Dissertations / Theses on the topic 'Stuttering in children'

Young children between the ages of two and six years often exhibit partword, whole word. and phrases repetitions as their language develops. This is also the age range when stutterertng most frequently appears. Consequently. speech-language pathologists need diagnostic criteria and evaluation tools to distinguish between the incipient stutterer and the normally disfluent child. Today a widely used evaluation tool is the Stuttering Severity Instrument (SSI) (Riley, 1972, 1980). The SSI is designed to provide a severity level based upon the parameters of frequency. duration. and physical concomitants. Riley (1972) first designed the SSI to not include monosyllabic word repetitions in the frequency count: however. he revised the SSI in 1980 to include monosyllabic word repetitions without providing new normative data nor standardization. It was questionable as to whether the SSI was a sufficiently sensitive means to determine stuttering severity for young children and to whether or not it was strengthened or weakened by the addition of whole monosyllabic words.

Thesis (B.Sc)--University of Hong Kong, 1995.
"A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, April 28, 1995." Also available in print.

A recent U.S.-based survey (Boyle et al,. 2011) estimated stuttering prevalence in American children ages 3-17 years at 1.6% or 1 in 63 children. In comparison to the reported 1 in 68 school age children living with Autism Spectrum Disorder (Centers for Disease Control and Prevention, 2010), stuttering affects nearly as many. These estimates suggest that Speech-Language Pathologist (SLPs) should increasingly develop their skill sets for identifying and providing interventions for children who stutter. The evidence base for school-age fluency intervention, while promising, leaves much room for further development (Nippold, 2011). The majority of current interventions revolve around the traditional methods of fluency shaping and stuttering management. While these approaches are widely used, there is limited evidence to support their efficacy with the school-aged population (Bothe, et al., 2006). In addition, there is disagreement about whether treatment of stuttering in children should focus exclusively on "building fluent speech" or, whether interventions should also include cognitive/emotional components (Yaruss, Coleman, & Quesal, 2012) as are often associated with interventions for stuttering in adults. As a solution to the need for a cognitive/emotional component, Michael Boyle (2011) suggested including mindfulness in school-aged stuttering intervention by pointing out the similarities between the advantages of mindfulness treatment and personality traits necessary for long-term fluency maintenance. Although there has not yet been any published research in direct support of this idea, the notion that these three elements influence the effects of fluency intervention provides a foundation for the proposed research questions.

People who stutter (PWS) tend to have increased levels of anxiety compared to people who do not stutter (PWNS), particularly in social situations (Messenger, Onslow, Packman, & Menzies, 2004). In addition, children who stutter (CWS) as young as 3 years of age reportedly have more negative communication attitudes than their fluent peers, and these attitudes appear to worsen with age and stuttering severity (De Nil & Brutten, 1990, 1991; Vanryckeghem, Brutten, & Hernandez, 2005). The present study sought to examine generalized anxiety and communication apprehension in preschool CWS. Seven CWS aged between 3;3 and 4;11 years, and seven sex and age-matched children who do not stutter (CWNS) provided salivary cortisol samples at three distinct sampling times across a one-week period. They additionally provided a conversational speech sample, and were administered the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007). Parents were required to complete the Preschool Anxiety Scale (Spence & Rapee, 1999) to provide estimates of their child's anxiety level. Results revealed no significant differences between CWS and CWNS in generalized anxiety or communication apprehension. No relationships were found between stuttering severity and generalized anxiety or communication apprehension either. Thus, it is concluded that generalized anxiety and communication apprehension are not associated with early childhood stuttering. Any changes in anxiety levels are likely to occur with increased chronological age and stuttering chronicity.

This study compared the attitudes and reactions of thirty preschool and thirty school-age children toward a child speaker with stuttering patterns. An introduction reviewed previous literature on defining stuttering, adults' and children's attitudes toward stuttering, and the stutterer's personality traits. The children of the study rated either a normal child speaker or a child speaker with stuttering patterns on a sociometric scale. In a giving task, the children were asked to choose one of the speakers. Statistical testing revealed that the school-age children had a more negative attitude toward and less social acceptance of the child speaker with stuttering patterns than the normal-speaking child. Implications for the speech-language pathologist in treating the child stutterer are discussed.

Speech-language pathologists are in need of useful assessment instruments which differentiate early stuttering behaviors and will enable them to identify preschool children who need immediate intervention for stuttering. Furthermore, useful assessment tools are needed especially due to the variability across studies of normal disfluency and lack of reliability information on more formal measures of differential evaluation of normal disfluency and incipient stuttering.

The purpose of this study was to investigate the disfluency characteristics of normal 33-39 month old children in order to determine the differential role of the SSI with young children. The following questions were answered: 1. What are the types and frequencies of disfluencies demonstrated by normal 33-39 month old children? 2. How do the scores of normal 33-39 month old children distribute on the Stuttering Severity Instrument?

Stuttering typically begins in the preschool years. Some children who begin to stutter will recover without formal treatment, but the natural course of the disorder for others is continued stuttering into adolescence and adulthood. These facts have contributed to the development over the last 2 decades of a broad acceptance that, in the absence of signs of natural recovery, stuttering should be treated in the early years. Parallel to this development has been the development of a number of treatments of early stuttering. However, some children with early stuttering are isolated from speech pathology clinics at which treatments are provided. This thesis investigates speech pathology services for children so isolated.

The Lidcombe-program (LP) is an empirically developed treatment program for stuttering based on behavioral therapy that adopts operant conditioning as methodology. The program is designed for children up to the age of six, and it is mainly conducted in the home environment by a parent under the supervision of a speech-language pathologist (Onslow, 2003a). In countries around the world, studies of outcomes of the program have shown positive effects (Lincoln &Onslow, 1997). LP is conducted in Sweden, but no major long-term study has been performed.Criticism towards LP regards that the intervention would affect the relationship between thechild and the parent in negative ways (Woods, Shearsby, Onslow & Burnham, 2002).The present study is a follow up of children and parents who have undergone treatment withLP. The aim was to investigate how childrens’ fluency of speech changed after treatmentand to examine how parents' experiences of the program can be characterized. Ten parents were included in the study, and they all answered a questionnaire about the experiences of thetreatment. Fluency of speech was documented and assessed in eight children.The results of the present study showed that all of the participating childrens’ stuttering was significantly reduced after treatment. A strong significant correlation between the time the child spent in treatment and the percentage of stuttered syllables at baseline was observed. The majority of the parents had positive experiences of the treatment, and would recommend the program to other families. However, parents also found it difficult to execute the therapy, mainly as regards finding the time in the everyday life of the family. In addition, four of the participating parents disregarded the treatment manual and shared the responsibility of implementing the treatment with their spouse, but this did not appear to influence the outcome of the treatment.
Lidcombe-programmet (LP) är ett empiriskt framtaget behandlingsprogram som grundar sig i beteendeterapi och som antar operant betingning som metod. Behandlingen är utformad för barn upp till sex års ålder och bedrivs huvudsakligen i hemmet av en förälder under handledningav logoped (Onslow, 2003a). I flera länder runt om i världen har uppföljningsstudier visat positiva effekter av programmet (Lincoln & Onslow, 1997). Behandlingsprogrammet bedrivs i Sverige, men ingen större långtidsuppföljning har utförts. Kritik som riktats mot LP avser att interventionsformen påverkar relationen mellan barn och förälder negativt (Woods et al., 2002).Föreliggande studie är en uppföljning av barn och föräldrar som genomgått stamningsbehandling enligt LP. Syftet var att undersöka hur barns talflyt förändrats efter avslutad behandling samt att undersöka hur föräldrars upplevelser av programmet kan karaktäriseras. I studien ingick tio föräldrar, vilka besvarade en enkät kring upplevelser av behandlingen, samt åtta barn vars talfly tdokumenterades och bedömdes.Resultatet visade att samtliga av de deltagande barnens stamning minskade signifikant efteravslutad behandling. Ett starkt signifikant samband mellan tiden barnet spenderade i behandling och andelen stammade stavelser i procent vid behandlingsstart kunde påvisas. Majoriteten av föräldrarna hade positiva upplevelser av behandlingen och samtliga skulle rekommendera behandlingsprogrammet till andra familjer. Dock upplevde föräldrarna vissa svårigheter kring implementeringen av behandlingen, främst avseende att finna tid i vardagen. Fyra av de deltagande föräldrarna frångick behandlingens manual och delade på ansvaret för utförandet medmake/maka eller motsvarande, men detta föreföll inte påverka utgången av behandlingen.

Until this time, few studies have examined differences in durational characteristics in words surrounding a moment of stuttering for untreated preschool children. It is important to determine whether or not untreated preschoolers' who stutter alter the duration of their speech when they stutter versus when they are fluent to determine what factors influence stuttering behaviors. The purpose of the present study was to examine the duration of words immediately before and after a stuttered word and the duration of the matched target word in the identical fluent utterance. The following questions were to be addressed: 1) Is there a significant durational difference between a word preceding a stuttered word and the duration of the same word in a corresponding fluent utterance? 2) Is there a significant durational difference between a word following a stuttered word and the duration of the same word in a corresponding fluent utterance? Three subjects between the ages of 4 years, 6 months and 6 years, 11 months who had never received treatment participated. Subjects were recorded using a delayed imitation task, elicited from 60 action pictures in the Patterned Elicited Syntax Test, (PEST} two times in succession with a five minute rest period between elicited utterances. Phrases and sentences containing a stuttered word and identical elicited fluent utterances were used for analysis. The duration of the following words in milliseconds (msec.) were calculated using the CSRE 4.2 software program: l} The duration of the word immediately preceding a stuttered event within the same utterance (BSTUT}. 2) The duration of the same word in the identical fluent utterance (BNSTUT). 3) The duration of the word immediately following a stuttered event within the same utterance (ASTUT) . 4) The duration of the same word in the identical fluent utterance (ANSTUT) . A total of 44 samples were obtained. A two tailed ttest was completed at the .05 confidence level to determine the significance between the BSTUT vs. BNSTUT and ASTUT vs. ANSTUT word pairs. Results did not find statistically significant differences.

Young children who stutter have shown the capability of developing an awareness of stuttering as early as age two (Ambrose & Yairi, 1994; Yairi & Ambrose, 2005; Boey et al., 2009; Ezrati-Vinacour, Platzky, & Yairi, 2001). The child's awareness of both his communication difficulty and the response of listeners to his speech has the potential to adversely affect his cognitive and social-emotional development, as well as his self-perception of overall competence. The purpose of this study was to examine self-perceived general competence and social acceptance in children who stutter (CWS) and children who do not stutter (CWNS), and to assess the extent to which temperament, speech disfluency, expressive and receptive language abilities, and home environment both co-vary and predict children's perception of their own competence. Participants included 16 CWS and 16 CWNS between the ages of 4;0 and 5;10. Results of the MANOVA revealed no significant between-group differences in perceived competence or social acceptance, language abilities, temperament, or home environment between the two groups; because stuttering severity and time since onset of stuttering were not calculated for CWNS, these two values were not included in the MANOVA. Results of the backwards linear regressions revealed that the best two-regressor model for predicting perceived general competence in all subjects included the temperament constructs of surgency and negative affectivity; in CWS only, surgency and expressive language together were the most predictive of perceived general competence. The best two-regressor model for predicting perceived social acceptance in all subjects included negative affectivity and receptive language; in CWS only, receptive language and stuttering severity together were most predictive of perceived social acceptance. However, none of these relationships reached significance. Taken together, results suggest that as a group, CWS present with similar temperamental profiles as CWNS, and that a child's speech and language skills are linked to his perception of peer acceptance, while a tendency for risk taking and a generally positive view of new situations may be more important for self-perception of overall competence in the world. Theoretical and clinical implications are discussed.

Early intervention provides children who stutter with the best opportunity to avoid the lifelong complications associated with stuttering. Access to effective treatment, in particular, the Lidcombe Program, provides preschool children with the best chance to overcome their stuttering. Currently many children are unable to access such efficacious treatment due to distance and lifestyle factors. One solution to this problem is to deliver the treatment via webcam over the internet. This service delivery model was designed to increase access to timely, best-practice intervention for those who are currently unable to access treatment. That model was thought to be able to produce efficiency rates similar to those of traditional clinic treatment. Further, it provides a method of service delivery that: (1) improves access to evidence-based best-practice stuttering treatment for children, (2) improves access to specialist speech pathologists and quality services, (3) reduces costs and resources involved with outreach service provision, (4) provides more convenient home-based treatment for young children, and (5) ensures more equitable service delivery for rural and remote preschool children and their families. A Phase I study showed that webcam delivery of the Lidcombe Program was a viable treatment delivery model (O’Brian, Smith & Onslow, 2012). This thesis further investigates delivery of the Lidcombe Program for preschool children using the internet and a webcam. The modification in this project, compared to previous, low-tech telehealth (phone and mail) trials of the Lidcombe Program, allowed the principles of standard delivery of the Lidcombe Program to remain relatively unchanged. This was due primarily to the use of a webcam and live videoconferencing. The speech pathologist-parent-child triad was preserved, with all parties having clinic contact. Real-time measurements, observation and education for parent implementation of the program were also achieved through this medium. Thus, treatment could be delivered mostly in accordance with the program treatment guide (Packman et al., 2011, p. 1). The design for this project was a parallel, open plan, Phase III noninferiority randomised controlled trial (RCT). The control group received standard delivery of the Lidcombe Program (Packman, et al., 2011) in a traditional clinic setting. The experimental group received the Lidcombe Program within their homes using a computer, a webcam, the internet and a live video calling program (Skype). The primary outcome measures – the number of consultations and speech pathologist hours to attain entry into Stage 2 – evaluated treatment efficiency. The secondary outcomes – stuttering reduction as measured by parent evaluated severity ratings, investigated treatment efficacy, as did quantitative and qualitative data obtained from parent questionnaires. The number of weeks to attain Stage 2 entry was also measured. Initially, 66 children were assessed for this trial. Eleven were ineligible and six withdrew during the assessment process, with 49 participants being randomised. Of these, 24 were assigned to the control arm and 25 to the experimental arm. Due to time restrictions associated with the student’s candidature, not all 18-month data were collected in time for inclusion in this thesis. Pretreatment data are reported for all 49 participants. Data for all 43 participants active in the trial 9 months postrandomisation are also reported. Stage 2 entry data are available for the 35 participants (71% of the total cohort) who reached Stage 2 by December 31st 2012. Results for both groups showed no significant difference between the number of consultations and the number of weeks to Stage 2. Efficacy measures showed no significant difference between the groups in stuttering reduction. A further secondary outcome measure was parent responses to a questionnaire at entry into Stage 2. Similarly, there was no significant difference between the two groups when asked about speech pathologist-child rapport, speech pathologist-parent rapport, ease of learning treatment, severity ratings and ability to adapt treatment. Further, two-thirds of clinic families said they would choose webcam treatment in the future. Webcam parents reported no difficulty in seeking out their own resources and did not feel treatment within their home was invasive. Webcam families listed convenience and comfort as the main advantages of webcam treatment, with technical difficulties as the main disadvantage. All webcam families would choose this same method for future stuttering treatment. The thesis concludes with a discussion of the speech pathologist’s role, consultation logistics and additional qualitative observations from the webcam group. These include convenience, treatment readiness, defining clinical space, trends in clinical transfer, clinical application, limitations and future directions. Overall, this thesis demonstrates that the findings from a Phase III RCT investigating the efficiency and efficacy of stuttering treatment for preschool support the use of webcam and internet to increase access to timely and appropriate stuttering intervention. The potential for community translation of these findings is considerable; children as young as 3 years of age can receive the same stuttering treatment within their homes as they would within a clinic; they can expect no difference in outcomes or experience. This is significant given that children as young as 2 years of age can be negatively affected by their stuttering. No longer do children who stutter need to be disadvantaged by where they live or by the skills of the closest speech pathologist. They can now access evidence-based treatment within their homes.

This thesis presents a randomised controlled trial of the Lidcombe Program of Early Stuttering Intervention. The Lidcombe Program was developed for the treatment of stuttering in preschool-age children. The effectiveness of the Lidcombe Program was compared to a control group in a parallel group randomised controlled trial with blinded outcome assessment. A number of supplementary studies were conducted in support of the trial; two literature reviews, two retrospective file audits and a statistical simulation study. A review of randomised studies of treatments for stuttering showed that there have been 27 such studies published in English language journals. Of these only one was devoted to a treatment for early stuttering and that was the Lidcombe Program. The randomised study showed that 3 months of this treatment was associated with a lower level of stuttering compared to a control group who received no treatment. However, with a sample size of 23, this study lacked power and the children did not receive a full course of treatment. Despite these limitations, this study provided evidence that a medium to large effect size could be anticipated in an adequately powered and properly conducted randomised controlled trial. The second review was of sample size and power in stuttering research studies that had been published in two speech pathology journals; the Journal of Speech, Language and Hearing Research (Vol 39, No. 1 to Vol 40, No, 4) and the Journal of Fluency Disorders (Vol 21, No. 1 to Vol 22, No, 3). Results suggested that the majority (73%) of the 26 studies reviewed were insufficiently powered to detect even large effects. However it was acknowledged that it is very difficult to recruit even moderate sample sizes of people who stutter. It was concluded that one way to help improve this situation is collaboration of multiple research centres or, in the case of a randomised controlled trial, inclusion of multiple recruitment sites in one study. This strategy was adopted in the randomised controlled trial reported in this thesis. Two retrospective file audit studies of children treated with the Lidcombe Program were conducted in Australia and Britain. One purpose of these file audits was to obtain information relevant to the design and conduct of the randomised controlled trial. Data from the case reports on more than 300 children from the two sites were included in a meta-analysis. Results showed that a median of 11 weekly clinic sessions were required for children to attain the criteria for low levels of stuttering for completion of Stage 1 of the Lidcombe Program. Approximately 90% of children had achieved those criteria within 6 months of beginning treatment and almost all children had achieved them within 1 year. In addition two variables were found to be associated with longer treatment duration: more severe pre-treatment stuttering and shorter times from onset of stuttering to the start of treatment. The latter was apparent in the meta-analysis but not for the individual cohorts. As a result of these findings, pre-treatment stuttering severity was stratified along with other relevant variables in the randomised controlled trial and follow up for participants was a minimum of 9 months. A simulation study was conducted prior to analysis of data from the primary outcome measure of the randomised controlled trial: percentage of syllables stuttered (%SS). The distribution of %SS scores is positively skewed. Nonetheless, simulation showed t-test to be an appropriate analysis for this primary outcome measure. There were two treatment sites for the randomised controlled trial: the University of Canterbury (Christchurch, New Zealand) and the Stuttering Treatment and Research Trust (Auckland, New Zealand). A total of 54 preschool-age children were recruited: 29 to the Lidcombe Program and 25 to the control group. Half the proposed sample size was achieved due to slower than anticipated recruitment. This occurred because, as the trial progressed, treatment with the Lidcombe Program became common knowledge among parents in New Zealand and they became increasingly reluctant to agree to have their child randomised to the trial. Analysis with t-test showed a highly statistically significant difference (p = 0.003) at 9-months post-randomisation. The mean percentage of syllables stuttered (%SS) at 9-months post-randomisation was 1.5 (SD = 1.4) for the Lidcombe Program group compared to 3.9 (SD = 3.5) for the control group, resulting in a treatment effect of 2.3 %SS (95% confidence interval: 0.8-3.9). This treatment effect was more than double the minimum clinically worthwhile difference specified in the trial protocol. These results show that the Lidcombe Program is significantly more effective than natural recovery for reducing stuttering levels in preschool children. The Lidcombe Program is the first early stuttering treatment to be shown to be more effective than natural recovery in a randomised controlled trial.

Philosophy(PhD)
This thesis presents a randomised controlled trial of the Lidcombe Program of Early Stuttering Intervention. The Lidcombe Program was developed for the treatment of stuttering in preschool-age children. The effectiveness of the Lidcombe Program was compared to a control group in a parallel group randomised controlled trial with blinded outcome assessment. A number of supplementary studies were conducted in support of the trial; two literature reviews, two retrospective file audits and a statistical simulation study. A review of randomised studies of treatments for stuttering showed that there have been 27 such studies published in English language journals. Of these only one was devoted to a treatment for early stuttering and that was the Lidcombe Program. The randomised study showed that 3 months of this treatment was associated with a lower level of stuttering compared to a control group who received no treatment. However, with a sample size of 23, this study lacked power and the children did not receive a full course of treatment. Despite these limitations, this study provided evidence that a medium to large effect size could be anticipated in an adequately powered and properly conducted randomised controlled trial. The second review was of sample size and power in stuttering research studies that had been published in two speech pathology journals; the Journal of Speech, Language and Hearing Research (Vol 39, No. 1 to Vol 40, No, 4) and the Journal of Fluency Disorders (Vol 21, No. 1 to Vol 22, No, 3). Results suggested that the majority (73%) of the 26 studies reviewed were insufficiently powered to detect even large effects. However it was acknowledged that it is very difficult to recruit even moderate sample sizes of people who stutter. It was concluded that one way to help improve this situation is collaboration of multiple research centres or, in the case of a randomised controlled trial, inclusion of multiple recruitment sites in one study. This strategy was adopted in the randomised controlled trial reported in this thesis. Two retrospective file audit studies of children treated with the Lidcombe Program were conducted in Australia and Britain. One purpose of these file audits was to obtain information relevant to the design and conduct of the randomised controlled trial. Data from the case reports on more than 300 children from the two sites were included in a meta-analysis. Results showed that a median of 11 weekly clinic sessions were required for children to attain the criteria for low levels of stuttering for completion of Stage 1 of the Lidcombe Program. Approximately 90% of children had achieved those criteria within 6 months of beginning treatment and almost all children had achieved them within 1 year. In addition two variables were found to be associated with longer treatment duration: more severe pre-treatment stuttering and shorter times from onset of stuttering to the start of treatment. The latter was apparent in the meta-analysis but not for the individual cohorts. As a result of these findings, pre-treatment stuttering severity was stratified along with other relevant variables in the randomised controlled trial and follow up for participants was a minimum of 9 months. A simulation study was conducted prior to analysis of data from the primary outcome measure of the randomised controlled trial: percentage of syllables stuttered (%SS). The distribution of %SS scores is positively skewed. Nonetheless, simulation showed t-test to be an appropriate analysis for this primary outcome measure. There were two treatment sites for the randomised controlled trial: the University of Canterbury (Christchurch, New Zealand) and the Stuttering Treatment and Research Trust (Auckland, New Zealand). A total of 54 preschool-age children were recruited: 29 to the Lidcombe Program and 25 to the control group. Half the proposed sample size was achieved due to slower than anticipated recruitment. This occurred because, as the trial progressed, treatment with the Lidcombe Program became common knowledge among parents in New Zealand and they became increasingly reluctant to agree to have their child randomised to the trial. Analysis with t-test showed a highly statistically significant difference (p = 0.003) at 9-months post-randomisation. The mean percentage of syllables stuttered (%SS) at 9-months post-randomisation was 1.5 (SD = 1.4) for the Lidcombe Program group compared to 3.9 (SD = 3.5) for the control group, resulting in a treatment effect of 2.3 %SS (95% confidence interval: 0.8-3.9). This treatment effect was more than double the minimum clinically worthwhile difference specified in the trial protocol. These results show that the Lidcombe Program is significantly more effective than natural recovery for reducing stuttering levels in preschool children. The Lidcombe Program is the first early stuttering treatment to be shown to be more effective than natural recovery in a randomised controlled trial.

A week-long intervention for five school-age children who stutter was implemented using techniques of fluency shaping, stuttering management, and mindfulness training. The purpose of this study was to investigate if children who stutter stuttered less frequently, stuttered with less struggle, and demonstrated changes in mindfulness measures after the completion of this week-long intervention. Pre- to post-treatment measures were analyzed by individual and group-level results. A comparative analysis between reading and narrative tasks was also performed. Findings indicate that three out of five children reduced the total number of disfluencies during the reading task, and two children reduced this total during the narrative task. Four out of five children decreased the level of struggle in both tasks. Two children improved their overall mindfulness scores; however, additional changes in sub-divisions of mindfulness varied by participant. As a group, the total number of disfluencies decreased during the reading task, while the total number of disfluencies did not change from pre- to post-treatment measures during the narrative task. The group demonstrated improvements in mindfulness in the areas of communication attitudes, cognitive reappraisal, and expressive suppression. A comparison between reading and narrative tasks suggest that performance on these tasks approximated to one another by the end of the treatment. The results of this study should be interpreted with caution as this was a pilot study with clinical limitations; however, future studies are necessary to verify and support these findings.

Development of fluency has always been an important focus of stuttering research. However, to date there are no standardized norms on the development of fluency. Reliable and valid information regarding the normal development of fluency is necessary in order to deferentially diagnose normal disfluency from incipient stuttering. Establishment of norms for part-word repetitions is especially important since this type of disfluency has traditionally been considered an indicator of early stuttering. The present study sought to contribute to the investigation of the development of fluency by examining the frequency of occurrence of repetitions in 30- to 36-month-old males.

Thesis (B.Sc)--University of Hong Kong, 1994.
"A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), the University of Hong Kong, 29th, April, 1994." Also available in print.

The purpose of this study was to determine the effect of utterance length and meaningfulness on the speech initiation times of stuttering and nonstuttering children. Subjects were 36 elementary school students: 18 stutterers and 18 nonstutterers matched by age, grade, and gender. Each child produced 23 each of a short meaningful, long meaningful, and long nonsense utterance in response to a visual cue. Results are consistent with other studies that found stutterers to be slower than nonstutterers when responding verbally to an external cue. It is also apparent that nonstuttering, stuttering-only, and stuttering-plus children are affected differently by utterance length and meaningfulness. This indicates that the three groups may process speech motor events for verbal responses differently.

This research investigated specific factors that contribute to a young child’s persistence or recovery from their lifelong disability of stuttering. It determined unique factors in the child’s temperament and developed and evaluated a new clinical treatment to meet these individual needs. The research combined fluency treatment with a behavioural self-regulation program which supported the parents to be positive change agents for their child and ensured durability of fluency for their child’s future development and success.

The purpose of this study was to compare the frequency of specific disfluencies in 3 year old and 5 year old normal male children in terms of part-word repetitions, word repetitions, phrase repetitions, interjections, revision-incomplete phrases, disrhythmic phonations and tense pauses. The disfluencies were observed while each child spontaneously interacted with an investigator in a clinical room. Two questions were addressed: 1. Do three-year-old male children exhibit a higher overall frequency of disfluencies than five-yearold male children? 2. Do three-year-old male children exhibit a greater frequency of certain disfluencies than five-year old male children?

This study investigated the advisability of utilizing parents to provide treatment for their dysfluent preschoolers. It involved the development, implementation and evaluation of a specific treatment program involving indirect language stimulation techniques. The primary question asked was whether or not parents can be successful in significantly reducing or eliminating dysfluent speech in their children. The secondary question was whether or not parents can be trained successfully to provide treatment.

Purpose: Research has shown that children who stutter (CWS) demonstrate poor adaptive functioning, or poor functional, social, and psychological skills, when compared to children who do not stutter (CWNS). Previous work has also shown that preschool CWS demonstrate significantly lower effortful control than CWNS. High effortful control, or the ability to inhibit a dominant response, is predictive of high adaptive functioning in children who are exposed to a range of adversities. The purposes of this study were fourfold: (a) to investigate if the differences between preschool CWS and CWNS in effortful control extended to school-aged children; (b) to determine if effortful control could uniquely explain adaptive functioning after controlling for a diagnosis of stuttering; (c) to investigate whether effortful control was more influential to CWS than to CWNS; and (d) to investigate whether effortful control uniquely explained adaptive functioning in CWS after controlling for stuttering frequency. Methods: Effortful control and seven core areas of adaptive functioning were investigated in 46 school-age CWS and 46 CWNS. Eight independent two tailed t-tests were used to assess whether CWS demonstrated lower effortful control than CWNS and lower adaptive functioning than CWNS in seven adaptive functioning areas: communication competence, peer competence, internalizing behaviors, externalizing behaviors, general anxiety, social anxiety, and depression. Correlation and hierarchical regression analyses were used to examine the extent to which each component of adaptive functioning was related to effortful control when controlling for age, intelligence, parent-child relationship, and stuttering group membership. Hierarchical regression analyses were used to assess the extent to which each separate component of adaptive functioning was related to effortful control in CWS only. Results: CWS demonstrated significantly lower effortful control when measured by the Early Adolescent Temperament Questionnaire (a parent report measure of hot effortful control) than CWNS. CWS also performed more poorly in all aspects of adaptive functioning; however statistical significance was only reached for internalizing behaviors and general anxiety. The hierarchical linear regressions indicated that effortful control predicted the majority of the variance in five areas of adaptive functioning: peer competence, externalizing behaviors, internalizing behaviors, general anxiety, and depression. In the group of CWS, stuttering frequency predicted internalizing behaviors, general anxiety, and social anxiety. However, stuttering was the most important contributor to only one of the seven components of adaptive functioning, social anxiety. Conclusions: This study with school-aged CWS extends previous work indicating that preschool CWS exhibit lower effortful control than their normally fluent peers. The fact that emotional aspects of effortful control were a stronger predictor of social functioning, internalizing behaviors, and externalizing behaviors than either a stuttering diagnosis or the quantity of stuttering, may explain the adaptive functioning deficits often observed in CWS. Because effortful control is both a powerful contributor to adaptive functioning, and is reduced in CWS, clinical therapy approaches, which boost effortful control skills, have the potential to greatly lessen the impact of stuttering for CWS.

Both theoretical models and empirical evidence implicate the combined influences of high emotional reactivity and low emotional regulation to exacerbation in children's stuttering behavior (e.g., Conture, Walden, Arnold, Graham, Hartfiled, Karrass, 2006; Conture & Walden, 2012; Karrass et al., 2006). Attentional control is a key factor in both the development and implementation of emotional regulation (Bell & Calkins, 2012; Rueda, Posner, & Rothbart, 2004). The purpose of this study was to investigate attentional control along the distraction process in children who stutter using two event-related potential (ERP) experimental tasks: auditory-auditory distraction and visual search. Eight school-age children who stutter (CWS) and eight school-age children who do not stutter (CWNS) were recruited in this study. Using a Go/No Go paradigm, children in this study were asked to discriminate tone duration in the auditory-auditory distraction task and detect specific visual targets in the visual search task in both the auditory and visual tasks. Behavioral measures included reaction time (RT), hit rate (HR, accuracy) and false alarm (FA), while electrophysiological measures included the peak latency and mean amplitude of the mismatch negativity (MMN), P3a, N2pc and reorientation negativity (RON), and N2pc. Each ERP component reflects a specific stage along the distraction process: automatic scanning and change detection (MMN), involuntary orientation to deviants (P3a), attentional filtering (N2pc) and voluntary attentional reorientation (RON). The first three components are involved in the sensory/perceptual processing, while the last component is involved in the goal-directed processing (cognitive control for distraction compensation). These behavioral and ERP results were correlated with temperament data obtained from parent-report questionnaires. There were three main findings. First, CWS, but no CWNS, exhibited a P600 and increased peak latency of the late phase of RON (lRON). The P600 is elicited by violations in rule-governed sequences or the effect of encountering unexpected stimuli, while the lRON reflects evaluation of task-relevant information and motor preparation. The existence of P600 suggests that CWS return and re-evaluate deviants, perhaps due to reduced inhibitory control. As a result, CWS are delayed to start the attentional process reflected by lRON. Second, CWS exhibited a higher rate of false alarms in the auditory-auditory distraction task; this finding confirmed the notion of less efficiency in inhibitory control for CWS. Third, similar to previous research findings, our temperament data also revealed that CWS tended to exhibit relatively high negative affect in combination with relatively low effortful and attentional control, compared to their fluent peers. Taken together, present findings corroborate previous observations of relatively high emotional reactivity and relatively low efficiency in emotional regulation for CWS, including attentional and inhibitory control. Further, our results reveal that the low attentional control in CWS may result from less efficiency in the goal-directed processing for distraction compensation.

The purpose of this study was to investigate effects of listener requests for clarification on dysfluency behavior and information content of stutterers' and nonstutterers' responses. Subjects were 40 boys (20 stutterers and 20 nonstutterers) between the ages of 5;0-6;8 years and 8;5-10;0 years. Two listener requests, "What?" and "I don't understand" were delivered on a time contingent basis during a one-hour conversation with the subject. Fluency and dysfluency measures included frequency and duration of stuttered words, within-word dysfluencies, pauses, and speech rate. Repair strategies were coded according to information content. Results indicated that responding to requests for clarification significantly decreased the frequency of dysfluencies for both groups. Stutterers were similar to nonstutterers in information content of repair strategy. Groups differed on pause measures, and there was a tendency for older children's fluency to be more disrupted by requests. Older children also used significantly more information in their responses to "I don't understand".

There is a rich literature demonstrating that adults who stutter (AWS) demonstrate atypical functional brain activity during speech production. These differences can be characterized by increased activity in the right inferior frontal gyrus and premotor regions and decreased activity in the left inferior frontal gyrus, premotor area, and bilaterally in the superior temporal gyrus. The process of speech production requires motor movements first be planned and then executed. However, few studies have examined activity related to speech-motor planning independently from speech-motor execution. Additionally, due to methodological limitations, few investigations have examined functional brain activity in children who stutter (CWS). We hypothesized that AWS and CWS would demonstrate atypical brain activity related to both speech-motor planning and execution. Using Near Infrared Spectroscopy (fNIRS), we measured the change in oxygenated hemoglobin concentration (HbO) during speech-motor planning (repetition of nonwords with three repeated or different syllables) and speech-motor execution (covert/overt naming). Results indicated that both AWS and CWS demonstrated cortical activity that was atypical during speech-motor planning processes in the right inferior frontal gyrus and atypical speech-motor execution processes in the left inferior frontal gyrus. Deactivations in the left inferior frontal gyrus may reflect inefficient feedforward mechanisms for speech production. Inefficient feedforward mechanisms will likely result in more variable movements, for which larger feedback correction signals will be necessary. Overactivations in the right inferior frontal gyrus may reflect this increased correction. Additionally, AWS demonstrated atypical speech-motor planning activity in the right middle frontal gyrus, potentially related to the production of prosody. These results are presented within a theoretical framework of two competing theories of stuttering.

Investigations into the speech of normal children have indicated that disfluencies are common. It is important for the Speech Language Pathologist to have knowledge of normal disfluencies for differential diagnosis, parent counseling, and in order to plan strategies for intervention. The purpose of this study was to compare the frequency of disfluencies in 4 year old and 6 year old normal male children to the frequency of disfluencies when they were 3 years old and 5 years old respectively.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico
Introduction: Speech fluency can be viewed as a complex event involving the organic, psychic and social dimensions. From this perspective, complaints about problems of speech fluency brought to the clinic by the family, call for the development of a therapeutic process that involves the entire family unit. Objective: To study, through the speech of parents, the effects and effectiveness of a therapeutic process for speech fluency problems based on a historical-dialectical approach. Method: qualitative research using semi-structured interviews with three families that have therapeutic work with the researcher. The interview began with the phrase: Tell me about your child's therapeutic process. The interviewer intervened to ensure that respondents talked about the vision they had about their children, his speech and the changes they observed. The transcribed interviews were categorized according to Bardin's Content Analysis (2009) in four categories: Therapeutic Approach; Experiences and Affections; Causes and Vision that Parents have about the Child, the Language and his Stuttering, the last one structured in three sub - categories: Feelings and Thoughts on Stuttering and Language; Social Situations and Characteristics of Communication. Results / Discussion: The therapeutic effects observed from the analysis of the categories were: in Therapeutic Approach parents reported that, unlike other approaches, whit the dialectical historical approach they felt part of the therapeutic process. In Experiences and Affections reports that speech moments before felt as harassed and helpless, came to be shared and seized as part of the process of speech production and that they understood that their feelings have an effect on the speech of the child. In Vision that Parents have about the Child, the Language and his Stuttering was reports about how the speech of their children was; about the changes observed; about the stigma they and their children carried and about their understanding that the social contexts intensified stuttering. Conclusion: These effects indicate that the therapeutic process supported on the historical dialectical approach was effective for the participants in this study. It also indicates that effectiveness is not only measured by the decrease in stuttering and disfluency of children, but mainly by change of attitude of parents toward this form of speech, which enabled such a decrease. This result points to the need and importance of further studies about this type of approach
Introdução: A fluência de fala pode ser encarada como um acontecimento complexo por envolver as dimensões orgânica, psíquica e social. Nessa perspectiva, as queixas sobre os problemas de fluência trazidas à clínica fonoaudiológica pela família, convocam ao desenvolvimento de um processo terapêutico que envolva todo o núcleo familiar. Objetivo: Estudar, por intermédio do discurso de pais, os efeitos e a efetividade de um processo terapêutico para problemas de fluência de fala baseados em uma abordagem dialético-histórica. Método: Trata-se de pesquisa qualitativa para a qual foram feitas entrevistas semi-estruturadas a três famílias em atendimento terapêutico com a pesquisadora. A entrevista iniciou-se com a frase: Fale-me sobre o processo terapêutico de seu filho. O entrevistador interferiu de modo a garantir que os entrevistados falassem sobre a visão que tinham e têm de seus filhos e de sua fala, além das mudanças que observaram. As entrevistas transcritas, foram categorizadas de acordo com a Análise de Conteúdo de Bardin (2009) em 4 categorias: Abordagem Terapêutica; Vivências e Afetos; Causas e Visão que os Pais têm do Filho, da Linguagem e da Gagueira, está estruturada em 3 subcategorias: Sentimentos/Pensamentos sobre a Gagueira/Linguagem; Situações Sociais e Características da Comunicação. Resultados/Discussão: Os efeitos terapêuticos observados a partir da análise das categorias foram: em Abordagem Terapêutica relatos dos pais que, diferentemente de outras abordagens, na abordagem dialético-histórica sentiram-se parte integrante do processo terapêutico. Na categoria Vivências e Afetos, relatos de que momentos de fala antes sentidos como aflitivos e exaustivos, passaram a ser compartilhados e apreendidos como parte integrante do processo de produção de fala e de que compreenderam de que os seus sentimentos tem efeitos sobre a fala das crianças. Na categoria Causas, relatos que relacionaram o surgimento da gagueira a algum evento importante de suas vidas. Na categoria Visão que os Pais têm do Filho, da Linguagem e da Gagueira, relatos sobre como era a fala de seus filhos; sobre as mudanças observadas nessa fala; sobre o estigma que eles e seus filhos carregavam e sobre sua compreensão de que os contextos sociais intensificavam a gagueira. Conclusão: Esses efeitos indicam que o processo terapêutico apoiado na vertente dialético histórica foi efetivo para os participantes desta pesquisa. Indica também que essa efetividade não se avalia apenas pela diminuição da gagueira e da disfluência das crianças, mas, principalmente, pela mudança da atitude dos pais em relação a esta forma de fala, que permitiu tal diminuição. Tal resultado aponta para a necessidade e importância de realizar outros estudos a respeito desse tipo de abordagem

Background: There is an established need to manage teasing and bullying of children who stutter (CWS) through changing the attitudes of their peers. The intervention, the Classroom Communication Resource (CCR), was implemented by teachers in classrooms. The primary objective of the main study was to determine the effectiveness of the CCR through a cluster Randomised Controlled Trial (RCT). The secondary objective of this study was to determine the treatment effect of the Stuttering Resource Outcomes Measure (SROM) within the subscales of Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine the primary objective between and across lower and higher school quintile clusters. Method: A cluster RCT was conducted. Participants in grade 7, aged 11 years and older, were randomly assigned to control and intervention groups using school and subgroup (quintile) clusters classifications. Following randomisation, stratification took place using a 1:1 allocation ratio. Participants viewed a video of a child who stuttered at baseline. Teachers administered the CCR (social story, role-play, discussion) in intervention groups only over a 60-90 minute session after they received an hour of training. Peer attitudes were measured at baseline and at 6 months post-intervention using the SROM in intervention and control groups. Results: A total of 10 schools were included whereby they were randomly allocated to control (k=5) and intervention groups (k=5). Within the schools, 454 participants were included with n =223 participants in the intervention and n= 231 in the control group. The study showed no statistically significant difference on the global SROM score (mean difference: -0.11 [95% confidence interval: -1.56, 1.34]; p = 0.88). Similarly, no significant differences were noted on SROM subscales: PSD (1.04 [-1.02,311]; p =0.32), SP (-0.45 [-1.22, 0.26]; p=0.21) and VI (0.05 [-1.01, 1.11]; 0.93), the secondary objective of this study. No significant subgroup effect on the global SROM score (lower vs higher quintile subgroups) [interaction p-value = 0.52] was observed during subgroup analysis. Results were however consistent with the hypothesis and quintile subgroups behaved similarly. Results were found clinically important when considering confidence intervals as well as the magnitude and direction of treatment effect. Conclusion: While the treatment effect showed no statistically significant differences on the global SROM and within the constructs of PSD, SP and VI, a clinically important result was noted when evaluating the meaningfulness of this study as well as its implications. Subgroup analysis showed that the quintiles behaved similarly, showing that the CCR was appropriate for schools within the lower and higher quintiles.

The aim of this paper is to study the long-term effects of stuttering treatment according to the Lidcombe Program in Sweden and to answer questions whether underlying factors may have affected the treatment results. Participants were seven children, one girl and six boys aged 7:10-14:2, who all completed Stage 1 of the program approximately 2-7 years ago.The children were video recorded during a conversation with one of the authors and while reading aloud. Before the recording, their parents estimated the level of stuttering according to a Severity Range (SR) Scale. The evaluations were used as reference for determining whether the recordings were representative for the children´s current speech fluency. Proportions of stuttered syllables (%SS) were calculated from the video recorded material and compared with the proportions of stuttered syllables (%SS) at the time when the first stage of the program was initiated.The results showed that the Lidcombe Program had a significant (z=-2.37, p=0.02) long term effect on stuttering treatment for the participants in this study. The effect size was calculated to 1.05, which indicates a large effect. No correlation between underlying factors and treatment results could be established at group level. However, the results showed differences among the participants and underlying factors as age at stuttering onset and age when treatment was introduced may have affected the treatment results.This is one of the very first long term follow-ups on Swedish preschool children that have been treated according to the Lidcombe Program and the authors hope to see further research.
Studien syftade till att undersöka långtidseffekten av Lidcombeprogrammet för svenska förskolebarn som stammar samt fastställa om bakgrundsfaktorer påverkar behandlingseffekt. I studien deltog sju svensktalande barn, en flicka och sex pojkar, i åldrarna 7:10–14:2, som alla avslutade det första steget i behandlingen för cirka 2-7 år sedan.Långtidsuppföljningen genomfördes i form av videoinspelningar av barnens tal under samtal med en av författarna samt under en högläsningssituation. Föräldrarna till varje barn fick inför inspelningarna skatta sitt barns stamning på en Severity Rating (SR) Scale. Utvärderingarna användes för att få information om huruvida inspelningarna var representativa för barnens tal idag. Utifrån samtliga inspelningar beräknades sedan den procentuella andelen stammade stavelser (%SS) och denna mätning jämfördes sedan med den procentuella andelen stammade stavelser (%SS) för tidpunkten när behandlingen enligt Lidcombeprogrammet introducerades.Resultatet i föreliggande studie visade att Lidcombeprogrammet har haft effekt på lång sikt för deltagarna i föreliggande studie och resultatet var statistiskt signifikant (z=-2.37, p=0.02). Effektstorleken för dessa beräkningar var 1.05, vilket motsvarar en stor effekt. Inget samband kunde påvisas mellan bakgrundsfaktorer och behandlingseffekt på gruppnivå men resultatet på individnivå påvisar skillnader mellan deltagarna avseende ålder vid stamningsdebut och ålder vid behandlingsstart, eventuellt kan detta ha påverkat behandlingsresultatet för enskilda deltagare.Det här är en av de första långtidsuppföljningarna av svenska förskolebarn som behandlats enligt Lidcombeprogrammet och författarna efterfrågar fler studier.

INTRODUÇÃO: A gagueira é um distúrbio da fluência multidimensional que resulta da interação de múltiplos processos fisiológicos, refletindo mais de um fator causal. Evidências científicas atuais sustentam a hipótese de que pessoas que gaguejam possuem conexões anômalas em regiões auditivas do hemisfério esquerdo, envolvidas no feedback sensorial dos sons da fala. Desta forma, é prudente pensar que déficits na sincronia neural, identificados por meio de alterações em testes comportamentais do processamento temporal e nos potenciais evocados auditivos (PEA), possam estar relacionados a este tipo de distúrbio. OBJETIVO: caracterizar os resultados do teste Gaps in Noise (GIN) e dos PEA com estímulos de diferentes complexidades em crianças gagas e em crianças em desenvolvimento típico. MÉTODOS: Dez crianças gagas com idades entre sete e 11 anos (grupo estudo - GE) e seus pares nãogagos (grupo controle - GC) foram submetidos a avaliações audiológicas e eletrofisiológicas da audição por meio dos seguintes testes: medidas de imitância acústica, audiometria tonal, logoaudiometria, teste GIN, potencial evocado auditivo de tronco encefálico (PEATE) com estímulos clique e de fala e potencial evocado auditivo de longa latência (PEALL) com estímulo tone burst e de fala. Os resultados obtidos no GC e GE foram comparados por meio de testes estatísticos. RESULTADOS: Ambos os grupos apresentaram resultados normais no teste GIN, de acordo com os critérios de normalidade adotados, contudo, observou-se melhor desempenho no GE. Não foram encontradas diferenças significantes entre os grupos para os resultados do teste GIN. No PEATE com estímulo clique, todos os sujeitos avaliados apresentaram resultados dentro dos padrões de normalidade. Observou-se no GE maior variabilidade nos tempos de latência, bem como tendência à diferença estatisticamente significante entre as orelhas direita e esquerda para o interpico I-III. No PEATE com estímulo de fala, verificaram-se valores de latência da onda C e de amplitude do complexo VA significantemente maiores no GE. No PEALL com estímulo tone burst não foi observada diferença estatisticamente significante entre os grupos. Contudo, observaram-se alterações (ausência de componentes do PEALL) em três sujeitos do GE e em um do GC. No PEALL com estímulo de fala, em ambos os grupos, verificou-se diferença estatisticamente significante entre as orelhas direita e esquerda no que tange a latência da onda N2 e amplitudes P2-N2 e da onda P300. Foram observadas alterações (ausência de componentes do PEALL) em um sujeito do GE. CONCLUSÃO: Embora não tenham sido verificadas alterações de resolução temporal no grupo de crianças gagas por meio do teste comportamental realizado, os resultados dos testes eletrofisiológicos sugerem a presença de diferenças nos processos neurais envolvidos no processamento da informação acústica, entre crianças em desenvolvimento típico e crianças gagas, principalmente em se tratando de elementos de maior complexidade, como a fala
INTRODUCTION: Stuttering is a multidimensional speech disorder that results from the interaction of multiple physiological processes, which means there is more than one causal factor. Current scientific evidence supports the hypothesis that people who stutter have anomalous connections in auditory regions of the left hemisphere, involved in the sensory feedback of speech sounds. Thus, it is reasonable to suppose that deficits in neural synchrony, showed by abnormal results in behavioral tests of temporal processing and auditory evoked potentials (AEP), may be related to this type of disorder. OBJECTIVE: to characterize the results of the Gaps in Noise Test (GIN) and the AEP using stimuli of different complexity, in children who stutter and in typically developing children. METHODS: Ten children who stutter aged between seven and 11 years (study group - SG) and their non-stuttering peers (control group - CG) underwent audiological and electrophysiological evaluation using the following tests: acoustic immittance measures, tonal audiometry, speech audiometry, GIN test, speech- and click-evoked Auditory Brainstem Response (ABR), and Long Latency Response (LLR) with tone burst and speech stimuli. Statistical tests were carried out for comparisons between CG and SG. RESULTS: Both groups presented normal results in the GIN test, according to the normality criteria. However, the SG showed better performance. No significant differences were found between groups for the GIN test results. In the click-evoked ABR, all subjects presented results within the normal range. The SG showed greater variability concerning the latency values, as well as a statistical trend toward significance regarding differences between the right and left ears for the interpeak I-III. In speech-evoked ABR, the latency values of wave C and the amplitude of VA complex were significantly higher in SG. No statistically significant difference between groups was observed in LLR with tone burst stimulus. However, abnormal results were observed (absence of LLR components) in three subjects from the SG and in one subject from the CG. In the LLR with speech stimuli, statistically significant differences were found for both groups, regarding the N2 latency, P2-N2, and P300 amplitudes, when the right and left ears were compared. Abnormal results were observed (absence of LLR components) in one subject from the SG. CONCLUSION: Although auditory temporal resolution deficits were not evidenced by the GIN test in the group of children who stutter, the results of the electrophysiological tests suggest the presence of differences in neural processes related to the acoustic information processing, when compared to typically developing children, especially when more complex elements, such as speech, are considered

The purpose of the present study was to examine, based on audio samples in both languages, the accuracy of diagnosis of the presence or absence of stuttering in a bilingual Spanish English (SE) child who may or may not stutter by bilingual SE speech- language pathologists (SLPs) living in Texas (n=14). This study also aimed to determine what speech characteristics (if any) influenced SLPs’ judgment of whether or not a bilingual SE child was a stutterer, as well as to explore whether personal characteristics of the bilingual SLPs who completed the ratings (i.e., years experience, confidence in diagnosing an SE child with stuttering, educational history on the topics of stuttering and/or bilingualism) uniquely impacted the accuracy of their diagnosis. Information gained from this study suggests that the atypically frequent (in comparison to monolingual children) word and phrases repetitions produced by bilingual SE children who do not stutter may put this population at risk for misdiagnosis of stuttering. Results also indicate that the accuracy of identification of a bilingual SE child who does not stutter is not influenced by any of the personal characteristics listed above. Rather, there seems to be an overall lack of knowledge regarding the speech disfluencies that differentiate bilingual SE children who do and do not stutter. Thus, the preliminary data from this investigation warrants a follow-up study of the same nature on a nationwide scale.
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The purpose of this study was to investigate the awareness of stuttering in children ages three through seven who do and do not stutter, and to examine how their awareness might contribute to negative perceptions of persons who stutter. Participants included 12 children who stutter and 16 children who do not stutter. Each participant observed a 90-second Digital Versatile Disc (DVD) of two seal puppets employing appropriate turn-taking skills during a conversation. In this video, each puppet produced eight identical sentences. One puppet produced typically fluent speech characteristics. The other puppet produced disfluent speech characteristics. The participants answered 14 discrimination, self-identification, labeling, and evaluation questions to examine the awareness, perceptions, and social perceptions of stuttering. The participants were asked to identify with the puppet (fluent or disfluent) whose speech characteristics were most similar to their own. They also evaluated the puppets' use of disfluent and fluent speech to further examine personal responses to stuttering and determine whether specific characteristics of participants' stuttering patterns elicited negative peer responses. Results indicated no significant difference between the children who stutter and the children who do not stutter across the following measures: (1) awareness of stuttering, (2) perceptions of stuttering, and (3) social perceptions of stuttering. However, participants demonstrated emerging awareness that influenced negative perceptions of stuttering, as evidenced within each of the fluency groups. The percentage of children with an awareness of stuttering and resulting perceptions of stuttering was not significantly different from those participants with a limited awareness of stuttering. Analyses of individual fluency groups confirmed that awareness of stuttering impacted one's speech perceptions of stuttering, which influenced social perceptions of stuttering.
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碩士
國立台北護理學院
聽語障礙科學研究所
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The purpose of this study is to revise Riley’s (1994) Stuttering Severity Instrument-3 (SSI-3) for Mandarin speaking children, aged 3 to 13, with disfluency in Taiwan. The main tasks for revising Stuttering Severity Instrument-3 for Mandarin speaking Children included: (1) rewriting six reading materials in Chinese for the stuttering children who can read above the second grade, (2) redrawing and utilizing 4 colorful pictures as stimuli to induce the oral expression of the stuttering children who can not read(under the second grade), (3) calculating the stuttering identification intra- and inter-reliabilities of the judgers, (4) deriving the criterion-related validity from calculating the correlation coefficient between the RSSI-3MSC and The Iowa Scale for Rating Severity of Stuttering, (5) recruiting 31 preschool and 30 school-age stuttering children from four different areas according to the distribution of population in Taiwan, and identifying stuttering frequency, duration, physical concomitants for establishing the normative data of the two groups, separately, and (6) finally collecting the speech samples of 15 preschool and 10 school-age nonstuttering children for construct validity. The intra-judge reliability is above .998, and the inter-judge reliability is above .936. The criterion-related validities are .98 and .95 for the preschool and the school-age groups. The stuttering and the nonstuttering children were significantly different on the stuttering frequency, the duration, the physical concomitants and the total score. Otherwise, two group norms and stuttering severity levels (very mild, mild, moderate, severe, and very severe) were offered. This Revised Stuttering Severity Instrument-3 for Mandarin Speaking Children (RSSI-3MSC) may provide an objective and useful tool when researchers and therapists assess the severity of the stuttering children who speak Mandarin.

A dissertation submitted to the Faculty of Arts, University of the Witwatersrand, Johannesburg. in fulfilment of the requirements for the degree of Master of Arts in Social Work.
The study sought to investigate the relationship of maternal and paternal attitudes and child-rearing practices towards children of different birth order positions. The research also investigated possible differences in the childrearing practices and attitudes toward" their children, of parents who had a child that stuttered, and of parents ill which there was no child wuo stuttered in the family. The research was conducted among a selected sample of forty three families who were matched on certain variables. Group A comprised thirty families in which there was no child who stuttered, and Group B comprised thirteen families each of whom had a child who had been identified as suffering from the disorder of stuttering. The data were collected by means of a postal questionnaire, and then analysed quantitavely and qualitatively using various statistical analyses. Selected variables were studied in an attempt to assess the possible effects on children as a result of birth order, parenting and stuttering. Findings revealed that parental attitudes towards the children of different birth order positions were not significantly different, However, the parents' expectations of and perceptions of their firstborn child's intelligence differed from their expectations and perceptions of their other children, No differences in child-rearing were identified between the parents of children who stuttered. and the parents of children who did not stutter. However, the parents in Group B reflected more confidence in their parenting skills. Religious centres were identified as being a popular venue for parenting programmes especially for the parents in Group A. Practice guidelines for social workers rendering services to the family in which there was a child who had the disorder of programmes were enumerated. Social workers need to be aware of the individual in interaction with an levels of the ecosystem. Social workers must also take cognizance of alternate family structures, the importance of the father in the development of the child and for Inclusi..a in therapy and benefits and methods of parenting programmes as a preventative tool to alleviate the possibility of future pathology.
Andrew Chakane 2018

A larger right prefrontal and a larger left occipital lobe (lobar asymmetry) and a larger left planum temporale (PT) are consistent asymmetries found in the human brain. Reduced or reversed asymmetries from these typical configurations are considered atypical and may be markers of atypical function. Atypical lobar and PT asymmetries have been found in adults with persistent developmental stuttering (PDS). These atypical asymmetries may represent a neural risk for developing PDS. To further understand the development of these asymmetries; volumes, ratios and asymmetry quotients were investigated in three groups: (1) healthy right-handed boys and girls ages 8--13 (2) righthanded boys with PDS and matched controls ages 8--13 (3) right-handed adult men with PDS and matched controls ages 21--49. The healthy boys and girls displayed sex-linked differences. Boys had larger total brain and total gray matter volumes than girls. Due to sex-linked gray matter differences, boys had larger right prefrontal and left occipital volumes which lead to a greater magnitude of brain torque. The PT was leftward in both sexes. The boys with PDS differed in multiple anatomical areas compared to controls. The PDS group had more total white matter and a smaller gray-to-white matter ratio in the right hemisphere compared to controls. The PDS group had a smaller right prefrontal region due to decreased prefrontal inferior gray matter. The occipital volume and asymmetry patterns also differed between groups. Controls had the expected leftward asymmetry while the PDS group was more atypical. Thus, the overall brain torque was more symmetrical in the PDS group. The stuttering severity scores positively correlated with right prefrontal white matter volume. The PT was leftward in the boys with no group difference. Right-handed men with PDS and controls did not differ in lobar volumes and asymmetries. The PT was more symmetrical in the PDS group than controls. Interestingly, in all PDS subjects and controls, the prefrontal and occipital white matter asymmetries followed the typical brain torque configuration while the gray matter asymmetries were more variable. This observation indicates that white matter volumes may be responsible for the typical brain torque configuration
acase@tulane.edu

The literature suggests that self-disclosure of stuttering may positively impact the listener’s perception of persons who stutter. This phenomenon, although investigated with adults, has not been studied with regards to children who stutter. The purpose of this study was to examine the effects of self-disclosure on listener perceptions of children who stutter. Specifically, this study examined whether listener perceptions of a child speaker who stutters are contingent upon the presence or absence of a self-disclosure statement prior to the speaker initiating his or her monologue, and whether listener perceptions are susceptible to gender bias. Child participants (n = 71) between the ages of 6 years, 0 months and 12 years, 11 months were randomly assigned to view two of the four possible videos (male self-disclosure, male no self-disclosure, female self-disclosure, and female no self-disclosure). Directly following the viewing of both videos, participants completed a survey analyzing their perceptions of the speaker for various traits related to personality and intelligence. Results for effects of self-disclosure achieved significance for all ten questions. With regard to gender, there was a significant difference for all questions except ‘more unintelligent’ and ‘less distracted’; however, when the gender viewing possibilities were compared across the three distinct groups (distinguished by whether the video pairing included the male speaker only, the female speaker only, or both a male and female speaker), there was no significant difference found. This suggests that the difference across responses are only present when all three gender groups are collapsed, which further indicates that gender did not have a distinct impact on the responses to the questions. Additionally, there was no significant interaction between self-disclosure and gender, suggesting that these two factors have independent, un-related influence on listener perception. In summary, the present findings indicate that the use of self-disclosure may positively impact children’s perceptions of other children who stutter, and that these perceptions are not uniquely impacted by gender.
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Stuttering is a universal phenomenon that has been identified in ethnic and cultural groups around the world. While it has been suggested that attitudes toward stuttering are different for various cultural groups, knowledge of, and attitudes toward stuttering have not been studied extensively across cultures. The purpose of the present study was twofold: (1) to investigate the awareness and perception of stuttering for American children age 3 to 7 from diverse cultures, and (2) to compare those to findings of awareness and perception of stuttering for children from Israel and America. Sixteen children in four different age groups were asked to complete three different types of experimental tasks after watching a video of fluent and disfluent identical seal puppets. The participant’s awareness of disfluency was assessed through discrimination between fluent and disfluent speech and identification of the puppet who spoke like them. Perception was addressed through labeling and evaluation of fluent and disfluent speech. Results revealed that at as young as age 3 some children began to demonstrate accurate awareness of disfluent speech. However, the highest level of accuracy was not demonstrated in the majority of participants until age 7. In addition, results further revealed across all age groups that children were more accurate when discriminating between fluent and disfluent speech than identifying it. Similarities and differences between previous studies that have used the same experimental stimuli (i.e., Ambrose & Yairi, 1994; Ezrati-Vinacour et al., 2001) are discussed. The lack of diverse cultural participants and its resulting effects on the present study’s recruitment methodologies are also discussed.
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This thesis extends a previous pilot study with children who stutter (CWS) to include children with specific language impairment (CSLI). The current study examines lexical-semantic organization in these two clinical populations in hopes of comparing and contrasting behavioral profiles. The study employed a list-recall task to assess the lexical-semantic organization of 9 CWS, 5 CSLI, and 20 typically developing children matched for age and vocabulary. Similar to previous investigations, our child participants demonstrated the well-documented list position effects. With regard to recall accuracy, by-participant analyses revealed significant differences between CSLI and their age-matched peers; however, they did not reveal significant differences between the CWS and either of their control groups nor between the CSLI and CWS groups. Further, inspection of error distribution suggested significant differences in the number and types of errors the CSLI and control groups produced. The prevalence of unrelated and previous list errors in CSLI suggest that deficits in inhibitory processes as well as perseveration may have affected their performance. Areas of overlap and divergence in the profiles of CWS and CSLI indicate continuity in the degree of lexical-semantic weakness as well as differences in lexical retrieval and executive functions among CSLI and CWS.
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Thesis (M.S.)--University of Wisconsin--Madison, 1985.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 64-68).

碩士
國立屏東教育大學
特殊教育學系
99
This study aimed to compare the phonological and articulation abilities between stuttering and nonstuttering school-age children who spoke Mandarin. All the subjects were assessed by the Revised Stuttering Severity Instrument-3 for children (SSI-3, Mandarin Edition), which resulted in 24 pairs of stuttering and nonstuttering children. For phonological abilities, the measures of the Phonological Awareness Inventory (PAI), and the Phonological Perception Inventory (PPI) were collected. In addition, all the children’s Nonword-Repetition (NR) performances including the Accuracy Ratio and the Stuttering Syllable Ratio were calculated, and their speech samples were analyzed to find the phonological processes (PP). For articulation abilities, the correct percentages of consonant, vowel and tone were obtained from the Articulation/Phonological Disorder Screen Test (A/PDST). Then, the researcher employed t-tests to examine whether the differences existed in the above measures between the two groups. As the results, no differences were found in the measures of the Total Score, Phonetic Symbols Recognition, Initial Consonant Deletion and Tonal Perception subtests in PAI, the Consonant Discrimination, Vowel Discrimination, Tone Discrimination, Mixed Consonant and Vowel Discrimination subtests in PPI, the Stuttering Syllable Ratio of NR and the stopping, backing and unaspiration of PP between the two groups. However, for the measures of the Phoneme Blending subtest in PAI, the Total Score of PPI, and the Accuracy Ratio of NR, the nonstuttering children were better than those of the stuttering children. Besides, no differences exhibited in the correct percentages of vowel, consonant and tone in A/PDST between the two groups. In sum, the stuttering children had better phonological abilities of Phoneme Blending in PAI, the Total Score of PPI, and the Accuracy Ratio of NR. No differences, however, appeared in the articulation abilities between the two groups. Accordingly, for some of the phonological abilities, the children with stuttering seemed to have poorer performances than the children without stuttering. Nevertheless, for the articulation abilities, the two groups seemed to perform similarly.

Recently, research has postulated that stuttering is a motor disorder that results from brain abnormalities within the central nervous system. Based on evidence of numerous irregularities within various motor systems, it has been suggested that other motor domains may be comprised. In particular, research in individuals who stutter has found fine, gross, and visual-spatial motor impairment. These studies, though, are dated, have numerous methodological concerns, or yielded contradictory results. Thus, this study investigated whether motor skills in children who stutter (CWS) were compromised. Fine motor skills are important in a school environment because students are required to utilize these skills to complete various assignments and projects, such as cutting and folding paper. Gross motor skills are equally as important as children use these skills to move around their environment. Visual-spatial motor skills are vital for children as they are often required to copy notes off of the board. Deficits in any of these areas may have potentially harmful effects on school performance. Thus, in a school setting, school psychologists are a valuable asset, as they are trained to consult and work with "at risk" populations to prevent long-term problems. Given the potential motor deficits in CWS, school psychologists can intervene and provide appropriate accommodations to remediate any motor deficits. Participants included 12 CWS and 12 children who do not stutter (CWNS). Participants were recruited from a large urban school district and were administered the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (Bruininks & Bruininks, 2005; BOT-2). Parents completed a demographic questionnaire. One Way Analyses of Variance (ANOVAs) were calculated to compare group means. Results indicated that CWS performed poorer on all but one motor area. Given these results, when a child is identified with a disfluency problem, a broader consideration of issues that may be facing the child is warranted. In particular, school psychologists are in a position to intervene and provide appropriate services to an "at risk" population (i.e., CWS) by conducting a brief motor assessment to identify motor strengths and weaknesses. If warranted, school psychologists can provide accommodations and services to address any identified weaknesses in motor areas.

The present study investigated phonological encoding skills in children who stutter (CWS). Participants were 4 CWS (M=10;9years) and 4 children who do no stutter (CNS) (M=12;1 years) The groups were compared in phoneme monitoring and rhyme monitoring, with a tone monitoring task providing a neutral baseline for comparison. Both the phoneme monitoring and rhyme monitoring tasks were performed during silent picture naming. Results revealed that both groups were faster and more accurate when monitoring the rhyme than when monitoring the phoneme. Results further indicated that the children who stutter were significantly slower in both conditions. These findings suggest that there may be a later transition to incremental processing in both typically developing children and those who stutter and that children who stutter may be even less efficient than children who do not stutter. However, these results may have been compromised by a few key variables.
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The aim of the study was to determine how Gestalt play therapy may be used in the therapeutic treatment of children in middle childhood who stutter. Stuttering is a problem that touches the lives of many people and is associated with great interpersonal distress. Stuttering is especially difficult for children in middle childhood, a time dominated by the school experience. Gestalt play therapy creates a child-friendly environment, in which the child can share information in a safe manner through the use of play therapeutic techniques. Literature was reviewed according to relevant topics, semi-structured interviews were conducted with three respondents, the data obtained was qualitatively analysed and research findings were discussed. The researcher concludes that Gestalt play therapy can be used to good effect with children who stutter, as it allows them to work through their emotions, and therefore, encourages them to communicate more freely within the therapeutic environment.
Social Work
M. Diac. (Play Therapy)

碩士
國立屏東師範學院
特殊教育學系碩士班
93
ABSTRACT The main purposes of this study were to investigate: (1) whether the differences existed in the communication attitude, the communication anxiety and the school adjustment among stuttering children according to their various background variables (stuttering severity, stuttering familial history, and receiving therapy or not), and whether the differences occurred in these three variables between stuttering and nonstuttering children according to their background variables (grade, family social economic status); (2) whether a high correlation existed between the teacher-rated and the stuttering-children-reported communication anxieties; (3) whether the stuttering severity, the communication attitude, and the communication anxiety of the stuttering children related to each other, and whether the three variables were predictors to stuttering children’s school adjustment. There were 34 stuttering children and 34 children without stuttering in the elementary schools recruited as the experimental and the control group, respectively. The data were analyzed by t-test, one-way ANOVA, two-way ANOVA, Pearson product-moment correlation and multiple regression analysis. The results show that no matter what background variables (stuttering familial history and receiving therapy or not) they are, no significant differences in the communication attitude, the communication anxiety, and the school adjustment among stuttering children, whereas differences appear in communication attitude and anxiety because of the various stuttering severity levels. The severe stuttering children perform most poorly. The different background variables (grade and family social economic status), however, can’t discriminate stuttering and nonstuttering children in communication attitude, communication anxiety, and school adjustment. Additionally, the communication anxieties rated by the teachers are lowly related to those of the stuttering children reported. The stuttering severity, communication attitude, and communication anxiety are significantly related to each other. The correlation between communication attitude and communication anxiety is the highest. The three variables can simultaneously predict stuttering children’s school adjustment significantly, but any of them can’t do it alone. Finally, the limitation of this study and the suggestions for worthwhile future research were discussed.

This qualitative pilot study investigated the bullying experiences of children who stutter, the type of coping strategies that they use to deal with these experiences, and their perceptions of the effectiveness of their coping strategies. Semi-structured interviews were conducted with seven 10- to 13-year-old children who stutter. Grounded theory methodology was used to analyze the interview data. Data analysis resulted in a preliminary four-element conceptualization of the process by which children who stutter experience and respond to bullying and the emergence of two themes: Individual Factors and Recommendations. Individual factors were found to influence the process of experiencing and responding to bullying, and recommendations are provided for how children who stutter may respond to bullying and how adults can help them. These recommendations may be used by speech-language pathologists, school psychologists, counselors, teachers, and parents. The findings of this study support previous research with typical children and children who stutter.
Speech Language Pathology

This report was developed to: a) enhance the clinician’s understanding of transfer and maintenance as it relates to stuttering, b) explore the unique challenges that face the school-aged population, c) examine research outside of the field that may be of benefit for school-aged stuttering clients, and d) provide the clinician with examples and activities that will facilitate the transfer and maintenance of stuttering treatment. The report will include a brief discussion of transfer and maintenance. The remainder of the report will focus on facilitating transfer and maintenance by increasing motivation, self-efficacy, realistic goal setting, and self-regulation.
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A gaguez é uma perturbação da fluência que tem vindo a ser descrita, por alguns autores, como uma perturbação do neurodesenvolvimento. Resulta da interação entre diversos fatores, tais como genéticos, neurofisiológicos e ambientais e é caraterizada por interrupções ou bloqueios na fluência da fala, acompanhada, frequentemente, de esforço e/ou comportamentos de evitamento. A forma como os diversos fatores, associados à gaguez, interagem entre si ainda não é totalmente conhecida e continua a ser alvo de discussão. Compreender o desenvolvimento da gaguez ao longo de diferentes faixas etárias, bem como os fatores de risco que podem estar na base da recuperação espontânea ou cronicidade da perturbação é o que tem despoletado o interesse da investigação nesta área. Nos últimos anos, vários autores mostraram que o impacto da gaguez não se limita às disfluências observadas na fala, existindo fortes evidências sobre os efeitos psicossociais da perturbação, não apenas na pessoa que gagueja, mas também junto de outros intervenientes, quer do seio familiar, quer do seio escolar. O presente trabalho apresenta um conjunto de estudos, cujos principais objetivos visam compreender a interação entre alguns dos fatores, que são apontados na literatura como relevantes para o desenvolvimento da gaguez ou que se relacionam, de alguma forma, com essa perturbação. Pretendeu-se ainda identificar o impacto da gaguez, no quotidiano das crianças Portuguesas, comparando a sua autoperceção com a de crianças de outros países. A perspetiva de impacto dos pais e os dos professores das crianças foi igualmente estudada. Participaram 100 crianças Portuguesas, em idade escolar (7-12 anos; M=9.13; SD=1.70), das quais 50 crianças gaguejavam e a outra metade correspondia aos seus pares fluentes. A amostra correspondente às crianças que gaguejam foi recolhida por conveniência, em diferentes cidades de Portugal, através de casos referenciados por profissionais de saúde ou de educação. O diagnóstico de gaguez foi confirmado através da utilização do Stuttering Severity Instrument (SSI4). Nos estudos com outros intervenientes, participaram ainda 50 pais e 27 professores das crianças do grupo de crianças que gagueja. São cinco os capítulos que constituem o presente trabalho de investigação. No primeiro, apresenta-se uma breve revisão da literatura que tem como base a v multidimensionalidade inerente à gaguez e onde se atualizam os conceitos, as causas e o impacto da perturbação na vida das crianças. De seguida, apresenta-se o primeiro estudo, cujo objetivo consistiu em relacionar a gaguez com o temperamento, o funcionamento executivo e a ansiedade, através da comparação de crianças que gaguejam e os seus pares fluentes. O temperamento foi avaliado através do questionário parental: Temperament in Middle Childhood Questionnaire (TMCQ), traduzido e adaptado para este efeito. A avaliação do funcionamento executivo foi realizada através da versão portuguesa do instrumento neuropsicológico Children Color Trails Test (CCTT). A ansiedade foi avaliada através da versão portuguesa do questionário de autoperceção Multidimensional Anxiety Scale for Children (MASC). Neste estudo, os grupos de crianças que gaguejam e que não gaguejam foram divididos em dois subgrupos, tendo em consideração a idade: o grupo de crianças mais novas (7-9 anos); e o grupo de crianças mais velhas (10-12 anos). Os resultados indicaram que as crianças que gaguejam podem precisar de mais tempo na orientação da atenção e, tendencialmente, manifestam maior reatividade emocional, em comparação com seus pares fluentes. Contudo, quando é considerada a idade das crianças, observam-se resultados significativos na comparação dos diferentes domínios de temperamento, apenas no subgrupo de crianças mais velhas, com médias superiores para as crianças que gaguejam, nas subescalas de: Raiva/Frustração; Impulsividade e Tristeza; e médias inferiores nas subescalas de: Atenção/Foco; Sensibilidade Percetiva e Recuperação de picos de Excitação. Por sua vez, no subgrupo de crianças mais novas, é no desempenho na tarefa relacionada com o funcionamento executivo que se verificam diferenças estatisticamente significativas. Neste grupo, as crianças que gaguejam utilizaram mais tempo a executar a tarefa, cometendo também um maior número de erros e falhas de execução, em comparação com os seus pares fluentes. Relativamente à ansiedade, e fazendo a mesma comparação entre os grupos de crianças que gaguejam e os seus pares fluentes, não foram encontradas diferenças significativas. Por último, foram encontradas correlações positivas entre a idade, alguns dos domínios relacionados com o funcionamento executivo e temperamento, sugerindo interação entre os diferentes fatores. Estes resultados permitiram reforçar a multidimensionalidade da gaguez e podem ser interpretados à luz do modelo Dual Diathesis - Stressor (DDS) que propõe que as capacidades endógenas (diathesis) das crianças interagem de forma dinâmica com os contextos exógenos (stressor). vi O segundo estudo pretendeu medir o impacto da gaguez na vida das crianças Portuguesas e verificou uma perceção de impacto moderado da gaguez nas suas vidas. Foi utilizado o questionário de autoperceção de impacto Overall Assessment of the Speaker’s Experience – School age children (OASES-S), que tem como base a Classificação Internacional de Funcionalidade (CIF) e que neste estudo foi traduzido, adaptado e validado para Português Europeu (OASES-S-PT). Verificou-se que o OASES-S-PT apresenta características psicométricas de fiabilidade e validade adequadas para avaliar a autoperceção de impacto nas crianças Portuguesas em idade escolar. Na comparação dos resultados com outros países, os resultados demonstraram que as crianças Portuguesas experienciam um impacto semelhante ao experienciado pelas crianças Holandesas e menor que as crianças Australianas. Verificou-se ainda um impacto menos relevante no quotidiano das crianças que gaguejam, comparando com as crianças Americanas, Holandesas e Australianas. De forma a perceber a perspetiva dos pais e professores, relativamente ao impacto da gaguez na vida dos seus filhos e alunos, respetivamente, foram realizados os últimos estudos, com os objetivos de comparar a autoperceção das crianças com a perceção dos seus pais e professores. Para estes estudos foram realizadas adaptações das questões do instrumento OASES-S-PT de forma a poderem ser respondidos por pais (OASES-S-P) e professores (OASES-S-T). No estudo direcionado para a perceção dos pais, realizou-se uma subdivisão do grupo, tendo em consideração a presença/ausência de história familiar de gaguez. Os resultados globais dos pais foram semelhantes aos resultados das crianças. No entanto, no caso dos pais com história familiar de gaguez, verificou-se maior impacto nos parâmetros relacionados com as reações das crianças à gaguez e a sua qualidade de vida. No estudo com os professores, apesar de não se terem verificado diferenças significativas na comparação das respostas com as dos seus alunos, não se observaram correlações entre as respostas dos dois grupos. Para além disso, identificou-se uma elevada taxa de absentismo num conjunto de questões sobre a gaguez em geral e intervenção terapêutica. Estes resultados sugerem que, apesar dos professores terem consciência de que a gaguez pode afetar a vida das crianças que gaguejam, as suas respostas não estão em total consonância com as dos seus alunos e denunciam desconhecimento em determinados domínios. É discutida a importância da educação dos professores relativamente à gaguez, bem como da ação destes principais intervenientes que acompanham as crianças que gaguejam. vii Os estudos realizados vêm reforçar a necessidade de desenvolver programas terapêuticos mais ajustados às particularidades de cada grupo específico, assim como destacar a importância do trabalho de parceria, quer com familiares, quer com professores. Contribui também para destacar a visão multidimensional, ressaltando a mais-valia na utilização de protocolos de avaliação que tenham em consideração outros domínios (ex: cognitivos, temperamentais, sociais), para além da fluência da fala. Conclui-se que a dessensibilização das crianças que gaguejam para a perturbação pode ajudar a lidar de uma forma mais positiva e menos reativa à gaguez, facilitando o processo terapêutico. Assim, um processo de avaliação e intervenção mais efetivos podem ser decisivos para a diminuição do impacto que a gaguez possa causar na vida das crianças.
Stuttering is a multifaceted disorder resulting from the interaction between genetic, neurophysiological, environmental, and other factors. The ways these factors interact with each other is not yet fully understood, and is still subject of research. In recent years, several authors have shown the impact of the disorder to reach far beyond the surface components, with strong evidence about the psychosocial effects of stuttering not only for the person who stutters but also for their family. This research work seeks to clarify the interaction between factors that contribute to the development of stuttering. In particular, it attempts to improve the assessment and therapeutic programs for stuttering in Portugal. This work presents five chapters: the first consists of a literature review based on the multidimensionality inherent to stuttering. The following chapters consist of four studies that are detailed below. The first study aimed to relate stuttering to temperament, executive functioning, and anxiety, by comparing stuttering children and their nonstuttering peers. Participants were 100 school-age children (mean age = 9.13 mos.; SD = 1.70 mos.), which included 50 children who stutter and 50 children who did not. In this study, participants were divided into two subgroups, taking age into account: a younger group (7-9 years) and an older group (10-12 years). Their temperament was evaluated through the parental questionnaire, Temperament in Middle Childhood Questionnaire (TMCQ), translated and adapted for this purpose. Executive functioning was assessed through the Portuguese version of the neuropsychological instrument, Children Color Trails Test (CCTT). Anxiety was assessed through the Portuguese version of the Multidimensional Anxiety Scale for Children (MASC) self-assessment questionnaire. The second study aimed to measure the impact of stuttering on the Portuguese children’s lives. Participants were 50 children who stutter (Mean age = 9.10 mos.; SD = 1.7 mos.). For this study, the Overall Assessment of the Speaker's Experience of Stuttering - School age (OASES-S) (OASES-S) was translated, adapted, and validated for European Portuguese (OASES-S-PT). Good reliability and validity of the OASESS- PT were verified for the assessment of impact in Portuguese school-age children. The third and fourth studies were conducted in order to understand the parents' and teachers' perspectives regarding the impact of stuttering on the lives of their children and students, and to compare the results with the children's self-perception of impact. ix In the study related to the perception of parents, a subdivision of the group was performed, taking into account the presence or absence of a family history of stuttering. The participants were 50 parents divided into: i) group of parents with a family history of stuttering (n= 30), and ii) group of parents with no history family of stuttering (n= 20). The study that aimed to investigate the teacher’s perceptions involved 27 teachers. In both studies adaptations, of the OASES-S-PT instrument were made so that they could be answered by parents (OASES-S-P) and teachers (OASES-S-T). The results indicated that children who stutter may experience lower ability to orient attention and may have greater emotional reactivity compared with their nonstuttering peers. Portuguese children who stutter experience a moderate impact of stuttering in their lives. In general, the results of parents and teachers were in agreement with the perceptions of the children; however, parents with a family history of stuttering reported significantly higher negative impact. This finding supports the idea that refinements in clinical and educational practices are needed; findings also highlight the importance of teamwork with parents and teachers.