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Chapter 1

Introduction to Stuttering

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The Words We Use
• “People who stutter” preferable to:
– Stutterer
– PWS
• Disfluency
– “Disfluency” = either normal or abnormal
– “Disfluency” is preferable to “dysfluency”

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins


Do All Cultures Have Stuttering?

• Yes. Stuttering is ancient and universal.

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What Causes People to Stutter?

• The causes of stuttering are not completely understood,


but scientists believe these are important factors:
– Genetic and congenital influences
– Developmental influences
– Environmental influences
• Repeated negative emotional experiences with stuttering
lead to negative feelings and attitudes

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins


Factors Contributing to Stuttering

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Definitions

• Fluency versus disfluent speech

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Definitions (cont’d)

• Starkweather (1980, 1987) suggests that rate and effort


are critical to fluency
• Thus, a fluent speaker effortlessly produces speech at a
rate comfortable to listeners

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins


Stuttering: General Description

• Stuttering = abnormally high frequency and/or duration


of stoppages in the flow of speech
• Stuttering also includes speakers’ reactions to stoppages
• These reactions include behavioral, emotional, and
cognitive responses to repeated experiences of getting
stuck while talking
• Need to distinguish between stuttering and typical
disfluencies, as well as from neurogenic and psychogenic
stuttering

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Core Behaviors
• Repetitions: May be single-syllable word or part-word
repetitions
– Word or syllable may be repeated more than two times,
li-li-li-like this
• Prolongations: Sound or airflow continues but
movement of articulators is stopped
– Prolongations as short as one-half second may be
perceived as abnormal

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Core Behaviors (cont’d)
• Blocks: inappropriate stoppage of airflow or voicing;
movement of articulators may be stopped
– Blocks may occur at any level – respiratory, laryngeal,
and/or articulatory
– Blocks may be accompanied by tremors of lips, tongue,
jaw, and/or laryngeal muscles
– On average, stutterers stutter on about 10 percent of the
words while reading
– On average, stutters last about one second

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Secondary Behaviors

• Secondary behaviors are learned behaviors that are


triggered by the experience of stuttering or the
anticipation of it
• Escape behaviors occur when the speaker is stuttering
and attempts to terminate the stutter and finish the word
(ex. Eye blinks and head nods)
• Avoidance behaviors occur when the speaker
anticipates a stutter and tries to avoid it by, for example,
changing the word or saying “uh”

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins


Feelings and Attitudes

• The experience of stuttering often creates feelings of


embarrassment and frustration in a speaker
• Feelings become more severe at the speaker has more
stuttering experiences
• Fear and shame may develop eventually and may
contribute to the frequency and severity of stuttering
• Attitudes are feelings that have become more permanent
and affect the person’s beliefs
• Beliefs may be about oneself or listeners

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins


Disability and Handicap
• The disability of stuttering is the limitation it puts on
individuals’ ability to communicate
• This limitation is affected by the severity of stuttering as
well as stutterers’ feelings and attitudes about
themselves and how listeners have reacted to them
• The handicap is the limitation it puts on individuals’ lives
• This refers to the lack of fulfillment they have in social
life, school, job, and community

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Basic Facts and Their Implications
• Onset
– May start as gradual increase in normal childhood
disfluencies or may start as sudden appearance of severe
blocks
– Often sporadic at outset, coming and going for periods of
days or weeks before becoming persistent
– Onset may occur between 18 months and 12 years but
most often between 2 and 3.5 years (average 2.8 years)
• Prevalence
– A measure of how many people stutter at any given time
– Prevalence is 2.4 percent in kindergarten, about 1 percent
in school-age children and slightly less than 1 percent in
adults

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Basic Facts and Their Implications
(cont’d)

• Incidence
– A measure of how many people have stuttered at some
point in their lives
– About 5 percent
• Recovery without treatment
– Somewhere between 70 and 80 percent of children who
begin to stutter recover without treatment

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Basic Facts and Their Implications
(cont’d)
• Children with these attributes have less likelihood of
spontaneous recovery (Yairi & Ambrose, 2005):
– Having relatives who were persistent stutterers
– Being male
– Onset after 3.5 years
– Stuttering not decreasing during first year after onset
– Stuttering persisting beyond one year after onset
– Multiple unit repetitions (li-li-li-li-like this)
– Continued presence of prolongations and blocks
– Below normal phonological skills

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Basic Facts and Their Implications
(cont’d)

• There is also evidence that recovery is associated with:


– Being right-handed
– Growing up in a home with a mother who is non-directive
and uses less complex language when speaking to child
– Having a slower speech rate and more mature speech
motor system

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Sex Ratio

• The sex ratio is almost even (1:1) at the onset of


stuttering
• However, girls start to stutter earlier than boys and
recover more frequently so that by the time they are of
school age, the ratio becomes three boys to every girl
who stutters and continues at a 3:1 ratio
• Girls begin to stutter earlier than boys and recover earlier
and more frequently

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins


Variability and Predictability of Stuttering
• In the 1930s, interest in stuttering turned from its
medical or organic aspects to social, psychological, and
linguistic aspects
• Anticipation: Stutterers can predict which words they
will stutter on in a reading passage
• Consistency: Stutterers tend to stutter on the same
words each time they read a passage
• Adaptation: Stutterers stutter less each time they read
a passage up to about six readings

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Language Factors
• Brown showed that adults who stutter do so more
frequently on:
– Consonants
– Sounds in word-initial position
– Sounds in contextual speech
– Nouns, verbs, adjectives, and adverbs
– Longer words
– Words at beginnings of sentences
– Stressed syllables

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Language Factors (cont’d)

• Loci and frequency of stuttering are different in preschool


children
• Stuttering in preschool children occurs most frequently
on pronouns and conjunctions (these occur frequently at
the beginning of utterances in young children)
• Stuttering most frequent as repetitions of parts of words
and single-syllable words in sentence-initial position
• In summary, because stuttering in preschoolers tends to
occur at beginning of syntactic units, the trigger seems
to be linguistic planning and preparation

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Fluency-Inducing Conditions
• Many conditions have been found which reduce or
eliminate stuttering. These include speaking:
– When alone, when relaxed
– In unison with another speaker
– To an animal or infant
– In time or a rhythmic stimulus or when singing, in a different
dialect
– While simultaneously writing, while swearing
– In a slow, prolonged manner
– Under loud masking noise, while listening to delayed auditory
feedback
– When shadowing another speaker, when reinforced for fluent
speech
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Fluency-Inducing Conditions (cont’d)

• Fluency-inducing conditions have been explained as


resulting from reduced demands on speech-motor control
and language formation (Andrews et al., 1982)

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The Facts about Stuttering Imply the
Following
• Stuttering is an inherited or congenital disorder
• It first appears when children are learning the complex
coordinations of spoken language
• It emerges in those children whose speech production
system is vulnerable to disruption by competing demands
of language, cognition, and emotion
• After it emerges, it becomes persistent in some children
– perhaps those whose stuttering arouses substantial
negative emotion which leads to a variety of learned
behaviors

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A Model of Stuttering

• Disorder of neuromotor control of speech


• Influenced by language production
• Perpetuated by temperament and complex learning, and
the response of their environment to their speech

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