口吃共病强迫症的访谈与治疗

本文目的是通过报道病例诊疗过程,呈现口吃共病强迫症的临床诊疗思路及治疗方案的制定。咨客是一位23岁的未婚男性,自幼口吃,在应激和焦虑状态下加重,影响工作和社交。咨客自高中二年级开始时出现反复数钱、反复计算的行为,被诊断为强迫症,予以SSRIs类药物联合第二代抗精神病药物治疗,强迫思维和强迫行为得到改善,但出现嗜睡、情绪烦躁等,减少思瑞康剂量后,出现失眠,焦虑加重影响口吃,伴有心慌、紧张、进食后腹泻等。咨客被诊断为口吃共病强迫症,建议采用生物-心理-社会综合干预方法,通过积极运动缓解压力,继续服用百忧解,降低思瑞康剂量,减轻嗜睡,予以β-受体阻断剂普萘洛尔弥补思瑞康减量带来的焦虑。心理治疗推荐认知行为治疗和正念减压;社会学方面,继续从事会计等人际交往较少的工作。     

Child and parent speech and language following the Lidcombe Programme of early stuttering intervention

The Lidcombe Programme of early stuttering intervention incorporates operant methods, and outcome data indicate that the procedure is an effective treatment. However, the mechanism or mechanisms responsible for the effects of this treatment remain unknown. One possible mechanism could involve untargeted change to parameters of parent and child speech during the intervention. In this preliminary report, speech samples from nine children were studied before and after treatment. The purpose was to target independent variables for future research. In spite of clear reductions in disfluency and stuttering in the children, there were no corresponding changes in child or parent speech rate, interspeaker turn latencies, or pragmatic functioning, that might account for such treatment effects. In fact, data suggested changes that would not be theoretically predicted to be associated with reductions in disfluent and stuttered speech: Maternal speech rate increased in post-treatment speech samples and the mothers decreased the proportion of their utterances that contained a request for information. However, some children's language measures did not meet developmental expectations during the period of study. Nonetheless, all children's language measures were within or above developmental expectancies during the period of study, which ruled out the possibility that this treatment induces extensive curtailment of language functioning.     

Neurodevelopment for syntactic processing distinguishes childhood stuttering recovery versus persistence

Background

Characterized by the presence of involuntary speech disfluencies, developmental stuttering is a neurodevelopmental disorder of atypical speech-motor coordination. Although the etiology of stuttering is multifactorial, language development during early childhood may influence both the onset of the disorder and the likelihood of recovery. The purpose of this study was to determine whether differences in neural indices mediating language processing are associated with persistence or recovery in school-age children who stutter.

Methods

Event-related brain potentials (ERPs) were obtained from 31 6–7-year-olds, including nine children who do not stutter (CWNS), 11 children who had recovered from stuttering (CWS-Rec), and 11 children who persisted in stuttering (CWS-Per), matched for age, and all with similar socioeconomic status, nonverbal intelligence, and language ability. We examined ERPs elicited by semantic and syntactic (phrase structure) violations within an auditory narrative consisting of English and Jabberwocky sentences. In Jabberwocky sentences, content words were replaced with pseudowords to limit semantic context. A mixed effects repeated measures analysis of variance (ANOVA) was computed for ERP components with four within-subject factors, including condition, hemisphere, anterior/posterior distribution, and laterality.

Results

During the comprehension of English sentences, ERP activity mediating semantic and syntactic (phrase structure) processing did not distinguish CWS-Per, CWS-Rec, and CWNS. Semantic violations elicited a qualitatively similar N400 component across groups. Phrase structure violations within English sentences also elicited a similar P600 component in all groups. However, identical phrase structure violations within Jabberwocky sentences elicited a P600 in CWNS and CWS-Rec, but an N400-like effect in CWS-Per.

Conclusions

The distinguishing neural patterns mediating syntactic, but not semantic, processing provide evidence that specific brain functions for some aspects of language processing may be associated with stuttering persistence. Unlike CWS-Rec and CWNS, the lack of semantic context in Jabberwocky sentences seemed to affect the syntactic processing strategies of CWS-Per, resulting in the elicitation of semantically based N400-like activity during syntactic (phrase structure) violations. This vulnerability suggests neural mechanisms associated with the processing of syntactic structure may be less mature in 6–7-year-old children whose stuttering persisted compared to their fluent or recovered peers.     

The effect of stuttering on communication: A preliminary investigation

This paper describes a study in which Systemic Functional Linguistics was applied to describe how people who stutter use language. The aim of the study was to determine and describe any differences in language use between a group of 10 adults who stutter and 10 matched normally‐fluent speakers. In addition to formal linguistic analyses, analyses drawn from Systemic Functional Linguistics were used to further investigate the expression of both syntactic and semantic complexity. The findings from this study replicated previous findings of Packman et al. in which they found that the language used by people who stutter was significantly less complex than the control group. Another major finding was that adults who stuttered used the linguistic resource of modality significantly less than the normally‐fluent matched peers. The implications these strategies have on communication and social participation will be discussed.     

Segmental and metrical complexity during non-word repetition in adults who stutter

Non-word repetition is weaker for adults who stutter (AWS) compared to adults who do not stutter (AWNS) as phonological demands increase. However, non-word stimuli used in previous studies varied by length, but did not vary with regard to segmental or metrical complexity. The purpose of the present study was to examine the unique influence of these two distinct types of complexity on non-word repetition in AWS and AWNS via administration of the Test of Phonological Structure (TOPhS). Twenty-four adults (12 AWNS, 12 AWS) repeated 96 non-words within a soundproof booth immediately after auditory presentation. All 96 non-word targets included on the TOPhS were one to four syllables in length and ranked based on segmental complexity (simple, moderate and complex) and metrical complexity (simple, moderate and complex). No main effect of metrical complexity was detected between groups, and no differences in accuracy were observed for non-words with simple or moderate segmental complexity. However, AWS were significantly more likely to produce a phonemic error when repeating words with complex segmental structure than AWNS, irrespective of metrical complexity. Segmental complexity may contribute to the differences in phonological working memory in AWS when controlling for metrical complexity and length.     

Speech timing in children after the Lidcombe Program of early stuttering intervention

It is known that operant treatments can control stuttering in children. However, at present it is unknown why such treatments are effective. Changes in the usual way of speaking are frequently observed after behavioural treatments for adults who stutter, and it is possible that operant treatments for children also invoke such changes. To explore this idea, selected acoustic measures of speech timing were made in eight preschool children before and after receiving the Lidcombe Program, which is an operant treatment for stuttering. No systematic changes were detected after treatment. Considering this finding and a previous report, there is no evidence to suggest that the reductions in stuttering that occur with this treatment are related to systematic changes in speech timing or curtailment of language function.     

Correlation of orofacial speeds with voice acoustic measures in the fluent speech of persons who stutter

Stuttering is often viewed as a problem in coordinating the movements of different muscle systems involved in speech production. From this perspective, it is logical that efforts be made to quantify and compare the strength of neural coupling between muscle systems in persons who stutter (PS) and those who do not stutter (NS). This problem was addressed by correlating the speeds of different orofacial structures with vowel fundamental frequency (F0) and intensity as subjects produced fluent repetitions of a simple nonsense phrase at habitual, high, and low intensity levels. It is assumed that resulting correlations indirectly reflect the strength of neural coupling between particular orofacial structures and the respiratory-laryngeal system. An electromagnetic system was employed to record movements of the upper lip, lower lip, tongue, and jaw in 43 NS and 39 PS. The acoustic speech signal was recorded and used to obtain measures of vowel F0 and intensity. For each subject, correlation measures were obtained relating peak orofacial speeds to F0 and intensity. Correlations were significantly reduced in PS compared to NS for the lower lip and tongue, although the magnitude of these group differences covaried with the correlation levels relating F0 and intensity. It is suggested that the group difference in correlation pattern reflects a reduced strength of neural coupling of the lower lip and tongue systems to the respiratory-laryngeal system in PS. Consideration is given to how this may contribute to temporal discoordination and stuttering.     

Lexical characteristics of sound change

In the profession of speech-language pathology, there is a strong belief that phonological disorders frequently occur in children who stutter. The purpose of this article is to examine recently published studies that addressed the frequency with which the two disorders co-occur. Over 10 years ago, a similar article was published in which studies that had been conducted from the 1920s through the 1980s were examined. Unfortunately, methodological problems with the earlier studies limited the conclusions that could be drawn. Because of the uncertainty generated by those studies, researchers since 1990 have continued to investigate this topic. Based on the previous review, it is argued that more rigorous methods are needed, including the use of more objective and comprehensive measures of phonological development and matched control groups of non-stuttering children. The current review indicates that frequency rates vary widely from one study to another, making it difficult to state with confidence just how often the two disorders co-occur. Possible explanations for the discrepancies are discussed, including differences in how phonological disorders are defined and identified. Suggestions are offered for future research to obtain more precise estimates of co-occurrence.     

Looking at stuttering through the lens of complexity

In this theoretical paper, the disorder of stuttering is viewed through the lens of complexity. The complexity perspective is a way of understanding complex systems and it has been applied for this purpose across a range of domains, including architecture, economics, sociology, psychology and, most importantly in the present context, health. In this paper we apply some principles and metaphors of complexity to explain the disorder of stuttering. Through the complexity lens, stuttering comprises a number of complex systems, within both the person and the environment, that self-organize in response to a disturbance in the neural processing that is thought to underpin stuttering. The complexity perspective allows us to see this complex disorder in its entirety and provides a framework for integrating research and theory. The complexity perspective also highlights the importance of early intervention.