Evaluation of an Integrated Fluency and Acceptance and Commitment Therapy Intervention for Adolescents and Adults Who Stutter.

PURPOSE: Developmental stuttering is a complex and multifaceted neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter (AWS). Historically, intervention for AWS has primarily addressed speech fluency, with less focus on the covert psychosocial aspects of the disorder. The purpose of this article is to report on a feasibility trial evaluating a novel integrated intervention that combines traditional stuttering management techniques with Acceptance and Commitment Therapy (ACT) for AWS. METHOD: Twenty-nine AWS participated in the feasibility trial. All participants successfully completed a combined fluency and ACT intervention, titled the fluency and Acceptance and Commitment Therapy for Stuttering (fACTS) Program. As this was a feasibility study, no control group was included. Intervention was administered by two certified practicing speech-language pathologists, over eight 60- to 90-min sessions. RESULTS: Generalized linear mixed modeling was used to determine change from pre- to post-intervention and follow-up. Significant pre- and post-intervention improvements in self-efficacy, psychosocial functioning, and psychological flexibility were observed, along with significant reductions in observable stuttering behaviors (i.e., stuttered speech frequency). Intervention gains for all variables of interest were maintained 3 and 6 months post-intervention. CONCLUSIONS: The fACTS Program was created to be a holistic and flexible intervention to promote self-efficacy beliefs and address stuttering-related psychosocial impacts and speech fluency goals of AWS. Preliminary results indicated positive improvement in all psychosocial outcomes (i.e., self-efficacy, psychosocial impact, and psychological flexibility) and observable speech fluency following completion of the program. Future clinical trials of the fACTS Program with an included control group will further investigate the mechanisms of change for the positive effects observed.

Profiling the Longitudinal Development of Babbling in Infants with Cerebral Palsy: Validation of the Infant Monitor of Vocal Production (IMP) Using the Stark Assessment of Early Vocal Development-Revised (SAEVD-R).

AIM: We compared early vocal development in children "at risk" for cerebral palsy (CP) with typically developing (TD) infants aged 6 to 15 months using the SAEVD-R, investigating potential pre-linguistic markers of communication impairment. Additionally, we sought to examine the agreement between the SAEVD-R and IMP, which uses parent report, in identifying departure from typical vocal development in at-risk infants. METHOD: Utilising a longitudinal cohort study, >10,000 vocalisations of 33 infants (15 at risk for CP and 18 TD) were assessed at 6, 9, 12, and 15 months using the SAEVD-R. Generalised linear mixed models (GLMMs) compared groups, and Spearman correlations explored IMP ceiling scores and SAEVD-R measures. RESULTS: At 6 months, both TD and CP groups reached SAEVD-R vocalisation level 3 (expansion). By 9 months, 51% of TD infants progressed to advanced babbling (levels 4 and 5), while 80% of at-risk infants remained at level 3. At 12 and 15 months, over 90% of TD children advanced, compared to 67% at 12 months and 53% at 15 months for at-risk infants, who stayed at the pre-canonical stage. Strong correlations were found between IMP scores and vocalisation levels at 9 and 12 months. Remaining at the pre-canonical stage at 12 months correlated with delayed vocal development as per IMP scores. INTERPRETATION: TD infants achieved higher SAEVD-R levels than at-risk infants. At 12 months, IMP scores effectively identified infants with speech-like vocalisation difficulties, demonstrating its clinical utility in identifying atypical vocal development in infants at risk for CP.

Improving Text-Independent Forced Alignment to Support Speech-Language Pathologists with Phonetic Transcription.

Problem: Phonetic transcription is crucial in diagnosing speech sound disorders (SSDs) but is susceptible to transcriber experience and perceptual bias. Current forced alignment (FA) tools, which annotate audio files to determine spoken content and its placement, often require manual transcription, limiting their effectiveness. Method: We introduce a novel, text-independent forced alignment model that autonomously recognises individual phonemes and their boundaries, addressing these limitations. Our approach leverages an advanced, pre-trained wav2vec 2.0 model to segment speech into tokens and recognise them automatically. To accurately identify phoneme boundaries, we utilise an unsupervised segmentation tool, UnsupSeg. Labelling of segments employs nearest-neighbour classification with wav2vec 2.0 labels, before connectionist temporal classification (CTC) collapse, determining class labels based on maximum overlap. Additional post-processing, including overfitting cleaning and voice activity detection, is implemented to enhance segmentation. Results: We benchmarked our model against existing methods using the TIMIT dataset for normal speakers and, for the first time, evaluated its performance on the TORGO dataset containing SSD speakers. Our model demonstrated competitive performance, achieving a harmonic mean score of 76.88% on TIMIT and 70.31% on TORGO. Implications: This research presents a significant advancement in the assessment and diagnosis of SSDs, offering a more objective and less biased approach than traditional methods. Our model's effectiveness, particularly with SSD speakers, opens new avenues for research and clinical application in speech pathology.

Chewing skills in two and three year old children: Gender and age comparisons on an adapted version of the test of mastication and swallowing (TOMASS-C).

PURPOSE: Few assessment tools objectively measure chewing skills in the paediatric population. There is a need for assessment tools that use consistent foods so comparisons can be made between typically developing children and children with paediatric feeding disorders, and to measure the efficacy of treatment. The Test of Masticating and Swallowing Solids for adults (TOMASS) and children (TOMASS-C) are assessments that use a cracker as a consistent measure to assess chewing skills. Normative data exist for children over 4 years, however, no data are available for younger children. This study investigated age and gender-related differences in mastication skills in typically developing children aged 2-3 years when eating a cracker. METHOD: Thirty participants aged 2;0-3;10 were assessed using an adapted version of the TOMASS-C. Participants were required to eat a single Arnott's Salada cracker, and the number of bites, masticatory cycles, swallows, and duration of time to finish the cracker were measured. RESULT: Two-year-old children used more masticatory cycles and took longer to finish the cracker than 3-year-old children. There were no significant effects of age on the number of swallows and number of bites, and no significant differences between boys and girls. CONCLUSION: This study provides preliminary normative data for chewing skills in children aged 2 and 3 years and confirms that the TOMASS-C is sensitive to developmental changes in mastication within this younger age range. These results expand our understanding of oral motor and chewing development in children.

Implementation of an Early Communication Intervention for Young Children with Cerebral Palsy Using Single-Subject Research Design.

The implementation of an intervention protocol aimed at increasing vocal complexity in three pre-linguistic children with cerebral palsy (two males, starting age 15 months, and one female, starting age 16 months) was evaluated utilising a repeated ABA case series design. The study progressed until the children were 36 months of age. Weekly probes with trained and untrained items were administered across each of three intervention blocks. Successive blocks targeted more advanced protophone production and speech movement patterns, individualised for each participant. Positive treatment effects were seen for all participants in terms of a greater rate of achievement of target protophone categories and speech movement patterns. Tau coefficients for trained items demonstrated overall moderate to large AB phase contrast effect sizes, with limited evidence of generalisation to untrained items. Control items featuring protophones and speech movements not targeted for intervention showed no change across phases for any participant. Our data suggest that emerging speech-production skills in prelinguistic infants with CP can be positively influenced through a multimodal intervention focused on capitalising on early periods of plasticity when language learning is most sensitive.

An Evaluation of an Integrated Stuttering and Parent-Administered Self-Regulation Program for Early Developmental Stuttering Disorders.

Purpose This study reports findings from a clinical trial that implemented an early stuttering treatment program integrated with evidence-based parenting support (EBPS) to children who stutter (CWS) with concomitant self-regulation challenges manifested in elevated attention-deficit/hyperactivity disorder (eADHD) symptoms and compared those outcomes to CWS receiving stuttering treatment without EBPS. Method Participants were 76 preschool CWS and their parent(s). Thirty-six of these children presented with eADHD and were quasirandomized into two groups: stuttering treatment only (eADHDstandard) or stuttering treatment integrated with EBPS (eADHDintegrated). The remaining children did not meet criteria for eADHD symptoms and received stuttering treatment only (No-eADHDstandard). Pre, post, and 3-month follow-up measures of stuttering treatment outcomes as well as treatment effects on measures of child behavior difficulties and parenting practices were examined. Results Significant reduction in stuttering was found for all groups. However, the eADHDintegrated group showed a greater reduction in stuttering frequency than the eADHDstandard group, and at follow-up, stuttering frequencies in the eADHDintegrated group matched those of children in the No-eADHDstandard group, while stuttering in the eADHDstandard group remained significantly higher. Children with eADHD symptoms who received the integrated program also required significantly less stuttering intervention time than those children with eADHD symptoms who received stuttering treatment only. Families in the eADHDintegrated group reported large and significant improvements in child behavior and parenting practices. Conclusion This study provides support for an early treatment program for CWS. The integrated stuttering and self-regulation management program for CWS with eADHD symptoms proved successful for fluency and behavioral improvements, which were sustained at follow-up.

Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering.

PURPOSE: Recent research has identified approximately half of children who stutter present with self-regulation challenges. These manifest in elevated inattentive and/or impulsive behaviours, aligned with attention deficit hyperactivity disorder (ADHD) symptoms. These symptoms have been found to influence the child's responsiveness to their stuttering treatment, and may exacerbate the psychosocial consequences of stuttering for them and their families. Early stuttering intervention identifies parents as key agents of change in the management of their children's stuttering. This study sought feedback from parents regarding their experiences with an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering, addressing the child's self-regulation challenges. METHOD: Eight parents of children who stutter who had co-occurring self-regulation challenges completed the integrated program. This incorporated the Triple P--Positive Parenting Program adapted for the developmental stuttering population, and the Curtin University Stuttering Program (CUSP). Semi-structured qualitative interviews were conducted to capture parents' reflections on, and experiences with, the integrated program. RESULTS: Thematic analysis identified several major themes regarding the parents' experiences with the integrated program: emotional impact on parents, child self-regulation, link between stuttering and behaviour, parent self-regulation, impact on family dynamics, and overall positive perceptions of the integrated program. All of the parents indicated they would recommend the program to future parents of children who stutter. CONCLUSION: This study provides insights into parents' perceptions regarding an integrated intervention approach for early stuttering and behavior management. It also indicates how adopting a holistic approach to stuttering intervention is positive and has social validity.

Determinants of assessing efficiency within auditory attention networks.

The attention network test (ANT) assesses efficiency across alerting, orienting, and executive components of visual attention. This study examined approaches to assessing auditory attention networks, and performance was compared to the visual ANT. Results showed (1) alerting was sufficiently elicited in a pitch discrimination and sound localization task, although these effects were unrelated, (2) weak orienting of attention was elicited through pitch discrimination, which varied based on ISI and conflict level, but robust orienting of attention was found through sound localization, and (3) executive control was sufficiently assessed in both pitch discrimination and sound localization tasks, but these effects were unrelated. Correlation analysis suggested that, unlike alerting and orienting, sound localization auditory executive control functions tap a shared attention network system. Overall, the results suggest that auditory ANT measures are largely task and modality specific, with sound localization offering potential to assess all three attention networks in a single task.

Elevated attention deficit hyperactivity disorder symptoms in children who stutter.

PURPOSE: This study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken. METHOD: Participants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria). RESULTS: One-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment. CONCLUSION: The large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.

Developmental changes in pharyngeal swallowing acoustics: a comparison of adults and children.

This study examined developmental differences in the acoustics of pharyngeal swallowing. Thirty-one young children (M = 4.5 years) and 29 adults (M = 22.5 years) were recorded swallowing thin liquid and puree boluses. In comparison with adults, children showed longer total swallow sound duration and duration to peak intensity, as well as greater variability in the duration to peak intensity and mean of the averaged spectrum in Hz. Thin and puree boluses differed in measures of duration, intensity and frequency of the averaged sound spectrum, although these effects did not interact with age. The increased variability in swallowing observed in children paralleled that found in acoustic measures of vowel formants, although speech and swallowing acoustic measures were uncorrelated. Using Formant 2 frequency as a proxy measure of vocal tract length, the age differences in swallowing acoustics appear to be independent of physical size, although associations between duration to peak intensity and pharyngeal size warrant further investigation. These findings suggest acoustic measures of swallowing are sensitive to developmental status, possibly reflecting ongoing refinement of the pharyngeal swallow across childhood, and support continued research into the use of digital cervical auscultation as a tool to assess the efficiency and stability of the swallowing neuromuscular control system in children and adults.

Anxiety and speaking in people who stutter: an investigation using the emotional Stroop task.

UNLABELLED: People with anxiety disorders show an attentional bias towards threat or negative emotion words. This exploratory study examined whether people who stutter (PWS), who can be anxious when speaking, show similar bias and whether reactions to threat words also influence speech motor planning and execution. Comparisons were made between 31 PWS and 31 fluent controls in a modified emotional Stroop task where, depending on a visual cue, participants named the colour of threat and neutral words at either a normal or fast articulation rate. In a manual version of the same task participants pressed the corresponding colour button with either a long or short duration. PWS but not controls were slower to respond to threat words than neutral words, however, this emotionality effect was only evident for verbal responding. Emotionality did not interact with speech rate, but the size of the emotionality effect among PWS did correlate with frequency of stuttering. Results suggest PWS show an attentional bias to threat words similar to that found in people with anxiety disorder. In addition, this bias appears to be contingent on engaging the speech production system as a response modality. No evidence was found to indicate that emotional reactivity during the Stroop task constrains or destabilises, perhaps via arousal mechanisms, speech motor adjustment or execution for PWS. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) explain the importance of cognitive aspects of anxiety, such as attentional biases, in the possible cause and/or maintenance of anxiety in people who stutter, (2) explain how the emotional Stroop task can be used as a measure of attentional bias to threat information, and (3) evaluate the findings with respect to the relationship between attentional bias to threat information and speech production in people who stutter.

Early development in infants at risk of childhood apraxia of speech: a longitudinal investigation.

This study examined early features of the heritable phenotype associated with childhood apraxia-of-speech (CAS). We compared speech and language development from 9 to 24 months of age in eight children at familial risk of CAS to that of eight infants with no such family history. At-risk infants scored lower on expressive language, speech development, and fine motor skills. Results support a broad, heritable verbal trait deficit for children at risk of CAS. Single case analyses showed poor prelinguistic speech development can dissociate from emerging receptive language and conceptualization skills, consistent with a deficit originating in speech motor control.

Community-based early intervention for language delay: a preliminary investigation.

BACKGROUND: A trial parent-focused early intervention (PFEI) programme for children with delayed language development is reported in which current research evidence was translated and applied within the constraints of available of clinical resources. The programme, based at a primary school, was run by a speech-language pathologist with speech-language pathology students. AIM: To investigate the changes in child language development and parent and child interactions following attendance at the PFEI. METHODS & PROCEDURES: Eighteen parents and their children attended six, weekly group sessions in which parents were provided with strategies to maximize language learning in everyday contexts. Pre- and post-programme assessments of vocabulary size and measures of parent-child interaction were collected. OUTCOME & RESULTS: Parents and children significantly increased their communicative interactions from pre- to post-treatment. Children's expressive vocabulary size and language skills increased significantly. Large-effect sizes were observed. CONCLUSIONS & IMPLICATIONS: The positive outcomes of the intervention programme contribute to the evidence base of intervention strategies and forms of service delivery for children at risk of language delay.

Prelinguistic communication development in children with childhood apraxia of speech: a retrospective analysis.

In a retrospective study of prelinguistic communication development, clinically referred preschool children (n = 9) aged 3-4 years, who as infants had failed a community-based screening program, were evaluated for features of childhood apraxia of speech (CAS). Four children showed no features and either delayed or normal language, five had from three-to-seven CAS features and all exhibited delayed language. These children were matched by age with 21 children with typically-developing (TD) speech and language skills. Case-control comparisons of retrospective data from 9 months of age for two participants with more severe features of CAS at preschool age showed a dissociated pattern with low expressive quotients on the Receptive-Expressive Emergent Language Assessment-Second Edition (REEL-2) and records of infrequent babbling, but normal receptive quotients. However, other profiles were observed. Two children with milder CAS features showed poor receptive and expressive development similar to other clinically referred children with no CAS features, and one child with severe CAS features showed poor receptive but normal expressive developmental milestones at 9 months and records of frequent babbling. Results suggest some but not all children with features of suspected CAS have a selective deficit originating within speech motor development.

Parenting styles and attachment in school-aged children who stutter.

UNLABELLED: Parental input has been described as influential in early childhood stuttering yet the exact nature of this influence remains equivocal. The present study aimed to examine whether quantitative measures of parenting styles, parent and peer attachment patterns, and parent- and self-reported child behaviour could differentiate between school-aged children who stutter (CWS) (n=10) and their fluent peers (n=10). In addition, qualitative individual semi-structured interviews with all CWS were conducted to gain insight into their life experiences and reflections in relation to stuttering. The interviews were classified into ancillary themes of school, peers and parents. Quantitative findings revealed that CWS perceived their parents with significantly lower attachment, particularly in relation to trust, and parents of CWS perceived their children with significantly higher maladjustments than fluent counterparts. Qualitative themes emerged pertaining to attitudes, perceptions and relationships with teachers, peers and parents, with consistent experiences of teasing and bullying reported as a consequence of the stutter. The majority of participants recounted frustration with the nature in which their parents attempted to remediate their stuttering. Collectively, these findings highlight imperative management considerations for school-aged CWS and their parents. The usefulness of quantitative and qualitative research paradigms is also emphasised. LEARNING OUTCOMES: The reader will be able to: (1) identify themes associated with the impact a childhood stutter has on parent and peer relationships; (2) identify how the quality of the parent child relationship is influenced by parenting styles and attachment; and (3) discuss the clinical implications of the results for children who stutter and their families.

Verbal repetition skill in language impaired children: evidence of inefficient lexical processing?

Speeded verbal repetition of spoken words in simple and primed conditions was used to examine lexical processing deficits in children with specific language impairment (SLI). During simple verbal repetition, children with SLI (n = 18) were slower at repeating abstract verbs compared to concrete verbs. This same effect was not observed for nouns. Age matched typically developing (TD) children (n = 18) showed no effect of concreteness for either verbs or nouns. During primed verbal repetition the children heard prime-target word pairs (e.g., lion-tiger) on each trial. Semantically related primes speeded verbal repetition for the TD but not SLI group, suggesting inefficient spreading activation within lexical semantics for children with SLI. Phonologically related primes (e.g., tiny) slowed verbal repetition of the target (e.g., tiger) in both groups, suggesting children with SLI were similar to their age-matched peers in lexical phonological competition. The results are generally supportive of graded deficits in lexical processing skill in SLI consistent with connectionist accounts, and approaches to therapy that combine semantic and phonological dimensions at the word level.

Speeded verbal responding in adults who stutter: are there deficits in linguistic encoding?

UNLABELLED: Linguistic encoding deficits in people who stutter (PWS, n=18) were investigated using auditory priming during picture naming and word vs. non-word comparisons during choice and simple verbal reaction time (RT) tasks. During picture naming, PWS did not differ significantly from normally fluent speakers (n=18) in the magnitude of inhibition of RT from semantically related primes and the magnitude of facilitation from phonologically related primes. PWS also did not differ from controls in the degree to which words were faster than non-words during choice RT, although PWS were slower overall than controls. Simple RT showed no difference between groups, or between words and non-words, suggesting differences in speech initiation time do not explain the choice RT results. The findings are consistent with PWS not being deficient in the time course of lexical activation and selection, phonological encoding, and phonetic encoding. Potential deficits underlying slow choice RTs outside of linguistic encoding are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to (1) describe possible relationships between linguistic encoding processes and speech motor control difficulties in people who stutter; (2) explain the role of lexical priming tasks during speech production in evaluating the efficiency of linguistic encoding; (3) describe the different levels of processing that may be involved in slow verbal responding by people who stutter, and identify which levels could be involved based on the findings of the present study.

Investigating factors related to the effects of time-out on stuttering in adults.

BACKGROUND: Response-contingent time-out has been shown to be an effective technique for enhancing fluency in people who stutter. However, the factors that determine individual responsiveness to time-out are not well understood. AIMS: The study investigated the effectiveness of using response-contingent time-out to reduce stuttering frequency in adults who stutter. In addition, it investigated the predictive value of participants' stutter severity, age, previous treatment history, and type of stutter on the responsiveness to time-out conditioning. METHODS & PROCEDURES: Sixty people who stutter participated in the study. Half were exposed to time-out following each moment of stuttering over a 40-min period, the remaining participants acted as controls. OUTCOMES & RESULTS: Results showed that individuals who stutter are highly responsive to time-out, and that the participants with a more severe stutter responded better than those with a mild stutter. To a lesser degree, previous treatment and speech rate also influenced treatment success. Age and type of stutter did not, although the proportion of repetition types of stutters increased over the experiment conditions, with prolongations and blocks decreasing, for the treatment group. CONCLUSIONS: This simple operant conditioning treatment method is effective in reducing stuttering. Individuals respond to time-out regardless of their age, type of stutter, stuttering severity or treatment history, thus it is a treatment methodology potentially suitable for all clients. This study investigated initial responsiveness to time-out; therefore, further research is necessary to determine the durability of fluency over time.

Social anxiety and the severity and typography of stuttering in adolescents.

UNLABELLED: The present study examined the relationship between anxiety, attitude toward daily communication, and stuttering symptomatology in adolescent stuttering. Adolescents who stuttered (n=19) showed significantly higher levels of trait, state and social anxiety than fluent speaking controls (n=18). Trait and state anxiety was significantly associated with difficulty with communication in daily situations for adolescents who stutter, but not for controls. No statistically significant associations were found between anxiety and measures of communication difficulty, and the severity or typography of stuttering surface behaviours. These results highlight some of the psychosocial concomitants of chronic stuttering in adolescence, but challenge the notion that anxiety plays a direct mediating role in stuttering surface behaviours. Rather, the results suggest stuttering is a disorder that features psychosocial conflict regardless of its surface features. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarise findings from previous studies with regards to stuttering and anxiety; (2) identify the sub-types of anxiety that may impact on the individual who stutters; and (3) discuss the clinical implications of the results with regards to working with adolescents who stutter.

Facilitating use of speech recognition software for people with disabilities: a comparison of three treatments.

This study examined the relative benefit of three interventions (i.e. physiological, behavioural, and pragmatic) designed to facilitate speech recognition software use. Participants were 15 adults with dysarthria associated with a variety of aetiological conditions, including cerebral palsy, Parkinson's disease, and motor neuron disease. Results suggested no clear dysarthric profile that would preclude at least some degree of speech recognition system use. Participants demonstrated systematic improvement in their dictation rates regardless of treatment order. The physiological treatment produced significantly higher dictation rates overall than the behavioural--but not the pragmatic--treatment. This finding suggests that improvement was not simply a function of software training, at least for the physiological treatment. This conclusion also was supported by changes in the participants' speech production during a post-treatment assessment.