Stammering and therapy views of people who stammer

This study used a postal questionnaire to seek the views of adults who stammer concerning the effect of stammering on their lives, the speech and language therapy and other remedies they have tried, and their hopes for speech and language therapy in the future. The 332 returned questionnaires indicated that stammering had the greatest adverse effect on school life and occupation. Speech and language therapy had been helpful to many, but the nature of the benefits and specific therapies used were not cited in many responses. An emergent theme in unhelpful therapy was the dissatisfaction that arises when individual needs are not met. In the future, people want help in controlling stammering and in developing coping strategies. The desire for timely and effective therapy for children, ongoing help and for group or intensive work has implications for service organization and therapist's skills. The survey highlights the need for therapists and clients to negotiate therapy aims and procedures that are clearly defined, appropriate to individual needs, achievable, and, if possible, recorded and measured. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to list (1) the areas most and least affected by stammering, (2) the therapy approaches respondents had found helpful, and (3) other remedies that tried to help stammering.     

Treatment of stammering by reinforcement of fluent speech

A series of small experimental studies was conducted with three stammerers. The studies show that stammering may be controlled by positive reinforcement of fluent speech in a machine reading task. This new procedure for the treatment of stammering is convenient and effective in producing fluent speech in the laboratory. Evidence suggests some generalization of a stable kind to outside settings.

Stammering interrupts speech and disturbs communication. It has been treated by a variety of methods, ranging from physical assault on the speech organs, through procedures designed to establish new speech patterns, training in deliberate speech control, and masking of auditory feedback, to psychotherapy and behaviour therapy.

Negative practice has brought about improvement in up to a third of cases (Dunlap, 1932; Fishman. 333 1937; Sheehan, 1953; Lehner, 1954; Jones, 1955; Case, 1960). The other common form of behaviour therapy has usually involved negative reinforcement or punishment. Flanagan, Goldiamond and Azrin (1958) used a loud blast of noise every time subjects stammered. Stammering rate was markedly depressed during the aversive conditioning, but when the aversive conditions were discontinued, stammering rate showed a pronounced increase. More recently, Goldiamond (1965) used fluency to terminate a noxious stimulus and reported a reduction in stammering.     

A REVIEW OF THE CONTRIBUTION OF PERSONAL CONSTRUCT PSYCHOLOGY TO STAMMERING THERAPY

In the wake of Fransella's (1972) seminal application of Kellyian ideas to the understanding of stammering, the impact of personal construct psychology (PCP) upon speech and language therapists working in this area has been significant. This article reviews the literature and considers the developments in the management of stammering wrought through the application of PCP. A number of key issues relating to the meshing of traditional speech therapy methods and PCP are discussed and these are illustrated further by a specific personal clinical experience.     

Life experiences of people who stutter, and the perceived impact of stuttering on quality of life: personal accounts of South African individuals

The purpose of the study was to investigate the life experiences of a group of South African adults who stutter and the impact of stuttering on their quality of life. Participants were 16 adults with a mean age of 28.9 and ranging from 20 to 59 years. Methods involved individual interviews designed to explore the life domains of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues. Main findings of the study indicated that the majority of participants perceived their stuttering to have impacted on their academic performance at school, and relationships with teachers and classmates. Although their stuttering was not perceived to adversely influence their ability to establish friendships, people generally reacted negatively to their stuttering. Many felt that their stuttering did not have an adverse effect on their choice of occupation, ability to obtain work, and relationships with managers and co-workers, although it was perceived to influence their work performance and hamper their chances for promotion. Although the majority viewed their speech therapy experiences as being negative; more than half the sample believed that speech therapy had, nevertheless exerted a positive effect on their quality of life. Overall, stuttering did not appear to have influenced participants’ family and marital life. Most participants felt that stuttering had affected their self-esteem and self-image, and had evoked strong emotions within them. Findings are taken to suggest the need to incorporate subjective feelings about stuttering into the clinical practice of speech-language therapy; to provide information and coping strategies for teachers and employers; and for further research.

Educational objectives: After completing this activity, the reader will be able to: (1) describe and explain the perceived impact of stuttering on quality of life in terms of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues; (2) to interpret and utilize the subjective meanings that individuals attach to their stuttering to improve stuttering treatment, counseling and research.     

A comparative investigation of the speech-associated attitude of preschool and kindergarten children who do and do not stutter

The data of recent research studies have shown that by 3 years of age children show an awareness of dysfluency and that by at least the age of six, youngsters who stutter have a speech-associated attitude that is more negative than that of their peers. These findings led to the present study in which the KiddyCAT, a self-report measure, was used to compare the attitude toward speech of 45 children, between the age of three and six, who stuttered with that of 63 who did not. The data of this investigation showed that, as a group, the preschool and kindergarten children who stuttered had significantly more in the way of a negative attitude toward their speech than was found among their nonstuttering peers of the same age and gender. This finding is not consistent with the classically held position that the reactive aspects of stuttering do not generally develop until well after its onset. It suggests the need to measure, by standardized means, the speech-associated attitude of incipient stutterers and, when appropriate, to make the assessment and treatment of negative attitude toward speech a meaningful aspect of therapy.

Educational objectives: The reader will be able to: (1) describe the difference in the speech-associated attitude of preschoolers and kindergartners who do and do not stutter; (2) summarize what we currently know about self-report tests used to assess speech-related attitude among children as young as 3; and (3) evaluate the usefulness of assessing the belief system of children whose fluency is considered problematic.     

The role of self-regulation strategies and self-efficacy perceptions in successful weight loss maintenance

Abstract

The purpose of this study was to identify the self-regulatory strategies which people use to lose, maintain, or manage their weight, and to assess their self-efficacy perceptions to implement these strategies. Thirty-three (N = 33) undergraduate college students were divided into three groups based on their past weight loss experience and confirmed by their current Body Mass Index: (a) overweight participants who tried but failed to lose weight, (b) participants who used to be overweight but lost significant weight and kept it off for at least six months, and (c) participants with an optimal weight. All participants were interviewed using a structured questionnaire. Data were analyzed using a one-way ANOVA and correlation analyses. Participants who used self-regulatory strategies such as goal-setting, self-monitoring, self-evaluation, environmental structuring, time management, social assistance and information seeking were better able to maintain or lose weight. Overweight participants reported significantly less strategy use than participants who had lost weight or who had a healthy weight. In addition, overweight participants had lower self-efficacy perceptions about implementing strategies than did healthy weight participants or participants who had successfully lost weight. Finally, a path analysis revealed that participants who reported high self-efficacy perceptions and applied their strategies persistently in the face of difficulties were more likely to successfully manage their weight.     

Differential levels of speech and manual dysfluency in adults who stutter during simultaneous drawing and speaking tasks

We examined the disruptive effects of stuttering on manual performance during simultaneous speaking and drawing tasks. Fifteen stuttering and fifteen non-stuttering participants drew continuous circles with a pen on a digitizer tablet under three conditions: silent (i.e., neither reading nor speaking), reading aloud, and choral reading (i.e., reading aloud in unison with another reader). We counted the frequency of stuttering events in the speaking tasks and measured pen stroke duration and pen stroke dysfluency (normalized jerk) in all three tasks. The control group was stutter-free and did not increase manual dysfluency in any condition. In the silent condition, the stuttering group performed pen movements without evidence of dysfluency, similar to the control group. However, in the reading aloud condition, the stuttering group stuttered on 12% of the syllables and showed increased manual dysfluency. In the choral reading condition stuttering was virtually eliminated (reduced by 97%), but manual dysfluency was reduced by only 47% relative to the reading aloud condition. Trials where more stuttered events were generally positively correlated with higher manual dysfluency. The results are consistent with a model in which episodes of stuttering and motor dysfluency are related to neural interconnectivity between manual and speech processes.     

Recounting the K-12 school experiences of adults who stutter: a qualitative analysis

This study qualitatively explored the primary and secondary (K-12) school experiences of adults who stutter. The primary investigator conducted semi-structured interviews with 11 participants, a first focus group interview with 6 participants, and a second focus group interview with 4 participants. Participants discussed the various ways in which stuttering affected their personality; emotional and psychological experiences in the context of school; academic and learning experiences; classroom participation; teacher and peer relationships; speech therapy experiences; school activity involvement; and post-educational experiences. Results suggest that school is a complex cultural environment in which students must engage on academic and social levels. People who stutter may experience observable and unobservable challenges as they navigate the complexity of school. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (1) provide a rationale for the need to explore the school experiences of people who stutter; (2) describe the major themes associated with the school experiences of participants in the study; and (3) discuss how knowledge of school experiences can be useful to classroom teachers and speech-language pathologists.     

Self-efficacy beliefs: Experiences of adults who stutter

PurposeChildhood-onset stuttering is a complex and multifaceted disorder. Intervention for adults who stutter has historically addressed speech fluency more so than psychosocial aspects of the disorder, including the nature of the individual’s self-efficacy beliefs concerning their confidence in their capacity to enact change. Self-efficacy is an important construct related to quality of life, resilience, and maintenance of treatment gains for adults who stutter. The purpose of this qualitative study is to explore the nature of the self-efficacy beliefs expressed by adults who stutter in order to inform efficacious and holistic intervention for these individuals.MethodSemi-structured interviews were conducted with 29 adults who stutter to describe their experiences as a person who stutters and elucidate the nature of their self-efficacy beliefs.ResultsThematic analysis identified several major themes that provided novel insight into the complex nature of the self-efficacy beliefs experienced by adults who stutter: speaker experiences shaped communicative confidence, there was a conflict between communication and fluency, stuttering was viewed as more than fluency, and individual perspectives shaped communicative confidence, as did the pervading influence of self. The notion that fluency and confidence are inextricably linked was evident within and across each major theme.ConclusionThese preliminary findings provide further support for a multidimensional approach to the treatment of adults who stutter. Findings will be used to inform a novel integrated fluency and psychosocial intervention for adults who stutter that addresses fluency and self-efficacy concurrently, with a view of engendering durable improvements in speech fluency and communicative confidence.     

The effectiveness of SpeechEasy during situations of daily living

A multiple single-subject design was used to examine the effects of SpeechEasy on stuttering frequency in the laboratory and in longitudinal samples of speech produced in situations of daily living (SDL). Seven adults who stutter participated, all of whom had exhibited at least 30% reduction in stuttering frequency while using SpeechEasy during previous laboratory assessments. For each participant, speech samples recorded in the laboratory and SDL during device use were compared to samples obtained in those settings without the device. In SDL, stuttering frequencies were recorded weekly for 9-16 weeks during face-to-face and phone conversations. Participants also provided data regarding device tolerance and perceived benefits. Laboratory assessments were conducted at the beginning and the end of the longitudinal data collection in SDL. All seven participants exhibited reduced stuttering in self-formulated speech in the Device compared to No-device condition during the first laboratory assessment. In the second laboratory assessment, four participants exhibited less stuttering and three exhibited more stuttering with the device than without. In SDL, five of seven participants exhibited some instances of reduced stuttering when wearing the device and three of these exhibited relatively stable amounts of stuttering reduction during long-term use. Five participants reported positive changes in speaking-related attitudes and perceptions of stuttering. Further investigation into the short- and long-term effectiveness of SpeechEasy in SDL is warranted. Educational objectives: The reader will be able to summarize: (1) issues pertinent to evaluating treatment benefits of wearable fluency aids and evaluate (2) the effect of SpeechEasy on stuttering frequency and the perceived benefits of device use in situations of daily living, as assessed weekly over the course of 9-16 weeks of wear, for seven adults who stutter.     

Different Effects of Dual Task Demands on the Speech of Young and Older Adults

Abstract

Young and older adults provided language samples in response to elicitation questions while concurrently performing 3 different tasks. The language samples were scored on three dimensions: fluency, grammatical complexity, and content. Previous research has shown that older adults use a restricted speech register that is grammatically less complex than young adults’ and has suggested that this restricted speech register is buffered from the costs of dual task demands. This hypothesis was tested by comparing language samples collected during a baseline condition with those produced while the participants were performing the concurrent tasks. The results indicate that young and older adults adopt different strategies when confronted with dual task demands. Young adults shift to a restricted speech register when confronted with dual task demands. Older adults, who were already using a restricted speech register, became less fluent although the grammatical complexity and informational content of their speech was preserved. Hence, some but not all aspects of older adults’ speech are buffered from dual task demands.     

Factors affecting occupational advice for speakers who do and do not stutter

Factors affecting perceptions of occupational suitability were examined for speakers who stutter and speakers who do not stutter. In Experiment 1, 58 adults who do not stutter heard one of two audio recordings (less severe stuttering, more severe stuttering) of a speaker who stuttered. Participants rated the speaker's communicative functioning, personal attributes, and suitability for 32 occupations, along with perceptions of the occupations' speaking demands and educational requirements. Perceived speaking demand strongly affected occupational suitability ratings at both levels of stuttering severity. In Experiment 2, 58 additional adults who do not stutter heard a recording of another adult in one of two conditions (fluent speech, pseudo-stuttering), and provided the same ratings as in Experiment 1. In the pseudo-stuttering condition, participants' perceptions of occupational speaking demand again had a strong effect on occupational suitability ratings. In the fluent condition, suitability ratings were affected primarily by perceived educational demand; perceived speaking demand was of secondary importance. Across all participants in Experiment 2, occupational suitability ratings were associated with ratings of the speaker's personal attributes and communicative functioning. In both experiments, speakers who stuttered received lower suitability ratings for high speaking demand occupations than for low speaking demand occupations. Ratings for many high speaking occupations, however, fell just below the midpoint of the occupational suitability scale, suggesting that participants viewed these occupations as less appropriate, but not necessarily inappropriate, for people who stutter. Overall, the findings support the hypothesis that people who stutter may face occupational stereotyping and/or role entrapment in work settings. EDUCATIONAL OBJECTIVES: At the end of this activity the reader will be able to (a) summarize main findings on research related to the work-related experiences of people who stutter, (b) describe factors that affect perceptions of which occupations are best suited for speakers who stutter and speakers who do not stutter, and (c) discuss how findings from the present study relate to previous findings on occupational advice for people who stutter.     

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.     

自然情境下舌尖效应的认知年老化——日记研究

舌尖效应是一种话到嘴边却说不出来的单词提取失败现象(Tip-of-the-Tongue, TOT)。本研究通过TOT回溯问卷和日记记录方法对青年人和老年人进行了为期28天的追踪, 考察了自然情境下舌尖效应认知年老化的发生特点及机制。结果表明：(1)自然情境下TOT存在认知老化现象, 老年人TOT发生频率比青年人更高; (2) TOT发生时, 个体存在替代词和语义相关信息的提取, 且青年人比老年人产生了更强烈的兴奋感和疲惫感的元认知体验; (3) TOT发生后目标词几乎都能获得提取, 老年人TOT的解决时间比青年人长, 但其解决率无年龄差异。TOT的解决时间受目标词熟悉性、是否存在替代词和个体主观体验的认知和元认知因素影响。(4)对TOT认知状态和元认知状态的记录会影响后续发生TOT的状态, 且延长其解决时间, 表明被试付出了更多努力和时间解决TOT。TOT的认知状态和元认知状态的因素都对TOT的解决时间产生了影响。     

Neuromotor speech deficits in children and adults with spina bifida and hydrocephalus

Acquired cerebellar lesions are associated with motor speech deficits. Spina bifida with hydrocephalus (SBH) is a neurodevelopmental disorder that involves significant dysmorphology of the cerebellum. Videotaped narratives produced by 40 children and adults with SBH and their 40 age-matched controls were coded for three motor speech deficits: dysfluency, ataxic dysarthria (articulatory inaccuracy, prosodic excess, and phonatory-prosodic insufficiency) (Brown, Darley, & Aronson, 1970; Darley, Aronson, & Brown, 1969a), and speech rate. Individuals with SBH had more motor speech deficits than controls. Dysfluency was related to an interaction between chronological age and SBH. Speech rate was related independently to chronological age and SBH. Ataxic dysarthria was related to the biology of SBH, and was associated with both physical phenotype (level of spinal cord lesion) and medical history (number of shunt revisions). The data show that developmental as well as acquired lesions of the cerebellum disrupt motor speech, and add to the developmental role of the cerebellum in the automatization of motor skills, including speech.     

Changes in stuttering in relation to children's locus of control

The locus of control of stuttering children before, during, and after treatment for dysfluency was investigated. Subjects participated in a one-week program combining delayed auditory feedback and training of parents to negotiate and implement contracts for their child's practice of stutter-free speech skills. The Children's Nowicki-Strickland Scale was used to measure locus of control before, immediately after, two months after, and six months after the training. Measures of speech dysfluency were available at each of these times and documented the effectiveness of treatment in reducing stuttering. The locus of control scores for stuttering children prior to treatment were comparable to normative groups. Internality on the locus of control measure prior to treatment was directly related to degree of change in dysfluency immediately following the one-week clinic, but not to dysfluency levels at the 2-month or 6-month follow-up sessions. Concomitant with improved speech, the children became progressively more internal following treatment. The results suggest that participation in a behavioral program for the treatment of stuttering increases internality.     

Phonological priming in adults who stutter

The purpose of this study was to compare the speed of phonological encoding between adults who stutter (AWS) and adults who do not stutter (ANS). Fifteen male AWS and 15 age- and gender-matched ANS participated in the study. Speech onset latency was obtained for both groups and stuttering frequency was calculated for AWS during three phonological priming tasks: (1) heterogeneous, during which the participants' single-word verbal responses differed phonemically; (2) C-homogeneous, during which the participants' response words shared the initial consonant; and (3) CV-homogeneous, during which the participants' response words shared the initial consonant and vowel. Response words containing the same C and CV patterns in the two homogeneous conditions served as phonological primes for one another, while the response words in the heterogeneous condition did not. During each task, the participants produced a verbal response after being visually presented with a semantically related cue word, with cue-response pairs being learned beforehand. The data showed that AWS had significantly longer speech onset latency when compared to ANS in all priming conditions, priming had a facilitating effect on word retrieval for both groups, and there was no significant change in stuttering frequency across the conditions for AWS. This suggests that phonological encoding may play no role, or only a minor role, in stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe previous research paradigms that have been used to assess phonological encoding in adults and children who stutter; (2) explain performance similarities and differences between adults who do and do not stutter during various phonological priming conditions; (3) compare the present findings to past research that examined the relationship between phonological encoding and stuttering.