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The aim of the present study was to assess the effectiveness of an Acceptance and Commitment Therapy group intervention program for adults who stutter (N = 20). The program consisted of 2-h therapeutic sessions conducted weekly for eight consecutive weeks. It was an integrated program designed to improve: (a) psychosocial functioning, (b) readiness for therapy and change, (c) utilisation of mindfulness skills and psychological flexibility, and (d) frequency of stuttering. The findings provide innovative evidence for Acceptance and Commitment Therapy as an effective intervention with statistically significant improvements in psychosocial functioning, preparation for change and therapy, utilisation of mindfulness skills, and overall speech fluency. Follow-up data collected at three months post-treatment revealed that therapeutic gains were successfully maintained over time. These findings enhance the understanding of the impact of stuttering on psychological wellbeing and offer a new perspective on what might constitute successful stuttering treatment. Further, clinical research support is provided for Acceptance and Commitment Therapy delivered in a group format as a promising and novel intervention for adults who stutter. Educational objectives: The reader will be able to: (a) appreciate the potential for Acceptance and Commitment Therapy for adults who stutter; (b) identify the improvements participants experienced in psychosocial functioning and frequency of stuttered speech; (c) appreciate the six core processes of Acceptance and Commitment Therapy; and (d) appreciate the differences between an ACT model of intervention for adults who stutter compared to a CBT approach. (Contains 1 table and 7 figures.)

This paper attempts to bridge the gap between past and present stuttering therapy approaches. Specifically, the ideas and methods of Wendell Johnson and Dean Williams are compared to current approaches used in treating mental illness and communication disorders in which there is an emphasis on focusing on what is "right" with the individual and spending less time focusing on the "disorder". There is particular emphasis on tying Johnson's and Williams' overall philosophy to modern psychological approaches rooted in "Positive Psychology", to highlight how these early ideas in stuttering therapy may help us to discover the common factors that underlie the success of several different stuttering therapy approaches, independent of the specific techniques employed. It is proposed that future research on clinical efficacy in stuttering should use focused hypotheses techniques to investigate common factors that make therapy effective across individuals and therapy approaches. Educational objectives: The reader will be able to: (1) summarize the basic philosophy of the "Iowa" approach to stuttering as laid out by Wendell Johnson and Dean Williams; (2) describe current therapeutic techniques that incorporate "positive psychology"; (3) discuss possible common factors that influence therapy outcome that are independent of the therapeutic technique employed.

Three experiments were designed to test whether perception and action are coordinated in a way that distinguishes sequencing from timing (Pfordresher, 2003). Each experiment incorporated a trial design in which altered auditory feedback (AAF) was presented for varying lengths of time and then withdrawn. Experiments 1 and 2 included AAF that resulted in action-effect asynchronies (delayed auditory feedback) during simple tapping (Experiment 1) and melody production (Experiment 2). Asynchronous AAF immediately slowed production; this effect then diminished rapidly after removal of AAF. By contrast, sequential alterations of feedback pitch during melody production (Experiment 3) had an effect that varied over successive presentations of AAF (by increasing error rates) that lasted after its withdrawal. The presence of auditory feedback after withdrawal of asynchronous AAF (Experiments 1 and 2) led to overcompensation of timing, whereas the presence of auditory feedback did not influence performance after withdrawal of AAF in Experiment 3. Based on these results, we suggest that asynchronous AAF perturbs the phase of an internal timekeeper, whereas alterations to feedback pitch over time degrade the internal representation of sequence structure. (Contains 8 figures, 2 tables, and 4 footnotes.)

This study examined the effects of the perceived cause of stuttering on perceptions of persons who stutter (PWS) using a 7-item social distance scale, a 25-item adjective pair scale and a 2-item visual analogue scale. Two hundred and four university students rated vignettes which varied on describing a PWS with different causalities for stuttering (psychological, genetic, or unknown). Ratings differed significantly according to assigned causality. The vignette with the stuttering due to psychological causes was rated more negatively on 14 adjective pairs and the Social Distance Scale Index when compared to the ratings of vignettes with stuttering caused by either genetic or unknown causes. Interestingly, there were no significant differences between ratings of the vignettes attributing stuttering to either genetic or unknown causes. Neither familiarity with PWS nor the perceived curability of stuttering had any significant association to the ratings. Implications of findings regarding negative stereotypes, stigmatization and perceived causality for PWS are discussed. Educational objectives: Readers will be able to describe and explain: (1) research regarding negative stereotypes and stigma associated with stuttering, (2) research about attribution theory and stigma, (3) two methods used to evaluate stereotypes and stigma in adults, and (4) the negative effects on ratings of PWS due to psychological causality. (Contains 3 figures.)

The present study was conducted to investigate the effectiveness of cognitive-behavioral play therapy on social anxiety and academic self-concept of elementary school students with stuttering. The method in terms of purpose, was an application and information-gathering aspect, was a semi-experimental type of pre-test, and post-test with a control group. The statistical population of this study included all primary school students in Shiraz of which 30 were selected by available sampling. The research tool was the Social Anxiety Questionnaire (LSAS-SR) and the academic self-concept questionnaire was administered to both groups, and the experimental group underwent intervention for 10 one-hour sessions. The collected data were analyzed using univariate and multivariate analysis of covariance in SPSS-24. The findings showed that there is a significant difference between the average scores of the compared groups in social anxiety in the post-test, which indicates that the average scores of social anxiety in the experimental group (53.93) compared to the control group (57.06) has significantly decreased. Also, there is a significant difference between the average scores of the compared groups in the academic self-concept in the post-exam, which indicates that the average scores of the academic self-concept in the post-exam in the experimental group (47.66) compared to the control group (43.36) ) has increased significantly. Therefore, the hypothesis of the research based on the effectiveness of cognitive-behavioral play therapy on social anxiety and academic self-concept of elementary school students with stuttering is confirmed.Keywords: Cognitive-Behavioral Play Therapy, Social Anxiety, Academic Self-Concept, Stuttering. Extended AbstractIntroductionStuttering as a communication disorder can lead to serious problems in interpersonal relationships and affect the quality of a person's life. People with stuttering are prone to anxiety and anxiety disorders, especially social anxiety disorder. People with stuttering gradually use avoidance behaviors due to their bitter experiences of stuttering. These behaviors and fears cause refusal of social communication. Social anxiety in childhood and adolescence is associated with problems in cognitive and emotional dimensions and social adaptation. These children have not made much progress in school due to anxiety, they have weak social relationships and have less adaptability than their peers. Lack of academic success causes these students to become discouraged from studying and weaken their morale or drop out. Therefore, these children can have weak self-concepts. Academic self-concept is a form of self-concept that is formed as a result of mutual actions and learning experiences and academic progress, and this shows that academic self-concept is learnable and acquired. Cognitive-behavioral play therapy training leads to the reduction of students' anxiety, tension, shyness and social isolation and increases their health and psychological ability. Therefore, the present study was designed with the aim of determining the effectiveness of cognitive-behavioral play therapy on social anxiety and academic self-concept of elementary school students with stuttering.MethodologyThe current research was a semi-experimental study of pre-test-post-test type with a control group. The statistical population of this research was all elementary school students with stuttering referred to speech therapy centers in Shiraz. The study sample was 30 people from the mentioned statistical population who were selected purposefully and available based on the entry and exit criteria and were placed in two experimental and control groups. The data collection tools including the Leibovitz social anxiety scale questionnaire, and academic self-concept scale were implemented in both groups, and the experimental group underwent cognitive-behavioral play therapy intervention for 10 sessions of 60 minutes with the plan suggested by Rivier (2006). And it was placed in a group. The data were analyzed using univariate and multivariate analysis of covariance in SPSS-24.ResultsTo check the presuppositions of covariance analysis, the results of the Shapiro-Wilk test showed that the data distribution is normal (p < 0.05), in order to check the homogeneity of the error variance of the research variable in the three groups, Levin's test was used, which level the significance of the F statistic was greater than 0.05, and in examining the slope of the regression line and the interaction between the groups and the pre-test of the variables, the results showed that the significance level of F is greater than the critical value of 0.05. The results of the covariance analysis and the table of averages show that the average scores of social anxiety in the post-test in the experimental group (53.93) compared to the control group (57.06) have decreased significantly. Also, the discriminant chi-square analysis indicates that cognitive-behavioral play therapy explains 37% of the variance of social anxiety in children with stuttering. Also, the results of the analysis of covariance showed that there is a significant difference between the average scores of the compared groups of academic self-concept in the post-test [P = 0.001, F = 13.25]. Examining the mean table shows that the mean scores of academic self-concept in the post-test in the experimental group (47.66) compared to the control group (43.26) have increased significantly. Also, the discriminant square root analysis indicates that cognitive-behavioral play therapy explains 32% of the variance of academic self-concept in children with stuttering.Discussion and ConclusionThe findings of the present study showed that cognitive-behavioral play therapy was effective on social anxiety and academic self-concept of elementary school students with stuttering. In cognitive-behavioral play therapy, the therapist accepts children's behavior unconditionally without surprising them, arguing with them, or pointing out the incorrectness of their work. During these games, the child understands the phenomena, understands the relationships and feels comfortable, and uses it as a tool to establish communication, exchange and test and master the external realities. In a way, it can be said that during this course of cognitive-behavioral play therapy in a safe environment, anxious children test the external reality without fear of evaluation. Academic self-concept is influenced by a person's educational experiences and the interpretation of the educational environment, and it expresses knowledge and perceptions in different academic fields. Stuttering can damage the student's perceptions, attitudes and beliefs about his ability. In cognitive-behavioral play therapy, encouragement is one of the main elements, encouragement helps the child to recognize which of his behaviors are approved by the therapist and which are not appropriate, and also helps the child to feel good about to earn.Ethical considerationsThis research is taken from the Master's thesis of Zahra Ezabadi, Department of General Psychology, Ardakan University, Yazd, code 2475187, dated 8/1/2018. Ethical considerations such as confidentiality, informed consent of the participants' parents and confidentiality of identity information have been fully observed in this study.AcknowledgmentsFrom all the officials of the speech therapy centers in Shiraz and the students of the sample group who cooperated in this research; thanks and appreciation is given.

Do adults who stutter have abnormally high social anxiety? Is it related to maladaptive cognition? As these are persistent, unresolved questions in stuttering research, it behooves clinicians to at least assess and attempt to identify social anxiety in patients who stutter and its basis before decisions are made about stuttering treatment. The Unhelpful Thoughts and Beliefs About Stuttering (UTBAS) scale is a self-administered questionnaire that measures the degree of non-adaptive cognition in people who stutter (PWS) due to social anxiety. The 66-item UTBAS is time-consuming to complete, prompting the development of a shorter 6-item version, the UTBAS-6, which is in English. Here, we aimed to assess some psychometric properties of the Japanese version of the UTBAS-6, the UTBAS-6-J, which has not been done to date. In 56 adult patients (mean 32.6 ± 11.1 years) who stutter, we quantified the reliability, the internal consistency, and the concurrent validity of the UTBAS-6-J. Along with the UTBAS-6-J, patients also were administered the Overall Assessment of the Speaker’s Experience of Stuttering – Japanese version (OASES-A-J), the Modified Erickson Communication Attitude Scale – Japanese version (S-24-J), and the Liebowitz Social Anxiety Scale – Japanese version (LSAS-J). Cronbach’s alpha for UTBAS-6-J total scores was 0.974, indicating excellent internal consistency. UTBAS-6-J scores were significantly correlated with scores on the OASES-A-J, the S-24-J, and the LSAS-J (all p

IntroductionAutomatic recognition of stutters (ARS) from speech recordings can facilitate objective assessment and intervention for people who stutter. However, the performance of ARS systems may depend on how the speech data are segmented and labelled for training and testing. This study compared two segmentation methods: event-based, which delimits speech segments by their fluency status, and interval-based, which uses fixed-length segments regardless of fluency.MethodsMachine learning models were trained and evaluated on interval-based and event-based stuttered speech corpora. The models used acoustic and linguistic features extracted from the speech signal and the transcriptions generated by a state-of-the-art automatic speech recognition system.ResultsThe results showed that event-based segmentation led to better ARS performance than interval-based segmentation, as measured by the area under the curve (AUC) of the receiver operating characteristic. The results suggest differences in the quality and quantity of the data because of segmentation method. The inclusion of linguistic features improved the detection of whole-word repetitions, but not other types of stutters.DiscussionThe findings suggest that event-based segmentation is more suitable for ARS than interval-based segmentation, as it preserves the exact boundaries and types of stutters. The linguistic features provide useful information for separating supra-lexical disfluencies from fluent speech but may not capture the acoustic characteristics of stutters. Future work should explore more robust and diverse features, as well as larger and more representative datasets, for developing effective ARS systems.

The main objective of this systematic review was to synthesize the evidence on the occurrence and characteristics of stuttering in individuals with Down syndrome and thus contribute knowledge about stuttering in this population. Group studies reporting outcome measures of stuttering were included. Studies with participants who were preselected based on their fluency status were excluded. We searched the Eric, PsychInfo, Medline, Scopus, and Web of Science Core Collection databases on 3rd January 2022 and conducted supplementary searches of the reference lists of previous reviews and the studies included in the current review, as well as relevant speech and language journals. The included studies were coded in terms of information concerning sample characteristics, measurement approaches, and stuttering-related outcomes. The appraisal tool for cross-sectional studies (AXIS) was used to evaluate study quality. We identified 14 eligible studies, with a total of 1,833 participants (mean = 131.29, standard deviation = 227.85, median = 45.5) between 3 and 58 years of age. The estimated occurrence of stuttering ranged from 2.38 to 56%, which is substantially higher than the estimated prevalence (1%) of stuttering in the general population. The results also showed that stuttering severity most often was judged to be mild-to-moderate and that individuals with Down syndrome displayed secondary behaviors when these were measured. However, little attention has been paid to investigating the potential adverse effects of stuttering for individuals with Down syndrome. We judged the quality of the evidence to be moderate-to-low. The negative evaluation was mostly due to sampling limitations that decreased the representability and generalizability of the results. Based on the high occurrence of stuttering and the potential negative effects of this condition, individuals with Down syndrome who show signs of stuttering should be referred to a speech and language pathologist for an evaluation of their need for stuttering treatment.

PurposeDevelopmental stuttering is a fluency disorder that may be caused by neurological, genetic, or familial factors. However, a general perception that stuttering is caused by psychological problems could lead to negative attitudes toward stuttering, causing prejudice or discrimination against people who stutter (PWS). Thus, our study aimed to investigate whether certain beliefs in etiology of stuttering are related to the negative perception of stuttering.MethodsA web-based survey of 413 native Japanese adults, aged 20−69, who did not suffer from stuttering, schizophrenia, or depression, was conducted in August 2021. The participants were recruited through the Web monitor panel. Participants were divided into three uniform groups based on their response to a 27-item questionnaire about their implicit belief regarding the etiology of stuttering: belief in the biological model (stuttering-biological group), belief in the psychological model (stuttering-psychological group), and the control group (those who responded to perception of healthy adult males). Participants were also asked to respond to 25 items of semantic differential scales about perception of stuttering or healthy adult males. Responses were summarized into several factors by factor analysis, and factor scores were compared among the three groups. The stuttering-biological group had the fewest participants, comprising 80 individuals. Overall, a total of 240 participants, 80 from each group, were included in the analysis.ResultsSome pairs of stereotypes included in semantic differential scales revealed differences between the groups; PWS, irrespective of the participants of the biological or psychological group, were considered as having negative stereotyping properties such as being “tense,” “anxious,” or “afraid.” Additionally, three concepts from the factor analysis of these 25 items were analyzed using an analysis of variance, and significant differences were found; the mean factor score of the “danger” stereotype was lower in the stuttering-biological group compared to the stuttering-psychological group.ConclusionAlthough the simplification of the biological model is not recommended, anti-stigma campaigns to educate people that stuttering is caused by multidimensional factors, not just psychological ones, could change the general public’s negative perceptions of stuttering.

This study reports a user evaluation of a DVD-based social simulator, developed for people who stutter to potentially gain confidence in using a learned fluency technique. The aim was to examine and evaluate the pilot of the DVD-based social simulator, Scenari-Aid, to inform the development of an online version of the program. Thirty-seven adults who were stuttering were recruited to the study from non-professional groups in Australia. The DVD comprised scenarios with actors in real-life settings that were designed to elicit verbal responses. Participants worked through the scenarios at their own rate and then completed an online survey. The survey comprised 29 statements requiring responses on a 5-point Likert scale and provided information about users’ perceptions of participating in the social simulations. There was high positive agreement among the participants on all statements, the most important being that they perceived the scenarios represented in everyday speaking situations and that they felt immersed in them. Participants also agreed that both their fluency and confidence increased in everyday speaking situations as a result of working through the DVD scenarios. The developers were satisfied that, despite the subjective nature of the findings, the study provided sufficient support for constructing the online version, which is now available to the public free of charge. Further research is needed to provide empirical evidence of the contribution it can make to the efficacy of speech programs for adults who stutter.

Introduction: Stuttering is a neurodevelopmental disorder with structural and functional neurological bases characterized by involuntary prolongations, repetitions and blocks in sounds, syllables and words. Multiple factors are assumed to participate in etiology and severity of stuttering and response inhibition is considered to be an important phenomenon for having a fluent speech. Therefore, this study aimed to evaluate response inhibition of Adults Who Stutter (AWS). Materials and Methods: In a case-control study, response inhibition of twenty-eight AWS and fluently-matched control group was compared by a visual stop-signal task and its evoked potentials in the brain. Behavioral measurements of the task, including the Reaction Time (RT) and the response accuracy, were compared between the two groups. Peak amplitude and peak latency of P3 and N2 components in parietal and frontal areas were measured after cue, go and stop stimuli in different trials of the task. Results: Although AWS reported more scores in anxiety level, they acted similarly to the control group in behavioral measurements. ERP findings, however, represented smaller N2 amplitude in the cues and earlier N2 latency for the Go trials in AWS than in the controls. Conclusion: Our findings did not support the idea of less efficient inhibitory control in AWS; however, smaller N2 amplitude in the cues may indicated decreased attention resources allocated to the stimuli and different preparation for executing the response. Earlier N2 latency for Go trials in AWS also showed different timing of mental access to go stimuli and faster conflict monitoring in competing stimuli.

Background: Social anxiety is a disorder with moderate prevalence and has wide social effects on people. Research reveled that methods of cognitive restructuring treatments such as acceptance and commitment therapy (ACT) can help people with social anxiety. According to studies, they are very limited in targeting this issue. Aims: This research was conducted with the aim of investigating the efficacy of group therapy based on acceptance and commitment on the social and psychological anxiety of speech of teenagers with stuttering. Methods: This quasi-experimental study was designed as a pre-test, post-test, and follow-up and was conducted with a control group. The statistical population of this study included all adolescents aged 13-17 years with stuttering referred to speech therapy centers in September 2021. The research was the Persian test to determine the severity of stuttering (Riley, 2009; Tahmasebi, 2011) and the Wells Social Anxiety Questionnaire (1994). Moreover, Covariance analysis was used to analyze the data. Results: The results of the research showed that group therapy based on acceptance and commitment has created significant changes in the variables of social anxiety and severity of stuttering in the experimental and control groups (significance level 0.05). Conclusion: Based on the findings of this research, it can be concluded that the designed program based on acceptance and commitment reduces the severity of stuttering and reduces the social anxiety of teenagers who stutter. Therefore, the use of the treatment mentioned by child specialists It is highly recommended for teenagers with stuttering.

IntroductionBilingualism has historically been claimed to be a risk factor for developmental stuttering. The Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) ostensibly contains evidence to test that claim.MethodsWe analyze data from monolingual and bilingual children in Kindergarten through fifth grade in the ECLS-K:2011.Results and discussionThe prevalence, male/female ratio, and onset and recovery of reported stuttering in the ECLS are inconsistent with widely-accepted clinical reports of stuttering. We argue that the reported figures may be misleading. We discuss some factors that may inflate the reported prevalence, including a lack of awareness of the difference between stuttering vs. normal disfluencies, and the informal usage of the word “stuttering” on the part of teachers and parents to describe typical disfluencies.

BackgroundStuttering, also known as childhood-onset fluency disorder, is a chronic neurodevelopmental disorder that affects 1% of the population and can greatly impact an individual's social, occupational, and academic functioning. Prior research has shown dopamine D2 antagonists are effective in reducing the severity of stuttering symptoms, but these compounds can be associated with metabolic and movement disorder adverse effects. Ecopipam is an investigational medication that acts as a selective dopamine D1 receptor antagonist. This mechanism should reduce the likelihood of metabolic and movement disorder adverse effects of D2 antagonists.MethodThis open-label pilot study investigated ecopipam in the treatment of adults who stutter.ResultsThe results showed that a majority of participants demonstrated improvement in their stuttering. The medication was well tolerated.ConclusionsThese positive, preliminary findings suggest that a doubleblind, randomized controlled clinical trial to examine the efficacy of ecopipam in the treatment of stuttering is warranted.

This paper reported a case of a 25-year-old male schizophrenic patient， who obtained remission from psychotic symptoms during the treatment of olanzapine and trihexylphenidyl， was given ziprasidone treatment additionally due to the occurrence of auditory hallucination， and developed stuttering 4 days later. The stuttering disappeared 2 days following the discontinuation of therapy， and reappeared after reinstitution of ziprasidone therapy， but disappeared again after discontinuation. The dose of olanzapine was increased to 20 mg/d to ensure the stability of psychotic remission. At a follow-up visit 4 months later， the patient’s mental condition was stable and stuttering did not recur， indicating that the stuttering was induced by ziprasidone. This case suggests that the possibility of stuttering as an adverse reaction should be considered in the clinical application of ziprasidone.

PurposeRecent research findings suggest possible weaknesses in cognitive flexibility (CF) in children who stutter (CWS) when compared to children who do not stutter (CWNS). Studies so far, have been conducted with either younger (3–6 years old) or older children (6–12 years old) with a variety of measures. The purpose of the present study was to investigate CF with the use of a single behavioral measure across a broader age range (4–10 years old).MethodsParticipants were 37 CWS (mean age = 6.90 years) and 37 age-and gender-matched CWNS (mean age = 6.88 years), divided in a younger (below 7 years) and older (above 7 years) age group. All participants undertook a computerized visual set-shifting task consisting of three blocks. CF was evaluated through across-and within-block comparisons of the actual response speed and accuracy values. In addition, mixing-and set-shifting-costs were evaluated based on the mean response speed and accuracy.ResultsAll participants showed expected mixing-and set-shifting-costs. Only the within-block analyses yielded significant between (sub)group differences. Investigation of the block × classification group × age group interactions showed that older CWS had larger set-shifting-costs (slowed down more and made more errors) compared to older CWNS.ConclusionWhile all participants required more time during set-shifting trials, only the older CWS (7–10 years old), and not younger CWS, were slower and made more errors. This finding corroborates previous findings in CWS of a similar age and could possibly point to a role of CF in stuttering persistence.

PurposeOver the last few years, research findings have suggested limitations in executive function (EF) of children who stutter (CWS) with the evidence being more consistent in studies with preschoolers (3–6 years old) than in studies with school-aged children (6–12 years old). The purpose of the current study was to assess complex response inhibition and cognitive flexibility in school-aged CWS and their non-stuttering peers.MethodsParticipants, 19 CWS (mean age = 7.58 years, range 6.08–9.17) and 19 age-and gender-matched children who do not stutter (CWNS; mean age = 7.58 years, range 6.08–9.33), completed a visual task consisting of three task blocks. Analyses were based on response times and error percentages during the different task blocks.ResultsAll participants showed expected performance-costs in task block comparisons targeting complex response inhibition and cognitive flexibility. Significant group differences were found in measures of cognitive flexibility with CWS performing slower compared to CWNS (p = 0.02). Additionally, significant block × group interactions demonstrated that CWS, compared to CWNS, slowed down more (i.e., higher performance-cost) under both complex response inhibition (p = 0.049) and cognitive flexibility task conditions (p = 0.04 for no-set-shifting and p = 0.02 for set-shifting).ConclusionThese results are in line with some of the previous findings in school-aged CWS and suggest that CWS present lower performance in complex response inhibition and cognitive flexibility task conditions when compared to their non-stuttering peers.

The main aim of the present study is to compare the effectiveness of unified transdiagnostic treatment of emotional disorders and emotion efficacy therapy on emotion regulation in adults with stuttering and anxiety disorder. The research method is applied purposively and the research design is a quasi-experimental with pre-test-post-test design and control group with a follow-up period. The statistical population include all stuttering adults who visited speech therapy clinics in Tehran and the Iranian Stuttering Association in 2018–2019. 36 individuals (27 males and 9 females) who stutter were selected using an available sample and based on inclusion criteria such as a structured clinical interview. They were then randomly assigned to the experimental groups and the control group. For the treatment groups, each intervention was based on two-hour sessions, and for the control group, no intervention was conducted. The tools used in the present study included the Gratz and Roemer’sDifficulties in Emotion Regulation Scale (DERS). According to the nature of the study and measurement in three stages, repeated measures analysis was used to analyze the data using SPSS 18. From the remarkable results, we can mention the effectiveness of EET on reducing all six components of emotion regulation difficulties (P

A mindfulness-based intervention (MBI) to address emotional factors that may negatively impact the fluency of the subjects was implemented. A MBI consisting of 5 weekly 2-h sessions was designed and applied to two stuttering cases. The goals were to lower stuttering and to reduce anxiety through the acquisition of mindfulness skills. Participants were asked to video-record a speaking task and to fill out anxiety and mindfulness skills self-reports pre and post-intervention. Both participants diminished stuttering error rates from severe (participant 1) and moderate (participant 2) to mild. Participant 2, who showed high pre-treatment anxiety, showed a significant reduction. A year-follow-up revealed that therapeutic gains in anxiety, mindfulness skills, and stuttering were successfully maintained in both participants. This is the first study focused on emotional aspects of stuttering showing long-term improvements through a MBI. MBI programs could serve as a promising complement for stuttering treatments.

A clinical, evidence-based model to inform clients and their parents about the nature of stuttering is indispensable for the field. In this paper, we propose the Erasmus Clinical Model of Stuttering 2.0 for children who stutter and their parents, and adult clients. It provides an up-to-date, clinical model summary of current insights into the genetic, neurological, motoric, linguistic, sensory, temperamental, psychological and social factors (be it causal, eliciting, or maintaining) related to stuttering. First a review is presented of current insights in these factors, and of six scientific theories or models that have inspired the development of our current clinical model. Following this, we will propose the model, which has proven to be useful in clinical practice. The proposed Erasmus Clinical Model of Stuttering visualizes the onset and course of stuttering, and includes scales for stuttering severity and impact, to be completed by the (parent of) the person who stutters. The pathway of the model towards stuttering onset is based on predisposing and mediating factors. In most children with an onset of stuttering, stuttering is transient, but if stuttering continues, its severity and impact vary widely. The model includes the circle of Engel (1977), which visualizes unique interactions of relevant biological, psychological, and social factors that determine the speaker's experience of stuttering severity and its impact. Discussing these factors and their interaction with an individual client can feed into therapeutic targets. The model is supplemented by a lifeline casus. • A new clinical, evidence-based model to inform children who stutter and their parents, and adult clients about stuttering. • The onset and development of stuttering is visualized in a Figure. • Biological, psychological, and social factors are related to the speaker's experience of stuttering severity and impact. • A hypothetical lifeline casus illustrates the model. [ABSTRACT FROM AUTHOR]

Stuttering is defined as a speech disorder characterized by involuntary repetitions and prolongations of speech elements, i.e. voices, syllables or words. The evaluation of interpersonal anxiety in stuttering pathology should indicate and encourage a new perspective and provide a conceptual approach that has the potential to enable better understanding of the affective field of a stuttering person, thus completing a guide to stuttering rehabilitation. The aim of this study is to compare the degree of interpersonal anxiety of stuttering subjects and the typical population and the potential effect of age differences and different forms of stuttering on the degree of interpersonal anxiety. The sample included 48 subjects, 24 stuttering subjects and 24 non-stuttering subjects. Interpersonal anxiety was evaluated using the Willoughby questionnaire which assesses the degree of interpersonal anxiety. The obtained results show that the subjects who stutter are more anxious than the subjects of the typical population [F(1, 44) = 13.66, p

Abstract Background The aim of this study was to investigate the relationship between executive function (EF), stuttering, and comorbidity by examining children who stutter (CWS) and children who do not stutter (CWNS) with and without comorbid conditions. Data from the National Health Interview Survey were used to examine behavioral manifestations of EF, such as inattention and self-regulation, in CWS and CWNS. Methods The sample included 2258 CWS (girls = 638, boys = 1620), and 117,725 CWNS (girls = 57,512; boys = 60,213). EF, and the presence of stuttering and comorbid conditions were based on parent report. Descriptive statistics were used to describe the distribution of stuttering and comorbidity across group and sex. Regression analyses were to determine the effects of stuttering and comorbidity on EF, and the relationship between EF and socioemotional competence. Results Results point to weaker EF in CWS compared to CWNS. Also, having comorbid conditions was also associated with weaker EF. CWS with comorbidity showed the weakest EF compared to CWNS with and without comorbidity, and CWS without comorbidity. Children with stronger EF showed higher socioemotional competence. A majority (60.32%) of CWS had at least one other comorbid condition in addition to stuttering. Boys who stutter were more likely to have comorbid conditions compared to girls who stutter. Conclusion Present findings suggest that comorbidity is a common feature in CWS. Stuttering and comorbid conditions negatively impact EF.

Introduction: Stuttering can begin with the experience of traumatic event and the stress it causes. Mind simulation model is one of the promising treatments for stuttering and its associated problems. Aim: This study aimed to investigate the effectiveness of mind simulation model on decreasing dissociative experiences caused by traumatic events in adult with stuttering disorder. Method: This was a quasi-experimental study with a pre-test/ post-test design and a control group. The study population included all stutterers who referred to the Tavanmandsazan-e-Zehn Clinic in 2018-2019. Among them, the number of 30 stuttering 18- 45 years old men who had experienced a traumatic event were selected through available sampling method and put randomly into the experimental and control groups. After measuring basic levels of dissociative experiences of all participants using dissociative experiences scale (Bernstein, 1993), the experimental group received mind simulation therapy, while the control group received no intervention. Finally, both groups completed the post-test. Results: Results of MANCOVA analysis showed that mind simulation model could significantly reduce dissociative experiences (including dissociative amnesia وdepersonalization/derealisation, and absorption/imaginative) (p

Stuttering is a neurodevelopmental speech disorder characterized by the symptoms of speech repetition, prolongation, and blocking. Stuttering-related dysfluency can be transiently alleviated by providing an external timing signal such as a metronome or the voice of another person. Therefore, the existence of a core motor timing deficit in stuttering has been speculated. If this is the case, then motoric behaviors other than speech should be disrupted in stuttering. This study examined motoric performance on four complex bimanual tasks in 37 adults who stutter and 31 fluent controls. Two tasks utilized bimanual rotation to examine motor dexterity, and two tasks used the bimanual mirror and parallel tapping movements to examine timing control ability. Video-based analyses were conducted to determine performance accuracy and speed. The results showed that individuals who stutter performed worse than fluent speakers on tapping tasks but not on bimanual rotation tasks. These results suggest stuttering is associated with timing control for general motor behavior.

Developmental stuttering is a widely discussed speech fluency disorder. Research on its mechanism has focused on an atypical interface between the planning (PLAN) and execution (EX) processes, known collectively as the EXPLAN model. However, it remains unclear how this atypical interface influences people who stutter. A straightforward assumption is that stuttering speakers adopt a smaller scope of speech planning, whereas a defect in word retrieval can be confounding. To shed light on this issue, we took the semantic blocking effect as an index to examine lexical planning in word and phrase production. In Experiment 1, for word production, pictures from the same semantic category were combined to form homogeneous blocks, and pictures from different categories were combined to form heterogeneous blocks. A typical effect of semantic blocking showing longer naming latencies for homogeneous blocks than heterogeneous ones was observed for both stuttering and fluent speakers. However, this effect was smaller for stuttering speakers, when it was subject to lexical defects in stuttering. In Experiment 2, for a conjoined noun phrase production task, the pictures referring to the first noun were manipulated into homogeneous and heterogeneous conditions. The semantic blocking effect was also much smaller for stuttering speakers, indicating a smaller scope of lexical planning. Therefore, the results provided more evidence in support of the EXPLAN model and indicated that a smaller scope of lexical planning rather than lexical defects causes the atypical interface for stuttering. Moreover, a comparison between these two tasks showed that the study findings have implications for syntactic defects in stuttering.

Originary neurogenic, non-syndromatic stuttering has been linked to a dysfunctional sensorimotor system. Studies have demonstrated that adults who stutter (AWS) perform poorly at speech and finger motor tasks and learning (e.g., Smits-Bandstra et al., 2006b; Namasivayam and van Lieshout, 2008). The high relapse rate after stuttering treatment could be a further hint for deficient motor learning and, in particular, for the limited generalization of the learned technique in daily communication. In this study, we tested generalization of finger sequence skills in AWS using an effector-dependent transfer task after a 24-h retention period. Additionally, we wanted to corroborate previous motor learning results in AWS for practice and retention: 16 AWS and 16 age-, sex-, and education-matched controls performed the task during four test sessions. Our results indicate that generalization performance in AWS was not inferior to that of fluent controls. In addition, we found, contrary to previous results, that AWS showed a steeper learning progress after practice and consolidation compared with controls. We suggest that with sufficient practice and a 24-h consolidation phase, AWS are able to retain the learned performance of tapping a five-item finger sequence as well as fluent controls in terms of speed and accuracy.

A number of studies have shown that phonetic peculiarities, especially at the coarticulation level, exist in the disfluent as well as in the perceptively fluent speech of people who stutter (PWS). However, results from fluent speech are very disparate and not easily interpretable. Are the coarticulatory features observed in fluent speech of PWS a manifestation of the disorder, or rather a compensation for the disorder itself? The purpose of the present study is to investigate the coarticulatory behavior in the fluent speech of PWS in the attempt to answer the question on its symptomatic or adaptive nature. In order to achieve this, we have studied the speech of 21 adult PWS (10 French and 11 Italian) compared to that of 20 fluent adults (10 French and 10 Italian). The participants had to repeat simple CV syllables in short carrier sentences, where C = /b, d, g/ and V = /a, i, u/. Crucially, this repetition task was performed in order to compare fluent speech coarticulation of PWS to that of PWNS, and to compare the coarticulation of PWS under a condition with normal auditory feedback (NAF) and under a fluency-enhancing condition due to an altered auditory feedback (AAF). This is the first study, to our knowledge, to investigate the coarticulation behavior under AAF. The degree of coarticulation was measured by means of the Locus Equations (LE). The coarticulation degree observed in fluent PWS speech is lower than that of the PWNS, and, more importantly, in AAF condition, PWS coarticulation appears even weaker than in the NAF condition. The results allow to interpret the lower degree of coarticulation found in fluent speech of PWS under NAF condition as a compensation for the disorder, based on the fact that PWS’s coarticulation is weakening in fluency-enhancing conditions, further away from the degree of coarticulation observed in PWNS. Since a lower degree of coarticulation is associated to a greater separation between the places of articulation of the consonant and the vowel, these results are compatible with the hypothesis that larger articulatory movements could be responsible for the stabilization of the PWS speech motor system, increasing the kinesthetic feedback from the effector system. This interpretation shares with a number of relatively recent proposal the idea that stuttering derives from an impaired feedforward (open-loop) control system, which makes PWS rely more heavily on a feedback-based (closed loop) motor control strategy.

Stuttering is a complex neurodevelopmental disorder that has to date eluded a clear explication of its pathophysiological bases. In this review, we utilize the Directions Into Velocities of Articulators (DIVA) neurocomputational modeling framework to mechanistically interpret relevant findings from the behavioral and neurological literatures on stuttering. Within this theoretical framework, we propose that the primary impairment underlying stuttering behavior is malfunction in the cortico-basal ganglia-thalamocortical (hereafter, cortico-BG) loop that is responsible for initiating speech motor programs. This theoretical perspective predicts three possible loci of impaired neural processing within the cortico-BG loop that could lead to stuttering behaviors: impairment within the basal ganglia proper; impairment of axonal projections between cerebral cortex, basal ganglia, and thalamus; and impairment in cortical processing. These theoretical perspectives are presented in detail, followed by a review of empirical data that make reference to these three possibilities. We also highlight any differences that are present in the literature based on examining adults versus children, which give important insights into potential core deficits associated with stuttering versus compensatory changes that occur in the brain as a result of having stuttered for many years in the case of adults who stutter. We conclude with outstanding questions in the field and promising areas for future studies that have the potential to further advance mechanistic understanding of neural deficits underlying persistent developmental stuttering.

Using an fMRI-based classification approach and the structural equation modeling (SEM) method, this study examined the neural bases of atypical planning and execution processes involved in stuttering. Twelve stuttering speakers and 12 controls were asked to name pictures under different conditions (single-syllable, multi-syllable, or repeated-syllable) in the scanner. The contrasts between conditions provided information about planning and execution processes. The classification analysis showed that, as compared to non-stuttering controls, stuttering speakers' atypical planning of speech was evident in their neural activities in the bilateral inferior frontal gyrus (IFG) and right putamen and their atypical execution of speech was evident in their activations in the right cerebellum and insula, left premotor area (PMA), and angular gyrus (AG). SEM results further revealed two parallel neural circuits-the basal ganglia-IFG/PMA circuit and the cerebellum-PMA circuit-that were involved in atypical planning and execution processes of stuttering, respectively. The AG appeared to be involved in the interface of atypical planning and execution in stuttering. These results are discussed in terms of their implications to the theories about stuttering and to clinical applications.

Combining structural equation modeling (SEM) and voxel-based morphometry (VBM), this study investigated the interactions among neural structures in the basal ganglia-thalamocortical circuit (BGTC) in the left hemisphere of stuttering and non-stuttering speakers. Stuttering speakers (n=12) and non-stuttering controls (n=12) were scanned while performing a picture-naming task and a passive-viewing (baseline) task. Results showed significant differences between stuttering and non-stuttering speakers in both effective connectivity and anatomical structures in the BGTC in the left brain. Specifically, compared to non-stuttering speakers, stuttering speakers showed weaker negative connectivity from the left posterior middle temporal gyrus (PMTG) to the putamen, but stronger positive connectivity from the putamen to the thalamus, from the thalamus to the PMTG and anterior supplementary motor area (preSMA), and from the anterior superior temporal gyrus (ASTG) to the preSMA. Accompanying such altered connectivity were anatomical differences: compared to non-stuttering controls, stuttering speakers showed more grey matter (GM) volume concentration in the left putamen, less GM volume concentration in the left medial frontal gyrus and ASTG, and less white matter volume concentration underlying the left posterior superior temporal gyrus inside the BGTC. These results shed significant light on the neural mechanisms (in terms of both functional connectivity and neural anatomy) of stuttering.

Background: Method of levels (MOL) is a cognitive therapy with an emerging evidence base. It is grounded in perceptual control theory, and its transdiagnostic nature means techniques are widely applicable and not diagnosis‐specific. This paper contributes to psychotherapy process research by investigating a key technique of MOL, asking about disruptions, and in doing so aims to explore how the technique works and aid the understanding of related techniques in other psychotherapies. Method: Conversation analysis (CA) is applied to asking about disruptions in 12 real‐life therapeutic interactions. Findings: Analyses explore how and when therapists ask about disruptions, with examples presented according to their degree of adherence to the MOL approach. The majority of identified instances project responses consistent with MOL aims, encouraging further talk, focused on the client's problem, and with a shift to metalevel commentary. Also presented are examples of therapist and client influence on disruptions. Conclusion: The paper provides support for a number of MOL practices, with clinical implications and links to other psychotherapies highlighted. [ABSTRACT FROM AUTHOR]

Introduction: Stuttering can begin with the experience of traumatic event and the stress it causes. Mind simulation model is one of the promising treatments for stuttering and its associated problems. Aim: This study aimed to investigate the effectiveness of mind simulation model on decreasing dissociative experiences caused by traumatic events in adult with stuttering disorder. Method: This was a quasi-experimental study with a pre-test/ post-test design and a control group. The study population included all stutterers who referred to the Tavanmandsazan-e-Zehn Clinic in 2018-2019. Among them, the number of 30 stuttering 18- 45 years old men who had experienced a traumatic event were selected through available sampling method and put randomly into the experimental and control groups. After measuring basic levels of dissociative experiences of all participants using dissociative experiences scale (Bernstein, 1993), the experimental group received mind simulation therapy, while the control group received no intervention. Finally, both groups completed the post-test. Results: Results of MANCOVA analysis showed that mind simulation model could significantly reduce dissociative experiences (including dissociative amnesia و depersonalization/derealisation, and absorption/imaginative) (p<0.01) in participants whose their stuttering were caused by experiencing traumatic events compared to the control group. Conclusion: Given these findings, it can be claimed that the use of this new method can help the therapists in the effective treatment of stuttering and its associated problems by mind enabling of the patients. [ABSTRACT FROM AUTHOR]

The purpose of the present research was to screen for social anxiety and perfectionism among young people who stutter (PWS). Participants included 71 PWS and 51 normally-fluent controls. Young PWS were characterized by significantly higher rates of social anxiety, which involved social distress, social avoidance and fear of negative evaluation. The rate of perfectionism in experimental group equated the severity of maladaptive perfectionism in patients with anxiety disorders. PWS tend to interpret others as imposing unrealistically high standards and re- quirements on them and critically evaluating their actions. They constantly select negative information, failures and mistakes, depreciating and not noticing their own achievements and successes. They are inclined to dichotomous and polarized thinking (of “all or nothing” type). Severity of stuttering in young people is associated with social anxiety and perfectionism. The results of present study evidence the need to highlight significant social anxiety and maladaptive perfectionism in PWS as targets of psychotherapy. We express gratitude to Khavanov A.Yu., Head of the Department of Logoneurosis of «Center of Speech Pathology and Neurorehabilitation — Moscow Department of Healthcare», and his colleagues (Geras’kin A.A., Bogdanov M.A.) for their help in research conduction.

Background Stuttering is a developmental speech disorder that affects the fluency of speech. Persons who stutter perceive speaking situations and social interactions as threatening. Participants and procedure Nineteen (47.50%) adults with speech fluency disorders (SFD) and 21 (52.50%) without participated in the study. All participants completed the following measures individually: the State-Trait Anxiety Inventory, the Coping Inventory for Stressful Situations (CISS), and an informational survey. Results Our study confirmed that persons with SFD experience more stressful situations in life and feel greater anxiety, both as a trait and as a state, which influences their daily life. The negative affect experienced contributed to their preferred use of Emotion-Oriented Coping strategies, at the expense of more proactive Task-Oriented Coping. Experienced stress and anxiety influenced and consolidated their habitual stress coping styles, devoted mainly to dealing with negative emotions. Conclusions Stuttering affects daily activities, interpersonal relationships, and the quality of life. Therefore, professional support should include adaptive, task-oriented coping.

Stuttering is a fluency disorder, partially alleviated during altered auditory feedback, suggesting abnormal sensorimotor integration in adults who stutter (AWS). As weighting of multiple integrating-information sources would be decided based on their reliabilities, the use of external (auditory feedback) and internal information (prediction of sensory consequences) could correlate with speech processing. We hypothesized that abnormal auditory-feedback processing in AWS could be related to decrease in internal processing precision. We used a perceptual-adaptation experiment of delayed auditory feedback (DAF) to verify the hypothesis. Seventeen AWS and 17 adults who do not stutter (ANS) were required to say “ah” and judge the simultaneity between their motor sensations and vocal sounds in each stimulus onset asynchrony (SOA) (0, 25, 50, 75, 100, 125, or 150 ms) after inducing adaptation of DAF (three conditions with 0-, 66-, or 133-ms delay). While no adaptation occurred during the 0 ms condition, perceptual change in simultaneity judgment (adaptation effect) occurred during the 66 and 133 ms conditions. The simultaneity judgments following exposure in each SOA were fitted to the psychometric function in each condition for the AWS and ANS groups. We calculated the μ (signifying the point of subjective simultaneity and adaptation-effect degree) and σ (signifying the detecting precision) of each function and analyzed them by parametric analyses. For the μ, participant groups and adaptation conditions showed a significant interaction; the adaptation effect was greater in the AWS than in the ANS group. Additionally, the μ and σ were only positively correlated in the AWS group. The point of subjective simultaneity for auditory delay by inducing DAF was higher in AWS than in ANS, indicating that perception of simultaneity in AWS was influenced by DAF to a greater extent. Moreover, the significant positive correlation between the μ and σ in AWS showed that the more imprecise the internal auditory processing, the more AWS relied on auditory feedback. It is suggested that the reliability of internal information differed within the AWS group, and AWS with reduced internal reliability appeared to compensate by relying to a great extent on auditory feedback information.

The purpose of this study was to examine temperament dimensions, executive functioning ability, and anxiety levels in school-age children who stutter and their non-stuttering peers. Participants were 100 Portuguese children aged 7 to 12 years (M = 9.13; SD = 1.70), including 50 children who stutter and 50 children who do not stutter. Analyses, which were performed separately for younger and older participants, sought to identify correlations between key variables. Temperament was evaluated through a parent questionnaire, executive functioning was evaluated through children’s responses on a performance test, and anxiety level was assessed through a self-perception scale. On the temperament measure, comparisons between children who stutter and their non-stuttering peers revealed that older children who stutter exhibited significantly higher scores on the Anger/Frustration, Impulsivity, and Sadness subscales, and lower averages on the Attention/Focusing, Perceptual sensitivity, and Soothability/Falling Reactivity subscales. On the executive functioning task, comparisons revealed that the group of younger children who stutter exhibited significantly higher average execution times than their non-stuttering peers. There were no statistically significant differences in anxiety between children who stutter and children who do not stutter, and there were no statistically significant correlations between temperament factors and measures of executive functioning. Children who stutter experienced lower ability to orient attention and greater emotional reactivity compared with their non-stuttering peers. Significant correlations were found between executive functioning and age and among the temperament factors themselves. These results, which support the need for a multidimensional view of stuttering, were interpreted in the context of the Dual Diathesis – Stressor model. Findings indicate that temperament and executive functioning abilities may contribute to the development of stuttering.

• Qualitative methodology was used to explore the lived experiences of adults who stutter and describe the nature of their self-efficacy beliefs. • Themes provide insight into the establishment, maintenance, and evolution of the self-efficacy beliefs of adults who sutter. • An inextricable link between fluency and confidence was identified within and across each major theme. • Findings highlight the complex and multidimensional nature of self-efficacy beliefs as experienced by adults who stutter. • Findings support integrated management of stuttering to address self-efficacy and fluency concurrently to support communicative confidence. Childhood-onset stuttering is a complex and multifaceted disorder. Intervention for adults who stutter has historically addressed speech fluency more so than psychosocial aspects of the disorder, including the nature of the individual's self-efficacy beliefs concerning their confidence in their capacity to enact change. Self-efficacy is an important construct related to quality of life, resilience, and maintenance of treatment gains for adults who stutter. The purpose of this qualitative study is to explore the nature of the self-efficacy beliefs expressed by adults who stutter in order to inform efficacious and holistic intervention for these individuals. Semi-structured interviews were conducted with 29 adults who stutter to describe their experiences as a person who stutters and elucidate the nature of their self-efficacy beliefs. Thematic analysis identified several major themes that provided novel insight into the complex nature of the self-efficacy beliefs experienced by adults who stutter: speaker experiences shaped communicative confidence, there was a conflict between communication and fluency, stuttering was viewed as more than fluency, and individual perspectives shaped communicative confidence, as did the pervading influence of self. The notion that fluency and confidence are inextricably linked was evident within and across each major theme. These preliminary findings provide further support for a multidimensional approach to the treatment of adults who stutter. Findings will be used to inform a novel integrated fluency and psychosocial intervention for adults who stutter that addresses fluency and self-efficacy concurrently, with a view of engendering durable improvements in speech fluency and communicative confidence. [ABSTRACT FROM AUTHOR]

Purpose: iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method: Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores (Carleton, McCreary, Norton, & Asmundson, 2006). Secondary outcomes included speech, psychology, and quality-of-life measures. Results: Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions: iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings. [ABSTRACT FROM AUTHOR]