SLP Fluency and Its Disorders 5 — Questions and Answers
Question 1: Which altered auditory feedback (AAF) mechanism involves playing speech back to the speaker slightly delayed in time?
- Frequency-altered feedback (FAF)
- Delayed auditory feedback (DAF) (Correct answer)
- Masking auditory feedback (MAF)
- Contralateral routing of signal (CROS)
Correct answer: Delayed auditory feedback (DAF)
DAF plays the speaker's own voice back with a short time delay (typically 50–200 ms), which often induces more fluent speech in people who stutter.
Question 2: The demands and capacities model (Starkweather) proposes that stuttering emerges when:
- Dopaminergic activity in the basal ganglia exceeds normal thresholds
- Environmental and internal demands for fluency exceed the child's capacities (Correct answer)
- A child's phonological system develops faster than motor planning
- Parental anxiety is transmitted to the child through operant conditioning
Correct answer: Environmental and internal demands for fluency exceed the child's capacities
Starkweather's model holds that stuttering results from a mismatch between fluency demands (linguistic, motoric, emotional) and the child's current fluency capacities.
Question 3: Which statement about the genetics of stuttering is most accurate?
- Stuttering follows a simple autosomal dominant inheritance pattern
- Variants in genes related to lysosomal enzyme pathways have been implicated (Correct answer)
- Stuttering has no heritable component and is entirely environmentally determined
- Only monozygotic twin concordance supports a genetic contribution
Correct answer: Variants in genes related to lysosomal enzyme pathways have been implicated
Research has identified variants in GNPTAB, GNPTG, and NAGPA genes (involved in lysosomal enzyme targeting) in familial and sporadic cases of stuttering.
Question 4: During a stuttering moment, the laryngoscopic finding most commonly observed is:
- Abductor spasm causing a wide-open glottis during attempted phonation
- Tight adductor hypercontraction creating a pressed, closed glottis (Correct answer)
- Paradoxical vocal fold movement similar to exercise-induced laryngeal obstruction
- Flaccid vocal folds with breathy airflow throughout the block
Correct answer: Tight adductor hypercontraction creating a pressed, closed glottis
Laryngoscopic studies show that during blocks, the vocal folds are often hyperadducted (pressed tightly together), impeding phonation initiation.
Question 5: A school-age child who stutters avoids reading aloud in class and refuses to answer the phone. These behaviors are best addressed through:
- Fluency shaping drills focused solely on slow speech rate
- Desensitization hierarchies and voluntary stuttering to reduce avoidance (Correct answer)
- Referral to special education for reading disability evaluation
- Parent training to discourage the child from speaking situations that cause anxiety
Correct answer: Desensitization hierarchies and voluntary stuttering to reduce avoidance
Avoidance behaviors are addressed through systematic desensitization and voluntary stuttering, which reduce fear and shame by confronting rather than escaping feared situations.
Question 6: Which statement best describes the relationship between stuttering and language formulation?
- Stuttering is solely a motor disorder with no relationship to language processing
- Increased linguistic complexity consistently increases stuttering frequency in school-age children and adults (Correct answer)
- Simpler syntactic structures always produce more stuttering due to reduced cognitive load
- Stuttering occurs independent of utterance length or syntactic complexity
Correct answer: Increased linguistic complexity consistently increases stuttering frequency in school-age children and adults
Research shows that longer, more syntactically complex utterances are associated with higher stuttering frequency, consistent with increased linguistic planning demands.
Question 7: The term 'fluency shaping' refers to therapy approaches that:
- Teach clients to stutter more easily by modifying the moment of stuttering
- Systematically reshape the entire speech pattern to establish pervasive fluency from the ground up (Correct answer)
- Focus exclusively on reducing secondary behaviors through behavioral extinction
- Combine acceptance-based strategies with limited motor practice
Correct answer: Systematically reshape the entire speech pattern to establish pervasive fluency from the ground up
Fluency shaping approaches (e.g., Precision Fluency Shaping, Camperdown Program) rebuild speech production using targets like gentle onset, easy airflow, and slow rate to establish fluency throughout the speech system.
SLP Fluency and Its Disorders 5
Which altered auditory feedback (AAF) mechanism involves playing speech back to the speaker slightly delayed in time?