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"Stuttering."
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How Stuttering Develops: The Multifactorial Dynamic Pathways Theory
Purpose: We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic, and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory. Method: We review evidence related to how stuttering develops, including genetic/epigenetic factors; motor, linguistic, and emotional features; and advances in neuroimaging studies. We update evidence for our earlier claim: Although stuttering ultimately reflects impairment in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic and emotional factors. Results: Our current account places primary emphasis on the dynamic developmental context in which stuttering emerges and follows its course during the preschool years. Rapid changes in many neurobehavioral systems are ongoing, and critical interactions among these systems likely play a major role in determining persistence of or recovery from stuttering. Conclusion: Stuttering, or childhood onset fluency disorder (\"Diagnostic and Statistical Manual of Mental Disorders,\" 5th edition; American Psychiatric Association [APA], 2013), is a neurodevelopmental disorder that begins when neural networks supporting speech, language, and emotional functions are rapidly developing. The multifactorial dynamic pathways theory motivates experimental and clinical work to determine the specific factors that contribute to each child's pathway to the diagnosis of stuttering and those most likely to promote recovery.
Journal Article
Treatment for preschool age children who stutter: Protocol of a randomised, non-inferiority parallel group pragmatic trial with Mini-KIDS, social cognitive behaviour treatment and the Lidcombe Program—TreatPaCS
Stuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions of sounds, syllables, words or phrases, stretched sounds or silent pauses in which the person is unable to produce sounds and sound transitions. Treatment success is the highest if stuttering is treated before the age of 6 years, before it develops into “persistent” stuttering. Stuttering treatment programs that focus directly on the speech of the child, like the Lidcombe Program, have shown to be effective in this age group. Mini-KIDS is also a treatment that focuses directly on the speech of the child. It is possible that capturing the increased brain plasticity at this age in combination with creating optimal conditions for recovery underlie these treatments’ success rate. A treatment focusing on the cognitions, emotions and behaviour of the child, the social cognitive behaviour treatment (SCBT), is also frequently delivered in Belgium. In this study we want to compare, and collect data on the effectiveness, of these three treatment programs: Mini-KIDS, SCBT and the Lidcombe Program (protocol registered under number NCT05185726). 249 children will be allocated to one of three treatment groups. Stuttering specialists will treat the child (and guide the parents) with Mini-KIDS, the SCBT or the Lidcombe Program. They will be trained to deliver the programs meticulously. At 18 months after randomisation, the speech fluency of the child and the attitude of the child and parent(s) towards speech will be measured. It is expected that the three programs will achieve the same (near) zero levels of stuttering in nearly all children and a positive attitude towards speech at 18 months after the start of treatment. The amount of treatment hours to reach the (near) zero levels of stuttering will be compared between the different programmes. For families as well as for the health system this could generate important information.
Journal Article
Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial
Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter.
In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99) or indirect treatment (RESTART-DCM treatment; n = 100). Main inclusion criteria were age 3-6 years, ≥3% syllables stuttered (%SS), and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS), stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude.
Percentage of non-stuttering children for direct treatment was 76.5% (65/85) versus 71.4% (65/91) for indirect treatment (Odds Ratio (OR), 0.6; 95% CI, 0.1-2.4, p = .42). At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: β = -1.89; t(282.82) = -2.807, p = .005). At 18 months, stuttering frequency was 1.2% (SD 2.1) for direct treatment and 1.5% (SD 2.1) for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant.
Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term.
isrctn.org ISRCTN24362190.
Journal Article
The Zoo at the Edge of the World
\"Marlin, a stutterer, can talk smoothly and freely with the jungle animals that populate his father's zoo in South America--until a mysterious man-eating black jaguar that his father catches and brings back home talks back\"-- Provided by publisher.
Book
Neurogenic Stuttering: Etiology, Symptomatology, and Treatment
Background: Neurogenic stuttering is a subtype of acquired stuttering, and it is characterized by disfluencies associated with acquired brain damage. Objective: To provide an insight into pathophysiology, symptomatology, differential diagnosis, assessment, and treatment of neurogenic stuttering through a critical review of the literature. Methods: Studies published during the past and recent years were searched and analyzed on neurogenic stuttering. Results: Neurogenic stuttering is a complex disorder. The pathophysiological mechanism of neurogenic stuttering is not yet fully understood. It appears with several neurological diseases and conditions, and the use of some drugs. Differential diagnosis of neurogenic and psychogenic stuttering is a challenge for clinicians. Treatment usually requires a joint effort from speech therapists and doctors, most often neurologists Conclusion: Although research on neurogenic stuttering can be found in the literature, the complexity of this disorder still requires detailed monitoring and studying to provide the best treatment for patients.
Journal Article
Love puppies and corner kicks
Andrea is devastated when her parents announce that the family is moving to Scotland for a year-long teacher exchange program, but as she makes new friends, joins a soccer team, and her stutter improves, life does not seem so bad.
Book
Kekemelerde İşitsel Uyarılmış Geç Latans Potansiyellerinin Değerlendirilmesi
Amaç: Kekemeliğin işitsel geri bildirimde gecikmeye sebep olabileceği hipoteziyle, işitsel uyarılmış geç latans potansiyeller kullanılarak kekemelerde ve akıcı konuşanlarda kortikal cevapların değerlendirilmesi ve karşılaştırılması amaçlanmıştır. Ayrıca işitsel geç latanslar ve kekemelik süresi arasındaki ilişki de incelenmiştir. Gereç ve Yöntemler: Çalışmaya 18-43 yaş arasında sağ elini kullanan, işitme kaybı ve nörolojik problemi olmayan 15 kekeme ve 15 normal konuşan (kontrol grubu) erkek birey alındı. Akıcı konuşan ve kekeme bireylere otoskopik muayene sonrasında immitansmetrik inceleme, distorsiyon ürünü otoakustik emisyon ve saf ses işitme testleri yapıldı. Normal odyolojik bulgular elde edildikten sonra geç latans potansiyel kayıtları alındı. Katılımcıların sağ kulaklarından klik uyaran verildi. Bireylere test esnasında bilgisayar aracılığı ile sessiz resimler gösterildi. Bulgular: İşitsel uyarılmış geç latans potansiyellerinden P1 dalga latansı kekemelerde 56,68±7,37 msn, akıcı konuşanlarda ise 57,36±7,74 msn olarak bulunmuştur. P1 dalga amplitüdü kekemelerde 0,71±0,53μV, akıcı konuşanlarda ise 0,73±0,51 μV olarak bulundu. Kekeme bireylerin kekemelik süreleri 11 ile 33 yıl arasında (ortalama 20,2 yıl) değişmekte olup P1 latansları ile korelasyon göstermemektedir. Sonuç: Kekeme ve akıcı konuşanlar arasında işitsel uyarılmış geç latans potansiyellerinden P1 dalgasının latans ve amplitüdleri açısından istatistiksel anlamlı fark yoktur. Bu bulgu, kekemelerin sesleri anlamalarında herhangi bir problemleri olmadığını göstermektedir. Kekemelik süresi ve işitsel geç latans cevapları arasında herhangi bir ilişki bulunmayışı ise çalışmamızın bir diğer sonucudur.
Journal Article