Here is a great review of fluency for SLPs. It includes information regarding assessment and treatment, as well as consideration when working with bilingual students who have fluency disorders.

1. Fluency Overview
Bilinguistics Tea Meeting
March 25th
, 2013
Lia Johnston & Ladaun Jackson

2. 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

3. La tartamudez - the disorder of stuttering
El tartamudeo - One stuttering instance
Tartamudear - to stutter
Repetir - to repeat
Extender - to prolong
Anything to add?
Basic info - Vocabulary

4. • "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

5. • 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

7. Basic Info - Characteristics
Some 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

8. Source: Stuttering Foundation of America
Basic Info – Risk Factors/
Recovery Profile
Risk Factor More likely in stuttering
Family History A parent, sibling, or other
family member who stutters
Age of onset After age 3.5
Time since onset Stuttering 6-12 months or
longer
Gender Male
Other speech-language
concerns
Speech sound errors, trouble
being understood

9. • 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

10. • Frequency of disfluencies
• Duration of disfluencies
• Clustering of disfluencies
• Iterations of disfluencies
• Secondary behaviors
Assessment- Speech Disfluency
Analysis

11. • 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

12. 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

13. 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

14. • eye blinking/avoidance of gaze
• irregular breathing patterns
• head movements
• tension in neck, shoulders, face
Assessment – Secondary
Behaviors

15. • 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

16. • 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

17. • 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

18. • Education
• Identification
• Modification
• Desensitization
• Development of positive communication
image
* Slide text from Byrd, 2012
Intervention- School Age

19. • Slowed rate
• Airflow coordination
• Easy onset
Intervention - Fluency shaping

20. • Desensitization
o Self-identification
o Voluntary stuttering
• Modification
o Cancellation
o Pull-Out
o Preparatory set
Intervention - Stuttering
modification

21. • 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 expectations
o Review suggestions from various sources
o 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

22. 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 word
3) identification (Spanish) 5 min.
4) fluency shaping (Spanish) 10 min.
- easy onset teaching
- set 1 of story sequence cards
6) fluency shaping (English) 10 min.
- set 2 of story sequence cards
7) convo sample (English) 5 min.
- play sample
Intervention- Bilingual Tx Example

23. 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 word
3) identification (English) 5 min.
4) fluency shaping (English) 10 min.
- set 1 of story sequence cards
6) fluency shaping (Spanish) 10 min.
- set 2 of story sequence cards
7) convo sample (Spanish) 5 min.
- play sample
Intervention- Bilingual Tx Example

24. Typical Session Schedule:
1) education (5 min.) L1
- read a short stuttering success story, learn a stuttering
fact, etc.
2) voluntary stuttering (5 min) L1
3) identification (5 min) L1
4) easy onset practice (10 min) L1
5) identification (5 min) L2
6) easy onset practice (10 min) L2
7) convo sample during play (5 min) L2
Intervention- Bilingual Tx Example

25. 1) Will my child be cured of stuttering?
Parent counseling - common
questions from parents

26. 1) Will my child be cured of stuttering?
• No, but therapy can improve all aspects
of stuttering.
Parent counseling - common
questions from parents

27. 2) How can I help my child at home?
Parent counseling - common
questions from parents

28. 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

29. 3) Should I ignore or acknowledge
stuttering moments?
Parent counseling - common
questions from parents

30. 3) Should I ignore or acknowledge
stuttering moments?
• Acknowledge!
Parent counseling - common
questions from parents

31. Stuttering Foundation of America
http://stutteringhelp.org
NSA Austin Youth Chapter
http://westutteraustin.org/youthmeetings.
html
Resources

32. Visit us at bilinguistics.com

33. Thank
you!