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A Preliminary Investigation of the Affective, Behavioral and Cognitive rde iso rs, D De on a ti f a S c t Vanryckeghem et al., Commun Disord Deaf Stud i u n d u i e m s Journal of Communication Disorders, & Hearing Aids 2015, 3:2 m o H C e f a o r l ISSN: 2375-4427i DOI: 10.4172/2375-4427.1000131 n a g n r A u i d o s J Deaf Studies & Hearing Aids Research Article Open Access A Preliminary Investigation of the Affective, Behavioral and Cognitive Variables Associated with Spasmodic Dysphonia Martine Vanryckeghem* and Bari Hoffman Ruddy Department of Communication Sciences and Disorders, University of Central Florida, Orlando, USA *Corresponding author: Martine Vanryckeghem, Professor, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, USA, Tel: 407-823 4808; E-mail: [email protected] Received date: April 02, 2015, Accepted date: April 20, 2015, Published date: April 25, 2015 Copyright: © 2015 Vanryckeghem M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Spasmodic dysphonia (SD) is often assessed and treated in a rather mono-dimensional way, despite knowledge of the impact of SD on a person’s quality of life. This study investigates how adults with SD think and feel about their speech, and cope with their voice problem. Methods: Adults with SD were asked to fill out the Behavior Assessment Battery’s (BAB-Voice) self-report tests. The Speech Situation Checklist-Emotional Reaction and Speech Disruption investigate negative emotional reaction and voice problems in particular speech situations. The Behavior Checklist provides an inventory of behaviours that might be used to avoid or escape voice problems. The Communication Attitude Test for Adults assesses speech- associated attitude. Results: Adults with SD had elevated scores on all BAB tests. Their results were comparable to BAB research with people who stutter. Conclusion: The data show the BAB’s potential to assist clinicians in diagnosis and in designing a tailored multi- dimensional treatment plan. Keywords: Spasmodic dysphonia; Behavior Assessment Battery; individuals with ADSD may also demonstrate increased vocal effort Multi-dimensional assessment; Evidence-based assessment; Stuttering during speech tasks, particularly when attempting to push through a spasm. As such, laryngeal involvement has been evidenced during Background these interruptions in the forward flow of speech [21,22]. Spasmodic dysphonia (SD) is a task specific, focal dystonia The fact that people who stutter (PWS) exhibit more than just characterized by involuntary spasms of the laryngeal muscles. SD is stuttering behaviours has been made clear in repeated research typically an adult-onset disorder [1] that is more prevalent in women investigations [23-27]. Aside from an interruption in the forward flow (nearly 80%) than in men [2]. The National Spasmodic Dysphonia of speech, PWS might use behaviours that are secondary to their Association estimates that 50,000 people in North America are affected stuttering, have a negative speech-associated attitude and experience by SD. The literature provides evidence in support of a neurogenic negative emotional reaction related to sounds, words and/or etiology [3-12] more recently linking SD to the basal ganglia, situations. These dimensions provide clinicians with a multi- thalamus, sensorimotor cortex and cerebellum [13,14]. In the past, SD dimensional "view from within” [27] of their clients’ difficulties. has been associated with controversy in the literature as it relates to Over the past decades, the Behavior Assessment Battery (BAB) varied neurologic, psychiatric and psychoneurotic variables [14-19]. [24,25,27,28] has been internationally used to investigate the Whereas the theory that SD is attributed to a psychogenic disorder has aforementioned dimensions among children and adults who stutter. been disproven, it is evident that a high proportion of patients with SD The BAB consists of a battery of self-report tests: the Speech Situation experience emotional reactions/disturbances, especially anxiety and Checklist (SSC), the Behavior Checklist (BCL) and the depression [20]. Communication Attitude Test for Adults (BigCAT). The BAB SD can present in a variety of forms (adductor, abductor, tremor provides norms for PWS and people who do not stutter (PWNS). It and mixed), each exhibiting distinct vocal symptoms. Adductor SD aids in differential diagnosis of people with and without fluency (ADSD) has been considered the most common form of SD and is disorders. characterized by irregular tight or strained-strangled voice stoppages In addition, the standardized tests that make up the BAB assist in that are caused by the intermittent hyper-adduction of the vocal folds determining the best treatment options for PWS. They point to during phonation [21]. components that need to be part of the treatment plan, such as ‘Speech interruption,’ a characteristic fluency break commonly addressing a person’s negative thoughts about his or her speech, associated with stuttering is frequently experienced by individuals with dealing with the coping behaviours being employed, and attend to the ADSD due to irregular muscular spasms. As with stuttering, difficult situations that create anxiety and evoke speech problems. Commun Disord Deaf Stud Hearing Aids Volume 3 • Issue 2 • 1000131 ISSN:2375-4427 JCDSHA, an open access journal Citation: Vanryckeghem M, Ruddy BH (2015) A Preliminary Investigation of the Affective, Behavioral and Cognitive Variables Associated with Spasmodic Dysphonia. Commun Disord Deaf Stud Hearing Aids 3: 131. doi:10.4172/2375-4427.1000131 Page 2 of 5 Historically, psychosocial implications of SD have received little Materials and procedure attention in the research literature [29]. However, over the past decades investigations have explored the psychosocial impact of SD on Each of the participants was instructed to complete the different daily life by utilizing scales of patient perception developed for a wide BAB self-report tests on an individual base. The NSDA attendees were range of voice disorders [30-33]. The intent of utilizing such scales is given the tests by graduate students who were trained by the first to emphasize the meaning of impairment from the patient’s author, who is also the BAB co-author, in the administration of the perspective, so that interventions have the potential to produce the test battery. The order in which the tests were given to the participants greatest benefit [34], however, these scales are not specific to SD. In was randomized to guard against an order effect. this vein, scales such as the Voice Handicap Index (VHI) [35,36], The four different BAB self-report tests were adapted to be more Voice-Related Quality of Life (V-RQOL) [37,38], and the Voice appropriate for individuals with SD disorders. In other words, the test Disability Coping Questionnaire [39] have been used as a widely- instructions and items were written in such a way to be specific to SD reported means of measuring the psychosocial impact of voice and to reflect the impact of SD on a person’s speech-associated belief, disorders. the possible use of coping behaviours and the extent to which anxiety Attempts to understand the psychosocial effect of SD has also been and voice difficulty is linked to particular speech situations. This reported in the literature through the use of more general health- adaptation resulted in the BAB-Voice [43]. related questionnaires [19,40-42]. While not specifically focusing on The Communication Attitude Test for Adults (BigCAT) SD, they attempt to measure the use of coping behaviours within the investigates a person’s speech-associated attitude. In other words, it social and occupational setting. tests what an individual thinks about his or her voice and way of Though the aforementioned work has broadened our speaking. The participants are asked to reflect on the 35 BigCAT understanding of the psychosocial consequences of SD, much is still statements and to indicate whether or not a statement indicates how unknown about the situational difficulties, speech-related anxiety, they perceive their voice. They do this by circling ‘true or false’ to attitude and coping strategies used by individuals with SD. Gaining an assertions such as “There is something wrong with my voice; my voice authentic view of what goes on within an individual suffering from SD limits my future”. This dichotomous scale uses a zero – one score for continues to be a challenge. This inside view can be difficult to obtain each item, whereby a score of 1 represents a negative speech-associated because of the unique and intricate manner in which a voice disorder attitude. Thus, the possible score for the BigCAT can range from 0 to interacts with many personal and environmental variables that shape 35. each individual’s experience [29]. The Speech Situation Checklist (SSC) consists of two sections. SSC- While SD has been consistently reported to restrict individuals from Emotional Reaction (SSC-ER) assesses negative emotional reaction social and occupational participation; the environments, the coping (anxiety, fear, worry) in particular speech situations. The second mechanisms and the personal factors that shape the consequences of section, SSC-Speech Disruption (SSC-SD) is designed to determine the individuals living with SD require further exploration [29]. All too extent of a person’s speech disruption in the same 51 situations as often, SD is still assessed and dealt with in a rather mono-dimensional described in SSC-ER. Examples of speech situations referred to are: way, although clinical experience has made it clear that individuals “talking on the telephone; being interviewed for a job”. The SSC uses a with SD suffer from more than just a voice/speech problem. Likert-type scale whereby the participants indicate, on a 5-point scale, the extent to which each situation creates negative emotion (SSC-ER) Given the perceived similarities between stuttering and SD and the or speech disruption (SSC-SD).
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