Self-acceptance,resilience, coping and satisfaction of life in people who stutter

PurposeThe purpose of the present study was to evaluate self-acceptance and satisfaction with life with people who stutter and the influence of coping and resilience on the two factors.MethodForty-seven people who stutter (PWS) and 47 people who do not stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6 main areas: (a) background information, (b) satisfaction with life, (c) coping, (d) avoidance, (e) self-acceptance, and resilience.ResultsAvoidant coping and maladaptive coping moderated the association between stuttering and self- acceptance but not satisfaction with life. Resilience was found to moderate the association between stuttering and self-acceptance as well as satisfaction with life.ConclusionStuttering was associated with lower self-acceptance at higher levels of avoidant coping and maladaptive coping. PWS who have lower levels of resilience were more likely to have a lower satisfaction with life indicating that higher levels of resilience could serve as a protective factor for having a greater satisfaction with life. Further, stuttering was associated with lower self-acceptance at lower levels of resilient attitude. Resilience and coping appear to protect against having diminished self-acceptance and satisfaction with life for PWS.     

口吃者的言语计划缺陷——来自词长效应的证据

口吃者与非口吃者在词长效应上的差异是口吃语音编码缺陷的一个重要的支持证据。本研究在综述词长效应研究的基础上,对这种解释提出了三点置疑,即词频、句法复杂性和发音长度也可能是造成词长效应差异的主要原因,并通过三个实验进行了验证。实验一和实验三在口吃者和非口吃者之间都得到了稳定的词长效应差异,并且排除了词频和发音长度对于这种差异的影响;实验二在控制词长的条件下,发现口吃者对于句法复杂性是敏感的。因此,本研究的结果支持口吃在言语产出中的语音编码和句法编码中都存在缺陷。同时,本研究对于口吃治疗也提供了有价值的参考建议     

The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

Educational objectives: The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.     

A comparative investigation of the speech-associated coping responses reported by adults who do and do not stutter

The Behavior Checklist, a self-report test procedure, was administered to 42 adults who stutter and 76 who do not in order to investigate the number, frequency of usage, type and nature of the responses that they reportedly employ to cope with the anticipation and/or presence of speech disruption. As a group, the participants who stutter reported a significantly greater number of speech-associated coping responses and a greater use of them than their nonstuttering peers did. Moreover, factor analysis made apparent fundamental between-group differences in the type and nature of certain forms of the coping responses reported by those who stutter and those who do not. This suggests that the quantitative and qualitative differences in the coping responses of those who do and do not stutter are potentially useful with respect to differential diagnostic and therapeutic decision making. EDUCATIONAL OBJECTIVES: (1) The reader will be able to describe differences in the number, frequency and types of coping behaviors used by PWS and PWNS. (2) The reader will be able to list similarities and differences in the type and nature of coping behaviors used by PWS and PWNS. (3) The reader will be able to discuss the features and use of the Behavior Checklist, a self-report procedure for assessing the responses used by adults to cope with the anticipation and occurrence of speech disruption.     

准备间隔对口吃者言语反应速度的影响

为了考察准备间隔对口吃者言语反应速度的影响,作者采用固定准备间隔下的预备反应时范式,设置了6种准备间隔,通过三个系列实验,检测口吃者的最佳言语准备间隔。结果发现,无论时间压力（项目间隔）怎样变化,口吃被试的问题在于,当准备间隔增加到800ms时,他们无法有效保持或提高反应速度;而且,这一现象只在言语命名任务上表现明显。作者认为,口吃者在言语运动准备过程中的异常,很可能是引起口吃现象的重要原因。     

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.     

Recurrent involuntary imagery in people who stutter and people who do not stutter

Objective

To compare intrusive memories in groups of people who do (PWS), and who do not (PWNS), stutter.

Method

Twenty-one participants who stuttered and 21 matched controls were given a semi-structured interview which explored imagery in speaking situations. The data were analyzed using a Content Analysis approach. Other outcome measures were the Beck Anxiety Inventory, the Beck Depression Inventory, the Post Traumatic Stress Disorder, PTSD, Symptom Scale: Self-Report Version.

Results

Significantly more stuttering participants than control participants indicated both recurrent imagery and associated memories. Content Analysis revealed themes of disfluency, anxiety, negative social evaluation, self-focus and pressure to speak that were common to both groups’ reports. Additional themes of helplessness, shame, sadness and frustration were found only in the images and memories of the stuttering group. No group differences were evident for the number of sensory modalities involved in images and memories, or for ratings of their vividness or strength of associated emotions, or on self-reports of depression, anxiety and trauma.

Conclusions

Recurrent imagery about events in childhood is a potent factor in the memories of PWS. It is worth modifying interventions that have been successfully applied for treating social anxiety for use with people who stutter.Educational objectives: After reading this article, participants will be able to: (a) identify the role of intrusive memories in psychiatric disorders and stuttering; (b) investigate how DSM criteria can be employed with people who stutter; (c) employ anxiety instruments used for assessing psychiatric disorders for stuttering; (d) distinguish between the intrusive memories experienced by people who stutter, and people who do not stutter; (e) apply treatments for intrusive memories in psychiatric disorders to work with people who stutter.     

Gestural overlap in consonant clusters: effects on the fluent speech of stuttering and non-stuttering subjects

This study was designed to investigate if persons who stutter differ from persons who do not stutter in the coproduction of different types of consonant clusters, as measured in the number of dysfluencies and incorrect speech productions, in speech reaction times and in word durations. Based on the Gestural Phonology Model of Browman and Goldstein, two types of consonant clusters were formed: homorganic and heterorganic clusters, both intra-syllabic (CVCC) and inter-syllabic (CVC#CVC). Overall, the results indicated that homorganic clusters elicited more incorrect speech productions and longer reaction times than the heterorganic clusters, but there was no difference between the homorganic and the heterorganic clusters in the word duration data. Persons who stutter showed a higher percentage dysfluencies and a higher percentage incorrect speech productions than PWNS but there were no main group effects in reaction times and word durations. However, there was a significant three-way interaction effect between group, cluster type and cluster place: homorganic clusters elicited longer reaction times than heterorganic clusters, but only in the inter-syllabic condition and only for persons who stutter. These results suggest that the production of two consonants with the same place of articulation across a syllable boundary puts higher demands on motor planning and/or initiation than producing the same cluster at the end of a syllable, in particular for PWS. The findings are discussed in light of current theories on speech motor control in stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to describe: (1) the effect of gestural overlap between consonant clusters on speech reaction time and word duration of people who do and do not stutter and be able to (2) identify the literature in the field of gestural overlap between consonant clusters.     

Effects of stuttering severity and therapy involvement on attitudes towards people who stutter

The purpose of this study was to explore whether stuttering severity or therapy involvement had an effect on the attitudes that individuals who do not stutter reported towards people who stutter (PWS). Two hundred and sixty (260) university students participated in this study. Direct survey procedures consisting of a 25-item semantic differential scale were utilized. Comparisons of the effects of stuttering severity, level of therapy involvement, and the interaction of these variables were completed. Results suggested that both stuttering severity and therapy involvement had significant effects on participants' attitudes towards PWS. Findings of this study support past research studies that has found that individuals who stutter mildly are perceived more positively than those who are severe. Similarly, the data supported past research that has found that PWS that attend therapy are perceived more positively than those who do not attend therapy. Surprisingly, the interaction of these variables was not significant. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) explain the possible effects of listeners' attitudes toward stuttering on the lives of PWS; (2) discuss how different factors might alter listeners' attitudes towards stuttering; (3) delineate how stuttering severity and involvement in therapy might impact listeners' attitudes towards PWS.     

The Connection between Perceived Workplace Discrimination and Viewing Work as a Spiritual Calling

Research shows that perceived workplace discrimination shapes an individual's job satisfaction and intent to leave a job. This study considers whether these impacts may be attenuated if an individual views their work as a spiritual calling. Using data from a nationally representative survey (N = 9,907), our analysis shows that perceived work discrimination due to race, gender, and religion are all independently associated with less job satisfaction net of a variety of other measures. Viewing work as a spiritual calling is associated with greater job satisfaction, even when accounting for traditional measures of religiosity. The negative impact of perceived discrimination on job satisfaction is weaker among those who view work as a spiritual calling. These findings provide evidence of the mechanisms underlying job satisfaction and have implications for understanding how religion might help mitigate the negative consequences of perceived discrimination in the workplace, or allow discrimination to potentially go unaddressed.     

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.     

The speech naturalness of people who stutter speaking under delayed auditory feedback as perceived by different groups of listeners

This study investigated listeners' perception of the speech naturalness of people who stutter (PWS) speaking under delayed auditory feedback (DAF) with particular attention for possible listener differences. Three panels of judges consisting of 14 stuttering individuals, 14 speech language pathologists, and 14 naive listeners rated the naturalness of speech samples of stuttering and non-stuttering individuals using a 9-point interval scale. Results clearly indicate that these three groups evaluate naturalness differently. Naive listeners appear to be more severe in their judgements than speech language pathologists and stuttering listeners, and speech language pathologists are apparently more severe than PWS. The three listener groups showed similar trends with respect to the relationship between speech naturalness and speech rate. Results of all three indicated that for PWS, the slower a speaker's rate was, the less natural speech was judged to sound. The three listener groups also showed similar trends with regard to naturalness of the stuttering versus the non-stuttering individuals. All three panels considered the speech of the non-stuttering participants more natural. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) discuss the speech naturalness of people who stutter speaking under delayed auditory feedback, (2) discuss listener differences about the naturalness of people who stutter speaking under delayed auditory feedback, and (3) discuss the importance of speech rate for the naturalness of speech.     

Speeded verbal responding in adults who stutter: are there deficits in linguistic encoding?

Linguistic encoding deficits in people who stutter (PWS, n=18) were investigated using auditory priming during picture naming and word vs. non-word comparisons during choice and simple verbal reaction time (RT) tasks. During picture naming, PWS did not differ significantly from normally fluent speakers (n=18) in the magnitude of inhibition of RT from semantically related primes and the magnitude of facilitation from phonologically related primes. PWS also did not differ from controls in the degree to which words were faster than non-words during choice RT, although PWS were slower overall than controls. Simple RT showed no difference between groups, or between words and non-words, suggesting differences in speech initiation time do not explain the choice RT results. The findings are consistent with PWS not being deficient in the time course of lexical activation and selection, phonological encoding, and phonetic encoding. Potential deficits underlying slow choice RTs outside of linguistic encoding are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to (1) describe possible relationships between linguistic encoding processes and speech motor control difficulties in people who stutter; (2) explain the role of lexical priming tasks during speech production in evaluating the efficiency of linguistic encoding; (3) describe the different levels of processing that may be involved in slow verbal responding by people who stutter, and identify which levels could be involved based on the findings of the present study.     

Evidence-based guidelines for being supportive of people who stutter in North America

PurposeWhile many resources, particularly those available on the Internet, provide suggestions for fluent speakers as they interact with people who stutter (PWS), little evidence exists to support these suggestions. Thus, the purpose of this study was to document the supportiveness of common public reactions, behaviors, or interventions to stuttering by PWS.Methods 148 PWS completed the Personal Appraisal of Support for Stuttering-Adults. Additionally, a comparison of the opinions of adults who stutter based on gender and their involvement in self-help/support groups was undertaken. Results Many of the Internet-based suggestions for interacting with PWS are aligned with the opinions of the participants of this study. Significant differences were found amongst people who stutter on the basis of gender and involvement in self-help groups.Conclusions Lists of “DOs and DON’Ts” that are readily available on the Internet are largely supported by the data in this study; however, the findings highlight the need for changing the emphasis from strict rules for interacting with people who stutter to more flexible principles that keep the needs of individual PWS in mind.     

The impact of threat and cognitive stress on speech motor control in people who stutter

PurposeIn the present study, an Emotional Stroop and Classical Stroop task were used to separate the effect of threat content and cognitive stress from the phonetic features of words on motor preparation and execution processes.MethodA group of 10 people who stutter (PWS) and 10 matched people who do not stutter (PNS) repeated colour names for threat content words and neutral words, as well as for traditional Stroop stimuli. Data collection included speech acoustics and movement data from upper lip and lower lip using 3D EMA.ResultsPWS in both tasks were slower to respond and showed smaller upper lip movement ranges than PNS. For the Emotional Stroop task only, PWS were found to show larger inter-lip phase differences compared to PNS. General threat words were executed with faster lower lip movements (larger range and shorter duration) in both groups, but only PWS showed a change in upper lip movements. For stutter specific threat words, both groups showed a more variable lip coordination pattern, but only PWS showed a delay in reaction time compared to neutral words. Individual stuttered words showed no effects. Both groups showed a classical Stroop interference effect in reaction time but no changes in motor variables.ConclusionThis study shows differential motor responses in PWS compared to controls for specific threat words. Cognitive stress was not found to affect stuttering individuals differently than controls or that its impact spreads to motor execution processes.Educational objectives: After reading this article, the reader will be able to: (1) discuss the importance of understanding how threat content influences speech motor control in people who stutter and non-stuttering speakers; (2) discuss the need to use tasks like the Emotional Stroop and Regular Stroop to separate phonetic (word-bound) based impact on fluency from other factors in people who stutter; and (3) describe the role of anxiety and cognitive stress on speech motor processes.     

Investigating speech motor practice and learning in people who stutter

In this exploratory study, we investigated whether or not people who stutter (PWS) show motor practice and learning changes similar to those of people who do not stutter (PNS). To this end, five PWS and five PNS repeated a set of non-words at two different rates (normal and fast) across three test sessions (T1, T2 on the same day and T3 on a separate day, at least 1 week apart). The results indicated that PWS and PNS may resemble each other on a number of performance variables (such as movement amplitude and duration), but they differ in terms of practice and learning on variables that relate to movement stability and strength of coordination patterns. These findings are interpreted in support of recent claims about speech motor skill limitations in PWS.

Educational objectives: The reader will be able to: (1) define oral articulatory changes associated with motor practice and learning and their measurement; (2) summarize findings from previous studies examining motor practice and learning in PWS; and (3) discuss hypotheses that could account for the present findings that suggest PWS and PNS differ in their speech motor learning abilities.     

Beliefs of teachers versus non-teachers about people who stutter

PurposeAlthough prior research has investigated teachers’ beliefs about people who stutter (PWS), this work has not indicated how these beliefs compare with those of the general public or taken into account key demographic variables that may be related to these beliefs. The main purpose of this study was to evaluate whether beliefs about PWS in teachers are different from those in the general public. The second purpose of this study was to examine whether gender is related to beliefs about PWS for teachers, who are more frequently women.MethodsAnalyses were based on questionnaire responses regarding beliefs about PWS from 269 teachers and 1388 non-teachers in the United States. Due to their potential link to beliefs about PWS, familiarity with PWS and sociodemographic variables were included in the statistical model for this study.ResultsTeachers’ beliefs about PWS are no different than those of people in non-teaching professions. Findings also indicated that, regardless of whether respondents were teachers, women had more accurate beliefs about PWS than men. The statistical model tested indicated that beliefs about PWS were more accurate when the respondents were older, had more education, and had familiarity with a PWS.ConclusionIn the first study to compare teachers’ beliefs about PWS to the general public, findings indicated that teachers are no more accurate than the public in their beliefs about PWS. Associations found between these beliefs and several variables may indicate some promising mechanisms for improving beliefs, such as increased familiarity with individuals who stutter.Educational Objectives: Readers should be able to: (a) describe stuttering's potential effects on children's participation in the school setting; (b) identify actions teachers can take to improve the school experience of their students who stutter; (c) summarize findings regarding teachers’ beliefs about people who stutter (PWS); (d) identify key variables that are associated with beliefs about PWS.     

Associations between beliefs about and reactions toward people who stutter

PurposeThis study sought to assess whether beliefs about people who stutter (PWS) predict intended behavioral and affective reactions toward them in a large and varied sample of respondents while taking into account familiarity with PWS and the demographic variables of age, education, and gender.MethodsAnalyses were based on 2206 residents of the United States of America. The seemingly unrelated regression (SUR) technique was used to test the relationship between beliefs about PWS and behavioral and affective reactions toward PWS. Variables such as familiarity with PWS and demographic data were also controlled in the statistical model.ResultsFindings indicated that, when demographic variables and familiarity were taken into account, the accuracy of participants’ beliefs about PWS significantly predicted their intended behavioral and affective reactions toward PWS. The participants’ gender and familiarity with PWS were also associated with these reactions toward PWS.ConclusionThe finding of an association between beliefs and intended reactions validates attempts to improve public treatment of PWS through improving the accuracy of beliefs about PWS. Additionally, because familiarity with PWS is a significant predictor of helpful and positive reactions toward PWS, interventions involving PWS educating others through direct interpersonal interactions may be one effective way to improve public reactions toward individuals who stutter.     

Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience

Purpose

To compare adults who stutter with and without support group experience on measures of self-esteem, self-efficacy, life satisfaction, self-stigma, perceived stuttering severity, perceived origin and future course of stuttering, and importance of fluency.

Method

Participants were 279 adults who stutter recruited from the National Stuttering Association and Board Recognized Specialists in Fluency Disorders. Participants completed a Web-based survey comprised of various measures of well-being including the Rosenberg Self-Esteem Scale, Generalized Self-Efficacy Scale, Satisfaction with Life Scale, a measure of perceived stuttering severity, the Self-Stigma of Stuttering Scale, and other stuttering-related questions.

Results

Participants with support group experience as a whole demonstrated lower internalized stigma, were more likely to believe that they would stutter for the rest of their lives, and less likely to perceive production of fluent speech as being highly or moderately important when talking to other people, compared to participants with no support group experience. Individuals who joined support groups to help others feel better about themselves reported higher self-esteem, self-efficacy, and life satisfaction, and lower internalized stigma and perceived stuttering severity, compared to participants with no support group experience. Participants who stutter as an overall group demonstrated similar levels of self-esteem, higher self-efficacy, and lower life satisfaction compared to averages from normative data for adults who do not stutter.

Conclusions

Findings support the notion that self-help support groups limit internalization of negative attitudes about the self, and that focusing on helping others feel better in a support group context is linked to higher levels of psychological well-being.Educational objectives: At the end of this activity the reader will be able to: (a) describe the potential psychological benefits of stuttering self-help support groups for people who stutter, (b) contrast between important aspects of well-being including self-esteem self-efficacy, and life satisfaction, (c) summarize differences in self-esteem, self-efficacy, life satisfaction, self-stigma, perceived stuttering severity, and perceptions of stuttering between adults who stutter with and without support group experience, (d) summarize differences in self-esteem, self-efficacy, and life satisfaction between adults who stutter and normative data for adults who do not stutter.