A speech and psychological profile of treatment-seeking adolescents who stutter

Associations between social anxiety, physiological reactivity, and speech disfluencies in autistic young adults and controls

INTRODUCTION

The aim of this study was to examine possible associations of social anxiety (SA) and speaking-related physiological reactivity with the frequencies of a) total disfluencies, b) typical disfluencies, and c) stuttering-like disfluencies, as well as d) stuttering-severity in autistic young adults and controls.

METHODS

Thirty-two autistic young adults and 35 controls participated in this study. Participants were presented with video clips (viewing condition) and were then asked to talk about the videos (narrating condition). SA was measured by the self-report Social Phobia and Anxiety Inventory (SPAI). Speaking-related physiological reactivity was measured by the electrodermal activity (EDA), an index of emotional arousal. The speech samples from the narrating condition were analyzed for type and frequency of speech disfluencies and used for determining the stuttering severity. SA and speaking-related physiological reactivity were compared between the groups. Correlation between SA, physiological reactivity, disfluency frequencies, and stuttering severity were tested separately for both groups.

RESULTS

No between-group differences were found in the overall SA, yet differences were found in SPAI subscales of social interaction, group interaction, and avoidance, as well as in agoraphobia. Both groups had higher physiological arousal in narrating condition in comparison to the video viewing condition, yet there was no between-group difference in the reactivity. No associations were found between SPAI measures, physiological reactivity, disfluency frequencies, and stuttering severity in the autistic group. In the control group, a negative association was found between physiological reactivity and total and typical disfluency frequencies.

CONCLUSIONS

SA or speaking-related physiological reactivity were not associated with disfluency frequencies or stuttering severity in autistic persons. Negative association between physiological reactivity and disfluency frequencies found in the control group may indicate that the physiological arousal may impact the speech production process by reducing the overt disfluencies.

"I Just Want People to Think I'm Normal": An Interview Study of Young Swedish Women With Covert Stuttering

PURPOSE

Research indicates that there is a tendency for females who stutter, more often than males, to use coping strategies that involve covering their stutter, for example, by avoiding situations that require verbal participation. The aim of the study is to increase knowledge about how covert stuttering develops and its impact on self-image and quality of life for women who stutter.

METHOD

Eleven young women who stutter covertly were interviewed, and data were subjected to qualitative content analysis. Background information was obtained from the self-report instruments measuring the impact of stuttering on different aspects of life (Overall Assessment of the Speaker's Experiences of Stuttering) and degree of perceived social anxiety (Liebowitz Social Anxiety Scale, Self-Report).

RESULTS

Three main themes were identified: (a) managing stuttering, (b) personal aspects, and (c) stuttering as a phenomenon. Shame and a desire to fit in emerged as distinct motives for covering stuttering. The women described that stuttering controlled both life choices and everyday life. Development of self-image had been strongly negatively affected, resulting in social anxiety. The women expressed a particular vulnerability of being a woman who stutters, due to societal norms of female behavior and a lack of female role models who stutter.

CONCLUSIONS

The choice of coping strategy was motivated by a desire to "be normal." As a result, stuttering had come to dominate life and affect self-image and life choices. The study highlights the importance for clinicians to be alert to and aware of the fact that the experiences of women who stutter can lead them to develop coping strategies that have far-reaching negative consequences.

Lidcombe Program translation to community clinics in Australia and England

BACKGROUND

Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it.

AIMS

This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England.

METHODS & PROCEDURES

Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift.

OUTCOMES & RESULTS

Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials.

CONCLUSIONS & IMPLICATIONS

Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined.

WHAT THIS PAPER ADDS

What is already known on the subject The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work? Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice.

Factors Associated With Symptoms of Anxiety and Depression in Children Who Stutter

PURPOSE

Children and adolescents who stutter may be at risk of elevated anxiety and depression symptoms, although studies have indicated variability in reported internalizing symptoms in this population. This study considers the association between anxiety and depression symptoms and stuttering, as well as child, family, and contextual factors that may affect this association.

METHOD

Thirty-five school-age children who stutter completed the Revised Children's Anxiety and Depression Scale-Short Version. We fitted regression models to examine the association between anxiety and depression symptoms with bullying, stuttering severity, family history of adverse mental health, and age in children who stutter.

RESULTS

Family history of adverse mental health was found to significantly predict anxiety and depression scores. Age also predicted depression scores, with older children reporting higher scores.

CONCLUSIONS

Family history of adverse mental health is associated with higher self-reported internalizing symptoms in children who stutter. The interaction between child, family, and contextual factors may change with age, and this requires further exploration in larger, longitudinal studies. The association between bullying and anxiety scores indicates the importance of anti-bullying initiatives in promoting psychosocial development in school-age children who stutter. This study also highlights the contribution of known risk factors for mental health, such as family history, to variability in symptom reporting.

Fostering Positive Stuttering Identities Using Stutter-Affirming Therapy

PURPOSE

School-age children and adolescents frequently have difficulty developing positive identities around their stuttering. Many students experience both physical and social consequences from stuttering. The great lengths that speakers go to try to hide their stuttering and to speak fluently increase their difficulty. As long as school-age children who stutter try to identify as fluent speakers, they will have difficulty lessening the negative impact of stuttering on their lives. Fortunately, many people who stutter also report positive stuttering experiences. Speech-language pathologists can use these positive experiences to help school-age children grow more comfortable with stuttering. They can also help school-age children reduce some of the speaking effort and social stigma that leads them to try to conceal their stuttering in the first place. To accomplish both these goals, I propose a stutter-affirming therapy.

METHOD

This clinical focus article summarizes previous research about identity development in stuttering. I discuss a therapy approach I call stutter-affirming therapy. In elucidating this approach, I discuss practical ways that speech-language pathologists can use to help school-age children develop positive stuttering identities through easier speaking and stuttering. I ground these examples in a case study of a 12-year-old boy who stutters.

DISCUSSION

stutter-affirming therapy focuses on conditioning the speaker's reaction to stuttering in ways that move toward and embrace stuttering (stutterphilic reactions) rather than in ways that move away from and reject stuttering (stutterphobic reactions). Speech-language pathologists can help school-age children who stutter foster positive stuttering identities using the three priorities of stutter-affirming therapy. First, reject fluency by reducing stutterphobic and increasing stutterphilic reactions to stuttering. Second, value stuttering by discovering what speakers gain from it. Third, create an environment in which it is easier to stutter through education, advocacy, disclosure, and voluntary stuttering.

A Cross-Sectional Investigation of the Impact of Stuttering on Swedish Females and Males in Childhood, Adolescence, and Young Adulthood

PURPOSE

We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males.

METHOD

We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7-30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves.

RESULTS

The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern.

CONCLUSIONS

In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21554877.

Covert and overt stuttering: Concepts and comparative findings

PURPOSE

One way of conceptualizing stuttering is on a continuum from primarily covert to primarily overt. Assertions have been made as to how those with covert stuttering might be impacted differently to those with overt stuttering, but findings from well-controlled studies remain scarce. The principal aim of the present study was to compare the impact of stuttering and emotional distress related to two subgroups of persons who stutter: people with primarily overt stuttering and people with primarily covert stuttering. In exploring this, we also offer some preliminary thoughts on challenges with the terminology surrounding the concepts of 'overtness' and 'covertness'.

METHODS

Twenty-one adults already enrolled in a multiple, single-case treatment study (Sønsterud et al., 2019, 2020) took part in the present study, and underwent a battery of tests that assessed anxiety, depression, fear of negative evaluation, and quality of life. The sub-groups were identified on the basis of self-categorization using the Tomaiuoli, Del Gado, Spinetti, Capparelli, and Venuti (2015) classification, as well as the evaluation of speech samples from two independent SLPs (Sønsterud et al., 2020). The classifications were further explored by five independent 'lay' assessors who reviewed pre-therapy video and rated participants' speech on a 4-point Likert Stuttering Probability Scale (1 = 'fluent with no doubt', 2 = 'fluent with some doubt', 3 = 'stuttering with some doubt' and 4 = 'stuttering with no doubt').

RESULTS

No significant differences were found between the primarily overt and primarily covert groups in relation to self-reported symptoms of anxiety, depression, and fear of negative evaluation. However, investigation at item level identified a significant difference in linguistic avoidance between the two groups.

CONCLUSION

There may be fewer differences between people with primarily overt and primarily covert stuttering than previously thought with regards to emotional impact, as well as most aspects of avoidance behavior.

The Complexity of Stuttering Behavior in Adults and Adolescents: Relationship to Age, Severity, Mental Health, Impact of Stuttering, and Behavioral Treatment Outcome

PURPOSE

This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender.

METHOD

For this study, a taxonomy was developed-LBDL-C7-which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression.

RESULTS

The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering.

CONCLUSION

Clinical and research applications of these findings are discussed.

Anxiety and Depression Symptoms in Children and Adolescents Who Stutter: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this study was to investigate whether there are elevated symptoms of anxiety or depression in children and adolescents (aged 2-18 years) who stutter, and to identify potential moderators of increased symptom severity.

METHOD

We conducted a preregistered systematic review of databases and gray literature; 13 articles met criteria for inclusion. A meta-analysis using robust variance estimation was conducted with 11 cohort studies comparing symptoms of anxiety in children and adolescents who do and do not stutter. Twenty-six effect sizes from 11 studies contributed to the summary effect size for anxiety symptoms (851 participants). Meta-analysis of depression outcomes was not possible due to the small number of studies.

RESULTS

The summary effect size indicates that children and adolescents who stutter present with increased anxiety symptoms (g = 0.42) compared with nonstuttering peers. There were insufficient studies to robustly analyze depression symptoms, and qualitative review is provided. No significant between-groups differences were reported in any of the depression studies.

CONCLUSIONS

Preliminary evidence indicates elevated symptoms of anxiety in some children and adolescents who stutter relative to peers. There was a tendency toward higher depression scores in this population, although reported between-groups differences did not reach statistical significance. These findings require replication in larger, preferably longitudinal studies that consider factors that may moderate risk. Nevertheless, our findings highlight a need for careful monitoring of mental health and well-being in young people who stutter. Supplemental Materials: http://osf.io/5m6zv.

Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents

PURPOSE

The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate.

METHODS

A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis.

RESULTS

There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations.

DISCUSSION

This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.

Bidirectional Associations of Childhood Stuttering With Behavior and Temperament

PURPOSE

Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood.

METHOD

This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed.

RESULTS

Six-month-old children who were less able to "recover from distress," indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (β = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (β = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (β = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years.

CONCLUSIONS

Behavior and temperament were associated with stuttering persistency-seemingly as both predictor and consequence-but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered. Supplemental Material https://doi.org/10.23641/asha.16869479.

Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter

PURPOSE

Many school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter.

METHODS

Ten children and adolescents who stutter (aged 9-17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions.

RESULTS

Results show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment.

CONCLUSION

Our results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking.

Validity of telephone calls to assess percentage of syllables stuttered with adolescents in clinical research

PURPOSE

Karimi, O'Brian, Onslow, and Jones (2013) reported, for adults, no systematic differences between percentage of syllables stuttered (%SS) scores during a 12-hour day and 10-minute phone calls. The present study replicated that finding with adolescents, using valid methods for the age group. The present study also extended that initial report by determining whether the gender of the caller influenced %SS scores.

METHOD

Participants were 17 adolescents with stuttering. Percentage of syllables stuttered scores were obtained from a 12-hour day of the adolescents' lives, and two 10-minute unscheduled phone calls made before and after that day. One phone call was from a male caller and the other from a female caller.

RESULTS

For adolescents, analysis of covariance (ANCOVA) and intraclass correlations (ICC) replicated the overall Karimi, O'Brian, Onslow, and Jones (2013) finding. No significant differences were found between the %SS scores of the three speech samples, and these %SS scores were found to be highly correlated. However, in contrast to the Karimi, O'Brian, Onslow, and Jones (2013) finding with adults, Bland-Altman plot results revealed a caveat to this finding when applied to individual adolescents. Additionally, there was no effect due to the gender of the caller.

CONCLUSION

A 10-minute phone call can be used confidently to assess group mean %SS scores during stuttering research with adolescents. However, a 10-minute phone call cannot be used confidently to assess %SS scores of individual adolescent participants. For the latter context, such as with data-based case studies and single-subject experimentation, we recommend supplementing %SS scores with self-reported severity scores.

Larger reported impact of stuttering in teenage females, compared to males - A comparison of teenagers' result on Overall Assessment of the Speaker's Experience of Stuttering (OASES)

PURPOSE

The aim of this cross-sectional study was to explore the impact and experience of stuttering, and attitude to communication for female and male teenagers who stutter (TWS) in comparison with teenagers with no stutter (TWNS).

METHODS

The Swedish version of the Overall Assessment of the Speaker's Experience of Stuttering (OASES-T-S), was administered to 56 TWS, 13-17 years old (26 females, 30 males). An adapted version of OASES, Attitude to Speech and Communication (ASC), was administered to 233 TWNS. The impact scores were analyzed in relation to sex in TWS and TWNS.

RESULTS

Female TWS reported that stuttering had a greater impact on their life than it did on male TWS (on average 0.5 higher impact scores; Hedges' g = 0.87). The differences did not seem to be caused by differences in severity of overt stuttering symptoms. Female and male TWS particularly differed on items related to difficulties in day-to-day communication and affective/behavioral reactions to stuttering. Such sex differences were not as pronounced among TWNS, suggesting that teenage women may be more vulnerable to the negative impact of stuttering than men the same age.

CONCLUSION

Female teenagers report more negative experiences and a greater tendency to use avoidance strategies than male teenagers.

Attentional Bias Among Adolescents Who Stutter: Evidence for a Vigilance-Avoidance Effect

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.

Effects of a transdiagnostic cognitive behaviour therapy-based programme on the natural course of anxiety symptoms in adolescence

BACKGROUND

Anxiety disorders frequently have an onset during adolescence, which when left untreated could lead to a chronic course and outcome. This study aimed to examine the way in which a cognitive behaviour therapy-based programme (Super Skills for Life - adolescent version; SSL-A) could change the course of anxiety symptoms through adolescent's behavioural performance and cardiac function.

METHOD

Sixty-one adolescents at risk of developing an anxiety disorder (45.30% boys; M = 13.76 years, SD = 0.32) were randomly assigned to either an intervention (IG), placebo (PG), or a waitlist group (WG). Adolescents in the IG participated in SSL-A over an 8-week period. Adolescents in the PG participated in an 8-session school-work programme. Adolescents in the WG did not receive any intervention. Anxiety symptoms were assessed every six months, twice before the intervention, as well as at the post-intervention and six months after the intervention. Participants in the IG additionally underwent a stressful task to assess behavioural performance and cardiac adjustment.

RESULTS

Adolescents in the IG significantly reported lower levels of social phobia and generalised anxiety symptoms at the follow-up assessment compared to the adolescents in the PG and the WG. They also showed a significant improvement in vocal quality and lower discomfort during a stressful task at post-intervention, and showed attenuated cardiac recovery indexes, in terms of sample entropy.

LIMITATIONS

The study has a small sample size.

CONCLUSION

SSL-A changed the natural course of anxiety symptoms, as shown by a significant reduction in social phobia and generalised anxiety symptoms, and a significant improvement in behaviour and physiological (cardiac) function during a stressful situation.

Phase I trial of a standalone internet social anxiety treatment for adolescents who stutter: iBroadway

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.

Sleep problems in children who stutter: Evidence from population data

Purpose Previous research has identified seizures, intellectual disability, learning disability, pervasive developmental disorder, and attention deficit hyperactivity disorder as coexisting disabilities frequently seen in children who stutter (CWS). The observation that those conditions are affected by sleep has incited the present study, which aimed to explore if sleep problems are also more frequent in CWS. Method Data was obtained from the 2012 National Health Interview Survey. Children included in the analysis were those whose caregivers answered definitively whether or not the sample child stuttered in the last 12 months and whose caregivers definitively answered questions regarding insomnia or trouble sleeping, sleepiness during the day, and fatigue during the day in the last 12 months. This sample included 203 CWS and 10,005 children who do not stutter (CWNS). Results CWS were at greater odds of presenting insomnia or trouble sleeping (OR = 3.72, p < .001), sleepiness during the day (OR = 2.20, p < .001), and fatigue during the day (OR = 2.87, p < .001) when compared to CWNS. Moreover, CWS with coexisting disabilities were at greater odds of presenting with sleep problems when compared to CWS without coexisting disabilities. Finally, CWS without coexisting disabilities were at greater odds of presenting insomnia when compared to CWNS without coexisting disabilities. Conclusion CWS are at risk for presenting with sleep problems. Additionally, sleep problems persist from early childhood to adolescence. The implications of these findings are unclear, though future studies should look to explore the impact of sleep problems on stuttering.

Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter

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

The working alliance in stuttering treatment: a neglected variable?

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.

Management of stuttering using cognitive behavior therapy and mindfulness meditation

Stuttering is a speech fluency disorder with varied etiological explanations. It is important to identify symptoms early so that adequate and timely intervention can be delivered with focus on management and recovery. Stuttering, besides affecting speech fluency, might have a number of negative psychosocial consequences for the sufferer that may lead to immense anxiety, besides other symptoms. Therefore, it is thus imperative to include multiple dimensions in the holistic treatment of stuttering. Cognitive behavior therapy and mindfulness equip the client with the skills to manage the problems that occur as a result of stuttering. Since the rate of relapse in this condition is high, the chosen therapeutic paradigm must involve booster sessions over a long term. Periodic, detailed assessment would update the therapist about the barriers in treatment and would help in devising appropriate methods to get rid of these hindrances.

Self-Esteem, Self-Efficacy, and Social Support as Predictors of Communicative Participation in Adults Who Stutter

PURPOSE

This study aimed to identify contributors to communicative participation in adults who stutter. Specifically, it was of interest to determine whether psychosocial variables of self-esteem, self-efficacy, and social support were predictive of communicative participation beyond contributions of demographic and speech-related variables.

METHOD

Adults who stutter (N = 339) completed an online survey that included measures of communicative participation, self-esteem, self-efficacy, social support, self-reported speech-related variables (speech usage, number of years stuttering, history of treatment and self-help support group participation for stuttering, and physical speech disruption severity), and demographics (age, sex, living situation, education, and employment status). Hierarchical regression was performed for prediction of communicative participation, in addition to calculating Spearman correlations between social roles variables, communicative participation, and physical speech disruption severity.

RESULTS

After controlling for demographic and speech-related variables, self-esteem, self-efficacy, and social support each significantly predicted communicative participation in adults who stutter. Large correlations were observed between communicative participation and measures of social roles, whereas medium correlations were observed between physical speech disruption severity and measures of social roles.

CONCLUSIONS

Communicative participation in adults who stutter is associated with a variety of demographic, speech-related, and psychosocial variables. Speech-language pathologists should be aware of predictors of communicative participation such as self-esteem, self-efficacy, and social support, in addition to severity of physical speech disruptions. They should consider and evaluate these factors in clients who stutter and target them in treatment if necessary.

Efeito da retroalimentação auditiva atrasada na gagueira com e sem alteração do processamento auditivo central

RESUMO Objetivo Verificar o efeito da retroalimentação auditiva atrasada na fluência da fala de indivíduos que gaguejam, com e sem alteração do processamento auditivo central. Método Participaram 20 indivíduos com gagueira, de sete a 17 anos, divididos em dois grupos, cada um com 10 indivíduos: Grupo Gagueira com Transtorno do Processamento Auditivo (GGTPA) e Grupo Gagueira (GG) sem alteração de processamento auditivo central. Os procedimentos foram: avaliação da fluência com retroalimentação auditiva habitual (RAH) e atrasada (RAA), e avaliação da gravidade da gagueira e do processamento auditivo central (PAC). O software Fono Tools foi utilizado para provocar o atraso de 100 milissegundos na retroalimentação auditiva. O teste dos Postos Sinalizados de Wilcoxon foi utilizado na análise intragrupos, e o teste de Mann-Whitney, na análise intergrupos. Resultados A RAA ocasionou no GG redução estatisticamente significante: no escore da frequência das disfluências típicas da gagueira na análise do Instrumento de Gravidade da Gagueira, na quantidade de bloqueios e de repetições de palavras monossilábicas, e na frequência de disfluências típicas da gagueira de duração. O atraso na retroalimentação auditiva não provocou efeitos estatisticamente significantes na fluência do GGTPA, grupo dos indivíduos com gagueira com alteração do PAC. Conclusão O efeito da retroalimentação auditiva atrasada na fala de indivíduos com gagueira foi diferente nos indivíduos com e sem alteração do processamento auditivo central, pois houve melhora da fluência apenas nos indivíduos sem alteração do PAC.