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.     

A welfare economic approach to measure outcomes in stuttering: Comparing willingness to pay and quality adjusted life years

PurposeThe purpose of this study was to compare two welfare outcome measures, willingness to pay (WTP) and quality adjusted life years (QALYs) gained, to measure outcomes in stuttering.MethodSeventy-eight adult participants (74 nonstuttering and 4 persons with stuttering) completed one face-to-face structured interview regarding how much they would be willing to pay to alleviate severe stuttering in three interventions of varying impact. These data were compared with QALYs gained as calculated from time trade off (TTO) and standard gamble (SG) data.ResultsMean (median) WTP bids ranged from US$ 16,875 (8000), for an intervention resulting in improvement from severe stuttering to mild stuttering, to US$ 41,844 (10,000) for an intervention resulting in a cure of severe stuttering. These data were consistent with mean changes in QALYs for the same stuttering interventions ranging from 2.19 (using SG) to 18.42 (using TTO).ConclusionsThis study presents the first published WTP and QALY data for stuttering. Results were consistent with previous cost-of-illness data for stuttering. Both WTP and QALY measures were able to quantify the reduction in quality of life that occurs in stuttering, and both can be used to compare the gains that might be achieved by different interventions. It is widely believed that stuttering can cause reduced quality of life for some speakers; the introduction into this field of standardized metrics for measuring quality of life is a necessary step for transparently weighing the costs and consequences of stuttering interventions in economic analyses.Educational objectives: The reader will be able to (a) describe the underlying theoretical foundations for willingness to pay and quality adjusted life years, (b) describe the application of willingness to pay and quality adjusted life years for use in economic analyses, (c) compare and contrast the value of willingness to pay and quality adjusted life years in measuring the impact of stuttering treatment on quality of life, (d) interpret quality adjusted life years, and (e) interpret willingness to pay data.     

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

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

Effect of word phonetic properties on stuttering anticipation and speech production in adults who stutter

PurposeStuttering anticipation is a significant factor in an individual’s stuttering experience. People who stutter have reported words and sounds that they anticipate stuttering on. Attempts at understanding the association between stuttering anticipation and stuttering outcomes and the impact of phonetic properties on stuttering anticipation and overt stuttering have been insufficiently examined. This study aims to address these important issues.MethodsData were collected as part of a larger brain imaging study. Twenty adults who stutter rated a 414 word-list on stuttering anticipation. Participant-specific ‘high’ and ‘low’ anticipated words were selected. Twelve of the 20 participants returned for a second session 2–11 weeks later, during which they read the selected words again and stuttering occurrence was recorded.ResultsAmong the 20 participants, three sub-groups with “high” (N = 6), “moderate” (N = 5) and “low” (N = 9) stuttering anticipation were identified. Significant “high stuttering” anticipation was found on consonants, plosives, bilabials and alveolars, as well as labials and coronals. In 5 of the 8 participants who stuttered during session 2, more than 80 % of words stuttered were previously rated with high anticipation. Consonants, plosives, bilabials and alveolars, and labials and coronals were the most frequently stuttered (>27 %).ConclusionWhile not all adults who stutter demonstrate high word-specific stuttering anticipation, we found that more than half anticipated this to a high degree. Furthermore, both word-specific phonetic properties and stuttering anticipation impact stuttering occurrence. The inclusion of word-specific stuttering anticipation ratings may increase the likelihood of stuttering in experimental studies and improve treatment outcomes through individualized intervention.     

Analysis of five cases with neurogenic stuttering following brain injury in the basal ganglia

This study examined stuttering patterns in five patients with basal ganglia injury. None of the patients had a history of developmental stuttering. Four patients were right-handed; one patient was ambidextrous. Stuttering tests administered to patients assessed sentence repetition, reading aloud, explanations of a comic strip, and conversation. Accessory behaviors such as facial grimaces, associated movements of the limbs, and avoidance behaviors were observed. The results of this study differ from those of previous studies of neurogenic stuttering in several respects: (1) blocks were frequently observed. (2) Adaptation was observed. (3) Almost all stuttering occurred at the initiation of words. (4) Across patients, stuttering frequency did not vary in a consistent manner with speaking task. New speech characteristics for neurogenic stuttering without aphasia following injury to the basal ganglia are described.Educational objectives: After reading this text, the reader will be able to: (1) provide characteristics of neurogenic stuttering after the basal ganglia in patients without aphasia; (2) discuss the difference of the features and characteristics of stuttering between previously reported patients and present patients.     

Is overt stuttered speech a prerequisite for the neural activations associated with chronic developmental stuttering?

Four adult right-handed chronic stutterers and four age-matched controls completed H(2)(15)O PET scans involving overt and imagined oral reading tasks. During overt stuttered speech prominent activations occurred in SMA (medial), BA 46 (right), anterior insula (bilateral), and cerebellum (bilateral) plus deactivations in right A2 (BA 21/22). These activations and deactivations also occurred when the same stutterers imagined they were stuttering. Some parietal regions were significantly activated during imagined stuttering, but not during overt stuttering. Most regional activations changed in the same direction when overt stuttering ceased (during chorus reading) and when subjects imagined that they were not stuttering (also during chorus reading). Controls displayed fewer similarities between regional activations and deactivations during actual and imagined oral reading. Thus overt stuttering appears not to be a prerequisite for the prominent regional activations and deactivations associated with stuttering.     

Middle school students' perceptions of a peer who stutters

Little is known about how middle school students perceive a similar-aged peer who stutters. Therefore, the purpose of this study was to examine the influence of stuttering frequency, Likert statement type (affective, behavioral, cognitive), and the gender of the listener on middle school students' perceptions of a peer who stutters. Sixty-four middle school students (10-14 years) individually viewed a video sample of a teen telling a joke at one of four stuttering frequencies (<1%, 5%, 10%, 14%). After the students viewed one of the video samples, they were asked to rate 11 Likert statements that reflected their affective, behavioral, and cognitive perceptions of a peer who stuttered. The results revealed an interaction between stuttering frequency and Likert statement type. Ratings of behavioral statements (speech production characteristics) were significantly more positive for the sample containing <1% stuttering than 10% and 14% stuttering. Ratings for cognitive statements (thought and beliefs) were significantly more positive for the sample containing <1% stuttering than 10% and 14% stuttering. The stuttering frequency of the peer did not significantly influence how students rated affective statements (feelings and emotions). It was also found that male and female middle school students did not significantly differ in their perceptions of a male peer who stutters. Clinical implications are discussed relative to peer teasing, friendship, listener comfort, and social acceptance within a middle school setting for a student who stutters. Future research directions are also discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize how middle school students perceive stuttering; (2) explain how the frequency of stuttering influences middle school students' perceptions of a peer who stutters; and (3) provide clinical implications of the data from this study.     

Overall Assessment of the Speaker's Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment

This paper describes a new instrument for evaluating the experience of the stuttering disorder from the perspective of individuals who stutter. Based on the World Health Organization's International Classification of Functioning, Disability, and Health [World Health Organization (2001). The International Classification of Functioning, Disability, & Health. Geneva: World Health Organization], the Overall Assessment of the Speaker's Experience of Stuttering (OASES) collects information about the totality of the stuttering disorder, including: (a) general perspectives about stuttering, (b) affective, behavioral, and cognitive reactions to stuttering, (c) functional communication difficulties, and (d) impact of stuttering on the speaker's quality of life. This paper summarizes scale development, reliability and validity assessment, and scoring procedures so clinicians and researchers can use the OASES to add to the available evidence about the outcomes of a variety of treatment approaches for adults who stutter. EDUCATIONAL OBJECTIVES: As a result of this activity, participants will be able to: (1) identify key issues related to the documentation of treatment outcomes in stuttering; (2) discuss the components of the international classification of functioning, disability, and health as they relate to the documentation of stuttering treatment outcomes; (3) evaluate and use a new measurement instrument for assessing the outcomes of stuttering treatment from the perspective of the person who stutters.     

A clinician survey of speech and non-speech characteristics of neurogenic stuttering

This study presents survey data on 58 Dutch-speaking patients with neurogenic stuttering following various neurological injuries. Stroke was the most prevalent cause of stuttering in our patients, followed by traumatic brain injury, neurodegenerative diseases, and other causes. Speech and non-speech characteristics were analyzed separately for these four etiology groups. Results suggested possible group differences, including site of lesion and influence of speech conditions on stuttering. Other characteristics, such as within-word localization of disfluencies and presence of secondary behaviors were comparable across the etiology groups. The implications of our results for the diagnosis of neurogenic stuttering will be discussed.

Educational objectives: After reading this article, the reader will be able to: (1) provide a concise overview of the main literature on neurogenic stuttering; (2) discuss the speech and non-speech characteristics of neurogenic stuttering; (3) provide an overview of current clinical practices for intervention with neurogenic stuttering patients and their perceived outcome.     

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.     

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.     

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.     

Working memory involvement in stuttering: exploring the evidence and research implications

Several studies of utterance planning and attention processes in stuttering have raised the prospect of working memory involvement in the disorder. In this paper, potential connections between stuttering and two elements of Baddeley's [Baddeley, A. D. (2003). Working memory: Looking back and looking forward. Neuroscience, 4, 829-839] working memory model, phonological memory and central executive, are posited. Empirical evidence is drawn from studies on phonological memory and dual-task performance among children and adults who stutter to examine support for the posited connections. Implications for research to examine working memory as one of the psycholinguistic bases of stuttering are presented. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) appraise potential relationships between working memory and stuttering; (2) evaluate empirical evidence that suggests the possibility of working memory involvement in stuttering; and (3) identify research directions to explore the role of working memory in stuttering.     

Evaluation and elimination of an avoidance response in a child who stutters: A case study

In this case study, efforts to treat stuttering in a 6-year-old male with cerebral palsy were complicated by frequent replies of “I don't know” that allowed the child to avoid more extensive answers to conversational questions. Following a program of extinction plus differential reinforcement of alternative behavior (DRA), the response “I don't know” was decreased while both speech rate and stuttering increased. Simplified habit reversal (SHR) techniques (controlled breathing) were then applied and resulted in a reduction of stuttering and maintenance of low rates of avoidance. A reversal to baseline resulted in initially high levels of avoidance and low levels of stuttering, with these trends reversing as baseline continued. The SHR treatment for stuttering was then reimplemented and stuttering rates again decreased while avoidance rates remained low, Implications are discussed.     

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.     

A speech and psychological profile of treatment-seeking adolescents who stutter

PurposeThe purpose of this study was to evaluate the relationship between stuttering severity, psychological functioning, and overall impact of stuttering, in a large sample of adolescents who stutter.MethodParticipants were 102 adolescents (11–17 years) seeking speech treatment for stuttering, including 86 boys and 16 girls, classified into younger (11–14 years, n = 57) and older (15–17 years, n = 45) adolescents. Linear regression models were used to evaluate the relationship between speech and psychological variables and overall impact of stuttering.ResultsThe impact of stuttering during adolescence is influenced by a complex interplay of speech and psychological variables. Anxiety and depression scores fell within normal limits. However, higher self-reported stuttering severity predicted higher anxiety and internalizing problems. Boys reported externalizing problems—aggression, rule-breaking—in the clinical range, and girls reported total problems in the borderline-clinical range. Overall, higher scores on measures of anxiety, stuttering severity, and speech dissatisfaction predicted a more negative overall impact of stuttering.ConclusionTo our knowledge, this is the largest cohort study of adolescents who stutter. Higher stuttering severity, speech dissatisfaction, and anxiety predicted a more negative overall impact of stuttering, indicating the importance of carefully managing the speech and psychological needs of adolescents who stutter. Further research is needed to understand the relationship between stuttering and externalizing problems for adolescent boys who stutter.     

Genetic and environmental effects on stuttering: a twin study from Finland

The present study explored the prevalence of self-reported stuttering in a Finnish twin population and examined the extent to which the variance in liability to stuttering was attributable to genetic and environmental effects. We analyzed data of 1728 Finnish twins, born between 1961 and 1989. The participants were asked to complete a questionnaire on speech, language, and voice. In two of the questions they were asked to report the occurrence of childhood and present stuttering of their own and that of their sibling. According to the results, 2.3% (52) of the participants were reported to have stuttered as children and 28.8% of them (15) were reported to continue to stutter in adulthood. There was no significant gender difference in the prevalence of stuttering in either childhood or adulthood. For childhood stuttering, the tetrachoric correlation was higher for monozygotic pairs (r=.74) than for dizygotic pairs (r=.27). By means of structural equation modeling it was found that 82% of the variance in liability to childhood stuttering was attributable to additive genetic effects, with the remaining 18% due to non-shared environmental effects. In conclusion, the results of the present study confirm findings from prior studies and support a strong genetic and only a moderate non-shared environmental effect on stuttering. Potential small differences in the prevalence of stuttering in different populations are suggested by our data. EDUCATIONAL OBJECTIVES: The reader will be able to recognize the contribution of genetic and environmental effects on stuttering.     

Syntactic influences on stuttering in young child stutterers

This study examined the location and rate of stuttering in the spontaneous speech of nine young stutterers (4.0–6.6 yr) in relation to certain aspects of syntax. It was designed to answer the following questions: Is there more stuttering at clause onset (boundary) than at other points in the clause? Does the type of clause influence rate of stuttering? Is there more stuttering on complex than on simple sentences? The syntactic analysis defined 10 clause types (seven pertaining to complex sentences and three pertaining to simple sentences); clause boundaries (taking into account “filler” words occuring in such positions); and hierarchical constituent structure within sentences. Stuttering was found with significantly greater frequency at clause boundaries than at internal (nonboundary) positions of clauses. This was apparent for nine of the 10 clause types, the exception being complement clauses. The word “and” at the beginning of simple and complex sentences provoked a high rate of stuttering. The hierarchical structure within the clause did not influence the location of stuttering, and sentence complexity was not a factor in the rate of stuttering.     

Identifying developmental stuttering and associated comorbidities in electronic health records and creating a phenome risk classifier

PurposeThis study aimed to identify cases of developmental stuttering and associated comorbidities in de-identified electronic health records (EHRs) at Vanderbilt University Medical Center, and, in turn, build and test a stuttering prediction model.MethodsA multi-step process including a keyword search of medical notes, a text-mining algorithm, and manual review was employed to identify stuttering cases in the EHR. Confirmed cases were compared to matched controls in a phenotype code (phecode) enrichment analysis to reveal conditions associated with stuttering (i.e., comorbidities). These associated phenotypes were used as proxy variables to phenotypically predict stuttering in subjects within the EHR that were not otherwise identifiable using the multi-step identification process described above.ResultsThe multi-step process resulted in the manually reviewed identification of 1,143 stuttering cases in the EHR. Highly enriched phecodes included codes related to childhood onset fluency disorder, adult-onset fluency disorder, hearing loss, sleep disorders, atopy, a multitude of codes for infections, neurological deficits, and body weight. These phecodes were used as variables to create a phenome risk classifier (PheRC) prediction model to identify additional high likelihood stuttering cases. The PheRC prediction model resulted in a positive predictive value of 83 %.ConclusionsThis study demonstrates the feasibility of using EHRs in the study of stuttering and found phenotypic associations. The creation of the PheRC has the potential to enable future studies of stuttering using existing EHR data, including investigations into the genetic etiology.     

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.