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

Differential Impacts of Anticipated Success on Employment Outcomes Among Adults Who Stutter

PURPOSE

Stuttering is associated with disparities in labor market outcomes among young adults, but little is known about how labor market outcomes associated with stuttering change over time. Therefore, this study characterized longitudinal associations between stuttering and early life expectations, job satisfaction, receipt of employer-provided insurance benefits, and income.

METHOD

The analysis used data from three waves of the National Longitudinal Study of Adolescent to Adult Health, which contained 16,653 individuals aged 18-43 years interviewed over 18 years. First, regression models evaluated the likelihood of employment between people who stutter (PWS) and people who do not stutter (PWNS). Second, conditional on employment, two-stage likelihood models quantified differences in their job satisfaction, receipt of employer-provided insurance benefits, and earned income, controlling for age, sex, race, and household characteristics. Finally, the relationship between their reported education and income expectations and these employment outcomes was evaluated.

RESULTS

Although stuttering was not related to the likelihood of working or receiving employer-provided benefits, PWS were 20%-22% (SE = 0.06-0.07) less likely to be satisfied with their jobs than PWNS, and dissatisfaction increased with age. Additionally, the odds of earning a higher income were significantly lower for PWS than for PWNS. PWS who anticipated attending college and earning a middle-class income were more likely to be satisfied with their jobs and earn a higher income. However, PWS were less likely to expect that they would earn a middle-class income (PWNS: 46.4%, PWS: 36.3%) or graduate from college (PWNS: 70.9%, PWS: 58.4%) compared to PWNS.

CONCLUSIONS

Labor market inequities associated with stuttering persist and increase with age. PWS have significantly lower expectations for their likelihood of future success, and these expectations predict their future occupational outcomes.

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.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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.

Self-regulation in children with vocal fold nodules: A multilevel analysis

INTRODUCTION

Vocal fold nodules (VNs) represent the most common cause of voice disorders in children. Phonotrauma related to chronic, repetitive, intense vocal activity is often cited as the proximate cause of VNs. However, diminished self-regulation (SR) may predispose some children toward extreme phonotraumatic voice use, thereby contributing secondarily to their development. This case-control study examined the association between features of SR and VNs in children.

METHOD

Parents of children with VNs (N = 40, Age Mean = 7.5, SD = 2.03 years) and vocally normal, medical controls (VNCs; N = 40, Age Mean = 7.6, SD = 1.54 years) completed the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2; Gioia, Isquith, Guy & Kenworthy, 2015), an inventory that evaluates components of SR in children.

RESULTS

Children with VNs, as compared with the vocally normal control group, were described as (i) impulsive (i.e., scoring significantly worse on the Behavior Regulation Index, BRI; P < 0.001, Cohen's d = 0.86), and (ii) emotionally dysregulated (i.e., scoring significantly worse on the Emotional Regulation Index, ERI; P < 0.001, Cohen's d = 0.81).

CONCLUSIONS

Diminished SR in some children with VNs may contribute to phonotraumatic vocal behaviors and potentially attenuate the effectiveness of voice therapy.

Developmental Factors That Predict Head Movement During Resting-State Functional Magnetic Resonance Imaging in 3-7-Year-Old Stuttering and Non-stuttering Children

Early childhood marks a period of dynamic neurocognitive development. Preschool-age coincides with the onset of many childhood disorders and is a developmental period that is frequently studied to determine markers of neurodevelopmental disorders. Magnetic resonance imaging (MRI) is often used to explore typical brain development and the neural bases of neurodevelopmental disorders. However, acquiring high-quality MRI data in young children is challenging. The enclosed space and loud sounds can trigger unease and cause excessive head movement. A better understanding of potential factors that predict successful MRI acquisition would increase chances of collecting useable data in children with and without neurodevelopmental disorders. We investigated whether age, sex, stuttering status, and childhood temperament as measured using the Child Behavioral Questionnaire, could predict movement extent during resting-state functional MRI (rs-fMRI) in 76 children aged 3–7 years, including 42 children who stutter (CWS). We found that age, sex, and temperament factors could predict motion during rs-fMRI scans. The CWS were not found to differ significantly from controls in temperament or head movement during scanning. Sex and age were significant predictors of movement. However, age was no longer a significant predictor when temperament, specifically effortful control, was considered. Controlling for age, boys with higher effortful control scores moved less during rs-fMRI procedures. Additionally, boys who showed higher negative affectivity showed a trend for greater movement. Considering temperament factors in addition to age and sex may help predict the success of acquiring useable rs-fMRI (and likely general brain MRI) data in young children in MR neuroimaging.

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.