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Speaker and Observer Perceptions of Physical Tension during Stuttering
Abstract
Purpose:
Speech-language pathologists routinely assess physical tension during evaluation of those who stutter. If speakers experience tension that is not visible to clinicians, then judgments of severity may be inaccurate. This study addressed this potential discrepancy by comparing judgments of tension by people who stutter and expert clinicians to determine if clinicians could accurately identify the speakers' experience of physical tension.
Method:
Ten adults who stutter were audio-video recorded in two speaking samples. Two board-certified specialists in fluency evaluated the samples using the Stuttering Severity Instrument-4 and a checklist adapted for this study. Speakers rated their tension using the same forms, and then discussed their experiences in a qualitative interview so that themes related to physical tension could be identified.
Results:
The degree of tension reported by speakers was higher than that observed by specialists. Tension in parts of the body that were less visible to the observer (chest, abdomen, throat) was reported more by speakers than by specialists. The thematic analysis revealed that speakers' experience of tension changes over time and that these changes may be related to speakers' acceptance of stuttering.
Conclusion:
The lack of agreement between speaker and specialist perceptions of tension suggests that using self-reports is a necessary component for supporting the accurate diagnosis of tension in stuttering.
... Secondary behaviours are believed to occur with the desire to try to speak fluently, stop stuttering, reduce tension, and prevent listeners' negative reactions and time pressure (Bloodstein et al., 2021;Guitar, 2014;Tichenor et al., 2018). ...
... There are different approaches to the classification and definition of secondary behaviours in literature. Based on these approaches, secondary behaviours can be classified as avoidance, struggle and physical tension (Guitar, 2014;Tichenor et al., 2018;Werle et al., 2021). For example, if PWS cannot produce a word that they want to say or use a word with a similar meaning to compensate, this is an avoidance behaviour. ...
... The assessment of the frequency of certain secondary behaviours by SLPs can be difficult (Connery et al., 2020). For example, SLPs might encounter challenges in assessing secondary behaviours, including word avoidance and substitutions (Mirawdeli & Howell, 2016;Tichenor et al., 2018). ...
Background
Secondary behaviours, which encompass reactions developed due to an individual's fear and stress about stuttering, have the potential to exacerbate the condition. Therefore, self‐evaluation of secondary behaviours is significant in the multidimensional approach for people who stutter (PWS).
Aim
To determine the validity and reliability of the Revised Scale of Avoidance and Struggle Behaviours in Stuttering (r‐SASBS).
Methods & Procedures
The results of the item analysis and content validity of the Scale of Avoidance and Struggle Behaviours in Stuttering (SASBS), whose pilot study was completed, were reviewed and the number of items was reduced from 30 to 16. The r‐SASBS was administered to 440 participants (PWS = 365; people who did not stutter = 75). The content, construct, discriminant validity, internal consistency and test–retest reliability of the r‐SASBS were analysed.
Outcomes & Results
Content validity was analysed quantitatively based on expert opinions and was found to be high. The r‐SASBS had two factors based on exploratory factor analysis. The number of items was reduced to 14 using confirmatory factor analysis. With discriminant validity, it was found that the r‐SASBS could distinguish between the groups. The internal consistency and reliability of the test–retest scores were found to be high.
Conclusions & Implication
These findings indicated that the r‐SASBS is a reliable and valid scale for the self‐evaluation of secondary behaviours in PWS. Thus, it can be used by speech–language pathologists for the multidimensional assessment of stuttering. The validity and reliability of the r‐SASBS should be investigated in school‐aged children who stutter.
WHAT THIS PAPER ADDS
What is already known on this subject
Assessment of secondary behaviours in stuttering can be performed using objective and subjective tools. In this regard, a preliminary study was conducted to evaluate these behaviours, using the SASBS, which was developed based on interviews with PWS and a literature review. This study established the content and structural validity of the assessment and found it to have high internal consistency.
What this study adds to the existing knowledge
Although secondary behaviour assessments need to be comprehensive, it can be time‐consuming in busy clinical settings. Owing to the importance of self‐reported secondary behaviours in the assessment of stuttering and the reliability of information obtained from the client, there is a need for scales that can be administered quickly to assess the impact of secondary behaviours in PWS. This study examines the validity and reliability of the r‐SASBS.
What are the practical and clinical implications of this work?
The SASBS was reviewed in this study and the number of items was reduced. The r‐SASBS was administered to 440 participants. The validity of the r‐SASBS was determined based on its content, discriminant, and construct validity. The reliability of the r‐SASBS was determined using internal consistency and test–retest reliability. The results indicate that the r‐SASBS is a reliable and valid tool for self‐evaluating secondary behaviours in PWS. This could be a valuable measure of secondary behaviours in stuttering, which could improve treatment outcomes.
... We would agree with them (and Wingate, 2001, whose letter to the editor is titled "SLD Is Not Stuttering") that not all SLDs are moments of stuttering. We were faced with the need to balance the imprecision of listener perception of tension (Tichenor et al., 2017), with the fact that some nontense monosyllabic whole-word repetitions and part-word repetitions produced by CWS will probably not be true moments of stuttering. Given the discrepancies between speaker and expert observer ratings of tension (Tichenor et al., 2017), we chose to draw the line at classifying all part-word and monosyllabic whole-word repetitions as stuttering, in a decision we felt would increase reliability. ...
... We were faced with the need to balance the imprecision of listener perception of tension (Tichenor et al., 2017), with the fact that some nontense monosyllabic whole-word repetitions and part-word repetitions produced by CWS will probably not be true moments of stuttering. Given the discrepancies between speaker and expert observer ratings of tension (Tichenor et al., 2017), we chose to draw the line at classifying all part-word and monosyllabic whole-word repetitions as stuttering, in a decision we felt would increase reliability. However, requiring perceptible tension to classify a part-word or monosyllabic whole-word repetition as an SLD would be another reasonable approach in a study addressing the questions assessed in this study. ...
... Simple fluency or disfluency was used because it is unclear whether there are qualitative distinctions between TDs and the SLDs produced by CWNS that would make a meaningful difference in the outcomes of these models. In other words, hallmarks of stuttering are tension and a feeling of being "stuck" (Ambrose & Yairi, 1994;Tichenor et al., 2017;Tichenor & Yaruss, 2019). To our knowledge, there is no evidence that CWNS experience tension or a feeling of being stuck when producing behaviors coded as SLDs, and therefore, we chose not to separate SLDs and TDs in these analyses. ...
Purpose
Most therapy programs for young children who stutter (CWS) involve caregiver counseling and adjustment of caregiver behavior to maximize opportunities for the child to be more fluent. One component sometimes included as a recommended adjustment is a reduction in caregiver question asking, as question asking is hypothesized to increase language formulation demands on the child. However, there is limited research to guide clinician advisement to caregivers that has controlled for numerous potential confounding factors, including utterance length and grammaticality, that may impact potential stressors on children. Our aim was to assess whether there was an empirical basis for such recommendations by comparing disfluency profiles of answers to questions and nonanswer utterances produced by children during spontaneous play with parents and examiners.
Method
We analyzed fluency and structural properties as well as pragmatic function of 15,782 utterances from language samples produced by 32 CWS and 32 children who do not stutter (CWNS) who were between 28 and 50 months of age. CWS and CWNS were matched on gender and age within 4 months and were matched as closely as possible on maternal education.
Results
For utterances produced by CWS, answers to adult questions were significantly less likely to contain stuttering-like disfluencies than other utterance types, and this was still true after controlling for utterance length and grammaticality. In contrast, for utterances produced by CWNS, answers to questions were significantly more likely to be disfluent than other utterance types after controlling for length and grammaticality.
Conclusion
Given the current findings, some prior research, and the documented potential benefits in language development for adult question asking of children, we do not believe that clinicians need to recommend changes to typical question-asking behavior by caregivers of CWS.
... Behavioral reactions, which occur as a speaker attempts to regain control or maintain outwardly fluent speech, can take the form of commonly identified stuttering behaviors, such as repetitions, prolongations, and blocks (Perkins, 1990;Tichenor & Yaruss, 2018, 2019b. In particular, physical tension has been long described a common behavioral reaction (Snidecor, 1955;Tichenor et al., 2017). Behavioral reactions can also be seen in other ways. ...
... Experiencing societal judgments about stuttering can lead to personal reactions such as self-stigma, or the feeling that a person does not meet societal expectations (e.g., fluency) due to their own failings or limitations (Boyle, 2018). Feeling external speaking pressure may also cause a person to increase their physical tension when speaking, and this, in turn, can increase observable stuttering severity and overall difficulty with communicating (Tichenor et al., 2017;Tichenor & Yaruss, 2018). Thus, the environmental context has a significant effect on a person's overall experience of stuttering. ...
... Although such classifications are widely used, numerous authors have highlighted various challenges with listener-based assessment of stuttering in both research and clinical contexts. These include the variability of the observable behavior (Constantino et al., 2016;Tichenor & Yaruss, 2020b), as well as poor reliability and questionable validity of listener judgments (see the studies by Brundage et al., 2006;Cordes & Ingham, 1994Hall et al., 1987;Kully & Boberg, 1988;Martin & Haroldson, 1992;Tichenor et al., 2017). These concerns raise the possibility that the underlying assumption-that the moment of stuttering can be accurately defined on the basis of what a listener sees or hears-may not be valid. ...
This article highlights the value for speech–language pathologists of considering the overall stuttering condition—including speakers' experiences during and around moments of stuttering—in treatment with individuals who stutter. We first highlight a framework for conceptualizing the entirety of the stuttering condition. We then present recent research and clinical perspectives about stuttering to support the claim that speech–language pathologists who account for individual differences in how their clients experience stuttering are better positioned to treat stuttering more effectively. Ultimately, this will yield better treatment outcomes and help clinicians achieve greater gains in quality of life for their clients who stutter.
... A growing number of research papers and popular press books have highlighted and given voice to people's experience of living with stuttering (Ahlbach & Benson, 1994;Blood et al., 2011;Boyle, 2017Boyle, , 2018Constantino, 2018;De Nardo, Gabel, Tetnowski, & Swartz, 2016;Jackson, Yaruss, Quesal, Terranova, & Whalen, 2015;Plexico, Manning, & Levitt, 2009a, 2009bPreston, 2013;St. Louis, 2001;Tetnowski & Damico, 2001;Tichenor, Leslie, Shaiman, & Yaruss, 2017;Tichenor & Yaruss, 2018;Yaruss & Quesal, 2004;Yaruss, Quesal, & Murphy, 2002;. For example, research has shown that so-called "covert" behaviors (Constantino, Manning, & Nordstrom, 2017;Douglass, Schwab, & Alvarado, 2018;Murphy, Quesal, & Gulker, 2007) and anticipation (Arenas & Zebrowski, 2017;Brocklehurst, Lickley, & Corley, 2012;Garcia-Barrera & Davidow, 2015;Jackson et al., 2015) are relatively common across the population of people who stutter. ...
... In order to gather information about how people who stutter experience the moment of stuttering, a questionnaire was developed based on the findings from prior studies examining key aspects of the experience of stuttering, including anticipation (Brocklehurst, Lickley, & Corley, 2013;Garcia-Barrera & Davidow, 2015;Jackson et al., 2015); variability (Constantino et al., 2016); physical tension/ other so-called secondary behaviors (Tichenor et al., 2017); the overall experience of stuttering (Tichenor & Yaruss, 2018;Yaruss & Quesal, 2006;Yaruss, Quesal, Reeves, et al., 2002), including behaviors exhibited during moments of both stuttered and fluent speech; and cognitive-affective experiences (e.g., Yaruss & Quesal, 2004). The larger survey addressed many topics related to the overall experience of stuttering; the present report focuses on stuttering behaviors as well as related thoughts and feelings; other findings from the survey are not presented in this article. ...
... Typical assessments of stuttering behaviors, such as those included in the Stuttering Severity Instrument-Fourth Edition (Riley, 2009), include clinician observations of the percent of syllables stuttered, the duration of the longest stuttering events, and the presence of physical concomitants (e.g., tension and struggle). Research has already shown that speakers experience-and are aware of-physical tension that even expert clinicians cannot observe (Tichenor et al., 2017). Data from this study further highlight the importance of self-reports of less observable aspects of the experience of stuttering, such as remaining silent, removing themselves from a situation, or letting someone else speak for them. ...
Purpose
This study explored group experiences and individual differences in the behaviors, thoughts, and feelings perceived by adults who stutter. Respondents' goals when speaking and prior participation in self-help/support groups were used to predict individual differences in reported behaviors, thoughts, and feelings.
Method
In this study, 502 adults who stutter completed a survey examining their behaviors, thoughts, and feelings in and around moments of stuttering. Data were analyzed to determine distributions of group and individual experiences.
Results
Speakers reported experiencing a wide range of both overt behaviors (e.g., repetitions) and covert behaviors (e.g., remaining silent, choosing not to speak). Having the goal of not stuttering when speaking was significantly associated with more covert behaviors and more negative cognitive and affective states, whereas a history of self-help/support group participation was significantly associated with a decreased probability of these behaviors and states.
Conclusion
Data from this survey suggest that participating in self-help/support groups and having a goal of communicating freely (as opposed to trying not to stutter) are associated with less negative life outcomes due to stuttering. Results further indicate that the behaviors, thoughts, and experiences most commonly reported by speakers may not be those that are most readily observed by listeners.
... For example, the behavioral reactions associated with stuttering include more commonly observed stuttering behaviors, such as repetitions, prolongations, or blocks, as well as the more difficult-to-observe behaviors related to physical tension, struggle, or avoidance (Constantino et al., • 2017;B. Murphy, Quesal, et al., 2007;Tichenor et al., 2017;Tichenor & Yaruss, 2019a). Many people who stutter also experience negative feelings, including guilt, shame, embarrassment, anger, resentment, hopelessness, and fear (Beilby, 2014;Brundage et al., 2017;Corcoran & Stewart, 1998;Daniels & Gabel, 2004;Sheehan, 1953Sheehan, , 1970Tichenor & Yaruss, 2018;Van Riper, 1982;Yaruss & Quesal, 2006). ...
Purpose:
Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.
Method:
One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.
Results:
Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.
Conclusions:
Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.
Supplemental material:
https://doi.org/10.23641/asha.23699688.
... WFRs also lack the visible muscle tension (Eichorn & Donnan, 2021;Brejon Teitler et al., 2016;Evans & Owens, 2019;McAllister & Kingston, 2005) that is apparent in stuttering (Gilman & Yaruss, 2000;Tichenor, Leslie, Shaiman, & Yaruss, 2018). Further, several contextual variables that are known to impact the rate of stuttering have been assessed in Word-Final Repetitions individual speakers who produce WFRs and have generally not reduced WFR production. ...
Purpose: We aim to provide a tutorial describing how atypical disfluencies can be assessed from a psycholinguistic perspective. We specifically focus on word-final repetitions (WFRs), e.g., “school-ool”. Methods: We identify the type of data that can be used to assess whether WFRs arise from difficulty at each stage of the word production process. WFRs produced by an adolescent with autism spectrum disorder are used to assess difficulty at each of these stages. Results: WFRs tended to occur on content rather than function words, and the portion repeated seemed to be driven by the syllabic rather than morphological structure. The pause time between the end of a WFR-containing word and the beginning of the repetition (e.g., between “school” and “ool”) was at least 298 ms. In contrast, there was only an audible pause between the repetition and the next word 42% of the time; the other 58% of the time, the repetition led directly into the next word. WFRs also tended to occur in longer utterances and in utterance-medial and -final positions. Conclusion: Our analysis suggested that the best candidates for loci where the production process breaks down to cause WFRs are (a) external channel monitoring of WFR words, which is consistent with the long pauses that occurred between the WFR word and the repetition, or (b) syntactic planning, which is supported by the occurrence of WFRs away from utterance-initial words and in longer utterances. We discuss the limitations of data collected through language sampling and make suggestions for future research.
... Repeatedly experiencing difficulty speaking (Perkins, 1990;Tichenor & Yaruss, 2019b) is, for many people, associated with the development of fear, shame, embarrassment, and other negative reactions concerning speech or communication. These feelings become habitual, anticipated, and reinforced by repeated speech difficulties, and, as a result, a person may learn to avoid, push, or struggle in an attempt to cope with the sensation (or anticipation) of being stuck or unable to communicate as they wish (Constantino et al., 2017;Jackson et al., 2015;Tichenor et al., 2017;Tichenor & Yaruss, 2018). Thus, these forms of adverse impact related to stuttering can meaningfully be viewed as resulting from nonoptimal forms of ER. ...
Purpose:
This study evaluated the relationship between emotional regulation (ER) and adverse impact related to stuttering across the developmental spectrum, in preschool and school-age children, adolescents, and adults who stutter. An additional aim examined how these variables relate to the ways that individuals approach speaking (i.e., their agreement on whether their goal is to speak fluently).
Method:
Participants were the parents of 60 preschoolers and younger school-age children (ages 3-9 years), 95 school-age children and adolescents who stutter (ages 7-18 years), and 180 adults who stutter (ages 18-81 years). All participants completed surveys with age-appropriate measures examining ER and the adverse impact of stuttering. Older children and adults who stutter also answered questions regarding their goals when speaking. Multiple regression and ordinal logistic regression were used to examine relationships among ER, adverse impact related to stuttering, and goal when speaking.
Results:
In preschool children, adverse impact was significantly predicted by a parent-reported measure of ER skills; in school-age children and adults, adverse impact was significantly predicted by measures of the ER strategies cognitive reappraisal (CR) and expressive suppression. Less frequent use of CR by adults was significantly associated with an increased likelihood of having "not stuttering" as a goal when speaking. Differences in the significance and magnitude of these relationships were found across the life span.
Discussion:
For both children and adults who stutter, ER is a significant factor related to the adverse impact of stuttering; the relationship between ER and adverse impact may change over development. Accounting for individual differences in ER can improve understanding of why a person copes with stuttering in the ways they do, and this has notable implications for individualizing intervention for both children and adults who stutter.
Supplemental material:
https://doi.org/10.23641/asha.20044469.
... In recent years, the fervor with which investigators have sought to describe stuttering from a first-person point of view has popularized the application of phenomenological research methodologies. This variant of qualitative inquiry has allowed researchers to gain an enhanced understanding of the many ways that PWS interact with, navigate, and describe a diverse range of both objective and subjective manifestations of stuttering (Beilby, Byrnes, Meagher, & Yaruss, 2013;Bricker-Katz, Lincoln, & Cumming, 2013;Constantino, Manning, & Nordstrom, 2017;Hughes, Gabel, Irani, & Schlagheck, 2010;Jackson, Yaruss, Quesal, Terranova, & Whalen, 2015;Plexico & Burrus, 2012;Tichenor, Leslie, Shaiman, & Yaruss, 2017;Tichenor & Yaruss, 2018, 2019a, 2019b. A prime example of how phenomenology can bring speaker-oriented insights to light comes from a series of investigations conducted by Tichenor and Yaruss (2018, 2019a, 2019b, which pursued the operationalization of a definition of stuttering created by PWS. ...
Stuttering is a neurologically based speech impairment often defined by listener-oriented parameters (i.e., its overt characteristics). These fail to encompass contextual variability and anticipation, two facets of the speaker’s experience which, though frequently encountered by people who stutter (PWS), remain poorly understood and largely under-researched. To better understand the subjective underpinnings of these phenomena, as well as how PWS conceptualize and relate to their stuttering, the present study sought to explore a) the experiences of PWS with the unpredictable and/or variable nature of their stuttering, as well as their beliefs surrounding potential contributors to its variability; b) the experiences of PWS with anticipation, and whether they believe that anticipation has a role in the variability of their stuttering across contexts; and c) the ways in which experiences of contextual variability and/or the anticipation of stuttering may impact levels of self-acceptance, quality of life, and life satisfaction of PWS.
... Stuttering is characterized by atypical blocks, repetitions, and prolongations during speech production. These primary symptoms are often accompanied by secondary non-speech behaviors (e.g., eye blinks, open jaw, pursed lips, neck tension, word and situation avoidance, circumlocution; Bloodstein & Bernstein Ratner, 2008;Tichenor et al., 2017). Listeners often associate these primary and secondary characteristics, and by extension people who stutter/stutterers (PWS/S) 1 , with negative personality traits such as anxious, shy, fearful, unintelligentreferred to collectively as the stuttering stereotype (e.g., Craig et al. 2009;Doody et al., 1993;Klassen, 2001). ...
Background: Microaggressions are subtle insults, invalidations, or slights that target people due to their association with a marginalized group. Microaggressive experiences have been shown to degrade quality of life and corroborate negative stereotypes towards persons with disabilities. To date, minimal research has been dedicated to exploring microaggressions within adults who stutter.
Methods: Seven adults who stutter participated in semi-structured focus group interviews similar to Keller and Galgay's (2010) qualitative investigation of microaggressions experienced by adults with a disability. Group interviews were transcribed and analyzed using QSR NVivo software to develop themes and subthemes.
Results: Eight major themes were identified within two supraordinate themes: Microaggressive Behavior (patronization, second-class status, perceived helplessness, workplace microaggression, clinical microaggression, denial of privacy) and Perception of Microaggressive Behavior (exoneration of listener, no or minimal microaggressive experience). Although patronization, second-class status, and helplessness were mentioned frequently by multiple participants, exoneration of the listener was the most frequently recurring theme.
Discussion: Based on these preliminary focus group interviews, stuttering-based microaggressions broadly resemble ableist microaggressions reported by Keller and Galgay (2010). Interviewees also expressed a reluctance to identify slights related to stuttering as microaggression and often characterized these incidents as unavoidable.
... More internalized and covert behaviors (e.g., the amount of physical tension experienced with stuttering or when not stuttering, and avoiding sounds, words, or situations) were reported as more variable than cognitiveaffective experiences (e.g., sense of self and negative thoughts). These findings indicate that internalized reactions or covert behaviors (Constantino et al., 2017;Douglass & Quarrington, 1952;Murphy et al., 2007;Tichenor et al., 2017;Tichenor & Yaruss, 2019a) should be assessed and addressed at various time points and in different situations, just as overt behaviors should be (Costello & Ingham, 1984). By not assessing covert features in this manner, a clinician may misunderstand a person's underlying experience of stuttering, underestimate the impact of stuttering on the speaker's life, and potentially, though unintentionally, limit progress in therapy. ...
Purpose
It has long been known that stuttering behaviors vary across time and situation. Preliminary evidence suggests that this variability negatively affects people who stutter and that stuttering behaviors are more variable than adverse impact associated with stuttering. More information is needed to determine how variability affects people who stutter and what the clinical and research implications of variability may be.
Method
Two hundred and four adults who stutter participated in a mixed-methods study exploring (a) how variability of stuttering affects people who stutter in comparison to other aspects of the condition and (b) which aspects of the overall experience of stuttering are variable.
Results
Analyses indicated that variability is very commonly experienced by people who stutter and that it is among the most frustrating aspects of the condition. Qualitative analyses revealed that variability is experienced in all aspects of the stuttering condition, including the observable behavior other affective, behavioral, and cognitive reactions; and the adverse impact of stuttering. Notable individual differences were found in terms of which specific aspects of the condition were more variable for different respondents. Overall, analyses revealed that the variability of different aspects of stuttering can be viewed in a hierarchy from most variable to least variable: more external aspects (e.g., frequency, duration), more internal aspects (e.g., covert behaviors, physical tension), and cognitive–affective experiences (e.g., negative thoughts, feelings, and self-image).
Discussion
These findings suggest that variability is a common and burdensome aspect of the experience of stuttering and underscore the importance of considering variability in stuttering behavior, reactions, and impact in research, assessment, and treatment for adults who stutter.
... In most qualitative research, representational counting of how often a theme or subtheme occurs is avoided because the frequency of a theme does not directly relate to the importance of the theme (for a discussion, see Sandelowski, 2001). This approach to qualitative research follows similar and recent qualitative work exploring various aspects of stuttering (see Jackson et al., 2015;Plexico et al., 2010;Tichenor et al., 2017;Tichenor & Yaruss, 2018, 2019b. ...
Purpose
Recovery and relapse relating to stuttering are often defined in terms of the presence or absence of certain types of speech disfluencies as observed by clinicians and researchers. However, it is well documented that the experience of the overall stuttering condition involves more than just the production of stuttered speech disfluencies. This study sought to identify what recovery and relapse mean to people who stutter based on their own unique experiences to account for both the stuttering behaviors and the broader adverse impact of the condition.
Method
In this study, 228 adults who stutter participated in a mixed-methods exploration of the terms “recovery” and “relapse.” Participants categorized themselves on whether they considered themselves to have recovered or experienced relapse. Data were analyzed thematically through the lens of the speaker self-categorizations to determine how adults who stutter define recovery and relapse regarding stuttering.
Results
Results indicate that, to adults who stutter, recovery from stuttering is associated with increases in positive affective/emotional, behavioral, and cognitive reactions to the condition and simultaneous decreases in associated negative constructs. These group-level definitions did not change as a function of whether respondents reported that they had experienced recovery or relapse themselves.
Discussion
Recovery or relapse from stuttering behaviors can occur independently from recovery or relapse from the broader adverse impact related to the condition, suggesting that researchers and clinicians should consider recovery and relapse as involving more than just a reduction or an increase in observable behaviors. These findings support recent research evidence further specifying the many individual phenotypes of stuttering, in that pathways to recovery and relapse can be experienced in different ways for people with different stuttering phenotype profiles.
... Note that this also appears to be true for other aspects of the condition, such as physical tension or struggle behavior. For example, research evidence shows that people who stutter report experiencing more locations and greater degrees of physical tension in parts of the body that expert observers cannot perceive (Tichenor, Leslie, Shaiman, & Yaruss, 2017). Thus, even aspects of the stuttering behavior that are widely accepted to be "part of the moment of stuttering" are not fully accessible to observers. ...
Purpose
Numerous frameworks and definitions have sought to differentiate what behaviors and experiences should be considered as a part of stuttering. Nearly all of these efforts have been based on the perspectives and beliefs of conversational partners and listeners. This outside-in approach to defining stuttering lacks validation from people who live with the condition.
Method
In this study, 430 adults who stutter participated in a qualitative exploration of the term stuttering . Data were analyzed thematically to determine speakers' perspectives about moment of stuttering and the overall experience of stuttering in their lives.
Results
To adults who stutter, the term stuttering signifies a constellation of experiences beyond the observable speech disfluency behaviors that are typically defined as stuttering by listeners. Participants reported that the moment of stuttering often begins with a sensation of anticipation, feeling stuck, or losing control. This sensation may lead speakers to react in various ways, including affective, behavioral, and cognitive reactions that can become deeply ingrained as people deal with difficulties in saying what they want to say. These reactions can be associated with adverse impact on people's lives. This interrelated chain of events can be exacerbated by outside environmental factors, such as the reactions of listeners.
Discussion
Data from this survey provide novel evidence regarding what stuttering means to adults who stutter. These data are used to update the adaptation of the World Health Organization's International Classification of Functioning, Disability and Health as it applies to stuttering ( Yaruss & Quesal, 2004 ) to better account for the complex and individualized phenotype of stuttering and to develop a definition of the experience of stuttering that is based not only on the observations of listeners but also on the impact of stuttering on the lives of adults who stutter.
... From the perspective of the speaker, these disfluencies involve a moment when the speaker knows what to say but, for some reason, is unable to say it (Perkins, 1990). In part because of that sensation of being unable to continue speaking, people who stutter may also exhibit 'secondary characteristics', such as physical tension and struggle behaviours (Tichenor et al., 2018). Examples include eye blinks, head turns, increased tension in the speech musculature and even movements of the extremities, as the person seeks to break out of the moment of stuttering and continue speaking. ...
Stuttering is a communication disorder that involves disruptions in a person's ability to produce speech fluently. In many cases, stuttering results in adverse impact on the person's communication and overall quality of life. The most common type of stuttering, childhood‐onset fluency disorder, typically starts during the preschool years. It is a genetically influenced condition associated with differences in neurological structure and function. It is believed to be due to a complex interaction involving several key aspects of a child's development. Many children go through a period of stuttering when they are very young, but the majority recover, even without intervention. Early intervention can increase the rate of recovery in young children. Individuals who do not recover in early childhood are likely to continue stuttering throughout their lives, though speech therapy and support experiences can help people enhance their fluency and reduce the adverse impact of the disorder.
Key Concepts
• Stuttering is a communication disorder that involves both disruptions in speech fluency and adverse impact on quality of life.
• Stuttering is associated with neurological differences; stuttering is not just a habit or behaviour that one learns.
• Stuttering behaviours are highly variable across situations and over time.
• Early intervention can help to hasten recovery in young children.
• There is no known cure for stuttering in school‐age children, adolescents and adults, though treatment and support experiences can help speakers improve their speech fluency and reduce the adverse impact of the disorder.
• Speech‐language pathologists should address more than just observable speech behaviours in treatment with individuals who stutter.
... (Yairi, 2013, pp. 295-296) The anecdotal reports of those who stutter challenges this thinking, for it appears that there are aspects about moments of stuttering for speakers that are not adequately captured by the perceptions of listeners (Jackson et al., 2015;Riley, Riley, & Maguire, 2004;Tichenor, Leslie, Shaiman, & Yaruss, 2017). ...
Purpose:
Stuttering behaviors and moments of stuttering are typically defined by what a listener perceives. This study evaluated participants' perceptions of their own experience of moments of stuttering.
Method:
Thirteen adults who stutter participated in a phenomenological qualitative study examining their experience of moments of stuttering. Analysis yielded several common themes and subthemes culminating in an essential structure describing the shared experience.
Results:
Speakers experience anticipation and react in action and nonaction ways. Many speakers experience a loss of control that relates to a lack of a well-formed speech plan or agency. The experience of moments of stuttering changes through therapy, over time, with self-help, and across situations. Many speakers experience so-called typical stuttering behaviors as reactions rather than direct consequences of trying to speak. Interactions with listeners can affect the experience of stuttering.
Conclusion:
Although research recognizes that the experience of the stuttering disorder involves more than just speech behaviors, people who stutter experience stuttering behaviors in time as involving more than just the disruption in speech. This finding has implications for both the theoretical understanding of stuttering and the clinical evaluation and treatment of the stuttering disorder.
... By reducing the perceived severity of stuttering from a speaker's standpoint, we may also be able to eventually improve an individual's self-perception as severity is directly correlated with self-perception. In a study by Snidecor (1955; as cited in Tichenor & Yaruss, 2013), the investigators found that the most commonly reported areas of the body where tension was present were the jaw, front of the tongue, front of the throat, inside or back of the throat, chest, and abdomen. The yoga postures selected for our study were tailored to target these areas of the musculature and to improve respiratory function in coordination with speech production. ...
Purpose: This pilot study investigated the effects of a modified Vinyasa yoga breathing program on the fluency skills and self-perception of 4 adults who stutter. The Valsalva hypothesis posits that stuttering is caused by a discoordination between the respiratory and laryngeal mechanisms; therefore, a modified yoga breathing program could be a complementary addition to traditional fluency treatment. tuttering is a complex disorder that can have detrimental effects on an individual's physical and emotional states, impacting Results: Each participant showed an overall decrease in the number of dysfluencies and accessory behaviors. There were no reported changes in the par-ticipants' self-perception of their stuttering. Several participants reported an increased awareness of their breathing following the yoga program. Conclusions: A modified yoga breathing program can potentially positively impact the fluency skills and decrease the core and accessory behaviors of adults who stutter. Further research is required to examine the long-term effects of such a program with adults who stutter.
... Therefore, some of the variability in SSI-4 score was simply due to variability in %SS. Still, the SSI-4 total overall score includes more than just the frequency of stuttered disfluencies, and the consistency of other aspects of the SSI-4 have also been questioned (Hall, Lynn, Altieri, Segers, & Conti, 1987;Lewis, 1994Lewis, , 1995Tichenor, Leslie, & Yaruss, 2015). Thus, the variability observed in the SSI-4 scores in the present study cannot be completely accounted for by differences in %SS. ...
Purpose:
Variability in frequency of stuttering has made the results of treatment outcome studies difficult to interpret. Many factors that affect variability have been investigated; yet the typical range of variability experienced by speakers remains unknown. This study examined the day-to-day variability in the percentage of syllables containing stuttered and nonstuttered disfluencies in the speech of six adult speakers in three spontaneous speaking situations and two reading tasks.
Methods:
The frequency of moments stuttering during the tasks were compared within and between speakers and days to document the degree of variability in stuttering frequency and explore whether there were any consistent patterns. The Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A) were also tested for day-to-day variability. Correlations between frequency, severity, and life impact were made.
Results:
The primary result of this study was the large range over which frequency of stuttering varied from day to day for the same individual. This variability did not correlate with any measures of stuttering severity but did correlate with life impact as measured by the OASES-A. No global pattern was detected in variability from day to day within or between participants. However, there were significantly more nonstuttered disfluencies present during the spontaneous speaking tasks than during the reading tasks. The day-to-day variability in the life impact of the disorder (OASES-A) was less than the day-to-day variability in observable stuttering behavior (percentage of syllables stuttered and SSI-4).
Conclusion:
Frequency of stuttering varies significantly from situation to situation and day to day, with observed variability exceeding the degree of change often reported in treatment outcomes studies from before to after treatment. This variability must be accounted for in future clinical and scientific work.
Purpose:
Disfluencies can be classified as stuttering-like disfluencies (SLDs) or typical disfluencies (TDs). Dividing TDs further, stalls (fillers and repetitions) are thought to be prospective, occurring due to planning glitches, and revisions (word and phrase revisions, word fragments) are thought to be retrospective, occurring when a speaker corrects language produced in error. In the first study assessing stalls, revisions, and SLDs in matched groups of children who stutter (CWS) and children who do not stutter (CWNS), we hypothesized that SLDs and stalls would increase with utterance length and grammaticality but not with a child's expressive language level. We expected revisions to be associated with a child having more advanced language but not with utterance length or grammaticality. We hypothesized that SLDs and stalls (thought to be planning-related) would tend to precede grammatical errors.
Method:
We analyzed 15,782 utterances from 32 preschool-age CWS and 32 matched CWNS to assess these predictions.
Results:
Stalls and revisions increased in ungrammatical and longer utterances and with the child's language level. SLDs increased in ungrammatical and longer utterances, but not with overall language level. SLDs and stalls tended to occur before grammatical errors.
Conclusions:
Results suggest that both stalls and revisions are more likely to occur in utterances that are harder to plan (those that are ungrammatical and/or longer) and that, as children's language develops, so do the skills they need to produce both stalls and revisions. We discuss clinical implications of the finding that ungrammatical utterances are more likely to be stuttered.
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.
Background:
Despite the importance of delivering speech and language therapy services to children who stutter (CWS), there are barriers to accessing speech and language therapy. One way to improve access for those who may otherwise be deprived of speech and language therapy services, including CWS, is through telepractice (TP). However, there is currently no evidence as to the viability of TP stuttering assessments for CWS.
Aim:
To investigate the validity and reliability, and acceptability of using a TP application to assess overt stuttering behaviour children aged 6-15 years.
Methods & procedure:
A total of 30 CWS, aged between 6 and 15 years, were recruited from a speech therapy clinic in King Abdulaziz University Hospital in Riyadh, Saudi Arabia. Children were divided into two testing conditions, either face-to-face (f2f)-led or TP-led testing, and the Stuttering Severity Instrument (SSI-IV) was administered, percentage of syllables stuttered (%SS) was calculated, and severity ratings (SR) assigned, either via f2f or via TP using two laptops with webcams, video conference software and a broadband internet connection. Agreement and reliability of scoring in the two testing conditions were reported in addition to findings from questionnaires exploring children's and their caregivers' perceptions both before and immediately after the TP assessment was carried out.
Outcome & results:
A total of 30 sessions were successfully carried out, with results revealing unsatisfactory levels of agreement when applying the Bland and Altman method. However, when discrepancies were found, these were comparable with those from traditional f2f studies. Generally, parents and children exhibited high levels of satisfaction and held a positive view regarding TP pre- and post-assessment.
Conclusions & implications:
The results of the study suggest that conducting an overt stuttering assessment via TP for 6-15-year-olds CWS is reliable and valid. Although the TP model posed some (mainly technical) challenges for executing the assessment, high levels of satisfaction were recorded by parents and children alike. The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS. These results are preliminary, but they can be seen as a building block for future research in TP assessment studies for CWS.
What this paper adds:
What is already known on the subject Stuttering treatment via TP has been proven to be feasible and successful across a variety of treatment programs (e.g., Lidcombe, Camperdown). However, the viability of assessing stuttering via videoconferencing has never been explored in children. What this paper adds to existing knowledge Preliminary support for the assessment of overt stuttering in CWS aged 6-15 years via video conferencing. The results justify larger scale studies of this service delivery method. What are the potential or actual clinical implications of this work? The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS aged 6-15 years.
Stuttering is a widespread speech disorder involving about the of the population and the of children under the age of 5. Much work in literature studies causes, mechanisms and epidemiology and much work is devoted to illustrate treatments, prognosis and how to diagnose stutter. Relevantly, a stuttering evaluation requires the skills of a multi-dimensional team. An expert speech-language therapist conduct a precise evaluation with a series of tests, observations, and interviews. During an evaluation, a speech language therapist perceive, record and transcribe the number and types of speech disfluencies that a person produces in different situations. Stuttering is very variable in the number of repeated syllables/words and in the secondary aspects that alter the clinical picture. This work wants to help in the difficult task of evaluating the stuttering and recognize the occurrencies of disfluency episodes like repetitions and prolongations of sounds, syllables, words or phrases silent pauses, hesitations or blocks before speech. In particular, we propose a deep-learning based approach able at automatically detecting difluent production point in the speech helping in early classification of the problems providing the number of disfluencies and time intervals where the disfluencies occur. A deep learner is built to preliminarily valuate audio fragments. However, the scenario at hand contains some peculiarities making the detection challenging. Indeed, (i) fragments too short lead to uneffective classification since a too short audio fragment is not able to capture the stuttering episode; and (ii) fragments too long lead to uneffective classification since stuttering episode can have a very small duration and, then, the much fluent speaking contained in the fragment masks the disfluence. So, we design an ad-hoc segment classifier that, exploiting the output of a deep learner working with non too short fragments, classifies each small segment composing an audio fragment by estimating the probability of containing a disfluence.
Two stuttering measurement training programs currently used for training clinicians were evaluated for their efficacy in improving the accuracy of total stuttering event counting.
Four groups, each with 12 randomly allocated participants, completed a pretest-posttest design training study. They were evaluated by their counts of stuttering events on eight 3-min audio-visual speech samples from adults and children who stutter. Stuttering judgment training involved use of either the Stuttering Measurement System (SMS), Stuttering Measurement Assessment and Training (SMAAT) programs, or no training. To test for the reliability of any training effect, SMS training was repeated with the fourth group.
Both SMS-trained groups produced approximately 34% improvement, significantly better than no training or the SMAAT program. The SMAAT program produced a mixed result.
The SMS program was shown to produce a "medium" effect size improvement in the accuracy of stuttering event counts and that this improvement was almost perfectly replicated in a second group. Half of the SMAAT judges produced a 36% improvement in accuracy, but the other half showed no improvement. While additional studies are needed to demonstrate the durability of the reported improvements, these positive effects justify the importance of stuttering measurement training.
To investigate the effects of 4 fluency-inducing (FI) conditions on self-rated speech effort and other variables in adults who stutter and in normally fluent controls.
Twelve adults with persistent stuttering and 12 adults who had never stuttered each completed 4 ABA-format experiments. During A phases, participants read aloud normally. During each B phase, they read aloud in 1 of 4 FI conditions: auditory masking, chorus reading, whispering, and rhythmic speech. Dependent variables included self-judged speech effort and observer-judged stuttering frequency, speech rate, and speech naturalness.
For the persons who stuttered, FI conditions reduced stuttering and speech effort, but only for chorus reading were these improvements obtained without diminishing speech naturalness or speaking rate. By contrast, speech effort increased during all FI conditions for adults who did not stutter.
Self-rated speech effort differentiated the effects of 4 FI conditions on speech performance for adults who stuttered, with chorus reading best approximating normally fluent speech. More generally, self-ratings of speech effort appeared to constitute an independent, reliable, and validly interpretable dimension of fluency that may be useful in the measurement and treatment of stuttering.
The goal of the present experiment was to determine if stuttering is associated with unusually high levels of activity in laryngeal muscles. Qualitative and quantitative analyses of thyroarytenoid and cricothyroid recordings from 4 stuttering and 3 nonstuttering adults revealed the following: Compared to periods of fluent speech, intervals of disfluent speech are not typically characterized by higher levels of activity in these muscles; and when EMG levels during conversational speech are compared to maximal activation levels for these muscles (e.g., those observed during singing and the Valsalva maneuver), normally fluent adults show robust and sometimes near maximal recruitment during conversational speech. The adults who stutter had a lower operating range for these muscles during conversational speech, and their disfluencies did not produce relatively high activation levels. In summary, the present data require us to reject the claim that adults with a history of chronic stuttering routinely produce excessive levels of intrinsic laryngeal muscle activity. These results suggest that the use of botulinum toxin injections into the vocal folds to treat stuttering should be questioned.
The purpose of this study was to determine whether accuracy training for interval judgments of stuttering might generalize to increased accuracy and/or interjudge agreement for intervals other than those used during training. Ten upper-division speech-language pathology students judged 5-s audiovisually recorded speech intervals as stuttered or nonstuttered in a series of group and single-subject experiments. Judgment accuracy was determined with respect to judgments provided previously by 10 recognized authorities on stuttering and its treatment. Training occurred within single-subject experiments that used multiple baselines across speakers and repeated generalization probes to assess training effects. Results showed that judgment accuracy tended to increase after training for speakers used during the training process as well as for unfamiliar speakers. Results also replicated previous findings of slight increases in interjudge and intrajudge agreement after interval-judgment training. The implications of these results for developing a valid and reliable stuttering measurement system are discussed.
The purpose of this study was to investigate whether a previously developed interval-based training program could improve judges' stuttering event judgments. Two groups of judges made real-time stuttering event judgments (computer-mouse button presses) in 3 to 6 trials before the response-contingent judgment training program and in another 3 to 6 trials after training, for recordings of 9 adults who stuttered. Their judgments were analyzed in terms of number of stuttering events, duration of stuttering, and 5-s intervals of speech that could be categorized as judged (or not judged) to contain stuttering. Results showed (a) changes in the amount of stuttering identified by the judges; (b) improved correspondence between the judges' identifications of stuttering events and interval-based standards previously developed from judgments made by experienced, authoritative judges; (c) improved correspondence between interval-based analyses of the judges' stuttering judgments and the previously developed standards; (d) improved intrajudge agreement; (e) improved interjudge agreement; and (f) convergence between the 2 judge groups, for samples and speakers used during training tasks and also for other speakers. Some implications of these findings for developing standardized procedures for the real-time measurement of stuttering are discussed.
This experiment was designed under the general hypothesis that stuttering is reduced most rapidly under conditions which permit least reinforcement of the stuttering response and most reinforcement of the normal speech attempt." 20 adult stutterers served as their own controls in the experiment. "The non-reinforcement technique was held to be more effective in reducing total stuttering behavior because it substituted the normal speaking of the word for the stuttering response at the point of reinforcement." Theoretical implications of the study are discussed. 17 references.
The purpose of this study was to investigate chorus reading's (CR's) effect on speech effort during oral reading by adult stuttering speakers and control participants. The effect of a speech effort measurement highlighting strategy was also investigated.
Twelve persistent stuttering (PS) adults and 12 normally fluent control participants completed 1-min base rate readings (BR-nonchorus) and CRs within a BR/CR/BR/CR/BR experimental design. Participants self-rated speech effort using a 9-point scale after each reading trial. Stuttering frequency, speech rate, and speech naturalness measures were also obtained. Instructions highlighting speech effort ratings during BR and CR phases were introduced after the first CR.
CR improved speech effort ratings for the PS group, but the control group showed a reverse trend. Both groups' effort ratings were not significantly different during CR phases but were significantly poorer than the control group's effort ratings during BR phases. The highlighting strategy did not significantly change effort ratings.
The findings show that CR will produce not only stutter-free and natural sounding speech but also reliable reductions in speech effort. However, these reductions do not reach effort levels equivalent to those achieved by normally fluent speakers, thereby conditioning its use as a gold standard of achievable normal fluency by PS speakers.
Purpose:
Variability in frequency of stuttering has made the results of treatment outcome studies difficult to interpret. Many factors that affect variability have been investigated; yet the typical range of variability experienced by speakers remains unknown. This study examined the day-to-day variability in the percentage of syllables containing stuttered and nonstuttered disfluencies in the speech of six adult speakers in three spontaneous speaking situations and two reading tasks.
Methods:
The frequency of moments stuttering during the tasks were compared within and between speakers and days to document the degree of variability in stuttering frequency and explore whether there were any consistent patterns. The Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A) were also tested for day-to-day variability. Correlations between frequency, severity, and life impact were made.
Results:
The primary result of this study was the large range over which frequency of stuttering varied from day to day for the same individual. This variability did not correlate with any measures of stuttering severity but did correlate with life impact as measured by the OASES-A. No global pattern was detected in variability from day to day within or between participants. However, there were significantly more nonstuttered disfluencies present during the spontaneous speaking tasks than during the reading tasks. The day-to-day variability in the life impact of the disorder (OASES-A) was less than the day-to-day variability in observable stuttering behavior (percentage of syllables stuttered and SSI-4).
Conclusion:
Frequency of stuttering varies significantly from situation to situation and day to day, with observed variability exceeding the degree of change often reported in treatment outcomes studies from before to after treatment. This variability must be accounted for in future clinical and scientific work.
An examination of the extent to which SSI-3 scores accurately reflect judges' observations of stuttering behaviors was conducted. A preliminary study was performed in order to achieve comparability with the SSI-3 procedure in terms of speech samples, data collection, SSI-3 scores, and reliability procedures and results. Subsequent to successful replication of those methods and results, the relationships of judges' counts/ratings of stuttering frequency, duration, and physical concomitant behaviors to the corresponding SSI-3 scores were examined. Obtained SSI-3 scores obscured the wide range of judges' raw counts and ratings of stuttering behaviors and, overall, did not accurately reflect the observational data from which they were derived. In addition, SSI-3 Severity Level agreement was found to be essentially identical to agreement levels for purely subjective ratings of severity. These results, along with concerns related to SSI-3 judge reliability procedures, are discussed.
The purpose of this study was to determine whether accuracy training for interval judgments of stuttering might generalize to increased accuracy and/or interjudge agreement for intervals other than those used during training. Ten upper-division speech-language pathology students judged 5-s audiovisually recorded speech intervals as stuttered or nonstuttered in a series of group and single-subject experiments. Judgment accuracy was determined with respect to judgments provided previously by 10 recognized authorities on stuttering and its treatment. Training occurred within single-subject experiments that used multiple baselines across speakers and repeated generalization probes to assess training effects. Results showed that judgment accuracy tended to increase after training for speakers used during the training process as well as for unfamiliar speakers. Results also replicated previous findings of slight increases in interjudge and intrajudge agreement after interval-judgment training. The implications of these results for developing a valid and reliable stuttering measurement system are discussed.
Experienced clinicians in several treatment centers were provided with audio-recorded speech samples from eight stutterers and two normal speakers. They were asked to 1) count the total number of syllables in each sample, 2) count the number of stuttered syllables in each sample, and 3) rate each speaker on a seven-point stuttering severity scale. There were substantial interclinic discrepancies in all three measures. The implications of these results are discussed, and suggestions to improve interclinic agreement are provided.
Unlabelled:
Using a grounded theory approach, four clusters were identified that represent patterns of coping by adults who stutter. In order to understand the complexities within the coping responses of speakers to the experience of stuttering, this first of two companion papers summarizes the literature on the human coping response to stress and the nature of two of the four main findings identified. These findings describe a coping process that emphasizes strategies of protecting both the speaker and the listener from experiencing discomfort associated with stuttering. The companion paper describes the remaining two main findings that emphasize the characteristics of self-focused and action oriented coping responses.
Educational objectives:
The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence the choice to use emotion-focused and problem-focused coping strategies, and (4) explain the factors that contribute to the use of methods of escape.
Little is known about the experience of stuttering for people over 55 years of age. Recent research has established that the same types of stuttering behaviours, cognitions, and emotional consequences experienced during young adulthood persist into older age.
The aims were to investigate perceptions of limitations to activity and participation in a group of older people who stuttered into adulthood. A further aim was to find out their perceptions about treatment.
This was a qualitative study involving eleven participants, eight males and three females over 55 years of age (mean age = 70.7, standard deviation = 9.13 years, range = 57.2-83.8 years) who self-reported stuttering into adulthood. Participants were randomly assigned to two focus groups for the discussion of topic questions posed by a moderator. The discussion was video- and audio-recorded, transcribed, and analysed using a comparative thematic analysis to derive emergent themes in relation to the topic questions.
Stuttering can impact on the lives of older people in a similar way to younger people who stutter. Participants who continued to work felt more limited by their stuttering because work involved unpredictable speaking situations with unfamiliar people. Others who had retired experienced some relief from these limitations because they were no longer required to communicate in a work context. The acceptance of stuttering was a theme expressed by some participants, and acceptance diminished the limitations because these older people were less fearful of the consequences of their stuttering. However, others remained constrained by the impact of stuttering on their communication and struggled with a fear of speaking and a fear of negative evaluation by others. They applied learnt and self-devised techniques to assist their speech and felt that if fear of speaking was removed and their self-confidence increased, communication might be better. They would like effective, individual, and short-term treatment with speech-language pathologists who are knowledgeable about stuttering and sensitive to their emotional needs.
Older people who stutter experienced limitations to participation because of their stuttering and there are implications for their future ability to remain independent and connected to relevant people and services. Further investigation of these limitations and research into effective intervention is indicated.
Unsophisticated raters, using 9-point interval scales, judged speech naturalness and stuttering severity of recorded stutterer and nonstutterer speech samples. Raters judged separately the audio-only and audiovisual presentations of each sample. For speech naturalness judgments of stutterer samples, raters invariably judged the audiovisual presentation more unnatural than the audio presentation of the same sample; but for the nonstutterer samples, there was no difference between audio and audiovisual naturalness ratings. Stuttering severity ratings did not differ significantly between audio and audiovisual presentations of the same samples. Rater reliability, interrater agreement, and intrarater agreement for speech naturalness judgments were assessed.
EMGs were recorded from muscles of the lip, jaw, and neck during conversational speech of 17 stuttering subjects. Averaged power spectra and coherence between pairs of EMGs were computed. Results indicate that tremorlike oscillations in the range of 5-15 Hz and high amplitudes of EMGs occupy a common continuum of motor patterns that may occur in stuttering. In subjects whose results fell at the strong end of this continuum, stuttered speech was distinguished by widely distributed, high-amplitude oscillations and relatively high coherence at the frequency of oscillation. At the other extreme, neither oscillatory activity nor amplitude was greater for stuttered speech; in fact stuttered and fluent speech were often associated with approximately equal EMG amplitude. These results suggest that there is not a single set of physiological events that uniformly characterize stuttering in all individuals; rather, events such as the occurrence of high-amplitude oscillations occur at different strengths in different individuals.
This exploratory study was undertaken to determine if the concept has merit that the information by which a stutterer identifies stuttering at time of occurrence is qualitatively different from that by which listeners identify stuttering. If it is not the same, then perceptually equivalent stuttered and nonstuttered speech disruptions should be experienced by the stutterer as qualitatively different, even though recordings of these disruptions would sound alike to listeners. To test this hypothesis a criterion was developed to validate a stutterer's ability to accurately identify her stuttering at time of occurrence. She simulated her own stuttering and then judged acoustical recordings of authentic and simulated samples at five intervals following occurrence. Listener judgments were also obtained. Listeners were able to distinguish simulated and authentic samples with 57% accuracy. The stutterer's judgments were never inaccurate at time of occurrence of a speech disruption, but her accuracy decreased rapidly following occurrence, plateauing at 54%. These results supported the concepts that the production of stuttered and nonstuttered speech disruptions are experienced as being qualitatively different, that the difference is involuntary blockage, that only stutterers can validly recognize this difference, and only when it occurs, and that stuttering is a speaker/production rather than a listener/perceptual disorder.
A new instrument for measuring stuttering severity has been standardized on 109 children and 28 adults. The instrument attempted to meet the criteria of simplicity, objectivity, sensitivity to fluency changes of clinical significance, reliability, validity, and usability with children and adults. The frequency, duration, and associated physical concomitants of prolongations or repetitions of short speech segments are described. Procedures have been devised for scoring so that a range of 0 to 45 is possible. The statistical reliability and validity appear to qualify the instrument for clinical and research uses.
The present study was concerned with the development and evaluation of a scale of speech naturalness. Speech samples were recorded of the typical speech of 10 stutterers, 10 stutterers speaking without stuttering under 250-ms delayed auditory feedback (DAF), and 10 nonstutterers speaking normally. Using a 9-point scale, 30 unsophisticated listeners judged how natural the speech sounded in each sample. Results indicated that the stutterer samples were judged as sounding significantly more unnatural than the nonstutterer samples, and the DAF stutter-free samples were judged as sounding significantly more unnatural than the nonstutterer samples. The stutterer and DAF stutter-free samples were not judged as sounding significantly different in terms of speech naturalness. Interrater reliability, interrater agreement, and rater consistency for judging speech naturalness were all satisfactory.
Previous studies have reported that the disfluent speech of stutterers is often associated with tremor in orofacial muscle systems. In the present report, spectral analyses of the amplitude envelopes of laryngeal and orofacial EMGs revealed that tremor-like oscillations of EMG activity, similar to those observed in orofacial muscles, are also present in laryngeal muscles during stuttered speech. Furthermore, tremor-like oscillations in orofacial and laryngeal muscles appear to be entrained in some subjects. It is speculated that autonomic systems may provide a mechanism whereby oscillations in different muscle groups may become entrained.
Unlabelled:
Support groups are rapidly becoming an important part of the recovery process for many people who stutter, and a growing number of speech-language pathologists (SLPs) are encouraging their clients to participate in support groups. At present, however, little is known about the individuals who join stuttering support groups and the benefits they derive from their participation. This study surveyed members of the National Stuttering Association (NSA) to learn about their experiences in support groups, as well as their experiences in speech therapy. Respondents were 71 people who attended the 1999 NSA conference in Tacoma, WA. The majority of respondents had participated in treatment several times during their lives, using a variety of techniques. Respondents who had participated in fluency-shaping treatments were more likely to report that they had experienced a relapse than those who had participated in stuttering modification or combined treatments. Also, there was a strong positive correlation between respondents' satisfaction with treatment and their judgments of clinicians' competence, suggesting that improved training for SLPs should lead to improved treatment for people who stutter. Results will be used to provide a foundation for further evaluations of the benefits of support group participation for people who stutter.
Educational objectives:
The reader will learn (a) that many people who participate in the NSA have had numerous and varied experiences with speech treatment throughout their lives, (b) which aspects of treatment and support group participation are seen as most beneficial for people who participate in the NSA.
The World Health Organization (WHO) recently presented a multidimensional classification scheme for describing health status and the experience of disablement. This new framework, the International Classification of Functioning, Disability, and Health (ICF; WHO, 2001), is a revision of WHO's prior framework for describing the consequences of disorders, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH; WHO, 1980). In previous papers, Yaruss had shown how the original ICIDH could be adapted to describe the consequences of stuttering at several levels that are relevant to the communication and life experiences of the person who stutters. The current manuscript presents an update of the Yaruss (1998) model that accounts for the new structure of the ICF. A comparison of the WHO's ICIDH and ICF frameworks is presented, followed by an analysis of how the ICF can be adapted to describe the speaker's experience of the stuttering disorder. Emphasis is placed on the fact that stuttering involves more than just observable behaviors. Specifically, the speaker's experience of stuttering can involve negative affective, behavioral, and cognitive reactions (both from the speaker and the environment), as well as significant limitations in the speaker's ability to participate in daily activities and a negative impact on the speaker's overall quality of life. LEARNING OUTCOMES: As a result of reading this manuscript, participants, willgain an understanding of the updates to the World Health Organization's original International Classification of Impairments, Disabilities, and Handicaps that are seen in the International Classification of Functioning, Disability, and Health understand how the ICF can be applied to the study of stuttering recognize that health conditions such as stuttering are affected by both internal and external factors, and can involve more than just observable behaviors that are seen on the surface.
Background:
Bloodstein reviewed hundreds of studies that investigated the efficacy of therapeutic protocols for ameliorating the stuttering syndrome. Surprisingly, almost all were effective in significantly reducing overtly perceptible behaviours such as repetitions and prolongations of speech sounds. These results seem highly improbable considering that many of the treatment methods were diametrically opposed in their principles and implementation procedures (e.g. psychoanalysis, drug therapy, behaviourism, cognitive behavioural therapy and auditory feedback devices with rate control, etc.). In addition, time and more ecologically valid methods such as self-report measures demonstrate that overt measures of success are tenuous, their ameliorative effects tend to diminish drastically over time and show poor generalizability. Further, the real conundrum in stuttering therapy is the failure to acknowledge stuttering as a complete syndrome of continuous compensatory behaviours.
Aims:
To highlight how self-report measures serve as a primary tool to understand the syndrome-like nature of stuttering and to test the efficacy of the therapy outside the confines of the clinic and the needs of the people who stutter.
Methods & procedures/outcomes & results:
In the past, therapeutic efficacy has typically been measured by the reduction in overtly observable and countable events of stuttering such as repetitions and prolongations. However, recent neuroimaging data and our research suggest that the stuttering syndrome is more than the mere presence of peripheral speech disruptions. Stuttering is a central, experiential sense of 'loss of control' that manifests itself across a continuum of compensatory behaviours from the central nervous system outwards to the speech periphery. In other words, aberrant neural activity, as well as covert stuttering behaviours, subperceptual stuttering forms and overt speech disruptions are all effects or compensations for the central involuntary 'neural block'. Hence, by counting only perceptible portions of the disorder, efficacy measures 'fail to capture' the experiential sense of 'loss of control' and the covert compensatory behaviours of the disorder (i.e. avoidances of words or situations, substitutions, circumlocutions, subperceptual stuttering forms, etc.). Furthermore, unnatural sounding speech, decreased ease of speech production, elevated levels of clinic room fluency and poor reliability in counting stuttering behaviours confound the overt measures in the clinic milieu. Therefore, while overt measures remain important, used in isolation, they cannot provide a 'true metric' of efficacy.
Conclusions:
Any efficient and effective means of evaluating intervention methods over the long-term should include a form of self-report as a primary tool as it best accesses the experiential sense of 'loss of control' and other covert behaviours. Overt measures should be used to supplement or complement the self-report data.
Unlabelled:
This paper describes a new instrument for evaluating the experience of the stuttering disorder from the perspective of individuals who stutter. Based on the World Health Organization's International Classification of Functioning, Disability, and Health [World Health Organization (2001). The International Classification of Functioning, Disability, & Health. Geneva: World Health Organization], the Overall Assessment of the Speaker's Experience of Stuttering (OASES) collects information about the totality of the stuttering disorder, including: (a) general perspectives about stuttering, (b) affective, behavioral, and cognitive reactions to stuttering, (c) functional communication difficulties, and (d) impact of stuttering on the speaker's quality of life. This paper summarizes scale development, reliability and validity assessment, and scoring procedures so clinicians and researchers can use the OASES to add to the available evidence about the outcomes of a variety of treatment approaches for adults who stutter.
Educational objectives:
As a result of this activity, participants will be able to: (1) identify key issues related to the documentation of treatment outcomes in stuttering; (2) discuss the components of the international classification of functioning, disability, and health as they relate to the documentation of stuttering treatment outcomes; (3) evaluate and use a new measurement instrument for assessing the outcomes of stuttering treatment from the perspective of the person who stutters.
There is a widespread clinical view that stuttering is associated with high levels of muscles activity. The proposal of this research was to compare stutterers and fluent speakers with respect to the electromyographic activity of the upper and lower lip muscles.
Ten individuals who stutter and 10 fluent speakers (control group) paired by gender and age were studied (mean age: 13.4 years). Groups were defined by the speech sample analysis of the ABFW-Language Test. A K6-I EMG (Myo-tronics Co., Seattle, WA, USA) with double disposable silver electrodes (Duotrodes, Myo-tronics Co., Seattle, WA) being used in order to analyze lip muscle activity. The clinical conditions investigated were movements during speech, orofacial non-speech tasks, and rest. Electromyographic data were normalized by lip pursing activity. The non-parametric Mann-Whitney test was used for the comparison of speech fluency profile, and the Student t-test for independent samples for group comparison regarding electromyographic data.
There was a statistically significant difference between groups regarding speech fluency profile and upper lip activity in the following conditions: lip lateralization to the right and to the left and rest before exercises (P<0.05). There was no significant difference between groups regarding lower lip activity (P>0.05).
The EMG activity of the upper lip muscle in the group with stuttering was significantly lower than in the control group in some of the clinical conditions analyzed. There was no significant difference between groups regarding the lower lip muscle. The subjects who stutter did not present higher levels of muscle activity in lip muscles than fluent speakers.
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Participant number ___________________ Date _______ Sample -Spontaneous Speech and Oral Reading Folia
Tension Checklist -Adapted from Snidecor (1955)
Participant number ___________________
Date _______
Sample -Spontaneous Speech and Oral Reading
Folia Phoniatr Logop 2017;69:180-189
DOI: 10.1159/000486032