Adaptation and Validation of Overall Assessment of the Speaker's Experience of Stuttering for Adults in Kannada (OASES-A-K).

INTRODUCTION: Psychosocial aspects of stuttering may affect the quality of life of a person who stutters (PWS). Further, the social stigma and experiences of PWS may vary globally. The WHO-ICF guidelines recommend quality of life as an essential component in the assessment of individuals who stutter. However, the availability of linguistically and culturally appropriate tools is often a challenge. Thus, the current study adapted and validated the OASES-A for Kannada-speaking adults who stutter. METHOD: The original English version of OASES-A was adapted to Kannada using a standard reverse translation process. The adapted version was administered on 51 Kannada-speaking adults with very mild to very severe stuttering. The data were analyzed for item characteristics, reliability, and validity assessment. RESULTS: The results revealed floor and ceiling effects for six and two items, respectively. The mean overall impact score indicated a moderate impact of stuttering. Further, the impact score for section II was relatively higher when compared to the data from other countries. The reliability and validity analyses showed good internal consistency and test-retest reliability for OASES-A-K. CONCLUSION: The findings of the current research suggest that OASES-A-K is a sensitive and reliable tool to assess the impact of stuttering in Kannada-speaking PWS. The findings also highlight cross-cultural differences and the need for research in this direction.

Linguistic disfluencies in Russian-speaking typically and atypically developing children: individual variability in different contexts.

Disfluency in children and adults seems to occur like errors of speech but, at the same time, is an essential feature of spontaneous (unprepared) speech. The present study aimed to evaluate linguistic disfluencies in typically and atypically developing Russian-speaking children from the perspective of the dynamic adaptive model of self-monitoring in speech production. The study collected four language samples from 10 six-year-old children with developmental language disorder and 14 typically developing peers: two storytelling tasks, structured conversation, and a play argument. After transcribing audio-recordings and marking linguistic disfluencies, the authors conducted structured distributional analysis. The distribution of several indexes of disfluency was estimated to assess the prevalence and profiles of different (sub)types of disfluencies. The disfluency rate statistics were similar between the typically developing children and children with developmental language disorder. The distributional indexes score showed that tasks significantly impacted the rate of different (sub)types of disfluencies. Task-related patterns in a set of the distributional indexes significantly distinguished the groups. Thus, changes in the disfluency profile related to different external factors, as a sign of a flexibility of an adaptive self-monitoring system, may be limited in children with developmental language disorder.

Social anxiety disorder in adolescents who stutter: A risk for school refusal.

BACKGROUND: Stuttering is a childhood-onset fluency disorder. Part of the counseling for middle and high school students with persistent stuttering is related to school refusal. Anxiety disorders are known to contribute to school refusal. However, it is not known whether social anxiety disorder (SAD) is a factor in school refusal among adolescents who stutter. METHODS: In our first study, we examined the relationship between school refusal and SAD in 84 middle and high school students who stutter; 26% of the 84 students were in the school refusal group and the remaining 74% were in the school attendance group. The second study examined whether SAD was associated with 10 factors related to speech and stuttering frequency using the Japanese version of the Liebowitz Social Anxiety Scale for Children and Adolescents to determine the presence of SAD. Of the 84 students in the first study, 40 participated in the second study. RESULTS: The school refusal group of adolescents who stutter had significantly higher rates of SAD than the school attendance group. Fifty percent of adolescents who stutter met the criteria for SAD. Moreover, adolescents who stutter with SAD had significantly higher scores on the items "When speaking in public, do you experience tremors in your limbs?" and "After you stutter, do you have negative thoughts about yourself?" than the adolescents who stutter without SAD. CONCLUSIONS: When examining adolescents who stutter, checking for comorbid SAD may lead to better support. Moreover, noticing their repetitive negative thinking, nervousness, and trembling during speech may help to resolve SAD.

Reduced duration of stuttering-like disfluencies and consistent anticipatory slowing during an adaptation task.

PURPOSE: The adaptation effect in stuttering, traditionally described as the reduction of stuttering moments over repeated readings, provides a context to investigate fluency facilitation as well as a relatively controlled means of comparing fluent speech in the immediate vicinity of words that were stuttered versus fluently produced. Acoustic studies have documented decreased duration of fluent speech during adaptation but rarely address changes in disfluencies or the speech preceding or following the disfluencies. This study addresses this gap in the research by documenting frequency and duration changes in both fluent and stuttered syllables. METHOD: Fifteen people who stutter read passages aloud five times in succession. Frequency and duration of fluent syllables, pauses, stuttering-like disfluencies (SLDs) and other disfluencies (ODs) were compared across the five readings. In addition, durations for syllables before and after pauses and SLDs were compared to determine if there were anticipation or carryover effects of SLDs on surrounding syllables. RESULTS: Durations measured for more than 22 000 fluent syllables, 1531 pauses, 128 ODs and 1752 SLDs. For most of the 15 participants, significant decreases in both frequency and duration of SLDs over the five readings were observed. In addition, lengthening of fluent syllables immediately preceding the disfluent syllables was observed: this pre-SLD lengthening did not change over the five readings. CONCLUSIONS: Decreased duration of SLDs across readings supports the motor practice hypothesis, which assumes that successive reading of the same text increases the efficiency of the speech motor plans resulting in less stuttering and decreased durations of the stuttering that persists. Pre-SLD lengthening merits further study, because it informs our knowledge of the time course of stuttered events and may be associated with conscious or unconscious anticipation of upcoming SLDs that does not decrease with motor practice. WHAT THIS PAPER ADDS: What is already known on this subject The frequency of stuttering-like disfluencies (SLDs) can be reduced using a variety of fluency-enhancing strategies. For example, the adaptation effect, in which a reduction of stuttered events occurs over repeated readings of the same material, has been widely studied. Previous studies have shown that durations of fluent syllables decrease during adaptation, supporting the hypothesis that repeated practice of the motor plan leads to increased fluency. However, temporal changes in disfluent syllables and syllables preceding and following SLDs have rarely been studied, so our understanding of the effect of motor practice on stuttering reduction is incomplete. What this study adds This study has two significant findings. First, stuttered disfluencies that persisted after the initial reading of the adaptation task tended to become shorter in duration. Fluently produced syllables and those that were stuttered, both of which are speech events related to motor control of articulators, were affected in a similar manner by the motor practice associated with adaptation. Second, lengthening of fluent syllables immediately preceding stuttered syllables was observed. This pre-stuttering lengthening, however, did not decrease in duration over the five readings: the mechanism that drives this anticipatory behaviour is not affected by repeated practice. What are the clinical implications of this work? People who stutter have neural differences that lead to speech motor planning and/or execution that is less efficient than that of typical speakers. The finding that stuttering is reduced and that persisting SLDs become shorter in duration over repeated readings provides evidence that motor practice can influence the manifestation of stuttering by temporarily making those specific motor plans more efficient. This may inform treatments for stuttering. The observation that fluent syllables immediately before SLDs were lengthened, and that this lengthening was not influenced by repeated practice, extends our understanding of the time course of stuttering events and may be useful in understanding anticipation and listener reactions to stuttering.

The reliability of simultaneous versus individual data collection during stuttering assessment.

BACKGROUND: Speech-language pathologists often multitask in order to be efficient with their commonly large caseloads. In stuttering assessment, multitasking often involves collecting multiple measures simultaneously. AIMS: The present study sought to determine reliability when collecting multiple measures simultaneously versus individually. METHODS & PROCEDURES: Over two time periods, 50 graduate students viewed videos of four persons who stutter (PWS) and counted the number of stuttered syllables and total number of syllables uttered, and rated speech naturalness. Students were randomly assigned to one of two groups: the simultaneous group, in which all measures were gathered during one viewing; and the individual group, in which one measure was gathered per viewing. Relative and absolute intra- and inter-rater reliability values were calculated for each measure. OUTCOMES & RESULTS: The following results were notable: better intra-rater relative reliability for the number of stuttered syllables for the individual group (intraclass correlation coefficient (ICC) = 0.839) compared with the simultaneous group (ICC = 0.350), smaller intra-rater standard error of measurement (SEM) (i.e., better absolute reliability) for the number of stuttered syllables for the individual group (7.40) versus the simultaneous group (15.67), and better inter-rater absolute reliability for the total number of syllables for the individual group (88.29) compared with the simultaneous group (125.05). Absolute reliability was unacceptable for all measures across both groups. CONCLUSIONS & IMPLICATIONS: These findings show that judges are likely to be more reliable when identifying stuttered syllables in isolation than when simultaneously collecting them with total syllables spoken and naturalness data. Results are discussed in terms of narrowing the reliability gap between data collection methods for stuttered syllables, improving overall reliability of stuttering measurements, and a procedural change when implementing widely used stuttering assessment protocols. WHAT THIS PAPER ADDS: What is already known on the subject The reliability of stuttering judgments has been found to be unacceptable across a number of studies, including those examining the reliability of the most popular stuttering assessment tool, the Stuttering Severity Instrument (4th edition). The SSI-4, and other assessment applications, involve collecting multiple measures simultaneously. It has been suggested, but not examined, that collecting measures simultaneously, which occurs in the most popular stuttering assessment protocols, may result in substantially inferior reliability when compared to collecting measures individually. What this paper adds to existing knowledge The present study has multiple novel findings. First, relative and absolute intra-rater reliability were substantially better when stuttered syllables data were collected individually compared to when the same data were collected simultaneously with total number of syllables and speech naturalness data. Second, inter-rater absolute reliability for total number of syllables was also substantially better when collected individually. Third, intra-rater and inter-rater reliability were similar when speech naturalness ratings were given individually compared to when they were given while simultaneously counting stuttered and fluent syllables. What are the potential or actual clinical implications of this work? Clinicians can be more reliable when identifying stuttered syllables individually compared to when they judge stuttering along with other clinical measures of stuttering. In addition, when clinicians and researchers use current popular protocols for assessing stuttering that recommend simultaneous data collection, including the SSI-4, they should instead consider collecting stuttering event counts individually. This procedural change will lead to more reliable data and stronger clinical decision making.

There is more to cluttering than meets the eye: The prevalence of cluttering and association with psychological well-being indices in an undergraduate sample.

BACKGROUND: Cluttering is a fluency disorder characterized by an abnormally fast or irregular speech delivery rate along with disfluencies that are frequent but are not judged to be stuttering. Data on cluttering prevalence in the general population are scarce, as well as its association with psychological well-being indices, such as anxiety, and depressive symptoms. AIMS: To estimate cluttering prevalence among undergraduates, as well as its relationship with psychological and well-being indicators. METHODS & PROCEDURES: To address these issues, a large sample (n = 1582) of undergraduates completed a questionnaire that provided a lay definition of cluttering and were asked to identify themselves as clutterers (SI-Clut), as well as to indicate the presence of several psychological and mental well-being indices. OUTCOMES & RESULTS: A total of 276 respondents (23%) self-identified as clutterers (now or in the past), with 55.1% of those being male. Only 56 respondents (3.5% of the total sample; about 21% of SI-Clut) reported having received speech therapy for cluttering. Relative to students self-identifying as non-clutterers, self-identification of cluttering was associated with higher levels of psychosomatic symptoms, depressive symptoms and stress, indicating a tendency toward internalizing psychopathology, along with lower self-esteem, and lower subjective happiness. CONCLUSIONS & IMPLICATIONS: The current findings point to the high prevalence of students self-identifying as clutterers, along with a significant link between cluttering and mental distress. Therefore, it is important to increase public awareness of cluttering, its diagnosis and treatment. From the clinical perspective, the elevated levels of somatic complaints, anxiety and depression may represent internalizing psychopathology, associated with more covert rather than overt symptomatology. Such symptom manifestation calls for special attention from the speech-language pathologists providing cluttering therapy, using designated well-being or mental health screening tools. Although data on standard cluttering treatment are limited, it should be customized to the client's unique difficulties. Speech-language pathologists' understanding of cluttering, which includes both speech characteristics as well as psychological and social aspects of well-being, may assist them in implementing effective treatments. WHAT THIS PAPER ADDS: What is already known on the subject Cluttering is a fluency disorder characterized by an abnormally fast or irregular speech rate, along with various disfluencies and articulatory imprecision. It may co-occur with other disorders, such as learning disabilities, and attention-deficit/hyperactivity disorder. Data on cluttering prevalence and its association with psychological well-being indices, such as anxiety and depression, are limited. What this paper adds to existing knowledge A total of 276 undergraduates (23%) self-identified as clutterers, of whom 55.1% were males. A total of 56 respondents (3.5% of the total sample, and about 21% of undergraduates self-identified as clutterers) reported having received speech therapy for cluttering. Psychosomatic symptoms, depressive symptoms and stress levels were higher among these students, suggesting a tendency toward internalizing psychopathology, along with a lower sense of self-esteem and subjective happiness. What are the potential or actual clinical implications of this work? The high prevalence of students self-identifying as clutterers, along with the low percentage of respondents who received speech therapy for cluttering, emphasize the need to raise public awareness of the problem, its diagnosis and treatment (Reichel et al., 2010). The association between cluttering and mental distress requires speech-language pathologists to be aware that cluttering may have covert symptomatology, similar to stuttering, which should be addressed in therapy.

Lidcombe Program translation to community clinics in Australia and England.

BACKGROUND: Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it. AIMS: This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England. METHODS & PROCEDURES: Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift. OUTCOMES & RESULTS: Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials. CONCLUSIONS & IMPLICATIONS: Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined. WHAT THIS PAPER ADDS: What is already known on the subject The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work? Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice.

Psychosocial features of stuttering for school-age children: A systematic review.

BACKGROUND: Contemporary clinical and empirical perspectives indicate that management of the psychosocial features of stuttering is fundamental for effective treatment. Interventions that improve psychosocial outcomes for school-age children who stutter are, therefore, needed. AIMS: This systematic review identifies what psychosocial outcomes have been explored in existing school-age clinical research, the measures used and the potential treatment effects. This will provide guidance for developing interventions that reflect contemporary perspectives of stuttering management. METHODS & PROCEDURES: A total of 14 databases and three conference proceedings were searched for clinical reports of psychosocial outcomes of children aged 6-12 years. The review did not include pharmacological interventions. Psychosocial measures and outcomes were analysed in each study based on data recorded pre-treatment, immediately post-treatment and for any follow-up assessments. MAIN CONTRIBUTIONS: Of the 4051 studies identified from the databases, a total of 22 studies met criteria for inclusion in the review. From these 22 studies, the review identified four prominent psychosocial domains that have been explored in school-age clinical research to date: Impact of stuttering, communication attitude, anxiety and speech satisfaction. These domains vary in measurement and effect sizes. Two behavioural treatments were associated with anxiety reduction, even though they did not contain anxiolytic procedures. No evidence of potential treatment effects emerged for communication attitudes. Quality of life-an important psychosocial domain pertinent to health economics-did not feature in school-age clinical reports. CONCLUSIONS & IMPLICATIONS: The psychosocial features of stuttering need to be managed during the school years. Three psychosocial domains-impact of stuttering, anxiety and speech satisfaction-show evidence of potential treatment effects. This review provides direction for future clinical research so that speech-language pathologists can effectively and holistically manage school-age children who stutter. WHAT THIS PAPER ADDS: What is already known on the subject Elevated levels of anxiety are apparent for children and adolescents who stutter. Therefore, the need to assess and manage psychosocial features of stuttering are expertly regarded as clinical priorities. Clinical trials of such psychosocial features of stuttering for children aged 6-12 years are not well advanced and, therefore, do not reflect current best practice management of this disorder. What this study adds to existing knowledge This systematic review identifies four different psychosocial domains measured and reported in the literature for school-age stuttering management. For three psychosocial domains, some evidence of potential treatment effects emerged with participant numbers greater than 10: Impact of stuttering, anxiety and speech satisfaction. Though treatment effect sizes varied, there is a suggestion that cognitive behaviour therapy can improve anxiety of school-age children who stutter. There is also suggestion that two other behavioural treatments can improve anxiety of school-age children who stutter. What are the potential or actual clinical implications of this work? Given the essential need for school-age children who stutter to receive management of any speech-related anxiety they may experience, it would be productive to discover in future clinical research what interventions could contribute to that goal-behavioural or psychosocial, or both. This review reveals that cognitive behaviour therapy, and other behavioural treatments, are associated with anxiety reductions. Such approaches should be considered for future clinical trial research to help advance the evidence base for managing school-age stuttering.

TranStutter: A Convolution-Free Transformer-Based Deep Learning Method to Classify Stuttered Speech Using 2D Mel-Spectrogram Visualization and Attention-Based Feature Representation.

Stuttering, a prevalent neurodevelopmental disorder, profoundly affects fluent speech, causing involuntary interruptions and recurrent sound patterns. This study addresses the critical need for the accurate classification of stuttering types. The researchers introduce "TranStutter", a pioneering Convolution-free Transformer-based DL model, designed to excel in speech disfluency classification. Unlike conventional methods, TranStutter leverages Multi-Head Self-Attention and Positional Encoding to capture intricate temporal patterns, yielding superior accuracy. In this study, the researchers employed two benchmark datasets: the Stuttering Events in Podcasts Dataset (SEP-28k) and the FluencyBank Interview Subset. SEP-28k comprises 28,177 audio clips from podcasts, meticulously annotated into distinct dysfluent and non-dysfluent labels, including Block (BL), Prolongation (PR), Sound Repetition (SR), Word Repetition (WR), and Interjection (IJ). The FluencyBank subset encompasses 4144 audio clips from 32 People Who Stutter (PWS), providing a diverse set of speech samples. TranStutter's performance was assessed rigorously. On SEP-28k, the model achieved an impressive accuracy of 88.1%. Furthermore, on the FluencyBank dataset, TranStutter demonstrated its efficacy with an accuracy of 80.6%. These results highlight TranStutter's significant potential in revolutionizing the diagnosis and treatment of stuttering, thereby contributing to the evolving landscape of speech pathology and neurodevelopmental research. The innovative integration of Multi-Head Self-Attention and Positional Encoding distinguishes TranStutter, enabling it to discern nuanced disfluencies with unparalleled precision. This novel approach represents a substantial leap forward in the field of speech pathology, promising more accurate diagnostics and targeted interventions for individuals with stuttering disorders.

Episodic stuttering as the presenting manifestation of acute ischemic stroke: A case report and systematic literature review.

BACKGROUND: Acquired episodic stuttering in adulthood represents a rare condition, which has been infrequently described in the literature. CASE PRESENTATION: We describe the case of a 62-year-old male who presented to the emergency room with three episodes of new-onset brief isolated stuttering with no other speech impairment or associated focal neurologic deficits. His brain magnetic resonance imaging was notable for the presence of a small acute ischemic stroke involving the left precuneus cortex. SYSTEMATIC LITERATURE REVIEW: We performed a systematic literature review to evaluate the association between stroke and acquired neurogenic stuttering. The evidence published to this date suggests that the underlying pathophysiology of acquired stutter does not localize to an isolated or focal region. The development of stuttering secondary to strokes may be the result of a disruption at any level in a cortico-striato-cortical integrative pathway mediating speech execution. CONCLUSION: Here we aimed to emphasize the importance of carefully evaluating new-onset recurrent episodic stuttering to rule out an underlying stroke or another neurogenic etiology. We provide a comprehensive review of acquired stuttering, its differential diagnosis, and its evaluation.

Stuttering Severity Judgments by Speech-Language Pathologists of Bilingual Children Who Do and Do Not Stutter.

INTRODUCTION: Recent studies conducted with bilingual populations have shown that bilingual children who do not stutter (CWNS) are often less fluent than their monolingual counterparts, which seems to affect the accuracy with which speech-language pathologists (SLPs) identify stuttering in bilinguals. That is, misdiagnosis appears frequently in bilingual children and is more likely to occur with bilingual CWNS (false positives) than with bilingual CWS (false negatives). METHODS: The goal of the current study was to gain insight in the extent of this misdiagnosis. Speech samples of 6 Lebanese bilingual CWNS and 2 CWS were rated by Lebanese SLPs in an audio-only and audiovisual presentation mode. SLPs had to identify each child as stuttering or not and subsequently rate on a 6-point scale the stuttering severity for each child. SLPs also provided background information by means of a questionnaire. RESULTS: The results showed that stuttering severity ratings (1) were on average significantly higher for CWS than for CWNS, (2) were for each CWS higher than for all but one of the CWNS, (3) varied significantly among the CWNS but not the CWS, (4) were not affected by the presentation mode, and (5) correlated positively with the percentage of stuttering-like disfluencies (SLD) and the mean number of iterations, but not with the percentage of other disfluencies (OD). CONCLUSION: Misdiagnosed bilingual CWNS are perceived by the SLPs as having a mild stutter, primarily based on the frequency of their disfluencies, but can be occasionally rated at par with CWS. Further research differentiating the disfluent speech of bilingual children who do and do not stutter is needed to reach a more adequate diagnosis of stuttering.

An event-contingent method to track disfluency effects on the relationship and the self.

BACKGROUND: Theoretically, reductions of self-esteem among people who stutter (PWS) are often explained by individual negative cognitions or emotions of the PWS or their conversation partners. We propose that the flow of a conversation can be seen as a representation of the relationship between speakers, and that by disrupting this flow, a stutter may directly threaten this relationship, and in turn affect self-esteem. Methodologically, we present a new, event-contingent, method that assesses fluctuations in self-esteem over time and thereby allows one to assess the predictive value of specific conversational experiences. AIMS: To have both a theoretical and a methodological contribution on conversational disfluency. METHODS & PROCEDURES: Our focus is not on stable individual factors, but we expect that fluctuations within the flow of everyday conversations predict changes in self-esteem. We studied these fluctuations with an experience sampling method which prompted participants to answer a brief survey after each of 10 conversations in a 2-week period. Self-identified PWS (n = 58) and people who do not stutter (PWNS; n = 53) reported on their individual negative cognitions and emotions and experienced relational quality and state self-esteem in more than 1000 conversations. By assessing fluctuations in self-esteem over time, this method allows one to assess the predictive value of specific conversational experiences. OUTCOMES & RESULTS: Correlational evidence demonstrates that flow disruptions are associated with temporary reductions in self-esteem. This association is mediated by increased individual negative cognitions and emotions, as well as threatened social relationships. This appeared to be true for both PWS and PWNS, although PWS experienced on average less conversational flow and lower state self-esteem. On average, PWS did not experience lower relational quality than PWNS. CONCLUSIONS & IMPLICATIONS: An event-contingent recording method is a useful way to assess momentary fluctuations in self-esteem. Findings are consistent with the notion that people monitor their relationship by attending to fluctuations in conversational flow; whereas a smooth conversational flow indicates a strong relationship, disruptions of flow (e.g., as caused by a stutter or other factors) signal a threat to the relationship. WHAT THIS PAPER ADDS: What is already known on the subject Even though adverse effects of stuttering on the experience of self-esteem have been reported, the evidence for this relation is equivocal. Because the evidence is mixed, it becomes interesting to examine the processes that provide insight in how stuttering may affect self-esteem. Theoretically, reductions of self-esteem among PWS are often explained by individual negative cognitions or emotions of the PWS or their conversation partners. Methodologically, studies examine this relation by single self-report measures, or by laboratory studies. What this paper adds to existing knowledge Our theoretical model shows that the flow of a conversation can be seen as a representation of the relationship between speakers, and that by disrupting this flow, a stutter directly threatens this relationship, and in turn, affects self-esteem. Methodologically, we present a new, event-contingent, method that assesses fluctuations in self-esteem over time and thereby allows one to assess the predictive value of specific conversational experiences. What are the potential or actual clinical implications of this work? Going beyond the study of stable individual cognitions and emotions of PWS and listeners, our findings show that a close examination of between-conversation fluctuations in flow can teach us about the day-to-day reality of people living with speech disorders, and the way they develop relationships and self-esteem.

Telepractice application for the overt stuttering assessment of children aged 6-15 years old.

BACKGROUND: Despite the importance of delivering speech and language therapy services to children who stutter (CWS), there are barriers to accessing speech and language therapy. One way to improve access for those who may otherwise be deprived of speech and language therapy services, including CWS, is through telepractice (TP). However, there is currently no evidence as to the viability of TP stuttering assessments for CWS. AIM: To investigate the validity and reliability, and acceptability of using a TP application to assess overt stuttering behaviour children aged 6-15 years. METHODS & PROCEDURE: A total of 30 CWS, aged between 6 and 15 years, were recruited from a speech therapy clinic in King Abdulaziz University Hospital in Riyadh, Saudi Arabia. Children were divided into two testing conditions, either face-to-face (f2f)-led or TP-led testing, and the Stuttering Severity Instrument (SSI-IV) was administered, percentage of syllables stuttered (%SS) was calculated, and severity ratings (SR) assigned, either via f2f or via TP using two laptops with webcams, video conference software and a broadband internet connection. Agreement and reliability of scoring in the two testing conditions were reported in addition to findings from questionnaires exploring children's and their caregivers' perceptions both before and immediately after the TP assessment was carried out. OUTCOME & RESULTS: A total of 30 sessions were successfully carried out, with results revealing unsatisfactory levels of agreement when applying the Bland and Altman method. However, when discrepancies were found, these were comparable with those from traditional f2f studies. Generally, parents and children exhibited high levels of satisfaction and held a positive view regarding TP pre- and post-assessment. CONCLUSIONS & IMPLICATIONS: The results of the study suggest that conducting an overt stuttering assessment via TP for 6-15-year-olds CWS is reliable and valid. Although the TP model posed some (mainly technical) challenges for executing the assessment, high levels of satisfaction were recorded by parents and children alike. The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS. These results are preliminary, but they can be seen as a building block for future research in TP assessment studies for CWS. WHAT THIS PAPER ADDS: What is already known on the subject Stuttering treatment via TP has been proven to be feasible and successful across a variety of treatment programs (e.g., Lidcombe, Camperdown). However, the viability of assessing stuttering via videoconferencing has never been explored in children. What this paper adds to existing knowledge Preliminary support for the assessment of overt stuttering in CWS aged 6-15 years via video conferencing. The results justify larger scale studies of this service delivery method. What are the potential or actual clinical implications of this work? The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS aged 6-15 years.

Examining the understandings of young adult South African men who stutter: The question of disability.

BACKGROUND: A disability studies approach seeks to understand and address political and social issues that affect disabled individuals. Disability studies scholars employ various models of disability to address and oppose the oppression and discrimination of disabled individuals. A disability studies approach, however, has largely been absent in studies that have investigated the lived experiences of people who stutter. AIM: To examine the understandings young adult South African men who stutter hold of whether, and in what way, stuttering may be considered to be a disability. METHODS & PROCEDURES: A total of 15 men who stutter, aged 20-39 years, participated in the study. Semi-structured interviews and two focus groups discussions were conducted to collect data for the study. The data were analysed according to a phenomenological approach and the affective turn in social research. OUTCOMES & RESULTS: The results indicated that some men in this study understood stuttering as a speech disorder that can be controlled, while other men constructed stuttering as a disability, subjectively positioning themselves either as disabled or non-disabled men. CONCLUSIONS & IMPLICATIONS: This article emphasizes the importance of adopting a disability studies approach when examining the lived experiences of people who stutter and enhancing intervention strategies to adequately address the disabled needs of such individuals. WHAT THIS PAPER ADDS: What is already known on the subject? The past few decades have seen researchers investigating the personal and social experiences of people who stutter. However, empirical studies exploring the disabling experiences of people who stutter have been absent from the existing body of knowledge. What this paper adds to existing knowledge? This research aimed to provide comprehensive insight into the disabling experiences of people who stutter. The results gave an insight into the oppression and disablism experienced by people who stutter. More specifically, the findings demonstrated how individuals who stutter are disabled by oppressive communication practices that dominate spaces of education and employment. What are the potential or actual clinical implications of this work? Several men in this study attended speech therapy to gain control over their stuttering. For a number of participants, speech therapy proved a valuable experience, while others saw speech therapy as being out of touch with their lived reality of stuttering. Speech and language therapists are encouraged to employ a disability studies approach in order to enhance intervention strategies to adequately address the disabling needs of people who stutter.

Lexipontix Program: Facilitating Change toward "Best Hopes" of the School-Age Child Who Stutters and the Family.

Lexipontix is a structured therapy program for school-age children who stutter. It is based on theoretical principles and clinical practices of cognitive behavioral therapy, parent-child interaction therapy, solution-focused brief therapy, fluency shaping, and stuttering modification. A case example of a school-age child who stutters and his family who participated in the Lexipontix program is illustrated to highlight the theoretical principles, structure, content, and clinical tools of the assessment and therapy process of the program. The Lexipontix program addresses the stuttering experience of the child and family in a holistic way. The child and family are assisted in facilitating changes in all components of the International Classification of Functioning, Disability, and Health model (i.e., body function, personal factors, activity and participation, environmental factors), which help them move toward their "best hopes" (i.e., personally meaningful change) from therapy. The role of the clinician in facilitating change is also considered. Therapy outcomes for the specific case example are presented and discussed in relation to data from a retrospective chart review. The mechanisms underlying the effectiveness of the program are explored and discussed.

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.

Treating Concomitant Language and/or Phonology Impairment in Children Who Stutter.

Stuttering can co-occur with phonological and/or language impairment in a nontrivial number of children. This article provides a framework for addressing concomitant phonology/language impairment and stuttering through the application of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Described is a multifactorial approach to understanding stuttering, the application of the ICF to treating children who stutter with concomitant disorders, and models for structuring-related therapy. A case study is explored to illustrate this process and includes a sample treatment plan with goals, short-term objectives, and sample activities.

Awareness of stuttering in Japanese children aged 3-7 years.

BACKGROUND: Boey et al. (2009) devised a questionnaire for measuring children's awareness of stuttering and showed that even very young children were often aware of their stuttering. There has been no replication of studies using Boey et al.'s parent-reported questionnaire. The aim of this study was to test whether using Boey et al.'s seven questions, developed for a Dutch speaking population could be effective for measuring the awareness of stuttering in Japanese children. METHODS: Participants were 54 children who stutter (CWS) aged 3-7 years. Parents answered seven questions about their child's awareness of stuttering according to the questions developed Boey et al. RESULTS: Parental-reported observations of the child responses citing at least one awareness incident were 76%. The percentage of stuttering children with awareness of their own speech difficulties, according to chronological age, were as follows: 70% at age 3 years; 67% at age 4 years; 75% at age 5 years; 81% at age 6 years; and 90% at age 7 years. CONCLUSIONS: We found that even at age 3 years, many CWS were already aware of their stuttering. The similarity of the data with the seminal study by Boey et al. suggests that the question-based assessment is reproducible even in a country with a different spoken language. The seven questions in Boey et al. are useful for evaluating whether children's awareness of stuttering could contribute to a clinical decision as well as stuttering severity.

The investigation of the validity and reliability of the Turkish version of the Wright and Ayre Stuttering Self-Rating Profile (WASSP).

BACKGROUND: Self-assessments for adults who stutter are recommended as a primary evaluation tool for including their views on stuttering. Evaluating adults who stutter with self-assessment scales is important. However, there is no tool in the Turkish literature that provides this measurement. AIMS: To develop the Turkish version of The Wright and Ayre Stuttering Self-Rating Profile (WASSP) in order to analyse its validity and reliability, and investigate its applicability for Turkish-speaking individuals. METHODS & PROCEDURES: The study included 120 adults who stutter (aged 18-54 years). All the participants completed The Wright and Ayre Stuttering Self-Rating Profile-Turkish version (WASSP-TR) and the SF-36 form. The reliability analysis involved the calculation of Cronbach's alphas for test-retest and the Pearson product-moment correlation coefficient for internal consistency. The validity analysis, in turn, involved a confirmatory factor analysis for construct validity and testing correlations with the SF-36 for criterion validity. OUTCOMES & RESULTS: Internal consistency coefficients of the WASSP-TR were reported to be high (> 0.70). The correlations between the WASSP-TR and its subscales showed significant results (0.858-0.966) (p < 0.01). The correlation between the subscales of the WASSP-TR and the SF-36 was reported to be consistent (from -0.492 to 0.747). There was a positive correlation between stuttering severity groups and the WASSP-TR scores (p < 0.01). CONCLUSIONS & IMPLICATIONS: The WASSP-TR is a valid and reliable scale for Turkish-speaking adults who stutter. What this paper adds What is already known on the subject Self-assessment tools are recommended as a primary use when assessing adults who stutter. The WASSP is one of these measurement tools. However, the adaptation, validity and reliability study of the WASSP to Turkish has not been investigated. What this paper adds to existing knowledge This study shows that the Turkish version of the WASSP scale is valid and reliable and can be used with adults who stutter. Furthermore, the present adaptation study has been developed in order to evaluate social-emotional aspects of stuttering. What are the potential or actual clinical implications of this work? A tool that includes evaluating the behaviour, cognition, affect and participation areas as well as the stuttering behaviours of adults who stutter was adapted. This tool is expected to be useful for comprehensive evaluation of adults who stutter in clinics, in research and for pre/post-therapy.

Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering.

BACKGROUND: Research suggests that some speech-language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech-language pathology programmes and the limited number of stuttering-specific placements available. Simulation-based learning is a viable option for providing speech-language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation-based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation-based learning are yet to be explored. AIMS: To investigate speech-language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation-based learning programme. METHODS & PROCEDURES: This study used a cross-sectional survey design. Participants were 105 undergraduate and graduate entry masters speech-language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation-based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre-course (T1), pre-simulation (T2) and post-simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. OUTCOMES & RESULTS: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre-course and pre-simulation. Open-ended responses on the post-simulation survey revealed that students valued learning about stuttering within a simulation-based learning environment. CONCLUSIONS & IMPLICATIONS: Simulation-based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation-based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. WHAT THIS PAPER ADDS: What is already known on this subject Simulation is a teaching approach used within speech-language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation-based learning programme. It describes a stuttering simulation-based learning programme that can be embedded into speech-language pathology programme curricula. What are the potential or actual clinical implications of this work? The stuttering simulation-based learning programme detailed in this study can be applied and embedded in speech-language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering.