Listener response to stuttering modification techniques

In two investigations, nonprofessional listeners used a 25-item bi-polar adjective scale to evaluate an adult male speaker who stuttered. In investigation one, 24 listeners evaluated the speaker during a Stuttering Only and a Stuttering + Cancellation condition. In investigation two, 50 listeners evaluated the speaker in a Stuttering Only and a Stuttering + Pullout condition. Listeners in the first investigation did not assign significantly different ratings to the Stuttering Only and Stuttering + Cancellation conditions. In the second investigation listeners rated the Stuttering Only condition more positively than the Stuttering + Pullout condition (p < 0.05). Analysis of listener response to four open-ended questions indicated significantly more positive reaction to the Stuttering Only condition than either of the Stuttering + Modification conditions. Finally, listeners rated the speaker using the cancellation and pullout techniques as being significantly more handicapped than when he was stuttering only. The findings provided preliminary evidence indicating that everyday listeners may react less favorably to an adult male speaker who is modifying his stuttered speech than when this same speaker is simply stuttering.     

Converting between word and syllable counts in children's conversational speech samples

Several authors have suggested that it is possible to convert between word and syllable counts for basic clinical measurements such as the frequency of speech disfluencies or speaking rate in conversational speech samples. Based primarily on results from adults' speech samples, proposed conversion factors have averaged approximately 1.5 syllables per word. Because children produce fewer multisyllabic words than adults, this conversion factor is probably not appropriate for children's speech samples. This study sought to develop a more accurate conversion factor for children's speech by comparing syllable and word counts in spontaneous speech samples produced by 50 children, age 3 to 5. Analyses revealed an average ratio of 1.15 syllables per word, which was consistent across different subjects, across subject groups (children who stutter and children who do not stutter) and also, somewhat surprisingly, across age groups (3-year olds, 4-year olds, and 5-year olds). Results suggest that this constant conversion factor of 1.15 can be used to convert between word and syllable with sufficient precision to allow clinicians to compare their data to published guidelines and benchmarks about childhood stuttering.     

Subjective distress associated with chronic stuttering

Stuttering is a chronic condition involving involuntary disruption to speech fluency. While elevated social anxiety has been found to be a risk factor for adults who have stuttered all their lives, it is unclear how stuttering influences other negative mood states such as interpersonal sensitivity and depressive mood. Consequently, controlled research was conducted that investigated negative affectivity across a number of domains in adults who stutter. Participants included 200 adults who have stuttered since childhood, with comparisons made to 200 non-stuttering controls of similar age and sex. The adults who stuttered were found to have significantly elevated levels of distress and negative mood states compared to the controls. As expected, significant differences were found for anxiety, however, significant and substantial differences were also found across a broad range of negative affect, including dimensions such as somatization, interpersonal sensitivity, depressive mood, hostility and paranoia. The implications of these findings for the better management of stuttering are discussed.Educational objectives: The reader will be able to describe: (a) the negative impact of a chronic disorder like stuttering on people who have stuttered all their life; (b) the factor structure of the SCL-90-R; (c) the negative affectivity construct, and (d) the difference between psychogenic theories of stuttering and neurological theories of stuttering.     

Perfectionism and stuttering: Findings of an online survey

PurposeUsing 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.MethodIn 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.ResultsBoth 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.ConclusionsThe 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.     

On childhood stuttering and the theory of clinging

In the treatment of stuttering I use the same therapeutic approach as with any other neurotic condition. I do not attempt to deal directly with the symptom, but try to make use of the child’s repetitive play to bring the damaging experience to the surface and to understand the underlying connections. This may, in part, be interpreted to the child. Difficulties to do with the need for an object (‘clinging’) are central. These are generally resolved spontaneously in a therapeutic relationship which offers security. Other problems, which manifest themselves in the negative transference, can be interpreted. Where the stuttering is long established and convulsive, it is not enough to understand the underlying dynamics. The child needs also to have repeated experience of spontaneous relaxation, e.g. in the course of joyful manual activity which can become a behaviour pattern (internalized). An important part of the therapeutic task is to deal with and relieve the anxiety of the mother. When the child has been stuttering for a time, a vicious circle can develop where the child’s stuttering induces anxiety in the mother and mother’s anxiety increases the child’s tendency to stutter. Case histories are used to illustrate the theme.     

Reprint of: stuttering treatment control using P300 event-related potentials

Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults.Educational objectives: The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.     

Listener perceptions of stuttering across two presentation modes: a quantitative and qualitative approach

The purpose of this study was to compare participants' quantitative and qualitative judgments of various forms and frequencies of stuttering, during either audiovisual or audio-only presentation modes. A total of 64 participants voluntarily agreed to participate in the study. Each participant was randomly assigned and exposed to only one of the four conditions of varying stuttering severity levels. The assigned speech sample was presented to the participant in either the audiovisual or audio-only mode. After watching or listening to the sample, participants completed a six-item Likert scale and were asked four open-ended questions. Comments made by listeners were developed into positive and negative comments as well as sorted into five theme clusters. The data analyses revealed a number of non-significant differences across mean Likert scale ratings for the six statements and for the number of positive and negative comments between the two presentation modes. However, the results provided partial support for the notion that as the frequency of stuttering increases, listeners tend to make increasingly more negative comments about the speaker. Additionally, there were no clear differences in comments across the five theme clusters between the two presentation modes. The findings suggest that the type of presentation mode does not appear to affect listeners' perceptions of stuttering to the same extent that stuttering severity does. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how listeners perceive and react to various frequencies of stuttering; (2) explain how audiovisual versus audio-only samples impact listener perceptions of stuttering and (3) provide examples of the ways in which qualitative data can enhance the understanding of how listeners react to various levels of stuttering.     

The effects of differential vowel prolongations on perceptions of speech naturalness

Prolongation of speech sounds is currently used to modify stuttering and enhance fluency. Prolonged speech (PS) (e.g., prolonged vowels, prolongation throughout utterances) is, however, often perceived as unnatural by listeners. This study examined at which durations and in which contexts 52 college students (primary language was American English) perceived PS to be unnatural. Stimuli were limited to controlled variation in prolongation of the vowel in the middle single-syllable word of a carrier phrase (i.e., say word again). The prolongation was effected by digital waveform manipulation within the Kay Elemetrics Computerized Speech Laboratory (CSL). The listeners judged if they strongly agreed, agreed, or disagreed that the phrases sounded natural. Results indicated that the extent of vowel duration (and possibly context) does influence listener's perception of speech naturalness, findings which can be applied to facilitate fluency therapy.

Educational objectives: (1) The reader will learn about and be able to summarize the digital waveform manipulation procedure in the study. (2) The reader will learn about and be able to describe the effects of differential vowel prolongation on listener's perception of speech naturalness. (3) The reader will learn about and evaluate how differential vowel prolongation can be used to enhance fluency.     

Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience

Purpose

To compare adults who stutter with and without support group experience on measures of self-esteem, self-efficacy, life satisfaction, self-stigma, perceived stuttering severity, perceived origin and future course of stuttering, and importance of fluency.

Method

Participants were 279 adults who stutter recruited from the National Stuttering Association and Board Recognized Specialists in Fluency Disorders. Participants completed a Web-based survey comprised of various measures of well-being including the Rosenberg Self-Esteem Scale, Generalized Self-Efficacy Scale, Satisfaction with Life Scale, a measure of perceived stuttering severity, the Self-Stigma of Stuttering Scale, and other stuttering-related questions.

Results

Participants with support group experience as a whole demonstrated lower internalized stigma, were more likely to believe that they would stutter for the rest of their lives, and less likely to perceive production of fluent speech as being highly or moderately important when talking to other people, compared to participants with no support group experience. Individuals who joined support groups to help others feel better about themselves reported higher self-esteem, self-efficacy, and life satisfaction, and lower internalized stigma and perceived stuttering severity, compared to participants with no support group experience. Participants who stutter as an overall group demonstrated similar levels of self-esteem, higher self-efficacy, and lower life satisfaction compared to averages from normative data for adults who do not stutter.

Conclusions

Findings support the notion that self-help support groups limit internalization of negative attitudes about the self, and that focusing on helping others feel better in a support group context is linked to higher levels of psychological well-being.Educational objectives: At the end of this activity the reader will be able to: (a) describe the potential psychological benefits of stuttering self-help support groups for people who stutter, (b) contrast between important aspects of well-being including self-esteem self-efficacy, and life satisfaction, (c) summarize differences in self-esteem, self-efficacy, life satisfaction, self-stigma, perceived stuttering severity, and perceptions of stuttering between adults who stutter with and without support group experience, (d) summarize differences in self-esteem, self-efficacy, and life satisfaction between adults who stutter and normative data for adults who do not stutter.     

The role of performance in the demands and capacities model

The Demands and Capacities Model (DCM) has become an influential framework for considering the factors that are believed to influence the development of stuttering in young children, even though several key aspects of the model have not been fully developed. Siegel (this issue, page 323) raised several valid concerns that must be addressed if the DCM is to achieve its potential for explaining childhood stuttering and suggested that the model would be improved if the elusive concept of capacities were replaced by the more concrete and measurable concept of performance. This paper proposes modifications to the DCM that may help to address several of Siegel's concerns and evaluates the role of performance in understanding the development of childhood stuttering. It is suggested that replacing capacity with performance does not solve the problems identified by Siegel, because implicit assumptions about the child's underlying abilities are still required if the model is to explain a breakdown in speaking performance. To address Siegel's concerns more directly, a different solution is proposed based on reframing the conceptual notions of demands and capacities in terms of measurable aspects of a child's speaking performance and speaking abilities.     

Fluency disruption in speech and in wind instrument playing

A case of an adult who stutters and complains of a similar fluency problem when playing the trombone is reported. This is the fourth such report, with previous cases involving trumpet, flute, and horn playing.     

An exploratory factor analysis of action responses to stuttering anticipation

PurposeWe previously introduced theStuttering Anticipation Scale (SAS; Jackson, E. S., Gerlach, H., Rodgers, N. H., & Zebrowski, P. M. (2018). My Client Knows That He’s About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? Seminars in Speech and Language, 39, 356–370) – a non-standardized self-report measure for children, teens, and adults who stutter (CWS, TWS, AWS) that quantifies how often they engage in 25 commonly reported action responses to anticipation. The purpose of this study was to leverage the SAS to explore the factor structure of action responses to stuttering anticipation.MethodsA total of 121 people who stutter completed the SAS online (27 CWS, 40 TWS, 54 AWS). We used exploratory factor analysis (EFA) to determine the underlying latent variables within the 25 SAS items that characterize how people who stutter respond to anticipation.ResultsA three-factor model was most appropriate for the data with regard to factor loadings and other model fit indices. The three factors were named: avoidance (17 items), physical change (4 items), and approach (4 items).ConclusionUnderstanding these three types of action responses to anticipation can help guide clinical decision-making by providing a novel framework for clinicians and their clients who stutter to discuss how the client tends to respond to anticipation, and explore ways to facilitate productive responses to anticipation.     

The frequency of simultaneous disfluency and phonological errors in children: A preliminary investigation

The frequency of simultaneous disfluency and phonological errors was examined in seven young English-speaking children exhibiting coexisting stuttering and phonological disorders. Data were gathered during 30 minutes of mother-child conversation and analyzed in three parts: (1) stuttering, (2) phonological errors, and (3) stuttering and phonological error co-occurrence. Results indicated that stuttering did not occur more frequently on syllables with phonological errors than on syllables without phonological errors. However, the frequency of disfluency on word-initial consonant clusters with phonological errors was significantly higher than on word-initial consonant clusters without phonological errors. Theoretical and clinical implications are discussed.     

Resilience in people who stutter: Association with covert and overt characteristics of stuttering

PurposeRecent literature stresses the importance of resilience, as a trait, for successful coping with life’s difficulties or stressors. However, only a limited number of studies were conducted on resilience among people-who-stutter (PWS). These studies did not examine the association between resilience and the specific characteristics of stuttering. This study was, therefore, aimed to directly examine the association between resilience and measures of both the covert and overt characteristics of stuttering.MethodThirty adults who stutter completed the Connor-Davidson Resilience Scale (CD-RISC) and the Overall Assessment of Speaker’s Experience of Stuttering - Adults (OASES-A). In addition, stuttering severity of all participants was quantified using the Stuttering Severity Instrument-4 (SSI-4). The associations between all measures were examined statistically.ResultsA strong and significant association was found between the participants' scores on the CD-RISC and the OASES-A (r= -.79, p < .001). In contrast, no significant correlation was found between the participants' scores in the CD-RISC and the SSI-4 (r = .02, p > .05). Within our cohort, no significant association was observed between the participants’ gender and age and their resilience levels (p > 0.05).ConclusionThis study demonstrates the role of resilience in shaping the individual's experience with stuttering. Results also show that the individuals' resilience levels do not necessarily predict stuttering severity per se, or its overt manifestations but can predict the individuals' subjective perception of his/her stuttering. This highlights the importance of addressing and promoting resilience among PWS in stuttering therapy.     

Health and human services for persons who stutter and education of logopedists in East-European countries

The International Association of Logopedics and Phoniatrics (IALP) assessed the therapy status of fluency disorders, service opportunities, and education of logopedists (speech-language pathologists) with a mail survey in Eastern Europe. Information was collected on the following aspects: incidence, prevalence, availability of information, non-therapeutic support for persons who stutter (PWS), providers of diagnostics and therapy, cooperating professionals, therapy approaches, forms, goals, financing, early detection and prevention, training of professionals, specialization in stuttering therapy, needs for improving the situation of PWS, and problems which hinder better care. Stuttering therapy for children is available in many countries and is frequently provided by the educational system. Therapy for adults is provided best by the health services but is not satisfactorily available everywhere. Modern therapeutic approaches coexist with obsolete ones. Lack of resources, awareness, entitlement, and assessment of therapy effectiveness are pervasive problems.

Educational objectives: Readers will be able to describe and evaluate: (1) the therapy status of fluency disorders and service opportunities in various East-European countries; (2) the training of logopedists (speech-language pathologists); (3) specialization in stuttering therapy; and (4) the organizational services for PWS within the health and human service systems.     

Treatment with medications affecting dopaminergic and serotonergic mechanisms: effects on fluency and anxiety in persons who stutter

Medications with dopamine antagonist properties, such as haloperidol, and those with serotonin reuptake inhibitor properties, such as clomipramine, have been shown to improve fluency. To examine the degree to which each of these two pharmacological mechanisms might independently affect fluency, a selective serotonin reuptake inhibitor, paroxetine, and a selective dopamine (D-2) antagonist, pimozide, were evaluated. Both types of medications also affect mood and anxiety, factors that could influence fluency levels. Therefore, we also evaluated the medications’ effects on generalized and speech-related anxiety and the relationships between changes in anxiety and changes in fluency in 11 subjects with a history of developmental stuttering. The randomized, double blind, placebo-controlled crossover study that was designed had to be terminated prior to completion due to severe side effects following withdrawal from paroxetine. Even with a reduced sample size (n = 6), significant improvement in percent fluent speaking time (p = 0.02) was found using a telephone task between baseline and pimozide (n = 6), with average duration of dysfluencies significantly shorter (p = 0.04) but no significant difference in the estimated number of dysfluencies per minute. This significant improvement was associated with non-significant increases in generalized anxiety, but non-significant decreases in speech-related anxiety. No significant differences were found in fluency between baseline and paroxetine (n = 5). These preliminary results suggest that fluency improvement is more likely to be mediated by dopaminergic rather than serotonergic mechanisms. Due to its side effects, however, pimozide may be considered a risk for treatment of stuttering.

Educational objectives: As a result of reading this paper the reader will describe and explain: (1) how medications may affect fluency and the rationale for selecting medications for treatment trials; (2) the interrelationship between fluency and anxiety; and (3) factors important in developing clinical trials using medications.     

Temperament and early stuttering intervention: Two perspectives

PurposeTo discuss clinical applications of research findings about temperament and early stuttering.MethodA “1000-bytes” format (Onslow & Millard, 2012) was used to provide readers with contemporaneous observation of a “conversation” between the authors. The conversation is proceeded by a prologue and followed by concluding statements from each author.ResultsOne author contended that comprehensive, multidimensional assessment of temperament domains is essential during clinical management of early stuttering, and the results of that assessment are best incorporated into a multifactorial treatment approach. The other author contested that view, arguing that such an approach is not empirically justifiable at present.ConclusionsThe authors agree about the salience of research on temperament and early stuttering but have different perspectives about the topic when applied to providing health care for early stuttering.