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Childhood stuttering: Incidence and development
Abstract
This article presents the results of a pilot study on the incidence and development of early childhood stuttering conducted on the Danish island of Bornholm, where the entire population of children born within a 2-year span was surveyed. The findings indicate that the incidence of stuttering reached the level of 5.19%, that 71.40% of the children stopped stuttering within 2 years after the original survey, and that more children stopped stuttering at a later time. Additional information on the characteristics of the children and early stuttering is presented. The results are compared to recent research in the field. Further research activities of this project are in progress.
... [15,17] This is significantly higher than the incidence of stuttering reported in families of normally fluent controls. [18,19] The family history of stuttering is the best-known question that clinicians usually ask in the first examination worldwide, maybe without any idea about its clinical implications, or agreement about the exact rate of the positive family history among PWS for clinical advice and prognostic judgments. ...
... This overall rate is similar to studies that recruited the same age group using parental interviews for data collection of family history. [15,19,21,30] The results are also similar to the study by Ambrose et al., 1993 who investigated the same age group using a more precise family pedigree method. [26] In addition, other studies which investigated the same age group with methods other than interviews reported similar results. ...
... Based on the result of the present study and similar studies that recruited a younger population, the rate of positive family history is higher among studies that recruited participants near the age of onset. [10,15,19,26,30,31] On the other hand, studies that recruited older populations reported a lower rate of positive family history of the disorder. [9,27,34] Based on these findings, the farther the age of the sample was from the age of the stuttering onset, the lower the rate of family history of the disorder. ...
Background
The family history of stuttering is one of the most important factors for the prediction of recovery from stuttering. There is a high controversy about the rate of positive family history of stuttering among people who stutter (PWS). In the present study, the family history of stuttering in the first-, second-, and third-degree relatives was investigated among a group of Kurdish children who stuttered (CWS) close to the onset of the disorder.
Materials and Methods
One hundred and seventy-two CWS, including 46 females (24.60%) aged 2–5 years (mean age: 3.71 years, SD = 0.75) were consecutively recruited. They were first examined close to the onset of the stuttering. Data about current and former stuttering among first-, second-, and third-degree relatives were collected using interviews with both parents. Data was described and analyzed by independent sample t test or Chi-square.
Results
Among 172 CWS (mean age: 3.71 years, SD = 0.75), 119 (69.20%) reported a family history of stuttering. According to the result, the most family history of stuttering was reported among third-degree relatives (32.60%). Sixty-five participants (37.80%) reported just one relative with stuttering. CWS with a positive family history of stuttering had no significant difference with CWS without a positive family history of stuttering in sex ( P = 0.48) and age of stuttering onset ( P = 0.96).
Conclusion
The rate of positive family history of stuttering among Kurdish CWS is similar to previously reported data in the same age group. There was no significant association of family history of stuttering with sex and age on the onset of the disorder.
... The male/female ratio of stuttering is typically calculated by dividing the number of boys who stutter by the number of girls who stutter in some sample. For example, the male/female ratio in Månsson (2000) is reported as 1.65:1, on the basis that there were 33 boys who stuttered and 20 girls, and 33 divided by 20 is 1.65. That procedure is unproblematic if equal proportions of boys and girls are included. ...
... That procedure is unproblematic if equal proportions of boys and girls are included. That was the case in Månsson (2000): Out of the 1,021 participants in that study (which included nearly all children born in the Danish island of Bornholm in the years 1990-1991), 51.8% were boys and 48.2% were girls. Number and percentage of children reported to stutter, by grade and home language: homes in which English was the only language regularly used ("English only", left-hand columns); homes in which a language other than English was regularly used ("Bilingual", right-hand columns); "CNS" children not reported to stutter; "CWS" children reported to stutter; "%" percentage of children reported to stutter. ...
... For example, 64.0% (309 out of 483) of the children from homes where only English was spoken in grade 5 were boys, compared to 58.4% (90 out 154) of those in whose homes another language was spoken. To ensure that our estimates were not unduly affected by the imbalance in the sample, we therefore calculated two sets of male/female ratios: (1) the ratio of the numbers of boys and girls who were described as stuttering (i.e., the method employed, for example, in Månsson, 2000), and (2) a ratio controlling for the gender balance by grade, which we term the "prevalence ratio". We estimated the prevalence ratio by dividing the percentage of boys described as stuttering, out of the boys in a given grade, by the percentage of girls described as stuttering, out of the number of girls in that grade. ...
Introduction
Bilingualism has historically been claimed to be a risk factor for developmental stuttering. The Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) ostensibly contains evidence to test that claim.
Methods
We analyze data from monolingual and bilingual children in Kindergarten through fifth grade in the ECLS-K:2011.
Results and discussion
The prevalence, male/female ratio, and onset and recovery of reported stuttering in the ECLS are inconsistent with widely-accepted clinical reports of stuttering. We argue that the reported figures may be misleading. We discuss some factors that may inflate the reported prevalence, including a lack of awareness of the difference between stuttering vs. normal disfluencies, and the informal usage of the word “stuttering” on the part of teachers and parents to describe typical disfluencies.
... D evelopmental stuttering is a speech fluency disorder that originates in childhood between 2 and 5 years of age (Kefalianos, Onslow, Packman, et al., 2017;Yairi & Ambrose, 2013). Stuttering occurs in 5%-11% of preschool-age children Craig et al., 2002;Dworzynski et al., 2007;Månsson, 2000;Reilly et al., 2013). Three to nine years after onset, 65%-80% will have recovered from stuttering, so that 20%-35% children develop persistent stuttering (Ambrose et al., 2015;Andrews & Harris, 1964;Franken et al., 2018;Kefalianos, Onslow, Ukourmunne, et al., 2017;Månsson, 2000;Rommel et al., 1999;Yairi & Ambrose, 2013). ...
... Stuttering occurs in 5%-11% of preschool-age children Craig et al., 2002;Dworzynski et al., 2007;Månsson, 2000;Reilly et al., 2013). Three to nine years after onset, 65%-80% will have recovered from stuttering, so that 20%-35% children develop persistent stuttering (Ambrose et al., 2015;Andrews & Harris, 1964;Franken et al., 2018;Kefalianos, Onslow, Ukourmunne, et al., 2017;Månsson, 2000;Rommel et al., 1999;Yairi & Ambrose, 2013). Current views on the etiology and developmental course of stuttering emphasize multifactorial models combining genetic/epigenetic, neurobiological, speech motor control, linguistic, behavioral (temperament, executive functioning), and environmental (socioeconomic status) factors Smith & Kelly, 1997;Smith & Weber, 2017). ...
... The classification of stuttering and persistent stuttering was not determined directly, by a speech sample or an expert assessment at any point in the Generation R Study, but was based only on parental reports of 9-year-old children. Parental reports have been used in several previous studies of persistence and recovery of stuttering in childhood (Dworzynski et al., 2007;Kloth et al., 1999;Koenraads et al., 2019;Månsson, 2000). Parents of children who stutter and parents of nonstuttering children can accurately and reliably identify the absence/presence of stuttering (Bloodstein & Bernstein Ratner, 2008;Einarsdottir & Ingham, 2009;Onslow et al., 2018;Reilly et al., 2009;Tumanova et al., 2018). ...
Purpose
Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood.
Method
This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed.
Results
Six-month-old children who were less able to “recover from distress,” indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (β = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (β = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (β = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years.
Conclusions
Behavior and temperament were associated with stuttering persistency—seemingly as both predictor and consequence—but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered.
Supplemental Material
https://doi.org/10.23641/asha.16869479
... However, community prospective studies are more representative of stuttering in the community. The best known of such studies are the Thousand Family Study (Andrews & Harris, 1964) and the Twins Early Development Study from the UK (Dworzynski et al., 2007), the Illinois Project (Yairi & Ambrose, 2004) and the Purdue Project (Leech, Ratner, Brown, & Weber, 2017) from the United States, the Bornholm Study (Månsson, 2000) from Denmark, and the Early Language in Victoria Study (Reilly et al., 2013) from Australia. A fourth issue is that the ages of children in the studies is also problematic because they range from 2 to 5 years, and if only older children are recruited, then recovery in younger children will be missed. ...
... Well, the ELVS study (Reilly et al., 2013) reports that only 6% of children recovered within 12 months of onset. The Bornholm project (Månsson, 2000) reports that 72% of children had recovered by age 5, and the Illinois Project (Yairi & Ambrose, 2004) reports that 74% of children had recovered 4 years after onset. ...
... A more recent study by Yairi and Ambrose (2005) showed a somewhat narrower age range for onset, between 16 to 69 months, with a mean age of 33 months. This average age of onset complied with other findings, such as those by Månsson (2000). Yairi and Ambrose also reported that over 85% of onsets had occurred before 42 months of age, increasing to 95% by age 4 years. ...
... There is a strong evidence though that this male-to-female ratio increases as children grow older. For example, Kloth, Kraaimaat, Janssen, and Brutten (1999) found a male-to-female ratio of 1.1:1 near stuttering onset, rising to 2.5:1 six years later, a similar pattern as was found by Månsson (2000). ...
... Stuttering has a more prevalent effect on males, with a 3:1 ratio versus females. It occurs in approximately 5-8% of children between two and four years of age [4,5]. ...
... However, BCHE and CACNA1F variants did not show co-segregation in the family. Sanger sequencing analysis showed that ARMC3 c.916 + 1G > A (NM_173081. 5 Figures 1 and 2C). The total allele frequency (AF: 0.00009521) for ARMC3 variant c.916 + 1G > A in the genomAD v2.1.1 dataset was calculated. ...
Stuttering is a common neurodevelopment speech disorder that negatively affects the socio-psychological dimensions of people with disability. It displays many attributes of a complex genetic trait, and a few genetic loci have been identified through linkage studies. Stuttering is highly variable regarding its phenotypes and molecular etiology. However, all stutters have some common features, including blocks in speech, prolongation, and repetition of sounds, syllables, and words. The involuntary actions associated with stuttering often involve increased eye blinking, tremors of the lips or jaws, head jerks, clenched fists, perspiration, and cardiovascular changes. In the present study, we recruited a consanguineous Pakistani family showing an autosomal recessive mode of inheritance. The exome sequencing identified a homozygous splice site variant in ARMC3 (Armadillo Repeat Containing 3) in a consanguineous Pashtun family of Pakistani origin as the underlying genetic cause of non-syndromic stuttering. The homozygous splice site variant (NM_173081.5:c.916 + 1G > A) segregated with the stuttering phenotype in this family. The splice change leading to the skipping of exon-8 is a loss of function (LoF) variant, which is predicted to undergo NMD (Nonsense mediated decay). Here, we report ARMC3 as a novel candidate gene causing the stuttering phenotype. ARMC3 may lead to neurodevelopmental disorders, including stuttering in humans.
... These span the domains of mental health (Blumgart et al., 2010;Craig & Tran, 2014;Iverach et al., 2016Iverach et al., , 2017Stein et al., 1996), quality of life Franic et al., 2012;Koedoot et al., 2011) and education and vocational attainment (Blumgart et al., 2010;Bricker-Katz et al., 2013;Klein & Hood, 2004;Klompas & Ross, 2004;McAllister et al., 2012;O'Brian et al., 2011). Cumulative incidence estimates of early stuttering from large cohorts recruited prior to onset are 5.0% (Månsson, 2000) and 8.5% (Reilly et al., 2009) at 3 years of age, and 11.2% at 4 years of age (Reilly et al., 2009). Longitudinal reports of natural recovery in large cohorts suggest that two-thirds of children will recover during childhood, either naturally, with treatment or with a combination of both: 74% at 4 years post-onset (Yairi & Ambrose, 2004), 67% at 4-5 years post-onset (Ambrose et al., 2015), 71% at 5 years of age (Månsson, 2000) and 65% at 7 years of age (Kefalianos et al., 2017). ...
... Cumulative incidence estimates of early stuttering from large cohorts recruited prior to onset are 5.0% (Månsson, 2000) and 8.5% (Reilly et al., 2009) at 3 years of age, and 11.2% at 4 years of age (Reilly et al., 2009). Longitudinal reports of natural recovery in large cohorts suggest that two-thirds of children will recover during childhood, either naturally, with treatment or with a combination of both: 74% at 4 years post-onset (Yairi & Ambrose, 2004), 67% at 4-5 years post-onset (Ambrose et al., 2015), 71% at 5 years of age (Månsson, 2000) and 65% at 7 years of age (Kefalianos et al., 2017). ...
Background:
Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it.
Aims:
This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England.
Methods & procedures:
Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift.
Outcomes & results:
Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials.
Conclusions & implications:
Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined.
What this paper adds:
What is already known on the subject The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work? Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice.
... Stuttering is a serious communication disorder, characterized by involuntary disruptions in speech, and it significantly affects or impedes the capacity of individuals to communicate efficiently (1). A higher prevalence rate of stuttering (~1.4%) is reported in children and adolescents aged (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) years old (2). ...
... Stuttering has been shown to significantly affect behavioral, cognitive, psychological and social aspects of a patient (3,4). In the preadolescent population, 4-5% of individuals exhibit stuttered speech, whereas in the adult, this decreases to ≤1% of individuals (7)(8)(9)(10). ...
Green tea and its polyphenolic compounds have been shown to exert positive effects in individuals with psychological disorders. The protective role of green tea against stuttering or its related consequences, depression, anxiety and stress, were evaluated in adolescents with moderate stuttering (MS). A total of 60 adolescents aged (12-18) years old were enrolled in this study. Patients were classified according to standardized test material Stuttering Severity Instrument, 4th Edition was used to estimate the severity of stuttering; participants were classified into two groups: a normal healthy group (n=30) and a MS group (n=30). The Depression Anxiety Stress Scale and General Health Questionnaire were used to estimate the degree of depression, anxiety and stress as well as general mental health. The physiological profile of stress hormones, as a measure of the response to green tea response, was also measured amongst participants. Adrenal stress hormones cortisol, dehydroepiandrosterone (DHEA), acetylcholine (ACTH), corticosterone and the cortisol:DHEA ratio were assayed. In addition, the constituent green tea polyphenols and their quantities were determined using liquid chromatography analysis. Decaffeinated green tea was administered six cups/day for 6 weeks, and this significantly improved the depression, anxiety, stress and mental health consequences associated with stuttering in adolescents. In addition, increased consumption of green tea significantly reduced elevated levels of adrenal stress hormones; cortisol, DHEA, ACTH and corticosterone, and increased the cortisol:DHEA ratio in the control and adolescents who stuttered. The data showed that drinking six cups of decaffeinated green tea, which is enriched in catechins (1,580 mg) and other related polyphenols, was sufficient to improve the consequences of mental health associated with stuttering in younger aged individuals.
... Stuttering is common in young children, affecting up to 11% by 4 years of age (Andrews, 1985;Månsson, 2000;Reilly et al., 2013). While the majority of these children will recover from stuttering by school entry, up to 35% will develop persistent stuttering (Kefalianos et al., 2017;Månsson, 2000). ...
... Stuttering is common in young children, affecting up to 11% by 4 years of age (Andrews, 1985;Månsson, 2000;Reilly et al., 2013). While the majority of these children will recover from stuttering by school entry, up to 35% will develop persistent stuttering (Kefalianos et al., 2017;Månsson, 2000). Some children and adults are not affected by the experience of stuttering. ...
Purpose
Early childhood professionals must accurately identify, refer, and treat children who stutter (CWS) within the scope of their respective roles to ensure each child receives the best possible care. This study aimed to investigate similarities and differences between the practices of speech-language pathologists (SLPs), preschool teachers, and public health nurses when they initially meet a young child reported as stuttering.
Method
This cross-sectional study was conducted in Norway. A sample of 342 early childhood professionals (126 preschool teachers, 95 public health nurses, and 121 SLPs) completed an online survey about their management practices with young children reported as stuttering. Descriptive statistics, ordinal regression, and chi-square analyses were used to analyze data.
Results
Initial management practices reflected the different roles and competencies of each profession. Less than 15% of SLPs reported they have access to guidelines for working with CWS. This figure was even lower for public health nurses (6.5%) and preschool teachers (12%). The most common recommendations provided to parents by all professions was giving the child time to talk and maintaining eye contact. Each profession's referral for further speech-language pathology management was most commonly influenced by stuttering severity. All professions reported collaborating about management of CWS; the most common reported collaboration was with preschool teachers.
Conclusions
Initial management practices varied between professions; however, differences largely reflected the roles and competencies of each profession. The development of guidelines and interdisciplinary seminars is recommended to develop a more complementary approach across professions to improve management practices and ensure young CWS receive the best possible care.
... This is also a time when the frequency of stuttering increases in some children, evident during their conversational speech (Guitar, 2006). However, reports have indicated that approximately 80% of 3-year-old children who stutter (CWS) undergo natural recovery and no longer stutter by 5 or 6 years of age, whereas the remaining 20% continue to stutter into the school years (Månsson, 2000;. Although many children recover naturally within the first 2 years of onset , 2013, in cases where stuttering persists beyond early childhood, it can become a chronic problem that is more difficult to treat (Onslow, 2023;Yairi, 1999Yairi, , 2004. ...
Purpose
This review article examines the proposal that language ability is a predictor or associate of natural recovery from stuttering. Specifically, this is the claim that preschool children who stutter (CWS) but have strong language skills are more likely to recover from this disorder naturally (without professional treatment) than those who have weaker language skills.
Method
Studies that investigated this proposal are described, and their findings are reported in an effort to achieve greater clarity regarding this claim. The review includes studies that were published in peer-reviewed research journals in English since 1996.
Results
Collectively, studies of language ability and natural recovery from stuttering have yielded mixed results. Although some studies found evidence to support an association, others did not, and still others yielded only partial support. Possible explanations for the complex and inconsistent findings are discussed, and suggestions are offered for speech-language pathologists who work with CWS.
Conclusions
Language ability in preschool children is not a consistent or robust predictor or associate of natural recovery from stuttering. For this reason, it is risky to assume that a young child who stutters but has strong language skills is likely to recover from stuttering naturally and therefore does not require professional treatment for this disorder.
... Stuttering is a speech fluency disorder that may not necessarily be fully resolved; symptoms in children and adolescents who still stutter after puberty are likely to persist (Johannsen, 2001;Månsson, 2000;Sandrieser & Schneider, 2015;Yairi & Ambrose, 2004, 2013. For this reason, stuttering treatment should not only be effective in the short-or mediumterm but should also help people who stutter (PWS) in the long term. ...
Purpose:
The purpose of this study was to assess the long-term stability of objective and subjective psychosocial improvements and fluency more than 10 years after participation in an intensive stuttering therapy camp.
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Method:
Ten former participants in intensive stuttering therapy (IST; mean age at time of intervention 14; 2 years) participated in this study. Outcomes of the IST at that time were assessed with the Stuttering Severity Instrument (SSI-3; Riley, 1994) and a questionnaire to measure the psychosocial impact of stuttering. A semi-structured video call and a general questionnaire for the long-term evaluation were used to gauge the participants’ perceptions of the IST. These follow-up data were compared to the therapy outcomes reported by Cook (2011, 2013).
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Result:
Therapy effects on the severity of stuttering and psychosocial impact were stable over the follow-up period of more than 10 years. Moreover, scores for psychosocial impact and severity of stuttering further decreased from the end of the IST to the long-term evaluation. The intensive time and the periodically offered follow-up treatments were described as particularly positive by the participants.
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Conclusion:
Intensive stuttering therapy in childhood or adolescence can have a long-term positive effect on both internal and external stuttering symptoms.
... This observation is consistent with findings from a specific study by Craig et al., [28] which noted a substantial male-to-female ratio in stuttering, often exceeding four to one. However, there have been reports of relatively smaller gender ratios specifically concerning SS scores [29] . ...
... Stuttering (childhood-onset fluency disorder) is a disruption in the fluency of speech. It affects 5%-11% of the population between the ages of two and four [1][2][3][4] ; however, 74% recover naturally within four years, 5 leaving 1% with persistent stuttering. 6 Persistent stuttering can lead to academic difficulties, 7 a decreased quality of life, 8,9 lower social status, 10 reduced wages, 11 and an increased risk of suicide. ...
Stuttering (childhood-onset fluency disorder) is characterized by disruptions in speech fluency. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the diagnosis of social anxiety disorder in people who stutter is prohibited. However, the introduction of the DSM-5 enabled the diagnosis of social anxiety disorder concurrently with stuttering, making the concerns of people who stutter more visible. Understanding the performance-only subtype of social anxiety disorder introduced in DSM-5 can prevent underestimating the concerns of people who stutter and lead to appropriate support. While cognitive-behavioral therapy is effective in treating stuttering, accumulating evidence for pharmacotherapy is also necessary.
... The American Speech-Language-Hearing Association, 2024 have a webpage devoted to speech disfluencies in children. Stuttering occurs in around 2-8% of children (Månsson, 2000;Zablotsky et al., 2019) and cluttering in 1.1-1.2% of school-age children (Van Zaalen and Reichel, 2017). ...
Purpose
The Listen to Learn for Life (L ³ ) Assessment Framework is a framework that outlines how to systematically assess the links between the classroom environment, listening, learning and well-being. The purpose of this paper is to review the published literature to understand what is known about the characterisation of activity component of the L ³ Assessment Framework and determine what is not known and needs to be investigated in future research.
Design/methodology/approach
Literature reviews (Web searches for systematic, scoping or general reviews; scoping reviews following the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews protocol; and extended Web searches) were conducted to characterise lecture, group work and independent work activities in terms of the perceptual setting, source degradation and transmission degradation.
Findings
Most research that has been conducted is for classrooms in general and does not specify results specifically for lecture, group work and independent work, which is important for understanding how the learning environment changes with the different activities. What is known about the lecture, group work and independent work activities are discussed; however, it is noted that this often comes from only a few studies. Future research areas to contribute to this literature as well as fill current research gaps are proposed.
Originality/value
To the best of the authors’ knowledge, this paper is the first review paper to synthesize previous research characterising the classroom environment for different activities using the L ³ Assessment Framework. It provides an analysis of the limitations of existing literature and proposes future research to help fill in these gaps.
... The abovementioned concerns and limitations related to stuttering assessment, in addition to the quality of the included studies, constitute the frame within which we can interpret and understand the findings of the current review. Nevertheless, studies consistently report high occurrences of stuttering in individuals with Down syndrome when interpreted against the estimated 1% prevalence for the typical adult population (see, e.g., Månsson, 2000) and the 5-11% cumulative incidence of stuttering in typically developing children (Reilly et al., 2009(Reilly et al., , 2013. The fact that a high percentage of the individuals in the included studies displayed core stuttering behaviors to a degree which they were judged to stutter is in line with previous research, showing that individuals with Down syndrome are vulnerable to speech, language, and communication difficulties (see, e.g., Martin et al., 2009;Naess et al., 2011;Jones et al., 2019;Wilson et al., 2019;Loveall et al., 2021), including stuttering (Kent and Vorperian, 2013). ...
The main objective of this systematic review was to synthesize the evidence on the occurrence and characteristics of stuttering in individuals with Down syndrome and thus contribute knowledge about stuttering in this population. Group studies reporting outcome measures of stuttering were included. Studies with participants who were preselected based on their fluency status were excluded. We searched the Eric, PsychInfo, Medline, Scopus, and Web of Science Core Collection databases on 3rd January 2022 and conducted supplementary searches of the reference lists of previous reviews and the studies included in the current review, as well as relevant speech and language journals. The included studies were coded in terms of information concerning sample characteristics, measurement approaches, and stuttering-related outcomes. The appraisal tool for cross-sectional studies (AXIS) was used to evaluate study quality. We identified 14 eligible studies, with a total of 1,833 participants (mean = 131.29, standard deviation = 227.85, median = 45.5) between 3 and 58 years of age. The estimated occurrence of stuttering ranged from 2.38 to 56%, which is substantially higher than the estimated prevalence (1%) of stuttering in the general population. The results also showed that stuttering severity most often was judged to be mild-to-moderate and that individuals with Down syndrome displayed secondary behaviors when these were measured. However, little attention has been paid to investigating the potential adverse effects of stuttering for individuals with Down syndrome. We judged the quality of the evidence to be moderate-to-low. The negative evaluation was mostly due to sampling limitations that decreased the representability and generalizability of the results. Based on the high occurrence of stuttering and the potential negative effects of this condition, individuals with Down syndrome who show signs of stuttering should be referred to a speech and language pathologist for an evaluation of their need for stuttering treatment.
... 38 However, some considerably smaller gender ratios in the domains of stuttering scores particularly in speech (only 2: 1 or 1:1.6). [39][40] The human life of all ages are commonly exposed to several degrees of decline in cognitive capacity. [41][42][43][44] In human of one's mid-twenties, "to disorders in the biological framework controlling both the centers of thinking and reason in the human brain might be related to decline in cognitive capacity among all ages of humans". ...
Objectives
This study aims to investigate the potential effects of serum trace elements and vitamin D levels on cognitive capacity and stuttering symptoms in adolescents. So, we will determine the serum levels of Iron (Fe), Manganese (Mn), Selenium (Se), copper (Cu), and zinc (Zn), vitamin D levels, and cognitive capacity scores and their association with the severity of stuttering scores among adolescences aged 10–18 years’ old.
Methods
The study included 100 adolescence aged 10–18 years’ old. Stuttering severity, cognitive capacity, as well as vitamin D levels, and serum trace elements were identified using stuttering severity instrument (SSI-4; 4th edit.), the LOTCA-7 scores, immunoassay system, and spectrophotometer analysis respectively.
Results
the results showed that stuttering was identified in 60% of the participants they were classified into students with mild (n = 30; 19.6 mean) and moderate stuttering (28.7 mean, n = 30) respectively. Only 40% of the students had a total stuttering score within normal range with 11.6 mean stuttering score. Obesity related markers such as BMI, WHR showed significant association with the severity of stuttering compared to normal controls. In addition, the decline in cognitive capacity showed to be significantly increased in adolescences in association with mild to moderate stuttering as well. Also, serum trace elements (Fe, Mn, Se, Cu, Zn, Cu/Zn ratio) and vitamin D levels as biochemical parameters were significantly reduced in adolescences with mild to moderated stuttering than normal subjects. The reduction is closely increased in correlation with an increment in the severity of stuttering. Males showed comparable results than females of the same group signifying that gender could play a role in the stuttering severity as differences in vitamin D, serum trace element contents in the serum of both gender.
Conclusion
This study found significant associations between the severity of stuttering, trace elements, vitamin D deficiencies, and cognitive function in adolescents. Both deficiencies of trace elements and vitamin D along with cognitive impairment may potentially be more helpful and preventable causes of stuttering among school students aged 12–18 years. The studied parameters could be of diagnostic potential and helpful in the treatment of stuttering. However, deeper knowledge of mechanisms is needed in order to draw policy conclusions and public health guidelines to determine the roles of serum trace elements and vitamin D levels in the pathogenesis of stuttering.
... Children as young as three years of age can demonstrate negative emotional and behavioral reactions to their stuttering (Langevin et al., 2010). Even though many children experience spontaneous recovery from stuttering (Kefalianos et al., 2017;Mansson, 2000), commencing treatment as close as possible to stuttering onset is essential to minimize the likelihood of these adverse effects developing (Langevin et al., 2010;. Early treatment is also recommended as we cannot predict which children will persist with stuttering (Kefalianos et al., 2017) nor the potential negative outcomes of postponing early intervention. ...
Purpose:
This study investigated the treatment practices of speech-language pathologists (SLPs) with preschool children who stutter to explore variations in service delivery and, consequently to better inform and support evidence-based practice.
Method:
121 Norwegian SLPs completed an online survey about stuttering treatment for preschool children aged up to six years. They reported on treatment training, choices, setting, dosage, and outcomes. Data was analysed descriptively. Correlation analyses between years of clinical experience and clinician perceived outcomes were conducted.
Result:
Sixty-eight percent of SLPs were trained in one or more stuttering treatment programs. The majority of SLPs (83 %) provided treatment in person in preschool centers; 59 % reported providing treatment once a week. Thirty-four percent of SLPs reported that they often or always delivered the whole treatment program. Treatment practice addressed various elements, including advising parents about language and communication strategies, supporting the child's self-image, and perceived outcomes. The SLPs reported their clinician perceived outcomes as 'always' or 'often' reduction of audible stuttering (70 %), reduced cognitive and emotional reactions (55 %), and improved communication skills (58 %). Factors influencing treatment choices were identified at the systemic level (e.g., work place regulations) and individual level (e.g., SLPs competency, child's best).
Conclusion:
Stuttering treatment services in Norway differ from those reported in existing literature as treatment is given in preschool settings, only 34 % of SLPs deliver programs as intended whilst the majority use treatment elements only, and still experience positive changes. Provision is variable, and seems influenced by SLP training and competence.
... Developmental stuttering is a speech disorder affecting the production of fluent speech in approximately 5 % of preschool age children (Bloodstein et al., 2021;Månsson, 2000;Yairi and Ambrose, 2013). Typical onset of stuttering is around 30-48 months of age (Bloodstein et al., 2021;Yairi et al., 2005). ...
Speech production forms the basis for human verbal communication. Though fluent speech production is effortless and automatic for most people, it is disrupted in speakers who stutter, who experience difficulties especially during spontaneous speech and at utterance onsets. Brain areas comprising the basal ganglia thalamocortical (BGTC) motor loop have been a focus of interest in the context of stuttering, given this circuit’s critical role in initiating and sequencing connected speech. Despite the importance of better understanding the role of the BGTC motor loop in supporting overt, spontaneous speech production, capturing brain activity during speech has been challenging to date, due to fMRI artifacts associated with severe head motions during speech production. Here, using an advanced technique that removes speech-related artifacts from fMRI signals, we examined brain activity occurring immediately before, and during, overt spontaneous speech production in 22 children with persistent stuttering (CWS) and 18 children who do not stutter (controls) in the 5-to-12-year age range. Brain activity during speech production was compared in two conditions: spontaneous speech (i.e., requiring language formulation) and automatic speech (i.e., overlearned word sequences). Compared to controls, CWS exhibited significantly reduced left premotor activation during spontaneous speech production but not during automatic speech. Moreover, CWS showed an age-related reduction in left putamen and thalamus activation during speech preparation. These results provide further evidence that stuttering is associated with functional deficits in the BGTC motor loop, which are exacerbated during spontaneous speech production.
... 71 % of stuttering, followed by a ratio of 29 % of stuttering results from environmental factors (Peters and Guitar, 1991). Thus, behavioral, cognitive components, psychological, and social factors are significantly associated with the progression of stuttering Månsson, 2000). ...
In this study, we amid to evaluate the correlation between the change in the expressed levels of anti-GAD antibodies titers, oxidative stress markers, cytokines markers, and cognitive capacity in adolescents with mild stuttering. Eighty participants (60 male/20 female) with the age range of 10-18 years with moderate stutteringparticipated in this study. To assess the stuttering and cognitive function, stutteringseverity instrument (SSI-4; 4th edit.)and the LOTCA-7 scores assessment were applied respectively in all subjects. In addition, serum GAD antibodies, cytokines like TNF-α, CRP,and IL-6 withtotal antioxidant capacity and nitric oxide as oxidative stress markers were estimated using calorimetry and immunoassay techniques.The results showed that good cognitive capacity was reported in about 56.25 % of the study population (n = 45) with a 117.52 ± 6.3 mean LOTCA-7 score. However, abnormal cognitive function was identified in 43.75 % of the study population (n = 35); they were categorized into moderate (score 62-92, n = 35), and poor (score 31-62; n = 10). There were significant associations between cognitive capacity reported and all biomarkers. The expression of GAD antibodies is significantly associated with the degree of cognitive capacity among students with stuttering. Significant association with the reduction (P = 0.01) in LOTCA-7 score domains, particularly orientation, thinking operations, attention, and concentration among students with variable cognitive capacity compared to controls. In addition, the expressed higher GAD antibodies in students with moderate and poor cognitive capacity showed to be significantly correlated with both elevated concentrations of cytokines; TNF-α, CRP, and IL-6, and the reduction of TAC and nitric oxide (NO) respectively. This study concludes that abnormality of cognitive capacity showed to be associated with higher expression of GAD antibodies, cytokines, and oxidative stress in school students with moderate stuttering.
... A review of 44 international studies of school-aged children reported 1% prevalence rate for stuttering [6]. The incidence rate of stuttering is approximately 5%, although a more recent large-scale survey suggests 5-8% [7], with the onset occurring primarily during the preschool years [8]. Stuttering is more prevalent in biological males than biological females, with an approximate ratio of 4 males to 1 female [9]. ...
This comprehensive survey and review presents stuttering treatment approaches that have been reported in the past 20 years in order to highlight the different characteristics in each intervention. The comprehensive survey presented in this article was conducted according to the PRISMA guidelines to extract articles on stuttering interventions, published between 01/01/2000 and 01/08/2020. 11 formal programs, 9 fluency induction techniques and 7 adjunct therapy approaches were identified through the comprehensive survey and summarized. The most common results were the Lidcombe program and altered auditory feedback techniques. The comprehensive survey and review presented in this article strives to provide knowledge that can help researchers in other areas, such as Human-Robot Interaction (HRI), acquire a preliminary understanding of stuttering interventions and further the field of stuttering interventions with the introduction of technological advancements.
... Developmental stuttering affects 5-8% of children and persists throughout the lifetime in approximately 1% of adults (Månsson 2000;Reilly et al. 2009;Yairi and Ambrose 2013). Males and children with a family history are more likely to persist (Singer et al. 2020), though other risk factors such as early language and speech sound development have also been suggested to predict persistent stuttering (Singer et al. 2020;Walsh et al. 2021). ...
Inferior frontal cortex pars opercularis (IFCop) features a distinct cerebral dominance and vast functional heterogeneity. Left and right IFCop are implicated in developmental stuttering. Weak left IFCop connections and divergent connectivity of hyperactive right IFCop regions have been related to impeded speech. Here, we reanalyzed diffusion magnetic resonance imaging data from 83 children (41 stuttering). We generated connection probability maps of functionally segregated area 44 parcels and calculated hemisphere-wise analyses of variance. Children who stutter showed reduced connectivity of executive, rostral-motor, and caudal-motor corticostriatal projections from the left IFCop. We discuss this finding in the context of tracing studies from the macaque area 44, which leads to the need to reconsider current models of speech motor control. Unlike the left, the right IFCop revealed increased connectivity of the inferior posterior ventral parcel and decreased connectivity of the posterior dorsal parcel with the anterior insula, particularly in stuttering boys. This divergent connectivity pattern in young children adds to the debate on potential core deficits in stuttering and challenges the theory that right hemisphere differences might exclusively indicate compensatory changes that evolve from lifelong exposure. Instead, early right prefrontal connectivity differences may reflect additional brain signatures of aberrant cognition–emotion–action influencing speech motor control.
... A review of 44 international studies of school-aged children reported 1% prevalence rate for stuttering [6]. The incidence rate of stuttering is approximately 5%, although a more recent large-scale survey suggests 5-8% [7], with the onset occurring primarily during the preschool years [8]. Stuttering is more prevalent in biological males than biological females, with an approximate ratio of 4 males to 1 female [9]. ...
The inclusion of technologies such as telepractice, and virtual reality in the field of communication disorders has transformed the approach to providing healthcare. This research article proposes the employment of similar advanced technology – social robots, by providing a context and scenarios for potential implementation of social robots as supplements to stuttering intervention. The use of social robots has shown potential benefits for all the age group in the field of healthcare. However, such robots have not yet been leveraged to aid people with stuttering. We offer eight scenarios involving social robots that can be adapted for stuttering intervention with children and adults. The scenarios in this article were designed by human–robot interaction (HRI) and stuttering researchers and revised according to feedback from speech-language pathologists (SLPs). The scenarios specify extensive details that are amenable to clinical research. A general overview of stuttering, technologies used in stuttering therapy, and social robots in health care is provided as context for treatment scenarios supported by social robots. We propose that existing stuttering interventions can be enhanced by placing state-of-the-art social robots as tools in the hands of practitioners, caregivers, and clinical scientists.
... For example, up to 35% of the children who stutter at a young age have been found to go on to develop persistent stuttering, and older children who continue to stutter often experience anxiety and social rejection; while in adulthood, stuttering has considerable negative effects on emotional well-being and participation in society, including employment. 6,7 Given the adverse effects of stuttering, effective management in the early years to reduce the chance of persistent stuttering is crucial. ...
... La edad de inicio de la tartamudez se sitúa entre los dos y los cinco años. La incidencia de disfluencias (interrupciones de fluidez al hablar) en el desarrollo del lenguaje hablado en la infancia es del 8% (Månsson, 2000), siendo del 1% la prevalencia oficial de personas con tartamudez crónica (Yairi & Ambrose, 2013). La tartamudez también es un síntoma asociado con otras enfermedades como síndrome de Tourette (comorbilidad 15.3% al 31.3%) ...
La imagen que el séptimo arte ofrece sobre la discapacidad es fundamental en la percepción colectiva que se tiene de la misma En este trabajo se estudia, en forma de análisis textual, dos películas que abordan la discapacidad de la tartamudez y a cuyas producciones las separan veintidós años de diferencia: Un pez llamado Wanda (A Fish Called Wanda, Charles Crichton, 1988) y El discurso del rey (The King’s Speech, Tom Hooper, 2010). Ambas producciones son fundamentales para entender cómo en las últimas décadas la representación del colectivo de las personas con tartamudez en el cine ha cambiado. Para ello se comenzará con una exposición de los principales trabajos sobre qué es la tartamudez, seguido del impacto del estigma asociada a ella que genera en sus afectados, prosiguiendo con el análisis textual de ambas piezas para finalmente discutir y concluir qué ha supuesto para las personas tartamudas este cambio en el imaginario colectivo, poniendo de manifiesto los beneficios en materia de inclusión social y dignificación en la sociedad de una representación realista y correcta de la discapacidad de la tartamudez en el medio cinematográfico.
... Kekemelik, konuşma sırasında gözlemlenen ses ve/veya hece tekrarları, ses uzatmaları ve duraksamalar nedeniyle konuşmanın akıcılığının kesintiye uğrayarak bozulması olarak tanımlanan bir konuşma sorunudur (Guitar, 2006;Plante ve Beeson, 2008). Çocuklarda kekemeliğin görülme sıklığının %5 civarında olduğu ve bunun önemli bölümünün okul öncesi dönemde rastlanan durumları içerdiği belirtilmektedir (Mansson, 2000). Çocukluk çağındaki kekemeliklerin önemli bölümü herhangi bir müdahaleye gerek duyulmaksızın kendiliğinden düzelmesine rağmen bazı olgularda problemin kalıcılık gösterdiği görülmektedir. ...
Nowadays, developing technology increases to communication possibilities. The rapidly changing
communication pıssibilities also brings the foreign language requirement. Technological innovations are
dragging the effect of visual media abd the focus of our lives. These rapid changes are also reflected in
educational practices. Eliminate borders with obsolete technology, foreign language requirement has also
increased in all areas.These rapid changes with the new tendencies in the process of foreign language
learning and teaching, it is increasing the need for new perspectives in education. The concept of visual
literacy has entered our lives with the influence of media and visuals. New approaches have increased the
need to use multiple learning occasion. In this context, there have been many studies on foreign language
training until today. Materials used in the teaching of foreign languages are very important. Different
materials are needed to parallel with the new orientation. Language teaching is not only objective in
developing a strong grammer and vocabulary, it aims to be able to use the target language in every
ambiance. In order toincrease the functionally of language skills, strategies and criteria facilitate the
understandig ad expression of texts that are appropriate for student-centered purposes come to the fore.
Literary texts are srtuctures with different cultural elements. Poetry, novels, fables, stories, literary genres
such as comics are being used effectively in foreign language teaching course. Comics are one of the
highlightd of this type of textwith visuals. Comics are text types in which shapes and colors, short sentences,
visual and text can be followed together. Comics are an important materialthat enables language
development and intercultural communation. According to the constructivist approach,comics are
motivating materials that activate the student and increase attention and curiosity. In this study was the
educational dimension of comics investigated. The study was carried out with the questionnaires of the
forth grade students of German language teaching department of Trakya University and the student who
had graduated from other German programs with open-ended questions. In order to be able to evaluate
teacher candidates and graduate teachers, special attention has been paid to our ability to take courses such
as special teaching methods, orientations and media literacy. The questionnaire was formed ad semi-
structured quantitative and qualitative data collection tool. Information was also collected with individual
and focus groups. In this study, learning effect ofcomic book usage in German learning are is examined.
The purpıse of this research isto measure the attitudes towards the use of comics in teaching these
languages.
Keywords: Foreign Language Teaching, Comics, New Orientations Visual Media Tools
... Yairi and Ambrose (2005) indicated that approximately 5% of pre-school age children exhibit episodes of stuttering; and that the mean onset age for those children is 33 months. The mean age of onset was also confirmed by Mansson (2000). Around 80% of these children spontaneously recover by puberty (Howell, 2007) and the highest rate of recovery is three years post onset (Yari & Ambrose, 2005). ...
The primary aim of this thesis was to screen school-aged (4+) children for two separate types of fluency issues and to distinguish both groups from fluent children. The two fluency issues are Word-Finding Difficulty (WFD) and other speech disfluencies (primarily stuttering). The cohort examined consisted of children who spoke Arabic and English. We first designed a phonological assessment procedure that can equitably test Arabic and English children, called the Arabic English non-word repetition task (AEN_NWR). Riley’s Stuttering Severity Instrument (SSI) is the standard way of assessing fluency for speakers of English. There is no standardized version of SSI for Arabic speakers. Hence, we designed a scheme to measure disfluency symptoms in Arabic speech (Arabic fluency assessment). The scheme recognizes that Arabic and English differ at all language levels (lexically, phonologically and syntactically).
After the children with WFD had been separated from those with stuttering, our second aim was to develop and deliver appropriate interventions for the different cohorts. Specifically, we aimed to develop treatments for the children with WFD using short procedures that are suitable for conducting in schools. Children who stutter are referred to SLTs to receive the appropriate type of intervention. To treat WFD, another set of non-word materials was designed to include phonemic patterns not used in the speaker’s native language that are required if that speaker uses another targeted language (e.g. phonemic patterns that occur in English, but not Arabic). The goal was to use these materials in an intervention to train phonemic sequences that are not used in the child’s additional language such as the phonemic patterns that occur in English, but not Arabic. The hypothesis is that a native Arabic speaker learning English would be expected to struggle on those phonotactic patterns not used in Arabic that are required for English.
In addition to the screening and intervention protocols designed, self-report procedures are desirable to assess speech fluency when time for testing is limited. To that end, the last chapter discussed the importance of designing a fluency questionnaire that can assess fluency in the entire population of speakers. Together with the AEN_NWR, the brief self-report instrument forms a package of assessment procedures that facilitate screening of speech disfluencies in Arabic children (aged 4+) when they first enter school. The seven chapters, described in more detail below, together constitute a package that achieves the aims of identifying speech problems in children using Arabic and/or English and offering intervention to treat WFD.
... Yairi and Ambrose (2005) indicated that approximately 5% of pre-school age children exhibit episodes of stuttering; and that the mean onset age for those children is 33 months. The mean age of onset was also confirmed by Mansson (2000). Around 80% of these children spontaneously recover by puberty (Howell, 2007) and the highest rate of recovery is three years post onset (Yari & Ambrose, 2005). ...
The primary aim of this thesis was to screen school-aged (4+) children for two separate types of fluency issues and to distinguish both groups from fluent children. The two fluency issues are Word-Finding Difficulty (WFD) and other speech disfluencies (primarily stuttering). The cohort examined consisted of children who spoke Arabic and English. We first designed a phonological assessment procedure that can equitably test Arabic and English children, called the Arabic English non-word repetition task (AEN_NWR). Riley’s Stuttering Severity Instrument (SSI) is the standard way of assessing fluency for speakers of English. There is no standardized version of SSI for Arabic speakers. Hence, we designed a scheme to measure disfluency symptoms in Arabic speech (Arabic fluency assessment). The scheme recognizes that Arabic and English differ at all language levels (lexically, phonologically and syntactically). After the children with WFD had been separated from those with stuttering, our second aim was to develop and deliver appropriate interventions for the different cohorts. Specifically, we aimed to develop treatments for the children with WFD using short procedures that are suitable for conducting in schools. Children who stutter are referred to SLTs to receive the appropriate type of intervention. To treat WFD, another set of non-word materials was designed to include phonemic patterns not used in the speaker’s native language that are required if that speaker uses another targeted language (e.g. phonemic patterns that occur in English, but not Arabic). The goal was to use these materials in an intervention to train phonemic sequences that are not used in the child’s additional language such as the phonemic patterns that occur in English, but not Arabic. The hypothesis is that a native Arabic speaker learning English would be expected to struggle on those phonotactic patterns not used in Arabic that are required for English. In addition to the screening and intervention protocols designed, self-report procedures are desirable to assess speech fluency when time for testing is limited. To that end, the last chapter discussed the importance of designing a fluency questionnaire that can assess fluency in the entire population of speakers. Together with the AEN_NWR, the brief self-report instrument forms a package of assessment procedures that facilitate screening of speech disfluencies in Arabic children (aged 4+) when they first enter school. The seven chapters, described in more detail below, together constitute a package that achieves the aims of identifying speech problems in children using Arabic and/or English and offering intervention to treat WFD.
... It usually begins between the ages of 2-5 and affects more males than females. 5% of people are reported to stutter during part of their lives (Mansson, 2000). Its incidence across all age groups is 0.72% since every 4 out of 5 children recover it spontaneously (Craig et al., 2002). ...
This study aims to evaluate the association of DRD2 gene C957T polymorphism with stuttering within Turkish children who stutter. The sample of the study included 121 children between the ages of 5-16, 44 children with stuttering and 77 typically developing children. The genomic DNA’s were extracted from the saliva of the individuals. The genotyping of DRD2 C957T was carried out using polymerase chain reaction-restriction fragment length polymorphism. The relationship between genotypes and stuttering was examined through logistic regression analysis. In the study, it was determined that distributions of allele frequencies and the DRD2 gene C957T polymorphism were not significantly different from the control group (OR 0.762; CI 0.458-1.267, p=0.304). The genotype distributions of the DRD2 gene were estimated for CT (OR 1.103; CI 0.443-2.743, p=0.833) and TT (OR 0.868; CI 0.306-2.461; P=0.791). The genotype distributions of DRD2 C957T polymorphism were not statistically significant for additive, dominant, recessive, and codominant models between study groups. As a result, the polymorphic feature of the alleles and genotypes for the DRD2 gene C957T in Turkish children who stutter were analyzed, and it was detected that the differences between CWS and CWNS groups were not significant.
Keywords: Stuttering, DRD2, rs6277, Turkish population
... In the Yairi cohort, 31% of children (whose mean age at onset was 3 years) had recovered within 2 years, 63% by 3 years postonset, 74% by 4 years, and almost 80% by 5 years after stuttering onset. In a Danish cohort (Månsson, 2000), more than 71% of children had stopped stuttering within 2 years after their initial identification. In another study, Dutch children (Kloth et al., 1999) were being tracked prospectively because at least one of the parents was an AWS. ...
Purpose:
Although commonly defined as a speech disorder, stuttering interacts with the language production system in important ways. Our purpose is to summarize research findings on linguistic variables that influence stuttering assessment and treatment.
Method and results:
Numerous topics are summarized. First, we review research that has examined linguistic features that increase stuttering frequency and influence where it occurs. Second, we tackle the question of whether or not persons who stutter exhibit subtle language differences or deficits. Next, we explore language factors that appear to influence recovery from early stuttering in children. The final topic discusses the unique challenges inherent in differentially diagnosing stuttering in bilingual children. Clinical implications for each topic are discussed.
Discussion:
The article concludes with a discussion of the unique differences in the integration of language and speech demands by people who stutter, when compared to people who are typically fluent, and their clinical ramifications.
... Stuttering is a neurodevelopmental communication disorder and typically develops when a child is between 2 and 5 years of age (Yairi & Ambrose, 2013). Approximately 5%-8% of preschool-aged children exhibit stuttering (Månsson, 2000;Yairi & Ambrose, 2013) and research reports that 20-80% of children who stutter (CWS) may recover without treatment (Bloodstein & Ratner, 2008;Kefalianos et al., 2017). Potential predictive factors for recovery include: phonological abilities, articulatory rate, change in the pattern of disfluencies, and trend in stuttering severity over one-year post-onset (Sugathan & Maruthy, 2020). ...
Introduction
Parental perceptions towards stuttering is an important consideration as parents play a crucial role in the initial identification and management of stuttering in young children. Although several studies have been conducted on parental perceptions towards childhood stuttering in other countries, little is known about how stuttering is perceived and managed by parents in Sri Lanka.
Aims
This study explored Sri Lankan parents’ perceptions towards childhood stuttering and their experiences regarding attending speech and language therapy for stuttering.
Methodology
Using a qualitative approach, 15 parents of children who stutter were recruited from a stuttering clinic at a state university in Sri Lanka. Parents participated in semi-structured interviews with the first author. The interviews were conducted via telephone in Sinhala language, recorded, transcribed verbatim in Sinhala and then translated into English. The data were analysed using thematic analysis.
Results
Five themes emerged from the data: (1) limited knowledge about stuttering and management (2) influence of religion and culture on stuttering (3) variable responses to stuttering (4) impact of stuttering on the parent and child (5) impact and engagement in speech therapy.
Conclusion
The findings highlighted the need to educate the Sri Lankan public about stuttering as a communication disorder and raise awareness about the profession of speech language therapy in the country. Specifically, it is important for other health professionals and teaching professionals to learn more about stuttering, so that appropriate early referrals can be made for speech and language therapy, lessening the impact on children and their families.
... More than half the respondents reported that they gave advice about stuttering, and that they made another appointment to see the parents and child if they suspected a stutter. According to several studies, stuttering tends to start between the ages of two and four (2, 14), and early identi cation and treatment of stuttering is considered key to a positive prognosis (7,8). ...
Stuttering is progressively reduced when persons who stutter repeatedly read the same text. This reduction has been recently attributed to motor learning with repeated practice of speech-motor sequences. In the present study, we investigated the adaptation effect of 17 bilingual adults who stutter (BAWS). We asked these participants to complete a particular paradigm of reading passages with a 30-minute break between them. Participants were Kannada-English speaking BAWS. We split them into two groups of eight and nine participants, respectively who read in counter-balanced order two passages written in the Kannada and English languages. The averaged data from the two groups resulted in a typical adaptation curve for the five readings when read separately in both languages. When there was a switch from readings in Kannada to readings in English, there was a significant increase in the percentage of syllables stuttered. This increase in dysfluencies reduced the adaptation effect from repeated reading. These findings support the hypothesis that motor learning plays a crucial role in stuttering adaptation when participants read the same passage repeatedly in any language, but the shift in the language read suggests an interference in motor learning. Collectively, our results highlight an interaction effect between motor learning and language proficiency, seen by increased dysfluencies and a reduced adaptation effect in bilingual speakers.
Introduction:
Many epidemiological studies of the disorder of stuttering have been conducted during the 20th century, continuing during the current one. Unfortunately, only a few were carried out in Japan. This study aimed at assessing (1) the incidence and prevalence of stuttering in 3-year-old children in multiple Japanese communities, and (2) factors associated with the onset of stuttering among these children.
Methods:
A questionnaire aimed at screening for the presence of stuttering was employed for 2,055 children aged 3 years, who underwent a standard nationwide health checkup. Positive responses were confirmed in several ways: (1) direct interviews and assessment of the child's speech, (2) confirmatory questionnaire, or (3) telephone interviews by licensed Speech Language Hearing Therapists.
Results:
Approximately 6.5% of the children were found to exhibit stuttering at the time of their health checkup. This figure rose to 9.0% after including individuals who previously, but not currently, were reported to have exhibited stuttering. Among the putative risk factors, higher stuttering odds (odds ratio, OR = 3.26) were detected in those with a family history of stuttering, those whose guardians had concerns about their child's development (OR = 1.77), and those with diagnosed diseases or disabilities (OR = 2.14).
Discussion/conclusions:
It was concluded that, in Japan, both the risk of stuttering incidence (8.9%) in children up to, and including, the age of 3 years, as well as its prevalence (6.5%) in this population, was similar to those reported by recent studies in other countries. Additionally, our findings also confirmed that an increased risk for stuttering at age 3 is associated with a family history of stuttering.
Objectives: Stuttering prevalence and incidence can be measured in very diverse ways and such differences in methodologies may contribute to variability of the results. Moreover stuttering prevalence and incidence can be different according to factors such as gender and age. The current study tried to provide a comprehensive view on stuttering prevalence and incidence through meta-analysis of the research results. We also tried to determine whether stuttering prevalence and incidence would be different according to gender, age, and region. Methods: A total of four databases (two Korean and two English databases) were used in the current study for article search. A total of 27 articles (26 English, 1 Korean) met the inclusion/exclusion criteria and were analyzed in the current study. Results: Overall stuttering prevalence was about 1.5% and overall stuttering incidence was about 3.9%. There was a statistically significant difference in stuttering prevalence according to gender and age. Stuttering prevalence for males and preschoolers was almost twice as much as that of females and other age groups. However there was no significant difference in prevalence according to regions. Furthermore there was no significant difference in stuttering incidence according to gender. Conclusion: The meta-analysis results of the current study showed very similar, but still somewhat different stuttering prevalence and incidence compared to the commonly held belief. Such differences may be due to the typical characteristics of the studies analyzed in the current study. There may be future studies on more diverse factors that influence stuttering prevalence and incidence.
Stuttering, a condition affecting many individuals in society, is characterized by disruptions in the smooth flow of speech. It usually begins during childhood and involves involuntary repetitions, prolongations, blocks, avoidance, and accompanying behaviors while speaking. Identifying children at risk of stuttering enables intervention services during their early years when the chances for improvement are highest. A speech-language pathologist employs comprehensive procedures to evaluate a child's stuttering, including its accompanying behaviors and elements. This evaluation is typically extensive and includes interviews, analysis of case histories, and assessments of fluency, speech, language, and communication abilities. This article discusses the different formal tests which are incorporated in the assessment of stuttering.
There are currently no internationally standardized diagnostic criteria for the diagnosis of spasmodic dysphonia. In Japan, diagnostic criteria and severity classifications for spasmodic dysphonia were established in 2018. Currently, we are working on validation and revision of these diagnostic criteria. According to Japanese diagnostic criteria, stuttering is one of the diseases that should be differentiated from spasmodic dysphonia. In this paper, we review the literature on the speech symptoms and epidemiology of spasmodic dysphonia and stuttering, and summarize the key points in their differential diagnosis.
Background:
Stuttering is a childhood-onset fluency disorder. Part of the counseling for middle and high school students with persistent stuttering is related to school refusal. Anxiety disorders are known to contribute to school refusal. However, it is not known whether social anxiety disorder (SAD) is a factor in school refusal among adolescents who stutter.
Methods:
In our first study, we examined the relationship between school refusal and SAD in 84 middle and high school students who stutter; 26% of the 84 students were in the school refusal group and the remaining 74% were in the school attendance group. The second study examined whether SAD was associated with 10 factors related to speech and stuttering frequency using the Japanese version of the Liebowitz Social Anxiety Scale for Children and Adolescents to determine the presence of SAD. Of the 84 students in the first study, 40 participated in the second study.
Results:
The school refusal group of adolescents who stutter had significantly higher rates of SAD than the school attendance group. Fifty percent of adolescents who stutter met the criteria for SAD. Moreover, adolescents who stutter with SAD had significantly higher scores on the items "When speaking in public, do you experience tremors in your limbs?" and "After you stutter, do you have negative thoughts about yourself?" than the adolescents who stutter without SAD.
Conclusions:
When examining adolescents who stutter, checking for comorbid SAD may lead to better support. Moreover, noticing their repetitive negative thinking, nervousness, and trembling during speech may help to resolve SAD.
It has been reported that childhood-onset fluency disorder is a neurodevelopmental disorder that affects 5-11％ of preschool-age children; however, approximately 80％ of children recover several years after onset. A great deal of research has been carried out over the past few decades to identify factors that are related to the prognosis of stuttering. These include a family history of stuttering; gender; age of onset; the severity of stuttering; the child's abilities in articulation and phonology; concomitant disorders; and the child's temperament. The present article gives an overview of three recent studies examining which factors predict the persistence and recovery of stuttering in preschoolers. These are a research review, a meta-analysis study, and research on building statistical models. The results of these studies suggest the prognosis of stuttering to be influenced by powerful and crucial genetic and biological factors, such as a family history of stuttering and gender, and with additional factors such as the severity of stuttering and speech-language vulnerabilities. Based on these conclusions, we discuss which clinical characteristics should be assessed and in what form support should be provided to allow the most appropriate and effective treatment decisions to be made. The duration of follow-up the children and the criteria for recovery of stuttering are also suggested as potential areas of future research.
Developmental stuttering is a common speech disorder (studies estimate at least a 5% lifetime prevalence) characterized by prolongations, blocks, and repetitions of speech sounds. In approximately 75–80% of cases in early childhood, stuttering will resolve within a few years (referred to as ‘recovery’); the remaining cases will often experience stuttering into school-age years and adulthood (referred to as ‘persistence’). In adults, the prevalence of stuttering is substantially higher in men compared to women, at a ratio of 4:1 or greater (compared to between 1:1 and 2:1 in young children); this has typically been explained by differences in likelihood of recovery by sex. Heritability studies have established that a genetic component for stuttering exists, with heritability estimates as high as 84%. However, genetic factors impacting stuttering risk remain largely uncharacterized. To date, only two prior genome-wide association studies (GWAS) of developmental stuttering have been published, both of which included less than 10,000 cases. Here, we performed eight self-reported stuttering GWAS that were stratified by sex and ancestries. These analyses included more than 1 million individuals (99,776 cases and 1,023,243 controls) and identified 36 unique genome-wide significant loci. We validated the self-reported stuttering phenotype using polygenic risk scores from two independent stuttering datasets. We examined genetic correlation of our GWAS results with published GWAS for other previously identified comorbid traits and found strong evidence of correlation with hearing loss, daytime sleepiness, depression, and poorer beat synchronization. We also performed Mendelian randomization analyses which revealed distinct causal relationships in males and females for genetically associated traits. These distinct causal relationships motivate continued research into sex-specific phenotypic differences, with emphasis on recovery status. Additionally, a high proportion of genes impacting stuttering risk were found to be associated with neurological traits from the GWAS catalog, supporting a neurological basis for stuttering. Our findings provide the first well-powered insight into genetic factors underlying stuttering, representing a major step forward in our understanding of this condition.
This article describes the therapeutic work of SAS clinicians (Stärker als Stottern) with adolescents who stutter. Core symptoms and accompanying symptoms of stuttering provide the map for individual stuttering interventions: With the focus on empowerment, clinicians move from diagnostics to dynamic therapy goals to individually targeted treatment for stuttering behaviors.
Introduction:
Little is known about the clinical decision-making process that speech-language pathologists( (SLPs) make when they decide which treatment approach they will use with Preschool age Children who Stutter (PCWS). Frequently used approaches are the Lidcombe Program, RESTART-DCM, Mini-KIDS, the Palin Parent-Child Interaction program and the Social-Cognitive Behaviour Therapy. In this study, we explored which attributes play a role in the complex process that precedes this clinical decision. We also explored if SLPs from the Netherlands, who are expected to follow the recommendations formulated in the Dutch professional stuttering guidelines, use different treatment approaches than SLPs from Belgium, who do not have specific guidelines to follow. Finally, we explored whether the number of years of experience of SLPs had an impact on the choice for treatment.
Methods:
This study used an observational design in which 36 SLPs, additionally qualified in the treatment of stuttering, completed a questionnaire. The SLPs spoke Dutch, resided in the Netherlands or Belgium and used more than one treatment approach for PCWS in their standard practice.
Results:
The following attributes affected the choice for treatment approach of most SLPs: (1) the child's reactions to the stuttering, (2) the child's language (and speech) skills, (3) the child's age, (4) the family's lifestyle, (5) the parent's ease to understand a treatment approach as judged by the SLPs and (6) the amount and quality of published research-based evidence. The decision-making of experienced SLPs is significantly more affected by the child's stuttering severity and time since onset compared to less experienced SLPs (both U = 90, p = .05). Dutch SLPs did not take other attributes into account than Belgian SLPs.
Discussion/conclusion:
This study was a first attempt to explore which attributes affect the decision for a specific treatment. Further prospective research is needed.
Background
Information about genetic influence is useful to when counselling parents or caregivers who have infants and children at risk for stuttering. Yet, the most comprehensive family aggregate database to inform that counselling is nearly four decades old (Andrews et al., 1983). Consequently, the present study was designed to provide a contemporary exploration of the relationship between stuttering and family history.
Methods
Data were sourced from the [REMOVED DUE TO BLINDING], comprising 739 participants who presented for assessment, treatment, or investigation of stuttering. Reported family history data were acquired from pedigrees collected during assessment. We sought to establish the relation of the following variables to family history of stuttering: incidence, proband sex, parent sex, stuttering severity, age, reported age of stuttering onset, and impact of stuttering. Data were analyzed with chi-square tests for independence, logistic and linear regression models.
Results
Results were broadly consistent with existing data, but the following findings were novel. Males and females who stutter have the same increased odds of having a father who stutters relative to a mother who stutters. Males had later stuttering onset than females, with genetic involvement in this effect. There was a greater impact of stuttering for females than males with a family history of stuttering.
Conclusion
These findings have clinical applications. Speech-language pathologists may have infant or child clients known to them who are at risk of beginning to stutter. Information from the present study can be applied to counselling parents or caregivers of such children about stuttering and family history.
Purpose
This study aimed to predict special educational needs in children who stutter (CWS) using a screening test for three neurodevelopmental disorders (specific learning disorder [SLD], attention-deficit/hyperactivity disorder [ADHD], and autism spectrum disorder [ASD]). While most previous studies have been conducted by speech-language pathologists, this study was conducted in an educational setting. Additionally, we investigated correlations between children's scores in scales for assessing neurodevelopmental disorders and stuttering severity.
Method
Participants were 116 CWS (ages 6–12 years) from resource rooms for speech-language disorders in Japan. Speech-language teachers in resource rooms were asked to evaluate CWS and respond to the Learning Disabilities Inventory–Revised, ADHD Rating Scale, and Autism Spectrum Screening Questionnaire.
Results
We received 90 valid responses with no missing values. Among them, 32 (35.5%) children were judged as having difficulties related to SLD, ADHD, and ASD in school life. Among them, 23 (25.6%) were SLD suspected, 12 (13.3%) were ADHD suspected, and nine (10.0%) were ASD suspected. Difficulty in speaking, writing, math, and hyperactivity/impulsivity was significantly and positively correlated with stuttering severity. Moreover, in the group of CWS with suspected neurodevelopmental disorders, the distribution of scores related to SLD was skewed toward high scores.
Conclusions
CWS in this study showed higher rates of suspected SLD, ADHD, and ASD within a school setting compared with the rates for typically developing children surveyed in Japan in 2012 through another prior study. In addition, the effect of stuttering severity on academic skills is discussed.
Purpose
This systematic review identified and synthesized published research articles, written in Japanese, on the clinical effectiveness of a broad range of nonpharmacological interventions for school-age children who stutter.
Method
A systematic review of Japanese literature published between January 1, 1980, and July 7, 2020, reporting interventions for school-age children who stutter, was carried out through a search of two databases (CiNii Article database and Japan Medical Abstract Society database) using the key words “stuttering” and “school-age” or “child” or “primary school students” or “children” or “school child” in Japanese. To be included in the review, the articles must report studies where data were subjectively reported by clinicians, where school-age participants were treated for developmental stuttering, where participants received interventions conducted by clinicians, and where quantitative outcomes (pre- and/or posttreatment) were measured; and they must be published in Japanese.
Results
Forty articles met all the inclusion criteria. Most articles adopted a case series or single-case study design. A total of 179 intervention programs were identified from all the articles and broadly classified into speech therapy, psychological therapy, interventions for modifying the child's environment, and others.
Conclusions
Our systematic review provided a broad overview of the treatments used for school-age children who stutter in Japan. Future research should focus on gathering more reliable, systematic, and rigorous evidence to establish the effectiveness of stuttering treatments for school-age children and thereby develop evidence-based practices.
Despite a lifetime prevalence of at least 5%, developmental stuttering, characterized by prolongations, blocks, and repetitions of speech sounds, remains a largely idiopathic speech disorder. Family, twin, and segregation studies overwhelmingly support a strong genetic influence on stuttering risk; however, its complex mode of inheritance combined with thus-far underpowered genetic studies contribute to the challenge of identifying and reproducing genes implicated in developmental stuttering susceptibility. We conducted a trans-ancestry genome-wide association study and meta-analysis of developmental stuttering in two primary datasets: The International Stuttering Project comprising 1,345 clinically-ascertained cases from multiple global sites and 6,759 matched population controls from the biobank at Vanderbilt University Medical Center, and 785 self-reported stuttering cases and 7,572 controls ascertained from The National Longitudinal Study of Adolescent to Adult Health (Add Health). Meta-analysis of these genome-wide association studies identified a genome-wide significant signal for clinically reported developmental stuttering in the general population: a protective variant in the intronic or genic upstream region of SSUH2 (rs113284510, protective allele frequency = 7.49%, Z = -5.576, p = 2.46 x 10⁻⁸) that acts as an eQTL in esophagus-muscularis tissue by reducing its gene expression. In addition, we identified 15 loci reaching suggestive significance (p < 5 x 10⁻⁶). This foundational population-based genetic study of a common speech disorder reports the findings of a clinically-ascertained study of developmental stuttering and highlights the need for further research.
Purpose
This narrative systematic review in line with PRISMA guidelines aims to investigate the implementation quality of previously published group comparison clinical trials of stuttering interventions for children and adolescents (under age 18 years).
Methods
We searched for publications in the databases Eric, PsychInfo, PubMed and Web of Science using the search terms ‘stutt*’ or ‘stamm*’and ‘intervention’, ‘trial’ or ‘treatment’. We reviewed the implementation elements reported in studies and how these elements were used to report intervention outcomes.
Results
3,017 references published between 1974 to 2019 were identified. All references were screened for eligibility using predefined selection criteria resulting in 21 included studies. The implementation quality details reported varied between studies. Existing studies most commonly lacked details about the support system provided to SLPs administering the interventions and monitoring of treatment fidelity both in the clinical setting and in the home environment. Support systems for participant’s parents and treatment dosage were generally well reported. Dosage was the most common implementation quality element considered in analyses of treatment effect and within discussions of findings.
Conclusion
Findings highlight the need for future clinical trials of stuttering interventions to closely adhere to systematic guidelines for reporting implementation quality to ensure reliability of trial outcomes. A checklist for reporting clinical trials of non-pharmacological stuttering interventions is proposed.
In this prospective study, 26 of the 93 preschool children with a parental history of stuttering who began to stutter were compared at preonset and 1 year later with those of a matched group of 26 children who continued to be seen as nonstutterers. These two groups of at-risk children were compared in terms of the development of their articulatory and language skills and in terms of the communicative style and speaking behaviors of their mothers. At preonset, the children who started to stutter demonstrated a faster articulatory rate than those who remained fluent. One year later, however, this difference was no longer statistically significant. The two groups of children did not differ in their linguistic skills at either of these time periods. Moreover, the communicative style and speaking behaviors of the mothers of the children who later began to stutter did not differ from that of the mothers of children who did not either prior to or after the onset of stuttering. This suggests that these variables did not contribute to the onset of stuttering or to its course.
This study describes relationships between speech, language, and related behaviors exhibited during an initial diagnostic evaluation by 2-to 6-year-old children referred for evaluation of their speech and language development. These children were referred as a result of their parents' concerns that they might be at risk for stuttering. Subjects were 100 children (85 boys and 15 girls; mean age = 54.7 months; SD = 12.2 months) who appeared to be representative of the children that clinicians are likely to evaluate in a clinical setting. Analyses were based on a retrospective examination of detailed diagnostic records prepared during the diagnostic evaluations. Results indicated that children recommended for treatment exhibited significantly higher scores than children recommended for reevaluation or for neither treatment nor reevaluation on all measures of speech fluency except the duration of disfluencies (which approached, but did not reach, significance). Importantly, analyses also revealed significant behavioral overlaps between children in the three recommendation subgroups, suggesting that absolute referral criteria probably should not be used when making treatment recommendations. In addition, diagnostic testing revealed that a proportion of these children exhibited concomitant difficulties with language, phonology, or oral motor skills, suggesting that stuttering is not necessarily independent of other aspects of children's speech and language development. Based on the distribution of children's scores on a variety of measures in this relatively large database, benchmarks are presented that may provide clinicians with a means for comparing their own treatment recommendations to those made by others.
This investigation provides updated information on the onset of stuttering, explores variations in the onset, and studies possible relationship of stuttering onset to the factors of age, gender, familial history, severity, and stress. Data were obtained for 87 preschool children through parent interviews, using a standardized questionnaire. Interviews were conducted within 12 months after the disorder was first diagnosed. Results for selected items indicated that onset tended to occur at an earlier age than was previously thought and was sudden and/or severe in a substantial number of cases. Physical or emotional stress and familial histories of stuttering were reported for many of the participating children. A significant gender factor was found. About twice as many boys as girls stuttered and girls began stuttering at a significantly earlier age. There was a positive relationship between severe stuttering and sudden onset. Several other tendencies for relationship between factors were either weak or not significant for the present sample size. The findings are discussed with special reference to the possible relationship between stuttering onset and maturational processes and the possible contribution of data on onset to the differentiation of stutterers.
Objective data on the development of stuttering during its first several months are sparse. Such a deficit is due to parents' tendency to postpone professional consultation regarding early stuttering until later in the course of the disorder and to a lack of longitudinal studies beginning close to onset. This report presents information on a rare group of 16 preschool subjects who were evaluated within several weeks after stuttering onset and followed for 6 months using multiple measures. The findings show that often early stuttering takes on a moderate-to-severe form. Substantial changes occurred, however, during the 6 months of the study, with a strong tendency for reduction in stuttering-like disfluencies, number of head/face movements, clinician severity ratings of stuttering, and parent ratings of stuttering. Several subjects, including severe cases, exhibited complete recovery. The large changes that occur during the early stage of stuttering suggest that relatively small differences in the length of post-onset interval (stuttering history) can greatly influence all research data of early childhood stuttering. The high, as well as fast, improvement rate suggests that the precise timing of early intervention should be conscientiously evaluated in carefully controlled studies.
The incidence of stuttering has always been reported to be higher in males than in females. Possible causes of the unequal sex ratio include various ascertainment biases, incomplete reporting, social role differences, X-linked inheritance, or a combination of environmental and genetic elements. Each of these factors has been examined against data collected in the large family study of stuttering, and all but one have been eliminated. Only the gene-environment interaction hypothesis can be supported by the data. Statistical analysis confirms that the sex effect in stuttering is real and supports a threshold model for the sex difference. We conclude that the possibility of differences between males and females must be considered in any etiological research in stuttering.
Although past research has provided evidence of a genetic component to the transmission of susceptibility to stuttering, the relationship between the genetic component to stuttering and persistence and recovery in the disorder has remained unclear. In an attempt to characterize this relationship, the immediate and extended families of 66 stuttering children were investigated to determine frequencies of cases of persistent and recovered stuttering. Pedigree analysis and segregation analysis were used to examine patterns of transmission. The following questions were investigated:
1. Is there a sex effect in recovery from stuttering? Here, we sought to test the hypothesis that females are more likely to recover than males, leading to the change in sex ratio from approximately 2:1 males to females close to onset of the disorder, to 4 or 5:1 in adulthood.
2. Is persistence/recovery in stuttering transmitted in families? If recovery/persistence appears to be transmitted, (a) are recovered and persistent stuttering independent disorders?; (b) is recovery a genetically milder form of persistent stuttering?; or (c) is persistence/recovery transmitted independent of the primary susceptibility to stuttering?
Results indicated sharply different sex ratios of persistent versus recovered stutterers in that recovery among females is more frequent than among males. It was found that recovery or persistence is indeed transmitted, and further, that recovery does not appear to be a genetically milder form of stuttering, nor do the two types of stuttering appear to be genetically independent disorders. Data are most consistent with the hypothesis that persistent and recovered stuttering possess a common genetic etiology, and that persistence is, in part, due to additional genetic factors. Segregation analyses supported these conclusions and provided statistical evidence for both a single major locus and polygenic component for persistent and recovered stuttering.
Theorists have increasingly suggested that both speech-motor and linguistic factors are involved in the etiology of stuttering. This contention has been supported by findings that tend to indicate that youngsters who stutter have a slower speech rate and are less linguistically skilled than nonstutterers. However, no inferences can be drawn from these findings as to the nature or the causation of this disorder. This is because the aforementioned findings might be a result rather than a cause of the disorder. In order to clarify the directionality issue, a multi-year prospective study was undertaken that involved 93 preschool children with a parental history of stuttering.At the initial session, none of the high-risk children sampled was regarded as having a stuttering problem. One year later, 26 children were classified as stutterers. Statistical analyses revealed that prior to the onset of stuttering these children did not differ from the other youngsters studied with respect to either their receptive or expressive language abilities. However, their rate of articulation was significantly faster. The latter finding is taken to mean that the children who developed stuttering were not limited in speechmotor ability. Rather, their fluency failures are seen as a result of a relatively high articulation rate. It is noteworthy, in this regard, that the rate of the high-risk children who continued to be viewed as nonstutterers was slower than that previously reported for youngsters of their age. This suggests that the slower rate served as a buffer against fluency breakdown.
This investigation provides updated information on the onset of stuttering, explores variations in the onset, and studies possible relationship of stuttering onset to the factors of age, gender, familial history, severity, and stress. Data were obtained for 87 preschool children through parent interviews, using a standardized questionnaire. Interviews were conducted within 12 months after the disorder was first diagnosed. Results for selected items indicated that onset tended to occur at an earlier age than was previously thought and was sudden and/or severe in a substantial number of cases. Physical or emotional stress and familial histories of stuttering were reported for many of the participating children. A significant gender factor was found. About twice as many boys as girls stuttered and girls began stuttering at a significantly earlier age. There was a positive relationship between severe stuttering and sudden onset. Several other tendencies for relationship between factors were either weak or not significant for the present sample size. The findings are discussed with special reference to the possible relationship between stuttering onset and maturational processes and the possible contribution of data on onset to the differentiation of stutterers.
The objectives of this pilot study were to establish methods for longitudinal research of stuttering in children and to provide preliminary data on the variations that occur in disfluencies during the developmental course of stuttering. Twenty-seven preschool-aged children were followed for a minimum of 2 years shortly after they began stuttering. Tape-recorded speech samples were obtained from the children at several intervals during this period. The number of various types of disfluencies was counted in the speech samples obtained in each testing period. Twenty-one children continued to be followed for varying periods of up to 12 years. Eighteen of the 27 subjects received a few speech treatment sessions during the initial period of the study, whereas 9 children did not receive direct treatment. Results indicated that for the two subgroups there was a marked deceleration over time in the mean frequency of stuttering-like disfluencies. Individual subjects' data showed considerable variability in the longitudinal development of disfluency but most subjects followed the patterns of the group means. Much of the reduction took place during the early stage of the disorder, especially near the end of the first year post-onset. There were indications that group differences between chronic and recovering stutterers become distinct by approximately 20 months post-onset.
Data on the onset of stuttering in 22 children 2 and 3 years of age were obtained through systematic parent interviews using a coded questionnaire. All children were reported to have begun stuttering prior to 36 months of age. The results indicated more similar sex distribution and greater diversity in manner of onset than was reported in past investigations. Most parents perceived early stuttering to be associated with some degree of tensions and force. The length of syllable and word repetition as reported appeared to be above the average for normally disfluent children of similar ages. Directions for future research of early childhood stuttering and clinical implications of the data are discussed.
Objective data on the development of stuttering during its first several months are sparse. Such a deficit is due to parents' tendency to postpone professional consultation regarding early stuttering until later in the course of the disorder and to a lack of longitudinal studies beginning close to onset. This report presents information on a rare group of 16 preschool subjects who were evaluated within several weeks after stuttering onset and followed for 6 months using multiple measures. The findings show that often early stuttering takes on a moderate-to-severe form. Substantial changes occurred, however, during the 6 months of the study, with a strong tendency for reduction in stuttering-like disfluencies, number of head/face movements, clinician severity ratings of stuttering, and parent ratings of stuttering. Several subjects, including severe cases, exhibited complete recovery. The large changes that occur during the early stage of stuttering suggest that relatively small differences in the length of post-onset interval (stuttering history) can greatly influence all research data of early childhood stuttering. The high, as well as fast, improvement rate suggests that the precise timing of early intervention should be conscientiously evaluated in carefully controlled studies.
The divergent developmental course of stuttering with its two major paths, persistency and spontaneous (unaided) recovery, has been a focus of scientific attention because of its critical theoretical, research, and clinical perspectives. Issues concerning factors underlying persistency and recovery and their implications for early intervention have stirred considerable controversy among scientists. In light of the intense interest, the scarcity of direct essential epidemiological data concerning the magnitude of the two paths and the timing of recovery is problematic. Most past studies have used retrospective methodologies. The few longitudinal studies have been severely limited in scope or objective data. The purpose of the investigation reported herein is to study the pathognomonic course of stuttering during its first several years in early childhood with special reference to the occurrence of persistent and spontaneously recovered forms of the disorder. Employing longitudinal methodology with thorough, frequent periodic follow-up observations, multiple testing, and recording of extensive speech samples, 147 preschool children who stutter have been closely followed for several years from near the onset of stuttering. In this, the first of three related articles, we present findings regarding the current stuttering status of 84 of these children, who have been followed for a minimum of 4 years after their onset of stuttering. The data indicate continuous diminution in the frequency and severity of stuttering over time as many children progressed toward recovery. Our findings lead to conservative estimates of 74% overall recovery and 26% persistency rates. The process of reaching complete recovery varied in length among the children and was distributed over a period of 4 years after onset. Detailed analyses of phonological and language skills pertaining to differentiation of the developmental paths of children who persist and those who recover are presented in the two other articles in the series (E. P. Paden et al., 1999, and R. V. Watkins et al., 1999).
Additionally, boys tended to have later onset than girls, an appreciable number of children had sudden onset, onset was frequently associated with The genetic basis of persistence and recovery in stuttering
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