Evidence-based practice in stuttering: Some questions to consider

A recent forum in JFD (28/3, 2003) evaluated the status of evidence-based practice in fluency disorders, and offered recommendations for improvement. This article re-evaluates the level of support available for some popular approaches to stuttering therapy and questions the relative value placed on some types of programs endorsed by the forum. Evidence-based practice is discussed within the context of emerging concerns over its application to non-medical interventions and suggestions are made for grounding fluency interventions by reference to empirically supported principles of change. A popular, evidence-based intervention for stuttering in young children (the Lidcombe program) is evaluated within the suggested parameters. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (1) evaluate the status of evidence-based practice in fluency disorders; (2) list concerns about the impact of narrow interpretation of EBP on research and practice in the field of fluency disorders and other non-medical domains; (3) articulate the role of theory and basic research in selecting among and evaluating therapy approach options.     

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.     

Long-term memory and retrieval at ages 2, 3, 4

Two experiments are reported examining the contents and accessibility of a subset of the knowledge represented in long-term memory by very young children. In Experiment 1, children aged 2 to 4 were asked in a production task to name items commonly found in particular rooms in a house, and then to verify the appropriate locations of a set of miniature replicas of household items in a dollhouse. In Experiment 2, object context was manipulated to observe if further external context improves or changes production. Children 3 and 4 years old were asked to produce appropriate room items under one of three conditons: either presented no room objects as in the first experiment, or given room objects highly- or less-frequently associated in the first study.Very young children revealed considerable knowledge in this domain, and even at the youngest ages, core defining information was retrieved. It was equally clear, however, that young children know much more than they can produce, that there is noticeable improvement in ability to retrieve information over this age range, and that additional external object context does not necessarily facilitate retrieval from long-term memory.     

Performance or capacity, the model still requires definitions and boundaries it doesn't have

Siegel is correct that, in its current form, the specific constructs underlying the Demands and Capacities Model cannot be adequately defined. However, substituting observable behavior (performance) for presumed underlying weaknesses in the speech production systems of those who stutter (capacity) does not appear to solve the problem of circularity identified. Rather, demands have not been adequately defined, either.

There is much to agree with in Siegel's note. However, it is not clear to me that the Demands and Capacities Model is salvaged by substituting the term “Performance” for “Capacity.” Rather, the problem with the Model is one of defining terms precisely enough so that the Model is not circular (as Ingham & Cordes (1997) have noted), or the logical inverse of Procruste's bed, as I have stated elsewhere (Bernstein Ratner, 1997), a model that fits all interpretations simply because it stretches to fit all possibilities.     

The role of collaborative planning in children's source-monitoring errors and learning.

The aim of this research was to provide empirical evidence for a cognitive process that may contribute to children's learning from another person. A cornerstone of Vygotsky's sociocultural theory is that knowledge is internalized from others; however, the cognitive processes that support this transformation are underspecified. In a series of three studies, kindergarten children (mean age 5 years 8 months) participated in a categorization task with an adult in several collaborative and noncollaborative conditions and then were tested on their memory of who had performed which actions in the task. After the memory task, children were asked to recategorize the items on their own. Source-monitoring patterns and children's learning varied across conditions according to predictions. A measure of recoding was related to children's planning language that, in turn, predicted learning among the children. The results suggest that one process that contributes to children's internalization of knowledge may involve recoding of agent information and that recoding can be indexed by source-monitoring performance.     

Increased perceived stress is associated with blunted hedonic capacity: potential implications for depression research

Preclinical studies suggest that stress exerts depressogenic effects by impairing hedonic capacity; in humans, however, the precise mechanisms linking stress and depression are largely unknown. As an initial step towards better understanding the association between stress and anhedonia, the present study tested, in two independent samples, whether individuals reporting elevated stress exhibit decreased hedonic capacity. The Perceived Stress Scale (PSS) measured the degree to which participants appraised their daily life as unpredictable, uncontrollable, and overwhelming. Hedonic capacity was objectively assessed using a signal-detection task based on a differential reinforcement schedule. Decreased reward responsiveness (i.e., the participants' propensity to modulate behavior as a function of reward) was used as an operational measure of hedonic capacity. In both Study 1 (n=88) and Study 2 (n=80), participants with high PSS scores displayed blunted reward responsiveness and reported elevated anhedonic symptoms. Additionally, PSS scores predicted reduced reward responsiveness even after controlling for general distress and anxiety symptoms. These findings are consistent with preclinical data highlighting links between stress and anhedonia, and offer promising insights into potential mechanisms linking stress to depression.     

COMPREHENSION MONITORING IN GOOD AND POOR READERS: EVIDENCE FROM VERBAL AND PERFORMANCE MEASURES

The present study examined the ability of second grade good and poor readers to monitor their comprehension of inconsistent texts. Comprehension monitoring was assessed by both a performance measure (underlining inconsistencies) as well as verbal measures (ratings of passage comprehensibility and liking). Because poor readers equate adequate comprehension with accurate decoding, while good reader equate adequate comprehension with accurately deriving the meaning of a text, it was expected that performance and verbal measures of comprehension monitoring would be related for good but not for poor readers. As predicted, self‐reports of comprehension and liking were highly related to the performance measure of error detection for good readers but not for poor readers. The implications of these results for assessing comprehension monitoring ability are discussed.     

PLAYING FATHERS' GAMES

“The Blank Page”, Isak Dinesen's Dinesen Isak Last Tales Harmondsworth: Penguin 1986  [Google Scholar] acclaimed story and its feminist reading, led by Susan Gubar's Gubar Susan “?‘The Blank Page’ and Issues of Female Creativity.” The New Feminist Criticism Ed. Elaine Showalter. London: Virago 1986 292 313  [Google Scholar] seminal work, epitomizes the defiance and subversiveness of women's writing. However, what Dinesen refers to in her story as “the germ” of women's narratives, has been ignored. This germ or source is the biblical story of Achsah, the daughter of Caleb (Joshua 15 and Judges 1), a dramatic story of concealed subversion of a national leader who gambled with his daughter to advance his conquests, and that of a daughter who dared to defy her appropriation as the spoils of war. The biblical text and the traditional commentary accompanying it present the story as a domestic narrative of familial arrangements, therefore concealing its political significance and marginalizing it within the context of the national narrative of conquests and settlement in the land of Canaan. Re‐reading the text shifts the focus from the professed context, namely the narrative of conquest whose protagonist is Caleb, to the concealed one, namely the emotional junction of father–daughter relations, whose protagonist is Achsah. Reading the story of Achsah in this new context not only sheds light on Dinesen's view of women's subversiveness, but also outlines the politics of women's resistance and its implications.