Emotional reactivity, regulation and childhood stuttering: a behavioral and electrophysiological study

Expressive Language Intratest Scatter of Preschool-Age Children Who Stutter

PURPOSE

The purpose of this study was to assess intratest scatter (variability) on standardized tests of expressive language by preschool-age children who do (CWS) and do not stutter (CWNS).

METHOD

Participants were 40 preschool-age CWS and 46 CWNS. Between-group comparisons of intratest scatter were made based on participant responses to the Expressive subtest of the Test of Early Language Development - 3 (TELD-Exp; Hresko, Reid, & Hamill, 1999) and the Expressive Vocabulary Test 2 (EVT-2; Williams, 2007). Within-group correlational analyses between intratest scatter and stuttering frequency and severity were also conducted for CWS.

RESULTS

Findings indicated that, for CWS, categorical scatter on the EVT-2 was positively correlated with their stuttering frequency. No significant between-group differences in intratest scatter were found on the TELD-Exp or the EVT-2.

CONCLUSIONS

Consistent with earlier findings, variability in speech-language performance appears to be related to CWS' stuttering, a finding taken to suggest an underlying cognitive-linguistic variable (e.g., cognitive load) may be common to both variables.

Speech sound articulation abilities of preschool-age children who stutter

PURPOSE

The purpose of this study was to assess the association between speech sound articulation and childhood stuttering in a relatively large sample of preschool-age children who do and do not stutter, using the Goldman-Fristoe Test of Articulation-2 (GFTA-2; Goldman & Fristoe, 2000).

METHOD

Participants included 277 preschool-age children who do (CWS; n=128, 101 males) and do not stutter (CWNS; n=149, 76 males). Generalized estimating equations (GEE) were performed to assess between-group (CWS versus CWNS) differences on the GFTA-2. Additionally, within-group correlations were performed to explore the relation between CWS' speech sound articulation abilities and their stuttering frequency and severity, as well as their sound prolongation index (SPI; Schwartz & Conture, 1988).

RESULTS

No significant differences were found between the articulation scores of preschool-age CWS and CWNS. However, there was a small gender effect for the 5-year-old age group, with girls generally exhibiting better articulation scores than boys. Additional findings indicated no relation between CWS' speech sound articulation abilities and their stuttering frequency, severity, or SPI.

CONCLUSIONS

Findings suggest no apparent association between speech sound articulation-as measured by one standardized assessment (GFTA-2)-and childhood stuttering for this sample of preschool-age children (N=277).

EDUCATIONAL OBJECTIVES

After reading this article, the reader will be able to: (1) discuss salient issues in the articulation literature relative to children who stutter; (2) compare/contrast the present study's methodologies and main findings to those of previous studies that investigated the association between childhood stuttering and speech sound articulation; (3) identify future research needs relative to the association between childhood stuttering and speech sound development; (4) replicate the present study's methodology to expand this body of knowledge.

Emotional reactivity and regulation in preschool-age children who stutter

PURPOSE

This study experimentally investigated behavioral correlates of emotional reactivity and emotion regulation and their relation to speech (dis)fluency in preschool-age children who do (CWS) and do not (CWNS) stutter during emotion-eliciting conditions.

METHOD

Participants (18 CWS, 14 boys; 18 CWNS, 14 boys) completed two experimental tasks (1) a neutral ("apples and leaves in a transparent box," ALTB) and (2) a frustrating ("attractive toy in a transparent box," ATTB) task, both of which were followed by a narrative task. Dependent measures were emotional reactivity (positive affect, negative affect), emotion regulation (self-speech, distraction) exhibited during the ALTB and the ATTB tasks, percentage of stuttered disfluencies (SDs) and percentage of non-stuttered disfluencies (NSDs) produced during the narratives.

RESULTS

Results indicated that preschool-age CWS exhibited significantly more negative emotion and more self-speech than preschool-age CWNS. For CWS only, emotion regulation behaviors (i.e., distraction, self-speech) during the experimental tasks were predictive of stuttered disfluencies during the subsequent narrative tasks. Furthermore, for CWS there was no relation between emotional processes and non-stuttered disfluencies, but CWNS's negative affect was significantly related to nonstuttered disfluencies.

CONCLUSIONS

In general, present findings support the notion that emotional processes are associated with childhood stuttering. Specifically, findings are consistent with the notion that preschool-age CWS are more emotionally reactive than CWNS and that their self-speech regulatory attempts may be less than effective in modulating their emotions.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) communicate the relevance of studying the role of emotion in developmental stuttering close to the onset of stuttering and (b) describe the main findings of the present study in relation to previous studies that have used different methodologies to investigate the role of emotion in developmental stuttering of young children who stutter.

Socioeconomic status, parental education, vocabulary and language skills of children who stutter

PURPOSE

The purpose of this project was to investigate the possible relation between standardized measures of vocabulary/language, mother and father education, and a composite measure of socioeconomic status (SES) for children who do not stutter (CWNS) and children who stutter (CWS).

METHODS

Participants were 138 CWNS and 159 CWS between the ages of 2;6 and 6;3 and their families. The Hollingshead Four Factor Index of Social Position (i.e., Family SES) was used to calculate SES based on a composite score consisting of weighted values for paternal and maternal education and occupation. Statistical regression analyses were conducted to investigate the relation between parental education and language and vocabulary scores for both the CWNS and CWS. Correlations were calculated between parent education, Family SES, and stuttering severity (e.g., SSI-3 score, % words stuttered).

RESULTS

Results indicated that maternal education contributed the greatest amount of variance in vocabulary and language scores for the CWNS and for participants from both groups whose Family SES was in the lowest quartile of the distribution. However, paternal education generally contributed the greatest amount of variance in vocabulary and language scores for the CWS. Higher levels of maternal education were associated with more severe stuttering in the CWS.

CONCLUSION

Results are generally consistent with existing literature on normal language development that indicates maternal education is a robust predictor of the vocabulary and language skills of preschool children. Thus, both father and mothers' education may impact the association between vocabulary/language skills and childhood stuttering, leading investigators who empirically study this association to possibly re-assess their participant selection (e.g., a priori control of parental education) and/or data analyses (e.g., post hoc covariation of parental education).

LEARNING OUTCOMES

The reader will be able to: (a) describe the influence of socioeconomic status on the development of vocabulary and language for children who do and do not stutter; (b) discuss the contribution of maternal education on vocabulary and language development; (c) describe possible reasons why paternal education contributes in unique ways to the vocabulary and language development of children who stutter as well as stuttering severity; and (d) explain possible reasons why socioeconomic status is an important variable for describing language related findings in young children.

Behavioral inhibition and childhood stuttering

PURPOSE

The purpose of this study was to assess the relation of behavioral inhibition to stuttering and speech/language output in preschool-age children who do (CWS) and do not stutter (CWNS).

METHOD

Participants were preschool-age (ages 36-68 months), including 26 CWS (22 males) and 28 CWNS (13 males). Participants' behavioral inhibition (BI) was assessed by measuring the latency to their sixth spontaneous comment during conversation with an unfamiliar experimenter, using methodology developed by Kagan, Reznick, and Gibbons (1989). In addition to these measures of BI, each participant's stuttered and non-stuttered disfluencies and mean length of utterance (in morphemes) were assessed.

RESULTS

Among the more salient findings, it was found that (1) there was no significant difference in BI between preschool-age CWS and CWNS as a group, (2) when extremely high versus low inhibited children were selected, there were more CWS with higher BI and fewer CWS with lower BI when compared to their CWNS peers, and (3) more behaviorally inhibited CWS, when compared to less behaviorally inhibited CWS, exhibited more stuttering.

CONCLUSIONS

Findings are taken to suggest that one aspect of temperament (i.e., behavioral inhibition) is exhibited by some preschool-age CWS and that these children stutter more than CWS with lower behavioral inhibition. The present results seem to support continued study of the association between young children's temperamental characteristics and stuttering, the diagnostic entity (i.e., CWS versus CWNS), as well as stuttering, the behavior (e.g., frequency of stuttered disfluencies).

EDUCATIONAL OBJECTIVES

After reading this article, the reader will be able to: (a) summarize the salient empirical findings in the extant literature with regard to the association between temperament and childhood stuttering; (b) describe the concept of behavioral inhibition (BI) as well as the methods to measure BI; and (c) discuss the association between behavioral inhibition and childhood stuttering in preschool-age children.

Inhibitory control in childhood stuttering

PURPOSE

The purpose of this study was to investigate whether previously reported parental questionnaire-based differences in inhibitory control (IC; Eggers, De Nil, & Van den Bergh, 2010) would be supported by direct measurement of IC using a computer task.

METHOD

Participants were 30 children who stutter (CWS; mean age=7;05 years) and 30 children who not stutter (CWNS; mean age=7;05 years). Participants were matched on age and gender (±3 months). IC was assessed by the Go/NoGo task of the Amsterdam Neuropsychological Tasks (De Sonneville, 2009).

RESULTS

Results indicated that CWS, compared to CWNS, (a) exhibited more false alarms and premature responses, (b) showed lower reaction times for false alarms, and (c) were less able to adapt their response style after experiencing response errors.

CONCLUSIONS

Our findings provide further support for the hypothesis that CWS and CWNS differ on IC. CWS, as a group, were lower in IC pointing toward a lowered ability to inhibit prepotent response tendencies. The findings were linked to previous IC-related studies and to emerging theoretical frameworks of stuttering development.

EDUCATIONAL OBJECTIVES

The reader will be able to: (1) describe the concept of inhibitory control, and its functional significance; (2) describe the findings on self-regulatory processes, attentional processes, and inhibitory control in CWS; (3) identify which Go/NoGo task variables differentiated between CWS and CWNS; and (4) summarize the theoretical implications for the development of stuttering and the possible clinical implications.

Temperament, speech and language: an overview

The purpose of this article is to discuss definitional and measurement issues as well as empirical evidence regarding temperament, especially with regard to children's (a)typical speech and language development. Although all ages are considered, there is a predominant focus on children. Evidence from considerable empirical research lends support to the association between temperament, childhood development and social competence. With regard to communication disorders, extant literature suggests that at least certain elements of temperament (e.g., attention regulation, inhibitory control) are associated with the presence of certain communication disorders. However, the precise nature of this association remains unclear. Three possible accounts of the association between temperament and speech-language disorder are presented. One, the disability model (i.e., certain disorders impact psychological processes leading to changes in these processes, personality, etc., Roy & Bless, 2000a) suggests speech-language disorders may lead to or cause changes in psychological or temperamental characteristics. The disability account cannot be categorically refuted based on currently available research findings. The (pre)dispositional or vulnerability model (i.e., certain psychological processes directly cause the disorder or indirectly modify the course or expression of the disorder, Roy & Bless, 2000a) suggests that psychological or temperamental characteristics may lead to or cause changes in speech-language disorders. The vulnerability account has received some empirical support with regard to stuttering and voice disorders but has not received widespread empirical testing for most speech-language disorders. A third, interaction account, suggests that "disability" and "vulnerability" may both impact communication disorders in a complex, dynamically changing manner, a possibility that must await further empirical study. Suggestions for future research directions are provided.

LEARNING OUTCOMES

After reading this article, the reader will be able to (1) define the concept of temperament as well as theories of and means to measure/study temperament, (2) describe the possible association of temperament to children's speech-language, in general, and children's speech-language disorders, in specific, and (3) be able to describe the disability, dispositional and interaction accounts of the association of temperament to speech-language disorders.

Early stuttering, temperament and anxiety: two hypotheses

PURPOSE

The topic of temperament and early stuttering and the extent to which it involves anxiety is theoretically and clinically relevant. The topic can contribute to theory development and clinical practices with early stuttering.

METHOD

We present a review of the empirical literature for this area with a view to determining which of two hypotheses might be true. The first is that, for the population of those who stutter, unusual temperament is a causal factor for the development of the disorder and its later association with anxiety. The second hypothesis is that for the population of those who stutter the developmental manifestation of anxiety is an effect of stuttering. Both hypotheses attempt to account for the well-known association of anxiety with chronic stuttering.

RESULTS

A firm conclusion about the matter would be premature at present because the literature involved is limited and contains some inconsistencies. We suggest some quantitative and qualitative directions for future research. We argue also that the only way to resolve the matter is with longitudinal studies of cohorts ascertained prior to stuttering onset.

CONCLUSION

Conclusive findings about the matter can only emerge when research extends beyond its modest scope of 10 interpretable publications.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) describe temperament and the role it plays during anxiety development, (b) explain two alternative hypotheses which implicate temperament in early childhood stuttering; (c) describe current knowledge regarding temperament similarities and differences between stuttering and control children, and (d) discuss the theoretical and clinical implications of understand the relationship between temperament, anxiety and early stuttering.

Communicative and psychological dimensions of the KiddyCAT

PURPOSE

The purpose of the present study was to investigate the underlying constructs of the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT; Vanryckeghem & Brutten, 2007), especially those related to awareness of stuttering and negative speech-associated attitudes.

METHOD

Participants were 114 preschool-age children who stutter (CWS; n=52; 15 females) and children who do not stutter (CWNS; n=62; 31 females). Their scores on the KiddyCAT were assessed to determine whether they differed with respect to talker group (CWS vs. CWNS), chronological age, younger versus older age groups, and gender. A categorical data principal components factor analysis (CATPCA) assessed the quantity and quality of the KiddyCAT dimensions.

RESULTS

Findings indicated that preschool-age CWS scored significantly higher than CWNS on the KiddyCAT, regardless of age or gender. Additionally, the extraction of a single factor from the CATPCA indicated that one dimension-speech difficulty-appears to underlie the KiddyCAT items.

CONCLUSIONS

As reported by its test developers, the KiddyCAT differentiates between CWS and CWNS. Furthermore, one factor, which appears related to participants' attitudes towards speech difficulty, underlies the questionnaire. Findings were taken to suggest that children's responses to the KiddyCAT are related to their perception that speech is difficult, which, for CWS, may be associated with relatively frequent experiences with their speaking difficulties (i.e., stuttering).

LEARNING OUTCOMES

After reading this article, the reader will be able to: (1) Better understand the concepts of attitude and awareness; (2) compare historical views with more recent empirical findings regarding preschool-age CWS' attitudes/awareness towards their stuttering; (3) describe the underlying dimension of the KiddyCAT questionnaire; (4) interpret KiddyCAT results and describe implications of those results.

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

This study assessed emotional and speech-language contributions to childhood stuttering. A dual diathesis-stressor framework guided this study, in which both linguistic requirements and skills, and emotion and its regulation, are hypothesized to contribute to stuttering. The language diathesis consists of expressive and receptive language skills. The emotion diathesis consists of proclivities to emotional reactivity and regulation of emotion, and the emotion stressor consists of experimentally manipulated emotional inductions prior to narrative speaking tasks. Preschool-age children who do and do not stutter were exposed to three emotion-producing overheard conversations-neutral, positive, and angry. Emotion and emotion-regulatory behaviors were coded while participants listened to each conversation and while telling a story after each overheard conversation. Instances of stuttering during each story were counted. Although there was no main effect of conversation type, results indicated that stuttering in preschool-age children is influenced by emotion and language diatheses, as well as coping strategies and situational emotional stressors. Findings support the dual diathesis-stressor model of stuttering.

Utterance complexity and stuttering on function words in preschool-age children who stutter

The purpose of the present investigation was to examine the relation between utterance complexity and utterance position and the tendency to stutter on function words in preschool-age children who stutter (CWS). Two separate studies involving two different groups of participants (Study 1, n=30; Study 2, n=30) were conducted. Participants were preschool-age CWS between the age of 3, 0 and 5, 11 who engaged in 15-20min parent-child conversational interactions. From audio-video recordings of each interaction, every child utterance of each parent-child sample was transcribed. From these transcripts, for each participant, measures of language (e.g., length and complexity) and measures of stuttering (e.g., word type and utterance position) were obtained. Results of Study 1 indicated that children stuttered more frequently on function words, but that this tendency was not greater for complex than simple utterances. Results of Study 2, involving the assessment of utterance position and MLU quartile, indicated that that stuttering was more likely to occur with increasing sentence length, and that stuttering tended to occur at the utterance-initial position, the position where function words were also more likely to occur. Findings were taken to suggest that, although word-level influences cannot be discounted, utterance-level influences contribute to the loci of stuttering in preschool-age children, and may help account for developmental changes in the loci of stuttering.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to: (a) describe the influence of word type (function versus content words), and grammatical complexity, on disfluent speech; (b) compare the effect of stuttering frequency based on the position of the word in the utterance; (c) discuss the contribution of utterance position on the frequency of stuttering on function words; and (d) explain possible reasons why preschoolers stutter more frequently on function words than content words.

Childhood stuttering and dissociations across linguistic domains: a replication and extension

The purpose of this investigation was to replicate the methods of Anderson, Pellowski, and Conture (2005) to determine whether a different sample of preschool children who stutter (CWS) exhibit more dissociations in speech-language abilities than children who do not stutter (CWNS; Study 1) and to examine the relation between dissociations and specific characteristics of stuttering (e.g., most common disfluency type) using a much larger sample size (Study 2). Participants for Study 1 were 40 CWS and 40 CWNS between the ages of 3;0 and 5;11. Participants for Study 2 were the same as for Study 1 plus the 45 CWS and 45 CWNS used by Anderson et al. (2005) for a total of 85 CWS and 85 CWNS. Participants were administered five standardized speech-language (sub)tests and a conversational speech sample was obtained from each participant for the analyses of speech disfluencies/stuttering. Standard scores from the standardized speech-language tests were analyzed using a correlation-based statistical procedure (Bates, Applebaum, Sacedo, Saygin, & Pizzamiglio, 2003) to identify possible dissociations among the speech-language measures. Findings from Study 1 supported Anderson et al.'s findings that CWS exhibited significantly more speech-language dissociations than CWNS. Results from Study 2 further revealed that CWS who exhibited dissociations were more likely to exhibit non-stuttered (other) disfluencies as their most common disfluency type. Findings provide further support for the possibility that dissociations among various aspects of the speech-language system may contribute to the difficulties that some children have establishing normally fluent speech.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) summarize findings from previous studies examining the speech and language performance of children who do and do not stutter; (b) describe the concept of "dissociations" in the speech and language skills of young children; (c) compare the results of the present study with previous work in this area; and (d) discuss speculations concerning the manner in which dissociations might affect fluency development in children who stutter.