Physiological Correlates of Fluent and Stuttered Speech Production in Preschool Children Who Stutter

Improving Stuttering Through Augmented Multisensory Feedback Stimulation

BACKGROUND/OBJECTIVES

Stuttering is a speech disorder involving fluency disruptions like repetitions, prolongations, and blockages, often leading to emotional distress and social withdrawal. Here, we present Augmented Multisensory Feedback Stimulation (AMFS), a novel personalized intervention to improve speech fluency in people who stutter (PWS). AMFS includes a five-day intensive phase aiming at acquiring new skills, plus a reinforcement phase designed to facilitate the transfer of these skills across different contexts and their automatization into effortless behaviors. The concept of our intervention derives from the prediction of the neurocomputational model Directions into Velocities of Articulators (DIVA). The treatment applies dynamic multisensory stimulation to disrupt PWS' maladaptive over-reliance on sensory feedback mechanisms, promoting the emergence of participants' natural voices.

METHODS

Forty-six PWS and a control group, including twenty-four non-stuttering individuals, participated in this study. Stuttering severity and physiological measures, such as heart rate and electromyographic activity, were recorded before and after the intensive phase and during the reinforcement stage in the PWS but only once in the controls.

RESULTS

The results showed a significant reduction in stuttering severity at the end of the intensive phase, which was maintained during the reinforcement training. Crucially, worse performance was found in PWS than in the controls at baseline but not after the intervention. In the PWS, physiological signals showed a reduction in activity during the training phases compared to baseline.

CONCLUSIONS

Our findings show that AMFS provides a promising approach to enhancing speech fluency. Future studies should clarify the mechanisms underlying such intervention and assess whether effects persist after the treatment conclusion.

Associations between social anxiety, physiological reactivity, and speech disfluencies in autistic young adults and controls

INTRODUCTION

The aim of this study was to examine possible associations of social anxiety (SA) and speaking-related physiological reactivity with the frequencies of a) total disfluencies, b) typical disfluencies, and c) stuttering-like disfluencies, as well as d) stuttering-severity in autistic young adults and controls.

METHODS

Thirty-two autistic young adults and 35 controls participated in this study. Participants were presented with video clips (viewing condition) and were then asked to talk about the videos (narrating condition). SA was measured by the self-report Social Phobia and Anxiety Inventory (SPAI). Speaking-related physiological reactivity was measured by the electrodermal activity (EDA), an index of emotional arousal. The speech samples from the narrating condition were analyzed for type and frequency of speech disfluencies and used for determining the stuttering severity. SA and speaking-related physiological reactivity were compared between the groups. Correlation between SA, physiological reactivity, disfluency frequencies, and stuttering severity were tested separately for both groups.

RESULTS

No between-group differences were found in the overall SA, yet differences were found in SPAI subscales of social interaction, group interaction, and avoidance, as well as in agoraphobia. Both groups had higher physiological arousal in narrating condition in comparison to the video viewing condition, yet there was no between-group difference in the reactivity. No associations were found between SPAI measures, physiological reactivity, disfluency frequencies, and stuttering severity in the autistic group. In the control group, a negative association was found between physiological reactivity and total and typical disfluency frequencies.

CONCLUSIONS

SA or speaking-related physiological reactivity were not associated with disfluency frequencies or stuttering severity in autistic persons. Negative association between physiological reactivity and disfluency frequencies found in the control group may indicate that the physiological arousal may impact the speech production process by reducing the overt disfluencies.

Electrodermal Activity of Preschool-Age Children Who Stutter During a Child-Friendly Stroop Paradigm

PURPOSE

The aim of the study was to assess whether emotional reactivity, indexed by a distinct physiological measure of sympathetic activation, differs between preschool-age children who stutter (CWS) and preschool-age children who do not stutter (CWNS) during a child-friendly Stroop task (i.e., day-night task). Additionally, researchers aimed to assess whether the Stroop task, compared to a control task, was a significant physiological stressor.

METHOD

Fifteen preschool-age CWS and 22 preschool-age CWNS were asked to perform a day-night Stroop task in order to elicit psychophysiological reactivity, indexed by electrodermal response (EDR) occurrence frequency and EDR amplitude. Physiological measurements were recorded during pretask baselines, performance of the day-night Stroop task, and performance of a speech-language control task.

RESULTS

Findings based on EDR measures did not support the hypothesis that the child-friendly day-night Stroop task is an effective stressor as compared to a control task based on measures of physiological arousal in preschool-age children. The CWS and CWNS did not significantly differ in their EDR measures relative to the control task or Stroop task (p > .05). However, CWS, compared to CWNS, exhibited significantly greater EDR amplitudes during the control task baseline (p < .05) and the Stroop task baseline (p < .05).

CONCLUSION

Overall, these findings may suggest that a predisposition to heightened levels of sympathetic activity prior to tasks in preschool-age CWS is important to consider with regard to the nature of developmental stuttering.

Psychophysiological Arousal in Young Children Who Stutter: An Interpretable AI Approach

The presented first-of-its-kind study effectively identifies and visualizes the second-by-second pattern differences in the physiological arousal of preschool-age children who do stutter (CWS) and who do not stutter (CWNS) while speaking perceptually fluently in two challenging conditions: speaking in stressful situations and narration. The first condition may affect children's speech due to high arousal; the latter introduces linguistic, cognitive, and communicative demands on speakers. We collected physiological parameters data from 70 children in the two target conditions. First, we adopt a novel modality-wise multiple-instance-learning (MI-MIL) approach to classify CWS vs. CWNS in different conditions effectively. The evaluation of this classifier addresses four critical research questions that align with state-of-the-art speech science studies' interests. Later, we leverage SHAP classifier interpretations to visualize the salient, fine-grain, and temporal physiological parameters unique to CWS at the population/group-level and personalized-level. While group-level identification of distinct patterns would enhance our understanding of stuttering etiology and development, the personalized-level identification would enable remote, continuous, and real-time assessment of stuttering children's physiological arousal, which may lead to personalized, just-in-time interventions, resulting in an improvement in speech fluency. The presented MI-MIL approach is novel, generalizable to different domains, and real-time executable. Finally, comprehensive evaluations are done on multiple datasets, presented framework, and several baselines that identified notable insights on CWSs' physiological arousal during speech production.

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.

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.

Emotion processing in children who do and do not stutter: An ERP study of electrocortical reactivity and regulation to peer facial expressions

PURPOSE

Event-related brain potentials (ERPs) were used to investigate the neural correlates of emotion processing in 5- to 8-year-old children who do and do not stutter.

METHODS

Participants were presented with an audio contextual cue followed by images of threatening (angry/fearful) and neutral facial expressions from similarly aged peers. Three conditions differed in audio-image pairing: neutral context-neutral expression (neutral condition), negative context-threatening expression (threat condition), and reappraisal context-threatening expression (reappraisal condition). These conditions reflected social stimuli that are ecologically valid to the everyday life of children.

RESULTS

P100, N170, and late positive potential (LPP) ERP components were elicited over parietal and occipital electrodes. The threat condition elicited an increased LPP mean amplitude compared to the neutral condition across our participants, suggesting increased emotional reactivity to threatening facial expressions. In addition, LPP amplitude decreased during the reappraisal condition- evidence of emotion regulation. No group differences were observed in the mean amplitude of ERP components between children who do and do not stutter. Furthermore, dimensions of childhood temperament and stuttering severity were not strongly correlated with LPP elicitation.

CONCLUSION

These findings are suggestive that, at this young age, children who stutter exhibit typical brain activation underlying emotional reactivity and regulation to social threat from peer facial expressions.

Emotional Reactivity and Regulation in Preschool-Age Children Who Do and Do Not Stutter: Evidence From Autonomic Nervous System Measures

Purpose: This experimental cross-sectional research study examined the emotional reactivity and emotion regulation in preschool-age children who do (CWS) and do not stutter (CWNS) by assessing their psychophysiological response during rest and while viewing pictures from the International Affective Picture System (Lang et al., 2008). Method: Participants were 18 CWS (16 boys and two girls; mean age 4 years, 5 months) and 18 age- and gender-matched CWNS. Participants' psychophysiological responses were measured during two baselines and two picture viewing conditions. Skin conductance level (SCL) and heart rate were measured to assess emotional reactivity. Respiratory sinus arrhythmia (RSA) was measured to assess emotional regulation. Participants' shyness and executive function were assessed via parent report and considered for their effects on participants' psychophysiological responses. Results: First, CWNS and CWS did not differ in their initial baseline SCL, heart rate, or RSA, but all participants had higher SCL and lower RSA in the second baseline, subsequent to the first challenge condition, compared to the first baseline. Second, during the challenge conditions, CWS did not differ from CWNS in their SCL, but showed a significantly higher heart rate than CWNS. Third, CWS exhibited a significantly lower RSA during the challenge conditions compared to CWNS. Lastly, the temperamental quality of shyness was associated with preschool-age children's SCL, such that participants who were rated higher in shyness had a higher SCL during the challenge conditions. Participants' executive function had a marginally significant effect on the RSA, such that the participants who had higher executive function composite scores exhibited lower RSA during the challenge conditions. Conclusions: Our findings suggest that CWS and CWNS did not differ in their emotional reactivity and emotional regulation abilities at rest. During challenge conditions, however, CWS tended to be more emotionally reactive, as indicated by a higher heart rate, and also employed more emotional regulation, indexed by a greater decrease in RSA, compared to CWNS. Preschool-age children's behavior is largely dominated by reactivity, but there is the emergence of regulation, which can help children adjust to various contextual demands. For CWS who are more emotionally reactive, regulatory skills may be particularly critical to their prognosis and treatment.