Parents' speech and children's stuttering: a critique of the literature

Validation of the Persian Version of the Palin Parent Rating Scales

INTRODUCTION

The Palin Parent Rating Scale (Palin PRS) is a structured questionnaire filled out by parents of children who stutter. It is designed to assess the effects of stuttering on both the children and their parents. The goal of this study was to translate the Palin PRS into Persian and to evaluate its validity and reliability for application in preschool children who stutter.

METHODS

This research was conducted from August 2021 to December 2022, involving 139 parents of children who stutter. The parents completed the Palin PRS and provided their demographic data. Descriptive statistics were used to examine the floor and ceiling effects on all subscales of the Palin PRS. The internal consistency of the scale was assessed using Cronbach's alpha method, while the intraclass correlation coefficient (ICC) was calculated to determine its test-retest reliability. An exploratory factor analysis was also performed to clarify the factor structure of the scale.

RESULTS

The exploratory factor analysis results were highly consistent with the factor structure found in the original version. No floor or ceiling effects were observed for the factors of the Palin PRS. The three factors of the Persian version of the Palin PRS (P-Palin PRS) showed good internal consistency (Cronbach's alpha >0.8) and excellent test-retest reliability (ICC >0.9). Additionally, normative scores were derived by converting raw scores into Stanine scores.

CONCLUSION

The P-Palin PRS showed strong reliability, thereby establishing it as a suitable instrument for evaluating how parents perceive the effects of stuttering on their children and themselves. Further research may explore its application in diverse clinical settings and populations.

What Is the Role of Questioning in Young Children's Fluency?

PURPOSE

Most therapy programs for young children who stutter (CWS) involve caregiver counseling and adjustment of caregiver behavior to maximize opportunities for the child to be more fluent. One component sometimes included as a recommended adjustment is a reduction in caregiver question asking, as question asking is hypothesized to increase language formulation demands on the child. However, there is limited research to guide clinician advisement to caregivers that has controlled for numerous potential confounding factors, including utterance length and grammaticality, that may impact potential stressors on children. Our aim was to assess whether there was an empirical basis for such recommendations by comparing disfluency profiles of answers to questions and nonanswer utterances produced by children during spontaneous play with parents and examiners.

METHOD

We analyzed fluency and structural properties as well as pragmatic function of 15,782 utterances from language samples produced by 32 CWS and 32 children who do not stutter (CWNS) who were between 28 and 50 months of age. CWS and CWNS were matched on gender and age within 4 months and were matched as closely as possible on maternal education.

RESULTS

For utterances produced by CWS, answers to adult questions were significantly less likely to contain stuttering-like disfluencies than other utterance types, and this was still true after controlling for utterance length and grammaticality. In contrast, for utterances produced by CWNS, answers to questions were significantly more likely to be disfluent than other utterance types after controlling for length and grammaticality.

CONCLUSION

Given the current findings, some prior research, and the documented potential benefits in language development for adult question asking of children, we do not believe that clinicians need to recommend changes to typical question-asking behavior by caregivers of CWS.

Methods in Stuttering Therapy for Desensitizing Parents of Children Who Stutter

PURPOSE

The aim of this study was to describe a range of methods used in stuttering therapy for desensitizing parents of children who stutter (CWS).

METHOD

This clinical tutorial will first briefly explore the rationale and benefit of including parents of CWS of all ages in the therapy process. The construct of desensitization will be defined, and a description will be given of how traditionally it has been incorporated into therapy with adults who stutter and CWS. Research evidence will be presented about the impact of a child's stuttering on parents. The article will then focus on clinical methods for desensitizing parents of CWS using examples of activities conducted in group and individual therapy with parents at the Michael Palin Centre in London with reference to desired outcomes, how to measure them, and how to address potential pitfalls.

CONCLUSION

Desensitization activities can be implemented with parents of CWS to help them recognize and manage their emotional reactions to their child's stuttering, to support parents to feel knowledgeable and confident in managing their child's stuttering, and ultimately to enhance the child's progress in therapy.

Stuttering in Preschool Children: Direct Versus Indirect Treatment

Purpose

The purpose of this article is to discuss the controversial topic of stuttering in preschool children and how to evaluate the options for treatment, emphasizing the role of external research evidence.

Method

A hypothetical but realistic case study of a 3-year-old boy who stutters is described. Two contrasting approaches to treatment are presented, the Lidcombe Program (LP) and the demands and capacities model (DCM). Studies published in peer-reviewed research journals that have examined the effectiveness of each approach are summarized and critiqued.

Results

The review indicates that the LP is the preferred treatment approach for stuttering in preschool children and that it offers the best opportunity for rapid success.

Conclusion

The LP should be carried out by knowledgeable, experienced, and flexible speech-language pathologists who are able to accommodate the individual needs and differences of every child and family.

Parents' reactions to children's stuttering and style of coping with stress

PURPOSE

The aim of the research was to determine: (a) how parents react to their child's stuttering, (b) what stress coping strategies they utilise, as well as (c) whether stress coping style depends on parents' reaction to their child's stuttering.

METHODS

The research involved 23 mothers and 23 fathers of children who stutter (CWS) at the age of three to six years old. The Reaction to Speech Disfluency Scale (RSDS), developed by the authors, was used in the research. To determine the parents' coping the Coping Inventory in Stressful Situations (CISS) by N.S. Endler and D.A Parker was applied.

RESULTS

The strongest reactions are observed on the cognitive level. Stronger cognitive, emotional and behavioural reactions are observed in the mothers towards their disfluently speaking sons and in the fathers towards their daughters. Having analysed the profiles of coping styles, it can be noticed that the task-oriented coping is most frequently adapted by the fathers. The mothers most often use the avoidance-oriented coping. No relevant correlation was observed between the fathers' coping style and their reactions to the child's disfluent speech. As far as the mothers are concerned, it has been proved that an increase in behavioural reactions correlates with the avoidance-oriented coping.

CONCLUSION

The cognitive reactions of the parents' towards their child's stuttering were most frequent, while the emotional ones were the least frequent. Confronted with a stressful situation, the fathers most often adapt the task-oriented coping, whereas the mothers use the avoidance-oriented coping.

EDUCATIONAL OBJECTIVES

the reader will be able to (1) learn what the key reactions of parents to their children's stuttering are, (2) describe stuttering as a stress factor for the parents, (3) describe the factors which influence parents' reactions to their child's stuttering and their coping style.

Perfectionism and stuttering: Findings of an online survey

PURPOSE

Using a multi-dimensional measure of perfectionism: the Frost Multi-dimensional Perfectionism Scale (FMPS: Frost, Marten, Lahart, & Rosenblate, 1990), this study investigates: (a) whether adults who stutter (AWS) display more perfectionistic attitudes and beliefs than those who do not stutter, and (b) whether, in AWS, more perfectionistic attitudes and beliefs are associated with greater self-reported difficulty communicating verbally and speaking fluently.

METHOD

In the first analysis, FMPS responses from 81 AWS and 81 matched, normally-fluent controls were analyzed using logistic regression to investigate the relative contributions of four FMPS perfectionism-subscale self-ratings to the likelihood of being in the AWS group. In the subsequent analyses, data from the 81 AWS were analyzed using linear multiple regression to determine which FMPS subscale self-ratings best predicted their Communication-Difficulty and Fluency-Difficulty scores.

RESULTS

Both the likelihood of being a member of the AWS group, and also the magnitude of the AWS group's Communication-Difficulty and Fluency-Difficulty scores, were positively part-correlated to respondents' Concern over Mistakes-Doubts about Actions (CMD) subscale self-ratings but negatively part-correlated to their Personal Standards (PS) subscale self-ratings.

CONCLUSIONS

The FMPS profiles of respondents who stutter suggest that, as a group, they are not abnormally perfectionistic overall, but may be (or perceive themselves to be) abnormally error-prone. Also, AWS who are more concerned about their errors and uncertain of their actions experience more difficulty communicating verbally and speaking fluently.

EDUCATIONAL OBJECTIVES

After reading this article, participants will be able to: (a) describe the findings of previous research investigating the role of perfectionism in stuttering and psychopathologies; (b) discuss why a multidimensional assessment of perfectionism is important in relation to stuttering; (c) discuss ways in which data from perfectionism assessments can contribute to the planning of therapy for adults who stutter.

Slow speech rate effects on stuttering preschoolers with disordered phonology

To study the effects of clinicians' slow rate on the speech of children who stutter with and without a concomitant phonological disorder, an A-B-A-B single case design was used with six clinician-child dyads, where B = Clinician's slow speech rate model. Two boys and one girl, aged 49-54 months, stuttering with disordered phonology (S + DP), were compared to three boys aged 42-50 months, stuttering with normal phonology (S + NP). Articulation rates were measured in phones per second (pps) in clinician-child adjacent utterance pairs. The S + NP dyads showed improved fluency in the B condition through a larger effect size, higher mean baseline stutter reductions and lower percentages of non-overlapping data than did the S + DP dyads. The S + DP girl showed relatively improved fluency in the B condition. S + DP children showed no articulation rate alignment (Range: 16% decrease to a 1.2% increase), whereas S + NP children averaged a 20% pps rate reduction (Range: 19.6-25.4% decrease), aligning with their clinicians who averaged a 38% pps rate reduction from baseline. The S + DP group spoke significantly (z = -4.63; p < 0.00) slower at baseline (Mdn = 6.9 pps; SE = 0.07 pps) than S + NP children in previously published samples (Mdn = 9.8 pps; SE = 0.22 pps). Results suggest that a slow rate model alone is not effective for facilitating fluency in S + DP boys with time since onset of about 2 years.

Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach

Purpose

The purpose of this article is to present a detailed description of a family-focused treatment for preschool children who stutter that addresses communication behaviors and attitudinal reactions that children and their parents may exhibit in reaction to stuttering, as well as a preliminary evaluation of the outcomes of that treatment.

Method

The study involved assessment of the children’s speech fluency and a client satisfaction questionnaire that sought parents' opinions about which aspects of the treatment were beneficial. Participants were 17 children who stutter, ages 31 to 62 months, and their families.

Results

Responses to the questionnaire indicated that treatment helped families learn about stuttering and about strategies that facilitate children’s fluency. Evaluation of the children’s fluency revealed that all participants achieved improved fluency at the conclusion of treatment and at long-term follow-up.

Implications

Findings suggest that this treatment approach may be useful for helping children achieve improved speech fluency, effective communication skills, and healthy communication attitudes.

Caregiver-Child Interactions and Their Impact on Children’s Fluency

There is a relatively strong focus in the stuttering literature on the desirability of selected alterations in parental speech and language style in the management of early stuttering. In this article, the existing research support for such recommendations is evaluated, together with relevant research from the normal language acquisition literature that bears on the potential consequences of changing parental interaction style. Recommendations with relatively stronger and weaker support are discussed. Ways in which children’s communication styles and fluency may be altered through newer fluency treatment protocols are contrasted with older, more general parent advisements. Finally, directions for future research into the efficacy of recommendations made to the parents of children who stutter (CWS) are offered.

Parental language input to children at stuttering onset

Many programs for the indirect management of stuttering in early childhood counsel adjustment of parental language models, which are presumed to play an exacerbating influence on vulnerable children's fluency. We examined the relative levels of linguistic demand in maternal language to stuttering and nonstuttering children, adjusted for each child's current level of linguistic development. No significant or observable differences were detected in the relative level of linguistic demand posed by parents of stuttering children very close to onset of symptoms. Empirical support for current advisement and potential ramifications are discussed.

An operant intervention for early stuttering. The development of the Lidcombe program

Stuttering is a common speech disorder that causes significant distress and may cause social maladjustment and hinder occupational potential. Treatments for chronic stuttering in adults can control stuttering by teaching the speaker to use a new speech pattern. However, these treatments are resource intensive and relapse prone, and they produce speech that sounds unnatural to the listener and feels unnatural to the speaker. This article describes the development and evaluation of an operant treatment for early stuttering. Parents are trained to present verbal contingencies for stuttered and stutter-free speech during everyday speaking situations with their children. The authors overview outcome data from several studies that suggest that this program produces relapse-free control of stuttered speech in preschool children in the medium and long term in a cost-effective manner.

Parental perceptions of children's communicative development at stuttering onset

There has been clinical speculation that parents of young stuttering children have expectations of their children's communication abilities that are not well-matched to the children's actual skills. We appraised the language abilities of 15 children close to the onset of stuttering symptoms and 15 age-, sex-, and SES-matched fluent children using an array of standardized tests and spontaneous language sample measures. Parents concurrently completed two parent-report measures of the children's communicative development. Results indicated generally depressed performance on all child speech and language measures by the children who stutter. Parent report was closely attuned to child performance for the stuttering children; parents of nonstuttering children were less accurate in their predictions of children's communicative performance. Implications for clinical advisement to parents of stuttering children are discussed.

Speaking rate, conversational speech acts, interruption, and linguistic complexity of 20 pre-school stuttering and non-stuttering children and their mothers

This is the second in a series of reports concerning stuttering pre-school children enrolled in a longitudinal study; the first was Ryan (1992). Conversational samples of 20 stuttering and 20 non-stuttering pre-school children and their mothers were analysed for speaking rate, conversational speech acts, interruption, and linguistic complexity. Between-group analyses revealed few differences between either the two children or two mother groups. Within-group analyses indicated differences that involved conversational speech acts and linguistic complexity. Most stuttering occurred on statements (M = 32.3% stuttered) and questions (M = 20.9% stuttered). Stuttered and disfluent sentences had higher Developmental Sentence Scoring (DSS) (Lee, 1974) scores (M = 10.9, 12.9, respectively) than fluent sentences (M = 7.6). Multiple correlation analyses indicated that speaking rate of mothers (0.561) and normal disfluency of children (0.396) were major predictor variables.