1. Bloodstein O, Ratner NB. A Handbook on Stuttering. 6th ed. Clifton Park, NY: Thomson Delmar Learning; 2008.
2. Yairi E, Ambrose NG, Paden EP, Throneburg RN. Predictive factors of persistence and recovery: pathways of childhood stuttering. J Commun Disord. 1996;29(1):51–77.[PubMed]
3. Teesson K, Packman A, Onslow M. The Lidcombe Behavioral Data Language of stuttering. J Speech Lang Hear Res. 2003;46(4):1009–1015.[PubMed]
4. Bennett EM. Working with People Who Stutter: A Lifespan Approach. Upper Saddle River, NJ; Pearson/Merrill/Prentice Hall; 2006.
5. Smith A, Kelly E. Stuttering: a dynamic, multifactorial model. In: Curlee RF, Siegel GM, editors. Nature and Treatment of Stuttering: New Directions. 2nd ed. Boston: Allyn and Bacon; 1997. pp. 204–217.
6. Blomgren M. Stuttering treatment outcomes measurement: Asssessing above and below the surface. Perspect Fluen Fluen Disord. 2007;17(3):19–23.
7. Blumgart E, Tran Y, Craig A. Social anxiety disorder in adults who stutter. Depress Anxiety. 2010;27(7):687–692.[PubMed]
8. Gabel RM, Hughes S, Daniels D. Effects of stuttering severity and therapy involvement on role entrapment of people who stutter. J Commun Disord. 2008;41(2):146–158.[PubMed]
9. Packman A, Attanasio JS. Theoretical Issues in Stuttering. Hove, East Sussex; New York: Psychology Press; 2004.
10. Blomgren M, Nagarajan SS, Lee JN, Li T, Alvord L. Preliminary results of a functional MRI study of brain activation patterns in stuttering and nonstuttering speakers during a lexical access task. J Fluency Disord. 2003;28(4):337–355. quiz 355–336. [PubMed]
11. Ingham RJ. Neuroimaging in Communication Sciences and Disorders. San Diego, CA: Plural Pub; 2008.
12. Salmelin R, Schnitzler A, Schmitz F, Freund HJ. Single word reading in developmental stutterers and fluent speakers. Brain. 2000;123(Pt 6):1184–1202.[PubMed]
13. Bennett E. Working with People Who Stutter: A Lifespan Approach. Upper Saddle River, NJ; Pearson/Merrill/Prentice Hall; 2006.
14. Yairi E, Seery CH. Stuttering: Foundations and Clinical Applications. Boston: Pearson; 2011.
15. Jelčić Jakšić S, Onslow M. The Science and Practice of Stuttering Treatment: A Symposium. West Sussex, UK: Wiley-Blackwell; 2012.
16. Bothe AK. Evidence-Based Treatment of Stuttering: Empirical Bases and Clinical Applications. Mahwah, NJ: L. Erlbaum; 2004.
17. Guitar B, McCauley RJ. Treatment of Stuttering: Established And Emerging Approaches. 1st ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010.
18. Martin RR, Kuhl P, Haroldson S. An experimental treatment with two preschool stuttering children. J Speech Hear Res. 1972;15(4):743–752.[PubMed]
19. Lasan M. Multifactorial treatment for preschool children. In: Jelcic Jaksic S, Onslow M., editors. The Science and Practice of Stuttering Treatment: A Symposium. West Sussex, UK: Wiley-Blackwell; 2012. pp. 171–181.
20. Andrews G, Craig A, Feyer AM, Hoddinott S, Howie P, Neilson M. Stuttering: a review of research findings and theories circa 1982. J Speech Hear Disord. 1983;48(3):226–246.[PubMed]
21. Sheehan JG. Stuttering; Research and Therapy. New York: Harper and Row; 1970.
22. Starkweather CW. Fluency and Stuttering. Englewood Cliffs, NJ: Prentice-Hall; 1987.
23. Yaruss JS, Coleman C, Hammer D. Treating preschool children who stutter: description and preliminary evaluation of a family-focused treatment approach. Lang Speech Hear Serv Sch. 2006;37(2):118–136.[PubMed]
24. Millard SK, Nicholas A, Cook FM. Is parent-child interaction therapy effective in reducing stuttering? J Speech Lang Hear Res. 2008;51(3):636–650.[PubMed]
25. Millard SK, Edwards S, Cook FM. Parent-child interaction therapy: Adding to the evidence. Int J Speech Lang Pa. 2009;11(1):61–76.
26. Rustin L, Botterill W, Kelman E. Assessment and Therapy for Young Dysfluent Children: Family Interaction. San Diego: Singular Pub. Group; 1996.
27. Conture EG. Stuttering: Its Nature, Diagnosis, and Treatment. Boston, MA: Allyn and Bacon; 2001.
28. Conture E, Melnick K. Parent-child group approach to stuttering in preschool and school-age children. In: Onslow M, Packman A, editors. Early Stuttering: A Handbook of Intervention Strategies. San Diego: Singular; 1999. pp. 17–51.
29. Richels C, Conture E. An indirect treatment approach for early intervention for childhood stuttering. In: Conture E, Curlee R, editors. Stuttering and Related Disorder. 3rd ed. New York: Thieme; 2007.
30. Franken MC, Kielstra-Van der Schalk CJ, Boelens H. Experimental treatment of early stuttering: a preliminary study. J Fluency Disord. 2005;30(3):189–199.[PubMed]
31. Reed C, Godden A. An experimental treatment using verbal punishment with two preschool stutterers. J Fluency Disord. 1977;2:225–233.
32. Harrison E, Onslow M. The Lidcombe Program for preschool children who stutter. In: Guitar B, McCauley R, editors. Treatment of Stuttering: Established and Emerging Interventions. Baltimore, MD: Lippincott Williams & Wilkins; 2009. pp. 118–140.
33. Onslow M, Costa L, Rue S. Direct early intervention with stuttering: some preliminary data. J Speech Hear Disord. 1990;55(3):405–416.[PubMed]
34. Onslow M, Andrews C, Lincoln M. A control/experimental trial of an operant treatment for early stuttering. J Speech Hear Res. 1994;37(6):1244–1259.[PubMed]
35. Jones M, Onslow M, Harrison E, Packman A. Treating stuttering in young children: Predicting treatment time in the lidcombe program. J Speech Lang Hear R. 2000;43(6):1440–1450.[PubMed]
36. Jones M, Onslow M, Packman A, et al. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. BMJ. 2005;331(7518):659–661.[PMC free article][PubMed]
37. Onslow M, Yaruss JS. Differing perspectives on what to do with a stuttering preschooler and why. Am J Speech Lang Pathol. 2007;16(1):65–68.[PubMed]
38. Blomgren M, Roy N, Callister T, Merrill RM. Intensive stuttering modification therapy: a multidimensional assessment of treatment outcomes. J Speech Lang Hear Res. 2005;48(3):509–523.[PubMed]
39. Blomgren M, Roy N, Callister T, Merrill R. Treatment outcomes research: A response to Ryan. J Speech Lang Hear Res. 2006;49:1415–1419.
40. Blomgren M, Roy N, Callister T, Merrill R. Assessing stuttering treatment without assissing stuttering? A response to Reitzes and Snyder. J Speech Lang Hear Res. 2006;49:1423–1426.
41. Reitzes P, Snyder G. Response to “Intensive stuttering modification therapy: a multidimensional assessment of treatment outcomes,” by Blomgren, Roy, Callister, and Merrill (2005) J Speech Lang Hear Res. 2006;49(6):1420–1422. author reply 1423–1426. [PubMed]
42. Ryan BP. Response to Blomgren, Roy, Callister, and Merrill (2005) J Speech Lang Hear Res. 2006;49(6):1412–1414. author reply 1415–1419. [PubMed]
43. Blomgren M. Stuttering treatment for adults: an update on contemporary approaches. Semin Speech Lang. 2010;31(4):272–282.[PubMed]
44. Ingham RJ. Stuttering and Behavior Therapy: Current Status and Experimental Foundations. San Diego: College-Hill Press; 1984.
45. Dunlap K. Habits: Their Making and Unmaking. New York: Liveright; 1932.
46. Bloodstein O. Stuttering as tension and fragmentation. In: Eisenson J, editor. Stuttering: A Symposium. New York: Harper; 1975. pp. 1–96.
47. Johnson W. Stuttering. In: Moeller WJD, editor. Speech-Handicapped School Children. New York: Harper and Row; 1967. pp. 229–329.
48. Sheehan J. Current issues on stuttering and recovery. In: Gregory HH, editor. Controversies About Stuttering Therapy. Baltimore, MD: University Park Press; 1979. pp. 175–208.
49. Van Riper C. The Treatment of Stuttering. Englewood Cliffs, NJ: Prentice-Hall; 1973.
50. Williams DE. Stuttering therapy for children. In: Travis LE, editor. Handbook of Speech Pathology and Audiology. Englewood Cliffs, NJ: Prentice-Hall; 1971. pp. 1073–1093.
51. Zebrowski PM, Arenas RM. The “Iowa Way” revisited. J Fluency Disord. 2011;36(3):144–157.[PubMed]
52. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.[PubMed]
53. Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall; 1986.
54. Wolpe J. Psychotherapy by Reciprocal Inhibition. Stanford, CA: Stanford University Press; 1958.
55. Blomgren M. Review of the Successful Stuttering Management Program. In: Jelčić Jakšić S, Onslow M., editors. The Science and Practice of Stuttering Treatment: A Symposium. Chichester, UK: John Wiley & Sons, Ltd; 2012. pp. 99–113.
56. Kraaimaat FW, Vanryckeghem M, Van Dam-Baggen R. Stuttering and social anxiety. J Fluency Disord. 2002;27(4):319–330. quiz 330–311. [PubMed]
57. Menzies RG, O’Brian S, Onslow M, Packman A, St Clare T, Block S. An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. J Speech Lang Hear Res. 2008;51(6):1451–1464.[PubMed]
58. Craig AR, Tran Y. Fear of speaking: Chronic anxiety and stuttering. Advances in Psychiatric Treatment. 2006;12:63–68.
59. Menzies RG, Onslow M, Packman A, O’Brian S. Cognitive behavior therapy for adults who stutter: a tutorial for speech-language pathologists. J Fluency Disord. 2009;34(3):187–200.[PubMed]
60. Rowley D. Cognitive behaviour therapy. In: Jelčić Jakšić S, Onslow M., editors. The Science and Practice of Stuttering Treatment: A Symposium. Chichester, UK: John Wiley & Sons, Ltd; 2012. pp. 183–193.
61. Howie PM, Tanner S, Andrews G. Short- and long-term outcome in an intensive treatment program for adult stutterers. J Speech Hear Disord. 1981;46(1):104–109.[PubMed]
62. Ingham RJ. Operant methodology in stuttering therapy. In: Eisenson J, editor. Stuttering: A Scond Symposium. New York: Harper and Row; 1975.
63. O’Brian S, Packman A, Onslow M. The Camperdown Program. In: Guitar B, McCauley R, editors. Treatment of Stuttering: Established and Emerging Interventions. Philadelphia: Wolters Kluwer/Lippencott Williams & Wilkins; 2010. pp. 256–276.
64. Ryan BP. Programmed Therapy for Stuttering in Children and Adults. Springfield, IL: Thomas; 1974.
65. Blomgren M. University of Utah Instensive Stuttering Clinic Therapy Manual. Acton, MA: Copley Custon Textbooks; 2009.
66. Boberg E, Kully D. Comprehensive Stuttering Program: Clinical Manual. San Diego: College-Hill Press; 1985.
67. Kroll R, Scott-Sulsky L. The Fluency Plus Program: An integration of fluency shaping and cognitive restructuring procedures for adolescents and adults who stutter\Guitar B, McCauley R, editors. Treatment of Stuttering: Established and Emerging Interventions Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010277–311.
68. Webster RL. Precision Fluency Shaping Program: Speech Reconstruction for Stutterers. Roanoke, VA: Communications Development Corporation; 1982.
69. O’Brian S, Onslow M, Cream A, Packman A. The Camperdown Program: outcomes of a new prolonged-speech treatment model. J Speech Lang Hear Res. 2003;46(4):933–946.[PubMed]
70. O’Brian S, Packman A, Onslow M. Telehealth delivery of the Camperdown Program for adults who stutter: a phase I trial. J Speech Lang Hear Res. 2008;51(1):184–195.[PubMed]
71. Goldiamond I. Stuttering and fluency as manipulatable operant response classes. In: Krasner L, Ullmann LP, editors. Research in Behavior Modification. New York: Holt, Rinehart and Winston; 1965.
72. Webster RL. Evolution of a target-based behavioral therapy for stuttering. In: Shames GH, Rubin H, editors. Stuttering Then and Now. Columbus, OH: Merrill Publishing; 1986. pp. 397–414.
73. Kully D, Langevin M, Lomheim H. Intensive treatment of stuttering in adolescents and adults. In: Conture EG, Curlee RF, editors. Stuttering and Related Disorders of Fluency. 3rd ed. New York: Thieme; 2007. pp. 213–232.
74. Montgomery CS. The treatment of stuttering: From the hub to the spoke. In: Bernstein Ratner N, Tetnowski JA., editors. Current Issues in Stuttering Research and Practice. Mahway, NJ: Lawrence Erlbaum; 2006. pp. 159–204.
75. Guidelines for practice in stuttering treatment. Special Interest Division on Fluency and Fluency Disorders American Speech-Language-Hearing Association. ASHA Suppl. 1995;37(3 Suppl 14):26–35. No authors listed. [PubMed]
76. Finn P, Howard R, Kubala R. Unassisted recovery from stuttering: self-perceptions of current speech behavior, attitudes, and feelings. J Fluency Disord. 2005;30(4):281–305.[PubMed]
77. Yaruss JS. Evaluating treatment outcomes for adults who stutter. J Commun Disord. 2001;34(1–2):163–182.[PubMed]
78. Yaruss JS, Quesal RW. Stuttering and the International Classification of Functioning, Disability, and Health: an update.
Ehud Yairi | Nicoline Ambrose
Epidemiological advances in stuttering during the current century are reviewed within the perspectives of past knowledge. The review is organized in six sections: (a) onset, (b) incidence, (c) prevalence, (d) developmental paths, (e) genetics and (f) subtypes. It is concluded that: (1) most of the risk for stuttering onset is over by age 5, earlier than has been previously thought, with a male-to-female ratio near onset smaller than what has been thought, (2) there are indications that the lifespan incidence in the general population may be higher than the 5% commonly cited in past work, (3) the average prevalence over the lifespan may be lower than the commonly held 1%, (4) the effects of race, ethnicity, culture, bilingualism, and socioeconomic status on the incidence/prevalence of stuttering remain uncertain, (5) longitudinal, as well as incidence and prevalence studies support high levels of natural recovery from stuttering, (6) advances in biological genetic research have brought within reach the identification of candidate genes that contribute to stuttering in the population at large, (7) subtype-differentiation has attracted growing interest, with most of the accumulated evidence supporting a distinction between persistent and recovered subtypes.Educational objectives: Readers will be exposed to a summary presentation of the most recent data concerning basic epidemiological factors in stuttering. Most of these factors also pertain to children's risks for experiencing stuttering onset, as well as risks for persistency. The article also aims to increase awareness of the implications of the information to research, and professional preparation that meets the epidemiology of the disorder. © 2012 Elsevier Inc.
Lisa Iverach | Ronald M. Rapee
Anxiety is one of the most widely observed and extensively studied psychological concomitants of stuttering. Research conducted prior to the turn of the century produced evidence of heightened anxiety in people who stutter, yet findings were inconsistent and ambiguous. Failure to detect a clear and systematic relationship between anxiety and stuttering was attributed to methodological flaws, including use of small sample sizes and unidimensional measures of anxiety. More recent research, however, has generated far less equivocal findings when using social anxiety questionnaires and psychiatric diagnostic assessments in larger samples of people who stutter. In particular, a growing body of research has demonstrated an alarmingly high rate of social anxiety disorder among adults who stutter. Social anxiety disorder is a prevalent and chronic anxiety disorder characterised by significant fear of humiliation, embarrassment, and negative evaluation in social or performance-based situations. In light of the debilitating nature of social anxiety disorder, and the impact of stuttering on quality of life and personal functioning, collaboration between speech pathologists and psychologists is required to develop and implement comprehensive assessment and treatment programmes for social anxiety among people who stutter. This comprehensive approach has the potential to improve quality of life and engagement in everyday activities for people who stutter. Determining the prevalence of social anxiety disorder among children and adolescents who stutter is a critical line of future research. Further studies are also required to confirm the efficacy of Cognitive Behaviour Therapy in treating social anxiety disorder in stuttering.Educational Objectives: The reader will be able to: (a) describe the nature and course of social anxiety disorder; (b) outline previous research regarding anxiety and stuttering, including features of social anxiety disorder; (c) summarise research findings regarding the diagnostic assessment of social anxiety disorder among people who stutter; (d) describe approaches for the assessment and treatment of social anxiety in stuttering, including the efficacy of Cognitive Behaviour Therapy; and (e) outline clinical implications and future directions associated with heightened social anxiety in stuttering. © 2013 The Authors.
Ashley Craig | Yvonne Tran
Purpose: The relationship between chronic stuttering and anxiety has been a matter of some debate over the past two decades, with a major emphasis of research focused on examining whether people who stutter have abnormally elevated levels of trait or social anxiety. The major goal of this paper was to perform a systematic literature review and perform meta-analyses on research that has assessed (i) trait anxiety and (ii) social anxiety, in adults who stutter. Method: Only studies that met strict inclusion criteria were selected for the meta-analyses. Two meta-analyses were conducted, the first for trait anxiety, and the second for social anxiety. Meta-analysis combines statistically the results of selected studies that meet strict design criteria, thereby clarifying the size of differences in trait and social anxiety between adults who stutter and adults who do not stutter. Results: Meta-analytic results confirmed that adults with chronic stuttering do have substantially elevated trait and social anxiety. The overall effect size for trait and social anxiety was calculated to be .57 and .82, respectively. Conclusions: Trait and social anxiety are definite problems for many adults who stutter. Clinical implications of these findings for the diagnosis and treatment of adult who stutter are discussed.Educational objectives: The reader will be able to: (a) describe the process of conducting a systematic review and meta-analysis; (b) describe the possible impact of publication bias on meta-analysis results; (c) explain the impact of a chronic disorder like stuttering on levels of trait anxiety; (d) explain the impact of stuttering on levels of social anxiety; (e) interpret the results of meta-analysis when applied to differences in anxiety between adult people who stutter and those who do not stutter; and (f) describe implications for fluency enhancing treatments. © 2014 Elsevier Inc.
Per A. Alm
Anxiety and emotional reactions have a central role in many theories of stuttering, for example that persons who stutter would tend to have an emotionally sensitive temperament. The possible relation between stuttering and certain traits of temperament or personality were reviewed and analyzed, with focus on temporal relations (i.e., what comes first). It was consistently found that preschool children who stutter (as a group) do not show any tendencies toward elevated temperamental traits of shyness or social anxiety compared with children who do not stutter. Significant group differences were, however, repeatedly reported for traits associated with inattention and hyperactivity/impulsivity, which is likely to reflect a subgroup of children who stutter. Available data is not consistent with the proposal that the risk for persistent stuttering is increased by an emotionally reactive temperament in children who stutter. Speech-related social anxiety develops in many cases of stuttering, before adulthood. Reduction of social anxiety in adults who stutter does not in itself appear to result in significant improvement of speech fluency. Studies have not revealed any relation between the severity of the motor symptoms of stuttering and temperamental traits. It is proposed that situational variability of stuttering, related to social complexity, is an effect of interference from social cognition and not directly from the emotions of social anxiety. In summary, the studies in this review provide strong evidence that persons who stutter are not characterized by constitutional traits of anxiety or similar constructs.Educational Objectives: This paper provides a review and analysis of studies of anxiety, temperament, and personality, organized with the objective to clarify cause and effect relations. Readers will be able to (a) understand the importance of effect size and distribution of data for interpretation of group differences; (b) understand the role of temporal relations for interpretation of cause and effect; (c) discuss the results of studies of anxiety, temperament and personality in relation to stuttering; and (d) discuss situational variations of stuttering and the poss ible role of social cognition. © 2014 Elsevier Inc.
Kurt Eggers | Luc F. De Nil | Bea R H Van Den Bergh
Purpose: The purpose of this study was to investigate whether previously reported parental questionnaire-based differences in inhibitory control (IC; Eggers, De Nil, & Van den Bergh, 2010) would be supported by direct measurement of IC using a computer task. Method: Participants were 30 children who stutter (CWS; mean age = 7;05 years) and 30 children who not stutter (CWNS; mean age = 7;05 years). Participants were matched on age and gender (±3 months). IC was assessed by the Go/NoGo task of the Amsterdam Neuropsychological Tasks (De Sonneville, 2009). Results: Results indicated that CWS, compared to CWNS, (a) exhibited more false alarms and premature responses, (b) showed lower reaction times for false alarms, and (c) were less able to adapt their response style after experiencing response errors. Conclusions: Our findings provide further support for the hypothesis that CWS and CWNS differ on IC. CWS, as a group, were lower in IC pointing toward a lowered ability to inhibit prepotent response tendencies. The findings were linked to previous IC-related studies and to emerging theoretical frameworks of stuttering development.Educational objectives: The reader will be able to: (1) describe the concept of inhibitory control, and its functional significance; (2) describe the findings on self-regulatory processes, attentional processes, and inhibitory control in CWS; (3) identify which Go/NoGo task variables differentiated between CWS and CWNS; and (4) summarize the theoretical implications for the development of stuttering and the possible clinical implications. © 2012 Elsevier Inc.
Katerina Ntourou | Edward G. Conture | Tedra A. Walden
Purpose: This study experimentally investigated behavioral correlates of emotional reactivity and emotion regulation and their relation to speech (dis)fluency in preschool-age children who do (CWS) and do not (CWNS) stutter during emotion-eliciting conditions. Method: Participants (18 CWS, 14 boys; 18 CWNS, 14 boys) completed two experimental tasks (1) a neutral ("apples and leaves in a transparent box," ALTB) and (2) a frustrating ("attractive toy in a transparent box," ATTB) task, both of which were followed by a narrative task. Dependent measures were emotional reactivity (positive affect, negative affect), emotion regulation (self-speech, distraction) exhibited during the ALTB and the ATTB tasks, percentage of stuttered disfluencies (SDs) and percentage of non-stuttered disfluencies (NSDs) produced during the narratives. Results: Results indicated that preschool-age CWS exhibited significantly more negative emotion and more self-speech than preschool-age CWNS. For CWS only, emotion regulation behaviors (i.e., distraction, s elf-speech) during the experimental tasks were predictive of stuttered disfluencies during the subsequent narrative tasks. Furthermore, for CWS there was no relation between emotional processes and non-stuttered disfluencies, but CWNS's negative affect was significantly related to nonstuttered disfluencies. Conclusions: In general, present findings support the notion that emotional processes are associated with childhood stuttering. Specifically, findings are consistent with the notion that preschool-age CWS are more emotionally reactive than CWNS and that their self-speech regulatory attempts may be less than effective in modulating their emotions.Educational objectives. The reader will be able to: (a) communicate the relevance of studying the role of emotion in developmental stuttering close to the onset of stuttering and (b) describe the main findings of the present study in relation to previous studies that have used different methodologies to investigate the role of emotion in developmental stuttering of young children who stutter. © 2013 Elsevier Inc.
Dahye Choi | Edward G. Conture | Tedra A. Walden | Warren E. Lambert | Victoria Tumanova
Purpose: The purpose of this study was to assess the relation of behavioral inhibition to stuttering and speech/language output in preschool-age children who do (CWS) and do not stutter (CWNS). Method: Participants were preschool-age (ages 36-68 months), including 26 CWS (22 males) and 28 CWNS (13 males). Participants' behavioral inhibition (BI) was assessed by measuring the latency to their sixth spontaneous comment during conversation with an unfamiliar experimenter, using methodology developed by Kagan, Reznick, and Gibbons (1989). In addition to these measures of BI, each participant's stuttered and non-stuttered disfluencies and mean length of utterance (in morphemes) were assessed. Results: Among the more salient findings, it was found that (1) there was no significant difference in BI between preschool-age CWS and CWNS as a group, (2) when extremely high versus low inhibited children were selected, there were more CWS with higher BI and fewer CWS with lower BI when compared to their CWNS peers, and (3) more behaviorally inhibited CWS, when compared to less behaviorally inhibited CWS, exhibited more stuttering. Conclusions: Findings are taken to suggest that one aspect of temperament (i.e., behavioral inhibition) is exhibited by some preschool-age CWS and that these children stutter more than CWS with lower behavioral inhibition. The present results seem to support continued study of the association between young children's temperamental characteristics and stuttering, the diagnostic entity (i.e., CWS versus CWNS), as well as stuttering, the behavior (e.g., frequency of stuttered disfluencies).Educational objectives: After reading this article, the reader will be able to: (a) summarize the salient empirical findings in the extant literature with regard to the association between temperament and childhood stuttering; (b) describe the concept of behavioral inhibition (BI) as well as the methods to measure BI; and (c) discuss the association between behavioral inhibition and childhood stuttering in preschool-age children. © 2013 Elsevier Inc.
Shane Erickson | Susan Block
Purpose: Stuttering can cause wide ranging psychosocial impact. This is particularly the case for adolescents who may face additional physical, emotional and personality changes as they become adults. This study reports the findings of an investigation into the social and communication impacts of stuttering on Australian adolescents seeking treatment for stuttering and their families. Method: A cross-sectional design utilising questionnaires assessed the self-perceived communication competence and apprehension, stigma and disclosure, and experiences of teasing and bullying of 36 adolescents who stutter. Additionally, the impact of stuttering on the families of these adolescents was investigated. Results: Adolescents who stutter have below average self-perceived communication competence, heightened communication apprehension, are teased and bullied more often than fluent peers, and they try to keep their stuttering secret. The families of the adolescents in the study reported high levels of emotional strain, family conflict and difficulty managing their child's frustrations. Conclusion: The findings from this study emphasise the wide-ranging impact of stuttering beyond the surface level behaviours. Clinicians working with adolescents who stutter should take note of both the outcomes of this study and the suggestions for more effectively coping with the condition in this population.Educational objectives: The reader will be able to: (a) summarise findings with regards to the impact of stuttering on an adolescent's social and communication skills; (b) summarise areas of impact on the families of adolescents who stutter; (c) compare these findings with previous reported data for this population; (d) discuss the clinical implications of the results for working with adolescents who stutter and their families. © 2013 Elsevier Inc.
Janet M. Beilby | Michelle L. Byrnes | Emily L. Meagher | J. Scott Yaruss
This study explored the impact of the stuttering disorder on perceived quality of life, with emphasis on the individual's relationship with their partner or spouse. Specifically, the purposes were: (a) to investigate what personal experiences and themes exist for both members of a couple dyad when one member of the couple stutters and (b) to examine whether the partners have different experiences with respect to the impact of stuttering on their lives.A mixed method research design was used. Participant dyads (adults who stutter and their fluent life partner) each completed one semi-structured qualitative interview and two questi onnaires: the Overall Assessment of Speakers' Experience of Stuttering (OASES), and the Medical Short Form 36 (SF-36).Interviews were analysed qualitatively and significant themes evaluated. Quantitative results of the OASES and SF-36 were analysed, and scores correlated to determine the strength of any clinically significant relationships.Results indicated that people who stutter and their fluent partners reported similar experiences in reactions to stuttering and perceived difficulties in communication. However, no relationship was seen between the two groups in perceived impact on quality of life. Qualitative results indicated that the participants shared life experiences including reactions to stuttering, treatment undertaken and support. Such findings lend support to a broad-based clinical programme for adults who stutter that includes the fluent partner as an agent of change in their treatment. Findings also support the utilisation of qualitative and quantitative research techniques to elucidate relevant psychosocial life themes and experiences for those who live with a stutter.Educational objectives The reader will be able to: (a) identify the life themes associated with having a partner who stutters; (b) identify the perceived impact of stuttering for adults who stutter compared to their partners; and (c) discuss the clinical implications of the results with regards to working with adults who stutter. © 2012 Elsevier Inc.
Christine Weber-Fox | Amanda Hampton Wray | Hayley Arnold
We examined neural activity mediating semantic and syntactic processing in 27 preschool-age children who stutter (CWS) and 27 preschool-age children who do not stutter (CWNS) matched for age, nonverbal IQ and language abilities. All participants displayed language abilities and nonverbal IQ within the normal range. Event-related brain potentials (ERPs) were elicited while participants watched a cartoon video and heard naturally spoken sentences that were either correct or contained semantic or syntactic (phrase structure) violations. ERPs in CWS, compared to CWNS, were characterized by longer N400 peak latencies elicited by semantic processing. In the CWS, syntactic violations elicited greater negative amplitudes for the early time window (150-350. ms) over medial sites compared to CWNS. Additionally, the amplitude of the P600 elicited by syntactic violations relative to control words was significant over the left hemisphere for the CWNS but showed the reverse pattern in CWS, a robust effect only over the right hemisphere. Both groups of preschoolage children demonstrated marked and differential effects for neural processes elicited by semantic and phrase structure violations; however, a significant proportion of young CWS exhibit differences in the neural functions mediating language processing compared to CWNS despite normal language abilities. These results are the first to show that differences in event-related brain potentials reflecting language processing occur as early as the preschool years in CWS and provide the first evidence that atypical lateralization of hemispheric speech/language functions previously observed in the brains of adults who stutter begin to emerge near the onset of developmental stuttering.Educational objectives: The reader will be able to: (1) describe the role of language processing in current theoretical models of developmental stuttering; (2) summarize current evidence regarding language processing differences between individuals who do and do not stutter; (3) describe typical changes in neural indices of semantic and syntactic processing across development; (4) discuss the potential implications of the current findings in relation to theories of developmental stuttering. © 2013 Elsevier Inc..
Pascal van Lieshout | Boaz Ben-David | Melinda Lipski | Aravind Namasivayam
Purpose: In the present study, an Emotional Stroop and Classical Stroop task were used to separate the effect of threat content and cognitive stress from the phonetic features of words on motor preparation and execution processes. Method: A group of 10 people who stutter (PWS) and 10 matched people who do not stutter (PNS) repeated colour names for threat content words and neutral words, as well as for traditional Stroop stimuli. Data collection included speech acoustics and movement data from upper lip and lower lip using 3D EMA. Results: PWS in both tasks were slower to respond and showed smaller upper lip movement ranges than PNS. For the Emotional Stroop task only, PWS were found to show larger inter-lip phase differences compared to PNS. General threat words were executed with faster lower lip movements (larger range and shorter duration) in both groups, but only PWS showed a change in upper lip movements. For stutter specific threat words, both groups showed a more variable lip coordination pattern, but only PWS showed a delay in reaction time compared to neutral words. Individual stuttered words showed no effects. Both groups showed a classical Stroop interference effect in reaction time but no changes in motor variables. Conclusion: This study shows differential motor responses in PWS compared to controls for specific threat words. Cognitive stress was not found to affect stuttering individuals differently than controls or that its impact spreads to motor execution processes.Educational objectives: After reading this article, the reader will be able to: (1) discuss the importance of understanding how threat content influences speech motor control in people who stutter and non-stuttering speakers; (2) discuss the need to use tasks like the Emotional Stroop and Regular Stroop to separate phonetic (word-bound) based impact on fluency from other factors in people who stutter; and (3) describe the role of anxiety and cognitive stress on speech motor processes. © 2014 Elsevier Inc.
Caroline Spencer | Christine Weber-Fox
© 2014 Elsevier Inc. Purpose: In preschool children, we investigated whether expressive and receptive language, phonological, articulatory, and/or verbal working memory proficiencies aid in predicting eventual recovery or persistence of stuttering. Methods: Participants included 65 children, including 25 children who do not stutter (CWNS) and 40 who stutter (CWS) recruited at age 3;9-5;8. At initial testing, participants were administered the Test of Auditory Comprehension of Language, 3rd edition (TACL-3), Structured Photographic Expressive Language Test, 3rd edition (SPELT-3), Bankson-Bernthal Test of Phonology-Consonant Inventory subtest (BBTOP-CI), Nonword Repetition Test (NRT; Dollaghan & Campbell, 1998), and Test of Auditory Perceptual Skills-Revised (TAPS-R) auditory number memory and auditory word memory subtests. Stuttering behaviors of CWS were assessed in subsequent years, forming groups whose stuttering eventually persisted (CWS-Per; n=. 19) or recovered (CWS-Rec; n=. 21). Proficiency scores in morphosyntactic skills, consonant production, verbal working memory for known words, and phonological working memory and speech production for novel nonwords obtained at the initial testing were analyzed for each group. Results: CWS-Per were less proficient than CWNS and CWS-Rec in measures of consonant production (BBTOP-CI) and repetition of novel phonological sequences (NRT). In contrast, receptive language, expressive language, and verbal working memory abilities did not distinguish CWS-Rec from CWS-Per. Binary logistic regression analysis indicated that preschool BBTOP-CI scores and overall NRT proficiency significantly predicted future recovery status. Conclusion: Results suggest that phonological and speech articulation abilities in the preschool years should be considered with other predictive factors as part of a comprehensive risk assessment for the development of chronic stuttering.Educational objectives: At the end of this activity the reader will be able to: (1) describe the current status of nonlinguistic and linguistic predictors for recovery and persistence of stuttering; (2) summarize current evidence regarding the potential value of consonant cluster articulation and nonword repetition abilities in helping to predict stuttering outcome in preschool children; (3) discuss the current findings in relation to potential implications for theories of developmental stuttering; (4) discuss the current findings in relation to potential considerations for the evaluation and treatment of developmental stuttering.
Geraldine Bricker-Katz | Michelle Lincoln | Steven Cumming
Purpose: The experiential claims of nine people who stuttered were examined with the purpose of determining the impact of stuttering on their work lives and to further examine what meaning they derive from these experiences. Method: Six male and three female participants aged 29-61 years (mean age, 41.4) who stuttered were interviewed and verbatim interview transcripts were analyzed using interpretative phenomenological analysis. Credibility was established by way of member checking, researcher comparison with only consensual themes and interpretations presented in the final analysis. Results: Four Superordinate themes, "stuttering is always there; stuttering at work reveals a problem; stuttering limits communication; and stuttering limits occupational progression" were distilled by descriptive and interpretative treatment of the interview transcripts. The interpretative level of analysis identified self-stigma as central to the meaning derived from these experiences. Participants' expectation of stigmatizing public attitudes, together with their own self-validation of such attitudes perpetuated diminished feelings about self-esteem and self-efficacy. Fear of negative evaluation may be heightened in the work context and might mediate feelings of self-stigma in this context. Conclusions: Superordinate themes and their subthemes indicate that stuttering is problematic at work by way of perpetuating in the PWS an expectation of negative evaluation by others. Findings implicate issues of self-stigma as generating feelings of self-doubt and self-reproach in PWS in the workplace. The development and effects of self-stigma in PWS have broader implications than the workplace context alone and further examination of the issues of self-stigma in stuttering is recommended.Educational objectives: At the end of this activity the reader will be able to: (a) describe how stuttering might affect workplace experiences; (b) describe the impact of stuttering on communication in the work context; (c) describe how qualitative methods can provide insights into the impact of stuttering in the work context; (d) describe the impact of self and public stigma on wellbeing in the work context. © 2013 Elsevier Inc.
Anthony Gunn | Ross G. Menzies | Sue O'Brian | Mark Onslow | Ann Packman | Robyn Lowe | Lisa Iverach | Robert Heard | Susan Block
Purpose: The purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents. Method: Participants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12-14 years; n=20) and older adolescents (15-17 years; n=17). Results: Thirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate-severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15-17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12-14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status. Discussion: These results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment. © 2013 Elsevier Inc.
Neville W. Hennessey | Esther Dourado | Janet M. Beilby
People with anxiety disorders show an attentional bias towards threat or negative emotion words. This exploratory study examined whether people who stutter (PWS), who can be anxious when speaking, show similar bias and whether reactions to threat words also influence speech motor planning and execution. Comparisons were made between 31 PWS and 31 fluent controls in a modified emotional Stroop task where, depending on a visual cue, participants named the colour of threat and neutral words at either a normal or fast articulation rate. In a manual version of the same task participants pressed the corresponding colour button with either a long or short duration. PWS but not controls were slower to respond to threat words than neutral words, however, this emotionality effect was only evident for verbal responding. Emotionality did not interact with speech rate, but the size of the emotionality effect among PWS did correlate with frequency of stuttering. Results suggest PWS show an attentional bias to threat words similar to that found in people with anxiety disorder. In addition, this bias appears to be contingent on engaging the speech production system as a response modality. No evidence was found to indicate that emotional reactivity during the Stroop task constrains or destabilises, perhaps via arousal mechanisms, speech motor adjustment or execution for PWS.Educational objectives: The reader will be able to: (1) explain the importance of cognitive aspects of anxiety, such as attentional biases, in the possible cause and/or maintenance of anxiety in people who stutter, (2) explain how the emotional Stroop task can be used as a measure of attentional bias to threat information, and (3) evaluate the findings with respect to the relationship between attentional bias to threat information and speech production in people who stutter. © 2013 Elsevier Inc.
Kylie A. Smith | Lisa Iverach | Susan O'Brian | Elaina Kefalianos | Sheena Reilly
Purpose: Adults who stutter have heightened rates of anxiety disorders, particularly social anxiety disorder, compared with non-stuttering controls. However, the timing of anxiety onset and its development in relation to stuttering is poorly understood. Identifying the typical age of anxiety onset in stuttering has significant clinical implications and is crucial for the management of both disorders across the lifespan. The present review aims to determine the scope of the research pertaining to this topic, identify trends in findings, and delineate timing of anxiety onset in stuttering. Methods: We examine putative risk factors of anxiety present for children and adolescents who stutter, and provide a review of the research evidence relating to anxiety for this population. Results: Young people who stutter can experience negative social consequences and negative attitudes towards communication, which is hypothesised to place them at increased risk of developing anxiety. The prevalence of anxiety of young people who stutter, and the timing of anxiety onset in stuttering could not be determined. This was due to methodological limitations in the reviewed research such as small participant numbers, and the use of measures that lack sensitivity to identify anxiety in the targeted population. Conclusions: In sum, the evidence suggests that anxiety in stuttering might increase over time until it exceeds normal limits in adolescence and adulthood. The cl inical implications of these findings, and recommendations for future research, are discussed.Educational Objectives: The reader will be able to: (a) discuss contemporary thinking on the role of anxiety in stuttering and reasons for this view; (b) describe risk factors for the development of anxiety in stuttering, experienced by children and adolescents who stutter (c) outline trends in current research on anxiety and children and adolescents with stuttering; and (d) summarise rationales behind recommendations for future research in this area. © 2014 Elsevier Inc.