Short communicationLanguage skills of children during the first 12 months after stuttering onset
Introduction
Stuttering typically emerges in the pre-school years as children are experiencing substantial growth in their language and are beginning to combine words to form short sentences (Packman & Attanasio, 2004). Stuttering occurs during the process of planning utterances and selecting and using sounds to form words and sentences (Watkins, 2005). An investigation of the extent to which the emergence of stuttering in some children is related to their developing language is therefore warranted (Watkins, 2005).
The onset of stuttering is difficult to describe accurately because very little early, prospective data exists (Yairi & Ambrose, 2013). Information is most commonly gleaned from parents several months after they first notice the beginning of stuttering in their child (Yairi & Lewis, 1984). Thus objective data about stuttering onset is limited in the published literature. Traditionally, stuttering has been described as a disorder that becomes more severe as time progresses, but research involving longitudinal tracking of children challenges this notion (Yairi & Ambrose, 2005). Consequently, closely tracking stuttering development and monitoring the changes that occur in this early period is important and requires further attention.
There has been considerable interest in the language ability of children who stutter and whether this is different from that of children who do not stutter. However, there is little empirical evidence and the existing information is inconsistent.
That children who stutter have less proficient language skills than their normally fluent peers is a common contention in the literature (Ntourou, Conture, & Lipsey, 2011). Many studies have demonstrated that children who stutter have lower scores on standardised language assessments and measures obtained from language samples (e.g. Mean Length of Utterance (MLU)) when compared to children who do not stutter (e.g. Bernstein Ratner and Silverman, 2000, Byrd and Cooper, 1989, Ryan, 1992). Furthermore, in a meta-analytic review of empirical studies of language abilities, Ntourou et al. (2011) found that children who stutter are typically outperformed by children who do not stutter.
In contrast, Nippold (2012) published a review of the literature and concluded that the evidence does not adequately demonstrate that children who stutter are more likely to have language deficits than their fluent peers. Nippold (2012) argued that many studies revealed that children who stutter have language skills within normal limits, and showed a range of language abilities comparable to children who do not stutter (e.g. Anderson & Conture, 2000; Kadi-Hanifi & Howell, 1992; Kloth, Janssen, Kraaimaat, & Brutten, 1998; Watkins & Yairi, 1997; Watkins, Yairi, & Ambrose, 1999; Yairi, Ambrose, Paden, & Throneburg, 1996).
Several studies, including Kadi-Hanifi and Howell (1992) and Kloth et al. (1998), have analysed the spontaneous speech-language samples of both children who stutter and non-stuttering children. In the Kadi-Hanifi and Howell (1992) study, the developmental changes in MLU and syntax were similar for both groups, and importantly, consistent with that which would be expected in normal language development. Similarly, in Kloth et al. (1998) prospective study exploring the development of linguistic skills of children who were at high risk of stuttering, the researchers concluded that the children who began to stutter “followed the same pattern than that of the non-stuttering control group” (p.224). MLU was derived from transcripts of mother-child interactions and was used as one of the measures of expressive language skill. Kloth et al. (1998) reported no significant group differences in MLU both before the onset of stuttering and one year later.
Language production abilities of preschool children who stutter were also examined by Watkins and Yairi (1997). Samples collected from 32 children near to stuttering onset, and then again one year later, were analysed and MLU was calculated. In addition, standardised language assessments were administered at each time point (Yairi et al., 1996). Each child’s performance was compared to normative data and results indicated that the majority of children had age-appropriate language skills. Similarly, Watkins et al. (1999) examined the language transcripts of 84 preschool children who had started to stutter and found that the average MLU and grammatical complexity scores were close to developmental expectations. A measure of grammatical complexity was also derived from conversational samples in Ryan’s (2000) study of 20 stuttering preschool children and a nonstuttering control group. No significant difference in grammatical complexity was found and both groups had scores that were well within normal limits (Ryan, 2000). In summary, these studies support the view that children who stutter have developmentally appropriate language abilities.
It has also been suggested that advanced language development may influence stuttering onset (Starkweather, 1987, Starkweather, 1991). For example, strong language skills in children who stutter were noted by Watkins (2005) in their discussion of the longitudinal research from the University of Illinois Stuttering Research Program. A large cohort of young children who stutter were prospectively tracked and Watkins (2005) noted that that children often performed at or above normative expectations on measures of expressive language ability such as MLU and grammar. More recently, in the longitudinal community study conducted by Reilly et al. (2009) stuttering onset was associated with advanced language development. Reporting on a cohort of 137 children who began to stutter up to the age of 3 years, Reilly et al. (2009) found that children who stutter had larger vocabularies than nonstuttering children at onset. Importantly, this finding was based on information collected about the children’s early communication and language before they started to stutter, ensuring that measures of language were not confounded by the influence of the onset of stuttering itself. Interestingly, this same cohort of children who stutter, as a group, also achieved higher scores than their nonstuttering peers on standardised measures of early communicative behaviours, expressive vocabulary, and receptive and expressive language at 2–5 years of age (Watts, Eadie, Block, Mensah, & Reilly, 2015). These findings contradict some of the previous research since they suggest that in some children it may be stronger, not weaker, language skills that are a risk factor for stuttering onset (Watkins, 2005).
Although there has been longstanding research interest in the language ability of children who stutter, there is a range of findings in the literature. Studies have utilised different, and not necessarily robust, methodologies, there is variability in the size of the sample used, the inclusion or not of a control group, the age and gender of participants, the time between stuttering onset and commencement of data collection, the severity of participants’ stuttering, the data collection method used, and the language outcomes that are measured. In addition, study participants are often recruited from speech-language clinics and therefore these cohorts may be more representative of the children who stutter from families who seek help. Such methodological inconsistencies and limitations may account for the contradictory evidence in the literature regarding the language ability of children who stutter.
This study is an extension of an earlier study that examined whether the communication and language skills of a cohort of children who stutter are different from children who do not stutter at ages 2–5 years (Watts et al., 2015). The finding from the Watts et al. (2015) study were based on standardised assessment data and demonstrated that the children who stutter, as a group, had higher scores than the control group on all language outcomes measured. The group differences were statistically significant on four of the seven measures and these findings were maintained when potentially confounding factors (e.g. maternal education and socioeconomic status) were controlled. Building upon that work, this current study aimed to examine the language performance of a sub-group drawn from the same cohort of children who stutter. Using speech-language samples collected from participants at three time points during the first year after stuttering onset, global indicators of expressive language proficiency were derived from the samples, and stuttering severity was measured.
Section snippets
Study context
This study is embedded within a pre-existing prospective longitudinal study, the Early Language in Victoria Study (ELVS). ELVS follows the communication and language development of a large cohort of Australian children (Reilly et al., 2007, Reilly et al., 2010). A sample of 1910 infants were recruited from low, middle and high socio-economic areas across Melbourne, Australia, according to standardised procedures from the Australian Census-based Socio-Economic Indexes for Areas (SEIFA) Index for
Participants
There were 66 children (42 males, 24 females) who met the inclusion criteria who started stuttering between the age of 2 and 4 years: 34 between 2 and 2.5 years; 26 between 2.5 and 3 years; 5 between 3 and 3.5 years; and 1 between 3.5 and 4 years. To facilitate longitudinal tracking participants have been grouped according to the age they were when the initial home visit was conducted soon after stuttering onset and during which the first speech-language sample was collected. The ‘youngest’
Discussion
In this study, stuttering was mild in severity for the majority of children at each time point examined and the spoken language skills of the children who began to stutter were consistent with developmental expectations, and comparable with normative data (Lee, 1974, Miller, 1981, Rice et al., 2010).
During the first year after stuttering onset, overall stuttering severity was rated as mild. The mean stuttering severity ratings for this cohort decreased over time, and there were more
Acknowledgements
This research is supported by grants from the Australian National Health and Medical Research Council and the Australian Research Council, and additional grants from the Murdoch Childrens Research Institute and La Trobe University. This research is supported by the Victorian Government’s Operational Infrastructure Support Program. The embedded study forms the first author’s doctoral project and was supported by the University of Melbourne and Murdoch Childrens Research Institute. The following
Amy Watts is a speech pathologist and researcher. She has recently completed her doctoral research at the University of Melbourne and is based at the Murdoch Childrens Research Institute.
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Children who stutter at 3 years of age: A community-based study
2018, Journal of Fluency DisordersCitation Excerpt :Finally, our descriptors of both fluency and language development were binary (+/− stuttering, +/− language delay), which do not permit nuanced appraisal of possible relationships between the two constructs. Although we did not measure language skills using standardized and quantitative measures at either 1.5 or 3 years of age, evaluating children’s expressive language skills with more elaborate procedures, such as measuring the length of utterances and grammatical complexity as in some recent studies (Watts, Eadie, Block, Mensah, & Reilly, 2017), will be important for future research. In addition, comorbidity of stuttering, with other developmental conditions, such as autism spectrum disorder, speech-motor or cognitive delay, should be given more consideration in evaluations.
Executive function and childhood stuttering: Parent ratings and evidence from a behavioral task
2018, Journal of Fluency DisordersCitation Excerpt :A plethora of studies have established an association between young children’s executive function skills and their language abilities (Carlson, Davis, & Leach, 2005; Gooch, Thompson, Nash, Snowling, & Hulme, 2016; Kuhn, Willoughby, Vernon-Feagans, & Blair, 2016; Müller, Jacques, Brocki, & Zelazo, 2009). Given that the findings of some studies have suggested that CWS exhibit weaker, but still within the typical range, language abilities compared to normally-fluent controls (Ntourou et al., 2011; cf. Reilly et al., 2013; Watts, Eadie, Block, Mensah, & Reilly, 2017), the close association between EF and language development motivates further study of EF skills in CWS. It may be, for example, that the observed differences between some CWS and CWNS in language abilities are actually a consequence of weaknesses in EF (low EF → low language skills) or that some CWS exhibit lower EF than their normally-fluent peers because their lower language skills negatively impact the development of EF (low language skills → low EF).
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Amy Watts is a speech pathologist and researcher. She has recently completed her doctoral research at the University of Melbourne and is based at the Murdoch Childrens Research Institute.
Patricia Eadie is Associate Professor, Early Childhood Education in the Melbourne Graduate School of Education at the University of Melbourne where her teaching and research focus on childhood language development and disorder. She holds an Honorary Senior Research Fellowship at the Murdoch Childrens Research Institute.
Susan Block is a Senior Lecturer at La Trobe University in Melbourne where she co-ordinates the academic and clinical stuttering programs. She holds honorary positions at James Cook University in Townsville, the Murdoch Childrens Research Institute in Melbourne and the Australian Stuttering Research Centre at Sydney University.
Fiona Mensah is a biostatistician and social scientist. She is currently undertaking a post-doctoral research fellowship at the Murdoch Childrens Research Institute, Royal Children’s Hospital and University of Melbourne.
Sheena Reilly is Pro Vice Chancellor (Health) at Griffith University and she holds an Honorary Fellowship at Murdoch Childrens Research Institute. Sheena’s research focuses on speech and language difficulties in children. She has produced over 150 (116 peer-reviewed) publications, in highly ranked journals.