Comparing speaker-based and observer-based measures of the perception of physical tension during stuttering

People who stutter commonly experience increased levels of physical tension during moments of stuttering. These increased levels of physical tension have been shown to vary in location of the body and from individual to individual (Brutten & Shoemaker, 1967; Wingate, 1964). Though treatment of increased physical tension often involves speaker self-evaluation (see Van Riper, 1973), a widely-used assessment of physical tension relies on a clinician’s observations (SSI-4; Riley, 2009). This study proposed to answer the question, “how do clinicians’ perceptions of physical tension compare to the speaker’s perceptions of physical tension?” Ten adults who stutter recruited from the Pittsburgh chapter of the National Stuttering Association (NSA), were audio-video recorded in select speaking samples. Two expert speech and language pathologists who are also board recognized specialists in fluency disorders (BRS-FD) evaluated selected samples from each participant who stutters using the SSI-4 and a Perception of Physical Tension Form developed for this study. Participants who stutter evaluated themselves using the same forms and discussed their experience of physical tension during an interview so key themes related to physical tension could be identified and compared to results from the clinicians’ observations and test results. Results revealed that physical tension occurring in certain locations, such as the abdomen, chest, throat, cheeks, and tongue, may not be perceived by clinicians. Thematic analysis revealed that the speakers’ experience of physical tension is highly variable and changes over time, possibly relating to other themes of acceptance and self-perception. These results warrant the development of a more specific method of perceiving physical tension using self-reports of speakers. Such assessment may lead to better diagnostic and therapeutic outcomes

Group Experiences and Individual Differences in Stuttering.

Purpose This study explored group experiences and individual differences in the behaviors, thoughts, and feelings perceived by adults who stutter. Respondents\u27 goals when speaking and prior participation in self-help/support groups were used to predict individual differences in reported behaviors, thoughts, and feelings. Method In this study, 502 adults who stutter completed a survey examining their behaviors, thoughts, and feelings in and around moments of stuttering. Data were analyzed to determine distributions of group and individual experiences. Results Speakers reported experiencing a wide range of both overt behaviors (e.g., repetitions) and covert behaviors (e.g., remaining silent, choosing not to speak). Having the goal of not stuttering when speaking was significantly associated with more covert behaviors and more negative cognitive and affective states, whereas a history of self-help/support group participation was significantly associated with a decreased probability of these behaviors and states. Conclusion Data from this survey suggest that participating in self-help/support groups and having a goal of communicating freely (as opposed to trying not to stutter) are associated with less negative life outcomes due to stuttering. Results further indicate that the behaviors, thoughts, and experiences most commonly reported by speakers may not be those that are most readily observed by listeners

Recovery and Relapse: Perspectives From Adults Who Stutter.

Purpose Recovery and relapse relating to stuttering are often defined in terms of the presence or absence of certain types of speech disfluencies as observed by clinicians and researchers. However, it is well documented that the experience of the overall stuttering condition involves more than just the production of stuttered speech disfluencies. This study sought to identify what recovery and relapse mean to people who stutter based on their own unique experiences to account for both the stuttering behaviors and the broader adverse impact of the condition. Method In this study, 228 adults who stutter participated in a mixed-methods exploration of the terms recovery and relapse. Participants categorized themselves on whether they considered themselves to have recovered or experienced relapse. Data were analyzed thematically through the lens of the speaker self-categorizations to determine how adults who stutter define recovery and relapse regarding stuttering. Results Results indicate that, to adults who stutter, recovery from stuttering is associated with increases in positive affective/emotional, behavioral, and cognitive reactions to the condition and simultaneous decreases in associated negative constructs. These group-level definitions did not change as a function of whether respondents reported that they had experienced recovery or relapse themselves. Discussion Recovery or relapse from stuttering behaviors can occur independently from recovery or relapse from the broader adverse impact related to the condition, suggesting that researchers and clinicians should consider recovery and relapse as involving more than just a reduction or an increase in observable behaviors. These findings support recent research evidence further specifying the many individual phenotypes of stuttering, in that pathways to recovery and relapse can be experienced in different ways for people with different stuttering phenotype profiles

A Phenomenological Analysis of the Experience of Stuttering.

Purpose:Stuttering behaviors and moments of stuttering are typically defined by what a listener perceives. This study evaluated participants\u27 perceptions of their own experience of moments of stuttering. Method:Thirteen adults who stutter participated in a phenomenological qualitative study examining their experience of moments of stuttering. Analysis yielded several common themes and subthemes culminating in an essential structure describing the shared experience. Results:Speakers experience anticipation and react in action and nonaction ways. Many speakers experience a loss of control that relates to a lack of a well-formed speech plan or agency. The experience of moments of stuttering changes through therapy, over time, with self-help, and across situations. Many speakers experience so-called typical stuttering behaviors as reactions rather than direct consequences of trying to speak. Interactions with listeners can affect the experience of stuttering. Conclusion:Although research recognizes that the experience of the stuttering disorder involves more than just speech behaviors, people who stutter experience stuttering behaviors in time as involving more than just the disruption in speech. This finding has implications for both the theoretical understanding of stuttering and the clinical evaluation and treatment of the stuttering disorder

Repetitive Negative Thinking, Temperament, and Adverse Impact in Adults Who Stutter.

Purpose Prior research has explored how repetitive negative thinking (RNT) contributes to both the increased persistence and severity of various disorders, such as depression, anxiety, and eating disorders. This study explored the potential role of RNT in the experience of stuttering, with a particular focus on the relationship between RNT, adverse impact, and certain temperament profiles. Method Three hundred thirteen adults who stutter completed a measurement of the frequency/severity of RNT (Perseverative Thinking Questionnaire; Ehring et al., 2011), 207 completed a temperament profile (Adult Temperament Questionnaire; Evans & Rothbart, 2007), and 205 completed a measurement of adverse stuttering impact (Overall Assessment of the Speaker\u27s Experience of Stuttering; Yaruss & Quesal, 2016). Analyses were conducted within and across instruments to ascertain how RNT, temperament markers, and adverse impact interrelate within individuals. Results Results indicated that RNT significantly predicts Overall Assessment of the Speaker\u27s Experience of Stuttering impact scores with great effect and that certain temperament markers (specifically, Effortful Control and Negative Affectivity) moderate this relationship for specific sections of the Overall Assessment of the Speaker\u27s Experience of Stuttering. Conclusion By assessing RNT in people who stutter, clinicians can better understand individual differences in their clients, and this will allow them to make targeted diagnoses and develop more tailored intervention plans

Stuttering as Defined by Adults Who Stutter.

Purpose Numerous frameworks and definitions have sought to differentiate what behaviors and experiences should be considered as a part of stuttering. Nearly all of these efforts have been based on the perspectives and beliefs of conversational partners and listeners. This outside-in approach to defining stuttering lacks validation from people who live with the condition. Method In this study, 430 adults who stutter participated in a qualitative exploration of the term stuttering. Data were analyzed thematically to determine speakers\u27 perspectives about moment of stuttering and the overall experience of stuttering in their lives. Results To adults who stutter, the term stuttering signifies a constellation of experiences beyond the observable speech disfluency behaviors that are typically defined as stuttering by listeners. Participants reported that the moment of stuttering often begins with a sensation of anticipation, feeling stuck, or losing control. This sensation may lead speakers to react in various ways, including affective, behavioral, and cognitive reactions that can become deeply ingrained as people deal with difficulties in saying what they want to say. These reactions can be associated with adverse impact on people\u27s lives. This interrelated chain of events can be exacerbated by outside environmental factors, such as the reactions of listeners. Discussion Data from this survey provide novel evidence regarding what stuttering means to adults who stutter. These data are used to update the adaptation of the World Health Organization\u27s International Classification of Functioning, Disability and Health as it applies to stuttering (Yaruss & Quesal, 2004) to better account for the complex and individualized phenotype of stuttering and to develop a definition of the experience of stuttering that is based not only on the observations of listeners but also on the impact of stuttering on the lives of adults who stutter

Disfluency Characteristics of 4- and 5-Year-Old Children Who Stutter and Their Relationship to Stuttering Persistence and Recovery.

Purpose The purpose of this study is to document disfluency behaviors expressed by 4- and 5-year-old children who stutter and to identify whether stuttering characteristics at this age are predictive of later stuttering recovery or persistence. Method We analyzed spontaneous speech samples from 47 children diagnosed with developmental stuttering when they were 4-5 years old. Based on their eventual diagnosis made the final year of participation in the longitudinal study when the children were 6-9 years old, the children were divided into two groups: children who eventually recovered from stuttering (n = 29) and children who were persisting (n = 18). We calculated a composite weighted stuttering-like disfluency (SLD) index of overall severity that considers the frequency, type, and number of repetition units of SLDs. The frequency and type of typical disfluencies were also examined. Results Higher weighted SLD scores at ages 4-5 years were associated with a higher probability of persistent stuttering. The weighted SLD also significantly discriminated between children who would eventually be diagnosed as persisting or recovered from stuttering. The frequency and type of typical disfluency did not distinguish the two groups of children; however, children who were persisting had significantly higher frequencies of part-word repetitions and dysrhythmic phonations (i.e., blocks, prolongations, and broken words) and maximum number of part-word repetitions compared to children who eventually recovered from stuttering. Conclusions Previous findings in younger, 2- to 3-year-old children who stutter did not suggest a relationship between the severity and type of children\u27s SLDs and their eventual stuttering outcome. Yet, by the age of 4-5 years, we found that the weighted SLD, a clinically applicable tool, may be used to help identify children at greater risk for stuttering persistence. We propose that the weighted SLD be considered, along with other predictive factors, when assessing risk of stuttering persistence in 4- and 5-year-old children who are stuttering

Speaker and Observer Perceptions of Physical Tension during Stuttering.

PURPOSE:Speech-language pathologists routinely assess physical tension during evaluation of those who stutter. If speakers experience tension that is not visible to clinicians, then judgments of severity may be inaccurate. This study addressed this potential discrepancy by comparing judgments of tension by people who stutter and expert clinicians to determine if clinicians could accurately identify the speakers\u27 experience of physical tension. METHOD:Ten adults who stutter were audio-video recorded in two speaking samples. Two board-certified specialists in fluency evaluated the samples using the Stuttering Severity Instrument-4 and a checklist adapted for this study. Speakers rated their tension using the same forms, and then discussed their experiences in a qualitative interview so that themes related to physical tension could be identified. RESULTS:The degree of tension reported by speakers was higher than that observed by specialists. Tension in parts of the body that were less visible to the observer (chest, abdomen, throat) was reported more by speakers than by specialists. The thematic analysis revealed that speakers\u27 experience of tension changes over time and that these changes may be related to speakers\u27 acceptance of stuttering. CONCLUSION:The lack of agreement between speaker and specialist perceptions of tension suggests that using self-reports is a necessary component for supporting the accurate diagnosis of tension in stuttering

Understanding the Speaker\u27s Experience of Stuttering Can Improve Stuttering Therapy

The purpose of this paper is to highlight the value for speech-language pathologists of considering the overall stuttering condition-including speakers\u27 experiences during and around moments of stuttering-in treatment with individuals who stutter. We first highlight a framework for conceptualizing the entirety of the stuttering condition. We then present recent research and clinical perspectives about stuttering to support the claim that speech-language pathologists who account for individual differences in how their clients experience stuttering are better positioned to treat stuttering more effectively. Ultimately, this will yield better treatment outcomes and help clinicians achieve greater gains in quality of life for their clients who stutter

A Point of View About Fluency

Purpose: This article presents several potential concerns with the common usage of the term fluency in the study of stuttering and people who stutter (or, as many speakers now prefer, stutterers ). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended. Method: We begin by reviewing the history of the term fluency . We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition. Results: By highlighting current research and perspectives of stutterers, we conclude that the term fluency (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole. Conclusions: We recommend that researchers and clinicians cease referring to stuttering as a fluency disorder and simply refer to it as stuttering . Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition