Stuttering Research - General Research

March 2010

The five factor model of personality applied to adults who stutter.

Iverach L, O'Brian S, Jones M, Block S, Lincoln M, Harrison E, Hewat S, Menzies RG, Packman A, Onslow M.

Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.

May 2009

The effects of self-generated synchronous and asynchronous visual speech feedback on overt stuttering frequency. 

The Laboratory for Stuttering Research, Department of Communication Sciences & Disorders, University of Mississippi, University, MS 38677, USA. GSnyder@OleMiss.edu

PURPOSE: Relatively recent research documents that visual choral speech, which represents an externally generated form of synchronous visual speech feedback, significantly enhanced fluency in those who stutter. As a consequence, it was hypothesized that self-generated synchronous and asynchronous visual speech feedback would likewise enhance fluency. Therefore, the purpose of this study was to investigate the effects of self-generated visual feedback (i.e., synchronous speech feedback with a mirror and asynchronous speech feedback via delayed visual feedback) on overt stuttering frequency in those who stutter. METHOD: Eight people who stutter (4 males, 4 females), ranging from 18 to 42 years of age participated in this study. Due to the nature of visual speech feedback, the speaking task required that participants recite memorized phrases in control and experimental speaking conditions so that visual attention could be focused on the speech feedback, rather than a written passage. During experimental conditions, participants recited memorized phrases while simultaneously focusing on the movement of their lips, mouth, and jaw within their own synchronous (i.e., mirror) and asynchronous (i.e., delayed video signal) visual speech feedback. RESULTS: Results indicated that the self-generated visual feedback speaking conditions significantly decreased stuttering frequency (Greenhouse-Geisser p=.000); post hoc orthogonal comparisons revealed no significant differences in stuttering frequency reduction between the synchronous and asynchronous visual feedback speaking conditions (p=.2554). CONCLUSIONS: These data suggest that synchronous and asynchronous self-generated visual speech feedback is associated with significant reductions in overt stuttering frequency. Study results were discussed relative to existing theoretical models of fluency-enhancement via speech feedback, such as the engagement of mirror neuron networks, the EXPLAN model, and the Dual Premotor System Hypothesis. Further research in the area of self-generated visual speech feedback, as well as theoretical constructs accounting for how exposure to a multi-sensory speech feedback enhances fluency, is warranted. LEARNING OUTCOMES: : Readers will be able to (1) discuss the multi-sensory nature of fluency-enhancing speech feedback, (2) compare and contrast synchronous and asynchronous self-generated and externally generated visual speech feedback, and (3) compare and contrast self-generated and externally generated visual speech feedback.

April 2009

Influence of stuttering variation on talker group classification in preschool children: preliminary findings.

Department of Communication Sciences & Disorders, Stuttering Research Laboratory, James Madison University, Harrisonburg, VA 22801, USA. johns3kn@jmu.edu

The purpose of this study was to investigate whether variations in disfluencies of young children who do (CWS) and do not stutter (CWNS) significantly change their talker group classification or diagnosis from stutterer to nonstutterer, and vice versa. Participants consisted of seventeen 3- to 5-year-old CWS and nine 3- to 5-year-old CWNS, with no statistically significant between-group difference in chronological age (CWS: M=45.53 months, S.D.=8.32; CWNS: M=47.67 months, S.D.=6.69). All participants had speech, language, and hearing development within normal limits, with the exception of stuttering for CWS. Both talker groups participated in a series of speaking samples that varied by: (a) conversational partner [parent and clinician], (b) location [home and clinic], and (c) context [conversation and narrative]. The primary dependent measures for this study were the number of stuttering-like disfluencies (SLD) per total number of spoken words [%SLD] and the ratio of SLD to total disfluencies (TD) [SLD/TD]. The results indicated that significant variability of stuttering did not exist as a result of conversational partner or location. Changes in context, however, did impact the CWS, who demonstrated higher SLD/TD in the conversation sample versus a narrative sample. Consistent with hypotheses, CWS and CWNS were accurately identified as stutterers and nonstutterers, respectively, regardless of changes to conversational partner, location or context for the overall participant sample. Present findings were taken to suggest that during assessment, variations in stuttering frequency resulting from changes in conversational partner, location or context do not significantly influence the diagnosis of stuttering, especially for children not on the talker group classification borderline between CWS and CWNS. LEARNING OUTCOMES: Readers will be able to: (1) Describe the role of variability in stuttering frequency for young children who stutter; (2) Identify three fundamental measurements of the frequency of stuttering-like and nonstuttering-like disfluencies; (3) Describe the effects of stuttering variation on talker group classification of stuttering or nonstuttering.

Influence of stuttering variation on talker group classification in preschool children: preliminary findings.

Department of Communication Sciences & Disorders, Stuttering Research Laboratory, James Madison University, Harrisonburg, VA 22801, USA. johns3kn@jmu.edu

The purpose of this study was to investigate whether variations in disfluencies of young children who do (CWS) and do not stutter (CWNS) significantly change their talker group classification or diagnosis from stutterer to nonstutterer, and vice versa. Participants consisted of seventeen 3- to 5-year-old CWS and nine 3- to 5-year-old CWNS, with no statistically significant between-group difference in chronological age (CWS: M=45.53 months, S.D.=8.32; CWNS: M=47.67 months, S.D.=6.69). All participants had speech, language, and hearing development within normal limits, with the exception of stuttering for CWS. Both talker groups participated in a series of speaking samples that varied by: (a) conversational partner [parent and clinician], (b) location [home and clinic], and (c) context [conversation and narrative]. The primary dependent measures for this study were the number of stuttering-like disfluencies (SLD) per total number of spoken words [%SLD] and the ratio of SLD to total disfluencies (TD) [SLD/TD]. The results indicated that significant variability of stuttering did not exist as a result of conversational partner or location. Changes in context, however, did impact the CWS, who demonstrated higher SLD/TD in the conversation sample versus a narrative sample. Consistent with hypotheses, CWS and CWNS were accurately identified as stutterers and nonstutterers, respectively, regardless of changes to conversational partner, location or context for the overall participant sample. Present findings were taken to suggest that during assessment, variations in stuttering frequency resulting from changes in conversational partner, location or context do not significantly influence the diagnosis of stuttering, especially for children not on the talker group classification borderline between CWS and CWNS. LEARNING OUTCOMES: Readers will be able to: (1) Describe the role of variability in stuttering frequency for young children who stutter; (2) Identify three fundamental measurements of the frequency of stuttering-like and nonstuttering-like disfluencies; (3) Describe the effects of stuttering variation on talker group classification of stuttering or nonstuttering.

Characteristics of stuttering in Dutch-speaking individuals.

Centre of Stuttering Therapy Antwerp.

Clinical diagnostic procedures to distinguish stuttering from non-stuttering individuals partially rely on the observation of characteristics of stuttered words or syllables. The purpose of this study was to examine the sensitivity and specificity of such a procedure, and to describe the observed characteristics of stuttered words. Methods involved the recording of the frequency, duration, and physical tension of stuttered words in conversational speech samples (total 43 100 words) and in an oral reading task (total 43 100 words). In this manner, 351 native Dutch speaking people, aged 8-53, who stutter were compared to a group of non-stuttering peers (n = 80). Findings suggest that applying a criterion of 3% stuttered words in conversational speech makes it possible to distinguish stuttering from non-stuttering individuals with high sensitivity (.9345) and perfect specificity (1.0000). Frequency, duration, and physical tension accompanying stuttered words are described for the group of stuttering participants, and these characteristics were compared to the group of non-stuttering speakers.

Does language influence the accuracy of judgments of stuttering in children?

University of Iceland.

PURPOSE: To determine whether stuttering judgment accuracy is influenced by familiarity with the stuttering speaker's language. METHOD: Audiovisual 7-min speech samples from nine 3-5 y.o. Icelandic children who stutter (CWS), pre-selected for different levels of stuttering, were subdivided into 5-s intervals. Ten experienced Icelandic Speech-Language Pathologists (ICE-SLPs) and 10 experienced US Speech-Language Pathologists (US-SLPs), the latter being unfamiliar with the Icelandic language, independently judged each 5-s interval (n = 756) as stuttered or nonstuttered on two separate occasions. RESULTS: As in previous studies, intervals judged to contain stuttering showed wide variability within the ICE-SLP and US-SLP groups. However, both SLP groups (1) displayed satisfactory mean intrajudge agreement, (2) met an independent stuttering judgment accuracy criterion test using English-speaking CWS samples, and (3) met an agreement criterion on approximately 90% of their stuttering and nonstuttering judgments on the Icelandic-speaking CWS samples. CONCLUSIONS: Experienced SLPs were shown to be highly accurate in recognizing stuttering and nonstuttering exemplars from young CWS speaking in an unfamiliar language. The findings suggest that judgments of occurrences of stuttering in CWS are not generally language dependent, although some exceptions were noted.

Speech rate according to stuttering severity.

Departamento de Fonoaudiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo. clauarcuri@gmail.com

BACKGROUND: Speech duration has been the subject of acoustic studies due to its relationship with rhythm and speech rate. The speech analysis of stutterers has revealed data which often differs from that found in non-stutterers. These differences most likely stem from timing disturbances related to speech motor control. OBJECTIVE: To compare the speech rates of individuals presenting different stuttering severity levels. METHOD: Participants were 6 adult stutterers with the following severity levels: 2 with mild stuttering; 2 with moderate stuttering and 2 with severe stuttering. The words 'cavalo' (horse), 'pipoca' (popcorn) and 'tapete' (carpet) were introduced in a carrier phrase, 'Digo......baixinho' (Say ......in a low voice). Each phrase was uttered by the researcher and then repeated aloud 3 times by the participants while being recorded in a computer. Utterances containing speech disruptions were discarded. Subsequently, timing measurements were made, using the Praat 4.2 software. Utterances were divided into segments delimited by two consecutive voice onsets, and speech rate was then calculated (number of vowel-vowel segments divided by the total sum of duration of the segments). The data were analyzed statistically using ANOVA. RESULTS: The group with mild/moderate stuttering presented higher and similar speech rates, differing statistically from the group with severe stuttering, therefore indicating that the higher the severity of stuttering, the lower the speech rate. This difference seems to be related to difficulties in motor programming, affecting mainly the rhythm and the timing of discourse. CONCLUSIONS: The rate of fluent speech during a repetition task differentiated the studied individuals according to the severity of stuttering.

A life-time of stuttering: How emotional reactions to stuttering impact activities and participation in older people.

Australian Stuttering Research Centre, The University of Sydney, Sydney, Australia.

Purpose: The International Classification of Functioning, Disability and Health (ICF) framework has a pragmatic focus on how impairment impacts the individual's activities and participation. Stuttering is known to impact communication in younger adults but this has not been established in older people who stutter. In this study, emotional reactions to stuttering were investigated in a group 55 years and older who self-reported stuttering since childhood. Method: This was a cross-sectional descriptive design. Twelve participants who self-reported that they still stuttered and in whom stuttering was confirmed, and 14 controls completed the Fear of Negative Evaluation Scale (FNES), The Endler Multi-dimensional Anxiety Scales-Trait (EMAS-T) and The Australian Personal Wellbeing Index (PWA-I). Participants whose stuttering persisted also completed the Overall Assessment of Speakers Experience of Stuttering (OASES). Results: The group who stuttered scored significantly higher on the FNES, with scores in the social phobia range. Responses on the OASES showed that stuttering continues to be a negative experience for this older group. Results for the EMAS-T and PWA-I were within the average range across both participant groups however significant differences existed between the groups in the social evaluative and physical danger domains of the EMAS-T, and the satisfaction with health domain of the PWA-I. Conclusions: Significant fear of negative evaluation, which is the key feature for social anxiety, was found in the group of older people who stuttered with a higher level of trait anxiety in social evaluative domains. The OASES showed that they also reacted to stuttering and communication in daily situations with moderate to severe impact scores which showed that stuttering impacted on speaking activities and by those negative experiences limited communication. Limited communication and restricted participation in the lives of older people have implications for healthy productive ageing and this is discussed.

Peer Responses to Stuttering in the Preschool Setting.

Australian Stuttering Research Centre, The University of Sydney, Australia.

PURPOSE: This study investigated peer responses to preschoolers' stuttering in preschool and sought to determine if specific characteristics of participants' stuttering pattern elicited negative peer responses. METHOD: Four outdoor free play sessions of four 3-4 year old preschoolers who stutter were videotaped. Stutters were identified on transcripts of the play sessions. Peer responses to stuttered utterances were judged to be negative or neutral/positive. Thereafter, participants' stuttering behaviors, durations of stutters, and judgments of the meaningfulness of peer-directed stuttered utterances were analyzed. RESULTS: Between 71.4% and 100% of peer responses were judged to be neutral/positive. In the minority of negative responses across three participants, peers were observed to react with confusion or to interrupt, mock, walk away from, or ignore the stuttered utterances. Utterances that elicited negative responses were typically meaningless and contained stutters that were behaviorally complex and/or of longer duration. Other social interaction difficulties also were observed, for example, difficulty leading peers in play, participating in pretend play, and resolving conflicts. CONCLUSIONS: Results indicate that the majority of peer responses to stuttered utterances were neutral/positive; however, results also indicate that stuttering has the potential to elicit negative peer responses and affect other social interactions in preschool.

December 2008 

Social anxiety and the severity and typography of stuttering in adolescents.

School of Psychology, Curtin University of Technology, GPO Box U 1987, Perth, Western Australia, 6845, Australia.

The present study examined the relationship between anxiety, attitude toward daily communication, and stuttering symptomatology in adolescent stuttering. Adolescents who stuttered (n=19) showed significantly higher levels of trait, state and social anxiety than fluent speaking controls (n=18). Trait and state anxiety was significantly associated with difficulty with communication in daily situations for adolescents who stutter, but not for controls. No statistically significant associations were found between anxiety and measures of communication difficulty, and the severity or typography of stuttering surface behaviours. These results highlight some of the psychosocial concomitants of chronic stuttering in adolescence, but challenge the notion that anxiety plays a direct mediating role in stuttering surface behaviours. Rather, the results suggest stuttering is a disorder that features psychosocial conflict regardless of its surface features. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarise findings from previous studies with regards to stuttering and anxiety; (2) identify the sub-types of anxiety that may impact on the individual who stutters; and (3) discuss the clinical implications of the results with regards to working with adolescents who stutter.

Non-linguistic auditory processing in stuttering: evidence from behavior and event-related brain potentials.

Purdue University, Speech, Language, & Hearing Sciences, Heavilon Hall, 500 Oval Drive, West Lafayette, IN 47907, USA.

Auditory processing deficits are hypothesized to play a role in the disorder of stuttering (e.g. Hall, J. W., & Jerger, J. (1978). Central auditory function in stutterers. Journal of Speech and Hearing Research, 21, 324-337). The current study focused on non-linguistic auditory processing without verbal responses to explore the relationship between behavior and neural activity in the absence of cognitive demands related to language processing and articulatory planning for speaking. A pure-tone, oddball paradigm was utilized to compare behavioral accuracy and reaction times for adults who stutter (AWS) and normally fluent speakers (NFS). Additionally, event-related potentials elicited by brief standard and target tones were compared for the two groups. Results revealed that, as a group, AWS tended to perform less accurately compared to the NFS and were slower to respond to target stimuli. However, inspection of individual data indicated that most of the AWS performed within the range of normally fluent speakers while a small subset of AWS were well outside the normal range. This subgroup of AWS also demonstrated early perceptual processes (as indexed by N100 and P200 amplitudes) indicative of reduced cortical representation of auditory input. The P300 mean amplitudes elicited in AWS tended to be reduced overall compared to those of the NFS, suggesting the possibility of weaker updates in working memory for representations of the target tone stimuli in AWS. Taken together, these findings point to the possibility that a subset of AWS exhibit non-linguistic auditory processing deficits related to altered cortical processing. Educational objectives: After reading this article, the reader will be able to: (1) summarize research findings of non-linguistic auditory processing in stuttering; (2) discuss the relationship between behavioral performance for auditory processing and the underlying event-related brain potentials; (3) discuss the importance of analyses of individual versus group data in stuttering; and (4) summarize how the findings of this study relate to a multifactorial model of stuttering.

The effects of self-generated synchronous and asynchronous visual speech feedback on overt stuttering frequency.

The Laboratory for Stuttering Research, Department of Communication Sciences & Disorders, University of Mississippi, University, MS 38677, USA. GSnyder@OleMiss.edu

PURPOSE: Relatively recent research documents that visual choral speech, which represents an externally generated form of synchronous visual speech feedback, significantly enhanced fluency in those who stutter. As a consequence, it was hypothesized that self-generated synchronous and asynchronous visual speech feedback would likewise enhance fluency. Therefore, the purpose of this study was to investigate the effects of self-generated visual feedback (i.e., synchronous speech feedback with a mirror and asynchronous speech feedback via delayed visual feedback) on overt stuttering frequency in those who stutter. METHOD: Eight people who stutter (4 males, 4 females), ranging from 18 to 42 years of age participated in this study. Due to the nature of visual speech feedback, the speaking task required that participants recite memorized phrases in control and experimental speaking conditions so that visual attention could be focused on the speech feedback, rather than a written passage. During experimental conditions, participants recited memorized phrases while simultaneously focusing on the movement of their lips, mouth, and jaw within their own synchronous (i.e., mirror) and asynchronous (i.e., delayed video signal) visual speech feedback. RESULTS: Results indicated that the self-generated visual feedback speaking conditions significantly decreased stuttering frequency (Greenhouse-Geisser p=.000); post hoc orthogonal comparisons revealed no significant differences in stuttering frequency reduction between the synchronous and asynchronous visual feedback speaking conditions (p=.2554). CONCLUSIONS: These data suggest that synchronous and asynchronous self-generated visual speech feedback is associated with significant reductions in overt stuttering frequency. Study results were discussed relative to existing theoretical models of fluency-enhancement via speech feedback, such as the engagement of mirror neuron networks, the EXPLAN model, and the Dual Premotor System Hypothesis. Further research in the area of self-generated visual speech feedback, as well as theoretical constructs accounting for how exposure to a multi-sensory speech feedback enhances fluency, is warranted. LEARNING OUTCOMES: : Readers will be able to (1) discuss the multi-sensory nature of fluency-enhancing speech feedback, (2) compare and contrast synchronous and asynchronous self-generated and externally generated visual speech feedback, and (3) compare and contrast self-generated and externally generated visual speech feedback.

Older people who stutter: barriers to communication and perceptions of treatment needs.

Australian Stuttering Research Centre, University of Sydney, Lidcombe, Australia.

Background: Little is known about the experience of stuttering for people over 55 years of age. Recent research has established that the same types of stuttering behaviours, cognitions, and emotional consequences experienced during young adulthood persist into older age. Aims: The aims were to investigate perceptions of limitations to activity and participation in a group of older people who stuttered into adulthood. A further aim was to find out their perceptions about treatment. Methods & Procedures: This was a qualitative study involving eleven participants, eight males and three females over 55 years of age (mean age = 70.7, standard deviation = 9.13 years, range = 57.2-83.8 years) who self-reported stuttering into adulthood. Participants were randomly assigned to two focus groups for the discussion of topic questions posed by a moderator. The discussion was video- and audio-recorded, transcribed, and analysed using a comparative thematic analysis to derive emergent themes in relation to the topic questions. Outcomes & Results: Stuttering can impact on the lives of older people in a similar way to younger people who stutter. Participants who continued to work felt more limited by their stuttering because work involved unpredictable speaking situations with unfamiliar people. Others who had retired experienced some relief from these limitations because they were no longer required to communicate in a work context. The acceptance of stuttering was a theme expressed by some participants, and acceptance diminished the limitations because these older people were less fearful of the consequences of their stuttering. However, others remained constrained by the impact of stuttering on their communication and struggled with a fear of speaking and a fear of negative evaluation by others. They applied learnt and self-devised techniques to assist their speech and felt that if fear of speaking was removed and their self-confidence increased, communication might be better. They would like effective, individual, and short-term treatment with speech-language pathologists who are knowledgeable about stuttering and sensitive to their emotional needs. Conclusions & Implications: Older people who stutter experienced limitations to participation because of their stuttering and there are implications for their future ability to remain independent and connected to relevant people and services. Further investigation of these limitations and research into effective intervention is indicated.

Characteristics of disfluency clusters in adults who stutter.

Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand. michael.robb@canterbury.ac.nz

BACKGROUND/AIMS: The purpose of this study was to examine characteristics of disfluency clusters in adults who stutter (AWS) and to compare these characteristics to those previously reported for children who stutter (CWS). METHOD: The spontaneous speech of ten AWS was sampled and organized according to utterance length in syllables. The overall number and type of disfluency clusters occurring in each sample were determined. RESULTS: Findings indicated that utterances containing disfluency clusters were significantly longer than fluent utterances, and the occurrence of disfluency clusters was correlated with overall percentage of disfluency. CONCLUSION: The results obtained in the present study for AWS tend to parallel those found for CWS and serve to validate their occurrence as a feature of the disorder of stuttering.

Students' perceptions of face-to-face pseudostuttering experience.

California State University, East Bay, Communicative Sciences and Disorders Department, 25800 Carlos Bee Blvd., MB 1099, Hayward, CA 94542-3035, USA. patricia.lohmanhawk@csueastbay.edu

Students' perceptions of simulating stuttering in public were obtained in order to quantify students' increased understanding of stuttering. 34 women and 2 men (M age=30.0 yr., SD=9.0) majoring in communication disorders participated. All were graduate students enrolled in their first class in fluency disorders. None had previous experience with individuals who stuttered. Participants completed a questionnaire before and after the experiment and discussed these experiences with the group. Responses to 39 questions using a 5-pt. Likert-type scale were analyzed for students' preparation, feelings, attitudes, and perception of listeners' reactions. Participants recounted both positive and negative experiences gaining understanding of and empathy for people who stutter, changing erroneous perceptions and broadening perspective of the disorder. Participants reported that the roundtable discussion contributed to their learning. Assigning students to simulate stuttering in public and participate in a follow-up discussion is an effective evidence-based teaching practice.

Stuttering in english-mandarin bilingual speakers: the influence of language dominance on stuttering severity.

Speech Therapy Department, Singapore General Hospital, Outram Road, Singapore 169608. E-mail: valerie.lim.p.c@sgh.com.sg.

PURPOSE: English and Mandarin are the 2 most spoken languages in the world, yet it is not known how stuttering manifests in English-Mandarin bilinguals. In this research, the authors investigated whether the severity and type of stuttering is different in English and Mandarin in English-Mandarin bilinguals, and whether this difference was influenced by language dominance. METHOD: Thirty English-Mandarin bilinguals who stutter (BWS), ages 12-44 years, were categorized into 3 groups (15 English-dominant, 4 Mandarin-dominant, and 11 balanced bilinguals) using a self-report classification tool. Three 10-min conversations in English and Mandarin were assessed by 2 English-Mandarin bilingual clinicians for percent syllables stuttered (%SS), perceived stuttering severity (SEV), and types of stuttering behaviors using the Lidcombe Behavioral Data Language (LBDL; Packman & Onslow, 1998; Teesson, Packman, & Onslow, 2003). RESULTS: English-dominant and Mandarin-dominant BWS exhibited higher %SS and SEV scores in their less dominant language, whereas the scores for the balanced bilinguals were similar for both languages. The difference in the percentage of stutters per LBDL category between English and Mandarin was not markedly different for any bilingual group. CONCLUSIONS: Language dominance appeared to influence the severity but not the types of stuttering behaviors in BWS. Clinicians working with BWS need to assess language dominance when diagnosing stuttering severity in bilingual clients.

September 2008

The Peer Attitudes Toward Children who Stutter (PATCS) scale: an evaluation of validity, reliability and the negativity of attitudes.

Australian Stuttering Research Centre.

Background: Persistent calls for school-based education about stuttering necessitate a better understanding of peer attitudes toward children who stutter and a means to measure outcomes of such educational interventions. Langevin and Hagler in 2004 developed the Peer Attitudes Toward Children who Stutter scale (PATCS) to address these needs and gave preliminary evidence of reliability and construct validity. Aims: To examine further the psychometric properties of PATCS and to examine the negativity of attitudes. Methods & Procedures: PATCS was administered to 760 Canadian children in grades 3-6. Measures included reliability, a confirmatory factor analysis (CFA), a known groups analysis, convergent validity with the Pro-Victim Scale of Rigby and Slee, and the negativity of attitudes. Outcomes & Results: PATCS appears to tap a second-order general attitude factor and three first-order factors representing the constructs of Positive Social Distance (PSD), Social Pressure (SP), and Verbal Interaction (VI). In the known groups analysis, participants who had contact with someone who stutters had higher scores (more positive attitudes) than those who had not, and girls had higher scores than boys. PATCS correlated moderately (0.43, p<0.01) with the Pro-Victim scale. Finally, one-fifth (21.7%) of participants had scores that were somewhat to very negative. Conclusions & Implications: Results provide evidence of the validity and reliability of PATCS and confirm the need for school-based education about stuttering. The PSD and SP factors suggest that education include discussions about (1) similarities and differences among children who do and do not stutter in order to increase acceptance, and (2) making personal choices and handling peer pressure in thinking about children who stutter. The VI factor suggests that open discussion about stuttering may alleviate frustration experienced by listeners and provide the opportunity to give strategies for responding appropriately. Results also suggest that education involve contact with a person who stutters.

The effects of bilingualism on stuttering during late childhood.

University College London, United Kingdom.

OBJECTIVES: To document distinct patterns of language use by bilingual children (use of an alternative language exclusively, LE, or along with English, BIL). To establish how these patterns affect onset of stuttering, school performance and recovery rate relative to monolingual speakers who stutter (MONO). DESIGN: Clinical referral sample with cases classified by speech-language therapists. Supplementary data obtained from speech recordings, interviews with child and family. SETTING: South-East England, 1999-2007. Participants Children aged 8-12 plus who stuttered (monolingual and bilingual) and fluent bilingual controls (FB). MAIN OUTCOME MEASURES: Participants' stuttering history, SATS scores, measures of recovery or persistence of stuttering. RESULTS: The sample of 317 children had 69 bilinguals (prevalence rate of bilingualism in the stuttering sample was 21.8%). 38 children used a language other than English primarily or exclusively in the home and 36 of these (94.7%) bilinguals who stuttered did so in both their languages. There were fewer LE than BIL stuttering children at time of first referral to clinic (of the bilinguals who stuttered, 15/38, 39.5%, were LE and 23/38, 60.5%, were BIL). The reverse was the case in the fluent control sample (of the bilinguals who did not stutter, 28/38, 73.7%, were LE and 10/38, 26.3%, were BIL). The association between stuttering and bilingual group (LE/BIL) was significant by 2 and this is consistent with a higher chance of stuttering for BIL than LE speakers. For speakers who stuttered, age of stuttering onset for LE and BIL was similar to that reported for MONO groups (4 years 9 months, 4 years 10 months and 4 years 3 months for LE, BIL, MONO respectively) and males were affected in each of these groups to about the same extent (the male/female ratio was 4.1:1, 4.75:1 and 4.43:1 for LE, BIL and MONO respectively). For the 29 children who were old enough to complete the assessments, educational achievement at key stages one and two was not affected by either form of bilingualism relative to the MONO and fluent bilingual groups. For these same children, recovery rate for LE and MONO controls was significantly higher by 2 than for those who were BIL since birth (recovery rate for LE and MONO together was 55%, and for BIL was 25%). CONCLUSIONS: There was an increased chance of stuttering onset for BIL children. The chances of recovery from stuttering were lower for BIL speakers than for LE and MONO speakers.

Persistent developmental stuttering as a cortical-subcortical dysfunction: evidence from muscle activation.

Departament of Physiotherapy, Speech-Language and Hearing Sciences and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil. clauan@usp.br

BACKGROUND: One contemporary view of stuttering posits that speech disfluencies arise from anomalous speech motor control. PURPOSE: To verify the rest muscle tension and speech reaction time of fluent and stuttering adults. METHOD: 22 adults, divided in two groups: G1--11 fluent individuals; G2--11 stutterers. Electromyography recordings (inferior orbicularis oris) were collected in two different situations: during rest and in a reaction time activity. RESULTS: The groups were significantly different considering rest muscle tension (G2 higher recordings) and did not differ when considering speech reaction time and muscle activity during speech. There was a strong positive correlation between speech reaction time and speech muscle activity for G2--the longer the speech reaction time, the higher the muscle activity during speech. CONCLUSION: In addition to perceptible episodes of speech disfluency, stutterers exhibit anomalies in speech motor output during fluent speech. Correlations with a possible cortical-subcortical disorder are discussed.

The speech naturalness of people who stutter speaking under delayed auditory feedback as perceived by different groups of listeners.

Ghent University Hospital, Belgium. john.vanborsel@ugent.be

This study investigated listeners' perception of the speech naturalness of people who stutter (PWS) speaking under delayed auditory feedback (DAF) with particular attention for possible listener differences. Three panels of judges consisting of 14 stuttering individuals, 14 speech language pathologists, and 14 naive listeners rated the naturalness of speech samples of stuttering and non-stuttering individuals using a 9-point interval scale. Results clearly indicate that these three groups evaluate naturalness differently. Naive listeners appear to be more severe in their judgements than speech language pathologists and stuttering listeners, and speech language pathologists are apparently more severe than PWS. The three listener groups showed similar trends with respect to the relationship between speech naturalness and speech rate. Results of all three indicated that for PWS, the slower a speaker's rate was, the less natural speech was judged to sound. The three listener groups also showed similar trends with regard to naturalness of the stuttering versus the non-stuttering individuals. All three panels considered the speech of the non-stuttering participants more natural. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) discuss the speech naturalness of people who stutter speaking under delayed auditory feedback, (2) discuss listener differences about the naturalness of people who stutter speaking under delayed auditory feedback, and (3) discuss the importance of speech rate for the naturalness of speech.

Influences of rate, length, and complexity on speech disfluency in a single-speech sample in preschool children who stutter.

Department of Communication Sciences and Disorders, Illinois State University, 204 Fairchild Hall, Campus Box 4720, Normal, IL 61790-4720, USA. jsawyer@ilstu.edu

The purpose of the present study was (1) to determine whether speech rate, utterance length, and grammatical complexity (number of clauses and clausal constituents per utterance) influenced stuttering-like disfluencies as children became more disfluent at the end of a 1200-syllable speech sample [Sawyer, J., & Yairi, E. (2006). The effect of sample size on the assessment of stuttering severity. American Journal of Speech-Language Pathology, 15, 36-44] and (2) to explore the interaction of speech rate, length, and grammatical complexity at the beginning (syllables 1-300, Section A) and the end (syllables 901-1200, Section B) of the speech sample. Participants were eight boys and six girls (M=40.9 months) who were selected from the Sawyer and Yairi [Sawyer, J., & Yairi, E. (2006). The effect of sample size on the assessment of stuttering severity. American Journal of Speech-Language Pathology, 15, 36-44] study. Mean length of utterance (MLU) in morphemes, the number of clauses, clausal constituents, and articulation rate, measured in syllables per second were analyzed from the children's conversational speech. The median split procedure [Logan, K., & Conture, E. (1995). Length, grammatical complexity, and rate differences in stuttered and fluent conversational utterances of children who stutter. Journal of Fluency Disorders, 20, 35-61; Yaruss, J. S. (1997). Utterance timing and childhood stuttering. Journal of Fluency Disorders, 22, 263-286] was used to study interactions between articulation rate, utterance length, and grammatical complexity across the two sections. The mean number of clauses per utterance, clausal constituents per utterance, and articulation rate revealed no significant differences between Section A and Section B, whereas MLU significantly increased in Section B (p=.013). Clausal constituents and MLU were significantly correlated both in Sections A and B. The median split procedure revealed trends for utterances characterized as high length and low-speech rate to be greater in number in Section B than A, but the differences were not significant. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (a) describe the influence of grammatical complexity and mean length of utterance on disfluent speech; (b) compare different procedures for assessing speech rate and determine why the effects of articulation rate have been inconclusive; (c) discuss procedures for comparing length, rate, and complexity across a single-speech sample; and (d) explain why therapeutic methods that emphasize shorter utterance lengths, rather than only slower speech rates, are advisable in establishing fluency in preschool children who stutter.

The effect of stuttering measurement training on judging stuttering occurrence in preschool children who stutter.

University of Iceland, Reykjavik, Iceland. jeinars@hi.is

PURPOSE: To evaluate the efficacy of a standardized training program to improve preschool teachers' ability to identify occurrences of stuttering accurately and reliably in preschool children who stutter (CWS). METHOD: An Icelandic version of the Stuttering Measurement Assessment and Training (SMAAT) program [Ingham, R. J., Cordes, A. K., Kilgo, M., & Moglia, R. (1998). Stuttering measurement assessment and training (SMAAT). Santa Barbara, CA: University of California, Santa Barbara] was developed using 2-min audio-visual recordings of nine Icelandic-speaking CWS (3-5 years). Twenty preschool teachers from preschools in Iceland volunteered to participate and were randomly allocated to an experimental and control group. The preschool teachers judged stuttering on nine pre-judged, interval-classified speech samples on two occasions 2-3 weeks apart; only the experimental group received judgment training between Occasion 1 and 2. RESULTS: The experimental and control groups displayed, on average, above 80% accuracy in identifying stuttering in the sampled CWS, even prior to training. After training the experimental group showed significantly higher mean percent judgment accuracy (p<.01), while the control group's mean accuracy level showed no significant difference between Occasion 1 and 2. CONCLUSIONS: The interval-based training program did improve the accuracy with which the judges identified stuttering in preschool CWS. However, the findings also showed that the preschool teachers possessed relatively satisfactory stuttering judgment skills, even without training. EDUCATIONAL OBJECTIVES: The reader will be able to (a) explain the development of a procedure for establishing standardized training material for measuring and identifying stuttering in preschool children, (b) evaluate whether preschool teachers are generally accurate judges of stuttering in young children, and (c) describe how their stuttering judgment accuracy can be improved through training.

October 2008

Results from applying the monaural compressed speech test in Spanish at 75% and 100% in cases of stuttering and controls

Area de Procesos Centrales de la Audición y de Foniatría, Universidad Nacional Autónoma de México, México DF, México. yploza@yahoo.com.mx

SUMMARY AIM: To evaluate the results obtained from applying the monaural compressed speech test in Spanish at 75% and 100% in cases of stutterers and controls. SUBJECTS AND METHODS: The study involved 50 cases with ages ranging from 8 to 36 years, 25 of whom were stutterers and 25 controls, who were paired one to one by age, sex and schooling. Severe cases of stuttering were not included. Subjects had to have normal auditory functioning, which was evaluated by means of audiometry and peripheral vocal audiometry, and also normal cognitive functioning, which was assessed using TONI-2 in children and by the Spanish version of the Mini-Mental State Examination in adults. RESULTS: The average number of correct answers on the CSTS at 75% was 60.98% in cases of stutterers and 82.04% in the group of controls (Student's t = -7.4; p = 0.0001), and on the CSTS at 100% the figures were 56.56% and 73.16%, respectively, (Student's t = -5.9; p = 0.0001). Sensitivity and specificity were calculated for each test by means of ROC curves, together with the cut-off point. CONCLUSION: Applying the CSTS in individuals who stutter helped us to identify disorders in the temporal processing of auditory information.

September 2008

Unhelpful thoughts and beliefs linked to social anxiety in stuttering: development of a measure.

School of Behavioural and Community Health Sciences, The University of Sydney, Sydney, Australia.

Background: Those who stutter have a proclivity to social anxiety. Yet, to date, there is no comprehensive measure of thoughts and beliefs about stuttering that represent the cognitions associated with that anxiety. Aims: The present paper describes the development of a measure to assess unhelpful thoughts and beliefs about stuttering. Methods & Procedures: The Unhelpful Thoughts and Beliefs about Stuttering (UTBAS) self-report measure contains 66 items that assess the frequency of unhelpful thoughts and beliefs. Items were constructed from a comprehensive file audit of all stuttering cases seen in a cognitive-behavior therapy based treatment programme over a ten-year period. Outcomes & Results: Preliminary investigations indicate that the UTBAS has high levels of test-retest reliability (r = 0.89) and internal consistency (Chronbach's alpha = 0.98). It has good known-groups validity, being able to discriminate between stuttering and non-stuttering participants on items that contain no reference to stuttering [t(38) = 8.06, p<0.0001], with a large effect size (d = 2.3). It has good convergent validity (r = 0.53-0.72) and discriminant validity (r = 0.24-0.27). The UTBAS sensitivity to change was supported by improvements in thoughts and beliefs related to social anxiety following cognitive-behavioural treatment for anxiety in stuttering [t(25) = 10.13, p<0.0001]. The effect size was large (d = 2.5). Conclusions & Implications: Implications for the use of the UTBAS as an outcome measure and a clinical tool are discussed, along with the potential value of the UTBAS to explore the well-documented social anxiety experienced by those who stutter.

August 2008

Identification of children's stuttered and nonstuttered speech by highly experienced judges: binary judgments and comparisons with disfluency-types definitions.

Department of Communication Sciences and Special Education, The University of Georgia, Athens, GA 30602, USA. abothe@uga.edu

PURPOSE: The purposes of this study were (a) to determine whether highly experienced clinicians and researchers agreed with each other in judging the presence or absence of stuttering in the speech of children who stutter and (b) to determine how those binary stuttered/nonstuttered judgments related to categorizations of the same speech based on disfluency-types descriptions of stuttering. METHOD: Eleven highly experienced judges made binary judgments of the presence or absence of stuttering for 600 audiovisually recorded 5-s speech samples from twenty 2- to 8-year-old children who stuttered. These judgments were compared with each other and with disfluency-types judgments in multiple interval-by-interval assessments and by using multiple definitions of agreement. RESULTS: Interjudge agreement for the highly experienced judges in the binary stuttered/nonstuttered task varied from 39.0% to 89.1%, depending on methods and definitions used. Congruence between binary judgments and categorizations based on disfluency types also varied depending on methods and definitions, from 21.6% to 100%. CONCLUSIONS: Agreement among highly experienced judges, and congruence between their binary judgments of stuttering and categorizations based on disfluency types, were relatively high using some definitions and very low using others. These results suggest the use of measurement methods other than those based on disfluency types for quantifying or describing children's stuttering. They also suggest both the need for, and potential methods for, training to increase judges' accuracy and agreement in identifying children's stuttering.

July 2008

Measurement of Phonated Intervals During Four Fluency-Inducing Conditions.

Hofstra University.

PURPOSE: Previous investigations of persons who stutter have demonstrated changes in vocalization variables during fluency-inducing conditions (FICs). A series of studies has also shown that a reduction in short intervals of phonation, those from 30-200 milliseconds (ms), is associated with decreased stuttering. The purpose of this study, therefore, was to test the hypothesis that the distribution of phonated intervals (PIs) should change during four of the most well-known FICs. METHOD: A repeated-measures design was used to explore the relationship between Pis and stuttering during four FICs: chorus reading, prolonged speech, singing, and rhythmic stimulation. Most conditions were conducted at two different speech rates. The distribution of PIs was measured during these conditions and compared to PI distributions obtained during control conditions. RESULTS: Overall PI distributions were significantly different during all four FICs, as compared to control conditions. It was also found that PIs in the range of 30-150 ms were reduced across all FICs, at all speech rates. CONCLUSION: These results provide further evidence of the importance of phonation variables to our understanding of how FICs may operate, and their importance to the treatment of stuttering. These findings, along with previous studies that showed how purposefully reducing the number of short PIs resulted in the elimination of stuttering, suggest that treatment programs based on prolonged speech or PIs, in particular, may benefit from emphasizing a reduction in the number of short phonated intervals and a simultaneous increase in the number of longer PIs.

A nationwide survey of nonspeech oral motor exercise use: implications for evidence-based practice.

MGH Institute of Health Professions, Boston, MA 02129-4557, USA. glof@mghihp.edu

PURPOSE: A nationwide survey was conducted to determine if speech-language pathologists (SLPs) use nonspeech oral motor exercises (NSOMEs) to address children's speech sound problems. For those SLPs who used NSOMEs, the survey also identified (a) the types of NSOMEs used by the SLPs, (b) the SLPs' underlying beliefs about why they use NSOMEs, (c) clinicians' training for these exercises, (d) the application of NSOMEs across various clinical populations, and (e) specific tasks/procedures/tools that are used for intervention. METHOD: A total of 2,000 surveys were mailed to a randomly selected subgroup of SLPs, obtained from the American Speech-Language-Hearing Association (ASHA) membership roster, who self-identified that they worked in various settings with children who have speech sound problems. The questions required answers that used both a forced choice and Likert-type scales. RESULTS: The response rate was 27.5% (537 out of 2,000). Of these respondents, 85% reported using NSOMEs to deal with children's speech sound production problems. Those SLPs reported that the research literature supports the use of NSOMEs, and that they learned to use these techniques from continuing education events. They also stated that NSOMEs can help improve the speech of children from disparate etiologies, and "warming up" and strengthening the articulators are important components of speech sound therapy. CONCLUSION: There are theoretical and research data that challenge both the use of NSOMEs and the efficacy of such exercises in resolving speech sound problems. SLPs need to follow the concepts of evidence-based practice in order to determine if these exercises are actually effective in bringing about changes in speech productions.

Diagnostics and therapy of stuttering children

Sektion für Phoniatrie und Pädaudiologie der Abteilung für Hals-Nasen-Ohrenheilkunde, Universität Ulm. sibylle.brosch@uniklinik-ulm.de

We demonstrate an overall concept for the early diagnosis and therapy of stuttering in early childhood. The idiographic view of childhood stuttering is detailed and a screening instrument presented to help decide between normal development of fluent speech and actual stuttering and hence whether referral is appropriate or not. The previously held dictum that the stuttering preschool child should be left alone is wrong - early diagnosis and intervention are important. The article shows that direct intervention of stuttering in preschool children is possible and does make sense. Because the prognosis for fluent speech diminishes rapidly from as early as age eight, the risk factors for chronic stuttering must be found and early therapy begun.

June 2008

Late childhood stuttering.

Department of Psychology, University College London, Gower Street, London WC1E 6BT, England. p.howell@ucl.ac.uk

PURPOSE: A study was conducted that examined factors that lead children who stutter at around age 8 years to persist in the disorder when they reach age 12 years. METHOD: Seventy-six children were verified to be stuttering at initial assessment. When they reached 12 years of age, they were classified as persistent or recovered. A range of measures was taken at the 2 age points, and measures were examined by recovery group. RESULTS: Although the tendency for more males than females to stutter was confirmed, the reasons for this tendency are not apparent for these speakers. Different patterns in speech were observed: Severity ratings of the recovered speakers dropped by age 12+. The severity ratings for the persistent speakers remained high at 12+, and dysfluency types tended to change from whole words to part words. Persistent and recovered speakers differed on temperamental performance at around age 8 years and performed differently on sensory and motor tasks at age 12+ years. CONCLUSIONS: Stuttering in late childhood affects mainly males. The later a child attends clinic, the longer he or she will stutter. Speech patterns of children who persist diverge from those who recover or who are fluent. As speakers persist, there are temperamental, sensory, and motor changes.

May 2008

Stuttering: an overview.

Stamford Hospital, Stamford, Connecticut, USA. Jprasse@stamhealth.org

Speech dysfluency (stuttering) is common in children. Although stuttering often resolves before adulthood, it can cause significant anxiety for children and their families. Stuttering speech patterns are often easily identifiable; when a child is learning to talk, repetition of sounds or words, prolonged pauses, or excessively long sounds in words usually occur. Secondary behaviors (e.g., eye blinking, jaw jerking, involuntary head or other movements) that accompany stuttering can further embarrass the child, leading to a fear of speaking. The etiology of stuttering is controversial, but contributing factors may include cognitive abilities, genetics, sex of the child, and environmental influences. Research has shown that more than 80 percent of stuttering cases are classified as developmental problems, although stuttering can also be classified as a neurologic or, less commonly, psychogenic problem. The initial assessment of patients who stutter addresses the severity of dysfluency; secondary behaviors; and the impact of stuttering, such as patient distress. Further testing is useful in assessing the need for therapy. Pharmacologic therapy has not been shown to improve stuttering. Encouraging patients to talk slowly and the use of fluency-shaping mechanisms such as delayed auditory feedback devices to slow the speech rate can help minimize or eliminate stuttering. For patients with persistent stuttering, controlled fluency or stuttering modification therapy may be effective.

Comparisons of audio and audiovisual measures of stuttering frequency and severity in preschool-age children.

Australian Stuttering Research Centre, The University of Sydney, Australia.

PURPOSE: To determine whether measures of stuttering frequency and measures of overall stuttering severity in preschoolers differ when made from audio-only recordings compared with audiovisual recordings. METHOD: Four blinded speech-language pathologists who had extensive experience with preschoolers who stutter measured stuttering frequency and rated overall severity from audio-only and audiovisual recordings of 36 preschool children who were stuttering. Stuttering frequency (percentage of syllables stuttered [%SS]) was based on counts of perceptually unambiguous stutterings, made in real time, and overall severity was measured using a 9-point rating scale. RESULTS: Stuttering frequency was statistically significantly lower by around 20% when made from audio-only recordings. This was found to be directly attributable to differences in the counts of stuttered syllables, rather than to differences in the total numbers of syllables spoken. No significant differences were found between recording modalities for the ratings of overall severity. Correlations between %SS scores in the 2 modalities and severity rating scores in the 2 modalities were high, indicating that observers agreed on data trends across speech samples. CONCLUSIONS: Measures of %SS made from audio-only recordings may underestimate stuttering frequency in preschoolers. Although audio-only %SS measures may underestimate stuttering frequency at the start of a clinical trial to a clinically significant extent, posttreatment scores at or below 1.0%SS are likely to underestimate by 0.2%SS or less, which is clinically insignificant.

Multiple voices in Charles Van Riper's desensitization therapy.

Clinical Speech & Language Studies, Trinity College Dublin, Dublin 2, Ireland. mleahy@tcd.ie

BACKGROUND: Charles Van Riper (1905-94) author, researcher and practitioner, was one of the major contributors to the field of stuttering in the 20th century. His series of Action Therapy videotapes provide a useful model of how therapy was implemented by a master clinician. AIMS: Van Riper's session with a client is analysed to reveal how voices are used by these two participants during desensitization therapy, and to demonstrate how Van Riper's expertise manifests itself during the session. METHODS & PROCEDURES: Interaction between Van Riper and a client during the desensitization stage of therapy was transcribed, annotated, and analysed using Goffman's (1974) frame analysis. Elements in the extensive discourse (about 4800 words exchanged) were chosen to illustrate a range of distinctive voices used by Van Riper and the client during this 'crucial' stage of therapy. OUTCOMES & RESULTS: Van Riper shifts his voice throughout the session. His comments are sometimes directed to the viewing audience, at which times he tends to use the voice of an exegeter. When directing his comments to the client, he uses two voices: an authoritative one and one that aligns with the person's feelings. The voice of the client is often silenced, especially when Van Riper is being authoritative. Sometimes Van Riper uses his expertise by speaking through the voice of the client. This is especially true when summarizing what the client might be feeling. The true voice of the client emerges only occasionally. Detailed discourse analysis focusing on the roles played by participants as revealed through footings taken by speakers show complexity in the interaction that is not obvious at surface level. CONCLUSIONS: By using discourse analysis, the multiple voices that Van Riper uses to achieve the complex tasks involved in desensitization can be specified.

Investigating factors related to the effects of time-out on stuttering in adults.

School of Psychology, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845. cliane.franklin@hotmail.com

BACKGROUND: Response-contingent time-out has been shown to be an effective technique for enhancing fluency in people who stutter. However, the factors that determine individual responsiveness to time-out are not well understood. AIMS: The study investigated the effectiveness of using response-contingent time-out to reduce stuttering frequency in adults who stutter. In addition, it investigated the predictive value of participants' stutter severity, age, previous treatment history, and type of stutter on the responsiveness to time-out conditioning. METHODS & PROCEDURES: Sixty people who stutter participated in the study. Half were exposed to time-out following each moment of stuttering over a 40-min period, the remaining participants acted as controls. OUTCOMES & RESULTS: Results showed that individuals who stutter are highly responsive to time-out, and that the participants with a more severe stutter responded better than those with a mild stutter. To a lesser degree, previous treatment and speech rate also influenced treatment success. Age and type of stutter did not, although the proportion of repetition types of stutters increased over the experiment conditions, with prolongations and blocks decreasing, for the treatment group. CONCLUSIONS: This simple operant conditioning treatment method is effective in reducing stuttering. Individuals respond to time-out regardless of their age, type of stutter, stuttering severity or treatment history, thus it is a treatment methodology potentially suitable for all clients. This study investigated initial responsiveness to time-out; therefore, further research is necessary to determine the durability of fluency over time.

University students' perceptions of pre-school and kindergarten children who stutter.

Diamond Elementary School, MD, United States.

To determine how early "the stuttering stereotype" is assigned, 160 university students rated a hypothetical vignette depicting either a 3-, 4-, 5-, or 6-year-old with or without the statement "He stutters". A factor analysis of the semantic differential scale showed a three-factor solution comprised of 17 of the 25 bi-polar adjective pairs. The factor labeled personality showed significantly more negative ratings for 2-, 4-, 5-, or 6-year-old children based on the inclusion of the "He stutters" sentence. There were no differences between male and female raters. A significant difference was found between raters who were knew someone who stuttered and raters who did not know someone who stuttered on the personality factor. Raters who were knew someone who stuttered were significantly more likely to assign more positive ratings to the children. LEARNING OUTCOMES: Readers should be able to learn and understand: (1) the research describing the negative stereotypes associated with stuttering; (2) the vignette method used to evaluate stereotypes in children and youth; (3) the negative perceptions of the sentence "He stutters" on raters' perception of personality, sociability and speech for children as young as 3-, 4-, 5-, or 6-year-olds; and (4) the familiarity with a person who stutters and raters' perceptions of children who stutter.

Fluency shaping with surface electromyography: a pilot study

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo. clauan@usp.br

BACKGROUND: the use of a technological resource in fluency promotion. AIM: to verify the effectiveness of a stuttering treatment based on the use of surface electromyography (SEMG) exclusively. METHOD: participants were four stuttering adults of both genders. Assessment, pre and post-treatment, consisted of a speech gathering session and the analyses of the rest tension and of the reaction time for speech. Treatment consisted of twelve twenty minute training sessions monitored by SEMG. RESULTS: there was a statistically significant reduction in the number of stuttering-like disfluencies (p = 0.094) and in the number of other disfluencies (p = 0.014). The other parameters, as well as differences in the electromyographic measurements, did not present significant variation. CONCLUSION: SEMG proved to be effective in the reduction of stuttering, with no need of association to other techniques.

April 2008

Effects of stuttering severity and therapy involvement on role entrapment of people who stutter.

Department of Communication Disorders, Bowling Green State University, Bowling Green, OH 43403, USA. rgabel@bgnet.bgsu.edu

The primary purpose of this study was to examine whether a group of university students would report role entrapment of people who stutter (PWS) in the form of occupational stereotyping. The study also examined whether severity of stuttering (mild or severe) and level of therapy involvement (choosing or not choosing to attend therapy) affected the perceptions of role entrapment. To examine these issues, 260 students completed the Vocational Advice Scale (VAS) [Gabel, R. M., Blood, G. W., Tellis, G., & Althouse, M. T. (2004). Measuring role entrapment of people who stutter. Journal of Fluency Disorders, 29, 27-49]. Results suggested that stuttering severity and the level of therapy involvement did not appear alter the judges' reports for all of the careers except for the career of speech therapist. For the career of speech therapist, therapy involvement improved the participants' reports and stuttering severity had no effect. Additionally, findings suggested that university students reported that 16 of the careers listed on the VAS were appropriate choices for people who stutter and were less certain about advising for 27 of the careers. Thus, the findings from this study do not support the notion that stuttering leads to role entrapment in the form vocational stereotyping and variations in therapy involvement or stuttering severity do not change perceptions of role entrapment. LEARNER OUTCOMES: The reader will be able to (1) identify common stereotypes of PWS, (2) describe the possible effects of stereotyping and role entrapment, and (3) describe the effects of severity and therapy involvement of role entrapment of PWS.

March 2008

Health and human services for persons who stutter and education of logopedists in East-European countries.

Rehabilitation Centre, Region of Southern Denmark, Odense, Denmark. Steen.Fibiger@soc.regionsyddanmark.dk

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.

Investigating speech motor practice and learning in people who stutter.

Oral Dynamics Laboratory, Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada M5G 1V7. a.namasivayam@utoronto.ca

In this exploratory study, we investigated whether or not people who stutter (PWS) show motor practice and learning changes similar to those of people who do not stutter (PNS). To this end, five PWS and five PNS repeated a set of non-words at two different rates (normal and fast) across three test sessions (T1, T2 on the same day and T3 on a separate day, at least 1 week apart). The results indicated that PWS and PNS may resemble each other on a number of performance variables (such as movement amplitude and duration), but they differ in terms of practice and learning on variables that relate to movement stability and strength of coordination patterns. These findings are interpreted in support of recent claims about speech motor skill limitations in PWS. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) define oral articulatory changes associated with motor practice and learning and their measurement; (2) summarize findings from previous studies examining motor practice and learning in PWS; and (3) discuss hypotheses that could account for the present findings that suggest PWS and PNS differ in their speech motor learning abilities.

January 2008 

Relationship between stuttering severity in children and their mothers speaking rate.

Department of Speech Therapy, School of Paramedicine, Zahedan University of Medical Sciences, Zahedan, Iran. dehqan@zdmu.ac.ir

CONTEXT AND OBJECTIVE: Stuttering is a complex disease that influences occupational, social, academic and emotional achievements. The aim of this study was to correlate the stuttering severity index with speaking rates of mothers and children. DESIGN AND SETTING: Cross-sectional study, at the child rehabilitation clinics of Tehran city. METHODS: 35 pairs of mothers and their children who stuttered were studied. There were 29 boys and six girls, of mean age 8.5 years (range: 5.1-12.0). Speech samples from the mother-child pairs were audiotaped for approximately 15 minutes, until a reciprocal verbal interaction had been obtained. This sample was then analyzed in accordance with a stuttering severity index test and speaking rate parameters. RESULTS: The research results outlined a significant relationship between the mothers speaking rate and their childrens stuttering severity. CONCLUSION: The results suggest that the mothers speaking rate should be incorporated in the assessment and treatment of stuttering.

Judging stuttering in an unfamiliar language: the importance of closeness to the native language.

Ghent University Hospital, Ghent, Belgium. john.vanborsel@ugent.be

In order to test the hypothesis that closeness to the listener's native language is a determining factor when identifying stuttering in an unfamiliar language, three panels of different linguistic background were asked to make judgements of stuttering in a sample of Dutch speakers. It was found that a panel speaking Dutch and a panel speaking English (both West Germanic languages) performed better in identifying Dutch people who stutter and people who do not stutter than a panel speaking Brazilian Portuguese (a Romance language) thus confirming the existence of a closeness of language influence. Further analysis showed that when the native language is more remote from the unfamiliar language there is the possibility of a higher risk for false positive identification.

Perceived stigmatization of children with speech-language impairment and their parents.

Department of Developmental Disorders, Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig Maximilian University, Munich, Germany.

OBJECTIVE: Developmental disorders in childhood are generally assumed to have stigmatizing effects. The goal of the present study was to assess whether parents of children with speech-language impairment perceive stigmatization of their child or themselves and which variables influence the degree of negative labeling. SUBJECTS AND METHODS: The study was based on 362 questionnaires completed by parents of children with speech-language impairment. The questionnaires concerned perceived stigmatization by other children, other adults and family members as a result of the child's developmental problems. RESULTS: In our sample, about 50% of the parents reported negative labeling of their child and about 30% felt they were involved in the stigmatizing process. Parents whose children also had behavioral problems more often reported negative labeling than parents whose children did not. CONCLUSION: The findings suggest that parents of children with speech-language disorders often perceive stigmatization of their children or themselves. In counseling such families, professionals should therefore address stigmatization and its consequences as a separate and important issue.

Dissecting choral speech: properties of the accompanist critical to stuttering reduction.

School of Human Communication Disorders, Dalhousie University, Nova Scota, Canada. mkiefte@dal.ca

The effects of choral speech and altered auditory feedback (AAF) on stuttering frequency were compared to identify those properties of choral speech that make it a more effective condition for stuttering reduction. Seventeen adults who stutter (AWS) participated in an experiment consisting of special choral speech conditions that were manipulated to selectively eliminate specific differences between choral speech and AAF. Consistent with previous findings, results showed that both choral speech and AAF reduced stuttering compared to solo reading. Although reductions under AAF were substantial, they were less dramatic than those for choral speech. Stuttering reduction for choral speech was highly robust even when the accompanist's voice temporally lagged that of the AWS, when there was no opportunity for dynamic interplay between the AWS and accompanist, and when the accompanist was replaced by the AWS's own voice, all of which approximate specific features of AAF. Choral speech was also highly effective in reducing stuttering across changes in speech rate and for both familiar and unfamiliar passages. We concluded that differences in properties between choral speech and AAF other than those that were manipulated in this experiment must account for differences in stuttering reduction. LEARNING OUTCOMES: The reader will be able to (1) describe differences in stuttering reduction associated with altered auditory feedback compared to choral speech conditions and (2) describe differences between delivery of a second voice signal as an altered rendition of the speakers own voice (altered auditory feedback) and alterations in the voice of an accompanist (choral speech).

Telerehabilitation for service delivery in speech-language pathology.

Division of Speech Pathology, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia 4072, Australia. d.theodoros@uq.edu.au

Communication disorders in adults and children can have a significant effect on their quality of life and on that of their families. Speech-language pathologists face several challenges in providing assessment and treatment services to such people. Challenges include facilitating equitable access to services and providing appropriate management within a changing social and economic context. Telerehabilitation has the potential to deliver services in the home or local community via videoconferencing and through interactive computer-based therapy activities. This form of service delivery has the capacity to optimize functional outcomes by facilitating generalization of treatment effects within the person's everyday environment, and enable monitoring of communication and swallowing behaviours on a long-term basis. A number of image-based telerehabilitation applications have been used in the management of adult neurogenic speech and language disorders, stuttering, voice disorders, speech and language disorders in children, laryngectomy and swallowing dysfunction. Further development of such applications and other computer-based therapies, cost-benefit and cost-effectiveness analyses, and professional education are needed if telerehabilitation is to become an integral part of speech-language pathology practice.

Phenomenology of abnormal movements in stuttering.

Neuroscience Department, Movement Disorders Section, Raúl Carrea Institute for Neurological Research, FLENI, Montañeses 2325, 1428AQK, Ciudad de Buenos Aires, Argentina.

BACKGROUND: Stuttering is often accompanied by involuntary movements, abnormal gestures or changes in facial expression. OBJECTIVE: To describe the incidence and phenomenology of abnormal movements (AMs) in stuttering patients. MATERIALS AND METHODS: Eighty-five consecutive patients with stuttering and 119 normal controls videotaped and subsequently reviewed, in which AMs were classified as voluntary or involuntary, and as concurrent or unrelated to speech. Movement phenomenology was correlated with disease severity. RESULTS: Of 85 stuttering patients studied, 51.7% had AMs and 22 more than one AM. Sixty-six different AMs were identified, of which 83.3% occurred during speech, 72.7% were classified as involuntary, and 27.2% as voluntary. Of 38 involuntary movements concurrent to speech, 25 were originally perceived as voluntary, but had since become involuntary through repeated use during stuttering. All involuntary movements not concurrent to speech fulfilled criteria for tics. CONCLUSION: AMs occurring during stuttering were not always involuntary; movements not concurrent with speech clearly fulfilled clinical criteria for tics and were similar in incidence to normal controls. Inverse correlation was found between conscious control of movement during speech and stuttering severity. Many involuntary movements occurring during speech were clearly referred by patients as initially voluntary early on in the development of their speech disorder (starters or unblockers), underlining the importance of repetitive use of complex motor sequences as a source for putative involuntary movement genesis.

Speech and non-speech activities in stuttering: a preliminary study]

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil. clauan@usp.br

BACKGROUND: stuttering. AIM: to compare muscle activation in fluent and stuttering individuals during speech and non-speech tasks. METHOD: six adults divided in two groups: G1 - three fluent individuals; G2 - three stuttering individuals. Muscle activity (surface electromyography) was captured by disposable electrodes fixed in four regions. Testing situations: muscle rest tension, speech reaction time, non-verbal activity, verbal activity. RESULTS: There was no significant statistical difference between the groups for the rest tension; G2 present longer speech reaction times; G2 presented muscle activity during the non-verbal task similar to that observed during rest; Muscle activity of G1 and G2 during the verbal task demonstrated to be similar. CONCLUSION: these results suggests that for G2 there is a poor control of timing for the coordination of motor processes.