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

Highlights

• Emotions of children who do (CWS) and do not (CWNS) were compared.

• During fluent utterances, regulation differed between-groups as a function of condition.

• Emotions of CWS were compared between fluent and stuttered utterances.

• For CWS, negative emotion is significantly more likely prior and during stuttered utterances, particularly following positive conditions.

• Emotion of CWS was associated with stuttered and fluent utterances.

Abstract

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.

Introduction

Attention has recently been paid to emotional factors in childhood stuttering, specifically focusing on characteristics such as emotional reactivity and regulation (e.g., Anderson, Pellowski, Conture, & Kelly, 2003; Conture, Kelly, & Walden, 2013; Choi, Conture, Walden, Lambert, & Tumanova, 2013; Eggers, De Nil, & Van den Bergh, 2010; Eggers, De Nil, & Van den Bergh, 2012; Eggers, De Nil, & Van den Bergh, 2013; Johnson, Conture, & Walden, 2010; Kefalianos, Onslow, Block, Menzies, & Reilly, 2012; Ntourou, Conture, & Walden, 2013; Schwenk, Conture, & Walden, 2007). Although results of these empirical studies as well as related speculation have not clarified all salient aspects of the association of emotion and childhood stuttering, they have provided evidence to support the continued investigation of this association.

Anderson et al. (2003) reported that children who stutter (CWS), when compared to children who do not stutter (CWNS), were more likely to exhibit temperamental profiles consistent with vigilance, nonadaptability to change, and irregular biological functions based on parental completion of the Behavioral Style Questionnaire (BSQ; McDevitt & Carey, 1978). Likewise, Eggers et al. (2010) reported that CWS, when compared to CWNS, exhibited significantly lower inhibitory control and attention shifting, as well as significantly higher anger/frustration, approach and motor activation, based on parent completion of the Dutch version of the Children's Behavior Questionnaire (CBQ-D; Van den Bergh & Ackx, 2003).

Based on three groups of items (i.e., items related to emotional reactivity, emotional regulation and attention regulation) from the BSQ, Karrass et al. (2006) reported that preschool-age CWS, when compared to their CWNS peers, were significantly more reactive, displayed greater difficulty regulating emotions, and had poorer attention regulation. Similarly, Felsenfeld, van Beijsterveldt, and Boomsma (2010) reported that probable stuttering and highly nonfluent children, when compared to typically fluent children, received more problematic scores on parent-based questionnaire ratings of attention, with attention often suggested to be a strategy to regulate emotion (e.g., Rothbart, Ahadi, & Evans, 2000). Taken together, the above empirical findings suggest that certain aspects of emotionality differentiate CWS and CWNS, and these differences may be associated with the difficulties CWS have establishing normally fluent speech.

Results from the aforementioned studies are promising and provide a substantive objective component in the assessment of children's temperamental characteristics (Henderson and Wachs, 2007, Wachs and Bates, 2001); however, it should be noted that these studies address only part of the emotional picture (Campos, Frankel, & Camras, 2004). For example, caregiver reports that are based on relatively long epochs of observation provide insights into more stable, trait-like aspects of emotion (i.e., temperament; Rothbart, Ahadi, Hershey, & Fisher, 2001), whereas behavioral observation provides information on more state-like, variable and dynamically changing aspects of emotion (Cole, Martin, & Dennis, 2004). Therefore, caregiver reports are best considered part of a comprehensive, multi-method means to study emotions in young children (see Campbell & Fiske, 1959 for further discussion of convergent lines of evidence). The use of additional methodological approaches to study emotion augment caregiver reports and address salient realities of childhood stuttering, for example, that stuttering varies considerably within and between situations, conversations, etc.

As an example of a methodological alternative to caregiver reports, Schwenk et al. (2007) used coded behavioral observations to compare the ability of preschool-age CWS and CWNS to maintain attention to a task and ignore irrelevant background stimuli. They reported that CWS were significantly more likely to redirect attention away from a task, via repeatedly looking at nontask stimuli (i.e., noise associated with a motorized camera). These findings were taken to suggest CWS have difficulty habituating to irrelevant environmental stimuli.

In order to further assess CWS's emotional processes, researchers (e.g., Arnold, Conture, Key, & Walden, 2011; Johnson et al., 2010, Walden et al., 2012) assessed two aspects of emotion—positive and negative emotion. Specifically, Johnson et al. (2010) investigated the frequency of expressive behaviors displayed by preschool-age CWS and CWNS after receiving a desired (i.e., positive condition) versus a disappointing gift (i.e., negative condition). In the disappointing gift condition, CWS displayed significantly more negative emotional expressions than CWNS. Furthermore, CWS were more disfluent after receiving the desirable gift than the disappointing gift, suggesting that increased disfluency is related to the emotional tenor—positive in this case—of the associated communicative situation. To further address this issue, Arnold et al. (2011)—on the basis of coded behavioral observations—assessed preschool-age CWS's and CWNS's speech following positive and negative emotionally-arousing background conversations. Findings indicated that decreased duration and frequency of behavioral regulatory strategies were associated with significantly more stuttering for CWS. Using similar coded behavioral observations, Walden et al. (2012) reported that higher stuttering in CWS was significantly related to more emotional arousal/reactivity when associated with lower emotion regulation. Conversely, CWS's stuttering was lower when negative emotion was coupled with regulatory behaviors. This interaction of emotion and regulatory behaviors was taken by Walden et al. (2012) to suggest that emotion is part of the “causal nexus of developmental stuttering” (p. 641). Said another way, if emotion was purely a reaction to stuttering (Alm, 2004), then its regulation would not result in decreases in stuttering. In addition, Walden et al. (2012) also reported that when the first emotion condition (neutral/happy/angry) was emotional in nature (happy or angry), CWS stuttered significantly more during all three subsequent narrative tasks, whereas CWNS stuttered significantly less. This finding suggests that the impact of prior emotion, positive or negative, on subsequent stuttering may linger for some time.

Given the above review, there is growing evidence for the association between emotion and childhood stuttering. Researchers (Arnold et al., 2011, Johnson et al., 2010, Walden et al., 2012) have speculated that conditions that elicit emotion and emotion regulation may divert CWS's attentional resources away from speech-language planning and production. Evidence has shown that CWS, compared to CWNS, exhibit poorer attentional control (Eggers et al., 2010; cf. Johnson, Conture, & Walden, 2012), attention regulation (Felsenfeld et al., 2010, Karrass et al., 2006, Schwenk et al., 2007), and lower efficiency of the orienting subsystem of the attentional system (Eggers et al., 2012). Therefore, emotions may interact with less adaptive attentional processes, and divert resources away from CWS's speech-language system, interfering with rapid and efficient planning for speech (e.g., Anderson and Conture, 2004, Pellowski and Conture, 2005, Weber-Fox et al., 2008). Further, it is possible that this disruption is greatest during the period just prior to and during the overt initiation of speech-language, which is theoretically associated with a number of speech-language planning processes (for review, see Levelt, Roelofs, & Meyer, 1999).

The purpose of the present study was to further empirically investigate the association of emotional reactivity, emotion regulation, and childhood stuttering. Although other empirical studies have assessed differences in emotion between CWS and CWNS (e.g., Eggers et al., 2013), as well as the influence of emotion on stuttering (e.g., Choi et al., 2013), the present study employed an experimental paradigm developed to investigate emotional reactivity and regulation in a more focused and narrow timeframe. Specifically, the temporal epoch immediately prior to and during onset of children's utterances was chosen because it is a time period when (1) stuttering is apt to occur and (2) both speech-language planning and production processes exhibit considerable activity, as well as temporal overlap with one another (for review, see Levelt et al., 1999). We hypothesized that heightened emotional reactivity and/or decreased emotion regulation immediately prior to and during overt production of an utterance would be associated with instances of stuttering.

As an index of emotional reactivity, positive (e.g., smiles) and negative (e.g., frowns) affective behaviors were coded (Calkins, 1997, Dollar and Stifter, 2012, Graziano et al., 2011; Kidwell and Barnett, 2007, Walden et al., 2012). As an index of emotion regulation, fidgeting and repetitive movements were coded (e.g., tapping fingers together, tugging at the ear lobe; Calkins, 1997, Cole et al., 1992; Dollar and Stifter, 2012, Graziano et al., 2011, Kidwell and Barnett, 2007, Stifter and Braungart, 1995, Walden et al., 2012). These measures were employed for various reasons. First, these measures have been previously used to assess the association of emotion and childhood stuttering (Johnson et al., 2010, Walden et al., 2012), and thus provide continuity with emotional behaviors coded in previous empirical studies of preschool-age CWS and CWNS. Second, these behaviors have been extensively used in the field of psychology as indexes of emotional reactivity and regulation in the preschool-age population (e.g., Calkins, 1997, Cole et al., 1992, Stifter and Braungart, 1995). Third, these behaviors change relatively rapidly and were codeable during the temporal epoch of interest, a timeframe during which instances of stuttering are apt to occur.

Measures of emotional reactivity and regulation were assessed prior to and during fluent and stuttered utterances from narratives that were immediately preceded by emotionally-arousing listening conditions. These conditions were similar to those used in previous research on emotion and childhood stuttering (Arnold et al., 2011, Walden et al., 2012), and consisted of auditory recordings of three “overheard” conversations between two adults (happy, angry, and neutral). This method was adapted from empirical studies that found overheard anger increases arousal and distress in preschool-age children (Cummings, 1987, Cummings et al., 1989). We hypothesized that exposure to emotionally-arousing conditions (happy and angry) before engaging in a speaking task would influence emotional processes and speech fluency, both within- and between-groups.

The present investigation addressed two specific issues. The first was whether preschool-age CWS and CWNS differ in terms of emotional processes associated with their fluent speech, and whether such processes were differentially influenced by the emotional tenor of the preceding emotion condition (between-group comparison). We hypothesized that preschool-age CWS, compared to their CWNS peers, would exhibit greater emotional reactivity and lower emotion regulation prior to and during their fluent utterances, particularly following the emotionally-arousing listening conditions. The second issue was whether emotions were more likely to be associated with CWS's stuttered than their fluent utterances, especially following the experimentally manipulated emotion conditions (within-group comparison). We hypothesized that CWS's stuttered, when compared to their fluent, utterances would be more likely associated with increased emotional reactivity and decreased emotion regulation, particularly following the emotionally-arousing listening conditions.