Eliana Maria Nigro Rocha


Abstract  - Janeiro a Julho de 2021


A Case of Acute Stuttering Resulting after a Sports-related Concussion - GAGUEIRA ADQUIRIDA

Curr Sports Med Rep. 2021 Jan 1;20(1):10-12


James Toldi , Jared Jones

Johns Hopkins All Children's Hospital, St. Petersburg, FL; University of South Alabama, Mobile, AL.


No abstract available




A Case Report of Clozapine-Associated Stuttering and Amisulpride-Associated Stuttering and Seizure in an Adult on Concurrent Fluoxetine Therapy

J Clin Psychopharmacol. 2021 Mar 5. Online ahead of print.


Rahul Mathur , Jawahar Singh, Mamta Sood

All India Institute of Medical Sciences (AIIMS) New Delhi, India.


No abstract available.

PMID: 33675589 DOI: 10.1097/JCP.0000000000001376




A comparison of the performance of Persian speaking children who do and do not stutter on three nonwords repetition tasks - INFANTIL / FALA

J Fluency Disord. 2021 Jan 5;67:105825. Online ahead of print.


Farhad Sakhai, Akbar Darouie, Julie D Anderson, Mahdi Dastjerdi-Kazemi, Golnoosh Golmohammadi, Enayatollah Bakhshi

University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Indiana University, United States; Allameh Tabataba'i University, Tehran, Iran.


Purpose: The purpose of the study was to examine the performance of Persian speaking children who stutter (CWS) and children who do not stutter (CWNS) on three nonword repetition tasks, while also focusing on which task and scoring method best differentiates the two groups of children.

Method: Thirty CWS and 30 CWNS between the ages of 5;0 to 6;6 completed three nonword repetition tasks that varied in complexity. Each task was scored using two methods: nonwords correct and phonemes correct. Between-group differences in performance on each task were examined, along with disfluencies for CWS and the task and scoring method that best differentiated the CWS and CWNS.

Results: The findings revealed that, across all three nonword repetition tasks, the CWS consistently produced fewer nonwords correct and phonemes correct than the CWNS group at virtually all syllable lengths. The CWS produced more disfluencies on longer nonwords than shorter nonwords in all three nonword repetition tasks. The nonword repetition task with lower wordlikeness and more phonologically complex items best differentiated the two groups of children. Findings further revealed that discriminative accuracy was highest for scoring based on the number of phonemes produced correctly.

Conclusion: Findings provide further evidence to suggest that CWS may have difficulty with phonological working memory and/or phonological processing.

PMID: 33395124 DOI: 10.1249/JSR.0000000000000795




A Framework for a Sociological Description of the Communicative Interaction in Adults Who Stutter - SOCIAL

Am J Speech Lang Pathol. 2021 Jun 17;1-13. Online ahead of print.


James M Mancinelli

La Salle University, Philadelphia, PA.


Purpose The author presents a descriptive sociological framework for the communicative interaction between an adult who stutters (AWS) and other communication partners. The author shows that the communicative interaction between an AWS and another interactant is a sociological object that can be evaluated by both parties in real-time, and is impacted by settings, participants, identity, stigmatization, and the type of talk. These elements are consistent with Hymes' SPEAKING model, which was developed to describe speech communication in a social context and can lay the foundation for the development of an ethnography of stuttering. The clinical applications and implications of a sociological framework are discussed and future directions for research are suggested.

Method This work is a refinement and enhancement of Mancinelli (2018) and Mancinelli (2019) and the research associated with that work. This is a tutorial with a clinical focus designed to introduce the readership to a sociological perspective on communicative interactions in AWS.

Conclusions Stuttering is an emergent phenomenon embedded within a social interaction, necessitating a deeper understanding of the processes at work during those interactions. A sociological framework can provide a more comprehensive description of the communicative interactions as well as the sociocommunicative lives of people who stutter. The information obtained can inform the formulation of realistic, functional goals based on the daily life of the client. Implications for the development of an ethnography of stuttering are discussed

PMID: 34138670 DOI: 10.1044/2021_AJSLP-20-00279




A new family with spastic paraplegia type 51 and novel mutations in AP4E1 - GENÉTICA

BMC Med Genomics. 2021 May 18;14(1):131


Izabela Winkler, Paweł Miotła, Monika Lejman, Aleksandra Pietrzyk, Magdalena Kacprzak, Marcin Kubiak, Agnieszka Sobczyńska-Tomaszewska, Maciej Skrzypczak, Ilona Jaszczuk

Lublin Oncology Centre, Lublin, Poland; Lublin Medical University, Lublin, Poland; Medical University, Lublin, Poland; MedGen Medical Centre, Warsaw, Poland; St. Johns Centre Oncology, Lublin, Poland.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130362/pdf/12920_2021_Article_980.pdf


Background: Autosomal recessive mutations in the AP-4 (adaptor protein complex 4) complex subunit ϵ - 1 (AP-4E1) gene on chromosome 15q21.2 are known to cause spastic paraplegia 51 (SPG51). The exact phenotype of SPG51 remains poorly characterized, because only a few families have been reported as carriers of the mutation. In addition, a previous study identified an autosomal dominant mutation in the AP4E1 gene as being associated with persistent stuttering. The aim of the current study was to characterize the phenotype of a paediatric patient with an identified novel AP4E1 mutation presenting with significant psychomotor retardation, intellectual disability and paraplegia.

Methods: Magnetic resonance imaging was used to identify hypoplasia of the corpus callosum. The DNA sample was tested using multiplex ligation-dependent probe amplification (MLPA) and array comparative genomic hybridization (aCGH). In addition, next-generation sequencing (NGS) was performed using the patient's DNA, and Sanger sequencing was performed using that of his family members.

Results: The phenotype was identified to be associated with a novel pathogenic variant c.942_943 + 3delinsCC in the AP4E1 gene. The patient manifested severely delayed psychomotor development, impaired global physical development and general illness. Movement disorders were evident during the neonatal period.

Conclusions: The present study identifies a previously unknown disease-inducing AP4E1 gene mutation.

PMID: 34006278 PMCID: PMC8130362 DOI: 10.1186/s12920-021-00980-5




A Preliminary Comparison of In-Person and Telepractice Evaluations of Stuttering - AVALIAÇÃO

Am J Speech Lang Pathol. 2021 May 31;1-13. Online ahead of print.


Megann McGill, Jordan Siegel, Natasha Noureal

Portland State University, OR.


Purpose The purpose of this study was to compare in-person and telepractice evaluations of stuttering with adult participants. The research questions were as follows: Is an evaluation for stuttering via telepractice equivalent to an in-person evaluation in terms of (a) duration of individual evaluation tasks and overall length of the evaluation, (b) clinical outcomes across evaluating clinicians, and (c) participant experience?

Method Participants were 14 adults who stutter (males = 11; age range: 20-68) who were simultaneously assessed via telepractice and in-person. Comprehensive evaluations included analysis of the speaker's stuttering, evaluation of the speaker's perceptions and attitudes about stuttering, and language testing. Evaluations were administered by either an in-person clinician or a telepractice clinician but were simultaneously scored by both clinicians. Participants were randomly assigned to the in-person-led assessment condition or the telepractice-led assessment condition.

Results No statistically significant differences were found between the in-person and telepractice-led evaluations in terms of overall evaluation task duration, evaluation clinical outcomes, or participants' reported experiences. That is, telepractice evaluations for stuttering in adults may be an equivalent option to in-person evaluations.

Conclusions Results of this preliminary study indicate that telepractice evaluations of stuttering may be comparable to in-person evaluations in terms of duration, clinical outcomes, and participant experiences. The current study supports the notion that telepractice evaluations may be a viable option for adult clients who stutter. Clinical considerations and future directions for research are discussed.

PMID: 34057858 DOI: 10.1044/2021_AJSLP-19-00215




A Preliminary Investigation of Attention-Deficit/Hyperactivity Disorder Characteristics in Adults Who Stutter - ATENÇÃO

J Speech Lang Hear Res. 2021 Mar 1;1-15. Online ahead of print.


Seth E Tichenor, Chelsea A Johnson, J Scott Yaruss

Michigan State University, East Lansing.


Purpose Recent studies have shown that many children who stutter may have elevated characteristics of attention-deficit/hyperactivity disorder (ADHD). Although childhood ADHD commonly persists into adulthood, it is unclear how many adults who stutter experience aspects of ADHD (e.g., inattention or hyperactivity /impulsivity). This study sought to increase understanding of how ADHD characteristics might affect individuals who stutter by evaluating (a) whether elevated ADHD characteristics are common in adults who stutter, (b) whether elevated ADHD characteristics in adults who stutter were significantly associated with greater adverse impact related to stuttering, and (c) whether individual differences in Repetitive Negative Thinking (RNT) and Effortful Control influenced this relationship.
Method Two hundred fifty-four adults who stutter completed the Adult ADHD Self-Report Scale, the Perseverative Thinking Questionnaire, the Adult Temperament Questionnaire short form, and the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed via multiple linear regression to determine whether the number of inattention or hyperactivity/impulsivity characteristics was significantly associated with RNT, Effortful Control, or Adverse Impact related to stuttering.
Results Almost one quarter of participants (23.2%; 60/254) self-reported experiencing six or more inattention characteristics, while fewer participants (8.3%; 21/254) self-reported experiencing six or more hyperactivity/impulsivity characteristics. Participants with lower Effortful Control and higher levels of both RNT and Adverse Impact were significantly more likely to self-report experiencing more inattention characteristics.

Discussion Many adults who stutter may exhibit previously unaccounted for characteristics of ADHD, especially inattention. Results highlight the value of continued research on the intersectionality of stuttering, ADHD, and attention, and the importance of individualizing therapy to the needs of each unique person who stutters.

PMID: 33647218 DOI: 10.1044/2020_JSLHR-20-00237




A Questionnaire Survey About Support Requests From School-Age Children and Adolescents Who Stutter - AMBIENTE

Lang Speech Hear Serv Sch. 2021 Jan 26;1-11. Online ahead of print.


Daichi Iimura, Osamu Ishida, Saburo Takahashi, Hideaki Yokoi, Shoko Miyamoto

Kawasaki University of Medical Welfare, Okayama, Japan; University of Tsukuba, Ibaraki, Japan; Saitama Municipal Nakamoto Elementary School, Saitama, Japan; Dai-nana Elementary School, Tokyo, Japan; Japan Stuttering Genyukai Association, Tokyo, Japan; Narumi Stuttering Consultation Room, Aichi, Japan.


Purpose Children who stutter (CWS) face communication difficulties in school activities and at home. Although the importance of receiving support from their surroundings has been documented, few studies have investigated potential requests of CWS from their surroundings. This study aimed to elucidate such requests.
Method A total of 43 school-age children and 25 adolescents who stutter completed a free-description questionnaire, including questions such as "what you want your classmates/your classroom teacher/your family to do about your stuttering?" Their descriptions were summarized and categorized based on similarity. Results The results indicate that 90.6% of the participants had more than one request for their classmates, classroom teacher, or family. A total of 197 items were extracted and categorized into seven themes. In particular, the responses included "listen attentively," "treat us naturally," and "make arrangements." While participants tended to hope for classmates or family to "listen attentively" and "treat us naturally," the request to "make arrangements" was higher for their teacher. Their potential requests varied by age: While school-age CWS wanted people around them to "listen carefully," the hope of adolescents who stutter was "treat us naturally."
Conclusions The various potential requests of CWS were categorized, and the responses shed light on the importance of increasing knowledge of stuttering. The difference between the requests could reflect psychosocial differences between school-age children and adolescents who stutter. In addition, social interaction among peers is more developed in adolescents, and they could harbor fear of being excluded within their community.

PMID: 33497578 DOI: 10.1044/2020_LSHSS-20-00069




A systematic review on the role of language-related factors in the manifestation of stuttering in bilinguals - LINGUAGEM

Review J Fluency Disord. 2021 Jan 23;68:105829 Online ahead of print.


Chanchal Chaudhary, Santosh Maruthy, Vasudeva Guddattu, Gopee Krishnan

Manipal Academy of Higher Education, Manipal, Karnataka, India; All India Institute of Speech and Hearing, Manasgangothri, Mysore, India.


Purpose: Bilingual(s) who stutter (BWS) provide an opportunity to explore the link between stuttering and language. Unlike in monolinguals, stuttering in bilinguals could be influenced by both speaker-related language (e.gs. dominance & proficiency) and linguistic typology-related factors (e.g., structure of languages). However, the available literature is largely inconclusive on these factors. In this context, we systematically reviewed the literature to compile evidence on the influence of such factors on BWS.

Method: We followed the conventional systematic review process that included five databases. Further, the quality of the included articles was assessed using Newcastle-Ottawa Scale (NOS) for quality rating.

Result: Thirteen articles passed the selection criteria. Review of these articles revealed that language proficiency and dominance are the important factors that affect stuttering frequency in BWS. Though the linguistic typology is portrayed as a factor on the differential manifestation of dysfluencies in both languages of the BWS, the literature does not provide substantiating data for this. Further, the lack of uniformity in assessing and reporting language dominance and proficiency are the major drawbacks in the existing literature on stuttering in BWS.

Conclusion: This review identifies proficiency and dominance as the major factors that influence the stuttering frequency in BWS. Currently, the evidence for the influence of typological differences between languages of the BWS on stuttering largely remains whimsical. Future research shall employ the recommended tasks and metrics while assessing the dysfluencies in BWS so that findings across centres become comparable, which in turn, could yield valid inferences.

PMID: 33556665




Acquired stuttering after pediatric concussion - GAGUEIRA ADQUIRIDA

Acta Neurol Belg. 2021 Mar 20. Online ahead of print.


Sean C Rose, David L Weldy, Svitlana Zhukivska, Thomas L Pommering

Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA; University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.


No abstract available

PMID: 33743164 DOI: 10.1007/s13760-021-01653-x




An experiment on measuring awareness of stuttering in individuals with Down syndrome - AVALIAÇÃO

J Fluency Disord. 2021 Apr 8;68:105849. Online ahead of print.


Babette Maessen, Inge Zink, Bea Maes, Ellen Rombouts

Experimental Otorinolaryngology, KU Leuven, Belgium; Parenting and Special Education Research Group, KU Leuven, Belgium.


Background: Awareness of stuttering is likely to depend upon the development of the metalinguistic skill to discriminate between fluent speech and stuttering and the ability to identify one's own speech as fluent or stuttered. Presently, little is known about these abilities in individuals with Down syndrome (DS).

Purpose: This study investigates whether individuals with DS and typically developing (TD) children who stutter and who do not stutter differ in their ability to discriminate between fluent speech and stuttering. The second purpose of this study is to discover if this ability is correlated with their self-identification ability.

Method: An experiment to investigate awareness with tasks for discrimination of stuttering and self-identification was developed. It was administered to 28 individuals (7-19 years) with DS, 17 of them stutter and 11 do not, and 20 TD children (3-10 years), 8 of them stutter and 12 do not. Skills to discriminate stuttering were compared between these groups and correlated with self-identification within these groups. The influence of stuttering severity and developmental/chronological age on their ability to discriminate was also investigated.

Results: The ability to discriminate does not differ significantly between the DS and TD group, but is highly influenced by developmental age. This ability correlates with self-identification but only for the TD individuals who speak fluently.

Conclusion: The ability to discriminate matures around the age of 7 and conscious awareness may rely on this ability. Differences between the present findings and earlier studies suggest that differentiation in levels and types of awareness is warranted.

PMID: 33862424 DOI: 10.1016/j.jfludis.2021.105849




Association Between Gray Matter Volume Variations and Energy Utilization in the Brain: Implications for Developmental Stuttering - INFANTIL / CONCEITO

J Speech Lang Hear Res. 2021 Mar 9;1-8. Online ahead of print.


Nathaniel Boley, Sanath Patil, Emily O Garnett, Hua Li, Diane C Chugani 5, Soo-Eun Chang, Ho Ming Chow

The George Washington University, Washington, DC; Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; Eberly College of Science, The Pennsylvania State University, University Park; University of Michigan Medical School, Ann Arbor; University of Delaware, Newark; Michigan State University, East Lansing.


Purpose The biological mechanisms underlying developmental stuttering remain unclear. In a previous investigation, we showed that there is significant spatial correspondence between regional gray matter structural anomalies and the expression of genes linked to energy metabolism. In the current study, we sought to further examine the relationship between structural anomalies in the brain in children with persistent stuttering and brain regional energy metabolism.
Method High-resolution structural MRI scans were acquired from 26 persistent stuttering and 44 typically developing children. Voxel-based morphometry was used to quantify the between-group gray matter volume (GMV) differences across the whole brain. Group differences in GMV were then compared with published values for the pattern of glucose metabolism measured via F18 fluorodeoxyglucose uptake in the brains of 29 healthy volunteers using positron emission tomography.

Results A significant positive correlation between GMV differences and F18 fluorodeoxyglucose uptake was found in the left hemisphere (ρ = .36, p < .01), where speech-motor and language processing are typically localized. No such correlation was observed in the right hemisphere (ρ = .05, p = .70).

Conclusions Corroborating our previous gene expression studies, the results of the current study suggest a potential connection between energy metabolism and stuttering. Brain regions with high energy utilization may be particularly vulnerable to anatomical changes associated with stuttering. Such changes may be further exacerbated when there are sharp increases in brain energy utilization, which coincides with the developmental period of rapid speech/language acquisition and the onset of stuttering during childhood.
PMID: 33719533 DOI: 10.1044/2020_JSLHR-20-00325



Australian attitudes towards stuttering: A cross-sectional study - SOCIAL

J Fluency Disord. 2021 Jul 22;69:105865. Online ahead of print.


Meryl K R Lefort, Shane Erickson, Susan Block, Brenda Carey, Kenneth O St Louis

La Trobe University, Bundoora, Australia; West Virginia University, Morgantown, WV, USA.


Background: Negative reactions experienced by people who stutter often stem from unfounded attitudes and beliefs in the community.

Purpose: There is a need to better understand current public attitudes towards stuttering in Australia. The purpose of this study was to: (a) explore the attitudes and knowledge of a large sample of the Australian public using the Public Opinion Survey of Human Attitudes-Stuttering [POSHA-S], (b) identify how the reported attitudes towards, and knowledge of, stuttering compare to existing data, and (c) identify differences between groups for variables identified.

Methods: A cross-sectional population study using the POSHA-S was conducted in Melbourne, Australia. Comparisons of the attitudes towards stuttering of this sample were made with data from other worldwide samples on the POSHA-S database. The influence on attitudes to stuttering of variables including age, gender, education level, country of birth, employment status and number of languages spoken was explored.

Results: The Overall Stuttering Score (OSS) of the Australian sample was higher than the median score on the POSHA-S database. This suggests that the Australian public holds more positive attitudes than those other countries represented in the database. Being younger, more educated, employed, female, monolingual, born in Australia and not familiar with people who stutter were related to more positive attitudes for this sample. Some negative stereotypes towards stuttering were noted; people who stutter were identified as 'shy and fearful', and 'nervous and excitable'.

Conclusions: While the Australian public has generally positive attitudes towards stuttering, these attitudes still reflect some 'stuttering stereotypes'.

PMID: 34380103 DOI: 10.1016/j.jfludis.2021.105865




Basal ganglia: Bursting with song - OUTRAS ÁREAS

Curr Biol. 2021 Jun 21;31(12):R791-R793.


Melissa J Coleman, Stephanie A White

Scripps and Pitzer Colleges, Claremont, CA, USA; University of California Los Angeles, Los Angeles, CA, USA.


The songs of mature zebra finches are notoriously repetitious, or 'crystallized'. Despite this stability, new work reveals that chronic pharmacologically driven bursting of cortical inputs to the basal ganglia can drive cumulative and lasting changes to multiple vocal features, including phenomena reminiscent of human stuttering.
PMID: 34157263 DOI: 10.1016/j.cub.2021.04.064




Behavioral and neural correlates of speech motor sequence learning in stuttering and neurotypical speakers: an fMRI investigation - FALA

Neurobiol Lang (Camb). 2021 Feb;2(1):106-137

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294667/pdf/nihms-1717602.pdf


Matthew Masapollo, Jennifer A Segawa, Deryk S Beal, Jason A Tourville, Alfonso Nieto-Castañón, Matthias Heyne, Saul A Frankford, Frank H Guenther

Boston University, Boston, MA; University of Florida, Gainesville, FL; Stonehill College, Easton, MA; University of Toronto, Toronto, Canada; Massachusetts Institute of Technology, Cambridge, MA.


Stuttering is a neurodevelopmental disorder characterized by impaired production of coordinated articulatory movements needed for fluent speech. It is currently unknown whether these abnormal production characteristics reflect disruptions to brain mechanisms underlying the acquisition and/or execution of speech motor sequences. To dissociate learning and control processes, we used a motor sequence learning paradigm to examine the behavioral and neural correlates of learning to produce novel phoneme sequences in adults who stutter (AWS) and neurotypical controls. Participants intensively practiced producing pseudowords containing non-native consonant clusters (e.g., "gvasf") over two days. The behavioral results indicated that although the two experimental groups showed comparable learning trajectories, AWS performed significantly worse on the task prior to and after speech motor practice. Using functional magnetic resonance imaging (fMRI), the authors compared brain activity during articulation of the practiced words and a set of novel pseudowords (matched in phonetic complexity). FMRI analyses revealed no differences between AWS and controls in cortical or subcortical regions; both groups showed comparable increases in activation in left-lateralized brain areas implicated in phonological working memory and speech motor planning during production of the novel sequences compared to the practiced sequences. Moreover, activation in left-lateralized basal ganglia sites was negatively correlated with in-scanner mean disfluency in AWS. Collectively, these findings demonstrate that AWS exhibit no deficit in constructing new speech motor sequences but do show impaired execution of these sequences before and after they have been acquired and consolidated.

PMID: 34296194 PMCID: PMC8294667 DOI: 10.1162/nol_a_00027




Cannabis Improves Stuttering: Case Report and Interview with the Patient - FARMACOLOGIA

Cannabis Cannabinoid Res. 2021 Jul 26. Online ahead of print.


Natalia Szejko, Carolin Fremer, Franziska Baacke, Martin Ptok, Kirsten R Müller-Vahl

Medical University of Warsaw, Warsaw, Poland; Hannover Medical School, Hannover, Germany.


Introduction: Speech dysfluency, often referred to as stuttering, is a frequent speech disorder encountered in about 5% of children. Although in the majority of people affected, symptoms improve in adulthood, in some patients, stuttering persists and significantly impairs everyday functioning and quality of life. Treatment for stuttering includes speech therapy, cognitive behavioral therapy, and relaxation techniques. However, a substantial number of patients do not benefit sufficiently from these treatment strategies or are even treatment resistant.

Methods: We present the case of a 20-year-old male with treatment-resistant stuttering, who markedly improved after treatment with medicinal cannabis.

Results: Besides improved speech fluency as assessed by several phoniatric tests, we observed remission of (social) anxiety, improved mood, and reduced stress, resulting in an overall improvement of quality of life after cannabis therapy. The patient, in addition, reported improved attention, concentration, and sleep, increased self-confidence, and better social life. No side effects occurred. Over a time period of more than a year, treatment was equally effective. In an interview, the patient describes his personal view and the influence of cannabis-based treatment on his life.

Conclusions: Medicinal cannabis could be effective in treatment of refractory stuttering, but these preliminary data have to be confirmed in controlled studies.

PMID: 34314602 DOI: 10.1089/can.2021.0060




Can Low Dose Sertraline Cause Serotonin Syndrome in Pediatric Patients? 2 Case Reports - FARMACOLOGIA

CNS Spectr. 2021 Apr;26(2):155


Sultana Jahan

University of Missouri, Department of Psychiatry, Columbia, MO, USA.


Background: Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. Serotonin syndrome is underreported complication of pharmacotherapy. The Hunter Criteria for serotonin syndrome (SS) are fulfilled if the patient has taken a serotonergic agent and has one of the following symptoms: 1) spontaneous clonus, 2) inducible clonus and agitation or diaphoresis, 3) ocular clonus and agitation or diaphoresis, 4) tremor and hyperreflexia, 5) hypertonia, or 6) temperature above 38 C and ocular clonus or inducible clonus.

Method: Patient A was a 16-year-old Caucasian male with history of major depressive disorder, social anxiety and OCD who presented to the emergency room with multiple complaints: twitching of bilateral cheeks, intermittent tremor of his hands and feet, mental fogginess/confusion, stuttering when attempting to speak, agitation, profuse sweating and headache. 3 weeks prior, his sertraline dose was increased from 25mg daily to 50 mg daily. His physical exam was remarkable for elevated blood pressure and heart rate as well as hyperreflexia noted on patellar reflex testing. No significant abnormalities were noted on routine labs. He was told his symptoms were likely due to medication side effects. The patient was discharged with instructions to decrease his sertraline dose from 50 mg to 25 mg daily and follow up with his outpatient psychiatrist. 2 days later the patient was seen at the outpatient child psychiatry clinic and he was advised to taper off sertraline completely by taking 12.5mg daily for 3 days before cessation. After stopping the medication, the patient's symptoms resolved. Patient B was a 16-year-old female with generalized anxiety disorder and major depressive disorder who presented to the general pediatric clinic with progressively worsening hand tremors and body shaking since her Zoloft dose was increased from 25mg to 50mg daily. She also felt it was more difficult to hold objects. At the physical exam she had an elevated heart rate to 93 and elevated blood pressure to 182/75. Her deep tendon reflexes were 4+ bilaterally. Upon consultation with child psychiatry, the patient was recommended to taper off sertraline. After the discontinuation of sertraline, her symptoms resolved.

Result: These 2 patients developed mild to moderate symptoms of serotonin syndrome with low doses of sertraline. Symptoms resolved after the discontinuation of the SSRI.

Discussion: In the pediatric patient population, serotonin syndrome can develop even with lower doses of an SSRI. To avoid a missed diagnosis, clinicians should familiarize themselves with the Hunter Criteria for serotonin syndrome. It is also vital to educate parents and caregivers about the toxicities of SSRIs, including serotonin syndrome, so they may monitor treatment and take appropriate action if needed.

PMID: 34127119 DOI: 10.1017/S1092852920002473




Case Report: Deep Brain Stimulation to the Ventral Internal Capsule/Ventral Striatum Induces Repeated Transient Episodes of Voltage-Dependent Tourette-Like Behaviors - OUTRAS ÁREAS

Front Hum Neurosci. 2021 Jan 25;14:590379. eCollection 2020.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869408/pdf/fnhum-14-590379.pdf


Joan A Camprodon, Tina Chou, Abigail A Testo, Thilo Deckersbach, Jeremiah M Scharf, Darin D Dougherty

Harvard Medical School, Boston, MA, United States.


Deep Brain Stimulation (DBS) is an invasive device-based neuromodulation technique that allows the therapeutic direct stimulation of subcortical and deep cortical structures following the surgical placement of stimulating electrodes. DBS is approved by the U.S. Federal Drug Administration for the treatment of movement disorders and obsessive-compulsive disorder, while new indications, including Major Depressive Disorder (MDD), are in experimental development. We report the case of a patient with MDD who received DBS to the ventral internal capsule and ventral striatum bilaterally and presented with 2 weeks of voltage-dependent Tourette-like symptoms including brief transient episodes of abrupt-onset and progressively louder coprolalia and stuttered speech; tic-like motor behavior in his right arm and leg; rushes of anxiety, angry prosody, angry affect; and moderate amnesia without confusion. We describe the results of the inpatient neuropsychiatric workup leading to the diagnosis of iatrogenic voltage-dependent activation of cortico-subcortical circuits and discuss insights into the pathophysiology of Tourette as well as safety considerations raised by the case.

PMID: 33568978 PMCID: PMC7869408 DOI: 10.3389/fnhum.2020.590379




Clozapine-induced stuttering in the absence of known risk factors: a case report - FARMACOLOGIA

J Med Case Rep. 2021 Apr 17;15(1):174.

Free article:  https://jmedicalcasereports.biomedcentral.com/track/pdf/10.1186/s13256-021-02803-8.pdf


Florence Jaguga

Moi Teaching & Referral Hospital, Eldoret, Kenya.


Background: Stuttering is a rare side effect of clozapine. It has been shown to occur in the presence of one or more factors such as abnormal electrophysiological findings and seizures, extrapyramidal symptoms, brain pathology, and a family history of stuttering. Few case reports have documented the occurrence of clozapine-induced stuttering in the absence of these risk factors.

Case presentation: A 29-year-old African male on clozapine for treatment-resistant schizophrenia presented with stuttering at a dosage of 400 mg/day that resolved with dose reduction. Electroencephalogram findings were normal, and there was no clinical evidence of seizures. The patient had no prior history or family history of stuttering, had a normal neurological examination, and showed no signs of extrapyramidal symptoms.

Conclusion: Clinicians ought to be aware of stuttering as a side effect of clozapine, even in the absence of known risk factors. Further research should investigate the pathophysiology of clozapine-induced stuttering.

PMID: 33863375 PMCID: PMC8052697 DOI: 10.1186/s13256-021-02803-8




Cognitive control of action naming in adults who stutter - LINGUAGEM

J Fluency Disord. 2021 Feb 27;70:105841. Online ahead of print.


Nathan D Maxfield

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


Purpose: Based on previous evidence that cognitive control of lexical selection in object (noun) naming operates differently in adults who stutter (AWS) versus typically-fluent adults (TFA), the aim was to investigate cognitive control of lexical selection in action (verb) naming in AWS.

Method: 12 AWS and 12 TFA named line drawings depicting actions using verbs. Half of the pictures had high-agreement action names and the other half low-agreement action names. Naming accuracy and reaction times (RT), and event-related potentials (ERPs) time-locked to picture onset, were compared between groups.

Results: Naming RTs were slower for low- versus high-agreement trials, and the magnitude of this effect was larger in AWS versus TFA. Delta-plot analysis of naming RTs revealed that individual differences in selective inhibition were associated with the agreement effect on naming RTs in AWS but not TFA. Action naming elicited frontal-central N2 activity in both agreement conditions in TFA but not AWS. Additionally, a later, posterior P3b component was affected by agreement in TFA only. In AWS, low-agreement action naming elicited frontal P3a activation.

Conclusions: Results suggest that cognitive control of action name selection was qualitatively different between groups. In TFA, cognitive control of lexical selection in action naming involved nonselective inhibition, as well as more efficient working memory updating on high- versus low-agreement trials. In AWS, cognitive control of low-agreement action naming involved increased focal attention. Individual differences in selective inhibition may have moderated cognitive control of action naming in AWS.

PMID: 33667938 DOI: 10.1016/j.jfludis.2021.105841




Cognitive Flexibility and Effortful Control in School-Age Children With and Without Stuttering Disorders - INFANTIL / ATENÇÃO

J Speech Lang Hear Res. 2021 Feb 25;1-16. Online ahead of print.


Naomi Eichorn, Steven Pirutinsky

The University of Memphis, TN; Touro College School of Social Work, New York, NY.


Purpose This study compared attention control and flexibility in school-age children who stutter (CWS) and children who do not stutter (CWNS) based on their performance on a behavioral task and parent report. We used a classic attention-shifting paradigm that included manipulations of task goals and timing to test effects of varying demands for flexibility on switching accuracy and speed. We also examined associations between task performance, group, and relevant aspects of temperament.

Method Participants included 33 children (15 CWS, 18 CWNS) between 8 and 11 years of age. Children sorted stimuli that differed on two dimensions (color and shape) based on sorting rules that varied from block to block or trial to trial. Timing manipulations included intervals of 200-, 600-, or 1,200-ms durations for critical trial components. Temperament data were obtained via the Children's Behavior Questionnaire.

Results All children showed expected performance costs in response to block and trial manipulations; however, CWS were more affected by task conditions that increased demands for cognitive flexibility. Effects of interval durations also differed by group. Factor scores on the Children's Behavior Questionnaire indicated differences in effortful control between groups; however, this aspect of temperament did not mediate between-groups differences in switching performance.

Conclusions Findings suggest that stuttering continues to be associated with differences in attention control and flexibility beyond the preschool years. Further research is needed to clarify how these cognitive processes shape the development of stuttering throughout childhood.

PMID: 33630654 DOI: 10.1044/2020_JSLHR-20-00440




Comprehensive Review of Factors Influencing the Use of Telepractice in Stuttering Treatment - TERAPIA

Healthc Inform Res. 2021 Jan;27(1):57-66. Epub 2021 Jan 31.


Baran Bayati, Haleh Ayatollahi

Iran University of Medical Sciences, Tehran, Iran.


Objectives: Stuttering is a speech disorder characterized by the repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech. Telepractice allows speech services to be delivered to patients regardless of their location. This review investigated factors influencing the use of telepractice in stuttering treatment.

Methods: Articles related to the application of telepractice in stuttering were searched using the Scopus, Web of Science, PubMed, Cochrane, and ProQuest databases without consideration of any time limit. Initially, 79 articles were found and after application of the inclusion and exclusion criteria, 15 articles were selected for the review study. Data were analyzed by using the content analysis method and synthesized narratively.

Results: Factors influencing the use of telepractice in stuttering treatment were categorized into individual, technical, clinical, and economic factors. Providing access to healthcare services, maintaining personal privacy, and allowing flexibility in arranging appointments were among individual factors. In terms of the technical factors, technical problems and Internet speed were addressed. Clinical factors were divided into positive and negative outcomes, and economic factors were mainly related to time and cost savings.

Conclusions: Although patients may benefit from using telepractice, the widespread adoption of this technology can be hindered by some technical and non-technical factors. Because telepractice can be employed as a complementary method to treat stuttering, more attention should be paid to the required infrastructure and factors that may negatively impact the use of this technology.
PMID: 33611877 DOI: 10.4258/hir.2021.27.1.57




Contemporary issues with stuttering: The Fourth Croatia Stuttering Symposium - CONCEITO

J Fluency Disord. 2021 Mar 17;70:105844. Online ahead of print


Robyn Lowe, Suzana Jelčić Jakšić, Mark Onslow, Sue O'Brian, Martine Vanryckeghem, Sharon Millard, Elaine Kelman, Susan Block, Marie-Christine Franken, Sabine Van Eerdenbrugh, Ross Menzies, Rosalee Shenker, Courtney Byrd, Hans-Georg Bosshardt, Francesca Del Gado, Valerie Lim

University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia; Zagreb Children's Hospital, Pediatric Clinic, Croatia; University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia; University of Central Florida, School of Communication Sciences and Disorders, USA; The Michael Palin Centre for Stammering, London, UK; La Trobe University, Australia; Erasmus University Medical Center, Rotterdam, the Netherlands; Thomas More College of Applied Sciences, Antwerp, Belgium; Montreal Fluency Center, Montreal, Canada; The University of Texas at Austin, TX, USA; Ruhr-University Bochum, Germany; Sapienza University of Rome, Italy; Singapore Institute of Technology, Singapore.


Purpose: During the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering.

Methods: The authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form.

Results: Seven contemporary issues for our field emerged from the Symposium.

Conclusion: Effective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive-behavior therapy for clients with persistent stuttering. Questions were raised about our discipline standards for basic professional preparation programs for stuttering management.

PMID: 34049093 DOI: 10.1016/j.jfludis.2021.105844




Conversational speech of school-age children after syllable-timed speech treatment for stuttering - TERAPIA

Int J Speech Lang Pathol. 2021 Jul 8;1-11. Online ahead of print.


Lisa Brown , Linda Wilson, Ann Packman, Mark Halaki, Cheryl Andrews, Sue O'Brian, Mark Onslow, Ross G Menzies

Charles Sturt University, Australia; University of Technology Sydney, Australia; The University of Sydney, Australia; Private Practice.


Purpose: The purpose of this laboratory study was to investigate whether rhythmic speech was primarily responsible for stuttering reductions in four school-aged children after the instatement stage of the Westmead Program of syllable-timed speech (STS) intervention. The study was designed to inform further development of the program. Reduction in variability of vowel duration is a marker of STS, and it was predicted that this would be present in the children's conversational speech after Stage 1 of the program if they were using STS. To strengthen such a finding, it was also predicted that there would be no reduction in articulation rate, sentence complexity, and utterance length after treatment, as there is evidence that reductions in these can reduce stuttering. Perceptual judgments of speech quality after treatment were also made by independent listeners.
Method: Participants were four children, ages 8-11 years, who completed Stage 1 of an STS program and whose stuttering had reduced significantly. Pre-treatment (PRE) and post-treatment (POST) within-clinic audio-visual recordings of conversational speech were analysed for percentage of syllables stuttered, variability of vowel duration, articulation rate, and length and complexity of utterance. Four blinded listeners made perceptual judgments of speech quality in the POST recordings.

Result: Recordings of all children showed that variability of vowel duration clearly reduced from the PRE to POST speech samples. Importantly, articulation rate and language use were not compromised. Some possible indicators of rhythmicity were identified in one child in the perceptual study.

Conclusion: The findings suggest that STS was primarily responsible for the clinically significant reductions in stuttering after Stage 1 of the program. There is an urgent need for more evidence-based interventions for stuttering in this age group and further development of STS interventions is warranted.

PMID: 34238105 DOI: 10.1080/17549507.2021.1946152




Cultural difference in attitudes towards stuttering among British, Arab and Chinese students: Considering home and host cultures - SOCIAL

Int J Lang Commun Disord. 2021 Apr 5. Online ahead of print.


Meryem S Üstün-Yavuz, Meesha Warmington, Hope Gerlach, Kenneth O St Louis

University of Sheffield, Sheffield, UK; Western Michigan University, Kalamazoo, MI, USA; West Virginia University, Morgantown, WV, USA.


Background: Geographical and cultural differences have been shown to affect public attitudes towards stuttering. However, increasingly for many individuals in the world one's birthplace culture (or home culture) and culture in their local geographical environment (or host culture) are not the same.

Aims: The effects of home culture and host culture in shaping the attitudes towards stuttering among students with British, Arab and Chinese home cultures attending one British university were explored. The effects of host culture were investigated by considering the time lived in the UK for Arab and Chinese students.

Methods & procedures: The study used a descriptive survey design that included a standardized self-delivered questionnaire: the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S). Purposive sampling was carried out thorough volunteer mailing lists, student societies and personal contact. The final sample of 156 university students included 51 British, 52 Arab and 53 Chinese students.

Outcomes & results: Overall stuttering score (OSS), which is indicative of attitudes towards stuttering, was highest for British participants (mean = 30) and lowest for Chinese participants (mean = 13), with Arab participants falling in the middle (mean = 21). The differences in attitudes between the three groups were statistically significant, suggesting that home culture is a contributor to attitudes towards stuttering. A post-hoc item analysis of the POSHA-S revealed numerous specific differences in attitudes towards stuttering between the three groups, including differences in the attribution of the aetiology of stuttering, their role in helping people who stutter (PWS) and sympathy toward PWS. Time lived in the UK-a proxy measure for the role of host culture-did not significantly influence the attitudes of Arab and Chinese respondents.

Conclusions & implications: To varying degrees, all three groups had evidence of stereotypical stuttering attitudes. Nevertheless, given similar ages and student status in the same university, observed respondent differences confirm previous research documenting geographical influences on stuttering attitudes in Western versus East Asian and Middle Eastern samples. The study also provides evidence that home culture was influential in shaping attitudes towards stuttering, but host culture was not a significant contributor. 

What this paper adds What is already known on the subject Public stereotypical beliefs towards stuttering are found across the world and hinder the quality of life among PWS. Different cultures have unique stereotypical beliefs towards PWS.
What this study adds to existing knowledge To the best of our knowledge, no other study has investigated specifically if individuals who live in the same geographical location but have different home cultures, have similar or differing attitudes towards PWS. Results provide preliminary evidence that the home culture of an individual was influential in shaping attitudes towards PWS, but host culture, measured as the length of time living in the current geographical location, did not have a significant relationship with attitudes towards stuttering.
What are the potential or actual clinical implications of this work This study highlights that culturally sensitive clinical practice should not be based on just the culture of the region but should take home culture into consideration as well, and clinicians should discuss cultural perceptions of stuttering with clients in clinical practice.

PMID: 33818900 DOI: 10.1111/1460-6984.12617




Deep brain stimulation fine-tuning in Parkinson's disease: Short pulse width effect on speech - OUTRAS ÁREAS

Parkinsonism Relat Disord. 2021 May 19;87:130-134. Online ahead of print.


Margherita Fabbri, Federico Natale, Carlo Alberto Artusi, Alberto Romagnolo, Marco Bozzali, Giovanni Giulietti, Isabel Guimaraes, Mario Giorgio Rizzone, Anna Accornero, Leonardo Lopiano, Maurizio Zibetti

University of Toulouse, Toulouse, France; University of Turin, Turin, Italy; University of Torino, Turin, Italy; AOU Città Della Salute e Della Scienza di Torino, Italy; University of Sussex, Brighton, East Sussex, United Kingdom; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Universidade de Lisboa, Portugal; Escola Superior de Saúde de Alcoitão, Estoril, Portugal.


Background: subthalamic nucleus deep brain stimulation (STN-DBS) may have a detrimental effect on speech in Parkinson's disease (PD) patients and new stimulation technologies may help in addressing this issue.

Objective: to evaluate the STN-DBS acute effect of 30 μs pulse width (30PW) versus conventional 60 μs PW (60PW) on speech and identify the core features of voice modified by 30PW.

Methods: seven STN-DBS treated PD patients participated into a pilot cross-sectional study. Motor and speech performances were tested by means of both automatic analysis and blinded clinical evaluations in four stimulation conditions: 30PW and 60PW both at the usual amplitude and at an amplitude just below the threshold for stimulation-related side effects.

Results: at the threshold amplitude, 30PW stimulation improved speech intelligibility for both words (p = 0.02) and sentences (p = 0.04), without worsening motor performance. A lower but not statistically significant voice variability and instability and percentage of stuttering disfluencies was also observed. The beneficial effect of 30PW detected by automatic analysis, was confirmed by patients' perception.

Conclusions: STN-DBS treated patients experiencing low speech intelligibility may benefit from a 30PW stimulation trial at a higher amplitude. Deep characterization of PD speech profiles may help in a better application of recent DBS hardware advances.

PMID: 34034153 DOI: 10.1016/j.parkreldis.2021.05.007




Deficit or Difference? Effects of Altered Auditory Feedback on Speech Fluency and Kinematic Variability in Adults Who Stutter - AUDITIVO

J Speech Lang Hear Res. 2021 Jun 21;1-18. Online ahead of print.


HeeCheong Chon, Eric S Jackson, Shelly Jo Kraft, Nicoline G Ambrose, Torrey M Loucks

Chosun University, Gwangju, South Korea; New York University, NY; Wayne State University, Detroit, MI; University of Illinois at Urbana-Champaign; University of Alberta, Edmonton, Canada.


Purpose The purpose of this study was to test whether adults who stutter (AWS) display a different range of sensitivity to delayed auditory feedback (DAF). Two experiments were conducted to assess the fluency of AWS under long-latency DAF and to test the effect of short-latency DAF on speech kinematic variability in AWS. Method In Experiment 1, 15 AWS performed a conversational speaking task under nonaltered auditory feedback and 250-ms DAF. The rates of stuttering-like disfluencies, other disfluencies, and speech errors and articulation rate were compared. In Experiment 2, 13 AWS and 15 adults who do not stutter (AWNS) read three utterances under four auditory feedback conditions: nonaltered auditory feedback, amplified auditory feedback, 25-ms DAF, and 50-ms DAF. Across-utterance kinematic variability (spatiotemporal index) and within-utterance variability (percent determinism and stability) were compared between groups.

Results In Experiment 1, under 250-ms DAF, the rate of stuttering-like disfluencies and speech errors increased significantly, while articulation rate decreased significantly in AWS. In Experiment 2, AWS exhibited higher kinematic variability than AWNS across the feedback conditions. Under 25-ms DAF, the spatiotemporal index of AWS decreased significantly compared to the other feedback conditions. AWS showed lower overall percent determinism than AWNS, but their percent determinism increased under 50-ms DAF to approximate that of AWNS.

Conclusions Auditory feedback manipulations can alter speech fluency and kinematic variability in AWS. Longer latency auditory feedback delays induce speech disruptions, while subtle auditory feedback manipulations potentially benefit speech motor control. Both AWS and AWNS are susceptible to auditory feedback during speech production, but AWS appear to exhibit a distinct continuum of sensitivity.

PMID: 34153192 DOI: 10.1044/2021_JSLHR-20-00606




Differential stuttering during conversation and oral reading in Kuwaiti-Arabic speakers: a note on diglossia - FALA

Clin Linguist Phon. 2021 May 24;1-13. Online ahead of print.


Tareq Alshatti, Michael P Robb, Bassam Alfoudari, Fauzia A Abdalla

Kuwait University, Kuwait City, Kuwait; Pennsylvania State University, State College, PA, USA; University of Canterbury, Christchurch, New Zealand.


The current study aimed to explore the frequency and types of stuttering in the oral reading and conversational samples of Arabic adults who stutter (AWS). Twelve Kuwaiti-Arabic AWS (mean age: 27.3 years) participated in the study. Each participant's stuttering was analyzed in two speaking contexts -oral reading of a standard Arabic passage and spontaneous conversational speech. The results showed that among a majority of the participants the amount of stuttering in conversation was significantly lower than that of reading. However, no significant differences were found in disfluency types within and between samples. The higher occurrence of stuttering in reading may be related to the diglossic nature of Arabic. The linguistic and rhythmic distinctions between Modern Standard Arabic (MSA) and Kuwaiti dialectal Arabic are explored to further explain the findings.

PMID: 34027773 DOI: 10.1080/02699206.2021.1928289




Do dyslexia and stuttering share a processing deficit? - AVALIAÇÃO

J Fluency Disord. 2021 Jan 6;67:105827. Online ahead of print.


Mahmoud M Elsherif, Linda R Wheeldon, Steven Frisson

University of Birmingham, Birmingham, UK; University of Agder, Kristiansand, Norway.


This study assessed the prevalence of childhood stuttering in adults with dyslexia (AWD) and the prevalence of dyslexia in adults who stutter (AWS). In addition, the linguistic profiles of 50 AWD, 30 AWS and 84 neurotypical adults were measured. We found that 17 out of 50 AWD (34 %) reported stuttering during childhood compared to 1 % of the neurotypical population. This was moderated by the severity of dyslexia: People with mild dyslexia showed a lower prevalence rate (15 %) of childhood stuttering than those with severe dyslexia (47 %). In addition, we observed that 50 % of the AWS (n = 30) fulfilled the diagnostic criteria of dyslexia, even though they had never been diagnosed as dyslexic. Compared to neurotypical adults, phonological working memory, awareness, and retrieval were similarly reduced in AWS and AWD. The findings supports the view that stuttering and dyslexia may share a phonological deficit.

PMID: 33444937 DOI: 10.1016/j.jfludis.2020.105827




Does the clinical utility of self-disclosure of stuttering transcend culturally and linguistically diverse populations? - TERAPIA

Int J Speech Lang Pathol. 2021 Feb 5;1-18. Online ahead of print.


Robyn L Croft , Courtney T Byrd

The University of Texas at Austin, Austin, USA.


Purpose: Research suggests that self-disclosure can improve listeners' perceptions of stuttering; however, it is unknown whether the effectiveness of self-disclosure transcends culture and language. This study examined the clinical utility of self-disclosure in a culturally and linguistically diverse population: Hebrew-speaking people who stutter in Israel.
Method: The experimental protocol replicated Byrd, Croft et al. Participants (N = 92 adults in Israel) viewed a video of either a male or female Hebrew-speaking person who simulated stuttering and self-disclosed informatively, apologetically, or not at all. Participants then rated the speaker on ten traits (i.e. friendly, outgoing, intelligent, confident, engaging, distracting, unfriendly, shy, unintelligent, insecure) using a bipolar likert scale.
Result: Results indicated that participants rated the speaker who self-disclosed in a neutral and informative manner as significantly more outgoing compared to the speaker who did not self-disclose at all, supporting the results from Byrd, Croft et al. Additionally, the male speaker was rated as significantly more friendly and outgoing than the female speaker.
Conclusion: This study suggests that self-disclosing in a neutral and informative manner can improve listeners' perceptions of people who stutter similarly across culture and language.

PMID: 33544005 DOI: 10.1080/17549507.2020.1861326




Do immigrants who stutter confront speech related anxiety in a foreign country? - EMOCIONAL

Saudi J Biol Sci. 2021 Aug;28(8):4318-4323 Epub 2021 Apr 14.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324956/pdf/main.pdf


Abdulaziz Almudhi

King Khalid University, P.O. Box 3665, Abha 61481, Saudi Arabia.


Purpose: The current study aimed at investigating the experience of immigrants who stutter in a foreign country.

Materials and methods: A questionnaire tapping details about the immigrants handling various communicative situations in a first and second language was configured and used in the current study. A total of 14 participants were enrolled in the study. Participants were sub-grouped based on the severity by using Stuttering Severity Instruments, 4th Edition (SSI-4). The composite scores on SSI-4 including the physical concomitants were used for sub grouping.

Results: The findings revealed that the amount of difficulty experienced by immigrants was directly proportional to the degree of stuttering. Participants had difficulty in communicating with boss and colleagues regardless of the language used. They experienced less difficulty while speaking in malls and courier persons. Participants who knew the native language Arabic could handle the situations better than individuals who did not know Arabic.

Conclusion: Stuttering would impede social participation and would increase anxiety. This speech-related anxiety is known to increase when these individuals immigrate to foreign countries.

PMID: 34354414 PMCID: PMC8324956 DOI: 10.1016/j.sjbs.2021.04.014




Drug induced stuttering: pharmacovigilance data - FARMACOLOGIA

Expert Opin Drug Saf. 2020 Dec 27;1-5. Online ahead of print.


Thierry Trenque, Aurore Morel, Agathe Trenque, Brahim Azzouz

Reims University Hospitals, Reims, France; University of Reims Champagne-Ardenne , Reims, France.


Background: Stuttering is a speech disorder characterized by poor fluency of speech despite the speech production organs being normal. Numerous factors contribute to stuttering, and it may also be an iatrogenic effect of certain drugs. The aim of this study was to investigate the association between stuttering and drug exposure.

Research design and methods: We investigated the association between drugs and stuttering. We analyzed reports in the World Health Organization global individual case safety reports database (Vigibase) up to 31 May 2020 with the MedDRA lower level terms 'stutter' and 'stuttering.' The association between a drug and the occurrence of the adverse drug reaction was estimated by disproportionality analysis. Reporting odds ratios (ROR) were calculated with 95% confidence intervals.

Results: In total, 724 notifications were identified using the MedDRA terms selected. The main drugs implicated were methylphenidate (ROR = 19.58; 95% CI: 13.3-28.8), topiramate (ROR = 12.5; 95% CI: 7.1-22.1), olanzapine (ROR = 12; 95% CI: 8-17.9) and golimumab (ROR = 10.2; 95% CI: 5.5-19.1).

Conclusions: When stuttering occurs in a patient treated by drugs affecting neurotransmission, a drug-induced origin of the stutter should be considered.

PMID: 33337944 DOI: 10.1080/14740338.2021.1867101




Efeitos da presença do cão na expressão de conteúdos psíquicos de um sujeito que gagueja: estudo de caso - EMOCIONAL

Case Reports Codas. 2021 May 3;33(2):e20190267. eCollection 2021

Article in Portuguese: https://www.scielo.br/pdf/codas/v33n2/2317-1782-codas-33-2-e20190267.pdf
Artigo também em inglês


Tatiane Ichitani, Annelisa Bruna Faccin, Julia Biancalana Costa, Fabiola Staróbole Juste, Claudia Regina Furquim de Andrade, Maria Claudia Cunha

Pontifícia Universidade Católica de São Paulo, São Paulo (SP), Brasil; Universidade de São Paulo - USP - São Paulo, SP, Brasil.


RESUMO A gagueira gera impactos negativos na qualidade de vida dos sujeitos e está associada a maior risco de desenvolvimento de problemas sociais e psíquicos. Nessa perspectiva, apesar da diversidade das hipóteses etiológicas e dos tratamentos da gagueira, destaca-se a interface entre psicologia e fonoaudiologia na abordagem dos aspectos bio-psíquicos envolvidos nesse quadro clínico. Pesquisas recentes indicam que a presença, especificamente de cães, pode auxiliar o paciente na elaboração simbólica de conteúdos psíquicos. Nessa perspectiva, o objetivo desse estudo é avaliar os efeitos da presença do cão na expressão de conteúdos psíquicos de um sujeito que gagueja, com a hipótese de que o enquadre pode reduzir o sintoma. O sujeito é M., sexo feminino, 45 anos, casada, sem filhos, cursou ensino fundamental completo e de auxiliar de cabeleireira. Passou pelo processo de terapia fonoaudiológica na presença do cão. Foi realizada uma entrevista semi-dirigida após o processo. Um cão coterapeuta, da raça Golden Retriever, participou de todas as sessões. Alguns conteúdos subjetivos relevantes observados no setting no decorrer do processo terapêutico fonoaudiológico, os quais parecem ter sido mobilizados pelo enquadre estabelecido pela interação entre terapeuta-paciente-cão, parecem demonstrar associação com a manifestação das disfluências. O cão fez contato físico, deu suporte, motivou e acolheu o sujeito em situações de demonstração de conflitos psíquicos. Assim, este estudo de caso clínico indica que o enquadre da presença e interação do cão favoreceu a redução do sintoma da gagueira, promovendo ambiente acolhedor possibilitando a integração psique-soma do sujeito.




Effect of Maximally Relaxed Lying Posture on the Severity of Stuttering in Young Adults Who Stutter - PSICOMOTOR

Motor Control. 2021 Mar 15;1-11. Online ahead of print.


Abdulaziz Almudhi , Hamayun Zafar

King Khalid University; King Saud University; Umea University.


The current study was carried out with the aim of investigating the effect of maximally relaxed lying posture on disfluencies in young adults who stutter. A total of 24 participants (17 males, seven females; mean age = 24.9 ± 6.2 years) with developmental stuttering were a part of the study. The participants were asked to perform spontaneous speaking and reading aloud tasks in standard sitting and maximally relaxed lying postures. The severity of stuttering for the studied postures was estimated by using the Stuttering Severity Instrument. The results on the Stuttering Severity Instrument showed that stuttering parameters improved during the maximally relaxed lying posture compared with the standard sitting position. The results are discussed in the light of motor control concepts. It is concluded that the maximally relaxed lying posture can facilitate improvement in stuttering scores during spontaneous speaking as well as reading aloud in young adults who stutter. Reduced stuttering scores in the maximally relaxed lying posture suggest that speech therapists can position participants in this position while treating people who stutter.

PMID: 33721838 DOI: 10.1123/mc.2020-0063




Effects of tDCS on Sound Duration in Patients with Apraxia of Speech in Primary Progressive Aphasia - OUTRAS ÁREAS

Brain Sci. 2021 Mar 6;11(3):335.


Charalambos Themistocleous, Kimberly Webster, Kyrana Tsapkini

Johns Hopkins School of Medicine, Baltimore, USA.


Transcranial direct current stimulation (tDCS) over the left inferior frontal gyrus (IFG) was found to improve oral and written naming in post-stroke and primary progressive aphasia (PPA), speech fluency in stuttering, a developmental speech-motor disorder, and apraxia of speech (AOS) symptoms in post-stroke aphasia. This paper addressed the question of whether tDCS over the left IFG coupled with speech therapy may improve sound duration in patients with apraxia of speech (AOS) symptoms in non-fluent PPA (nfvPPA/AOS) more than sham. Eight patients with non-fluent PPA/AOS received either active or sham tDCS, along with speech therapy for 15 sessions. Speech therapy involved repeating words of increasing syllable-length. Evaluations took place before, immediately after, and two months post-intervention. Words were segmented into vowels and consonants and the duration of each vowel and consonant was measured. Segmental duration was significantly shorter after tDCS compared to sham and tDCS gains generalized to untrained words. The effects of tDCS sustained over two months post-treatment in trained and untrained sounds. Taken together, these results demonstrate that tDCS over the left IFG may facilitate speech production by reducing segmental duration. The results provide preliminary evidence that tDCS may maximize efficacy of speech therapy in patients with nfvPPA/AOS.

PMID: 33800933 DOI: 10.3390/brainsci11030335




Effects of the presence of a dog on the psychic content expression of a stuttering person: case report - EMOCIONAL

Case Reports Codas. 2021 May 3;33(2):e20190267. eCollection 2021.
English: https://www.scielo.br/pdf/codas/v33n2/en_2317-1782-codas-33-2-e20190267.pdf
Artigo também em português.


Tatiane Ichitani, Annelisa Bruna Faccin, Julia Biancalana Costa, Fabiola Staróbole Juste, Claudia Regina Furquim de Andrade, Maria Claudia Cunha

Pontifícia Universidade Católica de São Paulo, São Paulo (SP), Brasil; Universidade de São Paulo - USP - São Paulo, SP, Brasil.

Abstract in English, Portuguese


Stuttering has negative impacts on an individual's quality of life and is associated with higher risk of development of social and psychological problems. From this perspective, despite the diversity of etiological hypotheses for and treatments of stuttering, the interface between psychology and speech therapy in the approach to the biopsychic aspects involved in this clinical scenario stands out. Recent research indicates that the presence, specifically of dogs, can assist patients in symbolic elaboration of psychic content. From this perspective, the aim of this study is evaluate the effects of a dog's presence on the expression of the psychic content of a stuttering person, with the hypothesis that framing may reduce symptoms. The subject is M., female, 45 years old, married, without children, hairdressing assistant, with elementary school completed. She underwent the process of speech therapy in presence of a dog. A semidirected interview was conducted after this process. A co-therapist dog of Golden Retriever breed participated in all sessions. The relevant subjective content observed in the setting during the speech therapy process, which seems to have been mobilized by the framework established by the interaction among the therapist, the patient, and the dog, seems to demonstrate an association with the manifestation of disfluencies. The dog made physical contact with, supported, motivated and welcomed the subject in situations in which psychic conflicts were demonstrated. This clinical case study indicates that the dog's presence and interaction framework favored the reduction of stuttering symptoms, promoting welcoming environment that enabled the subject's psyche-soma integration.

PMID: 33978105 DOI: 10.1590/2317-1782/20202019267




Enlarged Area of Mesencephalic Iron Deposits in Adults Who Stutter - INFANTIL / CONCEITO

Front Hum Neurosci. 2021 Feb 11;15:639269.


Jan Liman, Alexander Wolff von Gudenberg, Mathias Baehr, Walter Paulus, Nicole E Neef, Martin Sommer

University Medical Center Göttingen, Göttingen, Germany; Institut der Kasseler Stottertherapie (KST), Bad Emstal, Germany.


Purpose: Childhood onset speech fluency disorder (stuttering) is possibly related to dopaminergic dysfunction. Mesencephalic hyperechogenicity (ME) detected by transcranial ultrasound (TCS) might be seen as an indirect marker of dopaminergic dysfunction. We here determined whether adults who stutter since childhood (AWS) show ME.

Methods: We performed TCS in ten AWS and ten matched adults who never stuttered. We also assessed motor performance in finger tapping and in the 25 Foot Walking test.

Results: Compared to controls, AWS showed enlarged ME on either side. Finger tapping was slower in AWS. Walking cadence, i.e., the ratio of number of steps by time, tended to be higher in AWS than in control participants.

Discussion: The results demonstrate a motor deficit in AWS linked to dopaminergic dysfunction and extending beyond speech. Since iron deposits evolve in childhood and shrink thereafter, ME might serve as an easily quantifiable biomarker helping to predict the risk of persistency in children who stutter.

PMID: 33643015 PMCID: PMC7904683 DOI: 10.3389/fnhum.2021.639269




Evaluating adaptation effect in real versus virtual reality environments with people who stutter - TERAPIA

Expert Rev Med Devices. 2021 Mar 8;1-7. Online ahead of print.


Abdulaziz Almudhi

King Khalid University, Saudi Arabia.


Methods: This research aimed at measuring the adaptation effect in real and virtual reality (VR) environments for spontaneous-speech and reading. The objectives were divided into two categories. The first objective aimed at comparing the adaption effect for the real and VR environments on the reading task, while the second objective addressed the same objective, but for the spontaneous-speech task. The study involved 24 participants in the age range of 19-33 years. SSI-4 was administered on the participants.

Conclusion: The reduction in dysfluencies was seen for both real and VR testing environments. The reduction in the dysfluency was more marked for reading-task compared to spontaneous-speech task. The results shed light on the relationship between adaptation effect and the test environment.

PMID: 33678105 DOI: 10.1080/17434440.2021.1894124




Evolution in technology and changes in the perspective of stuttering therapy: A review study - TERAPIA

Review Saudi J Biol Sci. 2021 Jan;28(1):623-627. Epub 2020 Nov 4.

Free PMC article : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783783/pdf/main.pdf


Abdulaziz Almudhi

King Khalid University, Abha, Saudi Arabia.


Technology has been revolutionizing health care. The current article is split into three parts, the first portion discusses the usage of technological devices in stuttering treatment, the scan of technical devices may be used specifically in treatment or can be used to offer guidance and thereby improve the pace of expression. They will even help to create physiological improvements. The second section of the article refers to telehealth as a means of providing services to people with stuttering. This approach has become a simple benevolence of technology and has managed to enter the unreached. Teletherapy can also be utilized for individuals who are robbed of treatment owing to isolation from financial restrictions. The third part of the analysis is regarding the apps. Apps may be used as an adjunct to speech language training or can be used during the repair process.

PMID: 33424348 PMCID: PMC7783783 DOI: 10.1016/j.sjbs.2020.10.051




Evaluation of an integrated fluency and Acceptance and Commitment Therapy intervention for adolescents and adults who stutter: Participant perspectives - TERAPIA

J Fluency Disord. 2021 May 12;69:105852. Online ahead of print.


Alice K Hart, Lauren J Breen, Janet M Beilby

Curtin University, Western Australia, Australia.


Purpose: Childhood-onset stuttering is a neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter. In addition to significant challenges in personal, social, and emotional domains, stuttering has been shown to impose an economic burden on adults who stutter. Intervention for adults who stutter has historically addressed speech fluency more so than the covert psychosocial aspects of the disorder. There is an identified clinical need for holistic, efficacious, and cost-effective stuttering interventions that meet consumer needs. The purpose of the present study is to evaluate a novel, integrated intervention that combined traditional fluency techniques with Acceptance and Commitment Therapy, from the perspective of the adults who stutter who participated in the intervention.

Method: Twenty-eight adults who stutter completed the intervention program. Participants were invited to complete an online post-program written survey (including qualitative comments) and a semi-structured interview to explore their evaluations of the program with respect to its authenticity, acceptability, and social validity.

Results: Participants perceived positive psychosocial changes as a result of the program, and were satisfied with the program overall. Qualitative thematic analyses of the written survey comments and the semi-structured interviews identified two major themes: factors specific to the intervention and factors specific to the therapeutic process. Several important sub-themes were also identified.

Conclusion: Findings support the authenticity, acceptability, and social validity of an integrated fluency and psychosocial intervention for stuttering. Findings also highlight the need for consideration of the consumer voice in the management of stuttering disorders, in keeping with person-centred care.

PMID: 34023592 DOI: 10.1016/j.jfludis.2021.105852




Exploring Relationships Among Risk Factors for Persistence in Early Childhood Stuttering - AVALIAÇÃO

J Speech Lang Hear Res. 2021 Jul 14;1-19. Online ahead of print.


Bridget Walsh, Sharon Christ, Christine Weber

Michigan State University, East Lansing; Purdue University, West Lafayette, IN.


Purpose The purpose of this study is to investigate how epidemiological and clinical factors collectively predict whether a preschooler who is stuttering will persist or recover and to provide guidance on how clinicians can use these factors to evaluate a child's risk for stuttering persistence.

Method We collected epidemiological and clinical measures from 52 preschoolers (M = 54.4 months, SD = 6.7 months; 38 boys and 14 girls) diagnosed as stuttering. We then followed these children longitudinally to document whether they eventually recovered or persisted in stuttering. Risk factors found to be significantly associated with stuttering persistence were used to build single and multiple variable predictive statistical models. Finally, we assessed each model's prediction capabilities by recording how accurate a model was in predicting a child's stuttering outcome-persisting or recovered.

Results We found that a positive family history of stuttering, poorer performance on a standardized articulation/phonological assessment, higher frequency of stuttering-like disfluencies during spontaneous speech, and lower accuracy on a nonword repetition task were all significantly associated with an increased probability of persistence. The interaction between family history of stuttering and nonword repetition performance was also significant. The full multiple regression model incorporating all these risk factors resulted in the best fitting model with the highest predictive accuracy and lowest error rate.

Conclusions For the first time, we show how multiple risk factors collectively predict the probability of stuttering persistence in 3- to 5-year-old preschool children who stutter. Using the full combination of risk factors to assess preschoolers who stutter yielded more accurate predictions of persistence compared to sparser models. A better understanding of the factors that underlie stuttering persistence will yield insight into the underpinnings of chronic stuttering and will help identify etiological targets for novel treatment approaches.

PMID: 34260279 DOI: 10.1044/2021_JSLHR-21-00034




Fluência e compreensão da leitura em escolares com e sem gagueira - AVALIAÇÃO

Codas. 2021 Jul 9;33(5):e20200059.

[Article in Portuguese, English]
Free Full Text: https://www.scielo.br/j/codas/a/4MVpv5nnfbTpztW7KsRfF7H/?format=pdf&lang=pt


Juliana Sandoval Pinto, Luana Altran Picoloto, Simone Aparecida Capellini, Talissa Almeida Palharini, Cristiane Moço Canhetti de Oliveira

Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP - Marília (SP), Brasil.


Objetivo: Analisar e comparar os parâmetros da fluência na fala espontânea e leitura a compreensão de leitura de escolares que gaguejam com fluentes.

Método: Estudo transversal e prospectivo aprovado pelo Comitê de Ética da Instituição. Amostra composta por 30 escolares com idade entre 8 e 11 anos e 11 meses divididos em dois grupos: Grupo Pesquisa com 15 escolares com gagueira, Grupo Controle com 15 escolares fluentes. Os participantes foram submetidos à avaliação da fluência da fala espontânea, leitura dos textos expositivo e narrativo, e avaliação da compreensão de leitura. A análise estatística inferencial foi realizada por meio dos testes de Mann-Whitney e para análise de correlação foi utilizado o teste de Coeficiente de Spearman.

Resultados: A comparação entre os parâmetros da fluência indicou que escolares com gagueira manifestaram maior quantidade de disfluências típicas da gagueira, enquanto os fluentes mostraram maiores fluxos de sílabas e de palavras por minuto, na fala espontânea e na leitura. Em relação à compreensão de leitura, escolares com gagueira apresentaram desempenho inferior ao fluentes, em ambos os textos. Não houve associação entre a frequência de disfluências e compreensão de leitura, nos escolares com e sem gagueira.

Conclusão: Escolares com gagueira apresentaram prejuízos quanto à compreensão de leitura quando comparados à fluentes, porém não houve associação entre a frequência de disfluências com a compreensão de leitura em ambos os grupos. Sugere-se que a compreensão da leitura seja avaliada e se necessário trabalhada a fim de reduzir as consequências da gagueira e favorecer aprendizagem deste escolar.

PMID: 34259753 DOI: 10.1590/2317-1782/20202020059




Fluency and reading comprehension in students with and without stuttering - AVALIAÇÃO

Codas. 2021 Jul 9;33(5):e20200059.

[Article in Portuguese, English]
Free Full Text: https://www.scielo.br/j/codas/a/4MVpv5nnfbTpztW7KsRfF7H/?format=pdf&lang=en


Juliana Sandoval Pinto, Luana Altran Picoloto, Simone Aparecida Capellini, Talissa Almeida Palharini, Cristiane Moço Canhetti de Oliveira

Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP - Marília (SP), Brasil.


Abstract in English, Portuguese

Purpose: To analyze and to compare fluency parameters in spontaneous speech and reading and reading comprehension of school-age children who stutter and who do not stutter.

Methods: Cross-sectional and prospective study approved by the Research Ethics Committee. Sample consisted of 30 scholars aged 8 and 11 years and 11 months divided into two groups: Study Group with 15 school-age children who stutter, Control Group with 15 school-age children who do not stutter. Participants underwent fluency evaluation of spontaneous speech, reading of expository and narrative texts, and reading comprehension evaluation. Inferential statistical analysis was conducted using the Mann-Whitney tests and correlation analysis was conducted using the Spearman's Coefficient test.

Results: The comparison between the fluency parameters indicated that school-age children who stutter showed a greater amount of stuttering-like disfluencies, while school-age children who do not stutter showed longer flows of syllables and words per minute, in spontaneous speech and reading. Regarding reading comprehension, school-age children who stutter had lower performance than school-age children who do not stutter in both texts. There was no association between the frequency of disfluencies and reading comprehension in school-age children who stutter and who do not stutter.

Conclusion: School-age children who stutter showed impairments in reading comprehension when compared to fluent, since there was no association between the frequencies of disfluencies with reading comprehension for both groups. It is suggested that reading comprehension be evaluated and, if necessary, improved in order to reduce the consequences of stuttering and provide learning of this school-age children.

PMID: 34259753 DOI: 10.1590/2317-1782/20202020059




Identifying developmental stuttering and associated comorbidities in electronic health records and creating a phenome risk classifier - AVALIAÇÃO

J Fluency Disord. 2021 Apr 15;68:105847. Online ahead of print.


Dillon G Pruett, Douglas M Shaw, Hung-Hsin Chen, Lauren E Petty, Hannah G Polikowsky, Shelly Jo Kraft, Robin M Jones, Jennifer E Below

Vanderbilt University, United States; Wayne State University, United States.


Purpose: This study aimed to identify cases of developmental stuttering and associated comorbidities in de-identified electronic health records (EHRs) at Vanderbilt University Medical Center, and, in turn, build and test a stuttering prediction model.

Methods: A multi-step process including a keyword search of medical notes, a text-mining algorithm, and manual review was employed to identify stuttering cases in the EHR. Confirmed cases were compared to matched controls in a phenotype code (phecode) enrichment analysis to reveal conditions associated with stuttering (i.e., comorbidities). These associated phenotypes were used as proxy variables to phenotypically predict stuttering in subjects within the EHR that were not otherwise identifiable using the multi-step identification process described above.

Results: The multi-step process resulted in the manually reviewed identification of 1,143 stuttering cases in the EHR. Highly enriched phecodes included codes related to childhood onset fluency disorder, adult-onset fluency disorder, hearing loss, sleep disorders, atopy, a multitude of codes for infections, neurological deficits, and body weight. These phecodes were used as variables to create a phenome risk classifier (PheRC) prediction model to identify additional high likelihood stuttering cases. The PheRC prediction model resulted in a positive predictive value of 83 %.

Conclusions: This study demonstrates the feasibility of using EHRs in the study of stuttering and found phenotypic associations. The creation of the PheRC has the potential to enable future studies of stuttering using existing EHR data, including investigations into the genetic etiology.

PMID: 33894541 DOI: 10.1016/j.jfludis.2021.105847




Impact of cognitive behavioural play therapy on social anxiety among school children with stuttering deficit: A cluster randomised trial with three months follow-up - INFANTIL / EMOCIONAL

Medicine (Baltimore). 2021 May 14;100(19):e24350.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133212/pdf/medi-100-e24350.pdf


Patience Enuma Obiweluozo, Moses Onyemaechi Ede, Chimezie Nneka Onwurah, Uchenna Eugenia Uzodinma, Ibiwari Caroline Dike, Juliana Ngozi Ejiofor

University of Nigeria, Nsukka.


Background: Stuttering is a speech deficit which is characterized by obstruction of speech eloquence and verbal expression in addition to involuntary flow of air during communication. School children with communication deficit often experience social anxiety in their immediate environment. Currently, reports show that a good number of children with communication deficits are prone to social maladjustment due to their being socially inept. And this has significantly affected their thought pattern, social behaviours and emotional responses. In view of this, we examined the impact of cognitive behavioural play therapy in reducing social anxiety among school children with stuttering.

Method: This is a pretest-posttest randomized control group design. Participants were 178 schoolchildren in inclusive schools in South east Nigeria. Participants in the intervention group were treated using cognitive behavioural play therapy programme (CBPT). Participants in the waitlist control group were only assessed at three points of assessment. Data analyses were completed using repeated measures ANOVA.

Results: The results show that cognitive behavioural play therapy is beneficial in decreasing schoolchildren's social anxiety scores. The intervention equally showed the considerable impacts on the children when exposed to cognitive behavioural play programme at different times of assessment compared to waitlisted control group.

Conclusion: It is concluded that CBPT is a long-term psychotherapeutic programme that has significant impacts in reducing social anxiety among children with stuttering. This study makes a leading contribution on the limited scholarship focusing on the impact of CBPT on social anxiety of special population with stuttering deficits in developing countries.

PMID: 34106582 PMCID: PMC8133212




Inquiry Based Stress Reduction (IBSR) Improves Overall Stuttering Experience among Adults Who Stutter: A Randomized Controlled Trial - EMOCIONAL

J Clin Med. 2021 May 18;10(10):2187

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158472/pdf/jcm-10-02187.pdf


Omrit Feldman, Eran Goldstien, Benjamin Rolnik, Ariel B Ganz, Shahar Lev-Ari

Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Stanford University, Stanford, CA, USA.


Stuttering is a speech disorder that can cause disturbances in the timing and flow of speech. In addition to being a communication disorder, stuttering is often accompanied by a reduction in the quality of life and has impacts on social status, mental well-being, self-acceptance, and the chances of integration into the labor market. The Inquiry Based Stress Reduction (IBSR) program, developed in the United States by Byron Katie in 1986, is the clinical application of "The Work" method (Thework.com) and represents an emerging mindfulness and cognitive-reframing method. IBSR has been demonstrated to improve mental health and well-being in adults and may alleviate psychological and psychosocial symptoms of stuttering. The purpose of this trial was to examine the effect of a 12-week IBSR intervention on the overall stuttering experience and indicators of anxiety, psychological flexibility, and well-being among adults who stutter (AWS). This study was a randomized controlled clinical trial. Participants were randomized to IBSR (n = 28) and control (n = 28) groups. Validated questionnaires of overall stuttering experience (OASES-A), anxiety (STAI), psychological flexibility (PFQ), and satisfaction with life (SWLS) were completed before, after, and one month after the intervention. An intention-to-treat approach was implemented for analysis. Our results show that participants in the IBSR intervention group exhibited a greater improvement in their overall stuttering experience as compared to the control group, as well as in general information on stuttering awareness and perception, reactions to stuttering, communication in daily situations, and quality of life. In addition, we found a greater reduction in anxiety levels and an increase in satisfaction-with-life scores in the IBSR group. These results indicate that IBSR can improve the overall stuttering experience.

PMID: 34070161 PMCID: PMC8158472 DOI: 10.3390/jcm10102187




Interpretable Self-Supervised Facial Micro-Expression Learning to Predict Cognitive State and Neurological Disorders - AVALIAÇÃO

Proc Conf AAAI Artif Intell. 2021 May 18;35(1):818-826.
Free Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252663/pdf/nihms-1717651.pdf


Arun Das, Jeffrey Mock, Yufei Huang, Edward Golob, Peyman Najafirad

University of Texas at San Antonio.


Human behavior is the confluence of output from voluntary and involuntary motor systems. The neural activities that mediate behavior, from individual cells to distributed networks, are in a state of constant flux. Artificial intelligence (AI) research over the past decade shows that behavior, in the form of facial muscle activity, can reveal information about fleeting voluntary and involuntary motor system activity related to emotion, pain, and deception. However, the AI algorithms often lack an explanation for their decisions, and learning meaningful representations requires large datasets labeled by a subject-matter expert. Motivated by the success of using facial muscle movements to classify brain states and the importance of learning from small amounts of data, we propose an explainable self-supervised representation-learning paradigm that learns meaningful temporal facial muscle movement patterns from limited samples. We validate our methodology by carrying out comprehensive empirical study to predict future speech behavior in a real-world dataset of adults who stutter (AWS). Our explainability study found facial muscle movements around the eyes (p <0.×001) and lips (p <0.001) differ significantly before producing fluent vs. disfluent speech. Evaluations using the AWS dataset demonstrates that the proposed self-supervised approach achieves a minimum of 2.51% accuracy improvement over fully-supervised approaches.

PMID: 34221694 PMCID: PMC8252663




Interventions for children and adolescence who stutter: A systematic review, meta-analysis, and evidence map - iNFANTIL / TERAPIA

J Fluency Disord. 2021 Mar 11;70:105843. Online ahead of print.


Amanda Brignell, Michelle Krahe, Martin Downes, Elaina Kefalianos, Sheena Reilly, Angela Morgan

Murdoch Children's Research Institute, Victoria, Australia; Griffith University, Queensland, Australia; University of Melbourne, Victoria, Australia.


Purpose: This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence.

Methods: Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2-18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies.

Results: Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention.

Conclusion: The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.

PMID: 33743406 DOI: 10.1016/j.jfludis.2021.105843




Investigation of Risperidone Treatment Associated With Enhanced Brain Activity in Patients Who Stutter - FARMACOLOGIA

Front Neurosci. 2021 Feb 12;15:598949. eCollection 2021.


Gerald A Maguire, Bo Ram Yoo, Shahriar SheikhBahaei

University of California, Riverside, Riverside, CA, United States; National Institute of Neurological Disorders and Stroke/National Institutes of Health, Bethesda, MD, United States.


Stuttering is a childhood onset fluency disorder that leads to impairment in speech. A randomized, double-blinded placebo-controlled study was conducted with 10 adult subjects to observe the effects of risperidone (a dopamine receptor 2/serotonin receptor 2 antagonist) on brain metabolism, using [18F] deoxyglucose as the marker. At baseline and after 6 weeks of taking risperidone (0.5-2.0 mg/day) or a placebo pill, participants were assigned to a solo reading aloud task for 30 min and subsequently underwent a 90-min positron emission tomography scan. Paired t-tests were performed to compare the pre-treatment vs. post-treatment in groups. After imaging and analysis, the blind was broken, which revealed an equal number of subjects of those on risperidone and those on placebo. There were no significant differences in the baseline scans taken before medication randomization. However, scans taken after active treatment demonstrated higher glucose uptake in the specific regions of the brain for those in the risperidone treatment group (p < 0.05). Risperidone treatment was associated with increased metabolism in the left striatum, which consists of the caudate and putamen, and the Broca's area. The current study strengthens previous research that suggests the role of elevated dopamine activity and striatal hypometabolism in stuttering. We propose that the mechanism of risperidone's action in stuttering, in part, involves increased metabolism of striatal astrocytes. We conclude that using neuroimaging techniques to visualize changes in the brain of those who stutter can provide valuable insights into the pathophysiology of the disorder and guide the development of future interventions.
PMID: 33642973 PMCID: PMC7906995




Is social distancing a boon or bane for persons who stutter during COVID-19 pandemic? - SOCIAL

Saudi J Biol Sci. 2021 Feb 22. Online ahead of print.

Free full text: https://pubmed.ncbi.nlm.nih.gov/33642895/


Abdulaziz Almudhi

King Khalid University, Abha, Saudi Arabia.


The Covid-19 pandemic is an ongoing crisis and is colloquially known as the corona virus pandemic. As no specific treatment protocol are available for this viral infection, social distancing is considered as one of the remedies to prevent the infection. This study aimed to investigate the anxiety issues in persons who stutter (PWS). A total of 110 (55 PWS and 55 Neuro-typical Adults) were enrolled for the study. A questionnaire comprising of two parts on social anxiety and consequences of social distancing was administered on the participants. The results showed that PWS felt more socially anxious. PWS opined that they were comfortable during the corona virus lockdown period, as the situation demanded them to speak minimally to strangers. Neuro-typical adults, on the other hand, reported that they did not observe any change with respect to the social communication skills during lockdown.

PMID: 33642895 PMCID: PMC7899021 DOI: 10.1016/j.sjbs.2021.02.055




Late onset Sandhoff disease presenting with lower motor neuron disease and stuttering - AVALIAÇÃO

Case Reports Neuromuscul Disord. 2021 May 27. Online ahead of print.


Jorge Alonso-Pérez, Ana Casasús, Álvaro Gimenez-Muñoz, Jennifer Duff, Ricard Rojas-Garcia, Isabel Illa, Volker Straub, Ana Töpf, Jordi Díaz-Manera

Universitat Autònoma de Barcelona, Barcelona, Spain;  Newcastle Upon Tyne, United Kingdom; Neuromuscular Research Unit, IIS La Fe, Valencia, Spain; Royo Villanova Hospital, Zaragoza, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain.


Defects in the HEXB gene which encodes the β-subunit of β-hexosaminidase A and B enzymes, cause a GM2 gangliosidosis, also known as Sandhoff disease, which is a rare lysosomal storage disorder. The most common form of the disease lead to quickly progressing mental and motor decline in infancy; however there are other less severe forms with later onset that can also involve lower motor neurons. The diagnosis of this disease is based on low serum β-hexosaminidases A and B levels and confirmed using genetic test. We report two siblings with compound heterozygous HEXB mutations whose phenotype was extremely mild consisting in stuttering in both cases associated to mild proximal weakness in one of the cases, broadening the clinical spectrum of late onset Sandhoff disease.

PMID: 34210542 DOI: 10.1016/j.nmd.2021.04.011




Latent Class Analysis Reveals Distinct Groups Based on Executive Function and Socioemotional Traits, Developmental Conditions, and Stuttering: A Population Study - CONCEITO


Sara Ashley Smith, Ai Leen Choo, Matthew E Foster

University of South Florida, Tampa, FL, 33620, USA; Georgia State University, Atlanta, GA, USA.


A growing body of research has reported associations between weaker Executive Functions (EF), the set capacities that are needed to manage and allocate one's cognitive resources during cognitively challenging activities and various neurodevelopmental conditions, including stuttering. The majority of this research has been based on variable-centered approaches, which have the potential to obscure within-population heterogeneity. Person-centered analyses are essential to understanding multifactorial disorders where relationships between indicators have been elusive, such as stuttering. The current study addressed gaps in the literature by using latent class analysis (LCA), a person-centered approach, to identify homogenous subgroups within the National Health Interview Survey (2004-2018) publicly available data set. Using this exploratory approach, we examined the hypothesis that there exist distinct classes (or subgroups) of children based on parent reports of EF, Socioemotional (SE) traits, developmental atypicality, and stuttering. Our analyses revealed distinct subgroups with substantially different likelihoods of parent-reported stuttering behaviors and developmental atypicality. For children with both EF and SE difficulties, the likelihood of parental report of stuttering and atypical development was even higher, in fact this likelihood (of stuttering and not-typically developing) was highest among all subgroups. In contrast, children without difficulties were the least likely to be reported with stuttering or not-typically developing. Our findings are consistent with theoretical frameworks for stuttering, which cite EF as a crucial component in the disorder. Additionally, our findings suggest within-population heterogeneity among children with EF difficulties and, specifically, EF and SE heterogeneity among children who stutter.

PMID: 33782821 DOI: 10.1007/s10578-021-01160-3




Lexical Planning in People Who Stutter: A Defect in Lexical Encoding or the Planning Scope? - LINGUAGEM

Front Psychol. 2021 Feb 23;12:581304.
Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940678/pdf/fpsyg-12-581304.pdf


Liming Zhao, Miaoqing Lian

Tianjin Normal University, Tianjin, China; Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China.


Developmental stuttering is a widely discussed speech fluency disorder. Research on its mechanism has focused on an atypical interface between the planning (PLAN) and execution (EX) processes, known collectively as the EXPLAN model. However, it remains unclear how this atypical interface influences people who stutter. A straightforward assumption is that stuttering speakers adopt a smaller scope of speech planning, whereas a defect in word retrieval can be confounding. To shed light on this issue, we took the semantic blocking effect as an index to examine lexical planning in word and phrase production. In Experiment 1, for word production, pictures from the same semantic category were combined to form homogeneous blocks, and pictures from different categories were combined to form heterogeneous blocks. A typical effect of semantic blocking showing longer naming latencies for homogeneous blocks than heterogeneous ones was observed for both stuttering and fluent speakers. However, this effect was smaller for stuttering speakers, when it was subject to lexical defects in stuttering. In Experiment 2, for a conjoined noun phrase production task, the pictures referring to the first noun were manipulated into homogeneous and heterogeneous conditions. The semantic blocking effect was also much smaller for stuttering speakers, indicating a smaller scope of lexical planning. Therefore, the results provided more evidence in support of the EXPLAN model and indicated that a smaller scope of lexical planning rather than lexical defects causes the atypical interface for stuttering. Moreover, a comparison between these two tasks showed that the study findings have implications for syntactic defects in stuttering.

PMID: 33708156 PMCID: PMC7940678 DOI: 10.3389/fpsyg.2021.581304




Linguistic features of dysfluencies in Parkinson Disease - OUTRAS ÁREAS

J Fluency Disord. 2021 Mar 19;70:105845. Online ahead of print.


Angela E Reif, Alexander M Goberman

The University of Akron, United States; Bowling Green State University, United States.


Purpose: The purpose of this study was to examine dysfluency characteristics of individuals with Parkinson Disease (PD) relative to linguistic features of grammatical class and position within word. Few studies have reported dysfluency characteristics of PD relative to these characteristics. Those that do report on these characteristics include one case study and a study of six individuals with PD. No previous research is known to have examined dysfluency related to grammatical class and position within words for a large sample of individuals with PD.

Method: Dysfluencies from 32 individuals with PD were analyzed according to position within a word and grammatical class.

Results: Participants produced significantly more dysfluencies in the initial position of words compared to medial or final positions, and a significantly higher percent dysfluency for content words versus function words.

Conclusion: Effects of linguistic features of grammatical class and position within a word on dysfluencies are present within a population with PD and are similar to the linguistic features associated with developmental stuttering. Clinical implications of the effect of linguistic features on speech dysfluencies in PD are discussed.

PMID: 33780692 DOI: 10.1016/j.jfludis.2021.105845




Linking Lysosomal Enzyme Targeting Genes and Energy Metabolism with Altered Gray Matter Volume in Children with Persistent Stuttering

Neurobiol Lang (Camb). 2020 Aug;1(3):365-380. Epub 2020 Aug 1.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138901/pdf/nol-01-513.pdf


Ho Ming Chow, Emily O Garnett, Hua Li, Andrew Etchell, Jorge Sepulcre, Dennis Drayna, Diane Chugani, Soo-Eun Chang

University of Delaware, Newark, DE; duPont Hospital for Children, Wilmington, DE; University of Michigan, Ann Arbor, MI; Harvard Medical School, Boston, MA; National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD; Michigan State University, East Lansing, MI.


Developmental stuttering is a childhood onset neurodevelopmental disorder with an unclear etiology. Subtle changes in brain structure and function are present in both children and adults who stutter. It is a highly heritable disorder, and 12-20% of stuttering cases may carry a mutation in one of four genes involved in intracellular trafficking. To better understand the relationship between genetics and neuroanatomical changes, we used gene expression data from the Allen Institute for Brain Science and voxel-based morphometry to investigate the spatial correspondence between gene expression patterns and differences in gray matter volume between children with persistent stuttering (n = 26, and 87 scans) and their fluent peers (n = 44, and 139 scans). We found that the expression patterns of two stuttering-related genes (GNPTG and NAGPA) from the Allen Institute data exhibited a strong positive spatial correlation with the magnitude of between-group gray matter volume differences. Additional gene set enrichment analyses revealed that genes whose expression was highly correlated with the gray matter volume differences were enriched for glycolysis and oxidative metabolism in mitochondria. Because our current study did not examine the participants' genomes, these results cannot establish the direct association between genetic mutations and gray matter volume differences in stuttering. However, our results support further study of the involvement of lysosomal enzyme targeting genes, as well as energy metabolism in stuttering. Future studies assessing variations of these genes in the participants' genomes may lead to increased understanding of the biological mechanisms of the observed spatial relationship between gene expression and gray matter volume.

PMID: 34041495 PMCID: PMC8138901 DOI: 10.1162/nol_a_00017




[Living with stuttering] [Article in French]

Rev Prat. 2021 Apr;71(4):417-418.


Elisabeth Vincent

1"vice-présidente de l'Association Parole Bégaiement".


No abstract available
PMID: 34161011




Manganese exposure during early larval stages of C. elegans causes learning disability in the adult stage - OUTRAS ÁREAS

Biochem Biophys Res Commun. 2021 Jun 28;568:89-94. Online ahead of print.


Vishnu Raj, Agrima Nair, Anoopkumar Thekkuveettil

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.


Manganese (Mn), even though an essential trace element, causes neurotoxicity in excess. In adults, over-exposure to Mn causes clinical manifestations, including dystonia, progressive bradykinesia, disturbance of gait, slurring, and stuttering of speech. These symptoms are mainly because of Mn-associated oxidative stress and degeneration of dopamine neurons in the central nervous system. Children with excessive Mn exposure often show learning disabilities but rarely show symptoms associated with dopaminergic neuron dysfunction. It is unclear why Mn exposure shows distinctive clinical outcomes in developing brains versus adult brains. Studies on nematode C. elegans have demonstrated that it is an excellent model to elucidate Mn-associated toxicity in the nervous system. In this study, we chronically exposed Mn to L1 larval stage of the worms to understand the effects on dopamine neurons and cognitive development. The worms showed modified behavior to exogenous dopamine compared to the control. The dopamine neurons showed resistance to neurodegeneration on repeated Mn exposure during the adult stage. As observed in mammalian systems, these worms showed significantly low olfactory adaptive learning and memory. This study shows that C. elegans alters adaptive developmental plasticity during Mn overexposure, modifying its sensitivity towards the metal ion and leads to remodeling in its innate learning behavior.

PMID: 34198165 DOI: 10.1016/j.bbrc.2021.06.073




Measures of Psychological Impacts of Stuttering in Young School-Age Children: A Systematic Review - AVALIAÇÃO

J Speech Lang Hear Res. 2021 May 21;1-11. Online ahead of print.


Monique L Jones, Ross G Menzies, Mark Onslow, Robyn Lowe, Sue O'Brian, Ann Packman

University of Technology Sydney, Ultimo, New South Wales, Australia.


Purpose Recent research has shown that some school-age children who stutter may have speech-related anxiety. Given this, speech-language pathologists require robust measures to assess the psychological effects of stuttering during the school-age years. Accordingly, this systematic review aimed to explore available measures for assessing the psychological impacts of stuttering in young school-age children and to examine their measurement properties.

Method The systematic search protocol was registered with PROSPERO (ID: 163181). Seven online databases, in addition to manual searching and screening of reference lists, were used to identify appropriate measures for the population of children who stutter aged 7-12 years. The first two authors independently assessed the measures using the quality appraisal tool described by Terwee et al. (2007).

Results Despite the comprehensive search strategy, only six measures were identified for quality appraisal. No assessment tool was found to possess adequate measurement properties for the eight assessed domains: content validity, internal consistency, construct validity, reproducibility, reliability, responsiveness, floor and ceiling effects, and interpretability. No measure had clear evidence of responsiveness to clinical change. Based on the criterion defined by the Terwee et al. (2007) appraisal tool, the Communication Attitude Test and the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children received the highest number of ratings in support of their measurement properties.

Conclusions The results highlight a lack of available measures in this domain and poor practices in developing and testing measurement instruments. To ensure that clinicians and researchers are equipped with sound measures to meet the mental health needs of this vulnerable population, further research to establish resources is needed.

PMID: 34019770 DOI: 10.1044/2021_JSLHR-20-00455




Migraine and adult-onset stuttering: A proposed autoimmune phenomenon

Ann Clin Psychiatry. 2021 Feb;33(1):56-57.


Stephanie M Wong, Joyce Y Kim, Gerald A Maguire

Riverside, CA 92521, USA. Cite


No abstract available

PMID: 33529288 DOI: 10.12788/acp.0016




Perceptions of self-efficacy in providing multidimensional school-age stuttering therapy among board certified fluency specialists in the United States - OUTRAS ÁREAS

J Fluency Disord. 2021 Jun 17;69:105862. Online ahead of print.


Michael P Boyle, Carolina Beita-Ell, Nicole J Chagachbanian

Montclair State University, Bloomfield, NJ, United States.


Purpose: The purpose of this study was to document fluency specialists' self-efficacy beliefs for providing multidimensional treatment to children who stutter and to identify cognitive, affective, and behavioral correlates of self-efficacy.

Method: Sixty-six Board Certified Specialists in Fluency in the United States completed an online survey measuring self-efficacy in providing multidimensional stuttering therapy, perceived importance of multidimensional aspects of therapy, feelings of comfort in providing therapy, perceived treatment success, and employment and demographic questions. Open-ended questions were also asked for participants to describe why they chose to specialize and what benefits they received from it.

Results: Participants reported high levels of self-efficacy (averages above 9 on a scale from 0 to 10) in speech-related, cognitive, emotional, and social domains of stuttering therapy, as well as high levels of comfort and clinical success. Higher ratings of overall self-efficacy were significantly correlated with beliefs about the importance of multidimensional treatment, τ = 0.27, treatment comfort, τ = 0.25, and self-reported treatment success, τ = .49. Responses indicated that many participants believed that their self-efficacy grew because of specialty certification.

Conclusion: Although not the same as treatment outcome data, self-efficacy among clinical service providers is an important variable to consider. Board Certified Specialists in Fluency in the United States report very high levels of self-efficacy for school-age stuttering treatment. The process of certification helps to increase self-efficacy and provides a means for advertising competence in stuttering treatment. This information could help in recruiting the next generation of fluency specialists.

PMID: 34166997 DOI: 10.1016/j.jfludis.2021.105862




Perspectives of stuttering treatment: Children, adolescents, and parents - TERAPIA

J Fluency Disord. 2021 Jun 25;69:105863. Online ahead of print.


Heather D Salvo, Carol H Seery

University of Wisconsin-Milwaukee, United States


Purpose: Researchers investigated whether children who stutter (CWS), adolescents who stutter (ADWS), and their parents preferred treatment focused on changing speech or communicating regardless of stuttering.

Methods: Twenty-four parents and their CWS (n = 11, ages 8;0-12;11) or ADWS (n = 13, ages 13;0-17;11) answered questions about their preferences for stuttering treatment via an internet-based survey; an additional 11 surveys were filled in only by parents without responses by their child/adolescent. The researchers compared responses of the parents and their children, as well as between the two age groups and years in treatment (less than five years versus five or more years).

Results: Views tended to be mixed without any clear trends based on age. Just over half of the CWS, ADWS, and parents of CWS indicated a general tendency for therapy satisfaction; however, less years of treatment were associated with more satisfaction. When presented with a specific scenario, a higher proportion of parents expressed focus on their child saying what they want to say, regardless of stuttering. Otherwise, preferences were mixed on therapy goals of speaking freely vs. speaking more fluently.

Conclusions: Preferences for treatment goals do not predictably vary based on age or years in treatment; given the small sample size, these findings should be considered with caution. Given the variability in responses, it is evident that stuttering treatment for school-age children and adolescents should be individualized. These results also emphasize the importance of communication, education, and applying a person-centered approach when providing stuttering intervention to children, adolescents, and their parents.

PMID: 34214904 DOI: 10.1016/j.jfludis.2021.105863




Phonetic complexity and stuttering in Turkish-speaking children who stutter - FALA

Clin Linguist Phon. 2021 Jan 4;1-14. Online ahead of print.


Ayse Aydin Uysal, Dilek Fidan, Feda Yousef Al-Tamimi, Peter Howell

Kocaeli University , Kocaeli, Turkey; Jordan University of Science and Technology , Irbid, Jordan; University College London , London, UK.


The relationship between stuttering and phonetic complexity for words spoken by Turkish children who stutter was investigated. The research questions were: (1) Do Turkish-speaking children stutter more on unbound content words than on unbound function words? (2) Do Turkish-speaking children stutter more on words with higher phonetic complexity scores? Twenty-one monolingual children aged 6-11 years who had a clinical diagnosis of stuttering participated. Speech samples were transcribed and lexical categories determined. Phonetic complexity was assessed by an adaptation of Index of Phonetic Complexity (IPC) for Turkish. Results revealed that the mean rank of unbound content words differed significantly from the mean rank of unbound function words and that stuttering frequency for unbound content words was significantly higher than for unbound function words.

PMID: 33393379 DOI: 10.1080/02699206.2020.1866674




Plasticity of stereotyped birdsong driven by chronic manipulation of cortical-basal ganglia activity - OUTRAS ÁREAS

Curr Biol. 2021 May 5;S0960-9822(21)00543-1. Online ahead of print.


Sanne Moorman, Jae-Rong Ahn, Mimi H Kao

Utrecht University, CM Utrecht, the Netherlands; Tufts University, Medford, MA, USA.


Cortical-basal ganglia (CBG) circuits are critical for motor learning and performance, and are a major site of pathology. In songbirds, a CBG circuit regulates moment-by-moment variability in song and also enables song plasticity. Studies have shown that variable burst firing in LMAN, the output nucleus of this CBG circuit, actively drives acute song variability, but whether and how LMAN drives long-lasting changes in song remains unclear. Here, we ask whether chronic pharmacological augmentation of LMAN bursting is sufficient to drive plasticity in birds singing stereotyped songs. We show that altered LMAN activity drives cumulative changes in acoustic structure, timing, and sequencing over multiple days, and induces repetitions and silent pauses reminiscent of human stuttering. Changes persisted when LMAN was subsequently inactivated, indicating plasticity in song motor regions. Following cessation of pharmacological treatment, acoustic features and song sequence gradually recovered to their baseline values over a period of days to weeks. Together, our findings show that augmented bursting in CBG circuitry drives plasticity in well-learned motor skills, and may inform treatments for basal ganglia movement disorders.

PMID: 33974850 DOI: 10.1016/j.cub.2021.04.030




Predictors of communication attitude in preschool-age children who stutter - INFANTIL / EMOCIONAL

J Commun Disord. 2021 Apr 14;91:106100. Online ahead of print.


Katherine L Winters, Courtney T Byrd

The University of Texas at Austin, Austin, TX, United States.


Purpose: Although preschool-age children who stutter report more negative attitudes toward communication than their typically fluent peers, few investigations have explored factors that may contribute to the differences observed in communication attitude. The purpose of the present study was to explore whether behavioral characteristics of stuttering severity (frequency, duration, physical concomitants) and time since onset of stuttering predict communication attitude in preschool-age children.

Method: Fifty-nine preschool-aged children who stutter completed two speaking samples and the KiddyCAT, a self-report assessment of communication attitude. Speech samples were analyzed for stuttering frequency (measured by percentage of stuttered syllables), duration, and presence of physical concomitants. Linear regression models were used to assess if these behavioral measures of stuttering and time since onset of stuttering predicted self-reported communication attitude.

Results: Results indicate stuttering behavioral measures and time since onset do not predict KiddyCAT scores of preschool-age children who stutter.

Conclusions: Preliminary data suggest children who have presented with stuttering for a longer period of time are no more likely to report a negative communication attitude than children who have a shorter time since onset. Additionally, in contrast to school-age children who stutter, but similar to adults and adolescents who stutter, communication attitude is not linearly related to stuttering severity in preschool-age children.

PMID: 33862497 DOI: 10.1016/j.jcomdis.2021.106100




Preliminary study of self-perceived communication competence amongst adults who do and do not stutter - EMOCIONAL

J Fluency Disord. 2021 Apr 8;70:105848. Online ahead of print.


Danielle Werle, Katherine L Winters, Courtney T Byrd

University of Texas at Austin, Austin, TX, United States


Purpose: Adults who stutter report a significant impact of stuttering on their quality of life, including negative thoughts and attitudes toward communication. In addition to this impact, adolescents who stutter also report lower levels of self-perceived communication competence (SPCC) compared to fluent peers. The purpose of this study was to extend the investigation of SPCC to adults who do and do not stutter. Additional aims investigated included if 1) SPCC predicted overall impact of stuttering, and, 2) stuttering frequency predicted SPCC among adults who stutter.

Methods: Twenty-four adults who stutter and twenty-seven adults who do not stutter matched for age, gender, and education completed the Self-Perceived Communication Competence Scale (Richmond & McCroskey, 1997). All participants who stutter completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES [ages 18+]; Yaruss & Quesal, 2006) and speaking samples to measure stuttering frequency.

Results: Adults who stutter reported significantly lower SPCC scale total scores than adults who do not stutter. For adults who stutter, lower SPCC scale scores significantly predicted more severe overall impact of stuttering as measured by the OASES. Stuttering frequency did not predict SPCC scale scores.

Discussion: This is the first study to report differences in self-perceived communication competence between adults who do and do not stutter. Results suggest adults who stutter report lower self-perceived communication competence compared to adults who do not stutter. Adults who perceive themselves to have greater communication competence reported less severe overall impact of stuttering, and stuttering frequency did not influence SPCC. Clinical implications for intervention are discussed.

PMID: 33895686 DOI: 10.1016/j.jfludis.2021.105848




Prevalence and Therapy Rates for Stuttering, Cluttering, and Developmental Disorders of Speech and Language: Evaluation of German Health Insurance Data - CONCEITO

Front Hum Neurosci. 2021 Apr 12;15:645292. eCollection 2021.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071871/pdf/fnhum-15-645292.pdf


Martin Sommer, Andrea Waltersbacher, Andreas Schlotmann, Helmut Schröder, Adam Strzelczyk

German Stuttering Association, Cologne, Germany; University Medical Center Göttingen, Göttingen, Germany; Wissenschaftliches Institut der AOK (WIdO), AOK Research Institute, Berlin, Germany; Goethe University Frankfurt, Frankfurt, Germany.


Purpose: To evaluate the prevalence and treatment patterns of speech and language disorders in Germany.

Methods: A retrospective analysis of data collected from 32% of the German population, insured by the statutory German health insurance (AOK, Local Health Care Funds). We used The International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification (ICD-10 GM) codes for stuttering (F98.5), cluttering (F98.6), and developmental disorders of speech and language (F80) to identify prevalent and newly diagnosed cases each year. Prescription and speech therapy reimbursement data were used to evaluate treatment patterns.

Results: In 2017, 27,977 patients of all ages were diagnosed with stuttering (21,045 males, 75% and 6,932 females, 25%). Stuttering prevalence peaks at age 5 years (boys, 0.89% and girls, 0.40%). Cluttering was diagnosed in 1,800 patients of all ages (1,287 males, 71.5% and 513 females, 28.5%). Developmental disorders of speech and language were identified in 555,774 AOK-insurants (61.2% males and 38.8% females). Treatment data indicate a substantial proportion newly diagnosed stuttering individuals receive treatment (up to 45% of 6-year-old patients), with slightly fewer than 20 sessions per year, on average. We confirmed a previous study showing increased rates of atopic disorders and neurological and psychiatric comorbidities in individuals with stuttering, cluttering, and developmental disorders of speech and language.

Conclusion: This is the first nationwide study using health insurance data to analyze the prevalence and newly diagnosed cases of a speech and language disorder. Prevalence and gender ratio data were consistent with the international literature. The crude prevalence of developmental disorders of speech and language increased from 2015 to 2018, whereas the crude prevalence for stuttering remained stable. For cluttering, the numbers were too low to draw reliable conclusions. Proportional treatment allocation for stuttering peaked at 6 years of age, which is the school entrance year, and is later than the prevalence peak of stuttering.

PMID: 33912020 PMCID: PMC8071871 DOI: 10.3389/fnhum.2021.645292




Psychological characteristics of early stuttering – INFANTIL / EMOCIONAL

Int J Speech Lang Pathol. 2021 Apr 27;1-10. Online ahead of print.


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

The University of Sydney, Sydney, Australia; The University of Queensland, St Lucia, Australia; La Trobe University, Melbourne, Australia; Charles Sturt University, Albury, Australia; Macquarie University, Sydney, Australia; The University of Newcastle, Callaghan, Australia.


The purpose of this study was to use psychological measures of pre-schoolers who stutter and their parents to inform causal theory development and influence clinical practices. This was done using data from a substantive clinical cohort of children who received early stuttering treatment.
Method: The cohort (N = 427) comprised parents and their children who were treated with the Lidcombe Program, the Westmead Program, and the Oakville Program. The study incorporated demographic information, stuttering severity, and child and parent psychological measures prior to treatment.

Result: The cohort revealed nothing unusual about behavioural and emotional functioning, or the temperaments, of pre-school children that would influence treatment, be targeted during treatment, or influence causal theory development. However, a third of parents were experiencing moderate to high life stressors at the time of seeking treatment, and half the parents failed first-stage screening for Anankastic Personality Disorder.

Conclusion: The present results are consistent with a number of previous reports that showed that the population of pre-schoolers who stutter have no unusual psychological profiles. Hence, these results suggest that the association between mental health and stuttering later in life is a consequence of the disorder rather than being a part of its cause. The finding of the life stress of parents who seek stuttering treatment for pre-school children has potential clinical importance and warrants further investigation. Further psychological research is required about parents of pre-school children who stutter, because half the parents in the cohort failed the screener for Anankastic Personality Disorder. This is of interest because a previous study associated screening failure for another personality disorder (Impulsive Personality Disorder) with treatment dropout for early childhood stuttering.

PMID: 33906547 DOI: 10.1080/17549507.2021.1912826




Public attitudes towards people who stutter in South Egypt - SOCIAL

PLoS One. 2021 Feb 4;16(2):e0245673 eCollection 2021.

Free article: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245673


Ahmed Arafa, Shaimaa Senosy, Haytham A Sheerah, Kenneth St Louis

Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt; Osaka University, Osaka, Japan; West Virginia University, Morgantown, West Virginia, United States of America.


Purpose: Stuttering is a multifactorial speech disorder with significant social and psychological consequences. There is a lack of knowledge about public attitudes towards people who stutter (PWS) and the factors that can determine such attitudes in underprivileged communities. This study aimed to assess the public attitudes in South Egypt towards PWS and compare our results with those stored in a reference database representing 180 different samples.

Methods: A multi-stage random sampling approach was used to recruit 650 people from Beni-Suef City in South Egypt. All participants were interviewed using the Arabic version of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) after getting their informed consent. This instrument assesses people's Beliefs and Self Reactions towards PWS in addition to their sociodemographic characteristics.

Results: The Beliefs and Self Reactions subscores in addition to the Overall Stuttering Score of the Egyptian sample were remarkably lower than the median values of the reference database (12 versus 34), (-4 versus 2), and (4 versus 18), respectively. TV, radio, and films were the main sources of knowledge about stuttering. Egyptian participants who reported average to high income were more likely to have a positive attitude (≥50% of Overall Stuttering Score) towards PWS than their counterparts with low income (Odds Ratio = 1.57, 95% Confidence Interval: 1.08-2.28).

Conclusion: People in South Egypt showed a less positive attitude towards PWS compared with other populations worldwide. Further studies should focus on changing the public attitudes towards PWS through awareness programs that consider the cultural perspectives of the society.

PMID: 33539373 DOI: 10.1371/journal.pone.0245673




Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter - SOCIAL

J Fluency Disord. 2021 Feb 15;68:105830. Online ahead of print.


Anne Moïse-Richard, Lucie Ménard, Stéphane Bouchard, Anne-Lise Leclercq

University of Montreal, Canada; Université du Québec à Montréal, Canada; Université du Québec en Outaouais, Canada; l'Université de Liège, Belgium.


Purpose: Many school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter.

Methods: Ten children and adolescents who stutter (aged 9-17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions.

Results: Results show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment.

Conclusion: Our results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking.

PMID: 33662867 DOI: 10.1016/j.jfludis.2021.105830




Relationships between stigma-identity constructs and psychological health outcomes among adults who stutter - EMOCIONAL

J Fluency Disord. 2021 Mar 6;70:105842. Online ahead of print.


Hope Gerlach, Stephenie R Chaudoir, Patricia M Zebrowski

University of Iowa, United States; College of the Holy Cross, United States.


Purpose: In the current study, stuttering was conceptualized as a concealable stigmatized identity (CSI). The purpose of this investigation was to determine if four specific stigma-identity constructs that contribute to variability in psychological distress among people in other CSI groups also contribute among adult who stutter (AWS).

Method: 505 AWS completed an online survey that included measures of four stigma-identity constructs in addition to general demographics and measures of self-rated stuttering severity, distress, and adverse impact of stuttering on quality of life. Hierarchical regression was performed to determine the extent that stigma-identity constructs explained variability in psychological health outcomes among AWS. Self-rated stuttering severity was investigated as a moderator in these relationships.

Results: The stigma-identity constructs accounted for a significant proportion of the variability in distress (∼25 %) and adverse impact of stuttering on quality of life (∼30 %) among AWS. Further, the constructs of salience, centrality, and concealment were positively predictive of distress and adverse impact of stuttering after controlling for demographics and neuroticism. Compared to the other predictor variables (self-rated stuttering severity, demographic characteristics, neuroticism, and the three other stigma-identity constructs), concealment was the strongest predictor of adverse impact of stuttering on quality of life. Finally, self-rated stuttering severity was a moderating variable.

Conclusions: The results from this study suggest that there are useful applications in conceptualizing stuttering as a type of CSI. Speech-language pathologists should be aware of the relationships that stigma has with psychological health outcomes among AWS and should consider the implications for intervention.

PMID: 33713942 DOI: 10.1016/j.jfludis.2021.105842




Reliability of judgments of stuttering-related variables: The effect of language familiarity - AVALIAÇÃO

J Fluency Disord. 2021 May 5;69:105851. Online ahead of print.


Rosemarie E Sepulveda, Jason H Davidow, Evelyn P Altenberg, Zoran Šunić

Hofstra University, United States.


Previous studies demonstrate mixed results and some methodological limitations regarding judges' ability to reliably assess stuttering-related variables in an unfamiliar language. The present study examined intra- and inter-rater reliability for percent syllables stuttered (%SS), stuttering severity (SEV), syllables per minute (SPM), and speech naturalness (NAT) when English-speaking judges viewed speech samples in English and in a language with which they had no or minimal familiarity (Spanish). Over two time periods, 21 judges viewed eight videos of four bilingual persons who stutter. Data were analyzed for relative and absolute intra- and inter-rater reliability as well as for an effect of language on time period differences. Intra- and inter-rater relative reliability were good or excellent for all measures in both languages, with the exception of inter-rater relative reliability for NAT in both languages and %SS in Spanish. Intra-rater absolute reliability was acceptable in both languages for NAT and SEV and unacceptable in both for SPM and %SS. Inter-rater absolute reliability in both languages was unacceptable for all measures, even with judges with the same training. There was a clinically significant effect of language on %SS scores, but, despite a statistically significant effect of language for SPM and SEV, the differences were not clinically significant. Results indicate that reliability across and within languages varies by measure and is impacted by intra- vs. inter-rater reliability, relative vs. absolute reliability, and language familiarity. Modifications in training may be able to address some of the limitations found, particularly with regard to SPM and NAT.

PMID: 34033989 DOI: 10.1016/j.jfludis.2021.105851




Rhyming abilities in a dual-task in school-age children who stutter - LINGUAGEM

J Fluency Disord. 2021 Jul 16;69:105864. Online ahead of print.


Jayanthi Sasisekaran, Shriya Basu

University of Minnesota, USA; California State University, Long Beach, CA, USA.


Purpose: We compared school-age children who stutter (CWS) and age and gender matched control participants (CWNS) in a dual-task involving a word-level rhyming task and a tone task involving pitch decisions.

Methods: Participants were 30 children (CWS, n = 15) between 7 and 16 years. Auditory word - picture stimuli pairs from the rhyme task were categorized into nonrhyme (e.g., bear-cart), rhyme (e.g., bear-pear), and replica (e.g., bear-bear) categories. The effort associated with managing resources in the dual-task was varied through the manipulation of stimulus onset asynchrony (SOA) between the stimuli of the two tasks. Mixed methods analyses of the response time (RT, ms) and error (%) data were conducted with Group, Category, and SOA as the fixed effects and participants as the random effect. Age and phoneme awareness skills were included in the analyses.

Results: More rhyming errors and a significant positive correlation between rhyming errors and age was observed in the CWS compared to the CWNS. Compared to the CWNS, a higher percentage of rhyming errors was observed in the rhyme than the nonrhyme and replica categories in the CWS in both the SOA conditions, and this effect was influenced by age and phoneme awareness skills. Analysis of the tone task data indicated that a subgroup of CWNS with higher phoneme awareness skills showed reduced RT difference between the long and the short SOA conditions thereby suggesting higher efficiency with resource allocation for dual tasking. Task-specific differences between the CWS and CWNS are interpreted to suggest limitations in the encoding of the phonological aspects of covert speech in a dual-task.

PMID: 34325231 DOI: 10.1016/j.jfludis.2021.105864




'Satan is holding your tongue back': Stuttering as moral failure - SOCIAL

Afr J Disabil. 2021 Apr 23;10:773.


Dane H Isaacs

Stellenbosch University, Stellenbosch, South Africa; Human Sciences Research Council, Cape Town, South Africa.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111662/pdf/AJOD-10-773.pdf


Background: The last decade has seen researchers and speech-language pathologists employ and advocate for a disability studies approach in the study of the lived experiences of people who stutter and in the design of interventions and treatment approaches for such individuals. Joshua St. Pierre, one of the few theorists to explore stuttering as a disability, mentions as a key issue the liminal nature of people who stutter when describing their disabling experiences.

Objectives: This article aimed to build on the work of St. Pierre, exploring the liminal nature of people who stutter.

Method: Drawing on my personal experiences of stuttering as a coloured South African man, I illuminated the liminal nature of stuttering.

Results: This analytic autoethnography demonstrates how the interpretation of stuttering as the outcome of moral failure leads to the discrimination and oppression of people who stutter by able-bodied individuals as well as individuals who stutter.

Conclusion: As long as stuttering is interpreted as the outcome of moral failure, the stigma and oppression, as well as the disablism experience by people who stutter, will continue to be concealed and left unaddressed.

PMID: 34007818 PMCID: PMC8111662 DOI: 10.4102/ajod.v10i0.773




Sleep duration, insomnia, and stuttering: The relationship in adolescents and young adults - AMBIENTE

J Commun Disord. 2021 May 7;91:106106. Online ahead of print.


Molly M Jacobs , Sandra Merlo, Patrick M Briley

East Carolina University, 4340E Health Sciences Building, Greenville, NC, United States; Brazilian Fluency Institute, Sao Paulo, Brazil.


Purpose: Evidence of a linkage between neurodevelopmental stuttering and sleep difficulties has been suggested in studies involving children and adolescents. To further examine the relationship between stuttering and sleep, the current study explored both hours of sleep and insomnia in a longitudinal sample of adolescents and young adults living with stuttering.

Method: The data for this study came from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative survey study following 13,564 US respondents over the course of 20 years. In each of the five survey waves, respondents noted their average hours of sleep. In addition, Wave IV, respondents indicated whether they suffered from insomnia (i.e., difficulty falling or staying asleep). Respondents who indicated stuttering at ages 18-26 (Wave III) and 24-32 (Wave IV) are considered as those with persistent stuttering-the focus of this analysis. Regression analysis assessed the association between stuttering, hours of sleep and insomnia controlling for sex, age, race, education and other demographic characteristics.

Results: The sample included 261 participants (1.7% of total respondents) who identified themselves as people who stutter, comprised of 169 males and 92 females. Compared to their fluent counterparts, individuals who stutter reported to sleep, on average, 20 min less per night. Additionally, 15% of those who stutter reported difficulties falling or staying asleep almost every day or every day, which is twice as likely as controls. Results were robust to demographic characteristics and co-occurring conditions.

Conclusions: Speech-language pathologists should be aware of the association between stuttering and insomnia, as well as the lower average hours of sleep among adolescents and young adults who stutter. The possibility that lower sleep duration and insomnia may affect stuttering daily variability and impair improvement from stuttering are discussed.

PMID: 34015644 DOI: 10.1016/j.jcomdis.2021.106106




Societal knowledge of stuttering in Saudi population - SOCIAL

Saudi J Biol Sci. 2021 Jan;28(1):664-668. Epub 2020 Nov 4.

Free Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783795/pdf/main.pdf


Abdulaziz Almudhi, Mansour Aldokhi, Ibrahim Reshwan, Sultan Alshehri

King Khalid University, Abha, Saudi Arabia; Speech Fluency Clinic, Abha, Saudi Arabia; Prince Sultan Armed Forces Hospital, Medina, Saudi Arabia; AlKharj Armed Forces Hospital, AlKharj, Saudi Arabia.


Stuttering is a common disease that exists in all societies and ethnic groups of differing incidence rates. The aim of this study was therefore to investigate the social awareness of stuttering in the Saudi community on the basis of a questionnaire. We will try to examine the incidence, triggers and duration of stuttering in the Saudi community. This study is descriptive, a questionnaire-based analysis involving the active participation of the Saudi community. The questionnaire, exposure to Stuttering, was addressed and balanced in terms of ethnicity, age and schooling. A total of 1,000 Saudi people was invited to participate in this questionnaire-based survey, with only 878 participants between 18 and 65 years of age participating in the study; most of them were males. In this survey, 79.5% of the Saudi population studies, most of them male (60.5% vs. 25.0% female) claimed that more than 6% of the population had stutters. There was also a substantial correlation between the degree of schooling, sex, and person experience and attitudes towards stuttering. It was often assumed that younger ages were prone to higher instances of stuttering relative to older ages (≤18 years vs 18 years of age). In comparison, handiness and IQ scores did not indicate any correlation with the occurrence of stuttering among the Saudi community. In conclusion, this questionnaire-based analysis, participants of both sexes claimed that more than 6% of the Saudi population were impaired by stuttering, which increased dramatically in males relative to females. They also claimed that both handiness and IQ ratings had little impact on the rate of stuttering. However, scant research on the effects of stuttering has scarcely been reported. Future experiments of effective public education preparation and health actions for stuttering are also welcome.

PMID: 33424353 PMCID: PMC7783795 DOI: 10.1016/j.sjbs.2020.10.057




Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research - EMOCIONAL

J Speech Lang Hear Res. 2021 Jan 14;64(1):59-74. Epub 2021 Jan 5.


Robyn Lowe, Ross Menzies, Mark Onslow, Ann Packman, Sue O'Brian

University of Technology Sydney, Ultimo, New South Wales, Australia.


Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety.

Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management.

Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts.

Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

PMID: 33400555 DOI: 10.1044/2020_JSLHR-20-00144




Speech auditory-motor adaptation to formant-shifted feedback lacks an explicit component: reduced adaptation in adults who stutter reflects limitations in implicit sensorimotor learning - AUDITIVO

Eur J Neurosci. 2021 Mar 6. Online ahead of print.


Kwang S Kim, Ludo Max

University of Washington, Seattle, WA, USA; University of California San Francisco, San Francisco, CA, USA; Haskins Laboratories, New Haven, CT, USA.


The neural mechanisms underlying stuttering remain poorly understood. A large body of work has focused on sensorimotor integration difficulties in individuals who stutter, including recently the capacity for sensorimotor learning. Typically, sensorimotor learning is assessed with adaptation paradigms in which one or more sensory feedback modalities are experimentally perturbed in real-time. Our own previous work on speech with perturbed auditory feedback revealed substantial auditory-motor learning limitations in both children and adults who stutter (AWS). It remains unknown, however, which sub-processes of sensorimotor learning are impaired. Indeed, new insights from research on upper limb motor control indicate that sensorimotor learning involves at least two distinct components: (a) an explicit component that includes intentional strategy use and presumably is driven by target error, and (b) an implicit component that updates an internal model without awareness of the learner and presumably is driven by sensory prediction error. Here, we attempted to dissociate these components for speech auditory-motor learning in AWS vs. adults who do not stutter (AWNS). Our formant-shift auditory-motor adaptation results replicated previous findings that such sensorimotor learning is limited in AWS. Novel findings are that neither control nor stuttering participants reported any awareness of changing their productions in response to the auditory perturbation, and that neither group showed systematic drift in auditory target judgments made throughout the adaptation task. These results indicate that speech auditory-motor adaptation relies exclusively on implicit learning processes. Thus, limited adaptation in AWS reflects poor implicit sensorimotor learning.

PMID: 33675539 DOI: 10.1111/ejn.15175




Speech fluency in bilinguals who stutter: Language proficiency and attentional demands as mediating factors - LINGUAGEM

J Fluency Disord. 2021 Apr 23;69:105850. Online ahead of print.


Evy Woumans, Lize Van der Linden, Robert Hartsuiker, Wouter Duyck, Caroline Moerenhout, Marie-Pierre de Partz, Aurélie Pistono, Miet De Letter, Arnaud Szmalec

Ghent University, Ghent, Belgium; Université catholique de Louvain, Louvain-la-Neuve, Belgium; Stutter treatment center Algemene Aanpak Stotteren and Belgian Stuttering Association vzw BeSt, Ghent, Belgium.


Purpose: The current study examines how speech disfluencies manifest themselves in the two languages of bilingual persons who stutter, starting from the hypothesis that stuttering is associated with an attentional deficit at the level of speech production.

Methods: Twenty-eight bilingual people who stutter performed a spontaneous and a controlled speech production task, once in their dominant and once in their non-dominant language. The controlled production task (i.e. a network description task) was carried out once under a full-attention condition and once under a divided-attention condition where a non-linguistic, pitch discrimination task was performed simultaneously.

Results: In both the spontaneous and the controlled speech task, bilingual persons who stutter produced more (typical and stuttering-like) disfluencies in their L2 than in their L1. Furthermore, whereas the typical disfluencies increased when attention was directed away from speech production, stuttering-like disfluencies decreased. This effect was however restricted to L2. In addition, L2 proficiency was generally found to be a predicting factor, with higher proficiency leading to fewer disfluencies.

Conclusions: These results suggest that speaking in a non-dominant language increases both typical and stuttering-like disfluencies in bilingual persons who stutter, but also that these two types of dysfluencies differ regarding their attentional origins. Our findings offer further support for attentional accounts of stuttering and have both theoretical and clinical implications.

PMID: 33965883 DOI: 10.1016/j.jfludis.2021.105850




Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering

Int J Lang Commun Disord. 2021 Jun 29. Online ahead of print.


Adriana Penman, Anne E Hill, Sally Hewat, Nerina Scarinci

The University of Queensland, St Lucia, QLD, Australia; The University of Newcastle, Newcastle, NSW, Australia.


Background: Research suggests that some speech-language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech-language pathology programmes and the limited number of stuttering-specific placements available. Simulation-based learning is a viable option for providing speech-language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation-based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation-based learning are yet to be explored.

Aims: To investigate speech-language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation-based learning programme.

Methods & procedures: This study used a cross-sectional survey design. Participants were 105 undergraduate and graduate entry masters speech-language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation-based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre-course (T1), pre-simulation (T2) and post-simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively.

Outcomes & results: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre-course and pre-simulation. Open-ended responses on the post-simulation survey revealed that students valued learning about stuttering within a simulation-based learning environment.

Conclusions & implications: Simulation-based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation-based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter.

PMID: 34185338 DOI: 10.1111/1460-6984.12645




Speech Movement Variability in People Who Stutter: A Vocal Tract Magnetic Resonance Imaging Study - FALA

J Speech Lang Hear Res. 2021 Jun 22;1-15. Online ahead of print.


Charlotte E E Wiltshire, Mark Chiew, Jennifer Chesters, Máiréad P Healy, Kate E Watkins

University of Oxford, United Kingdom.


Purpose People who stutter (PWS) have more unstable speech motor systems than people who are typically fluent (PWTF). Here, we used real-time magnetic resonance imaging (MRI) of the vocal tract to assess variability and duration of movements of different articulators in PWS and PWTF during fluent speech production.
Method The vocal tracts of 28 adults with moderate to severe stuttering and 20 PWTF were scanned using MRI while repeating simple and complex pseudowords. Midsagittal images of the vocal tract from lips to larynx were reconstructed at 33.3 frames per second. For each participant, we measured the variability and duration of movements across multiple repetitions of the pseudowords in three selected articulators: the lips, tongue body, and velum.
Results PWS showed significantly greater speech movement variability than PWTF during fluent repetitions of pseudowords. The group difference was most evident for measurements of lip aperture using these stimuli, as reported previously, but here, we report that movements of the tongue body and velum were also affected during the same utterances. Variability was not affected by phonological complexity. Speech movement variability was unrelated to stuttering severity within the PWS group. PWS also showed longer speech movement durations relative to PWTF for fluent repetitions of multisyllabic pseudowords, and this group difference was even more evident as complexity increased.
Conclusions Using real-time MRI of the vocal tract, we found that PWS produced more variable movements than PWTF even during fluent productions of simple pseudowords. PWS also took longer to produce multisyllabic words relative to PWTF, particularly when words were more complex. This indicates general, trait-level differences in the control of the articulators between PWS and PWTF. Supplemental Material https://doi.org/10.23641/asha.14782092.
PMID: 34157239 DOI: 10.1044/2021_JSLHR-20-00507




Speech rate association with cerebellar white-matter diffusivity in adults with persistent developmental stuttering - NEUROCIÊNCIAS

Brain Struct Funct. 2021 Feb 4. Online ahead of print.


Sivan Jossinger, Vered Kronfeld-Duenias, Avital Zislis, Ofer Amir, Michal Ben-Shachar

Bar-Ilan University, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.


Speech rate is a basic characteristic of language production, which affects the speaker's intelligibility and communication efficiency. Various speech disorders, including persistent developmental stuttering, present altered speech rate. Specifically, adults who stutter (AWS) typically exhibit a slower speech rate compared to fluent speakers. Evidence from imaging studies suggests that the cerebellum contributes to the paced production of speech. People who stutter show structural and functional abnormalities in the cerebellum. However, the involvement of the cerebellar pathways in controlling speech rate remains unexplored. Here, we assess the association of the cerebellar peduncles with speech rate in AWS and control speakers. Diffusion MRI and speech-rate data were collected in 42 participants (23 AWS, 19 controls). We used deterministic tractography with Automatic Fiber segmentation and Quantification (AFQ) to identify the superior, middle, and inferior cerebellar peduncles (SCP, MCP, ICP) bilaterally, and quantified fractional anisotropy (FA) and mean diffusivity (MD) along each tract. No significant differences were observed between AWS and controls in the diffusivity values of the cerebellar peduncles. However, AWS demonstrated a significant negative association between speech rate and FA within the left ICP, a major cerebellar pathway that transmits sensory feedback signals from the olivary nucleus into the cerebellum. The involvement of the ICP in controlling speech production in AWS is compatible with the view that stuttering stems from hyperactive speech monitoring, where even minor deviations from the speech plan are considered as errors. In conclusion, our findings suggest a plausible neural mechanism for speech rate reduction observed in AWS.

PMID: 33538875 DOI: 10.1007/s00429-020-02210-7




Stuttering and incident type 2 diabetes: a population-based study of 2.2 million adolescents - CONCEITO

J Clin Endocrinol Metab. 2021 Jan 15;dgaa988. Online ahead of print.


Avishai M Tsur, Shir Hershkovich, Inbar Zucker, Miri Lutski, Orit Pinhas-Hamiel, Asaf Vivante, Maya Fischman, Ofer Amir, Jacob Rotchild, Hertzel C Gerstein, Tali Cukierman-Yaffe, Limor Friedensohn, Ofri Mosenzon, Estela Derazne, Dorit Tzur, Amir Tirosh, Arnon Afek, Itamar Raz, Gilad Twig

The Israel Defense Forces Medical Corps, Ramat Gan, Israel; Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel; Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel; McMaster University, Hamilton, Ontario, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel.


Purpose: To investigate the association between stuttering in adolescence and incident type 2 diabetes in young adulthood.

Materials and methods: This nationwide population-based study included 2,193,855 adolescents of age 16-20 years who were assessed for military service between 1980 and 2013. Diagnoses of stuttering in adolescence were confirmed by a speech-language pathologist. Diabetes status for each individual as of December 31, 2016, was determined by linkage to the Israeli National Diabetes Registry. Relationships were analysed using regression models adjusted for socioeconomic variables, cognitive performance, coexisting morbidities, and adolescent BMI.

Results: Analysis was stratified by sex (pinteraction=0.035). Of the 4,443 (0.4%) adolescent men with stuttering, 162 (3.7%) developed type 2 diabetes, compared to 25,678 (2.1%) men without stuttering (adjusted odds ratio 1.3, 95% CI 1.1-1.6). This relationship persisted when unaffected brothers of men with stuttering were used as the reference group (adjusted OR=1.5, 95%CI 1.01-2.2), or when the analysis included only adolescents with unimpaired health at baseline (adjusted OR=1.4, 95%CI 1.1-1.7). The association was stronger in later birth cohorts with an adjusted OR of 2.4 (1.4-4.1) for cases of type 2 diabetes before age 40. Of the 503 (0.1%) adolescent women with stuttering 7 (1.4%) developed type 2 diabetes, compared to 10,139 (1.1%) women without stuttering (OR=2.03, 95%CI 0.48-2.20).

Main conclusions: Adolescent stuttering is associated with an increased risk for early-onset type 2 diabetes among men.

PMID: 33449080 DOI: 10.1210/clinem/dgaa988




Stuttering: Initiating Factors, Evolution, Healing Perspectives - SUPERFICIAL

Georgian Med News. 2021 Jan;(310):23-28.


M Zenaishvili, Sh Japaridze, A Tushishvili, O Davitashvili, Z Kevanishvili

National Centre of Audiology; Tbilisi, Georgia; National Centre of Otorhinolaryngology; Tbilisi, Georgia; Georgian Technical University, Archil Eliashvili Institute of Control Systems; Tbilisi, Georgia.


Despite high amount of incidents, no scientific paper existed up to now in Georgia dealing with the stuttering. In present essay the views over are collated. It is confirmed that the phenomenon reflects the speech rate and/or the rhythm distortions created by convulsive type involuntary contractions of voice-producing muscles. The disorder is either congenital or acquired. Complicated pregnancy and/or delivery, heavy and/or recurred somatic diseases, speech-formation delay, conflicting social situations appear the main provoking/supporting factors of. The stuttering covers physical and psychological symptoms. The physicals are manifested in speech muscle twitches, while the psychological in phobias. Neurotic and neurotic-like stuttering types are differentiated. The neurotics arise on the background of psychological disorders, the linkage of the neurotic-likes with any concrete factor being mostly difficult or impossible. It is emphasized that the stuttering treatment demands the complex application of pedagogical and medical means and aims the cure of the whole organism, while predominantly of the nervous system, and improvement of mode-of-life conditions of the sufferer. The necessity of the cure of associated diseases is emphasized. It is stated that the stuttering psychotherapy implies the blockage of mental disturbances, while the speech recovery trials intends the establishment of adequate voice, articulation, and respiratory functions. In utilized habilitation/rehabilitation means the particular attention has to draw to initiation of well-balanced logo-rhythms. The regulation of hemisphere speech-center function is a primary target of the vocal exercises applied. Achievements attained in study sessions are regularly spread over the vital situations. The favorable social environment is also regarded as an important item for the pathology defeat. The significance of the systematic cure interventions is emphasized the frequent and/or long-term pauses between being judged as the cause of habit remissions happened. Just compound and customary treatment and active involvement of parents and other family members in applied efforts ensure the better chances for the positive care output.

PMID: 33658404




Telepractice in School-Age Children Who Stutter: A Controlled Before and After Study to Evaluate the Efficacy Of MIDA-SP - INFANTIL / TERAPIA

Int J Telerehabil. 2021 Jun 22;13(1):e6380.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287732/pdf/ijt-13-e6380.pdf


Donatella Tomaiuoli, Francesca Del Gado, Sara Marchetti, Lisa Scordino, Diletta Vedovelli

Center of Research and Cure of Rome, Rome, Italy; Sapienza University of Rome, Rome, Italy; University of Rome Tor Vergata, Rome, Italy.


The COVID-19 pandemic necessitated a general reorganization of rehabilitation services in Italy. The lockdown in Italy led to the use of telepractice for the delivery of speech therapy, including stuttering. The aim of the present work was to evaluate the effectiveness of the Multidimensional, Integrated, Differentiated, Art-Mediated Stuttering Program (MIDA-SP; Tomaiuoli et al., 2012), delivered online for school-age children who stutter. A non-randomized controlled pre- and post-treatment study included an experimental group (11 children) receiving a telepractice adaptation of MIDA-SP and a historical control group (11 children) receiving in-person MIDA-SP. Both groups had been assessed with the Stuttering Severity Instrument - Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering (OASES-S) pre- and post-treatment. No statistically significant differences were found between the two modes of delivery. These findings suggest that MIDA-SP treatment delivered via telepractice is effective for school-age children who stutter.

PMID: 34345351 PMCID: PMC8287732 DOI: 10.5195/ijt.2021.6380




Temperament and the Impact of Stuttering in Children Aged 8-14 Years - EMOCIONAL

J Speech Lang Hear Res. 2021 Jan 19;1-16. Online ahead of print.


Kurt Eggers, Sharon Millard, Elaine Kelman

Thomas More University College, Belgium; University of Turku, Finland; Michael Palin Centre, London, United Kingdom; University of London, United Kingdom.


Purpose The goal of this study was to evaluate possible associations between child- and mother-reported temperament, stuttering severity, and child-reported impact of stuttering in school-age children who stutter. Method Participants were 123 children who stutter (94 boys and 29 girls) who were between 9;0 and 14;10 (years;months) and their mothers. Temperament was assessed with the revised child and parent version of the Early Adolescent Temperament Questionnaire-Revised (Ellis & Rothbart, 2001). The Overall Assessment of the Speaker's Experience of Stuttering (Yaruss & Quesal, 2006) was used to evaluate the stuttering impact. Results Child- and mother-reported Early Adolescent Temperament Questionnaire-Revised temperament factors correlated moderately. No statistically significant associations were found between temperament and stuttering severity. The temperament factors of Surgency (both child- and mother-reported) and Negative Affect (only child-reported) correlated moderately with the Overall Impact and several subsections (i.e., Speaker's Reactions, Daily Communication, and/or Quality of Life) of the Overall Assessment of the Speaker's Experience of Stuttering.
Conclusions More extraverted and less fearful/shy children experience a lower overall impact of their stuttering. Children with higher levels of irritability and frustration experience a higher overall impact of their stuttering. Since children's ratings of temperament were more sensitive to these associations than mothers, this study supports the inclusion of child-reported temperament questionnaires in future research.

PMID: 33465312 DOI: 10.1044/2020_JSLHR-20-00095




Temperament is Linked to Avoidant Responses to Stuttering Anticipation - EMOCIONAL

J Commun Disord. 2021 Jun 17;93:106139. Online ahead of print.


Naomi H Rodgers, Eric S Jackson

University of Nebraska-Lincoln; New York University.


Purpose: The purpose of the present study was to examine the degree to which certain temperament constructs predict individual differences in three types of behavioral responses to anticipation among children and adults who stutter (CWS and AWS, respectively): avoidance, physical change, and approach.

Methods: Participants included 64 CWS (9- to 17-years-old) and 54 AWS (18- to 50-years-old) who completed an online survey package including a temperament questionnaire (Early Adolescent Temperament Questionnaire-Revised for the CWS; Adult Temperament Questionnaire for the AWS) and the Stuttering Anticipation Scale. The data were analyzed separately for CWS and AWS using multivariate multiple regressions to assess how each temperament construct predicted avoidance, physical change, and approach responses to anticipation.

Results: CWS who reported higher levels of shyness were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. AWS who reported higher levels of orienting sensitivity were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. No temperament constructs predicted physical change or approach responses to anticipation among either age group.

Conclusion: Specific aspects of temperament appear to be linked to the degree that CWS and AWS engage in avoidant behavioral responses to stuttering anticipation. These findings support the continued study of how individual differences impact the internal experience and outward manifestation of stuttering behaviors.

PMID: 34175560 DOI: 10.1016/j.jcomdis.2021.106139




The Communication Benefits of Participation in Camp Dream. Speak. Live.: An Extension and Replication - TERAPIA EM GRUPO

Semin Speech Lang. 2021 Mar;42(2):117-135. Epub 2021 Mar 16.


Courtney T Byrd, Katherine L Winters, Megan Young, Danielle Werle, Robyn L Croft, Elizabeth Hampton, Geoffrey Coalson, Andrew White, Zoi Gkalitsiou

The University of Texas at Austin, Austin, Texas; Louisiana State University, Baton Rouge, Louisiana.


School-based guidelines often require that treatment focuses on minimizing or eliminating stuttered speech. The purpose of this study was to examine the benefits of explicit training in communication competencies to children who stutter without targeting stuttered speech. Thirty-seven children (ages 4-16) completed Camp Dream. Speak. Live., an intensive group treatment program which targets the psychosocial needs and communication of children who stutter. Outcome measures included the Overall Assessment of the Speaker's Experience of Stuttering (OASES), the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT), and the Patient Reported Measurement Information System (PROMIS) Pediatric Peer Relationships Short Form (PROMIS Peer Relationships) and Parent Proxy Peer Relationships Short Form (PROMIS Parent Proxy). Pre- and posttreatment public presentations were rated on nine core verbal and nonverbal communication competencies by a neutral observer. Similar to previous studies, participants demonstrated significant improvements in communication attitudes (OASES) and perceived ability to establish peer relationships (PROMIS Peer Relationships), particularly school-aged participants (ages 7-16). Participants also demonstrated significant improvement in eight of the nine communication competencies. Findings suggest that, in addition to the psychosocial gains of programs such as Camp Dream. Speak. Live., children who stutter benefit from explicit training in communication skills, and these gains are not dependent on the presence of stuttered speech.

PMID: 33725730 DOI: 10.1055/s-0041-1723843





The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications - NEUROCIÊN
Front Neurol. 2021 Feb 24;12:641586.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7959833/pdf/fneur-12-641586.pdf

Emanuele La Corte et al

Istituto Neurologico Carlo Besta, Milan, Italy; Università degli Studi di Milano, Milan, Italy; University Medical Center Mainz, Mainz, Germany.


The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual-motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix-Chavany-Marie syndrome, social communication deficit in autism spectrum disorders, and attention-deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.

PMID: 33732210 PMCID: PMC7959833 DOI: 10.3389/fneur.2021.641586




The impact of self-reported levels of anxiety on respiratory sinus arrhythmia levels in adults who stutter - EMOCIONAL

J Commun Disord. 2021 Feb 3;90:106084 Online ahead of print.


Kim R Bauerly, Robin M Jones

University of Vermont, United States; Vanderbilt University, United States.


Purpose: This study investigated whether subjective levels of anxiety predict respiratory sinus arrythmia (RSA) levels in adults who stutter (AWS) compared to (ANS) during baseline and social stress situations.

Methods: Participants were eight AWS and 10 ANS who performed a modified version of the Trier Social Stress Test (TSST-M). For this, participants were required to prepare and deliver a 5-minute speech and perform a nonword reading task in front of what was perceived as a group of professionals trained in public speaking. Measures of respiratory sinus arrhythmia (RSA) were calculated for baseline and TSST-M conditions. Participants also completed the State-Trait Anxiety Inventory (STAI), both the trait (STAI-T) and state (STAI-S) portion, which served as subjective anxiety ratings. Univariate analyses of variances (UNIANOVA) were used to assess the effects of the STAI-T and STAI-S anxiety on respiratory sinus arrhythmia (RSA) levels at pre-stress and TSST-M conditions. RSA, an index of parasympathetic nervous system activity, is considered to be a measure of emotional regulation. The strength of the effects of STAI-T and STAI-S on RSA levels was evaluated with the unstandardized coefficients for each group separately.

Results: Results showed a significant difference between groups for the effects of STAI-T on RSA values for the pre-stress nonword reading task. No other significant differences were found between groups for the pre-stress or TSST-M conditions. Slope estimates showed that STAI-T was a significant predictor of RSA values for pre-stress speaking conditions for the AWS but not ANS. No significant fixed effects or interaction effects were found for the STAI-S and RSA levels in the AWS or ANS. Nor were there significant effects of STAI-T on RSA levels in the AWS or ANS for TSST-M conditions. Descriptive analysis revealed the effects found in the AWS during pre-stress conditions were attributed to a subgroup of AWS who reported low self-reports of anxiety (i.e. STAI-T) and high levels of emotional regulation (i.e. RSA) across social stress conditions.

Discussion: Low self-reported STAI-T scores simultaneous with high RSA levels in some AWS may reflect a self-regulatory strategy adapted in response to chronic, daily stress associated with stuttering.
PMID: 33611109 DOI: 10.1016/j.jcomdis.2021.106084




The Impact of Stuttering—Hiding in Plain Sight - SOCIAL

JAMA Neurol. 2021 Apr 12. Online ahead of print

Free Full Texthttps://jamanetwork.com/journals/jamaneurology/article-abstract/2778096


Patrick M. Briley, Charles Ellis Jr, Molly M. Jacobs

East Carolina University, Greenville, North Carolina


While the grandeur of the US presidency has historically been accompanied by eloquent speeches and a confident demeanor, President Joe Biden has the potential to shatter this guise of perfection. Often criticized as “hiding in plain sight,” Biden’s mental stamina and intellectual fortitude have also been questioned. Less attention has been given to his long-standing issue with stuttering and the substantial stigma associated with the condition. Stuttering is a communication disorder that poses difficulty in the processes of speech for millions of people living in the US and is now part of the core of President Biden’s journey as a man who is perceived by many as the most powerful person in the world. With that power comes significant responsibility and criticism that will ultimately revitalize interest in this multifaceted disorder.




The investigation of the validity and reliability of the Turkish version of the Wright and Ayre Stuttering Self-Rating Profile (WASSP) - AVALIAÇÃO

Int J Lang Commun Disord. 2021 Apr 19. Online ahead of print.


Halil Tayyip Uysal, Ayşen Köse

Ankara Yıldırım Beyazıt University, Ankara, Turkey; Hacettepe University, Ankara, Turkey.


Background: Self-assessments for adults who stutter are recommended as a primary evaluation tool for including their views on stuttering. Evaluating adults who stutter with self-assessment scales is important. However, there is no tool in the Turkish literature that provides this measurement.

Aims: To develop the Turkish version of The Wright and Ayre Stuttering Self-Rating Profile (WASSP) in order to analyse its validity and reliability, and investigate its applicability for Turkish-speaking individuals.

Methods & procedures: The study included 120 adults who stutter (aged 18-54 years). All the participants completed The Wright and Ayre Stuttering Self-Rating Profile-Turkish version (WASSP-TR) and the SF-36 form. The reliability analysis involved the calculation of Cronbach's alphas for test-retest and the Pearson product-moment correlation coefficient for internal consistency. The validity analysis, in turn, involved a confirmatory factor analysis for construct validity and testing correlations with the SF-36 for criterion validity.

Outcomes & results: Internal consistency coefficients of the WASSP-TR were reported to be high (> 0.70). The correlations between the WASSP-TR and its subscales showed significant results (0.858-0.966) (p < 0.01). The correlation between the subscales of the WASSP-TR and the SF-36 was reported to be consistent (from -0.492 to 0.747). There was a positive correlation between stuttering severity groups and the WASSP-TR scores (p < 0.01).

Conclusions & implications: The WASSP-TR is a valid and reliable scale for Turkish-speaking adults who stutter. What this paper adds What is already known on the subject Self-assessment tools are recommended as a primary use when assessing adults who stutter. The WASSP is one of these measurement tools. However, the adaptation, validity and reliability study of the WASSP to Turkish has not been investigated. What this paper adds to existing knowledge This study shows that the Turkish version of the WASSP scale is valid and reliable and can be used with adults who stutter. Furthermore, the present adaptation study has been developed in order to evaluate social-emotional aspects of stuttering. What are the potential or actual clinical implications of this work? A tool that includes evaluating the behaviour, cognition, affect and participation areas as well as the stuttering behaviours of adults who stutter was adapted. This tool is expected to be useful for comprehensive evaluation of adults who stutter in clinics, in research and for pre/post-therapy.

PMID: 33871904 DOI: 10.1111/1460-6984.12621




The Lidcombe Program for Early Stuttering in Non-English-Speaking Countries: A Systematic Review - INFANTIL / TERAPIA

Folia Phoniatr Logop. 2021 Jul 21;1-14. Online ahead of print.


Mustafa Subasi, John Van Borsel, Sabine Van Eerdenbrugh

Ghent University, Ghent, Belgium; Ankara Yildirim Beyazit University, Ankara, Turkey; Thomas More College of Applied Sciences, Antwerp, Belgium.


Background: The Lidcombe Program is a stuttering treatment approach for children between the ages of 3 and 6 years. Most papers about the Lidcombe Program, however, are based on studies conducted in native English-speaking countries. The aim of this paper is to systematically review the delivery and implementation of the Lidcombe Program in non-native English-speaking countries.

Summary: A resource search was conducted between October and November 2019. Scopus, PubMed, ASHA, Cochrane Library, ERIC, Google Scholar, and SpeechBITE databases and reference lists of relevant papers were searched for the identification process. Joanna Briggs Institute tools were used for the appraisal of the studies. The search yielded 8 studies conducted in non-native English-speaking countries. The Lidcombe Program is efficacious in non-native English-speaking countries when delivered to both preschool and young school age children who stutter. It is reported to be delivered with minor changes and challenges. The number of weekly clinic visits and the total time needed to reach zero or near-zero stuttering levels with the Lidcombe Program can be up to 3 times greater in non-native English-speaking countries than in native English-speaking countries, mostly due to the increased time needed to introduce the parental verbal contingencies. Key Messages: Speech and language therapists practicing in non-native English-speaking countries are encouraged to use the Lidcombe Program for both preschool and young school age children who stutter, although this can take more time than that reported in native English-speaking countries. Further investigation to explore the therapy process with children and parents in non-native English-speaking countries is needed.

PMID: 34289470 DOI: 10.1159/000517650




The Neural Circuitry Underlying the "Rhythm Effect" in Stuttering - NEUROCIÊNCIAS

J Speech Lang Hear Res. 2021 Apr 22;1-22. Online ahead of print.


Saul A Frankford, Elizabeth S Heller Murray, Matthew Masapollo, Shanqing Cai, Jason A Tourville, Alfonso Nieto-Castañón, Frank H Guenther

Boston University, MA; Massachusetts General Hospital, Boston; Massachusetts Institute of Technology, Cambridge.


Purpose: Stuttering is characterized by intermittent speech disfluencies, which are dramatically reduced when speakers synchronize their speech with a steady beat. The goal of this study was to characterize the neural underpinnings of this phenomenon using functional magnetic resonance imaging.

Method: Data were collected from 16 adults who stutter and 17 adults who do not stutter while they read sentences aloud either in a normal, self-paced fashion or paced by the beat of a series of isochronous tones ("rhythmic"). Task activation and task-based functional connectivity analyses were carried out to compare neural responses between speaking conditions and groups after controlling for speaking rate.

Results: Adults who stutter produced fewer disfluent trials in the rhythmic condition than in the normal condition. Adults who stutter did not have any significant changes in activation between the rhythmic condition and the normal condition, but when groups were collapsed, participants had greater activation in the rhythmic condition in regions associated with speech sequencing, sensory feedback control, and timing perception. Adults who stutter also demonstrated increased functional connectivity among cerebellar regions during rhythmic speech as compared to normal speech and decreased connectivity between the left inferior cerebellum and the left prefrontal cortex.

Conclusions: Modulation of connectivity in the cerebellum and prefrontal cortex during rhythmic speech suggests that this fluency-inducing technique activates a compensatory timing system in the cerebellum and potentially modulates top-down motor control and attentional systems. These findings corroborate previous work associating the cerebellum with fluency in adults who stutter and indicate that the cerebellum may be targeted to enhance future therapeutic interventions.

Supplemental Material https://doi.org/10.23641/asha.14417681.

PMID: 33887150 DOI: 10.1044/2021_JSLHR-20-00328




Corrigendum to
"The Satisfaction with Communication in Everyday Speaking Situations (SCESS) scale: An overarching outcome measure of treatment effect" [J. Fluency Disord. (2018), 58, 77-85]

Published Erratum J Fluency Disord. 2021 Mar 2;105831. Online ahead of print.


Hamid Karimi, Mark Onslow, Mark Jones, Sue O'Brian, Ann Packman, Ross Menzies, Sheena Reilly, Martin Sommer, Suzana Jelčić-Jakšić

The University of Sydney, NSW, Australia; University of Queensland, QLD, Australia; Griffith University, Australia; University Medical Center Göttingen, Germany; The Children's Hospital Zagreb, Croatia.


No abstract available
PMID: 33674058 DOI: 10.1016/j.jfludis.2021.105831




The Speech Situation Checklist-Emotional Reaction: Normative and comparative study of Kannada-speaking children who do and do not stutter - EMOCIONAL

Int J Speech Lang Pathol. 2021 Feb 15;1-17. Online ahead of print.


Rakesh Chowkalli Veerabhadrappa, Martine Vanryckeghem, Santosh Maruthy

All India Institute of Speech and Hearing, Mysore, India; University of Central Florida, Orlando, FL, USA.


Purpose: Existing data stemming from investigations with the Speech Situation Checklist (SSC) have shown this standardised test to be a valid and reliable tool for assessing speech-related anxiety in children who stutter (CWS). The main purpose of this study was to compare Speech Situation Checklist-Emotional Reaction (SSC-ER) scores for Kannada-speaking children who do not stutter (CWNS) and CWS. In addition, the Speech Situation Checklist-Emotional Reaction in Kannada (SSC-ER-K) scores among different stuttering severity and age groups were compared in CWS.

Method: The English version of the SSC-ER was forward-translated into Kannada and back-translated by the first author. SSC-ER-K was administered on 100 CWS and 275 CWNS aged between 7 and 14 years who were native speakers of the Kannada language. The severity of stuttering was estimated using the Stuttering Severity Instrument-fourth edition (SSI-4).
Result: The results revealed that the SSC-ER-K scores of CWS were significantly higher in comparison with CWNS. CWS with moderate and severe degrees of stuttering had significantly higher scores when compared to those with a mild degree of stuttering. Furthermore, the older CWS (11-14 years) had significantly higher scores compared to the younger CWS (7-10 years). In addition, the SSC-ER-K appears to be a reliable self-report test. The above findings suggest the presence of significantly increased speech-related anxiety in CWS. Also, as age and severity of stuttering increased so did the level of their speech-related anxiety.

Conclusion: The SSC-ER-K is a useful tool in the assessment of negative emotional reaction to specific speech situations in Kannada CWS and can assist speech-language pathologists in addressing speech-situation specific anxiety during treatment.

PMID: 33586523 DOI: 10.1080/17549507.2020.1862301




Towards real-world generalizability of a circuit for action-stopping - NEUROCIÊNCIAS

Review Nat Rev Neurosci. 2021 Jul 29. Online ahead of print.


Ricci Hannah, Adam R Aron

University of California San Diego, San Diego, CA, USA.


Two decades of cross-species neuroscience research on rapid action-stopping in the laboratory has provided motivation for an underlying prefrontal-basal ganglia circuit. Here we provide an update of key studies from the past few years. We conclude that this basic neural circuit is on increasingly firm ground, and we move on to consider whether the action-stopping function implemented by this circuit applies beyond the simple laboratory stop signal task. We advance through a series of studies of increasing 'real-worldness', starting with laboratory tests of stopping of speech, gait and bodily functions, and then going beyond the laboratory to consider neural recordings and stimulation during moments of control presumably required in everyday activities such as walking and driving. We end by asking whether stopping research has clinical relevance, focusing on movement disorders such as stuttering, tics and freezing of gait. Overall, we conclude there are hints that the prefrontal-basal ganglia action-stopping circuit that is engaged by the basic stop signal task is recruited in myriad scenarios; however, truly proving this for real-world scenarios requires a new generation of studies that will need to overcome substantial technical and inferential challenges.

PMID: 34326532 DOI: 10.1038/s41583-021-00485-1




Two cortical representations of voice control are differentially involved in speech fluency - TERAPIA

Brain Commun. 2021 Jan 5;3(2):fcaa232


Nicole E Neef, Annika Primaßin, Alexander Wolff von Gudenberg, Peter Dechent, Heiner Christian Riedel, Walter Paulus, Martin Sommer

Georg August University, Göttingen, Germany; Institut der Kasseler Stottertherapie, Bad Emstal, Germany.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088816/pdf/fcaa232.pdf


Recent studies have identified two distinct cortical representations of voice control in humans, the ventral and the dorsal laryngeal motor cortex. Strikingly, while persistent developmental stuttering has been linked to a white-matter deficit in the ventral laryngeal motor cortex, intensive fluency-shaping intervention modulated the functional connectivity of the dorsal laryngeal motor cortical network. Currently, it is unknown whether the underlying structural network organization of these two laryngeal representations is distinct or differently shaped by stuttering intervention. Using probabilistic diffusion tractography in 22 individuals who stutter and participated in a fluency shaping intervention, in 18 individuals who stutter and did not participate in the intervention and in 28 control participants, we here compare structural networks of the dorsal laryngeal motor cortex and the ventral laryngeal motor cortex and test intervention-related white-matter changes. We show (i) that all participants have weaker ventral laryngeal motor cortex connections compared to the dorsal laryngeal motor cortex network, regardless of speech fluency, (ii) connections of the ventral laryngeal motor cortex were stronger in fluent speakers, (iii) the connectivity profile of the ventral laryngeal motor cortex predicted stuttering severity (iv) but the ventral laryngeal motor cortex network is resistant to a fluency shaping intervention. Our findings substantiate a weaker structural organization of the ventral laryngeal motor cortical network in developmental stuttering and imply that assisted recovery supports neural compensation rather than normalization. Moreover, the resulting dissociation provides evidence for functionally segregated roles of the ventral laryngeal motor cortical and dorsal laryngeal motor cortical networks.

PMID: 33959707 PMCID: PMC8088816 DOI: 10.1093/braincomms/fcaa232




Two-Sided Perspective on Tele-speech Therapy: Experiences of stuttering patients, and their parents - TERAPIA

Assist Technol. 2021 Jun 1. Online ahead of print.


Maryam Eslami Jahromi, Jamileh Farokhzadian, Leila Ahmadian

Iran University of Medical Sciences, Tehran, Iran; Kerman University of Medical Sciences, Kerman, Iran.


The purpose of this study was to investigate the benefits and challenges of the tele-speech therapy from the perspective of patients who stutter, and their parents. Semi-structured interviews were conducted with 12 patients and three parents in two rehabilitation centers. Data were analyzed using a qualitative content analysis approach proposed by Graneheim and Lundman. Seven categories were determined: accessible treatment, motivation of comfort in tele-speech therapy, challenges of tele-therapy, satisfaction, virtual competency, lower quality compared to face-to-face therapy, and uncertainty about the effectiveness of tele-speech therapy. The participants had a two-sided perspective regarding tele-speech therapy. Positive experiences included benefitting from more qualified therapists at multiple locations, faster access to treatment, and saving cost and time. Negative experiences and challenges consisted of low-quality of technology infrastructure for rehabilitation including low quality of shared images and videos, ineffective communication, insufficient sympathy, indirect communication, and technology incompetency. Findings showed that the participants were interested in the application of tele-speech therapy, as this method could increase their accessibility and provide the opportunity to choose proper therapists. The determined benefits and challenges can provide the policy-makers with beneficial information to implement tele-speech therapy.

PMID: 34061724 DOI: 10.1080/10400435.2021.1937378




Validity of telephone calls to assess percentage of syllables stuttered with adolescents in clinical research - AVALIAÇÃO

J Commun Disord. 2021 Apr 10;91:106103. Online ahead of print.


Zahra Ilkhani, Hamid Karimi, Morteza Farazi, Sue O'Brian, Mark Onslow

Isfahan University of Medical Sciences, Isfahan, Iran; Charles Darwin University, Australia; University of Social Welfare and Rehabilitation Sciences, Iran; University of Technology Sydney, Australia.


Purpose: Karimi, O'Brian, Onslow, and Jones (2013) reported, for adults, no systematic differences between percentage of syllables stuttered (%SS) scores during a 12-hour day and 10-minute phone calls. The present study replicated that finding with adolescents, using valid methods for the age group. The present study also extended that initial report by determining whether the gender of the caller influenced %SS scores.

Method: Participants were 17 adolescents with stuttering. Percentage of syllables stuttered scores were obtained from a 12-hour day of the adolescents' lives, and two 10-minute unscheduled phone calls made before and after that day. One phone call was from a male caller and the other from a female caller.

Results: For adolescents, analysis of covariance (ANCOVA) and intraclass correlations (ICC) replicated the overall Karimi, O'Brian, Onslow, and Jones (2013) finding. No significant differences were found between the %SS scores of the three speech samples, and these %SS scores were found to be highly correlated. However, in contrast to the Karimi, O'Brian, Onslow, and Jones (2013) finding with adults, Bland-Altman plot results revealed a caveat to this finding when applied to individual adolescents. Additionally, there was no effect due to the gender of the caller.

Conclusion: A 10-minute phone call can be used confidently to assess group mean %SS scores during stuttering research with adolescents. However, a 10-minute phone call cannot be used confidently to assess %SS scores of individual adolescent participants. For the latter context, such as with data-based case studies and single-subject experimentation, we recommend supplementing %SS scores with self-reported severity scores.

PMID: 33873016 DOI: 10.1016/j.jcomdis.2021.106103




Waiting lists and prioritization of children for services: Speech-language pathologists' perspectives - TERAPIA

J Commun Disord. 2021 May 4;91:106099. Online ahead of print.


Nicole McGill, Sharynne McLeod, Kathryn Crowe, Cen Wang, Suzanne C Hopf

Charles Sturt University, Australia; University of Iceland, Iceland.


Background: Waiting lists occur when the availability of speech-language pathology services does not meet the demand. Speech-language pathologists (SLPs) commonly manage waiting lists and their consequences using prioritization.

Aims: The aims of this study were to: (1) describe speech-language pathology waiting lists for children and factors associated with their presence in workplaces throughout the world, and (2) describe factors considered in and influencing SLPs' prioritization of children for services.

Methods: A questionnaire about pediatric waiting lists and prioritization was completed by 267 SLPs from 10 countries working in health, disability, education, and private sectors. Valid responses to closed questions from 264 SLPs were analyzed quantitatively.

Results: Most (73.6 %) SLPs reported having a waiting list in their workplace. Waiting lists were most common in community health centres (97.4 %). Waiting times ranged from 0 to 42 months (M = 8.09, SD = 5.84). High priority was assigned to infants (77.4 %), toddlers (65.3 %), children with feeding difficulties (88.5 %), and children who stutter (47.4 %). Prioritization parameters ranked as most important were: severity (M = 4.34), availability of resources (M = 4.11), diagnosis (M = 4.04), and age (M = 3.91).

Conclusions: Many workplaces have long waiting lists for speech-language pathology services. Young children, feeding, and stuttering were most often considered high priority; however, prioritization can be complex, implicit, and influenced by external factors. Collaborative development of explicit, transparent waiting list and prioritization guidelines within workplaces, and the development and evaluation of active waiting strategies for children and families are recommended.

PMID: 33962247 DOI: 10.1016/j.jcomdis.2021.106099




White matter microstructural differences underlying beta oscillations during speech in adults who stutter - NEUROCIÊNCIAS

Brain Lang. 2021 Feb 4;215:104921. Online ahead of print.


Fatemeh Mollaei, Anna Mersov, Merron Woodbury, Cecilia Jobst, Douglas Cheyne, Luc De Nil

University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Toronto, Ontario, Canada.


The basal ganglia-thalamocortical (BGTC) loop may underlie speech deficits in developmental stuttering. In this study, we investigated the relationship between abnormal cortical neural oscillations and structural integrity alterations in adults who stutter (AWS) using a novel magnetoencephalography (MEG) guided tractography approach. Beta oscillations were analyzed using sensorimotor speech MEG, and white matter pathways were examined using tract-based spatial statistics (TBSS) and probabilistic tractography in 11 AWS and 11 fluent speakers. TBSS analysis revealed overlap between cortical regions of increased beta suppression localized to the mouth motor area and a reduced fractional anisotropy (FA) in the AWS group. MEG-guided tractography showed reduced FA within the BGTC loop from left putamen to subject-specific MEG peak. This is the first study to provide evidence that structural abnormalities may be associated with functional deficits in stuttering and reflect a network deficit within the BGTC loop that includes areas of the left ventral premotor cortex and putamen.

PMID: 33550120 DOI: 10.1016/j.bandl.2021.104921




Working memory in adults who stutter using a visual N-back task - LINGUAGEM

J Fluency Disord. 2021 Mar 26;70:105846. Online ahead of print.


Zoi Gkalitsiou, Courtney T Byrd

The University of Texas at Austin, USA


Purpose: The purpose of this study was to investigate working memory in adults who do (AWS) and do not (AWNS) stutter using a visual N-back task. Processes involved in an N-back task include encoding, storing, rehearsing, inhibition, temporal ordering, and matching.

Methods: Fifteen AWS (11 males, 4 females; M = 23.27 years, SD = 5.68 years) and 15 AWNS (M = 23.47 years, SD = 6.21 years) were asked to monitor series of images and respond by pressing a "yes" button if the image they viewed was the same as the image one, two, or three trials back. Stimuli included images with phonologically similar (i.e., phonological condition) or phonologically dissimilar (i.e., neutral condition) names. Accuracy and manual reaction time (mRT) were analyzed.

Results: No difference was found between AWS and AWNS in accuracy. Furthermore, both groups were more accurate and significantly faster in 1- followed by 2- followed by 3-back trials. Finally, AWNS demonstrated faster mRT in the phonological compared to neutral condition, whereas AWS did not.

Conclusion: Results from this study suggest different processing mechanisms between AWS and AWNS for visually presented phonologically similar stimuli. Specifically, a phonological priming effect occurred in AWNS but not in AWS, potentially due to reduced spreading activation and organization in the mental lexicon of AWS. However, the lack of differences between AWS and AWNS across all N-back levels does not support deficits in AWS in aspects of working memory targeted through a visual N-back task; but, these results are preliminary and additional research is warranted.

PMID: 33812337 DOI: 10.1016/j.jfludis.2021.105846






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