Eliana Maria Nigro Rocha


Abstracts - Janeiro a Julho de 2014



Ordem alfabética do título do artigo



Acute intermittent porphyria presenting as progressive muscular atrophy in a young black man. - GAGUEIRA ADQUIRIDA
S Afr Med J. 2014 Apr;104(4):283-5.

Albertyn CH, Sonderup M, Bryer A, Corrigall A, Meissner P, Heckmann JM.

Acute intermittent porphyria, the most common porphyria affecting the nervous system, typically presents with neurovisceral crises followed by a motor neuropathy. We describe a 23-year-old black South African man presenting with a progressive stuttering, lower motor neuron syndrome developing over months. He had not experienced pain or neuropsychiatric symptoms. One year after symptom onset he was bed-bound with a flaccid quadriparesis. There was marked amyotrophy, but without fasciculations. Sensation was intact apart from a hypo-aesthetic patch over the thigh. Electrophysiological investigations showed an active motor axonopathy. Urinary porphyrins, delta-aminolaevulinic acid and porphobilinogen were elevated. Mutation analysis revealed the c445C>T (R149X) mutation in the porphobilinogen deaminase gene. The patient responded dramatically to haem arginate and could walk with assistance 2 weeks later. We identified the first molecularly confirmed acute intermittent porphyria in a black South African. The clinical presentation mimicked a progressive lower motor neuron syndrome.
PMID: 25118551 [PubMed - indexed for MEDLINE]

A functional imaging study of self-regulatory capacities in persons who stutter. - NEUROCIÊNCIAS
PLoS One. 2014 Feb 27;9(2):e89891. doi: 10.1371/journal.pone.0089891. eCollection 2014.
Free Full Text - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937393/pdf/pone.0089891.pdf

Liu J, Wang Z, Huo Y, Davidson SM, Klahr K, Herder CL, Sikora CO, Peterson BS.
Columbia College of Physicians and Surgeons & American Institute for Stuttering, New York, New York

Developmental stuttering is a disorder of speech fluency with an unknown pathogenesis. The similarity of its phenotype and natural history with other childhood neuropsychiatric disorders of frontostriatal pathology suggests that stuttering may have a closely related pathogenesis. We investigated in this study the potential involvement of frontostriatal circuits in developmental stuttering. We collected functional magnetic resonance imaging data from 46 persons with stuttering and 52 fluent controls during performance of the Simon Spatial Incompatibility Task. We examined differences between the two groups of blood-oxygen-level-dependent activation associated with two neural processes, the resolution of cognitive conflict and the context-dependent adaptation to changes in conflict. Stuttering speakers and controls did not differ on behavioral performance on the task. In the presence of conflict-laden stimuli, however, stuttering speakers activated more strongly the cingulate cortex, left anterior prefrontal cortex, right medial frontal cortex, left supplementary motor area, right caudate nucleus, and left parietal cortex. The magnitude of activation in the anterior cingulate cortex correlated inversely in stuttering speakers with symptom severity. Stuttering speakers also showed blunted activation during context-dependent adaptation in the left dorsolateral prefrontal cortex, a brain region that mediates cross-temporal contingencies. Frontostriatal hyper-responsivity to conflict resembles prior findings in other disorders of frontostriatal pathology, and therefore likely represents a general mechanism supporting functional compensation for an underlying inefficiency of neural processing in these circuits. The reduced activation of dorsolateral prefrontal cortex likely represents the inadequate readiness of stuttering speakers to execute a sequence of motor responses.

PMID: 24587104 [PubMed - in process] PMCID: PMC3937393

A genetic linkage study in Brazil identifies a new locus for persistent developmental stuttering on chromosome 10. - GENÉTICA
Genet Mol Res. 2014 Mar 24;13(1):2094-101. doi: 10.4238/2014.March.24.13.
Free Full Text -  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937393/pdf/pone.0089891.pdf

Domingues CE, Olivera CM, Oliveira BV, Juste FS, Andrade CR, Giacheti CM, Moretti-Ferreira D, Drayna D.
National Institutes of Health, Rockville, MD, USA; Universidade Estadual Paulista "Júlio de Mesquita Filho", Marília, SP, Brasil; Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.

Although twin, adoption, and family studies demonstrate that genetic factors are involved in the origins of stuttering, the mode of transmission of the disorder in families is not well defined and stuttering is considered a genetically complex trait. We performed a genome-wide linkage scan in a group of 43 Brazilian families, each containing multiple cases of persistent developmental stuttering. Linkage analysis under a dominant model of inheritance generated significant evidence of linkage in two Brazilian families, with a combined maximum single-point LOD score of 4.02 and a multipoint LOD score of 4.28 on chromosome 10q21. This demonstrated the presence of a novel variant gene at this locus that predisposes individuals to stuttering, which provides an opportunity to identify novel genetic mechanisms that underlie this disorder.
PMID: 24737434 [PubMed - indexed for MEDLINE] 

Anterior capsulotomy improves persistent developmental stuttering with a psychiatric disorder: a case report and literature review. - OUTRAS ÁREAS
Neuropsychiatr Dis Treat. 2014 Apr 1;10:553-8. doi: 10.2147/NDT.S58984. eCollection 2014.
Free Full Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC3979796/pdf/ndt-10-553.pdf

Zhang S, Li P, Zhang Z, Wang W.
West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.

Stuttering is characterized by disrupted fluency of verbal expression, and occurs mostly in children. Persistent developmental stuttering (PDS) may occur in adults. Reports of the surgical management of PDS are limited. Here we present the case of a 28-year-old man who had had PDS since the age of 7 years, was diagnosed with depression and anxiety disorder at the age of 24 years, and had physical concomitants. He underwent a bilateral anterior capsulotomy 4 years after the diagnosis. Over one year of follow-up, his physical concomitants resolved, and significant improvements in his psychiatric disorders and PDS were observed. To the best of our knowledge, this is the first report of simultaneous improvement in a patient's PDS and psychiatric disorder after a bilateral anterior capsulotomy.
PMID: 24729709 [PubMed] PMCID: PMC3979796

Anxiety and speaking in people who stutter: an investigation using the emotional Stroop task. - EMOCIONAL
J Fluency Disord. 2014 Jun;40:44-57. doi: 10.1016/j.jfludis.2013.11.001. Epub 2013 Nov 19.

Hennessey NW, Dourado E, Beilby JM.
School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia.

People with anxiety disorders show an attentional bias towards threat or negative emotion words. This exploratory study examined whether people who stutter (PWS), who can be anxious when speaking, show similar bias and whether reactions to threat words also influence speech motor planning and execution. Comparisons were made between 31 PWS and 31 fluent controls in a modified emotional Stroop task where, depending on a visual cue, participants named the colour of threat and neutral words at either a normal or fast articulation rate. In a manual version of the same task participants pressed the corresponding colour button with either a long or short duration. PWS but not controls were slower to respond to threat words than neutral words, however, this emotionality effect was only evident for verbal responding. Emotionality did not interact with speech rate, but the size of the emotionality effect among PWS did correlate with frequency of stuttering. Results suggest PWS show an attentional bias to threat words similar to that found in people with anxiety disorder. In addition, this bias appears to be contingent on engaging the speech production system as a response modality. No evidence was found to indicate that emotional reactivity during the Stroop task constrains or destabilises, perhaps via arousal mechanisms, speech motor adjustment or execution for PWS.
EDUCATIONAL OBJECTIVES:The reader will be able to: (1) explain the importance of cognitive aspects of anxiety, such as attentional biases, in the possible cause and/or maintenance of anxiety in people who stutter, (2) explain how the emotional Stroop task can be used as a measure of attentional bias to threat information, and (3) evaluate the findings with respect to the relationship between attentional bias to threat information and speech production in people who stutter.
Copyright © 2013 Elsevier Inc. All rights reserved.
PMID: 24929466 [PubMed - indexed for MEDLINE]

Anxiety of children and adolescents who stutter: a review. - EMOCIONAL
J Fluency Disord. 2014 Jun;40:22-34. doi: 10.1016/j.jfludis.2014.01.003. Epub 2014 Feb 9.

Smith KA, Iverach L, O'Brian S, Kefalianos E, Reilly S.
Royal Childrens Research Institute, Parkville, Victoria, Australia; University of Melbourne, Victoria, Australia; Macquarie University, NSW, Australia; University of Sydney, Australia.

PURPOSE:Adults who stutter have heightened rates of anxiety disorders, particularly social anxiety disorder, compared with non-stuttering controls. However, the timing of anxiety onset and its development in relation to stuttering is poorly understood. Identifying the typical age of anxiety onset in stuttering has significant clinical implications and is crucial for the management of both disorders across the lifespan. The present review aims to determine the scope of the research pertaining to this topic, identify trends in findings, and delineate timing of anxiety onset in stuttering.
METHODS:We examine putative risk factors of anxiety present for children and adolescents who stutter, and provide a review of the research evidence relating to anxiety for this population.
RESULTS:Young people who stutter can experience negative social consequences and negative attitudes towards communication, which is hypothesised to place them at increased risk of developing anxiety. The prevalence of anxiety of young people who stutter, and the timing of anxiety onset in stuttering could not be determined. This was due to methodological limitations in the reviewed research such as small participant numbers, and the use of measures that lack sensitivity to identify anxiety in the targeted population.
CONCLUSIONS: In sum, the evidence suggests that anxiety in stuttering might increase over time until it exceeds normal limits in adolescence and adulthood. The clinical implications of these findings, and recommendations for future research, are discussed.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) discuss contemporary thinking on the role of anxiety in stuttering and reasons for this view; (b) describe risk factors for the development of anxiety in stuttering, experienced by children and adolescents who stutter (c) outline trends in current research on anxiety and children and adolescents with stuttering; and (d) summarise rationales behind recommendations for future research in this area.
PMID: 24929464 [PubMed - indexed for MEDLINE]

Assessing the nursing and midwifery students competencies in communication with patients with severe communication problems. - SOCIAL
Nurs Midwifery Stud. 2014 Jun;3(2):e18143. Epub 2014 Jun 20.
Free Full Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC4228534/pdf/nms-03-18143.pdf

Adib Hajbaghery M, Rezaei Shahsavarloo Z
Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran.

BACKGROUND:Clients with communication impairment are at risk for health disparity. Hence, health care workers should be knowledgeable and skillful in communication. However, no studies are available on Iranian nursing and midwifery students' communication skills with patients with severe communication problems.
OBJECTIVES:The present study was conducted to investigate Iranian nursing and midwifery students' competencies in communication with patients with severe communication problems.
MATERIALS AND METHODS:This study was performed on all senior nursing and midwifery students of Kashan University of Medical Sciences in spring 2013. Data were collected through a knowledge questionnaire and two checklists for evaluation of skills needed for communication with patients with severe communication problems. Data analysis was performed through independent samples t test, and Fisher's exact test.
RESULTS:In total, 68.8% of the participants were female, 37.6% had a history of part-time job as a nurse or midwife. The mean score of knowledge were 4.41 ± 1.42 and 4.77 ± 1.77 for nursing and midwifery students, respectively and the difference was not significant (P = 0.312). In addition, the mean score of communication skills with deaf patients was 13.23 ± 4.68 and 11.86 ± 5.55 for nursing and midwifery students, respectively and the difference was not significant (P = 0.258). Also, the mean score of communication skills with stutter patients was 23.91 ± 4.17 and 21.25 ± 3.91 for nursing and midwifery students, respectively but the difference was not significant (P = 0.269).
CONCLUSIONS:Nursing and midwifery students did not significantly differ in terms of communication with patients with severe communication problems. Most of the students had low or very low knowledge and skills in communication with patients with hearing impairment. However, they had better skills in communication with patient with speech problem. Special workshops or training programs are recommended to empower nursing and midwifery students in communication with patients with communication problems.
PMID: 25414902 [PubMed] PMCID: PMC4228534 Free PMC Article

Axis I anxiety and mental health disorders among stuttering adolescents. - EMOCIONAL
J Fluency Disord. 2014 Jun;40:58-68. doi: 10.1016/j.jfludis.2013.09.002. Epub 2013 Sep 29.

Gunn A, Menzies RG, O'Brian S, Onslow M, Packman A, Lowe R, Iverach L, Heard R, Block S.
The University of Sydney, Australia; La Trobe University, Australia.

PURPOSE:The purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.
METHOD:Participants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12-14 years; n=20) and older adolescents (15-17 years; n=17).
RESULTS:Thirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate-severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15-17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12-14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.
DISCUSSION:These results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.
Copyright © 2013 Elsevier Inc. All rights reserved.
PMID: 24929467 [PubMed - indexed for MEDLINE]

Behavioral and multimodal neuroimaging evidence for a deficit in brain timing networks in stuttering: a hypothesis and theory. - NEUROCIÊNCIAS
Front Hum Neurosci. 2014 Jun 25;8:467. doi: 10.3389/fnhum.2014.00467. eCollection 2014.
Free Full Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC4070061/pdf/fnhum-08-00467.pdf

Etchell AC, Johnson BW, Sowman PF.
Macquarie University Sydney, NSW, Australia

The fluent production of speech requires accurately timed movements. In this article, we propose that a deficit in brain timing networks is one of the core neurophysiological deficits in stuttering. We first discuss the experimental evidence supporting the involvement of the basal ganglia and supplementary motor area (SMA) in stuttering and the involvement of the cerebellum as a possible mechanism for compensating for the neural deficits that underlie stuttering. Next, we outline the involvement of the right inferior frontal gyrus (IFG) as another putative compensatory locus in stuttering and suggest a role for this structure in an expanded core timing-network. Subsequently, we review behavioral studies of timing in people who stutter and examine their behavioral performance as compared to people who do not stutter. Finally, we highlight challenges to existing research and provide avenues for future research with specific hypotheses.
PMID: 25009487 [PubMed] PMCID: PMC4070061

Birth weight and stuttering: Evidence from three birth cohorts. - AVALIAÇÃO
J Fluency Disord. 2014 Mar;39:25-33. doi: 10.1016/j.jfludis.2013.10.002. Epub 2013 Nov 2.

McAllister J, Collier J.
University of East Anglia, United Kingdom.

PURPOSE:Previous studies have produced conflicting results with regard to the association between birth weight and developmental stuttering. This study sought to determine whether birth weight was associated with childhood and/or adolescent stuttering in three British birth cohort samples.
METHODS:Logistic regression analyses were carried out on data from the Millenium Cohort Study (MCS), British Cohort Study (BCS70) and National Child Development Study (NCDS), whose initial cohorts comprised over 56,000 individuals. The outcome variables were parent-reported stuttering in childhood or in adolescence; the predictors, based on prior research, were birth weight, sex, multiple birth status, vocabulary score and mother's level of education. Birth weight was analysed both as a categorical variable (low birth weight, <2500g; normal range; high birth weight, ≥4000g) and as a continuous variable. Separate analyses were carried out to determine the impact of birth weight and the other predictors on stuttering during childhood (age 3, 5 and 7 and MCS, BCS70 and NCDS, respectively) or at age 16, when developmental stuttering is likely to be persistent.
RESULTS:None of the multivariate analyses revealed an association between birth weight and parent-reported stuttering. Sex was a significant predictor of stuttering in all the analyses, with males 1.6-3.6 times more likely than females to stutter.
CONCLUSION:Our results suggest that birth weight is not a clinically useful predictor of childhood or persistent stuttering.
PMID: 24759191 [PubMed - indexed for MEDLINE]

Brain, temperament, and behavior: new approaches to understanding fluency disorders.
Semin Speech Lang. 2014 May;35(2):65-6. doi: 10.1055/s-0034-1372691. Epub 2014 Apr 29.

Ratner NB.
Department of Hearing and Speech Sciences, University of Maryland, College Park, College Park, Maryland.

No abstract available
PMID: 24782271 [PubMed - indexed for MEDLINE]

Diffusion imaging of cerebral white matter in persons who stutter: evidence for network-level anomalies. - NEUROCIÊNCIAS
Front Hum Neurosci. 2014 Feb 11;8:54. doi: 10.3389/fnhum.2014.00054. eCollection 2014.
Free Full Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC3920071/pdf/fnhum-08-00054.pdf

Cai S, Tourville JA, Beal DS, Perkell JS, Guenther FH, Ghosh SS.
Boston University Boston, MA; University of Alberta Edmonton, AB, Canada; Massachusetts Institute of Technology Cambridge, MA, USA.

Deficits in brain white matter have been a main focus of recent neuroimaging studies on stuttering. However, no prior study has examined brain connectivity on the global level of the cerebral cortex in persons who stutter (PWS). In the current study, we analyzed the results from probabilistic tractography between regions comprising the cortical speech network. An anatomical parcellation scheme was used to define 28 speech production-related ROIs in each hemisphere. We used network-based statistic (NBS) and graph theory to analyze the connectivity patterns obtained from tractography. At the network-level, the probabilistic corticocortical connectivity from the PWS group were significantly weaker than that from persons with fluent speech (PFS). NBS analysis revealed significant components in the bilateral speech networks with negative correlations with stuttering severity. To facilitate comparison with previous studies, we also performed tract-based spatial statistics (TBSS) and regional fractional anisotropy (FA) averaging. Results from tractography, TBSS and regional FA averaging jointly highlight the importance of several regions in the left peri-Rolandic sensorimotor and premotor areas, most notably the left ventral premotor cortex (vPMC) and middle primary motor cortex, in the neuroanatomical basis of stuttering.
PMID: 24611042 [PubMed] PMCID: PMC3920071 Free PMC Article

Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. - EMOCIONAL
J Commun Disord. 2014 Mar-Apr;48:38-51. doi: 10.1016/j.jcomdis.2014.02.001. Epub 2014 Feb 23.
Free Full Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC4031757/pdf/nihms576866.pdf

Jones RM. Conture EG, Walden TA.
Vanderbilt University, Nashville, TN, United States.

PURPOSE: The purpose of this study was to assess the relation between emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter (CWS) and those who do not (CWNS).
PARTICIPANTS: Participants were eight 3 to 6-year old CWS and eight CWNS of comparable age and gender.
METHODS: Participants were exposed to three emotion-inducing overheard conversations-neutral, angry and happy-and produced a narrative following each overheard conversation. From audio-video recordings of these narratives, coded behavioral analysis of participants' negative and positive affect and emotion regulation associated with stuttered and fluent utterances was conducted.
RESULTS: Results indicated that CWS were significantly more likely to exhibit emotion regulation attempts prior to and during their fluent utterances following the happy as compared to the negative condition, whereas CWNS displayed the opposite pattern. Within-group assessment indicated that CWS were significantly more likely to display negative emotion prior to and during their stuttered than fluent utterances, particularly following the positive overheard conversation.
CONCLUSIONS: After exposure to emotional-inducing overheard conversations, changes in preschool-age CWS's emotion and emotion regulatory attempts were associated with the fluency of their utterances.
PMID: 24630144 [PubMed - as supplied by publisher]

Evaluation of disfluent speech by means of automatic acoustic measurements. - AVALIAÇÃO
J Acoust Soc Am. 2014 Mar;135(3):1457. doi: 10.1121/1.4863646.

Lustyk T, Bergl P, Cmejla R.
Czech Technical University in Prague, Prague, Czech Republic.

An experiment was carried out to determine whether the level of the speech fluency disorder can be estimated by means of automatic acoustic measurements. These measures analyze, for example, the amount of silence in a recording or the number of abrupt spectral changes in a speech signal. All the measures were designed to take into account symptoms of stuttering. In the experiment, 118 audio recordings of read speech by Czech native speakers were employed. The results indicate that the human-made rating of the speech fluency disorder in read speech can be predicted on the basis of automatic measurements. The number of abrupt spectral changes in the speech segments turns out to be the most appropriate measure to describe the overall speech performance. The results also imply that there are measures with good results describing partial symptoms (especially fixed postures without audible airflow).
PMID: 24606282 [PubMed - in process]

Exploring the link between stuttering and phonology: a review and implications for treatment. - LINGUÍSTICA
Semin Speech Lang. 2014 May;35(2):95-113. doi: 10.1055/s-0034-1371754. Epub 2014 Apr 29.

Sasisekaran J.
Department of Speech-Language Hearing Sciences, University of Minnesota, Minneapolis, Minnesota.

Three lines of research have been pursued in the literature to study the link between phonology and stuttering: (1) effects of phonological complexity on the location (loci) of stutter events; (2) outcomes of standardized test measures in children who do and do not stutter; and (3) studies of phonological encoding in children and adults who stutter. This review synthesizes findings from these three lines of research to address the purported link between phonology and stuttering and its potential implications for stuttering treatment. Results from the loci studies offer some support for the role of phonological complexity in the occurrence of stuttering. Studies of performance in standardized tests of phonology have not identified differences between children who do and do not stutter. Studies of phonological encoding have been equivocal in reporting differences between children and adults who stutter and those who do not stutter. Several cautions are raised in interpreting the findings from the discussed studies, and despite the mixed findings, some implications for treatments are considered.
PMID: 24782273 [PubMed - indexed for MEDLINE]

[Functional imaging of physiological and pathological speech production]. - NEUROCIÊNCIAS
Nervenarzt. 2014 Jun;85(6):701-7. doi: 10.1007/s00115-013-3996-0.
[Article in German]

Kell CA
Goethe Universität Frankfurt, Frankfurt, Deutschland

Numerous neurological patients suffer from speech and language disorders but the underlying pathomechanisms are not well understood. Imaging studies on speech production disorders lag behind aphasiological research on speech perception, probably due to worries concerning movement artifacts. Meanwhile, modern neuroimaging techniques allow investigation of these processes. This article summarizes the insights from neuroimaging on physiological speech production and also on the pathomechanisms underlying Parkinson's disease and developmental stuttering.
PMID: 24832012 [PubMed - in process]

Impaired timing adjustments in response to time-varying auditory perturbation during connected speech production in persons who stutter. - AUDITIVO
Brain Lang. 2014 Jan 30;129C:24-29. doi: 10.1016/j.bandl.2014.01.002. [Epub ahead of print]

Cai S, Beal DS, Ghosh SS, Guenther FH, Perkell JS.
Boston University, Boston and Massachusetts Institute of Technology, Cambridge MA, USA; University of Alberta, Edmonton, Alberta, Canada

Auditory feedback (AF), the speech signal received by a speaker's own auditory system, contributes to the online control of speech movements. Recent studies based on AF perturbation provided evidence for abnormalities in the integration of auditory error with ongoing articulation and phonation in persons who stutter (PWS), but stopped short of examining connected speech. This is a crucial limitation considering the importance of sequencing and timing in stuttering. In the current study, we imposed time-varying perturbations on AF while PWS and fluent participants uttered a multisyllabic sentence. Two distinct types of perturbations were used to separately probe the control of the spatial and temporal parameters of articulation. While PWS exhibited only subtle anomalies in the AF-based spatial control, their AF-based fine-tuning of articulatory timing was substantially weaker than normal, especially in early parts of the responses, indicating slowness in the auditory-motor integration for temporal control.
PMID: 24486601 [PubMed - as supplied by publisher]

Intensive non-avoidance group therapy with stutterer adults: preliminary results.- TERAPIA EM GRUPO
Codas. 2014 Mar-Apr;26(2):122-30.
Free Full Text - www.scielo.br/readcube/epdf.php?doi=10.1590/2317-1782/2014009&pid=S2317-17822014000200122&pdf_path=codas/v26n2/2317-1782-codas-26-02-00122.pdf

Georgieva D
Department of Logopedics, South-West University Neofit Rilski, Blagoevgrad, Bulgaria.

PURPOSE:The purpose of the present study was to evaluate and document the use and efficacy of intensive non-avoidance group treatment for Bulgarian adults who stutter (AWS), to specify that changes are adopted in different speech situations (in the stabilization phase), and to demonstrate that changes are maintained after intensive therapy.
METHODS:Participants were AWS (n=15, 12 males) with an average age of 25.2 years) Bulgarian native-speakers. Twelve participants were University students and three were clients with tertiary education in different areas. All participants were enrolled in First (overall effect) and Second (interim effect) Stages of Intensive Non-Avoidance Treatment for Stuttering. Van Riper's stuttering modification therapy approach was employed; the latter considers a non-avoidance treatment for stuttering. The treatment was conducted in participants' native Bulgarian language.
RESULTS:AWS, as a group (n=15), significantly decreased the number of stuttered utterances after intensive treatment; findings were consistent for participants with moderate as well as severe stuttering. Likewise, there was a significant decrease in duration (in seconds) of disfluencies after treatment; findings were consistent for participants with moderate as well as severe stuttering. Eighty percent of AWS used cancellation immediately and six months after treatment, 65% mastered preparatory sets immediately and six months after treatment, 35% exhibited pull-outs immediately after treatment and 55%, six months post-treatment.
CONCLUSION:These preliminary findings were taken to suggest that intensive non-avoidance treatment for stuttering can be successfully employed with Bulgarian adults who stutter. Special focus was on the positive fluency changes that occurred during the course of therapy regarding the duration of disfluencies in seconds, and index of disfluencies.
PMID: 24918505 [PubMed - indexed for MEDLINE] 

Lateralization of brain activation in fluent and non-fluent preschool children: a magnetoencephalographic study of picture-naming. -  INFANTIL
Front Hum Neurosci. 2014 May 28;8:354. doi: 10.3389/fnhum.2014.00354. eCollection 2014.
Free Full Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC4035571/pdf/fnhum-08-00354.pdf

Sowman PF, Crain S, Harrison E, Johnson BW.
Macquarie University , Sydney, NSW , Australia

The neural causes of stuttering remain unknown. One explanation comes from neuroimaging studies that have reported abnormal lateralization of activation in the brains of people who stutter. However, these findings are generally based on data from adults with a long history of stuttering, raising the possibility that the observed lateralization anomalies are compensatory rather than causal. The current study investigated lateralization of brain activity in language-related regions of interest in young children soon after the onset of stuttering. We tested 24 preschool-aged children, half of whom had a positive diagnosis of stuttering. All children participated in a picture-naming experiment whilst their brain activity was recorded by magnetoencephalography. Source analysis performed during an epoch prior to speech onset was used to assess lateralized activation in three regions of interest. Activation was significantly lateralized to the left hemisphere in both groups and not different between groups. This study shows for the first time that significant speech preparatory brain activation can be identified in young children during picture-naming and supports the contention that, in stutterers, aberrant lateralization of brain function may be the result of neuroplastic adaptation that occurs as the condition becomes chronic.
PMID: 24904388 [PubMed] PMCID: PMC4035571 

Lost in the literature, but not the caseload: working with atypical disfluency from theory to practice. - TERAPIA
Semin Speech Lang. 2014 May;35(2):144-52. doi: 10.1055/s-0034-1371757. Epub 2014 Apr 29.

Sisskin V, Wasilus S.
Department Hearing and Speech Sciences, University of Maryland, College Park, Maryland.

Atypical disfluency is a frustrating but little addressed clinical problem. The purpose of this article and case study was to summarize what is known about atypical fluency profiles and to describe the presenting behaviors and successful treatment of an unusual fluency profile (numerous word-final syllable repetitions) in a school-aged child. To this end, we describe the speech fluency and associated communication characteristics of a young boy diagnosed with Asperger disorder who was between 7;2 and 8;0 when seen for evaluation and treatment. We describe a therapy protocol that was successful in nearly eliminating these atypical disfluencies. The protocol emphasized self-monitoring and was integrated with other goals to improve the child's communication, which had features consistent with mild autism spectrum disorder (ASD). Following an 8-week treatment, the child significantly reduced his percent stuttered syllables of atypical disfluencies (word-final repetition and phrase-final repetition), resulting in significant qualitative improvements to his speech. This case study demonstrates that traditional stuttering modification treatment can be successful in reducing atypical and typical disfluencies in a child with concomitant social language impairment consistent with ASD. The therapy approach reported here may be useful in treatment of other cases having symptoms similar to the child we treated.
PMID: 24782276 [PubMed - indexed for MEDLINE]

Major controversies in Fluency disorders: clarifying the relationship between anxiety and stuttering. - EMOCIONAL
J Fluency Disord. 2014 Jun;40:1-3. doi: 10.1016/j.jfludis.2014.05.001. No abstract available

Craig A.

PMID: 24929462 [PubMed - indexed for MEDLINE]

Modifying attitudes of arab school teachers toward stuttering. - SOCIAL
Lang Speech Hear Serv Sch. 2014 Jan 1;45(1):14-25. doi: 10.1044/2013_LSHSS-13-0012.

Abdalla F, St Louis KO.

PURPOSE The authors of this quasi-experimental design study explored the effect of an educational documentary video that presented factual and emotional aspects of stuttering on changing attitudes toward stuttering of preservice trainees and in-service public school teachers in Kuwait. METHOD Participants were 99 preservice trainees (48 control, 51 experimental) and 103 in-service teachers (49 control, 54 experimental). All participants completed 22 items from the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S; St. Louis, 2005; translated into Arabic) and 17 additional items pre and post treatment. Participants in the experimental group viewed the awareness video. RESULTS Pretreatment comparisons confirmed that the control and experimental groups did not differ on their attitudes toward stuttering. As predicted, the posttreatment ratings for the control group were not different from the pretreatment ratings. A significant shift in attitudes (mostly in a positive direction) from pre to post treatment was observed for the experimental group of preservice trainees but not for the experimental group of in-service teachers. Interpretation of the difference in outcomes for the experimental preservice group as compared to the experimental in-service group is confounded by gender differences across groups. CONCLUSION The authors of this study demonstrated that it is possible to positively modify preservice trainees' attitudes of people who stutter by using an educational documentary video.
PMID: 24687764 [PubMed - in process]

Motor outcome of dystonic camptocormia treated with pallidal neurostimulation - GAGUEIRA ADQUIRIDA
Parkinsonism Relat Disord. 2014 Feb;20(2):176-9. doi: 10.1016/j.parkreldis.2013.10.022.Epub 2013 Nov 1.

Reese R, Knudsen K, Falk D, Mehdorn HM, Deuschl G, Volkmann J.
Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany; Department of Neurology, Julius-Maximilians-University, Würzburg, Germany [and others]

BACKGROUND: Deep brain stimulation of the internal pallidum (GPi-DBS) is effective for various types of drug-refractory primary dystonias. Rare clinical forms as dystonic camptocormia may profit but available data are scarce.
METHODS: We here report on a retrospective clinical assessment of three patients with primary dystonic camptocormia treated with GPi-DBS.
RESULTS: All three patients showed marked response to bilateral GPi-DBS within days to weeks after surgery which was preserved in the long-term (38-45 months after implantation: mean improvement 82% as rated on the Burke Fahn Marsden Dystonia Rating Scale, 89% in the subitem "trunk"). Two patients developed mild stimulation induced speech problems (stuttering or dysarthria) which resolved with reprogramming or were acceptable in return for the control of dystonic symptoms.
CONCLUSIONS: The diagnosis and treatment of camptocormia will continue to require expert knowledge in movement and neuromuscular disorders, but DBS may expand treatment options in this difficult patient population.
PMID: 24268100 [PubMed - in process]

Phonological encoding of young children who stutter. -  LINGUÍSTICA
J Fluency Disord. 2014 Mar;39:12-24. doi: 10.1016/j.jfludis.2013.10.003. Epub 2013 Nov 20.

Pelczarski KM, Yaruss JS.
Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA.

PURPOSE:Several empirical studies suggest that children who stutter, when compared to typically fluent peers, demonstrate relatively subtle, yet robust differences in phonological encoding. Phonological encoding can be measured through the use of tasks that reflect the underlying mechanisms of phonological processing, such as phonological awareness. This study investigated the phonological encoding abilities of five- and six-year old children who stutter.
METHODS:Young children who stutter were paired according to language ability, maternal education, and sex to their typically fluent peers. Participants completed multiple measures of phonological awareness abilities (i.e., sound matching, phoneme blending, elision), as well as measures of expressive and receptive vocabulary and articulation.
RESULTS:Young children who stutter performed significantly less well than nonstuttering peers on tasks of elision and sound blending. No between-group differences were found in sound matching abilities or in any of the background language measures.
CONCLUSIONS:Results suggest that young children who stutter have subtle, yet robust, linguistic differences in certain aspects of phonological encoding that may contribute to an unstable language planning system in young children who stutter.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe how phonological awareness can inform our understanding of phonological encoding; (b) summarize the findings of previously published studies that examined some aspects of phonological awareness in children who do and do not stutter; and (c) compare the results of the current study with other investigations of phonological awareness skills in children who stutter and their typically fluent peers.
PMID: 24759190 [PubMed - indexed for MEDLINE]

Preliminary study of disfluency in school-aged children with autism -  OUTRAS ÁREAS
Int J Lang Commun Disord. 2014 Jan-Feb;49(1):75-89. doi: 10.1111/1460-6984.12048. Epub 2013 Sep 11.

Scaler Scott K, Tetnowski JA, Flaitz JR, Yaruss JS.
Misericordia University, Dallas, PA, USA; University of Louisiana at Lafayette, Lafayette, LA, USA.

BACKGROUND: In recent years, there has been increased identification of disfluencies in individuals with autism, but limited examination of disfluencies in the school-age range of this population. We currently lack information about whether the disfluencies of children with autism represent concomitant stuttering, normal disfluency, excessive normal disfluency, or some form of disfluency unique to the school-age population of children with autism.
AIMS: This paper explores the nature of disfluencies in school-aged children with autism in comparison with matched children who stutter and controls. It explores stuttering-like disfluencies, non-stuttering-like disfluencies and word-final disfluencies.
METHODS & PROCEDURES: This study compared disfluency patterns in 11 school-aged children with Asperger's syndrome (AS), 11 matched children who stutter (CWS), and 11 matched children with no diagnosis (ND). Analyses were based on speech samples collected during an expository discourse task.
OUTCOMES & RESULTS: Results reveal statistically significant differences between children with AS and CWS and between children with AS and those with ND for the percentage of words containing stuttering-like disfluencies. In the AS group, four out of 11 (36%) met the common diagnostic criteria for a fluency disorder. Disfluencies in the AS group differed qualitatively and quantitatively from the CWS, and included a larger distribution of word-final disfluencies.
CONCLUSIONS & IMPLICATIONS: This study provides initial data regarding patterns of disfluency in school-aged children with AS that, with careful consideration and the cautious application of all findings, can assist therapists in making more evidence-based diagnostic decisions. Findings offer evidence that when working with children with AS, disfluencies both similar and dissimilar to those of CWS may be identified in at least a subset of those with AS. Therefore, children with AS should be screened for fluency disorders during their initial evaluation and treated if it is determined that the fluency disorder negatively impacts the effectiveness of communication.
PMID: 24372887 [PubMed - in process]

Pseudobulbar paralysis in the Renaissance: Cosimo I de' Medici case. - GAGUEIRA ADQUIRIDA
Neurol Sci. 2014 Mar 7. [Epub ahead of print]

Arba F, Inzitari D, Lippi D.
NEUROFARBA Department, University of Florence, Largo Brambilla 3, Florence, Italy

Cosimo I de' Medici (1519-1574) was the first Grand Duke of Tuscany. He was one of the most important members of the Medici family. He was an excellent conqueror and a good politician. Moreover, he was able to attract and encourage artists, scientists and architects to promote Florence as the cultural capital of the Italian Renaissance. Historical chronicles report that he suffered from a stroke when he was 49 years old. Together with the acute manifestation of stroke, he displayed peculiar symptoms. He had gait disturbances and sphincter dysfunctions. His language became poor and hard to understand. His mood was very fluctuating and in the last years of his life he was a short-tempered man. In addition, he had a characteristic symptom, so-called pathological laughing and crying. The course of his disease was slow and stuttering. Taken together, these data seem to be one of the first reports of pseudobulbar paralysis. The disease of Cosimo I was probably due to a chronic cerebral vasculopathy, known as small vessels disease. We discuss this hypothesis regarding an ancient clinical case, with the support of current studies.
PMID: 24604411 [PubMed - as supplied by publisher]

Psychosocial impact of living with a stuttering disorder: knowing is not enough. - SOCIAL
Semin Speech Lang. 2014 May;35(2):132-43. doi: 10.1055/s-0034-1371756. Epub 2014 Apr 29.

Beilby J.
School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia.

Stuttering requires a multidimensional perspective given that, in recent years, researchers have shown the impact of the disorder to reach far beyond the surface components with demonstrated psychosocial and anxiety effects for the individual living with a stutter. This article explores the impact a stuttering disorder has on the individual (child, adolescent, and adult) and on their family members (siblings, parents, and partners). These experiences include behavioral and social difficulties, self-awareness, reactions to stuttering, communication difficulties in daily situations, and overall quality of life. The influence of stuttering on the most intimate relationships of the person who stutters is presented. An overview of stuttering across the life span is discussed in terms of stuttering in children and adolescents, and the significant levels of adverse impact as a result of living with a stutter are described. In addition, the impact that the stuttering disorder has on the parents and siblings of children who stutter is also detailed through significant findings pertaining to lack of attachment and trust between the young people and their parents. The responsibilities and demands on parents and siblings in the family context are highlighted. Focus is also placed on the experience of living with a person who stutters from the perspective of their life partner. Perceived quality of life is explored with unexpected differences recounted between the quality of life experienced by the adult who stutters and their partner's perceptions of this disorder. Finally, the potential for a novel Acceptance and Commitment Therapy for individuals who stutter is presented.
PMID: 24782275 [PubMed - indexed for MEDLINE]

Research updates in neuroimaging studies of children who stutter.  - INFANTIL
Semin Speech Lang. 2014 May;35(2):67-79. doi: 10.1055/s-0034-1382151. Epub 2014 May 29.

Chang SE.
University of Michigan, Ann Arbor, Michigan.

In the past two decades, neuroimaging investigations of stuttering have led to important discoveries of structural and functional brain differences in people who stutter, providing significant clues to the neurological basis of stuttering. One major limitation, however, has been that most studies so far have only examined adults who stutter, whose brain and behavior likely would have adopted compensatory reactions to their stuttering; these confounding factors have made interpretations of the findings difficult. Developmental stuttering is a neurodevelopmental condition, and like many other neurodevelopmental disorders, stuttering is associated with an early childhood onset of symptoms and greater incidence in males relative to females. More recent studies have begun to examine children who stutter using various neuroimaging techniques that allow examination of functional neuroanatomy and interaction of major brain areas that differentiate children who stutter compared with age-matched controls. In this article, I review these more recent neuroimaging investigations of children who stutter, in the context of what we know about typical brain development, neuroplasticity, and sex differences relevant to speech and language development. Although the picture is still far from complete, these studies have potential to provide information that can be used as early objective markers, or prognostic indicators, for persistent stuttering in the future. Furthermore, these studies are the first steps in finding potential neural targets for novel therapies that may involve modulating neuroplastic growth conducive to developing and maintaining fluent speech, which can be applied to treatment of young children who stutter.
PMID: 24875668 [PubMed - indexed for MEDLINE]

Review of Telehealth Stuttering Management. - TERAPIA
Folia Phoniatr Logop. 2014 Feb 5;65(5):53-68. [Epub ahead of print]

Lowe R, O'Brian S, Onslow M.
Australian Stuttering Research Centre, The University of Sydney, Lidcombe, N.S.W., Austrália

Objective: Telehealth is the use of communication technology to provide health care services by means other than typical in-clinic attendance models. Telehealth is increasingly used for the management of speech, language and communication disorders. The aim of this article is to review telehealth applications to stuttering management.
Methods: We conducted a search of peer-reviewed literature for the past 20 years using the Institute for Scientific Information Web of Science database, PubMed: The Bibliographic Database and a search for articles by hand.
Results: Outcomes for telehealth stuttering treatment were generally positive, but there may be a compromise of treatment efficiency with telehealth treatment of young children. Our search found no studies dealing with stuttering assessment procedures using telehealth models. No economic analyses of this delivery model have been reported.
Conclusion: This review highlights the need for continued research about telehealth for stuttering management. Evidence from research is needed to inform the efficacy of assessment procedures using telehealth methods as well as guide the development of improved treatment procedures. Clinical and technical guidelines are urgently needed to ensure that the evolving and continued use of telehealth to manage stuttering does not compromise the standards of care afforded with standard in-clinic models.
PMID: 24504075 [PubMed - as supplied by publisher]

Risperidone: stuttering. - FARMACOLOGIA
Hosp Pharm. 2014 Mar;49(3):242-3. doi: 10.1310/hpj4903-242.
Free Full Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC3971108/pdf/hpj-49-242.pdf

Generali JA, Cada DJ.
University of Kansas, School of Pharmacy , Kansas City/Lawrence, Kansas; Off-Label Drug Facts

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.
PMID: 24715742 [PubMed] PMCID: PMC3971108

Social anxiety disorder and stuttering: current status and future directions - EMOCIONAL
J Fluency Disord. 2014 Jun;40:69-82. doi: 10.1016/j.jfludis.2013.08.003. Epub 2013 Sep 2.
Free Full Text - ac.els-cdn.com/S0094730X13000648/1-s2.0-S0094730X13000648-main.pdf?_tid=f31dae1a-dbe6-11e4-a75f-00000aab0f6c&acdnat=1428274749_0c3dad1c83853b740ff9f1c994811b0c

Iverach L, Rapee RM.
Centre for Emotional Health, Department of Psychology, Macquarie University, Australia.

Anxiety is one of the most widely observed and extensively studied psychological concomitants of stuttering. Research conducted prior to the turn of the century produced evidence of heightened anxiety in people who stutter, yet findings were inconsistent and ambiguous. Failure to detect a clear and systematic relationship between anxiety and stuttering was attributed to methodological flaws, including use of small sample sizes and unidimensional measures of anxiety. More recent research, however, has generated far less equivocal findings when using social anxiety questionnaires and psychiatric diagnostic assessments in larger samples of people who stutter. In particular, a growing body of research has demonstrated an alarmingly high rate of social anxiety disorder among adults who stutter. Social anxiety disorder is a prevalent and chronic anxiety disorder characterised by significant fear of humiliation, embarrassment, and negative evaluation in social or performance-based situations. In light of the debilitating nature of social anxiety disorder, and the impact of stuttering on quality of life and personal functioning, collaboration between speech pathologists and psychologists is required to develop and implement comprehensive assessment and treatment programmes for social anxiety among people who stutter. This comprehensive approach has the potential to improve quality of life and engagement in everyday activities for people who stutter. Determining the prevalence of social anxiety disorder among children and adolescents who stutter is a critical line of future research.  
EDUCATIONAL OBJECTIVES: The reader will be able to: (a) describe the nature and course of social anxiety disorder; (b) outline previous research regarding anxiety and stuttering, including features of social anxiety disorder; (c) summarise research findings regarding the diagnostic assessment of social anxiety disorder among people who stutter; (d) describe approaches for the assessment and treatment of social anxiety in stuttering, including the efficacy of Cognitive Behaviour Therapy; and (e) outline clinical implications and future directions associated with heightened social anxiety in stuttering.
Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.
PMID: 24929468 [PubMed - indexed for MEDLINE]

Social support and its association with negative affect in adults who stutter. - TERAPIA
J Fluency Disord. 2014 Jun;40:83-92. doi: 10.1016/j.jfludis.2014.02.002. Epub 2014 Feb 23.

Blumgart E, Tran Y, Craig A.
Rehabilitation Studies Unit, Sydney Medical School, The University of Sydney, PO Box 6, Ryde, NSW 1680, Australia.

PURPOSE:The purpose of the research reported in this manuscript is to clarify the relationship between social support and negative affect for people who stutter. Social support results in many benefits that help individuals to achieve self-esteem, motivation to adjust adaptively, and to experience a sense of belonging. Lack of such support is likely to result in heightened anxiety and negative affect manifesting in many forms.
METHOD:This study used the Symptom Checklist--Revised (SCL-90-R) and the Significant Others Scale (SOS) to investigate social support and its relationship to negative affect in 200 adults who stutter, with comparisons made to 200 adults who do not stutter. Negative affect was assessed by interpersonal sensitivity, depressive mood and anxiety. The Significant Others Scale was used to provide an indication of the participants' actual and ideal levels of social support.
RESULTS:It was found that (i) those participants who stuttered had significantly elevated levels of negative affect across the SCL-90-R domains of interpersonal sensitivity, depressive mood and anxiety; (ii) the group who stuttered was found to have lower levels of actual and ideal social support; and (iii) those who stuttered and who also had low social support had significantly elevated levels of negative affect.
CONCLUSION:Results highlight the potentially harmful influence that poor social support has on mood states for adults who stutter. These findings have implications for treatment such as the necessity to address and integrate social support and social integration issues in the treatment process for adults who stutter.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe the methodology of assessing social support using the Social Support Scale (SOS); (b) apply the concept of assessing social support in stuttering to treatment; (c) describe the protective contribution of helpful social support for adults who stutter; (d) describe the relationship between social support and negative mood states.
Copyright © 2014 Elsevier Inc. All rights reserved.
PMID: 24929469 [PubMed - indexed for MEDLINE]

Speech disfluencies of preschool-age children who do and do not stutter. - AVALIAÇÃO
J Commun Disord. 2014 Jan 19. pii: S0021-9924(14)00004-5. doi: 10.1016/j.jcomdis.2014.01.003. [Epub ahead of print]

Tumanova V, Conture EG, Lambert EW, Walden TA.
Syracuse University, Syracuse, NY, United States, Vanderbilt University, Nashville, TN, United States.

PURPOSE: The goals of the present study were to investigate whether (1) the speech disfluencies of preschool-age children are normally distributed; (2) preschool-age children who do (CWS) and do not stutter (CWNS) differ in terms of non-stuttered disfluencies; (3) age, gender, and speech-language ability affect the number and type of disfluencies children produce; and (4) parents' expressed concern that their child stutters is associated with examiners' judgments of stuttered disfluency.
METHOD: Four hundred and seventy two children participated, of which 228 were CWS (56 girls), and 244 CWNS (119 girls). Participants provided conversational speech samples that were analyzed for frequency of occurrence of (a) stuttered disfluencies, (b) non-stuttered disfluencies, and (c) total disfluencies.
RESULTS:Results indicated that the underlying distributions of preschool-age children's stuttered and non-stuttered disfluency counts followed a negative binomial distribution (i.e., were not normal), with more children "piling up" at the low end [none or few disfluencies] and fewer children scoring in the upper [more severe stuttering] end of the distribution. Findings also indicated that non-stuttered disfluencies significantly predicted CWS/CWNS talker group classification, information that may be helpful to augment, but not supplant, talker group classification criteria based on stuttered disfluencies. Moreover, expressed parental concern about stuttering was strongly associated with frequency of stuttered disfluencies.
CONCLUSION: Findings suggest that the entirety of preschool-age CWS' speech disfluencies - non-stuttered as well as stuttered - differs from that of their CWNS peers and that because these disfluencies are not normally distributed statistical analyses assuming normality of distribution are not the most appropriate means to assess these differences. In addition, certain "third-order" variables (e.g., gender) appear to impact frequency of children's disfluencies and expressed parental concerns about stuttering are meaningfully related to examiners' judgments of stuttered disfluencies. Learning outcomes: The reader will learn about differences in speech disfluencies of preschool-age children who do and do not stutter. The reader will learn whether age, gender and speech-language ability affect the number and type of disfluencies children produce. The reader will learn whether parental concern about stuttering is associated with examiners' judgments of stuttering.
PMID: 24503151 [PubMed - as supplied by publisher]

Stuttering attitudes of students: Professional, intracultural, and international comparisons - SOCIAL
J Fluency Disord. 2014 Mar;39:34-50. doi: 10.1016/j.jfludis.2013.10.001. Epub 2013 Oct 24.

St Louis KO, Przepiorka AM, Beste-Guldborg A, Williams MJ, Blachnio A, Guendouzi J, Reichel IK, Ware MB.
West Virginia University, Morgantown, WV, USA; The John Paul II Catholic University of Lublin, Lublin, Poland; Minot State University, Minot, ND, USA; University of South Dakota, Vermillion, SD, USA; Southeastern Louisiana University, Hammond, LA, USA; Touro College, New York, NY, USA; Ohio University, Athens, OH, USA.

PURPOSE:The study sought to identify major-specific, training, and cultural factors affecting attitudes toward stuttering of speech-language pathology (SLP) students.
METHOD:Eight convenience samples of 50 students each from universities in the USA and Poland filled out the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) in English or Polish, respectively. USA samples included undergraduate and graduate students in SLP majors or non-SLP majors as well as a sample of non-SLP students who were Native Americans. Polish samples included SLP (logopedics), psychology, and mixed majors.
RESULTS:SLP students held more positive attitudes than non-SLP students in both countries. Graduate students held more positive attitudes than undergraduate students in the USA, and this effect was stronger for SLP than for non-SLP students. Native American students' stuttering attitudes were similar to other American non-SLP students' attitudes. Polish student attitudes were less positive overall than those of their American student counterparts.
CONCLUSION:SLP students' attitudes toward stuttering are affected by a "halo effect" of being in that major, by specific training in fluency disorders, and by various cultural factors, yet to be clearly understood.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe major factors affecting SLP students' attitudes toward stuttering; (b) describe similarities and differences in attitudes toward stuttering of students from the USA and Poland; (c) describe similarities and differences in attitudes toward stuttering of Native American students from the USA and non-Native American students.
PMID: 24759192 [PubMed - indexed for MEDLINE]

Stuttering inhibition via altered auditory feedback during scripted telephone conversations. - AUDITIVO
Int J Lang Commun Disord. 2014 Jan-Feb;49(1):139-47. doi: 10.1111/1460-6984.12053. Epub 2013 Aug 30.

Hudock D, Kalinowski J.
Department of Communication Sciences and Disorders, Idaho State University, Pocatello, ID, USA.

BACKGROUND: Overt stuttering is inhibited by approximately 80% when people who stutter read aloud as they hear an altered form of their speech feedback to them. However, levels of stuttering inhibition vary from 60% to 100% depending on speaking situation and signal presentation. For example, binaural presentations of delayed auditory feedback (DAF) and frequency-altered feedback (FAF) have been shown to reduce stuttering by approximately 57% during scripted telephone conversations.
AIMS: To examine stuttering frequency under monaural auditory feedback with one combination of DAF with FAF (COMBO-2) and two combinations of DAF with FAF (COMBO-4) during scripted telephone conversations.
METHODS & PROCEDURES: Nine adult participants who stutter called 15 local businesses during scripted telephone conversations; each condition consisted of five randomized telephone calls. Conditions consisted of (1) baseline (i.e. non-altered feedback), (2) COMBO-2 (i.e. 50-ms delay with a half octave spectral shift up), and (3) COMBO-4 (i.e. 200-ms delay and a half octave spectral shift down in addition to the COMBO-2). Participants wore a supra-aural headset with a dynamic condenser microphone while holding a receiver to their contralateral ear when making telephone calls.
OUTCOMES & RESULTS: Stuttering was significantly reduced during both altered auditory feedback (AAF) conditions by approximately 65%. Furthermore, a greater reduction in stuttering was revealed during the COMBO with four effects (74%) as compared with the COMBO with two effects (63%).
CONCLUSIONS & IMPLICATIONS: Results from the current study support prior research reporting decreased stuttering under AAF during scripted telephone conversations. Findings that stuttering was significantly reduced to a greater extent under the COMBO with four effects condition suggest that second signals reduce stuttering along a continuum. Additionally, findings support prior research results of decreased stuttering frequency under AAF during hierarchically difficult speaking situations. Clinical application of these findings may be that people who stutter can use specific software or smartphone applications that produce second speech signals to inhibit stuttering frequency effectively during telephone conversations.
PMID: 24372890 [PubMed - in process]

Stuttering in relation to anxiety, temperament, and personality: review and analysis with focus on causality. - EMOCIONAL
J Fluency Disord. 2014 Jun;40:5-21. doi: 10.1016/j.jfludis.2014.01.004. Epub 2014 Feb 8.

Alm PA.
Department of Neuroscience, Speech and Language Pathology, Uppsala University, Sweden.

Anxiety and emotional reactions have a central role in many theories of stuttering, for example that persons who stutter would tend to have an emotionally sensitive temperament. The possible relation between stuttering and certain traits of temperament or personality were reviewed and analyzed, with focus on temporal relations (i.e., what comes first). It was consistently found that preschool children who stutter (as a group) do not show any tendencies toward elevated temperamental traits of shyness or social anxiety compared with children who do not stutter. Significant group differences were, however, repeatedly reported for traits associated with inattention and hyperactivity/impulsivity, which is likely to reflect a subgroup of children who stutter. Available data is not consistent with the proposal that the risk for persistent stuttering is increased by an emotionally reactive temperament in children who stutter. Speech-related social anxiety develops in many cases of stuttering, before adulthood. Reduction of social anxiety in adults who stutter does not in itself appear to result in significant improvement of speech fluency. Studies have not revealed any relation between the severity of the motor symptoms of stuttering and temperamental traits. It is proposed that situational variability of stuttering, related to social complexity, is an effect of interference from social cognition and not directly from the emotions of social anxiety.
In summary, the studies in this review provide strong evidence that persons who stutter are not characterized by constitutional traits of anxiety or similar constructs.
EDUCATIONAL OBJECTIVES:This paper provides a review and analysis of studies of anxiety, temperament, and personality, organized with the objective to clarify cause and effect relations. Readers will be able to (a) understand the importance of effect size and distribution of data for interpretation of group differences; (b) understand the role of temporal relations for interpretation of cause and effect; (c) discuss the results of studies of anxiety, temperament and personality in relation to stuttering; and (d) discuss situational variations of stuttering and the possible role of social cognition.
PMID: 24929463 [PubMed - indexed for MEDLINE]

Systematic studies of modified vocalization: the effect of speech rate on speech production measures during metronome-paced speech in persons who stutter. - FALA
Int J Lang Commun Disord. 2014 Jan-Feb;49(1):100-12. doi: 10.1111/1460-6984.12050. Epub 2013 Aug 24.

Davidow JH.
Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY, USA.

BACKGROUND: Metronome-paced speech results in the elimination, or substantial reduction, of stuttering moments. The cause of fluency during this fluency-inducing condition is unknown. Several investigations have reported changes in speech pattern characteristics from a control condition to a metronome-paced speech condition, but failure to control speech rate between conditions limits our ability to determine if the changes were necessary for fluency.
AIMS: This study examined the effect of speech rate on several speech production variables during one-syllable-per-beat metronomic speech in order to determine changes that may be important for fluency during this fluency-inducing condition.
METHODS & PROCEDURES: Thirteen persons who stutter (PWS), aged 18-62 years, completed a series of speaking tasks. Several speech production variables were compared between conditions produced at different metronome beat rates, and between a control condition and a metronome-paced speech condition produced at a rate equal to the control condition.
OUTCOMES & RESULTS: Vowel duration, voice onset time, pressure rise time and phonated intervals were significantly impacted by metronome beat rate. Voice onset time and the percentage of short (30-100 ms) phonated intervals significantly decreased from the control condition to the equivalent rate metronome-paced speech condition.
CONCLUSIONS & IMPLICATIONS: A reduction in the percentage of short phonated intervals may be important for fluency during syllable-based metronome-paced speech for PWS. Future studies should continue examining the necessity of this reduction. In addition, speech rate must be controlled in future fluency-inducing condition studies, including neuroimaging investigations, in order for this research to make a substantial contribution to finding the fluency-inducing mechanism of fluency-inducing conditions.

PMID: 24372888 [PubMed - in process]

Temperament and environmental contributions to stuttering severity in children: the role of effortful control - EMOCIONAL
Semin Speech Lang. 2014 May;35(2):80-94. doi: 10.1055/s-0034-1371753. Epub 2014 Apr 29.

Jo Kraft S, Ambrose N, Chon H.
Wayne State University, Detroit, Michigan; University of Illinois, Urbana-Champaign, Illinois; Chosun University, Gwahgju, Korea.

We investigated the contribution of temperament and external environment to the severity of children who stutter. Sixty-nine children who stutter, ages 2;4 to 5;9 (years; months), with a mean age of 3;7, were assessed for temperament, home environment, and significant life events. Temperament was assessed using the Children's Behavior Questionnaire. Home environment and life events were assessed using the Confusion, Hubbub and Order Scale (CHAOS) scale and the Life Events Checklist. Results indicated mother (parent)-reported stuttering severity and clinician-reported stuttering severity to be correlated with child temperament scores in the domain of Effortful Control. When temperament, home environment, and life events were combined, no statistically predictive outcomes were evident in corresponding severity ratings. The current study suggests the temperament domain of Effortful Control in children who stutter is a significant underlying mechanism influencing stuttering severity. Clinical implications are discussed.
PMID: 24782272 [PubMed - indexed for MEDLINE]

Temperament, emotion, and childhood stuttering. - EMOCIONAL
Semin Speech Lang. 2014 May;35(2):114-31. doi: 10.1055/s-0034-1371755. Epub 2014 Apr 29.
Free Ful Text - www.ncbi.nlm.nih.gov/pmc/articles/PMC4317269/pdf/nihms657451.pdf

Jones R, Choi D, Conture E, Walden T.
Department of Hearing and Speech Sciences; Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee.

Reactivity refers to arousal of emotions, motor activity, and attention, and self-regulation refers to the ability to moderate those tendencies. In general, temperament is typically thought of as an individual's constitutionally (biologically) based behavioral proclivities. These proclivities often include emotional reactivity and self-regulation. Reactivity refers to arousal of emotions, motor activity, and attention, and self-regulation refers to the ability to moderate those tendencies. The traitlike nature of temperament makes it potentially salient to our understanding of the onset and development of stuttering because temperamental tendencies may result in greater reactivity or difficulty in coping. Emotions, which are more statelike and variable, may influence the variation of stuttering commonly observed both within and between speaking situations. Temperament and emotion may serve as a causal contributor to developmental stuttering, with empirical findings indicating that preschool-aged children who stutter (CWS) exhibit differences in temperament and emotion when compared with children who do not stutter. Given that empirical study of temperament in preschool-aged CWS is nascent, extensive discussion of clinical implications is challenging. With that caution, we present some early possibilities, including matching treatment approaches with the child's temperamental profile and using temperament as a predictor of treatment outcome.
PMID: 24782274 [PubMed - indexed for MEDLINE] PMCID: PMC4317269



The effectiveness of stuttering treatments in Germany. - TERAPIA
J Fluency Disord. 2014 Mar;39:1-11. doi: 10.1016/j.jfludis.2014.01.002. Epub 2014 Jan 27.

Euler HA, Lange BP, Schroeder S, Neumann K.
Ruhr-University Bochum, Bochum, Germany; Georg-August-University Goettingen, Goettingen, Germany; Max Planck Institute for Human Development, Berlin, Germany; University of Kassel, Kassel, Germany.

PURPOSE:Persons who stutter (PWS) should be referred to the most effective treatments available, locally or regionally. A prospective comparison of the effects of the most common stuttering treatments in Germany is not available. Therefore, a retrospective evaluation by clients of stuttering treatments was carried out.
METHOD:The five most common German stuttering treatments (231 single treatment cases) were rated as to their perceived effectiveness, using a structured questionnaire, by 88 PWS recruited through various sources. The participants had received between 1 and 7 treatments for stuttering.
RESULTS:Two stuttering treatments (stuttering modification, fluency shaping) showed favorable and three treatments (breathing therapy, hypnosis, unspecified logopedic treatment) showed unsatisfactory effectiveness ratings. The effectiveness ratings of stuttering modification and fluency shaping did not differ significantly. The three other treatments were equally ineffective. The differences between the effective and ineffective treatments were of large effect sizes. The typical therapy biography begins in childhood with an unspecified logopedic treatment administered extensively in single and individual sessions. Available comparisons showed intensive or interval treatments to be superior to extensive treatments, and group treatments to be superior to single client treatments.
CONCLUSION:The stuttering treatment most often prescribed in Germany, namely a weekly session of individual treatment by a speech-language pathologist, usually with an assorted package of mostly unknown components, is of limited effectiveness. Better effectiveness can be expected from fluency shaping or stuttering modification approaches, preferably with an intensive time schedule and with group sessions.
EDUCATIONAL OBJECTIVES:Readers will be able to: (a) discuss the five most prevalent stuttering treatments in Germany; (b) summarize the effectiveness of these treatments; and (c) describe structural treatment components that seem to be preferable across different kinds of treatments.
PMID: 24759189 [PubMed - indexed for MEDLINE]

The impact of threat and cognitive stress on speech motor control in people who stutter - EMOCIONAL
J Fluency Disord. 2014 Jun;40:93-109. doi: 10.1016/j.jfludis.2014.02.003. Epub 2014 Mar 3.

Lieshout Pv, Ben-David B, Lipski M, Namasivayam A
University of Toronto, Canada; Department of Psychology, Canada; Institute of Biomaterials and Biomedical Engineering, Canada; Graduate Department of Rehabilitation Science, Canada; Toronto Rehabilitation Institute, Canada; Interdisciplinary Center (IDC) Herzliya, Israel.

PURPOSE:In the present study, an Emotional Stroop and Classical Stroop task were used to separate the effect of threat content and cognitive stress from the phonetic features of words on motor preparation and execution processes.
METHOD:A group of 10 people who stutter (PWS) and 10 matched people who do not stutter (PNS) repeated colour names for threat content words and neutral words, as well as for traditional Stroop stimuli. Data collection included speech acoustics and movement data from upper lip and lower lip using 3D EMA.
RESULTS:PWS in both tasks were slower to respond and showed smaller upper lip movement ranges than PNS. For the Emotional Stroop task only, PWS were found to show larger inter-lip phase differences compared to PNS. General threat words were executed with faster lower lip movements (larger range and shorter duration) in both groups, but only PWS showed a change in upper lip movements. For stutter specific threat words, both groups showed a more variable lip coordination pattern, but only PWS showed a delay in reaction time compared to neutral words. Individual stuttered words showed no effects. Both groups showed a classical Stroop interference effect in reaction time but no changes in motor variables.
CONCLUSION:This study shows differential motor responses in PWS compared to controls for specific threat words. Cognitive stress was not found to affect stuttering individuals differently than controls or that its impact spreads to motor execution processes.
EDUCATIONAL OBJECTIVES:After reading this article, the reader will be able to: (1) discuss the importance of understanding how threat content influences speech motor control in people who stutter and non-stuttering speakers; (2) discuss the need to use tasks like the Emotional Stroop and Regular Stroop to separate phonetic (word-bound) based impact on fluency from other factors in people who stutter; and (3) describe the role of anxiety and cognitive stress on speech motor processes.
Copyright © 2014 Elsevier Inc. All rights reserved.
PMID: 24929470 [PubMed - indexed for MEDLINE]

The Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) and Bipolar Adjective Scale (BAS): aspects of validity - SOCIAL
J Commun Disord. 2014 Jul-Aug;50:36-50. doi: 10.1016/j.jcomdis.2014.04.001. Epub 2014 May 5.

St Louis KO, Williams MJ, Ware MB, Guendouzi J, Reichel IK.
West Virginia University, Morgantown, WV, USA; University of South Dakota, Vermillion, SD, USA; Ohio University, Athens, OH, USA; Southeastern Louisiana University, Hammond, LA, USA; Touro College, New York, NY, USA.

PURPOSE:In order to estimate instrument validity, attitudes toward stuttering measured by the newly developed Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) and the Woods and Williams (1976) semantic differential scale (referred to herein as the Bipolar Adjective Scale [BAS]) are compared in college students on one occasion as well as before and after coursework on fluency disorders.
METHOD:Undergraduate and graduate students (n=321) from four universities filled out online versions of the POSHA-S and BAS. Two-thirds were speech-language pathology (SLP) majors; one-third were students in other majors. A subset of the SLP students (n=35) filled out the two instruments again after 8-13 weeks of coursework on fluency disorders.
RESULTS:Correlations between all ratings of the POSHA-S and BAS were run for the 321 students. Only 26% of the correlations were statistically significant (R ≥ ± 0.129), and the large majority of these reflected small relationships. POSHA-S ratings were correlated with up to 77% of the items of the BAS while BAS items were correlated with up to 45% of the POSHA-S ratings. After coursework on stuttering, students' attitudes improved on both instruments, but more on the POSHA-S than the BAS.
CONCLUSIONS:Greater evidence of discriminant validity than convergent validity characterized the POSHA-S and BAS. Both measures showed improved attitudes after fluency disorders coursework, but more so for the POSHA-S, confirming previous reports of construct validity. The POSHA-S taps relevant constructs not included in the BAS, which provide advantages for intracultural, international, and other comparisons of public attitudes toward stuttering.
LEARNING OUTCOMES:The reader will be able to: (1) describe differentiating characteristics of the POSHA-S and BAS as measures of public attitudes toward stuttering, (2) describe the overlap and lack of overlap in the constructs measured by POSHA-S and BAS, (3) describe discriminant versus convergent validity and (4) describe advantages of the POSHA-S and BAS in various types of comparative studies of stuttering attitudes.
Copyright © 2014 Elsevier Inc. All rights reserved.
PMID: 24929998 [PubMed - in process]

The reliability of a severity rating scale to measure stuttering in an unfamiliar language. - AVALIAÇÃO
Int J Speech Lang Pathol. 2014 Jun;16(3):317-26. doi: 10.3109/17549507.2014.898097. Epub 2014 Mar 28.

  Hoffman L, Wilson L, Copley A, Hewat S, Lim V.
School of Community Health, Charles Sturt University , Albury, NSW , Australia.

With increasing multiculturalism, speech-language pathologists (SLPs) are likely to work with stuttering clients from linguistic backgrounds that differ from their own. No research to date has estimated SLPs' reliability when measuring severity of stuttering in an unfamiliar language. Therefore, this study was undertaken to estimate the reliability of SLPs' use of a 9-point severity rating (SR) scale, to measure severity of stuttering in a language that was different from their own. Twenty-six Australian SLPs rated 20 speech samples (10 Australian English [AE] and 10 Mandarin) of adults who stutter using a 9-point SR scale on two separate occasions. Judges showed poor agreement when using the scale to measure stuttering in Mandarin samples. Results also indicated that 50% of individual judges were unable to reliably measure the severity of stuttering in AE. The results highlight the need for (a) SLPs to develop intra- and inter-judge agreement when using the 9-point SR scale to measure severity of stuttering in their native language (in this case AE) and in unfamiliar languages; and (b) research into the development and evaluation of practice and/or training packages to assist SLPs to do so.
PMID: 24678793 [PubMed - as supplied by publisher]

The role of language familiarity in bilingual stuttering assessment. - AVALIAÇÃO
Clin Linguist Phon. 2014 Mar 3. [Epub ahead of print]

Lee AS, Robb MP, Ormond T, Blomgren M.
Department of Communication Disorders, University of Canterbury , Christchurch , New Zealand

The aim of this study was to evaluate the ability of English-speaking speech-language pathologists (SLPs) to evaluate stuttering behaviour in two Spanish-English bilingual adults who stutter (AWS1 and AWS2). The English-speaking SLPs were asked to judge the frequency, severity, type, duration, and physical concomitants of stuttering in both languages of the two AWS. The combined results from the English-speaking SLPs were then compared to the judgements of three Spanish-English bilingual SLPs. Results indicated that English-speaking SLPs (1) judged stuttering frequency to be greater in Spanish than English for AWS1, and equal in Spanish and English for AWS2, (2) were more accurate at evaluating individual moments of stuttering for the English samples compared to the Spanish samples, (3) identified fewer and less severe stuttering behaviours than the bilingual SLPs in both languages, and (4) were accurate judges of overall stuttering severity in both languages. The results correspond to past research examining the accuracy of stuttering evaluations in unfamiliar languages. Possible explanations for the findings, clinical implications, and future research directions are discussed.

PMID: 24588470 [PubMed - as supplied by publisher]

Trait and social anxiety in adults with chronic stuttering: conclusions following meta-analysis. - EMOCIONAL
J Fluency Disord. 2014 Jun;40:35-43. doi: 10.1016/j.jfludis.2014.01.001. Epub 2014 Jan 15.

Craig A, Tran Y.
Rehabilitation Studies Unit, Sydney Medical School, The University of Sydney, St Leonards, Australia.

PURPOSE:The relationship between chronic stuttering and anxiety has been a matter of some debate over the past two decades, with a major emphasis of research focused on examining whether people who stutter have abnormally elevated levels of trait or social anxiety. The major goal of this paper was to perform a systematic literature review and perform meta-analyses on research that has assessed (i) trait anxiety and (ii) social anxiety, in adults who stutter.
METHOD:Only studies that met strict inclusion criteria were selected for the meta-analyses. Two meta-analyses were conducted, the first for trait anxiety, and the second for social anxiety. Meta-analysis combines statistically the results of selected studies that meet strict design criteria, thereby clarifying the size of differences in trait and social anxiety between adults who stutter and adults who do not stutter.
RESULTS:Meta-analytic results confirmed that adults with chronic stuttering do have substantially elevated trait and social anxiety. The overall effect size for trait and social anxiety was calculated to be .57 and .82, respectively.
CONCLUSIONS:Trait and social anxiety are definite problems for many adults who stutter. Clinical implications of these findings for the diagnosis and treatment of adult who stutter are discussed.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe the process of conducting a systematic review and meta-analysis; (b) describe the possible impact of publication bias on meta-analysis results; (c) explain the impact of a chronic disorder like stuttering on levels of trait anxiety; (d) explain the impact of stuttering on levels of social anxiety; (e) interpret the results of meta-analysis when applied to differences in anxiety between adult people who stutter and those who do not stutter; and (f) describe implications for fluency enhancing treatments.
PMID: 24929465 [PubMed - indexed for MEDLINE]

Tributes for Gene J. Brutten, Ph.D. (1928-2013)
J Fluency Disord. 2014 Jun;40:110-5. doi: 10.1016/j.jfludis.2014.02.001. Epub 2014 Feb 18.

van Lieshout P.
University of Toronto, Department of Speech-Language Pathology, Toronto, Ontario, Canada

PMID: 24929471 [PubMed - indexed for MEDLINE]

Webcam delivery of the Lidcombe Program for early stuttering: A Phase I clinical trial. - TERAPIA
J Speech Lang Hear Res. 2014 Jun 1;57(3):825-30. doi: 10.1044/2014_JSLHR-S-13-0094

O'Brian S, Smith K, Onslow M.

PURPOSE The Lidcombe Program is an operant treatment for early stuttering shown with meta-analysis to have a favorable odds ratio. However, many clients are unable to access the treatment due to distance and lifestyle factors. This Phase I trial explored the potential efficacy, practicality, and viability of an Internet webcam Lidcombe Program service delivery model. METHOD Participants were three preschool children who stuttered and their parents, all of whom received assessment and treatment using webcam in their homes with no clinic attendance. RESULTS At 6 months post Stage 1 completion, all children were stuttering below 1.0 percent syllable stuttered (%SS). The webcam intervention was acceptable to the parents and appeared to be practical and viable, with only occasional audiovisual problems. At present there is no reason to doubt that webcam-delivered Lidcombe Program will be shown with clinical trials to have comparable efficacy to the clinic version. CONCLUSION Webcam-delivered Lidcombe Program intervention is potentially efficacious, practical and viable, and requires further exploration with comparative clinical trials and a qualitative study of parent and caregiver experiences.

PMID: 24686834 [PubMed - as supplied by publisher]


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