Eliana Maria Nigro Rocha


Abstracts - Janeiro a Julho de 2015


Ordem alfabética do título do artigo

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia linked CSF1R mutation: Report of four Korean cases - GENÉTICA
J Neurol Sci. 2015 Feb 15;349(1-2):232-8. doi: 10.1016/j.jns.2014.12.021. Epub 2014 Dec 20.

Kim EJ, Shin JH, Lee JH, Kim JH, Na DL, Suh YL, Hwang SJ, Lee JH, Lee YM, Shin MJ, Lee MJ, Kim SJ, Yoon U, Park do Y, Jung DS, Ahn JW, Sung S, Huh GY.
Pusan National University School of Medicine and Medical Research Institute, Busan, South Korea; Pusan National University Yangsan Hospital, Yangsan, South Korea; National Health Insurance Corporation, Goyang-shi, South Korea; Sungkyunkwan University School of Medicine, Seoul, South Korea; Catholic University of Daegu, Gyeongsan, South Korea.

We describe detailed clinical, biochemical, neuroimaging and neuropathological features in adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP), encompassing hereditary diffuse leukoencephalopathy with axonal spheroids (HDLS) and pigmentary orthochromatic leukodystrophy (POLD), linked to colony-stimulating factor 1 receptor (CSF1R) mutations in four Korean cases. Clinical, biochemical, neuroimaging and neuropathological findings were obtained by direct evaluation and from previous medical records. The genetic analysis of the CSF1R gene was done in two autopsy-confirmed ALSP cases and two cases where ALSP was suspected based on the clinical and neuroimaging characteristics. We identified two known mutations: c.2342C>T (p.A781V) in one autopsy-proven HDLS and clinically ALSP-suspected case and c.2345G>A (p.R782H) in another autopsy-proven POLD case. We also found a novel mutation (c.2296A>G; p.M766V) in a patient presenting with hand tremor, stuttering and hesitant speech, and abnormal behavior whose father died from a possible diagnosis of spinocerebellar ataxia. To the best of our knowledge, this is the first documented ALSP-linked CSF1R mutation in Korea and supports the suggestion that HDLS and POLD, with pathological characteristics that are somewhat different but which are caused by CSF1R mutations, are the same spectrum of disease, ALSP.
Copyright © 2014 Elsevier B.V. All rights reserved.
PMID: 25563800 [PubMed - in process]

A model clarifying the role of mediators in the variability of mood states over time in people who stutter.- EMOCIONAL
J Fluency Disord. 2015 Mar 20. pii: S0094-730X(15)00024-8. doi: 10.1016/j.jfludis.2015.03.001. [Epub ahead of print]

Craig A, Blumgart E, Tran Y.

The University of Sydney, St Leonards, Australia; University of Technology, Sydney, Broadway, Australia.

PURPOSE: Elevated negative mood states such as social anxiety and depressive mood have been found in adults who stutter. Research is needed to assist in the development of a model that clarifies how factors like self-efficacy and social support contribute to the variability of negative mood states over time.
METHOD: Participants included 200 adults who stutter. A longitudinal design was employed to assess change in mood states over a period of five months. Hierarchical directed regression (path analysis) was used to determine contributory relationships between change in mood states and self-efficacy, social support, socio-demographic and stuttering disorder variables. Participants completed a comprehensive assessment regimen, including validated measures of mood states, perceived control (self-efficacy) and social support.
RESULTS:Results confirmed that self-efficacy performs a protective role in the change in mood states like anxiety and depressive mood. That is, self-efficacy cushioned the impact of negative mood states. Social support was only found to contribute a limited protective influence. Socio-demographic variables had little direct impact on mood states, while perceived severity of stuttering also failed to contribute directly to mood at any time point.
CONCLUSIONS:Mood was found to be influenced by factors that are arguably important for a person to cope and adjust adaptively to the adversity associated with fluency disorder. A model that explains how mood states are influenced over time is described. Implications of these results for managing adults who stutter with elevated negative mood states like social anxiety are discussed.
EDUCATIONAL OBJECTIVES:The reader will be able to describe: (a) the method involved in hierarchical (directed) regression used in path analysis; (b) the variability of mood states over a period of five months; (c) the nature of the mediator relationship between factors like self-efficacy and social support and mood states like anxiety, and (d) the contribution to mood states of socio-demographic factors like age and education and stuttering disorder variables like stuttering frequency and perceived severity.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25825349 [PubMed - as supplied by publisher]




An autopsy case of frontotemporal lobar degeneration with the appearance of fused in sarcoma inclusions (basophilic inclusion body disease) clinically presenting corticobasal syndrome - GAGUEIRA "ADQUIRIDA"

Neuropathology. 2015 Jul 31. doi: 10.1111/neup.12232. [Epub ahead of print]


Matsumoto A, Suzuki H, Fukatsu R, Shimizu H, Suzuki Y, Hisanaga K.

Miyagi Hospital, Watari-gun, Miyagi;  Sendai Medical Center; National Rehabilitation Center for Persons with Disabilities, Tokorozawa City, Saitama, Japan.


We describe an autopsy case of basophilic inclusion body disease (BIBD), a subtype of frontotemporal lobar degeneration (FTLD) with the appearance of fused in sarcoma (FUS) inclusions (FTLD-FUS), clinically presenting corticobasal syndrome (CBS). A 54-year-old man initially developed worsening of stuttering and right hand clumsiness. Neurological examinations revealed rigidity in the right upper and lower extremities, buccofacial apraxia, and right-side dominant limb-kinetic and ideomotor apraxia. Neuroimaging showed asymmetric left-dominant brain atrophy and a cerebral blood flow reduction in the ipsilateral frontal region. At 56 years, his apraxia had advanced, and ideational apraxia was observed. Furthermore, the asymmetry in the limb-kinetic and ideomotor apraxia had disappeared, and both conditions had become bilateral. He had a new onset of aphasia. His symptoms progressed and he died 9 years after the initial symptoms. The brain weighed 955 g. Diffuse brain atrophy was most obvious in the bilateral frontotemporal regions. The atrophy of the left superior frontal and precentral gyri and bilateral basal ganglia was remarkable. Histologically, there was a marked loss of neurons with gliosis in the affected areas, where basophilic neuronal cytoplasmic inclusions were observed. The inclusions were immunoreactive for FUS, p62, and TATA-binding protein-associated factor 15 (TAF15), but not for phosphorylated tau, transactive response DNA-binding protein of 43 kDa (TDP-43), neurofilament protein, or Ewing sarcoma (EWS). From these pathological findings, this case was diagnosed as having BIBD as an FTLD-FUS variant. Spinal cord lower motor neurons were spared in number, similar to primary lateral sclerosis. Mutations in FUS were undetectable. Common background pathologies for CBS include corticobasal degeneration, Alzheimer's disease, PSP, FTLD with phosphorylated TDP-43 inclusions (FTLD-TDP), Pick's disease, Lewy body disease and CJD. However, FTLD-FUS (BIBD) has been rarely reported. Our case suggested further pathological heterogeneity in CBS than had previously been reported. It is necessary to consider FTLD-FUS (BIBD) as a background pathology for CBS in the future.

PMID: 26227957 [PubMed - as supplied by publisher]



Anomalous white matter morphology in adults who stutter. - NEUROCIÊNCIAS
J Speech Lang Hear Res. 2015 Jan 29. doi: 10.1044/2015_JSLHR-S-14-0193. [Epub ahead of print]

Cieslak M, Ingham RJ, Ingham JC, Grafton ST.

AIMS:Developmental stuttering is now generally considered to arise from genetic determinants interacting with neurologic function. Changes within speech-motor white matter (WM) connections may also be implicated. These connections can now be studied in great detail by high angular resolution diffusion MRI. Therefore, diffusion spectrum imaging (DSI) was used to reconstruct streamlines to examine white matter connections in persons who stutter (PWS) and normally fluent controls.
METHODS:WM morphology of the entire brain was assayed in eight right-handed male PWS and eight similarly aged right-handed fluent males. WM was exhaustively searched using a deterministic algorithm that identifies missing or largely misshapen tracts. To be abnormal, at least one third of a tract (defined as all streamlines connecting a pair of gray matter regions) was required to be missing in seven out of eight subjects in one group and not in the other group.
RESULTS:Large portions of bilateral arcuate fasciculi, a heavily researched speech pathway, were abnormal in PWS. Conversely, all PWS had a prominent connection in the left temporo-striatal tract connecting frontal and temporal cortex that was not observed in nonstuttering control subjects.
CONCLUSIONS:These previously unseen structural differences of WM morphology in classical speech-language circuits may underlie developmental stuttering.
PMID: 25635376 [PubMed - as supplied by publisher]

A novel approach for measuring social participation in adults who stutter. - FALA
J Fluency Disord. 2015 Feb 16. pii: S0094-730X(15)00007-8. doi: 10.1016/j.jfludis.2015.02.001. [Epub ahead of print]

Mendes L, Dacakis G, Block S, Erickson S.
Department of Human Communication Sciences, La Trobe University, Victoria, Australia.

This paper reports a preliminary study which trialled a novel approach for measuring speech output and social participation. The amount of phonation was accumulated via an objective measure called an Ambulatory Phonation Monitor (APM).
PURPOSE: (1) To establish whether adults who stutter will tolerate wearing an APM for an extended period of time (three days), (2) to test whether the APM can accumulate useful data about the amount of phonation adults who stutter produce in the course of a normal day and (3) to examine a possible relationship between stuttering severity and amount of phonation.
METHOD: Three adults who stutter wore an APM for three consecutive days during their waking hours. Each completed a questionnaire regarding the device and kept a speech diary outlining daily speaking activities and self-reported stuttering severity. APM data regarding amount of phonation was collected, analysed and compared with the participants' speech diaries.
RESULTS:Each adult tolerated wearing the APM and while they felt comfortable speaking wearing the device, it was somewhat cumbersome. Variations in the amount of speaking across each day and in different speaking situations were evident. For two participants there was a positive correlation between phonation time and severity rating.
CONCLUSIONS: Preliminary data suggests that the APM can provide valuable information about the amount adults who stutter speak. The APM is sufficiently sensitive to differentiate variations in the amount of phonation during different speaking situations. These favourable preliminary results suggest the value of a larger scale study.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe the different aspects of stuttering currently routinely measured in clinical practice; (b) discuss the limitations of current measurement procedures; (c) discuss the advantages of speech measures obtained by an Ambulatory Phonation Monitor APM); (d) describe the perspectives of adults who stutter who have worn an APM to measure phonation time.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25777287 [PubMed - as supplied by publisher]

Anticipation in stuttering: A theoretical model of the nature of stutter prediction. - TERAPIA
J Fluency Disord. 2015 Mar 26. pii: S0094-730X(15)00025-X. doi: 10.1016/j.jfludis.2015.03.002. [Epub ahead of print]

Garcia-Barrera MA, Davidow JH.
Department of Psychology, University of Victoria, Victoria, British Columbia, Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY 11549

The fact that some people who stutter have the ability to anticipate a stuttering moment is essential for several theories of stuttering and important for maximum effectiveness of many currently used treatment techniques. The "anticipation effect," however, is poorly understood despite much investigation into this phenomenon. In the present paper, we combine (1) behavioral evidence from the stuttering-anticipation literature, (2) speech production models, and (3) models of error detection to propose a theoretical model of anticipation. Integrating evidence from theories such as Damasio's Somatic Marker Hypothesis, Levelt's Perceptual Monitoring Theory, Guenther's The Directions Into Velocities of Articulators (DIVA) model, Postma's Covert Repair Hypothesis, among others, our central thesis is that the anticipation of a stuttering moment occurs as an outcome of the interactions between previous learning experiences (i.e., learnt associations between stuttered utterances and any self-experienced or environmental consequence) and error monitoring. Possible neurological mechanisms involved in generating conscious anticipation are also discussed, along with directions for future research.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe historical theories that explain how PWS may learn to anticipate stuttering; (b) state some traditional sources of evidence of anticipation in stuttering; (c) describe how PWS may be sensitive to the detection of a stuttering; (d) state some of the neural correlates that may underlie anticipation in stuttering; and (e) describe some of the possible utilities of incorporating anticipation into stuttering interventions.
PMID: 25841698 [PubMed - as supplied by publisher]



Articulation Disorders in Serbian Language in Children with Speech Pathology - SUPERFICIAL

Med Pregl. 2015 May-Jun;68(5-6):168-72.


Dmitrić T, Veselinović M, Mitrović SM.


INTRODUCTION: Articulation is the result of speech organs and it means clean, clear and distinct pronunciation of voices in words.

MATERIAL AND METHODS: A prospective study included 24 children between 5 and 15 years of age, of both sexes. All children were monolingual, Serbian being their native language. The quality of articulation was tested with Triage articulation test.

RESULTS: Neither omission nor distortion of plosives was observed in any of them, whereas substitution of plosives occurred in 12% of patients. Omission of affricates was not observed in any of the subjects, but substitution and distortion occurred in 29%, and 76% of subjects, respectively. Omission of fricatives was found in 29% subjects, substitution in 52%, and distortion in 82% of subjects. Omission and distortion of nasals was not recorded in any of the subjects, and substitution occurred in 6% of children. Omission of laterals was observed in 6%, substitution in 46% and distortion in 52% of subjects with articulation disorders. Discussion and

CONCLUSION: Articulation disorders were observed not only in children diagnosed with dyslalia but in those with dysphasia and stuttering as well. Children with speech disorders articulate vowels best, then nasals and plosives. Articulation of fricatives and laterals was found to be most severely deviated, including all three disorders, i.e. substitution, omission and distortion. Spasms of speech muscles and vegetative reactions were also observed in this study, but only in children with stuttering.

PMID: 26234024 [PubMed - in process]




Assessing attentional biases with stuttering - AATENÇÃO

Int J Lang Commun Disord. 2015 Jul 14. doi: 10.1111/1460-6984.12187. [Epub ahead of print]


Lowe R, Menzies R, Packman A, O'Brian S, Jones M, Onslow M.

The University of Sydney, Lidcombe, Australia; University of Queensland, Herston,  Australia.


BACKGROUND: Many adults who stutter presenting for speech treatment experience social anxiety disorder. The presence of mental health disorders in adults who stutter has been implicated in a failure to maintain speech treatment benefits. Contemporary theories of social anxiety disorder propose that the condition is maintained by negative cognitions and information processing biases. Consistent with cognitive theories, the probe detection task has shown that social anxiety is associated with an attentional bias to avoid social information. This information processing bias is suggested to be involved in maintaining anxiety. Evidence is emerging for information processing biases being involved with stuttering.

AIMS: This study investigated information processing in adults who stutter using the probe detection task. Information processing biases have been implicated in anxiety maintenance in social anxiety disorder and therefore may have implications for the assessment and treatment of stuttering. It was hypothesized that stuttering participants compared with control participants would display an attentional bias to avoid attending to social information.

METHODS & PROCEDURES: Twenty-three adults who stutter and 23 controls completed a probe detection task in which they were presented with pairs of photographs: a face displaying an emotional expression-positive, negative or neutral-and an everyday household object. All participants were subjected to a mild social threat induction being told they would speak to a small group of people on completion of the task.

OUTCOMES & RESULTS: The stuttering group scored significantly higher than controls for trait anxiety, but did not differ from controls on measures of social anxiety. Non-socially anxious adults who stutter did not display an attentional bias to avoid looking at photographs of faces relative to everyday objects. Higher scores on trait anxiety were positively correlated with attention towards photographs of negative faces.

CONCLUSION & IMPLICATIONS: Attentional biases as assessed by the probe detection task may not be a characteristic of non-socially anxious adults who stutter. A vigilance to attend to threat information with high trait anxiety is consistent with findings of studies using the emotional Stroop task in stuttering and social anxiety disorder. Future research should investigate attentional processing in people who stutter who are socially anxious. It will also be useful for future studies to employ research paradigms that involve speaking. Continued research is warranted to explore information processing and potential biases that could be involved in the maintenance of anxiety and failure to maintain the benefits of speech treatment outcomes.

PMID: 26176777 [PubMed - as supplied by publisher]



Assessment of reliable change using 95% credible intervals for the differences in proportions: A statistical analysis for case study methodology. - TERAPIA
J Speech Lang Hear Res. 2015 Apr 1. doi: 10.1044/2015_JSLHR-S-14-0158. [Epub ahead of print]

Unicomb R, Colyvas K, Harrison E, Hewat S.

PURPOSE:Case study methodology studying change is often used in the field of speech-language pathology but can be criticised for not being statistically robust. Yet, with the heterogeneous nature of many communication disorders, case studies allow clinicians and researchers to closely observe and report on change. Such information is valuable and can further inform large-scale experimental designs. In this research note a statistical analysis for case study data is outlined that employs a modification to the Reliable Change Index (Jacobson & Truax, 1991). The relationship between reliable change and clinical significance is discussed. Example data are used to guide the reader through the use and application of this analysis.
METHOD:The authors detail a method of analysis that is suitable for assessing change in measures with binary categorical outcomes. The analysis is illustrated using data from one individual, measured pre- and post-treatment for stuttering.
CONCLUSION:The application of this approach to assess change in categorical, binary data has potential application in speech-language pathology. It enables clinicians and researchers to analyse results from case studies for their statistical and clinical significance. This new method addresses a gap in the research design literature, i.e., the lack of analysis methods for non-continuous data (such as counts, rates, proportions of events) that may be used in case study designs.
PMID: 25837410 [PubMed - as supplied by publisher]



Assessment of Severity of Stuttering in Native Versus Foreign Language in Secondary (Late) Bilingual Children. - AVALIAÇÃO

Indian J Otolaryngol Head Neck Surg. 2015 Jun;67(2):132-4. doi: 10.1007/s12070-015-0850-7. Epub 2015 Apr 28.


Mamdoh H, Gomaa MA

Faculty of Medicine, Minia University, Minia, Egypt.


The present study was conducted to investigate the severity of stuttering in native versus foreign language in secondary (late) bilingual children. The speech sample of 31 children with stuttering (age ranges 10 years, 1 month to 11 years, 8 months old) speaking in their first Arabic as a (native) language and acquired second English (foreign) language in the KG1 Class of school around the age of 4 years as secondary (late) bilinguals. The speech samples were recorded using Sony MHC-E60X mini Hi Fi component cassette with a fixed distance 15 cm between the speaker and the recorder. The severity of stuttering is assessed using Arabic version of stuttering severity index (A-SSI). The results indicate that there is a significant correlation between stuttering severity in both languages, being more severe in English (foreign) language than in Arabic (native) language.

PMID: 26075166 [PubMed] PMCID: PMC4460111 [Available on 2016-06-01]



Association study of stuttering candidate genes GNPTAB, GNPTG and NAGPA with dyslexia in Chinese population. - GENÉTICA
BMC Genet. 2015 Feb 3;16(1):7. [Epub ahead of print]
Free Full Text

Chen H, Xu J, Zhou Y, Gao Y, Wang G, Xia J, Huen M, Siok W, Jiang Y, Tan L, Sun Y.

Background: Dyslexia is a polygenic speech and language disorder characterized by an unexpected difficulty in reading in children and adults despite normal intelligence and schooling. Increasing evidence reveals that different speech and language disorders could share common genetic factors. As previous study reported association of GNPTAB, GNPTG and NAGPA with stuttering, we investigated these genes with dyslexia through association analysis. 
Results: The study was carried out in an unrelated Chinese cohort with 502 dyslexic individuals and 522 healthy controls. In all, 21 Tag SNPs covering GNPTAB, GNPTG and NAGPA were subjected to genotyping. Association analysis was performed on all SNPs. Significant association of rs17031962 in GNPTAB and rs882294 in NAGPA with developmental dyslexia was identified after FDR correction for multiple comparisons.
Conclusion: Our results revealed that the stuttering risk genes GNPTAB and NAGPA might also associate with developmental dyslexia in the Chinese population.
PMID: 25643770 [PubMed - as supplied by publisher] PMCID: PMC4342093 Free PMC Article

Attitudes toward stuttering of nonstuttering preschool and kindergarten children: A comparison using a standard instrument prototype. - SOCIAL
J Fluency Disord. 2015 Jun;44:74-87. doi: 10.1016/j.jfludis.2015.03.003. Epub 2015 Apr 4.

Weidner ME, St Louis KO, Burgess ME, LeMasters SN.
West Virginia University, Morgantown, WV, USA.

PURPOSE:This study investigated attitudes of nonstuttering preschool and kindergarten children toward peers who stutter in order to identify differences by age groups and better understand the genesis of stuttering attitudes. The study also examined the use of a new stuttering attitudes instrument designed for use with young children.
METHOD:The newly developed Public Opinion Survey on Human Attributes-Stuttering/Child was verbally administered to 27 preschool and 24 kindergarten children who do not stutter in the mid-Atlantic region of the USA.
RESULTS: Overall, preschoolers held more negative stuttering attitudes than kindergarteners, but results were not uniformly in that direction. In both groups, the attribute of stuttering was viewed more negatively than individuals who stutter. Children viewed the potential of peers who stutter as quite positive, whereas their knowledge about and experience with stuttering were generally limited and some of their beliefs quite negative.
CONCLUSIONS:Negative or uninformed stuttering attitudes among nonstuttering children begin as early as the preschool years. This study provides empirical evidence for the need to educate young children about the nature of stuttering and how to respond appropriately to peers who stutter.
EDUCATIONAL OBJECTIVES:Readers should be able to: (a) describe attitudinal differences between kindergarteners and preschoolers toward peers who stutter; (b) describe the parameters of the POSHA-S/Child; (c) describe the nature of stuttering attitudes in young children relative to their beliefs and self reactions; and (d) describe the implications and future direction of stuttering attitude research in young children.
PMID: 25906689 [PubMed - in process]

Behavioral and social competency profiles of stutterers. - EMOCIONAL/SOCIAL
Codas. 2015 Jan-Feb;27(1):44-50. doi: 10.1590/2317-1782/20152013065.
Free full text:

Giorgetti Mde P, Oliveira CM, Giacheti CM.
Universidade Estadual Paulista "Júlio de Mesquita Filho", Marília, SP, Brazil.

PURPOSE: To investigate the behavioral and social competency profiles of individuals who stutter and to compare them with persons who do not stutter, according to their parents; to correlate the behavioral and the social competence performances with the severity of stuttering.
METHODS: Sixty-four participants, aged 6 to 18 years, of both genders, were divided into two groups: the study group (SG), composed of 32 individuals with persistent developmental stuttering, and the control group (CG), composed of 32 fluent individuals. The procedures used were fluency assessment, stuttering severity instrument, and the Child Behavior Checklist inventory.
RESULTS: In the behavioral profile of the SG, the mean of the total score and that of the internalizing problems were classified as clinical. The comparison between the groups showed differences in the behavioral profile concerning the total score, and in the internalizing and externalizing problems; and in the social profile, concerning the total score and activity scale. There were no statistically significant differences in the scales among the mild, moderate, and severe stuttering.
CONCLUSION: According to the information provided by parents, children who stutter showed peculiar behavior and social competence, with a higher tendency to manifest alterations in this area, in comparison to those who do not stutter. Fear, nervousness/tension, guilt, anxiety, perfectionism, and worry were the most frequent alterations in relation to the behavior, whereas damages in the social field and in the habitual communication situations characterized the social competence of persons who stutter.
PMID: 25885196 [PubMed - in process]



Behavior Assessment Battery: A Pilot Study of the Affective, Behavioral, and Cognitive Correlates Surrounding Spasmodic Dysphonia - EMOCIONAL

J Voice. 2015 Jul 21. pii: S0892-1997(15)00049-1. doi: 10.1016/j.jvoice.2015.03.007. [Epub ahead of print]


Vanryckeghem M, Hoffman Ruddy B, Lehman J.

University of Central Florida; The Ear Nose Throat and Plastic Surgery Associates, Orlando, Florida.


OBJECTIVE/HYPOTHESIS: This study investigates if adults with adductor spasmodic dysphonia (ADSD) report to experience anxiety and voice problems in particular situations, indicate the presence of negative speech-associated attitude, and/or the use of coping behaviors, by means of the Behavior Assessment Battery (BAB) modified for voice.

METHODS: Thirty-two participants with ADSD and 32 adults without a voice disorder participated in this study. Each person completed four different BAB-Voice subtests. These standardized self-report tests are adaptations of the original BAB for people who stutter and explore an individual's speech-related belief, negative emotional reaction to and speech problems in particular speech situations, and the use of concomitant behaviors.

RESULTS: Individuals with spasmodic dysphonia (SD) scored statistically significantly higher compared to typical speakers on all BAB subtests, indicating that individuals with SD report being significantly more anxious and experiencing significantly more voice problems in particular speech circumstances. They also reported a significant amount of negative speech-associated attitude and the use of a significant number of coping behaviors. Internal reliability was good for three of the four BAB subtests.

CONCLUSIONS: The BAB is capable of reflecting the dimensions that surround the disorder of SD. The self-report measures have the potential to augment the observations made by the clinician and may lead to a more diverse and all-encompassing therapy for the person suffering from SD. Future research with a revised version of the BAB-Voice will continue to explore the validity, reliability, and replicability of the initial data.

PMID: 26209041 [PubMed - as supplied by publisher]



Beliefs of teachers versus non-teachers about people who stutter. - SOCIAL
J Fluency Disord. 2015 Mar;43:28-39. doi: 10.1016/j.jfludis.2014.12.001. Epub 2014 Dec 31.

Arnold HS, Li J, Goltl K.
Kent State University, United States.

PURPOSE: Although prior research has investigated teachers' beliefs about people who stutter (PWS), this work has not indicated how these beliefs compare with those of the general public or taken into account key demographic variables that may be related to these beliefs. The main purpose of this study was to evaluate whether beliefs about PWS in teachers are different from those in the general public. The second purpose of this study was to examine whether gender is related to beliefs about PWS for teachers, who are more frequently women.
METHODS: Analyses were based on questionnaire responses regarding beliefs about PWS from 269 teachers and 1388 non-teachers in the United States. Due to their potential link to beliefs about PWS, familiarity with PWS and sociodemographic variables were included in the statistical model for this study.
RESULTS: Teachers' beliefs about PWS are no different than those of people in non-teaching professions. Findings also indicated that, regardless of whether respondents were teachers, women had more accurate beliefs about PWS than men. The statistical model tested indicated that beliefs about PWS were more accurate when the respondents were older, had more education, and had familiarity with a PWS.
CONCLUSION: In the first study to compare teachers' beliefs about PWS to the general public, findings indicated that teachers are no more accurate than the public in their beliefs about PWS. Associations found between these beliefs and several variables may indicate some promising mechanisms for improving beliefs, such as increased familiarity with individuals who stutter.
EDUCATIONAL OBJECTIVES: Readers should be able to: (a) describe stuttering's potential effects on children's participation in the school setting; (b) identify actions teachers can take to improve the school experience of their students who stutter; (c) summarize findings regarding teachers' beliefs about people who stutter (PWS); (d) identify key variables that are associated with beliefs about PWS.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25619922 [PubMed - in process]

Beta oscillations, timing, and stuttering.
Front Hum Neurosci. 2015 Jan 5;8:1036. doi: 10.3389/fnhum.2014.01036. eCollection 2014.
Free Full Text

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

No Abstract.
PMID: 25601832 [PubMed] PMCID: PMC4283545 Free PMC Article




Capsule Commentary on Perez, Doig-Acuna, and Starrels, "Not Unless It's a Life or Death Thing": A Qualitative Study of the Health Care Experiences of Adults Who Stutter.

J Gen Intern Med. 2015 Jun 18. [Epub ahead of print]


Mancuso JM.

Clement J. Zablocki VA Medical Center,  Milwaukee, WI, USA.

PMID: 26084974 [PubMed - as supplied by publisher]


No abstract available


Catecholaminergic contributions to vocal communication signals. - OUTRAS ÁREAS
Eur J Neurosci. 2015 May;41(9):1180-94. doi: 10.1111/ejn.12885. Epub 2015 Apr 7.

Matheson LE, Sakata JT.
Department of Biology, McGill University, Montreal, QC, H3A 1B1, Canada.

Social context affects behavioral displays across a variety of species. For example, social context acutely influences the acoustic and temporal structure of vocal communication signals such as speech and birdsong. Despite the prevalence and importance of such social influences, little is known about the neural mechanisms underlying the social modulation of communication. Catecholamines are implicated in the regulation of social behavior and motor control, but the degree to which catecholamines influence vocal communication signals remains largely unknown. Using a songbird, the Bengalese finch, we examined the extent to which the social context in which song is produced affected immediate early gene expression (EGR-1) in catecholamine-synthesising neurons in the midbrain. Further, we assessed the degree to which administration of amphetamine, which increases catecholamine concentrations in the brain, mimicked the effect of social context on vocal signals. We found that significantly more catecholaminergic neurons in the ventral tegmental area and substantia nigra (but not the central grey, locus coeruleus or subcoeruleus) expressed EGR-1 in birds that were exposed to females and produced courtship song than in birds that produced non-courtship song in isolation. Furthermore, we found that amphetamine administration mimicked the effects of social context and caused many aspects of non-courtship song to resemble courtship song. Specifically, amphetamine increased the stereotypy of syllable structure and sequencing, the repetition of vocal elements and the degree of sequence completions. Taken together, these data highlight the conserved role of catecholamines in vocal communication across species, including songbirds and humans.
PMID: 25847067 [PubMed - in process]





Communication restriction in adults who stutter. - LINGUÍSTICA
Clin Linguist Phon. 2015 Apr 20:1-21. [Epub ahead of print]

Lee A, Van Dulm O, Robb MP, Ormond T.
University of Canterbury , Christchurch , New Zealand

This study explored communication restriction in adults with stuttering (AWS) by means of typical language measures obtained using the Systematic Analysis of Language Transcripts - New Zealand (SALT-NZ) software, as well as systemic functional linguistics (SFL) analyses. The areas of language productivity and complexity, modality (i.e. linguistic politeness) and the language of appraisal were compared between AWS and typically fluent speakers (adults with no stuttering (AWNS)). Ten-minute conversational samples were obtained from 20 AWS and 20 age- and sex-matched AWNS. Transcripts were analysed for quantity and complexity of verbal output, and frequency of use of modality and appraisal resource subtypes. Means comparison and correlation analyses were conducted using grouped data. AWS produced less language and less complex language than AWNS, measured by SALT-NZ and SFL indices. AWS also differed from AWNS in their use of modality resources to express politeness - they produced fewer modal operators and more comment adjuncts than AWNS. A smaller proportion of their language expressed the explicit appreciation of things. The linguistic patterns identified in the conversational language of AWS suggested a reduced openness to interpersonal engagement within communication exchanges, which may restrict opportunities for and the experience of such exchanges. The value of SFL to this area of research is discussed.
PMID: 25894831 [PubMed - as supplied by publisher]

Comparison of audio and audiovisual measures of adult stuttering: Implications for clinical trials. - AVALIAÇÃO
Int J Speech Lang Pathol. 2015 Apr 15:1-5. [Epub ahead of print]

O'Brian S, Jones M, Onslow M, Packman A, Menzies R, Lowe R.
Australian Stuttering Research Centre, The University of Sydney , Lidcombe, NSW , Australia.

PURPOSE:This study investigated whether measures of percentage syllables stuttered (%SS) and stuttering severity ratings with a 9-point scale differ when made from audiovisual compared with audio-only recordings.
METHOD:Four experienced speech-language pathologists measured %SS and assigned stuttering severity ratings to 10-minute audiovisual and audio-only recordings of 36 adults.
RESULT:There was a mean 18% increase in %SS scores when samples were presented in audiovisual compared with audio-only mode. This result was consistent across both higher and lower %SS scores and was found to be directly attributable to counts of stuttered syllables rather than the total number of syllables. There was no significant difference between stuttering severity ratings made from the two modes.
CONCLUSION:In clinical trials research, when using %SS as the primary outcome measure, audiovisual samples would be preferred as long as clear, good quality, front-on images can be easily captured. Alternatively, stuttering severity ratings may be a more valid measure to use as they correlate well with %SS and values are not influenced by the presentation mode.
PMID: 25874969 [PubMed - as supplied by publisher]

Determining the effect of laser acupuncture in treating stutterers in comparison with speech therapy. - TERAPIA
Adv Biomed Res. 2015 Jan 6;4:8. doi: 10.4103/2277-9175.148290. eCollection 2015.
Free Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300594/

Shafiei B1, Heshmatipour M2, Tavakol S1, Saghaei M3, Ghayumi Z1.
Isfahan University of Medical Sciences, Isfahan, Iran.

BACKGROUND: Investigation of strategies and methods of therapy in stutterers regarding to its characteristics, length of treatment, and relapse of stuttering is very important. Acupuncture has been introduced as a therapeutic method for the treatment of stuttering. The aim of the present research was the identification of the results of intervention of laser acupuncture in comparison with speech therapy in stutterers.
MATERIALS AND METHODS: This clinical - trial and case control research was conducted on 20 stutterers and 20 non-stutterers. In the present study, speech therapy and laser acupuncture were used on 10 persons who had developmental stuttering from childhood.
RESULTS: The results were compared with the data of speech therapy and placebo laser in 10 control subjects. All of the subjects were followed up for 12 weeks after the intervention. The obtained data showed that accompanying of speech therapy with laser acupuncture resulted the increasing of maintenance and therapeutic effects of stuttering treatment and decreasing of relapsing. The speech rate and percent of stuttered words before and after the intervention in both groups (A and B) were decreased. Following the results after 12 weeks showed that the results were stable in laser group more than the other group and there was a significant difference between the two groups.
CONCLUSION: The results of the present study showed that using of laser acupuncture therapy accompanying by speech therapy has many effects on the treatment of stuttering and prevents the relapsing of stuttering that is very common.
PMID: 25625114 [PubMed] PMCID: PMC4300594




Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial - INFANTIL

PLoS One. 2015 Jul 28;10(7):e0133758. doi: 10.1371/journal.pone.0133758. eCollection 2015.

Free Full Text:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517884/pdf/pone.0133758.pdf


de Sonneville-Koedoot C, Stolk E, Rietveld T, Franken MC.

Erasmus University Rotterdam, Rotterdam, the Netherlands; Radboud University Nijmegen, Nijmegen, the Netherlands.


OBJECTIVE: Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter.

METHODS: In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99) or indirect treatment (RESTART-DCM treatment; n = 100). Main inclusion criteria were age 3-6 years, ≥3% syllables stuttered (%SS), and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS), stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude.

RESULTS: Percentage of non-stuttering children for direct treatment was 76.5% (65/85) versus 71.4% (65/91) for indirect treatment (Odds Ratio (OR), 0.6; 95% CI, 0.1-2.4, p = .42). At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: β = -1.89; t(282.82) = -2.807, p = .005). At 18 months, stuttering frequency was 1.2% (SD 2.1) for direct treatment and 1.5% (SD 2.1) for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant.

CONCLUSIONS: Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term.

PMID: 26218228 [PubMed - in process] PMCID: PMC4517884 Free PMC Article




Disfluency characteristics of Kannada-English bilingual adults who stutter. - AVALIAÇÃO

J Commun Disord. 2015 Jul-Aug;56:19-28. doi: 10.1016/j.jcomdis.2015.06.001. Epub 2015 Jun 11.


Maruthy S, Raj N, Geetha MP, Priya CS.

All India Institute of Speech and Hearing, Manasagangothri, Mysore, India.


The primary purpose of the present study was to investigate whether stuttering frequency differs between two languages in Kannada-English bilingual adults who stutter. The second purpose was to compare the relationship between grammatical class (content-function word dichotomy) and stuttering frequency in two languages. In addition, we also examined whether types of disfluencies vary between content and function words in two languages. Twenty-five bilingual adults who stutter that were proficient in both languages (mean age=22.5 years, SD=3.0) participated in the present study. Spontaneous speech samples were recorded in both Kannada and English and stuttering frequencies were calculated in both languages and for each type of grammatical category. Further, different types of disfluencies were noted for each type of grammatical category in both the languages. Results revealed significantly greater stuttering in L2 (English) compared to L1 (Kannada). In both the languages, significantly higher content words were stuttered compared to function words. When the comparison was done between two languages, significantly higher content words were stuttered in L1 compared to L2, whereas significantly higher function words were stuttered in L2 compared to L1. The types of disfluencies did not vary between content and function words and between two languages. Present results suggest that frequency and other aspects of stuttering may depend on the proficiency of the language.

Copyright © 2015 Elsevier Inc. All rights reserved.

PMID: 26102268 [PubMed - in process]


Dysfluency in a service member with comorbid diagnoses: a case study. - EMOCIONAL
Mil Med. 2015 Jan;180(1):e157-9. doi: 10.7205/MILMED-D-14-00238.

Mattingly EO.
National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center (WRNMMC), Bethesda.

PURPOSE: Because of the noted increase in dysfluency among service members returning from Iraq and Afghanistan, this article describes differentiation between the various types of fluency as well as an evaluation and treatment course of a service member returning from war with the comorbid diagnoses of post-traumatic stress disorder, mild traumatic brain injury, and resulting stuttering.
METHOD: The subject of this case study signed a consent on his admission to National Intrepid Center of Excellence (NICoE) for use of any clinical information for research purposes. The patient-centered method of his evaluation and treatment is one standard for NICoE's 4-week treatment program. Fluency data were collected from the patient using observational and standardized assessment (Stuttering Severity Instrument-4). The patient underwent a course of treatment using fluency strategy education and practice to lead to generalization of skills across all communication environments.
CONCLUSION: This service member responded favorably following a short course of fluency treatment because of the psychogenic nature of his stuttering, which was a symptom of his psychological health diagnoses. The NICoE patient-centered care model achieved the desired results of fluency and improved overall function in this service member.
Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
PMID: 25562877 [PubMed - in process]

Effect of an 8-week practice of externally triggered speech on basal ganglia activity of stuttering and fluent speakers. - FALA
Neuroimage. 2015 Apr 1;109:458-68. doi: 10.1016/j.neuroimage.2015.01.024. Epub 2015 Jan 13.

Toyomura A, Fujii T, Kuriki S.
Tokyo Denki University, Inzai, Japan; Gunma University, Gunma, Japan; Hokkaido University, Kita-ku, Japan.

The neural mechanisms underlying stuttering are not well understood. It is known that stuttering appears when persons who stutter speak in a self-paced manner, but speech fluency is temporarily increased when they speak in unison with external trigger such as a metronome. This phenomenon is very similar to the behavioral improvement by external pacing in patients with Parkinson's disease. Recent imaging studies have also suggested that the basal ganglia are involved in the etiology of stuttering. In addition, previous studies have shown that the basal ganglia are involved in self-paced movement. Then, the present study focused on the basal ganglia and explored whether long-term speech-practice using external triggers can induce modification of the basal ganglia activity of stuttering speakers. Our study of functional magnetic resonance imaging revealed that stuttering speakers possessed significantly lower activity in the basal ganglia than fluent speakers before practice, especially when their speech was self-paced. After an 8-week speech practice of externally triggered speech using a metronome, the significant difference in activity between the two groups disappeared. The cerebellar vermis of stuttering speakers showed significantly decreased activity during the self-paced speech in the second compared to the first experiment. The speech fluency and naturalness of the stuttering speakers were also improved. These results suggest that stuttering is associated with defective motor control during self-paced speech, and that the basal ganglia and the cerebellum are involved in an improvement of speech fluency of stuttering by the use of external trigger.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25595501 [PubMed - in process]

Effect of dopaminergic medication on speech dysfluency in Parkinson's disease: a longitudinal study. - OUTRAS ÁREAS
J Neural Transm. 2015 Jan 13. [Epub ahead of print]

Tykalová T, Rusz J, Čmejla R, Klempíř J, Růžičková H, Roth J, Růžička E.
Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic

Although speech dysfluencies have been hypothesized to be associated with abnormal function of dopaminergic system, the effects of dopaminergic medication on speech fluency in Parkinson's disease (PD) have not been systematically studied. The aim of the present study was, therefore, to investigate the long-term effect of dopaminergic medication on speech fluency in PD. Fourteen de novo PD patients with no history of developmental stuttering and 14 age- and sex-matched healthy controls (HC) were recruited. PD subjects were examined three times; before the initiation of dopaminergic treatment and twice in following 6 years. The percentage of dysfluent words was calculated from reading passage and monolog. The amount of medication was expressed by cumulative doses of L-dopa equivalent. After 3-6 years of dopaminergic therapy, PD patients exhibited significantly more dysfluent events compared to healthy subjects as well as to their own speech performance before the introduction of dopaminergic therapy (p < 0.05). In addition, we found a strong positive correlation between the increased occurrence of dysfluent words and the total cumulative dose of L-dopa equivalent (r = 0.75, p = 0.002). Our findings indicate an adverse effect of prolonged dopaminergic therapy contributing to the development of stuttering-like dysfluencies in PD. These findings may have important implication in clinical practice, where speech fluency should be taken into account to optimize dopaminergic therapy.
PMID: 25583417 [PubMed - as supplied by publisher]

Efficacy of the Modifying Phonation Intervals (MPI) Stuttering Treatment Program with Adults Who Stutter. - TERAPIA
Am J Speech Lang Pathol. 2015 Jan 28. doi: 10.1044/2015_AJSLP-14-0076. [Epub ahead of print]

Ingham RJ, Ingham JC, Bothe AK, Wang Y, Kilgo M.

PURPOSE: This study compared a new adult stuttering treatment program (Modifying Phonation Intervals, or MPI) with the standard of care for reducing stuttered speech in adults (prolonged speech).
METHOD: 27 adults who stutter were assigned to either MPI or prolonged speech treatment, both of which used similar infrastructures. Speech and related variables were assessed in three within-clinic and three beyond-clinic speaking situations for participants who successfully completed all treatment phases.
RESULTS: At Transfer, Maintenance, and Follow-up, the speech of 14 participants who successfully completed treatment was similar to that of normally fluent adults. Successful participants also showed increased self-identification as a "normal speaker," decreased self-identification as a "stutterer," reduced short intervals of phonation, and some increased use of longer duration phonation intervals. Eleven successful participants received the MPI treatment and three the prolonged speech treatment.
CONCLUSIONS: Outcomes for successful participants were very similar for the two treatments. The much larger proportion of successful participants in the MPI group, however, combined with the predictive value of specific changes in PI durations, suggest that MPI treatment was relatively more effective at assisting clients to identify and change the specific speech behaviors that are associated with successful treatment of stuttered speech in adults.
PMID: 25633470 [PubMed - as supplied by publisher]


Event- and interval-based measurement of stuttering: a review. - AVALIAÇÃO
Int J Lang Commun Disord. 2015 Jan;50(1):14-30. doi: 10.1111/1460-6984.12113. Epub 2014 Jun 11.

Valente AR, Jesus LM, Hall A, Leahy M.
University of Aveiro, Aveiro, Portugal.

BACKGROUND:Event- and interval-based measurements are two different ways of computing frequency of stuttering. Interval-based methodology emerged as an alternative measure to overcome problems associated with reproducibility in the event-based methodology. No review has been made to study the effect of methodological factors in interval-based absolute reliability data or to compute the agreement between the two methodologies in terms of inter-judge, intra-judge and accuracy (i.e., correspondence between raters' scores and an established criterion).
AIMS:To provide a review related to reproducibility of event-based and time-interval measurement, and to verify the effect of methodological factors (training, experience, interval duration, sample presentation order and judgment conditions) on agreement of time-interval measurement; in addition, to determine if it is possible to quantify the agreement between the two methodologies
METHODS & PROCEDURES:The first two authors searched for articles on ERIC, MEDLINE, PubMed, B-on, CENTRAL and Dissertation Abstracts during January-February 2013 and retrieved 495 articles. Forty-eight articles were selected for review. Content tables were constructed with the main findings.
MAIN CONTRIBUTION:Articles related to event-based measurements revealed values of inter- and intra-judge greater than 0.70 and agreement percentages beyond 80%. The articles related to time-interval measures revealed that, in general, judges with more experience with stuttering presented significantly higher levels of intra- and inter-judge agreement. Inter- and intra-judge values were beyond the references for high reproducibility values for both methodologies. Accuracy (regarding the closeness of raters' judgements with an established criterion), intra- and inter-judge agreement were higher for trained groups when compared with non-trained groups. Sample presentation order and audio/video conditions did not result in differences in inter- or intra-judge results. A duration of 5 s for an interval appears to be an acceptable agreement. Explanation for high reproducibility values as well as parameter choice to report those data are discussed.
CONCLUSIONS & IMPLICATIONS:Both interval- and event-based methodologies used trained or experienced judges for inter- and intra-judge determination and data were beyond the references for good reproducibility values. Inter- and intra-judge values were reported in different metric scales among event- and interval-based methods studies, making it unfeasible to quantify the agreement between the two methods.
PMID: 24919948 [PubMed - in process]

Evidence for a rhythm perception deficit in children who stutter. - INFANTIL
Brain Lang. 2015 May;144:26-34. doi: 10.1016/j.bandl.2015.03.008. Epub 2015 Apr 13.

Wieland EA, McAuley JD, Dilley LC, Chang SE.
Michigan State University, East Lansing, USA; University of Michigan, Ann Arbor, USA.

Stuttering is a neurodevelopmental disorder that affects the timing and rhythmic flow of speech production. When speech is synchronized with an external rhythmic pacing signal (e.g., a metronome), even severe stuttering can be markedly alleviated, suggesting that people who stutter may have difficulty generating an internal rhythm to pace their speech. To investigate this possibility, children who stutter and typically-developing children (n=17 per group, aged 6-11years) were compared in terms of their auditory rhythm discrimination abilities of simple and complex rhythms. Children who stutter showed worse rhythm discrimination than typically-developing children. These findings provide the first evidence of impaired rhythm perception in children who stutter, supporting the conclusion that developmental stuttering may be associated with a deficit in rhythm processing.
KEYWORDS:beat perception; developmental stuttering; rhythm; temporal processing; timing
PMID: 25880903 [PubMed - in process]




Examination of validity in spoken language evaluations: Adult onset stuttering following mild traumatic brain injury1 - GAGUEIRA ADQUIRIDA

NeuroRehabilitation. 2015 Jul 20;36(4):415-26. doi: 10.3233/NRE-151230.


Roth CR, Cornis-Pop M, Beach WA.

Naval Medical Center San Diego, San Diego, CA; Veterans Health Administration, Washington, DC; Virginia Commonwealth University Medical Center, Richmond, VA, USA.


BACKGROUND: Reports of increased incidence of adult onset stuttering in veterans and service members with mild traumatic brain injury (mTBI) from combat operations in Iraq and Afghanistan lead to a reexamination of the neurogenic vs. psychogenic etiology of stuttering.

OBJECTIVE: This article proposes to examine the merit of the dichotomy between neurogenic and psychogenic bases of stuttering, including symptom exaggeration, for the evaluation and treatment of the disorder.

METHODS: Two case studies of adult onset stuttering in service members with mTBI from improvised explosive device blasts are presented in detail. Speech fluency was disrupted by abnormal pauses and speech hesitations, brief blocks, rapid repetitions, and occasional prolongations. There was also wide variability in the frequency of stuttering across topics and conversational situations. Treatment focused on reducing the frequency and severity of dysfluencies and included educational, psychological, environmental, and behavioral interventions.

RESULTS: Stuttering characteristics as well as the absence of objective neurological findings ruled out neurogenic basis of stuttering in these two cases and pointed to psychogenic causes. However, the differential diagnosis had only limited value for developing the plan of care.

CONCLUSIONS: The successful outcomes of the treatment serve to illustrate the complex interaction of neurological, psychological, emotional, and environmental factors of post-concussive symptoms and to underscore the notion that there are many facets to symptom presentation in post-combat health.

PMID: 26409490 [PubMed - in process]




Feasibility of automated speech sample collection with stuttering children using interactive voice response (IVR) technology - AVALIAÇÃO
Int J Speech Lang Pathol. 2015 Apr;17(2):115-20. doi: 10.3109/17549507.2014.923511. Epub 2014 Jul 14.

Vogel AP, Block S, Kefalianos E, Onslow M, Eadie P, Barth B, Conway L, Mundt JC, Reilly S.
Speech Neuroscience Unit, The University of Melbourne , Melbourne, VIC , Australia.

Purpose: To investigate the feasibility of adopting automated interactive voice response (IVR) technology for remotely capturing standardized speech samples from stuttering children.
Method: Participants were 10 6-year-old stuttering children. Their parents called a toll-free number from their homes and were prompted to elicit speech from their children using a standard protocol involving conversation, picture description and games. The automated IVR system was implemented using an off-the-shelf telephony software program and delivered by a standard desktop computer. The software infrastructure utilizes voice over internet protocol. Speech samples were automatically recorded during the calls. Video recordings were simultaneously acquired in the home at the time of the call to evaluate the fidelity of the telephone collected samples. Key outcome measures included syllables spoken, percentage of syllables stuttered and an overall rating of stuttering severity using a 10-point scale.
Results: Data revealed a high level of relative reliability in terms of intra-class correlation between the video and telephone acquired samples on all outcome measures during the conversation task. Findings were less consistent for speech samples during picture description and games.
Conclusions: Results suggest that IVR technology can be used successfully to automate remote capture of child speech samples.
PMID: 25020146 [PubMed - in process]

Gerald M. Siegel (1932–2014) – a tribute.
J Fluency Disord. 2015 Mar;43:54-6.

Ingham RJ.

PMID: 25618245 [PubMed - indexed for MEDLINE]

Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the Self-Stigma of Stuttering Scale (4S). - EMOCIONAL
J Fluency Disord. 2015 Mar;43:17-27. doi: 10.1016/j.jfludis.2014.12.002. Epub 2015 Jan 6.

Boyle MP
Department of Communication Sciences and Disorders, Oklahoma State University, United States.

PURPOSE: This study was set up to further establish the construct validity of the Self-Stigma of Stuttering Scale (4S) by demonstrating its associations with other established scales and replicating its original factor structure and reliability estimates.
METHOD: Web surveys were completed by 354 adults who stutter recruited from Board Certified Specialists in Fluency Disorders, and adult chapters of the National Stuttering Association. Participants completed a series of psychometrically validated scales measuring self-stigma, hope, empowerment, quality of life, social support, anxiety, depression, and self-rated speech disruption.
RESULTS: Higher subscale and total stigma scores on the 4S were associated with significantly lower levels of hope, empowerment, quality of life, and social support, and significantly higher levels of anxiety, depression, and self-rated speech disruption. The original factor structure of the 4S was replicated, and reliability estimates of the subscales ranged from adequate to excellent.
CONCLUSIONS: The findings of this study support the construct validity of the 4S and its use by clinicians and researchers intending to measure the construct of self-stigma in adults who stutter.
EDUCATIONAL OBJECTIVES: Readers should be able to: (a) distinguish between the various components of self-stigma; (b) describe how the various components of the self-stigma model relate to hope, empowerment, quality of life, and social support, self-rated speech disruption, anxiety, and depression; (c) summarize the psychometric properties of the Self-Stigma of Stuttering Scale (4S) in terms of reliability, factor structure, and construct validity; (d) discuss how the 4S could be used in research and clinical practice.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25614323 [PubMed - in process]

Language ability of children with and without a history of stuttering: a longitudinal cohort study. - iNFANTIL
Int J Speech Lang Pathol. 2015 Feb;17(1):86-95. doi: 10.3109/17549507.2014.923512. Epub 2014 Jul 11.

Watts A, Eadie P, Block S, Mensah F, Reilly S.
Murdoch Childrens Research Institute , Melbourne , Australia.

PURPOSE:This study aims to determine whether the communication and language skills of children who have a history of stuttering are different from children who do not have a history of stuttering at ages 2-5 years.
METHOD:This study utilizes data from the Early Language in Victoria Study (ELVS), a longitudinal study with a community sample of 1910 children recruited in Melbourne, Australia, as well as a concurrent study examining the onset and progression of stuttering. Participants with a history of stuttering (n = 181) and a control group without a history of stuttering (n = 1438) were identified according to the established protocol of these two existing studies.
RESULT:The stuttering group scored higher than the non-stuttering group on all of the communication and language outcomes measured. The group differences were statistically significant on four of the seven measures and these findings were maintained when potentially confounding factors were controlled for.
CONCLUSION:Importantly, the children with a history of stuttering, as a group, and the control group without a history of stuttering demonstrated developmentally-appropriate early communication and language skills.
PMID: 25014490 [PubMed - in process]

Lexical tone and stuttering loci in Mandarin: evidence from preschool children who stutter. - FALA
Clin Linguist Phon. 2015 Feb;29(2):115-30. doi: 10.3109/02699206.2014.966393. Epub 2014 Sep 30.

Chou FC, Zebrowski P, Yang SL.
Department of Communication Sciences and Disorders, The University of Iowa , Iowa City, IA , USA .

The purpose of this study was to examine the relationship between stuttering loci and lexical tone in Mandarin-speaking preschoolers. Conversational samples from 20 Taiwanese children who stutter (CWS; M = 4:9; range = 3:2-6:4) were analysed for frequency and type of speech disfluency and lexical tone associated with stuttering-like disfluencies (SLDs). Results indicated that SLDs were significantly more likely to be produced on Mandarin syllables carrying Tone 3 and Tone 4 syllables compared to syllables carrying either Tone 1 or Tone 2. Post-hoc analyses revealed: (1) no significant differences in the stuttering frequencies between Tone 1 and Tone 2, or between Tone 3 and Tone 4, and (2) a higher incidence of stuttering on syllables carrying Tone 3 and Tone 4 embedded in conflicting (as opposed to compatible) tonal contexts. Results suggest that the higher incidence of stuttering on Mandarin syllables carrying either Tone 3 or 4 may be attributed to the increased level of speech motor demand underlying rapid F0 change both within and across syllables.
PMID: 25268542 [PubMed - in process]

Metrical Encoding in Adults Who Do and Do Not Stutter - FALA
J Speech Lang Hear Res. 2015 Feb 12. doi: 10.1044/2015_JSLHR-S-14-0111. [Epub ahead of print]

Coalson GA, Byrd CT.

PURPOSE:The purpose of this study was to explore metrical aspects of phonological encoding (i.e., stress and syllable boundary assignment) in adults who do and do not stutter (AWS, AWNS).
METHOD:Participants monitored nonwords for target sounds during silent phoneme monitoring tasks across two distinct experiments. For Experiment 1, 22 participants (11 AWNS, 11 AWS) silently monitored target phonemes in nonwords with initial stress. For Experiment 2, an additional cohort of 22 participants (11 AWNS, 11 AWS) silently monitored phonemes in nonwords with non-initial stress.
RESULTS:In Experiment 1, AWNS and AWS silently monitored target phonemes in initial stress stimuli with similar speed and accuracy. In Experiment 2, AWS demonstrated a within-group effect that was not present for the AWNS. They required additional time when monitoring phonemes immediately following syllable boundary assignment in stimuli with non-initial stress. There was also a between group effect with AWS exhibiting significantly greater errors identifying phonemes in nonwords with non-initial stress than AWNS.
CONCLUSIONS:Findings suggest metrical properties may impact the time course of phonological encoding in AWS in a manner distinct from AWNS. Specifically, in the absence of initial stress, metrical encoding of the syllable boundary may delay speech planning in AWS and contribute to breakdowns in fluent speech production.
PMID: 25679444 [PubMed - as supplied by publisher]

Modulation of auditory processing during speech movement planning is limited in adults who stutter. - AUDITIVO
Brain Lang. 2015 Mar 18;143:59-68. doi: 10.1016/j.bandl.2015.03.002. [Epub ahead of print]

Daliri A, Max L.
University of Washington, Seattle, WA, United States; Now at Boston University, Boston, MA, United States; Haskins Laboratories, New Haven, CT, United States.

Stuttering is associated with atypical structural and functional connectivity in sensorimotor brain areas, in particular premotor, motor, and auditory regions. It remains unknown, however, which specific mechanisms of speech planning and execution are affected by these neurological abnormalities. To investigate pre-movement sensory modulation, we recorded 12 stuttering and 12 nonstuttering adults' auditory evoked potentials in response to probe tones presented prior to speech onset in a delayed-response speaking condition vs. no-speaking control conditions (silent reading; seeing nonlinguistic symbols). Findings indicate that, during speech movement planning, the nonstuttering group showed a statistically significant modulation of auditory processing (reduced N1 amplitude) that was not observed in the stuttering group. Thus, the obtained results provide electrophysiological evidence in support of the hypothesis that stuttering is associated with deficiencies in modulating the cortical auditory system during speech movement planning. This specific sensorimotor integration deficiency may contribute to inefficient feedback monitoring and, consequently, speech dysfluencies.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25796060 [PubMed - as supplied by publisher]

Motor practice effects and sensorimotor integration in adults who stutter: Evidence from visuomotor tracking performance. - MOTOR
J Fluency Disord. 2015 Apr 28. pii: S0094-730X(15)00027-3. doi: 10.1016/j.jfludis.2015.04.001. [Epub ahead of print]

Tumanova V, Zebrowski PM, Goodman SS, Arenas RM.
The University of Iowa, United States.

PURPOSE:The purpose of this study was to utilize a visuomotor tracking task, with both the jaw and hand, to add to the literature regarding non-speech motor practice and sensorimotor integration (outside of auditory-motor integration domain) in adults who do (PWS) and do not (PWNS) stutter.
METHOD:Participants were 15 PWS (14 males, mean age=27.0) and 15 PWNS (14 males, mean age=27.2). Participants tracked both predictable and unpredictable moving targets separately with their jaw and their dominant hand, and accuracy was assessed by calculating phase and amplitude difference between the participant and the target. Motor practice effect was examined by comparing group performance over consecutive tracking trials of predictable conditions as well as within the first trial of same conditions.
RESULTS:Results showed that compared to PWNS, PWS were not significantly different in matching either the phase (timing) or the amplitude of the target in both jaw and hand tracking of predictable and unpredictable targets. Further, there were no significant between-group differences in motor practice effects for either jaw or hand tracking. Both groups showed improved tracking accuracy within and between the trials.
CONCLUSION:Our findings revealed no statistically significant differences in non-speech motor practice effects and integration of sensorimotor feedback between PWS and PWNS, at least in the context of the visuomotor tracking tasks employed in the study. In general, both talker groups exhibited practice effects (i.e., increased accuracy over time) within and between tracking trials during both jaw and hand tracking. Implications for these results are discussed.
EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe the importance of motor learning and sensory-motor integration for speech, (b) summarize past research on PWS's performance during speech and nonspeech motor tasks, and (c) describe the relation between different aspects of speech and non-speech motor control and stuttering.
PMID: 25990027 [PubMed - as supplied by publisher]



Mucolipidosis types II and III and non-syndromic stuttering are associated with different variants in the same genes - GENÉTICA

Eur J Hum Genet. 2015 Jul 1. doi: 10.1038/ejhg.2015.154. [Epub ahead of print]


Raza MH, Domingues CE, Webster R, Sainz E, Paris E, Rahn R, Gutierrez J, Chow HM, Mundorff J, Kang CS, Riaz N, Basra MA, Khan S, Riazuddin S, Moretti-Ferreira D, Braun A, Drayna D.

Porter Neuroscience Research Center, Bethesda, MD, USA; Hollins Communications Research Institute, Roanoke, VA, USA; International Islamic University, Islamabad, Pakistan; University of Health Sciences, Lahore, Pakistan; Department of Genetics, Sao Paulo State University, Botucatu, Brazil.


Homozygous mutations in GNPTAB and GNPTG are classically associated with mucolipidosis II (ML II) alpha/beta and mucolipidosis III (ML III) alpha/beta/gamma, which are rare lysosomal storage disorders characterized by multiple pathologies. Recently, variants in GNPTAB, GNPTG, and the functionally related NAGPA gene have been associated with non-syndromic persistent stuttering. In a worldwide sample of 1013 unrelated individuals with non-syndromic persistent stuttering we found 164 individuals who carried a rare non-synonymous coding variant in one of these three genes. We compared the frequency of these variants with those in population-matched controls and genomic databases, and their location with those reported in mucolipidosis. Stuttering subjects displayed an excess of non-synonymous coding variants compared to controls and individuals in the 1000 Genomes and Exome Sequencing Project databases. We identified a total of 81 different variants in our stuttering cases. Virtually all of these were missense substitutions, only one of which has been previously reported in mucolipidosis, a disease frequently associated with complete loss-of-function mutations. We hypothesize that rare non-synonymous coding variants in GNPTAB, GNPTG, and NAGPA may account for as much as 16% of persistent stuttering cases, and that variants in GNPTAB and GNPTG are at different sites and may in general, cause less severe effects on protein function than those in ML II alpha/beta and ML III alpha/beta/gamma.European Journal of Human Genetics advance online publication, 1 July 2015; doi:10.1038/ejhg.2015.154.

PMID: 26130485 [PubMed - as supplied by publisher]



Neurodevelopment for syntactic processing distinguishes childhood stuttering recovery versus persistence. - LINGUAGEM
J Neurodev Disord. 2015;7(1):4. doi: 10.1186/1866-1955-7-4. Epub 2015 Jan 20.
Free Full Text - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318174/pdf/11689_2014_Article_97.pdf

Usler E, Weber-Fox C.
Department of Speech, Language, and Hearing Sciences, Purdue University, Lyles-Porter Hall, West Lafayette, IN, USA.

BACKGROUND:Characterized by the presence of involuntary speech disfluencies, developmental stuttering is a neurodevelopmental disorder of atypical speech-motor coordination. Although the etiology of stuttering is multifactorial, language development during early childhood may influence both the onset of the disorder and the likelihood of recovery. The purpose of this study was to determine whether differences in neural indices mediating language processing are associated with persistence or recovery in school-age children who stutter.
METHODS:Event-related brain potentials (ERPs) were obtained from 31 6-7-year-olds, including nine children who do not stutter (CWNS), 11 children who had recovered from stuttering (CWS-Rec), and 11 children who persisted in stuttering (CWS-Per), matched for age, and all with similar socioeconomic status, nonverbal intelligence, and language ability. We examined ERPs elicited by semantic and syntactic (phrase structure) violations within an auditory narrative consisting of English and Jabberwocky sentences. In Jabberwocky sentences, content words were replaced with pseudowords to limit semantic context. A mixed effects repeated measures analysis of variance (ANOVA) was computed for ERP components with four within-subject factors, including condition, hemisphere, anterior/posterior distribution, and laterality.
RESULTS:During the comprehension of English sentences, ERP activity mediating semantic and syntactic (phrase structure) processing did not distinguish CWS-Per, CWS-Rec, and CWNS. Semantic violations elicited a qualitatively similar N400 component across groups. Phrase structure violations within English sentences also elicited a similar P600 component in all groups. However, identical phrase structure violations within Jabberwocky sentences elicited a P600 in CWNS and CWS-Rec, but an N400-like effect in CWS-Per.
CONCLUSIONS:The distinguishing neural patterns mediating syntactic, but not semantic, processing provide evidence that specific brain functions for some aspects of language processing may be associated with stuttering persistence. Unlike CWS-Rec and CWNS, the lack of semantic context in Jabberwocky sentences seemed to affect the syntactic processing strategies of CWS-Per, resulting in the elicitation of semantically based N400-like activity during syntactic (phrase structure) violations. This vulnerability suggests neural mechanisms associated with the processing of syntactic structure may be less mature in 6-7-year-old children whose stuttering persisted compared to their fluent or recovered peers.
PMID: 25657823 [PubMed] PMCID: PMC4318174




Non-verbal sensorimotor timing deficits in children and adolescents who stutter.

Front Psychol. 2015 Jul 6;6:847. doi: 10.3389/fpsyg.2015.00847. eCollection 2015.

Free PMC Article - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491603/pdf/fpsyg-06-00847.pdf


Falk S, Müller T, Dalla Bella S.

Author information

Aix-Marseille University Aix-en-Provence, France ; Ludwig Maximilians University Munich, Germany; LVR Hospital Bonn, Germany; University of Montpellier Montpellier, France ; Institut Universitaire de France Paris, France ;  Wyższa Szkoła Finansów i Zarządzania Warsaw, Poland.


There is growing evidence that motor and speech disorders co-occur during development. In the present study, we investigated whether stuttering, a developmental speech disorder, is associated with a predictive timing deficit in childhood and adolescence. By testing sensorimotor synchronization abilities, we aimed to assess whether predictive timing is dysfunctional in young participants who stutter (8-16 years). Twenty German children and adolescents who stutter and 43 non-stuttering participants matched for age and musical training were tested on their ability to synchronize their finger taps with periodic tone sequences and with a musical beat. Forty percent of children and 90% of adolescents who stutter displayed poor synchronization with both metronome and musical stimuli, falling below 2.5% of the estimated population based on the performance of the group without the disorder. Synchronization deficits were characterized by either lower synchronization accuracy or lower consistency or both. Lower accuracy resulted in an over-anticipation of the pacing event in participants who stutter. Moreover, individual profiles revealed that lower consistency was typical of participants that were severely stuttering. These findings support the idea that malfunctioning predictive timing during auditory-motor coupling plays a role in stuttering in children and adolescents.

PMID: 26217245 [PubMed] PMCID: PMC4491603



"Not Unless It's a Life or Death Thing": A Qualitative Study of the Health Care Experiences of Adults Who Stutter. - SOCIAL
J Gen Intern Med. 2015 Apr 9. [Epub ahead of print]

Perez HR, Doig-Acuña C, Starrels JL.
Primary Care Research Fellow, New York University School of Medicine, New York, NY, USA

BACKGROUND:For adults who stutter, communication difficulties can impact many spheres of life. Previous studies have not examined how stuttering might impact patient's experiences with the medical system.
OBJECTIVE:Our objective was to understand the range and depth of experiences with the medical system among adults who stutter.
DESIGN:This was a qualitative study using age-stratified focus groups.
PARTICIPANTS:Sixteen adults who stutter were recruited at a national conference about stuttering.
APPROACH:We conducted three focus groups. Participants also completed a written questionnaire about sociodemographic characteristics, health status, and the impact of stuttering on their life [using the St. Louis Inventory of Life Perspectives Scale (SL-ILP-S) Total Effect Score]. We analyzed data using an iterative, thematic analysis, with an inductive approach, at a semantic level.
KEY RESULTS:Participants were mostly (75 %) male and resided throughout the United States. The mean SL-ILP-S Total Effect Score was 27.3, indicating that stuttering caused minimal concern in participants' lives. Despite this, we identified five themes that characterize ways in which stuttering affects interactions with the medical system. Participants described (1) discomfort speaking with office staff and physicians, which resulted in (2) avoiding health care interactions because of stuttering, and (3) relying on a third party to navigate the medical system. During visits with physicians, participants felt that (4) discussing stuttering with physicians required trust and rapport, and (5) speaking assertively with physicians required self-acceptance of their stuttering.
CONCLUSIONS:We identified ways in which stuttering affects medical interactions. These results highlight the need for increased awareness and training for medical staff and physicians when caring for persons who stutter. Future studies among diverse samples of stutterers can determine the effects of stuttering on medical interactions, and inform the development of interventions to provide high quality health care for adults who stutter.
PMID: 25855480 [PubMed - as supplied by publisher]

Nonword repetition and phoneme elision in adults who do and do not stutter: Vocal versus nonvocal performance differences. - FALA
J Fluency Disord. 2015 Jan 24. pii: S0094-730X(15)00006-6. doi: 10.1016/j.jfludis.2015.01.004. [Epub ahead of print]

Byrd CT, McGill M, Usler E.
The University of Texas at Austin, United States.Purdue University, United States.

PURPOSE:The purpose of the present study was to enhance our understanding of phonological working memory in adults who stutter through the comparison of nonvocal versus vocal nonword repetition and phoneme elision task performance differences.
METHOD:For the vocal nonword repetition condition, participants repeated sets of 4- and 7-syllable nonwords (n=12 per set). For the nonvocal nonword repetition condition, participants silently identified each target nonword from a subsequent set of three nonwords. For the vocal phoneme elision condition, participants repeated nonwords with a target phoneme eliminated. For the nonvocal phoneme elision condition, participants silently identified the nonword with the designated target phoneme eliminated from a subsequent set of three nonwords.
RESULTS:Adults who stutter produced significantly fewer accurate initial productions of 7-syllable nonwords compared to adults who do not stutter. There were no talker group differences for the silent identification of nonwords, but both talker groups required significantly more mean number of attempts to accurately silently identify 7-syllable as compared to 4-syllable nonwords. For the vocal phoneme elision condition, adults who stutter were significantly less accurate than adults who do not stutter in their initial production and required a significantly higher mean number of attempts to accurately produce 7-syllable nonwords with a phoneme eliminated. This talker group difference was also significant for the nonvocal phoneme elision condition for both 4- and 7-syllable nonwords.
CONCLUSION:Present findings suggest phonological working memory may contribute to the difficulties persons who stutter have establishing and/or maintaining fluent speech. Educational Objectives: (a) Readers can describe the role of phonological working memory in planning for and execution of speech; (b) readers can describe two experimental tasks for exploring the phonological working memory: nonword repetition and phoneme elision; (c) readers can describe how the nonword repetition and phoneme elision skills of adults who stutter differ from their typically fluent peers.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25680736 [PubMed - as supplied by publisher]

Perfectionism and stuttering: Findings of an online survey.- EMOCIONAL
J Fluency Disord. 2015 Feb 16. pii: S0094-730X(15)00008-X. doi: 10.1016/j.jfludis.2015.02.002. [Epub ahead of print]

Brocklehurst PH, Drake E, Corley M.
School of Philosophy, Psychology, and Language Sciences, University of Edinburgh, Edinburgh, Scotland, UK.

PURPOSE: Using a multi-dimensional measure of perfectionism: the Frost Multi-dimensional Perfectionism Scale (FMPS: Frost, Marten, Lahart, & Rosenblate, 1990), this study investigates: (a) whether adults who stutter (AWS) display more perfectionistic attitudes and beliefs than those who do not stutter, and (b) whether, in AWS, more perfectionistic attitudes and beliefs are associated with greater self-reported difficulty communicating verbally and speaking fluently.
METHOD:In the first analysis, FMPS responses from 81 AWS and 81 matched, normally-fluent controls were analyzed using logistic regression to investigate the relative contributions of four FMPS perfectionism-subscale self-ratings to the likelihood of being in the AWS group. In the subsequent analyses, data from the 81 AWS were analyzed using linear multiple regression to determine which FMPS subscale self-ratings best predicted their Communication-Difficulty and Fluency-Difficulty scores.
RESULTS:Both the likelihood of being a member of the AWS group, and also the magnitude of the AWS group's Communication-Difficulty and Fluency-Difficulty scores, were positively part-correlated to respondents' Concern over Mistakes-Doubts about Actions (CMD) subscale self-ratings but negatively part-correlated to their Personal Standards (PS) subscale self-ratings.
CONCLUSIONS:The FMPS profiles of respondents who stutter suggest that, as a group, they are not abnormally perfectionistic overall, but may be (or perceive themselves to be) abnormally error-prone. Also, AWS who are more concerned about their errors and uncertain of their actions experience more difficulty communicating verbally and speaking fluently. Educational Objectives: After reading this article, participants will be able to: (a) describe the findings of previous research investigating the role of perfectionism in stuttering and psychopathologies; (b) discuss why a multidimensional assessment of perfectionism is important in relation to stuttering; (c) discuss ways in which data from perfectionism assessments can contribute to the planning of therapy for adults who stutter.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 25748855 [PubMed - as supplied by publisher]

Phonological complexity in school-aged children who stutter and exhibit a language disorder - FALA
J Fluency Disord. 2015 Mar;43:40-53. doi: 10.1016/j.jfludis.2014.11.001. Epub 2014 Nov 20.

Wolk L, LaSalle LR.
Southern Connecticut State University, Department of Communication Sciences and Disorders, New Haven, United States; University of Redlands, Redlands, United States.

PURPOSE:The Index of Phonological Complexity and the Word Complexity Measure are two measures of the phonological complexity of a word. Other phonological measures such as phonological neighborhood density have been used to compare stuttered versus fluent words. It appears that in preschoolers who stutter, the length and complexity of the utterance is more influential than the phonetic features of the stuttered word. The present hypothesis was that in school-age children who stutter, stuttered words would be more phonologically complex than fluent words, when the length and complexity of the utterance containing them is comparable. School-age speakers who stutter were hypothesized to differ from those with a concomitant language disorder.
METHODS: Sixteen speakers, six females and ten males (M age=12;3; Range=7;7 to 19;5) available from an online database, were divided into eight who had a concomitant language disorder (S+LD) and eight age- and sex-matched speakers who did not (S-Only).
RESULTS:When all stuttered content words were identified, S+LD speakers produced more repetitions, and S-Only speakers produced more inaudible sound prolongations. When stuttered content words were matched to fluent content words and when talker groups were combined, stuttered words were significantly (p≤0.01) higher in both the Index of Phonological Complexity and the Word Complexity Measure and lower in density ("sparser") than fluent words.
CONCLUSIONS:Results corroborate those of previous researchers. Future research directions are suggested, such as cross-sectional designs to evaluate developmental patterns of phonological complexity and stuttering plus language disordered connections.
EDUCATIONAL OBJECTIVES: The reader will be able to: (a) Define and describe phonological complexity; (b) Define phonological neighborhood density and summarize the literature on the topic; (c) Describe the Index of Phonological Complexity (IPC) for a given word; (d) Describe the Word Complexity Measure (WCM) for a given word; (e) Summarize two findings from the current study and describe how each relates to studies of phonological complexity and fluency disorders.
Copyright © 2014 Elsevier Inc. All rights reserved.
PMID: 25488881 [PubMed - in process]

Prenatal testosterone and stuttering. - AVALIAÇÃO
Early Hum Dev. 2015 Jan;91(1):43-6. doi: 10.1016/j.earlhumdev.2014.11.003. Epub 2014 Nov 29.

Montag C, Bleek B, Breuer S, Prüss H, Richardt K, Cook S, Yaruss JS, Reuter M.
University of Ulm, Ulm, Germany; University of Bonn, Bonn, Germany; LVR Clinic Bonn, Bonn, Germany; Alexandria, VA, USA; niversity of Pittsburgh, PA, USA.

BACKGROUND:The prevalence of stuttering is much higher in males compared to females. The biological underpinnings of this skewed sex-ratio is poorly understood, but it has often been speculated that sex hormones could play an important role.
AIMS:The present study investigated a potential link between prenatal testosterone and stuttering. Here, an indirect indicator of prenatal testosterone levels, the Digit Ratio (2D:4D) of the hand, was used. As numerous studies have shown, hands with more "male" characteristics (putatively representing greater prenatal testosterone levels) are characterized by a longer ring finger compared to the index finger (represented as a lower 2D:4D ratio) in the general population.
STUDY DESIGN, SUBJECTS, OUTCOME MEASURES:We searched for differences in the 2D:4D ratios between 38 persons who stutter and 36 persons who do not stutter. In a second step, we investigated potential links between the 2D:4D ratio and the multifaceted symptomatology of stuttering, as measured by the Overall Assessment of the Speaker's Experience of Stuttering (OASES), in a larger sample of 44 adults who stutter.
RESULTS: In the first step, no significant differences in the 2D:4D were observed between individuals who stutter and individuals who do not stutter. In the second step, 2D:4D correlated negatively with higher scores of the OASES (representing higher negative experiences due to stuttering), and this effect was more pronounced for female persons who stutter.
CONCLUSIONS: The findings indicate for the first time that prenatal testosterone may influence individual differences in psychosocial impact of this speech disorder.
Copyright © 2014 Elsevier Ltd. All rights reserved.
PMID: 25460256 [PubMed - in process]

Prevalence of stuttering in primary school children in Cairo-Egypt - CONCEITO
Int J Speech Lang Pathol. 2015 Mar 5:1-6. [Epub ahead of print]

Abou Ella M, Saleh M, Habil I, El Sawy M, El Assal L.
Ain Shams Faculty of Medicine , Cairo , Egypt.

Purpose: To determine the prevalence of stuttering among primary school children in Cairo. Method: A cross-sectional design was employed. Using a multi-stage random sample from 10 schools in Cairo, a total of 8765 primary school students were enrolled in the study. The teacher referring method was initially used to detect stuttering students, which was then confirmed by a Speech Language Pathologist (SLP) using Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria. Personal data were collected for all students and separate questionnaires were administered to the parents of each stuttering child, inquiring about consanguinity, family history, presence of other disorders and family attitudes towards the child. Result: Prevalence of stuttering among primary school children in Cairo was 1.03%. The prevalence of stuttering showed a declining trend in the older age group. Stuttering was 7-fold more prevalent among left-handed students. Males had a higher prevalence of stuttering, but didn't reach statistical significance. Anxiety was expressed in 25% of the families of affected children. Positive family history was found in 28% of cases, mainly among first-degree relatives. Conclusion: The current study showed a prevalence of stuttering comparable to other areas of the world with some evidence of hereditary background, although lower than that reported by other studies.
PMID: 25739414 [PubMed - as supplied by publisher]




Psychosurgery for stuttering. - NEUROCIÊNCIAS
Neuropsychiatr Dis Treat. 2015 Apr 2;11:963-5. doi: 10.2147/NDT.S74875. eCollection 2015.
No abstract available. 

Free Full Text

Durand E, Weil AG, Lévêque M.
South Paris University, Paris, France. Sainte-Justine Hospital, Montreal, QC, Canada. Hôpital de la Pitié-Salpêtrière, Paris, France.

PMID: 25897232 [PubMed] PMCID: PMC4396649 



Reactions of teachers versus non-teachers toward people who stutter.
J Commun Disord. 2015 Jul-Aug;56:8-18. doi: 10.1016/j.jcomdis.2015.05.003. Epub 2015 May 28.


Li J, Arnold HS.
Kent State University, United States.


The primary purpose of this study was to assess whether kindergarten through twelfth grade teachers differ from people in non-teaching occupations in their reactions to people who stutter (PWS). Taking differences in age and education into account, we compared reactions to PWS between 263 teachers and 1336 non-teachers in the United States based on their responses on the Public Opinion Survey on Human Attributes-Stuttering (POSHA-S, St. Louis, 2012). Findings indicated that teachers use a greater number and variety of information sources about PWS than the general public and that male teachers do so even more than female teachers. With regard to the other POSHA-S components, accommodating/helping, knowledge/experience, and sympathy/social distancing of PWS, teachers' responses were not significantly different from their non-teaching counterparts. Regardless of occupation, women reported reactions to PWS that are considered more accommodating and helpful to PWS than the reported reactions of men.
LEARNING OUTCOMES:Readers should be able to: (1) identify the challenges that students who stutter encounter in the K-12 school setting, (2) identify recommended ways teachers can react to their students who stutter, (3) summarize findings regarding teachers' reactions to people who stutter (PWS), and (4) identify key variables that are associated with reactions to PWS.
Copyright © 2015 Elsevier Inc. All rights reserved.
PMID: 26073403 [PubMed - in process]



Real Enough: Using Virtual Public Speaking Environments to Evoke Feelings and Behaviors Targeted in Stuttering Assessment and Treatment. - TERAPIA
Am J Speech Lang Pathol. 2015 Jan 7. doi: 10.1044/2014_AJSLP-14-0087. [Epub ahead of print]

Brundage SB, Hancock AB.

PURPOSE: Virtual Reality Environments (VREs) are computer-generated, three-dimensional worlds that allow users to experience situations similar to those encountered in the real world. The purpose of this study was to investigate VREs for potential use in assessing and treating persons who stutter (PWS) by determining the extent to which PWS's affective, behavioral, and cognitive measures in a VRE correlate with those same measures in a similar live environment.
METHOD: Ten persons who stutter (PWS) delivered speeches to a live audience and, on another day, to two virtual audiences (neutral and challenging audiences). Participants completed standard tests of communication apprehension and confidence prior to each condition and frequency of stuttering was measured during each speech.
RESULTS: Correlational analyses revealed significant, positive correlations between virtual and live conditions for affective and cognitive measures, as well as frequency of stuttering.
CONCLUSIONS: Our findings suggest that public speaking virtual environments engender affective, behavioral, and cognitive reactions in PWS that correspond to those experienced in the real world. Therefore, the authentic, safe, and controlled environments provided by VREs may be useful for stuttering assessment and treatment.
PMID: 25569429 [PubMed - as supplied by publisher]

Real-time processing in picture naming in adults who stutter: ERP evidence. LINGUAGEM
Clin Neurophysiol. 2015 Feb;126(2):284-96. doi: 10.1016/j.clinph.2014.05.009. Epub 2014 May 20.

Maxfield ND, Morris K, Frisch SA, Morphew K, Constantine JL.
University of South Florida, USA.

OBJECTIVE:The aim was to compare real-time language/cognitive processing in picture naming in adults who stutter (AWS) versus typically-fluent adults (TFA).
METHODS:Participants named pictures preceded by masked prime words. Primes and target picture labels were identical or mismatched. Priming effects on naming and picture-elicited ERP activity were analyzed. Vocabulary knowledge correlations with these measures were assessed.
RESULTS:Priming improved naming RTs and accuracy in both groups. RTs were longer for AWS, and correlated positively with receptive vocabulary in TFA. Electrophysiologically, posterior-P1 amplitude negatively correlated with expressive vocabulary in TFA versus receptive vocabulary in AWS. Frontal/temporal-P1 amplitude correlated positively with expressive vocabulary in AWS. Identity priming enhanced frontal/posterior-N2 amplitude in both groups, and attenuated P280 amplitude in AWS. N400 priming was topographically-restricted in AWS.
CONCLUSIONS:Results suggest that conceptual knowledge was perceptually-grounded in expressive vocabulary in TFA versus receptive vocabulary in AWS. Poorer expressive vocabulary in AWS was potentially associated with greater suppression of irrelevant conceptual information. Priming enhanced N2-indexed cognitive control and visual attention in both groups. P280-indexed focal attention attenuated with priming in AWS only. Topographically-restricted N400 priming suggests that lemma/word form connections were weaker in AWS.
SIGNIFICANCE:Real-time language/cognitive processing in picture naming operates differently in AWS.
PMID: 24910149 [PubMed - in process] PMCID: PMC4239194 [Available on 2016-02-01

Reduced fractional anisotropy in the anterior corpus callosum is associated with reduced speech fluency in persistent developmental stuttering. - NEUROCIÊNCIAS
Brain Lang. 2015 Feb 26;143C:20-31. doi: 10.1016/j.bandl.2015.01.012. [Epub ahead of print]

Civier O, Kronfeld-Duenias V, Amir O, Ezrati-Vinacour R, Ben-Shachar M.
Bar-Ilan University, Ramat-Gan, Israel & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Developmental stuttering is a speech disorder that severely limits one's ability to communicate. White matter anomalies were reported in stuttering, but their functional significance is unclear. We analyzed the relation between white matter properties and speech fluency in adults who stutter (AWS). We used diffusion tensor imaging with tract-based spatial statistics, and examined group differences as well as correlations with behavioral fluency measures. We detected a region in the anterior corpus callosum with significantly lower fractional anisotropy in AWS relative to controls. Within the AWS group, reduced anisotropy in that region is associated with reduced fluency. A statistically significant interaction was found between group and age in two additional regions: the left Rolandic operculum and the left posterior corpus callosum. Our findings suggest that anterior callosal anomaly in stuttering may represent a maladaptive reduction in interhemispheric inhibition, possibly leading to a disadvantageous recruitment of right frontal cortex in speech production.
Copyright © 2015 Elsevier Inc. All rights reserved.

PMID: 25728013 [PubMed - as supplied by publisher]




Relations between causal attributions for stuttering and psychological well-being in adults who stutter - TERAPIA

Int J Speech Lang Pathol. 2015 Jul 27:1-10. [Epub ahead of print]


Boyle M

Oklahoma State University, Communication Sciences and Disorders, Stillwater, OK , USA.


PURPOSE: This study attempted to understand the relationship between causal attributions for stuttering and psychological well-being in adults who stutter.

METHOD: The study employed a cross-sectional design using a web survey distribution mode to gain information related to causal attributions and psychological well-being of 348 adults who stutter. Correlation analyses were conducted to determine relationships between participants' causal attributions (i.e. locus of causality, external control, personal control, stability, biological attributions, non-biological attributions) for stuttering and various measures of psychological well-being including self-stigma, self-esteem/self-efficacy, hope, anxiety and depression.

RESULT: Results indicated that higher perceptions of external control of stuttering were related to significantly lower ratings of hope and self-esteem/self-efficacy and higher ratings of anxiety and depression. Higher perceptions of personal control of stuttering were related to significantly lower ratings of self-stigma and higher ratings of hope and self-esteem/self-efficacy. Increased biological attributions were significantly related to higher ratings of permanency and unchangeableness of stuttering and lower ratings of personal control of stuttering.

CONCLUSION: The findings demonstrate the importance of instilling a sense of control in PWS regarding their ability to manage their stuttering. Findings also raise questions regarding the benefits of educating PWS about the biological underpinnings of stuttering.

PMID: 26212487 [PubMed - as supplied by publisher]



Relationships between psychosocial factors and quality of life for adults who stutter. - AVALIAÇÃO
Am J Speech Lang Pathol. 2015 Feb 1;24(1):1-12. doi: 10.1044/2014_AJSLP-14-0089.

Boyle MP.

PURPOSE: In this study, the author examined the relationship of social support, empowerment, self-help support group participation, and group identification to quality of life in adults who stutter.
METHOD: Two-hundred forty-nine adults who stutter completed a web-based survey, including measures of social support, empowerment, self-help support group participation, group identification, and quality of life.
RESULTS: After controlling for demographic and stuttering parameters, both empowerment in the self-esteem/self-efficacy domain and social support from family significantly predicted quality of life in adults in the sample.
CONCLUSIONS: Increased self-esteem/self-efficacy and social support from family relates to improved quality of life in adults who stutter, independent of stuttering severity. Treatments that increase feelings of self-esteem/self-efficacy and strengthen social support from the family should be considered for individuals who struggle to cope with stuttering in order to enhance their quality of life.
PMID: 25410098 [PubMed - in process]



Retention of implicit sequence learning in persons who stutter and persons with Parkinson's disease. - OUTRAS ÁREAS
J Mot Behav. 2015 Mar-Apr;47(2):124-41. doi: 10.1080/00222895.2014.961890. Epub 2014 Nov 4.

Smits-Bandstra S, Gracco V.
Department of Communication Sciences and Disorders , St. Cloud State University , Minnesota.

The authors investigated the retention of implicit sequence learning in 14 persons with Parkinson's disease (PPD), 14 persons who stutter (PWS), and 14 control participants. Participants completed a nonsense syllable serial reaction time task in a 120-min session. Participants named aloud 4 syllables in response to 4 visual stimuli. The syllables formed a repeating 8-item sequence not made known to participants. After 1 week, participants completed a 60-min retention session that included an explicit learning questionnaire and a sequence generation task. PPD showed retention of general learning equivalent to controls but PWS's reaction times were significantly slower on early trials of the retention test relative to other groups. Controls showed implicit learning during the initial session that was retained on the retention test. In contrast, PPD and PWS did not demonstrate significant implicit learning until the retention test suggesting intact, but delayed, learning and retention of implicit sequencing skills. All groups demonstrated similar limited explicit sequence knowledge. Performance differences between PWS and PPD relative to controls during the initial session and on early retention trials indicated possible dysfunction of the cortico-striato-thalamo-cortical loop. The etiological implications for stuttering, and clinical implications for both populations, of this dysfunction are discussed.
PMID: 25368907 [PubMed - in process]




Screening for Speech and Language Delays and Disorders in Children Age 5 Years or Younger: A Systematic Review for the U.S. Preventive Services Task Force - INFANTIL



Berkman ND, Wallace I, Watson L, Coyne-Beasley T, Cullen K, Wood C, Lohr KN.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Jul. Report No.: 13-05197-EF-1.

U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.

Free full text



PURPOSE: To evaluate the evidence on screening and treating children for speech and language delays or disorders for the U.S. Preventive Services Task Force (USPSTF).

DATA SOURCES: PubMed/MEDLINE®, the Cochrane Library, PsycInfo®, ClinicalTrials.gov, HSRProj, the World Health Organization International Clinical Trials Registry Platform, and reference lists of published literature (through July 2014).

STUDY SELECTION: Two investigators independently selected studies reporting on benefits and harms of screening; accuracy of screening tools compared with diagnostic evaluations; and benefits or harms of treatment of speech and language delays or disorders compared with placebo, watchful waiting, or wait-list interventions. To provide context for evaluating our Key Questions, we also included studies describing screening instruments and risk factors for speech and language delays or disorder.

DATA EXTRACTION: One reviewer extracted data and a second checked accuracy. Two independent reviewers assigned quality ratings using predefined criteria.

DATA SYNTHESIS: No included studies examined the effects of screening on speech and language or other functional outcomes. We included 23 studies evaluating the accuracy of speech and language screening in primary care settings to identify children for diagnostic evaluations and interventions. Among instruments in 13 studies in which parents rated their children’s skills, sensitivity ranged from 50 to 94 percent and specificity ranged from 45 to 96 percent. Of the three instruments widely used in the United States, the MacArthur Bates Communication Development Inventory (CDI) and the Language Development Survey (LDS) outperformed the Ages and Stages Questionnaire (ASQ) Communication Domain, especially in terms of their specificity, correctly identifying, on average, 82 percent (CDI) and 91 percent (LDS) compared with 58 percent (ASQ) of children without a language disorder. The ASQ and CDI have versions for infants, toddlers, and preschool-age children, with the CDI being more robust across age groups. The accuracy of professionally or paraprofessionally administered instruments was more variable across studies, and many did not perform as well as parent-rated instruments. Because few studies examined the same instrument in different populations or in different ages, it is unclear how professionally or paraprofessionally administered instruments for multiple ages fare more broadly or whether there is an optimal age for screening. We found no studies addressing adverse effects of screening, such as deleterious consequences of false conclusions from screening. We also found no studies concerning the role of enhanced surveillance by a primary care provider. We included 13 studies examining treatment for speech and language delays or disorders. Although the treatment approaches sometimes overlap, we organized our findings by outcome: language (including expressive and receptive language and more specific aspects of language, such as vocabulary, syntax/morphology, and narratives), speech sounds (including articulation, phonology, and speech intelligibility), and fluency (stuttering). Although results were mixed, the majority of studies found treatment to be effective. Characteristics of effective studies include higher intensity, treating children with more severe delays, and individualizing treatment to the child. We found little evidence concerning other functional outcomes or adverse effects of treatment. Risk factors that were generally associated with speech and language delays or disorders in multivariate analyses of cohort populations included being male, a family history of speech and language concerns, and lower levels of parental educational achievement.

LIMITATIONS: As in the earlier review, we did not find any well-conducted trials that could address our overarching question of whether screening leads to improved outcomes. Many screening studies do not include unselected samples from the population but rather participants with and without language delays. Intervention studies did not consistently control for additional community services that children may have been receiving and varied greatly in treatment approach and outcome measurement. Also, because young children with disabilities are entitled to treatment, it may not be possible for future studies in the United States to examine treatment versus no treatment.

CONCLUSION: Our review yields evidence that two parent-rated screening instruments, the CDI and LDS, can accurately identify children for diagnostic evaluations and interventions and likely can be interpreted with little difficulty in the primary care setting. Some treatments for young children identified with speech and language delays and disorders may be effective.

PMID: 26225412 [PubMed] Free Books & Documents



Slow speech rate effects on stuttering preschoolers with disordered phonology.- FALA
Clin Linguist Phon. 2015 Feb 4:1-24. [Epub ahead of print]

Lasalle LR.
Communicative Disorders Department, University of Redlands , CA , USA.

To study the effects of clinicians' slow rate on the speech of children who stutter with and without a concomitant phonological disorder, an A-B-A-B single case design was used with six clinician-child dyads, where B = Clinician's slow speech rate model. Two boys and one girl, aged 49-54 months, stuttering with disordered phonology (S + DP), were compared to three boys aged 42-50 months, stuttering with normal phonology (S + NP). Articulation rates were measured in phones per second (pps) in clinician-child adjacent utterance pairs. The S + NP dyads showed improved fluency in the B condition through a larger effect size, higher mean baseline stutter reductions and lower percentages of non-overlapping data than did the S + DP dyads. The S + DP girl showed relatively improved fluency in the B condition. S + DP children showed no articulation rate alignment (Range: 16% decrease to a 1.2% increase), whereas S + NP children averaged a 20% pps rate reduction (Range: 19.6-25.4% decrease), aligning with their clinicians who averaged a 38% pps rate reduction from baseline. The S + DP group spoke significantly (z = -4.63; p < 0.00) slower at baseline (Mdn = 6.9 pps; SE = 0.07 pps) than S + NP children in previously published samples (Mdn = 9.8 pps; SE = 0.22 pps). Results suggest that a slow rate model alone is not effective for facilitating fluency in S + DP boys with time since onset of about 2 years.
PMID: 25651198 [PubMed - as supplied by publisher]



Speech dynamics are coded in the left motor cortex in fluent speakers but not in adults who stutter. - MOTOR

Brain. 2015 Mar;138(Pt 3):712-25. doi: 10.1093/brain/awu390. Epub 2015 Jan 15.


Neef NE, Hoang TN, Neef A, Paulus W, Sommer M.

Georg-August-University, Göttingen, Germany; Department of Neuropsychology, Leipzig, Germany; Department of Nonlinear Dynamics, Göttingen, Germany.


The precise excitability regulation of neuronal circuits in the primary motor cortex is central to the successful and fluent production of speech. Our question was whether the involuntary execution of undesirable movements, e.g. stuttering, is linked to an insufficient excitability tuning of neural populations in the orofacial region of the primary motor cortex. We determined the speech-related time course of excitability modulation in the left and right primary motor tongue representation. Thirteen fluent speakers (four females, nine males; aged 23-44) and 13 adults who stutter (four females, nine males, aged 21-55) were asked to build verbs with the verbal prefix 'auf'. Single-pulse transcranial magnetic stimulation was applied over the primary motor cortex during the transition phase between a fixed labiodental articulatory configuration and immediately following articulatory configurations, at different latencies after transition onset. Bilateral electromyography was recorded from self-adhesive electrodes placed on the surface of the tongue. Off-line, we extracted the motor evoked potential amplitudes and normalized these amplitudes to the individual baseline excitability during the fixed configuration. Fluent speakers demonstrated a prominent left hemisphere increase of motor cortex excitability in the transition phase (P = 0.009). In contrast, the excitability of the right primary motor tongue representation was unchanged. Interestingly, adults afflicted with stuttering revealed a lack of left-hemisphere facilitation. Moreover, the magnitude of facilitation was negatively correlated with stuttering frequency. Although orofacial midline muscles are bilaterally innervated from corticobulbar projections of both hemispheres, our results indicate that speech motor plans are controlled primarily in the left primary speech motor cortex. This speech motor planning-related asymmetry towards the left orofacial motor cortex is missing in stuttering. Moreover, a negative correlation between the amount of facilitation and stuttering severity suggests that we discovered a main physiological principle of fluent speech production and its role in stuttering.

© The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PMID: 25595146 [PubMed - in process]

Brain. 2015 Mar;138(Pt 3):712-25. doi: 10.1093/brain/awu390. Epub 2015 Jan 15.



"Stuttering" after minor head trauma - GAGUEIRA ADQUIRIDA

Am J Emerg Med. 2015 Jul 29. pii: S0735-6757(15)00612-9. doi: 10.1016/j.ajem.2015.07.056. [Epub ahead of print]


Strasberg S, Johnson EJ, Parry T.

Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.


No abstract available.



Stuttering as a trait or state - an ALE meta-analysis of neuroimaging studies. - NEUROCIÊNCIAS
Eur J Neurosci. 2015 Jan;41(2):275-84. doi: 10.1111/ejn.12765. Epub 2014 Oct 28.

Belyk M, Kraft SJ, Brown S.
Department of Psychology, Neuroscience & Behaviour, McMaster University, Canada.

Stuttering is a speech disorder characterised by repetitions, prolongations and blocks that disrupt the forward movement of speech. An earlier meta-analysis of brain imaging studies of stuttering (Brown et al., 2005) revealed a general trend towards rightward lateralization of brain activations and hyperactivity in the larynx motor cortex bilaterally. The present study sought not only to update that meta-analysis with recent work but to introduce an important distinction not present in the first study, namely the difference between 'trait' and 'state' stuttering. The analysis of trait stuttering compares people who stutter (PWS) with people who do not stutter when behaviour is controlled for, i.e., when speech is fluent in both groups. In contrast, the analysis of state stuttering examines PWS during episodes of stuttered speech compared with episodes of fluent speech. Seventeen studies were analysed using activation likelihood estimation. Trait stuttering was characterised by the well-known rightward shift in lateralization for language and speech areas. State stuttering revealed a more diverse pattern. Abnormal activation of larynx and lip motor cortex was common to the two analyses. State stuttering was associated with overactivation in the right hemisphere larynx and lip motor cortex. Trait stuttering was associated with overactivation of lip motor cortex in the right hemisphere but underactivation of larynx motor cortex in the left hemisphere. These results support a large literature highlighting laryngeal and lip involvement in the symptomatology of stuttering, and disambiguate two possible sources of activation in neuroimaging studies of persistent developmental stuttering.
© 2014 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.
PMID: 25350867 [PubMed - in process]

Stuttering intervention in three service delivery models (direct, hybrid, and telepractice): two case studies. - TERAPIA
Int J Telerehabil. 2015 Jan 29;6(2):51-63. doi: 10.5195/ijt.2014.6154. eCollection 2014.
Free Full Text -  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353004/pdf/6154-24378-1-pb.pdf

Valentine DT
University Of Montevallo, Montevallo, Al, Usa.

This study assessed outcomes in stuttering intervention across three service delivery models: direct, hybrid, and telepractice for two 11-year old children who stutter. The goal of the study was to investigate whether short-term goals were maintained through the telepractice sessions. The Stuttering Severity Instrument, Fourth Edition (SSI-4) was administered to each child before and after each intervention period and weekly fluency samples (percentage of stuttered syllables in a monologue) were obtained in each of the 10-week intervention periods. In addition, the Communication Attitudes Test-Revised was used to assess the children's attitudes toward speaking. Following the telepractice period, parents and children completed a questionnaire concerning the therapy experience via telepractice. Both children continued to improve fluency as measured by the weekly fluency samples. SSI-4 severity ratings improved for one child and remained consistent for the other. These outcomes appear to demonstrate that telepractice is viable for improving and maintaining fluency.
PMID: 25945229 [PubMed] PMCID: PMC4353004

Testosterone levels of children with a diagnosis of developmental stuttering. - AVALIAÇÃO
Ther Clin Risk Manag. 2015 May 14;11:793-8. doi: 10.2147/TCRM.S83129. eCollection 2015.

Free PMC Article - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437599/pdf/tcrm-11-793.pdf


Selçuk EB, Erbay LG, Özcan ÖÖ, Kartalci Ş, Batcioğlu K.

Inonu University Medical Faculty, Malatya, Turkey; Inonu University Pharmacy Faculty, Malatya, Turkey.


BACKGROUND:Stuttering is defined as a disruption in the rhythm of speech and language articulation, where the subject knows what he/she wants to say, but is unable to utter the intended word or phrase fluently. The effect of sex on development and chronicity of stuttering is well known; it is more common and chronic in males. We aimed to investigate the relationship between developmental stuttering and serum testosterone levels in this study.

MATERIALS AND METHODS:In this study, we evaluated a total of 50 children (7-12 years of age); eight (16%) were female and 42 (84%) were male. Twenty-five children who stutter and 25 typically fluent peers with the same demographic properties (ages between 7 years and 12 years) were included in this study. The testosterone levels of the two groups were determined in terms of nanogram per milliliter (ng/mL) by enzyme-linked immunosorbent assay. The difference between the means of the two groups was analyzed.

RESULTS:The medians of the testosterone levels of the stutterer and control groups were determined as 20 ng/mL (range =12-184 ng/mL) and 5 ng/mL (range =2-30 ng/mL), respectively. Testosterone levels of the stutterer group were significantly higher than in the control group (P=0.001). Besides, there was a significant correlation between the severity of the stuttering and testosterone levels in the stutterer group (P=0.0001).

CONCLUSION:The findings of this study show that testosterone may have an effect on the severity of developmental stuttering and on the clinical differences between sexes. However, further investigations are needed to show that testosterone may play a role in the etiology of developmental stuttering.

PMID: 25999727 [PubMed] PMCID: PMC4437599

The disfluent speech of bilingual spanish-english children: considerations for differential diagnosis of stuttering. - SUPERFICIAL
Lang Speech Hear Serv Sch. 2015 Jan;46(1):30-43. doi: 10.1044/2014_LSHSS-14-0010.

Byrd CT, Bedore LM, Ramos D.

PURPOSE:The primary purpose of this study was to describe the frequency and types of speech disfluencies that are produced by bilingual Spanish-English (SE) speaking children who do not stutter. The secondary purpose was to determine whether their disfluent speech is mediated by language dominance and/or language produced.
METHOD:Spanish and English narratives (a retell and a tell in each language) were elicited and analyzed relative to the frequency and types of speech disfluencies produced. These data were compared with the monolingual English-speaking guidelines for differential diagnosis of stuttering.
RESULTS:The mean frequency of stuttering-like speech behaviors in the bilingual SE participants ranged from 3% to 22%, exceeding the monolingual English standard of 3 per 100 words. There was no significant frequency difference in stuttering-like or non-stuttering-like speech disfluency produced relative to the child's language dominance. There was a significant difference relative to the language the child was speaking; all children produced significantly more stuttering-like speech disfluencies in Spanish than in English.
CONCLUSION:Results demonstrate that the disfluent speech of bilingual SE children should be carefully considered relative to the complex nature of bilingualism.
PMID: 25215876 [PubMed - in process]

The Efficacy of Stuttering Measurement Training: Evaluating Two Training Programs. - AVALIAÇÃO
J Speech Lang Hear Res. 2015 Jan 27. doi: 10.1044/2015_JSLHR-S-14-0200. [Epub ahead of print]

Bainbridge LA, Stavros C, Ebrahimian M, Wang Y, Ingham RJ.

PURPOSE: Two stuttering measurement training programs currently used for training clinicians were evaluated for their efficacy in improving the accuracy of total stuttering event counting.
METHOD: Four groups, each with 12 randomly allocated participants, completed a pretest-posttest design training study. They were evaluated by their counts of stuttering events on eight 3-min audio-visual speech samples from adults and children who stutter. Stuttering judgment training involved use of either the Stuttering Measurement System (SMS), Stuttering Measurement Assessment and Training (SMAAT) programs, or no training. To test for the reliability of any training effect, SMS training was repeated with the fourth group.
RESULTS:Both SMS-trained groups produced approximately 34% improvement, significantly better than no training or the SMAAT program. The SMAAT program produced a mixed result.
CONCLUSIONS:The SMS program was shown to produce a "medium" effect size improvement in the accuracy of stuttering event counts and that this improvement was almost perfectly replicated in a second group. Half of the SMAAT judges produced a 36% improvement in accuracy, but the other half showed no improvement. While additional studies are needed to demonstrate the durability of the reported improvements, these positive effects justify the importance of stuttering measurement training.
PMID: 25629956 [PubMed - as supplied by publisher]




The function of repeating: The relation between word class and repetition type in developmental stuttering - INFANTIL

Int J Lang Commun Disord. 2015 Jul 24. doi: 10.1111/1460-6984.12189. [Epub ahead of print]


Buhr AP, Jones RM, Conture EG, Kelly EM.

Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA.


BACKGROUND: It is already known that preschool-age children who stutter (CWS) tend to stutter on function words at the beginning of sentences. It is also known that phonological errors potentially resulting in part-word repetitions tend to occur on content words. However, the precise relation between word class and repetition type in preschool-age stuttering is unknown.

AIMS: To investigate repetitions associated with monosyllabic words in preschool-age CWS. Specifically, it was hypothesized that repetition type should vary according to word class in preschool-age CWS and children who do not stutter (CWNS).

METHODS & PROCEDURES: Thirteen preschool-age CWS and 15 preschool-age CWNS produced age-appropriate narratives, which were transcribed and coded for part-word repetitions (PWR) and whole-word repetitions (WWR) occurring on monosyllabic words. Each repetition type was also coded for word class (i.e., function versus content).

OUTCOMES & RESULTS: Results indicated that although CWS and CWNS were significantly more likely to produce PWR on content words, this tendency did not differ between the two talker groups. Further, CWS and CWNS did not differ in their tendencies to produce PWR versus WWR overall, but the tendency to produce repetitions on function words was significantly greater for CWS versus CWNS.

CONCLUSIONS & IMPLICATIONS: Findings are taken to suggest that repetitions of monosyllabic words in young children are not easily explained from the perspective of phonological errors, but may instead be considered from an incremental planning of speech perspective.

© 2015 Royal College of Speech and Language Therapists.

PMID: 26205205 [PubMed - as supplied by publisher]




The Influence of Methylphenidate on the Frequency of Stuttering: A Randomized Controlled Trial - FARMACOLOGIA

Ann Pharmacother. 2015 Jul 30. pii: 1060028015596415. [Epub ahead of print]


Rabaeys H, Bijleveld HA, Devroey D.

Vrije Universiteit Brussel; Université Libre de Bruxelles; Vrije Universiteit Brussel, Brussels, Belgium


BACKGROUND: Recently, a case report described a decrease in frequency of stuttering after intake of methylphenidate (MPH).

OBJECTIVE: This study was undertaken to investigate if this effect could again be reproduced in a population of young healthy male adult persons with developmental stuttering.

METHODS: A double-blind randomized crossover trial, with a 2-week washout period, including 15 Dutch-speaking young healthy persons with developmental stuttering, assessed the effects of a single dose of 20 mg MPH compared with placebo on stuttering. Dependent and 1-sample t tests were used to detect significant differences. The end point was the number of stutter moments and self-perceived improvement.

RESULTS: MPH yielded a significant decrease in the number of stutter moments when reading and speaking (P = 0.002), which was not the case with placebo (P = 0.090). There was a significant improvement from baseline after intake of MPH as compared with placebo (P = 0.003). Self-perceived improvement with MPH was not significantly better as compared with placebo (P = 0.28).

CONCLUSIONS: This study showed that the participants had an objective statistically significant decrease in the frequency of stuttering with MPH, and this was not the case with placebo. This was also the case for a reduction in stutter moments when reading out loud and speaking spontaneously. However, this result was not subjectively perceived by the participants.

PMID: 26228939 [PubMed - as supplied by publisher]


The neurological underpinnings of cluttering: Some initial findings. - TAQUIFEMIA
J Fluency Disord. 2015 Mar;43:1-16. doi: 10.1016/j.jfludis.2014.12.003. Epub 2015 Jan 8.

Ward D, Connally EL, Pliatsikas C, Bretherton-Furness J, Watkins KE.
The University of Reading, UK; Warneford Hospital, Oxford, UK; University of Oxford, Oxford, UK.

BACKGROUND: Cluttering is a fluency disorder characterised by overly rapid or jerky speech patterns that compromise intelligibility. The neural correlates of cluttering are unknown but theoretical accounts implicate the basal ganglia and medial prefrontal cortex. Dysfunction in these brain areas would be consistent with difficulties in selection and control of speech motor programs that are characteristic of speech disfluencies in cluttering. There is a surprising lack of investigation into this disorder using modern imaging techniques. Here, we used functional MRI to investigate the neural correlates of cluttering.
METHOD: We scanned 17 adults who clutter and 17 normally fluent control speakers matched for age and sex. Brain activity was recorded using sparse-sampling functional MRI while participants viewed scenes and either (i) produced overt speech describing the scene or (ii) read out loud a sentence provided that described the scene. Speech was recorded and analysed off line. Differences in brain activity for each condition compared to a silent resting baseline and between conditions were analysed for each group separately (cluster-forming threshold Z>3.1, extent p<0.05, corrected) and then these differences were further compared between the two groups (voxel threshold p<0.01, extent>30 voxels, uncorrected).
RESULTS: In both conditions, the patterns of activation in adults who clutter and control speakers were strikingly similar, particularly at the cortical level. Direct group comparisons revealed greater activity in adults who clutter compared to control speakers in the lateral premotor cortex bilaterally and, as predicted, on the medial surface (pre-supplementary motor area). Subcortically, adults who clutter showed greater activity than control speakers in the basal ganglia. Specifically, the caudate nucleus and putamen were overactive in adults who clutter for the comparison of picture description with sentence reading. In addition, adults who clutter had reduced activity relative to control speakers in the lateral anterior cerebellum bilaterally. Eleven of the 17 adults who clutter also stuttered. This comorbid diagnosis of stuttering was found to contribute to the abnormal overactivity seen in the group of adults who clutter in the right ventral premotor cortex and right anterior cingulate cortex. In the remaining areas of abnormal activity seen in adults who clutter compared to controls, the subgroup who clutter and stutter did not differ from the subgroup who clutter but do not stutter.
CONCLUSIONS: Our findings were in good agreement with theoretical predictions regarding the neural correlates of cluttering. We found evidence for abnormal function in the basal ganglia and their cortical output target, the medial prefrontal cortex. The findings are discussed in relation to models of cluttering that point to problems with motor control of speech.
EDUCATIONAL OBJECTIVES: This paper reports findings on the neural correlates seen in adults who clutter, and offers hypotheses as to how these might map onto the behaviours seen amongst those who clutter. Readers will be able to (a) identify the structures that are implicated in the disorder of cluttering, (b) understand arguments relating these structures to the behavioural expression of the disorder, (c) understand some of the complexities in interpreting data pertaining to recovery from cluttering, (d) understand where future efforts in research into the neurological correlates of cluttering should be focussed.
Copyright © 2015. Published by Elsevier Inc.
PMID: 25662409 [PubMed - in process]



The trajectory of gray matter development in Broca's area is abnormal in people who stutter. - NEUROCIÊNCIAS
Front Hum Neurosci. 2015 Mar 3;9:89. doi: 10.3389/fnhum.2015.00089. eCollection 2015.
Free full text - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347452/pdf/fnhum-09-00089.pdf

Beal DS, Lerch JP, Cameron B, Henderson R, Gracco VL, De Nil LF.
University of Alberta Edmonton, AB, Canada; University of Toronto Toronto, ON, Canada &
McGill University Montreal, QC, Canada.
The acquisition and mastery of speech-motor control requires years of practice spanning the course of development. People who stutter often perform poorly on speech-motor tasks thereby calling into question their ability to establish the stable neural motor programs required for masterful speech-motor control. There is evidence to support the assertion that these neural motor programs are represented in the posterior part of Broca's area, specifically the left pars opercularis. Consequently, various theories of stuttering causation posit that the disorder is related to a breakdown in the formation of the neural motor programs for speech early in development and that this breakdown is maintained throughout life. To date, no study has examined the potential neurodevelopmental signatures of the disorder across pediatric and adult populations. The current study aimed to fill this gap in our knowledge. We hypothesized that the developmental trajectory of cortical thickness in people who stutter would differ across the lifespan in the left pars opercularis relative to a group of control participants. We collected structural magnetic resonance images from 116 males (55 people who stutter) ranging in age from 6 to 48 years old. Differences in cortical thickness across ages and between patients and controls were investigated in 30 brain regions previously implicated in speech-motor control. An interaction between age and group was found for the left pars opercularis only. In people who stutter, the pars opercularis did not demonstrate the typical maturational pattern of gradual gray matter thinning with age across the lifespan that we observed in control participants. In contrast, the developmental trajectory of gray matter thickness in other regions of interest within the neural network for speech-motor control was similar for both groups. Our findings indicate that the developmental trajectory of gray matter in left pars opercularis is abnormal in people who stutter.
PMID: 25784869 [PubMed] PMCID: PMC4347452 

The Wayward Hawaiian Boy Returns Home - SOCIAL
Annu Rev Phytopathol. 2015 Apr 9. [Epub ahead of print]
Free Full Text - http://www.annualreviews.org/doi/pdf/10.1146/annurev-phyto-080614-120314

Gonsalves D
College of Agriculture and Life Sciences, Cornell University, Geneva, New York

This chapter represents a travelog of my life and career and the philosophical points I acquired along the way. I was born on a sugar plantation on the island of Hawaii and early on had a stuttering problem. I attended the Kamehameha Schools and received my BS and MS degrees from the University of Hawaii and my Ph.D. from the University of California at Davis. I link my life and career to various principles and events, some of which are: the importance of positioning oneself; going for the big enchilada; music, the international language; the red zone of biotechnology; the human side of biotechnology; the transgenic papaya story; and my leadership time at USDA in Hawaii. The guiding light throughout my career were the words from Drs. Eduardo Trujillo and Robert Shepherd, respectively, "Dennis, don't just be a test tube scientist, do something to help people" and "Now tell me, what have you really accomplished?" Expected final online publication date for the Annual Review of Phytopathology Volume 53 is August 04, 2015. Please see
http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
PMID: 25898280 [PubMed - as supplied by publisher]





Validation and evaluation of the Dutch translation of the Overall Assessment of the Speaker's Experience of Stuttering for School-age children (OASES-S-D). - AVALIAÇÃO

J Fluency Disord. 2015 May 31. pii: S0094-730X(15)00054-6. doi: 10.1016/j.jfludis.2015.05.003. [Epub ahead of print]


Lankman RS, Yaruss JS, Franken MC.

Erasmus University Medical Center, Rotterdam, The Netherlands; University of Pittsburgh, Pittsburgh, USA.


BACKGROUND:Stuttering can have a negative impact on many aspects of a speaker's life. Comprehensive assessment must therefore examine a range of experiences in order to reflect the overall impact of the disorder.

PURPOSE:This study evaluated the Dutch translation of the Overall Assessment of the Speaker's Experience of Stuttering - School-age (OASES-S; Yaruss & Quesal, 2010), which examines the impact of stuttering on the lives of children ages 7-12.

METHOD:The OASES-S was translated to Dutch (OASES-S-D) using a forward/backward translation process. Participants were 101 Dutch-speaking children who stutter (ages 7-12) who were recruited by speech-language therapists throughout the Netherlands. All participants completed the OASES-S-D, the Children's Attitudes about Talking-Dutch, a self-assessment of severity, a clinical assessment of severity, and a speech satisfaction rating. A control group of 51 children who do not stutter also completed the OASES-S-D to determine whether the tool could differentiate between children who stutter and children who do not stutter.

RESULTS:All sections of the OASES-S-D except section I surpassed a Cronbach's alpha of 0.70, indicating good internal consistency and reliability. Comparisons between the OASES-S-D and other tools revealed moderate to high associations. The OASES-S-D was able to discriminate between children who stutter and children who do not stutter and between participants with different levels of stuttering severity.

DISCUSSION:The OASES-S-D appears to be a reliable and valid measure that can be used to assess the impact of stuttering on 7- to 12-year old Dutch-speaking children who stutter.

EDUCATIONAL OBJECTIVES:The reader will be able to: (a) describe the purpose of the OASES-S-D measurement tool; (b) summarize the translation process used in creating the OASES-S-D; (c) summarize the aspects of stuttering measured in the different sections of the OASES-S-D; (d) describe with what measurement tools the validity of the OASES-S-D was investigated; and (e) describe the differences between the American-English version and Dutch translation of the OASES-S.

Copyright © 2015. Published by Elsevier Inc.

PMID: 26078208 [PubMed - as supplied by publisher]

Veridical and false recall in adults who stutter. - LINGUAGEM
J Speech Lang Hear Res. 2015 Feb 1;58(1):28-42. doi: 10.1044/2014_JSLHR-S-13-0301.

Byrd CT, Sheng L, Ratner NB, Gkalitsiou Z.

PURPOSE:This study used a false memory paradigm to explore the veridical and false recall of adults who stutter.
METHOD:  Twelve adults who stutter and 12 age-matched typically fluent peers listened to and then verbally recalled lists of words that consisted of either semantic or phonological associates or an equal number of semantic and phonological associates (i.e., hybrid condition) of a single, unpresented critical "lure" word. Three parameters of recall performance were measured across these 3 conditions: (a) number of accurately recalled words, (b) order of recall (primacy vs. recency effect), and (c) number of critical lures produced (i.e., false memories).
RESULTS:Significant group differences were noted in recall accuracy specific to list type and also list position as well as relative to critical lure productions.
CONCLUSIONS:Results suggest that certain basic memory processes (i.e., recency effect) and the processing of gist semantic information are largely intact in adults who stutter, but recall of verbatim phonological information and subvocal rehearsal may be deficient.
PMID: 25321141 [PubMed - in process]

Video self-modeling as a post-treatment fluency recovery strategy for adults. - TERAPIA
J Fluency Disord. 2015 Jan 24. pii: S0094-730X(15)00005-4. doi: 10.1016/j.jfludis.2015.01.003. [Epub ahead of print]

Harasym J, Langevin M, Kully D.
Institute for Stuttering Treatment & Research (ISTAR,; Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Canada.

PURPOSE: This multiple-baseline across subjects study investigated the effectiveness of video self-modeling (VSM) in reducing stuttering and bringing about improvements in associated self-report measures. Participants' viewing practices and perceptions of the utility of VSM also were explored.
METHODS: Three adult males who had previously completed speech restructuring treatment viewed VSM recordings twice per week for 6 weeks. Weekly speech data, treatment viewing logs, and pre- and post-treatment self-report measures were obtained. An exit interview also was conducted.
RESULTS: Two participants showed a decreasing trend in stuttering frequency. All participants appeared to engage in fewer avoidance behaviors and had less expectations to stutter. All participants perceived that, in different ways, the VSM treatment had benefited them and all participants had unique viewing practices.
CONCLUSION: Given the increasing availability and ease in using portable audio-visual technology, VSM appears to offer an economical and clinically useful tool for clients who are motivated to use the technology to recover fluency. Educational Objectives: Readers will be able to describe: (a) the tenets of video-self modeling; (b) the main components of video-self modeling as a fluency recovery treatment as used in this study; and (c) speech and self-report outcomes.
Copyright © 2015 Elsevier Inc. All rights reserved.

PMID: 25707576 [PubMed - as supplied by publisher]

White matter neuroanatomical differences in young children who stutter. - NEUROCIÊNCIAS
Brain. 2015 Mar;138(Pt 3):694-711. doi: 10.1093/brain/awu400. Epub 2015 Jan 24.

Chang SE, Zhu DC, Choo AL, Angstadt M.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

The ability to express thoughts through fluent speech production is a most human faculty, one that is often taken for granted. Stuttering, which disrupts the smooth flow of speech, affects 5% of preschool-age children and 1% of the general population, and can lead to significant communication difficulties and negative psychosocial consequences throughout one's lifetime. Despite the fact that symptom onset typically occurs during early childhood, few studies have yet examined the possible neural bases of developmental stuttering during childhood. Here we present a diffusion tensor imaging study that examined white matter measures reflecting neuroanatomical connectivity (fractional anisotropy) in 77 children [40 controls (20 females), 37 who stutter (16 females)] between 3 and 10 years of age. We asked whether previously reported anomalous white matter measures in adults and older children who stutter that were found primarily in major left hemisphere tracts (e.g. superior longitudinal fasciculus) are also present in younger children who stutter. All children exhibited normal speech, language, and cognitive development as assessed through a battery of assessments. The two groups were matched in chronological age and socioeconomic status. Voxel-wise whole brain comparisons using tract-based spatial statistics and region of interest analyses of fractional anisotropy were conducted to examine white matter changes associated with stuttering status, age, sex, and stuttering severity. Children who stutter exhibited significantly reduced fractional anisotropy relative to controls in white matter tracts that interconnect auditory and motor structures, corpus callosum, and in tracts interconnecting cortical and subcortical areas. In contrast to control subjects, fractional anisotropy changes with age were either stagnant or showed dissociated development among major perisylvian brain areas in children who stutter. These results provide first glimpses into the neuroanatomical bases of early childhood stuttering, and possible white matter developmental changes that may lead to recovery versus persistent stuttering. The white matter changes point to possible structural connectivity deficits in children who stutter, in interrelated neural circuits that enable skilled movement control through efficient sensorimotor integration and timing of movements.
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PMID: 25619509 [PubMed - in process]



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