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PubMed1996

Time-interval measurement of stuttering: establishing and modifying judgment accuracy.

The purpose of this study was to determine whether accuracy training for interval judgments of stuttering might generalize to increased accuracy and/or interjudge agreement for intervals other than those used during training. Ten upper-division speech-language pathology students judged 5-s audiovisually recorded speech intervals as stuttered or nonstuttered in a series of group and single-subject experiments. Judgment accuracy was determined with respect to judgments provided previously by 10 recognized authorities on stuttering and its treatment. Training occurred within single-subject experiments that used multiple baselines across speakers and repeated generalization probes to assess training effects. Results showed that judgment accuracy tended to increase after training for speakers used during the training process as well as for unfamiliar speakers. Results also replicated previous findings of slight increases in interjudge and intrajudge agreement after interval-judgment training. The implications of these results for developing a valid and reliable stuttering measurement system are discussed.

Female↗
PubMed1996

Stuttering and phonological disorders in children: examination of the Covert Repair Hypothesis.

The purpose of this study was to evaluate whether the Covert Repair Hypothesis (CRH; Postma & Kolk, 1993), a theory designed to account for the occurrence of speech disfluencies in adults who stutter, can also account for selected speech characteristics of children who stutter and demonstrate disordered phonology. Subjects were 9 boys who stutter and exhibit normal phonology (S + NP; mean age = 61.33 months; SD = 10.16 months) and 9 boys who stutter and exhibit disordered phonology (S + DP; mean age = 59.11 months; SD = 9.37 months). Selected aspects of each child's speech fluency and phonology were analyzed on the basis of an audio/videotaped picture-naming task and a 30-min conversational interaction with his mother. Results indicated that S + NP and S + DP children are generally comparable in terms of their basic speech disfluency, nonsystematic speech error, and self-repair behaviors. CRH predictions that utterances produced with faster articulatory speaking rates or shorter response time latencies are more likely to contain speech errors or speech disfluencies were not supported. CRH predictions regarding the co-occurrence of speech disfluencies and speech errors were supported for nonsystematic ("slip-of-the-tongue"), but not for systematic (phonological process/rule-bases), speech errors. Furthermore, neither S + NP nor S + DP subjects repaired their systematic speech errors during conversational speech, suggesting that systematic deviations from adult forms may not represent true "errors, " at least for some children exhibiting phonological processes. Findings suggest that speech disfluencies may not represent by-products of self-repairs of systematic speech errors produced during conversational speech, but that self-repairs of nonsystematic speech errors may be related to children's production of speech disfluencies.

Age Factors↗
PubMed1998

Two- to six-year controlled-trial stuttering outcomes for children and adolescents.

This research is a long-term follow-up of a previously published, controlled trial on the effectiveness of 3 stuttering treatments (intensive smooth speech, parent-home smooth speech, and intensive electromyography feedback) for children and adolescents, aged 11 to 18 years, who stutter. The previous controlled trial showed all 3 treatments to be effective compared to nontreatment after 12 months. This paper reports on the treatment effectiveness after an average of 4 years post-treatment. Results demonstrate that treatment gains were maintained in the long term, with rates of stuttering similar to the 1-year postoutcomes. There were no significant differences among the 3 treatments in long-term effectiveness. This controlled study substantiates the claim that the treatments investigated will more than likely have substantial long-term benefits for the fluency and personality of children and adolescents who stutter.

Adolescent↗
PubMed2000

Timing and intensity variability in the metronomic speech of stuttering and nonstuttering speakers.

The timing and intensity variability of 8 adults who stutter and 8 age-matched fluent speakers was investigated under metronomic conditions. Participants were required to produce double or triple-stress patterns at a slow speech rate (1 syllable/870 ms) when repeating the syllable /staet/or/straet/nine times. Measures that are sensitive to cyclic rather than overall variation in syllable timing and intensity were employed. Specifically, durational variation between successive syllable onsets as well as intensity variation of the beginning consonant and vowel in successive syllables were computed. Results revealed that, although intensity variation was similar, the timing of successive syllables of persons who stutter was significantly more variable than that of persons who do not stutter. These outcomes are discussed in relation to previous experiments of timing control of persons who stutter and normally fluent persons during metronomic stimulation.

Adult↗
PubMed2000

Individual and consensus judgments of disfluency types in the speech of persons who stutter.

Previous research has suggested that the reliability with which judges identify individual disfluency types, such as repetitions or prolongations of speech sounds, may be very poor. The use of disfluency types judgments in research and clinical applications is also complicated by important differences among the several disfluency-based characterizations of stuttered speech. In an attempt to address these problems, this study arranged for 30 judges to identify all disfluency types that they perceived to be present in 5-s audiovisually recorded speech stimuli, each in an Individual task and then with a partner in a Consensus task. Intrapair agreement and interpair agreement for occurrences of disfluency types (from Consensus conditions) were significantly higher than intrajudge and interjudge agreement for occurrences (from Individual conditions). Despite being higher than individual values, however, intrapair and interpair agreement for occurrences both averaged less than 50%. Results also showed that disfluency types judgments, interpreted in terms of three common disfluency-based definitions of stuttering, were not strongly related to previous assessments of whether these speech tokens contained or did not contain stuttering. When combined with previously available data, the present findings suggest caution in the use of disfluency types to describe or define stuttered speech.

Adult↗
PubMed2002

Administering stuttering modification therapy in school settings.

Stuttering modification techniques can be used effectively in the school setting. In fact, speech-language pathologists can use this environment to their advantage to address not only disfluency but also the emotional and behavioral aspects of stuttering. Toward this end, stuttering modification goals and techniques are outlined, with a discussion of how to adapt them to school environments. Specific topics include writing clear, measurable IEP goals, taking advantage of the school setting to implement these goals, administering stuttering modification within a group therapy mode, involving parents and teachers, and monitoring progress.

Child↗
PubMed2002

Successful communication for children who stutter: finding the balance.

For many school-age children, stuttering consists of more than just speech disfluencies, physical tension, and struggle. Therefore, successful therapy for stuttering should address more than just these observable characteristics. In addition to working on fluency goals, clinicians can help children (as well as the people in the child's environment) reduce negative reactions to stuttering and increase their tolerance and acceptance of their speaking abilities. By treating the entire stuttering disorder in this way, clinicians can help children reduce barriers to successful communication and improve their overall communication skills. When children develop a balance between increased fluency and healthy communication attitudes, they have the greatest opportunity for becoming successful communicators who can speak freely and with confidence in any situation they face.

Child↗
PubMed2003

Planning a teacher in-service for stuttering disorders.

This article addresses the need for teacher in-service presentations about stuttering disorders as a means of changing the negative perceptions teachers (and others) may have toward people who stutter. Strategies for in-service planning include keeping the program simple while one engages, encourages, and empathizes with teachers. The agenda for the program includes three key areas: content, experience with children who stutter, and classroom adaptations. Ongoing follow-up with teachers also helps to shape teacher beliefs about stuttering. The article concludes with a discussion about the special challenges faced by the speech language pathologist working in the public schools and ideas about how clinicians can work to overcome these potential barriers.

Attitude↗
PubMedDate not supplied

Speech timing in children after the Lidcombe Program of early stuttering intervention.

It is known that operant treatments can control stuttering in children. However, at present it is unknown why such treatments are effective. Changes in the usual way of speaking are frequently observed after behavioural treatments for adults who stutter, and it is possible that operant treatments for children also invoke such changes. To explore this idea, selected acoustic measures of speech timing were made in eight preschool children before and after receiving the Lidcombe Program, which is an operant treatment for stuttering. No systematic changes were detected after treatment. Considering this finding and a previous report, there is no evidence to suggest that the reductions in stuttering that occur with this treatment are related to systematic changes in speech timing or curtailment of language function.

Child, Preschool↗
PubMedDate not supplied

Psychological impact of the Lidcombe Program of early stuttering intervention.

The Lidcombe Program is an operant treatment for stuttering in preschool children for which favourable outcome and social validity data have been published. The treatment involves parental praise for stutter-free speech in children's everyday speaking environments, and occasional correction of stuttered speech. Theoretical perspectives on the origins of stuttering have prompted suggestions that the Lidcombe Program may have an adverse psychological impact on children. The present preliminary investigation sought to identify any evidence of such a systematic, pernicious trend, which might justify statistically powerful investigations of the issue with large subject numbers. Subjects were eight preschool children who were successfully treated with the Lidcombe Program. The Child Behavior Checklist (CBCL) detected any post-treatment behavioural markers of changes in children such as anxiety, aggression, withdrawal or depression. The Attachment Q-Set (AQS) measured any changes in the quality of the attachment relationship between child and mother over the course of treatment. These case studies revealed no evidence of a systematic trend in either. In fact, CBCL data suggested improvements in the children after treatment. It is concluded that there is no reason to doubt that the Lidcombe Program is a safe treatment.

Child Behavior↗
PubMedDate not supplied

Connecting stuttering measurement and management: II. Measures of cognition and affect.

BACKGROUND: To the person who stutters, there are other experiences than the somatic ones of stuttered speech. These are experiences of cognition and affect: in other words, experiences of thought and emotion. For several reasons, it is quite difficult to determine and recommend core measures of cognition and affect for clinicians to consider using. AIMS: To catalogue some of the many instruments that may be regarded by clinicians as worthwhile for use in measuring cognition and affect in clinical practice. MAIN CONTRIBUTION: The presentation of measures of cognition and affect is organized according to those that have appeared in recent clinical trials of stuttering during roughly the last decade, and those that have not featured in clinical trials. CONCLUSIONS: Measures that have featured in the clinical trials literature might be looked on favourably, along with those for whom there are more than one data source in support. The various measures from the discipline of clinical psychology generally fall into the latter category. The notions of cognition and affect emerge from the discipline of clinical psychology, and therefore it makes sense to look to that discipline for measures of those constructs. Seeking such tools outside the discipline of speech pathology, especially those with established reliability and validity, seems to hold potential in contributing to one's understanding of affective and cognitive functioning in people who stutter.

Affect↗
PubMed2005

Genomewide significant linkage to stuttering on chromosome 12.

Stuttering is a common and sometimes severe communication disorder, of unknown primary etiology, that exists in populations worldwide. Many types of evidence suggest a genetic contribution to stuttering; however, the complex inheritance of this disorder has hindered identification of these factors. We have employed highly inbred families to increase the power of linkage analysis of this disorder. Forty-four Pakistani families with documented or probable consanguinity, from the city of Lahore and surrounding areas, were included. Each family contained multiple cases of stuttering, which were diagnosed using the Stuttering Severity Instrument. Using the Marshfield Weber 9 marker panel, we performed a genomewide linkage scan focused on affected individuals and their parents. The analysis included 199 genotyped individuals, 144 affected and 55 unaffected. The Pedigree Relationship Statistical Test (PREST) was used to identify pedigrees that required additional specification of inbreeding. Initial nonparametric analysis gave evidence of linkage on chromosomes 1, 5, 7, and 12. Additional genotyping was performed on chromosome 12 to a 5-cM level of resolution, and 16 additional individuals were then included, bringing the number of families to 46. Analysis of the enlarged data set provided consistent evidence of linkage on chromosome 12: the S(homoz) scoring function gave a nonparametric LOD score of 4.61, and a LOD score of 3.51 was obtained using the S(all) scoring function. These results suggest that a locus on chromosome 12q may contain a gene with a large effect in this sample.

Chromosome Mapping↗
PubMed2004

Counseling, support, and advocacy for clients who stutter.

Fluency disorders are communicative disabilities that can lead to psychosocial and emotional issues. The most prevalent of these disorders is stuttering. People who stutter may cope with stigmatization and discrimination throughout their lives as a result of misconceptions and misinformation about the disability's etiology and manifestations. Mental health professionals have contributed to these negative experiences by their lack of knowledge about stuttering. This article provides information on the physical, psychological, and social causal factors and implications of fluency disorders, so that social workers can engage in ethical practice to alleviate the mental anguish of their clients who stutter and enable them to reach their full potential. An advocacy role with other professionals, such as educators and speech-language pathologists, is described.

Adult↗
PubMed1997

Increased dopamine activity associated with stuttering.

Position emission tomography using 6-FDOPA as a marker of presynaptic dopaminergic activity was used to investigate the role of the dopamine system in stuttering. Three patients with moderate to severe developmental stuttering were compared with six normal controls. Stuttering subjects showed significantly higher 6-FDOPA uptake than normal controls in medial prefrontal cortex, deep orbital cortex, insular cortex, extended amygdala, auditory cortex and caudate tail. Elevated 6-FDOPA uptake in ventral limbic cortical and subcortical regions is compatible with the hypothesis that stuttering is associated with an overactive presynaptic dopamine system in brain regions that modulate verbalization.

Adult↗
PubMed1998

Functional organization of the auditory cortex is different in stutterers and fluent speakers.

Impaired auditory feedback has been suggested to cause stuttering, and subtle irregularities of audition have been reported in behavioural studies. To characterize processing at the auditory cortical level, we recorded neuromagnetic responses to monaural tones in nine stutterers and 10 fluent speakers while the subjects were reading silently, with mouth movements only, aloud, and in chorus with another person. The basic functional organization of the auditory cortices was found to be different in stutterers and controls. The altered interhemispheric balance in stutterers was affected by speech production, due to changes in the left auditory cortical representation, and more severely by self-paced than accompanied speech. This may lead to transient non-optimal interpretation of the auditory input and affect speech fluency.

Adult↗
PubMed1998

Drug-induced stuttering: a review of the literature.

The author critically reviews the world literature on drug-induced stuttering. The literature on stuttering as a side effect of pharmacologic agents was identified by means of a computer-assisted search. A diversity of drugs has been reported to induce stuttering in susceptible persons, including some agents that improve the speech of some known stutterers. In all instances, normal speech returned shortly after the offending drug was discontinued. Multiple, interacting neurotransmitter systems seem to be involved. Drug-induced imbalances in these systems may account for the speech disturbances.

Antidepressive Agents↗
PubMed1994

Differentiating normal speech dysfluency from stuttering in children.

The concept of stuttering refers to a lack of fluency or a hesitancy of a speech pattern. The incidence is reported to be 1% worldwide with a greater incidence of males to females (3:1). Theories of causation are briefly identified including a genetic predisposition and neurological factors. In the process of acquiring speech skills, preschool children normally pass through a transitional stage of speech dysfluency. This fact may impede recognition of early stuttering behavior, can be emotionally painful for the child and may interfere with psychological development. The health care provider is in a key position to provide early diagnosis and intervention to the child who presents with early stuttering. In order to do so, the health care provider must possess the knowledge and skill to differentiate normal developmental dysfluency from early stuttering. Factors that differentiate these speech patterns are identified along with guidelines for referral. Current treatment modalities employed by speech pathologists are described. Practical interventions to offer parents in order to promote the child's speech fluency and decrease speaker anxiety are summarized.

Child Development↗
PubMed2001

His mother-tongue: from stuttering to separation, a case history.

This paper delineates the transference and countertransference experiences in the analysis of a patient whose presenting symptom and main concern was his stutter. I suggest that oral-sadistic rather than anal-sadistic hostile elements may be identified in this patient's particular stutter. I focus on its significance in terms of object relationship: my patient's struggle to 'get born', to emerge as a separate other. I argue that early symbiotic fusion needs in conflict with the need to separate produce his stutter. Speech and language are seen as the vehicle for separation and the stutter as a flight from separateness back to an illusion of fusion with mother.

Adult↗