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

Delay frustration in children who do and do not stutter: A preliminary study

PURPOSE

Frustration is an emotion often clinically reported by persons who stutter. So far, mainly questionnaire-based studies have reported findings related to increased frustration or decreased frustration tolerance. The aim of this preliminary study was to determine possible group differences between children who stutter (CWS) and children who do not stutter (CWNS) using a behavioral experimental task, as well as to evaluate possible associations with the frequency, duration, and physical concomitants of stuttering disfluencies.

METHOD

Participants were 13 CWS (mean age = 6;05 years) and 13 CWNS (mean age = 6;06 years), matched on age (±4 months) and gender. Frustration tolerance was assessed by the Delay Frustration task. This task includes normal delay, short delay, and long delay trials. Responses during long delay trials provide an indication of frustration tolerance and were recorded across time intervals during the response window.

RESULTS

CWS, compared to CWNS, responded more frequently during the long delay trials, which is indicative of higher delay frustration. The variation in responding across time within intervals was similar for both groups. Decreased frustration tolerance was associated with increased duration of stuttered disfluencies and of physical concomitants.

CONCLUSIONS

In general, the current findings seem to provide support for earlier theoretical conceptualizations about the role of emotional reactivity in the development of stuttering.

A Study of Emotion Regulation Difficulties, Repetitive Negative Thinking, and Experiential Avoidance in Adults with Stuttering: A Comparative Study

Objective: Stuttering is a type of communication and fluency disorder that hurts mental and emotional health. It is also associated with a significant increase in both trait and social anxiety. Studies on stuttering in adults have indicated the nature and impact of this phenomenon. In addition, some psychological aspects of this phenomenon remain vague and need further investigation. Therefore, the present study aimed to compare emotion regulation difficulties, repetitive negative thinking, and experiential avoidance between people who stutter and healthy individuals. Method : In this study, 101 people who stutter (43 females and 58 males, with a mean age of 29.55 ± 187 years), as well as 110 healthy individuals (74 females and 36 males, with a mean age of 25.57 ± 489 years) as participants were chosen using the convenience sampling method among those who referred to the speech therapy clinics of Tehran, Iran. Research instruments including the repetitive negative thinking inventory, Difficulties in Emotion Regulation Scale, and Acceptance and Action Questionnaire (AAQ-I) were used for data collection. Data were analyzed using multivariate ANOVA test and Multiple Regression Analysis. Results: The mean age of the participants was 29.55 years in the people who stutter and 25.57 years in the healthy individuals (P < 0.01). The present results indicated that the mean score of experiential avoidance was higher in the people who stutter (M ± SD: 35.74 ± 9.24) compared to the healthy individuals (M ± SD: 8.89 ± 31.11). Additionally, the mean score of emotion regulation difficulties was higher in the people who stutter (M ± SD: 88.75 ± 20.59) compared to the healthy individuals (M ± SD: 64.14 ± 94.94) (P < 0.001). However, there was no significant difference in the mean score of repetitive negative thinking between the people who stutter (M ± SD: 98.45 ± 25.85) and healthy individuals (M ± SD: 93.71 ± 25.24) groups (P > 0.05). There was a significant correlation between experiential avoidance and emotion regulation difficulties in people who stutter (P < 0.01). Experiential avoidance and repetitive negative thinking can significantly predict emotion regulation difficulties in people who stutter (R = 0.65, P < 0.01). Conclusion: People who stutter obtained higher emotion regulation difficulties and experiential avoidance scores than those without stuttering and A significant correlation between experiential avoidance and emotion regulation difficulties was found. Future studies should consider the role of emotion regulation difficulties and experiential avoidance in people who stutter.

Hand Preference in Stuttering: Meta-Analyses

Reduced hemispheric asymmetries, as well as their behavioral manifestation in the form of atypical handedness (i.e., non-right, left-, or mixed-handedness), are linked to neurodevelopmental disorders, such as autism spectrum disorder, and several psychiatric disorders, such as schizophrenia. One neurodevelopmental disorder that is associated with reduced hemispheric asymmetries, but for which findings on behavioral laterality are conflicting, is stuttering. Here, we report a series of meta-analyses of studies that report handedness (assessed as hand preference) levels in individuals who stutter (otherwise healthy) compared to controls. For this purpose, articles were identified via a search in PubMed, Scopus, and PsycInfo (13 June 2023). On the basis of k = 52 identified studies totaling n = 2590 individuals who stutter and n = 17,148 controls, five random effects meta-analyses were conducted: four using the odds ratio [left-handers (forced choice); left-handers (extreme); mixed-handers; non-right-handers vs. total)] and one using the standardized difference in means as the effect size. We did not find evidence of a left (extreme)- or mixed-handedness difference or a difference in mean handedness scores, but evidence did emerge, when it came to left-handedness (forced-choice) and (inconclusively for) non-right-handedness. Risk-of-bias analysis was not deemed necessary in the context of these meta-analyses. Differences in hand skill or strength of handedness could not be assessed as no pertinent studies were located. Severity of stuttering could not be used s a moderator, as too few studies broke down their data according to severity. Our findings do not allow for firm conclusions to be drawn on whether stuttering is associated with reduced hemispheric asymmetries, at least when it comes to their behavioral manifestation.

Electrodermal Activity of Preschool-Age Children Who Stutter During a Child-Friendly Stroop Paradigm

PURPOSE

The aim of the study was to assess whether emotional reactivity, indexed by a distinct physiological measure of sympathetic activation, differs between preschool-age children who stutter (CWS) and preschool-age children who do not stutter (CWNS) during a child-friendly Stroop task (i.e., day-night task). Additionally, researchers aimed to assess whether the Stroop task, compared to a control task, was a significant physiological stressor.

METHOD

Fifteen preschool-age CWS and 22 preschool-age CWNS were asked to perform a day-night Stroop task in order to elicit psychophysiological reactivity, indexed by electrodermal response (EDR) occurrence frequency and EDR amplitude. Physiological measurements were recorded during pretask baselines, performance of the day-night Stroop task, and performance of a speech-language control task.

RESULTS

Findings based on EDR measures did not support the hypothesis that the child-friendly day-night Stroop task is an effective stressor as compared to a control task based on measures of physiological arousal in preschool-age children. The CWS and CWNS did not significantly differ in their EDR measures relative to the control task or Stroop task (p > .05). However, CWS, compared to CWNS, exhibited significantly greater EDR amplitudes during the control task baseline (p < .05) and the Stroop task baseline (p < .05).

CONCLUSION

Overall, these findings may suggest that a predisposition to heightened levels of sympathetic activity prior to tasks in preschool-age CWS is important to consider with regard to the nature of developmental stuttering.

Latent Class Analysis Reveals Distinct Groups Based on Executive Function and Socioemotional Traits, Developmental Conditions, and Stuttering: A Population Study

A growing body of research has reported associations between weaker Executive Functions (EF), the set capacities that are needed to manage and allocate one's cognitive resources during cognitively challenging activities and various neurodevelopmental conditions, including stuttering. The majority of this research has been based on variable-centered approaches, which have the potential to obscure within-population heterogeneity. Person-centered analyses are essential to understanding multifactorial disorders where relationships between indicators have been elusive, such as stuttering. The current study addressed gaps in the literature by using latent class analysis (LCA), a person-centered approach, to identify homogenous subgroups within the National Health Interview Survey (2004-2018) publicly available data set. Using this exploratory approach, we examined the hypothesis that there exist distinct classes (or subgroups) of children based on parent reports of EF, Socioemotional (SE) traits, developmental atypicality, and stuttering. Our analyses revealed distinct subgroups with substantially different likelihoods of parent-reported stuttering behaviors and developmental atypicality. For children with both EF and SE difficulties, the likelihood of parental report of stuttering and atypical development was even higher, in fact this likelihood (of stuttering and not-typically developing) was highest among all subgroups. In contrast, children without difficulties were the least likely to be reported with stuttering or not-typically developing. Our findings are consistent with theoretical frameworks for stuttering, which cite EF as a crucial component in the disorder. Additionally, our findings suggest within-population heterogeneity among children with EF difficulties and, specifically, EF and SE heterogeneity among children who stutter.

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.

The role of temperament in stuttering frequency and impact in children under 7

INTRODUCTION

Increased emotional reactivity and decreased regulation have been associated with increased stuttering severity and frequency in preschool children who stutter (CWS) and may be predictors for the development of negative reactions to stuttering in young children. Understanding which children are likely to be impacted to a greater or lesser degree has implications for clinical decision making. Associations between temperament and stuttering impact have been explored with older CWS, but not with preschool CWS.

AIM

To investigate the relationship between temperament (specifically emotional reactivity and regulation) and both stuttering frequency and stuttering impact in preschool CWS.

METHODS

Data collected at initial assessment for 119 young CWS (age range= 3;00-6;11 years) at a specialist centre for stuttering in London, UK were analysed. The following measures were completed: The Children's Behaviour Questionnaire-Short Form (Putnam & Rothbart, 2006); Palin Parent Rating Scales (Millard & Davis, 2016); The Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007); and a stuttering frequency measure.

RESULTS

Emotional reactivity and regulation were not significantly associated with stuttering frequency. Higher scores on negative reactivity were significantly associated with an increased impact of stuttering on the child (from parents' perspective), but not significantly associated with child-reported communication attitude. Positive reactivity was not significantly associated with parent-reported impact of stuttering or child-reported communication attitude. Additional investigation revealed negative affect as a significant predictor of parent-reported impact of stuttering before and after adjusting for age.

DISCUSSION

The results provide evidence to support the role of temperament on the impact that stuttering has in the early years. While the directionality of the relationship between negative reactivity and impact of stuttering is unknown, the importance of targeting emotional reactions in therapy for young CWS is implicated.

Temperament, anxiety, and depression in school-age children who stutter

PURPOSE

The main aim of this study was to gain insight into whether temperament and/or stuttering severity were associated with anxiety and depression in children who stutter. Additionally, the study also provided an indication into the prevalence of anxiety and depression in children who stutter in a clinical cohort.

METHOD

The participants were 132 English-speaking children (105 boys and 27 girls) between 9;0 and 14;11 years old (M = 11;8, SD = 1;10) and their mothers. At their first visit to a specialist center for children who stutter, mothers and children completed the relevant versions of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R; Ellis & Rothbart, 2001) and a screening of children's anxiety and depression, using the Revised Children's Anxiety and Depression Scale (RCADS; Chorpita et al., 2000). Stuttering was evaluated using the Stuttering Severity Instrument Fourth Edition (SSI-4). Correlations were conducted between child and parent versions of the EATQ-R and RCADS; EATQ-R and RCADS; as well as the SSI-4 and RCADS. A comparison was made between those children who scored below the clinical threshold for anxiety and depression, and those who scored above.

RESULTS

Significant correlations were found for all mother and child EATQ-R factors and RCADS scales (except for Obsessive Compulsive Disorder). Correlations were also found between the child- and mother-reported temperament factors of positive reactivity, negative reactivity, and self-regulation and anxiety and depression. Children who scored above the clinical threshold for any category of anxiety or depression had significantly lower positive reactivity and higher negative reactivity scores, compared to those who scored below the threshold. There were no differences between the two groups with regard to SSI-4 scores.

CONCLUSIONS

This is the first study to evaluate associations between temperament and anxiety and depression in children who stutter. Higher negative reactivity scores and lower positive reactivity and self-regulation scores are associated with elevated levels of anxiety and depression in children who stutter. Further, those who score above the clinical threshold have significantly higher levels of negative reactivity and lower levels of positive reactivity compared to those scoring below the threshold. Findings suggest that levels of anxiety that reach clinical threshold are more prevalent in children who stutter than would be expected based on population data. Current findings have implications for both the assessment and therapy of children who stutter presenting at clinics for support.

Emotion-related regulation strategy use in preschool-age children who stutter

PURPOSE

Past findings indicate the quality and quantity of emotion regulation often differs between preschool-age children who stutter (CWS) and children who do not stutter (CWNS). The purpose of this study was to identify whether specific emotion-related regulatory strategy types differ between preschool-age CWS and CWNS during a temptation task.

METHODS

Participants were 13 CWS and 13 CWNS between 3;2 and 5;7 (years;months), matched for gender and age (+/- 6 months). Participants completed a Forbidden Toy paradigm, a resistance to temptation task, in which the children were asked to refrain from touching a toy. Types of emotion-related regulation, including (1) verbal regulation, (2) behavioral regulation, and (3) attentional regulation, were behaviorally coded during the temptation task.

RESULTS

A higher proportion of the CWNS (92%) failed to resist the temptation to touch the toy than CWS (48%). Additionally, a higher proportion of the CWS (23%), compared to CWNS (0%), presented with signs of distress, resulting in their task ending prematurely. Limited differences were detected in the types of emotion-related regulatory strategies used by CWS, or the frequency of those strategies. CWNS, compared to the CWS, used more approach-related behavioral strategies.

CONCLUSIONS

Interpretations of these findings must be mitigated by the observation that a higher proportion of CWS than CWNS demonstrated distress during the paradigm, suggesting a need for further research into the interplay between emotional reactivity and emotion regulation for preschool-age CWS.

Bidirectional Associations of Childhood Stuttering With Behavior and Temperament

PURPOSE

Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood.

METHOD

This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed.

RESULTS

Six-month-old children who were less able to "recover from distress," indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (β = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (β = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (β = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years.

CONCLUSIONS

Behavior and temperament were associated with stuttering persistency-seemingly as both predictor and consequence-but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered. Supplemental Material https://doi.org/10.23641/asha.16869479.

Temperament is Linked to Avoidant Responses to Stuttering Anticipation

PURPOSE

The purpose of the present study was to examine the degree to which certain temperament constructs predict individual differences in three types of behavioral responses to anticipation among children and adults who stutter (CWS and AWS, respectively): avoidance, physical change, and approach.

METHODS

Participants included 64 CWS (9- to 17-years-old) and 54 AWS (18- to 50-years-old) who completed an online survey package including a temperament questionnaire (Early Adolescent Temperament Questionnaire-Revised for the CWS; Adult Temperament Questionnaire for the AWS) and the Stuttering Anticipation Scale. The data were analyzed separately for CWS and AWS using multivariate multiple regressions to assess how each temperament construct predicted avoidance, physical change, and approach responses to anticipation.

RESULTS

CWS who reported higher levels of shyness were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. AWS who reported higher levels of orienting sensitivity were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. No temperament constructs predicted physical change or approach responses to anticipation among either age group.

CONCLUSION

Specific aspects of temperament appear to be linked to the degree that CWS and AWS engage in avoidant behavioral responses to stuttering anticipation. These findings support the continued study of how individual differences impact the internal experience and outward manifestation of stuttering behaviors.

Quantitative EEG (QEEG) Analysis of Emotional Interaction between Abusers and Victims in Intimate Partner Violence: A Pilot Study

Background: The perpetrators of intimate partner violence (IPV) and their victims have different emotional states. Abusers typically have problems associated with low self-esteem, low self-awareness, violence, anger, and communication, whereas victims experience mental distress and physical pain. The emotions surrounding IPV for both abuser and victim are key influences on their behavior and their relationship. Methods: The objective of this pilot study was to examine emotional and psychological interactions between IPV abusers and victims using quantified electroencephalogram (QEEG). Two abuser–victim case couples and one non-abusive control couple were recruited from the Mental Image Recovery Program for domestic violence victims in Seoul, South Korea, from 7–30 June 2017. Data collection and analysis were conducted using BrainMaster and NeuroGuide. The emotional pattern characteristics between abuser and victim were examined and compared to those of the non-abusive couple. Results: Emotional states and reaction patterns were different for the non-abusive and IPV couples. Strong delta, theta, and beta waves in the right frontal and left prefrontal lobes were observed in IPV case subjects. This indicated emotional conflict, anger, and a communication block or impaired communication between abuser and victim. Conclusions: Our study findings suggest brainwave control training via neurofeedback could be a possible therapy in managing emotional and communication problems related to IPV.

Emotion processing in children who do and do not stutter: An ERP study of electrocortical reactivity and regulation to peer facial expressions

PURPOSE

Event-related brain potentials (ERPs) were used to investigate the neural correlates of emotion processing in 5- to 8-year-old children who do and do not stutter.

METHODS

Participants were presented with an audio contextual cue followed by images of threatening (angry/fearful) and neutral facial expressions from similarly aged peers. Three conditions differed in audio-image pairing: neutral context-neutral expression (neutral condition), negative context-threatening expression (threat condition), and reappraisal context-threatening expression (reappraisal condition). These conditions reflected social stimuli that are ecologically valid to the everyday life of children.

RESULTS

P100, N170, and late positive potential (LPP) ERP components were elicited over parietal and occipital electrodes. The threat condition elicited an increased LPP mean amplitude compared to the neutral condition across our participants, suggesting increased emotional reactivity to threatening facial expressions. In addition, LPP amplitude decreased during the reappraisal condition- evidence of emotion regulation. No group differences were observed in the mean amplitude of ERP components between children who do and do not stutter. Furthermore, dimensions of childhood temperament and stuttering severity were not strongly correlated with LPP elicitation.

CONCLUSION

These findings are suggestive that, at this young age, children who stutter exhibit typical brain activation underlying emotional reactivity and regulation to social threat from peer facial expressions.

College professors' perceptions of students who stutter and the impact on comfort approaching professors

PURPOSE

Previous literature has documented that college professors view hypothetical students who stutter more negatively than their fluent peers. The purpose of the present study was to investigate whether individuals who stutter report they experience more negative perceptions in the college classroom, and the impact of those perceptions on their comfort approaching professors.

METHODS

Two hundred forty-six adults who do and do not stutter, matched for age, participated in this study. Participants were presented with 16 positive and negative personality traits and asked to rate how strongly they believed their professor viewed them along each trait. All participants were asked whether they felt comfortable approaching their professors to discuss their performance. Adults who stutter were asked additional questions to investigate their college experience more comprehensively.

RESULTS

Adults who stutter reported they experienced significantly more negative perceptions from their professors than adults who do not stutter, and were significantly less likely to feel comfortable approaching their professors. These reported negative perceptions, specifically being perceived as less self-assured, predicted comfort approaching professors to receive performance feedback for adults who stutter. Finally, amongst adults who stutter, perception of how they were evaluated compared to their peers was significantly related to comfort approaching professors.

CONCLUSIONS

Results support that the negative perceptions towards hypothetical students who stutter reported in previous literature are experienced by individuals who stutter, and that these perceptions drive comfort approaching professors for performative feedback. Results suggest professors may increase students' comfort by clearly outlining equality in evaluation procedures.

Emotional Reactivity and Regulation in Preschool-Age Children Who Do and Do Not Stutter: Evidence From Autonomic Nervous System Measures

Purpose: This experimental cross-sectional research study examined the emotional reactivity and emotion regulation in preschool-age children who do (CWS) and do not stutter (CWNS) by assessing their psychophysiological response during rest and while viewing pictures from the International Affective Picture System (Lang et al., 2008).

Method: Participants were 18 CWS (16 boys and two girls; mean age 4 years, 5 months) and 18 age- and gender-matched CWNS. Participants' psychophysiological responses were measured during two baselines and two picture viewing conditions. Skin conductance level (SCL) and heart rate were measured to assess emotional reactivity. Respiratory sinus arrhythmia (RSA) was measured to assess emotional regulation. Participants' shyness and executive function were assessed via parent report and considered for their effects on participants' psychophysiological responses.

Results: First, CWNS and CWS did not differ in their initial baseline SCL, heart rate, or RSA, but all participants had higher SCL and lower RSA in the second baseline, subsequent to the first challenge condition, compared to the first baseline. Second, during the challenge conditions, CWS did not differ from CWNS in their SCL, but showed a significantly higher heart rate than CWNS. Third, CWS exhibited a significantly lower RSA during the challenge conditions compared to CWNS. Lastly, the temperamental quality of shyness was associated with preschool-age children's SCL, such that participants who were rated higher in shyness had a higher SCL during the challenge conditions. Participants' executive function had a marginally significant effect on the RSA, such that the participants who had higher executive function composite scores exhibited lower RSA during the challenge conditions.

Conclusions: Our findings suggest that CWS and CWNS did not differ in their emotional reactivity and emotional regulation abilities at rest. During challenge conditions, however, CWS tended to be more emotionally reactive, as indicated by a higher heart rate, and also employed more emotional regulation, indexed by a greater decrease in RSA, compared to CWNS. Preschool-age children's behavior is largely dominated by reactivity, but there is the emergence of regulation, which can help children adjust to various contextual demands. For CWS who are more emotionally reactive, regulatory skills may be particularly critical to their prognosis and treatment.

Emotional and behavioural problems of children and adolescents who stutter: Comparison with typically developing peers

PURPOSE

There are several studies showing contradictory results on concurrent emotional and behavioural problems of children and adolescents who stutter (CAWS). This study aimed to identify whether there is a difference between Turkish-speaking CAWS and their typically developing peers (TDP) in emotional and behavioural problems.

METHODS

The study group consisted of 45 CAWS, aged between 3.40 and 15.92 years, and the control group consisted of 45 TDP, aged between 3.15 and 16.80 years. Participants were divided into three age groups: early childhood (0-6 years), middle childhood (7-11 years) and adolescence (12-18 years). CAWS and TDP were compared separately in each age group with Mann-Whitney U tests. Assessments of emotional and behavioural problems were conducted with the Child Behaviour Checklist (CBCL) for Ages 1.5-5 and the CBCL for Ages 6-18.

RESULTS

In early childhood, CAWS had significantly higher emotional reactivity, anxiety/depression, somatic complaints, withdrawal, sleep problems, attention problems and aggressive behaviour scores than TDP. In middle childhood and adolescence, CAWS had significantly higher anxiety/depression, withdrawal/depression, social problems, attention problems, rule-breaking behaviour and aggressive behaviour scores compared to TDP. In adolescence, somatic problems and thought problems scores were also significantly higher in AWS than TDP.

CONCLUSIONS

We concluded that emotional and behavioural problems associated with stuttering are noticeable from early childhood to adolescence. Cooperation with mental health professionals may be needed to improve the quality of speech therapy in CAWS.

Manual response inhibition and quality of life in adults who stutter

BACKGROUND

A considerable amount of research has identified inhibition differences, including slower inhibition of manual responses, in people who stutter. Recent investigations have failed to link slowed motor inhibition with overt stuttering severity. This study investigated the potential relationship between slowed manual response inhibition and the negative impact of stuttering upon individual lives of adults who stutter (AWS).

METHODS

Thirty-four adults (AWS, n = 17; AWNS, n = 17) matched by nonverbal IQ completed a manual stop-signal task and provided a conversational speech sample. Motor inhibition latency for AWS and AWNS were compared. For AWS, motor inhibition latency was compared to the four subsections of the Overall Assessment of the Speaker's Experience with Stuttering (OASES; Yaruss & Quesal, 2006; General Information, Reactions to Stuttering, Communication in Daily Situations, Quality of Life).

RESULTS

Similar to previous studies, AWS were significantly slower to inhibit inaccurate manual responses than AWNS. Quality of Life subtest of the OASES was found to significantly predict inhibition latency.

CONCLUSION

These data replicate findings that indicate that AWS exhibit slower manual inhibition latency, and suggest that these inhibition differences may be associated with an individual's negative experience with stuttering rather than stuttering severity.

Associations between stuttering, comorbid conditions and executive function in children: a population-based study

Background

The aim of this study was to investigate the relationship between executive function (EF), stuttering, and comorbidity by examining children who stutter (CWS) and children who do not stutter (CWNS) with and without comorbid conditions. Data from the National Health Interview Survey were used to examine behavioral manifestations of EF, such as inattention and self-regulation, in CWS and CWNS.

Methods

The sample included 2258 CWS (girls = 638, boys = 1620), and 117,725 CWNS (girls = 57,512; boys = 60,213). EF, and the presence of stuttering and comorbid conditions were based on parent report. Descriptive statistics were used to describe the distribution of stuttering and comorbidity across group and sex. Regression analyses were to determine the effects of stuttering and comorbidity on EF, and the relationship between EF and socioemotional competence.

Results

Results point to weaker EF in CWS compared to CWNS. Also, having comorbid conditions was also associated with weaker EF. CWS with comorbidity showed the weakest EF compared to CWNS with and without comorbidity, and CWS without comorbidity. Children with stronger EF showed higher socioemotional competence. A majority (60.32%) of CWS had at least one other comorbid condition in addition to stuttering. Boys who stutter were more likely to have comorbid conditions compared to girls who stutter.

Conclusion

Present findings suggest that comorbidity is a common feature in CWS. Stuttering and comorbid conditions negatively impact EF.

Effects of Physiological Arousal on Speech Motor Control and Speech Motor Practice in Preschool-Age Children Who Do and Do Not Stutter

Purpose We examined the effects of physiological arousal on speech motor control and speech motor practice effects in preschool-age children who do (CWS) and do not stutter (CWNS). Method Participants included 18 CWS (M _age = 4 years 5 months) and 18 age- and gender-matched CWNS. The participants repeated a phrase "buy bobby a puppy" interspersed with viewing pictures from the International Affective Picture System under two experimental conditions speaking after viewing pictures with (a) negative and (b) neutral valence. Participants' lip movements were tracked using Optotrak system. The spatiotemporal index and mean utterance duration were calculated to examine speech motor control and speech motor practice effects. Skin conductance level was measured during the experimental conditions to assess participants' physiological level of arousal. Results Preschool-age CWS demonstrated greater speech movement variability across all conditions and trials than CWNS. Furthermore, the younger participants produced more variable articulatory movements than the older participants. Participants' speech movement variability did not significantly differ between the negative and neutral experimental conditions, and the level of physiological arousal did not have a significant effect on it. There was a nonsignificant trend of decrease in speech movement variability across the repeated trials in both groups. Last, CWS and CWNS did not differ in their mean utterance duration, suggesting that their articulation rate was similar across all conditions and trials. Conclusions Our findings indicate that, compared to preschool-age CWNS, CWS demonstrate less mature speech motor control. However, present findings do not support the hypothesis that CWS benefit less from motor practice relative to CWNS. Given that our conditions elicited similar levels of arousal in the participants, future research is needed to examine whether physiological arousal disrupts speech motor control in preschool-age children potentially contributing to disruptions of speech fluency and the development of stuttering.

Temperament and early stuttering intervention: Two perspectives

PURPOSE

To discuss clinical applications of research findings about temperament and early stuttering.

METHOD

A "1000-bytes" format (Onslow & Millard, 2012) was used to provide readers with contemporaneous observation of a "conversation" between the authors. The conversation is proceeded by a prologue and followed by concluding statements from each author.

RESULTS

One author contended that comprehensive, multidimensional assessment of temperament domains is essential during clinical management of early stuttering, and the results of that assessment are best incorporated into a multifactorial treatment approach. The other author contested that view, arguing that such an approach is not empirically justifiable at present.

CONCLUSIONS

The authors agree about the salience of research on temperament and early stuttering but have different perspectives about the topic when applied to providing health care for early stuttering.

The Application of EEG Mu Rhythm Measures to Neurophysiological Research in Stuttering

Deficits in basal ganglia-based inhibitory and timing circuits along with sensorimotor internal modeling mechanisms are thought to underlie stuttering. However, much remains to be learned regarding the precise manner how these deficits contribute to disrupting both speech and cognitive functions in those who stutter. Herein, we examine the suitability of electroencephalographic (EEG) mu rhythms for addressing these deficits. We review some previous findings of mu rhythm activity differentiating stuttering from non-stuttering individuals and present some new preliminary findings capturing stuttering-related deficits in working memory. Mu rhythms are characterized by spectral peaks in alpha (8-13 Hz) and beta (14-25 Hz) frequency bands (mu-alpha and mu-beta). They emanate from premotor/motor regions and are influenced by basal ganglia and sensorimotor function. More specifically, alpha peaks (mu-alpha) are sensitive to basal ganglia-based inhibitory signals and sensory-to-motor feedback. Beta peaks (mu-beta) are sensitive to changes in timing and capture motor-to-sensory (i.e., forward model) projections. Observing simultaneous changes in mu-alpha and mu-beta across the time-course of specific events provides a rich window for observing neurophysiological deficits associated with stuttering in both speech and cognitive tasks and can provide a better understanding of the functional relationship between these stuttering symptoms. We review how independent component analysis (ICA) can extract mu rhythms from raw EEG signals in speech production tasks, such that changes in alpha and beta power are mapped to myogenic activity from articulators. We review findings from speech production and auditory discrimination tasks demonstrating that mu-alpha and mu-beta are highly sensitive to capturing sensorimotor and basal ganglia deficits associated with stuttering with high temporal precision. Novel findings from a non-word repetition (working memory) task are also included. They show reduced mu-alpha suppression in a stuttering group compared to a typically fluent group. Finally, we review current limitations and directions for future research.

Temperament in Adults Who Stutter and Its Association With Stuttering Frequency and Quality-of-Life Impacts

Purpose The study aim was to determine whether self-reported temperament traits differentiate adults who stutter (AWS) from adults who do not stutter (AWNS). Additionally, associations between temperament and stuttering frequency, and between temperament and quality of life impacts of stuttering, were investigated in AWS. Method Self-reported temperament traits were documented for 33 AWS and 43 AWNS using the Adult Temperament Questionnaire (ATQ; Evans & Rothbart, 2007). Quality-of-life impacts of stuttering were assessed using the Overall Assessment of the Speaker's Experience with Stuttering (Yaruss & Quesal, 2010). Stuttering frequency was calculated from 100-word monologue and reading samples. Results A between-groups difference in scores on the ATQ Positive Affect subscale was nominally significant (i.e., before correcting for multiple tests) and also approached statistical significance after Bonferroni correction. Positive Affect scores were lower for AWS, and the size of this trending effect was moderate. Within AWS, a statistically significant positive correlation was found between impact scores on the General Information section of the Overall Assessment of the Speaker's Experience with Stuttering and ATQ Frustration subscale scores after Bonferroni correction. No associations were detected between temperament traits and stuttering frequency. Conclusions Results reveal a nontrivial tendency for AWS to experience decreased positive affect compared to AWNS. In addition, increased frustration was found to be associated with reduced general knowledge about stuttering in AWS. Neither effect has been previously reported for adults or children who stutter. Finally, self-reported temperament traits were not found to vary with stuttering frequency in adults, consistent with previous results for AWS.

Cerebral laterality as assessed by hand preference measures and developmental stuttering

The causes of developmental stuttering, a neurodevelopmental communicative disorder, have not been elucidated to date. Neuroimaging studies suggest that atypical cerebral laterality could be one of such causal factors. Moreover, handedness, a behavioural index for cerebral laterality, has been linked to stuttering and recovery from it. However, findings are conflicting, possibly due to sample selection procedures, which typically rely on self-reported stuttering, and to the fact that handedness is typically assessed with regards to its direction rather than degree. We investigated the possible relationship between handedness and stuttering. This is the first study where children who stutter (CWS) were selected using clinical criteria as well as speech samples and where a non-Western population was studied. Findings from 83 CWS aged 3-9 years (mean = 6.43, SD = 1.84) and 90 age- and sex-matched children who do not stutter (mean = 6.45, SD = 1.71) revealed no differences in their hand preference scores as evaluated by parent-completed Edinburgh Handedness Inventory, for both direction and degree. The severity of stuttering was not found to correlate with the degree of handedness. We suggest that parents and professionals not treat left- or mixed-hand preference as a reason for concern with regards to stuttering.

Elevated attention deficit hyperactivity disorder symptoms in children who stutter

PURPOSE

This study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken.

METHOD

Participants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria).

RESULTS

One-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment.

CONCLUSION

The large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.

The Role of Effortful Control in Stuttering Severity in Children: Replication Study

Background In 2014, Kraft et al. assessed the temperament, home environment, and significant life events of 69 North American children who stutter to examine the combined and compounded effects of these individualized factors on mediating overt stuttering severity. The temperament domain of effortful control was singularly found to be significantly predictive of stuttering severity. Purpose Because of the clinical significance of the initial study's findings, a replication study with a different, larger cohort of children who stutter was warranted to validate the reported outcomes. Method The current study assesses 98 children who stutter, ages 2;4 to 12;6 (years; months, M = 6;7), recruited from Perth, Australia. Results The results support the previous findings of Kraft, Ambrose, and Chon (2014) , with effortful control remaining the sole significant contributor to variability in stuttering severity, as rated by both parents and clinicians. Conclusion These cumulative and consistent outcomes support the need to develop targeted intervention strategies that specifically strengthen aspects of effortful control as a means to support positive therapeutic change in children who stutter.

Nurturing a Resilient Mindset in School-Aged Children Who Stutter

PURPOSE

To consider the rationale, methods, and potential benefits of nurturing the growth of resilience in school-aged children who stutter. Stuttering in childhood can have negative psychological consequences for some, including the development of a negative attitude toward their speech from a young age (Vanryckeghem, Brutten, & Hernandez, 2005) and possible co-occurring psychopathology in adolescence and adulthood, in particular, anxiety disorders (Blood, Blood, Maloney, Meyer, & Qualls, 2007; Iverach & Rapee, 2014; McAllister, Kelman, & Millard, 2015). Children who stutter also frequently report teasing and bullying by their peers (Blood & Blood, 2007; Boyle, 2011; Langevin, Packman, & Onslow, 2009), which can have a significant impact on children's confidence and psychological well-being. However, the capacity of children who stutter to cope or "bounce back" from adversity is not routinely explored or incorporated in therapy for stuttering.

METHOD

This clinical focus article will explore the construct of resilience and consider why it may be important for children who stutter and their parents. A framework for understanding resilience in relation to stuttering is used, drawing from the Reaching In Reaching Out Resiliency Program (for children aged under 8 years and their parents) and the Penn Resiliency Program (for children aged 8 years and over).

CONCLUSIONS

The role of parents is key in modeling resilient responses to children and creating a resilience-rich environment. As children who stutter may be more vulnerable to adversity, some may benefit from targeted support to build their resilience, in order to enhance their ability to overcome challenges and thrive.

Cognitive flexibility in preschool children with and without stuttering disorders

PURPOSE

Multifactorial explanations of developmental stuttering suggest that difficulties in self-regulation and weak attentional flexibility contribute to persisting stuttering. We tested this prediction by examining whether preschool-age children who stutter (CWS) shift their attention less flexibly than children who do not stutter (CWNS) during a modified version of the Dimension Card Change Sort (DCCS), a reliable measure of attention switching for young children.

METHODS

Sixteen CWS (12 males) and 30 children CWNS (11 males) participated in the study. Groups were matched on age (CWS: M=49.63, SD=10.34, range=38-80months; CWNS: M=50.63, SD=9.82, range=37-74months), cognitive ability, and language skills. All children completed a computer-based variation of the DCCS, in which they matched on-screen bivalent stimuli to response buttons based on rules that switched mid-task.

RESULTS

Results showed increased slowing for CWS compared to controls during the postswitch phase, as well as contrasting patterns of speed-accuracy tradeoff for CWS and CWNS as they moved from the preswitch to postswitch phase of the task.

CONCLUSIONS

Group differences in performance suggest that early stuttering may be associated with difficulty shifting attention efficiently and greater concern about errors. Findings are consistent with a growing literature indicating links between weak attentional control and persisting developmental stuttering.

What Are Predictors for Persistence in Childhood Stuttering?

Over the past 10 years, we (the Purdue Stuttering Project) have implemented longitudinal studies to examine factors related to persistence and recovery in early childhood stuttering. Stuttering develops essentially as an impairment in speech sensorimotor processes that is strongly influenced by dynamic interactions among motor, language, and emotional domains. Our work has assessed physiological, behavioral, and clinical features of stuttering within the motor, linguistic, and emotional domains. We describe the results of studies in which measures collected when the child was 4 to 5 years old are related to eventual stuttering status. We provide supplemental evidence of the role of known predictive factors (e.g., sex and family history of persistent stuttering). In addition, we present new evidence that early delays in basic speech motor processes (especially in boys), poor performance on a nonword repetition test, stuttering severity at the age of 4 to 5 years, and delayed or atypical functioning in central nervous system language processing networks are predictive of persistent stuttering.

The Effects of Emotion Suppression During Language Planning and Production

PURPOSE

Emotion regulation and language planning occur in parallel during interactive communication, but their processes are often studied separately. It has been suggested that emotion suppression and more complex language production both recruit cognitive resources. However, it is currently less clear how the language planning and production system is impacted when required to emotionally suppress outward displays of affect (i.e., expressive suppression). The purpose of the current study was to evaluate the interactive effects of emotion regulation and language production processes.

METHOD

Through discourse analysis of a corpus of interactive dialogue, we evaluated the production of interjections (i.e., also termed "filled pauses," a type of speech disfluency) when participants regulated outward displays of emotion and when language was lexically complex (i.e., via lexical diversity). One participant (the sender) was assigned to either express or suppress affective displays during the interaction. The other person (the receiver) was given no special instructions before the interaction. The interactions were transcribed, and their linguistic content (i.e., lexical diversity, lexical alignment, and interjections) was analyzed.

RESULTS

Results indicated that participants actively suppressing outward displays of affect produced more interjections and that participants asked to emotionally regulate, both expressors and suppressors, were more disfluent when producing lexically diverse statements (2 cognitively demanding tasks).

CONCLUSIONS

The current research provides support that, when suppressing emotion, one might be more disfluent when speaking. However, also when engaged in 2 simultaneous, demanding tasks of having to either upregulate or downregulate emotions and utter lexically diverse statements, the combined cognitive load may impede fluency in language production. More specifically, in the context of language planning and production, emotion suppression may pilfer resources away from the language planning and production system, leading to higher rates of disfluent speech. This finding is of particular importance because understanding the interactive effects of emotion and language production may be impactful to interventions for communication disorders.

Cortical associates of emotional reactivity and regulation in childhood stuttering

PURPOSE

This study sought to determine the cortical associates of emotional reactivity and emotion regulation (as indexed by the amplitude of evoked response potentials [ERP]) in young children who do and do not stutter during passive viewing of pleasant, unpleasant and neutral pictures.

METHOD

Participants were 17 young children who stutter and 22 young children who do not stutter (between 4 years 0 months to 6 years 11 months). The dependent measures were (1) mean amplitude of late positive potential (LPP, an ERP sensitive to emotional stimuli) during passive (i.e., no response required) picture viewing and directed reappraisal tasks and (2) emotional reactivity and regulation related scores on caregiver reports of young children's temperament (Children's Behavior Questionnaire, CBQ).

RESULTS

Young CWS, when compared to CWNS, exhibited significantly greater LPP amplitudes when viewing unpleasant pictures, but no significant between-group difference when viewing pleasant pictures and during the emotion regulation condition. There were, however, for CWS, but not CWNS, significant correlations between temperament-related measures of emotion and cortical measures of emotional reactivity and regulation.

CONCLUSIONS

Findings provide further empirical support for the notion that emotional processes are associated with childhood stuttering, and that CWS's inherent temperamental proclivities need to be taken into account when empirically studying or theorizing about this association.

The effect of emotion on articulation rate in persistence and recovery of childhood stuttering

PURPOSE

This study investigated the possible association of emotional processes and articulation rate in pre-school age children who stutter and persist (persisting), children who stutter and recover (recovered) and children who do not stutter (nonstuttering).

METHODS

The participants were ten persisting, ten recovered, and ten nonstuttering children between the ages of 3-5 years; who were classified as persisting, recovered, or nonstuttering approximately 2-2.5 years after the experimental testing took place. The children were exposed to three emotionally-arousing video clips (baseline, positive and negative) and produced a narrative based on a text-free storybook following each video clip. From the audio-recordings of these narratives, individual utterances were transcribed and articulation rates were calculated.

RESULTS

Results indicated that persisting children exhibited significantly slower articulation rates following the negative emotion condition, unlike recovered and nonstuttering children whose articulation rates were not affected by either of the two emotion-inducing conditions. Moreover, all stuttering children displayed faster rates during fluent compared to stuttered speech; however, the recovered children were significantly faster than the persisting children during fluent speech.

CONCLUSION

Negative emotion plays a detrimental role on the speech-motor control processes of children who persist, whereas children who eventually recover seem to exhibit a relatively more stable and mature speech-motor system. This suggests that complex interactions between speech-motor and emotional processes are at play in stuttering recovery and persistency; and articulation rates following negative emotion or during stuttered versus fluent speech might be considered as potential factors to prospectively predict persistence and recovery from stuttering.

Anomalous network architecture of the resting brain in children who stutter

PURPOSE

We combined a large longitudinal neuroimaging dataset that includes children who do and do not stutter and a whole-brain network analysis in order to examine the intra- and inter-network connectivity changes associated with stuttering. Additionally, we asked whether whole brain connectivity patterns observed at the initial year of scanning could predict persistent stuttering in later years.

METHODS

A total of 224 high-quality resting state fMRI scans collected from 84 children (42 stuttering, 42 controls) were entered into an independent component analysis (ICA), yielding a number of distinct network connectivity maps ("components") as well as expression scores for each component that quantified the degree to which it is expressed for each child. These expression scores were compared between stuttering and control groups' first scans. In a second analysis, we examined whether the components that were most predictive of stuttering status also predicted persistence in stuttering.

RESULTS

Stuttering status, as well as stuttering persistence, were associated with aberrant network connectivity involving the default mode network and its connectivity with attention, somatomotor, and frontoparietal networks. The results suggest developmental alterations in the balance of integration and segregation of large-scale neural networks that support proficient task performance including fluent speech motor control.

CONCLUSIONS

This study supports the view that stuttering is a complex neurodevelopmental disorder and provides comprehensive brain network maps that substantiate past theories emphasizing the importance of considering situational, emotional, attentional and linguistic factors in explaining the basis for stuttering onset, persistence, and recovery.

A systematic literature review of neuroimaging research on developmental stuttering between 1995 and 2016

PURPOSE

Stuttering is a disorder that affects millions of people all over the world. Over the past two decades, there has been a great deal of interest in investigating the neural basis of the disorder. This systematic literature review is intended to provide a comprehensive summary of the neuroimaging literature on developmental stuttering. It is a resource for researchers to quickly and easily identify relevant studies for their areas of interest and enable them to determine the most appropriate methodology to utilize in their work. The review also highlights gaps in the literature in terms of methodology and areas of research.

METHODS

We conducted a systematic literature review on neuroimaging studies on developmental stuttering according to the PRISMA guidelines. We searched for articles in the pubmed database containing "stuttering" OR "stammering" AND either "MRI", "PET", "EEG", "MEG", "TMS"or "brain" that were published between 1995/​01/​01 and 2016/​01/​01.

RESULTS

The search returned a total of 359 items with an additional 26 identified from a manual search. Of these, there were a total of 111 full text articles that met criteria for inclusion in the systematic literature review. We also discuss neuroimaging studies on developmental stuttering published throughout 2016. The discussion of the results is organized first by methodology and second by population (i.e., adults or children) and includes tables that contain all items returned by the search.

CONCLUSIONS

There are widespread abnormalities in the structural architecture and functional organization of the brains of adults and children who stutter. These are evident not only in speech tasks, but also non-speech tasks. Future research should make greater use of functional neuroimaging and noninvasive brain stimulation, and employ structural methodologies that have greater sensitivity. Newly planned studies should also investigate sex differences, focus on augmenting treatment, examine moments of dysfluency and longitudinally or cross-sectionally investigate developmental trajectories in stuttering.

Sympathetic arousal as a marker of chronicity in childhood stuttering

PURPOSE

This study investigated whether sympathetic activity during a stressful speaking task was an early marker for stuttering chronicity.

METHOD

Participants were 9 children with persisting stuttering, 23 children who recovered, and 17 children who do not stutter. Participants performed a stress-inducing picture-naming task and skin conductance was measured across three time points.

RESULTS

Findings indicated that at the initial time point, children with persisting stuttering exhibited higher sympathetic arousal during the stressful speaking task than children whose stuttering recovered.

CONCLUSIONS

Findings are taken to suggest that sympathetic activity may be an early marker of heightened risk for chronic stuttering.

Young children's family history of stuttering and their articulation, language and attentional abilities: An exploratory study

PURPOSE

The purpose of this study was to determine whether young children who do (CWS) and do not stutter (CWNS) with a positive versus negative family history of stuttering differ in articulation, language and attentional abilities and family histories of articulation, language and attention related disorders.

METHOD

Participants were 25 young CWS and 50 young CWNS. All 75 participants' caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points that were about 8 months apart for a total of approximately 16 months. Each participant's family history focused on the same, relatively limited number of generations (i.e., participants' parents & siblings). Children's family history of stuttering as well as articulation, language, and attention related disorders was obtained from one or two caregivers during an extensive interview. Children's speech and language abilities were measured using four standardized articulation and language tests and their attentional abilities were measured using caregiver reports of temperament.

RESULTS

Findings indicated that (1) most caregivers (81.5% or 75 out 92) were consistent in their reporting of positive or negative history of stuttering; (2) CWNS with a positive family history of stuttering, compared to those with a negative family history of stuttering, were more likely to have reported a positive family history of attention deficit/hyperactivity disorder (ADHD), and (3) CWNS with a positive family history of stuttering had lower language scores than those with a negative family history of stuttering. However, there were no such significant differences in family histories of ADHD and language scores for CWS with a positive versus negative family history of stuttering. In addition, although 24% of CWS versus 12% of CWNS's caregivers reported a positive family history of stuttering, inferential analyses indicated no significant differences between CWS and CWNS in relative proportions of family histories of stuttering.

CONCLUSION

Finding that a relatively high proportion (i.e., 81.5%) of caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points should provide some degree of assurance to those who collect such caregiver reports. Based on such consistent caregiver reports, linguistic as well as attentional vulnerabilities appear associated with a positive family history of stuttering, a finding that must await further empirical study for confirmation or refutation.

Executive Functions Impact the Relation Between Respiratory Sinus Arrhythmia and Frequency of Stuttering in Young Children Who Do and Do Not Stutter

Purpose

This study sought to determine whether respiratory sinus arrhythmia (RSA) and executive functions are associated with stuttered speech disfluencies of young children who do (CWS) and do not stutter (CWNS).

Method

Thirty-six young CWS and 36 CWNS were exposed to neutral, negative, and positive emotion-inducing video clips, followed by their participation in speaking tasks. During the neutral video, we measured baseline RSA, a physiological index of emotion regulation, and during video viewing and speaking, we measured RSA change from baseline, a physiological index of regulatory responses during challenge. Participants' caregivers completed the Children's Behavior Questionnaire from which a composite score of the inhibitory control and attentional focusing subscales served to index executive functioning.

Results

For both CWS and CWNS, greater decrease of RSA during both video viewing and speaking was associated with more stuttering. During speaking, CWS with lower executive functioning exhibited a negative association between RSA change and stuttering; conversely, CWNS with higher executive functioning exhibited a negative association between RSA change and stuttering.

Conclusion

Findings suggest that decreased RSA during video viewing and speaking is associated with increased stuttering and young CWS differ from CWNS in terms of how their executive functions moderate the relation between RSA change and stuttered disfluencies.

Temperament and Early Stuttering Development: Cross-Sectional Findings From a Community Cohort

PURPOSE

The purpose of this study was to ascertain if there is an association between stuttering severity and behaviors and the expression of temperament characteristics, including precursors of anxiety.

METHOD

We studied temperament characteristics of a prospectively recruited community cohort of children who stutter (N = 173) at ages 3, 4, and 6 years using the Short Temperament Scale STS (Prior, Sanson, Smart & Oberklaid, 2000).

RESULTS

Six of 131 statistical tests of association between stuttering severity and behaviors and temperament traits were statistically significant at the 5% level, which was no more than expected by chance alone.

CONCLUSIONS

On the basis of parent responses to the STS, preschoolers who exhibited different levels of stuttering severity and behaviors did not generally express temperament traits differently from one another. Stuttering severity and stuttering behaviors were not associated with the precursors of anxiety. Overall, taking multiple tests into consideration, results show little evidence of association between stuttering severity and temperament up to 4 years of age or between stuttering behaviors and temperament up to 6 years of age.

Explicit and Implicit Verbal Response Inhibition in Preschool-Age Children Who Stutter

PURPOSE

The purpose of this study was to examine (a) explicit and implicit verbal response inhibition in preschool children who do stutter (CWS) and do not stutter (CWNS) and (b) the relationship between response inhibition and language skills.

METHOD

Participants were 41 CWS and 41 CWNS between the ages of 3;1 and 6;1 (years;months). Explicit verbal response inhibition was measured using a computerized version of the grass-snow task (Carlson & Moses, 2001), and implicit verbal response inhibition was measured using the baa-meow task. Main dependent variables were reaction time and accuracy.

RESULTS

The CWS were significantly less accurate than the CWNS on the implicit task, but not the explicit task. The CWS also exhibited slower reaction times than the CWNS on both tasks. Between-group differences in performance could not be attributed to working memory demands. Overall, children's performance on the inhibition tasks corresponded with parents' perceptions of their children's inhibition skills in daily life.

CONCLUSIONS

CWS are less effective and efficient than CWNS in suppressing a dominant response while executing a conflicting response in the verbal domain.

Evidence-Based Multifactorial Assessment of Preschool-Age Children Who Stutter

This review summarizes extant findings supporting multifactorial models of stuttering within the context of preschool-age stuttering assessment. Evidence is given for a number of speech-language and associated factors/domains to consider when evaluating young children who stutter. Selected factors are presented in two parts: (1) Caregiver Interview and (2) Direct Child Assessment. Factors addressed during caregiver interviews include: gender, time since and age at stuttering onset, family history of stuttering, caregivers' perception/concerns about stuttering, and temperament. Factors addressed during direct child assessments include: stuttering behaviors, speech-associated attitudes/awareness, and speech rate, as well as speech sound and language development. Interactions/relations among factors are noted, showing their combined effects and contributions to childhood stuttering. Additionally, suggested clinical applications are provided wherever appropriate. Such evidence and practical applications bridge the gap between theory and clinical practice, thus advancing the abilities of speech-language pathologists to conduct well-informed, comprehensive stuttering evaluations.

Emotional Diathesis, Emotional Stress, and Childhood Stuttering

PURPOSE

The purpose of this study was to determine (a) whether emotional reactivity and emotional stress of children who stutter (CWS) are associated with their stuttering frequency, (b) when the relationship between emotional reactivity and stuttering frequency is more likely to exist, and (c) how these associations are mediated by a 3rd variable (e.g., sympathetic arousal).

METHOD

Participants were 47 young CWS (M age = 50.69 months, SD = 10.34). Measurement of participants' emotional reactivity was based on parental report, and emotional stress was engendered by viewing baseline, positive, and negative emotion-inducing video clips, with stuttered disfluencies and sympathetic arousal (indexed by tonic skin conductance level) measured during a narrative after viewing each of the various video clips.

RESULTS

CWS's positive emotional reactivity was positively associated with percentage of their stuttered disfluencies regardless of emotional stress condition. CWS's negative emotional reactivity was more positively correlated with percentage of stuttered disfluencies during a narrative after a positive, compared with baseline, emotional stress condition. CWS's sympathetic arousal did not appear to mediate the effect of emotional reactivity, emotional stress condition, and their interaction on percentage of stuttered disfluencies, at least during this experimental narrative task following emotion-inducing video clips.

CONCLUSIONS

Results were taken to suggest an association between young CWS's positive emotional reactivity and stuttering, with negative reactivity seemingly more associated with these children's stuttering during positive emotional stress (a stress condition possibly associated with lesser degrees of emotion regulation). Such findings seem to support the notion that emotional processes warrant inclusion in any truly comprehensive account of childhood stuttering.

Sympathetic arousal of young children who stutter during a stressful picture naming task

PURPOSE

The purpose of the current study was to investigate sympathetic arousal of young children who do and do not stutter during a stressful picture-naming task under instructions to name pictures as rapidly as possible.

METHOD

Thirty-seven young children who stutter (CWS) and 39 young children who do not stutter (CWNS) served as participants. Dependent measures consisted of tonic skin conductance during a pretask baseline, a stress-inducing rapid picture-naming task, and post-picture-naming task condition.

RESULTS

Findings indicated that, when chronological age was not taken into account, there was no between-group difference in tonic skin conductance level. When age was taken into account, however, there was a significant talker group×age group interaction, with follow-up analyses indicating that 3-year-old CWS exhibited significantly higher sympathetic arousal than their CWNS peers, and their 4-year-old CWNS peers.

CONCLUSIONS

Findings were taken to be consistent with non-physiological results indicating an association between emotional processes and childhood stuttering. This association, at least for this cross-sectional study of tonic skin conductance level (SCL) during a picture-naming task, was moderated by children's chronological age. Such developmental differences may be associated with various processes, for example, attention, cognition, or physiology, or some combination of two or more of these processes. Future empirical study of these processes in young CWS and CWNS may profit from longitudinal measurement of converging lines of evidence from behavioral, parent and psychophysiological indexes of emotional reactivity and regulation.

EDUCATIONAL OBJECTIVES

After reading this article, the reader will be able to: (a) discuss salient findings in the literature regarding the association between emotional processes and childhood stuttering; (b) discuss sympathetic arousal, and how skin conductance is used to measure it; and (c) discuss the role of chronological age in the association between emotion and stuttering in young children.

Speech-Language Dissociations, Distractibility, and Childhood Stuttering

PURPOSE

This study investigated the relation among speech-language dissociations, attentional distractibility, and childhood stuttering.

METHOD

Participants were 82 preschool-age children who stutter (CWS) and 120 who do not stutter (CWNS). Correlation-based statistics (Bates, Appelbaum, Salcedo, Saygin, & Pizzamiglio, 2003) identified dissociations across 5 norm-based speech-language subtests. The Behavioral Style Questionnaire Distractibility subscale measured attentional distractibility. Analyses addressed (a) between-groups differences in the number of children exhibiting speech-language dissociations; (b) between-groups distractibility differences; (c) the relation between distractibility and speech-language dissociations; and (d) whether interactions between distractibility and dissociations predicted the frequency of total, stuttered, and nonstuttered disfluencies.

RESULTS

More preschool-age CWS exhibited speech-language dissociations compared with CWNS, and more boys exhibited dissociations compared with girls. In addition, male CWS were less distractible than female CWS and female CWNS. For CWS, but not CWNS, less distractibility (i.e., greater attention) was associated with more speech-language dissociations. Last, interactions between distractibility and dissociations did not predict speech disfluencies in CWS or CWNS.

CONCLUSIONS

The present findings suggest that for preschool-age CWS, attentional processes are associated with speech-language dissociations. Future investigations are warranted to better understand the directionality of effect of this association (e.g., inefficient attentional processes → speech-language dissociations vs. inefficient attentional processes ← speech-language dissociations).

Behavioral and social competency profiles of stutterers

PURPOSE: To investigate the behavioral and social competency profiles of individuals who stutter and to compare them with persons who do not stutter, according to their parents; to correlate the behavioral and the social competence performances with the severity of stuttering. METHODS: Sixty-four participants, aged 6 to 18 years, of both genders, were divided into two groups: the study group (SG), composed of 32 individuals with persistent developmental stuttering, and the control group (CG), composed of 32 fluent individuals. The procedures used were fluency assessment, stuttering severity instrument, and the Child Behavior Checklist inventory. RESULTS: In the behavioral profile of the SG, the mean of the total score and that of the internalizing problems were classified as clinical. The comparison between the groups showed differences in the behavioral profile concerning the total score, and in the internalizing and externalizing problems; and in the social profile, concerning the total score and activity scale. There were no statistically significant differences in the scales among the mild, moderate, and severe stuttering. CONCLUSION: According to the information provided by parents, children who stutter showed peculiar behavior and social competence, with a higher tendency to manifest alterations in this area, in comparison to those who do not stutter. Fear, nervousness/tension, guilt, anxiety, perfectionism, and worry were the most frequent alterations in relation to the behavior, whereas damages in the social field and in the habitual communication situations characterized the social competence of persons who stutter.

Autonomic nervous system activity of preschool-age children who stutter

PURPOSE

The purpose of this study was to investigate potential differences in autonomic nervous system (ANS) activity to emotional stimuli between preschool-age children who do (CWS) and do not stutter (CWNS).

METHODS

Participants were 20 preschool-age CWS (15 male) and 21 preschool-age CWNS (11 male). Participants were exposed to two emotion-inducing video clips (negative and positive) with neutral clips used to establish pre-and post-arousal baselines, and followed by age-appropriate speaking tasks. Respiratory sinus arrhythmia (RSA)-often used as an index of parasympathetic activity-and skin conductance level (SCL)-often used as an index of sympathetic activity-were measured while participants listened to/watched the audio-video clip presentation and performed a speaking task.

RESULTS

CWS, compared to CWNS, displayed lower amplitude RSA at baseline and higher SCL during a speaking task following the positive, compared to the negative, condition. During speaking, only CWS had a significant positive relation between RSA and SCL.

CONCLUSION

Present findings suggest that preschool-age CWS, when compared to their normally fluent peers, have a physiological state that is characterized by a greater vulnerability to emotional reactivity (i.e., lower RSA indexing less parasympathetic tone) and a greater mobilization of resources in support of emotional reactivity (i.e., higher SCL indexing more sympathetic activity) during positive conditions. Thus, while reducing stuttering to a pure physiological process is unwarranted, the present findings suggest that the autonomic nervous system is involved.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) summarize current empirical evidence on the role of emotion in childhood stuttering; (b) describe physiological indexes of sympathetic and parasympathetic activity; (c) summarize how preschool-age children who stutter differ from preschool-age children who do not stutter in autonomic activity; (d) discuss possible implications of current findings in relation to the development of childhood stuttering.

Stuttering, temperament, and anxiety: data from a community cohort ages 2-4 years

PURPOSE

The purpose of this study was to ascertain whether and when temperament differences, including precursors of anxiety, emerge before onset and during stuttering development.

METHOD

The authors prospectively studied temperament characteristics of a community cohort of children who stutter (N = 183) and children in the control group (N = 1,261).

RESULTS

No significant differences were found at ages 2, 3, or 4 years between children who stutter and control children for approach or at ages 3 or 4 years for easy/difficult temperament. Both of these measures are precursors of anxiety. Significant differences were found for reactivity and persistence at age 3 years. Children who stutter were less reactive to environmental stimuli and had a reduced ability to attend to a task until completion. There was no evidence of this difference for persistence at age 4 years. Reactivity was not measured at age 4 years.

CONCLUSION

On the basis of parents' responses to the Short Temperament Scale, preschoolers who stutter did not have innately different temperaments from control children on those temperament traits measured from ages 2 to 4 years. They showed no signs of temperament precursors of anxiety before stuttering onset or shortly after. Results suggest, at most, that temperament is influenced somehow during the period after stuttering onset but with a waning developmental influence subsequently.

Research updates in neuroimaging studies of children who stutter

In the past two decades, neuroimaging investigations of stuttering have led to important discoveries of structural and functional brain differences in people who stutter, providing significant clues to the neurological basis of stuttering. One major limitation, however, has been that most studies so far have only examined adults who stutter, whose brain and behavior likely would have adopted compensatory reactions to their stuttering; these confounding factors have made interpretations of the findings difficult. Developmental stuttering is a neurodevelopmental condition, and like many other neurodevelopmental disorders, stuttering is associated with an early childhood onset of symptoms and greater incidence in males relative to females. More recent studies have begun to examine children who stutter using various neuroimaging techniques that allow examination of functional neuroanatomy and interaction of major brain areas that differentiate children who stutter compared with age-matched controls. In this article, I review these more recent neuroimaging investigations of children who stutter, in the context of what we know about typical brain development, neuroplasticity, and sex differences relevant to speech and language development. Although the picture is still far from complete, these studies have potential to provide information that can be used as early objective markers, or prognostic indicators, for persistent stuttering in the future. Furthermore, these studies are the first steps in finding potential neural targets for novel therapies that may involve modulating neuroplastic growth conducive to developing and maintaining fluent speech, which can be applied to treatment of young children who stutter.

Temperament, emotion, and childhood stuttering

Reactivity refers to arousal of emotions, motor activity, and attention, and self-regulation refers to the ability to moderate those tendencies. In general, temperament is typically thought of as an individual's constitutionally (biologically) based behavioral proclivities. These proclivities often include emotional reactivity and self-regulation. Reactivity refers to arousal of emotions, motor activity, and attention, and self-regulation refers to the ability to moderate those tendencies. The traitlike nature of temperament makes it potentially salient to our understanding of the onset and development of stuttering because temperamental tendencies may result in greater reactivity or difficulty in coping. Emotions, which are more statelike and variable, may influence the variation of stuttering commonly observed both within and between speaking situations. Temperament and emotion may serve as a causal contributor to developmental stuttering, with empirical findings indicating that preschool-aged children who stutter (CWS) exhibit differences in temperament and emotion when compared with children who do not stutter. Given that empirical study of temperament in preschool-aged CWS is nascent, extensive discussion of clinical implications is challenging. With that caution, we present some early possibilities, including matching treatment approaches with the child's temperamental profile and using temperament as a predictor of treatment outcome.

Speech disfluencies of preschool-age children who do and do not stutter

PURPOSE

The goals of the present study were to investigate whether (1) the speech disfluencies of preschool-age children are normally distributed; (2) preschool-age children who do (CWS) and do not stutter (CWNS) differ in terms of non-stuttered disfluencies; (3) age, gender, and speech-language ability affect the number and type of disfluencies children produce; and (4) parents' expressed concern that their child stutters is associated with examiners' judgments of stuttered disfluency.

METHOD

Four hundred and seventy two children participated, of which 228 were CWS (56 girls), and 244 CWNS (119 girls). Participants provided conversational speech samples that were analyzed for frequency of occurrence of (a) stuttered disfluencies, (b) non-stuttered disfluencies, and (c) total disfluencies.

RESULTS

Results indicated that the underlying distributions of preschool-age children's stuttered and non-stuttered disfluency counts followed a negative binomial distribution (i.e., were not normal), with more children "piling up" at the low end [none or few disfluencies] and fewer children scoring in the upper [more severe stuttering] end of the distribution. Findings also indicated that non-stuttered disfluencies significantly predicted CWS/CWNS talker group classification, information that may be helpful to augment, but not supplant, talker group classification criteria based on stuttered disfluencies. Moreover, expressed parental concern about stuttering was strongly associated with frequency of stuttered disfluencies.

CONCLUSION

Findings suggest that the entirety of preschool-age CWS' speech disfluencies - non-stuttered as well as stuttered - differs from that of their CWNS peers and that because these disfluencies are not normally distributed statistical analyses assuming normality of distribution are not the most appropriate means to assess these differences. In addition, certain "third-order" variables (e.g., gender) appear to impact frequency of children's disfluencies and expressed parental concerns about stuttering are meaningfully related to examiners' judgments of stuttered disfluencies.

LEARNING OUTCOMES

The reader will recognize differences in speech disfluencies of preschool-age children who do and do not stutter. The reader will recognize whether age, gender and speech-language ability affect the number and type of disfluencies children produce. The reader will describe whether parental concern about stuttering is associated with examiners' judgments of stuttering.

Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter

PURPOSE

The purpose of this study was to assess the relation between emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter (CWS) and those who do not (CWNS).

PARTICIPANTS

Participants were eight 3 to 6-year old CWS and eight CWNS of comparable age and gender.

METHODS

Participants were exposed to three emotion-inducing overheard conversations--neutral, angry and happy--and produced a narrative following each overheard conversation. From audio-video recordings of these narratives, coded behavioral analysis of participants' negative and positive affect and emotion regulation associated with stuttered and fluent utterances was conducted.

RESULTS

Results indicated that CWS were significantly more likely to exhibit emotion regulation attempts prior to and during their fluent utterances following the happy as compared to the negative condition, whereas CWNS displayed the opposite pattern. Within-group assessment indicated that CWS were significantly more likely to display negative emotion prior to and during their stuttered than fluent utterances, particularly following the positive overheard conversation.

CONCLUSIONS

After exposure to emotional-inducing overheard conversations, changes in preschool-age CWS's emotion and emotion regulatory attempts were associated with the fluency of their utterances.

LEARNING OUTCOMES

After reading this article, the reader will be able to: (1) describe various measures of emotional reactivity and regulation, including parent-based reports and behavioral coding, and how they may contribute to childhood stuttering; (2) explain emotional differences between the stuttered and fluent utterances of CWS and CWNS; and (3) discuss how emotions may contribute to CWS' instances of stuttering.