Emotional Processes and Speech Control for Stuttering

Overseen By Victoria Tumanova, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Syracuse University

Must not be taking: Seizure medications

Disqualifiers: Neurological diseases, Autism, others

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

Compensation: Varies

Number of Visits: 3

50 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will compare speech variability between preschool-age children who stutter and typically fluent, age-matched peers. Differences in emotional reactivity, regulation and speech motor control have been implicated in stuttering development in children. This study seeks to understand further how these processes interact. Children will repeat a simple phrase after viewing age-appropriate images of either negative or neutral valence to assess speech motor control.

Will I have to stop taking my current medications?

If your child is taking medications that affect brain functions, like seizure medications, they will need to stop taking them to participate in the trial.

What data supports the effectiveness of this treatment for stuttering?

The research suggests that emotional factors, such as anxiety and negative emotions, play a significant role in stuttering. Treatments that address these emotional aspects, like viewing pictures with different emotional valences, may help reduce negative emotions and improve speech fluency, as seen in the decrease of negative emotions in severe stuttering cases. ^{1 2 3 4 5}

Is the treatment for stuttering involving emotional processes and speech control safe for humans?

The research does not provide specific safety data for the treatment involving emotional processes and speech control for stuttering, but no evidence was found to indicate that emotional reactivity during related tasks constrains or destabilizes speech motor adjustment or execution. ^{2 6 7 8 9}

How does this treatment for stuttering differ from other treatments?

This treatment is unique because it focuses on the emotional processes and speech control by examining the role of the amygdala (a part of the brain involved in emotions) in stuttering. It aims to address the emotional and neural aspects of stuttering, which are not typically the focus of standard speech therapy treatments. ^{4 10 11 12 13}

Research Team

Victoria Tumanova, PhD

Principal Investigator

Syracuse University

Eligibility Criteria

This trial is for preschool-age children who stutter but do not have other speech-language disorders, neurological diseases, or oral-facial structural abnormalities like cleft lip/palate. They should be primarily English speakers with normal hearing and vision (with glasses if needed), and not on medications affecting neural functions.

Inclusion Criteria

You have normal vision according to what your parent says.

I have a cleft lip/palate or similar facial abnormality.

English as the primary language of communication

Exclusion Criteria

Failure to meet the inclusionary criteria listed above

The participant's parents have reported that the participant has a neurodevelopmental disorder like autism.

The participant has vision problems that are not fixed with glasses.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Experimental Condition

Children repeat a simple phrase after viewing images with negative or neutral valence to assess speech motor control

3 weeks

Multiple sessions over 3 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Speaking after viewing blank screen pictures
• Speaking after viewing pictures with negative and neutral valence
• Speaking after viewing pictures with negative valence

Trial Overview The study tests how viewing pictures that are emotionally charged (negative) versus neutral affects speech motor control in children who stutter compared to those who don't. It aims to understand the interaction between emotion and speech variability in early childhood stuttering.

Participant Groups

Group I: Experimental Condition Experimental Treatment 1 Intervention

Speaking while viewing images with negative and neutral valence

Who Is Running the Clinical Trial?

Syracuse University

Lead Sponsor

Trials

54

Recruited

118,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Findings from Research

A study involving 34 participants who stutter and 34 control participants found that those who stutter have significantly higher anxiety related to social situations, as measured by the Fear of Negative Evaluation Scale, indicating a strong expectation of social harm.

The results suggest that anxiety in people who stutter is specifically linked to social evaluation rather than general anxiety, highlighting the importance of using targeted psychological assessments like the Fear of Negative Evaluation and the Endler Multidimensional Anxiety Scales-Trait in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social anxiety in stuttering: measuring negative social expectancies. Messenger, M., Onslow, M., Packman, A., et al.[2013]

People who stutter (PWS) exhibit an attentional bias towards threat words, similar to individuals with anxiety disorders, as shown in a study comparing 31 PWS with 31 fluent controls using a modified emotional Stroop task.

The bias towards threat words in PWS affects their verbal responses, with slower reaction times to threat words correlating with the frequency of their stuttering, indicating that emotionality impacts speech production but does not destabilize speech motor execution.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anxiety and speaking in people who stutter: an investigation using the emotional Stroop task. Hennessey, NW., Dourado, E., Beilby, JM.[2018]

The study found that both emotional factors and language skills contribute to stuttering in preschool-age children, supporting the dual diathesis-stressor model.

Children who stutter showed variations in their stuttering instances based on their emotional responses and coping strategies during narrative tasks, indicating that emotional regulation plays a significant role in stuttering.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dual diathesis-stressor model of emotional and linguistic contributions to developmental stuttering. Walden, TA., Frankel, CB., Buhr, AP., et al.[2022]

In a study of 25 adults undergoing the Comprehensive Stuttering Program, it was found that stuttering severity does not correlate with the severity of negative emotions and cognitions related to stuttering, suggesting these factors should be assessed separately.

The severe stuttering group experienced the most significant treatment gains but also showed the highest regression, indicating that different subtypes of stuttering may require tailored treatment approaches for optimal outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The relationship between pre-treatment clinical profile and treatment outcome in an integrated stuttering program. Huinck, WJ., Langevin, M., Kully, D., et al.[2014]

Preschool-age children who stutter (CWS) show significantly more negative emotions and engage in more self-speech compared to children who do not stutter (CWNS), indicating heightened emotional reactivity.

For CWS, their attempts at emotion regulation (like distraction and self-speech) during frustrating tasks predict the frequency of stuttered disfluencies in their narratives, suggesting that emotional processes are closely linked to stuttering behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Emotional reactivity and regulation in preschool-age children who stutter. Ntourou, K., Conture, EG., Walden, TA.[2021]

A feasibility study involving 31 adults who stutter showed that a computerized attention training intervention for social anxiety disorder was acceptable, with 25 participants completing all data collection points.

The study successfully demonstrated a viable recruitment strategy and gathered positive feedback on the intervention, indicating that modifications are needed before conducting a larger definitive trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive bias modification for social anxiety in adults who stutter: a feasibility study of a randomised controlled trial. McAllister, J., Gascoine, S., Carroll, A., et al.[2021]

Adolescents who stutter show a unique pattern of attentional bias, engaging quickly with threatening facial expressions and disengaging rapidly from them, unlike their typically fluent peers who do not exhibit this bias.

Both groups of adolescents, regardless of stuttering status, displayed similar levels of social anxiety, suggesting that social anxiety does not significantly affect how they respond to threatening stimuli.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attentional Bias Among Adolescents Who Stutter: Evidence for a Vigilance-Avoidance Effect. Rodgers, NH., Lau, JYF., Zebrowski, PM.[2021]

Children who stutter (CWS) showed greater brain responses (measured by late positive potential, LPP) to unpleasant images compared to children who do not stutter (CWNS), indicating heightened emotional reactivity to negative stimuli.

The study suggests that emotional processes are linked to childhood stuttering, and that the temperament of children who stutter should be considered in future research on this topic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cortical associates of emotional reactivity and regulation in childhood stuttering. Zengin-Bolatkale, H., Conture, EG., Key, AP., et al.[2019]

In a study involving ten subjects, the use of a conditioned stimulus (a face slide) effectively suppressed stuttering frequency during treatment, indicating its potential as a therapeutic tool.

The study found varied responses in autonomic arousal (measured by GSR) among subjects, with some showing increased arousal and others decreased, suggesting that individual differences may influence the effectiveness of the treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Conditioned stimulus effects on stuttering and GSRs. Reed, CG., Lingwall, JB.[2019]

This study found that adults who stutter experience higher discomfort during interpersonal communication, which is linked to increased activity in the right amygdala, a brain region associated with emotions.

The research suggests that the right amygdala's activity correlates with instances of stuttering, while adults who stutter show decreased activity in the prefrontal cortex, indicating a potential disruption in emotion regulation during speech.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Speech Disfluency-dependent Amygdala Activity in Adults Who Stutter: Neuroimaging of Interpersonal Communication in MRI Scanner Environment. Toyomura, A., Fujii, T., Yokosawa, K., et al.[2018]

Adults who stutter (AWS) produced words more slowly than adults who do not stutter (ANS), especially under emotionally arousing conditions, indicating a potential impact of emotional state on speech fluency.

AWS exhibited greater fluctuations in second formant frequency (FFF2) when speaking in response to negative emotional stimuli, suggesting that their speech stability is more affected by negative emotions compared to ANS, who showed little change.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Emotion on Second Formant Frequency Fluctuations in Adults Who Stutter. Bauerly, KR.[2019]

In a study involving 19 participants (10 fluent speakers and 9 developmental stutterers), both groups performed similarly in reading tasks, but their brain activation patterns differed significantly, indicating distinct neural processing during speech production.

Fluent speakers showed a typical progression of brain activation from the left inferior frontal cortex to motor areas, while stutterers exhibited reversed activation, suggesting they initiate motor programs before fully preparing their speech, which may contribute to their stuttering difficulties.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single word reading in developmental stutterers and fluent speakers. Salmelin, R., Schnitzler, A., Schmitz, F., et al.[2022]

In a study involving 38 adults (19 who stutter and 19 fluent controls), functional MRI revealed that individuals who stutter exhibited increased connectivity between the right amygdala and areas of the prefrontal cortex during speech tasks, indicating a potential neural basis for heightened anxiety when speaking.

During rest, those who stutter showed stronger connectivity between the hippocampus and motor areas compared to fluent individuals, suggesting that anxiety regulation may be disrupted in people who stutter, which could contribute to their speech difficulties.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of anxiety in stuttering: Evidence from functional connectivity. Yang, Y., Jia, F., Siok, WT., et al.[2018]

References

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

Social anxiety in stuttering: measuring negative social expectancies. [2013]

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

Anxiety and speaking in people who stutter: an investigation using the emotional Stroop task. [2018]

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

Dual diathesis-stressor model of emotional and linguistic contributions to developmental stuttering. [2022]

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

The relationship between pre-treatment clinical profile and treatment outcome in an integrated stuttering program. [2014]

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

Emotional reactivity and regulation in preschool-age children who stutter. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Cognitive bias modification for social anxiety in adults who stutter: a feasibility study of a randomised controlled trial. [2021]

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

Attentional Bias Among Adolescents Who Stutter: Evidence for a Vigilance-Avoidance Effect. [2021]

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

Cortical associates of emotional reactivity and regulation in childhood stuttering. [2019]

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

Conditioned stimulus effects on stuttering and GSRs. [2019]

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

Speech Disfluency-dependent Amygdala Activity in Adults Who Stutter: Neuroimaging of Interpersonal Communication in MRI Scanner Environment. [2018]

11. Switzerland pubmed.ncbi.nlm.nih.gov

The Effects of Emotion on Second Formant Frequency Fluctuations in Adults Who Stutter. [2019]

12. England pubmed.ncbi.nlm.nih.gov

Single word reading in developmental stutterers and fluent speakers. [2022]

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

The role of anxiety in stuttering: Evidence from functional connectivity. [2018]