Technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

Millon Clinical Multiaxial Inventory (MCMI) scores with a collegiate sample: Long-term stability and self-other agreement

This study examined (a) the stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) for a sample of university undergraduates and (b) the correspondence between MCMI scores from self-report versus scores obtained from knowledgeable others who responded by describing the subject rather than themselves. The MCMI was administered to subjects during their freshman year and then again during their senior year. As in clinical populations, stability estimates in this collegiate sample were greater for the basic personality scales than for the symptom scales. Comparison of the results with those from previous studies further showed that the stability coefficients for the collegiate sample were somewhat lower overall than those from treatment follow-up studies with clinical populations. The results also showed that reasonable agreement between self- and others' ratings was obtained on most MCMI scales. The greatest agreement was found for scales that reflect more observable behaviors and relate to an introversion-extroversion dimension, whereas the least agreement was found for scales related to a psychoticism dimension. Lower levels of agreement were also found for scales having a lower mean proportion of items endorsed.This study was sponsored in part by PHS Grant R01 MH31750-01-6, by PHS Grant 5R01 AA06754-01-03, and by funds from the University of Connecticut Research Foundation and Computer Center.     

Stability of the Millon Clinical Multiaxial Inventory among psychiatric inpatients

This study investigated the stability of the Millon Clinical Multiaxial Inventory (MCMI) in a sample of psychiatric inpatients over a longer time period and from different perspectives than previous reliability studies. Test-retest reliability was assessed from three perspectives: correlation/regression, equivalence of dimensional structures across testings upon different admissions, and stability of personality style across testings. Some stability from a correlational perspective was found, with higher stability estimates indicated for the basic personality scales in comparison with the clinical symptom scales which is consistent with Millon's theory. The internal structure of the MCMI was essentially identical across testings. Although source of reinforcement and instrumental or coping style were stable across testings beyond chance, the MCMI profiles of a considerable number of subjects were inconsistent across testings. Correspondingly, clinicians should be cautious in using the MCMI to make categorical decisions regarding personality style with inpatients who are tested at admission and who have had repeated hospitalizations.     

Modes of understanding and mindfulness in clinical medicine

Beginning with a case vignette, this paper uses a semiotic approach to analyze several different kinds of understanding used in clinical medicine. By outlining semiotic structures, four distinct modes of understanding can be defined: (1) the representational mode, corresponding to scientific medicine; (2) the pragmatic mode, constituting the basic standpoint of medicine; (3) the hermeneutic mode, underlying the empathic, humanistic spirit of medicine; and (4) the ontologic mode, associated with both the ethical and ritual aspects of medicine. Clarifying the relationship between these modes avoids common confusions in clinical situations. Although experienced clinicians intuitively use these different modes, they do not necessarily reflect upon them. They are instead mindful of them, and this unique multi-modal consciousness, I suggest, provides a model for integrating theory and practice.This work was supported in part by the Robert Wood Johnson Clinical Scholars Program.     

Residual reading capability in a patient with alexia without agraphia

A case of pure alexia due to an ischemic lesion of the occipital temporal region is described. Written words could be matched but not read. Immediate memory span for graphemes was defective. The reading defect probably depends on the inability to modify the written word “globally”; the phonological process was intact, but the memory disturbance impeded reading. The dissociation is explained by the preservation of word forms, which are linked to the semantic stage. Nonwritten stimuli trigger a “meaning” which evokes the word form and so the written word is recognized even though it cannot be read.     

Self-evaluation,self-reinforcement,and locus of control

Two verbal recognition memory tests were administered to 24 internals and 24 externals. Subjects were required to self-evaluate (SE) their responses on the first test and both SE and self-reinforce (SR) on the second. There were no internal-external differences in performance accuracy on either task, but internals gave themselves consistently higher self-evaluations, administered more positive SR and less negative SR. There were no differences in the criteria used by the two groups for SR. SR differences appeared to be a function of the differential SE. It was suggested that external locus of control could be viewed as a self-regulation deficit. Externals are hypothesized to be unable to evaluate their own behavior adequately in the absence of external input and therefore do not make effective use of self-reinforcement. Discussion also made reference to the process of self-regulation.     

The effects of differential reinforcement on generalized imitation

The present study examines the transfer of imitative learning to other nonimitative performance conditions and compares imitative and nonimitative performance under contingencies of differential reinforcement for S⁰ behavior, differential reinforcement for nonimitative behavior, and extinction. Many authors have suggested that a child's continued imitative performance of rewarded S^D and unrewarded S^Δ behavior is a function of subtle social cues or experimental demand present in most generalized imitation procedures. The two experiments presented here support that conclusion but also provide evidence that conclusions drawn from such generalized imitation studies were generally accurate. Even though a child's trial-by-trial imitative performance appeared to be a function of procedural artifacts, the child's later performance in the role of a model indicated that a functionally interdependent generalized response class of imitative behavior had been learned while the child imitated. As such, these experiments generally supported Baer's secondary reinforcement hypothesis for imitative performance and suggest that future research employ nonimitative tasks such as reversed imitation as a measure of imitative learning.     

A comparison of 'flooding' and 'successive approximation' in the treatment of agoraphobia

Flooding (in the imagination and in vivo) and successive approximation were compared in a cross-over design with 14 agoraphobic patients. Assessments were made at the beginning of the treatment, at the cross-over, at the end of the treatment and at the follow-up 3 months later.The assessments were made by the therapist (in vivo measurement) and by the client (phobic anxiety scale; phobic avoidance scale; FSS; MAS; I-E scale and a depression inventory). At the time of the pre-test and the posttest, an independent external judge scored the clients on the following items : anxious mood, specific phobias, obsessive compulsive symptoms, depersonalization and depressed mood.Both methods of treatment resulted in a significant improvement on the in vivo measurements, phobic anxiety scale, phobic avoidance scale and FSS.Successive approximation also led to a significant decrease on the MAS and the I-E scale. The only significant difference between the two methods was shown by the phobic anxiety scale, the mean of the flooding group being significantly higher.     

Self-observation versus flooding in the treatment of agoraphobia

The effects on agoraphobia of (1) self-observation with a minimum of therapeutic intervention. (2) flooding, (3) a combination of flooding and self-observation, and (4) no-treatment control were compared. Assessments were made at the beginning of treatment, during and at the end of treatment and at the follow-up three months later. They were carried out by the therapist (in vivo) measurement; phobic anxiety and phobic avoidance scale) by an independent observer (phobic anxiety scale and phobic avoidance scale) and by the client (phobic anxiety scale; phobic avoidance scale: FSS; social anxiety scale; SDS and I-E scale).Self-observation, flooding and flooding/self-observation resulted in significant improvement on several variables, whereas the no-treatment control group did not improve. No difference in effectiveness was found between the self-observation and flooding treatments. In addition, the results suggest that a combined flooding/self-observation treatment is more effective than each of the individual treatments.