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

The Association Between Stuttering Burden and Psychosocial Aspects of Life in Adults

PURPOSE

Stuttering is a speech condition that can have a major impact on a person's quality of life. This descriptive study aimed to identify subgroups of people who stutter (PWS) based on stuttering burden and to investigate differences between these subgroups on psychosocial aspects of life.

METHOD

The study included 618 adult participants who stutter. They completed a detailed survey examining stuttering symptomatology, impact of stuttering on anxiety, education and employment, experience of stuttering, and levels of depression, anxiety, and stress. A two-step cluster analytic procedure was performed to identify subgroups of PWS, based on self-report of stuttering frequency, severity, affect, and anxiety, four measures that together inform about stuttering burden.

RESULTS

We identified a high- (n = 230) and a low-burden subgroup (n = 372). The high-burden subgroup reported a significantly higher impact of stuttering on education and employment, and higher levels of general depression, anxiety, stress, and overall impact of stuttering. These participants also reported that they trialed more different stuttering therapies than those with lower burden.

CONCLUSIONS

Our results emphasize the need to be attentive to the diverse experiences and needs of PWS, rather than treating them as a homogeneous group. Our findings also stress the importance of personalized therapeutic strategies for individuals with stuttering, considering all aspects that could influence their stuttering burden. People with high-burden stuttering might, for example, have a higher need for psychological therapy to reduce stuttering-related anxiety. People with less emotional reactions but severe speech distortions may also have a moderate to high burden, but they may have a higher need for speech techniques to communicate with more ease. Future research should give more insights into the therapeutic needs of people highly burdened by their stuttering.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25582980.

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.

Stuttering, family history and counselling: A contemporary database

BACKGROUND

Information about genetic influence is useful to when counselling parents or caregivers who have infants and children at risk for stuttering. Yet, the most comprehensive family aggregate database to inform that counselling is nearly four decades old (Andrews et al., 1983). Consequently, the present study was designed to provide a contemporary exploration of the relationship between stuttering and family history.

METHODS

Data were sourced from the Australian Stuttering Research Centre, comprising 739 participants who presented for assessment, treatment, or investigation of stuttering. Reported family history data were acquired from pedigrees collected during assessment. We sought to establish the relation of the following variables to family history of stuttering: incidence, proband sex, parent sex, stuttering severity, age, reported age of stuttering onset, and impact of stuttering. Data were analysed with chi-square tests for independence, logistic and linear regression models.

RESULTS

Results were broadly consistent with existing data, but the following findings were novel. Males and females who stutter have the same increased odds of having a father who stutters relative to a mother who stutters. Males had later stuttering onset than females, with genetic involvement in this effect. There was a greater impact of stuttering for females than males with a family history of stuttering.

CONCLUSION

These findings have clinical applications. Speech-language pathologists may have infant or child clients known to them who are at risk of beginning to stutter. Information from the present study can be applied to counselling parents or caregivers of such children about stuttering and family history.

Emotional Regulation and Its Influence on the Experience of Stuttering Across the Life Span

PURPOSE

This study evaluated the relationship between emotional regulation (ER) and adverse impact related to stuttering across the developmental spectrum, in preschool and school-age children, adolescents, and adults who stutter. An additional aim examined how these variables relate to the ways that individuals approach speaking (i.e., their agreement on whether their goal is to speak fluently).

METHOD

Participants were the parents of 60 preschoolers and younger school-age children (ages 3-9 years), 95 school-age children and adolescents who stutter (ages 7-18 years), and 180 adults who stutter (ages 18-81 years). All participants completed surveys with age-appropriate measures examining ER and the adverse impact of stuttering. Older children and adults who stutter also answered questions regarding their goals when speaking. Multiple regression and ordinal logistic regression were used to examine relationships among ER, adverse impact related to stuttering, and goal when speaking.

RESULTS

In preschool children, adverse impact was significantly predicted by a parent-reported measure of ER skills; in school-age children and adults, adverse impact was significantly predicted by measures of the ER strategies cognitive reappraisal (CR) and expressive suppression. Less frequent use of CR by adults was significantly associated with an increased likelihood of having "not stuttering" as a goal when speaking. Differences in the significance and magnitude of these relationships were found across the life span.

DISCUSSION

For both children and adults who stutter, ER is a significant factor related to the adverse impact of stuttering; the relationship between ER and adverse impact may change over development. Accounting for individual differences in ER can improve understanding of why a person copes with stuttering in the ways they do, and this has notable implications for individualizing intervention for both children and adults who stutter.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044469.

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

INTRODUCTION

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

AIM

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

METHODS

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

RESULTS

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

DISCUSSION

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

Bidirectional Associations of Childhood Stuttering With Behavior and Temperament

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Temperament is Linked to Avoidant Responses to Stuttering Anticipation

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Sleep duration, insomnia, and stuttering: The relationship in adolescents and young adults

PURPOSE

Evidence of a linkage between neurodevelopmental stuttering and sleep difficulties has been suggested in studies involving children and adolescents. To further examine the relationship between stuttering and sleep, the current study explored both hours of sleep and insomnia in a longitudinal sample of adolescents and young adults living with stuttering.

METHOD

The data for this study came from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative survey study following 13,564 US respondents over the course of 20 years. In each of the five survey waves, respondents noted their average hours of sleep. In addition, Wave IV, respondents indicated whether they suffered from insomnia (i.e., difficulty falling or staying asleep). Respondents who indicated stuttering at ages 18-26 (Wave III) and 24-32 (Wave IV) are considered as those with persistent stuttering-the focus of this analysis. Regression analysis assessed the association between stuttering, hours of sleep and insomnia controlling for sex, age, race, education and other demographic characteristics.

RESULTS

The sample included 261 participants (1.7% of total respondents) who identified themselves as people who stutter, comprised of 169 males and 92 females. Compared to their fluent counterparts, individuals who stutter reported to sleep, on average, 20 min less per night. Additionally, 15% of those who stutter reported difficulties falling or staying asleep almost every day or every day, which is twice as likely as controls. Results were robust to demographic characteristics and co-occurring conditions.

CONCLUSIONS

Speech-language pathologists should be aware of the association between stuttering and insomnia, as well as the lower average hours of sleep among adolescents and young adults who stutter. The possibility that lower sleep duration and insomnia may affect stuttering daily variability and impair improvement from stuttering are discussed.

Temperament and the Impact of Stuttering in Children Aged 8-14 Years

Purpose The goal of this study was to evaluate possible associations between child- and mother-reported temperament, stuttering severity, and child-reported impact of stuttering in school-age children who stutter. Method Participants were 123 children who stutter (94 boys and 29 girls) who were between 9;0 and 14;10 (years;months) and their mothers. Temperament was assessed with the revised child and parent version of the Early Adolescent Temperament Questionnaire-Revised (Ellis & Rothbart, 2001). The Overall Assessment of the Speaker's Experience of Stuttering (Yaruss & Quesal, 2006) was used to evaluate the stuttering impact. Results Child- and mother-reported Early Adolescent Temperament Questionnaire-Revised temperament factors correlated moderately. No statistically significant associations were found between temperament and stuttering severity. The temperament factors of Surgency (both child- and mother-reported) and Negative Affect (only child-reported) correlated moderately with the Overall Impact and several subsections (i.e., Speaker's Reactions, Daily Communication, and/or Quality of Life) of the Overall Assessment of the Speaker's Experience of Stuttering. Conclusions More extraverted and less fearful/shy children experience a lower overall impact of their stuttering. Children with higher levels of irritability and frustration experience a higher overall impact of their stuttering. Since children's ratings of temperament were more sensitive to these associations than mothers, this study supports the inclusion of child-reported temperament questionnaires in future research.

Presence of Allergies and Their Impact on Sleep in Children Who Stutter

Purpose

Population-based research has identified insomnia or trouble sleeping, sleepiness during the day, and fatigue during the day as frequent coexisting conditions in children who stutter (CWS). Considering that allergies are well known to disturb sleep, the purpose of this study was to explore if there is an association between the presence of allergies and sleep issues among CWS, as well as if allergies are frequent in CWS.

Method

Data from the 2012 National Health Interview Survey were used. Children used in this sample were those whose caregivers answered definitively whether or not the child stuttered within the past 12 months. Additionally, caregivers identified the presence of allergies and/or asthma and the presence of insomnia or trouble sleeping in the sample child.

Results

The sample included 200 CWS and 9,951 children who do not stutter (CWNS). The odds of insomnia/trouble sleeping were greater in CWS who present with allergies and/or asthma, with the exception of food allergy, compared to CWS who do not present with with allergies and/or asthma. Additionally, the odds of insomnia/trouble sleeping were greater in CWS without any allergy, asthma, and coexisting disability ( OR = 7.48, p < .001) as compared to CWNS without any allergy, asthma, and coexisting disability. The presence of either any allergy or an asthma attack was higher among CWS (46.4%) compared to CWNS (29.5%), p < .001. Specifically, CWS were found to be at greater odds of presenting with any kind of respiratory allergy ( OR = 1.72, p = .034), food allergy ( OR = 2.32, p = .002), and skin allergy ( OR = 1.84, p = .009) than CWNS.

Conclusions

CWS were found to be at greater odds of allergies and asthma, conditions that also impair sleep. Interestingly, insomnia/trouble sleeping was prevalent among CWS, even when allergies, asthma, and coexisting disabilities were not present. The possible implications of these findings are discussed.

Physiological Correlates of Fluent and Stuttered Speech Production in Preschool Children Who Stutter

Purpose The purpose of this study was to compare physiological indices of sympathetic nervous system arousal recorded during fluent and stuttered utterances in a preschool children who stutter (CWS). Method Twenty-two 4- to 5-year-old CWS participated in the experiment. We recorded children's skin conductance response amplitude and frequency, blood pulse volume amplitude, and pulse rate as they completed a picture description task. We then compared indices of phasic sympathetic arousal recorded during stuttered versus fluent utterances. In addition, children's communication attitudes were evaluated with a self-report measure. Results We detected significantly higher sympathetic arousal during stuttered utterances compared to fluent utterances. Specifically, we found larger skin conductance responses occurring at an increased frequency and decreased blood pulse volume amplitudes during stuttered speech. The behavioral measure indicated a negative communication attitude in only one-third of the participants. Conclusion Our findings suggest that preschool CWS may exhibit higher levels of sympathetic arousal during stuttered speech compared to when they are speaking fluently. We discuss the potential impact of increased sympathetic arousal on speech regulatory mechanisms in early childhood stuttering and present questions to guide future research.

Sympathetic Nervous System Activity in Preschoolers Who Stutter

BACKGROUND

In our Dynamic Pathways, account, we hypothesized that childhood stuttering reflects an impairment in speech sensorimotor control that is conditioned by cognitive, linguistic, and emotional factors. The purpose of this study was to investigate potential differences in levels of sympathetic arousal during performance of speech and non-speech tasks between children who do and do not stutter.

METHODS

Seventy-two preschool-aged children participated in the study, 47 children who stutter (CWS; 38 boys) and 25 children who do not stutter (CWNS; 18 boys). We recorded skin conductance and blood pulse volume (BPV) signals, indices of sympathetic arousal, during higher/lower load speech tasks (structured sentence production and picture description) and non-speech tasks (jaw wagging and forceful blowing). We included a measure that reflects children's attitudes about their communication skills and a parent-report assessment of temperament.

RESULTS

We found no significant differences between preschool CWS and CWNS in phasic skin conductance response amplitude or frequency, BPV, and pulse rate for any of the experimental tasks. However, compared to CWNS, CWS had, on average, significantly higher skin conductance levels (SCL), indexing slowly changing tonic sympathetic activity, across both speech and non-speech experimental conditions. We found distinctive task-related profiles of sympathetic arousal in both groups of preschool children. Most children produced the highest levels of sympathetic arousal in the physically demanding blowing task rather than in speech, as seen in previous studies of adults. We did not find differences in temperament between the two groups of preschool children nor a relationship among behavioral indices of temperament and communication attitude and physiological measures of sympathetic arousal.

CONCLUSION

We did not find that atypically high, speech-related sympathetic arousal is a significant factor in early childhood stuttering. Rather, CWS had higher, on average, task-related tonic SCLs across speech and non-speech tasks. A relationship among behavioral measures of temperament and physiological measures of sympathetic arousal was not confirmed. Key questions for future experiments are how the typical coupling of sympathetic and speech sensorimotor systems develops over childhood and adolescence and whether task related developmental profiles follow a different course in children who continue to stutter.

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

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

Stuttering and gray matter morphometry: A population-based neuroimaging study in young children

Stuttering is a developmental speech disorder originating in early childhood. We aimed to replicate the association of stuttering and structural morphometry using a large, population-based prospective cohort, the Generation R Study, and explore the neurobiological mechanism of stuttering in children. Twenty-six children with a history of stuttering and 489 fluent speaking peers (ages 6-9) were included in the MRI sub-study. Cortical and subcortical regions of interest were analyzed using linear regression models. Compared to fluent speakers, children with a history of stuttering had less gray matter volume in the left inferior frontal gyrus and supplementary motor area. Exploratory surface-based brain analysis showed thinner cortex in the left inferior frontal gyrus, and in bilateral frontal and parietal areas. These findings corroborate previous studies that reported aberrant brain morphometry in speech motor and auditory regions in children who stutter. Future research is needed to explore the causal nature of this association.

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

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