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.

Accepting Things as They Are: Dispositional Mindfulness, Decentering, Self-Compassion, and the Impact of Stuttering on Adults Who Stutter.

PURPOSE: Mindfulness is defined as intentional, present-moment, nonjudgmental awareness. Previous studies have proposed that mindfulness practice may benefit people who stutter. This study aimed to test the relationship between levels of dispositional mindfulness in people who stutter and the impact of stuttering and whether self-compassion and the metacognitive ability of shifting to an objective perspective (decentering) mediate this relationship. It is hypothesized that greater dispositional mindfulness is associated with attenuated negative impact of stuttering on a person's life through a higher capability to shift into an objective and compassionate perspective. METHOD: A total of 150 Israeli adults who stutter completed a full online survey in Hebrew to assess their levels of dispositional mindfulness, self-compassion, decentering capability, and impact of stuttering on their lives. The relationships between constructs were assessed using Pearson's correlation and mediation analysis. RESULTS: The adverse impact of stuttering was negatively and moderately associated with dispositional mindfulness, such that individuals with greater self-reported dispositional mindfulness reported fewer reactions to stuttering, difficulty in communication, and higher quality of life. This relationship was fully and sequentially mediated via decentering and self-compassion, which were also negatively and moderately associated with the impact of stuttering. CONCLUSIONS: People who stutter with greater dispositional mindfulness have an increased ability to view their experiences in a more objective and compassionate manner, which is associated with an attenuated impact of stuttering on their lives. As these capabilities can be cultivated through practice, this study proposes mindfulness practice as an additional beneficial tool for people who stutter.

Stuttering interventions for children, adolescents, and adults: a systematic review as a part of clinical guidelines.

INTRODUCTION: Stuttering may have a holistic effect on the quality of life of a person who stutters by limiting participation in social situations, resulting in feelings of isolation and frustration, leading to difficulties in education and employment and increasing the likelihood of mental health problems. Even young children who stutter may have negative experiences of speaking. Therefore, it is important to treat stuttering behavior effectively in both children and adults. The purpose of this paper was to systematically review group and case studies about the effectiveness of behavioral stuttering interventions to provide evidence-based guidelines for clinicians. METHODS: Systematic data retrieval was conducted in four electronic databases (PsycINFO, CINAHL, PubMed, Cochrane). The assessment of search results was conducted according to predetermined inclusion and exclusion criteria by two independent judges. The methodological quality of each paper was assessed using strict criteria to include only high-quality research. RESULTS: The search revealed 2293 results, and 38 papers (systematic reviews N=3, group design studies N=21 and case studies N=14) with acceptable methodological quality were included. The data show that there is most evidence about the treatment of early childhood stuttering, very little evidence about school-aged children and some evidence about adults. The most convincing evidence is about the Lidcombe Program in the treatment of young children who stutter, but also other methods have promising evidence. Our data imply that in the treatment of adults who stutter, holistic treatments may influence speech fluency and overall experience of stuttering behavior. Speech restructuring treatments may have a positive effect on overt characteristics of stuttering, but not on covert stuttering behavior. CONCLUSIONS: The results of this review agree with earlier reviews about the treatment of young children. However, due to different inclusion criteria, this review also shows the benefits of holistic treatment approaches with adults and adolescents.

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.

Impact of cognitive behavioural play therapy on social anxiety among school children with stuttering deficit: A cluster randomised trial with three months follow-up.

BACKGROUND: Stuttering is a speech deficit which is characterized by obstruction of speech eloquence and verbal expression in addition to involuntary flow of air during communication. School children with communication deficit often experience social anxiety in their immediate environment. Currently, reports show that a good number of children with communication deficits are prone to social maladjustment due to their being socially inept. And this has significantly affected their thought pattern, social behaviours and emotional responses. In view of this, we examined the impact of cognitive behavioural play therapy in reducing social anxiety among school children with stuttering. METHOD: This is a pretest-posttest randomized control group design. Participants were 178schoolchildren in inclusive schools in South east Nigeria. Participants in the intervention group were treated using cognitive behavioural play therapy programme (CBPT). Participants in the waitlist control group were only assessed at three points of assessment. Data analyses were completed using repeated measures ANOVA. RESULTS: The results show that cognitive behavioural play therapy is beneficial in decreasing schoolchildren's social anxiety scores. The intervention equally showed the considerable impacts on the children when exposed to cognitive behavioural play programme at different times of assessment compared to waitlisted control group. CONCLUSION: It is concluded that CBPT is a long-term psychotherapeutic programme that has significant impacts in reducing social anxiety among children with stuttering. This study makes a leading contribution on the limited scholarship focusing on the impact of CBPT on social anxiety of special population with stuttering deficits in developing countries.

Pilot Program Combining Acceptance and Commitment Therapy with Stuttering Modification Therapy for Adults who Stutter: A Case Report.

BACKGROUND: The impact of stuttering far exceeds its effects on speech production itself. It includes increased anxiety levels and avoidance of speech situations that may impact the general quality of life. Therefore, psychological treatment methods have been incorporated into speech therapy programs with positive results. Acceptance and commitment therapy (ACT) is a relatively recent addition to the field of stuttering. In this case report, we present a pilot program of integrating acceptance and commitment therapy (ACT) with stuttering modification therapy for adults who stutter. METHOD: Eight adults who stutter entered the approximately year-long program, which consisted of three parts: group ACT, individual/pair stuttering modification therapy, and monthly stabilization/follow-up sessions. RESULTS: Improvement was observed in group mean measures of mindfulness skills, speech-related attitudes, anxiety, daily communication, quality of life, and stuttering frequency. Improvement in quality of life was also self-described by participants throughout the program. CONCLUSIONS: Participant improvement and positive self-reports suggest a potentially promising effect of combining ACT with stuttering modification therapy. Further research is needed to evaluate treatment efficacy.

Self-efficacy beliefs: Experiences of adults who stutter.

PURPOSE: Childhood-onset stuttering is a complex and multifaceted disorder. Intervention for adults who stutter has historically addressed speech fluency more so than psychosocial aspects of the disorder, including the nature of the individual's self-efficacy beliefs concerning their confidence in their capacity to enact change. Self-efficacy is an important construct related to quality of life, resilience, and maintenance of treatment gains for adults who stutter. The purpose of this qualitative study is to explore the nature of the self-efficacy beliefs expressed by adults who stutter in order to inform efficacious and holistic intervention for these individuals. METHOD: Semi-structured interviews were conducted with 29 adults who stutter to describe their experiences as a person who stutters and elucidate the nature of their self-efficacy beliefs. RESULTS: Thematic analysis identified several major themes that provided novel insight into the complex nature of the self-efficacy beliefs experienced by adults who stutter: speaker experiences shaped communicative confidence, there was a conflict between communication and fluency, stuttering was viewed as more than fluency, and individual perspectives shaped communicative confidence, as did the pervading influence of self. The notion that fluency and confidence are inextricably linked was evident within and across each major theme. CONCLUSION: These preliminary findings provide further support for a multidimensional approach to the treatment of adults who stutter. Findings will be used to inform a novel integrated fluency and psychosocial intervention for adults who stutter that addresses fluency and self-efficacy concurrently, with a view of engendering durable improvements in speech fluency and communicative confidence.

A fNIRS Investigation of Speech Planning and Execution in Adults Who Stutter.

Our study aimed to determine the neural correlates of speech planning and execution in adults who stutter (AWS). Fifteen AWS and 15 controls (CON) completed two tasks that either manipulated speech planning or execution processing loads. Functional near-infrared spectroscopy (fNIRS) was used to measure changes in blood flow concentrations during each task, thus providing an indirect measure of neural activity. An image-based reconstruction technique was used to analyze the results and facilitate their interpretation in the context of previous functional neuroimaging studies of AWS that used positron emission tomography (PET) or functional magnetic resonance imaging (fMRI). For planning, we compared neural activity associated with high versus low planning load in AWS and CON. For execution, we compared the neural activity associated with overt versus covert naming in AWS and CON. Broadly, group level effects corroborate previous PET/fMRI findings including under-activation in left-hemisphere perisylvian speech-language networks and over-activation in right-hemisphere homologs. Increased planning load revealed atypical left-hemisphere activation in AWS, whereas increased execution load yielded atypical right fronto-temporo-parietal and bilateral motor activation in AWS. Our results add to the limited literature differentiating speech planning versus execution processes in AWS.

A cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students.

BACKGROUND: Classroom-based stuttering intervention addressing negative peer attitudes, perceptions, teasing and bullying of children who stutter (CWS) is required as part of holistic stuttering management because of its occurrence in primary school. This study was conducted in 2017, in 10 primary schools in the Western Cape, South Africa within lower (second and third) and higher (fourth and fifth) quintiles. OBJECTIVES: The primary objective of this study was to determine treatment effect at six months after intervention of grade 7 participants (Classroom Communication Resource [CCR] intervention versus no CCR) using global Stuttering Resource Outcomes Measure (SROM) scores in school clusters. The secondary objective was to determine grade 7 participant treatment effect on the SROM subscales including Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine any difference in the primary outcome between schools between and across quintile clusters (lower and higher). METHODS: Once schools were stratified into lower and higher quintile (which are defined according to geographical location, fee per school and resources) subgroup clusters, schools were assigned randomly to control and intervention groups consisting of grade 7 participants who were typically aged ≥ 11 years. Teachers received 1 h of training before administering the single-dose CCR intervention over a 60-90-min session. The CCR intervention included a social story, role-play and discussion. All participants viewed a video of a CWS and stuttering was defined at baseline. The SROM measured peer attitudes at six months after intervention. Randomisation was stratified by quintile group using a 1:1 allocation ratio. Full blinding was not possible; however, the outcome assessor was partially blinded and the analyst was also blinded. Generalised estimating equations (GEE) was used assuming an exchangeable correlation structure to analyse the data adopting an intention-to-treat principle. Multiple imputation was used to handle missing data. Criterion for statistical significance was set at alpha = 0.05. RESULTS: Ten schools were randomly allocated to control (k = 5) and intervention groups (k = 5), with n = 223 participants allocated to intervention and n = 231 to control groups. A total of 454 participants completed the SROMs in control (n = 231) and intervention (n = 223) groups and were analysed at baseline and six months after intervention. There was no statistically significant difference on the global SROM score (mean difference - 0.11; 95% confidence interval [CI] - 1.56-1.34; p = 0.88). There were also no significant differences on SROM subscales: PSD (mean difference 1.04; 95% CI - 1.02-311; p = 0.32), SP (mean difference - 0.45; 95% CI - 1.22-0.26; p = 0.21) and VI (mean difference 0.05; 95% CI - 1.01-1.11; p = 0.93). Additionally, there was no significant subgroup effect on the global SROM score (lower versus higher quintile subgroups) (interaction p value = 0.52). No harms were noted or reported. CONCLUSION: No statistically significant differences were noted. It is possible that the time frame was too short to note changes in peer attitudes and that further study is required to confirm the findings of this study. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03111524 . Registered on 9 March 2017.

The Role of Attention in Therapy for Children and Adolescents Who Stutter: Cognitive Behavioral Therapy and Mindfulness-Based Interventions.

Method: This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being. Conclusions: Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.

The Most Important Therapy Outcomes for School-Aged Children Who Stutter: An Exploratory Study.

Purpose: The aim of this article was to identify what school-aged children who stutter consider to be the most important outcomes from therapy. Method: A Delphi approach was employed for the study. Eighteen participants aged 9-13 years completed a survey, generating 90 statements that would constitute successful therapy outcomes. After categorization and reduction, 79 statements were sent to participants in a second survey to seek consensus on their importance. Fifteen participants aged 8-14 years completed this second survey. Statements with the highest median ratings and smallest standard deviations were retained. Results: Twenty-one statements were retained after analysis. These reflected hopes for affective and behavioral change in the young person and in other people after therapy. Important outcomes included, but are not limited to, increased fluency, greater independence, increased confidence at school, others knowing how to support the individual, and communication situations feeling easier. Conclusions: Participants identified a range of outcomes that were important to achieve as a result of speech and language therapy. The findings suggest a need for a more holistic view of what is meant by successful therapy, incorporating improvements in the ability to communicate and participate in daily situations. The findings suggest that an integrated or holistic approach to intervention would be required to achieve these goals and should include significant others from the child's environment. The important statements identified in this study could be used to inform the content of therapy and to evaluate change over time. Supplemental Material: https://doi.org/10.23641/asha.7144205.

A pilot study into a possible relationship between diet and stuttering.

PURPOSE: There are theoretical and empirical reasons to consider a potential role for copper metabolism in the brain in how it could influence stuttering. However, a link between stuttering and dietary intake has never been researched in a systematic way. This pilot study therefore aimed to explore a possible association between ingested amounts of copper and thiamine (vitamin B1) with stuttering frequency using a double blind cross-over longitudinal paradigm. METHODS: 19 adults who stutter between 20 and 51 years old filled out an online survey for 9 consecutive weeks. The survey consisted of self-assessed fluency and mood state scales, as well as food journals. After 4 weeks, the participants consumed either copper or thiamine supplements for 2 weeks, followed by a 1-week washout period, and another period of two weeks taking the other supplement. Formal speech assessments were done pre/post baseline and at the end of each supplement intake. Participants were not informed about the nature of the supplements during the experiment and the investigators were blinded to the order of the supplements. RESULTS: The results demonstrated that copper and thiamine had no measurable effect on the amount of stuttering (self and formal assessments) but there was a moderate, significant correlation between mood state and fluency. CONCLUSION: The findings do not support notions of dietary influences of ingested copper or thiamine on stuttering but do provide modest support for a relationship between variations in stuttering and self-perceived anxiety.

Abnormal auditory synchronization in stuttering: A magnetoencephalographic study.

In a previous magnetoencephalographic study, we showed both functional and structural reorganization of the right auditory cortex and impaired left auditory cortex function in people who stutter (PWS). In the present work, we reevaluated the same dataset to further investigate how the right and left auditory cortices interact to compensate for stuttering. We evaluated bilateral N100m latencies as well as indices of local and inter-hemispheric phase synchronization of the auditory cortices. The left N100m latency was significantly prolonged relative to the right N100m latency in PWS, while healthy control participants did not show any inter-hemispheric differences in latency. A phase-locking factor (PLF) analysis, which indicates the degree of local phase synchronization, demonstrated enhanced alpha-band synchrony in the right auditory area of PWS. A phase-locking value (PLV) analysis of inter-hemispheric synchronization demonstrated significant elevations in the beta band between the right and left auditory cortices in PWS. In addition, right PLF and PLVs were positively correlated with stuttering frequency in PWS. Taken together, our data suggest that increased right hemispheric local phase synchronization and increased inter-hemispheric phase synchronization are electrophysiological correlates of a compensatory mechanism for impaired left auditory processing in PWS.

Yoga: Potential Benefits for Persons Who Stutter.

Yoga has been demonstrated to modulate autonomic nervous system activity, decreasing anxiety and stress, and improving quality of life. This preliminary study sought to examine the use of yogic techniques on persons who stutter given the interaction between physiological arousal/anxiety and stuttering that current multifactorial models of stuttering propose. Four participants (M = 52 yr, SD = 10; 2 female, 2 male), recruited from local stuttering support groups in the greater Philadelphia community volunteered to participate. Stuttering severity, anxiety, and experiences regarding stuttering and communication were measured at baseline, post intervention, and at 4 months follow-up. The participants attended group yoga sessions and engaged in home practice. Descriptive results revealed that participants showed improvements across outcome measures, with the most improvement related to anxiety. Participants also reported improvements in their perceptions about communication as per qualitative analysis of responses to the open-ended questionnaires. The results suggest the potential benefits of yoga for persons who stutter and warrants further study using an experimental design.

Observer perspective imagery with stuttering.

PURPOSE: Adults who stutter are at risk of developing a range of psychological conditions. Social anxiety disorder is the most common anxiety disorder associated with stuttering. Observer perspective imagery is one cognitive process involved in the maintenance of some anxiety disorders. This involves viewing images as if looking at the self from the perspective of another. In contrast, the field perspective involves looking out from the self at the surrounding environment. The purpose of this study was to assess the presence of observer perspective imagery with stuttering. METHOD: The authors administered the Hackmann, Surawy and Clark (1998) semi-structured interview to 30 adults who stutter and 30 controls. Group images and impressions were compared for frequency, perspective recalled and emotional valence. RESULT: The stuttering group was significantly more likely than controls to recall images and impressions from an observer rather than a field perspective for anxious situations. CONCLUSION: It is possible the present results could reflect the same attentional processing bias that occurs with anxiety disorders in the non-stuttering population. These preliminary results provide an explanation for the persistence of conditions such as social anxiety disorder with stuttering. Clinical implications are discussed.

Modulation of auditory processing during speech movement planning is limited in adults who stutter.

Stuttering is associated with atypical structural and functional connectivity in sensorimotor brain areas, in particular premotor, motor, and auditory regions. It remains unknown, however, which specific mechanisms of speech planning and execution are affected by these neurological abnormalities. To investigate pre-movement sensory modulation, we recorded 12 stuttering and 12 nonstuttering adults' auditory evoked potentials in response to probe tones presented prior to speech onset in a delayed-response speaking condition vs. no-speaking control conditions (silent reading; seeing nonlinguistic symbols). Findings indicate that, during speech movement planning, the nonstuttering group showed a statistically significant modulation of auditory processing (reduced N1 amplitude) that was not observed in the stuttering group. Thus, the obtained results provide electrophysiological evidence in support of the hypothesis that stuttering is associated with deficiencies in modulating the cortical auditory system during speech movement planning. This specific sensorimotor integration deficiency may contribute to inefficient feedback monitoring and, consequently, speech dysfluencies.

Atypical central auditory speech-sound discrimination in children who stutter as indexed by the mismatch negativity.

PURPOSE: Recent theoretical conceptualizations suggest that disfluencies in stuttering may arise from several factors, one of them being atypical auditory processing. The main purpose of the present study was to investigate whether speech sound encoding and central auditory discrimination, are affected in children who stutter (CWS). METHODS: Participants were 10 CWS, and 12 typically developing children with fluent speech (TDC). Event-related potentials (ERPs) for syllables and syllable changes [consonant, vowel, vowel-duration, frequency (F0), and intensity changes], critical in speech perception and language development of CWS were compared to those of TDC. RESULTS: There were no significant group differences in the amplitudes or latencies of the P1 or N2 responses elicited by the standard stimuli. However, the Mismatch Negativity (MMN) amplitude was significantly smaller in CWS than in TDC. For TDC all deviants of the linguistic multifeature paradigm elicited significant MMN amplitudes, comparable with the results found earlier with the same paradigm in 6-year-old children. In contrast, only the duration change elicited a significant MMN in CWS. CONCLUSIONS: The results showed that central auditory speech-sound processing was typical at the level of sound encoding in CWS. In contrast, central speech-sound discrimination, as indexed by the MMN for multiple sound features (both phonetic and prosodic), was atypical in the group of CWS. Findings were linked to existing conceptualizations on stuttering etiology. EDUCATIONAL OBJECTIVES: The reader will be able (a) to describe recent findings on central auditory speech-sound processing in individuals who stutter, (b) to describe the measurement of auditory reception and central auditory speech-sound discrimination, (c) to describe the findings of central auditory speech-sound discrimination, as indexed by the mismatch negativity (MMN), in children who stutter.

Recurrent involuntary imagery in people who stutter and people who do not stutter.

OBJECTIVE: To compare intrusive memories in groups of people who do (PWS), and who do not (PWNS), stutter. METHOD: Twenty-one participants who stuttered and 21 matched controls were given a semi-structured interview which explored imagery in speaking situations. The data were analyzed using a Content Analysis approach. Other outcome measures were the Beck Anxiety Inventory, the Beck Depression Inventory, the Post Traumatic Stress Disorder, PTSD, Symptom Scale: Self-Report Version. RESULTS: Significantly more stuttering participants than control participants indicated both recurrent imagery and associated memories. Content Analysis revealed themes of disfluency, anxiety, negative social evaluation, self-focus and pressure to speak that were common to both groups' reports. Additional themes of helplessness, shame, sadness and frustration were found only in the images and memories of the stuttering group. No group differences were evident for the number of sensory modalities involved in images and memories, or for ratings of their vividness or strength of associated emotions, or on self-reports of depression, anxiety and trauma. CONCLUSIONS: Recurrent imagery about events in childhood is a potent factor in the memories of PWS. It is worth modifying interventions that have been successfully applied for treating social anxiety for use with people who stutter. EDUCATIONAL OBJECTIVES: After reading this article, participants will be able to: (a) identify the role of intrusive memories in psychiatric disorders and stuttering; (b) investigate how DSM criteria can be employed with people who stutter; (c) employ anxiety instruments used for assessing psychiatric disorders for stuttering; (d) distinguish between the intrusive memories experienced by people who stutter, and people who do not stutter; (e) apply treatments for intrusive memories in psychiatric disorders to work with people who stutter.

Acceptance and Commitment Therapy for adults who stutter: psychosocial adjustment and speech fluency.

UNLABELLED: The aim of the present study was to assess the effectiveness of an Acceptance and Commitment Therapy group intervention program for adults who stutter (N=20). The program consisted of 2-h therapeutic sessions conducted weekly for eight consecutive weeks. It was an integrated program designed to improve: (a) psychosocial functioning, (b) readiness for therapy and change, (c) utilisation of mindfulness skills and psychological flexibility, and (d) frequency of stuttering. The findings provide innovative evidence for Acceptance and Commitment Therapy as an effective intervention with statistically significant improvements in psychosocial functioning, preparation for change and therapy, utilisation of mindfulness skills, and overall speech fluency. Follow-up data collected at three months post-treatment revealed that therapeutic gains were successfully maintained over time. These findings enhance the understanding of the impact of stuttering on psychological wellbeing and offer a new perspective on what might constitute successful stuttering treatment. Further, clinical research support is provided for Acceptance and Commitment Therapy delivered in a group format as a promising and novel intervention for adults who stutter. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) appreciate the potential for Acceptance and Commitment Therapy for adults who stutter; (b) identify the improvements participants experienced in psychosocial functioning and frequency of stuttered speech; (c) appreciate the six core processes of Acceptance and Commitment Therapy; and (d) appreciate the differences between an ACT model of intervention for adults who stutter compared to a CBT approach.

Five analogies between a King's Speech treatment and contemporary play therapies.

OBJECTIVE: Psychiatric patients frequently respond positively to play therapy, which may rely on psychoanalytic, Jungian, cognitive-behavioral, familial, school-based, or other theories. I wished to determine if there were unifying principles that tie together these various types of play treatments. METHODS: The fact-based film, The King's Speech, vividly illustrates play utilized by Lionel Logue in his speech treatment (1926-1939) of the future King of England. In the film I found five analogies to the play therapy I employ in office practice. RESULTS: The play scenes in The King's Speech point to five unifying principles among contemporary play therapies: (1) the crucial nature of the relationship, (2) the centrality of having fun, (3) the occasional reliance on others, (4) the interjection of pithy talk, and (5) the usefulness of a little drama. CONCLUSION: No matter what theory a play therapist ascribes to, these five unifying principles should be kept in mind during treatment.