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PubMed2005

Have disfluency-type measures contributed to the understanding and treatment of developmental stuttering?

PURPOSE: This article critically reviews evidence to determine whether the use of disfluency typologies, such as syllable repetitions or prolongations, has assisted the understanding or treatment of developmental stuttering. Consideration is given to whether there is a need for a fundamental shift in the basis for constructing measures of stuttering behavior. METHOD: The history of using specific types of disfluencies to assess stuttering, including more recent developments such as counts of stuttering-like disfluencies, is reviewed. The focus is on studies that have investigated the validity and reliability of these perceptually based assessment methods. CONCLUSION: The evidence from use of disfluency-type measures shows that the behavioral difference between stuttering and normally fluent speakers is solely related to the amount of observable stuttering; the differences are only partially realized within disfluency-type measures. Indeed, because disfluency-type measures show poor reliability and conflate stuttered and nonstuttered speech, they have only limited heuristic value for research and provide no obvious benefits for clinicians. At best, they should be regarded as imprecise descriptors of observable stuttering and not a fundamental measure of stuttering. A recommended solution to the problematic history of verbal-based definitions of stuttering behavior is continued development and investigation of exemplar-based definition and measurement.

Articulation Disorders↗
PubMed2005

Differential diagnosis of stuttering for forensic purposes.

PURPOSE: This case study demonstrates the application of an assessment protocol for differential diagnosis of psychogenic stuttering, neurogenic stuttering, developmental stuttering, and malingering. METHOD: A male in his late 30s, accused of armed robbery, was evaluated for stuttering at the request of his defense attorney. The speech assessment included 4 main sections: collection of speech samples, observation in multiple speaking conditions, evaluation of communication attitudes, and consideration of case history and background information. RESULTS: The defendant stuttered severely in all speaking conditions. He demonstrated typical stuttering loci and consistency, but no adaptation. Communication attitudes were typical of people who stutter, but steady, direct eye contact was atypical. His statements about his speech conflicted with reports of outside witnesses. CONCLUSIONS: Characteristics were consistent with developmental stuttering and partial malingering. Both psychogenic and neurogenic forms of stuttering were suspected, but mixed results were largely unsupportive. Valuable protocol elements included speech sampling under multiple speaking conditions, careful examination of case history information, and indirect tests of malingering. Further knowledge and research are warranted to improve processes of differential diagnoses among subtypes of developmental, psychogenic, and neurogenic forms of stuttering as well as malingering.

Adult↗
PubMed2005

Intensive stuttering modification therapy: a multidimensional assessment of treatment outcomes.

Nineteen adults who stutter participated in a 3-week intensive stuttering modification treatment program (the Successful Stuttering Management Program [SSMP]). A series of 14 fluency and affective-based measures were assessed before treatment, immediately after treatment, and 6 months after treatment. Measures included stuttering frequency; the Stuttering Severity Instrument for Children and Adults, Third Edition (SSI-3); a self-rating of stuttering severity; the Perceptions of Stuttering Inventory (PSI); the Locus of Control of Behavior Scale; the Beck Depression Inventory; the Multicomponent Anxiety Inventory IV (MCAI-IV); and the State-Trait Anxiety Inventory. Statistically significant improvements were observed on 4 of the total 14 measures immediately following treatment and on 4 measures at 6 months posttreatment. Statistically significant improvements observed immediately posttreatment included scores on the SSI and the Struggle, Avoidance, and Expectancy subscales of the PSI. Sustained statistically significant improvements at 6 months posttreatment were observed only on client-reported perceptions of stuttering (the Avoidance and Expectancy subscales of the PSI) and 2 specific affective functioning measures (the Psychic and Somatic Anxiety subscales of the MCAI-IV). The SSMP generated some anxiolytic effects but was ineffective in producing durable reductions of core stuttering behaviors, such as stuttering frequency and severity. The discussion focuses on the strengths, weaknesses, and durability of the SSMP treatment approach.

Adolescent↗
PubMed1982

Contingent self-stimulation for stuttering.

In this investigation, 10 adult stutterers were given time-out contingent on each stuttering. Ten other stutterers administered themselves time-out contingent on each stuttering. Stutterers in both time-out conditions evidenced marked reductions in stuttering compared with spontaneous speaking base rates. Stutterers who presented their own time-outs for stuttering, however, showed significantly less extinction of reduced stuttering following the time-out period, and significantly greater generalization to a telephone speaking situation, than did stutterers who were given time-out by an experimenter.

Adult↗
PubMed1979

Women who stutter: personality and speech characteristics.

This investigation was undertaken to determine whether adult female stutterers, when compared to adult male stutterers, would (1) present a different pattern of speech fluency or (2) evidence reduced self-esteem or both. Spontaneous speech samples were obtained from 10 adult female stutterers, 10 adult male stutterers, and 10 adult female nonstutterers. All were administered the California Test of Personality and semantic differential forms designed to assess self-concept. The female stutterers produced significantly fewer instances of revision-incomplete phrase than either of the other two groups and were more heterogeneous with respect to total frequency of disfluency. The female stutterers evidenced a significantly higher level of self-esteem than the male stutterers. Moreover, unlike the male stutterers, the female stutterers did not consider themselves handicapped. This investigation indicates that there may be significant differences in the stuttering symptomatology of adults that are related to gender.

Adult↗
PubMed1981

Concordance for stuttering in monozygotic and dizygotic twin pairs.

The role of genetic factors in the etiology of stuttering was investigated in 30 pairs of same-sex twins, each pair containing at least one stutterer. Care was taken to ensure maximum accuracy in zygosity classification and objectivity in stuttering diagnosis. Zygosity classification was made independently of stuttering diagnosis. Pair-wise concordance for stuttering was significantly higher in identical twins (63%) than in fraternal same-sex twins (19%). The estimated risk of stuttering in the monozygotic (MZ) co-twin of a stutterer was .77, and .32 in the dizygotic (DZ) co-twin of a stutterer. The findings strongly suggest the operation of genetic factors in stuttering. However, the presence of as many as six pairs of identical twins who were discordant for stuttering underlines the importance of the interaction of genetic and environmental factors in the etiology of this disorder.

Adolescent↗
PubMed1985

Auditory stimulation, rhythm, and stuttering.

In a previous experiment, Martin, Siegel, Johnson, and Haroldson (1984) found that stutterers reduced their stuttering under amplified sidetone, but only if the amplified sidetone condition had been preceded by a condition of speaking in noise. The authors speculated that when stutterers were exposed initially to loud noise and its attendant reduction in stuttering, they became "sensitized" to reduced stuttering in any subsequent condition where their auditory feedback was modified. The current experiment tested that hypothesis with 24 adult stutterers divided evenly into three groups. One group of stutterers spoke with no auditory stimulation (quiet), then while receiving 100 dB SPL white noise, and then while receiving amplified sidetone (0, +10, +20 dB SPL). A second group spoke in quiet, then while receiving amplified sidetone, and then while receiving amplified sidetone again. A third group spoke in quiet, then while receiving rhythmic stimulation, and then while receiving amplified sidetone. Relative to vocal intensity in quiet, stutterers spoke with increased vocal intensity during noise, with decreased vocal intensity during amplified sidetone, and with no significant change in vocal intensity during rhythmic stimulation. Relative to stuttering frequency in quiet, subjects spoke with decreased stuttering frequency during loud noise and during amplified sidetone, but only when the amplified sidetone was preceded by the loud noise condition. These results are discussed in terms of the "sensitization" hypothesis.

Acoustic Stimulation↗
PubMed1989

Judgments of disfluency by mothers of stuttering and normally fluent children.

The purpose of this study was to examine the relation between selected aspects of speech disfluency and perceptual judgments of these events by mothers of young stutterers and mothers of age- and sex-matched normally fluent children. Each mother independently listened to and judged as either "stuttered" or "not stuttered" recorded examples of a young stutterer's imitated productions of: (a) five different types of speech disfluency, (b) sound prolongations, and (c) sound/syllable repetitions of five different durations each, along with a comparable number of fluent utterances. Results indicated that although some between-group differences in judgments were observed, both groups most frequently judged sound/syllable repetitions to be stuttered, followed by whole-word repetitions and broken words. Fluent utterances, interjections, and sound prolongations were most frequently judged to be not stuttered by all mothers. Both groups judged sound prolongations averaging 258 ms in duration to be stuttered an average of 25% of the time, increasing to 68% for sound prolongations averaging 1254 ms; however, both groups of mothers judged sound/syllable repetitions of two or more iterations to be stuttered an average of 93% of the time. Findings suggest that there are not appreciable differences between mothers of stuttering and normally fluent children regarding their perceptual judgments of speech disfluencies, but each group might more frequently judge as stuttered those types of speech disfluencies characteristic of their own children's speech.

Child, Preschool↗
PubMed1991

Family history as a basis for subgrouping people who stutter.

Of a clinical population of 169 adult and adolescent stutterers, 112 members (66%) reported a family history of stuttering. Only 3 (2.4%) of these reported any birth or early childhood factors or events that were thought to be associated with stuttering onset or that potentially might have precipitated stuttering. In contrast, 21 (37%) of the 57 members without a family history of stuttering reported such a factor or event. On the basis of this retrospective investigation of family history, the stutterers could be segregated in ways that may be informative relative to etiology and underlying mechanisms despite being apparently similar with respect to time of stuttering onset, dysfluency characteristics, and emotional concomitants. It is suggested that these data are consistent with a hypothesis that within the clinical population of adults presenting as developmental stutterers there are really two subgroups. One subgroup is thought to consist of individual with a genetically inherited predisposition for stuttering, and the second of individuals without such a predisposition but who may have sustained some form of early brain damage. The incidence of false negatives in the 36 individuals classified as having no family history and no known early physical trauma remains to be ascertained. Implications for research on both brain mechanisms of stuttering and responsiveness to clinical treatment and fluency maintenance are discussed.

Adolescent↗
PubMed1993

The early months of stuttering: a developmental study.

Objective data on the development of stuttering during its first several months are sparse. Such a deficit is due to parents' tendency to postpone professional consultation regarding early stuttering until later in the course of the disorder and to a lack of longitudinal studies beginning close to onset. This report presents information on a rare group of 16 preschool subjects who were evaluated within several weeks after stuttering onset and followed for 6 months using multiple measures. The findings show that often early stuttering takes on a moderate-to-severe form. Substantial changes occurred, however, during the 6 months of the study, with a strong tendency for reduction in stuttering-like disfluencies, number of head/face movements, clinician severity ratings of stuttering, and parent ratings of stuttering. Several subjects, including severe cases, exhibited complete recovery. The large changes that occur during the early stage of stuttering suggest that relatively small differences in the length of post-onset interval (stuttering history) can greatly influence all research data of early childhood stuttering. The high, as well as fast, improvement rate suggests that the precise timing of early intervention should be conscientiously evaluated in carefully controlled studies.

Child Development↗
PubMed1996

A controlled clinical trial for stuttering in persons aged 9 to 14 years.

This paper presents the results of a controlled trial of child stuttering treatment. The aim of the study was, first, to compare the effectiveness of three viable treatments, and, second, to compare these three treatments to a no-treatment control composed of children who stuttered of a similar age and sex ratio who were on treatment waiting lists. The three treatments investigated included intensive smooth speech, intensive electromyography feedback, and home-based smooth speech. The children/adolescents were assessed across three speaking contexts on measures of percentage syllables stuttered (% SS) and syllables spoken per minute (SPM) and outcomes were assessed 12 months later. Repeated measures analyses of variance demonstrated significant differences between the control group and all three treatment groups across time on conversations in the clinic, on the telephone, and at home (although home measures were not taken for the intensive smooth speech group). Although the controls' stuttering did not change across time, the treatment groups' stuttering was decreased to very low levels posttreatment (less than 1% syllables stuttered on average), with mean improvement in stuttering frequency of at least 85% to 90% across all assessment contexts. Stuttering did not increase significantly up to 3 months and one year posttreatment in the experimental groups, although levels did rise across time (less than 3% syllables stuttered on average). Speech naturalness results showed increasing naturalness across time as rated by the clinician and parent. This was not the case for the controls. The children were also less anxious across time following treatment. The results suggest that all three treatments for children aged 9-14 who stutter were very successful in the long term for over 70% of the group, though the EMG feedback and home-based treatments were superior when percentages falling below a cutoff point (2%SS) were used to discriminate between groups. Implications for child/adolescent treatment in the community are discussed. Long-term outcomes will be assessed up to 5 years after the treatment.

Adolescent↗
PubMed1998

Effect of extended exposure to frequency-altered feedback on stuttering during reading and monologue.

An ABA time series design was used to examine the effect of extended, continuous exposure to frequency-altered auditory feedback (FAF) during an oral reading and monologue task on stuttering frequency and speech rate. Twelve adults who stutter participated. A statistically significant decrease in number of stuttering events, an increase in number of syllables produced, and a decrease in percent stuttering was observed during the experimental segment relative to baseline segments for the oral reading task. In the monologue task, there were no statistically significant differences for the number of stuttering events, number of syllables produced, or percent stuttering between the experimental and baseline segments. Varying individual patterns of response to FAF were evident during the experimental segment of the reading task: a large consistent reduction in stuttering, an initial reduction followed by fluctuations in amount of stuttering, and essentially no change in stuttering frequency. Ten of 12 participants showed no reduction in stuttering frequency during the experimental segment of the monologue task. These findings have ramifications both for the clinical utilization of FAF and for theoretical explanations of fluency-enhancement.

Adult↗
PubMed1999

Effects of time-interval judgement training on real-time measurement of stuttering.

The purpose of this study was to investigate whether a previously developed interval-based training program could improve judges' stuttering event judgments. Two groups of judges made real-time stuttering event judgments (computer-mouse button presses) in 3 to 6 trials before the response-contingent judgment training program and in another 3 to 6 trials after training, for recordings of 9 adults who stuttered. Their judgments were analyzed in terms of number of stuttering events, duration of stuttering, and 5-s intervals of speech that could be categorized as judged (or not judged) to contain stuttering. Results showed (a) changes in the amount of stuttering identified by the judges; (b) improved correspondence between the judges' identifications of stuttering events and interval-based standards previously developed from judgments made by experienced, authoritative judges; (c) improved correspondence between interval-based analyses of the judges' stuttering judgments and the previously developed standards; (d) improved intrajudge agreement; (e) improved interjudge agreement; and (f) convergence between the 2 judge groups, for samples and speakers used during training tasks and also for other speakers. Some implications of these findings for developing standardized procedures for the real-time measurement of stuttering are discussed.

Adult↗
PubMed1999

Normative disfluency data for early childhood stuttering.

Although the past 50 years of research on early childhood stuttering and normal disfluency have produced vital information on the general features of disfluent speech behavior of young children, an adequate normative reference for early stuttering does not exist. The purpose of this report is to provide such reference and to provide a basis for clinical needs of differential diagnosis of stuttering from normal disfluency. Data are presented from 90 stuttering children ages 2 to 5 within 6 months of stuttering onset and from 54 age-matched normally fluent children. Means for disfluency types are presented. No significant differences were found for gender or for age. Stuttering-like disfluencies (SLD) did differ significantly for the stuttering and fluent groups, but other disfluencies (OD) did not. A weighted SLD is defined to further clarify differences between the groups. The pattern of disfluency types for normally fluent and for mild, moderate, and severe stuttering is presented. Stuttering is shown to be qualitatively as well as quantitatively different from normal disfluency even at the earliest stages of stuttering. Clinical and research implications are discussed.

Adult↗
PubMed2000

Treating stuttering in young children: predicting treatment time in the Lidcombe Program.

It is known that children may recover from stuttering without formal treatment during the first years after onset. Consequently, the timing of professional, early stuttering intervention is a pressing issue in speech-language pathology. This report presents data pertinent to this issue for 261 preschool-age children who received the Lidcombe Program of early stuttering intervention. Of these children, 250 completed the program and were considered by their clinicians to have been treated successfully. For the children who were treated successfully, logistical regression analyses were used to determine whether age, gender, period from onset to treatment, and stuttering severity related systematically to the time required for treatment. The present data confirmed previous reports that a median of 11 clinic visits was required to achieve zero or near-zero stuttering with the Lidcombe Program. Results were also consistent with a preliminary report of 14 children (C. W. Starkweather & S. R. Gottwald, 1993) showing a significant relation between stuttering severity and the time needed for treatment, with children with more severe stuttering requiring longer treatment times than children with less severe stuttering. However, results did not associate either increasing age or increased onset-to-treatment intervals with longer treatment times. This finding is not consistent with the Starkweather and Gottwald report, which linked advancing age with longer treatment time. In fact, the present data suggest that, for a short period after stuttering onset in the preschool years, a short delay in treatment does not appear to increase treatment time. An important caveat to these data is that they cannot be generalized to late childhood or early adolescence. The present findings are discussed in relation to natural recovery from stuttering.

Child↗
PubMed2004

Phonological and language disorders in children who stutter: impact on treatment recommendations.

In the profession of speech-language pathology, it is commonly reported that children who stutter, as a group, are more likely to have phonological and language disorders than their non-stuttering peers. Some support for this belief comes from survey studies that have questioned speech-language pathologists about the children on their caseloads who stutter. Recently, one such study reported that 44% of children who stuttered had at least one additional communication disorder (Arndt & Healey, 2001). In the present investigation, speech-language pathologists (n = 127) who were treating children with speech and language disorders were questioned about their views on the treatment of stuttering. The results indicated that children who stutter and have at least one additional disorder are more likely to be recommended for treatment than those whose only disorder is stuttering. This suggests that caseload surveys may overestimate the rate of additional communication disorders in children who stutter. The results provide reason to question the widespread belief that children who stutter have a high rate of concomitant disorders, especially when it is based on caseload surveys. Suggestions are offered for ways to determine more precisely the frequency with which stuttering co-occurs with other speech and language disorders in children through large-scale epidemiological research.

Age Factors↗
PubMed2000

Single word reading in developmental stutterers and fluent speakers.

Ten fluent speakers and nine developmental stutterers read isolated nouns aloud in a delayed reading paradigm. Cortical activation sequences were mapped with a whole-head magnetoencephalography system. The stutterers were mostly fluent in this task. Although the overt performance was essentially identical in the two groups, the cortical activation patterns showed clear differences, both in the evoked responses, time-locked to word presentation and mouth movement onset, and in task-related suppression of 20-Hz oscillations. Within the first 400 ms after seeing the word, processing in fluent speakers advanced from the left inferior frontal cortex (articulatory programming) to the left lateral central sulcus and dorsal premotor cortex (motor preparation). This sequence was reversed in the stutterers, who showed an early left motor cortex activation followed by a delayed left inferior frontal signal. Stutterers thus appeared to initiate motor programmes before preparation of the articulatory code. During speech production, the right motor/premotor cortex generated consistent evoked activation in fluent speakers but was silent in stutterers. On the other hand, suppression of motor cortical 20-Hz rhythm, reflecting task-related neuronal processing, occurred bilaterally in both groups. Moreover, the suppression was right-hemisphere dominant in stutterers, as opposed to left-hemisphere dominant in fluent speakers. Accordingly, the right frontal cortex of stutterers was highly active during speech production but did not generate synchronous time-locked responses. The speech-related 20-Hz suppression concentrated in the mouth area in fluent speakers, but was evident in both the hand and mouth areas in stutterers. These findings may reflect imprecise functional connectivity within the right frontal cortex and incomplete segregation between the adjacent hand and mouth motor representations in stutterers during speech production. A network including the left inferior frontal cortex and the right motor/premotor cortex, likely to be relevant in merging linguistic and affective prosody with articulation during fluent speech, thus appears to be partly dysfunctional in developmental stutterers.

Adult↗
PubMed1995

A positron emission tomography [18F]deoxyglucose study of developmental stuttering.

Positron emission tomography using [18F]deoxyglucose (FDG) as a marker of regional brain metabolism was used to investigate the neural substrate of stuttering. Four patients with severe developmental stuttering were studied while reading aloud to another person (stuttering condition) and while reading aloud in unison with someone else (non-stuttering condition). The patients were also compared with four normal controls reading aloud by themselves. In the stuttering condition, significant decreases in regional glucose metabolism in Broca's area, Wernicke's area and frontal pole were seen compared with themselves while not stuttering. These differences were also seen in stuttering condition compared with normal controls. Significantly lower left caudate metabolism was seen in patients during both stuttering and non-stuttering conditions compared with normal controls. A circuit for stuttering is proposed based on these findings.

Adult↗