Lecture Nine - Early and Late Childhood Stuttering

1. Lecture Nine - Early and Late Childhood Stuttering Orienting Questions: How does stuttering change over childhood? How does stuttering affect the wider spectrum of behaviour?

2. Lecture Outline How stuttering helps to understand why fluent speech breaks down Describe research with children who stutter Sensory and motor factors Social factors How research can inform speech therapy Use of external devices to improve fluency Using social psychology methodology

3. Prevalence and incidence Stuttering will affect approximately 5% of the population at some time. Disorder affects children disproportionately - the age of onset is usually between the ages of 3 and 7 years. Boys more affected than girls. Ratio 3:1 at onset Social factors may be important in this area.

4. Two recent studies that (together) deal with stuttering from onset to teenage: The Illinois study (Yairi, Ambrose and co-workers) children from around onset of stuttering (two years or so of age) to about eight years. The UCL study from age eight to teenage

5. The Illinois study Diagnostic factors : Three groups Primary Secondary Other

6. Primary Factors Family history Persistent stutterers come from families who have members who persisted Transmission model - single-major locus explanation (Ambrose et al, 1993). Contrasts with Kidd et al. - sex-modified polygenic mode Gender Boys at higher risk � (67% boys)

7. Primary Factors Stuttering like disfluencies (SLD) �Stutter-like disfluencies� because typical, but not exclusive to people who stutter SLD part-word repetitions single-syllable word repetitions disrhythmic phonation Other interjections multiple syllable word and phrase repetitions revisions or abandoned utterances Dissension about SLD Wingate (2001) SLD are not stuttering events our own two-class scheme puts some SLD and OD in each class advocate present separate counts so other people can do their way

8. Primary Factors Duration of stuttering history The longer stuttering goes on, the higher is the risk it will persist (esp. girls) Disfluency length: Extent and duration More extensive stuttering events (�bu, bu, but�) are sign of higher risk Sound prolongations and blocks Apart from early months, prolongation is a factor that differentiates children who will eventually persist from those who recover. Also as shrink, sign recovery in progress.

9. Secondary Factors Stuttering severity Head and neck movements Phonological skills Expressive language skills

10. Other Factors Concomitant disorders e.g. ADHD Awareness and affective reactions evidence that some young children are aware and that this upsets them

11. The UCL study from age eight to teenage Illinois work - important information but limitations Recovery not complete at age 8 (is by teenage) No control group, we have limited data on control subjects Our work shows important changes in disfluency and social characteristics happen after age eight that relate to diagnosis, assessment and possibly treatment.

12. The UCL study from age eight to teenage Follow-up study of children who stutter between the ages 8 and 18 years. First seen when attending clinic for initial assessment at around 3 - 8 years Cohort constant in terms of treatment received Recorded at age 8 or younger so verified that stuttering Followed up to age at which recovery complete

13. The UCL study from age eight to teenage Total number of children who stutter with English as a first language involved in the study - 372. Not all children have performed the full range of tests. Some of reasons � still participating (not yet reached age appropriate for some of the tests). Geographical Lost contact

14. The UCL study from age eight to teenage � Core Group Important subgroup of the children we have seen over the years Consists of 24 children all of whom have been classified as persistent (13) and recovered (11) using the following criteria Three recordings - 8-10 years, 10+12 years and 12 years+ SSI Parental and child rating using adaptation of Kully and Boberg questionnaire Researchers rating

15. The UCL study from age eight to teenage � Secondary Group Consists of 84 children who stutter for whom we have a minimum of one audio recording, together with history of therapy, initial contact details, date of birth, gender and at least one of the research projects. Sixty-six (79%) of secondary group have been classified as recovered/persistent Children in this group can be transferred to the Core Group when at appropriate age / assessment completed etc

16. We have the following information/data on the Secondary Group � Therapy history 84/84 (100%) Demographic 40/84 (48%) Family History 39/84 (46%) Anxiety 27/84 (32%) Health 44/84 (52%) Scans 9/84 (11%) Age of Onset 55/84 (65%) Hearing Threshold 40/84 (48%) Hearing problems 40/84 (48%) Masking threshold 40/84 (48%) Motor (tapping) 23/84 (27%) Motor (lip tracking) 14/84 (17%) Temperament 29/84 (35%) Handedness 67/84 (80%) Grammar 24/84 (29%) Vocabulary 17/84 (19%) Lexical retrieval 20/84 (24%) Priming 5/84 (6%) Intelligence 10/84 12%) Academic 37/84 (44%) Five children (6%) are no longer participating

17. Other participants There are a further 164 children for whom we have a minimum of one audio recording, but incomplete data with regard to therapy, contact details etc. Studies of recovered/persistent use subjects from core and secondary groups Studies that haven�t looked at recovered/persistent per se (e.g. some of the hearing tests and social studies) used selection of all the speakers