Search

Background: Self-assessments for adults who stutter are recommended as a primary evaluation tool for including their views on stuttering. Evaluating adults who stutter with self-assessment scales is important. However, there is no tool in the Turkish literature that provides this measurement. Aims: To develop the Turkish version of The Wright and Ayre Stuttering Self-Rating Profile (WASSP) in order to analyse its validity and reliability, and investigate its applicability for Turkish-speaking individuals. Methods & Procedures: The study included 120 adults who stutter (aged 18-54 years). All the participants completed The Wright and Ayre Stuttering Self-Rating Profile-Turkish version (WASSP-TR) and the SF-36 form. The reliability analysis involved the calculation of Cronbach's alphas for test-retest and the Pearson product-moment correlation coefficient for internal consistency. The validity analysis, in turn, involved a confirmatory factor analysis for construct validity and testing correlations with the SF-36 for criterion validity. Outcomes & Results: Internal consistency coefficients of the WASSP-TR were reported to be high (> 0.70). The correlations between the WASSP-TR and its subscales showed significant results (0.858-0.966) (p < 0.01). The correlation between the subscales of the WASSP-TR and the SF-36 was reported to be consistent (from -0.492 to 0.747). There was a positive correlation between stuttering severity groups and the WASSP-TR scores (p < 0.01). Conclusions & Implications: The WASSP-TR is a valid and reliable scale for Turkish-speaking adults who stutter.

Background: Geographical and cultural differences have been shown to affect public attitudes towards stuttering. However, increasingly for many individuals in the world one's birthplace culture (or home culture) and culture in their local geographical environment (or host culture) are not the same. Aims: The effects of home culture and host culture in shaping the attitudes towards stuttering among students with British, Arab and Chinese home cultures attending one British university were explored. The effects of host culture were investigated by considering the time lived in the UK for Arab and Chinese students. Methods & Procedures: The study used a descriptive survey design that included a standardized self-delivered questionnaire: "the Public Opinion Survey of Human Attributes--Stuttering (POSHA-S)." Purposive sampling was carried out thorough volunteer mailing lists, student societies and personal contact. The final sample of 156 university students included 51 British, 52 Arab and 53 Chinese students. Outcomes & Results: Overall stuttering score (OSS), which is indicative of attitudes towards stuttering, was highest for British participants (mean = 30) and lowest for Chinese participants (mean = 13), with Arab participants falling in the middle (mean = 21). The differences in attitudes between the three groups were statistically significant, suggesting that home culture is a contributor to attitudes towards stuttering. A post-hoc item analysis of the POSHA-S revealed numerous specific differences in attitudes towards stuttering between the three groups, including differences in the attribution of the aetiology of stuttering, their role in helping people who stutter (PWS) and sympathy toward PWS. Time lived in the UK--a proxy measure for the role of host culture--did not significantly influence the attitudes of Arab and Chinese respondents. Conclusions & Implications: To varying degrees, all three groups had evidence of stereotypical stuttering attitudes. Nevertheless, given similar ages and student status in the same university, observed respondent differences confirm previous research documenting geographical influences on stuttering attitudes in Western versus East Asian and Middle Eastern samples. The study also provides evidence that home culture was influential in shaping attitudes towards stuttering, but host culture was not a significant contributor.

Background: Research suggests that some speech-language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech-language pathology programmes and the limited number of stuttering-specific placements available. Simulation-based learning is a viable option for providing speech-language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation-based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation-based learning are yet to be explored. Aims: To investigate speech-language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation-based learning programme. Methods & Procedures: This study used a cross-sectional survey design. Participants were 105 undergraduate and graduate entry masters speech-language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation-based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre-course (T1), pre-simulation (T2) and post-simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Outcomes & Results: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre-course and pre-simulation. Open-ended responses on the post-simulation survey revealed that students valued learning about stuttering within a simulation-based learning environment. Conclusions & Implications: Simulation-based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation-based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter.

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.

Purpose: The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method: We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results: The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions: The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

Background: While evidence-based practice is widely endorsed by researchers, clinicians and professional bodies as a guiding framework for the provision of quality care to clients, the reliance on efficacy evidence may overshadow the benefits of other knowledge forms in supporting intervention design and evaluation. Due consideration needs to be given to varied forms of evidence, including practice and patient evidence. Stuttering intervention for adults is one area in which there is a significant shortage of practice-based research literature. Aims: This study aimed to add to practice evidence by exploring the perspectives of international researchers and clinical experts on the components of effective stuttering intervention. This practice-based evidence will be used to inform the multi-stakeholder co-design of an evidence-based stuttering intervention for adults. Methods & Procedures: Criteria defining expertise were developed based on a review of the literature. Experts were recruited using purposive sampling and snowballing. Seventeen international experts were approached, of which 10 completed semi-structured interviews. Interview questions were developed and centred on five topics: the nature of stuttering; efficacy evidence base; intervention techniques, principles of effective intervention; and outcome measurement. Outcomes & Results: Inductive thematic analysis identified three overarching themes: 'One size doesn't fit all', 'A really collaborative relationship where we are both bringing our sense of expertise to this' and 'Some of the most frustrating things'. Conclusions & Implications: These findings emphasize the complexity of stuttering intervention, the need for individually tailored treatments and the role of multiple factors, beyond therapeutic technique, that influence treatment outcomes. Findings also demonstrate the benefit of collecting practice-based evidence to support clinical decision-making and intervention evaluation.

Background: Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis. Aims: To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277). Methods & Procedures: A total of 32 variables were used as predictors in regression analyses of short- and medium-term Lidcombe Program outcome, and of treatment dropout. Outcomes & Results: Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity. Conclusions & Implications: Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop-out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions.

Coalson, Peña, and Byrd published a systematic review that demonstrated significant limitations in the language profile descriptions for multilingual participants who stutter for studies that were completed through September 2011. Given the average number of investigations of multilingual speakers who stutter has shifted from one study every 5 years to three and a half studies every year, the purpose of this study was to determine if these limitations in language profile descriptions have persisted. A systematic search of the stuttering literature between October 2011 and October 2018 was conducted to identify the number of published studies focusing on multilingual participants. Descriptors of participants' language history, function, and proficiency were assessed within and across studies. The quality of these descriptions remains insufficient. Despite the marked increase in published research, these persisting limitations in language profile descriptions continue to compromise our understanding of the manifestation of stuttering in more than one language.

Purpose: The purpose of this study was to examine cognitive flexibility for semantic and perceptual information in preschool children who stutter (CWS) and who do not stutter (CWNS). Method: Participants were 44 CWS and 44 CWNS between the ages of 3;0 and 5;11 (years;months). Cognitive flexibility was measured using semantic and perceptual categorization tasks. In each task, children were required to match a target object with two different semantic or perceptual associates. Main dependent variables were reaction time and accuracy. Results: The accuracy with which CWS and CWNS shifted between one semantic and perceptual representation to another was similar, but the CWS did so significantly more slowly. Both groups of children had more difficulty switching between perceptual representations than semantic ones. Conclusion: CWS are less efficient (slower), though not less accurate, than CWNS in their ability to switch between different representations in both the verbal and nonverbal domains.

Actuality of studying of an issue on specific manifestations of a monologue speech type in bilingual schoolchildren with stutter has been stipulated by the necessity of elaboration of a constituent concept on central mechanisms underlying this kind of communication disorder, on the nature of disturbances of speech formation mechanisms in the stuttering with bilingualism, as well as due to absence of trials on the influence of bilingualism upon the process of construction of textual reports and outer manifestations of stutter in children, speaking both Tatar and Russian languages. In this respect, the goal of this article is implied in revelation of particularities of a full and consistent monologue expression in stuttering schoolchildren, brought up and educated under the conditions of Tatar-Russian bilingualism, in comparison with the normality (children without stutter). As a result of speech production studying, we revealed both common (for all the stuttering schoolchildren with bilingualism) and specific (for the different kinds of native language speakers) principles for the construction of full and consistent monologue expressions. The principles can be followed depending on the level of evolvement of each of the lingual systems, that, in turn, is of special importance for occurrence of frequency and severity of the cases with stutter. Materials of this article should be helpful for tutors of higher educational establishments, young scientists and scientific researchers, as well as speech therapists of preschool establishments and schools, teachers of primary schools.

Purpose: The purposes of this study were to examine the self-efficacy of school-based speech-language pathologists (SLPs) in conducting multidimensional treatment with children who stutter (CWS) and to identify correlates of self-efficacy in treating speech-related, social, emotional, and cognitive domains of stuttering. Method: Three hundred twenty randomly selected school-based SLPs across the United States responded to an online survey that contained self-efficacy scales related to speech, social, emotional, and cognitive components of stuttering. These ratings were analyzed in relation to participants' beliefs about stuttering treatment and their comfort level in treating CWS, perceived success in therapy, and empathy levels, in addition to their academic and clinical training in fluency disorders as well as demographic information. Results: Overall, SLPs reported moderate levels of self-efficacy on each self-efficacy scale and on a measure of total self-efficacy. Significant positive associations were observed between SLPs' self-efficacy perceptions and their comfort level in treating CWS, self-reported success in treatment, beliefs about the importance of multidimensional treatment, and self-reported empathy. There were some discrepancies between what SLPs believed was important to address in stuttering therapy and how they measured success in therapy. Conclusions: Among school-based SLPs, self-efficacy for treating school-age CWS with a multidimensional approach appears stronger than previously reported; however, more progress in training and experience is needed for SLPs to feel highly self-efficacious in these areas. Continuing to improve clinician self-efficacy for stuttering treatment through improved academic training and increased clinical experiences should remain a high priority in order to enhance outcomes for CWS.

Purpose: The purpose of this study was to survey school speech-language practitioners' self-perceptions of their confidence, knowledge, and need for support for working with school-age students who stutter (SWS). Method: A total of 120 school-based speech-language practitioners from 27 Nashville, Tennessee, area counties completed an online, 35-item survey examining caseloads, coursework, continuing education, experience, and perceived levels of skill and confidence in service provision to SWS. They also rated their need for consultation from speech-language pathologists who specialize in stuttering to improve their skills with SWS. Results: Respondents were least confident in and needed most support for providing intervention to SWS. Those who needed most support for intervention rated themselves as less knowledgeable about stuttering theory, assessment, and intervention and were less confident about working with students who only stutter and with SWS who have concomitant communication concerns. Greater practitioner confidence in stuttering intervention skills was positively correlated with the number of SWS on caseloads; continuing education credits in stuttering; and knowledge of stuttering theory, assessment, and intervention. Respondents who completed a graduate course on stuttering had greater confidence in stuttering intervention and were less likely to identify a need for support from specialists. Conclusions: School speech-language practitioners continue to report needing additional education, practice opportunities, and support, especially with intervention, and desiring specialized guidance to serve SWS. Those with more experience, education, and knowledge about stuttering are more confident and skillful, reflecting the potential positive impact of increased opportunities to learn about and work with SWS. These needs may be addressed through increased availability of specialists in stuttering to consult with school practitioners; opportunities for school-based practitioners to become peer mentors; and provision of readily available, intervention-focused continuing education experiences and resources.

Purpose: We examined the effects of physiological arousal on speech motor control and speech motor practice effects in preschool-age children who do (CWS) and do not stutter (CWNS). Method: Participants included 18 CWS (M[subscript age] = 4 years 5 months) and 18 age- and gender-matched CWNS. The participants repeated a phrase "buy bobby a puppy" interspersed with viewing pictures from the International Affective Picture System under two experimental conditions speaking after viewing pictures with (a) negative and (b) neutral valence. Participants' lip movements were tracked using Optotrak system. The spatiotemporal index and mean utterance duration were calculated to examine speech motor control and speech motor practice effects. Skin conductance level was measured during the experimental conditions to assess participants' physiological level of arousal. Results: Preschool-age CWS demonstrated greater speech movement variability across all conditions and trials than CWNS. Furthermore, the younger participants produced more variable articulatory movements than the older participants. Participants' speech movement variability did not significantly differ between the negative and neutral experimental conditions, and the level of physiological arousal did not have a significant effect on it. There was a nonsignificant trend of decrease in speech movement variability across the repeated trials in both groups. Last, CWS and CWNS did not differ in their mean utterance duration, suggesting that their articulation rate was similar across all conditions and trials. Conclusions: Our findings indicate that, compared to preschool-age CWNS, CWS demonstrate less mature speech motor control. However, present findings do not support the hypothesis that CWS benefit less from motor practice relative to CWNS. Given that our conditions elicited similar levels of arousal in the participants, future research is needed to examine whether physiological arousal disrupts speech motor control in preschool-age children potentially contributing to disruptions of speech fluency and the development of stuttering.

Purpose: The Lidcombe Program is an efficacious and effective intervention for early stuttering. The treatment is based on parent verbal response contingent stimulation procedures, which are assumed to be responsible for treatment effect. The present trial tested this assumption. Method: The design was a parallel, open plan, noninferiority randomized controlled trial. In the experimental arm, the five Lidcombe Program verbal contingencies were removed from parent instruction. The primary outcome was beyond-clinic percentage syllables stuttered at 18-month follow-up. Seventy-four children and their parents were randomized to one of the two treatment arms. Results: Findings of noninferiority were inconclusive for the primary outcome of stuttering severity, based on a margin of 1.0 percentage syllables stuttered. Conclusions: The inconclusive finding of noninferiority means it is possible that verbal contingencies make some contribution to the Lidcombe Program treatment effect. However, considering all primary and secondary outcomes, an overriding impression from the trial is a similarity of outcomes between the control and experimental arms. The clinical applications of the trial are discussed, along with further research that is needed.

Purpose: The purpose of this study was to examine group and individual differences in attentional bias toward and away from socially threatening facial stimuli among adolescents who stutter and age- and sex-matched typically fluent controls. Method: Participants included 86 adolescents (43 stuttering, 43 controls) ranging in age from 13 to 19 years. They completed a computerized dot-probe task, which was modified to allow for separate measurement of attentional engagement with and attentional disengagement from facial stimuli (angry, fearful, neutral expressions). Their response time on this task was the dependent variable. Participants also completed the Social Anxiety Scale for Adolescents (SAS-A) and provided a speech sample for analysis of stuttering-like behaviors. Results: The adolescents who stutter were more likely to engage quickly with threatening faces than to maintain attention on neutral faces, and they were also more likely to disengage quickly from threatening faces than to maintain attention on those faces. The typically fluent controls did not show any attentional preference for the threatening faces over the neutral faces in either the engagement or disengagement conditions. The two groups demonstrated equivalent levels of social anxiety that were both, on average, very close to the clinical cutoff score for high social anxiety, although degree of social anxiety did not influence performance in either condition. Stuttering severity did not influence performance among the adolescents who stutter. Conclusion: This study provides preliminary evidence for a vigilance-avoidance pattern of attentional allocation to threatening social stimuli among adolescents who stutter.

Purpose: People who stutter are susceptible to discrimination, stemming from negative stereotypes and social misattributions. There has been a recent push to evaluate the underlying explicit and implicit cognitive mechanisms associated with social judgments, moving away from only evaluating explicit social bias about people who stutter. The purpose of the current study was to evaluate how listeners change their implicit and explicit social (mis)attributions after hearing a people who stutter produce disfluent speech. Method: The current project was an adaptation of the Byrd et al. (2017) study to evaluate listener implicit/explicit social judgments of stuttered speech across five categories (i.e., confidence, friendliness, intelligence, distractibility, and extroversion) before and after a stuttering self-disclosure. This was done by implementing a modified version of the Ferguson et al. (2019) computer mouse-tracking paradigm. Results: Consistent with previous findings, participants made more explicit positive social judgments of confidence, friendliness, extroversion, and intelligence after a stuttering self-disclosure, but the distractedness category was resistant to change. Also consistent with previous findings, participants experienced a higher degree of cognitive competition (i.e., higher area under the curve) shortly after self-disclosure, which lessened over time. Conclusions: Explicit and implicit biases exist, but self-disclosure significantly impacts the cognitive system of listeners. Specifically, self-disclosure may reduce explicit bias through experience and explicit belief updating, but when cognitive heuristics are strong, implicit bias may be slower to change.

Purpose: This study reports findings from a clinical trial that implemented an early stuttering treatment program integrated with evidence-based parenting support (EBPS) to children who stutter (CWS) with concomitant self-regulation challenges manifested in elevated attention-deficit/hyperactivity disorder (eADHD) symptoms and compared those outcomes to CWS receiving stuttering treatment without EBPS. Method: Participants were 76 preschool CWS and their parent(s). Thirty-six of these children presented with eADHD and were quasirandomized into two groups: stuttering treatment only (eADHD[subscript standard]) or stuttering treatment integrated with EBPS (eADHD[subscript integrated]). The remaining children did not meet criteria for eADHD symptoms and received stuttering treatment only (No-eADHD[subscript standard]). Pre, post, and 3-month follow-up measures of stuttering treatment outcomes as well as treatment effects on measures of child behavior difficulties and parenting practices were examined. Results: Significant reduction in stuttering was found for all groups. However, the eADHD[subscript integrated] group showed a greater reduction in stuttering frequency than the eADHD[subscript standard] group, and at follow-up, stuttering frequencies in the eADHD[subscript integrated] group matched those of children in the No-eADHD[subscript standard] group, while stuttering in the eADHD[subscript standard] group remained significantly higher. Children with eADHD symptoms who received the integrated program also required significantly less stuttering intervention time than those children with eADHD symptoms who received stuttering treatment only. Families in the eADHD[subscript integrated] group reported large and significant improvements in child behavior and parenting practices. Conclusion: This study provides support for an early treatment program for CWS. The integrated stuttering and self-regulation management program for CWS with eADHD symptoms proved successful for fluency and behavioral improvements, which were sustained at follow-up.

Purpose: The purpose of this study is to document disfluency behaviors expressed by 4- and 5-year-old children who stutter and to identify whether stuttering characteristics at this age are predictive of later stuttering recovery or persistence. Method: We analyzed spontaneous speech samples from 47 children diagnosed with developmental stuttering when they were 4-5 years old. Based on their eventual diagnosis made the final year of participation in the longitudinal study when the children were 6-9 years old, the children were divided into two groups: children who eventually recovered from stuttering (n = 29) and children who were persisting (n = 18). We calculated a composite weighted stuttering-like disfluency (SLD) index of overall severity that considers the frequency, type, and number of repetition units of SLDs. The frequency and type of typical disfluencies were also examined. Results: Higher weighted SLD scores at ages 4--5 years were associated with a higher probability of persistent stuttering. The weighted SLD also significantly discriminated between children who would eventually be diagnosed as persisting or recovered from stuttering. The frequency and type of typical disfluency did not distinguish the two groups of children; however, children who were persisting had significantly higher frequencies of part-word repetitions and dysrhythmic phonations (i.e., blocks, prolongations, and broken words) and maximum number of part-word repetitions compared to children who eventually recovered from stuttering. Conclusions: Previous findings in younger, 2- to 3-year-old children who stutter did not suggest a relationship between the severity and type of children's SLDs and their eventual stuttering outcome. Yet, by the age of 4-5 years, we found that the weighted SLD, a clinically applicable tool, may be used to help identify children at greater risk for stuttering persistence. We propose that the weighted SLD be considered, along with other predictive factors, when assessing risk of stuttering persistence in 4- and 5-year-old children who are stuttering.

Purpose: Phonological skills have been associated with developmental stuttering. The current study aimed to determine whether the neural processes underlying phonology, specifically for nonword rhyming, differentiated stuttering persistence and recovery. Method: Twenty-six children who stutter (CWS) and 18 children who do not stutter, aged 5 years, completed an auditory nonword rhyming task. Event-related brain potentials were elicited by prime, rhyming, and nonrhyming targets. CWS were followed longitudinally to determine eventual persistence (n = 14) or recovery (n = 12). This is a retrospective analysis of data acquired when all CWS presented as stuttering. Results: CWS who eventually recovered and children who do not stutter exhibited the expected rhyme effect, with larger event-related brain potential amplitudes elicited by nonrhyme targets compared to rhyme targets. In contrast, CWS who eventually persisted exhibited a reverse rhyme effect, with larger responses to rhyme than nonrhyme targets. Conclusions: These findings suggest that CWS who eventually persisted are not receiving the same benefit of phonological priming as CWS who eventually recovered for complex nonword rhyming tasks. These results indicate divergent patterns of phonological processing in young CWS who eventually persisted, especially for difficult tasks with limited semantic context, and suggest that the age of 5 years may be an important developmental period for phonology in CWS.

Purpose: This study measured between-group differences in perceived speech skills and personality characteristics of a 12-year-old boy who stutters as a function of a factual stuttering disclosure statement, delivered by the boy who stutters, his "mother," or his "teacher." Method: Two hundred seventeen college-aged adults were randomly assigned to one of four groups, including a control group (no stuttering disclosure) and three experimental groups (child disclosure, mother disclosure, and teacher disclosure). Participants in the control condition viewed a brief video of a 12-year-old boy who stutters. For the experimental conditions, participants viewed a brief factual stuttering disclosure video (delivered by the child, mother, or teacher), followed by the same minute-long video of a boy who stutters used in the control condition. Following the videos, participants completed surveys relative to their perception of the boy's speech skills and personality characteristics. Results: Results support previous research citing benefits of stuttering disclosure. Significant between-group differences in both perceived speech skills and personality characteristics were observed when stuttering was disclosed by not only the child who stutters but also his teacher. When stuttering was disclosed by the mother, limited positive attitudinal differences were observed in speech skills; as a matter of fact, a number of personality characteristics were perceived more negatively as a function of stuttering disclosure by the mother. Conclusions: While results were generally most positive when the boy disclosed his own stuttering, data from this study support the efficacy of verbal stuttering disclosure provided by a teacher as a means of improving perceptions associated with stuttering. Accordingly, data support the notion that children who stutter will experience an improved quality of life when taught effective self-disclosure strategies by both parents and professionals, and that professionals (but not necessarily parents) can effectively disclose their clients' stuttering during this mentorship and self-advocacy process.

Purpose: Recovery and relapse relating to stuttering are often defined in terms of the presence or absence of certain types of speech disfluencies as observed by clinicians and researchers. However, it is well documented that the experience of the overall stuttering condition involves more than just the production of stuttered speech disfluencies. This study sought to identify what recovery and relapse mean to people who stutter based on their own unique experiences to account for both the stuttering behaviors and the broader adverse impact of the condition. Method: In this study, 228 adults who stutter participated in a mixed-methods exploration of the terms "recovery" and "relapse." Participants categorized themselves on whether they considered themselves to have recovered or experienced relapse. Data were analyzed thematically through the lens of the speaker self-categorizations to determine how adults who stutter define recovery and relapse regarding stuttering. Results: Results indicate that, to adults who stutter, recovery from stuttering is associated with increases in positive affective/emotional, behavioral, and cognitive reactions to the condition and simultaneous decreases in associated negative constructs. These group-level definitions did not change as a function of whether respondents reported that they had experienced recovery or relapse themselves. Discussion: Recovery or relapse from stuttering behaviors can occur independently from recovery or relapse from the broader adverse impact related to the condition, suggesting that researchers and clinicians should consider recovery and relapse as involving more than just a reduction or an increase in observable behaviors. These findings support recent research evidence further specifying the many individual phenotypes of stuttering, in that pathways to recovery and relapse can be experienced in different ways for people with different stuttering phenotype profiles.

Purpose: The purpose of this study was to investigate executive control in adults who stutter (AWS) and adults who do not stutter (AWNS) via a nonspeech paradigm, wherein eye movements were monitored (i.e., antisaccade task). Processes involved in an antisaccade task include working memory, attention, and voluntary motor control, but the task primarily provides insight into inhibitory control. Method: Seventeen AWS (14 men, three women; M = 23.41 years) and 17 AWNS (M = 23.29 years) were presented with a combination of prosaccade (i.e., looking toward a target) and antisaccade (i.e., suppress a reflexive saccade toward the target and look in the opposite direction) trials. The distance of the target from the center of the screen was also manipulated (i.e., 5.5o = short distance and 10.8o = long distance). Data for accuracy and reaction time of the first accurate saccade were collected and analyzed. Results: No difference was found between AWS and AWNS in accuracy or in reaction time. Both groups were more accurate in the prosaccade than the antisaccade trials and in the long compared to the short distance trials. Furthermore, both groups demonstrated longer saccade latencies for long compared to short distances and for antisaccade compared to prosaccade trials. Conclusions: Preliminary results do not support deficits in inhibition in AWS during a motorically simple, non-speech-related oculomotor task, but additional research is warranted.

Purpose: In a companion paper, we found no statistical reason to favor percentage syllables stuttered (%SS) over parent-reported stuttering severity as a primary outcome measure for clinical trials of early stuttering. Hence, considering the logistical advantages of the latter measure, we recommended parent-reported stuttering severity for use as an outcome measure. The present report extends the prior analysis to a comparison of %SS with self-reported stuttering severity (SRSS) for use as an outcome measure in clinical trials of stuttering treatments for adults. Method: We analyzed data from four randomized clinical trials for adults that incorporated %SS and SRSS data at prerandomization and at 6 months post randomization. We analyzed the distributions associated with the two measures, their agreement, and their estimates of effect sizes. Results: The positively skewed distribution of %SS warrants much reservation about its value as a clinical trial outcome measure. This skew causes inherent instability because of spurious data associated with low scores, which occur commonly at the low end of such a distribution. This inherent instability is compounded by inherent problems with absolute reliability of %SS measures. These problems are reduced with the much more normal distribution of SRSS. Conclusions: The logistical arguments in favor of SRSS apply similarly to adults as they do when parents report the stuttering severity of their children. However, there are statistical reasons to favor SRSS over %SS measures as a primary outcome of clinical trials with adult participants: SRSS has acceptable discriminant validity and a normal distribution, and it is less error prone than %SS. We recommend SRSS as a primary outcome for clinical trials of adults with stuttering.

Purpose: Previous studies of neural processing of rhyme discrimination in 7- to 8-year-old children who stutter (CWS) distinguished children who had recovered, children who had persisted, and children who did not stutter (CWNS; Mohan & Weber, 2015). Here, we investigate neural processing mediating rhyme discrimination for early acquired real words in younger CWS and CWNS (4;1-6;0 years;months), when rhyming abilities are newly emerging, to examine possible relationships to "eventual" recovery (CWS-eRec) and persistence in stuttering (CWS-ePer). Method: Children performed a rhyme discrimination task while their event-related brain potentials were recorded. CWNS, CWS-eRec, and CWS-ePer had similar speech and language abilities. Inclusionary criteria incorporated at least 70% accuracy for rhyme discrimination. Analyses focused on the mean amplitude of the N400 component elicited by rhyming and nonrhyming words in anterior and posterior regions of interest. Results: CWNS, CWS-eRec, and CWS-ePer displayed a classic event-related potential rhyme effect for rhyme discrimination characterized by larger amplitude, posteriorly distributed N400s elicited by nonrhyming targets compared to rhyming targets. CWNS displayed a more robust anterior rhyme effect compared to the CWS groups with a larger amplitude N400 anteriorly for the rhyming targets. This effect was more consistent across individual CWNS than CWS. Conclusions: The groups of CWNS, CWS-eRec, and CWS-ePer, who had all developed rhyming discrimination abilities, exhibited similar underlying neural processes mediating phonological processing of early acquired words for the classic central-parietal rhyme effect. However, individual variability of the anterior rhyme effect suggested differences in specific aspects of phonological processing for some CWS-eRec and CWS-ePer compared to CWNS.

Purpose: This study measures the experience of spontaneous speech in everyday speaking situations. Spontaneity of speech is a novel concept developed to account for the subjective experience of speaking. Spontaneous speech is characterized by little premeditation and effortless production, and it is enjoyable and meaningful. Attention is not directed on the physical production of speech. Spontaneity is intended to be distinct from fluency so that it can be used to describe both stuttered and fluent speech. This is the first study to attempt to measure the concept of spontaneity of speech. Method: The experience sampling method was used with 44 people who stutter. They were surveyed five times a day for 1 week through their cell phones. They reported on their perceived spontaneity, fluency, and speaking context. Results: Results indicate that spontaneity and fluency are independent, though correlated, constructs that vary with context. Importantly, an increase in spontaneity significantly decreases the adverse impact of stuttering on people's lives. Fluency did not significantly affect adverse life impact of stuttering. Conclusion: Findings support a theoretical construct of spontaneity that is distinct from speech fluency and that can inform our views of stuttering and approaches to stuttering treatment.

Purpose: Working memory (WM) deficits are implicated in various communication disorders, including stuttering. The reading span test (RST) measures WM capacity with the dual task of reading sentences aloud and remembering target words. This study demonstrates a difference in strategy between people who stutter (PWS) and people who do not stutter (PWNS) in performing the RST. The impact of the effective strategy and the stuttering-like disfluencies during the RST were investigated. Method: Twenty-six PWS and 24 people who do not stutter performed the RST and a simple reading aloud task. After the RST, they were asked which strategy ("imagery" or "rehearsal") they had used in order to remember the target words during the task. Results: The proportion of those who used an "imagery" strategy during the RST was significantly smaller in the PWS group. However, the RST scores of those who used an "imagery" strategy were significantly higher than the RST scores of those who used a "rehearsal" strategy in both groups. The "rehearsal" users were asked to undertake one more RST with an "imagery" strategy, which resulted in an increased score for both groups. The disfluency frequency of the PWS group was significantly reduced during the RST than during the oral reading task, irrespective of the employed strategy. Conclusions: PWS tended to use the less effective verbal "rehearsal" strategy during the RST. The differential effects of switching strategies on the measured WM capacity and on the disfluency rate suggest that the enhanced fluency during the RST would be mostly attributable to the reduced attention to speech motor control. Therefore, the use of the "imagery" strategy and focusing on the contents of communication, away from speech motor control, should help PWS communicate better in daily conversation.

Purpose: The contextual variability of stuttering events makes it difficult to reliably elicit stuttered speech in laboratory settings. As a result, studies that compare stuttered versus fluent speech are difficult to conduct and, thus, are limited in the literature. The purpose of the current study is to describe a novel approach to elicit stuttering during laboratory testing. Method: A semistructured clinical interview leveraging the phenomenon of stuttering anticipation was administered to 22 adults who stutter (1st visit). The interview was used to generate participant-specific anticipated and unanticipated word lists, which were used as stimuli during a 2nd visit so that the validity of the method could be tested. Results: The method yielded a near-equal distribution of unambiguously stuttered and fluent utterances (43.6% and 43.5%, respectively). Moreover, 12.9% of the utterances were judged to be ambiguous, that is, not unambiguously stuttered or fluent. Conclusion: This approach outperformed previous attempts to elicit stuttering during laboratory testing. It could be implemented in future studies that compare neural, physiological, or behavioral correlates of fluent versus stuttered speech.

Background: Despite initial underreporting of language dysfunctions in corticobasal syndrome (CBS), aphasia is now recognized as a frequent feature of this disease. Aphasia in CBS seems clinically overlying to a non-fluent/agrammatic primary progressive aphasia (nfaPPA), which is also a clinical phenotype associated with corticobasal degeneration (CBD) pathology. However, the clinical features of aphasia in CBS still remain poorly delineated, resulting in misjudgements in the differential diagnosis from a PPA presentation of the disease. Aims: To investigate the language disorders of this syndrome, also through a systematic examination of recoding skills (reading, written spelling and repetition) and articulatory disturbances, which have been rarely examined in previous studies. Methods & Procedures: We present a clinical and neuropsychological descriptive study of the language impairments in a case series of 12 aphasic patients with a clinical diagnosis of CBS. Language assessment was conducted by means of the Esame NeuroPsicologico dell'Afasia, a comprehensive Italian battery for language functions, the Token Test, and the Apraxia of Speech Rating Scale. Outcomes & Results: The language profile of the patients showed a severe expressive language disorder, characterized by non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding and defective sentence repetition. Severe limb apraxia, visual-spatial deficit and alien hand syndrome were also present. Neuroimaging showed bilateral left asymmetric atrophies and hypometabolism in the frontal premotor, parietal posterior and temporal areas. Conclusions & Implications: These findings suggest that aphasia in CBS might present as a 'mixed PPA', instead of an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA, associated with AoS, stuttering and agraphia, which might be additional important cognitive markers for the clinical diagnosis of CBS and discriminating features of an nfaPPA presentation of a CBD. These results might also suggest specific intervention areas in the rehabilitation of patients with CBS.

Purpose: This study explored group experiences and individual differences in the behaviors, thoughts, and feelings perceived by adults who stutter. Respondents' goals when speaking and prior participation in self-help/support groups were used to predict individual differences in reported behaviors, thoughts, and feelings. Method: In this study, 502 adults who stutter completed a survey examining their behaviors, thoughts, and feelings in and around moments of stuttering. Data were analyzed to determine distributions of group and individual experiences. Results: Speakers reported experiencing a wide range of both overt behaviors (e.g., repetitions) and covert behaviors (e.g., remaining silent, choosing not to speak). Having the goal of "not stuttering when speaking" was significantly associated with more covert behaviors and more negative cognitive and affective states, whereas a history of self-help/support group participation was significantly associated with a decreased probability of these behaviors and states. Conclusion: Data from this survey suggest that participating in self-help/support groups and having a goal of communicating freely (as opposed to trying not to stutter) are associated with less negative life outcomes due to stuttering. Results further indicate that the behaviors, thoughts, and experiences most commonly reported by speakers may not be those that are most readily observed by listeners.

Purpose: The purpose of this study was to compare physiological indices of sympathetic nervous system arousal recorded during fluent and stuttered utterances in a preschool children who stutter (CWS). Method: Twenty-two 4- to 5-year-old CWS participated in the experiment. We recorded children's skin conductance response amplitude and frequency, blood pulse volume amplitude, and pulse rate as they completed a picture description task. We then compared indices of phasic sympathetic arousal recorded during stuttered versus fluent utterances. In addition, children's communication attitudes were evaluated with a self-report measure. Results: We detected significantly higher sympathetic arousal during stuttered utterances compared to fluent utterances. Specifically, we found larger skin conductance responses occurring at an increased frequency and decreased blood pulse volume amplitudes during stuttered speech. The behavioral measure indicated a negative communication attitude in only one-third of the participants. Conclusion: Our findings suggest that preschool CWS may exhibit higher levels of sympathetic arousal during stuttered speech compared to when they are speaking fluently. We discuss the potential impact of increased sympathetic arousal on speech regulatory mechanisms in early childhood stuttering and present questions to guide future research.

Purpose: Numerous frameworks and definitions have sought to differentiate what behaviors and experiences should be considered as a part of stuttering. Nearly all of these efforts have been based on the perspectives and beliefs of conversational partners and listeners. This outside-in approach to defining stuttering lacks validation from people who live with the condition. Method: In this study, 430 adults who stutter participated in a qualitative exploration of the term "stuttering." Data were analyzed thematically to determine speakers' perspectives about moment of stuttering and the overall experience of stuttering in their lives. Results: To adults who stutter, the term "stuttering" signifies a constellation of experiences beyond the observable speech disfluency behaviors that are typically defined as stuttering by listeners. Participants reported that the moment of stuttering often begins with a sensation of anticipation, feeling stuck, or losing control. This sensation may lead speakers to react in various ways, including affective, behavioral, and cognitive reactions that can become deeply ingrained as people deal with difficulties in saying what they want to say. These reactions can be associated with adverse impact on people's lives. This interrelated chain of events can be exacerbated by outside environmental factors, such as the reactions of listeners. Discussion: Data from this survey provide novel evidence regarding what stuttering means to adults who stutter. These data are used to update the adaptation of the World Health Organization's International Classification of Functioning, Disability and Health as it applies to stuttering (Yaruss & Quesal, 2004) to better account for the complex and individualized phenotype of stuttering and to develop a definition of the experience of stuttering that is based not only on the observations of listeners but also on the impact of stuttering on the lives of adults who stutter.

Purpose: Persons who stutter (PWS) may be susceptible to discrimination because of negative judgments made by listeners. The current study sought to determine how the cognitive system's explicit (i.e., conscious) and implicit (i.e., nonconscious) biases about PWS are impacted by self-disclosure. Method: A computer mouse-tracking paradigm was used to evaluate categorical social judgments about PWS. Computer mouse trajectories, which have been shown to reveal underlying cognitive pull or competition between opposing concepts, were used to measure implicit bias (i.e., nonconscious stereotypes). Participants were asked to explicitly categorize the speaker as either intelligent or unintelligent before and after listening to a speaker self-disclose. Mouse cursor trajectories during the explicit response categorization were used to evaluate implicit bias associated with the decision-making process. Results: Results indicated that participants chose "intelligent" for a higher proportion of the trials in the disclosure condition compared to baseline, showing that listeners' explicit biases changed after listening to a self-disclosure that the speaker stutters. Results also indicated listeners exhibited a more negative implicit bias, based on computer mouse trajectories, when rating the PWS relative to the "persons who do not stutter" talker, but this negative implicit bias did seem to reduce over time after the disclosure was made. Conclusions: These findings indicate that, even though explicit and implicit biases were evident when listeners heard stuttering, both explicit and implicit biases seemed to extinguish over time after a self-disclosure. Although the bias was not completely extinguished, these results provide promising evidence toward developing methods to reduce negative beliefs and reactions toward PWS.

Purpose: We studied speech-related sympathetic nervous system arousal of preschool-age children who do (CWS) and do not stutter (CWNS) and its association with children's proclivity to experience negative emotions and children's self-reported attitudes toward speaking. Method: Electrodermal activity measures were collected from 32 preschool-age children while they engaged in a picture description and a nonword repetition task. Children's proclivity to experience negative emotions was assessed with a parent report questionnaire. Children's communication attitude was assessed with a self-report questionnaire. Results: CWS did not differ from CWNS in their sympathetic arousal during a picture description task. However, during a more challenging nonword repetition task, preschool-age CWS had a higher sympathetic arousal level than CWNS. Although CWS were rated by their caregivers as more fearful and prone to sadness, children's tendency to experience stronger and more frequent negative emotions was not associated with their sympathetic arousal during speaking. Lastly, although CWS had a more negative communication attitude than CWNS, it was not associated with their level of sympathetic arousal during speaking. Conclusions: Our findings suggest that age-appropriate social communication tasks are not inherently more stressful for preschool-age CWS and are not associated with state-related stress or anxiety that is often reported for adults who stutter. However, speaking tasks that place a higher demand on children's cognitive-linguistic system may be more taxing and challenging to preschool CWS than CWNS, leading to a higher level of arousal.

This study investigated the impact of speech and language disorders on pupils' learning and socialization in schools of Kalomo District, Zambia. The Descriptive research design was employed for the study. The sample consisted of 48 pupils with speech and language disorders purposively selected from 6 schools. The instruments used for data collection were a questionnaire and a test for speech and language disorders. The instruments were both faced and content validated by experts. The questionnaires and test items were taken to experts at the University of Zambia and the Zambia Institute for Special Education (department of speech and language disorders) for validation. The questionnaire and the test were administered to the sampled students. The data collected were coded and analysed using the Statistical Packages for Social Sciences. Descriptive statistics and the regression analysis were employed. The result of the study revealed that the performance of pupils with speech and language disorder in English Language was low, but were average in their socialization. It was also discovered that 77.2% variance in academic performance was accounted for by the level of speech and language disorders. The positive beta value of 11.885 showed that, the less the severity of speech and language disorder, the better was the academic performance of pupils. The study also revealed that type of disorder and socialization accounted for 79% variance in academic performance. Type of disorder accounted 77.2% while socialization accounted 1.8%. The positive beta value of 11.648 for the type of disorder, and 6.099 for socialization indicated that, the less the severity of the disorder and the more pupils with speech and language disorders socialize the better is their academic performance. Type of disorder had greater influence on their academic performance.

Purpose: The primary aim of the current study was to examine the developing phonological awareness of 4- to 5-year-old children who stutter (CWS) in relation to eventual recovery (CWS-eRec) or persistance (CWS-ePer) in stuttering, accounting for the presence of typical speech (TS) production or speech sound disorder (SSD). Method: In the 1st year of a 5-year longitudinal study, 37 children who do not stutter (CWNS) and 48 CWS completed a rhyme discrimination and a rhyme production task from the Phonological Awareness Test--Second Edition (Robertson & Salter, 2007). Using data from their last year of participation, CWS were classified into CWS-ePer and CWS-eRec. Each CWS group was further divided into TS and SSD groups based on speech production abilities at the time of the rhyme tasks. Accuracy on the rhyme tasks was compared. Groups were also compared on strategies used to generate correct and incorrect responses for the rhyme production task (e.g., real-word correct, nonword correct, semantic association, repeated cues). Results: All groups performed similarly on the rhyme discrimination task. On the rhyme production task, CWS-ePer-SSD and CWS-eRec-SSD performed with less accuracy than CWNS, but CWS-ePer-TS, CWS-eRec-TS, and CWNS achieved similar task accuracy. On correct rhyme production trials, CWS-ePer-TS created more nonword rhymes than real-word rhymes. CWS-ePer-TS used the nonword strategy at 1.88 times the CWNS rate. CWS-eRec-TS fell between CWS-ePer-TS and CWNS in use of the nonword strategy. Conclusions: Reliance on a nonword strategy for rhyme production in CWS-ePer-TS may reflect differences in underlying phonological representations and ease of phonological access to the lexicon compared to CWNS.

Purpose: The study aim was to determine whether self-reported temperament traits differentiate adults who stutter (AWS) from adults who do not stutter (AWNS). Additionally, associations between temperament and stuttering frequency, and between temperament and quality of life impacts of stuttering, were investigated in AWS. Method: Self-reported temperament traits were documented for 33 AWS and 43 AWNS using the Adult Temperament Questionnaire (ATQ; Evans & Rothbart, 2007). Quality-of-life impacts of stuttering were assessed using the Overall Assessment of the Speaker's Experience with Stuttering (Yaruss & Quesal, 2010). Stuttering frequency was calculated from 100-word monologue and reading samples. Results: A between-groups difference in scores on the ATQ Positive Affect subscale was nominally significant (i.e., before correcting for multiple tests) and also approached statistical significance after Bonferroni correction. Positive Affect scores were lower for AWS, and the size of this trending effect was moderate. Within AWS, a statistically significant positive correlation was found between impact scores on the General Information section of the Overall Assessment of the Speaker's Experience with Stuttering and ATQ Frustration subscale scores after Bonferroni correction. No associations were detected between temperament traits and stuttering frequency. Conclusions: Results reveal a nontrivial tendency for AWS to experience decreased positive affect compared to AWNS. In addition, increased frustration was found to be associated with reduced general knowledge about stuttering in AWS. Neither effect has been previously reported for adults or children who stutter. Finally, self-reported temperament traits were not found to vary with stuttering frequency in adults, consistent with previous results for AWS.

Purpose: We review two recent neuroanatomical studies of children who stutter (CWS), one that examines white matter integrity and the other that focuses on cortical gray matter morphology. In both studies, we sought to examine differences between children whose stuttering persists ("persistent"), children who recovered from stuttering ("recovered"), and their nonstuttering peers ("controls"). Method: Both of the reviewed studies use data from a large pediatric sample spanning preschool- to school-age children (3-10 years old at initial testing). Study 1 focused on surface-based measures of cortical size (thickness) and shape (gyrification) using structural magnetic resonance imaging, whereas Study 2 utilized diffusion tensor imaging to examine white matter integrity. Results: In both studies, the main difference that emerged between CWS and fluent peers encompassed left hemisphere speech motor areas that are interconnected via the arcuate fasciculus. In the case of white matter integrity, the temporoparietal junction and posterior superior temporal gyrus, both connected via the left arcuate fasciculus, and regions along the corpus callosum that contain fibers connecting bilateral motor regions were significantly decreased in white matter integrity in CWS compared to controls. In the morphometric study, children who would go on to have persistent stuttering specifically had lower cortical thickness in ventral motor and premotor areas of the left hemisphere. Conclusion: These results point to aberrant development of cortical areas involved in integrating sensory feedback with speech movements in CWS and differences in interhemispheric connectivity between the two motor cortices. Furthermore, developmental trajectories in these areas seem to diverge between persistent and recovered cases. [Paper presented at the International Conference on Speech Motor Control (7th).]

Purpose: We review and interpret our recent series of studies investigating motor-to-auditory influences during speech movement planning in fluent speakers and speakers who stutter. In those studies, we recorded auditory evoked potentials in response to probe tones presented immediately prior to speaking or at the equivalent time in no-speaking control conditions. As a measure of pre-speech auditory modulation (PSAM), we calculated changes in auditory evoked potential amplitude in the speaking conditions relative to the no-speaking conditions. Whereas adults who do not stutter consistently showed PSAM, this phenomenon was greatly reduced or absent in adults who stutter. The same between-group difference was observed in conditions where participants expected to hear their prerecorded speech played back without actively producing it, suggesting that the speakers who stutter use inefficient forward modeling processes rather than inefficient motor command generation processes. Compared with fluent participants, adults who stutter showed both less PSAM and less auditory-motor adaptation when producing speech while exposed to formant-shifted auditory feedback. Across individual participants, however, PSAM and auditory-motor adaptation did not correlate in the typically fluent group, and they were negatively correlated in the stuttering group. Interestingly, speaking with a consistent 100-ms delay added to the auditory feedback signal--normalized PSAM in speakers who stutter, and there no longer was a betweengroup difference in this condition. Conclusions: Combining our own data with human and animal neurophysiological evidence from other laboratories, we interpret the overall findings as suggesting that (a) speech movement planning modulates auditory processing in a manner that may optimize its tuning characteristics for monitoring feedback during speech production and, (b) in conditions with typical auditory feedback, adults who stutter do not appropriately modulate the auditory system prior to speech onset. Lack of modulation of speakers who stutter may lead to maladaptive feedback-driven movement corrections that manifest themselves as repetitive movements or postural fixations. [Paper presented at the International Conference on Speech Motor Control (7th).]

Purpose: The purpose of this study was to assess changes in autonomic, behavioral, and acoustic measures in response to social stress in adults who stutter (AWS) compared to adults who do not stutter (ANS). Method: Participants completed the State-Trait Anxiety Inventory (Speilberger, Gorsuch, Luschene, Vagg, & Jacobs, 1983). In order to provoke social stress, participants were required to complete a modified version of the Trier Social Stress Test (TSST-M, Kirschbaum, Pirke, & Hellhammer, 1993), which included completing a nonword reading task and then preparing and delivering a speech to what was perceived as a group of professionals trained in public speaking. Autonomic nervous system changes were assessed by measuring skin conductance levels, heart rate, and respiratory sinus arrhythmia (RSA). Behavioral changes during speech production were measured in errors, percentage of syllable stuttered, percentage of other disfluencies, and speaking rate. Acoustic changes were measured using 2nd formant frequency fluctuations. In order to make comparisons of speech with and without social-cognitive stress, measurements were collected while participants completed a speaking task before and during TSST-M conditions. Results: AWS showed significantly higher levels of self-reported state and trait anxiety compared to ANS. Autonomic nervous system changes revealed similar skin conductance level and heart rate across pre-TSST-M and TSST-M conditions; however, RSA levels were significantly higher in AWS compared to ANS across conditions. There were no differences found between groups for speaking rate, fundamental frequency, and percentage of other disfluencies when speaking with or without social stress. However, acoustic analysis revealed higher levels of 2nd formant frequency fluctuations in the AWS compared to the controls under pre-TSST-M conditions, followed by a decline to a level that resembled controls when speaking under the TSST-M condition. Discussion: Results suggest that AWS, compared to ANS, engage higher levels of parasympathetic control (i.e., RSA) during speaking, regardless of stress level. Higher levels of self-reported state and trait anxiety support this view point and suggest that anxiety may have an indirect role on articulatory variability in AWS.

Background: The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model-based treatment (RESTART-DCM) for pre-school age children who stutter. Aims: To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention. Method: The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no-treatment control reasoning. Main Contribution: We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART-DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development. Conclusion: In addition to guiding future clinical research comparing RESTART-DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering.

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.

Purpose: The purpose of this study was to examine the verbal short-term memory skills of children who stutter (CWS) and children who do not stutter (CWNS) in 2 experiments, focusing on the influence of phonological and semantic similarity. Method: Participants were 42 CWS and 42 CWNS between the ages of 3;0 and 5;11 (years;months). In Experiment 1, children completed the phonological similarity task, in which they listened to lists of phonologically similar and dissimilar words and then repeated them when signaled to do so. In Experiment 2, children completed another forward span task, the semantic category task, which is similar to the phonological similarity task, except that it consisted of lists of semantically homogeneous and heterogeneous words. Main dependent variables were cumulative memory span, proportion of errors by type, and speech reaction time (SRT) for correct responses. Results: The CWS exhibited significantly shorter memory spans for phonologically dissimilar words and were less affected by the phonological qualities of the words than the CWNS in Experiment 1, based on the findings of both between-groups and within-group analyses. In Experiment 2, although the groups did not differ in their performance in either condition, within-group analyses revealed that the CWNS benefitted from semantic similarity, whereas the CWS did not. The between-groups difference in absolute difference scores, however, did not reach significance. The CWS produced more omissions and false alarms than the CWNS in both experiments, but the 2 groups of children were otherwise comparable in SRT, although the CWS exhibited overall faster SRT than the CWNS in Experiment 2. Conclusions: Verbal short-term memory is one domain-general cognitive process in which CWS display weakness relative to typically fluent peers. These weaknesses are likely due, in part, to differences in phonological and, perhaps, semantic processing of words to aid memory.

A mindfulness meditation exercise was incorporated into a stuttering treatment program for an adult male who stutters. Speech disfluencies were analyzed before and after mindfulness meditation and implementation of fluency shaping techniques. Findings suggested that including a mindfulness meditation exercise into a treatment program may be helpful for people who stutter.

The aim of this study is to discuss the needs of learners who stutter (LWS) in the skills of speaking, listening, reading, and writing in English as a foreign language (EFL) learning based on their levels of anxiety, and their experiences as individuals who stutter in the process of learning this language. To this end, the anxiety of these students (n = 16) in the foreign language was measured using the Foreign language classroom anxiety scale (FLCAS), and the Specific language skills anxiety scale (SLSAS), whilst their experiences were elicited through semi-structured interviews. Their foreign language anxiety (FLA) levels were then compared to those obtained from a control group of non-stuttering learners (n = 16), and interview content was scrutinised mainly using Interpretive Phenomenological Analysis (IPA). LWS scored significantly higher in FLA and speaking anxiety than the control group; however, no significant differences were found between both groups in other language skills. Findings from the qualitative study also indicated that reading aloud was highly problematic for these learners. Suggestions to attenuate anxiety in LWS are offered to educators.

Background: iGlebe is a fully automated internet treatment program for adults who stutter that has been shown, in some cases, to reduce anxiety and effectively manage social anxiety disorder for many participants. No such automated internet treatment program exists for adolescents who stutter. Aims: The present paper reports a Phase I trial of an adolescent version of the adult program: iBroadway. Methods & Procedures: Participants were 29 adolescents in the age range 12-17 years who were seeking cognitive-behaviour therapy (CBT) for anxiety associated with stuttering. The design was a non-randomized Phase I trial with outcome assessments at pre-treatment and immediately post-treatment after 5 months of access to the program. No contact by a clinical psychologist occurred during participant use of the program. Outcomes were a range of psychological, quality-of-life and stuttering severity measures. Outcomes & Results: The compliance rate for the seven iBroadway modules over 5 months was extremely favourable for internet CBT, at 52.4%. There was evidence of treatment effects for (1) the number of DSM-IV mental health diagnoses with the Diagnostic Interview Schedule for Children; (2) the Unhelpful Thoughts and Beliefs About Stuttering scale; (3) the Subjective Units of Distress Scale; and (4) parent-reported speech satisfaction. Conclusions & Implications: Further development of iBroadway, the adolescent version of iGlebe, with Phase II trialling is warranted.

Background: Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The 'working alliance' is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular. Aims: To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients' concept of motivation and treatment outcomes 6 months post-therapy. Methods & Procedures: Eighteen adults (21-61 years) participated in this multiple single-case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory--Short Version Revised (WAI-SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST-E), the Overall Assessment of Speakers' Experience of Stuttering--Adult version (OASES-A), the Wright & Ayre Stuttering Self-Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS). Outcomes & Results: Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post-treatment. The association between client-led goals and therapy tasks appeared particularly important. Conclusions & Implications: The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client-clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted.

Purpose: Stuttering is a disorder that has been associated with coexisting developmental disorders. To date, detailed descriptions of the coexistence of such conditions have not consistently emerged in the literature. Identifying and understanding these conditions can be important to the overall management of children who stutter (CWS). The objective of this study was to generate a profile of the existence of disabling developmental conditions among CWS using national data. Method: Six years of data from the National Health Interview Survey (2010-2015) were analyzed for this project. The sample consisted of children whose respondents clearly indicated the presence or absence of stuttering. Chi-square tests of independence were used for comparing categorical variables; and independent-samples t tests, for comparing continuous variables. Multiple logistic regression analyses were used for determining the odds of having a coexisting disabling developmental condition. Results: This study sample included 62,450 children, of which 1,231 were CWS. Overall, the presence of at least 1 disabling developmental condition was 5.5 times higher in CWS when compared with children who do not stutter. The presence of stuttering was also associated with higher odds of each of the following coexisting developmental conditions: intellectual disability (odds ratio [OR] = 6.67, p < 0.001), learning disability (OR = 5.45, p < 0.001), attention-deficit hyperactivity disorder/attention-deficit disorder (OR = 3.09, p < 0.001), seizures (OR = 7.52, p < 0.001), autism/Asperger's/pervasive developmental disorder (OR = 5.48, p < 0.001), and any other developmental delay (OR = 7.10, p < .001). Conclusion: Evidence from the National Health Interview Survey suggests a higher prevalence of coexisting developmental disabilities in CWS. The existence of coexisting disabling developmental conditions should be considered as part of an overall management plan for CWS.

This research promotes psycholinguistic paradigm, it focusing in delimitating several specific particularities in stuttering pathology. Structural approach, on language sides proves both the recurrent aspects found within specialized national and international literature and the psycholinguistic approaches dependence on the features of the linguistic material. Thus, the conclusions of this research study offer the possibility of promoting cross-cultural and cross-linguistic researches, with the aim of obtaining data which can be generalized beyond national boundaries, in stuttering pathology.