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Leech KA, Bernstein Ratner N, Brown B, Weber CM. Preliminary Evidence That Growth in Productive Language Differentiates Childhood Stuttering Persistence and Recovery. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:3097-3109. [PMID: 29049493 PMCID: PMC5945073 DOI: 10.1044/2017_jslhr-s-16-0371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/06/2017] [Accepted: 05/27/2017] [Indexed: 05/13/2023]
Abstract
Purpose Childhood stuttering is common but is often outgrown. Children whose stuttering persists experience significant life impacts, calling for a better understanding of what factors may underlie eventual recovery. In previous research, language ability has been shown to differentiate children who stutter (CWS) from children who do not stutter, yet there is an active debate in the field regarding what, if any, language measures may mark eventual recovery versus persistence. In this study, we examined whether growth in productive language performance may better predict the probability of recovery compared to static profiles taken from a single time point. Method Productive syntax and vocabulary diversity growth rates were calculated for 50 CWS using random coefficient models. Logistic regression models were then used to determine whether growth rates uniquely predict likelihood of recovery, as well as if these rates were predictive over and above currently identified correlates of stuttering onset and recovery. Results Different linguistic profiles emerged between children who went on to recover versus those who persisted. Children who had steeper productive syntactic growth, but not vocabulary diversity growth, were more likely to recover by study end. Moreover, this effect held after controlling for initial language ability at study onset as well as demographic covariates. Conclusions Results are discussed in terms of how growth estimates can be incorporated in recommendations for fostering productive language skills among CWS. The need for additional research on language in early stuttering and recovery is suggested.
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Affiliation(s)
- Kathryn A. Leech
- University of Maryland, College Park
- Harvard Graduate School of Education, Cambridge, MA
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Kreidler K, Hampton Wray A, Usler E, Weber C. Neural Indices of Semantic Processing in Early Childhood Distinguish Eventual Stuttering Persistence and Recovery. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:3118-3134. [PMID: 29098269 PMCID: PMC5945075 DOI: 10.1044/2017_jslhr-s-17-0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/17/2017] [Accepted: 06/13/2017] [Indexed: 05/13/2023]
Abstract
Purpose Maturation of neural processes for language may lag in some children who stutter (CWS), and event-related potentials (ERPs) distinguish CWS who have recovered from those who have persisted. The current study explores whether ERPs indexing semantic processing may distinguish children who will eventually persist in stuttering (CWS-ePersisted) from those who will recover from stuttering (CWS-eRecovered). Method Fifty-six 5-year-old children with normal receptive language listened to naturally spoken sentences in a story context. ERP components elicited for semantic processing (N400, late positive component [LPC]) were compared for CWS-ePersisted, CWS-eRecovered, and children who do not stutter (CWNS). Results The N400 elicited by semantic violations had a more focal scalp distribution (left lateralized and less anterior) in the CWS-eRecovered compared with CWS-ePersisted. Although the LPC elicited in CWS-eRecovered and CWNS did not differ, the LPC elicited in the CWS-ePersisted was smaller in amplitude compared with that in CWNS. Conclusions ERPs elicited in 5-year-old CWS-eRecovered compared with CWS-ePersisted suggest that future recovery from stuttering may be associated with earlier maturation of semantic processes in the preschool years. Subtle differences in ERP indices offer a window into neural maturation processes for language and may help distinguish the course of stuttering development.
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Affiliation(s)
- Kathryn Kreidler
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Amanda Hampton Wray
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Evan Usler
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Christine Weber
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
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Kefalianos E, Onslow M, Packman A, Vogel A, Pezic A, Mensah F, Conway L, Bavin E, Block S, Reilly S. The History of Stuttering by 7 Years of Age: Follow-Up of a Prospective Community Cohort. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2828-2839. [PMID: 28979988 DOI: 10.1044/2017_jslhr-s-16-0205] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE For a community cohort of children confirmed to have stuttered by the age of 4 years, we report (a) the recovery rate from stuttering, (b) predictors of recovery, and (c) comorbidities at the age of 7 years. METHOD This study was nested in the Early Language in Victoria Study. Predictors of stuttering recovery included child, family, and environmental measures and first-degree relative history of stuttering. Comorbidities examined at 7 years included temperament, language, nonverbal cognition, and health-related quality of life. RESULTS The recovery rate by the age of 7 years was 65%. Girls with stronger communication skills at the age of 2 years had higher odds of recovery (adjusted OR = 7.1, 95% CI [1.3, 37.9], p = .02), but similar effects were not evident for boys (adjusted OR = 0.5, 95% CI [0.3, 1.1], p = .10). At the age of 7 years, children who had recovered from stuttering were more likely to have stronger language skills than children whose stuttering persisted (p = .05). No evident differences were identified on other outcomes including nonverbal cognition, temperament, and parent-reported quality of life. CONCLUSION Overall, findings suggested that there may be associations between language ability and recovery from stuttering. Subsequent research is needed to explore the directionality of this relationship.
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Affiliation(s)
- Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Sydney, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Sydney, Australia
| | - Adam Vogel
- Department of Audiology and Speech Pathology, University of Melbourne, Victoria, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Angela Pezic
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Fiona Mensah
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Laura Conway
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Australia
| | - Edith Bavin
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Susan Block
- School of Human Communication Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Sheena Reilly
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
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Arenas RM, Walker EA, Oleson JJ. Developmental Stuttering in Children Who Are Hard of Hearing. Lang Speech Hear Serv Sch 2017; 48:234-248. [PMID: 28915514 PMCID: PMC5944374 DOI: 10.1044/2017_lshss-17-0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/24/2017] [Accepted: 06/23/2017] [Indexed: 02/03/2023] Open
Abstract
Purpose A number of studies with large sample sizes have reported lower prevalence of stuttering in children with significant hearing loss compared to children without hearing loss. This study used a parent questionnaire to investigate the characteristics of stuttering (e.g., incidence, prevalence, and age of onset) in children who are hard of hearing (CHH). Method Three hundred three parents of CHH who participated in the Outcomes of Children With Hearing Loss study (Moeller & Tomblin, 2015) were sent questionnaires asking about their child's history of stuttering. Results One hundred ninety-four parents of CHH responded to the survey. Thirty-three CHH were reported to have stuttered at one point in time (an incidence of 17.01%), and 10 children were still stuttering at the time of survey submission (a prevalence of 5.15%). Compared to estimates in the general population, this sample displayed a significantly higher incidence and prevalence. The age of onset, recovery rate, and other characteristics were similar to hearing children. Conclusions Based on this sample, mild to moderately severe hearing loss does not appear to be a protective factor for stuttering in the preschool years. In fact, the incidence and prevalence of stuttering may be higher in this population compared to the general population. Despite the significant speech and language needs that children with mild to moderately severe hearing loss may have, speech-language pathologists should appropriately prioritize stuttering treatment as they would in the hearing population. Supplemental Material https://doi.org/10.23641/asha.5397154.
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Affiliation(s)
- Richard M Arenas
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque
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Smith A, Weber C. How Stuttering Develops: The Multifactorial Dynamic Pathways Theory. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2483-2505. [PMID: 28837728 PMCID: PMC5831617 DOI: 10.1044/2017_jslhr-s-16-0343] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 02/21/2017] [Accepted: 04/19/2017] [Indexed: 05/12/2023]
Abstract
Purpose We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic, and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory. Method We review evidence related to how stuttering develops, including genetic/epigenetic factors; motor, linguistic, and emotional features; and advances in neuroimaging studies. We update evidence for our earlier claim: Although stuttering ultimately reflects impairment in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic and emotional factors. Results Our current account places primary emphasis on the dynamic developmental context in which stuttering emerges and follows its course during the preschool years. Rapid changes in many neurobehavioral systems are ongoing, and critical interactions among these systems likely play a major role in determining persistence of or recovery from stuttering. Conclusion Stuttering, or childhood onset fluency disorder (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; American Psychiatric Association [APA], 2013), is a neurodevelopmental disorder that begins when neural networks supporting speech, language, and emotional functions are rapidly developing. The multifactorial dynamic pathways theory motivates experimental and clinical work to determine the specific factors that contribute to each child's pathway to the diagnosis of stuttering and those most likely to promote recovery.
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Affiliation(s)
- Anne Smith
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Christine Weber
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
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Abstract
Remarkable progress has been made over the past two decades in expanding our understanding of the behavioral, peripheral physiologic, and central neurophysiologic bases of stuttering in early childhood. It is clear that stuttering is a neurodevelopmental disorder characterized by atypical development of speech motor planning and execution networks. The speech motor system must interact in complex ways with neural systems mediating language and other cognitive and emotional processes. During the time when stuttering typically appears and follows its path to either recovery or persistence, all of these neurobehavioral systems are undergoing rapid and dramatic developmental changes. We summarize our current understanding of the various developmental trajectories relevant for the understanding of stuttering in early childhood. We also present theoretical and experimental approaches that we believe will be optimal for even more rapid progress toward developing better and more targeted treatment for stuttering in the preschool children who are more likely to persist in stuttering.
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Affiliation(s)
- Anne Smith
- Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Christine Weber
- Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
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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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Pelczarski KM, Yaruss JS. Phonological memory in young children who stutter. JOURNAL OF COMMUNICATION DISORDERS 2016; 62:54-66. [PMID: 27280891 DOI: 10.1016/j.jcomdis.2016.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 05/04/2016] [Accepted: 05/15/2016] [Indexed: 06/06/2023]
Abstract
This study investigated phonological memory in 5- and 6-year old children who stutter. Participants were 11 children who stutter matched on general language abilities, maternal education level, and sex to 11 typically fluent children. Participants completed norm-referenced nonword repetition and digit span tasks, as well as measures of expressive and receptive vocabulary and articulation. The nonword repetition task included stimuli that ranged from 1 to 7 syllables, while the digit naming task contained number strings containing 2-10 digits. Standardized tests of vocabulary and articulation abilities were tested as well. Groups were comparable on measures expressive vocabulary, receptive vocabulary, and articulation. Despite the fact that the majority of participants scored within typical limits, young children who stutter still performed significantly less well than children who do not stutter on the nonword repetition task. No between-group differences were revealed in the digit naming task. Typically fluent children demonstrated strong correlations between phonological memory tasks and language measures, while children who stutter did not. These findings indicate that young children who stutter may have sub-clinical differences in nonword repetition.
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Affiliation(s)
- Kristin M Pelczarski
- Department of Communication Sciences and Disorders, Kansas State University, 237 Campus Creek Complex, Manhattan, KS 66503, USA.
| | - J Scott Yaruss
- Department of Communication Science and Disorders, University of Pittsburgh, 4033 Forbes Tower, Pittsburgh, PA 15260, USA
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Ambrose NG, Yairi E, Loucks TM, Seery CH, Throneburg R. Relation of motor, linguistic and temperament factors in epidemiologic subtypes of persistent and recovered stuttering: Initial findings. JOURNAL OF FLUENCY DISORDERS 2015; 45:12-26. [PMID: 26117417 PMCID: PMC4546885 DOI: 10.1016/j.jfludis.2015.05.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/30/2015] [Accepted: 05/12/2015] [Indexed: 05/08/2023]
Abstract
PURPOSE The purpose of this study was to determine the presence of any patterns reflecting underlying subtypes of persistence and recovery across epidemiologic, motor, language, and temperament domains in the same group of children beginning to stutter and followed for several years. METHODS Participants were 58 2-4-year-old CWS and 40 age and gender matched NFC from four different sites in the Midwest. At the end of the multi-year study, stuttering children were classified as Persistent or Recovered. The same protocol obtaining data to measure stuttering, motor, language and temperament characteristics was used at each site. They have not been included in previous reports. RESULTS The Persistent group performed consistently differently from the Recovered and Control groups. They performed lower on standardized language tests and in phonological accuracy, had greater kinematic variability, and were judged by their parents to be more negative in temperament. CONCLUSIONS The present study provides data supporting the hypothesis that subtypes of stuttering can be identified along persistency/recovery lines, but results were not definitive. EDUCATIONAL OBJECTIVES Readers will be able to (a) describe the current state of subtypes of stuttering research; (b) summarize possible contributions of epidemiologic, motoric, linguistic and temperament to such subtyping with regard to persistency and recovery.
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Affiliation(s)
| | - Ehud Yairi
- University of Illinois at Urbana-Champaign, United States
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Mohan R, Weber C. Neural systems mediating processing of sound units of language distinguish recovery versus persistence in stuttering. J Neurodev Disord 2015; 7:28. [PMID: 26284147 PMCID: PMC4538747 DOI: 10.1186/s11689-015-9124-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/06/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Developmental stuttering is a multi-factorial disorder. Measures of neural activity while children processed the phonological (language sound unit) properties of words have revealed neurodevelopmental differences between fluent children and those who stutter. However, there is limited evidence to show whether the neural bases of phonological processing can be used to identify stuttering recovery status. As an initial step, we aimed to determine if differences in neural activity during phonological processing could aid in distinguishing children who had recovered from stuttering and those whose stuttering persisted. METHODS We examined neural activity mediating phonological processing in forty-three 7-8 year old children. Groups included children who had recovered from stuttering (CWS-Rec), those whose stuttering persisted (CWS-Per), and children who did not stutter (CWNS). All children demonstrated normal non-verbal intelligence and language skills. Electroencephalograms were recorded as the children listened to pairs of pseudo-words (primes-targets) that either rhymed or did not. Behavioral rhyme judgments along with peak latency and mean amplitude of the N400s elicited by prime and target stimuli were examined. RESULTS All the groups were very accurate in their rhyme judgments and displayed a typical ERP rhyme effect, characterized by increased N400 amplitudes over central parietal sites for nonrhyming targets compared to rhyming targets. However, over anterior electrode sites, an earlier onset of the N400 for rhyming compared to non-rhyming targets, indexing phonological segmentation and rehearsal, was observed in the CWNS and CWS-Rec groups. This effect occurred bilaterally for the CWNS, was greater over the right hemisphere in the CWS-Rec, and was absent in the CWS-Per. CONCLUSIONS These results are the first to show that differences in ERPs reflecting phonological processing are marked by atypical lateralization in childhood even after stuttering recovery and more pronounced atypical neural patterns for the children whose stuttering persisted. Despite comparable language and phonological skills as revealed by standardized tests, the neural activity mediating phonological segmentation and rehearsal differentiated 7-8 year old children whose stuttering persisted from those who had recovered from stuttering and typically developing peers.
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Affiliation(s)
- Ranjini Mohan
- Department of Speech Language and Hearing Science, Purdue University, Lyles Porter Hall, 715 Clinic Drive, West Lafayette, IN USA
| | - Christine Weber
- Department of Speech Language and Hearing Science, Purdue University, Lyles Porter Hall, 715 Clinic Drive, West Lafayette, IN USA
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Usler E, Weber-Fox C. Neurodevelopment for syntactic processing distinguishes childhood stuttering recovery versus persistence. J Neurodev Disord 2015; 7:4. [PMID: 25657823 PMCID: PMC4318174 DOI: 10.1186/1866-1955-7-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/26/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Characterized by the presence of involuntary speech disfluencies, developmental stuttering is a neurodevelopmental disorder of atypical speech-motor coordination. Although the etiology of stuttering is multifactorial, language development during early childhood may influence both the onset of the disorder and the likelihood of recovery. The purpose of this study was to determine whether differences in neural indices mediating language processing are associated with persistence or recovery in school-age children who stutter. METHODS Event-related brain potentials (ERPs) were obtained from 31 6-7-year-olds, including nine children who do not stutter (CWNS), 11 children who had recovered from stuttering (CWS-Rec), and 11 children who persisted in stuttering (CWS-Per), matched for age, and all with similar socioeconomic status, nonverbal intelligence, and language ability. We examined ERPs elicited by semantic and syntactic (phrase structure) violations within an auditory narrative consisting of English and Jabberwocky sentences. In Jabberwocky sentences, content words were replaced with pseudowords to limit semantic context. A mixed effects repeated measures analysis of variance (ANOVA) was computed for ERP components with four within-subject factors, including condition, hemisphere, anterior/posterior distribution, and laterality. RESULTS During the comprehension of English sentences, ERP activity mediating semantic and syntactic (phrase structure) processing did not distinguish CWS-Per, CWS-Rec, and CWNS. Semantic violations elicited a qualitatively similar N400 component across groups. Phrase structure violations within English sentences also elicited a similar P600 component in all groups. However, identical phrase structure violations within Jabberwocky sentences elicited a P600 in CWNS and CWS-Rec, but an N400-like effect in CWS-Per. CONCLUSIONS The distinguishing neural patterns mediating syntactic, but not semantic, processing provide evidence that specific brain functions for some aspects of language processing may be associated with stuttering persistence. Unlike CWS-Rec and CWNS, the lack of semantic context in Jabberwocky sentences seemed to affect the syntactic processing strategies of CWS-Per, resulting in the elicitation of semantically based N400-like activity during syntactic (phrase structure) violations. This vulnerability suggests neural mechanisms associated with the processing of syntactic structure may be less mature in 6-7-year-old children whose stuttering persisted compared to their fluent or recovered peers.
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Affiliation(s)
- Evan Usler
- Department of Speech, Language, and Hearing Sciences, Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907 USA
| | - Christine Weber-Fox
- Department of Speech, Language, and Hearing Sciences, Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907 USA
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