A clinical training model for students: intensive treatment of stuttering using prolonged speech - TERAPIA
Codas. 2018 Oct 22;30(5)
Free full text - http://www.scielo.br/pdf/codas/v30n5/2317-1782-codas-30-5-e20170259.pdf
Georgieva D, Stoilova R.
South-West University "N. Rilski" - Blagoevgrad, Bulgaria & Sofia University "St. Kliment Ohridski" - Sofia, Bulgaria.
PURPOSE: This study describes a practical model for improving the quality of Speech-Language Pathology (SLP) education on a clinical setting in a Bulgarian University. During this study, adults who stutter (AWS) received intensive treatment (IT) to increase fluent speech. The intensive treatment was delivered by students trained in the SLP Master's degree program "Logopedics Management in Fluency and Voice Disorders".
METHODS: The La Trobe University intensive program of prolonged speech was implemented. SLP students were trained and delivered the IT for AWS, under supervision in all stages. The treatment followed a clinical modeling pattern.
RESULTS: The primary outcomes were measured according to (i) percent of syllables stuttered (%SS) within and outside the stuttering research center of the university; (ii) self-reported inventory scores; and (iii) speech naturalness score evaluations from pre-treatment, immediately following treatment, 11 months post-treatment, and 18 months after the intensive treatment using stutter-free speech samples. The outcomes were reported for the overall IT program delivered by the SLP Master students.
CONCLUSION: The treatment delivered by students can ensure objective speech outcomes. The evidence-based practice model allowed students to develop and master specific clinical skills in establishing fluent speech by applying a prolonged speech technique. During the IT experience, students began to incorporate elements of evidence-based practice (EBP), clinical expertise, and consider values held by AWS. After four outcome-sessions, the AWS developed self-consciousness about the quality of their prolonged speech during controlled fluent patterns. The participants produced objective speech fluency data and statistically significant differences before and immediately after the IT regarding %SS and overall speech naturalness.
PMID: 30365650 DOI: 10.1590/2317-1782/20182017259
A cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students - SOCIAL
Trials. 2018 Nov 29;19(1):664.
Free PMC Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267837/pdf/13063_2018_Article_3043.pdf
Mallick R, Kathard H, Borhan ASM, Pillay M, Thabane L.
University of Cape Town, Rondebosch, Cape Town, South Africa; McMaster University, Hamilton, Canada; University of KwaZulu Natal, Durban, South Africa.
BACKGROUND: Classroom-based stuttering intervention addressing negative peer attitudes, perceptions, teasing and bullying of children who stutter (CWS) is required as part of holistic stuttering management because of its occurrence in primary school. This study was conducted in 2017, in 10 primary schools in the Western Cape, South Africa within lower (second and third) and higher (fourth and fifth) quintiles.
OBJECTIVES: The primary objective of this study was to determine treatment effect at six months after intervention of grade 7 participants (Classroom Communication Resource [CCR] intervention versus no CCR) using global Stuttering Resource Outcomes Measure (SROM) scores in school clusters. The secondary objective was to determine grade 7 participant treatment effect on the SROM subscales including Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine any difference in the primary outcome between schools between and across quintile clusters (lower and higher).
METHODS: Once schools were stratified into lower and higher quintile (which are defined according to geographical location, fee per school and resources) subgroup clusters, schools were assigned randomly to control and intervention groups consisting of grade 7 participants who were typically aged ≥ 11 years. Teachers received 1 h of training before administering the single-dose CCR intervention over a 60-90-min session. The CCR intervention included a social story, role-play and discussion. All participants viewed a video of a CWS and stuttering was defined at baseline. The SROM measured peer attitudes at six months after intervention. Randomisation was stratified by quintile group using a 1:1 allocation ratio. Full blinding was not possible; however, the outcome assessor was partially blinded and the analyst was also blinded. Generalised estimating equations (GEE) was used assuming an exchangeable correlation structure to analyse the data adopting an intention-to-treat principle. Multiple imputation was used to handle missing data. Criterion for statistical significance was set at alpha = 0.05.
RESULTS: Ten schools were randomly allocated to control (k = 5) and intervention groups (k = 5), with n = 223 participants allocated to intervention and n = 231 to control groups. A total of 454 participants completed the SROMs in control (n = 231) and intervention (n = 223) groups and were analysed at baseline and six months after intervention. There was no statistically significant difference on the global SROM score (mean difference - 0.11; 95% confidence interval [CI] - 1.56-1.34; p = 0.88). There were also no significant differences on SROM subscales: PSD (mean difference 1.04; 95% CI - 1.02-311; p = 0.32), SP (mean difference - 0.45; 95% CI - 1.22-0.26; p = 0.21) and VI (mean difference 0.05; 95% CI - 1.01-1.11; p = 0.93). Additionally, there was no significant subgroup effect on the global SROM score (lower versus higher quintile subgroups) (interaction p value = 0.52). No harms were noted or reported.
CONCLUSION: No statistically significant differences were noted. It is possible that the time frame was too short to note changes in peer attitudes and that further study is required to confirm the findings of this study.
PMID: 30497490 PMCID: PMC6267837 DOI: 10.1186/s13063-018-3043-3
A Phenomenological Analysis of the Experience of Stuttering - CONCEITO
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1180-1194.
Tichenor S, Yaruss JS.
Michigan State University, East Lansing.
PURPOSE: Stuttering behaviors and moments of stuttering are typically defined by what a listener perceives. This study evaluated participants' perceptions of their own experience of moments of stuttering.
METHOD: Thirteen adults who stutter participated in a phenomenological qualitative study examining their experience of moments of stuttering. Analysis yielded several common themes and subthemes culminating in an essential structure describing the shared experience.
RESULTS: Speakers experience anticipation and react in action and nonaction ways. Many speakers experience a loss of control that relates to a lack of a well-formed speech plan or agency. The experience of moments of stuttering changes through therapy, over time, with self-help, and across situations. Many speakers experience so-called typical stuttering behaviors as reactions rather than direct consequences of trying to speak. Interactions with listeners can affect the experience of stuttering.
CONCLUSION: Although research recognizes that the experience of the stuttering disorder involves more than just speech behaviors, people who stutter experience stuttering behaviors in time as involving more than just the disruption in speech. This finding has implications for both the theoretical understanding of stuttering and the clinical evaluation and treatment of the stuttering disorder.
PMID: 30347062 DOI: 10.1044/2018_AJSLP-ODC11-17-0192
A response to reviewers Brow and Walther
J Fluency Disord. 2018 Dec;58:123-124.Epub 2018 Aug 20.
Florida Atlantic University, Boca Raton, FL, United States
No abstract available.
PMID: 30139508 DOI: 10.1016/j.jfludis.2018.08.002
Acquired Stuttering in Veterans of the Wars in Iraq and Afghanistan: The Role of Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Medications - FARMACOLOGIA
Mil Med. 2018 Nov 1;183(11-12):e526-e534.
Norman RS, Jaramillo CA, Eapen BC, Amuan ME, Pugh MJ.
University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX; Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA.
INTRODUCTION: Determine the association between acquired stuttering (AS), traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) in a cohort of 309,675 U.S. Iraq and Afghanistan veterans. The secondary aim was to determine the association between AS and medication patterns for veterans in the sample.
MATERIALS AND METHODS: Retrospective study using data from the Veterans Health Administration National Repository for veterans deployed in support of combat operations in Iraq and Afghanistan and who received Veterans Health Administration care in 2010 and 2011. We identified stuttering using ICD-9 codes to establish the association between AS, TBI, and PTSD, controlling for demographic characteristics and other comorbidities. Multivariable logistic regression was used to determine the association between comorbid conditions and potentially problematic medications associated with stuttering.
RESULTS: Two hundred thirty-five veterans (0.08%) were diagnosed with AS in the cohort. There was the greater likelihood of an AS diagnosis for veterans with concomitant TBI and PTSD when compared with veterans without these diagnoses. Over 66% of those with stuttering were prescribed at least one medication that affected speech fluency (antidepressants, anxiolytics, and antiepileptic drugs) compared with 35% of those without AS.
CONCLUSION: Veterans with a comorbid diagnosis of TBI and PTSD were more likely to be diagnosed with AS AOR: 9.77 (95% CI = 6.93-13.78, p < 0.05) and more likely to have been prescribed medications known to affect speech production OR: 3.68 (95% CI = 2.81-4.82, p < 0.05). Clinicians treating veterans with these complex comorbid conditions should consider the impact of medications on speech fluency.
PMID: 29912436 PMCID: PMC6262211 [Available on 2019-04-18] DOI: 10.1093/milmed/usy067
An ultrasound investigation of the speech motor skills of stuttering Italian children. - INFANTIL
Clin Linguist Phon. 2018;32(12):1126-1144. Epub 2018 Aug 23.
Lenoci G, Ricci I.
SMART lab , Scuola Normale Superiore , Pisa , Italy.
This study aims at evaluating speech motor skills in the fluent speech of a cohort of stuttering Italian children. Stuttering is a neurodevelopmental disorder that may arise from an innate limitation of the speech motor control system, which fails to prepare and organize the movements required for fluent speech (Van Lieshout, Hulstijn, & Peters, 2004). Anticipatory coarticulation in CV sequences and stability of speech movements have been used as measures of the maturity of articulatory processes for fluent speech production. This study aims to assess if direct measures of speech dynamics can identify impaired mechanisms in stuttering speech during a phrase-repetition task. The Ultrasound Tongue Imaging data of eight school-aged children, half of whom stutter while the other half don't, show different articulatory patterns between the two groups, for both motor aspects under investigation. Articulatory data show that the stuttering group presents a higher degree of intra-syllabic coarticulation compared to the control group and decreased stability (i.e. more variability) through multiple repetitions of the same alveolar and velar item. Outcomes of this study suggest that the speech motor control system of children who stutter is less mature in preparing and executing the speech gestures required for fluent speech. This study contributes to shedding light on the impaired articulatory patterns involved in stuttering speech and to identifying the diagnostic markers of the disorder by evaluating the speech of children close to the onset of stuttering.
PMID: 30136905 DOI: 10.1080/02699206.2018.1510983
Abnormal processing of prosodic boundary in adults who stutter: An ERP study. - NEUROCIÊNCIAS
Brain Cogn. 2018 Nov 10;128:17-27 [Epub ahead of print]
Liu M, Xing Y, Zhao L, Deng N, Li W.
Liaoning Normal University, Dalian, China; Tianjin Normal University, Tianjin, China.
Characterized by involuntary disruptions in fluency speech, adults who stutter (AWS) are different from normally fluent speakers (NFS) in speech-language processing indices of phonological, semantic, and syntactic information coding. However, the neural base of the prosodic information (i.e. prosodic boundary) processing in AWS is still elusive at this point. To investigate this question, Chinese temporarily ambiguous phrases (narrative-object/modifier-noun construction) were presented in pairs to AWS and NFS in both lexical judgment and structural judgment task by using structural priming paradigm. Results showed that both AWS and NFS produced prosodic priming in the two tasks, however, AWS were more sensitive to the priming than NFS in the midline. Besides, unlike the greater right hemisphere involvement of priming effect for NFS, AWS exhibited a left hemisphere asymmetry in the lateral areas. In addition, structural judgment task elicited stronger prosodic priming effect than lexical judgment task for both groups. These results indicate that the mode of prosodic priming for AWS is different from NFS, and the priming effect is influenced by the experimental task that participants completed.
PMID: 30423511 DOI: 10.1016/j.bandc.2018.10.009
Adults who stutter lack the specialised pre-speech facilitation found in non-stutterers - NEUROCIÊNCIAS
PLoS One. 2018 Oct 10;13(10)
Free PMC Article - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179203/pdf/pone.0202634.pdf
Whillier A, Hommel S, Neef NE, Wolff von Gudenberg A, Paulus W, Sommer M.
University Medical Centre Göttingen, Göttingen, Germany; Max Planck Institute for Human Cognitive and Brain Science, Leipzig, Germany; Institut der Kasseler Stottertherapie, Bad Emstal, Germany.
OBJECTIVES: Persistent developmental stuttering is a speech fluency disorder defined by its symptoms, where the underlying neurophysiological causes remain uncertain. This study examined the underlying neurophysiological mechanisms of the speech planning process, using facilitation in the motor cortex during speech preparation as an analogue.
METHODS: transcranial magnetic stimulation (TMS) pulses induced motor evoked potentials (MEPs), which were recorded from the tongue. Eighteen adults who stutter (AWS) and 17 adults who do not stutter (ANS) completed three experiments, which involved reading a German prefix+verb utterance from a screen. Each experiment involved 120 trials with three distinct levels of speech production: immediate speech, delayed speech without pacing and delayed speech with predefined pacing. TMS was applied shortly before speech onset. Trial MEPs were normalised to average non-speech MEPs. MEP amplitude, MEP facilitation ratio (amplitude: pre-speech offset) and group difference were the outcomes of interest analysed by multiple regression, as well as speech reaction time analysed by correlation.
RESULTS: MEP values were 11·1%-23·4% lower in AWS than ANS (by standardised Beta), across all three experiments. MEP facilitation ratio slopes were also 4·9%-18·3% flatter in AWS than ANS across all three experiments. Reaction times for AWS were only significantly slower than for ANS in immediate speech and predefined pacing experiments. No stuttering was detected during the trials. The group difference in immediate speech was 100% and 101% greater than the other two experiments respectively.
DISCUSSION: While performance of both ANS and AWS worsens under disturbed speech conditions, greater disturbance conditions affected controls worse than AWS. Future research and therapy in stuttering should focus on non-disturbed speech.
PMID: 30303960 PMCID: PMC6179203 DOI: 10.1371/journal.pone.0202634
Anomalous morphology in left hemisphere motor and premotor cortex of children who stutter - INFANTIL
Brain. 2018 Sep 1;141(9):2670-2684.
Garnett EO, Chow HM, Nieto-Castañón A, Tourville JA, Guenther FH, Chang SE.
University of Michigan, Ann Arbor, MI, USA; DuPont Hospital for Children, Wilmington, DE, USA; Boston University, Boston, MA, USA.
Stuttering is a neurodevelopmental disorder that affects the smooth flow of speech production. Stuttering onset occurs during a dynamic period of development when children first start learning to formulate sentences. Although most children grow out of stuttering naturally, ∼1% of all children develop persistent stuttering that can lead to significant psychosocial consequences throughout one's life. To date, few studies have examined neural bases of stuttering in children who stutter, and even fewer have examined the basis for natural recovery versus persistence of stuttering. Here we report the first study to conduct surface-based analysis of the brain morphometric measures in children who stutter. We used FreeSurfer to extract cortical size and shape measures from structural MRI scans collected from the initial year of a longitudinal study involving 70 children (36 stuttering, 34 controls) in the 3-10-year range. The stuttering group was further divided into two groups: persistent and recovered, based on their later longitudinal visits that allowed determination of their eventual clinical outcome. A region of interest analysis that focused on the left hemisphere speech network and a whole-brain exploratory analysis were conducted to examine group differences and group × age interaction effects. We found that the persistent group could be differentiated from the control and recovered groups by reduced cortical thickness in left motor and lateral premotor cortical regions. The recovered group showed an age-related decrease in local gyrification in the left medial premotor cortex (supplementary motor area and and pre-supplementary motor area). These results provide strong evidence of a primary deficit in the left hemisphere speech network, specifically involving lateral premotor cortex and primary motor cortex, in persistent developmental stuttering. Results further point to a possible compensatory mechanism involving left medial premotor cortex in those who recover from childhood stuttering.
PMID: 30084910 PMCID: PMC6113637 [Available on 2019-09-01] DOI: 10.1093/brain/awy199
Assessing Bilingual Children: Are Their Disfluencies Indicative of Stuttering or the By-product of Navigating Two Languages? - AVALIAÇÃO
Semin Speech Lang. 2018 Sep;39(4):324-332. Epub 2018 Aug 24.
The University of Texas at Austin, Austin, Texas.
Clinicians commonly report difficulty determining whether the disfluencies produced by their clients are indicative of stuttering or suggestive of something else, such as cluttering, autism, language impairment, or second language learning. In our clinical decision-making process, we identify features unique to specific speech and/or language disorders. This identification enables differential diagnosis in most cases. But what happens when features appear to overlap and, as a result, compromise our clinical decision making? This article provides information to assist in the differential diagnosis of stuttering, particularly as it pertains to the assessment of children who speak more than one language. It explores similarities in the speech behaviors produced by these speakers, contrasting them with stuttering behaviors in monolingual English speakers.
PMID: 30142643 DOI: 10.1055/s-0038-1667161
Attention levels in young children who stutter - ATENÇÃO
Appl Neuropsychol Child. 2018 Sep 28:1-11. [Epub ahead of print]
Costelloe S, Davis S, Cavenagh P, Doneva SP.
University of Suffolk , United Kingdom; University College London, United Kingdom.
The purpose of this study was to determine whether children who stutter (CWS) and children who do not stutter (CWNS) differ in terms of attentional ability. Participants were 40 age- and gender-matched CWS and CWNS (aged between 72 and 120 months). Attentional ability was assessed using the Test of Everyday Attention for Children (TEA-Ch), a clinical assessment battery comprising 13 attentional measures, assessing three areas of attention: selective attention, sustained attention, and attentional switching. A low score on the assessment indicates attentional difficulty. There was an overall tendency for CWS to score lower than CWNS on all 13 TEA-Ch measures and all three attentional abilities. This difference reached statistical significance for the sustained attentional component. The present study provides support for the hypothesis that there are some differences between CWS and CWNS in terms of attentional ability. The findings are interpreted within existing models of attention with regard to previous studies of attention in CWS.
PMID: 30265574 DOI: 10.1080/21622965.2018.1493996
Backward masking of tones and speech in people who do and do not stutter - AUDITIVO
J Fluency Disord. 2018 Sep;57:11-21. Epub 2018 Jul 20.
Basu S, Schlauch RS, Sasisekaran J.
University of Minnesota, United States.
PURPOSE: There is evidence of an auditory-perceptual component of stuttering, and backward masking (BM) is a task to explore that role. Prior research reported poorer thresholds for BM tones in a group of children who persisted in stuttering compared to those for a group that did not persist. This study examined BM for adults who stutter for tones and for speech, which tests a phonetic aspect of hearing.
METHOD: Eight persons who stutter (PWS) were closely matched with eight controls (PNS) in terms of phonological abilities, verbal span tasks, age, sex and non-verbal intelligence. These participants were examined for their ability to recognize vowel-consonant (VC) speech syllables and tones in BM paradigm with 0 ms and 300 ms masker to signal onset conditions.
RESULTS: PWS showed significantly poorer performance for speech syllable recognition in quiet and in conditions with masking noise. The pattern of speech errors was similar in both groups, but the PWS produced more errors. A significant condition by group interaction in backward masking for tones was attributed to higher masked thresholds in PWS than in PNS in the 0 ms delay condition for BM for tones.
CONCLUSION: This was the first study to examine BM for speech in PWS. Results provide support for a small auditory-perceptual deficit for speech understanding in adults who stutter that was revealed in the absence of a lexical context. The speech results are explained in terms of possible indistinct phoneme boundaries in PWS and the effects of vowel context in speech recognition.
PMID: 30064031 DOI: 10.1016/j.jfludis.2018.07.001
Behavior Assessment Battery: Normative and Psychometric Investigation Among Polish Adults Who Do and Do Not Stutter - AVALIAÇÃO
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1224-1234.
Wesierska K, Vanryckeghem M, Krawczyk A, Danielowska M, Fasciszewska M, Tuchowska J.
University of Silesia, Katowice, Poland; University of Central Florida, Orlando; Interneuron Private Practice in Skawina, Poland; University of Gdańsk, Pomeranian, Poland; Jagiellonian University, Krakow, Poland.
PURPOSE: The aim of this study was to establish normative data for Polish persons who stutter (PWS) and persons who do not stutter (PWNS) with the adapted version of the Behavior Assessment Battery (BAB; Vanryckeghem & Brutten, 2018) for adults and to investigate whether or not gender and age influenced the results. In addition, the BAB subtests' reliability and validity were examined.
METHOD: A Polish version of the BAB test procedures, including the Speech Situation Checklist-Emotional Reaction, Speech Situation Checklist-Speech Disruption, Behavior Checklist, and Communication Attitude Test for Adults Who Stutter (Vanryckeghem & Brutten, 2018), were individually administered to 123 adults who stutter and 151 adults who do not stutter between the ages of 17 and 70.
RESULTS: PWS scored statistically significantly higher on all BAB subtests compared to PWNS. No significant between-groups gender or age difference was detected. The test data indicate high internal validity. The test items correlate well with the total score and significantly differentiate the two groups. The test battery validly differentiates PWS from PWNS with high accuracy.
CONCLUSIONS: The Polish version of the BAB for adults confirms data collected in previous cross-cultural investigations. The results once again differentiate PWS from PWNS in a powerful way. Compared to PWNS, PWS report significantly more anxiety and speech breakdown when speaking in particular speech situations. They also report their attitude toward speech to be significantly more negative compared to the typical speaker and indicate using a significant number of coping behaviors to avoid or escape difficult speaking conditions. The BAB test battery, in its totality, assists in multidimensional assessment, pre- and posttreatment comparison, and identification of treatment targets based on the answers of PWS to each test item.
PMID: 30347065 DOI: 10.1044/2018_AJSLP-ODC11-17-0187
Challenges and Strategies for Speech-Language Pathologists Using the Lidcombe Program for Early Stuttering. - TERAPIA
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1259-1272.
Van Eerdenbrugh S, Packman A, O'Brian S, Onslow M.
Thomas More University College, Antwerp, Belgium; Australian Stuttering Research Centre, University of Technology, Sydney.
PURPOSE: The Lidcombe program is a treatment for preschool-age children who stutter. Studies indicate that its implementation is not always straightforward. In this study, challenges that parents and speech-language pathologists (SLPs) encounter when implementing the Lidcombe program were identified, and strategies to address them were sought.
METHOD: In Part 1, Lidcombe program treatment challenges were determined from 4 sources. In Part 2, 7 SLPs with 15 to 23 years of Lidcombe program experience were interviewed to develop strategies to respond to the identified treatment challenges.
RESULT: A template of the themes and a report with possible strategies are the outcomes of this study. A total of 124 themes were identified, mostly related to the implementation of Lidcombe program procedures. Strategies to deal with these challenges were formulated.
CONCLUSIONS: This study provides treatment challenges that parents or SLPs may encounter during the Lidcombe program. It also provides strategies that SLPs can suggest to address them. An added contribution of the findings is that SLPs in the clinic can now anticipate the sort of treatment challenges that parents may face. A summary of the findings will be made available on the Australian Stuttering Research Centre website and through the Lidcombe Program Trainers Consortium.
PMID: 30347068 DOI: 10.1044/2018_AJSLP-ODC11-17-0185
Changing Nonstuttering Preschool Children's Stuttering Attitudes - SOCIAL
Weidner ME, St Louis KO, Glover HL.
Marshall University, Huntington, WV; West Virginia University, Morgantown.
PURPOSE: Negative or uninformed stuttering attitudes proliferate among the general public, and bourgeoning research has shown that such attitudes might emerge as early as the preschool years. Much remains unknown about young children's stuttering attitudes, and conclusive recommendations to improve attitudes toward stuttering have yet to be advanced. This study sought to determine the effect of a new educational program on improving stuttering attitudes among preschool children using objective measures.
METHOD: Thirty-seven preschool children learned about stuttering and sensitive peer interactions by participating in the newly developed Attitude Change and Tolerance program. The program teaches children about human differences with an emphasis on stuttering and how to interact with people who stutter. Children's stuttering attitudes were measured using the Public Opinion Survey of Human Attributes-Stuttering/Child (Weidner & St. Louis, 2014) before and after the program.
RESULTS: Pre-post comparisons showed statistically significant improvements in children's overall stuttering attitudes. In particular, children demonstrated gains relative to their perceptions of and reactions toward people who stutter.
CONCLUSION: This study provides empirical evidence that young children's stuttering attitudes can be improved using the Attitude Change and Tolerance program. In addition, it supports previous research that negative stuttering attitudes emerge as early as preschool.
PMID: 30304375 DOI: 10.1044/2018_AJSLP-18-0019
Clinical trial of the D.E.L.P.H.I.N. speech treatment for children and adolescents who stutter. - TERAPIA
Logoped Phoniatr Vocol. 2018 Sep 11:1-14.[Epub ahead of print]
Keilmann A, Neumann K, Zöller D, Freude C.
The University Medical Center Mainz , Mainz , Germany; Voice Care Center Bad Rappenau , Bad Rappenau , Germany; Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI) , Mainz , Germany; Faculty of Medicine and Medical Center , University of Freiburg , Freiburg , Germany.
PURPOSE: The present trial investigated the D.E.L.P.H.I.N. (Deblockierungsimpuls, Entspannung, Logopädie, Phonetik, Hör-Wahrnehmungstraining, Intensität, nasaler Schwingungsakzent) speech treatment for children and adolescents who stutter, an approach using fluency shaping with an intensive time schedule and group sessions.
METHODS: Participants were 42 male and 14 female persons who stuttered with a median age of 13.0 years. Participants and their parents completed the strength and difficulties questionnaire at the beginning of the therapy and 1 year later. Participants completed the Speech Questionnaire, an instrument to measure the impact of stuttering, twice before and twice after completing the therapy. The stuttering rate and mean length of the three longest stuttering events were studied four times in videos of interviews, reading texts and three telephone calls. Outcomes are reported for the 56 children and young adults who stuttered and who completed D.E.L.P.H.I.N. The main analysis was performed using linear mixed models.
RESULTS: Quality of life as measured in the Strength and Difficulties Questionnaire (SDQ) - filled in by the participants/their parents - increased significantly from before the start of the therapy to 1 year after completion of the therapy. The subjective rating of the impact of stuttering also improved significantly. The stuttering rate and mean length of the longest stuttering event decreased significantly for all three modes from pre-treatment to 12 months post-treatment.
CONCLUSIONS: After D.E.L.P.H.I.N., a significant improvement of the relevant endpoints quality of life, impact of stuttering, and severity of stuttering is observed.
PMID: 30204526 DOI: 10.1080/14015439.2018.1498917
Clozapine-induced Weight Loss and Stuttering in a Patient with Schizophrenia - FARMACOLOGIA
Indian J Psychol Med. 2018 Jul-Aug;40(4):385-387.
Free PMC Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065125/?report=printable
Das S, Manjunatha N, Thirthali J.
National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
PMID: 30093754 PMCID: PMC6065125 DOI: 10.4103/IJPSYM.IJPSYM_523_17
Comparing stuttering attitudes of preschool through 5th grade children and their parents in a predominately rural Appalachian sample. - SOCIAL
J Fluency Disord. 2018 Nov 15. [Epub ahead of print]
Glover HL, St Louis KO, Weidner ME.
West Virginia University, Morgantown, WV, United States; Marshall University, Huntington, WV, United States.
BACKGROUND: Theories relating to young children's social cognitive maturity and their prevailing social groups play important roles in the acquisition of attitudes. Previous research has shown that preschool and kindergarten children's stuttering attitudes are characterized by stronger negative beliefs and self reactions than those of parents. By contrast, 12 year-old children's stuttering attitudes have been shown to be similar to their parents' attitudes. Other research indicates that parental stuttering attitudes are no different from attitudes of adults who are not parents.
PURPOSE: The purpose of this study was to explore children's stuttering attitudes of preschool through 5th grade children and to compare them to their parents' attitudes.
METHOD: Children and parents from a rural Appalachian elementary school and child/parent pairs from other areas in the region responded to child and adult versions of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S/Child and POSHA-S). Seven grade levels were included: preschool, kindergarten, 1st grade, 2nd grade, 3rd grade, 4th grade, and 5th grade.
RESULTS: Confirming earlier research, younger children's attitudes toward stuttering were considerably less positive than those of their parents. As children matured up to the fifth grade, however, their stuttering attitudes progressively were more positive. Parents' stuttering attitudes were quite consistent across all seven grade levels.
CONCLUSIONS: Consistent with theories of attitudinal development, between the ages of 4 and 11 years, children's measured attitudes toward stuttering improved and gradually approximated the attitudes of their parents and the general public.
PMID: 30528242 DOI: 10.1016/j.jfludis.2018.11.001
Covert Stuttering: Investigation of the Paradigm Shift From Covertly Stuttering to Overtly Stuttering - TERAPIA
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1235-1243
Douglass JE, Schwab M, Alvarado J.
Sacred Heart University, Fairfield, CT; Purdue University, West Lafayette, IN.
PURPOSE: Covert stuttering is a type of stuttering experience that occurs when a person who stutters conceals his or her stutter from others, attempting to be perceived as a nonstuttering individual. A person who covertly stutters experiences the cognitive and emotional elements of stuttering with minimum overt behavioral symptoms. Individuals who covertly stutter are able to provide insight into their experiences in attempting to be perceived as nonstuttering individuals. Covert stuttering is a topic that continues to be in need of a formal definition. The current investigation is utilizing thematic analysis to provide a detail-rich investigation of the paradigm shift from covertly stuttering to overtly stuttering.
METHOD: The current investigation is a qualitative analysis of individuals' transition process from covertly stuttering to overtly stuttering. Real-time video interviews were conducted with the use of open-ended phenomenological interview questions. Interviews were transcribed, and thematic analysis of interview transcripts was conducted to investigate the covertly to overtly stuttering process for participants.
RESULTS: The findings provide insight into a paradigm shift that occurs when individuals who covertly stutter begin to outwardly identify themselves and allow for overt stuttering. The primary theme was a paradigm shift in the 6 participants' mindset regarding stuttering; additional details are provided in the subthemes: attending speech therapy, meeting other people who stutter, and a psychological low point. The details of the covert-to-overt stuttering conversion are documented with the use of direct quotations.
CONCLUSION: The evidence suggests the various intricacies of the experiences of persons who are covert. Clinical implications of these findings for assessing and treating individuals who covertly stutter are discussed.
PMID: 30347066 DOI: 10.1044/2018_AJSLP-ODC11-17-0190
Decreased occipital alpha oscillation in children who stutter during a visual Go/Nogo task. - ATENÇÃO
Clin Neurophysiol. 2018 Sep;129(9):1971-1980. Epub 2018 Jul 7.
Piispala J, Starck T, Jansson-Verkasalo E, Kallio M.
Oulu University Hospital, Finland; University of Oulu, Finland; University of Turku, Finland.
OBJECTIVE: Our goal was to discover attention- and inhibitory control-related differences in the main oscillations of the brain of children who stutter (CWS) compared to typically developed children (TDC).
METHODS: We performed a time-frequency analysis using wavelets, fast Fourier transformation (FFT) and the Alpha/Theta power ratio of EEG data collected during a visual Go/Nogo task in 7-9 year old CWS and TDC, including also the time window between consecutive tasks.
RESULTS: CWS showed significantly reduced occipital alpha power and Alpha/Theta ratio in the "resting" or preparatory period between visual stimuli especially in the Nogo condition.
CONCLUSIONS: The CWS demonstrate reduced inhibition of the visual cortex and information processing in the absence of visual stimuli, which may be related to problems in attentional gating.
SIGNIFICANCE: Occipital alpha oscillation is elementary in the control and inhibition of visual attention and the lack of occipital alpha modulation indicate fundamental differences in the regulation of visual information processing in CWS. Our findings support the view of stuttering as part of a wide-ranging brain dysfunction most likely involving also attentional and inhibitory networks.
PMID: 30029047 DOI: 10.1016/j.clinph.2018.06.022
Disclosure of stuttering and quality of life in people who stutter - TERAPIA
J Fluency Disord. 2018 Dec;58:1-10. Epub 2018 Oct 15.
Boyle MP, Milewski KM, Beita-Ell C.
Montclair State University, United States
PURPOSE: This study investigated the disclosure practices of people who stutter, and the relationship between disclosure of stuttering and quality of life.
METHOD: Participants were 322 adults who stutter recruited from speech-language pathologists and support group leaders. Participants completed a survey that contained items measuring level of disclosure of stuttering, as well as a global measure of self-rated quality of life. Participants were grouped into low, average, and high quality of life subgroups. Analysis of variance tests compared disclosure levels among these subgroups.
RESULTS: The low quality of life subgroup reported significantly lower levels of disclosure compared to both the average and high quality of life subgroups. Participants with self-help/support group experience for stuttering demonstrated significantly higher levels of disclosure of stuttering compared to individuals without such experience. In addition, a substantial number of participants in the overall sample reported that they more than rarely feel the need to conceal stuttering from others (40%), and that no one knows that they stutter in many areas of life (37%).
CONCLUSIONS: Attempts to conceal stuttering in at least some life situations are not uncommon among adults who stutter. However, being involved in self-help support groups may be a helpful way of increasing disclosure of stuttering. Speech-language pathologists should become aware of the positive relationship between disclosure of stuttering and quality of life and its relevance in assessment and treatment when working with people who stutter.
PMID: 30352701 DOI: 10.1016/j.jfludis.2018.10.003
Effects of the Lidcombe Program and Parent-Child Interaction Therapy on Stuttering Reduction in Preschool Children. - TERAPIA
Folia Phoniatr Logop. 2018 Dec 12;71(1):29-41. [Epub ahead of print]
Shafiei B, Faramarzi S, Abedi A, Dehqan A, Scherer RC.
University of Isfahan, Isfahan, Irans; Zahedan University of Medical Sciences, Zahedan, Iran; Bowling Green State University, Bowling Green, Ohio, USA.
PURPOSE: The present study explored the effectiveness of the Lidcombe Program, the parent-child interaction therapy (PCIT) approach, and an integrated (Lid-PCIT) program on the treatment of children who stutter.
METHODS: The present research was a single-subject study with an alternative treatment design. Participants were 6 preschool children who were randomly assigned into three groups. Each group received the entire indirect (PCIT), direct (Lidcombe), or integrated (Lid-PCIT) program and were assessed through severity rating (SR), and percent stuttered syllables (%SS), and video analysis.
RESULTS: For all children the SR and the %SS were reduced but the percentage of non-overlapping data of the three interventions showed that it was reduced more in the Lidcombe and in the Lid-PCIT programs.
CONCLUSIONS: This study provided preliminary evidence that Lidcombe, PCIT, and integrated programs were effective in reducing the SR and the %SS in preschool children who stutter. These results are potentially important as both indirect and direct interventions in the primary years can help children who stutter to overcome their disorder.
PMID: 30541009 DOI: 10.1159/000493915
Effects of Phantom Electrode Stimulation on Vocal Production in Cochlear Implant Users. - OUTRAS ÁREAS
Ear Hear. 2018 Dec 21. [Epub ahead of print]
Caldwell MT, Jiradejvong P, Limb CJ.
Vanderbilt University Medical Center; University of California, San Francisco, California, USA.
OBJECTIVES: Cochlear implant (CI) users suffer from a range of speech impairments, such as stuttering and vocal control of pitch and intensity. Though little research has focused on the role of auditory feedback in the speech of CI users, these speech impairments could be due in part to limited access to low-frequency cues inherent in CI-mediated listening. Phantom electrode stimulation (PES) represents a novel application of current steering that extends access to low frequencies for CI recipients. It is important to note that PES transmits frequencies below 300 Hz, whereas Baseline does not. The objective of this study was to explore the effects of PES on multiple frequency-related characteristics of voice production.
DESIGN: Eight postlingually deafened, adult Advanced Bionics CI users underwent a series of vocal production tests including Tone Repetition, Vowel Sound Production, Passage Reading, and Picture Description. Participants completed all of these tests twice: once with PES and once using their program used for everyday listening (Baseline). An additional test, Automatic Modulation, was included to measure acute effects of PES and was completed only once. This test involved switching between PES and Baseline at specific time intervals in real time as participants read a series of short sentences. Finally, a subjective Vocal Effort measurement was also included.
RESULTS: In Tone Repetition, the fundamental frequencies (F0) of tones produced using PES and the size of musical intervals produced using PES were significantly more accurate (closer to the target) compared with Baseline in specific gender, target tone range, and target tone type testing conditions. In the Vowel Sound Production task, vowel formant profiles produced using PES were closer to that of the general population compared with those produced using Baseline. The Passage Reading and Picture Description task results suggest that PES reduces measures of pitch variability (F0 standard deviation and range) in natural speech production. No significant results were found in comparisons of PES and Baseline in the Automatic Modulation task nor in the Vocal Effort task.
CONCLUSIONS: The findings of this study suggest that usage of PES increases accuracy of pitch matching in repeated sung tones and frequency intervals, possibly due to more accurate F0 representation. The results also suggest that PES partially normalizes the vowel formant profiles of select vowel sounds. PES seems to decrease pitch variability of natural speech and appears to have limited acute effects on natural speech production, though this finding may be due in part to paradigm limitations. On average, subjective ratings of vocal effort were unaffected by the usage of PES versus Baseline.
PMID: 30601240 DOI: 10.1097/AUD.0000000000000690
Elevated attention deficit hyperactivity disorder symptoms in children who stutter - ATENÇÃO
J Fluency Disord. 2018 Nov 15. [Epub ahead of print]
Druker K, Hennessey N, Mazzucchelli T, Beilby J.
Curtin University, Western Australia, Australia.
PURPOSE: This study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken.
METHOD: Participants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria).
RESULTS: One-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment.
CONCLUSION: The large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.
PMID: 30477807 DOI: 10.1016/j.jfludis.2018.11.002
Envelope modulation spectral (EMS) analyses of solo reading and choral reading conditions suggest changes in speech rhythm in adults who stutter. - AUDITIVO
J Fluency Disord. 2018 Dec;58:47-60. Epub 2018 Sep 8.
Dechamma D, Maruthy S.
Samvaad Institute of Speech and Hearing, Bengaluru, Karnataka, India; All India Institute of Speech and Hearing, Mysuru, Karnataka, India.
PURPOSE: A longstanding finding in persons who stutter is that stuttering frequency significantly reduces during choral reading when compared to the solo reading condition. Here, we tested the hypothesis that this decrease in stuttering frequency may be because speech of the normal speaker dictates the speech rhythm of a person who stutters. We used an automated, sensitive acoustic technique-Envelope Modulation Spectral (EMS) analysis- that allowed us to document speech rhythm.
METHOD: Seventeen adults who stutter (AWS) read sentences under two conditions: solo reading and choral reading. Percentage of syllables stuttered (%SS), the rate of speech, and speech rhythm were calculated from the recorded sentences from AWS. Further, AWS speech rhythm during solo reading was compared with typical adults. EMS was extracted for the full signal and seven-octave bands. From the extracted envelope six predictor variables (peak frequency, peak amplitude, energy in the spectrum 3-6 Hz, energy in the spectrum from 0 to 4 Hz, energy in the spectrum from 4 to 10 Hz, and the ratio of energy below4 Hz/above 4 Hz) were computed.
RESULTS: Significant decrease in stuttering frequency and rate of speech was noticed in choral reading when compared to the solo reading condition. Further, analysis of EMS results suggested the statistically significant difference between two reading conditions (for peak frequency and peak amplitude), and between two groups for all predictor variables.
CONCLUSION: Overall, current results highlight that decreases in stuttering during the choral reading is characterized by a decrease in rate and changes in some aspects of speech rhythm in Kannada speaking AWS.
PMID: 30220404 DOI: 10.1016/j.jfludis.2018.09.002
Examining implicit and explicit attitudes toward stuttering - SOCIAL
J Fluency Disord. 2018 Sep;57:22-36. Epub 2018 Jun 27.
Walden TA, Lesner TA.
Vanderbilt University, Peabody College, Nashville, TN, United States.
PURPOSE: This study assessed implicit and explicit attitudes toward people who stutter among typically-fluent young adults.
METHOD: Participants completed an Implicit Association Test, a measure of implicit attitudes, to assess the strength of association between stuttered vs. fluent speech and positive vs. negative evaluative words. Participants also completed self-report ratings of their attitudes toward people who do and do not stutter (explicit attitude scales). In addition, participants completed measures of social desirability and a survey that assessed lifetime experience with people who stutter.
RESULTS: Results supported the existence of a negative stuttering stereotype. Participants demonstrated negative implicit and explicit attitudes toward people who stutter. Explicit attitudes toward those who stutter, but not implicit attitudes, were significantly predicted by social desirability scores. Familiarity with stuttering was significantly associated with implicit but not explicit attitudes toward stuttering.
CONCLUSIONS: These findings indicate the importance of examining both implicit and explicit attitudes toward stuttering to fully understand the challenges faced by those who stutter.
PMID: 30081274 DOI: 10.1016/j.jfludis.2018.06.001
Exploring how preschoolers who stutter use spoken language during free play: A feasibility study. - LINGUAGEM
Int J Speech Lang Pathol. 2018 Oct 22:1-12. [Epub ahead of print]
Langevin M, Schneider P, Packman A, Onslow M.
University of Alberta , Edmonton , Alberta , Canada and University of Sydney , Lidcombe , Australia.
PURPOSE: Play is critically important for the healthy development of children. This study explored the viability of a methodology to investigate how preschoolers who stutter use language in play with peers.
METHOD: Transcripts of peer-directed utterances of four preschoolers who stutter and four matched non-stuttering children during free play were analysed for measures of verbal output (numbers of utterances and words), length and complexity of utterances (mean length of communication unit and syntactic complexity), and lexical diversity (number of different words, type token ratio and vocd).
RESULT: Viable speech samples were obtained. Verbal output scores of two children who stutter were the same or higher than their matched controls whereas mean length of communication unit and syntactic complexity scores for three children who stutter were lower than their matched controls. In 22 of the 24 comparisons across number of different words, type token ratio, and vocd, scores of children who stutter were the same or higher than their matched controls.
CONCLUSION: Interpretation of data is limited by the small sample size and lack of standardised testing. However, results indicate that the methodology has promise for future research into the way preschoolers who stutter use spoken language during play and the quality of their play.
PMID: 30348021 DOI: 10.1080/17549507.2018.1505949
Exploring the Effectiveness of an Intensive Treatment Program for School-Age Children Who Stutter, Camp Dream. Speak. Live.: A Follow-up Study - TERAPIA EM GRUPO
Semin Speech Lang. 2018 Nov;39(5):458-468. Epub 2018 Sep 19.
Byrd CT, Gkalitsiou Z, Werle D, Coalson GA.
The University of Texas at Austin, University Station, Austin, Texas; Louisiana State University, Baton Rouge, Louisiana.
The purpose of this follow-up study was to explore the effectiveness of an intensive treatment program-Camp Dream. Speak. Live.-within older, school-age children who stutter. Twenty-three school-age children who stutter (age range: 7-14 years) attended this week-long intensive therapy program for the first time. Outcome measures included Overall Assessment of the Speaker's Experience of Stuttering and the Patient Reported Outcomes Measurement Information System Pediatric Peer Relationships Form. Findings demonstrate significant improvements in quality of life and communication attitudes can be achieved in a short period of time when increasing fluency is not a target.
PMID: 30231266 DOI: 10.1055/s-0038-1670669
Exposure therapy for social anxiety disorder in people who stutter: An exploratory multiple baseline design. - SOCIAL
J Fluency Disord. 2018 Dec 13;59:21-32. [Epub ahead of print]
Scheurich JA, Beidel DC, Vanryckeghem M.
University of Central Florida, Orlando,, United States.
BACKGROUND & OBJECTIVES: Social anxiety disorder (SAD) is a debilitating condition, and approximately half of adults who stutter have SAD. Cognitive-behavioral therapy (CBT) has shown promise in decreasing social anxiety symptoms among adults who stutter, but exposure, arguably the essential component for successful CBT for SAD, has been understudied and underemphasized. Aims of this study were to develop an exposure therapy protocol designed specifically for people who stutter and have SAD and evaluate its potential efficacy in reducing social anxiety and stuttering severity using a multiple baseline design.
METHODS: Six participants received ten sessions of exposure therapy. Participants reported daily social anxiety, and social distress and stuttering severity were evaluated at major assessment points.
RESULTS: There were substantial reductions in social anxiety and considerable improvements in affective, behavioral, and cognitive experiences of stuttering. No consistent change was observed for stuttering frequency. Gains were mostly maintained after six-months.
CONCLUSIONS: Results suggest that the novel exposure approach may decrease social distress, but not necessarily influence speech fluency. These findings underscore the importance of the assessment and treatment of SAD among adults who stutter and suggest that the integration of care between clinical psychologists and speech-language pathologists may prove beneficial for this population.
PMID: 30578977 DOI: 10.1016/j.jfludis.2018.12.001
Functional and Neuroanatomical Bases of Developmental Stuttering: Current Insights. - NEUROCIÊNCIAS
Neuroscientist. 2018 Sep 28. [Epub ahead of print]
Chang SE, Garnett EO, Etchell A, Chow HM.
University of Michigan, USA; Alfred I. DuPont Hospital for Children, USA.
Affecting 5% of all preschool-aged children and 1% of the general population, developmental stuttering-also called childhood-onset fluency disorder-is a complex, multifactorial neurodevelopmental disorder characterized by frequent disruption of the fluent flow of speech. Over the past two decades, neuroimaging studies of both children and adults who stutter have begun to provide significant insights into the neurobiological bases of stuttering. This review highlights convergent findings from this body of literature with a focus on functional and structural neuroimaging results that are supported by theoretically driven neurocomputational models of speech production. Updated views on possible mechanisms of stuttering onset and persistence, and perspectives on promising areas for future research into the mechanisms of stuttering, are discussed.
PMID: 30264661 DOI: 10.1177/1073858418803594
Genetic epidemiology of stuttering among school children in the state of Tamil Nadu, India - CONCEITO
J Fluency Disord. 2018 Dec;58:11-21. Epub 2018 Oct 11.
Nandhini Devi G, Thalamuthu A, Valarmathi S, Karthikeyen NP, Srikumari Srisailapathy CR.
University of Madras, Taramani Campus, Chennai, India; University of New South Wales, Sydney, Australia; MGR Medical University, Guindy, Chennai, India; Speech & Hearing Care Center and Integrated Therapy Center for Autism, Chennai, India.
PURPOSE: Stuttering is a fluency disorder with a worldwide prevalence of 1%. Reports on the epidemiology of stuttering in India are limited. Our primary goal was to examine the prevalence of the disorder among school children. The study also aimed to examine risk factors associated with severity and the impact of parental consanguinity in stuttering.
METHOD: Children from 97 schools in the State of Tamil Nadu, India were screened. Extensive speech characterization, epidemiological details and three-generational pedigrees were collected for 180 probands. The genetic basis of stuttering was examined using the analysis of genealogical index of families (GIF), kinship group and sibling recurrence risk (SRR) measures. Regression analysis and chi-square tests were performed to test the association of risk factors with severity of the disorder.
RESULTS: Among the 74,544 school children screened, the prevalence of stuttering was found to be 0.46%. Pedigree analysis revealed a positive family history in 101 (56%) probands; overall familial incidence was 11%. We observed an overall male-favored sex ratio (4:1). Familial aggregation (GIF = 442.60, p-value <0.001) and sibling recurrence risk ratio (Ks = 0.197, SD = 0.041) was high among consanguineous families. Severity of stuttering was strongly associated with gender and moderately associated with age at onset.
CONCLUSION: The prevalence of stuttering in Tamil Nadu is estimated for the first time in this study. High familial incidence, familial aggregation and sibling recurrence risk ratio point to the presence of a genetic basis. Familial aggregation was high among consanguineous families although consanguinity did not seem to play a role in severity.
PMID: 30343931 DOI: 10.1016/j.jfludis.2018.10.001
How Can We Overcome the Challenges of Providing School-Based Fluency Services? - SOCIAL
Semin Speech Lang. 2018 Sep;39(4):371-381. Epub 2018 Aug 24.
Chmela K, Johnson L.
Chmela Fluency Center, Buffalo Grove, Illinois; Madison Metropolitan School District, Madison, Wisconsin.
Providing speech and language services in the school setting can be challenging, especially for complex problems such as stuttering and other fluency disorders. Speech-language pathologists (SLPs) feel less comfortable working with students who have fluency disorders, which makes problem solving around delivering these services even more difficult. The purpose of this article is to identify three categories of challenges school-based therapists may face when evaluating and treating this population. The challenges discussed in this article are drawn from our literature, interviews with several practicing therapists, and the authors' experiences providing assessment and therapy to school-age children, as well as consultations and in-services for school-based SLPs. We provide suggestions for facilitating positive change across these challenges.
PMID: 30142647 DOI: 10.1055/s-0038-1667165
How Speech-Language Pathologists Can Minimize Bullying of Children Who Stutter.- SOCIAL
Semin Speech Lang. 2018 Sep;39(4):342-355. Epub 2018 Aug 24.
Yaruss JS, Reeves N, Herring C.
Michigan State University, East Lansing, Michigan; Frisco Independent Schools, Frisco, Texas.
Stuttering can be a significant problem for children who stutter, but there is much that speech-language pathologists can do to help. This article summarizes six key steps, based on the work of Murphy and colleagues, that clinicians can take to minimize the occurrence and impact of bullying for children who stutter: (1) educating children about stuttering; (2) educating children about bullying; (3) helping children change the way they think and feel about their stuttering through desensitization, cognitive restructuring, and acceptance activities; (4) helping children learn to use appropriately assertive responses that decrease the likelihood of bullying; (5) educating peers and bystanders about stuttering and bullying so that they are more likely to respond in helpful ways; and (6) educating parents, teachers, and administrators about how they can create an environment where it is not okay to bully, but it is okay to stutter.
PMID: 30142645 DOI: 10.1055/s-0038-1667163
Improving Polish Stuttering Attitudes: An Experimental Study of Teachers and University Students - SOCIAL
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1195-1210.
St Louis KO, Wesierska K, Polewczyk I.
West Virginia University, Morgantown; University of Silesia, Katowice, Poland.
PURPOSE: This quasi-experimental design study in Poland evaluated the effects of a course on stuttering for university students and the effects of an educational workshop for public school teachers, both interventions designed to improve attitudes toward stuttering.
METHOD: Participants (132 in-service teachers and 75 university students) completed the Polish version of the Public Opinion Survey of Human Attributes-Stuttering (St. Louis, 2011) twice, before and after 2 interventions for experimental groups and 3 months apart for control groups. Experimental teachers participated in a 2-hr workshop dedicated to stuttering. Experimental students enrolled in a 1-semester course wherein multiple activities (including the teacher workshop) were included to generate a comprehensive understanding of stuttering. None of the participants in either control group participated in the academic course for students or workshop for teachers.
RESULTS: Preintervention comparisons for teachers and for students confirmed that participants assigned to either experimental or control groups did not differ significantly on their attitudes toward stuttering. For both experimental teachers and students, the interventions resulted in significant positive changes in stuttering attitudes. Neither control group changed.
CONCLUSIONS: This experimental study demonstrated that it is possible to positively modify stuttering attitudes of teachers as well as university students. It has implications for the length, content, and experiential components of interventions designed to improve public attitudes toward stuttering.
PMID: 30347063 DOI: 10.1044/2018_AJSLP-ODC11-17-0179
Letter Specific Dysgraphia: A Silent Stutter.
Mov Disord Clin Pract. 2018 Oct 17;5(6):640-642. eCollection 2018 Nov-Dec.
Prasad S, Pal PK.
National Institute of Mental Health & Neurosciences, Karnataka India.
No abstract available
PMID: 30637286 PMCID: PMC6277357 [Available on 2019-10-17] DOI: 10.1002/mdc3.12650
Machado de Assis' Original Sin - OUTRAS ÁREAS
Front Neurol Neurosci. 2018;43:177-184. Epub 2018 Oct 18.
de Freitas GR.
Machado de Assis (1839-1908) suffered from temporal lobe epilepsy, probably with origin in the non-dominant hemisphere. The evidence for this is provided by the detailed reports of the characteristics of his seizures by his contemporaries and by his correspondence with other writers. He was treated with bromides and homeopathy. It is unclear whether his neurological disorder influenced his artistic performance. What is evident is that he was deeply ashamed of the disease - he avoided the word "epilepsy" and just wrote about it in his personal correspondence with friends in the last years of his life. Though controversial, he had no clear traces of personality disorders linked to his temporal lobe epilepsy. Despite all his adversities, including being "mulatto," having a stutter, being of humble origins, and epileptic in a period when there was no efficacious therapy and a profound stigma associated with the disease, Machado de Assis became one of the most important Brazilian writers of all times.
PMID: 30419563 DOI: 10.1159/000490685
Measuring and monitoring emotional changes in children who stutter - NEUROCIÊNCIAS
Comput Biol Med. 2018 Nov 1;102:138-150. Epub 2018 Sep 26.
Al-Nafjan A, Al-Wabil A, AlMudhi A, Hosny M.
Imam Muhammad Bin Saud University, Riyadh, Saudi Arabia; King Saud University, Riyadh, Saudi Arabia; King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia; King Khalid University, Abha, Saudi Arabia.
The assessment of clients with speech disorders presents challenges for speech-language pathologists. For example, having a reliable way of measuring the severity of the case, determining which remedial program is aligned with a patient's needs, and measuring of treatment processes. There is potential for brain-computer interface (BCI) applications to enhance speech therapy sessions by providing objective insights and real-time visualization of brain activity during the sessions. This paper presents a study on emotional state detection during speech pathology. The goal of this study is to investigate affective-motivational brain responses to stimuli in children who stutter. To this end, we conducted an experiment that involved recording frontal electroencephalography (EEG) activity from fifteen children with stuttering whilst they looked at visual stimuli. The contribution of our study is to provide a comprehensive background and a framework for emotional state detection experiments as assessment and monitoring tool in speech pathology. It mainly discusses the feasibility and potential benefits of applying EEG-based emotion detection in speech-language therapy contexts of use. The findings of our research indicate that emotional recognition using non-invasive EEG-based BCI system is sufficient to differentiate between affective states of individuals in treatment contexts.
PMID: 30278338 DOI: 10.1016/j.compbiomed.2018.09.022
Methods in Stuttering Therapy for Desensitizing Parents of Children Who Stutter - AMBIENTE
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1124-1138.
Berquez A, Kelman E.
The Michael Palin Centre for Stammering, London, United Kingdom.
PURPOSE: The aim of this study was to describe a range of methods used in stuttering therapy for desensitizing parents of children who stutter (CWS).
METHOD: This clinical tutorial will first briefly explore the rationale and benefit of including parents of CWS of all ages in the therapy process. The construct of desensitization will be defined, and a description will be given of how traditionally it has been incorporated into therapy with adults who stutter and CWS. Research evidence will be presented about the impact of a child's stuttering on parents. The article will then focus on clinical methods for desensitizing parents of CWS using examples of activities conducted in group and individual therapy with parents at the Michael Palin Centre in London with reference to desired outcomes, how to measure them, and how to address potential pitfalls.
CONCLUSION: Desensitization activities can be implemented with parents of CWS to help them recognize and manage their emotional reactions to their child's stuttering, to support parents to feel knowledgeable and confident in managing their child's stuttering, and ultimately to enhance the child's progress in therapy.
PMID: 30347058 DOI: 10.1044/2018_AJSLP-ODC11-17-0183
My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? - TERAPIA
Semin Speech Lang. 2018 Sep;39(4):356-370. Epub 2018 Aug 24.
Jackson ES, Gerlach H, Rodgers NH, Zebrowski PM.
New York University, New York, New York; University of Iowa, Iowa City, Iowa.
Stuttering anticipation is endorsed by many people who stutter as a core aspect of the stuttering experience. Anticipation is primarily a covert phenomenon and people who stutter respond to anticipation in a variety of ways. At the same time as anticipation occurs and develops internally, for many individuals the "knowing" or "feeling" that they are about to stutter is a primary contributor to the chronicity of the disorder. In this article, we offer a roadmap for both understanding the phenomenon of anticipation and its relevance to stuttering development. We introduce the Stuttering Anticipation Scale (SAS)-a 25-item clinical tool that can be used to explore a client's internal experience of anticipation to drive goal development and clinical decision making. We ground this discussion in a hypothetical case study of "Ryan," a 14-year-old who stutters, to demonstrate how clinicians might use the SAS to address anticipation in therapy with young people who stutter.
PMID: 30142646 DOI: 10.1055/s-0038-1667164
Nurturing a Resilient Mindset in School-Aged Children Who Stutter - EMOCIONAL
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1111-1123.
Caughter S, Crofts V.
The Michael Palin Centre for Stammering, London, United Kingdom.
PURPOSE: To consider the rationale, methods, and potential benefits of nurturing the growth of resilience in school-aged children who stutter. Stuttering in childhood can have negative psychological consequences for some, including the development of a negative attitude toward their speech from a young age (Vanryckeghem, Brutten, & Hernandez, 2005) and possible co-occurring psychopathology in adolescence and adulthood, in particular, anxiety disorders (Blood, Blood, Maloney, Meyer, & Qualls, 2007; Iverach & Rapee, 2014; McAllister, Kelman, & Millard, 2015). Children who stutter also frequently report teasing and bullying by their peers (Blood & Blood, 2007; Boyle, 2011; Langevin, Packman, & Onslow, 2009), which can have a significant impact on children's confidence and psychological well-being. However, the capacity of children who stutter to cope or "bounce back" from adversity is not routinely explored or incorporated in therapy for stuttering.
METHOD: This clinical focus article will explore the construct of resilience and consider why it may be important for children who stutter and their parents. A framework for understanding resilience in relation to stuttering is used, drawing from the Reaching In Reaching Out Resiliency Program (for children aged under 8 years and their parents) and the Penn Resiliency Program (for children aged 8 years and over).
CONCLUSIONS: The role of parents is key in modeling resilient responses to children and creating a resilience-rich environment. As children who stutter may be more vulnerable to adversity, some may benefit from targeted support to build their resilience, in order to enhance their ability to overcome challenges and thrive.
PMID: 30347057 DOI: 10.1044/2018_AJSLP-ODC11-17-0189
Online cathodal transcranial direct current stimulation to the right homologue of Broca's area improves speech fluency in people who stutter. - NEUROCIËNCIAS
Psychiatry Clin Neurosci. 2018 Oct 31. [Epub ahead of print]
Yada Y, Tomisato S, Hashimoto RI.
Tokyo Metropolitan University, Tokyo, Japan & Nihon Kokan Hospital, Kanagawa, Japan.
AIM: Previous functional imaging studies demonstrate that people who stutter (PWS) exhibit over- and under-activation of Broca's and Wernicke's areas and their right hemisphere homologues when speaking. However, it is unclear whether this altered activation represents the neural cause of speech dysfluency or a secondary compensatory activation in PWS. To clarify the functional significance of the altered activation pattern in classic language areas and their right homologues, we examined whether the severity of stuttering was affected when the activation of these areas was modulated by brain stimulation.
METHODS: While PWS read passages aloud, we applied transcranial direct current stimulation (tDCS) using electrode montages that included an anodal or cathodal electrode placed over one of the language areas and its right hemisphere homologue, with the second electrode placed over the contralateral supraorbital region. Each participant underwent both anodal and cathodal tDCS sessions, each of which included a sham stimulation. Effects of stimulation polarity and electrode location on the frequency of stuttering were analyzed.
RESULTS: We observed a significant interaction between polarity and location on the frequency of stuttering. Follow-up analyses revealed that a tDCS montage including the cathodal electrode over right Broca's area (RB) significantly reduced the frequency of stuttering.
CONCLUSION: The results indicated that stuttering severity was ameliorated when overactivation in RB was reduced by tDCS. This observation further suggests that speech dysfluency in PWS may be caused either by functional alteration in RB or by abnormal activation in speech motor control areas that are connected with RB.
PMID: 30379387 DOI: 10.1111/pcn.12796
Palin Parent-Child Interaction Therapy: The Bigger Picture - INFANTIL
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1211-1223.
Millard SK, Zebrowski P, Kelman E.
The Michael Palin Centre for Stammering, London, United Kingdom; City, University of London, United Kingdom; University of Iowa, Iowa City.
PURPOSE: Palin Parent-Child Interaction therapy (Kelman & Nicholas, 2008) is an evidence-based intervention for young children who stutter. The evidence consists of multiple single-subject replicated studies, and this demonstrates that the intervention is effective. The aim of this study was to enhance the evidence base by exploring the effectiveness of the therapy with a large cohort of children who stutter.
METHOD: Children and parents completed a range of assessments at 4 time points: start of therapy and then 3, 6, and 12 months later. The following variables were included: stuttering frequency, child's communication attitude, parents' perception of the impact of the stuttering on the child, the severity of stuttering and its impact on the parents, and their knowledge of stuttering and confidence in managing it. Hierarchical multiple regression analyses were conducted to explore whether the variables are predictive for the outcome "parent knowledge and confidence." In addition, we sought a preliminary view of factors associated with outcome level by separating children into 2 groups according to response to treatment (more successful and less successful).
RESULTS: The results demonstrated a significant improvement in all variables, and this improvement was maintained for 1 year posttreatment. Measures collected 3 months after the start of therapy showed significant improvement in child attitude to communication, parents' knowledge and confidence in how to manage stuttering, and mothers' ratings of stuttering severity and impact the child's stuttering has on the mothers. By 6 months after therapy onset, there was a significant reduction in stuttering frequency and fathers' perception of severity and their worry about it. Furthermore, these improvements were maintained 1 year posttherapy. Several variables predicted parents' knowledge and confidence 6 months after the start of therapy. Finally, those who made greater improvements had mothers who were more negative in their ratings of severity and worry, and had less knowledge and confidence at the start of therapy. There were no differences between the groups on a range of other variables.
CONCLUSIONS: The results demonstrate that, over a year, children who attend a course of Palin Parent-Child Interaction show reduced stuttering frequency and a more positive attitude to speech. In addition, parents observe these improvements in the child, feel more confident in managing the stuttering, and are less worried about it. The different times at which specific variables significantly improved provides insight to a process of change over time. Results suggest that parents' ability to notice positive change in fluency and the impact that these observations have on both the child and the family are linked to their confidence in how to support the child. The preliminary findings with regard to response to treatment suggest that children can benefit from this program even with factors that might be predicted to reduce therapy success.
PMID: 30347064 DOI: 10.1044/2018_AJSLP-ODC11-17-0199
Phonological neighborhood effect in spontaneous speech in adults who stutter - FALA
J Fluency Disord. 2018 Dec;58:86-93.Epub 2018 Aug 30.
University, San José, CA, USA.
PURPOSE: The study examined the relationship between word-form similarity network (phonological neighborhood) and stuttering occurrence in spontaneous speech in adults. The study asked whether neighborhood characteristics, including the number of neighbors (neighborhood density) and the average word frequency among neighbors (neighborhood frequency), differentiate stuttered from fluent words within spontaneous speech samples, and more specifically, whether neighborhood characteristics facilitate speech fluency in adults who stutter.
METHOD: Spontaneous speech samples were collected from 14 adults who stutter, including 7 with mild stuttering and 7 with severe stuttering. Each stuttered word was matched with a fluently produced word within the sample, controlling for multiple lexical factors. Neighborhood density and neighborhood frequency were compared between the stuttered and matched fluent words.
RESULTS: Adults stuttered on words with lower neighborhood density, compared to fluently produced words, with similar patterns in the two severity subgroups. There appeared to be a marginal difference between single-syllable whole-word repetition and the other stuttering typologies.
CONCLUSION: Neighborhood density facilitates fluent word production in spontaneous speech in adults who stutter, regardless of stuttering severity. This finding adds to the evidence supporting that phonological encoding plays a role in stuttering in naturalistic, spontaneous speech in adults.
PMID: 30180994 DOI: 10.1016/j.jfludis.2018.08.005
Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition - NEUROCIÊNCIAS
J Fluency Disord. 2018 Dec;58:94-117. Epub 2018 Sep 1.
Bowers A, Bowers LM, Hudock D, Ramsdell-Hudock HL.
University of Arkansas, Fayetteville, AR, United States; Idaho State University, Pocatello, United States.
The current review examines how neurobiological models of language and cognition could shed light on the role of phonological working memory (PWM) in developmental stuttering (DS). Toward that aim, we review Baddeley's influential multicomponent model of PWM and evidence for load-dependent differences between children and adults who stutter and typically fluent speakers in nonword repetition and dual-task paradigms. We suggest that, while nonword repetition and dual-task findings implicate processes related to PWM, it is unclear from behavioral studies alone what mechanisms are involved. To address how PWM could be related to speech output in DS, a third section reviews neurobiological models of language proposing that PWM is an emergent property of cyclic sensory and motor buffers in the dorsal stream critical for speech production. We propose that anomalous sensorimotor timing could potentially interrupt both fluent speech in DS and the emergent properties of PWM. To further address the role of attention and executive function in PWM and DS, we also review neurobiological models proposing that prefrontal cortex (PFC) and basal ganglia (BG) function to facilitate working memory under distracting conditions and neuroimaging evidence implicating the PFC and BG in stuttering. Finally, we argue that cognitive-behavioral differences in nonword repetition and dual-tasks are consistent with the involvement of neurocognitive networks related to executive function and sensorimotor integration in PWM. We suggest progress in understanding the relationship between stuttering and PWM may be accomplished using high-temporal resolution electromagnetic experimental approaches.
PMID: 30224087 DOI: 10.1016/j.jfludis.2018.08.006
Recovery from stuttering in preschool-age children: 9 year outcomes in a clinical population - TERAPIA
J Fluency Disord. 2018 Dec;58:35-46. doi: 10.1016/j.jfludis.2018.09.003. Epub 2018 Sep 24.
Franken MJP, Koenraads SPC, Holtmaat CEM, van der Schroeff MP.
Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Linguistics, Logopediepraktijk Salland, Raalte, the Netherlands.
PURPOSE: The first purpose was to define the recovery rate in children who stutter in a clinical sample, adding self-report to validate recovery status. The second purpose was to explore whether children who were judged to be recovered showed subjective experiences that might be interpreted as coping behaviors used to control speech fluency.
METHODS: In this longitudinal study, preschool-age children whose parents consulted a speech-language pathologist about stuttering were followed for 9 years. At follow-up, children's self-reports on stuttering were reported, as well as traditional criteria on recovery (parental and expert judgment). The Overall Assessment of the Speaker's Experience of Stuttering (OASES) was used to collect children's experiences with speaking.
RESULTS: Eleven of the 15 children (73%) were judged by parents and clinicians to have recovered from stuttering. However, when considering children's self-reports, 9 children (60%) might be considered to have recovered. In addition, 3 children who were judged to be recovered reported experiences with speaking that were uncommon, even compared to children who continued to stutter.
CONCLUSION: In this exploratory study of a clinical population, the recovery rate in children that received treatment for stuttering appeared to be comparable to a non-clinical population. Considering self-reports can improve validity of assessing the "recovery rate". Moreover, recovery in children may not be effortless; instead, it may be the result of conscious or unconscious coping behavior. Future studies are recommended to consider self-reports to improve validity of recovery, and to document experiences with speaking to explore effortless, spontaneous fluency versus controlled fluency.
PMID: 30309634 DOI: 10.1016/j.jfludis.2018.09.003
Relationship between serum homovanillic acid, DRD2 C957T (rs6277), and hDAT A559V (rs28364997) polymorphisms and developmental stuttering - NEUROCIÊNCIAS
J Commun Disord. 2018 Nov - Dec;76:37-46. Epub 2018 Aug 30.
Mohammadi H, Joghataei MT, Rahimi Z, Faghihi F, Farhangdoost H.
Kermanshah University of Medical Sciences, Kermanshah, Iran; Iran University of Medical Sciences, Tehran, Iran; University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
The involvement of the brain dopamine system in the pathophysiology of developmental stuttering has been previously suggested. In the present study, we aimed to investigate the relationship between developmental stuttering in children and the levels of serum homovanillic acid (HVA), dopamine D2 receptor (DRD2) C957T (rs6277), and solute carrier family 6 member 3 (SLC6A3) human dopamine transporter (hDAT) A559V (rs28364997) single-nucleotide polymorphisms. In a case-control study, serum level of HVA, DRD2 C957T, and DAT A559V were compared between 85 children who stuttered (CWS) and 85 age- and sex-matched children who did not stutter (CWNS). Although serum level of HVA was higher among the CWS (median = 25.50 ng/mL) than that in the CWNS (median = 17.40 ng/mL), the difference between the two groups was not significant (p = 0.43). No significant correlation was observed between age and the level of HVA among all the participants (r = -0.15, p = 0.06), nor was there any correlation among the CWS (r = -0.19, p = 0.14) or among the CWNS (r = -0.13, p = 0.27) according to the Spearman correlation coefficient. On the other hand, there was a significant negative correlation between age from stuttering onset and the serum level of HVA among the CWS group (r = -0.32, p = 0.01). The Spearman correlation coefficient did not indicate any significant correlation between stuttering severity and HVA in CWS (r = -0.06, p = 0.59). The mutant allele of hDAT A559V was observed neither in the CWS nor in the controls. The allele frequencies of DRD2 C957T were not significantly different between the CWS and the CWNS; however, the frequency of the TT genotype was significantly higher among the CWS (p = 0.02), which was associated with 2.25-fold susceptibility to stuttering (OR = 2.25, 95% CI = 1.03 to 4.90, p = 0.04). Our findings suggest that the serum level of HVA might be a biomarker for dopaminergic involvement in the pathogenesis of stuttering. Moreover, the present study indicates that the DRD2 C957T polymorphism might be a risk factor for the development of stuttering among Iranian Kurdish population.
PMID: 30199750 DOI: 10.1016/j.jcomdis.2018.08.003
Reliability, validity, and normative investigation of the Persian version of the Communication Attitude Test for Adults Who Stutter (BigCAT) - AVALIAÇÃO
Appl Neuropsychol Adult. 2018 Nov 2:1-5. [Epub ahead of print]
Valinejad V, Yadegari F, Vanryckeghem M.
University of Social Welfare and Rehabilitation Sciences , Tehran , Iran; Tehran university of Medical Science , Tehran , Iran; University of Central Florida , Orlando , Florida , USA.
The purpose of this study was to establish normative and psychometric data for the Persian version of the Communication Attitude Test for Adults who Stutter (BigCAT) and to determine if there is a significant difference between the speech-associated attitude of Persian stuttering adults and their nonstuttering peers. The Persian BigCAT was administered to 90 people who stutter (PWS) and 90 people who do not stutter (PWNS). After the translation of the test and its equalization to Persian Language, content validity was determined by the opinions of experts. Then, the criterion validity with Erickson S24's test of communication attitude was determined in people who stutter. The reliability was examined using Kuder-Richardson coefficient and test-retest correlations. The results showed that the mean BigCAT score of PWS was significantly higher than that of PWNS (p < .001). The Kuder-Richardson coefficient for PWS and PWNS was high (0.88 and 0.83, respectively). The test-retest correlations as measured by Intraclass Coefficient Correlation (ICC), was also strong (0.89). The present study suggests that the Persian BigCAT is a valid instrument and can be used for the pre, peri, and post-treatment assessment of speech-related attitude of those who stutter in Iran.
PMID: 30388892 DOI: 10.1080/23279095.2018.1480482
Revisiting the public awareness of aphasia in Exeter: 16 years on - SOCIAL
Int J Speech Lang Pathol. 2018 Oct 11:1-10. [Epub ahead of print]
Hill A, Blevins R, Code C.
University of Exeter , Exeter , UK.
BACKGROUND: Surveys of awareness of aphasia have been conducted worldwide. There has been no survey of change in awareness in one place over time. A survey in Exeter, UK in 2001 found awareness of aphasia was strikingly low. The aim of this study was to conduct a repeat survey using the same methods in the same city 16 years later to examine changes in awareness and knowledge.
METHOD: We surveyed 167 shoppers in Exeter examining awareness and knowledge of aphasia. Awareness of stroke, stuttering, dyslexia and autism were examined for comparison. Demographic information was collected.
RESULT: Thirty-four percent had heard of aphasia and 5% had some basic knowledge. Awareness of aphasia had improved significantly from 2001 to 2017, but basic knowledge had not. Awareness was higher in professional groups, such as lawyers and academics, and healthcare workers and in those who knew someone with aphasia. Awareness, but not knowledge, was higher in older respondents. Awareness of aphasia was significantly lower than awareness of all other conditions.
CONCLUSION: We found a significant increase in awareness of aphasia in Exeter since 2001, but not knowledge. The implications of ongoing low levels of aphasia awareness, like inadequate funding and difficulty integrating into an ill-informed society, are discussed.
PMID: 30309261 DOI: 10.1080/17549507.2018.1485742
Segmental and metrical complexity during non-word repetition in adults who stutter - FALA
Clin Linguist Phon. 2018 Aug 7:1-23. [Epub ahead of print]
Coalson GA, Byrd CT, Treleaven SB, Dang L.
Louisiana State University , Baton Rouge , LA , USA; The University of Texas at Austin , Austin , TX , USA.
Non-word repetition is weaker for adults who stutter (AWS) compared to adults who do not stutter (AWNS) as phonological demands increase. However, non-word stimuli used in previous studies varied by length, but did not vary with regard to segmental or metrical complexity. The purpose of the present study was to examine the unique influence of these two distinct types of complexity on non-word repetition in AWS and AWNS via administration of the Test of Phonological Structure (TOPhS). Twenty-four adults (12 AWNS, 12 AWS) repeated 96 non-words within a soundproof booth immediately after auditory presentation. All 96 non-word targets included on the TOPhS were one to four syllables in length and ranked based on segmental complexity (simple, moderate and complex) and metrical complexity (simple, moderate and complex). No main effect of metrical complexity was detected between groups, and no differences in accuracy were observed for non-words with simple or moderate segmental complexity. However, AWS were significantly more likely to produce a phonemic error when repeating words with complex segmental structure than AWNS, irrespective of metrical complexity. Segmental complexity may contribute to the differences in phonological working memory in AWS when controlling for metrical complexity and length.
PMID: 30084671 DOI: 10.1080/02699206.2018.1504988
Self-acceptance, resilience, coping and satisfaction of life in people who stutter. - TERAPIA
J Fluency Disord. 2018 Nov 1. [Epub ahead of print]
Plexico LW, Erath S2, Shores H, Burrus E.
Auburn University, United States.
PURPOSE: The purpose of the present study was to evaluate self-acceptance and satisfaction with life with people who stutter and the influence of coping and resilience on the two factors.
METHOD: Forty-seven people who stutter (PWS) and 47 people who do not stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6 main areas: (a) background information, (b) satisfaction with life, (c) coping, (d) avoidance, (e) self-acceptance, and resilience.
RESULTS: Avoidant coping and maladaptive coping moderated the association between stuttering and self- acceptance but not satisfaction with life. Resilience was found to moderate the association between stuttering and self-acceptance as well as satisfaction with life.
CONCLUSION: Stuttering was associated with lower self-acceptance at higher levels of avoidant coping and maladaptive coping. PWS who have lower levels of resilience were more likely to have a lower satisfaction with life indicating that higher levels of resilience could serve as a protective factor for having a greater satisfaction with life. Further, stuttering was associated with lower self-acceptance at lower levels of resilient attitude. Resilience and coping appear to protect against having diminished self-acceptance and satisfaction with life for PWS.
PMID: 30446168 DOI: 10.1016/j.jfludis.2018.10.004
Self-report of self-disclosure statements for stuttering - TERAPIA
J Fluency Disord. 2018 Dec;58:22-34. Epub 2018 Sep 28.
McGill M, Siegel J, Nguyen D, Rodriguez S.
Portland State University, Portland, Oregon, USA.
PURPOSE: To (1) analyze verbatim wording used by adults who stutter (AWS) to self-disclose stuttering, (2) determine contexts in which AWS may self-disclose, (3) examine the use of self-disclosure by AWS about other aspects of their identity, and (4) investigate the ways in which speech-language pathologists (SLPs) develop self-disclosure statements with AWS.
METHOD: Web-based questionnaires were administered to AWS (N = 42) and SLPs (N = 33) who work with AWS. The AWS questionnaire asked about the verbatim wording of self-disclosure statements used by AWS and the contexts in which they utilize them. For SLPs, the questionnaire probed how and why they work with AWS to formulate self-disclosure statements. Responses were openly coded and then funneled into concepts for analysis.
RESULTS: The majority of AWS provided verbatim self-disclosure statements which were educational in nature. However, when responding to fixed choices and when reporting on self-disclosing other aspects of their lives, the majority of participants selected a direct statement. The majority of AWS reported that they self-disclose when interviewing for a job. SLPs reportedly instruct their clients to use educational self-disclosure statements. SLPs also reported that they use an individualized approach to brainstorming self-disclosure statements. Finally, SLPs reported that they find self-disclosure beneficial because it facilitates self-empowerment for AWS.
CONCLUSION: AWS may benefit from learning about the type of self-disclosure statements and the contexts in which other AWS chose to disclose. Additionally, SLPs who work with AWS may benefit from the reported procedures for and types of self-disclosure statements formulated by AWS.
PMID: 30286946 DOI: 10.1016/j.jfludis.2018.09.004
Self-Esteem, Self-Efficacy, and Social Support as Predictors of Communicative Participation in Adults Who Stutter - SOCIAL
J Speech Lang Hear Res. 2018 Aug 8;61(8):1893-1906.
Boyle MP, Beita-Ell C, Milewski KM, Fearon AN.
Montclair State University, NJ.
PURPOSE: This study aimed to identify contributors to communicative participation in adults who stutter. Specifically, it was of interest to determine whether psychosocial variables of self-esteem, self-efficacy, and social support were predictive of communicative participation beyond contributions of demographic and speech-related variables.
METHOD: Adults who stutter (N = 339) completed an online survey that included measures of communicative participation, self-esteem, self-efficacy, social support, self-reported speech-related variables (speech usage, number of years stuttering, history of treatment and self-help support group participation for stuttering, and physical speech disruption severity), and demographics (age, sex, living situation, education, and employment status). Hierarchical regression was performed for prediction of communicative participation, in addition to calculating Spearman correlations between social roles variables, communicative participation, and physical speech disruption severity.
RESULTS: After controlling for demographic and speech-related variables, self-esteem, self-efficacy, and social support each significantly predicted communicative participation in adults who stutter. Large correlations were observed between communicative participation and measures of social roles, whereas medium correlations were observed between physical speech disruption severity and measures of social roles.
CONCLUSIONS: Communicative participation in adults who stutter is associated with a variety of demographic, speech-related, and psychosocial variables. Speech-language pathologists should be aware of predictors of communicative participation such as self-esteem, self-efficacy, and social support, in addition to severity of physical speech disruptions. They should consider and evaluate these factors in clients who stutter and target them in treatment if necessary.
PMID: 29998290 DOI: 10.1044/2018_JSLHR-S-17-0443
Similar within-utterance loci of dysfluency in acquired neurogenic and persistent developmental stuttering. - AVALIAÇÃO
Brain Lang. 2018 Dec 26;189:1-9. [Epub ahead of print]
Max L, Kadri M, Mitsuya T, Balasubramanian V.
University of Washington, Seattle, WA, USA; Haskins Laboratories, New Haven, CT, USA; Seton Hall University, South Orange, NJ, USA.
Although the underlying neural mechanisms remain unknown for both persistent developmental stuttering (PSD) and acquired neurogenic stuttering (ANS), few studies have examined similarities/differences between these two disorders. We evaluated in both PDS (n = 35) and ANS (n = 5) phonetic, word class, word length, and word position variables that are widely believed to influence at which loci within utterances PDS speakers' stuttering is most likely to occur. For both groups, (a) word weights based on the combination of variables were greater for stuttered vs. fluent words, and (b) stuttered words were loaded more by individual variables. However, contrary to long-standing views regarding PDS, greater loading for stuttered words was not found for the position variable. Findings suggest similar loci of stuttering in adults with PDS and ANS, and, for both groups, the probability of stuttering on a given word was more influenced by motor production variables than language variables.
PMID: 30593859 DOI: 10.1016/j.bandl.2018.12.003
Stuttering as a matter of delay in neural activation: A combined TMS/EEG study - NEUROCIÊNCIAS
Clin Neurophysiol. 2019 Jan;130(1):61-76. Epub 2018 Nov 10.
Busan P, Del Ben G, Russo LR, Bernardini S, Natarelli G, Arcara G, Manganotti P, Battaglini PP.
Fondazione Ospedale San Camillo IRCCS, Venice, Italy; University of Trieste, Trieste, Italy; ABC(®) Balbuzie, Padua, Italy; University of Padua, Padua, Italy..
OBJECTIVE: Brain dynamics in developmental stuttering (DS) are not well understood. The supplementary motor area (SMA) plays a crucial role, since it communicates with regions related to planning/execution of movements, and with sub-cortical regions involved in paced/voluntary acts (such as speech). We used TMS combined with EEG to shed light on connections in DS, stimulating the SMA.
METHODS: TMS/EEG was recorded in adult DS and fluent speakers (FS), stimulating the SMA during rest. TMS-evoked potentials and source distribution were evaluated.
RESULTS: Compared to FS, stutterers showed lower activity of neural sources in early time windows: 66-82 ms in SMA, and 91-102 ms in the left inferior frontal cortex and left inferior parietal lobule. Stutterers, however, showed higher activations in later time windows (i.e. from 260-460 ms), in temporal/premotor regions of the right hemisphere.
CONCLUSIONS: These findings represent the functional counterpart to known white matter and cortico-basal-thalamo-cortical abnormalities in DS. They also explain how white matter abnormalities and cortico-basal-thalamo-cortical dysfunctions may be associated in DS. Finally, a mechanism is proposed in which compensatory activity of the non-dominant (right) hemisphere is recruited.
SIGNIFICANCE: DS may be a disorder of neural timing that appears to be delayed compared to FS; new mechanisms that support stuttering symptoms are inferred; the SMA may be a promising target for neuro-rehabilitation.
PMID: 30476712 DOI: 10.1016/j.clinph.2018.10.005
Stuttering-like hesitation in speech during acute/post-acute phase of immune-mediated encephalitis - GAGUEIRA ADQUIRIDA
J Fluency Disord. 2018 Dec;58:70-76. Epub 2018 Sep 7.
Dinoto A, Busan P, Formaggio E, Bertolotti C, Menichelli A, Stokelj D, Manganotti P.
University of Trieste, Trieste, Italy; Fondazione Ospedale San Camillo IRCCS, Venice, Italy; Fondazione Ospedale San Camillo IRCCS, Venice, Italy; Department of Rehabilitation Medicine, ASUI Trieste, Trieste, Italy.
PURPOSE: Neurogenic stuttering may be evident after a lesion/dysfunction of wider neural networks. Here we present a case of acquired stuttering as the consequence of immune-mediated encephalitis.
METHODS: The case of a 71-year old male who complained about the progressive onset of stuttering and disequilibrium as the consequence of immune-mediated encephalitis, is here reported. Administration of corticosteroid methylprednisolone was useful to recover from impairments. An in depth analysis of the electroencephalography (relative power of brain rhythms and source localization) during different phases of the disease/treatment was also realized.
RESULTS: The patient showed a stuttering-like slowed speech with blocks and repetitions, especially at the beginning of words/sentences, with associated movements of the oro-facial muscles. Speech and general motor skills resulted slowed in their preparation/execution phases. Electroencephalography showed a "slowed" pattern, with delta/theta waves mainly in the prefrontal cortex and in sensorimotor networks.
CONCLUSION: This case reports a probable immune-mediated encephalitis that resulted in acquired stuttering. The effect of "slowed" oscillatory brain activity on motor skills requesting sequencing and fine coordination (e.g. speech) could result in less "synchronized" systems, easily prone to disruptions.
PMID: 30220403 DOI: 10.1016/j.jfludis.2018.09.001
Stuttering through the Lifespan: Questions and Answers.
Semin Speech Lang. 2018 Sep;39(4):297-298. Epub 2018 Aug 24.
University of Maryland, College Park, Maryland.
No abstract available.
PMID: 30142640 DOI: 10.1055/s-0038-1667292
Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys. - EMOCIONAL
PLoS One. 2018 Aug 7;13(8):e0198450.
Ajdacic-Gross V, Bechtiger L, Rodgers S, Müller M, Kawohl W, von Känel R, Mutsch M, Rössler W, Seifritz E, Castelao E, Strippoli MF, Vandeleur C, Preisig M, Howell P.
University of Zurich, Zurich, Switzerland; University Hospital Zurich, Zurich, Switzerland; Swiss Federal Institute of Technology, Zurich, Switzerland; University of Sao Paulo, Sao Paulo, Brazil; Lausanne University Hospital, Prilly, Switzerland; University College, London, United Kingdom.
AIMS: Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA).
METHODS: Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874, age 35-82 years) and the ZInEP Epidemiology Survey (N = 1,500, age 20-41 years). Associations between stuttering and sociodemographic characteristics, familial aggregation, comorbidity and psychosocial risk / associated factors were investigated in both samples. LCAs were conducted on selected items from people in both samples who reported having stuttered in childhood.
RESULTS: Initial analyses linked early anxiety disorders, such as separation anxiety disorder and overanxious disorder, to stuttering (PsyCoLaus). ADHD was associated with stuttering in both datasets. In the analyses of risk / associated factors, dysfunctional parental relationships, inter-parental violence and further childhood adversities were mutual predictors of stuttering. Moreover, comorbidities were seen with hay fever, asthma, eczema and psoriasis (PsyCoLaus). Subsequent LCA identified an unspecific group of persons who self-reported that they stuttered and a group defined by associations with psychosocial adversities (ZINEP, PsyCoLaus) and atopic diseases (PsyCoLaus).
CONCLUSIONS: The two subtypes of developmental stuttering have different risk / associated factors and comorbidity patterns. Most of the factors are associated with vulnerability mechanisms that occur early in life and that have also been linked with other neurodevelopmental disorders. Both psychosocial and biological factors appear to be involved in the etiopathogenesis of stuttering.
PMID: 30086147 PMCID: PMC6080750 DOI: 10.1371/journal.pone.0198450
The concentrations of bioelements in the hair samples of Jordanian children who stutter - AVALIAÇÃO
Int J Pediatr Otorhinolaryngol. 2018 Sep;112:158-162. Epub 2018 Jul 3.
Alqhazo M, Rashaid AB.
Jordan University of Science and Technology, Irbid, Jordan. 2
OBJECTIVES: This study investigates the levels of 15 bioelements (calcium, copper, chromium, sodium, iron, magnesium, manganese, zinc, cobalt, selenium, molybdenum, vanadium, potassium, boron, and lithium) in the hair species of Jordanian stutterer.
METHODS: The subjects of the study included 25 cases of stuttering, and 25 normal children (age and sex matched). The severity of stuttering (low, moderate, and severe) were assessed using Stuttering Severity Instrument, Fourth edition (SSI-4). Hair samples of subjects were cut, washed, dried, physically degraded, hydrolyzed, and analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS).
RESULTS: Results indicated that the levels of bioelements (Calcium, Copper, Chromium, Magnesium, Manganese, Cobalt, Selenium, Molybdenum, Vanadium, Boron, and Lithium) were significantly lesser in the hair samples of stuttering group than the control group.
CONCLUSION: The findings of the current study could support the use of biochemical analyses as diagnostic biomarker for stuttering.
PMID: 30055725 DOI: 10.1016/j.ijporl.2018.06.045
The Coexistence of Disabling Conditions in Children Who Stutter: Evidence From the National Health Interview Survey.- AVALIAÇÃO
J Speech Lang Hear Res. 2018 Dec 10;61(12):2895-2905.
Briley PM, Ellis C Jr.
East Carolina University, Greenville, NC.
PURPOSE: Stuttering is a disorder that has been associated with coexisting developmental disorders. To date, detailed descriptions of the coexistence of such conditions have not consistently emerged in the literature. Identifying and understanding these conditions can be important to the overall management of children who stutter (CWS). The objective of this study was to generate a profile of the existence of disabling developmental conditions among CWS using national data.
METHOD: Six years of data from the National Health Interview Survey (2010-2015) were analyzed for this project. The sample consisted of children whose respondents clearly indicated the presence or absence of stuttering. Chi-square tests of independence were used for comparing categorical variables; and independent-samples t tests, for comparing continuous variables. Multiple logistic regression analyses were used for determining the odds of having a coexisting disabling developmental condition.
RESULTS: This study sample included 62,450 children, of which 1,231 were CWS. Overall, the presence of at least 1 disabling developmental condition was 5.5 times higher in CWS when compared with children who do not stutter. The presence of stuttering was also associated with higher odds of each of the following coexisting developmental conditions: intellectual disability (odds ratio [OR] = 6.67, p < .001), learning disability (OR = 5.45, p < .001), attention-deficit hyperactivity disorder/attention-deficit disorder (OR = 3.09, p < .001), seizures (OR = 7.52, p < .001), autism/Asperger's/pervasive developmental disorder (OR = 5.48, p < .001), and any other developmental delay (OR = 7.10, p < .001).
CONCLUSION: Evidence from the National Health Interview Survey suggests a higher prevalence of coexisting developmental disabilities in CWS. The existence of coexisting disabling developmental conditions should be considered as part of an overall management plan for CWS.
PMID: 30458520 DOI: 10.1044/2018_JSLHR-S-17-0378
The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker - SOCIAL
J Fluency Disord. 2018 Nov 20;59:1-20. [Epub ahead of print]
La Salle University, 1900 W. Olney Avenue, Philadelphia, PA, United States.
PURPOSE: The purpose of this study was to investigate the effects of self-disclosure on the self-perception of stuttering severity, comfort, cognitive effort, and anxiety in a structured conversational interaction with a normally fluent speaker. The benefit of self-disclosure from the perspective of the person who stutters in a self-disclosed and in a non-disclosed condition was also studied. The total syllables produced and percent syllables stuttered were measured in both experimental conditions in order to evaluate the effects on the amount of speech produced and verbal fluency.
METHODS: Twenty-five adults who stutter were recruited in Philadelphia and New Jersey, through social media, university clinics, and National Stuttering Association (NSA) self-help groups. The participants engaged in a conversational task with a normally fluent speaker (NFS). The cognitive-affective variables (self-perception of stuttering severity, comfort, cognitive effort, anxiety and benefit) were measured using self-report questionnaires completed after each condition. The percent syllables stuttered and total syllables in each condition were also transcribed and analyzed.
RESULTS: Frequency distributions of Likert Scale ratings indicated a slight preference for self-disclosure over non-disclosure, but there was a non-significant difference on the benefit variable for the disclosed and non-disclosed conditions. There were correlations between total syllables produced and percent syllables stuttered and comfort, in the non-disclosed state only. Other findings included non-significant differences for the cognitive-affective variables across conditions.
CONCLUSION: From the perspective of the person who stutters, self-disclosure at the outset of the communicative interaction did not have a decisive impact on the cognitive-affective or speech variables.
PMID: 30500438 DOI: 10.1016/j.jfludis.2018.11.003
The Effects of Syntactic Complexity and Sentence Length on the Speech Motor Control of School-Age Children Who Stutter - INFANTIL
J Speech Lang Hear Res. 2018 Sep 19;61(9):2157-2167.
Usler ER, Walsh B.
Boston University, MA; MGH Institute of Health Professions, Boston, MA; Michigan State University, East Lansing.
PURPOSE: Early childhood stuttering is associated with atypical speech motor development. Compared with children who do not stutter (CWNS), the speech motor systems of school-age children who stutter (CWS) may also be particularly susceptible to breakdown under increased processing demands. The effects of increased syntactic complexity and sentence length on articulatory coordination were investigated.
METHOD: Kinematic, temporal, and behavioral indices of articulatory coordination were quantified for school-age CWS (n = 19) and CWNS (n = 18). Participants produced 4 sentences varying in syntactic complexity (simple declarative/complex declarative with a relative clause) and sentence length (short/long). Lip aperture variability (LAVar) served as a kinematic measure of interarticulatory consistency over repeated productions. Articulation rate (syllables per second) was also calculated as a related temporal measure. Finally, we computed accuracy and stuttering frequency percentages for each sentence to assess task performance.
RESULTS: Increased sentence length, but not syntactic complexity, increased LAVar in both groups. This effect was disproportionately greater for CWS compared with CWNS. No group differences were observed for articulation rate. CWS were also less accurate in their sentence productions than fluent peers and exhibited more instances of stuttering when processing demands associated with length and syntactic complexity increases.
CONCLUSIONS: The speech motor systems of school-age CWS appear to be particularly vulnerable to processing demands associated with increased sentence length, as evidenced by increased LAVar. Increasing the length and complexity of the sentence stimuli also resulted in reduced production accuracy and increased stuttering frequency. We discuss these findings within a motor control framework of speech production.
PMID: 30128477 PMCID: PMC6195042 [Available on 2019-03-01] DOI: 10.1044/2018_JSLHR-S-17-0435
The frontal aslant tract (FAT) and its role in speech, language and executive function - NEUROCIÊNCIAS
Cortex. 2018 Nov 1;111:148-163. [Epub ahead of print]
Dick AS, Garic D, Graziano P, Tremblay P.
Florida International University, Miami, FL, USA; Université Laval, Quebec City, Quebec, Canada; CERVO Brain Research Center, Quebec City, Canada.
In this review, we examine the structural connectivity of a recently-identified fiber pathway, the frontal aslant tract (FAT), and explore its function. We first review structural connectivity studies using tract-tracing methods in non-human primates, and diffusion-weighted imaging and electrostimulation in humans. These studies suggest a monosynaptic connection exists between the lateral inferior frontal gyrus and the pre-supplementary and supplementary motor areas of the medial superior frontal gyrus. This connection is termed the FAT. We then review research on the left FAT's putative role in supporting speech and language function, with particular focus on speech initiation, stuttering and verbal fluency. Next, we review research on the right FAT's putative role supporting executive function, namely inhibitory control and conflict monitoring for action. We summarize the extant body of empirical work by suggesting that the FAT plays a domain general role in the planning, timing, and coordination of sequential motor movements through the resolution of competition among potential motor plans. However, we also propose some domain specialization across the hemispheres. On the left hemisphere, the circuit is proposed to be specialized for speech actions. On the right hemisphere, the circuit is proposed to be specialized for general action control of the organism, especially in the visuo-spatial domain. We close the review with a discussion of the clinical significance of the FAT, and suggestions for further research on the pathway.
PMID: 30481666 DOI: 10.1016/j.cortex.2018.10.015
The Impact of Stuttering on Development of Self-Identity, Relationships, and Quality of Life in Women Who Stutter - TERAPIA
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1244-1258. doi: 10.1044/2018_AJSLP-ODC11-17-0201.
Nang C, Hersh D, Milton K, Lau SR.
Edith Cowan University, Perth, Australia; Disability Services Commission, Perth, Australia.
PURPOSE: The experiences of women who stutter have been underresearched. Clinicians have little guidance from the research literature on issues specific to women who stutter and are likely to have less clinical contact with this group than with men who stutter because of the higher prevalence of stuttering in men. This study explored the experiences of a small group of women who stutter with a particular focus on what the main current issues are and how gender may have influenced experiences with stuttering.
METHOD: This qualitative study involved recruitment of 9 women who stutter (aged 35-80 years) through a support network of people who stutter in Western Australia. All the women had received some form of speech therapy for stuttering, and they came from diverse cultural backgrounds. Individual, semistructured interviews were conducted, recorded, and transcribed verbatim. Data were managed with NVivo 10, and thematic analysis was used to identify recurring themes across the data. Data were coded independently by the researchers and refined through group discussion. Participants also completed the Overall Assessment of the Speaker's Experience of Stuttering.
RESULTS: A core theme of "gendered sense of self in society" emerged from the data. This related to 3 broad themes: perceptions of self that were primarily negative, the impact of stuttering on relationships and social connection with others (relationships with family, peers, colleagues, and intimate partners), and the management of stuttering (internal coping, motivations, and experiences with external support).
CONCLUSIONS: Stuttering has a pervasive impact on all aspects of women's lives and affects how they view themselves, their relationships, their career potential, and their perceptions of how others view them in society. The women interviewed in this study often had negative self-perceptions and felt that their quality of life had been impacted by their stuttering. However, the women's stories and experiences of stuttering were shaped by a broader context of perceived sociocultural expectations of females in society. Strong verbal communication was highlighted as a crucial factor in developing identity and forming relationships. This study highlights the need to be aware of the experiences of, and issues facing, women who stutter for clinicians to be more equipped, focused, and successful in their stuttering interventions for women.
PMID: 30347067 DOI: 10.1044/2018_AJSLP-ODC11-17-0201
The Most Important Therapy Outcomes for School-Aged Children Who Stutter: An Exploratory Study - INFANTIL
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1152-1163.
Cooke K, Millard SK.
City University London, United Kingdom; The Michael Palin Centre for Stammering, London, United Kingdom.
PURPOSE:The aim of this article was to identify what school-aged children who stutter consider to be the most important outcomes from therapy.
METHOD: A Delphi approach was employed for the study. Eighteen participants aged 9-13 years completed a survey, generating 90 statements that would constitute successful therapy outcomes. After categorization and reduction, 79 statements were sent to participants in a second survey to seek consensus on their importance. Fifteen participants aged 8-14 years completed this second survey. Statements with the highest median ratings and smallest standard deviations were retained.
RESULTS: Twenty-one statements were retained after analysis. These reflected hopes for affective and behavioral change in the young person and in other people after therapy. Important outcomes included, but are not limited to, increased fluency, greater independence, increased confidence at school, others knowing how to support the individual, and communication situations feeling easier.
CONCLUSIONS: Participants identified a range of outcomes that were important to achieve as a result of speech and language therapy. The findings suggest a need for a more holistic view of what is meant by successful therapy, incorporating improvements in the ability to communicate and participate in daily situations. The findings suggest that an integrated or holistic approach to intervention would be required to achieve these goals and should include significant others from the child's environment. The important statements identified in this study could be used to inform the content of therapy and to evaluate change over time.
PMID: 30347060 DOI: 10.1044/2018_AJSLP-ODC11-17-0195
The Role of Attention in Therapy for Children and Adolescents Who Stutter: Cognitive Behavioral Therapy and Mindfulness-Based Interventions - TERAPIA
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1139-1151.
The Michael Palin Centre for Stammering, London, United Kingdom.
METHOD: This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being.
CONCLUSIONS: Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.
PMID: 30347059 DOI: 10.1044/2018_AJSLP-ODC11-17-0196
The Role of Effortful Control in Stuttering Severity in Children: Replication Study - EMOCIONAL
Am J Speech Lang Pathol. 2018 Dec 5:1-15. [Epub ahead of print]
Kraft SJ, Lowther E, Beilby J.
Wayne State University, Detroit, MI; Curtin University, Perth, Australia.
BACKGROUND: In 2014, Kraft et al. assessed the temperament, home environment, and significant life events of 69 North American children who stutter to examine the combined and compounded effects of these individualized factors on mediating overt stuttering severity. The temperament domain of effortful control was singularly found to be significantly predictive of stuttering severity.
PURPOSE: Because of the clinical significance of the initial study's findings, a replication study with a different, larger cohort of children who stutter was warranted to validate the reported outcomes.
METHOD: The current study assesses 98 children who stutter, ages 2;4 to 12;6 (years; months, M = 6;7), recruited from Perth, Australia.
RESULTS: The results support the previous findings of Kraft, Ambrose, and Chon (2014), with effortful control remaining the sole significant contributor to variability in stuttering severity, as rated by both parents and clinicians.
CONCLUSION: These cumulative and consistent outcomes support the need to develop targeted intervention strategies that specifically strengthen aspects of effortful control as a means to support positive therapeutic change in children who stutter.
PMID: 30517950 DOI: 10.1044/2018_AJSLP-17-0097
The Role of Narratives in the Development of Stuttering as a Problem.
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1164-1179.
O'Dwyer M, Walsh IP, Leahy MM.
Trinity College Dublin, Ireland; Cork Kerry Community Healthcare, Tralee, Ireland.
PURPOSE: Narratives are how people make sense of experiences and give meaning to their lives (Bruner, 1990). Use of narrative therapy (White, 2007) with people who stutter to facilitate the development of preferred stories (as opposed to problem-based stories) has been documented in the literature (Logan, 2013; Ryan, O'Dwyer, & Leahy, 2015). The purpose of this research was to explore the role of narratives in the development of stuttering as a problem for people who stutter. This research sought to describe how these narratives develop and to identify the factors that influence this development.
METHOD: Narratives from 6 men who stutter were recorded, transcribed, and analyzed using the "Listening Guide" (Brown & Gilligan, 1992). This is a voice-centered relational method.
RESULTS: Findings indicate interaction between participants' narratives about stuttering and their wider self-narratives. Influencing factors identified include relationships, thoughts and feelings, and the dominant stories about stuttering in relevant social structures. An individual's consciousness of these influences was found to be integral to change in their narratives.
CONCLUSIONS: The findings point to the importance of considering the environment, including significant relationships and social structures, in our understanding of stuttering. They also provide insights regarding intrapersonal and interpersonal processes, which can influence the development of stuttering or pave the way to stuttering becoming less problematic for the person who stutters.
PMID: 30347061 DOI: 10.1044/2018_AJSLP-ODC11-17-0207
The Satisfaction with Communication in Everyday Speaking Situations (SCESS) scale: An overarching outcome measure of treatment effect - AVALIAÇÃO
J Fluency Disord. 2018 Dec;58:77-85. Epub 2018 Oct 15.
Karimi H, Onslow M, Jones M, O'Brian S, Packman A, Menzies R, Reilly S, Sommer M, Jelčić-Jakšić S.
The University of Sydney, Lidcombe, Sydney, Australia; University of Queensland, Herston, Australia; Griffith University, Australia; University Medical Center Göttingen, Germany; The Children's Hospital Zagreb, Croatia.
PURPOSE: The Consolidated Standards of Reporting Trials (CONSORT) statement strongly suggests one primary outcome for clinical trials, yet the outcomes of stuttering treatments span numerous behavioral and psychosocial domains. That presents a roadblock to eventual meta-analysis of clinical trials for adults who stutter.
METHOD: We propose a simple and convenient outcome measure for clinical trials of stuttering treatment for adults that spans whatever behavioral and psychosocial factors might impel clients to seek treatment: a nine-point scale of Satisfaction with Communication in Everyday Speaking Situations (SCESS). The scale consists of one question which is simple, brief, easy to administer, cost-free, and translatable into many languages. The present report develops the SCESS scale by determining its reliability, content validity, and construct validity.
RESULTS: Reliability, content validity, and construct validity of the SCESS were confirmed with statistically significant and substantive correlations with speech-related and anxiety-related measures. However, the SCESS did not correlate well with percentage syllables stuttered. Three behavioral and psychosocial measures had the highest correlation with the SCESS: total Overall Assessment of the Speaker's Experience of Stuttering, self-reported stuttering severity, and Unhelpful Thoughts and Beliefs about Stuttering.
CONCLUSION: The SCESS measure has potential to be applied as an overarching clinical trial outcome measure of stuttering treatment effect. This study provides some preliminary evidence for including it as a primary or secondary outcome in clinical trials of adult stuttering treatments. However, further studies are needed to establish the SCESS responsiveness to different stuttering treatments.
PMID: 30392583 DOI: 10.1016/j.jfludis.2018.10.002
The Speech Efficiency Score (SES): A time-domain measure of speech fluency - AVALIAÇÃO
J Fluency Disord. 2018 Dec;58:61-69. Epub 2018 Aug 13.
Amir O, Shapira Y, Mick L, Yaruss JS.
Sackler Faculty of Medicine, Tel Aviv University, Israel; NiNiSpeech Inc., Haifa, Israel; Michigan State University, East Lansing, MI, Israel.
PURPOSE: This study is a preliminary attempt to evaluate a new speech fluency measure, the Speech Efficiency Score (SES), in comparison with subjective stuttering severity rating scales and stuttered syllable counts (%SS).
METHODS: 277 listeners (92 naïve, 39 speech-language pathology (SLP) students, 124 practicing SLPs, and 22 SLPs who specialize in stuttering) evaluated short recordings of speech on an 11-point scale. Recordings were obtained from 56 adults, of whom 20 were people who stutter, 16 were people who stutter who were using fluency-shaping techniques, and 20 were speakers who do not stutter. In addition, %SS and the SES measure were obtained for each recording.
RESULTS: The four listener groups rated stuttering severity similarly, with no statistically significant between-group differences. Listeners' responses on the stuttering severity rating scales and the SES yielded significant differences between all three speaker groups. The %SS measure yielded a significant difference only between the stuttering group and the other two groups but not between the fluency-shaping and the control groups. A very strong positive correlation was found between the SES and the subjective stuttering-severity rating scales (r = 0.92). The correlation between %SS and the perceptual evaluation, as well as the correlation between %SS and the SES, were lower, though they still reached significance.
CONCLUSIONS: Results suggest that speech efficiency scores, which are based on a time-domain analysis, closely match subjective stuttering severity ratings and could ultimately provide a more objective way to measure speech fluency.
PMID: 30119862 DOI: 10.1016/j.jfludis.2018.08.001
Timing variability of sensorimotor integration during vocalization in individuals who stutter. - AUDITIVO
Sci Rep. 2018 Nov 5;8(1):16340.
Free PMC Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218511/pdf/41598_2018_Article_34517.pdf
Sares AG, Deroche MLD, Shiller DM5, Gracco VL.
McGill University, Montréal, QC, Canada; Université de Montréal, Montréal, QC, Canada; Haskins Laboratories, New Haven, CT, USA.
Persistent developmental stuttering affects close to 1% of adults and is thought to be a problem of sensorimotor integration. Previous research has demonstrated that individuals who stutter respond differently to changes in their auditory feedback while speaking. Here we explore a number of changes that accompany alterations in the feedback of pitch during vocal production. Participants sustained the vowel /a/ while hearing on-line feedback of their own voice through headphones. In some trials, feedback was briefly shifted up or down by 100 cents to simulate a vocal production error. As previously shown, participants compensated for the auditory pitch change by altering their vocal production in the opposite direction of the shift. The average compensatory response was smaller for adults who stuttered than for adult controls. Detailed analyses revealed that adults who stuttered had fewer trials with a robust corrective response, and that within the trials showing compensation, the timing of their responses was more variable. These results support the idea that dysfunctional sensorimotor integration in stuttering is characterized by timing variability, reflecting reduced coupling of the auditory and speech motor systems.
PMID: 30397215 PMCID: PMC6218511 DOI: 10.1038/s41598-018-34517-1
Understanding spoken language through TalkBank. - AVALIAÇÃO
Behav Res Methods. 2018 Dec 3. [Epub ahead of print]
Carnegie Mellon University, Pittsburgh, PA, USA.
Ongoing advances in computer technology have opened up a deluge of new datasets for understanding human behavior (Goldstone & Lupyan, 2016). Many of these datasets provide information on the use of written language. However, data on naturally occurring spoken-language conversations are much more difficult to obtain. A major exception to this is the TalkBank system, which provides online multimedia data for 14 types of spoken-language data: language in aphasia, child language, stuttering, child phonology, autism spectrum disorder, bilingualism, Conversation Analysis, classroom discourse, dementia, right hemisphere damage, Danish conversation, second language learning, traumatic brain injury, and daylong recordings in the home. The present report reviews these resources and describes the ways they are being used to further our understanding of human language and communication.
PMID: 30511153 DOI: 10.3758/s13428-018-1174-9
Visibility graph analysis of speech evoked auditory brainstem response in persistent developmental stuttering - NEUROCIÊNCIAS
Neurosci Lett. 2018 Dec 11;696:28-32. [Epub ahead of print]
Mozaffarilegha M, Adeli H.
Shahid Beheshti University, Tehran, Iran; The Ohio State University, United States.
In this research, the concept of fractality based on nonlinear science and chaos theory is explored to study and evaluate the complexity of speech-evoked auditory brainstem response (s-ABR) time series in order to capture its intrinsic multiscale dynamics. The visibility graph of the s-ABR series is proposed as a quantitative method to differentiate subjects with persistent developmental stuttering (PDS) from the normal group. Differential complexities between normal and PDS subjects is quantified using Graph index complexity (GIC). The model is applied to 14 individuals with PDS and 15 normal subjects. The results reveal the promising ability of GIC for assessment of abnormal activation of brainstem level in PDS group. It is observed that all s-ABR series have visibility graphs with a power-law topology and fractality in the s-ABR series is dictated by a mechanism associated with long-term memory of the auditory system dynamics at the brainstem level.
PMID: 30550878 DOI: 10.1016/j.neulet.2018.12.015
We Have a Voice: Exploring Participants' Experiences of Stuttering Modification Therapy - AVALIAÇÃO
Am J Speech Lang Pathol. 2018 Oct 19;27(3S):1273-1286.
Everard RA, Howell P.
University College London, United Kingdom; City Literary Institute, London, United Kingdom.
PURPOSE: Qualitative data were obtained from 8 people who stutter about their experiences and changes they perceived following attendance of an intensive group therapy intervention. Measures that related to reductions in stuttering, improved communicative confidence, and impacts on stuttering and quality of life were used to complement the qualitative data.
METHOD: Eight participants attended a group stuttering modification course for adults who stutter. They reported their experiences of therapy and perceived changes in a focus group immediately after therapy and at a semistructured interview 6 months post-therapy. Participants completed 5 additional quantitative standardized outcome measures at 3 data collection points (before and directly after therapy and 6 months post-therapy). These measures provided information about stuttering severity and frequency, use of avoidance strategies, attitude change, communicative confidence, quality of life, and locus of control.
RESULTS: Thematic analysis of the qualitative data identified 4 main areas: thoughts, feelings, and behaviors before therapy and motivation for seeking therapy; direct experience of the course; learning outcomes and challenges and solutions for maintaining change; and ways in which attending therapy had made a difference. These reported changes were supported by the quantitative measures that demonstrated improved communicative confidence; increased self-awareness; affective, behavioral, and cognitive changes; reduced use of avoidance strategies; and lower impact of stuttering on quality of life.
CONCLUSIONS: The qualitative analyses confirmed positive speech and attitude changes consequent on participants' attendance at stuttering modification therapy. These changes, further corroborated by quantitative measures, were linked to reports of improved quality of life. Further research is required to investigate the effectiveness of this form of therapy empirically and from the client's perspective.
PMID: 30347069 DOI: 10.1044/2018_AJSLP-ODC11-17-0198
What Are Predictors for Persistence in Childhood Stuttering? - AVALIAÇÃO
Semin Speech Lang. 2018 Sep;39(4):299-312. Epub 2018 Aug 24.
Walsh B, Usler E, Bostian A, Mohan R, Gerwin KL, Brown B, Weber C, Smith A
Michigan State University, Michigan; Boston University, Boston, Massachusetts; Purdue University, West Lafayette, Indiana; Texas State University, San Marcos, Texas.
Over the past 10 years, we (the Purdue Stuttering Project) have implemented longitudinal studies to examine factors related to persistence and recovery in early childhood stuttering. Stuttering develops essentially as an impairment in speech sensorimotor processes that is strongly influenced by dynamic interactions among motor, language, and emotional domains. Our work has assessed physiological, behavioral, and clinical features of stuttering within the motor, linguistic, and emotional domains. We describe the results of studies in which measures collected when the child was 4 to 5 years old are related to eventual stuttering status. We provide supplemental evidence of the role of known predictive factors (e.g., sex and family history of persistent stuttering). In addition, we present new evidence that early delays in basic speech motor processes (especially in boys), poor performance on a nonword repetition test, stuttering severity at the age of 4 to 5 years, and delayed or atypical functioning in central nervous system language processing networks are predictive of persistent stuttering.
PMID: 30142641 PMCID: PMC6154780 [Available on 2019-09-01] DOI: 10.1055/s-0038-1667159
What Are the Options for the Treatment of Stuttering in Preschool Children? - AVALIAÇÃO
Semin Speech Lang. 2018 Sep;39(4):313-323. Epub 2018 Aug 24.
Shenker RC, Santayana G.
Montreal Fluency Centre, Montreal, Quebec, Canada.
Treatment of stuttering during the preschool years is considered to be the best prevention of persistent chronic stuttering; however, many clinicians do not feel comfortable treating stuttering and may be confused about choosing an intervention. This article summarizes the history of direct and indirect methodology for treatment of stuttering in preschool children. It provides an update of contemporary treatments and discusses issues related to the timing of treatment. Guidelines for choosing a level of treatment based on the risk of a preschool child continuing to stutter are discussed, with examples of which children would be most appropriate for which level of intervention.
PMID: 30142642 DOI: 10.1055/s-0038-1667160
What Can Stutterers Learn from the Neurodiversity Movement? - SOCIAL
Semin Speech Lang. 2018 Sep;39(4):382-396. Epub 2018 Aug 24.
Florida State University, Tallahassee, Florida.
Neurodiversity is both an empowerment movement and a way of thinking about disability. Rather than focusing on pathology and impairment, neurodiversity emphasizes natural variation and the unique skills, experiences, and traits of neurodivergent individuals. People who stutter are beginning to work with and derive value from these concepts. In this article, we look at the history of neurodiversity and its key ideas. We discuss the conventional view of disability, the medical model, which situates disability within the individual as pathology. We also take up social and relation models of disability, which situate disability in social oppression or mismatches between individuals and their environment. Neurodiversity has not been without controversy. We look at some of the disagreements surrounding issues of intervention and cure. The ideas of neurodiversity are applied to stuttering, and a case example illustrating therapy using these ideas is given. We conclude that therapy should focus on subject's well-being and not normalization of superficial behaviors.
PMID: 30142648 DOI: 10.1055/s-0038-1667166
What Constitutes a Multidimensional Treatment Approach for School-Age Children Who Stutter? - AVALIAÇÃO
Semin Speech Lang. 2018 Sep;39(4):333-341. Epub 2018 Aug 24.
Fontbonne University, St. Louis, Missouri.
Research over the past several decades supports the view that stuttering is a complex and multidimensional disorder. Given the multiple factors that contribute to the development and persistence of stuttering, it follows that, for many children who stutter, treatment focused solely on the motor aspects of speech may be insufficient to help them successfully manage their stuttering. A complete assessment includes identifying all of the dimensions of the disorder that are relevant to a particular child. Likewise, treatment is best viewed as multidimensional, with the clinician developing a set of goals that address the relevant aspects of stuttering and communication. Such an approach leads to greater success for children who stutter with the end result being speakers who communicate openly and effectively.
PMID: 30142644 DOI: 10.1055/s-0038-1667162
Ziprasidone for the Treatment of Stuttering.
J Clin Psychopharmacol. 2018 Aug;38(4):404-405
Munjal S, Schultheis G, Ferrando S.
Yale School of Medicine New Haven, CT; New York Medical College Valhalla, NY.
No abstract available.
PMID: 29901564 DOI: 10.1097/JCP.0000000000000918