Repetitive Negative Thinking in Adolescents Who Stutter.

PURPOSE: Repetitive negative thinking (RNT) is the process of engaging in negatively valenced and habitual thought patterns. RNT is strongly associated with mental health conditions and often affects quality of life. This study explored RNT in older school-age children and adolescents who stutter to quantify the relationship between RNT and self-reported anxiety characteristics. An additional aim was to describe how individual differences in an adolescent's goal when speaking influences the frequency they engage in RNT. METHOD: Ninety-nine children and adolescents who stutter aged 9-18 years completed a measurement of the frequency/severity of RNT, a screener of anxiety characteristics, and a measure of adverse impact related to stuttering. Children aged 10 years and above also answered questions about their goal when speaking. RESULTS: Individual differences in RNT significantly predicted Overall Assessment of the Speaker's Experience of Stuttering (OASES) Total Scores more so than a child or adolescent's age. Higher generalized or social anxiety scores were significantly correlated with more frequent RNT and higher OASES Total Scores. Individual differences in goal when speaking (i.e., whether or not to stutter openly) were found to predict RNT. Finally, 22 children and adolescents (22.2%) also screened positive for generalized anxiety disorder and 32 (32.3%) screened positive for social anxiety disorder. DISCUSSION: These data provide strong evidence that (a) many children and adolescents who stutter engage in RNT; (b) children and adolescents who engage more frequently in RNT or who have higher OASES Total Scores may be at increased risk for more characteristics of generalized or social anxiety; and (c) individual differences in goal when speaking can predict the degree to which an adolescent engages in RNT. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23713296.

Exploring the Relationship Between Resilience and the Adverse Impact of Stuttering in Children.

PURPOSE: People who stutter often experience significant adverse impact related to stuttering. However, it is unclear how adverse impact develops in children who stutter (CWS) and whether there are protective factors that may mitigate its development. This study examined the relationship between resilience, a potentially protective factor, and stuttering's adverse impact in CWS. Resilience comprises external factors, such as family support and access to resources as well as personal attributes, making it a comprehensive protective factor to explore. METHOD: One hundred forty-eight CWS aged 5-18 years completed the age-appropriate version of the Child and Youth Resilience Measure (CYRM) and the Overall Assessment of the Speaker's Experience of Stuttering. Parents completed a caregiver version of the CYRM and a behavioral checklist for their child. The adverse impact of stuttering was modeled as a function of resilience (external, personal, and total), controlling for child age and behavioral checklist score. We also estimated correlations between child-report and parent-report CYRM measures to assess rater agreement. RESULTS: Children reporting greater external, personal, or total resilience were more likely to experience lower degrees of adverse impact related to their stuttering. We documented stronger correlations between younger child and parent ratings of resilience and weaker correlations between older child and parent ratings. CONCLUSIONS: These results yield valuable insight into the variability of adverse impact experienced by CWS and offer empirical support for strength-based speech therapy approaches. We discuss the factors that contribute to a child's resilience and provide practical suggestions for how clinicians can incorporate resilience-building strategies into intervention for children experiencing significant adverse impact from their stuttering. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23582172.

Error Characteristics Lend Specificity to Nonword Repetition Performance in Children Who Stutter With and Without Concomitant Disorders.

PURPOSE: In our earlier study, we found that overall accuracy on nonword repetition (NWR) lacked the specificity to differentiate among groups of children who stutter (CWS) with and without concomitant speech sound and/or language disorders and children who do not stutter (CWNS). The aim of this study was to determine whether NWR error characteristics distinguish these groups of children with different speech sound production and language abilities yielding insight into the deficits underlying poorer performance. METHOD: Participants were 141 children (88 CWS, 53 CWNS). CWS were divided into subgroups based on the presence or absence of concomitant speech sound and language disorders. Children completed an NWR task composed of one- to four-syllable nonwords. Error types included omissions, substitutions, and migrations. Error location was documented across the syllables of the longest, four-syllable nonwords and within each syllable (onset, nucleus, and coda) for all nonwords. RESULTS: We found that error patterns characterized groups' NWR performance. Specifically, CWS groups made more errors on syllable onsets, more errors on the first and fourth syllable of the four-syllable nonwords, and more substitution errors than CWNS. CWS with concomitant speech sound and/or language disorders made more omission errors than CWNS and CWS with typical speech sound and language abilities. CWS with both a speech sound and language disorder made more migration errors than all other groups. CONCLUSIONS: Using a data-driven framework derived from prior empirical investigations of NWR errors, this study demonstrated that error characteristics enhance the specificity of NWR by distinguishing groups of CWS with and without concomitant speech sound and language deficits. These error patterns also provide a window into the processes underlying NWR performance in CWS.

Emotional Regulation and Its Influence on the Experience of Stuttering Across the Life Span.

PURPOSE: This study evaluated the relationship between emotional regulation (ER) and adverse impact related to stuttering across the developmental spectrum, in preschool and school-age children, adolescents, and adults who stutter. An additional aim examined how these variables relate to the ways that individuals approach speaking (i.e., their agreement on whether their goal is to speak fluently). METHOD: Participants were the parents of 60 preschoolers and younger school-age children (ages 3-9 years), 95 school-age children and adolescents who stutter (ages 7-18 years), and 180 adults who stutter (ages 18-81 years). All participants completed surveys with age-appropriate measures examining ER and the adverse impact of stuttering. Older children and adults who stutter also answered questions regarding their goals when speaking. Multiple regression and ordinal logistic regression were used to examine relationships among ER, adverse impact related to stuttering, and goal when speaking. RESULTS: In preschool children, adverse impact was significantly predicted by a parent-reported measure of ER skills; in school-age children and adults, adverse impact was significantly predicted by measures of the ER strategies cognitive reappraisal (CR) and expressive suppression. Less frequent use of CR by adults was significantly associated with an increased likelihood of having "not stuttering" as a goal when speaking. Differences in the significance and magnitude of these relationships were found across the life span. DISCUSSION: For both children and adults who stutter, ER is a significant factor related to the adverse impact of stuttering; the relationship between ER and adverse impact may change over development. Accounting for individual differences in ER can improve understanding of why a person copes with stuttering in the ways they do, and this has notable implications for individualizing intervention for both children and adults who stutter. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20044469.

Consistency of children's hemodynamic responses during spontaneous speech.

Significance: Hemodynamic responses (HRs) are typically averaged across experimental sessions based on the assumption that brain activation is consistent over multiple trials. This may not be a safe assumption, especially in pediatric populations, due to unaccounted effects of inattention, fatigue, or habituation. Aim: The purpose of this study was to quantify the consistency of the HR over speech and language brain regions during speech production in typically developing school-aged children. Approach: Brain activity over speech and language regions of interest (ROIs) was recorded with functional near-infrared spectroscopy during a picture description paradigm with 37 children (aged 7 to 12 years). We divided the 30 experimental trials, each 5 s long, into three segments of 10 trials each corresponding with early (trials 1 to 10), middle (trials 11 to 20), and late (trials 21 to 30) trials. We then compared oxygenated (HbO) and deoxygenated (HbR) hemoglobin concentrations averaged across each 10 trial segment to overall concentrations averaged across all 30 trials. We also compared differential hemoglobin (HbD) across ROIs. Results: HbO and HbR averaged across all experimental trials most strongly correlated with HbO and HbR from early trials. HbD values from channels over most speech and language regions did not appreciably change throughout the experimental session. The exception was HbD values from channels over the dorsal inferior frontal gyrus (dIFG). This region showed significantly higher activation over the left hemisphere during the first segment of the experiment. Conclusions: Our findings suggest that brain activity from speech and language ROIs was relatively consistent over the experimental session. The exception was increased activation of left dIFG during earlier experimental trials. We suggest that researchers critically evaluate the consistency of HRs from different brain regions to determine the reliability of HRs recorded during experimental sessions. This step is instrumental in ensuring that uncontrolled effects do not mask patterns of task-related activation.

Nonword Repetition Performance Differentiates Children Who Stutter With and Without Concomitant Speech Sound and Developmental Language Disorders.

PURPOSE: The aim of this study was to examine how nonword repetition (NWR) performance may be impacted by the presence of concomitant speech and language disorders in young children who stutter (CWS). METHOD: One hundred forty-one children (88 CWS and 53 children who do not stutter [CWNS]) participated. CWS were divided into groups based on the presence of speech sound and/or language disorder or typical speech sound production and language abilities. NWR abilities were measured using stimuli composed of one- to four-syllable nonwords. RESULTS: CWS with typical speech and language and CWNS had higher accuracy scores than CWS with concomitant speech and language disorders. We found no difference in accuracy scores between CWNS and CWS with typical speech and language abilities, nor did we find differences between CWS with speech sound disorder and CWS with both speech sound and language disorders. Accuracy decreased as nonword length increased for all groups. CONCLUSIONS: We found that the presence of a concomitant speech and language disorder was a driving factor behind poorer NWR performance in CWS. Accuracy scores differentiated CWS with concomitant disorders from CWS with typical speech and language but not CWS with typical speech and language from CWNS. Considering the speech and language abilities of CWS helped clarify poorer NWR performance and enhances generalizability to the population that exists clinically.

Event-Related Potentials Elicited by Phonetic Errors Differentiate Children With Speech Sound Disorder and Typically Developing Peers.

PURPOSE: A growing body of research suggests that a deficit in speech perception abilities contributes to the development of speech sound disorder (SSD). However, little work has been done to characterize the neurophysiological processes indexing speech perception deficits in this population. The primary aim of this study was to compare the neural activity underlying speech perception in young children with SSD and with typical development (TD). METHOD: Twenty-eight children ages 4;1-6;0 (years;months) participated in this study. Event-related potentials (ERPs) were recorded while children completed a speech perception task that included phonetic (speech sound) and lexical (meaning) matches and mismatches. Groups were compared on their judgment accuracy for matches and mismatches as well as the mean amplitude of the phonological mapping negativity (PMN) and N400 ERP components. RESULTS: Children with SSD demonstrated lower judgment accuracy across the phonetic and lexical conditions compared to peers with TD. The ERPs elicited by lexical matches and mismatches did not distinguish the groups. However, in the phonetic condition, the SSD group exhibited a more consistent left-lateralized PMN effect and a delayed N400 effect over frontal sites compared to the TD group. CONCLUSIONS: These findings provide some of the first evidence of a delay in the neurophysiological processing of phonological information for young children with SSD compared to their peers with TD. This delay was not present for the processing of lexical information, indicating a unique difference between children with SSD and with TD related to speech perception of phonetic errors. Supplemental Material https://doi.org/10.23641/asha.16915579.

Novel Adjective Processing in Preschool Children: Evidence From Event-Related Brain Potentials.

Purpose Recent findings in preschool children indicated novel adjective recall was enhanced when learned using repeated retrieval with contextual reinstatement (RRCR) compared to repeated study (RS). Recall was similar for learned pictures used during training and new (generalized) pictures with the same adjective features. The current study compared the effects of learning method and learned/generalized pictures on the neural processes mediating the recognition of novel adjectives. Method Twenty typically developing children aged 4;6-5;11 (years;months) learned four novel adjectives, two using RRCR and two using RS. Five-minute and 1-week tests assessed adjective recall using learned and generalized pictures. Also, at the 1-week visit, event-related potentials (ERPs) were recorded to assess children's processing of learned/generalized pictures, followed by naturally spoken novel adjectives in a match-mismatch paradigm. Results Naming recall and match-mismatch judgment accuracy were similar for the RS and RRCR conditions and across learned/generalized pictures. However, ERPs revealed more reliable condition effects in the phonological mapping negativity, indexing phonological expectations, and the late positive component, indexing semantic reanalysis, for the adjectives learned in the RRCR relative to the RS condition. Unfamiliar pictures (generalized) elicited larger amplitude N300 and N400 components relative to learned pictures. Conclusions Although behavioral accuracy measures suggest similar effects of the RS and RRCR learning conditions, subtle differences in the ERPs underlying novel adjective processing indicate advantages of RRCR for phonological processing and semantic reanalysis. While children readily generalized the novel adjectives, ERPs revealed greater cognitive resources for processing unfamiliar compared to learned pictures of the novel adjective characteristics. Supplemental Material https://doi.org/10.23641/asha.13683214.

Neural Indices Mediating Rhyme Discrimination Differ for Some Young Children Who Stutter Regardless of Eventual Recovery or Persistence.

Purpose Previous studies of neural processing of rhyme discrimination in 7- to 8-year-old children who stutter (CWS) distinguished children who had recovered, children who had persisted, and children who did not stutter (CWNS; Mohan & Weber, 2015). Here, we investigate neural processing mediating rhyme discrimination for early acquired real words in younger CWS and CWNS (4;1-6;0 years;months), when rhyming abilities are newly emerging, to examine possible relationships to eventual recovery (CWS-eRec) and persistence in stuttering (CWS-ePer). Method Children performed a rhyme discrimination task while their event-related brain potentials were recorded. CWNS, CWS-eRec, and CWS-ePer had similar speech and language abilities. Inclusionary criteria incorporated at least 70% accuracy for rhyme discrimination. Analyses focused on the mean amplitude of the N400 component elicited by rhyming and nonrhyming words in anterior and posterior regions of interest. Results CWNS, CWS-eRec, and CWS-ePer displayed a classic event-related potential rhyme effect for rhyme discrimination characterized by larger amplitude, posteriorly distributed N400s elicited by nonrhyming targets compared to rhyming targets. CWNS displayed a more robust anterior rhyme effect compared to the CWS groups with a larger amplitude N400 anteriorly for the rhyming targets. This effect was more consistent across individual CWNS than CWS. Conclusions The groups of CWNS, CWS-eRec, and CWS-ePer, who had all developed rhyming discrimination abilities, exhibited similar underlying neural processes mediating phonological processing of early acquired words for the classic central-parietal rhyme effect. However, individual variability of the anterior rhyme effect suggested differences in specific aspects of phonological processing for some CWS-eRec and CWS-ePer compared to CWNS.