Responses of adults who stutter to the anticipation of stuttering

PurposeMany people who stutter experience the phenomenon of anticipation—the sense that stuttering will occur before it is physically and overtly realized. A systematic investigation of how people who stutter respond to anticipation has not been previously reported. The purposes of this study were to provide self-report evidence of what people do in response to anticipation of stuttering and to determine the extent to which this anticipation occurs.MethodsThirty adults who stutter indicated on a Likert rating scale the extent to which they anticipate stuttering and answered three open-ended (written) questions regarding how they respond to anticipation.ResultsAll participants reported experiencing anticipation at least “sometimes,” and 77% of the participants reported experiencing anticipation “often” or “always.” The extent to which participants reported experiencing anticipation was not related to stuttering severity, impact, or treatment history. Analysis of written responses revealed 24 major categories, which were heuristically divided into action or non-action responses. Categories representing avoidance and self-management strategies were further divided into 14 and 19 subcategories, respectively. Participants were just as likely to view anticipation as helpful as they were to view it as harmful.ConclusionFindings demonstrate that most, if not all, adults who stutter experience anticipation, and the majority of adults who stutter report doing so at least often. Adults who stutter respond to this anticipation by altering the speech production process in various ways. Results highlight the importance of the role that anticipation plays in how stuttering behaviors manifest themselves.Educational Objectives: The reader will be able to: (a) summarize existing literature on the anticipation of stuttering; (b) describe the role and extent of anticipation of stuttering in adults; (c) describe the various ways that adults who stutter respond to anticipation; (d) describe the importance of measuring anticipation in clinical and research domains.     

Improving judgement with prepaid expert advice

Decision makers (“Judges”) often make decisions after obtaining advice from an Advisor. The two parties often share a psychological “contract” about what each contributes in expertise to the decision and receives in monetary outcomes from it. In a laboratory experiment, we varied Advisor Experitise and the opportunity for monetary rewards. As expected, these manipulations influenced advice quality, advice taking, and Judge post‐advice decision quality. The main contribution of the study, however, was the manipulation of the timing of monetary rewards (before or after the advising interaction). We found, as predicted, that committing money for expert—but not novice—advice increases Judges' use of advice and their subsequent estimation accuracy. Implications for advice giving and taking are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

The Lidcombe Program of early stuttering intervention for Malaysian families: Four case studies

PurposeThis study investigated the outcomes of implementing the Lidcombe Program, an evidence-based early intervention for stuttering, with four preschool children in Malaysia. Early stuttering intervention is currently underdeveloped in Malaysia, where stuttering treatment is often more assertion-based than evidence-based. Therefore, introducing an evidence-based early stuttering intervention is an important milestone for Malaysian preschoolers who stutter.MethodThe participants ranged from 3 years 3 months to 4 years 9 months at the start of the study. Beyond-clinic speech samples were obtained at 1 month and 1 week pretreatment and immediately post-Stage 1, and at 1 month, 3 months, 6 months and 12 months post-Stage 1.ResultsTwo participants, who were bilingual, achieved near-zero levels of stuttering at 12 months posttreatment. Near zero levels of stuttering were also present in their untreated languages. One participant withdrew due to reasons not connected with the research or treatment. The remaining participant, who presented with severe stuttering, completed Stage 1 but had some relapse in Stage 2 and demonstrated mild stuttering 12 months post-Stage 1.ConclusionsThe outcomes were achieved without the need to significantly adapt Lidcombe Program procedures to Malaysian culture. Further research to continue evaluation of the Lidcombe Program with Malaysian families and to estimate proportion of those who will respond is warranted.     

An experimental investigation of the impact of the Lidcombe Program on early stuttering

Preliminary Phase I and II trials for the Lidcombe Program of early stuttering intervention have found favorable outcomes and that the treatment is safe. Although speech-language pathologists (SLPs) often need to intervene with pre-schoolers' early stuttering, many of these children will recover at some time in the future without such intervention. Consequently, they need to know whether the Lidcombe Program's effect on stuttering is greater than that of natural recovery. Participants were 23 pre-school children who were randomly assigned to either a control group or a treatment group that received the Lidcombe Program for 12 weeks. A repeated measures ANOVA showed no main effect on stuttering for the group (control/treatment), a significant main effect for the measurement occasion (at the start and at the end of the treatment period), and a significant interaction between group and measurement occasion. Stuttering in the treatment group reduced twice as much as in the control group. These results are interpreted to mean that the introduction of the Lidcombe Program has a positive impact on stuttering rate, which exceeds that attributable to natural recovery.     

The effect of SpeechEasy on stuttering frequency in laboratory conditions

The effect of SpeechEasy on stuttering frequency during speech produced in a laboratory setting was examined. Thirteen adults who stutter participated. Stuttering frequencies in two baseline conditions were compared to stuttering frequencies with the device fitted according to the manufacturer's protocol. The fitting protocol includes instructions for deliberate use of vowel prolongation. Relative to the initial baseline condition, stuttering was reduced by 74%, 36%, and 49% for reading, monologue, and conversation, respectively. In comparison, stuttering was reduced by 42%, 30%, and 36%, respectively with the device in place, but before participants were instructed to deliberately prolong vowels. Examination of individual response profiles revealed that although stuttering reduced in the device compared to the baseline conditions during at least one of three speech tasks for most participants, degree and pattern of benefit varied greatly across participants. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) discuss recent research in altered auditory feedback that led to the development of SpeechEasy, (2) analyze and describe issues related to evaluating the treatment benefits of fluency aids, and (3) summarize the range of outcomes that were observed with SpeechEasy in this study.     

Mindfulness training in stuttering therapy: a tutorial for speech-language pathologists

The use of mindfulness training for increasing psychological well-being in a variety of clinical and nonclinical populations has exploded over the last decade. In the area of stuttering, it has been widely recognized that effective long-term management often necessitates treatment of cognitive and affective dimensions of the disorder in addition to behavioral components. Yet, mindfulness based strategies and their possible usefulness in stuttering management have not been described in detail in the literature. This article seeks to engage professionals who treat stuttering in a conversation about the possible usefulness of incorporating mindfulness training into stuttering management. A review of the literature reveals that there is a substantial overlap between what is required for effective stuttering management and the benefits provided by mindfulness practices. Mindfulness practice results in decreased avoidance, increased emotional regulation, and acceptance in addition to improved sensory-perceptual processing and attentional regulation skills. These skills are important for successful long-term stuttering management on both psychosocial and sensory-motor levels. It is concluded that the integration of mindfulness training and stuttering treatment appears practical and worthy of exploration. Mindfulness strategies adapted for people who stutter may help in the management of cognitive, affective, and behavioral challenges associated with stuttering.Educational objectives: Readers should be able to: (1) describe what mindfulness is and how it is cultivated; (2) identify the benefits that can be produced from mindfulness practice; (3) summarize how the benefits of mindfulness practice parallel what is often required for effective long-term stuttering management; and (4) identify specific mindfulness techniques that can be taught in stuttering therapy and explain their rationale.     

Effects of simulated stuttering on listener recall

In an investigation of the effects of simulated stuttering on listener recall, a presentation was varied on two factors: degree of stuttering (mild or severe) and information value of stuttered words (low or high). A control presentation featuring non-stuttered speech also was prepared. Five groups of 16 subjects were randomly assigned to, and participated in, one of the five listening conditions. Then they completed a 20-item recall test. A one-way analysis of variance revealed sognificant differences among the five conditions. Two-way analysis of variance disclosed no main effects. However, a significant interaction showed that recall was lowest in the severe stuttering-high information condition. The results are discussed in terms of attention to critical information.     

Early position and stuttering occurrence

Early sentence position is one of several features of verbal expression frequently reported to be associated with stuttering occurrence. Some studies also have reported the concurrence of these features with normal disfluencies. A review of the pertinent literature reveals that, among these features, early position is associated significantly more often with stuttering than with normal dysfluencies. Results of a study investigating stress patterns in the fluent utterances of stuttering and normal speakers yielded contrasts which speak pointedly to the relationship between early position and stuttering occurrence.     

Linguistic stress, within-word position, and grammatical class in relation to early childhood stuttering

The purpose of the present study was to investigate whether the link that has been established between stuttering and linguistic stress in adolescents and adults (the so-called stress effect) can also be observed in childhood stuttering. To account for confounding variables, both within-word position and grammatical class were measured, because these factors covary with linguistic stress. Speech samples of 22 preschool children (mean time of 9 months since onset of stuttering) were analyzed. The relative stress of each syllable was rated and syllables were categorized into long and short stressed, unstressed, and intermediately stressed syllables. Results showed that 97.8% of stuttering events occurred on first syllables of words and 76.5% on the first sound of syllables, that means a clear word-initial effect. Stuttering frequency on first syllables of function words was 16.9% and significantly higher than the frequency of stuttered first syllables of content words (11.5%). In function words short stressed syllables and intermediately stressed syllables were stuttered more often than unstressed syllables. The analysis for individual disfluency types revealed that, for function words, stuttering on short stressed syllables was associated with prolongations and syllable repetitions. However, in intermediately stressed syllables stuttering coincided most often with one-syllable word repetitions. This differentiation of the stress effect may suggest different causal mechanisms underlying these disfluency types. Educational objectives: The reader will learn about and be able to: (1) describe how within-word position, grammatical class, and linguistic stress effect stuttering frequency in preschool children who stutter; (2) explain how the occurrence of individual disfluency types depends on linguistic stress; (3) discuss how patterns of adults and preschool children who stutter differ in regard to these aspects.     

The impact of stuttering on employment opportunities and job performance

The purpose of this study was to examine the impact that stuttering has on job performance and employability. The method involved administration of a 17-item survey that was completed by 232 people who stutter, age 18 years or older. Results indicated that more than 70% of people who stutter agreed that stuttering decreases one's chances of being hired or promoted. More than 33% of people who stutter believed stuttering interferes with their job performance, and 20% had actually turned down a job or promotion because of their stuttering. Results also indicated that men and minorities were more likely to view stuttering as handicapping than were women and Caucasians. These findings suggest that people who stutter believe stuttering to be handicapping in the workplace. The results may be helpful for clinicians who work with people who stutter.

Educational objectives:

The reader will be able to: (1) describe the impact that stuttering can have on employability and job performance and (2) be better able to explain how factors such as gender, ethnicity, and stuttering severity can impact the belief that stuttering is a handicapping condition.     

The effects of self-disclosure and non self-disclosure of stuttering on listeners' perceptions of a person who stutters

The aim of this study was to examine listener perceptions of an adult male person who stutters (PWS) who did or did not disclose his stuttering. Ninety adults who do not stutter individually viewed one of three videotaped monologues produced by a male speaker with severe stuttering. In one monologue, 30 listeners heard the speaker disclose stuttering at the beginning and in another monologue, 30 listeners heard the speaker disclose stuttering at the end. A third group of 30 listeners viewed a monologue where no disclosure of stuttering occurred. After listeners viewed a monologue, they were asked to rate a set of six Likert scale statements and answer three open-ended questions. The results showed that only one of six Likert statements was significantly different across the three conditions. The only statement that was different was that the speaker was perceived to be significantly more friendly when disclosing stuttering at the end of the monologue than when not disclosing stuttering. There were no significant differences between the percentage of positive and negative comments made by listeners across the three conditions. Listeners' comments to each open-ended question showed they were comfortable listening to stuttering with or without disclosure and slightly more than half of the listeners believed their perceptions of the speaker did not change when he disclosed stuttering. The results also showed that the speaker who disclosed stuttering at the beginning of the monologue received significantly more positive listener comments than when he disclosed stuttering at the end of the monologue. Results are discussed relative to comparisons with the study, the clinical relevance of acknowledging stuttering as a component of treatment, and future research on the self-disclosure of stuttering. Educational objectives: The reader will be able to: (1) describe how different groups of listeners perceive and respond to two conditions of self-disclosure of stuttering and one condition involving non self-disclosure of stuttering; (2) summarize the range of listener responses to and benefits of self-disclosure of stuttering; and (3) describe the value of self-disclosure of stuttering for the listener and the speaker.     

Public attitudes toward—and identification of—cluttering and stuttering in Norway and Puerto Rico

PurposeThe study sought to compare public attitudes toward cluttering versus stuttering in Norway and Puerto Rico and to compare respondents’ identification of persons known with these fluency disorders.MethodAfter reading lay definitions of cluttering and stuttering, three samples of adults from Norway and three from Puerto Rico rated their attitudes toward cluttering and/or stuttering on modified versions of the POSHA-Cl (for cluttering) and POSHA-S (for stuttering). They also identified children and adults whom they knew who either or both manifested cluttering or stuttering.ResultsAttitudes toward cluttering were essentially unaffected by rating either cluttering only or combined cluttering and stuttering on the same questionnaire in both countries. The same was also true of stuttering. Attitudes were very similar toward both disorders although slightly less positive for cluttering. Norwegian attitudes toward both disorders were generally more positive than Puerto Rican attitudes. The average respondent identified slightly more than one fluency disorder, a higher percentage for stuttering than cluttering and higher for adults than children. Cluttering–stuttering was rarely identified.ConclusionGiven a lay definition, this study confirmed that adults from diverse cultures hold attitudes toward cluttering that are similar to—but somewhat less positive than—their attitudes toward stuttering. It also confirmed that adults can identify cluttering among people they know, although less commonly than stuttering. Design controls in this study assured that consideration of stuttering did not affect either the attitudes or identification results for cluttering.Educational objectives: The reader will be able to: (a) describe the effects—or lack thereof—of considerations of stuttering on attitudes toward cluttering; (b) describe differences in public identification of children and adults who either clutter or stutter; (c) describe differences between attitudes toward cluttering and stuttering in Norway and Puerto Rico.     

The recovery rate of early stuttering

PurposeAcross studies there is great variability in reported rates of stuttering recovery. This study examined the impact that different definitions of recovery had on calculation of recovery rates and factors associated with recovery within the same sample of children.MethodSpeech samples and parents and child reports of their experiences of stuttering were collected from 38 children who stuttered aged 2–5 years of age (Occassion-1) and again at 9–13 years of age (Occassion-2). Four different criteria for recovery that were developed representing variations in criteria reported in previous research were applied to data from these children.Results. The majority of the participants (82%) showed very little disfluent speech (<1% syllables stuttered) at Occasion 2. Recovery rate varied greatly depending on the criteria used, ranging from 13.2%–94.7%. Definitions ordered from least to greatest recovery that were (a) parent and clinician report no stuttering and no stuttering observed (13.2 %); (b) ≤1% syllables stuttered; severity rated at ≤1; parent, clinician, and child report recovery (55.3 %); (c) ≤1% syllables stuttered; severity rated at ≤1; parent and clinician report recovery (71.1 %); (d) <3.0 % syllables stuttered (94.7 %). Five participants were considered recovered and two were considered persistent stutters across all criteria. Different factors were associated with recovery from stuttering depending on the criterion used.ConclusionThe concept of recovery from stuttering is complex and estimations of recovery rate are likely to be greatly affected by differences in definitions and measurement across studies. This has a flow-on effect in determining the factors associated with recovery from stuttering.     

Stuttering, emotions, and heart rate during anticipatory anxiety: a critical review

Persons who stutter often report their stuttering is influenced by emotional reactions, yet the nature of such relation is still unclear. Psychophysiological studies of stuttering have failed to find any major association between stuttering and the activity of the sympathetic nervous system. A review of published studies of heart rate in relation to stressful speech situations indicate that adults who stutter tend to show a paradoxical reduction of heart rate compared with nonstuttering persons. Reduction of heart rate has also been observed in humans and mammals during anticipation of an unpleasant stimulus, and is proposed to be an indication of anticipatory anxiety resulting in a "freezing response" with parasympathetic inhibition of the heart rate. It is suggested that speech-related anticipatory anxiety in persons who stutter is likely to be a secondary, conditioned reaction based on previous experiences of stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how the autonomic nervous system is modulated by emotional responses; (2) explain how anticipatory fear often results in inhibition of heart rate due to parasympathetic activation; (3) discuss why emotional reactions in persons who stutter may be secondary to negative experiences of speech problems.     

INTERNAL STRUCTURE OF CONTENT WORDS LEADING TO LIFESPAN DIFFERENCES IN PHONOLOGICAL DIFFICULTY IN STUTTERING

This study investigated whether frequency of stuttering was affected by factors that specify the phonological difficulty of a sound and whether and how any influences vary across age groups. Analyses were performed separately on content words and function words. The phonological factors examined were: a) Whether the word contained a late emerging consonant (LEC); and b) Whether the word contained a consonant string (CS). Analyses showed that these factors occurred at different rates across the age groups used (children under 12, teenagers between 12 and 18, and adults). A more detailed breakdown was also reported of frequency of usage of LEC and CS over age groups depending on whether and where these factors occurred in the content words; all nine combinations of no LEC, word-initial LEC, non-initial LEC with no CS, word-initial CS, and non-initial CS were examined. Usage of certain of these nine categories varied over age groups. Friedman statistic on the ratio of stuttering (proportion of stuttered words in a particular word class divided by the proportion of words in that particular word class) showed that the frequency of stuttering remained high for adult speakers when CS and LEC both occurred in a word and when they appeared in word-initial position. These findings support a recently proposed theory that accounts for life-span changes in stuttering.     

An awareness approach to the covert symptoms of stuttering

Speech-language clinicians working with the confirmed stuttering client are often faced with the clinical management of the covert symptoms of stuttering in addition to the more observable and measurable overt symptoms. The authors report the successful use of awareness techniques to exaggerate the subjective experience of these covert symptoms and encourage the use of these techniques as an adjunct to the counseling and desensitization procedures traditionally employed. A transcribed clinical management session in which several awareness techniques are used to aid the client in an introspective examination of “anticipation of stuttering,” is analyzed in order to reach some specific recommendations for using awareness techniques in the clinical management of the covert symptoms of stuttering.