Contemporary issues with stuttering: The Fourth Croatia Stuttering Symposium.

PURPOSE: During the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering. METHODS: The authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form. RESULTS: Seven contemporary issues for our field emerged from the Symposium. CONCLUSION: Effective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive-behavior therapy for clients with persistent stuttering. Questions were raised about our discipline standards for basic professional preparation programs for stuttering management.

The Pathogenesis, Assessment and Treatment of Speech Fluency Disorders.

BACKGROUND: Approximately 1% of children and adolescents, 0.2% of women, and 0.8% of men suffer from stuttering, and lesser numbers from cluttering. Persistent speech fluency disorders often cause lifelong problems in communication and social participation. METHODS: In an interdisciplinary, evidence and consensus based clinical practice guideline, the current understanding of the nature, identification, diagnosis, and treatment of stuttering and cluttering was summarized. A systematic review of the literature was carried out to assess the efficacy and effectiveness of treatments for stuttering. Evidence is lacking on the etiology, pathogenesis, evaluation, and treatment of cluttering. RESULTS: In view of the fact that common (developmental, idiopathic) stuttering is associated with structural and functional changes of the brain, the guideline recommends that it should be called "originary neurogenic non-syndromic stuttering." Heritability estimates for this disorder range from 70% to over 80%. For preschool children, the Lidcombe therapy has the best evidence of efficacy (Cohen's d = 0.72-1.00). There is also strong evidence for an indirect treatment approach. For children aged 6 to 12, there is no solid evidence for the efficacy of any treatment. For adolescents and adults, there is good evidence with high effect sizes (Cohen's d = 0.75-1.63) for speech restructuring methods such as fluency shaping; weak evidence with intermediate effect sizes for stuttering modification (Cohen's d = 0.56-0.65); and weak evidence for combined speech restructuring and stuttering modification. The evidence does not support the efficacy of pharmacotherapy, rhythmic speaking, or breathing regulation as the sole or main form of treatment, or that of hypnosis or eclectic, unspecified stuttering therapies. CONCLUSION: Stuttering is often treated in Germany with therapies for which there is inadequate evidence, and the initiation of treatment is often unnecessarily delayed. The guideline presents treatment methods whose efficacy is supported by the current evidence.

Measuring Stuttering in Preschool-Aged Children across Different Languages: An International Study.

BACKGROUND/AIMS: Many speech-language pathologists (SLPs) are working in linguistically diverse communities and have to identify and measure stuttering in a language other than their own. The aim of the present study was to extend our understanding of how well SLPs can measure stuttering in other languages and to encourage collaboration between SLPs across cultures. METHODS: Speech samples consisted of seven preschool-aged children each speaking one of the following languages: Danish, English, French, German, Greek, Italian, and Persian (Farsi). The judges were classified in seven groups of SLPs (n = 170) each speaking one of the seven languages of the children and two more English-speaking groups. Each judge rated the severity of stuttering in each child using a 10-point scale. The study was conducted over the Internet. RESULTS: Overall, the judges' proficiency in a child's language was not systematically related to the variability and agreement of the severity ratings, accounting for maximally 4.6% of the variance. CONCLUSION: SLPs should not be overly concerned about the appropriateness of their severity ratings if they feel less proficient in the native language of the stuttering children. It may also be encouraging for beginning clinicians that the severity ratings were not systematically related to professional experience.

Dual tasking and stuttering: from the laboratory to the clinic.

PURPOSE: The aim of the three studies in this article was to develop a way to include dual tasking in speech restructuring treatment for persons who stutter (PWS). It is thought that this may help clients maintain the benefits of treatment in the real world, where attentional resources are frequently diverted away from controlling fluency by the demands of other tasks. METHOD: In Part 1, 17 PWS performed a story-telling task and a computer semantic task simultaneously. Part 2 reports the incorporation of the Part 1 protocol into a handy device for use in a clinical setting (the Dual Task and Stuttering Device, DAS-D). Part 3 is a proof of concept study in which three PWS reported on their experiences of using the device during treatment. RESULTS: In Part 1, stuttering frequency and errors on the computer task both increased under dual task conditions, indicating that the protocol would be appropriate for use in a clinical setting. All three participants in Part 3 reported positively on their experiences using the DAS-D. CONCLUSIONS: Dual tasking during treatment using the DAS-D appears to be a viable clinical procedure. Further research is required to establish effectiveness.

Cognitive processing load as a determinant of stuttering: summary of a research programme.

The present paper integrates the results of experimental studies in which cognitive differences between stuttering and nonstuttering adults were investigated. In a monitoring experiment it was found that persons who stutter encode semantic information more slowly than nonstuttering persons. In dual-task experiments the two groups were compared in overt word-repetition and sentence-production experiments. The results of the two word-repetition experiments indicate that the speech of stuttering persons is sensitive to interference from concurrent attention-demanding cognitive processing-particularly when phonological coding is involved. In two sentence-generation and -production experiments it was found that under dual-task conditions stuttering persons produced sentences containing a smaller number of content units whereas persons who do not stutter did not show a significant single- vs. dual-task contrast. These results suggest that sentence generation and production required greater sustained attentional processing in stuttering than in nonstuttering persons and that persons who stutter reduce the amount of "conceptual work" in order to keep their stuttering rates low. Data from an fMRI-study indicate that in persons who stutter the neural systems activated during sentence generation and production overlap to a greater extent than those of persons who do not stutter. It is suggested that in persons who stutter neural subsystems involved in speech planning are "modularized" to a lesser extent than in persons who do not stutter.

Effects of category and rhyme decisions on sentence production.

The aim of the present experiment was to investigate differences between persons who stutter and persons who do not stutter during the production of sentences in a single task versus two dual-task conditions. Participants were required to form a sentence containing 2 unrelated nouns. In dual-task conditions, rhyme and category decisions were used as secondary tasks. The results for 14 adults who stutter and 16 adults who do not stutter are reported. Dependent variables were the number of correct rhyme and category decisions, decision latencies, length, number of propositions, sentence latency, speech rate of sentences, disfluencies, and stuttering rates. The results indicated that both groups reduced the average number of correct rhyme and category decisions when this task was performed concurrently with sentence generation and production. Similarly, the 2 groups of participants did not differ with respect to the correctness and latency of their decisions. Under single-task conditions the sentences of both groups had a comparable number of propositions. But under dual- as compared with single-task conditions persons who stutter significantly reduced the number of propositions whereas persons who do not stutter did not show a significant dual- versus single-task contrast. Experimental conditions did not significantly influence stuttering rates. These results suggest that persons who stutter require more processing capacity for sentence generation and articulation than persons who do not stutter and that both groups keep stuttering rates at a constant level by adjusting the number of propositional units of their linguistic productions. The results support the view that the organization of the speech-production system of persons who stutter makes it more vulnerable to interference from concurrent attention-demanding semantic tasks.

Effects of concurrent cognitive processing on the fluency of word repetition: comparison between persons who do and do not stutter.

UNLABELLED: This study investigated how silent reading and word memorization may affect the fluency of concurrently repeated words. The words silently read or memorized were phonologically similar or dissimilar to the words of the repetition task. Fourteen adults who stutter and 16 who do not participated in the experiment. The two groups were matched for age, education, sex, forward and backward memory span and vocabulary. It was found that the disfluencies of persons who stutter significantly increased during word repetition when similar words were read or memorized concurrently. In contrast, the disfluencies of persons who do not stutter were not significantly affected by either secondary task. These results indicate that the speech of persons who stutter is more sensitive to interference from concurrently performed cognitive processing than that of nonstuttering persons. It is proposed that the phonological and articulatory systems of persons who stutter are protected less efficiently from interference by attention-demanding processing within the central executive system. Alternative interpretations are also discussed. EDUCATIONAL OBJECTIVES: Readers will learn how modern speech production theories and the concept of modularity can account for stuttering, and will be able to explain the greater vulnerability of stutterer's speech fluency to concurrent cognitive processing.