Barry Guitar

Evaluating efficacy of treatment of stuttering: School-age children

Abstract Our purpose in writing this article is to discuss current problems and progress in evaluating efficacy of treatment of stuttering in school-age children. We will focus on children between approximately 6 and 12 years of age (i.e., 1st through 6th grades of elementary school). Problems unique to this population in terms of nature of stuttering, treatment approaches, measurement, reliability, validity, and long-term outcome will be discussed, with particular relevance to the evaluation of therapeutic efficacy with school-age stutterers. We will suggest guidelines and standards for conducting and evaluating research on treatment efficacy with school-age children who stutter, in the hope that this may lead to a more focused, coordinated effort in this area. One major point we wish to make in this chapter is that true therapy efficacy involves improving the stuttering childs ability to use his speech in daily communicative situations. Thus, we are concerned not only with improvement in stuttering in clinical settings, but also with gains in the childs use of his speech—whether he is fluent or stuttering—at home, school, and play.

The Integrity of Anticipatory Coarticulation in Fluent and Non-Fluent Tokens of Adults Who Stutter.

This article analysed the acoustic structure of voiced stop + vowel sequences in a group of persons who stutter (PWS). This phonetic unit was chosen because successful production is highly dependent on the differential tweaking of right-to-left anticipatory coarticulation as a function of stop place. Thus, essential elements of both speech motor planning and execution can be parsimoniously assessed. Five adult PWS read three passages 3 times in a randomised order. These passages contained an overabundance of words beginning with initial [bV], [dV] and [gV] sequences. Digital audio and visual recordings were analysed to first identify fluent and stuttered target words, which were then spectrally analysed to yield locus equation (LE) regression plots. The slope of the LE regression function directly indexes the coarticulatory extent of the vowels influence on the preceding stop consonant. The PWS revealed LE parameters falling within the normal ranges based on previously documented data obtained from fluent speakers. Theoretical considerations of possible underlying factors responsible for stuttering disfluencies are discussed relevant to these findings.

The Effects of Structured Turn-Taking on Disfluencies: A Case Study

The purpose of this study was to examine the effects of structured conversational turn-taking on the amount and types of disfluencies as well as on the speech rate of a 5-year-old boy who stuttered. A single subject design with measures of disfluencies under conditions of structured turn-taking versus no turn-taking was used (ABAB withdrawal design). All analyses were performed on tape recordings of dinner-time conversations in the subject’s home. Results appear to indicate that disfluencies decreased when structured conversational turn-taking was instituted and increased when turn-taking conditions were not enforced. The implications for counseling parents of children who stutter are discussed.

A comparison of stutterers and nonstutterers on masking level differences and synthetic sentence identification tasks

Ten stutterers and ten nonstutterers, matched for sex, were tested for Masking Level Differences (MLDs) at 500 Hz, and were evaluated on the Synthetic Sentence Identification test with Ipsilateral Competing Message (SSI-ICM) under message-to-competition ratios (MCRs) of 0, -10, and -20 dB. No significant differences on the SSI-ICM task were seen between groups, but the stutterers did produce significantly (p less than .01) poorer MLDs than the nonstutterers. This may be interpreted as support for Kents (1983) hypothesis that stutterers may be poorer at temporal processing. In addition, the present results support the concept of a continuum of auditory processing ability, with normals and stutterers of different degrees of disfluency revealing decreasing performance measures.

Reliability of verbal-manual interference

Considerable recent research has used unimanual finger tapping with concurrent vocalization to assess hemispheric lateralization for language. This study examined whether an index finger tapping task is a reliable measure in adults and whether the task demonstrates sex differences in hemispheric specialization for language. Thirty right-handed subjects, fifteen male and fifteen female, between the ages of 18 and 25 were tested. The task measured the differences in tapping rate for each hand between tapping with and without a concurrent verbal task. The task was completed once each day for 3 consecutive days to determine reliability. The tapping task was found to be a reliable measure. No significant differences were found between tapping scores of males and females.

Predicting Treatment Time and Long-Term Outcome of the Lidcombe Program: A Replication and Reanalysis

PURPOSE The present study presents treatment duration and outcome data on 14 children who stutter (CWS) recently treated by the Lidcombe Program (LP). These data were then combined with data from a previous LP treatment study (Miller & Guitar, 2009) to examine predictor variables for treatment duration and outcome. The present study also provides evidence of the effectiveness of LP from researchers who are independent of the developers of the program. METHOD Fourteen preschool CWS were assessed on stuttering severity variables and participant characteristics prior to treatment, given LP treatment, and reassessed 2 years after the children achieved stable fluency. These childrens data were added to the data of 15 previously treated CWS to examine predictors of treatment duration and long-term outcome. Preliminary analysis lead to the identification of two predictors that were tested in a generalized linear model. RESULTS For the new group of 14 CWS, median treatment duration was 15 clinic visits and resulted in near-zero stuttering long term for most of the children and substantial reductions in stuttering for all of the children. For the combined group of 29 children, pretreatment stuttering frequency and severity were the best predictors of treatment duration in both clinic visits and weeks. CONCLUSIONS Children with more frequent and more severe stuttering may take longer in LP treatment. Long-term outcome may best be predicted by pretreatment stuttering and sex.

Short-Term Intensive Stuttering Treatment in a Public School Setting

This paper describes a public school stuttering treatment program that combined long-term non-intensive and short-term intensive schedules. The program was used with a 12-year-old male. Clinical methodology and results of treatment, including a one-year follow-up evaluation, are discussed.

Fluency Shaping With Young Stutterers

This article presents the steps to be used in teaching a child to use slow, normal sounding, fluent speech in place of stuttering. Case selection, reward system, and arrangement of a hierarchy are discussed. Procedures for transferring and maintaining fluency are suggested.

Stuttering severity and responses to social-communicative challenge in preschool-age children who stutter

Abstract Purpose This study assessed indices of autonomic arousal and vocal tension during challenge in preschool-age children who do stutter (CWS) and do not stutter (CWNS). Method Participants were preschool-age CWS (n = 10) and gender- and age-matched CWNS (n = 10) who performed in two speaking conditions: (1) ‘low’ challenge – naming age-appropriate pictures in a familiar room with the same examiner who administered his/her speech-language prescreening test (2) ‘high’ challenge – recalling the pictures named in condition (1) in a different room with an unfamiliar examiner while wearing acoustic startle electrodes on his/her face. Immediately following the ‘high’ challenge speaking task, the participants’ acoustic startle eyeblink response (ASEB) was measured. Dependent variables were ASEB in the ‘high’ challenge condition and the acoustic measure of mean fundamental frequency (Fo) in both challenge conditions. Results Findings indicated no significant between-group (CWS vs. CWNS) differences in Fo or ASEB responses. However, CWS-severe (n = 5), when compared with CWS-mild/moderate (n = 5), exhibited a statistically significant increase in Fo in the ‘high’ challenge relative to the ‘low’ challenge condition. Conclusions Results were taken to suggest that preschool-age CWS-severe exhibit vocal tension while speaking in conditions of social (e.g. speaking to unfamiliar examiner) and communicative (e.g. recalling from memory names of pictures previously shown) challenge, and such vocal behavior is possibly associated with this subgroups difficulty establishing normally fluent speech.

Corpus callosum demyelination associated with acquired stuttering

Compared with developmental stuttering, adult onset acquired stuttering is rare. However, several case reports describe acquired stuttering and an association with callosal pathology. Interestingly, these cases share a neuroanatomical localisation also demonstrated in developmental stuttering. We present a case of adult onset acquired stuttering associated with inflammatory demyelination within the corpus callosum. This patient’s disfluency improved after the initiation of immunomodulatory therapy.