Theories, Treatment, and Ways to Promote Fluency of Speech at Home
Definition of Suttering: DSM 5 Disturbance in the normal fluency and time patterning of speech Inappropriate for the individual's age and language skills Persists over time and is characterized by frequent occurrences of one or more of the following: Sound and syllable repetitions Sound prolongations Interjections
Definition of Suttering: DSM 5 Broken words - pauses within a word Audible or silent blocking Circumlocutions Words produced with excess of physical tension Monosyllabic whole-word repetitions The disturbance causes anxiety about speaking or limitations in effective communication, social participation or academic or occupational performance
What is Stuttering Stuttering is a neurologically based disorder which impairs a person s ability to time and sequence the underlying movements necessary for speech. Over time this can result in: The characteristic stuttering behaviors Reduced confidence in communication skills. A sense of losing control for the speaker Increased tension, struggling, or pushing. The anticipation of future speech breakdowns.
Onset and Development Most stuttering begins between 2-4 years of age 60% by 36 months 85% by 42 months 95% by 48 months (Sudden onsets are not uncommon - 40%) Lifetime incidence of stuttering = 5-10% Prevalence of stuttering =.7% Highest prevalence from 2-5 years of age (1.4%) Reduces in adolescence (.5%) Lowest over 51 years of age (.3%) (Suggests recovery in 4/5 children who start) Craig et al., 2002; Yairi & Ambrose, 1999, 2005
Onset and Development 65-80% of CWS will recover spontaneously Typically within 3-5 years post onset CWS at 4 y.o. 75% chance of recovery CWS at 6 y.o. 50% chance of recovery CWS at 10 y.o. 25% chance of recovery Children with earliest onsets (<3yo) regardless of severity are more likely to recover Close to onset the presence of stuttering-like disfluencies does not predict persistence However, recovery is more likely when the % starts to drop in the first year Andrews et al., 1983; Craig et al., 2002; Yairi & Ambrose, 1999, 2005
Therapy Approaches Fluency Shaping Stuttering Modification Most therapies today use a combination of approaches.
Stuttering Therapy Increase the child s knowledge of the speech production process, stuttering and people who stutter. Decrease any negative reactions or avoidance behaviors through systematic desensitization. Increase the child s ability to self-monitor own speech. Increase the child s ability to modify his speech.
Promoting Change Draw attention to overall communication abilities - Eye contact, volume, prosody, turn taking, initiating conversation, content - Use positive reinforcement to encourage these - Praise & positive Reward Chart Promote positive speaking experiences - Parent listening drills (re-educating attention) - Work along a therapy hierarchy of situations and contexts designed by the client - Gradually Increase Length & Complexity of Utterance
When I stutter, people... Try to fix it or solve it Talk too much Talk for me Tell me it s not bad Tell me to think before I talk Tell me to talk slower or relax Ignore me Skip over me.
When I stutter, I wish people would Just listen to me. Let me finish. Stop interrupting me. Take me seriously. Look at me when we are talking. Ask me what I think. Know how smart I am. Not feel sorry for me. Be honest.
Things you can do at home See above list! It s ok to use the S word. Emphasis on the message over how it is delivered. Use and model slow and easy speech yourself. Have your child talk about a topic for 30 seconds. You may not speak, just listen. During a specified practice time, when your child stutters, have him/her go back and stutter hard, medium, and easy. (Sends the message they can control speech)
More Home Activities Have a 3 5 minute conversation. Every time you stutter (will sometimes have to be on purpose, though we are all disfluent at times) your child will raise a finger. Then have them do the same for their speech.