Validation of the Vanderbilt Responses to Your Child's Speech Rating Scale for Parents of Young Children Who Stutter.

PURPOSE: This study reports the development, refinement, and exploration of the psychometric properties of the Vanderbilt Responses to Your Child's Speech (VRYCS) rating scale, a novel measure designed to assess parents' self-perceived responses to the speech of their children who stutter (CWS). METHOD: Parents of 214 young (ages 2;4[years;months]-5;11) CWS completed the original 40-item version of the VRYCS. Content analyses and an exploratory factor analysis determined the scale's factors and identified specific items corresponding to each. Items that did not load onto the factors were removed and internal consistency was assessed. RESULTS: The final 18-item VRYCS rating scale includes five factors relating to parents' responses to the speech of their CWS including (a) Requesting Change, (b) Speaking for the Child, (c) Supporting Communication, (d) Slowing and Simplifying, and (e) Responding Emotionally. Reliability was demonstrated, responses by parents of CWS were described, and a revised scoring form developed. CONCLUSIONS: The VRYCS is a valid and reliable tool for assessing and exploring parents' perceptions of their own responses to the speech of their CWS for clinical and research purposes. Clinical applications of the VRYCS for assessment and treatment of childhood stuttering are discussed.

Treating Concomitant Language and/or Phonology Impairment in Children Who Stutter.

Stuttering can co-occur with phonological and/or language impairment in a nontrivial number of children. This article provides a framework for addressing concomitant phonology/language impairment and stuttering through the application of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Described is a multifactorial approach to understanding stuttering, the application of the ICF to treating children who stutter with concomitant disorders, and models for structuring-related therapy. A case study is explored to illustrate this process and includes a sample treatment plan with goals, short-term objectives, and sample activities.

Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approach.

PURPOSE: The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering. METHOD: We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated. RESULTS: Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased. CONCLUSIONS: Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

Stuttering Practice Self-Assessment by School Speech-Language Practitioners.

Purpose The purpose of this study was to survey school speech-language practitioners' self-perceptions of their confidence, knowledge, and need for support for working with school-age students who stutter (SWS). Method A total of 120 school-based speech-language practitioners from 27 Nashville, Tennessee, area counties completed an online, 35-item survey examining caseloads, coursework, continuing education, experience, and perceived levels of skill and confidence in service provision to SWS. They also rated their need for consultation from speech-language pathologists who specialize in stuttering to improve their skills with SWS. Results Respondents were least confident in and needed most support for providing intervention to SWS. Those who needed most support for intervention rated themselves as less knowledgeable about stuttering theory, assessment, and intervention and were less confident about working with students who only stutter and with SWS who have concomitant communication concerns. Greater practitioner confidence in stuttering intervention skills was positively correlated with the number of SWS on caseloads; continuing education credits in stuttering; and knowledge of stuttering theory, assessment, and intervention. Respondents who completed a graduate course on stuttering had greater confidence in stuttering intervention and were less likely to identify a need for support from specialists. Conclusions School speech-language practitioners continue to report needing additional education, practice opportunities, and support, especially with intervention, and desiring specialized guidance to serve SWS. Those with more experience, education, and knowledge about stuttering are more confident and skillful, reflecting the potential positive impact of increased opportunities to learn about and work with SWS. These needs may be addressed through increased availability of specialists in stuttering to consult with school practitioners; opportunities for school-based practitioners to become peer mentors; and provision of readily available, intervention-focused continuing education experiences and resources.

Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis.

Purpose The purpose of this meta-analytic study was to identify clinical characteristics, defined as child factors that can be assessed by a speech-language pathologist as part of a routine speech-language evaluation that may differentiate children who persist in stuttering from children who eventually recover from stuttering. Clinical characteristics explored included sex, age at onset, family history of stuttering, stuttering frequency and severity, speech-language skills, and temperament. Method Studies were identified through electronic databases, journals, and reference lists of relevant reports (e.g., research articles). Eligible studies followed young children who stutter (i.e., under 6 years old) for at least 24 months, assessed a potential clinical marker at study entry, and determined talker group classification (i.e., persistent or recovered) at study completion. Sex and family history differences were estimated using risk ratios; all other differences were estimated using Hedges's g. Heterogeneity and methodological differences among studies were evaluated. Results Eleven studies (41 reports) met eligibility criteria. Persistent children were older at stuttering onset and exhibited higher frequencies of stuttering-like disfluencies, lower speech sound accuracy, and lower expressive and receptive language skills than recovered children. Males and children with a family history of stuttering were also more likely to persist. Conclusions Clinical characteristics were identified that are associated with increased risk for stuttering persistence. Future studies have the potential to translate these clinical characteristics into prognostic markers for stuttering persistence risk.

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.

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.