Spelling Proficiency of Children with a Resolved Phonological Speech Sound Disorder Treated with an Integrated Approach-A Long-Term Follow-Up Randomized Controlled Trial

Phonological developmental speech sound disorders (pDSSD) in childhood are often associated with later difficulties in literacy acquisition. The present study is a follow-up of the randomized controlled trial (RCT) on the effectiveness of PhonoSens, a treatment for pDSSD that focuses on improving auditory self-monitoring skills and categorial perception of phoneme contrasts, which could have a positive impact on later spelling development. Our study examines the spelling abilities of 26 German-speaking children (15 girls, 11 boys; mean age 10.1 years, range 9.3-11.2 years) 3-6 years after their successful completion of the PhonoSens treatment. Spelling assessment revealed that only 3 out of 26 participants developed a spelling disorder. In the overall population of fourth-graders, one in five children showed a spelling deficit; in another study of elementary school children, with resolved pDSSD, 18 of 32 children had a spelling deficit. Thus, the applied pDSSD treatment method appears to be associated with positive spelling development. Multiple regression analysis revealed that among the potentially predictive factors for German-speaking children with resolved pDSSD to develop later spelling difficulties, parental educational level and family risk for developmental language disorder (DLD) had an impact on children's spelling abilities; gender and the child's phonological memory had not.

Newborn Hearing Screening Benefits Children, but Global Disparities Persist

There is substantial evidence that newborn hearing screening (NHS) reduces the negative sequelae of permanent childhood hearing loss (PCHL) if performed in programs that aim to screen all newborns in a region or nation (often referred to as Universal Newborn Hearing Screening or UNHS). The World Health Organization (WHO) has called in two resolutions for the implementation of such programs and for the collection of large-scale data. To assess the global status of NHS programs we surveyed individuals potentially involved with newborn and infant hearing screening (NIHS) in 196 countries/territories (in the following text referred to as countries). Replies were returned from 158 countries. The results indicated that 38% of the world's newborns and infants had no or minimal hearing screening and 33% screened at least 85% of the babies (hereafter referred to as UNHS). Hearing screening programs varied considerably in quality, data acquisition, and accessibility of services for children with PCHL. In this article, we summarize the main results of the survey in the context of several recent WHO publications, particularly the World Report on Hearing, which defined advances in the implementation of NHS programs in the Member States as one of three key indicators of worldwide progress in ear and hearing care (EHC).

The Effectiveness of an Integrated Treatment for Functional Speech Sound Disorders—A Randomized Controlled Trial

Background: The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and phonetic processing according to the Integrated Psycholinguistic Model of Speech Processing (IPMSP). Methods: Thirty-two German-speaking children aged from 3.5 to 5.5 years (median 4.6) with functional SSD were randomly assigned to a treatment or a wait-list control group with 16 children each. All children in the treatment group and, after an average waiting period of 6 months, 12 children in the control group underwent PhonoSens treatment. Results: The treatment group showed more percent correct consonants (PCC) and a greater reduction in phonological processes after 15 therapy sessions than the wait-list control group, both with large effect sizes (Cohen’s d = 0.89 and 1.04). All 28 children treated achieved normal phonological abilities: 21 before entering school and 7 during first grade. The average number of treatment sessions was 28; the average treatment duration was 11.5 months. Conclusion: IPMSP-aligned therapy is effective in the treatment of SSD and is well adaptable for languages other than German.

Speech restructuring group treatment for 6-to-9-year-old children who stutter: A therapeutic trial

For children who stutter (CWS), there is good evidence of the benefits of treatment for pre-school age, but an evidence gap for elementary school age. Here we report on the effectiveness of a fluency shaping treatment for 6- to 9-year-old children. The main treatment component is the reinforcement of soft voice onsets. An intensive in-patient group treatment phase lasts 6 days, followed by a 6-month maintenance phase with 3 in-patient weekend group refresher courses. Child and a parent participate together in various treatment activities. In this controlled intervention study (waitlist control, intention-to-treat design) assessments were performed before treatment (T1), 4 weeks after the intensive phase (T2), at the end of the maintenance phase (T3), and 1 year later (T4). Participants were 119 children (108 boys, 11 girls, age 5.5‑10.4 years). Control conditions included a subgroup with delayed treatment (N=25) as well as the assessment of complexity of utterances, inter-rater reliability, and speech naturalness. From before treatment to 1-year follow-up, percent stuttered syllables and OASES-S (Overall Assessment of the Speaker's Experience with Stuttering - School-age) scores decreased with large effect size. Speech naturalness improved during this period but did not reach the level of non-stuttering children. Complexity of utterances increased during the intensive phase, but only temporarily. Twenty children (16.8 %, including dropouts) showed no demonstrable treatment benefit. Fluency shaping treatment can be effectively applied to young school children. It is assumed that parental support, group therapy, intensive treatment, and regular exercises at home are essential.

"Spontaneous" late recovery from stuttering: Dimensions of reported techniques and causal attributions

PURPOSE

(1) To survey the employed techniques and the reasons/occasions which adults who had recovered from stuttering after age 11 without previous treatment reported as causal to overcome stuttering, (2) to investigate whether the techniques and causal attributions can be reduced to coherent (inherently consistent) dimensions, and (3) whether these dimensions reflect common therapy components.

METHODS

124 recovered persons from 8 countries responded by SurveyMonkey or paper-and-pencil to rating scale questions about 49 possible techniques and 15 causal attributions.

RESULTS

A Principal Component Analysis of 110 questionnaires identified 6 components (dimensions) for self-assisted techniques (Speech Restructuring; Relaxed/Monitored Speech; Elocution; Stage Performance; Sought Speech Demands; Reassurance; 63.7% variance explained), and 3 components of perceived causal attributions of recovery (Life Change, Attitude Change, Social Support; 58.0% variance explained).

DISCUSSION

Two components for self-assisted techniques (Speech Restructuring; Elocution) reflect treatment methods. Another component (Relaxed/Monitored Speech) consists mainly of items that reflect a common, non-professional understanding of effective management of stuttering. The components of the various perceived reasons for recovery reflect differing implicit theories of causes for recovery from stuttering. These theories are considered susceptible to various biases. This identification of components of reported techniques and of causal attributions is novel compared to previous studies who just list techniques and attributions.

CONCLUSION

The identified dimensions of self-assisted techniques and causal attributions to reduce stuttering as extracted from self-reports of a large, international sample of recovered formerly stuttering adults may guide the application of behavioral stuttering therapies.

The Pathogenesis, Assessment and Treatment of Speech Fluency Disorders

BACKGROUND

Approximately 1% of children and adolescents, 0.2% of women, and 0.8% of men suffer from stuttering, and lesser numbers from cluttering. Persistent speech fluency disorders often cause lifelong problems in communication and social participation.

METHODS

In an interdisciplinary, evidence and consensus based clinical practice guideline, the current understanding of the nature, identification, diagnosis, and treatment of stuttering and cluttering was summarized. A systematic review of the literature was carried out to assess the efficacy and effectiveness of treatments for stuttering. Evidence is lacking on the etiology, pathogenesis, evaluation, and treatment of cluttering.

RESULTS

In view of the fact that common (developmental, idiopathic) stuttering is associated with structural and functional changes of the brain, the guideline recommends that it should be called "originary neurogenic non-syndromic stuttering." Heritability estimates for this disorder range from 70% to over 80%. For preschool children, the Lidcombe therapy has the best evidence of efficacy (Cohen's d = 0.72-1.00). There is also strong evidence for an indirect treatment approach. For children aged 6 to 12, there is no solid evidence for the efficacy of any treatment. For adolescents and adults, there is good evidence with high effect sizes (Cohen's d = 0.75-1.63) for speech restructuring methods such as fluency shaping; weak evidence with intermediate effect sizes for stuttering modification (Cohen's d = 0.56-0.65); and weak evidence for combined speech restructuring and stuttering modification. The evidence does not support the efficacy of pharmacotherapy, rhythmic speaking, or breathing regulation as the sole or main form of treatment, or that of hypnosis or eclectic, unspecified stuttering therapies.

CONCLUSION

Stuttering is often treated in Germany with therapies for which there is inadequate evidence, and the initiation of treatment is often unnecessarily delayed. The guideline presents treatment methods whose efficacy is supported by the current evidence.

Altered morphology of the nucleus accumbens in persistent developmental stuttering

PURPOSE

Neuroimaging studies in persistent developmental stuttering repeatedly report altered basal ganglia functions. Together with thalamus and cerebellum, these structures mediate sensorimotor functions and thus represent a plausible link between stuttering and neuroanatomy. However, stuttering is a complex, multifactorial disorder. Besides sensorimotor functions, emotional and social-motivational factors constitute major aspects of the disorder. Here, we investigated cortical and subcortical gray matter regions to study whether persistent developmental stuttering is also linked to alterations of limbic structures.

METHODS

The study included 33 right-handed participants who stutter and 34 right-handed control participants matched for sex, age, and education. Structural images were acquired using magnetic resonance imaging to estimate volumetric characteristics of the nucleus accumbens, hippocampus, amygdala, pallidum, putamen, caudate nucleus, and thalamus.

RESULTS

Volumetric comparisons and vertex-based shape comparisons revealed structural differences. The right nucleus accumbens was larger in participants who stutter compared to controls.

CONCLUSION

Recent theories of basal ganglia functions suggest that the nucleus accumbens is a motivation-to-movement interface. A speaker intends to reach communicative goals, but stuttering can derail these efforts. It is therefore highly plausible to find alterations in the motivation-to-movement interface in stuttering. While behavioral studies of stuttering sought to find links between the limbic and sensorimotor system, we provide the first neuroimaging evidence of alterations in the limbic system. Thus, our findings might initialize a unified neurobiological framework of persistent developmental stuttering that integrates sensorimotor and social-motivational neuroanatomical circuitries.

Stuttering treatment and brain research in adults: A still unfolding relationship

PURPOSE

Brain imaging and brain stimulation procedures have now been used for more than two decades to investigate the neural systems that contribute to the occurrence of stuttering in adults, and to identify processes that might enhance recovery from stuttering. The purpose of this paper is to review the extent to which these dual lines of research with adults who stutter have intersected and whether they are contributing towards the alleviation of this impairment.

METHOD

Several areas of research are reviewed in order to determine whether research on the neurology of stuttering is showing any potential for advancing the treatment of this communication disorder: (a) attempts to discover the neurology of stuttering, (b) neural changes associated with treated recovery, and (c) direct neural intervention.

RESULTS AND CONCLUSIONS

Although much has been learned about the neural underpinnings of stuttering, little research in any of the reviewed areas has thus far contributed to the advancement of stuttering treatment. Much of the research on the neurology of stuttering that does have therapy potential has been largely driven by a speech-motor model that is designed to account for the efficacy of fluency-inducing strategies and strategies that have been shown to yield therapy benefits. Investigations on methods that will induce neuroplasticity are overdue. Strategies profitable with other disorders have only occasionally been employed. However, there are signs that investigations on the neurology of adults who have recovered from stuttering are slowly being recognized for their potential in this regard.

Assisted and unassisted recession of functional anomalies associated with dysprosody in adults who stutter

PURPOSE

Speech in persons who stutter (PWS) is associated with disturbed prosody (speech melody and intonation), which may impact communication. The neural correlates of PWS' altered prosody during speaking are not known, neither is how a speech-restructuring therapy affects prosody at both a behavioral and a cerebral level.

METHODS

In this fMRI study, we explored group differences in brain activation associated with the production of different kinds of prosody in 13 male adults who stutter (AWS) before, directly after, and at least 1 year after an effective intensive fluency-shaping treatment, in 13 typically fluent-speaking control participants (CP), and in 13 males who had spontaneously recovered from stuttering during adulthood (RAWS), while sentences were read aloud with 'neutral', instructed emotional (happy), and linguistically driven (questioning) prosody. These activations were related to speech production acoustics.

RESULTS

During pre-treatment prosody generation, the pars orbitalis of the left inferior frontal gyrus and the left anterior insula were activated less in AWS than in CP. The degree of hypo-activation correlated with acoustic measures of dysprosody. Paralleling the near-normalization of free speech melody following fluency-shaping therapy, AWS normalized the inferior frontal hypo-activation, sooner after treatment for generating emotional than linguistic prosody. Unassisted recovery was associated with an additional recruitment of cerebellar resources.

CONCLUSIONS

Fluency shaping therapy may restructure prosody, which approaches that of typically fluent-speaking people. Such a process may benefit from additional training of instructed emotional and linguistic prosody by inducing plasticity in the inferior frontal region which has developed abnormally during childhood in PWS.

Patterns and Universals of Adult Romantic Attachment Across 62 Cultural Regions

As part of the International Sexuality Description Project, a total of 17,804 participants from 62 cultural regions completedthe RelationshipQuestionnaire(RQ), a self-reportmeasure of adult romanticattachment. Correlational analyses within each culture suggested that the Model of Self and the Model of Other scales of the RQ were psychometrically valid within most cultures. Contrary to expectations, the Model of Self and Model of Other dimensions of the RQ did not underlie the four-category model of attachment in the same way across all cultures. Analyses of specific attachment styles revealed that secure romantic attachment was normative in 79% of cultures and that preoccupied romantic attachment was particularly prevalent in East Asian cultures. Finally, the romantic attachment profiles of individual nations were correlated with sociocultural indicators in ways that supported evolutionary theories of romantic attachment and basic human mating strategies.

Relationship-Specific Closeness of Intergenerational Family Ties

Cross-generational cultural transmission is facilitated by affectional ties between cultural model and recipient. A theory of cultural transmission must therefore account for how and why affectional ties vary between different dyadic relationships. Findings on the tie strengths of several intergenerational kin dyads (grandparent- grandchild, grandparent-parent, aunt/uncle-niece/nephew) as rated by recipients of kin investment (adult grandchildren or nieces/nephews) are presented, based on several studies with altogether more than 3,000 participants between 16 and 80 years old. The relationship structures were dyad specific; asymmetrical with a tilt to the maternal side; robust; and predictable from reproductively relevant variables of the kinpersons involved, namely, sex-specific reproductive strategy, paternity uncertainty, and genetic closeness. Implications for the study of intrafamilial cultural transmission are discussed, with an emphasis on the importance of evolutionary theory for this research field.

The effectiveness of stuttering treatments in Germany

PURPOSE

Persons who stutter (PWS) should be referred to the most effective treatments available, locally or regionally. A prospective comparison of the effects of the most common stuttering treatments in Germany is not available. Therefore, a retrospective evaluation by clients of stuttering treatments was carried out.

METHOD

The five most common German stuttering treatments (231 single treatment cases) were rated as to their perceived effectiveness, using a structured questionnaire, by 88 PWS recruited through various sources. The participants had received between 1 and 7 treatments for stuttering.

RESULTS

Two stuttering treatments (stuttering modification, fluency shaping) showed favorable and three treatments (breathing therapy, hypnosis, unspecified logopedic treatment) showed unsatisfactory effectiveness ratings. The effectiveness ratings of stuttering modification and fluency shaping did not differ significantly. The three other treatments were equally ineffective. The differences between the effective and ineffective treatments were of large effect sizes. The typical therapy biography begins in childhood with an unspecified logopedic treatment administered extensively in single and individual sessions. Available comparisons showed intensive or interval treatments to be superior to extensive treatments, and group treatments to be superior to single client treatments.

CONCLUSION

The stuttering treatment most often prescribed in Germany, namely a weekly session of individual treatment by a speech-language pathologist, usually with an assorted package of mostly unknown components, is of limited effectiveness. Better effectiveness can be expected from fluency shaping or stuttering modification approaches, preferably with an intensive time schedule and with group sessions.

EDUCATIONAL OBJECTIVES

Readers will be able to: (a) discuss the five most prevalent stuttering treatments in Germany; (b) summarize the effectiveness of these treatments; and (c) describe structural treatment components that seem to be preferable across different kinds of treatments.

Discriminative grandparental solicitude as reproductive strategy

1,857 adults rated the grandparental solicitude they received in childhood. Through a simple model based on the evolutionary concepts of ontogenetically differentiated reproductive strategy and paternity confidence, an ordered discriminative pattern of grandparental caregiving was predicted and confirmed by solid main effects, based on 603 complete cases. The maternal grandmother was the most caring. Unlike prevalent gender stereotypes, she was followed by the maternal grandfather, the paternal grandmother, and the paternal grandfather. The preferential grandparental solicitude was not influenced by residential distance, grandparent age, and availability of other grandparents. A predicted higher correlation for male than for female progenitors between solicitude and phenotypic resemblance could be confirmed.

A documentation system to save time and ensure proper application of the fiberoptic endoscopic evaluation of swallowing (FEES®)

A properly performed fiberoptic endoscopic evaluation of swallowing (FEES(®)) is comprehensive and time-consuming. Editing times of FEES protocols and attempts for efficiency maximization are unknown. Here, the protocol editing times of completed FEES examinations were determined. The present study reports the time savings and quality gains of a newly developed documentation system tailored to the FEES standard of Langmore. Four independent examiners analyzed twelve videos of FEES procedures, six without and six with the documentation system. Effectiveness of the documentation system was evaluated according to the times for total evaluation, interpretation, documentation, report writing, and for report completeness. The documentation system reduced editing times and increased report completeness with large effect sizes. Averaged total evaluation time decreased from 42 to 27 min, report completeness increased from 55 to 80%. The use of the documentation system facilitates and improves the assessment of the swallowing process.

A note on some reinforcing properties of university lectures

Contingency management systems in university courses have sometimes assigned the role of reinforcing stimulus to lectures and demonstrations. Attending a lecture was made contingent upon having previously finished certain course assignments. The present paper investigated some variables that control student attendance at lectures. Attendance remained high throughout each course at those class meetings where quizzes contributing to course grades were given or where impending quizzes were discussed. Attendance at lectures over the reading assignments or over material unrelated to course quizzes rapidly declined. When students were given course credit for attending these lectures, or when the lectures included information for future quizzes, attendance increased. When attending these lectures was made contingent upon having completed certain assignments the prior week, no increase in assignment completion was noted and the attendance at the lectures decreased even further. All lectures were given during one class meeting each week. Attendance at the other class meetings during the week remained stable.

Auditory status of persons with intellectual disability at the German Special Olympic Games

Among persons with intellectual disability, the prevalence of hearing impairments is high. During the German Special Olympics Summer Games 2004, a hearing screening was conducted on 755 athletes with intellectual disabilities. Obligatory screening included ear inspection and recording of otoacoustic emissions, and optional screening included tympanometry and brief pure-tone audiometry. 38.0% of the athletes failed the screening. 53.0% needed ear wax removal. 56.1% of the fails indicated sensorineural hearing loss and 13.6% indicated mixed hearing loss. 12.5% of the fails were caused by unremovable ear wax, 1.4% by ear canal affections, and 16.4% by middle ear problems. Left ear fails were more frequent than right ear fails. A peripheral hearing disturbance can thus be expected in every third subject. The high failure rate, a considerable percentage of previously undetected profound hearing loss (1.1%), and the frequent need for ear wax removal, suggest that nearly half of persons with intellectual disabilities need regular otological or audiological consultations.

Computer-assisted documentation of the fiberoptic endoscopic evaluation of swallowing

BACKGROUND

Because documentation and report writing in fiberoptic endoscopic evaluation of swallowing (FEES) is time consuming and susceptible to omissions, a software solution to ameliorate these problems by maintaining document quality is desirable.

MATERIAL/METHODS

Based on the FEES procedure of Langmore, a documentation software (DS) which presents a digitized FEES recording and masks with precast text fields was designed to facilitate and unify data input. The oropharyngeal secretion scale of Murray and the penetration-aspiration scale of Rosenbek were integrated to increase comparability of dysphagia information. Four independent examiners analyzed 12 digitized FEES-recordings, 6 without and 6 with the DS, to determine its effect on the times needed for total evaluation, interpretation, documentation, report writing, and report completeness.

RESULTS

The documentation software (DS) reduced the total evaluation time from 42 min to 18 min and increased the evaluation completeness from 55% to 95%, both with very large effect sizes. The time saving was mainly due to an automated report generation at the end of the analysis.

CONCLUSIONS

The DS can be offered as a valuable and effective tool in daily clinical routine and for research purposes.

High prevalence of hearing disorders at the Special Olympics indicate need to screen persons with intellectual disability

BACKGROUND

Persons with intellectual disabilities (ID) are at increased risk for hearing impairment which often remains undetected. If left untreated, such hearing impairments may worsen the social and communicative problems of these persons. The aims of this study are to determine the prevalence of hearing impairment, to specify type and degree of hearing loss, and to evaluate the sensitivity and specificity of the screening in this population.

METHODS

During the German Special Olympics Summer Games 2006, 552 athletes with ID had their hearing screened according to the international protocol of Healthy Hearing, Special Olympics. This screening protocol includes otoscopy, measurement of distortion product otoacoustic emissions, and - if necessary - tympanometry and pure tone audiometry (PTA) screening at 2 and 4 kHz. Additionally, 195 athletes underwent a full diagnostic PTA. The results of the screening and diagnostic PTA were compared.

RESULTS

Of the 524 athletes who completed the screening protocol, 76% passed and 24% failed it. Ear wax was removed in 48% of all athletes. 42% of the athletes were recommended to consult an otolaryngologist or an acoustician. Of the 99 athletes whose screening-based suspicion of a hearing loss was confirmed with diagnostic PTA, 74 had an undetected hearing loss. The correlation (Cramer's V) between screening and diagnostic PTA was .98. The sensitivity of the screening was 100% and the specificity 98%.

DISCUSSION

The screening reliably detects hearing disorders among persons with ID. The prevalence of hearing impairment in this population is considerably higher than in the general population, and the proportion of undetected hearing impairments is large, even among people with only mild and moderate ID, as examined in this study. Therefore, a screening is highly recommended, and special attention from caregivers and professionals as well as regular hearing assessment and standard therapy programmes are required for persons with ID.

Testing the diagnostic value of electrical ear canal stimulation in cochlear implant candidates by functional magnetic resonance imaging

Prior to cochlear implant (CI) surgery in children, the integrity of the auditory pathway is sometimes assessed by electrical ear canal stimulation (ECS). However, the evaluation of reactions as auditory is subjective. To test the prognostic value of ECS, functional magnetic resonance imaging (fMRI) was performed during ECS vicariously in 18 adult CI candidates. Activation of the primary auditory cortex was detected in 9 of 16 cases when auditory sensations during ECS occurred, and tended to be more bilaterally distributed in CI candidates than in normal-hearing controls. ECS sensations only tended to correlate with fMRI activations. However, solely frequency discrimination during electrical stimulation predicted CI outcome, but neither other auditory sensations nor fMRI activations did so satisfactorily, which limits the diagnostic value of these measures. Instead, preoperative residual hearing (nonamplified and amplified) was a robust predictor for CI benefit.

Health and human services for persons who stutter and education of logopedists in East-European countries

The International Association of Logopedics and Phoniatrics (IALP) assessed the therapy status of fluency disorders, service opportunities, and education of logopedists (speech-language pathologists) with a mail survey in Eastern Europe. Information was collected on the following aspects: incidence, prevalence, availability of information, non-therapeutic support for persons who stutter (PWS), providers of diagnostics and therapy, cooperating professionals, therapy approaches, forms, goals, financing, early detection and prevention, training of professionals, specialization in stuttering therapy, needs for improving the situation of PWS, and problems which hinder better care. Stuttering therapy for children is available in many countries and is frequently provided by the educational system. Therapy for adults is provided best by the health services but is not satisfactorily available everywhere. Modern therapeutic approaches coexist with obsolete ones. Lack of resources, awareness, entitlement, and assessment of therapy effectiveness are pervasive problems.

EDUCATIONAL OBJECTIVES

Readers will be able to describe and evaluate: (1) the therapy status of fluency disorders and service opportunities in various East-European countries; (2) the training of logopedists (speech-language pathologists); (3) specialization in stuttering therapy; and (4) the organizational services for PWS within the health and human service systems.

A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers

In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents' native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany.

EDUCATIONAL OBJECTIVES

Readers will discuss and evaluate: (1) the short-term effects of the Lidcombe Program in comparison to natural recovery on stuttering; (2) the impact of the Lidcombe Program on early stuttering in German-speaking preschool children.

Severity of dysfluency correlates with basal ganglia activity in persistent developmental stuttering

Previous studies suggest that anatomical anomalies [Foundas, A. L., Bollich, A. M., Corey, D. M., Hurley, M., & Heilman, K. M. (2001). Anomalous anatomy of speech-language areas in adults with persistent developmental stuttering. Neurology, 57, 207-215; Foundas, A. L., Corey, D. M., Angeles, V., Bollich, A. M., Crabtree-Hartman, E., & Heilman, K. M. (2003). Atypical cerebral laterality in adults with persistent developmental stuttering. Neurology, 61, 1378-1385; Foundas, A. L., Bollich, A. M., Feldman, J., Corey, D. M., Hurley, M., & Lemen, L. C. et al., (2004). Aberrant auditory processing and atypical planum temporale in developmental stuttering. Neurology, 63, 1640-1646; Jancke, L., Hanggi, J., & Steinmetz, H. (2004). Morphological brain differences between adult stutterers and non-stutterers. BMC Neurology, 4, 23], in particular a reduction of the white matter anisotropy underlying the left sensorimotor cortex [Sommer, M., Koch, M. A., Paulus, W., Weiller, C., & Buchel, C. (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet, 360, 380-383] could be at the origin of persistent developmental stuttering (PDS). Because neural connections between the motor cortex and basal ganglia are implicated in speech motor functions, PDS could also be associated with a dysfunction in basal ganglia activity [Alm, P. (2004). Stuttering and the basal ganglia circuits: a critical review of possible relations. Journal of Communication Disorders, 37, 325-369]. This fMRI study reports a correlation between severity of stuttering and activity in the basal ganglia and shows that this activity is modified by fluency shaping therapy through long-term therapy effects that reflect speech production improvement. A model of dysfunction in stuttering and possible repair modes is proposed that accommodates the data presented here and observations previously made by us and by others.

Effectiveness and Efficiency of a Universal Newborn Hearing Screening in Germany

The decision to mandate, finance, and implement a universal newborn hearing screening (UNHS) requires the evaluation of its therapy-directed benefit by comparing (1) a procedure employing a UNHS with (2) a targeted screening for at-risk babies for neonatal hearing disorders and (3) a procedure without systematic screening. In a cohort study the outcome of the UNHS program of Hessen in 2005 with 17,439 screened newborns was analyzed. Validity, effectiveness, and efficiency were evaluated and compared to a sample of 98 Hessian and 355 German children who were detected in 2005 as hearing-impaired but not by an UNHS. The UNHS group had a PASS rate of 97.0%. Forty-nine hearing-impaired children were diagnosed at a median age of 3.1 months and treated at a median age of 3.5 months. Corresponding values for the Hessian non-UNHS group were 17.8 and 21.0 months. For Germany the median age at diagnosis was 39.0 months. The age at therapy onset correlated negatively with parameters of speech/language and psychosocial development. A targeted screening would have resulted in a low sensitivity of 65.3%. Hence, a UNHS is the most effective way to an early therapy of neonatal hearing disorders with an optimal outcome.

The Interplay between Glottis and Vocal Tract during the Male Passaggio

The transition between 'chest' and 'head' register is essential for male opera singers in order to reach the higher pitches. The 'passaggio', which is a scale passage where this transition takes place, but also a maneuver of register equalization, is typically difficult to learn. Studies on parameters for a definition of this transition are restricted to a small number of singers so far. Audio, electroglottographic, and equivalent subglottic pressure signals of 11 male opera singers were recorded while singing scales on open back vowels and passing the register transition. A spectrum analysis of the audio signal revealed that the second harmonic (H2) dominates in 'chest', resonated by the first formant (F1), together with the fourth harmonic (H4), supported by the second formant (F2). During the passaggio, H2 level decreases because it loses the resonance of F1, while the third harmonic (H3) gains the resonance of F2. At this point the H4 level drops because that harmonic is no longer supported by F2. The transition from 'chest' to 'head' register is marked by characteristic changes in the amplitude patterns of the partials H2, H3, and H4, and the frequency progressions of the first two formants, defining an objective distinction between the two registers.

Cortical plasticity associated with stuttering therapy

Neuroimaging studies have indicated that persistent developmental stuttering (PDS) may be associated both with an abnormality in white matter of left-hemispheric speech areas and a right-hemispheric hyperactivity. The latter may compensate for the deficient structural connectivity in the left hemisphere. To investigate the effects of stuttering therapy on brain activity nine male adults with PDS underwent functional magnetic resonance imaging (fMRI) before and within 12 weeks after fluency shaping therapy. Brain response differences during overt sentence reading before and after therapy were assessed by utilizing random effects analyses. After therapy, a more widespread activation was observed in frontal speech and language regions and temporal areas of both hemispheres, particularly and more pronounced on the left side. Interestingly, distinct posttreatment left-sided activation increases were located directly adjacent to a recently detected area of white matter anomaly [M. Sommer, M.A. Koch, W. Paulus, C. Weiller, C. Buchel (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. The Lancet, 360, 380-383] suggesting that fluency shaping techniques reorganize neuronal communication between left-sided speech motor planning, motor execution, and temporal areas. Hence, a therapeutic mechanism can be assumed to remodel brain circuitry close to the source of the dysfunction instead of reinforcing compensation via homologous contralateral brain networks.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to: (1) describe brain activation changes detected shortly after fluency-shaping therapy; (2) identify left-hemispheric regions where a (re)functionalization after fluency-shaping therapy seems to occur adjacent to a recently described abnormal white matter region in PDS subjects; and (3) discuss how an effective cerebral compensation mechanism for stuttering could work.

Patterns and universals of mate poaching across 53 nations: the effects of sex, culture, and personality on romantically attracting another person's partner

As part of the International Sexuality Description Project, 16,954 participants from 53 nations were administered an anonymous survey about experiences with romantic attraction. Mate poaching--romantically attracting someone who is already in a relationship--was most common in Southern Europe, South America, Western Europe, and Eastern Europe and was relatively infrequent in Africa, South/Southeast Asia, and East Asia. Evolutionary and social-role hypotheses received empirical support. Men were more likely than women to report having made and succumbed to short-term poaching across all regions, but differences between men and women were often smaller in more gender-egalitarian regions. People who try to steal another's mate possess similar personality traits across all regions, as do those who frequently receive and succumb to the poaching attempts by others. The authors conclude that human mate-poaching experiences are universally linked to sex, culture, and the robust influence of personal dispositions.

Evidence for compensation for stuttering by the right frontal operculum

There is recent evidence of focal alteration in fibre tracts underlying the left sensorimotor cortex in persistent developmental stuttering (PDS) [Lancet 360 (2002) 380]. If, as proposed, this anatomical abnormality is the cause of PDS, then overactivation in the right hemisphere seen with functional neuroimaging in stutterers may reflect a compensatory mechanism. To investigate this hypothesis, we performed two functional magnetic resonance imaging (fMRI) experiments. The first showed systematic activation of a single focus in the right frontal operculum (RFO) in PDS subjects during reading, which was not observed in controls. Responses in this region were negatively correlated with the severity of stuttering, suggesting compensation rather than primary dysfunction. Negative correlation was also observed during the baseline task that consisted in passive viewing of meaningless signs, indicating that RFO compensation acts independently of specific demands on motor speech output. The second experiment, that involved a covert semantic decision task, confirmed that RFO activation does not require overt utterances or motor output. In combination these findings suggest that the RFO serves a nonspecific compensatory role rather than one restricted to the final stages of speech production.

Universal sex differences in the desire for sexual variety: tests from 52 nations, 6 continents, and 13 islands

Evolutionary psychologists have hypothesized that men and women possess both long-term and short-term mating strategies, with men's short-term strategy differentially rooted in the desire for sexual variety. In this article, findings from a cross-cultural survey of 16,288 people across 10 major world regions (including North America, South America, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, South/Southeast Asia, and East Asia) demonstrate that sex differences in the desire for sexual variety are culturally universal throughout these world regions. Sex differences were evident regardless of whether mean, median, distributional, or categorical indexes of sexual differentiation were evaluated. Sex differences were evident regardless of the measures used to evaluate them. Among contemporary theories of human mating, pluralistic approaches that hypothesize sex differences in the evolved design of short-term mating provide the most compelling account of these robust empirical findings.

Event-related fMRI for the suppression of speech-associated artifacts in stuttering

The purpose of this study was to establish functional magnetic resonance imaging (fMRI) for the investigation of brain function during overt speech production in stuttering. Up to now this technique has rarely been used for the investigation of speech production paradigms because artifacts related to overt speaking largely impair the sensitivity toward task-related activation. Recently, the temporal delay of the hemodynamic response has been exploited to achieve a suppression of speech-related artifacts. By the limitation to very short utterances (one word), a temporal segregation of the respective effects was accomplished by means of an event-related experimental design. However, the investigation of speech production in persons who stutter requires a more extensive speaking situation. Since longer and more complex utterances evoke more symptoms of stuttering than reading of single words, a useful task should at least include the reading of full sentences. In this study we performed simulations to investigate the correlation of speech-related artifacts with the respective hemodynamic response in dependency on speech duration and rate of data sampling. Furthermore, we show that prolonged stimulus durations and repetition times of 3 s still allow an effective suppression of speech-related artifacts in fluent as well as in nonfluent speakers. Not only were obvious false activations at high contrast cerebrospinal fluid tissue borders widely eliminated, subjects also displayed consistent activation in speech-related and motor areas. As these results widely resemble those obtained by earlier neuroimaging studies on language production, event-related fMRI seems to be capable of recording neurophysiological correlates of overt speech production.

Universal sex differences in the desire for sexual variety: tests from 52 nations, 6 continents, and 13 islands

Evolutionary psychologists have hypothesized that men and women possess both long-term and short-term mating strategies, with men's short-term strategy differentially rooted in the desire for sexual variety. In this article, findings from a cross-cultural survey of 16,288 people across 10 major world regions (including North America, South America, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, South/Southeast Asia, and East Asia) demonstrate that sex differences in the desire for sexual variety are culturally universal throughout these world regions. Sex differences were evident regardless of whether mean, median, distributional, or categorical indexes of sexual differentiation were evaluated. Sex differences were evident regardless of the measures used to evaluate them. Among contemporary theories of human mating, pluralistic approaches that hypothesize sex differences in the evolved design of short-term mating provide the most compelling account of these robust empirical findings.

The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.

Diskriminative Fürsorglichkeit von Tanten und Onkeln

Zusammenfassung: 398 Studierende beurteilten, wie sehr die jeweiligen Tanten und Onkel um das Wohlergehen der befragten Person besorgt sind, und ob ihnen mehr Fürsorglichkeit vom matrilateralen oder patrilateralen Verwandten zuteil wird. Der durch Vaterschaftsunsicherheit erwartete Lateralitätseffekt (größere Investition in Nachkommen der Schwester als in die des Bruders) war statistisch signifikant, aber kleiner als der Geschlechtereffekt (Tanten kümmern sich mehr als Onkel). Die ANCOVA der Fürsorgeratings, korrigiert um Alter und Wohnortnähe des Verwandten, zeigten zusätzlich eine signifikante Interaktion (matrilateraler Bias größer bei Tanten als bei Onkeln). Weiterhin wurden die Teilnehmer gefragt, mit welchen Namen sie ihre verschiedenen Großeltern, Tanten und Onkel ansprechen. Verwandtenspezifische diskriminative Fürsorge spiegelte sich in der Vielfalt individueller Anredeformen für die vier Großeltern wider, nicht aber in den Anredeformen für Onkel und Tanten. Die Ergebnisse werden im Zusammenhang mit neueren Untersuchungen zum Verwandteninvestment diskutiert und als Anpassung an vergangene Umwelten interpretiert.