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

Caregiver Predictions of Their 3- to 6-Year-Old Child Who Stutters' Communication Attitude

PURPOSE

Caregivers share critical insight during their child's stuttering evaluation; yet, there have been no empirical studies evaluating whether caregivers provide similar accounts of their 3- to 6-year-old child's communication attitude compared to their child's self-report. This study examined caregiver- and child-reported communication attitude and assessed potential moderators of more comparable caregiver and child ratings (i.e., caregiver confidence, caregiver-child conflict, observer-rated stuttering severity).

METHOD

One hundred thirteen children who stutter ages 3 through 6 years and a primary caregiver were recruited from clinical settings across the United States. Children completed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT) and three speaking samples, which were recorded to assess observer-rated stuttering severity using the Stuttering Severity Instrument-Fourth Edition. Caregivers predicted their child's communication attitude (C-KiddyCAT) and provided a confidence rating for their prediction. Caregivers also rated caregiver-child conflict using the Child-Parent Relationship Scale-Short Form (CPRS-SF). Multiple regression was used to (a) evaluate whether caregiver C-KiddyCAT scores predicted child KiddyCAT scores and (b) assess potential moderators of the relationship between C-KiddyCAT and KiddyCAT scores.

RESULTS

Caregiver ratings of their child's communication attitude (C-KiddyCAT) predicted child communication attitude ratings (KiddyCAT). A significant interaction between caregiver-child conflict (CPRS-SF) and caregiver ratings of their child's communication attitude (C-KiddyCAT) suggested caregiver-child conflict changed the underlying relationship between C-KiddyCAT and KiddyCAT scores, such that low conflict resulted in more similar C-KiddyCAT and KiddyCAT scores. Neither caregiver confidence nor observer-rated stuttering severity influenced the relationship between C-KiddyCAT and KiddyCAT scores.

CONCLUSIONS

Although many caregivers predicted communication attitude ratings that closely aligned with their child's report, some caregiver-child dyads provided divergent ratings. Clinicians should interpret caregiver predictions of their child's communication attitude within the context of their full evaluation and the caregiver-child relationship. Assessing both self-reported communication attitude and caregiver predictions of their child's communication attitude provides a meaningful starting point to counseling caregivers about cognitive components of stuttering for preschool- and kindergarten-age children who stutter.

Speech Disfluencies in Bilingual Lebanese Children Who Do and Do Not Stutter

PURPOSE

Prior studies have shown that bilingual children who do not stutter (CWNS) exhibit a high number of disfluencies in both languages, increasing the risk of misidentification by speech-language pathologists as children who stutter (CWS). Conversely, there is a risk of misidentifying CWS with a relatively low incidence of disfluencies as CWNS. This study aims to explore the qualitative and quantitative distinctions in speech disfluency profiles between CWNS and CWS. The assessment covers both the dominant and nondominant language to examine the impact of language dominance on disfluency patterns.

METHOD

A total of 92 Lebanese bilinguals (70 CWNS and 22 CWS) from 4;06 to 7;06 (years;months) were included. Language dominance was determined based on parental assessments. Spontaneous and narrative speech samples were collected for each child in both languages and all stuttering-like disfluencies (SLD) and other disfluencies (OD) were coded.

RESULTS

On average, CWNS showed a significantly lower percentage of total SLD, weighted SLD, SLD subtypes, and iterations compared to CWS. However, the number of disfluencies of CWNS exceeded monolingual clinical standards. Language dominance did not impact SLD and OD percentages, but some differences for SLD subtypes emerged. Binary logistic regression analyses showed that repetitions and dysrhythmic phonations are good predictors for correct CWS or CWNS classification, in contrast to OD. A combination of predictors from both languages led to better classification than using predictors from either language alone.

CONCLUSIONS

The current study shows that speech disfluency percentages in bilingual CWNS typically surpass monolingual standards and can be at par with those of CWS. However, through careful consideration of disfluency characteristics, ideally in both languages, an accurate differential diagnosis of stuttering in bilingual children can be achieved.

Inhibitory Control, Cognitive Flexibility, and the Production of Disfluencies in Children Who Do and Do Not Stutter

PURPOSE

Differences in inhibitory control and cognitive flexibility between children who stutter (CWS) and children who do not stutter (CWNS) have been previously demonstrated. The aim of the current study was to investigate whether the previously reported inhibitory control- and cognitive flexibility-related performance costs for CWS are associated with the number of speech disfluencies that they produce.

METHOD

Participants were 19 CWS (Mage = 7.58 years, range: 6.08-9.17) and 19 CWNS matched on age and gender (Mage = 7.58 years, range: 6.08-9.33). Gamma regression models were used to investigate possible associations between performance costs in speed and accuracy measured during a computer task evaluating inhibitory control and cognitive flexibility and the number of speech disfluencies during video-recorded speech samples (story retelling and casual conversation).

RESULTS

Two significant interactions were observed. For both inhibitory control and cognitive flexibility, we identified a significant group and inhibitory control/cognitive flexibility performance-cost interaction in stuttering-like disfluencies (SLDs), indicating that the performance-cost effects on SLD production were significantly higher in the CWS group, compared to the CWNS group.

CONCLUSIONS

CWS with reduced inhibitory control or cognitive flexibility produce more SLDs, but not other disfluencies. These results are partly in line with some previous findings in nonstuttering and stuttering populations linking inhibitory control and cognitive flexibility weaknesses to the production of speech disfluencies.

Linguistic disfluencies in Russian-speaking typically and atypically developing children: individual variability in different contexts

Disfluency in children and adults seems to occur like errors of speech but, at the same time, is an essential feature of spontaneous (unprepared) speech. The present study aimed to evaluate linguistic disfluencies in typically and atypically developing Russian-speaking children from the perspective of the dynamic adaptive model of self-monitoring in speech production. The study collected four language samples from 10 six-year-old children with developmental language disorder and 14 typically developing peers: two storytelling tasks, structured conversation, and a play argument. After transcribing audio-recordings and marking linguistic disfluencies, the authors conducted structured distributional analysis. The distribution of several indexes of disfluency was estimated to assess the prevalence and profiles of different (sub)types of disfluencies. The disfluency rate statistics were similar between the typically developing children and children with developmental language disorder. The distributional indexes score showed that tasks significantly impacted the rate of different (sub)types of disfluencies. Task-related patterns in a set of the distributional indexes significantly distinguished the groups. Thus, changes in the disfluency profile related to different external factors, as a sign of a flexibility of an adaptive self-monitoring system, may be limited in children with developmental language disorder.

Disfluencies in the narratives of Russian-Hebrew bilingual children with and without Developmental Language Disorder (DLD)

The present study examined disfluencies in the narratives of Russian-Hebrew bilingual children with Developmental Language Disorder (DLD) and Typical Language Development (TLD) in both Russian (home language) and Hebrew (societal language), with a focus on the independent and combined effects of language disorder and cross-linguistic differences on the rates and loci of disfluencies. Narratives were collected from 44 bilingual children (14 with DLD), ages 5;7-6;6, using a story retelling procedure. The narrative coding system targeted ratios of the following disfluencies (per C-unit): silent pauses, repetitions, self-corrections, and filled pauses. Silent pauses longer than 0.25 sec were identified using PRAAT software© and were classified according to the following durations: more than 0.5 sec, 1 sec, 1.5 sec, and 2 sec. In addition, the loci of pauses (utterance-initial or utterance-internal) and repetitions (content or function words) were coded. Overall, children with DLD and TLD had comparable rates of disfluencies but differed for pauses longer than 0.5 sec and repetition of content words in both languages. For the overall ratio of pauses (more than 0.25 sec), children with and without DLD had more pauses in Russian. Long pauses and repetition of content words reflect difficulties for bilingual children with DLD in dealing with the demands of storytelling, in particular planning processes. A higher ratio of pauses in Russian suggests that they reflect lower proficiency in that language.

Syllable- and word-based measures of stuttering in speech samples of Turkish-speaking school-aged children

Linguistic factors influence the likelihood of occurrence of stuttering instances on a certain word within an utterance. However, studies on the relationship between stuttering instances and linguistic factors of Turkish-speaking individuals are scarce. This study aimed to determine the syllable- and word-based measures of stuttering speech samples of Turkish-speaking school-aged children who stutter. Stuttering-like disfluencies (SLDs) and lexical categories were identified after transcription of 61 children's spontaneous speech samples (age range = 6-16). Syllable-, word- and utterance-level measures were employed. Syllable-based and word-based stuttering frequency findings were significantly different (p < .001); SLDs were more likely to occur at the utterance-initial (p < .001) and word-initial (p < .001) positions; content words were more likely to be stuttered and, there was a relation between the occurrence of SLDs and utterance length (p = .001). Since there is great variability between word-based and syllable-based measures, and SLDs tend to occur at word onsets, using word-based measures in Turkish would provide a measure of stuttering frequency that is comparable to the literature. Moreover, findings support that phrases requiring greater demands on utterance planning increase the possibility of occurrence of stuttering instances.

Attention networks in multilingual adults who do and who do not stutter

This study investigated whether multilinguals who stutter differ from multilinguals who do not stutter in terms of attention networks. Towards that end, it measured (a) performance differences in attention networks between multilinguals who stutter and those who do not stutter and (b) the correlation between stuttering characteristics and attention networks. Twenty-four multilingual Dutch-English speaking adults (20-46y), half of whom were diagnosed with stuttering, completed the Attentional Network Task (ANT) that evaluates the attention networks of alerting, orienting, and executive control. A language and social background questionnaire and a lexical decision task (LexTALE) assessed the participants' language proficiency. The Stuttering Severity Instrument 4th Ed. and the Brief Version of the Unhelpful Thoughts and Beliefs About Stuttering Scale were used to evaluate stuttering characteristics. The two groups did not differ in the ANT in terms of reaction time and error rate scores. Furthermore, no differences were observed in the three attention networks between the groups. Lastly, no correlation was found between stuttering characteristics and attention networks. The results suggest that the attention abilities of multilinguals who stutter do not differ from multilinguals who do not stutter.

Manifestation of speech disfluencies in preschool Cantonese-English speaking bilingual children

Stuttering is characterised by disruptions in speech fluency that normally emerges between the ages of 2 to 5 when children start to formulate sentences. Current stuttering identification in children is largely based on speech disfluency criteria (>3% stuttering-like disfluencies, SLDs) developed for monolingual English-speaking children. Research in a Western language context shows that application of the criteria for monolingual to bilingual children may result in false positive diagnosis of stuttering. The applicability of these criteria to children speaking languages typologically distinct from English remains unclear. This preliminary study focused on bilingual Cantonese-English-speaking children, aiming to explore the manifestations of the speech disfluencies in Cantonese (a syllable-timed language) and English (a stress-timed language) while accounting for language dominance/proficiency and speaking task. Nineteen typically fluent Cantonese-English bilingual preschoolers were recruited for this study and their speech samples were collected across different speaking tasks (i.e. conversation and narration), and languages (i.e. Cantonese and English). The types and frequency of speech disfluencies were compared across both languages and the speaking tasks. The results showed that between 21-68% of children showed higher than 3% SLDs across different languages and speaking tasks. Linear mixed-effect analysis revealed that the prevalence of SLDs is higher in English (less dominant language) than Cantonese (more dominant language), and the prevalence is also higher in narration than conversation. These findings suggest the need for tailored stuttering identification criteria for bilingual children speaking diverse languages and emphasise the importance of considering language dominance/proficiency and speaking task when assessing stuttering in bilingual populations.

Unique Patterns of Bilingual Speech: Factors Affecting Disfluency Rates in Russian-Hebrew Bilingual Children

PURPOSE

Bilingual children often demonstrate a high rate of disfluencies, which might impact the diagnostic evaluation of fluency disorders; however, research on the rates and types of disfluencies in bilinguals' two languages is limited. The purpose of this research is to profile disfluencies of two types, stuttering-like disfluencies (SLDs) and other disfluencies (ODs), in the speech of Russian-Hebrew bilingual typically developing children, focusing on cross-linguistic differences and the effect of language proficiency in both languages.

METHOD

Spontaneous narratives based on the Frog, Where Are You? (Mayer, 1969) picture book were collected in both languages from 40 bilingual Russian-Hebrew children aged 5;6-6;6 (years;months). The transcribed narratives were coded for SLD (sound, syllable, and monosyllabic word repetitions) and OD (multisyllabic word/phrase repetitions, interjections, and revisions), and their frequencies per 100 syllables were calculated.

RESULTS

Overall, most children had a percentage of SLD and OD below the cutoff point and within the existing criteria for stuttering diagnosis established based on monolingual data, but several children exceeded this stuttering criterion. Monosyllabic word repetitions (part of SLD) and interjections (part of OD) were more frequent in Hebrew than in Russian. Lower proficiency was associated with a higher percentage of monosyllabic word repetitions and of interjections in both languages.

CONCLUSIONS

Bilingual disfluency criteria are needed, since based on the existing monolingual criteria, some children might be erroneously assessed as children who stutter, thus leading to overdiagnosis. The results support the claim that proficiency is an important factor in the production of disfluencies.

Effects of behavior inhibition on stuttering severity and adverse consequences of stuttering in 3-6-year-old children who stutter

PURPOSE

The purpose of this study was to investigate whether 3- to-6-year-old children who stutter and exhibit a higher degree of behavioral inhibition (BI), a correlate of shyness, stutter more frequently and experience greater negative consequences of stuttering (per parent-report) than their peers who stutter but have lower BI.

METHOD

Forty-six children who stutter (CWS; 35 boys & 11 girls; mean age 4 years, 2 months) participated. Their degree of BI was assessed by measuring the latency to their 6th spontaneous comment during a conversation with an unfamiliar examiner (following Kagan, Reznick, & Gibbons's (1989) methodology). The frequency of stuttering and the negative impact of stuttering that CWS may have experienced was assessed using parent reports (i.e., Test of Childhood Stuttering (TOCS) Observational Rating Scale; Gillam, Logan, & Pearson, 2009).

RESULTS

We found that children's degree of BI was not associated with their speech fluency per parent report. However, children's degree of BI was significantly associated with greater negative consequences of stuttering. Specifically, among the four categories of TOCS Disfluency-Related Consequences, children's BI significantly predicted the occurrence of physical behaviors that accompany moments of stuttering (such as increased tension or excessive eye blinks). Other Disfluency-Related Consequences, such as avoidance behaviors, negative feelings, and negative social consequences, were not associated with children's behavioral inhibition tendencies. Additionally, children's stuttering severity (per the Stuttering Severity Instrument-4 scores) was significantly associated with increased physical behaviors that accompany moments of stuttering and greater negative social consequences of stuttering.

CONCLUSIONS

This study provides empirical evidence that behavioral inhibition to the unfamiliar may have salience for childhood stuttering as it predicted the development of physical behaviors associated with stuttering (e.g., tension or struggle) in 3- to 6-year-old CWS. Clinical implications of high BI for the assessment and treatment of childhood stuttering are discussed.

Identification of stuttering in bilingual Lebanese children across two presentation modes

The goals of this study were to investigate whether Lebanese speech-language pathologists (SLPs) are accurate at identifying stuttering in bilingual children, to examine whether the use of video-recordings instead of audio-recordings allows for better analyses, and to explore factors that may affect the SLPs' judgments. In phase 1, 32 SLPs listened to narrative samples in Lebanese Arabic of 6 children who do not stutter (CWNS) and 2 who stutter (CWS). They were instructed to label each child as stuttering or not, and to explain what motivated their decisions. Afterwards, they were asked to provide background information by means of a questionnaire. In phase 2, they were asked to judge the same speech samples on the basis of video-recordings, and to explain for each child which speech characteristics they relied on to make their decisions. The results showed that misidentification happens frequently, is significantly more likely to happen with CWNS than with CWS, but also varies within these categories. Moreover, the use of video-recordings does not provide more reliable analyses of speech disfluencies, and speech samples' characteristics and bilingual profile rather than SLPs' characteristics seem to influence the judgments. Qualitative analyses indicate that, in the current study, misidentification may be driven by neglecting or misinterpreting physical concomitants. In general, the findings indicate that identifying and analyzing speech fluency behaviors remain a challenging perceptual task, which underlies the need for developing consistent methods for training students and clinicians in identifying stuttering, especially in a bilingual context.

Behavioral and cognitive-affective features of stuttering in preschool-age children: Regression and exploratory cluster analyses

PURPOSE

The purpose of this study was to investigate associations among behavioral and cognitive-affective features of stuttering in preschool-age children who stutter, and the extent to which participants may or may not cluster together based on multiple indices of stuttering.

METHODS

Participants were 296 preschool-age children who stutter (mean age 47.9 months). Correlation and regression analyses, as well as k-means cluster analyses were conducted between and among several indices of stuttering: frequency of stuttering- and non-stuttering-like disfluencies (SLDs and NSLDs), ratios of repetitions and prolongations/blocks out of total number of SLDs, associated nonspeech behaviors, duration of stuttering events, KiddyCAT scores (Vanryckeghem & Brutten, 2007), and a TOCS parent-rated scale (Gillam et al., 2009).

RESULTS

For preschool-age children who stutter, most indices of overt stuttering behaviors were intercorrelated (e.g., more SLDs were associated with higher ratio of repetitions). Self-reported KiddyCAT scores (Vanryckeghem & Brutten, 2007) were largely not significantly associated with stuttering. Cluster analyses yielded two participant groupings: a larger group with less prominent stuttering features and a smaller group with more prominent features.

CONCLUSIONS

This study contributes to an increasingly comprehensive and nuanced understanding of the heterogeneous features of stuttering and their development in preschool-age children. Findings show strong intercorrelations between measures of stuttering behaviors, but more tenuous relationships between behaviors and cognitive-affective reactions to stuttering. Exploration of clusters of characteristics within this population revealed potential opportunities for future research.

Exploratory Examination of Speech Disfluencies in Spoken Narrative Samples of School-Age Bidialectal Children

PURPOSE

This study examined the relationship between school-age children's speech disfluencies and the use of and variation of Mainstream American English (MAE) and African American English (AAE). Given that bilingual children may present with notably more speech disfluencies than monolingual children, it was hypothesized that bidialectal speaking children (i.e., those that use both MAE and AAE) may exhibit higher speech disfluencies, as compared to children who speak mainly MAE and those who mainly speak AAE. It was also hypothesized that bidialectal speaking children would exhibit a greater variety of speech disfluency types when compared to the other two dialect groups (i.e., MAE and AAE).

METHOD

School-age children (n = 61) with typical development and fluency were classified into three dialect groups: MAE speakers (n = 21), bidialectal MAE-AAE speakers (n = 11), and AAE speakers (n = 29). Tell-retell narrative samples were elicited from each participant using a wordless picture book. Speech disfluencies exhibited during these narrative samples were examined for frequency of stuttering-like and nonstuttering-like speech disfluencies and type of speech disfluency.

RESULTS

Findings indicated that bidialectal speaking children do not present with a higher frequency of speech disfluencies when compared to children who speak MAE and children who speak AAE. Additionally, there were no differences in the types of speech disfluencies exhibited by the different dialect groups.

CONCLUSIONS

Unexpected findings of this study nullify both hypotheses and suggest that bidialectalism, in comparison to bilingualism, has less of an impact on speech fluency. Findings provide evidence that bidialectal speaking children are not at an increased risk for a misdiagnosis of stuttering. Clinically, these preliminary findings provide some scientific validity and specification to the appropriateness of using already established diagnostic criteria commonly used for stuttering with dialect speakers.

A Preliminary Study of Speech Rhythm Differences as Markers of Stuttering Persistence in Preschool-Age Children

PURPOSE

The purpose of this study was twofold: (a) to determine whether there are speech rhythm differences between preschool-age children who stutter that were eventually diagnosed as persisting (CWS-Per) or recovered (CWS-Rec) and children who do not stutter (CWNS), using empirical spectral analysis and empirical mode decomposition of the speech amplitude envelope, and (b) to determine whether speech rhythm characteristics close to onset are predictive of later persistence.

METHOD

Fifty children (3-4 years of age) participated in the study. Approximately 2-2.5 years after the experimental testing took place, children were assigned to the following groups: CWS-Per (nine boys, one girl), CWS-Rec (18 boys, two girls), and CWNS (18 boys, two girls). All children produced a narrative based on a text-free storybook. From the audio recordings of these narratives, fluent utterances were selected for each child from which seven envelope-based measures were extracted. Group-based differences on each measure as well as predictive analyses were conducted to identify measures that discriminate CWS-Per versus CWS-Rec.

RESULTS

CWS-Per were found to have a relatively higher degree of power in suprasyllabic oscillations and greater variability in the timing of syllabic rhythms especially for longer utterances. A logistic regression model using two speech rhythm measures was able to discriminate the eventual outcome of recovery versus persistence, with 80% sensitivity and 75% specificity.

CONCLUSION

Findings suggest that envelope-based speech rhythm measures are a promising approach to assess speech rhythm differences in developmental stuttering, and its potential for identification of children at risk of developing persistent stuttering should be investigated further.

A Comprehensive Analysis of Speech Disfluencies in Autistic Young Adults and Control Young Adults: Group Differences in Typical, Stuttering-Like, and Atypical Disfluencies

PURPOSE

The purpose of this study was to examine the nature of speech disfluencies in autistic young adults and controls by using a wide-range disfluency classification of typical disfluencies (TD; i.e., filled pauses, revisions, abandoned utterances, and multisyllable word and phrase repetitions), stuttering-like disfluencies (SLD; i.e., sound and syllable repetitions, monosyllable word repetitions, prolongations, blocks, and broken words), and atypical disfluencies (AD; i.e., word-final prolongations and repetitions and atypical insertions).

METHOD

Thirty-two autistic young adults and 35 controls completed a narrative telling task based on socially complex events. Frequencies of total disfluencies, TD, SLD, AD and stuttering severity were compared between groups.

RESULTS

The overall frequency of disfluencies was significantly higher in the autistic group and significant between-group differences were found for all disfluency categories. The autistic group produced significantly more revisions, filled pauses, and abandoned utterances, and each subtype of SLD and AD than the control group. In total, approximately every fourth autistic participants scored at least a very mild severity of stuttering, and every fifth produced more than three SLD per 100 syllables.

CONCLUSIONS

Disfluent speech can be challenging for effective communication. This study revealed that the speech of autistic young adults was highly more disfluent than that of the controls. The findings provide information on speech disfluency characteristics in autistic young adults and highlight the importance of evaluating speech disfluency with a wide-range disfluency classification in autistic persons in order to understand their role in overall communication. The results of this study offer tools for SLPs to evaluate and understand the nature of disfluencies in autistic persons.

The Pausing Strategies in Chinese Preschool Children's Narratives

PURPOSE

Language production, a dynamic process involving real-time language processing, is crucial for children's language and communication development. To explore the early development of children's real-time language production, this study investigated Chinese preschool children's pausing strategies in narratives and their associations with verbal working memory and vocabulary abilities.

METHOD

A picture-elicited narrative task was employed. Sixty Mandarin-speaking children aged 4-5 years were asked to tell a story according to the book Frog, Where Are You? The pausing types and positions in narratives were coded and analyzed. Additionally, children's verbal working memory and vocabulary were measured.

RESULTS

The results showed that 4- to 5-year-old children prefer to use silent pauses and tend to produce pauses within clauses. The total frequency of pausing decreases with age and shows a significant gender difference. Girls prefer to use within-clause pauses, whereas boys prefer to use between-clause pauses. More importantly, children's pausing frequency is closely associated with their verbal working memory and vocabulary, in which working memory plays a more important role.

CONCLUSIONS

This study is a first-step exploration of pausing strategies in 4- to 5-year-old Chinese children's narratives. The developmental characteristics of pausing strategies shown in typically developing children serve as a crucial reference for interventions for children with language deficits.

Stuttering Behavior in a National Age Cohort of Norwegian First-Graders With Down Syndrome

PURPOSE

The aims of this study were to investigate the occurrence of stuttering behavior across time and to evaluate the relationship between stuttering behavior and language ability in children with Down syndrome.

METHOD

A national age cohort of Norwegian first graders with Down syndrome (N = 75) participated in the study. Speech samples from a story-retelling task and a picture book dialogue as well as standardized measures of vocabulary, grammar, and nonverbal mental ability were collected at two time points approximately 5 months apart. Stuttering behavior was evaluated through counting stuttering-like disfluencies and stuttering severity ratings. The relationship between stuttering behavior and language ability was investigated through hierarchical regression analysis.

RESULTS

The participants had stuttering severity ratings ranging from no stuttering behavior to severe and displayed all types of stuttering-like disfluencies. There were significant relationships between stuttering behavior and language ability at the first time point, whereas the relationships were not significant at the second time point. The stuttering severity ratings were significantly predicted by language ability across time, whereas the frequency of stuttering-like disfluencies was not.

CONCLUSIONS

The occurrence of stuttering behavior was high across the measures and time points; however, the relationship between stuttering behavior and language ability varied across these variables. Thus, the nature of the relationship does not seem to follow a strict pattern that can be generalized to all children across time.

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.

Word-finding behaviours in narration for typically developing French speakers of school age

BACKGROUND

Research in word-finding difficulties is sparse, especially in languages other than English. As a result, the factors associated with the frequency of word-finding behaviours are poorly understood, particularly in discourse.

AIMS

This exploratory study is the first to collect data relative to the expected frequency of word-finding behaviours in narration for French speakers aged 7-12 years old with typical development; and (2) to identify the factors associated with the frequency of word-finding behaviours in narration. We hypothesized that sociodemographic characteristics, language abilities and characteristics of the spoken productions could be linked to word-finding behaviours.

METHODS & PROCEDURES

The participants consisted of 61 French-speaking children aged 7-12 years old (M = 9;09 years, SD = 1;06 years) with typical development. Children were asked to complete a receptive vocabulary task, a non-word-repetition task and two narrative tasks. The children's narrative samples were coded using a discourse analysis of word-finding behaviours, as described by Diane J. German.

OUTCOMES & RESULTS

Participants produced 39% of T-units with least one word-finding behaviour, which included relatively frequent use of repetitions and word reformulations. Regression analyses revealed that the participants' gender was the only significant variable associated with the frequency of word-finding behaviours in narration. Boys produced a higher percentage of T-units with at least one word-finding behaviour. Post-hoc analyses suggested that gender differences reflected differences in repetitions and word reformulations. Boys and girls did not differ on any other language measures collected.

CONCLUSIONS & IMPLICATIONS

Speech-language pathologists may want to take into account a child's gender when assessing word-finding difficulties in narration. Additional studies are needed to understand whether this finding extends to other word-finding tasks and to children with word-finding difficulties.

WHAT THIS PAPER ADDS

What is already known on the subject Studies in English have identified that analyses of word-finding behaviours in discourse can be used to correctly identify children with word-finding difficulties. Studies are needed in other languages to determine if this observation holds true across languages. Moreover, the factors associated with the frequency of word-finding behaviours in discourse are poorly understood. What this paper adds to existing knowledge The frequency of word-finding difficulties in narration was higher in our study of French-speaking children than in previous studies of English. Gender was the only factor associated with the frequency of word-finding difficulties. What are the potential or actual clinical implications of this work? The language and task used to assess word-finding skills as well as the child's gender may be important to take into account when assessing word-finding difficulties based on word-finding behaviours.

Psychophysiological Arousal in Young Children Who Stutter: An Interpretable AI Approach

The presented first-of-its-kind study effectively identifies and visualizes the second-by-second pattern differences in the physiological arousal of preschool-age children who do stutter (CWS) and who do not stutter (CWNS) while speaking perceptually fluently in two challenging conditions: speaking in stressful situations and narration. The first condition may affect children's speech due to high arousal; the latter introduces linguistic, cognitive, and communicative demands on speakers. We collected physiological parameters data from 70 children in the two target conditions. First, we adopt a novel modality-wise multiple-instance-learning (MI-MIL) approach to classify CWS vs. CWNS in different conditions effectively. The evaluation of this classifier addresses four critical research questions that align with state-of-the-art speech science studies' interests. Later, we leverage SHAP classifier interpretations to visualize the salient, fine-grain, and temporal physiological parameters unique to CWS at the population/group-level and personalized-level. While group-level identification of distinct patterns would enhance our understanding of stuttering etiology and development, the personalized-level identification would enable remote, continuous, and real-time assessment of stuttering children's physiological arousal, which may lead to personalized, just-in-time interventions, resulting in an improvement in speech fluency. The presented MI-MIL approach is novel, generalizable to different domains, and real-time executable. Finally, comprehensive evaluations are done on multiple datasets, presented framework, and several baselines that identified notable insights on CWSs' physiological arousal during speech production.

Dual-Task Effects on Concurrent Speech Production in School-Age Children With and Without Stuttering Disorders

PURPOSE

Contemporary motor theories indicate that well-practiced movements are best performed automatically, without conscious attention or monitoring. We applied this perspective to speech production in school-age children and examined how dual-task conditions that engaged sustained attention affected speech fluency, speech rate, and language productivity in children with and without stuttering disorders.

METHOD

Participants included 47 children (19 children who stutter, 28 children who do not stutter) from 7 to 12 years of age. Children produced speech in two baseline conditions with no concurrent task and under a dual-task condition requiring sustained attention to on-screen stimuli. Measures of speech fluency, speech rate, and language productivity were obtained for each trial and compared across conditions and groups.

RESULTS

Dual-task conditions resulted in a reduction in stutter-like disfluencies relative to the initial baseline speaking condition. Effects were similar for both groups of children and could not be attributed to decreases in language productivity or a simple order effect.

CONCLUSIONS

Findings suggest that diverting attention during the process of speech production enhances speech fluency in children, possibly by increasing the automaticity of motor speech sequences. Further research is needed to clarify neurophysiological mechanisms underlying these changes and to evaluate potential clinical applications of such effects.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19945838.

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.

Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approach

PURPOSE

The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering.

METHOD

We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated.

RESULTS

Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased.

CONCLUSIONS

Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

Linguistic aspects of stuttering: research updates on the language-fluency interface

PURPOSE

Although commonly defined as a speech disorder, stuttering interacts with the language production system in important ways. Our purpose is to summarize research findings on linguistic variables that influence stuttering assessment and treatment.

METHOD AND RESULTS

Numerous topics are summarized. First, we review research that has examined linguistic features that increase stuttering frequency and influence where it occurs. Second, we tackle the question of whether or not persons who stutter exhibit subtle language differences or deficits. Next, we explore language factors that appear to influence recovery from early stuttering in children. The final topic discusses the unique challenges inherent in differentially diagnosing stuttering in bilingual children. Clinical implications for each topic are discussed.

DISCUSSION

The article concludes with a discussion of the unique differences in the integration of language and speech demands by people who stutter, when compared to people who are typically fluent, and their clinical ramifications.

Speech fluency in bilinguals who stutter: Language proficiency and attentional demands as mediating factors

PURPOSE

The current study examines how speech disfluencies manifest themselves in the two languages of bilingual persons who stutter, starting from the hypothesis that stuttering is associated with an attentional deficit at the level of speech production.

METHODS

Twenty-eight bilingual people who stutter performed a spontaneous and a controlled speech production task, once in their dominant and once in their non-dominant language. The controlled production task (i.e. a network description task) was carried out once under a full-attention condition and once under a divided-attention condition where a non-linguistic, pitch discrimination task was performed simultaneously.

RESULTS

In both the spontaneous and the controlled speech task, bilingual persons who stutter produced more (typical and stuttering-like) disfluencies in their L2 than in their L1. Furthermore, whereas the typical disfluencies increased when attention was directed away from speech production, stuttering-like disfluencies decreased. This effect was however restricted to L2. In addition, L2 proficiency was generally found to be a predicting factor, with higher proficiency leading to fewer disfluencies.

CONCLUSIONS

These results suggest that speaking in a non-dominant language increases both typical and stuttering-like disfluencies in bilingual persons who stutter, but also that these two types of dysfluencies differ regarding their attentional origins. Our findings offer further support for attentional accounts of stuttering and have both theoretical and clinical implications.

Speech disfluencies in typically developing Finnish-speaking children - preliminary results

We investigated the speech disfluencies of 54 typically fluent Finnish-speaking children: 14 children randomly selected from a longitudinal study (age levels 2, 3, and 4 years), and 40 children from a cross-sectional study (age levels 6, 7, 8, and 9 years). Speech samples, collected during a semi-structured conversation, were analysed for disfluencies per 100 words and 100 syllables. No significant within-age effect was found for the total frequency of disfluencies or disfluency types among the 2- to 4-year-olds. Across the 6- to 9-year-olds, between-group differences were found for the total frequency and type of disfluencies. Clinically relevant was that the criterion to distinguish normally fluent children from those who stutter, i.e., <3 stuttering-like disfluencies (SLD) per 100 syllables, was applicable in all age groups whereas the criterion <3SLD per 100 words was not. Consequently, these preliminary results suggest that different guidelines are needed for defining normal disfluency from stuttering in different languages.

The Association between Difficulties with Speech Fluency and Language Skills in a National Age Cohort of Children with Down Syndrome

The present study (a) addressed difficulties in speech fluency in children with Down syndrome and typically developing children at a similar non-verbal level and (b) examined the association between difficulties with speech fluency and language skills in children with Down syndrome. Data from a cross-sectional parent survey that included questions about children's difficulties with speech fluency, as well as clinical tests from a national age cohort of 43 six-year-olds with Down syndrome and 57 young typically developing children, were collected. Fisher's exact test, Student's t-test, linear regression, and density ellipse scatter plots were used for analysis. There was a significantly higher occurrence of parent-reported difficulties with speech fluency in the children with Down syndrome. Higher language scores were significantly associated with a lower degree of difficulties; this association was strongest for vocabulary and phonological skills. Although difficulties with speech fluency were not reported for all children with Down syndrome, a substantially higher occurrence of such difficulties was reported compared to that for typically developing children. The significant association between difficulties with speech fluency and the level of language functioning suggests that speech fluency and language skills should be taken into consideration when planning treatment for children with Down syndrome.

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.

Comparison of Disfluent and Ungrammatical Speech of Preadolescents with and without ASD

This paper analyses disfluencies and ungrammatical expressions in the speech of 11-13-year-old Finnish-speaking boys with ASD (N = 5) and with neurotypical development (N = 6). The ASD data were from authentic group therapy sessions and neurotypical data from teacher-led group discussions. The proportion of disfluencies and ungrammatical expressions was greater in the speech of participants with ASD (26.4%) than in the control group (15.5%). Furthermore, a qualitative difference was noted: The ASD group produced long, complex disfluent turns with word searches, self-repairs, false starts, fillers, prolongations, inconsistent syntactic structures and grammatical errors, whereas in the control group, the disfluencies were mainly fillers and sound prolongations. The disfluencies and ungrammatical expressions occurring in the ASD participants' interactions also caused comprehension problems.

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.

Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis

Purpose The purpose of this meta-analytic study was to identify clinical characteristics, defined as child factors that can be assessed by a speech-language pathologist as part of a routine speech-language evaluation that may differentiate children who persist in stuttering from children who eventually recover from stuttering. Clinical characteristics explored included sex, age at onset, family history of stuttering, stuttering frequency and severity, speech-language skills, and temperament. Method Studies were identified through electronic databases, journals, and reference lists of relevant reports (e.g., research articles). Eligible studies followed young children who stutter (i.e., under 6 years old) for at least 24 months, assessed a potential clinical marker at study entry, and determined talker group classification (i.e., persistent or recovered) at study completion. Sex and family history differences were estimated using risk ratios; all other differences were estimated using Hedges's g. Heterogeneity and methodological differences among studies were evaluated. Results Eleven studies (41 reports) met eligibility criteria. Persistent children were older at stuttering onset and exhibited higher frequencies of stuttering-like disfluencies, lower speech sound accuracy, and lower expressive and receptive language skills than recovered children. Males and children with a family history of stuttering were also more likely to persist. Conclusions Clinical characteristics were identified that are associated with increased risk for stuttering persistence. Future studies have the potential to translate these clinical characteristics into prognostic markers for stuttering persistence risk.

Disfluency Characteristics of 4- and 5-Year-Old Children Who Stutter and Their Relationship to Stuttering Persistence and Recovery

Purpose The purpose of this study is to document disfluency behaviors expressed by 4- and 5-year-old children who stutter and to identify whether stuttering characteristics at this age are predictive of later stuttering recovery or persistence. Method We analyzed spontaneous speech samples from 47 children diagnosed with developmental stuttering when they were 4-5 years old. Based on their eventual diagnosis made the final year of participation in the longitudinal study when the children were 6-9 years old, the children were divided into two groups: children who eventually recovered from stuttering (n = 29) and children who were persisting (n = 18). We calculated a composite weighted stuttering-like disfluency (SLD) index of overall severity that considers the frequency, type, and number of repetition units of SLDs. The frequency and type of typical disfluencies were also examined. Results Higher weighted SLD scores at ages 4-5 years were associated with a higher probability of persistent stuttering. The weighted SLD also significantly discriminated between children who would eventually be diagnosed as persisting or recovered from stuttering. The frequency and type of typical disfluency did not distinguish the two groups of children; however, children who were persisting had significantly higher frequencies of part-word repetitions and dysrhythmic phonations (i.e., blocks, prolongations, and broken words) and maximum number of part-word repetitions compared to children who eventually recovered from stuttering. Conclusions Previous findings in younger, 2- to 3-year-old children who stutter did not suggest a relationship between the severity and type of children's SLDs and their eventual stuttering outcome. Yet, by the age of 4-5 years, we found that the weighted SLD, a clinically applicable tool, may be used to help identify children at greater risk for stuttering persistence. We propose that the weighted SLD be considered, along with other predictive factors, when assessing risk of stuttering persistence in 4- and 5-year-old children who are stuttering.

Speech disfluencies in bilingual Yiddish-Dutch speaking children

In this study, we investigated the frequency and types of stuttering-like (SLD) and other (OD) disfluencies in 59 typically developing bilingual Yiddish-Dutch (YD) speaking children. Participants were divided in two age categories: 6.01-7.07 and 9.00-10.04-year-olds. All children (1) were successive, bilingual YD speaking, (2) had Yiddish as their dominant language and (3) were sufficiently intelligible in both languages. A conversation sample of at least 300 syllables was collected in each of the two languages. The main findings in this study were (a) the total amount of SLD as well as OD were significantly higher in the non-dominant language. For the SLD, this was mainly caused by the higher frequency of monosyllabic word and syllable repetitions. For the OD, almost all disfluency types seem to have contributed to this. (b) The total amount of OD was significantly higher in the older group of bilingual YD children than in the younger group. This was primarily due to higher frequencies of phrase repetitions, lexical revisions and unfinished words. (c) The monolingual diagnostic guideline of three SLD per 100 words as a means to label stuttering cannot be used in this bilingual population. The majority of the non-stuttering children scored higher than the standard 3% SLD in both languages. In the dominant Yiddish language, 27 children (46%) scored above this percentage, in the non-dominant Dutch language, 46 children (78%).We conclude that bilingual YD-speaking children have a higher frequency of speech disfluencies in comparison to monolingual children. Consequently, monolingual stuttering guidelines cannot be used in this bilingual population.

The Role of Behavioral Inhibition for Conversational Speech and Language Characteristics of Preschool-Age Children Who Stutter

Purpose The purpose of this study was to investigate whether preschool-age children who stutter (CWS) were more likely to exhibit a temperamental trait of behavioral inhibition (BI), a correlate of shyness, than children who do not stutter (CWNS) and whether this temperamental trait affected preschool-age children's speech fluency and language complexity during a conversation with an unfamiliar adult. Method Sixty-eight preschool-age children (31 CWS, 37 CWNS) participated. The degree of BI was assessed by measuring the latency to their sixth spontaneous comment and the number of all spontaneous comments during a conversation with an unfamiliar examiner (following Kagan et al.'s [1987] methodology). Parent report of shyness from the Children's Behavior Questionnaire served as an indirect measure of BI. Children's language complexity was assessed by measuring their mean length of utterance and the number of words spoken. For CWS, the frequency of stuttering and the negative impact of stuttering were also assessed. Results First, we found no between-group differences in the degree of BI across the behavioral observation measures. However, CWS were rated shyer by parents than CWNS. Second, for CWS only, higher BI was associated with less complex utterances and fewer words spoken. Third, for CWS, higher BI was associated with fewer stuttered disfluencies produced. Conclusions This study provides empirical evidence that BI to the unfamiliar may have salience for childhood stuttering as it affected the quantity and quality of language spoken with an unfamiliar adult. Clinical implications of high BI for the assessment and treatment of preschool-age stuttering are discussed.

Indicators of speech fluency in stuttering and in phonological disorder

PURPOSE

To identify the indicators of speech fluency that differs subjects with stuttering, with phonological disorder, and with the two disorders in comorbidity.

METHODS

Thirty subjects aged 4-11 years old were divided into 3 groups, each one with 10 subjects: groups with developmental stuttering (SG), phonological disorder (PDG), and with two diagnoses in comorbidity (SPDG) participated in this study. The procedures were speech fluency and phonology evaluation. The data were submitted to statistical analysis.

RESULTS

Subjects from SG and SPDG showed a greater occurrence of stuttering-like disfluencies and total of disfluencies in relation to the subjects with PDG. Regarding to the other disfluencies, the three groups were similar. Subjects with PDG showed fewer monosyllabic word repetitions, part of word repetition and prolongations in relation to subjects from SG and SPDG. Blocks occurred more frequently in the two groups with stuttering (SG and SPDG) than in the group with PDG. Interjection occurred more frequently in subjects from SG than in PDG.

CONCLUSION

The PDG was the most differentiated in quantitative and qualitative terms in the three groups analyzed. The similarities and differences between the groups will assist the differential diagnosis and, consequently, will enable improved therapy. The presence of blocks represents an important marker for the diagnosis of stuttering.

A parent-report scale of behavioral inhibition: Validation and application to preschool-age children who do and do not stutter

PURPOSE

This two-part (i.e., Study 1, Study 2) study investigated behavioral inhibition (BI) in preschool-age children who do (CWS) and do not (CWNS) stutter. The purpose of Study 1 was to develop the Short Behavioral Inhibition Scale (SBIS), a parent-report scale of BI. The purpose of Study 2 was to determine, based on the SBIS, differences in BI between CWS and CWNS, and associations between BI and CWS's stuttering frequency, stuttering severity, speech-associated attitudes, and stuttering-related consequences/reactions.

METHOD

Participants in Study 1 were 225 CWS and 243 CWNS with the majority of them being included in Study 2. In Study 2, a speech sample was obtained for the calculation of stuttering frequency and severity, and the parents of a subset of CWS completed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007), and the Test of Childhood Stuttering Disfluency-Related Consequences Rating Scale (Gillam, Logan, & Pearson, 2009).

RESULTS

Study 1 analyses indicated that SBIS is a valid and reliable tool whose items assess a single, relatively homogeneous construct. In Study 2, CWS exhibited greater mean and extreme BI tendencies than CWNS. Also CWS with higher, compared to CWS with lower, BI presented with greater stuttering frequency, more severe stuttering, greater stuttering-related consequences, and more negative communication attitudes (for CWS older than 4 years of age).

CONCLUSION

Findings were taken to suggest that BI is associated with early childhood stuttering and that the SBIS could be included as part of a comprehensive evaluation of stuttering.

Autonomic Nervous System Response to Speech Production in Stuttering and Normally Fluent Preschool-Age Children

Purpose We studied speech-related sympathetic nervous system arousal of preschool-age children who do (CWS) and do not stutter (CWNS) and its association with children's proclivity to experience negative emotions and children's self-reported attitudes toward speaking. Method Electrodermal activity measures were collected from 32 preschool-age children while they engaged in a picture description and a nonword repetition task. Children's proclivity to experience negative emotions was assessed with a parent report questionnaire. Children's communication attitude was assessed with a self-report questionnaire. Results CWS did not differ from CWNS in their sympathetic arousal during a picture description task. However, during a more challenging nonword repetition task, preschool-age CWS had a higher sympathetic arousal level than CWNS. Although CWS were rated by their caregivers as more fearful and prone to sadness, children's tendency to experience stronger and more frequent negative emotions was not associated with their sympathetic arousal during speaking. Lastly, although CWS had a more negative communication attitude than CWNS, it was not associated with their level of sympathetic arousal during speaking. Conclusions Our findings suggest that age-appropriate social communication tasks are not inherently more stressful for preschool-age CWS and are not associated with state-related stress or anxiety that is often reported for adults who stutter. However, speaking tasks that place a higher demand on children's cognitive-linguistic system may be more taxing and challenging to preschool CWS than CWNS, leading to a higher level of arousal.

Effects of different attention tasks on concurrent speech in adults who stutter and fluent controls

PURPOSE

Motor theories indicate that focusing attention on well-practiced movements interferes with skilled performance; however, specific forms of attention (alerting vs. orienting vs. executive control) associated with this effect are not well understood. The present study explored this question in relation to stuttering, and examined whether dual task conditions that engaged sustained attention or working memory (WM) affected speech fluency in different ways. We also considered whether fluency changes were associated with changes in speech rate and language.

METHODS

Nineteen adults who stutter (AWS) and 20 controls produced spontaneous speech under a baseline condition and two dual task conditions: one involving a sustained attention task, the other involving WM demands.

RESULTS

Both groups produced fewer stutter-like disfluencies under dual task relative to baseline conditions and this reduction did not differ between the two dual tasks (attention vs. WM). Speech rate and language variables, which were potentially influenced by attention conditions, were not affected by dual tasks in the same way as disfluencies, and appeared to be unassociated with fluency results.

CONCLUSIONS

Findings indicate that atypical disfluencies decrease when attention is divided, even when secondary task demands are minimal, as they were in the sustained attention task. For simple secondary tasks, fluency changes do not appear to be a byproduct of slowed rate and are not accompanied by observable changes in language. These results demonstrate that simple manipulations of attention can induce measurable effects on aspects of speech production, and may be a useful tool for facilitating fluency in clinical intervention.

Differences in the relation between temperament and vocabulary based on children's stuttering trajectories

PURPOSE

The purpose of this study was to assess the relation between temperament and vocabulary development for children who stutter and persist, children who stutter and recover and children who do not stutter.

METHODS

Participants, aged 3;0-4;11 at the start of the study, were followed for two years. They were classified as persisting (n = 10), recovered (n = 26), and non-stuttering (n = 24) based on multiple assessments of stuttering spaced across study participation. Groups were balanced for age and gender ratios. At each visit, participants completed the Peabody Picture Vocabulary Test, 4th edition, and the Expressive Vocabulary Test, 2nd edition; caregivers completed the Children's Behavior Questionnaire.

RESULTS

For both persisting and recovered groups, higher negative emotionality was associated with lower receptive vocabulary. These associations were both significantly more negative than the non-stuttering group's association.

CONCLUSION

These findings suggest that receptive vocabulary development is differentially linked to temperament based on a child's stuttering status. As others have speculated (Conture & Walden, 2012), it appears as though there are salient associations between temperament, speech-language development, and childhood stuttering.

Rates of Typical Disfluency in the Conversational Speech of 30-Month-Old Spanish-English Simultaneous Bilinguals

PURPOSE

The aim of this study was to investigate the typical disfluency rates at 30 months old in a large group of simultaneous bilingual children and also investigate the relationships between disfluency rates and linguistic complexity (mean length of utterance in words [MLU-W]), vocabulary diversity (VocD), and speaking rate (utterances per unit time).

METHOD

Fifty-three typically developing children who had been exposed to Spanish and English from birth participated in this descriptive study. The average percent input at home was 46% in English and 54% in Spanish. Outside the home, the children averaged 9 hr of exposure per week in each language. Spontaneous speech samples in both languages were obtained during play sessions between the children and a parent.

RESULTS

Nonparametric tests revealed a significant difference in typical disfluency rates across languages, with more children being disfluent in English and with a larger range of disfluency rates in English. The effect size for this difference was small. The children had significantly higher MLU-W in English; there were no differences in VocD or speaking rate between the 2 languages. Typical disfluency rate in Spanish was not significantly correlated with MLU-W, VocD, or speaking rate. Typical disfluency rates in English were correlated with MLU-W and VocD, but not with speaking rate.

CONCLUSION

This article described the typical disfluency rates of a large group of simultaneous Spanish-English bilingual children at 30 months of age. The typical disfluency rates reported here are lower than those reported in the literature for monolingual children of similar ages. Clinical implications of these findings are addressed.

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.

Expressed parental concern regarding childhood stuttering and the Test of Childhood Stuttering

PURPOSE

The purpose of the present study was to determine whether the Test of Childhood Stuttering observational rating scales (TOCS; Gillam et al., 2009) (1) differed between parents who did versus did not express concern (independent from the TOCS) about their child's speech fluency; (2) correlated with children's frequency of stuttering measured during a child-examiner conversation; and (3) correlated with the length and complexity of children's utterances, as indexed by mean length of utterance (MLU).

METHOD

Participants were 183 young children ages 3:0-5:11. Ninety-one had parents who reported concern about their child's stuttering (65 boys, 26 girls) and 92 had parents who reported no such concern (50 boys, 42 girls). Participants' conversational speech during a child-examiner conversation was analyzed for (a) frequency of occurrence of stuttered and non-stuttered disfluencies, and (b) MLU. Besides expressing concern or lack thereof about their child's speech fluency, parents completed the TOCS observational rating scales documenting how often they observe different disfluency types in speech of their children, as well as disfluency-related consequences.

RESULTS

There were three main findings. First, parents who expressed concern (independently from the TOCS) about their child's stuttering reported significantly higher scores on the TOCS Speech Fluency and Disfluency-Related Consequences rating scales. Second, children whose parents rated them higher on the TOCS Speech Fluency rating scale produced more stuttered disfluencies during a child-examiner conversation. Third, children with higher scores on the TOCS Disfluency-Related Consequences rating scale had shorter MLU during child-examiner conversation, across age and level of language ability.

CONCLUSIONS

Findings support the use of the TOCS observational rating scales as one documentable, objective means to determine parental perception of and concern about their child's stuttering. Findings also support the notion that parents are reasonably accurate, if not reliable, judges of the quantity and quality (i.e., stuttered vs. non-stuttered) of their child's speech disfluencies. Lastly, findings that some children may decrease their verbal output in attempts to minimize instances of stuttering - as indexed by relatively low MLU and a high TOCS Disfluency-Related Consequences scores - provides strong support for sampling young children's speech and language across various situations to obtain the most representative index possible of the child's MLU and associated instances of 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.

Speech disfluencies in children with Down Syndrome

PURPOSE

Speech and language development in individuals with Down syndrome is often delayed and/or disordered and speech disfluencies appear to be more common. These disfluencies have been labeled over time as stuttering, cluttering or both.

FINDINGS

were usually generated from studies with adults or a mixed age group, quite often using different methodologies, making it difficult to compare findings. Therefore, the purpose of this study was to analyze and describe the speech disfluencies of a group, only consisting of children with Down Syndrome between 3 and 13 years of age.

METHOD

Participants consisted of 26 Dutch-speaking children with DS. Spontaneous speech samples were collected and 50 utterances were analyzed for each child. Types of disfluencies were identified and classified into stuttering-like (SLD) and other disfluencies (OD). The criterion of three or more SLD per 100 syllables (cf. Ambrose & Yairi, 1999) was used to identify stuttering. Additional parameters such as mean articulation rate (MAR), ratio of disfluencies, and telescoping (cf. Coppens-Hofman et al., 2013) were used to identify cluttering and to differentiate between stuttering and cluttering.

RESULTS & CONCLUSION

Approximately 30 percent of children with DS between 3 and 13 years of age in this study stutter, which is much higher than the prevalence in normally developing children. Moreover, this study showed that the speech of children with DS has a different distribution of types of disfluencies than the speech of normally developing children. Although different cluttering-like characteristics were found in the speech of young children with DS, none of them could be identified as cluttering or cluttering-stuttering.

Beyond stuttering: Speech disfluencies in normally fluent French-speaking children at age 4

The aim of this study was to establish normative data on the speech disfluencies of normally fluent French-speaking children at age 4, an age at which stuttering has begun in 95% of children who stutter (Yairi & Ambrose, 2013). Fifty monolingual French-speaking children who do not stutter participated in the study. Analyses of a conversational speech sample comprising 250-550 words revealed an average of 10% total disfluencies, 2% stuttering-like disfluencies and around 8% non-stuttered disfluencies. Possible explanations for these high speech disfluency frequencies are discussed, including explanations linked to French in particular. The results shed light on the importance of normative data specific to each language.

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.

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.

Self-perceived competence and social acceptance of young children who stutter: Initial findings

PURPOSE

The goals of this study were to determine whether young children who stutter (CWS) perceive their own competence and social acceptance differently than young children who do not stutter (CWNS), and to identify the predictors of perceived competence and social acceptance in young speakers.

METHOD

We administered the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA; Harter & Pike, 1984) to 13 CWS and 14 CWNS and examined group differences. We also collected information on the children's genders, temperaments, stuttering frequencies, language abilities, and phonological skills to identify which of these factors predicted PSPCSA scores.

RESULTS

CWS, as a group, did not differ from CWNS in their perceived general competence or social acceptance. Gender predicted scores of perceived general competence, and stuttering frequency predicted perceived social acceptance. Temperament, language abilities, and phonological skills were not significant predictors of perceived competence or social acceptance in our sample.

CONCLUSIONS

While CWS did not significantly differ from CWNS in terms of perceived competence and social acceptance, when both talker groups were considered together, girls self-reported greater perceived competence than boys. Further, lower stuttering frequency was associated with greater perceived social acceptance. These preliminary findings provide motivation for further empirical study of the psychosocial components of childhood stuttering.

LEARNING OUTCOMES

Readers will be able to describe the constructs of perceived competence and social acceptance in young children, and whether early stuttering plays a role in the development of these constructs.