A study of respiratory sinus arrhythmia and stuttering persistence.

INTRODUCTION: The present study investigated potential differences in respiratory sinus arrhythmia between preschool-age children with persisting stuttering, children who recovered from stuttering, and children who do not stutter. METHODS: Participants were 10 children with persisting stuttering (persisting group), 20 children who recovered from stuttering (recovered group), and 36 children who do not stutter (non-stuttering group). Participants viewed a neutral video clip to establish a pre-arousal baseline and then viewed two emotionally-arousing video clips (positive and negative, counterbalanced). Age-appropriate speaking tasks followed each of the video clips (post-baseline, post-positive, and post-negative). Respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system activity, was measured during the video clips and subsequent speaking tasks. RESULTS: First, the persisting group, recovered group, and non-stuttering group did not significantly differ in baseline RSA. Second, during the emotionally-arousing video clips, there was a significant group x condition interaction, with the recovered group exhibiting significantly lower RSA in the positive than negative condition, and the non-stuttering group exhibiting significantly higher RSA in the positive than negative condition. Third, in the narrative tasks, there was a significant group x condition interaction, with a greater difference in RSA between the post-baseline speaking task and the post-positive and post-negative speaking tasks for the persisting compared to the non-stuttering group. Lastly, a follow-up analysis indicated that the recovered and nonstuttering groups, compared to the persisting group, exhibited significantly greater RSA during the baseline (neutral) condition compared to the post-neutral narrative task. CONCLUSIONS: Findings provide a physiological perspective of emotion within children who stutter and persist and children who stutter and recover. Future investigations with larger sample sizes and diverse methodologies are necessary to provide novel insights on the specific emotion-related processes that are potentially involved with persistence of stuttering in young children.

A Preliminary Study of Speech Rhythm Differences as Markers of Stuttering Persistence in Preschool-Age Children.

PURPOSE: The purpose of this study was twofold: (a) to determine whether there are speech rhythm differences between preschool-age children who stutter that were eventually diagnosed as persisting (CWS-Per) or recovered (CWS-Rec) and children who do not stutter (CWNS), using empirical spectral analysis and empirical mode decomposition of the speech amplitude envelope, and (b) to determine whether speech rhythm characteristics close to onset are predictive of later persistence. METHOD: Fifty children (3-4 years of age) participated in the study. Approximately 2-2.5 years after the experimental testing took place, children were assigned to the following groups: CWS-Per (nine boys, one girl), CWS-Rec (18 boys, two girls), and CWNS (18 boys, two girls). All children produced a narrative based on a text-free storybook. From the audio recordings of these narratives, fluent utterances were selected for each child from which seven envelope-based measures were extracted. Group-based differences on each measure as well as predictive analyses were conducted to identify measures that discriminate CWS-Per versus CWS-Rec. RESULTS: CWS-Per were found to have a relatively higher degree of power in suprasyllabic oscillations and greater variability in the timing of syllabic rhythms especially for longer utterances. A logistic regression model using two speech rhythm measures was able to discriminate the eventual outcome of recovery versus persistence, with 80% sensitivity and 75% specificity. CONCLUSION: Findings suggest that envelope-based speech rhythm measures are a promising approach to assess speech rhythm differences in developmental stuttering, and its potential for identification of children at risk of developing persistent stuttering should be investigated further.

A parent-report scale of behavioral inhibition: Validation and application to preschool-age children who do and do not stutter.

PURPOSE: This two-part (i.e., Study 1, Study 2) study investigated behavioral inhibition (BI) in preschool-age children who do (CWS) and do not (CWNS) stutter. The purpose of Study 1 was to develop the Short Behavioral Inhibition Scale (SBIS), a parent-report scale of BI. The purpose of Study 2 was to determine, based on the SBIS, differences in BI between CWS and CWNS, and associations between BI and CWS's stuttering frequency, stuttering severity, speech-associated attitudes, and stuttering-related consequences/reactions. METHOD: Participants in Study 1 were 225 CWS and 243 CWNS with the majority of them being included in Study 2. In Study 2, a speech sample was obtained for the calculation of stuttering frequency and severity, and the parents of a subset of CWS completed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007), and the Test of Childhood Stuttering Disfluency-Related Consequences Rating Scale (Gillam, Logan, & Pearson, 2009). RESULTS: Study 1 analyses indicated that SBIS is a valid and reliable tool whose items assess a single, relatively homogeneous construct. In Study 2, CWS exhibited greater mean and extreme BI tendencies than CWNS. Also CWS with higher, compared to CWS with lower, BI presented with greater stuttering frequency, more severe stuttering, greater stuttering-related consequences, and more negative communication attitudes (for CWS older than 4 years of age). CONCLUSION: Findings were taken to suggest that BI is associated with early childhood stuttering and that the SBIS could be included as part of a comprehensive evaluation of stuttering.

Attention, Speech-Language Dissociations, and Stuttering Chronicity.

The purpose of this study was to investigate the singular and joint contributions of speech-language dissociations and attention (i.e., distractibility and attention span) to stuttering chronicity. Method Participants, aged 3;0-4;11 (years;months) at an initial visit, were classified as persisting (n = 10; 9 boys), recovered (n = 32; 23 boys), and nonstuttering (n = 28; 19 boys) based on multiple speech and language evaluations spread across 2 years. The evaluations included assessments of articulation, receptive and expressive vocabulary, and omnibus receptive and expressive language. These measures were used to identify speech-language dissociations using a correlation-based statistical approach. Attentional characteristics, which included measures of distractibility and attention span, were based on parent report. Analyses investigated between-group differences related to dissociations and attentional characteristics as well as the relation between these indices. Results There were no significant between-group differences for the persisting and recovered groups on measures of speech-language dissociations; however, the recovered group was found to exhibit less optimal attention span than the persisting group. In addition, children with dissociations exhibited less optimal distractibility and attention spans at the final time point than children without dissociations. Conclusions Present results indicate that attention is related to both stuttering chronicity and the presence of speech-language dissociations; however, they do not support the notion that dissociations are associated with stuttering persistence. These results provide novel insights into the complex nature of the association between developmental stuttering, speech-language dissociations, and attention.

Is what I think I think really what I think? Implicit and explicit attitudes toward stuttering among practicing speech-language pathologists.

PURPOSE: Two studies assessed implicit (Study 1) and explicit (Study 2) attitudes toward stuttering and those who stutter among speech-language pathologists (SLPs). METHOD: In Study 1, 15 SLPs completed the Stuttering Implicit Association Test, a measure of implicit attitudes toward stuttered speech. In Study 2, 40 SLPs provided explicit attitudes about individuals who stutter, assessed via self-report ratings of an adult who stutters and one who does not. Participants also completed measures of experience with stuttering. RESULTS: As a group, clinicians displayed negative implicit attitudes toward stuttering. Explicit attitudes toward a person who stutters were positive, albeit less positive than attitudes toward a person who does not stutter. Amount of prior exposure to stuttering among these experienced SLPs was not significantly associated with either implicit or explicit attitudes. CONCLUSIONS: These findings highlight the importance of evaluating both implicit and explicit attitudes toward stuttering. The finding of positive explicit attitudes but negative implicit attitudes among similar samples of SLPs underscores the need to study implicit attitudes toward stuttering. Considering only explicit attitudes could lead to incomplete conclusions about the complex nature of attitudes toward stuttering.

Differences in the relation between temperament and vocabulary based on children's stuttering trajectories.

PURPOSE: The purpose of this study was to assess the relation between temperament and vocabulary development for children who stutter and persist, children who stutter and recover and children who do not stutter. METHODS: Participants, aged 3;0-4;11 at the start of the study, were followed for two years. They were classified as persisting (n = 10), recovered (n = 26), and non-stuttering (n = 24) based on multiple assessments of stuttering spaced across study participation. Groups were balanced for age and gender ratios. At each visit, participants completed the Peabody Picture Vocabulary Test, 4th edition, and the Expressive Vocabulary Test, 2nd edition; caregivers completed the Children's Behavior Questionnaire. RESULTS: For both persisting and recovered groups, higher negative emotionality was associated with lower receptive vocabulary. These associations were both significantly more negative than the non-stuttering group's association. CONCLUSION: These findings suggest that receptive vocabulary development is differentially linked to temperament based on a child's stuttering status. As others have speculated (Conture & Walden, 2012), it appears as though there are salient associations between temperament, speech-language development, and childhood stuttering.

Examining implicit and explicit attitudes toward stuttering.

PURPOSE: This study assessed implicit and explicit attitudes toward people who stutter among typically-fluent young adults. METHOD: Participants completed an Implicit Association Test, a measure of implicit attitudes, to assess the strength of association between stuttered vs. fluent speech and positive vs. negative evaluative words. Participants also completed self-report ratings of their attitudes toward people who do and do not stutter (explicit attitude scales). In addition, participants completed measures of social desirability and a survey that assessed lifetime experience with people who stutter. RESULTS: Results supported the existence of a negative stuttering stereotype. Participants demonstrated negative implicit and explicit attitudes toward people who stutter. Explicit attitudes toward those who stutter, but not implicit attitudes, were significantly predicted by social desirability scores. Familiarity with stuttering was significantly associated with implicit but not explicit attitudes toward stuttering. CONCLUSIONS: These findings indicate the importance of examining both implicit and explicit attitudes toward stuttering to fully understand the challenges faced by those who stutter.

Cortical associates of emotional reactivity and regulation in childhood stuttering.

PURPOSE: This study sought to determine the cortical associates of emotional reactivity and emotion regulation (as indexed by the amplitude of evoked response potentials [ERP]) in young children who do and do not stutter during passive viewing of pleasant, unpleasant and neutral pictures. METHOD: Participants were 17 young children who stutter and 22 young children who do not stutter (between 4 years 0 months to 6 years 11 months). The dependent measures were (1) mean amplitude of late positive potential (LPP, an ERP sensitive to emotional stimuli) during passive (i.e., no response required) picture viewing and directed reappraisal tasks and (2) emotional reactivity and regulation related scores on caregiver reports of young children's temperament (Children's Behavior Questionnaire, CBQ). RESULTS: Young CWS, when compared to CWNS, exhibited significantly greater LPP amplitudes when viewing unpleasant pictures, but no significant between-group difference when viewing pleasant pictures and during the emotion regulation condition. There were, however, for CWS, but not CWNS, significant correlations between temperament-related measures of emotion and cortical measures of emotional reactivity and regulation. CONCLUSIONS: Findings provide further empirical support for the notion that emotional processes are associated with childhood stuttering, and that CWS's inherent temperamental proclivities need to be taken into account when empirically studying or theorizing about this association.

The effect of emotion on articulation rate in persistence and recovery of childhood stuttering.

PURPOSE: This study investigated the possible association of emotional processes and articulation rate in pre-school age children who stutter and persist (persisting), children who stutter and recover (recovered) and children who do not stutter (nonstuttering). METHODS: The participants were ten persisting, ten recovered, and ten nonstuttering children between the ages of 3-5 years; who were classified as persisting, recovered, or nonstuttering approximately 2-2.5 years after the experimental testing took place. The children were exposed to three emotionally-arousing video clips (baseline, positive and negative) and produced a narrative based on a text-free storybook following each video clip. From the audio-recordings of these narratives, individual utterances were transcribed and articulation rates were calculated. RESULTS: Results indicated that persisting children exhibited significantly slower articulation rates following the negative emotion condition, unlike recovered and nonstuttering children whose articulation rates were not affected by either of the two emotion-inducing conditions. Moreover, all stuttering children displayed faster rates during fluent compared to stuttered speech; however, the recovered children were significantly faster than the persisting children during fluent speech. CONCLUSION: Negative emotion plays a detrimental role on the speech-motor control processes of children who persist, whereas children who eventually recover seem to exhibit a relatively more stable and mature speech-motor system. This suggests that complex interactions between speech-motor and emotional processes are at play in stuttering recovery and persistency; and articulation rates following negative emotion or during stuttered versus fluent speech might be considered as potential factors to prospectively predict persistence and recovery from stuttering.

Sympathetic arousal as a marker of chronicity in childhood stuttering.

PURPOSE: This study investigated whether sympathetic activity during a stressful speaking task was an early marker for stuttering chronicity. METHOD: Participants were 9 children with persisting stuttering, 23 children who recovered, and 17 children who do not stutter. Participants performed a stress-inducing picture-naming task and skin conductance was measured across three time points. RESULTS: Findings indicated that at the initial time point, children with persisting stuttering exhibited higher sympathetic arousal during the stressful speaking task than children whose stuttering recovered. CONCLUSIONS: Findings are taken to suggest that sympathetic activity may be an early marker of heightened risk for chronic stuttering.

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

PURPOSE: The purpose of the present study was to determine whether the Test of Childhood Stuttering observational rating scales (TOCS; Gillam et al., 2009) (1) differed between parents who did versus did not express concern (independent from the TOCS) about their child's speech fluency; (2) correlated with children's frequency of stuttering measured during a child-examiner conversation; and (3) correlated with the length and complexity of children's utterances, as indexed by mean length of utterance (MLU). METHOD: Participants were 183 young children ages 3:0-5:11. Ninety-one had parents who reported concern about their child's stuttering (65 boys, 26 girls) and 92 had parents who reported no such concern (50 boys, 42 girls). Participants' conversational speech during a child-examiner conversation was analyzed for (a) frequency of occurrence of stuttered and non-stuttered disfluencies, and (b) MLU. Besides expressing concern or lack thereof about their child's speech fluency, parents completed the TOCS observational rating scales documenting how often they observe different disfluency types in speech of their children, as well as disfluency-related consequences. RESULTS: There were three main findings. First, parents who expressed concern (independently from the TOCS) about their child's stuttering reported significantly higher scores on the TOCS Speech Fluency and Disfluency-Related Consequences rating scales. Second, children whose parents rated them higher on the TOCS Speech Fluency rating scale produced more stuttered disfluencies during a child-examiner conversation. Third, children with higher scores on the TOCS Disfluency-Related Consequences rating scale had shorter MLU during child-examiner conversation, across age and level of language ability. CONCLUSIONS: Findings support the use of the TOCS observational rating scales as one documentable, objective means to determine parental perception of and concern about their child's stuttering. Findings also support the notion that parents are reasonably accurate, if not reliable, judges of the quantity and quality (i.e., stuttered vs. non-stuttered) of their child's speech disfluencies. Lastly, findings that some children may decrease their verbal output in attempts to minimize instances of stuttering - as indexed by relatively low MLU and a high TOCS Disfluency-Related Consequences scores - provides strong support for sampling young children's speech and language across various situations to obtain the most representative index possible of the child's MLU and associated instances of stuttering.

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

PURPOSE: The purpose of this study was to determine whether young children who do (CWS) and do not stutter (CWNS) with a positive versus negative family history of stuttering differ in articulation, language and attentional abilities and family histories of articulation, language and attention related disorders. METHOD: Participants were 25 young CWS and 50 young CWNS. All 75 participants' caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points that were about 8 months apart for a total of approximately 16 months. Each participant's family history focused on the same, relatively limited number of generations (i.e., participants' parents & siblings). Children's family history of stuttering as well as articulation, language, and attention related disorders was obtained from one or two caregivers during an extensive interview. Children's speech and language abilities were measured using four standardized articulation and language tests and their attentional abilities were measured using caregiver reports of temperament. RESULTS: Findings indicated that (1) most caregivers (81.5% or 75 out 92) were consistent in their reporting of positive or negative history of stuttering; (2) CWNS with a positive family history of stuttering, compared to those with a negative family history of stuttering, were more likely to have reported a positive family history of attention deficit/hyperactivity disorder (ADHD), and (3) CWNS with a positive family history of stuttering had lower language scores than those with a negative family history of stuttering. However, there were no such significant differences in family histories of ADHD and language scores for CWS with a positive versus negative family history of stuttering. In addition, although 24% of CWS versus 12% of CWNS's caregivers reported a positive family history of stuttering, inferential analyses indicated no significant differences between CWS and CWNS in relative proportions of family histories of stuttering. CONCLUSION: Finding that a relatively high proportion (i.e., 81.5%) of caregivers consistently reported a positive or negative family history of stuttering across three consecutive time points should provide some degree of assurance to those who collect such caregiver reports. Based on such consistent caregiver reports, linguistic as well as attentional vulnerabilities appear associated with a positive family history of stuttering, a finding that must await further empirical study for confirmation or refutation.

Executive Functions Impact the Relation Between Respiratory Sinus Arrhythmia and Frequency of Stuttering in Young Children Who Do and Do Not Stutter.

Purpose: This study sought to determine whether respiratory sinus arrhythmia (RSA) and executive functions are associated with stuttered speech disfluencies of young children who do (CWS) and do not stutter (CWNS). Method: Thirty-six young CWS and 36 CWNS were exposed to neutral, negative, and positive emotion-inducing video clips, followed by their participation in speaking tasks. During the neutral video, we measured baseline RSA, a physiological index of emotion regulation, and during video viewing and speaking, we measured RSA change from baseline, a physiological index of regulatory responses during challenge. Participants' caregivers completed the Children's Behavior Questionnaire from which a composite score of the inhibitory control and attentional focusing subscales served to index executive functioning. Results: For both CWS and CWNS, greater decrease of RSA during both video viewing and speaking was associated with more stuttering. During speaking, CWS with lower executive functioning exhibited a negative association between RSA change and stuttering; conversely, CWNS with higher executive functioning exhibited a negative association between RSA change and stuttering. Conclusion: Findings suggest that decreased RSA during video viewing and speaking is associated with increased stuttering and young CWS differ from CWNS in terms of how their executive functions moderate the relation between RSA change and stuttered disfluencies.

Emotional Diathesis, Emotional Stress, and Childhood Stuttering.

PURPOSE: The purpose of this study was to determine (a) whether emotional reactivity and emotional stress of children who stutter (CWS) are associated with their stuttering frequency, (b) when the relationship between emotional reactivity and stuttering frequency is more likely to exist, and (c) how these associations are mediated by a 3rd variable (e.g., sympathetic arousal). METHOD: Participants were 47 young CWS (M age = 50.69 months, SD = 10.34). Measurement of participants' emotional reactivity was based on parental report, and emotional stress was engendered by viewing baseline, positive, and negative emotion-inducing video clips, with stuttered disfluencies and sympathetic arousal (indexed by tonic skin conductance level) measured during a narrative after viewing each of the various video clips. RESULTS: CWS's positive emotional reactivity was positively associated with percentage of their stuttered disfluencies regardless of emotional stress condition. CWS's negative emotional reactivity was more positively correlated with percentage of stuttered disfluencies during a narrative after a positive, compared with baseline, emotional stress condition. CWS's sympathetic arousal did not appear to mediate the effect of emotional reactivity, emotional stress condition, and their interaction on percentage of stuttered disfluencies, at least during this experimental narrative task following emotion-inducing video clips. CONCLUSIONS: Results were taken to suggest an association between young CWS's positive emotional reactivity and stuttering, with negative reactivity seemingly more associated with these children's stuttering during positive emotional stress (a stress condition possibly associated with lesser degrees of emotion regulation). Such findings seem to support the notion that emotional processes warrant inclusion in any truly comprehensive account of childhood stuttering.

Sympathetic arousal of young children who stutter during a stressful picture naming task.

PURPOSE: The purpose of the current study was to investigate sympathetic arousal of young children who do and do not stutter during a stressful picture-naming task under instructions to name pictures as rapidly as possible. METHOD: Thirty-seven young children who stutter (CWS) and 39 young children who do not stutter (CWNS) served as participants. Dependent measures consisted of tonic skin conductance during a pretask baseline, a stress-inducing rapid picture-naming task, and post-picture-naming task condition. RESULTS: Findings indicated that, when chronological age was not taken into account, there was no between-group difference in tonic skin conductance level. When age was taken into account, however, there was a significant talker group×age group interaction, with follow-up analyses indicating that 3-year-old CWS exhibited significantly higher sympathetic arousal than their CWNS peers, and their 4-year-old CWNS peers. CONCLUSIONS: Findings were taken to be consistent with non-physiological results indicating an association between emotional processes and childhood stuttering. This association, at least for this cross-sectional study of tonic skin conductance level (SCL) during a picture-naming task, was moderated by children's chronological age. Such developmental differences may be associated with various processes, for example, attention, cognition, or physiology, or some combination of two or more of these processes. Future empirical study of these processes in young CWS and CWNS may profit from longitudinal measurement of converging lines of evidence from behavioral, parent and psychophysiological indexes of emotional reactivity and regulation. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (a) discuss salient findings in the literature regarding the association between emotional processes and childhood stuttering; (b) discuss sympathetic arousal, and how skin conductance is used to measure it; and (c) discuss the role of chronological age in the association between emotion and stuttering in young children.

Speech-Language Dissociations, Distractibility, and Childhood Stuttering.

PURPOSE: This study investigated the relation among speech-language dissociations, attentional distractibility, and childhood stuttering. METHOD: Participants were 82 preschool-age children who stutter (CWS) and 120 who do not stutter (CWNS). Correlation-based statistics (Bates, Appelbaum, Salcedo, Saygin, & Pizzamiglio, 2003) identified dissociations across 5 norm-based speech-language subtests. The Behavioral Style Questionnaire Distractibility subscale measured attentional distractibility. Analyses addressed (a) between-groups differences in the number of children exhibiting speech-language dissociations; (b) between-groups distractibility differences; (c) the relation between distractibility and speech-language dissociations; and (d) whether interactions between distractibility and dissociations predicted the frequency of total, stuttered, and nonstuttered disfluencies. RESULTS: More preschool-age CWS exhibited speech-language dissociations compared with CWNS, and more boys exhibited dissociations compared with girls. In addition, male CWS were less distractible than female CWS and female CWNS. For CWS, but not CWNS, less distractibility (i.e., greater attention) was associated with more speech-language dissociations. Last, interactions between distractibility and dissociations did not predict speech disfluencies in CWS or CWNS. CONCLUSIONS: The present findings suggest that for preschool-age CWS, attentional processes are associated with speech-language dissociations. Future investigations are warranted to better understand the directionality of effect of this association (e.g., inefficient attentional processes → speech-language dissociations vs. inefficient attentional processes ← speech-language dissociations).

Expressive Language Intratest Scatter of Preschool-Age Children Who Stutter.

PURPOSE: The purpose of this study was to assess intratest scatter (variability) on standardized tests of expressive language by preschool-age children who do (CWS) and do not stutter (CWNS). METHOD: Participants were 40 preschool-age CWS and 46 CWNS. Between-group comparisons of intratest scatter were made based on participant responses to the Expressive subtest of the Test of Early Language Development - 3 (TELD-Exp; Hresko, Reid, & Hamill, 1999) and the Expressive Vocabulary Test 2 (EVT-2; Williams, 2007). Within-group correlational analyses between intratest scatter and stuttering frequency and severity were also conducted for CWS. RESULTS: Findings indicated that, for CWS, categorical scatter on the EVT-2 was positively correlated with their stuttering frequency. No significant between-group differences in intratest scatter were found on the TELD-Exp or the EVT-2. CONCLUSIONS: Consistent with earlier findings, variability in speech-language performance appears to be related to CWS' stuttering, a finding taken to suggest an underlying cognitive-linguistic variable (e.g., cognitive load) may be common to both variables.

Autonomic nervous system activity of preschool-age children who stutter.

PURPOSE: The purpose of this study was to investigate potential differences in autonomic nervous system (ANS) activity to emotional stimuli between preschool-age children who do (CWS) and do not stutter (CWNS). METHODS: Participants were 20 preschool-age CWS (15 male) and 21 preschool-age CWNS (11 male). Participants were exposed to two emotion-inducing video clips (negative and positive) with neutral clips used to establish pre-and post-arousal baselines, and followed by age-appropriate speaking tasks. Respiratory sinus arrhythmia (RSA)-often used as an index of parasympathetic activity-and skin conductance level (SCL)-often used as an index of sympathetic activity-were measured while participants listened to/watched the audio-video clip presentation and performed a speaking task. RESULTS: CWS, compared to CWNS, displayed lower amplitude RSA at baseline and higher SCL during a speaking task following the positive, compared to the negative, condition. During speaking, only CWS had a significant positive relation between RSA and SCL. CONCLUSION: Present findings suggest that preschool-age CWS, when compared to their normally fluent peers, have a physiological state that is characterized by a greater vulnerability to emotional reactivity (i.e., lower RSA indexing less parasympathetic tone) and a greater mobilization of resources in support of emotional reactivity (i.e., higher SCL indexing more sympathetic activity) during positive conditions. Thus, while reducing stuttering to a pure physiological process is unwarranted, the present findings suggest that the autonomic nervous system is involved. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) summarize current empirical evidence on the role of emotion in childhood stuttering; (b) describe physiological indexes of sympathetic and parasympathetic activity; (c) summarize how preschool-age children who stutter differ from preschool-age children who do not stutter in autonomic activity; (d) discuss possible implications of current findings in relation to the development of childhood stuttering.

Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter.

PURPOSE: The purpose of this study was to assess the relation between emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter (CWS) and those who do not (CWNS). PARTICIPANTS: Participants were eight 3 to 6-year old CWS and eight CWNS of comparable age and gender. METHODS: Participants were exposed to three emotion-inducing overheard conversations--neutral, angry and happy--and produced a narrative following each overheard conversation. From audio-video recordings of these narratives, coded behavioral analysis of participants' negative and positive affect and emotion regulation associated with stuttered and fluent utterances was conducted. RESULTS: Results indicated that CWS were significantly more likely to exhibit emotion regulation attempts prior to and during their fluent utterances following the happy as compared to the negative condition, whereas CWNS displayed the opposite pattern. Within-group assessment indicated that CWS were significantly more likely to display negative emotion prior to and during their stuttered than fluent utterances, particularly following the positive overheard conversation. CONCLUSIONS: After exposure to emotional-inducing overheard conversations, changes in preschool-age CWS's emotion and emotion regulatory attempts were associated with the fluency of their utterances. LEARNING OUTCOMES: After reading this article, the reader will be able to: (1) describe various measures of emotional reactivity and regulation, including parent-based reports and behavioral coding, and how they may contribute to childhood stuttering; (2) explain emotional differences between the stuttered and fluent utterances of CWS and CWNS; and (3) discuss how emotions may contribute to CWS' instances of stuttering.

Speech disfluencies of preschool-age children who do and do not stutter.

PURPOSE: The goals of the present study were to investigate whether (1) the speech disfluencies of preschool-age children are normally distributed; (2) preschool-age children who do (CWS) and do not stutter (CWNS) differ in terms of non-stuttered disfluencies; (3) age, gender, and speech-language ability affect the number and type of disfluencies children produce; and (4) parents' expressed concern that their child stutters is associated with examiners' judgments of stuttered disfluency. METHOD: Four hundred and seventy two children participated, of which 228 were CWS (56 girls), and 244 CWNS (119 girls). Participants provided conversational speech samples that were analyzed for frequency of occurrence of (a) stuttered disfluencies, (b) non-stuttered disfluencies, and (c) total disfluencies. RESULTS: Results indicated that the underlying distributions of preschool-age children's stuttered and non-stuttered disfluency counts followed a negative binomial distribution (i.e., were not normal), with more children "piling up" at the low end [none or few disfluencies] and fewer children scoring in the upper [more severe stuttering] end of the distribution. Findings also indicated that non-stuttered disfluencies significantly predicted CWS/CWNS talker group classification, information that may be helpful to augment, but not supplant, talker group classification criteria based on stuttered disfluencies. Moreover, expressed parental concern about stuttering was strongly associated with frequency of stuttered disfluencies. CONCLUSION: Findings suggest that the entirety of preschool-age CWS' speech disfluencies - non-stuttered as well as stuttered - differs from that of their CWNS peers and that because these disfluencies are not normally distributed statistical analyses assuming normality of distribution are not the most appropriate means to assess these differences. In addition, certain "third-order" variables (e.g., gender) appear to impact frequency of children's disfluencies and expressed parental concerns about stuttering are meaningfully related to examiners' judgments of stuttered disfluencies. LEARNING OUTCOMES: The reader will recognize differences in speech disfluencies of preschool-age children who do and do not stutter. The reader will recognize whether age, gender and speech-language ability affect the number and type of disfluencies children produce. The reader will describe whether parental concern about stuttering is associated with examiners' judgments of stuttering.