Signs of developmental stuttering up to age eight and at 12 plus

Stuttering as a spectrum disorder: A hypothesis

Childhood-onset fluency disorder, commonly referred to as stuttering, affects over 70 million adults worldwide. While stuttering predominantly initiates during childhood and is more prevalent in males, it presents consistent symptoms during conversational speech. Despite these common clinical manifestations, evidence suggests that stuttering, may arise from different etiologies, emphasizing the need for personalized therapy approaches. Current research models often regard the stuttering population as a singular, homogenous group, potentially overlooking the inherent heterogeneity. This perspective consolidates both historical and recent observations to emphasize that stuttering is a heterogeneous condition with diverse causes. As such, it is crucial that both therapeutic research and clinical practices consider the potential for varied etiologies leading to stuttering. Recognizing stuttering as a spectrum disorder embraces its inherent variability, allowing for a more nuanced categorization of individuals based on the underlying causes. This perspective aligns with the principles of precision medicine, advocating for tailored treatments for distinct subgroups of people who stutter, ultimately leading to personalized therapeutic approaches.

Associations between glutamic acid decarboxylase antibodies, oxidative stress markers, and cognitive capacity in adolescents who stutter

In this study, we amid to evaluate the correlation between the change in the expressed levels of anti-GAD antibodies titers, oxidative stress markers, cytokines markers, and cognitive capacity in adolescents with mild stuttering. Eighty participants (60 male/20 female) with the age range of 10-18 years with moderate stutteringparticipated in this study. To assess the stuttering and cognitive function, stutteringseverity instrument (SSI-4; 4th edit.)and the LOTCA-7 scores assessment were applied respectively in all subjects. In addition, serum GAD antibodies, cytokines like TNF-α, CRP,and IL-6 withtotal antioxidant capacity and nitric oxide as oxidative stress markers were estimated using calorimetry and immunoassay techniques.The results showed that good cognitive capacity was reported in about 56.25 % of the study population (n = 45) with a 117.52 ± 6.3 mean LOTCA-7 score. However, abnormal cognitive function was identified in 43.75 % of the study population (n = 35); they were categorized into moderate (score 62-92, n = 35), and poor (score 31-62; n = 10). There were significant associations between cognitive capacity reported and all biomarkers. The expression of GAD antibodies is significantly associated with the degree of cognitive capacity among students with stuttering. Significant association with the reduction (P = 0.01) in LOTCA-7 score domains, particularly orientation, thinking operations, attention, and concentration among students with variable cognitive capacity compared to controls. In addition, the expressed higher GAD antibodies in students with moderate and poor cognitive capacity showed to be significantly correlated with both elevated concentrations of cytokines; TNF-α, CRP, and IL-6, and the reduction of TAC and nitric oxide (NO) respectively. This study concludes that abnormality of cognitive capacity showed to be associated with higher expression of GAD antibodies, cytokines, and oxidative stress in school students with moderate stuttering.

Perception of Stuttering in Individuals With Stuttering

Stuttering is a puzzling disorder which involves voluntary repetition, prolongation along with blocking and other interruptions to the flow of speech. Stuttering impacts on quality of life of individuals with difficulties in overall social behavior and performance. The present study focuses on perception of stuttering by individual with stuttering and their experiences toward their stuttering among family and society. The present study was carried out in two phases. Phase 1 included the development of questionnaire and phase 2 incorporated the administration of questionnaire and analysis of the results. Total of 20 participants (16 males and 4 females) between the age ranges of 15-50 years (SD = 8.33) were included in the study. The results of present study consisted of perception of the individual with stuttering, their family members and other people regarding the probable cause, effects and treatment of stuttering. The causes were than categorized into psychological, superstitious, genetic, physiological and unknown. Likewise the treatment was categorized into speech therapy, medical treatment, self management strategies, superstitious beliefs and unknown. Many of the participants, their family members and other people had inappropriate, irrational and superstitious believes about the cause and treatment of stuttering due to which they faced many difficulties in their life. Hence from this study we conclude that there is requirement of awareness regarding the etiologies of stuttering and its consequences in hazarding the quality of life. It was also observed the urgent need of awareness regarding the speech therapy and its beneficial outcome in enhancing the fluency of individuals with stuttering, therefore, avoiding the consequence of the condition in their life.

Association between stuttering and psychosocial complications in Saudi Arabian individuals: A pilot study

Background

Stuttering is a multifaceted speech disorder that affects the interpersonal communication. It has a significant psychosocial impact on individuals who stutter and on their families. Stuttering is associated with substantial psychosocial morbidity, including social or generalized anxiety, stigmatization or discrimination, impaired self-image, and poor quality of life. Psychosocial morbidity, such as the one reported among stuttering individuals, may provoke suicidal ideation that varies with gender, age, geographic region, and psychosocial reality. The present research aimed to determine the association between stuttering and psychosocial complications in Saudi Arabian individuals.

Materials and Methods

This study targeted a total of 107 male patients with stuttering. Only 59 of them fulfilled both inclusion and exclusion criteria. The researchers formulated a valid questionnaire to obtain quantifiable data for analysis. The questionnaire consisted of 76 questions spanning various domains. Following the data collection, a quantitative analysis was carried out.

Results

A total of 79.5% of the participants were adolescents or young adults between the ages of 16 and 26. Among them, 17.8% had a later onset of stuttering. The age of onset tended to be higher than 5 years, with over 80% of respondents reporting an age of onset in the last 5 years of their age. Among the participants, 57.6% reported a positive family history of stuttering.

Conclusions

The present study reports that patients who stutter (PWS) are at a higher risk of developing negative thoughts leading to suicidal attempts due to social anxiety and depression. Therefore, future studies should be designed to establish the relationship between stuttering and suicidal thoughts in order to establish policies that may improve the quality of life of those who stutter.

Green tea consumption and the management of adrenal stress hormones in adolescents who stutter

Green tea and its polyphenolic compounds have been shown to exert positive effects in individuals with psychological disorders. The protective role of green tea against stuttering or its related consequences, depression, anxiety and stress, were evaluated in adolescents with moderate stuttering (MS). A total of 60 adolescents aged (12-18) years old were enrolled in this study. Patients were classified according to standardized test material Stuttering Severity Instrument, 4th Edition was used to estimate the severity of stuttering; participants were classified into two groups: a normal healthy group (n=30) and a MS group (n=30). The Depression Anxiety Stress Scale and General Health Questionnaire were used to estimate the degree of depression, anxiety and stress as well as general mental health. The physiological profile of stress hormones, as a measure of the response to green tea response, was also measured amongst participants. Adrenal stress hormones cortisol, dehydroepiandrosterone (DHEA), acetylcholine (ACTH), corticosterone and the cortisol:DHEA ratio were assayed. In addition, the constituent green tea polyphenols and their quantities were determined using liquid chromatography analysis. Decaffeinated green tea was administered six cups/day for 6 weeks, and this significantly improved the depression, anxiety, stress and mental health consequences associated with stuttering in adolescents. In addition, increased consumption of green tea significantly reduced elevated levels of adrenal stress hormones; cortisol, DHEA, ACTH and corticosterone, and increased the cortisol:DHEA ratio in the control and adolescents who stuttered. The data showed that drinking six cups of decaffeinated green tea, which is enriched in catechins (1,580 mg) and other related polyphenols, was sufficient to improve the consequences of mental health associated with stuttering in younger aged individuals.

Lexical Planning in People Who Stutter: A Defect in Lexical Encoding or the Planning Scope?

Developmental stuttering is a widely discussed speech fluency disorder. Research on its mechanism has focused on an atypical interface between the planning (PLAN) and execution (EX) processes, known collectively as the EXPLAN model. However, it remains unclear how this atypical interface influences people who stutter. A straightforward assumption is that stuttering speakers adopt a smaller scope of speech planning, whereas a defect in word retrieval can be confounding. To shed light on this issue, we took the semantic blocking effect as an index to examine lexical planning in word and phrase production. In Experiment 1, for word production, pictures from the same semantic category were combined to form homogeneous blocks, and pictures from different categories were combined to form heterogeneous blocks. A typical effect of semantic blocking showing longer naming latencies for homogeneous blocks than heterogeneous ones was observed for both stuttering and fluent speakers. However, this effect was smaller for stuttering speakers, when it was subject to lexical defects in stuttering. In Experiment 2, for a conjoined noun phrase production task, the pictures referring to the first noun were manipulated into homogeneous and heterogeneous conditions. The semantic blocking effect was also much smaller for stuttering speakers, indicating a smaller scope of lexical planning. Therefore, the results provided more evidence in support of the EXPLAN model and indicated that a smaller scope of lexical planning rather than lexical defects causes the atypical interface for stuttering. Moreover, a comparison between these two tasks showed that the study findings have implications for syntactic defects in stuttering.

Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys

Aims

Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA).

Methods

Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874, age 35–82 years) and the ZInEP Epidemiology Survey (N = 1,500, age 20–41 years). Associations between stuttering and sociodemographic characteristics, familial aggregation, comorbidity and psychosocial risk / associated factors were investigated in both samples. LCAs were conducted on selected items from people in both samples who reported having stuttered in childhood.

Results

Initial analyses linked early anxiety disorders, such as separation anxiety disorder and overanxious disorder, to stuttering (PsyCoLaus). ADHD was associated with stuttering in both datasets. In the analyses of risk / associated factors, dysfunctional parental relationships, inter-parental violence and further childhood adversities were mutual predictors of stuttering. Moreover, comorbidities were seen with hay fever, asthma, eczema and psoriasis (PsyCoLaus). Subsequent LCA identified an unspecific group of persons who self-reported that they stuttered and a group defined by associations with psychosocial adversities (ZINEP, PsyCoLaus) and atopic diseases (PsyCoLaus).

Conclusions

The two subtypes of developmental stuttering have different risk / associated factors and comorbidity patterns. Most of the factors are associated with vulnerability mechanisms that occur early in life and that have also been linked with other neurodevelopmental disorders. Both psychosocial and biological factors appear to be involved in the etiopathogenesis of stuttering.

A systematic literature review of neuroimaging research on developmental stuttering between 1995 and 2016

PURPOSE

Stuttering is a disorder that affects millions of people all over the world. Over the past two decades, there has been a great deal of interest in investigating the neural basis of the disorder. This systematic literature review is intended to provide a comprehensive summary of the neuroimaging literature on developmental stuttering. It is a resource for researchers to quickly and easily identify relevant studies for their areas of interest and enable them to determine the most appropriate methodology to utilize in their work. The review also highlights gaps in the literature in terms of methodology and areas of research.

METHODS

We conducted a systematic literature review on neuroimaging studies on developmental stuttering according to the PRISMA guidelines. We searched for articles in the pubmed database containing "stuttering" OR "stammering" AND either "MRI", "PET", "EEG", "MEG", "TMS"or "brain" that were published between 1995/​01/​01 and 2016/​01/​01.

RESULTS

The search returned a total of 359 items with an additional 26 identified from a manual search. Of these, there were a total of 111 full text articles that met criteria for inclusion in the systematic literature review. We also discuss neuroimaging studies on developmental stuttering published throughout 2016. The discussion of the results is organized first by methodology and second by population (i.e., adults or children) and includes tables that contain all items returned by the search.

CONCLUSIONS

There are widespread abnormalities in the structural architecture and functional organization of the brains of adults and children who stutter. These are evident not only in speech tasks, but also non-speech tasks. Future research should make greater use of functional neuroimaging and noninvasive brain stimulation, and employ structural methodologies that have greater sensitivity. Newly planned studies should also investigate sex differences, focus on augmenting treatment, examine moments of dysfluency and longitudinally or cross-sectionally investigate developmental trajectories in stuttering.

Effect(s) of Language Tasks on Severity of Disfluencies in Preschool Children with Stuttering

Speech disfluency in children can be increased or decreased depending on the type of linguistic task presented to them. In this study, the effect of sentence imitation and sentence modeling on severity of speech disfluencies in preschool children with stuttering is investigated. In this cross-sectional descriptive analytical study, 58 children with stuttering (29 with mild stuttering and 29 with moderate stuttering) and 58 typical children aged between 4 and 6 years old participated. The severity of speech disfluencies was assessed by SSI-3 and TOCS before and after offering each task. In boys with mild stuttering, The mean stuttering severity scores in two tasks of sentence imitation and sentence modeling were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). But, in boys with moderate stuttering the stuttering severity in the both tasks were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). In girls with mild stuttering, the stuttering severity in two tasks of sentence imitation and sentence modeling were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). But, in girls with moderate stuttering the mean stuttering severity in the both tasks were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). In both gender of typical children, the score of speech disfluencies had no significant difference between two tasks ([Formula: see text]). In preschool children with mild stuttering and peer non-stutters, performing the tasks of sentence imitation and sentence modeling could not increase the severity of stuttering. But, in preschool children with moderate stuttering, doing the task of sentence modeling increased the stuttering severity score.

ACTH has beneficial effects on stuttering in ADHD and ASD patients with ESES: A retrospective study

INTRODUCTION

Etiology of stuttering remains unknown and no pharmacologic intervention has been approved for treatment. We aimed to evaluate EEG parameters and the effect of adrenocorticotropic hormone (ACTH) therapy in stuttering.

METHODS

In this retrospective study, 25 patients with attention deficit and hyperactivity (ADHD) or autism spectrum disorder (ASD), and comorbid stuttering were followed and treated with ACTH for electrical status epilepticus in sleep (ESES). Sleep EEGs were recorded at referral and follow-up visits and short courses of ACTH were administered when spike-wave index (SWI) was ⩾15%. The assessment of treatment effectiveness was based on reduction in SWI, and the clinician-reported improvement in stuttering, and ADHD or ASD. Statistical analyses were conducted in order to investigate the relationship between the clinical and EEG parameters.

RESULTS

Following treatment with ACTH, a reduction in SWI in all the patients was accompanied by a 72% improvement in ADHD or ASD, and 83.8% improvement in stuttering. Twelve of the 25 patients with stuttering showed complete treatment response. Linear regressions established that SWI at final visit significantly predicted improvement in ADHD or ASD, and in stuttering. If symptoms had recurred, improvement was once again achieved with repeated ACTH therapies. Stuttering always improved prior to, and recurred following ADHD or ASD.

CONCLUSION

The underlying etiology leading to ESES may play a significant role in the pathophysiology of stuttering and connect stuttering to other developmental disorders. ACTH therapy has beneficial effects on stuttering and improves EEG parameters.

Effect of aerobic exercises on stuttering

BACKGROUND AND OBJECTIVE

Stuttering is one of the most common speech disorders in adolescents than adults. Stuttering results in depression, anxiety, behavioral problem, social isolation and communication problems in daily life. Our objective was to determine the effect of Aerobic Exercises (AE) on stuttering.

METHODS

A quasi trail was conducted at National Institute of Rehabilitation Medicine (NIRM) from January to June 2015. Thirty patients were selected and placed in three different groups Experimental Group A, (EG = 10 patients, age between 7-14 years), Experimental Group B (EG =10 patients age between 15-28 years) and control group -group C, (CG = 10 patients, age between 7-28 years). Patient who stutter were included in this study and those with any other pathology or comorbidity of speech disorders were excluded. The assessment tool used was Real-Time analysis of speech fluency scale. Participants in all the groups received speech therapy while only the EG - A and B received aerobic exercises (AE) using treadmill and stationary bicycle along with the speech therapy. Pre-interventional and post interventional assessments were analyzed using the SPSS 21 in order to determine the significance of new treatment approach and the effectiveness of physical therapy on speech disorders.

RESULTS

All the groups showed significant treatment effects but both the EG groups (Group A, Group B) showed high improvement in the severity level of stuttering as compared to control group C. The results also showed that AE treated group B had significant difference in p-value (p=0.027) as compared to control group (p<0.05) while experimental group A had no significant difference (p > 0.05) between these groups.

CONCLUSION

The eclectic approach of aerobic exercises with the traditional speech therapy provides proximal rehabilitation of stuttering.

Disfluency characteristics of Kannada-English bilingual adults who stutter

The primary purpose of the present study was to investigate whether stuttering frequency differs between two languages in Kannada-English bilingual adults who stutter. The second purpose was to compare the relationship between grammatical class (content-function word dichotomy) and stuttering frequency in two languages. In addition, we also examined whether types of disfluencies vary between content and function words in two languages. Twenty-five bilingual adults who stutter that were proficient in both languages (mean age=22.5 years, SD=3.0) participated in the present study. Spontaneous speech samples were recorded in both Kannada and English and stuttering frequencies were calculated in both languages and for each type of grammatical category. Further, different types of disfluencies were noted for each type of grammatical category in both the languages. Results revealed significantly greater stuttering in L2 (English) compared to L1 (Kannada). In both the languages, significantly higher content words were stuttered compared to function words. When the comparison was done between two languages, significantly higher content words were stuttered in L1 compared to L2, whereas significantly higher function words were stuttered in L2 compared to L1. The types of disfluencies did not vary between content and function words and between two languages. Present results suggest that frequency and other aspects of stuttering may depend on the proficiency of the language.

Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study

BACKGROUND

There is clinical uncertainty of the benefits and costs of different treatment options for children with Down syndrome who have glue ear. This study was designed to assess the extent of this lack of knowledge and determine if pursuing further information would be practical, beneficial and cost-effective.

OBJECTIVES

To assess the level and practical effect of current uncertainty around treatment options for children with Down syndrome and glue ear. To assess the feasibility of studying the options for management of glue ear in children with Down syndrome via a randomised controlled trial (RCT) or multicentre prospective cohort study by evaluating the willingness of (1) parents to agree to randomisation for their children and (2) clinicians to recruit participants to a definitive study. To undertake value of information analyses to demonstrate the potential economic benefit from undertaking further research.

DESIGN

A feasibility study exploring the views of parents of children with Down syndrome and professionals who have responsibility for the health and education of children with Down syndrome, on the participation in, and value of, future research into interventions for glue ear. Data were collected from parents via self-completed questionnaires, face-to-face interviews and focus groups and from professionals via online questionnaires and a Delphi review exercise. Development of economic models to represent clinical pathways of care and a RCT informed a value of information (VOI) analysis.

SETTING

UK (professionals); East Midlands region of the UK (parents).

PARTICIPANTS

Parents of children aged 1-11 years with Down syndrome (n = 156). Professionals including audiologists, ear, nose and throat surgeons, audiological physicians, speech and language therapists, and teachers of the deaf (n = 128).

MAIN OUTCOME MEASURES

Quantitative and qualitative data on parental views and experiences of glue ear and its effects; interventions and treatment received; taking part in research and factors that would encourage or discourage participation; and the importance of various outcome domains to them and for their children. For professionals: information on caseloads; approaches to clinical management; opinions on frequency and significance of the consequences of glue ear for this population; importance of different outcome measures; opinions of interventions and their role in future research; views on health research; facilitators and barriers to recruitment, and participation in research involving RCTs.

RESULTS

The complexity of the experience and individual characteristics of children with Down syndrome poses challenges for the design of any future research but these challenges were not considered by professionals to raise sufficient barriers to prevent it being undertaken. Parents were generally supportive of the need for, and value of, research but identified practical and emotional issues that would need addressing. Glue ear was considered to impact more on speech, language and communication than on hearing. Outcome measures for future research would need to evaluate these elements but measures should be designed specifically for the population. Parents and professionals identified randomisation as a significant barrier to participation. The VOI analyses identified lack of data as problematic but concluded that a future trial involving surgical intervention would be feasible at costs of < £650,000.

CONCLUSIONS

Future research into the benefits of interventions for glue ear in children with Down syndrome would be feasible and could be cost-effective but should be carefully designed to facilitate and maximise participation from parents and professionals responsible for recruitment.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Stuttering: Genetic updates and a case report

Developmental stuttering is a common disorder of speech dissiliency that is characterized by excessive repetitions of sounds, syllables, and monosyllabic words, as well as sound prolongations and complete blockages of the vocal tract. About 60 million people are affected and it is more common between the age of 3 and 6, when children begin forming sentences and connecting thoughts verbally. There are three types of stuttering known as developmental stuttering, neurogenic stuttering, and psychogenic stuttering. The exact pathophysiology of developmental stuttering is unknown; however, various family and twin studies have repeatedly implicated heredity as a major factor in the etiology of stuttering. It is clear that the genetic influence is not in the form of an exact single gene effect such as autosomal recessive, autosomal dominant, or x-linked in all families; however, in all of the inheritance forms it is influenced by sex with higher occurrence in males than females at a ratio of 4:1 in older children and adults. Recently special genetic locus has been determined on several autosomal chromosomes related to developmental stuttering. In this report, the proband is a 20-year-old boy was referred to our clinic for premarriage genetic counseling; he has been affected since 3 years and now is under cure. three generation study of his family show 13 individuals are affected by stuttering. For the first it occurred in the proband's grandfather and after this time about all of affected cases has been seen in consanguineous marriages. Therefore, the genetical inheritance of stuttering is crystal clear in this family and autosomal recessive inheritance pattern is proposed. Totally in such families with repeated occur of stuttering, we cannot account it as a multifactorial disorder.

Stuttering characteristics of German-English bilingual speakers

The purpose of this study was to examine stuttering behavior in German-English bilingual people who stutter (PWS), with particular reference to the frequency of stuttering on content and function words. Fifteen bilingual PWS were sampled who spoke German as the first language (L1) and English as a second language (L2). Conversational speech was sampled in each language and analyzed for the percentage of overall stuttering-like disfluencies and distribution of stuttering on content and function words. Significantly more stuttering was found to occur in L2 compared to L1. Stuttering occurred significantly more often on content words compared to function words in L1. No significant difference between stuttering on function and content words was observed in L2. Examination across L1 and L2 found a significantly greater percentage of stuttering on function words in L2 compared to L1, and a significantly lower percentage of stuttering on content words in L2 compared to L1. The characteristics of stuttering in L2 could not be differentiated on the basis of an L2 proficiency measure. The differences observed in the amount of stuttering between L1 and L2 suggest that stuttering in bilingual speakers is closely related to language dominance, with features of stuttering in L2 indicative of a less developed language system.

Predicting persistence of and recovery from stuttering by the teenage years based on information gathered at age 8 years

OBJECTIVES

Information obtained at around age 8 years was used to construct a model that predicted persistence of, and recovery from, stuttering several years later. A logistic regression model that classified children as persistent or recovered at the teenage years using stuttering history and symptom information obtained at around age 8 years was constructed and validated.

METHODS

A longitudinal study of 222 children who stuttered was conducted. The children were followed up from around age 8 until the teenage years. Persistence and recovery outcomes were established at the teenage years for 206 of the children, based on agreement across 3 standardized instruments. The data from 132 children were used to develop the model, and the data from the remaining 74 children were used to validate the model. Risk factors assessed at the beginning of the study were head injury, age at stuttering onset, family history of stuttering, handedness, whether a second language was spoken in the home, gender, and scores from the Stuttering Severity Instrument Version 3. The information about risk factors was obtained at around age 8 years by interview, except for the severity estimate, which was obtained by analysis of recordings and observations of physical concomitants associated with stuttering. The model was developed using logistic regression procedures.

RESULTS

The only factor to predict the persistence of, and recovery from, stuttering at the teenage years was stuttering severity at around age 8 years (none of the other factors being significant). For the initial model, the sensitivity (percentage of the group that was classified as persistent) was 84.1% and specificity (the percentage of the group that was classified as recovered) was 78.3%. For the validation, sensitivity was 76.3% and specificity was 72.2%.

CONCLUSIONS

Persistence and recovery at teenage can be predicted from information that can be collected at around age 8 years with sensitivity and specificity of ∼ 80%.

Fatores de risco na gagueira desenvolvimental familial e isolada

OBJETIVO: investigar e comparar os achados dos fatores de risco para a cronicidade da gagueira em crianças com gagueira desenvolvimental familial e isolada. MÉTODOS: participaram 60 crianças de ambos os gêneros, divididas em dois grupos: GI - 30 crianças com gagueira desenvolvimental familial; GII - 30 crianças com gagueira desenvolvimental isolada. A coleta de dados foi realizada por meio do Protocolo de Risco para a Gagueira do Desenvolvimento - PRGD (Andrade, 2006), que considera os seguintes fatores de risco: idade, gênero, tipo de surgimento e tempo de duração das disfluências, tipologia das disfluências, fatores comunicativos e qualitativos associados, histórico mórbido pré, peri e pós natal, fatores estressantes que ocorreram próximo ao surgimento do distúrbio, histórico familial, reação pessoal, familiar e social e atitudes familiares. RESULTADOS: quando o grupo I (GI) foi comparado com o grupo II (GII), a única diferença estatisticamente significante foi com relação aos fatores estressantes que ocorreram próximo ao surgimento do distúrbio. CONCLUSÃO: os resultados confirmam a natureza complexa da gagueira, bem como a necessidade de se investigar os vários fatores considerados como de risco para o distúrbio, com intuito de melhorar a compreensão de suas possíveis etiologias.

Phonological neighborhood and word frequency effects on the stuttered disfluencies of children who stutter: comments on Anderson (2007)

PURPOSE

This letter comments on a study by Anderson (2007) that compared the effects of word frequency, neighborhood density, and phonological neighborhood frequency on part-word repetitions, prolongations, and single-syllable word repetitions produced by children who stutter. Anderson discussed her results with respect to 2 theories about stuttering: the covert repair hypothesis and execution planning (EXPLAN) theory. Her remarks about EXPLAN theory are examined.

RESULTS

Anderson considered that EXPLAN does not predict the relationship between word and neighborhood frequency and stuttering for part-word repetitions and prolongations (she considered that EXPLAN predicts that stuttering occurs on simple words for children). The actual predictions that EXPLAN makes are upheld by her results. She also considered that EXPLAN cannot account for why stuttering is affected by the same variables that lead to speech errors, and it is shown that this is incorrect.

CONCLUSION

The effects of word frequency, neighborhood density, and phonological neighborhood frequency on part-word repetitions, prolongations, and single-syllable word repetitions reported by Anderson (2007) are consistent with the predictions of the EXPLAN model.

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

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.

Changes in the pattern of stuttering over development for children who recover or persist

Three schemes for assessing stuttering were compared. They differed with respect to whether they included whole-word repetitions as characteristics more typical of stuttering. Persistent and recovered groups of children were examined to see whether: (1) one of the schemes differentiated the groups better than others; (2) more and less typical of stuttering characteristics changed over ages in different ways for the groups; and (3) the changes over ages of more and less typical of stuttering classes depended on word type. Twenty-six children who stuttered were classified as persistent or recovered and recorded at three ages between 8-12+ years. Stuttering characteristics were obtained according to the three schemes. The results show: (1) All schemes distinguished persistent, from recovered, children. (2) The proportion of less typical of stuttering characteristics increased and more typical of stuttering characteristics decreased over age for recovered children for all three schemes (there was no change for persistent children). (3) The increased proportion of less typical of stuttering characteristics for the recovered children across age was more apparent for one-syllable content words than one-syllable function words.

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

INTRODUCTION

Stuttering is a speech disorder in which the flow of speech is disrupted by repetitions, prolongation, and blocks of sounds, syllables, or words. No pharmacological treatments are approved for use in stuttering, and the most common form of treatment is speech therapy. This study was designed to assess the safety, tolerability, and effectiveness of pagoclone during 8 weeks of double-blind treatment followed by a 1-year open-label extension in patients who stutter.

METHODS

An 8-week, multicenter, parallel-group, 2-arm, randomized (ratio 2:1 pagoclone-placebo), double-blind study with a 1-year open-label extension conducted at 16 US centers, including men and women aged 18 to 65 years who developed stuttering before 8 years of age. Twice-daily dosing with pagoclone (n = 88 patients) or matching placebo (n = 44 patients), with primary and secondary efficacy variables defined a priori, including Stuttering Severity Instrument Version 3 outcomes, clinician global impressions of improvement, and the change in the percentage of syllables stuttered.

RESULTS

Pagoclone produced an average 19.4% reduction in percentage of syllables stuttered compared with 5.1% reduction for placebo. During open-label treatment, a 40% reduction in the percent syllables stuttered was observed after 1 year of treatment with pagoclone. The most commonly reported adverse event during double-blind treatment was headache (12.5% pagoclone patients, 6.8% placebo patients).

DISCUSSION

Pagoclone was effective in reducing symptoms of stuttering and was well tolerated. In light of its favorable tolerability profile, as well as consistency of effects across multiple efficacy variables, pagoclone may have potential as a pharmacological treatment of stuttering.

LIMITATIONS

The main limitation of this study was the adequacy of the number of subjects who participated because this study was conducted as a pilot investigation. Furthermore, as this condition waxes and wanes, the assessment of stuttering within the clinic setting may not be an adequate reflection of the stuttering of the patients within the community.

Comparison of acoustic and kinematic approaches to measuring utterance-level speech variability

PURPOSE

The spatiotemporal index (STI) is one measure of variability. As currently implemented, kinematic data are used, requiring equipment that cannot be used with some patient groups or in scanners. An experiment is reported that addressed whether STI can be extended to an audio measure of sound pressure of the speech envelope over time that did not need specialized equipment.

METHOD

STI indices of variability were obtained from lip track (L-STI) and amplitude envelope (E-STI) signals. These measures were made concurrent while either fluent speakers or speakers who stutter repeated "Buy Bobby a puppy" 20 times.

RESULTS

L-STI and E-STI correlated significantly. STI decreased with age for both L-STI and E-STI. E-STI scores and L-STI scores discriminated successfully between fluent speakers and speakers who stutter.

CONCLUSION

The amplitude-envelope-over-time signal can be used to obtain an STI score. This STI score can be used in situations where lip movement STI scores are precluded.

Characteristics of stuttering in Dutch-speaking individuals

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.

The University College London Archive of Stuttered Speech (UCLASS)

PURPOSE

This research note gives details of 2 releases of audio recordings available from speakers who stutter that can be accessed on the Web.

METHOD

Most of the recordings are from school-age children. These are available on the University College London Archive of Stuttered Speech (UCLASS) Web site, and information is provided about how to access the site. A description of the recordings and background information about the speakers who contributed recordings to UCLASS Releases One and Two are given. The sample types available in Release One are monologs. Release Two has monologs, readings, and conversations. Three optional software formats that can be used with the archive are described (although processing the archive is not restricted to these formats). Some perceptual assessment of the quality of each recording is given. An assessment of the strengths and limitations of the recording archive is presented. Finally, some past applications and future research possibilities using the recordings are discussed.

The effects of bilingualism on stuttering during late childhood

OBJECTIVES

To examine stuttering by children speaking an alternative language exclusively (LE) or with English (BIL) and to study onset of stuttering, school performance and recovery rate relative to monolingual speakers who stutter (MONO).

DESIGN

Clinical referral sample with supplementary data obtained from speech recordings and interviews.

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

69 (21.8%) of 317 children were bilingual. Of 38 children who used a language other than English at home, 36 (94.7%) stuttered in both languages. Fewer LE (15/38, 39.5%) than BIL (23/38, 60.5%) children stuttered at first referral to clinic, but more children in the fluent control sample were LE (28/38, 73.7%) than BIL (10/38, 26.3%). The association between stuttering and bilingual group (LE/BIL) was significant by chi(2) test; BIL speakers have more chance of stuttering than LE speakers. Age at stuttering onset and male/female ratio for LE, BIL and MONO speakers were similar (4 years 9 months, 4 years 10 months and 4 years 3 months, and 4.1:1, 4.75:1 and 4.43:1, respectively). Educational achievement was not affected by bilingualism relative to the MONO and FB groups. The recovery rate for the LE and MONO controls together (55%) was significantly higher by chi(2) test than for the BIL group (25%).

CONCLUSIONS

BIL children had an increased risk of stuttering and a lower chance of recovery from stuttering than LE and MONO speakers.

Lexical priming of function words and content words with children who do, and do not, stutter

The specific mechanisms that underlie childhood stuttering are not fully understood. The current study investigated these mechanisms by comparing the effect on fluency of priming different components of a short sentence. The main findings were that: (1) both children who stutter (CWS) (n=12, M age=6;3) and children who do not stutter (CWNS) (n=12, M age=6;6) were more fluent after function word (FW) priming than content word (CW) priming, (2) this effect was significantly greater for CWS than for CWNS, and (3) after FW priming, CWS produced CWs with significantly longer duration than did CWNS. These findings are discussed in relation to two competing theories of stuttering: the covert repair hypothesis (CRH) [Kolk, H., & Postma, A. (1997). Stuttering as a covert repair phenomenon. In R. F. Curlee & G. M. Siegel (Eds.), Nature and treatments of stuttering: New directions (pp. 182-203). Needham Heights, MA: Allyn & Bacon] and the developmentally focused model of Howell and Au-Yeung [Howell, P., & Au-Yeung, J. (2002). The EXPLAN theory of fluency control and the diagnosis of stuttering. In E. Fava (Ed.), Current issues in linguistic theory series: Pathology and therapy of speech disorders (pp. 75-94). Amsterdam: John Benjamins].

LEARNING OUTCOMES

After reading this article, the reader will be able to: (1) understand which linguistic levels can be primed in children who stutter; (2) see why EXPLAN predicts asymmetrical effects on fluency when function or content words are primed; (3) appreciate the distinguishing characteristics of CRH and EXPLAN theories.

Late childhood stuttering

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.

Family characteristics of stuttering children

INTRODUCTION Stuttering is a functional impairment of speech, which is manifested by conscious, but nonintentionally interrupted, disharmonic and disrhythmic fluctuation of sound varying in frequency and intensity. Aetiology of this disorder has been conceived within the frame of theoretical models, which tend to connect genetic and epigenetic factors. OBJECTIVE The goal of the paper was to study the characteristics of the family functioning of stuttering children in comparison to the family functioning of children without speech disorder, which confirmed the justification of the introduction of family orientated therapeutic interventions into the therapy spectrum of child stuttering. METHOD Seventy-nine nucleus families of 3 to 6 year-old children were examined; of these, 39 families had stuttering children and 40 had children without speech disorder. The assessment of family characteristics was made using the Family Health Scale, an observer-rating scale which according to semistructured interview and operational criteria, measures 6 basic dimensions of family functioning: Emotional State, Communication, Borders, Alliances, Adaptability & Stability, Family Skills. A total score calculated from the basic dimensions, is considered as a global index of family health. RESULTS Families with stuttering children compared to families with children without speech disorder showed significantly lower scores in all the basic dimension of family functioning, as well as in the total score on the Family Health Scale. CONCLUSION Our research results have shown that stuttering children in comparison with children without speech disorder live in families with unfavorable emotional atmosphere, impaired communication and worse control over situational and developmental difficulties, which affect children's development and well-being. In the light of previous research, the application of family therapy modified according to the child's needs is now considered indispensable in the therapeutic approach to stuttering children. The assessment of family characteristics with special reference to the ability of parents to recognize specific needs of children with speech disorder and adequate interaction, as well as readiness of parents for therapeutic collaboration are the necessary elements in legal custody evaluations.