Responses of adults who stutter to the anticipation of stuttering

Lower nonword syllable sequence repetition accuracy in adults who stutter is related to differences in audio-motor oscillations

OBJECTIVE

The goal of this study was to use independent component analysis (ICA) of high-density electroencephalography (EEG) to investigate whether differences in audio-motor neural oscillations are related to nonword syllable repetition accuracy in a group of adults who stutter compared to typically fluent speakers.

METHODS

EEG was recorded using 128 channels from 23 typically fluent speakers and 23 adults who stutter matched for age, sex, and handedness. EEG was recorded during delayed, 2 and 4 bilabial nonword syllable repetition conditions. Scalp-topography, dipole source estimates, and power spectral density (PSD) were computed for each independent component (IC) and used to cluster similar ICs across participants. Event-related spectral perturbations (ERSPs) were computed for each IC cluster to examine changes over time in the repetition conditions and to examine how dynamic changes in ERSPs are related to syllable repetition accuracy.

RESULTS

Findings indicated significantly lower accuracy on a measure of percentage correct trials in the AWS group and for a normalized measure of syllable load performance across conditions. Analysis of ERSPs revealed significantly lower alpha/beta ERD in left and right μ ICs and in left and right posterior temporal lobe α ICs in AWS compared to TFS (CC p < 0.05). Pearson correlations with %CT for frequency across time showed strong relationships with accuracy (FWE<0.05) during maintenance in the TFS group and during execution in the AWS group.

CONCLUSIONS

Findings implicate lower alpha/beta ERD (8-30 Hz) during syllable encoding over posterior temporal ICs and execution in left temporal/sensorimotor components. Strong correlations with accuracy and interindividual differences in ∼6-8 Hz ERSPs during execution implicate differences in motor and auditory-sensory monitoring during syllable sequence execution in AWS.

Communicative practices and perceptions towards stuttering people in South Africa

BACKGROUND

 A few studies have explored the life experiences of people who stutter. Research has shown that stuttering affects a significant number of people in the population.

OBJECTIVES

 The study was designed to explore the experiences of people who stutter and the perception of stuttering in South Africa.

METHOD

 Four people who identified as South Africans who stutter participated in this study. The primary investigator conducted semi-structured interviews with each of the participants. In addition, a questionnaire was administered to 20 acquaintances of all the participants. Transcriptions of interviews and results of questionnaires were analysed for major and minor themes.

RESULTS

 Results of this study suggest different perceptions by those who stutter and those acquainted with them. The findings of the study show that people who stutter experience communication barriers, so they adopt certain strategies to manage and cope with their speech disorder. The findings showed that stuttering has a pervasive impact on the lives of people who stutter and how they view themselves, considering negative societal views.

CONCLUSION

 Evaluation of the results from the study reveals that although stuttering is a common speech disorder, many people who are less informed about it harbour various stereotypes and myths that stigmatise stuttering. This study concludes by outlining recommendations for creating awareness of stuttering. It suggests vigorous campaigns aiming at promoting a multilevel approach that extends beyond the mere social and professional understanding of stuttering but addresses the inherent perceptions, myths, and stereotypes around stuttering.Contribution: Experiences of people who stutter and perceptions towards stuttering can help to better understand the speech disorder and overcome myths and stereotyping of stuttering.

Examining resting state functional connectivity and frequency power analysis in adults who stutter compared to adults who do not stutter

Introduction

Stuttering is a speech disorder characterized by impaired connections between brain regions involved in speech production. This study aimed to investigate functional connectivity and frequency power during rest in adults who stutter (AWS) compared to fluent adults (AWNS) in the dorsolateral prefrontal cortex (DLPFC), dorsolateral frontal cortex (DLFC), supplementary motor area (SMA), motor speech, angular gyrus (AG), and inferior temporal gyrus (ITG).

Materials and methods

Fifteen AWS (3 females, 12 males) and fifteen age- and sex-matched AWNS (3 females, 12 males) participated in this study. All participants were native Persian speakers. Stuttering severity in the AWS group was assessed using the Persian version of the Stuttering Severity Instrument Fourth Edition (SSI-4). Resting-state electroencephalography (EEG) was recorded for 5 min while participants sat comfortably with their eyes open. We analyzed frequency band power across various frequency bands and investigated functional connectivity within the specified speech region.

Results

Significant between-group differences were found in band powers including alpha, beta, delta, theta, and gamma, specifically in the premotor, SMA, motor speech, and frontal regions. AWS also showed increased coherence between the right motor speech region compared to controls. We demonstrate that the proposed hierarchical false discovery rate (FDR) method is the most effective for both simulations and experimental data. In the expected regions, this method revealed significant synchrony effects at an acceptable error rate of 5%.

Conclusion

The results highlight disrupted functional connectivity in AWS at resting state, particularly in speech-related and associated areas. Given the complex neurological basis of developmental stuttering, robust neural markers are closely linked to this phenomenon. These markers include imbalanced activity within brain regions associated with speech and motor functions, coupled with impaired functional connectivity between these regions. The cortico-basal ganglia-thalamo-cortical system governs the dynamic interplay between cortical regions, with SMA as a key cortical site. It is hypothesized that the aberrant resting state functional connectivity will impact the language planning and motor execution necessary for fluent speech. Examining resting-state metrics as biomarkers could further elucidate the neural underpinnings of stuttering and guide intervention.

Relationships Between Psychological Distress and Affective, Behavioral, and Cognitive Experiences of Stuttering

PURPOSE

People who stutter (PWS) are vulnerable to the development of various psychopathological symptoms, although prevalence data are mixed and less clarity exists about factors that potentially influence their occurrence. The current study sought to shed light on the prevalence of self-reported psychopathology in PWS and aimed to identify relationships between affective, behavioral, and cognitive (ABC) experiences of stuttering and psychological distress (PD).

METHOD

Forty-four PWS were administered the Behavior Assessment Battery (BAB) for Adults who Stutter and the Brief Symptom Inventory-18. The prevalence of clinically significant PD was calculated via BSI-18 global severity index t-score cutoffs. Regression analyses examined relationships between ABC variables of stuttering and PD.

RESULTS

Participants' BAB scores approximated normative values, while the PD score distribution was similar to that of a nonclinical sample. Nine percent of participants met thresholds for clinically significant PD. All ABC correlates of stuttering significantly and positively correlated with PD scores, capturing considerable amounts of shared variance.

CONCLUSIONS

Levels of PD in PWS approximate those of the general community, highlighting the existence of psychologically distressed subgroups of PWS. Speech situation-specific anxiety had the strongest relationship to PD, followed closely by one's report of situation-specific speech disruption. To a lesser but still significant extent, PWS' frequency to which they engage in various avoidance/escape behaviors, as well as their communication attitude, predicted levels of psychopathology. These data inform diagnostic and clinical decision making, drawing attention to factors that should be attended to in treatment.

Clinical and Psychosocial Predictors of Post-Event Processing in Adults Who Stutter

PURPOSE

Post-event processing, defined by self-critical rumination following a stressful communication event, is significantly associated with reduced quality of life. However, despite its relevance to the stuttering experience, to date, only a few studies have investigated post-event processing among adults who stutter, and no study has identified clinical and psychosocial predictors of post-event processing. The purpose of this study was to determine the contributions of clinical markers of stuttering and psychosocial variables to post-event processing.

METHOD

Adults who stutter (N = 96) participated in two virtual sessions. After completing the Trier Social Stress Test, a standardized social stress task in Session 1, participants completed measures of post-event processing, clinical markers of stuttering (i.e., the experience of stuttering, self- and observer-rated stuttering severity), and psychosocial characteristics (i.e., self-perceived performance, self-esteem, social anxiety, trait, and state self-compassion) in Session 2.

RESULTS

Hierarchical linear regression models indicated that a more negative experience of stuttering, higher self-rated stuttering severity, and greater social anxiety predicted more post-event processing. Greater self-perceived performance and state self-compassion predicted less rumination. Observer-rated severity, self-esteem, and trait self-compassion were not significantly associated with post-event processing behavior.

CONCLUSION

Findings reveal clinical and psychosocial variables to consider in the assessment and mitigation of post-event processing behavior in adults who stutter, and to bolster resiliency to social stress.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24223213.

Cost of Illness and Health-Related Quality of Life for Stuttering: Two Systematic Reviews

PURPOSE

For those who stutter, verbal communication is typically compromised in social situations. This may attract negative responses from listeners and stigmatization by society. These have the potential to impair health-related quality of life across a range of domains, including qualitative and quantitative impacts on speech output, mental health issues, and failure to attain educational and occupational potential. These systematic reviews were designed to explore this matter using traditional health economics perspectives of utility measures and cost of illness.

METHOD

Studies were included if they involved children, adolescents, or adults with stuttering as a primary diagnosis. The quality of life search strategy identified 2,607 reports, of which three were included in the quality of life analysis. The cost of illness search strategy identified 3,778 reports, of which 39 were included in the cost of illness analysis.

RESULTS

Two of the three studies included in the quality of life analysis had a high risk of bias. When measured using utility scores, quality of life for people who stutter was in the range of those reported for chronic health conditions such as diabetes mellitus, cardiovascular disease, and cancer. However, there is little such evidence of quality of life impairment during the preschool years. Studies included in the cost of illness analysis carried considerable risk of bias overall.

CONCLUSIONS

For people who stutter, there are substantive direct and indirect costs of illness. These include impairment, challenges, and distress across many domains throughout life, including income, education, employment, and social functioning. Evidence of quality of life impairment using utility measures is extremely limited. If this situation is not remedied, the lifetime impairment, challenges, and distress experienced by those who stutter cannot be documented in a form that can be used to influence health policy and health care spending.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24168201.

Reduced duration of stuttering-like disfluencies and consistent anticipatory slowing during an adaptation task

PURPOSE

The adaptation effect in stuttering, traditionally described as the reduction of stuttering moments over repeated readings, provides a context to investigate fluency facilitation as well as a relatively controlled means of comparing fluent speech in the immediate vicinity of words that were stuttered versus fluently produced. Acoustic studies have documented decreased duration of fluent speech during adaptation but rarely address changes in disfluencies or the speech preceding or following the disfluencies. This study addresses this gap in the research by documenting frequency and duration changes in both fluent and stuttered syllables.

METHOD

Fifteen people who stutter read passages aloud five times in succession. Frequency and duration of fluent syllables, pauses, stuttering-like disfluencies (SLDs) and other disfluencies (ODs) were compared across the five readings. In addition, durations for syllables before and after pauses and SLDs were compared to determine if there were anticipation or carryover effects of SLDs on surrounding syllables.

RESULTS

Durations measured for more than 22 000 fluent syllables, 1531 pauses, 128 ODs and 1752 SLDs. For most of the 15 participants, significant decreases in both frequency and duration of SLDs over the five readings were observed. In addition, lengthening of fluent syllables immediately preceding the disfluent syllables was observed: this pre-SLD lengthening did not change over the five readings.

CONCLUSIONS

Decreased duration of SLDs across readings supports the motor practice hypothesis, which assumes that successive reading of the same text increases the efficiency of the speech motor plans resulting in less stuttering and decreased durations of the stuttering that persists. Pre-SLD lengthening merits further study, because it informs our knowledge of the time course of stuttered events and may be associated with conscious or unconscious anticipation of upcoming SLDs that does not decrease with motor practice.

WHAT THIS PAPER ADDS

What is already known on this subject The frequency of stuttering-like disfluencies (SLDs) can be reduced using a variety of fluency-enhancing strategies. For example, the adaptation effect, in which a reduction of stuttered events occurs over repeated readings of the same material, has been widely studied. Previous studies have shown that durations of fluent syllables decrease during adaptation, supporting the hypothesis that repeated practice of the motor plan leads to increased fluency. However, temporal changes in disfluent syllables and syllables preceding and following SLDs have rarely been studied, so our understanding of the effect of motor practice on stuttering reduction is incomplete. What this study adds This study has two significant findings. First, stuttered disfluencies that persisted after the initial reading of the adaptation task tended to become shorter in duration. Fluently produced syllables and those that were stuttered, both of which are speech events related to motor control of articulators, were affected in a similar manner by the motor practice associated with adaptation. Second, lengthening of fluent syllables immediately preceding stuttered syllables was observed. This pre-stuttering lengthening, however, did not decrease in duration over the five readings: the mechanism that drives this anticipatory behaviour is not affected by repeated practice. What are the clinical implications of this work? People who stutter have neural differences that lead to speech motor planning and/or execution that is less efficient than that of typical speakers. The finding that stuttering is reduced and that persisting SLDs become shorter in duration over repeated readings provides evidence that motor practice can influence the manifestation of stuttering by temporarily making those specific motor plans more efficient. This may inform treatments for stuttering. The observation that fluent syllables immediately before SLDs were lengthened, and that this lengthening was not influenced by repeated practice, extends our understanding of the time course of stuttering events and may be useful in understanding anticipation and listener reactions to stuttering.

Understanding the Broader Impact of Stuttering: Suicidal Ideation

PURPOSE

Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.

METHOD

One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.

RESULTS

Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.

CONCLUSIONS

Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23699688.

Reactions and responses to anticipation of stuttering and how they contribute to stuttered speech that listeners perceive as fluent - An opinion paper

The experience of stuttering is wide ranging and includes a variety of perceived and unperceived behaviors and experiences. One of those experiences is anticipation of stuttering. While anticipation of stuttering is commonly discussed in terms of being a prediction of an upcoming event, it has also been equated to an internal realization of stuttering - which is the conceptualization applied here. The aim of this paper is to impress upon the reader that anticipated moments of stuttering (whether at a conscious or subconscious level) must be met with an adaptive reaction or response (which may also occur consciously or subconsciously). While these adaptive reactions and responses may differ based on whether they promote positive or negative communicative behaviors, they still represent adaptations by the speaker. Among the broad category of reactions and responses to anticipation of stuttering are motoric adaptations to speech, which include characteristic stuttering behaviors and other adaptations that may contribute to speech that is perceived by listeners as fluent. An outcome of this conceptualization is, even when adaptations result in listener perceived fluency, the speech of the person who stutters is still controlled by stuttering - meaning that some observable or unobservable adaptation is required. It is critical that speech-language pathologists recognize that the behaviors of people who stutter may reflect reactions and responses to an internal realization of stuttering and observable and unobservable reactions and responses must be considered in both assessments and interventions.

Eye movement as a simple, cost-effective tool for people who stutter: A case study

BACKGROUND

 Access to services remains the biggest barrier to helping the most vulnerable in the South African Stuttering Community. This novel stuttering therapy, harnessing an unconscious link between eye and tongue movement, may provide a new therapeutic approach, easily communicated and deliverable online.

OBJECTIVES

 This study provides both objective and subjective assessments of the feasibility of this intervention. Assessment tools holistically address all components of stuttering in line with comprehensive treatment approaches: core behaviours, secondary behaviours, anticipation and reactions.

METHOD

 On receipt of ethical approval, this single-subject case design recruited one adult (21-year-old) male with a developmental stutter (DS). The participant gave informed consent and completed four scheduled assessments: baseline, after 5-week training, 3 months post-intervention and 24 months post-completion. The study used objective assessment tools: Stuttering Severity Instrument-4 (SSI-4); Subjective-assessment tools: SSI-4 clinical use self-report tool (CUSR); Overall Assessment of Speaker's Experience of Stuttering (OASES-A); Premonitory Awareness in Stuttering (PAiS) and Self-Report Stuttering Severity* (SRSS) (*final assessment).

RESULTS

 The participant's scores improved across all assessment measures, which may reflect a holistic improvement. The participant reported that the tool was very useful. There were no negative consequences.

CONCLUSION

 This case report indicates that this innovative treatment may be feasible. No adverse effects were experienced, and the treatment only benefited the participant. The results justify the design of a pilot randomised feasibility clinical trial.Contribution: The results indicate that this is a needed breakthrough in stuttering therapy as the instructions can be easily translated into any language. It can also be delivered remotely reducing accessibility barriers.

Accepting Things as They Are: Dispositional Mindfulness, Decentering, Self-Compassion, and the Impact of Stuttering on Adults Who Stutter

PURPOSE

Mindfulness is defined as intentional, present-moment, nonjudgmental awareness. Previous studies have proposed that mindfulness practice may benefit people who stutter. This study aimed to test the relationship between levels of dispositional mindfulness in people who stutter and the impact of stuttering and whether self-compassion and the metacognitive ability of shifting to an objective perspective (decentering) mediate this relationship. It is hypothesized that greater dispositional mindfulness is associated with attenuated negative impact of stuttering on a person's life through a higher capability to shift into an objective and compassionate perspective.

METHOD

A total of 150 Israeli adults who stutter completed a full online survey in Hebrew to assess their levels of dispositional mindfulness, self-compassion, decentering capability, and impact of stuttering on their lives. The relationships between constructs were assessed using Pearson's correlation and mediation analysis.

RESULTS

The adverse impact of stuttering was negatively and moderately associated with dispositional mindfulness, such that individuals with greater self-reported dispositional mindfulness reported fewer reactions to stuttering, difficulty in communication, and higher quality of life. This relationship was fully and sequentially mediated via decentering and self-compassion, which were also negatively and moderately associated with the impact of stuttering.

CONCLUSIONS

People who stutter with greater dispositional mindfulness have an increased ability to view their experiences in a more objective and compassionate manner, which is associated with an attenuated impact of stuttering on their lives. As these capabilities can be cultivated through practice, this study proposes mindfulness practice as an additional beneficial tool for people who stutter.

Eliciting Stuttering in School-Age and Adolescent Stutterers in Experimental Settings

PURPOSE

Most neural and physiological research on stuttering focuses on the fluent speech of speakers who stutter due to the difficulty associated with eliciting stuttering reliably in the laboratory. We previously introduced an approach to elicit stuttered speech in the laboratory in adults who stutter. The purpose of this study was to determine whether that approach reliably elicits stuttering in school-age children and teenagers who stutter (CWS/TWS).

METHOD

Twenty-three CWS/TWS participated. A clinical interview was used to identify participant-specific anticipated and unanticipated words in CWS and TWS. Two tasks were administered: (a) a delayed word reading task in which participants read words and produced them after a 5-s delay and (b) a delayed response question task in which participants responded to examiner questions after a 5-s delay. Two CWS and eight TWS completed the reading task; six CWS and seven TWS completed the question task. Trials were coded as unambiguously fluent, ambiguous, and unambiguously stuttered.

RESULTS

The method yielded, at a group level, a near-equal distribution of unambiguously stuttered and fluent utterances: 42.5% and 45.1%, respectively, in the reading task and 40.5% and 51.4%, respectively, in the question task.

CONCLUSIONS

The method presented in this article elicited a comparable amount of unambiguously stuttered and fluent trials in CWS and TWS, at a group level, during two different word production tasks. The inclusion of different tasks supports the generalizability of our approach, which can be used to elicit stuttering in studies that aim to unravel the neural and physiological bases that underlie stuttered speech.

Fostering Positive Stuttering Identities Using Stutter-Affirming Therapy

PURPOSE

School-age children and adolescents frequently have difficulty developing positive identities around their stuttering. Many students experience both physical and social consequences from stuttering. The great lengths that speakers go to try to hide their stuttering and to speak fluently increase their difficulty. As long as school-age children who stutter try to identify as fluent speakers, they will have difficulty lessening the negative impact of stuttering on their lives. Fortunately, many people who stutter also report positive stuttering experiences. Speech-language pathologists can use these positive experiences to help school-age children grow more comfortable with stuttering. They can also help school-age children reduce some of the speaking effort and social stigma that leads them to try to conceal their stuttering in the first place. To accomplish both these goals, I propose a stutter-affirming therapy.

METHOD

This clinical focus article summarizes previous research about identity development in stuttering. I discuss a therapy approach I call stutter-affirming therapy. In elucidating this approach, I discuss practical ways that speech-language pathologists can use to help school-age children develop positive stuttering identities through easier speaking and stuttering. I ground these examples in a case study of a 12-year-old boy who stutters.

DISCUSSION

stutter-affirming therapy focuses on conditioning the speaker's reaction to stuttering in ways that move toward and embrace stuttering (stutterphilic reactions) rather than in ways that move away from and reject stuttering (stutterphobic reactions). Speech-language pathologists can help school-age children who stutter foster positive stuttering identities using the three priorities of stutter-affirming therapy. First, reject fluency by reducing stutterphobic and increasing stutterphilic reactions to stuttering. Second, value stuttering by discovering what speakers gain from it. Third, create an environment in which it is easier to stutter through education, advocacy, disclosure, and voluntary stuttering.

Rate of Stuttering and Factors Associated With Speech Fluency Characteristics in Adult Struggling Readers

Stuttering is a disorder that affects about 1% of the population and manifests as speech disfluencies. Reading difficulties and disabilities are commonly found in this population. Nonetheless, speech disfluencies have not been explored in adult struggling readers (ASRs). In the current study, we examined the rate of stuttering in ASRs as well as the relationships between their speech fluency and reading skills. A total of 120 participants were interviewed about their experiences with reading and administered standardized reading and reading-related assessments. Speech fluency and the criterion for stuttering were based on the interview. About 18.3% of the sample met the criterion for stuttering. ASRs who stutter (ASRs-S) and ASRs who do not stutter (ASRs-NS) did not differ in their reading and reading-related skills. ASRs-S had higher rates of negative correlations between reading and reading-related skills compared with ASRs-NS. Correlation patterns between performance on standardized assessments point to higher rates of uneven skills or dissociations in ASRs-S. These findings may have implications for the assessment and instruction for ASRs.

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.

Validity and reliability of safety behaviors questionnaire for Persian adults who stutter: A cultural perspective

INTRODUCTION

Adults who stutter (AWS) are reported to have higher social anxiety compared to those who do not stutter. Previous studies have suggested that safety behaviors, which are cognitive or behavioral strategies used by people with anxiety to prevent negative consequences, are important factors in maintaining anxiety. However, the frequency and types of such behaviors might vary in different cultures. Therefore, the aim of the present study was to develop a transcultural adaptation of Safety Behaviors Questionnaire (Helgadottir et al., 2014) for Persian-speaking AWS and assess its validity and reliability.

METHODS

In the first step, the original English questionnaire was translated into Persian using the International Quality of Life Assessment (IQOLA) method. Then, 17 speech and language pathologists (SLPs) and 5 AWS evaluated all questionnaire items using Likert scales to determine face validity. Finally, 167 Persian-speaking AWS completed the questionnaire to assess its construct validity and reliability. Their responses were analyzed using factor analysis and Cronbach's Alpha.

RESULTS

Some items of the original questionnaire were modified or combined with other similar items after assessing the face validity of the Persian-translated questionnaire. Construct validity analysis categorized the remaining 29 questionnaire items into four factors: general avoidance, practice and control, rehearsal, and choosing safe and easy people. The high Cronbach's Alpha of 0.89 for all items confirmed the internal reliability of the Persian-translated questionnaire.

DISCUSSION/CONCLUSIONS

The results confirmed the psychometric characteristics of the Persian- translated version of the Safety Behaviors Questionnaire (Helgadottir et al., 2014); therefore, speech pathologists can apply it in future clinical and research settings. Similar to Australian AWS, Persian participants of this study self-reported use of various types of safety behaviors frequently.

Self-Disclosure Experiences of Adults Who Stutter: An Interpretative Phenomenological Analysis

PURPOSE

Self-disclosure describes the act of revealing personal information to another person. To date, researchers in the area of stuttering have primarily demonstrated the utility of self-disclosure through analysis of listener perceptions. This study explores the utility of informative self-disclosure use from the perspectives of adults who stutter with experience using this strategy over time and across contexts.

METHOD

Twelve adults who stutter discussed their self-disclosure experiences in semistructured interviews. Interview transcripts were analyzed using interpretative phenomenological analysis to produce themes reflecting the most salient aspects of self-disclosure experiences. Credibility was achieved through bracketing, investigator triangulation, and member checking.

RESULTS

Four superordinate themes reflecting experiences shared by all 12 participants were generated. Each superordinate theme contained two to three corresponding subthemes. The superordinate themes included cognitive relief, self-empowerment, social connection, and personalization. These findings reflect the positive impact of informative self-disclosure use on communication and quality of life.

CONCLUSIONS

Adults who stutter perceive informative self-disclosure to be an effective strategy that provides various benefits to the speaker, in addition to facilitating positive listener perceptions. Clinicians should encourage clients to self-disclose in an informative and personalized manner, provide opportunities for practice, and support clients in determining when and where it is most beneficial for them to implement this strategy.

Activation in Right Dorsolateral Prefrontal Cortex Underlies Stuttering Anticipation

People who stutter learn to anticipate many of their overt stuttering events. Despite the critical role of anticipation, particularly how responses to anticipation shape stuttering behaviors, the neural bases associated with anticipation are unknown. We used a novel approach to identify anticipated and unanticipated words, which were produced by 22 adult stutterers in a delayed-response task while hemodynamic activity was measured using functional near infrared spectroscopy (fNIRS). Twenty-two control participants were included such that each individualized set of anticipated and unanticipated words was produced by one stutterer and one control participant. We conducted an analysis on the right dorsolateral prefrontal cortex (R-DLPFC) based on converging lines of evidence from the stuttering and cognitive control literatures. We also assessed connectivity between the R-DLPFC and right supramarginal gyrus (R-SMG), two key nodes of the frontoparietal network (FPN), to assess the role of cognitive control, and particularly error-likelihood monitoring, in stuttering anticipation. All analyses focused on the five-second anticipation phase preceding the go signal to produce speech. The results indicate that anticipated words are associated with elevated activation in the R-DLPFC, and that compared to non-stutterers, stutterers exhibit greater activity in the R-DLPFC, irrespective of anticipation. Further, anticipated words are associated with reduced connectivity between the R-DLPFC and R-SMG. These findings highlight the potential roles of the R-DLPFC and the greater FPN as a neural substrate of stuttering anticipation. The results also support previous accounts of error-likelihood monitoring and action-stopping in stuttering anticipation. Overall, this work offers numerous directions for future research with clinical implications for targeted neuromodulation.

Speech Related Anxiety in Adults Who Stutter

Abstract. The relationship between anxiety and stuttering has always been a topic of debate with a great emphasis on research focused on examining whether speech-related anxiety can exacerbate stuttering. This investigation compares some speech-related anticipatory anxiety indices in fluent and dysfluent utterances in adults who stutter (AWS). We scored the level of cognitive speech-related anxiety (anticipatory anxiety) using a self-reporting method and also evaluated the autonomic aspects of anxiety (state anxiety) through recording changes in Galvanic Skin Response (GSR) signals. Explaining the link between stuttering and anxiety is expected to assist practitioners in stuttering assessment and subsequent treatment strategies. Phasic GSR values of six events related to answering the verbal stimuli through fluent and dysfluent responses were registered to measure sympathetic arousal as an index of state anxiety in 20 AWS ( Mage = 35 ± 4 years, range: 21–42). To quantitatively examine the cognitive aspects of speech-related anticipatory anxiety, two questionnaires were rated by participants addressing the stuttering anticipation and semantic difficulty of verbal stimuli. GSR measures of fluent events were significantly higher than dysfluent counterparts within time windows before and during answering aloud the verbal stimuli ( p < .001). Later in the experiment, GSR values of dysfluent events were found to be higher than their fluent counterparts ( p < .001). Stuttering anticipation yielded a weak negative meaningful correlation with the scores of fluency ( r = −0.283, p = .046) and a positive yet nonsignificant correlation with the stuttering scores. The semantic difficulty had a moderately significant correlation with stuttering anticipation ( r = 0.354, p = .012) but not a meaningful correlation with fluency state. Autonomic and cognitive indices of speech-related anticipatory anxiety are not robust predictors of fluency. Anxiety seems to be more of a consequence of stuttering than a cause.

Emotional Regulation and Its Influence on the Experience of Stuttering Across the Life Span

PURPOSE

This study evaluated the relationship between emotional regulation (ER) and adverse impact related to stuttering across the developmental spectrum, in preschool and school-age children, adolescents, and adults who stutter. An additional aim examined how these variables relate to the ways that individuals approach speaking (i.e., their agreement on whether their goal is to speak fluently).

METHOD

Participants were the parents of 60 preschoolers and younger school-age children (ages 3-9 years), 95 school-age children and adolescents who stutter (ages 7-18 years), and 180 adults who stutter (ages 18-81 years). All participants completed surveys with age-appropriate measures examining ER and the adverse impact of stuttering. Older children and adults who stutter also answered questions regarding their goals when speaking. Multiple regression and ordinal logistic regression were used to examine relationships among ER, adverse impact related to stuttering, and goal when speaking.

RESULTS

In preschool children, adverse impact was significantly predicted by a parent-reported measure of ER skills; in school-age children and adults, adverse impact was significantly predicted by measures of the ER strategies cognitive reappraisal (CR) and expressive suppression. Less frequent use of CR by adults was significantly associated with an increased likelihood of having "not stuttering" as a goal when speaking. Differences in the significance and magnitude of these relationships were found across the life span.

DISCUSSION

For both children and adults who stutter, ER is a significant factor related to the adverse impact of stuttering; the relationship between ER and adverse impact may change over development. Accounting for individual differences in ER can improve understanding of why a person copes with stuttering in the ways they do, and this has notable implications for individualizing intervention for both children and adults who stutter.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044469.

Speech Therapy and Earnings: Economic Benefits for Individuals Who Stutter

Stuttering is a complex communication disorder with effects that extend beyond difficulty with communication. Negative thoughts and feelings by the person who stutters (PWS), about the disorder or themselves, may potentially lead to detrimental avoidance behaviors which may ultimately alter life choices and participation in life events. One such area is the labor market. Studies have revealed an association between stuttering and reduced earnings. What is not understood is whether provision of speech therapy for PWS can help mitigate the negative labor market impacts of this condition. This article discusses the disorder of stuttering and how approach versus avoidance responses can contribute to wage differentials among PWS, while also providing evidence of such differences using a nationally representative dataset. Additionally, this article outlines the potential benefits received from speech-language pathology services which may correlate with improved labor market outcomes.

The Relationship Between Auditory-Motor Integration, Interoceptive Awareness, and Self-Reported Stuttering Severity

Stuttering is a neurodevelopmental speech disorder associated with motor timing that differs from non-stutterers. While neurodevelopmental disorders impacted by timing are associated with compromised auditory-motor integration and interoception, the interplay between those abilities and stuttering remains unexplored. Here, we studied the relationships between speech auditory-motor synchronization (a proxy for auditory-motor integration), interoceptive awareness, and self-reported stuttering severity using remotely delivered assessments. Results indicate that in general, stutterers and non-stutterers exhibit similar auditory-motor integration and interoceptive abilities. However, while speech auditory-motor synchrony (i.e., integration) and interoceptive awareness were not related, speech synchrony was inversely related to the speaker’s perception of stuttering severity as perceived by others, and interoceptive awareness was inversely related to self-reported stuttering impact. These findings support claims that stuttering is a heterogeneous, multi-faceted disorder such that uncorrelated auditory-motor integration and interoception measurements predicted different aspects of stuttering, suggesting two unrelated sources of timing differences associated with the disorder.

A Point of View About Fluency

PURPOSE

This article presents several potential concerns with the common usage of the term fluency in the study of stuttering and people who stutter (or, as many speakers now prefer, stutterers). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended.

METHOD

We begin by reviewing the history of the term fluency. We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition.

RESULTS

By highlighting current research and perspectives of stutterers, we conclude that the term fluency (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole.

CONCLUSIONS

We recommend that researchers and clinicians cease referring to stuttering as a fluency disorder and simply refer to it as stuttering. Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition.

Microaggression and the adult stuttering experience

BACKGROUND

Microaggressions are subtle insults, invalidations, or slights that target people due to their association with a marginalized group. Microaggressive experiences have been shown to degrade quality of life and corroborate negative stereotypes towards persons with disabilities. To date, minimal research has been dedicated to exploring microaggressions within adults who stutter.

METHODS

Seven adults who stutter participated in semi-structured focus group interviews similar to Keller and Galgay's (2010) qualitative investigation of microaggressions experienced by adults with a disability. Group interviews were transcribed and analyzed using QSR NVivo software to develop themes and subthemes.

RESULTS

Eight major themes were identified within two supraordinate themes: Microaggressive Behavior (patronization, second-class status, perceived helplessness, workplace microaggression, clinical microaggression, denial of privacy) and Perception of Microaggressive Behavior (exoneration of listener, no or minimal microaggressive experience). Although patronization, second-class status, and helplessness were mentioned frequently by multiple participants, exoneration of the listener was the most frequently recurring theme.

DISCUSSION

Based on these preliminary focus group interviews, stuttering-based microaggressions broadly resemble ableist microaggressions reported by Keller and Galgay (2010). Interviewees also expressed a reluctance to identify slights related to stuttering as microaggression and often characterized these incidents as unavoidable.

Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents

PURPOSE

The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate.

METHODS

A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis.

RESULTS

There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations.

DISCUSSION

This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.

Understanding the Speaker's Experience of Stuttering Can Improve Stuttering Therapy

The purpose of this paper is to highlight the value for speech-language pathologists of considering the overall stuttering condition-including speakers' experiences during and around moments of stuttering-in treatment with individuals who stutter. We first highlight a framework for conceptualizing the entirety of the stuttering condition. We then present recent research and clinical perspectives about stuttering to support the claim that speech-language pathologists who account for individual differences in how their clients experience stuttering are better positioned to treat stuttering more effectively. Ultimately, this will yield better treatment outcomes and help clinicians achieve greater gains in quality of life for their clients who stutter.

Does stammering act as a barrier to exercise and sport in Irish adults who stammer?

PURPOSE

Exercise and sport participation lead to many physical and psychosocial benefits. However, barriers to exercise and sporting participation exist. This study aims to examine if stammering acts as a barrier to exercise and sporting participation in adults.

METHODS

One hundred and six adults who stammer (male n = 74, female n = 32; 33.83 ± 14.5 years) completed an anonymous questionnaire which evaluated their stammering history, exercise and sporting participation, views on why they exercise, whether stammering prevented or negatively influenced their participation in exercise or sport. Descriptive statistics were then calculated.

RESULTS

The majority (90.6 %) of participants take part in some form of exercise/sport. However, their stammer prevented them from taking part in a specific exercise/sport at least once (49.1 %), due to being too nervous to introduce themselves, nervous or fear of stammering or being judged. Their stammer also negatively impacted their involvement when participating at least once (42.4 %), with not feeling part of the team and fear of speaking reported. Self-disclosure of their stammer and improving awareness of stammering were identified as common facilitators for taking part in exercise/sport.

CONCLUSION

Stammering was not found to impact general participation in exercise and sport but was identified as a barrier to partaking in specific exercise and sport and their enjoyment thereof. Encouraging those who stammer to inform those involved in sport and exercise (e.g. fellow players, coaches) about their stammer and improving stammer awareness across the general and sporting population may encourage further participation in exercise and sport in those who stammer.

Resting autonomic activity in adults who stutter and its association with self-reports of social anxiety

PURPOSE

The purpose of this study was to investigate resting autonomic activity in adults who stutter (AWS) compared to adults who do not stutter (ANS) and the relationship this has on self-reports of social anxiety.

METHODS

Thirteen AWS and 15 ANS completed the Social Interaction Anxiety Scale (SIAS; Mattick & Clark, 1998) and Brief Fear of Negative Evaluation (BFNE; Leary, 1983). Following this, measures of skin conductance levels (i.e. index of sympathetic activity) and respiratory sinus arrhythmia (i.e. index of parasympathetic activity) were taken during a 5-minute resting, baseline period. Independent sample t tests were used to assess differences between groups on self-reports of anxiety (SIAS, BFNE) and resting autonomic levels (SCL, RSA). Separate multiple regression analyses were performed in order to assess the relationship between self-reports of anxiety and autonomic measures.

RESULTS

Results showed significantly higher mean SCL and lower mean RSA levels in the AWS compared to the ANS at resting, baseline. Regression analysis showed that self-reports from the SIAS had a significant effect on RSA levels for the AWS but not the ANS. No significant effects were found for BFNE on RSA. Nor was there a significant effect from SIAS or BFNE on SCL levels for either group.

CONCLUSION

Findings suggest that resting RSA levels may be a physiological marker for social anxiety levels in adults who stutter.

Temperament is Linked to Avoidant Responses to Stuttering Anticipation

PURPOSE

The purpose of the present study was to examine the degree to which certain temperament constructs predict individual differences in three types of behavioral responses to anticipation among children and adults who stutter (CWS and AWS, respectively): avoidance, physical change, and approach.

METHODS

Participants included 64 CWS (9- to 17-years-old) and 54 AWS (18- to 50-years-old) who completed an online survey package including a temperament questionnaire (Early Adolescent Temperament Questionnaire-Revised for the CWS; Adult Temperament Questionnaire for the AWS) and the Stuttering Anticipation Scale. The data were analyzed separately for CWS and AWS using multivariate multiple regressions to assess how each temperament construct predicted avoidance, physical change, and approach responses to anticipation.

RESULTS

CWS who reported higher levels of shyness were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. AWS who reported higher levels of orienting sensitivity were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. No temperament constructs predicted physical change or approach responses to anticipation among either age group.

CONCLUSION

Specific aspects of temperament appear to be linked to the degree that CWS and AWS engage in avoidant behavioral responses to stuttering anticipation. These findings support the continued study of how individual differences impact the internal experience and outward manifestation of stuttering behaviors.

Speech planning and execution in children who stutter: Preliminary findings from a fNIRS investigation

Few studies have investigated the neural mechanisms underlying speech production in children who stutter (CWS), despite the critical importance of understanding these mechanisms closer to the time of stuttering onset. The relative contributions of speech planning and execution in CWS therefore are also unknown. Using functional near-infrared spectroscopy, the current study investigated neural mechanisms of planning and execution in a small sample of 9-12 year-old CWS and controls (N = 12) by implementing two tasks that manipulated speech planning and execution loads. Planning was associated with atypical activation in bilateral inferior frontal gyrus and right supramarginal gyrus. Execution was associated with atypical activation in bilateral precentral gyrus and inferior frontal gyrus, as well as right supramarginal gyrus and superior temporal gyrus. The CWS exhibited some activation patterns that were similar to the adults who stutter (AWS) as reported in our previous study: atypical planning in frontal areas including left inferior frontal gyrus and atypical execution in fronto-temporo-parietal regions including left precentral gyrus, and right inferior frontal, superior temporal, and supramarginal gyri. However, differences also emerged. Whereas CWS and AWS both appear to exhibit atypical activation in right inferior and supramarginal gyri during execution, only CWS appear to exhibit this same pattern during planning. In addition, the CWS appear to exhibit atypical activation in left inferior frontal and right precentral gyri related to execution, whereas AWS do not. These preliminary results are discussed in the context of possible impairments in sensorimotor integration and inhibitory control for CWS.

Sleep duration, insomnia, and stuttering: The relationship in adolescents and young adults

PURPOSE

Evidence of a linkage between neurodevelopmental stuttering and sleep difficulties has been suggested in studies involving children and adolescents. To further examine the relationship between stuttering and sleep, the current study explored both hours of sleep and insomnia in a longitudinal sample of adolescents and young adults living with stuttering.

METHOD

The data for this study came from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative survey study following 13,564 US respondents over the course of 20 years. In each of the five survey waves, respondents noted their average hours of sleep. In addition, Wave IV, respondents indicated whether they suffered from insomnia (i.e., difficulty falling or staying asleep). Respondents who indicated stuttering at ages 18-26 (Wave III) and 24-32 (Wave IV) are considered as those with persistent stuttering-the focus of this analysis. Regression analysis assessed the association between stuttering, hours of sleep and insomnia controlling for sex, age, race, education and other demographic characteristics.

RESULTS

The sample included 261 participants (1.7% of total respondents) who identified themselves as people who stutter, comprised of 169 males and 92 females. Compared to their fluent counterparts, individuals who stutter reported to sleep, on average, 20 min less per night. Additionally, 15% of those who stutter reported difficulties falling or staying asleep almost every day or every day, which is twice as likely as controls. Results were robust to demographic characteristics and co-occurring conditions.

CONCLUSIONS

Speech-language pathologists should be aware of the association between stuttering and insomnia, as well as the lower average hours of sleep among adolescents and young adults who stutter. The possibility that lower sleep duration and insomnia may affect stuttering daily variability and impair improvement from stuttering are discussed.

Cognitive Flexibility and Effortful Control in School-Age Children With and Without Stuttering Disorders

Purpose This study compared attention control and flexibility in school-age children who stutter (CWS) and children who do not stutter (CWNS) based on their performance on a behavioral task and parent report. We used a classic attention-shifting paradigm that included manipulations of task goals and timing to test effects of varying demands for flexibility on switching accuracy and speed. We also examined associations between task performance, group, and relevant aspects of temperament. Method Participants included 33 children (15 CWS, 18 CWNS) between 8 and 11 years of age. Children sorted stimuli that differed on two dimensions (color and shape) based on sorting rules that varied from block to block or trial to trial. Timing manipulations included intervals of 200-, 600-, or 1,200-ms durations for critical trial components. Temperament data were obtained via the Children's Behavior Questionnaire. Results All children showed expected performance costs in response to block and trial manipulations; however, CWS were more affected by task conditions that increased demands for cognitive flexibility. Effects of interval durations also differed by group. Factor scores on the Children's Behavior Questionnaire indicated differences in effortful control between groups; however, this aspect of temperament did not mediate between-groups differences in switching performance. Conclusions Findings suggest that stuttering continues to be associated with differences in attention control and flexibility beyond the preschool years. Further research is needed to clarify how these cognitive processes shape the development of stuttering throughout childhood.

Life partners' perceptions of the emotional, speech disruptive, and attitudinal correlates of stuttering

PURPOSE

The purpose of the current investigation was to explore the extent to which the life partners (LPs) of people who stutter (PWS) perceive their loved ones' speech-situation specific emotional reaction, expectancy of speech disruption, and speech-related communication attitude.

METHODS

Three subtests of the Behavior Assessment Battery (BAB): the Speech Situation Checklist - Emotional Reaction (SSC-ER), the Speech Situation Checklist - Speech Disruption (SSC-SD) and the Communication Attitude Test for Adults Who Stutter (BigCAT) were administered to 33 PWS and modified versions were administered to their LPs via Qualtrics Survey Software. Effect of relationship duration on subtest scores was considered. Perceived stuttering severity by the participant and their LP was also queried as part of a demographic questionnaire.

RESULTS

PWS and their LPs rated BigCAT items in a similar way, while they rated certain SSC-ER and SSC-SD items differently. Importantly, between-group agreement was not affected by relationship duration. Among the PWS and LP, perceived stuttering severity influenced all BAB subtest scores.

CONCLUSION

LPs of PWS appear to be in tune with the cognitive aspects of their partner's experience of stuttering. This has important clinical implications as it relates to active involvement of the family in speech intervention targeting fluency.

Effect of word phonetic properties on stuttering anticipation and speech production in adults who stutter

PURPOSE

Stuttering anticipation is a significant factor in an individual's stuttering experience. People who stutter have reported words and sounds that they anticipate stuttering on. Attempts at understanding the association between stuttering anticipation and stuttering outcomes and the impact of phonetic properties on stuttering anticipation and overt stuttering have been insufficiently examined. This study aims to address these important issues.

METHODS

Data were collected as part of a larger brain imaging study. Twenty adults who stutter rated a 414 word-list on stuttering anticipation. Participant-specific 'high' and 'low' anticipated words were selected. Twelve of the 20 participants returned for a second session 2-11 weeks later, during which they read the selected words again and stuttering occurrence was recorded.

RESULTS

Among the 20 participants, three sub-groups with "high" (N = 6), "moderate" (N = 5) and "low" (N = 9) stuttering anticipation were identified. Significant "high stuttering" anticipation was found on consonants, plosives, bilabials and alveolars, as well as labials and coronals. In 5 of the 8 participants who stuttered during session 2, more than 80 % of words stuttered were previously rated with high anticipation. Consonants, plosives, bilabials and alveolars, and labials and coronals were the most frequently stuttered (>27 %).

CONCLUSION

While not all adults who stutter demonstrate high word-specific stuttering anticipation, we found that more than half anticipated this to a high degree. Furthermore, both word-specific phonetic properties and stuttering anticipation impact stuttering occurrence. The inclusion of word-specific stuttering anticipation ratings may increase the likelihood of stuttering in experimental studies and improve treatment outcomes through individualized intervention.

Relationships between stuttering, depression, and suicidal ideation in young adults: Accounting for gender differences

PURPOSE

The purpose of this study was to investigate the relationship between depressive symptoms and suicidal ideation and living with stuttering while accounting for time, sex, and health-related confounders.

METHOD

The data for this study come from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative survey study that has followed 13,564 respondents over the course of 14 years. Responses to the question "Do you have a problem with stuttering or stammering?" at two time points were used to establish stuttering and non-stuttering groups. Regression analysis, propensity score matching, and structural equation modeling were used.

RESULTS

Compared to their fluent counterparts, males and females reported significantly elevated symptoms of depression. Although symptoms of depression among males who stutter were stable over time, depressive symptoms among females who stutter increased with age. Compared to males who do not stutter, males who stutter were significantly more likely to report feelings of suicidal ideation. There were no differences in suicidal ideation between females who do and do not stutter.

CONCLUSIONS

Speech-language pathologists should be aware of the associations between stuttering and depressive symptoms, as well as the increased risk for suicidal ideation among males who stutter. Clinicians should be knowledgeable about symptoms of depression and suicidal ideation and be familiar with processes to refer as needed.

Variability of Stuttering: Behavior and Impact

Purpose It has long been known that stuttering behaviors vary across time and situation. Preliminary evidence suggests that this variability negatively affects people who stutter and that stuttering behaviors are more variable than adverse impact associated with stuttering. More information is needed to determine how variability affects people who stutter and what the clinical and research implications of variability may be. Method Two hundred and four adults who stutter participated in a mixed-methods study exploring (a) how variability of stuttering affects people who stutter in comparison to other aspects of the condition and (b) which aspects of the overall experience of stuttering are variable. Results Analyses indicated that variability is very commonly experienced by people who stutter and that it is among the most frustrating aspects of the condition. Qualitative analyses revealed that variability is experienced in all aspects of the stuttering condition, including the observable behavior other affective, behavioral, and cognitive reactions; and the adverse impact of stuttering. Notable individual differences were found in terms of which specific aspects of the condition were more variable for different respondents. Overall, analyses revealed that the variability of different aspects of stuttering can be viewed in a hierarchy from most variable to least variable: more external aspects (e.g., frequency, duration), more internal aspects (e.g., covert behaviors, physical tension), and cognitive-affective experiences (e.g., negative thoughts, feelings, and self-image). Discussion These findings suggest that variability is a common and burdensome aspect of the experience of stuttering and underscore the importance of considering variability in stuttering behavior, reactions, and impact in research, assessment, and treatment for adults who stutter.

Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research

Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

Relative contributions to overall impact of stuttering in adults using the overall assessment of the Speaker's Experience of Stuttering (OASES)

PURPOSE

Comprehensive assessment of stuttering requires consideration of a wide range of behaviors that impact outcomes, and the Overall Assessment of the Speaker's Experience of Stuttering (OASES) is an assessment tool that accomplishes such. The purpose of this study was to determine how the individual components of the test contribute to the OASES' impact score.

METHOD

Data collected at a university speech-language and hearing clinic from 29 adults were used for a relative weight analysis (RWA). RWA was utilized to determine the relative contributions of the OASES' subtests to the OASES' impact score. Confidence intervals for the individual relative weights were calculated for each OASES subtest and significance tests based on bootstrapping with 10,000 replications.

RESULTS

Differences were present in contributions of the OASES' subtests to the OASES' overall impact score, where the following explained a significant amount of variance in the OASES' impact score: Speaker's Reactions; Daily Communication; and Quality of Life. However, contribution of the subtest, "General Information", was not significant.

CONCLUSION

Through examination of relative contributions to the impact of stuttering using the OASES, this project has identified differences in contributors to the overall impact of the disorder of stuttering. This information is beneficial to researchers and clinicians alike in that it gives specific guidance into what determines increased impact in adults who stutter (AWS). Future works should pursue clarification of these differences with an end goal of identifying and overcoming barriers to positive outcomes while also identifying and nurturing facilitators to optimal management.

Recovery and Relapse: Perspectives From Adults Who Stutter

Purpose Recovery and relapse relating to stuttering are often defined in terms of the presence or absence of certain types of speech disfluencies as observed by clinicians and researchers. However, it is well documented that the experience of the overall stuttering condition involves more than just the production of stuttered speech disfluencies. This study sought to identify what recovery and relapse mean to people who stutter based on their own unique experiences to account for both the stuttering behaviors and the broader adverse impact of the condition. Method In this study, 228 adults who stutter participated in a mixed-methods exploration of the terms "recovery" and "relapse." Participants categorized themselves on whether they considered themselves to have recovered or experienced relapse. Data were analyzed thematically through the lens of the speaker self-categorizations to determine how adults who stutter define recovery and relapse regarding stuttering. Results Results indicate that, to adults who stutter, recovery from stuttering is associated with increases in positive affective/emotional, behavioral, and cognitive reactions to the condition and simultaneous decreases in associated negative constructs. These group-level definitions did not change as a function of whether respondents reported that they had experienced recovery or relapse themselves. Discussion Recovery or relapse from stuttering behaviors can occur independently from recovery or relapse from the broader adverse impact related to the condition, suggesting that researchers and clinicians should consider recovery and relapse as involving more than just a reduction or an increase in observable behaviors. These findings support recent research evidence further specifying the many individual phenotypes of stuttering, in that pathways to recovery and relapse can be experienced in different ways for people with different stuttering phenotype profiles.

Resilience in people who stutter: Association with covert and overt characteristics of stuttering

PURPOSE

Recent literature stresses the importance of resilience, as a trait, for successful coping with life's difficulties or stressors. However, only a limited number of studies were conducted on resilience among people-who-stutter (PWS). These studies did not examine the association between resilience and the specific characteristics of stuttering. This study was, therefore, aimed to directly examine the association between resilience and measures of both the covert and overt characteristics of stuttering.

METHOD

Thirty adults who stutter completed the Connor-Davidson Resilience Scale (CD-RISC) and the Overall Assessment of Speaker's Experience of Stuttering - Adults (OASES-A). In addition, stuttering severity of all participants was quantified using the Stuttering Severity Instrument-4 (SSI-4). The associations between all measures were examined statistically.

RESULTS

A strong and significant association was found between the participants' scores on the CD-RISC and the OASES-A (r= -.79, p < .001). In contrast, no significant correlation was found between the participants' scores in the CD-RISC and the SSI-4 (r = .02, p > .05). Within our cohort, no significant association was observed between the participants' gender and age and their resilience levels (p > 0.05).

CONCLUSION

This study demonstrates the role of resilience in shaping the individual's experience with stuttering. Results also show that the individuals' resilience levels do not necessarily predict stuttering severity per se, or its overt manifestations but can predict the individuals' subjective perception of his/her stuttering. This highlights the importance of addressing and promoting resilience among PWS in stuttering therapy.

The Speaker's Experience of Stuttering: Measuring Spontaneity

Purpose This study measures the experience of spontaneous speech in everyday speaking situations. Spontaneity of speech is a novel concept developed to account for the subjective experience of speaking. Spontaneous speech is characterized by little premeditation and effortless production, and it is enjoyable and meaningful. Attention is not directed on the physical production of speech. Spontaneity is intended to be distinct from fluency so that it can be used to describe both stuttered and fluent speech. This is the first study to attempt to measure the concept of spontaneity of speech. Method The experience sampling method was used with 44 people who stutter. They were surveyed five times a day for 1 week through their cell phones. They reported on their perceived spontaneity, fluency, and speaking context. Results Results indicate that spontaneity and fluency are independent, though correlated, constructs that vary with context. Importantly, an increase in spontaneity significantly decreases the adverse impact of stuttering on people's lives. Fluency did not significantly affect adverse life impact of stuttering. Conclusion Findings support a theoretical construct of spontaneity that is distinct from speech fluency and that can inform our views of stuttering and approaches to stuttering treatment.

Disfluencies and Strategies Used by People Who Stutter During a Working Memory Task

Purpose Working memory (WM) deficits are implicated in various communication disorders, including stuttering. The reading span test (RST) measures WM capacity with the dual task of reading sentences aloud and remembering target words. This study demonstrates a difference in strategy between people who stutter (PWS) and people who do not stutter (PWNS) in performing the RST. The impact of the effective strategy and the stuttering-like disfluencies during the RST were investigated. Method Twenty-six PWS and 24 people who do not stutter performed the RST and a simple reading aloud task. After the RST, they were asked which strategy ("imagery" or "rehearsal") they had used in order to remember the target words during the task. Results The proportion of those who used an "imagery" strategy during the RST was significantly smaller in the PWS group. However, the RST scores of those who used an "imagery" strategy were significantly higher than the RST scores of those who used a "rehearsal" strategy in both groups. The "rehearsal" users were asked to undertake one more RST with an "imagery" strategy, which resulted in an increased score for both groups. The disfluency frequency of the PWS group was significantly reduced during the RST than during the oral reading task, irrespective of the employed strategy. Conclusions PWS tended to use the less effective verbal "rehearsal" strategy during the RST. The differential effects of switching strategies on the measured WM capacity and on the disfluency rate suggest that the enhanced fluency during the RST would be mostly attributable to the reduced attention to speech motor control. Therefore, the use of the "imagery" strategy and focusing on the contents of communication, away from speech motor control, should help PWS communicate better in daily conversation.

Eliciting Stuttering in Laboratory Contexts

Purpose The contextual variability of stuttering events makes it difficult to reliably elicit stuttered speech in laboratory settings. As a result, studies that compare stuttered versus fluent speech are difficult to conduct and, thus, are limited in the literature. The purpose of the current study is to describe a novel approach to elicit stuttering during laboratory testing. Method A semistructured clinical interview leveraging the phenomenon of stuttering anticipation was administered to 22 adults who stutter (1st visit). The interview was used to generate participant-specific anticipated and unanticipated word lists, which were used as stimuli during a 2nd visit so that the validity of the method could be tested. Results The method yielded a near-equal distribution of unambiguously stuttered and fluent utterances (43.6% and 43.5%, respectively). Moreover, 12.9% of the utterances were judged to be ambiguous, that is, not unambiguously stuttered or fluent. Conclusion This approach outperformed previous attempts to elicit stuttering during laboratory testing. It could be implemented in future studies that compare neural, physiological, or behavioral correlates of fluent versus stuttered speech.

Group Experiences and Individual Differences in Stuttering

Purpose This study explored group experiences and individual differences in the behaviors, thoughts, and feelings perceived by adults who stutter. Respondents' goals when speaking and prior participation in self-help/support groups were used to predict individual differences in reported behaviors, thoughts, and feelings. Method In this study, 502 adults who stutter completed a survey examining their behaviors, thoughts, and feelings in and around moments of stuttering. Data were analyzed to determine distributions of group and individual experiences. Results Speakers reported experiencing a wide range of both overt behaviors (e.g., repetitions) and covert behaviors (e.g., remaining silent, choosing not to speak). Having the goal of not stuttering when speaking was significantly associated with more covert behaviors and more negative cognitive and affective states, whereas a history of self-help/support group participation was significantly associated with a decreased probability of these behaviors and states. Conclusion Data from this survey suggest that participating in self-help/support groups and having a goal of communicating freely (as opposed to trying not to stutter) are associated with less negative life outcomes due to stuttering. Results further indicate that the behaviors, thoughts, and experiences most commonly reported by speakers may not be those that are most readily observed by listeners.

Stuttering as Defined by Adults Who Stutter

Purpose Numerous frameworks and definitions have sought to differentiate what behaviors and experiences should be considered as a part of stuttering. Nearly all of these efforts have been based on the perspectives and beliefs of conversational partners and listeners. This outside-in approach to defining stuttering lacks validation from people who live with the condition. Method In this study, 430 adults who stutter participated in a qualitative exploration of the term stuttering. Data were analyzed thematically to determine speakers' perspectives about moment of stuttering and the overall experience of stuttering in their lives. Results To adults who stutter, the term stuttering signifies a constellation of experiences beyond the observable speech disfluency behaviors that are typically defined as stuttering by listeners. Participants reported that the moment of stuttering often begins with a sensation of anticipation, feeling stuck, or losing control. This sensation may lead speakers to react in various ways, including affective, behavioral, and cognitive reactions that can become deeply ingrained as people deal with difficulties in saying what they want to say. These reactions can be associated with adverse impact on people's lives. This interrelated chain of events can be exacerbated by outside environmental factors, such as the reactions of listeners. Discussion Data from this survey provide novel evidence regarding what stuttering means to adults who stutter. These data are used to update the adaptation of the World Health Organization's International Classification of Functioning, Disability and Health as it applies to stuttering (Yaruss & Quesal, 2004) to better account for the complex and individualized phenotype of stuttering and to develop a definition of the experience of stuttering that is based not only on the observations of listeners but also on the impact of stuttering on the lives of adults who stutter.

Theta Modulated Neural Phase Coherence Facilitates Speech Fluency in Adults Who Stutter

Adults who stutter (AWS) display altered patterns of neural phase coherence within the speech motor system preceding disfluencies. These altered patterns may distinguish fluent speech episodes from disfluent ones. Phase coherence is relevant to the study of stuttering because it reflects neural communication within brain networks. In this follow-up study, the oscillatory cortical dynamics preceding fluent speech in AWS and adults who do not stutter (AWNS) were examined during a single-word delayed reading task using electroencephalographic (EEG) techniques. Compared to AWNS, fluent speech preparation in AWS was characterized by a decrease in theta-gamma phase coherence and a corresponding increase in theta-beta coherence level. Higher spectral powers in the beta and gamma bands were also observed preceding fluent utterances by AWS. Overall, there was altered neural communication during speech planning in AWS that provides novel evidence for atypical allocation of feedforward control by AWS even before fluent utterances.

Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter

PURPOSE

Individuals who covertly stutter have a unique experience of stuttering that involves concealing the core behaviors of stuttering (e.g., repetitions, prolongations, and blocks). From the listener's perspective, covert stuttering results in minimum typical, overt stuttering behaviors. However, from the speaker's perspective, covert stuttering often increases the cognitive and emotional impact of stuttering. This study explores the speech-language therapy experiences of individuals who covertly stutter in order to improve treatment recommendations and best practice.

METHODS

This investigation is a qualitative analysis of individuals' speech-language therapy experiences as persons who covertly stutter. Real-time video interviews were conducted with the use of open-ended phenomenological interview questions. Interviews were transcribed and thematic analysis of interview transcripts was conducted to investigate the speech-language therapy experiences of the participants.

RESULTS

The participants indicated that stuttering therapy was most impactful when it included explicit goals and activities, personalized selection of therapy techniques or strategies beyond fluency techniques, encouraged self-education, and educated those in the person's environment.

CONCLUSION

The evidence suggests individualized therapy based on each client's unique manifestation of covert stuttering is beneficial; while, fluency-focused stuttering therapy is often incongruent with the needs of persons who covertly stutter. Therapeutic implications and recommendations for speech-language pathologists are discussed.