Speech Sound Stimulation for Stuttering

Recruiting at 1 trial location

Overseen By Ashley Parker, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Must not be taking: Neural function medications

Disqualifiers: Cognitive impairment, Major illness, Pregnancy, others

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

Compensation: Varies

Number of Visits: 4

600 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how children’s brains process speech and language, focusing on differences between those who stutter and those who do not. It involves speech sound stimulation (also known as speech sound therapy or auditory feedback therapy) and uses methods like EEG (a test that measures brain waves) and fMRI (a type of brain scan) to study these processes. Children who stutter and those who do not, but speak English, have typical language skills, and no other communication disorders, may be a good fit.

As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research on speech and language processing in children.

Will I have to stop taking my current medications?

If you are taking medication that alters brain function, you will need to stop taking it to participate in this trial.

What prior data suggests that speech sound stimulation is safe for children?

Research has shown that speech sound techniques, such as altered auditory feedback (AAF), are generally safe. This finding reassures those considering participation in a trial using these methods. While AAF differs slightly from other techniques, its similarity offers some comfort. Studies on these therapies aim to help with stuttering, and no major problems have been reported. Participants typically find the treatment manageable, with few or no side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about speech sound stimulation for stuttering because it takes a novel approach by combining behavioral exercises with advanced technologies like electrophysiological tasks and magnetic resonance imaging (MRI). Unlike traditional therapies that mainly focus on speech therapy and counseling, this method aims to directly stimulate the neural pathways involved in speech production. This multi-faceted approach could provide deeper insights into the neurological aspects of stuttering and potentially offer more targeted and effective treatment options.

What evidence suggests that speech sound stimulation is effective for stuttering?

Studies have shown that listening to altered speech sounds can help people who stutter. Research indicates that changing how individuals hear their own voice, such as by delaying the sound, can improve speech flow for those with severe stuttering. In one study, this method helped most participants reduce stuttering to less than 1% of spoken syllables. Another study found that participants spoke more fluently and scored better in reading and speaking tasks. These findings suggest that altering speech sounds can make a noticeable difference for people who stutter. In this trial, participants will receive speech sound stimulation to further explore its effects on stuttering. ^{1 3 6 7 8}

Who Is on the Research Team?

Amanda Hampton Wray, PhD, CCC-SLP

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

This trial is for children who stutter without other communication disorders, speak English primarily, and have typical language and cognitive abilities. They must not have a family history of stuttering (for non-stutterers), no metal implants, not be on neural-altering meds, nor pregnant. MRI contraindications apply.

Inclusion Criteria

I have had a stutter since childhood.

You don't have any reasons that would make it unsafe for you to have an MRI scan.

No history of other communication disorder (for children who stutter)

Exclusion Criteria

I have foreign objects, like metal, in my eye.

I have tattoos with iron or metal pigments.

My cognitive skills are below average.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Baseline Assessment

Participants undergo baseline assessments including standardized tests for speech, language, and cognitive skills

1 session (up to 2 hours)

1 visit (in-person)

Experimental Tasks

Participants complete EEG and fMRI tasks to evaluate neural processing of speech signals

3 sessions (up to 5 hours total)

3 visits (in-person)

Follow-up

Participants are monitored for any delayed effects or additional data collection

2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Speech sound stimulation

Trial Overview The study aims to understand how speech and language are processed in the brains of children who stutter compared to those who don't. It involves behavioral tests, EEG tasks, fMRI scans, and computational modeling to evaluate these neural processes.

How Is the Trial Designed?

Group I: Speech sound stimulation Experimental Treatment 1 Intervention

Speech sound stimulation via behavioral, electrophysiological, and magnetic resonance imaging-based tasks

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

University of Michigan

Collaborator

Trials

1,891

Recruited

6,458,000+

Published Research Related to This Trial

Altered auditory feedback (AAF) shows promise as a treatment for stuttering, with considerable experimental evidence supporting its effects, but there is limited Phase 1 treatment outcome data available.

There is a significant gap in understanding how AAF performs in everyday conversational speech and how to tailor AAF levels for individual needs, making it currently unsuitable as a clinical option for children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Altered auditory feedback and the treatment of stuttering: a review. Lincoln, M., Packman, A., Onslow, M.[2022]

The use of Delayed Auditory Feedback (DAF) and Frequency Altered Feedback (FAF) through an In-The-Canal (ITC) device showed significant promise in reducing stuttering, allowing for more fluent and natural speech after 10 months of use.

The author experienced a notable improvement in speech fluency and a reduction in fear associated with stuttering, suggesting that these auditory feedback techniques may inhibit stuttering without requiring a slower speech rate, although further research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-reported efficacy of an all in-the-ear-canal prosthetic device to inhibit stuttering during one hundred hours of university teaching: an autobiographical clinical commentary. Kalinowski, J.[2019]

In a study involving four adult males who stutter, the effects of frequency-altered auditory feedback (FAF) on speech performance were inconsistent, with one subject showing significant improvement while others had varied responses, including no change or even deterioration in speech quality.

The results suggest that FAF may not be a universally effective intervention for stuttering, highlighting the need for further research to understand individual differences in response to auditory feedback techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Experimental investigation of the effects of frequency-altered auditory feedback on the speech of adults who stutter. Ingham, RJ., Moglia, RA., Frank, P., et al.[2019]

In a randomized clinical trial involving 17 adults who stutter, both the SpeechEasy® device and behavioral fluency techniques resulted in a similar 40% reduction in stuttered syllables after treatment, indicating comparable efficacy.

Participants using the SpeechEasy® device for 6 months showed no significant relapse in stuttering after 3 or 6 months, suggesting that this device can be a reliable long-term treatment option for stuttering.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized clinical trial: the use of SpeechEasy® in stuttering treatment. Ritto, AP., Juste, FS., Stuart, A., et al.[2018]

Auditory feedback alterations (AAF) significantly improve the perceived naturalness of speech in individuals who stutter compared to non-altered feedback, indicating a beneficial effect of AAF on speech fluency.

Individuals who stutter rated their speech as less natural after completing therapy compared to when using AAF, suggesting that while therapy may help with fluency, it may not enhance the perceived naturalness of speech as effectively as AAF.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The perception of speech naturalness of post-therapeutic and altered auditory feedback speech of adults with mild and severe stuttering. Stuart, A., Kalinowski, J.[2009]

A survey of 14 Australian users of altered auditory feedback (AAF) devices showed mixed opinions on their effectiveness and satisfaction in everyday speaking situations, indicating variability based on the type of device used.

The study highlights the need for further research to explore how AAF devices can be integrated with traditional treatments for stuttering to enhance their effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A survey of Australian adult users of altered auditory feedback devices for stuttering: use patterns, perceived effectiveness and satisfaction. Lincoln, M., Walker, C.[2007]

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]

A 3-month study involving 9 individuals who stutter showed that repeated exposure to delayed auditory feedback (DAF) significantly reduced the percentage of stuttered words during non-altered feedback (NAF) conditions.

The results indicate that DAF can effectively improve speech fluency outside of a clinical setting, although the relationship between the length of exposure and fluency improvement may not be straightforward.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Delayed auditory feedback in the treatment of stuttering: clients as consumers. Van Borsel, J., Reunes, G., Van den Bergh, N.[2019]

The use of a self-contained ear-level device delivering altered auditory feedback significantly reduced stuttering events in nine individuals over a 12-month period, indicating its long-term efficacy.

Participants reported less struggle, avoidance, and negative expectations related to stuttering after using the device, and their speech was rated as more natural by listeners, suggesting both subjective and objective improvements in speech quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigations of the impact of altered auditory feedback in-the-ear devices on the speech of people who stutter: one-year follow-up. Stuart, A., Kalinowski, J., Saltuklaroglu, T., et al.[2006]

The systematic review of studies on delayed auditory feedback (DAF) for stuttering found that there is currently insufficient evidence to support its effectiveness in improving speech fluency, due to methodological variability across studies.

The limitations identified in the existing research highlight the need for more rigorous future studies to better assess the potential benefits of DAF and frequency-altered feedback in treating stuttering.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Systematic review of delayed auditory feedback effectiveness for stuttering reduction]. Andrade, CR., Juste, FS.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12118585/

Reimagining stuttering therapy and outcomes through an ... The purpose of this paper is to summarize a panel discussion at the 2024 World Stuttering and Cluttering Organization Congress that aimed to explore and reflect

2. sciencedirect.com sciencedirect.com/science/article/pii/S1808869419301120

Impact of auditory feedback alterations in individuals with ... The effect of delayed auditory feedback was favorable for the Severe Stuttering Group, promoting speech fluency.

3. pubs.asha.org pubs.asha.org/doi/10.1044/2023_JSLHR-23-00224

Effectiveness of Stuttering Modification Treatment in School ... In the treatment of school-age children who stutter, 89% of the clinicians reported providing stuttering modification therapy Kinder Dürfen Stottern (KIDS; “ ...

4. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK338625/

Results of the effectiveness review - NCBI - NIH In summary, this study found that for 6 out of the 10 children taking part, EMG reduced stuttering to less than 1% of syllables that are stuttered immediately ...

5. arxiv.org arxiv.org/html/2503.02743v1

Evaluating a Digital Speech Therapy App for Stuttering Results indicate significant improvements in fluency, with reductions in SSI-4 scores across reading, speaking, duration, and physical ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT07061730

NCT07061730 | Evaluating the Effectiveness of Hybrid and ... The purpose of this research study is to evaluate the effectiveness of a hybrid Artificial Intelligence-assisted speech therapy model, ...

7. withpower.com withpower.com/trial/phase-stuttering-8-2022-c3606

Speech Sound Stimulation for Stuttering The research on altered auditory feedback (AAF) devices, which are similar to speech sound stimulation, does not report any safety concerns for humans. However, ...

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0094730X08000673

Effects of altered auditory feedback (AAF) on stuttering ... The present study found that AAF is an effective means to reduce stuttering frequency during monologue speech production.