Journal of Fluency Disorders最新文献

Purpose

This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence.

Methods

Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2–18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies.

Results

Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention.

Conclusion

The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.

Purpose

During the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering.

Methods

The authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form.

Results

Seven contemporary issues for our field emerged from the Symposium.

Conclusion

Effective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive-behavior therapy for clients with persistent stuttering. Questions were raised about our discipline standards for basic professional preparation programs for stuttering management.

The Communication Attitude Test for Adults who stutter (BigCAT) is an established measure of cognitive traits in adults who stutter (AWS). The primary purpose of the present study was to adapt and validate the BigCAT to the Kannada language. The secondary purpose was to compare AWS’ and adults who do not stutter (AWNS) BigCAT-K scores and compare AWS’ score in sub-populations in terms of severity and age. The study included a purposive sample of 100 AWS and 317 AWNS. There was high test-retest reliability and solid construct validity, as made evident by the results of the discriminant analysis and cross-validation. Further, as in other investigations with the BigCAT (Vanryckeghem & Brutten, 2019), this self-report test revealed a statistically significant group mean difference between AWS and AWNS, suggesting the presence of a negative attitude towards communication in Kannada-speaking AWS. Further, individuals with severe stuttering had a significantly higher level of speech-associated negative attitude compared to those with mild stuttering. Age does not seem to influence the AWS’ speech-associated belief system. Both of these findings augment the existing scant literature on exploring the association between stuttering severity and age on the cognitive dimension of stuttering. The outcomes establish the BigCAT-K as an effective tool in the assessment and subsequent management of stuttering.

Purpose

Based on previous evidence that cognitive control of lexical selection in object (noun) naming operates differently in adults who stutter (AWS) versus typically-fluent adults (TFA), the aim was to investigate cognitive control of lexical selection in action (verb) naming in AWS.

Method

12 AWS and 12 TFA named line drawings depicting actions using verbs. Half of the pictures had high-agreement action names and the other half low-agreement action names. Naming accuracy and reaction times (RT), and event-related potentials (ERPs) time-locked to picture onset, were compared between groups.

Results

Naming RTs were slower for low- versus high-agreement trials, and the magnitude of this effect was larger in AWS versus TFA. Delta-plot analysis of naming RTs revealed that individual differences in selective inhibition were associated with the agreement effect on naming RTs in AWS but not TFA. Action naming elicited frontal-central N2 activity in both agreement conditions in TFA but not AWS. Additionally, a later, posterior P3b component was affected by agreement in TFA only. In AWS, low-agreement action naming elicited frontal P3a activation.

Conclusions

Results suggest that cognitive control of action name selection was qualitatively different between groups. In TFA, cognitive control of lexical selection in action naming involved nonselective inhibition, as well as more efficient working memory updating on high- versus low-agreement trials. In AWS, cognitive control of low-agreement action naming involved increased focal attention. Individual differences in selective inhibition may have moderated cognitive control of action naming in AWS.

Purpose

The purpose of this study was to examine dysfluency characteristics of individuals with Parkinson Disease (PD) relative to linguistic features of grammatical class and position within word. Few studies have reported dysfluency characteristics of PD relative to these characteristics. Those that do report on these characteristics include one case study and a study of six individuals with PD. No previous research is known to have examined dysfluency related to grammatical class and position within words for a large sample of individuals with PD.

Method

Dysfluencies from 32 individuals with PD were analyzed according to position within a word and grammatical class.

Results

Participants produced significantly more dysfluencies in the initial position of words compared to medial or final positions, and a significantly higher percent dysfluency for content words versus function words.

Conclusion

Effects of linguistic features of grammatical class and position within a word on dysfluencies are present within a population with PD and are similar to the linguistic features associated with developmental stuttering. Clinical implications of the effect of linguistic features on speech dysfluencies in PD are discussed.

Purpose

Adults who stutter tend not to stutter when they are alone. This phenomenon is difficult to study because it is difficult to know whether participants perceive that they are truly alone and not being heard or observed. This may explain the presence of stuttering during previous studies in which stutterers spoke while they were alone. We addressed this issue by developing a paradigm that elicited private speech, or overt speech meant only for the speaker. We tested the hypothesis that adults do not stutter during private speech.

Method

Twenty-four participants were audio-/video-recorded while speaking in several conditions: 1) conversational speech; 2) reading; 3) private speech, in which deception was used to increase the probability that participants produced speech intended for only themselves; 4) private speech+, for which real-time transcription was used so that participants produced the same words as in the private speech condition but while addressing two listeners; and 5) a second conversational speech condition.

Results

Stuttering was not observed in more than 10,000 syllables produced during the private speech condition, except for seven possible, mild stuttering events exhibited by 3 of 24 participants. Stuttering frequency was similar for the remaining conditions.

Conclusions

Adults appear not to stutter during private speech, indicating that speakers' perceptions of listeners, whether real or imagined, play a critical and likely necessary role in the manifestation of stuttering events. Future work should disentangle whether this is due to the removal of concerns about social evaluation or judgment, self-monitoring, or other communicative processes.

Purpose

The purpose of this study was to investigate resting autonomic activity in adults who stutter (AWS) compared to adults who do not stutter (ANS) and the relationship this has on self-reports of social anxiety.

Methods

Thirteen AWS and 15 ANS completed the Social Interaction Anxiety Scale (SIAS; Mattick & Clark, 1998) and Brief Fear of Negative Evaluation (BFNE; Leary, 1983). Following this, measures of skin conductance levels (i.e. index of sympathetic activity) and respiratory sinus arrhythmia (i.e. index of parasympathetic activity) were taken during a 5-minute resting, baseline period. Independent sample t tests were used to assess differences between groups on self-reports of anxiety (SIAS, BFNE) and resting autonomic levels (SCL, RSA). Separate multiple regression analyses were performed in order to assess the relationship between self-reports of anxiety and autonomic measures.

Results

Results showed significantly higher mean SCL and lower mean RSA levels in the AWS compared to the ANS at resting, baseline. Regression analysis showed that self-reports from the SIAS had a significant effect on RSA levels for the AWS but not the ANS. No significant effects were found for BFNE on RSA. Nor was there a significant effect from SIAS or BFNE on SCL levels for either group.

Conclusion

Findings suggest that resting RSA levels may be a physiological marker for social anxiety levels in adults who stutter.

Purpose

The current study examines how speech disfluencies manifest themselves in the two languages of bilingual persons who stutter, starting from the hypothesis that stuttering is associated with an attentional deficit at the level of speech production.

Methods

Twenty-eight bilingual people who stutter performed a spontaneous and a controlled speech production task, once in their dominant and once in their non-dominant language. The controlled production task (i.e. a network description task) was carried out once under a full-attention condition and once under a divided-attention condition where a non-linguistic, pitch discrimination task was performed simultaneously.

Results

In both the spontaneous and the controlled speech task, bilingual persons who stutter produced more (typical and stuttering-like) disfluencies in their L2 than in their L1. Furthermore, whereas the typical disfluencies increased when attention was directed away from speech production, stuttering-like disfluencies decreased. This effect was however restricted to L2. In addition, L2 proficiency was generally found to be a predicting factor, with higher proficiency leading to fewer disfluencies.

Conclusions

These results suggest that speaking in a non-dominant language increases both typical and stuttering-like disfluencies in bilingual persons who stutter, but also that these two types of dysfluencies differ regarding their attentional origins. Our findings offer further support for attentional accounts of stuttering and have both theoretical and clinical implications.

Previous studies demonstrate mixed results and some methodological limitations regarding judges’ ability to reliably assess stuttering-related variables in an unfamiliar language. The present study examined intra- and inter-rater reliability for percent syllables stuttered (%SS), stuttering severity (SEV), syllables per minute (SPM), and speech naturalness (NAT) when English-speaking judges viewed speech samples in English and in a language with which they had no or minimal familiarity (Spanish). Over two time periods, 21 judges viewed eight videos of four bilingual persons who stutter. Data were analyzed for relative and absolute intra- and inter-rater reliability as well as for an effect of language on time period differences. Intra- and inter-rater relative reliability were good or excellent for all measures in both languages, with the exception of inter-rater relative reliability for NAT in both languages and %SS in Spanish. Intra-rater absolute reliability was acceptable in both languages for NAT and SEV and unacceptable in both for SPM and %SS. Inter-rater absolute reliability in both languages was unacceptable for all measures, even with judges with the same training. There was a clinically significant effect of language on %SS scores, but, despite a statistically significant effect of language for SPM and SEV, the differences were not clinically significant. Results indicate that reliability across and within languages varies by measure and is impacted by intra- vs. inter-rater reliability, relative vs. absolute reliability, and language familiarity. Modifications in training may be able to address some of the limitations found, particularly with regard to SPM and NAT.

Purpose

Researchers investigated whether children who stutter (CWS), adolescents who stutter (ADWS), and their parents preferred treatment focused on changing speech or communicating regardless of stuttering.

Methods

Twenty-four parents and their CWS (n = 11, ages 8;0–12;11) or ADWS (n = 13, ages 13;0–17;11) answered questions about their preferences for stuttering treatment via an internet-based survey; an additional 11 surveys were filled in only by parents without responses by their child/adolescent. The researchers compared responses of the parents and their children, as well as between the two age groups and years in treatment (less than five years versus five or more years).

Results

Views tended to be mixed without any clear trends based on age. Just over half of the CWS, ADWS, and parents of CWS indicated a general tendency for therapy satisfaction; however, less years of treatment were associated with more satisfaction. When presented with a specific scenario, a higher proportion of parents expressed focus on their child saying what they want to say, regardless of stuttering. Otherwise, preferences were mixed on therapy goals of speaking freely vs. speaking more fluently.

Conclusions

Preferences for treatment goals do not predictably vary based on age or years in treatment; given the small sample size, these findings should be considered with caution. Given the variability in responses, it is evident that stuttering treatment for school-age children and adolescents should be individualized. These results also emphasize the importance of communication, education, and applying a person-centered approach when providing stuttering intervention to children, adolescents, and their parents.