Stuttering Research - Medication Research

February 2010

Exploratory randomized clinical study of pagoclone in persistent developmental stuttering: the EXamining Pagoclone for peRsistent dEvelopmental Stuttering Study.

Maguire G, Franklin D, Vatakis NG, Morgenshtern E, Denko T, Yaruss JS, Spotts C, Davis L, Davis A, Fox P, Soni P, Blomgren M, Silverman A, Riley G.

University of California, Irvine School of Medicine, Orange, CA 92868, USA. gerald.maguire@uci.edu

Risk factors for stuttering: a secondary analysis of a large data base.

Research Unit for Clinical and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstr. 8, PO Box 1930, 8021, Zurich, Switzerland, vajdacic@dgsp.uzh.ch.

The spectrum of risk and concomitant factors in stuttering is generally thought to be wide and heterogeneous. However, only a few studies have examined these factors using information from large databases. We examined the data on 11,905 Swiss conscripts from 2003. All cases with high psychiatric screening scores indicating "caseness" for a psychiatric disorder were excluded, among them potential malingerers, so that 9,814 records remained. The analyses rely on self-reported information about stuttering in childhood, problems at birth, problems in school, mental disorders of parents and relatives, childhood adversity and socio-demographic information. Statistical modelling was done using logistic regression and path analysis models. Risk factors determined in the logistic regression include premature birth, probable attention deficit hyperactive disorder, alcohol abuse of the parents, obsessive-compulsive disorder in parents and relatives, having a disabled mother and having a parent from a foreign country. There is no overwhelmingly strong risk factor; all odds ratios are about 2 or below. In conclusion, large databases are helpful in revealing less obvious and less frequent risk factors for heterogeneous disorders such as stuttering. Obviously, not only secondary analyses, but also systematical large scale studies would be required to complete the complex epidemiological puzzle in stuttering. An extensive examination of young adults who were initially assessed in childhood might provide the most promising design.

How the brain repairs stuttering.

Brain Imaging Center, Department of Neurology, Theodor Stern Kai 7, Frankfurt, Germany. c.kell@em.uni-frankfurt.de

Stuttering is a neurodevelopmental disorder associated with left inferior frontal structural anomalies. While children often recover, stuttering may also spontaneously disappear much later after years of dysfluency. These rare cases of unassisted recovery in adulthood provide a model of optimal brain repair outside the classical windows of developmental plasticity. Here we explore what distinguishes this type of recovery from less optimal repair modes, i.e. therapy-induced assisted recovery and attempted compensation in subjects who are still affected. We show that persistent stuttering is associated with mobilization of brain regions contralateral to the structural anomalies for compensation attempt. In contrast, the only neural landmark of optimal repair is activation of the left BA 47/12 in the orbitofrontal cortex, adjacent to a region where a white matter anomaly is observed in persistent stutterers, but normalized in recovered subjects. These findings show that late repair of neurodevelopmental stuttering follows the principles of contralateral and perianomalous reorganization.

How the brain repairs stuttering.

Brain Imaging Center, Department of Neurology, Theodor Stern Kai 7, Frankfurt, Germany. c.kell@em.uni-frankfurt.de

Stuttering is a neurodevelopmental disorder associated with left inferior frontal structural anomalies. While children often recover, stuttering may also spontaneously disappear much later after years of dysfluency. These rare cases of unassisted recovery in adulthood provide a model of optimal brain repair outside the classical windows of developmental plasticity. Here we explore what distinguishes this type of recovery from less optimal repair modes, i.e. therapy-induced assisted recovery and attempted compensation in subjects who are still affected. We show that persistent stuttering is associated with mobilization of brain regions contralateral to the structural anomalies for compensation attempt. In contrast, the only neural landmark of optimal repair is activation of the left BA 47/12 in the orbitofrontal cortex, adjacent to a region where a white matter anomaly is observed in persistent stutterers, but normalized in recovered subjects. These findings show that late repair of neurodevelopmental stuttering follows the principles of contralateral and perianomalous reorganization.

Differential levels of speech and manual dysfluency in adults who stutter during simultaneous drawing and speaking tasks.

Department of Audiology and Speech Pathology, University of Tennessee, Knoxville, TN 37996, USA. tsaltukl@utk.edu

We examined the disruptive effects of stuttering on manual performance during simultaneous speaking and drawing tasks. Fifteen stuttering and fifteen non-stuttering participants drew continuous circles with a pen on a digitizer tablet under three conditions: silent (i.e., neither reading nor speaking), reading aloud, and choral reading (i.e., reading aloud in unison with another reader). We counted the frequency of stuttering events in the speaking tasks and measured pen stroke duration and pen stroke dysfluency (normalized jerk) in all three tasks. The control group was stutter-free and did not increase manual dysfluency in any condition. In the silent condition, the stuttering group performed pen movements without evidence of dysfluency, similar to the control group. However, in the reading aloud condition, the stuttering group stuttered on 12% of the syllables and showed increased manual dysfluency. In the choral reading condition stuttering was virtually eliminated (reduced by 97%), but manual dysfluency was reduced by only 47% relative to the reading aloud condition. Trials where more stuttered events were generally positively correlated with higher manual dysfluency. The results are consistent with a model in which episodes of stuttering and motor dysfluency are related to neural interconnectivity between manual and speech processes.

Prevalence of anxiety disorders among adults seeking speech therapy for stuttering.

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

The present study explored the prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Employing a matched case-control design, participants included 92 adults seeking treatment for stuttering, and 920 age- and gender-matched controls from the Australian National Survey of Mental Health and Well-being. A conditional logistic regression model was used to estimate odds ratios for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases (ICD-10) anxiety disorders. Compared with matched controls, the stuttering group had six- to seven-fold increased odds of meeting a 12-month diagnosis of any DSM-IV or ICD-10 anxiety disorder. In terms of 12-month prevalence, they also had 16- to 34-fold increased odds of meeting criteria for DSM-IV or ICD-10 social phobia, four-fold increased odds of meeting criteria for DSM-IV generalized anxiety disorder, and six-fold increased odds of meeting criteria for ICD-10 panic disorder. Overall, stuttering appears to be associated with a dramatically heightened risk of a range of anxiety disorders.

Measurement of speech effort during fluency-inducing conditions in adults who do and do not stutter.

Department of Speech and Hearing Sciences, University of California, Santa Barbara, CA, USA. rjingham@speech.ucsb.edu

PURPOSE: To investigate the effects of 4 fluency-inducing (FI) conditions on self-rated speech effort and other variables in adults who stutter and in normally fluent controls. METHOD: Twelve adults with persistent stuttering and 12 adults who had never stuttered each completed 4 ABA-format experiments. During A phases, participants read aloud normally. During each B phase, they read aloud in 1 of 4 FI conditions: auditory masking, chorus reading, whispering, and rhythmic speech. Dependent variables included self-judged speech effort and observer-judged stuttering frequency, speech rate, and speech naturalness. RESULTS: For the persons who stuttered, FI conditions reduced stuttering and speech effort, but only for chorus reading were these improvements obtained without diminishing speech naturalness or speaking rate. By contrast, speech effort increased during all FI conditions for adults who did not stutter. CONCLUSIONS: Self-rated speech effort differentiated the effects of 4 FI conditions on speech performance for adults who stuttered, with chorus reading best approximating normally fluent speech. More generally, self-ratings of speech effort appeared to constitute an independent, reliable, and validly interpretable dimension of fluency that may be useful in the measurement and treatment of stuttering.

Intervention with the Lidcombe Program for a Bilingual School-Age Child Who Stutters in Iran.

Speech Therapy Department, School of Paramedicine, Zahedan University of Medical Sciences, Zahedan, Iran.

Objective: In this study, the immediate and extended effects of the Lidcombe Program were investigated for the first time in Iran. Treatment in the Lidcombe Program is carried out by the child's parent (or carer) in the child's everyday environment. The program has been shown to be effective with preschool children who stutter (i.e. younger than 6 years) and to a lesser extent with older children. Participant and Method: The participant was a bilingual (Baluchi-Persian) boy aged 8 years 11 months. Treatment was conducted in both languages. Stuttering severity was measured in Baluchi with the parental rating scale, and in Persian with percentage of syllables stuttered (%SS). Results: The child completed stage 1 of the program in 13 weeks. %SS was less than 1 during the last 3 clinic visits and severity ratings made by the parent indicated no stuttering (severity rating = 1) for all days of the final week. Speech recordings made beyond the clinic in both languages also indicated stuttering at below 1%SS. The child met all criteria for stage 2 in both languages, over 10 months. Conclusion: This case report suggests that the Lidcombe Program could be suitable for bilingual Iranian children who stutter.

University students' perceptions of the life effects of stuttering.

Department of Communication Disorders, Governors State University, University Park, IL 60484, United States.

An open-ended, written survey was administered to 146 university students who did not stutter to obtain their impressions of the effects of stuttering on the lives of people who stutter (PWS). Participants first wrote about the general effects of stuttering and then considered how their lives would be different if they stuttered. Both types of responses, while not qualitatively different, indicated that participants were more likely to focus on negative listener reactions and barriers to social, academic, and occupational success when they imagined themselves as PWS. Fewer participants indicated that PWS may positively cope with their stuttering through acceptance of stuttering, motivation and determination, and support systems. Quantitative differences based on gender and familiarity with PWS were not observed. The findings suggest that while university students are generally sensitive to the issues which can affect PWS, they may also tend to exaggerate the limitations placed on PWS by their stuttering. LEARNER OUTCOMES: The reader will be able to (1) understand the various ways in which fluent speakers perceive the life effects of stuttering; (2) discuss how fluent speakers, while apparently sensitive to the negative effects of stuttering, can also overemphasize the degree to which PWS are unable to participate effectively and autonomously in society; and (3) recognize the need for additional research in this area and for continued education of the general public and others by advocacy groups.

Use of formoterol in the treatment of stuttering. A pilot study.

Department of Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.

Aims: Stuttering is a serious health and social problem that can distinctively affect not only the mental development of an individual but also his life possibilities, including social fulfilment and his general life prospects. The etiology of stuttering is however unknown and that is why it is not possible to treat it causally. This pilot study takes into account the hypothesis of bronchial constriction as a negative factor in stuttering and investigates the effect of the long-acting bronchodilator formoterol fumarate on stuttering in 42 patients. Methods: Patients were divided in 2 groups - A (school children and juveniles) and B (adults 18-25 resistant to other treatment). The medicine was administered once a day in the morning in a dose of 12 microg for the total period of 6 months. The prime outcome parameter - severity of stuttering - was evaluated using the ordinary scale (McGill Pain Questionnaire). The evaluation was done by an examining physician during visits to the centres and by the patients themselves (in cases of the youngest with the assistance of a parent) in a daily diary. Results: A non-parametric pair test (Wilcoxon signed rank test) was used to compare the average marks in the whole set of patients. During the six moth period of administration of Foradil(R) the speech fluency improved. The average number of dysfluent words decreased from 10.5 +/- 1.3 to 6.6 +/-0.97. Conclusion: The average mark of speech fluency evaluated by the physicians between the period of non use of Foradil(R) and the six month period after the use of Foradil(R) improved from 2.95 +/- 0.76 to 1.95 +/- 0.56 (as proved by the chi-square test, p<0.0001). The evaluation of speech fluency of balbuties uses the logopedic practices. Other clinical evaluations of speech fluency are not known.

Awareness and reactions of young stuttering children aged 2-7 years old towards their speech disfluency.

Centre of Stuttering Therapy Antwerp, University of Antwerp, Belgium. ronny.boey@skynet.be

Awareness has been an important factor in theories of onset and development of stuttering. So far it has been suggested that even young children might be aware of their speech difficulty. The purpose of the present study was to investigate (a) the number of stuttering children aware of their speech difficulty, (b) the description of reported behavioural expression of awareness, (c) the relationship with age-related variables and with stuttering severity. For a total group of 1122 children with mean age of 4 year 7 months (range 2-7 years old), parental-reported unambiguous verbal and non-verbal reactions as a response to stuttering were available. In the present study, awareness is observed for 56.7% of the very young children (i.e., 2 years old) and gradually increases with age up until 89.7% of the children at the age of seven. All considered age-related factors (i.e., chronological age, age at onset and time since onset) and stuttering severity are statistically significantly related to awareness. Learning outcomes: Readers will be able to: (1) Describe findings of awareness of speech disfluency of stuttering children based on an overview of literature; (2) Describe methodological aspects of studies on awareness; (3) Know reported data on awareness of speech disfluency in young stuttering children of the present study; (4) Describe the relationship of awareness of speech disfluency with chronological age, age at onset, time since onset, gender and stuttering severity.

Factorial Temperament Structure in Stuttering, Voice Disordered, and Normal Speaking Children.

Dept. of Speech-Language Therapy and Audiology, Lessius University College, Belgium.

PURPOSE: The purpose of this study was to determine whether the underlying temperamental structure of the Dutch Children's Behavior Questionnaire (CBQ; Van den Bergh & Ackx, 2003) was identical for children who stutter (CWS), typically developing children (TDC), and children with vocal nodules (CWVN). METHOD: A principle axis factor analysis was performed on data obtained with the Dutch CBQ from 69 CWS, 149 TDC, and 41 CWVN. All children were between the ages of 3;0 and 8;11 years. RESULTS: Results indicated a three-factor solution, identified as Extraversion/Surgency, Negative Affect, and Effortful Control, for each of the participant groups, showing considerable similarity to previously published US, Chinese, Japanese, and Dutch samples. Congruence coefficients were highest for CWS and TDC and somewhat more modest when comparing CWVN and TDC. The factor 'Effortful Control'consistently yielded lowest congruence coefficients. CONCLUSIONS: These data confirm that while stuttering, voice disordered, and typically developing children may differ quantitatively with regard to mean scores on temperament scales, they are similar in terms of their overall underlying temperament structure. The equivalence of temperament structure provides a basis for further comparison of mean group scores on the individual temperament scales.

Peer responses to stuttering in the preschool setting.

Institute for Stuttering Treatment & Research, Faculty of Rehabilitation Medicine, University of Alberta, 1500, 8215-112 Street, Edmonton, Alberta T6G 2C8, Canada. marilyn.langevin@ualberta.ca

PURPOSE: This study investigated peer responses to preschoolers' stuttering in preschool and sought to determine whether specific characteristics of participants' stuttering patterns elicited negative peer responses. METHOD: Four outdoor free-play sessions of 4 preschoolers age 3-4 years 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 negative responses across 3 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.

The role of large-scale neural interactions for developmental stuttering.

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, PR China.

Using the structural equation modeling (SEM) method, the present study examined the role of large-scale neural interactions in developmental stuttering while 10 stuttering and nine non-stuttering subjects performed a covert picture-naming task. Results indicated that the connection patterns were significantly different between stuttering and non-stuttering speakers in both omnibus connection pattern and individual connection path coefficient. Specifically, stuttering speakers showed functional disconnection from the left inferior frontal gyrus to the left motor areas, and altered connectivity in the basal ganglia-thalamic-cortical circuit, and abnormal integration of supramodal information across the cerebellum and several frontal-parietal regions. These results indicate that the large-scale dysfunctional neural interactions may be involved in stuttering speakers' difficulties in planning, execution, and self-monitoring of speech motor sequence during word production.

The effect of stuttering on communication: a preliminary investigation.

The University of Newcastle, Callaghan, NSW, Australia. elizabeth.spencer@newcastle.edu.au

This paper describes a study in which Systemic Functional Linguistics was applied to describe how people who stutter use language. The aim of the study was to determine and describe any differences in language use between a group of 10 adults who stutter and 10 matched normally-fluent speakers. In addition to formal linguistic analyses, analyses drawn from Systemic Functional Linguistics were used to further investigate the expression of both syntactic and semantic complexity. The findings from this study replicated previous findings of Packman et al. in which they found that the language used by people who stutter was significantly less complex than the control group. Another major finding was that adults who stuttered used the linguistic resource of modality significantly less than the normally-fluent matched peers. The implications these strategies have on communication and social participation will be discussed.

Stuttering patients' opinions on the Digital Speech Aid.

Phoniatric Clinic of the Institute of Physiology and Pathology of Hearing, Warsaw, Poland. j.ratynska@ifps.org.pl

BACKGROUND: The Digital Speech Aid (DSA) is a portable device used to reduce stuttering. It incorporates delayed auditory feedback (DAF) and frequency-shifted auditory feedback (FAF). Due to its small size, the DSA can be used by the stutterer in everyday life. MATERIAL/METHOD: Three hundred thirty-five stutterers aged 6-64 years were included in the study. A subgroup of 100 stutterers who had used the device for at least six months was asked to fill out a questionnaire of 25 questions about their opinion of the device. The data were analyzed and the factors determining the patients' satisfaction with the device were investigated. RESULTS: The analysis showed that the patients used the DSA regularly for about 3 hours daily. Most patients applied the device at home; only small number used it at work or at school. Most patients (70%) reported decreased fear of speaking and improved self-confidence during communication when using the device (78%). Eighty-eight percent of the patients described the device as very useful or useful in everyday life. That patients' satisfaction with the device was not related to objective speech improvement but to a subjective feeling of increased self-confidence and decreased fear of speaking. CONCLUSIONS: The DSA is positively judged by patients as an option in stuttering therapy. Its effect can be attributed not only to fluency improvement, but also to increased self-confidence and reduced fear of speaking.

Gaze aversion to stuttered speech: a pilot study investigating differential visual attention to stuttered and fluent speech.

Audiology and Speech Pathology, University of Tennessee, Knoxville, TN, USA.

Background: People who stutter are often acutely aware that their speech disruptions, halted communication, and aberrant struggle behaviours evoke reactions in communication partners. Considering that eye gaze behaviours have emotional, cognitive, and pragmatic overtones for communicative interactions and that previous studies have indicated increased physiological arousal in listeners in response to stuttering, it was hypothesized that stuttered speech incurs increased gaze aversion relative to fluent speech. The possible importance in uncovering these visible reactions to stuttering is that they may contribute to the social penalty associated with stuttering. Aims: To compare the eye gaze responses of college students while observing and listening to fluent and severely stuttered speech samples produced by the same adult male who stutters. Methods & Procedures: Twelve normally fluent adult college students watched and listened to three 20-second audio-video clips of the face of an adult male stuttering and three 20-second clips of the same male producing fluent speech. Their pupillary movements were recorded with an eye-tracking device and mapped to specific regions of interest (that is, the eyes, the nose and the mouth of the speaker). Outcomes & Results: Participants spent 39% more time fixating on the speaker's eyes while witnessing fluent speech compared with stuttered speech. In contrast, participants averted their direct eye gaze more often and spent 45% more time fixating on the speaker's nose when witnessing stuttered speech compared with fluent speech. These relative time differences occurred as a function of the number of fixations in each area of interest. Thus, participants averted their gaze from the eyes of the speaker more frequently during the stuttered stimuli than the fluent stimuli. Conclusions & Implications: This laboratory study provides pilot data suggesting that gaze aversion is a salient response to the breakdown in communication that occurs during stuttering. This response may occur as a result of emotional, cognitive, and pragmatic factors in communication partners. Regardless of the factors contributing to the response, its primary importance may be that gaze aversion is a visible communication partner signal informing the person stuttering that something is amiss in the interaction and hence, may contribute to inducing negative emotions in the persons stuttering, via engagement of the mirror neuron system. We suggest that witnessing and interpreting communication partner responses to stuttering may play a role when a person who stutters engages in future interactions, perhaps contributing to the development of covert strategies to hide stuttering.

Disfluencies in non-stuttering adults across sample lengths and topics.

University of Ottawa, Audiology and Speech Language Pathology, 451 Smyth Road, Room 3071, Ottawa, ON K1H 8M5, Canada.

Data on disfluencies in the speech of non-stuttering adults are relevant to several aspects of the assessment and treatment of adults who stutter. Currently, very few sources provide relevant data. In the existing literature on normally fluent speakers, there is no consistency in sample length or topic or in which types of disfluency are counted. Many studies report incomplete data, making it difficult to compare new results to previous ones. The purpose of this study was to assess the effect of sample length and topic on fluency levels in the speech of non-stuttering adult men. Monologues produced by 25 English-speaking men with no reported communication disorder were analyzed for the presence of disfluencies. The group means for total disfluencies were between 6 and 8 per 100 syllables for all samples. A within-subjects Length (3) by Topic (3) ANOVA found a significant interaction (Length by Topic), however, the clinical importance of this result is minimal. The mean number of within-word disfluencies (also called stuttering-like disfluencies or SLDs) was below 1.5 per 100 syllables for all samples, although there was some variation across individual speakers. The data presented will be useful to clinicians and to researchers interested in disfluencies in spontaneous speech. Learning outcomes: Readers will be able to (1) identify several methodological problems in studies of disfluency including counting methods and descriptions of participants; (2) identify the range of within-word disfluencies (also called SLDs) and other disfluencies in this study and other similar ones; (3) know whether topic/type of speech or sample length is more likely to affect disfluency levels in non-stuttering adults.

Coping responses by adults who stutter: part II. Approaching the problem and achieving agency.

Department of Communication Disorders, 1199 Haley Center, Auburn University, Auburn, AL 36849, USA. lwp0002@auburn.edu

As with the first of two companion manuscripts, this investigation employed a grounded theory approach to identify patterns of coping responses by adults responding to the stress resulting from the threat of stuttering. The companion paper described emotion-based avoidant coping responses that were used to protect both the speaker and the listener from experiencing discomfort associated with stuttering. This paper describes two cognitive-based approach patterns that emphasize self-focused and problem-focused forms of coping. The first of the cognitive-based coping patterns involved speakers approaching stuttering with a broader perspective about themselves and the experience of stuttering, resulting in an improved self-concept and increased self-confidence. The second coping pattern involved speakers focusing on their own goals which results in increased agency and self-confidence. Participants described the development of more functional coping responses. They moved from emotion-based avoidant patterns of coping that focused on protecting the self and the listener from experiencing discomfort associated with stuttering to cognitive-based approach patterns that focused on the needs of the speaker. As the participants chose to approach rather than avoid or escape stuttering, they experienced many positive social, physical, cognitive, and affective results. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence coping choices, and (4) explain the factors that contribute the use of approach-oriented and agentic coping strategies.

Coping responses by adults who stutter: part I. Protecting the self and others.

Department of Communication Disorders, 1199 Haley Center, Auburn University, AL 36849, USA. lwp0002@auburn.edu

Using a grounded theory approach, four clusters were identified that represent patterns of coping by adults who stutter. In order to understand the complexities within the coping responses of speakers to the experience of stuttering, this first of two companion papers summarizes the literature on the human coping response to stress and the nature of two of the four main findings identified. These findings describe a coping process that emphasizes strategies of protecting both the speaker and the listener from experiencing discomfort associated with stuttering. The companion paper describes the remaining two main findings that emphasize the characteristics of self-focused and action oriented coping responses. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence the choice to use emotion-focused and problem-focused coping strategies, and (4) explain the factors that contribute to the use of methods of escape.

The Peer Attitudes Toward Children who Stutter scale: reliability, known groups validity, and negativity of elementary school-age children's attitudes.

Institute for Stuttering Treatment & Research, Faculty of Rehabilitation Medicine, University of Alberta, 1500, 8215 - 112 Street, Edmonton, Alberta, T6G 2C8, Canada. marilyn.langevin@ualberta.ca

Psychometric properties of the Peer Attitudes Toward Children who Stutter (PATCS) scale (Langevin, M., & Hagler, P. (2004). Development of a scale to measure peer attitudes toward children who stutter. In A.K. Bothe (Ed.), Evidence-based treatment of stuttering: empirical bases and clinical applications (pp. 139-171). Mahwah, NJ: Lawrence Erlbaum Associates.) and the extent to which peer attitudes are negative were re-examined. Results show that internal consistency was .97 and test-retest reliability was .85. In a known groups analysis participants who had contact with someone who stutters had statistically significant higher mean scores (more positive attitudes) than those who had not had contact. Nonsignificant findings for gender and grade call into question the usefulness of these variables as discriminators in future tests of known groups validity of peer attitudes toward children who stutter. Approximately one-fifth of participants had PATCS scores that were somewhat to very negative. These findings support calls for school-based education about stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize the social impacts of stuttering on school-age children who stutter, (2) describe the known groups method to test construct validity, (3) evaluate the psychometric properties of the Peer Attitudes Toward Children who Stutter scale, and (4) provide information about the proportion of students who appear to hold negative attitudes toward children who stutter.

The impact of stuttering on the quality of life in adults who stutter.

Rehabilitation Studies Unit, Northern Clinical School, Faculty of Medicine, The University of Sydney, PO Box 6, Ryde, NSW 1680, Australia. a.craig@med.usyd.edu.au

Stuttering is an involuntary fluency disorder that is not uncommon in society. However, the impact of stuttering on a composite measure such as quality of life has rarely been estimated. Quality of life (QOL) assesses the well-being of a person from a multidimensional perspective, and valid and reliable general QOL measures are available that can be used to estimate the impact of stuttering on QOL. This study involved the use of a general measure of QOL called the Medical Outcomes Study Short Form-36 (SF-36) in order to assess the impact of stuttering in 200 adults who stutter (AWS). Comparisons to 200 adults of similar age and sex ratio who do not stutter were made so that the unique contribution of stuttering on QOL could be estimated. Findings indicated that stuttering does negatively impact QOL in the vitality, social functioning, emotional functioning and mental health status domains. Results also tentatively suggest that people who stutter with increased levels of severity may have a higher risk of poor emotional functioning. These findings have implications for treatment such as the necessity to address the emotional and psychological aspects of QOL in AWS and the need for additional clinical resources to be invested in stuttering treatment. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) summarize the method used in quality of life assessment using the SF-36; (b) describe the impact of stuttering on the quality of life of adults who stutter; (c) compare the impact of stuttering to the quality of life of adults who do not stutter; (d) describe the relationship between frequency of stuttering and quality of life.

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

University of Iceland, School of Education, Bolholt 6, 105 Reykjavík, Iceland. jeinars@hi.is

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- to 5-year-olds were used. Icelandic children who stutter (CWS), preselected for different levels of stuttering, were subdivided into 5-s intervals. Ten experienced Icelandic speech-language pathologists (ICE-SLPs) and 10 experienced U.S. 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 2 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 (a) displayed satisfactory mean intrajudge agreement, (b) met an independent stuttering judgment accuracy criterion test using English-speaking CWS samples, and (c) met an agreement criterion on approximately 90% of their stuttering and nonstuttering judgments on the Icelandic-speaking CWS samples. CONCLUSION: 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.

Brain activation abnormalities during speech and non-speech in stuttering speakers.

Laryngeal and Speech Section, Medical Neurology Branch, NINDS/NIH, 10 Center Dr. MSC 1416 Building 10, Room 5D38, Bethesda, MD 20892, USA.

Although stuttering is regarded as a speech-specific disorder, there is a growing body of evidence suggesting that subtle abnormalities in the motor planning and execution of non-speech gestures exist in stuttering individuals. We hypothesized that people who stutter (PWS) would differ from fluent controls in their neural responses during motor planning and execution of both speech and non-speech gestures that had auditory targets. Using fMRI with sparse sampling, separate BOLD responses were measured for perception, planning, and fluent production of speech and non-speech vocal tract gestures. During both speech and non-speech perception and planning, PWS had less activation in the frontal and temporoparietal regions relative to controls. During speech and non-speech production, PWS had less activation than the controls in the left superior temporal gyrus (STG) and the left pre-motor areas (BA 6) but greater activation in the right STG, bilateral Heschl's gyrus (HG), insula, putamen, and precentral motor regions (BA 4). Differences in brain activation patterns between PWS and controls were greatest in females and less apparent in males. In conclusion, similar differences in PWS from the controls were found during speech and non-speech; during perception and planning they had reduced activation while during production they had increased activity in the auditory area on the right and decreased activation in the left sensorimotor regions. These results demonstrated that neural activation differences in PWS are not speech-specific.

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.

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

Australian Stuttering Research Centre, The University of Sydney, Sydney, NSW, Australia. marilyn.langevin@ualberta.ca

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.