Communicative Fluency and the Experience of Stuttering: A Viewpoint.

PURPOSE: Despite ambiguity in meaning and usage, "fluency" has played a central role in the understanding and treatment of developmental stuttering. The appropriateness of the term fluency in association with so-called fluency disorders, such as stuttering, has recently been questioned. The purpose of this article is to propose that fluency is best conceptualized as the efficiency of goal-directed action through cybernetic function. Spoken utterances are examples of sequences of action for the fulfillment of a hierarchy of nested and increasingly abstract social goals, including behaviors (e.g., introducing oneself) and values (e.g., being a sociable person). In contrast, some moments of speech disfluency, such as stuttering disfluencies, are inefficiencies in goal-directed action that may or may not hinder the fulfillment of higher level communicative behaviors and values, described here as communicative fluency. CONCLUSIONS: The concept of communicative fluency refers to the continual, reliable, and upward fulfillment of increasingly abstract social goals in the form of communicative actions, behaviors, and values. This expanded conceptualization of fluency beyond simply speech production has the potential to be a useful indicator of psychosocial well-being for individuals who stutter.

Speech intelligibility loss due to amyotrophic lateral sclerosis: the effect of tongue movement reduction on vowel and consonant acoustic features.

The purpose of this study was to identify aspects of impaired tongue motor performance that limit the ability to produce distinct speech sounds and contribute to reduced speech intelligibility in individuals with dysarthria secondary to amyotrophic lateral sclerosis (ALS). We analyzed simultaneously recorded tongue kinematic and acoustic data from 22 subjects during three target words (cat, dog, and took). The subjects included 11 participants with ALS and 11 healthy controls from the X-ray microbeam dysarthria database (Westbury, 1994). Novel measures were derived based on the range and speed of relative movement between two quasi-independent regions of the tongue - blade and dorsum - to characterize the global pattern of tongue dynamics. These "whole tongue" measures, along with the range and speed of single tongue regions, were compared across words, groups (ALS vs. control), and measure types (whole tongue vs. tongue blade vs. tongue dorsum). Reduced range and speed of both global and regional tongue movements were found in participants with ALS relative to healthy controls, reflecting impaired tongue motor performance in ALS. The extent of impairment, however, varied across words and measure types. Compared with the regional tongue measures, the whole tongue measures showed more consistent disease-related changes across the target words and were more robust predictors of speech intelligibility. Furthermore, these whole tongue measures were correlated with various word-specific acoustic features associated with intelligibility decline in ALS, suggesting that impaired tongue movement likely contributes to reduced phonetic distinctiveness of both vowels and consonants that underlie speech intelligibility decline in ALS.

Emotion processing in children who do and do not stutter: An ERP study of electrocortical reactivity and regulation to peer facial expressions.

PURPOSE: Event-related brain potentials (ERPs) were used to investigate the neural correlates of emotion processing in 5- to 8-year-old children who do and do not stutter. METHODS: Participants were presented with an audio contextual cue followed by images of threatening (angry/fearful) and neutral facial expressions from similarly aged peers. Three conditions differed in audio-image pairing: neutral context-neutral expression (neutral condition), negative context-threatening expression (threat condition), and reappraisal context-threatening expression (reappraisal condition). These conditions reflected social stimuli that are ecologically valid to the everyday life of children. RESULTS: P100, N170, and late positive potential (LPP) ERP components were elicited over parietal and occipital electrodes. The threat condition elicited an increased LPP mean amplitude compared to the neutral condition across our participants, suggesting increased emotional reactivity to threatening facial expressions. In addition, LPP amplitude decreased during the reappraisal condition- evidence of emotion regulation. No group differences were observed in the mean amplitude of ERP components between children who do and do not stutter. Furthermore, dimensions of childhood temperament and stuttering severity were not strongly correlated with LPP elicitation. CONCLUSION: These findings are suggestive that, at this young age, children who stutter exhibit typical brain activation underlying emotional reactivity and regulation to social threat from peer facial expressions.

Modulation of Intermuscular Beta Coherence in Different Rhythmic Mandibular Behaviors.

INTRODUCTION: Jaw movement during chewing and speech is facilitated by neural activation patterns for opening and closing movements of the mandible. This study investigated anatomic- and task-dependent differences in intermuscular coherence (IMC) and their association with the parameters of jaw muscle activity using surface electromyography (sEMG). METHODS: We recorded sEMG activation from bilateral and ipsilateral jaw-closing muscle pairs during non-nutritive and nutritive chewing, and during a syllable repetition task. IMC and cross-correlational analyses between bilateral and ipsilateral muscle pairs were performed. RESULTS: Intermuscular coherence in the beta band was statistically significant between agonist jaw-closing muscle pairs, with beta IMC weaker for rapid syllable repetition compared to chewing tasks. Cross-correlational analysis of muscle co-activation, as well as sEMG burst amplitude, was positively associated with beta IMC strength. DISCUSSION: Beta IMC was influenced heavily by task-dependent behavioral goals and physiologic demands, which was interpreted as evidence of shared neural drive among jaw-closing muscles.

Emotional reactivity and regulation in 5- to 8-year-old children: An ERP study of own-age face processing.

The school-age years is a period of increasing social interaction with peers and development of emotion regulation in facilitating that interaction. This study was an investigation of the neural correlates of emotional reactivity and reappraisal in typically developing school-age children elicited by threatening facial expressions of same-aged peers. This experimental paradigm is novel in eliciting event-related brain potentials (ERPs) to social stimuli that are ecologically valid to the everyday life of children. ERPs of 5- to 8-year-old children (N = 41, 18 females) were elicited by threatening (i.e., angry and fearful) and neutral child facial expressions, which were preceded by audio contextual cues. Three conditions differed in audio-image pairing: neutral context-neutral expression (neutral condition), negative context-threatening expression (threat condition), and reappraisal context-threatening expression (reappraisal condition). In addition, parental reporting of childhood temperament was collected to determine if elicited ERP morphologies were associated with temperamental dimensions of negative affect, extraversion, and effortful control. Elicitation of the P100 and N170 did not largely differ between conditions; however, amplitude of the late positive potential (LPP), a marker of heightened emotional reactivity and attention, was greater for threatening faces relative to neutral faces. During the reappraisal condition, no differences in ERP activity was observed compared to the threat condition. Neural substrates of emotional reactivity to social threat from peers were evident; however, the lack of ERP modulation facilitating reappraisal and the lack of strong associations between ERP morphology and temperamental dimensions is indicative of heterogeneity in LPP elicitation underlying emotion regulation in children.

Physiological Correlates of Fluent and Stuttered Speech Production in Preschool Children Who Stutter.

Purpose The purpose of this study was to compare physiological indices of sympathetic nervous system arousal recorded during fluent and stuttered utterances in a preschool children who stutter (CWS). Method Twenty-two 4- to 5-year-old CWS participated in the experiment. We recorded children's skin conductance response amplitude and frequency, blood pulse volume amplitude, and pulse rate as they completed a picture description task. We then compared indices of phasic sympathetic arousal recorded during stuttered versus fluent utterances. In addition, children's communication attitudes were evaluated with a self-report measure. Results We detected significantly higher sympathetic arousal during stuttered utterances compared to fluent utterances. Specifically, we found larger skin conductance responses occurring at an increased frequency and decreased blood pulse volume amplitudes during stuttered speech. The behavioral measure indicated a negative communication attitude in only one-third of the participants. Conclusion Our findings suggest that preschool CWS may exhibit higher levels of sympathetic arousal during stuttered speech compared to when they are speaking fluently. We discuss the potential impact of increased sympathetic arousal on speech regulatory mechanisms in early childhood stuttering and present questions to guide future research.

Retrieval-Based Word Learning in Young Typically Developing Children and Children With Development Language Disorder II: A Comparison of Retrieval Schedules.

Purpose Retrieval practice has been found to be a powerful strategy to enhance long-term retention of new information; however, the utility of retrieval practice when teaching young children new words is largely unknown, and even less is known for young children with language impairments. The current study examined the effect of 2 different retrieval schedules on word learning at both the behavioral and neural levels. Method Participants included 16 typically developing children ( M TD = 61.58 months) and 16 children with developmental language disorder ( M DLD = 59.60 months). Children participated in novel word learning sessions in which the spacing of retrieval practice was manipulated: Some words were retrieved only after other words had been presented (i.e., repeated retrieval that required contextual reinstatement [RRCR]); others were taught using an immediate retrieval schedule. In Experiment 1, children's recall of the novel word labels and their meanings was tested after a 5-min delay and a 1-week delay. In Experiment 2, event-related brain potentials were obtained from a match-mismatch task utilizing the novel word stimuli. Results Experiment 1 findings revealed that children were able to label referents and to retain the novel words more successfully if the words were taught in the RRCR learning condition. Experiment 2 findings revealed that mismatching picture-word pairings elicited a robust N400 event-related brain potential only for words that were taught in the RRCR condition. In addition, children were more accurate in identifying picture-word matches and mismatches for words taught in the RRCR condition, relative to the immediate retrieval condition. Conclusions Retrieval practice that requires contextual reinstatement through spacing results in enhanced word learning and long-term retention of words. Both typically developing children and children with developmental language disorder benefit from this type of retrieval procedure. Supplemental Material https://doi.org/10.23641/asha.7927112.

The Effects of Syntactic Complexity and Sentence Length on the Speech Motor Control of School-Age Children Who Stutter.

Purpose: Early childhood stuttering is associated with atypical speech motor development. Compared with children who do not stutter (CWNS), the speech motor systems of school-age children who stutter (CWS) may also be particularly susceptible to breakdown under increased processing demands. The effects of increased syntactic complexity and sentence length on articulatory coordination were investigated. Method: Kinematic, temporal, and behavioral indices of articulatory coordination were quantified for school-age CWS (n = 19) and CWNS (n = 18). Participants produced 4 sentences varying in syntactic complexity (simple declarative/complex declarative with a relative clause) and sentence length (short/long). Lip aperture variability (LAVar) served as a kinematic measure of interarticulatory consistency over repeated productions. Articulation rate (syllables per second) was also calculated as a related temporal measure. Finally, we computed accuracy and stuttering frequency percentages for each sentence to assess task performance. Results: Increased sentence length, but not syntactic complexity, increased LAVar in both groups. This effect was disproportionately greater for CWS compared with CWNS. No group differences were observed for articulation rate. CWS were also less accurate in their sentence productions than fluent peers and exhibited more instances of stuttering when processing demands associated with length and syntactic complexity increases. Conclusions: The speech motor systems of school-age CWS appear to be particularly vulnerable to processing demands associated with increased sentence length, as evidenced by increased LAVar. Increasing the length and complexity of the sentence stimuli also resulted in reduced production accuracy and increased stuttering frequency. We discuss these findings within a motor control framework of speech production.

What Are Predictors for Persistence in Childhood Stuttering?

Over the past 10 years, we (the Purdue Stuttering Project) have implemented longitudinal studies to examine factors related to persistence and recovery in early childhood stuttering. Stuttering develops essentially as an impairment in speech sensorimotor processes that is strongly influenced by dynamic interactions among motor, language, and emotional domains. Our work has assessed physiological, behavioral, and clinical features of stuttering within the motor, linguistic, and emotional domains. We describe the results of studies in which measures collected when the child was 4 to 5 years old are related to eventual stuttering status. We provide supplemental evidence of the role of known predictive factors (e.g., sex and family history of persistent stuttering). In addition, we present new evidence that early delays in basic speech motor processes (especially in boys), poor performance on a nonword repetition test, stuttering severity at the age of 4 to 5 years, and delayed or atypical functioning in central nervous system language processing networks are predictive of persistent stuttering.

An Initial Investigation of the Neural Correlates of Word Processing in Preschoolers With Specific Language Impairment.

Purpose: Previous behavioral studies have found deficits in lexical-semantic abilities in children with specific language impairment (SLI), including reduced depth and breadth of word knowledge. This study explored the neural correlates of early emerging familiar word processing in preschoolers with SLI and typical development. Method: Fifteen preschoolers with typical development and 15 preschoolers with SLI were presented with pictures followed after a brief delay by an auditory label that did or did not match. Event-related brain potentials were time locked to the onset of the auditory labels. Children provided verbal judgments of whether the label matched the picture. Results: There were no group differences in the accuracy of identifying when pictures and labels matched or mismatched. Event-related brain potential data revealed that mismatch trials elicited a robust N400 in both groups, with no group differences in mean amplitude or peak latency. However, the typically developing group demonstrated a more robust late positive component, elicited by mismatch trials. Conclusions: These initial findings indicate that lexical-semantic access of early acquired words, indexed by the N400, does not differ between preschoolers with SLI and typical development when highly familiar words are presented in isolation. However, the typically developing group demonstrated a more mature profile of postlexical reanalysis and integration, indexed by an emerging late positive component. The findings lay the necessary groundwork for better understanding processing of newly learned words in children with SLI.

Neural Indices of Semantic Processing in Early Childhood Distinguish Eventual Stuttering Persistence and Recovery.

Purpose: Maturation of neural processes for language may lag in some children who stutter (CWS), and event-related potentials (ERPs) distinguish CWS who have recovered from those who have persisted. The current study explores whether ERPs indexing semantic processing may distinguish children who will eventually persist in stuttering (CWS-ePersisted) from those who will recover from stuttering (CWS-eRecovered). Method: Fifty-six 5-year-old children with normal receptive language listened to naturally spoken sentences in a story context. ERP components elicited for semantic processing (N400, late positive component [LPC]) were compared for CWS-ePersisted, CWS-eRecovered, and children who do not stutter (CWNS). Results: The N400 elicited by semantic violations had a more focal scalp distribution (left lateralized and less anterior) in the CWS-eRecovered compared with CWS-ePersisted. Although the LPC elicited in CWS-eRecovered and CWNS did not differ, the LPC elicited in the CWS-ePersisted was smaller in amplitude compared with that in CWNS. Conclusions: ERPs elicited in 5-year-old CWS-eRecovered compared with CWS-ePersisted suggest that future recovery from stuttering may be associated with earlier maturation of semantic processes in the preschool years. Subtle differences in ERP indices offer a window into neural maturation processes for language and may help distinguish the course of stuttering development.

A Lag in Speech Motor Coordination During Sentence Production Is Associated With Stuttering Persistence in Young Children.

Purpose: The purpose of this study was to determine if indices of speech motor coordination during the production of sentences varying in sentence length and syntactic complexity were associated with stuttering persistence versus recovery in 5- to 7-year-old children. Methods: We compared children with persistent stuttering (CWS-Per) with children who had recovered (CWS-Rec), and children who do not stutter (CWNS). A kinematic measure of articulatory coordination, lip aperture variability (LAVar), and overall movement duration were computed for perceptually fluent sentence productions varying in length and syntactic complexity. Results: CWS-Per exhibited higher LAVar across sentence types compared to CWS-Rec and CWNS. For the participants who successfully completed the experimental paradigm, the demands of increasing sentence length and syntactic complexity did not appear to disproportionately affect the speech motor coordination of CWS-Per compared to their recovered and fluent peers. However, a subset of CWS-Per failed to produce the required number of accurate utterances. Conclusions: These findings support our hypothesis that the speech motor coordination of school-age CWS-Per, on average, is less refined and less mature compared to CWS-Rec and CWNS. Childhood recovery from stuttering is characterized, in part, by overcoming an earlier occurring maturational lag in speech motor development.

Neurodevelopment for syntactic processing distinguishes childhood stuttering recovery versus persistence.

BACKGROUND: Characterized by the presence of involuntary speech disfluencies, developmental stuttering is a neurodevelopmental disorder of atypical speech-motor coordination. Although the etiology of stuttering is multifactorial, language development during early childhood may influence both the onset of the disorder and the likelihood of recovery. The purpose of this study was to determine whether differences in neural indices mediating language processing are associated with persistence or recovery in school-age children who stutter. METHODS: Event-related brain potentials (ERPs) were obtained from 31 6-7-year-olds, including nine children who do not stutter (CWNS), 11 children who had recovered from stuttering (CWS-Rec), and 11 children who persisted in stuttering (CWS-Per), matched for age, and all with similar socioeconomic status, nonverbal intelligence, and language ability. We examined ERPs elicited by semantic and syntactic (phrase structure) violations within an auditory narrative consisting of English and Jabberwocky sentences. In Jabberwocky sentences, content words were replaced with pseudowords to limit semantic context. A mixed effects repeated measures analysis of variance (ANOVA) was computed for ERP components with four within-subject factors, including condition, hemisphere, anterior/posterior distribution, and laterality. RESULTS: During the comprehension of English sentences, ERP activity mediating semantic and syntactic (phrase structure) processing did not distinguish CWS-Per, CWS-Rec, and CWNS. Semantic violations elicited a qualitatively similar N400 component across groups. Phrase structure violations within English sentences also elicited a similar P600 component in all groups. However, identical phrase structure violations within Jabberwocky sentences elicited a P600 in CWNS and CWS-Rec, but an N400-like effect in CWS-Per. CONCLUSIONS: The distinguishing neural patterns mediating syntactic, but not semantic, processing provide evidence that specific brain functions for some aspects of language processing may be associated with stuttering persistence. Unlike CWS-Rec and CWNS, the lack of semantic context in Jabberwocky sentences seemed to affect the syntactic processing strategies of CWS-Per, resulting in the elicitation of semantically based N400-like activity during syntactic (phrase structure) violations. This vulnerability suggests neural mechanisms associated with the processing of syntactic structure may be less mature in 6-7-year-old children whose stuttering persisted compared to their fluent or recovered peers.

Nonword repetition and phoneme elision in adults who do and do not stutter: Vocal versus nonvocal performance differences.

PURPOSE: The purpose of the present study was to enhance our understanding of phonological working memory in adults who stutter through the comparison of nonvocal versus vocal nonword repetition and phoneme elision task performance differences. METHOD: For the vocal nonword repetition condition, participants repeated sets of 4- and 7-syllable nonwords (n=12 per set). For the nonvocal nonword repetition condition, participants silently identified each target nonword from a subsequent set of three nonwords. For the vocal phoneme elision condition, participants repeated nonwords with a target phoneme eliminated. For the nonvocal phoneme elision condition, participants silently identified the nonword with the designated target phoneme eliminated from a subsequent set of three nonwords. RESULTS: Adults who stutter produced significantly fewer accurate initial productions of 7-syllable nonwords compared to adults who do not stutter. There were no talker group differences for the silent identification of nonwords, but both talker groups required significantly more mean number of attempts to accurately silently identify 7-syllable as compared to 4-syllable nonwords. For the vocal phoneme elision condition, adults who stutter were significantly less accurate than adults who do not stutter in their initial production and required a significantly higher mean number of attempts to accurately produce 7-syllable nonwords with a phoneme eliminated. This talker group difference was also significant for the nonvocal phoneme elision condition for both 4- and 7-syllable nonwords. CONCLUSION: Present findings suggest phonological working memory may contribute to the difficulties persons who stutter have establishing and/or maintaining fluent speech. EDUCATIONAL OBJECTIVES: (a) Readers can describe the role of phonological working memory in planning for and execution of speech; (b) readers can describe two experimental tasks for exploring the phonological working memory: nonword repetition and phoneme elision; (c) readers can describe how the nonword repetition and phoneme elision skills of adults who stutter differ from their typically fluent peers.