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Abstract

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.

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... These emotional experiences are individualized to each speaker; they develop over time as people cope with stuttering throughout their lives (Tichenor & Yaruss, 2018). A better understanding of how the use of specific ER regulatory strategies relates to the development of these negative emotions may lead to more effective treatment of the stuttering condition by further elucidating the reasons that a person develops their individual phenotype of the stuttering condition (see the work of Tichenor & Yaruss, 2019b). ...
... No data from these children have yet appeared in prior publications. Of the 180 adult participants who stutter, 103 were unique to this study while 77 had completed other surveys in the ongoing survey project relating to individual differences in adverse impact from both the Michigan State University Spartan Stuttering Laboratory and the Duquesne University Life Impact of Speech and Stuttering Laboratory (see the works of Tichenor et al., 2021;Tichenor & Yaruss, 2019a, 2019b, 2020a, 2020b, 2020c. Participants were recruited using a mix of convenience sampling and snowball sampling in which recruitment cascades via multiple distribution channels (Goodman, 1961). ...
... Present findings shed light on how these manifestations may develop differently for different individuals who stutter, given that adults who less often engaged in CR as an ER strategy were more likely to have the goal of not stuttering when speaking. 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). ...
Article
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.
... Despite findings of depressed performance on the handwritten word fluency task in AWS compared to AWNS, there is little prior work examining oral letter fluency in people who stutter, for what may be obvious reasons that would contaminate interpretation of results. Oral formulation can be difficult for AWS for numerous reasons, such as anticipation of stuttering, undetected moments of stuttering, or avoidance of particular vocabulary words due to fear of stuttering (e.g., Brocklehurst et al., 2012;Bloodstein et al., 2021;Tichenor & Yaruss, 2019;Yaruss, 2007;Yaruss & Quesal, 2004). Thus, AWS may perform worse on oral letter fluency tasks compared to written letter fluency tasks but primarily because of their speech symptoms. ...
... Time pressure can put more demands on AWS to communicate and result in a faster rate of speech or more stuttering-like disfluencies (e.g., Bloodstein et al., 2021;Johnson & Rosen, 1937;Vanryckeghem et al., 1999). Thus, time pressure in combination with avoidance behaviors, negative feelings and thoughts about stuttering, and anticipation of stuttering could impact communication (e.g., Bloodstein et al., 2021;Brocklehurst et al., 2012;Tichenor & Yaruss, 2019;Yaruss, 2007;Yaruss & Quesal, 2004). AWS have even been found to be less accurate at estimating the time needed to complete 30-s oral tasks compared to AWNS (Ezrati-Vinacour & Levin, 2001). ...
... We added a typed component to the measurement of letter fluency, as AWS may have difficulties with oral formulation for numerous reasons unrelated to lexical retrieval skills, ranging from presumed motor speech instability, undetected moments of stuttering, anticipation of stuttering, or even avoidance of particular vocabulary words, as described earlier (e.g., Bloodstein et al., 2021;Brocklehurst et al., 2012;Kleinow & Smith, 2000;Smith et al., 2010;Tichenor & Yaruss, 2019;Yaruss, 2007;Yaruss & Quesal, 2004). Additionally, a previous study had found that AWS handwrote fewer words beginning with the letter "s" in 5 min compared to AWNS (Wingate, 1988). ...
Article
Purpose Language abilities have long been thought to be weaker in adults who stutter (AWS) compared to adults who do not stutter (AWNS). However, it is unknown whether modality affects language performance by AWS in time pressure situations. This study aimed to examine lexical access and retrieval abilities of AWS in oral and typed modes. Method Fifteen AWS and 15 well-matched AWNS completed computer-administered letter fluency tasks. Adults were asked to orally produce words that began with one of two letter targets and type words that began with one of two alternate letters. Conditions were counterbalanced across participants. Results Generalized linear mixed-effects models were evaluated to determine the effects of group (AWS/AWNS), mode (oral/typed), and expressive vocabulary on letter fluency performance. Group predicted letter fluency such that AWS generated fewer items on both the oral and typed letter fluency tasks. Mode did not impact letter fluency results. Expressive Vocabulary Test scores predicted letter fluency similarly in both AWS and AWNS. Conclusions AWS were not penalized by oral task demands. AWS generated fewer items on the letter fluency tasks regardless of response mode, suggesting that they have weaker lexical access abilities. Furthermore, better expressive vocabulary skills were associated with better letter fluency performance in both groups.
... Thus, relapse, typically viewed as a return of stuttering behaviors or a reduction in speech fluency, is a common experience for people who achieve increased fluency as a result of therapy (see Cream et al., 2009;Evesham & Fransella, 1985;Silverman, 1981). While research continues to reveal important differences between people who have apparently recovered or relapsed from stuttering behaviors and people who continue to exhibit overt stuttering behaviors, much less is known about recovery and relapse from the adverse impact of the condition (Tichenor & Yaruss, 2019b;Yaruss & Quesal, 2004). ...
... The adverse impact of stuttering refers to the environmental, personal, and physiological factors that can negatively affect and limit the life of a person who stutters (Tichenor & Yaruss, 2019b;Yaruss, 1998;Yaruss & Quesal, 2004). Research evidence has shown that measurements of adverse impact from the broader stuttering condition do not correlate strongly with measures of stuttering behaviors, such as percent syllables stuttered (Blumgart et al., 2012). ...
... For example, Franken et al. (2018) found that 13% of a sample of preschoolers who were judged to have recovered self-reported that they continued to live with stuttering, even though observations of their speech using standard listener-based methods did not reveal stuttering behaviors. 1 These children may have exhibited recovery from stuttering behaviors, but they had not experienced recovery from the broader adverse impact of the condition (for a discussion of adverse impact, see Tichenor & Yaruss, 2019b;Yaruss & Quesal, 2004). Just as recovery from adverse impact may occur independently from recovery from stuttering behaviors, so too may relapse from stuttering behaviors occur independently from relapse from adverse impact. ...
Article
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.
... Differences in the frequency of stuttering behaviors between tasks were significantly greater than the differences in the frequency of stuttering within tasks, indicating that the speaking task is an important factor influencing the amount of stuttering behaviors that a child exhibits. More recently, Constantino et al. (2016) measured the frequency, duration, and severity of stuttering behaviors, as well as adverse impact related to the condition (see Tichenor & Yaruss, 2019b;Yaruss & Quesal, 2004, for a discussion of adverse impact) experienced by six adults who stutter over five separate days spread across 2 weeks. The frequency of stuttering behavior showed great variation over time, with some participants changing observable severity classifications (e.g., mild or severe) from one point in time to another. ...
... Recruitment procedures were similar to recent survey studies published from the Spartan Stuttering Laboratory at Michigan State University (Tichenor & Yaruss, 2019a, 2019b, 2020a, 2020b. Specifically, participants were recruited using a mix of convenience sampling and snowball sampling, in which recruitment cascades from one or more outlets or respondents to others (see Goodman, 1961). ...
... To begin, a set of items was developed to broadly describe various aspects of the stuttering experience that are known from prior research to adversely affect people who stutter. These included cognitive/affective reactions, behaviors, and real-world impact (Craig et al., 2009;Tichenor & Yaruss, 2019b; Yaruss & Quesal, 2004). The authors drew upon their prior experience with survey and questionnaire development (e.g., Tichenor & Yaruss, 2019a;Yaruss & Quesal, 2006) to guide a series of pilot studies in which various questions addressing different aspects of the experience of stuttering were reviewed by small focus groups of people who stutter. ...
Article
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.
... D evelopmental stuttering is characterized by overt moments of disfluencies such as blocks, prolongations, and/or sound repetitions that begin during childhood and can persist into adulthood (e.g., Smith & Weber, 2017). Adults who stutter (AWS) report that moments of stuttering are preceded by covert sensations described as "loss of control" or feeling "stuck" during their attempts to suppress undesired speech behaviors (e.g., Tichenor & Yaruss, 2019). Based on these first-hand accounts of the stuttering experience, it is reasonable to examine whether executive functions dedicated to the inhibition of verbal behaviors, or verbal response inhibition, operate in a manner distinct from typically fluent adults. ...
... To date, no studies have examined verbal response inhibition in AWS. One might argue that, given the ubiquitous role of verbal response inhibition during the daily life of AWS (e.g., Tichenor & Yaruss, 2019), and its longstanding prominence within clinical approaches to stuttering interventions (e.g., stuttering modification, Van Riper, 1973;fluency shaping, Webster, 1979), verification of this relationship in AWS is particularly important and may potentially differ from patterns observed for AWNS. ...
... Based on the adverse impact of lifelong stuttering (e.g., Tichenor & Yaruss, 2019), and the reported bidirectional relationship between emotions and inhibition found in nonstuttering literature (e.g., Kalanthroff et al., 2013;Verbruggen & De Houwer, 2007), we predicted that adverse experiences with stuttering would significantly, positively predict slower verbal response inhibition. ...
Article
Full-text available
Purpose: Adults who stutter (AWS) often attempt, with varying degrees of success, to suppress their stuttered speech. The ability to effectively suppress motoric behavior after initiation relies on executive functions such as nonselective inhibition. Although previous studies found that AWS were slower to inhibit manual, button-press response than adults who do not stutter (AWNS), research has yet to confirm a consistent relationship between manual and verbal inhibition. No study has examined verbal inhibition ability in AWS. The purpose of this study, therefore, is to compare verbal response inhibition between AWS and AWNS, and compare verbal response inhibition to both the overt stuttering and the lived experience of stuttering. Method: Thirty-four adults (17 AWNS, 17 AWS) completed one manual and three verbal stop-signal tasks. AWS were assessed for stuttering severity (Stuttering Severity Instrument–Fourth Edition: SSI-4) and experience with stuttering (Overall Assessment of the Speaker’s Experience With Stuttering [OASES]). Results: Results indicate no correlation between manual and verbal inhibition for either group. Generalized linear mixed-model analyses suggested no significant group differences in manual or verbal inhibition. Manual and verbal inhibition did not predict SSI-4 in AWS. However, verbal inhibition was uniquely associated with OASES scores. Conclusion: Although underlying manual and verbal inhibition was comparable between AWS and AWNS, verbal inhibition may be linked to the adverse experience of stuttering rather than the overt symptoms of stuttering severity.
... The 89 statements from Rounds 2 and 3 that reached group consensus on their importance as intervention components were categorized using the domains of the ICF framework as it applies to stuttering (Tichenor & Yaruss, 2019a; WHO, 2013) (see Table S7 in the additional supporting information Table 7 in the additional supporting information). This categorization activity supported the development of the framework of stuttering intervention, which is presented in Figure 2. ...
... The three-round survey resulted in group consensus on the importance of 89 statements representing core components of stuttering intervention. These were subsequently categorized using the ICF framework as it applies to stuttering (Tichenor & Yaruss, 2019a;WHO, 2013). This categorization resulted in the development of an evidence-based and multi-stakeholder-informed framework to guide clinical practice. ...
... It is noteworthy that the participants did not reach consensus on any statements that could be classified within the domain of 'Impairments in Body Function or Structure' as defined by Tichenor and Yaruss (2019a: 9). In a previous version of the application of the ICF to stuttering (Yaruss & Quesal, 2004), speech disfluencies, for example, were categorized as an 'Impairment in body function' (48); however, the updated framework now classifies speech disfluencies as reflecting a behavioural reaction to an underlying sense of loss of control or an inability to move forward in speech (Tichenor & Yaruss, 2019a). Based on this updated framework, the core symptom of stuttering (sensation of losing control or being stuck) is proposed to be the direct result of using an impaired neurological system, and is classified as the impairment. ...
Article
Full-text available
Background: Evidence-based practice involves the synthesis of multiple forms of evidence to inform clinical decision-making and treatment evaluation. Practice- and patient-based evidence are two forms of evidence that are under-represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults. Aims: To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence-based interventions for adults who stutter. Methods & procedures: Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three-round e-Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering. Outcomes & results: A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors. Conclusions & implications: Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence-based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter. What this paper adds: What is already known on the subject Evidence-based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision-making and treatment evaluation. The stuttering literature is characterized by an over-representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge This study adds valuable practice- and patient-based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work? This research presents a stakeholder-informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence-based interventions. The framework supports the adoption of a person-centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy.
... Personal stories from stutterers affirm not only that this happens but also that it can be significantly damaging for the speaker (see Ahlbach & Benson, 1994;Campbell et al., 2019;Reitzes & Reitzes, 2012). Similarly, clinicians who are overly focused on fluency may over-emphasize fluency-focused therapy or seek to discharge clients who seem to be fluent but who are still experiencing adverse impact related to the condition (Tichenor & Yaruss, 2019b;Yaruss & Quesal, 2004). Again, this is widely documented and potentially damaging for the speaker (Yaruss, Quesal, & Murphy, 2002;Yaruss, Quesal, Reeves, et al., 2002). ...
... However, the very same listeners are likely to miss more subtle moments of stuttering, such as word substitutions, and they may make mistakes in effortful speech, such as prolonged speech, for fluent speech. Listeners, therefore, cannot truly judge fluency because they are not privy to the speaker's internal sensations, such as losing control (Perkins, 1990;Tichenor & Yaruss, 2018, 2019b or ease of speech (Constantino et al., 2017). Thus, we assert that the common use of term fluency can be misleading and, ultimately, inaccurate. ...
... Defining stuttering as a lack of fluency focuses the listener's attention on the disfluencies produced by the speakerthat is, the speaker's failures-instead of on the message conveyed. At the same time, the focus on fluency misses other aspects of the stuttering condition, including the broader experiences that may or may not be associated with overt speech (Tichenor & Yaruss, 2019b). ...
Article
Purpose This article presents several potential concerns with the common usage of the term fluency in the study of stuttering and people who stutter (or, as many speakers now prefer, stutterers ). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended. Method We begin by reviewing the history of the term fluency . We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition. Results By highlighting current research and perspectives of stutterers, we conclude that the term fluency (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole. Conclusions We recommend that researchers and clinicians cease referring to stuttering as a fluency disorder and simply refer to it as stuttering . Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition.
... Recent research evidence has also increased awareness of the broader impact of stuttering, including societal stigma and self-stigma (Boyle, 2013;, and occupational disadvantages (Bricker-Katz, Lincoln, & Cumming, 2013;Gabel, Blood, Tellis, & Althouse, 2004;Gerlach, Totty, Subramanian, & Zebrowski, 2018). These factors can have a notable impact on a person's life, so understanding them is vital for explaining why people experience stuttering in the way(s) they do and why one person might experience stuttering differently from another person (Tichenor & Yaruss, 2019;Yaruss & Quesal, 2004). ...
... Recruitment procedures were similar to those found in other recent surveys in stuttering research (see Boyle, 2013Boyle, , 2017Boyle, , 2018Boyle, Beita-Ell, Milewski, & Fearon, 2018;Tichenor & Yaruss, 2019). Specifically, participants were recruited using a mix of snowball and convenience sampling, using research registries from previous studies, social media outlets, personal contacts of the authors, word of mouth, and national and international stuttering associations (e.g., the International Stuttering Association, the National Stuttering Association, and Friends: The National Organization of Young People Who Stutter) to encourage a broad sampling of people who stutter from different backgrounds and with different experiences. ...
... Overt behaviors, such as prolongations, repetitions, and blocks, provide seemingly concrete, measurable events that clinicians can be trained to observe (Bainbridge, Stavros, Ebrahimian, Wang, & Ingham, 2015;Cordes & Ingham, 1994;Curlee, 1981;Ham, 1989;Kully & Boberg, 1988;Martin, Haroldson, & Woessner, 1988;Yaruss, 1998;Young, 1975). Nevertheless, stuttering is something that is experienced by a speaker, not just a listener (Tichenor & Yaruss, 2019). D. E. Williams (1957) stated, "a person who stutters may learn to vary, or to control the 'overt stuttering,' but to him 'his stuttering' is a constant, an entity, a something that still [emphasis added] remains" (p. ...
Article
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.
... on disruptions or "disfluencies" that listeners may observe in the speech of people who stutter; these disfluencies are typically referred to as stuttering or stuttering behavior (Conture, 1990;Cooper, 1968;Gregory et al., 2003;Wingate, 1964Wingate, , 2001Yairi, 2001;Yairi & Ambrose, 2005). From the perspective of a person who stutters, however, the experience of stuttering involves far more than the production of stuttered speech (Cooper, 1968(Cooper, , 1977Johnson, 1961b;Sheehan, 1970;Sheehan & Sheehan, 1984;Tichenor & Yaruss, 2018, 2019bVan Riper, 1982;Yaruss, 1998;Yaruss & Quesal, 2004). The focus of this article is to highlight how understanding these broader aspects of living with stuttering can help speech-language pathologists (SLPs) improve their therapy and interactions with people who stutter. ...
... (Note that in this article, we are referring to "Childhood Onset Fluency Disorder," sometimes called "developmental" stuttering, to differentiate it from other types of stuttering with neurogenic or psychogenic origin.) that may be related to a living life as a person who stutters (Tichenor & Yaruss, 2019b;Yaruss & Quesal, 2004). One useful framework for understanding adverse impact is the International Classification of Functioning, Disability and Health (ICF), developed by the World Health Organization (WHO, 2001). ...
... This framework has been adopted by the American Speech-Language-Hearing Association (ASHA) as reflecting the scope of practice of SLPs (ASHA, 2016). The ICF as applied to stuttering (Tichenor & Yaruss, 2019b;Yaruss, 1998Yaruss, , 2007Yaruss & Quesal, 2004) conceptualizes the stuttering condition in terms of several interdependent areas. These have been depicted in graphical format (Tichenor & Yaruss, 2019b;Yaruss, 1998;Yaruss & Quesal, 2004), with the most recent update-based on extensive data collected from hundreds of people who stutterdeveloped by Tichenor and Yaruss (2019b). ...
Article
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.
... The adverse impact of stuttering includes environmental, personal, and physiological factors that can negatively affect the life of a person who stutters (Tichenor & Yaruss, 2019b;Yaruss & Quesal, 2004). Research and popular press books have given voice to real-world experiences that many people who stutter report, including decreased participation in life events, and feelings such as shame, embarrassment, and anxiety (Ahlbach & Benson, 1994;Plexico, Manning, & Levitt, 2009a, 2009bPreston, 2013;Reitzes & Reitzes, 2012;St. ...
... Recruitment procedures were similar to those found in other recent surveys exploring aspects of stuttering (see Boyle, 2013Boyle, , 2017Boyle, , 2018Boyle, Beita-Ell, Milewski, & Fearon, 2018;Tichenor & Yaruss, 2019a, 2019b. Participants were recruited using a mix of convenience sampling (e.g., recruiting from personal contacts) and snowball sampling (in which recruitment cascades from one or more outlets or respondents to others; see Goodman, 1961). ...
Article
Purpose Prior research has explored how repetitive negative thinking (RNT) contributes to both the increased persistence and severity of various disorders, such as depression, anxiety, and eating disorders. This study explored the potential role of RNT in the experience of stuttering, with a particular focus on the relationship between RNT, adverse impact, and certain temperament profiles. Method Three hundred thirteen adults who stutter completed a measurement of the frequency/severity of RNT (Perseverative Thinking Questionnaire; Ehring et al., 2011 ), 207 completed a temperament profile (Adult Temperament Questionnaire; Evans & Rothbart, 2007 ), and 205 completed a measurement of adverse stuttering impact (Overall Assessment of the Speaker's Experience of Stuttering; Yaruss & Quesal, 2016 ). Analyses were conducted within and across instruments to ascertain how RNT, temperament markers, and adverse impact interrelate within individuals. Results Results indicated that RNT significantly predicts Overall Assessment of the Speaker's Experience of Stuttering impact scores with great effect and that certain temperament markers (specifically, Effortful Control and Negative Affectivity) moderate this relationship for specific sections of the Overall Assessment of the Speaker's Experience of Stuttering. Conclusion By assessing RNT in people who stutter, clinicians can better understand individual differences in their clients, and this will allow them to make targeted diagnoses and develop more tailored intervention plans.
... [28][29][30] These consequences are intensified during the school years when children become more involved in social and speaking situations and continue into adulthood, with negative effects on quality of life and socioemotional experiences. 31,32 AWS associates the moment of stuttering with a sensation of anticipation and loss of control, which leads to behavioural reactions that become deeply ingrained over time. 32 These aversive communicative events become generalized and associated with a breakdown in speech fluency. ...
... 31,32 AWS associates the moment of stuttering with a sensation of anticipation and loss of control, which leads to behavioural reactions that become deeply ingrained over time. 32 These aversive communicative events become generalized and associated with a breakdown in speech fluency. In this context, it is important to recognize that persistent stuttering is first and foremost a neurodevelopmental disorder, 33 and its cognitive, social and emotional consequences are likely secondary, stemming from the difficulty that these individuals have coordinating their speech. ...
Article
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Persistent developmental stuttering is a speech disorder that primarily affects normal speech fluency but encompasses a complex set of symptoms ranging from reduced sensorimotor integration to socioemotional challenges. Here, we investigated the whole brain structural connectome and its topological alterations in adults who stutter. Diffusion weighted imaging data of 33 subjects (13 adults who stutter and 20 fluent speakers) was obtained along with a stuttering severity evaluation. The structural brain network properties were analyzed using Network-based statistics and graph theoretical measures particularly focusing on community structure, network hubs and controllability. Bayesian power estimation was used to assess the reliability of the structural connectivity differences by examining the effect size. The analysis revealed reliable and wide-spread decreases in connectivity for adults who stutter in regions associated with sensorimotor, cognitive, emotional, and memory-related functions. The community detection algorithms revealed different subnetworks for fluent speakers and adults who stutter, indicating considerable network adaptation in adults who stutter. Average and modal controllability differed between groups in a subnetwork encompassing frontal brain regions and parts of the basal ganglia. The results revealed extensive structural network alterations and substantial adaptation in neural architecture in adults who stutter well beyond the sensorimotor network. These findings highlight the impact of the neurodevelopmental effects of persistent stuttering on neural organization and the importance of examining the full structural connectome and the network alterations that underscore the behavioral phenotype.
... suggest that stuttering is an experiential disorder, where the person who stutters (PWS) continually thinks about stuttering. The PWS does not need to actually stutter to experience stuttering (Tichenor & Yaruss, 2019). The PWS is able to anticipate a moment of stuttering, and this anticipation effect is a core feature of several theories of stuttering (Garcia- Barera & Davidow, 2015). ...
... Evidence from self-report sources demonstrates that verbal avoidance, of which word substitution is a key strategy, can significantly impact the quality of communication experienced by PWS (Cream et al., 2003(Cream et al., , 2004Plexico et al., 2009;Tichenor & Yaruss, 2019). Research suggests that confrontation naming data may provide a means for objectively commenting on the mechanisms of word substitution behaviour, including its frequency, variants, time efficiency, and relationship to speaker characteristics (Newman & Bernstein Ratner, 2007). ...
Article
BACKGROUND AND OBJECTIVE: People who stutter (PWS) are able to anticipate a moment of stuttering. We wished to explore whether this anticipation might be reflected by either unusual word choice and/or delayed word production during a single-word confrontation naming task. METHOD: Nine PWS and nine age- and sex-matched fluent controls completed the single-word confrontation-naming task. Groups were compared on numbers of word-finding and fluency errors, response latency, and naming accuracy, measured against a novel ‘usuality’ criterion. Regression modelling of response accuracy and latency was conducted. RESULTS: The groups did not differ on naming task performance, except for a greater frequency of response latency errors in the PWS group. For both groups, responses containing word-finding or fluency errors were more likely to be non-usual names, and these were associated with longer latencies than accurate responses. For PWS, latency was positively related to participant age, and accuracy inversely related to stuttering severity. CONCLUSIONS: The findings provide insights into word substitution as a generalized behaviour, its function, and associated time-cost. Group-specific relationships imply greater sensitivity in PWS to changing demands and capacities, and highlight the complexity of interactions between physical stuttering behaviour and verbal avoidance. Published in “Advances in Communication and Swallowing”
... Numerous studies have shown that many adults who stutter experience adverse impact related to the stuttering condition (Blumgart et al., 2010;Boyle, 2018;Craig et al., 2009;Craig & Calver, 1991;Gabel et al., 2004;Gerlach et al., 2018;Klein & Hood, 2004;Tichenor & Yaruss, 2019b;Yaruss, 2010;Yaruss & Quesal, 2004). For example, many people who stutter experience negative thoughts, feelings, and behaviors as a result of being a person who stutters (Blumgart et al., 2010;Tichenor & Yaruss, 2019a, 2020b. ...
... Recruitment procedures were similar to those for recently published survey studies from the Spartan Stuttering Laboratory (Tichenor & Yaruss, 2019a, 2019b, 2020a, 2020b, 2020c. Participants were recruited using a mix of convenience sampling (e.g., recruiting from personal contacts) and snowball sampling (in which recruitment cascades from one or more outlets or respondents to others: see Goodman, 1961). ...
Article
Purpose Recent studies have shown that many children who stutter may have elevated characteristics of attention-deficit/hyperactivity disorder (ADHD). Although childhood ADHD commonly persists into adulthood, it is unclear how many adults who stutter experience aspects of ADHD (e.g., inattention or hyperactivity/impulsivity). This study sought to increase understanding of how ADHD characteristics might affect individuals who stutter by evaluating (a) whether elevated ADHD characteristics are common in adults who stutter, (b) whether elevated ADHD characteristics in adults who stutter were significantly associated with greater adverse impact related to stuttering, and (c) whether individual differences in Repetitive Negative Thinking (RNT) and Effortful Control influenced this relationship. Method Two hundred fifty-four adults who stutter completed the Adult ADHD Self-Report Scale, the Perseverative Thinking Questionnaire, the Adult Temperament Questionnaire short form, and the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed via multiple linear regression to determine whether the number of inattention or hyperactivity/impulsivity characteristics was significantly associated with RNT, Effortful Control, or Adverse Impact related to stuttering. Results Almost one quarter of participants (23.2%; 60/254) self-reported experiencing six or more inattention characteristics, while fewer participants (8.3%; 21/254) self-reported experiencing six or more hyperactivity/impulsivity characteristics. Participants with lower Effortful Control and higher levels of both RNT and Adverse Impact were significantly more likely to self-report experiencing more inattention characteristics. Discussion Many adults who stutter may exhibit previously unaccounted for characteristics of ADHD, especially inattention. Results highlight the value of continued research on the intersectionality of stuttering, ADHD, and attention, and the importance of individualizing therapy to the needs of each unique person who stutters.
... Mapping the core areas identified in this study to the components of the ICF reveals that all respondents recommended assessment of factors related to body function and structure (Areas 1, 2, 3), personal context (Area 4), environmental context (Area 5), and activities and participation (Area 6). This congruence is not surprising, given that the ICF was developed to provide a comprehensive view of conditions such as stuttering (Tichenor & Yaruss, 2019a;Yaruss & Quesal, 2004) and the importance of taking a broad view of stuttering during assessment. ...
Article
Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.
... 65,66 For many people who stutter, the unpredictable nature of stuttering can lead to feelings of frustration and lack of control. 3 By selecting communication competence as a clinical treatment goal and incorporating activities, such as those described here, to support participants' improvement across competencies, children who stutter can experience consistent, tangible progress despite variations in stuttering frequency. ...
Article
School-based guidelines often require that treatment focuses on minimizing or eliminating stuttered speech. The purpose of this study was to examine the benefits of explicit training in communication competencies to children who stutter without targeting stuttered speech. Thirty-seven children (ages 4–16) completed Camp Dream. Speak. Live., an intensive group treatment program which targets the psychosocial needs and communication of children who stutter. Outcome measures included the Overall Assessment of the Speaker's Experience of Stuttering (OASES), the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT), and the Patient Reported Measurement Information System (PROMIS) Pediatric Peer Relationships Short Form (PROMIS Peer Relationships) and Parent Proxy Peer Relationships Short Form (PROMIS Parent Proxy). Pre- and posttreatment public presentations were rated on nine core verbal and nonverbal communication competencies by a neutral observer. Similar to previous studies, participants demonstrated significant improvements in communication attitudes (OASES) and perceived ability to establish peer relationships (PROMIS Peer Relationships), particularly school-aged participants (ages 7–16). Participants also demonstrated significant improvement in eight of the nine communication competencies. Findings suggest that, in addition to the psychosocial gains of programs such as Camp Dream. Speak. Live., children who stutter benefit from explicit training in communication skills, and these gains are not dependent on the presence of stuttered speech.
... A widely used instrument that intends to provide a comprehensive view of the stuttering disorder in school age children is the Overall Assessment of the Speaker's Experience of Stuttering -School-Age (Ages 7-12) (OASES-S; Yaruss & Quesal, 2016 Yaruss (1998) and Yaruss and Quesal (2004) (see also Tichenor & Yaruss, 2019). ...
Article
Stuttering is a multifaceted disorder that can affect children’s psychological state, academic performance, social relationships, and quality of life. Therefore, it is crucial to explore the impact of stuttering in children, based on their own perspectives and experiences. The purposes of this study were to: (a) investigate the impact of stuttering in Portuguese school-age children and (b) evaluate the reliability and validity of the European Portuguese translation of Overall Assessment of the Speaker’s Experience of Stuttering (OASES-S-PT). Participants were 50 Portuguese children who stutter, aged 7–12 years (M = 9.10, SD = 1.7). Overall, participants exhibited a mild to moderate overall impact from stuttering. Results suggest that the OASES-S-PT is a suitable measure for assessing the impact of stuttering on Portuguese children. A comparison of adverse impact with OASES data in other countries highlighted the need to include different cultural perceptions in the research about stuttering experiences.
... Subjective input from participants provided interesting insights in an earlier dual-task study with adult participants (Eichorn, 2014). Speakers' self-perceptions of stuttering and speaking are also central to the experience of stuttering (Tichenor & Yaruss, 2018;Tichenor & Yaruss, 2019) and necessary for fully understanding overt stuttering behaviors. Additionally, differences perceived by the children across the task blocks could extend recent findings related to speech spontaneity (Constantino et al., 2020) and clarify whether children are able to detect changes in spontaneity during and/or after dual-task conditions. ...
Article
Purpose Contemporary motor theories indicate that well-practiced movements are best performed automatically, without conscious attention or monitoring. We applied this perspective to speech production in school-age children and examined how dual-task conditions that engaged sustained attention affected speech fluency, speech rate, and language productivity in children with and without stuttering disorders. Method Participants included 47 children (19 children who stutter, 28 children who do not stutter) from 7 to 12 years of age. Children produced speech in two baseline conditions with no concurrent task and under a dual-task condition requiring sustained attention to on-screen stimuli. Measures of speech fluency, speech rate, and language productivity were obtained for each trial and compared across conditions and groups. Results Dual-task conditions resulted in a reduction in stutter-like disfluencies relative to the initial baseline speaking condition. Effects were similar for both groups of children and could not be attributed to decreases in language productivity or a simple order effect. Conclusions Findings suggest that diverting attention during the process of speech production enhances speech fluency in children, possibly by increasing the automaticity of motor speech sequences. Further research is needed to clarify neurophysiological mechanisms underlying these changes and to evaluate potential clinical applications of such effects. Supplemental Material https://doi.org/10.23641/asha.19945838
... Adults who stutter are often underemployed and face stigma and discrimination in academic and occupational settings. 7 Despite the efforts to help others identify with people who stutter, 8,9 not being able to speak fluently is a struggle that only those who stutter truly understand. Therefore, as a scientist and a clinician who stutter, we believe if we want to confront this long-ignored condition, we should start in our scientific and medical communities. ...
Article
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More than 70 million people worldwide are affected by developmental stuttering. It is important to reach out to the public, scientific and medical communities, and those who stutter with a goal to raise awareness about stuttering. In this short perspective, we argue that to educate, advocate, and spread awareness about stuttering, we need role models, support, and opportunities.
... The necessity for individualization is known, having been previously documented in the clinical and educational literature, including professional clinical guidelines (RCSLT 2009) and educational texts (Manning 2018). Thus, our participants agree that adults who stutter arrive to intervention with a unique collection of behaviours, reactions and experiences of stuttering in their personal context (Tichenor and Yaruss 2019), and responding to these form the basis of an individualized and appropriate treatment plan. Further reinforcement for this focus was obvious in participants clearly not expressing preferences for particular therapeutic techniques. ...
Article
Background While evidence‐based practice is widely endorsed by researchers, clinicians and professional bodies as a guiding framework for the provision of quality care to clients, the reliance on efficacy evidence may overshadow the benefits of other knowledge forms in supporting intervention design and evaluation. Due consideration needs to be given to varied forms of evidence, including practice and patient evidence. Stuttering intervention for adults is one area in which there is a significant shortage of practice‐based research literature. Aims This study aimed to add to practice evidence by exploring the perspectives of international researchers and clinical experts on the components of effective stuttering intervention. This practice‐based evidence will be used to inform the multi‐stakeholder co‐design of an evidence‐based stuttering intervention for adults. Methods & Procedures Criteria defining expertise were developed based on a review of the literature. Experts were recruited using purposive sampling and snowballing. Seventeen international experts were approached, of which 10 completed semi‐structured interviews. Interview questions were developed and centred on five topics: the nature of stuttering; efficacy evidence base; intervention techniques, principles of effective intervention; and outcome measurement. Outcomes & Results Inductive thematic analysis identified three overarching themes: ‘One size doesn't fit all’, ‘A really collaborative relationship where we are both bringing our sense of expertise to this’ and ‘Some of the most frustrating things’. Conclusions & Implications These findings emphasize the complexity of stuttering intervention, the need for individually tailored treatments and the role of multiple factors, beyond therapeutic technique, that influence treatment outcomes. Findings also demonstrate the benefit of collecting practice‐based evidence to support clinical decision‐making and intervention evaluation.
... Scott Yaruss i Robert Quesal, którzy dokonali adaptacji tego modelu dla jąkania, akcentują potrzebę uwzględniania zarówno potencjału osoby oraz zasobów tkwiących w jej środowisku, jak i negatywnego wpływu zaburzenia na życiową aktywność jednostki zmagającej się z jąkaniem i jej uczestniczenie w różnych formach życia społecznego [Yaruss, 1998;2007;Yaruss, Quesal, 2004;. W artykule prezentującym uaktualnioną wersję modelu ICF dla jąkania podkreślono, że -aby lepiej definiować złożoną i zindywidualizowaną naturę tego zaburzenia -należy opierać się nie tylko na obserwacjach słuchaczy, ale przede wszystkim na doświadczeniach osób, które zmagają się z jąkaniem [Tichenor, Yaruss, 2019]. Fundamentalne znaczenie dla jakości interwencji logopedycznej ma zatem uwzględnianie wpływu zaburzenia na jakość życia osoby, która doświadcza tego zjawiska [Klompas, Ross, 2004;Craig, Blumgart, Tran, 2009;Ścibisz, Węsierska, 2019]. ...
Article
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The article discusses a recent study on the effectiveness of persistent or chronic stuttering therapy based on the opinions of speech-language therapists (SLT’s) and SLT students. The purpose of the study was to consider their opinions in light of the conditions of effectiveness. In the theoretical section of the article, factors affecting chronic stuttering therapy are outlined both directly and indirectly. Factors affecting the success of chronic stuttering treatment were analyzed. To achieve the aim of the study a bespoke survey was used. The survey involved 147 respondents (81 SLTs and 66 SLT students). The results of this study show that both SLTs and SLT students have relatively adequate knowledge of the conditions that result in effective stuttering therapy. According to those surveyed, effective therapy is associated with the application of a comprehensive assessment process, the use of hybrid therapeutic approaches and various forms of therapy, as well as its adaptation to the client’s individual needs. The study has revealed the positive attitude of the respondents toward the client’s self-therapy, his or her participation in self-help group meetings together with the immediate environment’s involvement in the support process. The results of the study indicate that the respondents are aware of the impact of the quality of SLT-client relationships on the success of the therapy process. However, most of those surveyed expressed considerable doubts about their own skills in implementing the stuttering intervention. In the conclusion, the authors highlight that independently from the somewhat satisfactory level of knowledge about stuttering therapy it is important to pay attention to the development of practical competencies and the self-confidence of SLTs and SLT students in this realm. Additionally, the growing interest in the topic of speech and language disorders was highlighted.
... For example, social participation and academic or occupational achievement can be affected due to the resulting emotional challenges (e.g., bullying, shame and insecurity) that accompany stuttering. Therefore, it is highly recommended that stuttering diagnostic procedures involve criteria not only for the identification by the clinician of observable stuttering characteristics, but also clients' report of their experiences (Guitar, 2014;Manning & DiLollo, 2018;Tichenor & Yaruss, 2019;Vanryckeghem, 2007;2018;Vanryckeghem & Brutten, 2018;Yaruss & Quesal, 2004). When assessing stuttering in children, certain considerations come to mind. ...
Article
The Behavior Assessment Battery (BAB) for Children Who Stutter is a self-report test investigating the affective, behavioral and cognitive correlates of stuttering. Its sub-tests gauge a school-age child who stutters’ (CWS) level of anxiety and speech disruption in particular speech situations (SSC-ER: Speech Situation Checklist – Emotional Reaction and SSC-SD: Speech Situation Checklist – Speech Disruption), the use of coping behaviors (BCL: Behavior Checklist) and how a child thinks about his/her speech (CAT: Communication Attitude Test). Cross-cultural research with the BAB has pointed to its usefulness as a differential diagnostic tool and that the tests’ items lead to treatment targets. This type of multidimensional assessment instrument for children who stutter was previously unavailable in Poland, but its publication is now underway. This article presents the results of normative and psychometric testing related to the adaptation of the Polish version of the BAB.
... The term can be used to refer to a collective experience that individuals share (Tichenor & Yaruss, 2018) and to indicate a condition an individual has or a label they are given (Yaruss & Quesal, 2004). Meanings of the term account for a multitude of perspectives and experiences: those of individuals who stammer, clinicians and researchers, conversation partners, society and the public (Tichenor & Yaruss, 2019). ...
Article
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Music therapy and music-based interventions are increasingly used in the treatment of speech, language, and communication needs, and music therapy has been extensively applied to adolescent groups. To date, however, there has been no published work examining music therapy for adolescents who stammer. The aim of the current study was to explore adolescents’ experiences and perceptions of a group music therapy intervention. Four adolescents who stammer participated in semi-structured interviews examining their experience of group music therapy intervention. The music therapy group intervention consisted of five therapeutic sessions conducted at a summer camp for children and adolescents who stammer. Analysis of in-depth, semi-structured interviews revealed four main themes and several subthemes. Recurrent themes revealed a variety of psychosocial benefits related to the experience of group music therapy, such as developing new friendships and facilitating peer support, increasing self-confidence and self-expression. There was also an emphasis on fun and enjoyment. This paper highlights a number of key benefits of music therapy for adolescents who stammer. These preliminary results highlight the potential of music therapy for adolescents who stammer, and the role of addressing psychosocial aspects of stammering within this creative arts intervention.
... Parent perception of stuttering behavior may be influenced by multiple factors, such as their child's stuttering severity or behaviors over time, their child's reaction to stuttering moments, or their own attitudes or reactions to stuttering. Additionally, research with adults suggests that speakers' experiences and communication goals (Tichenor & Yaruss, 2019a, 2019b or stuttering variability or spontaneity (Constantino et al., 2016;Constantino et al., 2020) better predict communication attitude or overall impact of stuttering compared to stuttering severity. Future research should investigate factors other than stuttering severity that may influence communication attitude in preschool-age children who stutter and should recruit larger cohorts of children who stutter to allow for more complex statistical analyses. ...
Article
Purpose: Although preschool-age children who stutter report more negative attitudes toward communication than their typically fluent peers, few investigations have explored factors that may contribute to the differences observed in communication attitude. The purpose of the present study was to explore whether behavioral characteristics of stuttering severity (frequency, duration , physical concomitants) and time since onset of stuttering predict communication attitude in preschool-age children. Method: Fifty-nine preschool-aged children who stutter completed two speaking samples and the KiddyCAT, a self-report assessment of communication attitude. Speech samples were analyzed for stuttering frequency (measured by percentage of stuttered syllables), duration, and presence of physical concomitants. Linear regression models were used to assess if these behavioral measures of stuttering and time since onset of stuttering predicted self-reported communication attitude. Results: Results indicate stuttering behavioral measures and time since onset do not predict KiddyCAT scores of preschool-age children who stutter. Conclusions: Preliminary data suggest children who have presented with stuttering for a longer period of time are no more likely to report a negative communication attitude than children who have a shorter time since onset. Additionally, in contrast to school-age children who stutter, but similar to adults and adolescents who stutter, communication attitude is not linearly related to stuttering severity in preschool-age children.
... From the perspective of the adults who stutter (AWS), the moment of stuttering is preceded by a feeling of being halted, followed by the expectation of the onset of dysfluencies. Consequently, the externally observable patterns present in the AWS are the first to get noticed and examined (Tichenor & Yaruss, 2019). However, a superficial assessment of the stuttering "syndrome" would cause some of the most remarkable features to be overlooked due to their covert nature (Andrews & Cutler, 1974;Brutten & Vanryckeghem, 2003;Erickson, 1969;Watson, 1988). ...
Article
The Communication Attitude Test for Adults who stutter (BigCAT) is an established measure of cognitive traits in adults who stutter (AWS). The primary purpose of the present study was to adapt and validate the BigCAT to the Kannada language. The secondary purpose was to compare AWS’ and adults who do not stutter (AWNS) BigCAT-K scores and compare AWS’ score in sub-populations in terms of severity and age. The study included a purposive sample of 100 AWS and 317 AWNS. There was high test-retest reliability and solid construct validity, as made evident by the results of the discriminant analysis and cross-validation. Further, as in other investigations with the BigCAT (Vanryckeghem & Brutten, 2019), this self-report test revealed a statistically significant group mean difference between AWS and AWNS, suggesting the presence of a negative attitude towards communication in Kannada-speaking AWS. Further, individuals with severe stuttering had a significantly higher level of speech-associated negative attitude compared to those with mild stuttering. Age does not seem to influence the AWS’ speech-associated belief system. Both of these findings augment the existing scant literature on exploring the association between stuttering severity and age on the cognitive dimension of stuttering. The outcomes establish the BigCAT-K as an effective tool in the assessment and subsequent management of stuttering.
... Based on speaker-focused (vs. listener-focused) definitions of stuttering (Perkins, 1990;Tichenor & Yaruss, 2019), a key feature of stuttering is the internal sense of losing control, followed by overt behaviors (repetitions, blocks, physical struggle), as well as emotional and cognitive reactions in response to the underlying sensation of feeling stuck. Subjective measures for GG indicated that he was aware of and anticipated his stuttering to some extent. ...
Article
Purpose Disfluencies associated with stuttering generally occur in the initial position of words. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Our primary goals were to identify patterns in overt features of WFDs and to extend our understanding of this clinical profile by focusing on aspects of stuttering that lie beneath the surface. Method Analyses explored the patterns and distributions of the child's observable stuttering behaviors, in addition to his awareness, perceptions, and subjective experience of stuttering. Results Findings indicated that the WFD profile consists of relatively consistent and distinct overt features. We also found that, in many ways, the child perceived the impact of his disfluencies much like other children who stutter, even though his disfluencies manifested in a less common form. Conclusion Findings suggest the need for increased awareness of the varied forms stuttering may take in order to ensure accurate diagnosis, clear communication to clients and parents, and timely access to appropriate intervention.
Article
Individuals with speech, language, and communication disorders often present with psychosocial concerns that span the physiological, intrapersonal, and interpersonal domains of functioning. Despite this fact, the provision of counseling service by speech-language pathologist (SLP) that directly addresses clients' psychosocial needs is sparse. Research shows the primary counseling strategy used by therapists is psychoeducation, failing to effectively address the psychosocial concerns. Integrating complementary approaches to traditional counseling in SLP can enhance both the quality of therapeutic intervention and client outcomes. The purpose of this article is to demonstrate the potential of animal-assisted therapy (AAT) as an adjunctive or complementary approach for counseling within SLP. A review of literature demonstrates a need for improved counseling service provision within SLP treatment, as well as the benefits of integrating AAT. A framework for how AAT intentions and techniques fit within SLP Scope of Practice counseling activities is presented, along with case examples to demonstrate how AAT can be integrated within SLP treatment. It is concluded that the integration of AAT as a complementary approach to traditional SLP counseling can enhance both the frequency of counseling services provided and clients' psychosocial outcomes.
Article
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Stuttering is a neurodevelopmental speech disorder associated with motor timing that differs from non-stutterers. While neurodevelopmental disorders impacted by timing are associated with compromised auditory-motor integration and interoception, the interplay between those abilities and stuttering remains unexplored. Here, we studied the relationships between speech auditory-motor synchronization (a proxy for auditory-motor integration), interoceptive awareness, and self-reported stuttering severity using remotely delivered assessments. Results indicate that in general, stutterers and non-stutterers exhibit similar auditory-motor integration and interoceptive abilities. However, while speech auditory-motor synchrony (i.e., integration) and interoceptive awareness were not related, speech synchrony was inversely related to the speaker’s perception of stuttering severity as perceived by others, and interoceptive awareness was inversely related to self-reported stuttering impact. These findings support claims that stuttering is a heterogeneous, multi-faceted disorder such that uncorrelated auditory-motor integration and interoception measurements predicted different aspects of stuttering, suggesting two unrelated sources of timing differences associated with the disorder.
Article
Purpose There are many therapy approaches for stuttering, but speech-language pathologists (SLPs) often report that they are uncomfortable treating stuttering. The 3Es model for stuttering therapy (education, ease, and empowerment) is proposed to help SLPs understand stuttering treatment options efficiently and effectively. This model is based on emerging stuttering research trends such as redefining stuttering, anticipation of stuttering, and stigma of stuttering. A primary function of the 3Es model is to serve as a translational research-to-practice funnel for practicing SLPs. Conclusions This tool is conceptualized by identifying three key thematic components of stuttering therapy: education, ease, and empowerment. The Es are the values-based themes of stuttering therapy, and a successful application of the model will create an accessible, robust, and structured “menu” of activities for clinicians to use in treatment planning. These therapy activities can be flexibly combined to provide holistic stuttering therapy and communication outcomes, which include competence, confidence, and change.
Article
Introduction Stuttering may have a holistic effect on the quality of life of a person who stutters by limiting participation in social situations, resulting in feelings of isolation and frustration, leading to difficulties in education and employment and increasing the likelihood of mental health problems. Even young children who stutter may have negative experiences of speaking. Therefore, it is important to treat stuttering behavior effectively in both children and adults. The purpose of this paper was to systematically review group and case studies about the effectiveness of behavioral stuttering interventions to provide evidence-based guidelines for clinicians. Methods Systematic data retrieval was conducted in four electronic databases (PsycINFO, CINAHL, PubMed, Cochrane). The assessment of search results was conducted according to predetermined inclusion and exclusion criteria by two independent judges. The methodological quality of each paper was assessed using strict criteria to include only high-quality research. Results The search revealed 2293 results, and 38 papers (systematic reviews N=3, group design studies N=21 and case studies N=14) with acceptable methodological quality were included. The data show that there is most evidence about the treatment of early childhood stuttering, very little evidence about school-aged children and some evidence about adults. The most convincing evidence is about the Lidcombe Program in the treatment of young children who stutter, but also other methods have promising evidence. Our data imply that in the treatment of adults who stutter, holistic treatments may influence speech fluency and overall experience of stuttering behavior. Speech restructuring treatments may have a positive effect on overt characteristics of stuttering, but not on covert stuttering behavior. Conclusions The results of this review agree with earlier reviews about the treatment of young children. However, due to different inclusion criteria, this review also shows the benefits of holistic treatment approaches with adults and adolescents.
Article
Purpose It is known that people who stutter (PWS) benefit from self-help experiences, such as attending support groups or conferences. However, limited research has been done to explore the listening of stuttering-related podcasts as a form of self-help for PWS. This study seeks to understand the reasons why PWS listen to stuttering-related podcasts and provide descriptions of their listening experiences. Method Thirty-three PWS who have listened to stuttering-related podcasts were recruited to participate in an online survey that included multiple-choice and open-ended questions. Responses were analyzed and grouped into descriptive themes. Results Participants reported listening to stuttering-related podcasts as a way to gain information and perspective. They also reported experiences that fit themes of empowerment and camaraderie, as a result of listening. Conclusions Stuttering-related podcasts seem to be a positive self-help tool for PWS. Stuttering support group leaders and/or speech-language pathologists may consider introducing their group members or clients who stutter to this type of audio-based self-help experience.
Article
Purpose Numerous research studies indicate that stuttering is associated with increased risk for social anxiety disorder (SAD). Interpretation bias is one of four cognitive biases thought to maintain symptoms associated with SAD. Interpretation bias occurs when one evaluates social situations as more negative than they actually are. The purpose of this study was to investigate if adults who do and do not stutter interpret positive, ambiguous, mildly negative, and profoundly negative social situations similarly, or–if like individuals with SAD–adults who stutter exhibit negative interpretation biases. Method Forty-eight adults who stutter and 43 42 age- and gender-matched adults who do not stutter participated. Participants completed the Fear of Negative Evaluation (FNE) and were assigned to one of four groups: adults who stutter with high FNE (AWS-High), adults who stutter with low FNE (AWS-Low), adults who do not stutter with high FNE (AWNS-High), and adults who do not stutter with low FNE (AWNS-Low). All participants completed the trait scale of the State Trait Anxiety Inventory (STAI) and the Interpretation and Judgmental Questionnaire (IJQ). The IJQ contains descriptions of four types of social situations: positive, mildly negative, profoundly negative, and ambiguous. Within each situation type there are five different scenarios, for a total of 20 scenarios across the four situation types. Participants provided written responses to these 20 social scenarios. Qualitative analyses were used to understand how members of each group interpreted the different social scenarios. Results Thematic analysis revealed that each group responded in similar ways to each of the social scenarios, regardless of the type of situation. Adults who do and do not stutter with low and high FNE agreed on many themes related to the 20 social scenarios, and they agreed across all four types of social situations. Somewhat surprisingly, the theme “stuttering” was mentioned infrequently by the adults who stutter. Conclusions Results suggested that adults who do and do not stutter with low and high FNE interpret social situations similarly, and that no group demonstrated a negative interpretation bias consistent with what is observed in adults with SAD. The interpretations provided by each group were appropriate to the specific scenarios being evaluated.
Article
Purpose This study examined the role of uncertainty and perceived control in predicting the communicative participation and mental health of adults who stutter. Method Two hundred sixty-nine adults who stutter completed measures of uncertainty about stuttering, perceived control of stuttering, communicative participation, and global mental health. In addition, participants self-reported on a variety of demographic and speech-related measures. Correlational analyses and hierarchical regression were performed to determine associations between variables of interest. Results Uncertainty accounted for significant variance in communicative participation and global mental health after statistically controlling for the effects of demographic and speech-related variables. Perceived control accounted for significant variance in communicative participation over and above what was accounted for by demographic variables, speech-related variables, and uncertainty. Conclusions The findings suggest that uncertainty about stuttering and perceived control of stuttering should be accounted for during assessment and intervention with adults who stutter. Interventions that specifically target uncertainty and perceived control may be useful in improving therapeutic outcomes for individuals who stutter.
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Publikacja Dialog bez barier – kompleksowa interwencja w jąkaniu. Wydanie polskie rozszerzone to podręcznik dla logopedów, studentów logopedii i innych specjalistów zajmujących się jąkaniem. Książka składająca się z 21 rozdziałów jest kompendium wiedzy teoretycznej i praktycznej na temat skutecznej interwencji w jąkaniu. W publikacji znalazły się rozdziały przygotowane przez badaczy i praktyków, a także specjalistów z osobistym doświadczeniem jąkania z różnych zakątków świata (z Australii, Belgii, Grecji, Kanady, Libanu, Malty, Niemiec, Norwegii, Polski, Stanów Zjednoczonych i Wielkiej Brytanii). Twórcy poszczególnych rozdziałów prezentują holistyczne podejście do interwencji logopedycznej w jąkaniu, uwzględniając wieloaspektowość zajmującego ich zjawiska i wynikające z tego konsekwencje dla pracy logopedy. Podejmują rozważania dotyczące skutecznej profilaktyki, wielowymiarowej diagnozy, poradnictwa ukierunkowanego na klienta/pacjenta i jego rodzinę oraz metod terapii opartych na dowodach. W tomie szczegółowo zaprezentowano współczesne programy terapeutyczne: Camperdown, KIDS, Lexipontix czy MIST. Omówiono temat pracy z grupą, zapobiegania mobbingowi szkolnemu, autoterapii bądź działalności samopomocowej. Poruszono również kwestie, takie jak: jąkanie a wielojęzyczność, zmiana społecznych postaw wobec jąkania, praktyka logopedyczna oparta na dowodach, stawanie się terapeutą zaburzeń płynności mowy, jąkanie neurogenne, a nawet wykorzystanie humoru, kreatywności i współczesnych technologii w interwencji logopedycznej. Publikacja powstała w ramach wdrażania polsko-norweskiej współpracy podjętej przy projekcie LOGOLab – Dialog bez barier (EOG/19/K1/D1/W/0031; partnerzy: Uniwersytet Śląski w Katowicach, Norweski Uniwersytet Arktyczny w Tromsø i Fundacja Wiedzy i Dialogu Społecznego Agere Aude w Chorzowie).
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Language skills have long been posited to be a factor contributing to developmental stuttering. The current study aimed to evaluate whether novel word recognition, a critical skill for language development, differentiated children who stutter from children who do not stutter. Twenty children who stutter and 18 children who do not stutter, aged 3–8 years, completed a novel word recognition task. Real-time eye gaze was used to evaluate online learning. Retention was measured immediately and after a 1-hr delay. Children who stutter and children who do not stutter exhibited similar patterns of online novel word recognition. Both groups also had comparable retention accuracy. Together, these results revealed that novel word recognition and retention were similar in children who stutter and children who do not stutter. These patterns suggest that differences observed in previous studies of language in stuttering may not be driven by novel word recognition abilities in children who stutter.
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Purpose: Stuttering is a disorder that affects millions of people all over the world. Over the pasttwo decades, there has been a great deal of interest in investigating the neural basis of the disorder. This systematic literature review is intended to provide a comprehensive summary of theneuroimaging literature on developmental stuttering. It is a resource for researchers to quicklyand easily identify relevant studies for their areas of interest and enable them to determine themost appropriate methodology to utilize in their work. The review also highlights gaps in the literature in terms of methodology and areas of research. Methods: We conducted a systematic literature review on neuroimaging studies on developmental stuttering according to the PRISMA guidelines. We searched for articles in the pubmed database containing "stuttering" OR "stammering" AND either "MRI", "PET", "EEG", "MEG", "TMS"or "brain" that were published between 1995/ 01/ 01 and 2016/ 01/ 01. Results: The search returned a total of 359 items with an additional 26 identified from a manualsearch. Of these, there were a total of 111 full text articles that met criteria for inclusion in thesystematic literature review. We also discuss neuroimaging studies on developmental stutteringpublished throughout 2016. The discussion of the results is organized first by methodology andsecond by population (i.e., adults or children) and includes tables that contain all items returnedby the search. Conclusions: There are widespread abnormalities in the structural architecture and functional organization of the brains of adults and children who stutter. These are evident not only in speechtasks, but also non-speech tasks. Future research should make greater use of functional neuroimaging and noninvasive brain stimulation, and employ structural methodologies that havegreater sensitivity. Newly planned studies should also investigate sex differences, focus on augmenting treatment, examine moments of dysfluency and longitudinally or cross-sectionally investigate developmental trajectories in stuttering.
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Traditional therapy with children who stutter has focused on providing a tool box of strategies that the child may use to manage his fluency, which may be combined with identification and desensitization of the thoughts and emotions associated with stuttering. Therapy targeted at supporting children to identify their thoughts and feelings, and aiding their understanding of the relationship between cognitions and emotions, can have an important impact on children's speech, even at a young age.
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Failure to reach data saturation has an impact on the quality of the research conducted and hampers content validity. The aim of a study should include what determines when data saturation is achieved, for a small study will reach saturation more rapidly than a larger study. Data saturation is reached when there is enough information to replicate the study when the ability to obtain additional new information has been attained, and when further coding is no longer feasible. The following article critiques two qualitative studies for data saturation: Wolcott (2004) and Landau and Drori (2008). Failure to reach data saturation has a negative impact on the validity on one’s research. The intended audience is novice student researchers. © 2015: Patricia I. Fusch, Lawrence R. Ness, and Nova Southeastern University.
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The use of quantitative, qualitative, and mixed methods approaches has been foundational to research on emerging adulthood, yet there remain many unresolved methodological issues pertaining to how to handle qualitative data. The purpose of this article is to review best practices for coding and establishing reliability when working with narrative data. In doing so, we highlight how establishing reliability must be seen as an evolving process, rather than simply a focus on the end product. The review is divided into three broad sections. In the first section, we discuss relatively more quantitatively focused methods of coding and establishing reliability, whereas in the second section we discuss relatively more qualitatively focused methods. In the final section, we provide recommendations for researchers interested in coding narrative and other types of open-ended data. This article is intended to serve as an essential resource for researchers working on a variety of topics related to emerging adulthood and beyond.
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Much attention has been directed recently toward the problem of measuring occurrences of stuttering with satisfactory levels of interjudge agreement. This paper reviews the prominent concepts of the stuttering event, arguing that they may be one cause of the stuttering measurement problem. The evidence that has led to concerns about the reliability of stuttering event measurements is also reviewed. Reliability and measurement issues that were discussed in the first paper of this series (Cordes, 1994) emerge as basic to the interpretation of much stuttering research, and it is argued that the stuttering measurement problem is not confined to research on stuttering judgments but actually permeates other important stuttering research areas. Some recent attempts to resolve the stuttering measurement problem are reviewed, and the implications of developing an improved measurement system for this disorder are discussed.
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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.
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The practice of conducting research online is in its infancy. Consequently there is debate concerning the ethical implications of online data collection. We outline three approaches to online data collection and focus specifically on the issues of consent and anonymity of participants. We conclude that ethical issues raised when planning and implementing online data collection are no different to those raised by more traditional approaches to data collection.
Article
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.
Article
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.
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Purpose: Method: This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being. Conclusions: Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.
Article
Purpose: Covert stuttering is a type of stuttering experience that occurs when a person who stutters conceals his or her stutter from others, attempting to be perceived as a nonstuttering individual. A person who covertly stutters experiences the cognitive and emotional elements of stuttering with minimum overt behavioral symptoms. Individuals who covertly stutter are able to provide insight into their experiences in attempting to be perceived as nonstuttering individuals. Covert stuttering is a topic that continues to be in need of a formal definition. The current investigation is utilizing thematic analysis to provide a detail-rich investigation of the paradigm shift from covertly stuttering to overtly stuttering. Method: The current investigation is a qualitative analysis of individuals' transition process from covertly stuttering to overtly stuttering. Real-time video interviews were conducted with the use of open-ended phenomenological interview questions. Interviews were transcribed, and thematic analysis of interview transcripts was conducted to investigate the covertly to overtly stuttering process for participants. Results: The findings provide insight into a paradigm shift that occurs when individuals who covertly stutter begin to outwardly identify themselves and allow for overt stuttering. The primary theme was a paradigm shift in the 6 participants' mindset regarding stuttering; additional details are provided in the subthemes: attending speech therapy, meeting other people who stutter, and a psychological low point. The details of the covert-to-overt stuttering conversion are documented with the use of direct quotations. Conclusion: The evidence suggests the various intricacies of the experiences of persons who are covert. Clinical implications of these findings for assessing and treating individuals who covertly stutter are discussed.
Article
Purpose: The first purpose was to define the recovery rate in children who stutter in a clinical sample, adding self-report to validate recovery status. The second purpose was to explore whether children who were judged to be recovered showed subjective experiences that might be interpreted as coping behaviors used to control speech fluency. Methods: In this longitudinal study, preschool-age children whose parents consulted a speech-language pathologist about stuttering were followed for 9 years. At follow-up, children's self-reports on stuttering were reported, as well as traditional criteria on recovery (parental and expert judgment). The Overall Assessment of the Speaker's Experience of Stuttering (OASES) was used to collect children's experiences with speaking. Results: Eleven of the 15 children (73%) were judged by parents and clinicians to have recovered from stuttering. However, when considering children's self-reports, 9 children (60%) might be considered to have recovered. In addition, 3 children who were judged to be recovered reported experiences with speaking that were uncommon, even compared to children who continued to stutter. Conclusion: In this exploratory study of a clinical population, the recovery rate in children that received treatment for stuttering appeared to be comparable to a non-clinical population. Considering self-reports can improve validity of assessing the “recovery rate”. Moreover, recovery in children may not be effortless; instead, it may be the result of conscious or unconscious coping behavior. Future studies are recommended to consider self-reports to improve validity of recovery, and to document experiences with speaking to explore effortless, spontaneous fluency versus controlled fluency.
Article
Neurodiversity is both an empowerment movement and a way of thinking about disability. Rather than focusing on pathology and impairment, neurodiversity emphasizes natural variation and the unique skills, experiences, and traits of neurodivergent individuals. People who stutter are beginning to work with and derive value from these concepts. In this article, we look at the history of neurodiversity and its key ideas. We discuss the conventional view of disability, the medical model, which situates disability within the individual as pathology. We also take up social and relation models of disability, which situate disability in social oppression or mismatches between individuals and their environment. Neurodiversity has not been without controversy. We look at some of the disagreements surrounding issues of intervention and cure. The ideas of neurodiversity are applied to stuttering, and a case example illustrating therapy using these ideas is given. We conclude that therapy should focus on subject's well-being and not normalization of superficial behaviors.
Article
Purpose: This study aimed to identify contributors to communicative participation in adults who stutter. Specifically, it was of interest to determine whether psychosocial variables of self-esteem, self-efficacy, and social support were predictive of communicative participation beyond contributions of demographic and speech-related variables. Method: Adults who stutter (N = 339) completed an online survey that included measures of communicative participation, self-esteem, self-efficacy, social support, self-reported speech-related variables (speech usage, number of years stuttering, history of treatment and self-help support group participation for stuttering, and physical speech disruption severity), and demographics (age, sex, living situation, education, and employment status). Hierarchical regression was performed for prediction of communicative participation, in addition to calculating Spearman correlations between social roles variables, communicative participation, and physical speech disruption severity. Results: After controlling for demographic and speech-related variables, self-esteem, self-efficacy, and social support each significantly predicted communicative participation in adults who stutter. Large correlations were observed between communicative participation and measures of social roles, whereas medium correlations were observed between physical speech disruption severity and measures of social roles. Conclusions: Communicative participation in adults who stutter is associated with a variety of demographic, speech-related, and psychosocial variables. Speech-language pathologists should be aware of predictors of communicative participation such as self-esteem, self-efficacy, and social support, in addition to severity of physical speech disruptions. They should consider and evaluate these factors in clients who stutter and target them in treatment if necessary.
Article
Purpose: The aim of this study was to (1) document the experiences of enacted stigma (external stigma, experienced discrimination) and felt stigma (anticipation and expectation of discrimination or negative treatment by others) in adults who stutter, (2) investigate their relationships to each other, and (3) investigate their relationships to global mental health. Method: Participants were 324 adults who stutter recruited from clinicians and self-help group leaders in the United States. Participants completed an anonymous web survey consisting of measures of enacted stigma, felt stigma, and global mental health. Data analysis focused on obtaining descriptive statistics for enacted stigma and felt stigma, and performing correlational analysis between these variables, and also between these variables and global mental health. Results: Most participants reported experiencing several different forms of social devaluation and negative treatment from other people at some point in their lives (i.e., enacted stigma), although they rarely experienced these events during the past year. Most participants agreed that they anticipate future stigmatizing experiences (i.e., felt stigma). Enacted stigma in the past year demonstrated a significant positive relationship to felt stigma. Both enacted stigma in the past year and felt stigma demonstrated significant negative relationships with global mental health. Enacted stigma in the past year and felt stigma were unique predictors of participants' global mental health. Conclusions: People who stutter experience discrimination and social devaluation, and they anticipate future stigmatizing experiences. Both of these types of stigma, enacted and felt, are associated with reduced mental health in adults who stutter. Assessment and therapy with adults who stutter should address these aspects of stuttering.
Article
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.
Article
Purpose: The aim of this study was to identify potential relationships between self-stigma (stigma awareness and stigma application) and stress, physical health, and health care satisfaction among a large sample of adults who stutter. It was hypothesized that both stigma awareness and stigma application would be inversely related to measures of physical health and health care satisfaction, and positively related to stress. Furthermore, it was anticipated that stress mediated the relationship between self-stigma and physical health. Method: A sample of adults who stutter in the United States (n=397) completed a web survey that assessed levels of stigma awareness and stigma application, stress, physical health, and health care satisfaction. Correlational analyses were conducted to determine the relationships between these variables. Results: Higher levels of stigma awareness and stigma application were associated with increased stress, decreased overall physical health, and decreased health care satisfaction (i.e., discomfort obtaining health care due to stuttering, and adverse health care outcomes due to stuttering), and these relationships were statistically significant. Stress was identified as a mediator between stigma application and physical health. Conclusion: Because adults who stutter with higher levels of self-stigma are at risk for decreased physical health through increased stress, and lower satisfaction with their health care experiences as a result of stuttering, it is important for professionals to assess and manage self-stigma in clients who stutter. Self-stigma has implications for not only psychological well-being, but stress, physical health, and health care satisfaction as well.
Article
Purpose: This exploratory study was the first to obtain quantitative and qualitative data on both personal perceptions and perceived public opinion about stuttering in order to identify topics to include in anti-stigma programs for stuttering. Method: Three-hundred ten adults in the United States completed a web survey that assessed knowledge about stuttering and attitudes toward people who stutter (PWS) with questions addressing personal perceptions (direct questions) and perceived public opinion (indirect questions). Results: Many participants reported favorable personal perceptions of PWS regarding their intelligence, competence, and potential for success. However, most participants did not personally believe PWS were confident, and most believed they were shy. Perceived public opinion was more unfavorable as a majority agreed that the public is uncomfortable talking with PWS and that the public would recommend PWS avoid jobs requiring high speech demands and avoid talking to large audiences. A minority of participants agreed PWS are perceived publicly as capable or mentally healthy. Conclusions: The survey demonstrated misunderstandings and negative perceptions of PWS, especially when measured with perceived public opinion. Results can increase our understanding of content areas that should be included in anti-stigma programs for stuttering and highlight different methods for analyzing public perceptions of stuttering.
Article
Purpose: The experience of passing as fluent, also called covert stuttering, has been uncritically framed as an inherently negative pursuit. Historically passing has been understood as a repression of one's true, authentic self in response to either psychological distress or social discrimination. The authors of this paper seek a more nuanced understanding of passing. We ask, how must a person relate to herself in order to pass as fluent? Methodology: This is a qualitative research study in which the authors utilized the ethical theories of philosopher Michel Foucault to contextualize data obtained from semi-structured interviews with nine participants who pass as fluent. Results: Rather than a repression of an authentic self our data suggests passing is more usefully understood as a form of resistance by people who stutter to a hostile society. Participants learned from experiences of delegitimization that their stuttering had ethical ramifications. Consequently, they used a variety of self-forming practices to pass and thereby achieve the privileges that come with perceived able-bodiedness. Conclusion: Passing as fluent is not an inauthentic form of stuttering but a form of stuttering that is produced through the use of specific technologies of communication. These technologies of communication are constituted by the unique ethical relationship of the person who stutters with herself. Passing can be understood as an active form of resistance rather than a passive form of repression. By theorizing passing as fluent as an ethical relationship, we open up the possibility of changing the relationship and performing it differently.
Article
Objectives: The anticipation of stuttering is a common experience for many people who stutter. In this study, subjective ratings of stuttering anticipation were used to investigate the consistency of anticipation across time, beliefs about how anticipation affects the likelihood of stuttering, and the relationship between anticipation and verbal response time (VRT) in the perceptually fluent speech of 12 adults who stutter (AWS). Method: AWS used a visual analog scale to rate their beliefs about stuttering anticipation in general, and their degree of stuttering anticipation for 50 words at two separate visits that were separated by approximately 1 week. Participants performed a computer-prompted oral reading task with the same 50 words to obtain measures of VRT. Within-subject and group level correlations were used to explore relationships between stuttering anticipation, VRT, and stuttering severity. Results: Six of the participants had word-level stuttering anticipation ratings that were significantly correlated across the two testing visits. Two participants with the highest stuttering severity showed a positive correlation between word-level stuttering anticipation and VRT. Across the group, stuttering severity was positively correlated with the belief that the anticipation of stuttering increases the likelihood of stuttering, and the consistency of word level anticipation ratings across time. Conclusion: The results provide evidence for a relationship between stuttering severity, the consistency of anticipation, and the belief that anticipating stuttering increases the likelihood of stuttering. The relationship between anticipation and VRT in two of the most severe participants provides preliminary evidence that anticipation may be able to subtly influence the speech production system.
Article
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.
Article
Background: Undertaking qualitative research with vulnerable populations is a complex and challenging process for researchers. Traditional and common modes of collecting qualitative data with these groups have been via face-to-face recorded interviews. Methods: This article reports on three internet-based data collection methods; email and synchronous online interviews, as well as online qualitative survey. Results: The key characteristics of using email, sychronous online interviews and an online qualitative survey including the strengths and limitations of each are presented. Reflections and insights on the use of these internet-based data collection methods are provided to encourage researchers to embrace technology and move away from using traditional face-to-face interviews when researching with vulnerable populations. Conclusion: Using the internet to collect qualitative data offers additional ways to gather qualitative data over traditional data collection methods. The use of alternative interview methods may encourage participation of vulnerable participants.
Article
Many people who stutter experience the phenomenon of anticipation-the sense that stuttering will occur before it is physically and overtly realized. A systematic investigation of how people who stutter respond to anticipation has not been previously reported. The purposes of this study were to provide self-report evidence of what people do in response to anticipation of stuttering and to determine the extent to which this anticipation occurs. Thirty adults who stutter indicated on a Likert rating scale the extent to which they anticipate stuttering and answered three open-ended (written) questions regarding how they respond to anticipation. All participants reported experiencing anticipation at least "sometimes," and 77% of the participants reported experiencing anticipation "often" or "always." The extent to which participants reported experiencing anticipation was not related to stuttering severity, impact, or treatment history. Analysis of written responses revealed 24 major categories, which were heuristically divided into action or non-action responses. Categories representing avoidance and self-management strategies were further divided into 14 and 19 subcategories, respectively. Participants were just as likely to view anticipation as helpful as they were to view it as harmful. Findings demonstrate that most, if not all, adults who stutter experience anticipation, and the majority of adults who stutter report doing so at least often. Adults who stutter respond to this anticipation by altering the speech production process in various ways. Results highlight the importance of the role that anticipation plays in how stuttering behaviors manifest themselves. The reader will be able to: (a) summarize existing literature on the anticipation of stuttering; (b) describe the role and extent of anticipation of stuttering in adults; (c) describe the various ways that adults who stutter respond to anticipation; (d) describe the importance of measuring anticipation in clinical and research domains. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
The purpose of this paper is to describe the construct of mindfulness and how this can be applied to stuttering intervention. To increase understanding of the construct, mindfulness is defined, its origin is discussed, and the ways it is traditionally taught and assessed are reviewed. The use of mindfulness in stuttering intervention to facilitate improved well-being, desensitization, increased self-acceptance, reduction of stress and anxiety, and increased internal locus of control also is discussed. You wake up, get dressed and get ready to head to work on a Saturday morning. Your children are at Grandma's for the weekend, and you plan to get some work done. You get into your car and pull out of the driveway, all the while running through your mental list of things that you need to get done at work and then errands after. With your mind full of all that needs to get done, you realize you are on your way to your children's school, not your office. There are probably few people in this world who will not relate to this experience of mindlessness and its counterpart mindfulness. Whether it be this experience of mindlessly following your weekday driving routine or being consumed with outside thoughts, most of us have spent some, perhaps a lot, of time in our head completely unaware of our present experience. The question is: Is your mind full or are you mindful? The purpose of this paper is twofold. First, it will describe the construct of mindfulness and the ways in which it is traditionally assessed and taught. Second, it will illustrate the therapeutic benefits of increased mindfulness and how the construct of mindfulness can be applied to stuttering intervention.
Article
The field of fluency disorders has used Cognitive Behavioral Therapy (CBT) techniques to help clients who stutter manage their thoughts about stuttering by engaging in cognitive restructuring activities. In the late ‘90s, a new form of cognitive therapy called Acceptance and Commitment Therapy (ACT) emerged, stemming from classic CBT and Relational Frame Theory (RFT). Though there is only one documented study in which ACT is used with clients who stutter, there is tremendous clinical potential to assist clients who stutter of all ages using the six core principles of ACT (contact with the present moment, acceptance, thought defusion, self as a context, defining values, and committed actions). The core principles encourage clients who stutter to live a values‐based life by assisting them in defusing adverse thoughts related to stuttering and choosing committed action behaviors and goals in accordance with their individual values through mindfulness practices. Participating in activities related to the core principles of ACT can help clients who stutter to become more psychologically flexible when managing their perceptions related to stuttering. Using ACT can further lead clients toward acceptance of all thoughts while learning to observe themselves in the present moment and make values‐based choices for future behaviors.
Article
The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) proposed by the World Health Organization (WHO, 1980) can be a useful method for describing the experiences of individuals exhibiting speech and language disorders such as stuttering. Unfortunately, the definitions for the terms impairment, disability, and handicap that were previously presented in the stuttering literature have not accurately represented the true purpose of the ICIDH as a tool for describing the consequences of disorders. This paper reviews the history of these terms in the stuttering literature and proposes alternate definitions that are more consistent with the use of the ICIDH elsewhere in the field of communication disorders, as well as within the health-related professions in general. Based on the ICIDH framework, a model is proposed for discussing the outcomes of various types of stuttering treatments in the context of an individual's experience of the stuttering disorder, and the implications for treatment outcomes research using this framework are discussed.
Article
Many authors have suggested that it is possible for clinicians to collect basic data regarding their client's speech fluency on-line, or in real time, while the client is speaking. Unfortunately, the literature contains relatively little in the way of detailed instructions on exactly how such data should be collected. This article provides specific instructions for real-time collection of information about the frequency and types of speech disfluencies produced by individuals who stutter. The paper also outlines procedures for training students and clinicians to use this technique reliably and accurately and proposes tolerance limits for determining whether frequency counts are sufficiently reliable for clinical use.
Article
The fact that some people who stutter have the ability to anticipate a stuttering moment is essential for several theories of stuttering and important for maximum effectiveness of many currently used treatment techniques. The "anticipation effect," however, is poorly understood despite much investigation into this phenomenon. In the present paper, we combine (1) behavioral evidence from the stuttering-anticipation literature, (2) speech production models, and (3) models of error detection to propose a theoretical model of anticipation. Integrating evidence from theories such as Damasio's Somatic Marker Hypothesis, Levelt's Perceptual Monitoring Theory, Guenther's The Directions Into Velocities of Articulators (DIVA) model, Postma's Covert Repair Hypothesis, among others, our central thesis is that the anticipation of a stuttering moment occurs as an outcome of the interactions between previous learning experiences (i.e., learnt associations between stuttered utterances and any self-experienced or environmental consequence) and error monitoring. Possible neurological mechanisms involved in generating conscious anticipation are also discussed, along with directions for future research. The reader will be able to: (a) describe historical theories that explain how PWS may learn to anticipate stuttering; (b) state some traditional sources of evidence of anticipation in stuttering; (c) describe how PWS may be sensitive to the detection of a stuttering; (d) state some of the neural correlates that may underlie anticipation in stuttering; and (e) describe some of the possible utilities of incorporating anticipation into stuttering interventions. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
Objective data on the development of stuttering during its first several months are sparse. Such a deficit is due to parents' tendency to postpone professional consultation regarding early stuttering until later in the course of the disorder and to a lack of longitudinal studies beginning close to onset. This report presents information on a rare group of 16 preschool subjects who were evaluated within several weeks after stuttering onset and followed for 6 months using multiple measures. The findings show that often early stuttering takes on a moderate-to-severe form. Substantial changes occurred, however, during the 6 months of the study, with a strong tendency for reduction in stuttering-like disfluencies, number of head/face movements, clinician severity ratings of stuttering, and parent ratings of stuttering. Several subjects, including severe cases, exhibited complete recovery. The large changes that occur during the early stage of stuttering suggest that relatively small differences in the length of post-onset interval (stuttering history) can greatly influence all research data of early childhood stuttering. The high, as well as fast, improvement rate suggests that the precise timing of early intervention should be conscientiously evaluated in carefully controlled studies.
Article
Reliable and accurate stuttering measurement depends on the existence of unambiguous descriptions or exemplars of stuttered and nonstuttered speech. The development of clinically meaningful and useful exemplars, in turn, requires determining whether persons who stutter judge the same speech to be stuttered that other observers judge to be stuttered. The purpose of these experiments, therefore, was to compare stuttering judgments from several sources: 15 adults who stutter, judging their own spontaneous speech; the same adults who stutter, judging each other's speech; and a panel of 10 authorities on stuttering research and treatment. Judgments were made under several conditions, including self-judgments made while the speaker was talking and self- and other-judgments made from recordings in continuous and interval formats. Results showed substantial differences in stuttering judgments across speakers, judges, and judgment conditions, but across-task comparisons were complicated by low self-agreement for many judges. Some intervals were judged consistently by all judges to be Stuttered or Nonstuttered, across multiple conditions, but many other intervals were either not assigned replicable judgments or were consistently judged to be Non stuttered by the speaker who had produced them but were not assigned consistent judgments by other judges. The implications of these findings for stuttering measurement are considered.
Article
It has come to our attention that minor errors occurred in Table 3 on p. 759 of the Yairi and Ambrose article, "A Longitudinal Study of Stuttering in Children: A Preliminary Report," which appeared in the August 1992 issue (Vol. 35, pp. 755–760). A revised version of the table appears below that includes both the original values and the corrected values (in boldface). As can be seen, the differences are indeed minor. The changes do not affect the reported patterns or level of statistical significance. In the untreated group, 7 or 78% recovered by 24 months post-onset and 1 additional subject recovered later, making a total recovery rate of 89%, with 11% persistent. In the treated group, 11 or 61% recovered by 24 months post-onset and an additional 5 recovered later, again totalling 89% recovery and 11% persistent. These data do not in any way indicate that treatment is not beneficial nor that it has no effect but simply that success rates for treated individuals must take spontaneous recovery into account. We regret the error.
Article
Fifteen-second samples of speech were recorded from 20 adult stutterers. The samples were played to two groups (I and NI) of unsophisticated observers. The 18 observers in the NI Group were instructed to underline any word that was stuttered. The 18 observers in the I Group also were instructed to underline stuttered words, but these observers were given a "standard definition" of stuttering (Wingate, 1964): repetition of a sound, syllable, or one-syllable word; silent or audible prolongation; or both. On the average, observers who were given a definition of stuttering marked more words as stuttered than observers who were told only to mark stutterings. In addition, the observers for whom stuttering was defined also displayed significantly more variability in terms of the average number of words underlined. Both interobserver and intraobserver agreement were significantly higher for the NI Group than the I Group observers. The data from this and other identification studies were used to support the suggestion that the identification of stuttering is a threshold phenomenon.
Article
Much of the recent literature in the field of stuttering has a primary reliance on experimental designs and quantitative analysis. Since human communication is complex and multidimensional, it is difficult to study in an unnatural experimental setting. This paper proposes an alternative methodology for queries into the complex behaviors that are associated with stuttering. Qualitative methodologies have already been used as effective research tools in anthropology, sociology, and several other social sciences. Their emergence in the field of speech-language pathology is recent. The purpose of these paper is to justify the use of qualitative methodologies as an adjunct and/or alternative to more traditional experimental methodologies. Educational Objectives: The reader will learn and be able to (1) describe the objectives of qualitative research, (2) contrast quantitative and qualitative research goals and methods, and (3) list the major strengths and weaknesses of qualitative research.
Article
The attitudes of 1,198 speech-language pathologists toward stuttering, individuals who stutter and their parents, therapy, and related issues were studied between 1983 and 1991. Results of the study were compared with results obtained by the investigators in an identical study conducted between 1973 and 1983 of 674 speech-language pathologists. Among several changes in attitudes observed during the 18-year period were the rejection of concepts suggesting parental causality in fluency disorders, dangers in early intervention, and the perception that individuals who stutter possess characteristic personality traits. The results are interpreted as making a case for enhancing the education of the profession's general practitioner to serve those who stutter as well as developing a cadre of fluency specialists.
Article
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. 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. 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. 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.
Article
This is a response to a Letter to the Editor entitled "Stuttering prevalence, incidence and recovery rates depend on how we define it: Comment on Yairi & Ambrose' article Epidemiology of Stuttering: 21st Century advances" by Paul Brocklehurst (2013). The criticism was directed specifically toward Yairi and Ambrose' conclusions, based on review of recent studies, regarding the incidence and prevalence of stuttering. In this response, Brocklehurst's arguments and suggestions of criteria for incidence research are discussed and negated.
Article
The attitudes of 674 speech-language pathologists toward stuttering, stutterers, stuttering therapy, parents of stutterers, and related issues were studied during the years 1973–1983. During that period, clinician attitudes were found to shift away from support of the John-sonian concepts, which suggest parental causality and dangers in early intervention. In addition, clinicians became less likely to perceive stutterers as possessing psychologic disorders and misperceptions of their problem and of their interpersonal relationships. However, a significant number of clinician's were found to continue to hold unsubstantiated beliefs regarding the personality of stutterers, their parents, and the efficacy of early intervention with very young stutterers. The results of the study were interpreted as suggesting the need to educate fluency specialists.