fluency disorders in asd population jennifer lozier m.s. ccc-slp

16
S Fluency Disorders in ASD Population Jennifer Lozier M.S. CCC-SLP

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Fluency Disorders in ASD Population

Jennifer LozierM.S. CCC-SLP

What You Will Learn

Introduction and overview

What we do and don’t know about the presence, causes, and treatment of fluency disorders in……….

Cognitive features and potential contributors to disfluency in ASDs

Assessment and treatment

Stuttering-Like Disfluencies (SLDs)

Repetitions of:

Single-Syllable whole words (with tension)

Sounds or syllables (part-word repetition)

Prolongations

Blocks/Tense Pauses

Broken Words

“I-I-I”

“d-d-uck” “Spi-spiderman”

“sssometimes”

“st---uck”

“bro—ken”

Nonstuttering-Like Disfluencies

Repetitions of:

Multisyllable whole words Phrases

Revisions

Interjections/Fillers

“open-open” “I want—I want”

“I like unicorns, no, I mean dragons”

“um, uh, er, well, like, so”

Cluttering

Cluttering is a fluency disorder wherein segments of conversation1 in the speaker’s native language2 typically are perceived as too fast overall3, too irregular4, or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (a) excessive “normal” disfluencies5; (b) excessive collapsing6 or deletion of syllables; and/or (c) abnormal pauses, syllable stress, or speech rhythm.

St. Louis and Schulte (2011)

Atypical Disfluencies

Final sound and syllable repetitions “light-t” “train-ain”

Between syllable insertions “way-hay”

Within-word breaks “op—en”

Final sound prolongations “thissss”

Disfluency Noted in Individuals with ASD

Simmons and Baltaxe (1975) documented “hesitations, repetitions, prolongations, nonfluencies” (SLDs and NSLDs)

Klin, Volkmar, Sparrow (2000): “Dysfluencies are...common” (p. 378) in Asperger Syndrome” (AS)

Shriberg et al. 2001: 67% male speakers with Asperger’s and 40% with High-functioning autism: “inappropriate or nonfluent phrasing on more than 20% of utterances” (p. 1109)

“These data suggest that many speakers with autistic syndromes produce notably disfluent speech” (p. 1109)

Word Final Disluencies

Have been noted more in populations within a diagnostic category other than stuttering, such as children and adults with neurological insults

Commonly found in kids with other diagnoses, particularly those with autism, ADHD

Seems to be a growing consensus that regardless of diagnosis (or lack thereof), the kids with these issues also have other (sometimes subtle) pragmatic language issues

What We Know So Far

Disfluency (more and less typical) and stuttering (more and less typical) happen in Autism Spectrum Disorders

The same patterns have been seen in different individuals in the contexts of reading, repetition tasks, and conversation but there are individual differences as well

Awareness seems to be on a continuum Avoidance behavior – not aware at all

Cognitive Features of Autism

Working memory Williams et al. (2005): lack of deficits, more in processing

complex tasks Joseph et al. (2005): no use of verbal mediation to monitor goal-

related information in working memory

Self-monitoring Response inhibition (Agram et al., 2010)

Mixed findings for behavioral response inhibition Consistent findings for difficulties with eye movement inhibition

Preservation ((Rehfeldt & Chambers, 2003)

Treatment of verbal perseveration in cognitive approach

Cognitive Features That May Contribute to

Disfluency

Typical Disfluency Language factors?

Stuttering-like Disfluencies Neurological factors

Atypical Disfluencies Perseveration, pragmatic/perspective taking, language

organization

Cluttering Disinhibition, working memory

Treatment of Fluency Disorders in Autism

Stuttering (Brundage et al. 2013) Fluency Rules Program- dramatic reduction of stuttering Someone on Spectrum is very rule-based

Speak slowly, don’t repeat a word more than once, put pauses in speech, say each sound short

Word Final Disfluencies Sometimes go away without intervention (maturation and

executive functioning) Have client address them and suppress them (put in a pause or

pause and visualize to give more time to formulate thoughts- language organization or working memory issue?)

Application

Every case is an individual one, not every case is the same.

Be on the lookout for: Types of disfluencies Traditional stuttering or atypical Negative feelings and attitudes by the student

Application

Some children with ASD will not hear their disfluencies or want anything to do with treatment

On the other hand, some will understand once you bring it to their awareness

Cluttering Treatment

Proactive Use more pauses, emphasize sounds before

communication breakdown happens

Reactive Look for signs your communication partner has

misunderstood you and revise your sentence

References

“Fluency Disorders in the ASD Population” Presented by Kathleen Scaler Scott, Ph.D., CCC-SLP