that is recognisable to the conversational partner. Selects relevant information to be expressed. Monitors what has been said before. Monitors what we say and how we say it.

5 5 Produces a preverbal message. Formulator Translates a conceptual structure to a linguistic one by taking the preverbal message and produces a phonetic or articulatory plan. Two stages: Grammatical Encoding Phonological Encoding Grammatical Encoding Accesses lemmas and builds syntactic structure. This is the first stage of processing within the formulator. Lemma information contains at least 4 points of information: 1. The item s meaning or sense, ie the concept that goes with the word. 2. The syntax of the word related to the grammatical arrangement of the words in a sentence. 3. Morphological information about the item. 4. Form specification how the item will sound Surface Structure When all relevant lemmas and relevant syntactic building procedures are completed the surface structure has been produced and is stored. The surface structure is an ordered string of lemmas grouped in phrases and sub phrases. Phonological Encoding Builds or retrieves an articulatory plan for each lemma and for the utterance as a whole. Access the lexical form. Specifies intonation and stress patterns. Articulatory plan is an internal representation of how the utterance should be produced. Specifies both a motor plan and motor programme. SPE2104

6 Motor plan: planning movements needed to attain articulatory goals eg lip rounding. Motor programme: specific sequencing of the muscles of articulatory structures (phonetic encoder) Function is to build a phonetic plan for each lemma and the overall utterance. Retrieves information about the lemmas form. The lexicon s information about an item s composition. Articulator Execution of the articulatory plan by the muscles of the respiratory, laryngeal and supralaryngeal systems AcousticPhonetic Processor Sound is picked up and initially processed in the ear. The message is passed nerves that carry the message to the brain. The brain processes the incoming signal. This all happens before any linguistic information is collected from the auditory signal. SelfMonitoring Monitor internal and overt speech. Monitor our conversational partner and whether we have conveyed our communicative intent. Work is mainly done by the conceptualiser. Allows us to alter what we are about to say or fix what we have said Evaluate van Der Merwe s Neurolinguistic model of speech Speech production is a fine sensorimotor skill 1 and the externalised expression of language. 1 General requirements of a fine motor skill: 1. Performed with accuracy and skill. 2. Uses knowledge of results. 3. Is improved by practice.

7 7 4. Demonstrates motor flexibility in achieving goals. 5. Relegates all of this to automatic control. Different phases covering: Linguistic symbolic planning non motor/ premotor process. Phonological encoding Motor planning. Motor programming. Execution. Sensorimotor interaction occurs between the phases of the model Indicates the areas of the brain for each phase Sensory information is essential for motor control and coordination. Feedback occurs through: Auditory: what we hear Tactile: what we feel Proprioceptive: feedback from the muscles about what they are doing. Comes from inside our bodies and thought to be faster than other forms of feedback. Linguistic Symbolic Nonmotor Planning of utterance occurs simultaneously and not word for word. Semantic construction of message, recall and selection of lexical units, syntactic, morphological and phonological planning occur in coherence. Phonological planning entails the selection and sequential combination of phonemes. Output is a phonological representation Brain areas: temporalparietal area, Broca s area and adjacent areas However. Single word productions cerebral activation over Broca s area. Sentences Wernickes area becomes more active. Two areas are coactive during linguisticsymbolic and motor planning. Roles change depending on the nature of the speech task and phase of preparation of an utterance. Motor Planning Highest level of the sensorimotor hierarchy Defines motor goals guided by phonological input from previous phase SPE2104

8 Defines spatial and temporal goals for sounds, coarticulation (articulator specific) Manner and place of articulation Brain areas: Association cortex (prefrontal, parietal and temporal lobes), Broca s, Wernicke s, SMA Each sound has its own core features which determine the core motor plan. During production the core motor plan of the phonemes are recalled. These plans are attained during the development of speech and language and are stored in the sensorimotor memory. Specifies motor goals (spatial and temporal) Spatial = for manner and place of articulation Articulator specific Develops goals for speech production involving spatial (place and manner), voicing and temporal (timing) instructions for movements that produce sound. After the core motor plans for the various phonemes are retrieved the sequence of movements is planned. Motor planning is specific to the articulator eg tongue depression, lip rounding not muscle specific. Motor Programming Motor programming is MUSCLE SPECIFIC. Middle level where motor plans motor programs Level of movement is specified (velocity) for sequence of movements Muscle specific (tone, movement direction, velocity, force, range, mechanical stiffness Brain areas: sensorimotor cortex, cerebellum, putamen loop of the basal ganglia, SMA Motor programming involves selecting and sequencing the motor programmes of the muscles of the articulators. Programmes specify muscle tone, movement direction, force, range and rate as well as mechanical stiffness of joints pg 13 Programmes can be updated by sensory feedback. Motor Execution Lowest level where programs muscular activity resulting in execution

9 9 Brain areas: SMA, cerebellum, basal ganglia, motor cortex, thalamus, brainstem Motor programme is transformed into movement. Instructions are sent to the motor centers that control muscles and joints (as many as 100 different muscles). Neurological pathway involves: motor cortex, lower motor neurons and motor units in the muscles. Compare and contrast Levelt and van Der Merwe s models Levelt Motor plan and motor programme fit into the phonological encoding section within the formulator. Levelt refers to the output of the formulator as the phonetic plan/ internal speech. Also refers to it as the motor programme. Execution fits into the articulator. Levelt is 3 level. Van Der Merwe Van der Merwe has a focus on speech production is a fine motor skill. It is a sensorimotor skill. A 4 level model. SPE2104

10 Apply principles of sensorimotor theory to range of practice: Fluency, voice and swallowing Phonological planning (van der Merwe)/ Phonological encoding(levelt) Knowledge of sounds contained in a word access to lemma form Motor Plan (van der Merwe)/ Phonetic encoding (Levelt) Knowledge of movement each articulator will make to produce each sound Explain the epidemiology of stuttering Motor Programme (van der Merwe)/ Phonetic encoding (Levelt) Knowledge of specific movement each muscle will make for each sounds Articulation / Execution Ability to move muscles within, articulators in the right direction, with correct range, timing, force & rate. A disorder in the rhythm of speech (timing issue) in which the individual knows precisely what he or she wishes to say, but at the same time may have difficulty saying it because of an involuntary repetition, prolongation, or cessation of sound. Complex physiological, stuttering as a neurological deficit, as a disorder of speech motor control, possibly with genetic involvement (current theory). Epidemiology: Study of people, study of diseases in populations. o Not a word finding difficulty or a cognitive difficulty. Stuttering negatively impacts QOL in the vitality, social functioning, emotional functioning and mental health status domains. o Results also tentatively suggest that people who stutter with increased levels of severity may have a higher risk of poor emotional functioning. o Impacted on academic performance, relationships with teachers and classmates. o People generally reacted negatively to their stuttering.

11 11 o No adverse effect on choice of occupation, ability to obtain work, and relationships with managers and coworkers, although it influenced their work performance and decreased chances for promotion. Prevalence at any point in time, the number of people who stutter would be 1% of that population Incidence how many people has stuttered in their life, about 5% Recovery without formal treatment o Spontaneous recovery estimated to be at about 70 80%. o Yairi and Ambrose (1999) 74% children recovered, o Kloth et al., (1999) 70%, o Mansson (2000) 85%. o 20% of those who stutter as a child will go on to stutter as adults. Onset of stuttering o Onset usually within the first 25 years of a child s life, onset in later childhood is possible and adulthood o Gradual o Sudden o Beginning of multiword utterances (most of the time) o Can be sporadic (couple months/weeks) o Hazy parent recollections (Guitar pg 19) Neurogenic stuttering cause by brain injury is also possible but incidence is low (confused with ataxic dysarthria) Stages of Stuttering o Primary: Proposed to begin with primary stuttering repetitions, not much awareness (genetic predisposition and precipitating factor in developmental stage). o Secondary: Then develop into secondary stuttering increase tension and tempo of disfluencies, awareness is high and fears and reactions to stuttering develop o Two stages may overlap (stuttering can start at the secondary stage). Cluttering involves excessive breaks in the normal flow of speech that seem to result from disorganized speech planning, talking too fast or in spurts, or simply being unsure of what one wants to say. SPE2104

12 By contrast, the person who stutters typically knows exactly what he or she wants to say but is temporarily unable to say it. To make matters even more confusing, since cluttering is not well known, many who clutter are described by themselves or others as "stuttering." Also, and equally confusing, cluttering often occurs along with stuttering. Describe the major characteristics/behaviours of stuttering in children and adults Children have a period of time where they are disfluent Disfluency is used to denote interruptions of speech that may be either normal or abnormal. It can apply to natural pauses, repetitions and other hesitancies that occur in normal speech. Dysfluency is used for ABNORMAL hesitations. Children who are reactive and sensitive are more likely to stutter (more responsive to stress). Children Children with more susceptibility to stuttering (possibly due to genetics) may have fragile or unstable speech motor systems Characteristics of stuttering are thought to start with repetitions then can progress to more advanced stuttering behaviours Nonverbal behaviours could also be present grunts Episodic: Stuttering episodes can wax and wane, one day it s there, the next it s not Tractable: not as fixed due to the plasticity of their brains Adult Characteristics usually include advanced stuttering behaviours o Prolongations, blocks Secondary behaviours very common o Very individual characteristics Compensatory mechanisms Psychological consequences Core verbal behaviours Terms were first coined by Van Riper in 1971 & o Repetitions o Prolongations

13 13 o Blocks Secondary behaviours o Learned reactions o Avoidance vs escaping behaviours o Indication of stuttering developing to advance stages though can be present at onset of stuttering too Describe some factors found to contribute to persistent stuttering Persistent stuttering into adulthood Genetics have a family history Age of onset later (more likely to persist) How long they have been stuttering for the longer the more risk (more than 1 year) (Yairi and colleagues) Gender More likely to stutter/persist if you re male more likely to recover if you re female. Language, phonological skills if weaker less likely to recover More unstable speech motor system for example speech rate less likely to recover Mother s interactive style directive and more complex language (Kloth et al 1999; Rommel et al, 2000) child LESS likely to recover Describe the nature of stuttering (variability and predictability) Stuttering can differ greatly between different situations and contexts but the patterns are predictable Fluencyinducing conditions Can be related to psychological factors anxiety, nervousness Can be related to linguistic factors Brown s early studies found stutters occurs more frequently: o On consonants o On sounds in wordinitial position o In contextual speech (connected) o Stressed syllables SPE2104

14 o On content words (nouns, verbs, adjectives, adverbs (versus articles, prepositions, pronouns, conjunctions) o On longer words o On words at the beginning of sentences Other studies o Utterance length o Syntactic complexity of utterance V model (Packman et al., 1996) explains how stuttering can be reduced in particular situations/contexts Variability of syllabic stress (emphasis) is implicated NOT psychological stress! Variability in speech relates to rhythm, intonation, emphasis/stress in speech Proposes that stuttering is reduced or eliminated when the variability in speech is reduced Proposes that reducing variability is sufficient but not always necessary (not all ameliorative/fluency conditions involve a reduction in variability) Explain how the variability model accounts for conditions when stuttering is reduced V model explains why: Time of onset The repetitions of early stuttering Perceptual overlap between stuttering and disfluencies Stuttering and linguistic development Spontaneous recovery The tendency for stuttering to occur on stressed syllables The low prevalence of stuttering in the hearing impaired population Proposes that stuttering is reduced or eliminated when the variability in speech is reduced Proposes that reducing variability is sufficient but not always necessary (not all ameliorative/fluency conditions involve a reduction in variability) Stuttering is decreased: Chorus/unison o Singing or other rhythmic stimulus (metronome)

15 15 o Speaking in slow, prolonged way o Speaking under loud masking noise o Speaking with delayed auditory feedback o Shadowing (repeating immediately) All people who stutter should respond to these fluencyinducing conditions in a similar manner Define three types of causal factors: predisposition, precipitating, perpetuating Predisposition factors that incline a person to stutter e.g., genetics, neurophysiological. Primary Stage o Brain maturation and reorganisation o Influenced by genetics Secondary Stage o Reactive temperament o Tension, escape behaviours, avoidance behaviours o These may interact with developmental and environmental factors to precipitate (trigger or exacerbate) stuttering Language development Maturation of the brain o Inherent o Brain Cerebral dominance theory delay in growth of left hemisphere (theory by Orton Travis in 1920s) Observed left handed individuals forced to write with right hand Change led to conflict in the control of speech Lacked a dominant hemisphere for speech control causing disorganisation and hence stuttering Switch back to left handedness Perhaps related to less growth of left hemisphere, right hemisphere takes over primary speech and language functions (but it s not designed for it) SPE2104

16 Recent brain imaging studies have interestingly found that people who stutter have overactivation of their right hemisphere compared to controls Right hemisphere may be involved with regulation of negative emotions Decreased temporal lobe activation, unusual cerebellar activity. o Van Riper 1982 and Kent 1984 and 1994 Temporal programming Again, the brain is implicated inappropriate localisation of speech and language functions to the right hemisphere Kent 1994: Stutterer s left brain is less developed than the right hemisphere left hemisphere is specialized so PWS may be disadvantaged when trying to process at the speed required for normal speech. Disruption in the simultaneous and successive programming of muscular movements to produce integrated sounds, possibly arising from deficits or differences in processing in the brain Emotions also play a part (R regulates negative emotions) and timing function is vulnerable to interference by right hemisphere activity during increased emotion. Disorder of sensorymotor o Relationship between how speech movements are made and the sounds we hear. o Sensorymotor model is a mental model of the relationship between speech sounds and motor commands o Children constantly have to refine their sensorymodel for speech. Different models are needed for different speaking contexts/situations. o Stutterers may have had difficulty with early learning of the relationship between the sounds they want to say and the movements required to produce them, particularly when the brain has reduced capacity o Repetitions and prolongations occur because speaker is attempting to push ahead with speech while brain is still planning following syllables and how to link with the initial sound. mouth is faster than the brain!

17 17 Disorder of language o Kolk & Postma (1997) Covert repair hypothesis. Internal monitoring deficit. Error detection faults. Stuttering behaviors are a result of repairing phonological errors detected in the phonetic plan before they are spoken. o Linguistic factors on stuttering onset of stuttering ($ begins at a period of intense language development). o Stuttering most frequent with longer utterances, more syntactically complex, less familiar words (Bloodstien 2002). o Deficit not only in motor execution but also in planning stages (assembly language units/phonemes). o Physiology Unstable neuromuscular system, can be influenced by variety of cognitive, linguistic, and psychosocial factors Some stutters are tremorlike and these may be amplified by emotions Found to be the case in those stuttering longer tense blocks o Physiological Tremor Unstable neuromuscular system, can be influenced by variety of cognitive, linguistic, and psychosocial factors Some stutters are tremorlike and these may be amplified by emotions Found to be the case in those stuttering longer tense blocks o Genetics Has been found those who stutter have more family members who stutter (70% of PWS have family history). If there are family members who persisted with stuttering, you are more likely to persist. Those who have family members who have persisted with stuttering are more likely to persist as well. Genetics involvement is somewhat unclear, but genetics can inform about who MAY develop a stutter. SPE2104

18 Females are more resistant to an inherited susceptibility to stuttering but they pass on more genetic susceptibility to their children than males. Precipitating factors in which a stutter manifests and becomes identifiable e.g., environmental or developmental o Diagnosogenic Theory (Guitar p 116) Ignore it Johnson and colleagues highly influential 40 s, 50 s The Monster study 1939 by Mary Tudor under the supervision of Johnson to test the theory that stuttering started in the listeners rather than speaker Parents or other listeners mislabelled normal disfluencies as stuttering Caused children to become over conscious and develop stuttering o Stuttering emerges when child s capacity for fluency does not match speech demands (view not theory) Internal environment demands language skills, other development External demands parent demands, may ask questions too quickly, expect answers too quickly, interrupt frequently, time pressured The view can describe why stuttering can fluctuate often in young children and also the differences in stuttering between individuals Perpetuating factors that maintain stuttering e.g., learned reactions to stuttering o Bloodstein (Guitar p 117) Stuttering emerges from child s frustrations and failures with trying to speak Results in child dreading or anticipating failure This need not have started as a stuttering problem as such Explain broadly the major theoretical stances of stuttering and what the current stance of stuttering is

19 19 Levelt (1989): Impairment at the level of the articulator & phonological encoding Identify important information to be gathered as part of the case history for clients who stutter All clients: Client background details age, gender Reason for referral/concern What, when, how long and why? Family history of stuttering Medical history Biopsychosocial environmental and personal (Inc. support network) History of stuttering Stuttering behaviours/reactions When stuttering is worse/better Children: Literacy skills Development/onset Adults: Previous treatment history Compensatory mechanisms Psychological reactions Describe how stuttering disfluencies are different to normal disfluencies, particularly for diagnosis of stuttering in young children All preschool children go through periods of disfluency A child with normal disfluency WON T have these behaviours, a child with stuttering disfluencies WILL: Core verbal behaviours Repetitions Prolongations Blocks Secondary nonverbal behaviours SPE2104

20 Learned reactions resulting from avoidance, delaying a stuttering event Nonverbal associated behaviours Psychological reactions to stuttering Normal disfluencies: Repetition of whole words, multi word phrase/fluctuations in speech esp. when planning long, complex language structures, revision, pauses, hesitations, interjections. o Disfluencies may increase at periods of time and decrease at others o May increase when tired, excited, upset, being rushed to speak o More disfluent when asking questions/answering o 18 months 7 years o Unaware of disfluency no signs of frustrations/surprise o Fluent preschool children may have about 6 disfluencies per 100 syllables o No more than 10 disfluencies per 100 words 18 months 3 years o Repetitions of sounds, syllables, and words, especially at the beginning of sentences. After 3 years o Less likely to repeat sounds or syllables but will instead repeat whole words (III can t) and phrases (I want I want I want to go). They will also commonly use fillers such as uh or um and sometimes switch topics in the middle of a sentence, revising and leaving sentences unfinished. Abnormal disfluencies: Repetitions of speech segments, part words/prolongations, awkward pausing (duration/location), nonverbal behaviours, tense and secondary behaviours o Secondary behaviours have been indicative of perpetuating stuttering Explain common procedures and measures of stuttering (i.e. percentage syllables stuttered, parent rating scales) as well as covert stuttering in children, adolescents and adults who stutter and the impact of quality of life Covert Stuttering: Word omittance, substitution and circumlocution as a strategy by the speaker to hide an overt stutter

21 21 Assessment Process Casehistory Assessment of stuttering behaviour Assessing speech naturalness o Techniques to reduce stuttering can result in speech sounding unnatural o Slower speech rate o Dragging out vowels o Less clearly articulated sounds Assessing speaking and reading rate o Consequences when speech rate is too fast/slow o Relates to severity of stuttering o Has been found that stuttering frequency decreases as speech rate does o Syllables spoken per second/minute is commonly used Assessment of parentchild interaction* o Type of utterance (comment vs question vs answer etc) o Amount of questions vs comments? o Speech Rate (words/syllables per min) o Complexity of mother s language (MLU) o Pace of session: Measure the pauses in conversation o Teaching style? Directive? o Parent/family response to Stuttering? o Modelling appropriate syntax / vocab? Assessment of feelings and attitudes Assessment of the impact of stuttering on the individual s life Feedback to parent or client Assessing: Amount of disfluency Number of units per repetition or interjection Nonstuttering children produce 12 units Type of disfluency Reactions because of disfluency SPE2104

22 Frustration or embarrassment is more likely to occur with stuttering children. Measures for ALL ages Frequency of stuttering how many Disfluencies per number of syllables spoken (%SS) Stutters per minute of speaking time Frequency of stuttering segments/utterances Type of disfluencies describe the stuttering characteristics Rate of stuttering how often? Stutters per minute Severity of stuttering how bad is it? Severity rating scales (likert scale 110) Percent syllables stuttered (%SS) o Each syllable spoken is judged to be fluent or nonfluent (stuttering) o The total number of syllables in the sample = stuttering syllables + fluent syllables o Perceptual judgment is required to determine whether or not a syllable was stuttered or fluent Frequency (%SS) has been found to highly correlate with severity o Under 5% SS mild o 5%SS 10%SS moderate o 10%SS and above severe Can also measure frequency of stutters per minute (SPM). Covert strategies used: o Ask client how often they avoid stuttering and HOW they do it o Change word, use of circumlocutions, avoid speaking How can we assess COVERT behaviours? o Ask them Can you avoid or stop a stutter? Can you hide your stuttering? What do you do? o Estimate how often they do it. o Interrupt midsentence and ask, What were you doing there? What happened?

23 23 o Have a conversation. Ask them to tell/show you when they do it. o Describe the behaviour o How often? o Videotaping client is a good resource Understand the concept of stuttering severity Types of stuttering behaviours Presence of secondary behaviours Frequency of behaviours Duration of behaviours Speech rate pauses Impact on communication Impact on person s life Speech naturalness Stuttering Severity Instrument 3 (Riley, 1994) o Samples from clinic and home o Reading A total overall score o Frequency o Duration (mean of 3 longest) o Physical concomitants are rated Videotaping is required SPE2104

24 Lidcombe Severity Rating Scale o 1 = no stuttering, 2 = extremely mild stuttering, 10 = extremely severe stuttering o Has been found to correlate highly with percent syllables stuttered (O Brian et al., 2004)

25 25 o Parents undergoing Lidcombe program use this tool to measure child s speech at home Describe sampling issues associated with fluency measurement Stuttering is more common in natural and connected speech You want a naturalistic environment at home/covertly Sample size/how many words/syllables can be a sampling issue How representative the sample is In young children, stuttering can be episodic Consider methods of measuring the biopsychosocial and psychological effects of stuttering OASES Form (Overall Assessment of the Speaker s Experience of Stuttering) Promotes selfawareness of how stuttering affects different areas of life, including, school, word, home and social settings Examines functional communication difficulties and QOL from the perspective of the person who stutters Information about the persons reaction to stuttering and challenges Help plan treatment Activity 1 What is stuttering/how is it caused? Stuttering is a disorder of the fluency of speech. The rhythm and/or timing of speech is disrupted. The child knows exactly what they want to say but has a loss of control over their speech which can be frustrating for the child. Stuttering consists of hesistations (blocks), repetitions of words or parts of words, prolongations of sounds and interjections such as um and er. It isn t an emotional or psychological problem. It is also not rare as 5% of the population have experience stuttering at some stage in their lives. When does it start? Between 2 5 years (twoword combinations)/neurogenic stuttering. SPE2104

26 What can make stuttering worse? Certain situations i.e. public speaking Stressful situations What factors may cause stuttering to start or persist? (for example; sex, genetics, family history, age etc). Family history (did that family member stutter? Do they still stutter? If they persist, the child is more likely to have a persistent stutter. Males are less likely to recover How long they ve been stuttering Age of onset Activity 2 Communication Successful communication requires the accurate perception of the intent of each other s conversational messages. Two parts in conveying intention: Speaker must be able to communicate their message so addressee can understand the intention = ENCODING Addressee must be able to understand the communicated message as well as the underlying intention = DECODING Miscommunication Misunderstandings occur when: The speaker fails to convey their communicative intent in a way that the addressee understands. The addressee fails to recognise the intent of the speaker. Interestingly it is not how correct our utterances are that influence our communicative success but our ability to effectively convey our intent. In some cases, for example head injury, communication breakdown occurs due to the lack of ability to recognise another s intentions.

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