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Stuttering Severity and Responses to Social-Communicative Challenge In Thank you for using our service! Interlibrary Services The Ohio State University Libraries (614)292-9077 [email protected] Article Express documents are delivered 24/7 directly to your ILLiad account from scanning libraries around the world. If there is a problem with a PDF you receive, please contact our office so we might report it to the scanning location for resolution. NOTICE WARNING CONCERNING COPYRIGHT RESTRICTIONS The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. 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Stuttering severity and responses to social- communicative challenge in preschool-age children who stutter Danra Kazenski1, Barry Guitar1, Rebecca McCauley1,2, William Falls3, Lindsay Stallings Dutko1,4 1Department of Communication Sciences and Disorders, University of Vermont, Pomeroy Hall, 489 Main Street, Burlington, VT 05405, USA, 2Present Address: Department of Speech and Hearing Science, The Ohio State University, 134a Pressey Hall, 1070 Carmack Road, Columbus, OH 43210-1002, USA, 3Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA, 4Present Address: Department of Speech Pathology & Audiology, Duke University Hospital, DUMC 3887, Durham, NC 27710, USA Purpose: This study assessed indices of autonomic arousal and vocal tension during challenge in preschool- age children who do stutter (CWS) and do not stutter (CWNS). Method: Participants were preschool-age CWS (n = 10) and gender- and age-matched CWNS (n = 10) who performed in two speaking conditions: (1) ‘low’ challenge – naming age-appropriate pictures in a familiar room with the same examiner who administered his/her speech-language prescreening test (2) ‘high’ challenge – recalling the pictures named in condition (1) in a different room with an unfamiliar examiner while wearing acoustic startle electrodes on his/her face. Immediately following the ‘high’ challenge speaking task, the participants’ acoustic startle eyeblink response (ASEB) was measured. Dependent variables were ASEB in the ‘high’ challenge condition and the acoustic measure of mean fundamental frequency (Fo) in both challenge conditions. Results: Findings indicated no significant between-group (CWS vs. CWNS) differences in Fo or ASEB responses. However, CWS-severe (n = 5), when compared with CWS-mild/moderate (n = 5), exhibited a statistically significant increase in Fo in the ‘high’ challenge relative to the ‘low’ challenge condition. Conclusions: Results were taken to suggest that preschool-age CWS-severe exhibit vocal tension while speaking in conditions of social (e.g. speaking to unfamiliar examiner) and communicative (e.g. recalling from memory names of pictures previously shown) challenge, and such vocal behavior is possibly associated with this subgroup’s difficulty establishing normally fluent speech. Keywords: Preschool, Stuttering, Acoustic startle, Fundamental frequency, Challenge Autonomic arousal has long been speculated to be control for both adults and children who do not associated with stuttering (e.g. Brutten and stutter (Kleinow and Smith, 2006). A recent prelimi- Shoemaker, 1967; Conture and Walden, 2012; nary study utilizing skin conductance response as a Guitar, 2013; Smith, 1999), with such speculation primary measure (Arenas and Zebrowski, 2013), indi- receiving some empirical support. For example, cated that AWS had a significantly greater autonomic Weber and Smith (1990) reported that extreme auto- conditioned response to an aversive stimulus relative to nomic arousal in a stressor condition was positively adults who do not stutter (AWNS). correlated with stuttering severity and frequency in Unfortunately, less is known about these variables adults who stutter (AWS), suggesting that such in preschool-age children who stutter (CWS) com- arousal may affect speech motor control. pared to children who do not stutter (CWNS) closer Furthermore, autonomic arousal has been shown to to the onset of stuttering. Lack of information regard- be associated with more variable speech motor ing preschool-age CWS is salient because young CWS typically have minimal experience with stuttering and hence less opportunity to develop learned reactions Correspondence to: Danra Kazenski, Department of Communication to stuttering. One exception to this dearth of infor- Sciences and Disorders, University of Vermont, Pomeroy Hall, 489 Main Street, Burlington, VT 05405, USA. Email: [email protected] mation relates to empirical studies employing ©W.S.Maney&SonLtd2014 142 DOI 10.1179/2050572813Y.0000000032 Speech, Language and Hearing 2014 VOL. 17 NO. 3 Kazenski et al. Stuttering severity and responses to social-communicative challenge in CWS behavioral measures of expressed emotion, the latter between-group differences in the overall variation in believed to be an indirect index of autonomic activity. mean Fo. For instance, Hall and Yairi (1992) demon- Specifically, findings based on behavioral indices of strated a low positive correlation between stuttering preschool-age CWS and CWNS’s expressed emotional severity and mean Fo in preschool-age boys who arousal (e.g. Arnold et al., 2011; Johnson et al., 2010; stutter. In contrast, other researchers have reported Ntourou et al., in press; Walden et al., 2012) appear to that the mean Fo of AWS does not significantly support the notion that increases in emotional arousal differ from AWNS (Healey, 1982; Sacco and Metz, are associated with childhood stuttering. For example, 1989). In this study, Fo will be referred to as an indirect preschool-age CWS’s stuttering has been reported to index of vocal tension. increase when increased emotional reactivity is associ- ated with decreased emotional regulation (Walden Acoustic startle eyeblink response et al., 2012). As intriguing as these behavioral findings ASEB is a robust non-speech measure of physiological may be regarding preschool-age CWS, the impli- reactivity (Grillon, 2002; Grillon and Baas, 2003; cations might be more comprehensive if they were cor- Mauss and Robinson, 2009). Startle is a defensive, roborated by converging lines of evidence, particularly reflexive response consisting of a rapid contraction of in the form of (non-speech) physiological as well as the orbicularis oculi muscle, which is innervated by speech indices of autonomic arousal. Given empirical the facial nerve. The ASEB response is a measure of evidence suggesting that autonomic arousal affects the magnitude and latency of a reflexive eyeblink speech motor control in AWS (Kelly et al., 1995; response to randomly administered brief pulses of Kleinow and Smith, 2006; Peters and Hulstijn, 1984; high-intensity white noise. Latency (in ms) is the Weber and Smith, 1990), measuring physiological time from the onset of the startle stimulus to the first responses in preschool-age CWS and CWNS closer sign of eyeblink response, with shorter latencies reflect- to the onset of stuttering should provide useful infor- ing higher levels of neurophysiological reactivity. The mation about the association of speech motor amplitude of startle response has been shown to control and autonomic arousal during the early increase when the person is in an aroused emotional stages of developmental stuttering. state such as fear (Lang et al., 1990) or anticipatory It seems possible that the association between anxiety (Grillon, et al., 1991; Sabatinelli et al., 2001). changes in autonomic or emotional variables and To date, the only published studies of ASEB that speech motor control activity is apt to be subtle as these authors are aware of has involved AWS and well as brief in nature, particularly in young children AWNS. For example, Bradley and Lang (2000) near the onset of stuttering. Thus, as a preliminary found that AWNS exhibited an increase in magnitude attempt to non-invasively measure such possibly of ASEB response when exposed to unpleasant com- subtle autonomic reactions in a preschool-age popu- pared to pleasant or neutral affective sounds. lation, both speech (mean fundamental frequency) Further, Guitar (2003) reported a statistically signifi- and non-speech (acoustic startle eyeblink response cant difference (81% higher) mean amplitude of (ASEB)) indices of autonomic arousal were employed. startle response for 14 AWS compared to matched Following is a brief discussion of the general back- AWNS. In contrast, Alm and Risberg (2007) found ground of each measure as well as each measure’s that startle amplitude was not significantly associated specific application to stuttering. with anxiety or reactive temperament even though the ‘trait anxiety’ scores for the AWS group were sig- Vocal measure fundamental frequency nificantly higher than for the controls in their study. Vocal fundamental frequency (Fo), or pitch, is the Ellis et al. (2008) also measured the latency and peak vibratory rate of the vocal folds measured
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