Prevalence of anxiety disorders among children who stutter

Validity and utility of the Japanese version of the brief unhelpful thoughts and beliefs about stuttering scale: UTBAS-6-J

Do adults who stutter have abnormally high social anxiety? Is it related to maladaptive cognition? As these are persistent, unresolved questions in stuttering research, it behooves clinicians to at least assess and attempt to identify social anxiety in patients who stutter and its basis before decisions are made about stuttering treatment. The Unhelpful Thoughts and Beliefs About Stuttering (UTBAS) scale is a self-administered questionnaire that measures the degree of non-adaptive cognition in people who stutter (PWS) due to social anxiety. The 66-item UTBAS is time-consuming to complete, prompting the development of a shorter 6-item version, the UTBAS-6, which is in English. Here, we aimed to assess some psychometric properties of the Japanese version of the UTBAS-6, the UTBAS-6-J, which has not been done to date. In 56 adult patients (mean 32.6 ± 11.1 years) who stutter, we quantified the reliability, the internal consistency, and the concurrent validity of the UTBAS-6-J. Along with the UTBAS-6-J, patients also were administered the Overall Assessment of the Speaker's Experience of Stuttering - Japanese version (OASES-A-J), the Modified Erickson Communication Attitude Scale - Japanese version (S-24-J), and the Liebowitz Social Anxiety Scale - Japanese version (LSAS-J). Cronbach's alpha for UTBAS-6-J total scores was 0.974, indicating excellent internal consistency. UTBAS-6-J scores were significantly correlated with scores on the OASES-A-J, the S-24-J, and the LSAS-J (all p < 0.005). Concurrent validity of the UTBAS-6-J with these three questionnaires was confirmed. The UTBAS-6-J has good internal consistency and concurrent validity, which will aid clinical decision-making about stuttering treatments.

Global Prevalence of Social Anxiety Disorder in Children, Adolescents and Youth: A Systematic Review and Meta-analysis

Social anxiety disorder is a prevalent mental health condition that significantly impairs social interactions, academic performance, and professional functioning in children, adolescents, and youth. This study aimed to investigate the global prevalence of social anxiety disorder across these developmental stages. Six electronic databases (PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar) were systematically searched for studies related to the prevalence of social anxiety disorder in children, adolescents and youth. Random-effects models were employed for data analysis and Comprehensive Meta-Analysis Version 2.0. Heterogeneity was assessed using the I2 index. A total of 38 studies were included in the final analysis. The global prevalence of social anxiety disorder was estimated to be 4.7% in children, 8.3% in adolescents, and 17% in youth. These findings suggest a progressive increase in the prevalence of SAD across these developmental stages. Considering the prevalence of social anxiety disorder in this study, policymakers can use the findings of this study to inform and develop effective prevention strategies for individuals and communities most susceptible to this disorder.

Erasmus clinical model of the onset and development of stuttering 2.0

A clinical, evidence-based model to inform clients and their parents about the nature of stuttering is indispensable for the field. In this paper, we propose the Erasmus Clinical Model of Stuttering 2.0 for children who stutter and their parents, and adult clients. It provides an up-to-date, clinical model summary of current insights into the genetic, neurological, motoric, linguistic, sensory, temperamental, psychological and social factors (be it causal, eliciting, or maintaining) related to stuttering. First a review is presented of current insights in these factors, and of six scientific theories or models that have inspired the development of our current clinical model. Following this, we will propose the model, which has proven to be useful in clinical practice. The proposed Erasmus Clinical Model of Stuttering visualizes the onset and course of stuttering, and includes scales for stuttering severity and impact, to be completed by the (parent of) the person who stutters. The pathway of the model towards stuttering onset is based on predisposing and mediating factors. In most children with an onset of stuttering, stuttering is transient, but if stuttering continues, its severity and impact vary widely. The model includes the circle of Engel (1977), which visualizes unique interactions of relevant biological, psychological, and social factors that determine the speaker's experience of stuttering severity and its impact. Discussing these factors and their interaction with an individual client can feed into therapeutic targets. The model is supplemented by a lifeline casus.

Lidcombe Program telehealth treatment for children 6-12 years of age: A Phase II trial

BACKGROUND

For children older than 6 years who stutter, there is a gap in clinical research. This is an issue for speech-language pathologists because the tractability of stuttering decreases and the risk of long-term psychological consequences increase with age.

PURPOSE

To report a Phase II trial of a telehealth version of the Lidcombe Program with school-age children.

METHODS

Participants were 37 children who stuttered, 6-12 years of age, from Australia, New Zealand, Hong Kong, and Singapore. Parents were trained by video telehealth how to deliver the Lidcombe Program to their child. Primary and secondary outcomes were stuttering severity and psychosocial functioning measured pre-treatment and at 6 months and 12 months after starting treatment. Parents submitted two 10-minute recordings of their child speaking in conversation, and three measures of anxiety, impact of stuttering, and communication attitude.

RESULTS

Six months after starting treatment, seven children (18.9%) attained Lidcombe Program Stage 2 criteria, 25 children (67.6%) showed a partial response to treatment, and five children (13.5%) showed no response. By 12 months, 12 children (32.4%) had reached Stage 2 criteria. Psychosocial improvements were observed 6 and 12 months after starting treatment.

CONCLUSIONS

The Lidcombe Program may eliminate or nearly eliminate stuttering for about one third of children 6-12 years of age. Randomized controlled trials with this age group involving the Lidcombe Program are warranted. In the interim, the Lidcombe Program is a clinical option clinicians can implement with this age group to reduce stuttering and its psychosocial impacts.

Are comorbidities of poor reading related to elevated anxiety in children?

Studies of the association between dyslexia and mental health have typically tried to minimise the influence of dyslexia comorbidities on the outcomes. However, in the "real world", many children with dyslexia have these comorbidities. In this study, we tested (1) if children with dyslexia with three common comorbidities - inattention, hyperactivity, language difficulties - experience more anxiety than children with dyslexia without these comorbidities; and (2) if any type of comorbidity is related to a certain type of anxiety (reading, social, generalised, or separation). The data of 82 children with dyslexia (mean age = 9 years and 4 months; 25 girls) were analysed using Fisher exact tests, which revealed that those with inattention (40.54%) or hyperactivity (42.30%) were statistically significantly more likely to experience elevated anxiety than children with dyslexia without these comorbidities (8.11 and 14.28%, respectively). This was not the case for language difficulties (24.5% versus 30%). Spearman ρ correlations (α = .05) indicated significant moderate relationships between inattention and reading anxiety (.27), social anxiety (.37), and generalised anxiety (.24); and between hyperactivity and social anxiety (.24) and generalised anxiety (.28). There were no significant correlations between language and anxiety. Examination of highly inter-correlated variables suggested a specific relationship between one type of comorbidity (inattention) and one type of anxiety (reading anxiety).

Risk of sleep problems in a clinical sample of children who stutter

PURPOSE

Previous studies have shown increased prevalence of sleep problems among people who stutter. However, there is a lack of knowledge about what these sleep problems may specifically be.

METHOD

Fifty children who stutter (CWS) from 6;0 to 12;9 years of age and 50 age- and gender-matched controls participated in this study. Parents did not report coexisting conditions, excepting stuttering and/or sleep problems. Sleep problems were investigated using a standardized questionnaire answered by parents. The questionnaire shows cut-off scores to identify the risk of sleep problems as a whole and on each one of the six subscales (i.e., disorders of initiating and maintaining sleep; sleep breathing disorders; disorders of arousal; sleep-wake transition disorders; disorders of excessive somnolence; and sleep hyperhidrosis). Scores above the cut-off are suggestive of sleep problems.

RESULTS

Twenty-one CWS scored higher than the cut-off on the sleep questionnaire compared to only two controls (p < 0.00001). Specifically, CWS scored higher than controls in disorders of initiating and maintaining sleep, sleep-wake transition disorders (especially jerking, sleep talking, and bruxism), and disorders of excessive somnolence (p < 0.0083, corrected for multiple comparisons).

DISCUSSION

Compared to controls, CWS are at greater risk for sleep problems, which are not consequences of coexisting disorders. Present findings confirm and expand current knowledge about sleep problems in CWS. Directionality possibilities and clinical implications are discussed.

Brain response to errors in children who stutter

PURPOSE

Heightened rates of social anxiety have been reported in adults who stutter (AWS), but it is unclear whether anxiety is heightened also in children who stutter (CWS). Objective neurophysiological responses such as the error-related negativity (ERN) have been associated with anxiety, and ERN was reported to be increased in AWS. In this study, we examined whether ERN and error positivity (Pe) are increased in CWS. We further characterized ERN associations with age and anxiety in CWS relative to children who do not stutter (CWNS).

METHODS

EEG data were recorded from twenty-four CWS and twenty-four matched CWNS aged 3-9 years as they performed a Go/No-Go task. Parent-reported anxiety, and child-reported speech-associated attitude measures were collected. Linear regression models tested the effects of age, group, and their interaction, and the effects of anxiety, group, and their interaction on ERN and Pe.

RESULTS

Contrary to expectations, no ERN or Pe difference were observed between CWS and CWNS. However, larger ERN amplitudes were associated with older age in CWS but not CWNS, suggesting altered development of the error monitoring system in CWS. Association of Pe with anxiety also differed between groups: smaller Pe amplitudes were associated with higher level of parent-reported child anxiety in CWNS but not in CWS. Neither anxiety nor self-reported communication attitude differed between groups.

CONCLUSIONS

Brain responses to errors were overall comparable between CWS and CWNS. However, CWS differed in how error monitoring responses varied with age and with anxiety levels. More research is warranted to examine how these factors contribute to persistent stuttering.

Self-Reported Stuttering Severity Is Accurate: Informing Methods for Large-Scale Data Collection in Stuttering

PURPOSE

To our knowledge, there are no data examining the agreement between self-reported and clinician-rated stuttering severity. In the era of big data, self-reported ratings have great potential utility for large-scale data collection, where cost and time preclude in-depth assessment by a clinician. Equally, there is increasing emphasis on the need to recognize an individual's experience of their own condition. Here, we examined the agreement between self-reported stuttering severity compared to clinician ratings during a speech assessment. As a secondary objective, we determined whether self-reported stuttering severity correlated with an individual's subjective impact of stuttering.

METHOD

Speech-language pathologists conducted face-to-face speech assessments with 195 participants (137 males) aged 5-84 years, recruited from a cohort of people with self-reported stuttering. Stuttering severity was rated on a 10-point scale by the participant and by two speech-language pathologists. Participants also completed the Overall Assessment of the Subjective Experience of Stuttering (OASES). Clinician and participant ratings were compared. The association between stuttering severity and the OASES scores was examined.

RESULTS

There was a strong positive correlation between speech-language pathologist and participant-reported ratings of stuttering severity. Participant-reported stuttering severity correlated weakly with the four OASES domains and with the OASES overall impact score.

CONCLUSIONS

Participants were able to accurately rate their stuttering severity during a speech assessment using a simple one-item question. This finding indicates that self-report stuttering severity is a suitable method for large-scale data collection. Findings also support the collection of self-report subjective experience data using questionnaires, such as the OASES, which add vital information about the participants' experience of stuttering that is not captured by overt speech severity ratings alone.

Reduced stuttering for school-age children: A systematic review

BACKGROUND

Treatment of school-age children (6-12 years of age) who stutter is a public health priority. Their clinical needs include a psychosocial focus and stuttering reduction. For the latter clinical need, there is a critical window of opportunity for these children warranting research attention.

PURPOSE

The purpose of the review is to guide future clinical research by establishing (a) what interventions are associated with stuttering reduction for school-age children (b) the reported immediate and longer-term effects of those interventions, and (c) the level of evidence for these interventions in terms of study design.

METHODS

Fourteen databases and three conference proceedings were searched for interventions used to reduce stuttering in school-age children. Primary outcomes were mean stuttering reductions pre-treatment, immediately post-treatment, and any follow-up assessments.

RESULTS

Of the 4305 studies identified from the databases, 67 studies met inclusion criteria. Five different treatment approaches were reported in the literature that might reduce stuttering for a school-age child, but with varying effect sizes. These include (a) operant methods, (b) speech restructuring, (c) combined operant methods and speech restructuring, (d) machine-driven treatments, and (e) treatments with a cognitive behaviour therapy component.

CONCLUSIONS

Operant methods warrant investigation in future clinical trial research, as do variants of speech restructuring. Hybrid approaches showed encouraging results, including speech restructuring variants combined with operant methods or with cognitive behaviour therapy. However, evidence is preliminary only at Phase I and II trials. Several treatments with reported clinical promise have been overlooked for decades and require further investigation.

Cost of Illness and Health-Related Quality of Life for Stuttering: Two Systematic Reviews

PURPOSE

For those who stutter, verbal communication is typically compromised in social situations. This may attract negative responses from listeners and stigmatization by society. These have the potential to impair health-related quality of life across a range of domains, including qualitative and quantitative impacts on speech output, mental health issues, and failure to attain educational and occupational potential. These systematic reviews were designed to explore this matter using traditional health economics perspectives of utility measures and cost of illness.

METHOD

Studies were included if they involved children, adolescents, or adults with stuttering as a primary diagnosis. The quality of life search strategy identified 2,607 reports, of which three were included in the quality of life analysis. The cost of illness search strategy identified 3,778 reports, of which 39 were included in the cost of illness analysis.

RESULTS

Two of the three studies included in the quality of life analysis had a high risk of bias. When measured using utility scores, quality of life for people who stutter was in the range of those reported for chronic health conditions such as diabetes mellitus, cardiovascular disease, and cancer. However, there is little such evidence of quality of life impairment during the preschool years. Studies included in the cost of illness analysis carried considerable risk of bias overall.

CONCLUSIONS

For people who stutter, there are substantive direct and indirect costs of illness. These include impairment, challenges, and distress across many domains throughout life, including income, education, employment, and social functioning. Evidence of quality of life impairment using utility measures is extremely limited. If this situation is not remedied, the lifetime impairment, challenges, and distress experienced by those who stutter cannot be documented in a form that can be used to influence health policy and health care spending.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24168201.

Self-Stigma of Stuttering: Implications for Communicative Participation and Mental Health

PURPOSE

The purpose of this study was to determine if self-stigma-related variables predicted communicative participation and mental health in adults who stutter. A progressive model of self-stigma was theorized and tested.

METHOD

Adults who stutter (N = 344) completed a survey that included measures of communicative participation, global mental health, and a variety of self-stigma-related variables including perceived enacted stigma, stigma awareness, anticipated stigma, felt stigma, stereotype agreement, and stigma application, in addition to demographic and speech-related variables. Hierarchical regression was performed to test whether self-stigma-related variables progressively explained significant variance in both communicative participation and global mental health.c Results: After controlling for demographic and speech-related variables, stigma-related variables were found to be significant predictors of both communicative participation and global mental health among adults who stutter. Most self-stigma-related variables entered later in the model predicted additional unique variance in the outcome variables than the self-stigma-related variables entered in previous steps, thus supporting the trickle-down and progressive nature of the self-stigma model theorized.

CONCLUSIONS

Accounting for self-stigma in the assessment and treatment of individuals who stutter may identify and ultimately reduce environmental and personal barriers to communicative functioning and well-being in people who stutter. The self-stigma terminology and model described in this study will help practitioners, researchers, and the public better understand the process of self-stigma and how it may be associated with adverse outcomes experienced by people who stutter.

Psychosocial features of stuttering for school-age children: A systematic review

BACKGROUND

Contemporary clinical and empirical perspectives indicate that management of the psychosocial features of stuttering is fundamental for effective treatment. Interventions that improve psychosocial outcomes for school-age children who stutter are, therefore, needed.

AIMS

This systematic review identifies what psychosocial outcomes have been explored in existing school-age clinical research, the measures used and the potential treatment effects. This will provide guidance for developing interventions that reflect contemporary perspectives of stuttering management.

METHODS & PROCEDURES

A total of 14 databases and three conference proceedings were searched for clinical reports of psychosocial outcomes of children aged 6-12 years. The review did not include pharmacological interventions. Psychosocial measures and outcomes were analysed in each study based on data recorded pre-treatment, immediately post-treatment and for any follow-up assessments.

MAIN CONTRIBUTIONS

Of the 4051 studies identified from the databases, a total of 22 studies met criteria for inclusion in the review. From these 22 studies, the review identified four prominent psychosocial domains that have been explored in school-age clinical research to date: Impact of stuttering, communication attitude, anxiety and speech satisfaction. These domains vary in measurement and effect sizes. Two behavioural treatments were associated with anxiety reduction, even though they did not contain anxiolytic procedures. No evidence of potential treatment effects emerged for communication attitudes. Quality of life-an important psychosocial domain pertinent to health economics-did not feature in school-age clinical reports.

CONCLUSIONS & IMPLICATIONS

The psychosocial features of stuttering need to be managed during the school years. Three psychosocial domains-impact of stuttering, anxiety and speech satisfaction-show evidence of potential treatment effects. This review provides direction for future clinical research so that speech-language pathologists can effectively and holistically manage school-age children who stutter.

WHAT THIS PAPER ADDS

What is already known on the subject Elevated levels of anxiety are apparent for children and adolescents who stutter. Therefore, the need to assess and manage psychosocial features of stuttering are expertly regarded as clinical priorities. Clinical trials of such psychosocial features of stuttering for children aged 6-12 years are not well advanced and, therefore, do not reflect current best practice management of this disorder. What this study adds to existing knowledge This systematic review identifies four different psychosocial domains measured and reported in the literature for school-age stuttering management. For three psychosocial domains, some evidence of potential treatment effects emerged with participant numbers greater than 10: Impact of stuttering, anxiety and speech satisfaction. Though treatment effect sizes varied, there is a suggestion that cognitive behaviour therapy can improve anxiety of school-age children who stutter. There is also suggestion that two other behavioural treatments can improve anxiety of school-age children who stutter. What are the potential or actual clinical implications of this work? Given the essential need for school-age children who stutter to receive management of any speech-related anxiety they may experience, it would be productive to discover in future clinical research what interventions could contribute to that goal-behavioural or psychosocial, or both. This review reveals that cognitive behaviour therapy, and other behavioural treatments, are associated with anxiety reductions. Such approaches should be considered for future clinical trial research to help advance the evidence base for managing school-age stuttering.

Exploring the Relationship Between Resilience and the Adverse Impact of Stuttering in Children

PURPOSE

People who stutter often experience significant adverse impact related to stuttering. However, it is unclear how adverse impact develops in children who stutter (CWS) and whether there are protective factors that may mitigate its development. This study examined the relationship between resilience, a potentially protective factor, and stuttering's adverse impact in CWS. Resilience comprises external factors, such as family support and access to resources as well as personal attributes, making it a comprehensive protective factor to explore.

METHOD

One hundred forty-eight CWS aged 5-18 years completed the age-appropriate version of the Child and Youth Resilience Measure (CYRM) and the Overall Assessment of the Speaker's Experience of Stuttering. Parents completed a caregiver version of the CYRM and a behavioral checklist for their child. The adverse impact of stuttering was modeled as a function of resilience (external, personal, and total), controlling for child age and behavioral checklist score. We also estimated correlations between child-report and parent-report CYRM measures to assess rater agreement.

RESULTS

Children reporting greater external, personal, or total resilience were more likely to experience lower degrees of adverse impact related to their stuttering. We documented stronger correlations between younger child and parent ratings of resilience and weaker correlations between older child and parent ratings.

CONCLUSIONS

These results yield valuable insight into the variability of adverse impact experienced by CWS and offer empirical support for strength-based speech therapy approaches. We discuss the factors that contribute to a child's resilience and provide practical suggestions for how clinicians can incorporate resilience-building strategies into intervention for children experiencing significant adverse impact from their stuttering.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23582172.

The Association Between Atypical Speech Development and Adolescent Self-Harm

BACKGROUND

Adolescent self-harm is a major public health issue internationally. Various factors associated with adolescent self-harm have been identified, including being bullied and experiencing mental health problems. Stuttering and speech sound disorder are associated with both of these factors. It was hypothesized that both stuttering and speech sound disorder would be associated with self-harm. This is the first study to explore the relationship between communication disorders and adolescent self-harm.

METHOD

Secondary analysis of a large, longitudinal, prospective, community sample, the Avon Longitudinal Study of Parents and Children, was carried out. Clinicians identified children who stuttered or exhibited speech sound disorder at the age of 8 years. When the cohort members were 16 years old, they were asked to complete a questionnaire about self-harm. Multinomial logistic regression was used to examine the associations between stuttering and speech sound disorder and the self-harm outcomes, adjusting for other relevant factors.

RESULTS

Of 3,824 participants with data for both speech status and self-harm, 94 (2.5%; 95% confidence interval [CI; 2.0, 3.0]) stuttered at 8 years of age and 127 (3.3%; 95% CI [2.8, 3.9]) displayed speech sound disorder. Speech sound disorder at the age of 8 years was associated with self-harm with suicidal intent in both unadjusted and adjusted models. Differences between the adjusted and unadjusted models were small, suggesting that speech sound disorder is largely an independent risk factor for self-harm with suicidal intent. Stuttering at the age of 8 years was not associated with adolescent self-harm, and there was no association between speech sound disorder and self-harm without suicidal intent.

CONCLUSION

Compared with individuals without speech sound disorder, adolescents with speech sound disorder at the age of 8 years have twice the risk of reporting self-harm with suicidal intent, even when other important predictors are taken into account.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22573030.

Dissecting structural connectivity of the left and right inferior frontal cortex in children who stutter

Inferior frontal cortex pars opercularis (IFCop) features a distinct cerebral dominance and vast functional heterogeneity. Left and right IFCop are implicated in developmental stuttering. Weak left IFCop connections and divergent connectivity of hyperactive right IFCop regions have been related to impeded speech. Here, we reanalyzed diffusion magnetic resonance imaging data from 83 children (41 stuttering). We generated connection probability maps of functionally segregated area 44 parcels and calculated hemisphere-wise analyses of variance. Children who stutter showed reduced connectivity of executive, rostral-motor, and caudal-motor corticostriatal projections from the left IFCop. We discuss this finding in the context of tracing studies from the macaque area 44, which leads to the need to reconsider current models of speech motor control. Unlike the left, the right IFCop revealed increased connectivity of the inferior posterior ventral parcel and decreased connectivity of the posterior dorsal parcel with the anterior insula, particularly in stuttering boys. This divergent connectivity pattern in young children adds to the debate on potential core deficits in stuttering and challenges the theory that right hemisphere differences might exclusively indicate compensatory changes that evolve from lifelong exposure. Instead, early right prefrontal connectivity differences may reflect additional brain signatures of aberrant cognition-emotion-action influencing speech motor control.

Lidcombe Program translation to community clinics in Australia and England

BACKGROUND

Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it.

AIMS

This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England.

METHODS & PROCEDURES

Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift.

OUTCOMES & RESULTS

Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials.

CONCLUSIONS & IMPLICATIONS

Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined.

WHAT THIS PAPER ADDS

What is already known on the subject The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work? Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice.

Virtual reality exposure therapy for reducing social anxiety in stuttering: A randomized controlled pilot trial

We report on findings from the first randomized controlled pilot trial of virtual reality exposure therapy (VRET) developed specifically for reducing social anxiety associated with stuttering. People who stutter with heightened social anxiety were recruited from online adverts and randomly allocated to receive VRET (n = 13) or be put on a waitlist (n = 12). Treatment was delivered remotely using a smartphone-based VR headset. It consisted of three weekly sessions, each comprising both performative and interactive exposure exercises, and was guided by a virtual therapist. Multilevel model analyses failed to demonstrate the effectiveness of VRET at reducing social anxiety between pre- and post-treatment. We found similar results for fear of negative evaluation, negative thoughts associated with stuttering, and stuttering characteristics. However, VRET was associated with reduced social anxiety between post-treatment and one-month follow-up. These pilot findings suggest that our current VRET protocol may not be effective at reducing social anxiety amongst people who stutter, though might be capable of supporting longer-term change. Future VRET protocols targeting stuttering-related social anxiety should be explored with larger samples. The results from this pilot trial provide a solid basis for further design improvements and for future research to explore appropriate techniques for widening access to social anxiety treatments in stuttering.

Social anxiety disorder in adolescents who stutter: A risk for school refusal

BACKGROUND

Stuttering is a childhood-onset fluency disorder. Part of the counseling for middle and high school students with persistent stuttering is related to school refusal. Anxiety disorders are known to contribute to school refusal. However, it is not known whether social anxiety disorder (SAD) is a factor in school refusal among adolescents who stutter.

METHODS

In our first study, we examined the relationship between school refusal and SAD in 84 middle and high school students who stutter; 26% of the 84 students were in the school refusal group and the remaining 74% were in the school attendance group. The second study examined whether SAD was associated with 10 factors related to speech and stuttering frequency using the Japanese version of the Liebowitz Social Anxiety Scale for Children and Adolescents to determine the presence of SAD. Of the 84 students in the first study, 40 participated in the second study.

RESULTS

The school refusal group of adolescents who stutter had significantly higher rates of SAD than the school attendance group. Fifty percent of adolescents who stutter met the criteria for SAD. Moreover, adolescents who stutter with SAD had significantly higher scores on the items "When speaking in public, do you experience tremors in your limbs?" and "After you stutter, do you have negative thoughts about yourself?" than the adolescents who stutter without SAD.

CONCLUSIONS

When examining adolescents who stutter, checking for comorbid SAD may lead to better support. Moreover, noticing their repetitive negative thinking, nervousness, and trembling during speech may help to resolve SAD.

Speech-language disorder severity, academic success, and socioemotional functioning among multilingual and English children in the United States: The National Survey of Children's Health

Research points to negative associations between educational success, socioemotional functioning, and the severity of symptoms in some speech-language disorders (SLDs). Nonetheless, the majority of studies examining SLDs in children have focused on monolinguals. More research is needed to determine whether the scant findings among multilinguals are robust. The present study used parent report data from the U.S. National Survey of Children's Health (2018 to 2020) to gain a better understanding of the impacts of SLD severity on indicators of academic success and socioemotional functioning among multilingual (n = 255) and English monolingual (n = 5,952) children with SLDs. Tests of between-group differences indicated that multilingual children evidenced more severe SLDs, had lower school engagement, and had lower reports of flourishing than English monolingual children with SLDs. Further, a greater proportion of multilingual children with SLDs missed more school days than English monolinguals. However, multilinguals were less likely to bully others or have been bullied than monolinguals. While the previous between-group differences were statistically significant, they were small (vs ≤ 0.08). Increased SLD severity predicted an increased number of repeated school grades, increased absenteeism, and decreased school engagement, when age and socioeconomic status were controlled. Increased SLD severity also predicted greater difficulty making and keeping friends and decreased flourishing. The effect of SLD severity on being bullied was statistically significant for the monolinguals but not multilinguals. There was a statistically significant interaction for SLD severity and sex for school engagement and difficulty making and keeping friends for monolinguals but not multilinguals. The interactions indicated that school engagement decreased more for females than for males while difficulties making and keeping friends increased more for males than females as one's SLD severity increased. While some findings were specific to monolinguals, tests of measurement invariance indicated that the same general pattern of relations among the variables were evident across the groups of multilinguals and monolinguals. These final findings can inform the interpretation of the results from both the current and future studies, while the overall findings can inform the development of intervention programs, thereby improving the long-term academic and socioemotional outcomes of children with SLDs.

Validation of the Vanderbilt Responses to Your Child's Speech Rating Scale for Parents of Young Children Who Stutter

PURPOSE

This study reports the development, refinement, and exploration of the psychometric properties of the Vanderbilt Responses to Your Child's Speech (VRYCS) rating scale, a novel measure designed to assess parents' self-perceived responses to the speech of their children who stutter (CWS).

METHOD

Parents of 214 young (ages 2;4[years;months]-5;11) CWS completed the original 40-item version of the VRYCS. Content analyses and an exploratory factor analysis determined the scale's factors and identified specific items corresponding to each. Items that did not load onto the factors were removed and internal consistency was assessed.

RESULTS

The final 18-item VRYCS rating scale includes five factors relating to parents' responses to the speech of their CWS including (a) Requesting Change, (b) Speaking for the Child, (c) Supporting Communication, (d) Slowing and Simplifying, and (e) Responding Emotionally. Reliability was demonstrated, responses by parents of CWS were described, and a revised scoring form developed.

CONCLUSIONS

The VRYCS is a valid and reliable tool for assessing and exploring parents' perceptions of their own responses to the speech of their CWS for clinical and research purposes. Clinical applications of the VRYCS for assessment and treatment of childhood stuttering are discussed.

Self-reported impact of developmental stuttering across the lifespan

AIM

To examine the phenomenology of stuttering across the lifespan in the largest prospective cohort to date.

METHOD

Participants aged 7 years and older with a history of developmental stuttering were recruited. Self-reported phenotypic data were collected online including stuttering symptomatology, co-occurring phenotypes, genetic predisposition, factors associated with stuttering severity, and impact on anxiety, education, and employment.

RESULTS

A total of 987 participants (852 adults: 590 males, 262 females, mean age 49 years [SD = 17 years 10 months; range = 18-93 years] and 135 children: 97 males, 38 females, mean age 11 years 4 months [SD = 3 years; range = 7-17 years]) were recruited. Stuttering onset occurred at age 3 to 6 years in 64.0%. Blocking (73.2%) was the most frequent phenotype; 75.9% had sought stuttering therapy and 15.5% identified as having recovered. Half (49.9%) reported a family history. There was a significant negative correlation with age for both stuttering frequency and severity in adults. Most were anxious due to stuttering (90.4%) and perceived stuttering as a barrier to education and employment outcomes (80.7%).

INTERPRETATION

The frequent persistence of stuttering and the high proportion with a family history suggest that stuttering is a complex trait that does not often resolve, even with therapy. These data provide new insights into the phenotype and prognosis of stuttering, information that is critically needed to encourage the development of more effective speech therapies.

WHAT THIS PAPER ADDS

Half of the study cohort had a family history of stuttering. While 75.9% of participants had sought stuttering therapy, only 15.5% identified as having recovered. There was a significant negative correlation between age and stuttering frequency and severity in adults.

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.

Palin parent-child interaction therapy with children with autism spectrum disorder and stuttering

INTRODUCTION

It is estimated that 8% of children who stutter (CWS) have autism spectrum disorder (ASD) Briley & Ellis (2018). There is evidence that interventions for CWS and interventions for children with ASD can be effective, but there is little evidence to guide clinical decision making when working with CWS with a co-existing diagnosis of ASD. Palin Parent-Child Interaction (PCI) therapy Kelman & Nicholas (2020) is an evidence-based intervention for CWS, with the authors suggesting that the approach may be beneficial for CWS with ASD. The aim of this study was to examine outcomes for three CWS with ASD who received Palin PCI at a specialist centre for stuttering in London.

METHOD

The participants were three CWS with ASD aged 4;5, 6;7 and 7;7. Assessments were administered before therapy, and then at three, six and twelve months after therapy began. Outcome measures included stuttering frequency, child's communication attitude, parents' perception of the impact of stuttering on the child, the severity of stuttering and its impact on the parents, and parents' knowledge and confidence in managing stuttering.

RESULTS

All three children showed improvement in three or more variables. Four out of five parents reported reduced impact of stuttering on the child and themselves following therapy, and change was maintained one year post-therapy. All five parents reported increased knowledge of stuttering and confidence in managing it after therapy, and four parents maintained these changes for a year.

CONCLUSIONS

Over a one year period, these CWS with ASD who received Palin PCI showed change across multiple variables. The observed increases in parent knowledge and confidence were comparable to previously published data. These preliminary findings suggest that CWS with ASD and their parents can benefit from Palin PCI therapy and that further experimental evaluation of this approach with this client group is indicated.

Epilepsy and Diagnostic Dilemmas: The Role of Language and Speech-Related Seizures

Although the impact of epilepsy on expressive language is heavily discussed, researched, and scientifically grounded, a limited volume of research points in the opposite direction. What about the causal relationship between disorder-related language activities and epileptic seizures? What are the possible diagnostic dilemmas that experts in the field of speech-language pathology, neurology, and related fields face? How far has research gone in investigating psychogenic nonepileptic seizures, the misdiagnosis of which can be a thorny issue for clinicians and a detrimental factor for the patients’ health? In order to address these questions, the study at hand focuses on a common, ever-intensified (by the COVID-19 pandemic) speech disorder—stuttering, and explores the pathophysiological and psychogenic background of the phenomenon. It also looks at the role of stuttering as a contributing factor to the appearance of epileptic seizures, in the hope of drawing attention to the complexity and importance of precise detection of stuttering-induced epilepsy, as a specific subcategory of language-induced epilepsy.

Cluttering in the Speech of Young Men With Fragile X Syndrome

PURPOSE

Cluttering is a fluency disorder that has been noted clinically in individuals with fragile X syndrome (FXS). Yet, cluttering has not been systematically characterized in this population, hindering identification and intervention efforts. This study examined the rates of cluttering in male young adults with FXS using expert clinical opinion, the alignment between expert clinical opinion and objectively quantified features of cluttering from language transcripts, and the association between cluttering and aspects of the FXS phenotype.

METHOD

Thirty-six men with FXS (aged 18-26 years; M = 22, SD = 2.35) contributed language samples and completed measures of nonverbal cognition, autism symptoms, anxiety, and symptoms of attention-deficit/hyperactivity disorder (ADHD). The presence of cluttering was determined by the consensus of two clinical experts in fluency disorders based on characteristics exhibited in the language sample. Cluttering features (speech rate, disfluencies, etc.) were also objectively quantified from the language transcripts.

RESULTS

Clinical experts determined that 50% of participants met the criteria for a cluttering diagnosis. Phrase repetitions were the most salient feature that distinguished individuals who cluttered. Although the presence of cluttering was not associated with autism symptoms or mean length of utterance, cluttering was more likely to occur when nonverbal cognitive ability was higher, ADHD symptoms were elevated, and anxiety symptoms were low.

CONCLUSIONS

Half of the male young adults with FXS exhibited cluttering, which supports FXS as a genetic diagnosis that is highly enriched for risk of cluttering. Cluttering was associated with increased ADHD symptoms and cognitive ability and reduced anxiety symptoms. This study contributes a new description of the clinical presentation of cluttering in men with FXS and may lead to improved understanding of the potential underlying mechanisms of cluttering and eventual refinements to treatment and diagnosis.

Anxiety and Depression Symptoms in Children and Adolescents Who Stutter: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this study was to investigate whether there are elevated symptoms of anxiety or depression in children and adolescents (aged 2-18 years) who stutter, and to identify potential moderators of increased symptom severity.

METHOD

We conducted a preregistered systematic review of databases and gray literature; 13 articles met criteria for inclusion. A meta-analysis using robust variance estimation was conducted with 11 cohort studies comparing symptoms of anxiety in children and adolescents who do and do not stutter. Twenty-six effect sizes from 11 studies contributed to the summary effect size for anxiety symptoms (851 participants). Meta-analysis of depression outcomes was not possible due to the small number of studies.

RESULTS

The summary effect size indicates that children and adolescents who stutter present with increased anxiety symptoms (g = 0.42) compared with nonstuttering peers. There were insufficient studies to robustly analyze depression symptoms, and qualitative review is provided. No significant between-groups differences were reported in any of the depression studies.

CONCLUSIONS

Preliminary evidence indicates elevated symptoms of anxiety in some children and adolescents who stutter relative to peers. There was a tendency toward higher depression scores in this population, although reported between-groups differences did not reach statistical significance. These findings require replication in larger, preferably longitudinal studies that consider factors that may moderate risk. Nevertheless, our findings highlight a need for careful monitoring of mental health and well-being in young people who stutter. Supplemental Materials: http://osf.io/5m6zv.

Conversational speech of school-age children after syllable-timed speech treatment for stuttering

Purpose: The purpose of this laboratory study was to investigate whether rhythmic speech was primarily responsible for stuttering reductions in four school-aged children after the instatement stage of the Westmead Program of syllable-timed speech (STS) intervention. The study was designed to inform further development of the program. Reduction in variability of vowel duration is a marker of STS, and it was predicted that this would be present in the children's conversational speech after Stage 1 of the program if they were using STS. To strengthen such a finding, it was also predicted that there would be no reduction in articulation rate, sentence complexity, and utterance length after treatment, as there is evidence that reductions in these can reduce stuttering. Perceptual judgments of speech quality after treatment were also made by independent listeners.Method: Participants were four children, ages 8-11 years, who completed Stage 1 of an STS program and whose stuttering had reduced significantly. Pre-treatment (PRE) and post-treatment (POST) within-clinic audio-visual recordings of conversational speech were analysed for percentage of syllables stuttered, variability of vowel duration, articulation rate, and length and complexity of utterance. Four blinded listeners made perceptual judgments of speech quality in the POST recordings.Result: Recordings of all children showed that variability of vowel duration clearly reduced from the PRE to POST speech samples. Importantly, articulation rate and language use were not compromised. Some possible indicators of rhythmicity were identified in one child in the perceptual study.Conclusion: The findings suggest that STS was primarily responsible for the clinically significant reductions in stuttering after Stage 1 of the program. There is an urgent need for more evidence-based interventions for stuttering in this age group and further development of STS interventions is warranted.

Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents

PURPOSE

The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate.

METHODS

A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis.

RESULTS

There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations.

DISCUSSION

This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.

Relationship between social anxiety and coping profile in adults who stutter

INTRODUCTION

Stuttering is a condition that can be severely disabling in the workplace and socially. Although many stuttering cases resolve, some adults who stutter (AWS) continue to be affected not only by dysfluent speech, but also by other social and psychological conditions that may develop as a result of stuttering. The aim of the present study was to determine the relationship between severity of stuttering, severity of social anxiety, and coping profile.

METHODS

We objectively assessed adults who stutter (n = 44; mean age = 27.5 years) and age-matched non-stuttering control subjects on four variables: stuttering frequency, communication attitude, social anxiety, and coping profile. Stuttering frequency was calculated as the percentage stuttered morae in the Kitsuon-kensa-ho test. All subjects were assessed on the Japanese versions of the Modified Erickson's Communication Attitude Scale (S-24-J), Liebowitz Social Anxiety Scale (LSAS-J), and the Brief Scale for Coping Profile (BSCP).

RESULTS

Compared to the non-stuttering group, the stuttering group had a higher average score on the S-24-J and LSAS-J, and tended to "avoid and suppress" instead of "seek help for resolution" on the BSCP. Comparison of individual stutterers' S-24-J scores whose LSAS-J scores were above or below the LSAS-J cutoff score revealed that their the S-24-J scores tended to be higher. Also, BSCP participants tended to engage in "proactive resolution" and "emotional venting involving others," not "seeking help for resolution." The stuttering group (vs. the non-stuttering group) and the high social-anxiety group (vs. the low social-anxiety group) adopted non-adaptive coping strategies.

CONCLUSIONS

This suggests that the coping profile of AWS may contribute to the cycle of social anxiety and stuttering to a greater or lesser extent. Thus, therapy that reduces anxiety and helps AWS to adopt more adaptive coping strategies may improve stuttering.

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.

Psychological characteristics of early stuttering

PURPOSE

The purpose of this study was to use psychological measures of pre-schoolers who stutter and their parents to inform causal theory development and influence clinical practices. This was done using data from a substantive clinical cohort of children who received early stuttering treatment.

METHOD

The cohort (N = 427) comprised parents and their children who were treated with the Lidcombe Program, the Westmead Program, and the Oakville Program. The study incorporated demographic information, stuttering severity, and child and parent psychological measures prior to treatment.

RESULT

The cohort revealed nothing unusual about behavioural and emotional functioning, or the temperaments, of pre-school children that would influence treatment, be targeted during treatment, or influence causal theory development. However, a third of parents were experiencing moderate to high life stressors at the time of seeking treatment, and half the parents failed first-stage screening for Anankastic Personality Disorder.

CONCLUSION

The present results are consistent with a number of previous reports that showed that the population of pre-schoolers who stutter have no unusual psychological profiles. Hence, these results suggest that the association between mental health and stuttering later in life is a consequence of the disorder rather than being a part of its cause. The finding of the life stress of parents who seek stuttering treatment for pre-school children has potential clinical importance and warrants further investigation. Further psychological research is required about parents of pre-school children who stutter, because half the parents in the cohort failed the screener for Anankastic Personality Disorder. This is of interest because a previous study associated screening failure for another personality disorder (Impulsive Personality Disorder) with treatment dropout for early childhood stuttering.

The Speech Situation Checklist-Emotional Reaction: Normative and comparative study of Kannada-speaking children who do and do not stutter

Purpose: Existing data stemming from investigations with the Speech Situation Checklist (SSC) have shown this standardised test to be a valid and reliable tool for assessing speech-related anxiety in children who stutter (CWS). The main purpose of this study was to compare Speech Situation Checklist-Emotional Reaction (SSC-ER) scores for Kannada-speaking children who do not stutter (CWNS) and CWS. In addition, the Speech Situation Checklist-Emotional Reaction in Kannada (SSC-ER-K) scores among different stuttering severity and age groups were compared in CWS.Method: The English version of the SSC-ER was forward-translated into Kannada and back-translated by the first author. SSC-ER-K was administered on 100 CWS and 275 CWNS aged between 7 and 14 years who were native speakers of the Kannada language. The severity of stuttering was estimated using the Stuttering Severity Instrument-fourth edition (SSI-4).Result: The results revealed that the SSC-ER-K scores of CWS were significantly higher in comparison with CWNS. CWS with moderate and severe degrees of stuttering had significantly higher scores when compared to those with a mild degree of stuttering. Furthermore, the older CWS (11-14 years) had significantly higher scores compared to the younger CWS (7-10 years). In addition, the SSC-ER-K appears to be a reliable self-report test. The above findings suggest the presence of significantly increased speech-related anxiety in CWS. Also, as age and severity of stuttering increased so did the level of their speech-related anxiety.Conclusion: The SSC-ER-K is a useful tool in the assessment of negative emotional reaction to specific speech situations in Kannada CWS and can assist speech-language pathologists in addressing speech-situation specific anxiety during treatment.

Non-pharmacological interventions for stuttering in children six years and younger

BACKGROUND

Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non-verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning.

OBJECTIVES

Primary objective To assess the immediate and long-term effects of non-pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) and quasi-RCTs that assessed non-pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait-list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial.  All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects.  The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait-list control group at post-test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) -2.16, 95% confidence interval (CI) -3.48 to -0.84, 4 studies, 151 participants; P = 0.001; very low-certainty evidence).  However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate-certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long-term follow-up. The long-term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within-group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow-up, and showed a significant reduction in frequency of stuttering.  AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait-list control group in children aged up to six years at post-test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long-term effects of other non-pharmacological interventions for stuttering compared to no intervention or a wait-list control group.

Fluency and reading comprehension in students with and without stuttering

PURPOSE

To analyze and to compare fluency parameters in spontaneous speech and reading and reading comprehension of school-age children who stutter and who do not stutter.

METHODS

Cross-sectional and prospective study approved by the Research Ethics Committee. Sample consisted of 30 scholars aged 8 and 11 years and 11 months divided into two groups: Study Group with 15 school-age children who stutter, Control Group with 15 school-age children who do not stutter. Participants underwent fluency evaluation of spontaneous speech, reading of expository and narrative texts, and reading comprehension evaluation. Inferential statistical analysis was conducted using the Mann-Whitney tests and correlation analysis was conducted using the Spearman's Coefficient test.

RESULTS

The comparison between the fluency parameters indicated that school-age children who stutter showed a greater amount of stuttering-like disfluencies, while school-age children who do not stutter showed longer flows of syllables and words per minute, in spontaneous speech and reading. Regarding reading comprehension, school-age children who stutter had lower performance than school-age children who do not stutter in both texts. There was no association between the frequency of disfluencies and reading comprehension in school-age children who stutter and who do not stutter.

CONCLUSION

School-age children who stutter showed impairments in reading comprehension when compared to fluent, since there was no association between the frequencies of disfluencies with reading comprehension for both groups. It is suggested that reading comprehension be evaluated and, if necessary, improved in order to reduce the consequences of stuttering and provide learning of this school-age children.

Measures of Psychological Impacts of Stuttering in Young School-Age Children: A Systematic Review

Purpose Recent research has shown that some school-age children who stutter may have speech-related anxiety. Given this, speech-language pathologists require robust measures to assess the psychological effects of stuttering during the school-age years. Accordingly, this systematic review aimed to explore available measures for assessing the psychological impacts of stuttering in young school-age children and to examine their measurement properties. Method The systematic search protocol was registered with PROSPERO (ID: 163181). Seven online databases, in addition to manual searching and screening of reference lists, were used to identify appropriate measures for the population of children who stutter aged 7-12 years. The first two authors independently assessed the measures using the quality appraisal tool described by Terwee et al. (2007). Results Despite the comprehensive search strategy, only six measures were identified for quality appraisal. No assessment tool was found to possess adequate measurement properties for the eight assessed domains: content validity, internal consistency, construct validity, reproducibility, reliability, responsiveness, floor and ceiling effects, and interpretability. No measure had clear evidence of responsiveness to clinical change. Based on the criterion defined by the Terwee et al. (2007) appraisal tool, the Communication Attitude Test and the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children received the highest number of ratings in support of their measurement properties. Conclusions The results highlight a lack of available measures in this domain and poor practices in developing and testing measurement instruments. To ensure that clinicians and researchers are equipped with sound measures to meet the mental health needs of this vulnerable population, further research to establish resources is needed.

Identifying developmental stuttering and associated comorbidities in electronic health records and creating a phenome risk classifier

PURPOSE

This study aimed to identify cases of developmental stuttering and associated comorbidities in de-identified electronic health records (EHRs) at Vanderbilt University Medical Center, and, in turn, build and test a stuttering prediction model.

METHODS

A multi-step process including a keyword search of medical notes, a text-mining algorithm, and manual review was employed to identify stuttering cases in the EHR. Confirmed cases were compared to matched controls in a phenotype code (phecode) enrichment analysis to reveal conditions associated with stuttering (i.e., comorbidities). These associated phenotypes were used as proxy variables to phenotypically predict stuttering in subjects within the EHR that were not otherwise identifiable using the multi-step identification process described above.

RESULTS

The multi-step process resulted in the manually reviewed identification of 1,143 stuttering cases in the EHR. Highly enriched phecodes included codes related to childhood onset fluency disorder, adult-onset fluency disorder, hearing loss, sleep disorders, atopy, a multitude of codes for infections, neurological deficits, and body weight. These phecodes were used as variables to create a phenome risk classifier (PheRC) prediction model to identify additional high likelihood stuttering cases. The PheRC prediction model resulted in a positive predictive value of 83 %.

CONCLUSIONS

This study demonstrates the feasibility of using EHRs in the study of stuttering and found phenotypic associations. The creation of the PheRC has the potential to enable future studies of stuttering using existing EHR data, including investigations into the genetic etiology.

Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter

PURPOSE

Many school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter.

METHODS

Ten children and adolescents who stutter (aged 9-17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions.

RESULTS

Results show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment.

CONCLUSION

Our results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking.

Impact of cognitive behavioural play therapy on social anxiety among school children with stuttering deficit: A cluster randomised trial with three months follow-up

BACKGROUND

Stuttering is a speech deficit which is characterized by obstruction of speech eloquence and verbal expression in addition to involuntary flow of air during communication. School children with communication deficit often experience social anxiety in their immediate environment. Currently, reports show that a good number of children with communication deficits are prone to social maladjustment due to their being socially inept. And this has significantly affected their thought pattern, social behaviours and emotional responses. In view of this, we examined the impact of cognitive behavioural play therapy in reducing social anxiety among school children with stuttering.

METHOD

This is a pretest-posttest randomized control group design. Participants were 178schoolchildren in inclusive schools in South east Nigeria. Participants in the intervention group were treated using cognitive behavioural play therapy programme (CBPT). Participants in the waitlist control group were only assessed at three points of assessment. Data analyses were completed using repeated measures ANOVA.

RESULTS

The results show that cognitive behavioural play therapy is beneficial in decreasing schoolchildren's social anxiety scores. The intervention equally showed the considerable impacts on the children when exposed to cognitive behavioural play programme at different times of assessment compared to waitlisted control group.

CONCLUSION

It is concluded that CBPT is a long-term psychotherapeutic programme that has significant impacts in reducing social anxiety among children with stuttering. This study makes a leading contribution on the limited scholarship focusing on the impact of CBPT on social anxiety of special population with stuttering deficits in developing countries.

Validity of telephone calls to assess percentage of syllables stuttered with adolescents in clinical research

PURPOSE

Karimi, O'Brian, Onslow, and Jones (2013) reported, for adults, no systematic differences between percentage of syllables stuttered (%SS) scores during a 12-hour day and 10-minute phone calls. The present study replicated that finding with adolescents, using valid methods for the age group. The present study also extended that initial report by determining whether the gender of the caller influenced %SS scores.

METHOD

Participants were 17 adolescents with stuttering. Percentage of syllables stuttered scores were obtained from a 12-hour day of the adolescents' lives, and two 10-minute unscheduled phone calls made before and after that day. One phone call was from a male caller and the other from a female caller.

RESULTS

For adolescents, analysis of covariance (ANCOVA) and intraclass correlations (ICC) replicated the overall Karimi, O'Brian, Onslow, and Jones (2013) finding. No significant differences were found between the %SS scores of the three speech samples, and these %SS scores were found to be highly correlated. However, in contrast to the Karimi, O'Brian, Onslow, and Jones (2013) finding with adults, Bland-Altman plot results revealed a caveat to this finding when applied to individual adolescents. Additionally, there was no effect due to the gender of the caller.

CONCLUSION

A 10-minute phone call can be used confidently to assess group mean %SS scores during stuttering research with adolescents. However, a 10-minute phone call cannot be used confidently to assess %SS scores of individual adolescent participants. For the latter context, such as with data-based case studies and single-subject experimentation, we recommend supplementing %SS scores with self-reported severity scores.

A Questionnaire Survey About Support Requests From School-Age Children and Adolescents Who Stutter

Purpose Children who stutter (CWS) face communication difficulties in school activities and at home. Although the importance of receiving support from their surroundings has been documented, few studies have investigated potential requests of CWS from their surroundings. This study aimed to elucidate such requests. Method A total of 43 school-age children and 25 adolescents who stutter completed a free-description questionnaire, including questions such as "what you want your classmates/your classroom teacher/your family to do about your stuttering?" Their descriptions were summarized and categorized based on similarity. Results The results indicate that 90.6% of the participants had more than one request for their classmates, classroom teacher, or family. A total of 197 items were extracted and categorized into seven themes. In particular, the responses included "listen attentively," "treat us naturally," and "make arrangements." While participants tended to hope for classmates or family to "listen attentively" and "treat us naturally," the request to "make arrangements" was higher for their teacher. Their potential requests varied by age: While school-age CWS wanted people around them to "listen carefully," the hope of adolescents who stutter was "treat us naturally." Conclusions The various potential requests of CWS were categorized, and the responses shed light on the importance of increasing knowledge of stuttering. The difference between the requests could reflect psychosocial differences between school-age children and adolescents who stutter. In addition, social interaction among peers is more developed in adolescents, and they could harbor fear of being excluded within their community.

The Youth Online Diagnostic Assessment (YODA): Validity of a New Tool to Assess Anxiety Disorders in Youth

This study developed an online diagnostic tool for anxiety disorders in youth, and evaluated its reliability and validity amongst 297 children aged 6-16 years (M_age = 9.34, 46% male). Parents completed the online tool, the Youth Online Diagnostic Assessment (YODA), which is scored either using a fully-automated algorithm, or combined with clinician review. In addition, parents and children completed a clinician-administered diagnostic interview and self-report measures of internalizing and externalizing symptoms and wellbeing. The fully-automated YODA demonstrated relatively weak agreement with the diagnostic interview for identifying the presence of any anxiety disorder and specific anxiety disorders, apart from separation anxiety (which had moderate agreement). The clinician-reviewed YODA showed better agreement than fully-automated scoring, particularly for identifying the presence of any anxiety disorder. The YODA demonstrated good agreement with parent-reported measures of symptoms/interference. The YODA offers a fully or largely automated method to determine the presence of anxiety disorders in youth, with particular value in situations where low-resource assessments are needed. While it currently requires further research and improvement, the YODA provides a promising start to the development of such a tool.

Natural recovery from stuttering for a clinical cohort of pre-school children who received no treatment

PURPOSE

The natural stuttering recovery rate by adulthood is high. Community cohort studies suggest a much lower rate during the first 18 months after onset, but this may be different for clinical cohorts of pre-school aged children. The present research and case presentations add to data reported by Franken et al. by investigating early natural recovery for a clinical cohort.

METHOD

Participants were 16 pre-school children presenting to a clinic with stuttering onset 1-15 months earlier. The children were studied for a mean of 19.4 months (84.3 weeks) using parent report and clinician identification of stuttering from recorded conversations. The children received no treatment during the study. Data were obtained for each participant and are presented graphically.

RESULT

Experienced speech-language pathologists detected stuttering in the recordings of 3 of 4 children identified as recovered by their parents. Only 1 of the 16 children (6.3%) was confirmed as recovered.

CONCLUSION

There is no reason to believe that the early natural recovery rate for clinically presenting children is different from community cohorts. Parent report of natural recovery during the pre-school years needs to be confirmed by clinician observation of the child's speech; otherwise, there is risk of harmful false negative identification. The present data support the Yairi et al. different recovery pathways for children who stutter.

Using EMDR to Address Social Anxiety With Clients Who Stutter: Treatment Considerations

This article describes the treatment considerations when providing eye movement desensitization and reprocessing (EMDR) therapy to treat clients who stutter. Since stuttering is often developed in childhood and persists into adulthood, it has long-term impacts on the educational, social, psychological, and professional development of those who stutter. While stuttering can present with physiological impairments not amendable to psychological interventions, EMDR therapy may effectively decrease the psychological stressors (such as social anxiety and shame) that can intensify stuttering. The authors present an extensive literature review on the traumatic experiences and adverse effects of stuttering. They also discuss essential treatment guidelines when using EMDR to work with people who stutter (PWS), including processing developmental trauma when stuttering, experiences of being bullied because of stuttering, shame and internalized negative self-statements, distrust of one's body due to inability to control one's speaking, and the social anxiety and avoidance in dealing with triggering situations. The clinical instructions are illustrated with a case example of a 40-year-old college professor who experienced anxiety and shame related to persistent developmental stuttering, and who sought treatment due to difficulties speaking in front of his classes. After completing 20 sessions of EMDR therapy, the client reported decreased social anxiety and shame and was able to teach courses comfortably. Further research considerations using EMDR treatment with PWS are recommended.

Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research

Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

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.