Lexipontix Program: Facilitating Change toward "Best Hopes" of the School-Age Child Who Stutters and the Family.

Lexipontix is a structured therapy program for school-age children who stutter. It is based on theoretical principles and clinical practices of cognitive behavioral therapy, parent-child interaction therapy, solution-focused brief therapy, fluency shaping, and stuttering modification. A case example of a school-age child who stutters and his family who participated in the Lexipontix program is illustrated to highlight the theoretical principles, structure, content, and clinical tools of the assessment and therapy process of the program. The Lexipontix program addresses the stuttering experience of the child and family in a holistic way. The child and family are assisted in facilitating changes in all components of the International Classification of Functioning, Disability, and Health model (i.e., body function, personal factors, activity and participation, environmental factors), which help them move toward their "best hopes" (i.e., personally meaningful change) from therapy. The role of the clinician in facilitating change is also considered. Therapy outcomes for the specific case example are presented and discussed in relation to data from a retrospective chart review. The mechanisms underlying the effectiveness of the program are explored and discussed.

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.

Short-Term Memory, Inhibition, and Attention in Developmental Stuttering: A Meta-Analysis.

Purpose: This study presents a meta-analytic review of differences in verbal short-term memory, inhibition, and attention between children who stutter (CWS) and children who do not stutter (CWNS). Method: Electronic databases and reference sections of articles were searched for candidate studies that examined verbal short-term memory, inhibition, and attention using behavioral and/or parent report measures. Twenty-nine studies met the eligibility criteria, which included, among other things, children between the ages of 3 and 18 years and the availability of quantitative data for effect size calculations. Data were extracted, coded, and analyzed, with the magnitude of the difference between the 2 groups of children being estimated using Hedge's g (Hedges & Olkin, 1985). Results: Based on the random-effects model (Hunter & Schmidt, 2004), findings revealed that CWS scored lower than CWNS on measures of nonword repetition (Hedges' g = -0.62), particularly at lengths of 2 and 3 syllables (Hedges' g = -0.62 and - 0.50, respectively), and forward span (Hedges' g = -0.40). Analyses further revealed that the parents of CWS rated their children as having weaker inhibition (Hedges' g = -0.44) and attentional focus/persistence (Hedges' g = -0.36) skills than the parents of CWNS, but there were no significant differences between CWS and CWNS in behavioral measures of inhibition and attention. Conclusion: The present findings were taken to suggest that cognitive processes are important variables associated with developmental stuttering.

Executive function and childhood stuttering: Parent ratings and evidence from a behavioral task.

PURPOSE: The purpose of this study was to examine the executive function (EF) abilities of preschool children who do (CWS) and do not stutter (CWNS) using a parent-report questionnaire and a behavioral task. METHOD: Participants were 75 CWS and 75 CWNS between the ages of 3;0 and 5;11 (years; months). Parents rated their children's EF abilities using the Behavioral Rating Inventory of Executive Function-Preschool Version (BRIEF-P; Gioia, Espy, & Isquith, 2003). Children's ability to integrate cognitive flexibility, inhibitory control, and working memory was measured using a behavioral task, the Head-Toes-Knees-Shoulders (HTKS; Cameron Ponitz, McClelland, Matthews, & Morrison, 2009). RESULTS: The CWS were judged by their parents as being less proficient in working memory, shift/flexibility, and overall EF than the parents of the CWNS. Children in the CWS group were also 2½ to 7 times more likely than children in the CWNS group to exhibit clinically significant difficulties with EF. Behavioral task findings revealed that 3-year old CWS performed more poorly than their peers on the HTKS. Parental ratings of executive function and working memory were significantly and moderately correlated with receptive and expressive vocabulary skills only for the CWNS group. CONCLUSION: CWS have more difficulty with EF in everyday life and may experience early delays in their ability to integrate aspects of attention and EF compared to CWNS.

Emotional reactivity and regulation in preschool-age children who stutter.

PURPOSE: This study experimentally investigated behavioral correlates of emotional reactivity and emotion regulation and their relation to speech (dis)fluency in preschool-age children who do (CWS) and do not (CWNS) stutter during emotion-eliciting conditions. METHOD: Participants (18 CWS, 14 boys; 18 CWNS, 14 boys) completed two experimental tasks (1) a neutral ("apples and leaves in a transparent box," ALTB) and (2) a frustrating ("attractive toy in a transparent box," ATTB) task, both of which were followed by a narrative task. Dependent measures were emotional reactivity (positive affect, negative affect), emotion regulation (self-speech, distraction) exhibited during the ALTB and the ATTB tasks, percentage of stuttered disfluencies (SDs) and percentage of non-stuttered disfluencies (NSDs) produced during the narratives. RESULTS: Results indicated that preschool-age CWS exhibited significantly more negative emotion and more self-speech than preschool-age CWNS. For CWS only, emotion regulation behaviors (i.e., distraction, self-speech) during the experimental tasks were predictive of stuttered disfluencies during the subsequent narrative tasks. Furthermore, for CWS there was no relation between emotional processes and non-stuttered disfluencies, but CWNS's negative affect was significantly related to nonstuttered disfluencies. CONCLUSIONS: In general, present findings support the notion that emotional processes are associated with childhood stuttering. Specifically, findings are consistent with the notion that preschool-age CWS are more emotionally reactive than CWNS and that their self-speech regulatory attempts may be less than effective in modulating their emotions. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) communicate the relevance of studying the role of emotion in developmental stuttering close to the onset of stuttering and (b) describe the main findings of the present study in relation to previous studies that have used different methodologies to investigate the role of emotion in developmental stuttering of young children who stutter.

Language abilities of children who stutter: a meta-analytical review.

PURPOSE: To identify, integrate, and summarize evidence from empirical studies of the language abilities of children who stutter (CWS) and children who do not stutter (CWNS). METHOD: Candidate studies were identified through electronic databases, the tables of contents of speech-language journals, and reference lists of relevant articles and literature reviews. The 22 included studies met the following criteria: studied both children who did and did not stutter between ages 2;0 (years;months) and 8;0, and reported norm-referenced language measures and/or measures from spontaneous language samples amenable to effect size calculation. Data were extracted using a coding manual and were assessed by application of general and specialized analytical software. Mean difference effect size was estimated using Hedges's g (Hedges, 1982). RESULTS: Findings indicated that CWS scored significantly lower than CWNS on norm-referenced measures of overall language (Hedges's g = -0.48), receptive (Hedges's g = -0.52) and expressive vocabulary (Hedges's g = -0.41), and mean length of utterance (Hedges's g = -0.23). CONCLUSIONS: Present findings were taken to suggest that children's language abilities are potentially influential variables associated with childhood stuttering.

Utterance complexity and stuttering on function words in preschool-age children who stutter.

UNLABELLED: The purpose of the present investigation was to examine the relation between utterance complexity and utterance position and the tendency to stutter on function words in preschool-age children who stutter (CWS). Two separate studies involving two different groups of participants (Study 1, n=30; Study 2, n=30) were conducted. Participants were preschool-age CWS between the age of 3, 0 and 5, 11 who engaged in 15-20min parent-child conversational interactions. From audio-video recordings of each interaction, every child utterance of each parent-child sample was transcribed. From these transcripts, for each participant, measures of language (e.g., length and complexity) and measures of stuttering (e.g., word type and utterance position) were obtained. Results of Study 1 indicated that children stuttered more frequently on function words, but that this tendency was not greater for complex than simple utterances. Results of Study 2, involving the assessment of utterance position and MLU quartile, indicated that that stuttering was more likely to occur with increasing sentence length, and that stuttering tended to occur at the utterance-initial position, the position where function words were also more likely to occur. Findings were taken to suggest that, although word-level influences cannot be discounted, utterance-level influences contribute to the loci of stuttering in preschool-age children, and may help account for developmental changes in the loci of stuttering. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (a) describe the influence of word type (function versus content words), and grammatical complexity, on disfluent speech; (b) compare the effect of stuttering frequency based on the position of the word in the utterance; (c) discuss the contribution of utterance position on the frequency of stuttering on function words; and (d) explain possible reasons why preschoolers stutter more frequently on function words than content words.