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94 Cards in this Set

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Overt concomitants
behaviors that can be seen or heard
Covert concomitants
behaviors that you cannot just observe; need equipment
*physiological: internal body phenonmenon
Introspective concomitants
info obtained from talking to people; inner feelings/experiences
* not necessary or sufficient
*sort of automatic or unconscious
* effect wears off
Types of Overt:
1. associated movements
2. interjected speech fragments
3. vocal abnormalities
4. skin reactions
Types of associated movements:
(any part of body)
1. voluntary- voluntary muscles:
- tension in neck/face
- movements of extremities
2. involuntary
-smooth muscle (ANS)
-
Types of interjected speech fragments:
1. audible phenomenon: interjected sounds, syllables, words phrases, revisions, circumlocutions
2. occur in immediate conjunction with stuttering
3. attempt to cover or get out of stutter
Types of vocal abnormalities:
1. absense of normal pitch variation
2. monotony
3. pitch level
Van Riper's classification of associated behaviors:
1. Escape- to terminate block
2. Avoidance symptoms-feared words avaded
3. postponements- delay an utterance of feared word
4. starters- to start feared word
5. anti-expectancy- prevent the antincipation
Behavior Checklist:
Brutten
self-report
1. child- 50 ?s
2. adult- 95 ?s
Types of physiological covert concomitants:
1. eye movements: fixations, foward/backward movement, vertical twitches
2. cardiovascular: heart accelerate, blood distribution (flush), low blood flow in Broca's
3. tremor: rapid hand tremor
4. Brain- see next slide
5. biochemical: lower blood sugar/protein, increase in adrenaline, noraderenaline, dopamine
6. electrodermal: anxiety, Galvanic skin response, palmar sweat index (not effective)
Brain research:
- EEG difficult to interpret
-cerebral dominance theory
-recent studies w/ PET, CAT, MRI, fMRI, SPECT, MIG
Cerebral Dominace Theory
-Orton & Travis (30s)
-intenseified activity during stutter
- artic organs are midline organs. LAck of cerebral dominance (needed for timing of nerve impulses) results in lack of coordination between both sides of the organs and a breakdown of speech
Disouters: Fox, Boberg, De Nil
Fox (66)
disruption of inter-hemisphere syncronization
Boberg (83)
failed to see inter-hemisphere conflict in stutters
De Nil
-showed increase R hemisphere & bilateral activation
- increase in R hem. function = inherant characterisitc or result of new motor learning?
Covert concomitants are not present when:
speaker is silent or speaking fluently
*present in stressed normal speakers
Types of introspective concomitants:
-obtained through self-report
1. Frustration: involuntary report lips come together hard, tongue sticks to mouth roof, feel physically halted, loss of control
2. muscular tension feelings: speech musculature (resp., phona., atric.)
3. emotional: anticipation, apprehension, hypertonic, avoidance
anxiety
fear of something that has not yet occured
anticipation
expectancy; most unpleasant stutter aspect (sutterers can predict w/ great accuracy)
during stuttering emotions:
1. confusion
2. loss of contact, no control
after stutter emotions:
1. relief
2. frustration
3. tension relief
4. anxiety of upcoming
5. shame, guilt, embarassment
ABC of stutter
Affective
Behavioral
Cognitive
Attitude:
speech related belief system
-negative:
- shameful
- listener is critical
-unable to speak normal
-always a stutterer
-think nonstutter is always fluent
Adaption:
coping behaviors, adjustments
-secondary to stuttering that relate to words & situations
-restict verbal output and socialization
college students:
- influences personality, social, home, school, look ahead for danger
-avoid professors
-do not take part in class
-take overqual. jobs
-expect little success
dyad conversation:
-little relection on what other person said (back channel)
-few turn-taking
-gives other more floor time
Children reactions:
-give wrong answer
-speak less words
-correct 1/2 of oral reading
-pretned not to know
State test:
tests stutter reaction
- how people react in certain situations
-behavior display
Trait test:
looks at reactions across situations
-deals w/ belief system
-What do you think about your speech?
Iowa Scale of Attitude Toward Stuttering
Ammons & Johnson
-sutterer judges statments from moderate to strong
Shumac attitude testers
- reaction to 40 situations
- 5 point scale, little regarding norms
Lanyon stuttering severity scale:
T/F items
measures avoidance, effort, breathing, attitude
-confounding scale
Woolf perception of stuttering inventory:
looks at struggle, avoidance, expectancy
-confounding scale
Erikson communication attitude scale (s-scale)
T/F
-significant differences
Revision: narrow items, best for adults
BigCAT:
brutten & V
-still requires research
Silverman child attitude test
-3 wishes
- not useful if no speech was mentioned
CAT:
brutten & V
-35 T/F for attitude
-self-report
13+ languages
-norms are in agreement
-standardized
-significant differences by 6 years and differnce diverge w/ age
KiddyCAT
brutten & V
-12 yes/no for attitude
-for 3 to 6 yrs
-6 yes + 6 no = poor attitude
-significant diff at 3 to 4 years
Speech situation checklist (SSC)
brutten & V
-state test
looks at emotiona reaction (affective)& speech disruption
-self-report
child & adult
-significant difference
-get a clinical profile
Anxiety measures:
1. subjective: self-report
2 Objective:
-Galvanic skin response
-palmar sweat index
To measure stutter:
1. reading
2. during speech
*do both
To measure coping:
1. BCL
2. observation
3. self-report
To measure emotional reaction:
1. speech situation checklist
To measure attitude:
1. Erickson S-24
2. CAT
3. Kiddy CAT
To measure speech disruption:
1. speech situation checklist
Theories relate to:
etiology
form
Involuntary Breakdown Hypothesis:
-organic limitation
-disorganization, disruption, disintegration
-momentray failure of coordination
-negative emotion, environ stress, anxiety
*above 2 variables interact but are interdependant
-stress triggers breakdown
-Orthogonal relationship
nature-nature
Orthogonal relationship:
more/less predisposed to breakdown=more/less stress
Reps of Involuntary breakdown:
West
Travis
Eisenson
Van Riper
Adams/Starkweather
Brutten/shoemaker
Demands & Capacities model:
-interactional view
-stuttering results from fluency demands exceed child's capacity
-cognitive, emotional,motor, linguistic level
-adams & starkweather
Two Factor Theory:
-repetitions & prolongations result from negative emotional from classical conditioning
-words & situations trigger neg emotion
-involuntary disruption of fluency(factor 1)result from neg. emotions learned through classical
-escape behaviors (factor 2)learned through operant conditioning
-both factores need therapy
-brutten & shoemaker
Voluntary response hypothesis:
-stutters interfere w/ the way they talk
-belief system that speech is hard
-they expect to stutter
-stutteirng is what they do to not have speech difficutly
-voluntary avoidance response
Reps of voluntary:
Johnson
Bloodstein
Sheehan
Van Riper
Shames
Avoidance reaction:
-stuttering result of inappropraite environment reactions to normal speech
-stuttering is not a constitutional abnormality
-Johnson
Diagnosogenic theory:
-stutter caused by negative response of loved ones to normal disfluencies
-perfectionist parents
Preparatory Set:
-when attempt hard word sutterer tenses and focuses on 1st spund production
-psychological
-tension of organs
-unatural posture of artic
-fixation makes normal speech impossible
-van riper
Shames and Sherrick:
Skinner point of view
-suttering is operant behavior
-punishment keeps stuttering going
Laryngeal dysfunction
-larynx related to stutter
-laryngeal muscles too tense
-simultaneous/arrhythmic/irregular vibration
Genetic data:
-runs in family
-males more prone
-polygenic
-possible dominant gene
Involuntary therapy approaches:
1. modification
2. negative emotion reduction
3. artic tension/posture reduction
4. reduction of abnormal movements
Voluntary therapy approaches:
1. reinforce fluent speech
2. non-reinforce stutter
3. punish stutter
Other approaches:
1. supported respiration
2. easy initiation
3. soft contact
4. slow speech
5. continuous phonation
Two Factor approach:
1. stuttering modification and fluency enhancing for factor 1
2. reward/punish for factor 2
3. mod of negative attitude
Stuttering involves:
1. interruption of forward flow of speech
2. fluency is impaired
3. may also involve-rate, loudness, inflection, facials, posture
What defines a stutterer:
sound and syllable repetitions
sound prolongations (silent & oral)
Good operational defanition of stuttering:
1. frequency
2. mean duration
3. frequency of fluency types
4. rate
5. severity
Primary stuttering:
1. simple repetitions
2. no effort/tension/struggle
3. no emotion reaction
4. episodic
Transitional phase:
1. faster repititions
2. force/struggle
3. surprise reactions
4. escape
5. frustration
Secondary stuttering:
1. chronic
2. awareness
3. physical effort
4. avoidance
5. anticipation
6. fear of words/situations
7. embarassment
Bloodstein development of stutter:
4 phases mild to severe
-problem: people may skip around phases, no universal, medical model
Van Riper development of stutter:
4 tracts that classify stutterers based on onset, cause, emotions, behaviors, etc.
Track 1:
-young onset
-cyclic becomes chronic
-concern
-associated movements
-embarasment
Track 2:
-late to talk
-fast speech rate
-rapid/irregular reps.
-slur
-no awareness
-no cover
-no fear/tension
Track 3:
-sudden inability to speak
-any age
-after psychological trauma
-tension/frustration
-high emotion
-fear
-avoidance
Track 4:
-late/sudden onset
-after neurological trauma
-aware w/ no fear/frustration
-willing to talk
-erratic
-function & content words
Glottagraphy:
measuring amount of light passing through VF
-shows breaks in vibration
-fluttering
-slow initiation
-tremor
Electromyography:
recording of electrical potentials from muscles to observe laryngeal function
-shows increase in action potential
-excessive muscle activity
-simultaneous contraction of add/abductor muscles
Fiberoptics:
direct visual observation of the glottis
-show inapp. ab/adduction
-larynx shuddering
Electro-myographic studies
articulation
-defective synchronization
-masseter muscle tension build-up
Aerodynamics:
articualtion
-measures intraoral pressure from oral cavity
-shows peaks and elevations or air pressure during stutter
Spectrographic studies:
-looks at transition of speech sounds during part-word repetitions
-problem is with transition between words (van riper) not seen by others
begins as an effort to avoid disfluency
Johnson
stuttering is a certain form of normal disfluency that becomes more frequent and severe
Bloodstein
normal disfluency has nothing to do with stuttering
Brutten, Conture, Hamre
Essence of Johnson’s diagnosogenic theory
at the moment of initial diagnosis the speech of children called stutterers does not differ in essential respects from that of children regarded as nonstutterers
distinct difference
Group data did not support the diagnosogenic theory- two groups do differ in disfluency type
Johnson’s Iowa studies
Johnson revised his theory
Johnson’s diagnosogenic theory
at the moment of initial diagnosis the speech of children called stutterers does not differ in essential respects from that of children regarded as nonstutterers
Group data did not support the diagnosogenic theory- two groups do differ in disfluency type
Johnson revised his theory
Bloodstein: Continuity hypothesis
stuttering and disfluency are not categorically different things
just more of the same - to which society reacts
Brutten, Hamre, Conture...
sharp demarcation line between stuttering and normal disfluency: within-word versus between-word disfluencies
Variables related to the identification of stuttering
Type of dysfluency
oral and silent sound and syllable repetitions
oral and silent sound prolongations (blocks)
Double (or more) unit repetition versus single unit
Sound prolongation if it exceeds 912 msec
Identification of stuttering increases with increase in frequency and severity of dysfluency
Adams: differentiation guidelines
Type
audible and silent part-word repetitions, prolongations and broken words
Unit repetitions
at least 3 repetitions (b-b-b-ball)
Total frequency (all types)
10% or more disfluencies
Voicing and air flow
frequent difficulty in starting or sustaining voicing or air flow in association with stuttering behaviors
more effortful disfluencies
Intrusion of schwa
buh-buh-buh-baby
Distribution of early stuttering
Consistency is present: 71%
Stuttering at beginning of syntactic units
Stuttering on function words
Word length has no influence
Consonant - vowel effect is absent
Repetition of whole words
Variations in frequency of stuttering
Same amount of stuttering whether alone or speaking to a listener
Nature of conversational partner does not impact stuttering
Frequency of stuttering increases with increasing levels of communicative demand
Stuttered sentences tend to be longer and more complex than fluent sentences
Age and Gender
Onset of stuttering:
between age 2 - 5
decline in frequency from year to year
Sex ratio: different in the preschooler
1.4 male - 1 female