J. Scott Yaruss

Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update

UNLABELLED The World Health Organization (WHO) recently presented a multidimensional classification scheme for describing health status and the experience of disablement. This new framework, the International Classification of Functioning, Disability, and Health (ICF; WHO, 2001), is a revision of WHOs prior framework for describing the consequences of disorders, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH; WHO, 1980). In previous papers, Yaruss had shown how the original ICIDH could be adapted to describe the consequences of stuttering at several levels that are relevant to the communication and life experiences of the person who stutters. The current manuscript presents an update of the Yaruss (1998) model that accounts for the new structure of the ICF. A comparison of the WHOs ICIDH and ICF frameworks is presented, followed by an analysis of how the ICF can be adapted to describe the speakers experience of the stuttering disorder. Emphasis is placed on the fact that stuttering involves more than just observable behaviors. Specifically, the speakers experience of stuttering can involve negative affective, behavioral, and cognitive reactions (both from the speaker and the environment), as well as significant limitations in the speakers ability to participate in daily activities and a negative impact on the speakers overall quality of life. LEARNING OUTCOMES As a result of reading this manuscript, participants, willgain an understanding of the updates to the World Health Organizations original International Classification of Impairments, Disabilities, and Handicaps that are seen in the International Classification of Functioning, Disability, and Health understand how the ICF can be applied to the study of stuttering recognize that health conditions such as stuttering are affected by both internal and external factors, and can involve more than just observable behaviors that are seen on the surface.

Assessing quality of life in stuttering treatment outcomes research.

UNLABELLED Stuttering can affect many aspects of a persons life. People who stutter report that they experience negative reactions to stuttering, difficulty communicating in key situations, diminished satisfaction with life, and a reduced ability to achieve their goals in life. Unfortunately, most treatment outcomes studies have focused on changes in the observable characteristics of stuttering, with significantly fewer studies examining the broader consequences of stuttering. This paper proposes that evaluation of stuttering treatment outcomes can be enhanced through assessment of impact of stuttering on a speakers quality of life. A means of assessing quality of life is described, based on the Overall Assessment of the Speakers Experience of Stuttering (OASES; Yaruss & Quesal, 2006, 2008). The OASES is a multi-dimensional assessment instrument built upon the World Health Organizations International Classification of Functioning, Disability, and Health (ICF; WHO, 2001; see also Yaruss & Quesal, 2004). One section of the OASES is designed to assess specific aspects of quality of life in individuals who stutter. Preliminary data from two ongoing studies involving the OASES are briefly summarized in order to demonstrate: (a) that individuals who stutter do report an adverse impact on their quality of life as a result of stuttering and (b) that quality of life can improve following treatment for stuttering. It is recommended that future stuttering treatment outcomes studies directly examine the broader consequence of stuttering by focusing, in part, on quality of life. EDUCATIONAL OBJECTIVES After reading this article, the participant will be able to: (1) describe some of the adverse consequences of stuttering reported by individuals who stutter; (2) define quality of life as it relates to the study of the stuttering disorder; (3) explain the value of assessing quality of life in stuttering treatment outcomes research.

Evaluating Stuttering in Young ChildrenDiagnostic Data

This study describes relationships between speech, language, and related behaviors exhibited during an initial diagnostic evaluation by 2- to 6-year-old children referred for evaluation of their sp...

Real-Time Analysis of Speech FluencyProcedures and Reliability Training

Many authors have suggested that it is possible for clinicians to collect basic data regarding their clients speech fluency on-line, or in real time, while the client is speaking. Unfortunately, t...

Clinical implications of situational variability in preschool children who stutter

Abstract Variability is one of the hallmarks of stuttering. Nevertheless, differences in childrens frequency of stuttering in different speaking situations have not been thoroughly investigated. This study examined variability in the frequency of disfluencies produced by 45 preschool children who stutter (mean age = 42.3 months) in five different speaking situations (parent-child interaction, play with clinician, play with pressures imposed, story retell, and picture description). Significant differences were found in the frequency of disfluencies between these situations, and the variability between situations was significantly greater than the variability seen within a single speaking situation. In general, the “play with pressure” situation elicited the highest frequency of disfluencies from many subjects, though subjects exhibited highly individualized patterns of variability. Finally, children with a higher average frequency of “less typical” disfluency types exhibited a significantly higher degree of variability. Results highlight the importance of evaluating more than one speaking situation when diagnosing a child who stutters both to obtain a better understanding of the nature of the childs stuttering disorder and to ensure that the true extent of the childs stuttering is not overlooked.

Acceptance and commitment therapy for adults who stutter: Psychosocial adjustment and speech fluency

UNLABELLED The aim of the present study was to assess the effectiveness of an Acceptance and Commitment Therapy group intervention program for adults who stutter (N=20). The program consisted of 2-h therapeutic sessions conducted weekly for eight consecutive weeks. It was an integrated program designed to improve: (a) psychosocial functioning, (b) readiness for therapy and change, (c) utilisation of mindfulness skills and psychological flexibility, and (d) frequency of stuttering. The findings provide innovative evidence for Acceptance and Commitment Therapy as an effective intervention with statistically significant improvements in psychosocial functioning, preparation for change and therapy, utilisation of mindfulness skills, and overall speech fluency. Follow-up data collected at three months post-treatment revealed that therapeutic gains were successfully maintained over time. These findings enhance the understanding of the impact of stuttering on psychological wellbeing and offer a new perspective on what might constitute successful stuttering treatment. Further, clinical research support is provided for Acceptance and Commitment Therapy delivered in a group format as a promising and novel intervention for adults who stutter. EDUCATIONAL OBJECTIVES The reader will be able to: (a) appreciate the potential for Acceptance and Commitment Therapy for adults who stutter; (b) identify the improvements participants experienced in psychosocial functioning and frequency of stuttered speech; (c) appreciate the six core processes of Acceptance and Commitment Therapy; and (d) appreciate the differences between an ACT model of intervention for adults who stutter compared to a CBT approach.

Academic and clinical education in fluency disorders: an update

UNLABELLED This paper presents a survey of the academic and clinical education in fluency disorders provided by American Speech-Language-Hearing Association (ASHA)-accredited training programs. Respondents were 159 programs (out of 256, return rate = 67.4%) that completed a questionnaire seeking information about the courses and clinical experiences they require, the expertise of their faculty and supervisors, changes following the 1993 modification of training requirements for the ASHA certificate of clinical competence (CCC), and preliminary plans for changes in preparation for the 2005 standards. Results, which supplement findings from an earlier survey distributed in 1997 (Yaruss, 1999), indicated that nearly one-quarter of programs allow students to graduate without coursework in fluency disorders, and nearly two-thirds allow students to graduate without clinical practicum experiences. Findings suggest a trend toward fewer required classes taught by less experienced faculty, fewer clinical hours guided by less experienced supervisors, and a greater likelihood that students will graduate without any academic or clinical education in fluency disorders. Given the repeated finding that many speech-language pathologists are uncomfortable working with people who stutter, as well as ASHAs apparent de-emphasis of fluency disorders within the increasing scope of practice in the field of speech-language pathology, these results are a cause for concern about the future of fluency disorders. EDUCATIONAL OBJECTIVES The reader will learn about (1) the coursework and clinical practicum experiences that are currently required for students in ASHA-accredited training programs; (2) trends indicating a reduction in training requirements for fluency disorders; and (3) ways of improving these requirements.

National Stuttering Association members' opinions about stuttering treatment

UNLABELLED As stuttering support groups, such as the National Stuttering Association (NSA), have gained prominence and visibility, it has become increasingly important for speech-language pathologists (SLPs) to learn about the people who participate in such groups. This article presents results of a brief survey completed by 200 members of the NSA to examine the opinions of support group members regarding the field of speech-language pathology and stuttering treatment options. Results indicate that NSA members hold a variety of opinions, both positive and negative, about the resources available to them. Findings highlight a number of ways in which SLPs can work with stuttering support groups, both to learn more about the needs of people who stutter and also to provide needed information about treatment options that are available for people who stutter. EDUCATIONAL OBJECTIVES The reader will learn about and be able to describe (1) the role of support groups in stuttering treatment; (2) the people who are members of the NSA; and (3) their opinions about various issues related to stuttering and its treatment.

Exploratory randomized clinical study of pagoclone in persistent developmental stuttering: the EXamining Pagoclone for peRsistent dEvelopmental Stuttering Study.

Introduction: Stuttering is a speech disorder in which the flow of speech is disrupted by repetitions, prolongation, and blocks of sounds, syllables, or words. No pharmacological treatments are approved for use in stuttering, and the most common form of treatment is speech therapy. This study was designed to assess the safety, tolerability, and effectiveness of pagoclone during 8 weeks of double-blind treatment followed by a 1-year open-label extension in patients who stutter. Methods: An 8-week, multicenter, parallel-group, 2-arm, randomized (ratio 2:1 pagoclone-placebo), double-blind study with a 1-year open-label extension conducted at 16 US centers, including men and women aged 18 to 65 years who developed stuttering before 8 years of age. Twice-daily dosing with pagoclone (n = 88 patients) or matching placebo (n = 44 patients), with primary and secondary efficacy variables defined a priori, including Stuttering Severity Instrument Version 3 outcomes, clinician global impressions of improvement, and the change in the percentage of syllables stuttered. Results: Pagoclone produced an average 19.4% reduction in percentage of syllables stuttered compared with 5.1% reduction for placebo. During open-label treatment, a 40% reduction in the percent syllables stuttered was observed after 1 year of treatment with pagoclone. The most commonly reported adverse event during double-blind treatment was headache (12.5% pagoclone patients, 6.8% placebo patients). Discussion: Pagoclone was effective in reducing symptoms of stuttering and was well tolerated. In light of its favorable tolerability profile, as well as consistency of effects across multiple efficacy variables, pagoclone may have potential as a pharmacological treatment of stuttering. Limitations: The main limitation of this study was the adequacy of the number of subjects who participated because this study was conducted as a pilot investigation. Furthermore, as this condition waxes and wanes, the assessment of stuttering within the clinic setting may not be an adequate reflection of the stuttering of the patients within the community.

Relationships between personality characteristics of people who stutter and the impact of stuttering on everyday life

OBJECTIVE This study investigates the association between the five-factor model of personality measured by the NEO Five-Factor Inventory (NEO-FFI) and the Overall Assessment of the Speakers Experience of Stuttering (OASES). The OASES measures the adverse impact of stuttering on a persons life. DESIGN Participants in the present study were 112 persons who stutter from Germany. METHODS All participants filled in both the NEO-FFI and the OASES questionnaires. RESULTS Results revealed a strong positive correlation between the personality trait Neuroticism and scores on the OASES. Moreover, Extraversion was negatively correlated with the OASES scores. CONCLUSIONS The findings suggest that people with higher Neuroticism and lower Extraversion scores experience a greater impact of stuttering on their daily life. The results underscore the importance of considering personality as a potential moderator or mediator factor in future stuttering research and, potentially, also in treatment. EDUCATIONAL OBJECTIVES The reader will learn (a) about the different personality dimensions reflected by the NEO-FFI, (b) why it is important to consider the impact of stuttering on everyday life from the perspective of the people who stutter and (c) how personality is linked to the Overall Assessment of the Speakers Experience of Stuttering (OASES).