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.

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.

The Effects of Parent-Focused Slow Relaxed Speech Intervention on Articulation Rate, Response Time Latency, and Fluency in Preschool Children Who Stutter.

Purpose: This study investigated the effects of an intervention to reduce caregivers' articulation rates with children who stutter on (a) disfluency, (b) caregiver and child's articulation rates, and (c) caregiver and child's response time latency (RTL). Method: Seventeen caregivers and their preschool children who stuttered participated in a group study of treatment outcomes. One speech sample was collected as a baseline, and 2 samples were collected after treatment. Posttreatment samples were of caregivers speaking as they typically would and using reduced articulation rates. Results: Caregivers reduced articulation rates significantly in the 2 posttreatment samples, and a significant decrease of stuttering-like disfluencies (SLD) was found in the children in those 2 samples. No direct relationship was found between the caregiver's articulation rate and RTL, and there was a small correlation of RTL with the lower levels of SLD found postintervention. No significant relationships were found between the reduced levels of SLD and articulation rates for either caregivers or children. Conclusions: Results suggest caregivers can be trained to slow their speech, and children increased their fluency at the end of a program designed to slow caregiver articulation. The intentionally slower rate of the caregivers, however, was not significantly related to fluency.

Differences of articulation rate and utterance length in fluent and disfluent utterances of preschool children who stutter.

PURPOSE: The purpose of this study was to investigate characteristics of four types of utterances in preschool children who stutter: perceptually fluent, containing normal disfluencies (OD utterance), containing stuttering-like disfluencies (SLD utterance), and containing both normal and stuttering-like disfluencies (SLD+OD utterance). Articulation rate and length of utterance were measured to seek the differences. Because articulation rate may reflect temporal aspects of speech motor control, it was predicted that the articulation rate would be different between perceptually fluent utterances and utterances containing disfluencies. The length of utterance was also expected to show different patterns. METHOD: Participants were 14 preschool children who stutter. Disfluencies were identified from their spontaneous speech samples, and articulation rate in syllables per second and utterance length in syllables were measured for the four types of utterances. RESULTS AND DISCUSSION: There was no significant difference in articulation rate between each type of utterance. Significantly longer utterances were found only in SLD+OD utterances compared to fluent utterances, suggesting that utterance length may be related to efforts in executing motor as well as linguistic planning. The SLD utterance revealed a significant negative correlation in that longer utterances tended to be slower in articulation rates. Longer utterances may place more demand on speech motor control due to more linguistic and/or grammatical features, resulting in stuttering-like disfluencies and a decreased rate.

Characteristics of disfluency clusters over time in preschool children who stutter.

PURPOSE: Disfluency clusters in preschool children were analyzed to determine whether they occurred at rates above chance, whether they changed over time, and whether they could differentiate children who would later persist in, or recover from, stuttering. METHOD: Thirty-two children recruited near stuttering onset were grouped on the basis of their eventual course of stuttering and matched to 16 normally fluent children. Clusters were classified as stuttering-like disfluencies (SLD), other disfluencies (OD), or mixed (SLD and OD combined). Cluster frequency and length were calculated for all children and again after 6 months for those who stuttered. RESULTS: Clusters occurred at rates greater than chance for both stuttering and normally fluent children. Children who stuttered had significantly more and longer clusters than did normally fluent children. Close to stuttering onset, clusters did not differentiate the course of stuttering. Cluster frequency and length decreased over time for children in the persistent and recovered groups. The proportion of disfluencies in clusters was significantly lower in the recovered group than it was in the persistent group after 6 months. CONCLUSIONS: Clusters are an integral part of disfluent speech in preschool children in general. Although they do not serve as indicators of recovery or persistency at the onset of stuttering, they may have some prognostic value several months later.

Influences of rate, length, and complexity on speech disfluency in a single-speech sample in preschool children who stutter.

UNLABELLED: The purpose of the present study was (1) to determine whether speech rate, utterance length, and grammatical complexity (number of clauses and clausal constituents per utterance) influenced stuttering-like disfluencies as children became more disfluent at the end of a 1200-syllable speech sample [Sawyer, J., & Yairi, E. (2006). The effect of sample size on the assessment of stuttering severity. American Journal of Speech-Language Pathology, 15, 36-44] and (2) to explore the interaction of speech rate, length, and grammatical complexity at the beginning (syllables 1-300, Section A) and the end (syllables 901-1200, Section B) of the speech sample. Participants were eight boys and six girls (M=40.9 months) who were selected from the Sawyer and Yairi [Sawyer, J., & Yairi, E. (2006). The effect of sample size on the assessment of stuttering severity. American Journal of Speech-Language Pathology, 15, 36-44] study. Mean length of utterance (MLU) in morphemes, the number of clauses, clausal constituents, and articulation rate, measured in syllables per second were analyzed from the children's conversational speech. The median split procedure [Logan, K., & Conture, E. (1995). Length, grammatical complexity, and rate differences in stuttered and fluent conversational utterances of children who stutter. Journal of Fluency Disorders, 20, 35-61; Yaruss, J. S. (1997). Utterance timing and childhood stuttering. Journal of Fluency Disorders, 22, 263-286] was used to study interactions between articulation rate, utterance length, and grammatical complexity across the two sections. The mean number of clauses per utterance, clausal constituents per utterance, and articulation rate revealed no significant differences between Section A and Section B, whereas MLU significantly increased in Section B (p=.013). Clausal constituents and MLU were significantly correlated both in Sections A and B. The median split procedure revealed trends for utterances characterized as high length and low-speech rate to be greater in number in Section B than A, but the differences were not significant. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (a) describe the influence of grammatical complexity and mean length of utterance on disfluent speech; (b) compare different procedures for assessing speech rate and determine why the effects of articulation rate have been inconclusive; (c) discuss procedures for comparing length, rate, and complexity across a single-speech sample; and (d) explain why therapeutic methods that emphasize shorter utterance lengths, rather than only slower speech rates, are advisable in establishing fluency in preschool children who stutter.

The effect of sample size on the assessment of stuttering severity.

The relationships between the length of the speech sample and the resulting disfluency data in 20 stuttering children who exhibited a wide range of disfluency levels were investigated. Specifically, the study examined whether the relative number of stuttering-like disfluencies (SLD) per 100 syllables, as well as the length of disfluencies (number of iterations per disfluent event), varied systematically across 4 consecutive, 300-syllable sections in the same speech sample. The difference in the number of SLD per 100 syllables between the early and later sections of the speech sample was statistically significant. In addition, the length of the speech sample had a critical influence on the identification of stuttering in children exhibiting relatively low levels of disfluency. Also, when a 20% difference in the number of SLD per 100 syllables was taken as a criterion, 50% of the children exhibited upward shifts in continuous speech samples that were longer than 300 syllables (i.e., 600, 900, and 1,200 syllables). Results indicated that, in general, group means for SLD grew larger as the sample size increased. The length of disfluent events did not significantly differ as the sample size increased; however, there were large differences for some children. Implications for clinicians and investigators are discussed.