Eliana Maria Nigro Rocha



Abstract - Agosto a Dezembro de 2021





A preliminary study on the quantification of soft palate movement using ultrasonography - FALA

Congenit Anom (Kyoto). 2021 Oct 7.  Online ahead of print.


Kumiko Fujiwara, Satoru Saitou, Ryo Nagaoka, Naomi Nakamichi, Kei Tomihara, Hideyuki Hasegawa, Makoto Noguchi

University of Toyama, Toyama, Japan; Pigeon Central Research Institute, Pigeon Co., Ltd., Ibaragi, Japan.


Velopharyngeal incompetence (VPI) is a motor impairment of the soft palate that can result in functional disorders, such as stuttering. Therefore, therapeutic interventions for VPI should begin at an early stage. We examined the possibility of early detection of motor impairments of the soft palate with ultrasonographic observations. The study was conducted on five individuals without suckling disorders (two males, three females) at 6-9 postnatal weeks of age (stage 1) and 13-23 postnatal weeks of age (stage 2). The extent and speed of soft palate movement during suckling was measured with ultrasonography. The extent of movement of the soft palate was 5.67 ± 0.68 mm at stage 1 and 6.42 ± 1.55 mm at stage 2 (t = 0.929, p = 0.190). The speed of soft palate movements at stage 1 was 44.00 ± 9.93 mm/s during elevation and 27.37 ± 8.07 mm/s during depression (t = 5.182, p = 0.007), whereas that at stage 2 was 42.89 ± 14.37 mm/s during elevation and 26.43 ± 9.06 mm/s during depression (t = 3.195, p = 0.033). We observed regular soft palate elevations and depressions during suckling. There were no differences in the extent or speed of movements between stages 1 and 2. Future studies are needed to compare differences in motor impairments of the soft palate between healthy children and those suspected of having a submucous cleft palate or VPI.

PMID: 34622489 DOI: 10.1111/cga.12446




Adults who stutter do not stutter during private speech - SOCIAL

J Fluency Disord. 2021 Sep 9;70:105878. Online ahead of print.


Eric S Jackson, Lindsay R Miller, Haley J Warner, J Scott Yaruss

New York University, New York, NY, United States; Michigan State University, MI, United States.


Purpose: Adults who stutter tend not to stutter when they are alone. This phenomenon is difficult to study because it is difficult to know whether participants perceive that they are truly alone and not being heard or observed. This may explain the presence of stuttering during previous studies in which stutterers spoke while they were alone. We addressed this issue by developing a paradigm that elicited private speech, or overt speech meant only for the speaker. We tested the hypothesis that adults do not stutter during private speech.

Method: Twenty-four participants were audio-/video-recorded while speaking in several conditions: 1) conversational speech; 2) reading; 3) private speech, in which deception was used to increase the probability that participants produced speech intended for only themselves; 4) private speech+, for which real-time transcription was used so that participants produced the same words as in the private speech condition but while addressing two listeners; and 5) a second conversational speech condition.

Results: Stuttering was not observed in more than 10,000 syllables produced during the private speech condition, except for seven possible, mild stuttering events exhibited by 3 of 24 participants. Stuttering frequency was similar for the remaining conditions.

Conclusions: Adults appear not to stutter during private speech, indicating that speakers' perceptions of listeners, whether real or imagined, play a critical and likely necessary role in the manifestation of stuttering events. Future work should disentangle whether this is due to the removal of concerns about social evaluation or judgment, self-monitoring, or other communicative processes.

PMID: 34534899 DOI: 10.1016/j.jfludis.2021.105878




Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part I. Scale Development - TERAPIA

Am J Speech Lang Pathol. 2021 Sep 15;1-18. Online ahead of print.


Patricia M Zebrowski, Naomi H Rodgers, Hope Gerlach, Andrea L Paiva, Mark L Robbins

University of Iowa, Iowa City; University of Nebraska-Lincoln; Western Michigan University, Kalamazoo; University of Rhode Island, Kingston.


Purpose This article is the first in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. In this article, we describe the process of developing measures to assess stage of change (SOC) by defining behaviors of stuttering management, as well as the two primary cognitive constructs that underlie one's readiness to make behavioral change: decisional balance (DB) and situational self-efficacy (SSE). This work hinges on the ability to develop an operational definition of what it means to successfully manage or do something positive about one's stuttering.

Method We used an iterative process to develop the three scales. Through qualitative analysis of key informant interview and focus group transcripts with 24 adolescents who stutter and 26 clinicians specializing in stuttering, we developed stuttering-specific SOC, DB, and SSE scales. The drafted scales were cognitively tested with nine adolescents who stutter.

Results Thematic analysis yielded a three-part definition of successful stuttering management that formed the basis for the SOC scale: (a) learning and using strategies to modify speech or stuttering, (b) changing negative thoughts and attitudes regarding stuttering, and (c) talking without avoiding sounds, words, or situations. Results from this analysis support a broader view of successful stuttering management; that is, it is likely that doing so requires more than just behavior change, which has long been considered the main objective of stuttering treatment. Additional analyses yielded pros and cons of managing stuttering (62 items for the DB scale) and situations in which it is difficult to manage stuttering (39 items for the SSE scale). Conclusions Qualitative analyses provided a three-part definition of "stuttering management" and a comprehensive pool of items that would allow measurement of DB and SSE that underlie readiness to manage stuttering among adolescents. In the companion article in this two-part series, we describe the next step in scale development: exploratory scale validation of the drafted SOC, DB, and SSE scales.

PMID: 34525312 DOI: 10.1044/2021_AJSLP-20-00186




Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part II. Exploratory Scale Validation - TERAPIA

Am J Speech Lang Pathol. 2021 Oct 12;1-18. Online ahead of print.


Naomi H Rodgers, Hope Gerlach, Andrea L Paiva, Mark L Robbins, Patricia M Zebrowski

University of Nebraska-Lincoln; Western Michigan University, Kalamazoo; University of Rhode Island, Kingston; The University of Iowa, Iowa City.


Purpose This article is the second in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. The purpose of this article was to apply and explore the validity of newly developed Transtheoretical measures for adolescents who stutter.

Method The online survey was completed by a national sample of 173 adolescents who stutter between the ages of 13 and 21 years. The multipart survey included a Stage of Change scale, Decisional Balance scale, and Situational Self-Efficacy scale. Participants also completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES), either the teenage or adult version depending on the participant's age, so preliminary construct validity of the new scales could be examined. Exploratory factor analyses were conducted to determine model fit and reduce the scales to the most meaningful items. External validity of the three-part survey was examined by comparing OASES scores across stage of change as well as evaluating the functional relations between the three scales.

Results Adolescents' readiness to manage stuttering could be clearly described with five discrete stages, although most of the respondents reported being in the Maintenance stage. The pros of managing stuttering reliably predicted stage placement. Internal consistency of the scales ranged from good to excellent. OASES scores differed across stages of readiness in complex but predictable ways.

Conclusions These findings suggest that the Transtheoretical Model fits the target behaviors involved stuttering management among adolescents. Further examination of the application of the model to validate a stage-based framework for change among individuals who stutter is warranted.

PMID: 34637348 DOI: 10.1044/2021_AJSLP-21-00108




Attentional biases in adults who stutter before and following social threat induction

Folia Phoniatr Logop. 2021 Oct 6. Online ahead of print.


Kim R Bauerly


No abstract available
PMID: 34614498 DOI: 10.1159/000519865





Bidirectional Associations of Childhood Stuttering With Behavior and Temperament -  EMOCIONAL

J Speech Lang Hear Res. 2021 Nov 4;1-17. Online ahead of print.


Simone P C Koenraads, Pauline W Jansen, Robert Jan Baatenburg de Jong , Marc P van der Schroeff, Marie-Christine Franken

Erasmus University Medical Center, Rotterdam, the Netherlands.


Purpose Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood.

Method This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed.

Results Six-month-old children who were less able to "recover from distress," indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (β = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (β = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (β = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years.

Conclusions Behavior and temperament were associated with stuttering persistency-seemingly as both predictor and consequence-but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered. Supplemental Material https://doi.org/10.23641/asha.16869479.

PMID: 34735297 DOI: 10.1044/2021_JSLHR-20-00252




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




Case Report: Deutetrabenazine as an Adjunctive Treatment for Stuttering - FARMACOLOGIA

Case Reports Front Psychiatry. 2021 Oct 25;12:683368. eCollection 2021.


Catherine A Ha , Gerald A Maguire

University of California, Riverside, CA, United States.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8574968/pdf/fpsyt-12-683368.pdf


Childhood-Onset Fluency Disorder (Stuttering) is a neurodevelopmental disorder in which disturbances occur in the normal fluency and time patterning of speech. While the dopamine system has been well-described in its neurophysiology, there currently is no FDA-approved treatment for stuttering. Second-generation antipsychotics, which have been effective in the treatment of schizophrenia and bipolar disorder, act as dopamine D-2 receptor antagonists at the postsynaptic neuron and have been shown to reduce the symptoms of stuttering. However, the D-2 receptor antagonist and partial agonist agents carry the potential for metabolic side effects and can potentially lead to movement disorders. Deutetrabenazine, a VMAT-2 inhibitor indicated to treat hyperkinetic movement disorders, is a potential candidate in the treatment of stuttering, based on its mechanism of action in decreasing dopamine activity while not carrying the risk of metabolic adverse events.

PMID: 34759847 PMCID: PMC8574968 DOI: 10.3389/fpsyt.2021.683368




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




Complex nonverbal response inhibition and stopping impulsivity in childhood stuttering - PSICOMOTOR

J Fluency Disord. 2021 Sep 6;70:105877. Online ahead of print.


Levi C Ofoe, Julie D Anderson

Indiana University, Bloomington, United States


Purpose: The primary purpose of this study was to examine complex nonverbal response inhibition and stopping impulsivity in children who do (CWS) and do not stutter (CWNS).

Method: A total of 30 CWS and 30 CWNS between the ages of 3;1 and 6;0 (years; months) performed the Peg-Tapping Task (PTT; Diamond & Taylor, 1996; Luria, 1966), in which children were required to tap a dowel once when an examiner taps twice and vice versa. The main dependent variables were the number of practice trials, response accuracy, response latency for accurate responses, and the number of extra taps (i.e., tapping more than two times).

Results: The CWS were less accurate and slower on the PTT than the CWNS, with no differences in the number of practice trials. Furthermore, the CWS, especially boys, produced more extra taps than the CWNS.

Conclusions: Findings revealed that preschool CWS have weaknesses in complex response inhibition and stopping impulsivity in the nonverbal domain compared to CWNS. Taken together, these findings along with those of previous studies indicate that CWS may have weaknesses in inhibition and impulsivity in the nonverbal domain as well as the verbal domain, suggesting a domain-general weakness.

PMID: 34534900 DOI: 10.1016/j.jfludis.2021.105877




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




Convergence in voice fundamental frequency during synchronous speech - FALA

PLoS One. 2021 Oct 21;16(10):e0258747. eCollection 2021.


Abigail R Bradshaw, Carolyn McGettigan

University College London, London, United Kingdom.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530294/pdf/pone.0258747.pdf


Joint speech behaviours where speakers produce speech in unison are found in a variety of everyday settings, and have clinical relevance as a temporary fluency-enhancing technique for people who stutter. It is currently unknown whether such synchronisation of speech timing among two speakers is also accompanied by alignment in their vocal characteristics, for example in acoustic measures such as pitch. The current study investigated this by testing whether convergence in voice fundamental frequency (F0) between speakers could be demonstrated during synchronous speech. Sixty participants across two online experiments were audio recorded whilst reading a series of sentences, first on their own, and then in synchrony with another speaker (the accompanist) in a number of between-subject conditions. Experiment 1 demonstrated significant convergence in participants' F0 to a pre-recorded accompanist voice, in the form of both upward (high F0 accompanist condition) and downward (low and extra-low F0 accompanist conditions) changes in F0. Experiment 2 demonstrated that such convergence was not seen during a visual synchronous speech condition, in which participants spoke in synchrony with silent video recordings of the accompanist. An audiovisual condition in which participants were able to both see and hear the accompanist in pre-recorded videos did not result in greater convergence in F0 compared to synchronisation with the pre-recorded voice alone. These findings suggest the need for models of speech motor control to incorporate interactions between self- and other-speech feedback during speech production, and suggest a novel hypothesis for the mechanisms underlying the fluency-enhancing effects of synchronous speech in people who stutter.

PMID: 34673811 PMCID: PMC8530294




Determining the effect of tele-rehabilitation on patients with stutter using the goal attainment scaling (GAS) - TERAPIA

BMC Med Inform Decis Mak. 2021 Oct 12;21(1):280.


Maryam Eslami Jahromi, Leila Ahmadian

Iran University of Medical Sciences, Tehran, Iran; Kerman University of Medical Sciences, Kerman, Iran.

Free article: https://bmcmedinformdecismak.biomedcentral.com/track/pdf/10.1186/s12911-021-01642-3.pdf


Background: Lack of proper and timely patients' access to speech pathologists can affect the treatment and follow-up process; therefore, patients do not achieve the expected therapeutic goals. The aim of this study was to determine the effect of tele-rehabilitation on the stuttering patients using the goal attainment scaling (GAS).

Methods: This interventional study was carried out on patients who visited the rehabilitation centers affiliated to the Jahrom Welfare Office. They underwent remote speech therapy using Skype. To evaluate the treatment outcomes of the stuttering patients, GAS was used.

Results: The participants' speech and lingual skills improved using videoconferencing. The mean score of total GAS for patients was 53.08. Of 112 health goals, patients reached the expected or higher than expected levels in 78 goals.

Conclusions: Rehabilitation through video conferencing was effective for patients with stuttering, improved their speech, and decreased their stuttering. Since, application of remote rehabilitation services can provide regular access to healthcare services, it can lead to improving patient treatment provide more frequent and faster treatment follow-up.

PMID: 34641856 DOI: 10.1186/s12911-021-01642-3




Does a simulation-based learning programme assist with the development of speech-language pathology students' clinical skills in stuttering management? - TERAPIA

Review Int J Lang Commun Disord. 2021 Sep 14. Online ahead of print.


Adriana Penman, Anne E Hill, Sally Hewat, Nerina Scarinci

The University of Queensland, St Lucia, QLD, Australia; The University of Newcastle, Callaghan, NSW, Australia.


Background: Simulation-based learning can be used in university programmes to provide speech-language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students' development of skills in clinical practice with people who stutter.

Aims: (1) To evaluate students' clinical skills in managing stuttering within a simulation-based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students' performance.

Methods & procedures: Speech-language pathology students (n = 114) participated in a simulation-based stuttering programme in addition to academic coursework in fluency disorders. Students' clinical skills were assessed over two simulation sessions using the SPIRS-Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra-rater reliability and internal consistency of the SPIRS-Stuttering tool were also explored.

Outcomes & results: Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation-based stuttering programme. Good content validity was achieved for the SPIRS-Stuttering tool with a low level of intra-rater reliability and variable internal consistency.

Conclusions & implications: This study identified that students' clinical skills in stuttering improved during participation in a simulation-based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS-Stuttering tool enabled assessment of speech-language pathology students' clinical skills in stuttering management, further exploration of reliability is required.

PMID: 34519389 DOI: 10.1111/1460-6984.12670




Does stammering act as a barrier to exercise and sport in Irish adults who stammer? - SOCIAL

J Fluency Disord. 2021 Sep 15;70:105880. Online ahead of print.


Siobhán O'Connor, Kieran A Moran, Enda F Whyte, Aisling C Lacey

Dublin City University, Dublin, Ireland.


Purpose: Exercise and sport participation lead to many physical and psychosocial benefits. However, barriers to exercise and sporting participation exist. This study aims to examine if stammering acts as a barrier to exercise and sporting participation in adults.

Methods: One hundred and six adults who stammer (male n = 74, female n = 32; 33.83 ± 14.5 years) completed an anonymous questionnaire which evaluated their stammering history, exercise and sporting participation, views on why they exercise, whether stammering prevented or negatively influenced their participation in exercise or sport. Descriptive statistics were then calculated.

Results: The majority (90.6 %) of participants take part in some form of exercise/sport. However, their stammer prevented them from taking part in a specific exercise/sport at least once (49.1 %), due to being too nervous to introduce themselves, nervous or fear of stammering or being judged. Their stammer also negatively impacted their involvement when participating at least once (42.4 %), with not feeling part of the team and fear of speaking reported. Self-disclosure of their stammer and improving awareness of stammering were identified as common facilitators for taking part in exercise/sport.

Conclusion: Stammering was not found to impact general participation in exercise and sport but was identified as a barrier to partaking in specific exercise and sport and their enjoyment thereof. Encouraging those who stammer to inform those involved in sport and exercise (e.g. fellow players, coaches) about their stammer and improving stammer awareness across the general and sporting population may encourage further participation in exercise and sport in those who stammer.

PMID: 34543807 DOI: 10.1016/j.jfludis.2021.105880




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




Elevated iron concentration in putamen and cortical speech motor network in developmental stuttering - CONCEITO

Brain. 2021 Nov 9;awab283. Online ahead of print.


Gabriel J Cler, Saloni Krishnan, Daniel Papp, Charlotte E E Wiltshire, Jennifer Chesters, Kate E Watkins

University of Oxford, Oxford, UK; University of London, Egham Hill, UK; North Bristol NHS Trust, Bristol BS10 5NB, UK.


Theoretical accounts of developmental stuttering implicate dysfunctional cortico-striatal-thalamo-cortical motor loops through the putamen. However, the analysis of conventional MRI brain scans in individuals who stutter has failed to yield strong support for this theory in terms of reliable differences in the structure or function of the basal ganglia. Here, we performed quantitative mapping of brain tissue, which can be used to measure iron content alongside markers sensitive to myelin and thereby offers particular sensitivity to the measurement of iron-rich structures such as the basal ganglia. Analysis of these quantitative maps in 41 men and women who stutter and 32 individuals who are typically fluent revealed significant group differences in maps of R2*, indicative of higher iron content in individuals who stutter in the left putamen and in left hemisphere cortical regions important for speech motor control. Higher iron levels in brain tissue in individuals who stutter could reflect elevated dopamine levels or lysosomal dysfunction, both of which are implicated in stuttering. This study represents the first use of these quantitative measures in developmental stuttering and provides new evidence of microstructural differences in the basal ganglia and connected frontal cortical regions.

PMID: 34750604 DOI: 10.1093/brain/awab283




Ensaio clínico de tratamento – em três modalidades – para crianças com distúrbios da fluência e gagueira - INFANTIL / TERAPIA

Codas. 2021 Oct 22;34(2):e20200264. eCollection 2021.

 [Article in Portuguese, English]


Nathalia Dos Santos Fernandes de Ávila, Fabiola Juste, Julia Biancalana Costa, Claudia Regina Furquim de Andrade

Universidade de São Paulo - USP - São Paulo (SP), Brasil.

Free article: Abstract in English: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=en 

Portuguese: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=pt


Objetivo: Delinear um ensaio clínico de tratamento – em três modalidades – que verificasse se os tramentos testados para a gagueira crônica do desenvolvimento (GCD) apresentam indicadores que permitam reunir informações para a continuidade da sua aplicação, estabelecendo uma relação benefício-risco eficaz e segura.

Método: Para a realização do estudo foram analisadas 252 crianças, com idades entre 2 e 12 anos, que realizaram avaliação e tratamento para a GCD. Dentre as crianças atendidas, 93 cumpriram todos os critérios de elegibilidade. Após a obtenção dos escores de risco para GCD (Protocolo de Risco para a Gagueira do Desenvolvimento) todas as crianças foram avaliadas segundo seu perfil da fluência e grau de gravidade da gagueira. Foram aplicados os tratamentos para GCD: Programa Verde; Programa Amarelo e Programa Vermelho. A determinação do tratamento mais indicado para cada criança foi baseada na análise do grau de risco para a GCD.

Resultados: Todos os programas terapeuticos apresentaram resultados de melhora pós-tratamento consistentes nos segmentos analisados com exceção de: repetição de palavras; prolongamentos no final das palavras e intrusão de sons/segmentos.

Conclusão: Os programas terapêuticos testados – verde, amarelo e vermelho – foram eficientes para a ampla maioria dos participantes. A intervenção direta, aplicada no Programa Vermelho, foi altamente eficiente para a promoção da fala fluente, indicando que para os casos com maior índice de cronicidade a aplicação de técnicas específicas é indicada.




Implementation fidelity in parent-implemented interventions for stuttering - TERAPIA

Clin Linguist Phon. 2021 Sep 23;1-24. Online ahead of print.


Íris Ö Bergþórsdóttir, Kathryn Crowe, Jóhanna T Einarsdóttir

University of Iceland, Reykjavik, Iceland; Charles Sturt University, Bathurst, Australia.


Knowledge of the fidelity with which interventions are delivered in research studies is crucial to meaningful examination of intervention impact. This paper presents a review of fidelity implementation (FOI) measurements in interventions jointly delivered by speech-language pathologists (SLP) and parents in research for preschool-aged children who stutter (CWS). Four key FOI components were examined: dosage, adherence, quality, responsiveness. Thirty-six studies met the inclusion criteria for this study. Articles were published between 1990 and 2020 described nine different interventions and examined CWS aged 2-6 years. No study reported all FOI components in both the clinical and the home setting and five did not report on any FOI component in either setting. The number of FOI components reported ranged from 0 to 4 in both clinical (M = 1.5) and home (M = 1.0) settings. Across studies, dosage was most often reported (n = 27, 75.0%) and responsiveness was least often reported (n = 16, 44.4%). The number of FOI components reported in articles did not increase over time, although a trend towards greater reporting in recent years was observed. Poor reporting of FOI in intervention research presents a serious methodological concern that impacts the ability of clinicians and researchers to interpret the findings of these studies. Rigorous measurement and reporting of FOI in future intervention studies is required in order to better inform evidence-based practices for interventions with CWS.

PMID: 34553655 DOI: 10.1080/02699206.2021.1965659




Intensive Stuttering Therapy with Telepractice Follow-up: Longitudinal Outcomes

Folia Phoniatr Logop. 2021 Sep 28. Online ahead of print.


Farzan Irani, Raúl Rojas


No abstract available
PMID: 34583350 DOI: 10.1159/000519866




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




No other choice: Speech-Language Pathologists' attitudes toward using telepractice to administer the Lidcombe Program during a pandemic - TERAPIA

J Fluency Disord. 2021 Sep 15;70:105879. Online ahead of print.


Gissella Santayana, Brenda Carey, Rosalee C Shenker

Montreal Fluency Centre, Montreal, Quebec, Canada; Brenda Carey Speech Pathology, Melbourne, VIC, Australia.


Purpose: Telepractice has been shown to be a viable modality for the delivery of stuttering treatment. Since the advent of COVID-19, speech-language pathologists must adapt in-clinic treatments for online presentation. This research aimed to gather information from speech-language pathologists on their experiences of telepractice to deliver the Lidcombe Program to treat stuttering in young children.

Methods: This paper presents the findings of an online survey that polled the clinical experiences of 106 speech-language pathologists who were delivering the Lidcombe Program via telepractice during COVID-19.

Results: The majority of respondents were experienced clinicians from the United States and Canada who had attended a Lidcombe Program workshop. Prior to COVID-19, 80 % had provided some clinical services online (up to 10 % of the time), and at the start of COVID-19 public lockdown orders, 77 % viewed telepractice as both a necessity and an opportunity. Three months after the public lockdown orders, the large majority, 94 %, said that they would continue to use both telepractice and in-clinic treatment in the future. Technology issues, concerns about establishing the clinical relationship, and identification of mild stuttering featured as challenges of telepractice service delivery, while benefits included time efficiency, flexibility of scheduling, and improved clinical processes.

Conclusion: Respondents reported that the Lidcombe Program was easily translatable to telepractice and the majority intend to continue telepractice in the future.

PMID: 34624789 DOI: 10.1016/j.jfludis.2021.105879




Outcomes Following Participation in a Support-Based Summer Camp for Children Who Stutter - TERAPIA EM GRUPO

Lang Speech Hear Serv Sch. 2021 Oct 18;1-13. Online ahead of print.


Caryn Herring, Ryan A Millager, J Scott Yaruss

Michigan State University, East Lansing; Vanderbilt University, Nashville, TN.


Purpose Self-help and support activities are often recommended for people who stutter, and there is growing interest in understanding whether and how such experiences might be beneficial for children who stutter. The purpose of this study was to explore the potential impact of participation in Camp SAY, an overnight support-based summer camp experience for children who stutter, by measuring changes in scores on the Overall Assessment of the Speaker's Experience of Stuttering (OASES).

Method Participants were 107 children who stutter (age range: 8-18 years) who attended Camp SAY during the summers of 2013, 2015, and/or 2016. We examined changes in OASES scores (a) pre- to postcamp, (b) the durability of changes 6 months after the conclusion of the camp, and group differences (c) between school-age campers and teenage campers and (d) between first-time campers and those who had previously attended the camp.

Results Comparison of precamp to postcamp scores revealed significant improvements related to reactions to stuttering, quality of life, and overall adverse impact of stuttering. Scores on each subsection of the OASES were maintained (and further improved) 6 months after camp. There were no significant differences between school-age campers and teenage campers. Both first-time and returning campers showed significant improvements related to reactions to stuttering, though first-time campers had a significantly larger improvement in attitudes toward communication related to stuttering than returning campers.
Conclusion These outcomes suggest that participation in support activities, like Camp SAY, is associated with significant reductions in the overall adverse impact of stuttering and can therefore be beneficial for children who stutter.

PMID: 34662219 DOI: 10.1044/2021_LSHSS-21-00034




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




Performance of Bimanual Finger Coordination Tasks in Speakers Who Stutter - PSICOMOTOR

Front Psychol. 2021 Sep 23;12:679607.


Akira Toyomura, Tetsunoshin Fujii, Paul F Sowman

Gunma University, Maebashi, Japan; Tokyo Denki University, Inzai, Japan; Hokkaido University, Sapporo, Japan; Macquarie University, Sydney, NSW, Australia.

Free text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495154/pdf/fpsyg-12-679607.pdf


Stuttering is a neurodevelopmental speech disorder characterized by the symptoms of speech repetition, prolongation, and blocking. Stuttering-related dysfluency can be transiently alleviated by providing an external timing signal such as a metronome or the voice of another person. Therefore, the existence of a core motor timing deficit in stuttering has been speculated. If this is the case, then motoric behaviors other than speech should be disrupted in stuttering. This study examined motoric performance on four complex bimanual tasks in 37 adults who stutter and 31 fluent controls. Two tasks utilized bimanual rotation to examine motor dexterity, and two tasks used the bimanual mirror and parallel tapping movements to examine timing control ability. Video-based analyses were conducted to determine performance accuracy and speed. The results showed that individuals who stutter performed worse than fluent speakers on tapping tasks but not on bimanual rotation tasks. These results suggest stuttering is associated with timing control for general motor behavior.

PMID: 34630201 PMCID: PMC8495154 DOI: 10.3389/fpsyg.2021.679607




Psychogenic Stuttering - Case Report

Psychiatr Danub. Spring-Summer 2021;33(Suppl 4):684-685.

Free article: http://www.psychiatriadanubina.com/UserDocsImages/pdf/dnb_vol33_noSuppl%204/dnb_vol33_noSuppl%204_684.pdf


Ana Došen, Tanja Grahovac Juretić, Diana Palaić, Klementina Ružić, Elizabeta Dadić-Hero

Faculty of Medicine Rijeka, Rijeka, Croatia


No abstract available

PMID: 34718302




Resting autonomic activity in adults who stutter and its association with self-reports of social anxiety - EMOCIONAL

J Fluency Disord. 2021 Oct 22;70:105881. Online ahead of print.


Kim R Bauerly, Cameron Bilardello

University of Vermont, VT, United States


Purpose: The purpose of this study was to investigate resting autonomic activity in adults who stutter (AWS) compared to adults who do not stutter (ANS) and the relationship this has on self-reports of social anxiety.

Methods: Thirteen AWS and 15 ANS completed the Social Interaction Anxiety Scale (SIAS; Mattick & Clark, 1998) and Brief Fear of Negative Evaluation (BFNE; Leary, 1983). Following this, measures of skin conductance levels (i.e. index of sympathetic activity) and respiratory sinus arrhythmia (i.e. index of parasympathetic activity) were taken during a 5-minute resting, baseline period. Independent sample t tests were used to assess differences between groups on self-reports of anxiety (SIAS, BFNE) and resting autonomic levels (SCL, RSA). Separate multiple regression analyses were performed in order to assess the relationship between self-reports of anxiety and autonomic measures.

Results: Results showed significantly higher mean SCL and lower mean RSA levels in the AWS compared to the ANS at resting, baseline. Regression analysis showed that self-reports from the SIAS had a significant effect on RSA levels for the AWS but not the ANS. No significant effects were found for BFNE on RSA. Nor was there a significant effect from SIAS or BFNE on SCL levels for either group.

Conclusion: Findings suggest that resting RSA levels may be a physiological marker for social anxiety levels in adults who stutter.

PMID: 34763119 DOI: 10.1016/j.jfludis.2021.105881




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-Language Pathologist Perspectives of the Implementation of Telepractice-Delivered Stuttering Treatment for School-Age Children - TERAPIA

Lang Speech Hear Serv Sch. 2021 Nov 9;1-14. Online ahead of print.


Shane Erickson, Kate Bridgman, Lisa Furlong, Hannah Stark

La Trobe University, Bundoora, Victoria, Australia; Catholic Education Melbourne, East Melbourne, Victoria, Australia.


Purpose: The impact of stuttering can be significant, and effective treatment is critical. Despite evidence supporting direct treatment approaches for school-age children who stutter, a complex set of barriers can prevent access at school. One potential solution is telepractice. To date, however, there is no published evidence regarding the use of telepractice to deliver the Lidcombe Program within a school setting.

Method: In this pilot study, a telepractice service was established and the perspectives of the five treating speech-language pathologists (SLPs) were evaluated before, during, and after the trial through focus groups and recorded telesupervision sessions.

Results: An inductive and reflexive thematic analysis identified four main themes: (a) Understanding and managing technology is critical; (b) logistical considerations can be time-consuming and challenging; (c) preparation and support are essential; and (d) family engagement, acceptance, and independence with telepractice services can be facilitated by external support and coaching. Initially, the SLPs shared feelings of uncertainty, fear, and apprehension. Yet, despite this concern, the SLPs ultimately reported that telepractice can play an important role in their service.

Conclusions: In order to maximize the potential value of telepractice, SLPs require training and support to (a) manage the technology and troubleshoot problems that invariably arise, (b) have the opportunity to watch demonstrations of the technology, and (c) clearly explain the roles, responsibilities, and expectations of the parent engaging in treatment. These findings have particular relevance now, as schools and support services navigate a COVID-safe delivery model for the indefinite future.

PMID: 34752153 DOI: 10.1044/2021_LSHSS-20-00167




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




Stuttering: A Disorder of Energy Supply to Neurons? - CONCEITO

Front Hum Neurosci. 2021 Aug 26;15:662204. eCollection 2021.


Per A Alm

Uppsala University, Uppsala, Sweden.

Free Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496059/pdf/fnhum-15-662204.pdf


Stuttering is a disorder characterized by intermittent loss of volitional control of speech movements. This hypothesis and theory article focuses on the proposal that stuttering may be related to an impairment of the energy supply to neurons. Findings from electroencephalography (EEG), brain imaging, genetics, and biochemistry are reviewed: (1) Analyses of the EEG spectra at rest have repeatedly reported reduced power in the beta band, which is compatible with indications of reduced metabolism. (2) Studies of the absolute level of regional cerebral blood flow (rCBF) show conflicting findings, with two studies reporting reduced rCBF in the frontal lobe, and two studies, based on a different method, reporting no group differences. This contradiction has not yet been resolved. (3) The pattern of reduction in the studies reporting reduced rCBF corresponds to the regional pattern of the glycolytic index (GI; Vaishnavi et al., 2010). High regional GI indicates high reliance on non-oxidative metabolism, i.e., glycolysis. (4) Variants of the gene ARNT2 have been associated with stuttering. This gene is primarily expressed in the brain, with a pattern roughly corresponding to the pattern of regional GI. A central function of the ARNT2 protein is to act as one part of a sensor system indicating low levels of oxygen in brain tissue and to activate appropriate responses, including activation of glycolysis. (5) It has been established that genes related to the functions of the lysosomes are implicated in some cases of stuttering. It is possible that these gene variants result in a reduced peak rate of energy supply to neurons. (6) Lastly, there are indications of interactions between the metabolic system and the dopamine system: for example, it is known that acute hypoxia results in an elevated tonic level of dopamine in the synapses. Will mild chronic limitations of energy supply also result in elevated levels of dopamine? The indications of such interaction effects suggest that the metabolic theory of stuttering should be explored in parallel with the exploration of the dopaminergic theory.

PMID: 34630054 PMCID: PMC8496059 DOI: 10.3389/fnhum.2021.662204




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




Tools for standardized data collection: Speech, Language, and Hearing measurement protocols in the PhenX Toolkit - CONCEITO

Ann Hum Genet. 2021 Sep 28. Online ahead of print.


Cynthia C Morton, Mary L Marazita, Beate Peter, Mabel L Rice, Shelly Jo Kraft, Julie Barkmeier-Kraemer, Carey Balaban, Michael Phillips, Jennifer Schoden, Deborah Maiese, Tabitha Hendershot, Carol M Hamilton

University of Manchester, Manchester, UK; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Arizona State University, Phoenix, Arizona, USA; University of Kansas, Lawrence, Kansas, USA; Wayne State University, Detroit, Michigan, USA; University of Utah, Salt Lake City, Utah, USA; International, Research Triangle Park, North Carolina, USA.


The PhenX Toolkit (https://www.phenxtoolkit.org/) is an online catalog of recommended measurement protocols to facilitate cross-study analyses for biomedical research. An expert review panel (ERP) reviewed and updated the PhenX Toolkit Speech and Hearing domain to improve the precision and consistency of speech, language, and hearing disorder phenotypes. A three-member ERP convened in August 2018 to review the measurement protocols in the PhenX Speech and Hearing domain. Aided by three additional experts in voice assessment, vertigo, and stuttering, the ERP updated the 28 protocols to reflect the latest science and technology. ERP recommendations include six new protocols, five updated protocols (from the same source), and one retired protocol. New additions include two voice-related, three hearing-related, and two speech-related protocols. Additions reflect new phone/tablet applications for hearing and language, and clinical evaluations of voice. "Language" was added to the domain name, which is now "Speech, Language, and Hearing," to represent language-related protocols. These protocols can facilitate the assessment of speech, language, and hearing in clinical and population research. Common data elements (i.e., use of the same variables across studies) used by geneticists, otolaryngologists, audiologists, speech-language pathologists, and in other disciplines can lead to cross-study data integration and increased statistical power when studies are combined.

PMID: 34582045 DOI: 10.1111/ahg.12447




Treatment clinical trial - three types - for children with fluency disorders and stuttering - INFANTIL / TERAPIA

Codas. 2021 Oct 22;34(2):e20200264. eCollection 2021.

 [Article in Portuguese, English]


Nathalia Dos Santos Fernandes de Ávila, Fabiola Juste, Julia Biancalana Costa, Claudia Regina Furquim de Andrade

Universidade de São Paulo - USP - São Paulo (SP), Brasil.

Free article: Abstract in English: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=en 

Portuguese: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=pt


Purpose: To present a treatment clinical trial, involving three types of treatment for chronic developmental stuttering (CDS), to verify whether they present indicators and sufficient information to establish an effective and safe benefit-risk relationship.

Methods: The study included 252 children between 2 and 12 years old, who underwent assessment and treatment for CDS. Among the selected children, 93 met the established inclusion criteria. After obtaining the scores for the risk of CDS (Protocol for the Risk of Developmental Stuttering), all children were assessed according to their fluency profile and the severity level of stuttering. The children underwent treatment for CDS Green, Yellow and Red Programs. The treatment chosen for each child was based on the analysis of the risk for CDS.

Results: All therapeutic programs presented positive results in the post-treatment assessment considering the analyzed parameters, with the exception of word repetition, sound prolongation at the end of words, and intrusion of sounds/word segments.

Conclusion: The tested therapeutic programs - green, yellow, and red - were efficient for most of the participants. The direct intervention used in the Red Program was highly efficient in promoting fluent speech. This result suggests that for most of the patients with a higher risk of developing the chronic form of stuttering, the use of specific fluency promotion techniques is indicated.

PMID: 34705998 DOI: 10.1590/2317-1782/20212020264




Valproate-associated Movement Disorder: A Literature Review - FARMACOLOGIA

Review Prague Med Rep. 2021;122(3):140-180.


Jamir Pitton RissardO, Ana Letícia Fornari Caprara, Ícaro Durante

Federal University of Santa Maria, Santa Maria, Brazil; Federal University of Fronteira Sul, Passo Fundo, Brazil.


Valproate (VPA) was first synthesized in 1882, but it was only in the early 1960s that its anticonvulsant properties were discovered. The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of VPA-associated movement disorder (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. A total of 138 reports containing 362 cases of subjects who developed a MD secondary to VPA were reported. The MD identified were parkinsonism (PKN) (252), myoclonus (MCL) (54), dystonia (DTN) (17), dyskinesia (DKN) (16), stutters (4), tics (3), akathisia (AKT) (1). In the not clearly defined group, 15 extrapyramidal symptoms, 3 AKT, 2 DTN, 1 rigidity, 1 unstable gait were assessed. The mean and median age was 55.8 (SD: 16.58) and 61 years (range: 4-87 years). The most common VPA-indication was epilepsy, and 51.36% were males. The mean and median time from the VPA start to the MD onset was 32.75 (SD: 30.05) and 21.15 months (range: 1 day - 20 years). The mean and median time from the VPA withdrawal until the MD recovery was 2.89 (SD: 2.79) and 3 months (1 day - 12 months). The most common management was drug withdrawal. A complete recovery was obtained in 80.61%. VPA-associated MD was extensively reported in the literature. PKN was the most well-described. Future studies need to clearly report the clinical history of the patient, considering the full investigation of other adverse events during their entire life.

PMID: 34606429 DOI: 10.14712/23362936.2021.14




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




Weak Vestibular Response in Persistent Developmental Stuttering

Front Integr Neurosci. 2021 Sep 1;15:662127. eCollection 2021.


Max Gattie, Elena V M Lieven, Karolina Kluk

The University of Manchester, Manchester, United Kingdom.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477904/pdf/fnint-15-662127.pdf


Vibrational energy created at the larynx during speech will deflect vestibular mechanoreceptors in humans (Todd et al., 2008; Curthoys, 2017; Curthoys et al., 2019). Vestibular-evoked myogenic potential (VEMP), an indirect measure of vestibular function, was assessed in 15 participants who stutter, with a non-stutter control group of 15 participants paired on age and sex. VEMP amplitude was 8.5 dB smaller in the stutter group than the non-stutter group (p = 0.035, 95% CI [-0.9, -16.1], t = -2.1, d = -0.8, conditional R 2 = 0.88). The finding is subclinical as regards gravitoinertial function, and is interpreted with regard to speech-motor function in stuttering. There is overlap between brain areas receiving vestibular innervation, and brain areas identified as important in studies of persistent developmental stuttering. These include the auditory brainstem, cerebellar vermis, and the temporo-parietal junction. The finding supports the disruptive rhythm hypothesis (Howell et al., 1983; Howell, 2004) in which sensory inputs additional to own speech audition are fluency-enhancing when they coordinate with ongoing speech.

PMID: 34594189 PMCID: PMC8477904 DOI: 10.3389/fnint.2021.662127





Word-Final Disfluencies in a School-Age Child: Beneath the Tip of the Iceberg - AVALIAÇÃO

Lang Speech Hear Serv Sch. 2021 Oct 7;1-11. Online ahead of print.


Naomi Eichorn, Sidney Donnan

The University of Memphis, TN.


Purpose Disfluencies associated with stuttering generally occur in the initial position of words. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Our primary goals were to identify patterns in overt features of WFDs and to extend our understanding of this clinical profile by focusing on aspects of stuttering that lie beneath the surface.

Method Analyses explored the patterns and distributions of the child's observable stuttering behaviors, in addition to his awareness, perceptions, and subjective experience of stuttering.

Results Findings indicated that the WFD profile consists of relatively consistent and distinct overt features. We also found that, in many ways, the child perceived the impact of his disfluencies much like other children who stutter, even though his disfluencies manifested in a less common form.

Conclusion Findings suggest the need for increased awareness of the varied forms stuttering may take in order to ensure accurate diagnosis, clear communication to clients and parents, and timely access to appropriate intervention.

PMID: 34618549 DOI: 10.1044/2021_LSHSS-21-00005