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PubMed2006

A phase II clinical trial of self-imposed time-out treatment for stuttering in adults and adolescents.

PURPOSE: This study reports the development and clinical trial of a new treatment program for persistent developmental stuttering in adolescents and adults. The treatment is based on the operant procedure of self-imposed time-out. This involves the person stopping speaking for a short period after each stutter. METHOD: Twenty-two participants completed Stage 1 (Instatement and Generalisation) of the program and 18 completed Stage 2 (Maintenance) of the program. Stuttering outcome was measured from independent audio and video recordings made outside and inside the clinic, before and after treatment. Speech naturalness was measured at the end of Stage 1. Secondary analyses were conducted to investigate whether responsiveness to the program was related to stuttering severity or age. Participants completed an extensive self-report inventory at the end of treatment. RESULTS: There was a range of responsiveness to the treatment, with more than half the participants reducing their stuttering by more than 50%. Participants with more severe types of stuttering appeared to respond better but no other predictors of responsiveness were identified. Speech sounded reasonably natural after treatment. Participants' perceptions of the treatment were for the most part positive with the majority reporting that the treatment was easier to use and more effective than treatment based on prolonged-speech. CONCLUSIONS: The self-imposed time-out treatment program reported here is clearly effective for a significant number of adolescents and adults who stutter. Given that it does not require speech restructuring and the constant attention to speech that this involves, this could be a treatment of choice for those who are likely to respond. Consequently, further research is needed to determine which clients seeking behavioural treatment for their stuttering will benefit most from this program. Further research is also needed to determine the extent to which the effectiveness of time-out is increased when combined with other behavioural treatments.

Adolescent↗
PubMedDate not supplied

Delayed auditory feedback in the treatment of stuttering: clients as consumers.

PURPOSE: To investigate the effect of repeated exposure to delayed auditory feedback (DAF) during a 3-month period outside a clinical environment and with only minimal clinical guidance on speech fluency in people who stutter. METHOD: A pretest-post-test design was used with repeated exposure to DAF during 3 months as the independent variable. Nine stuttering individuals aged between 18 and 45 years served as subjects. Videotaped samples from different speech tasks were collected before and after 3 months' exposure to DAF, each time under two conditions: first during non-altered feedback (NAF) and subsequently during DAF. RESULTS: Before the repeated exposure to DAF, the percentage of stuttered words was significantly higher during NAF than during DAF. After 3 months' exposure to DAF, the percentage of stuttered words during NAF had dropped to a non-significant level in comparison with the DAF condition. Comparison of the percentage of stuttered words during NAF before and after repeated exposure to DAF showed significantly less stuttering after the repeated exposure to DAF. The percentage of stuttered words during DAF was generally somewhat higher, but not significantly so, after the 3 months' repeated exposure to DAF than before the exposure to DAF. CONCLUSIONS: Results confirm that DAF is an effective means of reducing stuttering even when employed as the only treatment approach outside a therapeutic environment. They also suggest that DAF continues to promote fluency when used over a longer period, but also that length of exposure and fluency enhancement are probably not in a linear relationship.

Adolescent↗
PubMed2006

New complexities in the genetics of stuttering: significant sex-specific linkage signals.

Stuttering is a speech disorder long recognized to have a genetic component. Recent linkage studies mapped a susceptibility locus for stuttering to chromosome 12 in 46 highly inbred families ascertained in Pakistan. We report here on linkage studies in 100 families of European descent ascertained in the United States, Sweden, and Israel. These families included 252 individuals exhibiting persistent stuttering, 45 individuals classified as recovered from stuttering, and 19 individuals too young to classify. Primary analyses identified moderate evidence for linkage of the broader diagnosis of "ever stuttered" (including both persistent and recovered stuttering) on chromosome 9 (LOD = 2.3 at 60 cM) and of the narrower diagnosis of persistent stuttering on chromosome 15 (LOD = 1.95 at 23 cM). In contrast, sex-specific evidence for linkage on chromosome 7 at 153 cM in the male-only data subset (LOD = 2.99) and on chromosome 21 at 34 cM in the female-only data subset (LOD = 4.5) met genomewide criteria for significance. Secondary analyses revealed a significant increase in the evidence for linkage on chromosome 12, conditional on the evidence for linkage at chromosome 7, with the location of the increased signal congruent with the previously reported signal in families ascertained in Pakistan. In addition, a region on chromosome 2 (193 cM) showed a significant increase in the evidence for linkage conditional on either chromosome 9 (positive) or chromosome 7 (negative); this chromosome 2 region has been implicated elsewhere in studies on autism, with increased evidence for linkage observed when the sample is restricted to those with delayed onset of phrase speech. Our results support the hypothesis that the genetic component to stuttering has significant sex effects.

Chromosome Mapping↗
PubMed2004

Development of auditory sensitivity in children who stutter and fluent children.

OBJECTIVE: The purpose of this study was to establish whether there are any differential changes in auditory sensitivity over ages in a variety of peripheral and central auditory tasks between participants who stutter and participants who do not stutter. DESIGN: The auditory sensitivity of 37 participants who stutter and 44 participants who do not stutter, ages between 8 and 19 yr, assigned to three age categories, were obtained in five listening conditions: Pure tone threshold, simultaneous masking, backward masking, notched backward masking, and simple dichotic (simultaneous) masking. RESULTS: Across all listening conditions and both talker groups, thresholds decreased over age. The thresholds of participants who do not stutter decreased for simultaneous, backward, and notched backward masking conditions over the 8- to 19-year age range. Analysis of each condition only showed significant improvement over age groups for backward masking for the participants who stutter. CONCLUSIONS: These results indicate that auditory sensitivity for sounds in noise continues to develop through to teenage, and a different pattern of auditory development exists for the participants who stutter compared with participants who do not stutter.

Adolescent↗
PubMed1986

Identification thresholds of nonsense syllables by stutterers.

Stutterers react emotionally to syllables they stutter because they experience difficulty in articulating those syllables. The identification thresholds of nonsense syllables containing syllables stuttered by six stutterers were investigated. Four one-syllable stimuli and eight three-syllable stimuli were displayed by a tachistoscope, and the subjects were asked to respond with the syllables. The identification thresholds of one-syllable stimuli were lower than those of three-syllable stimuli, and the identification thresholds of one-syllable stimuli containing stuttered syllables were not higher, but rather lower, than those of one-syllable stimuli which did not contain stuttered syllables. It was concluded that stutterers were generally sensitive to syllables they stutter, and this phenomenon was referred to as perceptual vigilance.

Adolescent↗
PubMed2002

Self-reported anxiety of adults who do and do not stutter.

This is a preliminary investigation of the differences in self-reported anxiety of people who do and do not stutter. Participants and experimental procedures were the same as those used by Gabel, Colcord, and Petrosino in 2001. 10 people who stuttered, all of whom had experience with stuttering therapy, were matched with 10 participants who did not stutter. Each participant in both groups was engaged in a session to evaluate speech in a format similar to a professional diagnostic session for stuttering. Each participant was stopped and asked to rate his anxiety during specific moments during the session. This procedure is similar to in vivo cognitive assessment used in cognitive-behavioral treatments and research. The participants' reports were taken during a baseline period, during a period in which they were thinking about their speech, and during three different speaking tasks. The anxiety reported by the group of people who stuttered was compared to the anxiety reported by the group of individuals who did not stutter. Statistical analyses indicated a significant main effect for the group who stuttered as they reported more anxiety during the entire session. There was no main effect for condition. The interaction of group by condition fell short of significance. Possible explanations and suggestions for research were discussed.

Adaptation, Psychological↗
PubMed2001

Dysfluency and involuntary movements: a new look at developmental stuttering.

Studies using modern imaging techniques suggest that, in developmental stuttering, there is dysfunction within the cortical and subcortical areas of the motor control system wider than that pertaining to speech motor control alone. If this is the case, one might expect motor deficits extending beyond and unrelated to the production of speech in people who stutter. This study explored this proposal by investigating the presence and characteristics of involuntary movements accompanying stuttering. Sixteen adults with developmental stuttering and 16 controls matched for age and sex were audio-videotaped during 5 minutes of conversational speech and reading a passage of 350 words. Audio-data were examined for dysfluencies. Movements of the face, head and upper body considered involuntary and not part of normal facial expression or gesture and not part of the mechanics of speech were identified and described from muted video-data. Subjects who stuttered had a higher proportion of classic (within-word) dysfluencies accompanied by involuntary movements (IMs) than controls during speech (24.4% vs. 4.5%, p = .054) and reading (28.6% vs. 4.9%, p = .033). There was no difference in proportion of classic dysfluencies accompanied by IMs between speech and reading for either group. IMs were also seen in both groups during fluent speech, with a similar incidence during free speech (3.9% vs. 3.0%, NS) but a greater incidence in the subjects who stuttered during reading (2.4% vs. 0.8%, p = .03). In contrast, there was no difference between the two groups for IMs accompanying normal (between-word) dysfluencies. This suggests that classic and normal dysfluency and their accompanying IMs have different etiologies. The notion that stuttering and IMs are due to altered function in a motor control system wider than that of speech motor control alone is supported by a higher incidence of IMs in people who stutter during both classic dysfluencies and fluent speech.

Adolescent↗
PubMed2005

[Parental attitudes at the beginning of child's stuttering].

OBJECTIVES: Stuttering is a communication disorder that frequently starts at the age of three or four years. Its appearance and progression may impose psychological effects on children and their families. We evaluated parental attitudes in the initial period of stuttering. PATIENTS AND METHODS: Twenty-two children or adolescents (16 males, 6 females; mean age 8.8+/-4.4 years; range 4 to 18 years) were assessed. A semi-structured clinical interview was administered to all the patients to determine whether stuttering was triggered by stressors and to examine the attitudes of parents and the course of their applying for treatment. RESULTS: After the onset of stuttering symptoms, the most frequent parental attitude was found as punishment and warning to their child (54.5%). Before stuttering appeared, the most frequent triggering event was of being excessively scared of anything (68.2%). The mean age of onset of stuttering was 3.4+/-1.1 years (range 2 to 7 years). CONCLUSION: The events that trigger stuttering also continue in the attitudes and thoughts of parents concerning stuttering. After the diagnosis, the parental attitude plays a significant role in the effectiveness of treatment. In this respect, parents should be informed during their first application for treatment.

Adolescent↗
PubMed1981

Early stutterings: some aspects of their form and distribution.

The speech of five stutterers ranging in age from 3 years, 10 months to 5 years, 7 months was analyzed to determine the types and loci of stutterings. Word repetition was the most frequent feature in three cases and one of the two predominant features in the remaining two cases. Almost without exception, word repetitions occurred at the beginning of syntactic units. A greater proportion of stutterings of all types appeared on the initial words of sentences or clauses than on the other words. In most cases proportionately more function words than control words were stuttered, as were more monosyllabic than polysyllabic words--just the reverse of the usual pattern in older children and adults. The tendency of older stutterers to have more difficulty on initial consonants than initial vowels appeared in only one case. The findings on the properties of stuttered words were interpreted to mean that word-bound factors as such have little influence on the loci of early stutterings. The results as a whole were related to the hypothesis that early stuttering represents mainly a type of difficulty in either the formulation or the execution of syntactic units.

Child, Preschool↗
PubMed2006

Characterization of the N+3 stutter product in the trinucleotide repeat locus DYS392.

Stutter products generated during DNA amplification by the polymerase chain reaction (PCR) may complicate mixture interpretation. The PCR amplification of the DYS392 locus typically results in three distinct detectable PCR products: the true allele product (N), a stutter product three bases smaller (N-3), and a reproducible low-level product, three bases larger (N+3). Sequence analysis of the N+3 product demonstrated that its sequence is one TAT repeat longer than the true allele product. Our experiments demonstrated that the quantity of both N-3 and N+3 stutter increased as the allele number increased. The percent stutter also increased as the magnesium concentration was increased in the reaction, as well as when the amount of input DNA was decreased. As both stutter products behave in a similar and reproducible fashion, the same rules that apply to the interpretation of N-3 stutter products in short tandem repeat analysis, can be applied to N+3 stutters. The characterization of the DYS392 N+3 product is the first detailed published study of a stutter product larger than the true allele.

Chromosomes, Human, Y↗
PubMed1975

Stuttering, dichotic listening, and cerebral dominance.

Fully right-sided stutterers (35) and fully right-sided nonstutterers (35) had a dichotic listening task to test hypotheses that stutterers have incomplete cerebral lateralization or reversed lateralization of speech function, or both. An assumption of the procedure is that a right-ear preference indicates left-cerebral dominance for speech. Six stutterers and no nonstutterers showed a reversal, ie, a left-ear preference. As a group, the remaining stutterers who showed no such reversal were the same as nonstutterers in the magnitiude of the right-ear preference. This suggests that a subset of stutterers may have an anomaly in the lateralization of speech functions. A nonsignificant tendency emerged for stutterers to show smaller between-ear differences on the test, consistent with the hypothesis that stutterers have less or incomplete lateralization of speech function than nonstutterers.

Adult↗
PubMed2006

A study of familial stuttering.

Here we study 13 families with stuttering. Of the 13 families, 9 were persistent stutterers and 4 were recovered stutterers. In the 9 families with persistent stuttering, 24 were male and 10 were females. Of the 4 families with recovered stutterers, 17 were male and 3 were female. Of the 17 males, 12 were persistent stutterers and 5 recovered after adolescence. All females were recovered stutterers. We conclude with a short discussion of recent molecular studies.

Adolescent↗
PubMed1989

Stuttering severity and treatment outcome.

This study evaluated a multidimensional treatment of stuttering (awareness training, regulated breathing, cognitive restructuring and relapse prevention) for mild, moderate and severe stutterers. Behavioral measures (percentage of syllables stuttered and rate of speech) and cognitive measures (self-efficacy perception, locus of control and Erickson Scale) were taken. Using three multiple baseline designs across subjects, results showed that all mild stutterers and most moderate stutterers were clinically improved at the end of treatment and at six months follow-up. No severe stutterers (more than 15% of syllables stuttered) achieved clinical improvement. Self-efficacy perceptions were quite accurate in predicting the performance of successfully treated patients. No consistent changes were observed on the locus of control or the Erickson Scale. The clinical and theoretical implications of the results are discussed.

Adaptation, Psychological↗
PubMed1977

Parental attitudes toward and knowledge of stuttering.

Parenteral attitudes toward and knowledge of stuttering were studied in 50 parents of stutterers and 50 parents of nonstutterers following the development of the Parenteral Attitudes Toward Stuttering (PATS) Inventory and the Alabama Stuttering Knowledge (ASK) Test. Results indicated that the parents of nonstutterers displayed more desirable attitudes toward stuttering and more accurate knowledge of stuttering than did the parents of stutterers. Although the PATS Inventory and the ASK Test as presently constructed may be clinically useful particularly with respect to parental counseling, continued research appears warranted to enhance their usefulness as research and clinical instruments.

Attitude↗
PubMed1982

Reaction time for /s/ and /z/ in stutterers and nonstutterers: a test of discoordination hypothesis.

In an attempt to test the hypothesis that stuttering is the result of discoordination between phonation and articulation, 10 adult stutterers and 10 adult nonstutterers were asked to produce prolonged versions of /z/ and /s/ sounds, as quickly as possible, in response to tone stimuli. It was hypothesized that stutterers would exhibit significantly longer reaction time (RT) for the /z/, a voiced sound, than would a similar group of nonstutterers, whereas the two groups would not differ in RT for the /s/ sound, the unvoiced counterpart of /z/. The results showed that stutterers as a group did not differ from nonstutterers in RT for either the /z/ of the /s/ sound. However, it was found that severe stutterers exhibited significantly longer RTs for the /z/ sound than did mild stutterers. There were no differences between severe and mild stutterers in RT for the /s/ sound.

Adult↗
PubMed1985

Self-efficacy scaling by adult stutterers.

A scale was developed for estimating adult stutterers' confidence for entering and maintaining fluency in a variety of speaking situations. This Self-Efficacy Scale for Adult Stutterers (SESAS) was administered to 20 adult stutterers along with the shortened form of the Erickson Scale of Communication Attitudes and the Perceptions of Stuttering Inventory. Twenty nonstuttering adults were also given the SESAS the self-efficacy scores significantly differentiated between stutterers and nonstutterers. SESAS scores were correlated with the Erickson Scale (-0.71) and the Perceptions of Stuttering Inventory (-0.52). A correlation of -0.51 was found for SESAS scores and stutterers' self-ratings of severity. Test-retest reliability for the SESAS averaged 0.89. The results suggest that with continued development, self-efficacy scaling may be a useful technique for measuring one aspect of change during treatment.

Adolescent↗
PubMedDate not supplied

Predictive factors of persistence and recovery: pathways of childhood stuttering.

This article presents broad preliminary findings from a longitudinal study of stuttering pertaining to differentiation of developmental paths of childhood stuttering, as well as possible early prediction of High Risk, Low Risk, and No Risk for chronic stuttering. More than 100 preschool children who stutter have been closely followed for several years from near the onset of stuttering using a multiple data collection system, with 45 nonstuttering children serving as controls. Thirty-two stuttering and 32 control subjects who have progressed through several stages of the investigation were identified for the present indepth analyses. They represent four subgroups: I. Persistent Stuttering; II. Late Recovery; III. Early Recovery; IV. Control. Comparative data for the groups with special reference to differences in frequency of disfluency, acoustic features, phonologic skills, language development, nonverbal skills, and genetics are presented. The results suggest several promising predictors of recovery and chronicity.

Age of Onset↗
PubMed1990

Evidence in bimanual finger-tapping of an attentional component to stuttering.

The performance of right- and left-handed male and female stutters was compared with that of non-stutters on a bimanual coordination task that involved tapping a key twice with one hand for each single tap of a key by the other hand. Right-handed non-stutters performed this 2:1 tapping better when it was the right hand that tapped twice (R2/L1 condition) rather than the left hand (L2/R1 condition), but among left-handers performance was similar under the two conditions. This replicated previous findings of Peters10 that were interpreted as indicating the role of attentional mechanisms in the expression of handedness. The performance of the stutters differed in two major respects. First, overall bimanual tapping rates were significantly slower than those of the non-stutters. Second, right-handed stutters did not show the asymmetry in performance between the R2/L1 and L2/R1 conditions. The results are interpreted within the framework of current neuropsychological research that relates stuttering to anomalous mechanisms of interhemispheric communication.

Adult↗