Chapter 12-Fluency Disorders.ppt

1、Chapter 12: Fluency Disorders,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Focus Questions,What is a fluency disorder? How are fluency disorders classified? What are the defining char

2、acteristics of fluency disorders? How are fluency disorders identified? How are fluency disorders treated?,12.1,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Introduction Fluency Disor

3、ders,Ability to produce speech effortlessly and automatically is compromised Better known as stuttering Relatively small number of persons affected compared to other communication disorders 1 to 2% of population at a given time,12.2,Justice Communication Sciences and Disorders: An Introduction,Copyr

4、ight 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,The Familiarity of Stuttering,Despite the low incidence, the general population seems to be most familiar with fluency disorders WHY? Perhaps longest documented history of any communication disorder Affect

5、ed some famous faces, including contemporary celebrities Often used in the media, either comically or as a dramatic, metaphoric technique,12.3,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reser

6、ved.,What you may not know,Most young children go through a period of disfluency (up to 5% of their speech) Majority of cases in children are resolved, either spontaneously or through treatment Many of the public perceptions of people with fluency disorders are not accurate, such as being timid or f

7、earful,12.4,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Case Study #1: Ralston,4-year old boy in private day care center in West Virginia family (consisting of mother, father, and fo

8、ur siblings) lives in two-bedroom subsidized apartment Social and communicative child, but recently day care teacher has noticed stuttering and more frequent temper tantrums Mother says not to worry, that older siblings also went through this stage, but teacher is worried that the stuttering might i

9、nterfere with Ralstons interactions with the other children and that it might be related to the tantrums,12.5,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Case Study #1 Questions,What

10、 warning signs should Ms. Henry look for when documenting Ralstons stuttering behaviors? What are some strategies Ms. Henry might use in the day care center to promote Ralstons ability to effectively communicate? What are some events or challenges in Ralstons life that might be related to the emerge

11、nce of disfluencies?,12.6,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Case Study #2: Kaimon,7-year old boy just starting second grade treated for fluency disorder in K 1st grades, bu

12、t dismissed from treatment Mr. Damon, teacher, reports that Kaimon is still stuttering and using avoidance tactics Kaimon doesnt want to go to therapy again, and his teacher agreed to try different strategies in the classroom for next three months,12.7,Justice Communication Sciences and Disorders: A

13、n Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Case Study #2 Questions,What are some strategies that Mr. Damon might use to promote peer acceptance of children with communication disabilities in his classroom? What are some strategi

14、es that Mr. Damon might use in the next few months to increase Kaimons fluency and decrease his disfluency within the classroom? Do you agree or disagree with Kaimons parents for keeping him out of therapy for the next few months? Why or why not?,12.8,Justice Communication Sciences and Disorders: An

15、 Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Case Study #3: Mr. Cho,39-year old suffered a stroke during heart surgery paralyzed on right side and exhibits communication impairments, including severe fluency problem Shows pauses, i

16、nterjections, repetitions, and prolongations, but no fear or embarrassment Insurance only covers 12 sessions of outpatient therapy, but hes using those for physical therapy Decided to pay out-of-pocket $1,200 for a 3-month vitamin treatment that claims 100% cure for acquired stuttering that his daug

17、hter found advertised in the newspaper,12.9,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Case Study #3 Questions,Do you agree with Mr. Chos decision to forfeit the outpatient speech t

18、herapy in lieu of the physical therapy and to pursue the vitamin treatment? How can a consumer differentiate between those treatments that are effective and those that are questionable? What other explanations are possible to explain Mr. Chos improved fluency following two months of a special vitami

19、n regimen?,12.10,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,I. What is a Fluency Disorder?,What is fluency? Speech moves at an appropriate rate Easy rhythm Smoothness Effortless Aut

20、omatic Disfluency occurs when there is a disruption in any of these elements,12.11,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Fluency Disorders,Unusually high rate of stoppages that

21、 disrupt the flow of communication and re inappropriate for a persons age, culture, and linguistic background Three essential characteristics: Disturbance in the normal fluency and timing patterns of speech Disturbance in social communication, academic performance, or occupational achievement If ano

22、ther disability is present, the fluency disturbance is in excess of what is expected of that disability,12.12,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Core and Secondary Features,

23、Core features: primary characteristics of a fluency disorder Repetitions Prolongations Blocks Secondary features: emerge in response to the core behaviors Avoid and escape moments of disfluency, such as eye blinks, head jerks, pauses, fillers Negative feelings and attitudes, such as worrying about s

24、peaking, viewing speaking as difficult,12.13,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Terminology,Stuttering: describes fluency disorder Stutterer: describes a person affected by

25、a fluency disorder Person first language gives the individual primacy over the disorder (e.g., “child who stutters”),12.14,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Prevalence and

26、Incidence,Incidence: 1 in 100 persons Prevalence: 5 in 100 persons Affect children between the ages of two and 10 years at the highest rates Males are affected at a higher rate than females (approximately 3:1),12.15,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pear

27、son Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Recovery from Stuttering,Difference between prevalence and incidence rates indicate that the majority of persons (perhaps 80%) who exhibit fluency disorders do recover Raises question concerning need for treatment (i.e., t

28、o treat or to wait and see) Three reasons why treatment is necessary: Children who recover from stuttering often do experience stuttering for a relatively long time No way to know whether children will eventually recover or not Relatively high rate of co-occurring speech and language problems that e

29、xist beyond fluency disorder,12.16,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,II. How are Fluency Disorders Classified?,A. Etiology-Focused Classification Developmental Disorder of

30、Fluency: Emerges in early childhood (2-5 years) and its cause is unknown Characterized by stuttering-like dysfluencies (SLDs): part- and single-syllable word repetitions, prolongations, and blocks Acquired Disorder of Fluency: Dramatic onset anytime in lifespan, resulting from illness, trauma, accid

31、ent, or psychological trauma,12.17,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,B. Symptom-Focused Classification Several systems exist to describe fluency disorders in terms of how f

32、ar they have advanced Peters and Guitars 5-Level System: Normal disfluency: 18 mos. 6 yrs. of age Borderline stuttering: (18 mos. 6 yrs.) produce more and different types of disfluencies than normal Beginning stuttering: (2 8 yrs.) true fluency disorder Intermediate stuttering: 6 13 years Advanced s

33、tuttering: over 14 years,12.18,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Cluttering,Cluttering: Breakdowns at the word or phrase level Poor cohesion and coherence in expressing tho

34、ughts and organizing sentences Fast and spurty speaking rate Reduced intelligibility NOT inhibited or anxious about speaking,12.19,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,III. De

35、fining Characteristics of Fluency Disorders,Core Features Within-word and between-word disfluencies Secondary Features Escape behaviors Avoidance behaviors Feelings and Attitudes Causes and Risk Factors Predisposing factors Precipitating factors,12.20,Justice Communication Sciences and Disorders: An

36、 Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Core Features,Part-word repetition: sound or syllable is repeated 2 to 4 times Single-syllable word repetition: two or more times Sound prolongation: duration of speech sound is lengthen

37、ed Block: articulators and airflow completely stop during the production of a sound Within-word disfluencies (stuttering) vs. between-word disfluencies (normal),12.21,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jerse

38、y 07458 All rights reserved.,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Secondary Features,Escape behaviors: response to moments of stuttering Head nods, eye blinking, leg slapping

39、Avoidance behaviors: avoid moments of stuttering Word and sound avoidance (substitution, circumlocution, postponement) Situation avoidance Feelings and attitudes: negative feelings towards communication Fear, embarrassment, shame,12.22,Justice Communication Sciences and Disorders: An Introduction,Co

40、pyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,Causes and Risk Factors,For the majority of children, stuttering begins for no apparent reason Hard to identify, because results from complex interaction of two types of factors: Predisposing: individua

41、ls constitutional factors that make him susceptible to a fluency disorder (70% of likelihood) Precipitating: developmental and environmental factors that can worsen stuttering (30%),12.23,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Sa

42、ddle River, New Jersey 07458 All rights reserved.,Predisposing Factors,Family history: tendency to run in families, and genetic link seen in twin studies Gender: boys are more likely to develop a fluency disorder and slower to recover Processing ability: underlying problem with linguistic processing

43、 (demand and capacity model) Motor-speech coordination: difficulty in coordinating and timing the motor activities required for fluent speech,12.24,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights

44、reserved.,Precipitating Factors,Age: average age of emergence is 3 years for boys and 2.5 years for girls Development stressors: Stressful adult speech models: children exposed to adult speech not appropriate for their own speech, language, and cognitive abilities Stressful speaking situations for c

45、hildren: competing or hurrying to speak, having too many things to say Stressful life events: moving, divorce of parents, loss of family member, illness, or accident Self awareness: atypically high awareness of own disfluencies,12.25,Justice Communication Sciences and Disorders: An Introduction,Copy

46、right 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,IV. How are Fluency Disorders Identified?,Determine if the quality and/or quantity of disfluencies significantly differ from normal Quantity: two common metrics Average # of disfluencies per 100 words Ave

47、rage # of disfluencies per 100 syllables Quality: Normal: interjection and revisions predominate Disordered: repetitions, prolongations, and blocks predominate,12.26,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey

48、 07458 All rights reserved.,The Assessment Process,Referral Assessment Protocol Diagnosis Severity Prognosis Treatment Recommendations,12.27,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserve

49、d.,Referral,Important for other professionals to recognize warning signs and make referrals to SLPs Warning signs for developmental fluency disorders: Repetition of words or parts of words that involve 3 or more repetitions, prolongation of a sound, feelings of frustration or embarrassment towards c

50、ommunication Warning signs for acquired fluency disorders: “stuttering-like” or “cluttering-like” disfluencies, inability to effectively communicate,12.28,Justice Communication Sciences and Disorders: An Introduction,Copyright 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.,