Elisabeth Harrison

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.

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.

Screening for personality disorders among adults seeking speech treatment for stuttering.

UNLABELLED Stuttering is frequently associated with negative consequences which typically begin in early childhood. Despite this, no previous studies have investigated the presence of personality disorders among adults who stutter. Therefore, the aims of the present study were to screen for personality disorders among adults who stutter, and to compare these screening estimates with matched controls from a national population sample. Using a matched case-control design, participants were 94 adults seeking treatment for stuttering, 92 of whom completed the International Personality Disorders Examination Questionnaire (IPDEQ) as a first-stage screener, and 920 age- and gender-matched controls from the Australian National Survey of Mental Health and Well-Being (ANSMHWB). A conditional logistic regression model was used to estimate odds ratios for the primary outcome: first-stage presence of any personality disorder; as well as specific personality disorders. Based on first-stage screening, the presence of any personality disorder was significantly higher for adults in the stuttering group than matched controls, demonstrating almost threefold increased odds. This difference between groups remained significant for all specific personality disorders, with four- to sevenfold increased odds found for Dissocial, Anxious, Borderline, Dependent and Paranoid personality disorders, and two- to threefold increased odds found for Histrionic, Impulsive, Schizoid and Anankastic personality disorders. In conclusion, stuttering appears to be associated with a heightened risk for the development of personality disorders. These results highlight the need for research regarding the assessment and treatment of personality disorders among adults who stutter. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe the nature of personality disorders, including factors thought to contribute to their development; (2) identify some of the negative consequences associated with stuttering which may contribute to the development of personality disorders among adults who stutter; (3) describe the process involved in screening for personality disorders, including various methods of scoring; and (4) summarize findings regarding the first-stage presence of personality disorders among adults seeking speech treatment for stuttering in the present sample in comparison with age- and gender-matched controls from a national population sample.

Distance Intervention for Early Stuttering with the Lidcombe Programme

The Lidcombe Programme is a parent-conducted operant intervention for early stuttering. This article presents a case study of the Lidcombe Programme adapted for distance intervention with a family who were isolated from treatment services. The subject, Matthew, was 5 years 10 months old and had been stuttering severely for nearly 4 years at the start of treatment. The entire treatment occurred by telephone contact and was supplemented by audiotape and videotape recordings of the subjects speech, which were mailed to the clinician by his parents. Matthews mother was taught to implement all aspects of the Lidcombe Programme: control of stuttering with on-line praise and correction, measurement of stuttering severity, and administration of a maintenance programme. Matthew attained near-zero stuttering levels after 25 telephone consultations over a period of 9 months. Data suggest that he maintained those levels for 23 months posttreatment. Plans for further research into distance intervention with the Lidc...

Lateralization of Brain Activation in Fluent and Non-Fluent Preschool Children: A Magnetoencephalographic Study of Picture-Naming

The neural causes of stuttering remain unknown. One explanation comes from neuroimaging studies that have reported abnormal lateralization of activation in the brains of people who stutter. However, these findings are generally based on data from adults with a long history of stuttering, raising the possibility that the observed lateralization anomalies are compensatory rather than causal. The current study investigated lateralization of brain activity in language-related regions of interest in young children soon after the onset of stuttering. We tested 24 preschool-aged children, half of whom had a positive diagnosis of stuttering. All children participated in a picture-naming experiment whilst their brain activity was recorded by magnetoencephalography. Source analysis performed during an epoch prior to speech onset was used to assess lateralized activation in three regions of interest. Activation was significantly lateralized to the left hemisphere in both groups and not different between groups. This study shows for the first time that significant speech preparatory brain activation can be identified in young children during picture-naming and supports the contention that, in stutterers, aberrant lateralization of brain function may be the result of neuroplastic adaptation that occurs as the condition becomes chronic.

Reduced activation of left orbitofrontal cortex precedes blocked vocalization : a magnetoencephalographic study

UNLABELLED While stuttering is known to be characterized by anomalous brain activations during speech, very little data is available describing brain activations during stuttering. To our knowledge there are no reports describing brain activations that precede blocking. In this case report we present magnetoencephalographic data from a person who stutters who had significant instances of blocking whilst performing a vowel production task. This unique data set has allowed us to compare the brain activations leading up to a block with those leading up to successful production. Surprisingly, the results are very consistent with data comparing fluent production in stutterers to controls. We show here that preceding a block there is significantly less activation of the left orbitofrontal and inferiorfrontal cortices. Furthermore, there is significant extra activation in the right orbitofrontal and inferiorfrontal cortices, and the sensorimotor and auditory areas bilaterally. This data adds weight to the argument forwarded by Kell et al. (2009) that the best functional sign of optimal repair in stutterering is activation of the left BA 47/12 in the orbitofrontal cortex. EDUCATIONAL OBJECTIVES At the end of this activity the reader will be able to (a) identify brain regions associated with blocked vocalization, (b) discuss the functions of the orbitofrontal and inferior frontal cortices in regard to speech production and (c) describe the usefulness and limitations of magnetoencephalography (MEG) in stuttering research.

The Lidcombe Programme of early stuttering intervention: methods and issues

The Lidcombe Programme is an operant intervention for early stuttering that parents administer to children in their everyday speaking environments. The treatment was developed at the Suttering Unit, Bankstown Health Service, Sydney, and The University of Sydney. Recently, staff from the Australian Stuttering Research Centre. The University of Sydney, toured universities and clinics in the UK to present lectures about this treatment. We were encouraged to write this paper because an independent survey showed that most speech and language therapists who attended the presentations were open to this treatment. Prior to and following that lecture tour, publications in the press and professional journals in the UK alluded to many positive features of the Lidcombe Programme, but also raised several issues about it. The purpose of this paper is to summarise the Lidcombe Programme and address the following criticisms of the treatment that were raised in the UK: (1) Stuttering is complex but the Lidcombe Programme is simple; (2) the Lidcombe Programme is not an operant treatment, but invokes positive changes in childrens environments; (3) the Lidcombe Programme is harmful to children; and (4) the scientific evidence in support of the Lidcombe Programme is flawed. Each of these issues is addressed from logical, theoretical and empirical viewpoints.

Assessment of Reliable Change Using 95% Credible Intervals for the Differences in Proportions: A Statistical Analysis for Case-Study Methodology.

PURPOSE Case-study methodology studying change is often used in the field of speech-language pathology, but it can be criticized for not being statistically robust. Yet with the heterogeneous nature of many communication disorders, case studies allow clinicians and researchers to closely observe and report on change. Such information is valuable and can further inform large-scale experimental designs. In this research note, a statistical analysis for case-study data is outlined that employs a modification to the Reliable Change Index (Jacobson & Truax, 1991). The relationship between reliable change and clinical significance is discussed. Example data are used to guide the reader through the use and application of this analysis. METHOD A method of analysis is detailed that is suitable for assessing change in measures with binary categorical outcomes. The analysis is illustrated using data from one individual, measured before and after treatment for stuttering. CONCLUSIONS The application of this approach to assess change in categorical, binary data has potential application in speech-language pathology. It enables clinicians and researchers to analyze results from case studies for their statistical and clinical significance. This new method addresses a gap in the research design literature, that is, the lack of analysis methods for noncontinuous data (such as counts, rates, proportions of events) that may be used in case-study designs.

Clinicians’ management of young children with co-occurring stuttering and speech sound disorder

Abstract Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants’ main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload.

Grey matter volume differences in the left caudate nucleus of people who stutter

HIGHLIGHTSDysfunction of the striatum is proposed to be involved in stuttering.We report a voxel‐based morphometry study of the striatum in a cohort of chronic stutterers.Left caudate has reduced grey matter volume in people who stutter compared to controls.Data suggest that stuttering arises from deficient articulatory movement selection and sequencing. ABSTRACT The cause of stuttering has many theoretical explanations. A number of research groups have suggested changes in the volume and/or function of the striatum as a causal agent. Two recent studies in children and one in adults who stutter (AWS) report differences in striatal volume compared that seen in controls; however, the laterality and nature of this anatomical volume difference is not consistent across studies. The current study investigated whether a reduction in striatal grey matter volume, comparable to that seen in children who stutter (CWS), would be found in AWS. Such a finding would support claims that an anatomical striatal anomaly plays a causal role in stuttering. We used voxel‐based morphometry to examine the structure of the striatum in a group of AWS and compared it to that in a group of matched adult control subjects. Results showed a statistically significant group difference for the left caudate nucleus, with smaller mean volume in the group of AWS. The caudate nucleus, one of three main structures within the striatum, is thought to be critical for the planning and modulation of movement sequencing. The difference in striatal volume found here aligns with theoretical accounts of stuttering, which suggest it is a motor control disorder that arises from deficient articulatory movement selection and sequencing. Whilst the current study provides further evidence of a striatal volume difference in stuttering at the group level compared to controls, the significant overlap between AWS and controls suggests this difference is unlikely to be diagnostic of stuttering.