Factors affecting occupational advice for speakers who do and do not stutter

Factors affecting perceptions of occupational suitability were examined for speakers who stutter and speakers who do not stutter. In Experiment 1, 58 adults who do not stutter heard one of two audio recordings (less severe stuttering, more severe stuttering) of a speaker who stuttered. Participants rated the speaker's communicative functioning, personal attributes, and suitability for 32 occupations, along with perceptions of the occupations' speaking demands and educational requirements. Perceived speaking demand strongly affected occupational suitability ratings at both levels of stuttering severity. In Experiment 2, 58 additional adults who do not stutter heard a recording of another adult in one of two conditions (fluent speech, pseudo-stuttering), and provided the same ratings as in Experiment 1. In the pseudo-stuttering condition, participants' perceptions of occupational speaking demand again had a strong effect on occupational suitability ratings. In the fluent condition, suitability ratings were affected primarily by perceived educational demand; perceived speaking demand was of secondary importance. Across all participants in Experiment 2, occupational suitability ratings were associated with ratings of the speaker's personal attributes and communicative functioning. In both experiments, speakers who stuttered received lower suitability ratings for high speaking demand occupations than for low speaking demand occupations. Ratings for many high speaking occupations, however, fell just below the midpoint of the occupational suitability scale, suggesting that participants viewed these occupations as less appropriate, but not necessarily inappropriate, for people who stutter. Overall, the findings support the hypothesis that people who stutter may face occupational stereotyping and/or role entrapment in work settings. EDUCATIONAL OBJECTIVES: At the end of this activity the reader will be able to (a) summarize main findings on research related to the work-related experiences of people who stutter, (b) describe factors that affect perceptions of which occupations are best suited for speakers who stutter and speakers who do not stutter, and (c) discuss how findings from the present study relate to previous findings on occupational advice for people who stutter.     

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.     

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.     

Auditory backward-masking performance by children who stutter and its relation to dysfluency rate

The fluency of people who stutter is affected markedly when auditory feedback is altered, suggesting that stuttering may be associated with hearing. Peripheral hearing problems, however, are no more common in people who stutter than in those who do not. Performance was investigated in a task that involves central auditory processing (backward masking). Children who stuttered had deficits in backward masking (indicated by higher thresholds) compared with a group of fluent control children. The backward-masking thresholds were positively correlated with frequency of stuttering.     

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.     

Listener perceptions of stuttering and stuttering modification techniques

PurposeThe purpose of this study was to analyse naïve listener perceptions of speech containing unmodified stuttering, use of the pull-out technique, and use of preparatory-sets.MethodParticipants (N = 62) were randomly assigned to listen to one audio sample (unmodified stuttered speech, speech with pull-outs, or speech with preparatory-sets) and completed a survey assessing perceptions of the speaker’s speech and personality and the listener’s comfort level and willingness to social interact with the speaker.ResultsSurvey results revealed low perceptual ratings in all experimental conditions. Unmodified stuttered speech received significantly more positive ratings than the stuttering modification conditions in all measurements except for speech naturalness. Listeners reported being less willing to socially interact with those who use preparatory-sets than unmodified stuttered speech.ConclusionThe use of stuttering modification techniques did not improve listeners’ perceptions or willingness to interact with persons who stutter. Clinicians and those who stutter should be aware that the use of speech techniques will not decrease negative social interactions or stereotypes.     

Phonological complexity in school-aged children who stutter and exhibit a language disorder

PurposeThe Index of Phonological Complexity and the Word Complexity Measure are two measures of the phonological complexity of a word. Other phonological measures such as phonological neighborhood density have been used to compare stuttered versus fluent words. It appears that in preschoolers who stutter, the length and complexity of the utterance is more influential than the phonetic features of the stuttered word. The present hypothesis was that in school-age children who stutter, stuttered words would be more phonologically complex than fluent words, when the length and complexity of the utterance containing them is comparable. School-age speakers who stutter were hypothesized to differ from those with a concomitant language disorder.MethodsSixteen speakers, six females and ten males (M age = 12;3; Range = 7;7 to 19;5) available from an online database, were divided into eight who had a concomitant language disorder (S + LD) and eight age- and sex-matched speakers who did not (S-Only).ResultsWhen all stuttered content words were identified, S + LD speakers produced more repetitions, and S-Only speakers produced more inaudible sound prolongations. When stuttered content words were matched to fluent content words and when talker groups were combined, stuttered words were significantly (p ≤ 0.01) higher in both the Index of Phonological Complexity and the Word Complexity Measure and lower in density (“sparser”) than fluent words.ConclusionsResults corroborate those of previous researchers. Future research directions are suggested, such as cross-sectional designs to evaluate developmental patterns of phonological complexity and stuttering plus language disordered connections.Educational objectives: The reader will be able to: (a) Define and describe phonological complexity; (b) Define phonological neighborhood density and summarize the literature on the topic; (c) Describe the Index of Phonological Complexity (IPC) for a given word; (d) Describe the Word Complexity Measure (WCM) for a given word; (e) Summarize two findings from the current study and describe how each relates to studies of phonological complexity and fluency disorders.     

The role of temporal speech cues in facilitating the fluency of adults who stutter

PurposeAdults who stutter speak more fluently during choral speech contexts than they do during solo speech contexts. The underlying mechanisms for this effect remain unclear, however. In this study, we examined the extent to which the choral speech effect depended on presentation of intact temporal speech cues. We also examined whether speakers who stutter followed choral signals more closely than typical speakers did.Method8 adults who stuttered and 8 adults who did not stutter read 60 sentences aloud during a solo speaking condition and three choral speaking conditions (240 total sentences), two of which featured either temporally altered or indeterminate word duration patterns. Effects of these manipulations on speech fluency, rate, and temporal entrainment with the choral speech signal were assessed.ResultsAdults who stutter spoke more fluently in all choral speaking conditions than they did when speaking solo. They also spoke slower and exhibited closer temporal entrainment with the choral signal during the mid- to late-stages of sentence production than the adults who did not stutter. Both groups entrained more closely with unaltered choral signals than they did with altered choral signals.ConclusionsFindings suggest that adults who stutter make greater use of speech-related information in choral signals when talking than adults with typical fluency do. The presence of fluency facilitation during temporally altered choral speech and conversation babble, however, suggests that temporal/gestural cueing alone cannot account for fluency facilitation in speakers who stutter. Other potential fluency enhancing mechanisms are discussed.Educational Objectives: The reader will be able to (a) summarize competing views on stuttering as a speech timing disorder, (b) describe the extent to which adults who stutter depend on an accurate rendering of temporal information in order to benefit from choral speech, and (c) discuss possible explanations for fluency facilitation in the presence of inaccurate or indeterminate temporal cues.     

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.     

The duration component of the stress effect in stuttering

The purpose of the present study was to investigate whether there is a relationship between stuttering on stressed syllables and the duration of these syllables. Sixteen adults who stutter read a text consisting of 226 syllables. The relative stress of each syllable was rated, and syllables were categorized into long- and short-stressed syllables, unstressed syllables and intermediate syllables lying in-between. In order to isolate effects caused by within-word position from those caused by linguistic stress, syllables in initial and in subsequent positions were analyzed separately. In both word position categories stressed syllables were stuttered more often than unstressed syllables. Stuttering frequency of intermediate syllables seems to be in-between stressed and unstressed syllables, just as their stress level is rated in-between. Results regarding the duration of stressed syllables do not allow final conclusions.

Educational objectives: The reader will learn about and be able to describe (1) language factors related with stuttering events, (2) the stress effect in adults who stutter, and (3) methods to control for its confounding variables.     

Responses of adults who stutter to the anticipation of stuttering

PurposeMany people who stutter experience the phenomenon of anticipation—the sense that stuttering will occur before it is physically and overtly realized. A systematic investigation of how people who stutter respond to anticipation has not been previously reported. The purposes of this study were to provide self-report evidence of what people do in response to anticipation of stuttering and to determine the extent to which this anticipation occurs.MethodsThirty adults who stutter indicated on a Likert rating scale the extent to which they anticipate stuttering and answered three open-ended (written) questions regarding how they respond to anticipation.ResultsAll participants reported experiencing anticipation at least “sometimes,” and 77% of the participants reported experiencing anticipation “often” or “always.” The extent to which participants reported experiencing anticipation was not related to stuttering severity, impact, or treatment history. Analysis of written responses revealed 24 major categories, which were heuristically divided into action or non-action responses. Categories representing avoidance and self-management strategies were further divided into 14 and 19 subcategories, respectively. Participants were just as likely to view anticipation as helpful as they were to view it as harmful.ConclusionFindings demonstrate that most, if not all, adults who stutter experience anticipation, and the majority of adults who stutter report doing so at least often. Adults who stutter respond to this anticipation by altering the speech production process in various ways. Results highlight the importance of the role that anticipation plays in how stuttering behaviors manifest themselves.Educational Objectives: The reader will be able to: (a) summarize existing literature on the anticipation of stuttering; (b) describe the role and extent of anticipation of stuttering in adults; (c) describe the various ways that adults who stutter respond to anticipation; (d) describe the importance of measuring anticipation in clinical and research domains.     

Behavioural,emotional and social development of children who stutter

PurposeDevelopmental stuttering may be associated with diminished psychological well-being which has been documented from late childhood onwards. It is important to establish the point at which behavioural, emotional and social problems emerge in children who stutter.MethodsThe study used data from the Millennium Cohort Study, whose initial cohort comprised 18,818 children. Analysis involved data collected when the cohort members were 3, 5 and 11 years old. The association between parent-reported stuttering and performance on the Strengths and Difficulties Questionnaire was determined in regression analyses which controlled for cohort members’ sex, verbal and non-verbal abilities, maternal education, and family economic status.ResultsCompared with typically-developing children, those who stuttered had significantly higher Total Difficulties scores at all three ages; in addition, scores on all of the sub-scales for 5-year-olds who stuttered indicated poorer development than their peers, and 11-year-olds who stuttered had poorer development than peers in all areas except prosocial skills. At ages 5 and 11, those who stuttered were more likely than peers to have scores indicating cause for clinical concern in almost all areas.ConclusionChildren who stutter may begin to show impaired behavioural, emotional and social development as early as age 3, and these difficulties are well established in older children who stutter. Parents and practitioners need to be aware of the possibility of these difficulties and intervention needs to be provided in a timely fashion to address such difficulties in childhood and to prevent the potential development of serious mental health difficulties later in life.     

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.     

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

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

Frequency of stuttering during challenging and supportive virtual reality job interviews

This paper seeks to demonstrate the possibility of manipulating the frequency of stuttering using virtual reality environments (VREs). If stuttering manifests itself in VREs similarly to the way it manifests itself in real world interactions, then VREs can provide a controlled, safe, and confidential method for treatment practice and generalization. Though many researchers and clinicians recognize the need for generalization activities in the treatment of stuttering, achieving generalization in a clinical setting poses challenges to client confidentiality, safety, and the efficient use of a professionals’ time. Virtual reality (VR) technology may allow professionals the opportunity to enhance and assess treatment generalization while protecting the safety and confidentiality of their clients. In this study, we developed a VR job interview environment which allowed experimental control over communication style and gender of interviewers. In this first trial, persons who stutter (PWS) experienced both challenging and supportive VR job interview conditions. The percentage of stuttered syllables was calculated for both interviews for each participant. Self-reported ratings of communication apprehension and confidence were also obtained, and were not significantly correlated with stuttering severity. Results indicated that interviewer communication style affected the amount of stuttering produced by participants, with more stuttering observed during challenging virtual interviews. Additionally, the amount of stuttering observed during the VR job interviews was significantly, positively correlated with the amount of stuttering observed during an interview with the investigator prior to VR exposure. Participants’ subjective reports of the VR experience indicate reactions similar to those they report experiencing in the real world. Possible implications for the use of VR in the assessment and treatment of stuttering are discussed.

Educational objectives: After reading this article, the reader will be able to—(1) list some of the challenges to treatment generalization; (2) describe how virtual reality technology can assist in alleviating some of these challenges; (3) describe how the frequency of stuttering varies across two different virtual environments.     

Linguistic stress, within-word position, and grammatical class in relation to early childhood stuttering

The purpose of the present study was to investigate whether the link that has been established between stuttering and linguistic stress in adolescents and adults (the so-called stress effect) can also be observed in childhood stuttering. To account for confounding variables, both within-word position and grammatical class were measured, because these factors covary with linguistic stress. Speech samples of 22 preschool children (mean time of 9 months since onset of stuttering) were analyzed. The relative stress of each syllable was rated and syllables were categorized into long and short stressed, unstressed, and intermediately stressed syllables. Results showed that 97.8% of stuttering events occurred on first syllables of words and 76.5% on the first sound of syllables, that means a clear word-initial effect. Stuttering frequency on first syllables of function words was 16.9% and significantly higher than the frequency of stuttered first syllables of content words (11.5%). In function words short stressed syllables and intermediately stressed syllables were stuttered more often than unstressed syllables. The analysis for individual disfluency types revealed that, for function words, stuttering on short stressed syllables was associated with prolongations and syllable repetitions. However, in intermediately stressed syllables stuttering coincided most often with one-syllable word repetitions. This differentiation of the stress effect may suggest different causal mechanisms underlying these disfluency types. Educational objectives: The reader will learn about and be able to: (1) describe how within-word position, grammatical class, and linguistic stress effect stuttering frequency in preschool children who stutter; (2) explain how the occurrence of individual disfluency types depends on linguistic stress; (3) discuss how patterns of adults and preschool children who stutter differ in regard to these aspects.     

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.     

Stuttering, emotions, and heart rate during anticipatory anxiety: a critical review

Persons who stutter often report their stuttering is influenced by emotional reactions, yet the nature of such relation is still unclear. Psychophysiological studies of stuttering have failed to find any major association between stuttering and the activity of the sympathetic nervous system. A review of published studies of heart rate in relation to stressful speech situations indicate that adults who stutter tend to show a paradoxical reduction of heart rate compared with nonstuttering persons. Reduction of heart rate has also been observed in humans and mammals during anticipation of an unpleasant stimulus, and is proposed to be an indication of anticipatory anxiety resulting in a "freezing response" with parasympathetic inhibition of the heart rate. It is suggested that speech-related anticipatory anxiety in persons who stutter is likely to be a secondary, conditioned reaction based on previous experiences of stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how the autonomic nervous system is modulated by emotional responses; (2) explain how anticipatory fear often results in inhibition of heart rate due to parasympathetic activation; (3) discuss why emotional reactions in persons who stutter may be secondary to negative experiences of speech problems.