Stuttering or dysphemia is a impaired speech rhythm, inappropriate for the subject's mental age
There are repetitions of syllables, prolongation of sounds or syllables, blockages of the emission, or production of words with excessive tension.
- 1 Associated disorders
- 2 Prevalence of stuttering in the population
- 3 Beginning and course of dysphemia
- 4 Family pattern
- 5 Differential Diagnosis
- 6 Evaluation
Dysphemia can be accompanied by movements that are not consistent with the context, such as strong blinking, grimaces on the face, or head movements.
Stuttering increases the anxiety of the subject who suffers it and in turn, stress or anxiety exacerbates stuttering.
There may be low self-esteem and changes in social activity.
Phonological Disorder and Expressive Language Disorder occur more frequently in people who suffer from stuttering.
Prevalence of stuttering in the population
In prepubertal children the frequency is 1% and falls to 0.8% in adolescence. It occurs with a frequency three times higher in men than in women.
Beginning and course of dysphemia
The onset usually occurs between 2 and 7 years, with a maximum around 5. 98% of cases begin before 10 years. The onset is usually insidious. Most often, it starts with repetitions of initial consonants. More than 80% of the subjects are recovered, of which up to 60% do so spontaneously and before the age of 16.
The risk among first-degree relatives is 3 times higher than in the general population. In stuttering boys 10% of daughters and 20% of sons can suffer from the disorder.
It is distinguished from normal verbal fluency anomalies because they usually disappear instead of settling in the subject's speech style.
- Identification of the different types of errors in the diction (Repeating syllables, partitioning of words, interjections, blockages, etc.)
- Identification of grammatical, prosodic and lexical-semantic errors.
- Use of severity indicators (Words per minute, stuttered words per 100 issued).
- Use of records on audio or video tapes in the evaluation of the previous points
- E.M.G. (establish level of involvement of tongue, face, neck, etc.)
- Breathing (find out if the level of air when speaking exceeds the minimum reached at rest; Number of words emitted between two pauses; inspire atonas)
- Record the previous points in silence, with single words, in reading and text, and in spontaneous conversation.
Evaluation of discriminative stimuli
- Identification of stimuli and situations that cause or increase stuttering (telephone, certain people, specific topics, specific words, etc.)
- Evaluation through: interview, questionnaires, self-registration, observation. in laboratory and natural situations.
- Evaluation of other characteristics
- Side effects of stuttering: shyness, poor school performance, personality.
- Motivation to treatment
- Difficulty or ease of the subject to use speech patterns that affect the appearance of the problem (syllable, rhythmic speech, whispering, etc.)
Explanation of dysphemia
After a careful evaluation, an objective stuttering index is established, a description of the type, and a list of situations in which the problem is caused or aggravated, an explanation is offered to the subject or his parents, of how their problem occurs.
Specification of specific goals
- You must explain to the client the process to follow in the treatment, with the specific goals to be achieved in each of the steps of the treatment.
- Explain the need to establish a continuous evaluation, due to different incidents that may arise throughout the treatment, among which regression must be taken into account (decrease in symptoms once treatment has started); adaptation to therapy; the placebo effect
Learning a non-stuttering speech pattern (PHNT)
- The subject should be taught to talk in a way that doesn't make stuttering mistakes, or that in case you have committed one. Rest assured that you can start speech again without errors.
- Use the molded to get to learn the PHNT with an acceptable speech speed, reinforcing the appropriate executions in the different frequencies of speech speed.
- During this phase, it is also advisable to follow the mistakes made by the subject and make a behavior overlearning adequate, until you are able to realize the actions prior to your stuttering and avoid it.
- In this phase, the subject will only use the pattern he is learning in the consultation or when he is alone, or recording on a tape recorder.
Shift to a prosodic speech pattern
- Quick changes from a PHNT to a normal type of speech in the consultation until you can change at will, when you perceive that you can make a mistake.
- Use of the PHNT outside the sessions, starting it with a particular person, in a given situation, that constitutes an easy level of execution, to later go on to talk with other people and in other situations with greater difficulty. It is important that you record the number of occasions in which you are forced to resort to the non-stuttering speech pattern, so that he himself can observe if his performance improves, and that the therapist can help you solve the possible difficulties that arise.
- Generalization of the slow pattern to difficult situations
- In this phase the subject is asked to use the non-stuttering speech pattern in situations that were previously especially difficult.
- Assertiveness training is performed in cases that are necessary.
- A number of exercises are established for the time between sessions in which the subject must use a prosodic speech pattern, be able to prevent errors, and be able to recognize them to serve as a discriminative stimulus to return to the non-speech pattern. stutterer
Establishment of self-control of the pattern of had and monitoring
The subject is trained in the self-control of his speech, instructing him in self-observation techniques. goal setting and self-reinforcement.
Sessions are spaced and they deal with possible problems.
All Psychological Therapies