Fluency Overview

Fluency Overview

Bilinguistics Tea MeetingMarch 25th, 2013

Lia Johnston & Ladaun Jackson

Two fluency disorders:1) Stuttering - Stuttering is a disorder of speech

fluency characterized by various speech and non-speech behaviors that interfere with the forward flow of speech. (Byrd, 2011)

2) Cluttering- Cluttering is a fluency disorder characterized by a rapid and/or irregular speaking rate, excessive disfluencies, and often other symptoms such as language or phonological errors and attention deficits. (ASHA, 1999)

Basic Info - Definition

La tartamudez - the disorder of stuttering

El tartamudeo - One stuttering instanceTartamudear - to stutterRepetir - to repeatExtender - to prolong

Anything to add?

Basic info - Vocabulary

• "About 5% of all children go through a period of stuttering that lasts six months or more." • "Three-quarters of those who begin to stutter will

recover by late childhood, leaving about 1% of the population with a long-term problem." • The sex ratio for stuttering is roughly equal at

stuttering onset, but among school-age children with persistent stuttering, there are 3 to 4 times as many boys as girls.

Source: Stuttering Foundation of America

Basic Info - Prevalence

• Hereditary component - Recently three genes associated with stuttering found.

http://www.stammering.org/genes.html

Current theories: • Demands-Capacities model• Approach-Avoidance model

Debunked theories: • Diagnosogenic

Basic Info - Cause

Basic Info - CharacteristicsSome important characteristics of stuttering to keep in mind during assessment and treatment:•Conjunctions/pronouns stuttered more often than content words; pattern reverses with age•Variability •Adaptation

Source: Stuttering Foundation of America

Basic Info – Risk Factors/ Recovery Profile

Risk Factor More likely in stutteringFamily History A parent, sibling, or other

family member who stutters

Age of onset After age 3.5Time since onset Stuttering 6-12 months or

longerGender MaleOther speech-language concerns

Speech sound errors, trouble being understood

• No evidence has been found to suggest that speaking two languages in the home since birth causes stuttering (Au-Yeung, J., Howell, P., Davis, S., Charles, N., and Sackin, S., 2000), Byrd, 2010

• The majority of research has shown that stuttering appears to occur primarily in the more dominant language (Jarayam, 1983; Bernstein Ratner and Benitez, 1985; & Nwokah, 1988)

• Researchers have investigated whether code-switching increases or decreases disfluencies.

Basic Info- Bilingual Issues

• Frequency of disfluencies• Duration of disfluencies• Clustering of disfluencies• Iterations of disfluencies• Secondary behaviors

Assessment- Speech Disfluency Analysis

• Number of total disfluencies per total words > 10%

• Number of stuttering-like disfluencies per total words > 3%

• Number of stuttering-like disfluencies per total disfluencies > 72%

Assessment- Frequency

Stuttering-like Disfluencies (SLDs):•Sound/Syllable repetitions (SSR) e.g. – “go-go-going”•Whole-word repetitions (WWR) e.g. – “I gave-gave-

gave it to her”•Audible sound prolongation (ASP) e.g. –

“Mmmmmonday is the first of the month”•Inaudible sound prolongation (ISP) e.g. – “(M)---My

name is Sally”

Assessment - SLDs vs NSLDs

Non Stuttering-like Disfluencies (NSLDs)• Phrase Repetitions (PR) e.g. -- "I went to the--I

went to the store."• Revisions (REV) e.g. -- "She saw the--She talked to

the teacher."• Interjections (INT) e.g. -- "He's, um, taller."

*SLDs can present as NSLDs in certain circumstances. A child may use filler words, which are usually categorized as NSLDs, to delay initiation of a word the child is aware they will stutter on.

Assessment - SLDs vs NSLDs

• eye blinking/avoidance of gaze• irregular breathing patterns• head movements• tension in neck, shoulders, face

Assessment – Secondary Behaviors

• Maze use: Because bilinguals use two languages and use each language less

than a fluent monolingual, an increased level of language uncertainty compared to monolingual children occurs and as a result more mazes are produced (Byrd, 2010)• Compare the types and frequency of disfluency between the

two languages spoken to see if the disfluencies noted are seen in both languages. o Determine proficiency (as best as possible)

* Slide text from Byrd, 2010

Assessment – Bilingual Issues

• Observe code mixing/switching

• Develop hierarchy relative to each language

• Consider situational variation in reactions to stuttering as it relates to potential differences in home versus school environments.

* Slide text from Byrd, 2010

Assessment – Bilingual Issues

• Appropriate interaction styles• Different ways of talking and the related

consequences• Appropriate reactions to speech

disfluencies• Feelings related to speech and stuttering• Develop positive communication

attitudes

* Slide text from Byrd, 2012

Intervention- Preschool

• Education• Identification• Modification• Desensitization• Development of positive

communication image

* Slide text from Byrd, 2012

Intervention- School Age

• Slowed rate• Airflow coordination• Easy onset

Intervention - Fluency shaping

• Desensitizationo Self-identificationo Voluntary stuttering

• Modificationo Cancellationo Pull-Out o Preparatory set

Intervention - Stuttering modification

• Suggestion by Stuttering Foundation of America (no data): treat the child in his/her stronger language and monitor the weaker language(s) to determine whether the treatment effects carry over when the second language becomes more complex.• Dr. Courtney Byrd’s suggestion (also no published data): o Discuss language expectationso Review suggestions from various sourceso If possible and desired, practice in both languages

• NOTE: fluency shaping needs to be practiced across languages

* Slide text adapted from Byrd, 2010

Intervention - Bilingual issues

Session 1: 1) education (Spanish) 10 min. - teach re: articulators, speech production machine- activity: match words to pictures- talk about where words ‘get stuck’2) voluntary stuttering (Spanish) 5 min.- using picture cards, take turns stuttering on each word3) identification (Spanish) 5 min.4) fluency shaping (Spanish) 10 min. -  easy onset teaching- set 1 of story sequence cards6) fluency shaping (English) 10 min. - set 2 of story sequence cards7) convo sample (English) 5 min. - play sample

Intervention- Bilingual Tx Example

Session 2: 1) education (English) 10 min. - teach re: articulators, speech production machine- activity: match words to pictures- talk about where words get stuck (donde se atascan) 2) voluntary stuttering (English) 5 min.- using picture cards, take turns stuttering on each word3) identification (English) 5 min.4) fluency shaping (English) 10 min. - set 1 of story sequence cards6) fluency shaping (Spanish) 10 min. - set 2 of story sequence cards7) convo sample (Spanish) 5 min.- play sample

Intervention- Bilingual Tx Example

Typical Session Schedule: 1) education (5 min.) L1- read a short stuttering success story, learn a stuttering fact, etc. 2) voluntary stuttering (5 min) L13) identification (5 min) L14) easy onset practice (10 min) L15) identification (5 min) L26) easy onset practice (10 min) L27) convo sample during play (5 min) L2

Intervention- Bilingual Tx Example

1) Will my child be cured of stuttering?

Parent counseling - common questions from parents

1) Will my child be cured of stuttering?

• No, but therapy can improve all aspects of stuttering.

Parent counseling - common questions from parents

2) How can I help my child at home?

Parent counseling - common questions from parents

2) How can I help my child at home?

• Slow rate of speech• Pausing (before responding to

something your child says, and after you have said something)

• Use of reduced demand speech

Parent counseling - common questions from parents

3) Should I ignore or acknowledge stuttering moments?

Parent counseling - common questions from parents

3) Should I ignore or acknowledgestuttering moments?

• Acknowledge!

Parent counseling - common questions from parents

Stuttering Foundation of America http://stutteringhelp.org

NSA Austin Youth Chapterhttp://westutteraustin.org/

youthmeetings.html

Resources

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