A preliminary investigation of daily variability of stuttering in adults

A descriptive analysis of assessment measures on the effectiveness of a comprehensive stuttering intervention approach: A single case study

BACKGROUND

For effective client outcomes, stuttering assessment and intervention approaches need to be aligned. This encompasses using assessment and intervention approaches that address the three multidimensional constructs of stuttering, namely core behaviours, secondary behaviours and negative feelings and attitudes.

OBJECTIVE

The study aimed to explore whether multiple assessment measures could be used to describe the effectiveness of a comprehensive stuttering intervention approach, undergirded by the International Classification of Functioning, Disability and Health (ICF) framework.

METHOD

A single-subject case design was employed with one male adult who stutters. Data was collected by administering the Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering-Adults (OASES-A) at three testing periods (pre-intervention, immediately post-intervention and 7 months post-intervention), and a semi-structured interview schedule immediately post-intervention. Descriptive statistics was used to analyse the SSI-4 and OASES-A, and thematic analysis was conducted to evaluate the participant's interview schedule responses.

RESULTS

The participant's total scores, impact scores and severity ratings of both the SSI-4 and OASES decreased across the three testing periods. The main theme of effectiveness of the comprehensive stuttering intervention to reduce aspects of disability emerged from the participant's responses.

CONCLUSION

Evaluation of the results from the assessment measures revealed that the comprehensive stuttering intervention approach was effective in reducing the participant's core behaviours, secondary behaviours and negative feelings and attitudes. Assessment and management of fluency disorders should promote a client-specific multidimensional approach that extends beyond the core behaviours and secondary behaviours, by addressing the underlying social and emotional facets of fluency disorders.

The Speaker's Experience of Stuttering: Measuring Spontaneity

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.

Toward a better understanding of the process of disclosure events among people who stutter

PURPOSE

The purpose of this study was to identify components of disclosure events among people who stutter, and identify possible relations between these components in order to understand how disclosure events unfold.

METHOD

Twelve adults who stutter participated in semi-structured interviews focused on disclosure of stuttering. Participants were purposefully selected due to their self-reported history of disclosing stuttering. Qualitative content analysis using a grounded theory approach helped to identify relevant themes and subthemes related to the process of disclosure of stuttering.

RESULTS

The findings describe the complex process of disclosure as being comprised of antecedents (including considerations about when and why to disclose), the disclosure event itself (including the content and form of the disclosure, most and least helpful methods of disclosure, as well as immediate listener reactions), and the perceived outcomes of the disclosure at individual, dyadic, and societal/contextual levels. These components of the process are linked and affect one another, resulting in a feedback loop. Disclosure methods are context-dependent and not mutually exclusive within individuals who stutter.

CONCLUSION

Professionals and advocates gaining a more nuanced understanding of the process of disclosure events can increase their ability to help people who stutter make optimal decisions about disclosure. Making good disclosure decisions can help PWS improve their quality of life and reduce a variety of environmental communicative barriers.

Group Experiences and Individual Differences in Stuttering

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.

Stuttering as Defined by Adults Who Stutter

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.

The utility of stuttering support organization conventions for young people who stutter

BACKGROUND

Stuttering Support Organizations (SSOs) are places where people who stutter can share their experiences with stuttering and lend support to each other. There is evidence that SSO participation may be helpful in reducing the negative impact of stuttering and promoting positive cognitive and affective changes in adults who stutter. The benefits of participating in SSO organizations for young people, however, are currently unknown.

PURPOSE

This study investigated the relationship between attending a multi-day SSO convention and cognitive and affective changes among young people who stutter (YPWS).

METHODS

Twenty-two YPWS (ages 10 to 18) were recruited from the 2016 FRIENDS annual convention to participate in this study. FRIENDS is the National Association of Young People Who Stutter. A mixed methods approach was used to collect and analyze quantitative and qualitative data. The Overall Assessment of the Speaker's Experience with Stuttering (OASES) was administered at three times points: pre-convention, post-convention, and three months following the convention. Semi-structured interviews were conducted with seven participants to further explain the quantitative results.

RESULTS

Analysis of OASES scores across the three time points indicated that there were significant decreases in the negative impact of stuttering between pre-convention and post-convention measures. Qualitative analysis of semi-structured interview transcripts revealed five themes related to community building, collaborative learning, cognitive and communicative changes, self-acceptance, and normalizing stuttering.

CONCLUSION

SSOs may be beneficial in reducing the negative impact of stuttering and should be considered a potentially valuable addition to traditional therapy for stuttering.

Swedish outcomes of the Overall Assessment of the Speaker's Experience of Stuttering in an international perspective

Aim: The purpose of the present project was to translate the Overall Assessment of the Speaker's Experience of Stuttering (OASES) to Swedish, and to compare the results with available international data.Method: The Swedish versions of OASES-A, OASES-T and OASES-S were administered to 80 adults, 27 teenagers and 32 children who stutter, respectively. The overall impact scores and the impact scores for each of the four sections of the instrument were analyzed in relation to other studies involving the OASES.Results: The results revealed that all three Swedish versions of OASES had normally distributed outcomes and that they were reliable and valid. The overall impact scores for adults (2.33), teenagers (2.60) and children (2.28) all fell within Impact Rating Moderate. The mean overall impact score for OASES-A-S was significantly lower than corresponding data from USA, Australia and Japan (p < .01). There was no difference between Swedish and American teenagers, or between Swedish and American or Dutch schoolchildren.Conclusion: There seems to be cultural differences in the experience of negative consequences associated with stuttering. This suggests that cultural aspects should be carefully considered in assessment, treatment, and research involving individuals who stutter.

Recovery from stuttering in preschool-age children: 9 year outcomes in a clinical population

PURPOSE

The first purpose was to define the recovery rate in children who stutter in a clinical sample, adding self-report to validate recovery status. The second purpose was to explore whether children who were judged to be recovered showed subjective experiences that might be interpreted as coping behaviors used to control speech fluency.

METHODS

In this longitudinal study, preschool-age children whose parents consulted a speech-language pathologist about stuttering were followed for 9 years. At follow-up, children's self-reports on stuttering were reported, as well as traditional criteria on recovery (parental and expert judgment). The Overall Assessment of the Speaker's Experience of Stuttering (OASES) was used to collect children's experiences with speaking.

RESULTS

Eleven of the 15 children (73%) were judged by parents and clinicians to have recovered from stuttering. However, when considering children's self-reports, 9 children (60%) might be considered to have recovered. In addition, 3 children who were judged to be recovered reported experiences with speaking that were uncommon, even compared to children who continued to stutter.

CONCLUSION

In this exploratory study of a clinical population, the recovery rate in children that received treatment for stuttering appeared to be comparable to a non-clinical population. Considering self-reports can improve validity of assessing the "recovery rate". Moreover, recovery in children may not be effortless; instead, it may be the result of conscious or unconscious coping behavior. Future studies are recommended to consider self-reports to improve validity of recovery, and to document experiences with speaking to explore effortless, spontaneous fluency versus controlled fluency.

A Phenomenological Analysis of the Experience of Stuttering

PURPOSE

Stuttering behaviors and moments of stuttering are typically defined by what a listener perceives. This study evaluated participants' perceptions of their own experience of moments of stuttering.

METHOD

Thirteen adults who stutter participated in a phenomenological qualitative study examining their experience of moments of stuttering. Analysis yielded several common themes and subthemes culminating in an essential structure describing the shared experience.

RESULTS

Speakers experience anticipation and react in action and nonaction ways. Many speakers experience a loss of control that relates to a lack of a well-formed speech plan or agency. The experience of moments of stuttering changes through therapy, over time, with self-help, and across situations. Many speakers experience so-called typical stuttering behaviors as reactions rather than direct consequences of trying to speak. Interactions with listeners can affect the experience of stuttering.

CONCLUSION

Although research recognizes that the experience of the stuttering disorder involves more than just speech behaviors, people who stutter experience stuttering behaviors in time as involving more than just the disruption in speech. This finding has implications for both the theoretical understanding of stuttering and the clinical evaluation and treatment of the stuttering disorder.

Behavior Assessment Battery: Normative and Psychometric Investigation Among Polish Adults Who Do and Do Not Stutter

PURPOSE

The aim of this study was to establish normative data for Polish persons who stutter (PWS) and persons who do not stutter (PWNS) with the adapted version of the Behavior Assessment Battery (BAB; Vanryckeghem & Brutten, 2018) for adults and to investigate whether or not gender and age influenced the results. In addition, the BAB subtests' reliability and validity were examined.

METHOD

A Polish version of the BAB test procedures, including the Speech Situation Checklist-Emotional Reaction, Speech Situation Checklist-Speech Disruption, Behavior Checklist, and Communication Attitude Test for Adults Who Stutter (Vanryckeghem & Brutten, 2018), were individually administered to 123 adults who stutter and 151 adults who do not stutter between the ages of 17 and 70.

RESULTS

PWS scored statistically significantly higher on all BAB subtests compared to PWNS. No significant between-groups gender or age difference was detected. The test data indicate high internal validity. The test items correlate well with the total score and significantly differentiate the two groups. The test battery validly differentiates PWS from PWNS with high accuracy.

CONCLUSIONS

The Polish version of the BAB for adults confirms data collected in previous cross-cultural investigations. The results once again differentiate PWS from PWNS in a powerful way. Compared to PWNS, PWS report significantly more anxiety and speech breakdown when speaking in particular speech situations. They also report their attitude toward speech to be significantly more negative compared to the typical speaker and indicate using a significant number of coping behaviors to avoid or escape difficult speaking conditions. The BAB test battery, in its totality, assists in multidimensional assessment, pre- and posttreatment comparison, and identification of treatment targets based on the answers of PWS to each test item.

Cortical dynamics of disfluency in adults who stutter

Stuttering is a disorder of speech production whose origins have been traced to the central nervous system. One of the factors that may underlie stuttering is aberrant neural miscommunication within the speech motor network. It is thus argued that disfluency (any interruption in the forward flow of speech) in adults who stutter (AWS) could be associated with anomalous cortical dynamics. Aberrant brain activity has been demonstrated in AWS in the absence of overt disfluency, but recording neural activity during disfluency is more challenging. The paradigm adopted here took an important step that involved overt reading of long and complex speech tokens under continuous EEG recording. Anomalies in cortical dynamics preceding disfluency were assessed by subtracting out neural activity for fluent utterances from their disfluent counterparts. Differences in EEG spectral power involving alpha, beta, and gamma bands, as well as anomalies in phase-coherence involving the gamma band, were observed prior to the production of the disfluent utterances. These findings provide novel evidence for compromised cortical dynamics that directly precede disfluency in AWS.

Speech Situation Checklist-Revised: Investigation With Adults Who Do Not Stutter and Treatment-Seeking Adults Who Stutter

PURPOSE

The aim of this study was to evaluate the usefulness of the Speech Situation Checklist for adults who stutter (SSC) in differentiating people who stutter (PWS) from speakers with no stutter based on self-reports of anxiety and speech disruption in communicative settings. The SSC's psychometric properties were examined, norms were established, and suggestions for treatment were formulated.

METHOD

The SSC was administered to 88 PWS seeking treatment and 209 speakers with no stutter between the ages of 18 and 62. The SSC consists of 2 sections investigating negative emotional reaction and speech disruption in 38 speech situations that are identical in both sections.

RESULTS

The SSC-Emotional Reaction and SSC-Speech Disruption data show that these self-report tests differentiate PWS from speakers with no stutter to a statistically significant extent and have great discriminative value. The tests have good internal reliability, content, and construct validity. Age and gender do not affect the scores of the PWS.

CONCLUSIONS

The SSC-Emotional Reaction and SSC-Speech Disruption seem to be powerful measures to investigate negative emotion and speech breakdown in an array of speech situations. The item scores give direction to treatment by suggesting speech situations that need a clinician's attention in terms of generalization and carry-over of within-clinic therapeutic gains into in vivo settings.

Semantic and Phonological Encoding Times in Adults Who Stutter: Brain Electrophysiological Evidence

PURPOSE

Some psycholinguistic theories of stuttering propose that language production operates along a different time course in adults who stutter (AWS) versus typically fluent adults (TFA). However, behavioral evidence for such a difference has been mixed. Here, the time course of semantic and phonological encoding in picture naming was compared in AWS (n = 16) versus TFA (n = 16) by measuring 2 event-related potential (ERP) components: NoGo N200, an ERP index of response inhibition, and lateralized readiness potential, an ERP index of response preparation.

METHOD

Each trial required a semantic judgment about a picture in addition to a phonemic judgment about the target label of the picture. Judgments were mapped onto a dual-choice (Go-NoGo/left-right) push-button response paradigm. On each trial, ERP activity time-locked to picture onset was recorded at 32 scalp electrodes.

RESULTS

NoGo N200 was detected earlier to semantic NoGo trials than to phonemic NoGo trials in both groups, replicating previous evidence that semantic encoding generally precedes phonological encoding in language production. Moreover, N200 onset was earlier to semantic NoGo trials in TFA than in AWS, indicating that semantic information triggering response inhibition became available earlier in TFA versus AWS. In contrast, the time course of N200 activity to phonemic NoGo trials did not differ between groups. Lateralized readiness potential activity was influenced by strategic response preparation and, thus, could not be used to index real-time semantic and phonological encoding.

CONCLUSION

NoGo N200 results point to slowed semantic encoding in AWS versus TFA. Discussion considers possible factors in slowed semantic encoding in AWS and how fluency might be impacted by slowed semantic encoding.

A pilot study into a possible relationship between diet and stuttering

PURPOSE

There are theoretical and empirical reasons to consider a potential role for copper metabolism in the brain in how it could influence stuttering. However, a link between stuttering and dietary intake has never been researched in a systematic way. This pilot study therefore aimed to explore a possible association between ingested amounts of copper and thiamine (vitamin B1) with stuttering frequency using a double blind cross-over longitudinal paradigm.

METHODS

19 adults who stutter between 20 and 51 years old filled out an online survey for 9 consecutive weeks. The survey consisted of self-assessed fluency and mood state scales, as well as food journals. After 4 weeks, the participants consumed either copper or thiamine supplements for 2 weeks, followed by a 1-week washout period, and another period of two weeks taking the other supplement. Formal speech assessments were done pre/post baseline and at the end of each supplement intake. Participants were not informed about the nature of the supplements during the experiment and the investigators were blinded to the order of the supplements.

RESULTS

The results demonstrated that copper and thiamine had no measurable effect on the amount of stuttering (self and formal assessments) but there was a moderate, significant correlation between mood state and fluency.

CONCLUSION

The findings do not support notions of dietary influences of ingested copper or thiamine on stuttering but do provide modest support for a relationship between variations in stuttering and self-perceived anxiety.