Stuttering in adolescence and the risk for dysglycemia in early adulthood.

AIMS: To investigate the association between stuttering during adolescence and the onset of dysglycemia (prediabetes or type 2 diabetes) in early adulthood among men and women. MATERIALS AND METHODS: This cohort study included Maccabi Health Services members assessed for mandatory military service at ages 16-19 during 1990-2019 and followed until 31 December 2020. Stuttering status was recorded in the baseline medical evaluation. Incident cases of dysglycemia were identified systematically using prediabetes and diabetes registries. Cox proportional hazard models were applied for men and women separately, adjusting for sociodemographics and medical status. RESULTS: The study cohort comprised 866,304 individuals (55% men; 0.21% with stuttering) followed for a total of 12,696,250 person-years. During the study period, 7.6% (n = 36,603) of men and 9.0% (n = 34,723) of women were diagnosed with dysglycemia. The mean ages at diagnosis were 34 and 32 years for men and women, respectively. Women with stuttering exhibited the highest dysglycemia incidence rate (102.3 per 10,000 person-years) compared with the other groups (61.4, 69.0, and 51.9 per 10,000 person-years for women without stuttering, men with stuttering, and men without stuttering, respectively). For both men and women, those with stuttering showed an increased risk of being diagnosed with dysglycemia compared with those without (adjusted hazard ratios 1.18 [1.01-1.38] and 1.61 [1.15-2.26], respectively). The associations persisted in extensive sub-analyses. CONCLUSIONS: Stuttering in adolescence is associated with a higher risk of dysglycemia in early adulthood for men and women. Screening and targeted prevention in this population, especially women, may be beneficial.

Lower nonword syllable sequence repetition accuracy in adults who stutter is related to differences in audio-motor oscillations.

OBJECTIVE: The goal of this study was to use independent component analysis (ICA) of high-density electroencephalography (EEG) to investigate whether differences in audio-motor neural oscillations are related to nonword syllable repetition accuracy in a group of adults who stutter compared to typically fluent speakers. METHODS: EEG was recorded using 128 channels from 23 typically fluent speakers and 23 adults who stutter matched for age, sex, and handedness. EEG was recorded during delayed, 2 and 4 bilabial nonword syllable repetition conditions. Scalp-topography, dipole source estimates, and power spectral density (PSD) were computed for each independent component (IC) and used to cluster similar ICs across participants. Event-related spectral perturbations (ERSPs) were computed for each IC cluster to examine changes over time in the repetition conditions and to examine how dynamic changes in ERSPs are related to syllable repetition accuracy. RESULTS: Findings indicated significantly lower accuracy on a measure of percentage correct trials in the AWS group and for a normalized measure of syllable load performance across conditions. Analysis of ERSPs revealed significantly lower alpha/beta ERD in left and right µ ICs and in left and right posterior temporal lobe α ICs in AWS compared to TFS (CC p < 0.05). Pearson correlations with %CT for frequency across time showed strong relationships with accuracy (FWE<0.05) during maintenance in the TFS group and during execution in the AWS group. CONCLUSIONS: Findings implicate lower alpha/beta ERD (8-30 Hz) during syllable encoding over posterior temporal ICs and execution in left temporal/sensorimotor components. Strong correlations with accuracy and interindividual differences in ∼6-8 Hz ERSPs during execution implicate differences in motor and auditory-sensory monitoring during syllable sequence execution in AWS.

Evidence for planning and motor subtypes of stuttering based on resting state functional connectivity.

We tested the hypothesis, generated from the Gradient Order Directions Into Velocities of Articulators (GODIVA) model, that adults who stutter (AWS) may comprise subtypes based on differing connectivity within the cortico-basal ganglia planning or motor loop. Resting state functional connectivity from 91 AWS and 79 controls was measured for all GODIVA model connections. Based on a principal components analysis, two connections accounted for most of the connectivity variability in AWS: left thalamus - left posterior inferior frontal sulcus (planning loop component) and left supplementary motor area - left ventral premotor cortex (motor loop component). A k-means clustering algorithm using the two connections revealed three clusters of AWS. Cluster 1 was significantly different from controls in both connections; Cluster 2 was significantly different in only the planning loop; and Cluster 3 was significantly different in only the motor loop. These findings suggest the presence of planning and motor subtypes of stuttering.

Localization of stuttering based on causal brain lesions.

Stuttering affects approximately 1 in 100 adults and can result in significant communication problems and social anxiety. It most often occurs as a developmental disorder but can also be caused by focal brain damage. These latter cases may lend unique insight into the brain regions causing stuttering. Here, we investigated the neuroanatomical substrate of stuttering using three independent datasets: (i) case reports from the published literature of acquired neurogenic stuttering following stroke (n = 20, 14 males/six females, 16-77 years); (ii) a clinical single study cohort with acquired neurogenic stuttering following stroke (n = 20, 13 males/seven females, 45-87 years); and (iii) adults with persistent developmental stuttering (n = 20, 14 males/six females, 18-43 years). We used the first two datasets and lesion network mapping to test whether lesions causing acquired stuttering map to a common brain network. We then used the third dataset to test whether this lesion-based network was relevant to developmental stuttering. In our literature dataset, we found that lesions causing stuttering occurred in multiple heterogeneous brain regions, but these lesion locations were all functionally connected to a common network centred around the left putamen, including the claustrum, amygdalostriatal transition area and other adjacent areas. This finding was shown to be specific for stuttering (PFWE < 0.05) and reproducible in our independent clinical cohort of patients with stroke-induced stuttering (PFWE < 0.05), resulting in a common acquired stuttering network across both stroke datasets. Within the common acquired stuttering network, we found a significant association between grey matter volume and stuttering impact for adults with persistent developmental stuttering in the left posteroventral putamen, extending into the adjacent claustrum and amygdalostriatal transition area (PFWE < 0.05). We conclude that lesions causing acquired neurogenic stuttering map to a common brain network, centred to the left putamen, claustrum and amygdalostriatal transition area. The association of this lesion-based network with symptom severity in developmental stuttering suggests a shared neuroanatomy across aetiologies.

The experience of stuttering in everyday life among adults who stutter: The impact of trait social anxiety and the social situations.

PURPOSE: The purpose of this study was to investigate the emotional and stuttering experience of adults who stutter (AWS) in everyday life, and how that experience may be shaped by personal (i.e., trait social anxiety) and situational factors (i.e., social partner reaction, communication channel type, social closeness, stuttering knowledge). METHOD: AWS completed ecological momentary assessments on their smartphones multiple times a day for up to three weeks. Data (n = 62) were analyzed with multilevel models to determine how situational factors and trait social anxiety influence the Negative Affect (NA), Positive Affect (PA), and self-reported stuttering severity of AWS. RESULTS: Results indicated that having high (vs. low) trait social anxiety was associated with a tendency to experience high NA, low PA, and high self-reported stuttering severity among AWS. A range of situational factors significantly influenced the within-person variation of NA, PA, and self-reported stuttering severity in everyday life. In addition, interacting with distant social partners relative to being alone heightened NA, and the effect was more prominent among AWS with high (vs. low) trait social anxiety. CONCLUSIONS: Overall, the findings suggest that the variation of affects and stuttering severity among AWS can be partly accounted for by factors from both the situational and personal levels. Clinicians should be aware of the low PA experienced by AWS who have high (vs low) trait social anxiety in everyday life.

Development and validation of a research version of the Overall Assessment of the Speaker's Experience of Stuttering- Adult (OASES-A-R).

BACKGROUND: The Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A; Yaruss & Quesal, 2016) is a widely used measurement tool designed to evaluate the adverse impact associated with stuttering. Items examine general perceptions of stuttering, personal reactions to stuttering, functional communication difficulties, and consequences for quality of life. This paper presents a shortened research version of the OASES-A response form (OASES-A-R) that can be used by researchers in scientific studies involving adults who stutter that reflect the Section and Total Scores of the original OASES-A using fewer items. METHOD: Previously collected OASES-A data (N = 315) were analyzed via graded response modeling to identify discrimination values of each OASES-A item in measuring each OASES-A Section Total Score. Items with the highest discrimination and items judged by expert clinicians to be more important in measuring adverse impact (N = 27) were used to create a shortened OASES-A-R. The shortened OASES-A-R response form was then validated and compared to the full OASES-A response form in an independent sample (N = 156). RESULTS: The shortened 25-item OASES-A-R response form demonstrated very high and positive correlations with the full OASES-A response form. Similarly, each OASES-A-R Section demonstrated high internal reliability coefficients similar to those of the OASES-A. DISCUSSION: The resulting 25-item OASES-A-R response form provides a reflection of the speaker's experience of stuttering as measured by the original 100-item OASES-A that is suitable for use in certain research studies of adults who stutter. Clinical use is not recommended, as the full OASES-A provides additional insights about a client's experience of stuttering that are necessary for effective treatment planning and intervention.

Observer-rated outcomes of communication-centered treatment for adults who stutter: A social validation study.

Previous studies have reported that adults who stutter demonstrate significant gains in communication competence, per self-ratings and clinician-ratings, upon completion of a communication-centered treatment, or CCT. The purpose of this social validation study was to determine whether communication competence ratings reported by untrained observers are consistent with client and clinician judgments of communication competence gains following CCT. Eighty-one untrained observers completed an online survey that required each to view one of two videos depicting an adult who stutters during a mock interview recorded prior to CCT or after CCT. Observers were then asked to rate the communication competence of the interviewee on a 100-point visual analog scale and provide additional demographic information. Communication competence of the adult who stutters who had completed CCT was rated significantly higher in their post-treatment video. Upon controlling for two demographic factors found to be associated with observer ratings (years of education, years the observers had known an adult who stutters), significantly higher ratings of communication competence for the post-treatment video were maintained. These preliminary findings provide social validity for CCT by demonstrating that the gains in communication competence reported in previous studies through clinician and client observations are also reported by untrained observers who are not familiar with CCT.

A prospective 14-year follow-up study of the persistence and recovery of stuttering.

PURPOSE: To document the trajectory of early childhood stuttering longitudinally for 14. years with a consideration on the features of overt and covert stuttering related to recovery status. METHOD: Thirty-eight participants were observed longitudinally at three different time points: early childhood (Occasion 1), middle childhood (Occasion 2), and late adolescence (Occasion 3). Data collection involved speech samples and reports of stuttering experiences. Recovery on Occasion 3 was estimated through analysis of speech samples, parent and expert judgments, and self- judgement. Two categories of persistence were used: persistent-subjective (no observable stuttering) and persistent-objective (observable stuttering). RESULTS: The recovery rate was 65.6%. The majority of the participants showed minimal disfluent speech with 88% showing less than 1% syllables stuttered and 97% showing less than 3% syllables stuttered in the collected speech samples. All participants classified as persistent reported covert symptoms of stuttering. No relapses in recovery were observed between Occasion 2 and Occasion 3. Late recovery was only observed for those classified as persistent-subjective on Occasion 2. About 64% of the participants showing observable stuttering (persistent-objective) on Occasion 2 showed no observable stuttering (persistent-subjective) on Occasion 3. CONCLUSIONS: Children continue to recover from early childhood stuttering as they age.The inclusion of self-reports adds to the understanding of recovery especially concerning the covert stuttering behaviours. The presence of overt symptoms of stuttering in the speech samples of children aged 7 to 13 years seems to be associated with the likelihood of late recovery of stuttering.

Mental state verb use in play by preschool-age children who stutter and their mothers.

INTRODUCTION: Preschool-age children use mental state verbs (MSVs; e.g., think, know) to reference thoughts and other cognitive states. In play-based language, MSV use requires conversational flexibility, as speakers shift from discussion of actions happening in the here-and-now to more abstract discussion of mental states. Some evidence suggests that children who stutter (CWS) demonstrate subtle differences in shifting on experimental tasks of cognitive flexibility, differences which may extend to conversational flexibility. This study explored MSV use in conversational language between CWS and their mothers. METHODS: Thirty-five preschool-age CWS and 35 age- and gender-matched children who do not stutter (CWNS), all performing within the typical range on standardized language testing, conversed with their mothers during play. Samples were transcribed and coded for MSV use. RESULTS: No between-group differences were observed in MSV use, either between the CWS and CWNS or between the groups of mothers. Age and language skills were positively associated with MSV use in the CWNS group only. For both groups of dyads, mothers' MSV use corresponded at least to some extent to their children's language skills. Finally, correspondence between CWNS and their mothers was observed for two conversational language measures, representing lexical diversity and morphosyntax; this overall pattern was not observed in the CWS dyad group. CONCLUSIONS: Although these findings point to similar use of MSVs among the groups of children and their mothers, for the CWS group, the patterns of use in relation to age and language skills are somewhat different from developmental expectations.

Communicative practices and perceptions towards stuttering people in South Africa.

BACKGROUND:  A few studies have explored the life experiences of people who stutter. Research has shown that stuttering affects a significant number of people in the population. OBJECTIVES:  The study was designed to explore the experiences of people who stutter and the perception of stuttering in South Africa. METHOD:  Four people who identified as South Africans who stutter participated in this study. The primary investigator conducted semi-structured interviews with each of the participants. In addition, a questionnaire was administered to 20 acquaintances of all the participants. Transcriptions of interviews and results of questionnaires were analysed for major and minor themes. RESULTS:  Results of this study suggest different perceptions by those who stutter and those acquainted with them. The findings of the study show that people who stutter experience communication barriers, so they adopt certain strategies to manage and cope with their speech disorder. The findings showed that stuttering has a pervasive impact on the lives of people who stutter and how they view themselves, considering negative societal views. CONCLUSION:  Evaluation of the results from the study reveals that although stuttering is a common speech disorder, many people who are less informed about it harbour various stereotypes and myths that stigmatise stuttering. This study concludes by outlining recommendations for creating awareness of stuttering. It suggests vigorous campaigns aiming at promoting a multilevel approach that extends beyond the mere social and professional understanding of stuttering but addresses the inherent perceptions, myths, and stereotypes around stuttering.Contribution: Experiences of people who stutter and perceptions towards stuttering can help to better understand the speech disorder and overcome myths and stereotyping of stuttering.

Associations between social anxiety, physiological reactivity, and speech disfluencies in autistic young adults and controls.

INTRODUCTION: The aim of this study was to examine possible associations of social anxiety (SA) and speaking-related physiological reactivity with the frequencies of a) total disfluencies, b) typical disfluencies, and c) stuttering-like disfluencies, as well as d) stuttering-severity in autistic young adults and controls. METHODS: Thirty-two autistic young adults and 35 controls participated in this study. Participants were presented with video clips (viewing condition) and were then asked to talk about the videos (narrating condition). SA was measured by the self-report Social Phobia and Anxiety Inventory (SPAI). Speaking-related physiological reactivity was measured by the electrodermal activity (EDA), an index of emotional arousal. The speech samples from the narrating condition were analyzed for type and frequency of speech disfluencies and used for determining the stuttering severity. SA and speaking-related physiological reactivity were compared between the groups. Correlation between SA, physiological reactivity, disfluency frequencies, and stuttering severity were tested separately for both groups. RESULTS: No between-group differences were found in the overall SA, yet differences were found in SPAI subscales of social interaction, group interaction, and avoidance, as well as in agoraphobia. Both groups had higher physiological arousal in narrating condition in comparison to the video viewing condition, yet there was no between-group difference in the reactivity. No associations were found between SPAI measures, physiological reactivity, disfluency frequencies, and stuttering severity in the autistic group. In the control group, a negative association was found between physiological reactivity and total and typical disfluency frequencies. CONCLUSIONS: SA or speaking-related physiological reactivity were not associated with disfluency frequencies or stuttering severity in autistic persons. Negative association between physiological reactivity and disfluency frequencies found in the control group may indicate that the physiological arousal may impact the speech production process by reducing the overt disfluencies.

Identification of the Biomechanical Response of the Muscles That Contract the Most during Disfluencies in Stuttered Speech.

Stuttering, affecting approximately 1% of the global population, is a complex speech disorder significantly impacting individuals' quality of life. Prior studies using electromyography (EMG) to examine orofacial muscle activity in stuttering have presented mixed results, highlighting the variability in neuromuscular responses during stuttering episodes. Fifty-five participants with stuttering and 30 individuals without stuttering, aged between 18 and 40, participated in the study. EMG signals from five facial and cervical muscles were recorded during speech tasks and analyzed for mean amplitude and frequency activity in the 5-15 Hz range to identify significant differences. Upon analysis of the 5-15 Hz frequency range, a higher average amplitude was observed in the zygomaticus major muscle for participants while stuttering (p < 0.05). Additionally, when assessing the overall EMG signal amplitude, a higher average amplitude was observed in samples obtained from disfluencies in participants who did not stutter, particularly in the depressor anguli oris muscle (p < 0.05). Significant differences in muscle activity were observed between the two groups, particularly in the depressor anguli oris and zygomaticus major muscles. These results suggest that the underlying neuromuscular mechanisms of stuttering might involve subtle aspects of timing and coordination in muscle activation. Therefore, these findings may contribute to the field of biosensors by providing valuable perspectives on neuromuscular mechanisms and the relevance of electromyography in stuttering research. Further research in this area has the potential to advance the development of biosensor technology for language-related applications and therapeutic interventions in stuttering.

The Association Between Stuttering Burden and Psychosocial Aspects of Life in Adults.

PURPOSE: Stuttering is a speech condition that can have a major impact on a person's quality of life. This descriptive study aimed to identify subgroups of people who stutter (PWS) based on stuttering burden and to investigate differences between these subgroups on psychosocial aspects of life. METHOD: The study included 618 adult participants who stutter. They completed a detailed survey examining stuttering symptomatology, impact of stuttering on anxiety, education and employment, experience of stuttering, and levels of depression, anxiety, and stress. A two-step cluster analytic procedure was performed to identify subgroups of PWS, based on self-report of stuttering frequency, severity, affect, and anxiety, four measures that together inform about stuttering burden. RESULTS: We identified a high- (n = 230) and a low-burden subgroup (n = 372). The high-burden subgroup reported a significantly higher impact of stuttering on education and employment, and higher levels of general depression, anxiety, stress, and overall impact of stuttering. These participants also reported that they trialed more different stuttering therapies than those with lower burden. CONCLUSIONS: Our results emphasize the need to be attentive to the diverse experiences and needs of PWS, rather than treating them as a homogeneous group. Our findings also stress the importance of personalized therapeutic strategies for individuals with stuttering, considering all aspects that could influence their stuttering burden. People with high-burden stuttering might, for example, have a higher need for psychological therapy to reduce stuttering-related anxiety. People with less emotional reactions but severe speech distortions may also have a moderate to high burden, but they may have a higher need for speech techniques to communicate with more ease. Future research should give more insights into the therapeutic needs of people highly burdened by their stuttering. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25582980.

Treatment for Stuttering in Preschool-Age Children: A Qualitative Document Analysis of Treatment Programs.

PURPOSE: The purpose of this study was to identify commonalities and differences between content components in stuttering treatment programs for preschool-age children. METHOD: In this document analysis, a thematic analysis of the content was conducted of handbooks and manuals describing Early Childhood Stuttering Therapy, the Lidcombe Program, Mini-KIDS, Palin Parent-Child Interaction Therapy, RESTART Demands and Capacities Model Method, and the Westmead Program. First, a theoretical framework defining a content component in treatment was developed. Second, we coded and categorized the data following the procedure of reflexive thematic analysis. In addition, the first authors of the treatment documents have reviewed the findings in this study, and their feedback has been analyzed and taken into consideration. RESULTS: Sixty-one content components within the seven themes-interaction, coping, reactions, everyday life, information, language, and speech-were identified across the treatment programs. The content component SLP providing information about the child's stuttering was identified across all treatment programs. All programs are multithematic, and no treatment program has a single focus on speech, language, or parent-child interaction. A comparison of the programs with equal treatment goals highlighted more commonalities in content components across the programs. The differences between the treatment programs were evident in both the number of content components that varied from seven to 39 and the content included in each treatment program. CONCLUSIONS: Only one common content component was identified across programs, and the number and types of components vary widely. The role that the common content component plays in treatment effects is discussed, alongside implications for research and clinical practice. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25457929.

Lidcombe Program telehealth treatment for children 6-12 years of age: A Phase II trial.

BACKGROUND: For children older than 6 years who stutter, there is a gap in clinical research. This is an issue for speech-language pathologists because the tractability of stuttering decreases and the risk of long-term psychological consequences increase with age. PURPOSE: To report a Phase II trial of a telehealth version of the Lidcombe Program with school-age children. METHODS: Participants were 37 children who stuttered, 6-12 years of age, from Australia, New Zealand, Hong Kong, and Singapore. Parents were trained by video telehealth how to deliver the Lidcombe Program to their child. Primary and secondary outcomes were stuttering severity and psychosocial functioning measured pre-treatment and at 6 months and 12 months after starting treatment. Parents submitted two 10-minute recordings of their child speaking in conversation, and three measures of anxiety, impact of stuttering, and communication attitude. RESULTS: Six months after starting treatment, seven children (18.9%) attained Lidcombe Program Stage 2 criteria, 25 children (67.6%) showed a partial response to treatment, and five children (13.5%) showed no response. By 12 months, 12 children (32.4%) had reached Stage 2 criteria. Psychosocial improvements were observed 6 and 12 months after starting treatment. CONCLUSIONS: The Lidcombe Program may eliminate or nearly eliminate stuttering for about one third of children 6-12 years of age. Randomized controlled trials with this age group involving the Lidcombe Program are warranted. In the interim, the Lidcombe Program is a clinical option clinicians can implement with this age group to reduce stuttering and its psychosocial impacts.

Investigation of central auditory processing performance in individuals with and without stuttering.

BACKGROUND: Differences in core auditory processing abilities, such as sound timing, frequency discrimination, auditory perception, and auditory memory, have been suggested in stutterers, despite the fact that the precise origin of stuttering is not entirely understood. It is suggested that these differences may play a role in the development of stuttering. The aim of our study is to assess the temporal central auditory processing performance in individuals with stuttering and compare it to individuals without stuttering to uncover potential differences stuttering and compare it to individuals without stuttering to reveal potential differences. METHOD: In current study, a total of 60 right-handed participants between the ages of 8 and 17 were included, divided into two balanced groups based on age, education, and gender: individuals with stuttering (n = 30) and individuals without stuttering (n = 30). All participants underwent the Frequency Pattern Test, Duration Pattern Test, and Gaps-In-Noise test. RESULTS: Individuals who stutter showed lower performance in the gap detection threshold and the percentage of total correct gap identification parameters of the Frequency Pattern Test, Duration Pattern Test, and Gaps-In-Noise test compared to fluent speakers. CONCLUSIONS: The findings indicate a potential relationship between stuttering and central auditory processing. In this context, incorporating central auditory processing measures into the assessment and therapy processes for stuttering may enhance the likelihood of obtaining more accurate results.

Major discrimination due to stuttering and its association with quality of life.

PURPOSE: This study aimed to identify what types of major discrimination have been experienced by adults who stutter throughout their lives, and investigate the association between the number of different types of major discrimination events experienced and quality of life. METHODS: Measures of quality of life (Kemp Quality of Life Scale) and major discrimination (adapted Major Experiences of Discrimination Scale) were completed by 303 adults who stutter. Correlational and regression analyses were conducted with these variables. RESULTS: A majority (56%) of the participants had experienced at least one episode of major discrimination due to stuttering during their lives. The major discrimination experiences most commonly reported included not being hired for a job and being discouraged by a teacher or advisor from pursuing certain careers or jobs because of stuttering. There was a significant negative relationship between quality of life and major discrimination. Increased major discrimination predicted lower quality of life even after taking into account demographic variables and severity of physical speech disruption. CONCLUSIONS: The findings of a negative association between major discrimination and quality of life add support to the notion that reducing societal stigma related to stuttering should be a priority of the field. Discriminatory practices of listeners constitute a social-environmental barrier to communicative participation and quality of life in people who stutter and should be addressed by professionals in the field of speech-language pathology and other stakeholders.