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Repetitive Negative Thinking in Adolescents Who Stutter
Abstract
Purpose
Repetitive negative thinking (RNT) is the process of engaging in negatively valenced and habitual thought patterns. RNT is strongly associated with mental health conditions and often affects quality of life. This study explored RNT in older school-age children and adolescents who stutter to quantify the relationship between RNT and self-reported anxiety characteristics. An additional aim was to describe how individual differences in an adolescent's goal when speaking influences the frequency they engage in RNT.
Method
Ninety-nine children and adolescents who stutter aged 9–18 years completed a measurement of the frequency/severity of RNT, a screener of anxiety characteristics, and a measure of adverse impact related to stuttering. Children aged 10 years and above also answered questions about their goal when speaking.
Results
Individual differences in RNT significantly predicted Overall Assessment of the Speaker's Experience of Stuttering (OASES) Total Scores more so than a child or adolescent's age. Higher generalized or social anxiety scores were significantly correlated with more frequent RNT and higher OASES Total Scores. Individual differences in goal when speaking (i.e., whether or not to stutter openly) were found to predict RNT. Finally, 22 children and adolescents (22.2%) also screened positive for generalized anxiety disorder and 32 (32.3%) screened positive for social anxiety disorder.
Discussion
These data provide strong evidence that (a) many children and adolescents who stutter engage in RNT; (b) children and adolescents who engage more frequently in RNT or who have higher OASES Total Scores may be at increased risk for more characteristics of generalized or social anxiety; and (c) individual differences in goal when speaking can predict the degree to which an adolescent engages in RNT.
Supplemental Material
https://doi.org/10.23641/asha.23713296
... Previous studies have shown correlations between the OASES-A and other social anxiety scales but not specifically with the LSAS. 49,52,53 The correlation between the OASES-A and LSAS observed here is a novel finding of this study. The LSAS is a familiar index for healthcare professionals that is frequently used to assess the therapeutic effects of cognitive-behavioral therapy for SAD, 54-56 and pharmacologic therapy. ...
Background: Stuttering is a speech fluency disorder that can significantly affect quality of life. Among adults who seek consultations for stuttering, 40–60% have comorbid social anxiety disorder (SAD). The Liebowitz Social Anxiety Scale (LSAS) has been developed to assess the severity of SAD, while the overall assessment of the speaker’s experience of stuttering for adults (OASES-A) questionnaire can measure the broader impact of stuttering. However, some medical professionals lack knowledge of such questionnaires. Aims: Here, we aimed to investigate the correlation between the severity of stuttering and the OASES-A, and between the OASES-A and the LSAS. Methods: Overall, 51 adults who stutter were included in this study. Stuttering frequency was assessed using a Japanese test, whereas the OASES-A questionnaire captured the comprehensive impact of stuttering on the participants’ lives. The LSAS was used to measure the severity of social anxiety. Pearson’s correlation analysis was used to determine the relationship between the variables. Results: The average stuttering frequency was 10%, and the mean OASES-A total score was 2.86. The mean total LSAS score was 51.5. While no significant correlation was found between stuttering frequency and OASES-A total scores, a significant correlation was noted between LSAS and OASES-A total scores. Conclusion: This study found that stuttering frequency did not correlate with the OASES-A. Notably, a novel moderate correlation was identified between OASES-A and LSAS total scores. The LSAS may help to evaluate the challenges faced by people who stutter when the OASES-A is unavailable.
Background
Depression and anxiety are prevalent in youth populations and typically emerge during adolescence. Repetitive negative thinking (RNT) is a putative transdiagnostic mechanism with consistent associations with depression and anxiety. Targeting transdiagnostic processes like RNT for youth depression and anxiety may offer more targeted, personalised and effective treatment.
Methods
A meta-analysis was conducted to examine the effect of psychological treatments on RNT, depression and anxiety symptoms in young people with depression or anxiety, and a meta-regression to examine relationships between outcomes.
Results
Twenty-eight randomised controlled trials examining 17 different psychological interventions were included. Effect sizes were small to moderate across all outcomes (Hedge's g depression = −0.47, CI −0.77 to −0.17; anxiety = −0.42, CI −0.65 to −0.20; RNT = −0.45, CI −0.67 to −0.23). RNT-focused and non-RNT focused approaches had comparable effects; however, those focusing on modifying the process of RNT had significantly larger effects on RNT than those focusing on modifying negative thought content. Meta-regression revealed a significant relationship between RNT and depression outcomes only across all intervention types and with both depression and anxiety for RNT focused interventions only.
Conclusion
Consistent with findings in adults, this review provides evidence that reducing RNT with psychological treatment is associated with improvements in depression and anxiety in youth. Targeting RNT specifically may not lead to better outcomes compared to general approaches; however, focusing on modifying the process of RNT may be more effective than targeting content. Further research is needed to determine causal pathways.
It is not clear if treatments for anxiety specifically targeting repetitive negative thinking (RNT: rumination, worry, and content-independent perseverative thinking) have a specific effect on RNT resulting in better outcomes than other psychological and nonpsychological treatments. We conducted a systematic search of randomized controlled trials comparing RNT-focused and non-RNT-focused psychological treatments, as well as nonpsychological treatments for anxiety with control groups and reporting outcomes on RNT. Inclusion criteria were met by 46 studies with a total of 3,194 participants. RNT-focused and non-RNT-focused psychological treatments had comparable effects on RNT, and level of anxiety and changes in RNT and anxiety were highly associated across treatments. Further mediation and mechanistic studies to test whether reductions in RNT during RNT-focused cognitive behavioral therapy predict subsequent reductions in anxiety are called for.
It is not clear if treatments for anxiety specifically targeting repetitive negative thinking (RNT: rumination, worry, and content‐independent perseverative thinking) have a specific effect on RNT resulting in better outcomes than other psychological and nonpsychological treatments. We conducted a systematic search of randomized controlled trials comparing RNT‐focused and non‐RNT‐focused psychological treatments, as well as nonpsychological treatments for anxiety with control groups and reporting outcomes on RNT. Inclusion criteria were met by 46 studies with a total of 3,194 participants. RNT‐focused and non‐RNT‐focused psychological treatments had comparable effects on RNT, and level of anxiety and changes in RNT and anxiety were highly associated across treatments. Further mediation and mechanistic studies to test whether reductions in RNT during RNT‐focused cognitive behavioral therapy predict subsequent reductions in anxiety are called for.
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a measure widely used to assess childhood anxiety based on parent and child report. However, while the SCARED is a reliable, valid, and sensitive measure to screen for pediatric anxiety disorders, informant discrepancy can pose clinical and research challenges. The present study assesses informant discrepancy, measurement invariance, test–retest reliability, and external validity of the SCARED in 1092 anxious and healthy parent–child dyads. Our findings indicate that discrepancy does not vary systematically by the various clinical, demographic, and familial variables examined. There was support for strict measurement invariance, strong test–retest reliability, and adequate external validity with a clinician-rated measure of anxiety. These findings further support the utility of the SCARED in clinical and research settings, but low parent–child agreement highlights the need for further investigation of factors contributing to SCARED informant discrepancy.
Background
Cognitive–behavioural therapy (CBT) is the treatment of choice for generalised anxiety disorder (GAD), yielding significant improvements in approximately 50% of patients. There is significant room for improvement in the outcomes of treatment, especially in recovery.
Aims
We aimed to compare metacognitive therapy (MCT) with the gold standard treatment, CBT, in patients with GAD (clinicaltrials.gov identifier: NCT00426426).
Method
A total of 246 patients with long-term GAD were assessed and 81 were randomised into three conditions: CBT ( n = 28), MCT ( n = 32) and a wait-list control ( n = 21). Assessments were made at pre-treatment, post-treatment and at 2 year follow-up.
Results
Both CBT and MCT were effective treatments, but MCT was more effective (mean difference 9.762, 95% CI 2.679–16.845, P = 0.004) and led to significantly higher recovery rates (65% v . 38%). These differences were maintained at 2 year follow-up.
Conclusions
MCT seems to produce recovery rates that exceed those of CBT. These results demonstrate that the effects of treatment cannot be attributed to non-specific therapy factors.
Declaration of interest
A.W. wrote the treatment protocol in MCT and several books on CBT and MCT, and receives royalties from these. T.D.B. wrote the protocol in CBT and has published several articles and chapters on CBT and receives royalties from these. All other authors declare no competing interests.
It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time.
When outcome variables are ordinal rather than continuous, the ordered logit model, aka the proportional odds model (ologit/po), is a popular analytical method. However, generalized ordered logit/partial proportional odds models (gologit/ppo) are often a superior alternative. Gologit/ppo models can be less restrictive than proportional odds models and more parsimonious than methods that ignore the ordering of categories altogether. However, the use of gologit/ppo models has itself been problematic or at least sub-optimal. Researchers typically note that such models fit better but fail to explain why the ordered logit model was inadequate or the substantive insights gained by using the gologit alternative. This paper uses both hypothetical examples and data from the 2012 European Social Survey to address these shortcomings.
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.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
Repetitive negative thinking (RNT) has been shown to be an important vulnerability factor for a variety of emotional problems. Recently, the Perseverative Thinking Questionnaire (PTQ) was developed as a content-independent measure of RNT in adults, which allows research into this process from a transdiagnostic perspective. The current study describes the construction of a child-appropriate version of the instrument and provides initial evidence for its reliability and validity. Both a one-factor model and a three-factor higher-order model were found to adequately fit with the data but the more parsimonious one-factor model was retained for further analyses. The unidimensional PTQ-C scale showed excellent internal consistency and its validity was supported by substantial correlations with other measures of repetitive thinking as well as with symptom levels of depression and anxiety. Finally, as expected, regression analyses suggested that the PTQ-C scale captures the general repetitive negative thinking associated with anxiety and depression, whereas measures of worry and brooding tap additional content-related aspects of these symptom dimensions.
People typically want to feel good. At times, however, they seek to maintain or enhance negative affect or to dampen positive affect. The prevalence of such contrahedonic motivation has been related to simultaneous experiences of positive and negative (i.e., mixed) affect. We investigated the role that implicit mental representations of affect valence may play in this regard in a study with N = 400 participants aged 11-88 years. Results demonstrated the age-fairness and reliability of the affect-valence Implicit Association Test, a newly developed implicit measure of interindividual differences in mental representations of affect valence. The older participants were, the more distinctively they implicitly associated happiness with pleasantness and/or unhappiness with unpleasantness. Participants furthermore carried mobile phones as assessment instruments with them for 3 weeks while pursuing their daily routines. The phones prompted participants on average 54 times to report their momentary affective experience and affect-regulation motivation. Contrahedonic motivation and mixed affect were most prevalent among adolescents and least prevalent among older adults, and thus showed a similar pattern of age differences as the affect-valence Implicit Association Test. Furthermore, the more distinctive participants' implicit associations of happiness with pleasantness, and/or unhappiness with unpleasantness, the less likely participants were to report contrahedonic motivation and mixed affect in their daily lives. These findings contribute to a refined understanding of the mixed-affect perspective on contrahedonic motivation by demonstrating the respective role of implicit affect-valence representations. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Purpose
Social anxiety is common for those who stutter and efficacious Cognitive Behavior Therapy (CBT) for them appears viable. However, there are difficulties with provision of CBT services for anxiety among those who stutter. Standalone Internet CBT treatment is a potential solution to those problems. CBTpsych is a fully automated, online social anxiety intervention for those who stutter. This report is a Phase I trial of CBTpsych.
Method
Fourteen participants were allowed 5 months to complete seven sections of CBTpsych. Pre-treatment and post-treatment assessments tested for social anxiety, common unhelpful thoughts related to stuttering, quality of life and stuttering frequency.
Results
Significant post-treatment improvements in social anxiety, unhelpful thoughts, and quality of life were reported. Five of seven participants diagnosed with social anxiety lost those diagnoses at post-treatment. The two participants who did not lose social anxiety diagnoses did not complete all the CBTpsych modules. CBTpsych did not improve stuttering frequency. Eleven of the fourteen participants who began treatment completed Section 4 or more of the CBTpsych intervention.
Conclusions
CBTpsych provides a potential means to provide CBT treatment for social anxiety associated with stuttering, to any client without cost, regardless of location. Further clinical trialing is warranted.
Educational objectives
The reader will be able to: 1) describe that social anxiety is common in those who stutter 2) discuss the origin of social anxiety and the associated link with bullying 3) summarize the problems in provision of effective evidence based cognitive behavior therapy for adults who stutter 4) describe a scalable computerized treatment designed to tackle the service provision gap 5) describe the unhelpful thoughts associated with stuttering that this fully automated computer program was able to tackle 6) list the positive outcomes for individuals who stuttered that participated in this trial such as the reduction of social anxiety symptoms and improvement in the quality of life for individuals who stuttered and participated in this trial.
Purpose
We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males.
Method
We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7–30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves.
Results
The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern.
Conclusions
In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers.
Supplemental Material
https://doi.org/10.23641/asha.21554877
Purpose
The purpose of this study was to explore experiences with concealing stuttering in children and young people who stutter based on recollections from adults. In addition, we explored how school-based speech therapists can be helpful or unhelpful to children who are concealing stuttering from the perspective of adults who stutter.
Method
Thirty adults who stutter, who previously or currently conceal stuttering, participated in semistructured interviews exploring their early experiences with hiding stuttering. Purposeful and random sampling was used to diversify experiences and opinions. Reflexive thematic analysis was used to develop themes and subthemes to describe participants' experiences.
Results
All participants in the study reported beginning to conceal stuttering at 18 years of age or younger, with more than two thirds sharing that they began in elementary school. Participants reported that exposure to implicit and explicit ableist messaging about stuttering and traumatic social experiences at school contributed to their inclination to hide disfluencies. Many participants described concealment as a strategy for protecting themselves from stigma. Several participants condemned fluency shaping, calling it harmful and likening it to teaching concealment. Participants believed that speech therapists could be helpful by promoting safe and supportive school environments and by being responsive to the social and emotional challenges that can accompany speaking differently and navigating stigma at school.
Conclusions
Some children who stutter may attempt to protect themselves from stigma by concealing their disfluencies, but doing so can feel isolating and confusing. Speech therapists can play an important role in making the school environment safer and more supportive for children who stutter.
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.
Objectives
This study aimed to identify and summarize published guidance and recommendations for child self- and proxy assessment of existing child-specific instruments of health-related quality of life (HRQoL) that are accompanied by utilities.
Methods
A total of 9 databases plus websites of (1) health technology assessment and health economics outcomes research organizations and (2) instrument developers were systematically searched. Studies were included if they reported guidance for child self- and proxy assessment for child populations (0-18 years old). Three reviewers independently screened titles, abstracts, and full-text reviews against the inclusion criteria. Key features of the guidance identified were summarized.
Results
A total of 19 studies met the inclusion criteria. In general, journal articles provided little guidance on child self- and proxy assessment, with the majority focused on instrument development and psychometric performance more broadly. Instrument developers’ websites provided more guidance for child self- and proxy reports with specific guidance found for the EQ-5D-Y and the Pediatric Quality of Life Inventory. This guidance included the minimum age for self-report and mode of administration; recommended proxy types, age range of child for whom proxy report can be completed, and target population; and recall period. Websites of leading organizations provided general guidance on HRQoL evaluation in children but lacked specific guidance about self- and proxy completion.
Conclusions
EQ-5D-Y and Pediatric Quality of Life Inventory developers’ websites provided the most comprehensive guidance for self-report and proxy report of their respective instruments. More evidence is required for developing best practice guidance on why, when, and how to use self- and proxy reports in assessing HRQoL in child populations.
Purpose
The purpose of this study was to investigate whether there are elevated symptoms of anxiety or depression in children and adolescents (aged 2–18 years) who stutter, and to identify potential moderators of increased symptom severity.
Method
We conducted a preregistered systematic review of databases and gray literature; 13 articles met criteria for inclusion. A meta-analysis using robust variance estimation was conducted with 11 cohort studies comparing symptoms of anxiety in children and adolescents who do and do not stutter. Twenty-six effect sizes from 11 studies contributed to the summary effect size for anxiety symptoms (851 participants). Meta-analysis of depression outcomes was not possible due to the small number of studies.
Results
The summary effect size indicates that children and adolescents who stutter present with increased anxiety symptoms ( g = 0.42) compared with nonstuttering peers. There were insufficient studies to robustly analyze depression symptoms, and qualitative review is provided. No significant between-groups differences were reported in any of the depression studies.
Conclusions
Preliminary evidence indicates elevated symptoms of anxiety in some children and adolescents who stutter relative to peers. There was a tendency toward higher depression scores in this population, although reported between-groups differences did not reach statistical significance. These findings require replication in larger, preferably longitudinal studies that consider factors that may moderate risk. Nevertheless, our findings highlight a need for careful monitoring of mental health and well-being in young people who stutter.
Objective
The literature on the association between sex, rumination, and depression indicates significant variability from childhood to adulthood. Although this variability indicates the need for a developmental lens, a surprising lack of research has been conducted on the association between these variables from middle to late adolescence.
Method
The present study seeks to bridge this gap using structured equation modeling (SEM) to evaluate the reciprocal associations between sex, brooding rumination, reflective rumination, and depressive symptoms in a sample of students measured at 8th grade, 9th grade, and 12th grade time points.
Results
In line with findings across the lifespan, female participants indicated significantly higher average levels of both subtypes of rumination and depressive symptoms versus males. Novel results of this study include the findings that for male participants in this age range, brooding rumination predicted later depressive symptoms, while for female participants, early depressive symptoms predicted later brooding. For female participants, early reflective rumination predicted later depressive symptoms.
Conclusions
This is the first investigation of its kind to demonstrate deleterious longitudinal effects of self-reflective rumination. Findings are interpreted through an ecological framework and mark the transition to high school as a potential risk for interrupted problem-solving of circumstances related to adolescents’ distress.
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.
Purpose
Adults who stutter tend not to stutter when they are alone. This phenomenon is difficult to study because it is difficult to know whether participants perceive that they are truly alone and not being heard or observed. This may explain the presence of stuttering during previous studies in which stutterers spoke while they were alone. We addressed this issue by developing a paradigm that elicited private speech, or overt speech meant only for the speaker. We tested the hypothesis that adults do not stutter during private speech.
Method
Twenty-four participants were audio-/video-recorded while speaking in several conditions: 1) conversational speech; 2) reading; 3) private speech, in which deception was used to increase the probability that participants produced speech intended for only themselves; 4) private speech+, for which real-time transcription was used so that participants produced the same words as in the private speech condition but while addressing two listeners; and 5) a second conversational speech condition.
Results
Stuttering was not observed in more than 10,000 syllables produced during the private speech condition, except for seven possible, mild stuttering events exhibited by 3 of 24 participants. Stuttering frequency was similar for the remaining conditions.
Conclusions
Adults appear not to stutter during private speech, indicating that speakers' perceptions of listeners, whether real or imagined, play a critical and likely necessary role in the manifestation of stuttering events. Future work should disentangle whether this is due to the removal of concerns about social evaluation or judgment, self-monitoring, or other communicative processes.
Purpose
In the current study, stuttering was conceptualized as a concealable stigmatized identity (CSI). The purpose of this investigation was to determine if four specific stigma-identity constructs that contribute to variability in psychological distress among people in other CSI groups also contribute among adult who stutter (AWS).
Method
505 AWS completed an online survey that included measures of four stigma-identity constructs in addition to general demographics and measures of self-rated stuttering severity, distress, and adverse impact of stuttering on quality of life. Hierarchical regression was performed to determine the extent that stigma-identity constructs explained variability in psychological health outcomes among AWS. Self-rated stuttering severity was investigated as a moderator in these relationships.
Results
The stigma-identity constructs accounted for a significant proportion of the variability in distress (∼25%) and adverse impact of stuttering on quality of life (∼30%) among AWS. Further, the constructs of salience, centrality, and concealment were positively predictive of distress and adverse impact of stuttering after controlling for demographics and neuroticism. Compared to the other predictor variables (self-rated stuttering severity, demographic characteristics, neuroticism, and the three other stigma-identity constructs), concealment was the strongest predictor of adverse impact of stuttering on quality of life. Finally, self-rated stuttering severity was a moderating variable.
Conclusions
The results from this study suggest that there are useful applications in conceptualizing stuttering as a type of CSI. Speech-language pathologists should be aware of the relationships that stigma has with psychological health outcomes among AWS and should consider the implications for intervention.
Purpose
The purpose of this study was to examine group and individual differences in attentional bias toward and away from socially threatening facial stimuli among adolescents who stutter and age- and sex-matched typically fluent controls.
Method
Participants included 86 adolescents (43 stuttering, 43 controls) ranging in age from 13 to 19 years. They completed a computerized dot-probe task, which was modified to allow for separate measurement of attentional engagement with and attentional disengagement from facial stimuli (angry, fearful, neutral expressions). Their response time on this task was the dependent variable. Participants also completed the Social Anxiety Scale for Adolescents (SAS-A) and provided a speech sample for analysis of stuttering-like behaviors.
Results
The adolescents who stutter were more likely to engage quickly with threatening faces than to maintain attention on neutral faces, and they were also more likely to disengage quickly from threatening faces than to maintain attention on those faces. The typically fluent controls did not show any attentional preference for the threatening faces over the neutral faces in either the engagement or disengagement conditions. The two groups demonstrated equivalent levels of social anxiety that were both, on average, very close to the clinical cutoff score for high social anxiety, although degree of social anxiety did not influence performance in either condition. Stuttering severity did not influence performance among the adolescents who stutter.
Conclusion
This study provides preliminary evidence for a vigilance–avoidance pattern of attentional allocation to threatening social stimuli among adolescents who stutter.
Background
Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD.
Aim
The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children.
Method
We enrolled 122 clinically anxious children aged 7–13 years; of these, 33 had an SAD diagnosis.
Results
SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis.
Conclusions
Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.
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
Prior research has explored how repetitive negative thinking (RNT) contributes to both the increased persistence and severity of various disorders, such as depression, anxiety, and eating disorders. This study explored the potential role of RNT in the experience of stuttering, with a particular focus on the relationship between RNT, adverse impact, and certain temperament profiles.
Method
Three hundred thirteen adults who stutter completed a measurement of the frequency/severity of RNT (Perseverative Thinking Questionnaire; Ehring et al., 2011 ), 207 completed a temperament profile (Adult Temperament Questionnaire; Evans & Rothbart, 2007 ), and 205 completed a measurement of adverse stuttering impact (Overall Assessment of the Speaker's Experience of Stuttering; Yaruss & Quesal, 2016 ). Analyses were conducted within and across instruments to ascertain how RNT, temperament markers, and adverse impact interrelate within individuals.
Results
Results indicated that RNT significantly predicts Overall Assessment of the Speaker's Experience of Stuttering impact scores with great effect and that certain temperament markers (specifically, Effortful Control and Negative Affectivity) moderate this relationship for specific sections of the Overall Assessment of the Speaker's Experience of Stuttering.
Conclusion
By assessing RNT in people who stutter, clinicians can better understand individual differences in their clients, and this will allow them to make targeted diagnoses and develop more tailored intervention plans.
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: 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.
It is not clear if treatments for depression targeting repetitive negative thinking (RNT: rumination, worry and content-independent perseverative thinking) have a specific effect on RNT resulting in better outcomes than treatments that do not specifically target rumination. We conducted a systematic search of PsycINFO, PubMed, Embase and the Cochrane library for randomized trials in adolescents, adults and older adults comparing CBT treatments for (previous) depression with control groups or with other treatments and reporting outcomes on RNT. Inclusion criteria were met by 36 studies with a total of 3307 participants. At post-test we found a medium-sized effect of any treatment compared to control groups on RNT (g = 0.48; 95% CI: 0.37-0.59). Rumination-focused CBT: g = 0.76, <0.01; Cognitive Control Training: g = 0.62, p < .01; CBT: g = 0.57, p < .01; Concreteness training: g = 0.53, p < .05; and Mindfulness-based Cognitive Therapy: g = 0.42, p < .05 had medium sized and significantly larger effect sizes than other types of treatment (i.e., anti-depressant medication, light therapy, engagement counseling, life review, expressive writing, yoga) (g = 0.14) compared to control groups. Effects on RNT at post-test were strongly associated with the effects on depression severity and this association was only significant in RNT-focused CBT. Our results suggest that in particular RNT-focused CBT may have a more pronounced effect on RNT than other types of interventions. Further mediation and mechanistic studies to test the predictive value of reductions in RNT following RNT-focused CBT for subsequent depression outcomes are called for.
Purpose:
Social anxiety disorder is a debilitating anxiety disorder associated with significant life impairment. The purpose of the present study is to evaluate overall functioning for adults who stutter with and without a diagnosis of social anxiety disorder.
Method:
Participants were 275 adults who stuttered (18-80 years), including 219 males (79.6%) and 56 females (20.4%), who were enrolled to commence speech treatment for stuttering. Comparisons were made between participants diagnosed with social anxiety disorder (n = 82, 29.8%) and those without that diagnosis (n = 193, 70.2%).
Results:
Although the socially anxious group was significantly younger than the non-socially anxious group, no other demographic differences were found. When compared to the non-socially anxious group, the socially anxious group did not demonstrate significantly higher self-reported stuttering severity or percentage of syllables stuttered. Yet the socially anxious group reported more speech dissatisfaction and avoidance of speaking situations, significantly more psychological problems, and a greater negative impact of stuttering.
Conclusion:
Significant differences in speech and psychological variables between groups suggest that, despite not demonstrating more severe stuttering, socially anxious adults who stutter demonstrate more psychological difficulties and have a more negative view of their speech. The present findings suggest that the demographic status of adults who stutter is not worse for those with social anxiety disorder. These findings pertain to a clinical sample, and cannot be generalized to the wider population of adults who stutter from the general community. Further research is needed to understand the longer-term impact of social anxiety disorder for those who stutter.
Social appearance anxiety (SAA), or fear of having one's appearance negatively evaluated by others, is a risk factor for eating pathology and social anxiety, but maintenance processes for SAA remain unclear. The current study evaluated repetitive negative thinking (RNT) as a process through which SAA is maintained over time. Undergraduates (N = 126) completed self-report measurements, made an impromptu speech task to induce SAA, and were randomized to either engage in RNT or distraction following the speech task. Participants then attended a second appointment one day later and were asked to make a second speech. Results indicated positive associations between self-reported trait SAA and RNT. Individuals asked to engage in RNT following the appointment 1 speech task reported significantly higher state SAA than those who engaged in distraction. Findings indicated no significant effect of group on appointment 2 SAA, but post-hoc analyses suggested that naturally-occurring RNT may have accounted for increases in SAA across appointments. Overall, results provide support for the importance of RNT in maintaining various internalizing symptoms.
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:
Stuttering is a speech disorder frequently accompanied by anxiety in social-evaluative situations. A growing body of research has confirmed a significant rate of social anxiety disorder among adults who stutter. Social anxiety disorder is a chronic and disabling anxiety disorder associated with substantial life impairment. Several influential models have described cognitive-behavioral factors that contribute to the maintenance of social anxiety in nonstuttering populations. The purpose of the present article is to apply these leading models to the experience of social anxiety for people who stutter.
Method:
Components from existing models were applied to stuttering in order to determine cognitive-behavioral processes that occur before, during, and after social-evaluative situations, which may increase the likelihood of stuttering-related social fears persisting.
Results:
Maintenance of social anxiety in stuttering may be influenced by a host of interrelated factors, including fear of negative evaluation, negative social-evaluative cognitions, attentional biases, self-focused attention, safety behaviors, and anticipatory and postevent processing.
Conclusion:
Given the chronic nature of social anxiety disorder, identifying factors that contribute to the persistence of stuttering-related social fears has the potential to inform clinical practice and the development of psychological treatment programs to address the speech and psychological needs of people who stutter with social anxiety.
Repetitive negative thinking (RNT) is a transdiagnostic process associated with numerous emotional disorders. Most measures of RNT are disorder-specific, limiting utility in comorbid populations. Transdiagnostic measures of RNT have been developed in adults and are associated with anxiety and depression. However, a transdiagnostic measure is needed to assess RNT in adolescents as a potential vulnerability factor for emotional disorders. This study validates a transdiagnostic measure of RNT—Repetitive Thinking Questionnaire–10 (RTQ-10)—in adolescents (N = 840, Mage = 15.7 years). Exploratory and confirmatory factor analyses supported a unidimensional structure. The RTQ-10 manifested good internal consistency and measurement invariance across genders and age. RNT was equally associated with anxiety and depression symptoms irrespective of gender or age. Convergent validity was demonstrated by correlations with disorder-specific measures of RNT. These findings support the RTQ-10 as a reliable and valid transdiagnostic measure of RNT in adolescents.
A guide to using S environments to perform statistical analyses providing both an introduction to the use of S and a course in modern statistical methods. The emphasis is on presenting practical problems and full analyses of real data sets.
Purpose:
Developmental stuttering may be associated with diminished psychological well-being which has been documented from late childhood onwards. It is important to establish the point at which behavioural, emotional and social problems emerge in children who stutter.
Methods:
The study used data from the Millennium Cohort Study, whose initial cohort comprised 18,818 children. Analysis involved data collected when the cohort members were 3, 5 and 11 years old. The association between parent-reported stuttering and performance on the Strengths and Difficulties Questionnaire was determined in regression analyses which controlled for cohort members' sex, verbal and non-verbal abilities, maternal education, and family economic status.
Results:
Compared with typically-developing children, those who stuttered had significantly higher Total Difficulties scores at all three ages; in addition, scores on all of the sub-scales for 5-year-olds who stuttered indicated poorer development than their peers, and 11-year-olds who stuttered had poorer development than peers in all areas except prosocial skills. At ages 5 and 11, those who stuttered were more likely than peers to have scores indicating cause for clinical concern in almost all areas.
Conclusion:
Children who stutter may begin to show impaired behavioural, emotional and social development as early as age 3, and these difficulties are well established in older children who stutter. Parents and practitioners need to be aware of the possibility of these difficulties and intervention needs to be provided in a timely fashion to address such difficulties in childhood and to prevent the potential development of serious mental health difficulties later in life.
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.
In contemporary clinical allied health and medical settings, there has been a proliferation of Acceptance and Commitment Therapy (ACT) programs. These clinically effective programs have reduced comorbid anxiety, depression, and stress for individuals suffering from chronic medical and psychosocial issues. However, to date, there has been no published work examining the effectiveness of an integrated ACT program for individuals who stutter. In this review, we will provide a platform from which readers will be able to (a) appraise the literature regarding combined speech pathology and psychology therapeutic programs for people who stutter, (b) appreciate an overview of ACT in the context of stuttering disorders, and (c) understand the relevant psychosocial outcome measures that constitute therapeutic change. This unique review of ACT will distinguish the processes of self-concept, defusion, acceptance, mindfulness, values, and committed action in support for people who stutter who experience psychosocial distress. In the culmination of the review, we advance the integration of ACT into current treatments for individuals who stutter.
Sex differences are prominent in mood and anxiety disorders and may provide a window into mechanisms of onset and maintenance of affective disturbances in both men and women. With the plethora of sex differences in brain structure, function, and stress responsivity, as well as differences in exposure to reproductive hormones, social expectations and experiences, the challenge is to understand which sex differences are relevant to affective illness. This review will focus on clinical aspects of sex differences in affective disorders including the emergence of sex differences across developmental stages and the impact of reproductive events. Biological, cultural, and experiential factors that may underlie sex differences in the phenomenology of mood and anxiety disorders are discussed.