Stuttering Severity Research Articles

Stuttering severity and social anxiety among adults who stutter: A multilevel analysis

PurposeThe purpose of this study is to further investigate the association between social anxiety and stuttering severity among adults who stutter (AWS) at both the between- and within-person levels of analysis. MethodSixty-two AWS (women = 27, men = 35; Mage = 39.5 years, SDage = 14.8) first completed a questionnaire (e.g., trait social anxiety and personality traits) and provided two speech samples (i.e., conversation, reading). Then, participants enrolled in up to 21 days of ecological momentary assessment (EMA) to self-report their momentary stuttering severity, social anxiety, and avoidance behaviors during social interactions. Correlational analyses and hierarchical regression analyses were conducted on between-person level measures. Multilevel mediation analysis was conducted on EMA data to disaggregate between- and within-person processes. ResultsAt the between-person level, percent syllables stuttered (%SS) and person mean Self-Reported Stuttering Severity (iSRSS) were both significantly correlated with trait social anxiety, but not above and beyond the effects of neuroticism, extraversion, the overall impact of stuttering, and avoidance behaviors. At the within-person level, when AWS self-reported to stutter more than they usually do on average, they also tended to exhibit higher levels of social anxiety than they usually did, regardless of the amount of avoidance behaviors exhibited at those moments. The within-person effect between stuttering severity and social anxiety was also significantly mediated by avoidance behaviors. ConclusionThe associations between social anxiety and stuttering differed based on the analysis level (between vs within-person) and whether covariates are included.

Long-term evaluation of psychosocial impact and stuttering severity after intensive stuttering therapy.

The purpose of this study was to assess the long-term stability of objective and subjective psychosocial improvements and fluency more than 10 years after participation in an intensive stuttering therapy camp. Ten former participants in intensive stuttering therapy (IST; mean age at time of intervention 14; 2 years) participated in this study. Outcomes of the IST at that time were assessed with the Stuttering Severity Instrument (SSI-3; Riley, 1994) and a questionnaire to measure the psychosocial impact of stuttering. A semi-structured video call and a general questionnaire for the long-term evaluation were used to gauge the participants' perceptions of the IST. These follow-up data were compared to the therapy outcomes reported by Cook (2011, 2013). Therapy effects on the severity of stuttering and psychosocial impact were stable over the follow-up period of more than 10 years. Moreover, scores for psychosocial impact and severity of stuttering further decreased from the end of the IST to the long-term evaluation. The intensive time and the periodically offered follow-up treatments were described as particularly positive by the participants. Intensive stuttering therapy in childhood or adolescence can have a long-term positive effect on both internal and external stuttering symptoms.

Caregiver Predictions of Their 3- to 6-Year-Old Child Who Stutters' Communication Attitude.

Caregivers share critical insight during their child's stuttering evaluation; yet, there have been no empirical studies evaluating whether caregivers provide similar accounts of their 3- to 6-year-old child's communication attitude compared to their child's self-report. This study examined caregiver- and child-reported communication attitude and assessed potential moderators of more comparable caregiver and child ratings (i.e., caregiver confidence, caregiver-child conflict, observer-rated stuttering severity). One hundred thirteen children who stutter ages 3 through 6 years and a primary caregiver were recruited from clinical settings across the United States. Children completed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT) and three speaking samples, which were recorded to assess observer-rated stuttering severity using the Stuttering Severity Instrument-Fourth Edition. Caregivers predicted their child's communication attitude (C-KiddyCAT) and provided a confidence rating for their prediction. Caregivers also rated caregiver-child conflict using the Child-Parent Relationship Scale-Short Form (CPRS-SF). Multiple regression was used to (a) evaluate whether caregiver C-KiddyCAT scores predicted child KiddyCAT scores and (b) assess potential moderators of the relationship between C-KiddyCAT and KiddyCAT scores. Caregiver ratings of their child's communication attitude (C-KiddyCAT) predicted child communication attitude ratings (KiddyCAT). A significant interaction between caregiver-child conflict (CPRS-SF) and caregiver ratings of their child's communication attitude (C-KiddyCAT) suggested caregiver-child conflict changed the underlying relationship between C-KiddyCAT and KiddyCAT scores, such that low conflict resulted in more similar C-KiddyCAT and KiddyCAT scores. Neither caregiver confidence nor observer-rated stuttering severity influenced the relationship between C-KiddyCAT and KiddyCAT scores. Although many caregivers predicted communication attitude ratings that closely aligned with their child's report, some caregiver-child dyads provided divergent ratings. Clinicians should interpret caregiver predictions of their child's communication attitude within the context of their full evaluation and the caregiver-child relationship. Assessing both self-reported communication attitude and caregiver predictions of their child's communication attitude provides a meaningful starting point to counseling caregivers about cognitive components of stuttering for preschool- and kindergarten-age children who stutter.

FreDESS: a clinical tool for perceptual evaluation of stuttering

Aim Stuttering is a communication disorder that involves both manifest speech disfluencies and associated symptoms. The purpose of the present study was to introduce an easily administered and ecologically valid assessment tool designed for perceptual evaluation of stuttered speech, FreDESS (frequency of stuttering events, duration of events, effort, secondary behaviours, and severity). More specifically, we wanted to study its reliability and validity. Method Video recordings of conversations with 38 people who stutter (PWS), 19 females and 19 males aged 13–25, were assessed by three speech language pathologists (SLP). Inter- and intrajudge reliability was estimated with intraclass correlation, standard error of measurement, and agreement between listeners. Internal consistency for the FreDESS parameters was estimated with Cronbach’s alpha (α). To test the validity of FreDESS, the relationships between the average estimated parameters of frequency, duration, secondary behaviours, and severity of FreDESS and the Stuttering Severity Instrument (SSI-3), were analysed using intraclass correlation. Results The interjudge reliability was good, especially for the frequency, duration, and severity parameters (90 per cent + agreement given 1 scale point difference). All parameters of the FreDESS had strong intrajudge reliability (ICC = 0.86–0.94) and the overall internal consistency was high (α = 0.98). The average ratings on the two assessment scales were in line with each other (r = 0.90–0.96), indicating high concurrent validity. Conclusion The FreDESS scale for the assessment of stuttered speech may be a valuable tool in clinical and research contexts. It is a valid and more time-efficient assessment instrument than the more commonly used SSI.

Examining resting state functional connectivity and frequency power analysis in adults who stutter compared to adults who do not stutter.

Stuttering is a speech disorder characterized by impaired connections between brain regions involved in speech production. This study aimed to investigate functional connectivity and frequency power during rest in adults who stutter (AWS) compared to fluent adults (AWNS) in the dorsolateral prefrontal cortex (DLPFC), dorsolateral frontal cortex (DLFC), supplementary motor area (SMA), motor speech, angular gyrus (AG), and inferior temporal gyrus (ITG). Fifteen AWS (3 females, 12 males) and fifteen age- and sex-matched AWNS (3 females, 12 males) participated in this study. All participants were native Persian speakers. Stuttering severity in the AWS group was assessed using the Persian version of the Stuttering Severity Instrument Fourth Edition (SSI-4). Resting-state electroencephalography (EEG) was recorded for 5 min while participants sat comfortably with their eyes open. We analyzed frequency band power across various frequency bands and investigated functional connectivity within the specified speech region. Significant between-group differences were found in band powers including alpha, beta, delta, theta, and gamma, specifically in the premotor, SMA, motor speech, and frontal regions. AWS also showed increased coherence between the right motor speech region compared to controls. We demonstrate that the proposed hierarchical false discovery rate (FDR) method is the most effective for both simulations and experimental data. In the expected regions, this method revealed significant synchrony effects at an acceptable error rate of 5%. The results highlight disrupted functional connectivity in AWS at resting state, particularly in speech-related and associated areas. Given the complex neurological basis of developmental stuttering, robust neural markers are closely linked to this phenomenon. These markers include imbalanced activity within brain regions associated with speech and motor functions, coupled with impaired functional connectivity between these regions. The cortico-basal ganglia-thalamo-cortical system governs the dynamic interplay between cortical regions, with SMA as a key cortical site. It is hypothesized that the aberrant resting state functional connectivity will impact the language planning and motor execution necessary for fluent speech. Examining resting-state metrics as biomarkers could further elucidate the neural underpinnings of stuttering and guide intervention.

Self-Reported Stuttering Severity Is Accurate: Informing Methods for Large-Scale Data Collection in Stuttering.

To our knowledge, there are no data examining the agreement between self-reported and clinician-rated stuttering severity. In the era of big data, self-reported ratings have great potential utility for large-scale data collection, where cost and time preclude in-depth assessment by a clinician. Equally, there is increasing emphasis on the need to recognize an individual's experience of their own condition. Here, we examined the agreement between self-reported stuttering severity compared to clinician ratings during a speech assessment. As a secondary objective, we determined whether self-reported stuttering severity correlated with an individual's subjective impact of stuttering. Speech-language pathologists conducted face-to-face speech assessments with 195 participants (137 males) aged 5-84 years, recruited from a cohort of people with self-reported stuttering. Stuttering severity was rated on a 10-point scale by the participant and by two speech-language pathologists. Participants also completed the Overall Assessment of the Subjective Experience of Stuttering (OASES). Clinician and participant ratings were compared. The association between stuttering severity and the OASES scores was examined. There was a strong positive correlation between speech-language pathologist and participant-reported ratings of stuttering severity. Participant-reported stuttering severity correlated weakly with the four OASES domains and with the OASES overall impact score. Participants were able to accurately rate their stuttering severity during a speech assessment using a simple one-item question. This finding indicates that self-report stuttering severity is a suitable method for large-scale data collection. Findings also support the collection of self-report subjective experience data using questionnaires, such as the OASES, which add vital information about the participants' experience of stuttering that is not captured by overt speech severity ratings alone.

Effect of Use of Lidcombe Program on Degree of Stuttering Severity

Abstract Background The incidence rate of stuttering is 5% among preschool children and about 1% among adults. Although the cause of stuttering has not been identified, a multifactorial hypothesis of stuttering has gained acceptance. Aim of the Work To evaluate the effect of using Lidcombe program on the degree of stuttering after its application on a group of children versus persistance or minimal change in the severity in other group of children facing the same citcumstances. Patients and Methods This randomized controlled clinical trial study was carried out at the outpatient clinic of Phoniatrics unit, ENT department, Ain Shams University Hospitals. A total of 60 children were included and divided between two groups. Control group; which included 30 cases who were submitted to parents counselling alone without involving the child with follow up weekly for three months to assess if there was improvement or not by SSI and SPI tools and also to predict the degree of chronicity of childhood stuttering, and test group; which included 30 cases who were submitted to Lidcombe Program. Results There was statistical significant differences between study groups as regard post-intervention assessment of stuttering severity using stuttering severity instrument. cases treated with program improved and become very mild and mild, also severe cases improved to become moderate cases, while in group treated with counselling, only very mild and mild cases who have improved while other cases become the same or got worsen. Conclusion stuttering will remain a perplexing disorder and assessing its severity is a matter of clinician's clinical experience. Despite the tools used to assess stuttering severity, it is better to assess the child with the disorder rather than assessing the disorder. Taking in considerations that the covert symptoms are the key for deciding the stuttering severity more than the overt symptoms, specifically with the older children.

Effectiveness of the Camperdown Program in Reducing Stuttering Severity of Kurdish-speaking Adolescents With Stuttering in Iran

Background and Objectives Stuttering, due to different reactions of stutterers in different ages, needs age-specific treatment. Considering the lack of study on the effect of the Camperdown program on treatment of stuttering in adolescents in Iran, the present study aims to investigate the effect of the Camperdown program on the stuttering severity of Kurdish-speaking adolescents with stuttering in Iran. Subjects and Methods This is a single-subject study with an A-B-A design which was conducted on 4 Kurdish-speaking adolescents with stuttering. The pre-test assessments were first done. Then, they received 40 sessions of intervention using the Camperdown program. The measures were was the percentage of stuttered syllables, the 9-point severity rating scale, and the speech naturalness scale (NAT). The data were analyzed based on visual analysis and descriptive statistics. Results The intervention was effective in reducing the stuttering severity of all four subjects (percentage of non-overlapping data=100%) and the scores of NAT scale in subjects after intervention was significantly different from their pre-intervention scores. Conclusion The Camperdown program is effective in reducing the stuttering severity of Kurdish-speaking adolescents with stuttering.

Prevalence of stuttering among school age children in Dakshina Kannada district of Karnataka, India

PurposeStuttering is a fluency disorder with a worldwide prevalence of 1%. Reports on the epidemiology of stuttering in India is limited. Our primary goal was to examine the prevalence of the disorder among school children. The study also aimed to study the impact of several risk factors on the prevalence of stuttering. MethodA total of 3437 children in the age range of 6–15 years were screened in 16 camps conducted in and around schools of Dakshina Kannada. The children were screened for stuttering using a screening tool by an SLP based on their grade and medium of instruction and further validated using Stuttering Severity Instrument-4. ResultThe prevalence of stuttering in school going children was 1.68%. Gaussian test reveals effect of gender on the prevalence of stuttering (Z1 = 3.501, p < 0.001) with a ratio of 2.4:1 among males and females respectively. No significant association was obtained for socioeconomic status (X22 = 1.42, p = 0.492) and linguistic structure (Z1=1.653, p = 0.0984) on the prevalence of stuttering. Good to excellent inter-rater and intra-rater reliability was obtained. ConclusionThe prevalence of stuttering in Dakshina Kannada is established for the first time in the current study which helped determine in early identification and intervention for children with stuttering leading to better prognosis and quality of life.

Effects of behavior inhibition on stuttering severity and adverse consequences of stuttering in 3–6-year-old children who stutter

PurposeThe purpose of this study was to investigate whether 3- to-6-year-old children who stutter and exhibit a higher degree of behavioral inhibition (BI), a correlate of shyness, stutter more frequently and experience greater negative consequences of stuttering (per parent-report) than their peers who stutter but have lower BI. MethodForty-six children who stutter (CWS; 35 boys & 11 girls; mean age 4 years, 2 months) participated. Their degree of BI was assessed by measuring the latency to their 6th spontaneous comment during a conversation with an unfamiliar examiner (following Kagan, Reznick, & Gibbons's (1989) methodology). The frequency of stuttering and the negative impact of stuttering that CWS may have experienced was assessed using parent reports (i.e., Test of Childhood Stuttering (TOCS) Observational Rating Scale; Gillam, Logan, & Pearson, 2009). ResultsWe found that children's degree of BI was not associated with their speech fluency per parent report. However, children's degree of BI was significantly associated with greater negative consequences of stuttering. Specifically, among the four categories of TOCS Disfluency-Related Consequences, children's BI significantly predicted the occurrence of physical behaviors that accompany moments of stuttering (such as increased tension or excessive eye blinks). Other Disfluency-Related Consequences, such as avoidance behaviors, negative feelings, and negative social consequences, were not associated with children's behavioral inhibition tendencies. Additionally, children's stuttering severity (per the Stuttering Severity Instrument-4 scores) was significantly associated with increased physical behaviors that accompany moments of stuttering and greater negative social consequences of stuttering. ConclusionsThis study provides empirical evidence that behavioral inhibition to the unfamiliar may have salience for childhood stuttering as it predicted the development of physical behaviors associated with stuttering (e.g., tension or struggle) in 3- to 6-year-old CWS. Clinical implications of high BI for the assessment and treatment of childhood stuttering are discussed.

The reliability of simultaneous versus individual data collection during stuttering assessment.

Speech-language pathologists often multitask in order to be efficient with their commonly large caseloads. In stuttering assessment, multitasking often involves collecting multiple measures simultaneously. The present study sought to determine reliability when collecting multiple measures simultaneously versus individually. Over two time periods, 50 graduate students viewed videos of four persons who stutter (PWS) and counted the number of stuttered syllables and total number of syllables uttered, and rated speech naturalness. Students were randomly assigned to one of two groups: the simultaneous group, in which all measures were gathered during one viewing; and the individual group, in which one measure was gathered per viewing. Relative and absolute intra- and inter-rater reliability values were calculated for each measure. The following results were notable: better intra-rater relative reliability for the number of stuttered syllables for the individual group (intraclass correlation coefficient (ICC) = 0.839) compared with the simultaneous group (ICC = 0.350), smaller intra-rater standard error of measurement (SEM) (i.e., better absolute reliability) for the number of stuttered syllables for the individual group (7.40) versus the simultaneous group (15.67), and better inter-rater absolute reliability for the total number of syllables for the individual group (88.29) compared with the simultaneous group (125.05). Absolute reliability was unacceptable for all measures across both groups. These findings show that judges are likely to be more reliable when identifying stuttered syllables in isolation than when simultaneously collecting them with total syllables spoken and naturalness data. Results are discussed in terms of narrowing the reliability gap between data collection methods for stuttered syllables, improving overall reliability of stuttering measurements, and a procedural change when implementing widely used stuttering assessment protocols. What is already known on the subject The reliability of stuttering judgments has been found to be unacceptable across a number of studies, including those examining the reliability of the most popular stuttering assessment tool, the Stuttering Severity Instrument (4th edition). The SSI-4, and other assessment applications, involve collecting multiple measures simultaneously. It has been suggested, but not examined, that collecting measures simultaneously, which occurs in the most popular stuttering assessment protocols, may result in substantially inferior reliability when compared to collecting measures individually. What this paper adds to existing knowledge The present study has multiple novel findings. First, relative and absolute intra-rater reliability were substantially better when stuttered syllables data were collected individually compared to when the same data were collected simultaneously with total number of syllables and speech naturalness data. Second, inter-rater absolute reliability for total number of syllables was also substantially better when collected individually. Third, intra-rater and inter-rater reliability were similar when speech naturalness ratings were given individually compared to when they were given while simultaneously counting stuttered and fluent syllables. What are the potential or actual clinical implications of this work? Clinicians can be more reliable when identifying stuttered syllables individually compared to when they judge stuttering along with other clinical measures of stuttering. In addition, when clinicians and researchers use current popular protocols for assessing stuttering that recommend simultaneous data collection, including the SSI-4, they should instead consider collecting stuttering event counts individually. This procedural change will lead to more reliable data and strongerclinical decision making.

Effect of an Auditory Temporal Training Program on Speech Fluency of Children with Developmental Stuttering.

The present study aims to investigate the effect of a temporal processing-based auditory training program on alleviating stuttering severity in children diagnosed with auditory temporal processing disorders. Thirty-one children with stuttering diagnosed with auditory temporal processing disorders participated in this study (intervention group: 17 participants between seven to 12 years old; control group: 14 participants between eight to 12 years old). The auditory temporal processing test and Stuttering Severity Instrument-3 (SSI-3) were examined before/after 12 sessions (nearly 540 minutes) of training and three months following the conclusion of the intervention. According to the results, auditory temporal processing improved significantly in the intervention group after temporal processing-based auditory training. Besides, the differences between the intervention and control groups were significant (P<0.05). The improvement of auditory temporal processing skills remained stable in the post-training evaluation after three months (P>0.05). Although the SSI-3 score was somewhat improved in the intervention group, no significant difference was found between the two groups (P=0.984). The findings revealed that auditory temporal processing training acted as a complementary therapy alleviating the stuttering severity of children who stutter with auditory temporal processing disorders to some extent.

Sleep Problems, Social Anxiety and Stuttering Severity in Adults Who Do and Adults Who Do Not Stutter

Background: While there is sufficient evidence that children and adolescents who stutter reported more impaired sleep compared to children and adolescents who did not stutter, findings among adults who stutter (AWS) were scarce. Furthermore, stuttering is associated with issues related to verbal communication in a social context. As such, it was conceivable that AWS reported higher scores for social anxiety, compared to adults who do not stutter (AWNS). In the present study, we tested whether AWS reported higher sleep complaints compared to AWNS. We further tested whether scores for social anxiety and stuttering independently predicted sleep disturbances. Methods: A total of 110 AWS (mean age; 28.25 years, 27.30% females) and 162 AWNS (mean age; 29.40 years, 51.20% females) completed a series of self-rating questionnaires covering sociodemographic information, sleep disturbances and social anxiety. Adults with stuttering further completed a questionnaire on stuttering. Results: Compared to AWNS, AWS reported a shorter sleep duration, a lower sleep efficiency, higher scores for drug use in terms of sleep-promoting medications (significant p-values and medium effect sizes), and an overall higher PSQI score (significant p-values and large effect size), when controlling for age and social anxiety. Next, while p-values were always significant for subjective sleep quality, sleep disturbances, and daytime functioning, when controlling for age and social anxiety, their effect sizes were trivial or small. For sleep latency, the p-value was not significant and the effect size was trivial. Among AWS, higher scores for stuttering and older age, but not social anxiety, predicted higher sleep disturbances. The association between higher sleep disturbances and higher stuttering severity was greatest among those AWS with highest scores for social anxiety. Conclusions: When compared to AWNS, AWS self-reported higher sleep disturbances, which were associated with older age, and higher scores for stuttering severity, but not with social anxiety. Adults who stutter might be routinely asked for their sleep quality.

The Performances on Non-Word Repetition in Inner and Overt Speech Between Mandarin-Speaking Adults Who Do and Do Not Stutte

&lt;p&gt;本研究之目的在探討口吃成人與非口吃成人於內在與外在言語非詞複誦表現之差異情形。本研究以29位口吃成人和29位非口吃成人，共計58位為研究對象，以修訂中文口吃嚴重度評估工具──成人版，確認出口吃成人與非口吃成人，之後進行內在和外在言語非詞複誦作業，以獨立樣本t檢定和二因子混合設計變異數分析進行統計考驗，探討口吃成人與非口吃成人於內在與外在言語之非詞複誦的差異情形。本研究結果發現：口吃成人和非口吃成人於內在或外在言語下的非詞複誦反應時間、正確率和流暢度均達顯著差異，皆是口吃成人的表現較非口吃成人為差；在言語形式的表現上，不論口吃成人或非口吃成人，內在言語的非詞複誦流暢度均顯著高於外在言語，但在正確率表現上，兩組不論在內在語言或外在語言則無顯著差異。本研究的結論為，口吃成人於內在與外在言語非詞複誦的反應時間和正確率均不如非口吃成人，可能源自於口吃者的音韻處理困難；口吃成人的內、外在言語非詞複誦的流暢度皆較非口吃成人不佳，可能代表口吃者的言語不流暢於內在言語期間就發生了，而且可能與內外在短期音韻記憶不佳有關，但此仍需更精確的研究設計加以證實。最後，研究者提出有關未來研究的建議，以供之後的研究者參考。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;This study aimed to make a comparison of the non-word repetition performances be-tween inner and overt speech of the adults with and without stuttering (AWS and AWOS). The 29 pairs of AWS and AWOS were recruited by matching their ages, genders and edu-cation levels. All of the participants were assessed by the Revised Stuttering Severity In-strument-4 for Mandarin-Speaking Adults to determine whether they had stuttering or not. Then, both of the groups repeated the non-words in two speech conditions, inner and overt, separately. The three measures including response time (RT), accuracy ratio (AR) and dis-fluency ratio (DR) in the task of non-word repetition were recorded and t-tests and two-way mixed ANOVA were employed to examine whether the differences existed in the three measures between the two groups and between the two speech conditions. The results of this study showed that for both the inner and overt speech, the performances on the three measures (RT, AR and DR) in NWR of the AWS were significantly poorer than those of AWOS. Ad-ditionally, for both the groups, the DRs in NWR in the inner speech were significantly higher than those in the overt speech, but no significant difference existed in AR of NWR between the inner and overt speech. The results showed that AWS may have phonological processing difficulties so that they took more time and made more mistakes than AWOS. Also, the dis-fluencies of AWS might occur in inner speech before they spoke out bumpily.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Investigation of Dual Task Effect on the Severity of Stuttering in School-Age Children

Objective Stuttering is a speech disorder that occurs with frequent and abnormal disruptions in speech, such as sound repetition, sound prolongation, and sound or airflow blockage. Despite the many theories, the cause of stuttering has not been entirely determined, and various factors have been proposed for its etiology. According to the vicious circle hypothesis, increased speech disfluency results from hypervigilance to speech. This study aimed to measure the effect of reduced attention on speech through verbal and non-verbal dual tasks among school children with stuttering. Furthermore, the effect of dual tasks on the severity of stuttering was investigated among them. Materials &amp; Methods In this cross-sectional study, the participants included 39 children (5 girls, 12.8%) and (34 boys, 87.2%) aged 8-12 years (10.25±1.35) with developmental stuttering selected via convenience sampling from primary schools in districts four and eight and speech therapy clinics in Tehran, Iran. Dual tasks were designed using the Visual Basic program. During the study, four speech samples were recorded for each participant. The second and third samples were designed as a dual task (addition of verbal or non-verbal tasks), while the first and fourth samples were designed as a single task. The participant’s severity of stuttering in each sample was calculated based on the number of stuttered syllables (SS%), and data were analyzed by SPSS 20 software. Given the non-normal distribution of data, the generalized linear model with the Generalized Estimating Equation (GEE) and Bonferroni test were used to determine the difference in stuttering severity among speech samples. Results The GEE results showed that the severity of stuttering was different among the four speech samples (P=0.015). The lowest and highest mean stuttering severity among the 39 participants pertained to the non-verbal dual task (14.85) and the single initial task (17.11), respectively. A pairwise comparison of stuttering severity showed that the mean severity in the final single task was significantly lower than in the single initial task (P&lt;0.05). However, mean stuttering severity was not significantly different between verbal and non-verbal tasks (P&gt;0.05). Conclusion The findings showed that stuttering severity reduces when children with stuttering perform dual tasks. In other words, focusing children’s attention on verbal and non-verbal tasks while talking reduced their dysfluency.

The Effect of Distance Delivery of Lidcombe Program on The Severity of Stuttering in Preschool Children: A Single-Subject Study

Objective The Lidcombe therapeutic program is one of the treatments for stuttering in preschool children whose effectiveness on improvement in stuttering has been confirmed. Some families have no access to care centers due to different reasons and as such, they are deprived of treatment. Distant treatment would be a proper solution for this issue, in which all people can reach their needed treatment without being concerned over their geographical locations. Because some research has been conducted on telepractice for speech and language disorders in different ways in different countries, regarding the cultural differences that influence the duration of the Lidcombe program as well as its distant implementation, we investigated the extent of the stuttering effect in telepractice program on preschool children in Iran. Materials &amp; Methods In this single-subject study, the Lidcombe program was implemented through live video communication between the therapist in a clinic and the subjects at home for 15 weekly sessions on five 4-6-year-old children, including three boys and two girls. To investigate the progress of the effect, the percentage of stuttered syllables, which were recorded by the therapist as well as the 9-score stuttering severity scale, which was recorded by the parents at home, were employed. During the first base line, which had been considered as three weeks, 21 times the severity rating were recorded, while 3 times the percentage of stuttered syllables were recorded. In the treatment phase, which lasted 15 weekly sessions, 105 and 15 times the score of severity and the percentage of stuttered syllables were recorded respectively. In the second base line, which had been considered as three weeks, 21 and 3 times the score of severity and the percentage of stuttered syllables were recorded respectively. Results To analyze the data of this study, Z-index and diagram plotting were used. The investigation of the stuttering severity scores and the percentage of stuttered syllables before and after the treatment suggest diminished severity and percentage of the stuttered syllables in children. After 15 sessions, two subjects approached the final criteria of the first phase of the Lidcombe program (scores with intensities one and two); however, they did not achieve the criteria. Other subjects did not achieve the final criteria in the first phase either, in spite of the diminished severity and percentage of stuttering. Conclusion The results obtained from this research suggest the effects of the Lidcombe telepractice program on the reduction of stuttering in the subjects. The results of this study showed that after 15 treatment sessions, the other subjects did not manage to achieve the final criteria of the first phase of this program. The outcome of this research indicates a positive effect of the Lidcombe telepractice program on the reduction of stuttering severity in the subjects. Nevertheless, they did not manage to approach the final criteria in the first phase of this program after joining 15 sessions. Based on these results, it can be concluded that the presentation of the Lidcombe telepractice program can be effective in reducing the severity of stuttering. However, more sessions may be required in this type of treatment, compared to the in-person one.

Telepractice application for the overt stuttering assessment of children aged 6-15 years old.

Despite the importance of delivering speech and language therapy services to children who stutter (CWS), there are barriers to accessing speech and language therapy. One way to improve access for those who may otherwise be deprived of speech and language therapy services, including CWS, is through telepractice (TP). However, there is currently no evidence as to the viability of TP stuttering assessments for CWS. To investigate the validity and reliability, and acceptability of using a TP application to assess overt stuttering behaviour children aged 6-15 years. A total of 30 CWS, aged between 6 and 15 years, were recruited from a speech therapy clinic in King Abdulaziz University Hospital in Riyadh, Saudi Arabia. Children were divided into two testing conditions, either face-to-face (f2f)-led or TP-led testing, and the Stuttering Severity Instrument (SSI-IV) was administered, percentage of syllables stuttered (%SS) was calculated, and severity ratings (SR) assigned, either via f2f or via TP using two laptops with webcams, video conference software and a broadband internet connection. Agreement and reliability of scoring in the two testing conditions were reported in addition to findings from questionnaires exploring children's and their caregivers' perceptions both before and immediately after the TP assessment was carried out. A total of 30 sessions were successfully carried out, with results revealing unsatisfactory levels of agreement when applying the Bland and Altman method. However, when discrepancies were found, these were comparable with those from traditional f2f studies. Generally, parents and children exhibited high levels of satisfaction and held a positive view regarding TP pre- and post-assessment. The results of the study suggest that conducting an overt stuttering assessment via TP for 6-15-year-olds CWS is reliable and valid. Although the TP model posed some (mainly technical) challenges for executing the assessment, high levels of satisfaction were recorded by parents and children alike. The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS. These results are preliminary, but they can be seen as a building block for future research in TP assessment studies for CWS. What is already known on the subject Stuttering treatment via TP has been proven to be feasible and successful across a variety of treatment programs (e.g., Lidcombe, Camperdown). However, the viability of assessing stuttering via videoconferencing has never been explored in children. What this paper adds to existing knowledge Preliminary support for the assessment of overt stuttering in CWS aged 6-15 years via video conferencing. The results justify larger scale studies of this service delivery method. What are the potential or actual clinical implications of this work? The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS aged 6-15 years.

The Relationship Between Auditory-Motor Integration, Interoceptive Awareness, and Self-Reported Stuttering Severity.

Stuttering is a neurodevelopmental speech disorder associated with motor timing that differs from non-stutterers. While neurodevelopmental disorders impacted by timing are associated with compromised auditory-motor integration and interoception, the interplay between those abilities and stuttering remains unexplored. Here, we studied the relationships between speech auditory-motor synchronization (a proxy for auditory-motor integration), interoceptive awareness, and self-reported stuttering severity using remotely delivered assessments. Results indicate that in general, stutterers and non-stutterers exhibit similar auditory-motor integration and interoceptive abilities. However, while speech auditory-motor synchrony (i.e., integration) and interoceptive awareness were not related, speech synchrony was inversely related to the speaker’s perception of stuttering severity as perceived by others, and interoceptive awareness was inversely related to self-reported stuttering impact. These findings support claims that stuttering is a heterogeneous, multi-faceted disorder such that uncorrelated auditory-motor integration and interoception measurements predicted different aspects of stuttering, suggesting two unrelated sources of timing differences associated with the disorder.

Temperament, anxiety, and depression in school-age children who stutter

Purpose: The main aim of this study was to gain insight into whether temperament and/or stuttering severity were associated with anxiety and depression in children who stutter. Additionally, the study also provided an indication into the prevalence of anxiety and depression in children who stutter in a clinical cohort.Method: The participants were 132 English-speaking children (105 boys and 27 girls) between 9;0 and 14;11 years old (M = 11;8, SD = 1;10) and their mothers. At their first visit to a specialist center for children who stutter, mothers and children completed the relevant versions of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R; Ellis & Rothbart, 2001) and a screening of children's anxiety and depression, using the Revised Children's Anxiety and Depression Scale (RCADS; Chorpita et al., 2000). Stuttering was evaluated using the Stuttering Severity Instrument Fourth Edition (SSI-4). Correlations were conducted between child and parent versions of the EATQ-R and RCADS; EATQ-R and RCADS; as well as the SSI-4 and RCADS. A comparison was made between those children who scored below the clinical threshold for anxiety and depression, and those who scored above.Results: Significant correlations were found for all mother and child EATQ-R factors and RCADS scales (except for Obsessive Compulsive Disorder). Correlations were also found between the child- and mother-reported temperament factors of positive reactivity, negative reactivity, and self-regulation and anxiety and depression. Children who scored above the clinical threshold for any category of anxiety or depression had significantly lower positive reactivity and higher negative reactivity scores, compared to those who scored below the threshold. There were no differences between the two groups with regard to SSI-4 scores.Conclusions: This is the first study to evaluate associations between temperament and anxiety and depression in children who stutter. Higher negative reactivity scores and lower positive reactivity and self-regulation scores are associated with elevated levels of anxiety and depression in children who stutter. Further, those who score above the clinical threshold have significantly higher levels of negative reactivity and lower levels of positive reactivity compared to those scoring below the threshold. Findings suggest that levels of anxiety that reach clinical threshold are more prevalent in children who stutter than would be expected based on population data. Current findings have implications for both the assessment and therapy of children who stutter presenting at clinics for support.

Investigation of the effect of delayed auditory feedback and transcranial direct current stimulation (DAF-tDCS) treatment for the enhancement of speech fluency in adults who stutter: A randomized controlled trial

BackgroundStuttering is a disorder that begins in childhood and can persist into adulthood. In the present study, it was hypothesized that the combined intervention of transcranial direct current stimulation (tDCS) and Delayed Auditory Feedback (DAF) would cause greater improvement in speech fluency in comparison to the intervention with DAF alone. MethodsA randomized, double-blind, sham-controlled clinical trial was conducted to investigate the effects of the combined intervention. Fifty adults with moderate to severe stuttering (25 females, 25 males, Mean age=26.92, SD=6.23) were randomly allocated to the anodal or sham tDCS group. In the anodal tDCS group, participants received DAF combined with anodal tDCS (1 mA), while the sham tDCS group was exposed to sham tDCS simultaneously with DAF. In this study, a 60-ms delay was used for DAF intervention, and tDCS was applied over the left superior temporal gyrus. Each individual participated in six 20-minute intervention sessions (held on six consecutive days). Speech fluency was assessed before and after the intervention. ResultsIn the anodal tDCS group, the scores of the Stuttering Severity Instrument, Overall Assessment of the Speaker’s Experience of Stuttering questionnaire, and the percentage of stuttered syllable reduced significantly (from average baseline rates of 8.45%, across three tasks, to 5.36% at the follow-up assessment) after the intervention. ConclusionThe results of this study suggest that delivery of anodal tDCS when combined with DAF may enhance stuttering reduction effects for six weeks following the intervention.