“Openness and progress with communication and confidence have all gone hand in hand”: Reflections on the experience of transitioning between concealment and openness among adults who stutter

PurposeThe purpose of this study was to gain a deeper understanding of the experience of people who stutter as they navigate through the growth process from concealment to openness.MethodTwelve adults who stutter who are active in self-help/support groups for stuttering described their experiences of concealment and openness in a semi-structured interview. Purposeful selection was utilized to recruit participants who could comment thoughtfully on previous concealing, but became more open about their stuttering. A phenomenological approach was utilized to gain a deeper understanding of how people who stutter experience the transition from concealment to openness regarding their stuttering and identity. Thematic analysis contributed to identification of themes and subthemes describing participants’ experiences.ResultsParticipants described precursors to concealment that led to hiding and avoidance, which grew in strength until they reached a turning point. They then changed how they related to their stuttering by changing their behaviors and perceptions of stuttering, which led to increased openness about their identity. This process of continued adaptation to stuttering was ongoing and non-linear, but suggested general trends from concealment to more openness over time. Level of openness was impacted by situational context and individual differences.ConclusionsThe findings extend our understanding of how people who stutter navigate transitions from concealment to openness. This deeper understanding could be helpful in explaining the complexities involved in managing the identity of a person who stutters, and the process of adapting to living with stuttering over time.     

Stuttering severity and educational attainment

Purpose

This study investigated the relationship between self-reported stuttering severity ratings and educational attainment.

Method

Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering severity on a 9-point scale for a range of speaking situations. These included: (1) talking with a family member, (2) talking with a familiar person, not a family member, (3) talking in a group of people, (4) talking with a stranger, (5) talking with an authority figure such as a work manager or teacher, (6) talking on the telephone, (7) ordering food or drink, and (8) giving their name and address.

Results

There was a significant negative relationship between highest educational achievement and mean self-reported stuttering severity rating for the eight situations.

Conclusions

Future research is needed to investigate how this result should be addressed in educational institutions.Educational objectives: The reader will be able to: (1) describe the negative effects of stuttering through childhood to adulthood; (2) identify some of the negative consequences associated with stuttering on peer and teacher relationships, and academic performance at school; and (3) summarise the relationship between stuttering severity and educational attainment.     

Defining stuttering for research purposes

This is a response to a Letter to the Editor entitled “Stuttering prevalence, incidence and recovery rates depend on how we define it: Comment on Yairi & Ambrose’ article Epidemiology of Stuttering: 21st Century advances” by Paul Brocklehurst (2013). The criticism was directed specifically toward Yairi and Ambrose’ conclusions, based on review of recent studies, regarding the incidence and prevalence of stuttering. In this response, Brocklehurst's arguments and suggestions of criteria for incidence research are discussed and negated.     

LANGUAGE ABILITIES OF CHILDREN WHO STUTTER: A PRELIMINARY STUDY

The purpose of this study was to examine differences between children who do (CWS) and children who do not stutter (CWNS) on standardized tests of receptive/expressive language and receptive vocabulary. Subjects were 16 boys and 4 girls who stutter (mean age = 46.80 months) and 16 boys and 4 girls who do not stutter (mean age = 47.55 months). Each child was audio recorded during a loosely structured, 30-minute conversation with an adult. This conversational interaction was subsequently assessed to provide information pertinent to the child's frequency and type of speech disfluency. After completion of the adult-child conversational interaction, each child was administered and responded to standardized tests of syntactic, semantic, and phonological abilities and development. Results indicated that the difference between measures of receptive/expressive language and receptive vocabulary is significantly greater for CWS than CWNS; however, this difference between receptive/expressive language and receptive vocabulary scores was not significantly correlated with the overall stuttering frequency of CWS. Findings were taken to suggest that the semantic development of CWS may lag behind their syntactic development, a possible imbalance among components of the speech-language systems of CWS that may contribute to the difficulties they have establishing normal speech fluency. Research supported by an NIH grant (DC00523) to Vanderbilt University.     

The "Iowa Way" revisited

This paper attempts to bridge the gap between past and present stuttering therapy approaches. Specifically, the ideas and methods of Wendell Johnson and Dean Williams are compared to current approaches used in treating mental illness and communication disorders in which there is an emphasis on focusing on what is “right” with the individual and spending less time focusing on the “disorder”. There is particular emphasis on tying Johnson's and Williams’ overall philosophy to modern psychological approaches rooted in “Positive Psychology”, to highlight how these early ideas in stuttering therapy may help us to discover the common factors that underlie the success of several different stuttering therapy approaches, independent of the specific techniques employed. It is proposed that future research on clinical efficacy in stuttering should use focused hypotheses techniques to investigate common factors that make therapy effective across individuals and therapy approaches.Educational objectives: The reader will be able to: (1) summarize the basic philosophy of the “Iowa” approach to stuttering as laid out by Wendell Johnson and Dean Williams; (2) describe current therapeutic techniques that incorporate “positive psychology”; (3) discuss possible common factors that influence therapy outcome that are independent of the therapeutic technique employed.     

Assessing Efficacy of Stuttering Treatments

Efficacy has been defined as the extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideally controlled conditions when administered or monitored by experts. Studies on efficacy can be divided into those that study methods of conducting treatment (i.e., treatment process research) and those that are concerned with the effects of treatments (i.e., treatment outcome research). This review covers both areas, emphasizes the former, and considers such key determinants of efficacy as measurement, treatment integrity, and design issues. A set of criteria is given and a meta-analysis of whether studies published since 1993 meet these criteria is reported (incorporating some pragmatic and ethical considerations). The review ends by considering directions that warrant further investigation in the future.

Educational objectives: The reader will learn about and be able to describe (1) measurements appropriate for evaluating treatment efficacy studies; (2) how to evaluate reports of stuttering treatment programs; and (3) different designs used in treatment efficacy studies.     

Language skills of children during the first 12 months after stuttering onset

PurposeTo describe the language development in a sample of young children who stutter during the first 12 months after stuttering onset was reported.MethodsLanguage production was analysed in a sample of 66 children who stuttered (aged 2–4 years). The sample were identified from a pre-existing prospective, community based longitudinal cohort. Data were collected at three time points within the first year after stuttering onset. Stuttering severity was measured, and global indicators of expressive language proficiency (length of utterances and grammatical complexity) were derived from the samples and summarised. Language production abilities of the children who stutter were contrasted with normative data.ResultsThe majority of children’s stuttering was rated as mild in severity, with more than 83% of participants demonstrating very mild or mild stuttering at each of the time points studied. The participants demonstrated developmentally appropriate spoken language skills comparable with available normative data.ConclusionIn the first year following the report of stuttering onset, the language skills of the children who were stuttering progressed in a manner that is consistent with developmental expectations.     

Health and human services for persons who stutter and education of logopedists in East-European countries

The International Association of Logopedics and Phoniatrics (IALP) assessed the therapy status of fluency disorders, service opportunities, and education of logopedists (speech-language pathologists) with a mail survey in Eastern Europe. Information was collected on the following aspects: incidence, prevalence, availability of information, non-therapeutic support for persons who stutter (PWS), providers of diagnostics and therapy, cooperating professionals, therapy approaches, forms, goals, financing, early detection and prevention, training of professionals, specialization in stuttering therapy, needs for improving the situation of PWS, and problems which hinder better care. Stuttering therapy for children is available in many countries and is frequently provided by the educational system. Therapy for adults is provided best by the health services but is not satisfactorily available everywhere. Modern therapeutic approaches coexist with obsolete ones. Lack of resources, awareness, entitlement, and assessment of therapy effectiveness are pervasive problems.

Educational objectives: Readers will be able to describe and evaluate: (1) the therapy status of fluency disorders and service opportunities in various East-European countries; (2) the training of logopedists (speech-language pathologists); (3) specialization in stuttering therapy; and (4) the organizational services for PWS within the health and human service systems.     

Comparison of pausing behavior in children who stutter and children who have Asperger syndrome

Purpose

The objective of this research was to compare the number and types of grammatical and non-grammatical silent pauses presented by stutterers and subjects with Asperger syndrome in their narratives.

Method

Ten children who stutter and four participants with Asperger syndrome (mean ages of both groups 10 years) were assessed at the Speech and Language Disorders Department of the Universidade Federal de São Paulo/Brasil. They narrated a story based on a pre-selected sequence of pictures. They were filmed and their productions were analyzed using version 5.0.47 of Praat (http://www.fon.hum.uva.nl/praat/download_win.html). Silent intervals in the speech that ranged from 0.25 to 4 s were considered pauses. The pauses were classified as grammatical and non-grammatical, depending on the words that preceded and followed them.

Results

Both groups presented grammatical and non-grammatical pauses and the former predominated. The children with Asperger syndrome produced a greater number of pauses than the stutterers.Educational objectives: The reader will be able to: (1) characterize the use of pauses in the oral narrative; (2) distinguish a grammatical pause from a non-grammatical pause regarding the use and function; (3) recognize the pattern of pause found in the two populations.     

Comments concerning Iverach, et al., Screening for personality disorders among adults seeking speech treatment for stuttering [J. Fluency Disorders 34 (2009) 173-186

Iverach, Jones, O’Brian, Block, Lincoln, and Harrison (2009) indicate the high co-occurrence of one or more Personality Disorders (PD) for adults who stutter. The findings of Iverach et al. argue against many years of research and the experiences of skilled clinicians who have considered the relationship between stuttering and anxiety/negative affectivity. The results of Iverach et al. are questioned based on several methodological issues.Educational objectives: 1. To explain why the unusually high occurrence of personality disorders (PD) for individuals who stutter found by Iverach et al. (2009) may be questionable based on methodological approach. 2. To explain the heightened levels of anxiety experienced by many individuals who stutter as a natural and reasonable response to a chronic and serious problem such as stuttering. 3. To debate the potential for the inaccurate diagnosis of Axis II Personality Disorders to unnecessarily stigmatize individuals who stutter.