Eliana Maria Nigro Rocha


Abstract - Agosto a Dezembro de 2020



An Evaluation of an Integrated Stuttering and Parent-Administered Self-Regulation Program for Early Developmental Stuttering Disorders - ATENÇÃO

J Speech Lang Hear Res. 2020 Aug 19;1-19. Online ahead of print.


Kerianne Druker, Trevor Mazzucchelli, Neville Hennessey, Janet Beilby

Curtin University, Perth, Western Australia, Australia; The University of Queensland, Brisbane, Australia.


Purpose This study reports findings from a clinical trial that implemented an early stuttering treatment program integrated with evidence-based parenting support (EBPS) to children who stutter (CWS) with concomitant self-regulation challenges manifested in elevated attention-deficit/hyperactivity disorder (eADHD) symptoms and compared those outcomes to CWS receiving stuttering treatment without EBPS. Method Participants were 76 preschool CWS and their parent(s). Thirty-six of these children presented with eADHD and were quasirandomized into two groups: stuttering treatment only (eADHDstandard) or stuttering treatment integrated with EBPS (eADHDintegrated). The remaining children did not meet criteria for eADHD symptoms and received stuttering treatment only (No-eADHDstandard). Pre, post, and 3-month follow-up measures of stuttering treatment outcomes as well as treatment effects on measures of child behavior difficulties and parenting practices were examined.

Results Significant reduction in stuttering was found for all groups. However, the eADHDintegrated group showed a greater reduction in stuttering frequency than the eADHDstandard group, and at follow-up, stuttering frequencies in the eADHDintegrated group matched those of children in the No-eADHDstandard group, while stuttering in the eADHDstandard group remained significantly higher. Children with eADHD symptoms who received the integrated program also required significantly less stuttering intervention time than those children with eADHD symptoms who received stuttering treatment only. Families in the eADHDintegrated group reported large and significant improvements in child behavior and parenting practices.

Conclusion This study provides support for an early treatment program for CWS. The integrated stuttering and self-regulation management program for CWS with eADHD symptoms proved successful for fluency and behavioral improvements, which were sustained at follow-up.

PMID: 32812840 DOI: 10.1044/2020_JSLHR-19-00310




Associations between stuttering, comorbid conditions and executive function in children: a population-based study - INFANTIL

BMC Psychol. 2020 Oct 31;8(1):113.


Ai Leen Choo, Sara Ashley Smith, Hongli Li

Georgia State University, Atlanta, GA, USA, University of South Florida, Tampa, FL, USA.


Background: The aim of this study was to investigate the relationship between executive function (EF), stuttering, and comorbidity by examining children who stutter (CWS) and children who do not stutter (CWNS) with and without comorbid conditions. Data from the National Health Interview Survey were used to examine behavioral manifestations of EF, such as inattention and self-regulation, in CWS and CWNS.

Methods: The sample included 2258 CWS (girls = 638, boys = 1620), and 117,725 CWNS (girls = 57,512; boys = 60,213). EF, and the presence of stuttering and comorbid conditions were based on parent report. Descriptive statistics were used to describe the distribution of stuttering and comorbidity across group and sex. Regression analyses were to determine the effects of stuttering and comorbidity on EF, and the relationship between EF and socioemotional competence.

Results: Results point to weaker EF in CWS compared to CWNS. Also, having comorbid conditions was also associated with weaker EF. CWS with comorbidity showed the weakest EF compared to CWNS with and without comorbidity, and CWS without comorbidity. Children with stronger EF showed higher socioemotional competence. A majority (60.32%) of CWS had at least one other comorbid condition in addition to stuttering. Boys who stutter were more likely to have comorbid conditions compared to girls who stutter.

Conclusion: Present findings suggest that comorbidity is a common feature in CWS. Stuttering and comorbid conditions negatively impact EF.

PMID: 33129350 DOI: 10.1186/s40359-020-00481-7




Attentional Bias Among Adolescents Who Stutter: Evidence for a Vigilance-Avoidance Effect - SOCIAL

J Speech Lang Hear Res. 2020 Oct 16;63(10):3349-3363. Epub 2020 Sep 15.


Naomi H Rodgers, Jennifer Y F Lau, Patricia M Zebrowski

University of Nebraska-Lincoln; King's College London, United Kingdom; University of Iowa, Iowa City.


Purpose The purpose of this study was to examine group and individual differences in attentional bias toward and away from socially threatening facial stimuli among adolescents who stutter and age- and sex-matched typically fluent controls.

Method Participants included 86 adolescents (43 stuttering, 43 controls) ranging in age from 13 to 19 years. They completed a computerized dot-probe task, which was modified to allow for separate measurement of attentional engagement with and attentional disengagement from facial stimuli (angry, fearful, neutral expressions). Their response time on this task was the dependent variable. Participants also completed the Social Anxiety Scale for Adolescents (SAS-A) and provided a speech sample for analysis of stuttering-like behaviors.

Results The adolescents who stutter were more likely to engage quickly with threatening faces than to maintain attention on neutral faces, and they were also more likely to disengage quickly from threatening faces than to maintain attention on those faces. The typically fluent controls did not show any attentional preference for the threatening faces over the neutral faces in either the engagement or disengagement conditions. The two groups demonstrated equivalent levels of social anxiety that were both, on average, very close to the clinical cutoff score for high social anxiety, although degree of social anxiety did not influence performance in either condition. Stuttering severity did not influence performance among the adolescents who stutter.

Conclusion This study provides preliminary evidence for a vigilance-avoidance pattern of attentional allocation to threatening social stimuli among adolescents who stutter.

PMID: 32931347 DOI: 10.1044/2020_JSLHR-20-00090




Atypical Spinal Cord Infarction: A Prolonged and Stuttering Course for Six Days - GAGUEIRA ADQUIRIDA

Acta Neurol Taiwan. 2020 Sep;29(3):95-98.


Meng-Chi Chiu, Chi-Yuan Liang, Yung-Sung Huang, Wen-Long Tsao

Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.


Purpose: Spinal infarction is a rare condition and usually presents with a sudden or acute course. A prolonged course is rare and may mimic the presentation of inflammatory myelitis. Here we present a case of atypical spinal cord infarction with a stuttering course for six days..

Case report: A 47-year-old male presented initially with symptoms of sudden onset, limb pain. Sudden chest pain radiating to the back, occurred three days later. Sudden urinary retention and quadriparesis were presented after another three days. The diagnosis of spinal cord infarction was made through diffusion restriction in spinal magnetic resonance imaging.

Conclusion: A prolonged course of spinal cord infarction is relatively uncommon but a stepwise and stuttering course may provide clues. Diffusion restriction in magnetic resonance imaging also may be helpful. The diagnosis of spinal cord infarction should always be kept in mind.

PMID: 32996118




Behavioral, social, and emotional well-being in children who stutter: the influence of race-ethnicity - SOCIAL

Logoped Phoniatr Vocol. 2020 Aug 5;1-9. Online ahead of print.


Patrick M Briley, Charles Ellis

East Carolina University, Greenville, NC, USA.


Purpose: The purpose of this study was to determine if reports of behavioral, emotional and social well-being in children who stutter differ across racial-ethnic groups.

Materials and methods: Using 2010-2015 National Health Interview Surveys, data was analyzed from responses of children who stutter's parents, in the United States, to items of the Strength and Difficulties Questionnaire. Parent responses of reporting Strengths and Difficulties Questionnaire items were determined using multiple logistic regression analyses.

Results: This sample included a total 42,962 children, of which 875 were identified as children who stutter. Among the children who stutter, reports of well-being were compared from 294 non-Hispanic White, 249 non-Hispanic Black, and 332 Hispanic children who stutter. Results indicated Black children who stutter were less likely than White children who stutter to have many worries, to be unhappy/depressed, and less likely to have difficulties with emotions and concentration. Hispanic children who stutter were less likely than White children who stutter to have many worries, to be unhappy/depressed, and less likely to have difficulties with emotions and concentration. Additionally, differences were observed in measures of behavioral, emotional, and social well-being when within-group comparisons were made, as a function of gender, and when comparisons were made across racial-ethnic groups at different age ranges.

Conclusions: Evidence from National Health Interview Surveys suggests racial-ethnic differences exist in reports of behavioral, emotional, and social well-being among children who stutter. Future research is needed to clarify specific contributors to the observed differences across racial-ethnic groups and whether differences are primarily associated with race-ethnicity, the presence of stuttering, or both.

PMID: 32755342 DOI: 10.1080/14015439.2020.1801833




Bilingualism as a Purported Risk Factor for Stuttering: A Close Look at a Seminal Study (Travis et al., 1937)

J Speech Lang Hear Res. 2020 Sep 25;1-5.
Free Access: https://pubs.asha.org/doi/pdf/10.1044/2020_JSLHR-20-00364


Susanne Gahl

University of California at Berkeley.

PMID: 32976049 DOI: 10.1044/2020_JSLHR-20-00364




Bilinguals who stutter: A cognitive perspective - LINGUAGEM

Review J Fluency Disord. 2020 Dec 3;67:105819. Online ahead of print.

Free Full Texthttps://www.sciencedirect.com/science/article/pii/S0094730X20300747?via%3Dihub


Myriam Kornisch

The University of Mississippi, Oxford, MS, United StatesPMID: 33296800


Purpose: Brain differences, both in structure and executive functioning, have been found in both developmental stuttering and bilingualism. However, the etiology of stuttering remains unknown. The early suggestion that stuttering is a result of brain dysfunction has since received support from various behavioral and neuroimaging studies that have revealed functional and structural brain changes in monolinguals who stutter (MWS). In addition, MWS appear to show deficits in executive control. However, there is a lack of data on bilinguals who stutter (BWS). This literature review is intended to provide an overview of both stuttering and bilingualism as well as synthesize areas of overlap among both lines of research and highlight knowledge gaps in the current literature.

Methods: A systematic literature review on both stuttering and bilingualism studies was conducted, searching for articles containing "stuttering" and/or "bilingualism" and either "brain", "executive functions", "executive control", "motor control", "cognitive reserve", or "brain reserve" in the PubMed database. Additional studies were found by examining the reference list of studies that met the inclusion criteria.

Results: A total of 148 references that met the criteria for inclusion in this paper were used in the review. A comparison of the impact of stuttering or bilingualism on the brain are discussed.

Conclusion: Previous research examining a potential bilingual advantage for BWS is mixed. However, if such an advantage does exist, it appears to offset potential deficits in executive functioning that may be associated with stuttering.

DOI: 10.1016/j.jfludis.2020.105819




Categorical perception of speech sounds in adults who stutter - AUDITIVO

Clin Linguist Phon. 2020 Aug 12;1-17. Online ahead of print.


Mehdi Bakhtiar, Jing Shao, Man Na Cheung, Caicai Zhang

The Hong Kong Polytechnic University , Hong Kong SAR, China; Faculty of Arts, Hong Kong Baptist University , Hong Kong SAR, China.


Stuttering is often attributed to the impaired speech production system, however, there is growing evidence implicating issues in speech perception. Our previous research showed that children who stutter have similar patterns but slower categorical perception (i.e. the ability to categorise different acoustic variations of the speech sounds into the same or different phonemic categories) compared to the children who do not stutter. This study aimed to extend our previous research to adults who stutter (AWS) using the same categorical perception paradigm. Fifteen AWS and 15 adults who do not stutter (A WNS) were recruited to complete identification and discrimination tasks involving acoustic variations of Cantonese speech sounds in four stimulus contexts: consonants (varying in voice onset times, VOTs), lexical tones, vowels and pure tones. The results showed similar categorical perception between the two groups in terms of the boundary position and width in the identification task and between-category benefits in the discrimination task. However, there were some trends for lower discrimination accuracy (overall d' scores) and slower discrimination of the between-category stimuli versus within-category stimuli for AWS than AWNS. These results partially confirm our previous finding on children in terms of a comparable pattern of categorical perception between the two groups, but slower processing speed to access the phoneme representations in speech perception among AWS than AWNS.

PMID: 32787467 DOI: 10.1080/02699206.2020.1803407




Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis - AVALIAÇÃO

J Speech Lang Hear Res. 2020 Aug 10;1-24. Online ahead of print.


Cara M Singer, Alison Hessling, Ellen M Kelly, Lisa Singer, Robin M Jones

Grand Valley State University, Grand Rapids, MI; Baylor University, Waco, TX; Vanderbilt University Medical Center, Nashville, TN; Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.


Purpose The purpose of this meta-analytic study was to identify clinical characteristics, defined as child factors that can be assessed by a speech-language pathologist as part of a routine speech-language evaluation that may differentiate children who persist in stuttering from children who eventually recover from stuttering. Clinical characteristics explored included sex, age at onset, family history of stuttering, stuttering frequency and severity, speech-language skills, and temperament.

Method Studies were identified through electronic databases, journals, and reference lists of relevant reports (e.g., research articles). Eligible studies followed young children who stutter (i.e., under 6 years old) for at least 24 months, assessed a potential clinical marker at study entry, and determined talker group classification (i.e., persistent or recovered) at study completion. Sex and family history differences were estimated using risk ratios; all other differences were estimated using Hedges's g. Heterogeneity and methodological differences among studies were evaluated.

Results Eleven studies (41 reports) met eligibility criteria. Persistent children were older at stuttering onset and exhibited higher frequencies of stuttering-like disfluencies, lower speech sound accuracy, and lower expressive and receptive language skills than recovered children. Males and children with a family history of stuttering were also more likely to persist.

Conclusions Clinical characteristics were identified that are associated with increased risk for stuttering persistence. Future studies have the potential to translate these clinical characteristics into prognostic markers for stuttering persistence risk.

PMID: 32772868 DOI: 10.1044/2020_JSLHR-20-00096




Cognitive Flexibility for Semantic and Perceptual Information in Developmental Stuttering - INFANTIL / ATENÇÃO

J Speech Lang Hear Res. 2020 Oct 27;1-21. Online ahead of print.


Julie D Anderson, Stacy A Wagovich, Levi Ofoe

Indiana University, Bloomington, University of Missouri, Columbia.


Purpose The purpose of this study was to examine cognitive flexibility for semantic and perceptual information in preschool children who stutter (CWS) and who do not stutter (CWNS).

Method Participants were 44 CWS and 44 CWNS between the ages of 3;0 and 5;11 (years;months). Cognitive flexibility was measured using semantic and perceptual categorization tasks. In each task, children were required to match a target object with two different semantic or perceptual associates. Main dependent variables were reaction time and accuracy.

Results The accuracy with which CWS and CWNS shifted between one semantic and perceptual representation to another was similar, but the CWS did so significantly more slowly. Both groups of children had more difficulty switching between perceptual representations than semantic ones.

Conclusion CWS are less efficient (slower), though not less accurate, than CWNS in their ability to switch between different representations in both the verbal and nonverbal domains.

PMID: 33108236 DOI: 10.1044/2020_JSLHR-19-00119




College professors' perceptions of students who stutter and the impact on comfort approaching professors - SOCIAL

J Fluency Disord. 2020 Dec 25;67:105826. Online ahead of print.


Danielle Werle, Courtney T Byrd

University of Texas at Austin, University Station, Austin, TX, USA. PMID:


Purpose: Previous literature has documented that college professors view hypothetical students who stutter more negatively than their fluent peers. The purpose of the present study was to investigate whether individuals who stutter report they experience more negative perceptions in the college classroom, and the impact of those perceptions on their comfort approaching professors.

Methods: Two hundred forty-six adults who do and do not stutter, matched for age, participated in this study. Participants were presented with 16 positive and negative personality traits and asked to rate how strongly they believed their professor viewed them along each trait. All participants were asked whether they felt comfortable approaching their professors to discuss their performance. Adults who stutter were asked additional questions to investigate their college experience more comprehensively.

Results: Adults who stutter reported they experienced significantly more negative perceptions from their professors than adults who do not stutter, and were significantly less likely to feel comfortable approaching their professors. These reported negative perceptions, specifically being perceived as less self-assured, predicted comfort approaching professors to receive performance feedback for adults who stutter. Finally, amongst adults who stutter, perception of how they were evaluated compared to their peers was significantly related to comfort approaching professors.

Conclusions: Results support that the negative perceptions towards hypothetical students who stutter reported in previous literature are experienced by individuals who stutter, and that these perceptions drive comfort approaching professors for performative feedback. Results suggest professors may increase students' comfort by clearly outlining equality in evaluation procedures.

33360979 DOI: 10.1016/j.jfludis.2020.105826




Comparing and Predicting Public Attitudes Toward Stuttering, Obesity, and Mental Illness - SOCIAL

Am J Speech Lang Pathol. 2020 Aug 28;1-16. Online ahead of print.

Kenneth O St Louis  

West Virginia University, Morgantown.


Purpose Extensive research on public attitudes has documented stigma toward stuttering, obesity, and mental illness; however, most studies have focused on only one of these conditions. This study sought to compare public attitudes toward stuttering, obesity, and mental illness as well as to identify the predictive potential of four ratings relating to these and other neutral or desirable conditions.

Method Five hundred respondents who were selected from each of three international databases filled out the Public Opinion Survey of Human Attributes (POSHA) for stuttering, obesity, or mental illness. The POSHA surveys were as similar as possible, and all contained four general items asking respondents' "impression" of the attribute, extent to which he or she "wants to be/have" that attribute, "amount known" about the attribute, and "persons known" who manifest the attribute, for stuttering, obesity, and mental illness plus two others, namely, left-handedness and intelligence. The POSHA surveys also had the same summary scores, Beliefs, Self-Reactions, and an Overall Score.

Results Summary scores for the three POSHA surveys in the 500-respondent samples revealed negative attitudes toward all three conditions, the most positive being toward obesity, followed by stuttering and then by mental illness. Stepwise regression analysis indicated that various general items had significant prediction potential not only of attitudes for the same condition but also of attitudes for other conditions. The greatest other condition predictions were between stuttering and mental illness.

Conclusions Stuttering is regarded as less stigmatizing than mental illness but more stigmatizing than obesity. Additionally, positivity toward one condition results in limited positivity toward the others. Impressions and knowledge of-as well as experience with-stigmatized conditions can inform public awareness campaigns and individual clinical programs dealing with stigma.

PMID: 32857617 DOI: 10.1044/2020_AJSLP-20-00038




Disfluency characteristics of Omani Arabic-English bilingual speakers - LINGUAGEM

Clin Linguist Phon. 2020 Oct 28;1-17. Online ahead of print.


Fathiya Al'Amri, Michael P Robb

University of Canterbury , Christchurch, New Zealand, Pennsylvania State University , University Park, Pennsylvania, USA.


This study examined the oral reading and conversational speech of eight bilinguals who stutter (BWS). The participants spoke Omani Arabic as the dominant and English as the less-dominant language. The samples were examined with particular reference to the production of overall disfluency, stuttering-like disfluencies (SLDs) and other-disfluencies (ODs) occurring at the syllable and word level. The results indicated no difference in the amount of overall disfluency or ODs between the two languages in either reading or conversation. A significantly higher amount of SLDs were found to occur in words during reading in Arabic compared to English, which was attributed to the linguistic complexity of formal Arabic. A higher amount of SLDs in syllables were found in English compared to Arabic during conversation, although no such difference was found at the word level. The results align with a small body of research suggesting equivalent amounts of stuttering between dominant and less-dominant languages during conversation. The finding of a higher amount of stuttering during reading in Arabic is suggestive of motor differences in the production of the two languages that differentially affect speech fluency.

PMID: 33111590 DOI: 10.1080/02699206.2020.1806931




Dissociated Development of Speech and Limb Sensorimotor Learning in Stuttering: Speech Auditory-motor Learning is Impaired in Both Children and Adults Who Stutter - PSICOMOTOR

Neuroscience. 2020 Oct 20;S0306-4522(20)30665-5. Online ahead of print.

Free Full Text: https://www.sciencedirect.com/science/article/pii/S0306452220306655?via%3Dihub


Kwang S Kim, Ayoub Daliri, J Randall Flanagan, Ludo Max

University of Washington, Seattle, WA, United States; Arizona State University, Tempe, AZ, United States; Haskins Laboratories, New Haven, CT, United States


Stuttering is a neurodevelopmental disorder of speech fluency. Various experimental paradigms have demonstrated that affected individuals show limitations in sensorimotor control and learning. However, controversy exists regarding two core aspects of this perspective. First, it has been claimed that sensorimotor learning limitations are detectable only in adults who stutter (after years of coping with the disorder) but not during childhood close to the onset of stuttering. Second, it remains unclear whether stuttering individuals' sensorimotor learning limitations affect only speech movements or also unrelated effector systems involved in nonspeech movements. We report data from separate experiments investigating speech auditory-motor learning (N = 60) and limb visuomotor learning (N = 84) in both children and adults who stutter versus matched nonstuttering individuals. Both children and adults who stutter showed statistically significant limitations in speech auditory-motor adaptation with formant-shifted feedback. This limitation was more profound in children than in adults and in younger children versus older children. Between-group differences in the adaptation of reach movements performed with rotated visual feedback were subtle but statistically significant for adults. In children, even the nonstuttering groups showed limited visuomotor adaptation just like their stuttering peers. We conclude that sensorimotor learning is impaired in individuals who stutter, and that the ability for speech auditory-motor learning - which was already adult-like in 3-6 year-old typically developing children - is severely compromised in young children near the onset of stuttering. Thus, motor learning limitations may play an important role in the fundamental mechanisms contributing to the onset of this speech disorder.

PMID: 33091464 DOI: 10.1016/j.neuroscience.2020.10.014




Does Working-Memory Training Given to Reception-Class Children Improve the Speech of Children at Risk of Fluency Difficulty? - INFANTIL / TERAPIA

Front Psychol. 2020 Nov 17;11:568867. doi: 10.3389/fpsyg.2020.568867. eCollection 2020.

Free Full Texthttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718024/pdf/fpsyg-11-568867.pdf


Peter Howell, Li Ying Chua , Kaho Yoshikawa , Hannah Hau Shuen Tang , Taniya Welmillage , John Harris and Kevin Tang

University College London, London, United Kingdom; University of Florida, Gainesville, FL, United States.


Procedures were designed to test for the effects of working-memory training on children at risk of fluency difficulty that apply to English and to many of the languages spoken by children with English as an Additional Language (EAL) in UK schools. Working-memory training should: (1) improve speech fluency in high-risk children; (2) enhance non-word repetition (NWR) (phonological) skills for all children; (3) not affect word-finding abilities. Children starting general education (N = 232) were screened to identify those at risk of fluency difficulty. Children were selected who were at high-risk (12), or low-risk (27) of fluency difficulty. For the low-risk children 10 received, and 17 did not receive, the working-memory training. All children in the treatment groups received working-memory training over a 2-week period. For the high-risk group, fluency improved and lasted for at least a week after the end of the study. Phonological skills improved in this group and in the low-risk group who received the training and the improvements continued for at least a week. The low-risk group who did not receive working-memory training showed no improvements, and no group improved word-finding ability.

PMID: 33329206 PMCID: PMC7718024




Dysarthria and Speech Intelligibility Following Parkinson's Disease Globus Pallidus Internus Deep Brain Stimulation - GAGUEIRA ADQUIRIDA

J Parkinsons Dis. 2020;10(4):1493-1502.


Shannon Y Chiu , Takashi Tsuboi, Karen W Hegland , Nicole E Herndon, Aparna Wagle Shukla, Addie Patterson, Leonardo Almeida, Kelly D Foote, Michael S Okun, Adolfo Ramirez-Zamora

University of Florida, Gainesville, FL, USA; Nagoya University Graduate School of Medicine, Nagoya, Japan; Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA.


Background: Although earlier studies reported variable speech changes following subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients, the effects of globus pallidus internus (GPi) DBS on speech performance in PD remain largely unknown.

Objective: We aimed to characterize speech changes following PD GPi-DBS.

Methods: We retrospectively analyzed clinical and speech outcomes of 25 PD patients treated with bilateral GPi-DBS at a single center. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), speech subsystem domains (respiratory, laryngeal, resonance, orofacial, rate, prosody, rhythm, and naturalness), and overall speech intelligibility. Scores at baseline were compared with those at 6 months, 1 year, and the longest clinical follow-up available.

Results: In the off-medication state, activities of daily living and motor function based on UPDRS II and III significantly improved postoperatively. We observed unique patterns of speech changes in patients with PD following GPi-DBS in the short- (n = 25) and longer-term (n = 8) follow-up periods. Velopharyngeal (resonance), laryngeal components, and prosody worsened after bilateral GPi-DBS (p < 0.015). Speech intelligibility did not worsen after GPi-DBS in the short-term, but there was a trend to deteriorate at long-term follow-up (e.g., one year and beyond). We observed worsening of hypokinetic dysarthria in individual patients. Also, a minority of patients developed stuttering, spastic dysarthria, or ataxic dysarthria.

Conclusion: Bilateral GPi-DBS worsened several modalities of parkinsonian speech without compromising overall speech intelligibility. GPi-DBS can potentially worsen or induce hypokinetic dysarthria, stuttering, spastic dysarthria, or ataxic dysarthria. GPi-DBS may have different and variable effects on speech function when compared to STN-DBS.

PMID: 32955467 DOI: 10.3233/JPD-202246




Early childhood educators' knowledge and attitudes toward young children who stutter - SOCIAL

Psychiatriki. Oct-Dec 2020;31(4):352-356.

Free article: https://www.psychiatriki-journal.gr/documents/psychiatry/31.4-EN-2020-352.pdf


I Grigoropoulos

Department of Early Childhood Education and Care International Hellenic University, Thessaloniki, Greece.


Attitudes of 74 early childhood educators toward young children who stutter were explored using a Greek translation of Teacher Attitudes Toward Stuttering (TATS) Inventory and the Alabama Stuttering Knowledge Test (ASK). Results indicated a significant positive correlation between educators' attitudes towards stuttering (TATS) and knowledge of stuttering (ASK). Multiple regression analysis showed that age, years of experience and educational level were not significant predictors of attitudes (TATS) toward young children who stutter. Participants' responses appeared to indicate positive attitudes towards young children who stutter. This study highlighted the need for awareness campaigns and education opportunities to ensure fewer negative perceptions for very young children who stutter.

PMID: 33361065 DOI: 10.22365/jpsych.2020.314.352




Effect of word phonetic properties on stuttering anticipation and speech production in adults who stutter - TERAPIA

J Fluency Disord. 2020 Nov 7;67:105803. Online ahead of print.

Free Full Texthttps://www.sciencedirect.com/science/article/pii/S0094730X20300589?via%3Dihub


Anna Mersov, Luc De Nil

University of Toronto, Canada.


Purpose: Stuttering anticipation is a significant factor in an individual's stuttering experience. People who stutter have reported words and sounds that they anticipate stuttering on. Attempts at understanding the association between stuttering anticipation and stuttering outcomes and the impact of phonetic properties on stuttering anticipation and overt stuttering have been insufficiently examined. This study aims to address these important issues.

Methods: Data were collected as part of a larger brain imaging study. Twenty adults who stutter rated a 414 word-list on stuttering anticipation. Participant-specific 'high' and 'low' anticipated words were selected. Twelve of the 20 participants returned for a second session 2-11 weeks later, during which they read the selected words again and stuttering occurrence was recorded.

Results: Among the 20 participants, three sub-groups with "high" (N = 6), "moderate" (N = 5) and "low" (N = 9) stuttering anticipation were identified. Significant "high stuttering" anticipation was found on consonants, plosives, bilabials and alveolars, as well as labials and coronals. In 5 of the 8 participants who stuttered during session 2, more than 80 % of words stuttered were previously rated with high anticipation. Consonants, plosives, bilabials and alveolars, and labials and coronals were the most frequently stuttered (>27 %).

Conclusion: While not all adults who stutter demonstrate high word-specific stuttering anticipation, we found that more than half anticipated this to a high degree. Furthermore, both word-specific phonetic properties and stuttering anticipation impact stuttering occurrence. The inclusion of word-specific stuttering anticipation ratings may increase the likelihood of stuttering in experimental studies and improve treatment outcomes through individualized intervention.

PMID: 33242720 DOI: 10.1016/j.jfludis.2020.105803




Effects of Physiological Arousal on Speech Motor Control and Speech Motor Practice in Preschool-Age Children Who Do and Do Not Stutter - MOTOR

J Speech Lang Hear Res. 2020 Oct 16;63(10):3364-3379. Epub 2020 Sep 15.


Victoria Tumanova, Carly Woods, Qiu Wang

Syracuse University, NY.


Purpose We examined the effects of physiological arousal on speech motor control and speech motor practice effects in preschool-age children who do (CWS) and do not stutter (CWNS).
Method Participants included 18 CWS (M age = 4 years 5 months) and 18 age- and gender-matched CWNS. The participants repeated a phrase "buy bobby a puppy" interspersed with viewing pictures from the International Affective Picture System under two experimental conditions speaking after viewing pictures with (a) negative and (b) neutral valence. Participants' lip movements were tracked using Optotrak system. The spatiotemporal index and mean utterance duration were calculated to examine speech motor control and speech motor practice effects. Skin conductance level was measured during the experimental conditions to assess participants' physiological level of arousal.

Results Preschool-age CWS demonstrated greater speech movement variability across all conditions and trials than CWNS. Furthermore, the younger participants produced more variable articulatory movements than the older participants. Participants' speech movement variability did not significantly differ between the negative and neutral experimental conditions, and the level of physiological arousal did not have a significant effect on it. There was a nonsignificant trend of decrease in speech movement variability across the repeated trials in both groups. Last, CWS and CWNS did not differ in their mean utterance duration, suggesting that their articulation rate was similar across all conditions and trials.

Conclusions Our findings indicate that, compared to preschool-age CWNS, CWS demonstrate less mature speech motor control. However, present findings do not support the hypothesis that CWS benefit less from motor practice relative to CWNS. Given that our conditions elicited similar levels of arousal in the participants, future research is needed to examine whether physiological arousal disrupts speech motor control in preschool-age children potentially contributing to disruptions of speech fluency and the development of stuttering.

PMID: 32931716 DOI: 10.1044/2020_JSLHR-20-00092




Ehud Yairi: Reflections on a Career - HISTÓRIA

J Fluency Disord. 2020 Aug 12;65:105779. Online ahead of print.


Mark Onslow

University of Technology Sydney, Australia.


This is the second in a series of papers that provides an historical record in this journal of contributions made by the most influential researchers in the field of fluency disorders. The present paper reflects on the long and productive career of Ehud Yairi, outlining his many contributions to the field of stuttering, and his outstanding achievements and accomplishments. The paper is based on interviews with him during 2020, after the conclusion of his research career. His visionary, lifetime work has advanced our understanding of the nature, origins, and epidemiology of this disorder.
PMID: 32823252 DOI: 10.1016/j.jfludis.2020.105779




Emotional and behavioural problems of children and adolescents who stutter: Comparison with typically developing peers - EMOCIONAL

Logoped Phoniatr Vocol. 2020 Dec 23;1-13. Online ahead of print.


Tuğçe Karahan Tığrak, Maviş Emel Kulak Kayıkcı, Meltem Çiğdem Kirazlı, Arcan Tığrak

Hacettepe University, Ankara, Turkey; Kütahya Dumlupınar University, Kütahya, Turkey.


Purpose: There are several studies showing contradictory results on concurrent emotional and behavioural problems of children and adolescents who stutter (CAWS). This study aimed to identify whether there is a difference between Turkish-speaking CAWS and their typically developing peers (TDP) in emotional and behavioural problems.

Methods: The study group consisted of 45 CAWS, aged between 3.40 and 15.92 years, and the control group consisted of 45 TDP, aged between 3.15 and 16.80 years. Participants were divided into three age groups: early childhood (0-6 years), middle childhood (7-11 years) and adolescence (12-18 years). CAWS and TDP were compared separately in each age group with Mann-Whitney U tests. Assessments of emotional and behavioural problems were conducted with the Child Behaviour Checklist (CBCL) for Ages 1.5-5 and the CBCL for Ages 6-18.

Results: In early childhood, CAWS had significantly higher emotional reactivity, anxiety/depression, somatic complaints, withdrawal, sleep problems, attention problems and aggressive behaviour scores than TDP. In middle childhood and adolescence, CAWS had significantly higher anxiety/depression, withdrawal/depression, social problems, attention problems, rule-breaking behaviour and aggressive behaviour scores compared to TDP. In adolescence, somatic problems and thought problems scores were also significantly higher in AWS than TDP.

Conclusions: We concluded that emotional and behavioural problems associated with stuttering are noticeable from early childhood to adolescence. Cooperation with mental health professionals may be needed to improve the quality of speech therapy in CAWS.

PMID: 33355015 DOI: 10.1080/14015439.2020.1855472




Emotional Reactivity and Regulation in Preschool-Age Children Who Do and Do Not Stutter: Evidence From Autonomic Nervous System Measures - EMOCIONAL

Front Hum Neurosci. 2020 Dec 16;14:600790. eCollection 2020.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772147/pdf/fnhum-14-600790.pdf


Victoria Tumanova, Blair Wilder, Julia Gregoire, Michaela Baratta, Rachel Razza

Syracuse University, Syracuse, NY, United States.


Purpose: This experimental cross-sectional research study examined the emotional reactivity and emotion regulation in preschool-age children who do (CWS) and do not stutter (CWNS) by assessing their psychophysiological response during rest and while viewing pictures from the International Affective Picture System (Lang et al., 2008). Method: Participants were 18 CWS (16 boys and two girls; mean age 4 years, 5 months) and 18 age- and gender-matched CWNS. Participants' psychophysiological responses were measured during two baselines and two picture viewing conditions. Skin conductance level (SCL) and heart rate were measured to assess emotional reactivity. Respiratory sinus arrhythmia (RSA) was measured to assess emotional regulation. Participants' shyness and executive function were assessed via parent report and considered for their effects on participants' psychophysiological responses. Results: First, CWNS and CWS did not differ in their initial baseline SCL, heart rate, or RSA, but all participants had higher SCL and lower RSA in the second baseline, subsequent to the first challenge condition, compared to the first baseline. Second, during the challenge conditions, CWS did not differ from CWNS in their SCL, but showed a significantly higher heart rate than CWNS. Third, CWS exhibited a significantly lower RSA during the challenge conditions compared to CWNS. Lastly, the temperamental quality of shyness was associated with preschool-age children's SCL, such that participants who were rated higher in shyness had a higher SCL during the challenge conditions. Participants' executive function had a marginally significant effect on the RSA, such that the participants who had higher executive function composite scores exhibited lower RSA during the challenge conditions. Conclusions: Our findings suggest that CWS and CWNS did not differ in their emotional reactivity and emotional regulation abilities at rest. During challenge conditions, however, CWS tended to be more emotionally reactive, as indicated by a higher heart rate, and also employed more emotional regulation, indexed by a greater decrease in RSA, compared to CWNS. Preschool-age children's behavior is largely dominated by reactivity, but there is the emergence of regulation, which can help children adjust to various contextual demands. For CWS who are more emotionally reactive, regulatory skills may be particularly critical to their prognosis and treatment.

PMID: 33390919 PMCID: PMC7772147




Evaluating three stuttering assessments through network analysis, random forests and cluster analysis - AVALIAÇÃO

J Fluency Disord. 2020 Dec 9;67:105823 Online ahead of print.


David Ward, Ronan Miller, Alexandre Nikolaev

University of Reading, Reading, UK;  University of Helsinki, Helsinki FI, Finland.


Purpose: In stuttering, cognitive and behavioural variables interact in nonlinear fashion. These variables can be assessed by instruments which evaluate perceived impact of stuttering and stuttering severity. We applied three statistical methods in combination to the analysis of three assessment protocols to discover relationships within and between the tests to better understand variations in behavioural and social aspects of stuttering.

Methods: Scores from Stuttering Severity Index (SSI-IV), Overall Assessment of the Speaker's Experience of Stuttering scale (OASES), and Unhelpful Thoughts and Beliefs About Stuttering scale (UTBAS), collected from 26 participants were compared using three statistical methods: network analysis, random forests, and cluster analysis.

Results: Network analysis demonstrated that SSI-IV only weakly interacts with a quality of life index (OASES) and a self-perception and belief systems index (UTBAS). Random forest analyses revealed the last two measures relate strongly to each other. The results from cluster analysis suggest a) a possible regrouping of OASES items and b) a possible use of one UTBAS scale instead of the three.

Conclusion: A combination of three statistical methods allowed us to evaluate the three assessments in more depth. The lack of interaction between the SSI-IV on the one hand, and OASES and UTBAS on the other, suggests that the network of the three commonly used stuttering assessments may be fractured in a non-productive way. A potential gap may exist for an assessment tool that would link behavioural and social aspects of stuttering.

PMID: 33571755 DOI: 10.1016/j.jfludis.2020.105823




Functional Near-Infrared Spectroscopy in the Study of Speech and Language Impairment Across the Life Span: A Systematic Review - NEUROCIÊNCIAS

Am J Speech Lang Pathol. 2020 Aug 4;29(3):1674-1701. Epub 2020 Jul 8 


Lindsay K Butler, Swathi Kiran, Helen Tager-Flusberg

Boston University, MA.


Purpose Functional brain imaging is playing an increasingly important role in the diagnosis and treatment of communication disorders, yet many populations and settings are incompatible with functional magnetic resonance imaging and other commonly used techniques. We conducted a systematic review of neuroimaging studies using functional near-infrared spectroscopy (fNIRS) with individuals with speech or language impairment across the life span. We aimed to answer the following question: To what extent has fNIRS been used to investigate the neural correlates of speech-language impairment?

Method This systematic review was preregistered with PROSPERO, the international prospective register of systematic reviews (CRD42019136464). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for preferred reporting items for systematic reviews. The database searches were conducted between February and March of 2019 with the following search terms: (a) fNIRS or functional near-infrared spectroscopy or NIRS or near-infrared spectroscopy, (b) speech or language, and (c) disorder or impairment or delay.

Results We found 34 fNIRS studies that involved individuals with speech or language impairment across nine categories: (a) autism spectrum disorders; (b) developmental speech and language disorders; (c) cochlear implantation and deafness; (d) dementia, dementia of the Alzheimer's type, and mild cognitive impairment; (e) locked-in syndrome; (f) neurologic speech disorders/dysarthria; (g) stroke/aphasia; (h) stuttering; and (i) traumatic brain injury.

Conclusions Though it is not without inherent challenges, fNIRS may have advantages over other neuroimaging techniques in the areas of speech and language impairment. fNIRS has clinical applications that may lead to improved early and differential diagnosis, increase our understanding of response to treatment, improve neuroprosthetic functioning, and advance neurofeedback.

PMID: 32640168




Inhibitory Control of Lexical Selection in Adults who Stutter - LINGUAGEM

J Fluency Disord. 2020 Sep 11;66:105780. Online ahead of print.


Nathan D Maxfield

University of South Florida, Tampa, FL, 33620, United States.


Purpose: Based on previous evidence that lexical selection may operate differently in adults who stutter (AWS) versus typically-fluent adults (TFA), and that atypical attentional processing may be a contributing factor, the purpose of this study was to investigate inhibitory control of lexical selection in AWS.

Method: 12 AWS and 12 TFA completed two tasks. One was a picture naming task featuring High and Low Agreement object naming. Naming accuracy and reaction times (RT), and event-related potentials (ERPs) time-locked to picture onset, were recorded. Second was a flanker task featuring Congruent and Incongruent arrow arrays. Push-button accuracy and RTs, and ERPs time-locked to arrow array onset, were recorded.

Results: Low Agreement pictures were named less accurately and slower than High Agreement pictures in both Groups. The magnitude of the Agreement effect on naming RTs was larger in AWS versus TFA. Delta-plot analysis revealed that the Agreement effect was positively correlated with individual differences in inhibition in TFA but not in AWS. Moreover, Low Agreement pictures elicited negative-going ERP activity relative to High Agreement pictures in both Groups. However, the scalp topography of this effect was markedly reduced in AWS versus TFA. For the Flanker task, Congruency affected push-button accuracy and RTs, and N2 amplitudes, similarly between groups.

Conclusions: Results point to a selective deficit in inhibitory control of lexical selection in AWS. Potential pathways between diminished inhibitory control of lexical selection, speech motor control and stuttering are discussed.

PMID: 32950028 DOI: 10.1016/j.jfludis.2020.105780




International expert perspectives on the principles and components of effective intervention for adults who stutter - TERAPIA

Int J Lang Commun Disord. 2020 Oct 22. Online ahead of print.


Amy Connery, Rose Galvin, Arlene McCurtin

University of Limerick, Limerick, Ireland; HSE Dublin South West, Tallaght, Dublin, Ireland.


Background: While evidence-based practice is widely endorsed by researchers, clinicians and professional bodies as a guiding framework for the provision of quality care to clients, the reliance on efficacy evidence may overshadow the benefits of other knowledge forms in supporting intervention design and evaluation. Due consideration needs to be given to varied forms of evidence, including practice and patient evidence. Stuttering intervention for adults is one area in which there is a significant shortage of practice-based research literature.

Aims: This study aimed to add to practice evidence by exploring the perspectives of international researchers and clinical experts on the components of effective stuttering intervention. This practice-based evidence will be used to inform the multi-stakeholder co-design of an evidence-based stuttering intervention for adults.

Methods & procedures: Criteria defining expertise were developed based on a review of the literature. Experts were recruited using purposive sampling and snowballing. Seventeen international experts were approached, of which 10 completed semi-structured interviews. Interview questions were developed and centred on five topics: the nature of stuttering; efficacy evidence base; intervention techniques, principles of effective intervention; and outcome measurement.

Outcomes & results: Inductive thematic analysis identified three overarching themes: 'One size doesn't fit all', 'A really collaborative relationship where we are both bringing our sense of expertise to this' and 'Some of the most frustrating things'.

Conclusions & implications: These findings emphasize the complexity of stuttering intervention, the need for individually tailored treatments and the role of multiple factors, beyond therapeutic technique, that influence treatment outcomes. Findings also demonstrate the benefit of collecting practice-based evidence to support clinical decision-making and intervention evaluation.

What this paper adds What is already known on the subject Evidence-based practice involves the synthesis of multiple forms of knowledge, including research, practice and patient evidence to support clinical decision-making and intervention evaluation. Research evidence for stuttering intervention effectiveness is the dominant form of knowledge in stuttering literature, while other forms such as practice and patient evidence are less represented.

What this paper adds to existing knowledge This study provides valuable practice evidence for effective stuttering intervention components, including individually tailored intervention, person-related factors and therapeutic alliance. It highlights the need to consider multiple forms of knowledge to guide the design and evaluation of intervention.

What are the potential or actual clinical implications of this work? Clinicians should adopt a person-centred care approach when designing and evaluating an intervention for adults who stutter. Multiple factors beyond therapeutic technique influence treatment outcomes and should be incorporated into any intervention for adults who stutter.

PMID: 33089623 DOI: 10.1111/1460-6984.12580




Larger reported impact of stuttering in teenage females, compared to males - A comparison of teenagers' result on Overall Assessment of the Speaker's Experience of Stuttering (OASES) - EMOCIONAL

J Fluency Disord. 2020 Dec 8;67:105822. Online ahead of print.


Ineke Samson, Elisabeth Lindström, Anders Sand, Agneta Herlitz, Ellika Schalling

Karolinska Institutet, Stockholm, Sweden; Danderyd Hospital, Stockholm, Sweden; Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turkku, Finland; Karolinska University Hospital, Stockholm, Sweden.


Purpose: The aim of this cross-sectional study was to explore the impact and experience of stuttering, and attitude to communication for female and male teenagers who stutter (TWS) in comparison with teenagers with no stutter (TWNS).

Methods: The Swedish version of the Overall Assessment of the Speaker's Experience of Stuttering (OASES-T-S), was administered to 56 TWS, 13-17 years old (26 females, 30 males). An adapted version of OASES, Attitude to Speech and Communication (ASC), was administered to 233 TWNS. The impact scores were analyzed in relation to sex in TWS and TWNS.

Results: Female TWS reported that stuttering had a greater impact on their life than it did on male TWS (on average 0.5 higher impact scores; Hedges' g = 0.87). The differences did not seem to be caused by differences in severity of overt stuttering symptoms. Female and male TWS particularly differed on items related to difficulties in day-to-day communication and affective/behavioral reactions to stuttering. Such sex differences were not as pronounced among TWNS, suggesting that teenage women may be more vulnerable to the negative impact of stuttering than men the same age.

Conclusion: Female teenagers report more negative experiences and a greater tendency to use avoidance strategies than male teenagers.

PMID: 33348210 DOI: 10.1016/j.jfludis.2020.105822




Life partners' perceptions of the emotional, speech disruptive, and attitudinal correlates of stuttering - SOCIAL

J Fluency Disord. 2020 Nov 25;67:105821. Online ahead of print.
Free Full Text: https://www.sciencedirect.com/science/article/pii/S0094730X20300760


A Svenning, R Panzarino, M Vanryckeghem, T Vestner

University of Central Florida, United States; University of London, United Kingdom.


Purpose: The purpose of the current investigation was to explore the extent to which the life partners (LPs) of people who stutter (PWS) perceive their loved ones' speech-situation specific emotional reaction, expectancy of speech disruption, and speech-related communication attitude.

Methods: Three subtests of the Behavior Assessment Battery (BAB): the Speech Situation Checklist - Emotional Reaction (SSC-ER), the Speech Situation Checklist - Speech Disruption (SSC-SD) and the Communication Attitude Test for Adults Who Stutter (BigCAT) were administered to 33 PWS and modified versions were administered to their LPs via Qualtrics Survey Software. Effect of relationship duration on subtest scores was considered. Perceived stuttering severity by the participant and their LP was also queried as part of a demographic questionnaire.

Results: PWS and their LPs rated BigCAT items in a similar way, while they rated certain SSC-ER and SSC-SD items differently. Importantly, between-group agreement was not affected by relationship duration. Among the PWS and LP, perceived stuttering severity influenced all BAB subtest scores.

Conclusion: LPs of PWS appear to be in tune with the cognitive aspects of their partner's experience of stuttering. This has important clinical implications as it relates to active involvement of the family in speech intervention targeting fluency.

PMID: 33290956 DOI: 10.1016/j.jfludis.2020.105821




Manual response inhibition and quality of life in adults who stutter - MOTOR

J Commun Disord. 2020 Sep 29;88:106053.


Shanley B Treleaven, Geoffrey A Coalson

Louisiana State University, LA, United States.


Background: A considerable amount of research has identified inhibition differences, including slower inhibition of manual responses, in people who stutter. Recent investigations have failed to link slowed motor inhibition with overt stuttering severity. This study investigated the potential relationship between slowed manual response inhibition and the negative impact of stuttering upon individual lives of adults who stutter (AWS).

Methods: Thirty-four adults (AWS, n = 17; AWNS, n = 17) matched by nonverbal IQ completed a manual stop-signal task and provided a conversational speech sample. Motor inhibition latency for AWS and AWNS were compared. For AWS, motor inhibition latency was compared to the four subsections of the Overall Assessment of the Speaker's Experience with Stuttering (OASES; Yaruss & Quesal, 2006; General Information, Reactions to Stuttering, Communication in Daily Situations, Quality of Life).

Results: Similar to previous studies, AWS were significantly slower to inhibit inaccurate manual responses than AWNS. Quality of Life subtest of the OASES was found to significantly predict inhibition latency.

Conclusion: These data replicate findings that indicate that AWS exhibit slower manual inhibition latency, and suggest that these inhibition differences may be associated with an individual's negative experience with stuttering rather than stuttering severity.

PMID: 33065458 DOI: 10.1016/j.jcomdis.2020.106053




Neuronavigated rTMS inhibition of right pars triangularis anterior in stuttering: Differential effects on reading and speaking - NEUROCIÊNCIAS

Brain Lang. 2020 Nov;210:104862. Epub 2020 Sep 23.


Oyku Tezel-Bayraktaroglu, Zubeyir Bayraktaroglu, Asli Demirtas-Tatlidede, Tamer Demiralp, A Emre Oge

Lali Speech and Language Disorders Center, Istanbul, Turkey, Istanbul Medipol University, Istanbul, Turkey; Istanbul University, Istanbul, Turkey; Bahcesehir University, Istanbul, Turkey.


Functional neuroimaging studies show an overactivation of speech and language related homologous areas of the right hemisphere in persons who stutter. In this study, we inhibited Broca's homologues using 1 Hz repetitive transcranial magnetic stimulation (rTMS) and assessed its effects on stuttering severity. The investigated cortical areas included pars opercularis (BA44), anterior and posterior pars triangularis (BA45), mouth area on the primary motor cortex (BA4). We collected reading and speaking samples before and after rTMS sessions and calculated the percentage of syllables stuttered. Only right anterior pars triangularis stimulation induced significant changes in speech fluency. Notably, the effects were differential for reading and speaking conditions. Overall, our results provide supportive evidence that right anterior BA45 may be a critical region for stuttering. The observed differential effects following the inhibition of right anterior BA45 merits further study of contributions of this region on different language domains in persons who stutter.

PMID: 32979643 DOI: 10.1016/j.bandl.2020.104862




"Openness and progress with communication and confidence have all gone hand in hand": Reflections on the experience of transitioning between concealment and openness among adults who stutter - TERAPIA

J Fluency Disord. 2020 Aug 14;65:105781. Online ahead of print.


Michael P Boyle, Rodney M Gabel

Montclair State University, Bloomfield, NJ, United States; University of Toledo, Toledo, OH, United States.


Purpose: The purpose of this study was to gain a deeper understanding of the experience of people who stutter as they navigate through the growth process from concealment to openness.

Method: Twelve adults who stutter who are active in self-help/support groups for stuttering described their experiences of concealment and openness in a semi-structured interview. Purposeful selection was utilized to recruit participants who could comment thoughtfully on previous concealing, but became more open about their stuttering. A phenomenological approach was utilized to gain a deeper understanding of how people who stutter experience the transition from concealment to openness regarding their stuttering and identity. Thematic analysis contributed to identification of themes and subthemes describing participants' experiences.

Results: Participants described precursors to concealment that led to hiding and avoidance, which grew in strength until they reached a turning point. They then changed how they related to their stuttering by changing their behaviors and perceptions of stuttering, which led to increased openness about their identity. This process of continued adaptation to stuttering was ongoing and non-linear, but suggested general trends from concealment to more openness over time. Level of openness was impacted by situational context and individual differences.

Conclusions: The findings extend our understanding of how people who stutter navigate transitions from concealment to openness. This deeper understanding could be helpful in explaining the complexities involved in managing the identity of a person who stutters, and the process of adapting to living with stuttering over time.

PMID: 32846333 DOI: 10.1016/j.jfludis.2020.105781




Predictive factors for persistence and recovery of stuttering in children: A systematic review - INFANTIL / AVALIAÇÃO

Int J Speech Lang Pathol. 2020 Sep 16;1-13. Online ahead of print.


Nirmal Sugathan, Santosh Maruthy

All India Institute of Speech and Hearing, Mysuru, India.


Purpose: The purpose of this study was to systematically review the available literature on various factors that can predict the persistence and recovery of stuttering in children.

Method: An electronic search yielded a total of 35 studies, which considered 44 variables that can be potential factors for predicting persistence and recovery.

Result: Among 44 factors studied, only four factors- phonological abilities, articulatory rate, change in the pattern of disfluencies, and trend in stuttering severity over one-year post-onset were identified to be replicated predictors of recovery of the stuttering. Several factors, such as differences in the second formant transition between fluent and disfluent speech, articulatory rate measured in phones/sec, etc., were observed to predict the future course of stuttering. However, these factors lack replicated evidence as predictors.

Conclusion: There is clear support only for limited factors as reliable predictors. Also, it is observed to be too early to conclude on several replicated factors due to differences in the age group of participants, participant sample size, and the differences in tools used in research that lead to mixed findings as a predictive factor. Hence there is a need for systematic and replicated testing of the factors identified before initiating their use for clinical purposes.

PMID: 32933336 DOI: 10.1080/17549507.2020.1812718




Predictors of Lidcombe Program treatment dropout and outcome for early stuttering - TERAPIA

Int J Lang Commun Disord. 2020 Nov 29. Online ahead of print.


Veronica Park, Mark Onslow, Robyn Lowe, Mark Jones, Sue O'Brian, Ann Packman, Ross Menzies, Susan Block, Linda Wilson, Elisabeth Harrison, Sally Hewat

The University of Sydney, Sydney, NSW, Australia; The University of Queensland, Brisbane, QLD, Australia; La Trobe University, Melbourne, VIC, Australia; Charles Sturt University, Albury / Wodonga, NSW, Australia; Macquarie University, Macquarie Park, NSW, Australia; The University of Newcastle, Newcastle, NSW, Australia.


Background: Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis.

Aims: To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277).

Methods & procedures: A total of 32 variables were used as predictors in regression analyses of short- and medium-term Lidcombe Program outcome, and of treatment dropout.

Outcomes & results: Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity.

Conclusions & implications: Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop-out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions.

What this paper adds What is already known on the subject Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts Lidcombe Program treatment outcome.

What this paper adds to existing knowledge There are predictors of Lidcombe Program treatment outcome that are statistically significant, but none are clinically significant.

What are the potential or actual clinical implications of this work? Clinicians can tell parents that nothing has been found that can assist with making prognostic indications about treatment outcome for their children.

PMID: 33251679 DOI: 10.1111/1460-6984.12586




Prevalence of stammering among internally displaced population in North Waziristan Agency - EMOCIONAL

East Mediterr Health J. 2020 Aug 25;26(8):982-986.


Mehtab Khatoon, Nazia Mumtaz, Ghulam Saqulain

FATA Secretariat, Orakzai, Pakistan; Riphah International University, Lahore. Pakistan; Post Graduate Medical Institute, Islamabad, Pakistan.


Background: Stammering is a dysfluency disorder that is common in children exposed to stressful conditions. Displacement from home is one such situation. There is a large internally displaced population in Pakistan.

Aims: To determine the prevalence of stammering among children of internally displaced persons (IDPs) in North Waziristan Agency, Pakistan.

Methods: This cross-sectional survey included 400 Pushto-speaking children of IDPs, aged 5-18 years enrolled from schools in North Waziristan Agency, from July 2017 to July 2018. The Fluency Rating Scale was used for speech assessment. Data were analysed by SPSS version 20.

Results: The prevalence of stammering was 11%, with moderate stammering being more prevalent. Five (5.6%) girls and 39 (12.5%) boys were identified with stammering.

Conclusions: Stammering is highly prevalent among IDPs.

PMID: 32896895 DOI: 10.26719/emhj.20.011




Processing of Self-Repairs in Stuttered and Non-Stuttered Speech - SOCIAL

Lang Cogn Neurosci. 2020;35(1):93-105. Epub 2019 Jun 26.


Matthew W Lowder, Nathan D Maxfield, Fernanda Ferreira

University of Richmond; University of South Florida; University of California


Previous research suggests that listeners can use the presence of speech disfluencies to predict upcoming linguistic input. But how is the processing of typical disfluencies affected when the speaker also produces atypical disfluencies, as in the case of stuttering? We addressed this question in a visual-world eye-tracking experiment in which participants heard self-repair disfluencies while viewing displays that contained a predictable target entity. Half the participants heard the sentences spoken by a speaker who stuttered, and half heard the sentences spoken by the same speaker who produced the sentences without stuttering. Results replicated previous work in demonstrating that listeners engage in robust predictive processing when hearing self-repair disfluencies. Crucially, the magnitude of the prediction effect was reduced when the speaker stuttered compared to when the speaker did not stutter. Overall, the results suggest that listeners' ability to model the production system of a speaker is disrupted when the speaker stutters.

PMID: 32953925 PMCID: PMC7500508 (available on 2021-01-01)




Public attitudes toward people who stutter in the workplace: A questionnaire survey of Japanese employees - SOCIAL

J Commun Disord. 2020 Dec 29;89:106072. Online ahead of print.
Free full text:  https://www.sciencedirect.com/science/article/pii/S0021992420301404?via%3Dihub


Daichi Iimura, Shoko Miyamoto

Kawasaki University of Medical Welfare,Kurashiki-shi, Okayama, Japan; University of Tsukuba, Tennodai, Tsukuba-shi, Ibaraki, Japan;


Purpose: Negative attitudes toward stuttering by people in their work roles have been previously reported. These attitudes could differ depending on whether or not someone knows a person or has been in contact with a person who stutters. This study aimed to elucidate public attitudes toward people who stutter at work.

Methods: A web-based questionnaire survey of 730 adults drawn from the general public throughout Japan was conducted. It gathered information on respondents' demographics, contact experience with people who stutter, knowledge of stuttering, and attitudes and experiences toward stuttering at work, using a Likert-type scale. To investigate the factors associated with their attitudes and experiences toward stuttering at work, respondents' demographic information and contact experience were entered into a multivariable model using ordinal logistic regression analysis.

Results: We analyzed the data of 671 respondents, of whom 77.2 % were company employees; 41.3 % knew a person who stutters at their workplace, among their friends, and/or in their family, and 34.7 % had been in the position of hiring any individual. Respondents perceived the employment of people who stutter to be somewhat positive overall. Regression analysis revealed that only the factor of workplace contact experience to be significantly positively associated with the respondents' attitudes toward stuttering. That is, knowing a person who stutters in one's workplace was significantly associated with more positive attitudes.

Conclusion: Previous studies have reported widespread negative public attitudes toward stuttering. Our results can supplement this literature, especially regarding attitudes in the workplace. Our findings suggest that the main factor that is associated with people's positive attitudes is their contact experience with people who stutter in their workplace.

PMID: 33388698 DOI: 10.1016/j.jcomdis.2020.106072




Quality and readability of internet information about stuttering - SOCIAL

J Fluency Disord. 2020 Dec 8;67:105824. Online ahead of print.

Free Full Text: https://www.sciencedirect.com/science/article/pii/S0094730X20300796


Richard I. Zraick, Michael Azios, Melanie M. Handly, Monica L. Bellon-Harn, Vinaya Manchaiah

University of Central Florida, Orlando, FL, USA; Lamar University, Beaumont, TX, USA; Manipal University, Manipal, Karnataka, India.


Purpose: We examined the quality and readability of English-language Internet information about stuttering and evaluated the results considering recommendations by experts in health literacy.

Method: A search of Internet websites containing information about stuttering was conducted. Three key words (i.e., stuttering, stammering, speech disfluency) were entered into five country-specific versions of the most commonly used Internet search engine. A total of 79 websites were assessed. Their origin (commercial, non-profit, government, personal or university), quality [Health On the Net (HON) certification and DISCERN scores], and readability [Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG)] were assessed.

Results: Of the 79 websites, 38 % were of commercial, 42 % were of nonprofit organization, 15 % were of government and 5% were of university origins, respectively. Only 13 % had obtained HON certification and the mean DISCERN scores was 3.10 in a 5-point scale. The mean reading grade levels were at 13th and 14th grade and 100 % of the websites exceeded the recommended 5th to 6th reading grade level for health information.

Conclusions: The quality of Internet-based health information about the treatment of stuttering is generally adequate, but actual usability of the sites examined in this study may be limited due to poor readability levels. This is problematic in persons with poor literacy skills. Since the Internet can be readily accessed as a valuable consumer information resource, speech-language pathologists and other healthcare professionals have an opportunity to direct consumers to websites that provide readable information of good quality.

PMID: 33316553 DOI: 10.1016/j.jfludis.2020.105824




Rapid naming ability in adults with stuttering - FALA

Appl Neuropsychol Adult. 2020 Aug 26;1-6. Online ahead of print


Krupa Rajan Pothen, Sunila John, Vasudeva Guddattu

Manipal Academy of Higher Education, Manipal, India.


The investigation of phonological encoding abilities in persons with stuttering has gained importance recently. There is limited information available on the rapid automatized naming ability in adults with stuttering. In the present study, rapid naming ability was assessed in 32 persons with stuttering and 32 persons without stuttering in the age range of 18-30 years on Rapid Automatized Naming and Rapid Alternating Stimulus test. The study findings indicated that the persons with stuttering took a longer time to complete the tasks as compared to persons without stuttering, suggestive of a possible breakdown in phonological encoding ability. Among the subtasks, the longer completion time was observed for the rapid alternating stimulus 3-set task and the color subtasks. The findings of the study clearly propose the need to encompass rapid naming skills, as a part of the assessment and management protocol for individuals with stuttering.

PMID: 32847407 DOI: 10.1080/23279095.2020.1808787




Relationships between stuttering, depression, and suicidal ideation in young adults: Accounting for gender differences - EMOCIONAL

J Fluency Disord. 2020 Nov 27;67:105820. Online ahead of print.


Patrick M Briley, Hope Gerlach, Molly M Jacobs

East Carolina University, Greenville, NC, USA; Western Michigan University, Kalamazoo, MI, USA.


Purpose: The purpose of this study was to investigate the relationship between depressive symptoms and suicidal ideation and living with stuttering while accounting for time, sex, and health-related confounders.

Method: The data for this study come from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative survey study that has followed 13,564 respondents over the course of 14 years. Responses to the question "Do you have a problem with stuttering or stammering?" at two time points were used to establish stuttering and non-stuttering groups. Regression analysis, propensity score matching, and structural equation modeling were used.

Results: Compared to their fluent counterparts, males and females reported significantly elevated symptoms of depression. Although symptoms of depression among males who stutter were stable over time, depressive symptoms among females who stutter increased with age. Compared to males who do not stutter, males who stutter were significantly more likely to report feelings of suicidal ideation. There were no differences in suicidal ideation between females who do and do not stutter.

Conclusions: Speech-language pathologists should be aware of the associations between stuttering and depressive symptoms, as well as the increased risk for suicidal ideation among males who stutter. Clinicians should be knowledgeable about symptoms of depression and suicidal ideation and be familiar with processes to refer as needed.

PMID: 33316554 DOI: 10.1016/j.jfludis.2020.105820




School-Based Speech-Language Pathologists' Perceived Self-Efficacy in Conducting Multidimensional Treatment With Children Who Stutter - INFANTIL / TERAPIA

Lang Speech Hear Serv Sch. 2020 Oct 2;51(4):1172-1186.


Carolina Beita-Ell, Michael P Boyle

Montclair State University, Bloomfield, NJ.


Purpose The purposes of this study were to examine the self-efficacy of school-based speech-language pathologists (SLPs) in conducting multidimensional treatment with children who stutter (CWS) and to identify correlates of self-efficacy in treating speech-related, social, emotional, and cognitive domains of stuttering. Method Three hundred twenty randomly selected school-based SLPs across the United States responded to an online survey that contained self-efficacy scales related to speech, social, emotional, and cognitive components of stuttering. These ratings were analyzed in relation to participants' beliefs about stuttering treatment and their comfort level in treating CWS, perceived success in therapy, and empathy levels, in addition to their academic and clinical training in fluency disorders as well as demographic information. Results Overall, SLPs reported moderate levels of self-efficacy on each self-efficacy scale and on a measure of total self-efficacy. Significant positive associations were observed between SLPs' self-efficacy perceptions and their comfort level in treating CWS, self-reported success in treatment, beliefs about the importance of multidimensional treatment, and self-reported empathy. There were some discrepancies between what SLPs believed was important to address in stuttering therapy and how they measured success in therapy. Conclusions Among school-based SLPs, self-efficacy for treating school-age CWS with a multidimensional approach appears stronger than previously reported; however, more progress in training and experience is needed for SLPs to feel highly self-efficacious in these areas. Continuing to improve clinician self-efficacy for stuttering treatment through improved academic training and increased clinical experiences should remain a high priority in order to enhance outcomes for CWS. Supplemental Material https://doi.org/10.23641/asha.12978194.

PMID: 32966163 DOI: 10.1044/2020_LSHSS-20-00044




Scientists, Society, and Stuttering - CONCEITO

Int J Clin Pract. 2020 Aug 15;e13678. Online ahead of print.


Shahriar SheikhBahaei, Gerald A Maguire

National Institutes of Health (NIH), Bethesda, MD, USA; University of California, Riverside, School of Medicine, CA, USA.


More than 70 million people worldwide are affected by developmental stuttering. It is important to reach out to the public, scientific and medical communities, and those who stutter with a goal to raise awareness about stuttering. In this short perspective, we argue that to educate, advocate, and spread awareness about stuttering, we need role models, support, and opportunities.

PMID: 32798317 DOI: 10.1111/ijcp.13678




Self-Compassion and Quality of Life in Adults Who Stutter - EMOCIONAL

Am J Speech Lang Pathol. 2020 Sep 23;1-12.


Robyn L Croft, Courtney T Byrd

The University of Texas at Austin.


Purpose The purpose of this study was to identify levels of self-compassion in adults who do and do not stutter and to determine whether self-compassion predicts the impact of stuttering on quality of life in adults who stutter.

Method Participants included 140 adults who do and do not stutter matched for age and gender. All participants completed the Self-Compassion Scale. Adults who stutter also completed the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed for self-compassion differences between and within adults who do and do not stutter and to predict self-compassion on quality of life in adults who stutter. Results Adults who do and do not stutter exhibited no significant differences in total self-compassion, regardless of participant gender. A simple linear regression of the total self-compassion score and total Overall Assessment of the Speaker's Experience of Stuttering score showed a significant, negative linear relationship of self-compassion predicting the impact of stuttering on quality of life.

Conclusions Data suggest that higher levels of self-kindness, mindfulness, and social connectedness (i.e., self-compassion) are related to reduced negative reactions to stuttering, an increased participation in daily communication situations, and an improved overall quality of life. Future research should replicate current findings and identify moderators of the self-compassion-quality of life relationship.

PMID: 32966107 DOI: 10.1044/2020_AJSLP-20-00055




Social Judgments of Digitally Manipulated Stuttered Speech: Cognitive Heuristics Drive Implicit and Explicit Bias - SOCIAL

J Speech Lang Hear Res. 2020 Oct 16;63(10):3443-3452. Epub 2020 Sep 21.


Jennifer M Roche, Hayley S Arnold, Ashley M Ferguson

Kent State University, OH.


Purpose People who stutter are susceptible to discrimination, stemming from negative stereotypes and social misattributions. There has been a recent push to evaluate the underlying explicit and implicit cognitive mechanisms associated with social judgments, moving away from only evaluating explicit social bias about people who stutter. The purpose of the current study was to evaluate how listeners change their implicit and explicit social (mis)attributions after hearing a people who stutter produce disfluent speech.

Method The current project was an adaptation of the Byrd et al. (2017) study to evaluate listener implicit/explicit social judgments of stuttered speech across five categories (i.e., confidence, friendliness, intelligence, distractibility, and extroversion) before and after a stuttering self-disclosure. This was done by implementing a modified version of the Ferguson et al. (2019) computer mouse-tracking paradigm.

Results Consistent with previous findings, participants made more explicit positive social judgments of confidence, friendliness, extroversion, and intelligence after a stuttering self-disclosure, but the distractedness category was resistant to change. Also consistent with previous findings, participants experienced a higher degree of cognitive competition (i.e., higher area under the curve) shortly after self-disclosure, which lessened over time.

Conclusions Explicit and implicit biases exist, but self-disclosure significantly impacts the cognitive system of listeners. Specifically, self-disclosure may reduce explicit bias through experience and explicit belief updating, but when cognitive heuristics are strong, implicit bias may be slower to change.

PMID: 32956006 DOI: 10.1044/2020_JSLHR-20-00188




Speech disfluencies in typically developing Finnish-speaking children - preliminary results - AVALIAÇÃO

Clin Linguist Phon. 2020 Sep 30;1-20.


E Jansson-Verkasalo, M Silvén, I Lehtiö, K Eggers

University of Turku , Turku, Finland; Thomas More University College , Antwerp, Belgium.


We investigated the speech disfluencies of 54 typically fluent Finnish-speaking children: 14 children randomly selected from a longitudinal study (age levels 2, 3, and 4 years), and 40 children from a cross-sectional study (age levels 6, 7, 8, and 9 years). Speech samples, collected during a semi-structured conversation, were analysed for disfluencies per 100 words and 100 syllables. No significant within-age effect was found for the total frequency of disfluencies or disfluency types among the 2- to 4-year-olds. Across the 6- to 9-year-olds, between-group differences were found for the total frequency and type of disfluencies. Clinically relevant was that the criterion to distinguish normally fluent children from those who stutter, i.e., <3 stuttering-like disfluencies (SLD) per 100 syllables, was applicable in all age groups whereas the criterion <3SLD per 100 words was not. Consequently, these preliminary results suggest that different guidelines are needed for defining normal disfluency from stuttering in different languages.

PMID: 32993385 DOI: 10.1080/02699206.2020.1818287




Speech restructuring group treatment for 6-to-9-year-old children who stutter: A therapeutic trial - TERAPIA EM GRUPO

J Commun Disord. 2020 Dec 29;89:106073. Online ahead of print.


Harald A Euler, Anna Merkel, Katja Hente, Nicole Neef, Alexander Wolff von Gudenberg, Katrin Neumann

Westphalian Wilhelms University of Münster, Münster, Germany; Bad Emstal, Germany; Georg-August-University, Göttingen, Germany.


For children who stutter (CWS), there is good evidence of the benefits of treatment for pre-school age, but an evidence gap for elementary school age. Here we report on the effectiveness of a fluency shaping treatment for 6- to 9-year-old children. The main treatment component is the reinforcement of soft voice onsets. An intensive in-patient group treatment phase lasts 6 days, followed by a 6-month maintenance phase with 3 in-patient weekend group refresher courses. Child and a parent participate together in various treatment activities. In this controlled intervention study (waitlist control, intention-to-treat design) assessments were performed before treatment (T1), 4 weeks after the intensive phase (T2), at the end of the maintenance phase (T3), and 1 year later (T4). Participants were 119 children (108 boys, 11 girls, age 5.5‑10.4 years). Control conditions included a subgroup with delayed treatment (N=25) as well as the assessment of complexity of utterances, inter-rater reliability, and speech naturalness. From before treatment to 1-year follow-up, percent stuttered syllables and OASES-S (Overall Assessment of the Speaker's Experience with Stuttering - School-age) scores decreased with large effect size. Speech naturalness improved during this period but did not reach the level of non-stuttering children. Complexity of utterances increased during the intensive phase, but only temporarily. Twenty children (16.8 %, including dropouts) showed no demonstrable treatment benefit. Fluency shaping treatment can be effectively applied to young school children. It is assumed that parental support, group therapy, intensive treatment, and regular exercises at home are essential.

PMID: 33444874 DOI: 10.1016/j.jcomdis.2020.106073




Stigma and the Hispanic stuttering experience: A qualitative study - SOCIAL

Review J Commun Disord. 2020 Nov 21;89:106056. Online ahead of print.

Free Full Text: https://www.sciencedirect.com/science/article/pii/S0021992420301246


Leslee Dean, Angela M Medina

Florida International University, United States.


The stigmatization of stuttering has profound effects on the education, employment, and mental health of people who stutter. While there is a large body of research into the impact of stuttering stigma, few studies have considered the effects of cultural differences. The purpose of this study is to provide an in-depth analysis of how Hispanic adults who stutter experience stigma. To do so, seven Hispanic/Latino adults who stutter were interviewed using ethnographic interviewing techniques. A thematic analysis of participants' narrative responses gave rise to four major themes: Family, Stigma in Society, Stuttering Experiences in Cultural and Linguistic Contexts, and Stigma's Impact on Identity. Findings indicate that Hispanic adults who stutter experience stigma in unique ways that affect their language use, cultural participation, and identity. An understanding of these cultural and linguistic factors will allow clinicians to develop a more nuanced and effective approach when treating Hispanic adults who stutter.

PMID: 33259946 DOI: 10.1016/j.jcomdis.2020.106056




Streptococcal Infection as a Major Historical Cause of Stuttering: Data, Mechanisms, and Current Importance - CONCEITO

Front Hum Neurosci. 2020 Nov 9;14:569519. eCollection 2020.
Free Full Text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693426/pdf/fnhum-14-569519.pdf


Per A Alm

Uppsala University, Uppsala, Sweden.


Stuttering is one of the most well-known speech disorders, but the underlying neurological mechanisms are debated. In addition to genetic factors, there are also major non-genetic contributions. It is here proposed that infection with group A beta-hemolytic streptococcus (GAS) was a major underlying cause of stuttering until the mid-1900s when penicillin was introduced in 1943. The main mechanism proposed is an autoimmune reaction from tonsillitis, targeting specific molecules, for example within the basal ganglia. It is here also proposed that GAS infections may have continued to cause stuttering to some extent, to the present date, though more rarely. If so, early diagnosis of such cases would be of importance. Childhood cases with sudden onset of stuttering after throat infection may be particularly important to assess for possible GAS infection. The support for this hypothesis primarily comes from three lines of argument. First, medical record data from the 1930s strongly indicates that there was one type of medical event in particular that preceded the onset of childhood stuttering with unexpected frequency: diseases related to GAS throat infections. In particular, this included tonsillitis and scarlet fever, but also rheumatic fever. Rheumatic fever is a childhood autoimmune sequela of GAS infection, which was a relatively widespread medical problem until the early 1960s. Second, available reports of changes of the childhood prevalence of stuttering indicate striking parallels between stuttering and the incidence of rheumatic fever, with: (1) decline from the early 1900s; (2) marked decline from the introduction of penicillin in the mid 1940s; and (3) reaching a more stable level in the 1960s. The correlations between the data for stuttering and rheumatic fever after the introduction of penicillin are very high, at about 0.95. Third, there are established biological mechanisms linking GAS tonsillitis to immunological effects on the brain. Also, a small number of more recent case reports have provided further support for the hypothesis linking stuttering to GAS infection. Overall, it is proposed that the available data provides strong evidence for the hypothesis that GAS infection was a major cause of stuttering until the mid-1900s, interacting with genetic predisposition.

PMID: 33304252 PMCID: PMC7693426 DOI: 10.3389/fnhum.2020.569519




Stuttering and Word-Finding Difficulties in a Patient With COVID-19 Presenting to the Emergency Department - GAGUEIRA ADQUIRIDA

Case Reports Cureus. 2020 Nov 29;12(11):e11774

Free PMC articlehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779121/pdf/cureus-0012-00000011774.pdf


Nathan Morrison, Joshua Levy, Talia Shoshany, Aaron Dickinson, Michael Whalen

Philadelphia College of Osteopathic Medicine, Philadelphia, USA.; Lankenau Medical Center, Wynnewood, USA.


Coronavirus disease 2019 (COVID-19) was designated as a global pandemic by the World Health Organization (WHO) on March 11, 2020. The Cochrane Database of Systematic Reviews documents that COVID-19 has a wide range of common symptoms, which have made it difficult to characterize the disease. To date, the neurological symptoms of stuttering and word-finding difficulties have not been reported in confirmed COVID-19 cases. This case report describes the clinical course of a 53-year-old female that presented to the emergency department (ED) twice with varying symptoms consistent with COVID-19. At the second ED visit, she complained of new-onset stuttering and word-finding difficulties and tested positive for COVID-19 using the polymerase chain reaction (PCR) nasopharynx test. When contacted, the patient stated that her speech issues persisted at least seven days after discharge from her second ED visit. As a result, the virus may cause symptoms of an acute neurological event and should be taken into diagnostic consideration. These neurological findings may be explained by the recent discovery of the COVID-19 spike protein's ability to destabilize the blood-brain barrier (BBB) and enter the central nervous system (CNS). Increased classification of unrecognized COVID-19 symptoms and complications may aid in the characterization, surveillance, and prevention of the disease.

PMID: 33409021 PMCID: PMC7779121 DOI: 10.7759/cureus.11774




Stuttering Practice Self-Assessment by School Speech-Language Practitioners -  OUTRAS  ÁREAS

Lang Speech Hear Serv Sch. 2020 Oct 2;51(4):1156-1171.


Ellen M Kelly, Cara M Singer, Jack K Henderson, Kenton O Shaw

Vanderbilt University Medical Center, Nashville, TN, Grand Valley State University, Grand Rapids, MI.


Purpose The purpose of this study was to survey school speech-language practitioners' self-perceptions of their confidence, knowledge, and need for support for working with school-age students who stutter (SWS). Method A total of 120 school-based speech-language practitioners from 27 Nashville, Tennessee, area counties completed an online, 35-item survey examining caseloads, coursework, continuing education, experience, and perceived levels of skill and confidence in service provision to SWS. They also rated their need for consultation from speech-language pathologists who specialize in stuttering to improve their skills with SWS.

Results Respondents were least confident in and needed most support for providing intervention to SWS. Those who needed most support for intervention rated themselves as less knowledgeable about stuttering theory, assessment, and intervention and were less confident about working with students who only stutter and with SWS who have concomitant communication concerns. Greater practitioner confidence in stuttering intervention skills was positively correlated with the number of SWS on caseloads; continuing education credits in stuttering; and knowledge of stuttering theory, assessment, and intervention. Respondents who completed a graduate course on stuttering had greater confidence in stuttering intervention and were less likely to identify a need for support from specialists.

Conclusions School speech-language practitioners continue to report needing additional education, practice opportunities, and support, especially with intervention, and desiring specialized guidance to serve SWS. Those with more experience, education, and knowledge about stuttering are more confident and skillful, reflecting the potential positive impact of increased opportunities to learn about and work with SWS. These needs may be addressed through increased availability of specialists in stuttering to consult with school practitioners; opportunities for school-based practitioners to become peer mentors; and provision of readily available, intervention-focused continuing education experiences and resources.

PMID: 32960705 DOI: 10.1044/2020_LSHSS-20-00028




Stuttering therapy through telepractice in Turkey: A mixed method study - TERAPIA

J Fluency Disord. 2020 Sep 28;66:105793.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521915/pdf/main.pdf


M Emrah Cangi, Bülent Toğram

Üsküdar University, İstanbul, Turkey, Anadolu University, Eskişehir, Turkey.


Purpose: The effectiveness of telepractice in stuttering therapy in Turkey may be unclear, but there is good evidence for the efficaciousness of it from other countries, e.g., Australia. The purpose of the present study is to compare the outcomes of telepractice and in-person therapy delivery on traditional stuttering treatment and explore telepractice stuttering therapy experience in Turkey.

Methods: 20 adults who stutter participated in the study. Half the participants received treatment via telepractice, while the others were provided with services in-clinic. Based on a convergent parallel mixed-method research, quantitative (Study 1) and qualitative data (Study 2) were collected in parallel, analyzed separately, and then combined. Study 1 included a non-inferiority controlled trial, repeated measures, quasiexperimental design. Within the scope of the quantitative research, the objective clinical data, including the scale and assessment scores, were collected from two groups in three stages. Study 2 used the phenomenology approach to assess the qualitative aspects of our study.

Results: According to the quantitative findings in Study 1, the effectiveness of telepractice and in-person in the post-test and follow up is not significantly different. The following themes emerged out of the qualitative data analysis in Study 2: expectation, telepractice-participant suitability and advantages of telepractice, technology, therapy techniques and clinician skills, therapeutic components, satisfaction, and preference.

Conclusion: The triangulation of quantitative and qualitative findings indicated that these data sets were compatible in general. The results show that telepractice is equally effective as the in-person method as a service delivery method for adults who stutter.

PMID: 33011586 PMCID: PMC7521915 DOI: 10.1016/j.jfludis.2020.105793




The Case of a Patient with Pantothenate Kinase-Associated Neurodegeneration Presenting with a Prolonged History of Stuttering Speech and a Misdiagnosis of Parkinson's Disease - OUTRAS ÁREAS

J Mov Disord. 2020 Sep 21. Online ahead of print.

Free article: https://www.e-jmd.org/upload/jmd-20062.pdf


Prashant A Natteru, Juebin Huang

University of Mississippi Medical Center, Jackson, MS, USA.


No abstract available

PMID: 32942839 DOI: 10.14802/jmd.20062




The perceived impact of fluency on personalities of adults who stutter: implicit evidence of self-stigma - EMOCIONAL

Logoped Phoniatr Vocol. 2020 Oct 27;1-6. Online ahead of print.


Tricia Hedinger, Kristen Eskridge, Ellie Porter, Daniel Hudock, Tim Saltuklaroglu

University of Tennessee Health Sciences Center, Knoxville, TN, USA, Idaho State University, Pocatello, ID, USA.


Purpose: The NEO-FFI is an extensively used instrument that has been used to identify personality differences between those who stutter and matched controls or group norms. The goal of this study was to use the NEO-FFI to implicitly capture and quantify self-stigma related to personality in persons who stutter (PWS).

Methods: Thirty PWS completed the NEO-FFI twice; once as themselves and once while mentalizing (using theory of mind) to respond as though they did not stutter and had never stuttered, thus comparing their true personality to their perceived personality if they were fluent speakers. Compared to their true personalities, PWS perceived their fluent counterparts to be significantly less neurotic and more extroverted.

Results: The differences observed are somewhat analogous, though considerably larger in magnitude than personality differences that have previously been reported when comparing PWS to fluent controls or norms. Differences were interpreted to be due to "contrast effects" influencing the comparison. That is, PWS cognitively separated themselves from their fluent counterparts, seeing their true selves in a negative light compared to their fluent counterparts. This "us" vs. "them" separation is considered evidence of self-stigma related to personality in PWS.

Conclusions: The finding that the perceived differences were in the domains of Neuroticism and Extraversion is consistent with prevailing stereotypes about PWS and exemplifies how public stigma can become internalized. Clinical implications are discussed with respect to how similar theory of mind/social comparison exercises can be used in cognitive behavioral therapy to help identify and restructure negative thoughts and beliefs about stuttering.

PMID: 33106060 DOI: 10.1080/14015439.2020.1833982




The Relationship Between Speech Characteristics and Motor Subtypes of Parkinson's Disease - OUTRAS ÁREAS

Am J Speech Lang Pathol. 2020 Sep 30;1-10.


Katherine A Brown, Kristie A Spencer

University of Washington, Seattle.


Purpose The aim of this study was to examine whether acoustic dysarthria characteristics align with overall motor profile in individuals with Parkinson's disease (PD). Potential speech differences between tremor-dominant and non-tremor-dominant subtypes are theoretically motivated but empirically inconclusive. Method Twenty-seven individuals with dysarthria from PD provided a contextual speech sample. Participants were grouped into non-tremor-dominant (n = 12) and tremor-dominant (n = 15) motor subtypes according to the Unified Parkinson Disease Rating Scale. Dependent speech variables included fundamental frequency range, average pause duration, cepstral peak prominence, stuttering dysfluencies, and maze dysfluencies. Results There were no significant differences between the speech of the tremor-dominant and non-tremor-dominant groups. High within-group variability existed across parameters and motor subtypes.

Conclusion Speech characteristics across the areas of phonation, prosody, and fluency did not differ appreciably between PD motor subtypes.

PMID: 32997516 DOI: 10.1044/2020_AJSLP-20-00058




The Utility of Cinematherapy for Stuttering Intervention: An Exploratory Study - TERAPIA

Semin Speech Lang. 2020 Nov;41(5):400-413. Epub 2020 Sep 21


Michael Azios, Farzan Irani, Monica Bellon-Harn, Eric Swartz, Cristiana Benson

Lamar University, Beaumont, Texas; Texas State University, Round Rock, Texas; Texas A&M University Kingsville, Kingsville, Texas.


This preliminary study explored the feasibility and benefits of using cinematherapy with adults who stutter to address affective and cognitive reactions to stuttering and their impact on the persons' life. A mixed methods research design was used to explore the impact of cinematherapy. Four clients completed a 4-week structured cinematherapy program. All clients completed two questionnaires: Unhelpful Thoughts and Beliefs about Stuttering and Overall Experience of the Speaker's Experience of Stuttering, before starting and after completing the program. At the end of the program, clients also completed a semistructured interview. The semistructured interviews provide insight on clients' perceptions of cinematherapy, and questionnaires provided quantitative insights on the clients' perceptions of change. Qualitative data analysis indicated that clients reported five themes related to perceptions of cinematherapy: Promoted Vulnerability; Nurtured Empowerment; Stimulated Self-Reflection; Incited Feelings of Belonging; and Diminished Self-Stigma. Overall, clients reported a clinically significant decrease in scores on both questionnaires after completion of the 4-week cinematherapy program. Results indicate that cinematherapy was well received and had a positive impact on cognitive and affective aspects of stuttering in the four adult clients. These results provide preliminary support for larger scale clinical trials of cinematherapy as an adjuvant to traditional stuttering therapy.

PMID: 32957157 DOI: 10.1055/s-0040-1716705




Variability of Stuttering: Behavior and Impact - TERAPIA

Am J Speech Lang Pathol. 2020 Nov 16;1-14. Online ahead of print.


Seth E Tichenor, J Scott Yaruss

Michigan State University, East Lansing.


Purpose It has long been known that stuttering behaviors vary across time and situation. Preliminary evidence suggests that this variability negatively affects people who stutter and that stuttering behaviors are more variable than adverse impact associated with stuttering. More information is needed to determine how variability affects people who stutter and what the clinical and research implications of variability may be. Method Two hundred and four adults who stutter participated in a mixed-methods study exploring (a) how variability of stuttering affects people who stutter in comparison to other aspects of the condition and (b) which aspects of the overall experience of stuttering are variable.

Results Analyses indicated that variability is very commonly experienced by people who stutter and that it is among the most frustrating aspects of the condition. Qualitative analyses revealed that variability is experienced in all aspects of the stuttering condition, including the observable behavior other affective, behavioral, and cognitive reactions; and the adverse impact of stuttering. Notable individual differences were found in terms of which specific aspects of the condition were more variable for different respondents. Overall, analyses revealed that the variability of different aspects of stuttering can be viewed in a hierarchy from most variable to least variable: more external aspects (e.g., frequency, duration), more internal aspects (e.g., covert behaviors, physical tension), and cognitive-affective experiences (e.g., negative thoughts, feelings, and self-image).

Discussion These findings suggest that variability is a common and burdensome aspect of the experience of stuttering and underscore the importance of considering variability in stuttering behavior, reactions, and impact in research, assessment, and treatment for adults who stutter.

PMID: 33197323 DOI: 10.1044/2020_AJSLP-20-00112




Verbal Contingencies in the Lidcombe Program: A Noninferiority Trial - INFANTIL / TERAPIA

J Speech Lang Hear Res. 2020 Oct 16;63(10):3419-3431. Epub 2020 Sep 21.


Michelle Donaghy, Sue O'Brian, Mark Onslow, Robyn Lowe, Mark Jones, Ross G Menzies

Australian Catholic University, North Sydney, New South Wales, Australia; University of Technology Sydney, New South Wales, Australia; The University of Queensland, Herston, Australia.


Purpose The Lidcombe Program is an efficacious and effective intervention for early stuttering. The treatment is based on parent verbal response contingent stimulation procedures, which are assumed to be responsible for treatment effect. The present trial tested this assumption.

Method The design was a parallel, open plan, noninferiority randomized controlled trial. In the experimental arm, the five Lidcombe Program verbal contingencies were removed from parent instruction. The primary outcome was beyond-clinic percentage syllables stuttered at 18-month follow-up. Seventy-four children and their parents were randomized to one of the two treatment arms.

Results Findings of noninferiority were inconclusive for the primary outcome of stuttering severity, based on a margin of 1.0 percentage syllables stuttered.

Conclusions The inconclusive finding of noninferiority means it is possible that verbal contingencies make some contribution to the Lidcombe Program treatment effect. However, considering all primary and secondary outcomes, an overriding impression from the trial is a similarity of outcomes between the control and experimental arms. The clinical applications of the trial are discussed, along with further research that is needed.

PMID: 32956008 DOI: 10.1044/2020_JSLHR-20-00155




Visual exogenous and endogenous attention and visual memory in preschool children who stutter - ATENÇÃO

J Fluency Disord. 2020 Sep 25;66:105792.


Stacy A Wagovich, Julie D Anderson, Margaret S Hill 

University of Missouri, United States, Indiana University, United States.


Purpose: Attention develops gradually from infancy to the preschool years and beyond. Exogenous attention, consisting of automatic responses to salient stimuli, develops in infancy, whereas endogenous attention, or voluntary attention, begins to develop later, in the preschool years. The purpose of this study was to examine (a) exogenous and endogenous attention in young children who stutter (CWS) and children who do not stutter (CWNS) through two conditions of a visual sustained selective attention task, and (b) visual short-term memory (STM) between groups within the context of this task.

Method: 42 CWS and 42 CWNS, ages 3;0-5;5 (years;months), were pair-matched in age, gender (31 males, 11 females per group), and socioeconomic status. Children completed a visual tracking task (Track-It Task; Fisher et al., 2013) requiring sustained selective attention and engaging exogenous and endogenous processes. Following each item, children were asked to recall the item they had tracked, as a memory check.

Results: The CWS group demonstrated significantly less accuracy in overall tracking and visual memory for the tracked stimuli, compared to the CWNS group. Across groups, the children performed better in sustained selective attention when the target stimuli were more salient (the condition tapping both exogenous and endogenous attention) than when stimuli were less so (the condition tapping primarily endogenous processes).

Conclusions: Relative to peers, preschool-age CWS, as a group, display weaknesses in visual sustained selective attention and visual STM.

PMID: 33032169 DOI: 10.1016/j.jfludis.2020.105792




What works for whom? Multidimensional individualized stuttering therapy (MIST) - TERAPIA

J Commun Disord. 2020 Oct 4;88:106052 Online ahead of print.


Hilda Sønsterud, Margrethe Seeger Halvorsen, Kristin Billaud Feragen, Melanie Kirmess, David Ward

University of Oslo, Norway; Oslo University Hospital, Centre for Rare Disorders, Oslo, Norway; University of Reading, Department of Speech Research Laboratory, United Kingdom.


Purpose: This study reports outcomes from a stuttering therapy approach that combines value and awareness-based elements from Acceptance and Commitment Therapy (ACT) with those of stuttering and speech modification interventions. The approach, entitled Multidimensional Individualized Stuttering Therapy (MIST), includes a combined clinician and client selection of factors across five areas: 1) general breathing patterns and body tension, 2) breathing patterns during speech production, 3) vocal features in speech production, 4) value and mindfulness-based strategies, and 5) general communication and/or presentation skills. The aims of this study were to evaluate whether the MIST a) reduces the impact of stuttering and stuttering severity, and b) has a positive impact on speaking ability, confidence in communication, avoidance-behavior, and quality of life.

Method: Eighteen adults, age 21-61 years took part in an A-B-A multiple case study design. Participants underwent a pre-clinic assessment phase, followed by 10 h of therapy over four sessions administered by an experienced speech-language therapist. Outcome measures examined both psychosocial and behavioral aspects of therapy three-, six- and twelve-months post-therapy.

Results: Most participants chose elements from at least four of the five areas of focus. There was a significant reduction in the impact of stuttering at both 6- and 12-months post-therapy, with moderate (d = .71) to very large (d = 1.06) effect sizes. A strong association was found between overall satisfaction with MIST and improved speaking abilities. Moderate to strong associations were also found between experienced speaking abilities, confidence in communication, reduction in avoidance behaviors and improved quality of life.

Discussion: Findings indicate that MIST can be effective in managing adult stuttering. The findings highlight the importance of shared decision making and personal considerations using flexible therapy approaches that integrate stuttering and speech modification interventions with value and awareness-based skills. The nature of a multidimensional individualized approach, as shown in this study, highlights the importance of adjusting the relative weighting of different subcomponents according to each individual's needs and goals.

Conclusion: MIST was shown to be efficacious in clinical settings and effective in real life settings. Findings were promising, despite a relatively small sample, and replication by other SLPs and with larger samples is warranted.

PMID: 33080388 DOI: 10.1016/j.jcomdis.2020.106052






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