Understanding the Speaker's Experience of Stuttering Can Improve Stuttering Therapy

Speech-Language Pathologists' Perceptions of Their Competence in Managing Stuttering: A Systematic Review with Narrative Synthesis

BACKGROUND

Stuttering can significantly impact an individual's quality of life and has the potential to affect social interactions, academic and career opportunities, and well-being. Speech-language pathologists (SLPs) play a crucial role in the treatment of stuttering across the lifespan.

AIMS

This systematic review aimed to describe (1) how competent SLPs perceive themselves to be in their management of stuttering and (2) the factors that influence SLPs' perceived competence in managing stuttering.

METHODS

A comprehensive search of eight electronic databases resulted in 13 studies that met the inclusion criteria. A narrative synthesis was completed on the extracted data.

MAIN CONTRIBUTION

Competence was perceived to be lower in treatment than in assessment. Perceived competence was higher in SLPs who saw people who stutter more frequently and engaged in more continuing professional education in stuttering. Factors affecting SLPs' perceived competence also included: the level of support to implement treatment, knowledge of stuttering, formal education in stuttering, years of experience as an SLP, experiences with stuttering, familiarity with people who stutter, previous treatment outcomes and the perceived complexity of stuttering. The available data were primarily focused on participants working in paediatric populations.

CONCLUSIONS

The review revealed diversity in perceived competence when managing stuttering, influenced by factors related to SLPs' professional and personal experiences, the practice context and available evidence, with notable variation in competence across different settings and regions. Further research is required across the lifespan to better understand the relationships between factors and to guide future interventions for competence.

WHAT THIS PAPER ADDS

What is already known on the subject Research has identified gaps in SLPs' knowledge, clinical experience and confidence in treating stuttering. These studies highlighted SLPs' limited awareness of effective interventions, varying levels of perceived competence across different age groups, low preference for treating stuttering and difficulty applying clinical trial evidence. This study was needed to consolidate these findings and examine factors influencing SLPs' perceived competence in stuttering management. What this paper adds to the existing knowledge This review provides a synthesis of SLPs' perceptions of their competency in managing stuttering and identifies key factors influencing competency. It details perceived competence of stuttering treatment across the lifespan, in assessment and treatment. Additionally, it explores factors such as experience with stuttering, level of support, the practice context, familiarity with people who stutter, the perceived complexity of stuttering and previous treatment outcomes. These findings have implications for stuttering treatment and guiding professional development. What are the potential or actual clinical implications of this work? The findings of this review emphasise the importance of ongoing education and support for SLPs to enhance their clinical competence in stuttering management. Specifically, targeted professional development, supportive work environments and familiarity with people who stutter can positively impact SLPs' confidence and proficiency. The results reinforced the need for SLPs whose caseloads include stuttering to prioritise ongoing education in stuttering, seek support to implement treatment where needed and pursue opportunities to gain experience with people who stutter. These insights can inform the development of guidelines and training programmes to improve SLPs' competence and ultimately benefit people who stutter.

A pilot study of stuttering treatment for older children (STOC)

PURPOSE

This pilot study explored an operant treatment for school-age children, Stuttering Treatment for Older Children (STOC), in increasing quality of life and the fluency of school-aged children who stutter.

METHOD

The participants were seven children 9-13 years old. A single-case experimental design using multiple baselines was utilized, with participants randomly assigned to baselines of different lengths. STOC is a home-based treatment program that combined time-out with a specific performance-based criteria. Recordings of children's speech were collected routinely as monthly samples (n = 653) and during treatment sessions (n = 1551). Clinicians immediately reviewed and provided feedback on recordings of sessions. Fidelity was measured in terms of dosage, adherence, quality of the delivery, and responsiveness.

RESULTS

For all participants, the STOC intervention showed promising results. Participant-reported quality of life significantly increased for those participants who completed the STOC program. The frequency of stuttering (percentage of syllables stuttered) decreased by an average of 72 % between the initial baseline measurement and later stages. Additionally, the quantity of speech increased by 18 %, speech sounded more natural, with naturalness scores increased by 50 %, and the severity of stuttering decreased by 56 %. Only four participants finished the intervention. This suggests that the benefits of the intervention include both overall greater well-being and less disfluencies.

CONCLUSIONS

This pilot study showed increased speech fluency and quality of life among participants who completed the intervention. However, further investigation is crucial, and we encourage the academic community to engage in this research area.

Self-perception of stuttering: association with self-perception of hearing, fluency profile, and contextual aspects

PURPOSE

This study investigated the association between self-perception of stuttering and self-perception of hearing, speech fluency profile, and contextual aspects in Brazilian adults who stutter.

METHODS

Fifty-five adults who stutter (ages 18 to 58 years), speakers of Brazilian Portuguese speakers, participated in an observational study that included: (a) a clinical history survey to collect identification, sociodemographic, clinical, and assistance data; (b) the Brazil Economic Classification Criteria (CCEB); (c) a hearing self-perception questionnaire (Speech, Spatial and Qualities of Hearing Scale - SSQ, version 5.6); (d) self-perception of the impact of stuttering (Brazilian Portuguese version of the Overall Assessment of the Speaker's Experience of Stuttering - Adults - OASES-A); and (e) an assessment of speech fluency (Fluency Profile Assessment Protocol -- PAPF). Data analysis consisted of descriptive and bivariate analysis using Pearson's chi-square, Mann-Whitney, Kruskal-Wallis, and Spearman correlation coefficient.

RESULTS

Most participants were classified as moderate to severe in the total classification of the impact of stuttering. There were moderate and weak negative correlations between the participants' self-perception of stuttering and self-perception of hearing.

CONCLUSION

Self-perception of auditory abilities was greater to the extent that self-perception of the impacts of stuttering on quality of life was lower.

Speech characteristics that differentiate stuttering and cluttering in Japanese speakers

Background

Cluttering is a speech disorder distinct from stuttering. Despite this distinction, there is no established method to clearly differentiate the two disorders. This study aimed to use objective criteria to differentiate cluttering from stuttering in Japanese speakers.

Methods

Participants were 32 consecutive native-Japanese speakers who visited the Keio University Hospital between July 2020 and January 2023 with a chief complaint of speech disfluency. One physician and two speech-language-hearing therapists concurred on a stuttering or cluttering diagnosis of the 32 patients based on recordings of the Kitsuon kensa-ho test. The frequencies of stuttering-like disfluencies (SDF) and normal disfluencies (NDF) were calculated from the Kitsuon kensa-ho, and the ratio of disfluencies (RDF) was calculated as the ratio of SDF to NDF. Differences between the cluttering and stuttering groups in the RDF and the mean articulatory rate (MAR) for oral reading and a monologue task were tested using the Mann-Whitney U test. ROC curves were used to determine the sensitivity and specificity that well-distinguished subjects with cluttering from those with stuttering; the experts' diagnosis was the gold standard.

Results

Of the 32 participants, 12 (38%) were diagnosed with cluttering and 20 (62%) with stuttering. The cluttering and stuttering groups were comparable in demographic characteristics. The RDF on monologue task had the highest sensitivity in diagnosing cluttering, and the MAR on monologue task had the highest specificity. Adopting provisional criteria of a monologue RDF greater than 1.2 and a monologue MAR greater than 7.5 produced a sensitivity of 0.92 and a specificity of 0.95.

Conclusion

We conclude that combining monologue RDF and monologue MAR well-distinguished cluttering from stuttering. This method provides new objective diagnostic criteria, which can aid clinicians, therapists, and basic researchers.

Predicting attitudes related to stuttering from an international database

PURPOSE

A vast number of studies over the past 50 years have explored public and professional attitudes toward stuttering, and many of them have identified variables that predict more-or less-positive attitudes. Part I of this study summarized 91 studies in terms of consistency of prediction of stuttering attitudes. Part II sought to compare a considerable number of potential predictors and to quantify their prediction strengths.

METHOD

Thirty-seven predictors were analyzed in linear regression models using a retrospective analysis of a database consisting of 22,413 respondents from 44 countries who had filled out the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) in 26 different languages. Dependent variables were two POSHA-S subscores, Beliefs about stuttering and Self Reactions to people who stutter, as well as the mean of these two subscores, the Overall Stuttering Score.

RESULTS

All 37 predictors were statistically significant for most-but at least one-of the three scores. The strongest predictors related to regions of the world and related variables of countries and languages, with greater strength for Beliefs than for Self Reactions. Knowing persons who stutter, or knowing about stuttering, were moderate predictors of Self Reactions but weak predictors of Beliefs. Different populations, such as the public, students, or speech-language pathologists, moderately predicted attitudes on all three dependent variables while education level and self-ratings of ability to speak were weak predictors. Sex (gender), age, income, parental or marital status, and most of 12 life priorities (e.g., get things done; be safe and secure) had very weak and practically insignificant predictive potential.

CONCLUSIONS

The study confirmed previous research showing ambiguous results for such predictors as sex and age but consistent differences from various geographic regions. Beliefs and Self Reactions measure different constructs that are often predicted differently by variables.

Lived experiences of children who stutter in their own voices

INTRODUCTION

Significant research has explored the lived experiences of adults who stutter, but less research exists regarding the lived experiences of children who stutter. The opinions and ideas of children who stutter may differ from those of adults, making it important for clinicians and researchers to obtain information directly from children who stutter. Asking children directly can lead to treatment outcomes and research questions that better align with the children's needs and values.

METHOD

Interviews with 18 children who stutter (9 girls/9 boys) ages 8-17 were sourced from the Voices of Children Who Stutter database located at Talkbank.org. Interview questions asked the children about living with a stutter, participating in stuttering support organizations (SSOs), and their perspectives on treatment. Qualitative, phenomenological analysis was performed on their answers following standardized qualitative procedures.

RESULTS

Analysis of 910 total utterances yielded 7 themes and 9 subthemes. Themes indicated that the children: (a) had significant knowledge regarding their own stuttering, (b) had opinions regarding what constituted worthwhile treatment outcomes, (c) were clear about desirable clinician characteristics for working with kids who stutter, and (d) saw the benefits of being part of a community.

CONCLUSIONS

Themes revealed that overall, children who stutter exhibit deep understanding regarding their experiences with stuttering, which clinicians can harness in person-centered goal setting. Additionally, the participants express the importance of participating in stuttering support organizations.

Cognitive processing biases of social anxiety in adults who do and do not stutter

PURPOSE

Adults who stutter are at risk of developing high levels of social anxiety, leading to negative outcomes and contributing towards stuttering relapse post treatment. To ensure that psychological treatments for social anxiety in stuttering adults are relevant and effective, a broader empirical understanding of the mechanisms of social anxiety in stuttering populations is required. Four key cognitive processing biases identified as maintenance factors in cognitive behavioral models of social anxiety were examined: self-focused attention, safety behavior use, negative self-imagery, and interpretation bias.

METHODS

Adults who stutter and non-stuttering adults (N = 186) were assessed via an online survey. Participants were categorised into two groups based on stuttering: formally diagnosed stuttering and non-stuttering. Within those groups, participants were further categorised as having low or high levels of social anxiety. Cognitive processing bias was assessed in response to two hypothetical social scenarios (i.e., social interaction and social performance).

RESULTS

As predicted, in both adults who stutter and who are non-stuttering, high social anxiety was related to greater self-focused attention, safety behavior use and negative self-imagery compared to low social anxiety. No significant effect of social anxiety or stuttering was found in relation to interpretation bias. A significant effect of social anxiety upon negative self-imagery was observed in formally-diagnosed adults who stutter compared to non-stuttering adults.

CONCLUSION

The results support the use of cognitive behavioral models of social anxiety as a framework for research and treatment development within stuttering populations.

Communication Public Health: An Integration of Audiology, Speech-Language Pathology, and Public Health

PURPOSE

Health care is advancing toward a collaborative and integrative approach that promotes general health and wellness while addressing health inequities through the consideration of broader social and economic factors that influence the well-being of the entire population. Recently, there has been growing evidence of public health concept applications in fields related to speech, language, and hearing. However, there is an outstanding need to explicitly define the intersection of public health, including prevention and health promotion, and the discipline of communication sciences and disorders (CSD) across the areas of education, clinical practice, research, and policy. The authors propose a definition for this intersection using the new term communication public health.

METHOD

This tutorial provides guidance on how to conceptualize communication public health and invites refinement and expansion of the intersection between public health and CSD. Because readers are experts in CSD, this tutorial aims to supplement existing knowledge with information on public health to achieve three main objectives: (a) increase knowledge of the application of public health concepts among speech, language, hearing, and related professionals (SLHP+); (b) introduce the concept of communication public health; and (c) discuss the relevance of communication public health across domains within CSD. The authors utilize the socioecological model to provide examples of applications.

RESULTS

The concept of communication public health is proposed as the collaborative area of CSD and public health, which encompasses prevention and promotion of equity in communication health through individual-, community-, and population-level efforts. The goals of communication public health are achieved through applications of public health principles in CSD education, clinical practice, research, and policy.

CONCLUSION

Communication public health defines an area of collaboration between public health and CSD in which SLHP+ can apply public health concepts to both advance communication health and address health disparities.

Caregiver and child perspectives of wellbeing in school-age children with childhood apraxia of speech

PURPOSE

Childhood apraxia of speech (CAS) is a communication deficit that impacts a child's overall quality of life, including their academic and social interactions, yet few studies have investigated the impact from the child's perspective. Using The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework, we examined the children's and caregivers' perspectives on the impact of CAS on their overall wellbeing.

METHOD

Survey data were collected from 32 child-caregiver dyads for children ages 9-17 years with CAS. Items elicited responses along a 5-point scale to examine the perceived impact of children's speech impairments using the framework, including impact on communication, interpersonal interactions/relationships, and major life events.

RESULT

Results from non-parametric statistical analyses revealed: (a) caregivers reported a significantly greater impact than children across individual ICF domains; (b) child responses were not significantly correlated with their caregiver's responses or with the child's age, gender, or severity indicators; and (c) both caregivers and children indicated the domain of communication was impacted more than other domains.

CONCLUSION

Results suggest a potential disconnect in the perceived impact of CAS between the caregiver and child. Recommendations include facilitating a dialogue between the child-caregiver dyad and considering treatment goals that address wellbeing.

Understanding the Broader Impact of Stuttering: Suicidal Ideation

PURPOSE

Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.

METHOD

One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.

RESULTS

Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.

CONCLUSIONS

Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23699688.

"I Just Want People to Think I'm Normal": An Interview Study of Young Swedish Women With Covert Stuttering

PURPOSE

Research indicates that there is a tendency for females who stutter, more often than males, to use coping strategies that involve covering their stutter, for example, by avoiding situations that require verbal participation. The aim of the study is to increase knowledge about how covert stuttering develops and its impact on self-image and quality of life for women who stutter.

METHOD

Eleven young women who stutter covertly were interviewed, and data were subjected to qualitative content analysis. Background information was obtained from the self-report instruments measuring the impact of stuttering on different aspects of life (Overall Assessment of the Speaker's Experiences of Stuttering) and degree of perceived social anxiety (Liebowitz Social Anxiety Scale, Self-Report).

RESULTS

Three main themes were identified: (a) managing stuttering, (b) personal aspects, and (c) stuttering as a phenomenon. Shame and a desire to fit in emerged as distinct motives for covering stuttering. The women described that stuttering controlled both life choices and everyday life. Development of self-image had been strongly negatively affected, resulting in social anxiety. The women expressed a particular vulnerability of being a woman who stutters, due to societal norms of female behavior and a lack of female role models who stutter.

CONCLUSIONS

The choice of coping strategy was motivated by a desire to "be normal." As a result, stuttering had come to dominate life and affect self-image and life choices. The study highlights the importance for clinicians to be alert to and aware of the fact that the experiences of women who stutter can lead them to develop coping strategies that have far-reaching negative consequences.

Eye movement as a simple, cost-effective tool for people who stutter: A case study

BACKGROUND

 Access to services remains the biggest barrier to helping the most vulnerable in the South African Stuttering Community. This novel stuttering therapy, harnessing an unconscious link between eye and tongue movement, may provide a new therapeutic approach, easily communicated and deliverable online.

OBJECTIVES

 This study provides both objective and subjective assessments of the feasibility of this intervention. Assessment tools holistically address all components of stuttering in line with comprehensive treatment approaches: core behaviours, secondary behaviours, anticipation and reactions.

METHOD

 On receipt of ethical approval, this single-subject case design recruited one adult (21-year-old) male with a developmental stutter (DS). The participant gave informed consent and completed four scheduled assessments: baseline, after 5-week training, 3 months post-intervention and 24 months post-completion. The study used objective assessment tools: Stuttering Severity Instrument-4 (SSI-4); Subjective-assessment tools: SSI-4 clinical use self-report tool (CUSR); Overall Assessment of Speaker's Experience of Stuttering (OASES-A); Premonitory Awareness in Stuttering (PAiS) and Self-Report Stuttering Severity* (SRSS) (*final assessment).

RESULTS

 The participant's scores improved across all assessment measures, which may reflect a holistic improvement. The participant reported that the tool was very useful. There were no negative consequences.

CONCLUSION

 This case report indicates that this innovative treatment may be feasible. No adverse effects were experienced, and the treatment only benefited the participant. The results justify the design of a pilot randomised feasibility clinical trial.Contribution: The results indicate that this is a needed breakthrough in stuttering therapy as the instructions can be easily translated into any language. It can also be delivered remotely reducing accessibility barriers.

Accepting Things as They Are: Dispositional Mindfulness, Decentering, Self-Compassion, and the Impact of Stuttering on Adults Who Stutter

PURPOSE

Mindfulness is defined as intentional, present-moment, nonjudgmental awareness. Previous studies have proposed that mindfulness practice may benefit people who stutter. This study aimed to test the relationship between levels of dispositional mindfulness in people who stutter and the impact of stuttering and whether self-compassion and the metacognitive ability of shifting to an objective perspective (decentering) mediate this relationship. It is hypothesized that greater dispositional mindfulness is associated with attenuated negative impact of stuttering on a person's life through a higher capability to shift into an objective and compassionate perspective.

METHOD

A total of 150 Israeli adults who stutter completed a full online survey in Hebrew to assess their levels of dispositional mindfulness, self-compassion, decentering capability, and impact of stuttering on their lives. The relationships between constructs were assessed using Pearson's correlation and mediation analysis.

RESULTS

The adverse impact of stuttering was negatively and moderately associated with dispositional mindfulness, such that individuals with greater self-reported dispositional mindfulness reported fewer reactions to stuttering, difficulty in communication, and higher quality of life. This relationship was fully and sequentially mediated via decentering and self-compassion, which were also negatively and moderately associated with the impact of stuttering.

CONCLUSIONS

People who stutter with greater dispositional mindfulness have an increased ability to view their experiences in a more objective and compassionate manner, which is associated with an attenuated impact of stuttering on their lives. As these capabilities can be cultivated through practice, this study proposes mindfulness practice as an additional beneficial tool for people who stutter.

Can Stoicism inspire stuttering intervention? The clinical usefulness of an ancient philosophy

BACKGROUND

A range of psychotherapies are effective in managing an individual's personal reactions to stuttering and reducing the impact stuttering has on their lives. Many of these therapies, such as cognitive behavioural therapy, have their origins in Stoicism, an ancient Greek philosophy founded in 301 bce. Stoicism remains a relatively unexplored topic in the psychotherapy and speech and language therapy literatures.

AIMS

This paper aims to highlight the potential benefits of integrating Stoic principles and techniques into stuttering intervention.

METHODS

This aim is achieved through a discussion on Stoic philosophy and the range of techniques that have informed modern evidence-based psychotherapies that are effective with the stuttering population.

MAIN CONTRIBUTION

This paper initiates an important conversation on the usefulness of Stoicism to the field of stuttering. Key recommendations are provided for the integration of Stoic philosophy into future clinical and research practice related to stuttering.

CONCLUSIONS

Stoicism offers philosophical guidance for the art of living, but also provides a range of strategies and practical techniques that have potential to expand the clinical toolkit of modern psychotherapy and speech and language therapy. Scientific validation of the clinical application of Stoicism is recommended to exploit its effectiveness with the stuttering population.

WHAT THIS PAPER ADDS

What is already known on the subject Stoicism is an ancient philosophy that has informed modern-day psychotherapies including cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). Such therapies are recommended for use with individuals who stutter to target their personal reactions to stuttering and reduce any adverse impacts on their lives. What this paper adds to existing knowledge This paper discusses the principles and techniques of Stoicism with reference to how they align with modern psychotherapeutic approaches and speech and language therapy interventions used with individuals who stutter. Clinical implications and directions for future research are also presented. What are the potential or actual clinical implications of this work? Speech and language therapists (SLTs) are recommended to continue their use of psychotherapies such as CBT and ACT with individuals who stutter. In addition, SLTs are advised to explore Stoicism and its range of techniques to better understand the philosophical underpinnings of evidence-based psychotherapies and to expand their clinical toolkit.

A Cross-Sectional Investigation of the Impact of Stuttering on Swedish Females and Males in Childhood, Adolescence, and Young Adulthood

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.

The importance of understanding the broader experience of stuttering

This commentary is on the original article by Boyce et al. on pages 1297–1306 of this issue.

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

PURPOSE

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

METHOD

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

RESULTS

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

DISCUSSION

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

SUPPLEMENTAL MATERIAL

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