Using genetics to understand the causes of stuttering
Dennis Drayna, Carlos E.F. Domingues and M. Hashim Raza
National Institute on Deafness and Other Communication Disorders. National Institutes of Health, Bethesda, Maryland, USA
Although the causes of stuttering remain poorly understood, numerous twin studies have demonstrated that genetic factors make a
significant contribution to this disorder. The identification of the genes that make up this contribution could provide an
understanding of the molecules and cells involved and lead to improved diagnosis and treatment. Genetic linkage studies in our
laboratory have identified locations on chromosomes 2, 3, 10, 12, 14, 15, and 16 that contain genes associated with persistent
developmental stuttering in families. Studies on chromosome 12 have identified mutations in the GNPTAB gene and subsequent studies
identified mutations in the related GNPTG and NAGPA genes that cause stuttering in populations worldwide. These three genes encode
enzymes that attach a mannose 6-phosphate residue to a diverse group of ~50 enzymes, which acts as a targeting signal that causes the
cell to route these enzymes to their proper location in the lysosome compartment within the cell. Severe mutations in GNPTAB and
GNPTG have previously been associated with Mucolipidosis Types II and III, rare fatal disorders characterized by multiple pathologies.
The mutations in these genes present in stuttering have a less severe effect and occur at positions different from those found in Mucolipidosis, which is consistent with the lack of mucolipidosis symptoms present in stuttering subjects with mutations in these genes. Mutations in the genes identified to date may account for 8-16% of persistent developmental stuttering cases worldwide. While more genes remain to be identified, the genes found to date indicate that deficits in intracellular trafficking are important in stuttering.
On brain processes and stuttering
MD, Department of Clinical Neurophysiology, University of Gottingen, Germany, EU
Individuals who stutter experience stuttering events as a loss of control of the speech muscles — they know what they want to say,
but cannot articulate it in a fluent manner. This loss of control suggests a dysfunction of the speech motor system. In at least some
stuttering events, the dysfluency is preceded by a precognition or perception of the impending dysfluency.
Such precognitions are reminiscent of premonitory urges reported by people with Tourette’s syndrome, wherein many affected individuals perceive an urge to produce a tic before the tic actually happens. We recently adapted a questionnaire for premonitory urges, used in Tourette’s syndrome, and applied it to stuttering. Two groups were tested – one group of adults with stuttering and one age matched control group. The two groups could be clearly differentiated by these premonitory feelings preceding speech dysfluencies.
The ability to anticipate movement lapses is a typical feature of basal ganglia disorders and presumably related to feedforward control of speech execution.
From the perspective of movement disorders, the repetitions seen in stuttering can be clinically analogous to the freezing of gait in Parkinson’s disease patients, who ≪stutter with their feet≫. They are stuck in repetitions of the initial movement segment, because they are unable to shift from the initial set into the subsequent movement segments of gait. This clinical analogy made us wonder whether the motor cortex of adults who stutter prepares them for the transition between subsequent articulatory sets, in a fashion equivalent to Parkinson’s disease.
We investigated the excitability of the tongue motor cortex during the transition between the initial and the subsequent segments of an utterance. While a group of fluent speaking control subjects showed an increase in excitability, in preparation for the second segment of the utterance, this dynamic modulation of motor cortex excitability was lacking in a group of adults who stutter. Not only was this difference significant between groups, but so was the extent to which the lack of motor cortex excitability correlated with general stuttering level. Since patients were fluent in most speaking situations during this study, it appears to be a trait marker of stuttering, rather than a state marker.
In summary, recent data uncover a disease core of sequential movement execution with both basal ganglia involvement and a linguistic component.
Having clarified the pivotal involvement of the left hemisphere motor cortex, it remains to be seen whether modulation of excitability of this area or the afferent brain areas may serve to improve the outcome of speech fluency treatment.
Tongue motor representation in adults with persistent developmental stuttering
Pierpaolo Busan1, Giovanni Del Ben2, Fabrizio Monti3, Simona Bernardini4, Giulia Natarelli5, Piero Paolo Battaglini6
1IRCCS Fondazione Ospedale San Camillo, Venice, Italy, 2BRAIN Centre for Neuroscience, Department of Life Sciences, University of Trieste, Trieste, Italy 3Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy, 4 ABC Balbuzie Turin, Italy, 5Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy, 6BRAIN Centre for Neuroscience, Department of Life Sciences, University of Trieste, Trieste, Italy
The neurophysiology of developmental stuttering is not completely clear, but increasing evidence suggests the existence of
differences in the structure and the functioning of brain motor systems in adults with persistent developmental stuttering (PDS).
A group of 11 right-handed males with PDS was evaluated by using transcranial magnetic stimulation (TMS) on their tongue representation in primary motor cortex and data were compared with those obtained in 15 matched normal speakers. Motor representations in both hemispheres were evaluated, recording motor evoked potentials. Variables such as motor thresholds, silent period thresholds and silent period durations were evaluated. Non-motor variables were also taken into account, such as the psychological profile (CBA 2.0) and speech-associated attitudes (BigCAT).
Adults with PDS showed higher motor thresholds in the left hemisphere with respect to the right hemisphere, especially when considering silent period thresholds. Silent period duration resulted significantly increased in PDS when stimulating the left hemisphere. This suggests the presence of a particular intracortical balance in the tongue motor cortex of adults with PDS. More specifically, while the higher silent period threshold in adults with stuttering could also speculatively suggest a tendency toward a lower intracortical inhibition, the presence of longer silent period duration, when stimulating the tongue representation of the left hemisphere, points toward a greater inhibition in the left motor cortex of stutterers. From a behavioral and cognitive point of view, principal findings indicated that adults with PDS confirmed a negative attitude toward speech situations in comparison to fluent speakers. This evidence, in line with previous ones in stuttering research, supports the existence of dysfunctional motor circuits in the left hemisphere of adults with PDS. Present suggestions could be useful for a better focusing of rehabilitative purposes.
A Multifactorial neurodevelopmental approach to stuttering:(1) Language and motor factors and (2) Pathways to persistence and recovery
Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
Stuttering is a neurodevelopmental disorder which emerges in early childhood when the multiple neural networks involved in language processing and speech production are being formed. We present a theoretical account of stuttering as a neurodevelopmental disorder involving multiple factors, including motor, language, and emotional factors. This account is motivated by recent findings from our laboratory showing that the wellknown characteristics of stuttering present in adults, including speech motor instabilities and atypical language processing functions, are also present near stuttering onset in 4 and 5-year-old children.
Stuttering and reading: preliminary study for speed reading detection
Claudio Vio1 , Biancamaria Venuti2, Eleonora Pasqua2, Emilia Capparelli2, Francesca Del Gado2 and Donatella Tomaiuoli2
1University of Padua; University of Trieste, Italy; 2CRC Balbuzie, Italy
Assessment of reading disability in presence of stuttering is a difficult task and there are no studies that have
investigated the quality of reading in cases of comorbidity.
Many studies have investigated the relationship between stuttering and language (eg. phonological encoding, phonetic segmentation, judgments of rhymes, repetition of non-words).
We can assume three possible ways to investigate the characteristics of reading in children who stutter: 1) the sound masking, which can be used as means for assessing the actual quality of reading in people who stutter in childhood, taking advantage of its characteristic to "wipe" the speech by any possible disfluencies; 2) whispered reading, that represents a further condition that facilitates verbal fluency (Bloodstein, 1950); in this case facilitation is given by the modification of the tone of voice, without interference on the auditory feedback; 3) finally, a further possibility of investigation is represented by the silent reading.
About silent reading tests it was shown that in adults, both normal reader and dyslexics ones, we observe an increase in reading speed in silent mode compared to reading aloud. The results show that normal reader performance improves of about 50% in speed while he reads silently about 50% and the increase in people with dyslexia does not exceed 25% (Ciuffa et al. 2014).
The purpose of this paper is to study the influence of different modes of reading in dyslexic and stutterers.
The Croatia Protocol for Clinical Trials of Stuttering
University of Sydney
There are many treatments for stuttering with many different intended benefits. At present, the different benefits of all those treatments cannot be captured with a single, overarching primary outcome that reflects a common goal for all of them. This makes it currently impossible to directly compare effect sizes of different treatments with different goals in a single, comparative randomised trial. The Croatia Protocol for Clinical Trials of Stuttering proposes a solution to that problem with an overarching measure intended to reflect the benefit of any treatment for stuttering, and which is valid and inexpensive. The present proposal overviews the Croatia Protocol and presents research that establishes its validity and describes its relationship to other primary outcomes currently used in clinical trials.
Evaluating stuttering from the speaker’s perspective
J. Scott Yaruss
University of Pittsburgh, PA, Stuttering Therapy Resources, Inc.
Clinical evaluations of stuttering have long been based, at least in part, on measuring the frequency, duration, or severity of observable speech behaviors. These assessments, which describe aspects of stuttering behavior from the listener’s perspective, are valuable because they contribute to our understanding of the impact that stuttering may have on a speaker’s communication abilities. A second perspective that also plays a key role in the experience of stuttering is that of the person who stutters. Ample evidence shows that people who stutter perceive the moment of stuttering in a way that involves more than just the production of repetitions, prolongations, or blocks. People who stutter report feelings of “being stuck” during or before moments of observable stuttering; they explain that they know what they want to say but are unable to it; and they state that they anticipate in advance what words will be problematic. Such “under-the-surface” or intrinsic aspects of the moment of stuttering may leave no mark on the observable speech behavior, but they certainly affect the speaker. These feelings of impending “loss of control” contribute to speakers’ negative reactions to stuttering: their fears and anxieties about speaking, their tendency to tense their muscles in an attempt to push words out, or their desire to avoid words or situations. These reactions, in turn, play a key role in determining whether a speaker will experience difficulties with communication in daily situations or adverse impact on quality of life as a result of stuttering. Understanding the perception of the speaker during the moment of stuttering should therefore be a central focus in clinical assessment, for unless clinicians are aware of what the moment of stuttering feels like for the person who stutters, they may not fully appreciate the impact of the stuttering disorder on a speaker’s life. The purpose of this presentation is to discuss the moment of stuttering—and the experience of the stuttering disorder—from the viewpoint of the person who stutters, so clinicians will be better able to incorporate the speaker’s perception in the evaluation and treatment of stuttering.
Evidence from narratives of PWS: what are the implications for interventions
University of Cape Town
Stuttering interventions are intended to make a difference in the lives of People Who Stutter. Therefore, it seems sensible that the voices of PWS must be heard and understood by speech-language therapists as a basis for developing personally-relevant interventions. In this paper, the importance of narrative evidence is explained by contrasting the difference between a case history which is typically used in clinical practice and a life history as a research method. The data generated from life history narrative study (Kathard, 2003) is used to explain core issues of self-identity and stuttering — who am I? The key constructs of self-identity as DisOther, Able and ≪undisabled≫ are discussed illuminating the deeply human complexity of self-identity formations evident in the stories of adults who stutter. Given such complexity, the paper considers the implications of these narratives and emerging constructs for clinicians as they enter into the therapeutic relationship. It urges clinicians to approach their interventions will full awareness of how the personal, social and political forces are at play both for the client and clinician. It highlights the tensions and conflicts that emerge when approach to intervention is swayed by the underpinnings of the medical model while the lifeworld of the client calls for a deeper understanding of the stuttering experience through alternative lenses of the social model or capabilities model. The implications for clinical practice which value the depth of stories and subjective experience are explained.
Safety behaviours and stuttering
Robyn Lowe, Fjola Helgadottir, Ross Menzies, Susan O’Brian, Ann Packman and Mark Onslow
University of Sidney
For many, stuttering is associated with debilitating mental health problems. Social anxiety disorder is the most prevalent
condition associated with adults who stutter.
Safety behaviours are a core component of social anxiety disorder. Those who are socially anxious use safety behaviours to avoid negative outcomes or events such as social humiliation during social encounters. The person attributes the non-occurrence of a negative event to the safety behaviour.
Safety behaviours prevent the unlearning of fear and maintain anxiety.
In a recent report it was found that during routine clinical treatment of stuttering, speech pathologists commonly recommend that patients engage in certain tasks that might, under certain circumstances, be considered safety behaviours.
The aims of this study were (1) to identify safety behaviours used by adults who stutter and (2) determine whether a relationship exists between safety behaviour use and scores on psychological measures including fear of negative evaluation, avoidance and cognitions.
Participants were 134 stuttering patients who completed a cognitive behaviour therapy program for anxiety. The participants completed a range of psychological measures and identified safety behaviours, from a list of potential behaviours, they typically used in everyday speaking situations.
Results were obtained that were statistically and clinically significant.
Future research is required to investigate safety behaviours, anxiety and stuttering treatment.
Clients’ demands and clinicians’ capacities: can we meet?
Children’s Hospital Zagreb, Croatia
Clinical wisdom, infused into the profession decades ago by Don Baer, is that the complaints of clients fundamentally drive clinical practice. Also of interest to clinicians is empirical information about how stuttering affects people and drives them to clinicians with such complaints. When clients present to clinicians, the cycle of evidence based practice begins with knowledge from clinical trials about effect sizes that can realistically be expected from treatments. This presentation synthesises available knowledge about what those affected with stuttering complain about, what is known about how stuttering affects them, and what is known about effect sizes that can be expected from treatment when they come to clinics. Conclusions are suggested that might inform clinical practice and research.
Attitudes of nonstuttering children and youth toward stuttering: what we know and what we need to learn
Kenneth O. St. Louis and Mary E. Weidner
West Virginia University, Morgantown, West Virginia, USA
The adult nonstuttering public holds negative and biased attitudes toward stuttering and people who stutter. These
negative beliefs and self reactions have been observed in nearly all populations around the world in which they have
been studied. The research unambiguously documents that people who stutter experience stigma and discrimination as a
result of their stuttering. The Public Opinion Survey of Human Attributes-Stuttering (POSHA-S), has been used extensively
in research among adult populations worldwide. Even though differences in populations exist, overall results show that
the similarities among adults in different study populations are greater than differences. Two questions logically arise:
≪Where do the negative attitudes so widely shared around the world come from?≫ and ≪How do the attitudes change from
children to adults?≫.
Emerging research is suggestive of disparate attitudes among different age groups across the lifespan (i.e., young children, children, adolescents, and adults). Attitudes of nonstuttering children are important because a host of anecdotal accounts and numerous studies have documented that children who stutter are subjected to teasing and bullying by their peers (Langevin, 2015).
Recent research on children’s attitudes is summarized for various ages, from preschool through high school. Preliminary results from a new measure, the POSHA-S/Child developed by Weidner and St. Louis (2014), are highlighted to augment previous research with preschool and kindergarten samples. Three studies on changeability of stuttering attitudes in middle and high school are also described.
A possible explanation for observed changes in attitudes from young children to young adults is advanced. Some of these changes have been quite surprising and others relatively predictable. A call for additional research with nonstuttering children and youth is advanced, identifying especially promising or important areas of inquiry.
Inquiry on stuttering in Italy: characteristics of the public service (regarding university education and health care) and characteristics of logopedic practice
Marianna Stella1, Carla Lazzari2, Pasqualina Andretta3, Federica Chiari4 , Fabio Ferretti5, Claudio Zmarich6
1 Università di Padova, 2 Università di Siena, 3 Università di Padova, 4 Università di Padova, 5 Università di Siena, 6 CNR-ISTC and Università di Padova
In Italy, the diagnosis and treatment of stuttering is not included in the ≪essential levels of care≫ (Italian: ≪LEA≫)
guaranteed everywhere by National Health System, although regions are able to devote their own resources to the issue. Possible
inadequacies of the Italian welfare, academic, and research institutions could be both the cause and the effect of a very
confused legal framework for the professions involved.
Consequently, we set out to investigate these inadequacies through the use of three questionnaires. Two questionnaires were submitted online to almost all relevant Italian public services and universities with courses potentially involved addressing stuttering. The third questionnaire focusing on speech therapists’ practices and materials was sent to more than 190 logopedists. Results confirm a problematic Italian situation for both the training of future speech therapists on disfluencies and access to public health services for the person who stutters (PWS). In addition, there is a shortage of etiological and clinical research and of evidence-based (EB) treatment programs and clinical materials.
Verbal fluency, lexical production and socio-economic characteristics in a group of 24-months-old children with a family history of stuttering, in relation to possible stuttering onset and final recovery or persistence
Cinzia Quartarone1, Simona Bernardini2, Sabrina Bonichini3, Giulia Natarelli4, Caterina Pisciotta5, Claudio Zmarich6
1 Università di Padova, 2 ABC Balbuzie-Torino, 3 Università di Padova, 4 Università di Padova, 5 Centro Medico di Foniatria-Padova and A.I.BA.COM. Onlus, 6CNR-ISTC and Università di Padova
The research project ≪Phonetic indexes predictive of persistent stuttering in preschool children≫ (CNR, RSTL n. 995),
examines 40 subjects, divided in 26 children who have never started to stutter, and 14 who developed stuttering.
As to the latter, 4 have became persistent and 10 recovered spontaneously. At 24 months of age, the Disfluency Profile (Yairi and Ambrose, 2005) was calculated in a representative sample of connected speech. The occurrences of Stuttering-Like Disfluencies and the occurrences of Other Disfluencies (equally common among stutterers and not stutterers) were counted. Lexical age (MacArthur-Bates, CDI) and socioeconomic score of parents (SES) were also obtained. The main result shows that future stutterers produce more SLD (3.01% vs 0.75%) and have smaller vocabulary size than future non-stutterers.
Awareness and anxiety among preschool children who stutter (CWS)
Ruth Ezrati-Vinacour1, Keren Mamistvalove-Amir2, Daniela Lobel3, Nitza Katz-Bernstein4
1 The Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel, 2The Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel, 3 Clalit Health Services, Israel, 4 The Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv, University, Israel. The Department of Speech and Communication, Faculty of Rehabilitation Sciences, TU Dortmund University, Germany
In the majority of cases, the disorder of stuttering begins before the age of four. For many years the question of whether
young children who stutter are aware of their stuttering has been central in both theoretical and clinical thinking. Recent
studies show that from the age of three CWS show signs of awareness towards dysfluency (Ambrose and Yairi, 1994; Yairi, 1983)
and that CWNS are aware between the ages of four to five (Ezrati-Vinacour et al. 2001). Starting at the age of four we notice
negative attitudes towards stuttering speech (Ezrati-Vinacour et al., 2001; Vanryckeghem et al., 2005).
CWS experience undefined stress and anticipation of being insulted that may lead to feelings of anxiety. Most research studies conducted among PWS support a positive relationship between stuttering and state anxiety, there is lower agreement between trait anxiety and stuttering. However, the relationship between stuttering and anxiety among preschool children remains vague. One study has been published regarding the question about the relationship between the level of anxiety and stuttering in CWS and that study found no difference in anxiety levels between CWS and CWNS (Craig and Hancock, 1996).
The purpose of this current study is to examine the existence of anxiety (trait and state), awareness and attitudes towards speech among preschool CWS in comparison with two groups CWNS: 1. Preschool children with articulation disorders 2. Preschool children with no speech disorders. The speech of 50 children was recorded, 15 of them were CWS, 15 children with articulation disorders and 20 children with no speech disorders. Speech samples were analyzed for severity of stuttering and speech intelligibility via instrumental and subjective measurements. Three self-report measures were used: the Hebrew version of the FSSC (Fear Survey Schedule for Children, Ollendick, 1983), a questionnaire which evaluates trait anxiety level; RCSS (Reaction of Children to Speech Situations), a questionnaire that was developed in this study to evaluate state anxiety level; and the Hebrew version of the KiddyCAT (Communication Attitude Test for Preschool and Kindergarten Children Who Stutter, Vanryckeghem and Brutten, 2007) in order to evaluate levels of awareness and attitude towards speech. Results show a significant higher level of trait and state anxiety in the group of CWS as compared with both groups of CWNS. In addition, the awareness and attitude towards speech among both the CWS and the children with articulation disorders was significantly higher than that of children with no speech disorders. These results emphasize the importance of early intervention in stuttering in direct or indirect therapy by technical and/or communicational-emotional therapy. This may reduce anxiety levels and prevent the side effects of anxiety in young CWS.
Differential diagnosis of early childhood stuttering and other unusual disfluency patterns.
Carol Hubbard Seery
University of Wisconsin-Milwaukee
The differential diagnosis of childhood stuttering bears on issues of definition, measurement and interpretation of observed
characteristics, and alternative diagnostic distinctions to be made. There are many factors to consider in assessment. These
factors are reviewed: speech sample procedures and contexts, sample size, word and syllable counts, stuttering and disfluency
types and frequency measures, locations and nature of the observed characteristics, secondary (concomitant) behaviors, speech
rate and intelligibility, demographics (age, gender, family background) and social communication behaviors.
Although diagnosis of childhood stuttering may be based primarily on an established definition and measures of observed speech characteristics, additional considerations are noteworthy, such as a child’s awareness of speech disruptions. The evaluation of a child’s developmental abilities (i.e., cognitive, linguistic, motor, articulatory, sensory-perceptual) close to and after stuttering onset also contributes importantly to understanding the fluency disruptions and associated communication behaviors. An analysis of risk factors will aid interpretation, as well.
The majority of diagnostic decisions about stuttering can be made confidently by the application of research-based diagnostic criteria, but sometimes a child presents with speech characteristics that are different from the classic profile. The pattern of disfluent speech may suggest an alternative clinical interpretation. A child’s speech characteristics sometimes are not ≪stuttering-like≫ but are not ≪normally≫ disfluent, either.
Consideration is given to other patterns and forms of fluency disruptions, including the types and patterns characteristic of language impairments. Other unusual cases are encountered when a child inserts pauses at inappropriate locations, for example, in the middle of words, but displays no other stuttering-like disfluencies. Yet another diagnostic challenge may be faced if disruptions are stuttering-like, but occur predominantly in word-final position. Does an atypical pattern signify a different disorder subtype? When and how may the term ≪stuttering≫ still apply?
The nature of diagnosis, definitions and symptom characteristics of stuttering and other fluency disorders will be reviewed. A framework of classifications will be examined. Perspectives on the application of diagnostic and prognostic criteria will be considered, and clinical decision trees will be shared.
Assessment of bilingual children who stutter: What can we learn from non-stuttering bilingual children
Rosalee C. Shenker
Montreal Fluency Centre
With about 60% of the world’s children being raised as dual language learners and approximately 6,000 languages spoken throughout the world, globalization has re-emphasized the benefits of being bilingual. This comes with the need for better understanding of the impact of bilingualism on all areas of child development. With the trend toward more children being raised bilingual, it is inevitable that, as speech pathologists, we must update our techniques to properly treat these children. In order to treat stuttering in bilingual children, we must first understand where speech patterns of monolingual and bilingual children differ, so that our diagnostic tools can be updated to reflect these differences.
Relation between stuttering and anxiety disorders in Italian children and adolescents who stutter
S. Bernardini1, L. Cocco2, C. Zmarich3, M. Di Pietro4, G. Natarelli5 e M. Ghisi6
1 ABC Balbuzie Turin, Italy, 2 ABC Balbuzie Turin, Italy, 3 National Research Council — ISTC, Padua, Italy, 4 ITC, Padua, Italy, 5 Department of Development and Socialization Psychology, University of Padua, Italy, 6 Department of General Psychology, University of Padua, Italy
The relationship between anxiety and stuttering has been widely studied. Indeed, over the past 50 years this has resulted
in compelling and controversial theories and hypotheses that tried to shed light on the nature of this relationship. Previous
researches have shown an increase of negative emotional reactions, as anxiety, related to particular speech situations in
people who stutter. Specifically, it was found that levels of trait anxiety of children and adolescents who stutter do not
differ from that one of non stutter peers; however, children and adolescents who stutter display a significant increase of
the state anxiety in speech situations, due to the fear of receiving a negative evaluation. Current study aimed at assessing 1.
Possible difference in negative emotional reaction to speech situations and general anxiety between children and adolescents
who stutter and non-stuttering peers; 2. possible associations between emotional reactions in speech situations and general
anxiety in both groups.
In order to evaluate the general level of anxiety and its component the Italian version of the Revised Children’s Manifest Anxiety Scale, Second Edition, (RCMAS-2) and the Speech Situation Checklist–Emotional Reaction (SSC-ER) were administered to 65 children and adolescents who stutter and 65 non stuttering peers aged from 9 to 17.
A series of univariate ANOVAs, with Status, Age and Gender as independent variables and SSC-ER scores and RCMAS-2 total and subscales scores as dependent variables, were performed. The stuttering group was significantly higher than non stuttering group on the subscales Defensiveness and Social Anxiety scores of RCMAS-2, in addition, the interaction between Status and Age resulted significant. A series of separate correlations between SSC-ER scores and RCMAS-2 showed that in both groups levels of anxiety were associated to levels of emotional reactions to speech domain.
Children and adolescent who stutter did not result more anxious than fluent peers, however, presented higher levels of emotional reaction in social communication that might increase over time. They also referred higher levels of anxiety in social situations than non-stuttering peers although these levels are not clinically significant.
Effectiveness of the Classroom Communication Resource in improving primary school learners’ attitudes towards children who stutter: lessons learnt from a randomized control trial feasibility study
Freda Walters, Rizwana Badroodien, Vivienne Norman, Harsha Kathard
University of Cape Town
Children who stutter are bullied and teased by their peers, especially in the primary schooling years. The
Classroom Communication Resource (CCR) was developed as a teacher-administered classroom-based education programme
aiming to improve peers’ attitudes towards CWS. The focus of this feasibility study was to determine the initial
treatment effect of the CCR to improve peers’ attitudes towards CWS and the procedural aspects for a larger scale
cluster randomised trial (CRT) in future. Peer attitudes were determined via a Likert scale questionnaire, the
Stuttering Resource Outcomes Measure (SROM), completed by primary school learners. A quantitative, CRT design with
a control group was utilized to describe the direction and magnitude of changes in Grade 7 peers’ attitudes towards
CWS following the administration of the CCR at one-month and 6-month intervals. The evidence confirmed that the SROM
was a valid and reliable outcomes measure. Attitude changes after the administration of the CCR were analysed through
inferential statistics. A significant positive change in SROM scores were found in the experimental group (p = 0.005)
when compared to the control group (p = 0.41) at one month as well as at 6 months (p = 0.002). Further improvement in
SROM scores was found in the intervention group at 6-month follow up. The study indicated initial positive treatment
effect of the CCR and validates further investigation.
Participation rates decreased at the 1-month interval (91.5%) and even further at the 6-month interval (65.2%). This was mainly due to poor questionnaire completion and absenteeism. The implications of these findings for future full scale CRTs are discussed.
ABC BALBUZIE®: an effective integrated flexible approach to stuttering focusing on school age children and their families
Luisella Cocco, Monica Anisio, Simona Bernardini
ABC BALBUZIE, Turin
The ABC BALBUZIE project, based in Turin, is a set of activities aimed at: increase knowledge and raise awareness of
issues related to stuttering in Pediatric and School field, replace common stereotypes with more accurate evidence-based
information; provide comprehensive information to the parents of children who stuttering (CWS) about risk factors, chronic
stuttering and facilitating speech fluency; help the CWS to realize how they can become active and effective communicators,
modify their dysfluency and improving their communication skills. The methodological approach run by specialized professionals,
speech therapists (ST) and psychotherapist (PSY) integrates numerous aspects in compliance with the International Intervention
Guidelines, (ASHA Guidelines, 1995) and the CALMS Model (Healey and al., 2004).
One of the goals of our structured Preliminary Therapy Course (PTC) for CWS and their families is to develop in the participants positive attitudes toward stuttering. The Rational Emotive Behavior Therapy (REBT) is incorporated to the treatment to change the irrational beliefs about self-worth who generates emotional upset, reduced feelings of self-efficacy and lead the CWS to avoid the speech situation in social contexts perceived as demanding.
It had become very useful to involve parents, as a strong point of the program, to change their speech associated negative attitude, which tends to be corrective and leads as a result, to believe that stutter is a wrong way of talking. At the same time, the children will carry out activities in which they will learn to identify their stuttering characteristics, the maladaptive emotions that they could feel and will work on improving fluency, changing the negative speech-associated attitude and learning problem solving strategy to deal with teasing or bulling. We have had positive feedback in this structured approach from CWS, parents and teachers. At the moment we are collecting result data, based on assessment, post treatment and follow-up through structured interview, stuttering severity rate, speech-associated attitude.
Issues to consider when working with school-aged children who stutter: for clinicians
Susan L. Block
School of Allied Health, College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
Treating children who stutter should be a quick and easy process. However, it can often be long and complex, much to
the frustration of the children, their parents and their clinicians. It is vital that we improve this situation as school-aged
children become increasingly vulnerable to the devastating effects of developing chronic stuttering and all the implications
that follow. Treatment in preschool children has ample and robust evidence demonstrating positive outcomes in relatively short
timeframes. Similarly, treatment in adults has much evidence supporting positive fluency outcomes.
Despite this, adults who stutter can also present with accompanying high levels of speech-related anxiety, which can impact the outcome of treatment and the maintenance of fluency. At what stage do children experience such negative impacts?
However, there are some very important considerations with schoolaged children. They are increasingly aware of the stuttering, increasing adept at self-monitoring and self-evaluation and usually very motivated to stop stuttering. They experience increasing communication demands as they progress through school. Often they also have parents who are increasingly concerned about their child’s communication problems and their consequent well-being. Parents also have to contend with the impact of the stuttering on the family — in a multitude of ways.
With scant, varying and conflicting information about the treatment of stuttering in school-aged children, clinicians can be confounded in choosing appropriate, evidence-based strategies. This can result in them being reticent to work with this age group. The complexity of co-ordinating children, parents, families and teachers can be overwhelming for many clinicians.
It can also be problematic in clinical situations which can be bound by administrative regulations or restrictions that do not allow best practice or sufficient treatment.
One of the best things researchers can do for clinicians working with school aged children who stutter is to translate the research findings into clinical implications and strategies. We have been hampered at times by adherence to the golden model of RCTS, without acknowledging other levels of evidence. This other evidence may give clinicians some strategies and considerations to enhance fluency and treatment outcome in the absence of high level research evidence for this school-aged group.
Clinicians can also be hampered by their lack of awareness of the social context in which their school-aged clients now function. What are the social determinants of their lives? Do we address these in treatment?
How can we meet the challenge of finding quicker, easier and more positive treatment outcomes?
A common factors approach to treating childhood stuttering
Ellen M. Kelly PhD, CCC-SLP
Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center - Vanderbilt University Medical Center
Early intervention for stuttering is intended to help avert the potentially adverse, life-long impact of persistent stuttering on communication, social, academic and vocational achievements and to help parents understand how best to help their young children who are stuttering. Divergent parent-based treatment approaches appear to be similarly successful in reducing stuttering in young children, doing so more rapidly than without formal intervention in many cases, yet mirroring natural recovery rates. What, then, do these findings tell us about with whom it is best to intervene, when, why, and how? In this presentation, we will build a framework for addressing these questions by: (1) examining what we presently know about (a) children whose stuttering persists versus those who recover and (b) treatment for early childhood stuttering, (2) contrasting medical and contextual models of intervention, (3) identifying common elements across treatment approaches, in general, and for early stuttering, in particular, and, (4) using the common elements to propose an integration of medical and contextual approaches to inform future research and intervention in early childhood stuttering.
Psychosocial aspects of stuttering
University of East Anglia, UK
Much recent research in the field of stuttering has focused on its psychosocial aspect, that is, the way that perceptual, cognitive, emotional and biological factors in the individual interact with social and physical factors in the environment. Although much of this research has highlighted social anxiety disorder in people who stutter, stuttering is also associated with other forms of anxiety, as well diminished psychological wellbeing across various other domains. This paper outlines current research into the psychosocial factors associated with stuttering from the preschool years to adulthood.
Prolonged speech intensive treatment model for adults who stutter: a students’ training delivery
Prof. Dobrinka Georgieva, PhD1; Rositsa Stoilova, PhD student2
1 Maya Tcholakova 2 Faculty of Public Health, Healthcare and Sports. South-West University «Neofit Rilski», Blagoevgrad, Bulgaria
It has been suggested that to increase the clinicians’ (master degree students) competences in Bulgaria is necessary
to update the Speech Language Pathology (Logopedics) educational curriculum in terms of clinical training with clients
who stutter, and to provide relevant clinical training during the academic preparation (Georgieva, 2012).
This study describes adults who stutter (AWS) intensive treatment (IT) that was conducted by students in the SLP master degree programme: ≪Logopedics Management in Fluency and Voice Disorders≫.
To increase the quality of the academic Speech Language Pathology (SLP) training of master degree students trough application of an intensive treatment programme for adults who stutter (AWS). A very important part of that clinical educational experience is to apply fluency shaping approach through prolonged speech technique introduction. The aim of the present research was to establish speech fluency outcomes for the IT and to prove that the master degree programme meets the good IALP and CPLOL standards for successful students’ training. This study is the first and unique trial of such intensive treatment at university level in Bulgaria and follows the Australian leading experience of the La Trobe University speech clinic.
The IT was conducted by eleven SLP students, under supervision, during their master degree training. 12 adults participated and were treated in the Prolonged speech model. The treatment was a traditional intensive speech restructuring known as Prolonged (Smooth) speech. Speech fluency assessment was conducted 1 week and 1 day before the beginning of the IT programme. The post-treatment evaluation was performed immediately after the intensive programme application.
Outcomes were reported for an IT programme delivered by master degree students in SLP. Primary outcomes were measured according to (i) per cent syllables stuttered (%SS) within and outside university stuttering research center, (ii) speech naturalness score evaluation from pre- and immediately after the intensive treatment stutter-free speech samples, and (iii) self-report inventory scores.
The IT offered to AWS by master degree students during their professional clinical preparation was effective. The master degree students felt more confident to deliver such a logopedical care for AWS. They produced objective speech fluency data and statistically important differences before and immediately after the IT regarding %SS and speech naturalness.
The rational emotive education in stuttering speech therapy
Anna Accornero and Mara Angelini
Department of Surgical Sciences of University of Turin, Italy. Speech Therapy Unit of ≪AOU Citta della Salute e della Scienza≫, Turin, Italy.
Stuttering is a complex, multifactorial disorder, so speech therapists must often work not only on the fluency
disorders but also on the attached negative emotions. Rational Emotive Education (REE) is recognized as an
efficient psychoeducational method for promoting a harmonious affective growth of the individual in presence of
difficulties. The aim of our study was to evaluate the effectiveness of a REE path in association with speech
therapy on 15 stutterers of age 723.
The treatment consisted in 8 weekly sessions. The REE Questionnaire was used to measure patients’ ability to cope with stress associated with stuttering before and after treatment.
Results: 85% of patients improved their REE score, with an overall significant increase (p = 0.036), witnessing the development of a more rational way of thinking and a greater selfacceptance.
The Camperdown Program and stepped care for stuttering
Australian Stuttering Research Centre, The University of Sydney
There are many who stutter who wish to obtain behavioural control of their stuttering. However, there are
so many of such clients, and so few speech-language pathologists, that we have a pressing public health problem.
This presentation overviews how the Camperdown Program has been adapted to a standalone Internet version, and how that Internet treatment can be a part of a stepped care approach to clients who stutter. It is suggested that such an approach can be part of the solution to the public health problem of stuttering.
Stuttering and web-radio. A new art-mediated activity
D. Tomaiuoli1,2, M. De Meis2, R. Siddi2, E. Capparelli2
1Sapienza Università di Roma, 2CRC Balbuzie, Rome, Italy
Maintenance is often considered as the main drawback of the program with a client. Maintenance stage has
to favor in people who stutter their responsibility and individual self-regulation (Finn, 2003) through
self-monitoring and self management regarding target behaviors, fluency and changes of attitude. This is
particularly true for adolescents and young adults, who encounter more difficulties to stabilize treatment outcomes.
So, treatments for stuttering require a post-therapy maintenance stage, to keep in everyday life therapy outcomes in terms of cognitive, communication and behavioral changes.
The MIDA-SP (Tomaiuoli et al.,2012) is a multidimensional, integrated, differentiated program which uses art-mediated activities to make clients practice the acquired competences. Besides the traditional maintenance program, we designed and are testing an advanced one. This specific and potentiated program is targeted on those subjects researchers recognized as more exposed to relapse, by both age and characteristics of their disorder, that is adolescents and young adults with a high severity of the disorder and in particular in its covert aspects.
Radio speaking is a very interesting training ground for practicing and checking personal communication abilities and fluency. As a matter of common knowledge, radio speaking requires a particular ability to manage own verbal communication.
The paper presents a preliminary study aiming at exploring the possibility for adolescents and adults who stutter and show a high severity rate of the disorder (especially as for covert aspects) to integrate the first part of their maintenance program through an art-mediated experience of radio speaking.
The study has been conducted on a sample of ten persons who stutter.
Collected data reveal the importance of ensuring advanced post-therapy maintenance sessions in patients with high stuttering severity levels. The advanced maintenance phase can be thought of as a stage of integration between traditional follow-up sessions and art-mediated activities. Specifically, radio hosting, due to its characteristics, seems to be an interesting testing ground.
What’s the real goal of stuttering treatment?
J. Scott Yaruss
Stuttering Therapy Resources, Inc., Ph.D. University of Pittsburgh, PA
Different viewpoints about the goals of stuttering therapy lead clinicians to pursue different strategies in therapy. This is understandable, given the complexity of the disorder and the wide range of experiences reported by people who stutter. Unfortunately, however, current opinions about the goals of therapy do not appear to have sufficiently accounted for the views of those who stutter. This brief paper seeks to refocus the attention of speech-language pathology researchers and clinicians on the expressed desires of each specific client who stutters in an attempt to identify a more responsive and individualized approach to stuttering treatment.
Future trends in research and treatment of stuttering
University of Illinois; Tel Aviv University
Considerations of stuttering treatment are closely tied to information concerning the epidemiology of the disorder:
such as incidence, prevalence, and natural recovery. It has direct implications to (a) level of research funding, (b)
the focus of research, (c) training of clinicians to work with age groups most affected, and (d) availability of clinical
services where mostly needed.
Quite likely, in the near future, research will continue the current emphasis on three domains: (a) genetics, (b) brain morphology/physiology, and (c) motor aspects.
Keeping in mind that the typical age of stuttering onset is early childhood, a large percent of people who stutter are preschool children. Hence, future research activities in the above domains, as well as clinical innovations should be directed toward issues involving young children and their parents.
In this respect, research of the phenomenon of natural recovery is of central importance. A second, related line of future research would be aimed at identifying factors associated with natural recovery.
Future treatment of stuttering will have to deal with the reality of: (a) the growing world-wide demands for help, especially in countries with large populations where economies have improved, and (b) a very limited number of clinical personnel (data will be presented). With so many millions of people who stutter, and so many more at the time of onset, current standard therapeutic methods with face-to-face individual or small group therapy sessions, will not do nearly enough to meet the demands.
In the future, we will witness several significant developments regarding the use of: modern mass delivery (telepractice), instrument-aided therapy, computer-based therapy incorporating new parameters, gene therapy and others. In general, therapy will be aimed to change not only overt speech but also brain anatomy and physiology.
More specific data, examples, and illustrations will be presented.
An introduction to cognitive-behaviour therapy and its use with people who stutter
The Michael Palin Center, Londra
Cognitive behaviour therapy (CBT) is widely used as a treatment of choice for people experiencing a range of
emotional disorders. It is concerned with the relationship between an individual’s thoughts, feelings and behaviours
and on working with unhelpful patterns and biases which have a role in maintaining problems. CBT integrates cognitive
and behavioural strategies and uses a collaborative therapeutic style to promote self-understanding, empowerment, greater
flexibility in thinking, self-compassion and resilience.
It is used with children, young people and adults, and in individual and group settings. CBT for people who stutter has been particularly influenced by models of social anxiety (Clark and Wells, 1995; Rapee and Heimberg, 1997 #mancano riferimenti bibliografici#). These emphasise the role of fear of negative evaluation, attentional bias, pre- and post-event processing and the use of safety behaviours in maintaining social anxiety.
This workshop will give an introduction to the core theory, principles and techniques of CBT and an overview of its current use with people who stutter. Specific theoretical models of social anxiety will be discussed in relationship to work with people who stutter and key therapy steps will be presented. Participants will be shown techniques to help clients identify unhelpful patterns of thinking, attentional focus and ways of responding to events together with strategies for working with these in order to nurture more adaptive self-talk and behavioural choices.
Video excerpts from individual and group therapy sessions will be used to illustrate selected skills and to demonstrate how these core CBT skills may be applied with children, young people and adults.
Overview of the Lidcombe Program
Brenda Carey (substituted for health problems by Mark Onslow)
University of Sydney
The Lidcombe Program is a treatment for preschool children younger than 6 years old who stutter. Researchers at the Australian Stuttering Research Centre at the University of Sydney led its development. The goal of the Lidcombe Program is no stuttering. Hundreds of clinicians around the world each year are trained in the use of the program, thousands of children are being treated with this program, and researchers from several countries are researching this treatment. But what is the Lidcombe Program, and how is it used? What do parents need to learn to do the Lidcombe program with their children? What are the components and stages of the program? What evidence is there for its benefits to children? What difficulties are commonly experienced by parents who do the Lidcombe Program? And why, 25 years after the first clinical trial was published, is the Lidcombe Program still being used? This workshop will provide an introduction to the Lidcombe Program, will allow participants to see some videos of children and parents doing the treatment, and hear what some clinicians and parents say about it. Participants attending this workshop will have the opportunity to ask questions about all aspects of the Lidcombe Program.
Stuttering: for better or for worse use creativity «choose for better»!
University of Malta
The presentation highlights the importance of shifting attitudes in stuttering intervention. Changes in attitude of clinicians, adults who stutter and school-age children who stutter could determine the success of therapy. Research has also shown that children who stutter view speaking more negatively and experience more negative speech-related emotions than non-stuttering peers do. While practical strategies for helping children who stutter change their feelings and beliefs about stuttering are widely available, speech language pathologists feel uncomfortable targeting such goals. Our attitudes also have an influence in the therapeutic process. In this presentation, the results of a study exploring shifts in the attitudes and feelings of school-age children who stutter following a thinking skills program will be presented. The findings of this study led to a suggested model of intervention, the Smart Intervention Strategy (SIS), with school-age children who stutter. An overview of the SIS is highlighted and introduced.