Anxiety and speaking in people who stutter: An investigation using the emotional Stroop task

People with anxiety disorders show an attentional bias towards threat or negative emotion words. This exploratory study examined whether people who stutter (PWS), who can be anxious when speaking, show similar bias and whether reactions to threat words also influence speech motor planning and execution. Comparisons were made between 31 PWS and 31 fluent controls in a modified emotional Stroop task where, depending on a visual cue, participants named the colour of threat and neutral words at either a normal or fast articulation rate. In a manual version of the same task participants pressed the corresponding colour button with either a long or short duration. PWS but not controls were slower to respond to threat words than neutral words, however, this emotionality effect was only evident for verbal responding. Emotionality did not interact with speech rate, but the size of the emotionality effect among PWS did correlate with frequency of stuttering. Results suggest PWS show an attentional bias to threat words similar to that found in people with anxiety disorder. In addition, this bias appears to be contingent on engaging the speech production system as a response modality. No evidence was found to indicate that emotional reactivity during the Stroop task constrains or destabilises, perhaps via arousal mechanisms, speech motor adjustment or execution for PWS.Educational objectives: The reader will be able to: (1) explain the importance of cognitive aspects of anxiety, such as attentional biases, in the possible cause and/or maintenance of anxiety in people who stutter, (2) explain how the emotional Stroop task can be used as a measure of attentional bias to threat information, and (3) evaluate the findings with respect to the relationship between attentional bias to threat information and speech production in people who stutter.     

Effects of concurrent cognitive processing on the fluency of word repetition: comparison between persons who do and do not stutter

This study investigated how silent reading and word memorization may affect the fluency of concurrently repeated words. The words silently read or memorized were phonologically similar or dissimilar to the words of the repetition task. Fourteen adults who stutter and 16 who do not participated in the experiment. The two groups were matched for age, education, sex, forward and backward memory span and vocabulary. It was found that the disfluencies of persons who stutter significantly increased during word repetition when similar words were read or memorized concurrently. In contrast, the disfluencies of persons who do not stutter were not significantly affected by either secondary task. These results indicate that the speech of persons who stutter is more sensitive to interference from concurrently performed cognitive processing than that of nonstuttering persons. It is proposed that the phonological and articulatory systems of persons who stutter are protected less efficiently from interference by attention-demanding processing within the central executive system. Alternative interpretations are also discussed. EDUCATIONAL OBJECTIVES: Readers will learn how modern speech production theories and the concept of modularity can account for stuttering, and will be able to explain the greater vulnerability of stutterer's speech fluency to concurrent cognitive processing.     

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.     

The relationship between pre-treatment clinical profile and treatment outcome in an integrated stuttering program

A procedure for subtyping individuals who stutter and its relationship to treatment outcome is explored. Twenty-five adult participants of the Comprehensive Stuttering Program (CSP) were classified according to: (1) stuttering severity and (2) severity of negative emotions and cognitions associated with their speech problem. Speech characteristics (percentage of stuttered syllables, distorted speech score, and the number of correctly produced syllables on a diadochokinesis task) and emotional/cognitive states (emotional reaction, speech satisfaction, and attitudes toward speaking) were assessed before and after treatment, and at a 1- and 2-year follow-up. The results showed that: (a) there was no relationship between stuttering severity and the severity of negative emotions and cognitions, (b) the severe stuttering group had the largest treatment gains but also the highest level of regression, and (c) at post-treatment and both follow-up assessments the differences on measures of emotions between the mild and severe emotional group had disappeared, chiefly due to a large decrease in the latter group's negative emotions and cognitions. Our findings show that, based on treatment gains, specific subgroups can be identified, each requiring different treatment approaches. This underlines the necessity of developing a better understanding of how various dimensions of stuttering relate to treatment outcome. Educational objectives: The reader will be able to: (1) describe why stuttering severity and negative emotions and cognitions that are related to stuttering should be investigated separately and (2) describe how treatment outcome relates to subtypes of persons who stutter.     

The effect of syntactic structure upon speech initiation times of stuttering and nonstuttering speakers

Past research has shown that adults who stutter tend to be slower than adults who do not stutter at initiating various speech-like movements, nonsense syllables, words, short phrases, and simple sentences. The present study sought to extend this research by examining the effect that syntactic structure has upon stutterers' and nonstutterers' ability to initiate sentences. Eleven persons who stutter (mean age=22.2 years) and 11 nonstuttering controls (mean age=23.3 years) read, rehearsed, and then reproduced a series of 96 sentences within a simple reaction time paradigm. The sentences were presented in four blocks of 24 sentences, and each block contained one version of each of the 24 base sentences. Versions of the base sentences varied, from simple to complex, along four levels of syntactic complexity. Results indicated that speech initiation times (SITs) were significantly longer for participants who stutter than they were for nonstuttering controls for three of the four sentence types. There was no significant difference in SITs across the four sentence types for either group. Among the stuttering participants, there was no significant correlation between stuttering severity and overall initiation time for the sentences. Consistent with other studies, the present findings suggest that persons who stutter are slower than persons who do not stutter at planning and/or initiating motor movements associated with speech production. EDUCATIONAL OBJECTIVES: The reader will be able to (1). describe how persons who stutter typically perform during various reaction time tasks, (2). explain the rationale for examining the effect of syntactic complexity upon speech initiation time, (3). discuss how the speech initiation times of persons who stutter compare to those of persons who do not stutter during the production of various types of sentences, (4). identify future research needs in this area.     

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.     

图-词干扰范式下汉语口吃者的语义编码

采用图-词干扰范式, 通过2个实验考察了汉语口吃者的语义编码。实验1发现, 在基本水平命名中,口吃者与非口吃者均表现出语义干扰效应, 语义相关干扰词的命名时间显著长于语义无关干扰词的命名时间, 口吃者在语义相关干扰条件下所受到的干扰比非口吃者大; 在类别水平命名中, 口吃者与非口吃者的表现类似, 都表现出语义促进效应, 语义相关干扰词的命名时间显著短于语义无关干扰词的命名时间, 语义相关干扰词的命名错误率也显著低于语义无关干扰词的命名错误率。实验2发现, 在基本水平命名中, 当SOA为-200 ms、-100 ms和0 ms时, 语义相关干扰条件下的反应时显著长于在语义无关干扰条件下的反应时, 当SOA为-100 ms和0 ms时, 口吃者的语义干扰效应比非口吃者更加明显。整个研究表明, 口吃者的语义编码出现了延缓, 口吃者比非口吃者需要更多的时间来排除语义干扰词的干扰。研究结果在一定程度上支持了关于口吃的多因素模型。     

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.     

Avoidance of eye gaze by adults who stutter

PurposeAdults who stutter are at significant risk of developing social phobia. Cognitive theorists argue that a critical factor maintaining social anxiety is avoidance of social information. This avoidance may impair access to positive feedback from social encounters that could disconfirm fears and negative beliefs. Adults who stutter are known to engage in avoidance behaviours, and may neglect positive social information. This study investigated the gaze behaviour of adults who stutter whilst giving a speech.Method16 adults who stutter and 16 matched controls delivered a 3-min speech to a television display of a pre-recorded lecture theatre audience. Participants were told the audience was watching them live from another room. Audience members were trained to display positive, negative and neutral expressions. Participant eye movement was recorded with an eye-tracker.ResultsThere was a significant difference between the stuttering and control participants for fixation duration and fixation count towards an audience display. In particular, the stuttering participants, compared to controls, looked for shorter time at positive audience members than at negative and neutral audience members and the background.ConclusionsAdults who stutter may neglect positive social cues within social situations that could serve to disconfirm negative beliefs and fears.Educational objectives: The reader will be able to: (a) describe the nature of anxiety experienced by adults who stutter; (b) identify the most common anxiety condition among adults who stutter; (c) understand how information processing biases and the use of safety behaviours contribute to the maintenance of social anxiety; (d) describe how avoiding social information may contribute to the maintenance of social anxiety in people who stutter; and (e) describe the clinical implications of avoidance of social information in people who stutter.     

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.     

Unassisted recovery from stuttering: self-perceptions of current speech behavior, attitudes, and feelings

The purpose of this study was to investigate the nature of recovery from stuttering based on the experiences of adults who recovered without treatment. Using a semi-structured, open-ended interview format, 15 speakers verified as persons who recovered without treatment were asked to describe their status as everyday speakers. Seven speakers reported that they no longer stuttered and eight reported that they still stuttered on occasion. Interview material was coded and analyzed by the investigators and checked by independent judges. Results suggested that complete recovery was possible for speakers who reported that they no longer stuttered; whereas, those who still stuttered occasionally appeared to no longer be handicapped by stuttering, but required some vigilance to maintain their relatively fluent speech.

Educational objectives: After completing this activity, the learner will be able to: (1) describe the relevance of self-report data for evaluating the nature of recovery from stuttering without treatment; (2) describe the differences in self-perception concerning the nature of recovery for those who no longer have any tendency to stutter compared to those who still have an occasional tendency to stutter; and (3) suggest the possible implications for understanding the nature of recovery from persistent stuttering based on investigations of late recovery without treatment.     

Pseudofluency in adults who stutter: the illusory outcome of therapy

The majority of therapy programs for people who stutter are aimed at modifying the entire speech output by using techniques that reduce the overt signature events. Use of these techniques for extended time periods are thought to induce true fluency that is automatic, natural, and effortless. It is proposed that the present form of therapeutic intervention induces pseudofluency rather than true fluency. Pseudofluency is the speech posrtherapy of persons who stutter, free of the discrete signature events of stuttering, but replaced by cognitively mediated gestures that are embedded as continuous prolongation or masked stuttering events throughout the speech act. This may account for the high rate of relapse and the problems associated with the maintenance, stability, and naturalness of speech after stuttering therapy.     

Auditory‐motor adaptation is reduced in adults who stutter but not in children who stutter

Previous studies have shown that adults who stutter produce smaller corrective motor responses to compensate for unexpected auditory perturbations in comparison to adults who do not stutter, suggesting that stuttering may be associated with deficits in integration of auditory feedback for online speech monitoring. In this study, we examined whether stuttering is also associated with deficiencies in integrating and using discrepancies between expected and received auditory feedback to adaptively update motor programs for accurate speech production. Using a sensorimotor adaptation paradigm, we measured adaptive speech responses to auditory formant frequency perturbations in adults and children who stutter and their matched nonstuttering controls. We found that the magnitude of the speech adaptive response for children who stutter did not differ from that of fluent children. However, the adaptation magnitude of adults who stutter in response to auditory perturbation was significantly smaller than the adaptation magnitude of adults who do not stutter. Together these results indicate that stuttering is associated with deficits in integrating discrepancies between predicted and received auditory feedback to calibrate the speech production system in adults but not children. This auditory‐motor integration deficit thus appears to be a compensatory effect that develops over years of stuttering.     

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.     

Reprint of: technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

Psychological counseling as an adjunct to stuttering treatment: Clients’ experiences and perceptions

PurposeStuttering can trigger anxiety and other psychological and emotional reactions, and limit participation in society. It is possible that psychological counseling could enhance stuttering treatment outcomes; however, little is known about how clients view such counseling. The purpose of this study was to gain an understanding of clients’ experiences with, and perceptions of, a psychological counseling service that was offered as an optional adjunct to speech therapy for stuttering.MethodNine individuals who stutter (13-38 years old) participated in semi-structured interviews. Six participants had taken part in psychological counseling; three participants did not do so. Interview data were analyzed using grounded theory as a guiding framework.ResultsFour thematic clusters emerged from participants’ accounts: insights into personal decision-making, why others may not participate in counseling, psychological counseling as a worthwhile part of therapy, and counseling as a necessary component in a stuttering treatment program.ConclusionIn addition to experiencing barriers and facilitators to help-seeking that are reported in related fields, participants accounts also revealed novel facilitators (i.e., a ‘why not’ mentality and the importance of having a pre-existing relationship with the clinician who offered the service) and barriers (i.e., viewing the service as a ‘limited resource,’ and, the overwhelming nature of intensive stuttering treatment programs). Findings suggest that clients value the option to access psychological counseling with trained mental health professionals to support the stuttering treatment provided by speech-language pathologists. Participants made recommendations for the integration of psychological counseling into stuttering treatment programs.     

Technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.