Fluency shaping increases integration of the command-to-execution and the auditory-to-motor pathways in persistent developmental stuttering

Purpose: The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering. Method: We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated. Results: Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased. Conclusions: Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

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An Advanced Concept of Altered Auditory Feedback as a Prosthesis-Therapy for Stuttering Founded on a Non-Speech Etiologic Paradigm

Clinical Technologies ◽

10.4018/978-1-60960-561-2.ch417 ◽

2011 ◽

pp. 1284-1326

Author(s):

Manuel Prado-Velasco ◽

Carlos Fernández-Peruchena

Keyword(s):

Auditory Feedback ◽

Intelligent System ◽

Adult Population ◽

True Nature ◽

New Approach ◽

Persistent Developmental Stuttering ◽

The World ◽

Developmental Stuttering ◽

Neuroimaging Techniques

Persistent Developmental Stuttering affects 1-2% of the world adult population. Its etiology is still unknown, although modern neuroimaging techniques have shown a new and exciting perspective of earlier ideas and hypotheses. However, it is now clear that a new approach to understand the true nature of the disorder is needed. We present a new etiological model of persistent developmental stuttering based on a deep analysis of earlier models and on the stuttering phenomenology, described in basic, clinical, and even ethnographic sources. One of the more stimulating conclusions has been the suggestion that stuttering is a non-speech based disorder, in opposition to the accepted belief. The implications of this model have guided the design of a new adaptive AAF device for prosthetic and therapeutic functions. It is supported by a wearable multimodal intelligent system, which evolves from a preliminary proposal presented in (Prado & Roa, 2007).

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