Dual diathesis-stressor model of emotional and linguistic contributions to developmental stuttering

Associations between social anxiety, physiological reactivity, and speech disfluencies in autistic young adults and controls

INTRODUCTION

The aim of this study was to examine possible associations of social anxiety (SA) and speaking-related physiological reactivity with the frequencies of a) total disfluencies, b) typical disfluencies, and c) stuttering-like disfluencies, as well as d) stuttering-severity in autistic young adults and controls.

METHODS

Thirty-two autistic young adults and 35 controls participated in this study. Participants were presented with video clips (viewing condition) and were then asked to talk about the videos (narrating condition). SA was measured by the self-report Social Phobia and Anxiety Inventory (SPAI). Speaking-related physiological reactivity was measured by the electrodermal activity (EDA), an index of emotional arousal. The speech samples from the narrating condition were analyzed for type and frequency of speech disfluencies and used for determining the stuttering severity. SA and speaking-related physiological reactivity were compared between the groups. Correlation between SA, physiological reactivity, disfluency frequencies, and stuttering severity were tested separately for both groups.

RESULTS

No between-group differences were found in the overall SA, yet differences were found in SPAI subscales of social interaction, group interaction, and avoidance, as well as in agoraphobia. Both groups had higher physiological arousal in narrating condition in comparison to the video viewing condition, yet there was no between-group difference in the reactivity. No associations were found between SPAI measures, physiological reactivity, disfluency frequencies, and stuttering severity in the autistic group. In the control group, a negative association was found between physiological reactivity and total and typical disfluency frequencies.

CONCLUSIONS

SA or speaking-related physiological reactivity were not associated with disfluency frequencies or stuttering severity in autistic persons. Negative association between physiological reactivity and disfluency frequencies found in the control group may indicate that the physiological arousal may impact the speech production process by reducing the overt disfluencies.

Delay frustration in children who do and do not stutter: A preliminary study

PURPOSE

Frustration is an emotion often clinically reported by persons who stutter. So far, mainly questionnaire-based studies have reported findings related to increased frustration or decreased frustration tolerance. The aim of this preliminary study was to determine possible group differences between children who stutter (CWS) and children who do not stutter (CWNS) using a behavioral experimental task, as well as to evaluate possible associations with the frequency, duration, and physical concomitants of stuttering disfluencies.

METHOD

Participants were 13 CWS (mean age = 6;05 years) and 13 CWNS (mean age = 6;06 years), matched on age (±4 months) and gender. Frustration tolerance was assessed by the Delay Frustration task. This task includes normal delay, short delay, and long delay trials. Responses during long delay trials provide an indication of frustration tolerance and were recorded across time intervals during the response window.

RESULTS

CWS, compared to CWNS, responded more frequently during the long delay trials, which is indicative of higher delay frustration. The variation in responding across time within intervals was similar for both groups. Decreased frustration tolerance was associated with increased duration of stuttered disfluencies and of physical concomitants.

CONCLUSIONS

In general, the current findings seem to provide support for earlier theoretical conceptualizations about the role of emotional reactivity in the development of stuttering.

A case study of bilingual neurogenic stuttering: Measures of fluency, emotion, and articulation rate

INTRODUCTION

This study explores the features of bilingual neurogenic stuttering and the potential connection between emotion and articulation rate on speech disfluencies.

METHOD

The participant is  a 59-year old, Yiddish-English bilingual male with a moderate non-fluent aphasia. Thirty-two narratives (16 in each language), elicited using cue words, were analyzed for frequency of disfluency, type of disfluency (stuttering vs. non-stuttering-like), word-type (content vs. function), within-word location of disfluency, and occurrence of accessory behaviors. Additionally, the percentage and type of emotion (positive vs. negative) expressed, and articulation rate (fluent syllables spoken/duration of fluent utterances) was assessed.

RESULTS

Disfluency occurred in each language with approximately equal frequency. The most common stuttering-like disfluencies were repetitions (monosyllabic, sound, and syllable) and prolongations. The most common non-stuttering-like disfluencies were self-correction/revisions, phrase and multisyllabic word repetitions, and pauses (silent and filled). In both languages, disfluencies occurred on both content and function words, but primarily content words, and in any position of the word, although primarily initial position. No accessory behaviors were noted. There was a similar amount of emotion words used in each language although the first acquired language, L1/Yiddish, had an overall more positive tone, and his second acquired language, L2/English, had a more negative tone. Additionally, there was a negative relationship between emotion and the number of disfluencies in L1/Yiddish, and a positive relationship in L2/English. A faster articulation rate was found in his native and more proficient language, Yiddish, than English. There was a negative relationship between articulation rate and the number of disfluencies in L1/Yiddish, and a positive relationship in L2/English.

CONCLUSIONS

Cross-linguistics differences for emotion and articulation rate demonstrates that these aspects impact on fluency and contributes to the disfluencies in each language. Clinical implications of the study demonstrates the importance of assessment of bilingual (i.e., proficiency and dominance) and fluency features of each language in the diagnostic process and the significance of considering emotional processes and articulation rate as part of a comprehensive intervention plan for acquired stuttering.

A Study of Emotion Regulation Difficulties, Repetitive Negative Thinking, and Experiential Avoidance in Adults with Stuttering: A Comparative Study

Objective: Stuttering is a type of communication and fluency disorder that hurts mental and emotional health. It is also associated with a significant increase in both trait and social anxiety. Studies on stuttering in adults have indicated the nature and impact of this phenomenon. In addition, some psychological aspects of this phenomenon remain vague and need further investigation. Therefore, the present study aimed to compare emotion regulation difficulties, repetitive negative thinking, and experiential avoidance between people who stutter and healthy individuals. Method : In this study, 101 people who stutter (43 females and 58 males, with a mean age of 29.55 ± 187 years), as well as 110 healthy individuals (74 females and 36 males, with a mean age of 25.57 ± 489 years) as participants were chosen using the convenience sampling method among those who referred to the speech therapy clinics of Tehran, Iran. Research instruments including the repetitive negative thinking inventory, Difficulties in Emotion Regulation Scale, and Acceptance and Action Questionnaire (AAQ-I) were used for data collection. Data were analyzed using multivariate ANOVA test and Multiple Regression Analysis. Results: The mean age of the participants was 29.55 years in the people who stutter and 25.57 years in the healthy individuals (P < 0.01). The present results indicated that the mean score of experiential avoidance was higher in the people who stutter (M ± SD: 35.74 ± 9.24) compared to the healthy individuals (M ± SD: 8.89 ± 31.11). Additionally, the mean score of emotion regulation difficulties was higher in the people who stutter (M ± SD: 88.75 ± 20.59) compared to the healthy individuals (M ± SD: 64.14 ± 94.94) (P < 0.001). However, there was no significant difference in the mean score of repetitive negative thinking between the people who stutter (M ± SD: 98.45 ± 25.85) and healthy individuals (M ± SD: 93.71 ± 25.24) groups (P > 0.05). There was a significant correlation between experiential avoidance and emotion regulation difficulties in people who stutter (P < 0.01). Experiential avoidance and repetitive negative thinking can significantly predict emotion regulation difficulties in people who stutter (R = 0.65, P < 0.01). Conclusion: People who stutter obtained higher emotion regulation difficulties and experiential avoidance scores than those without stuttering and A significant correlation between experiential avoidance and emotion regulation difficulties was found. Future studies should consider the role of emotion regulation difficulties and experiential avoidance in people who stutter.

A study of respiratory sinus arrhythmia and stuttering persistence

INTRODUCTION

The present study investigated potential differences in respiratory sinus arrhythmia between preschool-age children with persisting stuttering, children who recovered from stuttering, and children who do not stutter.

METHODS

Participants were 10 children with persisting stuttering (persisting group), 20 children who recovered from stuttering (recovered group), and 36 children who do not stutter (non-stuttering group). Participants viewed a neutral video clip to establish a pre-arousal baseline and then viewed two emotionally-arousing video clips (positive and negative, counterbalanced). Age-appropriate speaking tasks followed each of the video clips (post-baseline, post-positive, and post-negative). Respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system activity, was measured during the video clips and subsequent speaking tasks.

RESULTS

First, the persisting group, recovered group, and non-stuttering group did not significantly differ in baseline RSA. Second, during the emotionally-arousing video clips, there was a significant group x condition interaction, with the recovered group exhibiting significantly lower RSA in the positive than negative condition, and the non-stuttering group exhibiting significantly higher RSA in the positive than negative condition. Third, in the narrative tasks, there was a significant group x condition interaction, with a greater difference in RSA between the post-baseline speaking task and the post-positive and post-negative speaking tasks for the persisting compared to the non-stuttering group. Lastly, a follow-up analysis indicated that the recovered and nonstuttering groups, compared to the persisting group, exhibited significantly greater RSA during the baseline (neutral) condition compared to the post-neutral narrative task.

CONCLUSIONS

Findings provide a physiological perspective of emotion within children who stutter and persist and children who stutter and recover. Future investigations with larger sample sizes and diverse methodologies are necessary to provide novel insights on the specific emotion-related processes that are potentially involved with persistence of stuttering in young children.

Electrodermal Activity of Preschool-Age Children Who Stutter During a Child-Friendly Stroop Paradigm

PURPOSE

The aim of the study was to assess whether emotional reactivity, indexed by a distinct physiological measure of sympathetic activation, differs between preschool-age children who stutter (CWS) and preschool-age children who do not stutter (CWNS) during a child-friendly Stroop task (i.e., day-night task). Additionally, researchers aimed to assess whether the Stroop task, compared to a control task, was a significant physiological stressor.

METHOD

Fifteen preschool-age CWS and 22 preschool-age CWNS were asked to perform a day-night Stroop task in order to elicit psychophysiological reactivity, indexed by electrodermal response (EDR) occurrence frequency and EDR amplitude. Physiological measurements were recorded during pretask baselines, performance of the day-night Stroop task, and performance of a speech-language control task.

RESULTS

Findings based on EDR measures did not support the hypothesis that the child-friendly day-night Stroop task is an effective stressor as compared to a control task based on measures of physiological arousal in preschool-age children. The CWS and CWNS did not significantly differ in their EDR measures relative to the control task or Stroop task (p > .05). However, CWS, compared to CWNS, exhibited significantly greater EDR amplitudes during the control task baseline (p < .05) and the Stroop task baseline (p < .05).

CONCLUSION

Overall, these findings may suggest that a predisposition to heightened levels of sympathetic activity prior to tasks in preschool-age CWS is important to consider with regard to the nature of developmental stuttering.

Self-Disclosure Experiences of Adults Who Stutter: An Interpretative Phenomenological Analysis

PURPOSE

Self-disclosure describes the act of revealing personal information to another person. To date, researchers in the area of stuttering have primarily demonstrated the utility of self-disclosure through analysis of listener perceptions. This study explores the utility of informative self-disclosure use from the perspectives of adults who stutter with experience using this strategy over time and across contexts.

METHOD

Twelve adults who stutter discussed their self-disclosure experiences in semistructured interviews. Interview transcripts were analyzed using interpretative phenomenological analysis to produce themes reflecting the most salient aspects of self-disclosure experiences. Credibility was achieved through bracketing, investigator triangulation, and member checking.

RESULTS

Four superordinate themes reflecting experiences shared by all 12 participants were generated. Each superordinate theme contained two to three corresponding subthemes. The superordinate themes included cognitive relief, self-empowerment, social connection, and personalization. These findings reflect the positive impact of informative self-disclosure use on communication and quality of life.

CONCLUSIONS

Adults who stutter perceive informative self-disclosure to be an effective strategy that provides various benefits to the speaker, in addition to facilitating positive listener perceptions. Clinicians should encourage clients to self-disclose in an informative and personalized manner, provide opportunities for practice, and support clients in determining when and where it is most beneficial for them to implement this strategy.

Latent Class Analysis Reveals Distinct Groups Based on Executive Function and Socioemotional Traits, Developmental Conditions, and Stuttering: A Population Study

A growing body of research has reported associations between weaker Executive Functions (EF), the set capacities that are needed to manage and allocate one's cognitive resources during cognitively challenging activities and various neurodevelopmental conditions, including stuttering. The majority of this research has been based on variable-centered approaches, which have the potential to obscure within-population heterogeneity. Person-centered analyses are essential to understanding multifactorial disorders where relationships between indicators have been elusive, such as stuttering. The current study addressed gaps in the literature by using latent class analysis (LCA), a person-centered approach, to identify homogenous subgroups within the National Health Interview Survey (2004-2018) publicly available data set. Using this exploratory approach, we examined the hypothesis that there exist distinct classes (or subgroups) of children based on parent reports of EF, Socioemotional (SE) traits, developmental atypicality, and stuttering. Our analyses revealed distinct subgroups with substantially different likelihoods of parent-reported stuttering behaviors and developmental atypicality. For children with both EF and SE difficulties, the likelihood of parental report of stuttering and atypical development was even higher, in fact this likelihood (of stuttering and not-typically developing) was highest among all subgroups. In contrast, children without difficulties were the least likely to be reported with stuttering or not-typically developing. Our findings are consistent with theoretical frameworks for stuttering, which cite EF as a crucial component in the disorder. Additionally, our findings suggest within-population heterogeneity among children with EF difficulties and, specifically, EF and SE heterogeneity among children who stutter.

The Relationship Between Auditory-Motor Integration, Interoceptive Awareness, and Self-Reported Stuttering Severity

Stuttering is a neurodevelopmental speech disorder associated with motor timing that differs from non-stutterers. While neurodevelopmental disorders impacted by timing are associated with compromised auditory-motor integration and interoception, the interplay between those abilities and stuttering remains unexplored. Here, we studied the relationships between speech auditory-motor synchronization (a proxy for auditory-motor integration), interoceptive awareness, and self-reported stuttering severity using remotely delivered assessments. Results indicate that in general, stutterers and non-stutterers exhibit similar auditory-motor integration and interoceptive abilities. However, while speech auditory-motor synchrony (i.e., integration) and interoceptive awareness were not related, speech synchrony was inversely related to the speaker’s perception of stuttering severity as perceived by others, and interoceptive awareness was inversely related to self-reported stuttering impact. These findings support claims that stuttering is a heterogeneous, multi-faceted disorder such that uncorrelated auditory-motor integration and interoception measurements predicted different aspects of stuttering, suggesting two unrelated sources of timing differences associated with the disorder.

The role of temperament in stuttering frequency and impact in children under 7

INTRODUCTION

Increased emotional reactivity and decreased regulation have been associated with increased stuttering severity and frequency in preschool children who stutter (CWS) and may be predictors for the development of negative reactions to stuttering in young children. Understanding which children are likely to be impacted to a greater or lesser degree has implications for clinical decision making. Associations between temperament and stuttering impact have been explored with older CWS, but not with preschool CWS.

AIM

To investigate the relationship between temperament (specifically emotional reactivity and regulation) and both stuttering frequency and stuttering impact in preschool CWS.

METHODS

Data collected at initial assessment for 119 young CWS (age range= 3;00-6;11 years) at a specialist centre for stuttering in London, UK were analysed. The following measures were completed: The Children's Behaviour Questionnaire-Short Form (Putnam & Rothbart, 2006); Palin Parent Rating Scales (Millard & Davis, 2016); The Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007); and a stuttering frequency measure.

RESULTS

Emotional reactivity and regulation were not significantly associated with stuttering frequency. Higher scores on negative reactivity were significantly associated with an increased impact of stuttering on the child (from parents' perspective), but not significantly associated with child-reported communication attitude. Positive reactivity was not significantly associated with parent-reported impact of stuttering or child-reported communication attitude. Additional investigation revealed negative affect as a significant predictor of parent-reported impact of stuttering before and after adjusting for age.

DISCUSSION

The results provide evidence to support the role of temperament on the impact that stuttering has in the early years. While the directionality of the relationship between negative reactivity and impact of stuttering is unknown, the importance of targeting emotional reactions in therapy for young CWS is implicated.

Emotion-related regulation strategy use in preschool-age children who stutter

PURPOSE

Past findings indicate the quality and quantity of emotion regulation often differs between preschool-age children who stutter (CWS) and children who do not stutter (CWNS). The purpose of this study was to identify whether specific emotion-related regulatory strategy types differ between preschool-age CWS and CWNS during a temptation task.

METHODS

Participants were 13 CWS and 13 CWNS between 3;2 and 5;7 (years;months), matched for gender and age (+/- 6 months). Participants completed a Forbidden Toy paradigm, a resistance to temptation task, in which the children were asked to refrain from touching a toy. Types of emotion-related regulation, including (1) verbal regulation, (2) behavioral regulation, and (3) attentional regulation, were behaviorally coded during the temptation task.

RESULTS

A higher proportion of the CWNS (92%) failed to resist the temptation to touch the toy than CWS (48%). Additionally, a higher proportion of the CWS (23%), compared to CWNS (0%), presented with signs of distress, resulting in their task ending prematurely. Limited differences were detected in the types of emotion-related regulatory strategies used by CWS, or the frequency of those strategies. CWNS, compared to the CWS, used more approach-related behavioral strategies.

CONCLUSIONS

Interpretations of these findings must be mitigated by the observation that a higher proportion of CWS than CWNS demonstrated distress during the paradigm, suggesting a need for further research into the interplay between emotional reactivity and emotion regulation for preschool-age CWS.

Structural brain network topological alterations in stuttering adults

Persistent developmental stuttering is a speech disorder that primarily affects normal speech fluency but encompasses a complex set of symptoms ranging from reduced sensorimotor integration to socioemotional challenges. Here, we investigated the whole brain structural connectome and its topological alterations in adults who stutter. Diffusion weighted imaging data of 33 subjects (13 adults who stutter and 20 fluent speakers) was obtained along with a stuttering severity evaluation. The structural brain network properties were analyzed using Network-based statistics and graph theoretical measures particularly focusing on community structure, network hubs and controllability. Bayesian power estimation was used to assess the reliability of the structural connectivity differences by examining the effect size. The analysis revealed reliable and wide-spread decreases in connectivity for adults who stutter in regions associated with sensorimotor, cognitive, emotional, and memory-related functions. The community detection algorithms revealed different subnetworks for fluent speakers and adults who stutter, indicating considerable network adaptation in adults who stutter. Average and modal controllability differed between groups in a subnetwork encompassing frontal brain regions and parts of the basal ganglia.

The results revealed extensive structural network alterations and substantial adaptation in neural architecture in adults who stutter well beyond the sensorimotor network. These findings highlight the impact of the neurodevelopmental effects of persistent stuttering on neural organization and the importance of examining the full structural connectome and the network alterations that underscore the behavioral phenotype.

Bidirectional Associations of Childhood Stuttering With Behavior and Temperament

PURPOSE

Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood.

METHOD

This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed.

RESULTS

Six-month-old children who were less able to "recover from distress," indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (β = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (β = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (β = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years.

CONCLUSIONS

Behavior and temperament were associated with stuttering persistency-seemingly as both predictor and consequence-but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered. Supplemental Material https://doi.org/10.23641/asha.16869479.

Temperament is Linked to Avoidant Responses to Stuttering Anticipation

PURPOSE

The purpose of the present study was to examine the degree to which certain temperament constructs predict individual differences in three types of behavioral responses to anticipation among children and adults who stutter (CWS and AWS, respectively): avoidance, physical change, and approach.

METHODS

Participants included 64 CWS (9- to 17-years-old) and 54 AWS (18- to 50-years-old) who completed an online survey package including a temperament questionnaire (Early Adolescent Temperament Questionnaire-Revised for the CWS; Adult Temperament Questionnaire for the AWS) and the Stuttering Anticipation Scale. The data were analyzed separately for CWS and AWS using multivariate multiple regressions to assess how each temperament construct predicted avoidance, physical change, and approach responses to anticipation.

RESULTS

CWS who reported higher levels of shyness were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. AWS who reported higher levels of orienting sensitivity were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. No temperament constructs predicted physical change or approach responses to anticipation among either age group.

CONCLUSION

Specific aspects of temperament appear to be linked to the degree that CWS and AWS engage in avoidant behavioral responses to stuttering anticipation. These findings support the continued study of how individual differences impact the internal experience and outward manifestation of stuttering behaviors.

Cognitive Flexibility and Effortful Control in School-Age Children With and Without Stuttering Disorders

Purpose This study compared attention control and flexibility in school-age children who stutter (CWS) and children who do not stutter (CWNS) based on their performance on a behavioral task and parent report. We used a classic attention-shifting paradigm that included manipulations of task goals and timing to test effects of varying demands for flexibility on switching accuracy and speed. We also examined associations between task performance, group, and relevant aspects of temperament. Method Participants included 33 children (15 CWS, 18 CWNS) between 8 and 11 years of age. Children sorted stimuli that differed on two dimensions (color and shape) based on sorting rules that varied from block to block or trial to trial. Timing manipulations included intervals of 200-, 600-, or 1,200-ms durations for critical trial components. Temperament data were obtained via the Children's Behavior Questionnaire. Results All children showed expected performance costs in response to block and trial manipulations; however, CWS were more affected by task conditions that increased demands for cognitive flexibility. Effects of interval durations also differed by group. Factor scores on the Children's Behavior Questionnaire indicated differences in effortful control between groups; however, this aspect of temperament did not mediate between-groups differences in switching performance. Conclusions Findings suggest that stuttering continues to be associated with differences in attention control and flexibility beyond the preschool years. Further research is needed to clarify how these cognitive processes shape the development of stuttering throughout childhood.

Evaluating three stuttering assessments through network analysis, random forests and cluster analysis

PURPOSE

In stuttering, cognitive and behavioural variables interact in nonlinear fashion. These variables can be assessed by instruments which evaluate perceived impact of stuttering and stuttering severity. We applied three statistical methods in combination to the analysis of three assessment protocols to discover relationships within and between the tests to better understand variations in behavioural and social aspects of stuttering.

METHODS

Scores from Stuttering Severity Index (SSI-IV), Overall Assessment of the Speaker's Experience of Stuttering scale (OASES), and Unhelpful Thoughts and Beliefs About Stuttering scale (UTBAS), collected from 26 participants were compared using three statistical methods: network analysis, random forests, and cluster analysis.

RESULTS

Network analysis demonstrated that SSI-IV only weakly interacts with a quality of life index (OASES) and a self-perception and belief systems index (UTBAS). Random forest analyses revealed the last two measures relate strongly to each other. The results from cluster analysis suggest a) a possible regrouping of OASES items and b) a possible use of one UTBAS scale instead of the three.

CONCLUSION

A combination of three statistical methods allowed us to evaluate the three assessments in more depth. The lack of interaction between the SSI-IV on the one hand, and OASES and UTBAS on the other, suggests that the network of the three commonly used stuttering assessments may be fractured in a non-productive way. A potential gap may exist for an assessment tool that would link behavioural and social aspects of stuttering.

Emotion processing in children who do and do not stutter: An ERP study of electrocortical reactivity and regulation to peer facial expressions

PURPOSE

Event-related brain potentials (ERPs) were used to investigate the neural correlates of emotion processing in 5- to 8-year-old children who do and do not stutter.

METHODS

Participants were presented with an audio contextual cue followed by images of threatening (angry/fearful) and neutral facial expressions from similarly aged peers. Three conditions differed in audio-image pairing: neutral context-neutral expression (neutral condition), negative context-threatening expression (threat condition), and reappraisal context-threatening expression (reappraisal condition). These conditions reflected social stimuli that are ecologically valid to the everyday life of children.

RESULTS

P100, N170, and late positive potential (LPP) ERP components were elicited over parietal and occipital electrodes. The threat condition elicited an increased LPP mean amplitude compared to the neutral condition across our participants, suggesting increased emotional reactivity to threatening facial expressions. In addition, LPP amplitude decreased during the reappraisal condition- evidence of emotion regulation. No group differences were observed in the mean amplitude of ERP components between children who do and do not stutter. Furthermore, dimensions of childhood temperament and stuttering severity were not strongly correlated with LPP elicitation.

CONCLUSION

These findings are suggestive that, at this young age, children who stutter exhibit typical brain activation underlying emotional reactivity and regulation to social threat from peer facial expressions.

Manual response inhibition and quality of life in adults who stutter

BACKGROUND

A considerable amount of research has identified inhibition differences, including slower inhibition of manual responses, in people who stutter. Recent investigations have failed to link slowed motor inhibition with overt stuttering severity. This study investigated the potential relationship between slowed manual response inhibition and the negative impact of stuttering upon individual lives of adults who stutter (AWS).

METHODS

Thirty-four adults (AWS, n = 17; AWNS, n = 17) matched by nonverbal IQ completed a manual stop-signal task and provided a conversational speech sample. Motor inhibition latency for AWS and AWNS were compared. For AWS, motor inhibition latency was compared to the four subsections of the Overall Assessment of the Speaker's Experience with Stuttering (OASES; Yaruss & Quesal, 2006; General Information, Reactions to Stuttering, Communication in Daily Situations, Quality of Life).

RESULTS

Similar to previous studies, AWS were significantly slower to inhibit inaccurate manual responses than AWNS. Quality of Life subtest of the OASES was found to significantly predict inhibition latency.

CONCLUSION

These data replicate findings that indicate that AWS exhibit slower manual inhibition latency, and suggest that these inhibition differences may be associated with an individual's negative experience with stuttering rather than stuttering severity.

An Evaluation of an Integrated Stuttering and Parent-Administered Self-Regulation Program for Early Developmental Stuttering Disorders

Purpose This study reports findings from a clinical trial that implemented an early stuttering treatment program integrated with evidence-based parenting support (EBPS) to children who stutter (CWS) with concomitant self-regulation challenges manifested in elevated attention-deficit/hyperactivity disorder (eADHD) symptoms and compared those outcomes to CWS receiving stuttering treatment without EBPS. Method Participants were 76 preschool CWS and their parent(s). Thirty-six of these children presented with eADHD and were quasirandomized into two groups: stuttering treatment only (eADHD_standard) or stuttering treatment integrated with EBPS (eADHD_integrated). The remaining children did not meet criteria for eADHD symptoms and received stuttering treatment only (No-eADHD_standard). Pre, post, and 3-month follow-up measures of stuttering treatment outcomes as well as treatment effects on measures of child behavior difficulties and parenting practices were examined. Results Significant reduction in stuttering was found for all groups. However, the eADHD_integrated group showed a greater reduction in stuttering frequency than the eADHD_standard group, and at follow-up, stuttering frequencies in the eADHD_integrated group matched those of children in the No-eADHD_standard group, while stuttering in the eADHD_standard group remained significantly higher. Children with eADHD symptoms who received the integrated program also required significantly less stuttering intervention time than those children with eADHD symptoms who received stuttering treatment only. Families in the eADHD_integrated group reported large and significant improvements in child behavior and parenting practices. Conclusion This study provides support for an early treatment program for CWS. The integrated stuttering and self-regulation management program for CWS with eADHD symptoms proved successful for fluency and behavioral improvements, which were sustained at follow-up.

Temperament and early stuttering intervention: Two perspectives

PURPOSE

To discuss clinical applications of research findings about temperament and early stuttering.

METHOD

A "1000-bytes" format (Onslow & Millard, 2012) was used to provide readers with contemporaneous observation of a "conversation" between the authors. The conversation is proceeded by a prologue and followed by concluding statements from each author.

RESULTS

One author contended that comprehensive, multidimensional assessment of temperament domains is essential during clinical management of early stuttering, and the results of that assessment are best incorporated into a multifactorial treatment approach. The other author contested that view, arguing that such an approach is not empirically justifiable at present.

CONCLUSIONS

The authors agree about the salience of research on temperament and early stuttering but have different perspectives about the topic when applied to providing health care for early stuttering.

Lexical diversity and lexical skills in children who stutter

PURPOSE

Numerous "small N" studies of language ability in children who stutter have produced differing conclusions. We combined test and spontaneous language data from a large cohort of children who stutter (CWS) and typically fluent peers, gathered from independent laboratories across the US, to appraise a variety of lexical measures.

METHOD

Standardized receptive and expressive vocabulary test data and spontaneous language samples from 99 pairs of CWS (ages 25-100 months), and age-, gender-, and SES-matched children who do not stutter (CWNS) were compared. Language sample transcripts were analyzed with four measures of lexical diversity. Correlations between lexical diversity measures and expressive vocabulary scores were also calculated.

RESULTS

On standardized tests of both receptive and expressive vocabulary, there were significant differences between CWS and CWNS. In contrast, on spontaneous language measures of lexical diversity, CWS did not differ in their lexical diversity, across analyses, compared to CWNS. Three of the four lexical diversity analyses, MATTR, VocD, and NDW, were significantly correlated with each other.

CONCLUSIONS

We were able to confirm prior findings of relative disadvantage on standardized vocabulary tests for a very large sample of well-matched CWS. However, spontaneous language measures of lexical diversity did not distinguish the groups. This relative weakness in CWS may emerge from task differences: CWS are free to encode their own spontaneous utterances but must comply with explicit lexical prompts in standardized testing situations.

Physiological Correlates of Fluent and Stuttered Speech Production in Preschool Children Who Stutter

Purpose The purpose of this study was to compare physiological indices of sympathetic nervous system arousal recorded during fluent and stuttered utterances in a preschool children who stutter (CWS). Method Twenty-two 4- to 5-year-old CWS participated in the experiment. We recorded children's skin conductance response amplitude and frequency, blood pulse volume amplitude, and pulse rate as they completed a picture description task. We then compared indices of phasic sympathetic arousal recorded during stuttered versus fluent utterances. In addition, children's communication attitudes were evaluated with a self-report measure. Results We detected significantly higher sympathetic arousal during stuttered utterances compared to fluent utterances. Specifically, we found larger skin conductance responses occurring at an increased frequency and decreased blood pulse volume amplitudes during stuttered speech. The behavioral measure indicated a negative communication attitude in only one-third of the participants. Conclusion Our findings suggest that preschool CWS may exhibit higher levels of sympathetic arousal during stuttered speech compared to when they are speaking fluently. We discuss the potential impact of increased sympathetic arousal on speech regulatory mechanisms in early childhood stuttering and present questions to guide future research.

Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering

PURPOSE

Recent research has identified approximately half of children who stutter present with self-regulation challenges. These manifest in elevated inattentive and/or impulsive behaviours, aligned with attention deficit hyperactivity disorder (ADHD) symptoms. These symptoms have been found to influence the child's responsiveness to their stuttering treatment, and may exacerbate the psychosocial consequences of stuttering for them and their families. Early stuttering intervention identifies parents as key agents of change in the management of their children's stuttering. This study sought feedback from parents regarding their experiences with an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering, addressing the child's self-regulation challenges.

METHOD

Eight parents of children who stutter who had co-occurring self-regulation challenges completed the integrated program. This incorporated the Triple P--Positive Parenting Program adapted for the developmental stuttering population, and the Curtin University Stuttering Program (CUSP). Semi-structured qualitative interviews were conducted to capture parents' reflections on, and experiences with, the integrated program.

RESULTS

Thematic analysis identified several major themes regarding the parents' experiences with the integrated program: emotional impact on parents, child self-regulation, link between stuttering and behaviour, parent self-regulation, impact on family dynamics, and overall positive perceptions of the integrated program. All of the parents indicated they would recommend the program to future parents of children who stutter.

CONCLUSION

This study provides insights into parents' perceptions regarding an integrated intervention approach for early stuttering and behavior management. It also indicates how adopting a holistic approach to stuttering intervention is positive and has social validity.

Sympathetic Nervous System Activity in Preschoolers Who Stutter

BACKGROUND

In our Dynamic Pathways, account, we hypothesized that childhood stuttering reflects an impairment in speech sensorimotor control that is conditioned by cognitive, linguistic, and emotional factors. The purpose of this study was to investigate potential differences in levels of sympathetic arousal during performance of speech and non-speech tasks between children who do and do not stutter.

METHODS

Seventy-two preschool-aged children participated in the study, 47 children who stutter (CWS; 38 boys) and 25 children who do not stutter (CWNS; 18 boys). We recorded skin conductance and blood pulse volume (BPV) signals, indices of sympathetic arousal, during higher/lower load speech tasks (structured sentence production and picture description) and non-speech tasks (jaw wagging and forceful blowing). We included a measure that reflects children's attitudes about their communication skills and a parent-report assessment of temperament.

RESULTS

We found no significant differences between preschool CWS and CWNS in phasic skin conductance response amplitude or frequency, BPV, and pulse rate for any of the experimental tasks. However, compared to CWNS, CWS had, on average, significantly higher skin conductance levels (SCL), indexing slowly changing tonic sympathetic activity, across both speech and non-speech experimental conditions. We found distinctive task-related profiles of sympathetic arousal in both groups of preschool children. Most children produced the highest levels of sympathetic arousal in the physically demanding blowing task rather than in speech, as seen in previous studies of adults. We did not find differences in temperament between the two groups of preschool children nor a relationship among behavioral indices of temperament and communication attitude and physiological measures of sympathetic arousal.

CONCLUSION

We did not find that atypically high, speech-related sympathetic arousal is a significant factor in early childhood stuttering. Rather, CWS had higher, on average, task-related tonic SCLs across speech and non-speech tasks. A relationship among behavioral measures of temperament and physiological measures of sympathetic arousal was not confirmed. Key questions for future experiments are how the typical coupling of sympathetic and speech sensorimotor systems develops over childhood and adolescence and whether task related developmental profiles follow a different course in children who continue to stutter.

Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter

The purpose of this study was to examine temperament dimensions, executive functioning ability, and anxiety levels in school-age children who stutter and their non-stuttering peers. Participants were 100 Portuguese children aged 7 to 12 years (M = 9.13; SD = 1.70), including 50 children who stutter and 50 children who do not stutter. Analyses, which were performed separately for younger and older participants, sought to identify correlations between key variables. Temperament was evaluated through a parent questionnaire, executive functioning was evaluated through children’s responses on a performance test, and anxiety level was assessed through a self-perception scale. On the temperament measure, comparisons between children who stutter and their non-stuttering peers revealed that older children who stutter exhibited significantly higher scores on the Anger/Frustration, Impulsivity, and Sadness subscales, and lower averages on the Attention/Focusing, Perceptual sensitivity, and Soothability/Falling Reactivity subscales. On the executive functioning task, comparisons revealed that the group of younger children who stutter exhibited significantly higher average execution times than their non-stuttering peers. There were no statistically significant differences in anxiety between children who stutter and children who do not stutter, and there were no statistically significant correlations between temperament factors and measures of executive functioning. Children who stutter experienced lower ability to orient attention and greater emotional reactivity compared with their non-stuttering peers. Significant correlations were found between executive functioning and age and among the temperament factors themselves. These results, which support the need for a multidimensional view of stuttering, were interpreted in the context of the Dual Diathesis – Stressor model. Findings indicate that temperament and executive functioning abilities may contribute to the development of stuttering.

Rhyme Production Strategies Distinguish Stuttering Recovery and Persistence

Purpose The primary aim of the current study was to examine the developing phonological awareness of 4- to 5-year-old children who stutter (CWS) in relation to eventual recovery (CWS-eRec) or persistance (CWS-ePer) in stuttering, accounting for the presence of typical speech (TS) production or speech sound disorder (SSD). Method In the 1st year of a 5-year longitudinal study, 37 children who do not stutter (CWNS) and 48 CWS completed a rhyme discrimination and a rhyme production task from the Phonological Awareness Test-Second Edition (Robertson & Salter, 2007). Using data from their last year of participation, CWS were classified into CWS-ePer and CWS-eRec. Each CWS group was further divided into TS and SSD groups based on speech production abilities at the time of the rhyme tasks. Accuracy on the rhyme tasks was compared. Groups were also compared on strategies used to generate correct and incorrect responses for the rhyme production task (e.g., real-word correct, nonword correct, semantic association, repeated cues). Results All groups performed similarly on the rhyme discrimination task. On the rhyme production task, CWS-ePer-SSD and CWS-eRec-SSD performed with less accuracy than CWNS, but CWS-ePer-TS, CWS-eRec-TS, and CWNS achieved similar task accuracy. On correct rhyme production trials, CWS-ePer-TS created more nonword rhymes than real-word rhymes. CWS-ePer-TS used the nonword strategy at 1.88 times the CWNS rate. CWS-eRec-TS fell between CWS-ePer-TS and CWNS in use of the nonword strategy. Conclusions Reliance on a nonword strategy for rhyme production in CWS-ePer-TS may reflect differences in underlying phonological representations and ease of phonological access to the lexicon compared to CWNS.

Disfluencies and phonological revisions in a nonword repetition task in school-age children who stutter

Phonological encoding and associated functions, including monitoring of covert and overt speech, have been attributed relevant roles in stuttering. The aim of this study was to investigate these processes by testing the effects of nonword length in syllables (3-, 4-, 6-syllable), phonotactics, and phonemic/phonetic complexity on disfluencies and phonological revisions in 26 school-age children who stutter (CWS, n = 13) and matched fluent controls (CWNS). Participants repeated nonwords in two sessions separated by an hour. Within-group comparisons of percentage disfluencies using nonparametric tests resulted in significantly more disfluencies for the 6- compared to the 3-syllable nonwords and suggested that nonword length influences disfluencies in the CWS. The groups were comparable in the percentage of disfluencies at all levels of nonword length. The findings failed to provide conclusive evidence that phonological complexity and phonotactic manipulations have a greater effect on disfluencies in CWS compared to CWNS. The findings of significantly fewer phonological revisions and the lack of a significant correlation between disfluencies and revisions in the CWS in Session 1 compared to the CWNS are interpreted to suggest reduced external auditory monitoring. Demands on incremental phonological encoding with increasing task complexity (the Covert Repair Hypothesis, Postma & Kolk, 1993) and reduced external auditory monitoring of stuttered speech can account for the disfluencies, speech errors, and revisions in the speech of school-age CWS.

Temperament in Adults Who Stutter and Its Association With Stuttering Frequency and Quality-of-Life Impacts

Purpose The study aim was to determine whether self-reported temperament traits differentiate adults who stutter (AWS) from adults who do not stutter (AWNS). Additionally, associations between temperament and stuttering frequency, and between temperament and quality of life impacts of stuttering, were investigated in AWS. Method Self-reported temperament traits were documented for 33 AWS and 43 AWNS using the Adult Temperament Questionnaire (ATQ; Evans & Rothbart, 2007). Quality-of-life impacts of stuttering were assessed using the Overall Assessment of the Speaker's Experience with Stuttering (Yaruss & Quesal, 2010). Stuttering frequency was calculated from 100-word monologue and reading samples. Results A between-groups difference in scores on the ATQ Positive Affect subscale was nominally significant (i.e., before correcting for multiple tests) and also approached statistical significance after Bonferroni correction. Positive Affect scores were lower for AWS, and the size of this trending effect was moderate. Within AWS, a statistically significant positive correlation was found between impact scores on the General Information section of the Overall Assessment of the Speaker's Experience with Stuttering and ATQ Frustration subscale scores after Bonferroni correction. No associations were detected between temperament traits and stuttering frequency. Conclusions Results reveal a nontrivial tendency for AWS to experience decreased positive affect compared to AWNS. In addition, increased frustration was found to be associated with reduced general knowledge about stuttering in AWS. Neither effect has been previously reported for adults or children who stutter. Finally, self-reported temperament traits were not found to vary with stuttering frequency in adults, consistent with previous results for AWS.

Language development in children who stutter: A review of recent research

Purpose: This article reviews recent studies that examined the controversial claim that children who stutter (CWS), as a group, have weaker language skills than children who do not stutter (CWNS). The article was an effort to address the conflicting conclusions of two previous reviews of the research in this area. Method: Studies published in research journals during the past 7 years (2011-2018) were located through a systematic review of the literature. Each study was analysed to determine how well it supported the claim that CWS, as a group, have weaker language skills than CWNS. Result: The evidence was not convincing to support this controversial claim. Rather, the review indicated that CWS performed as well as or better than CWNS on formal language tasks. Conclusion: The claim that language weaknesses are linked to children's stuttering is not well supported by recently published studies. Alternative interpretations of the literature are offered.

Why do bilinguals code-switch when emotional? Insights from immigrant parent-child interactions

Previous research has found that bilingual speakers' first (L1) and second languages (L2) are differentially associated with their emotional experiences. Moreover, bilinguals appear to code-switch (alternate between two or more languages in a single conversation) during emotional episodes. However, prior evidence has been limited to clinical case studies and self-report studies, leaving open the specificity of the link between code-switching (CS) and emotion and its underlying mechanisms. The present study examined the dynamic associations between CS and facial emotion behavior in a sample of 68 Chinese American parents and children during a dyadic emotion-inducing puzzle box task. Specifically, bilingual parents' language use (L1 Chinese or L2 English), CS behavior (L1→L2 or L2→L1 switches), and facial emotion behavior (positive and negative valence) were coded at each 5-s interval. Multilevel modeling was used to analyze whether facial emotion behavior predicted later CS and vice versa. We found that negative facial emotion predicted higher subsequent CS in both L1→L2 and L2→L1 directions, with stronger associations for the L2→L1 direction. On the other hand, positive facial emotion was associated with lower contemporaneous L2→L1 CS. CS did not predict later facial emotion behavior, suggesting language switching may not have an immediate effect on emotion. The present findings are consistent with the idea that emotional arousal, especially negative arousal, reduces cognitive control and may trigger spontaneous CS. Together, these findings provide insight into why bilingual speakers switch languages during emotional episodes and hold implications for clinical interventions serving bilingual individuals and families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Role of Effortful Control in Stuttering Severity in Children: Replication Study

Background In 2014, Kraft et al. assessed the temperament, home environment, and significant life events of 69 North American children who stutter to examine the combined and compounded effects of these individualized factors on mediating overt stuttering severity. The temperament domain of effortful control was singularly found to be significantly predictive of stuttering severity. Purpose Because of the clinical significance of the initial study's findings, a replication study with a different, larger cohort of children who stutter was warranted to validate the reported outcomes. Method The current study assesses 98 children who stutter, ages 2;4 to 12;6 (years; months, M = 6;7), recruited from Perth, Australia. Results The results support the previous findings of Kraft, Ambrose, and Chon (2014) , with effortful control remaining the sole significant contributor to variability in stuttering severity, as rated by both parents and clinicians. Conclusion These cumulative and consistent outcomes support the need to develop targeted intervention strategies that specifically strengthen aspects of effortful control as a means to support positive therapeutic change in children who stutter.

Cognitive flexibility in preschool children with and without stuttering disorders

PURPOSE

Multifactorial explanations of developmental stuttering suggest that difficulties in self-regulation and weak attentional flexibility contribute to persisting stuttering. We tested this prediction by examining whether preschool-age children who stutter (CWS) shift their attention less flexibly than children who do not stutter (CWNS) during a modified version of the Dimension Card Change Sort (DCCS), a reliable measure of attention switching for young children.

METHODS

Sixteen CWS (12 males) and 30 children CWNS (11 males) participated in the study. Groups were matched on age (CWS: M=49.63, SD=10.34, range=38-80months; CWNS: M=50.63, SD=9.82, range=37-74months), cognitive ability, and language skills. All children completed a computer-based variation of the DCCS, in which they matched on-screen bivalent stimuli to response buttons based on rules that switched mid-task.

RESULTS

Results showed increased slowing for CWS compared to controls during the postswitch phase, as well as contrasting patterns of speed-accuracy tradeoff for CWS and CWNS as they moved from the preswitch to postswitch phase of the task.

CONCLUSIONS

Group differences in performance suggest that early stuttering may be associated with difficulty shifting attention efficiently and greater concern about errors. Findings are consistent with a growing literature indicating links between weak attentional control and persisting developmental stuttering.

Cortical associates of emotional reactivity and regulation in childhood stuttering

PURPOSE

This study sought to determine the cortical associates of emotional reactivity and emotion regulation (as indexed by the amplitude of evoked response potentials [ERP]) in young children who do and do not stutter during passive viewing of pleasant, unpleasant and neutral pictures.

METHOD

Participants were 17 young children who stutter and 22 young children who do not stutter (between 4 years 0 months to 6 years 11 months). The dependent measures were (1) mean amplitude of late positive potential (LPP, an ERP sensitive to emotional stimuli) during passive (i.e., no response required) picture viewing and directed reappraisal tasks and (2) emotional reactivity and regulation related scores on caregiver reports of young children's temperament (Children's Behavior Questionnaire, CBQ).

RESULTS

Young CWS, when compared to CWNS, exhibited significantly greater LPP amplitudes when viewing unpleasant pictures, but no significant between-group difference when viewing pleasant pictures and during the emotion regulation condition. There were, however, for CWS, but not CWNS, significant correlations between temperament-related measures of emotion and cortical measures of emotional reactivity and regulation.

CONCLUSIONS

Findings provide further empirical support for the notion that emotional processes are associated with childhood stuttering, and that CWS's inherent temperamental proclivities need to be taken into account when empirically studying or theorizing about this association.

The effect of emotion on articulation rate in persistence and recovery of childhood stuttering

PURPOSE

This study investigated the possible association of emotional processes and articulation rate in pre-school age children who stutter and persist (persisting), children who stutter and recover (recovered) and children who do not stutter (nonstuttering).

METHODS

The participants were ten persisting, ten recovered, and ten nonstuttering children between the ages of 3-5 years; who were classified as persisting, recovered, or nonstuttering approximately 2-2.5 years after the experimental testing took place. The children were exposed to three emotionally-arousing video clips (baseline, positive and negative) and produced a narrative based on a text-free storybook following each video clip. From the audio-recordings of these narratives, individual utterances were transcribed and articulation rates were calculated.

RESULTS

Results indicated that persisting children exhibited significantly slower articulation rates following the negative emotion condition, unlike recovered and nonstuttering children whose articulation rates were not affected by either of the two emotion-inducing conditions. Moreover, all stuttering children displayed faster rates during fluent compared to stuttered speech; however, the recovered children were significantly faster than the persisting children during fluent speech.

CONCLUSION

Negative emotion plays a detrimental role on the speech-motor control processes of children who persist, whereas children who eventually recover seem to exhibit a relatively more stable and mature speech-motor system. This suggests that complex interactions between speech-motor and emotional processes are at play in stuttering recovery and persistency; and articulation rates following negative emotion or during stuttered versus fluent speech might be considered as potential factors to prospectively predict persistence and recovery from stuttering.

Uniqueness Point Effects during Speech Planning in Adults Who Do and Do Not Stutter

BACKGROUND/AIMS

Previous studies employing a variety of tasks have demonstrated that adults who stutter (AWS) pre-sent with phonological encoding differences compared to adults who do not stutter (AWNS). The present study examined whether atypical preverbal monitoring also influenced AWS performance during one such paradigm - the silent phoneme monitoring task. Specifically, we investigated whether monitoring latencies for AWS were accelerated after the word's uniqueness point - the phoneme that isolates the word from all lexical competitors - as observed for AWNS when monitoring internal and external speech.

METHODS

Twenty adults (10 AWS, 10 AWNS) completed a silent phoneme monitoring task using stimuli which contained either (a) early uniqueness points (EUP), (b) late uniqueness points, or (c) no uniqueness point (NUP). Response latency when identifying word-final phonemes was measured.

RESULTS

AWNS exhibited the expected uniqueness point effect when monitoring internal speech; word-final phonemes were accessed more rapidly for words with EUP than NUP. In contrast, AWS did not differ in the phoneme monitoring speed. That is, AWS did not exhibit the expected uniqueness point effects.

CONCLUSION

Findings suggest that inefficient or atypical preverbal monitoring may be present in AWS and support theories that implicate the internal speech monitor as an area of deficit.

Anomalous network architecture of the resting brain in children who stutter

PURPOSE

We combined a large longitudinal neuroimaging dataset that includes children who do and do not stutter and a whole-brain network analysis in order to examine the intra- and inter-network connectivity changes associated with stuttering. Additionally, we asked whether whole brain connectivity patterns observed at the initial year of scanning could predict persistent stuttering in later years.

METHODS

A total of 224 high-quality resting state fMRI scans collected from 84 children (42 stuttering, 42 controls) were entered into an independent component analysis (ICA), yielding a number of distinct network connectivity maps ("components") as well as expression scores for each component that quantified the degree to which it is expressed for each child. These expression scores were compared between stuttering and control groups' first scans. In a second analysis, we examined whether the components that were most predictive of stuttering status also predicted persistence in stuttering.

RESULTS

Stuttering status, as well as stuttering persistence, were associated with aberrant network connectivity involving the default mode network and its connectivity with attention, somatomotor, and frontoparietal networks. The results suggest developmental alterations in the balance of integration and segregation of large-scale neural networks that support proficient task performance including fluent speech motor control.

CONCLUSIONS

This study supports the view that stuttering is a complex neurodevelopmental disorder and provides comprehensive brain network maps that substantiate past theories emphasizing the importance of considering situational, emotional, attentional and linguistic factors in explaining the basis for stuttering onset, persistence, and recovery.

Sympathetic arousal as a marker of chronicity in childhood stuttering

PURPOSE

This study investigated whether sympathetic activity during a stressful speaking task was an early marker for stuttering chronicity.

METHOD

Participants were 9 children with persisting stuttering, 23 children who recovered, and 17 children who do not stutter. Participants performed a stress-inducing picture-naming task and skin conductance was measured across three time points.

RESULTS

Findings indicated that at the initial time point, children with persisting stuttering exhibited higher sympathetic arousal during the stressful speaking task than children whose stuttering recovered.

CONCLUSIONS

Findings are taken to suggest that sympathetic activity may be an early marker of heightened risk for chronic stuttering.

Young children's family history of stuttering and their articulation, language and attentional abilities: An exploratory study

PURPOSE

The purpose of this study was to determine whether young children who do (CWS) and do not stutter (CWNS) with a positive versus negative family history of stuttering differ in articulation, language and attentional abilities and family histories of articulation, language and attention related disorders.

METHOD

Participants were 25 young CWS and 50 young CWNS. All 75 participants' caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points that were about 8 months apart for a total of approximately 16 months. Each participant's family history focused on the same, relatively limited number of generations (i.e., participants' parents & siblings). Children's family history of stuttering as well as articulation, language, and attention related disorders was obtained from one or two caregivers during an extensive interview. Children's speech and language abilities were measured using four standardized articulation and language tests and their attentional abilities were measured using caregiver reports of temperament.

RESULTS

Findings indicated that (1) most caregivers (81.5% or 75 out 92) were consistent in their reporting of positive or negative history of stuttering; (2) CWNS with a positive family history of stuttering, compared to those with a negative family history of stuttering, were more likely to have reported a positive family history of attention deficit/hyperactivity disorder (ADHD), and (3) CWNS with a positive family history of stuttering had lower language scores than those with a negative family history of stuttering. However, there were no such significant differences in family histories of ADHD and language scores for CWS with a positive versus negative family history of stuttering. In addition, although 24% of CWS versus 12% of CWNS's caregivers reported a positive family history of stuttering, inferential analyses indicated no significant differences between CWS and CWNS in relative proportions of family histories of stuttering.

CONCLUSION

Finding that a relatively high proportion (i.e., 81.5%) of caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points should provide some degree of assurance to those who collect such caregiver reports. Based on such consistent caregiver reports, linguistic as well as attentional vulnerabilities appear associated with a positive family history of stuttering, a finding that must await further empirical study for confirmation or refutation.

The Influence of Executive Functions on Phonemic Processing in Children Who Do and Do Not Stutter

PURPOSE

The aim of the present study was to investigate dual-task performance in children who stutter (CWS) and those who do not to investigate if the groups differed in the ability to attend and allocate cognitive resources effectively during task performance.

METHOD

Participants were 24 children (12 CWS) in both groups matched for age and sex. For the primary task, participants performed a phoneme monitoring in a picture-written word interference task. For the secondary task, participants made pitch judgments on tones presented at varying (short, long) stimulus onset asynchrony (SOA) from the onset of the picture.

RESULTS

The CWS were comparable to the children who do not stutter in performing the monitoring task although the SOA-based performance differences in this task were more variable in the CWS. The CWS were also significantly slower in making tone decisions at the short SOA and showed a trend for making more errors in this task.

CONCLUSIONS

The findings are interpreted to suggest higher dual-task cost effects in CWS. A potential explanation for this finding requiring further testing and confirmation is that the CWS show reduced efficiency in attending to the tone stimuli while simultaneously prioritizing attention to the phoneme-monitoring task.

How Stuttering Develops: The Multifactorial Dynamic Pathways Theory

Purpose

We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic, and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory.

Method

We review evidence related to how stuttering develops, including genetic/epigenetic factors; motor, linguistic, and emotional features; and advances in neuroimaging studies. We update evidence for our earlier claim: Although stuttering ultimately reflects impairment in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic and emotional factors.

Results

Our current account places primary emphasis on the dynamic developmental context in which stuttering emerges and follows its course during the preschool years. Rapid changes in many neurobehavioral systems are ongoing, and critical interactions among these systems likely play a major role in determining persistence of or recovery from stuttering.

Conclusion

Stuttering, or childhood onset fluency disorder (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; American Psychiatric Association [APA], 2013), is a neurodevelopmental disorder that begins when neural networks supporting speech, language, and emotional functions are rapidly developing. The multifactorial dynamic pathways theory motivates experimental and clinical work to determine the specific factors that contribute to each child's pathway to the diagnosis of stuttering and those most likely to promote recovery.

Executive Functions Impact the Relation Between Respiratory Sinus Arrhythmia and Frequency of Stuttering in Young Children Who Do and Do Not Stutter

Purpose

This study sought to determine whether respiratory sinus arrhythmia (RSA) and executive functions are associated with stuttered speech disfluencies of young children who do (CWS) and do not stutter (CWNS).

Method

Thirty-six young CWS and 36 CWNS were exposed to neutral, negative, and positive emotion-inducing video clips, followed by their participation in speaking tasks. During the neutral video, we measured baseline RSA, a physiological index of emotion regulation, and during video viewing and speaking, we measured RSA change from baseline, a physiological index of regulatory responses during challenge. Participants' caregivers completed the Children's Behavior Questionnaire from which a composite score of the inhibitory control and attentional focusing subscales served to index executive functioning.

Results

For both CWS and CWNS, greater decrease of RSA during both video viewing and speaking was associated with more stuttering. During speaking, CWS with lower executive functioning exhibited a negative association between RSA change and stuttering; conversely, CWNS with higher executive functioning exhibited a negative association between RSA change and stuttering.

Conclusion

Findings suggest that decreased RSA during video viewing and speaking is associated with increased stuttering and young CWS differ from CWNS in terms of how their executive functions moderate the relation between RSA change and stuttered disfluencies.

Temperament and Early Stuttering Development: Cross-Sectional Findings From a Community Cohort

PURPOSE

The purpose of this study was to ascertain if there is an association between stuttering severity and behaviors and the expression of temperament characteristics, including precursors of anxiety.

METHOD

We studied temperament characteristics of a prospectively recruited community cohort of children who stutter (N = 173) at ages 3, 4, and 6 years using the Short Temperament Scale STS (Prior, Sanson, Smart & Oberklaid, 2000).

RESULTS

Six of 131 statistical tests of association between stuttering severity and behaviors and temperament traits were statistically significant at the 5% level, which was no more than expected by chance alone.

CONCLUSIONS

On the basis of parent responses to the STS, preschoolers who exhibited different levels of stuttering severity and behaviors did not generally express temperament traits differently from one another. Stuttering severity and stuttering behaviors were not associated with the precursors of anxiety. Overall, taking multiple tests into consideration, results show little evidence of association between stuttering severity and temperament up to 4 years of age or between stuttering behaviors and temperament up to 6 years of age.

The Relationship Between Grammatical Development and Disfluencies in Preschool Children Who Stutter and Those Who Recover

PURPOSE

The dual diathesis stressor model indicates that a mismatch between a child's endogenous linguistic abilities and exogenous linguistic contexts is one factor that contributes to stuttering behavior. In the present study, we used a developmental framework to investigate if reducing the gap between endogenous and exogenous linguistics factors would result in less disfluency for typical children, children who recover from stuttering (CWS-R), and children who persist.

METHOD

Children between 28 and 43 months of age participated in this study: 8 typical children, 5 CWS-R, and 8 children who persist. The children were followed for 18 months with language samples collected every 6 months. The Index of Productive Syntax (Scarborough, 1990) served as a measure of endogenous grammatical ability. Length and complexity of active declarative sentences served as a measure of exogenous linguistic demand. A hierarchical linear model analysis was conducted using a mixed-model approach.

RESULTS

The results partially corroborate the dual diathesis stressor model. Disfluencies significantly decreased in CWS-R as grammatical abilities (not age) increased. Language development may serve as a protective factor or catalyst for recovery for CWS-R. As grammatical ability grew and the gap between linguistic ability and demand decreased; however, none of the three groups was more likely to produce disfluencies in longer and more complex utterances.

Childhood Stuttering: Where Are We and Where Are We Going?

Remarkable progress has been made over the past two decades in expanding our understanding of the behavioral, peripheral physiologic, and central neurophysiologic bases of stuttering in early childhood. It is clear that stuttering is a neurodevelopmental disorder characterized by atypical development of speech motor planning and execution networks. The speech motor system must interact in complex ways with neural systems mediating language and other cognitive and emotional processes. During the time when stuttering typically appears and follows its path to either recovery or persistence, all of these neurobehavioral systems are undergoing rapid and dramatic developmental changes. We summarize our current understanding of the various developmental trajectories relevant for the understanding of stuttering in early childhood. We also present theoretical and experimental approaches that we believe will be optimal for even more rapid progress toward developing better and more targeted treatment for stuttering in the preschool children who are more likely to persist in stuttering.

The Client's Perspective on Voluntary Stuttering

PURPOSE

Voluntary stuttering is a strategy that has been suggested for use in the clinical literature but has minimal empirical data regarding treatment outcomes. The purpose of the present study is to explore client perspectives regarding the impact of the use of this strategy on the affective, behavioral, and cognitive components of stuttering.

METHOD

The present study used an original survey designed to explore the intended purpose. A total of 206 adults who stutter were included in the final data corpus. Responses were considered with respect to the type of voluntary stuttering the participants reportedly produced and the location of use.

RESULTS

A client perceives significantly greater affective, behavioral, and cognitive benefits from voluntary stuttering when the production is closely matched to the client's actual stutter and when it is used outside the clinical environment.

CONCLUSIONS

To enhance client perception of associated benefits, clinicians should encourage use of voluntary stuttering that closely matches the client's own stuttering. Clinicians should also facilitate practice of voluntary stuttering outside of the therapy room. Finally, clinicians should be aware that clients, at least initially, may not perceive any benefits from the use of this strategy.

Emotional Diathesis, Emotional Stress, and Childhood Stuttering

PURPOSE

The purpose of this study was to determine (a) whether emotional reactivity and emotional stress of children who stutter (CWS) are associated with their stuttering frequency, (b) when the relationship between emotional reactivity and stuttering frequency is more likely to exist, and (c) how these associations are mediated by a 3rd variable (e.g., sympathetic arousal).

METHOD

Participants were 47 young CWS (M age = 50.69 months, SD = 10.34). Measurement of participants' emotional reactivity was based on parental report, and emotional stress was engendered by viewing baseline, positive, and negative emotion-inducing video clips, with stuttered disfluencies and sympathetic arousal (indexed by tonic skin conductance level) measured during a narrative after viewing each of the various video clips.

RESULTS

CWS's positive emotional reactivity was positively associated with percentage of their stuttered disfluencies regardless of emotional stress condition. CWS's negative emotional reactivity was more positively correlated with percentage of stuttered disfluencies during a narrative after a positive, compared with baseline, emotional stress condition. CWS's sympathetic arousal did not appear to mediate the effect of emotional reactivity, emotional stress condition, and their interaction on percentage of stuttered disfluencies, at least during this experimental narrative task following emotion-inducing video clips.

CONCLUSIONS

Results were taken to suggest an association between young CWS's positive emotional reactivity and stuttering, with negative reactivity seemingly more associated with these children's stuttering during positive emotional stress (a stress condition possibly associated with lesser degrees of emotion regulation). Such findings seem to support the notion that emotional processes warrant inclusion in any truly comprehensive account of childhood stuttering.

Yoga: Potential Benefits for Persons Who Stutter

Yoga has been demonstrated to modulate autonomic nervous system activity, decreasing anxiety and stress, and improving quality of life. This preliminary study sought to examine the use of yogic techniques on persons who stutter given the interaction between physiological arousal/anxiety and stuttering that current multifactorial models of stuttering propose. Four participants (M = 52 yr, SD = 10; 2 female, 2 male), recruited from local stuttering support groups in the greater Philadelphia community volunteered to participate. Stuttering severity, anxiety, and experiences regarding stuttering and communication were measured at baseline, post intervention, and at 4 months follow-up. The participants attended group yoga sessions and engaged in home practice. Descriptive results revealed that participants showed improvements across outcome measures, with the most improvement related to anxiety. Participants also reported improvements in their perceptions about communication as per qualitative analysis of responses to the open-ended questionnaires. The results suggest the potential benefits of yoga for persons who stutter and warrants further study using an experimental design.

Factors Associated With Negative Attitudes Toward Speaking in Preschool-Age Children Who Do and Do Not Stutter

PURPOSE

This study explored relations between the negativity of children's speech-related attitudes as measured by the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT; Vanryckeghem & Brutten, 2007) and (a) age; (b) caregiver reports of stuttering and its social consequences; (c) types of disfluencies; and (d) standardized speech, vocabulary, and language scores.

METHOD

Participants were 46 preschool-age children who stutter (CWS; 12 females, 34 males) and 66 preschool-age children who do not stutter (CWNS; 35 females, 31 males). After a conversation, children completed standardized tests and the KiddyCAT while their caregivers completed scales on observed stuttering behaviors and their consequences.

RESULTS

The KiddyCAT scores of both the CWS and the CWNS were significantly negatively correlated with age. Both groups' KiddyCAT scores increased with higher scores on the Speech Fluency Rating Scale of the Test of Childhood Stuttering (Gillam, Logan, & Pearson, 2009). Repetitions were a significant contributor to the CWNS's KiddyCAT scores, but no specific disfluency significantly contributed to the CWS's KiddyCAT scores. Greater articulation errors were associated with higher KiddyCAT scores in the CWNS. No standardized test scores were associated with KiddyCAT scores in the CWS.

CONCLUSION

Attitudes that speech is difficult are not associated with similar aspects of communication for CWS and CWNS. Age significantly contributed to negative speech attitudes for CWS, whereas age, repetitions, and articulation errors contributed to negative speech attitudes for CWNS.