Comparing the performance of people who stutter and people who do not stutter on the Test of Everyday Attention

ABSTRACT

Introduction: Compelling findings into the relationship between stuttering and attentional ability have started to emerge, with some child and adult studies indicating poorer attentional ability among people who stutter (PWS). The purpose of the present research was to provide a more complete picture of the attentional abilities of PWS, as well as to gather insights into their individual attentional performance.

Method: We compared the attentional ability of PWS to that of people who do not stutter (PWNS) by using the Test of Everyday Attention (TEA). TEA is a clinical assessment battery with a very good validity and reliability comprising 8 subtests that pose differential demands on sustained attention, selective attention, attentional switching, and divided attention. Fifty age- and gender-matched PWS and PWNS (aged 19–77 years) took part in the study. Importantly, we also examined stuttering severity in the PWS group.

Results: PWS performed significantly worse on tasks tapping into visual selective and divided attentional resources. Furthermore despite failing to reach statistical significance, the results also revealed an interesting trend for stuttering to be associated with poorer performance on two subtests measuring attentional switching and one tapping into auditory selective attention. Moreover, as hypothesized, there was also a negative association between stuttering severity and performance on two TEA subtests measuring visual selective attention. Finally, the type of TEA test variant produced no significant effect on performance.

Conclusions: We interpret these results as indicative of stuttering being associated with poorer performance on tasks measuring certain attentional abilities. These tie in well with theoretical models identifying speech production as particularly attention-demanding in stuttering or approaches placing attentional dysfunction at the heart of the condition. The present research also has practical implications for the use of attentional training to improve fluency.

KEYWORDS:

• Adults
• attention
• cognitive control
• stuttering
• TEA

Acknowledgments

We would like to thank the Dominic Barker Trust for fully funding this research.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Some tests to study inhibitory control are go/no-go tasks, flanker tasks, delay gratification paradigms, the Simon effect (see Diamond, 2013 for a review).

2. ERP stands for event-related potential (ERP). ERPs are used to measure brain activity in response to different events (these could be sensory, cognitive, motor, etc.).

3. One interpretation is that semantic interference made it more difficult for AWS to encode and/or maintain target words in short-term memory until standard tones were verified at the Long Tone SOA.

4. Inhibitory control is effectively the converse of selecting task-relevant information (see Zanto & Gazzaley, 2017, for a discussion).

5. Attentional switching stands for another aspect of the attentional system that requires cognitive control: how quickly one can switch between tasks and apply new rules. The latter is often used as an index of mental flexibility (Kreutzfeldt, Stephan, Sturm, Willmes, & Koch, 2015).

6. Posner and Petersen (1990) identify three separate attentional systems: selective attention, sustained attention, and attentional orienting. TEA measures selective and sustained attention but not attentional orienting (Robertson et al., 1994).

7. The present study included more male participants, in line with the gender bias in stuttering. The disorder is 2.4–5.33 times more prevalent in males (Andrews & Harris, 1964; Howell, Davis, & Williams, 2008).

8. These included 7 TEA subtests: Map Search 1 min (MS1); Map Search 2 min (MS2); Elevator Counting with Distraction (ECWD); Visual Elevator timing score (VE); Elevator with Reversal (ER); Telephone Search (TS); Telephone Search while Counting Dual Task Decrement (DTD).

9. It is likely that participants were subvocally repeating the tone count in memory.

10. Attentional orienting has not been included in TEA as it is difficult to assess with a paper-and-pen test, as explained in the TEA manual (Robertson et al., 1994). Attentional orienting has been defined as “the aligning of attention with a source of sensory input or an internal semantic structure stored in memory” (Posner, 1980, p. 4).

Additional information

Funding

This work was supported by the the Dominic Barker Trust.