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Engelen MM, Franken MCJP, Stipdonk LW, Horton SE, Jackson VE, Reilly S, Morgan AT, Fisher SE, van Dulmen S, Eising E. The Association Between Stuttering Burden and Psychosocial Aspects of Life in Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1385-1399. [PMID: 38625147 DOI: 10.1044/2024_jslhr-23-00562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
PURPOSE Stuttering is a speech condition that can have a major impact on a person's quality of life. This descriptive study aimed to identify subgroups of people who stutter (PWS) based on stuttering burden and to investigate differences between these subgroups on psychosocial aspects of life. METHOD The study included 618 adult participants who stutter. They completed a detailed survey examining stuttering symptomatology, impact of stuttering on anxiety, education and employment, experience of stuttering, and levels of depression, anxiety, and stress. A two-step cluster analytic procedure was performed to identify subgroups of PWS, based on self-report of stuttering frequency, severity, affect, and anxiety, four measures that together inform about stuttering burden. RESULTS We identified a high- (n = 230) and a low-burden subgroup (n = 372). The high-burden subgroup reported a significantly higher impact of stuttering on education and employment, and higher levels of general depression, anxiety, stress, and overall impact of stuttering. These participants also reported that they trialed more different stuttering therapies than those with lower burden. CONCLUSIONS Our results emphasize the need to be attentive to the diverse experiences and needs of PWS, rather than treating them as a homogeneous group. Our findings also stress the importance of personalized therapeutic strategies for individuals with stuttering, considering all aspects that could influence their stuttering burden. People with high-burden stuttering might, for example, have a higher need for psychological therapy to reduce stuttering-related anxiety. People with less emotional reactions but severe speech distortions may also have a moderate to high burden, but they may have a higher need for speech techniques to communicate with more ease. Future research should give more insights into the therapeutic needs of people highly burdened by their stuttering. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25582980.
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Affiliation(s)
- Marscha M Engelen
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
| | - Marie-Christine J P Franken
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lottie W Stipdonk
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sarah E Horton
- Speech and Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Victoria E Jackson
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Sheena Reilly
- Speech and Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Angela T Morgan
- Speech and Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Else Eising
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
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Franken MC, Oonk LC, Bast BJEG, Bouwen J, De Nil L. Erasmus clinical model of the onset and development of stuttering 2.0. JOURNAL OF FLUENCY DISORDERS 2024; 80:106040. [PMID: 38493582 DOI: 10.1016/j.jfludis.2024.106040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/25/2023] [Accepted: 02/11/2024] [Indexed: 03/19/2024]
Abstract
A clinical, evidence-based model to inform clients and their parents about the nature of stuttering is indispensable for the field. In this paper, we propose the Erasmus Clinical Model of Stuttering 2.0 for children who stutter and their parents, and adult clients. It provides an up-to-date, clinical model summary of current insights into the genetic, neurological, motoric, linguistic, sensory, temperamental, psychological and social factors (be it causal, eliciting, or maintaining) related to stuttering. First a review is presented of current insights in these factors, and of six scientific theories or models that have inspired the development of our current clinical model. Following this, we will propose the model, which has proven to be useful in clinical practice. The proposed Erasmus Clinical Model of Stuttering visualizes the onset and course of stuttering, and includes scales for stuttering severity and impact, to be completed by the (parent of) the person who stutters. The pathway of the model towards stuttering onset is based on predisposing and mediating factors. In most children with an onset of stuttering, stuttering is transient, but if stuttering continues, its severity and impact vary widely. The model includes the circle of Engel (1977), which visualizes unique interactions of relevant biological, psychological, and social factors that determine the speaker's experience of stuttering severity and its impact. Discussing these factors and their interaction with an individual client can feed into therapeutic targets. The model is supplemented by a lifeline casus.
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Affiliation(s)
- Marie-Christine Franken
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Leonoor C Oonk
- StotterFonds, Nijkerk, the Netherlands; University of Applied Sciences, Department of Speech-Language Therapy, Utrecht, the Netherlands
| | | | - Jan Bouwen
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Luc De Nil
- Department of Speech-Language Pathology, University of Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada.
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Liu Y, Hampton Wray A, Hall M, Lescht ER, Gehring WJ, Fitzgerald KD, Chang SE. Brain response to errors in children who stutter. JOURNAL OF FLUENCY DISORDERS 2024; 79:106035. [PMID: 38160505 PMCID: PMC10939925 DOI: 10.1016/j.jfludis.2023.106035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
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.
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Affiliation(s)
- Yanni Liu
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Amanda Hampton Wray
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa Hall
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Erica R Lescht
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Gehring
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Kate D Fitzgerald
- Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Department of Communication Disorders, Ewha Womans University, Seoul, South Korea
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SheikhBahaei S, Millwater M, Maguire GA. Stuttering as a spectrum disorder: A hypothesis. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100116. [PMID: 38020803 PMCID: PMC10663130 DOI: 10.1016/j.crneur.2023.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Childhood-onset fluency disorder, commonly referred to as stuttering, affects over 70 million adults worldwide. While stuttering predominantly initiates during childhood and is more prevalent in males, it presents consistent symptoms during conversational speech. Despite these common clinical manifestations, evidence suggests that stuttering, may arise from different etiologies, emphasizing the need for personalized therapy approaches. Current research models often regard the stuttering population as a singular, homogenous group, potentially overlooking the inherent heterogeneity. This perspective consolidates both historical and recent observations to emphasize that stuttering is a heterogeneous condition with diverse causes. As such, it is crucial that both therapeutic research and clinical practices consider the potential for varied etiologies leading to stuttering. Recognizing stuttering as a spectrum disorder embraces its inherent variability, allowing for a more nuanced categorization of individuals based on the underlying causes. This perspective aligns with the principles of precision medicine, advocating for tailored treatments for distinct subgroups of people who stutter, ultimately leading to personalized therapeutic approaches.
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Affiliation(s)
- Shahriar SheikhBahaei
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Marissa Millwater
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Gerald A. Maguire
- CenExel Research/ American University of Health Sciences, Signal Hill, CA, 90755, USA
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Matheson T, Arnott S, Donaghy M. Australian pre-service primary teachers' knowledge, attitudes, and skills regarding stuttering. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:710-721. [PMID: 36251645 DOI: 10.1080/17549507.2022.2125073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Purpose: Exploring Australian pre-service primary teachers' knowledge, attitudes, and classroom strategies regarding stuttering provides speech-language pathologists (SLPs) with information that can facilitate enhanced outcomes for school-aged children who stutter.Method: In this exploratory descriptive cross-sectional study, 51 final-year Bachelor of Education (Primary) students enrolled at an Australian university completed an online survey about stuttering.Result: Responses demonstrated positive and negative beliefs. Seventy-four per cent of pre-service teachers believed that stuttering has a psychological aetiology and that students who stutter are more likely to be shy or anxious. Participants agreed that their reactions and support offered would largely be based on their assumptions rather than knowledge.Conclusion: Pre-service primary teachers share similar misconceptions and unhelpful attitudes towards stuttering with previously evaluated populations. Implications for SLPs are discussed.
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Affiliation(s)
- Tim Matheson
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
- Word by Mouth Speech Pathology, Mitcham, Australia
| | | | - Michelle Donaghy
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
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Tichenor SE, Gerwin KL, Walsh B. Repetitive Negative Thinking in Adolescents Who Stutter. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3290-3306. [PMID: 37494925 PMCID: PMC10558142 DOI: 10.1044/2023_jslhr-23-00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Repetitive negative thinking (RNT) is the process of engaging in negatively valenced and habitual thought patterns. RNT is strongly associated with mental health conditions and often affects quality of life. This study explored RNT in older school-age children and adolescents who stutter to quantify the relationship between RNT and self-reported anxiety characteristics. An additional aim was to describe how individual differences in an adolescent's goal when speaking influences the frequency they engage in RNT. METHOD Ninety-nine children and adolescents who stutter aged 9-18 years completed a measurement of the frequency/severity of RNT, a screener of anxiety characteristics, and a measure of adverse impact related to stuttering. Children aged 10 years and above also answered questions about their goal when speaking. RESULTS Individual differences in RNT significantly predicted Overall Assessment of the Speaker's Experience of Stuttering (OASES) Total Scores more so than a child or adolescent's age. Higher generalized or social anxiety scores were significantly correlated with more frequent RNT and higher OASES Total Scores. Individual differences in goal when speaking (i.e., whether or not to stutter openly) were found to predict RNT. Finally, 22 children and adolescents (22.2%) also screened positive for generalized anxiety disorder and 32 (32.3%) screened positive for social anxiety disorder. DISCUSSION These data provide strong evidence that (a) many children and adolescents who stutter engage in RNT; (b) children and adolescents who engage more frequently in RNT or who have higher OASES Total Scores may be at increased risk for more characteristics of generalized or social anxiety; and (c) individual differences in goal when speaking can predict the degree to which an adolescent engages in RNT. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23713296.
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Walsh BM, Grobbel H, Christ SL, Tichenor SE, Gerwin KL. Exploring the Relationship Between Resilience and the Adverse Impact of Stuttering in Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2278-2295. [PMID: 37390495 PMCID: PMC10468119 DOI: 10.1044/2023_jslhr-23-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 07/02/2023]
Abstract
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.
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Tumanova V, Choi D, Wang Q. Effects of behavior inhibition on stuttering severity and adverse consequences of stuttering in 3-6-year-old children who stutter. JOURNAL OF COMMUNICATION DISORDERS 2023; 104:106332. [PMID: 37178639 DOI: 10.1016/j.jcomdis.2023.106332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 03/10/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to investigate whether 3- to-6-year-old children who stutter and exhibit a higher degree of behavioral inhibition (BI), a correlate of shyness, stutter more frequently and experience greater negative consequences of stuttering (per parent-report) than their peers who stutter but have lower BI. METHOD Forty-six children who stutter (CWS; 35 boys & 11 girls; mean age 4 years, 2 months) participated. Their degree of BI was assessed by measuring the latency to their 6th spontaneous comment during a conversation with an unfamiliar examiner (following Kagan, Reznick, & Gibbons's (1989) methodology). The frequency of stuttering and the negative impact of stuttering that CWS may have experienced was assessed using parent reports (i.e., Test of Childhood Stuttering (TOCS) Observational Rating Scale; Gillam, Logan, & Pearson, 2009). RESULTS We found that children's degree of BI was not associated with their speech fluency per parent report. However, children's degree of BI was significantly associated with greater negative consequences of stuttering. Specifically, among the four categories of TOCS Disfluency-Related Consequences, children's BI significantly predicted the occurrence of physical behaviors that accompany moments of stuttering (such as increased tension or excessive eye blinks). Other Disfluency-Related Consequences, such as avoidance behaviors, negative feelings, and negative social consequences, were not associated with children's behavioral inhibition tendencies. Additionally, children's stuttering severity (per the Stuttering Severity Instrument-4 scores) was significantly associated with increased physical behaviors that accompany moments of stuttering and greater negative social consequences of stuttering. CONCLUSIONS This study provides empirical evidence that behavioral inhibition to the unfamiliar may have salience for childhood stuttering as it predicted the development of physical behaviors associated with stuttering (e.g., tension or struggle) in 3- to 6-year-old CWS. Clinical implications of high BI for the assessment and treatment of childhood stuttering are discussed.
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Affiliation(s)
- Victoria Tumanova
- Department of Communication Sciences and Disorders, Syracuse University, 621 Skytop Rd, Syracuse, NY, 13244, United States.
| | - Dahye Choi
- Department of Speech Pathology and Audiology, University of South Alabama, 5721 USA Drive North, Mobile, AL, 36688, United States
| | - Qiu Wang
- Department of Higher Education, Department of Mathematics, Syracuse University, 350 Huntington Hall, Syracuse, NY, 13244, United States
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Bernard RFL, Norbury CF. Factors Associated With Symptoms of Anxiety and Depression in Children Who Stutter. Lang Speech Hear Serv Sch 2023; 54:535-549. [PMID: 36800488 DOI: 10.1044/2022_lshss-22-00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE Children and adolescents who stutter may be at risk of elevated anxiety and depression symptoms, although studies have indicated variability in reported internalizing symptoms in this population. This study considers the association between anxiety and depression symptoms and stuttering, as well as child, family, and contextual factors that may affect this association. METHOD Thirty-five school-age children who stutter completed the Revised Children's Anxiety and Depression Scale-Short Version. We fitted regression models to examine the association between anxiety and depression symptoms with bullying, stuttering severity, family history of adverse mental health, and age in children who stutter. RESULTS Family history of adverse mental health was found to significantly predict anxiety and depression scores. Age also predicted depression scores, with older children reporting higher scores. CONCLUSIONS Family history of adverse mental health is associated with higher self-reported internalizing symptoms in children who stutter. The interaction between child, family, and contextual factors may change with age, and this requires further exploration in larger, longitudinal studies. The association between bullying and anxiety scores indicates the importance of anti-bullying initiatives in promoting psychosocial development in school-age children who stutter. This study also highlights the contribution of known risk factors for mental health, such as family history, to variability in symptom reporting.
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Affiliation(s)
| | - Courtenay Frazier Norbury
- Department of Language and Cognition, University College London, United Kingdom.,Department of Special Needs Education, University of Oslo, Norway
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Samson I, Schalling E, Herlitz A, Lindström E, Sand A. A Cross-Sectional Investigation of the Impact of Stuttering on Swedish Females and Males in Childhood, Adolescence, and Young Adulthood. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4608-4622. [PMID: 36399792 DOI: 10.1044/2022_jslhr-22-00043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males. METHOD We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7-30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves. RESULTS The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern. CONCLUSIONS In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21554877.
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Affiliation(s)
- Ineke Samson
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Division of Speech and Language Pathology, Danderyd Hospital, Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences/Speech-Language Pathology, Uppsala University, Sweden
| | - Agneta Herlitz
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Lindström
- Logopedics, Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
| | - Anders Sand
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
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Morison LD, Meffert E, Stampfer M, Steiner-Wilke I, Vollmer B, Schulze K, Briggs T, Braden R, Vogel A, Thompson-Lake D, Patel C, Blair E, Goel H, Turner S, Moog U, Riess A, Liegeois F, Koolen DA, Amor DJ, Kleefstra T, Fisher SE, Zweier C, Morgan AT. In-depth characterisation of a cohort of individuals with missense and loss-of-function variants disrupting FOXP2. J Med Genet 2022; 60:597-607. [DOI: 10.1136/jmg-2022-108734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
BackgroundHeterozygous disruptions ofFOXP2were the first identified molecular cause for severe speech disorder: childhood apraxia of speech (CAS), and yet few cases have been reported, limiting knowledge of the condition.MethodsHere we phenotyped 28 individuals from 17 families with pathogenicFOXP2-only variants (12 loss-of-function, five missense variants; 14 males; aged 2 to 62 years). Health and development (cognitive, motor, social domains) were examined, including speech and language outcomes with the first cross-linguistic analysis of English and German.ResultsSpeech disorders were prevalent (23/25, 92%) and CAS was most common (22/25, 88%), with similar speech presentations across English and German. Speech was still impaired in adulthood, and some speech sounds (eg, ‘th’, ‘r’, ‘ch’, ‘j’) were never acquired. Language impairments (21/25, 84%) ranged from mild to severe. Comorbidities included feeding difficulties in infancy (10/27, 37%), fine (13/26, 50%) and gross (13/26, 50%) motor impairment, anxiety (5/27, 19%), depression (6/27, 22%) and sleep disturbance (11/15, 44%). Physical features were common (22/27, 81%) but with no consistent pattern. Cognition ranged from average to mildly impaired and was incongruent with language ability; for example, seven participants with severe language disorder had average non-verbal cognition.ConclusionsAlthough we identify an increased prevalence of conditions like anxiety, depression and sleep disturbance, we confirm that the consequences ofFOXP2dysfunction remain relatively specific to speech disorder, as compared with other recently identified monogenic conditions associated with CAS. Thus, our findings reinforce thatFOXP2provides a valuable entry point for examining the neurobiological bases of speech disorder.
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Eggers K, Millard SK, Kelman E. Temperament, anxiety, and depression in school-age children who stutter. JOURNAL OF COMMUNICATION DISORDERS 2022; 97:106218. [PMID: 35597191 DOI: 10.1016/j.jcomdis.2022.106218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 03/21/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Kurt Eggers
- Department of Rehabilitation Sciences, Ghent University, Belgium; Department of Speech-Language Pathology, Thomas More University College, Belgium; Department of Psychology and Speech-Language Pathology, University of Turku, Finland.
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13
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Gracco VL, Sares AG, Koirala N. Structural brain network topological alterations in stuttering adults. Brain Commun 2022; 4:fcac058. [PMID: 35368614 PMCID: PMC8971894 DOI: 10.1093/braincomms/fcac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/06/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
- Vincent L. Gracco
- Haskins Laboratories, New Haven, CT, USA
- School of Communication Sciences & Disorders, McGill University, Montreal, Canada
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14
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Bernard R, Hofslundsengen H, Frazier Norbury C. Anxiety and Depression Symptoms in Children and Adolescents Who Stutter: A Systematic Review and Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:624-644. [PMID: 35084999 DOI: 10.1044/2021_jslhr-21-00236] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate whether there are elevated symptoms of anxiety or depression in children and adolescents (aged 2-18 years) who stutter, and to identify potential moderators of increased symptom severity. METHOD We conducted a preregistered systematic review of databases and gray literature; 13 articles met criteria for inclusion. A meta-analysis using robust variance estimation was conducted with 11 cohort studies comparing symptoms of anxiety in children and adolescents who do and do not stutter. Twenty-six effect sizes from 11 studies contributed to the summary effect size for anxiety symptoms (851 participants). Meta-analysis of depression outcomes was not possible due to the small number of studies. RESULTS The summary effect size indicates that children and adolescents who stutter present with increased anxiety symptoms (g = 0.42) compared with nonstuttering peers. There were insufficient studies to robustly analyze depression symptoms, and qualitative review is provided. No significant between-groups differences were reported in any of the depression studies. CONCLUSIONS Preliminary evidence indicates elevated symptoms of anxiety in some children and adolescents who stutter relative to peers. There was a tendency toward higher depression scores in this population, although reported between-groups differences did not reach statistical significance. These findings require replication in larger, preferably longitudinal studies that consider factors that may moderate risk. Nevertheless, our findings highlight a need for careful monitoring of mental health and well-being in young people who stutter. Supplemental Materials: http://osf.io/5m6zv.
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Affiliation(s)
- Ria Bernard
- Language and Cognition, Division of Psychology and Language Sciences, University College London, United Kingdom
| | - Hilde Hofslundsengen
- Department of Language, Literature, Mathematics and Interpreting, Western Norway University of Applied Sciences, Bergen
| | - Courtenay Frazier Norbury
- Language and Cognition, Division of Psychology and Language Sciences, University College London, United Kingdom
- Language & Cognition, UCL and Department of Special Needs Education, University of Oslo, Norway
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15
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Rodgers NH, Lau JYF, Zebrowski PM. Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents. JOURNAL OF COMMUNICATION DISORDERS 2022; 95:106179. [PMID: 34902801 DOI: 10.1016/j.jcomdis.2021.106179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/05/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate. METHODS A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis. RESULTS There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations. DISCUSSION This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.
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Affiliation(s)
- Naomi H Rodgers
- Department of Special Education and Communication Sciences and Disorders, University of Nebraska-Lincoln United States.
| | - Jennifer Y F Lau
- Youth Resilience Research Unit, Queen Mary University of London England
| | - Patricia M Zebrowski
- Department of Communication Sciences and Disorders, University of Iowa United States
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16
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Prince A, Marsden J, Wren Y, Hayhow R, Harding S. The Fluency Trust Residential Course for young people who stutter: A pragmatic feasibility study. JOURNAL OF COMMUNICATION DISORDERS 2022; 95:106181. [PMID: 35051833 DOI: 10.1016/j.jcomdis.2021.106181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 11/24/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION A feasibility study of The Fluency Trust Residential Course (FTRC) for adolescents who stutter was conducted. The study aimed to measure key areas of a feasibility trial, for example, recruitment and retention, outcome measure completion, outcome measure reliability, and acceptability of the intervention to inform future research into the FTRC. METHODS Quantitative and qualitative methods were used. Participants were 23 adolescents (12-17 years), 23 parents and 2 Speech-Language Pathologists (SLPs) from the FTRC. Data collection included: outcome measure collection via a pre-test post-test quasi-experimental design (including two baseline measures), intervention fidelity checklists, semi-structured interviews with adolescents to explore acceptability of the intervention and semi-structured interviews with SLPs to explore their experiences of research participation and views on a future trial. RESULTS Recruitment, retention and outcome measure completion levels were all 100%. Intervention fidelity was 95% and there were no adverse events. Outcome measures showed good test- re-test reliability: Progress Questionnaire Child Intraclass Correlation Coefficient (ICC) = 0.87 (95% CI = 0.69-0.94 sig< 0.001) and Progress Questionnaire Parent ICC = 0.88 (95% CI = 0.70-0.95 sig< 0.001). Descriptive statistics showed that group medians and means of all outcome measures shifted in a positive direction between pre and post-tests (9 weeks follow-up). Twenty-five percent of young people showed changes on the Progress Questionnaire Child that were above the minimal important difference. Seventy-five percent of parents showed changes on the Progress Questionnaire Parent that were above the minimal important difference. Acceptability of the intervention by adolescents was high. SLPs reported participation was manageable and they were pleased to be part of the research. CONCLUSION Quantitative and qualitative data suggest that a future definitive trial of the FTRC is indicated after additional development work and feasibility testing. Recommendations for further research are included.
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Affiliation(s)
- Anna Prince
- Sirona care and health, Speech and Language Therapy Department, Community Children's Health Partnership, Unit 9 Eastgate Office Centre, Unit 9 Eastgate Office Centre, Eastgate Road, Bristol BS5 6XX, United Kingdom; University of Plymouth, School of Health Professions, FF20 Peninsular Allied Health Centre, College of St Mark and St John, PL6 8BH, United Kingdom.
| | - Jonathan Marsden
- University of Plymouth, School of Health Professions, FF20 Peninsular Allied Health Centre, College of St Mark and St John, PL6 8BH, United Kingdom
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Pines and Steps, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom; Bristol Dental School, Upper Maudlin Street, University of Bristol, BS1 2LY UK, United Kingdom
| | - Rosemarie Hayhow
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Pines and Steps, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom
| | - Sam Harding
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Pines and Steps, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom
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Koenraads SPC, Jansen PW, Baatenburg de Jong RJ, van der Schroeff MP, Franken MC. Bidirectional Associations of Childhood Stuttering With Behavior and Temperament. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4563-4579. [PMID: 34735297 DOI: 10.1044/2021_jslhr-20-00252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Simone P C Koenraads
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - Robert Jan Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc P van der Schroeff
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marie-Christine Franken
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Brignell A, Krahe M, Downes M, Kefalianos E, Reilly S, Morgan A. Interventions for children and adolescents who stutter: A systematic review, meta-analysis, and evidence map. JOURNAL OF FLUENCY DISORDERS 2021; 70:105843. [PMID: 33743406 DOI: 10.1016/j.jfludis.2021.105843] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence. METHODS Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2-18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies. RESULTS Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention. CONCLUSION The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.
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Affiliation(s)
- Amanda Brignell
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Michelle Krahe
- Health Group, Griffith University, Southport, Queensland, 4222, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Queensland, 4111, Australia
| | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Sheena Reilly
- Health Group, Griffith University, Southport, Queensland, 4222, Australia
| | - Angela Morgan
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.
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Veerabhadrappa RC, Vanryckeghem M, Maruthy S. The Speech Situation Checklist-Emotional Reaction: Normative and comparative study of Kannada-speaking children who do and do not stutter. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:559-568. [PMID: 33586523 DOI: 10.1080/17549507.2020.1862301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: Existing data stemming from investigations with the Speech Situation Checklist (SSC) have shown this standardised test to be a valid and reliable tool for assessing speech-related anxiety in children who stutter (CWS). The main purpose of this study was to compare Speech Situation Checklist-Emotional Reaction (SSC-ER) scores for Kannada-speaking children who do not stutter (CWNS) and CWS. In addition, the Speech Situation Checklist-Emotional Reaction in Kannada (SSC-ER-K) scores among different stuttering severity and age groups were compared in CWS.Method: The English version of the SSC-ER was forward-translated into Kannada and back-translated by the first author. SSC-ER-K was administered on 100 CWS and 275 CWNS aged between 7 and 14 years who were native speakers of the Kannada language. The severity of stuttering was estimated using the Stuttering Severity Instrument-fourth edition (SSI-4).Result: The results revealed that the SSC-ER-K scores of CWS were significantly higher in comparison with CWNS. CWS with moderate and severe degrees of stuttering had significantly higher scores when compared to those with a mild degree of stuttering. Furthermore, the older CWS (11-14 years) had significantly higher scores compared to the younger CWS (7-10 years). In addition, the SSC-ER-K appears to be a reliable self-report test. The above findings suggest the presence of significantly increased speech-related anxiety in CWS. Also, as age and severity of stuttering increased so did the level of their speech-related anxiety.Conclusion: The SSC-ER-K is a useful tool in the assessment of negative emotional reaction to specific speech situations in Kannada CWS and can assist speech-language pathologists in addressing speech-situation specific anxiety during treatment.
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Affiliation(s)
| | - Martine Vanryckeghem
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Santosh Maruthy
- All India Institute of Speech and Hearing, Mysore, India and
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20
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Subasi M, Van Borsel J, Van Eerdenbrugh S. The Lidcombe Program for Early Stuttering in Non-English-Speaking Countries: A Systematic Review. Folia Phoniatr Logop 2021; 74:89-102. [PMID: 34289470 DOI: 10.1159/000517650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Lidcombe Program is a stuttering treatment approach for children between the ages of 3 and 6 years. Most papers about the Lidcombe Program, however, are based on studies conducted in native English-speaking countries. The aim of this paper is to systematically review the delivery and implementation of the Lidcombe Program in non-native English-speaking countries. SUMMARY A resource search was conducted between October and November 2019. Scopus, PubMed, ASHA, Cochrane Library, ERIC, Google Scholar, and SpeechBITE databases and reference lists of relevant papers were searched for the identification process. Joanna Briggs Institute tools were used for the appraisal of the studies. The search yielded 8 studies conducted in non-native English-speaking countries. The Lidcombe Program is efficacious in non-native English-speaking countries when delivered to both preschool and young school age children who stutter. It is reported to be delivered with minor changes and challenges. The number of weekly clinic visits and the total time needed to reach zero or near-zero stuttering levels with the Lidcombe Program can be up to 3 times greater in non-native English-speaking countries than in native English-speaking countries, mostly due to the increased time needed to introduce the parental verbal contingencies. Key Messages: Speech and language therapists practicing in non-native English-speaking countries are encouraged to use the Lidcombe Program for both preschool and young school age children who stutter, although this can take more time than that reported in native English-speaking countries. Further investigation to explore the therapy process with children and parents in non-native English-speaking countries is needed.
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Affiliation(s)
- Mustafa Subasi
- Department of Speech, Language, and Hearing Sciences, Ghent University, Ghent, Belgium.,Department of Speech and Language Therapy, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - John Van Borsel
- Department of Speech, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Sabine Van Eerdenbrugh
- Department of Speech Therapy and Audiology, Thomas More College of Applied Sciences, Antwerp, Belgium
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21
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Ilkhani Z, Karimi H, Farazi M, O'Brian S, Onslow M. Validity of telephone calls to assess percentage of syllables stuttered with adolescents in clinical research. JOURNAL OF COMMUNICATION DISORDERS 2021; 91:106103. [PMID: 33873016 DOI: 10.1016/j.jcomdis.2021.106103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Karimi, O'Brian, Onslow, and Jones (2013) reported, for adults, no systematic differences between percentage of syllables stuttered (%SS) scores during a 12-hour day and 10-minute phone calls. The present study replicated that finding with adolescents, using valid methods for the age group. The present study also extended that initial report by determining whether the gender of the caller influenced %SS scores. METHOD Participants were 17 adolescents with stuttering. Percentage of syllables stuttered scores were obtained from a 12-hour day of the adolescents' lives, and two 10-minute unscheduled phone calls made before and after that day. One phone call was from a male caller and the other from a female caller. RESULTS For adolescents, analysis of covariance (ANCOVA) and intraclass correlations (ICC) replicated the overall Karimi, O'Brian, Onslow, and Jones (2013) finding. No significant differences were found between the %SS scores of the three speech samples, and these %SS scores were found to be highly correlated. However, in contrast to the Karimi, O'Brian, Onslow, and Jones (2013) finding with adults, Bland-Altman plot results revealed a caveat to this finding when applied to individual adolescents. Additionally, there was no effect due to the gender of the caller. CONCLUSION A 10-minute phone call can be used confidently to assess group mean %SS scores during stuttering research with adolescents. However, a 10-minute phone call cannot be used confidently to assess %SS scores of individual adolescent participants. For the latter context, such as with data-based case studies and single-subject experimentation, we recommend supplementing %SS scores with self-reported severity scores.
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Affiliation(s)
- Zahra Ilkhani
- Student Research Committee, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Karimi
- College of Health and Human Sciences, Charles Darwin University, Australia
| | - Morteza Farazi
- University of Social Welfare and Rehabilitation Sciences, Iran
| | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Australia.
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22
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Nonis D, Unicomb R, Hewat S. Parental perceptions of stuttering in children: a systematic review of the literature. SPEECH, LANGUAGE AND HEARING 2021. [DOI: 10.1080/2050571x.2021.1913299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Dinusha Nonis
- Speech Pathology, University of Newcastle, Callaghan, Australia
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Rachael Unicomb
- Speech Pathology, University of Newcastle, Callaghan, Australia
| | - Sally Hewat
- Speech Pathology, University of Newcastle, Callaghan, Australia
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23
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Briley PM, Gerlach H, Jacobs MM. Relationships between stuttering, depression, and suicidal ideation in young adults: Accounting for gender differences. JOURNAL OF FLUENCY DISORDERS 2021; 67:105820. [PMID: 33316554 DOI: 10.1016/j.jfludis.2020.105820] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between depressive symptoms and suicidal ideation and living with stuttering while accounting for time, sex, and health-related confounders. METHOD The data for this study come from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative survey study that has followed 13,564 respondents over the course of 14 years. Responses to the question "Do you have a problem with stuttering or stammering?" at two time points were used to establish stuttering and non-stuttering groups. Regression analysis, propensity score matching, and structural equation modeling were used. RESULTS Compared to their fluent counterparts, males and females reported significantly elevated symptoms of depression. Although symptoms of depression among males who stutter were stable over time, depressive symptoms among females who stutter increased with age. Compared to males who do not stutter, males who stutter were significantly more likely to report feelings of suicidal ideation. There were no differences in suicidal ideation between females who do and do not stutter. CONCLUSIONS Speech-language pathologists should be aware of the associations between stuttering and depressive symptoms, as well as the increased risk for suicidal ideation among males who stutter. Clinicians should be knowledgeable about symptoms of depression and suicidal ideation and be familiar with processes to refer as needed.
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Affiliation(s)
- Patrick M Briley
- Department of Communication Sciences & Disorders, East Carolina University, Greenville, NC, USA.
| | - Hope Gerlach
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Molly M Jacobs
- Department of Health Services & Information Management, East Carolina University, Greenville, NC, USA
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24
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Societal knowledge of stuttering in Saudi population. Saudi J Biol Sci 2021; 28:664-668. [PMID: 33424353 PMCID: PMC7783795 DOI: 10.1016/j.sjbs.2020.10.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
Stuttering is a common disease that exists in all societies and ethnic groups of differing incidence rates. The aim of this study was therefore to investigate the social awareness of stuttering in the Saudi community on the basis of a questionnaire. We will try to examine the incidence, triggers and duration of stuttering in the Saudi community. This study is descriptive, a questionnaire-based analysis involving the active participation of the Saudi community. The questionnaire, exposure to Stuttering, was addressed and balanced in terms of ethnicity, age and schooling. A total of 1,000 Saudi people was invited to participate in this questionnaire-based survey, with only 878 participants between 18 and 65 years of age participating in the study; most of them were males. In this survey, 79.5% of the Saudi population studies, most of them male (60.5% vs. 25.0% female) claimed that more than 6% of the population had stutters. There was also a substantial correlation between the degree of schooling, sex, and person experience and attitudes towards stuttering. It was often assumed that younger ages were prone to higher instances of stuttering relative to older ages (≤18 years vs 18 years of age). In comparison, handiness and IQ scores did not indicate any correlation with the occurrence of stuttering among the Saudi community. In conclusion, this questionnaire-based analysis, participants of both sexes claimed that more than 6% of the Saudi population were impaired by stuttering, which increased dramatically in males relative to females. They also claimed that both handiness and IQ ratings had little impact on the rate of stuttering. However, scant research on the effects of stuttering has scarcely been reported. Future experiments of effective public education preparation and health actions for stuttering are also welcome.
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25
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Karahan Tığrak T, Kulak Kayıkcı ME, Kirazlı MÇ, Tığrak A. Emotional and behavioural problems of children and adolescents who stutter: Comparison with typically developing peers. LOGOP PHONIATR VOCO 2020; 46:186-192. [PMID: 33355015 DOI: 10.1080/14015439.2020.1855472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Arcan Tığrak
- Department of Primary Education, Kütahya Dumlupınar University, Kütahya, Turkey
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Chu SY, Sakai N, Lee J, Harrison E, Tang KP, Mori K. Comparison of social anxiety between Japanese adults who stutter and non-stuttering controls. JOURNAL OF FLUENCY DISORDERS 2020; 65:105767. [PMID: 32535211 DOI: 10.1016/j.jfludis.2020.105767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 12/18/2019] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Adults who stutter (AWS) often develop social anxiety disorder. This study was to provide comparative data on the Liebowitz Social Anxiety Scale-Japanese version (LSAS-J) from AWS and non-stuttering adult controls. METHODS LSAS-J, a 24-item self-reported survey of social phobia and avoidance across various daily situations, was administered to 130 AWS (Mean Age = 41.5 years, SD = 15.8, 111 males) and 114 non-stuttering adults (Mean Age = 39.5, SD = 14.9, 53 males). The test-retest reliability and internal consistency of the LSAS-J were assessed. A between-subject multivariate analysis of variance (MANOVA) was also conducted to determine whether attitude toward social anxiety differed between AWS and AWNS, or by age (<40 and ≥ 40 years old), or sex (female and male). RESULTS AWS reported higher scores on both fear subscales of the LSAS-J. Age had no significant influence on the social anxiety levels reported by either participant group. Sex differences were found in the fear subscales, with females scoring higher on both fear subscales, although these were only marginally significant (p = .06). LSAS-J showed good test-retest reliability and high Cronbach's alpha coefficient, indicating that it is an internally consistent measure of attitudes about social anxiety. CONCLUSION Given the similarly high incidence of social anxiety in adults in Japan who stutter compared with those in other countries, social anxiety should be identified and assessed during clinical decision making and before decisions are made about stuttering treatment. LSAS-J is an easy tool to administer, and showed reliable results of social phobia and avoidance for AWS.
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Affiliation(s)
- Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia.
| | - Naomi Sakai
- National Rehabilitation Center for Persons with Disabilities, Research Institute, Department of Rehabilitation for Sensory Functions, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan.
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, Box 41071, Lubbock, TX, 79409-1071, USA.
| | | | - Keng Ping Tang
- Faculty of Health Sciences, Speech Sciences Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia.
| | - Koichi Mori
- National Rehabilitation Center for Persons with Disabilities, Rehabilitation Services Bureau, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan.
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Onslow M, Kelly EM. Temperament and early stuttering intervention: Two perspectives. JOURNAL OF FLUENCY DISORDERS 2020; 64:105765. [PMID: 32442826 DOI: 10.1016/j.jfludis.2020.105765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 02/26/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Australia.
| | - Ellen M Kelly
- Department of Hearing and Speech Sciences, Vanderbilt University, USA.
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Brignell A, Krahe M, Downes M, Kefalianos E, Reilly S, Morgan AT. A systematic review of interventions for adults who stutter. JOURNAL OF FLUENCY DISORDERS 2020; 64:105766. [PMID: 32438123 DOI: 10.1016/j.jfludis.2020.105766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/05/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter. METHODS Five electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded. RESULTS Five RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50-57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don't stutter. The study on tDCS reduced stuttering frequency by 22-27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions. CONCLUSION Speech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered.
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Affiliation(s)
- Amanda Brignell
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Michelle Krahe
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Queensland, Australia.
| | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, Australia.
| | - Sheena Reilly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Angela T Morgan
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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Toyomura A, Miyashiro D, Kuriki S, Sowman PF. Speech-Induced Suppression for Delayed Auditory Feedback in Adults Who Do and Do Not Stutter. Front Hum Neurosci 2020; 14:150. [PMID: 32390816 PMCID: PMC7193705 DOI: 10.3389/fnhum.2020.00150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/06/2020] [Indexed: 12/04/2022] Open
Abstract
Speech-induced suppression is the normal, relative amplitude reduction of the auditory evoked potential for self-, compared to externally-generated, auditory stimulation. It remains controversial as to whether adults who stutter exhibit expected auditory modulation during speech; some studies have reported a significant difference between stuttering and fluent groups in speech-induced suppression during speech movement planning, while others have not. We compared auditory evoked potentials (N1 component) for auditory feedback arising from one’s own voice (Speaking condition) with passive listening to a recording of one’s own voice (Listening condition) in 24 normally-fluent speakers and 16 adults who stutter under various delayed auditory feedback (DAF) time conditions (100 ms, 200 ms, 500 ms, and 1,000 ms). We presented the participant’s own voice with a delay, immediately after presenting it without a delay. Our working hypothesis was that the shorter the delay time, the more likely the delayed sound is perceived as self-generated. Therefore, shorter delay time conditions are proposed to result in relatively enhanced suppression of the auditory system. Results showed that in fluent speakers, the shorter the delay time, the more the auditory evoked potential in the Speaking condition tended to be suppressed. In the Listening condition, there was a larger evoked potential with shorter delay times. As a result, speech-induced suppression was only significant at the short delay time conditions of 100 and 200 ms. Adults who stutter did not show the opposing changes in the Speaking and Listening conditions seen in the fluent group. Although the evoked potential in the Listening condition tended to decrease as the delay time increased, that in the Speaking condition did not show a distinct trend, and there was a significant suppression only at 200 ms delay. For the 200 ms delay condition, speakers with more severe stuttering showed significantly greater speech-induced suppression than those with less severe stuttering. This preliminary study suggests our methods for investigating evoked potentials by presenting own voice with a delay may provide a clue as to the nature of auditory modulation in stuttering.
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Affiliation(s)
- Akira Toyomura
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Daiki Miyashiro
- Faculty of Medicine, School of Health Sciences, Gunma University, Maebashi, Japan.,Gunma University Hospital, Maebashi, Japan
| | - Shinya Kuriki
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Paul F Sowman
- Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia.,Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney, NSW, Australia
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Maguire GA, Nguyen DL, Simonson KC, Kurz TL. The Pharmacologic Treatment of Stuttering and Its Neuropharmacologic Basis. Front Neurosci 2020; 14:158. [PMID: 32292321 PMCID: PMC7118465 DOI: 10.3389/fnins.2020.00158] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
Stuttering is a DSM V psychiatric condition for which there are no FDA-approved medications for treatment. A growing body of evidence suggests that dopamine antagonist medications are effective in reducing the severity of stuttering symptoms. Stuttering shares many similarities to Tourette's Syndrome in that both begin in childhood, follow a similar male to female ratio of 4:1, respond to dopamine antagonists, and symptomatically worsen with dopamine agonists. In recent years, advances in the neurophysiology of stuttering have helped further guide pharmacological treatment. A newer medication with a novel mechanism of action, selective D1 antagonism, is currently being investigated in FDA trials for the treatment of stuttering. D1 antagonists possess different side-effect profiles than D2 antagonist medications and may provide a unique option for those who stutter. In addition, VMAT-2 inhibitors alter dopamine transmission in a unique mechanism of action that offers a promising treatment avenue in stuttering. This review seeks to highlight the different treatment options to help guide the practicing clinician in the treatment of stuttering.
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Affiliation(s)
- Gerald A Maguire
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Diem L Nguyen
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Kevin C Simonson
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Troy L Kurz
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
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Ntourou K, DeFranco EO, Conture EG, Walden TA, Mushtaq N. A parent-report scale of behavioral inhibition: Validation and application to preschool-age children who do and do not stutter. JOURNAL OF FLUENCY DISORDERS 2020; 63:105748. [PMID: 32065916 PMCID: PMC7061916 DOI: 10.1016/j.jfludis.2020.105748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 12/02/2019] [Accepted: 01/03/2020] [Indexed: 05/27/2023]
Abstract
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.
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Affiliation(s)
- Katerina Ntourou
- Department of Speech and Hearing Sciences, Vanderbilt University, United States.
| | - Elizabeth Oyler DeFranco
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder, United States
| | - Edward G Conture
- Department of Speech and Hearing Sciences, Vanderbilt University, United States
| | - Tedra A Walden
- Department of Psychology and Human Development, Department of Speech and Hearing Sciences, Vanderbilt University, United States
| | - Nasir Mushtaq
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, United States
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Walsh B, Usler E. Physiological Correlates of Fluent and Stuttered Speech Production in Preschool Children Who Stutter. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4309-4323. [PMID: 31805242 PMCID: PMC7201324 DOI: 10.1044/2019_jslhr-s-19-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
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.
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Affiliation(s)
- Bridget Walsh
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Evan Usler
- Department of Communication Sciences and Disorders, University of Delaware, Newark
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Nang C, Reynolds V, Hersh D, Andrews C, Humphries O. The experiences of migrants to Australia who stutter. JOURNAL OF FLUENCY DISORDERS 2019; 62:105723. [PMID: 31711011 DOI: 10.1016/j.jfludis.2019.105723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Charn Nang
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
| | - Victoria Reynolds
- Communication Sciences and Disorders, State University of New York at Plattsburgh, New York, United States of America
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Clare Andrews
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Oswell Humphries
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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Gerlach H, Hollister J, Caggiano L, Zebrowski PM. The utility of stuttering support organization conventions for young people who stutter. JOURNAL OF FLUENCY DISORDERS 2019; 62:105724. [PMID: 31634790 DOI: 10.1016/j.jfludis.2019.105724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Stuttering Support Organizations (SSOs) are places where people who stutter can share their experiences with stuttering and lend support to each other. There is evidence that SSO participation may be helpful in reducing the negative impact of stuttering and promoting positive cognitive and affective changes in adults who stutter. The benefits of participating in SSO organizations for young people, however, are currently unknown. PURPOSE This study investigated the relationship between attending a multi-day SSO convention and cognitive and affective changes among young people who stutter (YPWS). METHODS Twenty-two YPWS (ages 10 to 18) were recruited from the 2016 FRIENDS annual convention to participate in this study. FRIENDS is the National Association of Young People Who Stutter. A mixed methods approach was used to collect and analyze quantitative and qualitative data. The Overall Assessment of the Speaker's Experience with Stuttering (OASES) was administered at three times points: pre-convention, post-convention, and three months following the convention. Semi-structured interviews were conducted with seven participants to further explain the quantitative results. RESULTS Analysis of OASES scores across the three time points indicated that there were significant decreases in the negative impact of stuttering between pre-convention and post-convention measures. Qualitative analysis of semi-structured interview transcripts revealed five themes related to community building, collaborative learning, cognitive and communicative changes, self-acceptance, and normalizing stuttering. CONCLUSION SSOs may be beneficial in reducing the negative impact of stuttering and should be considered a potentially valuable addition to traditional therapy for stuttering.
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Affiliation(s)
- Hope Gerlach
- The University of Iowa, 250 Hawkins Drive, Iowa City, IA 52242, United States; Western Michigan University, 1903 Western Michigan Avenue, Kalamazoo, MI 49009, United States.
| | - Julia Hollister
- Loma Linda University, 24851 Circle Drive, Loma Linda, CA 92354, United States
| | - Lee Caggiano
- FRIENDS: The National Association of Young People Who Stutter, United States
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Tumanova V, Backes N. Autonomic Nervous System Response to Speech Production in Stuttering and Normally Fluent Preschool-Age Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4030-4044. [PMID: 31644362 DOI: 10.1044/2019_jslhr-s-19-0121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Victoria Tumanova
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Nicole Backes
- Department of Communication Sciences and Disorders, Syracuse University, NY
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Rocha MS, Yaruss JS, Rato JR. Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter. Front Psychol 2019; 10:2244. [PMID: 31636587 PMCID: PMC6788391 DOI: 10.3389/fpsyg.2019.02244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Mónica Soares Rocha
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal
| | - J Scott Yaruss
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - Joana R Rato
- Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Lisbon, Portugal
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Karimi H, Onslow M, Jones M, O'Brian S, Packman A, Menzies R, Reilly S, Sommer M, Jelčić-Jakšić S. The Satisfaction with Communication in Everyday Speaking Situations (SCESS) scale: An overarching outcome measure of treatment effect. JOURNAL OF FLUENCY DISORDERS 2018; 58:77-85. [PMID: 30392583 DOI: 10.1016/j.jfludis.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/29/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The Consolidated Standards of Reporting Trials (CONSORT) statement strongly suggests one primary outcome for clinical trials, yet the outcomes of stuttering treatments span numerous behavioral and psychosocial domains. That presents a roadblock to eventual meta-analysis of clinical trials for adults who stutter. METHOD We propose a simple and convenient outcome measure for clinical trials of stuttering treatment for adults that spans whatever behavioral and psychosocial factors might impel clients to seek treatment: a nine-point scale of Satisfaction with Communication in Everyday Speaking Situations (SCESS). The scale consists of one question which is simple, brief, easy to administer, cost-free, and translatable into many languages. The present report develops the SCESS scale by determining its reliability, content validity, and construct validity. RESULTS Reliability, content validity, and construct validity of the SCESS were confirmed with statistically significant and substantive correlations with speech-related and anxiety-related measures. However, the SCESS did not correlate well with percentage syllables stuttered. Three behavioral and psychosocial measures had the highest correlation with the SCESS: total Overall Assessment of the Speaker's Experience of Stuttering, self-reported stuttering severity, and Unhelpful Thoughts and Beliefs about Stuttering. CONCLUSION The SCESS measure has potential to be applied as an overarching clinical trial outcome measure of stuttering treatment effect. This study provides some preliminary evidence for including it as a primary or secondary outcome in clinical trials of adult stuttering treatments. However, further studies are needed to establish the SCESS responsiveness to different stuttering treatments.
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Affiliation(s)
- Hamid Karimi
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Mark Onslow
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Mark Jones
- School of Public Health, University of Queensland, Level 2, Public Health Building, Herston Road, Herston QLD 4006, Australia.
| | - Sue O'Brian
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Ann Packman
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Ross Menzies
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | | | - Martin Sommer
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Germany.
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Ajdacic-Gross V, Bechtiger L, Rodgers S, Müller M, Kawohl W, von Känel R, Mutsch M, Rössler W, Seifritz E, Castelao E, Strippoli MPF, Vandeleur C, Preisig M, Howell P. Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys. PLoS One 2018; 13:e0198450. [PMID: 30086147 PMCID: PMC6080750 DOI: 10.1371/journal.pone.0198450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/18/2018] [Indexed: 02/03/2023] Open
Abstract
Aims Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA). Methods Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874, age 35–82 years) and the ZInEP Epidemiology Survey (N = 1,500, age 20–41 years). Associations between stuttering and sociodemographic characteristics, familial aggregation, comorbidity and psychosocial risk / associated factors were investigated in both samples. LCAs were conducted on selected items from people in both samples who reported having stuttered in childhood. Results Initial analyses linked early anxiety disorders, such as separation anxiety disorder and overanxious disorder, to stuttering (PsyCoLaus). ADHD was associated with stuttering in both datasets. In the analyses of risk / associated factors, dysfunctional parental relationships, inter-parental violence and further childhood adversities were mutual predictors of stuttering. Moreover, comorbidities were seen with hay fever, asthma, eczema and psoriasis (PsyCoLaus). Subsequent LCA identified an unspecific group of persons who self-reported that they stuttered and a group defined by associations with psychosocial adversities (ZINEP, PsyCoLaus) and atopic diseases (PsyCoLaus). Conclusions The two subtypes of developmental stuttering have different risk / associated factors and comorbidity patterns. Most of the factors are associated with vulnerability mechanisms that occur early in life and that have also been linked with other neurodevelopmental disorders. Both psychosocial and biological factors appear to be involved in the etiopathogenesis of stuttering.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- * E-mail: (VA); (PH)
| | - Laura Bechtiger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Margot Mutsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland
- Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paulo, Sao Paulo, Brazil
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | | | - Caroline Vandeleur
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Peter Howell
- Department of Experimental Psychology, University College, London, United Kingdom
- * E-mail: (VA); (PH)
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Zengin-Bolatkale H, Conture EG, Key AP, Walden TA, Jones RM. Cortical associates of emotional reactivity and regulation in childhood stuttering. JOURNAL OF FLUENCY DISORDERS 2018; 56:81-99. [PMID: 29723729 PMCID: PMC5970082 DOI: 10.1016/j.jfludis.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 01/05/2018] [Accepted: 04/12/2018] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Hatun Zengin-Bolatkale
- Department of Hearing and Speech Sciences, Vanderbilt University, 1215 21st Avenue South, Suite 8310 MCE South Tower, Nashville, TN 37232-8242, United States.
| | - Edward G Conture
- Department of Hearing and Speech Sciences, Vanderbilt University, 1215 21st Avenue South, Suite 8310 MCE South Tower, Nashville, TN 37232-8242, United States.
| | - Alexandra P Key
- Department of Hearing and Speech Sciences, Vanderbilt University, 1215 21st Avenue South, Suite 8310 MCE South Tower, Nashville, TN 37232-8242, United States; Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt University Medical Center, 230 Appleton Place, Nashville, TN 37203, United States.
| | - Tedra A Walden
- Department of Hearing and Speech Sciences, Vanderbilt University, 1215 21st Avenue South, Suite 8310 MCE South Tower, Nashville, TN 37232-8242, United States; Department of Psychology and Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203-5721, United States.
| | - Robin M Jones
- Department of Hearing and Speech Sciences, Vanderbilt University, 1215 21st Avenue South, Suite 8310 MCE South Tower, Nashville, TN 37232-8242, United States.
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Shimada M, Toyomura A, Fujii T, Minami T. Children who stutter at 3 years of age: A community-based study. JOURNAL OF FLUENCY DISORDERS 2018; 56:45-54. [PMID: 29602051 DOI: 10.1016/j.jfludis.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Lack of social resources to support children who stutter may be due, in part, to the absence of epidemiological data regarding stuttering. This study investigated the proportion of three-year-old children who stutter in a city located in Hokkaido, a northern island of Japan. METHODS The speech of individual children was assessed as part of a routine, government-conducted health care examination for 3-year-old children. The number of children screened was 2274, or 94.4% of all children in the city. The first author participated in the health care examination, and followed up all of the children who were found to stutter. RESULTS At 3 years of age, 1.41% of the children exhibited stuttering; 82.8% of these children subsequently did not exhibit stuttering six months later. Boys were 1.57 times more likely to stutter than girls, but they had only 86% of the probability of reported or observed fluency seen in girls six months later. Significantly higher probability of later fluency was observed in children who exhibited normal, rather than delayed, language development at the 1.5-year health checkup preceding the 3-year health checkup. CONCLUSION The proportion of three-year-old children who stutter and fluency status 6 months later are reported for a large cohort of Japanese children in Hokkaido. Language skills at 1;6 year may potentially be a factor in natural recovery or persistence; because of limitations in our study design, this assumption requires additional study. This is the first preliminary study to determine the proportion of three-year-old children who stutter in a Japanese community.
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Affiliation(s)
- Michiko Shimada
- Sapporo Medical Technology, Welfare, and Dentistry Professional Training, College of Nishino Gakuen School Foundation, Minami 5, Nishi 11, Chuoku, Sapporo 064-0805, Japan
| | - Akira Toyomura
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Tetsunoshin Fujii
- Graduate School of Letters, Hokkaido University, Kita 10, Nishi 7, Kita-ku, Sapporo 060-0810, Japan
| | - Takayuki Minami
- Minami-Tsukisamu Elementary School, Tsukisamu Nishi 4-8, Toyohira-ku, Sapporo 062-0024, Japan; Japan Stuttering Genyukai Association, Minami-Otsuka 1-30-15, Toshima-ku, Tokyo 170-0005, Japan
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41
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Diehl J, Robb MP, Lewis JG, Ormond T. Situational speaking anxiety in adults who stutter. SPEECH LANGUAGE AND HEARING 2018. [DOI: 10.1080/2050571x.2018.1441782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Janine Diehl
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - Michael P. Robb
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - John G. Lewis
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Tika Ormond
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
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Toyomura A, Fujii T, Yokosawa K, Kuriki S. Speech Disfluency-dependent Amygdala Activity in Adults Who Stutter: Neuroimaging of Interpersonal Communication in MRI Scanner Environment. Neuroscience 2018; 374:144-154. [PMID: 29378280 DOI: 10.1016/j.neuroscience.2018.01.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/14/2022]
Abstract
Affective states, such as anticipatory anxiety, critically influence speech communication behavior in adults who stutter. However, there is currently little evidence regarding the involvement of the limbic system in speech disfluency during interpersonal communication. We designed this neuroimaging study and experimental procedure to sample neural activity during interpersonal communication between human participants, and to investigate the relationship between the amygdala activity and speech disfluency. Participants were required to engage in live communication with a stranger of the opposite sex in the MRI scanner environment. In the gaze condition, the stranger gazed at the participant without speaking, while in the live conversation condition, the stranger asked questions that the participant was required to answer. The stranger continued to gaze silently at the participant while the participant answered. Adults who stutter reported significantly higher discomfort than fluent controls during the experiment. Activity in the right amygdala, a key anatomical region in the limbic system involved in emotion, was significantly correlated with stuttering occurrences in adults who stutter. Right amygdala activity from pooled data of all participants also showed a significant correlation with discomfort level during the experiment. Activity in the prefrontal cortex, which forms emotion regulation neural circuitry with the amygdala, was decreased in adults who stutter than in fluent controls. This is the first study to demonstrate that amygdala activity during interpersonal communication is involved in disfluent speech in adults who stutter.
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Affiliation(s)
- Akira Toyomura
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514, Japan; Research Center for Advanced Technologies, Tokyo Denki University, Muzai-Gakuendai, Inzai, Chiba 270-1382, Japan; Research and Education Center for Brain Science, Hokkaido University, Kita 15, Nishi 7 Kita-ku, Sapporo 060-8638, Japan.
| | - Tetsunoshin Fujii
- Department of Psychology, Hokkaido University, Kita 10, Nishi 7 Kita-ku, Sapporo 060-0810, Japan
| | - Koichi Yokosawa
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5 Kita-ku, Sapporo 060-0812, Japan
| | - Shinya Kuriki
- Department of Information Environment, Tokyo Denki University, Muzai-Gakuendai, Inzai, Chiba 270-1382, Japan
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Smith KA, Iverach L, O'Brian S, Mensah F, Kefalianos E, Hearne A, Reilly S. Anxiety in 11-Year-Old Children Who Stutter: Findings From a Prospective Longitudinal Community Sample. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1211-1222. [PMID: 28418529 DOI: 10.1044/2016_jslhr-s-16-0035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 10/27/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE To examine if a community sample of 11-year-old children with persistent stuttering have higher anxiety than children who have recovered from stuttering and nonstuttering controls. METHOD Participants in a community cohort study were categorized into 3 groups: (a) those with persistent stuttering, (b) those with recovered stuttering, and (c) nonstuttering controls. Linear regression modeling compared outcomes on measures of child anxiety and emotional and behavioral functioning for the 3 groups. RESULTS Without adjustment for covariates (unadjusted analyses), the group with persistent stuttering showed significantly increased anxiety compared with the recovered stuttering group and nonstuttering controls. The group with persistent stuttering had a higher number of children with autism spectrum disorder and/or learning difficulties. Once these variables were included as covariates in subsequent analysis, there was no difference in anxiety, emotional and behavioral functioning, or temperament among groups. CONCLUSION Although recognized to be associated with stuttering in clinical samples, anxiety was not higher in school-age children who stutter in a community cohort. It may be that anxiety develops later or is less marked in community cohorts compared with clinical samples. We did, however, observe higher anxiety scores in those children who stuttered and had autism spectrum disorder or learning difficulties. Implications and recommendations for research are discussed.
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Affiliation(s)
- Kylie A Smith
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, AustraliaDepartment of Paediatrics, University of Melbourne, Victoria, Australia
| | - Lisa Iverach
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe NSW, AustraliaDepartment of Psychology, Macquarie University, North Ryde NSW, Australia
| | - Susan O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe NSW, Australia
| | - Fiona Mensah
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, AustraliaDepartment of Paediatrics, University of Melbourne, Victoria, Australia
| | - Elaina Kefalianos
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, AustraliaDepartment of Audiology and Speech Pathology, University of Melbourne, Victoria, Australia
| | - Anna Hearne
- Speech Language Therapy, Institute of Education, Massey University, Albany, New Zealand
| | - Sheena Reilly
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, AustraliaDepartment of Paediatrics, University of Melbourne, Victoria, AustraliaMenzies Health Institute Queensland, Griffith University, Southport, Australia
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Iverach L, Lowe R, Jones M, O'Brian S, Menzies RG, Packman A, Onslow M. A speech and psychological profile of treatment-seeking adolescents who stutter. JOURNAL OF FLUENCY DISORDERS 2017; 51:24-38. [PMID: 28212718 DOI: 10.1016/j.jfludis.2016.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/30/2016] [Accepted: 11/06/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the relationship between stuttering severity, psychological functioning, and overall impact of stuttering, in a large sample of adolescents who stutter. METHOD Participants were 102 adolescents (11-17 years) seeking speech treatment for stuttering, including 86 boys and 16 girls, classified into younger (11-14 years, n=57) and older (15-17 years, n=45) adolescents. Linear regression models were used to evaluate the relationship between speech and psychological variables and overall impact of stuttering. RESULTS The impact of stuttering during adolescence is influenced by a complex interplay of speech and psychological variables. Anxiety and depression scores fell within normal limits. However, higher self-reported stuttering severity predicted higher anxiety and internalizing problems. Boys reported externalizing problems-aggression, rule-breaking-in the clinical range, and girls reported total problems in the borderline-clinical range. Overall, higher scores on measures of anxiety, stuttering severity, and speech dissatisfaction predicted a more negative overall impact of stuttering. CONCLUSION To our knowledge, this is the largest cohort study of adolescents who stutter. Higher stuttering severity, speech dissatisfaction, and anxiety predicted a more negative overall impact of stuttering, indicating the importance of carefully managing the speech and psychological needs of adolescents who stutter. Further research is needed to understand the relationship between stuttering and externalizing problems for adolescent boys who stutter.
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Affiliation(s)
- Lisa Iverach
- Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Mark Jones
- School of Public Health, University of Queensland, Level 2, Public Health Building, Herston Road, Herston, QLD 4006, Australia.
| | - Susan O'Brian
- Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Ross G Menzies
- Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
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Blood GW, Blood IM. Long-term Consequences of Childhood Bullying in Adults who Stutter: Social Anxiety, Fear of Negative Evaluation, Self-esteem, and Satisfaction with Life. JOURNAL OF FLUENCY DISORDERS 2016; 50:72-84. [PMID: 27865231 DOI: 10.1016/j.jfludis.2016.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/28/2016] [Accepted: 10/06/2016] [Indexed: 05/22/2023]
Abstract
PURPOSE Psychosocial disorders have been reported in adults who stutter, especially social anxiety disorder. Social anxiety has been linked to childhood victimization. It is possible that recalled childhood victimization could be linked to psychosocial problems reported in some adults who stutter. METHOD Participants were 36 adults who stutter and 36 adults who do not stutter (mean age=21.9 years). The Retrospective Bullying Questionnaire was completed for primary school, secondary school and university environments for physical, verbal, relational and cyber bullying. Participants were categorized into one of five groups (bully, victim, bully-victim, bystander and uninvolved) based ontheir responses. Participants completed four psychosocial scales: social interaction anxiety, fear of negative evaluation, self-esteem and satisfaction with life scales. RESULTS The two groups differed with adults who stutter having higher social interaction anxiety, fear of negative evaluation and satisfaction with life. Analyses of variance revealed that victims had the highest scores among both groups on all four scales. CONCLUSION Adults who recalled being victimized during childhood were more likely, regardless of whether they stutter or did not stutter, to have poorer psychosocial scale scores. These results show the lingering effects of childhood victimization, common in some children who stutter, may contribute to the reported psychosocial problems in adulthood. The need for early intervention for children who are bullied and future research with larger samples is warranted.
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McAllister J. Behavioural, emotional and social development of children who stutter. JOURNAL OF FLUENCY DISORDERS 2016; 50:23-32. [PMID: 27865227 DOI: 10.1016/j.jfludis.2016.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/26/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Developmental stuttering may be associated with diminished psychological well-being which has been documented from late childhood onwards. It is important to establish the point at which behavioural, emotional and social problems emerge in children who stutter. METHODS The study used data from the Millennium Cohort Study, whose initial cohort comprised 18,818 children. Analysis involved data collected when the cohort members were 3, 5 and 11 years old. The association between parent-reported stuttering and performance on the Strengths and Difficulties Questionnaire was determined in regression analyses which controlled for cohort members' sex, verbal and non-verbal abilities, maternal education, and family economic status. RESULTS Compared with typically-developing children, those who stuttered had significantly higher Total Difficulties scores at all three ages; in addition, scores on all of the sub-scales for 5-year-olds who stuttered indicated poorer development than their peers, and 11-year-olds who stuttered had poorer development than peers in all areas except prosocial skills. At ages 5 and 11, those who stuttered were more likely than peers to have scores indicating cause for clinical concern in almost all areas. CONCLUSION Children who stutter may begin to show impaired behavioural, emotional and social development as early as age 3, and these difficulties are well established in older children who stutter. Parents and practitioners need to be aware of the possibility of these difficulties and intervention needs to be provided in a timely fashion to address such difficulties in childhood and to prevent the potential development of serious mental health difficulties later in life.
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Affiliation(s)
- Jan McAllister
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
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Iverach L, Jones M, McLellan LF, Lyneham HJ, Menzies RG, Onslow M, Rapee RM. Prevalence of anxiety disorders among children who stutter. JOURNAL OF FLUENCY DISORDERS 2016; 49:13-28. [PMID: 27638189 DOI: 10.1016/j.jfludis.2016.07.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 05/13/2023]
Abstract
PURPOSE Stuttering during adulthood is associated with a heightened rate of anxiety disorders, especially social anxiety disorder. Given the early onset of both anxiety and stuttering, this comorbidity could be present among stuttering children. METHOD Participants were 75 stuttering children 7-12 years and 150 matched non-stuttering control children. Multinomial and binary logistic regression models were used to estimate odds ratios for anxiety disorders, and two-sample t-tests compared scores on measures of anxiety and psycho-social difficulties. RESULTS Compared to non-stuttering controls, the stuttering group had six-fold increased odds for social anxiety disorder, seven-fold increased odds for subclinical generalized anxiety disorder, and four-fold increased odds for any anxiety disorder. CONCLUSION These results show that, as is the case during adulthood, stuttering during childhood is associated with a significantly heightened rate of anxiety disorders. Future research is needed to determine the impact of those disorders on speech treatment outcomes.
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Affiliation(s)
- Lisa Iverach
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia; School of Public Health, University of Queensland, Level 2, Public Health Building, Herston Road, Herston, QLD 4006, Australia.
| | - Mark Jones
- School of Public Health, University of Queensland, Level 2, Public Health Building, Herston Road, Herston, QLD 4006, Australia.
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia.
| | - Heidi J Lyneham
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia.
| | - Ross G Menzies
- Australian Stuttering Research Centre, The University of Sydney, P.O. Box 170, Lidcombe, NSW 1825, Australia.
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, P.O. Box 170, Lidcombe, NSW 1825, Australia.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia.
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Donaghy MA, Smith KA. Management options for pediatric patients who stutter: current challenges and future directions. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2016; 7:71-77. [PMID: 29388582 PMCID: PMC5683286 DOI: 10.2147/phmt.s77568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Stuttering is a speech disorder, with onset often occurring in the preschool years. The prevalence of stuttering in young children is much higher than that in the general population, suggesting a high rate of recovery. However, we are unable to predict which children will recover without treatment, and it is widely acknowledged that stuttering therapy during childhood provides the best safeguard against chronic stuttering. This review reports on current evidence-based stuttering treatment options for preschoolers through to adolescents. We discuss the clinical challenges associated with treating pediatric clients who stutter at different stages of development and explore potential areas of treatment research that might serve to advance current clinical practice in the future.
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Affiliation(s)
- Michelle A Donaghy
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW
| | - Kylie A Smith
- Murdoch Childrens Research Institute, Royal Childrens Hospital.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Andrews C, O'Brian S, Onslow M, Packman A, Menzies R, Lowe R. Phase II trial of a syllable-timed speech treatment for school-age children who stutter. JOURNAL OF FLUENCY DISORDERS 2016; 48:44-55. [PMID: 27498894 DOI: 10.1016/j.jfludis.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/01/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE A recent clinical trial (Andrews et al., 2012) showed Syllable Timed Speech (STS) to be a potentially useful treatment agent for the reduction of stuttering for school-age children. The present trial investigated a modified version of this program that incorporated parent verbal contingencies. METHODS Participants were 22 stuttering children aged 6-11 years. Treatment involved training the children and their parents to use STS in conversation. Parents were also taught to use verbal contingencies in response to their child's stuttered and stutter-free speech and to praise their child's use of STS. Outcome assessments were conducted pre-treatment, at the completion of Stage 1 of the program and 6 months and 12 months after Stage 1 completion. RESULTS Outcomes are reported for the 19 children who completed Stage 1 of the program. The group mean percent stuttering reduction was 77% from pre-treatment to 12 months post-treatment, and 82% with the two least responsive participants removed. There was considerable variation in response to the treatment. Eleven of the children showed reduced avoidance of speaking situations and 18 were more satisfied with their fluency post-treatment. However, there was some suggestion that stuttering control was not sufficient to fully eliminate situation avoidance for the children. CONCLUSIONS The results of this trial are sufficiently encouraging to warrant further clinical trials of the method.
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Affiliation(s)
- Cheryl Andrews
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Ross Menzies
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney, Australia.
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Menzies R, O'Brian S, Lowe R, Packman A, Onslow M. International Phase II clinical trial of CBTPsych: A standalone Internet social anxiety treatment for adults who stutter. JOURNAL OF FLUENCY DISORDERS 2016; 48:35-43. [PMID: 27498893 DOI: 10.1016/j.jfludis.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/31/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE CBTPsych is an individualized, fully automated, standalone Internet treatment program that requires no clinical contact or support. It is designed specifically for those who stutter. Two preliminary trials demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. However, both trials involved pre- and post-treatment assessment at a speech clinic. This contact may have increased compliance, commitment and adherence with the program. The present study sought to establish the effectiveness of CBTPsych in a large international trial with no contact of any kind from researchers or clinicians. METHOD Participants were 267 adults with a reported history of stuttering who were given a maximum of 5 months access to CBTPsych. Pre- and post-treatment functioning was assessed within the online program with a range of psychometric measures. RESULTS Forty-nine participants (18.4%) completed all seven modules of CBTPsych and completed the post-treatment online assessments. That compliance rate was far superior to similar community trials of self-directed Internet mental health programs. Completion of the program was associated with large, statistically and clinically significant reductions for all measures. The reductions were similar to those obtained in earlier trials of CBTPsych, and those obtained in trials of in-clinic CBT with an expert clinician. CONCLUSIONS CBTPsych is a promising individualized treatment for social anxiety for a proportion of adults who stutter, which requires no health care costs in terms of clinician contact or support. EDUCATIONAL OBJECTIVES The reader will be able to: (a) discuss the reasons for investigating CBTPsych without any clinical contact; (b) describe the main components of the CBTPsych treatment; (c) summarize the results of this clinical trial; (d) describe how the results might affect clinical practice, if at all.
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Affiliation(s)
- Ross Menzies
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, Australia.
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