Rhyme Production Strategies Distinguish Stuttering Recovery and Persistence

Nonword Repetition Performance Differentiates Children Who Stutter With and Without Concomitant Speech Sound and Developmental Language Disorders

PURPOSE

The aim of this study was to examine how nonword repetition (NWR) performance may be impacted by the presence of concomitant speech and language disorders in young children who stutter (CWS).

METHOD

One hundred forty-one children (88 CWS and 53 children who do not stutter [CWNS]) participated. CWS were divided into groups based on the presence of speech sound and/or language disorder or typical speech sound production and language abilities. NWR abilities were measured using stimuli composed of one- to four-syllable nonwords.

RESULTS

CWS with typical speech and language and CWNS had higher accuracy scores than CWS with concomitant speech and language disorders. We found no difference in accuracy scores between CWNS and CWS with typical speech and language abilities, nor did we find differences between CWS with speech sound disorder and CWS with both speech sound and language disorders. Accuracy decreased as nonword length increased for all groups.

CONCLUSIONS

We found that the presence of a concomitant speech and language disorder was a driving factor behind poorer NWR performance in CWS. Accuracy scores differentiated CWS with concomitant disorders from CWS with typical speech and language but not CWS with typical speech and language from CWNS. Considering the speech and language abilities of CWS helped clarify poorer NWR performance and enhances generalizability to the population that exists clinically.

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

PURPOSE

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

METHOD AND RESULTS

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

DISCUSSION

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

Novel word recognition in childhood stuttering

Language skills have long been posited to be a factor contributing to developmental stuttering. The current study aimed to evaluate whether novel word recognition, a critical skill for language development, differentiated children who stutter from children who do not stutter. Twenty children who stutter and 18 children who do not stutter, aged 3–8 years, completed a novel word recognition task. Real-time eye gaze was used to evaluate online learning. Retention was measured immediately and after a 1-hr delay. Children who stutter and children who do not stutter exhibited similar patterns of online novel word recognition. Both groups also had comparable retention accuracy. Together, these results revealed that novel word recognition and retention were similar in children who stutter and children who do not stutter. These patterns suggest that differences observed in previous studies of language in stuttering may not be driven by novel word recognition abilities in children who stutter.

Co-Production within Child and Adolescent Mental Health: A Systematic Review

Background: Mental health services are currently experiencing much systemic and organisational change. Many countries have adopted a recovery approach to service provision through the development of national policies and frameworks. Within an Irish context, co-production has been identified as one of the four pillars required for services to become recovery orientated. However, there is a paucity of literature relating to the concept within child and adolescent mental health services. This paper aims to synthesise the peer-reviewed evidence on co-production within such services. Methods: A PRISMA compliant systematic review was undertaken. This includes how the reviewer retrieved, shortlisted, and selected studies for inclusion in the review. It outlines the inclusion/exclusion criteria and how these were further developed through the PICO framework. Finally, the methods also outline how the reviewer assessed bias and quality, as well as the process of data synthesis. Results: Two studies were included in this review, both focusing on co-production, but in different contexts within child and adolescent mental health. Two themes were identified: ‘road less travelled’ and ‘co-producing equality’. These themes and the associated sub-themes describe how co-production works in these services. Discussion: These results highlight the paucity of quality literature in co-production within child and adolescent mental health. Both studies scored poorly in terms of quality. Resulting from this review, a number of actions relating to the therapeutic environment need to be taken into account for co-production to be further implemented. Other: The reviewer has not received any funding for this paper. A protocol was not created or registered for this review.

Rhyming abilities in a dual-task in school-age children who stutter

PURPOSE

We compared school-age children who stutter (CWS) and age and gender matched control participants (CWNS) in a dual-task involving a word-level rhyming task and a tone task involving pitch decisions.

METHODS

Participants were 30 children (CWS, n = 15) between 7 and 16 years. Auditory word - picture stimuli pairs from the rhyme task were categorized into nonrhyme (e.g., bear-cart), rhyme (e.g., bear-pear), and replica (e.g., bear-bear) categories. The effort associated with managing resources in the dual-task was varied through the manipulation of stimulus onset asynchrony (SOA) between the stimuli of the two tasks. Mixed methods analyses of the response time (RT, ms) and error (%) data were conducted with Group, Category, and SOA as the fixed effects and participants as the random effect. Age and phoneme awareness skills were included in the analyses.

RESULTS

More rhyming errors and a significant positive correlation between rhyming errors and age was observed in the CWS compared to the CWNS. Compared to the CWNS, a higher percentage of rhyming errors was observed in the rhyme than the nonrhyme and replica categories in the CWS in both the SOA conditions, and this effect was influenced by age and phoneme awareness skills. Analysis of the tone task data indicated that a subgroup of CWNS with higher phoneme awareness skills showed reduced RT difference between the long and the short SOA conditions thereby suggesting higher efficiency with resource allocation for dual tasking. Task-specific differences between the CWS and CWNS are interpreted to suggest limitations in the encoding of the phonological aspects of covert speech in a dual-task.

Predictive factors for persistence and recovery of stuttering in children: A systematic review

PURPOSE

The purpose of this study was to systematically review the available literature on various factors that can predict the persistence and recovery of stuttering in children.

METHOD

An electronic search yielded a total of 35 studies, which considered 44 variables that can be potential factors for predicting persistence and recovery.

RESULT

Among 44 factors studied, only four factors- phonological abilities, articulatory rate, change in the pattern of disfluencies, and trend in stuttering severity over one-year post-onset were identified to be replicated predictors of recovery of the stuttering. Several factors, such as differences in the second formant transition between fluent and disfluent speech, articulatory rate measured in phones/sec, etc., were observed to predict the future course of stuttering. However, these factors lack replicated evidence as predictors.

CONCLUSION

There is clear support only for limited factors as reliable predictors. Also, it is observed to be too early to conclude on several replicated factors due to differences in the age group of participants, participant sample size, and the differences in tools used in research that lead to mixed findings as a predictive factor. Hence there is a need for systematic and replicated testing of the factors identified before initiating their use for clinical purposes.

Automated Analysis of Digitized Letter Fluency Data

The letter-guided naming fluency task is a measure of an individual's executive function and working memory. This study employed a novel, automated, quantifiable, and reproducible method to investigate how language characteristics of words produced during a fluency task are related to fluency performance, inter-word response time (RT), and over task duration using digitized F-letter-guided fluency recordings produced by 76 young healthy participants. Our automated algorithm counted the number of correct responses from the transcripts of the F-letter fluency data, and individual words were rated for concreteness, ambiguity, frequency, familiarity, and age of acquisition (AoA). Using a forced aligner, the transcripts were automatically aligned with the corresponding audio recordings. We measured inter-word RT, word duration, and word start time from the forced alignments. Articulation rate was also computed. Phonetic and semantic distances between two consecutive F-letter words were measured. We found that total F-letter score was significantly correlated with the mean values of word frequency, familiarity, AoA, word duration, phonetic similarity, and articulation rate; total score was also correlated with an individual's standard deviation of AoA, familiarity, and phonetic similarity. RT was negatively correlated with frequency and ambiguity of F-letter words and was positively correlated with AoA, number of phonemes, and phonetic and semantic distances. Lastly, the frequency, ambiguity, AoA, number of phonemes, and semantic distance of words produced significantly changed over time during the task. The method employed in this paper demonstrates the successful implementation of our automated language processing pipelines in a standardized neuropsychological task. This novel approach captures subtle and rich language characteristics during test performance that enhance informativeness and cannot be extracted manually without massive effort. This work will serve as the reference for letter-guided category fluency production similarly acquired in neurodegenerative patients.

Developmental Differences in the Availability of Cognitive Resources Supporting Rhyming and Dual Tasking

Purpose We investigated developmental differences in a dual task involving rhyming and tone judgment/decisions and the effects of varying cognitive demands on task performance. Method Participants were 7- to 11-year-olds, 12- to 15-year-olds, and adults between 18 and 40 years (n = 19 per group). The rhyming task consisted of three stimuli categories (nonrhyme, rhyme, and replica), and the tone task stimuli were presented at short (100 ms) versus long (900 ms) stimulus onset asynchrony (SOA) from the onset of the rhyme task to vary cognitive demands. Response time (RT) and error data were analyzed using linear and binomial mixed-methods analysis, respectively. Results and Conclusions Adults did not show an SOA-based effect in rhyming RT, while the 12- to 15-year-olds showed the most effect (RT, long > short SOA). Response to the replica category was significantly faster than for the other categories in all age groups. A reverse SOA effect was evident in the tone task (RT, short > long SOA) in all age groups. The 7- to 11-year-olds showed twice the task switch cost effect in the tone task RT. Age grouping and phoneme awareness were significant predictors of performance in both tasks, and additionally, SOA was a significant predictor of performance in the secondary task. The findings have implications for (a) understanding maturational differences in rhyming and executive control for dual tasking and the cognitive mechanisms supporting such effects and (b) identifying variables contributing to the developmental differences.

Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis

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

Neural Processes Underlying Nonword Rhyme Differentiate Eventual Stuttering Persistence and Recovery

Purpose Phonological skills have been associated with developmental stuttering. The current study aimed to determine whether the neural processes underlying phonology, specifically for nonword rhyming, differentiated stuttering persistence and recovery. Method Twenty-six children who stutter (CWS) and 18 children who do not stutter, aged 5 years, completed an auditory nonword rhyming task. Event-related brain potentials were elicited by prime, rhyming, and nonrhyming targets. CWS were followed longitudinally to determine eventual persistence (n = 14) or recovery (n = 12). This is a retrospective analysis of data acquired when all CWS presented as stuttering. Results CWS who eventually recovered and children who do not stutter exhibited the expected rhyme effect, with larger event-related brain potential amplitudes elicited by nonrhyme targets compared to rhyme targets. In contrast, CWS who eventually persisted exhibited a reverse rhyme effect, with larger responses to rhyme than nonrhyme targets. Conclusions These findings suggest that CWS who eventually persisted are not receiving the same benefit of phonological priming as CWS who eventually recovered for complex nonword rhyming tasks. These results indicate divergent patterns of phonological processing in young CWS who eventually persisted, especially for difficult tasks with limited semantic context, and suggest that the age of 5 years may be an important developmental period for phonology in CWS. Supplemental Material https://doi.org/10.23641/asha.12682874.

Neural Indices Mediating Rhyme Discrimination Differ for Some Young Children Who Stutter Regardless of Eventual Recovery or Persistence

Purpose Previous studies of neural processing of rhyme discrimination in 7- to 8-year-old children who stutter (CWS) distinguished children who had recovered, children who had persisted, and children who did not stutter (CWNS; Mohan & Weber, 2015). Here, we investigate neural processing mediating rhyme discrimination for early acquired real words in younger CWS and CWNS (4;1-6;0 years;months), when rhyming abilities are newly emerging, to examine possible relationships to eventual recovery (CWS-eRec) and persistence in stuttering (CWS-ePer). Method Children performed a rhyme discrimination task while their event-related brain potentials were recorded. CWNS, CWS-eRec, and CWS-ePer had similar speech and language abilities. Inclusionary criteria incorporated at least 70% accuracy for rhyme discrimination. Analyses focused on the mean amplitude of the N400 component elicited by rhyming and nonrhyming words in anterior and posterior regions of interest. Results CWNS, CWS-eRec, and CWS-ePer displayed a classic event-related potential rhyme effect for rhyme discrimination characterized by larger amplitude, posteriorly distributed N400s elicited by nonrhyming targets compared to rhyming targets. CWNS displayed a more robust anterior rhyme effect compared to the CWS groups with a larger amplitude N400 anteriorly for the rhyming targets. This effect was more consistent across individual CWNS than CWS. Conclusions The groups of CWNS, CWS-eRec, and CWS-ePer, who had all developed rhyming discrimination abilities, exhibited similar underlying neural processes mediating phonological processing of early acquired words for the classic central-parietal rhyme effect. However, individual variability of the anterior rhyme effect suggested differences in specific aspects of phonological processing for some CWS-eRec and CWS-ePer compared to CWNS.