Paediatric stuttering

In the field of speech language pathology, there are few issues that have contentious history as the ongoing debate about whether, when, and how to treat young children who stutter (Blood Stein, 1986; Curlee, 1993). It is because of uncertainties between nature and characteristics of children who stutter. Froeschels (1921) stated that stuttering begins in a childs search for words,

thoughts, or grammatical forms, a search which creates repetitions of syllables in short words. And initially these repetitions are of normal tempo and without tension. In the literature on early childhood stuttering, a central place is occupied by

identifying the aspects of speech that differentiate children who have begun to stutter and those who are normally disfluent. One potentially useful differentiating parameter is the extent of instances of disfluency. In the case of repetitions, extent is defined by the number of times that a particular segment is repeated, and has been designated as repetition units. The influence of increase in the number of repetition units on the perception of speech as stuttering was reported (Sanders, 1963). Branscom, Hughes, and Oxtoby (1955) were perhaps the first to address the issue of

repetition units in speech of normally disfluent children. For example, the data reported for Oxtobys 25 3-year-olds show that 79% of word and syllable repetitions contained just one extra unit (e.g., but-but); 17% contained 2 extra units; 2% contained 3 units; 1% contained 4 units; and .1% contained 5 units. Yairi and Lewis (1984) further stated that for part-word repetition, the most

frequent disfluency element in speech of stutterers, there was almost no overlap between the two groups in terms of the number of repetition units. The range for the children who stutter was from 1 to 11, whereas the range for the controls was from 1 to 2. Zebrowski (1991) reported on an age group older than the Yairi and Lewis study but within the range of Johnsons subjects. Her 10 stuttering and 10 normally disfluent control subjects ranged in age from 2;10 to 5;1 years of age, with a mean of 4;0. The interval following onset of stuttering ranged up to 1 year,

with a mean of 8 months. In contrast to the findings reported above, Zebrowski results did not yield significant differences in the number of units produced by the two groups of subjects. In view of (a) hypothesis about the potential contribution of the number of

repetition units to the perception of incipient stuttering, (b) evidence of differences along this dimension in the speech output of children who stutter and normally disfluent children (Johnson et al., 1959; Yairi & Lewis, 1984), and (c) some contradictory data for such differences (Zebrowski, 1991), it would appear that current information on this aspect of disfluency needs to be expanded. Parents verbal interactions contribute to the emergence or persistence of childrens stuttering (Egolf, Shames, Johnson, & Kasprisin-Burrelli, 1972; Johnson, 1949; Kasprisin- Burrelli, Egolf, & Shames, 1972; Langlois, Hanrahan, & Inouye, 1986; Langlois & Long, 1988; Sander, 1959). A number of studies have assessed the relationship between childrens disfluencies and stuttering and such variables as parental speaking rate, interruptions, turn-switching latency, and verbal demands (Kelly & Conture, 1992; Langlois et al., 1986; Meyers, 1990; Meyers & Freeman, 1985a, 1985b, 1985c; Stephenson-Opsal & Bernstein Ratner, 1988). Verbal demands include questions or requests for verbal information and are thought to adversely affect childrens fluency, because they place expectations on children to produce the requested information within a limited time period. If this assumption is valid, children who stutter may increase their speech rates or exhibit some other change in communication behavior, in response to these informational and temporal constraints. Such changes may compromise or disrupt childrens fluency (Stark weather, Gottwald, & Hal fond, 1990). Consequently, parents have long been counseled to reduce the number of questions and demands for verbal responses when conversing with children who stutter (Adams, 1991; Gregory, 1984; Gregory & Hill, 1993; Langlois & Long, 1988; Mallard, 1991; Stark weather et al., 1990; Wall & Myers, 1984; Zwitman, 1978). It was also found that children who had been stuttering longer were somewhat

more likely to exhibit sound prolongations as their most common type of speech disfluency. In contrast, children who had been stuttering for a shorter time were

significantly more likely to exhibit sound/syllable repetitions. This finding supports previous findings that children produce sound/syllable repetitions when they first start stuttering, then begin to produce more sound prolongations as stuttering develops (e.g., Bloodstein, 1960; Conture, 1990b; Gregory & Hill, 1993; Johnson & Associates, 1959). Some children who stutter may also exhibit difficulties with the rate of oral

motor movements (e.g., Riley & Riley, 1985, 1986). We would caution clinicians and researchers, however, to also consider the precision and sequencing of DDK productions (e.g., Yaruss, 1997c), because DDK rate by itself appears to be a relatively insensitive measure of the oral motor development of children who stutter (Yaruss, Logan, & Conture, 1995). Recent studies have indicated that the dyadic rate (i.e., the difference between the mothers and children speaking rate) is related to the childs stuttering severity (e.g., Yaruss & Conture, 1995; see review in Kelly, 1993). A study was done by Irwin and his associates on the Repetitions in the vocalizations and speech of children in the first two years of life, the age range of infants was 2 18 months, sound utterances of these children were recorded, i.e., 30 breaths. It was apparent from the analysis of speech sound productions of children during the first two years of life that repetitions are characteristics of the infant vocalizations and early speech. And the study also stated that there was a peak of breath patterns containing repetition at the age of one year and a gradual decrease from the end of the first year through the second. Nonword repetition skills in young children who do and do not stutter (Anderson JD,

Wagovich SA, Hall NE).The purpose of this study was to assess the nonword repetition skills of 24 children who do (CWS; n = 12) and do not stutter (CWNS; n = 12) between the ages of 3;0 and 5;2. Findings revealed that CWS produced significantly fewer correct twoand three-syllable nonword repetitions and made significantly more phoneme errors on three-syllable non words relative to CWNS. In addition, there was a significant relationship between performance on a test of expressive phonology and nonword repetition for CWS, but not CWNS. Findings further revealed no significant fluctuation in fluency as non words increased in length. Taken together, findings lend support to previous

work, suggesting that nonword repetition skills differ for CWS compared with CWNS, and that these findings cannot be attributed to (a) weak language performance on the part of CWS, or (b) the occurrence of stuttering in the course of non word production. Final part-word repetitions in school-age children: two case studies (McAllister J,

Kingston M) In contrast to the many published accounts of the disfluent repetition of sounds at the beginnings of words, cases where it is predominantly the final parts of words that are repeated have been reported relatively rarely. With few exceptions, those studies that have been published have described either pre-school children or neurologically impaired subjects. The purpose of this case report was to describe final part-word repetitions in the speech of two school-age boys of normal intelligence with no known neurological lesions. Their speech was recorded during spontaneous conversation, reading, and sentence repetition. The repetitions occurred in all three speaking conditions, although the majority of instances were observed in spontaneous speech, and on both content words and function words. The participants exhibited no apparent awareness of the disfluencies, no abnormal muscle tension, and no accessory behaviors. Each child produced word-final repeated fragments whose phonological structure was highly predictable according to his individual set of rules. The results are discussed in terms of possible motor and cognitive explanations for the disfluencies. Orofacial muscle activity of children who stutter: a preliminary study. (Kelly EM,

Smith A, Goffman L). This study was a preliminary investigation of the relations between stuttering development and the maturation of speech motor processes. Electromyographic (EMG) activity was recorded from the orofacial muscles of children who stutter and their normally fluent peers during fluent and disfluent speech. Nine children who stutter (8 boys and 1 girl), ranging in age from 2:7 to 14:0, and 9 age- and sex-matched children who do not stutter were subjects. Pairs of surface EMG electrodes were placed on children's faces overlying the anterior belly of the digastric (ABD), levator labii superior (ULIP), and orbicularis oris inferior (LLIP) muscles. Twenty segments of stuttered (for the children who stutter) and perceptually fluent speech was extracted from children's conversational speech samples. Spectra of the amplitude envelopes of the EMG activity were computed. The 3 oldest children who stutter showed evidence of tremor like

oscillations of EMG activity in the 5 to 15 Hz range during stuttering in either ULIP, LLIP, or ABD muscles. The younger children who stutter and the children who do not stutter demonstrated primary spectral peaks in the 1 to 4 Hz range during stuttered and/or perceptually fluent speech. It is hypothesized that the emergence of tremor like instabilities in the speech motor processes of children who stutter may coincide with aspects of their general neural maturation and with the development of stuttering. Phonological neighborhood and word frequency effects in the stuttered disfluencies of

children who stutter (Anderson JD) PURPOSE: The purpose of this study was to examine (a) the role of neighborhood density (number of words that are phonologically similar to a target word) and frequency variables on the stuttering-like disfluencies of preschool children who stutter, and (b) whether these variables have an effect on the type of stuttering-like disfluency produced. METHOD: A 500+ word speech sample was obtained from each participant (N = 15). Each stuttered word was randomly paired with the firstly produced word that closely matched it in grammatical class, familiarity, and number of syllables/phonemes. Frequency, neighborhood density, and neighborhood frequency values were obtained for the stuttered and fluent words from an online database. RESULTS: Findings revealed that stuttered words were lower in frequency and neighborhood frequency than fluent words. Words containing part-word repetitions and sound prolongations were also lower in frequency and/or neighborhood frequency than fluent words, but these frequency variables did not have an effect on single-syllable word repetitions. Neighborhood density failed to influence the susceptibility of words to stuttering, as well as the type of stuttering-like disfluency produced. CONCLUSIONS: In general, findings suggest that neighborhood and frequency variables not only influence the fluency with which words are produced in speech, but also have an impact on the type of stuttering-like disfluency produced. Disfluency data of German preschool children who stutter and comparison children

(Natke U, Sandrieser P, Pietrowsky R, Kalveram KT) This study compared the disfluencies of German-speaking preschool children who stutter (CWS, N = 24) with those produced by age- and sex-matched comparison children who do not stutter (CWNS, N = 24). over 95% of the CWS group had not received any type of speech therapy intervention. Consistent with previous findings for English-speaking preschool children, 'stuttering-like'

disfluencies (prolongations, blocks, part- and one-syllable word repetitions) were significantly more frequent in CWS (mean = 9.2%) than in CWNS (mean = 1.2%), whereas no significant group differences occurred with respect to 'normal' disfluencies. The number of iterations in stuttering-like disfluencies was also significantly higher in CWS (mean = 1.28 iterations) than in CWNS (mean = 1.09 iterations). In contrast to previous findings, a sub-group of children who have been stuttering for a shorter time (1-5 months) did not differ from a sub-group who had stuttered for a longer period (8-22 months). A comparative investigation of the speech-associated attitude of preschool and

kindergarten children who do and do not stutter (Vanryckeghem M, Brutten GJ, Hernandez LM.) The data of recent research studies have shown that by 3 years of age children show an awareness of dysfluency and that by at least the age of six, youngsters who stutter have a speech-associated attitude that is more negative than that of their peers. These findings led to the present study in which the KiddyCAT, a self-report measure, was used to compare the attitude toward speech of 45 children, between the age of three and six, who stuttered with that of 63 who did not. The data of this investigation showed that, as a group, the preschool and kindergarten children who stuttered had significantly more in the way of a negative attitude toward their speech than was found among their non-stuttering peers of the same age and gender. This finding is not consistent with the classically held position that the reactive aspects of stuttering do not generally develop until well after its onset. It suggests the need to measure, by standardized means, the speech-associated attitude of incipient stutterers and, when appropriate, to make the assessment and treatment of negative attitude toward speech a meaningful aspect of therapy. Phonological neighborhood density in the picture naming of young children who

stutter: preliminary study (Arnold HS, Conture EG, Ohde RN) 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. Development of auditory sensitivity in children who stutter and fluent children

(Howell P, Williams SM) OBJECTIVE: The purpose of this study was to establish whether there are any differential changes in auditory sensitivity over ages in a variety of peripheral and central auditory tasks between participants who stutter and participants who do not stutter. DESIGN: The auditory sensitivity of 37 participants who stutter and 44 participants who do not stutter, ages between 8 and 19 yr, assigned to three age categories, were obtained in five listening conditions: Pure tone threshold, simultaneous masking, backward masking, notched backward masking, and simple dichotic (simultaneous) masking. RESULTS: Across all listening conditions and both talker groups, thresholds decreased over age. The thresholds of participants who do not stutter decreased for simultaneous, backward, and notched backward masking conditions over the 8- to 19-year age range. Analysis of each condition only showed significant improvement over age groups for backward masking for the participants who stutter. CONCLUSIONS: These results indicate that auditory sensitivity for sounds in noise continues to develop through to teenage, and a different pattern of auditory development exists for the participants who stutter compared with participants who do not stutter. Performance on phonological and grammatical awareness metalinguistic tasks by

children who stutter and their fluent peers (Bajaj A, Hodson B, Schommer-Aikins M) This study was undertaken to examine the performance of 23 children who stutter (CWS) and 23 children who do not stutter (CWNS) on three metalinguistic tasks. These included two phonological awareness assessment procedures (The Lindamood Auditory Conceptualization Test (LAC) and a Phoneme Reversal Task) and one modified Grammar Judgments Task where syntactic and semantic appropriateness of sentences was evaluated. Differences between groups were significant for the grammar judgment task, where CWNS outperformed CWS in judging syntactically and semantically anomalous sentences. Group differences were not significant for the phonological awareness tasks.

Characteristics of speech disfluency and stuttering behaviors in 3- and 4-year-old

children (Pellowski MW, Conture EG) The purpose of this investigation was to quantitatively and qualitatively characterize speech disfluencies exhibited by 3- and 4year-old children who do (CWS, N = 36) and do not (CWNS, N = 36) stutter. Five measures of speech disfluency (e.g., percentage of total, other, and stuttering-like disfluencies, mean number of repetition units, and weighted SLD measure) were used in attempts to differentiate CWS from CWNS. Similar measures of stuttering (e.g., percentage of stuttering-like disfluencies consisting of disrhythmic phonations) were used to characterize speech disfluencies in 3- and 4-year-old CWS in relation to time since stuttering onset (TSO). It was hypothesized that such measures of speech disfluency should significantly differ between CWS and CWNS, as well as 3- versus 4-year-old CWS in relation to TSO. Results indicated that 4 out of the 5 dependent measures significantly differed between CWS and CWNS, and within the CWS group there was a significant relationship between TSO and the percentage of stuttering-like disfluencies when the effects of chronological age were partialled out of the regression analyses. Furthermore, 4year-old CWS exhibited a moderate correlation between TSO and the percentage of stuttering-like disfluencies consisting of disrhythmic phonations, whereas 3-year-old CWS exhibited no such relationship between these two variables. Findings were taken to suggest that certain measures of speech disfluency appreciably differentiate CWS from CWNS and that 4-year-old CWS exhibit changes in non reiterative forms of stuttering as a function of time since stuttering onset. Temperamental characteristics of young children who stutter (Anderson JD, Pellowski

MW, Conture EG, Kelly EM) The purpose of this investigation was to assess the temperamental characteristics of children who do (CWS) and do not (CWNS) stutter using a norm-referenced parent-report questionnaire. Participants were 31 CWS and 31 CWNS between the ages of 3;0 (years;months) and 5;4 (CWS: mean age = 48.03 months; CWNS: mean age = 48.58 months). The CWS were matched by age (+/- 4 months), gender, and race to the CWNS. All participants had speech, language, and hearing development within normal limits, with the obvious exception of stuttering for CWS. Children's temperamental characteristics were determined using the Behavioral Style Questionnaire (BSQ; S. C. McDevitt & W. B. Carey, 1978), which was completed by each child's parents. Results,

based on parent responses to the BSQ, indicated that CWS are more apt, when compared to CWNS, to exhibit temperamental profiles consistent with hypervigilance (i.e., less distractibility), nonadaptability to change, and irregular biological functions. Findings suggest that some temperamental characteristics differentiate CWS from CWNS and could conceivably contribute to the exacerbation, as well as maintenance, of their stuttering. Childhood stuttering and speech disfluencies in relation to children's mean length of

utterance: a preliminary study (Zackheim CT, Conture EG) The purpose of this study was to examine the influence of utterance length and complexity relative to the children's mean length of utterance (MLU) on stuttering-like disfluencies (SLDs) for children who stutter (CWS) and nonstuttering-like disfluencies (nonSLDs) for children who do not stutter (CWNS). Participants were 12 (3;1-5;11, years;months) children: 6 CWS and 6 agematched (+/-5 months) CWNS, with equal numbers in each talker group (CWS and CWNS) exhibiting MLU from the lower to the upper end of normal limits. Data were based on audio-video recordings of each child in two separate settings (i.e., home and laboratory) during loosely structured, 30-min parent-child conversational interactions and analyzed in terms of each participant's utterance length, MLU, frequency and type of speech disfluency. Results indicate that utterances above children's MLU are more apt to be stuttered or disfluent and that both stuttering-like as well as nonstuttering-like disfluencies are most apt to occur on utterances that are both long and complex. Findings were taken to support the hypothesis that the relative "match" or "mismatch" between linguistic components of an utterance (i.e., utterance length and complexity) and a child's language proficiency (i.e., MLU) influences the frequency of the child's stuttering/speech disfluency. Coarticulation and formant transition rate in young children who stutter (Chang SE,

Ohde RN, Conture EG) The purpose of this study was to assess anticipatory coarticulation and second formant (F2) transition rate (FTR) of speech production in young children who stutter (CWS) and who do not stutter (CWNS). Fourteen CWS and 14 age- and gendermatched CWNS in three age groups (3-, 4-, and 5-year-olds) participated in a picturenaming task that elicited single-word utterances. The initial consonant-vowel (CV) syllables of these utterances, comprising either bilabial [b m] or alveolar [d n s z] consonants and a number of vowels [i I e epsilon ae u o c aI av],were used for acoustic

analysis. To assess coarticulation and speech movement velocity, the F2 onset frequency and F2 vowel target frequency (for coarticulation) and FTR (for speech movement velocity) were computed for each CV syllable and for each participant. Based on these measures, locus equation statistics of slope, y-intercept, and standard error of estimate as well as the FTR were analyzed. Findings revealed a significant main effect for place of articulation and a significantly larger difference in FTR between the two places of articulation for CWNS than for CWS. Findings suggest that the organization of the FTR production for place of articulation may not be as contrastive or refined in CWS as in CWNS, a subtle difficulty in the speed of speech-language production, which may contribute to the disruption of their speech fluency. Phonological progress during the first 2 years of stuttering (Paden EP, Ambrose NG,

Yairi E) This report is the third in a series on phonological impairment in children who stutter, comparing its extent in those whose stuttering will be persistent with those in whom that disorder will disappear spontaneously. The first (E. P. Paden & E. Yairi, 1996) compared small groups of these children with normally fluent children of the same ages and sex. The second (E. P. Paden, E. Yairi, & N. G. Ambrose, 1999) compared the phonological abilities evidenced soon after onset of stuttering for 84 young children. In that study, the mean level of phonological skills of the 22 participants whose stuttering eventually persisted for at least 4 years was found to be significantly poorer than that of 62 others whose stuttering would disappear without fluency intervention before that time. In the present study, recorded performances of the same 84 children, made 1 and 2 years later, were similarly evaluated to determine how their phonological development progressed after the initial visit. Results of assessment at the 1-year visit showed that the mean difference between the two groups of children was no longer significant. The children whose stuttering would persist had improved more phonologically than had those who would recover from stuttering. At the 2-year visit, the mean percentage of phonological error for the two groups was identical. Furthermore, at this assessment, only 3 of the children in the Persistent group and 11 of those in the Recovered group had not essentially mastered all of the 10 basic patterns of phonology that were the focus of our evaluation. The findings concerning the longitudinal covariance of stuttering and phonological skills

provide information that should be considered in any attempt to explain the relation between the two. Exchange of stuttering from function words to content words with age (Howell P, Au-

Yeung J, Sackin S) Dysfluencies on function words in the speech of people who stutter mainly occur when function words precede, rather than follow, content words (Au-Yeung, Howell, & Pilgrim, 1998). It is hypothesized that such function word dysfluencies occur when the plan for the subsequent content word is not ready for execution. Repetition and hesitation on the function words buys time to complete the plan for the content word. Stuttering arises when speakers abandon the use of this delaying strategy and carry on, attempting production of the subsequent, partly prepared content word. To test these hypotheses, the relationship between dysfluency on function and content words was investigated in the spontaneous speech of 51 people who stutter and 68 people who do not stutter. These participants were subdivided into the following age groups: 2-6-year-olds, 79-year-olds, 10-12-year-olds, teenagers (13-18 years), and adults (20-40 years). Very few dysfluencies occurred for either fluency group on function words that occupied a position after a content word. For both fluency groups, dysfluency within each phonological word occurred predominantly on either the function word preceding the content word or on the content word itself, but not both. Fluent speakers had a higher percentage of dysfluency on initial function words than content words. Whether dysfluency occurred on initial function words or content words changed over age groups for speakers who stutter. For the 2-6year-old speakers that stutter, there was a higher percentage of dysfluencies on initial function words than content words. In subsequent age groups, dysfluency decreased on function words and increased on content words. These data are interpreted as suggesting that fluent speakers use repetition of function words to delay production of the subsequent content words, whereas people who stutter carry on and attempt a content word on the basis of an incomplete plan.