Altered Auditory Feedback

Some Perspectives..

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)

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

Types of AAF
Delayed Auditory Feedback : DAF
Delay of conductive voice signal by typically 50100 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.

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

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

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)

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: 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

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)

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

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)

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

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)

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

 Heidi takes over here

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

But most importantly we need to know what

our clients think of the devices and
what they are wanting from treatment

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, 127136.
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, 347357.

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,
259269.
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, 396401.
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, 11301134.

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, 359366.
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, 119129.
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,
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