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

The Influence of Caregiver Language on the Association Between Child Temperament and Spoken Language in Children Who Are Deaf or Hard of Hearing

OBJECTIVES

To examine the interaction between child temperament and caregiver linguistic input (i.e., syntactic complexity and lexical diversity) on receptive language in children who are deaf or hard of hearing (DHH).

DESIGN

Families of 59 DHH children ( Mage = 5.66 years) using spoken language for communication participated in this cross-sectional study. Caregivers completed the Child Behavior Questionnaire-Short Form, which measured child temperament across three established factors (i.e., effortful control, negative affectivity, surgency-extraversion) and participated with their child in a semi-structured, dyadic play interaction that occurred during a home visit. Caregivers' language during the play interaction was quantified based on lexical diversity and syntactic complexity. Children also completed norm-referenced receptive language measures (i.e., Comprehensive Assessment of Spoken Language-2, age-appropriate Clinical Evaluation of Language Fundamentals) during the home visit that were combined into a composite measure of child receptive language.

RESULTS

When caregivers used lower to moderate levels of lexical diversity, child effortful control was positively related to child receptive language. However, when caregivers used higher levels of lexical diversity, child effortful control and child receptive language were not related to each other.

CONCLUSIONS

Family environments rich in caregiver lexical input to children might provide a protective influence on DHH child language outcomes by helping to ensure DHH children with varying self-regulatory abilities achieve better spoken language comprehension. These findings highlight the importance of encouraging caregivers to provide rich and stimulating language-learning environments for DHH children.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

What Is the Role of Questioning in Young Children's Fluency?

PURPOSE

Most therapy programs for young children who stutter (CWS) involve caregiver counseling and adjustment of caregiver behavior to maximize opportunities for the child to be more fluent. One component sometimes included as a recommended adjustment is a reduction in caregiver question asking, as question asking is hypothesized to increase language formulation demands on the child. However, there is limited research to guide clinician advisement to caregivers that has controlled for numerous potential confounding factors, including utterance length and grammaticality, that may impact potential stressors on children. Our aim was to assess whether there was an empirical basis for such recommendations by comparing disfluency profiles of answers to questions and nonanswer utterances produced by children during spontaneous play with parents and examiners.

METHOD

We analyzed fluency and structural properties as well as pragmatic function of 15,782 utterances from language samples produced by 32 CWS and 32 children who do not stutter (CWNS) who were between 28 and 50 months of age. CWS and CWNS were matched on gender and age within 4 months and were matched as closely as possible on maternal education.

RESULTS

For utterances produced by CWS, answers to adult questions were significantly less likely to contain stuttering-like disfluencies than other utterance types, and this was still true after controlling for utterance length and grammaticality. In contrast, for utterances produced by CWNS, answers to questions were significantly more likely to be disfluent than other utterance types after controlling for length and grammaticality.

CONCLUSION

Given the current findings, some prior research, and the documented potential benefits in language development for adult question asking of children, we do not believe that clinicians need to recommend changes to typical question-asking behavior by caregivers of CWS.

Contemporary Theories of Stuttering Development

The article presents a theoretical analysis of contemporary models of persistent stuttering development in children and adults at the current period of development of science. The accumulated amount of scientific knowledge suggests that stuttering has a neurological basis: it is associated with disorders in the structure and function of the brain. On this basis, there have been emerged models of stuttering that link the cause of a speech disorder with an unstable speech motor system. Theories and models of stuttering based on cognitive and language processing are likely to be useful in that they have explanatory power in relation to the mechanisms that play an important role in the production of key symptoms of stuttering. Considering that stuttering is a complex disorder, the logical result of this was the proposal of multifactorial models of impaired speech fluency. The presented overview may be useful to psychiatrists, clinical psychologists, speech therapists, teachers, and practitioners interacting with children and adults with stuttering and other speech fluency disorders.

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.

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

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

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

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

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