Effectiveness of speech therapy in treating vocal blocking tics in children with Tourette syndrome: Two case reports.

Tourette syndrome is characterized by at least two motor tics and one vocal tic, which persist for over a year. Infrequently, tics can manifest as blocking tics in speech when they prevent a person from starting to speak or interrupt their speech flow. Vocal blocking tics (VBTs) resemble stuttering, and they can be difficult to differentiate from each other. A previous report described two patients with severe VBTs who did not benefit from stuttering-therapy-based speech therapy and were treated effectively with cannabis-based medicine. Here, we present the cases of two patients, seven- and nine-year-old boys, who benefited from speech therapy in which stuttering therapy techniques were used. Detailed descriptions of the interventions are included. Further research is needed to test the effectiveness of speech therapy in treating VBTs in a larger group of children with Tourette syndrome.

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.

Efeitos da presença do cão na expressão de conteúdos psíquicos de um sujeito que gagueja: estudo de caso / Effects of the presence of a dog on the psychic content expression of a stuttering person: case report

RESUMO A gagueira gera impactos negativos na qualidade de vida dos sujeitos e está associada a maior risco de desenvolvimento de problemas sociais e psíquicos. Nessa perspectiva, apesar da diversidade das hipóteses etiológicas e dos tratamentos da gagueira, destaca-se a interface entre psicologia e fonoaudiologia na abordagem dos aspectos bio-psíquicos envolvidos nesse quadro clínico. Pesquisas recentes indicam que a presença, especificamente de cães, pode auxiliar o paciente na elaboração simbólica de conteúdos psíquicos. Nessa perspectiva, o objetivo desse estudo é avaliar os efeitos da presença do cão na expressão de conteúdos psíquicos de um sujeito que gagueja, com a hipótese de que o enquadre pode reduzir o sintoma. O sujeito é M., sexo feminino, 45 anos, casada, sem filhos, cursou ensino fundamental completo e de auxiliar de cabeleireira. Passou pelo processo de terapia fonoaudiológica na presença do cão. Foi realizada uma entrevista semi-dirigida após o processo. Um cão coterapeuta, da raça Golden Retriever, participou de todas as sessões. Alguns conteúdos subjetivos relevantes observados no setting no decorrer do processo terapêutico fonoaudiológico, os quais parecem ter sido mobilizados pelo enquadre estabelecido pela interação entre terapeuta-paciente-cão, parecem demonstrar associação com a manifestação das disfluências. O cão fez contato físico, deu suporte, motivou e acolheu o sujeito em situações de demonstração de conflitos psíquicos. Assim, este estudo de caso clínico indica que o enquadre da presença e interação do cão favoreceu a redução do sintoma da gagueira, promovendo ambiente acolhedor possibilitando a integração psique-soma do sujeito.

ABSTRACT Stuttering has negative impacts on an individual's quality of life and is associated with higher risk of development of social and psychological problems. From this perspective, despite the diversity of etiological hypotheses for and treatments of stuttering, the interface between psychology and speech therapy in the approach to the biopsychic aspects involved in this clinical scenario stands out. Recent research indicates that the presence, specifically of dogs, can assist patients in symbolic elaboration of psychic content. From this perspective, the aim of this study is evaluate the effects of a dog's presence on the expression of the psychic content of a stuttering person, with the hypothesis that framing may reduce symptoms. The subject is M., female, 45 years old, married, without children, hairdressing assistant, with elementary school completed. She underwent the process of speech therapy in presence of a dog. A semidirected interview was conducted after this process. A co-therapist dog of Golden Retriever breed participated in all sessions. The relevant subjective content observed in the setting during the speech therapy process, which seems to have been mobilized by the framework established by the interaction among the therapist, the patient, and the dog, seems to demonstrate an association with the manifestation of disfluencies. The dog made physical contact with, supported, motivated and welcomed the subject in situations in which psychic conflicts were demonstrated. This clinical case study indicates that the dog's presence and interaction framework favored the reduction of stuttering symptoms, promoting welcoming environment that enabled the subject's psyche-soma integration.

Surface Electrical Stimulation for Persistent Stuttering and Concomitant Orofacial Disorders: A Multiple Case Study.

This multiple case study analysis describes the immediate effects on speech fluency of transcutaneous electrical nerve stimulation (TENS) applied to participants with persistent stuttering and concomitant orofacial disorders. Study participants were 14 adolescents and adults who stuttered and had jaw clenching bruxism or mouth breathing. Participants experienced low-frequency TENS applied at mild motor level for 20 minutes with electrodes placed at the lower third of the face (Area A), submandibular region (Area B), posterior neck (Area C), or shoulder girdle (Area D), with speech fluency assessed immediately before and after each stimulation.For participants with stuttering and bruxism, AB stimulation reduced the median frequency of syllables stuttered by 27% and reduced the median duration of the three highest stuttering moments by 29%. In addition, for participants with stuttering and mouth breathing, CD stimulation reduced the median duration of the three highest stuttering moments by 28% and increased their median speech rate by 113%. As a single session of TENS may help participants with stuttering and concomitant orofacial disorders better use fluency shaping techniques, the therapeutic potential of TENS for treating stuttering should be further investigated.

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.

Clinical Trial for Stuttering Treatment: pilot study about dog participation in the therapy session. / Ensaio Clínico de Tratamento da Gagueira: estudo piloto com variável monitorada, participação do cão na sessão de terapia.

PURPOSE: To verify the effect of dog intervention on the regular session of speech therapy for developmental stuttering in adults. METHODS: The study involved young adults and adults with developmental stuttering. The study sample was composed of eight participants, six males and two females, ranging in age from 16 to 45 years. Participants were divided into two groups: G1 - those who underwent treatment for stuttering with the presence of a dog-therapist in the therapy room and G2 - those who underwent treatment for stuttering without the presence of the dog therapist. We included a control group, G3, composed of fluent participants, matched in age and sex to G1 and G2 to control the natural variability of speech fluency. RESULTS: Comparative results between the groups indicated that the group that performed the treatment without the presence of the dog achieved better performance, evolution and efficacy rates. CONCLUSION: for the population in this study, the dog intervention on speech therapy did not improve treatment.

OBJETIVO: Verificar o efeito da intervenção do cão na sessão regular de terapia fonoaudiológica para a gagueira do desenvolvimento em jovens adultos. MÉTODO: Foram selecionados jovens adultos e adultos com diagnóstico de gagueira do desenvolvimento. Concluíram o estudo oito participantes, seis do sexo masculino e dois do sexo feminino, com idades variando entre 16 e 45 anos. Os participantes foram divididos em dois grupos: G1 ­ que realizou o tratamento para gagueira com a presença de um cão terapeuta em sala de terapia e G2 ­ que realizou o tratamento para gagueira sem a presença do cão terapeuta. Foi incluído um grupo controle, G3 ­ composto por participantes fluentes, pareado em idade e sexo ao G1 e G2, para controle da variabilidade natural da fluência da fala. RESULTADOS: A análise comparativa entre os grupos indicou que o grupo que realizou o tratamento sem a presença do cão alcançou melhores índices de performance, evolução e eficácia. CONCLUSÃO: Para a população pesquisada neste estudo, não foi observado efeito da intervenção do cão na terapia fonoaudiológica.

Auriculoterapia y tratamiento habitual en niños con tartamudez en Municipio Matanzas. Año 2017 / Auriculotherapy and habitual treatment in children with stuttering in the municipality of Matanzas. 2017

RESUMEN Introducción: se realizó un estudio experimental, longitudinal, prospectivo sobre el tratamiento de los niños con tartamudez con el tratamiento habitual y la adición de auriculoterapia en el Centro Auditivo Provincial en Matanzas entre enero y diciembre del 2017. Objetivo: comparar la evolución clínica de los pacientes con el tratamiento habitual y con la adición de auriculoterapia. Materiales y métodos: el universo del estudio fue de 14 pacientes con tartamudez. Según la llegada de los pacientes a consulta los mismos fueron ubicados alternativamente en dos grupos, uno control que se trató con tratamiento habitual y otro experimental, donde se aplicó el tratamiento habitual más la auriculoterapia. Fue elaborada la historia clínica con una evaluación logofoniátrica antes y después del tratamiento. Resultados: el 64,3% de los pacientes correspondió al grupo etáreo de 6-9 años, predominó el sexo masculino con 57,1 % y raza blanca con 64,3%. Los síntomas y signos más frecuente antes del tratamiento fueron la conciencia de sus dificultades en el 100 % de los pacientes y la ansiedad en 92,8%. Después del tratamiento en el grupo experimental hubo mayor disminución de la ansiedad con 28,6% y el 71,4% de este grupo consideró su evolución satisfactoria. Conclusión: en ambos grupos de estudio predominó la edad entre 6 y 9 años, el sexo masculino, la raza blanca y los síntomas y signos más frecuentes fueron: la conciencia de sus dificultades y la ansiedad. En pacientes del grupo experimental la evolución fue más satisfactoria y hubo una mayor reducción de la ansiedad (AU).

SUMMARY Introduction: a prospective, longitudinal experimental study on the treatment of children with stuttering using the habitual treatment and the addition of Auriculotherapy in the Provincial Auditory Center in Matanzas, from January to December 2017. Objective: to compare the clinical evolution of the patients with the habitual treatment and with the addition of auriculotherapy. Materials and methods: the universe of study was 14 patients with stuttering. According to the arrival of the patients to the consultation they were alternatively located in two groups, a control one treated with the customary treatment, and an experimental one treated with the usual treatment plus auriculotherapy. The clinical records were elaborated with a logo-phoniatric assessment before and after treatment. Results: 64.3 % of patients were in the 6-9 years-old age group; male sex and white race predominated, with 57.1 % and 64.3 % respectively. The most frequent symptoms and signs before treatment were the consciousness of their difficulties in 100 % of patients, and anxiety in 92.8 % of them. After treatment, there it was a higher diminution of anxiety for 28.6 % in the experimental group, and 71.4 % of them considered satisfactory their evolution. Conclusion: age between 6 and 9 years, male sex and white race predominated in both groups; the most frequent symptoms and signs were the consciousness of their difficulties and anxiety. In the experimental group the evolution was satisfactory and the reduction of anxiety was higher (AU).

Ensaio Clínico de Tratamento da Gagueira: estudo piloto com variável monitorada, participação do cão na sessão de terapia / Clinical Trial for Stuttering Treatment: pilot study about dog participation in the therapy session

RESUMO Objetivo Verificar o efeito da intervenção do cão na sessão regular de terapia fonoaudiológica para a gagueira do desenvolvimento em jovens adultos. Método Foram selecionados jovens adultos e adultos com diagnóstico de gagueira do desenvolvimento. Concluíram o estudo oito participantes, seis do sexo masculino e dois do sexo feminino, com idades variando entre 16 e 45 anos. Os participantes foram divididos em dois grupos: G1 - que realizou o tratamento para gagueira com a presença de um cão terapeuta em sala de terapia e G2 - que realizou o tratamento para gagueira sem a presença do cão terapeuta. Foi incluído um grupo controle, G3 - composto por participantes fluentes, pareado em idade e sexo ao G1 e G2, para controle da variabilidade natural da fluência da fala. Resultados A análise comparativa entre os grupos indicou que o grupo que realizou o tratamento sem a presença do cão alcançou melhores índices de performance, evolução e eficácia. Conclusão Para a população pesquisada neste estudo, não foi observado efeito da intervenção do cão na terapia fonoaudiológica.

ABSTRACT Purpose To verify the effect of dog intervention on the regular session of speech therapy for developmental stuttering in adults. Methods The study involved young adults and adults with developmental stuttering. The study sample was composed of eight participants, six males and two females, ranging in age from 16 to 45 years. Participants were divided into two groups: G1 - those who underwent treatment for stuttering with the presence of a dog-therapist in the therapy room and G2 - those who underwent treatment for stuttering without the presence of the dog therapist. We included a control group, G3, composed of fluent participants, matched in age and sex to G1 and G2 to control the natural variability of speech fluency. Results Comparative results between the groups indicated that the group that performed the treatment without the presence of the dog achieved better performance, evolution and efficacy rates. Conclusion for the population in this study, the dog intervention on speech therapy did not improve treatment.

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.

Tratamento homeopático em crianças com tartamudez: relato de caso

Através do relato de um caso clínico de Tartamudez o autor procura demonstrar a eficácia do tratamento homeopático, respeitadas as individualidades de cada paciente. Comenta a restrita bibliografia referente ao tema e discute o resultado obtido por tratamento fonoaudiológico associado a Homeopatia. Conclui pelo sucesso obtido com a abordagem homeopática, que inclui minuciosa anamnese e individualização. (AU)

Through the report of a clinical case of stuttering the autor tries to demonstrate the effectiveness of the homeopatic treatment, respeting the individualities of each patient. It comments the narrow biobliography that refers to the subject and discuss the obtained result by speech therapy associated with Homeopathy. It concludes by the sucess with homeopathic approach, which includes detailed anamnesis and individualization. (AU)

The effects of actors vocal exercises for relaxation on fluency: A preliminary study.

PURPOSE: To determine the efficacy of treatment based on Kristin Linklater's technique for vocal preparation for performance for use with people who stutter. METHOD: A protocol for a treatment for stuttering involving breathing exercises, relaxation techniques, and focus on awareness was designed by the first author from Linklater's published exercises in her book Freeing the Natural Voice (2006). Four adults who stutter participated in a 12-week, single-case reversal design study. Treatment efficacy was determined by baseline and post-treatment measures on the OASES, self-report naturalness, tension and severity scale, and percentage of stuttering-like disfluency (SLD). Qualitative measures included a daily tension and practice log, a program completion questionnaire, and accounts from the clinicians administering the treatment protocol. RESULTS: Three of four participants scored lower on the OASES post-treatment, suggesting that the impact of stuttering on their daily lives had decreased. All four experienced a reduction in the number of SLD counted throughout treatment sessions compared to baseline data. CONCLUSION: A treatment for stuttering based on Linklater's work including regulation of breathing, relaxation, and awareness of breath may be effective in improving fluency and decreasing the impact of stuttering and warrants further study.

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.

Carry-over fluency induced by extreme prolongations: A new behavioral paradigm.

Extreme prolongations, which can be generated via extreme delayed auditory feedback (DAF) (e.g., 250-500 ms) or mediated cognitively with timing applications (e.g., analog stopwatch) at 2 s per syllable, have long been behavioral techniques used to inhibit stuttering. Some therapies have used this rate solely to establish initial fluency, while others use extremely slowed speech to establish fluency and add other strategic techniques such as easy onsets and diaphragmatic breathing. Extreme prolongations generate effective, efficient, and immediate forward flowing fluent speech, removing the signature behaviors of discrete stuttering (i.e., syllable repetitions and audible and inaudible postural fixations). Prolonged use of extreme prolongations establishes carry-over fluency, which is spontaneous, effortless speech absent of most, if not all, overt and covert manifestations of stuttering. The creation of this immediate fluency and the immense potential of extreme prolongations to generate long periods of carry-over fluency have been overlooked by researchers and clinicians alike. Clinicians depart from these longer prolongation durations as they attempt to achieve the same fluent results at a near normal rate of speech. Clinicians assume they are re-teaching fluency and slow rates will give rise to more normal rates with less control, but without carry-over fluency, controls and cognitive mediation are always needed for the inherently unstable speech systems of persons who stutter to experience fluent speech. The assumption being that the speech system is untenable without some level of cognitive and motoric monitoring that is always necessary. The goal is omnipresent "near normal rate sounding fluency" with continuous mediation via cognitive and motoric processes. This pursuit of "normal sounding fluency" continues despite ever-present relapse. Relapse has become so common that acceptance of stuttering is the new therapy modality because relapse has come to be understood as somewhat inevitable. Researchers and clinicians fail to recognize that immediate amelioration of stuttering and its attendant carry-over fluency are signs of a different pathway to fluency. In this path, clinicians focus on extreme prolongations and the extent of their carry-over. While fluency is automatically generated under these extreme prolongations, the realization is that communication at this rate in routine speaking tasks is not feasible. The perceived solution is a systematic reduction in the duration of these prolongations, which attempts to approximate "normal speech." Typically, the reintroduction of speech at a normalized rate precipitates a laborious style that is undesirable to the person who stutters (PWS) and is discontinued, once departed from the comforts of the clinical setting. The inevitable typically occurs; the well-intentioned therapist instructs the PWS to focus on the techniques while speaking at a rate that is nearest normal speech, but the overlooked extreme prolongations are unlikely to ever be revisited. The foundation of this hypothesis is that the departure from fluency generators (e.g. extreme prolongations) is the cause of regression to the stuttering set point. In turn, we postulate that the continued use of extreme prolongations, as a solitary practice method, will establish and nurture different neural pathways that will create a modality of fluent speech, able to be experienced without cognitive or motoric mediation. This would therefore result in fewer occurrences of stuttering due to a phenomenon called carry-over fluency. Thus, we hypothesize that the use of extreme prolongations fosters neural pathways for fluent speech, which will result in carry-over fluency that does not require mediation by the speaker.

Economic evaluation of stuttering treatment in preschool children: The RESTART-study.

PURPOSE: The purpose of this study was to evaluate the incremental cost-effectiveness and cost-utility of the Lidcombe Program (LP) compared with treatment based on the Demands and Capacities Model (RESTART-DCM) for preschool children who stutter. METHOD: A cost-effectiveness and cost-utility analysis were carried out alongside a Randomized Clinical Trial (the RESTART-study). In total, 199 children in 20 speech clinics participated. Outcome measures included the number needed to treat, based on the percentage of children who did not stutter at 18 months, and Health-related Quality of Life (EQ-VAS and HUI3) at 3, 6, 12 and 18 months. Health-related Quality of Life scores were used to calculate quality adjusted life years (V-QALYs for the EQ-VAS and U-QALYs for the HUI3). Direct and indirect costs were measured by cost questionnaires. Missing data were multiply imputed. Percentages of children who did not stutter in both groups were compared by a chi-square test. Between-group differences in mean QALYs and costs, as well as cost effectiveness and cost-utility ratios, were evaluated by applying bootstrapping techniques. RESULTS: After 18 months, health outcomes were slightly better in the LP group, although only the difference in V-QALYs was statistical significant (0.018; 95% CI: 0.008 to 0.027) with a small effect size (Cohen's d=0.17). Mean costs for the LP group were significantly higher compared to the RESTART-DCM group (€3199 versus €3032), again with a small effect size (Cohen's d=0.14). The incremental cost-effectiveness ratio was €3360 for one additional child who did not stutter with the LP, and the estimated cost-utility ratios were €10,413 (extra cost per extra V-QALY) and €18,617 (extra cost per extra U-QALY). The results indicated a high probability that the LP is cost-effective compared to RESTART-DCM treatment given a threshold for willingness-to-pay of €20,000 per QALY. CONCLUSIONS: Differences in effects and costs between the LP and RESTART-DCM treatment were small. Cost-effectiveness and cost-utility ratios were in favor of the LP. The LP is considered a good alternative to RESTART-DCM treatment in Dutch primary care.

Stuttering inhibition via altered auditory feedback during scripted telephone conversations.

BACKGROUND: Overt stuttering is inhibited by approximately 80% when people who stutter read aloud as they hear an altered form of their speech feedback to them. However, levels of stuttering inhibition vary from 60% to 100% depending on speaking situation and signal presentation. For example, binaural presentations of delayed auditory feedback (DAF) and frequency-altered feedback (FAF) have been shown to reduce stuttering by approximately 57% during scripted telephone conversations. AIMS: To examine stuttering frequency under monaural auditory feedback with one combination of DAF with FAF (COMBO-2) and two combinations of DAF with FAF (COMBO-4) during scripted telephone conversations. METHODS & PROCEDURES: Nine adult participants who stutter called 15 local businesses during scripted telephone conversations; each condition consisted of five randomized telephone calls. Conditions consisted of (1) baseline (i.e. non-altered feedback), (2) COMBO-2 (i.e. 50-ms delay with a half octave spectral shift up), and (3) COMBO-4 (i.e. 200-ms delay and a half octave spectral shift down in addition to the COMBO-2). Participants wore a supra-aural headset with a dynamic condenser microphone while holding a receiver to their contralateral ear when making telephone calls. OUTCOMES & RESULTS: Stuttering was significantly reduced during both altered auditory feedback (AAF) conditions by approximately 65%. Furthermore, a greater reduction in stuttering was revealed during the COMBO with four effects (74%) as compared with the COMBO with two effects (63%). CONCLUSIONS & IMPLICATIONS: Results from the current study support prior research reporting decreased stuttering under AAF during scripted telephone conversations. Findings that stuttering was significantly reduced to a greater extent under the COMBO with four effects condition suggest that second signals reduce stuttering along a continuum. Additionally, findings support prior research results of decreased stuttering frequency under AAF during hierarchically difficult speaking situations. Clinical application of these findings may be that people who stutter can use specific software or smartphone applications that produce second speech signals to inhibit stuttering frequency effectively during telephone conversations.

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.