Auditory Interventions for Stuttering

Recruiting at 1 trial location

Overseen By Ayoub Daliri, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Arizona State University

Must not be taking: CNS medications

Disqualifiers: Developmental, psychological, neurological, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: Each session may last up to 2 hours

300 Participants Needed

Trial Summary

What is the purpose of this trial?

Stuttering negatively impacts communication and reduces the overall quality of life and well-being of individuals who stutter. This study will provide a strong foundation for developing neural and behavioral interventions for stuttering. Participants will be asked to name pictures, read words/sentences silently or aloud, and listen to speech and nonspeech sounds while their speech, muscle, and brain signals are collected. Some participants may also receive brain stimulation while reading and speaking.

Will I have to stop taking my current medications?

If you are taking any medications that affect the central nervous system, you will need to stop taking them to participate in this trial.

What data supports the effectiveness of the treatment Auditory Interventions for Stuttering?

Research shows that delayed auditory feedback (DAF) can help people who stutter by increasing their ability to modulate auditory processing before speaking, which is often limited in those who stutter. This treatment has been found to partially improve speech fluency in stutterers, even though it may disrupt speech in people who do not stutter. ^{1 2 3 4 5}

Is delayed auditory feedback (DAF) safe for humans?

Research on delayed auditory feedback (DAF) shows it can improve fluency in people who stutter and disrupt fluency in those who do not stutter, but there is no indication of harm or safety concerns in humans from the studies provided. ^{1 2 5 6 7}

How does the auditory intervention treatment for stuttering differ from other treatments?

This treatment is unique because it uses delayed auditory feedback (DAF), where individuals hear their own voice with a slight delay, which can help normalize auditory processing in people who stutter. Unlike other treatments, DAF specifically targets the auditory feedback loop, which is often impaired in stuttering, to improve speech fluency. ^{1 2 3 4 5}

Eligibility Criteria

This trial is for monolingual, native American English speakers who stutter but don't have other developmental, psychological, neurological disorders. They must have normal hearing and not be on central nervous system medications. Adults can't have conditions that make brain stimulation or MRI unsafe.

Inclusion Criteria

My hearing is normal for my age.

I have no health issues preventing me from undergoing tDCS, TMS, or MRI.

I am not on any medications that affect my brain or nerves.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in tasks such as naming pictures, reading words/sentences, and listening to speech and nonspeech sounds while their speech, muscle, and brain signals are collected. Some participants may also receive brain stimulation.

Each session may last up to 2 hours

Follow-up

Participants are monitored for changes in speech and brain activity in response to auditory errors and speech tasks.

4 weeks

Treatment Details

Interventions

• Auditory errors and pre-speech auditory modulation
• Contributions of the speech premotor cortex to pre-speech auditory modulation
• Delaying auditory feedback
• Delaying speech initiation

Trial Overview The study tests how individuals who stutter predict and process auditory errors before speaking. It involves naming pictures, reading silently or aloud, listening to sounds while monitoring speech, muscle, and brain signals. Some may get brain stimulation during these tasks.

Participant Groups

Group I: Group 4 Experimental Treatment 1 Intervention

Group II: Group 3 Experimental Treatment 1 Intervention

Group III: Group 2 Experimental Treatment 1 Intervention

Group IV: Group 1 Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Arizona State University

Lead Sponsor

Trials

311

Recruited

109,000+

University of Washington

Collaborator

Trials

1,858

Recruited

2,023,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Findings from Research

A study involving 12 stuttering and 12 nonstuttering adults found that nonstuttering individuals showed a significant reduction in N1 amplitude during speech planning, indicating effective modulation of auditory processing.

In contrast, the stuttering group did not exhibit this modulation, suggesting that deficiencies in auditory system integration during speech planning may contribute to the speech dysfluencies seen in stuttering.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modulation of auditory processing during speech movement planning is limited in adults who stutter. Daliri, A., Max, L.[2018]

Adults who stutter (AWS) exhibit deficits in pre-speech auditory modulation and auditory-motor learning compared to adults who do not stutter (AWNS), indicating a potential link between these two factors and stuttering frequency.

Interestingly, when exposed to delayed auditory feedback (DAF), AWS showed an increase in pre-speech auditory modulation, which contrasts with the decrease observed in AWNS, suggesting that DAF may help normalize some auditory processing deficits in AWS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stuttering adults' lack of pre-speech auditory modulation normalizes when speaking with delayed auditory feedback. Daliri, A., Max, L.[2019]

Delayed auditory feedback (DAF) significantly improved speech fluency in individuals who stutter without central auditory processing disorders, reducing stuttering-like disfluencies and repetitions.

In contrast, DAF did not show a significant effect on fluency for individuals who stutter and also have central auditory processing disorders, indicating that auditory processing issues may limit the effectiveness of this intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of delayed auditory feedback on stuttering with and without central auditory processing disorders. Picoloto, LA., Cardoso, ACV., Cerqueira, AV., et al.[2022]

The study identified a significant auditory error signal in the auditory cortex when participants experienced delayed auditory feedback, which disrupted their speech fluency, indicating how the brain detects and corrects vocalization errors in real time.

Additionally, the dorsal precentral gyrus (dPreCG) showed a similar response enhancement during speech production, particularly for longer utterances, suggesting it plays a crucial role in processing auditory feedback to maintain fluent speech.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A cortical network processes auditory error signals during human speech production to maintain fluency. Ozker, M., Doyle, W., Devinsky, O., et al.[2022]

In a study involving 22 participants (11 stutterers and 11 controls), delayed auditory feedback (DAF) and various masking conditions were tested, showing that stutterers' speech improved under all experimental conditions, indicating that DAF is not uniquely effective.

Modulated masking was found to be more effective than continuous masking for improving speech fluency, suggesting that the benefits of DAF and masking are not specific to the type of feedback but rather related to the overall auditory environment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acoustic properties of masking/delayed feedback in the fluency of stutterers and controls. Stephen, SC., Haggard, MP.[2019]

The study used positron emission tomography to show that delayed auditory feedback activates specific areas in the brain, particularly the bilateral superior temporal lobes, which are involved in processing auditory information.

Increased delay duration not only heightened activation in these auditory areas but also highlighted the role of the posterior sensorimotor system in speech production when experiencing delays, suggesting a neural basis for how stutterers may compensate for such feedback.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of delayed auditory feedback on activity in the temporal lobe while speaking: a positron emission tomography study. Takaso, H., Eisner, F., Wise, RJ., et al.[2022]

Participants who stutter showed increased Beta band activity in the right temporal-parietal lobe during normal auditory feedback, indicating heightened brain activity related to speech production.

Under delayed and frequency-altered auditory feedback conditions, stuttering behavior decreased significantly, which was associated with reduced Beta activity in the posterior-temporal-parietal regions, suggesting that these feedback alterations may help normalize brain activity and improve speech fluency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quantitative electroencephalogram of posterior cortical areas of fluent and stuttering participants during reading with normal and altered auditory feedback. Rastatter, MP., Stuart, A., Kalinowski, J.[2009]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Modulation of auditory processing during speech movement planning is limited in adults who stutter. [2018]

2. Italy pubmed.ncbi.nlm.nih.gov

Stuttering adults' lack of pre-speech auditory modulation normalizes when speaking with delayed auditory feedback. [2019]

3. Brazil pubmed.ncbi.nlm.nih.gov

Effect of delayed auditory feedback on stuttering with and without central auditory processing disorders. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

A cortical network processes auditory error signals during human speech production to maintain fluency. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Acoustic properties of masking/delayed feedback in the fluency of stutterers and controls. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

The effect of delayed auditory feedback on activity in the temporal lobe while speaking: a positron emission tomography study. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Quantitative electroencephalogram of posterior cortical areas of fluent and stuttering participants during reading with normal and altered auditory feedback. [2009]