Robert W. Quesal

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.

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.

Stutterers and others: A comparison of communication attitudes

Abstract The Erickson 39-item S-scale was administered to 24 persons who stutter, 24 persons with voice or articulation disorders, and 24 normal speakers. The purpose of the study was to determine if the three populations differed in communication attitude. The one-way analysis of variance showed that the three groups differed significantly. Normal speakers revealed the most desirable communication attitude; the communication attitude of the voice and articulation disorders population was less favorable than normals; the communication attitude of the stuttering population was least favorable.

A preliminary investigation of daily variability of stuttering in adults.

PURPOSE Variability in frequency of stuttering has made the results of treatment outcome studies difficult to interpret. Many factors that affect variability have been investigated; yet the typical range of variability experienced by speakers remains unknown. This study examined the day-to-day variability in the percentage of syllables containing stuttered and nonstuttered disfluencies in the speech of six adult speakers in three spontaneous speaking situations and two reading tasks. METHODS The frequency of moments stuttering during the tasks were compared within and between speakers and days to document the degree of variability in stuttering frequency and explore whether there were any consistent patterns. The Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speakers Experience of Stuttering for Adults (OASES-A) were also tested for day-to-day variability. Correlations between frequency, severity, and life impact were made. RESULTS The primary result of this study was the large range over which frequency of stuttering varied from day to day for the same individual. This variability did not correlate with any measures of stuttering severity but did correlate with life impact as measured by the OASES-A. No global pattern was detected in variability from day to day within or between participants. However, there were significantly more nonstuttered disfluencies present during the spontaneous speaking tasks than during the reading tasks. The day-to-day variability in the life impact of the disorder (OASES-A) was less than the day-to-day variability in observable stuttering behavior (percentage of syllables stuttered and SSI-4). CONCLUSION Frequency of stuttering varies significantly from situation to situation and day to day, with observed variability exceeding the degree of change often reported in treatment outcomes studies from before to after treatment. This variability must be accounted for in future clinical and scientific work.

The impact of stuttering on quality of life of children and adolescents

BACKGROUND Understanding the experience of people who stutter, both in and out treatment, will lead to improved outcomes. AIM To investigate how stuttering affects the quality of life of children and adolescents who stutter. METHOD The Overall Assessment of the Speakers Experience of Stuttering--School-Age (OASES-S) was used to assess the impact of stuttering and the Fluency Profile Protocol was used to stuttering severity. RESULTS These age groups do experience moderate negative impact as measured by the OASES-S. The results showed a tendency toward a positive correlation between severity and the impact of stuttering on quality of life. CONCLUSION A better understanding of the impact of stuttering in these age groups provides a needed guide for the development of stuttering treatments and treatment outcomes research.

Crystal Ball Gazing: Research and Clinical Work in Fluency Disorders in 2026.

In this article, the authors (with the assistance of colleagues from whom they solicited comments), provide a forward-looking perspective on research and clinical work in fluency disorders in the next 10-15 years. Issues discussed include neurology, genetics, early intervention, and clinical training in stuttering.