Comparative Diagnostic Judgments from the Rorschach and the MMPI

Three experienced psychologists made diagnostic judgments from the Rorschach, the MMPI, and gave an overall diagnostic impression for 50 male and 48 female patients. Judgment on the first test viewed was given before looking at the second test. Order of viewing the tests and sex of patient were counterbalanced. The results indicated (a) the judges consistently rated the tests on a given individual as agreeing on diagnostic impression significantly more often than disagreeing; (b) interjudge agreement was low but significant for the MMPI and overall impressions, not significant for the Rorschach impressions; (c) in cases of disagreement, there was a highly significant tendency for the Rorschach to be seen as indicating more pathology than the MMPI.     

Inter-intrajudge reliability of the stuttering severity instrument

Intra- and interjudge reliability were measured for two stutterers using the Stuttering Severity Insttument (SSI) as scored by nine judges. Results indicate good intrajudge reliability, but call interjudge reliability into question. The findings partially support Riley's (1980) contention that the SSI differentiates stuttering severity. Caution is urged in the clinical application of SSI test results.     

Unassisted recovery from stuttering: self-perceptions of current speech behavior, attitudes, and feelings

The purpose of this study was to investigate the nature of recovery from stuttering based on the experiences of adults who recovered without treatment. Using a semi-structured, open-ended interview format, 15 speakers verified as persons who recovered without treatment were asked to describe their status as everyday speakers. Seven speakers reported that they no longer stuttered and eight reported that they still stuttered on occasion. Interview material was coded and analyzed by the investigators and checked by independent judges. Results suggested that complete recovery was possible for speakers who reported that they no longer stuttered; whereas, those who still stuttered occasionally appeared to no longer be handicapped by stuttering, but required some vigilance to maintain their relatively fluent speech.

Educational objectives: After completing this activity, the learner will be able to: (1) describe the relevance of self-report data for evaluating the nature of recovery from stuttering without treatment; (2) describe the differences in self-perception concerning the nature of recovery for those who no longer have any tendency to stutter compared to those who still have an occasional tendency to stutter; and (3) suggest the possible implications for understanding the nature of recovery from persistent stuttering based on investigations of late recovery without treatment.     

Clinical judgment, clinical training, and professional experience

Reviews studies on training, experience, and clinical judgment. The results on the validity of judgments generally fail to support the value of on-the-job experience in mental health fields. The validity results do provide limited support for the value of training. Other results suggest that experienced clinicians are better than less experienced judges at knowing which of their judgments are likely to be correct and which are likely to be wrong. Reasons why clinicians have trouble learning from experience are given. Recommendations are made for improving training and clinical practice.     

Determinants of Interjudge Agreement on Personality Traits: The Big Five Domains, Observability, Evaluativeness, and the Unique Perspective of the Self

ABSTRACT We examined several determinants of interjudge agreement on personality traits. The findings, which were cross-validated in two samples, suggest that agreement is a function of four factors: which Big Five content domain the trait represents, how observable relevant behaviors are, how evaluative the trait is, and whether the self is one of the judges. Agreement was highest for traits related to Extraversion and lowest for traits related to Agreeableness. More observable and less evaluative traits elicited higher interjudge agreement. On average, self-peer agreement was lower than peer-peer agreement. However, this effect was limited to evaluative traits; for neutral traits, self-peer agreement was as high as peer-peer agreement. These findings suggest that self- and peer perception proceed through similar processes for neutral traits but not for highly evaluative traits, raising the possibility that self-perceptions become distorted when the trait is affectively charged.     

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.     

Olympic medals as fruits of comparison? Assimilation and contrast in sequential performance judgments

The authors investigated the evaluative consequences of sequential performance judgments. Recent social comparison research has suggested that performance judgments may be influenced by judgments about a preceding performance. Specifically, performance judgments may be assimilated to judgments of the preceding performance if judges focus on similarities between the two. If judges focus on differences, however, contrast may ensue. The authors examined sequential performance judgments, using data gathered from the 2004 Olympic Games as well as data gathered in the laboratory with students or experienced gymnastics judges as participants. Sequential performance judgments were influenced by previously judged performances, and the direction of this influence depended on the degree of perceived similarity between the successive performances.     

The Draw-A-Person Test: an indicator of children's cognitive and socioemotional adaptation?

The authors examined aspects of reliability and validity of the Goodenough-Harris Draw-A-Person Test (DAP; D. B. Harris, 1963). The participants were 115 seven- to nine-year-old students attending regular or special education schools. Three judges, with a modest degree of training similar to that found among practicing clinicians, rated the students' human figure drawings on developmental and personality variables. The authors found that counting details and determining developmental level in the DAP test could be carried out reliably by judges with limited experience. However, the reliability of judgments of children's social and emotional development and personality was insufficient. Older students and students attending regular schools received significantly higher scores than did younger students or students attending special education schools. The authors found that the success of the DAP test as an indicator of cognitive level, socioemotional development, and personality is limited when global judgments are used. The authors concluded that more specific, reliable, valid, and useful scoring systems are needed for the DAP test.     

The impact of stuttering on employment opportunities and job performance

The purpose of this study was to examine the impact that stuttering has on job performance and employability. The method involved administration of a 17-item survey that was completed by 232 people who stutter, age 18 years or older. Results indicated that more than 70% of people who stutter agreed that stuttering decreases one's chances of being hired or promoted. More than 33% of people who stutter believed stuttering interferes with their job performance, and 20% had actually turned down a job or promotion because of their stuttering. Results also indicated that men and minorities were more likely to view stuttering as handicapping than were women and Caucasians. These findings suggest that people who stutter believe stuttering to be handicapping in the workplace. The results may be helpful for clinicians who work with people who stutter.

Educational objectives:

The reader will be able to: (1) describe the impact that stuttering can have on employability and job performance and (2) be better able to explain how factors such as gender, ethnicity, and stuttering severity can impact the belief that stuttering is a handicapping condition.     

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.     

Assessment of stuttering in a familiar versus an unfamiliar language

The present study investigated how well individuals knowledgeable about stuttering are able to make disfluency judgments in clients who speak another language than their own. Fourteen native speakers of Brazilian Portuguese identified and judged stuttering in Dutch speakers and in Portuguese speakers. Fourteen native speakers of Dutch identified and judged stuttering in Brazilian Portuguese speakers and in Dutch speakers. It was found that judges can make similar level of judgment in a native and a foreign language, and that native and foreign judges can make similar level of judgment irrespective of native/foreign differences. It was also found, however, that the Dutch judges performed significantly better in identifying native stutterers than foreign stutterers. And for the identification of nonstutterers, both panels performed better in their native language than in the foreign language, and in their native language they both performed better than the other panel. Both the Brazilian Portuguese and the Dutch speaking panel were generally also less confident, and found identification of stuttering more difficult in the foreign language than in the native language. In addition, when asked for the characteristics that helped them identify stutterers, they provided more detail in the native language than in the foreign language. Also a number of differences were found between the two panels which may be due to differences in training or cultural background. The implications of the findings for clinical practice and for future research in this area are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how language influences the identification of a speech disorder such as stuttering, and (2) list, and (3) define behaviors that help to identify stuttering in a foreign language.     

Fluency-related behaviors and attitudes of 178 young stutterers

An item-by-item analysis was made of the scores of 178 five- to eighteen-year-old stutterers on the 27-item Cooper Chronicity Prediction Checklist for School-Aged Stutterers and a stuttering frequency estimate form. Results were interpreted as suggesting that male stutterers generally possess a more complex stuttering pattern than do females and that the definition as to what constitutes stuttering continues to vary significantly between parents, clinicians, and individuals labeled as stutterers.     

Friends and strangers: acquaintanceship, agreement, and the accuracy of personality judgment

We examined the effect of acquaintanceship on interjudge agreement in personality ratings. Approximately 150 undergraduates described their own personalities using the Q-sort. They were also described by two close acquaintances and by two "strangers" who knew them only via a single, spontaneous interaction viewed on videotape. The effect of acquaintanceship was powerful: Judgments by close acquaintances agreed with each other and with subjects' self-judgments much better than did judgments by strangers, even though strangers' judgments agreed with each other and with subjects' self-judgments beyond a chance level. This result implies that agreement among acquaintances' judgments must derive at least partly from experience with and observation of the person who is judged. The same traits that yielded better agreement among acquaintances also yielded better agreement among strangers and tended to be rated higher in subjective visibility, suggesting that people are intuitively knowledgeable about the traits they can judge with more and less agreement.     

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.     

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.     

The effect of instructional bias on listener ratings of specific disfluency types in children

This study evaluated the influence of instructional bias on severity ratings of children's disfluencies. Normal speaking children were trained to simulate specific types of disfluency and severity judgments were made by judges who had been exposed to instructional bias. The 75 judges who participated in the study were divided into three groups of 25 each and were given a bias “toward stuttering,” bias “toward fluency,” and a “neutral” bias toward neither perceptual set. Both univariate and multivariate analyses were employed for data analysis.Although predictable differences were found between the specific types of speech disfluency, no significant differences were found for the experimental bias conditions. These findings, based on molecular analyses, differ from previous results based on molar speech samples. Molecular approaches to understanding the nature of stuttering were found to be powerful modes of assessment, and it is suggested that the type of disfluency emitted by children may be more important than the instructional bias or perceptual set of the listener.     

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.     

The effects of differential vowel prolongations on perceptions of speech naturalness

Prolongation of speech sounds is currently used to modify stuttering and enhance fluency. Prolonged speech (PS) (e.g., prolonged vowels, prolongation throughout utterances) is, however, often perceived as unnatural by listeners. This study examined at which durations and in which contexts 52 college students (primary language was American English) perceived PS to be unnatural. Stimuli were limited to controlled variation in prolongation of the vowel in the middle single-syllable word of a carrier phrase (i.e., say word again). The prolongation was effected by digital waveform manipulation within the Kay Elemetrics Computerized Speech Laboratory (CSL). The listeners judged if they strongly agreed, agreed, or disagreed that the phrases sounded natural. Results indicated that the extent of vowel duration (and possibly context) does influence listener's perception of speech naturalness, findings which can be applied to facilitate fluency therapy.

Educational objectives: (1) The reader will learn about and be able to summarize the digital waveform manipulation procedure in the study. (2) The reader will learn about and be able to describe the effects of differential vowel prolongation on listener's perception of speech naturalness. (3) The reader will learn about and evaluate how differential vowel prolongation can be used to enhance fluency.     

The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

Educational objectives: The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.     

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.