No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Stuttering as Defined by Adults Who Stutter
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.
... The psychological sources of stuttering Stuttering is a complex, multi-faceted disorder that affects the emotional state, personal life, and social functioning of the person who stutters [Alqhazo et al., 2017;Tichenor, Yaruss, 2019]. The mechanism of the occurrence of speech fluency disorder is still unclear and insufficiently investigated. ...
... Apart from speech disfluency, which hinders free communication, negative emotions (fear, anxiety, shame, etc.) are also a frequent reason why people who stutter report their willingness to participate in therapy. The inability to communicate fluently is usually accompanied by strong emotions such as anger, frustration, guilt, shame or anxiety [Alqhazo et al., 2017;Tichenor, Yaruss, 2019]. There may also appear a feeling of losing control and getting stuck [Klompas, Ross, 2004;Tichenor, Yaruss, 2018;. ...
... There may also appear a feeling of losing control and getting stuck [Klompas, Ross, 2004;Tichenor, Yaruss, 2018;. Emotions that accompany stuttering often lead to disturbances in behavioral, cognitive and emotional responses, which may become inadequate to the situation [Tichenor, Yaruss, 2019]. Moreover, people with impaired speech fluency are generally characterized by increased levels of negative affect and anxiety [Ezrati-Vinacour, Levin, 2004;Blumgart, Tran, Craig, 2010]. ...
The inability to communicate fluently is often accompanied by strong emotions: anger, frustration, shame and fear, however, it is not the rule. Experiencing stuttering is highly dependent on individual characteristics and personality traits. Emotional experiences of people who stutter are increasingly subject to analysis. Notwithstanding, there is a noticeable deficit of research concerning the experiences of people who stutter in daily contact with music, especially on the opera stage, hence the text presents a description of the opera singer’s career and experiences.
... Another challenge is that most neuroimaging research to date has focused on interpreting differences between PWS and typically fluent speakers or how brain imaging patterns are related to quantitative measures of stuttering behavior perceived by human raters (e.g., "trait" vs. "state"; Etchell et al., 2018). This focus has persisted despite ongoing concerns about the stability and reliability of observer-based measures (Constantino, Leslie, et al., 2017;Karimi et al., 2013;Riley, 1972;Tichenor & Yaruss, 2021) and lack of a direct relationship between such measures and the experience of stuttering (Tichenor & Yaruss, 2018, 2019a, 2019b, 2020. Finally, neurocomputational models of stuttering with the promise to predict brain imaging patterns focus on speech motor control (Chang & Guenther, 2020), whereas stuttering encompasses a much wider range of cognitive-affective processes and occurs in the context of and interacts with language production embedded in social interactions (Bloodstein et al., 2021;Garcia-Barrera & Davidow, 2015;Jackson et al., 2015;A. ...
... One significant difficulty is in defining what behaviors or cognitive processes imaging researchers should be studying. Definitions of stuttering tend to focus on primary overt stuttering behaviors (e.g., part-word repetitions), followed by a description of covert features (e.g., word substitution) and overt struggle behaviors (e.g., facial grimacing; Tichenor & Yaruss, 2019b). However, more recent attempts to define stuttering focus on cognitive, behavioral, and affective features shared to a greater or lesser extent across individuals who stutter. ...
... However, more recent attempts to define stuttering focus on cognitive, behavioral, and affective features shared to a greater or lesser extent across individuals who stutter. According to an updated model based on the International Classification of Functioning, Disability and Health (ICF) framework, the primary symptom of stuttering is the internal sensation of being stuck or a feeling of being unable to continue speaking (Tichenor & Yaruss, 2019b;Yaruss, 1998;Yaruss & Quesal, 2006). An important characteristic of this sensation is that it occurs whether a communication partner hears or otherwise observes any overt stuttering behavior. ...
Purpose
This perspective article examines whether brain imaging in stuttering will lead to a translational neuroscience of stuttering.
Method
A brief narrative review of insights gained from neuroimaging in stuttering is provided, followed by a series of questions about whether such insights can facilitate better understanding sufficient to inform a translational neuroscience of stuttering.
Results and Conclusions
Despite the continually growing body of brain imaging data and the introduction of causal approaches, it is unclear whether or how neuroimaging will lead to brain-based approaches to facilitate neuroplasticity or the development of novel interventions. Most neuroimaging studies to date have focused on overt stuttering as a primary behavioral correlate of brain images or causal manipulations, but it is unclear how those measures are related to important insights derived from the internal experience of stuttering. It is suggested that additional knowledge working from cognitive–behavioral–affective measures derived from the experience of stuttering could lead to further insights into underlying mechanisms that would be a boon to translational neuroscience. Following broader objections to reductionism in neuroscience, it is argued that functional models and cognitive processes specific to stuttering in context are critical as epistemological priors followed by careful behavioral and then neurophysiological experiments. As a potential path forward, a pluralistic perspective is offered, working from multifactorial conceptualizations of stuttering and Marr's concept of multiple levels.
... The term adverse impact as it relates to stuttering commonly refers to the negative personal reactions (e.g., negative thoughts, feelings, and behaviors) and the broader speech-or communication-related limitations that a person who stutters experiences in daily life (Tichenor & Yaruss, 2019b;Yaruss, 1998;Yaruss & Quesal, 2006, 2004. Adverse impact that takes the form of negative personal reactions has been well specified in stuttering research. ...
... As noted, many people who stutter experience negative affective, behavioral, and cognitive reactions to their stuttering, and these reactions can be heavily influenced by external factors. These reactions develop as a person lives life dealing with the stuttering condition; the negative valence of their reactions is reinforced and increased by ongoing negative experiences (Tichenor & Yaruss, 2019b). Indeed, personal stories and qualitative research suggest that at least some people who stutter develop feelings of self-hatred and frustration; as a result, they may experience internalized stigma and decreased self-esteem (Ahlbach & Benson, 1994;Boyle, 2013Boyle, , 2016Boyle & Fearon, 2018;Kuster et al., 2013;Tichenor & Yaruss, 2018, 2019b. ...
... These reactions develop as a person lives life dealing with the stuttering condition; the negative valence of their reactions is reinforced and increased by ongoing negative experiences (Tichenor & Yaruss, 2019b). Indeed, personal stories and qualitative research suggest that at least some people who stutter develop feelings of self-hatred and frustration; as a result, they may experience internalized stigma and decreased self-esteem (Ahlbach & Benson, 1994;Boyle, 2013Boyle, , 2016Boyle & Fearon, 2018;Kuster et al., 2013;Tichenor & Yaruss, 2018, 2019b. A lack of social support is also significantly associated with experiencing more negative affective, behavioral, and cognitive reactions (Tichenor & Yaruss, 2019a). ...
Purpose:
Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.
Method:
One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.
Results:
Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.
Conclusions:
Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.
Supplemental material:
https://doi.org/10.23641/asha.23699688.
... Developmental stuttering is a fluency disorder involving disruptions of the rhythmic flow of speech, such as repetition, prolongation, and silent blocks (e.g., Bloodstein & Ratner, 2008;Guitar, 2018), and signifies a constellation of experience beyond the observable speech disfluency (Tichenor & Yaruss, 2019a;Tichenor, Herring, & Yaruss, 2022). Symptoms of stuttering disfluency generally begin in early childhood (Guitar, 2018;Yairi & Ambrose, 2013) and, as the person becomes older, secondary psychological problems such as fear and anxiety associated with speech or communication could become severe in people who stutter (PWS) [Blumgart, Tran, & Craig, 2010;Iverach & Rapee, 2014], which decrease their quality of life (Craig, Blumgart, & Tran, 2009;Koedoot, Bouwmans, Franken, & Stolk, 2011). ...
... Stuttering assessment or therapy has recently been focused on the psychological problems related to stuttering (Tichenor et al., 2022;Vanryckeghem & Brutten, 2011;Yaruss & Quesal, 2006). In addition to the assessment of observable speech problems, it is important to better understand and describe what PWS experience during the moment of stuttering (Tichenor et al., 2022;Tichenor & Yaruss, 2019a). Therefore, professions related to speechlanguage pathology are encouraged to understand the importance of psychological problems of stuttering and of addressing these issues. ...
... It is also difficult to measure stuttering severity through questionnaires, and it needs to be measured strictly by professionals, such as speech-language-pathologists, based on participants' speech visual performance. However, the perceptions retrieved from PWS themselves are still valuable to better understand the characteristics of stuttering that are not limited in the surface (Tichenor et al., 2022;Tichenor & Yaruss, 2019a). ...
Many studies have reported that stuttering self-help/support groups have a positive psychological effect on people who stutter (PWS). This systematic review aims to identify and synthesize the published research articles that quantitatively investigate, with a control condition, the influence of the self-help/support group experience on PWS. The literature review was conducted on 6 July 2020 and updated on 14 April 2022. We searched the PubMed, Education Resources Information Center, Web of Science, and PsycINFO databases for articles containing the words 'stuttering' OR 'stammering' AND 'self-help' OR 'support group.' The inclusion criteria were: participants had a stutter, main text was in English, study used an experimental or quasi-experimental design, and the quantitative outcomes of the self-help/support group activities were measured. We collected the information and main findings of each article. Nine articles met all the inclusion criteria. Various questionnaires were used to measure the psychological aspects related to general characteristics of personality or stuttering. The effect of the self-help/support group experience varied; most articles reported positive effects, while some articles reported not significant or mixed effects. Our systematic review overviewed the previous quantitative studies and summarized the results of each psychological scale. Overall, the experience of stuttering self-help/ support group had a positive psychological effect on PWS regarding their stuttering.
... 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). ...
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.
... 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). ...
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.
... 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). ...
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.
... Belief regarding the etiology of stuttering") included items that are supposed to be "environmental, " we did not consider the biopsychosocial framework, such as the International Classification of Functioning, Disability, and Health (ICF), for the included items. In the ICF framework, disability is illustrated as the interaction of personal conditions and social-related factors such as personal and environmental factors (World Health Organization [WHO], 2001;Yaruss and Quesal, 2004;Tichenor and Yaruss, 2019). Furthermore, the framework of the ICF illustrates not only the causes of disabilities, but also their effects, such as how the reactions speakers receive from other people can influence their own reactions to stuttering (Yaruss and Quesal, 2004;Tichenor and Yaruss, 2019). ...
... In the ICF framework, disability is illustrated as the interaction of personal conditions and social-related factors such as personal and environmental factors (World Health Organization [WHO], 2001;Yaruss and Quesal, 2004;Tichenor and Yaruss, 2019). Furthermore, the framework of the ICF illustrates not only the causes of disabilities, but also their effects, such as how the reactions speakers receive from other people can influence their own reactions to stuttering (Yaruss and Quesal, 2004;Tichenor and Yaruss, 2019). The social factors of stuttering should be assessed in future research. ...
Purpose
Developmental stuttering is a fluency disorder that may be caused by neurological, genetic, or familial factors. However, a general perception that stuttering is caused by psychological problems could lead to negative attitudes toward stuttering, causing prejudice or discrimination against people who stutter (PWS). Thus, our study aimed to investigate whether certain beliefs in etiology of stuttering are related to the negative perception of stuttering.
Methods
A web-based survey of 413 native Japanese adults, aged 20−69, who did not suffer from stuttering, schizophrenia, or depression, was conducted in August 2021. The participants were recruited through the Web monitor panel. Participants were divided into three uniform groups based on their response to a 27-item questionnaire about their implicit belief regarding the etiology of stuttering: belief in the biological model (stuttering-biological group), belief in the psychological model (stuttering-psychological group), and the control group (those who responded to perception of healthy adult males). Participants were also asked to respond to 25 items of semantic differential scales about perception of stuttering or healthy adult males. Responses were summarized into several factors by factor analysis, and factor scores were compared among the three groups. The stuttering-biological group had the fewest participants, comprising 80 individuals. Overall, a total of 240 participants, 80 from each group, were included in the analysis.
Results
Some pairs of stereotypes included in semantic differential scales revealed differences between the groups; PWS, irrespective of the participants of the biological or psychological group, were considered as having negative stereotyping properties such as being “tense,” “anxious,” or “afraid.” Additionally, three concepts from the factor analysis of these 25 items were analyzed using an analysis of variance, and significant differences were found; the mean factor score of the “danger” stereotype was lower in the stuttering-biological group compared to the stuttering-psychological group.
Conclusion
Although the simplification of the biological model is not recommended, anti-stigma campaigns to educate people that stuttering is caused by multidimensional factors, not just psychological ones, could change the general public’s negative perceptions of stuttering.
... Previous authors have proposed that behaviors exhibited by people who stutter can be categorized into core and secondary behaviors (Brutten & Shoemaker, 1967;Van Riper, 1982). However, recent findings point to a different viewpoint (Tichenor & Yaruss, 2019a) that is, "core" and "secondary" behaviors fall under the same umbrella. The viewpoint of the current author is that collective "core" and "secondary" behaviors simply represent different reactions and responses to anticipation. ...
... For nearly all (if not all) people who stutter, realization of stuttering occurs consciously or subconsciously before execution of the desired utterance (Jackson et al., 2015), meaning stuttering is present when first perceived (Tichenor & Yaruss, 2018;Tichenor & Yaruss, 2019a), which occurs first as an internal disruption (i.e., anticipated). There are similarities with the present conceptualization of anticipation of stuttering to Johnson's anticipatory avoidance theory, which defines stuttering as those behaviors that a PWS exhibits as a result of trying not to stutter again (Johnson, 1938). ...
The experience of stuttering is wide ranging and includes a variety of perceived and unperceived behaviors and experiences. One of those experiences is anticipation of stuttering. While anticipation of stuttering is commonly discussed in terms of being a prediction of an upcoming event, it has also been equated to an internal realization of stuttering - which is the conceptualization applied here. The aim of this paper is to impress upon the reader that anticipated moments of stuttering (whether at a conscious or subconscious level) must be met with an adaptive reaction or response (which may also occur consciously or subconsciously). While these adaptive reactions and responses may differ based on whether they promote positive or negative communicative behaviors, they still represent adaptations by the speaker. Among the broad category of reactions and responses to anticipation of stuttering are motoric adaptations to speech, which include characteristic stuttering behaviors and other adaptations that may contribute to speech that is perceived by listeners as fluent. An outcome of this conceptualization is, even when adaptations result in listener perceived fluency, the speech of the person who stutters is still controlled by stuttering - meaning that some observable or unobservable adaptation is required. It is critical that speech-language pathologists recognize that the behaviors of people who stutter may reflect reactions and responses to an internal realization of stuttering and observable and unobservable reactions and responses must be considered in both assessments and interventions.
... It is unclear, however, how adverse impact develops in people who stutter. We define the adverse impact of stuttering as the summative effect of the negative thoughts, feelings, and behaviors that a person develops in reaction to the underlying impairment, combined with the real-world limitations that result from living with the condition (Tichenor & Yaruss, 2019;Yaruss & Quesal, 2004). Yaruss and colleagues adapted the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (WHO, 2001) classification scheme for stuttering to provide a more comprehensive profile of the condition and meaningful framework to capture how individuals experience stuttering (Tichenor & Yaruss, 2019;Yaruss, 1998;Yaruss & Quesal, 2004). ...
... We define the adverse impact of stuttering as the summative effect of the negative thoughts, feelings, and behaviors that a person develops in reaction to the underlying impairment, combined with the real-world limitations that result from living with the condition (Tichenor & Yaruss, 2019;Yaruss & Quesal, 2004). Yaruss and colleagues adapted the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (WHO, 2001) classification scheme for stuttering to provide a more comprehensive profile of the condition and meaningful framework to capture how individuals experience stuttering (Tichenor & Yaruss, 2019;Yaruss, 1998;Yaruss & Quesal, 2004). Their adaptation includes barriers associated with the impairment (observable characteristics including speech disfluencies) along with the adverse impact (e.g., negative thoughts, societal stigma, and limitations/barriers to participation) to a person's life. ...
Purpose:
People who stutter often experience significant adverse impact related to stuttering. However, it is unclear how adverse impact develops in children who stutter (CWS) and whether there are protective factors that may mitigate its development. This study examined the relationship between resilience, a potentially protective factor, and stuttering's adverse impact in CWS. Resilience comprises external factors, such as family support and access to resources as well as personal attributes, making it a comprehensive protective factor to explore.
Method:
One hundred forty-eight CWS aged 5-18 years completed the age-appropriate version of the Child and Youth Resilience Measure (CYRM) and the Overall Assessment of the Speaker's Experience of Stuttering. Parents completed a caregiver version of the CYRM and a behavioral checklist for their child. The adverse impact of stuttering was modeled as a function of resilience (external, personal, and total), controlling for child age and behavioral checklist score. We also estimated correlations between child-report and parent-report CYRM measures to assess rater agreement.
Results:
Children reporting greater external, personal, or total resilience were more likely to experience lower degrees of adverse impact related to their stuttering. We documented stronger correlations between younger child and parent ratings of resilience and weaker correlations between older child and parent ratings.
Conclusions:
These results yield valuable insight into the variability of adverse impact experienced by CWS and offer empirical support for strength-based speech therapy approaches. We discuss the factors that contribute to a child's resilience and provide practical suggestions for how clinicians can incorporate resilience-building strategies into intervention for children experiencing significant adverse impact from their stuttering.
Supplemental material:
https://doi.org/10.23641/asha.23582172.
... Another way that ableism has historically shaped the discipline of speech-language pathology is through an emphasis on listener-focused definitions of stuttering and outcomes of stuttering therapy. With few exceptions (e.g., Perkins, 1990;Tichenor & Yaruss, 2019), definitions of stuttering and classification systems for identifying it have Table 2. Modeling empowering ways of talking about stuttering with clients: hypothetical exchanges. ...
... been based on features that can be observed by listeners, as opposed to what is experienced by speakers (for a brief review, see Tichenor & Yaruss, 2019). The emphasis on the observable components of stuttering (i.e., production of overt stuttering-like disfluencies), rather than the unobservable features (i.e., feeling a loss of control), also shapes expectations for what "effective" outcomes of stuttering therapy should look like. ...
Purpose
The purposes of this tutorial are (a) to critically review the ways in which stuttering therapy and research are both constrained by and resistant to ableism and (b) to offer practical suggestions for further interrupting stuttering-related ableism in the discipline of speech-language pathology.
Method
At the beginning of the tutorial, the concept of ableism is introduced and the effects of ableism on people who stutter are discussed. Following an overview of the discipline's current strengths in resisting ableism associated with stuttering, five practical suggestions for further interrupting ableism are provided. To illustrate how these suggestions might be enacted, real and hypothetical clinical and research scenarios are presented throughout. Although this tutorial draws heavily on the experiences of adults who stutter, many of the concepts are also relevant to kids and teens who stutter.
Conclusion
Speech-language pathologists can be change agents in interrupting ableism associated with stuttering and powerful allies to people who stutter.
... Stuttering is often viewed by listeners as consisting primarily of overt disfluencies, such as repetitions, prolongations, and blocks; however, the experience of stuttering involves much more than just observable speech disruptions. 1 Individuals who stutter consistently report that the defining characteristic of a moment of stuttering is a sensation of being 'stuck' or of 'losing control' of their speech, and this feeling ultimately leads to adverse impact in their lives. 1 Because this fundamental aspect of stuttering may not be fully apparent to listeners, it is imperative that assessment (and, ultimately, treatment) accounts for individual experiences of stuttering. ...
... Stuttering is often viewed by listeners as consisting primarily of overt disfluencies, such as repetitions, prolongations, and blocks; however, the experience of stuttering involves much more than just observable speech disruptions. 1 Individuals who stutter consistently report that the defining characteristic of a moment of stuttering is a sensation of being 'stuck' or of 'losing control' of their speech, and this feeling ultimately leads to adverse impact in their lives. 1 Because this fundamental aspect of stuttering may not be fully apparent to listeners, it is imperative that assessment (and, ultimately, treatment) accounts for individual experiences of stuttering. This is most commonly done via selfreport measures. ...
This commentary is on the original article by Boyce et al. on pages 1297–1306 of this issue.
... consequences. 1,2 In addition to the audible characteristics heard by the listener, stuttering also includes unobserved experiences which are not readily perceived, creating differences in the speaker's and listener's characterizations of stuttering (i.e., observable and unobservable behaviors and reactions). In other words, what a listener hears differs quite substantially from the experience of a person who stutters (PWS). ...
... 6 When a PWS anticipates stuttering, they are aware of its presence before speech is executed, and as a result, they may (1) exhibit observable signs of stuttering; (2) motorically change how speech is delivered (either consciously or subconsciously); (3) avoid words, people, places, and/or situations; or (4) exhibit speech that is perceivably fluent to the listener, as stuttering is oftentimes experienced by the speaker even when not perceived by the listener. 1,[5][6][7] Therefore, in response to the internal loss of control (or anticipation of stuttering), the PWS either consciously or subconsciously makes a choice to either approach or avoid the situation. The choice of the PWS to either approach or avoid speaking situations 6 is a determinant to either impaired or improved well-being, which can include career satisfaction. ...
Stuttering is a complex communication disorder with effects that extend beyond difficulty with communication. Negative thoughts and feelings by the person who stutters (PWS), about the disorder or themselves, may potentially lead to detrimental avoidance behaviors which may ultimately alter life choices and participation in life events. One such area is the labor market. Studies have revealed an association between stuttering and reduced earnings. What is not understood is whether provision of speech therapy for PWS can help mitigate the negative labor market impacts of this condition. This article discusses the disorder of stuttering and how approach versus avoidance responses can contribute to wage differentials among PWS, while also providing evidence of such differences using a nationally representative dataset. Additionally, this article outlines the potential benefits received from speech-language pathology services which may correlate with improved labor market outcomes.
... [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. ...
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.
... In summary, although frequency and severity of stuttering may fluctuate from day to day and with the speaking situation, the existence of broad variations of type and severity of symptoms in AWS (Tichenor and Yaruss, 2019) suggests that stuttering may be a heterogeneous disorder and the phenotypic characteristics may be different from one group to another. ...
Childhood-onset fluency disorder, commonly referred to as stuttering, affects over 70 million adults worldwide. While stuttering predominantly initiates during childhood and is more prevalent in males, it presents consistent symptoms during conversational speech. Despite these common clinical manifestations, evidence suggests that stuttering, may arise from different etiologies, emphasizing the need for personalized therapy approaches. Current research models often regard the stuttering population as a singular, homogenous group, potentially overlooking the inherent heterogeneity. This perspective consolidates both historical and recent observations to emphasize that stuttering is a heterogeneous condition with diverse causes. As such, it is crucial that both therapeutic research and clinical practices consider the potential for varied etiologies leading to stuttering. Recognizing stuttering as a spectrum disorder embraces its inherent variability, allowing for a more nuanced categorization of individuals based on the underlying causes. This perspective aligns with the principles of precision medicine, advocating for tailored treatments for distinct subgroups of people who stutter, ultimately leading to personalized therapeutic approaches.
... Stuttering, a complex fluency disorder, affects speech and disrupts communication [22,23]. Its causes are unclear and may involve biological and psychological factors [24], leading to frustration and isolation [25]. Speech therapy [26] aims to improve fluency, reduce anxiety, and boost confidence [27]. ...
The popularity of automatic speech recognition (ASR) systems nowadays leads to an increasing need for improving their accessibility. Handling stuttering speech is an important feature for accessible ASR systems. To improve the accessibility of ASR systems for stutterers, we need to expose and analyze the failures of ASR systems on stuttering speech. The speech datasets recorded from stutterers are not diverse enough to expose most of the failures. Furthermore, these datasets lack ground truth information about the non-stuttered text, rendering them unsuitable as comprehensive test suites. Therefore, a methodology for generating stuttering speech as test inputs to test and analyze the performance of ASR systems is needed. However, generating valid test inputs in this scenario is challenging. The reason is that although the generated test inputs should mimic how stutterers speak, they should also be diverse enough to trigger more failures. To address the challenge, we propose ASTER, a technique for automatically testing the accessibility of ASR systems. ASTER can generate valid test cases by injecting five different types of stuttering. The generated test cases can both simulate realistic stuttering speech and expose failures in ASR systems. Moreover, ASTER can further enhance the quality of the test cases with a multi-objective optimization-based seed updating algorithm. We implemented ASTER as a framework and evaluated it on four open-source ASR models and three commercial ASR systems. We conduct a comprehensive evaluation of ASTER and find that it significantly increases the word error rate, match error rate, and word information loss in the evaluated ASR systems. Additionally, our user study demonstrates that the generated stuttering audio is indistinguishable from real-world stuttering audio clips.
... Any discussion of prevalence estimates, onset and recovery, and risk factors of stuttering is complicated by disagreement over what the diagnostic criteria for stuttering should be, and even how stuttering should be defined (cf. Tichenor and Yaruss, 2019). Moreover, decisions about intervention and treatment depend on additional factors besides diagnosing the presence of the disorder, such as severity, life impact, and attitudes toward stuttering. ...
Introduction
Bilingualism has historically been claimed to be a risk factor for developmental stuttering. The Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) ostensibly contains evidence to test that claim.
Methods
We analyze data from monolingual and bilingual children in Kindergarten through fifth grade in the ECLS-K:2011.
Results and discussion
The prevalence, male/female ratio, and onset and recovery of reported stuttering in the ECLS are inconsistent with widely-accepted clinical reports of stuttering. We argue that the reported figures may be misleading. We discuss some factors that may inflate the reported prevalence, including a lack of awareness of the difference between stuttering vs. normal disfluencies, and the informal usage of the word “stuttering” on the part of teachers and parents to describe typical disfluencies.
... The implications of stuttering in an individual's life extend far beyond the mere experience of disfluency. They might include unobservable emotional reactions, such as guilt, shame, embarrassment, anxiety, and fear, as well as behavioral reactions, such as avoidance and struggle, that accompany the noticeable disfluency (Sheehan, 1970;Tichenor & Yaruss, 2019). Additional consequences of stuttering include selfstigma (Boyle & Blood, 2015;Boyle & Fearon, 2018) and cognitive patterns such as rumination (Tichenor & Yaruss, 2020). ...
Purpose:
Mindfulness is defined as intentional, present-moment, nonjudgmental awareness. Previous studies have proposed that mindfulness practice may benefit people who stutter. This study aimed to test the relationship between levels of dispositional mindfulness in people who stutter and the impact of stuttering and whether self-compassion and the metacognitive ability of shifting to an objective perspective (decentering) mediate this relationship. It is hypothesized that greater dispositional mindfulness is associated with attenuated negative impact of stuttering on a person's life through a higher capability to shift into an objective and compassionate perspective.
Method:
A total of 150 Israeli adults who stutter completed a full online survey in Hebrew to assess their levels of dispositional mindfulness, self-compassion, decentering capability, and impact of stuttering on their lives. The relationships between constructs were assessed using Pearson's correlation and mediation analysis.
Results:
The adverse impact of stuttering was negatively and moderately associated with dispositional mindfulness, such that individuals with greater self-reported dispositional mindfulness reported fewer reactions to stuttering, difficulty in communication, and higher quality of life. This relationship was fully and sequentially mediated via decentering and self-compassion, which were also negatively and moderately associated with the impact of stuttering.
Conclusions:
People who stutter with greater dispositional mindfulness have an increased ability to view their experiences in a more objective and compassionate manner, which is associated with an attenuated impact of stuttering on their lives. As these capabilities can be cultivated through practice, this study proposes mindfulness practice as an additional beneficial tool for people who stutter.
... Empirical evidence from the field of psychology and from stuttering research suggest that the association between stuttering and anxiety could be bi-directional (e.g., Koenraads et al., 2021). Namely, the anxiety reported by people who stutter could be the result of the experience of stuttering (Tichenor & Yaruss, 2018, 2019a, 2019b. It is also possible that some people who stutter experience greater anxiety than other people who stutter because of their temperament. ...
Purpose:
The purpose of this study was to investigate whether 3- to-6-year-old children who stutter and exhibit a higher degree of behavioral inhibition (BI), a correlate of shyness, stutter more frequently and experience greater negative consequences of stuttering (per parent-report) than their peers who stutter but have lower BI.
Method:
Forty-six children who stutter (CWS; 35 boys & 11 girls; mean age 4 years, 2 months) participated. Their degree of BI was assessed by measuring the latency to their 6th spontaneous comment during a conversation with an unfamiliar examiner (following Kagan, Reznick, & Gibbons's (1989) methodology). The frequency of stuttering and the negative impact of stuttering that CWS may have experienced was assessed using parent reports (i.e., Test of Childhood Stuttering (TOCS) Observational Rating Scale; Gillam, Logan, & Pearson, 2009).
Results:
We found that children's degree of BI was not associated with their speech fluency per parent report. However, children's degree of BI was significantly associated with greater negative consequences of stuttering. Specifically, among the four categories of TOCS Disfluency-Related Consequences, children's BI significantly predicted the occurrence of physical behaviors that accompany moments of stuttering (such as increased tension or excessive eye blinks). Other Disfluency-Related Consequences, such as avoidance behaviors, negative feelings, and negative social consequences, were not associated with children's behavioral inhibition tendencies. Additionally, children's stuttering severity (per the Stuttering Severity Instrument-4 scores) was significantly associated with increased physical behaviors that accompany moments of stuttering and greater negative social consequences of stuttering.
Conclusions:
This study provides empirical evidence that behavioral inhibition to the unfamiliar may have salience for childhood stuttering as it predicted the development of physical behaviors associated with stuttering (e.g., tension or struggle) in 3- to 6-year-old CWS. Clinical implications of high BI for the assessment and treatment of childhood stuttering are discussed.
... While speech-related behaviors associated with stuttering (repetitions, prolongations) are most noticeable, affective and cognitive reactions such as anxiety, fear, and shame are primary contributors to the stuttering experience (Plexico et al., 2009b(Plexico et al., , 2009aTichenor & Yaruss, 2018, 2019b. This is due to negative listener reactions to stuttering (e.g., teasing, mocking, confusion), which contribute to social anxiety (Iverach et al., 2009(Iverach et al., , 2016 as stutterers learn to expect these reactions in their daily interactions. ...
Stuttering is a neurodevelopmental communication disorder that can lead to significant social, occupational, and educational challenges. Traditional behavioral interventions for stuttering can be helpful, but effects are often limited. Classic psychedelics hold promise as a complement to traditional interventions, but their impact on stuttering is unknown. We conducted a qualitative content analysis to explore potential benefits and negative effects of psychedelics on stuttering using publicly available Reddit posts. A combined inductive-deductive approach was used whereby meaningful units were extracted and codes were initially assigned inductively. We then deductively applied an established framework to organize the effects (i.e., codes) into five subthemes (Behavioral, Emotional, Cognitive, Belief, and Social Connection), each of which was grouped under an organizing theme (positive, negative, neutral). Results indicated that the effects of psychedelics spanned all subthemes. Nearly 75% of participants reported overall positive effects. Nearly 60% of participants indicated positive behavioral change (e.g., reduced stuttering, increased speech control), 40% reported positive emotional benefit, 15% reported positive cognitive changes, 12% reported positive effects on beliefs, and 7% indicated positive social effects. Approximately 10% of participants reported negative behavioral effects (e.g., increased stuttering, reduced speech control). Psychedelics may help many stutterers improve communication, cultivate a healthier outlook, and promote psychological well-being. These preliminary results indicate that future clinical trials investigating psychedelic-assisted speech therapy for stuttering are warranted.
... Despite of the stuttering severity reduction after VR treatment, including 3 years' post-treatment data, the authors agree with the phenomenological analyses of the experience of stuttering reported by Tichenor and Yaruss who wrote that "…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" (Tichenor & Yaruss 2019, p. 1180. Generally, the AWS functioned successfully, but they continued to experience minimal limitations in their ability to feel satisfied with their university training. ...
Purpose: The main purpose of this study is to apply a multidimensional comprehensive instrument to evaluate the overall impact of stuttering (OASES-A) from the perspective of adults who stutter (AWS) who completed one of two intensive stuttering therapies: The La Trobe prolonged speech program and Van Riper’s non avoidance approach. Methods: The OASES-A was applied to evaluate participants’perceptions of their experience of stuttering with the specific aim of compare the changes in the experience of stuttering following two intensive treatments. An essential element in post-treatment evaluation are changes in the speaker’s self reported quality of life. Results: OASES-A group results regarding the La Trobe and Van Riper intensive treatment outcomes show positive changes in stuttering experience for 27 AWS in four sections: 1) general information on stuttering; 2) reactions to stuttering; 3) communication in daily situations; and 4) quality of life. Conclusions: The article represents the first English-language documentation of the Bulgarian results of OASES-A application of previously conducted intensive treatments. OASES-A outcomes show significantly greater overall improvement and changes in the four sections that relate to the experience of stuttering following two intensive treatments. As a research-based instrument for assessment of quality of life in AWS, the OASES-A was easy to administer and analyze. The OASES-A describes in substantial detail the experience and influence that stuttering exerts on quality of life from the client’s perspective. Its application was preferred because it assists speech-language pathology Master’s degree students to recognize the speech needs, abilities, preferences, and interests of AWS.
... The ICF also defines discrepancies in the individual's experiences and reactions within the personal and environmental contexts. yaruss and Quesal (2004; see also Yaruss, 1998) adapted the ICF framework to stuttering, and the framework was updated by Tichenor and Yaruss (2019) to more directly account for the experiences of people who stutter. The self-report instrument The Overall Assessment of the Speaker's Experience of Stuttering -OaSES (yaruss & Quesal, 2006, 2016 was developed based on the World Health Organization's original the International Classification of Impairments, Disabilities, and Handicaps (ICIDH;WHO, 1980WHO, , 1993 and the current ICF. ...
Summary The Overall Assessment of the Speaker’s Experience of Stuttering (OaSES; yaruss & Quesal, 2006; 2016) is a comprehensive evaluation tool designed to support holistic, evidence-based diagnostic and therapeutic decision-making for children, teenagers, and adults who stutter. The OASES is based on the World Health Organization’s International Classification of Functioning, Disability, and Health (WHO, 2001) as adapted to stuttering by Yaruss and Quesal (2004; see also Tichenor & Yaruss, 2019). It enables diagnosticians to gather information about the totality of the stuttering experience, including its social, emotional, and cognitive aspects. It also allows a deep exploration of the quality of life of an individual who stutters. This paper presents the study results for the Polish version of the OASES-S (for school-age children, ages 7 to 12). The general purpose of the study was to develop the Polish translation of the OASES-S and then to evaluate the validity and reliability of that translation. The OASES-S-PL was evaluated based on a sample of 55 Polish-speaking school-age children who stutter. The study findings show that OASES-S-PL can be considered a high validity test. Given the limited number of evidence-based and standardized Polish diagnostic tools, the OASES-S-PL has important therapeutic implications for the treatment of stuttering in the population of polish children.
... Simple fluency or disfluency was used because it is unclear whether there are qualitative distinctions between TDs and the SLDs produced by CWNS that would make a meaningful difference in the outcomes of these models. In other words, hallmarks of stuttering are tension and a feeling of being "stuck" (Ambrose & Yairi, 1994;Tichenor et al., 2017;Tichenor & Yaruss, 2019). To our knowledge, there is no evidence that CWNS experience tension or a feeling of being stuck when producing behaviors coded as SLDs, and therefore, we chose not to separate SLDs and TDs in these analyses. ...
Purpose
Most therapy programs for young children who stutter (CWS) involve caregiver counseling and adjustment of caregiver behavior to maximize opportunities for the child to be more fluent. One component sometimes included as a recommended adjustment is a reduction in caregiver question asking, as question asking is hypothesized to increase language formulation demands on the child. However, there is limited research to guide clinician advisement to caregivers that has controlled for numerous potential confounding factors, including utterance length and grammaticality, that may impact potential stressors on children. Our aim was to assess whether there was an empirical basis for such recommendations by comparing disfluency profiles of answers to questions and nonanswer utterances produced by children during spontaneous play with parents and examiners.
Method
We analyzed fluency and structural properties as well as pragmatic function of 15,782 utterances from language samples produced by 32 CWS and 32 children who do not stutter (CWNS) who were between 28 and 50 months of age. CWS and CWNS were matched on gender and age within 4 months and were matched as closely as possible on maternal education.
Results
For utterances produced by CWS, answers to adult questions were significantly less likely to contain stuttering-like disfluencies than other utterance types, and this was still true after controlling for utterance length and grammaticality. In contrast, for utterances produced by CWNS, answers to questions were significantly more likely to be disfluent than other utterance types after controlling for length and grammaticality.
Conclusion
Given the current findings, some prior research, and the documented potential benefits in language development for adult question asking of children, we do not believe that clinicians need to recommend changes to typical question-asking behavior by caregivers of CWS.
... This dovetails with findings from Neumann et al. (2019), in which adults who stutter identified social support as an important facilitator of positive change. The emphasis on social relationships reported by adults who stutter supports the utility of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) as a comprehensive framework for clinical decision making with clients who stutter (Tichenor & Yaruss, 2019). The ICF framework indicates that stuttering therapy can and should address participation restrictions (e.g., forming relationships) in addition to the primary impairment of feeling "stuck" while speaking. ...
Purpose
The purpose of the current study was to document the pros and cons that adults who stutter may consider when deciding to change how they live with stuttering.
Methods
Semi-structured interviews were conducted with 11 adults who stutter and 12 speech-language pathologists who specialize in stuttering therapy. Participants were asked to identify and discuss the advantages and disadvantages of making a change to how they live with stuttering. Reflexive thematic analysis was used to generate multilevel themes.
Results
Meaningful units were extracted from interview transcripts to develop 37 discrete pros and 15 discrete cons. The pros of change clustered into five organizing themes: enriching one’s social relationships, feeling better in social interactions, developing a healthier sense of self, gaining autonomy, and communicating easier. The cons of change clustered into three organizing themes: experiencing discomfort, expending resources, and recognizing that some things may not change.
Conclusion
This study documented why adults who stutter may or may not seek change. Identifying the pros and cons of behavior change is an important step in understanding why some clients who stutter are ambivalent about, or resistant to, the therapeutic process.
... Stuttering involves more than just observable behaviors, such as repetitions, prolongations, and blocks (Bloodstein et al., 2021). It should be viewed as a multifactorial issue involving environmental, genetic, and constitutional factors (Ambrose & Yairi, 1999;Conture, 2001;Smith & Weber, 2017;Rocha et al., 2019a;Rocha et al., 2019b) that can lead to activity limitations and participation restrictions in a person's life (Tichenor & Yaruss, 2019;Yaruss & Quesal, 2004;2006). Stuttering is likely to affect education, health, personal relationships, social life, and occupation (e.g. ...
Stuttering is a neurodevelopmental disorder involving interruptions in the flow of speech. The reactions of listeners and others in a child’s environment could affect how children perceive their stuttering. Children experience many of their everyday social situations in the school context. Because it might be hard for children who stutter to deal with communication in the school setting, it is essential to know how teachers perceive the impact of stuttering on their students. In this study, we collected data about teachers’ perceptions of the impact of stuttering on Portuguese children who stutter using an adaptation of the European Portuguese translation of Overall Assessment of the Speaker’s Experience of Stuttering (OASES-S-PT). Participants were 27 teachers and their students who stutter (n=27; mean age=9.0 mos., SD=1.8 mos.), recruited from different cities in Portugal. In general, teachers perceived the overall impact of stuttering in their students’ lives as mild-to-moderate. Our results did not reveal any statistically significant differences between the teachers’ perceptions of the impact of stuttering and the students’ self-reports. Still, there was no statistically significant correlation between the students’ impact scores and the teachers’ impact scores. Teachers were unable to rate several items on the instrument, which indicates that they were unfamiliar with some aspects of the children’s experiences with stuttering. This finding highlights the need to integrate teachers into therapy programs to increase support within the environment of for children who stutter.
... 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. ...
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
... Expanding on their recent line of research, Tichenor and colleagues (2022) review their revised framework for stuttering based on the World Health Organization International Classification of Functioning, Disability, and Health (WHO-ICF; Tichenor & Yaruss, 2019;World Health Organization, 2001). They then detail multiple aspects of personal context, or individual reactions to stuttering that individuals experience. ...
... The implications of stuttering in an individual's life extend far beyond the mere experience of disfluency. They might include unobservable emotional reactions, such as guilt, shame, embarrassment, anxiety, and fear, as well as behavioral reactions, such as avoidance and struggle, that accompany the noticeable disfluency (Sheehan, 1970;Tichenor & Yaruss, 2019). Additional consequences of stuttering include selfstigma (Boyle & Blood, 2015;Boyle & Fearon, 2018) and cognitive patterns such as rumination (Tichenor & Yaruss, 2020). ...
Purpose: Mindfulness is defined as intentional present-moment non-judgmental awareness. Previous studies have proposed that mindfulness practice might benefit people who stutter. The current study aims to test the relationship between levels of dispositional mindfulness in people who stutter and the negative impact of stuttering, and whether self-compassion and the meta-cognitive ability of shifting from subjective to objective perspective (decentering) mediate this relation. It is hypothesized that greater dispositional mindfulness allows the person who stutters to shift to an objective and compassionate perspective and react with less judgment to moments of stuttering, attenuating the negative impact of stuttering on experience. Method: An online survey was administered to adults who stutter (N=186) to assess their levels of dispositional mindfulness, self-compassion, decentering capability, and overall stuttering experience. The relation between the constructs was assessed via Pearson correlation and mediation analysis. Results: One hundred and fifty adults completed the full survey. The adverse effect of stuttering was correlated negatively with dispositional mindfulness, such that individuals with greater self-reported dispositional mindfulness also reported fewer negative effects of stuttering on their lives. This relation was found to be fully mediated by levels of decentering and self-compassion. Decentering partially mediated the relationship between mindfulness and self-compassion, while self-compassion alone was found to directly affect the experience of stuttering. Conclusion: People who stutter with greater dispositional mindfulness have an increased ability to view their experience in a more objective and compassionate way, and this attenuates the adverse effects of stuttering on their subjective experience. As these capabilities can be cultivated through practice, it substantiates the potential benefits of mindfulness practice for people who stutter.
... These are the psychological, emotional, social, and functional impacts which are frequently seen as the majority of the disorder and can have a lasting impact on psychosocial well-being and quality of life. 4 However, more recently, Yaruss and colleagues [5][6][7] have progressively represented the experience(s) of people who stutter, much of which is translatable to people who have other communication disorders. The World Health Organization-International Classification of Functioning, Disability, and Health 8 clearly depicts the multifaceted dynamic interrelationship and influence of various domains, elements, and interactions upon one another within the context of constructivist's lived experiences with communication disorders and how one event, or therapeutic strategy, may express multifaceted influences on the psychological, emotional, social, and functional well-being. ...
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.
Purpose
People who stutter (PWS) are vulnerable to the development of various psychopathological symptoms, although prevalence data are mixed and less clarity exists about factors that potentially influence their occurrence. The current study sought to shed light on the prevalence of self-reported psychopathology in PWS and aimed to identify relationships between affective, behavioral, and cognitive (ABC) experiences of stuttering and psychological distress (PD).
Method
Forty-four PWS were administered the Behavior Assessment Battery (BAB) for Adults who Stutter and the Brief Symptom Inventory-18. The prevalence of clinically significant PD was calculated via BSI-18 global severity index t -score cutoffs. Regression analyses examined relationships between ABC variables of stuttering and PD.
Results
Participants' BAB scores approximated normative values, while the PD score distribution was similar to that of a nonclinical sample. Nine percent of participants met thresholds for clinically significant PD. All ABC correlates of stuttering significantly and positively correlated with PD scores, capturing considerable amounts of shared variance.
Conclusions
Levels of PD in PWS approximate those of the general community, highlighting the existence of psychologically distressed subgroups of PWS. Speech situation-specific anxiety had the strongest relationship to PD, followed closely by one's report of situation-specific speech disruption. To a lesser but still significant extent, PWS' frequency to which they engage in various avoidance/escape behaviors, as well as their communication attitude, predicted levels of psychopathology. These data inform diagnostic and clinical decision making, drawing attention to factors that should be attended to in treatment.
BACKGROUND: Despite acknowledgement by various stakeholders that therapeutic alliance (TA) is an essential component of stuttering intervention, a comprehensive understanding of this concept is lacking in the field of speech and language therapy. There continues to be a significant gap in our knowledge regarding what adults who stutter (AWS) perceive to be the qualities and activities required by both themselves and the speech and language therapist (SLT) to facilitate an effective TA. Collection of such knowledge will support the establishment and maintenance of positive TA in clinical contexts and enhance treatment outcomes for those who stutter. OBJECTIVE: To explore the perspectives of AWS on the meaning of TA and the variables that influence its establishment and maintenance. METHODS: Semi-structured interviews were completed with eight AWS. The interview questions centred on three key topics: the conceptualisation of TA through the perspective of AWS; the activities and personal qualities of the SLT that influence TA; and the activities and personal qualities of the AWS that influence TA. RESULTS: Reflexive thematic analysis identified two overarching themes: ‘Recognising stuttering in a biopsychosocial context in order to enhance therapeutic alliance’ and ‘Person-related variables influencing therapeutic alliance’. In addition, five subthemes were identified which further illuminated each overarching theme. CONCLUSIONS: Findings of this study highlight the benefit of collecting patient-based evidence to support our understanding of TA. Results demonstrate the complexity of TA in stuttering intervention, and the impact that person-related variables have on its quality.
Purpose
The purpose of this large-scale, qualitative study is to investigate the perceived positive experiences and benefits of stuttering as reported by adults who stutter.
Method
Data from a registration survey hosted by a free stuttering management app were extracted by the app developers and shared for the purposes of this study. Seventy-seven adults who stutter responded to an optional, open-ended prompt on the survey, “Make a list of any positive experiences you have encountered due to stuttering. Write down as many as you can think of.” Responses were analyzed using qualitative content analysis.
Results
Four major themes emerged regarding positive experiences with stuttering including (a) development of skills, qualities, and talents; (b) personal development; (c) coping strategies; and (d) support from others.
Conclusion
Findings from this study align with previous literature that addresses positive outcomes of stuttering as described by adults who stutter; however, this study is unique in that it is the only research that has exclusively explored this topic in a large sample using qualitative methods.
Purpose:
The purpose of this study was to investigate the frequency and types of disfluencies in Greek-English bilingual adults across naturalistic speech samples and compare frequency and types of disfluencies between the participants' L1 and L2.
Methods:
Participants in the study included 26 Greek-English bilingual young adults. All participants were sequential bilinguals, whose first language was Greek and second language was English. Two speech samples were collected in each language, a conversational and a narrative sample, which were subsequently analyzed for the frequency and types of disfluencies.
Results:
Results indicated that participants produced more typical disfluencies in English compared to Greek across speaking samples. The most frequent types of disfluencies were filled pauses and vowel prolongations (without tension or struggle) across speaking samples and languages.
Conclusion:
Our results revealed differences in the types and frequencies of disfluencies produced in participants' native compared to their second language. Results add to the growing body of literature addressing the manifestation of speech disfluencies in bilingual speakers.
Purpose:
Research indicates that there is a tendency for females who stutter, more often than males, to use coping strategies that involve covering their stutter, for example, by avoiding situations that require verbal participation. The aim of the study is to increase knowledge about how covert stuttering develops and its impact on self-image and quality of life for women who stutter.
Method:
Eleven young women who stutter covertly were interviewed, and data were subjected to qualitative content analysis. Background information was obtained from the self-report instruments measuring the impact of stuttering on different aspects of life (Overall Assessment of the Speaker's Experiences of Stuttering) and degree of perceived social anxiety (Liebowitz Social Anxiety Scale, Self-Report).
Results:
Three main themes were identified: (a) managing stuttering, (b) personal aspects, and (c) stuttering as a phenomenon. Shame and a desire to fit in emerged as distinct motives for covering stuttering. The women described that stuttering controlled both life choices and everyday life. Development of self-image had been strongly negatively affected, resulting in social anxiety. The women expressed a particular vulnerability of being a woman who stutters, due to societal norms of female behavior and a lack of female role models who stutter.
Conclusions:
The choice of coping strategy was motivated by a desire to "be normal." As a result, stuttering had come to dominate life and affect self-image and life choices. The study highlights the importance for clinicians to be alert to and aware of the fact that the experiences of women who stutter can lead them to develop coping strategies that have far-reaching negative consequences.
Purpose
The initial diagnosis of stuttering is based on stuttering-like disfluencies. This approach fails to capture the variability in overt stuttering behaviors of persons who stutter across speaking tasks and over time. This preliminary study explored the relationships between day-to-day variability of stuttering and several commonly used self-report and behavioral outcomes used to diagnose and monitor stuttering in clinical and research settings.
Method
Five adults who stutter participated in this study. All participants completed a demographic questionnaire; the Overall Assessment of the Experience of Stuttering, State, and Trait Anxiety Inventory; and the Brief Version of Unhelpful Thoughts and Beliefs About Stuttering (UTBAS), followed by six (i.e., twice weekly) online sessions where conversation and reading samples were video-recorded to determine stuttering frequency and severity. Participants also rated their stuttering severity, variability, stress, anxiety, and sleep on a 7-point Likert scale for each session.
Results
No self-report measures correlated with stuttering frequency or severity measures determined at each twice-weekly online session. Positive correlations were observed between self-rated stuttering severity and stress, anxiety, and normal disfluencies. Stuttering variability across tasks and sessions was positively correlated with the one-time Overall Assessment of the Speaker's Experience of Stuttering (OASES) and UTBAS-6 scores.
Conclusions
Stuttering frequency was found to vary to different degrees for individual participants, and preliminary data suggest that scores on standardized assessments such as the OASES and UTBAS-6 are predictive of stuttering variability. Objective data on stuttering frequency may not capture the entire experience of stuttering.
The book Dialogue without barriers: A comprehensive approach to dealing with stuttering is the result of Norwegian-Polish cooperation undertaken in the project LOGOLab – Dialogue without barriers. Three partners have been involved in the production of this book, namely, the University of Silesia in Katowice, Poland, the UiT Arctic University of Norway in Tromsø, and the Agere Aude Foundation for Knowledge and Social Dialogue. The project was implemented under the Education Program financed by the EEA Grants (EEA / 19 / K1 / D1 / W / 0031).
We wanted to provide comprehensive coverage of current issues in the field of
stuttering, and invited an international group of specialists to write chapters for
the book. The result is a collaborative effort of researchers, practitioners, and professionals, some of whom have personal experience with stuttering. In addition to authors from Norway and Poland, other experts from Australia, Belgium, Canada,
United Kingdom, Greece, Germany, Lebanon, Malta and the United States have contributed. The book consists of 16 chapters, involving 25 contributing authors. Thanks to their generosity, the English version of this volume was created, which we are presenting to you herewith.
We expect the book to be useful for diverse groups worldwide. The book’s
authors present a holistic approach to speech therapy intervention in stuttering, taking into account the multi-faceted nature of the phenomena that concern
them, and the consequences for speech therapists’ work. They consider effective
prevention strategies, multi-dimensional diagnosis, and Evidence-based treatment
methods. The book describes in detail topics related to the change of social attitudes towards stuttering and Evidence-based practice. The following contemporary therapeutic programs are also presented: Camperdown Program, KIDS (German title: Kinder dürfen stottern, which translates to: Children should be allowed to stutter in English), Lexipontix Programme, and MIST (Multidimensional Individualized Stuttering Therapy). Topics such as becoming an SLT with high competence in developmental and acquired stuttering, practical aspects of group therapy, prevention of school bullying, and stuttering and multi-lingualism are also covered. Furthermore, issues such as the use of humor, creativity, and modern technologies in speech therapy interventions are included.
Purpose
The purpose of this clinical focus article is to describe how meta-therapy applies to stuttering treatment.
Method
We briefly summarize the concept of meta-therapy , which was first introduced by Helou (2017) in the context of behavioral voice therapy. We then apply basic meta-therapy principles to stuttering, with the goal of helping novice clinicians leverage their clinical dialogue to improve effectiveness and efficiency in the treatment setting. Examples of effective clinical dialogues are presented within the basic goal-based structure of meta-therapy.
Conclusion
The application of meta-therapy approaches in stuttering treatment should improve outcomes and increase efficiency.
Purpose
School-based speech-language pathologists (SLPs) face uniquely complex webs of guidelines and criteria that can undermine their ability to move toward disability-affirming practices. The purpose of this clinical focus article is to present a contrast between ableist and disability-affirming practices in school-based stuttering therapy while highlighting the critical perspectives of students who stutter. Practical examples of disability-affirming stuttering therapy in public school settings are provided.
Conclusions
This clinical focus article outlines practical guidelines and specific examples of affirming collaboration, eligibility decisions, goal choice, and accommodations for students who stutter. These discussions demonstrate how SLPs can adopt updated assessment therapy planning and institutional practices to affirm students who stutter while informing school cultures and society about the dignity and value of stuttered voices.
Supplemental Material
https://doi.org/10.23641/asha.21818028
Purpose:
Stuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients' needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.
Method:
Eighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.
Results:
The experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.
Conclusion:
Individual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.
Purpose:
School-age children and adolescents frequently have difficulty developing positive identities around their stuttering. Many students experience both physical and social consequences from stuttering. The great lengths that speakers go to try to hide their stuttering and to speak fluently increase their difficulty. As long as school-age children who stutter try to identify as fluent speakers, they will have difficulty lessening the negative impact of stuttering on their lives. Fortunately, many people who stutter also report positive stuttering experiences. Speech-language pathologists can use these positive experiences to help school-age children grow more comfortable with stuttering. They can also help school-age children reduce some of the speaking effort and social stigma that leads them to try to conceal their stuttering in the first place. To accomplish both these goals, I propose a stutter-affirming therapy.
Method:
This clinical focus article summarizes previous research about identity development in stuttering. I discuss a therapy approach I call stutter-affirming therapy. In elucidating this approach, I discuss practical ways that speech-language pathologists can use to help school-age children develop positive stuttering identities through easier speaking and stuttering. I ground these examples in a case study of a 12-year-old boy who stutters.
Discussion:
stutter-affirming therapy focuses on conditioning the speaker's reaction to stuttering in ways that move toward and embrace stuttering (stutterphilic reactions) rather than in ways that move away from and reject stuttering (stutterphobic reactions). Speech-language pathologists can help school-age children who stutter foster positive stuttering identities using the three priorities of stutter-affirming therapy. First, reject fluency by reducing stutterphobic and increasing stutterphilic reactions to stuttering. Second, value stuttering by discovering what speakers gain from it. Third, create an environment in which it is easier to stutter through education, advocacy, disclosure, and voluntary stuttering.
Background:
A range of psychotherapies are effective in managing an individual's personal reactions to stuttering and reducing the impact stuttering has on their lives. Many of these therapies, such as cognitive behavioural therapy, have their origins in Stoicism, an ancient Greek philosophy founded in 301 bce. Stoicism remains a relatively unexplored topic in the psychotherapy and speech and language therapy literatures.
Aims:
This paper aims to highlight the potential benefits of integrating Stoic principles and techniques into stuttering intervention.
Methods:
This aim is achieved through a discussion on Stoic philosophy and the range of techniques that have informed modern evidence-based psychotherapies that are effective with the stuttering population.
Main contribution:
This paper initiates an important conversation on the usefulness of Stoicism to the field of stuttering. Key recommendations are provided for the integration of Stoic philosophy into future clinical and research practice related to stuttering.
Conclusions:
Stoicism offers philosophical guidance for the art of living, but also provides a range of strategies and practical techniques that have potential to expand the clinical toolkit of modern psychotherapy and speech and language therapy. Scientific validation of the clinical application of Stoicism is recommended to exploit its effectiveness with the stuttering population.
What this paper adds:
What is already known on the subject Stoicism is an ancient philosophy that has informed modern-day psychotherapies including cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). Such therapies are recommended for use with individuals who stutter to target their personal reactions to stuttering and reduce any adverse impacts on their lives. What this paper adds to existing knowledge This paper discusses the principles and techniques of Stoicism with reference to how they align with modern psychotherapeutic approaches and speech and language therapy interventions used with individuals who stutter. Clinical implications and directions for future research are also presented. What are the potential or actual clinical implications of this work? Speech and language therapists (SLTs) are recommended to continue their use of psychotherapies such as CBT and ACT with individuals who stutter. In addition, SLTs are advised to explore Stoicism and its range of techniques to better understand the philosophical underpinnings of evidence-based psychotherapies and to expand their clinical toolkit.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.