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.     

The effect of fast speech rate on stuttering frequency during delayed auditory feedback

Delayed auditory feedback (DAF) has been documented to improve fluency in those who stutter. The increased fluency has been attributed to the slowed speech rate induced by DAF, but recent experiments have suggested that increasing the speech rate may also decrease stuttering under DAF. This investigation described the effect of combining a fast speech rate and DAF on the fluency of four people who stutter. Fluency of the two mildly dysfluent subjects was the same for both no DAF and DAF conditions at normal and at fast oral reading rates. In contrast, the two severely dysfluent subjects improved in fluency from the no DAF to the DAF conditions. They were found to be dysfluent at both normal and fast oral reading rates without DAF. The results of the study point to the need for further research on the relationship between speech rate and stuttering frequency under conditions of DAF and no DAF. EDUCATIONAL OBJECTIVES: Readers will learn about and be able to describe how the frequency of stuttering is affected by: (1) speech rates; (2) DAF; and (3) how stuttering severity influences such effects.     

Acquired stuttering following right frontal and bilateral pontine lesion: a case study

We report neurological information and experimental data regarding acquired neurogenic stuttering in a 57-year-old male following ischemic lesion to the orbital surface of the right frontal lobe and the pons. The experimental data consist of stuttering frequency measures under various conditions that are well known to enhance fluency in most individuals with developmental stuttering. Specifically, we report data for adaptation, unison reading, delayed auditory feedback (DAF), and frequency altered feedback (FAF). This work is the first published report of such a comprehensive examination of a variety of fluency-enhancing conditions in acquired stuttering. The patient read six 200-word texts under different conditions: Six solo readings (Text 1), five unison readings followed by five solo readings (Text 2), five readings with non-altered auditory feedback (Text 3), five readings with 50 ms delayed auditory feedback (Text 4), five readings with increased FAF (Text 5), and five readings with decreased FAF (Text 6). Results indicate that, unlike the typical situation for developmental stuttering, this individual with acquired neurogenic stuttering did not show increased fluency during an adaptation paradigm or under unison, DAF, and FAF conditions. We discuss possible implications of these findings and emphasize the need for further research on acquired neurogenic stuttering.     

The relevance of DAF-induced speech disruption to the understanding of stuttering

The literature on delayed auditory feedback (DAF) repeatedly makes reference to the occurence of disfluencies under DAF in nonstutterers. However, no attempt has been made to determine the relative frequency of occurence of various types of disfluencies in nonstutterers under DAF. The present study investigated the frequency of occurence of various types of disfluencies in normal-speaking subjects in five successive oral readings under DAF. Twenty-four young adults read aloud a prose passage five times successively under 200 msec of bilateral DAF. Measures of the frequency of different types of disfluencies, locus of occurence of disfluencies in the speech sample, adaptation and consistency indicate that DAF-induced disfluencies are remarkably similar to those found in stuttering. It is suggested that DAF and stuttering disrupt speech at approximately the same “level” along the speech production process, possibly at the prosodic level.     

Perceptual study of the speech of “successfully therapeutized” stutterers

The purpose of this investigation was to determine if the fluent speech of “successfully therapeutized” stutterers and a group of partially treated stutterers was perceptually different from the fluent speech of normal speaking subjects. Tape recorded speech samples of treated stutterers were obtained from leading exponents of (1) Van Riperian, (2) metronome-conditioned speech retraining, (3) delayed auditory feedback, (4) operant conditioning, (5) precision fluency shaping, and (6) “holistic” therapy programs. All forms of disfluency were edited out of these tapes. The remaining samples were then paired with matched fluent samples of normal talkers and presented to a group of 20 sophisticated judges. The judges were instructed to select from each paired speech sample presented to them the one produced by the stuttering subject. The results of the analyses of variance for correct identification of the stutterers showed that the partially treated stutterers, as well as each group of therapeutized stutterers, were identified at levels significantly above chance. This meant that the fluent speech of the partially and successfully treated stutterers was perceptibly different from the utterances of the normal speakers sampled. In addition, the analyses of variance also revealed that all stuttering groups had a significant severity factor. This finding indicated there was a significant difference between the severity subgroup in all the samples investigated. These results were discussed in terms of their clinical implications.     

Changes in stuttering in relation to children's locus of control

The locus of control of stuttering children before, during, and after treatment for dysfluency was investigated. Subjects participated in a one-week program combining delayed auditory feedback and training of parents to negotiate and implement contracts for their child's practice of stutter-free speech skills. The Children's Nowicki-Strickland Scale was used to measure locus of control before, immediately after, two months after, and six months after the training. Measures of speech dysfluency were available at each of these times and documented the effectiveness of treatment in reducing stuttering. The locus of control scores for stuttering children prior to treatment were comparable to normative groups. Internality on the locus of control measure prior to treatment was directly related to degree of change in dysfluency immediately following the one-week clinic, but not to dysfluency levels at the 2-month or 6-month follow-up sessions. Concomitant with improved speech, the children became progressively more internal following treatment. The results suggest that participation in a behavioral program for the treatment of stuttering increases internality.     

Speech disruption under delayed auditory feedback in multilingual speakers

The present study investigated the language familiarity hypothesis formulated by Mackay [(1970). How does language familiarity influence stuttering under delayed auditory feedback? Perceptual and Motor Skills, 30, 655-669] that bilinguals speak faster and stutter less under delayed auditory feedback (DAF) when speaking their more familiar language than a less familiar language. Thirty normally fluent native speakers of Dutch (17 males and 13 females, aged between 18;1 and 26;4 years) who were also proficient in French and English read meaningful and nonsense text under DAF in their mother tongue and in the two later acquired languages. The existence of a language familiarity effect was confirmed. The participants required significantly more time and showed significantly more speech disruptions under DAF in the later acquired languages than in the mother tongue, and reading time and number of speech disruptions was significantly higher for the nonsense texts than for the meaningful text for each of the three languages. An additional question addressed was whether or not there were any gender differences in the susceptibility to DAF. Results did not reveal a clear gender difference. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize the importance of language familiarity for the degree of speech disruption experienced by normally fluent multilingual speakers under delayed auditory feedback; and (2) describe gender differences in the susceptibility to delayed auditory feedback.     

The differential effect of three auditory stimuli on the frequency of stuttering behaviors

In view of the frequent clinical use of external auditory stimuli in fluency building programs, the purpose of the present experiment was to compare the effects of rhythmic pacing, delayed auditory feedback, and high intensity masking noise on the frequency of stuttering by dysfluency type. Twelve normal hearing young adult stutterers completed an oral reading (approximately 250 syllables) and conversational speech task (3 min) while listening to the three auditory stimuli and during a control condition presented in random order. The results demonstrated that during oral reading all three auditory stimuli were associated with significant reductions in stuttering frequency. However, during conversational speech, only the metronome produced a significant reduction in total stuttering frequency. Individual dysfluency types were not differentially affected by the three auditory stimuli.     

Auditory‐motor adaptation is reduced in adults who stutter but not in children who stutter

Previous studies have shown that adults who stutter produce smaller corrective motor responses to compensate for unexpected auditory perturbations in comparison to adults who do not stutter, suggesting that stuttering may be associated with deficits in integration of auditory feedback for online speech monitoring. In this study, we examined whether stuttering is also associated with deficiencies in integrating and using discrepancies between expected and received auditory feedback to adaptively update motor programs for accurate speech production. Using a sensorimotor adaptation paradigm, we measured adaptive speech responses to auditory formant frequency perturbations in adults and children who stutter and their matched nonstuttering controls. We found that the magnitude of the speech adaptive response for children who stutter did not differ from that of fluent children. However, the adaptation magnitude of adults who stutter in response to auditory perturbation was significantly smaller than the adaptation magnitude of adults who do not stutter. Together these results indicate that stuttering is associated with deficits in integrating discrepancies between predicted and received auditory feedback to calibrate the speech production system in adults but not children. This auditory‐motor integration deficit thus appears to be a compensatory effect that develops over years of stuttering.     

A technique for controlling speech disfluencies induced by delayed auditory feedback

On the basis of cybernetic models of speech it was hypothesized that “stuttering” induced by delayed auditory feedback could be significantly reduced if the Ss were provided with an alternate input to which they could attend. The results of the experiment supported the hypothesis. The possible implications for the treatment stuttering are discussed.     

Common features of fluency-evoking conditions studied in stuttering subjects and controls: an H2O PET study

We used H₂¹⁵O PET to characterize the common features of two successful but markedly different fluency-evoking conditions — paced speech and singing — in order to identify brain mechanisms that enable fluent speech in people who stutter. To do so, we compared responses under fluency-evoking conditions with responses elicited by tasks that typically elicit dysfluent speech (quantifying the degree of stuttering and using this measure as a confounding covariate in our analyses). We evaluated task-related activations in both stuttering subjects and age- and gender-matched controls.

Areas that were either uniquely activated during fluency-evoking conditions, or in which the magnitude of activation was significantly greater during fluency-evoking than dysfluency-evoking tasks included auditory association areas that process speech and voice and motor regions related to control of the larynx and oral articulators. This suggests that a common fluency-evoking mechanism might relate to more effective coupling of auditory and motor systems — that is, more efficient self-monitoring, allowing motor areas to more effectively modify speech.

These effects were seen in both PWS and controls, suggesting that they are due to the sensorimotor or cognitive demands of the fluency-evoking tasks themselves. While responses seen in both groups were bilateral, however, the fluency-evoking tasks elicited more robust activation of auditory and motor regions within the left hemisphere of stuttering subjects, suggesting a role for the left hemisphere in compensatory processes that enable fluency.

Educational objectives: The reader will learn about and be able to: (1) compare brain activation patterns under fluency- and dysfluency-evoking conditions in stuttering and control subjects; (2) appraise the common features, both central and peripheral, of fluency-evoking conditions; and (3) discuss ways in which neuroimaging methods can be used to understand the pathophysiology of stuttering.     

Common features of fluency-evoking conditions studied in stuttering subjects and controls: an H(2)15O PET study

We used H(2)15O PET to characterize the common features of two successful but markedly different fluency-evoking conditions -- paced speech and singing -- in order to identify brain mechanisms that enable fluent speech in people who stutter. To do so, we compared responses under fluency-evoking conditions with responses elicited by tasks that typically elicit dysfluent speech (quantifying the degree of stuttering and using this measure as a confounding covariate in our analyses). We evaluated task-related activations in both stuttering subjects and age- and gender-matched controls. Areas that were either uniquely activated during fluency-evoking conditions, or in which the magnitude of activation was significantly greater during fluency-evoking than dysfluency-evoking tasks included auditory association areas that process speech and voice and motor regions related to control of the larynx and oral articulators. This suggests that a common fluency-evoking mechanism might relate to more effective coupling of auditory and motor systems -- that is, more efficient self-monitoring, allowing motor areas to more effectively modify speech. These effects were seen in both PWS and controls, suggesting that they are due to the sensorimotor or cognitive demands of the fluency-evoking tasks themselves. While responses seen in both groups were bilateral, however, the fluency-evoking tasks elicited more robust activation of auditory and motor regions within the left hemisphere of stuttering subjects, suggesting a role for the left hemisphere in compensatory processes that enable fluency. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) compare brain activation patterns under fluency- and dysfluency-evoking conditions in stuttering and control subjects; (2) appraise the common features, both central and peripheral, of fluency-evoking conditions; and (3) discuss ways in which neuroimaging methods can be used to understand the pathophysiology of stuttering.     

Unsophisticated judges' perceptual evaluations of the speech of “successfully treated” stutterers

The purpose of this investigation was to determine if the speech of “successfully therapeutized” stutterers and a group of partially treated stutterers was perceptually different from the speech of normal speakers when judged by unsophisticated listeners. Tape-recorded speech samples of treated stutterers were obtained from leading proponents of (1) Van Riperian, (2) metronome-conditioned speech retraining, (3) delayed auditory feedback, (4) operant conditioning, (5) precision fluency shaping, and (6) “holistic” therapy programs. Fluent speech samples from these groups of stutterers were paired with matched fluent samples of normal talkers and presented to a group of 20 unsophisticated judges. The judges were instructed to select from each paired speech sample presented to them the one produced by the stuttering subject. The results of the analyses showed that five of seven experimental groups were identified at levels significantly above chance. It can be concluded that the fluent speech of the partially and successfully treated stutterers was perceptibly different from the utterances of the normal speakers and that the perceptual disparity can be detected, even by unsophisticated listeners.     

A comparison between two treatment programs for stuttering: A personal account

This article features a personal evaluation of two treatment methods for stuttering, the Precision Fluency Shaping Program (PFSP) (Webster, 1990; 1986), and the Comprehensive Stuttering Program (CSP) (Boberg and Kully, 1985). The CSP program is described as promoting natural-sounding speech by focusing, from the outset, on smooth blending of syllables or within breath groups. The PFSP program is described as tending to focus on syllables or words in isolation, particularly during early stages of instruction. In addition, the Boberg/ Kully program featured individualized instruction by a series of clinicians interacting with clients in accordance with a rotating schedule. In contrast, the PFSP program emphasized solitary interaction with a voice monitor and client manual. Differences in timing of instruction and calculation of speech rates are discussed. Treatment refinements are suggested, including enhanced precision in distinguishing between soft phrase onsets on individual words.     

Strength of German accent under altered auditory feedback.

Borden's (1979, 1980) hypothesis that speakers with vulnerable speech systems rely more heavily on feedback monitoring than do speakers with less vulnerable systems was investigated. The second language (L2) of a speaker is vulnerable, in comparison with the native language, so alteration to feedback should have a detrimental effect on it, according to this hypothesis. Here, we specifically examined whether altered auditory feedback has an effect on accent strength when speakers speak L2. There were three stages in the experiment. First, 6 German speakers who were fluent in English (their L2) were recorded under six conditions--normal listening, amplified voice level, voice shifted in frequency, delayed auditory feedback, and slowed and accelerated speech rate conditions. Second, judges were trained to rate accent strength. Training was assessed by whether it was successful in separating German speakers speaking English from native English speakers, also speaking English. In the final stage, the judges ranked recordings of each speaker from the first stage as to increasing strength of German accent. The results show that accents were more pronounced under frequency-shifted and delayed auditory feedback conditions than under normal or amplified feedback conditions. Control tests were done to ensure that listeners were judging accent, rather than fluency changes caused by altered auditory feedback. The findings are discussed in terms of Borden's hypothesis and other accounts about why altered auditory feedback disrupts speech control.     

Strength of German accent under altered auditory feedback

Borden’s (1979, 1980) hypothesis that speakers with vulnerable speech systems rely more heavily on feedback monitoring than do speakers with less vulnerable systems was investigated. The second language (L2) of a speaker is vulnerable, in comparison with the native language, so alteration to feedback should have a detrimental effect on it, according to this hypothesis. Here, we specifically examined whether altered auditory feedback has an effect on accent strength when speakers speak L2. There were three stages in the experiment. First, 6 German speakers who were fluent in English (their L2) were recorded under six conditions—normal listening, amplified voice level, voice shifted in frequency, delayed auditory feedback, and slowed and accelerated speech rate conditions. Second, judges were trained to rate accent strength. Training was assessed by whether it was successful in separating German speakers speaking English from native English speakers, also speaking English. In the final stage, the judges ranked recordings of each speaker from the first stage as to increasing strength of German accent. The results show that accents were more pronounced under frequency-shifted and delayed auditory feedback conditions than under normal or amplified feedback conditions. Control tests were done to ensure that listeners were judging accent, rather than fluency changes caused by altered auditory feedback. The findings are discussed in terms of Borden’s hypothesis and other accounts about why altered auditory feedback disrupts speech control.     

Entrainment and Modulation of Gesture–Speech Synchrony Under Delayed Auditory Feedback

Gesture–speech synchrony re‐stabilizes when hand movement or speech is disrupted by a delayed feedback manipulation, suggesting strong bidirectional coupling between gesture and speech. Yet it has also been argued from case studies in perceptual–motor pathology that hand gestures are a special kind of action that does not require closed‐loop re‐afferent feedback to maintain synchrony with speech. In the current pre‐registered within‐subject study, we used motion tracking to conceptually replicate McNeill's ( 1992 ) classic study on gesture–speech synchrony under normal and 150 ms delayed auditory feedback of speech conditions (NO DAF vs. DAF). Consistent with, and extending McNeill's original results, we obtain evidence that (a) gesture‐speech synchrony is more stable under DAF versus NO DAF (i.e., increased coupling effect), (b) that gesture and speech variably entrain to the external auditory delay as indicated by a consistent shift in gesture‐speech synchrony offsets (i.e., entrainment effect), and (c) that the coupling effect and the entrainment effect are co‐dependent. We suggest, therefore, that gesture–speech synchrony provides a way for the cognitive system to stabilize rhythmic activity under interfering conditions.     

Effect of reading with reversed speech on frequency of stuttering in adults

This study explored the effect of reading with reversed speech on the frequency of stuttering. Eight adults who stutter served as participants and read four 300-syllable passages while listening to three types of speech stimuli: normal speech (choral reading), reversed speech at normal speed, reversed speech at half speed, and a control condition of no auditory feedback. A repeated-measures analysis of variance showed a significant decrease in stuttering frequency in the choral reading condition but not in reversed speech at normal and half speed. However, the reversed speech at half-speed condition showed a large effect size (omega2 = 0.32). Data suggest that a forward moving speech feedback is not essential to decrease the frequency of stuttering in adults who stutter.     

The separate and combined effects of GSR biofeedback and delayed auditory feedback on stuttering: A preliminary study

The separate and combined effects of galvanic skin response biofeedback low wave amplitude self regulation (GSR LW) and amplified delayed auditory feedback (DAF) upon stuttering dysfluency are examined. Two college age male stutterers who were seen on an intensive longitudinal basis were the subjects in this study.Results suggest that GSR LW, when it is accomplished, functions to moderately but significantly reduce stuttering dysfluency compared to no GSR biofeedback. This effect does not noticeably dissipate over time. There occurred a marked and sustained reduction in stuttering dysfluency under DAF compared to no DAF conditions. Without separating accomplished and not accomplished GSR LW, there occurred slightly but not statistically significantly fewer blocks under the combined DAF-GSR LW condition than under DAF alone. Nevertheless, it does seem likely, considering these findings overall, that when GSR LW is accomplished, the fluency facilitating effect of its simultaneous combination with DAF is additive i.e., greater than either alone. Possible theoretical and therapeutic implications are discussed.