Parental perceptions of children's communicative development at stuttering onset

Examining the relationship of acetaminophen use during pregnancy with early language development in children

BACKGROUND

Acetaminophen is the only analgesic considered safe for use throughout pregnancy. Recent studies suggest that use during pregnancy may be associated with poorer neurodevelopmental outcomes in children, but few have examined language development.

METHODS

The Illinois Kids Development Study is a prospective birth cohort in east-central Illinois. Between December 2013 and March 2020, 532 newborns were enrolled and had exposure data available. Participants reported the number of times they took acetaminophen six times across pregnancy. Language data were collected at 26.5-28.5 months using the MacArthur-Bates Communicative Development Inventories (CDI; n = 298), and 36-38 months using the Speech and Language Assessment Scale (SLAS; n = 254).

RESULTS

Taking more acetaminophen during the second or third trimester was associated with marginally smaller vocabularies and shorter utterance length (M3L) at 26.5-28.5 months. More acetaminophen use during the third trimester was also associated with increased odds of M3L scores ≤25th percentile in male children. More use during the second or third trimester was associated with lower SLAS scores at 36-38 months. Third trimester use was specifically related to lower SLAS scores in male children.

CONCLUSIONS

Higher prenatal acetaminophen use during pregnancy may be associated with poorer early language development.

IMPACT

Taking more acetaminophen during pregnancy, particularly during the second and third trimesters, was associated with poorer scores on measures of language development when children were 26.5-28.5 and 36-38 months of age. Only male children had lower scores in analyses stratified by child sex. To our knowledge, this is the first study that has used a standardized measure of language development to assess the potential impact of prenatal exposure to acetaminophen on language development. This study adds to the growing body of literature suggesting that the potential impact of acetaminophen use during pregnancy on fetal neurodevelopment should be carefully evaluated.

Mental state verb use in play by preschool-age children who stutter and their mothers

INTRODUCTION

Preschool-age children use mental state verbs (MSVs; e.g., think, know) to reference thoughts and other cognitive states. In play-based language, MSV use requires conversational flexibility, as speakers shift from discussion of actions happening in the here-and-now to more abstract discussion of mental states. Some evidence suggests that children who stutter (CWS) demonstrate subtle differences in shifting on experimental tasks of cognitive flexibility, differences which may extend to conversational flexibility. This study explored MSV use in conversational language between CWS and their mothers.

METHODS

Thirty-five preschool-age CWS and 35 age- and gender-matched children who do not stutter (CWNS), all performing within the typical range on standardized language testing, conversed with their mothers during play. Samples were transcribed and coded for MSV use.

RESULTS

No between-group differences were observed in MSV use, either between the CWS and CWNS or between the groups of mothers. Age and language skills were positively associated with MSV use in the CWNS group only. For both groups of dyads, mothers' MSV use corresponded at least to some extent to their children's language skills. Finally, correspondence between CWNS and their mothers was observed for two conversational language measures, representing lexical diversity and morphosyntax; this overall pattern was not observed in the CWS dyad group.

CONCLUSIONS

Although these findings point to similar use of MSVs among the groups of children and their mothers, for the CWS group, the patterns of use in relation to age and language skills are somewhat different from developmental expectations.

T-PALS framework to assess children who stutter with coexisting disorders: A tutorial

The purpose of this paper is to present a tutorial on a diagnostic framework developed to assess children who stutter and exhibit co-existing disorders. While we have guidelines for treating these children, there are no specific guidelines for assessing them. We provide a rationale for the development of T-PALS with support from the literature. The T-PALS framework assesses 5 foundational key elements for the child: Temperament (T), Pragmatics (P), Articulation/phonology (A), Language (L), and Stuttering (S). Both qualitative and quantitative measures are used within each dimension. This framework is discussed with reference to using two clinical case examples. T-PALS observation data are presented as well as treatment suggestions for each case. We conclude that T-PALS may be a useful framework for both clinicians and researchers, working with children who present with stuttering and comorbid conditions. Clinicians are encouraged to reach beyond the traditional focus on solely assessing the stuttering behavior, even when that is the main concern for referral, and to consider a broader view of the child. It is hoped that this more integrative approach to assessment may yield a more holistic diagnostic picture of a dual diagnosis child from which treatment goals can be derived.

Complex response inhibition and cognitive flexibility in school-aged Cypriot-Greek-speaking children who stutter

PURPOSE

Over the last few years, research findings have suggested limitations in executive function (EF) of children who stutter (CWS) with the evidence being more consistent in studies with preschoolers (3-6  years old) than in studies with school-aged children (6-12  years old). The purpose of the current study was to assess complex response inhibition and cognitive flexibility in school-aged CWS and their non-stuttering peers.

METHODS

Participants, 19 CWS (mean age = 7.58  years, range 6.08-9.17) and 19 age-and gender-matched children who do not stutter (CWNS; mean age = 7.58  years, range 6.08-9.33), completed a visual task consisting of three task blocks. Analyses were based on response times and error percentages during the different task blocks.

RESULTS

All participants showed expected performance-costs in task block comparisons targeting complex response inhibition and cognitive flexibility. Significant group differences were found in measures of cognitive flexibility with CWS performing slower compared to CWNS (p = 0.02). Additionally, significant block × group interactions demonstrated that CWS, compared to CWNS, slowed down more (i.e., higher performance-cost) under both complex response inhibition (p = 0.049) and cognitive flexibility task conditions (p = 0.04 for no-set-shifting and p = 0.02 for set-shifting).

CONCLUSION

These results are in line with some of the previous findings in school-aged CWS and suggest that CWS present lower performance in complex response inhibition and cognitive flexibility task conditions when compared to their non-stuttering peers.

Data Representativeness in Accessibility Datasets: A Meta-Analysis

As data-driven systems are increasingly deployed at scale, ethical concerns have arisen around unfair and discriminatory outcomes for historically marginalized groups that are underrepresented in training data. In response, work around AI fairness and inclusion has called for datasets that are representative of various demographic groups. In this paper, we contribute an analysis of the representativeness of age, gender, and race & ethnicity in accessibility datasets-datasets sourced from people with disabilities and older adults-that can potentially play an important role in mitigating bias for inclusive AI-infused applications. We examine the current state of representation within datasets sourced by people with disabilities by reviewing publicly-available information of 190 datasets, we call these accessibility datasets. We find that accessibility datasets represent diverse ages, but have gender and race representation gaps. Additionally, we investigate how the sensitive and complex nature of demographic variables makes classification difficult and inconsistent (e.g., gender, race & ethnicity), with the source of labeling often unknown. By reflecting on the current challenges and opportunities for representation of disabled data contributors, we hope our effort expands the space of possibility for greater inclusion of marginalized communities in AI-infused systems.

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.

The Association between Difficulties with Speech Fluency and Language Skills in a National Age Cohort of Children with Down Syndrome

The present study (a) addressed difficulties in speech fluency in children with Down syndrome and typically developing children at a similar non-verbal level and (b) examined the association between difficulties with speech fluency and language skills in children with Down syndrome. Data from a cross-sectional parent survey that included questions about children's difficulties with speech fluency, as well as clinical tests from a national age cohort of 43 six-year-olds with Down syndrome and 57 young typically developing children, were collected. Fisher's exact test, Student's t-test, linear regression, and density ellipse scatter plots were used for analysis. There was a significantly higher occurrence of parent-reported difficulties with speech fluency in the children with Down syndrome. Higher language scores were significantly associated with a lower degree of difficulties; this association was strongest for vocabulary and phonological skills. Although difficulties with speech fluency were not reported for all children with Down syndrome, a substantially higher occurrence of such difficulties was reported compared to that for typically developing children. The significant association between difficulties with speech fluency and the level of language functioning suggests that speech fluency and language skills should be taken into consideration when planning treatment for children with Down syndrome.

Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter

The purpose of this study was to examine temperament dimensions, executive functioning ability, and anxiety levels in school-age children who stutter and their non-stuttering peers. Participants were 100 Portuguese children aged 7 to 12 years (M = 9.13; SD = 1.70), including 50 children who stutter and 50 children who do not stutter. Analyses, which were performed separately for younger and older participants, sought to identify correlations between key variables. Temperament was evaluated through a parent questionnaire, executive functioning was evaluated through children’s responses on a performance test, and anxiety level was assessed through a self-perception scale. On the temperament measure, comparisons between children who stutter and their non-stuttering peers revealed that older children who stutter exhibited significantly higher scores on the Anger/Frustration, Impulsivity, and Sadness subscales, and lower averages on the Attention/Focusing, Perceptual sensitivity, and Soothability/Falling Reactivity subscales. On the executive functioning task, comparisons revealed that the group of younger children who stutter exhibited significantly higher average execution times than their non-stuttering peers. There were no statistically significant differences in anxiety between children who stutter and children who do not stutter, and there were no statistically significant correlations between temperament factors and measures of executive functioning. Children who stutter experienced lower ability to orient attention and greater emotional reactivity compared with their non-stuttering peers. Significant correlations were found between executive functioning and age and among the temperament factors themselves. These results, which support the need for a multidimensional view of stuttering, were interpreted in the context of the Dual Diathesis – Stressor model. Findings indicate that temperament and executive functioning abilities may contribute to the development of stuttering.

Language development in children who stutter: A review of recent research

Purpose: This article reviews recent studies that examined the controversial claim that children who stutter (CWS), as a group, have weaker language skills than children who do not stutter (CWNS). The article was an effort to address the conflicting conclusions of two previous reviews of the research in this area. Method: Studies published in research journals during the past 7 years (2011-2018) were located through a systematic review of the literature. Each study was analysed to determine how well it supported the claim that CWS, as a group, have weaker language skills than CWNS. Result: The evidence was not convincing to support this controversial claim. Rather, the review indicated that CWS performed as well as or better than CWNS on formal language tasks. Conclusion: The claim that language weaknesses are linked to children's stuttering is not well supported by recently published studies. Alternative interpretations of the literature are offered.

Short-Term Memory, Inhibition, and Attention in Developmental Stuttering: A Meta-Analysis

Purpose

This study presents a meta-analytic review of differences in verbal short-term memory, inhibition, and attention between children who stutter (CWS) and children who do not stutter (CWNS).

Method

Electronic databases and reference sections of articles were searched for candidate studies that examined verbal short-term memory, inhibition, and attention using behavioral and/or parent report measures. Twenty-nine studies met the eligibility criteria, which included, among other things, children between the ages of 3 and 18 years and the availability of quantitative data for effect size calculations. Data were extracted, coded, and analyzed, with the magnitude of the difference between the 2 groups of children being estimated using Hedge's g (Hedges & Olkin, 1985).

Results

Based on the random-effects model (Hunter & Schmidt, 2004), findings revealed that CWS scored lower than CWNS on measures of nonword repetition (Hedges' g = -0.62), particularly at lengths of 2 and 3 syllables (Hedges' g = -0.62 and - 0.50, respectively), and forward span (Hedges' g = -0.40). Analyses further revealed that the parents of CWS rated their children as having weaker inhibition (Hedges' g = -0.44) and attentional focus/persistence (Hedges' g = -0.36) skills than the parents of CWNS, but there were no significant differences between CWS and CWNS in behavioral measures of inhibition and attention.

Conclusion

The present findings were taken to suggest that cognitive processes are important variables associated with developmental stuttering.

Expressed parental concern regarding childhood stuttering and the Test of Childhood Stuttering

PURPOSE

The purpose of the present study was to determine whether the Test of Childhood Stuttering observational rating scales (TOCS; Gillam et al., 2009) (1) differed between parents who did versus did not express concern (independent from the TOCS) about their child's speech fluency; (2) correlated with children's frequency of stuttering measured during a child-examiner conversation; and (3) correlated with the length and complexity of children's utterances, as indexed by mean length of utterance (MLU).

METHOD

Participants were 183 young children ages 3:0-5:11. Ninety-one had parents who reported concern about their child's stuttering (65 boys, 26 girls) and 92 had parents who reported no such concern (50 boys, 42 girls). Participants' conversational speech during a child-examiner conversation was analyzed for (a) frequency of occurrence of stuttered and non-stuttered disfluencies, and (b) MLU. Besides expressing concern or lack thereof about their child's speech fluency, parents completed the TOCS observational rating scales documenting how often they observe different disfluency types in speech of their children, as well as disfluency-related consequences.

RESULTS

There were three main findings. First, parents who expressed concern (independently from the TOCS) about their child's stuttering reported significantly higher scores on the TOCS Speech Fluency and Disfluency-Related Consequences rating scales. Second, children whose parents rated them higher on the TOCS Speech Fluency rating scale produced more stuttered disfluencies during a child-examiner conversation. Third, children with higher scores on the TOCS Disfluency-Related Consequences rating scale had shorter MLU during child-examiner conversation, across age and level of language ability.

CONCLUSIONS

Findings support the use of the TOCS observational rating scales as one documentable, objective means to determine parental perception of and concern about their child's stuttering. Findings also support the notion that parents are reasonably accurate, if not reliable, judges of the quantity and quality (i.e., stuttered vs. non-stuttered) of their child's speech disfluencies. Lastly, findings that some children may decrease their verbal output in attempts to minimize instances of stuttering - as indexed by relatively low MLU and a high TOCS Disfluency-Related Consequences scores - provides strong support for sampling young children's speech and language across various situations to obtain the most representative index possible of the child's MLU and associated instances of stuttering.

Young children's family history of stuttering and their articulation, language and attentional abilities: An exploratory study

PURPOSE

The purpose of this study was to determine whether young children who do (CWS) and do not stutter (CWNS) with a positive versus negative family history of stuttering differ in articulation, language and attentional abilities and family histories of articulation, language and attention related disorders.

METHOD

Participants were 25 young CWS and 50 young CWNS. All 75 participants' caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points that were about 8 months apart for a total of approximately 16 months. Each participant's family history focused on the same, relatively limited number of generations (i.e., participants' parents & siblings). Children's family history of stuttering as well as articulation, language, and attention related disorders was obtained from one or two caregivers during an extensive interview. Children's speech and language abilities were measured using four standardized articulation and language tests and their attentional abilities were measured using caregiver reports of temperament.

RESULTS

Findings indicated that (1) most caregivers (81.5% or 75 out 92) were consistent in their reporting of positive or negative history of stuttering; (2) CWNS with a positive family history of stuttering, compared to those with a negative family history of stuttering, were more likely to have reported a positive family history of attention deficit/hyperactivity disorder (ADHD), and (3) CWNS with a positive family history of stuttering had lower language scores than those with a negative family history of stuttering. However, there were no such significant differences in family histories of ADHD and language scores for CWS with a positive versus negative family history of stuttering. In addition, although 24% of CWS versus 12% of CWNS's caregivers reported a positive family history of stuttering, inferential analyses indicated no significant differences between CWS and CWNS in relative proportions of family histories of stuttering.

CONCLUSION

Finding that a relatively high proportion (i.e., 81.5%) of caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points should provide some degree of assurance to those who collect such caregiver reports. Based on such consistent caregiver reports, linguistic as well as attentional vulnerabilities appear associated with a positive family history of stuttering, a finding that must await further empirical study for confirmation or refutation.

How Stuttering Develops: The Multifactorial Dynamic Pathways Theory

Purpose

We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic, and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory.

Method

We review evidence related to how stuttering develops, including genetic/epigenetic factors; motor, linguistic, and emotional features; and advances in neuroimaging studies. We update evidence for our earlier claim: Although stuttering ultimately reflects impairment in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic and emotional factors.

Results

Our current account places primary emphasis on the dynamic developmental context in which stuttering emerges and follows its course during the preschool years. Rapid changes in many neurobehavioral systems are ongoing, and critical interactions among these systems likely play a major role in determining persistence of or recovery from stuttering.

Conclusion

Stuttering, or childhood onset fluency disorder (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; American Psychiatric Association [APA], 2013), is a neurodevelopmental disorder that begins when neural networks supporting speech, language, and emotional functions are rapidly developing. The multifactorial dynamic pathways theory motivates experimental and clinical work to determine the specific factors that contribute to each child's pathway to the diagnosis of stuttering and those most likely to promote recovery.

Language skills of children during the first 12 months after stuttering onset

PURPOSE

To describe the language development in a sample of young children who stutter during the first 12 months after stuttering onset was reported.

METHODS

Language production was analysed in a sample of 66 children who stuttered (aged 2-4 years). The sample were identified from a pre-existing prospective, community based longitudinal cohort. Data were collected at three time points within the first year after stuttering onset. Stuttering severity was measured, and global indicators of expressive language proficiency (length of utterances and grammatical complexity) were derived from the samples and summarised. Language production abilities of the children who stutter were contrasted with normative data.

RESULTS

The majority of children's stuttering was rated as mild in severity, with more than 83% of participants demonstrating very mild or mild stuttering at each of the time points studied. The participants demonstrated developmentally appropriate spoken language skills comparable with available normative data.

CONCLUSION

In the first year following the report of stuttering onset, the language skills of the children who were stuttering progressed in a manner that is consistent with developmental expectations.

Ages and Stages Questionnaire: a global screening scale

With standardized screening tools, research studies have shown that developmental disabilities can be detected reliably and with validity in children as young as 4 months of age by using the instruments such as the Ages and Stages Questionnaire. In this review, we will focus on one tool, the Ages and Stages Questionnaire, to illustrate the usefulness of developmental screening across the globe.

Evidence-Based Multifactorial Assessment of Preschool-Age Children Who Stutter

This review summarizes extant findings supporting multifactorial models of stuttering within the context of preschool-age stuttering assessment. Evidence is given for a number of speech-language and associated factors/domains to consider when evaluating young children who stutter. Selected factors are presented in two parts: (1) Caregiver Interview and (2) Direct Child Assessment. Factors addressed during caregiver interviews include: gender, time since and age at stuttering onset, family history of stuttering, caregivers' perception/concerns about stuttering, and temperament. Factors addressed during direct child assessments include: stuttering behaviors, speech-associated attitudes/awareness, and speech rate, as well as speech sound and language development. Interactions/relations among factors are noted, showing their combined effects and contributions to childhood stuttering. Additionally, suggested clinical applications are provided wherever appropriate. Such evidence and practical applications bridge the gap between theory and clinical practice, thus advancing the abilities of speech-language pathologists to conduct well-informed, comprehensive stuttering evaluations.

The concurrent and predictive validity of the Dutch version of the Communicative Development Inventory in children with Down Syndrome for the assessment of expressive vocabulary in verbal and signed modalities

The expressive vocabulary of children with Down Syndrome (DS) is generally measured with parental reports, such as the Communicative Development Inventory (CDI), given that standardized tests for assessing vocabulary levels may be too difficult for most young children with DS. The CDI provides important insight into the parents' perception of their child's vocabulary development. The CDI has proven to be a valid measurement of expressive vocabulary, spoken and gestural, in typical and atypical populations. The validity in children with DS is not well established and signed vocabulary is often not included. This longitudinal study examined the concurrent and predictive validity of the Dutch version of the CDI (N-CDI) in children with DS between 2;0 and 7;6 years old to assess spoken and signed vocabulary. N-CDI scores were assessed on strength of association with mental age, an expressive vocabulary test and spontaneous language analyses in a play setting with parents at T1 and T2 (1.5 years later), and a therapy setting with speech language pathologists at T1. The results of the present study show that the N-CDI is a valuable and valid measurement of expressive vocabulary in children with DS. Strengths and weaknesses of several assessment methods for expressive vocabulary are discussed.

Parents' reactions to children's stuttering and style of coping with stress

PURPOSE

The aim of the research was to determine: (a) how parents react to their child's stuttering, (b) what stress coping strategies they utilise, as well as (c) whether stress coping style depends on parents' reaction to their child's stuttering.

METHODS

The research involved 23 mothers and 23 fathers of children who stutter (CWS) at the age of three to six years old. The Reaction to Speech Disfluency Scale (RSDS), developed by the authors, was used in the research. To determine the parents' coping the Coping Inventory in Stressful Situations (CISS) by N.S. Endler and D.A Parker was applied.

RESULTS

The strongest reactions are observed on the cognitive level. Stronger cognitive, emotional and behavioural reactions are observed in the mothers towards their disfluently speaking sons and in the fathers towards their daughters. Having analysed the profiles of coping styles, it can be noticed that the task-oriented coping is most frequently adapted by the fathers. The mothers most often use the avoidance-oriented coping. No relevant correlation was observed between the fathers' coping style and their reactions to the child's disfluent speech. As far as the mothers are concerned, it has been proved that an increase in behavioural reactions correlates with the avoidance-oriented coping.

CONCLUSION

The cognitive reactions of the parents' towards their child's stuttering were most frequent, while the emotional ones were the least frequent. Confronted with a stressful situation, the fathers most often adapt the task-oriented coping, whereas the mothers use the avoidance-oriented coping.

EDUCATIONAL OBJECTIVES

the reader will be able to (1) learn what the key reactions of parents to their children's stuttering are, (2) describe stuttering as a stress factor for the parents, (3) describe the factors which influence parents' reactions to their child's stuttering and their coping style.

Speech-Language Dissociations, Distractibility, and Childhood Stuttering

PURPOSE

This study investigated the relation among speech-language dissociations, attentional distractibility, and childhood stuttering.

METHOD

Participants were 82 preschool-age children who stutter (CWS) and 120 who do not stutter (CWNS). Correlation-based statistics (Bates, Appelbaum, Salcedo, Saygin, & Pizzamiglio, 2003) identified dissociations across 5 norm-based speech-language subtests. The Behavioral Style Questionnaire Distractibility subscale measured attentional distractibility. Analyses addressed (a) between-groups differences in the number of children exhibiting speech-language dissociations; (b) between-groups distractibility differences; (c) the relation between distractibility and speech-language dissociations; and (d) whether interactions between distractibility and dissociations predicted the frequency of total, stuttered, and nonstuttered disfluencies.

RESULTS

More preschool-age CWS exhibited speech-language dissociations compared with CWNS, and more boys exhibited dissociations compared with girls. In addition, male CWS were less distractible than female CWS and female CWNS. For CWS, but not CWNS, less distractibility (i.e., greater attention) was associated with more speech-language dissociations. Last, interactions between distractibility and dissociations did not predict speech disfluencies in CWS or CWNS.

CONCLUSIONS

The present findings suggest that for preschool-age CWS, attentional processes are associated with speech-language dissociations. Future investigations are warranted to better understand the directionality of effect of this association (e.g., inefficient attentional processes → speech-language dissociations vs. inefficient attentional processes ← speech-language dissociations).

Evidence for a rhythm perception deficit in children who stutter

Stuttering is a neurodevelopmental disorder that affects the timing and rhythmic flow of speech production. When speech is synchronized with an external rhythmic pacing signal (e.g., a metronome), even severe stuttering can be markedly alleviated, suggesting that people who stutter may have difficulty generating an internal rhythm to pace their speech. To investigate this possibility, children who stutter and typically-developing children (n=17 per group, aged 6-11 years) were compared in terms of their auditory rhythm discrimination abilities of simple and complex rhythms. Children who stutter showed worse rhythm discrimination than typically-developing children. These findings provide the first evidence of impaired rhythm perception in children who stutter, supporting the conclusion that developmental stuttering may be associated with a deficit in rhythm processing.

Language ability of children with and without a history of stuttering: a longitudinal cohort study

PURPOSE

This study aims to determine whether the communication and language skills of children who have a history of stuttering are different from children who do not have a history of stuttering at ages 2-5 years.

METHOD

This study utilizes data from the Early Language in Victoria Study (ELVS), a longitudinal study with a community sample of 1910 children recruited in Melbourne, Australia, as well as a concurrent study examining the onset and progression of stuttering. Participants with a history of stuttering (n = 181) and a control group without a history of stuttering (n = 1438) were identified according to the established protocol of these two existing studies.

RESULT

The stuttering group scored higher than the non-stuttering group on all of the communication and language outcomes measured. The group differences were statistically significant on four of the seven measures and these findings were maintained when potentially confounding factors were controlled for.

CONCLUSION

Importantly, the children with a history of stuttering, as a group, and the control group without a history of stuttering demonstrated developmentally-appropriate early communication and language skills.

White matter neuroanatomical differences in young children who stutter

The ability to express thoughts through fluent speech production is a most human faculty, one that is often taken for granted. Stuttering, which disrupts the smooth flow of speech, affects 5% of preschool-age children and 1% of the general population, and can lead to significant communication difficulties and negative psychosocial consequences throughout one's lifetime. Despite the fact that symptom onset typically occurs during early childhood, few studies have yet examined the possible neural bases of developmental stuttering during childhood. Here we present a diffusion tensor imaging study that examined white matter measures reflecting neuroanatomical connectivity (fractional anisotropy) in 77 children [40 controls (20 females), 37 who stutter (16 females)] between 3 and 10 years of age. We asked whether previously reported anomalous white matter measures in adults and older children who stutter that were found primarily in major left hemisphere tracts (e.g. superior longitudinal fasciculus) are also present in younger children who stutter. All children exhibited normal speech, language, and cognitive development as assessed through a battery of assessments. The two groups were matched in chronological age and socioeconomic status. Voxel-wise whole brain comparisons using tract-based spatial statistics and region of interest analyses of fractional anisotropy were conducted to examine white matter changes associated with stuttering status, age, sex, and stuttering severity. Children who stutter exhibited significantly reduced fractional anisotropy relative to controls in white matter tracts that interconnect auditory and motor structures, corpus callosum, and in tracts interconnecting cortical and subcortical areas. In contrast to control subjects, fractional anisotropy changes with age were either stagnant or showed dissociated development among major perisylvian brain areas in children who stutter. These results provide first glimpses into the neuroanatomical bases of early childhood stuttering, and possible white matter developmental changes that may lead to recovery versus persistent stuttering. The white matter changes point to possible structural connectivity deficits in children who stutter, in interrelated neural circuits that enable skilled movement control through efficient sensorimotor integration and timing of movements.

Preschool speech articulation and nonword repetition abilities may help predict eventual recovery or persistence of stuttering

PURPOSE

In preschool children, we investigated whether expressive and receptive language, phonological, articulatory, and/or verbal working memory proficiencies aid in predicting eventual recovery or persistence of stuttering.

METHODS

Participants included 65 children, including 25 children who do not stutter (CWNS) and 40 who stutter (CWS) recruited at age 3;9-5;8. At initial testing, participants were administered the Test of Auditory Comprehension of Language, 3rd edition (TACL-3), Structured Photographic Expressive Language Test, 3rd edition (SPELT-3), Bankson-Bernthal Test of Phonology-Consonant Inventory subtest (BBTOP-CI), Nonword Repetition Test (NRT; Dollaghan & Campbell, 1998), and Test of Auditory Perceptual Skills-Revised (TAPS-R) auditory number memory and auditory word memory subtests. Stuttering behaviors of CWS were assessed in subsequent years, forming groups whose stuttering eventually persisted (CWS-Per; n=19) or recovered (CWS-Rec; n=21). Proficiency scores in morphosyntactic skills, consonant production, verbal working memory for known words, and phonological working memory and speech production for novel nonwords obtained at the initial testing were analyzed for each group.

RESULTS

CWS-Per were less proficient than CWNS and CWS-Rec in measures of consonant production (BBTOP-CI) and repetition of novel phonological sequences (NRT). In contrast, receptive language, expressive language, and verbal working memory abilities did not distinguish CWS-Rec from CWS-Per. Binary logistic regression analysis indicated that preschool BBTOP-CI scores and overall NRT proficiency significantly predicted future recovery status.

CONCLUSION

Results suggest that phonological and speech articulation abilities in the preschool years should be considered with other predictive factors as part of a comprehensive risk assessment for the development of chronic stuttering.

EDUCATIONAL OBJECTIVES

At the end of this activity the reader will be able to: (1) describe the current status of nonlinguistic and linguistic predictors for recovery and persistence of stuttering; (2) summarize current evidence regarding the potential value of consonant cluster articulation and nonword repetition abilities in helping to predict stuttering outcome in preschool children; (3) discuss the current findings in relation to potential implications for theories of developmental stuttering; (4) discuss the current findings in relation to potential considerations for the evaluation and treatment of developmental stuttering.

A Survey on Conceptions of Stuttering

The conceptions about stuttering vary amongst cultures. Culturally specific findings regarding stuttering help in understanding the peoples' views and conceptions about stuttering and devising awareness and counselling strategies. A total of 132 passengers on the Coromandal Express from Chennai to Howrah participated in this study. All of them belonged to the upper middle socio-economic class. Preliminary Stuttering Conception Questionnaire (PSCQ) was used to understand their conceptions of stuttering. 23% had no idea and 12% had myths about the etiology of stuttering. 11% assumed it was a genetic problem and 5—6% a physical-mental problem. 31% had no idea of treatment options. 25% preferred medicine, 23% rehabilitation for treatment of stuttering. For rehabilitation, only 45% precisely knew about the speech language pathologist; the remaining 55% were unaware of this profession. Steps need to be taken towards educating the common man about stuttering.

Stuttering severity, psychosocial impact and lexical diversity as predictors of outcome for treatment of stuttering

OBJECTIVE

This study assessed factors that predicted therapy outcome for children and adolescents who stuttered after attendance at an intensive therapy course. The factors examined were stuttering severity, lexical diversity measured by Type Token Ratio, and psychosocial impact of stuttering on the child's life.

DESIGN

Fifty-four children who stuttered (CWS) participated in the study. The hypotheses were: (1) CWS with high initial stuttering severity would be more likely to persist than those with low initial severity; (2) lexical diversity before treatment should be related to therapy outcome; (3) psychosocial factors would affect therapy outcome. The predictions were assessed by linear and logistic regression analyses.

RESULTS

Initial stuttering severity was the only significant predictor for stuttering severity after therapy. However, psychosocial impact correlated with improvement in fluency, and lexical diversity correlated with therapy outcome.

CONCLUSIONS

Only initial stuttering severity was a significant predictor of therapy outcome after an intensive therapy intervention. This is in agreement with the study of Howell and Davis (2011).

EDUCATIONAL OBJECTIVES

Readers will get an overview of the literature on risk factors that are considered to predict therapy outcomes for CWS. They will be able to (a) identify what variable represent potential risk factors, (b) describe the psychosocial impact of stuttering, (c) explain how lexical diversity is measured, and (d) describe different assessment instruments used to decide on the outcome of therapy.

Early childhood stuttering and electrophysiological indices of language processing

We examined neural activity mediating semantic and syntactic processing in 27 preschool-age children who stutter (CWS) and 27 preschool-age children who do not stutter (CWNS) matched for age, nonverbal IQ and language abilities. All participants displayed language abilities and nonverbal IQ within the normal range. Event-related brain potentials (ERPs) were elicited while participants watched a cartoon video and heard naturally spoken sentences that were either correct or contained semantic or syntactic (phrase structure) violations. ERPs in CWS, compared to CWNS, were characterized by longer N400 peak latencies elicited by semantic processing. In the CWS, syntactic violations elicited greater negative amplitudes for the early time window (150-350 ms) over medial sites compared to CWNS. Additionally, the amplitude of the P600 elicited by syntactic violations relative to control words was significant over the left hemisphere for the CWNS but showed the reverse pattern in CWS, a robust effect only over the right hemisphere. Both groups of preschoolage children demonstrated marked and differential effects for neural processes elicited by semantic and phrase structure violations; however, a significant proportion of young CWS exhibit differences in the neural functions mediating language processing compared to CWNS despite normal language abilities. These results are the first to show that differences in event-related brain potentials reflecting language processing occur as early as the preschool years in CWS and provide the first evidence that atypical lateralization of hemispheric speech/language functions previously observed in the brains of adults who stutter begin to emerge near the onset of developmental stuttering.

EDUCATIONAL OBJECTIVES

The reader will be able to: (1) describe the role of language processing in current theoretical models of developmental stuttering; (2) summarize current evidence regarding language processing differences between individuals who do and do not stutter; (3) describe typical changes in neural indices of semantic and syntactic processing across development; (4) discuss the potential implications of the current findings in relation to theories of developmental stuttering.

Past tense marking in the spontaneous speech of preschool children who do and do not stutter

PURPOSE

The aim of this study was to identify whether different patterns of errors exist in irregular past-tense verbs in children who stutter (CWS) and children who do not stutter (CWNS).

METHOD

Spontaneous language samples of thirty-one age- and gender-matched pairs of children (total N=62) between the ages of 24 months and 59 months were analyzed.

RESULTS

Results indicated that children who do and do not stutter over-regularize irregular past-tense verbs (i.e., saying runned for ran) with comparable frequency. However, two nonsignificant trends which suggest possible intra-group differences were noted. First, irregular past tense verbs represented a greater portion of total verbs for CWS than for CWNS. Second, CWS appeared to double-mark (i.e., say ranned for ran) more often than CWNS. Results are discussed in light of theories about the acquisition of the irregular past-tense and about differences in language skills between CWS and CWNS.

EDUCATIONAL OBJECTIVES

After reading this article, the reader will be able to: (a) summarize previous findings about connections between stuttering and language in CWS and CWNS; (b) describe similarities and differences between irregular past-tense verb use and errors in CWS and CWNS; (c) discuss possible connections between the declarative-procedural model and stuttering.

Language abilities of children who stutter: a meta-analytical review

PURPOSE

To identify, integrate, and summarize evidence from empirical studies of the language abilities of children who stutter (CWS) and children who do not stutter (CWNS).

METHOD

Candidate studies were identified through electronic databases, the tables of contents of speech-language journals, and reference lists of relevant articles and literature reviews. The 22 included studies met the following criteria: studied both children who did and did not stutter between ages 2;0 (years;months) and 8;0, and reported norm-referenced language measures and/or measures from spontaneous language samples amenable to effect size calculation. Data were extracted using a coding manual and were assessed by application of general and specialized analytical software. Mean difference effect size was estimated using Hedges's g (Hedges, 1982).

RESULTS

Findings indicated that CWS scored significantly lower than CWNS on norm-referenced measures of overall language (Hedges's g = -0.48), receptive (Hedges's g = -0.52) and expressive vocabulary (Hedges's g = -0.41), and mean length of utterance (Hedges's g = -0.23).

CONCLUSIONS

Present findings were taken to suggest that children's language abilities are potentially influential variables associated with childhood stuttering.

Testing orofacial abilities of children who stutter: the Movement, Articulation, Mandibular and Sensory awareness (MAMS) assessment procedure

OBJECTIVE

The purpose of this article is to introduce a new assessment designed to measure the orofacial abilities of children who stutter (CWS), the Movement, Articulation, Mandibular and Sensory Awareness (MAMS) Orofacial Assessment. The new instrument was developed and validated to measure orofacial abilities in a comprehensive manner.

DESIGN

A group of 43 CWS (mean age 13.10 years, S.D. 2.10 years) and a control group of 32 fluent children (mean age 13.4 years, S.D. 2.6 years) were tested with the new tool. It was hypothesized, that (a) the MAMS is a reliable and valid instrument to measure orofacial abilities in CWS, (b) fluent children have better orofacial abilities than CWS and (c) that the therapy outcome of CWS depend on their orofacial abilities.

RESULTS

The MAMS Orofacial Assessment proved to be a valid and reliable instrument to assess orofacial abilities. Compared with their fluent peers, CWS had significantly worse orofacial abilities. CWS with better orofacial abilities had a better prognosis for therapy outcome.

CONCLUSIONS

The new instrument is a reliable and valid tool to measure orofacial abilities and MAMS distinguishes CWS and controls. Orofacial abilities are one set of factors that influence therapy outcome for CWS.

EDUCATIONAL OBJECTIVES

The reader will get an overview over of the literature on orofacial abilities in people who stutter and will learn about and be able to (1) describe different characteristics of orofacial abilities, (2) use the MAMS Orofacial Assessment in the diagnostic process for CWS and for research purposes, and (3) interpret the results of the MAMS to use them for therapy planning.

The role of selected lexical factors on confrontation naming accuracy, speed, and fluency in adults who do and do not stutter

PURPOSE

The purpose of this study was to investigate whether lexical access in adults who stutter (AWS) differs from that in people who do not stutter. Specifically, the authors examined the role of 3 lexical factors on naming speed, accuracy, and fluency: word frequency, neighborhood density, and neighborhood frequency. If stuttering results from an impairment in lexical access, these factors were hypothesized to differentially affect AWS performance on a confrontation naming task.

METHOD

Twenty-five AWS and 25 normally fluent comparison speakers, matched for age and education, participated in a confrontation naming task designed to explore within-speaker performance on naming accuracy, speed, and fluency based on stimulus word frequency and neighborhood characteristics. Accuracy, fluency, and reaction time (from acoustic waveform analysis) were computed.

RESULTS

In general, AWS demonstrated the same effects of lexical factors on their naming as did adults who do not stutter. However, accuracy of naming was reduced for AWS. Stuttering rate was influenced by word frequency but not other factors.

CONCLUSIONS

Results suggest that AWS could have a fundamental deficit in lexical retrieval, but this deficit is unlikely to be at the level of the word's abstract phonological representation. Implications for further research are discussed.

Subtyping stuttering II: contributions from language and temperament

This paper is the second in a series of two articles exploring subtypes of stuttering, and it addresses the question of whether and how language ability and temperament variables may be relevant to the study of subtypes within the larger population of children who stutter. Despite observations of varied profiles among young children who stutter, efforts to identify and characterize subtypes of stuttering have had limited influence on theoretical or clinical understanding of the disorder. This manuscript briefly highlights research on language and temperament in young children who stutter, and considers whether the results can provide guidance for efforts to more effectively investigate and elucidate subtypes in childhood stuttering. Issues from the literature that appear relevant to research on stuttering subtypes include: (a) the question of whether stuttering is best characterized as categorical or continuous; (b) interpretation of individual differences in skills and profiles; and (c) the fact that, during the preschool years, the interaction among domains such as language and temperament are changing very rapidly, resulting in large differences in developmental profiles within relatively brief chronological age periods.

EDUCATIONAL OBJECTIVES

The reader will be able to: (1) discuss possible associations of language ability and temperament to the development of stuttering in young children; (2) summarize the subtyping research from the literature on language ability and temperament in young children; (3) generate directions for future research of stuttering subtypes drawn from the literature related to language ability and temperament in young children.

Frequency of verb use in young children who stutter

Several recent studies have suggested that young children who stutter (CWS) tend to show depressed lexical performance relative to peers. Given the developmental literature as well as several studies of verb processing in individuals who stutter, verbs may pose a particular challenge for this group. The purpose of the present study was to examine verb use in CWS. In theory, if young CWS differ in their production of verbs, this finding would partially explain the findings of studies that probed conversational vocabulary skills more generally. Fifteen CWS and 15 children who do not stutter (CWNS) participated in a play-based conversational sample with a parent. Samples were analyzed for the total number of verbs, the number of different verbs, and the proportion of general all-purpose (GAP) verbs within the samples. CWS produced significantly fewer different verbs and total verbs than the CWNS. However, previously reported near-significant differences in utterance length between groups would appear to temper the robustness of this finding. The groups did not differ in the proportion of GAP verbs used, suggesting that the CWS did not over-rely on GAP verbs in conversational language production but rather used these verbs to the same extent as their peers.

EDUCATIONAL OBJECTIVES

As a result of this activity, the participant will be able to: (1) relate the purpose and rationale for examining verb use in children who stutter (CWS); (2) summarize the procedures used to assess verb use and GAP verb use in the present study; (3) explain the findings of the present study; (4) relate findings to the extant literature on lexical diversity in CWS.

Effects of perceptual and conceptual similarity in lexical priming of young children who stutter: preliminary findings

The purpose of this study was to investigate the influence of conceptual and perceptual properties of words on the speed and accuracy of lexical retrieval of children who do (CWS) and do not stutter (CWNS) during a picture-naming task. Participants consisted of 13 3-5-year-old CWS and the same number of CWNS. All participants had speech, language, and hearing development within normal limits, with the exception of stuttering for CWS. Both talker groups participated in a picture-naming task where they named, one at a time, computer-presented, black-on-white drawings of common age-appropriate objects. These pictures were named during four auditory priming conditions: (a) a neutral prime consisting of a tone, (b) a word prime physically related to the target word, (c) a word prime functionally related to the target word, and (d) a word prime categorically related to the target word. Speech reaction time (SRT) was measured from the offset of presentation of the picture target to the onset of participant's verbal speech response. Results indicated that CWS were slower than CWNS across priming conditions (i.e., neutral, physical, function, category) and that the speed of lexical retrieval of CWS was more influenced by functional than perceptual aspects of target pictures named. Findings were taken to suggest that CWS tend to organize lexical information functionally more so than physically and that this tendency may relate to difficulties establishing normally fluent speech and language.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to (1) communicate the relevance of examining lexical retrieval in relation to childhood stuttering and (2) describe the method of measuring speech reaction times of accurate and fluent responses during a picture-naming task as a means of assessing lexical retrieval skills.

Some empirical observations about early stuttering: a possible link to language development

This article suggests a possible link between incipient stuttering and early difficulty in language formulation. The hypothesis offers a unifying explanation of an array of empirical observations. Among these observations are the following: early stuttering occurs only on the first word of a syntactic structure; stuttering does not appear to be influenced by word-related factors; early stuttering seldom occurs on one-word utterances; the earliest age at which stuttering is reported is 18 months, with the beginning of grammatical development; the age at which most onset of stuttering is reported, 2-5 years, coincides with the period during which children acquire syntax; considerable spontaneous recovery takes place at the time most children have mastered syntax; incipient stuttering is influenced by the length and grammatical complexity of utterances; young children who stutter may be somewhat deficient in language skills; boys who stutter outnumber girls.

LEARNING OUTCOMES

The reader will learn about a number of empirical observations about incipient stuttering and how they may be explained by a syntax-based hypothesis about its etiology.

Concurrent and predictive validity of parent reports of child language at ages 2 and 3 years

The MacArthur-Bates Communicative Development Inventories (CDI; Dale, 1996; Fenson et al., 1994), parent reports about language skills, are being used increasingly in studies of theoretical and public health importance. This study (N = 113) correlated scores on the CDI at ages 2 and 3 years with scores at age 3 years on tests of cognition and receptive language and measures from parent-child conversation. Associations indicated reasonable concurrent and predictive validity. The findings suggest that satisfactory vocabulary scores at age 2 are likely to predict normal language skills at age 3, although some children with limited skills at age 3 will have had satisfactory scores at age 2. Many children with poor vocabulary scores at 2 will have normal skills at 3.

Progression of language complexity during treatment with the Lidcombe Program for early stuttering intervention

The Lidcombe Program is an operant treatment for early stuttering. Outcomes indicate that the program is effective; however, the underlying mechanisms leading to a successful reduction of stuttering remain unknown. The purpose of this study was to determine whether fluency achieved with the Lidcombe Program was accompanied by concomitant reduction of utterance length and decreases in linguistic complexity. Standardized language tests were administered pretreatment to 4 male preschool children. Spontaneous language samples were taken 2 weeks prior to treatment, at Weeks 1, 4, 8, and 12 during treatment, and 6 months after the onset of treatment. Samples were analyzed for mean length of utterance (MLU), percentage of simple and complex sentences, number of different words (NDW), and percentage of syllables stuttered. Analysis revealed that all participants presented with language skills in the average and above average range. The children achieved an increase in stutter-free speech accompanied by increases in MLU, percentage of complex sentences, and NDW. For these preschool children who stutter, improved stutter-free speech during treatment with the program appeared to be achieved without a decrease in linguistic complexity. Theoretical and clinical implications are discussed.

Phonological neighborhood density in the picture naming of young children who stutter: preliminary study

The purpose of this study was to assess the effect of phonological neighborhood density on the speech reaction time (SRT) and errors of children who do and do not stutter during a picture-naming task. Participants were nine 3-5-year-old children who stutter (CWS) matched in age and gender to nine children who do not stutter (CWNS). Initial analyses indicated that both CWNS and CWS were significantly faster (i.e., exhibited shorter SRTs) and more accurate on phonologically sparse than phonologically dense words, findings consistent with those found with older children (Newman & German, 2002). Further analyses indicated that talker group differences in receptive language scores weakened these findings. These preliminary findings were taken to suggest that phonological neighborhood density appears to influence the picture-naming speed and accuracy of preschool-aged children.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to: (1) recognize the relevance of examining phonological variables in relation to childhood stuttering; and (2) describe the method of measuring speech reaction times and errors during a picture-naming task as a means of assessing linguistic skills.

Lexical development and retrieval in treating children who stutter

This article describes the role of lexical acquisition in stuttering by examining the research on word learning and interactions between semantics and syntax in typically developing children and children who stutter. The potential effects of linguistic mismatches, or dysynchronies in language skills, on the possible onset and development of stuttering are discussed. The article concludes with assessment and treatment considerations.

Nonword repetition abilities of children who stutter: an exploratory study

Past research has suggested that children who stutter (CWS) may have less well-developed language skills than fluent children, and that such relative linguistic deficiencies may play a role in precipitating their disfluencies. However, data to support this position are primarily derived from results of standardized diagnostic inventories, which are originally designed to identify frank language impairment. Nonword repetition has emerged as a more sensitive measure of children's linguistic abilities. In this exploratory study, eight CWS (mean age 5:10, range 4:3-8:4) were compared to eight normally developing children (ND) (mean age 5:9, range 4:1-8:4) in their ability to repeat the nonwords of the Children's Test of Nonword Repetition. CWS performed more poorly than NS on measures of Number of Words Correct and Number of Phoneme Errors at all nonword lengths, although statistical differences were observed only for 3-syllable nonwords. When lexical stress of the nonwords was varied to a non-English stress pattern, all participants repeated the stimuli with less accuracy, and the CWS again exhibited more errors than NS. Fluency for the CWS group did not change systematically with increasing nonword length. These preliminary findings are interpreted in light of a number of extant theories of the underlying deficit in childhood stuttering. We conclude that children who stutter may have diminished ability to remember and/or reproduce novel phonological sequences, and that further investigation into this possibility may shed light on the emergence and characteristics of childhood stuttering.

EDUCATIONAL OBJECTIVES

After completing this activity, the learner will: (1) be able to evaluate the research support for a linguistic component to stuttering; (2) describe the use of nonword repetition as an experimental and assessment device with children with SLI and children who stutter; (3) suggest future directions for research to further refine the potential role that linguistic encoding plays in the etiology and persistence of stuttering.

Caregiver-Child Interactions and Their Impact on Children’s Fluency

There is a relatively strong focus in the stuttering literature on the desirability of selected alterations in parental speech and language style in the management of early stuttering. In this article, the existing research support for such recommendations is evaluated, together with relevant research from the normal language acquisition literature that bears on the potential consequences of changing parental interaction style. Recommendations with relatively stronger and weaker support are discussed. Ways in which children’s communication styles and fluency may be altered through newer fluency treatment protocols are contrasted with older, more general parent advisements. Finally, directions for future research into the efficacy of recommendations made to the parents of children who stutter (CWS) are offered.

Language Abilities in Children Who Stutter

The nature of the association between language and stuttering in young children has been the focus of debate for many years. One aspect of this ongoing discussion is the status of language abilities in children who stutter (CWS). Available research findings and associated interpretations of these findings are equivocal. This article asserts that an important contributor to the ambiguous nature of this literature may be differences in research traditions and methods that typically have been employed in the study of language development and in the study of stuttering. Cross-disciplinary investigations are inherently complex and, in designing and interpreting research of this nature, a larger set of issues must be considered and more diverse variables must be addressed and/or controlled. This article presents five principles that can be used to guide future research in the area of language and stuttering. These principles also assist in interpreting and applying the current research literature to clinical concerns.

Measuring lexical diversity in children who stutter: application of vocd

There is growing but equivocal evidence that the language abilities of young children who stutter (CWS) may be depressed when compared to those of their fluent peers. In particular, the lexical skills of CWS have variously been reported to be weaker or stronger than comparison children in a number of recent studies. One source for such disagreement may be the measures used to compute lexical characteristics of these children's spoken conversations. In this study, we examined the concurrent validity of two measures of lexical diversity in spontaneous language samples, Type-Token Ratio (TTR) and the newly developed utility vocd (Malvern & Richards, 1997), using a standard test of expressive vocabulary as the comparison measure. Findings indicated that vocd values ("D") correlated well with standardized measures of expressive vocabulary, while TTR values did not. In addition, both the standardized measure and vocd revealed significantly poorer expressive lexical skills of CWS, whereas TTR analyses did not evidence this difference. Results are discussed in relation to the relative strength of vocd over TTR as a method for describing lexical characteristics of the spontaneous language samples of this population.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to (1) identify several common measures of conversational vocabulary and the strengths and weaknesses of each, and (2) compare the performance of the young CWS in this study to their normally fluent peers in terms of vocabulary performance on both formal and conversational measures of vocabulary.

Parental language input to children at stuttering onset

Many programs for the indirect management of stuttering in early childhood counsel adjustment of parental language models, which are presumed to play an exacerbating influence on vulnerable children's fluency. We examined the relative levels of linguistic demand in maternal language to stuttering and nonstuttering children, adjusted for each child's current level of linguistic development. No significant or observable differences were detected in the relative level of linguistic demand posed by parents of stuttering children very close to onset of symptoms. Empirical support for current advisement and potential ramifications are discussed.

What is stuttering?

When it comes to stuttering, one must be very careful of a priori assumptions they may have formed about the nature of the disorder and its associated behaviors. A broad understanding and thorough familiarity with the evidence are essential to averting misinterpretations, such as those made by Wingate, concerning the bases of terminology (SLD) and category (part-word repetitions) selections. We understand Wingate’s impression regarding the primary role of syllable repetitions, given that typically they are the most common component in the disfluent speech behavior of those who stutter and that in many children they are the dominant disfluency type. Indeed, some children display few monosyllabic whole-word repetitions. Nevertheless, this does not mean that the monosyllabic whole-word repetitions, especially in very young children, are not a valid reflection of stuttering.

As we have shown, Wingate’s argument can be contested in several ways. Because some fundamental measures of accuracy, validity, and internal consistency, as well as reliance on published data, are essential for credibility, we believe that his letter represents a harsh violation of these principles. Wingate has offered an opinion, but that is the limit to the nature of his remarks. His points are merely opinions because he has not considered all the evidence and has not acknowledged all the facts regarding the nature of speech and its identification. Wingate frequently makes sweeping statements (e.g., there are "…clear-cut differences that exist between monosyllabic word repetitions and stutters" [Wingate, 2001, p. 383]) without any substantiation from the research literature and appears to be oblivious to progress in the field. His last paragraph, which completely distorts our record of research, is scientifically dangerous. Although we appreciate his previous contributions to the field, regrettably, as we have stated earlier, his letter fails to meet acceptable scientific standards. We respectfully suggest that Wingate’s call for honestly employed scientific methods in stuttering research be directed at his own writing.

Finally, our large longitudinal study on persistency and recovery in stuttering, as reported in the series of publications (e.g., Yairi & Ambrose, 1999), arbitrarily selected by Wingate for attack as a means to expose his opinion about the "real thing," has been repeatedly and rigorously reviewed by various panels of the National Institutes of Health, the agency supporting this work, and by the editorial boards of several scientific journals, including JSLHR . Having been found to be of sound quality, our ongoing project has been repeatedly approved, and its findings reported in many peer-reviewed publications. We take this record as an indication that many scholars in the field evaluate our research as meritorious.