1. Altered Auditory Feedback Some Perspectives..

2. What is Altered Auditory Feedback (AAF)? A definition: “AAF is a collective term for conditions that involve electronically altering the speech signal so speakers perceive their voice differently from normal” (Lincoln, Packman and Onslow 2006)

3. Types of AAF Masking Edinburgh masker 1970s Interest waned in the 1980s : problems with continuous usage, and discovery that DAF and FAF were more effective

4. Types of AAF Delayed Auditory Feedback : DAF Delay of conductive voice signal by typically 50- 100 ms. Speakers experience this as a delay in hearing what they have just said. Historically used as a method for inducing prolonged speech (Goldiamond 1965) Only in the 1990s was DAF alone considered as a treatment for stuttered speech.

5. Types of AAF Frequency Altered Feedback : FAF Shifting the frequency of the speakers voice up or down, typically between a ¼ to 1 octave. Speakers hear their voice at a higher or lower pitch than usual.

6. General effects of Altered Auditory Feedback (DAF and FAF) DAF and FAF both shown to reduce stuttering in reading tasks in lab conditions by 40-85% An estimated 10% show no reduction under these conditions Children ( 9-11) showed a smaller reduction than adults under these conditions (10%as opposed to 65% reduction). Howell et al 1999

7. General effects continued.. Reduced speech rate is not essential for stuttering reduction to occur under AAF conditions (though a smaller reduction occurred in faster speech rates) Listeners rated enhanced speech naturalness as opposed to no AAF (Stuart and Kalinowski 2004)

8. Conditions under which AAF has been researched Manipulation of delay: 50 ms best for most (Kalinowski et al 1996). But individual differences Manipulation of Frequency shift: ¼ octave may be best for most (Stuart et al 1996). But individual differences Monaural v binaural delivery. Binaural may be more effective (Kalinowski and Rastatter 1997).Left v right ear, no significant differences

9. Speaking Tasks Oral reading and monologue have been extensively researched. Oral reading has the best results Conversation- as yet no real experimental evidence about day today use outside the clinic. Telephone ( scripted calls, from a clinic), though authors say there was spontaneous conversation too. Significant reduction in stuttering( Zimmerman et al 1997)

10. Speaking tasks.. Audience size (reading aloud). Argued audience size will provoke anxiety. Approx 75% reduction in stuttering regardless of audience size (2,4,15 people). Armson et al 1997

11. AAF as a treatment Very little reported to date Van Borsel et al (2003) Looked at DAF (Casa Futura School DAF) Sampled speech before and after 3 months of daily use Assessed on reading, picture description and conversation (in the clinic only)

12. Findings.. At initial assessment immediate reduction in stuttering noted across all speech tasks More stuttering noted in conversation as compared to oral reading and picture description The reduction noted on first assessment was maintained after 3 months, with, again, conversation showing less reduction in stuttering Some carry over effects of DAF noted as NAF tasks were significantly more stutter free after 3 months No speech naturalness data reported

13. Stuart et al (2004) Used SpeechEasy device (FAF and DAF) with 4 adults and four youths 4 month follow up period Significant reduction in stuttering in both assessments (within clinic) No carry over effects noted Speech naturalness judged higher using the device (except in the youths in monologue tasks)

14. What is successful treatment? Is it reduction in %SS, such as these studies have been examining? OR… are there other parameters we should be looking at? E.g. reduction in avoidance E.g. reduction in struggle E.g. being more open about stuttering E.g. enjoying more speech related challenges

15. Heidi takes over here…

16. Some final comments.. We need good assessment procedures We need to know more about using the device outside of clinic conditions: in particular conversational speech, telephone use etc We need to think about where we stand as regards children using these devices We need to think about whether AAF should be used with other treatment strategies e.g. prolonged speech

17. But most importantly we need to know what our clients think of the devices and …what they are wanting from treatment

18. References in order of presentation Lincoln M., Packman A., Onslow M. (2006) Altered auditory feedback and the treatment of stuttering: a review. Journal of Fluency Disorders 3, 71-89 Goldiamond, I. (1965). Stuttering and fluency as manipulatable operant response classes. In L. Krasner & L. Ullman (Eds.), Research in behaviour modification. New York: Holt, Rinehart and Winston. Howell, P., Sackin, S., & Williams, R. (1999). Differential effects of frequency-shifted feedback between child and adult stutterers. Journal of Fluency Disorders, 24, 127–136. Stuart, A.,&Kalinowski, J. (2004). The perception of speech naturalness of post-therapeutic and altered auditory feedback speech of adults with mild and severe stuttering. Folia Phoniatrica et Logopaedica, 56, 347–357.

19. References Kalinowski, J., Stuart, A., Sark, S., & Armson, J. (1996). Stuttering amelioration at various auditory feedback delays and speech rates. European Journal of Disorders of Communication, 31, 259–269. Stuart, A., Kalinowski, J., Armson, J., Stenstrom, R., & Jones, K. (1996). Fluency effect of frequency alterations of plus/minus one-half and one-quarter octave shifts in auditory feedback of people who stutter. Journal of Speech and Hearing Research, 39, 396–401. Stuart, A., Kalinowski, J.,& Rastatter,M. P. (1997). Effect of monaural and binaural altered auditory feedback on stuttering Zimmerman, S., Kalinowski, J., Stuart, A., & Rastatter, M. (1997). Effect of altered auditory feedback on people who stutter during scripted telephone conversations. Journal of Speech, Language and Hearing Research, 40, 1130–1134.

20. References Armson, J., Foote, S., Witt, C., Kalinowski, J., & Stuart, A. (1997). Effect of frequency altered feedback and audience size on stuttering. European Journal of Disorders of Communication, 32, 359–366. Van Borsel, J., Reunes, G., & Van den Bergh, N. (2003). Delayed auditory feedback in the treatment of stuttering: Clients as consumers. International Journal of Language and Communication Disorders, 38, 119–129. Stuart, A., Kalinowski, J., Rastatter, M., Saltuklaroglu, T., & Dayalu, V. (2004). Investigations of the impact of altered auditory feedback in-the-ear devices on the speech of people who stutter: Initial fitting and 4-month follow-up. International Journal of Language and Communication Disorders, 39, 93–119