Operant Stuttering: the Control of Stuttering Behavior through Response-contingent Consequences.
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Journal Article↗
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Symptoms of maladjustment differentiating young stutterers from non-stutterers.
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Emotions↗
Verbal dichotic listening in developmental stuttering: subgroups with atypical auditory processing.
OBJECTIVE: The major aim of this study was to determine whether adults with persistent developmental stuttering have atypical auditory processing. BACKGROUND: Stuttering has been attributed to aberrant hemispheric dominance, and auditory processing deficits have been found in some adults who stutter. Dichotic listening, an indirect measure of auditory processing, has not been used to study auditory laterality in right- and left-handers who stutter. Because left-handers and people who stutter may have aberrant hemispheric dominance, it is important to examine auditory neural systems in right- and left-handed people who do and do not stutter. METHODS: Adults with persistent developmental stuttering (n = 18) and matched controls (n = 28) were studied by simultaneous binaural (dichotic) presentation of consonant-vowel stimuli in three attention conditions: nondirected attention, attention directed right, and attention directed left. Sex-handedness groups (stutter and control) included right-handed men and women and left-handed men, but not left-handed women because this stutter subgroup could not be recruited. To study ear advantage and auditory laterality, two dependent measures were examined: percent left and right ear responses and lateralization shift magnitude. Potential relationships between degree of handedness and dichotic listening measures were also examined. RESULTS: Matched controls and right-handed men who stutter had the expected right-ear advantage (REA) in the nondirected attention condition. In contrast, left-handed men who stutter had a left-ear advantage (LEA), and right-handed women who stutter did not have a lateral ear bias in the nondirected attention condition. Right-handed women who stutter had the greatest tendency to hear a sound that was not presented to either ear, and were relatively unable to selectively direct attention left or right. In contrast, left-handed men who stutter were able to shift attention to the left and right ear better than any other group. For the fluent control group, there were no significant relationships among degree of handedness and dichotic-listening variables. For the stutter group, degree of handedness was significantly related to percentage left and right ear response and to the lateralization shift magnitude. CONCLUSIONS: Left-handed men who stutter and right-handed women who stutter have atypical auditory processing but differ in important ways. The left-ear bias found in left-handed men who stutter in the nondirected attention condition suggests that their right temporal lobe may be important in perceiving speech, and, therefore, they have mixed dominance. These subjects were also better at shifting attention in both directions in comparison to all other groups; thus, the right hemisphere, which is dominant for shifting attention to both right and left space, may be activated. In contrast, the right-handed women who stutter had no ear bias in the nondirected attention condition, made more perceptual errors, and had difficulty shifting attention to the left and right. Although these results suggest that right-handed women who stutter have attentional deficits, the relationship between attentional disorders and stuttering remains to be elucidated. Because right-handed men who stutter were not different from controls, aberrant hemispheric dominance cannot fully account for stuttering. Unfortunately, left-handed women were not examined in this study. Therefore, these interesting sex-handedness effects found in left-handed men and right-handed women who stutter must be interpreted with caution.
Adult↗
Is it possible for speech therapy to improve upon natural recovery rates in children who stutter?
BACKGROUND: Speech and language therapists treating children who stutter appear to be assigned a difficult task. Natural spontaneous remission accounts for approximately 60-80% of all children recovering from stuttering. Despite our best efforts, no protocol has ever shown its effectiveness separate from natural recovery rates (i.e. 60-80%). Although speech and language therapists have used a vast array of therapeutic protocols, the incidence and prevalence of childhood stuttering appears to have remained unchanged. Therefore, although in possession of multiple treatment tools, speech and language therapists might be ill-equipped to treat stuttering children effectively and efficiently to the point of recovery. AIM: To assess speech and language therapists' self-reported perceptions of their success in helping children 'completely recover from stuttering' (i.e. no longer exhibiting any overt or covert stuttering symptoms or using therapeutic strategies to modify speech and no longer being viewed by themselves or anyone else as a 'stutterer'). METHODS & PROCEDURES: A questionnaire was sent to 290 speech and language therapists providing stuttering therapy to children attending school in North Carolina, USA, in a system similar to what can be found in many other US states. It addressed therapeutic efficacy in the management of stuttering: the numbers of stuttering children treated and those perceived to be recovered, the therapeutic methods, the time spent in practice, therapy durations and schedules. OUTCOMES & RESULTS: Usable questionnaires were returned by 101 respondents who reported treating a total of 2036 children who stutter. They reported using a full array of techniques known to reduce stuttering. The median reported recovery rate among respondents was 13.9%. Twenty-eight respondents reported no recoveries whatsoever, and 81 reported five recoveries or fewer. The median time spent on a caseload was 3 years. In addition, longer practising therapists reported significantly higher recover rates than those with less time practising. CONCLUSIONS: Remission from stuttering in children being treated in the schools of North Carolina appears to be the exception rather than the rule. The reported recovery rates suggest that not much is being done therapeutically to help children recover from stuttering. The chance of recovery decreases with age, and speech therapy for children who stutter appears to do little to improve their odds of recovery. Speech and language therapists treating these children either do not possess the tools or the tools do not yet exist to change 'nature's recovery agendum' and put children who stutter on the path towards natural sounding, fluent and spontaneous in all situations. As such, the provision of therapy, in North Carolina at least, does not yet allow for stuttering children to shed the label of 'stutterer', in their own eyes and in the eyes of all others for the rest of their lives. In light of these data, the authors suggest re-examining the tools, policies and procedures used in the treatment of stuttering children.
Attitude of Health Personnel↗
Re-emergence of childhood stuttering in Parkinson's disease: a hypothesis.
OBJECTIVE: To characterize speech patterns in patients with Parkinson's disease (PD) who have a history of childhood stuttering. BACKGROUND: Childhood stuttering usually resolves, but it re-emerges in some patients after stroke or other brain disorders. This phenomenon of recurrent stuttering has not been characterized in childhood stutterers who later develop PD. METHODS/PATIENTS: Twelve patients with a history of childhood stuttering that remitted and subsequently recurred were included in the study. A structured interview was administered to seven patients, and six were able to answer questions about childhood stuttering. The Johnson Severity Scale (JSS) (range 0-7) and a Situation Avoidance Scale (SAS) were used to rate stuttering severity (range 0-15) and avoidance (range 0-15). RESULTS: The mean age at onset of childhood stuttering was 6.2 years (range 5-10); the mean latency from the onset of childhood stuttering to adult stuttering was 46.1 years; and the stuttering recurred on average 5.9 years (range 0-21) after the onset of PD. The stuttering characteristics in childhood and adulthood included repetitions of sounds and syllables at the beginnings of words, blocks and interjections, physical tension, and a worsening of symptoms with stress. The patients rated themselves as having mild-to-moderate childhood stuttering by the JSS (mean 3.0, range 2-4) and mild-to-moderate stuttering and avoidance by the SAS (mean stuttering score 5.3, range 3-7; mean avoidance score 4.2, range 3-6). There was no apparent association between the severity of childhood stuttering and the severity of PD, but those patients who had higher Unified Parkinson's Disease Rating Scale scores tended to have more and worse symptoms of stuttering. CONCLUSION: Our patients provide evidence for the hypothesis that childhood stuttering may re-emerge in adulthood with the onset of PD.
Age of Onset↗
The impact of stuttering on employment opportunities and job performance.
UNLABELLED: The purpose of this study was to examine the impact that stuttering has on job performance and employability. The method involved administration of a 17-item survey that was completed by 232 people who stutter, age 18 years or older. Results indicated that more than 70% of people who stutter agreed that stuttering decreases one's chances of being hired or promoted. More than 33% of people who stutter believed stuttering interferes with their job performance, and 20% had actually turned down a job or promotion because of their stuttering. Results also indicated that men and minorities were more likely to view stuttering as handicapping than were women and Caucasians. These findings suggest that people who stutter believe stuttering to be handicapping in the workplace. The results may be helpful for clinicians who work with people who stutter. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the impact that stuttering can have on employability and job performance and (2) be better able to explain how factors such as gender, ethnicity, and stuttering severity can impact the belief that stuttering is a handicapping condition.
Adolescent↗
Neuropharmacology of theophylline induced stuttering: the role of dopamine, adenosine and GABA.
Developmental stuttering is a poorly understood speech disorder that starts out in childhood and some individuals continue to stutter throughout their lives. Stuttering is a disruption in smooth and fluent speech. Some stuttering primarily involves vocal blocks, which are spasms of the laryngeal musculature while prolongations, and repetitions of sound occur in other cases. Acquired stuttering, on the other hand, can occur at all ages and can be caused by brain injury and by pharmacological agents. Theophylline-induced stuttering is form of acquired stuttering. It is a rare side effect of theophylline therapy, but it provides interesting clues to the pharmacological mechanisms involved in stuttering. Theophylline-induced stuttering may involve the disrupt the optimal balance between excitatory and inhibitory neurotransmission throughout the brain by inhibiting GABA receptors. The disruption of the optimal balance between excitatory and inhibitory neurotransmission can also cause dysfunction in white matter fiber tracts such as those that connect the Broca's area to the motor cortex. This leads to a hyperexitation of the motor cortex which may mimic the motor cortex hyperexitability that exists in developmental stuttering. Theophylline also enhances dopaminergic neurotransmission through the inhibition of adenosine receptors and this may mimic the hyperdopaminergic state that exists in the brain of developmental stutterers. Theophylline causes the greatest release of dopamine in the basal ganglia through the inhibition of adenosine and GABA receptors. This may also cause dysfunction in the basal ganglia similar in some ways to the dysfunction that exits in developmental stuttering. Pharmacological enhancement of dopaminergic neurotransmission by other drugs been reported to cause stuttering in fluent individuals and to aggrevate dysfluency in stutterers.
Brain↗
The genetic basis of persistence and recovery in stuttering.
Although past research has provided evidence of a genetic component to the transmission of susceptibility to stuttering, the relationship between the genetic component to stuttering and persistence and recovery in the disorder has remained unclear. In an attempt to characterize this relationship, the immediate and extended families of 66 stuttering children were investigated to determine frequencies of cases of persistent and recovered stuttering. Pedigree analysis and segregation analysis were used to examine patterns of transmission. The following questions were investigated: 1. Is there a sex effect in recovery from stuttering? Here, we sought to test the hypothesis that females are more likely to recover than males, leading to the change in sex ratio from approximately 2:1 males to females close to onset of the disorder, to 4 or 5:1 in adulthood. 2. Is persistence/recovery in stuttering transmitted in families? If recovery/ persistence appears to be transmitted, (a) are recovered and persistent stuttering independent disorders?; (b) is recovery a genetically milder form of persistent stuttering?; or (c) is persistence/recovery transmitted independent of the primary susceptibility to stuttering? Results indicated sharply different sex ratios of persistent versus recovered stutterers in that recovery among females is more frequent than among males. It was found that recovery or persistence is indeed transmitted, and further, that recovery does not appear to be a genetically milder form of stuttering, nor do the two types of stuttering appear to be genetically independent disorders. Data are most consistent with the hypothesis that persistent and recovered stuttering possess a common genetic etiology, and that persistence is, in part, due to additional genetic factors. Segregation analyses supported these conclusions and provided statistical evidence for both a single major locus and polygenic component for persistent and recovered stuttering.
Child↗
How effective is therapy for childhood stuttering? Dissecting and reinterpreting the evidence in light of spontaneous recovery rates.
BACKGROUND: Similar positive results (e.g. immediate decreases in stuttering frequency and a 60-80% recovery rate from stuttering) have been reported for numerous therapeutic protocols for treating childhood stuttering, many of which have been diametrically opposite in their orientations and implementations. For example, Johnson advocated indirect treatments that simply advocated refraining from drawing any negative attention to childhood disfluencies as persistent and chronic stuttering was thought to progress via negative parental reactions to normal disfluencies. In contrast, direct interventionists sought immediately to eliminate stuttered speech patterns by training 'corrected' speech models that usually involved some form of prolonged speech. However, reports from speech and language therapists around North Carolina, USA, suggest much lower recovery rates in the children they treat (i.e. 13.9% over a median therapeutic period of 3 years, which to the present authors is an indicator of therapeutic inefficiency and ineffectiveness). AIMS: The discrepancy between these recovery rates calls for a re-examination of the efficacy of stuttering therapy for children, especially in light of recent statements from some therapies suggesting that therapy might be curative in nature. MAIN CONTRIBUTION: Spontaneous and complete recovery (removing all overt and covert markers of the pathology) occurs in 60-80% of all children who display incipient stuttering behaviours. As such, it appears that many claims of therapeutic success in children who stutter are confounded by the possibility of spontaneous recovery during the testing and intervention period. Simply put, it is impossible to discriminate between recovery that would occur naturally over time, and what may have been simply accelerated via therapy. Based on stable prevalence rates and the data in the present paper, it is suggested that therapy does little to boost recovery rates from incipient stuttering. Therapy can provide 'inhibitory' symptomatic relief with varying degrees of success with respect to decreasing stuttering severity and the need for continued therapy. However, it must be made clear that curing stuttering is not a likely outcome of therapy, although successful management can decrease the severity of the problem. It is argued that all forms of stuttering inhibition, including those at work during spontaneous recovery, are all mediated by the degree of mirror neuron engagement in the brain. CONCLUSIONS: It is proposed that in children who stutter, the best source of relief from stuttering is in the effective and efficient engagement of mirror neurons via methods that best replicate choral speech. In order to induce natural sounding, fluent speech, it is suggested that one uses primarily derivations of choral speech such as altered auditory feedback. Motoric techniques might also be used synergistically to provide supplementary sources of mirror neuron engagement.
Child↗
Brain correlates of stuttering and syllable production. A PET performance-correlation analysis.
To distinguish the neural systems of normal speech from those of stuttering, PET images of brain blood flow were probed (correlated voxel-wise) with per-trial speech-behaviour scores obtained during PET imaging. Two cohorts were studied: 10 right-handed men who stuttered and 10 right-handed, age- and sex-matched non-stuttering controls. Ninety PET blood flow images were obtained in each cohort (nine per subject as three trials of each of three conditions) from which r-value statistical parametric images (SPI¿r¿) were computed. Brain correlates of stutter rate and syllable rate showed striking differences in both laterality and sign (i.e. positive or negative correlations). Stutter-rate correlates, both positive and negative, were strongly lateralized to the right cerebral and left cerebellar hemispheres. Syllable correlates in both cohorts were bilateral, with a bias towards the left cerebral and right cerebellar hemispheres, in keeping with the left-cerebral dominance for language and motor skills typical of right-handed subjects. For both stutters and syllables, the brain regions that were correlated positively were those of speech production: the mouth representation in the primary motor cortex; the supplementary motor area; the inferior lateral premotor cortex (Broca's area); the anterior insula; and the cerebellum. The principal difference between syllable-rate and stutter-rate positive correlates was hemispheric laterality. A notable exception to this rule was that cerebellar positive correlates for syllable rate were far more extensive in the stuttering cohort than in the control cohort, which suggests a specific role for the cerebellum in enabling fluent utterances in persons who stutter. Stutters were negatively correlated with right-cerebral regions (superior and middle temporal gyrus) associated with auditory perception and processing, regions which were positively correlated with syllables in both the stuttering and control cohorts. These findings support long-held theories that the brain correlates of stuttering are the speech-motor regions of the non-dominant (right) cerebral hemisphere, and extend this theory to include the non-dominant (left) cerebellar hemisphere. The present findings also indicate a specific role of the cerebellum in the fluent utterances of persons who stutter. Support is also offered for theories that implicate auditory processing problems in stuttering.
Adult↗
Stuttering in adults: the acoustic startle response, temperamental traits, and biological factors.
UNLABELLED: The purpose of this study was to investigate the relation between stuttering and a range of variables of possible relevance, with the main focus on neuromuscular reactivity, and anxiety. The explorative analysis also included temperament, biochemical variables, heredity, preonset lesions, and altered auditory feedback (AAF). An increased level of neuromuscular reactivity in stuttering adults has previously been reported by [Guitar, B. (2003). Acoustic startle responses and temperament in individuals who stutter. Journal of Speech Language and Hearing Research, 46, 233-240], also indicating a link to anxiety and temperament. The present study included a large number of variables in order to enable analysis of subgroups and relations between variables. Totally 32 stuttering adults were compared with nonstuttering controls. The acoustic startle eyeblink response was used as a measure of neuromuscular reactivity. No significant group difference was found regarding startle, and startle was not significantly correlated with trait anxiety, stuttering severity, or AAF. Startle was mainly related to calcium and prolactin. The stuttering group had significantly higher scores for anxiety and childhood ADHD. Two subgroups of stuttering were found, with high versus low traits of childhood ADHD, characterized by indications of preonset lesions versus heredity for stuttering. The study does not support the view that excessive reactivity is a typical characteristic of stuttering. The increased anxiety is suggested to mainly be an effect of experiences of stuttering. LEARNING OUTCOMES: As a result of reading this article, the reader will be able to: (a) critically discuss the literature regarding stuttering in relation to acoustic startle, anxiety, and temperament; (b) describe the effect of calcium on neuromuscular reactivity; (c) discuss findings supporting the importance of early neurological incidents in some cases of stuttering, and the relation between such incidents and traits of ADHD or ADD; and (d) discuss the role of genetics in stuttering.
Acoustics↗
Social anxiety in stuttering: measuring negative social expectancies.
UNLABELLED: Much research has suggested that those who stutter are likely to be anxious. However, to date, little research on this topic has addressed the role of expectancies of harm in anxiety, which is a central construct of anxiety in modern clinical psychology. There are good reasons to believe that the anxiety of those who stutter is related to expectancies of social harm. Therefore, in the present study, 34 stuttering and 34 control participants completed the Fear of Negative Evaluation (FNE) Scale and the Endler Multidimensional Anxiety Scales-Trait (EMAS-T). The FNE data showed a significant difference between the stuttering and control participants, with a large effect size. Results suggested that, as a group, a clinical population of people who stutter has anxiety that is restricted to the social domain. For the EMAS-T, significant differences between groups were obtained for the two subtests that refer specifically to people and social interactions in which social evaluation might occur (Social Evaluation and New/Strange Situations) but not for the subtests that contained no specific reference to people and social interactions (Physical Danger and Daily Routines). These results were taken to suggest that those who stutter differ from control subjects in their expectation of negative social evaluation, and that the effect sizes are clinically significant. The findings also suggest that the FNE and the EMAS-T are appropriate psychological tests of anxiety to use with stuttering clients in clinical settings. The clinical and research implications of these findings are discussed, in terms of whether social anxiety mediates stuttering or is a simple by-product of stuttering. Possible laboratory explorations of this issue are suggested, and potential Cognitive Behavior Therapy packages for stuttering clients who might need them are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) explain why expectancy of social threat or harm may be associated with stuttering; (2) name and describe two psychological tests that are suitable for assessment of the social threat or harm that may be associated with stuttering; and (3) explain how findings for the EMAS-T test in the present results suggest that expectancy of social threat or harm, but not other kinds of negative expectancy, are associated with stuttering.
Adult↗
Disfluency data of German preschool children who stutter and comparison children.
UNLABELLED: This study compared the disfluencies of German-speaking preschool children who stutter (CWS, N = 24) with those produced by age- and sex-matched comparison children who do not stutter (CWNS, N = 24). In accordance with Yairi and Ambrose's [Yairi, E., & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminary report. Journal of Speech and Hearing Research, 35, 755-760] guidelines the CWS group had a narrow age range (2-5 years) and were seen close to the reported time of their stuttering onset (average of 8 months). Furthermore, over 95% of the CWS group had not received any type of speech therapy intervention. Consistent with previous findings for English-speaking preschool children, 'stuttering-like' disfluencies (prolongations, blocks, part- and one-syllable word repetitions) were significantly more frequent in CWS (mean = 9.2%) than in CWNS (mean = 1.2%), whereas no significant group differences occurred with respect to 'normal' disfluencies. The number of iterations in stuttering-like disfluencies was also significantly higher in CWS (mean = 1.28 iterations) than in CWNS (mean = 1.09 iterations). In contrast to previous findings, a sub-group of children who have been stuttering for a shorter time (1-5 months) did not differ from a sub-group who had stuttered for a longer period (8-22 months). EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how German-speaking preschool children who stutter and who do not stutter display stuttering-like and normal disfluencies including number of iterations; (2) explain how powerful classification measures for the diagnosis of stuttering are for German-speaking preschool children; (3) discuss how disfluency patterns of native English- and German-speaking children close to onset of stuttering differ.
Case-Control Studies↗
Gestural recovery and the role of forward and reversed syllabic repetitions as stuttering inhibitors in adults.
Instead of being the core stuttering 'problem', syllabic repetitions may be a biological mechanism, or 'solution', to the central involuntary stuttering block. Simply put, stuttering is an endogenous transitory state of 'shadowed speech', a choral speech derivative that allows for a neural release of the central block. To investigate this possibility, 14 adults who stutter read while listening to forward fluent speech, reversed fluent speech, forward stuttered speech, and reversed stuttered speech. All conditions induced significant degrees of stuttering inhibition when compared to a control condition. However, the reversed fluent condition was less powerful than the other three conditions ( approximately 42% vs. approximately 65%) for inhibiting stuttering. Stuttering inhibition appears to proceed by 'gestural recovery', made possible by the presence of an exogenous or 'second' set of speech gestures and engagement of mirror neurons. When reversed fluent speech was used, violations in normal gesture-time relationships (i.e., normal speech entropy) resulted in gestural configurations that apparently were inadequately recovered, and therefore, were not as conducive to high levels of stuttering inhibition. In contrast, high levels of encoding found in the simple syllabic structures of stuttered speech allowed its forward and reversed forms to be equally effective for gestural recovery and stuttering inhibition. The reversal of repeated syllables did not appear to significantly degrade the natural gesture-time relationships (i.e., they were perceptually recognizable). Thus, exogenous speech gestures that displayed near normal gestural relationships allowed for easy recovery and fluent productions via mirror systems, suggesting a more choral-like nature. The importance of syllabic repetitions is highlighted: both their perceived (exogenous) and produced (endogenous) forms appear to be fundamental, surface acoustic manifestations for central stuttering inhibition via the engagement of mirror neurons.
Adult↗
Predicting stuttering from linguistic factors for German speakers in two age groups.
UNLABELLED: Brown's factors [J. Speech Disorders 10 (1945) 181] predict the likely loci of disfluency in English-speaking adults who stutter. A word is more likely to be stuttered for these speakers if it is a content word, starts with a consonant, is positioned at the beginning of a sentence, and if it is a long word. These same factors were examined in native German-speaking children and adults who stutter. Speech data of 15 German adults and 17 children were coded according to Brown's factors. For the adult group, it was predicted that words starting with consonants would not lead to as much of an increase in disfluencies compared with English samples, because of cross-linguistic differences in syllable onset properties. It was predicted that stuttering would be more likely in later sentence positions in German because in German the verb is usually near the end of a sentence. There were no obvious reasons to expect differences on the two remaining factors, content words and word length. With children, it was hypothesised that Brown's factors that specify level of linguistic difficulty would not be such a good predictor of stuttering rate. Specifically, it was predicted that the difference in stuttering rate between function and content words would be lower in children. For the adults both word type (content/function) and word length increased stuttering rate significantly, whereas changes in stuttering rate for the other two factors were non-significant. It was also found that when word difficulty (based on a combined measure of all factors) increased, stuttering rate rose. With children, only the word-length factor was significant, and stuttering rate was not governed to the same extent by overall word difficulty. Conclusions are drawn as to the effect of linguistic and motor influences on stuttering. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe: (1) how linguistic factors affect stuttering rates in German; (2) the different patterns of adults and children who stutter and how language might influence this pattern; and (3) how to interpret these findings in light of a current theory of fluency failure.
Adolescent↗
Cognitive anxiety as a function of speaker role for fluent speakers and persons who stutter.
UNLABELLED: Fransella [Personal change and reconstruction. London: Academic Press] suggested that persons who stutter experience a lack of meaningfulness of their fluent speaker role and demonstrated that a Personal Construct Psychology approach to therapy with persons who stutter may be useful. Few studies, however, have investigated her claims. This study investigated the "meaningfulness" with which fluent and disfluent persons were able to construe themselves in stuttering and non-stuttering speaker roles. Results indicated that persons who stuttered displayed greater cognitive anxiety (difficulty integrating their experience meaningfully) in a fluent speaking role than in a stuttering role, whereas the reverse was found for fluent speakers. These results suggest the relevance of assessing and addressing the meaningfulness of the "dominant" disfluent speaker role in treating persons who stutter, insofar as a tendency to maintain the predictability of this familiar role may contribute to stuttering maintenance and relapse. The refined guidelines developed for applying the Cognitive Anxiety Scale to the content analysis of self-descriptions of persons who stutter can make a practical contribution to this effort. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) describe the potential influence of speaker roles in the maintenance of stuttering; (2) define cognitive anxiety and how it relates to meaningful interpretations of experience; (3) detect potential signs that a person who stutters may be engaged in "defending" a stutterer role; and (4) describe the clinical implications of this view of stuttering maintenance.
Adult↗
Anxiety levels in people who stutter: a randomized population study.
The question of whether people who stutter are generally more anxious than people who do not stutter has not yet been resolved. One major methodological barrier to determining whether differences exist has been the type of stuttering sample used. Studies investigating anxiety levels of those who stutter have mostly assessed people referred to stuttering therapy clinics, which is arguably a biased sample. To date, no studies have been published that have measured the anxiety levels of people who stutter in the community using random selection procedures. Such a sample is more likely to be representative of the population of people who stutter. The present study involved a random selection and telephone interview of people in 4,689 households. The telephone respondent was given a description of stuttering and asked if any person living in their household stuttered. If yes, a number of corroborative questions were asked, and permission was requested to tape the speech of the person believed to stutter over the telephone. A definite case of stuttering was based on (a) a positive detection of stuttering from the tape and (b) at least one of the corroborative questions supporting the diagnosis. A total of 87 people were identified as definite cases of stuttering across all ages, and 63 participants who were 15 years or older completed a trait anxiety questionnaire over the telephone. Mean trait anxiety levels were significantly higher than levels generally found in society, though differences were not large. Implications of these results are discussed.
Adolescent↗
Orofacial muscle activity of children who stutter: a preliminary study.
This study was a preliminary investigation of the relations between stuttering development and the maturation of speech motor processes. Electromyographic (EMG) activity was recorded from the orofacial muscles of children who stutter and their normally fluent peers during fluent and disfluent speech. Nine children who stutter (8 boys and 1 girl), ranging in age from 2:7 to 14:0, and 9 age- and sex-matched children who do not stutter were subjects. Pairs of surface EMG electrodes were placed on children's faces overlying the anterior belly of the digastric (ABD), levator labii superior (ULIP), and orbicularis oris inferior (LLIP) muscles. Twenty segments of stuttered (for the children who stutter) and perceptually fluent speech were extracted from children's conversational speech samples. Spectra of the amplitude envelopes of the EMG activity were computed. The 3 oldest children who stutter showed evidence of tremorlike oscillations of EMG activity in the 5 to 15 Hz range during stuttering in either ULIP, LLIP, or ABD muscles. The younger children who stutter and the children who do not stutter demonstrated primary spectral peaks in the 1 to 4 Hz range during stuttered and/or perceptually fluent speech. It is hypothesized that the emergence of tremorlike instabilities in the speech motor processes of children who stutter may coincide with aspects of their general neural maturation and with the development of stuttering.
Adolescent↗