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6. CD1-Stuttering


What is stuttering? An interruption to the forward progress of the speech signal - a fluency disruption. It is not a language problem. Folks with dysfluencies often develop large, compensatory vocabularies (substitution options).
Signs of Stuttering (4) Repetitions (whole word, part word, whole phrase, part phrase), Prolongations, Tense Pauses/Blocks, Interjections
Demographics Early childhood (~2.5 to 4 years of age). More boys than girls (3.5:1). Paternally linked. All ethnic, racial, and SES distinctions.
Etilogy IDIOPATHIC. Genetics? Psycho-Social Factors? Hormonal Variables?. Neuro-motor Difficulties? (cluttering-childhood phon proc correlation) Demands/Capacity Model?
Diagnosis (6) 1.Informal interview/formal speech sample 2.Case history 3.Identify severity and impact 4.Test for other underlying disabilities 5.Formal testing 6.Informal assessments
Informal asssessment Note primary/secondary behaviors & pragmatic symptoms. Obtain sample representative of everyday speech - different contexts, with different people, in different environments.
Case history Family history (attitudes?). Time since onset. Gender. Other speech/language problems. Motivation Present characteristics. Development course. Degree of awareness. Environmental influences. Parent/child or family relationship. Skills/interests.
Severity & impact Some are going to plow through. Others will be defeated the event.
Formal testing Artic test (required by some schools) may come back normal. SLP must describe pragmatic difficulties, latency issues, social-emotional impact on academic achievement (won’t even raise hand, can’t make friends, teasing/bullying).
Tests Poor reliability - cyclical disorder: 1.Stuttering Prediction Instrument (SPI) (3-5 years of age) 2.Stuttering Severity Instrument (SSI-4) (adults and children) 3.Overall Assessment of the Speaker’s Experience of Stuttering (OASES) (adults)
Materials Recorder (w/permission). Reading material (confrontational task). Standardized test (insurance likes #s). Parental/self-rating form (pre-/post-measure). Language test (distinguish dysfluency/apraxia)
Management 1.Fluency-Shaping (Vocal Control) 2.Stuttering Modification 3.Contingency management
Fluency-Shaping Slowed rate of speech movement, easy onset, light contacts, etc. "Vocal Control" - better vocal tone, breath support, appropriate loudness.
Stuttering Modification Reduce anxiety. Desensitization. Voluntary stuttering. Cancellations, pull-outs, acknowledgments, etc.
Contingency management Non-aversive punishment for stuttering behaviors, successive approximation (shaping) toward fluent speech, use fluency-enhancement (mix of 2 main management techniques and seen in many intensive stuttering programs)
Parents/communication partners Train slower speech rates. Lessen demand for rate matching (take breaths, exaggerate pauses). Don’t interrupt and don’t finish sentences. Don’t presume. Be mindful: don’t ask questions that require long, elaborate responses.
Transfer and maintenance It’s not successful therapy if you can’t get similar results out in the parking lot or at a restaurant.
Created by: ashea01