Speech Disorders

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Stuttering

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a disorder in the fluency of speech

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Stuttering is diagnosed when:

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• The dysfluency rate of all types of dysfluencies of spoken words exceeds 5%
• The frequency of part-word repetitions, speech sound prolongations, and broken words occurs more than in 2% of speech
• The duration of dysfluencies is more than 1 second
• The presence of associated motor behaviors, such as excessive tensing of the facial muscles, mouth tremors, grimacing, rapid blinking, hand wringing, foot stomping, or foot tapping
• Associated breathing abnormalities, such as poor breath control during speaking and abnormal breath holding
• The presence of negative emotions and avoidance behaviors: Many persons who stutter will develop a behavior to disguise or avoid stuttering. They may completely avoid certain situations, such as public speaking. They may substitute words or avoid situations in which certain words have to be used. The prospect of stuttering may produce anxiety, hostility, depression, or passive behaviors.

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Broken Words:

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placing unusually long pauses between words (I want to play with mom– {pause} –my.)

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Incomplete Sentences:

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production of incomplete phrases (I want to play. . . I want to . . My mommy will play with me.)

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Interjections:

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placement of sounds, words, or phrases extraneously into speech (I want, um, to play with mommy.)

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Pauses:

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placing unusually long gaps of silence or nonverbal gaps within sentences or phrases (I want {pause} to play with mommy.)

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Repetitions:

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saying a word, part of a word, or a phrase more than once (I wa-wa-wa want to play with mommy.)

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Revisions:

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changing a wording of a sentence, which does not alter the sentences meaning (I want to play: I will throw ball with mommy.)

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Sound Prolongation:

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pronouncing a sound for an unusually long duration (I want to play with mmmmmommy.)

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Silent Prolongation:

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holding the articulation position of a sound without vocal production

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Stuttering is more likely to occur...

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1. with consonants, the first sound or syllables of words, or the first word of a sentence or clause
2. with long, complex sentences
3. with words that are used less frequently

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Stuttering Adaption:

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The frequency of stuttering can be reduced by repeated oral readings of printed material. This effect, called adaptation, is not sustained. If given the same material in another setting, stuttering will again occur.

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Stuttering Consistency:

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Most persons will stutter on the same word or position of a sound when repeating oral readings. This effect is called consistency and tends to be a sustained phenomenon. This effect will be repeated among different trials.

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Stuttering Adjacency

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Words pronounced correctly can be made to stutter. By blocking out the stuttered word of an oral reading, the adjacent word is then stuttered. This phenomenon is called adjacency.

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Genetic theory

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Given that stuttering has a high familial prevalence, some researchers believe that it is genetically driven. However, given the rates of occurrences, a single-gene theory cannot yet be supported with clinical evidence.

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Neurological theories

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Some researchers believe that stuttering is due to a dysfunction of laryngeal muscle activity, an abnormality of the speech centers of the brain, a brain auditory processing disorder, or a dysfunction in the auditory feedback mechanism of the brain.

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Learning and conditioning theory

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Studies suggest that stuttering may be a product of certain environmental factors, such as: avoidance behavior, overwhelming speech expectations, or learned behaviors.
Psychosocial

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Psychosocial theory

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In this theory, stuttering is thought to be a psychological disorder or neurosis, like anxiety and depression, whereby the child is undergoing a subconscious psychological conflict.

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The assessment of stuttering should include...

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- interviews with clients, caregivers, an teachers to develop a case history (pay attention to caregiver/teacher speech interactions)
- determine frequency, types and variability of dysfluencies
- ID any associated motor behaviors, negative emotions, or avoidance behaviors