Abstract - Agosto a Dezembro de 2021
Biomarkers Obtained by Transcranial Magnetic Stimulation in Neurodevelopmental Disorders - NEUROCIÊNCIAS
J Clin Neurophysiol. 2021 Aug 3. Online ahead of print.
Ali Jannati, Mary A Ryan, Harper L Kaye, Melissa Tsuboyama, Alexander Rotenberg
Harvard Medical School, Boston, Massachusetts, U.S.A.; Boston University School of Medicine, Boston, U.S.A.
Transcranial magnetic stimulation (TMS) is a method for focal brain stimulation that is based on the principle of electromagnetic induction where small intracranial electric currents are generated by a powerful fluctuating magnetic field. Over the past three decades, TMS has shown promise in the diagnosis, monitoring, and treatment of neurological and psychiatric disorders in adults. However, the use of TMS in children has been more limited. We provide a brief introduction to the TMS technique; common TMS protocols including single-pulse TMS, paired-pulse TMS, paired associative stimulation, and repetitive TMS; and relevant TMS-derived neurophysiological measurements including resting and active motor threshold, cortical silent period, paired-pulse TMS measures of intracortical inhibition and facilitation, and plasticity metrics after repetitive TMS. We then discuss the biomarker applications of TMS in a few representative neurodevelopmental disorders including autism spectrum disorder, fragile X syndrome, attention-deficit hyperactivity disorder, Tourette syndrome, and developmental stuttering.
PMID: 34366399 DOI: 10.1097/WNP.0000000000000784
Communication attitude of Kannada-speaking adults who do and do not stutter - EMOCIONAL
J Fluency Disord. 2021 Aug 28;70:105866. Online ahead of print.
Rakesh Chowkalli Veerabhadrappa, Jyotsna Krishnakumar, Martine Vanryckeghem, Santosh Maruthy
All India Institute of Speech and Hearing, Mysore, India; University of Central Florida, Orlando, USA.
The Communication Attitude Test for Adults who stutter (BigCAT) is an established measure of cognitive traits in adults who stutter (AWS). The primary purpose of the present study was to adapt and validate the BigCAT to the Kannada language. The secondary purpose was to compare AWS' and adults who do not stutter (AWNS) BigCAT-K scores and compare AWS' score in sub-populations in terms of severity and age. The study included a purposive sample of 100 AWS and 317 AWNS. There was high test-retest reliability and solid construct validity, as made evident by the results of the discriminant analysis and cross-validation. Further, as in other investigations with the BigCAT (Vanryckeghem & Brutten, 2019), this self-report test revealed a statistically significant group mean difference between AWS and AWNS, suggesting the presence of a negative attitude towards communication in Kannada-speaking AWS. Further, individuals with severe stuttering had a significantly higher level of speech-associated negative attitude compared to those with mild stuttering. Age does not seem to influence the AWS' speech-associated belief system. Both of these findings augment the existing scant literature on exploring the association between stuttering severity and age on the cognitive dimension of stuttering. The outcomes establish the BigCAT-K as an effective tool in the assessment and subsequent management of stuttering.
PMID: 34481196 DOI: 10.1016/j.jfludis.2021.105866
Consensus Guidelines for the Assessments of Individuals who Stutter Across the Lifespan - AVALIAÇÃO
Am J Speech Lang Pathol. 2021 Sep 13;1-15. Online ahead of print.
Shelley B Brundage, Nan Bernstein Ratner, Michael P Boyle, Kurt Eggers, Rachel Everard, Marie-Christine Franken, Elaina Kefalianos, Anne K Marcotte, Sharon Millard, Ann Packman, Martine Vanryckeghem, J Scott Yaruss
George Washington University, Washington, DC; University of Maryland, College Park; Montclair State University, Bloomfield, NJ; Thomas More University, Antwerp, Belgium; University of Turku, Finland; City Lit, London, United Kingdom; Erasmus University Medical Center, Rotterdam, the Netherlands; The University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; University of Georgia, Athens; The Michael Palin Centre for Stammering Children, London, United Kingdom; University of Technology Sydney, New South Wales, Australia; University of Central Florida, Orlando; Michigan State University, East Lansing.
Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan.
Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups.
Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering.
Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.
PMID: 34516299 DOI: 10.1044/2021_AJSLP-21-00107
Drug-Induced Stuttering: Occurrence and Possible Pathways - GAGUEIRA ADQUIRIDA
Front Psychiatry. 2021 Aug 25;12:692568.
Free Article: https://www.frontiersin.org/article/10.3389/fpsyt.2021.692568
Corine Ekhart, Florence van Hunsel, Peter van Harten, Jeanette van Baarsen, Tan Yingying, Bert Bast
Background: Stuttering is a well-known condition that affects mainly children. Often, they recover as they get older. However, a drug-induced form of stuttering may occur at any age. The aim of the present study was to detect drugs that have been associated with stuttering and discuss the mechanisms involved.
Method: A descriptive study based on reports submitted to the global pharmacovigilance database VigiBase of the WHO was conducted.
Results: A total of 3,385 reports of dysphemia were retrieved from VigiBase. These reports were contributed by 51 countries. Antiepileptics, antidepressants, immunosuppressants, antipsychotics, and centrally acting sympathomimetics were among the most frequently implicated drugs.
Conclusion: A wide variety of drugs has been linked to the occurrence or recurrence of stuttering. Several mechanisms, such as increased dopamine levels, reduction of GABA, anticholinergic properties of drugs, or changes in serotonin levels, have been associated with the development of drug-induced stuttering. Paradoxically, agents known to reduce stuttering in some people may induce it in others.
PMID: 34512414 PMCID: PMC8423914 DOI: 10.3389/fpsyt.2021.692568
Non-pharmacological interventions for stuttering in children six years and younger - INFANTIL / TERAPIA
Review Cochrane Database Syst Rev. 2021 Sep 9;9(9):CD013489.
Åse Sjøstrand, Elaina Kefalianos, Hilde Hofslundsengen, Linn S Guttormsen, Melanie Kirmess, Arne Lervåg, Charles Hulme, Kari-Anne Bottegaard Næss
University of Oslo, Oslo, Norway; University of Melbourne, Parkville, Australia; Western Norway University of Applied Sciences, Sogndal, Norway; University of Oxford, Oxford, UK.
Background: Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non-verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning.
Objectives: Primary objective To assess the immediate and long-term effects of non-pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest.
Search methods: We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences.
Selection criteria: We included randomized controlled trials (RCTs) and quasi-RCTs that assessed non-pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual.
Data collection and analysis: We used standard methodological procedures expected by Cochrane.
Main results: We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait-list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial. All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects. The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait-list control group at post-test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) -2.16, 95% confidence interval (CI) -3.48 to -0.84, 4 studies, 151 participants; P = 0.001; very low-certainty evidence). However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate-certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long-term follow-up. The long-term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within-group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow-up, and showed a significant reduction in frequency of stuttering.
AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait-list control group in children aged up to six years at post-test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long-term effects of other non-pharmacological interventions for stuttering compared to no intervention or a wait-list control group.
PMID: 34499348 PMCID: PMC8428330
Parents' Perceptions of the Overall Impact of Stuttering on Young Children - AMBIENTAL
Am J Speech Lang Pathol. 2021 Aug 25;1-13. Online ahead of print.
Linn Stokke Guttormsen, J Scott Yaruss, Kari-Anne Bottegård Næss
University of Oslo, Norway; Michigan State University, East Lansing.
Introduction Research has revealed the presence of emotional, behavioral, and cognitive reactions in young children who stutter; however, prior studies have not examined the overall impact of stuttering on young children's lives. Such information is necessary for improving understanding of how stuttering affects young children and for ensuring appropriate early intervention.
Method This study employed an adaptation of the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children that was designed to ask parents about their perceptions of the impact of stuttering on their young children. Thirty-eight parents of young children who stutter (2-5 years of age) provided their perceptions of the impact of stuttering on their children. Parents rated how certain they were in their judgments using a 5-point scale to provide an indication of their confidence in proxy ratings of impact. Results Results indicated that, on average, parents perceived that stuttering affected their children negatively. Qualitatively, parents provided descriptions of the impact of stuttering on their children's quality of life, communication difficulties across people and situations, and reactions to stuttering; they also commented on their own feelings and strategies for handling impact. On average, parents perceived themselves to be certain in rating the impact of stuttering on their children.
Conclusions Results indicated that parents identified adverse impact in their children's lives. Even though parents considered themselves to be certain in their impact ratings, clinicians and researchers should also assess the perspective of the children if appropriate. This is because present findings reveal that parents may not have insight into all aspects of impact, in particular, cognitive reactions to stuttering. Still, parents' perceptions of impact are important for clinicians to consider when giving recommendations for therapy, as they can provide important insight into the family's needs.
PMID: 34433002 DOI: 10.1044/2021_AJSLP-20-00113
rsfMRI based evidence for functional connectivity alterations in adults with developmental stuttering - NEUROCIÊNCIAS
Heliyon. 2021 Aug 21;7(9):e07855.
Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414185/pdf/main.pdf
Seyedehsamaneh Shojaeilangari, Narges Radman, Mohammad Ehsan Taghizadeh, Hamid Soltanian-Zadeh
Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Tehran University of Medical Sciences, Tehran, Iran; Payame Noor University, Tehran, Iran; Tehran University, Tehran, Iran; Henry Ford Health System, Detroit, Michigan, USA.
Persistent developmental stuttering (PDS) is defined as a speech disorder mainly characterized by intermittent involuntary disruption in normal fluency, time patterning, and rhythm of speech. Although extensive functional neuroimaging studies have explored brain activation alterations in stuttering, the main affected brain regions/networks in PDS still remain unclear. Here, using functional magnetic resonance imaging (fMRI), we investigated resting-state whole-brain functional connectivity of 15 adults who stutter (PDS group) and 15 age-matched control individuals to reveal the connectivity abnormalities associated with stuttering. We were also interested in exploring how the severity of stuttering varies across individuals to understand the compensatory mechanism of connectivity pattern in patients showing less symptoms. Our results revealed decreased connectivity of left frontal pole and left middle frontal gyrus (MidFG) with right precentral/postcentral gyrus in stuttering individuals compared with control participants, while less symptomatic PDS individuals showed greater functional connectivity between left MidFG and left caudate. Additionally, our finding indicated reduced connectivity in the PDS group between the left superior temporal gyrus (STG) and several brain regions including the right limbic lobe, right fusiform, and right cerebellum, as well as the left middle temporal gyrus (MTG). We also observed that PDS individuals with less severe symptoms had stronger connectivity between right MTG and several left hemispheric regions including inferior frontal gyrus (IFG) and STG. The connectivity between right fronto-orbital and right MTG was also negatively correlated with stuttering severity. These findings may suggest the involvement of right MTG and left MidFG in successful compensatory mechanisms in more fluent stutterers.
PMID: 34504967 PMCID: PMC8414185
Situational Embarrassment and Its Relationship to Social Anxiety in Adults Who Stutter - EMOCIONAL
J Speech Lang Hear Res. 2021 Sep 13;1-10. Online ahead of print.
Yvonne Tran, Elaine Blumgart, Ashley Craig
Macquarie University, Sydney, New South Wales, Australia; The University of Sydney, New South Wales, Australia.
Purpose Adults who stutter (AWS) have increased risk of comorbid social anxiety about speaking in social contexts. AWS also report experiencing embarrassment in different social situations; however, research has rarely been conducted on embarrassment and its relationship to social anxiety in AWS.
Method AWS (N = 200) reported their level of embarrassment on four 10-point Likert items when speaking in four situational contexts: at home, to an individual important to them, in social groups, and at work. Participants were also assessed for sociodemographic, stuttering, and anxiety variables. Construct validity for the four embarrassment items was examined, the extent of embarrassment established in the four contexts as a function of age and sex, and the relationship of embarrassment to social anxiety evaluated.
Results Evidence of acceptable construct validity and reliability is presented for the four embarrassment Likert items. Sixty-five percent of the sample experienced high levels of embarrassment when speaking in groups or at work, while 35.5% experienced high levels when speaking at home or to an individual important to them. Participants were significantly more embarrassed (p < .01) when speaking at work or when socializing in groups. Embarrassment was lowest when speaking in the home. Younger females were significantly more embarrassed when speaking at work or when socializing in groups. Those with high embarrassment scores on all four items were more likely to have elevated social anxiety scores (p < .001). Conclusion These preliminary results suggest that the assessment of situational embarrassment could be an important clinical measure that may help improve stuttering treatment outcomes that also target social anxiety.
PMID: 34516233 DOI: 10.1044/2021_JSLHR-21-00158
Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence - NEUROCIÊNCIAS / TERAPIA
Front Hum Neurosci. 2021 Aug 11;15:662016.
Pierpaolo Busan, Beatrice Moret, Fabio Masina, Giovanni Del Ben, Gianluca Campana
IRCCS Ospedale San Camillo, Venice, Italy; University of Trieste, Trieste, Italy; University of Padua, Padua, Italy.
Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that may be interpreted as very debilitating in the most affected cases. Interventions for DS are historically based on the behavioral modifications of speech patterns (e.g., through speech therapy), which are useful to regain a better speech fluency. However, a great variability in intervention outcomes is normally observed, and no definitive evidence is currently available to resolve stuttering, especially in the case of its persistence in adulthood. In the last few decades, DS has been increasingly considered as a functional disturbance, affecting the correct programming of complex motor sequences such as speech. Compatibly, understanding of the neurophysiological bases of DS has dramatically improved, thanks to neuroimaging, and techniques able to interact with neural tissue functioning [e.g., non-invasive brain stimulation (NIBS)]. In this context, the dysfunctional activity of the cortico-basal-thalamo-cortical networks, as well as the defective patterns of connectivity, seems to play a key role, especially in sensorimotor networks. As a consequence, a direct action on the functionality of "defective" or "impaired" brain circuits may help people who stutter to manage dysfluencies in a better way. This may also "potentiate" available interventions, thus favoring more stable outcomes of speech fluency. Attempts aiming at modulating (and improving) brain functioning of people who stutter, realized by using NIBS, are quickly increasing. Here, we will review these recent advancements being applied to the treatment of DS. Insights will be useful not only to assess whether the speech fluency of people who stutter may be ameliorated by acting directly on brain functioning but also will provide further suggestions about the complex and dynamic pathophysiology of DS, where causal effects and "adaptive''/''maladaptive" compensation mechanisms may be strongly overlapped. In conclusion, this review focuses future research toward more specific, targeted, and effective interventions for DS, based on neuromodulation of brain functioning.
PMID: 34456692 PMCID: PMC8386014 DOI: 10.3389/fnhum.2021.662016
Speech planning and execution in children who stutter: Preliminary findings from a fNIRS investigation - INFANTIL / NEUROCIÊNCIAS
J Clin Neurosci. 2021 Sep;91:32-42. Epub 2021 Jun 28.
Eric S Jackson, Sobanawartiny Wijeakumar, Deryk S Beal, Bryan Brown, Patricia M Zebrowski, John P Spencer
York University, New York, NY, USA; University of Nottingham, University Park, UK; Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada; University of Wisconsin-Eau Claire, Eau Claire, WI, USA; Wendell Johnson Speech and Hearing Center, Iowa City, IA, USA; University of East Anglia, Norwich, UK.
Few studies have investigated the neural mechanisms underlying speech production in children who stutter (CWS), despite the critical importance of understanding these mechanisms closer to the time of stuttering onset. The relative contributions of speech planning and execution in CWS therefore are also unknown. Using functional near-infrared spectroscopy, the current study investigated neural mechanisms of planning and execution in a small sample of 9-12 year-old CWS and controls (N = 12) by implementing two tasks that manipulated speech planning and execution loads. Planning was associated with atypical activation in bilateral inferior frontal gyrus and right supramarginal gyrus. Execution was associated with atypical activation in bilateral precentral gyrus and inferior frontal gyrus, as well as right supramarginal gyrus and superior temporal gyrus. The CWS exhibited some activation patterns that were similar to the adults who stutter (AWS) as reported in our previous study: atypical planning in frontal areas including left inferior frontal gyrus and atypical execution in fronto-temporo-parietal regions including left precentral gyrus, and right inferior frontal, superior temporal, and supramarginal gyri. However, differences also emerged. Whereas CWS and AWS both appear to exhibit atypical activation in right inferior and supramarginal gyri during execution, only CWS appear to exhibit this same pattern during planning. In addition, the CWS appear to exhibit atypical activation in left inferior frontal and right precentral gyri related to execution, whereas AWS do not. These preliminary results are discussed in the context of possible impairments in sensorimotor integration and inhibitory control for CWS.
PMID: 34373047 DOI: 10.1016/j.jocn.2021.06.018
The Effects of Written Stuttering Disclosure on the Perceptions of a Child Who Stutters - INFANTIL / TERAPIA
Lang Speech Hear Serv Sch. 2021 Aug 26;1-18. Online ahead of print.
Greg Snyder, Ashlee Manahan, Peyton McKnight, Myriam Kornisch
The University of Mississippi, Oxford.
Purpose This study measured between-groups differences in perceived speech skills and personality characteristics of a 12-year-old male child who stutters (CWS) as a function of a written factual stuttering disclosure statement, delivered by the CWS, his "mother," or his "teacher."
Method Four hundred twenty-four college-age adults were assigned to one of four groups, including three experimental groups (i.e., written self-disclosure, mother-written disclosure, and teacher-written disclosure) and a control group (no written disclosure). Participants in the control conditions viewed a brief video of the CWS. In the experimental conditions, participants read a brief written disclosure statement for 30 s, followed by the same video used in the control condition. After viewing the video, all participants completed surveys relative to their perceptions of the CWS speech skills and personality characteristics.
Results Results reveal that a written stuttering disclosure statement provided by the mother correlated with select significant desirable perceptual differences of the CWS, while a written disclosure statement provided by the CWS yielded insignificant or even undesirable perceptual differences of the CWS. Written stuttering disclosures provided by a "teacher" did not yield any significant between-groups differences in the perception of a CWS. Gender affiliation was found to be a source of covariance in a number of perceived speech skills and personality characteristics.
Conclusions Written stuttering disclosure statements provided by the "mother" correlated with select favorable perceptual differences of speech skills and personal characteristics of a CWS. Clinically, the application of novel methods (written and oral disclosure statements) and sources (i.e., CWS advocates such as "mother" and "teacher") of stuttering disclosure statement can be integrated into a systematic therapeutic program, creating an innovative approach of scaffolding self-advocacy via stuttering disclosure in CWS. Supplemental Material https://doi.org/10.23641/asha.15505857.
PMID: 34436943 DOI: 10.1044/2021_LSHSS-20-00119
Verbal Response Inhibition in Adults Who Stutter - PSICOMOTOR
J Speech Lang Hear Res. 2021 Aug 17;1-16. Online ahead of print.
Shanley B Treleaven, Geoffrey A Coalson
Louisiana State University, Baton Rouge.
Purpose Adults who stutter (AWS) often attempt, with varying degrees of success, to suppress their stuttered speech. The ability to effectively suppress motoric behavior after initiation relies on executive functions such as nonselective inhibition. Although previous studies found that AWS were slower to inhibit manual, button-press response than adults who do not stutter (AWNS), research has yet to confirm a consistent relationship between manual and verbal inhibition. No study has examined verbal inhibition ability in AWS. The purpose of this study, therefore, is to compare verbal response inhibition between AWS and AWNS, and compare verbal response inhibition to both the overt stuttering and the lived experience of stuttering.
Method Thirty-four adults (17 AWNS, 17 AWS) completed one manual and three verbal stop-signal tasks. AWS were assessed for stuttering severity (Stuttering Severity Instrument-Fourth Edition: SSI-4) and experience with stuttering (Overall Assessment of the Speaker's Experience With Stuttering [OASES]).
Results Results indicate no correlation between manual and verbal inhibition for either group. Generalized linear mixed-model analyses suggested no significant group differences in manual or verbal inhibition. Manual and verbal inhibition did not predict SSI-4 in AWS. However, verbal inhibition was uniquely associated with OASES scores.
Conclusion Although underlying manual and verbal inhibition was comparable between AWS and AWNS, verbal inhibition may be linked to the adverse experience of stuttering rather than the overt symptoms of stuttering severity. Supplemental Material https://doi.org/10.23641/asha.15145185.
PMID: 34403265 DOI: 10.1044/2021_JSLHR-20-00739