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Reduced Speech Perceptual Acuity for Stop Consonants in Individuals Who

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DOI: 10.1044/1092-4388(2011/10-0224) · Source: PubMed

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Research Article

Reduced Speech Perceptual Acuity for Stop

Consonants in Individuals Who Stutter
Nicole E. Neef,a Martin Sommer,a Andreas Neef,a, c Walter Paulus,a
Alexander Wolff von Gudenberg,b Kristina Jung,b and Torsten Wüstenbergd

Purpose: In individuals who stutter ( IWS), speech fluency can be
enhanced by altered auditory feedback, although it has adverse
effects in control speakers. This indicates abnormalities in the
auditory feedback loop in stuttering. Current motor control theories
on stuttering propose an impaired processing of internal forward
models that might be related to a blurred auditory-to-motor
translation. Although speech sound perception is an essential
skill to form internal models, perceptual acuity has not been studied
in IWS so far. The authors tested the stability of phoneme percepts
by analyzing participants’ ability to identify voiced and voiceless
stop consonants.
Method: Two syllable continua were generated by systematic
modification of the voice onset time. The authors determined
speech perceptual acuity by means of discriminatory power in
25 IWS and 24 matched control participants by determining the
phoneme boundaries and by quantifying the interval of voice
onset times for which phonemes were perceived ambiguously.
Results: In IWS, discriminatory performance was weaker and
less stable over time when compared with control participants. In
addition, phoneme boundaries were located at longer voice onset
times in IWS.
Conclusion: Persistent developmental stuttering is associated with
less reliable phonological percepts, supporting current theories
regarding the sensory–motor interaction in human speech.
Key Words: phoneme categorization, speech perception,
stuttering, voice onset time

S
tuttering is characterized by sudden interruptions
of fluent speech that are due to an intermittent
loss of motor control (Ludlow & Loucks, 2003).
The dynamic, multifactorial view of stuttering postu-
lates a nonlinear interaction between a vulnerable
speech motor system and factors such as genetic predis-
position, emotional and autonomic arousal, and linguis-
tic and other cognitive processing demands (Smith &
Kelly, 1997; Smith, Sadagopan, Walsh, & Weber-Fox,
2010). These multifactorial dynamics might be mirrored
in the reports that childhood stuttering often co-occurs
a tures relevant to distinguish meanings. Fine-tuning
Department of Clinical Neurophysiology, Georg August
University, Göttingen, Germany
b
Institute of the Kassel Stuttering Therapy, Bad Emstal,
Germany
c
Bernstein Focus Neurotechnology, Göttingen
d tween a speaker’s production of a phoneme contrast
Charité Universitaetsmedizin, Berlin, Germany
Correspondence to Nicole Neef: nneef@gwdg.de
Editor: Janna Oetting
Associate Editor: Pascal van Lieshout
Received August 13, 2010
Revision received December 20, 2010
Accepted June 11, 2011
DOI: 10.1044/1092-4388(2011/10-0224)
with phonological difficulties related to linguistic compe-
tences rather than motor skills (Arndt & Healey, 2001).
Although stuttering manifests in the articulatory do-
main, speech perception was the focus of several studies
designed to elucidate its role in stuttering (Beal et al.,
2010; Biermann-Ruben, Salmelin, & Schnitzler, 2005;
Corbera, Corral, Escera, & Idiazabal, 2005; Liotti et al.,
2010). Because proper articulation results in distin-
guishable auditory targets, audition is a modality that
serves mainly to control success of articulation. Speech
acquisition comprises subtle refinement of articulatory
configurations resulting in fine-tuned phonemic fea-
requires the representation of a produced sound in the
processing system and a mapping between an auditory
target and the produced item. This process is still active
in adulthood, a fact demonstrated by the relation be-
and the perception of this contrast by the speaker him-
or herself ( Newman, 2003; Perkell et al., 2004) as well as
the influence of speech motor learning on adult speakers’
auditory maps (Nasir & Ostry, 2009). Because of the
tight link between production and perception, a coinci-
dence of pathological speech patterns and altered speech
perception has been suggested (Heiser & Cheung, 2008).

276 Journal of Speech, Language, and Hearing Research • Vol. 55 • 276–289 • February 2012 • D American Speech-Language-Hearing Association
 Complimentary Author PDF: Not for Broad Dissemination
The temporal processing demands of auditory and
proprioceptive information during speaking are pre-
sumed to challenge the speech motor systems of individ-
uals who stutter ( IWS; Kent, 2000). The auditory and
proprioceptive information that is to be expected during
speech production are proposed to be held in internal
models of speech sounds (Hickok, Houde, & Rong,
2011). The speech motor control deficit is possibly linked
to instability of these internal sensory models or to in-
sufficient access to them, thereby restricting the feed-
forward control mechanisms in speech production (Max,
Guenther, Gracco, Ghosh, & Wallace, 2004). Such an im-
paired feed-forward control system might force IWS to
rely more strongly on a feedback-based motor control
strategy (Civier, Tasko, & Guenther, 2010; De Nil, Kroll,
& Houle, 2001; Kalveram & Jancke, 1989; Zimmermann,
1980). That IWS rely too heavily on sensory feedback may
be disadvantageous (Civier et al., 2010; Tourville, Reilly, &
Guenther, 2008; van Lieshout, Peters, Starkweather, &
Hulstijn, 1993).
The most recent model of speech motor control, the
state feedback control model of speech production (Hickok
et al., 2011; Ventura, Nagarajan, & Houde, 2009), pro-
poses that monitoring is mainly achieved by using inter-
nal forward models. These internal forward models are
continuously trained and updated by the feedback infor-
mation (Hickok, Okada, & Serences, 2009). Because
feedback information is regularly extracted from one’s
own speech production, produced irregularities as evi-
dent in stuttered as well as in perceptually fluent speech
in IWS (Max & Gracco, 2005) will influence internal
models, as we outline later in this article. The concept
of unstable internal sensory models in stuttering, to-
gether with the demonstrated link between speech pro-
duction and perception, led us to probe a selected speech
perception ability of IWS: the categorization of pho-
nemes. Sublexical speech stimuli are syllables or pseudo-
words without entry in the mental lexicon (Levelt, 1989)
and thus do not activate processes related to semantics.
Therefore, they are suitable to test phoneme perception
without contextually driven top-down information that
facilitates recognition. Although some studies have in-
vestigated phoneme segmentation and monitoring
in IWS on a lexical level (Sasisekaran & De Nil, 2006;
Sasisekaran, De Nil, Smyth, & Johnson, 2006), we are
not aware of a behavioral study that has examined pho-
neme categorization on a sublexical level in IWS.
In contrast, one magnetoencephalography ( MEG)
study (Beal et al., 2010) and one electroencephalography
( EEG) study (Corbera et al., 2005) did investigate elec-
trophysiological patterns of sublexical speech perception
in IWS. Corbera and colleagues (2005) recorded the mis-
match negativity ( MMN) event-related brain potential
elicited to simple tone contrasts and to vowel contrasts.
An MMN results from the detection of a deviant stimulus.
For example, in Corbera et al.’s vowel contrast condition,
participants listened to the repeated presentation of /o/.
The unexpected presentation of /e / resulted in an en-
larged electrophysiological response that indicated a
detected mismatch between the previous presented /o /
and the now-presented /e /. This increase of the MMNs
was significantly larger in the left supratemporal region
in IWS compared with control participants. A larger
MMN indicates a greater perceptual difference between
a standard and a deviant, or a higher sensitivity of the
neural population to a certain deviation. Thus, Corbera
et al. suggested that there was an abnormal speech
sound representation within the auditory region of the
left hemisphere in IWS.
Although the EEG study (Corbera et al., 2005) elu-
cidated changes in amplitudes in the left hemisphere in
response to a passive listening task, the MEG study
(Beal et al., 2010) registered changes in timing. IWS
had longer M50 and M100 responses in the right hemi-
sphere in response to passively listening to the replayed
self-produced vowel / i /. Both studies demonstrated al-
tered cortical activation patterns on perception of pho-
nemes in IWS, but neither of these studies examined
behavior. Thus, a link between altered physiological pat-
terns and behavioral consequences is missing. Such be-
havioral consequences might include prolonged reaction
times or a diminished discriminatory power. In stutter-
ing research the use of reaction times as critical param-
eter is complicated, because reaction times are usually
longer in the stuttering population compared with fluent
speakers, and it is difficult to disentangle motor from cog-
nitive effects (Smits-Bandstra, 2010). Another way to
quantitatively capture perceptive behavior is the deter-
mination of discriminatory power. This information is
provided by the psychophysical phoneme identification
study presented here. One phonetically relevant prop-
erty of speech is the voice onset time ( VOT). Differences
in VOT are perceptually essential to discriminate voiced
from voiceless stop consonants. In word-initial position,
German voiced stops such as /b/ and /d / are typically
produced with short VOTs or, in some cases, with pre-
voicing, and German voiceless stops such as /p / and /t /
are produced with longer VOTs (Keating, 1984). The
stimuli of the present study were created by systematic
e e
variation of the VOT, creating a / b /–/p / and a /d /–/t / e e
continuum. Each VOT continuum can be separated into
three different sections according to the listener’s perfor-
mance on the psychophysical test. Two sections contain
those stimuli that are reliably identified as the voiced
and voiceless phoneme, respectively. Between those
sections lies a range of VOT in which no reliable identi-
fication is possible, and the listener reports different per-
cepts on repeated presentation. The width of this range of
ambivalent reception is proportional to the parameter b of
the psychometric function describing the discriminatory
Neef et al.: Speech Perceptual Acuity in Stuttering 277
 Complimentary Author PDF: Not for Broad Dissemination
performance (see Supplemental Appendix A). The
center of the psychometric function in Supplemental
Appendix A represents the VOT where discrimination
is at chance level. This VOT is here termed the phoneme
boundary ( PB). The parameters b and PB were extracted
for each listener by fitting the results of the identifica-
tion task with a logistic curve. A small b, corresponding
to a steep slope, indicates a small range in which stim-
uli are perceived as ambiguous. Conversely, a large b
(i.e., shallow slope) indicates a large range of VOTs in
which stimuli are not reliably identified. This concept
has been used in recent publications, including in a study
of speech perceptual acuity in adults with dyslexia (Hazan,
Messaoud-Galusi, Rosen, Nouwens, & Shakespeare,
2009), and it has permitted researchers to detect the
influence of the lip primary motor cortex inhibition on
phoneme categorization and discrimination in healthy
individuals (Möttönen & Watkins, 2009).
We designed our study to determine the parameters
b and PB of two stop consonant–vowel (CV) continua: the
e e e e
bilabial /b /-/p / and the alveolar /d /-/t /. We chose the
two continua, differing in place of articulation and PB for
internal control and to determine generalized effects of
discriminatory performance. Thus, discriminatory power
as a measure of specific perceptual acuity was determined
only by b in our study.
We conducted a pilot experiment in which we used a
constant stimulus identification task and observed a
trend toward increased b values in IWS (see Supplemen-
tal Appendix B) that motivated the following specific hy-
potheses. First, we hypothesized that in stuttering
speech perceptual acuity is compromised: IWS would
show larger bs compared with fluently speaking partici-
pants. We also hypothesized that PBs would similar for
both groups, because PB is a feature that depends mainly
on the native language and the idiom of the participants
(Braun, 1996; Lisker & Abramson, 1964).
Method
Participants
Twenty-seven IWS (age: 32.4 ± 11.5 years, eight
women) and 24 control participants (age: 31.8 ± 10.6,
seven women) took part in the study. The IWS were
recruited from the local stuttering support group and
the Institute for Kassel Stuttering Therapy ( KST) in
Bad Emstal, Germany. Fourteen IWS were familiar
and 13 IWS were not familiar with KST, which is a
2-week intensive fluency-shaping treatment focusing
on a syllable prolongation, gentle voice onset, and
smooth sound transitions (Euler, Gudenberg, Jung, &
Neumann, 2009). Control participants were recruited
through advertisements. Both groups were matched for
278 Journal of Speech, Language, and Hearing Research • Vol. 55 • 276–289 • February 2012
age, t(49) = –0.22, p = .824 (unpaired two-tailed test),
level of education ( p = .237; Mann–Whitney U test)
and handedness ( p = .519; Mann–Whitney U test).
Four IWS participants and two control participants
were left handed, according to the Edinburgh Inventory
(Oldfield, 1971).
All participants were native speakers of German;
none of them had been raised in a bilingual household.
Twenty IWS reported a family history of stuttering.
None of the control participants reported having a fam-
ily history of speech or language disorders, and none
reported a speech, language, or hearing deficit, except
of stuttering in the stuttering group, or showed neuro-
logical abnormalities on routine examination. No partic-
ipant was taking drugs that affect the central nervous
system at the time of the study. The Ethics Committee
of the Göttingen Medical Faculty approved the study,
and all participants gave written informed consent. All
participants were paid for their participation.
Fluency Assessment
To assess stuttering severity, speech fluency assess-
ments were performed according to the German version
of the Stuttering Severity Instrument for Children and
Adults—Third Version (SSI–3; Riley, 1994; Sandrieser
& Schneider, 2008). Speech samples of all participants
containing a conversation about job or school and a read-
ing task were videotaped and analyzed by a qualified
speech-language pathologist. SSI–3 norms were adapted
from Riley (1994). The offline analysis of dysfluencies in-
cluded 500 syllables for the conversation and no fewer
than 340 syllables for the reading task. Sound prolonga-
tions and blocks (silent prolongation of an articulatory
posture), as well as sound and syllable repetitions,
were counted as stuttered syllables. Monosyllabic
words that were repeated with apparent undue stress
or tension were counted. Furthermore, the estimated
duration of the three longest blocks and observation of
physical concomitants were included for the estimate
of stuttering severity in IWS.
IWS produced more stuttered syllables than control
participants, 12.69 ± 9.44 (M ± SD) versus 0.29 ± 0.23
( p < .001; Mann–Whitney U test). Stuttering severity
was very mild in six, mild in three, moderate in five,
severe in five, and very severe in eight IWS (Sandrieser
& Schneider, 2008). Averaged stuttering onset was at
age 5;2 ± 2;8. A detailed description of participants is
reported in Table 1.
A random subsample of 10 IWS was reanalyzed by
an independent rater, and the interrater reliability over
both raters was calculated. An analysis of the overall
SSI–3 scores yielded an unadjusted intraclass correlation
coefficient ( ICCunadjust) of .88 (95% confidence interval
 Complimentary Author PDF: Not for Broad Dissemination

Table 1. Description of participants.

Age Family Stuttered SSI–3

Participant (years) Sex Educationa Handednessb history syllablesc score Onset KST

IWS 1 24 M 1 –58 No 18.6 36 8;0 Yes

IWS 2 24 F 2 100 Yes 27.9 48 4;0 Yes
IWS 3 25 M 5 100 Yes 1.5 7 12;0 Yes
IWS 4 33 M 5 89 Yes 20.8 42 4;0 Yes
IWS 5 28 F 6 100 Yes 18.3 47 3;0 Yes
IWS 6 14 M 1 90 No 6.5 32 6;0 Yes
IWS 7 43 M 5 88 No 25.2 33 5;0 Yes
IWS 8 24 M 2 –40 Yes 1.8 12 2;6 Yes
IWS 9 18 M 1 100 Yes 29.0 41 7;6 Yes
IWS 10 33 M 1 –90 No 15.1 31 10;0 Yes
IWS 11 26 M 4 100 Yes 3.0 17 2;6 No
IWS 12 47 M 6 79 Yes 10.7 26 3;0 No
IWS 13 40 M 6 100 Yes 3.1 17 3;0 No
IWS 14 49 M 5 100 Yes 1.8 14 3;6 No
IWS 15 36 F 6 100 Yes 5.6 25 3;6 No
IWS 16 54 M 1 100 No 2.8 17 5;0 No
IWS 17 57 F 5 100 Yes 2.5 18 2;0 Yes
IWS 18 32 F 1 100 Yes 22.4 36 5;0 Yes
IWS 19 22 M 1 80 Yes 11.0 37 5;0 Yes
IWS 20 15 M 1 11 Yes 9.1 22 4;6 Yes
IWS 21 37 F 2 100 Yes 10.6 34 2;6 No
IWS 22 37 M 2 100 Yes 31.1 42 6;6 No
IWS 23 20 F 1 100 No 15.6 44 4;0 No
IWS 24 41 M 5 100 Yes 4.8 18 6;6 No
IWS 25 43 M 1 89 No 12.9 28 12;0 No
IWS 26 28 F 5 50 Yes 24.2 52 3;6 No
IWS 27 26 M 4 –56 Yes 7.1 27 5;0 No
M 32;5 3.1 67.8 12.7 29.7 5;2
SD 11;7 2.1 58.4 9.4 12.2 2;8
C1 33 F 5 100 No 0.1
C2 33 F 6 100 No 0.2
C3 35 M 6 100 No 0.4
C4 21 M 3 100 No 0.3
C5 36 M 4 100 No 0.9
C6 28 M 4 79 No 0.3
C7 22 M 3 100 No 0.5
C8 23 M 4 100 No 0.3
C9 26 M 3 80 No 0.6
C 10 27 M 3 100 No 0.1
C 11 28 M 4 100 No 0.6
C 12 28 M 4 100 No 0.1
C 13 25 F 4 89 No 0.1
C 14 26 M 4 88 No 0.0
C 15 40 M 3 88 No 0.3
C 16 15 M 1 100 No 0.2
C 17 32 M 5 63 No 0.2
C 18 45 M 2 –18 No 0.0
C 19 54 M 1 100 No 0.1
C 20 60 F 5 100 No 0.0
C 21 30 F 6 100 No 0.2
C 22 26 F 4 90 No 0.6

(Continued on the following page)

Neef et al.: Speech Perceptual Acuity in Stuttering 279

 Complimentary Author PDF: Not for Broad Dissemination

Table 1 Continued . Description of participants.

Age Family Stuttered SSI–3

Participant (years) Sex Educationa Handednessb history syllablesc score Onset KST

C 23 43 M 6 100 No 0.4
C 24 26 F 4 –100 No 0.4
M 31;10* 3.7*** 65.7** 0.3****
SD 10;7 1.4 60.30 0.2

Note. Boldface type denotes individuals who participated in the pilot study as well as in the main experiment. Group difference
for age was tested by an unpaired two-tailed t test. Group differences for all other variables were examined with Mann–Whitney
U tests; the asymptotic significance is reported. SSI–3 = German version of the Stuttering Severity Instrument for Children and
Adults—Third version; IWS = individual who stutters; C = control participant; M = male; F = female; KST = Kassel Stuttering
Therapy.
a
Estimated as follows: 1 = some school, 2 = high school, 3 = less than 2 years of college, 4 = 2 years of college, 5 = 4 years of
college, 6 = postgraduate degree. bQuantified with the 10-item scale of the Edinburgh Handedness Inventory. cMean percentage
out of not fewer than 340 read and 500 spoken syllables.
*p = .82. **p = .52. ***p = .24. ****p < .001.

[CI] [.58, .97]) comparable to a previous reliability result testing with random stimuli. Participants were asked to
for the same raters (Neef et al., 2011). listen to the stimuli and to press the left mouse button if
e e
they perceive a /b / (d ), to press the right mouse button
e e
if they perceive a /p / (/t / ), or to press the space bar if
Stimuli
Synthetically generated sets of syllables /b /-/p / e e Figure 1. Waveforms and spectrograms of the /b / (voice onset
e
e e
and /d /-/t / with VOTs from 7 ms to 61 ms, in steps of time [VOT] = 7 ms) and /p / (VOT = 43 ms) of the speech continuum
e
1 ms, served as stimuli. These sets were created once, be- used to measure categorical perception of the voicing contrast.
fore the psychophysical test, with the following five-step
process: (a) Voiceless syllables were generated using an
AT&T Bell Research Lab speech synthesizer (http://
www2.research.att.com /Èttsweb /tts /; sample rate =
16 kHz, number of bits per sample = 16); (b) spectrograms
of these syllables were computed with the software pack-
age Praat (http: //www.fon.hum.uva.nl /praat / ); (c) the
first three formants of the vowel were extracted from
these spectrograms; (d) stimuli were segmented into
consonants and vowels regarding the formant with the
earliest onset; and (e) to form the CV continua, the result-
ing segments were superimposed with a step width of
1 ms using an algorithm made in house written in the
MATLAB programming language ( Release 2007a). Fig-
ure 1 depicts oscillograms and spectrograms of two stim-
e e
uli of the /b /–/ p / continuum.

Procedure
Participants sat in front of a computer in a quiet
room. Stimuli were presented binaurally via dynamic,
closed-ear headphones (Sennheiser HD 280; up to 32 dB
attenuation of outside noise) at a comfortable hearing
level they regulated by themselves. The two sets of CV
continua were presented in separate blocks, and the
order of blocks was balanced in each subject group.
Each block comprised five trial series. Each series con-
sisted of a staircase procedure followed by a conventional

280 Journal of Speech, Language, and Hearing Research • Vol. 55 • 276–289 • February 2012
 Complimentary Author PDF: Not for Broad Dissemination

they needed to hear the stimulus again. These choices Figure 2. Combination of adaptive threshold estimation and con-
were displayed on the screen during the entire trial se- ventional testing with equally spaced VOTs. The data shown were
ries. After the mouse click, the stimulus onset interval obtained from one control person; perceived /b / is denoted by open
e

was 2 s. Thus, one series lasted approximately 2 min. circles, and /p / is denoted by filled circles. The red circles denote
e
the VOTs of the presented stimuli during the adaptive search; the first
The two blocks were separated by a 15-min break. Speech
VOT was chosen at random, and all of the following were calculated.
samples for the SSI–3 fluency assessment were recorded
With the nth reversal, the step-width is reduced to 40/(n + 1) ms.
during this break. These values have been rounded to integers because the stimuli were
The adaptive selection of stimulus VOTs was based prepared before experiment start for integer VOTs. After the 10th
on an accelerated stochastic approximation (Kesten, reversal, the search is aborted. The last four VOTs were averaged to
1958; Treutwein, 1995). In adaptive threshold estima- obtain a preliminary estimate of the phoneme boundary (PB; 16 ms,
tion, the stimuli presented are not predetermined before dotted blue line). The VOT region of 20 ms around this PB was then
beginning the test; instead, the next stimulus is chosen probed by 21 stimuli in a random sequence. The logistic psychometric
function is fitted to the participant’s responses to all stimuli presented,
according to the previously presented stimuli and the
in this case yielding a PB of 15.3 ms and a b value of 0.97.
participant’s responses. If two subsequent stimuli are
categorized differently (i.e., if the individual’s percept
has reversed), one has to assume that the phoneme
boundary, the target of the search, lies in between the
VOTs of those two stimuli; consequently, the next stim-
ulus will have a VOT that lies between those previous
values. The reversal is followed by a decrease in the
step-width of VOT change, and the test stimuli contract
around the target. The staircase procedure began with a
randomly chosen VOT and was aborted after 10 rever-
sals. The average of the last four VOT used served as a
preliminary estimate of the PB. The remainder of the
trial series consisted of a conventional, nonadaptive
identification task: Twenty-one stimuli with VOTs be-
tween PB–10 ms and PB+10 ms were presented in a
random sequence, covering the instructive VOT interval
around the PB in 1-ms steps. For more information, see all five series. We also conducted 10 fits for each partic-
Figure 2 . The parameters of the psychometric function ipant, covering five series in each CV continuum. With
were estimated from all trials per series (Ramus et al., this procedure, we generated a total of 12 b values and
e e
2003). For the /b /–/p / continuum, control participants 12 PB values for each participant.
required a mean of 35.6 trials (SD = 2.16), and IWS re-
Statistics
e e
quired a mean of 36.3 (SD = 2.47) trials. For the /d /–/t /
continuum, the average amount of trials for one series
was 36.9 (SD = 3.16) for control participants and 38.0 To test our hypotheses regarding the speech percep-
(SD = 3.82) for IWS. tual acuity and PB, we entered the b values and the PB
values in two separate two-factor mixed-design 2 ×
It is an intrinsic property of the applied adaptive al-
2 analyses of variance (ANOVAs) for repeated measures
gorithm that the stimuli are concentrated near the PB.
e e with the between-subjects factor group ( IWS or control)
For control participants, 38.4% of /b /–/p / and 46.3% of e e
e e and the within-subject factor continuum (/b /–/p / or
/d /–/t / stimuli were presented in the range PB ± 2b. e e
/d /–/t / ). This analysis involved the data pooled across
For IWS this ratio was slightly higher: 42.9% for the
e e e e all five series.
/b /–/p / and 53.2% for the /d /–/t / continuum.
We conducted separate three-factor mixed-design
The experiment was run on Presentation software
2 × 2 × 5 ANOVAs for repeated measures with the be-
( Version 0.71; http://www.neurobs.com / ).
tween-subjects factor group ( IWS or control) and the
e
within-subject factors continuum ( /b /–/p / or /d /–/t / ) e e e
Data Analysis and series (1–5). We performed this analysis to test for
With MATLAB, we modeled the data by fitting a lo- an effect of series. Main effects were tested via pairwise
gistic psychometric function for the voiceless percept tests with Bonferroni correction or Tukey’s honestly sig-
using a maximum likelihood algorithm (psygnifit; see nificant difference test depending on the epsilon of the
http://www.bootstrap-software.org/psignifit /; Wichmann test for sphericity.
& Hill, 2001a, 2001b). Two fits were run for each partic- To test potential correlations between stuttering
ipant and each continuum, with the data pooled across severity and discriminatory power as well as PB, we

Neef et al.: Speech Perceptual Acuity in Stuttering 281

 Complimentary Author PDF: Not for Broad Dissemination

calculated Spearman’s correlation coefficient between
the stutterer’s SSI–3 overall-scores and the parameter
b or PB values, respectively.
To test the relation between b and PB values, we cal-
culated Pearson’s correlation coefficients separately for
each CV continuum and each group.
Interrater reliability was determined by calculat-
ing the unadjusted ICCunadjust (two-way mixed, single
measures; Wirtz & Caspar, 2002). Statistics were per-
formed with the SPSS 17.0.
Results
Discriminatory Power and b Values
Figure 3 illustrates the individual performance on
the identification task by showing fitted psychometric
functions for the individually pooled data points out
of all five series. As can be seen, at the individual level,
differences in the shapes of the individual psychomet-
ric functions of both groups are visible. For the IWS
group, the fitted psychometric models have flatter char-
acteristics and higher variability in shape than in the
control group. The bottom graphs contain almost linear
lines indicating two outliers from the IWS group (Partici-
pants IWS 11 and IWS 25; see Table 1). Revision of the
individual data showed that Participant IWS 11 exhib-
ited an almost random performance during the fifth
e e
series in the tests of the /b /–/p / continuum. Participant
IWS 25 was characterized by a PB of 60 ms for the
e e
/d /–/t / continuum, which lies outside the measurable
spectrum because stimuli of this continuum range until a
VOT of 61 ms. Thus, we excluded these two participants
from further statistical analyses.
Figure 4 shows the group averages of the parameter
b separated for continuum and series. These graphs
show high b values, that is, low discriminatory power
in the IWS group for the second and fifth series of the
e e e e
/b /–/p / continuum and for the /d /–/t / continuum for
all but the third series.
The last columns in the panels of Figure 4 depict the
b values calculated by fitting the psychometric function
to the individually pooled data points. Control participants
had mean b values of 1.24 (SD = 0.44) ms for the /b /–/p /
e e
e e
continuum and 1.61 (SD = 0.71) ms for the /d /–/t / con-
tinuum; IWS showed mean b values of 1.48 (SD = 0.52)
e e
ms for the /b /–/p / continuum and 2.21 (SD = 0.87) ms
e e
for the /d /–/t / continuum.

Figure 3. Individual psychometric functions for /b /–/p / identification and the /d /–/t / identification
e e e e
for participants in the stuttering (red) and the control (black) group. The sigmoid curves were obtained
from the pooled individual data points using logistic regression. The curves are plotted with VOT
related to the PB. Dashed lines mark the outliers, Participants IWS 11 and IWS 25, whose data were
extracted from the statistical analyses. CS = control subject/participant; IWS = individual who stutters.

282 Journal of Speech, Language, and Hearing Research • Vol. 55 • 276–289 • February 2012
 Complimentary Author PDF: Not for Broad Dissemination

Figure 4. Group averages and standard errors of the mean of the b values, separated for series of
the /b /–/p / continuum (Panel A) and of the /d /–/t /continuum (Panel B) for participants in the
e e e e
stuttering (IWS) and the control (CS) group. Group averages for the PB were seperated for series and
continuum (Panel C). Note that pooled values yielded higher b values because the series-to-series
variability of PBs was incorporated.

We conducted a 2 × 2 repeated measures ANOVA
with group as the between-subjects factor and CV con-
tinuum as the within-subjects factor to test for group dif-
ferences considering the b values from the individually
pooled data. The ANOVA yielded a main effect of group,
F(1, 47) = 7.37, p = .009, confirming the significance of
increase in b values in IWS. The ANOVA also revealed a
main effect of CV continuum, F(1, 47) = 24.95, p < .001,
with higher b values for the /d /–/t / continuum (M b =
e e
e
1.9 ms, SD = 0.84) compared with the /b /–/p / con- e Appendix C; Table C1).
tinuum (M b = 1.4 ms, SD = 0.49). It yielded no Group ×
Continuum interaction, F(1, 47) = 2.57, p = .115.
Because we repeated the psychophysical test five
times for each continuum, we were able to test whether dis-
criminatory power was influenced by repetition. Thus,
we conducted separate 2 × 2 × 5 ANOVAs for each series.
The analysis confirmed the main effects of the previous
ANOVA: a main effect of group, F(1, 47) = 5.21, p = .027;
a main effect of CV continuum, F(1, 47) = 31.91, p < .001;
and no Group × Continuum interaction, F(1, 47) = 2.10,
p = .154. The ANOVA also revealed an effect of series,
F(3.0, 142.6) = 3.83, p = .011 (Greenhouse–Geisser
corrected, Mauchly W = .295, p = .001, ɛ = .758), with
larger b values for the first series (bSeries1, M = 1.42 ms,
SD = 0.70) compared with the other series (bSeries2, M =
1.11 ms, SD = 0.66; bSeries3, M = 0.99 ms, SD = 0.63;
bSeries4, M = 1.10 ms, SD = 0.82; bSeries5, M = 1.31 ms,
SD = 0.87). Post-ANOVA comparison with the Tukey
honestly significant difference test revealed no signifi-
cant differences between series. An ANOVA yielded
no further significant interactions (see Supplemental
Phoneme Boundaries
Figure 4 shows group averages of the PBs separated
for continuum and series. The PB of the /b /–/p / con- e e
tinuum was located at 18 ms (SD = 4.0 ms) in control par-
ticipants and at 20 ms (SD = 4.6 ms) in IWS. The PB
e e
of the /d /–/t / continuum was positioned at 31 ms
(SD = 5.4 ms) for control participants and at 34 ms
(SD = 5.9 ms) for IWS.
The 2 × 2 ANOVA of PB revealed a marginal effect of
group, F(1, 47) = 3.99, p = .052, with PBs located at larger

Neef et al.: Speech Perceptual Acuity in Stuttering 283

 Complimentary Author PDF: Not for Broad Dissemination
VOTs for IWS relative to control participants. The effect
of continuum was significant, F(1, 47) = 421.81, p < .001.
This is in accord with previous observations with the PB
e e
of the /b /–/p / continuum to be located at smaller VOT
e
values compared with PBs of the /d /–/t / continuum e representations. Our study delivers a first data set on
(e.g., Phillips et al., 2000). No Group × Continuum inter-
action was found, F(1, 47) = 0.67, p = .419. An additional
2 × 2 × 5 ANOVA regarding the PB confirmed previous
results: There was an effect of group, F(1, 47) = 4.29,
p = .044; and an effect of continuum, F(1, 47) = 314.33,
p < .001; but no Continuum × Group interaction, F(1, 47) =
0.96, p = .333. The ANOVA further revealed a significant
effect of series, F(2.6, 120.6) = 3.33, p = .028 (Greenhouse–
Geisser corrected, Mauchly W = .539, p < .001, ɛ = .641);
post hoc pairwise t tests revealed no significant differ-
ences for the comparison of PBs between series (Bonferroni
corrected). No interactions were revealed (see Supple-
mental Appendix C, Table C1).
Correlation analyses yielded no correlation between
stuttering severity and parameter b, –.22 < r s < .18,
p > .314, or PB, –.08 < rs < .15, p > .461, respectively.
Likewise, no correlation was found between b values
e e
and PBs, either for the /b /–/p / continuum (control par-
ticipants: rp = –.169, p = .429; IWS: rp = .007, p = .974) or
e e
for the /d /–/t / continuum (control participants: rp =
.284, p = .200; IWS: rp = .142, p = .497; see Figure 5).
Discussion
The current study was motivated by theories relat-
ing the breakdowns in fluent speech in IWS to an im-
paired feed-forward control system due to impoverished
sensory representations of the expected speech sounds
(Civier et al., 2010; Kalveram & Jancke, 1989; Max
et al., 2004). If that relation indeed held true, one
would expect broader intervals in which IWS, compared
Figure 5. Scatter plot for individually pooled, continuum-specific b
and PB. Circles indicate values for the IWS, squares indicate values
for the CS, open symbols denote values for the /b /–/p / continuum,
e e
and filled symbols indicate values for the /d /–/t / continuum.
e e
284 Journal of Speech, Language, and Hearing Research • Vol. 55 • 276–289 • February 2012
with fluent speakers, perceive CVs ambiguously. As in-
dicated by a shallower slope of the psychometric func-
tion, this would suggest diminished speech perceptual
acuity in IWS as a consequence of blurred phoneme
phoneme identification of voicing contrasts in stuttering
that points toward lower discriminatory power in IWS.
The lack of correlation between b values and stuttering
severity demonstrates that the tested auditory per-
formance does not serve as a sufficient or necessary
parameter to define key characteristics of IWS. None-
theless, our study ties in an interesting currently confla-
grant discussion: the sensorimotor integration of speech
processing.
Diminished Speech Perceptual Acuity
for Stop Consonants in Stuttering
The perceptual acuity to discriminate the voicing
contrast in stop consonants at the sublexical level is im-
paired in IWS as compared with control subjects. In re-
gard to the pooled data, the intergroup difference of
b values between control participants and IWS had mag-
e e
nitudes of 0.24 ms (/b /–/p / continuum) and 0.59 ms
e e
(/d /–/t / continuum). Thus, the relative difference
e
amounts to a sizable effect: an increase of 16% (/b /–
e e e
/p / continuum) and 27% (/d /–/t / continuum), respec-
tively, in the b values.
This result is consistent with the theories that moti-
vated this study (Civier et al., 2010; Kalveram & Jancke,
1989; Max et al., 2004), and, interpreted through the
framework of these theories, the results suggest a
blurred auditory representation in IWS.
The discrimination of speech sounds implements a
meta-linguistic process that does not lead to lexical ac-
cess or further semantic processing; instead, it includes
acoustic and phonetic processing that operates on con-
tinuous, analog auditory signals, possibly mediated
through a comparison between phonological features
and an articulatory plan (Rauschecker & Scott, 2009;
Turkeltaub & Coslett, 2010).
Deciding whether the presented phoneme is either
voiced or voiceless most likely requires the activation
of the articulatory model of the specific phoneme (Meister,
Wilson, Deblieck, Wu, & Iacoboni, 2007; Turkeltaub &
Coslett, 2010), the so-called speech sound map in the
ventral premotor cortex and posterior inferior frontal
gyrus (Golfinopoulos, Tourville, & Guenther, 2010). Fur-
thermore, this process is likely to also recruit the primary
motor cortex (Möttönen & Watkins, 2009). In our study,
more than one third of the stimuli lay within the ambig-
uous VOT range, and therefore the identification task
was demanding. The data showed that task demand
influences neural activity and increases functional
 Complimentary Author PDF: Not for Broad Dissemination
connectivity (Biswal, Eldreth, Motes, & Rypma, 2010;
Rypma et al., 2006). In turn, an intense neural commu-
nication requires an intact anatomical architecture and
an undisturbed neural synchronization. If connections
were malfunctioning, discriminatory power would likely
be impaired, and b values would be enlarged. This view
is supported by the finding that the left perisylvian
fibers connecting cortical sensory and motor areas ex-
hibit reduced integrity in IWS (Cykowski, Fox, Ingham,
Ingham, & Robin, 2010; Sommer, Koch, Paulus, Weiller,
& Büchel, 2002; Watkins, Smith, Davis, & Howell, 2008).
Thus, less coherent connections in IWS might slow the
transfer of information or diminish the quality of the
transported signals, leading to a lower discriminatory
power, which becomes detectable in demanding tasks
as phoneme categorization near the PB.
There are other possible interpretations of our
results. It has been proposed that speech production
and speech perception share the same elementary
events: gestural motor commands, and thus the essen-
tial units of speech perception are inherently motoric
(Liberman & Mattingly, 1985, p. 31), leading to the
close link between speech perception and speech produc-
tion. Therefore, a broadened VOT range of ambivalent
perception for the voicing contrast complements obser-
vations of a higher variability of the VOT production of
bilabial voiceless plosives in IWS (Max & Gracco, 2005).
Stuttering might serve as a model to further elucidate
this perception–production relationship.
A further possible explanation ties in the dynamic
influence of top-down attentional modulation on the au-
ditory saliency map. This saliency map of the auditory
environment flags sounds of interest. The saliency
map is proposed to emerge from the implementation of
a multistage selection process, in which bottom-up stim-
ulus features and top-down attentional modulation are
combined such that relevant information is continuously
favored and ultimately analyzed at the expense of infor-
mation deemed to have lesser relevance (Kayser, Petkov,
Lippert, & Logothetis, 2005). Thus, auditory attention
heavily influences the sustained neural representation
of a given stimulus (Elhilali, Xiang, Shamma, &
Simon, 2009). In regard to stuttering, researchers have
suggested that attention may be impaired (Bosshardt,
2006; Kaganovich, Wray, & Weber-Fox, 2010). For in-
stance, researchers have shown, in recent EEG studies
of IWS, that nonlinguistic auditory processing is charac-
terized by a smaller P300 component, which suggests
less efficient attentional allocation and working memory
update in adults who stutter (Hampton & Weber-Fox,
2008) as well as in children who stutter (Kaganovich
et al., 2010).
In Hampton and Weber-Fox’s (2008) study, a sub-
sample of IWS showed early EEG signals ( N1 and P2)
that were indistinguishable from those of fluent speakers.
Such a heterogeneous pattern within groups of IWS is
often observed (e.g., De Nil & Abbs, 1991). Also in the
current study, some IWS showed a psychometric curve
that was indistinguishable from curves of individuals
in the control group. This, together with the lack of cor-
relation between stuttering severity and b value, indi-
cates that the discriminatory power for the voicing
contrast is not a dominant factor of speech fluency.
Effect of Series
The strongest group differences were in the earliest
and in the latest series, a phenomenon entirely unex-
pected when we designed this experiment. The influence
of attention on performance might also contribute to the
effect of series found in either group: Improved perfor-
mance in early series could indicate familiarization,
whereas the lower performance in the final series that
is most pronounced in the stuttering group in the /d /– e
e
/t / continuum could indicate reduced attention. This
novel finding is astonishing and raises a lot of specula-
tion regarding reasons, such as fatigue or lack of auto-
mation, impaired consolidation of acquired skills, and
lack of attentional allocation. We calculated a 2 × 2 × 4
ANOVA excluding the fifth series. This ANOVA con-
firmed a strong trend for an effect of group, F(1, 47) =
3.2, p = .080, and the consistent effect of continuum,
F(1, 47) = 20.5, p < .001. It also yielded an effect of series,
F(3, 141) = 5.4, p = .02, emphasizing the significant in-
crease of discriminatory power when the first series is
compared with later series. Thus, the existing phoneme
discrimination ability is not an invariable entity but
is subject to further recalibration and adjustments
(Meister et al., 2007; Möttönen & Watkins, 2009; Nasir
& Ostry, 2009; Shiller, Sato, Gracco, & Baum, 2009). It is
interesting that performance by IWS was similar to
that of control participants in Series 3. If one takes the
optimal conditions in the laboratory into account, one
sees that the problem is probably not an impossibility
to perform but instead ready access to sufficient perfor-
mance. We expect these novel findings to encourage fur-
ther studies to elucidate in particular the reasons for the
bad performance in later series by IWS.
Phoneme Boundaries
PBs are different between IWS and control. This
parameter is not fixed for a given individual; instead,
it is subject to dynamic changes (Nasir & Ostry, 2009).
Furthermore, it varies between different German idioms
(Lisker & Abramson, 1964). The PB is therefore not a
suitable measure of individual performance. The ob-
served group difference fits with an observation of
VOT production in IWS. Max and Gracco (2005) reported
that the durations of the devoicing interval in the
production of the voiceless /p/ was longer in IWS
Neef et al.: Speech Perceptual Acuity in Stuttering 285
 Complimentary Author PDF: Not for Broad Dissemination
compared with fluently speaking control participants;
however, neither this nor the present study controlled
for provenance of the participants, complicating inter-
pretations of the observed difference.
Effect of Continuum
The absolute value of bs for the /d /–/t / continuum
e e
e
was enlarged compared to the /b /–/p / continuum in e
either group. Whether this indicates an increased com-
plexity or difficulty for the perception of this continuum
is unclear. Note that the production of alveolar plosives
/d/ and /t/ is more complex due to the decoupling of jaw
from tongue movements and is acquired at a later age
compared with the bilabial plosives / b/ and /p/ (Fox,
2003). The perception of the place of articulation is mainly
cued by the burst duration and the fast F2 and F3 formant
transitions (Alwan, Jiang, & Chen, 2011). In our test
stimuli, the burst duration was not modified, and thus
the formant transitions might be less salient for the al-
veolar plosives compared with the bilabial plosives;
therefore, processing demands might have been in-
creased for the alveolar plosives.
Limitations
Our finding of a reduced discriminatory power in
IWS compared with control participants is particularly
related to the perception of the voicing contrast in the bi-
labial and alveolar stop consonants and most prominent
in the contrast of alveolar stop consonants. Whether this
holds true for other phoneme contrasts with changing
e
place of articulation, such as the /b /–/d / continuum, e
for a different articulatory mode, such as the /f /–/s/ con-
tinuum, or for a different duration of a vowel, such as /a /,
needs to be tested in future studies.
Our results are furthermore restricted to the condi-
tion of passive listening, whereas the theories we have
discussed associate the dysfluencies with impaired
motor-to-sensory priming in response to self-generated
speech (Civier et al., 2010; Kalveram & Jancke, 1989).
Electrophysiological evidence for altered speech sound
perception is related to auditory evoked responses to
passive listening to sublexical stimuli (Corbera et al.,
2005) or to combinatory approaches that study auditory
evoked responses to passive listening as well as to self-
generated speech (Beal et al., 2010; Liotti et al., 2010). A
combinatory approach that considers sublexical speech
perception and speech production, such as that used
for the nonspeech production humming (Nudelman,
Herbrich, Hess, Hoyt, & Rosenfield, 1992), might help
clarify whether the compromised phoneme percep-
tion during passive listening suggested by the current
results is somehow linked to perceptive mechanisms
involved during speech motor control. This suggestion
286 Journal of Speech, Language, and Hearing Research • Vol. 55 • 276–289 • February 2012
seems plausible because speech production experiments
in IWS indicate an enlarged variability of the production
of VOT in voiceless bilabial stops in perceptually fluent
speech (Max & Gracco, 2005).
Another limitation of the current study is the poten-
tial influence of a particular speech motor training in our
heterogeneous group of IWS . More than half of the sam-
ple of IWS have been recruited from KST. KST involves a
sensitization of the perception of the voicing contrast be-
cause fluency-shaping emerges from an intentional voic-
ing of voiceless consonants (Euler et al., 2009). Thus, the
treatment involves the training of the metalinguistic
knowledge of the voicing contrast and the perception of
this contrast, which is essential for a correct production. To
consider this aspect, we conducted additional ANOVAs.
These analyses revealed no influence of KST, either on
PBs or on b values (see Supplemental Appendix C).
Our results on the potential influence of a speech motor
training are preliminary. Because we did not plan to in-
vestigate the influence of speech therapy, we did not at-
tempt to quantify the speakers’ level of proficiency (e.g.,
to build a gentle voice onset). However, IWS who had
been in KST were at different stages of their therapy,
and IWS who were not familiar with KST were familiar
with different other therapies, such as the stuttering
modification technique adopted by van Riper (Alpermann,
Huber, Natke, & Willmes, 2011), in which a gentle voice
onset is again a goal of the treatment. It seems tempting to
conduct future studies to account for the effect of a motor
speech therapy, especially when the modification of the
voicing contrast is part of the speech motor training.
Conclusion
Our results provide behavioral evidence for less sta-
ble phoneme representations in IWS. Phoneme rep-
resentation is a pivotal element underlying speech
perception. Thus, our results support neuroimaging
studies that have demonstrated irregularities in the
neuroanatomic correlates of speech perception. In ad-
dition, our data underpin theoretical frameworks on
stuttering that assume less stable speech sound repre-
sentations, or an insufficient access to them, by IWS,
thereby highlighting the role of auditory perception in
persistent developmental stuttering. Future studies
should evaluate the link between sublexical speech per-
ception and production to further elucidate the nature of
stuttering. Such studies would provide data to complete
theoretical models of stuttering as well as of speech pro-
cessing and its neural implementation in general.
Acknowledgments
This work was supported by the Stifterverband für
die Deutsche Wissenschaft, Walter und Ilse Rose Stiftung,
 Complimentary Author PDF: Not for Broad Dissemination
the Goettingen Graduate School for Neurosciences and
Molecular Biosciences, the German Ministry of Health
(Grants BMBF 01GQ0811 and 01GQ0810), and the Deutsche
Forschungsgemeinschaft (Grant SO 429/2-2). For his support
concerning statistics, we thank Reinhard Hilgers from the
Department of Medical Statistics, Georg-August University,
Göttingen, Germany. We also thank Veronika Gutmann for
her help in participant recruitment and testing in the pilot
study.
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