Utterance timing and childhood stuttering

Articulatory speaking rate and response time latency are believed by many to be important factors in determining whether stuttering will occur in a given utterance. Currently, however, there is little empirical evidence to suggest that these measures of utterance timing are directly related to stuttering. This study examined the relationship between articulatory speaking rate and response time latency in the conversational speech of 12 boys who stutter (mean age = 55.2 months; SD = 8.8 months) who participated in 30-min conversational interactions with their mothers. Discriminant function analyses were conducted on 75 utterances drawn from each child's speech sample to determine if the articulatory speaking rate or response time latency of a specific utterance was related to the likelihood that the child would stutter on that utterance. No significant relationships between these measures of utterance timing and stuttering were found for any of the 12 subjects, and there were no significant relationships between these two measures of utterance timing. Findings do not provide support for many current theories of stuttering and suggest that the role of these measures of utterance timing in predicting the occurrence of stuttering in conversational speech in these theories may need to be reexamined.     

Stress-induced Fos-like Immunoreactivity in the Pons and the Medulla Oblongata of Rats

Immunoreactivity of the immediate early gene c-fos was used to investigate changes in the activity of brainstem neurons in response to acute stressors like immobilization, formalin-induced pain, cold exposure, hemorrhage and insulin-induced hypoglycemia. Different stressors induced Fos-like immunoreactivity in different pontine and medullary neurons. A single, 3 hour immobilization was found to be a very strong stimulus that activated brainstem catecholaminergic (tyrosine hydroxylase-immunopositive) neurons and cells in the raphe and certain pontine tegmental nuclei, as well as in the reticular formation. Pain, induced by a subcutaneous injection of formalin was also effective on catecholamine-synthesizing neurons and on others cells in the nucleus of the solitary tract. Cold exposure activated cells mainly in the sensory spinal trigeminal and parabrachial nuclei and in the so-called "pontine thermoregulatory area". Moderate Fos-like immunoreactivity was induced by a hypotonic (25%) hemorrhage in medullary catecholaminergic neurons, the nucleus of the solitary tract and the Barrington nucleus. Among stressful stimuli used, insulin-induced hypoglycemia elicited the smallest Fos activation in the lower brainstem. The present observations indicate that different stressors may use different neuronal pathways in the central organization of the stress response.     

Speech treatment and support group experiences of people who participate in the National Stuttering Association

Support groups are rapidly becoming an important part of the recovery process for many people who stutter, and a growing number of speech-language pathologists (SLPs) are encouraging their clients to participate in support groups. At present, however, little is known about the individuals who join stuttering support groups and the benefits they derive from their participation. This study surveyed members of the National Stuttering Association (NSA) to learn about their experiences in support groups, as well as their experiences in speech therapy. Respondents were 71 people who attended the 1999 NSA conference in Tacoma, WA. The majority of respondents had participated in treatment several times during their lives, using a variety of techniques. Respondents who had participated in fluency-shaping treatments were more likely to report that they had experienced a relapse than those who had participated in stuttering modification or combined treatments. Also, there was a strong positive correlation between respondents' satisfaction with treatment and their judgments of clinicians' competence, suggesting that improved training for SLPs should lead to improved treatment for people who stutter. Results will be used to provide a foundation for further evaluations of the benefits of support group participation for people who stutter. EDUCATIONAL OBJECTIVES: The reader will learn (a) that many people who participate in the NSA have had numerous and varied experiences with speech treatment throughout their lives, (b) which aspects of treatment and support group participation are seen as most beneficial for people who participate in the NSA.     

Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency

The aim of the present study was to assess the effectiveness of an Acceptance and Commitment Therapy group intervention program for adults who stutter (N = 20). The program consisted of 2-h therapeutic sessions conducted weekly for eight consecutive weeks. It was an integrated program designed to improve: (a) psychosocial functioning, (b) readiness for therapy and change, (c) utilisation of mindfulness skills and psychological flexibility, and (d) frequency of stuttering. The findings provide innovative evidence for Acceptance and Commitment Therapy as an effective intervention with statistically significant improvements in psychosocial functioning, preparation for change and therapy, utilisation of mindfulness skills, and overall speech fluency. Follow-up data collected at three months post-treatment revealed that therapeutic gains were successfully maintained over time. These findings enhance the understanding of the impact of stuttering on psychological wellbeing and offer a new perspective on what might constitute successful stuttering treatment. Further, clinical research support is provided for Acceptance and Commitment Therapy delivered in a group format as a promising and novel intervention for adults who stutter.Educational objectives: The reader will be able to: (a) appreciate the potential for Acceptance and Commitment Therapy for adults who stutter; (b) identify the improvements participants experienced in psychosocial functioning and frequency of stuttered speech; (c) appreciate the six core processes of Acceptance and Commitment Therapy; and (d) appreciate the differences between an ACT model of intervention for adults who stutter compared to a CBT approach.     

Enhancing treatment for school-age children who stutter II. Reducing bullying through role-playing and self-disclosure

This paper describes several treatment strategies that clinicians can use to help children who stutter who are experiencing bullying and other negative reactions from their peers. Specific strategies include problem-solving activities designed to help the child develop appropriate responses to bullying and a classroom presentation designed to educate peers about stuttering. To facilitate clinicians' application of these techniques, the strategies are presented in the context of a case study involving a 9-year-old boy who participated in a comprehensive treatment program for stuttering. Following treatment, the child exhibited an increased ability to respond to bullying experiences in a constructive fashion. In addition, negative comments by the child's peers diminished following the classroom presentation. Findings suggest that clinicians can help children overcome bullying and other negative reactions associated with stuttering through a number of well-supported treatment strategies that can be applied in a variety of clinical settings. Educational objectives: After reading this article, participants will be able to: (1) define bullying and teasing and explain the difference between the two experiences; (2) describe two strategies for helping children who stutter successfully manage bullying experiences at school and in other settings; and (3) explain two strategies for educating children about stuttering and about bullying.     

Enhancing treatment for school-age children who stutter I. Reducing negative reactions through desensitization and cognitive restructuring

This paper describes several treatment strategies that clinicians can use to address negative affective, behavioral, and cognitive reactions that school-age children who stutter may experience as part of their disorder. Specific strategies include desensitization to stuttering, cognitive restructuring, self-acceptance, purposeful self-disclosure, and a combination of both fluency enhancing and stuttering modification approaches. To facilitate clinicians' application of these techniques, the strategies are presented in the context of a case study involving a 9-year-old boy who participated in a comprehensive treatment program for stuttering. Following treatment, the child exhibited improved communication attitudes and a reduced frequency and severity of stuttering, combined with reduced concern about stuttering, as indicated through formal and informal assessments. Findings suggest that clinicians can help children overcome the negative reactions associated with stuttering through a number of treatment strategies that can be applied in a variety of clinical settings. Educational objectives: After reading this article, participants will be able to: (1) define desensitization and cognitive restructuring and provide two arguments in favor of using these strategies in treatment for school-age children who stutter; (2) describe two treatment strategies for helping school-age children achieve desensitization through stuttering therapy; (3) describe two treatment strategies for helping school-age children engage in cognitive restructuring in the context of therapy.     

The role of performance in the demands and capacities model

The Demands and Capacities Model (DCM) has become an influential framework for considering the factors that are believed to influence the development of stuttering in young children, even though several key aspects of the model have not been fully developed. Siegel (this issue, page 323) raised several valid concerns that must be addressed if the DCM is to achieve its potential for explaining childhood stuttering and suggested that the model would be improved if the elusive concept of capacities were replaced by the more concrete and measurable concept of performance. This paper proposes modifications to the DCM that may help to address several of Siegel's concerns and evaluates the role of performance in understanding the development of childhood stuttering. It is suggested that replacing capacity with performance does not solve the problems identified by Siegel, because implicit assumptions about the child's underlying abilities are still required if the model is to explain a breakdown in speaking performance. To address Siegel's concerns more directly, a different solution is proposed based on reframing the conceptual notions of demands and capacities in terms of measurable aspects of a child's speaking performance and speaking abilities.     

Academic and clinical education in fluency disorders: an update

This paper presents a survey of the academic and clinical education in fluency disorders provided by American Speech-Language-Hearing Association (ASHA)-accredited training programs. Respondents were 159 programs (out of 256, return rate = 67.4%) that completed a questionnaire seeking information about the courses and clinical experiences they require, the expertise of their faculty and supervisors, changes following the 1993 modification of training requirements for the ASHA certificate of clinical competence (CCC), and preliminary plans for changes in preparation for the 2005 standards. Results, which supplement findings from an earlier survey distributed in 1997 (Yaruss, 1999), indicated that nearly one-quarter of programs allow students to graduate without coursework in fluency disorders, and nearly two-thirds allow students to graduate without clinical practicum experiences. Findings suggest a trend toward fewer required classes taught by less experienced faculty, fewer clinical hours guided by less experienced supervisors, and a greater likelihood that students will graduate without any academic or clinical education in fluency disorders. Given the repeated finding that many speech-language pathologists are uncomfortable working with people who stutter, as well as ASHA's apparent de-emphasis of fluency disorders within the increasing scope of practice in the field of speech-language pathology, these results are a cause for concern about the future of fluency disorders. EDUCATIONAL OBJECTIVES: The reader will learn about (1) the coursework and clinical practicum experiences that are currently required for students in ASHA-accredited training programs; (2) trends indicating a reduction in training requirements for fluency disorders; and (3) ways of improving these requirements.     

Australian normative data for the Overall Assessment of the Speaker's Experience of Stuttering

People who stutter often report negative impacts on their wellbeing as a result of their chronic fluency disorder. The need for a comprehensive assessment of the wellbeing and experience of stuttering should be a prime consideration when measuring treatment outcomes. One such measure designed to evaluate wellbeing and aspects of the individual's experience of his or her stuttering is the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Normative data for the OASES Adult version (OASES-A; and hereafter referred to simply as the OASES) has begun to be collected over the past 10 years, though none are available for an Australian population. This paper presents Australian normative data for the OASES for 200 adult males and females who stutter, aged between 18 and 85 years. Additionally, the influence of age, sex, and frequency of stuttering on the Australian OASES scores are also presented. No significant relationships between OASES scores were found for sex and age, which is in keeping with the USA original dataset. However, those participants who had more severe stuttering were more likely to have higher negative impacts for 'General Information', Communication in Daily Situations,' and for the overall OASES score. Implications for further research are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (i) describe the purpose of the Overall Experience of the Speaker's Experience of Stuttering for Adults (OASES), (ii) evaluate the relevance of the OASES to treatment planning and the evaluation of stuttering treatment outcomes in the adult population, and (iii) compare Australian normative dataset with the USA and Dutch normative datasets for the OASES.     

Psychometric evaluation of the Dutch translation of the Overall Assessment of the Speaker's Experience of Stuttering for adults (OASES-A-D)

The Overall Assessment of the Speaker's Experience of Stuttering for adults (OASES-A; [Yaruss and Quesal, 2006] and [Yaruss and Quesal, 2010]) is a patient-reported outcome measure that was designed to provide a comprehensive assessment of “the experience of the stuttering disorder from the perspective of individuals who stutter” (Yaruss & Quesal, 2006, p. 90). This paper reports on the translation process and evaluates the psychometric performance of a Dutch version of the OASES-A. Translation of the OASES-A into Dutch followed a standard forward and backward translation process. The Dutch OASES-A (OASES-A-D) was then administered to 138 adults who stutter. A subset of 91 respondents also evaluated their speech on a 10-point Likert scale. For another subset of 45 respondents, a clinician-based stuttering severity rating on a 5-point Likert scale was available. Thirty-two of the respondents also completed the Dutch S-24 scale (Brutten & Vanryckeghem, 2003). The OASES-A-D showed acceptable item properties. No ceiling effects were observed. For 30 out of 100 items, most of which were in Section IV (Quality of Life), floor effects were observed. Cronbach's α coefficients for all sections and subsections surpassed the 0.70 criterion of good internal consistency and reliability. Concurrent validity was moderate to high. Construct validity was confirmed by distinct scores on the OASES-A-D for groups with different levels of stuttering severity as rated by the speakers themselves or by clinicians. These results suggest that the OASES-A-D is a reliable and valid measure that can be used to assess the impact of stuttering on Dutch adults who stutter.Educational objectives: The reader will be able to: (a) describe the purpose of the Overall Assessment of the Speaker's Experience of Stuttering for adults (OASES-A) measurement tool; (b) summarize the translation process used in creating the Dutch version of the OASES-A (OASES-A-D); (c) evaluate the psychometric properties of the OASES-A-D; and (d) compare the psychometric properties of the OASES-A-D with those of the original American English OASES-A.