Relation of emotional reactivity and regulation to childhood stuttering

Structural and functional brain correlates of socioeconomic status across the life span: A systematic review

It is well-established that higher socioeconomic status (SES) is associated with improved brain health. However, the effects of SES across different life stages on brain structure and function is still equivocal. In this systematic review, we aimed to synthesise findings from life course neuroimaging studies that investigated the structural and functional brain correlates of SES across the life span. The results indicated that higher SES across different life stages were independently and cumulatively related to neural outcomes typically reflective of greater brain health (e.g., increased cortical thickness, grey matter volume, fractional anisotropy, and network segregation) in adult individuals. The results also demonstrated that the corticolimbic system was most commonly impacted by socioeconomic disadvantages across the life span. This review highlights the importance of taking into account SES across the life span when studying its effects on brain health. It also provides directions for future research including the need for longitudinal and multimodal research that can inform effective policy interventions tailored to specific life stages.

Communicative practices and perceptions towards stuttering people in South Africa

BACKGROUND

 A few studies have explored the life experiences of people who stutter. Research has shown that stuttering affects a significant number of people in the population.

OBJECTIVES

 The study was designed to explore the experiences of people who stutter and the perception of stuttering in South Africa.

METHOD

 Four people who identified as South Africans who stutter participated in this study. The primary investigator conducted semi-structured interviews with each of the participants. In addition, a questionnaire was administered to 20 acquaintances of all the participants. Transcriptions of interviews and results of questionnaires were analysed for major and minor themes.

RESULTS

 Results of this study suggest different perceptions by those who stutter and those acquainted with them. The findings of the study show that people who stutter experience communication barriers, so they adopt certain strategies to manage and cope with their speech disorder. The findings showed that stuttering has a pervasive impact on the lives of people who stutter and how they view themselves, considering negative societal views.

CONCLUSION

 Evaluation of the results from the study reveals that although stuttering is a common speech disorder, many people who are less informed about it harbour various stereotypes and myths that stigmatise stuttering. This study concludes by outlining recommendations for creating awareness of stuttering. It suggests vigorous campaigns aiming at promoting a multilevel approach that extends beyond the mere social and professional understanding of stuttering but addresses the inherent perceptions, myths, and stereotypes around stuttering.Contribution: Experiences of people who stutter and perceptions towards stuttering can help to better understand the speech disorder and overcome myths and stereotyping of stuttering.

Brain response to errors in children who stutter

PURPOSE

Heightened rates of social anxiety have been reported in adults who stutter (AWS), but it is unclear whether anxiety is heightened also in children who stutter (CWS). Objective neurophysiological responses such as the error-related negativity (ERN) have been associated with anxiety, and ERN was reported to be increased in AWS. In this study, we examined whether ERN and error positivity (Pe) are increased in CWS. We further characterized ERN associations with age and anxiety in CWS relative to children who do not stutter (CWNS).

METHODS

EEG data were recorded from twenty-four CWS and twenty-four matched CWNS aged 3-9 years as they performed a Go/No-Go task. Parent-reported anxiety, and child-reported speech-associated attitude measures were collected. Linear regression models tested the effects of age, group, and their interaction, and the effects of anxiety, group, and their interaction on ERN and Pe.

RESULTS

Contrary to expectations, no ERN or Pe difference were observed between CWS and CWNS. However, larger ERN amplitudes were associated with older age in CWS but not CWNS, suggesting altered development of the error monitoring system in CWS. Association of Pe with anxiety also differed between groups: smaller Pe amplitudes were associated with higher level of parent-reported child anxiety in CWNS but not in CWS. Neither anxiety nor self-reported communication attitude differed between groups.

CONCLUSIONS

Brain responses to errors were overall comparable between CWS and CWNS. However, CWS differed in how error monitoring responses varied with age and with anxiety levels. More research is warranted to examine how these factors contribute to persistent 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.

Differences in auditory verbal working memory between adults who do and do not stutter on an N-back task

PURPOSE

The purpose of this study was to investigate auditory verbal working memory in adults who do (AWS) and do not (AWNS) stutter using a highly demanding linguistic N-back task.

METHODS

Fifteen AWS and 15 AWNS matched in age, gender and educational level were asked to hear series of words and respond by pressing a "yes" button if the word they just heard was the same as the word one, two, or three trials back. Words were either phonologically similar (i.e., Phonological Linguistic Condition) or phonologically dissimilar (i.e., Neutral Linguistic Condition). Accuracy and false alarms rates as well as reaction time on correct target trials, missed target trials and false alarms were collected and analyzed.

RESULTS

Differences were not found between AWS and AWNS in accuracy. Both groups were more accurate and significantly faster in 1- followed by 2- followed by 3-back trials. However, AWS were significantly slower than AWNS in the 2-back level, regardless of linguistic condition. Furthermore, AWS demonstrated more false alarms compared to AWNS.

CONCLUSION

Results revealed differences in auditory verbal working memory and interference control between AWS and AWNS when processing highly linguistically demanding stimuli.

Exploring the Relationship Between Resilience and the Adverse Impact of Stuttering in Children

PURPOSE

People who stutter often experience significant adverse impact related to stuttering. However, it is unclear how adverse impact develops in children who stutter (CWS) and whether there are protective factors that may mitigate its development. This study examined the relationship between resilience, a potentially protective factor, and stuttering's adverse impact in CWS. Resilience comprises external factors, such as family support and access to resources as well as personal attributes, making it a comprehensive protective factor to explore.

METHOD

One hundred forty-eight CWS aged 5-18 years completed the age-appropriate version of the Child and Youth Resilience Measure (CYRM) and the Overall Assessment of the Speaker's Experience of Stuttering. Parents completed a caregiver version of the CYRM and a behavioral checklist for their child. The adverse impact of stuttering was modeled as a function of resilience (external, personal, and total), controlling for child age and behavioral checklist score. We also estimated correlations between child-report and parent-report CYRM measures to assess rater agreement.

RESULTS

Children reporting greater external, personal, or total resilience were more likely to experience lower degrees of adverse impact related to their stuttering. We documented stronger correlations between younger child and parent ratings of resilience and weaker correlations between older child and parent ratings.

CONCLUSIONS

These results yield valuable insight into the variability of adverse impact experienced by CWS and offer empirical support for strength-based speech therapy approaches. We discuss the factors that contribute to a child's resilience and provide practical suggestions for how clinicians can incorporate resilience-building strategies into intervention for children experiencing significant adverse impact from their stuttering.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23582172.

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.

Complex response inhibition and cognitive flexibility in school-aged Cypriot-Greek-speaking children who stutter

PURPOSE

Over the last few years, research findings have suggested limitations in executive function (EF) of children who stutter (CWS) with the evidence being more consistent in studies with preschoolers (3-6  years old) than in studies with school-aged children (6-12  years old). The purpose of the current study was to assess complex response inhibition and cognitive flexibility in school-aged CWS and their non-stuttering peers.

METHODS

Participants, 19 CWS (mean age = 7.58  years, range 6.08-9.17) and 19 age-and gender-matched children who do not stutter (CWNS; mean age = 7.58  years, range 6.08-9.33), completed a visual task consisting of three task blocks. Analyses were based on response times and error percentages during the different task blocks.

RESULTS

All participants showed expected performance-costs in task block comparisons targeting complex response inhibition and cognitive flexibility. Significant group differences were found in measures of cognitive flexibility with CWS performing slower compared to CWNS (p = 0.02). Additionally, significant block × group interactions demonstrated that CWS, compared to CWNS, slowed down more (i.e., higher performance-cost) under both complex response inhibition (p = 0.049) and cognitive flexibility task conditions (p = 0.04 for no-set-shifting and p = 0.02 for set-shifting).

CONCLUSION

These results are in line with some of the previous findings in school-aged CWS and suggest that CWS present lower performance in complex response inhibition and cognitive flexibility task conditions when compared to their non-stuttering peers.

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.

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.

Emotional Regulation and Its Influence on the Experience of Stuttering Across the Life Span

PURPOSE

This study evaluated the relationship between emotional regulation (ER) and adverse impact related to stuttering across the developmental spectrum, in preschool and school-age children, adolescents, and adults who stutter. An additional aim examined how these variables relate to the ways that individuals approach speaking (i.e., their agreement on whether their goal is to speak fluently).

METHOD

Participants were the parents of 60 preschoolers and younger school-age children (ages 3-9 years), 95 school-age children and adolescents who stutter (ages 7-18 years), and 180 adults who stutter (ages 18-81 years). All participants completed surveys with age-appropriate measures examining ER and the adverse impact of stuttering. Older children and adults who stutter also answered questions regarding their goals when speaking. Multiple regression and ordinal logistic regression were used to examine relationships among ER, adverse impact related to stuttering, and goal when speaking.

RESULTS

In preschool children, adverse impact was significantly predicted by a parent-reported measure of ER skills; in school-age children and adults, adverse impact was significantly predicted by measures of the ER strategies cognitive reappraisal (CR) and expressive suppression. Less frequent use of CR by adults was significantly associated with an increased likelihood of having "not stuttering" as a goal when speaking. Differences in the significance and magnitude of these relationships were found across the life span.

DISCUSSION

For both children and adults who stutter, ER is a significant factor related to the adverse impact of stuttering; the relationship between ER and adverse impact may change over development. Accounting for individual differences in ER can improve understanding of why a person copes with stuttering in the ways they do, and this has notable implications for individualizing intervention for both children and adults who stutter.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044469.

Temperament, anxiety, and depression in school-age children who stutter

PURPOSE

The main aim of this study was to gain insight into whether temperament and/or stuttering severity were associated with anxiety and depression in children who stutter. Additionally, the study also provided an indication into the prevalence of anxiety and depression in children who stutter in a clinical cohort.

METHOD

The participants were 132 English-speaking children (105 boys and 27 girls) between 9;0 and 14;11 years old (M = 11;8, SD = 1;10) and their mothers. At their first visit to a specialist center for children who stutter, mothers and children completed the relevant versions of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R; Ellis & Rothbart, 2001) and a screening of children's anxiety and depression, using the Revised Children's Anxiety and Depression Scale (RCADS; Chorpita et al., 2000). Stuttering was evaluated using the Stuttering Severity Instrument Fourth Edition (SSI-4). Correlations were conducted between child and parent versions of the EATQ-R and RCADS; EATQ-R and RCADS; as well as the SSI-4 and RCADS. A comparison was made between those children who scored below the clinical threshold for anxiety and depression, and those who scored above.

RESULTS

Significant correlations were found for all mother and child EATQ-R factors and RCADS scales (except for Obsessive Compulsive Disorder). Correlations were also found between the child- and mother-reported temperament factors of positive reactivity, negative reactivity, and self-regulation and anxiety and depression. Children who scored above the clinical threshold for any category of anxiety or depression had significantly lower positive reactivity and higher negative reactivity scores, compared to those who scored below the threshold. There were no differences between the two groups with regard to SSI-4 scores.

CONCLUSIONS

This is the first study to evaluate associations between temperament and anxiety and depression in children who stutter. Higher negative reactivity scores and lower positive reactivity and self-regulation scores are associated with elevated levels of anxiety and depression in children who stutter. Further, those who score above the clinical threshold have significantly higher levels of negative reactivity and lower levels of positive reactivity compared to those scoring below the threshold. Findings suggest that levels of anxiety that reach clinical threshold are more prevalent in children who stutter than would be expected based on population data. Current findings have implications for both the assessment and therapy of children who stutter presenting at clinics for support.

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.

Working memory in adults who stutter using a visual N-back task

PURPOSE

The purpose of this study was to investigate working memory in adults who do (AWS) and do not (AWNS) stutter using a visual N-back task. Processes involved in an N-back task include encoding, storing, rehearsing, inhibition, temporal ordering, and matching.

METHODS

Fifteen AWS (11 males, 4 females; M = 23.27 years, SD = 5.68 years) and 15 AWNS (M = 23.47 years, SD = 6.21 years) were asked to monitor series of images and respond by pressing a "yes" button if the image they viewed was the same as the image one, two, or three trials back. Stimuli included images with phonologically similar (i.e., phonological condition) or phonologically dissimilar (i.e., neutral condition) names. Accuracy and manual reaction time (mRT) were analyzed.

RESULTS

No difference was found between AWS and AWNS in accuracy. Furthermore, both groups were more accurate and significantly faster in 1- followed by 2- followed by 3-back trials. Finally, AWNS demonstrated faster mRT in the phonological compared to neutral condition, whereas AWS did not.

CONCLUSION

Results from this study suggest different processing mechanisms between AWS and AWNS for visually presented phonologically similar stimuli. Specifically, a phonological priming effect occurred in AWNS but not in AWS, potentially due to reduced spreading activation and organization in the mental lexicon of AWS. However, the lack of differences between AWS and AWNS across all N-back levels does not support deficits in AWS in aspects of working memory targeted through a visual N-back task; but, these results are preliminary and additional research is warranted.

Developmental Factors That Predict Head Movement During Resting-State Functional Magnetic Resonance Imaging in 3-7-Year-Old Stuttering and Non-stuttering Children

Early childhood marks a period of dynamic neurocognitive development. Preschool-age coincides with the onset of many childhood disorders and is a developmental period that is frequently studied to determine markers of neurodevelopmental disorders. Magnetic resonance imaging (MRI) is often used to explore typical brain development and the neural bases of neurodevelopmental disorders. However, acquiring high-quality MRI data in young children is challenging. The enclosed space and loud sounds can trigger unease and cause excessive head movement. A better understanding of potential factors that predict successful MRI acquisition would increase chances of collecting useable data in children with and without neurodevelopmental disorders. We investigated whether age, sex, stuttering status, and childhood temperament as measured using the Child Behavioral Questionnaire, could predict movement extent during resting-state functional MRI (rs-fMRI) in 76 children aged 3–7 years, including 42 children who stutter (CWS). We found that age, sex, and temperament factors could predict motion during rs-fMRI scans. The CWS were not found to differ significantly from controls in temperament or head movement during scanning. Sex and age were significant predictors of movement. However, age was no longer a significant predictor when temperament, specifically effortful control, was considered. Controlling for age, boys with higher effortful control scores moved less during rs-fMRI procedures. Additionally, boys who showed higher negative affectivity showed a trend for greater movement. Considering temperament factors in addition to age and sex may help predict the success of acquiring useable rs-fMRI (and likely general brain MRI) data in young children in MR neuroimaging.

Atypical development of Broca's area in a large family with inherited stuttering

Developmental stuttering is a condition of speech dysfluency, characterized by pauses, blocks, prolongations and sound or syllable repetitions. It affects around 1% of the population, with potential detrimental effects on mental health and long-term employment. Accumulating evidence points to a genetic aetiology, yet gene-brain associations remain poorly understood due to a lack of MRI studies in affected families. Here we report the first neuroimaging study of developmental stuttering in a family with autosomal dominant inheritance of persistent stuttering. We studied a four-generation family, 16 family members were included in genotyping analysis. T1-weighted and diffusion-weighted MRI scans were conducted on seven family members (six male; aged 9-63 years) with two age and sex matched controls without stuttering (n = 14). Using Freesurfer, we analysed cortical morphology (cortical thickness, surface area and local gyrification index) and basal ganglia volumes. White matter integrity in key speech and language tracts (i.e. frontal aslant tract and arcuate fasciculus) was also analysed using MRtrix and probabilistic tractography. We identified a significant age by group interaction effect for cortical thickness in the left hemisphere pars opercularis (Broca's area). In affected family members this region failed to follow the typical trajectory of age-related thinning observed in controls. Surface area analysis revealed the middle frontal gyrus region was reduced bilaterally in the family (all cortical morphometry significance levels set at a vertex-wise threshold of P < 0.01, corrected for multiple comparisons). Both the left and right globus pallidus were larger in the family than in the control group (left P = 0.017; right P = 0.037), and a larger right globus pallidus was associated with more severe stuttering (rho = 0.86, P = 0.01). No white matter differences were identified. Genotyping identified novel loci on chromosomes 1 and 4 that map with the stuttering phenotype. Our findings denote disruption within the cortico-basal ganglia-thalamo-cortical network. The lack of typical development of these structures reflects the anatomical basis of the abnormal inhibitory control network between Broca's area and the striatum underpinning stuttering in these individuals. This is the first evidence of a neural phenotype in a family with an autosomal dominantly inherited stuttering.

Validation of the Need for Competing Inventory

Past studies have been conducted on competitiveness and achievement orientation as two noncooperative explanations for achievement motivation and achievement behavior. But a complimentary representation of a competitive-achievement orientation has yet to be explored. This paper developed and validated the need for competing inventory (NCI), and further investigated its relations with achievement orientation, emotional assessment, self-efficacy, grit, anxiety, and flow. The results from the present study support the theoretical construct of the need for competing, in the hope that it will provide a solid foundation for a competitive-achievement orientation, which is suggested to play a significant role in competitive achievement behavior. It is anticipated that the results from the present study will open a debate for including a competitive-achievement orientation in future research with the aim for a stronger predictor for achievement behavior.

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.

A Preliminary Investigation of Attention-Deficit/Hyperactivity Disorder Characteristics in Adults Who Stutter

Purpose Recent studies have shown that many children who stutter may have elevated characteristics of attention-deficit/hyperactivity disorder (ADHD). Although childhood ADHD commonly persists into adulthood, it is unclear how many adults who stutter experience aspects of ADHD (e.g., inattention or hyperactivity/impulsivity). This study sought to increase understanding of how ADHD characteristics might affect individuals who stutter by evaluating (a) whether elevated ADHD characteristics are common in adults who stutter, (b) whether elevated ADHD characteristics in adults who stutter were significantly associated with greater adverse impact related to stuttering, and (c) whether individual differences in Repetitive Negative Thinking (RNT) and Effortful Control influenced this relationship. Method Two hundred fifty-four adults who stutter completed the Adult ADHD Self-Report Scale, the Perseverative Thinking Questionnaire, the Adult Temperament Questionnaire short form, and the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed via multiple linear regression to determine whether the number of inattention or hyperactivity/impulsivity characteristics was significantly associated with RNT, Effortful Control, or Adverse Impact related to stuttering. Results Almost one quarter of participants (23.2%; 60/254) self-reported experiencing six or more inattention characteristics, while fewer participants (8.3%; 21/254) self-reported experiencing six or more hyperactivity/impulsivity characteristics. Participants with lower Effortful Control and higher levels of both RNT and Adverse Impact were significantly more likely to self-report experiencing more inattention characteristics. Discussion Many adults who stutter may exhibit previously unaccounted for characteristics of ADHD, especially inattention. Results highlight the value of continued research on the intersectionality of stuttering, ADHD, and attention, and the importance of individualizing therapy to the needs of each unique person who stutters.

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.

College professors' perceptions of students who stutter and the impact on comfort approaching professors

PURPOSE

Previous literature has documented that college professors view hypothetical students who stutter more negatively than their fluent peers. The purpose of the present study was to investigate whether individuals who stutter report they experience more negative perceptions in the college classroom, and the impact of those perceptions on their comfort approaching professors.

METHODS

Two hundred forty-six adults who do and do not stutter, matched for age, participated in this study. Participants were presented with 16 positive and negative personality traits and asked to rate how strongly they believed their professor viewed them along each trait. All participants were asked whether they felt comfortable approaching their professors to discuss their performance. Adults who stutter were asked additional questions to investigate their college experience more comprehensively.

RESULTS

Adults who stutter reported they experienced significantly more negative perceptions from their professors than adults who do not stutter, and were significantly less likely to feel comfortable approaching their professors. These reported negative perceptions, specifically being perceived as less self-assured, predicted comfort approaching professors to receive performance feedback for adults who stutter. Finally, amongst adults who stutter, perception of how they were evaluated compared to their peers was significantly related to comfort approaching professors.

CONCLUSIONS

Results support that the negative perceptions towards hypothetical students who stutter reported in previous literature are experienced by individuals who stutter, and that these perceptions drive comfort approaching professors for performative feedback. Results suggest professors may increase students' comfort by clearly outlining equality in evaluation procedures.

Temperament and the Impact of Stuttering in Children Aged 8-14 Years

Purpose The goal of this study was to evaluate possible associations between child- and mother-reported temperament, stuttering severity, and child-reported impact of stuttering in school-age children who stutter. Method Participants were 123 children who stutter (94 boys and 29 girls) who were between 9;0 and 14;10 (years;months) and their mothers. Temperament was assessed with the revised child and parent version of the Early Adolescent Temperament Questionnaire-Revised (Ellis & Rothbart, 2001). The Overall Assessment of the Speaker's Experience of Stuttering (Yaruss & Quesal, 2006) was used to evaluate the stuttering impact. Results Child- and mother-reported Early Adolescent Temperament Questionnaire-Revised temperament factors correlated moderately. No statistically significant associations were found between temperament and stuttering severity. The temperament factors of Surgency (both child- and mother-reported) and Negative Affect (only child-reported) correlated moderately with the Overall Impact and several subsections (i.e., Speaker's Reactions, Daily Communication, and/or Quality of Life) of the Overall Assessment of the Speaker's Experience of Stuttering. Conclusions More extraverted and less fearful/shy children experience a lower overall impact of their stuttering. Children with higher levels of irritability and frustration experience a higher overall impact of their stuttering. Since children's ratings of temperament were more sensitive to these associations than mothers, this study supports the inclusion of child-reported temperament questionnaires in future research.

Emotional Reactivity and Regulation in Preschool-Age Children Who Do and Do Not Stutter: Evidence From Autonomic Nervous System Measures

Purpose: This experimental cross-sectional research study examined the emotional reactivity and emotion regulation in preschool-age children who do (CWS) and do not stutter (CWNS) by assessing their psychophysiological response during rest and while viewing pictures from the International Affective Picture System (Lang et al., 2008).

Method: Participants were 18 CWS (16 boys and two girls; mean age 4 years, 5 months) and 18 age- and gender-matched CWNS. Participants' psychophysiological responses were measured during two baselines and two picture viewing conditions. Skin conductance level (SCL) and heart rate were measured to assess emotional reactivity. Respiratory sinus arrhythmia (RSA) was measured to assess emotional regulation. Participants' shyness and executive function were assessed via parent report and considered for their effects on participants' psychophysiological responses.

Results: First, CWNS and CWS did not differ in their initial baseline SCL, heart rate, or RSA, but all participants had higher SCL and lower RSA in the second baseline, subsequent to the first challenge condition, compared to the first baseline. Second, during the challenge conditions, CWS did not differ from CWNS in their SCL, but showed a significantly higher heart rate than CWNS. Third, CWS exhibited a significantly lower RSA during the challenge conditions compared to CWNS. Lastly, the temperamental quality of shyness was associated with preschool-age children's SCL, such that participants who were rated higher in shyness had a higher SCL during the challenge conditions. Participants' executive function had a marginally significant effect on the RSA, such that the participants who had higher executive function composite scores exhibited lower RSA during the challenge conditions.

Conclusions: Our findings suggest that CWS and CWNS did not differ in their emotional reactivity and emotional regulation abilities at rest. During challenge conditions, however, CWS tended to be more emotionally reactive, as indicated by a higher heart rate, and also employed more emotional regulation, indexed by a greater decrease in RSA, compared to CWNS. Preschool-age children's behavior is largely dominated by reactivity, but there is the emergence of regulation, which can help children adjust to various contextual demands. For CWS who are more emotionally reactive, regulatory skills may be particularly critical to their prognosis and treatment.

Emotional and behavioural problems of children and adolescents who stutter: Comparison with typically developing peers

PURPOSE

There are several studies showing contradictory results on concurrent emotional and behavioural problems of children and adolescents who stutter (CAWS). This study aimed to identify whether there is a difference between Turkish-speaking CAWS and their typically developing peers (TDP) in emotional and behavioural problems.

METHODS

The study group consisted of 45 CAWS, aged between 3.40 and 15.92 years, and the control group consisted of 45 TDP, aged between 3.15 and 16.80 years. Participants were divided into three age groups: early childhood (0-6 years), middle childhood (7-11 years) and adolescence (12-18 years). CAWS and TDP were compared separately in each age group with Mann-Whitney U tests. Assessments of emotional and behavioural problems were conducted with the Child Behaviour Checklist (CBCL) for Ages 1.5-5 and the CBCL for Ages 6-18.

RESULTS

In early childhood, CAWS had significantly higher emotional reactivity, anxiety/depression, somatic complaints, withdrawal, sleep problems, attention problems and aggressive behaviour scores than TDP. In middle childhood and adolescence, CAWS had significantly higher anxiety/depression, withdrawal/depression, social problems, attention problems, rule-breaking behaviour and aggressive behaviour scores compared to TDP. In adolescence, somatic problems and thought problems scores were also significantly higher in AWS than TDP.

CONCLUSIONS

We concluded that emotional and behavioural problems associated with stuttering are noticeable from early childhood to adolescence. Cooperation with mental health professionals may be needed to improve the quality of speech therapy in CAWS.

Visual exogenous and endogenous attention and visual memory in preschool children who stutter

PURPOSE

Attention develops gradually from infancy to the preschool years and beyond. Exogenous attention, consisting of automatic responses to salient stimuli, develops in infancy, whereas endogenous attention, or voluntary attention, begins to develop later, in the preschool years. The purpose of this study was to examine (a) exogenous and endogenous attention in young children who stutter (CWS) and children who do not stutter (CWNS) through two conditions of a visual sustained selective attention task, and (b) visual short-term memory (STM) between groups within the context of this task.

METHOD

42 CWS and 42 CWNS, ages 3;0-5;5 (years;months), were pair-matched in age, gender (31 males, 11 females per group), and socioeconomic status. Children completed a visual tracking task (Track-It Task; Fisher et al., 2013) requiring sustained selective attention and engaging exogenous and endogenous processes. Following each item, children were asked to recall the item they had tracked, as a memory check.

RESULTS

The CWS group demonstrated significantly less accuracy in overall tracking and visual memory for the tracked stimuli, compared to the CWNS group. Across groups, the children performed better in sustained selective attention when the target stimuli were more salient (the condition tapping both exogenous and endogenous attention) than when stimuli were less so (the condition tapping primarily endogenous processes).

CONCLUSIONS

Relative to peers, preschool-age CWS, as a group, display weaknesses in visual sustained selective attention and visual STM.

Neural and self-reported reward responsiveness are associated with dispositional affectivity and emotion dysregulation in adolescents with evidence for convergent and incremental validity

Adolescence is a developmental period characterized by heightened reward sensitivity which, in turn, confers risk for pertinent negative outcomes, underscoring the need to better understand biological bases and behavioral correlates of reward responsiveness during this developmental phase. Our goals in the current study were to examine, in a sample of 43 typically developing adolescents (M_age  = 15.67 years; SD = 1.01; 32.6% boys), (1) evidence of convergent validity between neural and self-report reward responsiveness, (2) associations between neural reward responsiveness and self-report dispositional affectivity and emotion dysregulation (ED) and (3) evidence of incremental validity of self-report beyond neural reward responsiveness in predicting affectivity and ED. During electroencephalography (EEG), adolescents completed two experimental paradigms probing event-related potential (ERP) indices of reward anticipation and initial responsiveness to reward attainment. Following EEG, they completed self-report measures of reward responsiveness, affectivity, and ED. Findings indicated some evidence of convergent validity between enhanced ERP indices of reward anticipation and initial response to reward and greater reinforcement sensitivity; that ERP indices of both reward responsiveness aspects predicted lower negative affectivity and less ED; and evidence of incremental validity of self-report beyond neural reward responsiveness in predicting outcomes. Results underscore the utility of a multi-method framework in assessing adolescent reward responsiveness and support the relevance of reward responsiveness in explaining individual differences in dispositional affectivity and ED.

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.

Associations between stuttering, comorbid conditions and executive function in children: a population-based study

Background

The aim of this study was to investigate the relationship between executive function (EF), stuttering, and comorbidity by examining children who stutter (CWS) and children who do not stutter (CWNS) with and without comorbid conditions. Data from the National Health Interview Survey were used to examine behavioral manifestations of EF, such as inattention and self-regulation, in CWS and CWNS.

Methods

The sample included 2258 CWS (girls = 638, boys = 1620), and 117,725 CWNS (girls = 57,512; boys = 60,213). EF, and the presence of stuttering and comorbid conditions were based on parent report. Descriptive statistics were used to describe the distribution of stuttering and comorbidity across group and sex. Regression analyses were to determine the effects of stuttering and comorbidity on EF, and the relationship between EF and socioemotional competence.

Results

Results point to weaker EF in CWS compared to CWNS. Also, having comorbid conditions was also associated with weaker EF. CWS with comorbidity showed the weakest EF compared to CWNS with and without comorbidity, and CWS without comorbidity. Children with stronger EF showed higher socioemotional competence. A majority (60.32%) of CWS had at least one other comorbid condition in addition to stuttering. Boys who stutter were more likely to have comorbid conditions compared to girls who stutter.

Conclusion

Present findings suggest that comorbidity is a common feature in CWS. Stuttering and comorbid conditions negatively impact EF.

Effects of Physiological Arousal on Speech Motor Control and Speech Motor Practice in Preschool-Age Children Who Do and Do Not Stutter

Purpose We examined the effects of physiological arousal on speech motor control and speech motor practice effects in preschool-age children who do (CWS) and do not stutter (CWNS). Method Participants included 18 CWS (M _age = 4 years 5 months) and 18 age- and gender-matched CWNS. The participants repeated a phrase "buy bobby a puppy" interspersed with viewing pictures from the International Affective Picture System under two experimental conditions speaking after viewing pictures with (a) negative and (b) neutral valence. Participants' lip movements were tracked using Optotrak system. The spatiotemporal index and mean utterance duration were calculated to examine speech motor control and speech motor practice effects. Skin conductance level was measured during the experimental conditions to assess participants' physiological level of arousal. Results Preschool-age CWS demonstrated greater speech movement variability across all conditions and trials than CWNS. Furthermore, the younger participants produced more variable articulatory movements than the older participants. Participants' speech movement variability did not significantly differ between the negative and neutral experimental conditions, and the level of physiological arousal did not have a significant effect on it. There was a nonsignificant trend of decrease in speech movement variability across the repeated trials in both groups. Last, CWS and CWNS did not differ in their mean utterance duration, suggesting that their articulation rate was similar across all conditions and trials. Conclusions Our findings indicate that, compared to preschool-age CWNS, CWS demonstrate less mature speech motor control. However, present findings do not support the hypothesis that CWS benefit less from motor practice relative to CWNS. Given that our conditions elicited similar levels of arousal in the participants, future research is needed to examine whether physiological arousal disrupts speech motor control in preschool-age children potentially contributing to disruptions of speech fluency and the development of stuttering.

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.

Adult stuttering and attentional ability: A meta-analytic review

Purpose: The study presents the first review in which the link between attentional ability and developmental stuttering is explored. The review aimed to summarise the published research literature and provide a more conclusive understanding as to the relationship between stuttering and attention.Method: To be included in this review, the studies had to compare the attentional performance of adult people who stutter (PWS) and people who do not stutter (PWNS) over the age of 18 years with a validated psychometric instrument for measuring attentional ability. Articles were searched in four electronic databases where each of the following search terms (attention, vigilance, inhibitory, inhibition, interference, executive and processing) was cross-referenced with each of the following terms (stutter, stammer, speech disfluency and speech dysfluency). A total of 21 studies met the inclusion criteria to be submitted into a meta-analysis.Result: The results of the main meta-analysis, which included all selected studies, demonstrated that PWS had a significantly worse attentional performance as compared to PWNS. Two further meta-analyses on selective attention and dual tasking performance confirmed the latter finding. Importantly, however, the effect was not present in all studies.Conclusion: Our findings should be taken as an indication that stuttering sometimes (but not always) manifests together with poorer attentional ability, such that the identified link does not affect all PWS. These results provide support for the notion that there is a close association between stuttering and attentional ability in a subgroup of PWS, highlighting potential practical implications for stuttering treatment.

A parent-report scale of behavioral inhibition: Validation and application to preschool-age children who do and do not stutter

PURPOSE

This two-part (i.e., Study 1, Study 2) study investigated behavioral inhibition (BI) in preschool-age children who do (CWS) and do not (CWNS) stutter. The purpose of Study 1 was to develop the Short Behavioral Inhibition Scale (SBIS), a parent-report scale of BI. The purpose of Study 2 was to determine, based on the SBIS, differences in BI between CWS and CWNS, and associations between BI and CWS's stuttering frequency, stuttering severity, speech-associated attitudes, and stuttering-related consequences/reactions.

METHOD

Participants in Study 1 were 225 CWS and 243 CWNS with the majority of them being included in Study 2. In Study 2, a speech sample was obtained for the calculation of stuttering frequency and severity, and the parents of a subset of CWS completed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007), and the Test of Childhood Stuttering Disfluency-Related Consequences Rating Scale (Gillam, Logan, & Pearson, 2009).

RESULTS

Study 1 analyses indicated that SBIS is a valid and reliable tool whose items assess a single, relatively homogeneous construct. In Study 2, CWS exhibited greater mean and extreme BI tendencies than CWNS. Also CWS with higher, compared to CWS with lower, BI presented with greater stuttering frequency, more severe stuttering, greater stuttering-related consequences, and more negative communication attitudes (for CWS older than 4 years of age).

CONCLUSION

Findings were taken to suggest that BI is associated with early childhood stuttering and that the SBIS could be included as part of a comprehensive evaluation of stuttering.

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.

The experiences of migrants to Australia who stutter

PURPOSE

Migration is a contemporary, global matter. With the number of international migrants doubling over the past four decades, speech-language pathologists will likely work with migrants who have childhood-onset stuttering. However, combined migration and stuttering experiences have never been investigated specifically. This study is the first to investigate the experiences of migrants to Australia who stutter.

METHODS

Three women and six men, aged 23 to 66 years old, participated. Data from individual interviews were analysed using Interpretative Phenomenological Analysis to examine the 'lived experience' of participants, as well as with NVivo 12 software for the management of coding. Participants also completed The Overall Assessment of the Speaker's Experience of Stuttering (OASES™).

RESULTS

The stress experienced from migration interacted and compounded the existing stress of stuttering. Central themes emerged pertaining to the impact of increased stress on self-identity, the interactions of the stresses, as well as the coping strategies/facilitators. Stuttering and other personal factors, such as language(s) spoken and accent, had a negative impact on communication skills.

CONCLUSION

Migration cannot be experienced independently of a stutter, as both are intrinsically linked to self-identity. The combined stress of migration with stuttering amplified the perception of feeling abnormal and resulted in difficulties with establishing a stable self-identity and a sense of belonging in the new context. Participants found strength in the company of others and considered Australia to be accepting of stuttering.

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.

Autonomic Nervous System Response to Speech Production in Stuttering and Normally Fluent Preschool-Age Children

Purpose We studied speech-related sympathetic nervous system arousal of preschool-age children who do (CWS) and do not stutter (CWNS) and its association with children's proclivity to experience negative emotions and children's self-reported attitudes toward speaking. Method Electrodermal activity measures were collected from 32 preschool-age children while they engaged in a picture description and a nonword repetition task. Children's proclivity to experience negative emotions was assessed with a parent report questionnaire. Children's communication attitude was assessed with a self-report questionnaire. Results CWS did not differ from CWNS in their sympathetic arousal during a picture description task. However, during a more challenging nonword repetition task, preschool-age CWS had a higher sympathetic arousal level than CWNS. Although CWS were rated by their caregivers as more fearful and prone to sadness, children's tendency to experience stronger and more frequent negative emotions was not associated with their sympathetic arousal during speaking. Lastly, although CWS had a more negative communication attitude than CWNS, it was not associated with their level of sympathetic arousal during speaking. Conclusions Our findings suggest that age-appropriate social communication tasks are not inherently more stressful for preschool-age CWS and are not associated with state-related stress or anxiety that is often reported for adults who stutter. However, speaking tasks that place a higher demand on children's cognitive-linguistic system may be more taxing and challenging to preschool CWS than CWNS, leading to a higher level of arousal.

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.

A preliminary study of early childhood parenting and adult past month drug use risk in low-income African American women

PURPOSE

This preliminary study was designed to assess the feasibility of examining early childhood parenting factors and their relationship with adult past month drug use among low-income African American women.

METHODS

A cross-sectional survey of 156 low-income African American women was conducted. Measures included the childhood parental bonding scale, frequency of exposure to corporal punishment (CP) in childhood, The Drug Abuse Screening Test (DAST) and The Differentiation of Self Scale. Structural equation modeling (SEM) was used to assess the relationship between the primary predictors, latent parental bonding and corporal punishment exposure, with past month drug use. The intermediary construct, emotional reactivity, was also included in the SEM model to test mechanisms of mediation.

RESULTS

There was a significant main effect for maternal care on lower emotional reactivity patterns in adulthood. There was also a significant main effect for frequent CP on higher emotional reactivity patterns in adulthood. The relationship between both parenting measures and drug use were mediated by emotional reactivity.

CONCLUSION

Childhood maternal factors are a strong predictor of adult past month drug use, and this may be accounted for, in part, by the influence that parenting patterns in childhood have on adult emotional reactivity patterns. These observations should be examined in a longitudinal study to determine the stability of our observation that CP in childhood, even when controlling for positive maternal bonding patterns, influences emotional reactivity patterns that predispose an individual to negative coping strategies, such as drug use, in adulthood, among low-income African American women.

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.

Differences in the relation between temperament and vocabulary based on children's stuttering trajectories

PURPOSE

The purpose of this study was to assess the relation between temperament and vocabulary development for children who stutter and persist, children who stutter and recover and children who do not stutter.

METHODS

Participants, aged 3;0-4;11 at the start of the study, were followed for two years. They were classified as persisting (n = 10), recovered (n = 26), and non-stuttering (n = 24) based on multiple assessments of stuttering spaced across study participation. Groups were balanced for age and gender ratios. At each visit, participants completed the Peabody Picture Vocabulary Test, 4th edition, and the Expressive Vocabulary Test, 2nd edition; caregivers completed the Children's Behavior Questionnaire.

RESULTS

For both persisting and recovered groups, higher negative emotionality was associated with lower receptive vocabulary. These associations were both significantly more negative than the non-stuttering group's association.

CONCLUSION

These findings suggest that receptive vocabulary development is differentially linked to temperament based on a child's stuttering status. As others have speculated (Conture & Walden, 2012), it appears as though there are salient associations between temperament, speech-language development, and childhood stuttering.

Elevated attention deficit hyperactivity disorder symptoms in children who stutter

PURPOSE

This study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken.

METHOD

Participants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria).

RESULTS

One-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment.

CONCLUSION

The large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.

An evaluation of an integrated fluency and resilience program for early developmental stuttering disorders

PURPOSE

The temperament construct of effortful control, an index of self-regulation and resilience, has been found to be predictive of stuttering severity in children and is a potential indicator of clinical prognosis. Evidence supports early intervention for preschool stuttering, and the successful effect of parents as agents of change in their children's stuttering therapy. However, no previous studies have trained parents to improve self-regulation in their children as a component of stuttering therapy. This study aimed to explore the effects of addressing self-regulation, as a component of stuttering treatment, on child fluency as well as parent and child psychosocial outcomes.

METHODS

This study implemented a preliminary parent administered resilience component in conjunction with stuttering therapy for children who stutter, and compared outcomes to a cohort of children who stutter who received stuttering therapy only. Twenty-eight children who stutter were randomly allocated to one of the two treatment groups. Dependent variables tested pre- and post-treatment included stuttered speech severity, parenting practices, and child resilience indicators. Outcomes were compared between groups at post treatment.

RESULTS

Stuttered speech severity decreased in both treatment groups. A reduction in behavioural and emotional problems, and increase in resilience was observed in the children who stutter whose parents received the additional resilience component of therapy. Furthermore, a significant improvement in parenting practices was demonstrated in this group. No significant changes in emotional and behavioural problems in children or parents were observed in the group of children who received fluency therapy only.

CONCLUSION

Results demonstrate that implementation of the resilience component was successful in positively shifting parenting practices and increasing behavioural resilience in children who stutter. This has clinical implications for successfully managing fluency while concurrently targeting the concomitant behavioural and emotional impacts of the disorder on both children and parents, potentially a key future prognostic indicator of the maintenance of fluency outcomes.

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.

Nurturing a Resilient Mindset in School-Aged Children Who Stutter

PURPOSE

To consider the rationale, methods, and potential benefits of nurturing the growth of resilience in school-aged children who stutter. Stuttering in childhood can have negative psychological consequences for some, including the development of a negative attitude toward their speech from a young age (Vanryckeghem, Brutten, & Hernandez, 2005) and possible co-occurring psychopathology in adolescence and adulthood, in particular, anxiety disorders (Blood, Blood, Maloney, Meyer, & Qualls, 2007; Iverach & Rapee, 2014; McAllister, Kelman, & Millard, 2015). Children who stutter also frequently report teasing and bullying by their peers (Blood & Blood, 2007; Boyle, 2011; Langevin, Packman, & Onslow, 2009), which can have a significant impact on children's confidence and psychological well-being. However, the capacity of children who stutter to cope or "bounce back" from adversity is not routinely explored or incorporated in therapy for stuttering.

METHOD

This clinical focus article will explore the construct of resilience and consider why it may be important for children who stutter and their parents. A framework for understanding resilience in relation to stuttering is used, drawing from the Reaching In Reaching Out Resiliency Program (for children aged under 8 years and their parents) and the Penn Resiliency Program (for children aged 8 years and over).

CONCLUSIONS

The role of parents is key in modeling resilient responses to children and creating a resilience-rich environment. As children who stutter may be more vulnerable to adversity, some may benefit from targeted support to build their resilience, in order to enhance their ability to overcome challenges and thrive.

The Role of Attention in Therapy for Children and Adolescents Who Stutter: Cognitive Behavioral Therapy and Mindfulness-Based Interventions

METHOD

This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being.

CONCLUSIONS

Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.

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.

What Are Predictors for Persistence in Childhood Stuttering?

Over the past 10 years, we (the Purdue Stuttering Project) have implemented longitudinal studies to examine factors related to persistence and recovery in early childhood stuttering. Stuttering develops essentially as an impairment in speech sensorimotor processes that is strongly influenced by dynamic interactions among motor, language, and emotional domains. Our work has assessed physiological, behavioral, and clinical features of stuttering within the motor, linguistic, and emotional domains. We describe the results of studies in which measures collected when the child was 4 to 5 years old are related to eventual stuttering status. We provide supplemental evidence of the role of known predictive factors (e.g., sex and family history of persistent stuttering). In addition, we present new evidence that early delays in basic speech motor processes (especially in boys), poor performance on a nonword repetition test, stuttering severity at the age of 4 to 5 years, and delayed or atypical functioning in central nervous system language processing networks are predictive of persistent stuttering.