Eliana Maria Nigro Rocha

 e-gagueira.com.br

 

Abstract - Agosto a Dezembro de 2022

 

 

A Cross-Sectional Investigation of the Impact of Stuttering on Swedish Females and Males in Childhood, Adolescence, and Young Adulthood - AVALIAÇÃO

J Speech Lang Hear Res. 2022 Nov 18;1-15. Online ahead of print.

 

Ineke Samson, Ellika Schalling, Agneta Herlitz, Elisabeth Lindström, Anders Sand

Karolinska Institutet, Stockholm, Sweden; Danderyd Hospital, Stockholm, Sweden; Uppsala University, Sweden; Åbo Akademi University, Turku, Finland.

 

Purpose: We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males.

Method: We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7-30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves.

Results: The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern.

Conclusions: In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers.

Supplemental material: https://doi.org/10.23641/asha.21554877.

PMID: 36399792 DOI: 10.1044/2022_JSLHR-22-00043

 

 

 

Attributes that affect the choice of treatment for preschool age children who stutter: an observational study - INFANTIL / TERAPIA

Folia Phoniatr Logop. 2022 Nov 16. Online ahead of print.

 

Sabine Van Eerdenbrugh, Irma Uijterlinde, Kurt Eggers, Marie-Christine Franken

 

Introduction: Little is known about the clinical decision-making process that speech-language pathologists( (SLPs) make when they decide which treatment approach they will use with Preschool age Children who Stutter (PCWS). Frequently used approaches are the Lidcombe Program, RESTART-DCM, Mini-KIDS, the Palin Parent-Child Interaction program and the Social-Cognitive Behaviour Therapy. In this study, we explored which attributes play a role in the complex process that precedes this clinical decision. We also explored if SLPs from the Netherlands, who are expected to follow the recommendations formulated in the Dutch professional stuttering guidelines, use different treatment approaches than SLPs from Belgium, who do not have specific guidelines to follow. Finally, we explored whether the number of years of experience of SLPs had an impact on the choice for treatment.

Methods: This study used an observational design in which 36 SLPs, additionally qualified in the treatment of stuttering, completed a questionnaire. The SLPs spoke Dutch, resided in the Netherlands or Belgium and used more than one treatment approach for PCWS in their standard practice.

Results: The following attributes affected the choice for treatment approach of most SLPs: (1) the child's reactions to the stuttering, (2) the child's language (and speech) skills, (3) the child's age, (4) the family's lifestyle, (5) the parent's ease to understand a treatment approach as judged by the SLPs and (6) the amount and quality of published research-based evidence. The decision-making of experienced SLPs is significantly more affected by the child's stuttering severity and time since onset compared to less experienced SLPs (both U = 90, p = .05). Dutch SLPs did not take other attributes into account than Belgian SLPs.

Discussion/conclusion: This study was a first attempt to explore which attributes affect the decision for a specific treatment. Further prospective research is needed.

PMID: 36384697 DOI: 10.1159/000528101

 

 

 

Auditory feedback control in adults who stutter during metronome-paced speech I. Timing Perturbation - AUDITIVO

J Fluency Disord. 2022 Nov 17;75:105943. Online ahead of print.

 

Saul A Frankford, Shanqing Cai, Alfonso Nieto-Castañón, Frank H Guenther

Boston University, Boston, MA 02215, USA.

 

Purpose: This study determined whether adults who stutter (AWS) exhibit deficits in responding to an auditory feedback timing perturbation, and whether external timing cues, which increase fluency, attenuate any disruptions due to altered temporal auditory feedback.

Methods: Fifteen AWS and sixteen adults who do not stutter (ANS) read aloud a multisyllabic sentence either with normal pacing or with each syllable paced at the rate of a metronome. On random trials, an auditory feedback timing perturbation was applied, and timing responses were compared between groups and pacing conditions.

Results: Both groups responded to the timing perturbation by delaying subsequent syllable boundaries, and there were no significant differences between groups in either pacing condition. Furthermore, no response differences were found between normally paced and metronome-paced conditions.

Conclusion: These findings are interpreted as showing that 1) AWS respond normally to pure timing perturbations, and 2) metronome-paced speech has no effect on online speech timing control as assessed in the present experiment.

PMID: 36423506 DOI: 10.1016/j.jfludis.2022.105943

 

 

 

Auditory feedback control in adults who stutter during metronome-paced speech II. Formant Perturbation - AUDITIVO

J Fluency Disord. 2022 Aug 27;74:105928. Online ahead of print.

 

Saul A Frankford, Shanqing Cai, Alfonso Nieto-Castañón, Frank H Guenther

Boston University, Boston, MA 02215, USA.

 

Purpose: Prior work has shown that Adults who stutter (AWS) have reduced and delayed responses to auditory feedback perturbations. This study aimed to determine whether external timing cues, which increase fluency, resolve auditory feedback processing disruptions.

Methods: Fifteen AWS and sixteen adults who do not stutter (ANS) read aloud a multisyllabic sentence either with natural stress and timing or with each syllable paced at the rate of a metronome. On random trials, an auditory feedback formant perturbation was applied, and formant responses were compared between groups and pacing conditions.

Results: During normally paced speech, ANS showed a significant compensatory response to the perturbation by the end of the perturbed vowel, while AWS did not. In the metronome-paced condition, which significantly reduced the disfluency rate, the opposite was true: AWS showed a significant response by the end of the vowel, while ANS did not.

Conclusion: These findings indicate a potential link between the reduction in stuttering found during metronome-paced speech and changes in auditory motor integration in AWS.

PMID: 36063640 DOI: 10.1016/j.jfludis.2022.105928

 

 

 

Australian pre-service primary teachers' knowledge, attitudes, and skills regarding stuttering - INFANTIL / SOCIAL

Int J Speech Lang Pathol. 2022 Oct 17;1-12. Online ahead of print.

 

Tim Matheson, Simone Arnott, Michelle Donaghy

Australian Catholic University, Fitzroy, Australia; Word by Mouth Speech Pathology, Mitcham, Australia; Speech Pathology Australia, Melbourne, Australia.

 

Purpose: Exploring Australian pre-service primary teachers' knowledge, attitudes, and classroom strategies regarding stuttering provides speech-language pathologists (SLPs) with information that can facilitate enhanced outcomes for school-aged children who stutter.
Method: In this exploratory descriptive cross-sectional study, 51 final-year Bachelor of Education (Primary) students enrolled at an Australian university completed an online survey about stuttering.

Result: Responses demonstrated positive and negative beliefs. Seventy-four per cent of pre-service teachers believed that stuttering has a psychological aetiology and that students who stutter are more likely to be shy or anxious. Participants agreed that their reactions and support offered would largely be based on their assumptions rather than knowledge.

Conclusion: Pre-service primary teachers share similar misconceptions and unhelpful attitudes towards stuttering with previously evaluated populations. Implications for SLPs are discussed.

PMID: 36251645 DOI: 10.1080/17549507.2022.2125073

 

 

 

Australian speech-language pathologists' experiences and perceptions of working with children who stutter: A qualitative study - INFANTIL / TERAPIA

J Fluency Disord. 2022 Nov 21;75:105944. Online ahead of print.

 

Shane Erickson, Kate Bridgman, Lisa Furlong

La Trobe University, Bundoora, Australia; University of Canterbury, Christchurch, New Zealand.

 

Purpose: Effective early intervention is recommended to ameliorate the potential long term negative effects of stuttering. Efficacious treatments are available, but speech-language pathologists (SLPs) report finding implementation to be challenging due to a range of clinician, client and clinical context factors. Previous survey-based research has found that SLPs lack self-efficacy working with CWS, however the reasons contributing to this are not well understood. This study presents the first in-depth analysis of the current practices and perceptions of SLPs working with children who stutter (CWS).

Methods: In this qualitative study 18 Australian SLPs who provide services to CWS were interviewed using a semi-structured interview approach. Data were analysed using reflexive thematic analysis.

Results: The thematic analysis identified four themes: (1) A stronger sense of self-efficacy is needed in stuttering management compared to other areas of clinical practice; 2) SLPs' sense of self-efficacy in stuttering management is influenced by early career experiences, client factors and the practice context; 3) Professional development and collaboration strengthen self-efficacy; and 4) Parental involvement and engagement are crucial to treatment success.

Conclusion: SLP self-efficacy for working with CWS appears a critical factor in the provision of effective management for this population. This study provides an in-depth analysis of the role of SLP self-efficacy and the factors that influence it.
PMID: 36434976 DOI: 10.1016/j.jfludis.2022.105944

 

 

 

Communication tools for scientists who stammer - SOCIAL

Nature. 2022 Aug;608(7922):266.

 

Mobbassar Hassan Sk

 

No abstract available

PMID: 35945373 DOI: 10.1038/d41586-022-02127-7

 

 

 

Communicative Fluency and the Experience of Stuttering: A Viewpoint - CONCEITO

J Speech Lang Hear Res. 2022 Sep 12;1-8. Online ahead of print.

 

Evan Usler

University of Delaware, Newark.

 

Purpose: Despite ambiguity in meaning and usage, "fluency" has played a central role in the understanding and treatment of developmental stuttering. The appropriateness of the term fluency in association with so-called fluency disorders, such as stuttering, has recently been questioned. The purpose of this article is to propose that fluency is best conceptualized as the efficiency of goal-directed action through cybernetic function. Spoken utterances are examples of sequences of action for the fulfillment of a hierarchy of nested and increasingly abstract social goals, including behaviors (e.g., introducing oneself) and values (e.g., being a sociable person). In contrast, some moments of speech disfluency, such as stuttering disfluencies, are inefficiencies in goal-directed action that may or may not hinder the fulfillment of higher level communicative behaviors and values, described here as communicative fluency.

Conclusions: The concept of communicative fluency refers to the continual, reliable, and upward fulfillment of increasingly abstract social goals in the form of communicative actions, behaviors, and values. This expanded conceptualization of fluency beyond simply speech production has the potential to be a useful indicator of psychosocial well-being for individuals who stutter.

PMID: 36095283 DOI: 10.1044/2022_JSLHR-22-00073

 

 

 

Concealing Stuttering at School: "When You Can't Fix It…the Only Alternative Is to Hide It" - SOCIAL

Lang Speech Hear Serv Sch. 2022 Nov 3;1-18. Online ahead of print.

 

Hope Gerlach-Houck, Kristel Kubart, Eilidh Cage

Western Michigan University, Kalamazoo; American Institute for Stuttering, New York, NY; University of Stirling, United Kingdom.

 

Purpose: The purpose of this study was to explore experiences with concealing stuttering in children and young people who stutter based on recollections from adults. In addition, we explored how school-based speech therapists can be helpful or unhelpful to children who are concealing stuttering from the perspective of adults who stutter.

Method: Thirty adults who stutter, who previously or currently conceal stuttering, participated in semistructured interviews exploring their early experiences with hiding stuttering. Purposeful and random sampling was used to diversify experiences and opinions. Reflexive thematic analysis was used to develop themes and subthemes to describe participants' experiences.

Results: All participants in the study reported beginning to conceal stuttering at 18 years of age or younger, with more than two thirds sharing that they began in elementary school. Participants reported that exposure to implicit and explicit ableist messaging about stuttering and traumatic social experiences at school contributed to their inclination to hide disfluencies. Many participants described concealment as a strategy for protecting themselves from stigma. Several participants condemned fluency shaping, calling it harmful and likening it to teaching concealment. Participants believed that speech therapists could be helpful by promoting safe and supportive school environments and by being responsive to the social and emotional challenges that can accompany speaking differently and navigating stigma at school.

Conclusions: Some children who stutter may attempt to protect themselves from stigma by concealing their disfluencies, but doing so can feel isolating and confusing. Speech therapists can play an important role in making the school environment safer and more supportive for children who stutter.

PMID: 36327554 DOI: 10.1044/2022_LSHSS-22-00029

 

 

 

Concomitant mood disorder and stutter in a post-COVID-19 patient

Ann Clin Psychiatry. 2022 Nov;34(4):277-278.
 

Zeyd Sarwar, Estee George, Manzoor Elahi

Summa Health, Akron, Ohio, USA; Cleveland Clinic Akron General, Akron, Ohio, USA; Northeast Ohio Medical University, Rootstown, Ohio, USA.

 

No abstract available

PMID: 36282608 DOI: 10.12788/acp.0085

 

 

 

Differences in implicit motor learning between adults who do and do not stutter - PSICOMOTOR

Neuropsychologia. 2022 Aug 2;108342. Online ahead of print.

 

Fiona Höbler, Tali Bitan, Luc Tremblay, Luc De Nil

University of Toronto, Toronto, ON, Canada; University of Haifa, Haifa, Israel.

 

Implicit learning allows us to acquire complex motor skills through repeated exposure to sensory cues and repetition of motor behaviours, without awareness or effort. Implicit learning is also critical to the incremental fine-tuning of the perceptual-motor system. To understand how implicit learning and associated domain-general learning processes may contribute to motor learning differences in people who stutter, we investigated implicit finger-sequencing skills in adults who do (AWS) and do not stutter (ANS) on an Alternating Serial Reaction Time task. Our results demonstrated that, while all participants showed evidence of significant sequence-specific learning in their speed of performance, male AWS were slower and made fewer sequence-specific learning gains than their ANS counterparts. Although there were no learning gains evident in accuracy of performance, AWS performed the implicit learning task more accurately than ANS, overall. These findings may have implications for sex-based differences in the experience of developmental stuttering, for the successful acquisition of complex motor skills during development by individuals who stutter, and for the updating and automatization of speech motor plans during the therapeutic process.

PMID: 35931135 DOI: 10.1016/j.neuropsychologia.2022.108342

 

 

 

Disfluency-Affirming Therapy for Young People Who Stutter: Unpacking Ableism in the Therapy Room - INFANTIL / SOCIAL

Lang Speech Hear Serv Sch. 2022 Oct 24;1-6. Online ahead of print.

 

Vivian Sisskin

University of Maryland, College Park.

 

Purpose: Ableist messages are conveyed early in the life of a stutterer and are amplified throughout the school-age years. Increased recognition of the benefits of acceptance-based therapies for positive long-term outcomes has changed the narrative about stuttering and stutterers. Speech-language therapists are resonating with the ideas that "it is okay to stutter," socioemotional aspects of stuttering must be considered, and support and community are valuable. Despite the shift in understanding, messages conveyed to students and parents commonly encourage suppression of stuttering and masking of one's stuttering identity. The purpose of this article was to (a) expose unintentional ableist messages that perpetuate stigma and feeling "othered" in the therapy relationship and (b) offer suggestions for congruent messaging in stuttering therapy.

Conclusions: Ableism in stuttering therapy contributes to the physical struggle and socioemotional challenges experienced by stutterers. The author offers ideas for revisioning therapy outcomes, language, and messaging to students to encourage a congruent, disfluency-affirming culture in schools and community. Introspection and advocacy by both therapists and the broader professional community, in collaboration with young people who stutter, will serve to reduce the stigma that fuels many of the daily challenges faced by school-age children who stutter.

PMID: 36279203 DOI: 10.1044/2022_LSHSS-22-00015

 

 

 

Dissecting structural connectivity of the left and right inferior frontal cortex in children who stutter - INFANTIL / NEUROCIÊNCIAS

Cereb Cortex. 2022 Sep 4;bhac328. Online ahead of print.

 

Nicole E Neef, Mike Angstadt, Simone P C Koenraads, Soo-Eun Chang

University Medical Center Göttingen, Göttingen, Germany; University of Michigan, Ann Arbor, MI, USA; Erasmus University Medical Center, Rotterdam, the Netherlands; Michigan State University, MI, USA.

 

Inferior frontal cortex pars opercularis (IFCop) features a distinct cerebral dominance and vast functional heterogeneity. Left and right IFCop are implicated in developmental stuttering. Weak left IFCop connections and divergent connectivity of hyperactive right IFCop regions have been related to impeded speech. Here, we reanalyzed diffusion magnetic resonance imaging data from 83 children (41 stuttering). We generated connection probability maps of functionally segregated area 44 parcels and calculated hemisphere-wise analyses of variance. Children who stutter showed reduced connectivity of executive, rostral-motor, and caudal-motor corticostriatal projections from the left IFCop. We discuss this finding in the context of tracing studies from the macaque area 44, which leads to the need to reconsider current models of speech motor control. Unlike the left, the right IFCop revealed increased connectivity of the inferior posterior ventral parcel and decreased connectivity of the posterior dorsal parcel with the anterior insula, particularly in stuttering boys. This divergent connectivity pattern in young children adds to the debate on potential core deficits in stuttering and challenges the theory that right hemisphere differences might exclusively indicate compensatory changes that evolve from lifelong exposure. Instead, early right prefrontal connectivity differences may reflect additional brain signatures of aberrant cognition-emotion-action influencing speech motor control.

PMID: 36057839 DOI: 10.1093/cercor/bhac328

 

 

 

Efficacy of Addition of Atomoxetine to Speech Therapy in Stuttering Severity of Children Aged 4-12 Years: A Double-Blind Randomized Controlled Trial - FARMACOLOGIA

Iran J Child Neurol. 2022 Summer;16(3):47-56. Epub 2022 Jul 16.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9531205/pdf/ijcn-16-47.pdf

 

Farzad Ahmadabadi, Abdullah Motamedi, Ghazal Zahed, Akram Motamedi, Farshid Shahriari, Farhad Pourfarzi, Narjes Jafari, Mohammad Mehdi Hosseini

Shahid Beheshti University of Medical Sciences, Tehran, Iran; Allameh Tabatabai University,Tehran,Iran, Ardabil University of Medical Sciences, Ardabil,Iran.

 

Objectives: Stuttering is a common problem at all ages that is required to be treated since childhood. Atomoxetine is currently used for the treatment of attention deficit hyperactivity disorder (ADHD). It can be effective for the treatment of stuttering due to its selective inhibition of norepinephrine reuptake and dopaminergic properties. Therefore, this randomized controlled trial aimed to evaluate the effect of atomoxetine on children's stuttering.

Materials & methods: The children aged 4-12 years and diagnosed with stuttering, referred to Pediatric Neurology and Psychology clinics , were randomly divided into experimental (n=50) and control (n=50) groups. One group received atomoxetine plus speech therapy, and the other group received only speech therapy. Both groups completed the Stuttering Severity Instrument-Fourth Edition at the baseline (on the first visit) and 3 months after the intervention. The results were compared between the two groups using SPSS software (version 21).

Results: Most of the children (67%) were male. Moreover, 24%, 46%, and 30% of the subjects were within the age ranges of < 60, 60-95, and > 95 months, respectively. Nearly half of the patients (52%) had a positive family history of stuttering. Stuttering severity was the highest within the age range of 60-95 months, in left-handed children, in those who used formula, and in those who felt insecure in the family; however, there was no difference in stuttering severity based on child's gender, concomitant ADHD, multilingualism, facial or movement tics, sleeping hours, and using teats. The mean stuttering severity reduced in both groups (P<0.001), with a greater decrease in the experimental group, compared to that of the control group (P=0.011).

Conclusion: Atomoxetine plus speech therapy is effective for the treatment of children's stuttering and can be used as a complementary treatment strategy in such patients.

PMID: 36204431 PMCID: PMC9531205 DOI: 10.22037/ijcn.v16i3.34450

 

 

 

Electrodermal Activity of Preschool-Age Children Who Stutter During a Child-Friendly Stroop Paradigm - INFANTIL / EMOCIONAL

Am J Speech Lang Pathol. 2022 Oct 4;1-18. Online ahead of print.

 

Heather D Salvo, Hayley S Arnold

Kent State University, OH.

 

Purpose: The aim of the study was to assess whether emotional reactivity, indexed by a distinct physiological measure of sympathetic activation, differs between preschool-age children who stutter (CWS) and preschool-age children who do not stutter (CWNS) during a child-friendly Stroop task (i.e., day-night task). Additionally, researchers aimed to assess whether the Stroop task, compared to a control task, was a significant physiological stressor.

Method: Fifteen preschool-age CWS and 22 preschool-age CWNS were asked to perform a day-night Stroop task in order to elicit psychophysiological reactivity, indexed by electrodermal response (EDR) occurrence frequency and EDR amplitude. Physiological measurements were recorded during pretask baselines, performance of the day-night Stroop task, and performance of a speech-language control task.

Results: Findings based on EDR measures did not support the hypothesis that the child-friendly day-night Stroop task is an effective stressor as compared to a control task based on measures of physiological arousal in preschool-age children. The CWS and CWNS did not significantly differ in their EDR measures relative to the control task or Stroop task (p > .05). However, CWS, compared to CWNS, exhibited significantly greater EDR amplitudes during the control task baseline (p < .05) and the Stroop task baseline (p < .05).

Conclusion: Overall, these findings may suggest that a predisposition to heightened levels of sympathetic activity prior to tasks in preschool-age CWS is important to consider with regard to the nature of developmental stuttering.

PMID: 36194770 DOI: 10.1044/2022_AJSLP-21-00225

 

 

 

Evaluating Palin Stammering Therapy for School Children (Palin STSC 8-14): protocol for a feasibility randomised controlled trial comparing Palin STSC(8-14) with usual treatment - TERAPIA

Pilot Feasibility Stud. 2022 Sep 16;8(1):210.

Free PMC article: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-022-01158-1

 

 

S K Millard et al

The Michael Palin Centre for Stammering, Whittington Hospital NHS Trust, London, UK; Unversity of Bedfordshire, Luton, UK; University of East Anglia, Norwich, UK;  University of London, London, UK; University of Essex, Colchester, UK.

 

Background: Having a stammer can have a significant effect on a child's social, emotional and educational development. With approximately 66,000 children in the UK having a stammer, there is a need to establish an adequate evidence base to inform clinical practice. We describe a feasibility trial to explore the effectiveness of a new therapy programme for children aged 8-14: Palin Stammering Therapy for School Children (Palin STSC(8-14)). Preliminary data from the Michael Palin Centre, where the programme was developed, indicate that Palin STSC(8-14) is effective in reducing stammering frequency and impact for children, with beneficial effects for parents too. We will investigate the feasibility of the methods required for a definitive randomised controlled trial to investigate the application of this therapy by NHS speech and language therapists (SLTs), compared with 'treatment as usual' (TAU), beyond the specialist context in which it was developed.

Methods: This is a two-arm feasibility cluster-randomised controlled trial of Palin STSC(8-14) with TAU control arm, and randomisation at the level of the SLT. Quantitative and qualitative data will be collected to examine the following: the recruitment and retention of therapists and families, the acceptability of the research processes and the therapeutic intervention and the appropriateness of the therapy outcome measures. Assessments will be completed by children and parents at baseline and 6 months later, including measures of stammering severity; the impact of child's stammering on both children and parents; child temperament, behaviour and peer relations, anxiety; quality of life; and economic outcomes. There will also be a qualitative process evaluation, including interviews with parents, children, SLTs and SLT managers to explore the acceptability of both the research and therapy methods. Treatment fidelity will be examined through analysis of therapy session records and recordings.

Discussion: The findings of this feasibility trial will inform the decision as to whether to progress to a full-scale randomised controlled trial to explore the effectiveness of Palin STSC(8-14) when compared to Treatment as Usual in NHS SLT services. There is a strong need for an evidence-based intervention for school age children who stammer.

PMID: 36114558 PMCID: PMC9479243 DOI: 10.1186/s40814-022-01158-1

 

 

 

Improving Clinical Competence Through Simulated Training in Evidence-Based Practice for Stuttering: A Pilot Study - TERAPIA

Am J Speech Lang Pathol. 2022 Nov 4;1-19. Online ahead of print.

 

Courtney T Byr, Robyn L Croft, Ellen M Kelly

The University of Texas at Austin.

 

Purpose: The purpose of this pilot study was to determine the effectiveness and acceptability of an initial module (1.1; active listening skills) of the Simulated Training in Evidence-Based Practice for Stuttering (STEPS) program, a theory-driven, multimodule, content and learning platform designed to advance knowledge and skills in working with culturally and linguistically diverse persons who stutter of all ages.

Method: Fifteen preservice speech-language pathologists (SLPs) were randomly assigned to complete either the STEPS 1.1 module or a control module. In both conditions, all participants engaged in pre- and post-clinical interviews with a standardized patient portraying a parent of a child who stutters. Prior to participation, all participants provided self-ratings on the Jefferson Scale of Physician Empathy-Health Profession Student. Post participation, trained observers rated all participants' active listening behaviors using the Active Listening Observation Scale-Modified. Post participation, the STEPS 1.1 participants also completed an intervention acceptability questionnaire.

Results: No differences between groups were found in self-perceived clinical empathy prior to participation. Participants who completed the STEPS 1.1 condition utilized paraphrasing and client-directed eye gaze significantly more frequently at posttest than at pretest and significantly more than the control group at posttest. Quantitative and qualitative responses from the participants who completed STEPS 1.1 indicated high acceptability of its content, structure, duration, and perceived impact.

Conclusion: Preliminary data from the present pilot study support use of the STEPS 1.1 module to improve preservice SLPs' use of skills that have been shown to predict perceived clinical empathy and increase assessment and treatment effectiveness.

PMID: 36332141 DOI: 10.1044/2022_AJSLP-22-00116

 

 

 

Individual differences in attentional control predict working memory capacity in adults who stutter - ATENÇÃO

J Commun Disord. 2022 Oct 15;100:106273. Online ahead of print.

 

Seth E Tichenor, Amanda Hampton Wray, Susan M Ravizza, J Scott Yaruss

Duquesne University, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; Michigan State University, East Lansing, MI.

 

Purpose: Prior research has suggested that people who stutter exhibit differences in some working memory tasks, particularly when more phonologically complex stimuli are used. This study aimed to further specify working memory differences in adults who stutter by not only accounting for linguistic demands of the stimuli but also individual differences in attentional control and experimental influences, such as concomitant processing requirements.

Method: This study included 40 adults who stutter and 42 adults who do not stutter who completed the Attention Network Test (ANT; Fan et al., 2002) and three complex span working memory tasks: the Operation Span (OSPAN), Rotation Span, and Symmetry Span (Draheim et al., 2018; Foster et al., 2015; Unsworth et al., 2005, 2009). All complex span tasks were dual-tasks and varied in linguistic content in task stimuli.

Results: Working memory capacities demonstrated by adults who stutter paralleled the hierarchy of linguistic content across the three complex span tasks, with statistically significant between-group differences in working memory capacity apparent in the task with the highest linguistic demand (i.e., OSPAN). Individual differences in attentional control in adults who stutter also significantly predicted working memory capacity on the OSPAN.

Discussion: Findings from this study extend existing working memory research in stuttering by showing that: (1) significant working memory differences are present between adults who stutter and adults who do not stutter even using relatively simple linguistic stimuli in dual-task working memory conditions; (2) adults who stutter with stronger executive control of attention demonstrate working memory capacity more comparable to adults who do not stutter on the OSPAN compared to adults who stutter with lower executive control of attention.

PMID: 36274445 DOI: 10.1016/j.jcomdis.2022.106273

 

 

 

Infection and speech: Disfluency and other speech symptoms in Pediatric Acute-onset Neuropsychiatric Syndrome - AVALIAÇÃO

J Commun Disord. 2022 Aug 5;99:106250. Online ahead of print.

 

Una Prosell, Hanna Norman, Anders Sand, Anita McAllister

Karolinska Institutet, CLINTEC, Stockholm, Sweden; Autismcenter små barn, Rosenlund Hospital, Stockholm, Sweden; Logopedbyrån Dynamica, Stockholm, Sweden. Intervention and Technology, Karolinska Institutet, Sweden; Karolinska University Hospital, Stockholm, Sweden.

 

Introduction: In the early 20th century a link between infection and speech disfluency was discussed. Recent reports indicate that PANS (Pediatric Acute-onset Neuropsychiatric Syndrome), and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) may be associated with a high incidence of speech disfluency. The present study specifically investigates disfluency and other speech symptoms following onset of PANS and PANDAS. Prevalence of previously reported speech related symptoms vocal tics, selective mutism and "baby talk" is included. The present study also aims to explore possible changes in articulation and intelligibility, distress due to speech impairment, and effect of PANS or PANDAS medication on speech symptoms.

Methods: A questionnaire was distributed to caregivers of children with diagnosed or suspected PANS or PANDAS. In total 55 individuals in Sweden were included.

Results: Onset of speech disfluency in association with PANS or PANDAS was reported by 54.5% of the caregivers. Most frequent disfluency symptoms were higher speech rate, superfluous verbal behavior, verbal blocks and associated motor symptoms. Previous findings of vocal tics, baby talk and mutistic behavior are supported. The present study also exposed previously unreported symptoms such as impaired articulation, reduced intelligibility, reduced speech production and language impairment. Eleven caregivers reported that medical treatment had a positive effect on speech fluency.

Conclusions: A connection between PANS and PANDAS and speech disfluency is supported, and a possible link between infection and disfluency is reactualized. Reported disfluency shares several characteristics with stuttering and cluttering, but the caregivers did not consistently associate it with stuttering. The present study also sheds new light on how symptoms of "baby talk", selective mutism and vocal tics might be viewed in this population. In all, the results indicate a substantial impact on speech fluency, speech and language in affected children, reducing quality of life.

PMID: 35964340 DOI: 10.1016/j.jcomdis.2022.106250

 

 

 

International Pediatric Multidisciplinary Management Using Telemedicine to Promote Equitable Care Telemed - TERAPIA

J E Health. 2022 Sep 16. Online ahead of print.

 

Rafael Mena et al

Centro de Obstetricia y Ginecologia, Santo Domingo, Dominican Republic; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA.

 

Objective: To evaluate the use of telemedicine as a collaboration tool between a pediatrician and subspecialists looking to address challenges, such as the lack of health care specialists, which are present in the Dominican Republic.
Study design: During this 6-year study, 65 patients were evaluated by a medical team consisting of a local pediatrician and 17 subspecialists from a leading academic medical center in the Unites States. Patient's age ranged from 2 months to 16 years of age (mean 8 years old). The most common reasons for referral were masses or malignancies, vascular malformations, urogenital anomalies, stuttering, and cochlear implant programming.

Results: A total of 39 out of 65 cases (60%) carried an initial diagnosis. Of the 65 cases, a change in medical management occurred in 92.31% of cases (60 cases). There was no change in medical diagnosis or treatment in 5 of 65 cases (8%).

Conclusion: This protocol exhibited high patient satisfaction with the technology and platform and direct patient savings from transportation costs. It also demonstrated the importance of thorough diagnosis in providing appropriate treatment and solutions. Telemedicine use in comparable practices should be studied further to aid in the development of policies for the diagnosis and management of chronic illnesses that require referrals to subspecialists.

PMID: 36112346 DOI: 10.1089/tmj.2022.0165

 

 

 

Lidcombe Program translation to community clinics in Australia and England - TERAPIA

Int J Lang Commun Disord. 2022 Sep 17. Online ahead of print.

 

Sue O'Brian et al

University of Technology Sydney, NSW, Australia; University of Sydney, NSW, Australia; Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK; Bond University, QLD, Australia.

 

Background: Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it.

Aims: This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/ speech and language therapists) and their clients from Australia and England.

Methods & procedures: Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift.

Outcomes & results: Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials.

Conclusions & implications: Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined.

PMID: 36114801 DOI: 10.1111/1460-6984.12785

 

 

 

Mental well-being and related factors in individuals with stuttering - EMOCIONAL

Heliyon. 2022 Aug 31;8(9):e10446.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465350/pdf/main.pdf

 

Seda Türkili, Serkan Türkili, Zeynep Feryal Aydın

Mersin University, Mersin, Turkey; Mersin City Training and Research Hospital, Mersin, Turkey; Forum Yaşam Hospital, Mersin, Turkey.

 

Aim: This study aimed to determine the effects of various sociodemographic variables and experiences, unhelpful beliefs about stuttering, and perceived social support on psychological well-being in stuttering adults.

Methods: Forty-five stuttering adults were included in our study, and sociodemographic data were collected using a stuttering experiences information form, the Unhelpful Thoughts and Beliefs About Stuttering (UTBAS)-6 scale, the perceived social support scale, and the Warwick-Edinburgh Mental Well-being Scale.

Results: It was determined that the total score of the UTBAS scale, the high scores on the fear of negative evaluation, avoidance, self-doubt and insecurity, and the hopelessness subscales, and the low scores of the perceived social support scale were correlated with lower psychological well-being results in stuttering individuals.

Conclusions: To support the mental well-being of individuals with stuttering, we believe it would be beneficial to provide mental assessment and supportive approaches, raise awareness to eliminate prejudice and stigmatizing attitudes toward individuals with stuttering in the family and wider society, and develop social support systems, alongside speech therapy.

PMID: 36105477 PMCID: PMC9465350

 

 

 

Milder Phenotype of Homoplasmic Versus Heteroplasmic m.8344A>G Variant in the Same Family: A Case Report - AVALIAÇÃO

Case Reports Cureus. 2022 Aug 28;14(8):e28490.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9513505/pdf/cureus-0014-00000028490.pdf

 

Josef Finsterer, Sounira Mehri

Neurology and Neurophysiology Center, Vienna, AUT; Faculty of Medicine, Monastir, TUN.

 

A myoclonic epilepsy with ragged-red fibers (MERRF) patient who carried the m.8344A>G variant in the homoplasmic form manifested a milder phenotype than his sister who carried the same variant in the heteroplasmic form, which has not yet been reported. The 27-year-old male, with an uneventful history, presented at age 19 with fatigue and persistent tremor in both hands. When he talked for a long time, his speech would slow down, and he would stutter. Although electroencephalography showed spike-wave complexes in both occipital projections with generalization, no anti-seizure drugs were given. At age 20, the patient suffered a fall due to muscle weakness. From age 21, generalized myocloni occurred. Because the sister had been diagnosed with MERRF-plus syndrome, the patient underwent genetic testing, which revealed the m.8344A>G variant in homoplasmy. L-carnitine was started. At age 27, the patient experienced a first "syncope" after a long walk, which subsequently recurred up to 2-3 times per day. EEG showed low-amplitude spikes, slow-spike waves at the posterior vertex, and generalized slow-spike waves. Clonazepam was recommended but declined by the patient. In conclusion, the m.8344A>G variant may manifest milder and with a later onset in the homoplasmic as compared to the heteroplasmic form. Further, the homoplasmy of the m.8344A>G variant appears to be more beneficial than harmful.

PMID: 36176839 PMCID: PMC9513505 DOI: 10.7759/cureus.28490

 

 

 

Mouth Breathing and Speech Disorders: A Multidisciplinary Evaluation Based on The Etiology - AVALIAÇÃO

J Pharm Bioallied Sci. 2022 Jul;14(Suppl 1):S911-S916. Epub 2022 Jul 13.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9469305/?report=printable

 

Waleed A Alhazmi

Qassim University (QU), Kingdom of Saudi Arabia (KSA), Kingdom of Saudi Arabia.

 

Objective: The objective of the study was to determine the most common speech impairments among mouth breathing (MB) children and to assess the relationship between them in terms of etiology, gender, clinical symptoms, clinical findings, and dental traits.

Materials and methods: A total of 498 mouth-breathers, both male and female, aged 9-17 years, were screened for allergic rhinitis (AR), adenoid hypertrophy (AH), and/or functional mouth breathing (FM). The subjects were assessed by a team that included an otorhinolaryngologist, an allergologist, an orthodontist, and a speech pathologist.

Results: MB was associated with AR, AH, FM, and orofacial myofunctional disorders (OMD). AR was the most common etiology, followed by FM. Further, 81.7% of the children had speech disorders such as speech sound problems, fluency disorders, and voice disorders. A statistically significant association was found between etiology, OMD, and speech alterations. Males had a statistically highly significant frequency of speech abnormalities than females. Frontal lisp was found in 36.1%, followed by stuttering (19.2%). In 10.6% of the children, two or more speech impediments occurred simultaneously. There was also a statistically significant association between various speech abnormalities and malocclusion.

Conclusion: The findings of the study suggested that articulation disorders were frequently associated with MB children. It emphasizes the necessity of monitoring MB children through a multidisciplinary approach to prevent the adverse effects of MB and improve the overall development of individuals.

PMID: 36110622 PMCID: PMC9469305 DOI: 10.4103/jpbs.jpbs_235_22

 

 

 

Moving past my stutter - SOCIAL

Science. 2022 Oct 7;378(6615):106.

 

Gianfranco Matrone

University of Edinburgh.

Free Full text: https://www.science.org/doi/epdf/10.1126/science.adf1314

PMID: 36201595 DOI: 10.1126/science.adf1314

 

 

 

Multimodal explainable AI predicts upcoming speech behavior in adults who stutter - PSICOMOTOR

Front Neurosci. 2022 Aug 1;16:912798

Free Full Text: frontiersin.org/articles/10.3389/fnins.2022.912798/full

 

Arun Das et al

University of Texas at San Antonio, San Antonio, TX, United States; University of Pittsburgh Medical Center, Pittsburgh, PA, United States.

 

A key goal of cognitive neuroscience is to better understand how dynamic brain activity relates to behavior. Such dynamics, in terms of spatial and temporal patterns of brain activity, are directly measured with neurophysiological methods such as EEG, but can also be indirectly expressed by the body. Autonomic nervous system activity is the best-known example, but, muscles in the eyes and face can also index brain activity. Mostly parallel lines of artificial intelligence research show that EEG and facial muscles both encode information about emotion, pain, attention, and social interactions, among other topics. In this study, we examined adults who stutter (AWS) to understand the relations between dynamic brain and facial muscle activity and predictions about future behavior (fluent or stuttered speech). AWS can provide insight into brain-behavior dynamics because they naturally fluctuate between episodes of fluent and stuttered speech behavior. We focused on the period when speech preparation occurs, and used EEG and facial muscle activity measured from video to predict whether the upcoming speech would be fluent or stuttered. An explainable self-supervised multimodal architecture learned the temporal dynamics of both EEG and facial muscle movements during speech preparation in AWS, and predicted fluent or stuttered speech at 80.8% accuracy (chance=50%). Specific EEG and facial muscle signals distinguished fluent and stuttered trials, and systematically varied from early to late speech preparation time periods. The self-supervised architecture successfully identified multimodal activity that predicted upcoming behavior on a trial-by-trial basis. This approach could be applied to understanding the neural mechanisms driving variable behavior and symptoms in a wide range of neurological and psychiatric disorders. The combination of direct measures of neural activity and simple video data may be applied to developing technologies that estimate brain state from subtle bodily signals.

PMID: 35979337 PMCID: PMC9376608 DOI: 10.3389/fnins.2022.912798

 

 

 

Public attitudes toward stuttering in Malaysia - SOCIAL

J Fluency Disord. 2022 Nov 7;74:105942. Online ahead of print.

 

Shin Ying Chu, Rachael Unicomb, Jaehoon Lee, Kai Shuo Cho, Kenneth O St Louis, Elisabeth Harrison, Grace McConnell

Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; The University of Newcastle, Callaghan, Australia; Texas Tech University, Lubbock, TX, USA; UKM Specialist Children Hospital, Kuala Lumpur, Malaysia; West Virginia University, Morgantown, WV, USA; Macquarie University, Australia; Rockhurst University, Kansas City, USA

 

Purpose: This study aims to: (a) measure public attitudes toward stuttering in Malaysia using the Public Opinion Survey of Human Attitudes-Stuttering [POSHA-S], (b) determine how reported attitudes and knowledge related to stuttering compare to existing data, and (c) determine whether there are differences between groups for identified variables.

Method: A total of 250 adults (mean age = 29 years; range = 19-60 years) completed the POSHA-S in English. We compared this sample's attitudes toward stuttering to POSHA-S data from other global samples. General linear modeling examined differences in overall stuttering score, beliefs, and self reaction subscores for demographic variables such as age, gender, marital status, parenting, education, employment status, prior exposure to a person who stutters, multilingual, race, and religion.

Results: The Malaysian participants' overall stuttering score and the beliefs and self reactions subscores were all considerably lower (i.e., less positive) than the other samples around the world from the POSHA-S database median values. Being male, receiving a higher education, and knowing someone who stutters were linked to having more positive self reactions, but none of those factors was linked to positive or negative beliefs. Those who had previously been exposed to stuttering scored significantly higher than those who had not.

Conclusion: Malaysians may have less positive attitudes toward stuttering than Westerners. More needs to be done to make society more accepting of people who stutter. Future research should aim to find ways to educate and to raise public awareness about stuttering.

PMID: 36395547 DOI: 10.1016/j.jfludis.2022.105942

 

 

 

Public Speech Anxiety among Medical Residency Trainees in Riyadh - SOCIAL

Health Psychol Res. 2022 Nov 3;10(4):38354.
Free PMC article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680837/pdf/healthpsychologyresearch_2022_10_4_38354.pdf

 

Taha Alhazmi, Aisha Khalid Alraddadi, Hussa Ibrahim Alabdulkarim, Norah Abdullah Al-Rowais

King Saud University Medical City.

 

Objective: The present study aimed at measuring the level of public speaking anxiety (PSA) among medical residents in Riyadh, in addition to identifying the factors influencing public speaking anxiety from the perspective of the medical residents.

Method: A cross-sectional survey was conducted over a sample of 203 medical residents in Riyadh. The study adopted the questionnaire as a data collection tool. The questionnaire consisted of a demographic data part, PSA scale (17 items) and a third part concerned with the factors influencing public speaking anxiety among medical residents.

Results: The results of the study revealed that medical residents in Riyadh had a low level of public speaking anxiety (47.3±11.32). The participants had a low PSA score on all scale domain; cognitive (23.28±5.43), behavioral (10.45±4.16), and physiological (13.54±3.44). Moreover, the findings of the study showed that stuttering (91.1%), negative perceptions of individuals' own voice (77.8%), and language barriers (76.8%) were the main factors influencing the public speaking anxiety among medical residents. Finally, we found through linear regression analysis that PSA is not significantly predicted by participants' living region, marital Status, gender, residency level, type of pre-college school, age or being previously diagnosed by a mental health issue.

Conclusion: There is a low level of public speaking anxiety among medical residents in Riyadh. In addition, the study concluded that stuttering, negative perceptions about voice and language barriers are negatively influencing the public speaking anxiety among medical residents in Riyadh.
PMID: 36425229 PMCID: PMC9680837 DOI: 10.52965/001c.38354

 

 

 

Reinvestigating the Neural Bases Involved in Speech Production of Stutterers: An ALE Meta-Analysis - NEUROCIÊNCIAS

Review Brain Sci. 2022 Aug 3;12(8):1030.
Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9406059/pdf/brainsci-12-01030.pdf

 

Ning Zhang, Yulong Yin, Yuchen Jiang, Chenxu Huang

Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Northwest Normal University, Lanzhou, China; Renmin University of China, Beijing, China.

 

Background: Stuttering is characterized by dysfluency and difficulty in speech production. Previous research has found abnormalities in the neural function of various brain areas during speech production tasks. However, the cognitive neural mechanism of stuttering has still not been fully determined.

Method: Activation likelihood estimation analysis was performed to provide neural imaging evidence on neural bases by reanalyzing published studies.

Results: Our analysis revealed overactivation in the bilateral posterior superior temporal gyrus, inferior frontal gyrus, medial frontal gyrus, precentral gyrus, postcentral gyrus, basal ganglia, and cerebellum, and deactivation in the anterior superior temporal gyrus and middle temporal gyrus among the stutterers. The overactivated regions might indicate a greater demand in feedforward planning in speech production, while the deactivated regions might indicate dysfunction in the auditory feedback system among stutterers.

Conclusions: Our findings provide updated and direct evidence on the multi-level impairment (feedforward and feedback systems) of stutterers during speech production and show that the corresponding neural bases were differentiated.

PMID: 36009093 PMCID: PMC9406059 DOI: 10.3390/brainsci12081030

 

 

 

Searching for Lidcombe Program mechanisms of action: Inter-turn speaker latency - AMBIENTE

Clin Linguist Phon. 2022 Nov 12;1-13. Online ahead of print.

 

Monique Amato Maguire, Mark Onslow, Robyn Lowe, Sue O'Brian, Ross Menzies

University of Technology Sydney, Ultimo, NSW, Australia.

 

The Lidcombe Program is a well-established and efficacious treatment for early stuttering, but little is currently known about its mechanisms of action. The present report explores the possibility that inter-turn speaker latency might be associated with such mechanisms of action. Inter-turn speaker latency was measured in audio recordings of children, parents, and clinicians conversing, taken during Lidcombe Program treatment consultations. Five clinicians reduced their inter-turn speaker latencies during clinical consultations when they were speaking to children, in comparison with when they were speaking to parents. It is possible that inter-turn speaker latency is associated with the Lidcombe Program treatment process vicariously, and this possibility requires further research.

PMID: 36370111 DOI: 10.1080/02699206.2022.2140075

 

 

 

Self-Disclosure Experiences of Adults Who Stutter: An Interpretative Phenomenological Analysis - TERAPIA

Am J Speech Lang Pathol. 2022 Aug 19;1-16. Online ahead of print.

 

Megan M Young, Courtney T Byrd, Rodney Gabel, Andrew Z White

The University of Texas at Austin; Binghamton University, NY.

 

Purpose: Self-disclosure describes the act of revealing personal information to another person. To date, researchers in the area of stuttering have primarily demonstrated the utility of self-disclosure through analysis of listener perceptions. This study explores the utility of informative self-disclosure use from the perspectives of adults who stutter with experience using this strategy over time and across contexts.

Method: Twelve adults who stutter discussed their self-disclosure experiences in semistructured interviews. Interview transcripts were analyzed using interpretative phenomenological analysis to produce themes reflecting the most salient aspects of self-disclosure experiences. Credibility was achieved through bracketing, investigator triangulation, and member checking.

Results: Four superordinate themes reflecting experiences shared by all 12 participants were generated. Each superordinate theme contained two to three corresponding subthemes. The superordinate themes included cognitive relief, self-empowerment, social connection, and personalization. These findings reflect the positive impact of informative self-disclosure use on communication and quality of life.

Conclusions: Adults who stutter perceive informative self-disclosure to be an effective strategy that provides various benefits to the speaker, in addition to facilitating positive listener perceptions. Clinicians should encourage clients to self-disclose in an informative and personalized manner, provide opportunities for practice, and support clients in determining when and where it is most beneficial for them to implement this strategy.

PMID: 35985338 DOI: 10.1044/2022_AJSLP-22-00048

 

 

 

Spastic paraplegia 51: phenotypic spectrum related to novel homozygous AP4E1 mutation - GENÉTICA

J Genet. 2022;101:40.

Free article: https://www.ias.ac.in/article/fulltext/jgen/101/0040

 

Jamal Manoochehri, Hamed Reza Goodarzi, Seyed Mohammad Bagher Tabei

Islamic Azad University, Marvdasht, Iran.

 

AP-4-associated hereditary spastic paraplegia (HSP), also known as AP-4 deficiency syndrome, is a genetically diverse group of neurologic disorders defined by complex spastic paraplegia. Different forms of AP-4-associated HSP are classified by chromosomal locus or causative gene. Spastic paraplegia 51 (SPG51) is a neurodevelopmental condition that is caused by autosomal recessive mutations in the adaptor protein complex 4 complex subunit 1 (AP4E1) gene. Further, previous studies described an autosomal dominant mutation in the AP4E1 gene has also been linked to persistent stuttering. Here, we describe a patient from a consanguineous marriage who manifested severe intellectual disability (ID), absent speech, microcephaly, seizure, and movement disorders. Exome sequencing identified a novel homozygous frame-shift variant (NM_007347.5:c.3214_3215del, p.Leu1072AlafsTer10) in the AP4E1 gene, which was confirmed by Sanger sequencing. In this study, we also reviewed the phenotype of the former cases. Our findings added to the knowledge of little-studied homozygous AP4E1 mutation

PMID: 36226339

 

 

 

Speech and Language Errors during Awake Brain Surgery and Postoperative Language Outcome in Glioma Patients: A Systematic Review - OUTRAS ÁREAS

Review Cancers (Basel). 2022 Nov 7;14(21):5466.

 

Ellen Collée, Arnaud Vincent, Clemens Dirven, Djaina Satoer

Erasmus MC-University Medical Center, Rotterdam, The Netherlands.

 

Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with gliomas in eloquent areas. Even though language is monitored carefully during surgery, many patients suffer from postoperative aphasia, with negative effects on their quality of life. Some perioperative factors are reported to influence postoperative language outcome. However, the influence of different intraoperative speech and language errors on language outcome is not clear. Therefore, we investigate this relation. A systematic search was performed in which 81 studies were included, reporting speech and language errors during awake craniotomy with DES and postoperative language outcomes in adult glioma patients up until 6 July 2020. The frequencies of intraoperative errors and language status were calculated. Binary logistic regressions were performed. Preoperative language deficits were a significant predictor for postoperative acute (OR = 3.42, p &lt; 0.001) and short-term (OR = 1.95, p = 0.007) language deficits. Intraoperative anomia (OR = 2.09, p = 0.015) and intraoperative production errors (e.g., dysarthria or stuttering; OR = 2.06, p = 0.016) were significant predictors for postoperative acute language deficits. Postoperatively, the language deficits that occurred most often were production deficits and spontaneous speech deficits. To conclude, during surgery, intraoperative anomia and production errors should carry particular weight during decision-making concerning the optimal onco-functional balance for a given patient, and spontaneous speech should be monitored. Further prognostic research could facilitate intraoperative decision-making, leading to fewer or less severe postoperative language deficits and improvement of quality of life.

PMID: 36358884 DOI: 10.3390/cancers14215466

 

 

 

Stuttering and the State of the Union - SOCIAL

Editorial Acad Psychiatry. 2022 Sep 20. Online ahead of print.

Free Full Text: https://link.springer.com/article/10.1007/s40596-022-01709-x

 

Greg Mahr

Northville, MI, USA.

 

Stuttering is a poorly understood and highly stigmatizing disorder. The author describes his personal experiences with childhood stuttering, as they are stirred by listening to President Biden speak the State of the Union speech. As a stutterer, he can hear and understand the pauses in President Biden’s speech and appreciate the effort the President makes as a public speaker and the control he uses to avoid stuttering.

PMID: 36127486 DOI: 10.1007/s40596-022-01709-x

 

 

 

Stuttering Behavior in a National Age Cohort of Norwegian First-Graders With Down Syndrome - OUTRAS ÁREAS

J Speech Lang Hear Res. 2022 Oct 27;1-18. Online ahead of print.
 

Silje Hokstad, Kari-Anne B Næss, J Scott Yaruss, Karoline Hoff, Ane H Melle, Arne Ola Lervåg

University of Oslo, Norway; Michigan State University, East Lansing; The National Service for Special Needs Education, Statped, Holmestrand, Norway.

 

Purpose: The aims of this study were to investigate the occurrence of stuttering behavior across time and to evaluate the relationship between stuttering behavior and language ability in children with Down syndrome.

Method: A national age cohort of Norwegian first graders with Down syndrome (N = 75) participated in the study. Speech samples from a story-retelling task and a picture book dialogue as well as standardized measures of vocabulary, grammar, and nonverbal mental ability were collected at two time points approximately 5 months apart. Stuttering behavior was evaluated through counting stuttering-like disfluencies and stuttering severity ratings. The relationship between stuttering behavior and language ability was investigated through hierarchical regression analysis.

Results: The participants had stuttering severity ratings ranging from no stuttering behavior to severe and displayed all types of stuttering-like disfluencies. There were significant relationships between stuttering behavior and language ability at the first time point, whereas the relationships were not significant at the second time point. The stuttering severity ratings were significantly predicted by language ability across time, whereas the frequency of stuttering-like disfluencies was not.

Conclusions: The occurrence of stuttering behavior was high across the measures and time points; however, the relationship between stuttering behavior and language ability varied across these variables. Thus, the nature of the relationship does not seem to follow a strict pattern that can be generalized to all children across time.

PMID: 36302044 DOI: 10.1044/2022_JSLHR-21-00605

 

 

 

Stuttering, family history and counselling: A contemporary database - AVALIAÇÃO

J Fluency Disord. 2022 Aug 13;73:105925. Online ahead of print.

 

Tara Darmody, Sue O'Brian, Kris Rogers, Mark Onslow, Chris Jacobs, Alison McEwen, Robyn Lowe, Ann Packman, Ross Menzies

University of Technology Sydney, Graduate School of Health, NSW, Australia; University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia.

 

Background: Information about genetic influence is useful to when counselling parents or caregivers who have infants and children at risk for stuttering. Yet, the most comprehensive family aggregate database to inform that counselling is nearly four decades old (Andrews et al., 1983). Consequently, the present study was designed to provide a contemporary exploration of the relationship between stuttering and family history.

Methods: Data were sourced from the Australian Stuttering Research Centre, comprising 739 participants who presented for assessment, treatment, or investigation of stuttering. Reported family history data were acquired from pedigrees collected during assessment. We sought to establish the relation of the following variables to family history of stuttering: incidence, proband sex, parent sex, stuttering severity, age, reported age of stuttering onset, and impact of stuttering. Data were analysed with chi-square tests for independence, logistic and linear regression models.

Results: Results were broadly consistent with existing data, but the following findings were novel. Males and females who stutter have the same increased odds of having a father who stutters relative to a mother who stutters. Males had later stuttering onset than females, with genetic involvement in this effect. There was a greater impact of stuttering for females than males with a family history of stuttering.

Conclusion: These findings have clinical applications. Speech-language pathologists may have infant or child clients known to them who are at risk of beginning to stutter. Information from the present study can be applied to counselling parents or caregivers of such children about stuttering and family history.

PMID: 35998418 DOI: 10.1016/j.jfludis.2022.105925

 

 

 

Stuttering, Intersectionality, and Identity: A Qualitative Analysis of the Experiences of Lesbian, Gay, and Bisexual Individuals Who Stutter - TERAPIA

Lang Speech Hear Serv Sch. 2022 Nov 23;1-14 Online ahead of print.
 

Derek E Daniels, Michael P Boyle, Brent E Archer

Wayne State University, Detroit, MI; Montclair State University, NJ; Bowling Green State University, OH.

 

Purpose: Speech-language pathologists are influential in shaping identity development for individuals who stutter, particularly as it relates to communication. This study investigated the experiences of lesbian, gay, and bisexual individuals who stutter to learn more about how multiple marginalized identities affect their psychosocial experiences.

Method: Semi-structured interviews were conducted with seven individuals who stutter with lesbian, gay, and bisexual identities. Participants ranged in age from 22 to 60 years. Data were analyzed for themes and categories by using interpretive phenomenological analysis.

Results: Four primary themes were identified: (a) the importance of visibility and shared social identity connections for affirmation; (b) effects of oppressive social expectations on identity; (c) intersectionality of stuttering, gay, lesbian, and bisexual identities; and (d) effects of not being affirmed for identity.

Discussion: Results are discussed in the context of identity affirmation and intersectionality. Through an understanding of identity formation and psychosocial experiences of lesbian, gay, and bisexual individuals who stutter, speech-language pathologists can use identity-affirmative practices to support individuals who stutter and mitigate stigmatizing experiences. Implications focus on suggestions for the provision of identity-affirming speech-language pathology practices for students who stutter.
PMID: 36417770 DOI: 10.1044/2022_LSHSS-22-00036

 

 

 

Stuttering related and psychosocial predictors of impact of stuttering - SOCIAL

J Pak Med Assoc. 2022 Sep;72(9):1704-1707

 

Humaira Naz, Rukhsana Kausar

University of the Punjab, Lahore, Pakistan; Vice Chancellor Government College for Women University, Sialkot, Pakistan.

 

Objective: To investigate the psychosocial factors having an impact on persons with a stuttering problem.

Methods: The correlation study was conducted from October 2016 to February 2018 at hospitals, speech clinics and educational institutes of Lahore. The sample comprised of young adults aged 16-30 years of either gender with stuttering problem. Data was collected using Stuttering Severity Instrument-4, Social Interaction Anxiety Scale-Urdu, Big Five Measure-20, Overall Assessment of the Speaker's Experience of Stuttering and the Urdu version of the shortened form of the Coping Orientation to Problems Experienced inventory. Data was analysed using SPSS 23.

Results: Of the 78 subjects, 66(84.6 %) were males and 12 (15.4 %) were females. There were 21(27%) subjects aged 16-19 years and 57(73%) with age range of 20-30 years. The overall mean age was 21.96±3.89 years. Mean age of onset was 4.59±1.29 years, while gradual onset and progressive stuttering was reported by 74(94.9 %). The Bilingual users 49(63%) reported to have frequent stuttering. Among the 43(55.1%) who had received treatment, 30(38%) received speech therapy and 26(33.3%) reported dissatisfaction. Stuttering severity and social anxiety were significantly positively correlated with all domains of impact of stuttering (p<0.05). Age, and duration were negatively correlated with day-to-day communication (p<0.05) and previous speech treatment showed negative association with impact on general knowledge about stuttering (p<0.05). Avoidance coping strategy had a significant relationship with all domains of impact (p<0.05).

Conclusions: Severity of stuttering and social anxiety were found to have repercussions on people who stuttered, while avoidance coping was practised more to deal with the negative impact on reactions toward stuttering and quality of life.

PMID: 36280960 DOI: 10.47391/JPMA.925

 

 

 

The good, the bad, and the ugly: Unpacking the pros and cons associated with change for adults who stutter - AVALIAÇÃO

J Fluency Disord. 2022 Aug 3;73:105924. Online ahead of print.

 

Hope Gerlach-Houck, Naomi H Rodgers

Western Michigan University, USA; University of Nebraska-Lincoln, USA.

 

Purpose: The purpose of the current study was to document the pros and cons that adults who stutter may consider when deciding to change how they live with stuttering.

Methods: Semi-structured interviews were conducted with 11 adults who stutter and 12 speech-language pathologists who specialize in stuttering therapy. Participants were asked to identify and discuss the advantages and disadvantages of making a change to how they live with stuttering. Reflexive thematic analysis was used to generate multilevel themes.

Results: Meaningful units were extracted from interview transcripts to develop 37 discrete pros and 15 discrete cons. The pros of change clustered into five organizing themes: enriching one's social relationships, feeling better in social interactions, developing a healthier sense of self, gaining autonomy, and communicating easier. The cons of change clustered into three organizing themes: experiencing discomfort, expending resources, and recognizing that some things may not change.

Conclusion: This study documented why adults who stutter may or may not seek change. Identifying the pros and cons of behavior change is an important step in understanding why some clients who stutter are ambivalent about, or resistant to, the therapeutic process.

PMID: 35947913 DOI: 10.1016/j.jfludis.2022.105924

 

 

 

The Impact of Self-Disclosure and Strategies for Communication Competence on Professors' Perceptions and Evaluations of Students Who Do and Do Not Stutter - SOCIAL

J Speech Lang Hear Res. 2022 Aug 30;1-15. Online ahead of print.

 

Danielle Werle, Courtney T Byrd

The University of Texas at Austin.

 

Purpose: The purpose of this study was to examine the impact of self-disclosure and strategies for communication competence on perceptual ratings and performance evaluations of undergraduate students who do and do not stutter by professors who require oral presentations.

Method: Two hundred thirty-eight college instructors who require oral presentations in their classes participated in this study. Each participant viewed one video of six possible randomized conditions varying according to the presence and disclosure of stuttering (i.e., fluent, stuttering, stuttering + disclosure) and level of communication competence (i.e., high vs. low). Participants evaluated public speaking performance against a standardized rubric and rated the student along 16 personality traits.

Results: Results of separate 2 × 3 analyses of variance revealed that professors perceived a student who disclosed stuttering, compared to the identical video without disclosure, more positively overall. Significant interactions between fluency (i.e., presence vs. absence of stuttering vs. disclosure of stuttering) and communication competence (i.e., high vs. low) were found for overall performance evaluation scores. The video during which the student disclosed stuttering and presented with low communication competence was given a higher score than the identical video without disclosure.

Conclusions: Professors respond positively to both strategies for high communication competence and self-disclosure. High communication competence behaviors mitigate positive feedback bias. Disclosure results in improved positive perceptions across levels of communication competence. For students presenting with low communication competence, disclosure may improve evaluation of performance in oral presentations. The greatest perceptual and evaluative benefits were achieved with the combination of the two strategies.

PMID: 36041466 DOI: 10.1044/2022_JSLHR-22-00118

 

 

 

The Impact of Time Spent in Natural Outdoor Spaces on Children's Language, Communication and Social Skills: A Systematic Review Protocol - INFANTIL / AMBIENTE

Int J Environ Res Public Health. 2022 Sep 23;19(19):12038

Free PMC article: https://www.mdpi.com/1660-4601/19/19/12038/htm

 

Steph Scott, Tonia Gray, Jenna Charlton, Sharon Millard

Shropshire Community Health NHS Trust, Coral House, Longbow Close, Shrewsbury, UK; The University of Birmingham, Edgbaston, Birmingham, UK; Western Sydney University, Sydney, Australia; Newcastle University, Newcastle upon Tyne, UK; Michael Palin Centre for Stammering, London, UK.

 

There has been increasing interest over the past decade with regard to the health and wellbeing implications of time spent outdoors in nature for children. Universal systematic reviews of evidence report benefits to physical health, social-emotional mental health and wellbeing, cognition and academic learning. Internationally, there is indicative evidence to suggest outdoor engagement with nature may also impact children's language and communication skills, skills that are critical to development, education, social relationships and life opportunities. Yet, at present such evidence has not been synthesised. Despite evidence for the benefits of the outdoors, the amount of time children are spending outdoors is in rapid decline, and has been further exacerbated by the COVID-19 pandemic. Alongside this are increasing numbers of children starting primary education with significant speech, language and communication needs (SLCN) which remain persistent over time. With established wide-reaching benefits of nature to children's physical and mental health and psychological development, there is a need to further explore the more specific impacts of the natural environment on children's language, communication and social skills, which could provide a unique opportunity to consider nature as a universal public health intervention for SLCN. The current review will aim to synthesise existing qualitative and quantitative evidence of the impact of time spent in natural outdoor spaces on the language, communication and social skills of 2-11-year-old children. Literature will be searched across seven databases and considered for inclusion against inclusion and exclusion criteria. Potential implications of the review include informing public health practice and policy for child development and education, informing priorities for speech, language, and communication interventions, and providing directions for future international research.

PMID: 36231338 PMCID: PMC9566327 DOI: 10.3390/ijerph191912038

 

 

 

The influence of active listening on parents' perceptions of clinical empathy in a stuttering assessment: A preliminary study - TERAPIA

J Commun Disord. 2022 Oct 29;100:106274. Online ahead of print.

 

Robyn L Croft, Courtney T Byrd, Ellen M Kelly

The University of Texas at Austin, Austin, United States; University Station, Austin, United States.

 

Purpose: The primary purpose of this preliminary study was to explore whether a clinician's use of active listening skills (i.e., client-directed eye gaze and paraphrasing) influenced parents' perceptions of clinical empathy in a stuttering assessment. A secondary purpose was to determine whether parent age, education, or parent concern predicted perceived clinical empathy.

Method: Participants (n = 51 parents/guardians of children who stutter) watched two counter-balanced videos of a clinician demonstrating either high or low frequency use of active listening skills during the clinician's initial assessment with a standardized patient actor portraying a parent of a child who stutters. After each video, parents rated the clinician's empathy and active listening skills via the Jefferson Scale of Physician Empathy for Observers (JSPEO; Hojat et al., 2017) and the Counselor Activity Self-Efficacy Scales - Modified (Victorino & Hinkle, 2018). Participants then completed a demographic questionnaire and rated their concern about their child's stuttering.

Results: Paired t-tests demonstrated significantly higher ratings of perceived clinical empathy in the high frequency active listening condition compared to the low frequency condition (d = 0.548). Simple linear regression analyses indicated parent age or level of education did not predict perceived clinical empathy. An independent samples t-test indicated that parent concern about stuttering did not predict perceived clinical empathy.

Conclusions: Preliminary findings suggest that the clinician was viewed as significantly more understanding, concerned, and caring (i.e., perceived as empathic) when active listening skills were used. Parents' ratings of empathy on the JSPEO, based on high levels of active listening by the clinician, were not associated with parents' ages, education levels, or concern about their children's stuttering. This may reflect the value of active listening in clinical relationships regardless of variables specific to the recipient (e.g., parent of a child who stutters). Given that parents are more apt to share thoughts and emotions about their child's communication with clinicians who demonstrate empathic qualities, this preliminary study suggests that the use of active listening skills warrant emphasis in clinical training.

PMID: 36327574 DOI: 10.1016/j.jcomdis.2022.106274

 

 

 

The Role of Basal Ganglia and Its Neuronal Connections in the Development of Stuttering: A Review Article - INFANTIL / NEUROCIÊNCIAS

Review Cureus. 2022 Aug 31;14(8):e28653.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9525748/pdf/cureus-0014-00000028653.pdf

 

Deepa G, Shrikrishna B H, Ujwal Gajbe, Brij Raj Singh, Anupama Sawal, Trupti Balwir

Datta Meghe Institute of Medical Sciences, Nagpur, IND; All India Institute of Medical Sciences, Nagpur, Nagpur, IND.

 

Dysfluent speech has the potential to lower one's standard of living drastically. Although there is a lot of theoretical support for basal ganglia dysfunction in developmental stuttering, there isn't any imaging data to back it up. According to several studies, there is a difference in gray matter volume between people who stammer and those who don't. According to studies, the right inferior longitudinal fasciculus and the uncinate fasciculus have higher fractional anisotropy (FA) than fluent controls. A high fractional anisotropy means good white matter integrity in these areas. In children who stutter, grey matter volume was higher in the Rolandic operculum, middle frontal gyrus, superior temporal gyrus, and inferior parietal lobule. These regions are found to be more active in adults who stammer as their speech fluency improves. Stuttering is previously linked to structural deficiencies in the corpus callosum. However, there are differences in the directionality of the findings between studies, which are unknown. According to current theories, stuttering is caused by a breakdown in the integration of auditory data in speech motor planning, which affects behavior tasks that rely on basal ganglia structures. According to some studies, connectivity in the left inferior frontal gyrus (IFG) and basal ganglia of persons with stuttering (PWS) was significantly reduced. Still, it was more robust in the left supplementary motor cortex (SMC) and premotor cortex (PMC) (primary motor cortex). In the Broca's region, there was also decreased perfusion and spectroscopic indicators of neuronal density. Spontaneous speech is more affected by stuttering than conversation, reading, sentence repetition, or singing. As per the dual process theory of language formation, the basal ganglia are essential for formulaic phrases, but the left hemisphere is important for innovative, freshly constructed sentences. According to current theories on their functional traits and connections to cortical areas of control, the basal ganglia are the complex networks in charge of organizing, initiating, carrying out, and controlling motor behaviors. Given the distinct neuroanatomical characteristics of people who stutter, more research into this cohort is required to further our understanding of the illness. The primary goal of this review article is to fill in any knowledge voids between the neuroanatomical structure of the basal ganglia and the onset of stuttering.

PMID: 36196326 PMCID: PMC9525748 DOI: 10.7759/cureus.28653

 

 

 

Validity and reliability of safety behaviors questionnaire for Persian adults who stutter: A cultural perspective - AVALIAÇÃO

J Commun Disord. 2022 Aug 10;100:106251. Online ahead of print.

 

Maryam Azarinfar, Hamid Karimi, Fariba Jowkar, Bijan Shafiei

Isfahan University of Medical Sciences, Isfahan, Iran; Charles Darwin University, Australia.

 

Introduction: Adults who stutter (AWS) are reported to have higher social anxiety compared to those who do not stutter. Previous studies have suggested that safety behaviors, which are cognitive or behavioral strategies used by people with anxiety to prevent negative consequences, are important factors in maintaining anxiety. However, the frequency and types of such behaviors might vary in different cultures. Therefore, the aim of the present study was to develop a transcultural adaptation of Safety Behaviors Questionnaire (Helgadottir et al., 2014) for Persian-speaking AWS and assess its validity and reliability.

Methods: In the first step, the original English questionnaire was translated into Persian using the International Quality of Life Assessment (IQOLA) method. Then, 17 speech and language pathologists (SLPs) and 5 AWS evaluated all questionnaire items using Likert scales to determine face validity. Finally, 167 Persian-speaking AWS completed the questionnaire to assess its construct validity and reliability. Their responses were analyzed using factor analysis and Cronbach's Alpha.

Results: Some items of the original questionnaire were modified or combined with other similar items after assessing the face validity of the Persian-translated questionnaire. Construct validity analysis categorized the remaining 29 questionnaire items into four factors: general avoidance, practice and control, rehearsal, and choosing safe and easy people. The high Cronbach's Alpha of 0.89 for all items confirmed the internal reliability of the Persian-translated questionnaire.

Discussion/conclusions: The results confirmed the psychometric characteristics of the Persian- translated version of the Safety Behaviors Questionnaire (Helgadottir et al., 2014); therefore, speech pathologists can apply it in future clinical and research settings. Similar to Australian AWS, Persian participants of this study self-reported use of various types of safety behaviors frequently.

PMID: 36088780 DOI: 10.1016/j.jcomdis.2022.106251

 

 

 

What Is the Role of Questioning in Young Children's Fluency? INFANTIL / AMBIENTE

Am J Speech Lang Pathol. 2022 Sep 1;1-17. Online ahead of print.

 

Julianne Garbarino, Nan Bernstein Ratner

University of Maryland, College Park.

 

Purpose: Most therapy programs for young children who stutter (CWS) involve caregiver counseling and adjustment of caregiver behavior to maximize opportunities for the child to be more fluent. One component sometimes included as a recommended adjustment is a reduction in caregiver question asking, as question asking is hypothesized to increase language formulation demands on the child. However, there is limited research to guide clinician advisement to caregivers that has controlled for numerous potential confounding factors, including utterance length and grammaticality, that may impact potential stressors on children. Our aim was to assess whether there was an empirical basis for such recommendations by comparing disfluency profiles of answers to questions and nonanswer utterances produced by children during spontaneous play with parents and examiners.

Method: We analyzed fluency and structural properties as well as pragmatic function of 15,782 utterances from language samples produced by 32 CWS and 32 children who do not stutter (CWNS) who were between 28 and 50 months of age. CWS and CWNS were matched on gender and age within 4 months and were matched as closely as possible on maternal education.

Results: For utterances produced by CWS, answers to adult questions were significantly less likely to contain stuttering-like disfluencies than other utterance types, and this was still true after controlling for utterance length and grammaticality. In contrast, for utterances produced by CWNS, answers to questions were significantly more likely to be disfluent than other utterance types after controlling for length and grammaticality.

Conclusion: Given the current findings, some prior research, and the documented potential benefits in language development for adult question asking of children, we do not believe that clinicians need to recommend changes to typical question-asking behavior by caregivers of CWS.

PMID: 36048622 DOI: 10.1044/2022_AJSLP-21-00209