Oliver Bloodstein: reflections on a career. Interview by Mark Onslow

Oliver Bloodstein arrived at the University of Iowa in 1941 to study under Wendell Johnson. There he began an influential career that included a seminal documentation of the development of stuttering, the development of the continuity hypothesis and the anticipatory struggle hypothesis, and the writing of five editions of the influential text “A Handbook on Stuttering.” In this interview Dr. Bloodstein reflects on his remarkable and inspiring career, which continues today with his involvement in the preparation of a sixth edition of this text.

Educational objectives: The reader will; (1) describe the contribution to the field of stuttering made by Dr. Bloodstein; (2) discuss the career influences that led to his achievements; (3) know Dr. Bloodstein's current views on the cause of stuttering; and (4) identify the locations at which he worked during his career.     

Stuttering: a dynamic motor control disorder

The purpose of this review is to determine what neural mechanisms may be dysfunctional in stuttering. Three sources of evidence are reviewed. First, studies of dynamic inter-relationships among brain regions during normal speech and in persons who stutter (PWS) suggest that the timing of neural activity in different regions may be abnormal in PWS. Second, the brain lesions associated with acquired stuttering are reviewed. These indicate that in a high percentage of cases, the primary speech and language regions are not affected but lesions involve other structures, such as the basal ganglia, which may modulate the primary speech and language regions. Third, to characterize the motor control disorder in stuttering, similarities and differences from focal dystonias such as spasmodic dysphonia (SD) and Tourette’s syndrome (TS) are reviewed. This review indicates that the central control abnormalities in stuttering are not due to disturbance in one particular brain region but rather a system dysfunction that interferes with rapid and dynamic speech processing for production.

Educational objectives: The reader will be able to describe: (1) the similarities and differences between stuttering and other speech motor control disorders, (2) which brain lesions are most likely to produce acquired stuttering in adults, and (3) what type of brain abnormality most likely underlies stuttering.     

On Becoming a Psychoanalyst

This article traces an intellectual journey from a university environment in Rio de Janeiro, Brazil, under military dictatorship in the sixties, to becoming a training analyst of the British Psychoanalytic Society. The journey includes an M. Phil. in Social Anthropology from the National Museum in Rio de Janeiro, followed by a Ph.D. in Social Anthropology at the London School of Economics. Reading the classic texts of social anthropology, as well as Latin American writers and the Jewish classics, paved the way for an understanding of the world of others. Training in family therapy and ten years of clinical work in the NHS gave the clinical foundation required for the longed-for training with the British Psychoanalytic Society. From then on, the journey to becoming a training analyst is delineated, as well as the new challenges which this new phase has brought in the last ten years.     

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.     

A clinician survey of speech and non-speech characteristics of neurogenic stuttering

This study presents survey data on 58 Dutch-speaking patients with neurogenic stuttering following various neurological injuries. Stroke was the most prevalent cause of stuttering in our patients, followed by traumatic brain injury, neurodegenerative diseases, and other causes. Speech and non-speech characteristics were analyzed separately for these four etiology groups. Results suggested possible group differences, including site of lesion and influence of speech conditions on stuttering. Other characteristics, such as within-word localization of disfluencies and presence of secondary behaviors were comparable across the etiology groups. The implications of our results for the diagnosis of neurogenic stuttering will be discussed.

Educational objectives: After reading this article, the reader will be able to: (1) provide a concise overview of the main literature on neurogenic stuttering; (2) discuss the speech and non-speech characteristics of neurogenic stuttering; (3) provide an overview of current clinical practices for intervention with neurogenic stuttering patients and their perceived outcome.     

Jewish agricultural settlement in Brazil

Jewish agricultural colonization in Brazil began in 1904 in the state of Rio Grande do Sul, supported by the Jewish Colonization Association (JCA). The JCA created the first colonies – Philippson (1904) and Quatro Irmãos (1912) – with the intention of resettling Russian Jews during the decisive years of mass immigration from the Russian empire. In 1936, the JCA administration in Brazil proposed a new project to establish a colony for German Jews in Rezende, situated in the state of Rio de Janeiro. Similar to other initiatives undertaken by the São Paulo and Paraná state governments some years before, the Rezende colony did not last long. This essay analyzes the main factors behind the disintegration of the JCA colonies, noting that, in spite of their relative failure, the colonies aided Brazil and helped change the stereotypical image of the non-productive Jew, capable of working only in commerce and finance. The main benefit from these agricultural experiments was the removal of restrictions in Brazil on Jewish immigration from Europe during the twentieth century.     

The Intersect of Psychoanalysis and Totalitarianism

This conjunction is fraught with danger, with difficulties, and with irreconcilables. I discuss three examples: (a) very briefly, the Soviet Union, where psychoanalysis, established before the October Revolution, came finally to be abolished, as incompatible with Soviet-enforced psychological theory; (b) somewhat more, Nazi Germany, where psychoanalysis struggled to survive in a truncated and grossly distorted form, as a Nazi-sponsored “Aryanized” depth-psychology stripped of Freud’s name and of its necessary conditions of safety and confidentiality; and (c) in considerable detail, my personal experiences on behalf of the International Psychoanalytical Association, in Rio de Janeiro, Brazil, dealing, after the overthrow of the military junta that had ruled in the 1970s, with the psychoanalytic aftermath, the complete breakdown of the analytic society’s functioning consequent to the shielding of a government torturer during the dictatorship years.     

Comparing judgments of stuttering made by students, clinicians, and highly experienced judges

Purpose: The purpose of this study was to compare judgments of stuttering made by students and clinicians with previously available judgments made by highly experienced judges in stuttering. Method: On two occasions, 41 university students and 31 speech-language pathologists judged the presence or absence of stuttering in each of 216 audiovisually recorded 5-s intervals of the speech of adults who stutter. Intrajudge and interjudge agreement were calculated, and comparisons were made to judgments previously made about the same recordings by 10 highly experienced judges of stuttering. Results: Students and clinicians showed similar and relatively high levels of intrajudge and interjudge agreement, but both students and clinicians identified less than half as much stuttering as the highly experienced judges had identified. Conclusions: These results replicate previous findings of high agreement coexisting with low accuracy in students’ judgments of stuttering, extending those findings to show that similar problems are evident in judgments made by practicing clinicians. Implications include the need for explicit stuttering judgment training programs for both students and practicing clinicians.

Educational objectives: After reading this article, the reader will be able to: (1) describe different methods for identifying stuttering and possible problems associated with each method; (2) describe two different methods for reporting interjudge reliability; (3) describe how the identification of stuttering differs for student, clinician, and highly experienced judges.     

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.     

形状-性别内隐联结及其对消费者形状偏好的影响

本文探讨了形状与性别之间的内隐联结及其对消费者形状偏好的影响。通过4个实验, 作者发现形状与性别之间存在内隐联结, 即圆润的形状与女性更相关, 而有棱角的形状与男性更相关。这一内隐联结被拓展到品牌感知上, 导致品牌的性别形象影响消费者对圆形或棱角形产品的偏好, 而感知匹配度在其中起中介作用。这些研究发现进一步丰富了现有关于形状偏好以及形状象征意义的文献, 并对视觉营销中的形状设计提供了重要的实践指导。     

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.     

Australian attitudes towards stuttering: A cross-sectional study

BackgroundNegative reactions experienced by people who stutter often stem from unfounded attitudes and beliefs in the community.PurposeThere is a need to better understand current public attitudes towards stuttering in Australia. The purpose of this study was to: (a) explore the attitudes and knowledge of a large sample of the Australian public using the Public Opinion Survey of Human Attitudes-Stuttering [POSHA-S], (b) identify how the reported attitudes towards, and knowledge of, stuttering compare to existing data, and (c) identify differences between groups for variables identified.MethodsA cross-sectional population study using the POSHA-S was conducted in Melbourne, Australia. Comparisons of the attitudes towards stuttering of this sample were made with data from other worldwide samples on the POSHA-S database. The influence on attitudes to stuttering of variables including age, gender, education level, country of birth, employment status and number of languages spoken was explored.ResultsThe Overall Stuttering Score (OSS) of the Australian sample was higher than the median score on the POSHA-S database. This suggests that the Australian public holds more positive attitudes than those other countries represented in the database. Being younger, more educated, employed, female, monolingual, born in Australia and not familiar with people who stutter were related to more positive attitudes for this sample. Some negative stereotypes towards stuttering were noted; people who stutter were identified as ‘shy and fearful’, and ‘nervous and excitable’.ConclusionsWhile the Australian public has generally positive attitudes towards stuttering, these attitudes still reflect some ‘stuttering stereotypes’.     

Health and human services for persons who stutter and education of logopedists in East-European countries

The International Association of Logopedics and Phoniatrics (IALP) assessed the therapy status of fluency disorders, service opportunities, and education of logopedists (speech-language pathologists) with a mail survey in Eastern Europe. Information was collected on the following aspects: incidence, prevalence, availability of information, non-therapeutic support for persons who stutter (PWS), providers of diagnostics and therapy, cooperating professionals, therapy approaches, forms, goals, financing, early detection and prevention, training of professionals, specialization in stuttering therapy, needs for improving the situation of PWS, and problems which hinder better care. Stuttering therapy for children is available in many countries and is frequently provided by the educational system. Therapy for adults is provided best by the health services but is not satisfactorily available everywhere. Modern therapeutic approaches coexist with obsolete ones. Lack of resources, awareness, entitlement, and assessment of therapy effectiveness are pervasive problems.

Educational objectives: Readers will be able to describe and evaluate: (1) the therapy status of fluency disorders and service opportunities in various East-European countries; (2) the training of logopedists (speech-language pathologists); (3) specialization in stuttering therapy; and (4) the organizational services for PWS within the health and human service systems.     

Fragments of a Case of Psychosis: From Institutional Sheltering to Psychoanalytical Experience

This article describes a psychoanalytical experience that took place in an institution for mental health, located in Rio de Janeiro, Brazil. There, an art workshop was created in an attempt to welcome and shelter psychotic patients. This work space later proportioned a ''setting'' for the practice of psychoanalysis with psychotic patients. In the clinical case, herein examined, the author dedicates special attention to the relation that exists between certain psychotic aspects and the process described by Jacques Lacan as: the ''foreclosure of the name of the father''.     

A positron emission tomography study of short- and long-term treatment effects on functional brain activation in adults who stutter

Previous studies have shown that fluency-inducing techniques, such as choral speech, result in changes in neural activation as measured by functional neuroimaging. In the present study, positron emission tomography was used to investigate the effects of intensive behavioural treatment, followed by a 1-year maintenance program, on the pattern of cortical and subcortical activation in stuttering adults during silent and oral reading of single words. The results indicate changes in activation lateralisation, as well as a general reduction in overactivation, especially in the motor cortex, following treatment. The results are discussed in light of previous functional imaging studies with stuttering adults.

Educational objectives: The reader will learn about and be able to describe the: (1) use of functional neuroimaging PET in the study of stuttering; (2) differences in neural activation between stuttering and non-stuttering adults; and (3) effects of behavioural fluency treatment on cortical and subcortical activations in stuttering speakers.     

Are we there yet? A review of gender comparisons in three behavioral journals through the 20th century

Despite overwhelming evidence that gender plays a significant role in the course of numerous psychological disorders, researchers have historically neglected to address gender similarities and differences in their research. Previous reviews of the psychological literature have indicated that personality, psychotherapy, and behavioral psychology journals have published few studies that focus on gender comparisons. The current review examined published articles in three prominent behavioral psychology journals—Behavior Therapy, Behavior Modification, and Behaviour Research and Therapy—from their inception through 2001. Raters coded each article (N = 4,635) for gender content in the title or abstract, analyses of gender differences, and discussion of gender. Overall, very few articles focused on gender content in the title, abstract, or discussion or analyzed data by gender. Implications of these results and suggestions for enhancing attention to gender comparisons are discussed.     

Fluency disorders in genetic syndromes

The characteristics of various genetic syndromes have included “stuttering” as a primary symptom associated with that syndrome. Specifically, Down syndrome, fragile X syndrome, Prader-Willi syndrome, Tourette syndrome, Neurofibromatosis type I, and Turner syndrome all list “stuttering” as a characteristic of that syndrome. An extensive review of these syndromes indicated clients diagnosed with these syndromes do show evidence of nonfluency patterns, but not all would be considered stuttering. Many of the syndromes are marked by degrees of mental retardation that probably contribute to a higher than average prevalence of stuttering, as well as a higher than average prevalence of other fluency disorders (when compared to the population at large).

An in-depth analysis of the available data indicates that some of these genetic syndromes show patterns of stuttering that may be indicative of only that syndrome (or similar syndromes) that can be differentially diagnosed from developmental stuttering. Among these patterns are the word-final nonfluencies noted in Prader-Willi syndrome; the presence of stuttering in the absence of secondary behaviors noted in Prader-Willi syndrome and; the presence of palilalia, word-final and word-medial nonfluencies, and word-medial and word-final nonfluencies in Tourette syndrome. Implications for future research are discussed in light of these findings.

Educational objectives: The reader will be able to: (1) describe the various different genetic syndromes that are associated with fluency disorders; (2) describe the types of nonfluencies that are associated with the major types of genetic syndromes that have fluency disorders; (3) describe the behaviors that may assist in differentially diagnosing different types of speech characteristics associated with various genetic syndromes.     

Effects of perceptual and conceptual similarity in lexical priming of young children who stutter: preliminary findings

The purpose of this study was to investigate the influence of conceptual and perceptual properties of words on the speed and accuracy of lexical retrieval of children who do (CWS) and do not stutter (CWNS) during a picture-naming task. Participants consisted of 13 3–5-year-old CWS and the same number of CWNS. All participants had speech, language, and hearing development within normal limits, with the exception of stuttering for CWS. Both talker groups participated in a picture-naming task where they named, one at a time, computer-presented, black-on-white drawings of common age-appropriate objects. These pictures were named during four auditory priming conditions: (a) a neutral prime consisting of a tone, (b) a word prime physically related to the target word, (c) a word prime functionally related to the target word, and (d) a word prime categorically related to the target word. Speech reaction time (SRT) was measured from the offset of presentation of the picture target to the onset of participant's verbal speech response. Results indicated that CWS were slower than CWNS across priming conditions (i.e., neutral, physical, function, category) and that the speed of lexical retrieval of CWS was more influenced by functional than perceptual aspects of target pictures named. Findings were taken to suggest that CWS tend to organize lexical information functionally more so than physically and that this tendency may relate to difficulties establishing normally fluent speech and language.

Educational objectives: The reader will learn about and be able to (1) communicate the relevance of examining lexical retrieval in relation to childhood stuttering and (2) describe the method of measuring speech reaction times of accurate and fluent responses during a picture-naming task as a means of assessing lexical retrieval skills.     

A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers

In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents’ native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany.

Educational objectives: Readers will discuss and evaluate: (1) the short-term effects of the Lidcombe Program in comparison to natural recovery on stuttering; (2) the impact of the Lidcombe Program on early stuttering in German-speaking preschool children.