Predisposing factors Precipitating factors Perpetuating factors.
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Transcript of Predisposing factors Precipitating factors Perpetuating factors.
“What factors cause one person to be at greater risk than another for beginning to stutter?” (i.e., genetics)
“Nature vs. Nurture”
Those agents thought to have made stuttering surface or those that brought it to its present state◦ Rapid growth in speech-language skills during the
preschool years◦ Competition among siblings for attention and
conversational turns◦ Social adjustments necessary when entering
Factors are not static/rather are dynamic and changing
Do not always know the causal link between predisposing and precipitating factors and the occurrence of stuttering
Child presents with a family history of stuttering (predisposing factor), stuttering began around the age of 3 years when his speech-language skills were growing rapidly, whose home routine was busy as both parents worked outside, and who was beginning preschool (precipitating factors)
variables that are continuing/maintaining stuttering Certain environmental/physical factors may
reinforce/perpetuate stuttering Need to identify perpetuating factors Criticism of speech Inappropriate linguistic models Unrealistic expectations Experience of fluency failure Negative feelings and attitudes Vary with each individual Simple or complex/ Subtle or obvious Malleable or resistant to change
Neurotic Theories◦ Psychoanalytic explanations of stuttering held
that stuttering satisfies oral or anal erotic needs or represents repressed hostility.
◦ Stuttering is an attempt to suppress speech and is a symptom of a deep neurotic conflict.
Flexible interpretation:◦ If the stutterer admits to, or is assessed as
having personal problems, it is quickly assumed that his stuttering is a manifestation of these problems.
◦ If the stutterer gives all appearance of being normal and well-adjusted, his “symptoms” (stuttering) can be interpreted as representing his “solution” to inner conflicts
Clinical and research data do not provide strong support for the conclusion that stuttering is usually a symptom of a neurosis or other type of emotional disorder.
But they do not rule out the possibility that it is a symptom of such a disorder for some persons who stutter
Results of most studies indicate that stutterers are as well adjusted as their non-stuttering peers.
Stutterers are more similar to their non-stuttering peers than they are to persons who are known to be emotionally disturbed.
1. Attitudes toward speaking 2. less well adjusted as a consequence of living with
stuttering. 3. not as outgoing. 4. avoid talking on the telephone. 5. Unwilling to express anger openly when doing so would be
appropriate 6. may be depressed bc they’re trying to cope with stuttering. 7. Self persecution: failure to overcome stuttering viewed as
their fault 8. They may over react to stuttering. 9. They may feel guilty about stuttering. 10. They may experience anxiety about speaking.
No significant difference in degree of◦ Dependency◦ Sensitivity◦ Shyness◦ Fears◦ Enuresis◦ Disturbing dreams
◦ Ability to form relationships with peers◦ Mother-child relationships◦ Father-child relationships
Stuttering as communicative failure and anticipatory struggle behavior
◦ Diagnosogenic theory-semantic theory-states that stuttering is caused by the parent’s or care giver’s misdiagnosis of and inappropriate reaction to normal disfluencies in a child’s speech, followed by the child’s attempts to avoid the disfluencies that are mistakenly assumed to render the child’s speech as abnormal.
The Continuity Hypothesis-proposed by Bloodstein-suggests that stuttering develops from normal disfluency that becomes tense and fragmented as the child experiences frustration and failure in attempts to talk.
Experiences that increase difficulty with speech◦ Criticism of normal disfluencies◦ Delay in speech-language development◦ Traumatic experience in oral reading◦ Cluttering◦ Reminders to “slow down”
Preparatory Set-Van Riper-stuttering emerges gradually from a child’s normal hesitations and repetitions.
Become chronic when the child begins to:
◦ Anticipate, avoid and fear speech◦ Stuttering originates from environmental, organic,
Stuttering as an avoidance response
◦ Conflict theory of stuttering and avoidance reduction
◦ Operant conditioning◦ Classical conditioning◦ Eclectic conditioning◦ Vicarious conditioning
Sheehan-viewed stuttering as resulting from a double approach-avoidance conflict between speaking and not speaking and between being silent and not being silent.
Stuttering is the result of “speech vs. silence”
Speech is a behavior subject to operant control of positive and negative reinforcements and punishments.
Stuttering begins as “normal disfluencies” which are natural and understandable.
Initially, these disfluencies are reinforced through some schedule of positive reinforcement.
These conditions recur and become discriminative cues which control disfluencies
Positive reinforcement is replaced with punishment by the parent or significant someone when they begin to disapprove of the disfluencies.
The child develops negative emotions about speaking and begins to struggle with the nonfluencies
Fluency failure explained by Brutten and Shoemaker◦ Stage 1-the speech features of stuttering are a
“form of fluency failure” which is believed to be associated with a negative emotional state. (negative emotion causes initial fluency failure)
◦ Stage 2-negative emotion and resulting fluency failure become linked to certain external stimuli through associative learning
◦ Stage 3-there is an extension of the range of stimuli to which the negative emotional response becomes associated.
1. Does not assume that the original stuttering behavior was normal. Original disfluent behaviors are not normal.
2. Original fluency breaks consist of disorganized forms of previously integrated behaviors
3. Antecedents of stuttering are considered to be as important as its consequences
Any combination of learning theories can be operating for the individual simultaneously
The behavior of the person becomes conditioned as that person watches someone else being conditioned.
Referred to as “Breakdown Theories” characterize the moment of stuttering as an indication of failure or breakdown in the complex coordination required for speech.
Dysphemia-the stutterer is believed to be inherently different from the non-stutterer.
◦ Stuttering is the joint product of hereditary predisposition and precipitating factors in the environment
Shock Fright Illness Injury
Cerebral dominance theory-Travis-postulated that a conflict exists between the two halves of the cerebrum for control of the activity of the speech organs
◦ Also known as handedness theory
◦ 20’s and 30’s changed children’s handedness to correct stuttering
Travis (1978) indicated “I have never disavowed the cerebral dominance theory as an explanation of the underlying basis of stuttering. I have; however, acknowledged publicly the futility of shifting handedness in its management.”
The conflict between the two hemispheres for the control of speech resulted in neuromotor disorganization and mistiming resulting in stuttering
Adheres to the belief that the basic difference between stutterers and non-stutterers rests in metabolic factors and tissue chemistry.
West (1958)-concept of stuttering as a convulsive disorder related to epilepsy-called “pyknolepsy”
Persons who stutter have an organic predisposition to motor and sensory perseveration of which stuttering is an outward manifestation.
◦ Eisenson-stuttering is a transient disturbance in propositional language usage.
Stuttering involves changes in the interaction of laryngeal, supra-laryngeal, and respiratory reflexes
◦ Implicates the brainstem as the site of lesion
◦ Stuttering is the consequence of disruption of motor organization, timing, and control
Auditory function-questions regarding the basic integrity of the auditory system of stutterers have had a long history
◦ Dichotic listening-to determine hemispheric specialization for speech
◦ Acoustic reflex
◦ Phase disparity
◦ Central auditory function
All have been investigated to assess the effects of auditory feedback
Clinical results indicate that disruption in the auditory channel of a stutterer while speaking produces fluent speech
Closed-loop systems-behavior and physiological control interpret activity and learning as self-regulated processes rather than a series of stimulus-controlled reflexes or discrete stimulus-response units.
Error sensitive, error measuring, self adjusting, goal-directed mechanisms which employ feedback of the output to the place of control
Vocal organs + motor innervations=the effectors
Speech-When errors occur, the system corrects itself by searching for the appropriate output until it is achieved
Stuttering-The feedback system used to monitor speech has too much distortion, interference, and overload.
Child’s capacity-Fluent speech characterized by continuous production, without effort at an appropriate rate
Demands-pressure imposed on the child by listeners and himself
When the demands exceed the child’s capacities for fluent speech stuttering occurs
Capacities for fluent speech
◦ 1. speech motor control-rate of syllable production and coordination of movement
◦ 2. language formulation-word finding, formulation of grammatical sentences, and knowledge of conversational rules
◦ 3. social-emotional maturation
◦ 4. cognitive skill-general intelligence and metalinguistic skill
Those conditions that impose a pressure perceived by the child to speak at greater rate (i.e., faster) or with greater continuity (i.e., smoothness)
Demands increase with maturity and include time pressure, uncertainty, and avoidance
Research about linguistic aspects of stuttering and stutterers has contributed to concern over language development
1. Some stutterers acquire language more slowly
2. Poorer auditory recall of linguistic information
3. Higher number of grammatical errors 4. Increased word length/increased stuttering 5. Stuttering occurs more on words of
importance 6. Less stuttering with high word frequency 7. Repeating prosodic patterns reduces
amount of stuttering
Factors increasing risk or predisposition for stuttering:◦ Gender◦ Age (majority between 2 and 5 years)◦ Family history◦ Socioeconomic status and nationality- middle and upper-
middle class families and certain groups from Canada, Korea, and West Africa show greater risk
◦ Twins◦ Mental retardation◦ Brain injury◦ bilingualism
Greater likelihood to have a history of delayed articulation or language development
Poorer performance on verbal and motor tests of intelligence
Poorer school performance Less left-hemisphere dominance for speech Slower reaction times Poorer recognition and recall of competing
messages Slower speech movements even during fluent
Shapiro, D.A. Stuttering Intervention. Texas: Pro Ed., 1999
Gregory, H. H. Stuttering Therapy: rationale and procedures. Boston: Pearson Education, 2003