Ann Packman

Prevalence of anxiety disorders among adults seeking speech therapy for stuttering

The present study explored the prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Employing a matched case-control design, participants included 92 adults seeking treatment for stuttering, and 920 age- and gender-matched controls from the Australian National Survey of Mental Health and Well-being. A conditional logistic regression model was used to estimate odds ratios for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases (ICD-10) anxiety disorders. Compared with matched controls, the stuttering group had six- to seven-fold increased odds of meeting a 12-month diagnosis of any DSM-IV or ICD-10 anxiety disorder. In terms of 12-month prevalence, they also had 16- to 34-fold increased odds of meeting criteria for DSM-IV or ICD-10 social phobia, four-fold increased odds of meeting criteria for DSM-IV generalized anxiety disorder, and six-fold increased odds of meeting criteria for ICD-10 panic disorder. Overall, stuttering appears to be associated with a dramatically heightened risk of a range of anxiety disorders.

Predicting Stuttering Onset by the Age of 3 Years: A Prospective, Community Cohort Study

OBJECTIVES. Our goals were to document (1) the onset of stuttering and (2) whether specific child, family, or environmental factors predict stuttering onset in children aged up to 3 years. METHODS. Participants included a community-ascertained cohort of 1619 2-year-old Australian children recruited at 8 months of age to study the longitudinal development of early language. The main outcome measure was parental telephone report of stuttering onset, verified by face-to-face expert diagnosis. Preonset continuous measures of the childs temperament (approach/withdrawal) and language development were available. Information on a range of predictor measures hypothesized to be associated with stuttering onset was obtained (maternal mental health and education levels, gender, premature birth status, birth weight, birth order, twinning, socioeconomic status, family history of stuttering). RESULTS. By 3 years of age, the cumulative incidence of stuttering onset was 8.5%. Onset often occurred suddenly over 1 to 3 days (49.6%) and involved the use of word combinations (97.1%). Children who stuttered were not more shy or withdrawn. Male gender, twin birth status, higher vocabulary scores at 2 years of age, and high maternal education were associated with stuttering onset. The multivariable model, however, had low predictive strength; just 3.7% of the total variation in stuttering onset was accounted for. CONCLUSIONS. The cumulative incidence of stuttering onset was much higher than reported previously. The hypothesized risk factors for stuttering onset together explained little of the variation in stuttering onset up to 3 years of age. Early onset was not associated with language delay, social and environmental factors, or preonset shyness/withdrawal. Health professionals can reassure parents that onset is not unusual up to 3 years of age and seems to be associated with rapid growth in language development.

The relationship between mental health disorders and treatment outcomes among adults who stutter

UNLABELLED The ability to reduce stuttering in everyday speaking situations is the core component of the management plan of many who stutter. However, the ability to maintain the benefits of speech-restructuring treatment is known to be compromised, with only around a third of clients achieving this [Craig, A. R., & Hancock, K. (1995). Self-reported factors related to relapse following treatment for stuttering. Australian Journal of Human Communication Disorders, 23, 48-60; Martin, R. (1981). Introduction and perspective: Review of published research. In E. Boberg (Ed.), Maintenance of fluency. New York: Elsevier]. The aim of this study was to determine whether the presence of mental health disorders contributes to this failure to maintain fluency after treatment. Assessments for mental health disorders were conducted with 64 adults seeking speech-restructuring treatment for their stuttering. Stuttering frequency, self-rated stuttering severity and self-reported avoidance were measured before treatment, immediately after treatment and 6 months after treatment. Stuttering frequency and situation avoidance were significantly worse for those participants who had been identified as having mental health disorders. The only subgroup that maintained the benefits of the treatment for 6 months was the third of the participants without a mental health disorder. These results suggest that prognosis for the ability to maintain fluency after speech restructuring should be guarded for clients with mental health disorders. Further research is needed to determine the benefits of treating such disorders prior to, or in combination with, speech-restructuring. EDUCATIONAL OBJECTIVES The reader will (1) evaluate the impact of one or more mental health disorders on medium-term outcomes from speech-restructuring treatment for stuttering, (2) describe how this finding affects prognosis for certain groups of stuttering clients, (3) evaluate how these finding are consistent with estimates of post-treatment relapse after speech-restructuring treatment, (4) describe two test instruments for detecting mental health disorders, and (5) outline the findings about the relation between pre-treatment stuttering severity and mental health disorders.

Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists

UNLABELLED This paper explores the relationships between anxiety and stuttering and provides an overview of cognitive-behavior therapy (CBT) strategies that can be applied by speech-language pathologists. There is much support for the idea that adults who stutter (AWS) may need CBT. First, approximately 50% of AWS may be suffering from social anxiety disorder. A difficult developmental history marked by problematic peer relationships and bullying may contribute to this. Stereotypes in the general community lead AWS to have occasional experiences that confirm their fears of negative evaluation. This can leave AWS with significant social and occupational avoidance and can impact on their quality of life. Second, in a recent large study of behavioral treatment for AWS, participants who had a mental health disorder, including social anxiety, failed to maintain the benefits of treatment. Available evidence supports the contention that CBT can effectively decrease anxiety and social avoidance, and increase engagement in everyday speaking situations for AWS. The components of CBT presented here are drawn from a model widely used in clinical psychology, and existing supportive data reviewed. Worksheets for speech-language pathologists undertaking CBT in this population are provided. CBT procedures, in their essentials, are straightforward to implement. Hence, the present authors suggest that speech-language pathologists who have had training in conducting CBT should be able to apply the techniques described in this paper. EDUCATIONAL OBJECTIVES The reader will be able to explain: (1) the relation between stuttering and anxiety; (2) the nature of Social Anxiety Disorder; (3) why those who stutter are often diagnosed with Social Anxiety Disorder; (4) the four components of cognitive behavior therapy; (5) how cognitive behavior therapy is adapted for the management of speech-related anxiety in those who stutter.

Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program

BACKGROUND Although there are treatments that can alleviate stuttering in adults for clinically significant periods, in Australia there are barriers to the accessibility and availability of best-practice treatment. AIMS This parallel group, non-inferiority randomized controlled trial with multiple blinded outcome assessments investigated whether telehealth delivery of the Camperdown Program provides a non-inferior alternative to face-to-face treatment for adults who stutter. METHODS & PROCEDURES Forty participants who presented to a university speech clinic were randomized: 20 to the telehealth arm and 20 to the face-to-face arm. Exclusion criteria were age younger than 18 years, frequency of stuttering less than 2% of syllables stuttered and previous speech-restructuring treatment within the past 12 months. The Camperdown Program for adults who stutter was the intervention. Primary outcome measures were frequency of stuttering measured in per cent syllables stuttered (%SS) before treatment and at 9 months post-randomization and efficiency, measured by counting the number of speech pathologist contact hours used by each participant. Intention to treat analysis was conducted using last observation carried forward. Secondary outcome measures were speech naturalness, self-reported stuttering severity, and treatment satisfaction. OUTCOMES & RESULTS There was no statistically or clinically significant difference in %SS between the two groups at 9 months post-randomization. Analysis of covariance adjusting for baseline %SS showed telehealth had 0.8% absolute lower per cent syllables stuttered than face-to-face. There were also no differences in %SS between groups immediately post-treatment, or at 6 months and 12 months post-treatment (p = 0.9). In the second primary outcome measure, the telehealth group used statistically less contact time (221 min) on average than the face-to-face group (95% confidence interval = - 387 to - 56 min, p = 0.01). CONCLUSIONS & IMPLICATIONS The results provide evidence to support the use of the Camperdown Program delivered by telehealth as an alternate to the face-to-face treatment delivery of this programme for adults who stutter. Such a model will increase accessibility to this evidence-based treatment for adults currently isolated from treatment services.

Protection from harm: the experience of adults after therapy with prolonged‐speech

BACKGROUND It is well documented that adults can control stuttering if they use certain novel speech patterns referred to generically as prolonged-speech (PS). These speech patterns were refined in the 1960s and developed into behavioural treatment programmes. The bulk of available PS treatment research has focused on speech parameters thought to reflect favourable treatment outcome. Considering this, and that post-treatment relapse is known to be common, clinicians and researchers could be usefully informed by knowledge about the experiences of those who receive these treatments. Subsequently, they could use such information in attempts to control stuttering in their clients. Yet, at present, systematic research on this topic is scant. AIMS The continued development of PS treatments could be usefully informed by research into the experiences of those who use PS to control stuttering. Hence, that is the topic of the present report. METHODS & PROCEDURES The method used was phenomenology. Participants were a purposive sample of 10 people who had received PS treatment. During a 2-year period, a collaborative approach to the study of the topic was developed between the participants and interviewer. Interviews were from 1.5 to 2 hours, and a total of 34 interviews and discussions were undertaken with participants. Transcripts of these were used to generate text from which themes were identified using line-by-line, holistic and selective approaches. OUTCOMES & RESULTS The main findings were that even after therapy with PS there is a continued risk of stuttering occurring, and although adults have the novel experience of controlling stuttering, they also continue to experience feeling different from those who do not stutter, which may be exacerbated after therapy. Given the negative consequences associated with stuttering and feeling different, the essence of the experience after therapy with PS is that adults use their own resources to integrate behavioural skills with existing experiences in order to protect themselves from the harm of stuttering as best they can. PS changes speech, but not the dynamic and often unpredictable communication situations of everyday life. Hence, the maximum benefits of PS are attained when clients use a strategic approach to control stuttered speech and daily communication. CONCLUSIONS These findings are consistent with the results of existing outcome research as well as with other current research from the present group. Their implications are discussed in relation to the structure of PS treatments as well as in relation to future PS outcome research. The clinical implications of these findings are discussed in terms of informing prospective clients of the experiential consequences of PS, selecting clients who might benefit from PS and in terms of assisting clients to achieve optimal benefits from PS.

Syllabic stress and variability : a model of stuttering

Wingate suggested that prosody has an important role in stuttering, particularly in treatment for the disorder. Results of recent research by the authors indicate that alteration of one aspect of prosody, namely syllabic stress, is a feature of some behavioural stuttering treatments and that this may contribute to stuttering reduction. It is thought that people who stutter have unstable speech systems that may be disrupted by variability, and it is suggested that the production of stress contrasts is a source of such variability. We present a model that suggests that stuttering decreases when people who stutter decrease the variability with which they typically produce syllabic stress. As well as explaining the role of syllabic stress in stuttering reduction, the model implies that the development of variable stress induces stuttering in those children whose motor systems are susceptible to variability. The model also explains some of the phenomenology of stuttering and challenges some long-held beliefs a...

Novel speech patterns and the treatment of stuttering.

Variants of rhythmic speech and legato speech have been used for centuries to treat stuttering. Despite considerable empirical and theoretical inquiry, the reason for the effectiveness of these novel speech patterns in suppressing stuttering is unknown. Recent acoustic research conducted at the University of Sydney suggests that a reduction in the variability of syllabic stress is a critical feature of these two speech patterns, and that this reduction suppresses stuttering by stabilizing the speech motor system. This paper reviews what is known about rhythmic speech and legato speech from this perspective, and the theoretical and clinical implications of reconceptualizing them in this way are discussed.

Stuttering severity and educational attainment

PURPOSE This study investigated the relationship between self-reported stuttering severity ratings and educational attainment. METHOD Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering severity on a 9-point scale for a range of speaking situations. These included: (1) talking with a family member, (2) talking with a familiar person, not a family member, (3) talking in a group of people, (4) talking with a stranger, (5) talking with an authority figure such as a work manager or teacher, (6) talking on the telephone, (7) ordering food or drink, and (8) giving their name and address. RESULTS There was a significant negative relationship between highest educational achievement and mean self-reported stuttering severity rating for the eight situations. CONCLUSIONS Future research is needed to investigate how this result should be addressed in educational institutions. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe the negative effects of stuttering through childhood to adulthood; (2) identify some of the negative consequences associated with stuttering on peer and teacher relationships, and academic performance at school; and (3) summarise the relationship between stuttering severity and educational attainment.

On the cause of stuttering: Integrating theory with brain and behavioral research

Abstract Stuttering is present in all cultures with a prevalence of around 1%. While there has been extensive brain and behavioral research into stuttering over the last 50 years, its cause remains unknown. Brain imaging research has shown anomalous activations during stuttered speech and, more recently, has identified structural anomalies in the speech language areas of the brain. A recent meta-analysis concluded that these aberrant neural activations are a consequence of stuttering rather than a cause, and that stuttering is a disorder of the initiation of speech motor plans. Expanding on this hypothesis we propose that this disorder comprises the initiation of syllables. We provide evidence that this is underpinned by a disturbance of neural function in SMA. Our syllable initiation (SI) theory has evolved from our working model, the variability or Vmodel. SI theory draws not only on brain research in stuttering but also on research into speech production deficits after brain damage. SI theory locates stuttering at the interface of speech and language and we suggest that it provides a plausible and parsimonious explanation of the cause and critical phenomena of stuttering.