STUTTERING

1.INTRODUCTION 2.DEFINITION 3.INCIDENCE 4.THEORIES OF STUTTERING 5.SYMPTOMATOLOGY 6.DEVELOPMENT OF STUTTERING 7.DIFFERENTIAL DIAGNOSIS

dysfluency results.INTRODUCTION  Fluent speech is smooth. phonatory. resonatory.1986)   . When there is an aberration the timing.  Fluent speech production results when the motor skills to produce a desired verbal message occur sequentially and synchronously in a smooth manner. (Daly. synchronicity. The respiratory. unhesitant and effortless speech. and articulatory systems must function independently to produce fluent speech. or sequencing of these systems . valving. forward-moving.

morphologic and/or syntactic language units are spoken. Louis1991) . rhythm and/or effort with which phonological. lexical. smoothness. (Guitar1998) Fluency disorder is a speech disorder characterized by deviations in continuity. whereas the professional interest in other fluency disorders is relatively new.INTRODUCTION  The definition of fluency is very hard because normal speech is filled with hesitations. (ASHA1999)   The fluency disorder most extensively described in literature is of course stuttering. (St.

a biological problem .perceptual aspect . There are 3 aspects of definition . ASHA1999   Stuttering is easier to be recognized than to be defined precisely. audible sound prolongations or silent fixations or blockages. part word repetitions.a problem of production .SUTTERING DEFINITION  Speech events that contain monosyllable whole word repetitions. These may or may not be accompanied by accessory(secondary) behaviors that used to escape and/or avoid these speech events.

influenced by the interactive processes of language production and intensified by complex learning processes. Johnson(1967)   A problem of production: Involuntary disruption of a continuing attempt to produce a spoken voluntary utterance. Peters and Guitars(1991)   A biological problem: It is a disorder in the neuromotor control of speech.STUTTERING DEFINITION   Perceptual aspect: What the speaker does when he expects to stutter. dreads doing it. Perkins(1990) . and reacts negatively usually by tensing in an effort to avoid doing it.

3 types for of stuttering of adult onset: Relapsed people CNS injuries Emotional trauma (Hysterical stuttering) (Maher and Leith1992)   Sex incidence Male : female 4:1   Familial predisposition First degree relatives of stutters has 3 times risk more than the general population .INCIDENCE     Age incidence Stuttering occurs in the early years of life. 18mon-13years.

THEORIES OF STUTTERING  Theories of stuttering may be delineated under one of the following categories. Physiological hypothesis Psychological or repressed need theory Learned behavior Compound theory     .

] . The speech center is located in the Rt hemisphere which is inadequate for language processing. plasma level of adrenergic neurotransmitters. 1. In stutterers.Each hemisphere of the brain is in struggle to gain dominance of the speech center. sugar level.  Hormonal theory: Male sex hormone testosterone retards neuronal development in the fetal brain. 2.  Biochemical theory: There is a biochemical imbalance in metabolic factors and tissue chemistry. but the stutter is vulnerable to the disruptive effects of such pressures by a biochemical imbalance. primary amino acids as glutamine. Males are more prone to developmental disturbances of the Lt hemisphere functions[speech & lang.THEORIES OF STUTTERING   Physiological hypothesis The cerebral dominance theory: The Lt side is the dominant side for processing speech. The speech interruptions are triggered by social and emotional pressures.

Global reduction in absolute regional cerebral blood flow.THEORIES OF STUTTERING  Perseverative theory: An individual has an organic predisposition to motor and sensory perseveration. Supporting evidence are. This reduction appears in the EEG as decrease in amplitude of B-wave. . which manifests itself in the stuttering act.  Stuttering and central nervous abnormality: It states that stuttering is associated with hyperirritability of the CNS.

Perkins). Flanagan. & Siegel. . and they seek to identify the motivational factors. in which denial of basic psychological needs results in one of many behaviors. and reinforcing conditions. (Sheehan.states that stuttering is the involuntary disruption of speech resulting from negative emotional responses that are classically conditioned. Goldiamond. including stuttering. (b) Conditioned Disintegration Theory.Stuttering is the result of a conflict between opposing drives within the individual to speak or to refrain from speakin g . secondary characteristics (escape and avoidance) are the instrumentally conditioned responses of the individual to unpleasant experiences.THEORIES OF STUTTERING  Psychological Repressed Need Theory Stuttering as neurotic behavior. (Azrin. & Sherrick). (d) Operant Behavior Theory.  Learned behavior These theories of stuttering concentrates on defining the processes by which stuttering is originally learned and maintained.states that speech is a behavior under operant control of positive and negative reinforcements. Shames. as proposed by Freudian models. (Brutten and Shoemaker). stimulus variables. Martin. These are: (a) Approach-Avoidance Theory.

(Peters and Guitar) . developmental and environmental factors may precipitate stuttering. The interaction between constitutional.THEORIES OF STUTTERING  Compound theory Non of the above theories is satisfactory by itself but the integration between all theories can explain stuttering.

SYMPTOMATOLOGY  Stuttering is easily to be diagnosed than to explain its etiology. Overt stuttering Covert stuttering Concomitant problems    .

. last core behavior to develop. syllable or word repeated several times which occur mostly at the begining of syntactic unit.   Prolongations. or articulation.SYMPTOMATOLOGY  Overt stuttering: Starkweather(1987)stated that it is characterized by core disfluencies such as syllable repetition. They may occur at any level of the speech mechanism. Blocks . phonation. They are sounds. appear in children who are just beginning to stutter at 2nd or 3rd years of life.respiration. They denote continuous airflow with stop movement of one or more articulations. and blocks. develops later than repetition. prolongations.  Repetitions.

They include word substitution. Non-speech behaviors as head turning to the Lt .blinking of eyes.   .circumlocations. Speech behaviors as inserting a filler ”uh” “well” They give enough time to attempt following difficult sounds or words. Escaping behaviors. Avoidance behaviors. they try to finish them quickly which may lead to many escaping and avoidance behaviors. it occurs later to escaping reactions.SYMPTOMATOLOGY   Covert behavior: Stutters cannot avoid core behavior. and antiexpectancy devices as using a funny voice. include speech and non-speech behaviors. It occurs when the stutter anticipates stuttering.

SYMPTOMATOLOGY  Concomitant problems: There are 2 main concomitant problems  Fear and frustration. It was found that 30% of young stutters have language difficulty that needs to treatment. (Perry2000) . the stutter becomes frustrated or embarrassed as he cannot say what he wants to say as smoothly and quickly as others. . Possible hereditary underlying neurological processing deficiency. (Peters and Guitar1991)  Language difficulty. Riley1988) (Riley and Some authors explain the language problem associated with stuttering as a co-product along with stuttering of some primary.

they are reactions to disfluency include. head thrust. anger. finger tapping]  Cognitive[thoughts and attitude].       Behavioral[moments of stuttering].starts by frustration and include feelings of anxiety . The child self-esteem is reduced and may believe that speaking has to be hard and unpleasant.fear. Signs of struggle and tension in speech system [pitch and loudness rise] Autonomic NS response[heart palpitations. flushing] Facial grimacing or eye squinting.SYMPTOMATOLOGY  Cooper and Cooper(1996) viewed stuttering as a syndrome of 3 components(ABCs): Affective[feelings].it includes awareness of difficulty beyond the child’s capacity with generalization of negative thoughts. panic. Counterproductive coping mechanism to get out stuttering[open mouth thrust. inferiority. arm swinging. shame. guilt. .

. age: 2-6years. beating on the wall with their hands. articles and prepositions. refusing to speak. crying. The difficulty has the tendency to be episodic. Stuttering is affecting the function words of speech as pronouns. Children are concerned about the interruptions in their speech. Stuttering tends to occur at the beginning of the sentence. Phase 1.DEVELOPMENT OF STUTTERING          Bloodstein(1975) classified the development of stuttering into four phases. Dominant symptom is repetition. conjunctions. They show acute frustration when they stutter. The child stutters most when excited or upset.

adverbs. Elementary school The disorder is essentially chronic. Stuttering occurs on the major parts of speech as verbs.DEVELOPMENT OF STUTTERING        Phase 2. The child shows little concern about his speech difficulty. . Stuttering increases chiefly under conditions of excitement or when speaking rapidly. adjectives. Age. The child has a self concept as a stutter.

late childhood and early adolescence. Anticipation of stuttering as conscious process begins to develop in this phase. Word substitutions and circumlocutions is used. Age . No avoidance of speech situations.little or no evidence of fear or embarrassment.DEVELOPMENT OF STUTTERING        Phase 3. Stuttering comes and goes largely in response to specific situations. Certain words or sounds are regarded as more difficult than others. .

Avoidance of speech situations. Word substitution and circumlocution occurs frequently. . later adolescence and adulthood. and other evidence of fear and embarrassment. Age. sounds and situations.DEVELOPMENT OF STUTTERING       Phase 4. Feared words. fearful anticipations of stuttering.

.articulation disturbances . It has repetitions .DIFFERENTIAL DIAGNOSIS   Stuttering should be differentiated from Normal developmental dysfluency. prolongation duration is one second or less no vocal tension . normal eye contact. children between the age2-6years. no frustration. It is characterized by normal tempo.fluency disorder characterized by rapid and/or irregular speaking rate.prolongations and blocks. -rapid rate of speech . It lacks facial grimaces.excessive number repetitions of speech . (ASHA1999) It is characterised by. excessive dysfluencies. fears and anxieties.monotonous speech  Neurogenic acuired stuttering.  Cluttering . and often other symptoms such as language and phonological errors and attention deficits. eye blinking.

 Spasmodic dysphonia. starts in the middle age affects equal number of males and females . starts suddenly following psychological stress. maintenance of normal eye contact. repetition of initial or stressed syllable.DIFFERENTIAL DIAGNOSIS  Psychogenic stuttering.

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