Group play therapy for Japanese children who stutter

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

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.     

Multilingual children who stutter: clinical issues

Stuttering occurs across all languages and cultures. However, the impact of speaking more than one language on assessment and treatment of young children who stutter is not well documented. This paper discusses some of the challenges related to clinical issues pertaining to this population including (a) identifying stuttering in an unfamiliar language, (b) the influence of language proficiency, and (c) treatment of multilingual young children who stutter. The paper is written from the perspective of the author's experience treating multilingual children who stutter within the context of the linguistic and cultural diversity of Canada, notably in the French speaking Province of Quebec where many children grow up speaking two or more languages in everyday life. Clinical examples will be taken from the evidence-based literature as well as the author's clinical experience.Educational objectives: After reading this paper, the learner will be able to (1) summarize the literature regarding assessment and treatment of stuttering in young children speaking more than one language, (2) summarize some of the challenges related to this issue and (3) describe some of the findings associated with treatment of bilingual children who stutter and (4) be prepared to apply some of these suggestions in the treatment of bilingual children who stutter.     

Projective drawings and children who stutter

Five young stutterers (aged 5–10 yr) and a matched group of five nonstuttering children completed five projective drawings and a scale for assessing communication attitudes of children at the beginning and at the end of a 3-mo treatment period. While the attitude scale failed to indicate differences between stuttering and nonstuttering children, performances on selected drawings did distinguish between experimental and control subjects. In addition, significant changes were observed in selected drawings over the treatment period for the young stutterers.     

Developing physiologic stress profiles for school-age children who stutter

Purpose

Physiologic reactivity profiles were generated for 9 school-age children with a history of stuttering. Utilizing salivary sampling, stress biomarkers cortisol and alpha-amylase were measured in response to normal daily stressors. Children with a history of stuttering were characterized as high or low autonomic reactors when compared to age-normed references established for cortisol and alpha-amylase levels.

Method

Salivary samples were collected four times daily over three consecutive days from children (6 boys and 3 girls) aged 6–11 years. Samples were measured for two important stress biomarkers, cortisol and alpha-amylase. Following laboratory training on appropriate sampling technique using the Salivette, families collected all samples in their homes.

Results

Compared to published references established for normal children, children with a history of stuttering exhibited mean cortisol and alpha-amylase levels that were significantly lower, though within normal limits.

Conclusions

Results reflect an initial investigation into the use of salivary sampling to measure reactivity in children who stutter. As children who stutter have historically been excluded from physiologic stress studies, salivary sampling appears to provide an innovative and minimally invasive option for investigators. Though interpreted with caution secondary to the small sample size, initial findings suggest that in response to normal daily stressors, school-age children with a history of stuttering do not exhibit significantly elevated stress biomarkers.Educational objectives: The reader will be able to: (1) identify two biomarkers that reflect activation of the body's stress response; (2) discuss possible implications the generation of individualized stress profiles may have on the treatment of stuttering; and (3) discuss and evaluate the research needs associated with the inclusion of children in physiological studies of fluency.     

A component model for diagnosing and treating children who stutter

Nine components of stuttering and their distribution among 54 children who stutter are described. The components are arranged into a model that includes four neurologic components (attending disorder, auditory-processing disorder, sentence-formulation disorder, and oral-motor disorder) and five traditional components (high self-expectations, manipulative stuttering, disruptive communication environment, unrealistic parental expectations, and abnormal parental need for the child to stutter). Diagnostic and treatment usefulness of the model are discussed. Thirty-two of the children have been followed through component-based treatment and 12 mo post termination. Results indicate that treatment was successful with 27 (84%) of the 32 children. Only one child regressed during the 12 mo after treatment ended. These results suggest that treating the neurologic and traditional factors which disrupt fluency improves maintenance and carry-over.     

Communication attitudes in children who stutter: A meta-analytic review

BackgroundThis article presents a meta-analytic review of differences in communication attitudes between children who stutter (CWS) and children who do not stutter (CWNS).MethodTo be included in this review, the studies had to include a group of CWS and CWNS between the ages of 3–18 years and a measurement of communication attitudes. The journal articles were identified by using the key words stutter*, speech disfluenc*, fluency disorder*, and stammer* cross-referenced to awareness*, reaction*, attitude*, KiddyCAT, CAT, A-19 Scale, PASS and OASES.ResultsA total of 18 studies met the inclusion criteria for this meta-analysis. The results showed that CWS exhibit more negative communication attitudes than CWNS from the preschool years. The differences between the groups increased with age, but were not influenced by gender.ConclusionThe results indicate that negative communication attitudes can be an effect of stuttering. Key issues requiring further investigation are whether communication attitudes differ as a function of age at stuttering onset and whether communication attitudes influence the development of stuttering.Educational Objectives: After reading this article, the reader will be able to: (a) summarise empirical findings with regard to the relationship between communication attitudes and childhood stuttering; (b) describe the different instruments used to measure communication attitudes; (c) discuss the relationship between communication attitudes, age and gender.     

Comparison of pausing behavior in children who stutter and children who have Asperger syndrome

Purpose

The objective of this research was to compare the number and types of grammatical and non-grammatical silent pauses presented by stutterers and subjects with Asperger syndrome in their narratives.

Method

Ten children who stutter and four participants with Asperger syndrome (mean ages of both groups 10 years) were assessed at the Speech and Language Disorders Department of the Universidade Federal de São Paulo/Brasil. They narrated a story based on a pre-selected sequence of pictures. They were filmed and their productions were analyzed using version 5.0.47 of Praat (http://www.fon.hum.uva.nl/praat/download_win.html). Silent intervals in the speech that ranged from 0.25 to 4 s were considered pauses. The pauses were classified as grammatical and non-grammatical, depending on the words that preceded and followed them.

Results

Both groups presented grammatical and non-grammatical pauses and the former predominated. The children with Asperger syndrome produced a greater number of pauses than the stutterers.Educational objectives: The reader will be able to: (1) characterize the use of pauses in the oral narrative; (2) distinguish a grammatical pause from a non-grammatical pause regarding the use and function; (3) recognize the pattern of pause found in the two populations.     

Nonword repetition abilities of children who stutter: an exploratory study

Past research has suggested that children who stutter (CWS) may have less well-developed language skills than fluent children, and that such relative linguistic deficiencies may play a role in precipitating their disfluencies. However, data to support this position are primarily derived from results of standardized diagnostic inventories, which are originally designed to identify frank language impairment. Nonword repetition has emerged as a more sensitive measure of children's linguistic abilities. In this exploratory study, eight CWS (mean age 5:10, range 4:3-8:4) were compared to eight normally developing children (ND) (mean age 5:9, range 4:1-8:4) in their ability to repeat the nonwords of the Children's Test of Nonword Repetition. CWS performed more poorly than NS on measures of Number of Words Correct and Number of Phoneme Errors at all nonword lengths, although statistical differences were observed only for 3-syllable nonwords. When lexical stress of the nonwords was varied to a non-English stress pattern, all participants repeated the stimuli with less accuracy, and the CWS again exhibited more errors than NS. Fluency for the CWS group did not change systematically with increasing nonword length. These preliminary findings are interpreted in light of a number of extant theories of the underlying deficit in childhood stuttering. We conclude that children who stutter may have diminished ability to remember and/or reproduce novel phonological sequences, and that further investigation into this possibility may shed light on the emergence and characteristics of childhood stuttering. EDUCATIONAL OBJECTIVES: After completing this activity, the learner will: (1) be able to evaluate the research support for a linguistic component to stuttering; (2) describe the use of nonword repetition as an experimental and assessment device with children with SLI and children who stutter; (3) suggest future directions for research to further refine the potential role that linguistic encoding plays in the etiology and persistence of stuttering.     

Measuring lexical diversity in children who stutter: application of vocd

There is growing but equivocal evidence that the language abilities of young children who stutter (CWS) may be depressed when compared to those of their fluent peers. In particular, the lexical skills of CWS have variously been reported to be weaker or stronger than comparison children in a number of recent studies. One source for such disagreement may be the measures used to compute lexical characteristics of these children's spoken conversations. In this study, we examined the concurrent validity of two measures of lexical diversity in spontaneous language samples, Type-Token Ratio (TTR) and the newly developed utility vocd (Malvern & Richards, 1997), using a standard test of expressive vocabulary as the comparison measure. Findings indicated that vocd values ("D") correlated well with standardized measures of expressive vocabulary, while TTR values did not. In addition, both the standardized measure and vocd revealed significantly poorer expressive lexical skills of CWS, whereas TTR analyses did not evidence this difference. Results are discussed in relation to the relative strength of vocd over TTR as a method for describing lexical characteristics of the spontaneous language samples of this population. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) identify several common measures of conversational vocabulary and the strengths and weaknesses of each, and (2) compare the performance of the young CWS in this study to their normally fluent peers in terms of vocabulary performance on both formal and conversational measures of vocabulary.     

Self-help conferences for people who stutter: a qualitative investigation

Self-help activities for people who stutter (PWS) have been gaining in popularity; however, there is a scarcity of evidence to support their utility in stuttering management. The purpose of this investigation was to understand the lived experience of individuals who attended a self-help conference(s) for PWS from the perspective of a PWS to learn its potential utility in stuttering management. The investigator used Interpretive Phenomenological Analysis (IPA) to systematically collect authentic data of this social phenomenon. Twelve participants were recruited from a self-help conference and the self-help community of PWS. Semi-structured interviews were conducted 4–18 months after each participant's last conference. Interviews were transcribed and analyzed. Themes were explained in investigator narratives and illustrated through participants’ quotes. Interpreted themes of the experience of having attended a self-help conference(s) for PWS included: socializing opportunities with other PWS, affiliation, redefining oneself and post-conference disclosures. A conclusion of the study was that the experience of having attended a self-help conference(s) for PWS helped to minimize negative impact that stuttering can have on daily functioning. It appears that self-help conferences were perceived as a safer or “stutter-friendly” environment and promoted social interaction, relationship building, and community building through planned and unplanned activities. Another conclusion was that the experience of having attended self-help conferences for PWS helped participants to communicate more easily. Reported increases in social activity and an “openness” about stuttering, suggest self-help conferences’ utility in stuttering management. These findings are supported by other studies about successful stuttering management and self-help activities for PWS. They have helped attendees who stutter to communicate more easily and suggest a reduction in the negative impact that stuttering has on their lives.Educational objectives: The reader will be able to: (1) describe recurring themes associated with the lived experience having attended a self-help conference(s) for people who stutter (PWS) from the perspective of a group of adults who stutter, and (2) describe the potential benefits of attending self-help conferences for PWS in order to make appropriate evidence-based referrals to self-help conferences for PWS.     

Pseudofluency in adults who stutter: the illusory outcome of therapy

The majority of therapy programs for people who stutter are aimed at modifying the entire speech output by using techniques that reduce the overt signature events. Use of these techniques for extended time periods are thought to induce true fluency that is automatic, natural, and effortless. It is proposed that the present form of therapeutic intervention induces pseudofluency rather than true fluency. Pseudofluency is the speech posrtherapy of persons who stutter, free of the discrete signature events of stuttering, but replaced by cognitively mediated gestures that are embedded as continuous prolongation or masked stuttering events throughout the speech act. This may account for the high rate of relapse and the problems associated with the maintenance, stability, and naturalness of speech after stuttering therapy.     

Speech sound articulation abilities of preschool-age children who stutter

Purpose

The purpose of this study was to assess the association between speech sound articulation and childhood stuttering in a relatively large sample of preschool-age children who do and do not stutter, using the Goldman–Fristoe Test of Articulation-2 (GFTA-2; Goldman & Fristoe, 2000).

Method

Participants included 277 preschool-age children who do (CWS; n = 128, 101 males) and do not stutter (CWNS; n = 149, 76 males). Generalized estimating equations (GEE) were performed to assess between-group (CWS versus CWNS) differences on the GFTA-2. Additionally, within-group correlations were performed to explore the relation between CWS’ speech sound articulation abilities and their stuttering frequency and severity, as well as their sound prolongation index (SPI; Schwartz & Conture, 1988).

Results

No significant differences were found between the articulation scores of preschool-age CWS and CWNS. However, there was a small gender effect for the 5-year-old age group, with girls generally exhibiting better articulation scores than boys. Additional findings indicated no relation between CWS’ speech sound articulation abilities and their stuttering frequency, severity, or SPI.

Conclusions

Findings suggest no apparent association between speech sound articulation—as measured by one standardized assessment (GFTA-2)—and childhood stuttering for this sample of preschool-age children (N = 277).Educational objectives: After reading this article, the reader will be able to: (1) discuss salient issues in the articulation literature relative to children who stutter; (2) compare/contrast the present study's methodologies and main findings to those of previous studies that investigated the association between childhood stuttering and speech sound articulation; (3) identify future research needs relative to the association between childhood stuttering and speech sound development; (4) replicate the present study's methodology to expand this body of knowledge.     

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.     

Frequency of verb use in young children who stutter

Several recent studies have suggested that young children who stutter (CWS) tend to show depressed lexical performance relative to peers. Given the developmental literature as well as several studies of verb processing in individuals who stutter, verbs may pose a particular challenge for this group. The purpose of the present study was to examine verb use in CWS. In theory, if young CWS differ in their production of verbs, this finding would partially explain the findings of studies that probed conversational vocabulary skills more generally. Fifteen CWS and 15 children who do not stutter (CWNS) participated in a play-based conversational sample with a parent. Samples were analyzed for the total number of verbs, the number of different verbs, and the proportion of general all-purpose (GAP) verbs within the samples. CWS produced significantly fewer different verbs and total verbs than the CWNS. However, previously reported near-significant differences in utterance length between groups would appear to temper the robustness of this finding. The groups did not differ in the proportion of GAP verbs used, suggesting that the CWS did not over-rely on GAP verbs in conversational language production but rather used these verbs to the same extent as their peers. Educational objectives: As a result of this activity, the participant will be able to: (1) relate the purpose and rationale for examining verb use in children who stutter (CWS); (2) summarize the procedures used to assess verb use and GAP verb use in the present study; (3) explain the findings of the present study; (4) relate findings to the extant literature on lexical diversity in CWS.     

Emotional reactivity and regulation in preschool-age children who stutter

Purpose.

This study experimentally investigated behavioral correlates of emotional reactivity and emotion regulation and their relation to speech (dis)fluency in preschool-age children who do (CWS) and do not (CWNS) stutter during emotion-eliciting conditions.

Method.

Participants (18 CWS, 14 boys; 18 CWNS, 14 boys) completed two experimental tasks (1) a neutral (“apples and leaves in a transparent box,” ALTB) and (2) a frustrating (“attractive toy in a transparent box,” ATTB) task, both of which were followed by a narrative task. Dependent measures were emotional reactivity (positive affect, negative affect), emotion regulation (self-speech, distraction) exhibited during the ALTB and the ATTB tasks, percentage of stuttered disfluencies (SDs) and percentage of non-stuttered disfluencies (NSDs) produced during the narratives.

Results.

Results indicated that preschool-age CWS exhibited significantly more negative emotion and more self-speech than preschool-age CWNS. For CWS only, emotion regulation behaviors (i.e., distraction, self-speech) during the experimental tasks were predictive of stuttered disfluencies during the subsequent narrative tasks. Furthermore, for CWS there was no relation between emotional processes and non-stuttered disfluencies, but CWNS's negative affect was significantly related to nonstuttered disfluencies.

Conclusions.

In general, present findings support the notion that emotional processes are associated with childhood stuttering. Specifically, findings are consistent with the notion that preschool-age CWS are more emotionally reactive than CWNS and that their self-speech regulatory attempts may be less than effective in modulating their emotions.Educational objectives. The reader will be able to: (a) communicate the relevance of studying the role of emotion in developmental stuttering close to the onset of stuttering and (b) describe the main findings of the present study in relation to previous studies that have used different methodologies to investigate the role of emotion in developmental stuttering of young children who stutter.     

Recasts in parents' language to their school-age children who stutter: a preliminary study

Language samples collected from 13 school-age children diagnosed as stutterers (CWS) in conversation with a parent and a similar corpus of data collected from a matched control group of 13 normally-fluent children (CWNS) were analyzed for the quality and quantity of recast usage in the parents' language. Recasts, a frequently studied type of child-directed language (CDL) pattern hypothesized to increase the length and complexity of young children's expressive language, have not been studied typically in older children's conversations with parents nor have they been studied in the CDL of parents of CWS. Comparisons of these samples revealed that both groups of parents were frequent users of imitations, as well as simple and complex type recasts. Indeed, the rank order of recast types used was identical for the two groups of caregivers. When parents' conversations with the CWS were analyzed further, it was noted that they were not more likely to focus on stuttered utterances as the utterances on which to base their recasts (i.e., "platform utterances") than on the child's fluently-produced utterances. These results suggest there is one additional conversation parameter for which there are evident similarities in the CDL used by parents of CWS and CWNS. Clinical implications gleaned from this preliminary study are discussed, as are suggestions for future study. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe (1) the role of recasts in young children's language development; (2) the types of recasts that were observed in the conversations of parents of CWS and CWNS; and (3) the similarities observed in the recasts produced by parents of CWS and CWNS.     

An exploration of the mechanisms of change following an integrated group intervention for stuttering,as perceived by school-aged children who stutter (CWS)

PurposeTo explore the process of change and role of resilience following an integrated group intervention for children who stutter (CWS).MethodUsing an exploratory multiple case study design, this research sought to identify the most significant changes perceived by seven participants following therapy, the mechanisms of change, and the role of resilience in the process of change. Quantitative measurements of resilience were combined with qualitative analysis of semi-structured interviews.ResultsThematic analysis of qualitative data showed that cognitive and emotional change was a key driver for therapeutic change, enabled by the shared experience of the group and a positive therapeutic environment. These changes were generalised into clients’ real-world experiences, facilitated by their support network. Quantitative data demonstrated a statistically reliable positive change in overall Resiliency scores for four participants and reduced impact of stuttering scores on OASES-S for all participants, maintained at 12 month follow-up.ConclusionsThis study demonstrates the importance of adopting an integrated approach in therapy for CWS, which incorporates Cognitive Behavioural Therapy (CBT) as a key component, to facilitate change and build resilience. These results are unique to this cohort of CWS and further investigation into the use of CBT and the process of change may be warranted.Educational ObjectivesThe reader will be able to (1) describe the integrated intervention used in this study (2) define the most significant change following therapy for the participants involved (3) summarise the key factors that facilitated change during the therapy process (as perceived by the participants).