Stuttering and Related Disorders of Fluency (eBook)

1 Common Characteristics

Edward G. Conture, Victoria Tumanova, and Dahye Choi

Abstract

The purpose of this chapter is to describe and discuss some of the more common characteristics of stuttering, particularly in children. The chapter begins with a definition of stuttering, incidence and prevalence, the types of speech disfluencies most apt to be judged as stuttering, measures of stuttering and associated variables as well as nonspeech behaviors associated with stuttering. Following that, the chapter describes basic facts about stuttering, for example, variability, an important hallmark of stuttering. Finally, the chapter discusses some of the more common behaviors (e.g., singing) and conditions (e.g., delayed auditory feedback) associated with decreases in stuttering. Underlying the above information is the fact that stuttering begins in early childhood, with more children exhibiting mild than severe stuttering, and that more children recover (70–80%) from stuttering than persist (20–30%). Although the precise mechanism that causes stuttering to emerge in young children remains unclear, multifactorial perspectives suggest that causation involves interactions among a finite number of variables. Available information further suggests that stuttering does not randomly occur within an utterance; rather it appears to be associated with speech-language aspects of the utterance (e.g., adjectives, adverbs, nouns, and verbs). Some of these speech-language aspects associated with instances of stuttering may be unique to the individual who stutters (e.g., stuttering on words that begin with “f”), while others are more common for many people who stutter (e.g., stuttering on words in the beginning of the utterance).

stuttering, common characteristics, basic facts, children

1.1 Purpose

The purpose of this chapter is to describe the most common and well-documented characteristics of stuttering. Although no single chapter can include all such characteristics, our description should provide readers with a broad perspective regarding stuttering behaviors and associated phenomena. With such a perspective, the reader will better appreciate the information presented in subsequent chapters discussing constitutional and environmental processes associated with stuttering as well as assessment and treatment of stuttering.

1.2 Common Characteristics: Definitions of Stuttering, Speech Disfluency Types and Stuttered and Nonstuttered Disfluencies

1.2.1 Definition

Stuttering is a speech disorder that typically emerges in early childhood (i.e., for most children, stuttering onset occurs between 2.5 and 4 years of age). Stuttering is typically characterized by frequent repetitions of sounds (e.g., “S-s-see the dog”) and monosyllabic words (e.g., “I-I-I am going”), sound prolongations, and interruptions in the forward flow of speech, often accompanied by physical muscle tension and struggle. The disorder has a lifetime incidence of approximately 5 to 8%, with prevalence of approximately 1% at any one point in time.1 ,​ 2 Stuttering can significantly impact children’s academic, emotional, and social abilities as well as their later vocational potential and achievements.3 ,​ 4 As is true with many disorders, early detection followed by appropriate intervention has been shown to increase the odds of a successful outcome.

Stuttering can also occur, although less commonly, in older individuals experiencing neurodegenerative disease, stroke, traumatic brain injury, tumors, emotional trauma, and psychiatric disorders. For the purpose of this chapter, we will focus on developmental stuttering, which typically begins in early childhood. Adult-onset stuttering is discussed in detail in Chapter 17 of this book.

1.2.2 Speech Disfluency Types

Speech disfluency refers to any interruption in the rhythm and forward flow of speech. For example, when saying the sentence, “Bobby look at this,” someone may say the word “Bobby” as “B-B-Bobby,” repeating the first sound of the word multiple times. This type of speech disfluency is described as a “sound/syllable repetition” (i.e., “part-word repetition”). If in the same sentence someone repeats the first word multiple times, “Bobby-Bobby look at this,” then this speech disfluency would be described as a multisyllabic whole-word repetition.

1.2.3 Stuttered and Nonstuttered Disfluencies

Naïve listeners as well as expert clinicians and researchers most frequently judge the following types of speech disfluencies to be “stuttered”: sound/syllable repetitions, audible and inaudible sound prolongations (the latter, in particular, often referred to as “blocks”), monosyllabic whole-word repetitions, and within-word pauses. Listeners are apt to notice these speech disfluencies in someone’s speech and perceive them as different, atypical, or abnormal. People who stutter often report that these “stuttered” disfluencies are associated with a feeling of loss of control and tension. On the other hand, listeners more typically perceive phrase repetitions, revisions of words, phrases, and sentences, interjections (e.g., “uh,” “um”), and repetitions of multisyllabic words to be normal, “not stuttered,” or typical. Often, listeners do not notice these speech disfluencies in their own or someone else’s speech. Further, speakers do not usually associate these more typical speech disfluencies as being connected with any specific feeling, such as loss of control or tension.

To assess someone’s speech fluency, clinicians and researchers count both types of speech disfluency: stuttered (e.g., “I-I-I will go”) and nonstuttered (e.g., “I will-I will go”). The typical way to do this is to obtain a speech sample, usually during a conversation, and an oral reading sample for those children and adults who can read. Based on these samples and associated counts of stuttered and nonstuttered disfluencies, the examiner can determine the frequency of stuttered and nonstuttered disfluencies, important measures of any comprehensive assessment of stuttering. We will provide a bit more detail regarding these measures in the following sections.

Of these two categories of stuttered and nonstuttered disfluencies, it is the stuttered disfluency that is of primary focus during an assessment for stuttering. Typically, the examiner focuses on stuttered disfluencies because he or she is trying to determine whether someone stutters as well as determine the severity of their stuttering. Measures of stuttering frequency and severity are clinically important because they contribute to the diagnosis of stuttering and inform the decisions about the need for therapeutic intervention.

It should be noted, however, that although stuttering frequency and severity are related to one another, they are not identical measures (more about each measure later). As suggested earlier, these two measures—stuttering frequency and stuttering severity—are usually considered together to achieve a comprehensive index of stuttering. Although we described “stuttered” and “nonstuttered” as two different types of disfluencies earlier, it should be noted that some stuttered disfluencies (e.g., brief sound prolongations) are not always perceived as stuttering. Likewise, some nonstuttered disfluencies may be perceived as stuttered (e.g., multiple repetitions of an interjection). Despite these challenges to measurement accuracy, Table 1.1 provides examples of the different types of speech disfluencies and whether they are most apt to be judged by listeners as stuttered or nonstuttered (i.e., typical).

Table 1.1 Speech disfluencies most apt to be associated with listener judgments of stuttering and not stuttering