1. Integrating Stuttering Modification and Fluency Shaping Methods
1.1. People who stutter are shown how to alter their speech style so that they are more likely to be fluent, but they are also taught how to modify their speech when they encounter moments of stuttering
2. The Development of Stuttering
2.1. Early Stuttering
2.1.1. Unfortunately, some children's speech disfluencies increase in frequency and their speech contains more sound repetitions, prolongations, and blocks
2.2. Genetic Influences
2.2.1. Yairi and Ambrose concluded that there is strong evidence for genetic influences on the development of stuttering. It is clear that relatives of people who stutter are generally at greater risk of stuttering that relatives of people who do not stutter.
2.3. Environment Demands and the capacity for Fluency
2.3.1. suggested that disfluencies are likely to occur in children’s speech when there is an imbalance between the demands for fluency and the child’s capacity to produce fluent speech
2.4. Influence of Learning
2.4.1. When multiple experiences occur over time, as might happen during repeated instances of speech disfluency, new neural groups that are related to speech disfluency may form, grow, and strengthen
3. Factors that Contribute to Chronic Stuttering
3.1. Genetics
3.1.1. Children who have a positive history of stuttering in their family are less likely toto recover naturally than children who do not have a family history of stuttering
3.1.2. Stuttering may run in families because of an inherited abnormality in the part of the brain that governs language
3.2. Negative Feelings and Attitudes
3.2.1. Adolescents and adults often feel their stuttering is out of their own control; it is something that happens to them rather than something that they do
3.3. Avoidance
3.3.1. Individuals who stutter sometimes avoid stuttering by changing the words they plan to say as they talk
3.3.2. Another way people who stutter keep from stuttering is to avoid speaking situations in which they believe they will stutter
3.4. Difficulties with Speech Motor Control
3.4.1. They may tense the muscles in their chest, neck, larynx, jaw, or face before they start to talk, and they may maintain excess tension in these areas while they are speaking
4. Assessments of Stuttering
4.1. Cultural Considerations
4.1.1. Clinicians need to be sensitive to cultural issues that can affect childrearing practices, conceptions about disabilities, and interaction practices.
4.2. Language Considerations
4.2.1. assessment and treatment should allow for adequate evaluation of stuttering across languages as adequate practice of fluency-facilitating techniques in each language.
4.3. Interviews and Case History
4.3.1. The clinician should always ask questions about other family members who stutter, changes in the rate and nature of disfluency over time, and perceptions about the person’s fluency at the time of the evaluation.
4.4. Tests of Stuttering
4.4.1. The Test of Childhood Stuttering (TOCS; Gillam & Logan, 2012) provides and objective measure of core disfluencies that characterize stuttering
4.4.2. The Stuttering Severity Instrument-4 (SSI-4; Riley, 2014) can help clinicians determine the severity of stuttering.
4.5. Speech Samples
4.5.1. At minimum, clinicians measure the frequency of certain types of stuttering. To do this, we select a 10-to-15-minute segment of conversation that seems to be representative of the individual’s fluency and disfluency
4.6. Consistency and Adaptation
4.6.1. People who stutter tend to stutter on the same words from the first reading of a passage to the second reading of the same passage. This is known as consistency.
4.6.2. They also tend to stutter less on successive readings. This effect is called adaption
4.7. Screening
4.7.1. the client should receive a hearing screening and an oral mechanism screening. We also make informal judgments about the individual’s voice quality
4.8. Speech and Language Testing
4.8.1. tests typically used assess receptive and expressive vocabulary, receptive and expressive language skills, and articulation abilities
4.9. Feelings and Attitudes
4.9.1. Clinicians usually administer these scales to get a sense for the extent to which negative attitude and feelings contribute to stuttering behaviors.
4.10. critical for clinicians to remember that their primary concern is to serve the needs of the client. Clinicians should always ask individuals and their family members what they want to learn from the evaluation
5. Treatment
5.1. Stuttering Modification Therapy
5.1.1. The primary goal of Van Riper’s therapy is to help stutters acquire a speech style that they find to be acceptable
5.1.2. Talking to a speech therapist is the best way to get help for stuttering
5.2. Fluency Shaping Therapy
5.2.1. most involve slower rates of speech, relaxed breathing, easy initiation of sounds, and smoother transitions between words
5.2.2. The goal of this Fluency Shaping therapy was not to stutter more easily, but to “speak more fluently” as opposed to stuttering modification’s goal “stutter more easily
5.3. Therapy for Children Who Stutter
5.3.1. Most Clinicians utilize fluency shaping approaches somewhat more than stuttering modification because young children may not be developmentally ready for the self-awareness that is required for stuttering modification
5.4. Stuttering modification procedures help the stutterer change or modify his stuttering so that it is relaxed and easy. Fluency shaping procedures establish a fluent manner of speaking that replaces stuttering
6. The Nature of Fluent Speech
6.1. FLUENCY: used to describe speech that is effortless in nature. It is easy, rhythmical and evenly flowing
6.2. FLUENCY refers to continuity, smoothness, rate, and effort in speech production
6.3. STUTTERING: used to describe an atypical disruption in the flow of speech
7. What is Stuttering?
7.1. STUTTERING is characterized by an unusually high frequency or duration of repetition, prolongations, and/ or blockages
7.2. excessive mental and physical and mental effort to resume talking
7.3. Stuttering may change from day to day. You may have times when you are fluent and times when you stutter more
7.4. Primary Stuttering Behaviors
7.4.1. “core behaviors” - stuttering-like speech disfluencies that were mentioned earlier (i.e., tense repetitions, prolongations, and blocks)
7.4.2. may also produce prolongations in which they hold out or prolong a sound for an unusually long period of time
7.4.3. an inaudible sound prolongation or a block, that is rarely heard in the speech of people who do not stutter. People who stutter sometimes feel like they become stuck as they are producing sounds
7.5. Secondary Stuttering Behaviors
7.5.1. counterproductive adaptations that people who stutter make as they get through primary stuttering behaviors
7.6. Incidence and Prevalence of Stuttering
7.6.1. PREVALENCE: the percentage of individuals who stutter at any given point in time
7.6.2. INCIDENCE: the percentage of people who report having stuttered at some point int their lives.
8. Individuals Who Stutter
8.1. Individual Variability
8.1.1. Not all individuals stutter in the same manner or with the same frequency
8.1.2. Despite the considerable degree of individual variation between and within people who stutter, some generalizations apply to many individuals who stutter
8.2. Differences Between Individuals Who Do and Do Not Stutter
8.2.1. stuttering is often related to emotional, conceptual, linguistic, and motor performance
9. Etiology of Stuttering
9.1. Myth: Stuttering Is a Nervous Reaction
9.1.1. Many studies have shown that individuals who stutter are not more anxious than individuals who do not stutter
9.1.2. Nervous disorders and other psychiatric disabilities are not more common in people who stutter than they are in the general population
9.2. Myth: Stuttering Is Caused by Overly Sensitive Parents
9.2.1. parent reactions do not cause stuttering, although parents’ behavior can exacerbate stuttering or facilitate fluency in young children who stutter
9.3. Current Thinking About Etiology of Stuttering
9.3.1. Current models of stuttering depict the disorder as arising from complex relationships between internal factors and external conditions