Poster Session 3

Cluttering is a communication disorder that involves disruptions in speech fluency and intelligibility associated with a perceived rapid rate of speech and other speech disruptions. The majority of research on cluttering has focused on developing appropriate definitions of the condition and identifying observable features that can aid in diagnosis. Such work is certainly necessary, and there is much that the field can continue to learn about the nature of cluttered speech.

One aspect of cluttering that has not received as much attention is the overall life impact of cluttering. Like stuttering, cluttering can have significant consequences for people’s lives. People who clutter may have difficulty with intelligibility due to differences in speaking rate and efficiency. This can lead to communication breakdowns that can be exacerbated by listener misperceptions of speech symptoms and inaccurate judgments of cognitive skills and potential.

Just as with stuttering, living with the negative consequences of cluttering can lead to communication avoidance, decreased communication confidence, and underemployment. Although some qualitative studies have highlighted the negative impact cluttering can have on a speaker’s quality of life, relatively little research has formally examined these consequences of living with cluttering.

In an attempt to address this gap in the literature, the authors have developed an adaptation of the Overall Assessment of the Speaker’s Experience of Stuttering (OASES) to address the unique needs and experiences of people who clutter. This poster presentation will describe the development process for the OASES-Cluttering, present preliminary data collected as part of the validation process for this new assessment tool, and solicit input from attendees about concepts, items, and wording. The goal of the poster will be to improve understanding of cluttering and support further research on the impact of cluttering on people’s lives.

There is an increasingly diverse body of research that highlights the mutli-faceted nature of stuttering, both internal to the speaker and external, as society impacts the person who stutters, and vice versa. Stuttering research in the past ten years ranges from neurophysiology to genetics to counseling to stigma and social justice (Smith & Weber, 2017; Chang, 2014; Frigerio-Domingues & Drayna, 2017; Sonsterud et al., 2019; Boyle & Blood, 2015; Gerlach et al., 2018). A true evidence-based approach to stuttering therapy in 2020 should account for all of these facets. We have developed a mnemonically-driven "3Es model" to help identify the evidence-based Common Factors (Yaruss, 2007; Sonsterud et al., 2019) present in various stuttering therapy approaches, and assist generalist clinicians in treatment planning. The 3Es is a “supramodel” encompassing all therapy approaches. We present a corresponding set of 3Es treatment planning tools, designed to help generalist clinicians identify treatment targets and select relevant and appropriate interventions. The 3Es does not answer the question of “how to do stuttering therapy”, but is a tool for the clinician who asks, “How can I figure out how to do stuttering therapy for this specific client?” This model is evidence-based, using all tiers of the triangle. 1. Our model is built on the individual experience of stuttering, based on stories, experiences, and wisdom we hear from our clients. 2. Our model is significantly informed by our 13 year collective experience as clinicians who specialize in stuttering. 3. Our model is developed based on research from the past 5-10 years. Themes that have emerged in the last five years include: the effect that stigma has on physical and emotional wellbeing of people who stutter to create disempowerment and feelings of helplessness (Boyle & Fearon, 2018), the emerging differences between the speech motor system of people who stutter and people who do not stutter (Sares et al., 2019), defining stuttering from a client’s point of view (Tichenor & Yaruss, 2019), the therapeutic effects of attending support and self-help groups for people who stutter (Gerlach et al., 2019; Herring et al., 2018), the role of anticipatory thoughts, feelings, and behaviors before a stuttering moment (Jackson et al., 2015), and much more. The 3Es of stuttering are ease, empower, and educate. These primary three themes overlap to create secondary targets of competence (ease + educate), confidence (ease + empower), and change (educate + empower). Each circle (3Es) represents a class of therapy activities. These activities combine for different therapeutic effects (3Cs). The model is presented as a Venn diagram, which we can forward to the reviewers, both the application-tool version and the research summary version. In this seminar, we will explain the theory and application of this model. Assessment and treatment activities using the 3Es will be discussed.

Purpose: Disclosure has been well-studied in the existing stuttering literature, but most of these studies have adopted a listener-focused approach. In other words, these studies have emphasized how stuttering affects disclosure confidants and how they feel about the person who is disclosing, rather than how disclosure affects the person who stutters themselves. The few existing studies that have investigated disclosure outcomes among people who stutter have produced mixed results (e.g., Boyle & Gabel, 2020; Manicelli, 2019). In the current study, we aimed to extend the existing literature on speaker-focused experiences with verbal stuttering disclosure, guided by the following research questions:

1) Are there differences in the extent that adults who stutter disclose their stuttering to various social referent groups (e.g., friends)?

2) Is the extent of stuttering disclosure to certain social referent groups predictive of psychological distress among adults who stutter after controlling for relevant demographics?

Methods: The participants in this study (n=506) were a subset of participants from a larger sample of 629 adults who stutter who completed an online survey. To measure extent of verbal stuttering disclosure to various social referent groups, participants were asked “to rate the extent that they had verbally disclosed stuttering” to seven social referent groups (e.g., friends, romantic partners, health care providers, people in the workplace) on a scale of 1 to 5 (1 = “none of them” to 5 = “all of them”). Psychological distress was measured using a composite measure of anxiety (STAI-T) and depression (CES-D). Statistical procedures included descriptive statistics and regression.

Results: Preliminary results indicated that there were not significant differences in extent of verbal stuttering disclosure across social referent groups, but there were interesting trends. Romantic partners was the only social referent group to which extent of disclosure predicted psychological distress.

Discussion: Clinical implications will be discussed.

Introduction: Nonword repetition performance is one cognitive-linguistic factor that is associated with persistence in children and lower accuracy in adults who stutter (AWS), but it is unclear how the mechanisms underlying stuttering might be related to nonword repetition performance. The aim of this study was to determine whether intrinsic differences in oscillatory power and event-related spectral perturbations (ERSPs) in a syllable repetition task were different from those of typically fluent speakers (TFS).

Methods: Electroencephalography (EEG) was recorded from 129 channels in a resting-state, eyes-open condition and in delayed 2 and 4 syllable bilabial repetition conditions in sex and age matched TFS and AWS. One channel was used to record myographic artefact and to determine speech execution response time. Following analysis methodology used in previous studies, independent component analysis (ICA) was used to identify the same independent component (IC) network in the resting state and task. Spectral density (1-65Hz) was used to quantify power in the resting state and syllable repetition task. Permutation statistics were used to test for condition and group differences with a cluster correction at p<.05. Pearson correlations were used to quantify relationships between baseline and task-related spectral power with a correction for false discovery.

Results: Analysis revealed a network active during the encoding, maintenance, and execution task phases that also showed a positive relationship with resting state power in both groups. Analysis showed greater alpha/beta event-related desynchronization (ERD) in posterior temporal, sensorimotor, and frontal lobe component clusters in TFS. AWS presented with greater theta and gamma event-related synchronization (ERS) in midline frontal and parietal clusters and greater alpha/beta suppression in a right frontal lobe cluster. Analysis of behaviour is ongoing.

Conclusions: Findings will be discussed relative to an intrinsic dorsal stream sensorimotor integration deficit in AWS and potential compensatory mechanisms from midline prefrontal and right hemisphere processing.

Introduction:

Research has suggested awareness of stuttered versus fluent speech may begin as early as the preschool years (e.g., Ezrati-Vinacour, Platzky, & Yairi, 2001). Although multiple studies have been conducted on changing public attitudes toward stuttering among adults (Abdalla, 2015; St. Louis et al., 2020), there is limited research on changing young children’s stuttering attitudes. The studies included in this proposal aimed to extend attitude change research to young, non-stuttering children. These studies, carried out among American and Polish young nonstuttering children, investigated whether children’s attitudes toward stuttering could be significantly improved after an application the Attitude Change & Tolerance Program – InterACT (Weidner, 2015).

Methods:

Participants were 80 young non-stuttering children.

The participants were divided into two study groups:

• the US group (N=37)
• the Polish group (N=43).

Study participants included preschool children (in the US and Poland) and first grade elementary children (in Poland). The children learned about stuttering and sensitive peer interactions by participating in the InterACT program. The program teaches children about human differences with an emphasis on stuttering and how to interact with people who stutter. Children’s stuttering attitudes were measured using the Public Opinion Survey of Human Attributes–Stuttering/Child – POSHA–S/Ch (Weidner & St. Louis, 2014) before and after the intervention.

Results:

Pre–post comparisons showed statistically significant improvements in children’s overall stuttering attitudes. Based on the results from the POSHA–S/Ch, pre intervention Overall Stuttering Score (OSS) measures were 3 for American group and -3 for Polish; while post intervention OSS measures were 15 for American and 10 for Polish. This study provides empirical evidence that young children’s stuttering attitudes can be improved using the Attitude Change and Tolerance program. In addition, it shows that InterACT program could be effective tool to improve stuttering attitudes also with non-English speaking children.

Children who stutter (CWS) are reported to have weaker phonological abilities than children who do not stutter (CWNS) while also exhibiting decreased white matter integrity (FA) along major language tracts. Specifically, the bilateral ventral language pathway is involved in speech recognition and phonological-lexical processing while the left dorsal language pathway relates to speech production given its support in mapping sound-to-articulation (Hickok & Poeppel, 2004). 

The current study examined the phonological complexity and accuracy using whole-word phonological measures of CWS (N = 24) and CWNS (N = 31) that were extracted from spontaneous speech. These phonological scores, phonological mean length of utterance (PMLU) and proportion of whole-word proximity (PWP), provide a quantitative measure of phonological complexity and accuracy, respectively (Ingram, 2002). In addition, we examined whether the association between PWP and FA along major white matter pathways differed between CWS and CWNS. We hypothesized that CWNS, relative to CWS, would produce words with greater phonological complexity (PMLU) and accuracy (PWP), and would exhibit greater association between phonology scores and white matter integrity in the left hemisphere dorsal language pathway. 

The results showed that: 1) CWS exhibited similar whole-word phonology as CWS, 2) contrary to expectations there was greater association between PWP and FA in bilateral dorsal tracts in CWS relative to CWNS, 3) CWS exhibited an overall attenuated age-related FA growth in areas overlapping with those with heightened PWP-FA associations. The greater association between PWP and the bilateral dorsal tracts in the context of attenuated overall age related FA increases in CWS suggests that stronger links between PWP and dorsal pathway FA may be needed for CWS to achieve comparable phonological development to age matched CWNS. These results provide novel insights into neural development associations relevant to phonological development in CWS.

A health inventory to examine co-morbid disorders in individuals with a developmental stutter has been developed with the ultimate goal of discovering underlying genetic variants that are contributory to both the correlated disorder(s) and developmental stuttering. Through the utilization of a DNA database linked EMR system, ongoing collaborative research between Vanderbilt University and Wayne State University has identified over 80 disorders across bodily systems that are statistically linked to developmental stuttering. This inventory investigates the validity of these co-morbid disorders through online survey self-report to aid in the potential future discovery of genetic interconnectivity between disorders, as well as to analyze relevant sequelae of developmental stuttering. Preliminary results of the survey research will be discussed.

The purpose of the current study is to assess the effectiveness of a novel technological solution, the BeneTalk digital environment, in treating adults who stutter. Stuttering presents both behavioural and cognitive symptoms that are commonly treated by addressing speech fluency via approaches such as the Camperdown Programme (Carey et al., 2010), underlying emotional reactions through CBT, Mindfulness, or ACT based interventions (Cheasman et al., 2015; Harley, 2018), or a combination of these (Beilby et al., 2012). A primary challenge for speech therapists and People Who Stutter (PWS) is transferring progress and knowledge gained in the clinical context to everyday situations. Previous technological solutions providing altered-auditory feedback, frequency-altered feedback, and biofeedback have been designed to help PWS in this endeavour. Equally, a small number of applications for smartphones have also emerged (Ward, 2018). The current study assesses the effectiveness of a novel digital approach to speech therapy, the BeneTalk digital environment. The BeneTalk digital environment differs from previous solutions in that it consists of a discreet wearable device, an integrated smartphone application, and an online discussion forum. The wearable records frequencies present in the diaphragm during speech in order to track speed and flow of utterances, the app teaches the user fluency shaping and CBT techniques, displays progress and provides a practice schedule, while the online forum provides peer support.

Participants in the study were adults who stutter (n = 24) matched in age, sex, SSI-4 and OASES (Yaruss & Quesal, 2006) scores were randomly assigned to control and experimental groups. The Camperdown Program was delivered to all participants via teletherapy by an experienced Speech Therapist in the UK. Participants were placed in small groups for a total of 20 hours of intervention. Participants in the experimental group (n = 12) also used the BeneTalk digital environment. Data collected from all participants via the OASES and SSI-4 pre intervention, post-invention, 10-weeks post-intervention, and 24-weeks post-intervention.

Research is in progress. The conference talk will discuss preliminary findings including pre and post intervention data obtained via the OASES and SSI-4. Additionally, examples of the biofeedback data collected via the BeneTalk digital environment will be discussed.

The application of the technology present in the BeneTalk digital environment represents a potential step change in the treatment of adults who stutter. Specifically, the wearable aspect of the BeneTalk device has implications for the maintenance of client progress when away from the clinical context. The digital environment may also provide clinicians with objective data related to speech behaviours and physiological reactions of clients. This may be used to inform intervention, delivery of more effective treatment, and drive future scientific study.

Introduction

The goal was to investigate the reliability and validity of adolescents’ self-measurement of their stuttering.

Methods

Participants were 10 adolescents who stuttered, aged 11.8 to 14.6 years (M=13.0). Participants estimated their own stuttering severity using a 10-point scale (0-9) before and after different speaking/listening task on three occasions. At occasions 1 and 2 participants rated the severity of their stuttering, completed a speak tasks which was video-recorded, and re-rated their severity. At both occasion participants completed ratings before and after the six speech tasks. At occasion 3 participants rated the severity of their stuttering after watching the each of the six video-recorded speech samples collected at occasions 1 and 2 in total 12 recordings. Therefore, for each participant 6 pre- and 6 post-ratings were obtained at occasion 1 and occasion 2 (n=240), and 12 pre- and 12 post-ratings at occasion 3 (n=120), making a total sample of 360 ratings from these adolescents. Ratings were compared to determine exact matches, near matches (±1 difference), and mismatches (>1 difference). Reliability was evaluated through comparing participants’ ratings pre- and post-ratings at each occasion and between occasions. Validity was evaluated by comparing adolescents’ self-ratings to the ratings of experienced clinicians.

Results

Consistency: There were exact or near matches for 84% of the samples comparing pre-pre and 80% for comparing post-post ratings between occasion 1 and 2 and 83% for the pre-post ratings without watching video recordings. After watching the video recordings the rating consistency was poorer, or 58% of the samples comparing the pre ratings and 63% for comparing post.

Validity: Validity was poor, with only 62% of pre-ratings and 61% of post-ratings and 60% of the after watching the video ratings forming a match with expert ratings.

Discussion

Consistent with findings from previous studies, the present study found that adolescents who stutter were consistent in their ratings before observing themselves on video. This study adds to current knowledge by finding that after seeing video recordings, adolescents’ judgements were changed. Further, adolescents’ self-ratings of their stuttering severity were poorly aligned with those of experience clinicians.

Introduction: The purpose of this study was to determine the fluency education perceptions and needs of speech-language pathology graduate students attending American Speech-Language Hearing Association (ASHA) accredited programs at universities in the United States. This study examined the information taught the fluency disorders information taught in classrooms as well as the amount of exposure students received to fluency disorders in a clinical setting.

Methods: A 70-question survey was sent to 258 professors in the United States who taught fluency disorders courses in accredited Communication Sciences and Disorders (CSD) programs. Professors were then asked to forward the survey to their students. Data was collected from 766 responding students and 102 different universities.

Results: Results indicated that as speech-language pathology students advance through their programs, both their knowledge and comfort levels increase in the assessment and treatment of fluency disorders. However, graduate students reported lacking adequate knowledge of administering assessment tests or differentiating between various methods of treatment for fluency disorders.

Discussion: This study shows that a large number of graduate speech-language pathology students are lacking in exposure to and knowledge of fluency disorders. In this study, 30.4% of speech-language pathology graduate students reported finishing coursework without ever treating a client with a fluency disorder. This study emphasizes the lack of knowledge and experience graduate students have with fluency disorders, and suggests that moving forward, universities should strive to improve the quantity and quality of instruction pertaining to fluency disorders. This could be achieved by having faculty attend workshops tailored toward fluency disorders, and by increasing the number of hands-on learning opportunities for treatment and assessment of fluency disorders. Taking such actions could help graduate students feel more confident and comfortable in the assessment and treatment of fluency disorders, and also enable them to better serve this population in the future.

Introduction: Microaggressions, or day-to-day discriminations unnoticed by the perpetrator, have received considerable attention within marginalized groups (e.g., members of racial and ethnic minorities, LGBTQ+ community, people with mental illness and/or visible disability). The purpose of this research is to improve social and professional interactions with these stigmatized or misunderstood populations. To date, microaggression has not been explored in adults who stutter (AWS) who likely experience similar types of discrimination as well as disorder-specific microaggressive behaviors.

Methods: Seven AWS participated in two focus groups including a semi-structured qualitative interview (Keller & Galgay, 2010) and self-report questionnaires focusing on the (a) impact of stuttering on life (OASES; Yaruss & Quesal, 2010), and (b) stigmatization experienced as an AWS (4S scale; Boyle, 2013). Video-recordings were transcribed, edited, and analyzed using QSR NVivo software to develop a set of themes and subthemes.

Results: Initial analyses have revealed five prominent themes. The first - rejection of victimhood – reflects the AWS respondents’ initial reticence to acknowledge that the listener has done anything wrong. The second – macroaggression as microaggression – reflects AWS respondents’ description of classic and overtly harmful behaviors such as laughing or mocking as an “unintended insult”. The third – patronization – reflects listener praising the AWS for almost anything (e.g., “You are so inspiring”). The fourth – denial of experience – reflects listeners’ comments that trivialize stuttering-related experiences (e.g., “I don’t even notice your stutter”/“I stutter sometimes too”). The fifth – second-class status – reflects listeners’ attempts to physically avoid interacting with AWS (e.g., avoiding eye-contact).

Discussion: Although patronization, denial of experience, and second-class status are microaggressions shared by a variety of marginalized groups, the initial two themes were more specific to AWS. It is notable that SLPs were also implicated in the latter three behaviors. Ongoing analysis may reveal and prioritize additional themes and subthemes specific to the AWS experience.

Do early childhood professionals in Norway distinguish between stuttering and normal childhood dysfluencies?

Introduction: Research has revealed that children as young as 3 years of age can be socially and emotionally affected by stuttering (McAllister, 2016). Since predictors for recovery are unclear, treatment close to the onset of stuttering is recommended (Onslow & Lowe, 2019). In Norway, early childhood professionals (including kindergarten teachers and public health nurses) are central in identifying stuttering due to their regular interaction with young children and can initiate referral to speech language pathologists (SLPs) (§§ 19a Kindergarten Act; § 5-10 Folketrygdloven). However, prior studies have revealed that early childhood professionals such as teachers, pediatricians or even generalist SLPs have insufficient knowledge about stuttering and hence, may therefore not be able to identify the children that stutter early enough. This study explores if early childhood professionals in Norway differ in their understanding of stuttering compared to normal disfluency.

Methods: A web-based questionnaire was sent to kindergarten teachers (n = 126), public health nurses (n = 95) and SLPs (n = 120). All participants were asked if they differentiate between stuttering and normal dysfluency, and to provide detailed descriptions for their chosen answer.

Results: The results revealed that similar numbers of participants in the three groups differentiate between stuttering and normal disfluency. However, more SLPs did not differentiate than the health nurses and kindergarten teacher. The descriptions revealed both updated knowledge as well as knowledge gaps within all three professions.

Discussion: In order to ensure good identification of children who stutter, early childhood professionals need more knowledge to be able to distinguish between normal dysfluencies and stuttering. The knowledge gap may lead to a ‘wait-and-see’ approach that may interfere with the children’s stuttering development.

Introduction:

Behavioural measures of stuttering (i.e., SSI) do not always correlate with measures of life impact (i.e., OASES). To explain this discrepancy, this study explores whether sense of humour is a modulating factor in coping with stuttering. One aspect of change that often takes place during therapy is an appreciation of the humorous aspects of stuttering (Manning & Beachy, 2014). Past experiences that were once embarrassing and shameful become humorous tales to share with others (Manning & DiLollo, 2018). Humour and laughter are related to a feeling of mastery of a task or situation and a reduction of stress (Lefcourt & Martin, 1986). Fortunately, both often take place during successful stuttering treatment. Humour is also evidence that clients have achieved distance from a problem and that it is no longer threatening (Kuhlman, 1984).

Method:

Data collection is ongoing. At the time of submission, 20 people have participated in this study.

We are measuring the life impact of stuttering using the OASES, the physical severity of stuttering using the SSI, and sense of humour using several humour scales. These include the coping humour scale (Martin & Lefcourt, 1983), the situational humour response questionnaire (Martin & Lefcourt, 1984), and the multidimensional sense of humour scale (Thorson & Powell, 1993). Our hypothesis is that, when compared with speakers with a similar physical severity of stuttering, people with lower sense of humour scores will report that stuttering impacts their lives more than people with higher sense of humour scores.

Results and Discussion:

Results are pending as of this submission. This poster will give a background of the literature on humour, therapy, and stuttering. It will also summarize the results of our investigation. Finally, it will comment on the clinical implications of the results and offers suggestions for targeting humour in one-on-one and group therapy.

Introduction: This study explores whether people who stutter (PWS) differ in rhythmic tapping behavior compared to people who do not stutter (PNS). Stuttering is a neuro-motor disorder, presenting itself as disfluent speech production. One of the theories proposed is that temporal processing deficiencies play a role in stuttering. Speech is characterized by a quasi-rhythmic structure that requires complex temporal skills to estimate the often-unpredictable timing of strong and weak syllables. Most studies to date explore the temporal processing skills of PWS and PNS with simple rhythmic tasks, such as the ability to synchronize with a predictable external beat. To the authors’ knowledge, it has not been explored whether PWS have a deficit in estimating temporal dimensions between beats, for example when they are instructed to fill up the time between two metronome beats, a skill needed in the quasi-rhythmic prosodic structure of speech. This first study investigates whether PWS differ in their ability to fill an empty time interval with a sequence of regular beats. In addition, to validate earlier studies, the study examines whether PWS differ in their ability to tap synchronously to a beat and to continue tapping a periodic rhythm without an external beat.

Methods: 16 French PWS and 16 French PNS (controlled for age and gender) were instructed to tap in 3 rhythmic tasks:

Dependent variables were mean tapping period (MT) and tapping variability TV:

mean ()).

Independent variables were Group (PWS, PNS), Musical experience (no (0), some (1), advanced (2)), and task (T1, T2, T3).

Results: PWS showed significant higher TV than PNS (fig. A), confirming the findings from earlier studies. In addition, for both PWS and PNS, lower TV was observed in T1 compared to T2 and T3. T1 showed smaller MT than T2 (fig. C). Interestingly, musical experience had a significant effect on variability measures (fig. B). The prediction that PWS, compared to PNS, showed more difficulty filling up a timeframe with extra taps was not confirmed, although they missed more taps in the condition in which they had to fill up the temporal space between two beats (fig. D). This possibly indicates temporal planning difficulties in T2 for PWS.

Discussion: Based on the variability values and the number of missed taps, it is concluded that PWS show deficiencies in rhythmic tapping. Currently, additional data is being analyzed, focusing on more complex rhythms. In addition, next steps focus on how gestural coordination is affected by an external auditory beat, as it has been shown that, despite the more variable tapping patterns observed by PWS, fluency frequently improves with external auditory triggers.

Introduction: A subset of speakers produce “atypical disfluencies” that affect medial and final components of words. They are aptly described as “lost in the literature but not on the caseload” (Sisskin & Wasilus, 2014). We aim to contribute to the research on these disfluencies by providing a tutorial on how they can be assessed psycholinguistically. The present analysis concerns one type of atypical disfluencies, word-final repetitions (WFRs).

Methods: We outlined the speech production process and determined which type of data collected through language sampling can be used to analyze whether WFRs arise from difficulty at each step of this process. Then, we used cases of two adolescents with autism spectrum disorders who produce WFRs to assess whether problems causing WFRs result from difficulty at each production step.

Results: We found that the two best candidates for production stages causing WFRs are (1) external channel monitoring or (2) syntactic planning. The possibility of external channel monitoring (i.e., monitoring for whether the produced word matches the intended word by hearing a word through the same system used for comprehending others’ speech) causing WFRs was supported by the long duration of the pauses between the end of the word and the beginning of the repetition. The possibility of syntactic planning causing WFRs was supported by the occurrence of WFRs in utterance-medial and -final positions, where they can delay syntactically-demanding constituents, and by the occurrence of these disfluencies in longer utterances.

Discussion: Our detailed psycholinguistic analysis can be used as a frame for future assessments of the production problems that might cause WFRs or other types of atypical disfluencies. A limitation is that our analysis, based in language sampling, could only suggest that these possibilities are good candidates, so we will also discuss how future research can be designed to support stronger inferences.

Stuttering has an impact on a person’s social life. Recent studies show that the development of negative emotions in children who stutter begins at the age of 3 years (McAllister, 2016). In Lebanon, research on this subject is in an early stage. Lebanese speech-language therapists are facing difficulties related to the evaluation and treatment of fluency disorders due to a lack of standardized and adapted resources for the assessment of stuttering and related sequelae. Therefore, this pilot study aims to reach a better understanding of beliefs and perceptions about stuttering in bilingual Lebanese children who stutter (CWS) aged between 3 and 6 years. In order to do so, this investigation explores the calibration of the revised "KiddyCAT" (Vanryckeghem & Brutten, 2015) on the Lebanese population. To achieve these goals, 110 children were recruited: 60 children who do not stutter (CWNS) and 50 CWS. The "KiddyCAT" assesses the belief children hold with regards to their speech. Results showed a significant difference in the report of speech reactive attitudes of CWNS and CWS. It has been found that the presence of negative thoughts in CWS is independent of their age and sex, but largely dependent on the awareness of the disorder. These results represent a first database for the development of reactionary attitudes in Lebanese CWS aged between 3 and 6 years old, and will be adopted in the evaluation and treatment of CWS in Lebanon.

Introduction: In this presentation, we will provide an updated checklist containing clinical characteristics associated with stuttering persistence based on a systematic review and meta-analysis of extent research. We identified clinical characteristics - defined as child factors that can be assessed by a speech-language pathologist/therapist as part of a routine speech-language evaluation, that differentiate children who persist in stuttering from children who eventually recover. Findings, based on all currently available evidence, were compared to the Risk Factor Chart found in Guitar and Conture (2006) and updated accordingly.

Methods: Studies included in the systematic review were identified through electronic databases, journals, and reference lists from relevant reports (e.g., research articles). Eligible studies followed young children who stutter (i.e., under six-years old) for at least 24 months, assessed at least one clinical characteristic (e.g., age at onset, stuttering characteristics, speech-sound accuracy, etc.) at study entry, and determined talker group classification (i.e., persistent or recovered) at study completion. Clinical characteristics reported in at least two studies were included in the meta-analysis and differences were estimated using either using risk ratios or Hedges’ g. Clinical characteristics found to differentiate the groups in only one study were included in the systematic review. Clinical characteristics found to differentiate the groups were then used to produce an updated checklist of clinical characteristics associated with stuttering persistence.

Results: Eleven studies (41 reports) met eligibility criteria. Meta-analytic findings indicated that persistent children exhibited later stuttering onset, higher frequencies of stuttering-like disfluencies, lower speech-sound accuracy, and lower expressive and receptive language skills than recovered children. Males and children with a family history of stuttering were also more likely to persist. The systematic review also revealed that persistent children exhibit a more stable frequency of stuttering-like disfluencies within the first 18-24 months of onset and lower performance on a nonword repetition task than did recovered children.

Discussion: Clinical characteristics were identified that are associated with stuttering persistence based on all currently available evidence. The resultant checklist of clinical characteristics may be used to better aid clinicians in evaluating the chance of persistence for a child who stutters. The most notable differences between the updated checklist and that of Guitar and Conture (2006) include findings of the value of specific speech-language skills (i.e., speech-sound accuracy, receptive language, and expressive language) and the child’s frequency of stuttering-like disfluencies when evaluating a child’s chances of persisting. These findings support inclusion of focused analyses of disfluencies and comprehensive speech-language testing in professional evaluations of young children who stutter.

Our purpose is to develop skills for the clinician and the researcher interested in assessing preschool- and school-age children who stutter. Our primary focus is to inspire the diagnostician to assess the whole child, thereby forming a foundation for more effective, more individually-centered treatment planning.  Since the theme of this convention is "challenge and change", it is fitting that in this seminar, we challenge the traditional approach which focuses mostly on speech dysfluency.  We propose a broader view looking at five different levels of behavior. This template, named “T-PALS” includes: Temperament (T), Pragmatics (P), Articulation/phonology (A), Language (L), and Stuttering (S). Temperament refers to the child’s inborn style of behaving and emotional regulation.  When the child’s temperament is measured, the clinician should also remain attentive to the most important behavior in a child who stutters -- the stuttering (Onslow & Kelly, 2020).  Pragmatics involves a variety of factors pertaining to communicative competence, for example, eye contact. Another example is assertiveness vs. responsiveness, given that there is a higher likelihood of stuttering during assertive utterances (Weiss & Zebrowski, 1992). Articulation/phonology is complex, whether it be residual articulation difficulties or a phonological coexisting disorder (approx. 30% of CWS; Byrd, Wolk & Davis, 2007; Logan & LaSalle, 2003). It is important to assess articulation/phonology as it may change the treatment trajectory.  Language skills are another important piece of the puzzle. Recent research has shown that 2- to 8-year-old children who stutter are significantly lower in expressive and receptive language skills (Luckman et al., 2020).  Stuttering is the central component of the template; we use both qualitative and quantitative measures. We will present pilot data using the TPALS template on four children: two preschoolers and two school-aged children.  This presentation will provide clinicians and researchers with a broader foundation upon which to plan treatment.

Purpose: Lexipontix (Fourlas & Marousos 2015, 2019) is a therapy programme for school-age children who stutter that addresses the overall stuttering experience of the child and the family. Parents are actively engaged in therapy supporting their child and exploring their own thoughts and feelings about their child’s stuttering and their hopes and expectations of therapy outcomes. This study explored parents’ experience with Lexipontix. 

Method: Parents (19 mothers, 17 fathers) of 19 children who completed Lexipontix filled-out an 8-item, visual analog (0 to 10 scale) questionnaire that assessed the level of fulfilment of their expectations from the programme, their perceived level of motivation of their child, their perceptions of the programme’s overall quality, the quality of therapy materials and assignments, the demands of the programme in terms of family time and resources, and the pace of the programme. Each construct was assessed with a single question with the exception of the “quality of therapy materials and assignments,” which was assessed with three questions, the average of which was calculated and used in analyses. Also, parents provided a written answer to the open-ended question “Please write about your experience with Lexipontix.” 

Results:  The mean rating of the aforementioned constructs ranged from 7.89 to 9.18 for mothers and 7.85 to 8.85 for fathers. A series of paired sample t-tests did not detect statistically significant difference in mean ratings between fathers and mothers (p < .05). Parents’ written replies to the open-ended question were analyzed with thematic analysis (Attride-Stirling, 2001) and the QDA miner software. The following five main themes (organizing themes) were identified: “Experience with the programme,” “Cognitive Restructuring,” “Speech Restructuring,” “Affective Change,” and “Change of the Environment.” The most common basic theme under each of the aforementioned organizing themes was “positive comments for the programme,” “better understanding of stuttering,” “psychological resilience,” “speech control,” and “empowerment of parents” respectively. An initial descriptive view of the frequency of basic themes (to be further analyzed for the poster – if accepted) is suggestive of differences between mothers and fathers. 

Conclusions: Results demonstrate that parents’ expectations for Lexipontix were largely fulfilled. Parents rated different aspects of the programme highly and they reported positive changes at various domains (e.g., cognitive, affective, motoric, environment).

Introduction: The affective and cognitive impacts of cluttering and atypical disfluencies have not yet been explored in detail. This study was conducted to determine how speaking with cluttering and/or atypical disfluencies affects different aspects of a person’s life (e.g., education, social, employment), as well as how it impacts the significant others in their lives. 

Methods: This ethnographic study collected and analyzed interviews of 10 people who clutter and/or speak with atypical disfluencies as well as their family members or significant others. Each participant participated in a semi-structured interview focusing on grand and mini tour questions. The participants were asked to speak about their perspective and experience with cluttering and/or atypical disfluencies. Each interview was transcribed, and themes were culled by three researchers. Triangulation and member checking was conducted to establish reliability and validity of themes.

Results: Preliminary results of this study revealed the following themes: lack of resources and understanding impact all aspects of life; in/accurate diagnosis impacts life outcome; social impact is significant. Plans are underway to interview an additional 10 participants. Analysis will involve integration of new themes as applicable.

Discussion: Clinical and research implications of findings will be discussed.

Purpose: Parents observe increased levels of fluency in their children, feel more confident in managing their child’s stuttering, and feel less worried after therapy (e.g. Millard et al., 2018). According to Millard et al. (2018), the process and timing of these changes differ between mothers and fathers, but it is not known whether and how different parts of the therapy process contribute to this change. A number of authors advocate a multifactorial assessment (e.g. Clarke, Tumanova and Choi 2017; Kelman and Nicholas, 2020). This is considered to be an integral part of the therapy process, with the potential to increase parents’ knowledge, reduce their anxiety and begin the process of change.  

Aim: This preliminary study seeks to explore the impact of one multifactorial assessment process (Kelman and Nicholas, 2020) on parents’ perceptions of stuttering, the impact it has on their child, the impact that it has on them and their knowledge and confidence to manage it.

Method: Parents (n=204) from 104 children completed the Palin Parent Rating Scales (Palin PRS; Millard & Davis, 2016) before and after assessment. A two-factor mixed ANOVA was used to explore group (mothers vs fathers) and time (before vs after assessment) effects, and the interaction of group and time.

Results: A significant main effect for the within subjects factor (time: before vs after assessment) was found. There was no significant main effect for the between subjects factor (group: mothers vs fathers) and no significant interaction between group and time.

Conclusion: Findings suggest that this multifactorial assessment process has a positive impact on mothers and fathers before therapy has begun and initiates the process of change. Results reinforce the benefits of both parents being involved. This preliminary study supports the need to explore the benefits and contribution of the assessment process as part of therapy.

Previous work has indicated that stuttering may occur as a result of abnormal sensorimotor integration or improper timing signals for initiating and terminating speech motor commands. Both of these assertions have been supported by speech auditory feedback perturbation experiments. Furthermore, timing syllable production to a steady beat reduces dysfluencies in people who stutter. It is yet unclear, however, whether syllable-timed speech improves fluency by directly modulating these purported causes of stuttering. 

To test this, 15 adults who stutter (AWS) and 16 adults who do not stutter (ANS) read the sentence “The steady bad gave birth to pups.” aloud either using a typical rate and rhythm or with each syllable paced at the rate of a pre-trial metronome. On 20% of either type of trial, participants’ auditory feedback was modified such that the first formant frequency of the /ε/ in “steady” was increased by 25% (spectral perturbation). On another 20% of trials, the duration of the /s/ in “steady” was stretched by ~55ms in their auditory feedback (timing perturbation). Responses were determined by measuring changes in either first formant frequencies or subsequent syllable boundaries between the perturbed and non-perturbed conditions. 

Results indicated that during normally paced speech, ANS showed a significant compensatory response to the spectral perturbation by the end of the /ε/ vowel, while AWS did not. In the syllable-timed condition, which significantly reduced the dysfluency rate, the opposite was true: AWS showed a significant response by the end of the /ε/ vowel, while ANS did not. This was accompanied by a 60ms increase in vowel duration for AWS (averaged across perturbed and non-perturbed trials). For the timing perturbation, both groups responded by delaying the timing of subsequent syllable boundaries, and there were no significant differences between groups in either condition. There was, however, a significant correlation between dysfluency rate during the experiment and response magnitude, where AWS with more dysfluencies responded with larger delays in subsequent syllable boundaries. This was not modulated by speaking condition.

These findings suggest that syllable-timed speech leads to a resolution of spectral auditory-motor integration impairments in AWS, potentially by increasing vowel duration which may allow AWS more time to make corrective adjustments. Regarding the timing perturbation, the correlation of response size with dysfluency rate suggests that stuttering frequency is related to increased responses to auditory timing errors. In addition, less dysfluent AWS had decreased responses compared to ANS. These AWS may down-weight the use of auditory feedback for timing speech to reduce stuttering. Finally, the present results do not support the assertion that syllable-timed speech reduces dysfluencies by modulating the auditory feedback control mechanism for speech timing.  These results inform mechanistic theories of stuttering which may eventually be used to optimize stuttering therapy.

Introduction: The benefits of implementing evidence-based practice in the field of speech and language therapy are widely recognised by both researchers and clinicians. The dominant model of employing efficacy evidence to inform clinical decision-making in recent decades has overshadowed the benefits of other forms of knowledge and of synthesising a broad range of evidence and knowledge, including practice and patient-based research to support the intervention process. Stuttering intervention for adults is one such area in which there is a significant shortage of practice and patient-based research literature. Additionally, intervention for adults who stutter remains fraught with challenges including high unsuccessful treatment and relapse rates, therapists’ reduced knowledge of stuttering intervention, and a failure to explore the psychosocial needs of the individual.^1,2 This study which is part of a project developing a multi-stakeholder, evidence-based model of intervention aimed to retrieve the perspectives of international researchers and clinical experts on theoretical underpinnings, principles, components and outcomes of effective intervention for adults who stutter. Methods: Experts were identified using expertise criteria developed through a literature review on expertise in healthcare and expertise specific to the field of speech and language therapy. Following completion of two pilot interviews, internet-mediated semi-structured interviews were completed with a total of ten identified international experts. Purposive sampling and snowballing were used to recruit the participants, which were geographically representative, extending across Australia, Belgium, Canada, UK, and USA. Interview questions centred on five core topics: the evidence base for stuttering intervention; components of effective intervention; theory of stuttering origin/development guiding intervention; therapy outcomes; and overarching principles of effective intervention. Results: Inductive thematic analysis identified three overarching themes and ten subthemes that provided insight into the complexity of stuttering intervention: 1) “One size doesn’t fit all”; 2) “I can establish a really collaborative relationship with my client where we are both bringing our sense of expertise to this”, and 3) “Nothing about the process is easy”. The credibility and trustworthiness of the data and results were addressed using member checking, intercoder agreement and multiple researcher consensus on the final themes. Discussion: These findings emphasize the complexity of stuttering intervention and highlight a clear mismatch between research-based evidence and experts’ perceptions of effective stuttering intervention. Further, results elucidate the importance of the consideration of multiple factors, beyond therapeutic technique, that influence the effectiveness of stuttering intervention. Factors related to the clinician such as empathy and specialised training, and those related to the adult who stutters such as motivation and readiness to change are all perceived to contribute to therapeutic effectiveness. This research study highlights the importance of retrieving researched practice evidence and expert knowledge to improve adults’ experience of stuttering intervention, inform intervention design, enhance treatment outcomes and effectively use healthcare resources. Findings will be used to inform the novel co-design of a model for evidence-based stuttering intervention using input from multiple stakeholders including adults who stutter.

References

1.Johnson M, Baxter S, Blank L, et al. The state of the art in non-pharmacological interventions for developmental stuttering. Part 2: qualitative evidence synthesis of views and experiences. Int J Lang Comm Disord, 2016; 51(1):3 17.

2.Yaruss JS, Quesal RW, Reeves L, et al. Speech treatment and support group experiences of people who participate in the National Stuttering Association. J Fluen Disord, 2002;27:115 134.

Inhibitory control is an aspect of cognitive control that regulates withholding a prepotent response in order to achieve a goal. Numerous studies have evaluated inhibitory control in children who stutter (CWS) and findings have been inconclusive (Eggers et al., 2013, 2018; Harrewijn et al., 2017; Piispala et al., 2016, 2017, 2018). Piispala et al. (2016, 2017) found less distinct neural markers of inhibition (smaller P3 peak amplitudes) in CWS compared to children who do not stutter (CWNS) using event-related potentials (ERPs) with 50% no-go trials in a visual go/no-go paradigm. Utilisation of less probable no-go events may elicit larger P3 responses and would aid in better understanding of neural markers of response inhibition. The current study aimed to evaluate inhibitory control using a modified visual response inhibition task in CWS compared to CWNS. Forty-five children ages 5-8 years, 23 CWS [mean age (SD) = 6.29 (1.07)] and 22 CWNS [mean age (SD) = 6.24 (1.11)], completed a child-friendly visual go/no-go task (Grammer et al., 2014). Electroencephalography (EEG) was recorded from 32 scalp electrodes while children pressed a button for all animals (go; 75%) except to the orangutan (no-go; 25%). No differences in behavioural response accuracy were observed between CWS and CWNS for go [t (40) = -0.43, p = 0.67] or no-go [t (43) = 0.79, p = 0.43] trials. Although ERP waveforms showed amplitude differences between groups, cluster-based permutation statistics revealed significant effects of condition in both the groups (p < 0.05), but no effect of group for go or no-go conditions (p > 0.05). Methodological factors, including larger sample size, younger children, task complexity and differences in ERP analyses, might have influenced the present findings compared to previous studies. However, the results suggest comparable inhibitory control mechanisms in CWS compared to CWNS for visual response inhibition.

Mental state verbs (MSVs) are conceptually more abstract than other types of verbs, such as action verbs. They denote internal cognitive states and are therefore likely to be embedded in utterances that are more conceptually complex. For example, “She forgot [MSV] his name” is more abstract than “She said [action] his name.”  Children in the preschool years understand and produce some MSVs, and production increases over childhood.

In the preschool years, disfluency has been observed to occur more frequently on syntactically complex and longer utterances in children who stutter (CWS) and children who do not stutter (CWNS). Less clear is the potential relationship between the conceptual complexity of an idea coded within an utterance and the likelihood of disfluency in the production of that utterance. 

Through examination of the play-based language samples of 30 preschool-age CWS and 30 age- and gender-matched CWNS with their mothers, we explored (a) the frequency of MSV use among CWS and CWNS, (b) the correspondence between mothers’ use of MSVs and their children’s use, and (c) the proportion of MSV utterances versus non-MSV utterances that contain stutter-like and other disfluencies for each group. Mean length of utterance (MLU) for MSV-disfluent versus MSV-fluent utterances will also be compared to explore the potential contributing role of utterance morphosyntax. 

We hypothesize that both CWS and CWNS will demonstrate greater disfluency on utterances containing MSVs than on other utterances; that children whose mothers use more MSVs will use more MSVs, themselves; and that MLU will not differ significantly between disfluent and fluent MSV utterances, demonstrating that it is the conceptual complexity, rather than length, that is associated with fluency breakdown. 

Results will be discussed in relation to the idea that disfluency may serve as an indicator of the challenge associated with conceptually complex, abstract language.