Let’s talk first about the characteristics of PWS. About 5% of the population has stuttered at some point in their lives, but only about 1% of these people go on to experience chronic, lifelong stuttering. So 4/5 children who begin to stutter will outgrow it. As we’ll see later on in the course, this statistic can have important diagnostic and therapeutic implications.
In this course, we are focused on developmental stuttering, or the kind of stuttering that begins in childhood and that can persist into adulthood. Most developmental stuttering occurs between ages 2 and 5, with an average onset of just under 3 years of age. Girls tend to begin stuttering earlier than boys, and it’s important to note that severe stuttering tends to occur closer to ages 2 and 3 than ages 4 and 5. Developmental stuttering can begin suddenly or gradually. Sometimes stuttering may appear to start around times of stress in a child’s life, such as a move or the birth of a new sibling. But sometimes no such stressors appear to be associated with the onset of stuttering. I want to emphasize here that stressful situations by themselves don’t cause stuttering. They may act as environmental triggers if a child is predisposed to stutter, but parents and life events do not cause stuttering. We’ll talk about this more in our theories chapter, but be aware that parents can carry major guilt for their children’s stuttering. It’s important to assure them that the child’s stuttering is not their fault.
One of the predisposing factors to stuttering is whether there is a family history of stuttering. We know that genetics can play a role in whether someone will stutter, and over years of research have found some interesting facts. Let’s say, for example, that a brother and sister are born to a parent who stutters. The brother will be more likely than the sister to stutter. If both siblings show signs of developmental stuttering, the sister is more likely to outgrow her stuttering as compared to her brother. And if the parent who stutters is female, the son is that much more likely to stutter. This is because stuttering genes in females must be especially strong in order for stuttering to manifest itself, and to be passed on to children. On a related note, you may think that the child of a parent who stutters severely is more likely to develop stuttering as compared to the child of a parent who stutters only mildly. This does not appear to be the case. Overall, we know that about 15% of all first-degree relatives of someone who stutters will also stutter. This means that genetics can contribute to developmental stuttering, but is probably not the only cause.
There are relatively few differences when it comes to the personality of PWS and PWDS. PWS on average are as intelligent as PWDS, and they are not emotionally impaired or less-well adjusted than PWDS. There are also some interesting temperament studies which have found that children who stutter are more sensitive to their environments, among other factors, but we’re still researching how temperament and stuttering are related. There have been studies which have found that phonology and language skills of children who stutter may be disordered, though this is certainly not true for all children who stutter. We do know that the brains of PWS function somewhat differently from PWDS. In PWS, the right hemisphere may be overactive and prevent the left hemisphere from processing speech as it should.
So having identified the characteristics associated with stuttering, let’s move on now to a discussion of what your textbook author calls the ABCs of stuttering. Recall from your reading that stuttering involves affective, or emotional, components; behavioral, or stuttering and speech related components; and cognitive components. We’ll take a closer look at these aspects of stuttering, as each has important implications for the holistic treatment of PWS.
So first we begin with the affective components of stuttering. Recalling Sheehan’s Iceberg Analogy will help to frame this discussion. Remember that the speech characteristics associated with stuttering are only the tip of the iceberg. The internal emotional reactions of PWS to their speech can be far more devastating to PWS than speech disfluencies. Anger, guilt, and shame are commonly experienced by PWS. As speech clinicians, we must be able to help our clients who stutter to take an objective look at their emotional reactions to stuttering. Grieving for lack of typical speech fluency is also common for PWS and parents of children who stutter. Our clients may experience the stages of grief, such as denial, depression, anger, and hopefully, acceptance. But it’s important to note that the stages of grief are not linear, and that clients often regress to an earlier stage of grief at difficult times in their lives, even if they generally accept and manage their stuttering quite well.
The B part of the ABCs of stuttering involves the behavioral aspects of stuttering. I’ve listed some of these behaviors for you on the PowerPoint, and you can see how some of the behaviors, especially those on the left side of your screen, may relate more to how the person produces speech, including the core types of stuttering, and how fast they speak. On the right side of the screen are some of the more problematic behaviors that are not necessarily related to the way someone who stutters talks, but rather what they do in reaction to their stuttering. So thing like muscle tension, distracting limb movements, words substitutions, and even avoiding speaking altogether. It’s important to have fluency clients sit down and write up a list of what they do when they stutter. Some of these behaviors may be very telling and may give you a good direction to begin therapy.
On a related note, as we’re talking about behaviors, is what goes on physiologically when someone stutters, and how language production influences speech and stuttering. We know that stuttering is a disorder of the timing, integration, and coordination of respiration, phonation, and articulation. We also know that language factors can influence how we produce speech, and subsequently PWS can be more or less likely to stutter depending on what it is they’re trying to say. For example, PWS tend to have difficulty transitioning from consonants to vowels and vowels to consonants. Note that if someone stutters on the word car, like this, “c-c-car,” it’s not that they have problems producing the “k” sound, it’s that they can’t transition from the “k” sound to the rest of the word. Longer words and content words that carry more weight receive the most linguistic stress, and are also likely to cause someone to stutter. It’s difficult for someone to begin to speak and to maintain connected speech. Both of these situations have a lot of motor-linguistic complexity. So as you think about behavioral aspects of stuttering, don’t forget that PWS may be more likely to stutter in some circumstances than others.
And then finally, the cognitive aspect of stuttering relates to the thoughts that PWS have about their communication and their stuttering. The bulk of my research has investigated fluent speakers’ reactions to PWS, and there is a negative bias toward stuttering. So PWS have to deal with listener reactions to their stuttering from an early age. And we know that attitudes are shaped over time. So PWS learn to have negative attitudes about their speech and stuttering. It’s really interesting to note that we all talk to ourselves. We have an internal monologue, also known as self-talk, and this self-talk is about 75% negative. Considering that we can think about 1200 wpm, that’s a lot of self talk. So we’re our own worst enemy. This goes double for PWS. There are a variety of ways to measure communication attitudes, and attitudes toward one’s stuttering, including the S-24 scale and the CAT. One of the most beneficial things a clinician can do in therapy is to educate PWS about stuttering, and to work on reducing these negative thoughts about speech and stuttering.
Finally, to wrap up our discussion of the ABCs of stuttering, I want to emphasize that if you are treating a PWS, working on reducing stuttering is only one piece of effective therapy. You really have to focus on thoughts and attitudes associated with speech and stuttering. And to better understand these concepts that have been presented in a very academic, or theoretical way, you should definitely watch the video called Transcending Stuttering. This video has PWS talking about their journey with stuttering, and highlights the affective and cognitive components of managing stuttering. I’ve provided the link here, but you can also just do a Google Search for it. So do watch it, and enjoy.
Unit 2 characteristics of pws and the abcs of stuttering
Fluency Disorders: Unit 2 Characteristics of People who Stutter & The ABC’s of Stuttering
Characteristics of PWS Prevalence of stuttering Approximately 1% of adults worldwide have chronic stuttering Approximately 3 million people in U.S. Incidence of stuttering Refers to how many people have ever stuttered at some point in their lives Approximately 5% of the population
Onset of developmental stuttering Stuttering occurs between 2-5 years of age (average age of 33 months) Onset for girls averages 5 months earlier than boys Onset of severe stuttering tends to occur earlier than less severe stuttering Onset may be sudden or gradual and may or may not co-occur with physical or emotional stress. Neurogenic (acquired) stuttering is rare, but may accompany strokes or other neurological disorders. Psychogenic stuttering (stuttering due to a psychological disorder) is extremely rare.
Genetics Family studies suggest the following: Male relatives are at a greater risk for stuttering than females Female relatives of PWS are more likely to recover than male relatives, and they recover at an earlier age Sons of females who stutter are more likely to stutter Females require greater genetic loading in the transmission of stuttering Severity of stuttering does not impact the likelihood that stuttering will develop in family members
Personality and other differences PWS are not less intelligent than other people. Some temperamental differences may exist between PWS and PWDS; research is ongoing. But PWS do not have innate emotional problems. Some children who stutter may have concomitant phonology disorders, perhaps due to a central neurological processing deficit. More research is needed on language disorders and their relationship to stuttering. It can be difficult to tell if children who stutter have word-finding difficulties or not, due to the nature of stuttering. PWS are likely to have some degree of dysfunction in the left hemisphere, perhaps with an overactive right hemisphere.
The ABC’s of Stuttering Affective components Behavioral components Cognitive components
Affective components of stuttering PWS will experience a range of emotions about themselves and their stuttering Anger, guilt, and shame can be major emotions for PWS Objective self-awareness can be an important goal to work toward in clinic Note that PWS and the parents of children who stutter often grieve the loss of typical speech fluency and may work through stages of grief.
Behaviors Associated with Stuttering Core stuttering Secondary behaviors Repetitions Muscle tension Prolongations Limb movements meant to Blocks distract from stuttering Fast speech rate Word substitutions Avoidance behaviors including use of fillers (interjections)
Physiological/linguistic (behavioral) components of stuttering Stuttering is a disorder of the timing, integration, and coordination of respiration, phonation, and articulation. Language factors can change the way we produce speech: Difficulty with consonant-vowel transitions Increased tension and effort required for content words, longer words, and stressed syllables. Difficulty with words at the beginning of sentences and in word- initial position Connected speech more difficult to produce due to increased motor-linguistic complexity.
Cognitive components of stuttering Self-perceptions and listener reactions influence thoughts before, during, and after stuttering Attitudes and thoughts are closely related: Attitudes are learned reactions Negative self talk can prevent PWS from feeling positively about their communication abilities 75% of our cognitive thoughts (1200WPM) are negative! It is important that we measure communication attitudes and the way they may change over the course of therapy, (i.e., S-24 scale for adults and the Communication Attitudes Test for children)
Finally…. Remember that when working with clients who stutter, changing behavioral patterns in order to reduce stuttering is only one part of effective therapy. Focus on improving thoughts and attitudes toward stuttering and communication. You should watch a great video called Transcending Stuttering to better understand these points.