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Purpose: The aims of this study were to investigate the occurrence of stuttering behavior across time and to evaluate the relationship between stuttering behavior and language ability in children with Down syndrome. Method: A national age cohort of Norwegian first graders with Down syndrome ( N = 75) participated in the study. Speech samples from a story-retelling task and a picture book dialogue as well as standardized measures of vocabulary, grammar, and nonverbal mental ability were collected at two time points approximately 5 months apart. Stuttering behavior was evaluated through counting stuttering-like disfluencies and stuttering severity ratings. The relationship between stuttering behavior and language ability was investigated through hierarchical regression analysis. Results: The participants had stuttering severity ratings ranging from no stuttering behavior to severe and displayed all types of stuttering-like disfluencies. There were significant relationships between stuttering behavior and language ability at the first time point, whereas the relationships were not significant at the second time point. The stuttering severity ratings were significantly predicted by language ability across time, whereas the frequency of stuttering-like disfluencies was not. Conclusions: The occurrence of stuttering behavior was high across the measures and time points; however, the relationship between stuttering behavior and language ability varied across these variables. Thus, the nature of the relationship does not seem to follow a strict pattern that can be generalized to all children across time.

Purpose: The purpose of this pilot study was to determine the effectiveness and acceptability of an initial module (1.1; active listening skills) of the Simulated Training in Evidence-Based Practice for Stuttering (STEPS) program, a theory-driven, multimodule, content and learning platform designed to advance knowledge and skills in working with culturally and linguistically diverse persons who stutter of all ages. Method: Fifteen preservice speech-language pathologists (SLPs) were randomly assigned to complete either the STEPS 1.1 module or a control module. In both conditions, all participants engaged in pre– and post–clinical interviews with a standardized patient portraying a parent of a child who stutters. Prior to participation, all participants provided self-ratings on the Jefferson Scale of Physician Empathy–Health Profession Student. Post participation, trained observers rated all participants' active listening behaviors using the Active Listening Observation Scale–Modified. Post participation, the STEPS 1.1 participants also completed an intervention acceptability questionnaire. Results: No differences between groups were found in self-perceived clinical empathy prior to participation. Participants who completed the STEPS 1.1 condition utilized paraphrasing and client-directed eye gaze significantly more frequently at posttest than at pretest and significantly more than the control group at posttest. Quantitative and qualitative responses from the participants who completed STEPS 1.1 indicated high acceptability of its content, structure, duration, and perceived impact. Conclusion: Preliminary data from the present pilot study support use of the STEPS 1.1 module to improve preservice SLPs' use of skills that have been shown to predict perceived clinical empathy and increase assessment and treatment effectiveness.

Purpose: The purpose of this study was to examine the impact of self-disclosure and strategies for communication competence on perceptual ratings and performance evaluations of undergraduate students who do and do not stutter by professors who require oral presentations. Method: Two hundred thirty-eight college instructors who require oral presentations in their classes participated in this study. Each participant viewed one video of six possible randomized conditions varying according to the presence and disclosure of stuttering (i.e., fluent, stuttering, stuttering + disclosure) and level of communication competence (i.e., high vs. low). Participants evaluated public speaking performance against a standardized rubric and rated the student along 16 personality traits. Results: Results of separate 2 × 3 analyses of variance revealed that professors perceived a student who disclosed stuttering, compared to the identical video without disclosure, more positively overall. Significant interactions between fluency (i.e., presence vs. absence of stuttering vs. disclosure of stuttering) and communication competence (i.e., high vs. low) were found for overall performance evaluation scores. The video during which the student disclosed stuttering and presented with low communication competence was given a higher score than the identical video without disclosure. Conclusions: Professors respond positively to both strategies for high communication competence and self-disclosure. High communication competence behaviors mitigate positive feedback bias. Disclosure results in improved positive perceptions across levels of communication competence. For students presenting with low communication competence, disclosure may improve evaluation of performance in oral presentations. The greatest perceptual and evaluative benefits were achieved with the combination of the two strategies.

Purpose: Evidence increasingly indicates that people with developmental stuttering have auditory perception deficits. Our previous research has indicated similar but slower performance in categorical perception of the speech sounds under the quiet condition in children who stutter and adults who stutter (AWS) compared with their typically fluent counterparts. We hypothesized that the quiet condition may not be sufficiently sensitive to reveal subtle perceptual deficiencies in people who stutter. This study examined this hypothesis by testing the categorical perception of speech and nonspeech sounds under backward masking condition (i.e., a noise was presented immediately after the target stimuli). Method: Fifteen Cantonese-speaking AWS and 15 adults who do not stutter (AWNS) were tested on the categorical perception of four stimulus continua, namely, consonant varying in voice onset time (VOT), vowel, lexical tone, and nonspeech, under the backward masking condition using identification and discrimination tasks. Results: AWS demonstrated a broader boundary width than AWNS in the identification task. AWS also exhibited a worse performance than AWNS in the discrimination of between-category stimuli but a comparable performance in the discrimination of within-category stimuli, indicating reduced sensitivity to sounds that belonged to different phonemic categories among AWS. Moreover, AWS showed similar patterns of impaired categorical perception across the four stimulus types, although the boundary location on the VOT continuum occurred at an earlier point in AWS than in AWNS. Conclusions: The findings provide robust evidence that AWS exhibit impaired categorical perception of speech and nonspeech sounds under the backward masking condition. Temporal processing (i.e., VOT manipulation), frequency/spectral/formant processing (i.e., lexical tone or vowel manipulations), and nonlinguistic pitch processing were all found to be impaired in AWS. Altogether, the findings support the hypothesis that AWS might be less efficient in accessing the phonemic representations when exposed to a demanding listening condition. Supplemental Material: https://doi.org/10.23641/asha.20249718

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

A disability studies approach seeks to understand and address political and social issues that affect disabled individuals. Disability studies scholars employ various models of disability to address and oppose the oppression and discrimination of disabled individuals. A disability studies approach, however, has largely been absent in studies that have investigated the lived experiences of people who stutter.To examine the understandings young adult South African men who stutter hold of whether, and in what way, stuttering may be considered to be a disability.A total of 15 men who stutter, aged 20-39 years, participated in the study. Semi-structured interviews and two focus groups discussions were conducted to collect data for the study. The data were analysed according to a phenomenological approach and the affective turn in social research.The results indicated that some men in this study understood stuttering as a speech disorder that can be controlled, while other men constructed stuttering as a disability, subjectively positioning themselves either as disabled or non-disabled men.This article emphasizes the importance of adopting a disability studies approach when examining the lived experiences of people who stutter and enhancing intervention strategies to adequately address the disabled needs of such individuals.What is already known on the subject? The past few decades have seen researchers investigating the personal and social experiences of people who stutter. However, empirical studies exploring the disabling experiences of people who stutter have been absent from the existing body of knowledge. What this paper adds to existing knowledge? This research aimed to provide comprehensive insight into the disabling experiences of people who stutter. The results gave an insight into the oppression and disablism experienced by people who stutter. More specifically, the findings demonstrated how individuals who stutter are disabled by oppressive communication practices that dominate spaces of education and employment. What are the potential or actual clinical implications of this work? Several men in this study attended speech therapy to gain control over their stuttering. For a number of participants, speech therapy proved a valuable experience, while others saw speech therapy as being out of touch with their lived reality of stuttering. Speech and language therapists are encouraged to employ a disability studies approach in order to enhance intervention strategies to adequately address the disabling needs of people who stutter.

Purpose:Children with speech sound disorders (SSDs) comprise a large portion of caseloads for school-based speech-language pathologists (SLPs). Despite the existence of several evidence-based SSD intervention approaches, the translation from research to practice is often limited by ecological validity because of various factors unique to school settings (e.g., scheduling constraints, caseload size, child availability). The purpose of this study was to use the experience sampling method (ESM) to examine the current practices of school-based SLPs when treating children with SSDs on their caseloads.Method:SLPs (N= 106) from 42 different states working full-time in school-based K–12 settings participated in this study. At the beginning of the study, each SLP completed a one-time demographic survey about treatment practices for children with SSDs. The SLPs then participated in a series of brief surveys every day for one workweek using a specialized ESM phone application that randomly alerted participants to report on their treatment practices for children with SSDs.Results:Findings revealed that although most SLPs reported using a variety of SSD intervention approaches in a one-time survey, the majority of SLPs reported using one of three approaches in situ: the traditional articulation therapy approach, cycles, and minimal pairs. We also report a significant negative relationship between the years of experience of an SLP and the number of different approaches used.Conclusions:This study is the first to use the ESM to determine which approaches school-based SLPs use to treat children with SSDs. Findings demonstrate that SLPs have knowledge of many different SSD approaches but tend to utilize only a few in school-based settings.

Purpose: The purpose of this study was to synthesize the methodological variability in the speech perception literature for school-age children with residual speech sound disorder (RSSD), with the primary intention of using the existing knowledge to inform clinical decisions and optimize treatment outcomes for children. Method: Ten electronic databases were systematically searched to identify articles examining the speech perception skills of school-age children with RSSD. A total of 11 articles met inclusion criteria, reporting of methodological characteristics was rated and compared across studies, and findings were summarized. Results: The majority of studies reviewed here confirmed the presence of a perceptual deficit for a subset of children with RSSD. However, marked variability across study methodologies limits clinical interpretation and application of the findings. Conclusions: Despite limited research in children with RSSD and wide variability across study procedures, stimulus type, perception type, and task type emerged as potential key factors that provide critical insight into a child's perceptual skill. The current evidence suggests that deficits in speech perception may significantly impact acquisition of accurate phoneme production for children with RSSD. Furthermore, these findings suggest that assessment and treatment of speech perception may be a critical component of an intervention program for school-age children, although further research is needed to determine effective clinical procedures.

Purpose: Listening to children using age-appropriate techniques supports evidence-based clinical decision-making. In this article, we test the Sound Effects Study Drawing Protocol, an arts-based technique, to support children with speech sound disorder (SSD) to express their views about talking. Method: Participants were 124 Australian children aged 4–5 years in the Sound Effects Study. Their parents and teachers were concerned about their talking, and they were assessed as having SSD on the Diagnostic Evaluation of Articulation and Phonology. Drawings and children's interpretations were elicited then analyzed using the (a) Who Am I? Draw-a-Person Scale and (b) Sound Effects Study Focal Points. Results: Drawings were developmentally typical for 4- to 5-year-olds. The six Sound Effects Study Focal Points were identified across the 124 drawings: body parts and facial expressions, talking and listening, relationships and connection, positivity, negativity, and no talking. Participants portrayed talking and listening as an action requiring mouths and ears represented by symbols (letters, speech bubbles) or as an activity with a variety of people. Children typically portrayed themselves as happy when talking; however, some portrayed negativity and some chose not to draw talking. Conclusions: In keeping with Articles 12 and 13 of the Convention on the Rights of the Child, this research demonstrated that 4- to 5-year-old children with SSD can express their views about talking via drawing. Professionals may use the Sound Effects Study Drawing Protocol as a child-friendly technique to support children to express views to guide holistic, evidence-based, child-centered speech-language pathology practice.

Priapism is a persistent penile erection lasting longer than 4 hours, that needs emergency management. This disorder can induce irreversible erectile dysfunction. There are three subtypes of priapism: ischemic, non-ischemic, and stuttering priapism. If the patient has ischemic priapism (IP) of less than 24-hours (h) duration, the initial management should be a corporal blood aspiration followed by instillation of phenylephrine into the corpus cavernosum. If sympathomimetic fails or the patient has IP from 24 to 48h, surgical shunts should be performed. It is recommended that distal shunts should be attempted first. If distal shunt failed, proximal, venous shunt, or T-shunt with tunneling could be performed. If the patient had IP for 48 to 72h, proximal and venous shunt or T-shunt with tunneling is indicated, if those therapies failed, a penile prosthesis should be inserted. Non-ischemic priapism (NIP) is not a medical emergency and many patients will recover spontaneously. If the NIP does not resolve spontaneously within six months or the patient requests therapy, selective arterial embolization is indicated. The goal of the management of a patient with stuttering priapism (SP) is the prevention of future episodes. Phosphodiesterase type 5 (PDE5) inhibitor therapy is considered an effective tool to prevent stuttering episodes but it is not validated yet. The management of priapism should follow the guidelines as the future erectile function is dependent on its quick resolution. This review briefly discusses the types, pathophysiology, and diagnosis of priapism. It will discuss an updated approach to treat each type of priapism.

Purpose: Contemporary motor theories indicate that well-practiced movements are best performed automatically, without conscious attention or monitoring. We applied this perspective to speech production in school-age children and examined how dual-task conditions that engaged sustained attention affected speech fluency, speech rate, and language productivity in children with and without stuttering disorders. Method: Participants included 47 children (19 children who stutter, 28 children who do not stutter) from 7 to 12 years of age. Children produced speech in two baseline conditions with no concurrent task and under a dual-task condition requiring sustained attention to on-screen stimuli. Measures of speech fluency, speech rate, and language productivity were obtained for each trial and compared across conditions and groups. Results: Dual-task conditions resulted in a reduction in stutter-like disfluencies relative to the initial baseline speaking condition. Effects were similar for both groups of children and could not be attributed to decreases in language productivity or a simple order effect. Conclusions: Findings suggest that diverting attention during the process of speech production enhances speech fluency in children, possibly by increasing the automaticity of motor speech sequences. Further research is needed to clarify neurophysiological mechanisms underlying these changes and to evaluate potential clinical applications of such effects. Supplemental Material: https://doi.org/10.23641/asha.19945838

The neurophysiological dynamics of the occurrence of a stuttering event are largely unknown. This sensor-level EEG study investigated whether already the intention to speak alters the formation of the speech production network in stuttering.We studied alpha (8-13 Hz), low beta (15-25 Hz) and high beta (25-30 Hz) power modulation in 19 adults with developmental stuttering (AWS) and 19 fluently speaking control participants during speech intention.Both groups show that the anticipation of overt reading coincides with broadband low-frequency suppression in posterior sensors, a common sign of network formation for speech production. Prior to fluent speech, frontotemporal alpha and low-beta power were weaker in AWS with mild stuttering but stronger in AWS with severe stuttering. These correlations were not significant prior stuttered speech. Further, post hoc comparisons confirmed the difference between AWS with mild and severe stuttering in low beta power.AWS with more severe stuttering seem to show stronger maintenance of the current cognitive or sensorimotor state, as stuttering severity was associated with increased beta power. Increased beta power levels may influence subsequent speech preparation and execution processes.Upcoming breakdowns of the speech production network as evident in actual stuttering are related to beta power during the intention to speak.

Stuttering can co-occur with phonological and/or language impairment in a nontrivial number of children. This article provides a framework for addressing concomitant phonology/language impairment and stuttering through the application of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Described is a multifactorial approach to understanding stuttering, the application of the ICF to treating children who stutter with concomitant disorders, and models for structuring-related therapy. A case study is explored to illustrate this process and includes a sample treatment plan with goals, short-term objectives, and sample activities.

Therapy for school-aged children who stutter (CWS) and their parents should be holistic, individualized, and multidimensional, considering the child within their real-life context and using a solution rather than problem-focused approach; highlighting and drawing on the strengths, resources, values; and coping skills that each family brings. Therapy at the Michael Palin Centre draws on a number of psychological approaches, including solution-focused brief therapy, cognitive behavior therapy, acceptance and commitment therapy, and compassion-focused therapy. Aspects of these approaches are discussed in this article to describe the therapeutic intervention for two school-aged CWS (aged 8 and 15 years). The Palin Model (2019) is used to conceptualize the factors that influence stuttering, as well as the different components of therapy that may be relevant for each individual family. The overarching aim of therapy, for children to become competent and effective communicators, whether they stutter or not, is described through a range of practical therapeutic activities, including exploring communication skills, openness and desensitization, exploring thoughts and feelings around stuttering, building confidence, expanding comfort zones, and developing self-efficacy. Qualitative and quantitative outcomes are presented for each clinical case.

Avoidance Reduction Therapy for Stuttering (ARTS) is a behavioral therapy for children and adults that incorporates speech therapy and counseling to reduce learned physical and socioemotional struggle that constitute the problem for the stutterer.a While stuttering is a neurodevelopmental difference, efforts to mask a stigmatized identity can contribute to avoidance, shame, and fear of speaking. This article provides theoretical foundations for therapy principles, describes the processes of self-acceptance and change, and outlines therapy goals and activities using child-friendly explanations and case study vignettes.

Purpose: The purpose of this study was to investigate whether there are elevated symptoms of anxiety or depression in children and adolescents (aged 2–18 years) who stutter, and to identify potential moderators of increased symptom severity. Method: We conducted a preregistered systematic review of databases and gray literature; 13 articles met criteria for inclusion. A meta-analysis using robust variance estimation was conducted with 11 cohort studies comparing symptoms of anxiety in children and adolescents who do and do not stutter. Twenty-six effect sizes from 11 studies contributed to the summary effect size for anxiety symptoms (851 participants). Meta-analysis of depression outcomes was not possible due to the small number of studies. Results: The summary effect size indicates that children and adolescents who stutter present with increased anxiety symptoms ( g = 0.42) compared with nonstuttering peers. There were insufficient studies to robustly analyze depression symptoms, and qualitative review is provided. No significant between-groups differences were reported in any of the depression studies. Conclusions: Preliminary evidence indicates elevated symptoms of anxiety in some children and adolescents who stutter relative to peers. There was a tendency toward higher depression scores in this population, although reported between-groups differences did not reach statistical significance. These findings require replication in larger, preferably longitudinal studies that consider factors that may moderate risk. Nevertheless, our findings highlight a need for careful monitoring of mental health and well-being in young people who stutter. Supplemental Materials: http://osf.io/5m6zv

Objectives: In this study, we examined the effectiveness of the Enriched Stuttering Intervention Program (ESIP), developed by the researchers, on children with stuttering difficulties. More specifically, we examined the frequency of stuttering, duration of stuttering, behaviors accompanying stuttering, and whether there was a significant difference in the naturalness of speech. Methods: We used a quasi-experimental design. The study group study consisted of 5 boys admitted to a Special Education and Rehabilitation Centre during 2019-2020 and diagnosed by a pediatric psychiatrist with stuttering. The information forms prepared by the researchers were used to be completed by the family, the teacher, and the child to collect personal information about the children. We used the Stuttering Severity Instrument (SSI-4) to collect our research data. Results: When we compared pre-test and post-test data, we found a statistically significant difference in the severity of stuttering in the 5 children. Conclusion: The Enriched Stuttering Intervention Program improved stuttering in this group of children.

Purpose: The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering. Method: We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated. Results: Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased. Conclusions: Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

Purpose:The purpose of this study was to examine the perceptual ratings and performance evaluations of students who do and do not stutter by professors who require oral presentations. Additionally, this study sought to investigate the influence of behaviors related to communication competence on perceptual and evaluative ratings.Method:One hundred fifty-eight college instructors who require oral presentations in their classes participated in this study. Participants viewed one video of four possible randomized conditions: (a) presence of stuttering + low communication competence, (b) absence of stuttering + low communication competence, (c) presence of stuttering + high communication competence, and (d) absence of stuttering + high communication competence. Participants evaluated student performance against a standardized rubric and rated the student along 16 personality traits.Results:Results of separate 2 × 2 analyses of variance revealed professors' view and evaluate students presenting with high communication competence more positively overall, regardless as to whether stuttering is present or not. Significant interactions between fluency (i.e., presence vs. absence of stuttering) and communication competence (i.e., high vs. low) were found for negative personality traits, as well as delivery evaluation scores. The video for which the student stuttered and presented with low communication competence was rated more positively than the video for which the student did not stutter and presented with low communication competence.Conclusions:Professors perceive and evaluate students who stutter differently from their nonstuttering peers, and those ratings are moderated by levels of communication competence. High-communication-competence behaviors improved perceptual and evaluation scores; however, in the presence of low-communication-competence behaviors, professors overcorrect in the form of positive feedback bias, which may have negative long-term academic consequences.

Purpose: Self-help and support activities are often recommended for people who stutter, and there is growing interest in understanding whether and how such experiences might be beneficial for children who stutter. The purpose of this study was to explore the potential impact of participation in Camp SAY, an overnight support-based summer camp experience for children who stutter, by measuring changes in scores on the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Method: Participants were 107 children who stutter (age range: 8–18 years) who attended Camp SAY during the summers of 2013, 2015, and/or 2016. We examined changes in OASES scores (a) pre- to postcamp, (b) the durability of changes 6 months after the conclusion of the camp, and group differences (c) between school-age campers and teenage campers and (d) between first-time campers and those who had previously attended the camp. Results: Comparison of precamp to postcamp scores revealed significant improvements related to reactions to stuttering, quality of life, and overall adverse impact of stuttering. Scores on each subsection of the OASES were maintained (and further improved) 6 months after camp. There were no significant differences between school-age campers and teenage campers. Both first-time and returning campers showed significant improvements related to reactions to stuttering, though first-time campers had a significantly larger improvement in attitudes toward communication related to stuttering than returning campers. Conclusion: These outcomes suggest that participation in support activities, like Camp SAY, is associated with significant reductions in the overall adverse impact of stuttering and can therefore be beneficial for children who stutter.

Purpose: Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood. Method: This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed. Results: Six-month-old children who were less able to “recover from distress,” indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (β = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (β = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (β = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years. Conclusions: Behavior and temperament were associated with stuttering persistency—seemingly as both predictor and consequence—but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered. Supplemental Material https://doi.org/10.23641/asha.16869479

Summary Developmental stuttering is a speech disorder characterized by disruption in the forward movement of speech. This disruption includes part-word and single-syllable repetitions, prolongations, and involuntary tension that blocks syllables and words, and the disorder has a life-time prevalence of 6–12%. Within Vanderbilt’s electronic health record (EHR)-linked biorepository (BioVU), only 142 individuals out of 92,762 participants (0.15%) are identified with diagnostic ICD9/10 codes, suggesting a large portion of people who stutter do not have a record of diagnosis within the EHR. To identify individuals affected by stuttering within our EHR, we built a PheCode-driven Gini impurity-based classification and regression tree model, PheML, by using comorbidities enriched in individuals affected by stuttering as predicting features and imputing stuttering status as the outcome variable. Applying PheML in BioVU identified 9,239 genotyped affected individuals (a clinical prevalence of ∼10%) for downstream genetic analysis. Ancestry-stratified GWAS of PheML-imputed affected individuals and matched control individuals identified rs12613255, a variant near CYRIA on chromosome 2 (B = 0.323; p value = 1.31 × 10−8) in European-ancestry analysis and rs7837758 (B = 0.518; p value = 5.07 × 10−8), an intronic variant found within the ZMAT4 gene on chromosome 8, in African-ancestry analysis. Polygenic-risk prediction and concordance analysis in an independent clinically ascertained sample of developmental stuttering cases validate our GWAS findings in PheML-imputed affected and control individuals and demonstrate the clinical relevance of our population-based analysis for stuttering risk.

Purpose This article is the second in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. The purpose of this article was to apply and explore the validity of newly developed Transtheoretical measures for adolescents who stutter. Method The online survey was completed by a national sample of 173 adolescents who stutter between the ages of 13 and 21 years. The multipart survey included a Stage of Change scale, Decisional Balance scale, and Situational Self-Efficacy scale. Participants also completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES), either the teenage or adult version depending on the participant's age, so preliminary construct validity of the new scales could be examined. Exploratory factor analyses were conducted to determine model fit and reduce the scales to the most meaningful items. External validity of the three-part survey was examined by comparing OASES scores across stage of change as well as evaluating the functional relations between the three scales. Results Adolescents' readiness to manage stuttering could be clearly described with five discrete stages, although most of the respondents reported being in the Maintenance stage. The pros of managing stuttering reliably predicted stage placement. Internal consistency of the scales ranged from good to excellent. OASES scores differed across stages of readiness in complex but predictable ways. Conclusions These findings suggest that the Transtheoretical Model fits the target behaviors involved stuttering management among adolescents. Further examination of the application of the model to validate a stage-based framework for change among individuals who stutter is warranted.

The King's Speech is a 2010 film based on historical facts of the friendship between King George VI of England, who had a stutter, and Lionel Logue, a speech therapist from Australia who treated him. The film presents a neuroscientific examination of speech and stuttering as a disorder that forms the basis of Logue's seemingly bizarre treatment and actions.

Purpose: This study reports the development, refinement, and exploration of the psychometric properties of the Vanderbilt Responses to Your Child's Speech (VRYCS) rating scale, a novel measure designed to assess parents' self-perceived responses to the speech of their children who stutter (CWS). Method: Parents of 214 young (ages 2;4[years;months]–5;11) CWS completed the original 40-item version of the VRYCS. Content analyses and an exploratory factor analysis determined the scale's factors and identified specific items corresponding to each. Items that did not load onto the factors were removed and internal consistency was assessed. Results: The final 18-item VRYCS rating scale includes five factors relating to parents' responses to the speech of their CWS including (a) Requesting Change, (b) Speaking for the Child, (c) Supporting Communication, (d) Slowing and Simplifying, and (e) Responding Emotionally. Reliability was demonstrated, responses by parents of CWS were described, and a revised scoring form developed. Conclusions: The VRYCS is a valid and reliable tool for assessing and exploring parents' perceptions of their own responses to the speech of their CWS for clinical and research purposes. Clinical applications of the VRYCS for assessment and treatment of childhood stuttering are discussed.

Purpose: We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males. Method: We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7–30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves. Results: The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern. Conclusions: In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers. Supplemental Material: https://doi.org/10.23641/asha.21554877

BACKGROUND: Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non‐verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning. OBJECTIVES: Primary objective To assess the immediate and long‐term effects of non‐pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi‐RCTs that assessed non‐pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait‐list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial. All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects. The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait‐list control group at post‐test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) −2.16, 95% confidence interval (CI) −3.48 to −0.84, 4 studies, 151 participants; P = 0.001; very low‐certainty evidence). However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate‐certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long‐term follow‐up. The long‐term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within‐group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow‐up, and showed a significant reduction in frequency of stuttering. AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait‐list control group in children aged up to six years at post‐test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long‐term effects of other non‐pharmacological interventions for stuttering compared to no intervention or a wait‐list control group.

Purpose This study measured between-groups differences in perceived speech skills and personality characteristics of a 12-year-old male child who stutters (CWS) as a function of a written factual stuttering disclosure statement, delivered by the CWS, his “mother,” or his “teacher.” Method Four hundred twenty-four college-age adults were assigned to one of four groups, including three experimental groups (i.e., written self-disclosure, mother-written disclosure, and teacher-written disclosure) and a control group (no written disclosure). Participants in the control conditions viewed a brief video of the CWS. In the experimental conditions, participants read a brief written disclosure statement for 30 s, followed by the same video used in the control condition. After viewing the video, all participants completed surveys relative to their perceptions of the CWS speech skills and personality characteristics. Results Results reveal that a written stuttering disclosure statement provided by the mother correlated with select significant desirable perceptual differences of the CWS, while a written disclosure statement provided by the CWS yielded insignificant or even undesirable perceptual differences of the CWS. Written stuttering disclosures provided by a “teacher” did not yield any significant between-groups differences in the perception of a CWS. Gender affiliation was found to be a source of covariance in a number of perceived speech skills and personality characteristics. Conclusions Written stuttering disclosure statements provided by the “mother” correlated with select favorable perceptual differences of speech skills and personal characteristics of a CWS. Clinically, the application of novel methods (written and oral disclosure statements) and sources (i.e., CWS advocates such as “mother” and “teacher”) of stuttering disclosure statement can be integrated into a systematic therapeutic program, creating an innovative approach of scaffolding self-advocacy via stuttering disclosure in CWS. Supplemental Material https://doi.org/10.23641/asha.15505857

Purpose Disfluencies associated with stuttering generally occur in the initial position of words. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Our primary goals were to identify patterns in overt features of WFDs and to extend our understanding of this clinical profile by focusing on aspects of stuttering that lie beneath the surface. Method Analyses explored the patterns and distributions of the child's observable stuttering behaviors, in addition to his awareness, perceptions, and subjective experience of stuttering. Results Findings indicated that the WFD profile consists of relatively consistent and distinct overt features. We also found that, in many ways, the child perceived the impact of his disfluencies much like other children who stutter, even though his disfluencies manifested in a less common form. Conclusion Findings suggest the need for increased awareness of the varied forms stuttering may take in order to ensure accurate diagnosis, clear communication to clients and parents, and timely access to appropriate intervention.

Background Lack of proper and timely patients' access to speech pathologists can affect the treatment and follow-up process; therefore, patients do not achieve the expected therapeutic goals. The aim of this study was to determine the effect of tele-rehabilitation on the stuttering patients using the goal attainment scaling (GAS). Methods This interventional study was carried out on patients who visited the rehabilitation centers affiliated to the Jahrom Welfare Office. They underwent remote speech therapy using Skype. To evaluate the treatment outcomes of the stuttering patients, GAS was used. Results The participants' speech and lingual skills improved using videoconferencing. The mean score of total GAS for patients was 53.08. Of 112 health goals, patients reached the expected or higher than expected levels in 78 goals. Conclusions Rehabilitation through video conferencing was effective for patients with stuttering, improved their speech, and decreased their stuttering. Since, application of remote rehabilitation services can provide regular access to healthcare services, it can lead to improving patient treatment provide more frequent and faster treatment follow-up.

The PhenX Toolkit (https://www.phenxtoolkit.org/) is an online catalog of recommended measurement protocols to facilitate cross-study analyses for biomedical research. An expert review panel (ERP) reviewed and updated the PhenX Toolkit Speech and Hearing domain to improve the precision and consistency of speech, language, and hearing disorder phenotypes. A three-member ERP convened in August 2018 to review the measurement protocols in the PhenX Speech and Hearing domain. Aided by three additional experts in voice assessment, vertigo, and stuttering, the ERP updated the 28 protocols to reflect the latest science and technology. ERP recommendations include six new protocols, five updated protocols (from the same source), and one retired protocol. New additions include two voice-related, three hearing-related, and two speech-related protocols. Additions reflect new phone/tablet applications for hearing and language, and clinical evaluations of voice. "Language" was added to the domain name, which is now "Speech, Language, and Hearing," to represent language-related protocols. These protocols can facilitate the assessment of speech, language, and hearing in clinical and population research. Common data elements (i.e., use of the same variables across studies) used by geneticists, otolaryngologists, audiologists, speech-language pathologists, and in other disciplines can lead to cross-study data integration and increased statistical power when studies are combined.

Knowledge of the fidelity with which interventions are delivered in research studies is crucial to meaningful examination of intervention impact. This paper presents a review of fidelity implementation (FOI) measurements in interventions jointly delivered by speech-language pathologists (SLP) and parents in research for preschool-aged children who stutter (CWS). Four key FOI components were examined: dosage, adherence, quality, responsiveness. Thirty-six studies met the inclusion criteria for this study. Articles were published between 1990 and 2020 described nine different interventions and examined CWS aged 2-6 years. No study reported all FOI components in both the clinical and the home setting and five did not report on any FOI component in either setting. The number of FOI components reported ranged from 0 to 4 in both clinical (M = 1.5) and home (M = 1.0) settings. Across studies, dosage was most often reported (n = 27, 75.0%) and responsiveness was least often reported (n = 16, 44.4%). The number of FOI components reported in articles did not increase over time, although a trend towards greater reporting in recent years was observed. Poor reporting of FOI in intervention research presents a serious methodological concern that impacts the ability of clinicians and researchers to interpret the findings of these studies. Rigorous measurement and reporting of FOI in future intervention studies is required in order to better inform evidence-based practices for interventions with CWS.

Introduction Research has revealed the presence of emotional, behavioral, and cognitive reactions in young children who stutter; however, prior studies have not examined the overall impact of stuttering on young children's lives. Such information is necessary for improving understanding of how stuttering affects young children and for ensuring appropriate early intervention. Method This study employed an adaptation of the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children that was designed to ask parents about their perceptions of the impact of stuttering on their young children. Thirty-eight parents of young children who stutter (2–5 years of age) provided their perceptions of the impact of stuttering on their children. Parents rated how certain they were in their judgments using a 5-point scale to provide an indication of their confidence in proxy ratings of impact. Results Results indicated that, on average, parents perceived that stuttering affected their children negatively. Qualitatively, parents provided descriptions of the impact of stuttering on their children's quality of life, communication difficulties across people and situations, and reactions to stuttering; they also commented on their own feelings and strategies for handling impact. On average, parents perceived themselves to be certain in rating the impact of stuttering on their children. Conclusions Results indicated that parents identified adverse impact in their children's lives. Even though parents considered themselves to be certain in their impact ratings, clinicians and researchers should also assess the perspective of the children if appropriate. This is because present findings reveal that parents may not have insight into all aspects of impact, in particular, cognitive reactions to stuttering. Still, parents' perceptions of impact are important for clinicians to consider when giving recommendations for therapy, as they can provide important insight into the family's needs.

BACKGROUND Simulation-based learning can be used in university programmes to provide speech-language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students' development of skills in clinical practice with people who stutter. AIMS (1) To evaluate students' clinical skills in managing stuttering within a simulation-based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students' performance. METHODS & PROCEDURES Speech-language pathology students (n = 114) participated in a simulation-based stuttering programme in addition to academic coursework in fluency disorders. Students' clinical skills were assessed over two simulation sessions using the SPIRS-Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra-rater reliability and internal consistency of the SPIRS-Stuttering tool were also explored. OUTCOMES & RESULTS Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation-based stuttering programme. Good content validity was achieved for the SPIRS-Stuttering tool with a low level of intra-rater reliability and variable internal consistency. CONCLUSIONS & IMPLICATIONS This study identified that students' clinical skills in stuttering improved during participation in a simulation-based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS-Stuttering tool enabled assessment of speech-language pathology students' clinical skills in stuttering management, further exploration of reliability is required. WHAT THIS PAPER ADDS What is already known on this subject Within speech-language pathology, simulation-based learning is a teaching approach used in university clinical programme curricula. Simulation-based learning is used as an opportunity for students to gain specific clinical skills, particularly if clinical experiences are readily not available. Research in speech-language pathology has revealed that students value simulation because it provides a safe learning environment. What this study adds to existing knowledge There are fewer opportunities for students to gain clinical experience in the management of stuttering in adults. This study explored students' clinical skill development within a stuttering simulation-based learning programme. Additionally, it detailed the development and preliminary investigation of validity of the SPIRS-Stuttering, an assessment tool used in a simulation-based learning environment. What are the potential or actual clinical implications of this work? Students' clinical skills in the assessment and management of stuttering in adults, as measured by the SPIRS-Stuttering, improved during participation in the stuttering simulation-based learning programme. Further investigation of validity of the SPIRS-Stuttering tool is required to confidently measure students' performance. The stuttering simulation-based learning programme can be used to provide students with an opportunity to develop their clinical skills in stuttering, a practice area in speech-language pathology that is not always available to students.

Purpose Adults who stutter (AWS) often attempt, with varying degrees of success, to suppress their stuttered speech. The ability to effectively suppress motoric behavior after initiation relies on executive functions such as nonselective inhibition. Although previous studies found that AWS were slower to inhibit manual, button-press response than adults who do not stutter (AWNS), research has yet to confirm a consistent relationship between manual and verbal inhibition. No study has examined verbal inhibition ability in AWS. The purpose of this study, therefore, is to compare verbal response inhibition between AWS and AWNS, and compare verbal response inhibition to both the overt stuttering and the lived experience of stuttering. Method Thirty-four adults (17 AWNS, 17 AWS) completed one manual and three verbal stop-signal tasks. AWS were assessed for stuttering severity (Stuttering Severity Instrument–Fourth Edition: SSI-4) and experience with stuttering (Overall Assessment of the Speaker's Experience With Stuttering [OASES]). Results Results indicate no correlation between manual and verbal inhibition for either group. Generalized linear mixed-model analyses suggested no significant group differences in manual or verbal inhibition. Manual and verbal inhibition did not predict SSI-4 in AWS. However, verbal inhibition was uniquely associated with OASES scores. Conclusion Although underlying manual and verbal inhibition was comparable between AWS and AWNS, verbal inhibition may be linked to the adverse experience of stuttering rather than the overt symptoms of stuttering severity. Supplemental Material https://doi.org/10.23641/asha.15145185

Purpose: To study the occurrence of speech features commonly associated with Childhood Apraxia of Speech (CAS) in Swedish children with suspected CAS (sCAS) or Speech Sound Disorder (SSD) related t...

Purpose The purpose of this study is to investigate how epidemiological and clinical factors collectively predict whether a preschooler who is stuttering will persist or recover and to provide guidance on how clinicians can use these factors to evaluate a child's risk for stuttering persistence. Method We collected epidemiological and clinical measures from 52 preschoolers ( M = 54.4 months, SD = 6.7 months; 38 boys and 14 girls) diagnosed as stuttering. We then followed these children longitudinally to document whether they eventually recovered or persisted in stuttering. Risk factors found to be significantly associated with stuttering persistence were used to build single and multiple variable predictive statistical models. Finally, we assessed each model's prediction capabilities by recording how accurate a model was in predicting a child's stuttering outcome—persisting or recovered. Results We found that a positive family history of stuttering, poorer performance on a standardized articulation/phonological assessment, higher frequency of stuttering-like disfluencies during spontaneous speech, and lower accuracy on a nonword repetition task were all significantly associated with an increased probability of persistence. The interaction between family history of stuttering and nonword repetition performance was also significant. The full multiple regression model incorporating all these risk factors resulted in the best fitting model with the highest predictive accuracy and lowest error rate. Conclusions For the first time, we show how multiple risk factors collectively predict the probability of stuttering persistence in 3- to 5-year-old preschool children who stutter. Using the full combination of risk factors to assess preschoolers who stutter yielded more accurate predictions of persistence compared to sparser models. A better understanding of the factors that underlie stuttering persistence will yield insight into the underpinnings of chronic stuttering and will help identify etiological targets for novel treatment approaches.

SUMMARY Transcranial magnetic stimulation (TMS) is a method for focal brain stimulation that is based on the principle of electromagnetic induction where small intracranial electric currents are generated by a powerful fluctuating magnetic field. Over the past three decades, TMS has shown promise in the diagnosis, monitoring, and treatment of neurological and psychiatric disorders in adults. However, the use of TMS in children has been more limited. We provide a brief introduction to the TMS technique; common TMS protocols including single-pulse TMS, paired-pulse TMS, paired associative stimulation, and repetitive TMS; and relevant TMS-derived neurophysiological measurements including resting and active motor threshold, cortical silent period, paired-pulse TMS measures of intracortical inhibition and facilitation, and plasticity metrics after repetitive TMS. We then discuss the biomarker applications of TMS in a few representative neurodevelopmental disorders including autism spectrum disorder, fragile X syndrome, attention-deficit hyperactivity disorder, Tourette syndrome, and developmental stuttering.

To investigate the psychosocial factors having an impact on persons with a stuttering problem.The correlation study was conducted from October 2016 to February 2018 at hospitals, speech clinics and educational institutes of Lahore. The sample comprised of young adults aged 16-30 years of either gender with stuttering problem. Data was collected using Stuttering Severity Instrument-4, Social Interaction Anxiety Scale-Urdu, Big Five Measure-20, Overall Assessment of the Speaker's Experience of Stuttering and the Urdu version of the shortened form of the Coping Orientation to Problems Experienced inventory. Data was analysed using SPSS 23.Of the 78 subjects, 66(84.6 %) were males and 12 (15.4 %) were females. There were 21(27%) subjects aged 16-19 years and 57(73%) with age range of 20-30 years. The overall mean age was 21.96±3.89 years. Mean age of onset was 4.59±1.29 years, while gradual onset and progressive stuttering was reported by 74(94.9 %). The Bilingual users 49(63%) reported to have frequent stuttering. Among the 43(55.1%) who had received treatment, 30(38%) received speech therapy and 26(33.3%) reported dissatisfaction. Stuttering severity and social anxiety were significantly positively correlated with all domains of impact of stuttering (p0.05). Age, and duration were negatively correlated with day-to-day communication (p0.05) and previous speech treatment showed negative association with impact on general knowledge about stuttering (p0.05). Avoidance coping strategy had a significant relationship with all domains of impact (p0.05).Severity of stuttering and social anxiety were found to have repercussions on people who stuttered, while avoidance coping was practised more to deal with the negative impact on reactions toward stuttering and quality of life.

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.

Purpose: Despite ambiguity in meaning and usage, “fluency” has played a central role in the understanding and treatment of developmental stuttering. The appropriateness of the term fluency in association with so-called fluency disorders , such as stuttering, has recently been questioned. The purpose of this article is to propose that fluency is best conceptualized as the efficiency of goal-directed action through cybernetic function. Spoken utterances are examples of sequences of action for the fulfillment of a hierarchy of nested and increasingly abstract social goals, including behaviors (e.g., introducing oneself) and values (e.g., being a sociable person). In contrast, some moments of speech disfluency, such as stuttering disfluencies, are inefficiencies in goal-directed action that may or may not hinder the fulfillment of higher level communicative behaviors and values, described here as communicative fluency . Conclusions: The concept of communicative fluency refers to the continual, reliable, and upward fulfillment of increasingly abstract social goals in the form of communicative actions, behaviors, and values. This expanded conceptualization of fluency beyond simply speech production has the potential to be a useful indicator of psychosocial well-being for individuals who stutter.