Dichotic speech perception: A comparison between stuttering and nonstuttering children

A stop consonant-vowel dichotic listening task was administered to 90 right- handed boys, 30 in each age group of 5, 7, and 9 yr. Half in each group were stutterers, half nonstutterers. Two and a half times as many stutterers as nonstutterers were found to display either a left-ear advantage (LEA) or no ear advantage (NEA). This finding suggested a greater tendency on the part of stutterers, as opposed to nonstutterers, for reversed or bilateral representation of the auditory speech areas of the brain. In addition, both stutterers and nonstutterers displayed significant developmental increases in the number of times they were able to identify both dichotic speech stimuli, thereby supporting the hypothesis of an age-related increase in children's total information processing capacity. The results are discussed in terms of the differences between stutterers and nonstutterers with respect to the issues of motor representation, cognitive modes, and higher-order linguistic processes.     

Programmed stuttering therapy for children: Comparison of four establishment programs

Four different establishment programs (programmed traditional, delayed auditory feedback, pause, and gradual increase in length and complexity of utterance) for improving the fluency of school-age children who stutter were compared. The programs were carried out by eight public school clinicians with 16 children (eight elementary and eight junior-senior high school) in their respective schools. All four programs produced important improvement in the speech fluency of the 16 children. All the children demonstrated transfer of fluency to extratraining settings. The delayed auditory feedback program required the least therapy hours, but it was difficult for the clinicians to operate correctly. The gradual increase in length and complexity of utterance programs produced the best overall results. The transfer and maintenance programs provided for additional generalization and permanency of fluency. Follow-up revealed that the children continued their increased level of fluency.     

The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

Educational objectives: The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.     

Living in two worlds: A personal appraisal

This statement was presented at a conference on pluralism at the centennial celebration of the World Parliament of Religions, in Chicago, on August 31 September 3, 1993. In doing so, I also had in mind the generosity of spirit of Prof. Max Charlesworth and his wife Stephanie for their vision of pluralist Australia.     

Efficacy of two behavioral treatment programs for comorbid geriatric insomnia

Older adults with comorbid insomnia and medical illness have been excluded from behavioral treatment research, but recent evidence suggested that such treatments would be effective with this population. In this study, 38 older adults with comorbid insomnia were randomized to 1 of 3 conditions: classroom cognitive-behavioral treatment (CBT), home-based audio relaxation treatment (HART), or delayed-treatment control. Compared to the control group, the CBT group had significant changes in 5 of 7 self-report measures of sleep at the 4-month follow-up. The HART group obtained significant outcomes on 3 of 7 measures. Wrist actigraphy measures and secondary-outcome measures did not yield significant findings for either treatment. Clinically significant changes at follow-up were obtained for 54% of patients in CBT, 35% in HART, and 6% in the control group when treatment dropouts were included. Although not as effective as in-person CBT, home interventions may have utility as a first-line, low-cost treatment.     

Evidence-based treatment of stuttering: II. Clinical significance of behavioral stuttering treatments

An evidence-based framework can be described as an empirically-driven, measurement-based, client-sensitive approach for selecting treatments. It is believed that using such a framework is more likely to result in a clinically significant outcome. For this paper, a clinically significant outcome was defined as a meaningful treatment change. It was suggested that there are at least three groups for whom a treatment's outcome is meaningful. These groups include clinicians/clinical researchers, the clients, and relevant others who have some interest in the outcome (e.g., parents of a child who stutters). The meaning and measurement of clinical significance was discussed for each of these three groups, based on research from the behavioral stuttering treatment literature. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) broadly define a clinically significant outcome and identify some of the groups who are interested in such an outcome and (2) describe how clinical significance has been evaluated in stuttering treatment within an evidence-based framework.     

Language task effects A comparison of stuttering and nonstuttering children

This study examined the effects of language-elicitation tasks and syntactic complexity on disfluencies of stuttering and nonstuttering children. The total disfluencies occurring on the production of imitated and modeled sentences of varying syntactic complexity was compared for the two groups. Results indicated a significant task effect, but nonsignificant complexity and group effects. Results are discussed within the framework of the “Demands and Capacities” model.     

Cleanliness and godliness: Mutual association between two kinds of personal purity

Purity rituals (such as baptism, mikvah, and ablution) are an important component of many religious practices. These practices not only help protect the faithful from physical contaminants, but also bestow symbolic purity and maintain the sanctity of sacred objects. The present work examines the association between religion and cleanliness, as two representations of personal purity. Religious primes were found to activate cleanliness concepts in a word-stem completion task (Study 1), and increased the subjective value of cleaning products (Study 2). In a final study, cleaning primes increased ratings of religious value. These studies suggest a mutual association between religiousness and cleanliness, and that each may activate the other as goals for personal purity.     

A two process memory-based account for mental and physical practice differences

The authors investigated the underlying processing structures for mental and physical practice. Participants mentally or physically performed 4 tasks during practice. Halfway through practice, 2 tasks were switched from mental to physical practice, or vice versa. After completing practice trials, participants performed 2 retention tests. The first retention test required memory retrieval and the second retention test reinstated the practice context and did not require memory retrieval. Measures of response initiation and execution showed discrepant findings suggesting that different processing structures underlie response initiation and execution during mental and physical practice. Findings for the switch conditions supported this interpretation suggesting that different neural structures may facilitate processing related to mental and physical practice.     

"Roadblocks" revisited: neural change, stuttering treatment, and recovery from stuttering

In light of emerging findings concerning untreated recovery and neural plasticity, this paper re-examines the viability of an NIH conference recommendation [Cooper, J. A. (1990). Research directions in stuttering: Consensus and conflict. In Cooper, J. A. (Ed.), Research needs in stuttering: Roadblocks and future directions (pp. 98-100). Rockville, MD: American Speech-Language-Hearing Association.] that adults who have recovered from stuttering might inform our understanding of the nature and treatment of persistent stuttering. It is suggested that those who have recovered could constitute a behavioral, cognitive, and neurophysiologic benchmark for evaluating stuttering treatment for adolescents and adults, while helping to identify the limits of recovery from a persistent disorder. This possibility seems especially promising because of findings from recent studies investigating untreated recovery during childhood and adulthood, the emerging evidence concerning neural plasticity and reorganization, and reports of neural system changes during stuttering treatment. Potential obstacles to applying findings from unassisted recovery to treatment do exist, but the benefits of attempts to fully understand stuttering certainly outweigh the difficulties. EDUCATIONAL OBJECTIVES: After completing this activity, the learner will be able to: (1) describe two complexities involved in determining whether recovery from stuttering was assisted or unassisted; (2) discuss the implications for stuttering research of two neural plasticity research findings from areas other than stuttering; and (3) evaluate the possible implications for stuttering treatment of a coordinated research program that addresses behavioral, cognitive, and neurological characteristics of assisted and unassisted recovery from stuttering.     

Assessment of the taste interaction between two qualitatively similar-tasting substances: a comparison between comparison rules

The taste interaction between sucrose and fructose was assessed by using three different comparison procedures: the summated response comparison, the factorial plot comparison, and the equimolar comparison rule. The perceived sweetness intensities were obtained on a ratio scale by using a functional measurement approach in combination with a two-stimulus procedure. The conclusions obtained from each of the three comparison rules were identical. The taste interaction between sucrose and fructose could be explained to a large extent, but not completely, by the apparent taste "interactions" within sucrose and fructose as single substances. It is argued that the apparent taste interaction within a large number of single sugars and between two of these sugars in a mixture is somewhat synergistic at low sweetness levels, additive at intermediate sweetness levels, and suppressive at high sweetness levels.     

Experimental treatment of early stuttering: a preliminary study

This pilot study compared two treatments for stuttering in preschool-age children. Thirty children were randomly assigned to either a Lidcombe Program (LP) treatment or a Demands and Capacities Model (DCM) treatment. Stuttering frequencies and severity ratings were obtained immediately before and after treatment (12 weeks). The stuttering frequencies and severity ratings significantly decreased for both treatment groups. No differences between groups were found. Parents of children in both groups were cooperative in many respects, and there were no differences between them on scales that measured their satisfaction with the two treatments. The findings suggest that randomized controlled trials of LP versus DCM treatments are feasible, and they underline the need for experimental analyses of the two treatments. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the principles and methods of Lidcombe treatment for early stuttering; (2) delineate principles and methods of Demands and Capacities Model treatment; and (3) summarize results of an investigation that compared these programs' relative effects in a pilot study.     

Getting the story right: a Reductionist narrative account of personal identity

A popular “Reductionist” account of personal identity unifies person stages into persons in virtue of their psychological continuity with one another. One objection to psychological continuity accounts is that there is more to our personal identity than just mere psychological continuity: there is also an active process of self-interpretation and self-creation. This criticism can be used to motivate a rival account of personal identity that appeals to the notion of a narrative. To the extent that they comment upon the issue, proponents of narrative accounts typically reject Reductionist metaphysics that (ontologically) reduce persons to aggregates of person stages. In contrast to this trend, we seek to develop a narrative account of personal identity from within Reductionist metaphysics: we think person stages are unified into persons in virtue of their narrative continuity with one another. We argue that this Reductionist version of the narrative account avoids some serious problems facing non-Reductionist versions of the narrative account.     

Evidence-based treatment of stuttering: IV. Empowerment through evidence-based treatment practices

Assertion-based treatments for stuttering have historically been more popular than evidence-based treatments. In this paper it is argued that the use of evidence-based treatments for stuttering is professionally empowering for clinicians, but that the use of assertion-based treatments is a circular process that inhibits professional development. The arguments in favor of evidence-based treatment are elaborated under headings of "professional investment," "professional development and diversity," and "optimizing treatment efficacy." EDUCATIONAL OBJECTIVES: The reader will understand and be able (1) to describe the distinction between assertion-based and evidence-based treatment practices (2) to present a series of arguments that evidence-based treatment practices are professionally empowering.