Temperament
*Defined temperament as the child's inborn style of behavior
*Listed Inhibited (ex. shy, reserved, timid), uninhibited (ex. social, spontaneous, fearless) temperaments
* Self-regulation is the ability to refrain from desired behaviors while retaining attention.
* Decreased emotion regulation associated with increased stuttering frequency.
*CWS who are able to shift their attention from frustrating stimuli decreased stuttering speaking tasks immediately after stimuli presentation (and the opposite is true too).
What were Jerome Kagan's contributions as a psychologist to the field of stuttering?
Example: "Truck"
-Semantic Process-conceptual features (e.g., transport vehicle with pick-up capability) are retrieved in this stage.
-Phonological Process-sound structure (e.g., /t/, /r/, /uh/, k/) is retrieved in this stage.
-Lexical Process-a word is selected out of other competing words with similar semantics (ex. car v. truck)
-Speech-Motor Programming- the phonological code of the selected word is transformed into motor programs, which then leads to articulation.
What are the speech, language, and cognitive processes?
-Linguistics can influence a person's fluency
-However, it's unclear whether speech and/or language difficulties are directly implicated in the onset and development of stuttering.
-Cognitive process such as executive functiona and attention may play a role (yet uknown) by placing more cognitive and linguistic demands on the speaker
How do linguistic demands influence a person's ability to be fluent?
When using syllable-based analysis, only one disfluency is counted per cell.
Ex. A syllable with a repetition of the initial consonant and then a prolonged vowel within the same syllable (ex. dog ---> [d-d-d-ooooo] g), the clinician could enter one code for sound/syllable repetition and one code for sound prolongation into the cell that corresponds for "dog."
What is a Disfluency Cluster? Provide an example and how to code in the Dyfluency Frequency Type form. (Part 1)
Language impairment is observed more frequently in children who stutter than in the general population, as well as phonology and/or language deficits.
Articulation Disorders
Phonological Disorders
Fluency Disorders
Pragmatic Disorders
What are common speech-language disorders associated with stuttering?
Palin Parent-Child Interaction Therapy
Lidcome Program
Restart-DCM Treatment
However, because 80% of stuttering resolves without intervention, and with little evidence of the effectiveness of treatment, there is a strong argument for waiting until such unassisted recovery was unlikely.
What are the two basic approaches and their techniques to treating stuttering in preschoolers?
Speech attitudes (negative/positive) related to stuttering
Quality of life associated with acquired stuttering
Use of the OASES questionnaire is helpful
What are the imporant psychological and emotional reactions individuals with acquired stuttering should also be assessed for?
-Overall Assessment of the Speaker's Experience of Stuttering (OASES)
-Short Behavioral Inhibition Scale (SBIS)
-Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT)
-Childhood Behavioral Questionnaire (CBQ)
***Stuttering Severity Instrument-4 (Excluded)
What are some standardized assessment tools used for learning about a child's functional and emotional "impact" of stuttering or useful for temperament measurements?
-COVERT REPAIR Hypothesis- a temporal impairment in phonological encoding, causing covert errors that the speaker attempts to repair
-VICIOUS CIRCLE Hypothesis -the speaker perceives excessive internal errors in language processing, a resulting need for their repair, cycling back to more perceived errors in the repair processing
-NEUROPSYCHOLINGUISTIC- a lack of synchrony between phonetic and prosodic language components; time pressure is also a factor
EXPLAN THEORY- a timing mismatch between language PLANning and motor EXecution process
What are some of the theories surrounding stuttering?
Function words because they tend to occur in the first three words of the utterance or because they are fundamentally different types of words than so-called content words.
Ex. determiners, conjunctions, prepositions, pronouns)
What words are more commonly stuttered among preschoolers?
A clinician could simple code the syllable as containing "complex" disfluency (in this case, a Dyfluency Cluster that includes both repeated and prolonged speech).
And the clinician can use a unique code to show that a cluster of stutter like disfluencies has occurred.
What is a disfluency cluster? (part 2)
Assess the client in both languages.
Language Choice.
Cultural Considerations
Goal-setting
Therapy technniques
Collaboration
How do we clinically manage a bilingual client who stutters?
Includes 3 sets of strategies: interaction, family, and child-strategies
- Parent Interaction Strategies (Child play, language fascilitating strategies)
-Family Strategies (Coaching strenghts, maintance strategies, counseling)
-Child Strategies (talking about stuttering in a positive way, managing thoughts and emotions, and teaching strategies)
What is the Palin Parent-Child Interaction Approach?
2) The patient's reaction towards stuttering
3) Communication in daily situations
4) Quality of Life
-Rated from a scale of 1 to 5)
What are the 4 Parts of the OASES?
-Increased reactivity (both positive and negative) is associated with increased stuttering frequency and/or stuttered utterances.
-Decreased regulation is associated with increased stuttering frequency and/or severity
-Studies indicate a decrease in stuttering when a CWS (a child who stutters) has the following regulation components-attention control and shifting effortful control, and emotion regulation.
What are your thoughts on the evidence for increased reactivity and decreased regulation associated with developmental stuttering?
Inhibition
What is the correct term for a child's ability to disregard irrelevant information or to suppress certain responses?
Content words:
Ex. nouns, verbs, adjectives, or adverbs
Ex. Longer words (five or more letters)
Ex. Sentence-initial words (first three words)
Ex. Words beginning with a consonant
What are the common words adults who stutter tend to stutter on most?
Rapid Speech Rate
Disorganized Language
Lack of Awareness
Difficulty with timing and pacing
What are the salient features of Cluttering?
Developing bilingual children are more likely to be misidentified as exhibiting a language deficit and more likely mislabeled as being a child who stutters.
Such false-positive identifications are likely caused by:
1) use of monolingual guidelines for stuttering assessment
2) a misperception of bilingualism as a risk factor for onset and persistence of stuttering
3) inconsistency in the description of bilingualism
4) an assumption that stuttering and typical speech dysfluency areas related to language dominance
What are some takeaways from the bilingual stuttering presentation?
Uses Parent-Administered Feedback
-types of feedback: acknowledgement, praise, and request for self-evaluation
What is the Lidcome Program?
Originally proposed by Joseph Sheehan stating that:
The top of the iceberg includes the technical challenges such as the observable behaviors (types, duration of disfluencies, secondary behaviors)
The bottom of the iceberg includes the adaptive challenges such as less visible and/or unconscious dynamics (avoidance, fears, anticipation of stuttering, beliefs about stuttering, self-image, readiness for change, social support structures, self-efficacy)
What is the "Iceberg of stuttering"?
An aspect of temperament that shows the capacity an individual has to refrain from a desired or dominant behavior while also maintaining attention on a task; resisting distraction; showing effortful control.
What is Self-Regulation?
Working Memory
What is the correct term for a child's ability to temporarily store and manipulate information?
MOPTOP
-Male
-Older (than 3.5 year onset)
-Poorer (phonological skills)
-Tenser (Stutter types)
-One-year (post-onset child is still stuttering)
Positive Family History (for recovered, persistent stuttering in the immediate, extended biological family members of the child)
What are the risk factors for stuttering in pre-school age children?
Let the stutter happen, don't prevent it.
What is the new school of thought about Stuttering?
1) (Stuttering-like dysfluency) Monosyllabic word repetition, sound repetition, and syllable repetition
2) (Non-stuttering-like dysfluency) Revision, unfinished word, phrase repetition, interjection, polysyllabic word repetition
3) Record only disfluencies that indicate tense, arrhythmic manner in the SSI-4, if not bilingual could be erroneously identified as moderate-severe stutterers.
What is categorized as stuttering-like dysfluencies?
Assessment
First Parente Conference
Therapy Phase 1 (lowering demands)
Therapy Phase 2 (if needed, increasing capacities)
Therapy Phase 3 (if needed, enhancing fluency more directly)
Tapering off treatment
Optimal fluency (Effortful communication)
What is the Restart-Demands and Capacities Model Based Treatment?
A clinician who stutters would be in a more facilitative role as a model and example that can provide buy-in and build better rapport and treatment outcomes for a CWS or PWS.
What effect does it have on a CWS or PWS if the treating SLP also stutters?
the child's inborn style of behavior
What is temperament?
Executive Function & Attention Skills
Because they need to inhibit prior behaviors of speech with pausing, phrasing, slow rate of speech, and cancellations, as well as vigilance and greater self-monitoring of skills outside therapy sessions; and finally cognitive flexibility for these children to be able to talk about their stuttering and communication skills.
What did Anderson et al. (2021) argue that older children who stutter need to draw up?
SSI-4 (Stuttering Severity Instrument-4th Edition)-over the age of 2:10
KiddyCAT (Communication Attitude Test for Preschool and Kindergarten Children Who Stutter)-under the age of 6
Test of Childhood Stuttering (TOCS)
What are at least two standardized (norm-referenced) tests we can use to assess preschoolers who stutter, older than 4 years of age?
What's the old school thought about stuttering?
A disfluency disorder wherein segments of conversation (1) speker's native language (2) typically are perceived as too fast overall (3) too irregular (4) or both, and must be accompanied by more of the following: (a) excessive "normal" disfluencies 5; (b) excessive collapsing (6) or deletion of syllables; and/or abnormal pauses, syllable stress, or speech rythm, and (7) telescoping (shorten multisyllabic words).
What is Cluttering?
Speech Modification
Stuttering Modification
What are the two basic approaches to treating stuttering in school-age children (and beyond that age)?
A temporal impairment in phonological encoding, causing covert errors that the speaker attempts to repair
What is the Covert Repair Hypothesis?
Semantic
Syntactic
Phonological
Lexical
Speech-Motor Programming
What are the linguistic demands that influence a person's ability to be fluent?
When stuttering develops later in life (beyond early childhood)
What is acquired stuttering?
Speech Mod:
1) Reduction in frequency and severity of observable stuttering behavior
2) All (or nearly all) speech is modified to prevent moments of stuttering from occurring
3) Easy onset, pausing and phrasing, light articulatory contacts
What are the techniques belonging to Speech Modification?
The speaker perceives excessive internal errors in language processing, a resulting need for their repair, cycling back to more perceived errors in the repair process.
What is the Vicious Cycle Hypothesis?
A timing mismatch between language PLANning and motor EXecution process
What is the EXPLAN Theory?
Neurogenic stuttering: associated with a known or suspected neurological condition with known or suspected neurological condition
Functional stuttering: associated with traumatic emotional or psychological events, in the absence of an underlying neurologic disorder (requiring a comprehensive assessment for differential diagnosis)
What are types of acquired stuttering?
Stuttering Mod:
1) Reduction in physical tension and struggle during moments of stuttering
2) Only moments of stuttering are modified; nonstuttered speech is not modified
3) Cancellation, pullout, voluntary stuttering
What are the techniques belonging to Stuttering Modification?