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A Point of View About Fluency
Abstract
Purpose
This article presents several potential concerns with the common usage of the term fluency in the study of stuttering and people who stutter (or, as many speakers now prefer, stutterers ). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended.
Method
We begin by reviewing the history of the term fluency . We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition.
Results
By highlighting current research and perspectives of stutterers, we conclude that the term fluency (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole.
Conclusions
We recommend that researchers and clinicians cease referring to stuttering as a fluency disorder and simply refer to it as stuttering . Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition.
... • Replace ableist language with positive and empowering, strengths-based terms. For example, remove use of the term "fluency disorder" and refer simply to "stuttering" (Tichenor et al., 2022). This change recognizes that stuttering is not just about fluency while also removing the stigmatizing language of "disorder." ...
Purpose:
This article examines the responses of the founders of the American Speech-Language-Hearing Association (ASHA; original name, the American Academy of Speech Correction) to the social trends of their day in the United States. Those trends included migrations from Europe and the rural South, the emergence of new scientific methodologies, and the birth of a professional class. Our aims are to reveal how the founders reacted to these select social changes, to show how their reactions served to shape the newly formed profession in and around 1925, and to describe how that profession is still grappling with their choices even today.
Method:
The writings of the founding members of ASHA were examined for evidence of their views in relation to 20th century historical trends, specifically examining their attitudes toward clients and clinical practice.
Results:
We identified elitist, ethnocentric, racist, regionalist, classist, and ableist statements in the writings of the founders. They promoted practices that denigrated those speaking dialects that were deemed nonstandard, including linguistic patterns originating from ethnic, racial, regional, and class differences. They also used ableist language in writing about people with communication disabilities, adopting a medical model that elevated the professional practitioner over the client.
Conclusions:
Our founders' response to social and political trends led to their creation of oppressive professional practices rather than to work within a more positive social model of professional practice, which was readily available to them at the time, one that would have embraced differences rather than seeking to erase them. Once again, we are experiencing sea changes in our society, ones that offer us the opportunity to reverse the practices shaped by our predecessors. We can learn from the missteps of our founders to create practices that empower and respect those with communication differences or disabilities.
Supplemental material:
https://doi.org/10.23641/asha.22213738.
... This was most likely due to the neuropsychological state of the society, which was experiencing the most difficult times of stress in the last century. Today, "logo-neurosis", which is one of the main characteristics of stuttering, is found in almost 5% of patients (Onslow, 2022;Tichenor, Constantino & Yaruss, 2022). In the modern world, many hardened approaches to this issue have changed, new technologies, methods, even remote technologies for overcoming stuttering continue to be created like "Lidcomb Therapy" and programs (Onslow, 2022), "Method of stable regulation of stutterers' speech" regardless of the age, severity of stuttering (Harutyunyan (Andronova), 1993). ...
The aim of the study was to discover the level of awareness, knowledge and perceptions of the pedagogues on the perspectives and the ways of overcoming stuttering and the role of the psychological-pedagogical environment. The theoretical basis for this study was obtained throughout the analysis of about 32 scientific-pedagogical sources that address the issues of understanding the problems in the information-consulting field during the process of overcoming stuttering. Quantitative and qualitative methods were used to outline the gaps in the psychological and pedagogical support provided to stuttering people and to identify the level of awareness of the pedagogical staff of the educational settings regarding these issues. In total 100 employees: 77 pedagogues (30 teachers, 30 subject teachers, and 17 educators) and 23 special pedagogues working in the field of psycho-pedagogy took part in the current survey. The results stated that the perception about the real edges of overcoming stuttering formed in the society in Armenia was very limited and the efficiency of speech therapy work was low. About 93% of the participants had general view related to the stuttering manifestations and there were passive implementation and awareness of effective methods for overcoming the stuttering. Only 5% (special pedagogues) were aware of the single approaches such as “silence mode; syllabic speech” used with stuttering children, which were not considered comprehensive methods to treat the stuttering. Due to absence of professional speech therapy information-consulting system and lack of highly qualified specialists, 59% of the respondents convinced that overcoming the stuttering was impossible. The findings of current study indicated the need to develop the information-consulting system and recommendation guidelines for the pedagogues to support children in process of overcoming stuttering, as well as the methods of cooperation between the family members and speech therapists.
... 1190). The same authors have recently suggested that the term 'fluency' is not fully inclusive, but that it is limiting and misleading, so that we should stop referring to stuttering as a fluency disorder and simply refer to it as stuttering (Tichenor et al., 2022). ...
... 하지만 이와는 달리 말의 유창함은 연속적(continuous) 또는 점진적으로(gradient or gradually increasing) 지각되는 개념이라 는 주장들이 제기되었다 (Adams & Runyan, 1981;Kawai et al., 2005;Kawai et al., 2007;Tichenor et al., 2022 (Burley & Rinaldi, 1986;Dietrich et al., 2001;Hulit & Wirtz, 1994;Kawai et al., 2007;Patterson & Pring, 1991;Schroder et al., 2002;Susca & Healey, 2001). 일반적으로 장 애(인)에 대해 여성이 남성보다 큰 포용성 또는 관용성을 보인 다는 점을 고려해 볼 때 (Ferguson, 1999;Horne, 1985), (Ha, 2009;Metz et al., 1990;Schiavetti et al., 1994). ...
This study aimed to examine Korean listeners’ mode of perceiving sound duration as prolongation, whether dichotomous or continuous. Thirty-five Korean participants (17 men and 18 women) listened to the Korean segment /s/, which was lengthened by 0– 980ms in 20-ms increments. Then, the participants were asked to rate each version of the sound based on a rating of one to 100 (the closer to 100, the more disfluent). To examine whether listeners perceived durational variations for the fricative segment dichotomously or continuously, a curve was estimated using the best-fitting regression model for the observed data with the highest adjusted R-squared value. The mode of perceiving durational variations for the segment was continuous (or gradient) rather than
discontinuous (or dichotomous). No gender difference was found in the mode of perceiving prolongation. However, there was a significant gender difference in that men rated the most disfluent sounds higher than women. The findings of this study were further discussed in relation to the existing literature, and clinical implications for the assessment of stuttering were presented.
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
The article presents a theoretical analysis of contemporary models of persistent stuttering development in children and adults at the current period of development of science. The accumulated amount of scientific knowledge suggests that stuttering has a neurological basis: it is associated with disorders in the structure and function of the brain. On this basis, there have been emerged models of stuttering that link the cause of a speech disorder with an unstable speech motor system. Theories and models of stuttering based on cognitive and language processing are likely to be useful in that they have explanatory power in relation to the mechanisms that play an important role in the production of key symptoms of stuttering. Considering that stuttering is a complex disorder, the logical result of this was the proposal of multifactorial models of impaired speech fluency. The presented overview may be useful to psychiatrists, clinical psychologists, speech therapists, teachers, and practitioners interacting with children and adults with stuttering and other speech fluency disorders.
Purpose
Despite ambiguity in meaning and usage, “fluency” has played a central role in the understanding and treatment of developmental stuttering. The appropriateness of the term fluency in association with so-called fluency disorders , such as stuttering, has recently been questioned. The purpose of this article is to propose that fluency is best conceptualized as the efficiency of goal-directed action through cybernetic function. Spoken utterances are examples of sequences of action for the fulfillment of a hierarchy of nested and increasingly abstract social goals, including behaviors (e.g., introducing oneself) and values (e.g., being a sociable person). In contrast, some moments of speech disfluency, such as stuttering disfluencies, are inefficiencies in goal-directed action that may or may not hinder the fulfillment of higher level communicative behaviors and values, described here as communicative fluency .
Conclusions
The concept of communicative fluency refers to the continual, reliable, and upward fulfillment of increasingly abstract social goals in the form of communicative actions, behaviors, and values. This expanded conceptualization of fluency beyond simply speech production has the potential to be a useful indicator of psychosocial well-being for individuals who stutter.
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.
Purpose
Persons who stutter (PWS) may be susceptible to discrimination because of negative judgments made by listeners. The current study sought to determine how the cognitive system's explicit (i.e., conscious) and implicit (i.e., nonconscious) biases about PWS are impacted by self-disclosure.
Method
A computer mouse–tracking paradigm was used to evaluate categorical social judgments about PWS. Computer mouse trajectories, which have been shown to reveal underlying cognitive pull or competition between opposing concepts, were used to measure implicit bias (i.e., nonconscious stereotypes). Participants were asked to explicitly categorize the speaker as either intelligent or unintelligent before and after listening to a speaker self-disclose. Mouse cursor trajectories during the explicit response categorization were used to evaluate implicit bias associated with the decision-making process.
Results
Results indicated that participants chose “intelligent” for a higher proportion of the trials in the disclosure condition compared to baseline, showing that listeners' explicit biases changed after listening to a self-disclosure that the speaker stutters. Results also indicated listeners exhibited a more negative implicit bias, based on computer mouse trajectories, when rating the PWS relative to the “persons who do not stutter” talker, but this negative implicit bias did seem to reduce over time after the disclosure was made.
Conclusions
These findings indicate that, even though explicit and implicit biases were evident when listeners heard stuttering, both explicit and implicit biases seemed to extinguish over time after a self-disclosure. Although the bias was not completely extinguished, these results provide promising evidence toward developing methods to reduce negative beliefs and reactions toward PWS.
Supplemental Material
http://osf.io/mwrp7/
Purpose: The purpose of this study was to quantify relationships between stuttering and labor market outcomes, determine if outcomes differ by gender, and explain the earnings difference between people who stutter and people who do not stutter.
Method: Survey and interview data were obtained from the National Longitudinal Study of Adolescent to Adult Health. Of the 13,564 respondents who completed 4 waves of surveys over 14 years and answered questions about stuttering, 261 people indicated that they stutter. Regression analysis, propensity score matching, and Blinder–Oaxaca decomposition were used.
Results: After controlling for numerous variables related to demographics and comorbidity, the deficit in earnings associated with stuttering exceeded $7,000. Differences in observable characteristics between people who stutter and people who do not stutter (e.g., education, occupation, self-perception, hours worked) accounted for most of the earnings gap for males but relatively little for females. Females who stutter were also 23% more likely to be underemployed than females who do not stutter.
Conclusions: Stuttering was associated with reduced earnings and other gender-specific disadvantages in the labor market. Preliminary evidence indicates that discrimination may have contributed to the earnings gap associated with stuttering, particularly for females.
Purpose:
This study surveyed didactic and clinical education in fluency disorders at undergraduate and graduate institutions in the United States that provide education in speech-language pathology to determine whether a previously observed reduction in requirements has continued since prior surveys (Yaruss, 1999; Yaruss & Quesal, 2002).
Method:
The study involved a detailed questionnaire that was sent to 282 communication science and disorders departments. Questions examined didactic and clinical education, as well as faculty knowledge about fluency disorders.
Results:
Comparisons with prior surveys revealed several findings, including (a) on average, programs have increased academic coursework and incorporated more practical sessions and competency-based testing in the classroom; (b) the number of faculty who possess extensive clinical experience with fluency disorders has decreased; and (c) although an increase in clinical requirements in fluency disorders was detected, the number of programs providing minimal education about fluency disorders remains high.
Conclusion:
Given an expanding scope of practice, many programs have continued to try to provide adequate education about fluency disorders. Still, direct clinical experiences are limited, and faculty expertise in this area has continued to decrease. To raise students' confidence and competence in fluency disorders, efforts beyond graduate work-or systemic changes in the profession-may be necessary.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
Purpose: The aim of the study was to investigate and compare factors related to recovery and relapse outcomes after treatment, among adults with stuttering. Method: The participants were 24 adults who underwent fluency therapy and reported for follow-up 6 months after cessation of treatment. Pre, immediate post and 6-months post-treatment follow-up evaluations were done using stuttering severity instrument SSI-3. On the basis of total scores and severity obtained, participants were then grouped as either recovered or relapsed persons with stuttering. A questionnaire was administered to obtain their ratings for the different domains of factors that contributed to treatment outcomes. Results: A significant difference was found between both the groups with respect to factors contributing to recovery and relapse. The four domains which were found to be more responsible for treatment outcomes in persons with stuttering were: individual related, therapy related, environment related, and behaviour and personality related factors. Conclusion: The study was conducted with fewer participants, and it is possible that there could be many other pre-treatment and post-treatment factors such as attitude, anxiety, and speech naturalness which may influence the treatment outcomes in persons with stuttering. Future research should include these other factors.
The purpose of this study was to examine school speech-language pathologists’ knowledge of and skill levels with assessing and treating stuttering. This paper provides information on 255 school speech-language pathologists who responded to a 49-question survey about stuttering. The instrument contained questions that addressed specific aspects of assessment and treatment as well as general questions about stuttering. Results indicate that on average, the speech-language pathologists had only treated 12 children who stuttered throughout their careers and averaged 2 children who stuttered on their caseloads per year. Data indicate that regardless of whether the speech-language pathologists took graduate course work in fluency disorders, had their Certificate of Clinical Competence, or attended continuing education workshops in fluency disorders, they lacked basic knowledge and skills in assessing and treating stuttering. Systematic training in specific aspects of assessment and treatment for people who stutter is urgently needed for speech-language pathology students and practicing clinicians.
Purpose
It has long been known that stuttering behaviors vary across time and situation. Preliminary evidence suggests that this variability negatively affects people who stutter and that stuttering behaviors are more variable than adverse impact associated with stuttering. More information is needed to determine how variability affects people who stutter and what the clinical and research implications of variability may be.
Method
Two hundred and four adults who stutter participated in a mixed-methods study exploring (a) how variability of stuttering affects people who stutter in comparison to other aspects of the condition and (b) which aspects of the overall experience of stuttering are variable.
Results
Analyses indicated that variability is very commonly experienced by people who stutter and that it is among the most frustrating aspects of the condition. Qualitative analyses revealed that variability is experienced in all aspects of the stuttering condition, including the observable behavior other affective, behavioral, and cognitive reactions; and the adverse impact of stuttering. Notable individual differences were found in terms of which specific aspects of the condition were more variable for different respondents. Overall, analyses revealed that the variability of different aspects of stuttering can be viewed in a hierarchy from most variable to least variable: more external aspects (e.g., frequency, duration), more internal aspects (e.g., covert behaviors, physical tension), and cognitive–affective experiences (e.g., negative thoughts, feelings, and self-image).
Discussion
These findings suggest that variability is a common and burdensome aspect of the experience of stuttering and underscore the importance of considering variability in stuttering behavior, reactions, and impact in research, assessment, and treatment for adults who stutter.
Purpose
Recovery and relapse relating to stuttering are often defined in terms of the presence or absence of certain types of speech disfluencies as observed by clinicians and researchers. However, it is well documented that the experience of the overall stuttering condition involves more than just the production of stuttered speech disfluencies. This study sought to identify what recovery and relapse mean to people who stutter based on their own unique experiences to account for both the stuttering behaviors and the broader adverse impact of the condition.
Method
In this study, 228 adults who stutter participated in a mixed-methods exploration of the terms “recovery” and “relapse.” Participants categorized themselves on whether they considered themselves to have recovered or experienced relapse. Data were analyzed thematically through the lens of the speaker self-categorizations to determine how adults who stutter define recovery and relapse regarding stuttering.
Results
Results indicate that, to adults who stutter, recovery from stuttering is associated with increases in positive affective/emotional, behavioral, and cognitive reactions to the condition and simultaneous decreases in associated negative constructs. These group-level definitions did not change as a function of whether respondents reported that they had experienced recovery or relapse themselves.
Discussion
Recovery or relapse from stuttering behaviors can occur independently from recovery or relapse from the broader adverse impact related to the condition, suggesting that researchers and clinicians should consider recovery and relapse as involving more than just a reduction or an increase in observable behaviors. These findings support recent research evidence further specifying the many individual phenotypes of stuttering, in that pathways to recovery and relapse can be experienced in different ways for people with different stuttering phenotype profiles.
Purpose
This study measures the experience of spontaneous speech in everyday speaking situations. Spontaneity of speech is a novel concept developed to account for the subjective experience of speaking. Spontaneous speech is characterized by little premeditation and effortless production, and it is enjoyable and meaningful. Attention is not directed on the physical production of speech. Spontaneity is intended to be distinct from fluency so that it can be used to describe both stuttered and fluent speech. This is the first study to attempt to measure the concept of spontaneity of speech.
Method
The experience sampling method was used with 44 people who stutter. They were surveyed five times a day for 1 week through their cell phones. They reported on their perceived spontaneity, fluency, and speaking context.
Results
Results indicate that spontaneity and fluency are independent, though correlated, constructs that vary with context. Importantly, an increase in spontaneity significantly decreases the adverse impact of stuttering on people's lives. Fluency did not significantly affect adverse life impact of stuttering.
Conclusion
Findings support a theoretical construct of spontaneity that is distinct from speech fluency and that can inform our views of stuttering and approaches to stuttering treatment.
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
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.
Background:
Stuttering Support Organizations (SSOs) are places where people who stutter can share their experiences with stuttering and lend support to each other. There is evidence that SSO participation may be helpful in reducing the negative impact of stuttering and promoting positive cognitive and affective changes in adults who stutter. The benefits of participating in SSO organizations for young people, however, are currently unknown.
Purpose:
This study investigated the relationship between attending a multi-day SSO convention and cognitive and affective changes among young people who stutter (YPWS).
Methods:
Twenty-two YPWS (ages 10 to 18) were recruited from the 2016 FRIENDS annual convention to participate in this study. FRIENDS is the National Association of Young People Who Stutter. A mixed methods approach was used to collect and analyze quantitative and qualitative data. The Overall Assessment of the Speaker's Experience with Stuttering (OASES) was administered at three times points: pre-convention, post-convention, and three months following the convention. Semi-structured interviews were conducted with seven participants to further explain the quantitative results.
Results:
Analysis of OASES scores across the three time points indicated that there were significant decreases in the negative impact of stuttering between pre-convention and post-convention measures. Qualitative analysis of semi-structured interview transcripts revealed five themes related to community building, collaborative learning, cognitive and communicative changes, self-acceptance, and normalizing stuttering.
Conclusion:
SSOs may be beneficial in reducing the negative impact of stuttering and should be considered a potentially valuable addition to traditional therapy for stuttering.
Purpose:
Individuals who covertly stutter have a unique experience of stuttering that involves concealing the core behaviors of stuttering (e.g., repetitions, prolongations, and blocks). From the listener's perspective, covert stuttering results in minimum typical, overt stuttering behaviors. However, from the speaker's perspective, covert stuttering often increases the cognitive and emotional impact of stuttering. This study explores the speech-language therapy experiences of individuals who covertly stutter in order to improve treatment recommendations and best practice.
Methods:
This investigation is a qualitative analysis of individuals' speech-language therapy experiences as persons who covertly stutter. 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 speech-language therapy experiences of the participants.
Results:
The participants indicated that stuttering therapy was most impactful when it included explicit goals and activities, personalized selection of therapy techniques or strategies beyond fluency techniques, encouraged self-education, and educated those in the person's environment.
Conclusion:
The evidence suggests individualized therapy based on each client's unique manifestation of covert stuttering is beneficial; while, fluency-focused stuttering therapy is often incongruent with the needs of persons who covertly stutter. Therapeutic implications and recommendations for speech-language pathologists are discussed.
Purpose:
We previously introduced theStuttering Anticipation Scale (SAS; Jackson, E. S., Gerlach, H., Rodgers, N. H., & Zebrowski, P. M. (2018). My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? Seminars in Speech and Language, 39, 356-370) - a non-standardized self-report measure for children, teens, and adults who stutter (CWS, TWS, AWS) that quantifies how often they engage in 25 commonly reported action responses to anticipation. The purpose of this study was to leverage the SAS to explore the factor structure of action responses to stuttering anticipation.
Methods:
A total of 121 people who stutter completed the SAS online (27 CWS, 40 TWS, 54 AWS). We used exploratory factor analysis (EFA) to determine the underlying latent variables within the 25 SAS items that characterize how people who stutter respond to anticipation.
Results:
A three-factor model was most appropriate for the data with regard to factor loadings and other model fit indices. The three factors were named: avoidance (17 items), physical change (4 items), and approach (4 items).
Conclusion:
Understanding these three types of action responses to anticipation can help guide clinical decision-making by providing a novel framework for clinicians and their clients who stutter to discuss how the client tends to respond to anticipation, and explore ways to facilitate productive responses to anticipation.
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.
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:
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:
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:
We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic, and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory.
Method:
We review evidence related to how stuttering develops, including genetic/epigenetic factors; motor, linguistic, and emotional features; and advances in neuroimaging studies. We update evidence for our earlier claim: Although stuttering ultimately reflects impairment in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic and emotional factors.
Results:
Our current account places primary emphasis on the dynamic developmental context in which stuttering emerges and follows its course during the preschool years. Rapid changes in many neurobehavioral systems are ongoing, and critical interactions among these systems likely play a major role in determining persistence of or recovery from stuttering.
Conclusion:
Stuttering, or childhood onset fluency disorder (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; American Psychiatric Association [APA], 2013), is a neurodevelopmental disorder that begins when neural networks supporting speech, language, and emotional functions are rapidly developing. The multifactorial dynamic pathways theory motivates experimental and clinical work to determine the specific factors that contribute to each child's pathway to the diagnosis of stuttering and those most likely to promote recovery.
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.
Purpose:
This study examined the impact of social-cognitive stress on sentence-level speech variability, determinism, and stability in adults who stutter (AWS) and adults who do not stutter (AWNS). We demonstrated that complementing the spatiotemporal index (STI) with recurrence quantification analysis (RQA) provides a novel approach to both assessing and interpreting speech variability in stuttering.
Method:
Twenty AWS and 21 AWNS repeated sentences in audience and nonaudience conditions while their lip movements were tracked. Across-sentence variability was assessed via the STI; within-sentence determinism and stability were assessed via RQA.
Results:
Compared with the AWNS, the AWS produced speech that was more variable across sentences and more deterministic and stable within sentences. Audience presence contributed to greater within-sentence determinism and stability in the AWS. A subset of AWS who were more susceptible to experiencing anxiety exhibited reduced across-sentence variability in the audience condition compared with the nonaudience condition.
Conclusions:
This study extends the assessment of speech variability in AWS and AWNS into the social-cognitive domain and demonstrates that the characterization of speech within sentences using RQA is complementary to the across-sentence STI measure. AWS seem to adopt a more restrictive, less flexible speaking approach in response to social-cognitive stress, which is presumably a strategy for maintaining observably fluent speech.
Stuttering is a disorder of communication that for many people extends far beyond overt instances of disfluent speech. The multidimensional nature of the disorder includes cognitive, affective, and social components. Because stuttering manifests mostly in social situations, there are bound to be social consequences, many of which are negative and may impact the individual who stutters. The public’s negative reactions toward stuttering and people who stutter are relevant to the concept of stuttering being classified as a stigmatized disorder. This chapter will focus on the stigma of being a person who stutters. We will first review various conceptualizations and models of stigma, and how these notions of stigma are relevant for people who stutter. Then we will detail various coping mechanisms that people who stutter employ to deal with a stigmatized condition, and conclude with ideas for reducing the stigma experienced by people who stutter
Previous investigations of the timing of speech motor responses of stutterers (Janssen et al., 1983; Janssen and Wieneke, this volume, Chapter 25) have indicated that stutterers were more variable in their segmental timing during oral reading than nonstutterers. The aim of the present study was to analyze further the measured durational variability in the speech of stutterers (Janssen and Wieneke, this volume, Chapter 25). An interesting question is, whether the greater variability can be considered a manifestation of general instability in the stutterers’ motor system, or whether there are other reasons for it. We considered two possible reasons. Firstly the possibility that the greater variability evidenced by the stutterers was due to greater variability of speaking rate was explored. Secondly the possibility that the greater variability was due to one or more extremely variable segments was investigated.
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.
This paper presents final results of earlier reported research (Craig & Calver, 1991) of the self-reported perceptions of relapse of people who stutter. The difficulties for those who struggle to remain fluent following successful treatment for stuttering requires further analysis through investigation into relapse. The present study undertook a cross sectional questionnaire study of a large group of persons from an Australian self-help group who were dedicated to maintaining treatment gains in the long term. Relapse was defined as “stuttering to a degree which was not acceptable for at least a period of one week.” Altogether, 152 of 300 questionnaires were returned. Seventy percent of the participants believed they had relapsed, but the majority also believed they had regained fluency subsequent to that relapse. Relapse appeared to occur in cycles, with an average frequency of up to three times per year. They believed that relapse was (a) more likely to occur in demanding contexts such as the work enviro...
A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions.
To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency.
We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study populations were either adults or children affected by a diagnosed stutter and/or providers of therapy for stuttering. An iterative approach was used to search for published qualitative evidence in relevant databases from 1990 to 2014. Retrieved citations were sifted for relevance and the data from articles that met the inclusion criteria were extracted. Each included paper was assessed for quality and a thematic analysis and synthesis of findings was carried out.
Synthesized qualitative evidence highlights the changing experiences for people who stutter both historically and, for individuals, over the life course. Barriers and facilitators to the implementation of interventions for stuttering are encountered at the individual, intervention, interpersonal and social levels. Interventions may be particularly pertinent at certain transition points in the life course. Attention to emotional as well as practical aspects of stuttering is valued by people receiving therapy. The client-therapist relationship and support from others are also key factors in achieving successful outcomes.
A synthesis of qualitative findings from published papers has added to the effectiveness data reported in an accompanying paper in understanding how stuttering impacts on people across the life course. Evidence suggests that a client-centred and individually tailored approach enhances the likelihood of successful intervention outcomes through attention to emotional, situational and practical needs.
© 2015 Royal College of Speech and Language Therapists.
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.
This paper examines difficulties inherent in interpreting results of studies that compare the fluent speech characteristics of stutterers and nonstutterers. The majority of these studies have reported stutterer/nonstutterer differences in temporal parameters of fluent speech production. Such differences have been interpreted as indicating that stutterers possess temporal-motor deficits that are ever-present in speech and, therefore, causal to stuttering. However, a problem for researchers studying the fluent speech of stutterers is that samples may be contaminated by the influence of stuttering. In this paper, evidence is reviewed which suggests that characteristics of the perceptually fluent speech of stutterers change as a function of a number of variables: (a) context of experimental samples, (b) treatment history of subjects, (c) stuttering severity of subjects, and (d) developmental history of stuttering. In addition, evidence is presented which can be interpreted to show that each of these variables reflect stuttering, either directly or indirectly. It is argued that because these variables are difficult to fully control, or account for, comparison of the characteristics of the perceptually fluent speech of stutterers and nonstutterers as a method of studying stuttering causation is problematic. Alternative directions for research activity are discussed.
This paper presents an analytic review of many conditions known to induce fluent speech in stutterers, and derives an integral explanation which accounts for the beneficial effect of all of them. This explanation suggests new avenues of approach to basic research in stuttering as well as pointing up the value of reviving areas of exploration initiated, but abandoned, a number of years ago.
The purpose of this study was to test a hypothesis concerning the origin of the stereotype of the stuttering personality. According to this hypothesis the stereotype is formed by inference from beliefs about the internal variables that accompany disfluencies resembling stuttering on occasions when they occur in normally fluent speakers. This hypothesis leads to the prediction that ratings of the personality of the typical adult male stutterer will be similar to ratings of the internal state of a normally fluent speaker during a transitory spell of disfluent speech. This prediction was tested by obtaining.ratings of each of these targets, using the 25 bipolar rating scales employed in previous research on this topic, from two groups each of 40 students. As predicted, the mean ratings of each target were highly correlated across the scales. These results imply that the Stereotype of the stuttering personality, although mainly negative, may be derived not from motivational factors, but from judgments made under uncertainty.
High speed (150 fps) einefluorographie techniques were used to record articulatory movements during fluent and dis fluent speech from four stutterers and control utter- ances from one normal speaker. Analyses of 11 perceptually disfluent utterances are reported. The results show: (1) interarticulator positions occurring in both perceptually fluent and disfluent utterances of stutterers were unlike those in fluent utterances of a normal speaker; (2) aberrant interarticulator positions preceded repetitive movements and static posturing; (3) consistent interarticulator repositioning which precedes termi- nation of an oscillatory movement or static position often results in: (a) the lowering of the jaw or lip, and/or (b) tongue shapes which resemble shapes found in normal speak- ers' fluent productions or the resting tongue shapes of the stutterer: The systematic re- positioning and other patterns found are discussed in terms of possible neuromotor mechanisms involved in disfluency. It is suggested that reflex interactions among the muscles of articulation might account for some of these effects. A brief discussion of theoretical and therapeutic implications is included.
Within the literature of disability studies, surprisingly little work has been done on communicative disabilities as such. In this paper I intend to locate stuttering, as an exemplar of communicative disabilities, within the current literature. Highlighting the distinctively dialogical nature of communicative disabilities, I first argue that “broken speech” is constructed by both the speaker and the hearer. In this sense, the speaker alone does not bear the responsibility for her construction as abnormal and therefore disabled.
Secondly, since stuttering is an embodied act, attention must be given to the construction of the speaker’s body. In exploring how stuttering is constructed as a disability by cultural norms of efficiency, pace, and self-mastery, I argue that the vulnerability of the stutterer’s body troubles the cultural fantasy of the body as an invisible medium of communication.
Lastly, this paper calls attention to the liminal nature of the stutterer, who is neither clearly abled nor disabled. This liminality can help explain the unclear and conflicting expectations forced upon stutterers, who, unlike many other disabled people, are often expected to perform on the same terms as the able-bodied. Disfluency can thus be interpreted as a distinctly moral failure: the failure of a stutterer’s individual will and self-discipline which undercuts and threatens capitalistic virtues. In disrupting the binary of abled/disabled and questioning the boundaries of disability, stuttering thus offers itself as an important case study within disability studies for seemingly “less severe” disabilities in liminal spaces of oppression.
This study was set up to further establish the construct validity of the Self-Stigma of Stuttering Scale (4S) by demonstrating its associations with other established scales and replicating its original factor structure and reliability estimates.
Web surveys were completed by 354 adults who stutter recruited from Board Certified Specialists in Fluency Disorders, and adult chapters of the National Stuttering Association. Participants completed a series of psychometrically validated scales measuring self-stigma, hope, empowerment, quality of life, social support, anxiety, depression, and self-rated speech disruption.
Higher subscale and total stigma scores on the 4S were associated with significantly lower levels of hope, empowerment, quality of life, and social support, and significantly higher levels of anxiety, depression, and self-rated speech disruption. The original factor structure of the 4S was replicated, and reliability estimates of the subscales ranged from adequate to excellent.
The findings of this study support the construct validity of the 4S and its use by clinicians and researchers intending to measure the construct of self-stigma in adults who stutter. Educational objectives: Readers should be able to: (a) distinguish between the various components of self-stigma; (b) describe how the various components of the self-stigma model relate to hope, empowerment, quality of life, and social support, self-rated speech disruption, anxiety, and depression; (c) summarize the psychometric properties of the Self-Stigma of Stuttering Scale (4S) in terms of reliability, factor structure, and construct validity; (d) discuss how the 4S could be used in research and clinical practice.
Copyright © 2015 Elsevier Inc. All rights reserved.
The characteristics of stutterers' fluency has been the object of much research in recent years, but it is not always clear what the term "fluency" refers to in this research. This paper reviews the concept of fluency and considers the ways in which it has been employed in research on stuttering. The methods that have been used to identify fluent intervals in stutterers' speech are reviewed along with their reliability and validity. It is concluded that there is an urgent need to clarify the referent for fluency in such studies, and to develop procedures for measuring and quantifying fluency. Additional avenues for research are also discussed.
The purpose of this study was to determine whether accuracy training for interval judgments of stuttering might generalize to increased accuracy and/or interjudge agreement for intervals other than those used during training. Ten upper-division speech-language pathology students judged 5-s audiovisually recorded speech intervals as stuttered or nonstuttered in a series of group and single-subject experiments. Judgment accuracy was determined with respect to judgments provided previously by 10 recognized authorities on stuttering and its treatment. Training occurred within single-subject experiments that used multiple baselines across speakers and repeated generalization probes to assess training effects. Results showed that judgment accuracy tended to increase after training for speakers used during the training process as well as for unfamiliar speakers. Results also replicated previous findings of slight increases in interjudge and intrajudge agreement after interval-judgment training. The implications of these results for developing a valid and reliable stuttering measurement system are discussed.
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.
In recent years, several studies have been conducted in which the fluency of stutterers was compared with that of normal speakers. These investigations have been of two basic types, some involving objective measures of physiologic, aerodynamic, or acoustic features of the subjects' fluent speech signal, and others involving experiments performed in which listeners attempted to distinguish the fluency produced by stutterers from that generated by normal speakers. The body of literature pertaining to each of these two types of investigations is reviewed and interpreted. The interpretations offered are then developed in an effort to shed further light on both fluency and stuttering. Implications for further research, as well as for the evaluation, treatment, and post-therapy assessment of stutterers are drawn.
After recounting the story of Todd to illustrate the significance of the issue, the chronic perseverative stuttering (CPS) syndrome is defined and its characteristics identified. After a discussion of treatment goals for the CPS syndrome client, the significance of its identification in the client's teenage years and its relevance to support groups for stutterers, the paper concludes with a call for acknowledging the reality of the CPS syndrome and for establishing realistic therapy goals in view of its existence.
To create a psychometrically sound scale that measures different levels of internalized stigma (i.e., self-stigma) among adults who stutter and analyze factor structure, reliability, and initial construct validity of the scale.
Two-hundred and ninety one adults who stutter were recruited from Board Recognized Specialists in Fluency Disorders and the National Stuttering Association. Participants completed a Web-based survey including an experimental scale called the Self-Stigma of Stuttering Scale (4S), designed to measure different levels of self-stigma in people who stutter, along with a series of established measures of self-esteem, self-efficacy, and life satisfaction.
The experimental scale demonstrated adequate reliability in internal consistency and temporal stability. Factor analysis revealed underlying components supportive of a multidimensional model of stigma. Stigma self-concurrence, and to a lesser extent stereotype agreement and stigma awareness, were negatively correlated with self-esteem, self-efficacy, and life satisfaction, supporting initial construct validity of the scale.
Speech-language pathologists can identify the presence of self-stigma in their adult clients who stutter and help them to alter these beliefs. The 4S can be a means for researchers and clinicians to achieve these goals.