Premonitory Awareness in Stuttering Scale (PAiS)

An active inference account of stuttering behavior

This paper presents an interpretation of stuttering behavior, based on the principles of the active inference framework. Stuttering is a neurodevelopmental disorder characterized by speech disfluencies such as repetitions, prolongations, and blocks. The principles of active inference, a theory of predictive processing and sentient behavior, can be used to conceptualize stuttering as a disruption in perception-action cycling underlying speech production. The theory proposed here posits that stuttering arises from aberrant sensory precision and prediction error dynamics, inhibiting syllable initiation. Relevant to this theory, two hypothesized mechanisms are proposed: (1) a mistiming in precision dynamics, and (2) excessive attentional focus. Both highlight the role of neural oscillations, prediction error, and hierarchical integration in speech production. This framework also explains the contextual variability of stuttering behaviors, including adaptation effects and fluency-inducing conditions. Reframing stuttering as a synaptopathy integrates neurobiological, psychological, and behavioral dimensions, suggesting disruptions in precision-weighting mediated by neuromodulatory systems. This active inference perspective provides a unified account of stuttering and sets the stage for innovative research and therapeutic approaches.

Validity and reliability of the revised scale of avoidance and struggle behaviours in stuttering (r-SASBS)

BACKGROUND

Secondary behaviours, which encompass reactions developed due to an individual's fear and stress about stuttering, have the potential to exacerbate the condition. Therefore, self-evaluation of secondary behaviours is significant in the multidimensional approach for people who stutter (PWS).

AIM

To determine the validity and reliability of the Revised Scale of Avoidance and Struggle Behaviours in Stuttering (r-SASBS).

METHODS & PROCEDURES

The results of the item analysis and content validity of the Scale of Avoidance and Struggle Behaviours in Stuttering (SASBS), whose pilot study was completed, were reviewed and the number of items was reduced from 30 to 16. The r-SASBS was administered to 440 participants (PWS = 365; people who did not stutter = 75). The content, construct, discriminant validity, internal consistency and test-retest reliability of the r-SASBS were analysed.

OUTCOMES & RESULTS

Content validity was analysed quantitatively based on expert opinions and was found to be high. The r-SASBS had two factors based on exploratory factor analysis. The number of items was reduced to 14 using confirmatory factor analysis. With discriminant validity, it was found that the r-SASBS could distinguish between the groups. The internal consistency and reliability of the test-retest scores were found to be high.

CONCLUSIONS & IMPLICATION

These findings indicated that the r-SASBS is a reliable and valid scale for the self-evaluation of secondary behaviours in PWS. Thus, it can be used by speech-language pathologists for the multidimensional assessment of stuttering. The validity and reliability of the r-SASBS should be investigated in school-aged children who stutter.

WHAT THIS PAPER ADDS

What is already known on this subject Assessment of secondary behaviours in stuttering can be performed using objective and subjective tools. In this regard, a preliminary study was conducted to evaluate these behaviours, using the SASBS, which was developed based on interviews with PWS and a literature review. This study established the content and structural validity of the assessment and found it to have high internal consistency. What this study adds to the existing knowledge Although secondary behaviour assessments need to be comprehensive, it can be time-consuming in busy clinical settings. Owing to the importance of self-reported secondary behaviours in the assessment of stuttering and the reliability of information obtained from the client, there is a need for scales that can be administered quickly to assess the impact of secondary behaviours in PWS. This study examines the validity and reliability of the r-SASBS. What are the practical and clinical implications of this work? The SASBS was reviewed in this study and the number of items was reduced. The r-SASBS was administered to 440 participants. The validity of the r-SASBS was determined based on its content, discriminant, and construct validity. The reliability of the r-SASBS was determined using internal consistency and test-retest reliability. The results indicate that the r-SASBS is a reliable and valid tool for self-evaluating secondary behaviours in PWS. This could be a valuable measure of secondary behaviours in stuttering, which could improve treatment outcomes.

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.

Developmental stuttering, physical concomitants associated with stuttering, and Tourette syndrome: A scoping review

BACKGROUND AND PURPOSE

Developmental stuttering and Tourette syndrome (TS) are common neurodevelopmental disorders. Although disfluencies may co-occur in TS, their type and frequency do not always represent pure stuttering. Conversely, core symptoms of stuttering may be accompanied by physical concomitants (PCs) that can be confused for tics. This scoping review aimed to explore the similarities and differences between stuttering and tics in terms of epidemiology, comorbidities, phenomenology, evolution, physiopathology, and treatment. We also described the nature of PCs in stuttering and disfluencies in TS.

METHODS

A literature search on Medline, Embase and PsycInfo was executed in March 2022. From 426 studies screened, 122 were included in the review (a majority being narrative reviews and case reports).

RESULTS

TS and stuttering have several epidemiological, phenomenological, comorbidity, and management similarities suggesting shared risk factors and physiopathology (involving the basal ganglia and their connections with speech and motor control cortical regions). PCs in stuttering commonly involve the face (eyelids, jaw/mouth/lip movements) and sometimes the head, trunk and limbs. PCs can be present from early stages of stuttering and vary over time and within individuals. The function of PCs is unknown. Some individuals with TS have a distinct disfluency pattern, composed of a majority of typical disfluencies (mostly between-word disfluencies), and a mix of cluttering-like behaviors, complex phonic tics (e.g. speech-blocking tics, echolalia, palilalia), and rarely, atypical disfluencies.

CONCLUSION

Future investigations are warranted to better understand the complex relationships between tics and stuttering and address the management of disfluencies in TS and PCs in stuttering.

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.

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.

Enlarged Area of Mesencephalic Iron Deposits in Adults Who Stutter

PURPOSE

Childhood onset speech fluency disorder (stuttering) is possibly related to dopaminergic dysfunction. Mesencephalic hyperechogenicity (ME) detected by transcranial ultrasound (TCS) might be seen as an indirect marker of dopaminergic dysfunction. We here determined whether adults who stutter since childhood (AWS) show ME.

METHODS

We performed TCS in ten AWS and ten matched adults who never stuttered. We also assessed motor performance in finger tapping and in the 25 Foot Walking test.

RESULTS

Compared to controls, AWS showed enlarged ME on either side. Finger tapping was slower in AWS. Walking cadence, i.e., the ratio of number of steps by time, tended to be higher in AWS than in control participants.

DISCUSSION

The results demonstrate a motor deficit in AWS linked to dopaminergic dysfunction and extending beyond speech. Since iron deposits evolve in childhood and shrink thereafter, ME might serve as an easily quantifiable biomarker helping to predict the risk of persistency in children who stutter.

An exploratory factor analysis of action responses to stuttering anticipation

PURPOSE

We previously introduced theStuttering Anticipation Scale (SAS; Jackson, E. S., Gerlach, H., Rodgers, N. H., & Zebrowski, P. M. (2018). My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? Seminars in Speech and Language, 39, 356-370) - a non-standardized self-report measure for children, teens, and adults who stutter (CWS, TWS, AWS) that quantifies how often they engage in 25 commonly reported action responses to anticipation. The purpose of this study was to leverage the SAS to explore the factor structure of action responses to stuttering anticipation.

METHODS

A total of 121 people who stutter completed the SAS online (27 CWS, 40 TWS, 54 AWS). We used exploratory factor analysis (EFA) to determine the underlying latent variables within the 25 SAS items that characterize how people who stutter respond to anticipation.

RESULTS

A three-factor model was most appropriate for the data with regard to factor loadings and other model fit indices. The three factors were named: avoidance (17 items), physical change (4 items), and approach (4 items).

CONCLUSION

Understanding these three types of action responses to anticipation can help guide clinical decision-making by providing a novel framework for clinicians and their clients who stutter to discuss how the client tends to respond to anticipation, and explore ways to facilitate productive responses to anticipation.