People Who Stutter Research Articles

Speech Motor Skill and Stuttering

ABSTRACT The authors review converging lines of evidence from behavioral, kinematic, and neuroimaging data that point to limitations in speech motor skills in people who stutter (PWS). From their review, they conclude that PWS differ from those who do not in terms of their ability to improve with practice and retain practiced changes in the long term, and that they are less efficient and less flexible in their adaptation to lower (motor) and higher (cognitive–linguistic) order requirements that impact on speech motor functions. These findings in general provide empirical support for the position that PWS may occupy the low end of the speech motor skill continuum as argued in the Speech Motor Skills approach (Van Lieshout, Hulstijn, & Peters, 2004).

Self-help conferences for people who stutter: A qualitative investigation

Self-help activities for people who stutter (PWS) have been gaining in popularity; however, there is a scarcity of evidence to support their utility in stuttering management. The purpose of this investigation was to understand the lived experience of individuals who attended a self-help conference(s) for PWS from the perspective of a PWS to learn its potential utility in stuttering management. The investigator used Interpretive Phenomenological Analysis (IPA) to systematically collect authentic data of this social phenomenon. Twelve participants were recruited from a self-help conference and the self-help community of PWS. Semi-structured interviews were conducted 4–18 months after each participant's last conference. Interviews were transcribed and analyzed. Themes were explained in investigator narratives and illustrated through participants’ quotes. Interpreted themes of the experience of having attended a self-help conference(s) for PWS included: socializing opportunities with other PWS, affiliation, redefining oneself and post-conference disclosures. A conclusion of the study was that the experience of having attended a self-help conference(s) for PWS helped to minimize negative impact that stuttering can have on daily functioning. It appears that self-help conferences were perceived as a safer or “stutter-friendly” environment and promoted social interaction, relationship building, and community building through planned and unplanned activities. Another conclusion was that the experience of having attended self-help conferences for PWS helped participants to communicate more easily. Reported increases in social activity and an “openness” about stuttering, suggest self-help conferences’ utility in stuttering management. These findings are supported by other studies about successful stuttering management and self-help activities for PWS. They have helped attendees who stutter to communicate more easily and suggest a reduction in the negative impact that stuttering has on their lives. Educational objectives : The reader will be able to: (1) describe recurring themes associated with the lived experience having attended a self-help conference(s) for people who stutter (PWS) from the perspective of a group of adults who stutter, and (2) describe the potential benefits of attending self-help conferences for PWS in order to make appropriate evidence-based referrals to self-help conferences for PWS.

Speech sequence skill learning in adults who stutter

The present study compared the ability of 12 people who stutter (PWS) and 12 people who do not stutter (PNS) to consolidate a novel sequential speech task. Participants practiced 100 repetitions of a single, monosyllabic, nonsense word sequence during an initial practice session and returned 24-h later to perform an additional 50 repetitions. Results showed significantly slower sequence durations in the PWS compared to PNS following extensive practice and consolidation. However, the hypothesis that poor performance gains in PWS compared to PNS during practice would be maintained following a 24-h consolidation period was not supported. Further descriptive analysis revealed large within group differences in PWS which to some extent were attributed to a subgroup of PWS who failed to show any improvements in performance following practice or consolidation. The results and the possible presence of subgroups of PWS are discussed with regard to their limitations in motor learning abilities. Educational objectives : The reader will be able to (1) explain the difference between practice and learning, (2) define consolidation and explain the importance of measuring performance following a consolidation period, (3) understand past research on PWS’ performance during both speech and nonspeech motor tasks, and (4) explain why individual differences in practice effects and learning may have important implications for client variability in treatment outcome.

Developing the therapeutic relationship: From ‘expert’ professional to ‘expert’ person who stutters

This article looks back over the years and identifies some of the most influential thinkers, writers, and researchers who have had a profound effect on the way the therapy at the Michael Palin Centre for Stammering Children in London has evolved. It tracks the changes that have occurred in theoretical perspective, treatments offered, and the delivery of therapy. In particular this author is interested in the changing nature of the therapeutic relationship between professionals and people who stutter (PWS), and describes the way it has developed from the “expert professional” towards a more collaborative relationship that recognises the “expert patient”. It was inspired by a book written in 1902 by Mr Beasley, a person who stammered. After several unsuccessful attempts to find a ‘cure’ he found his own solution to his stuttering and then used what he had learned to help many others. Much of what he wrote was well ahead of his time and reminds us, the professionals, of the importance of listening to and taking account of the views of PWS in therapy and designing treatment that meets the needs of the individual. This article also looks briefly at evidence based practice (EBP) and the issues involved in measuring outcomes that reflect the complex and individual nature of the problem. Finally the importance of the research in developing the knowledge and skill base of clinicians as well as PWS is acknowledged and discussed and the way ahead signposted. Educational objectives: The reader will learn about (1) the early history and development of stuttering therapy, (2) the influence of a variety of psychotherapeutic approaches, (3) the relevance of designing therapy to meet the needs of the PWS, and (4) discuss the role of ‘common’ factors in EBP.

Spatiotemporal signatures of an abnormal auditory system in stuttering

People who stutter (PWS) can reduce their stuttering rates under masking noise and altered auditory feedback; such a response can be attributed to altered auditory input, which suggests that abnormal speech processing in PWS results from abnormal processing of auditory input. However, the details of this abnormal processing of basic auditory information remain unclear. In order to characterize such abnormalities, we examined the functional and structural changes in the auditory cortices of PWS by using a 306-channel magnetoencephalography system to assess auditory sensory gating (P50m suppression) and tonotopic organization. Additionally, we employed voxel-based morphometry to compare cortical gray matter (GM) volumes on structural MR images. PWS exhibited impaired left auditory sensory gating. The tonotopic organization in the right hemisphere of PWS is expanded compared with that of the controls. Furthermore, PWS showed a significant increase in the GM volume of the right superior temporal gyrus, consistent with the right tonotopic expansion. Accordingly, we suggest that PWS have impaired left auditory sensory gating during basic auditory input processing and that some error signals in the auditory cortex could result in abnormal speech processing. Functional and structural reorganization of the right auditory cortex appears to be a compensatory mechanism for impaired left auditory cortex function in PWS.

Investigating the inner speech of people who stutter: Evidence for (and against) the Covert Repair Hypothesis

In their Covert Repair Hypothesis, Postma and Kolk (1993) suggest that people who stutter make greater numbers of phonological encoding errors, which are detected during the monitoring of inner speech and repaired, with stuttering-like disfluencies as a consequence. Here, we report an experiment that documents the frequency with which such errors are made. Thirty-two people who stutter (PWS) and thirty-two normally fluent controls, matched for age, gender and education, recited tonguetwisters and self-reported any errors they perceived themselves to have made. In 50% of trials the tonguetwisters were recited silently and errors reported were those detected in inner speech. Compared to controls, PWS produced significantly more word-onset and word-order errors. Crucially, this difference was found in inner as well as in overt speech. Comparison of experimenter ratings and participants’ own self-ratings of their overt speech revealed similar levels of accuracy across the two groups, ruling out a suggestion that PWS were simply more sensitive to the errors they made. However, the frequency of participants’ inner-speech errors was not correlated to their SSI4 scores, nor to two other measures of stuttering severity. Our findings support Postma and Kolk's contention that, when speech rate is held constant, PWS make, and therefore detect, more errors of phonological encoding. They do not, however, support the hypothesis that stuttering-like disfluencies in everyday speech stem from covert repairs of errors of phonological encoding.Learning outcomes: Readers will learn about three current psycholinguistic theories of stuttering, and how speech-errors elicited during tonguetwister recitation can be used to explore the controversies that exist surrounding: (a) Whether or not people who stutter are more prone to making language production errors; and (b) The extent to which stuttering-like disfluencies stem from covert repairs of language-production errors.

University students’ explanations for their descriptions of people who stutter: An exploratory mixed model study

Semantic differential instruments are often used to assess fluent speakers’ attitudes toward people who stutter (PWS). Such instruments are prone to response bias and often lack the power to explain respondents’ general impressions of PWS. To address these concerns 149 fluent university students completed an open-ended questionnaire in which they described PWS and provided an explanation for their descriptions. A mixed model design with a qualitative emphasis allowed for thematic as well as quantitative data analysis. The results suggest that individuals may have simultaneously positive and negative attitudes toward PWS regardless of gender or familiarity with PWS. Multiple explanations were provided and took into account personal and societal reactions to stuttering. Fluent speakers appear to perceive PWS as being likeable individuals who are poor communicators, a combination of high-warmth and low-competence that elicits pity and passive harm from listeners according to social psychologists ( Cuddy et al., 2008). The implications of these findings and future research directions are discussed. Educational objectives After reading this article, the reader will be able to: (1) describe issues of concern related to the measurement of attitudes toward PWS; (2) describe how mixed (qualitative and quantitative) designs can contribute to a deeper understanding of fluent speakers’ attitudes toward PWS; and (3) discuss how the ways in which fluent speakers’ thoughts about stuttering and PWS can influence their emotions and behaviors when in the presence of someone who stutters.

Does a Graduate Course in Fluency Disorders Make a Difference?

Abstract A study by Yaruss and Quesal (2002), based on responses from 134 of 239 ASHA accredited graduate programs, indicated that approximately 25% of graduate programs in the United States allow students to earn their degree without having coursework in fluency disorders and 66% of programs allow students to graduate without clinical experience treating people who stutter (PWS). It is not surprising that many clinicians report discomfort in treating PWS. This cross-sectional study compares differences in beliefs about the cause of stuttering between freshman undergraduate students enrolled in an introductory course in communicative disorders and graduate students enrolled and in the final weeks of a graduate course in fluency disorders.

Trait and State Anxiety in People Who Stutter and People Who Do Not Stutter

Abstract Previous research suggests that people who stutter (PWS) tend to have heightened general anxiety (i.e., trait anxiety) and situational anxiety (i.e., state anxiety) compared to people who do not stutter (PWDS). Most research with anxiety and stuttering utilizes self-perception scales; however, few studies have looked at anxiety over time. The current study examined self-reported state and trait anxiety in PWS and PWDS over six weeks, along with an investigation of the effects of audio-recording on anxiety. Results indicated no significant group differences in trait (general) anxiety over six weeks; however trends indicated that PWS may have increased trait anxiety compared to PWDS. Furthermore, for both groups, state (situational) anxiety was lower after a recording session compared to before.

A Mixed Methods Study of Stereotypes of People Who Stutter

Purpose: Many research studies have con- sistently found that a variety of individuals who do not stutter report stereotypical attitudes toward stuttering and people who stutter (PWS). There is less agreement regard- ing whether certain characteristics of listeners, such as their relative familiarity with PWS and their gender, have any effect on the attitudes they report regarding PWS. The purpose of this study was to explore whether normally flu- ent speakers would report negative stereotypical attitudes toward PWS and whether they perceived certain careers as less appropriate choices for PWS. In addition, the impact of the participants' familiarity with stuttering and gender were explored using both quantitative and qualitative methods. Method: One-hundred and fifty-four individuals from the general population completed a questionnaire that included both open-ended and forced-choice items. The participants'

University students’ perceptions of the life effects of stuttering

An open-ended, written survey was administered to 146 university students who did not stutter to obtain their impressions of the effects of stuttering on the lives of people who stutter (PWS). Participants first wrote about the general effects of stuttering and then considered how their lives would be different if they stuttered. Both types of responses, while not qualitatively different, indicated that participants were more likely to focus on negative listener reactions and barriers to social, academic, and occupational success when they imagined themselves as PWS. Fewer participants indicated that PWS may positively cope with their stuttering through acceptance of stuttering, motivation and determination, and support systems. Quantitative differences based on gender and familiarity with PWS were not observed. The findings suggest that while university students are generally sensitive to the issues which can affect PWS, they may also tend to exaggerate the limitations placed on PWS by their stuttering. Learner outcomes The reader will be able to (1) understand the various ways in which fluent speakers perceive the life effects of stuttering; (2) discuss how fluent speakers, while apparently sensitive to the negative effects of stuttering, can also overemphasize the degree to which PWS are unable to participate effectively and autonomously in society; and (3) recognize the need for additional research in this area and for continued education of the general public and others by advocacy groups.

Role Entrapment of People Who Stutter Reported by K-12 Teachers

Purpose: This study explored whether K-12 teachers reported attitudes that were indicative of role entrapment of people who stutter (PWS) in the form of occupational stereotyping. Method: The Vocational Advice Scale (VAS; R. M. Gabel, G. W. Blood, G. M. Tellis, & M. T. Althouse, 2004) was completed by 204 teachers. The teachers also completed an open-ended question and a demographic questionnaire to identify factors that influenced their choices on the VAS. Results: The findings did not indicate the presence of role entrapment for most careers; however, this group of teachers did perceive that 10 careers on the VAS were less advisable for PWS. Analysis of the responses to the open- ended question found 3 major themes that influenced the teacher's decisions: related to disorder, related to career, S

Brain activation abnormalities during speech and non-speech in stuttering speakers

Although stuttering is regarded as a speech-specific disorder, there is a growing body of evidence suggesting that subtle abnormalities in the motor planning and execution of non-speech gestures exist in stuttering individuals. We hypothesized that people who stutter (PWS) would differ from fluent controls in their neural responses during motor planning and execution of both speech and non-speech gestures that had auditory targets. Using fMRI with sparse sampling, separate BOLD responses were measured for perception, planning, and fluent production of speech and non-speech vocal tract gestures. During both speech and non-speech perception and planning, PWS had less activation in the frontal and temporoparietal regions relative to controls. During speech and non-speech production, PWS had less activation than the controls in the left superior temporal gyrus (STG) and the left pre-motor areas (BA 6) but greater activation in the right STG, bilateral Heschl's gyrus (HG), insula, putamen, and precentral motor regions (BA 4). Differences in brain activation patterns between PWS and controls were greatest in females and less apparent in males. In conclusion, similar differences in PWS from the controls were found during speech and non-speech; during perception and planning they had reduced activation while during production they had increased activity in the auditory area on the right and decreased activation in the left sensorimotor regions. These results demonstrated that neural activation differences in PWS are not speech-specific.

Brain activation in adults who stutter under delayed auditory feedback: An fMRI study

It is well known that some people who stutter (PWS) show an immediate reduction of stuttering when they speak under a condition of delayed auditory feedback (DAF). In the present study, to investigate cortical activations during speech production through the DAF effect, we performed functional magnetic resonance imaging (fMRI) experiments under the NAF (non-altered feedback) and DAF conditions for PWS and people who do not stutter (PWNS). The results are that (1) the PWS showed the higher activation in the right inferior frontal gyrus (Brodmann Area (BA)45) than the PWNS under the NAF condition; (2) the activations of the right superior temporal gyrus and the right middle temporal gyrus were higher under the DAF condition than the NAF in both PWNS and PWS groups; (3) the PWNS showed the higher activation in the right supplementary motor area and superior temporal gyrus than the PWS under both NAF and DAF conditions; (4) the PWNS showed the higher activation in the inferior frontal gyrus(the right BA45 and the bilateral BA46) under the DAF condition than the NAF. These results reconfirm most of the previous findings with some slightly different activation areas, and underscore the involvement of inferior frontal gyrus and superior temporal gyrus in dysfluency.

A test of speech motor control on word level productions: The SPA Test (Dutch: Screening Pittige Articulatie)

The primary objective of this article is to study whether an assessment instrument specifically designed to assess speech motor control on word level productions would be able to add differential diagnostic speech characteristics between people who clutter and people who stutter. It was hypothesized that cluttering is a fluency disorder in which speech motor control on word level is disturbed in high speech rate, resulting in errors in flow of speech and sequencing. An assessment instrument on speech motor coordination on word level was developed and validated. In an elicitation procedure, repetitions of complex multi-syllabic words at a fast speech rate were obtained from 47 dysfluent participants (mean age 24.3; SD 10.25, range 14.2–47.4 yrs) and 327 controls (mean age 25.56 yrs; SD 8.49; age range 14.3–50.1). Speech production was judged on articulatory accuracy, smooth-flow (coarticulation, flow and sequencing) and articulatory rate. Results from people who clutter (PWC) and people who stutter (PWS) were compared to normative data based on control group data. PWC produced significantly more flow and sequencing errors compared to PWS. Further research is needed in order to study speech motor control in spontaneous speech of people who clutter.

The speech naturalness of people who stutter speaking under delayed auditory feedback as perceived by different groups of listeners

This study investigated listeners’ perception of the speech naturalness of people who stutter (PWS) speaking under delayed auditory feedback (DAF) with particular attention for possible listener differences. Three panels of judges consisting of 14 stuttering individuals, 14 speech language pathologists, and 14 naive listeners rated the naturalness of speech samples of stuttering and non-stuttering individuals using a 9-point interval scale. Results clearly indicate that these three groups evaluate naturalness differently. Naive listeners appear to be more severe in their judgements than speech language pathologists and stuttering listeners, and speech language pathologists are apparently more severe than PWS. The three listener groups showed similar trends with respect to the relationship between speech naturalness and speech rate. Results of all three indicated that for PWS, the slower a speaker's rate was, the less natural speech was judged to sound. The three listener groups also showed similar trends with regard to naturalness of the stuttering versus the non-stuttering individuals. All three panels considered the speech of the non-stuttering participants more natural. Educational objectives: The reader will be able to: (1) discuss the speech naturalness of people who stutter speaking under delayed auditory feedback, (2) discuss listener differences about the naturalness of people who stutter speaking under delayed auditory feedback, and (3) discuss the importance of speech rate for the naturalness of speech.

Bite-block perturbation in people who stutter: Immediate compensatory and delayed adaptive processes

This exploratory study investigated sensory-motor mechanisms in five people who stutter (PWS) and five people who do not (PNS). Lip kinematic and coordination data were recorded as they produced bi-syllabic nonwords at two rates (normal and fast) in three conditions (jaw-free, immediately after insertion of a bite-block, and after a 10-min accommodation period). At normal speech rates, effects of bite-blocks on lip kinematics were similar for both PWS and PNS speakers showing larger amplitudes, peak velocities, shorter durations and more stable movement cycle patterns. However, at fast speech rates upper lip responses of PWS exhibited larger amplitudes and peak velocities. At both speech rates, the presence of a bite-block changed movement coordination patterns only for PNS. However, at fast speech rates bite-blocks decreased variability of coordination patterns for both groups. No adaptive changes in movement stability were found for either group, but a practice-related increase in lower lip peak velocity was found at normal speech rates. These findings indicate that bite-block perturbation did not exacerbate any hypothesized limitation or difficulty in controlling individual articulatory movements or their coordination in PWS. The results also support the position that specific motor control strategies are used by PWS as compared to PNS to compensate for bite-block perturbations under increased speech rate demands. Learning outcomes: The reader will be able to: (1) distinguish between compensatory and adaptive responses to bite-block perturbation; (2) explain the measurement of articulatory stability; (3) summarize the potential role of motor control strategies in people who stutter; and (4) discuss the assumptions of the motor skills approach to stuttering.

Investigating speech motor practice and learning in people who stutter

In this exploratory study, we investigated whether or not people who stutter (PWS) show motor practice and learning changes similar to those of people who do not stutter (PNS). To this end, five PWS and five PNS repeated a set of non-words at two different rates (normal and fast) across three test sessions (T1, T2 on the same day and T3 on a separate day, at least 1 week apart). The results indicated that PWS and PNS may resemble each other on a number of performance variables (such as movement amplitude and duration), but they differ in terms of practice and learning on variables that relate to movement stability and strength of coordination patterns. These findings are interpreted in support of recent claims about speech motor skill limitations in PWS. Educational objectives : The reader will be able to: (1) define oral articulatory changes associated with motor practice and learning and their measurement; (2) summarize findings from previous studies examining motor practice and learning in PWS; and (3) discuss hypotheses that could account for the present findings that suggest PWS and PNS differ in their speech motor learning abilities.

Perfectionism in People who Stutter: Preliminary Findings Using a Modified Cognitive-Behavioral Treatment Approach

AbstractPerfectionistic people set unrealistic goals and, when they fail to reach them, experience self-criticism and blame. Preliminary research revealed that perfectionism appears to be a characteristic of people who stutter (PWS) (Amster, 1995). The purpose of the present study was to explore perfectionism in PWS and to determine if a modified cognitive behavioral therapy approach alone and combined with Stuttering Modification could help reduce perfectionistic tendencies and stuttering behaviors. Degree of perfectionism and scores of stuttering severity were measured with eight adult PWS and compared at pre-treatment, mid-treatment, after 6-weeks of treatment, and at 15 weeks follow-up, after treatment was withdrawn. Initial open-trial testing showed promising results as perfectionism and stuttering severity were reduced and communication attitudes improved. CBT significantly reduced perfectionism by mid-point. Stuttering decreased significantly throughout all phases of the study. Possible implications are discussed.

Effects of stuttering severity and therapy involvement on role entrapment of people who stutter

The primary purpose of this study was to examine whether a group of university students would report role entrapment of people who stutter (PWS) in the form of occupational stereotyping. The study also examined whether severity of stuttering (mild or severe) and level of therapy involvement (choosing or not choosing to attend therapy) affected the perceptions of role entrapment. To examine these issues, 260 students completed the Vocational Advice Scale (VAS) [Gabel, R. M., Blood, G. W., Tellis, G., & Althouse, M. T. (2004). Measuring role entrapment of people who stutter. Journal of Fluency Disorders, 29, 27–49]. Results suggested that stuttering severity and the level of therapy involvement did not appear alter the judges’ reports for all of the careers except for the career of speech therapist. For the career of speech therapist, therapy involvement improved the participants’ reports and stuttering severity had no effect. Additionally, findings suggested that university students reported that 16 of the careers listed on the VAS were appropriate choices for people who stutter and were less certain about advising for 27 of the careers. Thus, the findings from this study do not support the notion that stuttering leads to role entrapment in the form vocational stereotyping and variations in therapy involvement or stuttering severity do not change perceptions of role entrapment. Learner outcomes: The reader will be able to (1) identify common stereotypes of PWS, (2) describe the possible effects of stereotyping and role entrapment, and (3) describe the effects of severity and therapy involvement of role entrapment of PWS.