First-Generation OTC Antihistamine Use and Voice Function in Individuals with Allergic Rhinitis: A Preliminary Report of Clinically Impactful Findings.

PURPOSE: The primary goal of this investigation was to characterize the effect of the first-generation, over-the-counter antihistamine Chlor-Trimeton on laryngeal structure and function in a previously unstudied population - individuals diagnosed with allergic rhinitis who routinely take over-the-counter antihistamines and deny the experience or diagnosis of voice disorder. STUDY DESIGN: Prospective within-participant multimodality repeated measures design. METHODS: Eight consented participants (seven females, one male) previously diagnosed with allergic rhinitis and without history of voice disorder who routinely took over-the-counter antihistamines completed the study. Volunteers completed the following measures before and 2hours after antihistamine administration: perceptual vocal function measures, phonation threshold pressure (PTP), acoustic measures, and laryngeal imaging. All pre- and post-administration data were descriptively analyzed for clinically significant change. RESULTS: No clinically significant differences were identified for any acoustic or aerodynamic measures taken. Analyses of laryngeal imaging data indicated that all participants had evidence of mucosal changes in one or more of the following parameters: increased vascularity, mucus in the anterior commissure, and vocal fold color changes, all of which are consistent with prior descriptions of allergy larynx. CONCLUSIONS: Empirical study of laryngeal appearance in individuals diagnosed with allergic rhinitis, affirmed clinical observations of laryngeal tissue changes consistent with allergy larynx. Stable PTP suggests potential vocal fold cover adaptations from routine use of over-the-counter antihistamines that may buffer the typical desiccating effect on voice function observed in prior studies of healthy individuals.

Speech-language pathologists' counselor self-efficacy.

INTRODUCTION: The purpose of this study was to measure and determine the factors that influence counseling self-efficacy in speech-language pathologists. METHODS: Data was collected through an anonymous 95-question web-based survey. Five hundred and twenty-seven completed responses were received. RESULTS: The results indicated that participants in the study were confident in their counseling abilities and skills; however, lesser confidence in skills related to personal adjustment counseling were observed. Further, emotional intelligence, internal locus of control, counseling training, and years of experience were positively related to counseling self-efficacy. CONCLUSIONS: Speech-language pathologists may increase their counseling self-efficacy through increased training opportunities and experiences, development of greater emotional intelligence, and by having an internal locus of control.

High-Speed Characterization of Vocal Fold Vibrations in Normally Cycling and Postmenopausal Women: Randomized Double-Blind Analyses.

Purpose The aim of this study was to examine the influence of menstrual cycle phases (follicular, ovulatory, luteal, and ischemic) and hormone levels (estradiol, testosterone, progesterone, and neuropeptide Y) on vocal fold vibrations in reproductive and postmenopausal women. Method Glottal area waveforms were extracted from high-speed videoendoscopy during sustained phonation, inhalation phonation, and voice onset/offset in the reproductive (n = 15) and postmenopausal (n = 13) groups. Linear mixed-model analysis was conducted to evaluate hormone levels and high-speed videoendoscopy outcome variables between the reproductive and postmenopausal groups. In the reproductive group, simple linear regression and multiple regression were conducted to determine the effects of hormones on the dependent variables. Results Group differences between reproductive and postmenopausal women were identified for stiffness index, oscillatory onset time, and oscillatory offset time. Neuropeptide Y hormone in the ischemic phase significantly predicted changes in the reproductive group for some dependent variables; however, the relationship varied for sustained phonation and inhalation phonation. Conclusion These findings provide preliminary evidence that vocal fold vibrations in the reproductive group are different predominantly in the ischemic phase due to neuropeptide Y changes.

Quantifying Vocal Power: Correlation of Whole-Body Anaerobic Power to Vocal Function Measures.

Purpose The purpose of this preliminary study was to identify a vocal task that could be used as a clinical indicator of the vocal aptitude or vocal fitness required for vocally demanding occupations in a manner similar to that of the anaerobic power tests commonly used in exercise science. Performance outcomes for vocal tasks that require rapid acceleration and high force production may be useful as an indirect indicator of muscle fiber complement and bioenergetic fitness of the larynx, an organ that is difficult to study directly. Method Sixteen women (age range: 19-24 years, M age = 22 years) were consented for participation and completed the following performance measures: forced vital capacity, three adapted vocal function tasks, and the horizontal sprint test. Results Using a within-participant correlational analyses, results indicated a positive relationship between the rate of the last second of a laryngeal diadochokinesis task that was produced at a high fundamental frequency/high sound level and anaerobic power. Forced vital capacity was not correlated with any of the vocal function tasks. Conclusions These preliminary results indicate that aspects of the laryngeal diadochokinesis task produced at a high fundamental frequency and high sound level may be useful as an ecologically valid measure of vocal power ability. Quantification of vocal power ability may be useful as a vocal fitness assessment or as an outcome measure for voice rehabilitation and habilitation for patients with vocally demanding jobs.

Data Collection Methods for the Voice Range Profile: A Systematic Review.

Purpose To assess data collection variability in the voice range profile (VRP) across clinicians and researchers, a systematic review was conducted to evaluate the extent of variability of specific data collection points that affect the determination of frequency range and sound level and determine next steps in standardization of a VRP protocol. Method A systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist. Full-text journal articles were identified through PubMed, Web of Science, Psych Info, ProQuest Dissertations and Theses Global, Google Scholar, and hand searching of journals. Results A total of 1,134 articles were retrieved from the search; of these, 463 were duplicates. Titles and abstracts of 671 articles were screened, with 202 selected for full-text review. Fifty-four articles were considered eligible for inclusion. The information extracted from these articles revealed the methodology used to derive the VRP was extremely variable across the data points selected. Additionally, there were eight common acoustic measures used for statistical analysis described in included studies that were added as a data point. Conclusions The data collection methods for the VRP varied considerably. Standardization of procedures was recommended for clinicians and researchers.

Blood Plasma Hormone-Level Influence on Vocal Function.

Purpose This preliminary study examined the influence of menstrual cycle phase and hormone levels on acoustic measurements of vocal function in reproductive and postmenopausal females. Mean fundamental frequency (f0), speaking fundamental frequency (Sf0), and cepstral peak prominence (CPP) were evaluated. It was hypothesized that Sf0 and CPP would be lower during the luteal and ischemic phases of the menstrual cycle. Group differences with lower values in postmenopausal females and greater variability in the reproductive females were also hypothesized. Method A mixed factorial analysis of variance was used to examine differences between reproductive and postmenopausal females and the four phases of the menstrual cycle. Separate analyses of variances were implemented for each of the dependent measures. Twenty-eight female participants (15 reproductive cycling, 13 postmenopausal) completed the study. Participants were recorded reading the Rainbow Passage and sustaining the vowel /a/. Mean vocal f0, Sf0, and CPP were determined from the acoustic samples. Blood assays were used to determine estrogen, progesterone, testosterone, and neuropeptide Y levels at four data collection time points. Results Group differences in hormone levels and Sf0 values were established with the postmenopausal group having significantly lower hormone levels and significantly lower Sf0 than the reproductive cycling group across the phases. Analysis of the reproductive group by hormone levels and cycle phase revealed no significant differences for CPP or Sf0 across phases. Higher estrogen was identified in the ovulation phase, and higher progesterone was identified in the luteal phase. Conclusions Significant differences in hormone levels and Sf0 were identified between groups. Within the reproductive cycling group, the lack of significant difference in acoustic measures relative to hormone levels indicated that the measures taken may not have been sensitive enough to identify hormonally mediated vocal function changes. The participant selection may have biased the findings in that health conditions and medications that are known to influence voice function were used as exclusion criteria.

The influence of workplace discrimination and vigilance on job satisfaction with people who stutter.

Purpose The purpose of the present study is to examine the association between workplace discrimination, vigilance, and job satisfaction in people who stutter and compare this with people who do not stutter. Method Seventy-two people who stutter (PWS) and 92 people who do not stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6 different areas: (a) background information, (b) job satisfaction, (c) everyday discrimination, and (d) heightened vigilance. Mediation analyses were conducted to evaluate the relationship between the independent variables and dependent variable. Results There was a relationship between being a PWS and job satisfaction, discrimination, and vigilance. PWS were found to experience higher discrimination as well as be more vigilant. Discrimination and vigilance were found to mediate the relationship between stuttering and job satisfaction. Conclusion Results of this study indicate that the participants who stutter differ from PWNS in their job satisfaction, discrimination, and vigilance. Clinicians can prepare PWS with self-advocacy strategies, legal knowledge of what their rights are as an employee who identifies as a person who stutters with a disability, a legal understanding of workplace discrimination, and counseling on the impact of vigilance on workplace experiences.

Neuropeptide Y and dipeptidyl peptidase IV in normally cycling and postmenopausal women: A prospective pilot study.

The purpose was to investigate changes in neuropeptide Y (NPY) protein and dipeptidyl peptidase IV (DPP-IV) activity in the plasma and saliva in normally cycling women and women after menopause. We recruited 7 cycling women and 7 postmenopausal women for a cross-sectional, prospective pilot study. Blood via venipuncture and saliva samples were taken at each point in the menstrual cycle (premenopausal) or once per week (postmenopausal) for 2 months. Blood and saliva were analyzed for estrogen, NPY using ELISA and DPP-IV activity using a fluorometric assay. Plasma ß-estradiol was an average of 96.45 ±â€Š57.04 pg/mL over 2 cycles in the premenopausal group and 1.72 ±â€Š0.35 pg/mL over 2 months in the postmenopausal group (P < .05). In the cycling group, there were no significant differences in saliva or plasma NPY or DPP-IV over the cycle. For the postmenopausal group, salivary NPY and DPP-IV did not change over 2 months. Plasma NPY was lowest in the middle 2 weeks (average: 0.52 ±â€Š0.10 ng/mL) compared to the first and fourth weeks (average of week 1 and 4: 0.60 ±â€Š0.14 ng/mL; P < .05). Plasma NPY in postmenopausal women was higher overall (0.56 ±â€Š0.13 ng/mL) compared to cycling women (0.30 ±â€Š0.11 ng/mL; P < .05). Plasma DPP-IV activity was unchanged by time in the postmenopausal group. Saliva DPP-IV and saliva NPY in the cycling group had a significant negative correlation (R = -0.95; P < .05). We found that saliva measures of NPY and DPP-IV activity appear to be poor estimates of plasma concentrations and activities, but a larger sample size is required to conform this. Differences in plasma NPY concentrations between the groups and the relationship between salivary NPY and DPP-IV suggests that there may be some unique differences between these groups.

Self-acceptance, resilience, coping and satisfaction of life in people who stutter.

PURPOSE: The purpose of the present study was to evaluate self-acceptance and satisfaction with life with people who stutter and the influence of coping and resilience on the two factors. METHOD: Forty-seven people who stutter (PWS) and 47 people who do not stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6 main areas: (a) background information, (b) satisfaction with life, (c) coping, (d) avoidance, (e) self-acceptance, and resilience. RESULTS: Avoidant coping and maladaptive coping moderated the association between stuttering and self- acceptance but not satisfaction with life. Resilience was found to moderate the association between stuttering and self-acceptance as well as satisfaction with life. CONCLUSION: Stuttering was associated with lower self-acceptance at higher levels of avoidant coping and maladaptive coping. PWS who have lower levels of resilience were more likely to have a lower satisfaction with life indicating that higher levels of resilience could serve as a protective factor for having a greater satisfaction with life. Further, stuttering was associated with lower self-acceptance at lower levels of resilient attitude. Resilience and coping appear to protect against having diminished self-acceptance and satisfaction with life for PWS.

Elementary School Teachers' Vocal Dose: Muscle Bioenergetics and Training Implications.

Purpose: Translating exercise-science methodology for determination of muscle bioenergetics, we hypothesized that the temporal voice-use patterns for classroom and music teachers would indicate a reliance on the immediate energy system for laryngeal skeletal-muscle metabolism. It was hypothesized that the music-teacher group would produce longer voiced segments than the classroom teachers. Method: Using a between- and within-group multivariate analysis-of-variance design (5 classroom teachers; 7 music teachers), we analyzed fundamental-frequency data-collected via an ambulatory phonation monitor-for length (seconds) of voiced and nonvoiced intervals. Data were collected for 7.5 hr during the workday, over the course of several workdays for each teacher. Results: Descriptive analyses of voiced and nonvoiced intervals indicated that over 99% of voiced segments for both groups were no longer than 3.15 s, supporting the hypothesis of reliance on the immediate energy system for muscle bioenergetics. Significant differences were identified between and within the classroom- and music-teacher groups, with the music-teacher group producing longer voiced segments overall. Conclusions: Knowledge of probable intrinsic laryngeal skeletal-muscle bioenergetics requirements could inform new interdisciplinary considerations for voice habilitation and rehabilitation.

Influence of Glottal Fry on Acoustic Voice Assessment: A Preliminary Study.

PURPOSE: This preliminary study examined the influence of glottal fry on measurement of speaking fundamental frequency (SF0) and whether sex differences influence the impact glottal fry has on SF0 and cepstral peak prominence (CPP). It was hypothesized that SF0 and CPP would decrease as percent glottal fry in the sample increased, with larger changes observed in the female voice. METHODS: Twenty-six participants (13 men, 13 women) completed the study. Participants were recorded reading the Rainbow Passage. SF0 and CPP were determined from the original sample. Percent glottal fry SF0 was determined and semitone change was recalculated after removal of glottal fry from the sample. Regression analysis was used to determine the impact of glottal fry and sex on semitone change and CPP differences in SF0. RESULTS: Significant differences were found for both sex and percent glottal fry on semitone change in SF0. A significant relationship was not found between CPP and semitone change when sex was accounted for. CONCLUSIONS: Findings from this study indicate that the measurement of SF0 for women will decline as percent of glottal fry increases. These findings have clinical implications for interpretation of SF0 measurement and evidence-based outcomes for voice therapy.

School-Based Speech-Language Pathologists' Knowledge and Perceptions of Autism Spectrum Disorder and Bullying.

PURPOSE: The purpose of the current investigation was to examine speech-language pathologists' (SLPs') knowledge and perceptions of bullying, with an emphasis on autism spectrum disorder (ASD). METHOD: A 46-item, web-based survey was used to address the purposes of this investigation. Participants were recruited through e-mail and electronic mailing lists for American Speech-Language-Hearing Association (ASHA) special interest divisions 1 (Language, Learning, and Education) and 16 (School-Based Issues). Also, an embedded link to the survey was posted on the ASHA Community website and ASHA Facebook page. RESULTS: Participants demonstrated knowledge of many aspects of bullying research; however, they demonstrated weaknesses in others. All respondents agreed that SLPs should intervene in moments of bullying, but not all indicated that they feel comfortable intervening. Few participants indicated that their school district implemented antibullying campaigns specific to children with special needs, such as ASD. CONCLUSIONS: As recognized experts in working with children with communication deficits, including individuals with ASD, SLPs have the opportunity to play a key role in antibullying efforts. Results revealed, however, that school-based SLPs may benefit from more information on bullying in order to understand the nature, context, and extent of this issue, as well as ways in which to respond to bullying when it is observed.

Clinical Utility of CAPE-V Sentences for Determination of Speaking Fundamental Frequency.

OBJECTIVES/HYPOTHESIS: Sentence stimuli from the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) were compared with standard speaking fundamental frequency (SF0) tasks to establish clinical utility of the sentence stimuli for standardized assessment of SF0. STUDY DESIGN: Using a within-participant repeated measures design, 60 consented participants (30 males and 30 females) completed the study. METHODS: Participants provided 10 acoustic samples (six CAPE-V sentences and four additional standard tasks), counterbalanced for order effect, for determining SF0. A within-participant repeated measures analysis of variance was used in a 2 (males vs females) by 11 (10 tasks and CAPE-V sentence average) design to determine significant differences in SF0 with significance set at α < .05. RESULTS: Significant differences were found for the CAPE-V sentences "Peter will keep at the peak" and "How hard did he hit him" with seven of the remaining tasks and the CAPE-V average determined to be statistically similar in female participants. No significant differences were found for male participants. CONCLUSIONS: Findings from this study indicate that taken individually, four of the CAPE-V sentences and the average of the six CAPE-V sentences may be used instead of longer tasks to determine SF0 in nonvoice-disordered individuals. This may streamline clinical service by using the CAPE-V sentences for both standardized acoustic and perceptual voice assessments.

The Effect of Traditional Singing Warm-Up Versus Semioccluded Vocal Tract Exercises on the Acoustic Parameters of Singing Voice.

OBJECTIVES/HYPOTHESES: This study investigated the effect of traditional vocal warm-up versus semioccluded vocal tract exercises on the acoustic parameters of voice through three questions: does vocal warm-up condition significantly alter the singing power ratio of the singing voice? Is singing power ratio dependent upon vowel? Is perceived phonatory effort affected by warm-up condition? Hypotheses were that vocal warm-up would alter the singing power ratio, and that semioccluded vocal tract warm-up would affect the singing power ratio more than no warm-up or traditional warm-up, that singing power ratio would vary across vowel, and that perceived phonatory effort would vary with warm-up condition. STUDY DESIGN: This study was a within-participant repeated measures design with counterbalanced conditions. METHODS: Thirteen male singers were recorded under three different conditions: no warm-up, traditional warm-up, and semioccluded vocal tract exercise warm-up. Recordings were made of these singers performing the Star Spangled Banner, and singing power ratio (SPR) was calculated from four vowels. Singers rated their perceived phonatory effort (PPE) singing the Star Spangled Banner after each warm-up condition. RESULTS: Warm-up condition did not significantly affect SPR. SPR was significantly different for /i/ and /e/. PPE was not significantly different between warm-up conditions. CONCLUSIONS: The present study did not find significant differences in SPR between warm-up conditions. SPR differences for /i/, support previous findings. PPE did not differ significantly across warm-up condition despite the expectation that traditional or semioccluded warm-up would cause a decrease.

Autism spectrum disorders: experience, training, and confidence levels of school-based speech-language pathologists.

PURPOSE: To investigate the graduate training experiences of school-based speech-language pathologists (SLPs) working with children with autism spectrum disorders (ASDs). Comparisons were made between recent graduates (post 2006) and pre-2006 graduates to determine if differences existed in their academic and clinical experiences or their confidence in working with children with ASDs. METHOD: A 46-item, web-based, national survey was used. Participants were recruited through e-mail and listservs for American Speech-Language-Hearing Association Special Interest Divisions 1 (Language, Learning, and Education) and 16 (School-Based Issues). RESULTS: Recent graduates reported a greater amount of graduate coursework relating to ASDs than pre-2006 graduates. However, the pre-2006 graduates reported significantly greater confidence in the areas of counseling parents of children who exhibit "red flags" of ASDs and addressing social communication, literacy, and academics in intervention. CONCLUSION: Results of the current survey indicated an increase in the amount of preprofessional training that SLPs receive relating to ASDs. Nonetheless, the majority of SLPs reported that they could have benefitted from additional clinical experience and training working with children with ASDs. The greater degree of confidence reported by the pre-2006 graduates highlights the importance of experience and continuing education for professionals in the field of speech-language pathology.

Coping with a child who stutters: a phenomenological analysis.

UNLABELLED: Qualitative methods were used in the form of a phenomenological analysis to explore how families cope with having a child who stutters. Twelve participants, 2 men and 10 women, who have children who stutter participated in this study. The participants were asked to consider their experiences with being the parent of a child who stutters. Analysis of these data resulted in 3 primary categories. The results indicate that parents experience and cope with stresses associated with being the parent of a child who stutters. The participants described feelings of uncertainty and concern as well as the desire to do what is best for their children. Results highlight the importance of providing information and avenues of support that will help parents more effectively cope with having a child who stutters. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) describe, from the perspective of a parent of a child who stutters, the themes associated with the process of coping with a child who stutters, (b) describe types of coping resources, (c) describe the factors that influence the choice to use emotion-focused and problem-focused coping strategies, and (d) describe four specific areas to consider when providing resources for families of children who stutter.

Influence of vowel selection on determination of phonation threshold pressure.

OBJECTIVE/HYPOTHESIS: Phonation threshold pressure values reported in the literature have largely been determined with use of one of three consonant-vowel sequences, /pi/, /pae/, and /pa/; however, it is not currently known if vowel choice influences phonation threshold pressure values. Based on the evidence that describes velopharyngeal closure variations between vowels, this research effort hypothesized that phonation threshold pressure values measured from the consonant-vowel sequence /pi/ would be significantly lower than the /pae/ and /pa/ sequences. METHODS: Twelve female participants aged between 20 and 27 years produced five-syllable trains of /pi/, /pae/, and /pa/ at low, modal, and high pitches. STUDY DESIGN: A within-subject repeated measures approach was conducted to compare phonation threshold pressure value differences between the three consonant-vowel sequences for three different pitches while controlling for other task elicitation variables that may also influence phonation threshold pressure values. RESULTS: Repeated measures analysis of the data indicated that there was no significant difference (P<0.05) in phonation threshold pressure values between the three consonant-vowel sequences at any frequency assessed. Further, for all three consonant-vowel sequences measured, significant differences of phonation threshold pressure magnitude were observed when comparing the high frequency versus the low and modal frequencies, a finding consistent with previous publications. CONCLUSIONS: The vowel selected for task elicitation for phonation threshold pressure determination does not appear to significantly affect phonation threshold values, indicating flexibility of the vowel aspect of this measure for clinical use of phonation threshold pressure.

Influence of syllable train length and performance end effects on estimation of phonation threshold pressure.

OBJECTIVES: The purpose of this study was to determine whether the number of syllables collected and performance end effects had a significant effect on phonation threshold pressure (PTP) estimates. METHODS: Ten adult females with normal voices produced five- and seven-syllable trains of /pi/ at low, modal, and high pitches. The results were analyzed using repeated-measures analysis of variance to determine whether a difference existed in PTP when a five-syllable train was collected versus when a seven-syllable train was collected and whether the typically discarded first and last syllables within a train differed from the middle syllables. RESULTS: The results indicated that there was no significant difference in estimated PTP values when calculated from a five-syllable versus a seven-syllable train or between the first, middle, and last syllables within a train. CONCLUSIONS: Based on these findings, it appears that a five-syllable train provides adequate information from which to estimate PTP values. Furthermore, these findings also suggest that within the five-syllable train, any three adjacent syllables could be used to estimate PTP. These findings are significant in developing a clinically standardized, effective, and efficient method for collecting PTP.

Assessment of phonation threshold pressure: a critical review and clinical implications.

PURPOSE: To describe the origins of the task elicitation procedure for determining phonation threshold pressure and, through a literature review and online survey, describe published procedural, environmental, and participant variable departures from the original methodology. METHOD: Literature search terms included phonation threshold pressure, subglottal pressure and phonation, pressure measurement and phonation, lung pressure and phonation, and vocal fold oscillation onset. Inclusion criteria were limited to indirect assessment of phonation threshold pressure, English language publications between 1980 and 2009, and peer-reviewed journals. Studies including animals, computer or physical models, alaryngeal speakers, laryngeal airway resistance, or any airflow interruption technique were excluded. Twenty-four articles matched the inclusionary criteria. An online survey to query task elicitation procedures was then developed from the literature review. RESULTS: The scientific rationale for inclusion of phonation threshold pressure data was consistent across published studies; however, variations in procedural methodology for task elicitation were identified, as were environmental and participant inconsistencies that might affect phonation threshold pressure values. Findings of the online survey mirrored the inconsistencies identified in the literature review. CONCLUSIONS: The methodological differences for task elicitation identified in this comprehensive review of the literature and the online survey, while bringing into question the reliability of phonation threshold pressure measurement, illuminate scientific questions yet to be answered to further refine and potentially standardize phonation threshold pressure as a more reliable research and clinical measurement.

Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering.

UNLABELLED: The treatment components that contribute to and account for successful therapeutic outcomes for people who stutter are not well understood and are debated by many. The purpose of this phenomenological study was to describe in detail the underlying factors that contribute to a successful or unsuccessful therapeutic interaction between clients and their clinicians. Twenty-eight participants, 19 men and 9 women, who had received from 6 months to more than 12 years of therapy for stuttering were studied. The participants were asked to consider their experience with one or more speech-language pathologists with whom they had received fluency therapy and to describe the characteristics that made that individual effective or ineffective in promoting successful change in their ability to communicate. Analysis of these data resulted in 15 primary categories. Finally, the essential structure of an effective and ineffective therapeutic interaction was described. Results highlighted the importance for effective therapy of understanding the stuttering experience, forming a positive client-clinician, alliance, and being knowledgeable about stuttering and its treatment. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with an effective therapeutic interaction, (2) describe, from the perspective of a select group of adults who stutter, the themes associated with an ineffective therapeutic interaction, and (3) describe the ways in which an effective or ineffective therapeutic interaction could impact a person who stutters.