Auditory abilities of speakers who persisted, or recovered, from stuttering

OBJECTIVE: The purpose of this study was to see whether participants who persist in their stutter have poorer sensitivity in a backward masking task compared to those participants who recover from their stutter. DESIGN: The auditory sensitivity of 30 children who stutter was tested on absolute threshold, simultaneous masking, backward masking with a broadband and with a notched noise masker. The participants had been seen and diagnosed as stuttering at least 1 year before their 12th birthday. The participants were assessed again at age 12 plus to establish whether their stutter had persisted or recovered. Persistence or recovery was based on participant's, parent's and researcher's assessment and Riley's [Riley, G. D. (1994). Stuttering severity instrument for children and adults (3rd ed.). Austin, TX: Pro-Ed.] Stuttering Severity Instrument-3. Based on this assessment, 12 speakers had persisted and 18 had recovered from stuttering. RESULTS: Thresholds differed significantly between persistent and recovered groups for the broadband backward-masked stimulus (thresholds being higher for the persistent group). CONCLUSIONS: Backward masking performance at teenage is one factor that distinguishes speakers who persist in their stutter from those who recover. Education objectives: Readers of this article should: (1) explain why auditory factors have been implicated in stuttering; (2) summarise the work that has examined whether peripheral, and/or central, hearing are problems in stuttering; (3) explain how the hearing ability of persistent and recovered stutterers may differ; (4) discuss how hearing disorders have been implicated in other language disorders.     

Persistence and remission of incipient stuttering among high-risk children

This investigation concerns the persistence of stuttering and recovery from it among high-risk children. At the end of the second year of a 6-year prospective study, 26 of 93 preschool children with a parental history of stuttering were classified as stutterers. Four years later, seven of these children were classified as persistent stutterers, and 16 children were classified as recovered stutterers. The articulatory and linguistic skills of these two groups of children and the communicative and speaking behaviors of their mothers, were measured before and after the onset of stuttering. The analysis of these measures revealed that the articulatory skills of the children and the communicative style and language complexity of the mothers differentiated the incipient stutters whose stuttering subsequently became chronic from those who recovered.     

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.     

Disfluency data of German preschool children who stutter and comparison children

This study compared the disfluencies of German-speaking preschool children who stutter (CWS, N = 24) with those produced by age- and sex-matched comparison children who do not stutter (CWNS, N = 24). In accordance with Yairi and Ambrose's [Yairi, E., & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminary report. Journal of Speech and Hearing Research, 35, 755-760] guidelines the CWS group had a narrow age range (2-5 years) and were seen close to the reported time of their stuttering onset (average of 8 months). Furthermore, over 95% of the CWS group had not received any type of speech therapy intervention. Consistent with previous findings for English-speaking preschool children, 'stuttering-like' disfluencies (prolongations, blocks, part- and one-syllable word repetitions) were significantly more frequent in CWS (mean = 9.2%) than in CWNS (mean = 1.2%), whereas no significant group differences occurred with respect to 'normal' disfluencies. The number of iterations in stuttering-like disfluencies was also significantly higher in CWS (mean = 1.28 iterations) than in CWNS (mean = 1.09 iterations). In contrast to previous findings, a sub-group of children who have been stuttering for a shorter time (1-5 months) did not differ from a sub-group who had stuttered for a longer period (8-22 months). EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how German-speaking preschool children who stutter and who do not stutter display stuttering-like and normal disfluencies including number of iterations; (2) explain how powerful classification measures for the diagnosis of stuttering are for German-speaking preschool children; (3) discuss how disfluency patterns of native English- and German-speaking children close to onset of stuttering differ.     

The recovery rate of early stuttering

PurposeAcross studies there is great variability in reported rates of stuttering recovery. This study examined the impact that different definitions of recovery had on calculation of recovery rates and factors associated with recovery within the same sample of children.MethodSpeech samples and parents and child reports of their experiences of stuttering were collected from 38 children who stuttered aged 2–5 years of age (Occassion-1) and again at 9–13 years of age (Occassion-2). Four different criteria for recovery that were developed representing variations in criteria reported in previous research were applied to data from these children.Results. The majority of the participants (82%) showed very little disfluent speech (<1% syllables stuttered) at Occasion 2. Recovery rate varied greatly depending on the criteria used, ranging from 13.2%–94.7%. Definitions ordered from least to greatest recovery that were (a) parent and clinician report no stuttering and no stuttering observed (13.2 %); (b) ≤1% syllables stuttered; severity rated at ≤1; parent, clinician, and child report recovery (55.3 %); (c) ≤1% syllables stuttered; severity rated at ≤1; parent and clinician report recovery (71.1 %); (d) <3.0 % syllables stuttered (94.7 %). Five participants were considered recovered and two were considered persistent stutters across all criteria. Different factors were associated with recovery from stuttering depending on the criterion used.ConclusionThe concept of recovery from stuttering is complex and estimations of recovery rate are likely to be greatly affected by differences in definitions and measurement across studies. This has a flow-on effect in determining the factors associated with recovery from stuttering.     

Child and mother variables in the development of stuttering among high-risk children: A longitudinal study

In this prospective study, 26 of the 93 preschool children with a parental history of stuttering who began to stutter were compared at preonset and 1 year later with those of a matched group of 26 children who continued to be seen as nonstutterers. These two groups of at-risk children were compared in terms of the development of their articulatory and language skills and in terms of the communicative style and speaking behaviors of their mothers. At preonset, the children who started to stutter demonstrated a faster articulatory rate than those who remained fluent. One year later, however, this difference was no longer statistically significant. The two groups of children did not differ in their linguistic skills at either of these time periods. Moreover, the communicative style and speaking behaviors of the mothers of the children who later began to stutter did not differ from that of the mothers of children who did not either prior to or after the onset of stuttering. This suggests that these variables did not contribute to the onset of stuttering or to its course.     

A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers

In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents’ native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany.

Educational objectives: Readers will discuss and evaluate: (1) the short-term effects of the Lidcombe Program in comparison to natural recovery on stuttering; (2) the impact of the Lidcombe Program on early stuttering in German-speaking preschool children.     

"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.     

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.     

Elevated attention deficit hyperactivity disorder symptoms in children who stutter

PurposeThis study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken.MethodParticipants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria).ResultsOne-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment.ConclusionThe large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.     

Successful treatment of stuttering following closed head injury

Based on a review of the literature, sudden onset of stuttering following a closed head injury has generally had a prognosis of poor recovery. The present case study of an adult male reviews the relevant neurologic data, psychologic information, and subsequent speech therapy methods used to facilitate an essentially complete recovery of normal speech within a few months. A possible neurologic explanation for the stuttering behavior and associated factors in recovery is discussed.     

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.     

Group play therapy for Japanese children who stutter

Twenty-one sessions of group play therapy were conducted with children who stutter in order to improve their stuttering and to promote their development in social adaptation. Follow-up surveys were made 6 mo and 5 yr after therapy.As therapy progressed, a definite process of change was observed in each child, from periods of anxiety, appearance of aggressive behavior, frequent occurence of aggressive behavior, to a decrease in aggressive behavior. After the appearance of aggressive behavior, a fluctuation in stuttering occured as cooperative play with other children was established. This was followed by a decrease in stuttering. The appearance of aggressive behavior during therapy is thought to be of major significance for the disappearance of stuttering and for interpersonal relationships.A follow-up survey showed that both stuttering and social adjustment had improved, indicating the effectiveness of therapy.     

Predicting stuttering from linguistic factors for German speakers in two age groups

Brown's factors [J. Speech Disorders 10 (1945) 181] predict the likely loci of disfluency in English-speaking adults who stutter. A word is more likely to be stuttered for these speakers if it is a content word, starts with a consonant, is positioned at the beginning of a sentence, and if it is a long word. These same factors were examined in native German-speaking children and adults who stutter. Speech data of 15 German adults and 17 children were coded according to Brown's factors. For the adult group, it was predicted that words starting with consonants would not lead to as much of an increase in disfluencies compared with English samples, because of cross-linguistic differences in syllable onset properties. It was predicted that stuttering would be more likely in later sentence positions in German because in German the verb is usually near the end of a sentence. There were no obvious reasons to expect differences on the two remaining factors, content words and word length. With children, it was hypothesised that Brown's factors that specify level of linguistic difficulty would not be such a good predictor of stuttering rate. Specifically, it was predicted that the difference in stuttering rate between function and content words would be lower in children. For the adults both word type (content/function) and word length increased stuttering rate significantly, whereas changes in stuttering rate for the other two factors were non-significant. It was also found that when word difficulty (based on a combined measure of all factors) increased, stuttering rate rose. With children, only the word-length factor was significant, and stuttering rate was not governed to the same extent by overall word difficulty. Conclusions are drawn as to the effect of linguistic and motor influences on stuttering. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe: (1) how linguistic factors affect stuttering rates in German; (2) the different patterns of adults and children who stutter and how language might influence this pattern; and (3) how to interpret these findings in light of a current theory of fluency failure.     

Language and motor abilities of preschool children who stutter: Evidence from behavioral and kinematic indices of nonword repetition performance

Stuttering is a disorder of speech production that typically arises in the preschool years, and many accounts of its onset and development implicate language and motor processes as critical underlying factors. There have, however, been very few studies of speech motor control processes in preschool children who stutter. Hearing novel nonwords and reproducing them engages multiple neural networks, including those involved in phonological analysis and storage and speech motor programming and execution. We used this task to explore speech motor and language abilities of 31 children aged 4–5 years who were diagnosed as stuttering. We also used sensitive and specific standardized tests of speech and language abilities to determine which of the children who stutter had concomitant language and/or phonological disorders. Approximately half of our sample of stuttering children had language and/or phonological disorders. As previous investigations would suggest, the stuttering children with concomitant language or speech sound disorders produced significantly more errors on the nonword repetition task compared to typically developing children. In contrast, the children who were diagnosed as stuttering, but who had normal speech sound and language abilities, performed the nonword repetition task with equal accuracy compared to their normally fluent peers. Analyses of interarticulator motions during accurate and fluent productions of the nonwords revealed that the children who stutter (without concomitant disorders) showed higher variability in oral motor coordination indices. These results provide new evidence that preschool children diagnosed as stuttering lag their typically developing peers in maturation of speech motor control processes.Educational objectives: The reader will be able to: (a) discuss why performance on nonword repetition tasks has been investigated in children who stutter; (b) discuss why children who stutter in the current study had a higher incidence of concomitant language deficits compared to several other studies; (c) describe how performance differed on a nonword repetition test between children who stutter who do and do not have concomitant speech or language deficits; (d) make a general statement about speech motor control for nonword production in children who stutter compared to controls.     

Communicative behavior of mothers of stuttering and nonstuttering high-risk children prior to the onset of stuttering

This portion of a multiyear prospective study was designed to investigate the communicative style, speaking rate, and language complexity of 93 mothers of preschool children with a parental history of stuttering. At the initial session none of the children sampled was regarded as being a stutterer. One year later, 26 of the children were classified as stutterers. Statistical analyses revealed that prior to the onset of stuttering the mothers of these children did not differ from the mothers of the children who continued to be seen as nonstutterers with respect to either communicative style or speaking rate. The only significant difference between the two groups of mothers was the complexity of their language. The pre-onset mean lengths of utterance (MLUs) of the mothers of children who later came to be regarded as stutterers were significantly shorter than those of the mothers whose children continued to be viewed as being fluent. These findings suggest that the communicative behavior of mothers of normally fluent children do not contribute to the development of stuttering.     

The Peer Attitudes Toward Children who Stutter scale: Reliability, known groups validity, and negativity of elementary school-age children's attitudes

Psychometric properties of the Peer Attitudes Toward Children who Stutter (PATCS) scale (Langevin, M., & Hagler, P. (2004). Development of a scale to measure peer attitudes toward children who stutter. In A.K. Bothe (Ed.), Evidence-based treatment of stuttering: empirical bases and clinical applications (pp. 139–171). Mahwah, NJ: Lawrence Erlbaum Associates.) and the extent to which peer attitudes are negative were re-examined. Results show that internal consistency was .97 and test–retest reliability was .85. In a known groups analysis participants who had contact with someone who stutters had statistically significant higher mean scores (more positive attitudes) than those who had not had contact. Nonsignificant findings for gender and grade call into question the usefulness of these variables as discriminators in future tests of known groups validity of peer attitudes toward children who stutter. Approximately one-fifth of participants had PATCS scores that were somewhat to very negative. These findings support calls for school-based education about stuttering.

Educational objectives

The reader will be able to: (1) summarize the social impacts of stuttering on school-age children who stutter, (2) describe the known groups method to test construct validity, (3) evaluate the psychometric properties of the Peer Attitudes Toward Children who Stutter scale, and (4) provide information about the proportion of students who appear to hold negative attitudes toward children who stutter.     

Tokens for stuttering

Four young stutterers were observed during 10 weekly sessions. Each session was divided into pretreatment, treatment, and posttreatment segments. Redeemable tokens were administered contingent upon stuttering behaviors in the treatment segment of the Experimental condition. In a Parallel Control condition, no tokens were administered during the entire session. The differences between the pretreatment and treatment segments were compared for the two conditions. Three subjects had dramatically fewer stuttering behaviors when tokens were being administered, while the fourth had more stuttering under the same condition. The subject whose stuttering increased had a history of therapy in which voluntary, “faked” stuttering had been called for, and the behaviors that increased were judged to be of this type. The decreases were interpreted as suggesting that the contingent tokens acted to countercondition the aversiveness of the stuttering experience, which reduced the anticipation of stuttering and hence the stuttering itself. The increase was felt to be simple reinforcement. The counterconditioning interpretation was borne out in two clinical applications in which money was presented contingent on stuttering behaviors judged to be aversive to the stutterer, and in which dramatically sudden, but long-lasting, improvement was seen.     

Voice initiation and termination time in stuttering and nonstuttering children

Voice initiation time (VIT) and voice termination time (VTT) was measured in seven stuttering and eight nonstuttering children ranging in age from 4 yr, 6 mo to 6 yr, 10 mo. The experimental task was the production of /a/ in response to a 1000-Hz pure tone. Voice initiation time was defined as the period of time elapsing between the onset of the auditory stimulus and the onset of the subject's response of /a/, as displayed on an oscilloscope. Voice termination time was defined as the latency between termination of the stimulus tone and the point at which the oscilloscopic signal decreased by 90%. No statistically significant differences were found between the two groups with respect to either VIT or VTT. In addition, no apparent relationships were present among VIT, VTT, or stuttering severity.