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PubMed1989

Acoustic and physiological reaction times of stutterers and nonstutterers.

This study investigates reaction times in the fluent speech utterances of stutterers and nonstutterers under several experimental conditions. Twenty adult stutterers and twenty matched controls produced utterances of three lengths--one syllable words, polysyllabic words, and sentences--in two conditions of time pressure (high and low) and two conditions of preparation (delayed and immediate responding) in a reaction-time paradigm. Recordings were made of EMG signals from the orbicularis oris inferior and from the extrinsic laryngeal area, as well as electroglottographic and acoustic signals. Measures were made of the duration of intervals between the stimulus, the acoustical onset of voicing, the onset of laryngeal EMG activity, and the onset of lip EMG activity. The durations of subintervals between the stimulus, the three physiological signals, and the acoustic signal were also measured. The results suggest that the reaction times of stutterers and nonstutterers are both increased by longer utterances, and that the effect is proportionally greater for the stutterers. The requirement to respond with minimal preparation produced longer reaction times in both groups, particularly for longer utterances, but this finding was stronger for stutterers than for nonstutterers, particularly in the prelaryngeal subintervals. The high time-pressure condition produced an unusual pattern of responding in many subjects. The analysis of subintervals indicated that the additional time taken by stutterers in responding was located in the earlier parts of the response, particularly when the utterances were longer. The results are interpreted as suggesting that stutterers may have difficulty in the motor programming of speech behavior.

Adult↗
PubMed1990

Kinematic analysis of lip closure in stutterers' fluent speech.

An analysis of lip and jaw motion was carried out in order to evaluate previous observations on the fluent speech of stutterers and to describe possible effects of speech therapy. A strain gauge system was used to transduce lip and jaw movements during fluent repetitions of "sapapple" in adult stutterers and nonstutterers. Fifteen movement parameters were measured on lip closure for the initial /p/ sound in a group of 10 normal speakers, 10 stutterers who had no recent speech therapy, and 8 stutterers who had been through an intensive speech therapy program involving modification of speech timing. The no-therapy group and nonstutterers did not differ significantly in terms of any movement parameter. Stutterers who had been through speech therapy showed significant increases in jaw movement duration and time to peak velocity of the upper lip, lower lip, and jaw. The expected timing pattern for lip and jaw velocity peaks on lip closure (UL-LL-J) was the most frequently occurring pattern, but deviations from this pattern were observed in both stutterers and nonstutterers. The occurrence of reversals was most prevalent in the therapy group, and it was associated with increases in jaw movement duration across subjects. It is suggested that for the type of movement studied here, anomalies in stutterers' fluent speech are likely to be the result of acquired adjustments rather than properties of the speech neuromotor system that underly dysfluency.

Adult↗
PubMed1992

Articulation, language, rate, and fluency characteristics of stuttering and nonstuttering preschool children.

Articulation (Arizona Articulation Proficiency Scale), language (TOLD, Peabody Picture Vocabulary Test), and fluency (Fluency Interview) tests were given to 20 stuttering and 20 nonstuttering male and female preschool children to examine potential performance differences between the two groups. Speaking rate was also measured. There were several significant but minor differences between the two groups. The stuttering children scored lower on seven out of eight language measures than the nonstuttering children and slightly lower than the average score for their age group when compared with the tests' normative samples. Girls demonstrated higher language scores and faster speaking rates. There were no differences between the stuttering and nonstuttering groups on articulation proficiency, although 25% of the stuttering group (all boys) later required articulation treatment. There were few statistically significant correlations between measures of stuttering rate, speaking rate, and language performances within each of the two groups of children, although there were consistent, low-to-moderate negative correlations between stuttering rate and language measures and low positive correlations between speaking rate and language measures. A stepwise regression analysis suggested that selected variables of language proficiency combined with speaking rate were at best moderately predictive (R = .52) of stuttering behavior for the total group of children.

Child, Preschool↗
PubMed1993

Coexistence of stuttering and disordered phonology in young children.

The purpose of the present study was to assess differences in stuttering, phonological, and diadochokinetic behaviors in young children who exhibit both stuttering and disordered phonology and children who exhibit only one of the disorders. Subjects were 21 male children (aged 4 to 6 years), representing three groups of seven children each: (a) stuttering and normal phonological abilities (S+NP), (b) stuttering and disordered phonology (S+DP), and (c) normal fluency and disordered phonology (NF+DP). Stuttering behavior was assessed during a 30-minute conversational speech task; phonological behavior was assessed during a 162 item picture-naming task; and diadochokinetic abilities were assessed during bi- and multisyllable productions. Results indicated that the S+DP group produced significantly more sound prolongations and significantly fewer iterations per whole-word repetition than the S+NP group. However, there were no differences between the two groups in other stuttering indices. Moreover, no differences were noted between the S+DP and NF+DP groups in phonological behavior. Diadochokinetic rates did not differ among the three groups. The possibility of two types of stuttering, one occurring with and one without disordered phonology, is discussed.

Articulation Disorders↗
PubMed1994

Stutterers' self-ratings of how natural speech sounds and feels.

The efficacy of stuttering treatment has been a contentious issue in recent years. Two issues of primary concern include the treated stutterer's abnormal speech quality and the problem of continually self-monitoring fluency skills. One approach to addressing these issues is to obtain stutterers' self-ratings of speech quality and levels of speech monitoring. However, the reliability and validity of such self-ratings need to be assessed before they are suitable for use in stuttering treatment. The present study investigated one method of estimating the reliability and validity of stutterers' self-ratings of how natural their speech sounds (speech naturalness), and how natural they feel about the amount of attention they are paying to the way they are speaking (feel naturalness). Twelve adult stutterers were instructed to self-rate the speech and feel naturalness of their speech under a variety of rhythmic stimulation conditions across repeated rating occasions. With some qualifications, the results showed that stutterers were relatively consistent and valid self-raters of speech quality and levels of speech monitoring.

Adult↗
PubMed1994

Relation between phonologic difficulty and the occurrence of disfluences in the early stage of stuttering.

People who stutter, especially children, have often been reported to exhibit a wide range of concomitant communication problems including articulation and phonologic deficiencies. This study investigated the relation between the phonologic difficulty of words and the point at which stuttering-like disfluencies occurred in the speech of preschool children identified as having a stuttering problem (n = 24). The children were divided into subgroups according to stuttering severity and phonologic ability. A spontaneous speech sample of approximately 1,000 words was tape-recorded from each child, and perceived disfluencies were identified. The phonologic difficulty of each word on which there was a stuttering-like disfluency and of each fluent word immediately following such a disfluency was categorized. The proportion of words in each child's speech sample that contained each category of phonologic difficulty was determined. The data showed that the proportion of disfluent and immediately following words in each type of phonologic difficulty closely resembled the proportion of words in the speech sample of the same type of difficulty. There were no significant differences between the subgroups of stutterers. We concluded, therefore, that the phonologic difficulty of the disfluent word, and the fluent word following it, did not contribute to fluency breakdown regardless of the children's stuttering severity or phonologic ability.

Age of Onset↗
PubMed1996

Speech production in people who stutter: testing the motor plan assembly hypothesis.

The main purpose of the present study was to test the hypothesis that persons who stutter, when compared to persons who do not stutter, are less able to assemble abstract motor plans for short verbal responses. Subjects were adult males who stutter and age- and sex-matched control speakers, who were tested on naming pictures and words, using a choice-reaction time paradigm for both tasks. Words varied in the number of syllables (1, 2, and 3 syllables) and, for the bisyllabic words, also in the number of consonants (one or more) at the onset of the second syllable. Measurements consisted of speech reaction times, word durations, and measures of relative timing of specific motor events in the respiratory, phonatory, and articulatory subsystems. Results indicated that, in spite of longer speech reaction times for persons who stutter in comparison to control speakers, there was no interaction with word size, a finding that does not lend support to the abovementioned hypothesis. Word durations were found to be longer for persons who stutter, and, in addition, there was an interaction of group with word size. Both findings were associated with longer delays for persons who stutter in the onset of upper lip integrated electromyographic (IEMG) activity and thoracic compression, and a group effect on the order of upper lip and lower lip IEMG onset. Findings are taken to suggest the possibility that persons who stutter may use different motor control strategies to compensate for a reduced verbal motor skill, and although the nature of this reduced skill is unknown, it is speculated that it relates to the processes involved in the integration of sensory-motor information.

Adult↗
PubMed1996

Fluency effect of frequency alterations of plus/minus one-half and one-quarter octave shifts in auditory feedback of people who stutter.

The effect of frequency alterations in auditory feedback of people who stutter on stuttering frequency was investigated. Twelve participants who stutter read aloud under nonaltered auditory feedback (NAF) and four conditions of frequency-altered feedback ([FAF], plus/minus one-half and one-quarter octaves) at normal and fast speech rates. Stuttering frequency was significantly higher while reading aloud with NAF relative to the four conditions of FAF (p < 0.05). There were no differences among participants' stuttering frequency between the four FAF conditions (p > 0.05). Reductions in stuttering frequency of approximately 50% to 60% were found with FAF relative to NAF. More disfluencies occurred with the fast versus the normal speech rate condition (p = .0007) irrespective of auditory feedback condition. These findings suggest that slight alterations in the frequency of auditory feedback of people who stutter are fluency-enhancing.

Adult↗
PubMed1996

Speech outcomes of a prolonged-speech treatment for stuttering.

It has been shown that people who stutter can speak with greatly reduced stuttering after treatments that use variations of Goldiamond's (1965) prolonged-speech (PS). However, outcome research to date has not taken account of several important issues. In particular, speech outcome measures in that research have been insufficient to show that lasting relief from stuttering has been achieved by clients outside the clinic for meaningful periods. The present study used extensive speech outcome measures across a variety of situations in evaluating the outcome of an intensive PS treatment (Ingham, 1987). The speech of 12 clients in this treatment was assessed on three occasions prior to treatment and frequently-on eight occasions-after discharge from the residential setting. For 7 clients, a further assessment occurred at 3 years posttreatment. Concurrent dependent measures were percent syllables stuttered, syllables per minute, and speech naturalness. The dependent measures were collected in many speaking situations within and beyond the clinic. Dependent measures were based on speech samples of substantive duration, and covert assessments were included in the study. Detailed data were presented for individual subjects. Results showed that 12 subjects who remained with the entire 2-3-year program achieved zero or near-zero stuttering. The majority of subjects did not show a regression trend in %SS or speech naturalness scores during the posttreatment period, either within or beyond the clinic. Some subjects showed higher posttreatment %SS scores during covert assessment than during overt assessment. Results also showed that stuttering was eliminated without using unusually slow and unnatural speech patterns. This treatment program does not specify a target speech rate range, and many clients maintained stutter-free speech using speech rates that were higher than the range typically specified in intensive PS programs. A significant correlation was found between speech rate and perceived posttreatment speech naturalness.

Adolescent↗
PubMed1996

Genetics of stuttering: a critical review.

The fact that stuttering runs in families has been documented over a long period and has led to speculations and research about the role of a genetic component to this disorder. Although the genetic factor cannot be proved by familial aggregation and twin studies alone, such research has continued to provide support for a relationship between stuttering and genetics. The purposes of this article are to review and critique the research in this area. The article first assesses research methodologies that have been employed in familial studies of stuttering. It proceeds to review and critique incidence, twin, and aggregation studies. In addition, it includes sections on subgroups, genetic models of stuttering, and implications for future research as well as for clinical work. With a focus on improved methodology and recent findings, a current perspective on our knowledge of the genetic component to stuttering is provided. Among other conclusions, the article emphasizes that failure to consider epidemiologic factors has probably biased previous results regarding the genetics of stuttering. New preliminary data also appear to provide evidence that spontaneous recovery and chronicity are influenced by genetic factors. Generally, however, the review of incidence and twin studies, as well as of evidence for the various inheritance models, confirms previous conclusions about the interaction between genetic and environmental factors in stuttering.

Adolescent↗
PubMed1997

Selected temporal, grammatical, and phonological characteristics of conversational utterances produced by children who stutter.

The purpose of this study was to assess clause, syllable, and response latency characteristics of conversational utterances produced by children who stutter. Subjects were 14 boys who stutter (M age = 52.07 months; SD = 9.02 months) and 14 boys who do not stutter (M age = 51.93 months; SD = 8.55 months). Selected aspects of speech fluency, clause and syllable structure, and response latency were analyzed in utterances collected from each subject as he spoke with his mother during a 30-minute conversation. Results indicated that stuttered utterances of children who stutter contained significantly more clausal constituents than their length-matched fluent utterances. There was, however, no significant difference in syllable structure of the length-matched utterances, and neither stuttering frequency nor duration was significantly associated with syllable structure measures. Further, there was no significant difference in response latency of non-length-matched stuttered and fluent utterances. Findings are taken to suggest that changes in the number of clausal constituents that must be constructed, stored, or coordinated within an utterance may influence the likelihood of speech errors and, hence speech disfluencies within that utterance.

Child↗
PubMed1997

Stuttering and communicative suitability of speech.

The purpose of the present study was to develop and evaluate an instrument for assessing the communicative suitability of speech (i.e., the speaking situation-dependent adequacy of speech as judged by listeners). Listeners judged the suitability of speech of people who stutter (N = 10) at three stages of treatment (before, immediately after, and 6 months after) and that of people who do not stutter (N = 10, the latter serving as a reference). The listeners rated the suitability of the speech, using a 10-point scale, for 10 speaking situations that supposedly make different demands, with listeners consisting of three groups: unsophisticated listeners (N = 17), clinicians specializing in the treatment of stuttering (N = 17), and stuttering listeners (N = 17). Results indicate that the rating instrument can be scored reliably. Analysis of variance for the ratings of the reference speakers showed that the factor "situation" had a significant effect on the suitability ratings, with more demanding situations receiving lower suitability scores than the less demanding ones. Also, the speech of the people who stutter was judged significantly less suitable than the speech of the reference speakers. Furthermore, unsophisticated listeners were considerably less tolerant in their judgments than clinicians and stuttering listeners. Findings suggest that communicative suitability is a promising criterion to further investigate, especially as it may apply to the objective evaluation of treatment outcome for stuttering.

Adolescent↗
PubMed1997

Adults recovered from stuttering without formal treatment: perceptual assessment of speech normalcy.

The purpose of this study was to determine if the speech of adults who self-judged that they were recovered from stuttering without the assistance of treatment is perceptually different from that of adults who never stuttered. Fifteen adult speakers verified as persons who had recovered from a valid stuttering problem without the assistance of treatment were compared with 15 adult speakers verified as persons with normally fluent speech. Judges viewed videotaped speech samples of all speakers and were instructed to decide whether a speaker used to stutter or never stuttered. A separate group of judges rated the same samples for speech naturalness. Various speech behavior measures were also obtained. Results revealed that the speech of speakers who used to stutter was perceptually different from that of speakers who never stuttered. This difference was correlated with unnatural sounding speech and a high frequency of part-word repetitions.

Adult↗
PubMed1997

Modifications in aerodynamic variables by persons who stutter under fluency-evoking conditions.

The purposes of this study were to (a) compare the effects of fluency-evoking conditions on aerodynamic variables in 10 persons who stutter with those previously reported for 12 individuals who do not stutter; (b) determine if any changes demonstrated in the amplitude and/or timing of aerodynamic variables were accounted for by changes in speech intensity; and (c) determine if any amplitude or timing changes in flow and intraoral pressure were related to improved fluency. The fluency-evoking conditions were choral reading (CR), metronome-pacing (MET), delayed auditory feedback (DAF), and noise (NOISE). From 8 words beginning with plosive consonants in CVC contexts read aloud in sentences, measures were made of 8 variables, including closure duration, amplitude and time to maximum airflow and intraoral pressure for initial plosives, and the duration and intensity of the following vowel. Speech rate was also computed. Only fluently produced target words from persons who stutter were analyzed. All persons who stutter showed improved fluency under all conditions. Both groups demonstrated significant (p < or = 0.006) condition effects for peak flow, vowel intensity, and pressure rise time. Thus, fluency-evoking conditions affected these variables regardless of speaker type. Both groups changed peak pressure in similar directions from baseline depending on condition, but not significantly for each group in the same conditions. Persons who stutter significantly increased speech rate for CR, DAF, and NOISE; and persons who do not stutter significantly decreased rate under DAF. The reported changes in peak pressure and peak flow could not be accounted for by changes in vowel intensity. Larger improvements in fluency occurred under conditions when peak flow and peak pressure values were decreased from baseline. Thus, variables that were modified by both groups when speaking under conditions were also the variables related to changes in fluency for the persons who stutter.

Adult↗
PubMed1999

Exchange of stuttering from function words to content words with age.

Dysfluencies on function words in the speech of people who stutter mainly occur when function words precede, rather than follow, content words (Au-Yeung, Howell, & Pilgrim, 1998). It is hypothesized that such function word dysfluencies occur when the plan for the subsequent content word is not ready for execution. Repetition and hesitation on the function words buys time to complete the plan for the content word. Stuttering arises when speakers abandon the use of this delaying strategy and carry on, attempting production of the subsequent, partly prepared content word. To test these hypotheses, the relationship between dysfluency on function and content words was investigated in the spontaneous speech of 51 people who stutter and 68 people who do not stutter. These participants were subdivided into the following age groups: 2-6-year-olds, 7-9-year-olds, 10-12-year-olds, teenagers (13-18 years), and adults (20-40 years). Very few dysfluencies occurred for either fluency group on function words that occupied a position after a content word. For both fluency groups, dysfluency within each phonological word occurred predominantly on either the function word preceding the content word or on the content word itself, but not both. Fluent speakers had a higher percentage of dysfluency on initial function words than content words. Whether dysfluency occurred on initial function words or content words changed over age groups for speakers who stutter. For the 2-6-year-old speakers that stutter, there was a higher percentage of dysfluencies on initial function words than content words. In subsequent age groups, dysfluency decreased on function words and increased on content words. These data are interpreted as suggesting that fluent speakers use repetition of function words to delay production of the subsequent content words, whereas people who stutter carry on and attempt a content word on the basis of an incomplete plan.

Adolescent↗
PubMed1999

Early childhood stuttering I: persistency and recovery rates.

The divergent developmental course of stuttering with its two major paths, persistency and spontaneous (unaided) recovery, has been a focus of scientific attention because of its critical theoretical, research, and clinical perspectives. Issues concerning factors underlying persistency and recovery and their implications for early intervention have stirred considerable controversy among scientists. In light of the intense interest, the scarcity of direct essential epidemiological data concerning the magnitude of the two paths and the timing of recovery is problematic. Most past studies have used retrospective methodologies. The few longitudinal studies have been severely limited in scope or objective data. The purpose of the investigation reported herein is to study the pathognomonic course of stuttering during its first several years in early childhood with special reference to the occurrence of persistent and spontaneously recovered forms of the disorder. Employing longitudinal methodology with thorough, frequent periodic follow-up observations, multiple testing, and recording of extensive speech samples, 147 preschool children who stutter have been closely followed for several years from near the onset of stuttering. In this, the first of three related articles, we present findings regarding the current stuttering status of 84 of these children, who have been followed for a minimum of 4 years after their onset of stuttering. The data indicate continuous diminution in the frequency and severity of stuttering over time as many children progressed toward recovery. Our findings lead to conservative estimates of 74% overall recovery and 26% persistency rates. The process of reaching complete recovery varied in length among the children and was distributed over a period of 4 years after onset. Detailed analyses of phonological and language skills pertaining to differentiation of the developmental paths of children who persist and those who recover are presented in the two other articles in the series (E. P. Paden et al., 1999, and R. V. Watkins et al., 1999).

Age Factors↗
PubMed2000

Variations in the relative speeds of orofacial structures with stuttering severity.

Stuttering can be characterized in part as a disorder in the coordination of different muscle systems. In light of basic aspects of orofacial physiology and development, the speeds of the lips and tongue relative to the jaw may be an important dimension for evaluating motor coordination among persons who stutter (PWS). To test this idea, an electromagnetic system was used to obtain measures of lip, tongue, and jaw speed in 38 adults (29 PWS and 9 normally fluent speakers, NFS) as they repeated a simple speech utterance at a normal rate. Using categorical ratings of stuttering severity, ratios of tongue speed to jaw speed were significantly greater in PWS rated as severe, compared to NFS and other PWS. Significant increases in lower lip-to-jaw and tongue-to-jaw speed ratios with stuttering severity were also reflected in correlation analyses relating speed ratios to a continuous measure of stuttering severity. These trends in speed ratio were related to increases in lower lip and tongue speed and decreases in jaw speed with stuttering severity. Sources of the speed differences are discussed in relation to underlying muscle activity, motor compensation processes in adults, and the development of orofacial motor control in children who stutter.

Adult↗
PubMed2003

[Treatment outcome study of the stuttering therapy summer camp 2000 for children and adolescents].

Therapists are generally confronted with the question, to what extent results of randomised clinical trials with their emphasis on internal validity are relevant for practitioners and their unselected patients. Often results from clinical trials are neglected in clinical practice and the "normal" practice remains unstudied. In this study a therapeutic approach for stuttering has been studied under practice conditions, but with a maximum of methodological validity. Beyond the concrete study it is also discussed whether the chosen procedure can be a model for practice studies. Patients from age 9 to 19 participated in a stuttering therapy summer-camp for children and adolescents by the Austria-Self-Aid-Initiative Stuttering. Participants were supposed to learn a more open handling of their stuttering and acquire basics for a fluent speech. The therapy concept includes elements of a fluency shaping and a stuttering modification therapy. The evaluation followed a panel design with two assessments before, one assessment after therapy and one follow-up and three types of measurement: 1. three videotaped speech situations, 2. four questionnaires for the participants and their parents, and 3. Goal Attainment Scalings (GAS). The stuttering frequency shows a reduction from 22.2 to 9.5 % (effect size 1.29). Follow-up results, GAS and all questionnaires also indicate clear improvements. Altogether, the Therapeutic Stuttering Summer-camp was able to reach its aims.

Adolescent↗