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.

Disfluency data of German preschool children who stutter and comparison children.

UNLABELLED: This study compared the disfluencies of German-speaking preschool children who stutter (CWS, N = 24) with those produced by age- and sex-matched comparison children who do not stutter (CWNS, N = 24). In accordance with Yairi and Ambrose's [Yairi, E., & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminary report. Journal of Speech and Hearing Research, 35, 755-760] guidelines the CWS group had a narrow age range (2-5 years) and were seen close to the reported time of their stuttering onset (average of 8 months). Furthermore, over 95% of the CWS group had not received any type of speech therapy intervention. Consistent with previous findings for English-speaking preschool children, 'stuttering-like' disfluencies (prolongations, blocks, part- and one-syllable word repetitions) were significantly more frequent in CWS (mean = 9.2%) than in CWNS (mean = 1.2%), whereas no significant group differences occurred with respect to 'normal' disfluencies. The number of iterations in stuttering-like disfluencies was also significantly higher in CWS (mean = 1.28 iterations) than in CWNS (mean = 1.09 iterations). In contrast to previous findings, a sub-group of children who have been stuttering for a shorter time (1-5 months) did not differ from a sub-group who had stuttered for a longer period (8-22 months). EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how German-speaking preschool children who stutter and who do not stutter display stuttering-like and normal disfluencies including number of iterations; (2) explain how powerful classification measures for the diagnosis of stuttering are for German-speaking preschool children; (3) discuss how disfluency patterns of native English- and German-speaking children close to onset of stuttering differ.

Linguistic stress, within-word position, and grammatical class in relation to early childhood stuttering.

UNLABELLED: The purpose of the present study was to investigate whether the link that has been established between stuttering and linguistic stress in adolescents and adults (the so-called stress effect) can also be observed in childhood stuttering. To account for confounding variables, both within-word position and grammatical class were measured, because these factors covary with linguistic stress. Speech samples of 22 preschool children (mean time of 9 months since onset of stuttering) were analyzed. The relative stress of each syllable was rated and syllables were categorized into long and short stressed, unstressed, and intermediately stressed syllables. Results showed that 97.8% of stuttering events occurred on first syllables of words and 76.5% on the first sound of syllables, that means a clear word-initial effect. Stuttering frequency on first syllables of function words was 16.9% and significantly higher than the frequency of stuttered first syllables of content words (11.5%). In function words short stressed syllables and intermediately stressed syllables were stuttered more often than unstressed syllables. The analysis for individual disfluency types revealed that, for function words, stuttering on short stressed syllables was associated with prolongations and syllable repetitions. However, in intermediately stressed syllables stuttering coincided most often with one-syllable word repetitions. This differentiation of the stress effect may suggest different causal mechanisms underlying these disfluency types. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) describe how within-word position, grammatical class, and linguistic stress effect stuttering frequency in preschool children who stutter; (2) explain how the occurrence of individual disfluency types depends on linguistic stress; (3) discuss how patterns of adults and preschool children who stutter differ in regard to these aspects.

The duration component of the stress effect in stuttering.

UNLABELLED: The purpose of the present study was to investigate whether there is a relationship between stuttering on stressed syllables and the duration of these syllables. Sixteen adults who stutter read a text consisting of 226 syllables. The relative stress of each syllable was rated, and syllables were categorized into long- and short-stressed syllables, unstressed syllables and intermediate syllables lying in-between. In order to isolate effects caused by within-word position from those caused by linguistic stress, syllables in initial and in subsequent positions were analyzed separately. In both word position categories stressed syllables were stuttered more often than unstressed syllables. Stuttering frequency of intermediate syllables seems to be in-between stressed and unstressed syllables, just as their stress level is rated in-between. Results regarding the duration of stressed syllables do not allow final conclusions. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe (1) language factors related with stuttering events, (2) the stress effect in adults who stutter, and (3) methods to control for its confounding variables.