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Adolescent Brain: Speech disorders

Sue, David
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T ang

on 20 November 2013

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Transcript of Adolescent Brain: Speech disorders

Definition &
Diagnostic Criteria
Neuroscience Research
Stuttering:
Why it is important?
Underlying causes
References & Resources
Teaching Strategies
Stuttering
The Adolescent Brain: Implications for Instruction
EDU5537HS
Spring 2013
Sue Tang
David McClary
What would you do?
What does it feel like to be a student who experiences stuttering?
Preemptive approach
Minds On
What is stuttering and what do you know about it?
(Refer to personal experiences, media portrayal)
Stuttering affects 5% of children
Linked to anxiety, academic and social performance
Normally manifests itself around the age of 3
In about 1% of the adult population over 15, stuttering develops into Persistent Developmental Stuttering (PDS)
4 times as many males as females develop PDS
Fill in words or phrases they are having a problem with
Have a private talk and ask them how they would like to be treated while they are speaking
Tell a student to “Relax” or “Take a deep breath”
Tell a student to “Slow down” during while they are talking
Ask a student who stutters to reduce the um’s and uh’s in their speech
Allow the student the time to finish what they are trying to say without interrupting
Video:
Genetics
Agenda
Minds On
Definition/Diagnostic
Underlying Causes
Treatment
Teaching Strategies
Questions/Comments
References
is a multifactorial influent speech disorder defined by frequent prolongations, repetitions, or blocks of spoken sounds and/or syllables.
Treatment
Tongue and larynx modification
Behavioural treatment
Qualified speech-language pathologist
Speech therapy (behavioral and cognitive methods)
Group treatment
Provides support, facilitates confidence
Safe space to narrate struggle with stuttering
Change our attitudes and behaviour
Increase awareness and understanding
Acknowledge feelings and reactions
Create a relaxed environment
Promote self-expression
Resources:
http://www.stutteringhelp.org/
http://www.westutter.org/
(National Stuttering Association)
http://www.stammeringcentre.org/
facial grimacing
tremors of muscles involved in speech
excessive eye blinks
avoidance of words or situations which exacerbate stuttering episodes
Research now indicates that stuttering is likely a multifactorial process with a physiologic etiology.
Developmental Stuttering
Neurogenic Stuttering
Usually caused by injury or disease to the central nervous system
Cerebrovascular accident, with or without aphasia
Head trauma
Ischemic attacks
Tumors, cysts, and other neoplasms
Degenerative diseases
Other diseases, such as meningitis, Guillain-Barré Syndrome, and AIDS
Drug-related causes such as side-effects of some medications
Most common form of stuttering
Begins in childhood while young children are still learning speech and language skills
A total of 80-90% of developmental stuttering begins by 6 years of age
Affects approximately 2-5% of children.
Spontaneous recovery occurs in about 75% of individuals
Approximately 60% of children who stutter, the symptoms will remit by 16 years of age
Treatment requires early intervention
Stuttering:
Kids talk about stuttering
Diagnostic Criteria
Coexistent Symptoms:
Video:
Characteristics
Questions/Comments?
A. Disturbance in the normal fluency and time patterning of speech (inappropriate for the individual's age), characterized by frequent occurrences of one or more of the following:

(1) sound and syllable repetitions
(2) sound prolongations
(3) interjections
(4) broken words (e.g., pauses within a word)
(5) audible or silent blocking (filled or unfilled pauses in speech)
(6) circumlocutions (word substitutions to avoid problematic words)
(7) words produced with an excess of physical tension
(8) monosyllabic whole-word repetitions (e.g., "I-I-I-I see him")

B. The disturbance in fluency interferes with academic or occupational achievement or with social communication.

C. If a speech-motor or sensory deficit is present, the speech difficulties are in excess of those usually associated with these problems.

-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association
Case Study Analysis
Cerebral blood flow was increased in premotor, primary motor and somatosensory cortices on the left
Increases in the primary and secondary auditory cortices were greater on the right in stuttering subjects
Case Study Analysis
19 males with PDS and 16 controls
Increased # of suprasylvian gyral banks on right hemisphere of those who stutter (Broca's area)
Increased sulcal connectivity with the right Sylvian fissure in the PDS subjects
Genetic factors are thought to be involved in many cases of stuttering, accounting for about 50-80% of stuttering cases based on twin and family studies.

No single region of the brain has been identified as the etiology of developmental stuttering, but imaging studies have implicated brain asymmetry, extra sulci, or reduced white matter changes involved in areas involved in speech or articulation.
Currently no cure for stuttering, but there are a variety of treatments
None approved by the FDA to treat stuttering
Lowers dopamine by blocking D2 receptors in the striatum
Haloperidol, Risperidone, Olanzapine, Asenapine, Aripiprazole, Pagoclone
Side effects: dysphoria, sexual dysfunction, extrapyramidal concerns, risks of tardive dyskinesia, galactorrhea, amenorrhea, hyperprolactinemia, weight gain and triglyceride elevation.
Pharmacological treatments
Historical treatments
Therapy
Assistive Technology
Electronic devices to help control fluency
Replays and delays speech
Fluencymaster, iPad application
Modify rate of your own speech, model fluent speech
Pause before speaking and answering
Allow student to finish speaking
Student who stutters is observant, so be aware
Listen attentively and respond appropriately
Communication breakdown = students mimic and tease
Address the issue, discuss with students, classroom expectations, community circle
Role play/Read Alouds/resources
Equip student with strategy to deal with teasing/bullying
Tell them to slow down
Force student to speak
Interrupt
Ask them to stop
Ask them to start over
Goal is for student to embrace speaking
Teasing
Don't
In the classroom
Modify linguistic complexity when student is struggling (restate into simpler more common words)
Discuss strategy with student (eg. prepare to answer questions)
Other ways of expressing oneself (visually, music, chorus reading)
Sulcal Connectivity
White Matter Abnormalities
Cerebral Blood Flow
Classifications

Exhibits more than two disfluencies per one hundred words
Exhibits part-word repetitions and single-syllable whole-word repetition
May exhibit more than two repetitions may occurrence
Does not exhibit tension about their speech


Exhibits the presence of tension and “hurry” in the stuttering
The emergence of prolongations takes place
Repetitions may be rapid and abrupt, and pitch and loudness rise
Facial tension and difficulty initiating airflow or voicing may occur
May show signs of awareness or their stuttering and may be quite frustrated by it
May begin using escape behaviours- such as head nods or eye blinks


All of the preceding characteristics plus avoidance behaviours
Avoidance of words and situations begin to appear
Feelings of shame and fear also emerge.


Typically fourteen years or older and exhibit all the preceding characteristics
Summary
Thumbs up, thumbs neutral, thumbs down
Think/Pair/Share
Video:
Student Feelings
Borderline Stuttering:
Beginning Stuttering:
Intermediate Stuttering:
Advanced/Persistent Stuttering:
Case Study Analysis
20 subjects, 14 controls, age 14-27
White matter disconnection in left hemisphere in central fissure
Abnormalities in ventral premotor cortex (frontal lobe)
Could intefer with auditory and sensormotor integration
Increase of white matter in right hemisphere
Multi-factorial inconclusive studies
Brain asymmetry
Extra sulci
White matter differences
References

Soo-Eun Chang, Ph.D. August 23, 2011 Using Brain Imaging to Unravel the Mysteries of Stuttering, Cerebrum, The Dana Foundation, http://www.dana.org/news/cerebrum/detail.aspx?id=33796

Christian Büchel, Martin Sommer, What Causes Stuttering?

Büchel C, Sommer M (2004) What Causes Stuttering? PLoS Biol 2(2): e46. doi:10.1371/journal.pbio.0020046

American Speech-language-hearing Association, Stuttering, http://www.asha.org/public/speech/disorders/
stuttering.htm

Christian Kell et al (2009), How the brain repairs stuttering , Brain A Journal of Neurology Aug 26, 2009

M. Boldrini (2003) Paroxetime efficacy in stuttering treatment. International Journal of Neuropsychology 311-312

Anne Foundas (2001), Are the Brains of People who Stutter Different? The Stuttering Foundation, http://
www.stutteringhelp.org/are-brains-people-who-stutter-differentRe
Yairi E, Ambrose N. 1992. Onset of stuttering in preschool children: Selected factors. J Speech Hear Res. 35:782--788.

Watkins KE, Vargha-Khadem F, Ashburner J, Passingham RE, Connelly A, Friston KJ, et al. MRI analysis of an inherited speech and language disorder: structural brain abnormalities. Brain 2002b; 125: 465–78.

Giraud AL, Neumann K, Bachoud-Levi AC, von Gudenberg AW, Euler HA, Lanfermann H, et al. Severity of dysfluency correlates with basal ganglia activity in persistent developmental stuttering. Brain Lang 2007.

Sommer M, Koch MA, Paulus W, Weiller C, Buchel C. Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet 2002; 360: 380–3.

Chang, S., Horwitz, B., Ostuni, J., Reynolds, R., & Ludlow, C. (2011). Evidence of Left Inferior Frontal--Premotor Structural and Functional Connectivity Deficits in Adults Who Stutter. Cerebral Cortex, V21(11), 2507-2518.

Chang, S., Kenney, M., Loucks, T., & Ludlow, C. (2009). Brain activation abnormalities during speech and non-speech in stuttering speakers. NeuroImage, 2(46), 201–212.

Fox PT, Ingham RJ, Ingham JC, Hirsch TB, Downs JH, Martin C, et al. A PET study of the neural systems of stuttering. Nature 1996; 382: 158–61.

Kraft, S., & Yairi, E. (2012). Genetic Bases of Stuttering: The State of the Art, 2011. Folia Phoniatricia Logopaedica, 1(64), 34–47.

Maguire, G., Yeh, C., & Ito, B. (2012). Overview of the Diagnosis and Treatment of Stuttering. Journal of Experimental and Clinical Medicine, 4(2), 92-97.

Cykowski, M., Kochunov, P., Ingham, R., Ingham, J., Mangin, J., Riviere, D., et al. (2008). Perisylvian Sulcal Morphology and Cerebral Asymmetry Patterns in Adults Who Stutter. Cerebral Cortex, 1(18), 571--583.
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