Stuttering in general

Euler, H. A., Lange, B. P., Schroeder, S., & Neumann, K.
The effectiveness of stuttering treatments in Germany
Journal of Fluency Disorders (accepted for publication)
Kommentar: Zweck: Stotterer sollten die wirksamsten Behandlungen erhalten, die lokal oder regional verfügbar sind. Da eine vorausblickende vergleichende Behandlungsstudie für Deutschland nicht exisitiert, wurde eine rückblickende Befragung von behandelten Stotterern vorgenommen. Methode: Die 5 häufigsten Stottertherapien im deutschsprachigen Raum (231 einzelne Therapiefälle) wurden nach ihrer Wirksamkeit anhand eines strukturierten Fragebogens rückschauend bewertet. Die Teilnehmer hatten zwischen 1 und 7 Stotterbehandlungen erhalten. Ergebnisse: Zwei Behandlungsarten (Stottermodifikation, Fluency Shaping) zeigten positive Wirkung, 3 Behandlungsarten (Atemtherapie, Hypnose, unspezifizierte logopädische Therapie) unzureichende Wirkung. Die beiden wirksamen Stottertherapien waren nicht signifikant unterschiedlich in ihrer Wirksamkeit, die drei wenig wirksamen Therapien untereinander ebenfalls nicht unterschiedlich. Die Wirksamkeitslücke zwischen den besseren und den weniger guten Therapien war groß. Die typische Therapiekarriere eines Stotterers beginnt in der Kindheit mit einer unspezifischen logopädischen Behandlung, die extensiv (z. B. ein Mal wöchentlich) in Einzelsitzungen verabreicht wird. Im Vergleich waren intensive Verfahren besser als extensive Verfahren und Behandlung in Gruppen besser als Einzelbehandlung. Schlussfolgerung: Die am häufigsten verschriebene Stotterbehandlung, nämlich 1 wöchtliche Behandlungssitzung in logopädischer Einzeltherapie, ist von begrenzter Wirksamkeit. Mehr Erfolg versprechen Verfahren des Fluency Shaping oder der Stottermodifikation, die in einem intensiven Zeitplan (mindestens mehrere Tage hintereinander) und mit Anteilen von Gruppensitzungen verabreicht werden.
Abstract: Purpose: Persons who stutter (PWS) should be referred to the most effective treatments available, locally or regionally. A prospective comparison of the effects of the most common stuttering treatments in Germany is not available. Therefore, a retrospective evaluation by clients of stuttering treatments was carried out. Method: The five most common German stuttering treatments (231 single treatment cases) were rated as to their perceived effectiveness, using a structured questionnaire, by 88 PWS recruited through various sources. The participants had received between 1 and 7 treatments for stuttering. Results: Two stuttering treatments (stuttering modification, fluency shaping) showed favorable and three treatments (breathing therapy, hypnosis, unspecified logopedic treatment) showed unsatisfactory effectiveness ratings. The effectiveness ratings of stuttering modification and fluency shaping did not differ significantly. The three other treatments were equally ineffective. The differences between the effective and ineffective treatments were of large effect sizes. The typical therapy biography begins in childhood with an unspecified logopedic treatment administered extensively in single and individual sessions. Available comparisons showed intensive or interval treatments to be superior to extensive treatments, and group treatments to be superior to single client treatments. Conclusion: The stuttering treatment most often prescribed in Germany, namely a weekly session of individual treatment by a speech-language pathologist, usually with an assorted package of mostly unknown components, is of limited effectiveness. Better effectiveness can be expected from fluency shaping or stuttering modification approaches, preferably with an intensive time schedule and with group sessions.

Fibiger, S., Peters, H., de Touzet, B. B., & Neumann, K.
Therapy for persons who stutter. Eastern Europe and Latin America
In J. Au-Yeung & M. M. Leahy (Eds.) (2007), Research, Treatment, and Self-help in Fluency Disorders: New Horizons. (pp. 156-160). Dublin, Ireland: The International Fluency Association.
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Kommentar: Beschreibt die Versorgungssituation von Stotterern in osteuropäischen und südamerikanischen Ländern. In Lateinamerika muss weitgehend die Behandlung von stotternden Kindern oder Erwachsenen selbst bezahlt werden. Damit wird dort Armut das größte Hindernis für eine angemessene Versorgung. Fluency Shaping und Stottermodifikationen scheinen die gebräuchlichsten Therapieansätze zu sein. Es bestehen aber sehr große Unterschiede zwischen den einzelnen Ländern. In Russland scheinen obsolete Ansätze noch besonders stark vertreten zu sein.
Abstract: The Fluency Committee of the IALP carried out a survey in Eastern Europe and Latin America in order to assess the therapy status of fluency disorders and service opportunities. Information was collected on prevalence and incidence rates, involvement of government-affiliated agencies, prices, insurance, social support, financing, information, and education about stuttering and stuttering therapy, training of speech language pathologists (logopeds), specialization in stuttering therapy, and cooperation with other specialists. Information was collected for five age groups: Infants and preschool children, primary school children, secondary school children, adolescents, and adults. The reported therapy approaches seemed to be appropriate. We recommend focus on development of efficacy.

Neumann, K.
Verbal bottleneck
Scientific American Mind Oct.-Nov. 2006, 50-55
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Kommentar: Populärwissenschaftliche Darstellung des Wissenstandes über Stottern mit Schwerpunkt auf den beteiligten zerebralen Prozessen.
Abstract: People who stutter sometimes suffer from mistaken notions about their intelligence or emotional balance, but the problem is the neurophysiolocal processes of speaking itself.

von Tiling, J.
Listener perceptions of stuttering, prolonged speech, and verbal avoidance behaviors.
Journal of Communication Disorders; doi:10.1016/j.jcomdis.2010.09.002.
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Kommentar: Zögerliches Sprechen wurde von Zuhörern als weniger angenehm, selbstsicher und kommunikativ kompetent bewertet als gestottertes oder gedehntes Sprechen. Zwischen gestottertem und gedehntem Sprechen gab es keine überzufälligen Unterschiede. Die Bewertungen der Zuhörer hingen von ihren Annahmen über das Stottern ab, z. B. ob sie ein vorübergehendes Problem oder einen chronischen Sprachfehler vermuteten.
Abstract: This study examined listener perceptions of different ways of speaking often produced by people who stutter. Each of 115 independent listeners made quantitative and qualitative judgments upon watching one of four randomly assigned speech samples. Each of the four video clips showed the same everyday conversation between three young men, but differed in how the target person spoke. The four ways of speaking comprised: (1) stuttered speech, i.e., a speech containing repetitions, prolongations, and blocks, (2) hesitant speech, i.e., a speech containing verbal avoidance behaviors like interjections and revisions, (3) a mix of both, and (4) prolonged speech learned in fluency-shaping therapy. Quantitative data revealed that listeners perceived a speaker producing hesitant speech as less pleasant, self-confident, and communicatively competent than a speaker producing stuttered speech or prolonged speech. There were no differences between stuttered speech and prolonged speech. Ratings were partly dependent on the listeners' implicit theory of speaking difficulties, that is, whether they assumed a chronic speech defect or a temporary problem. Implications of these findings are discussed.

Lattermann, T., Neumann, K. & Euler, H. A.
Das Lidcombe-Programm. Ein Interventionsverfahren zur Behandlung frühkindlichen Stotterns, auch für deutschsprachige Kinder
Forum Logopädie, 2009, 23, Heft 2, 16-23
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Abstract: Das Lidcombe-Programm (LP) zur Behandlung frühkindlichen Stotterns, eine hier beschriebene verhaltensmodifi katorische Methode mit den Eltern als Co-Therapeuten, wird bisher vor allem in englischsprachigen Ländern eingesetzt. Die bisherigen evidenz-basierten Ergebnisse dieser Behandlung, einschließlich einer eigenen Untersuchung mit deutschen Kindern, belegen, dass das LP einen über Spontanerholung hinausgehenden dauerhaften Erfolg bewirkt und keine unerwünschten Nebenwirkungen hat. Allerdings sind bei der Anwendung elterliche Vorbehalte gegen diese verhaltenstherapeutische Methode zu berücksichtigen ebenso wie die anscheinend deutsche Neigung, verhaltenskontingente positive soziale Verstärkung eher sparsam einzusetzen.
ENGLISH ABSTRACT:
The Lidcomb Program (LP) for the treatment of child stuttering, a behavior modification method with parents as co-therapists, has been applied mostly in English speaking countries. Evidence-based results, including an own study with German children, shows the program to be significantly effective beyond spntaneous remission, without negative side effects. However, parents' reservations against the method have to be considered as well as the German disposition to be stingy with positive social reinforcement for kids.

Neef N, Sommer M, Neef A, Paulus W, v Gudenberg A, Jung K, Wüstenberg T
Reduced speech perceptual acuity for stop consonants in persons who stutter
Journal of Speech, Language, and Hearing Research, in press.
Kommentar: Stotternde haben eine schwächere Unterscheidungsfähigkeit für unterschiedliche Dauer von Lautanfängen (voice onset times for phonemes). Dieser Befund stützt die motorischen Kontrolltheorien des Stotterns, die feststellen, dass bei Stotternden die internen forward models (Sprecherwartung) verwaschener sind als bei nicht Stotternden. Der Befund ist auch im Einklang mit den Erkenntnissen, dass veränderter auditorischer Feedback bei nicht Stotternden die Sprechfähigkeit stört, bei Stotternden aber die Redeflüssigkeit fördern kann.
Abstract: Purpose: In individuals who stutter (IWS), speech fluency can be enhanced by altered auditory feedback, while it has adverse effects in control speakers. This indicates abnormalities in the auditory feedback loop in stuttering. Current motor control theories on stuttering propose an impaired processing of internal forward models which might be related to a blurred auditory-to-motor translation. Although speech sound perception is an essential skill to form internal models, perceptual acuity has not been studied in IWS so far. We tested the stability of phoneme percepts by analyzing participants' ability to identify voiced and voiceless stop-consonants. Methods: Two syllable continua were generated by systematic modification of the voice onset time. We determined speech perceptual acuity by means of discriminatory power in 25 IWS and 24 matched control subjects by determining the phoneme boundaries, and by quantifying the interval of voice onset times where phonemes were perceived ambiguously. Results: In IWS discriminatory performance was weaker and less stable over time when compared to control subjects. In addition, phoneme boundaries were located at longer voice onset times in IWS. Conclusion: Persistent developmental stuttering is associated with less reliable phonological percepts, supporting current theories regarding the sensory-motor interaction in human speech.

Lattermann, C., Euler, H. A., Neumann, K.
A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers.
Journal of Fluency Disorders, 2008, 33, 52-65.
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Kommentar: Lidcomb-Verfahren bei 3- bis 6-jährigen Kindern signifikant besser als Warte-Kontrollgruppe. Es wird empfohlen, Bestandteile des Lidcomb-Verfahrens in Stottertherapie für Kinder einzubeziehen.
Abstract: In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents' native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany. EDUCATIONAL OBJECTIVES: Readers will discuss and evaluate: (1) the short-term effects of the Lidcombe Program in comparison to natural recovery on stuttering; (2) the impact of the Lidcombe Program on early stuttering in German-speaking preschool children.

 
   
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