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PubMed1998

Brief application of simplified habit reversal to treat stuttering in children.

We evaluated a brief therapy protocol involving the simplified regulated breathing method as a treatment for stuttering in children. The simplified treatment included awareness training, competing response training, and social support. Treatment was implemented in a multiple baseline across subjects design for 5 boys between the ages of 5 and 11. Each child received a 1 h treatment session, and 1/2 h booster sessions as needed. Four of the 5 children reduced their stuttering to less than 3% stuttered words (the criterion for successful treatment) after one 1 h treatment session. These results were maintained for 3 of the subjects from 6 to 9 months posttreatment. Social validity measures revealed significant differences between ratings on baseline and posttreatment speech samples. Treatment acceptability and credibility measures indicated that the subjects' guardians found the simplified regulated breathing method a reasonable treatment for stuttering in children.

Behavior Therapy↗
PubMedDate not supplied

Addressing generalization and maintenance of stuttering treatment in the schools: a critical look.

UNLABELLED: Generalization and maintenance are a widely recognized challenge for stuttering treatment. There are many reasons why this is the case. First, there is no accepted model of recovery, though self-efficacy may be a helpful construct and, secondly, the client's age, stuttering severity, and negative attitudes may be complicating factors. Three strategies for promoting generalization and maintenance in school settings are suggested based on current research evidence. They include probing and training for generalization, incorporating real-life elements into therapy, and training clients to self-regulate their behavior. These strategies appear to be viable and practical, but further research is needed to fully evaluate their effectiveness for school settings. LEARNING OUTCOMES: Readers will learn about (1) typical approaches to managing stuttering in the school setting, (2) barriers to generalization and maintenance of stuttering treatment gains, and (3) three strategies for promoting generalization and maintenance.

Adolescent↗
PubMedDate not supplied

The effects of fluency-evoking conditions on voicing onset types in persons who do and do not stutter.

Voicing onset changes between control conditions and three fluency-evoking conditions (choral reading [CHORAL], delayed auditory feedback [DAF], and noise [NOISE]) were studied in 12 persons who do not stutter and 10 who do stutter. Voicing onsets were distinguished physiologically using airflow prior to voicing, with zero airflow prevoicing categorized as hard and the rest as breathy. Persons who stutter were more fluent under all fluency-evoking conditions than control conditions. Speaking under fluency-evoking conditions did not significantly increase the overall proportion of breathy onsets from control conditions for either group. However, looking only at hard onsets in the control condition, we found that both groups changed significantly more to breathy (p = 0.001) under CHORAL and NOISE. In persons who stutter, onset type was not associated with whether a word was produced fluently or dysfluently in the control condition. Also, no relationship was found between onsets changing to breathy under fluency-evoking conditions and onsets changing to fluent. The results suggest that although fluency-evoking conditions can modify some voicing onset behaviors, these modifications do not relate to improvements in fluency.

Adult↗
PubMedDate not supplied

Reliability of judgments of stuttering and disfluency in young children's speech.

This study examined interjudge agreement levels for two forms of judgments of overt speech characteristics in young children's speech: stuttering and disfluency types. Five experienced adult listeners made judgments of disfluencies and stuttering in samples of eight young children's spontaneous speech on separate occasions with the order of tasks counterbalanced across listeners. Results showed that the interjudge reliability for judgments based on a disfluency taxonomy was not significantly different from that based on stuttering. The high coefficients of reliability for both procedures indicated that subjects would be ranked consistently on the basis of either form of judgment. The importance of both forms of judgments to stuttering treatment and research is discussed.

Adult↗
PubMed2003

ADHD and stuttering: a tutorial.

UNLABELLED: The purpose of this tutorial is twofold. The first is to provide a brief description of some of the key diagnostic features of attention deficit hyperactivity disorder (ADHD) for speech-language pathologists who might not be knowledgeable about this disorder. The second purpose is to provide information and suggestions about treating children who stutter and who have been diagnosed with ADHD. Specific information is provided regarding medication used to treat ADHD symptoms as well as the minimal documented evidence of its impact on stuttering. Suggestions for educational, behavioral, and cognitive management of children who stutter and have ADHD also are discussed. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) identify diagnostic criteria for children with ADHD; (2) differentiate pharmacological, environmental, and behavioral interventions for children with ADHD; and (3) examine effective instructional techniques for children who stutter and have ADHD.

Adolescent↗
PubMed2003

Evidence-based treatment of stuttering: I. Definition and application.

UNLABELLED: The philosophy guiding evidence-based treatment and its application to decision-making in stuttering treatment is described. Limitations to the use of evidence-based treatment principles to guide stuttering treatment, namely the lack of a substantial treatment research literature that can serve as the basis for meta-analyses and systematic reviews of effective treatment studies, are bemoaned. Guidelines are provided to aid clinicians in their own conduct of critical evaluations of treatment research. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) describe the four steps that characterize evidence-based practice, (2) evaluate previous efforts to develop practice guidelines for stuttering, (3) assess the importance of an evidence-based approach to stuttering treatment, and (4) discuss the need for more research that will contribute to the evidence base.

Decision Making↗
PubMed2003

Choral speech: the amelioration of stuttering via imitation and the mirror neuronal system.

'Choral' speech or speaking in unison is an undeniable phenomenon that immediately induces fluent and natural sounding speech in almost all people who stutter, regardless of linguistic content, situation or audience size. We propose that the choral speech effect is a form direct imitation, a primitive and innate human capacity that is possibly mediated at the neuronal level by 'mirror neurons'. Mirror systems link observations and actions are considered by many to be a neuronal substrate for gestural language acquisition, as well as forming the basis for many learned behaviors, thus possibly playing a vital role in ensuring survival during infancy. The engagement of these systems allows gestural sequences, including speech, to be fluently replicated. Choral speech and its permutations use the capacity for fluent imitation in people who stutter via a 'loose' gestural matching system in which gestures in the external signal possessing cues found in the intended utterance can serve as stuttering inhibitors. We suggest implementing these innate gestural mirrors to provide immediate and effective amelioration for stuttering.

Animals↗
PubMed1997

Spontaneous imitation of fundamental frequency and speech rate by nonstutterers and stutterers.

Speech can be described either in terms of acoustics, as a perceptual outcome, or as a motor event. Central to theories of speech perception and production is an attempt to describe how these aspects of speech are interrelated. The present experiment investigated how the nonstutterers' and stutterers' reproductions of acoustically presented interrogative sentences were influenced by experimental variations of intonation (sentence initial vs. sentence final) and speech rate (normal vs. time compressed). We studied the effects of these stimulus manipulations on the speech rate and fundamental frequency (F0) of 10 adult German-speaking nonstutterers and seven stutterers. Experimental manipulations of intonation and speech rate significantly influenced the syllable duration and speech rate of both normal speakers and stutterers. The fundamental frequency of the subjects' responses were also significantly influenced by the intonation of the stimulus. But the stutterers' increase in F0 for stressed syllables was generally less pronounced than that of nonstutterers. These results imply that (a) the subject not only extract linguistic meaning from intonation but that they also store extragrammatical speech rate information, and (b) the speakers adopt these speech rate variations for their own productions. Generally, these results demonstrate that speech perception is not limited to extracting linguistically invariant information. The results show that speakers actively generate their own prosody and that this generative process is influenced by the prosodic structure of another speaker's antecedent speech. The implications of these results for theories of speech production are discussed.

Adult↗
PubMed2004

Language abilities in children who stutter: toward improved research and clinical applications.

The nature of the association between language and stuttering in young children has been the focus of debate for many years. One aspect of this ongoing discussion is the status of language abilities in children who stutter (CWS). Available research findings and associated interpretations of these findings are equivocal. This article asserts that an important contributor to the ambiguous nature of this literature may be differences in research traditions and methods that typically have been employed n the study of language development and in the study of stuttering. Cross-disciplinary investigations are inherently complex and, in designing and intterpreting research of this nature, a larger set of issues must be considered and more diverse variables must be aressed and/or controlled. This article presents five prinples that can be used to guide future research in the area language and stuttering. These principles also assist in interpreting and applyng the current research literature to clinical concerns.

Child↗
PubMed2006

Treating preschool children who stutter: description and preliminary evaluation of a family-focused treatment approach.

PURPOSE: The purpose of this article is to present a detailed description of a family-focused treatment for preschool children who stutter that addresses communication behaviors and attitudinal reactions that children and their parents may exhibit in reaction to stuttering, as well as a preliminary evaluation of the outcomes of that treatment. METHOD: The study involved assessment of the children's speech fluency and a client satisfaction questionnaire that sought parents' opinions about which aspects of the treatment were beneficial. Participants were 17 children who stutter, ages 31 to 62 months, and their families. RESULTS: Responses to the questionnaire indicated that treatment helped families learn about stuttering and about strategies that facilitate children's fluency. Evaluation of the children's fluency revealed that all participants achieved improved fluency at the conclusion of treatment and at long-term follow-up. IMPLICATIONS: Findings suggest that this treatment approach may be useful for helping children achieve improved speech fluency, effective communication skills, and healthy communication attitudes.

Child, Preschool↗
PubMed2004

Telehealth adaptation of the Lidcombe Program of Early Stuttering Intervention: five case studies.

This article describes and reports data-based outcomes of a low-tech telehealth adaptation of the Lidcombe Program of Early Stuttering Intervention. Participants were 5 children with early stuttering, ranging in age from 3;5 (years;months) to 5;7, and their families. All children met the speech criteria for completion of Stage 1 of the Lidcombe Program. Data suggested that the treatment method may be viable and that favorable outcomes may be achievable. Mean posttreatment stuttering rates in everyday speaking situations were available 12 months posttreatment for 4 children. Two children scored a mean percent syllables stuttered of less than 1.0 at that time, and 2 children scored a mean of below 2.0. As occurs often in standard delivery of the Lidcombe Progam, 1 child relapsed after Stage 1, apparently because of parental noncompliance, but this relapse was managed successfully. Follow up data were unavailable for 1 child. For 4 of the 5 cases, the number of consultations required exceeded established benchmarks for standard Lidcombe Program delivery, suggesting that telephone-based telehealth may be a less efficient version of the treatment. The implications of these preliminary data are discussed.

Child, Preschool↗
PubMed2006

The Stuttering Treatment Research Evaluation and Assessment Tool (STREAT): evaluating treatment research as part of evidence-based practice.

PURPOSE: This article presents, and explains the issues behind, the Stuttering Treatment Research Evaluation and Assessment Tool (STREAT), an instrument created to assist clinicians, researchers, students, and other readers in the process of critically appraising reports of stuttering treatment research. METHOD: The STREAT was developed by combining and reorganizing previously published recommendations about the design and conduct of stuttering treatment research. CONCLUSIONS: If evidence-based practice is to be widely adopted as the basis for stuttering assessment and treatment, procedures must be developed and distributed that will allow students, clinicians, and other readers without specialized knowledge of research design to critically appraise treatment research reports. The STREAT is intended to be such an instrument: It represents the consensus of previous methodological recommendations; it is consistent with and complements existing recommendations in evidence-based medicine and in the broader science of treatment outcome evaluation; and it is formatted into a single instrument for ease of use.

Evidence-Based Medicine↗
PubMed2006

Stuttering treatment research 1970-2005: I. Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches.

PURPOSE: To complete a systematic review, with trial quality assessment, of published research about behavioral, cognitive, and related treatments for developmental stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence about stuttering treatment for preschoolers, school-age children, adolescents, and adults. METHOD: Multiple readers reviewed 162 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations. Articles were then assessed using 5 methodological criteria and 4 outcomes criteria, also developed from previously published recommendations. RESULTS: Analyses found 39 articles that met at least 4 of the 5 methodological criteria and were considered to have met a trial quality inclusion criterion for the purposes of this review. Analysis of those articles identified a range of stuttering treatments that met speech-related and/or social, emotional, or cognitive outcomes criteria. CONCLUSIONS: Review of studies that met the trial quality inclusion criterion established for this review suggested that response-contingent principles are the predominant feature of the most powerful treatment procedures for young children who stutter. The most powerful treatments for adults, with respect to both speech outcomes and social, emotional, or cognitive outcomes, appear to combine variants of prolonged speech, self-management, response contingencies, and other infrastructural variables. Other specific clinical recommendations for each age group are provided, as are suggestions for future research.

Acupuncture↗
PubMed2006

Speech effort measurement and stuttering: investigating the chorus reading effect.

PURPOSE: The purpose of this study was to investigate chorus reading's (CR's) effect on speech effort during oral reading by adult stuttering speakers and control participants. The effect of a speech effort measurement highlighting strategy was also investigated. METHOD: Twelve persistent stuttering (PS) adults and 12 normally fluent control participants completed 1-min base rate readings (BR-nonchorus) and CRs within a BR/CR/BR/CR/BR experimental design. Participants self-rated speech effort using a 9-point scale after each reading trial. Stuttering frequency, speech rate, and speech naturalness measures were also obtained. Instructions highlighting speech effort ratings during BR and CR phases were introduced after the first CR. RESULTS: CR improved speech effort ratings for the PS group, but the control group showed a reverse trend. Both groups' effort ratings were not significantly different during CR phases but were significantly poorer than the control group's effort ratings during BR phases. The highlighting strategy did not significantly change effort ratings. CONCLUSION: The findings show that CR will produce not only stutter-free and natural sounding speech but also reliable reductions in speech effort. However, these reductions do not reach effort levels equivalent to those achieved by normally fluent speakers, thereby conditioning its use as a gold standard of achievable normal fluency by PS speakers.

Adult↗
PubMed1976

Verbal versus tangible reward for children who stutter.

The results of several previous attempts to modify the speech of stuttering children suggest that tangible (as opposed to verbal) rewards are efficient forms of positive reinforcement. The purpose of this study was to investigate the relative effectiveness of these two forms of positive reinforcement with young stuttering subjects. Each of three stuttering children was seen for a base rate session, three experimental sessions, and a carry-over session. Experimental sessions were preceded by verbal instructions explaining the response contingency, and subjects selected their own verbal and tangible reinforcers. Results revealed that both verbal and tangible reinforcements were equally effective in modifying the speech of the three subjects. The possibility is discussed that the effectiveness of verbal and tangible rewards with young stuttering subjects can be explained by (1) selection of the rewards by the subjects; (2) reinforcement of easily identifiable behavior; and (3) subject awareness of the response contingency.

Behavior Therapy↗
PubMed1977

A reexamination of the role of heredity in stuttering.

In the light of recent breakthrough in the study of schizophrenia indicating a far stronger genetic factor than has been previously suspected, the role of heredity in stuttering is critically reexamined. Present knowledge of the role of heredity in stuttering springs from four principal data sources: (1) studies of familial incidence; (2) spontaneous recovery studies; (3) twin studies; and (4) studies of parental disfluency. It is hypothesized that the 4:1 sex ratio in stuttering may be the product of selective genetic factors. Critical examination of earlier and more recent studies leads to substantial evidence that a familial predisopsing factor exists in about 25% cases of stuttering.

Dominance, Cerebral↗
PubMed1977

Facilitating transfer and maintenance of fluency in stuttering therapy.

The present state of stuttering therapy programs enables the clinician to render many stuttering virtually stutter-free in the clinic. A major clinical problem, however, is the transfer of fluency to nonclinical situations and its maintenance over time. Concepts and techniques extrapolated from the literature on behavior change are applied to assessment, treatment objectives, treatment techniques, and to a number of procedures designed to facilitate transfer and maintenance during therapy. When fluency has been established, self-control techniques based on speech practice, self-monitoring, and the deliberate use of self-administered and social contingencies are stressed. Guidelines for termination of therapy and follow-up are given. For many of these techniques, specific examples are offered from clinical work with stutterers. Other techniques are presented because of their potential relevance and their demonstrated effectiveness with a variety of clinical problems.

Behavior Therapy↗
PubMed1981

Regression to the mean in pretreatment measures of stuttering.

Pre-post treatment evaluation designs are common in stuttering research. Their propriety depends on the assumption that spontaneous remission is not likely. There are six studies in the literature in which stutterers have been measured on two occasions some months apart. In all studies there was a trend to less stuttering on the second assessment, but in no study was the difference between scores significant. One hundred and thirty-two stutterers awaiting treatment were assessed when they were first seen and then at the beginning of treatment 1--23 months later. There was a small but significant improvement between the two assessments. The size of the improvement was comparable to those reported in the six published studies. This spontaneous improvement occurs mainly in the three months following the first assessment, and there is little change thereafter. It is concluded that pre-post studies of subjects who waited more than three months for treatment are valid and that the observed improvement can be due solely to the effects of treatment. Studies that assess improvement from the time subjects are first seen should allow for spontaneous remission to determine the improvement due to treatment.

Adult↗