Herman F.M. Peters

Stuttering and anxiety: The difference between stutterers and nonstutterers in verbal apprehension and physiologic arousal during the anticipation of speech and non-speech tasks

Abstract To test if stressful anticipation of speech situations is a factor in eliciting stuttering behavior, the difference between 24 stutterers and 24 nonstutterers in verbal apprehension and physiologic activity was studied before and during speech tasks (reading and conversation), and nonspeech tasks (motor and intelligence task). Results indicate that the difference between stutterers and nonstutterers mainly were restricted to anxiety ratings assessed after each task. Heart rate, vasomotor responses, and electrodermal activity recorded before and during speech tasks were higher compared with the physiologic activity before and during nonspeech tasks but, unexpectedly, this was also the case for nonstutterers. It is concluded that stuttering is not elicited by anxiety.

Recent Developments in Speech Motor Research into Stuttering

This paper discusses recent speech motor research into stuttering within the framework of a speech production model. There seems to be no support for the claim that stutterers differ from nonstutterers in assembling motor plans for speech. However, physiological data suggest that stutterers may at least have different ways of initiating and controlling speech movements. It is hypothesized that stuttering may be the result of a deficiency in speech motor skill. Furthermore, objections to the use of stuttering frequency as a severity index are formulated and future developments in the assessment of speech motor behavior in stuttering are described.

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: A randomized clinical trial

OBJECTIVE To investigate the effects of infant orthopedics (IO) on the language skills of children with complete unilateral cleft lip and palate (UCLP). DESIGN In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed up longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group); the other group did not receive this treatment (non-IO group). At the ages of 2, 2(1/2), 3, and 6 years, language development was evaluated in 12 children (six IO and six non-IO). Receptive language skills were assessed using the Reynell test. Expressive language skills of the toddlers were evaluated by calculating mean length of utterance (MLU) and mean length of longest utterances (MLLU); in the 6-year-olds, the expressive language skills were measured using standardized Dutch language tests. PATIENTS The participants had complete UCLP without soft tissue bands or other malformations. RESULTS IO did not affect the receptive language skills. However, the expressive language measures MLU and MLLU were influenced by IO. At age 2(1/2) and 3 years, the IO group produced longer utterances than the non-IO group. In the follow-up, the difference in expressive language between the two groups was no longer significant. CONCLUSIONS Children treated with IO during their first year of life produced longer sentences than non-IO children at the ages of 2(1/2) and 3 years. At 6 years of age, both groups presented similar expressive language skills. Hence, IO treatment did not have long-lasting effects on language development.

Phonological Development of Toddlers With Unilateral Cleft Lip and Palate Who Were Treated With and Without Infant Orthopedics: A Randomized Clinical Trial

OBJECTIVE To investigate the phonological development of toddlers from 2 to 3 years of age with complete unilateral cleft lip and palate (UCLP) treated during the first year of life with and without infant orthopedics (IO). DESIGN In a randomized clinical trial (Dutchcleft), two groups of children were followed up: one treated with IO (IO group) and another that did not receive IO (non-IO group). Phonological skills were analyzed at 2, 2.5, and 3 years of age using a system for assessing phonological development of Dutch children (Fonologische Analyse van het Nederlands: FAN). The analysis included number of acquired consonants, order of phonological development, use of phonological processes, and occurrence of nasal escape. PATIENTS Criteria for inclusion were complete UCLP, no soft tissue bands, no other malformations, parents fluent in Dutch, birth weight of a minimum of 2500 g, and gestation time of a minimum of 38 weeks. INTERVENTIONS IO treatment based on a modified Zurich approach was started within 2 weeks after birth and used until soft palate closure at 12 months of age. Children in the non-IO group visited the clinic for an extra check-up at 6 weeks as well as before and after lip repair and soft palate closure. All other interventions were the same across groups. RESULTS Phonological development of most 2.5-year-old IO children was normal or delayed. Most children in the non-IO group followed an abnormal developmental pattern. At age 3, the children in the IO group had acquired more initial consonants. There were no group differences in the use of phonological processes or the occurrence of nasal escape. CONCLUSIONS Children treated with IO during their first year of life followed a more normal path of phonological development between 2 and 3 years of age.

Timing in finger tapping and speech: A comparison between stutterers and fluent speakers

Abstract Stutterers, even in their fluent utterances, seem to be less able than nonstutterers to time speech motor activity precisely. The question addressed in this study is whether this timing inability is caused by a deficient central timing mechanism or whether it is caused by a more variable motor output process. To this end, twelve adult stutterers and twelve control subjects were asked to perform several variants of a rhythmic keytapping task and a speaking task in which they were asked to utter a vowel or a short word at regular intervals. The results were remarkably similar for both groups. This was true for conditions requiring finger movements, speech movements, or coordination of two simultaneous activities. Only on one measure — the ability to synchronize speech and tapping with a rhytmic tone - did the stutterers show larger variability than the nonstutterers. In contrast to the rhythmic performance, the simultaneous measurements of lip EMGs showed strong group differences. The order of upper lip and lower lip peak EMGs was different in stutterers and in nonstutterers, and the length of the time interval between these EMG peaks was also more variable in stutterers than in nonstutterers. In addition, the duration of lip EMG from peak to acoustic onset was longer in stutterers. It is argued that stutterers do not have a large general timing deficit. Rather, they have coordination disabilities which result in the EMG irregularities.

Perceptual evaluation of the speech before and after fluency shaping stuttering therapy

Abstract An often-cited criterion for assessing the effect of a stuttering therapy is the ability of the stutterers to produce normally fluent speech. Many modern stuttering therapies use special techniques that may produce stutter-free speech that does not sound completely normal. The present study investigates this problem in the framework of the Dutch adaptation of the Precision Fluency Shaping Program. Pre-, post-, and 1 2 -year follow-up therapy speech samples of 32 severe stutterers who were treated in a four-week intensive therapy are compared with comparable samples of 20 nonstutterers. For that aim the samples were rated on 14 bipolar scales by groups of about 20 listeners. The results show that the speech of the stutterers in all three conditions differs significantly from the speech of the nonstutterers. The pretherapy speech takes an extreme position on a Distorted Speech dimension, due to the large proportion of disfluencies. The posttherapy speech has extremely low scores on a Dynamics/Prosody dimension, a`1 while the follow-up therapy speech differs from the normal speech on both dimensions, but now the distances are smaller. These results are discussed in relation to the severity of the stuttering problem in the group of treated stutterers. Finally, implications for future research on therapy evaluation are discussed.

The interaction between speech motor coordination and language processes in the development of stuttering: Hypotheses and suggestions for research☆

Abstract This article summarizes the data relating motoric and linguistic functioning in stutterers, develops hypotheses that are explanatory of these findings, and suggests lines of research designed to test the hypotheses. The first line of research suggests the possibility that there may be subgroups of stutterers with regard to the relationship of language to stuttering. The second hypothesis suggests that the motor production of speech and the formulation of language may interfere with one another. A third line of investigation is that the language competence and language performance may have different influences on speech fluency. Implications of the findings for the development of new diagnostic techniques and methods of intervention are also explored.

An intelligibility assessment of toddlers with cleft lip and palate who received and did not receive presurgical infant orthopedic treatment.

A randomized, prospective, clinical study was performed investigating the effects of presurgical infant orthopedic treatment (PIO) in children with unilateral cleft lip and palate (UCLP). The influence of PIO on speech intelligibility was evaluated with two groups, each consisting of 10 children with UCLP. One group used PIO during the first year of life, whereas the other group did not use the device. Eight children without cleft served as a second control group. Intelligibility was assessed by lay listeners using two methods: transcription and listener rating. The ratings proved to be reliable and to have sufficient validity, but they did not completely reflect intelligibility defined as the proportion of words understood by the listener. Children in the treatment group were rated as exhibiting greater intelligibility than those in the nontreatment group. However, data obtained by means of transcriptions indicated that, in fact, there were no group differences in actual intelligibility. Only in comparison with their noncleft peers were the children with cleft lip and palate significantly less well understood.

Development of stuttering throughout life

Abstract It is now widely accepted that adults as well as children are in a state of development throughout life. The development of normal and abnormal speech fluency is considered from this perspective of lifelong development. Five stages are presupposed in the development of three aspects of human development: motor behavior, language competence and performance, and social/emotional and cognitive behavior. In this article, these three domains are examined at each of the five stages with regard to normal as well as abnormal fluency development. This broad view provides insight into stuttering in children as well as adults.

Use of a Perceptual Evaluation Instrument to Assess the Effects of Infant Orthopedics on the Speech of Toddlers With Cleft Lip and Palate

OBJECTIVE To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. DESIGN In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. PARTICIPANTS Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. METHOD Five trained listeners assessed the childrens speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales. RESULTS The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales. CONCLUSIONS Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects.