Studied by 7 people3 categories of psychological theories of stuttering
psychoemotional
psychobehavioral
psycholinguistic
psychoemotional theories suggest…
stuttering is caused by psychological trauma or emotional disturbance
In the past, stuttering was thought to be due to a psychological disturbance and purposeful behavior.
it is a purposeful behavior that:
represents repressed hostility
satisfies oral and anal erotic needs
represents an unconscious desire to repress speech
t/f: adults and children who stutter are more likely to show anxiety and social difficulties compared to those who do not stutter.
true
t/f: parents and children who stutter are more likely to report separation anxiety, social phobia, and generalized anxiety
true
psychobehavioral theories propose….
stuttering is a learned behavior
avoidance behaviors
learned behaviors
AWS may avoid speaking situations, certain words by substitution or circumlocution
approach-avoidance conflict and diagnosogenic theories
Approach-Avoidance Conflict theory
occurs when an individual is attracted and repelled by the same goal
stuttering is viewed as a consequence of the need to speak and desire to hold back from speaking
(approach-avoidance conflict theory)
if the avoidance is dominant, then AWS is ______
silent
(approach-avoidance conflict theory)
if the approach and avoidance drives are equally strong, then …
stuttering occurs
(approach-avoidance conflict theory)
once a moment of stuttering occurs, the fear response is ____ and thus the avoidance drive is _____ and the conflict is ________
reduced
reduced
resolved
Johnson’s Diagnosogenic theory
the diagnosis of stuttering is the cause of stuttering/the disorder
normal disfluencies are misdiagnosed as stuttering
stuttering begins in the ears of parents when they overreact to their child’s normal disfluencies
Conditioned Anxiety Response theory
agrees with Johnson that children react to parents reaction to disfluencies
BUT he proposes children are NOT trying to avoid disfluencies but they are trying to avoid feelings of anxiety, hurt, and shame
feelings of anxiety → change behavior (avoidance behavior)→ reduced anxiety
Anticipatory Struggle hypothesis
suggests people who stutter tend to stutter when they expect to stutter
PWS tend to talk fluently when they are not thinking about speech
anticipation of stuttering → stuttering
Demands and Capacities model
stuttering results when demands for fluency from the child’s social environment exceed their cognitive, linguistic, motor, or emotional capacities for fluent speech
internal and external factors influence the production of fluent and non-fluent speech
(Demands and Capacities model)
capacities:
inherited tendencies, strengths, weaknesses, and perceptions that may influence the child’s ability to speak fluently
(Demands and Capacities model)
demands:
may be from the child or other listeners
rapid rate of speech or speech continuity
demands may change over time
psycholinguistic theories suggests…
stuttering is a consequence of speech-language encoding disorder
speech and language processing in individuals who stutter are deficient in some way
Covert Repair Hypothesis
individuals who stutter produce more disfluencies because they may..
be slower in phonological encoding
attempting to begin speaking too soon or try to speak too quickly for their impaired encoding mechanism to make accurate selections
(Covert Repair Hypothesis)
errors are detected _____ but the correction or repairs are done ______
covertly
overtly
(Covert Repair Hypothesis)
errors can be ___ or ________ but there is a higher rate of _______
real or perceived
corrections
(Covert Repair Hypothesis)
disfluencies are the result of ….
hyperactive self-monitoring and correction of speech
Neuropsycholinguistic Theory
disfluency is a result of disruption in timing between various linguistic formulation and motor execution
in abnormal disfluency there is an added component of time pressure and feeling loss of control
(Neuropsycholinguistic Theory)
time pressure:
loss of control:
sounds are not inserted into syllables at a timely fashion during speech production
some aspects of language formulation are accessible to conscious awareness while others are not
loss of control occurs when disruption takes place in an aspect of language that is not accessible to conscious awareness (ex: phonological encoding)
motor learning in stuttering
motor skills can be improved with practice
action learned in slow motion can be transferred to action in higher speeds
motor skills can be improved with practice
with increased rehearsal, the frequency of stuttering _______
decreases
adaptation effect
stuttering decreases over repeated readings HOWEVER, if there is a pause between the readings, the frequency of stuttering increases when the reading resumes
differences of motor ability in AWS and controls in:
fine and gross motor coordination
bimanual coordination
reaction time
speech and motor coordination
fine and gross motor coordination in AWS
AWS have reduced fine and gross motor coordination even in tasks NOT involving speech
AWS are slower and less accurate than controls
finger tapping with either left of right hand (fine motor skills in AWS)
right handed AWS were slower than right handed controls
overall tapping rates were slower in right handed AWS than left handed AWS
when asked to write concurrently with both hands, AWS:
performed more poorly with their non-dominant hand
made more mirror reversals compared to controls
poor bimanual writing
bimanual crank task (AWS)
AWS with persistent stuttering were the fastest
AWS had the most errors
AWS had most excess output
compared to controls, adults and children who stutter are:
less coordinated at motor tasks
show poorer performance (slower, less accurate) in bimanual tasks
in AWS, reaction time in speech tasks may be influenced by ________
secondary and avoidance behaviors
(reaction time tasks) AWS display slower:
manual reaction
vocal reaction
(during speech and non-speech tasks when compared to controls)
(speech motor coordination)
in both speech and non-sequences AWS:
AWS take longer time to accomplish the task compared to controls
AWS movement velocity was higher than controls
AWS moved their mouths to a greater extent
AWS were less coordinated (less lip coordination)
controls have larger _____ prefrontal lobe and larger _____ occipital lobe volume BUT, AWS did not show these asymmetries
right
left
AWS have extra gyri in the ……. close to….
superior bank of the Sylvian fissure
regions involved in speech and language processing
The larger left planum temporale (PT) in controls is assumed to be an indicator of the…. \n PT is part of ….
left hemisphere \n specialization for language
Wernicke’s area
in AWS, the planum temporal was larger on the _____ or equal in size
right
AWS have a larger _______ compared to controls
corpus callosum
AWS had more _____ in the rostrum of the corpus callosum → which connects the….
white matter
prefrontal and motor areas
AWS display atypical brain anatomy in…
gyrification, lobes, grey matter, white matter, and planum temporal
AWS display deficits in the….. but compensatory effects found in the….
left hemisphere
right hemisphere
AWS display less activity in the ______ hemisphere compared to controls during language processing
left hemisphere
During moments of stuttering, the right hemisphere motor cortex controlling the lips, and the \n supplementary motor area were ________ in AWS.
\n The motor regions were _______ during choral reading.
overactivated
not overactivated (fluent speech when choral reading)
Before treatment: _____ > _____
\n Immediately after treatment:_____>____ \n
One year after treatment: ___ >___
before: right > left
immediately after: Left > Right
One year after treatment: Left > right
Imagined stuttering produced activation…. \n Only small differences were found between the 2 conditions
similar to actual moments of stuttering
In general, most areas of the brain activated during overt stuttering were also activated during…
imagined stuttering
During moments of stuttering, _________
showed bilateral activation while ______ showed more right hemisphere \n activation.
females
males
In both males and females, the ……… was correlated with moments of stuttering. \n ________ is involved in speech planning and production.
anterior insula
During fluent speech (choral reading) ____ AWS showed more \n bilateral activation when compared to _____ AWS who showed \n right hemisphere lateralization.
female
male
The activation of ______ was \n only observed in AWS but not controls. \n ______ is the right hemisphere homologue of Broca’s area.
right frontal operculum (RFO)
In AWS , the ____ was only activated during the _______ task but not during passive reading and it was _____ correlated with \n stuttering.
\n This observation suggests that activation of the ____ \n may be a __________ to produce \n fluent speech.
right frontal operculum (RFO)
reading and semantic decision
negatively
compensatory mechanism
damage to the RFO has \n been linked to……
articulatory disorders
Fluent speech: associated with activation of the \n regions involved in…..
auditory processing
(STG and MTG)
During moments of stuttering: AWS were observed to overactivate regions of the….. (associated with speech production) in the ______ \n hemisphere and deactivate ________
motor cortex
right hemisphere
auditory regions
AWS: ______ motor activity even when speech is not required and during moments of stuttering
increased
AWS: Increased ____ hemisphere compensatory activation (related to the motor system and \n compensation-RFO)
right
Overall, people who stutter show _____ hemisphere dominance for speech-language processing
right
Sex differences: _____ AWS show more _____ activation than _____ AWS during speech and language processing
female, bilateral
male
other conditions that ameliorate stuttering:
masking noise
paced speech
core executive function skills:
attention
inhibitory control
working memory
executive function underpins:
self-control
emotional regulation
goal oriented behavior
speech fluency
individuals with neurodevelpmental disorders have _____ executive function compared to typically developing children
ex:
lower
ADHD, ASD, SLI, and stuttering
Children who stutter (CWS) have _____ EF compared to children who do not stutter (CWNS)
lower
Working memory
Inhibitory control
Attention
Children with ________ and children with ________ were more likely to \n stutter.
weaker EF and comorbid conditions
Children with comorbidity showed _____ EF than children without comorbidity and typically developing children
weaker
Prevalence of stuttering was ______ for children with comorbid conditions relative to children without comorbidity
higher (4.19%)
without comorbidity (1.02%)
CWS who recover show stronger ________ skills compared to those with persistent stuttering
working memory
types of acquired stuttering:
neurogenic
psychogenic
In _____ AS, stuttering onset is observed in adults following neurological disease, brain injury, stroke, etc
neurogenic
______ AS typically occurs after a period of prolonged stress or after a traumatic event. \n
________ stuttering can occur alone or together with other signs or psychological or neurological involvement
Psychogenic
_________ AS = acquired stuttering that starts in late adolescence or adulthood but the cause is unclear
idiopathic stuttering
t/f: Acquired stuttering may not develop immediately after the \n traumatic event but later on
true
most common etiology/causes of neurogenic AS:
stroke
head trauma
tumor
neurological disease (parkinson’s)
drugs
Acquired stuttering may be more common in individuals with both _______ and ____________
brain trauma & post-traumatic stress disorder (PTSD)
t/f: onset of acquired stuttering can be sudden or gradual
true
t/f: Disfluencies observed in DS are also observed in AS
true
t/f: Adaptation and pacing effects rarely occur in AS.
true
in acquired stuttering, secondary behaviors….
are present but not as common
for acquired stuttering, repeated readings of the same material showed….
no adaptation effect
for acquired stuttering, choral reading did/did not increase fluency?
did NOT increase fluency
for acquired stuttering, reading under delayed auditory feedback did/did not increase fluency?
did NOT increase fluency
in acquired stuttering, physical concomitants are…
rare and less likely to be observed in AS compared to DS
Treatments used with DS have been used with patients with ______ AS. \n
Strategies include:
psychogenic
Easy onset, light contact and easy repetitions
additional treatments for AS:
neurosurgery
drugs
differences between DS and AS:
AS speakers typically do not have the long-history of negative emotions associated with speech
Repetitions, prolongations and blocks (SLDs) do NOT occur only on initial syllables of words and utterances in AS
Secondary symptoms such as facial grimacing, eye blinking, or fist clenching may be present but they are not as common in AS
adaptation effect not commonly observed in AS
Stuttering occurs relatively consistently across various types of speech task in AS (e.g. fluency inducing conditions such as choralreading may not reduce disfluencies in AS)
SAAND:
stuttering associated with acquired neurological disorders: subtype of acquired stuttering; most general term to refer to dysfluency associated with acquired brain damage; can also be used in individuals with pre-existing stuttering
palilalia:
subtype of neurogenic stuttering characterized by the repetition of words or phrases, often with increasing rapidity and decreasing voice volume, and mostly at the end of utterances. The number of repetitions may be impressive
thalamic stuttering:
possibly a distinct subtype of neurogenic stuttering due to thalamic brain damage
drug-induced stuttering:
subtype of acquired stuttering; dysfluency associated with the use of medication
connecting with your clients involves…
Express empathy
Show positive regard
Have a collaborative relationship
Collect and use feedback
assessments for presence of stuttering:
%SLD (3% or higher)
Stuttering Severity Instrument (SSI-4)
Test of Childhood Stuttering (TOCS)
SSI-4
o Ages:
o Duration:
o Task:
o Measures:
Normed and validated
Ages: 2;10 months and older (for children and adults)
Duration: 15 to 20 minutes
Task: story telling, conversation, reading
Measures:
Frequency
Duration
Physical concomitants
Natural of the individual’s speech
TOCS
o Ages:
o Duration:
o Task:
o Measures:
Ages: 4 to 12 years
Duration: 20-30 mins
Task: picture naming, conversation, story telling
Measures:
frequency
duration
physical concomitants
nature of the individual’s speech
assessments for looking at the impact of stuttering:
Overall Assessment of the Speaker’s \n Experience of Stuttering (OASES)
Communication Attitude Test for Preschool \n and Kindergarten Children Who Stutter
KittyCAT (preschool)
CAT (kindergarten)
Spence Children’s Anxiety Scale
OASES \n Three different forms: \n Assesses:
school-age (7-12 years)
teens (13-17 years)
adults (> 18)
Information about self-perception of stuttering
Reactions to stuttering
Impact of stuttering on daily communication
Impact of stuttering on quality of life
CAT and KiddyCAT \n assesses/involves:
Questions related to perceptions of speaking
Impact of stuttering on attitudes toward speech
Spence Anxiety Scale
involves/assesses:
Self-report for children and parent report
44 items related to anxiety, social phobia, panic/agoraphobia, obsessive compulsive issues, fears of physical injury
Children are asked to rate on a 4 point scale involving never (0), sometimes (1), often (2), and always (3), the frequency with which they experience each symptom
Note
Flashcard