Acoustic measures of stutterers'' speech following an intensive therapy program

Characteristics of consonant-vowel duration and vocal fundamental frequency (F₀) are reported for 12 school-age stuttering males. Subjects' speech was recorded pre- and post- therapy and at 2-mo follow-up. Mean F₀ and voice onset time values remained stable from pretherapy to 2-mo follow-up, and an increase of 12% vocalized time was maintained across all posttherapy samples. It is suggested that increases in speech fluency may not be accompanied by changes in fundamental timing gestures. Increased speech fluency may be accomplished through increases in vocalized time permitting adjustments in motor sequencing which accompany stuttering.     

Fluency disorders in genetic syndromes

The characteristics of various genetic syndromes have included “stuttering” as a primary symptom associated with that syndrome. Specifically, Down syndrome, fragile X syndrome, Prader-Willi syndrome, Tourette syndrome, Neurofibromatosis type I, and Turner syndrome all list “stuttering” as a characteristic of that syndrome. An extensive review of these syndromes indicated clients diagnosed with these syndromes do show evidence of nonfluency patterns, but not all would be considered stuttering. Many of the syndromes are marked by degrees of mental retardation that probably contribute to a higher than average prevalence of stuttering, as well as a higher than average prevalence of other fluency disorders (when compared to the population at large).

An in-depth analysis of the available data indicates that some of these genetic syndromes show patterns of stuttering that may be indicative of only that syndrome (or similar syndromes) that can be differentially diagnosed from developmental stuttering. Among these patterns are the word-final nonfluencies noted in Prader-Willi syndrome; the presence of stuttering in the absence of secondary behaviors noted in Prader-Willi syndrome and; the presence of palilalia, word-final and word-medial nonfluencies, and word-medial and word-final nonfluencies in Tourette syndrome. Implications for future research are discussed in light of these findings.

Educational objectives: The reader will be able to: (1) describe the various different genetic syndromes that are associated with fluency disorders; (2) describe the types of nonfluencies that are associated with the major types of genetic syndromes that have fluency disorders; (3) describe the behaviors that may assist in differentially diagnosing different types of speech characteristics associated with various genetic syndromes.     

Electromyographic indications of laryngeal-area activity during stuttering expectancy

Using surface electrodes, mean microvolt values of laryngeal-area muscle activity were determined for 13 male and 6 female stutterers during 10-sec periods in which single words were silently read and stuttering expectancy was indicated. No significant differences in levels of laryngeal-area muscle activity were found between periods of fluency expectancy and stuttering expectancy preceding both fluent and stuttered speech. The results were interpreted as being nonsupportive of the hypothesis that a breakdown in stutterers' laryngeal-area muscle activity occurs during moments of stuttering expectancy. In addition, the results suggest that the most common rationale for the utilization of laryngeal biofeedback procedures to enhance fluency should be questioned.     

Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering

The treatment components that contribute to and account for successful therapeutic outcomes for people who stutter are not well understood and are debated by many. The purpose of this phenomenological study was to describe in detail the underlying factors that contribute to a successful or unsuccessful therapeutic interaction between clients and their clinicians. Twenty-eight participants, 19 men and 9 women, who had received from 6 months to more than 12 years of therapy for stuttering were studied. The participants were asked to consider their experience with one or more speech-language pathologists with whom they had received fluency therapy and to describe the characteristics that made that individual effective or ineffective in promoting successful change in their ability to communicate. Analysis of these data resulted in 15 primary categories. Finally, the essential structure of an effective and ineffective therapeutic interaction was described. Results highlighted the importance for effective therapy of understanding the stuttering experience, forming a positive client-clinician, alliance, and being knowledgeable about stuttering and its treatment. Educational objectives: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with an effective therapeutic interaction, (2) describe, from the perspective of a select group of adults who stutter, the themes associated with an ineffective therapeutic interaction, and (3) describe the ways in which an effective or ineffective therapeutic interaction could impact a person who stutters.     

The effect of manual movements on stuttering in individuals with down syndrome

PurposeStuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients’ needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.MethodEighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.ResultsThe experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.ConclusionIndividual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.     

Evaluation of an integrated fluency and Acceptance and Commitment Therapy intervention for adolescents and adults who stutter: Participant perspectives

PurposeChildhood-onset stuttering is a neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter. In addition to significant challenges in personal, social, and emotional domains, stuttering has been shown to impose an economic burden on adults who stutter. Intervention for adults who stutter has historically addressed speech fluency more so than the covert psychosocial aspects of the disorder. There is an identified clinical need for holistic, efficacious, and cost-effective stuttering interventions that meet consumer needs. The purpose of the present study is to evaluate a novel, integrated intervention that combined traditional fluency techniques with Acceptance and Commitment Therapy, from the perspective of the adults who stutter who participated in the intervention.MethodTwenty-eight adults who stutter completed the intervention program. Participants were invited to complete an online post-program written survey (including qualitative comments) and a semi-structured interview to explore their evaluations of the program with respect to its authenticity, acceptability, and social validity.ResultsParticipants perceived positive psychosocial changes as a result of the program, and were satisfied with the program overall. Qualitative thematic analyses of the written survey comments and the semi-structured interviews identified two major themes: factors specific to the intervention and factors specific to the therapeutic process. Several important sub-themes were also identified.ConclusionFindings support the authenticity, acceptability, and social validity of an integrated fluency and psychosocial intervention for stuttering. Findings also highlight the need for consideration of the consumer voice in the management of stuttering disorders, in keeping with person-centred care.     

Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency

The aim of the present study was to assess the effectiveness of an Acceptance and Commitment Therapy group intervention program for adults who stutter (N = 20). The program consisted of 2-h therapeutic sessions conducted weekly for eight consecutive weeks. It was an integrated program designed to improve: (a) psychosocial functioning, (b) readiness for therapy and change, (c) utilisation of mindfulness skills and psychological flexibility, and (d) frequency of stuttering. The findings provide innovative evidence for Acceptance and Commitment Therapy as an effective intervention with statistically significant improvements in psychosocial functioning, preparation for change and therapy, utilisation of mindfulness skills, and overall speech fluency. Follow-up data collected at three months post-treatment revealed that therapeutic gains were successfully maintained over time. These findings enhance the understanding of the impact of stuttering on psychological wellbeing and offer a new perspective on what might constitute successful stuttering treatment. Further, clinical research support is provided for Acceptance and Commitment Therapy delivered in a group format as a promising and novel intervention for adults who stutter.Educational objectives: The reader will be able to: (a) appreciate the potential for Acceptance and Commitment Therapy for adults who stutter; (b) identify the improvements participants experienced in psychosocial functioning and frequency of stuttered speech; (c) appreciate the six core processes of Acceptance and Commitment Therapy; and (d) appreciate the differences between an ACT model of intervention for adults who stutter compared to a CBT approach.     

The separate and combined effects of GSR biofeedback and delayed auditory feedback on stuttering: A preliminary study

The separate and combined effects of galvanic skin response biofeedback low wave amplitude self regulation (GSR LW) and amplified delayed auditory feedback (DAF) upon stuttering dysfluency are examined. Two college age male stutterers who were seen on an intensive longitudinal basis were the subjects in this study.Results suggest that GSR LW, when it is accomplished, functions to moderately but significantly reduce stuttering dysfluency compared to no GSR biofeedback. This effect does not noticeably dissipate over time. There occurred a marked and sustained reduction in stuttering dysfluency under DAF compared to no DAF conditions. Without separating accomplished and not accomplished GSR LW, there occurred slightly but not statistically significantly fewer blocks under the combined DAF-GSR LW condition than under DAF alone. Nevertheless, it does seem likely, considering these findings overall, that when GSR LW is accomplished, the fluency facilitating effect of its simultaneous combination with DAF is additive i.e., greater than either alone. Possible theoretical and therapeutic implications are discussed.     

Clinical notes: Masking devices and The Edinburgh Masker—Clinical applications within a prison setting

This paper outlines portions of the writer's therapeutics in the field of stuttering with emphasis upon use of masking the hearing of stutterers as a part of a total therapeutic approach. Commencing with devices providing continuous noise to override the voice of the stutterer so that he cannot hear himself and, thus, eliciting fluency. Described is the use of the voice actuated Edinburgh Auditory Masker within an intensive stuttering program in a prison setting since September 1978. It is concluded that the use of masking and the Edinburgh device has been helpful and productive with severe stutterers.     

The effect of fast speech rate on stuttering frequency during delayed auditory feedback

Delayed auditory feedback (DAF) has been documented to improve fluency in those who stutter. The increased fluency has been attributed to the slowed speech rate induced by DAF, but recent experiments have suggested that increasing the speech rate may also decrease stuttering under DAF. This investigation described the effect of combining a fast speech rate and DAF on the fluency of four people who stutter. Fluency of the two mildly dysfluent subjects was the same for both no DAF and DAF conditions at normal and at fast oral reading rates. In contrast, the two severely dysfluent subjects improved in fluency from the no DAF to the DAF conditions. They were found to be dysfluent at both normal and fast oral reading rates without DAF. The results of the study point to the need for further research on the relationship between speech rate and stuttering frequency under conditions of DAF and no DAF. EDUCATIONAL OBJECTIVES: Readers will learn about and be able to describe how the frequency of stuttering is affected by: (1) speech rates; (2) DAF; and (3) how stuttering severity influences such effects.     

Primary-school stutterers: Have attitudes changed?

How concerned are primary-school-aged stuttering children about their communication problem? What are the clinical implications of this concern?Fifteen years ago, Silverman (1970) suggested that primary-school-aged children who stuttered were not concerned about their disfluencies. A clinical implication of that report was that the interpreted lack of concern might negatively affect the children's motivation and desire for change in therapy. Scant research exists to support or refute this implication. While research is available on reactions to stuttering, pretherapeutic attitudes—especially those of children—have not been systematically reported. Guitar (1976) measured the pre-treatment attitudes of 38 adult stutterers and reported that, “those stutterers with more negative attitudes measured just prior to treatment, were most likely to have high levels of stuttering a year later, even though all subjects left therapy entirely fluent.” In related areas, research by Kolb, Winter, and Berlen (1968), McFall (1970), and McFall and Hammen (1971) has indicated that clients who are more motivated do better in behavior modification programs.Whether or not these findings may be generalized to children, in the midst of a developmental process, is purely speculative.     

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.     

A comparison of the Probe technique and conventional therapy for young stutterers

This study contrasted the gains made in speech theraphy by 39 stutterers, 15 of whom were treated by conventional methods and 24 by the Probe technique. It was found that the Probe technique yielded substantially greater gains in fluency than did the conventional method, having more influence on final performance than factors such as initial fluency, time since onset of stuttering, or the presence of other unacceptable behaviors.     

Stottern

Stuttering is a fluency disorder with a point prevalence of approximately 1%. Stuttering begins in childhood and is characterized by frequently occurring breaks in the flow of speaking. These fluency breaks are repetitions of words and syllables, prolongations of sounds and pauses. Many people who stutter show avoidance behaviors, social anxiety, shame and social withdrawal. Empirical studies point to genetic origins of the disorder; however, distinct physical deficits causing stuttering are not yet known. While most children outgrow stuttering before adolescence those who do not typically continue to stutter throughout their life. The severity of stuttering as well as its impact on the quality of life can be reduced by a combination of cognitive-behavioral therapy and speech-language therapy.     

The differential effect of three auditory stimuli on the frequency of stuttering behaviors

In view of the frequent clinical use of external auditory stimuli in fluency building programs, the purpose of the present experiment was to compare the effects of rhythmic pacing, delayed auditory feedback, and high intensity masking noise on the frequency of stuttering by dysfluency type. Twelve normal hearing young adult stutterers completed an oral reading (approximately 250 syllables) and conversational speech task (3 min) while listening to the three auditory stimuli and during a control condition presented in random order. The results demonstrated that during oral reading all three auditory stimuli were associated with significant reductions in stuttering frequency. However, during conversational speech, only the metronome produced a significant reduction in total stuttering frequency. Individual dysfluency types were not differentially affected by the three auditory stimuli.     

Are there constraints on childhood disfluency?

Analysis of the spontaneous speech of eight stuttering and eight normally fluent children reveals that (a) the location of both stuttering and normal disfluent moments is constrained by sentential constituent structure, and (b) stuttering children experience fluency breakdown with a particular type of constituent (verb phrase) not usually disfluently produced by normals. A view of early stuttering as a sentence planning and integration disorder is present.     

Exposure therapy for social anxiety disorder in people who stutter: An exploratory multiple baseline design

Background & objectives: Social anxiety disorder (SAD) is a debilitating condition, and approximately half of adults who stutter have SAD. Cognitive-behavioral therapy (CBT) has shown promise in decreasing social anxiety symptoms among adults who stutter, but exposure, arguably the essential component for successful CBT for SAD, has been understudied and underemphasized. Aims of this study were to develop an exposure therapy protocol designed specifically for people who stutter and have SAD and evaluate its potential efficacy in reducing social anxiety and stuttering severity using a multiple baseline design.Methods: Six participants received ten sessions of exposure therapy. Participants reported daily social anxiety, and social distress and stuttering severity were evaluated at major assessment points.Results: There were substantial reductions in social anxiety and considerable improvements in affective, behavioral, and cognitive experiences of stuttering. No consistent change was observed for stuttering frequency. Gains were mostly maintained after six-months.Conclusions: Results suggest that the novel exposure approach may decrease social distress, but not necessarily influence speech fluency. These findings underscore the importance of the assessment and treatment of SAD among adults who stutter and suggest that the integration of care between clinical psychologists and speech-language pathologists may prove beneficial for this population.     

In pursuit of fluency

It is suggested that fluent speech is a behavior that is relatively easy for the clinician to obtain from the majority of stuttering clients. Specific moments of stuttering, on the other hand, are often much more difficult to elicit. The rationale for this opinion and some therapeutic implications are discussed. Two areas of future research are advocated: (1) investigation of the conditions that appear to aid the clinician in eliciting moments of stuttering and (2) exploration into a phenomena that appears to be a basic component of the moment of stuttering-“loss of control.”     

The use of self-efficacy scaling in training student clinicians: Implications for working with stutterers

A scaling technique developed by Bandura for determining an individual's personal performance expectations (self efficacy) was applied to student clinicians working with stutterers. The self-efficacy scores of clinicians conducting treatment increased significantly while the scores of clinicians without treatment experience showed no significant change. As the student clinicians gained clinical experience there appeared to be a corresponding reduction in fear and avoidance of the treatment situation. Clinician fear concerning stuttering treatment appeared to have little relation to performance in treatment as rated by supervisors. The results indicate that self-efficacy scaling may be used to indicate clinician avoidance of working with stuttering clients.     

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.