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PubMed1992

A longitudinal study of stuttering in children: a preliminary report.

The objectives of this pilot study were to establish methods for longitudinal research of stuttering in children and to provide preliminary data on the variations that occur in disfluencies during the developmental course of stuttering. Twenty-seven preschool-aged children were followed for a minimum of 2 years shortly after they began stuttering. Tape-recorded speech samples were obtained from the children at several intervals during this period. The number of various types of disfluencies was counted in the speech samples obtained in each testing period. Twenty-one children continued to be followed for varying periods of up to 12 years. Eighteen of the 27 subjects received a few speech treatment sessions during the initial period of the study, whereas 9 children did not receive direct treatment. Results indicated that for the two subgroups there was a marked deceleration over time in the mean frequency of stuttering-like disfluencies. Individual subjects' data showed considerable variability in the longitudinal development of disfluency but most subjects followed the patterns of the group means. Much of the reduction took place during the early stage of the disorder, especially near the end of the first year post-onset. There were indications that group differences between chronic and recovering stutterers become distinct by approximately 20 months post-onset.

Child↗
PubMed1993

Physiological differences between stutterers and nonstutterers in perceptually fluent speech: EMG amplitude and duration.

Electromyograph (EMG) signals of the m. orbicularis oris inferior evoked by lip-rounding gestures were analyzed to see whether stutterers in their perceptually fluent speech had higher levels of EMG and longer EMG durations. The relationship between levels of EMG and durations of elevated muscle activity was investigated, and a search for the best discriminating EMG measure was made. In contrast to some previous studies on the EMG signals of stutterers, a relatively large group of stutterers (n = 15) and control speakers (n = 20), matched for age and gender, was examined. Both groups took part in a reaction time experiment using verbal items of different length (syllables, words, and sentences) in two time-stress conditions. Measures were taken for lip muscle activity during lip-rounding gestures for the Dutch /o/ sound. Only perceptually fluent trials were analyzed. The results showed that stutterers had significantly higher EMG levels at the moment of speech onset and during speech production than nonstutterers. A much larger difference between the two groups, however, was found for the EMG peak latency measure, which proved to be a very powerful distinctive feature in differentiating stutterers from nonstutterers. The results were discussed with respect to previous findings and recent theories about (speech) motor control strategies.

Adult↗
PubMed1993

Differences between stutterers' and nonstutterers' short-term recall and recognition performance.

Longer rehearsal times presumably reduce the efficiency of rehearsal and, hence, of short-term recall. The present experiment examined the question as to whether the slower subvocalization rate of people who stutter is correlated with inferior short-term serial recall and recognition performance. Rate of overt articulation was taken as a measure of rehearsal time. Lists of four nonlexical CVC syllables were presented for short-term serial recall and for short-term recognition. Nineteen adults who stutter and 30 nonstutterers participated in the experiment. In the serial reproduction task the subjects who stuttered reproduced significantly fewer items correctly than did nonstutterers. Recognition performance was measured by nonparametric measures of sensitivity and bias as defined in signal detection theory. The stuttering subjects had a significantly lower sensitivity resulting primarily from a higher false alarm rate. Rate of overt articulation was significantly related to one measure of short-term recall but not to the sensitivity of recognition. These results were interpreted as suggesting that people who stutter have slower phonological encoding and rehearsal times, that they make less use of nonphonological forms of coding than do nonstutterers, and that within their phonological system, activation more easily spills over to similar items.

Adult↗
PubMed1994

Duration of sound prolongation and sound/syllable repetition in children who stutter: preliminary observations.

The purpose of this study was to measure the duration of sound prolongations and sound/syllable repetitions (stutterings) in the conversational speech of school-age children who stutter. The relationships between duration and (a) frequency and type of speech disfluency, (b) number and rate of repeated units per instance of sound/syllable repetition, (c) overall speech rate, and (d) articulatory rate were also examined. Results indicated that for the children in this study the average duration of stuttering was approximately three-quarters of a second, and was not significantly correlated with age, length of post-onset interval, or frequency of speech disfluency. In addition, findings can be taken to suggest that part of the clinical significance of stuttering duration for children who stutter might lie in its relationship to the amount of sound prolongations these children produce, as well as their articulatory rate during fluent speech.

Age Factors↗
PubMed1994

Linguistic performance and regional cerebral blood flow in persons who stutter.

In a series of studies regarding CNS dysfunction in stuttering, we have examined linguistic and motoric performance in the context of measures of brain function. Previous studies of adults with developmental stuttering identified alterations in brain function (metabolic and electrophysiologic) in cortical regions implicated in models of speech motor control and language processing. We also identified a sub-group of these subjects who exhibited linguistic performance deficits related to speech performance deficits. The present study examined the hypothesis that adults who stutter and who show linguistic performance deficits will also show metabolic alterations in cortical regions classically related to language processing, whereas adults who stutter but who do not show linguistic performance deficits will not show these cortical metabolic alterations. Significant relative blood flow asymmetry (left < right) was observed in middle temporal and inferior frontal cortical regions only for adults who both stuttered and showed linguistic performance deficits. Results support models that explicitly recognize that efficient integration of linguistic, motoric, and cognitive processes is critical to the production of oral/verbal fluency and to understanding sources of fluency failure.

Adult↗
PubMed1994

Effect of frequency-altered feedback on stuttering frequency at normal and fast speech rates.

The purpose of this study was to determine the effect of the magnitude and direction of the frequency shift of frequency-altered auditory feedback (FAF) on stuttering frequency at both normal and fast speech rates. Twelve adult male and 2 adult female subjects who stutter read 10 different passages at either a normal or fast speech rate under nonaltered auditory feedback (NAF) and each of four FAF conditions in which the feedback signal was shifted: up one-half octave; up one octave; down one-half octave; and down one octave. Mean stuttering frequency for NAF was significantly higher than mean stuttering frequencies for all FAF conditions (p < 0.05). There were no statistically significant differences between the FAF conditions (p > 0.05). Subjects exhibited significantly more disfluencies under the fast speech rate condition relative to the normal speech rate condition. Future research should examine the relationship between frequency shifts of less than one-half octave and stuttering amelioration.

Adolescent↗
PubMed1995

Effects of linguistic correlates of stuttering on Emg activity in nonstuttering speakers.

In this study changes in upper lip and lower lip integrated electromyographic (IEMG) amplitude and temporal measures related to linguistic factors known for their influence on stuttering were investigated. Nonstuttering subjects first read and then verbalized sentences of varying length (sentence length factor), in which meaningless but phonologically appropriate character strings were varied in their position within the sentence (word position factor) and their size (word size factor). It was hypothesized that the production of stressed, vowel-rounding gestures of words in initial position, longer words, and words in longer sentences would be characterized by specific changes in IEMG amplitude that would reflect an increase in speech motor demands, intuitively defined as articulatory effort. Basically, the findings corroborated our assumptions, showing that words in sentence initial position have shorter word and vowel durations in combination with an increase in IEMG activity. Similarly, we found shorter vowel durations for longer words, and in sentence final position an increase in IEMG activity. For longer sentences we found a clear increase in speech rate, but contrary to our expectations a decrease in IEMG activity. It was speculated that this might relate to the use of a movement reduction strategy to allow higher speech rates with increased coarticulation. These findings were discussed both for their implications in normal speech production, as well as for their possible implications for explaining stuttering behavior. To this end our data can illustrate both why stutterers might run a higher risk of stuttering at these linguistic loci of stuttering, and why they might come up with a strategic solution to decrease the motor demands in speech production. The basic outcome of this study shows that higher order (linguistic) specifications can have clear effects on speech motor production.

Adolescent↗
PubMed1997

Experimental investigation of the effects of frequency-altered auditory feedback on the speech of adults who stutter.

A series of single-subject experiments evaluated the effects of frequency-altered auditory feedback (FAF) on the speech performance of four adult males who stutter. Using alterations of plus or minus one octave, FAF was compared with normal auditory feedback (NAF) in oral reading and spontaneous speech with measurements made of stuttered intervals, stutter-free speech rate, and speech naturalness. The effects of extended FAF conditions on spontaneous speech were also evaluated for two subjects who demonstrated a positive response to FAF. Results showed no consistencies across subjects in responses to FAF: One subject showed no response, another produced an initial temporary response, a third showed a deterioration in speech quality with minimal reductions in stuttering, and a fourth displayed substantial and sustained improvements in speech performance. Some implications of these findings for current research and theory about the relationship between stuttering and FAF are discussed.

Adult↗
PubMed1998

Describing the consequences of disorders: stuttering and the International Classification of Impairments, Disabilities, and Handicaps.

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) proposed by the World Health Organization (WHO, 1980) can be a useful method for describing the experiences of individuals exhibiting speech and language disorders such as stuttering. Unfortunately, the definitions for the terms impairment, disability, and handicap that were previously presented in the stuttering literature have not accurately represented the true purpose of the ICIDH as a tool for describing the consequences of disorders. This paper reviews the history of these terms in the stuttering literature and proposes alternate definitions that are more consistent with the use of the ICIDH elsewhere in the field of communication disorders, as well as within the health-related professions in general. Based on the ICIDH framework, a model is proposed for discussing the outcomes of various types of stuttering treatments in the context of an individual's experience of the stuttering disorder, and the implications for treatment outcomes research using this framework are discussed.

Persons with Disabilities↗
PubMed2000

Respiratory control in stuttering speakers: evidence from respiratory high-frequency oscillations.

This study tested the hypothesis that, in stuttering speakers, relations between the neural control systems for speech and life support, or metabolic breathing, may differ from relations previously observed in normally fluent subjects. Bilaterally coherent high-frequency oscillations in inspiratory-related EMGs, measured as maximum coherence in the frequency band of 60-110 Hz (MC-HFO), were used as indicators of participation by the brainstem controller for metabolic breathing in 10 normally fluent and 10 stuttering speakers. In all controls and most stuttering subjects, MC-HFO for speech was higher than or comparable to MC-HFO for deep breathing. For 4 stuttering subjects, higher MC-HFO was observed for speech than for deep breathing. Comparison of deep breathing to a speechlike breathing task yielded similar results. No relationship between MC-HFO during speech and severity of disfluency was observed. We conclude that in some stuttering speakers, the relations between respiratory controllers are atypical, but that high participation by the HFO-producing circuitry in the brainstem during speech is not sufficient to disrupt fluency.

Adult↗
PubMed2000

Parental perceptions of children's communicative development at stuttering onset.

There has been clinical speculation that parents of young stuttering children have expectations of their children's communication abilities that are not well-matched to the children's actual skills. We appraised the language abilities of 15 children close to the onset of stuttering symptoms and 15 age-, sex-, and SES-matched fluent children using an array of standardized tests and spontaneous language sample measures. Parents concurrently completed two parent-report measures of the children's communicative development. Results indicated generally depressed performance on all child speech and language measures by the children who stutter. Parent report was closely attuned to child performance for the stuttering children; parents of nonstuttering children were less accurate in their predictions of children's communicative performance. Implications for clinical advisement to parents of stuttering children are discussed.

Child Language↗
PubMed2002

IDEA '97 and children who stutter: evaluation and intervention that lead to successful, productive lives.

The Individuals with Disabilities Education Act (IDEA) '97 is the federal law that shapes the legal process involved with evaluating and treating children who stutter. The speech-language pathologist is required to provide a complete evaluation of the child's communication skills, including documentation of the impact of the child's stuttering on his involvement in his education. Goals and benchmarks are written based on the weaknesses identified in the child's present level of performance within the Individualized Education Plan (IEP). Transition plans are crucial for the child who stutters to become a healthy, productive member of society. Therapy frequency and location are based on the child's individual needs. Placement, dismissal, and re-enrollment are issues that vary for each child who stutters. IDEA '97 provides speech-language pathologists with clear direction as to the programming for children with the complex disorder of stuttering.

Child↗
PubMed2002

Stuttering therapy in partnership with support groups: the best of both worlds.

The current challenges facing school-based speech-language pathologist (SLPs) make it increasingly difficult to provide "best practice" services for children who stutter. Traditional modes of therapy alone do not meet many of the needs of children who stutter and their families. Using an interdisciplinary "team" approach to therapy that incorporates support organizations may increase the probability of positive outcomes for children who stutter. By facilitating the introduction of a support organization experience into the direct therapy process, the school-based SLP is uniquely positioned to use this resource to complement an overall treatment strategy. Although there is no substitute for a competent, professional SLP as the primary care provider in the treatment of stuttering, this article outlines some of the many benefits that can be gained by partnering with support organizations when treating children who stutter.

Child↗
PubMed2003

One size does not fit all: special topics in stuttering therapy.

One of the greatest challenges facing clinicians working with school-age children who stutter is the fact that there are such vast differences between and among children who stutter. These differences are seen not only in the speech behaviors children may exhibit, but also in children's experiences with stuttering and in their reactions to those experiences. This article introduces the second of two issues of Seminars in Speech and Language that focuses on school-age children who stutter. The first volume addressed general issues in treatment, and this second volume is aimed at helping clinicians face the challenges posed by the differences in children who stutter. Specific topics include identifying resources designed to meet the needs of different children, tailoring treatment programs to children with specific needs (e.g., other cultural backgrounds, concomitant disorders), helping children face obstacles to achieving success outside the therapy room, and helping clinicians develop partnerships with family and teachers.

Child↗
PubMed2000

Shame, self-consciousness, and locus of control in people who stutter.

Stuttering is a multidimensional disorder, including psychological as well as physiological elements. This investigation of the value of 3 psychological constructs (shame, self-consciousness, and locus of control) in the prediction of 3 self-reported behavioral dimensions of stuttering (struggle, avoidance, and expectancy) revealed shame and self-consciousness to be significant psychological predictors of the selected dimensions of stuttering, whereas locus of control was found not to be. Certain demographic elements, including affiliations with others who stutter, were also determined to be predictive of the stuttering dimensions. The present findings and their implications for theory, research, and practice are discussed.

Adult↗
PubMed1986

Changes in stuttering in relation to children's locus of control.

The locus of control of stuttering children before, during, and after treatment for dysfluency was investigated. Subjects participated in a one-week program combining delayed auditory feedback and training of parents to negotiate and implement contracts for their child's practice of stutter-free speech skills. The Children's Nowicki-Strickland Scale was used to measure locus of control before, immediately after, two months after, and six months after the training. Measures of speech dysfluency were available at each of these times and documented the effectiveness of treatment in reducing stuttering. The locus of control scores for stuttering children prior to treatment were comparable to normative groups. Internality on the locus of control measure prior to treatment was directly related to degree of change in dysfluency immediately following the one-week clinic, but not to dysfluency levels at the 2-month or 6-month follow-up sessions. Concomitant with improved speech, the children became progressively more internal following treatment. The results suggest that participation in a behavioral program for the treatment of stuttering increases internality.

Adolescent↗
PubMedDate not supplied

Treatment of chronic stuttering: outcomes from a student training clinic.

BACKGROUND: It has been suggested that one way to increase speech pathologists' confidence in working with people who stutter is to provide them with relevant and stimulating clinical experiences during their professional preparation. This paper describes a treatment programme for adults who stutter that is conducted by speech pathology students, under supervision, in an Australian university setting. The aim of the research presented here was to establish speech outcomes for this programme, and to determine whether the programme meets benchmarks set by reports of similar programmes, in addition to providing mentorship for student clinicians. METHODS & PROCEDURE: Participants were 78 adults who were treated in one of five consecutive treatment programmes during a 3-year period. The treatment was a traditional intensive speech restructuring treatment known as Smooth Speech, conducted over a 5-day period. Speech assessments were conducted 1 week and 1 day before the start of the treatment programme. Post-treatment assessments were conducted immediately following the intensive component of the programme, and 3 months, 12 months and 3.5-5 years post-treatment. The student clinic treatment model in this report produced objective speech data for more subjects in one outcome study than has ever been reported before. Data for 87% (68/78) of participants were available at 3.5-5-year follow-up. Results showed that outcomes for stuttering, speech naturalness, and client self-reports were all comparable with existing reports of similar programmes. The present results were attained with a student/supervisor ratio of around 8:1. CONCLUSIONS: We conclude that a clinician-supervised student clinic has the potential to supply services for those with chronic stuttering, as well as providing effective clinical education for student clinicians during their professional preparation. The student clinic treatment model produced varied, objective speech data for more subjects than has ever been reported before in one study. The present findings also replicated a previous finding that stuttering was more severe within the clinic than in speech samples collected in everyday speaking environments.

Adolescent↗
PubMedDate not supplied

Introduction to qualitative research and its application to stuttering.

BACKGROUND: Those engaged in research might argue that we are involved in a process of explaining the world to others and to ourselves. The way in which we go about that process differs. The kind of questions we are concerned about answering will determine the approach we use, the information we gather and how we analyse the data. Some research questions are best answered using qualitative methods. AIMS: To explain the place of qualitative research methods within the context of different approaches to scientific enquiry. To describe qualitative research through an examination of the characteristics that differentiate it from quantitative approaches, to describe the types of strategies used, and the roles the researcher may adopt. To show how these methods have been applied to the study of stuttering. METHODS & PROCEDURES: Stuttering research was reviewed with the aim of finding studies using a range of qualitative methods. Work for discussion was selected based on historical importance, the methods used and the contribution the work has made to our understanding of stuttering and qualitative methods. MAIN CONTRIBUTION: Papers using explorative qualitative research and mixed methodologies are described and their various contributions to our understanding of stuttering are discussed. CONCLUSIONS: The qualitative research reviewed in this paper has added to our understanding of the experiences, thinking and views of people who stutter. The reports on people's experiences of therapy show that we still have much to learn and that we need to listen to our clients and involve them in therapy and in outcome planning.

Adult↗