The onset of stuttering following drug overdose

Recently, some attention has been focused on acquired stuttering, disfluencies that begin in adulthood. The nature of acquired stuttering differs in several respects from developmental stuttering. A case of acquired stuttering following drug overdose is presented and contrasted with previously reported cases. The case is noteworthy in that, while many characteristics of acquired stuttering are evidenced, several symptoms associated with developmental stuttering are also observed. The findings are discussed in terms of a possible link between developmental and acquired forms of stuttering.     

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

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

Phonation in stuttering: A review of current research

Current research including studies which implicate the phonatory mechanism in stuttering as well as physiological studies offering direct evidence of abnormal laryngeal activity in stuttering are reviewed. It is concluded that while present research does not support claims for laryngeal causation of stuttering, the evidence is strong that abnormal laryngeal behaviors are an important aspect of the disrupted peripheral speech physiology that characterizes stuttering. Since this is true, it follows that abnormal laryngeal behavior deserves consideration in the diagnosis and management of stuttering.     

Mindfulness training in stuttering therapy: a tutorial for speech-language pathologists

The use of mindfulness training for increasing psychological well-being in a variety of clinical and nonclinical populations has exploded over the last decade. In the area of stuttering, it has been widely recognized that effective long-term management often necessitates treatment of cognitive and affective dimensions of the disorder in addition to behavioral components. Yet, mindfulness based strategies and their possible usefulness in stuttering management have not been described in detail in the literature. This article seeks to engage professionals who treat stuttering in a conversation about the possible usefulness of incorporating mindfulness training into stuttering management. A review of the literature reveals that there is a substantial overlap between what is required for effective stuttering management and the benefits provided by mindfulness practices. Mindfulness practice results in decreased avoidance, increased emotional regulation, and acceptance in addition to improved sensory-perceptual processing and attentional regulation skills. These skills are important for successful long-term stuttering management on both psychosocial and sensory-motor levels. It is concluded that the integration of mindfulness training and stuttering treatment appears practical and worthy of exploration. Mindfulness strategies adapted for people who stutter may help in the management of cognitive, affective, and behavioral challenges associated with stuttering.Educational objectives: Readers should be able to: (1) describe what mindfulness is and how it is cultivated; (2) identify the benefits that can be produced from mindfulness practice; (3) summarize how the benefits of mindfulness practice parallel what is often required for effective long-term stuttering management; and (4) identify specific mindfulness techniques that can be taught in stuttering therapy and explain their rationale.     

The early history of behavior modification of stuttering: A view from the trenches

The attitudes of 644 employers toward stuttering were studied through the use of a questionnaire which required the respondents to indicate their strenght-of- agreement to seven attitudinal statements concerning stuttering. While rejecting the suggestion that stuttering interferes with job performance, the employers agreed that stuttering decreases employability and interferes with promotion possibilities. It was concluded that although stuttering may not typically interfere with job performance, it is a significant vocationally handicapping problem.     

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.     

"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.     

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.     

Are there constraints on childhood disfluency?

Analysis of the spontaneous speech of eight stuttering and eight normally fluent children reveals that (a) the location of both stuttering and normal disfluent moments is constrained by sentential constituent structure, and (b) stuttering children experience fluency breakdown with a particular type of constituent (verb phrase) not usually disfluently produced by normals. A view of early stuttering as a sentence planning and integration disorder is present.     

The effects of self-disclosure and non self-disclosure of stuttering on listeners' perceptions of a person who stutters

The aim of this study was to examine listener perceptions of an adult male person who stutters (PWS) who did or did not disclose his stuttering. Ninety adults who do not stutter individually viewed one of three videotaped monologues produced by a male speaker with severe stuttering. In one monologue, 30 listeners heard the speaker disclose stuttering at the beginning and in another monologue, 30 listeners heard the speaker disclose stuttering at the end. A third group of 30 listeners viewed a monologue where no disclosure of stuttering occurred. After listeners viewed a monologue, they were asked to rate a set of six Likert scale statements and answer three open-ended questions. The results showed that only one of six Likert statements was significantly different across the three conditions. The only statement that was different was that the speaker was perceived to be significantly more friendly when disclosing stuttering at the end of the monologue than when not disclosing stuttering. There were no significant differences between the percentage of positive and negative comments made by listeners across the three conditions. Listeners' comments to each open-ended question showed they were comfortable listening to stuttering with or without disclosure and slightly more than half of the listeners believed their perceptions of the speaker did not change when he disclosed stuttering. The results also showed that the speaker who disclosed stuttering at the beginning of the monologue received significantly more positive listener comments than when he disclosed stuttering at the end of the monologue. Results are discussed relative to comparisons with the study, the clinical relevance of acknowledging stuttering as a component of treatment, and future research on the self-disclosure of stuttering. Educational objectives: The reader will be able to: (1) describe how different groups of listeners perceive and respond to two conditions of self-disclosure of stuttering and one condition involving non self-disclosure of stuttering; (2) summarize the range of listener responses to and benefits of self-disclosure of stuttering; and (3) describe the value of self-disclosure of stuttering for the listener and the speaker.     

Early position and stuttering occurrence

Early sentence position is one of several features of verbal expression frequently reported to be associated with stuttering occurrence. Some studies also have reported the concurrence of these features with normal disfluencies. A review of the pertinent literature reveals that, among these features, early position is associated significantly more often with stuttering than with normal dysfluencies. Results of a study investigating stress patterns in the fluent utterances of stuttering and normal speakers yielded contrasts which speak pointedly to the relationship between early position and stuttering occurrence.     

Stroke-associated acquired stuttering

In this case report, the syndrome of acquired stuttering is described including its etiology, common presenting features, and differences from developmental stuttering. A case is described in an elderly female patient with sudden acquired stuttering associated with ischemic infarct near the left basal ganglia.     

The effectiveness of SpeechEasy during situations of daily living

A multiple single-subject design was used to examine the effects of SpeechEasy on stuttering frequency in the laboratory and in longitudinal samples of speech produced in situations of daily living (SDL). Seven adults who stutter participated, all of whom had exhibited at least 30% reduction in stuttering frequency while using SpeechEasy during previous laboratory assessments. For each participant, speech samples recorded in the laboratory and SDL during device use were compared to samples obtained in those settings without the device. In SDL, stuttering frequencies were recorded weekly for 9-16 weeks during face-to-face and phone conversations. Participants also provided data regarding device tolerance and perceived benefits. Laboratory assessments were conducted at the beginning and the end of the longitudinal data collection in SDL. All seven participants exhibited reduced stuttering in self-formulated speech in the Device compared to No-device condition during the first laboratory assessment. In the second laboratory assessment, four participants exhibited less stuttering and three exhibited more stuttering with the device than without. In SDL, five of seven participants exhibited some instances of reduced stuttering when wearing the device and three of these exhibited relatively stable amounts of stuttering reduction during long-term use. Five participants reported positive changes in speaking-related attitudes and perceptions of stuttering. Further investigation into the short- and long-term effectiveness of SpeechEasy in SDL is warranted. Educational objectives: The reader will be able to summarize: (1) issues pertinent to evaluating treatment benefits of wearable fluency aids and evaluate (2) the effect of SpeechEasy on stuttering frequency and the perceived benefits of device use in situations of daily living, as assessed weekly over the course of 9-16 weeks of wear, for seven adults who stutter.     

Stuttering and sensory gating: a study of acoustic startle prepulse inhibition

It was hypothesized that stuttering may be related to impaired sensory gating, leading to overflow of superfluous disturbing auditory feedback and breakdown of the speech sequence. This hypothesis was tested using the acoustic startle prepulse inhibition (PPI) paradigm. A group of 22 adults with developmental stuttering were compared with controls regarding the degree of PPI. No significant differences were found between the stuttering adults and the control group; the groups showed similar means and distribution. Likewise, no relation between the degree of PPI and the effect of altered auditory feedback on stuttering was found. In summary, the results of the study indicate that there is no relation between stuttering and PPI.     

Theory and therapy in stuttering: A complex relationship

There are many treatments currently available for stuttering, for both children and adults. These range from direct interventions intended to reduce the severity and/or frequency of the speech behaviors of stuttering, to those intended to alleviate the anxiety and other mental health issues that can accompany the disorder. However, as there are little supporting data for many of these treatments, there is little consensus about which to use. Another way to evaluate stuttering treatments is to explore the extent to which they address the cause of the disorder. However, the cause of stuttering is not yet known. In this theoretical paper, a 3-factor causal model is presented, to which the mechanisms thought to be driving different treatments are then aligned. The model is innovative, in that it attempts to explain moments of stuttering. It is argued that all causal factors must be operating at each moment of stuttering. The model is intended as a new way of looking at cause, and how treatments may address cause. It is hoped this will stimulate discussion and lead to further lines of inquiry.Educational objectives: The reader will be able to: (a) describe the P&A 3-factor causal model of moments of stuttering; (b) state how indirect direct stuttering treatments relate to cause, according to the P&A model; (c) describe how direct stuttering treatments relate to cause, according to the P&A model; (d) state the purpose of cognitive behavior therapy; and (e) describe at least one suggestion for further research arising from the P&A model.     

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

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

The Lidcombe Program of early stuttering intervention for Malaysian families: Four case studies

PurposeThis study investigated the outcomes of implementing the Lidcombe Program, an evidence-based early intervention for stuttering, with four preschool children in Malaysia. Early stuttering intervention is currently underdeveloped in Malaysia, where stuttering treatment is often more assertion-based than evidence-based. Therefore, introducing an evidence-based early stuttering intervention is an important milestone for Malaysian preschoolers who stutter.MethodThe participants ranged from 3 years 3 months to 4 years 9 months at the start of the study. Beyond-clinic speech samples were obtained at 1 month and 1 week pretreatment and immediately post-Stage 1, and at 1 month, 3 months, 6 months and 12 months post-Stage 1.ResultsTwo participants, who were bilingual, achieved near-zero levels of stuttering at 12 months posttreatment. Near zero levels of stuttering were also present in their untreated languages. One participant withdrew due to reasons not connected with the research or treatment. The remaining participant, who presented with severe stuttering, completed Stage 1 but had some relapse in Stage 2 and demonstrated mild stuttering 12 months post-Stage 1.ConclusionsThe outcomes were achieved without the need to significantly adapt Lidcombe Program procedures to Malaysian culture. Further research to continue evaluation of the Lidcombe Program with Malaysian families and to estimate proportion of those who will respond is warranted.     

Inner speech and the inner life

The pathophysiology of developmental or acquired stuttering still remains an enigma. In a few cases, the developmental stuttering that had disappeared spontaneously or as a result of therapy reoccurred following a brain lesion. We report on a patient with return of developmental stuttering following a left hemispheric stroke. This case supports the theory that acquired brain lesions may cause a return of stuttering, possibly by interfering with the compensatory mechanism(s) that once had relieved the developmental stuttering.     

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

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