• During the past years the understanding and the measurement of stuttering appear to have been dominated by different concept of the stuttering behaviour. It should be noted that is also common for stuttering events to be described as moments of fluency, disfluency or dysfluency, these terms are essentially interchangeable to some authors. But others distinguish between normal disfluencies and abnormal dysfluencies (Quesel, 1988). The traditional view is that the speech behaviours that listeners identify as stuttering are at once the disfluencies and stuttering that is a stuttering is a dysfluency or a speech interruption. • Option that is perceived by the speaker or the listener as an abnormal or stuttered disfluency rather than the normal disfluency. It is the symptomatic many of the difficulties in the stuttering measurement that such disagreements exist over these basic behavioural descriptors. • Johnson and Johnson 1959 recognised that the speech of those who stutter does contain distinctive intervals of non-fluency that could be labelled moments of stuttering (Johnson and Knott 1936) Moments of stuttering are bouts of non- fluency accompanied by some reaction on the part of the speaker or another listener that caused the entire event to be labelled as stutter. Marcel Wingate 1964 proposed a standard definition of stuttering that incorporate much of Johnson concept of stuttering and at the same time focused attention the behaviours that the listeners seem to associate with the label stuttering. Wingate definition drew heavily on his experience with children. • Disruption in the fluency of verbal expression which is characterized by involuntary audible or silent repetition or prolongations in the utterance of short speech elements namely sound, syllables and the words of one syllable. These disruptions usually occur frequently or a marked in character and are not readily controllable (Wingate). • Occasions of stuttering are defined simply as those events that an observer recognizes as stuttering behaviour. Because they exceed some threshold for stuttering identification.

1. UNIT 4
A. FLUENCY DISORDERS:
(Theoretical issues in measurement of stuttering. Treatment outcomes in stuttering – relapse,
Prognosis and maintenance. The nature of recovery. Prevention of stuttering)
Submitted to Submitted by
DR. ROHILA SHETTY HIMANI BANSAL
MVSCOSH MASLP 1st year

2. Theoretical Issues in Measurement of Stuttering
Stuttering measurement adhere more or less to the
principles of behavioural psychology preferring the
quantification of overt speech behaviours rather than
emotional or psychological aspect of the disorder
Assessment of stuttering involves a number of aspects
including neurological psychological, emotional and
linguistic aspects

3. Shine 1980: Used
transcription to identify the
stuttered word including
whole word repetition
prolongations and visible
struggle behaviour with all
other dysfluencies
considered normal.
Conture 1990 & Kellyu
1991: Within the word
disfluency are stuttering
instances and between
words disfluencies are
normal
Gregory and Hill 1993:
Presence of a typical
disfluency in up to 2% of the
spoken syllable is not
necessarily stuttering and
that the presence of typical
disfluency is not particularly
normal if they occur at 10%
of the spoken syllable
Curlee 1993: The fluency
problem may be suspected
on the basis of all
disfluencies in stutterers
and non- stutterers and the
presence of stuttered
disfluencies on up to 2% in
35 words or syllables may
not be labelled as stuttering

4. Treatment Outcomes in Stuttering
Bloodstein & Gregory, 1979: It seems unlikely that clinical researchers
in stuttering will ever arrive at a consensus regarding which treatment
approaches are most appropriate or most effective
To recommend that treatment be restricted only to approaches that
have been proven to be effective, through scientifically valid research
methodologies
1.The importance of documentation with broad range of options for
treating stuttering, it would provide way for documenting outcomes of
the treatment.

5. Defining Success
Success of
treatment is
determined by:
Complaint as the stuttering event:
The focus is on frequent disruptions in
speech fluency that are characterised
by overt features such as physical
tension and struggle
Complaint as the stuttering
disorder by: the treatment programs
view not only the speech disruptions,
but also the complex minimum of
negative feelings and emotions that
often accompany the production of
stuttering events

6. Measures that need to be included
% SS: syllable
stuttered
Syllables/min
(SPM)
Naturalness of
speech
Type of
stuttering
behaviours to be
measured
Stuttering
severity
measures
Covert measures

7. Criteria for Efficacy of Treatment
Reports of therapeutic
success must be based
on repeated evaluation
and adequate samples
of speech
Improvement must be
shown to carry over to
speaking situations
outside the clinical
setting
Bloodstein (1987): presented criteria that
have generally accepted as a way to
determine whether a treatment for
stuttering has been successful or not

8. Studies on Efficacy of Stuttering Therapy
Ryan (1983): compared four programs
(i.e., programmed traditional, delayed
auditory feedback, time out,
contingency and GILU) for effectiveness
in sixteen school children with a
stuttering disorder. Although all four
treatments were reported to be
effective in reducing stuttering, only
four of the sixteen children completed
follow up stages. This large dropout rate
and the lack of a control group raise
questions about the success of these
treatments
Hanna & Owen 1977: stutterers have a
tendency to seek help only when stuttering
appears to be at its worst. After treatment is
sought and before it begins, there appears to be
a spontaneous return of symptoms to their
average level, which are non-specific benefits
of having sought help

9. Relapse
Relapse covers all
forms of client
regression from
occasionally
stuttered words to
the resumption of
speaking patterns
to pre therapy
patterns
Craig and Calver
(1991): The
majority of those
who had suffered
relapse related to
feeling under
pressure to talk
faster while others
reported it due to
embarrassment to
use the new
speech patterns
Silverman (1981):
Clients who are
especially likely to
relapse are those
who, following
treatment, believe
themselves to be
cured. Other
clients may regress
as they come to
lose confidence in
the treatment
program

10. Possible Causes of Relapse
Client
adjustme
nt to a
new role
Speaking
in non-
habitual
manner
Failure to
practice
Slow
decay
due to
similar
stimuli
Failure to
follow
maintenan
ce
procedure
Neurophy
siological
loading
Listener
adjustme
nt to a
new
speaker
The cyclic
nature of
fluency
Client’s
assumption
of
responsibili
ty

11. Factors Related to Relapse
 Chronicity
and severity
of the
problem
 Achievement
of false
fluency
 Lack of
motivation
and interest
 Attitude
change
Genetic
factors
Poor self-
monitoring
Jost’s law-
when two
responses of
approximately
equal strength
compete, the
older one will
replace the
newer one,
over time
Dissatisfaction
with the new
methods of
speaking

12. The Possibility of Relapse
Prins (1970) found that about
40% of clients taking part in an
intense residential program
experienced some regression
following treatment
Silverman (1992) reports
fewer than 50% of older
children and adults who
acquire normal sounding
fluency during treatment are
able to maintain fluency
permanently
Craig and Hancock (1995)
found that 71.7% of 152 adults
surveyed experienced relapse
but that the majority found
that they subsequently
regained fluency. They also
found that relapse tended to
be cyclic, occurring up to 3
times a year

13. Helping Events Manage Relapse
Client’s first experience
with relapse is
traumatizing
Re-evaluation of the
problem with respect to
frequency and severity
Cognitive behaviour
therapy is particularly
very helpful

14. Maintenance
Establishment and Transfer: first two of the required
three steps in a complete fluency management program
Maintenance: third step is to maintain a satisfactory
level of fluency in the client’s natural environment after
clinical treatment has been terminated
The research reviewed indicates the presence of relapse
in the post treatment environment whether or not
maintenance activities are carried out

15. Activities for Maintenance
Regular clinical
contact following
treatment
Emphasis on the
need for changes in
attitudes to speech,
self- concepts, etc.
Intensive ‘refresher
programs’ or
recycling through
the initial program
Emphasis on client
self-responsibility

16. Recovery from Stuttering
Total
Recovery
Kalinowski & Saltuklaroglu (2006):
Complete removal of the overt (e.g.,
Syllabic repetitions, part-word
prolongation of speech sounds) and
covert (e.g., avoidances, substitutions
and circumlocutions) stuttering events
Finn et al. (1997): It also entails
producing speech that is natural
sounding, and therefore,
indistinguishable from speech of those
who do not stutter, as perceived by
both the child and listeners
Spontaneous
Recovery
Cordes & Ingham (1996): Recovery as
an often-gradual process with
knowable factors underlying the
process. This alternative is based on
the notion that recovery occurs
without treatment
It is an example of the wonders of
Mother Nature. Mother Nature does
seem to have a time schedule for
recovery. For example, Andrews et al.
(1983) reported that 75% of 4-yr old,
50% of 6-yr old and only 25% of 10-yr
old will recover from stuttering

17. Model of Recovery
Recovery
WITHOUT
Treatment
Traditional View: SR is the result of maturation process, especially among
preschool and early school age children.
Perkins (1992): One possibility is that child’s stuttering is the result of an
immature speech and language system that, with time, sufficiently matures to
overcome the disability.
Yairi, Ambrose & Cox (1996): Genetic factors; children who spontaneously
recover are more likely to have a family history of recovery than children who
continue to stutter.
Alternative Model: SR is the result of informal corrective factors that were
either parent-directed among children or self-directed among adults.
Onslow and colleagues’ clinician-guided, parent-directed program for young
children who stutter was developed from this model.
Ingham (1984): Fluency-inducing techniques; adults have reported modifying
their speech behavior by slowing down or by stopping and thinking before
speaking.

18. Model of Recovery
Recovery
WITH
Treatment
When cognitive/behavioral techniques
are used to bring fears under control
and to counter tendencies to avoid
social and speaking situations,
inevitably right hemisphere activation
is being kept under control.
As clients practice their skills and
become more proficient in an ever-
broadening range of social and
speaking situations, the skills become
more automatic and require less
concentration.
With the maintenance of this skill
altered state of brain activation will
also become more automatic.
Neural plasticity: There are well
documented evidences of
reorganization of the neural system
in response to developmental and
environmental demands

19. Studies
CITATION RESULT
Ambrose, N. G., Cox, N. J., & Yairi, E. (1997).
The genetic basis of persistence and recovery in
stuttering. Journal of Speech, Language, and
Hearing Research, 40(3), 567-580.
Results indicated sharply different sex ratios of persistent versus recovered stutterers in that
recovery among females is more frequent than among males. It was found that recovery or
persistence is indeed transmitted, and further, that recovery does not appear to be a
genetically milder form of stuttering, nor do the two types of stuttering appear to be
genetically independent disorders.
Sheehan, J. G., & Martyn, M. M. (1966).
Spontaneous recovery from stuttering. Journal
of Speech and Hearing Research, 9(1), 121-135.
Thirty-two spontaneously recovered stutterers were compared with 32 active stutterers and the
normal controls, and a computer bivariate association analysis showed: (1) four out of five
recover from stuttering spontaneously; (2) fewer of those who had received public school
speech therapy recovered from stuttering; (3) fewer of those who had ever been severe
recovered spontaneously; (4) no familial incidence pattern with either group of stutterers as
compared to controls; (5) no differences in reported handedness in stutterers or their families;
(6) improvement attributed to self-acceptance and role acceptance; (7) there appear to be
many different paths to recovery.
Arya, P., & YV, G. (2012). Speech Naturalness of
Recovered and Relapsed Persons with Stuttering
Following Treatment. Language in India, 12(12).
Results of the present study showed a significant difference between recovered and relapsed
group of persons with stuttering following treatment across different speech parameters. The
present study concludes that recovered persons with stuttering showed a perceptually more
natural sounding speech across all the parameters as compared to relapsed persons with
stuttering following treatment.

20. Prevention of Stuttering
CITATION RESULT
Gottwald, S. R., Goldbach,
P., & Isack, A. H. (1985).
Stuttering: Prevention and
detection. Young Children.
Teachers of young children are in a good position to make early
detections of potential stuttering problems. Negative reactions to a
child's stuttering may make stuttering worse. Adults are encouraged
to develop an unemotional, matter-of-fact reaction to dysfluencies.
Parents and teachers can alter their speaking style and the classroom
environment to enhance children's speech fluency by, for example,
slowing their own rate of speech; simplifying their grammar and
vocabulary; reducing use of direct questions; responding to the
meaning of a child's speech, not the way it is said; eliminating
interruptions; allowing plenty of time for all activities, especially
those that involve talking; and avoiding requests for verbal
performance.

21. REFERENCES:
1. Stuttering and Related Disorders of Fluency- Richard F. Curlee
2. Clinical decision making in fluency disorders – Manning
3. Stuttering and other Fluency Disorders- Franklin H Silverman
4. http://kunnampallilgejo.blogspot.com/2012/09/efficacy-of-fluency-
therapy.html?q=stuttering
5. https://ahn.mnsu.edu/departments/center-for-communication-sciences-and-
disorders/services/stuttering/speech-and-language-disorders/support-for-
parents/stuttering-prevention-a-manual-for-parents/
Questions asked in previous years:
1. Short note on objectives measures in evaluation of stuttering. (4 marks) (2013)