Perceptual evaluation of the speech before and after fluency shaping stuttering therapy

An often-cited criterion for assessing the effect of a stuttering therapy is the ability of the stutterers to produce normally fluent speech. Many modern stuttering therapies use special techniques that may produce stutter-free speech that does not sound completely normal. The present study investigates this problem in the framework of the Dutch adaptation of the Precision Fluency Shaping Program.

Pre-, post-, and -year follow-up therapy speech samples of 32 severe stutterers who were treated in a four-week intensive therapy are compared with comparable samples of 20 nonstutterers. For that aim the samples were rated on 14 bipolar scales by groups of about 20 listeners. The results show that the speech of the stutterers in all three conditions differs significantly from the speech of the nonstutterers. The pretherapy speech takes an extreme position on a Distorted Speech dimension, due to the large proportion of disfluencies. The posttherapy speech has extremely low scores on a Dynamics/Prosody dimension, a‘1 while the follow-up therapy speech differs from the normal speech on both dimensions, but now the distances are smaller. These results are discussed in relation to the severity of the stuttering problem in the group of treated stutterers. Finally, implications for future research on therapy evaluation are discussed.     

Word-by-word analysis of observer agreement utilizing audio and audiovisual techniques

The purpose of this study was to compare audio and audiovisual techniques of analyzing stuttering behavior using a recently developed index of agreement (Young, 1975). Twenty speech pathologists identified moments of stuttering for ten adult stutterers using both audio and audiovisual methods. Although no statistically significant differences existed between the two conditions, the listeners had more difficulty identifying moments of stuttering during the audio condition when mild stutterers were used.     

Vocal changes in stutterers and nonstutterers when speaking to children

Within the last few years, considerable attention has been devoted to the possibility that the amelioration of stuttering in many novel speaking conditions is a function of vocal changes with or without accompanying modifications in prosodic expression. These formulations have made reference primarily to conditions in which stutterers were induced into one or another novel speech pattern by an external stimulus such as masking noise, a rhythmic cue, or by instructions to sing, or read in unison with another speaker. In contrast, far less attention has been paid to other ameliorative conditions that lack a novel external stimulus or special instructions that direct the stutterer to speak in some unique manner. Speaking or reading to a child is an example of this latter type of condition. The present study was conducted to see if nine adult stutterers and a matched group of nonstutterers would evince vocal changes as they read aloud to another adult, a child, and a child and adult together. There was also a fourth control condition wherein the subjects read to one of the experimenters. Dependent measures of disfluency and stuttering, fundamental frequency, fundamental frequency deviation, fluent reading rate, and peak vocal sound pressure level were made and treated statistically. The major findings of this study indicated that, relative to the control condition, both subject groups exhibited several vocal changes when reading to a child alone and to a child and adult together. In addition, the stutterers experienced a reduction in disfluency, but only when reading to the child alone. The normal speakers exhibited too few disfluencies in the control condition for any meaningful change to occur in that dependent variable. The fact that the stutterers evinced vocal changes in both experimental conditions but a significant drop in disfluency in just one bears importantly on hypotheses that emphasize vocal changes in conditions that ameliorate stuttering.     

An analysis of a token economy in stuttering therapy

A stuttering therapy program in which adult stutterers were hospitalized and treated in small groups (n = 4) under token economy conditions is described. The Token System reinforced reductions and penalized increases in stuttering during conversation. The therapy program was divided into three stages. Initially, subjects were treated by the token system, which was then integrated with a delayed auditory feedback schedule designed to instate and shape a prolonged speech pattern into normal fluent speech. Finally, subjects passed through a speech situation hierarchy while under token control conditions. Experiments conducted in the first two stages of treatment are described. The first-stage experiments examined the design of the token system; the second-stage experiment assessed the effect of a contingent punishment schedule integrated with the delayed auditory feedback procedure in order to shape rate of speaking as well as fluency.     

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.     

Effect of communicative stress on the frequency and form-types of disfluent behavior in adult stutterers

Twenty adult stutterers spoke spontaneously for two minutes under each of four monitoring conditions of imposed communicative stress. Results indicated that being heard stuttering (The Auditory Component) is more stressful than being seen stuttering (The Visual Component). This finding applied to the total sample of subjects and for subgroups based on predominant disfluency form-type. In spite of changes in the frequency of molar disruptions, stutterers and stutterer-subgroups evidenced a consistent, stereotyped, molecular stuttering pattern in terms of specific disruption form-types.     

Patterns of vocal fold movement during stuttering

By means of an electroglottography, 114 tokens of stuttering produced by 12 adult stutterers were analyzed for patterns of vocal fold vibration as observed in eight types of stuttering episodes. Results suggest that stuttering events share certain phonational attributes. Issues concerning the nature of the disorder and approach to treatment are discussed.     

Vocal changes in stutterers and nonstutterers during monotoned speech

For years, reports have circulated that stutterers experience marked decrements in their stuttering when they speak or read in monotone. Wingate has suggested that the ameliorative effects of various novel speaking conditions on stuttering can be attributed to modifications in vocalization induced by such conditions. The present study was conducted to see whether this explanation would extend to monotoned speech as well. Ten teenage and adult stutterers and 10 normal speakers were tested in control and monotone reading conditions. Dependent measures were the frequencies of disfluency and stuttering, fundamental frequency, fundamental frequency standard deviation, vocal SPL, vocal SPL standard deviation, and fluent reading rate. Only within-group statistical comparisons were made, because members of the two groups could not be matched pairwise along critical vocal parameters. The major findings of this study indicated that across the two conditions, both groups significantly reduced their fundamental frequency, fundamental frequency standard deviation, vocal SPL and vocal SPL standard deviation. Only the stutterers exhibited a significant decrement in disfluency and stuttering. The normals did not evince enough disfluency in the control condition for a reduction to occur during monotoning. Neither group effected a reduction in fluent reading rates. These and other findings and interpretations are discussed relative to Wingate's modified vocalization hypothesis.     

Attitude and personality characteristics of older stutterers

Attitude and personality characteristics of 29 stutterers (19 male, 10 female) aged 52–82 yr were assessed using five questionnaires. Results indicate that, while the older stutterers score approximately the same as young adult stutterers on scales assessing approach and performance behaviors, the large majority of older stutterers perceive their stuttering as less handicapping than when they were young adults. Self-perceived personality characteristics of the older stutterers were similar to a group of older nonstutterers. While a few of the subjects had experienced some degree of success as a result of treatment later in life, the majority of the subjects did not currently desire treatment.     

The relationship between treatment exposure times and changes in stuttering frequency during contingent stimulation

Four adult stutterers were exposed to 60 consecutive minutes of verbal contigent stimulation. In each session subjects spoke until a stuttering frequency stability criterion was met (baserate) followed by 60 min of exposure to the word wrong presented contingently upon each instance of stuttering. The data were analyzed according to changes in stuttering which occured following 20, 40, and 60 min of treatment exposure. The results revealed that stuttering frequency was reduced for all subjects during all three 20-min segments of the treatment condition. The only significant reductions in stuttering frequency, however, occured within the first 20 min of treatment.     

Towards a functional neural systems model of developmental stuttering

This paper overviews recent developments in an ongoing program of brain imaging research on developmental stuttering that is being conducted at the University of Texas Health Science Center, San Antonio. This program has primarily used H₂¹⁵O PET imaging of different speaking tasks by right-handed adult male and female persistent stutterers, recovered stutterers and controls in order to isolate the neural regions that are functionally associated with stuttered speech. The principal findings have emerged from studies using condition contrasts and performance correlation techniques. The emerging findings from these studies are reviewed and referenced to a neural model of normal speech production recently proposed by Jürgens [Neurosci. Biobehav. Rev. 26 (2002) 235]. This paper will report (1) the reconfiguration of previous findings within the Jürgens Model; (2) preliminary findings of an investigation with late recovered stutterers; (3) an investigation of neural activations during a treatment procedure designed to produce a sustained improvement in fluency; and (4) an across-studies comparison that seeks to isolate neural regions within the Jürgens Model that are consistently associated with stuttering. Two regions appear to meet this criterion: right anterior insula (activated) and anterior middle and superior temporal gyri (deactivated) mainly in right hemisphere. The implications of these findings and the direction of future imaging investigations are discussed.

Educational objectives: The reader will learn about (1) recent uses of H₂¹⁵O PET imaging in stuttering research; (2) the use of a new neurological model of speech production in imaging research on stuttering; and (3) initial findings from PET imaging investigations of treated and recovered stutterers.     

Dichotic ear preferences of stuttering children and adults.

39 stutterers and 39 normal speakers indicated their ear preferences for dichotically presented words and digits. A single response mode for both dichotic words and digits was selected to study speech perception. Stutterers showed significantly less of the normal right-ear preference for dichotic words and digits than non-stutterers. The proportion of stutterers who failed to demonstrate a right-ear preference for dichotic words was significantly greater than for non-stutterers. 18% of the stutterers and none of the non-stutterers showed reversed or a left-ear preference for dichotic digits. Although non-stuttering children and adults performed alike on the dichotic tasks, the right-ear dichotic-words scores of stuttering children were significantly smaller than those of adult stutterers. The results are related to an early notion that stuttering may be related to mixed dominance and recent evidence showing that large percentages of older stuttering children show spontaneous remission of stuttering.     

Defining clinically significant changes in the treatment of child stutterers.

This study established a clinically significant criterion to evaluate outcomes of children's stuttering therapy. 30 stutterers, ages 6 to 15 years, and 30 non-stutterers served as subjects. Speech samples were recorded and the percentage of stuttered syllables and rate of speech analyzed. According to Jacobson and Revenstorf's procedure, 3% of stuttered syllables and 160 syllables per minute should become the target behaviors in the treatment of children's stuttering.     

Is overt stuttered speech a prerequisite for the neural activations associated with chronic developmental stuttering?

Four adult right-handed chronic stutterers and four age-matched controls completed H(2)(15)O PET scans involving overt and imagined oral reading tasks. During overt stuttered speech prominent activations occurred in SMA (medial), BA 46 (right), anterior insula (bilateral), and cerebellum (bilateral) plus deactivations in right A2 (BA 21/22). These activations and deactivations also occurred when the same stutterers imagined they were stuttering. Some parietal regions were significantly activated during imagined stuttering, but not during overt stuttering. Most regional activations changed in the same direction when overt stuttering ceased (during chorus reading) and when subjects imagined that they were not stuttering (also during chorus reading). Controls displayed fewer similarities between regional activations and deactivations during actual and imagined oral reading. Thus overt stuttering appears not to be a prerequisite for the prominent regional activations and deactivations associated with stuttering.     

Communicative stress and stuttering frequency during normal,whispered, and articulation-without-phonation speech modes

The effect of communicative stress on the frequency of stuttered syllables in 12 adult stutterers reading six different but equivalent passages using normal voicing, whispering, and articulation-without-phonation speech under a stress and a non-stress condition was studied. Although the frequency of stuttering was significantly greater in the normal voicing mode than in the whispering mode and greater in the whispering mode than in the articulation-without-phonation mode, no differences were found between the stress and the nonstress conditions with respect to stuttering.     

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.     

Reprint of: stuttering treatment control using P300 event-related potentials

Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults.Educational objectives: The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.     

Stuttering treatment control using P300 event-related potentials

Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults.Educational objectives: The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.     

Choral reading with filtered speech: effect on stuttering

This study investigated use of choral reading with filtered components of speech and whispered speech on the frequency of stuttering. Three passages read by a normal adult male were lowpass filtered with kneepoint frequencies at 100 Hz (approximate glottal source), 500 Hz (source and first formant), and 1 kHz (source and the first two formants). Along with a whispered passage, a normal passage, and a control condition, these stimuli were used in a repeated-measures design with 12 adult stutterers as they read passages while listening to one of the stimuli. Frequencies of stuttering in each condition were analyzed. The choral speech, the 500-Hz, the 1-kHz, and the whispered speech conditions all decreased the frequency of stuttering while the 100-Hz stimuli did not. It is suggested that articulatory events, chiefly the encoded speech output from the vocal tract, create effective cues and may induce fluent speech in people who stutter.     

Acoustics of stop consonant-vowel relationships during fluent and stuttered utterances

Acoustic duration measures were made on the stop-gap, voice onset time (VOT), and vowel portions of the utterance [tu] in the context “425” as spoken ten times or more by five normal speakers, four mild stutterers, and four severe stutterers. The fluent utterances of the severe stutterers were significantly longer than those of normal speakers on stop-gap and vowel durations but not on voice onset times. Despite the slower speech of the severe stutterers, indications of normalization were found in the relatively stable consonant-to-vowel ratios across groups and in the lack of any significant differences of segment durations as a percentage of total utterance times. Normal speakers and mild stutterers showed an inverse relationship between stop-gap and VOT measures across speakers, but severe stutterers did not maintain this relationship for either fluent or stuttered tokens, nor did a mild stutterer suspected of covert stuttering. Stop-gap durations increased while VOTs stayed within normal limits for fluent tokens. For stuttered tokens, some subjects increased the stop-gap and some the VOT depending upon the location of the block. Abnormal gap to VOT ratios may serve to detect convert stuttering.