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.

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.

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.

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.

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.