Language Based Dysfluency

2. LANGUAGE BASED
DYSFLUENCY
Maliha Nizam
Rahat Umer
Shumaila Akhtar
Asma Agha
Yasmeen Jamil
Wajeeha Fatima

3. INTRODUCTION OF
DYSFLUENCY
Maliha Nizam

4. STUTTERING
• Stuttering is a disruption in the
forward flow of speech that is
typically accompanied by physical
tension, secondary behaviors,
avoidance of communication, and/or
negative reactions on the part of the
speaker.

5. TYPES OF STUTTERING
Disruptions in the forward flow of speech may consist of:
• Repetitions: repeating of a syllable, sound, word, or phrase
(e.g., “li-li-li-like this”)
• Prolongations: holding onto a sound for an extended
period of time (e.g, “llllike this”)
• Blocks: no sound is produced then a “burst” of tension is
released when the speaker if able to vocalize (e.g., “----like
this”)
• Interjections: extra words (e.g, “um, uh, like”)
• Revisions: speech is revised during and utterance (e.g., “I
have to go…I need to go to the store.”)

6. WILL A YOUNG CHILD
OUTGROW STUTTERING?
• Many children between the ages of 2-5 go
through a normal period of disfluent
speech as their expressive language
develops.
• This is a normal part of speech and
language development for most children.
• While many children recover from periods
of normal dysfluency, children are far less
likely to recover from stuttering without
intervention.

7. WHAT IS THE DIFFERENCE BETWEEN
NORMAL DYSFLUENCY AND STUTTERING?
• Normal dysfluency tends to consist
primarily of whole-word and phrase
repetitions.
• Children may also exhibit a higher number
of speech interjections as they develop
their language formulation abilities.
• Stuttering typically consists of speech
dysfluencies along with tension, struggle,
secondary behaviors, or negative
reactions to dysfluencies (e.g.,
frustration).

8. WHAT IS THE DIFFERENCE BETWEEN
NORMAL DYSFLUENCY AND STUTTERING?
• Risk factors for young children
(between 2-6) include a family history
of stuttering, male gender, presence
of other speech/language deficits,
disfluent speech that has persisted
for 6-12 months or more, or negative
reaction to dysfluency.
• Children with any of the above risk
factors should be evaluated by a
speech-language pathologist.

9. WHAT ARE TREATMENT OPTIONS
FOR PEOPLE WHO STUTTER?
• For younger children (ages 2-6), treatment is
likely to include a combination of indirect
(environmental modifications) and direct
(teaching the child to modify his speech)
treatment.
• For this population, the ultimate goal is typically
to eliminate stuttering or reduce it to a mild level.
• For older children (age 7 and above) and adults,
the goals of treatment shift to successful
management of stuttering.

10. WHAT ARE TREATMENT OPTIONS
FOR PEOPLE WHO STUTTER?
• This may include teaching strategies such as
speech modification and stuttering modification
strategies, increasing knowledge of stuttering,
and reducing negative reactions to stuttering.
• The ultimate goal for older children and adults is
to ensure that the person who stutters has the
ability to manage their stuttering so that it does
not interfere with their life or prevent them from
communication with people or participating in
social situations.

11. WHO CAN HELP?
• It is important to remember that parents do not
cause stuttering.
• Still, there are several things you can do to help
your child learn to speak more fluently.
• Parents of young children can help by:
(i) providing a model of an easier, more fluent
way of speaking,
(ii) reducing demands on the child to speak,
particularly demands to speak fluently, and
(iii) minimizing the time pressures a child may
feel when speaking.

12. DIFFERENCE BETWEEN
NORMAL LANGUAGE AND
DYSFLUENCY
Shumaila Akhtar

13. NORMAL SPEECH AND LANGUAGE
• Reach major milestones in predictable stages by 6
years of age. The exact pace at which speech and
language develop varies among children, especially
the age at which they begin to talk.
• Although speech and language continue to develop
through adolescence, children usually
• Communication skills are often categorized as
receptive language and expressive language.
Receptive language is the understanding of words
and sounds. Expressive language is the use of
speech (sounds and words) and gestures to
communicate meaning.
• Developmental milestones can be described
according to age.

14. BIRTH TO AGE 1:
• Babies start to process the communication
signals they receive and learn to vary their
cries to communicate their needs. During the
first months of life, a baby is usually able to
recognize his or her mother's voice and
actively listen to language rhythms. By 6
months of age, most babies express
themselves through cooing. This progresses
to babbling and repeating sounds.
• By the first birthday, babies understand and
can identify each parent, often by name
("mama," "dada"). They repeat sounds they
hear and may know a few words.

15. Age 2:
• After the first birthday through age 2, a toddler's speech and
language foundation grows rapidly. During that time, 1-year-
olds learn that words have meaning. They point to things they
want, and often use one- or two-syllable sounds, such as
"baba" for "bottle." By age 2, children usually can say at least
50 words and recognize the names of many objects, including
those in pictures. They also understand simple requests and
statements, such as "all gone.“
• They usually can name some body parts (such as arms and
legs) and objects (such as a book). Not all their words are
intelligible; some are made-up and combined with real words. In
addition to understanding simple requests, they can also follow
them (such as "put the book on the table"). They should be able
to say at least 50 words. They usually can say about 150 to 200
words, some of which are simple phrases, such as "want
cookie." Pronouns (such as "me" or "she") are used, but often
incorrectly.
• Some children are naturally quieter than others. But a child who
consistently uses gestures and facial expressions to
communicate should be evaluated by a doctor. These children
are at increased risk for having speech problems.

16. Age 3:
• More sophisticated speech and language
develops from ages 3 through 5. By age 3,
most children learn new words quickly and
can follow two-part instructions (such as
"wash your face and comb your hair"). They
start to use plurals and form short complete
sentences. And most of the time their
speech can be understood by others
outside of their family. "Why" and "what"
become popular questions.

17. Age 4:
• Most 4-year-olds use longer
sentences and can describe an event.
They understand how things are
different, such as the distinction
between children and grown-ups.
Most 5-year-olds can carry on a
conversation with another person.

18. LANGUAGE DISFLUENCY
• A dysfluency is a break or
interruption in otherwise normal
speech. Depending on the degree of
dysfluency involved, it may slip by
without notice, or make someone
hard to understand. In some cases,
dysfluency is also combined with
stuttering, which can make someone
almost unintelligible, and it can also
be very frustrating for the speaker.
Almost everyone uses dysfluencies
in their speech

19. LANGUAGE DYSFLUENCY
• Dysfluency can also take the form of
sentence repair, as someone recognizes
that an error has been made and
backtracks to fix it. Humans are
surprisingly good at fixing errors on their
own, so sentence repair can draw
attention to an error which might have
otherwise slipped past without notice.
Sentence repair often involves a partial
repeat, as in "the cats wants to sit on
lap...er, rather the cat wants to sit on your
lap."

20. FACTORS OF
DYSFLUENCIES
Rahat Umer

21. • ND is the result of an identifiable
neuropathology in a speaker with no
history of fluency problem prior to the
occurrence of the pathology.
• Often speech dysfluencies appear at
onset, or progressive disease.
• Neurologic dysfluencies are often
different in form from those presented
by stutters.
• Like articulation dysphensis and
dysprosody disorder

22. • The different dysarthrias that can result
from the neuromotor speech system often
include dysfluencies and other
communication deficits like articulation.
dysphonias and dysprosody, disorder which
occur as infrequently in stutterers as they
do ii: the general

23. • The aphasic patient who experiences
dysnomia or dementia may display
highly disfluent speech while
searching for words. Interjections,
unusual pauses, and circumlocution
are all probable.

24. • Reports that drugs which affect the basal
ganglia may affect speech fluency. She
report three studies that tend to link
disfluent behavior with concurrently
administered medications in clients with
no previous history of disfluent speech.

25. • Psychogenic dysfluencies may be
grouped into three categories.
• Emotionally based dysfluencies
• Manipulative dysfluency
• Malingering
• Language delay

26. This is a dysfluency that is attributed to the development
of linguistic sophistication.
The main root of the problem here would be language
problems, which would require language based therapy
rather than fluency-based therapy.
Mixed Fluency Failures
These are fluency failures that are characterized by
overlapping causative factors. Speech pattern observed is
the result of a blend of two or more factors/dysfluency.

27. ASSESSMENT Of LANGUAGE
BASED DYSFLUENCY
Asma Agha

28. Introduction
• Individuals suspected of having a fluency
disorder are referred to a speech-language
pathologist (SLP) for a comprehensive
assessment.
• A thorough assessment focuses on
components known to accompany fluency
disorders (e.g., behavioral, cognitive, and
others).
• Assessment is individualized and based on
the person's communication environment.

29. Comprehensive Assessment
A comprehensive assessment typically includes
 relevant case history, including
– medical history;
– general development;
– speech and language development, including frequency of
exposure to all languages used by the child and the child's
proficiency in understanding and expressing himself/herself in
all languages spoken;
– family history of stuttering or cluttering;
– description of characteristics of dysfluency and rating of
severity;
– age of onset of dysfluency and patterns of dysfluency since
onset (e.g., continuous or variable) and other speech and
language concerns;
– previous treatment experiences and treatment outcomes;
– information regarding family, personal, and cultural perception
of fluency;

30. Comprehensive Assessment
 consultation with family members,
educators, and other professionals,
including their observations of fluency
variability (when dysfluencies are noticed
most and least) and impact of dysfluency;
 real-time analysis or analysis based on
review of a taped speech sample, if
provided by a parent or teacher,
demonstrating representative
dysfluencies beyond the clinic setting;

31. Comprehensive Assessment
• review of previous evaluations and
educational records;
• assessment of speech fluency (e.g.,
frequency, type, and duration of
dysfluencies; presence of secondary
behaviors; speech rate; and
intelligibility) in a variety of speaking
tasks (e.g., conversational and
narrative contexts);

32. Comprehensive Assessment
• stimulability testing in which the child is asked to
increase pausing and/or decrease speech rate in
some other way-a reduction of overall rate of
speech typically assists with a reduction in
cluttering symptoms;
• assessment of the impact of stuttering or
cluttering-including assessment of the emotional,
cognitive, and attitudinal impact of dysfluency-for
information concerning speaking frequency and
socialization;

33. Comprehensive Assessment
• assessment of other communication
dimensions, including speech sound
production, receptive and expressive
language development, pragmatic
language, voice, hearing, and oral-motor
function/structure;
• determination of individual strengths,
coping strategies, and available resources
that may facilitate the treatment process.

34. Assessment Evaluation
• diagnosis of a fluency disorder,
including differential diagnosis of
type of fluency disorder (stuttering,
cluttering, or both) and between
fluency disorder and reading
disorders, language disorders,
and/or speech sound disorders;
• descriptions of the characteristics
and severity of the fluency disorder;

35. Evaluation
• judgments on the degree of impact the
fluency disorder has on verbal
communication and quality of life;
• determination if the child will benefit from
treatment;
• determination of adverse educational,
social, and vocational impact;

36. Evaluation
• recommendations for treatment;
• consultation with and referral to
other professionals as needed;
• ongoing education about stuttering
or cluttering for family, school
personnel, and other significant
people in the child's environment.

38. “The measurement of attitudes and
attitude change
are essential parts of successful
treatment!!”

39. CONSIDERATION
Yasmeen Jamil

40. CONSIDERATION:
• Frequency of dysfluencies
• types of dysfluencies
• duration of dysfluencies
• secondary behaviors
• high risk environmnet
• high risk family history
• high risk fluent speech

41. DECISION ABOUT
TREATMENT:
• Decision 1: Explore your level of
confidence in treating stuttering
• Decision 2: Establish the long-term goal
of treatment
• Decision 3: Choose a philosophical
approach to treatment

42. • Decision 4: Design a system of
documentation
• Decision 5: Consider factors over which
you have minimal control
• Decision 6: Establish realistic short-
term goals

43. • Decision 7: Examine reasons for slow progress or
failure to achieve goal.
• Decision 8: Examine the clinician’s role in success of
intervention
• Decision 9: Determine whether stabilization of
progress has occurred.
• Decision 10: Examine motivations for termination of
treatment

44. TREATMENT
Wajeeha Fatima

45. OBJECTIVES OF THERAPY:
• Help child feel comfortable talking about
stuttering
• show how stuttering can be changed to
make talking easier
• teach child to ‘slide’ into difficult words
• teach child to ‘keep their voices going’
once they begin a sentence

46. PROCEDURE FOR THERAPY:
• Reduce avoidance by
reinforcing stuttering
• child is reinforced for
communicating
regardless
of fluency
• child is reassured that
speech is sometimes
hard for everyone but
that it is no big deal to
have trouble once in a
while

47. TREATMENT APPROACHES
Treatment approaches for preschool children who
stutter include:
INDIRECT: Indirect treatment focuses on counseling
families about how to make changes in their own
speech and how to make changes in their child's
environment. These modifications are used to
facilitate speech fluency and may include reducing
communication rate, using indirect prompts rather
than direct questions, and recasting/rephrasing to
model fluent speech.

48. Direct
Direct treatment focuses on changing the
child's speech in order to facilitate
fluency. Direct treatment approaches
may include speech modification and
stuttering modification strategies to
reduce dysfluency rate, physical
tension, and secondary behaviors

49. • Operant
• Operant treatment incorporates principles of operant
conditioning and uses a response contingency to
reinforce the child for fluent speech and redirect
disfluent speech (the child is periodically asked for
correction). With this approach, parents are trained to
provide verbal contingencies based on whether a
child's speech is fluent or stuttered In this way,
positive reinforcement is used to increase or
strengthen the response of fluency (the desired
behavior). Operant approaches operate within a
framework of stuttering as learned behavior

50. Multifaceted treatment goals
 provide family with accurate
information
 help family modify environmental
factors that may stress child’s fluency
 help family learn new ways to
communicate to better match child’s
current level of development

51. Multi-modal procedures
– identify successes and problem areas
– choose a target area
– brainstorm ways to address the target
– practice the skill
– utilize the skill with the child in the
clinic
– carry over the skill to home

52. Utilize a Fluency Enhancing Model (FEM) to Meet
Child’s Needs
Facilitate a rate reduction in the child’s speech
Reduce other potential demands
Set up talking time rules
Support/expand the child’s positive image of self

53. Preschool child who stutters
• Intervening
with the
child’s
family

54. • A comprehensive treatment approach for school-age
children and adolescents includes multiple goals
based on individual needs, focused on increasing
fluency as well as other goals, such as "increasing
acceptance of stuttering and of being a person who
stutters, reducing secondary behaviors, minimizing
avoidance, improving communication skills,
increasing self-confidence, managing bullying
effectively, and ultimately, minimizing the adverse
impact of stuttering on the child's life"

55. • PLANNING TREATMENT OF
STUTTERING FOR YOUNG
CHILDREN

56. • Disfluent behavior becomes more complex as fear of speaking,
anxiety, and resulting avoidance increases. Similarly,
communication apprehension and shame may develop as the
child experiences greater difficulty with communication.
Treatment may include reduction in the child's and others'
negative reactions to stuttering For example, clinicians may use
treatment strategies to reduce bullying through desensitization
exercises and by educating the child's peers about stuttering.
Many of the treatment options are used in combination for
optimal outcomes. For example, counseling a student to accept
or tolerate embarrassment can facilitate the desensitization
needed to reduce the use of word avoidance. As word
avoidance decreases, the teen is better able to communicate
effectively, and, as fear reduces, the resultant reduction in
physical tension and struggle enhances observable fluency.

57. Additional strategies that may be
useful
– modeling normal dysfluencies for child
– teaching child to use slow rate
– More normal volume
– Easy vocal onset