Fluency disorders in genetic syndromes

Developmental stuttering, physical concomitants associated with stuttering, and Tourette syndrome: A scoping review

BACKGROUND AND PURPOSE

Developmental stuttering and Tourette syndrome (TS) are common neurodevelopmental disorders. Although disfluencies may co-occur in TS, their type and frequency do not always represent pure stuttering. Conversely, core symptoms of stuttering may be accompanied by physical concomitants (PCs) that can be confused for tics. This scoping review aimed to explore the similarities and differences between stuttering and tics in terms of epidemiology, comorbidities, phenomenology, evolution, physiopathology, and treatment. We also described the nature of PCs in stuttering and disfluencies in TS.

METHODS

A literature search on Medline, Embase and PsycInfo was executed in March 2022. From 426 studies screened, 122 were included in the review (a majority being narrative reviews and case reports).

RESULTS

TS and stuttering have several epidemiological, phenomenological, comorbidity, and management similarities suggesting shared risk factors and physiopathology (involving the basal ganglia and their connections with speech and motor control cortical regions). PCs in stuttering commonly involve the face (eyelids, jaw/mouth/lip movements) and sometimes the head, trunk and limbs. PCs can be present from early stages of stuttering and vary over time and within individuals. The function of PCs is unknown. Some individuals with TS have a distinct disfluency pattern, composed of a majority of typical disfluencies (mostly between-word disfluencies), and a mix of cluttering-like behaviors, complex phonic tics (e.g. speech-blocking tics, echolalia, palilalia), and rarely, atypical disfluencies.

CONCLUSION

Future investigations are warranted to better understand the complex relationships between tics and stuttering and address the management of disfluencies in TS and PCs in stuttering.

Expanding the speech and language phenotype in Koolen-de Vries syndrome: late onset and periodic stuttering a novel feature

Speech and language impairment is core in Koolen-de Vries syndrome (KdVS), yet only one study has examined this empirically. Here we define speech, language, and functional/adaptive behaviour in KdVS; while deeply characterising the medical/neurodevelopmental phenotype in the largest cohort to date. Speech, language, literacy, and social skills were assessed using standardised measures, alongside an in-depth health and medical questionnaire. 81 individuals with KdVS were recruited (35 female, mean age 9y 10mo), 56 of whom harboured the typical 500-650 kb 17q21.31 deletion. The core medical phenotype was intellectual disability (largely moderate), eye anomalies/vision disturbances, structural brain anomalies, dental problems, sleep disturbance, musculoskeletal abnormalities, and cardiac defects. Most were verbal (62/81, 76.5%), while minimally-verbal communicators used alternative and augmentative communication (AAC) successfully in spite of speech production delays. Speech was characterised by apraxia (39/61, 63.9%) and dysarthria (28/61, 45.9%) in verbal participants. Stuttering was described in 36/47 (76.6%) verbal participants and followed a unique trajectory of late onset and fluctuating presence. Receptive and expressive language abilities were commensurate with one another, but literacy skills remained a relative weakness. Social competence, successful behavioural/emotional control, and coping skills were areas of relative strength, while communication difficulties impacted daily living skills as an area of comparative difficulty. Notably, KdVS individuals make communication gains beyond childhood and should continue to access targeted therapies throughout development, including early AAC implementation, motor speech therapy, language/literacy intervention, as well as strategies implemented to successfully navigate activities of daily living that rely on effective communication.

The effect of manual movements on stuttering in individuals with down syndrome

PURPOSE

Stuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients' needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.

METHOD

Eighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.

RESULTS

The experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.

CONCLUSION

Individual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.

Stuttering Behavior in a National Age Cohort of Norwegian First-Graders With Down Syndrome

PURPOSE

The aims of this study were to investigate the occurrence of stuttering behavior across time and to evaluate the relationship between stuttering behavior and language ability in children with Down syndrome.

METHOD

A national age cohort of Norwegian first graders with Down syndrome (N = 75) participated in the study. Speech samples from a story-retelling task and a picture book dialogue as well as standardized measures of vocabulary, grammar, and nonverbal mental ability were collected at two time points approximately 5 months apart. Stuttering behavior was evaluated through counting stuttering-like disfluencies and stuttering severity ratings. The relationship between stuttering behavior and language ability was investigated through hierarchical regression analysis.

RESULTS

The participants had stuttering severity ratings ranging from no stuttering behavior to severe and displayed all types of stuttering-like disfluencies. There were significant relationships between stuttering behavior and language ability at the first time point, whereas the relationships were not significant at the second time point. The stuttering severity ratings were significantly predicted by language ability across time, whereas the frequency of stuttering-like disfluencies was not.

CONCLUSIONS

The occurrence of stuttering behavior was high across the measures and time points; however, the relationship between stuttering behavior and language ability varied across these variables. Thus, the nature of the relationship does not seem to follow a strict pattern that can be generalized to all children across time.

Stuttering and Autism Spectrum Disorders: Assessment and Treatment

Dual diagnoses of autism spectrum disorders (ASDs) and stuttering have been reported in the literature, but little is known about how often they co-occur, the best practices for assessment, and even less about intervention. In this article, we gathered the data available on these issues and compiled and analyzed the sparse findings to offer suggestions for assessment and treatment. This article begins with a glossary of terms to promote consistency and understanding. Next, suggestions for assessment are provided along with a work sheet to document fluency breakdowns and monitor change. Suggestions for language and cognitive issues are also provided with a sample worksheet. Finally, an outline and explanation of stuttering/fluency goals for clients with these dual diagnoses are included. Case studies of two individuals who stutter and are diagnosed with ASD are presented to provide exemplars of how to assess and treat individuals with these dual diagnoses. Caveats on how to work with individuals with ASD and fluency disorders, based on our current understanding, are presented in the conclusion.

Influence of gestures on the intelligibility and comprehensibility of utterances with stuttering events in individuals with Down syndrome

INTRODUCTION

Individuals with Down syndrome (DS) often stutter, which can affect their speech intelligibility. Previous research has shown that manual signs can enhance speech intelligibility and comprehensibility. It remains unclear to what extent spontaneous hand gestures, such as iconic and beat gestures, may enhance intelligibility and/or comprehensibility during utterances with stuttering events.

METHODS

Eleven individuals with DS who stutter provided video-recorded speech samples. From these samples, 60 utterances containing a stuttering event were selected. In half of them, the stuttering events were accompanied by gestures; in the other half, the stuttering events were not accompanied by gestures. The samples were shown to 250 assessors who were blind to the study's goals. Each sample was shown in three visibility conditions: 1) video-with-audio, 2) video-with-audio but with the speaker's mouth covered and 3) audio-only. The assessors rated speech intelligibility on a 7-point Likert scale and transcribed the speech sample. The effect of gesture production, gesture type and the visibility conditions on comprehensibility and intelligibility was examined with a hierarchical multiple linear regression.

RESULTS

When a speaker had used a gesture during a stuttering event, the Likert scale score increased with 0.47 and the accuracy of transcription with 9.07%. There was no difference in effect between the different gesture types. Despite the effect from gesture use, there was no effect of the visibility conditions on the Likert scale or transcription score.

CONCLUSIONS

Gestures positively affect intelligibility and comprehensibility of utterances with stuttering events in individuals with DS by altering the speech production. The possibility of beat gestures as a therapy method should be examined, with caution for the development of maladaptive behaviours.

Non-pharmacological interventions for stuttering in children six years and younger

BACKGROUND

Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non-verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning.

OBJECTIVES

Primary objective To assess the immediate and long-term effects of non-pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) and quasi-RCTs that assessed non-pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait-list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial.  All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects.  The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait-list control group at post-test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) -2.16, 95% confidence interval (CI) -3.48 to -0.84, 4 studies, 151 participants; P = 0.001; very low-certainty evidence).  However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate-certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long-term follow-up. The long-term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within-group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow-up, and showed a significant reduction in frequency of stuttering.  AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait-list control group in children aged up to six years at post-test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long-term effects of other non-pharmacological interventions for stuttering compared to no intervention or a wait-list control group.

An experiment on measuring awareness of stuttering in individuals with Down syndrome

BACKGROUND

Awareness of stuttering is likely to depend upon the development of the metalinguistic skill to discriminate between fluent speech and stuttering and the ability to identify one's own speech as fluent or stuttered. Presently, little is known about these abilities in individuals with Down syndrome (DS).

PURPOSE

This study investigates whether individuals with DS and typically developing (TD) children who stutter and who do not stutter differ in their ability to discriminate between fluent speech and stuttering. The second purpose of this study is to discover if this ability is correlated with their self-identification ability.

METHOD

An experiment to investigate awareness with tasks for discrimination of stuttering and self-identification was developed. It was administered to 28 individuals (7-19 years) with DS, 17 of them stutter and 11 do not, and 20 TD children (3-10 years), 8 of them stutter and 12 do not. Skills to discriminate stuttering were compared between these groups and correlated with self-identification within these groups. The influence of stuttering severity and developmental/chronological age on their ability to discriminate was also investigated.

RESULTS

The ability to discriminate does not differ significantly between the DS and TD group, but is highly influenced by developmental age. This ability correlates with self-identification but only for the TD individuals who speak fluently.

CONCLUSION

The ability to discriminate matures around the age of 7 and conscious awareness may rely on this ability. Differences between the present findings and earlier studies suggest that differentiation in levels and types of awareness is warranted.

Expressive language development in adolescents with Down syndrome and fragile X syndrome: change over time and the role of family-related factors

BACKGROUND

It is well known that individuals with Down syndrome (DS) or fragile X syndrome (FXS) demonstrate expressive language difficulties beginning early in childhood. It is less clear, however, whether expressive language skills change during the adolescent period in these individuals, and if any of these changes are syndrome specific. Studying this, as well as the role of maternal and family-related factors in expressive language development, may provide the foundation for efficacious interventions for adolescents with DS or FXS.

METHODS

In this study, we examined expressive language trajectories, assessed through conversation and narration, in 57 adolescent males with intellectual disability (ID) (20 DS and 37 FXS) in relation to the diagnostic group (DS vs. FXS) and family-related factors (maternal IQ, maternal psychological distress, closeness in the mother-child relationship, family income, and maternal and paternal education) after adjusting for chronological age (CA) and nonverbal cognition.

RESULTS

Changes over repeated annual assessments for males with DS or FXS were observed only during conversation, such as an increase in talkativeness, but a decrease in syntax complexity and lexical diversity. We found a diagnosis-related effect in the change over time in conversational talkativeness favoring those with FXS. Finally, a closer mother-child relationship predicted less decrease over time in lexical diversity during conversation, and participants of mothers who graduated college showed a greater increase in conversational talkativeness over time compared to those of mothers with a high school education.

CONCLUSIONS

Our results suggest that, during the adolescent period for males with DS or FXS, there is an increase in the amount of talk produced in conversational contexts, but also a decrease in the quality of the language produced. In addition, our results indicate syndrome-specificity for aspects of expressive language development and reinforce the protective role of family-related factors.

Tics and Tourette Syndrome

PURPOSE OF REVIEW

The purpose of this article is to present current information on the phenomenology, epidemiology, comorbidities, and pathophysiology of tic disorders and discuss therapy options. It is hoped that a greater understanding of each of these components will provide clinicians with the necessary information to deliver thoughtful and optimal care to affected individuals.

RECENT FINDINGS

Recent advances include the finding that Tourette syndrome is likely due to a combination of several different genes, both low-effect and larger-effect variants, plus environmental factors. Pathophysiologically, increasing evidence supports involvement of the cortical-basal ganglia-thalamocortical circuit; however, the primary location and neurotransmitter remain controversial. Behavioral therapy is first-line treatment, and pharmacotherapy is based on tic severity. Several newer therapeutic agents are under investigation (eg, valbenazine, deutetrabenazine, cannabinoids), and deep brain stimulation is a promising therapy.

SUMMARY

Tics, defined as sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations, are essential components of Tourette syndrome. Although some tics may be mild, others can cause significant psychosocial, physical, and functional difficulties that affect daily activities. In addition to tics, most affected individuals have coexisting neuropsychological difficulties (attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, mood disorder, disruptive behaviors, schizotypal traits, suicidal behavior, personality disorder, antisocial activities, and sleep disorders) that can further impact social and academic activities or employment.

Speech profile in Down syndrome: speech apraxia x speech disorder of musculoskeletal origin

ABSTRACT This study presents an analysis of linguistic aspects at the segmental and suprasegmental levels in individuals with Down syndrome with or without a diagnosis of speech apraxia. Ten individuals of both sexes, aged between 13 and 32 years, participated in the study. Data collection was performed, individually and separately, in a video recorded therapeutic session. Speech tasks consisted of word repetition, repetition of sentences and automatic speech. The speech samples were submitted to phonetic transcription with a description and analysis of phonoarticulatory alterations, typology of disfluencies and prosodic alterations. The data were submitted to descriptive and inferential statistical analysis, using the Mann-Whitney test for independent samples and considering p-value≤0.05 as significant. Individuals with speech apraxia (n=6), compared with those without it (n=4), presented a higher occurrence of phonoarticulatory alterations, with a statistically significant difference between the two groups in omission (p=0.018) and articulatory inaccuracy (p=0.030) alterations; a higher occurrence of disfluencies, mainly of the syllable repetition type; and the occurrence of prosodic alterations (83.3%), which was not found in the group without speech apraxia. The importance of the differential diagnosis of speech disorders in Down syndrome is revealed with an evaluation that considers the different linguistic aspects resulting from the differentiation of the characteristics of speech. Clinical intervention should be early and guided by specific parameters.

Craniofacial and oral alterations in patients with Neurofibromatosis 1

ABTSRACT

Neurofibromatosis type 1 (NF1) is one of the most common inherited syndromes. The literature on craniofacial alterations associated with NF1 has been limited and partially contradictory. This review is based on literature search and the results of the clinical study "Craniofacial and Oral Alterations and Speech in patients with Neurofibromatosis 1", carried out at the University of Turku and Turku University Hospital, Finland in 2006-2012. By the end of 2012, a total of 110 NF1 patients, 54 female and 56 male patients, were examined.A part of our results confirms pre-existing understanding, a part is contradictory to previous considerations based mainly on case reports, and some are entirely novel. Specifically, our results confirmed that enlargement the mandibular canal is the most common abnormality of the mandible in patients with NF1. It should be noted, however, that this finding does not require treatment. Caries was not a major problem. In fact, it was less frequent in NF1 patients compared to reference population. These findings abrogate some previous perceptions. Novel findings of our project include periapical cemental dysplasia in females; short jaws, a finding which usually does not affect bite; and immunohistological analysis of oral mucosal abnormalities. Pioneering study on speech showed that various deviations were very common: As many as 94% of the participants showed some alterations.To conclude, the awareness of craniofacial alterations common in NF1would help avoiding unnecessary and even harmful involvement, e.g. of periapical cemental dysplasia or enlarged mandibular canal which do not require treatment.

Speech disfluencies in children with Down Syndrome

PURPOSE

Speech and language development in individuals with Down syndrome is often delayed and/or disordered and speech disfluencies appear to be more common. These disfluencies have been labeled over time as stuttering, cluttering or both.

FINDINGS

were usually generated from studies with adults or a mixed age group, quite often using different methodologies, making it difficult to compare findings. Therefore, the purpose of this study was to analyze and describe the speech disfluencies of a group, only consisting of children with Down Syndrome between 3 and 13 years of age.

METHOD

Participants consisted of 26 Dutch-speaking children with DS. Spontaneous speech samples were collected and 50 utterances were analyzed for each child. Types of disfluencies were identified and classified into stuttering-like (SLD) and other disfluencies (OD). The criterion of three or more SLD per 100 syllables (cf. Ambrose & Yairi, 1999) was used to identify stuttering. Additional parameters such as mean articulation rate (MAR), ratio of disfluencies, and telescoping (cf. Coppens-Hofman et al., 2013) were used to identify cluttering and to differentiate between stuttering and cluttering.

RESULTS & CONCLUSION

Approximately 30 percent of children with DS between 3 and 13 years of age in this study stutter, which is much higher than the prevalence in normally developing children. Moreover, this study showed that the speech of children with DS has a different distribution of types of disfluencies than the speech of normally developing children. Although different cluttering-like characteristics were found in the speech of young children with DS, none of them could be identified as cluttering or cluttering-stuttering.

Ultrasensitive and in situ DNA detection in various pH environments based on a microfiber with a graphene oxide linking layer

Ultrasensitive and in situ DNA detection at different pH values, ranging from 4.3 to 8.5, based on a microfiber with a graphene oxide linking layer was proposed and experimentally demonstrated.

Specific subtype of fluency disorder affecting French speaking children: A phonological analysis

PURPOSE

Clinicians working with fluency disorders sometimes see children whose word repetitions are mostly located at the end of words and do not induce physical tension. Prior studies on the topic have proposed several names for these disfluencies including "end word repetitions", "final sound repetitions" and "atypical disfluency". The purpose of this study was to use phonological analysis to explore the patterns of this poorly recognized fluency disorder in order to better understand its specific speech characteristics.

METHODS

We analyzed a spontaneous language sample of 8 French speaking children. Audio and video recordings allowed us to study general communication issues as well as linguistic and acoustical data.

RESULTS

We did not detect speech rupture or coarticulation failures between the syllable onset and rhyme. The problem resides primarily on the rhyme production with a voicing interruption in the middle of the syllable nucleus or a repetition of the rhyme (nucleus alone or nucleus and coda), regardless of the position in the word or phrase.

CONCLUSION

The present study provides data suggesting that there exist major differences in syllable production between the disfluencies produced by our 8 children and stuttered disfluencies. Consequently, we believe that this fluency disorder should be recognized as distinct from stuttering.

Clinical features associated with an early onset in chronic tic disorders

In chronic tic disorders such as Tourette syndrome (TS), tics often appear between 4 and 8 years but they can also appear in early childhood, a period in which symptom expression may be affected by early brain development. The present study examined whether symptom expression in early-onset TS was distinct from that observed in TS with a later onset. We compared the clinical characteristics in children with TS who developed tics before age 4 or after age 6. Early-onset TS was significantly associated with an increased rate of stuttering and other speech disfluencies as well as an increased rate of oppositional defiant disorder, symptoms that often appear before age 4. Early-onset TS was also linked to maternal transmission of tics. Early-onset TS was not significantly associated with tic severity, obsessive-compulsive behavior or attention-deficit hyperactivity disorder. The results suggest that an early onset affects symptom expression in tic disorders.

Linguagem narrativa e fluência na síndrome de down: uma revisão

A síndrome de Down é uma condição na qual os indivíduos apresentam comprometimento intelectual e alterações de linguagem oral. A disfluência de fala está presente tanto durante a conversa espontânea como em produções orais de narrativas direcionadas. Este estudo teve como principal objetivo revisar a literatura sobre a disfluência e a narrativa em indivíduos com a síndrome de Down, publicada entre 2002 e 2012, em bases de dados eletrônicos. Foram encontrados 17 artigos e selecionados oito, de acordo com os critérios de inclusão e exclusão. Destes, dois discorriam especificamente sobre a disfluência na síndrome de Down, e seis sobre a narrativa nesta população. A deficiência intelectual é parte do fenótipo dos indivíduos com SD e, em decorrência do comprometimento intelectual, prejuízos na aquisição e no desenvolvimento da linguagem. Estudos específicos, principalmente sobre a fluência/disfluência; e, sobre o desempenho na tarefa da narrativa, ainda são escassos e inconclusivos. A disfluência não aparece na maioria das descrições do fenótipo de linguagem dos indivíduos com esta condição, que mereceria, estudos clínicos adicionais.

A national profile of Tourette syndrome, 2011-2012

OBJECTIVE

To provide recent estimates of the prevalence of Tourette syndrome among a nationally representative sample of US children and to describe the association of Tourette syndrome with indicators of health and functioning.

METHODS

Data on 65,540 US children aged 6 to 17 years from the 2011-2012 National Survey of Children's Health were analyzed. Parents reported whether a health care provider had ever told them their child had Tourette syndrome or other neurobehavioral or chronic health conditions and whether their child had current Tourette syndrome.

RESULTS

Based on parents' report, 0.19% of US children had Tourette syndrome; the average age of diagnosis was 8.1 years. Children with Tourette syndrome, compared with those without, were more likely to have co-occurring neurobehavioral and other health conditions, meet criteria for designation as having a special health care need, receive mental health treatment, have unmet mental health care needs, and have parents with high parenting aggravation and parents who were contacted about school problems; they were less likely to receive effective care coordination or have a medical home. After controlling for co-occurring neurobehavioral conditions, the findings on parents being contacted about school problems and children having unmet mental health care needs were no longer significant.

CONCLUSIONS

Tourette syndrome is characterized by co-occurring neurobehavioral and other health conditions, and poorer health, education, and family relationships. The findings support previous recommendations to consider co-occurring conditions in the diagnosis and treatment of Tourette syndrome. Future research may explore whether having a medical home improves outcomes among children with Tourette syndrome.

Communication and self-esteem in adults with Down syndrome

BACKGROUND

It is estimated that around 50-90% of people with learning disabilities experience difficulties in communicating. Previous research has linked communication difficulties and self-esteem in other populations, yet this relationship has not previously been investigated for people with Down syndrome.

AIMS

To explore the relationship between communication and self-esteem in adults with Down syndrome. This research also aimed to offer an empowering and inclusive opportunity for adults with learning disabilities to be involved in research.

METHODS & PROCEDURES

Recruitment took place via a charity established for people with Down syndrome. Twelve adults with Down syndrome and an adult they nominated were approached. A qualitative methodology was selected to explore communication and self-esteem. A thematic analysis focused on the qualitative data collected via semi-structured interviews.

OUTCOMES & RESULTS

Major themes within the data revealed that a relationship between communication and self-esteem may exist for adults with Down syndrome.

CONCLUSIONS & IMPLICATION

This study demonstrated that people with Down syndrome may experience low self-esteem that may be linked to communication. The clinical implications of this are considered and areas for future research are identified.

Preliminary study of disfluency in school-aged children with autism

BACKGROUND

In recent years, there has been increased identification of disfluencies in individuals with autism, but limited examination of disfluencies in the school-age range of this population. We currently lack information about whether the disfluencies of children with autism represent concomitant stuttering, normal disfluency, excessive normal disfluency, or some form of disfluency unique to the school-age population of children with autism.

AIMS

This paper explores the nature of disfluencies in school-aged children with autism in comparison with matched children who stutter and controls. It explores stuttering-like disfluencies, non-stuttering-like disfluencies and word-final disfluencies.

METHODS & PROCEDURES

This study compared disfluency patterns in 11 school-aged children with Asperger's syndrome (AS), 11 matched children who stutter (CWS), and 11 matched children with no diagnosis (ND). Analyses were based on speech samples collected during an expository discourse task.

OUTCOMES & RESULTS

Results reveal statistically significant differences between children with AS and CWS and between children with AS and those with ND for the percentage of words containing stuttering-like disfluencies. In the AS group, four out of 11 (36%) met the common diagnostic criteria for a fluency disorder. Disfluencies in the AS group differed qualitatively and quantitatively from the CWS, and included a larger distribution of word-final disfluencies.

CONCLUSIONS & IMPLICATIONS

This study provides initial data regarding patterns of disfluency in school-aged children with AS that, with careful consideration and the cautious application of all findings, can assist therapists in making more evidence-based diagnostic decisions. Findings offer evidence that when working with children with AS, disfluencies both similar and dissimilar to those of CWS may be identified in at least a subset of those with AS. Therefore, children with AS should be screened for fluency disorders during their initial evaluation and treated if it is determined that the fluency disorder negatively impacts the effectiveness of communication.

Dysfluencies in the speech of adults with intellectual disabilities and reported speech difficulties

BACKGROUND

In individuals with an intellectual disability, speech dysfluencies are more common than in the general population. In clinical practice, these fluency disorders are generally diagnosed and treated as stuttering rather than cluttering.

PURPOSE

To characterise the type of dysfluencies in adults with intellectual disabilities and reported speech difficulties with an emphasis on manifestations of stuttering and cluttering, which distinction is to help optimise treatment aimed at improving fluency and intelligibility.

METHOD

The dysfluencies in the spontaneous speech of 28 adults (18-40 years; 16 men) with mild and moderate intellectual disabilities (IQs 40-70), who were characterised as poorly intelligible by their caregivers, were analysed using the speech norms for typically developing adults and children. The speakers were subsequently assigned to different diagnostic categories by relating their resulting dysfluency profiles to mean articulatory rate and articulatory rate variability.

RESULTS

Twenty-two (75%) of the participants showed clinically significant dysfluencies, of which 21% were classified as cluttering, 29% as cluttering-stuttering and 25% as clear cluttering at normal articulatory rate. The characteristic pattern of stuttering did not occur.

CONCLUSION

The dysfluencies in the speech of adults with intellectual disabilities and poor intelligibility show patterns that are specific for this population. Together, the results suggest that in this specific group of dysfluent speakers interventions should be aimed at cluttering rather than stuttering.

LEARNING OUTCOMES

The reader will be able to (1) describe patterns of dysfluencies in the speech of adults with intellectual disabilities that are specific for this group of people, (2) explain that a high rate of dysfluencies in speech is potentially a major determiner of poor intelligibility in adults with ID and (3) describe suggestions for intervention focusing on cluttering rather than stuttering in dysfluent speakers with ID.

The impact of adolescent stuttering and other speech problems on psychological well-being in adulthood: evidence from a birth cohort study

BACKGROUND

Developmental stuttering is associated with increased risk of psychological distress and mental health difficulties. Less is known about the impact of other developmental speech problems on psychological outcomes, or the impact of stuttering and speech problems once other predictors have been adjusted for.

AIMS

To determine the impact of parent-reported adolescent stuttering and other speech difficulties on psychological distress and associated symptoms as measured by the Rutter Malaise Inventory.

METHOD & PROCEDURES

A British birth cohort dataset provided information about 217 cohort members who stuttered and 301 cohort members who had other kinds of speech problem at age 16 according to parental report, and 15,694 cohort members who had experienced neither stuttering nor other speech difficulties. The main analyses concerned associations between adolescent stuttering or speech difficulty and score on the Rutter Malaise Inventory at age 42. Other factors that had previously been shown to be associated with score on the Malaise Inventory were also included in the analyses.

OUTCOMES & RESULTS

In the adjusted analyses that controlled for other predictors, cohort members who were reported to stutter had higher malaise scores than controls overall, indicating a higher level of psychological distress, but they were not at significantly more likely to have malaise scores in the range indicating a risk of serious mental health difficulties. Cohort members who were reported to have other speech difficulties during adolescence had malaise scores that overall did not differ significantly from those of controls in the adjusted analyses, but they were at significantly greater risk of serious mental health difficulties.

CONCLUSIONS & IMPLICATIONS

These findings support those of other studies that indicate an association between stuttering and psychological distress. This study is the first to have shown that adolescents who experience speech difficulties other than stuttering are more likely than controls to be at risk of poorer mental health in adulthood. The results suggest a need for therapeutic provision to address psychosocial issues for both stuttering and other developmental speech disorders in adulthood, as well as further research into the consequences in adulthood of stuttering and other developmental speech disorders.

Speech-language pathologists' knowledge of genetics: perceived confidence, attitudes, knowledge acquisition and practice-based variables

The purpose of this study was to determine (a) the general knowledge bases demonstrated by school-based speech-language pathologists (SLPs) in the area of genetics, (b) the confidence levels of SLPs in providing services to children and their families with genetic disorders/syndromes, (c) the attitudes of SLPs regarding genetics and communication disorders, (d) the primary sources used by SLPs to learn about genetic disorders/syndromes, and (e) the association between general knowledge, confidence, attitudes, the number of years of experience working as an SLP, and the number of children currently provided services with genetic disorders/syndromes on SLPs' caseloads. Survey data from a nationwide sample of 533 SLPs was analyzed. Results showed SLPs earned a median knowledge score about genetics of 66% correct responses. Their mean confidence and attitude ratings were in the "unsure" categories while they reported they learned about genetics from three main sources, (a) self-study via web and internet-based searches, (b) on-the-job training and (c) popular press magazines and newspapers. Analyses revealed that Confidence summary scores, Attitude Summary scores, the number of children with genetic disorders/syndromes on SLPs' caseloads are positively associated with the ratings of participants with the highest Knowledge scores.

LEARNING OUTCOMES

Readers will be able to (a) explain the important links between developmental and communication disabilities and genetics, (b) describe the associations between knowledge about genetics and confidence, attitudes, and the number of children with genetic disorders/syndromes on their caseloads, and (c) outline the clinical and theoretical implications of the results from this study.

Stuttering treatment for a school-age child with Down syndrome: a descriptive case report

BACKGROUND

Little is known about optimal treatment approaches and stuttering treatment outcomes for children with Down syndrome.

AIMS AND METHOD

The purpose of this study was to investigate outcomes for a child with Down syndrome who received a combination of fluency shaping therapy and parent delivered contingencies for normally fluent speech, prolonged speech, and stuttered speech.

RESULTS

In-clinic speech measures obtained at post-treatment and at 4 months follow-up reflected improvements in fluency of 89.0% and 98.6%, respectively. The participant's beyond-clinic follow-up sample reflected an improvement of 95.5%. Following treatment, the participant demonstrated improved self-confidence, self-esteem, and improved participation and functioning at school.

CONCLUSIONS

Findings suggest that fluency shaping with parental contingencies may be a viable treatment approach to reduce stuttering in children with Down syndrome. Future research using an experimental research design is warranted.

EDUCATIONAL OBJECTIVES

Readers will be able to describe (a) prevalence estimates of stuttering in individuals with Down syndrome, (b) the main components of a fluency shaping program for a child with Down syndrome who stutters and has co-occurring speech and language delays, and (c) speech and parent-, teacher-, and self-report treatment outcomes.

The impact of adolescent stuttering on educational and employment outcomes: evidence from a birth cohort study

PURPOSE

In interview and survey studies, people who stutter report the belief that stuttering has had a negative impact on their own education and employment. This population study sought objective evidence of such disadvantage for people who stutter as a group, compared with people who do not stutter.

METHOD

A secondary analysis of a British birth cohort dataset was used in the study. At age 16, there were 217 cohort members who were reported by their parents to stutter, and 15,694 cohort members with no known history of stuttering or other speech problems. Data were analysed concerning factors associated with report of stuttering at 16, school leaving age, highest qualification, unemployment early in working life, pay at age 23 and 50, and social class of job at age 23 and 50.

RESULTS

Those who stuttered at 16 were statistically more likely than those who did not stutter to be male, to have poorer cognitive test scores, and to have been bullied. There were no significant effects of stuttering on educational outcomes. For employment outcomes, the only significant association with stuttering concerned socioeconomic status of occupation at 50, with those who had been reported to stutter having lower-status jobs.

DISCUSSION

These findings fail to support the belief that stuttering has a negative impact on education and employment. The higher likelihood of those who stutter working in lower-status positions may reflect their preference for avoiding occupations perceived to require good spoken communication abilities. Therapeutic implications are discussed.

EDUCATIONAL OBJECTIVES

The reader will be able to describe (a) prior work on the impact of stuttering on education and employment, (b) some characteristics of the National Child Development Study (NCDS), (c) the effect of stuttering on school leaving age and highest educational qualification in NCDS, (d) the effect of stuttering on employment outcomes in NCDS: unemployment by age 23, pay at 23 and 50, and socioeconomic status of occupation at 23 and 50.

Two genetic loci control syllable sequences of ultrasonic courtship vocalizations in inbred mice

Background

The ultrasonic vocalizations (USV) of courting male mice are known to possess a phonetic structure with a complex combination of several syllables. The genetic mechanisms underlying the syllable sequence organization were investigated.

Results

This study compared syllable sequence organization in two inbred strains of mice, 129S4/SvJae (129) and C57BL6J (B6), and demonstrated that they possessed two mutually exclusive phenotypes. The 129S4/SvJae (129) strain frequently exhibited a "chevron-wave" USV pattern, which was characterized by the repetition of chevron-type syllables. The C57BL/6J strain produced a "staccato" USV pattern, which was characterized by the repetition of short-type syllables. An F1 strain obtained by crossing the 129S4/SvJae and C57BL/6J strains produced only the staccato phenotype. The chevron-wave and staccato phenotypes reappeared in the F2 generations, following the Mendelian law of independent assortment.

Conclusions

These results suggest that two genetic loci control the organization of syllable sequences. These loci were occupied by the staccato and chevron-wave alleles in the B6 and 129 mouse strains, respectively. Recombination of these alleles might lead to the diversity of USV patterns produced by mice.

Manifestações clínicas e fonoaudiológicas na Síndrome de Turner: estudo bibliográfico

TEMA: síndrome genética e achados fonoaudiológicos. OBJETIVO: descrever as manifestações clínicas e fonoaudiológicas em indivíduos com a Síndrome de Turner CONCLUSÃO: foram levantados 23 artigos sobre a Síndrome de Turner dos quais 7 discorriam sobre a audição e suas alterações nesses indivíduos, 6 sobre linguagem receptiva e/ou expressiva e praxia, 5 sobre aspectos psicológicos e cognitivos além de 28 artigos referentes às manifestações clínicas em geral. Por meio do levantamento bibliográfico pode-se observar que as manifestações fonoaudiológicas na Síndrome de Turner são pouco estudadas e, dentro da fonoaudiologia as manifestações audiológicas como perda de audição e otites são as mais estudadas, ao contrário dos aspectos práxicos e de recepção/ expressão da linguagem.

Word-final prolongations in an adult male with neurofibromatosis type 1

A case of word-final prolongations occurring in an adult male with neurofibromatosis type 1 is reported. Speech samples were collected in five different speech modalities (i.e. spontaneous speech, monologue, repetition, automatic series and reading) and subsequently analyzed in a semi-automatic manner using Praat software. Results on the frequency, nature and distribution of the word-final prolongations are presented. The possible pathogenesis of these word-final disfluencies and their relation to stuttering is discussed.

EDUCATIONAL OBJECTIVES

The reader will be able to: (1) describe the characteristics of word-final prolongations as displayed by an adult male with neurofibromatosis type 1 and (2) discuss the possible pathogenesis of these word-final prolongations and their relation to stuttering.

Speech characteristics in neurofibromatosis type 1

Neurofibromatosis 1 (NF1) is a neurocutaneous-skeletal disorder often accompanied with varying degrees of cognitive and motor problems that potentially affect speech and language. While previous studies have shown that NF1 may be associated with a variety of deviations in the patients' speech, they have not investigated the characteristics in phonetic detail. Our clinical observation that many patients share a distinct voice and manner of speaking led to the primary aim of this study, which was to present a comprehensive description of speech in NF1. A total of 62 patients with NF1 (age range 7-66 years), and a control group of 24 speakers (age range 7-62 years) were evaluated for their speech. The test sessions were recorded and the data were analyzed both by ear and by acoustic measurements. The data were analyzed separately by two trained phoneticians, and a summary was produced after comparing the two independent analyses. Various speech problems were observed among patients with NF1. Individual variation was remarkable, but the deviations were more common and severe in children than in adult patients. In addition, men with NF1 had more speech deviations than women with NF1. Findings include deviations in voice quality, problems in regulating pitch, deviant nasality, misarticulation, and disfluency. We suggest that difficulties in speech, particularly in regulating pitch, may have negative social implications. Our results highlight which components of speech require particular attention in speech therapy for patients with NF1.

Speech fluency profile in Williams-Beuren syndrome: a preliminary study

BACKGROUND

the speech fluency pattern attributed to individuals with Williams-Beuren syndrome (WBS) is supported by the effectiveness of the phonological loop. Some studies have reported the occurrence of speech disruptions caused by lexical and semantic deficits. However, the type and frequency of such speech disruptions has not been well elucidated.

AIM

to determine the speech fluency profile of individuals with WBS and to compare the speech performance of these individuals to a control group matched by gender and mental age.

METHOD

Twelve subjects with Williams-Beuren syndrome, chronologically aged between 6.6 and 23.6 years and mental age ranging from 4.8 to 14.3 years, were evaluated. They were compared with another group consisting of 12 subjects with similar mental age and with no speech or learning difficulties. Speech fluency parameters were assessed according to the ABFW Language Test: type and frequency of speech disruptions and speech rate. The obtained results were compared between the groups.

RESULTS

In comparison with individuals of similar mental age and typical speech and language development, the group with Williams-Beuren syndrome showed a greater percentage of speech discontinuity, and an increased frequency of common hesitations and word repetition.

CONCLUSION

The speech fluency profile presented by individuals with WBS in this study suggests that the presence of disfluencies can be caused by deficits in the lexical, semantic, and syntactic processing of verbal information. The authors stress that further systematic investigations on the subject are warranted.

Differential diagnostic characteristics between cluttering and stuttering--part one

Speech-language pathologists generally agree that cluttering and stuttering represent two different fluency disorders. Differential diagnostics between cluttering and stuttering is difficult because these disorders have similar characteristics and often occur in conjunction with each other. This paper presents an analysis of the differential diagnostic characteristics of the two disorders, and a proposal for distinguishing between the two in clinical settings. The main goal of this two-part article is to set objective norms for differential diagnostic assessment of cluttering and stuttering symptoms, based on the three main characteristics of cluttering indicated/identified by St. Louis, Raphael, Myers & Bakker [St. Louis, K. O., Raphael, L. J., Myers, F. L., & Bakker, K. (2003). Cluttering updated. The ASHA leader. ASHA, 4-5, 20-22]: a fast and/or irregular articulatory rate together with errors in syllable, word or sentence structure and or a high frequency of normal disfluencies (not being stuttering). In the first half of the article objective measures are compared to the subjective clinical judgement made by fluency experts. In other words, which characteristics can be found in the speech profiles of persons who were diagnosed as people who clutter or stutter? In the second part of the article results on the Predictive Cluttering Inventory [Daly, D. A., & Cantrell, R. P. (2006). Cluttering characteristics identified as diagnostically significant by 60 fluency experts. Proceedings of second world congress on fluency disorders] are discussed in relationship to the subjective and objective measurements studied in the first half of the article.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to (1) describe obligatory characteristics of cluttering, (2) plan cluttering assessment on speech characteristics and (3) use and interpret a checklist on possible cluttering characteristics.