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PubMed2003

Event-related fMRI for the suppression of speech-associated artifacts in stuttering.

The purpose of this study was to establish functional magnetic resonance imaging (fMRI) for the investigation of brain function during overt speech production in stuttering. Up to now this technique has rarely been used for the investigation of speech production paradigms because artifacts related to overt speaking largely impair the sensitivity toward task-related activation. Recently, the temporal delay of the hemodynamic response has been exploited to achieve a suppression of speech-related artifacts. By the limitation to very short utterances (one word), a temporal segregation of the respective effects was accomplished by means of an event-related experimental design. However, the investigation of speech production in persons who stutter requires a more extensive speaking situation. Since longer and more complex utterances evoke more symptoms of stuttering than reading of single words, a useful task should at least include the reading of full sentences. In this study we performed simulations to investigate the correlation of speech-related artifacts with the respective hemodynamic response in dependency on speech duration and rate of data sampling. Furthermore, we show that prolonged stimulus durations and repetition times of 3 s still allow an effective suppression of speech-related artifacts in fluent as well as in nonfluent speakers. Not only were obvious false activations at high contrast cerebrospinal fluid tissue borders widely eliminated, subjects also displayed consistent activation in speech-related and motor areas. As these results widely resemble those obtained by earlier neuroimaging studies on language production, event-related fMRI seems to be capable of recording neurophysiological correlates of overt speech production.

Adult↗
PubMed2003

Evidence for compensation for stuttering by the right frontal operculum.

There is recent evidence of focal alteration in fibre tracts underlying the left sensorimotor cortex in persistent developmental stuttering (PDS) [Lancet 360 (2002) 380]. If, as proposed, this anatomical abnormality is the cause of PDS, then overactivation in the right hemisphere seen with functional neuroimaging in stutterers may reflect a compensatory mechanism. To investigate this hypothesis, we performed two functional magnetic resonance imaging (fMRI) experiments. The first showed systematic activation of a single focus in the right frontal operculum (RFO) in PDS subjects during reading, which was not observed in controls. Responses in this region were negatively correlated with the severity of stuttering, suggesting compensation rather than primary dysfunction. Negative correlation was also observed during the baseline task that consisted in passive viewing of meaningless signs, indicating that RFO compensation acts independently of specific demands on motor speech output. The second experiment, that involved a covert semantic decision task, confirmed that RFO activation does not require overt utterances or motor output. In combination these findings suggest that the RFO serves a nonspecific compensatory role rather than one restricted to the final stages of speech production.

Adult↗
PubMed2005

Stroke-associated acquired stuttering.

In this case report, the syndrome of acquired stuttering is described including its etiology, common presenting features, and differences from developmental stuttering. A case is described in an elderly female patient with sudden acquired stuttering associated with ischemic infarct near the left basal ganglia.

Aged↗
PubMed2000

A study of the genetic and environmental etiology of stuttering in a selected twin sample.

Stuttering is a developmental disorder of speech production that usually emerges in childhood. In this study, a large population-based twin sample from the Australian Twin Registry (1567 pairs and 634 singles aged 17-29 years) was screened to identify twin pairs in which one or both members reported themselves to be affected by stuttering. Telephone interview-based diagnoses were obtained for 457 of these individuals (self-reported affected cases, cotwins, and controls) to determine whether the self-report was correct. To correct for ascertainment bias we carried out a bivariate analysis of the final diagnosis in the selected sample with the screening item in the full sample, using the categorical raw data option of Mx 1.47c. After correcting for ascertainment bias, approximately 70% (95% confidence interval: 39-86%) of the variance in liability to stuttering was found to be attributable to additive genetic effects, with the remainder due to nonshared environmental effects.

Adolescent↗
PubMed2004

Why we should consider pragmatics when planning treatment for children who stutter.

Pragmatics, the use of language in context, has been investigated only recently in the language used by children who stutter (CWS). Historically researchers compared the length and complexity of the syntactic constructions produced by these children with those of children who do not stutter (CWNS) and generally found the CWS to be relatively deficient. More recently, some investigators have begun to address how the language and fluency of CWS are influenced in different communicative settings. This article describes several findings concerning the pragmatic competencies of CWS set against the traditional famework of pragmatic language development. Most studies have shown no significant differences between the CWS and CWNS groups, although some aspects of pagmatic language use have yielded an exacerbation of stuttering for CWS. These findings have suggested specific ways of incorporating a pragmatic focus in the treatment programming for CWS where the degree of difficulty of language use is increased gradually.

Child↗
PubMed2004

Lexical development and retrieval in treating children who stutter.

This article describes the role of lexical acquisition in stuttering by examining the research on word learning and interactions between semantics and syntax in typically developing children and children who stutter. The potential effects of linguistic mismatches, or dysynchronies in language skills, on the possible onset and development of stuttering are discussed. The article concludes with assessment and treatment considerations.

Child↗
PubMed2003

The relationship of self-efficacy and depression to stuttering.

This study investigated the relationship of self-efficacy for verbal fluency, academic self-efficacy, and depression between adolescents who stutter and fluent speakers. Two separate discriminant function analyses were performed. The first analysis used the self-efficacy and depression scores as response variables and fluency classification as the grouping variable. Results indicated that self-efficacy for speech was the sole significant variable and accounted for 61% of the variance in group status. A second simplified discriminant function analysis was performed using speech self-efficacy as the sole predictor of group membership. This single discriminant function correctly classified 81% of the overall sample into their known groups. Further, classification for participants who did not stutter (95.2%) was better than for those who did stutter (67%). Based on this and earlier research, adolescents appear to be capable of using self-efficacy scaling as a measure of confidence for verbal fluency, which may eventually prove to be useful in treatment.

Adolescent↗
PubMed2006

The effect of sample size on the assessment of stuttering severity.

The relationships between the length of the speech sample and the resulting disfluency data in 20 stuttering children who exhibited a wide range of disfluency levels were investigated. Specifically, the study examined whether the relative number of stuttering-like disfluencies (SLD) per 100 syllables, as well as the length of disfluencies (number of iterations per disfluent event), varied systematically across 4 consecutive, 300-syllable sections in the same speech sample. The difference in the number of SLD per 100 syllables between the early and later sections of the speech sample was statistically significant. In addition, the length of the speech sample had a critical influence on the identification of stuttering in children exhibiting relatively low levels of disfluency. Also, when a 20% difference in the number of SLD per 100 syllables was taken as a criterion, 50% of the children exhibited upward shifts in continuous speech samples that were longer than 300 syllables (i.e., 600, 900, and 1,200 syllables). Results indicated that, in general, group means for SLD grew larger as the sample size increased. The length of disfluent events did not significantly differ as the sample size increased; however, there were large differences for some children. Implications for clinicians and investigators are discussed.

Child, Preschool↗
PubMed2001

The young child's awareness of stuttering-like disfluency.

The emergence of awareness of stuttering has been an important factor in theoretical and clinical considerations for early childhood stuttering. The present research program is aimed at studying the development of awareness of stuttering-like disfluency in normally fluent preschool and first-grade children using responses to video speech samples. A total of 79 children in five different age groups were asked to discriminate between the speech (fluent and disfluent) of two puppets, identify with the one who speaks like them, and evaluate the disfluent and fluent speech of the puppets. It was found that from age 3, children show evidence of awareness of the disfluency used in the study, but most children reached full awareness at age 5. Also, negative evaluation of disfluent speech is observed from age 4. Theoretical and clinical implications are discussed.

Attitude to Health↗
PubMed2001

Neural systems for sentence processing in stuttering.

The role of neurolinguistic factors in stuttering was investigated by determining whether individuals who stutter display atypical neural functions for language processing, even with no speech production demands. Event-related brain potentials (ERPs) were obtained while 9 individuals who stutter (IWS) and 9 normally fluent speakers (NS) read sentences silently. The ERPs were elicited by: (a) closed-class words that provide structural or grammatical information, (b) open-class words that convey referential meaning, and (c) semantic anomalies (violations in semantic expectation). In standardized tests, adult IWS displayed similar grammatical and lexical abilities in both comprehension and production tasks compared to their matched, normally fluent peers. Yet the ERPs elicited in IWS for linguistic processing tasks revealed differences in functional brain organization. The ERPs elicited in IWS were characterized by reduced negative amplitudes for closed-class words (N280), open-class words (N350), and semantic anomalies (N400) in a temporal window of approximately 200-450 ms after word onsets. The overall pattern of results indicates that alterations in processing for IWS are related to neural functions that are common to word classes and perhaps involve shared, underlying processes for lexical access.

Adolescent↗
PubMed2001

Parental language input to children at stuttering onset.

Many programs for the indirect management of stuttering in early childhood counsel adjustment of parental language models, which are presumed to play an exacerbating influence on vulnerable children's fluency. We examined the relative levels of linguistic demand in maternal language to stuttering and nonstuttering children, adjusted for each child's current level of linguistic development. No significant or observable differences were detected in the relative level of linguistic demand posed by parents of stuttering children very close to onset of symptoms. Empirical support for current advisement and potential ramifications are discussed.

Adult↗
PubMed2003

Acoustic startle responses and temperament in individuals who stutter.

Fourteen individuals who stutter and 14 individuals who do not stutter were presented with 10 bursts of white noise to assess the magnitude of their eyeblink responses as a measure of temperament. Both the magnitude of the eyeblink response to the initial noise burst and the mean of the 10 responses were significantly greater for the stuttering group. The Taylor-Johnson Temperament Analysis (R. M. Taylor & L P. Morrison, 1996) did not distinguish between the two groups, but informal follow-up statistics indicated that the Nervous subscale showed a significant group difference. Scores on this subscale were also significantly positively correlated with the magnitude of the startle response. A discriminant analysis demonstrated that although both the startle response and the nervous trait differentiated the two groups, the startle response measures were more powerful in making this differentiation.

Acoustic Stimulation↗
PubMed2003

Is listener comfort a viable construct in stuttering research?

This article reports the development of a tool for measuring how comfortable a person feels when communicating with someone who has undergone treatment for stuttering. The person rates the speaker on a 9-point Listener Comfort Scale (9 = extremely comfortable, 1 = extremely uncomfortable). In a preliminary investigation of the reliability and validity of the scale, 15 unsophisticated listeners rated video recordings of 10 adults before and after a prolonged-speech treatment for stuttering and of 10 matched controls. The results were compared with those of another 15 listeners who rated the same recordings with the widely used 9-point Speech Naturalness Scale (R. R. Martin, S. K. Haroldson, & K. A. Triden, 1984). Results showed that reliability of the Speech Naturalness Scale was superior to the Listener Comfort Scale, although users of both scales were able to distinguish between pretreatment speech, posttreatment speech, and the speech of controls. The results suggest that the Listener Comfort Scale captures information that is somewhat different than the information captured by the Speech Naturalness Scale. The authors concluded that the concept of listener comfort is a potentially useful additional way of investigating the social validity of behavioral treatments for stuttering.

Adolescent↗
PubMed2003

Exchange of disfluency with age from function words to content words in spanish speakers who stutter.

The main purpose of the present study was to examine whether the developmental change in loci of disfluency from mainly function words to mainly content words, observed for English speakers who stutter (P. Howell, J. Au-Yeung, & S. Sackin, 1999), also occurs for comparable Spanish speakers who stutter. The participants were divided into 5 age groups. There were 7 participants in Group 1, from 3 to 5 years old; 11 in Group 2, from 6 to 9 years old; 10 in Group 3, from 10 to 11 years old; 9 in Group 4, from 12 to 16 years old; and 9 in Group 5, from 20 to 68 years old. Across all groups, 36 of the 46 participants were male. The study method involved segmenting speech into phonological words (PWs) that consist of an obligatory content word with optional function words that precede and follow it. The initial function words in the PWs were examined to establish whether they have a higher disfluency rate than the final ones (J. Au-Yeung, P. Howell, & L. Pilgrim, 1998). Disfluency on function words in a PW was higher when the word occurred before a content word rather than after a content word for all age groups. Disfluencies on function and content words were then examined to determine whether they change over age groups in the same way as for English speakers who stutter (Howell et al., 1999). The rate of disfluency on function words was higher than that on content words, particularly in the youngest speakers. Function word disfluency rate dropped off and content word disfluency rate increased across age groups. These patterns are similar to those reported for English. Possible explanations for these similarities across the two languages are discussed.

Adolescent↗
PubMed2003

Temperamental characteristics of young children who stutter.

The purpose of this investigation was to assess the temperamental characteristics of children who do (CWS) and do not (CWNS) stutter using a norm-referenced parent-report questionnaire. Participants were 31 CWS and 31 CWNS between the ages of 3;0 (years;months) and 5;4 (CWS: mean age = 48.03 months; CWNS: mean age = 48.58 months). The CWS were matched by age (+/- 4 months), gender, and race to the CWNS. All participants had speech, language, and hearing development within normal limits, with the obvious exception of stuttering for CWS. Children's temperamental characteristics were determined using the Behavioral Style Questionnaire (BSQ; S. C. McDevitt & W. B. Carey, 1978), which was completed by each child's parents. Results, based on parent responses to the BSQ, indicated that CWS are more apt, when compared to CWNS, to exhibit temperamental profiles consistent with hypervigilance (i.e., less distractibility), nonadaptability to change, and irregular biological functions. Findings suggest that some temperamental characteristics differentiate CWS from CWNS and could conceivably contribute to the exacerbation, as well as maintenance, of their stuttering.

Adaptation, Psychological↗
PubMed2003

Phonological priming in picture naming of young children who stutter.

The purpose of this study was to assess the influence of phonological priming on the speech reaction time (SRT) of children who do (CWS) and who do not (CWNS) stutter during a picture-naming task. Participants were eighteen 3-5-year-old CWS (M = 50.67 months, SD = 11.83 months), matched in age and gender with 18 CWNS (M = 49.44 months, SD = 10.22 months). The picture-naming task required each child to name, one at a time, computer-presented, white-on-black line drawings of common, age-appropriate objects "as quickly as you can" during 3 different conditions: (a) no prime, (b) related prime, and (c) unrelated prime, with naming latency (alternatively referred to as SRT; in milliseconds) as the main dependent variable. Results indicated that all children exhibited faster or shorter SRTs during the related condition compared to the no prime condition. Similarly, SRT was influenced with advancing age for all children, with 5-year-olds exhibiting faster SRTs than 3-year-olds. Furthermore, CWNS, but not CWS, demonstrated a negative correlation between articulatory mastery and SRT. Findings were taken to suggest that phonological priming is a feasible procedure for studying the speech-language planning and production of 3-5-year-old children and that preschool children who stutter, as a group, may have somewhat less well developed articulatory systems than preschool children who do not stutter.

Age Factors↗
PubMed2004

Orofacial movements associated with fluent speech in persons who stutter.

This study was intended to replicate and extend previous findings that (a) during fluent speech persons who stutter (PS) and those who do not (NS) differ in their vocal tract closing movements (L. Max, A. J. Caruso, and V. L. Gracco, 2003) and (b) ratios relating lip and tongue speed to jaw speed increase with stuttering severity (M. D. McClean and C. R. Runyan, 2000). An electromagnetic system was used to record movements of the upper lip, lower lip, tongue, and jaw of 43 NS and 37 PS during productions of a nonsense phrase and a sentence. Measurement and analysis of movement speeds, durations, and ratios of lip and tongue speed to jaw speed were performed on fluent productions of a nonsense phrase and sentence. Statistical comparisons were made between PS with low and high stuttering severity levels (LPS and HPS) and NS. Significant variations across groups in movement speed and duration were observed, but the pattern of these effects was complex and did not replicate the results of the two earlier studies. In the nonsense phrase, significant reductions in lower lip closing duration, jaw closing duration, and jaw closing speed were seen in PS. In the sentence task, HPS showed elevated tongue opening and closing durations. For tongue opening in the sentence, LPS showed elevated speeds and HPS showed reduced speeds. The elevated speeds for LPS are interpreted as a contributing factor to speech disfluency, whereas the reduced speeds and increased durations in HPS are attributed to adaptive behavior intended to facilitate fluent speech. Significant group effects were not seen for the speed ratio measures. Results are discussed in relation to multivariate analyses intended to identify subgroups of PS.

Adult↗
PubMed2004

Sentence-structure priming in young children who do and do not stutter.

The purpose of this study was to use an age-appropriate version of the sentence-structure priming paradigm (e.g., K. Bock, 1990; K. Bock, H. Loebell, and R. Morey, 1992) to assess experimentally the syntactic processing abilities of children who stutter (CWS) and children who do not stutter (CWNS). Participants were 16 CWS and 16 CWNS between the ages of 3;3 (years; months) and 5;5, matched for gender and age (+/-4 months). All participants had speech, language, and hearing development within normal limits, with the exception of stuttering for CWS. All children participated in a sentence-structure priming task where they were shown and asked to describe, on a computer screen, black-on-white line drawings of children, adults, and animals performing activities that could be appropriately described using simple active affirmative declarative (SAAD) sentences (e.g., "The man is walking the dog"). Speech reaction time (SRT) was measured from the onset of the picture presentation to the onset of the child's verbal response in the absence and presence of priming sentences, counterbalanced for order. Main findings indicated that CWS exhibited slower SRTs in the absence of priming sentences and greater syntactic-priming effects than CWNS. These findings suggest that CWS may have difficulty rapidly, efficiently planning and/or retrieving sentence-structure units, difficulties that may contribute to their inabilities to establish fluent speech-language production.

Case-Control Studies↗