Stuttering and Autism Spectrum Disorders: Assessment and Treatment.

Dual diagnoses of autism spectrum disorders (ASDs) and stuttering have been reported in the literature, but little is known about how often they co-occur, the best practices for assessment, and even less about intervention. In this article, we gathered the data available on these issues and compiled and analyzed the sparse findings to offer suggestions for assessment and treatment. This article begins with a glossary of terms to promote consistency and understanding. Next, suggestions for assessment are provided along with a work sheet to document fluency breakdowns and monitor change. Suggestions for language and cognitive issues are also provided with a sample worksheet. Finally, an outline and explanation of stuttering/fluency goals for clients with these dual diagnoses are included. Case studies of two individuals who stutter and are diagnosed with ASD are presented to provide exemplars of how to assess and treat individuals with these dual diagnoses. Caveats on how to work with individuals with ASD and fluency disorders, based on our current understanding, are presented in the conclusion.

The sociolinguistics of lisping: a review.

This article presents a review of the lisping research literature with the aim of providing a framework for the consideration of the sociolinguistics of lisping. We consider, in turn, the nature of lisping, the construction of identity through speech, the nature of stigma, and, in particular, stigma associated with communication disorders and especially lisping. Further, we examine two aspects of the literature on lisping in more detail: lisping as minor bodily stigma and lisping and the internet. We conclude that experiential research on identity construction at the level of the individual, and stigma theory at a collective speech community level, support the case for viewing the sociolinguistics of lisping as a legitimate field of study and establishing a framework for acknowledgment of and further investigation into the self-identified adult who lisps.

Preliminary study of disfluency in school-aged children with autism.

BACKGROUND: In recent years, there has been increased identification of disfluencies in individuals with autism, but limited examination of disfluencies in the school-age range of this population. We currently lack information about whether the disfluencies of children with autism represent concomitant stuttering, normal disfluency, excessive normal disfluency, or some form of disfluency unique to the school-age population of children with autism. AIMS: This paper explores the nature of disfluencies in school-aged children with autism in comparison with matched children who stutter and controls. It explores stuttering-like disfluencies, non-stuttering-like disfluencies and word-final disfluencies. METHODS & PROCEDURES: This study compared disfluency patterns in 11 school-aged children with Asperger's syndrome (AS), 11 matched children who stutter (CWS), and 11 matched children with no diagnosis (ND). Analyses were based on speech samples collected during an expository discourse task. OUTCOMES & RESULTS: Results reveal statistically significant differences between children with AS and CWS and between children with AS and those with ND for the percentage of words containing stuttering-like disfluencies. In the AS group, four out of 11 (36%) met the common diagnostic criteria for a fluency disorder. Disfluencies in the AS group differed qualitatively and quantitatively from the CWS, and included a larger distribution of word-final disfluencies. CONCLUSIONS & IMPLICATIONS: This study provides initial data regarding patterns of disfluency in school-aged children with AS that, with careful consideration and the cautious application of all findings, can assist therapists in making more evidence-based diagnostic decisions. Findings offer evidence that when working with children with AS, disfluencies both similar and dissimilar to those of CWS may be identified in at least a subset of those with AS. Therefore, children with AS should be screened for fluency disorders during their initial evaluation and treated if it is determined that the fluency disorder negatively impacts the effectiveness of communication.

Looking at gesture: The reciprocal influence between gesture and conversation.

INTRODUCTION: There is limited research in group communication treatment for people with aphasia but existing studies report benefits of gesture to support conversation. Gesture supports conversation through recipient design features and reducing linguistic demands of lexical retrieval and formulation. Additionally, gesture serves an affiliative function. However, the relationship between gesture use and gestural capacity has not been widely examined. As part of a larger study on group cohesiveness and conversation, this investigation examined the patterns of co-speech gesture within authentic conversations among persons with aphasia to discern the functions of gesture use for the participants, changes in the use of gesture over time, and the relationship between gesture use and gesture ability. METHODS: Conversation Analysis (CA) was applied in an embedded case-study design. Three participants received an academic semester of group and individual conversation-based treatment according to Facilitating Authentic Conversation (Damico et al., 2015). Four conversations from the treatment were selected and transcribed for multi-modality communication with CA conventions applied, and then cyclically analysed for patterns of gesture. RESULTS: Participants demonstrated gesture that served social and linguistic functions: ratifying clinicians' proxy turns, turn-allocation, turn repair, relaying novel visual information, emphasizing content, demonstrating affiliation with the prior speaker, demonstrating their assessment others' talk, and demonstrating humor. All three participants showed an increased rate of gesture per turn and increasingly used gesture to repair conversation breakdown. Increased gesture use over the course of the semester coincided with increased scores for pantomime on the Porch Index of Communicative Ability (Porch, 1981, PICA). CONCLUSION: Individuals with aphasia demonstrated increased use of gesture for varied purposes and improved gestural processing following a semester of conversation-based treatment. This is significant because gesture is an effective support for the repair of conversation breakdown typical of persons with aphasia.

Listener perceptions of stuttering and stuttering modification techniques.

PURPOSE: The purpose of this study was to analyse naïve listener perceptions of speech containing unmodified stuttering, use of the pull-out technique, and use of preparatory-sets. METHOD: Participants (N = 62) were randomly assigned to listen to one audio sample (unmodified stuttered speech, speech with pull-outs, or speech with preparatory-sets) and completed a survey assessing perceptions of the speaker's speech and personality and the listener's comfort level and willingness to social interact with the speaker. RESULTS: Survey results revealed low perceptual ratings in all experimental conditions. Unmodified stuttered speech received significantly more positive ratings than the stuttering modification conditions in all measurements except for speech naturalness. Listeners reported being less willing to socially interact with those who use preparatory-sets than unmodified stuttered speech. CONCLUSION: The use of stuttering modification techniques did not improve listeners' perceptions or willingness to interact with persons who stutter. Clinicians and those who stutter should be aware that the use of speech techniques will not decrease negative social interactions or stereotypes.

Stuttering experience of people in China: A cross-cultural perspective.

PURPOSE: This study uses the Simplified Chinese version of the Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A-SC) to examine the stuttering experience of people in China and determine if there are differences between the data collected in China and other countries. METHODS: A total of 139 responses to the OASES-A-SC were collected in an online self-help community of people in China who stutter. Descriptive analyses were conducted to obtain the understanding of how stuttering impacts the life experience of people in China who stutter. Comparisons were conducted regarding the groups of gender, highest education, and therapy history. Cross-cultural comparisons among the data collected from China, Australia, the Netherlands, Japan, Sweden, and the USA were also conducted. RESULTS: The data for the OASES-A-SC showed a skewed distribution toward the severe end of the OASES-A impacting scale. About 93.5% participants rated the overall impact of stuttering on their life at and above the "Moderate" category. The mean scores of the General Information, Reaction to Stuttering, and Qualify of Life sections fell in the moderate-to-severe category. Compared with the data in other five countries, the Chinese data were significantly higher in the impact severity level. CONCLUSION: The results showed that people in China who stutter have more adverse experiences related to stuttering compared with their counterparts in western or developed countries. Higher negative attitudes toward stuttering in China, social stigma against people with disabilities, and the fewer professional supports were discussed to be associated with this more adverse experience. Cultural differences such as a greater power distance and higher collectivism in Chinese culture were considered to be associated with the elevated level of adverse impact of stuttering in China.

Patterns of Conversation Trouble Source and Repair as Indices of Improved Conversation in Aphasia: A Multiple-Case Study Using Conversation Analysis.

Purpose Social approaches to intervention for aphasia are being increasingly employed to address the functional communication barriers experienced by persons with aphasia. One specific approach is the use of conversation-based treatment in both group and two-person dyads. Although there are several methods to measure improvement for stimulation and cognitive neurolinguistic approaches, researchers have consistently indicated a need for outcome measures that can objectively demonstrate improved communication following conversation treatment. This study aims to demonstrate the utility for examining the patterns of conversation trouble source and repair as indices for improved communication as a positive response to intervention. Method The conversations of 20 consecutive participants, before and after 3 months, or 40 hr, of group and individual conversation-based treatment, were transcribed using conventions of conversation analysis, and sociolinguistic discourse analysis was applied. Measures of trouble source and repair were aggregated and subjected to statistical analysis. Results Persons with aphasia demonstrated statistically significant improvement in patterns of conversation trouble source and repair posttreatment for the rate of conversation trouble source and the length of repair. However, measures of self-initiation and self-completion of repair did not reach significance. Conclusion The study indicates that, following conversation-based treatment, the conversations of persons with aphasias were more efficient, experiencing fewer trouble sources and shorter repair sequences. These findings suggest that measures of conversation for the rate of trouble source and length of the repair sequence are valid indices of improved conversation.

Fluency disorders in genetic syndromes.

UNLABELLED: The characteristics of various genetic syndromes have included "stuttering" as a primary symptom associated with that syndrome. Specifically, Down syndrome, fragile X syndrome, Prader-Willi syndrome, Tourette syndrome, Neurofibromatosis type I, and Turner syndrome all list "stuttering" as a characteristic of that syndrome. An extensive review of these syndromes indicated clients diagnosed with these syndromes do show evidence of nonfluency patterns, but not all would be considered stuttering. Many of the syndromes are marked by degrees of mental retardation that probably contribute to a higher than average prevalence of stuttering, as well as a higher than average prevalence of other fluency disorders (when compared to the population at large). An in-depth analysis of the available data indicates that some of these genetic syndromes show patterns of stuttering that may be indicative of only that syndrome (or similar syndromes) that can be differentially diagnosed from developmental stuttering. Among these patterns are the word-final nonfluencies noted in Prader-Willi syndrome; the presence of stuttering in the absence of secondary behaviors noted in Prader-Willi syndrome and; the presence of palilalia, word-final and word-medial nonfluencies, and word-medial and word-final nonfluencies in Tourette syndrome. Implications for future research are discussed in light of these findings. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the various different genetic syndromes that are associated with fluency disorders; (2) describe the types of nonfluencies that are associated with the major types of genetic syndromes that have fluency disorders; (3) describe the behaviors that may assist in differentially diagnosing different types of speech characteristics associated with various genetic syndromes.

Self-acceptance of stuttering: A preliminary study.

PURPOSE: This study explored the relationship between self-acceptance of stuttering and (1) psychosocial factors (self-esteem, hostility towards others, emotional support, and perceived discrimination); (2) treatment history (support group participation, therapy duration, and perceived therapy success); and (3) previously reported variables in self-acceptance of stuttering, which include age and stuttering severity. METHOD: Participants were 80 adults who stutter who were recruited with assistance from the National Stuttering Association and Board Certified Specialists in Fluency Disorders. Participants completed an electronic survey composed of an acceptance of stuttering scale, psychosocial scales, and a participant information questionnaire. RESULTS: Statistical analysis identified significant correlations between participants' reports of self-acceptance of stuttering and self-esteem, perceived discrimination, hostility towards others, and perceived therapy outcome. Self-esteem was positively correlated with self-acceptance, while hostility towards others and perceived discrimination was negatively correlated with self-acceptance. Participants who perceived their therapy outcome to be successful were significantly more likely to report higher levels of self-acceptance. No significant relationships were found between self-acceptance of stuttering and support group participation, emotional support, stuttering severity, and participant age. CONCLUSION: This exploratory investigation has provided a foundation for future studies on the self-acceptance of stuttering. The findings indicate common psychosocial variables in self-acceptance of stuttering and of other disabilities. The significant relationships between self-acceptance of stuttering and psychosocial and therapeutic variables found need to be further explored to identify its causalities and clinical implications. LEARNING OUTCOMES: The reader will be able to (1) discuss the importance of assessing self-acceptance of stuttering, (2) summarize the literature on self-acceptance of disability, and (3) describe the significant findings related to self-acceptance of stuttering and psychosocial, therapeutic variables.

Qualitative research: implications for description and assessment.

As clinical speech-language pathologists seeking different ways to understand the complexity of communication within naturalistic and social contexts, we are progressively adapting the qualitative research methods of the social sciences for our assessment purposes. This article discusses some basic principles and practices discussed previously in this forum on qualitative research and demonstrates how they can be employed to provide effective and sufficient clinical communicative assessment.

Overcoming unintelligibility in aphasia: the impact of non-verbal interactive strategies.

As a follow-up to previous research, this report focuses on the wide range of gestures employed by an individual with aphasia to overcome instances of unintelligibility and re-establish intelligibility. The gestures observed are woven seamlessly into the fabric of the interactions and range from deictic to metaphorical or symbolic in nature. Specific examples are provided.

Attention deficit hyperactivity disorder and concomitant communicative disorders.

The relationship between attention deficit hyperactivity disorder (ADHD) and communication disorders is complex and often misunderstood. Misunderstandings arise in part because of definitions and diagnostic categorizations that change over the years and because of overlapping symptoms between diagnostic categories. In addition, many of the symptoms that are necessary for the diagnosis of ADHD are prerequisite skills required to perform well on standardized language tests. Consequently, it is difficult to know the exact prevalence of ADHD and concomitant communicative disorders, especially language disorders. Several hypotheses are developed that indicate why the differential diagnosis is so difficult.

The clinical analysis layer of transcription.

The clinical analysis layer of transcription is part of a 'toolkit' approach for detailed analysis of communication samples. This article provides a rationale for using the clinical analysis strategy and is supported by several examples of how a clinical analysis layer can add to the understanding of communication errors or other clinical areas of interest. The examples used in this paper are drawn from the areas of stuttering and aural rehabilitation and demonstrate the utility of this clinical analysis layer of transcription.

Emerging issues and trends in attention deficit hyperactivity disorder: an update for the speech-language pathologist.

There are many trends in the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) that have emerged over the past several years. The first of these emerging trends is the growing prevalence of ADHD diagnoses across age groups and cultures. Although the causes of this growing prevalence are unclear, several suggestions, including a broader definition of ADHD, are discussed as potential contributions. A second emerging issue is related to the underlying theory of ADHD. Barkley's biopsychosocial model of ADHD is briefly discussed as a prototype model to help in the understanding of ADHD. Finally, the growing trend in pharmacological treatment of ADHD is discussed. Stimulant medications, as well as a recent nonstimulant medication are discussed and compared with nonpharmacological alternatives.