Tipologia das rupturas de fala e classes gramaticais em crianças gagas e fluentes*** - PDF

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Fabiola Juste* Claudia Regina Furquim de Andrade** Tipologia das rupturas de fala e classes gramaticais em crianças gagas e fluentes*** Typology of speech disruptions and grammatical classes in stuttering

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Fabiola Juste* Claudia Regina Furquim de Andrade** Tipologia das rupturas de fala e classes gramaticais em crianças gagas e fluentes*** Typology of speech disruptions and grammatical classes in stuttering and fluent children *Fonoaudióloga. Doutora em Semiótica e Lingüística Geral pela Faculdade de Filosofia, Letras e Ciências Humanas da Universidade de São Paulo. Assistente do Laboratório de Investigação Fonoaudiológica da Fluência, Motricidade e Funções Orofaciais do Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo. Endereço para correspondência: Av Paes de Barros, Apto São Paulo - SP - CEP **Fonoaudióloga. Professora Titular do Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo. ***Parte da Tese de Doutorado da Primeira Autora Realizada no Laboratório de Investigação Fonoaudiológica da Fluência, Motricidade e Funções Orofaciais do Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo. Artigo de Pesquisa Artigo Submetido a Avaliação por Pares Abstract Background: developmental stuttering is a pathology which begins during childhood, during the phase of language acquisition and development and is characterized as being chronic. Aim: to verify the influence of typology and grammatical classes on the occurrence of speech disruptions of stuttering and fluent children. Method: participants of this study were 80 children, with ages between 4.0 and years, residents in the city of São Paulo. Participants were divided in two groups: GI (research group) was composed by 40 children (29 male and 11 female) with the diagnosis of stuttering, and with no other associated communication, neurologic and cognitive deficits; GII (control group) was composed by 40 fluent children, paired by age and gender with the participants of GI. Results: the data indicate that the groups do not differ regarding the occurrence of typical disfluencies. Less typical disfluencies occurred predominantly for GI. As for the grammatical class, speech disruptions were more frequent in function words for both groups. Conclusion: these results indicate that the analyses of speech disruptions, in terms of typology and grammatical classes, bring several information that are necessary for the assessment and diagnosis of childhood stuttering. This analysis points the differences and similarities between stuttering and fluent children. Key Words: Speech, Language and Hearing Sciences; Fluency; Stuttering; Speech; Childhood. Resumo Tema: a gagueira de desenvolvimento é aquela cujo surgimento se dá na infância, durante a fase de aquisição e desenvolvimento da linguagem, e que se caracteriza como uma desordem crônica. Objetivo: verificar a influência da tipologia e classe gramatical na ocorrência de rupturas na fala de crianças gagas e fluentes. Método: Participaram desse estudo 80 crianças, com idades entre 4.0 a anos, residentes no município de São Paulo e Grande São Paulo. Os participantes foram divididos em dois grupos: GI (grupo de pesquisa) foi composto por 40 crianças, (29 do sexo masculino e 11 do sexo feminino) com diagnóstico de gagueira, sem qualquer outro déficit comunicativo, neurológico e cognitivo associado; GII (grupo controle) foi composto por 40 crianças fluentes, pareadas por idade e sexo aos participantes de GI. Resultados: os dados indicaram que os grupos não se diferenciaram quanto à ocorrência de rupturas comuns. As rupturas gagas ocorreram predominantemente para GI. Em relação à classe gramatical, as rupturas foram mais freqüentes nas palavras funcionais, para ambos os grupos. Conclusão: Esses resultados mostram que a análise das rupturas da fala, tanto em termos de tipologia quanto em termos gramaticais trazem um grande número de informações necessárias para a avaliação e diagnóstico da gagueira infantil, uma vez que aponta diferenças e semelhanças entre crianças gagas e fluentes. Palavras-Chave: Fonoaudiologia; Fluência; Gagueira; Fala; Infância. Conflito de Interesse: não Recebido em Revisado em ; Aceito para Publicação em Referenciar este material como: JUSTE, F.; ANDRADE, C. R. F. de. Typology of speech disruptions and grammatical classes in stuttering and fluent children (original title: Tipologia das rupturas de fala e classes gramaticais em crianças gagas e fluentes). Pró-Fono Revista de Atualização Científica, Barueri (SP), v. 18, n. 2, p , maio-ago Tipologia das rupturas de fala e classes gramaticais em crianças gagas e fluentes 129 v18n2a1ing.pmd 129 Introduction According to Andrade (2003), disruptions are the most obvious feature of stuttering and have been used as a parameter to describe, define and measure the severity of this disorder. Since disruptions are also found in fluent individual's speech there is often difficulty in distinguishing normal disruptions from those that may be suggestive of stuttering. Andrade (2003, 2004) suggests that disruptions of speech flow can be differentiated according to their typology, that is, some disruptions are common to all speakers and fundamentally reflect linguistic uncertainty and imprecision, or else, they intend to improve the message's comprehension. These disruptions may be considered typical (hesitations; interjections; revisions; un-finished words; word, phrase or segment repetition). According to the author there are some disruptions that, although can seldom occur to every speaker, are suggestive of a greater speech processing impairment. These disruptions are classified as atypical disruptions (sound and syllable disruptions, blocking, sound and segment intrusions and long pauses). As Andrade, Pereira (2003) also stresses that there are several types of disruptions that can be present in people's speech and that their type and frequency of occurrence are the factors that will differentiate a fluent speaker from a stutter speaker and, in their case, point to the severity of the disorder. Since the beginning of the 20th century studies suggest that the occurrence of discourse disruptions is associated to various aspects of language formulation. Au-Yeung et al. (2003) suggest that there is an influence of the grammatical classes of words on the occurrence of speech disruptions. In their study they used a definition of grammatical classes dividing them in content word and functional words. Content words (or open class words) present lexical meaning and are words to which, in principle, there can always be attached new creations (Rosa, 2003). These words are nouns, adjectives, verbs and adverbs. These words have a fundamental role in semantic information transmission. According to Rosa (2003), traditional studies direct too much attention towards content words. They are in larger number in languages (including Portuguese), carry meaning and generate new words. Syntax studies, however, have shown the importance of another type of words: the functional ones. Functional words (or words of closed class) present grammatical mean, they are indices of grammatical properties that provide differences between languages. These words are articles, prepositions, conjunctions and pronouns. These words have mainly syntactical functions, acting as connecting elements between phrases and have low semantic load on their own (Grela et al., 2004). In their study Au-Yeung et al. (2003) suggest that disruptions in functional words happen mostly when they precede content words in the speech of fluent and stuttering children. Results confirm the hypothesis proposed to the study, that disruptions in functional words are used as a delaying tactic when the next content word is not ready to execution. In a prior study, Howell et al. (1999) researched the changes in occurrence of disruptions in functional words to content words in stuttering speakers and in fluent speakers with increasing age. Results indicated that fluent as well as stuttering children presented a larger number of disruptions in functional words. A differentiation between groups can be observed with age increase. Fluent speakers continue using the delaying tactic in content word production, presenting disruptions in functional words with increasing age. The stuttering group seems to abandon this delaying tactic and, from adolescence on, start presenting a larger number of disruptions in content words. In studies published in 2002 and 2003 Dayalu et al. researched the occurrence of speech disruptions related to word class in adults' speech and the results show that the number of disruptions in content words was significantly larger than in functional words, and the same results were obtained by Pereira (2003) to Portuguese adolescents and adult speakers. According to Bloodstein (2001) children tend to present a larger number of disruptions in functional words, specially articles, pronouns and conjunctions because these words frequently initiate phrases. Mansur and Radanovic (2004) point out that, functional words are examples of expressions that can be contained on an automatic package (inserted in the phrase already in the final phase of motor processing), while content words are subjected to a more refined (cognitive) elaboration 130 Juste e Andrade v18n2a1ing.pmd 130 and with larger possibilities to undergo circumstantial modifications. Owens (1996) mentions that functional words are produced latter than content words and that functional words tend to be omitted from the first speech segments produced by the child. According to the author, the lexical growth is slow until the 18th month of life and that in this period the child's lexicon is formed of about 50 words. These words refer predominantly to object names (nouns). Form that moment on the child starts a faster acquisition process. The acquisition of substantives decreases and there is a growth in the acquisition of verbs and functional words (mostly articles and pronouns). Araujo (2003) in her study of 60 Portuguese speaking children with ages between 2.0 and 4.11 years suggests that verbs are the most occurring words followed by nouns and pronouns. Grammatical classes as articles, prepositions and conjunctions were also used by the children but with a lesser number when compared with the classes of verbs, nouns and pronouns. Based on the presented literature this study has the following objectives: a) to classify, quantify and compare the disruption typology presented on the speech of fluent and stuttering children; b) to verify if the different grammatical classes interfere with the occurrence of stuttering and fluent speech disruptions. The research hypotheses tested to answer to the proposed objectives were: 1 - Referring to the disruption occurrence, the groups will differentiate themselves about the frequency and typology of the presented disruptions, and the stuttering children will present a larger number of disruptions when compared to the group of fluent children. 2 - Referring to the word classes, both groups will present more disruptions in functional words than in content words. 3 - The distribution of common disruptions and stuttering disruptions between content and functional words will be equivalent to both groups. Method Selection and assessment processes followed the appropriate ethical procedures: Approval by the institution's ethical committee (CAPPesq HCFMUSP nº 045/04) and signature of the consent form by each participant child's parent. Participants Participated in this research 80 children between 4.0 and years of both genders (58 male and 22 female) enrolled in public education residing in the city of Sao Paulo whose parents agreed, by signing the consent form, with the realization of the proposed research procedures. The participants of this study were divided in two groups: The research group (GI) had 40 children (29 male and 11 female) with diagnosis of stuttering, without any other communicative, neurological or cognitive associated deficit. The diagnosis of stuttering was determining according to the evaluation criteria adopted in the Speech Pathology Research Laboratory in Fluency and Speech Motor Processing (LIF-FPMF). The inclusion criteria to GI were: 1. Present fluency profile outside the age reference values (Andrade, 2004). 2. Receive at least 11 points (equivalent of at least mild severity) on the Stuttering Severity Instrument - 3 (SSI-3 - Riley, 1994). All children of this group received speech therapy on the mentioned laboratory (LIF-FPMF) during the years of 2001 to The control group (GII) had 40 children paired to the research group according to age and gender and without stuttering complaints or any other communicative, neurological or cognitive associated deficit according to information provided by the parents. Inclusion criteria to GII were: a) Present fluency profile within the age reference values (Andrade, 2004). b) Receive a total of 1o points (equivalent of very mild severity) on the SSI-3 Material To record the speech samples were used a Panasonic NVRJ-28 camera, and an audio recorder (Casio TP-6 brand) as a safety measure to ensure the speech transcription quality, cassette tapes (TDK A-60) and video tapes (JVC TC-30). The speech samples were collected and analyzed about disruptions typology according to the Fluency Profile Protocol (Andrade, 2004 and to the Stuttering Severity Instrument - SSI (Riley, 1994), to determine the stuttering severity on GI. Tipologia das rupturas de fala e classes gramaticais em crianças gagas e fluentes 131 v18n2a1ing.pmd 131 Procedure 1. Speech sample gathering: to obtain speech samples it was adopted the methodology proposed by Andrade (2004). A picture was presented to the participants and the following order was given: Please, look at this picture and tell me everything you want about it . The discourse was interrupted only with questions and/or comments if there was need to further the discourse to obtain 200 fluent syllables (number of fluent syllables necessary to the sample analysis). The time estimated to each sample gathering was of at least five minutes. 2. Assessing the speech samples: after obtaining the participants' speech sample, they were transcribed and characterized according to the disruption typology and their grammatical categorization. A confiability analysis was considered necessary due to the great variation of information and results produced by the above mentioned analysis. To evaluate the fidegnity of analyzes, a within-judges validation of compatibility was performed, resulting on an agreeing index of 96% to judge 1 and 92% to judge A. Disruption typology characterization: disruptions were analyzed and classified according to the Fluency Profile Protocol (Andrade, 2004) and divided as: typical disruptions - hesitations, interjections, revisions, un-finished words, segments and phrases repetition; atypical disruptions - syllable and sound repetition, prolonging, pauses and intrusions. 2. B. Disruption grammatical class characterization The totality of samples (including disruptions) were classified referring to their grammatical class (nouns, article, adjective, numeral, pronoun, verb, adverb, preposition, conjunction and interjection) according to the Normative Grammar proposed by Lima (2002). After this classification the disruptions were divided in content words (nouns, adjectives, verbs, adverbs and numerals) and functional words (articles, prepositions, conjunctions, pronouns and interventions), according to the criteria adopted by Howell et al. (1999) and Shapiro and Caramazza (2002). To characterize each disruption as to their grammatical class and guaranty the fidedignity of this characterization the Houaiss (2003) dictionary was used as reference. To this analysis not all disruptions presented by the groups were considered because some disruptions as hesitation, incomplete words, pauses and intrusions are non-classifiable as to their grammatical class. Statistical analysis To the statistical analysis of data, parametric tests were used (t-paired test; t-independent test; analysis of variance (ANOVA) and Turkey test) and also non-parametric tests (Friedman test; Mann-Whitney test) with significance level of 5%. Results According to the research hypothesis tested the speech samples were analyzed and the results are presented on the tables that follow. Table 1 shows that to GI the distribution of the number of typical and atypical disruptions has an even distribution to GI, not presenting any significant difference. In GII it can be observed that the number of typical disruptions was approximately ten times as big as the number of atypical disruptions and this is a significant difference. Comparing both groups it can be observed that they didn't differ statistically about the number of typical disruptions. In what refers to the atypical disruptions there was statistically significant difference between groups and the GI presented a number of atypical disruptions approximately 13 times as big as the number presented by GII. Table 2 presents the results referring to the occurrence of typical disruptions in the participants' speech, distributed by their typology. To GI the average occurrence of typical typologies was statistically different, with hesitation and word repetition as the most frequent typologies, showing no difference between them, but displaying a significant difference with the other typical disruptions. In what refers to GII the average distribution of the typologies of typical disruptions was also statistically different and hesitation was the most frequent typology (different from the other typical typologies). Both groups presented smaller average occurrence of the un-finish word typology and didn't present the phrase repetition typology. To compare both groups each typology was analyzed separately. Results indicate that the groups didn't differentiate themselves statistically according to the number of disruptions as interjection, revision, un-finish word and phrase repetition. The occurrence of the hesitation typology was larger to GII and the difference to 132 Juste e Andrade v18n2a1ing.pmd 132 GI was statistically significant. The typologies word repetition and segment repetition also differentiated the groups statistically, with larger occurrence to GI. Table 3 presents the results referring to the occurrence of atypical disruptions in the participants' speech distributed according to their typologies. It can be observed that to GI the average number of occurrences of the atypical disruptions was statistically different and syllable repetition, blocking and prolonging were the most frequent typologies, without differences between them but with significant differences to the other atypical disruptions. The atypical disruptions with smaller average occurrences were pauses and intrusions. To GII the mean of typical distribution occurrence was also statistically different, with prolonging and pauses as the most frequent typologies, without differences between them but with significant differences to the other atypical typologies. The typology with smallest occurrence average was the sound repetition. The typologies blocking and intrusion were not observed on the samples of this group of children. Comparing the groups by the separate analysis of each typology it can be observed that the pause typology didn't differentiate the groups statistically. The typologies of sound repetition, syllable repetition and prolonging were more frequent in GI and this difference was statistically significant. The typologies blocking and intrusion were not compared numerically because they were not observed on the speech samples of GII. Table 4 shows that GI as well as GII presented more content words than functional words in their speech samples and that this difference was
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