Richard M. Arenas

Nonlinear frequency compression in hearing aids: impact on speech and language development.

Objectives: The research questions of this study were: (1) Are children using nonlinear frequency compression (NLFC) in their hearing aids getting better access to the speech signal than children using conventional processing schemes? The authors hypothesized that children whose hearing aids provided wider input bandwidth would have more access to the speech signal, as measured by an adaptation of the Speech Intelligibility Index, and (2) are speech and language skills different for children who have been fit with the two different technologies; if so, in what areas? The authors hypothesized that if the children were getting increased access to the speech signal as a result of their NLFC hearing aids (question 1), it would be possible to see improved performance in areas of speech production, morphosyntax, and speech perception compared with the group with conventional processing. Design: Participants included 66 children with hearing loss recruited as part of a larger multisite National Institutes of Health–funded study, Outcomes for Children with Hearing Loss, designed to explore the developmental outcomes of children with mild to severe hearing loss. For the larger study, data on communication, academic and psychosocial skills were gathered in an accelerated longitudinal design, with entry into the study between 6 months and 7 years of age. Subjects in this report consisted of 3-, 4-, and 5-year-old children recruited at the North Carolina test site. All had at least at least 6 months of current hearing aid usage with their NLFC or conventional amplification. Demographic characteristics were compared at the three age levels as well as audibility and speech/language outcomes; speech-perception scores were compared for the 5-year-old groups. Results: Results indicate that the audibility provided did not differ between the technology options. As a result, there was no difference between groups on speech or language outcome measures at 4 or 5 years of age, and no impact on speech perception (measured at 5 years of age). The difference in Comprehensive Assessment of Spoken Language and mean length of utterance scores for the 3-year-old group favoring the group with conventional amplification may be a consequence of confounding factors such as increased incidence of prematurity in the group using NLFC. Conclusions: Children fit with NLFC had similar audibility, as measured by a modified Speech Intelligibility Index, compared with a matched group of children using conventional technology. In turn, there were no differences in their speech and language abilities.

Outcomes of Children with Hearing Loss: Data Collection and Methods.

Objectives: The primary objective of this article was to describe recruitment, data collection, and methods for a longitudinal, multicenter study involving children with bilateral mild to severe hearing loss. The goals of this research program were to characterize the developmental outcomes of children with mild to severe bilateral hearing loss during infancy and the preschool years. Furthermore, the researchers examined how these outcomes were associated with the child’s hearing loss and how home background and clinical interventions mediated and moderated these outcomes. Design: The participants in this study were children who are hard of hearing (CHH) and children with normal hearing (CNH) who provided comparison data. CHH were eligible for participation if (1) their chronological age was between 6 months and 7 years of age at the time of recruitment, (2) they had a better-ear pure-tone average of 25 to 75 dB HL, (3) they had not received a cochlear implant, (4) they were from homes where English was the primary language, and (5) they did not demonstrate significant cognitive or motor delays. Across the time span of recruitment, 430 parents of potential children with hearing loss made contact with the research group. This resulted in 317 CHH who qualified for enrollment. In addition, 117 CNH qualified for enrollment. An accelerated longitudinal design was used, in which multiple age cohorts were followed long enough to provide overlap. Specifically, children were recruited and enrolled continuously across an age span of 6.5 years and were followed for at least 3 years. This design allowed for tests of time (period) versus cohort age effects that could arise by changes in services and technology over time, yet still allowed for examination of important developmental relationships. Results: The distribution of degree of hearing loss for the CHH showed that the majority of CHH had moderate or moderate-to-severe hearing losses, indicating that the sample undersampled children with mild HL. For mothers of both CHH and CNH, the distribution of maternal education level showed that few mothers lacked at least a high school education and a slight majority had completed a bachelor’s degree, suggesting that this sample of research volunteers was more advantaged than the United States population. The test battery consisted of a variety of measures concerning participants’ hearing and behavioral development. These data were gathered in sessions during which the child was examined by an audiologist and a speech-language examiner. In addition, questionnaires concerning the child’s behavior and development were completed by the parents. Conclusion: The Outcomes of Children with Hearing Loss study was intended to examine the relationship between variation in hearing ability across children with normal and mild to severe hearing loss and variation in their outcomes across several domains of development. In addition, the research team sought to document important mediators and moderators that act between the hearing loss and the outcomes. Because the study design provided for the examination of outcomes throughout infancy and early childhood, it was necessary to employ a number of different measures of the same construct to accommodate changes in developmental performance across age. This resulted in a large matrix of measures across variable types and developmental levels, as described in this manuscript.

Children with ASD can use gaze in support of word recognition and learning

BACKGROUND Many children with autism spectrum disorders (ASD) struggle to understand familiar words and learn unfamiliar words. We explored the extent to which these problems reflect deficient use of probabilistic gaze in the extra-linguistic context. METHOD Thirty children with ASD and 43 with typical development (TD) participated in a spoken word recognition and mapping task. They viewed photographs of a woman behind three objects and simultaneously heard a word. For word recognition, the objects and words were familiar and the woman gazed ahead (neutral), toward the named object (facilitative), or toward an un-named object (contradictory). For word mapping, the objects and words were unfamiliar and only the neutral and facilitative conditions were employed. The children clicked on the named object, registering accuracy and reaction time. RESULTS Speed of word recognition did not differ between groups but varied with gaze such that responses were fastest in the facilitative condition and slowest in the contradictory condition. Only the ASD group responded slower to low frequency than high-frequency words. Accuracy of word mapping did not differ between groups, but accuracy varied with gaze with higher performance in the facilitative than neutral condition. Both groups scored above single-trial chance levels in the neutral condition by tracking cross-situational information. Only in the ASD group did mapping vary with receptive vocabulary. CONCLUSIONS Under laboratory conditions, children with ASD can monitor gaze and judge its reliability as a cue to word meaning as well as typical peers. The use of cross-situational statistics to support word learning may be problematic for those who have weak language abilities.

Phonetically Governed Voicing Onset and Offset in Preschool Children Who Stutter.

UNLABELLED Phonetically governed changes in the fundamental frequency (F₀) of vowels that immediately precede and follow voiceless stop plosives have been found to follow consistent patterns in adults and children as young as four years of age. In the present study, F₀ onset and offset patterns in 14 children who stutter (CWS) and 14 children who do not stutter (CWNS) were investigated to evaluate differences in speech production. Participants produced utterances containing two VCV sequences. F₀ patterns in the last ten vocal cycles in the preceding vowel (voicing offset) and the first ten vocal cycles in the subsequent vowel (voicing onset) were analyzed. A repeated measures ANOVA revealed no group differences between the CWS and CWNS in either voicing onset or offset gestures. Both groups showed patterns of F₀ onset and offset that were consistent with the mature patterns seen in children and adults in previous studies. These findings suggest that in both CWS and CWNS, a mature pattern of voicing onset and offset is present by age 3;6. This study suggests that there is no difference between CWS and CWNS in the coordination of respiratory and laryngeal systems during voicing onset or offset. EDUCATIONAL OBJECTIVES The reader will be able to: (a) discuss the importance of investigating children who stutter close to the onset of stuttering; (b) describe the typical change in F₀ during voicing onset; (c) discuss the potential implications of these results with regard to future research.

Motor practice effects and sensorimotor integration in adults who stutter: Evidence from visuomotor tracking performance.

PURPOSE The purpose of this study was to utilize a visuomotor tracking task, with both the jaw and hand, to add to the literature regarding non-speech motor practice and sensorimotor integration (outside of auditory-motor integration domain) in adults who do (PWS) and do not (PWNS) stutter. METHOD Participants were 15 PWS (14 males, mean age = 27.0) and 15 PWNS (14 males, mean age = 27.2). Participants tracked both predictable and unpredictable moving targets separately with their jaw and their dominant hand, and accuracy was assessed by calculating phase and amplitude difference between the participant and the target. Motor practice effect was examined by comparing group performance over consecutive tracking trials of predictable conditions as well as within the first trial of same conditions. RESULTS Results showed that compared to PWNS, PWS were not significantly different in matching either the phase (timing) or the amplitude of the target in both jaw and hand tracking of predictable and unpredictable targets. Further, there were no significant between-group differences in motor practice effects for either jaw or hand tracking. Both groups showed improved tracking accuracy within and between the trials. CONCLUSION Our findings revealed no statistically significant differences in non-speech motor practice effects and integration of sensorimotor feedback between PWS and PWNS, at least in the context of the visuomotor tracking tasks employed in the study. In general, both talker groups exhibited practice effects (i.e., increased accuracy over time) within and between tracking trials during both jaw and hand tracking. Implications for these results are discussed. EDUCATIONAL OBJECTIVES The reader will be able to: (a) describe the importance of motor learning and sensory-motor integration for speech, (b) summarize past research on PWSs performance during speech and nonspeech motor tasks, and (c) describe the relation between different aspects of speech and non-speech motor control and stuttering.

Conceptualizing and investigating the contextual variability of stuttering: The speech and monitoring interaction (SAMI) framework

Researchers, clinicians, and people who stutter find it difficult to adequately explain the variability across contexts in the frequency and severity of stuttering. The purpose of this paper is to present the speech and monitoring interaction framework of stuttering that incorporates potential deficits within the speech production system and a contextually modulated monitoring system to provide a biologically plausible explanation for the contextual variability of stuttering. SAMI incorporates trait and state factors within the speech production system and the monitoring system that can account for stuttering variability. The specificity of the neural substrates of the monitoring system and how the monitor interacts with the speech production system can be used to drive hypotheses based research and computational modeling of the contextual variable stuttering. The framework can also be used clinically to inform clients of the social and emotional factors contributing to their stuttering; while highlighting the importance of addressing these factors in therapy.

The effects of autonomic arousal on speech production in adults who stutter: A preliminary study

Abstract The purpose of this study was to investigate the influence of autonomic system reactivity and response on the speech production of people who stutter. Participants included three adults who stutter (AWS) and three who did not (AWNS). An aversive acoustic stimulus was paired with a set of neutral pictures to condition an autonomic system response as measured by skin conductance response (SCR). Speech production probes were placed in trials where a conditioned autonomic response was expected in order to record fundamental frequency (F0) and temporal acoustic measures of segments of speech from utterances at different levels of autonomic arousal. Analyses of SRC indicated that AWS had a significantly greater autonomic response to the aversive stimulus compared to AWNS. All of the AWS, but none of the AWNS, acquired a conditioned response. In addition, AWS exhibited F0, voice onset time, and frication durations that were positively correlated with SCR. This study provides evidence that AWS show a greater susceptibility to classical conditioning, along with higher autonomic reactivity and related changes in speech production than AWNS. Findings are discussed as they pertain to risk factors in the development of stuttering.

The relationship between stuttering anticipation and verbal response time in adults who stutter

Objectives: The anticipation of stuttering is a common experience for many people who stutter. In this study, subjective ratings of stuttering anticipation were used to investigate the consistency of anticipation across time, beliefs about how anticipation affects the likelihood of stuttering, and the relationship between anticipation and verbal response time (VRT) in the perceptually fluent speech of 12 adults who stutter (AWS). Method: AWS used a visual analog scale to rate their beliefs about stuttering anticipation in general, and their degree of stuttering anticipation for 50 words at two separate visits that were separated by approximately 1 week. Participants performed a computer-prompted oral reading task with the same 50 words to obtain measures of VRT. Within-subject and group level correlations were used to explore relationships between stuttering anticipation, VRT, and stuttering severity. Results: Six of the participants had word-level stuttering anticipation ratings that were significantly correlated across the two testing visits. Two participants with the highest stuttering severity showed a positive correlation between word-level stuttering anticipation and VRT. Across the group, stuttering severity was positively correlated with the belief that the anticipation of stuttering increases the likelihood of stuttering, and the consistency of word level anticipation ratings across time. Conclusion: The results provide evidence for a relationship between stuttering severity, the consistency of anticipation, and the belief that anticipating stuttering increases the likelihood of stuttering. The relationship between anticipation and VRT in two of the most severe participants provides preliminary evidence that anticipation may be able to subtly influence the speech production system.

High prevalence of pineal cysts in adults who stutter

Pineal cysts are a common incidental finding noted on brain magnetic resonance imaging (MRI). Cysts over 5mm in diameter occur from 1% to 4% (Al-Holou, Garton, Muraszko, Ibrahim, & Maher, 2009; AlHolou et al., 2011; Gur et al., 2013; Nevins et al., 2016; Sawamura et al., 1995; Sener, 1995; Sullivan et al., 2016), with a much larger occurrence of smaller cysts (Nolte, Brockmann, Gerigk, Groden, & Scharf, 2010; Pu et al., 2007; Whitehead, Oh, & Choudhri, 2013). Pineal cysts are typically benign, asymptomatic and remain stable in size across time (Nevins et al., 2016). In rare cases cysts may enlarge causing headaches, ocular movement abnormalities, secondary parkinsonism, ataxia and obstructive hydrocephalus (Gore, Gonzalez, Rekate, & Nakaji, 2008; Morgan et al., 2008). The pineal gland is a midline neuroendocrine brain structure located immediately above the midbrain and between lobes of the thalamus. It is involved in sleep regulation through secretion of melatonin and may also play a role in pubertal development (Silman, Leone, Hooper, & Preece, 1979). Pineal cysts are circumscribed, fluid-filled lesions with a three layered wall; an outer fibrocollagenous rim, an intermediate pineocyte layer and an inner glial layer (Whitehead et al., 2013). The pineal gland forms early in embryologic development out of a diverticulum of the developing third ventricle. The etiology of pineal cysts is unknown, but several hypotheses exist. In some cases, remnants of the diverticulum form a cavity lined by ependymal cells which may proliferate to form a cyst (Osborn & Preece, 2006). Alternative hypotheses propose, pineal cysts may develop secondary to focal degeneration of the pineal gland (Kahilogullari, Massimi, & Rocco, 2013) due to hemorrhage or necrosis of the pineal gland during fetal development (Laure-Kamionowska, Maślińska, Deregowski, Czichos, & Raczkowska, 2003), or cysts may develop from necrosis or cavitation of pineal gland following the ischemic degeneration (Bregant, Rados, Derganc, Neubauer, & Kostovic, 2011). An increased prevalence of pineal cysts have been associated with some disorders. For example, Gupta et al. (2016) found that 50% of children with familial retinoblastoma had pineal cysts. They hypothesized that cyst development may be a consequence of altered biology induced by the specific gene mutations related to familial retinoblastoma. An investigation of children with cerebral palsy and periventricular leukomalacia demonstrated a 32.3% prevalence of pineal cysts (Ozmen et al., 2015). Besides increased prevalence in some disorders, Gur et al. (2013) found that Caucasians were 195% more likely than African Americans to have a pineal cyst. There is also evidence that pineal cysts are more prevalent in females compared to males (Al-Holou et al., 2009; Sawamura et al., 1995; Sullivan et al., 2016). These examples demonstrate that genetic or hormonal factors may play a role in the pathobiological mechanisms of pineal cysts development. Developmental stuttering is a neurodevelopmental disorder that typically first presents between two and four years of age (Chang, 2014). It is estimated that 75%, or more, of children who begin stuttering will outgrow it within a few years of onset (Yairi & Ambrose, 2013). Consistent with other neurodevelopmental disorders, there is a higher prevalence of stuttering in males compared to females (Bloodstein & Ratner, 2008). Subtle structural and functional differences have been discovered in the brains of adults who stutter (AWS), and more recently in children who stutter, compared to fluent speakers (for reviews see Chang, 2014; Etchell, Civier, Ballard, & Sowman, in press). The most robust findings are related to aberrant white matter tracts in the left hemisphere connecting critical speech motor areas (e.g. superior longitudinal fasciculus, arcuate fasciculus). Chang, Zhu, Choo, and Angstadt (2015) found that these white matter tract deficits exist in children close to the age of stuttering onset and may be part of the neurobiological basis of the disorder. There is evidence that white matter deficits may result from abnormal post-natal myelogenesis (Cykowski, Fox, Ingham, Ingham, & Robin, 2010). The frequently observed increased right hemisphere functional activity during speech tasks in AWS is likely related to compensation for left hemisphere structural deficits (Sowman, Crain, Harrison, & Johnson, 2014). The familial heritability of stuttering and recent linkage and association studies provide support that there is a genetic component involved in the neurodevelopment of stuttering (Frigerio-Domingues & Drayna, 2017). However stuttering is not a simple genetic disorder, and understanding comorbid features (e.g. pineal cysts) may provide information on shared neurodevelopmental processes. While conducting a study of the neural correlates of stuttering

Developmental Stuttering in Children Who Are Hard of Hearing.

Purpose A number of studies with large sample sizes have reported lower prevalence of stuttering in children with significant hearing loss compared to children without hearing loss. This study used a parent questionnaire to investigate the characteristics of stuttering (e.g., incidence, prevalence, and age of onset) in children who are hard of hearing (CHH). Method Three hundred three parents of CHH who participated in the Outcomes of Children With Hearing Loss study (Moeller & Tomblin, 2015) were sent questionnaires asking about their childs history of stuttering. Results One hundred ninety-four parents of CHH responded to the survey. Thirty-three CHH were reported to have stuttered at one point in time (an incidence of 17.01%), and 10 children were still stuttering at the time of survey submission (a prevalence of 5.15%). Compared to estimates in the general population, this sample displayed a significantly higher incidence and prevalence. The age of onset, recovery rate, and other characteristics were similar to hearing children. Conclusions Based on this sample, mild to moderately severe hearing loss does not appear to be a protective factor for stuttering in the preschool years. In fact, the incidence and prevalence of stuttering may be higher in this population compared to the general population. Despite the significant speech and language needs that children with mild to moderately severe hearing loss may have, speech-language pathologists should appropriately prioritize stuttering treatment as they would in the hearing population. Supplemental Material https://doi.org/10.23641/asha.5397154.