predisposing factors precipitating factors perpetuating factors

44

Upload: neal-hicks

Post on 21-Dec-2015

241 views

Category:

Documents


2 download

TRANSCRIPT

Page 1: Predisposing factors  Precipitating factors  Perpetuating factors
Page 2: Predisposing factors  Precipitating factors  Perpetuating factors

Predisposing factors

Precipitating factors

Perpetuating factors

Page 3: 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”

Page 4: Predisposing factors  Precipitating factors  Perpetuating factors

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

school settings

Page 5: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 6: Predisposing factors  Precipitating factors  Perpetuating factors

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)

Page 7: Predisposing factors  Precipitating factors  Perpetuating 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

Page 8: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 9: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 10: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 11: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 12: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 13: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 14: Predisposing factors  Precipitating factors  Perpetuating factors

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”

Page 15: Predisposing factors  Precipitating factors  Perpetuating factors

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,

emotional sources

Page 16: Predisposing factors  Precipitating factors  Perpetuating factors

Stuttering as an avoidance response

◦ Conflict theory of stuttering and avoidance reduction

◦ Operant conditioning◦ Classical conditioning◦ Eclectic conditioning◦ Vicarious conditioning

Page 17: Predisposing factors  Precipitating factors  Perpetuating factors

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”

Page 18: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 19: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 20: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 21: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 22: Predisposing factors  Precipitating factors  Perpetuating factors

Any combination of learning theories can be operating for the individual simultaneously

Page 23: Predisposing factors  Precipitating factors  Perpetuating factors

The behavior of the person becomes conditioned as that person watches someone else being conditioned.

Page 24: Predisposing factors  Precipitating factors  Perpetuating factors

Referred to as “Breakdown Theories” characterize the moment of stuttering as an indication of failure or breakdown in the complex coordination required for speech.

Page 25: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 26: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 27: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 28: Predisposing factors  Precipitating factors  Perpetuating factors

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”

Page 29: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 30: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 31: Predisposing factors  Precipitating factors  Perpetuating factors

Auditory function-questions regarding the basic integrity of the auditory system of stutterers have had a long history

Areas investigated

◦ Dichotic listening-to determine hemispheric specialization for speech

Page 32: Predisposing factors  Precipitating factors  Perpetuating factors

◦ 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

Page 33: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 34: Predisposing factors  Precipitating factors  Perpetuating factors

Error sensitive, error measuring, self adjusting, goal-directed mechanisms which employ feedback of the output to the place of control

Page 35: Predisposing factors  Precipitating factors  Perpetuating factors

Ear=the sensor

Vocal organs + motor innervations=the effectors

Brain=the control

Page 36: Predisposing factors  Precipitating factors  Perpetuating factors

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.

Page 37: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 38: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 39: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 40: Predisposing factors  Precipitating factors  Perpetuating factors

Research about linguistic aspects of stuttering and stutterers has contributed to concern over language development

Page 41: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 42: Predisposing factors  Precipitating factors  Perpetuating factors

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

Page 43: Predisposing factors  Precipitating factors  Perpetuating factors

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

speech

Page 44: Predisposing factors  Precipitating factors  Perpetuating factors

Shapiro, D.A. Stuttering Intervention. Texas: Pro Ed., 1999

Gregory, H. H. Stuttering Therapy: rationale and procedures. Boston: Pearson Education, 2003