Bilingual children who stutter: Convergence,gaps and directions for research

PurposeThe aim of this systematic review is to examine the early interactions between bilingualism and stuttering to synthesize knowledge that could inform diagnosis and treatment for bilingual children who stutter.MethodScopus, Science Direct, PubMed, ERIC Ebsco, and Google Scholar were searched with no limits placed on the year of publication. Search terms consisted of: (“stuttering” [MeSH] OR “stutter”) AND (“child” [MeSH] OR “children”) AND (“multilingualism” [MeSH] OR “bilingualism”). Inclusion criteria were children who stutter, bilinguals who stutter, empirical research articles, and published in peer review journals. Exclusion criteria were studies that reported on only adults, only monolinguals, or were not published in English.ResultsA total of 50 articles met the criteria. There was convergence with monolingual studies reporting sexually dimorphic and familial trends in the prevalence of stuttering and rates of recovery. Findings surrounding language proficiency, cross-linguistic stuttering severity, and development were ambivalent. Results point to the difficulty in identifying stuttering in bilingual children, and the need for culturally competent research and interpretations.ConclusionCurrent findings offer a fragmented view of bilingual development and echoes a recurring theme, i.e., the current understanding of bilingualism and stuttering is limited and more research is warranted.     

A systematic review on the role of language-related factors in the manifestation of stuttering in bilinguals

PurposeBilingual(s) who stutter (BWS) provide an opportunity to explore the link between stuttering and language. Unlike in monolinguals, stuttering in bilinguals could be influenced by both speaker-related language (e.gs. dominance & proficiency) and linguistic typology-related factors (e.g., structure of languages). However, the available literature is largely inconclusive on these factors. In this context, we systematically reviewed the literature to compile evidence on the influence of such factors on BWS.MethodWe followed the conventional systematic review process that included five databases. Further, the quality of the included articles was assessed using Newcastle-Ottawa Scale (NOS) for quality rating.ResultThirteen articles passed the selection criteria. Review of these articles revealed that language proficiency and dominance are the important factors that affect stuttering frequency in BWS. Though the linguistic typology is portrayed as a factor on the differential manifestation of dysfluencies in both languages of the BWS, the literature does not provide substantiating data for this. Further, the lack of uniformity in assessing and reporting language dominance and proficiency are the major drawbacks in the existing literature on stuttering in BWS.ConclusionThis review identifies proficiency and dominance as the major factors that influence the stuttering frequency in BWS. Currently, the evidence for the influence of typological differences between languages of the BWS on stuttering largely remains whimsical. Future research shall employ the recommended tasks and metrics while assessing the dysfluencies in BWS so that findings across centres become comparable, which in turn, could yield valid inferences.     

Effect of word phonetic properties on stuttering anticipation and speech production in adults who stutter

PurposeStuttering anticipation is a significant factor in an individual’s stuttering experience. People who stutter have reported words and sounds that they anticipate stuttering on. Attempts at understanding the association between stuttering anticipation and stuttering outcomes and the impact of phonetic properties on stuttering anticipation and overt stuttering have been insufficiently examined. This study aims to address these important issues.MethodsData were collected as part of a larger brain imaging study. Twenty adults who stutter rated a 414 word-list on stuttering anticipation. Participant-specific ‘high’ and ‘low’ anticipated words were selected. Twelve of the 20 participants returned for a second session 2–11 weeks later, during which they read the selected words again and stuttering occurrence was recorded.ResultsAmong the 20 participants, three sub-groups with “high” (N = 6), “moderate” (N = 5) and “low” (N = 9) stuttering anticipation were identified. Significant “high stuttering” anticipation was found on consonants, plosives, bilabials and alveolars, as well as labials and coronals. In 5 of the 8 participants who stuttered during session 2, more than 80 % of words stuttered were previously rated with high anticipation. Consonants, plosives, bilabials and alveolars, and labials and coronals were the most frequently stuttered (>27 %).ConclusionWhile not all adults who stutter demonstrate high word-specific stuttering anticipation, we found that more than half anticipated this to a high degree. Furthermore, both word-specific phonetic properties and stuttering anticipation impact stuttering occurrence. The inclusion of word-specific stuttering anticipation ratings may increase the likelihood of stuttering in experimental studies and improve treatment outcomes through individualized intervention.     

Responses of adults who stutter to the anticipation of stuttering

PurposeMany people who stutter experience the phenomenon of anticipation—the sense that stuttering will occur before it is physically and overtly realized. A systematic investigation of how people who stutter respond to anticipation has not been previously reported. The purposes of this study were to provide self-report evidence of what people do in response to anticipation of stuttering and to determine the extent to which this anticipation occurs.MethodsThirty adults who stutter indicated on a Likert rating scale the extent to which they anticipate stuttering and answered three open-ended (written) questions regarding how they respond to anticipation.ResultsAll participants reported experiencing anticipation at least “sometimes,” and 77% of the participants reported experiencing anticipation “often” or “always.” The extent to which participants reported experiencing anticipation was not related to stuttering severity, impact, or treatment history. Analysis of written responses revealed 24 major categories, which were heuristically divided into action or non-action responses. Categories representing avoidance and self-management strategies were further divided into 14 and 19 subcategories, respectively. Participants were just as likely to view anticipation as helpful as they were to view it as harmful.ConclusionFindings demonstrate that most, if not all, adults who stutter experience anticipation, and the majority of adults who stutter report doing so at least often. Adults who stutter respond to this anticipation by altering the speech production process in various ways. Results highlight the importance of the role that anticipation plays in how stuttering behaviors manifest themselves.Educational Objectives: The reader will be able to: (a) summarize existing literature on the anticipation of stuttering; (b) describe the role and extent of anticipation of stuttering in adults; (c) describe the various ways that adults who stutter respond to anticipation; (d) describe the importance of measuring anticipation in clinical and research domains.     

Relationships between stuttering,depression, and suicidal ideation in young adults: Accounting for gender differences

PurposeThe purpose of this study was to investigate the relationship between depressive symptoms and suicidal ideation and living with stuttering while accounting for time, sex, and health-related confounders.MethodThe data for this study come from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative survey study that has followed 13,564 respondents over the course of 14 years. Responses to the question “Do you have a problem with stuttering or stammering?” at two time points were used to establish stuttering and non-stuttering groups. Regression analysis, propensity score matching, and structural equation modeling were used.ResultsCompared to their fluent counterparts, males and females reported significantly elevated symptoms of depression. Although symptoms of depression among males who stutter were stable over time, depressive symptoms among females who stutter increased with age. Compared to males who do not stutter, males who stutter were significantly more likely to report feelings of suicidal ideation. There were no differences in suicidal ideation between females who do and do not stutter.ConclusionsSpeech-language pathologists should be aware of the associations between stuttering and depressive symptoms, as well as the increased risk for suicidal ideation among males who stutter. Clinicians should be knowledgeable about symptoms of depression and suicidal ideation and be familiar with processes to refer as needed.     

Association between biological markers of sickle cell disease and cognitive functioning amongst Cameroonian children

Background: Some of the major complications of sickle cell disease (SCD) occur in the brain and apart from overt stroke, patients also present with cognitive impairments. We sought to evaluate the prevalence of cognitive deficits as well as their biological predicting factors in young SCD patients in Cameroon.

Methods: The cognitive performances of Cameroonian SCD young patients were evaluated using a neuropsychological test battery assessing four domains of cognitive functioning (executive functions, attention, memory, and sensory-motor skills) previously adapted and normalized on healthy subjects in Yaoundé.

Findings: Up to 37.5% of the 96 SCD patients aged 6 to 24 years (M?=?13.5, SD?=?4.9) had mild-to-severe cognitive deficits. The cognitive deficits tend to increase with age. There was a significant effect of SCD on executive functions and attention, whereas SCD patients performed as well as controls on memory and sensory-motor skills tests. Structural equation models showed a significant association between (a) severe anemia and lower executive functioning, (b) low fetal hemoglobin levels and lower executive functioning and attention, (c) history of cerebrovascular accidents and lower performances in executive functioning, sensory-motor skills, and memory, (d) pathological electroencephalogram and lower attention, and (e) abnormal Transcranial Doppler and lower memory.

Conclusion: SCD patients in Cameroon presented a very high prevalence of cognitive deficits, with a specific impairment of executive functions and attention. Routine neuropsychological evaluation for early detection of cognitive deficits in SCD patients could represent a cost-effective tool to implement in resource-limited contexts such as in sub-Saharan Africa.     

Stuttering: a dynamic motor control disorder

The purpose of this review is to determine what neural mechanisms may be dysfunctional in stuttering. Three sources of evidence are reviewed. First, studies of dynamic inter-relationships among brain regions during normal speech and in persons who stutter (PWS) suggest that the timing of neural activity in different regions may be abnormal in PWS. Second, the brain lesions associated with acquired stuttering are reviewed. These indicate that in a high percentage of cases, the primary speech and language regions are not affected but lesions involve other structures, such as the basal ganglia, which may modulate the primary speech and language regions. Third, to characterize the motor control disorder in stuttering, similarities and differences from focal dystonias such as spasmodic dysphonia (SD) and Tourette’s syndrome (TS) are reviewed. This review indicates that the central control abnormalities in stuttering are not due to disturbance in one particular brain region but rather a system dysfunction that interferes with rapid and dynamic speech processing for production.

Educational objectives: The reader will be able to describe: (1) the similarities and differences between stuttering and other speech motor control disorders, (2) which brain lesions are most likely to produce acquired stuttering in adults, and (3) what type of brain abnormality most likely underlies stuttering.     

Independent effects of bilingualism and socioeconomic status on language ability and executive functioning

One hundred and seventy-five children who were 6-years old were assigned to one of four groups that differed in socioeconomic status (SES; working class or middle class) and language background (monolingual or bilingual). The children completed tests of nonverbal intelligence, language tests assessing receptive vocabulary and attention based on picture naming, and two tests of executive functioning. All children performed equivalently on the basic intelligence tests, but performance on the language and executive functioning tasks was influenced by both SES and bilingualism. Middle-class children outperformed working-class children on all measures, and bilingual children obtained lower scores than monolingual children on language tests but higher scores than monolingual children on the executive functioning tasks. There were no interactions with either group factors or task factors. Thus, each of SES and bilingualism contribute significantly and independently to children’s development irrespective of the child’s level on the other factor.     

Do group-based mindfulness meditation programs enhance executive functioning? A systematic review and meta-analysis of the evidence

Research examining the effects of group-based mindfulness interventions on executive functioning have yielded inconsistent findings, with some reports of enhanced performance and other reports of null findings. Inconsistencies in the literature may be due to methodological differences across studies, including the type of control group employed and sample characteristics (e.g., clinical vs. non-clinical samples). The current systematic review and meta-analysis examined the effect of group-based mindfulness programs on executive functioning in persons 18+ years of age. Following the standards for systematic review, a total of 29 studies were included in the meta-analysis, of which 21 comparisons contributed to the analysis of inhibition; nine to working memory; nine to attention shifting; and four to the analysis of verbal fluency. After removing outliers, random effects models suggested a small but significant synthesized effect of group-mindfulness training on overall executive functioning (95% CI = 0.256, 0.725). Examination of executive subdomains after removing outliers suggested a small, statistically significant effect for inhibition (95% CI = 0.055, 0.387), working memory (95% CI = 0.010, 0.437), and verbal fluency (95% CI = 0.071, 1.931). No significant pooled effects were found for attention shifting. A priori subgroup analysis by randomization, type of control group, and sample cohort revealed inconsistent results. Overall, the current review suggests that the effect of group-based mindfulness training on executive functioning is not robust.     

A speech and psychological profile of treatment-seeking adolescents who stutter

PurposeThe purpose of this study was to evaluate the relationship between stuttering severity, psychological functioning, and overall impact of stuttering, in a large sample of adolescents who stutter.MethodParticipants were 102 adolescents (11–17 years) seeking speech treatment for stuttering, including 86 boys and 16 girls, classified into younger (11–14 years, n = 57) and older (15–17 years, n = 45) adolescents. Linear regression models were used to evaluate the relationship between speech and psychological variables and overall impact of stuttering.ResultsThe impact of stuttering during adolescence is influenced by a complex interplay of speech and psychological variables. Anxiety and depression scores fell within normal limits. However, higher self-reported stuttering severity predicted higher anxiety and internalizing problems. Boys reported externalizing problems—aggression, rule-breaking—in the clinical range, and girls reported total problems in the borderline-clinical range. Overall, higher scores on measures of anxiety, stuttering severity, and speech dissatisfaction predicted a more negative overall impact of stuttering.ConclusionTo our knowledge, this is the largest cohort study of adolescents who stutter. Higher stuttering severity, speech dissatisfaction, and anxiety predicted a more negative overall impact of stuttering, indicating the importance of carefully managing the speech and psychological needs of adolescents who stutter. Further research is needed to understand the relationship between stuttering and externalizing problems for adolescent boys who stutter.     

Executive Functioning and Gambling: Performance on the Trail Making Test is Associated with Gambling Problems in Older Adult Gamblers

ABSTRACT

Rates of gambling problems in older adults have risen with increased accessibility of gambling venues. One possible contributor to problem gambling among older adults is decreased self-control brought about by diminished executive functioning. Consistent with this possibility, Study 1 revealed that older adults recruited from gambling venues reported greater gambling problems if they also experienced deficits in executive functioning, measured via the Trail Making Test. Study 2 replicated this finding and demonstrated that problem gambling is associated with increased depression among older adults, mediated by increased financial distress. These studies provide support for the hypothesis that older adult gamblers who have executive functioning problems are also likely to have gambling problems.     

Neuropsychological Functioning in Children with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been associated with deficits in the areas of verbal memory and learning, executive functioning, working memory, and attention in adults. Findings have been less consistent in the few studies examining neuropsychological functioning in childhood PTSD, which are often limited by comparing children with PTSD to children without trauma histories, making it unclear whether observed neuropsychological deficits are related to trauma exposure or to PTSD symptomatology. In an ethnically diverse sample of 62 children who witnessed intimate partner violence (n = 27 PTSD+ and 35 PTSD?), children with PTSD exhibited slower and less effective learning, heightened sensitivity to interference, and impaired effect of rehearsal on memory acquisition on the California Verbal Learning Test – Children's Version, a word list learning task. Both groups performed in the below average range on measures of executive functioning, attention, and intellectual ability.     

The role of white matter hyperintensities and medial temporal lobe atrophy in age-related executive dysfunctioning

Various studies support an association between white matter hyperintensities (WMH) and deficits in executive function in nondemented ageing. Studies examining executive functions and WMH have generally adopted executive function as a phrase including various functions such as flexibility, inhibition, and working memory. However, these functions include distinctive cognitive processes and not all may be affected as a result of WMH. Furthermore, atrophy of the medial temporal lobe (MTA) is frequently observed in ageing. Nevertheless, in previous studies of nondemented ageing MTA was not considered when examining a relationship between white matter and executive function. The goal of the present study was to examine how WMH and MTA relate to a variety of executive functions, including flexibility, fluency, inhibition, planning, set shifting, and working memory. Strong correlations were observed between WMH and MTA and most of the executive functions. However, only MTA was related to flexibility and set shifting performance. Regression analysis furthermore showed that MTA was the strongest predictor of working memory, after which no further significant association with WMH was noted. Alternatively, both MTA and periventricular hyperintensities independently predicted inhibition performance. These findings emphasize the importance of MTA when examining age-related decline in executive functioning.     

Formant transitions in the fluent speech of Farsi-speaking people who stutter

PurposeSecond formant (F2) transitions can be used to infer attributes of articulatory transitions. This study compared formant transitions during fluent speech segments of Farsi (Persian) speaking people who stutter and normally fluent Farsi speakers.MethodsTen Iranian males who stutter and 10 normally fluent Iranian males participated. Sixteen different “CVt” tokens were embedded within the phrase “Begu CVt an”. Measures included overall F2 transition frequency extents, durations, and derived overall slopes, initial F2 transition slopes at 30 ms and 60 ms, and speaking rate.Results(1) Mean overall formant frequency extent was significantly greater in 14 of the 16 CVt tokens for the group of stuttering speakers. (2) Stuttering speakers exhibited significantly longer overall F2 transitions for all 16 tokens compared to the nonstuttering speakers. (3) The overall F2 slopes were similar between the two groups. (4) The stuttering speakers exhibited significantly greater initial F2 transition slopes (positive or negative) for five of the 16 tokens at 30 ms and six of the 16 tokens at 60 ms. (5) The stuttering group produced a slower syllable rate than the non-stuttering group.ConclusionsDuring perceptually fluent utterances, the stuttering speakers had greater F2 frequency extents during transitions, took longer to reach vowel steady state, exhibited some evidence of steeper slopes at the beginning of transitions, had overall similar F2 formant slopes, and had slower speaking rates compared to nonstuttering speakers. Findings support the notion of different speech motor timing strategies in stuttering speakers. Findings are likely to be independent of the language spoken.Educational objectives This study compares aspects of F2 formant transitions between 10 stuttering and 10 nonstuttering speakers. Readers will be able to describe: (a) characteristics of formant frequency as a specific acoustic feature used to infer speech movements in stuttering and nonstuttering speakers, (b) two methods of measuring second formant (F2) transitions: the visual criteria method and fixed time criteria method, (c) characteristics of F2 transitions in the fluent speech of stuttering speakers and how those characteristics appear to differ from normally fluent speakers, and (d) possible cross-linguistic effects on acoustic analyses of stuttering.     

Communication attitudes in children who stutter: A meta-analytic review

BackgroundThis article presents a meta-analytic review of differences in communication attitudes between children who stutter (CWS) and children who do not stutter (CWNS).MethodTo be included in this review, the studies had to include a group of CWS and CWNS between the ages of 3–18 years and a measurement of communication attitudes. The journal articles were identified by using the key words stutter*, speech disfluenc*, fluency disorder*, and stammer* cross-referenced to awareness*, reaction*, attitude*, KiddyCAT, CAT, A-19 Scale, PASS and OASES.ResultsA total of 18 studies met the inclusion criteria for this meta-analysis. The results showed that CWS exhibit more negative communication attitudes than CWNS from the preschool years. The differences between the groups increased with age, but were not influenced by gender.ConclusionThe results indicate that negative communication attitudes can be an effect of stuttering. Key issues requiring further investigation are whether communication attitudes differ as a function of age at stuttering onset and whether communication attitudes influence the development of stuttering.Educational Objectives: After reading this article, the reader will be able to: (a) summarise empirical findings with regard to the relationship between communication attitudes and childhood stuttering; (b) describe the different instruments used to measure communication attitudes; (c) discuss the relationship between communication attitudes, age and gender.     

Enfin,a podcast in French on stuttering! — "Je je je suis un podcast": Impacts of accessing stuttering-related information in one’s mother tongue

PurposeEnglish-language podcasts on stuttering are numerous. However, stuttering-related podcasts in French are far more rare. In order to create a space to explore stuttering for a French-speaking population, the Association bégaiement communication (ABC), a French-Canadian stuttering organization, produced “Je je je suis un podcast”. This study seeks to understand 1) how French, as the language of the podcast, has impacted accessibility to stuttering-related information in the Francophone stuttering community, and 2) how this information impacted listeners’ experience with stuttering.MethodAn anonymous online survey which included multiple choice, Likert scale and open-ended questions was conducted to better understand the impact, among listeners, of having access to a stuttering-related podcast in French. Answers were analyzed quantitatively and qualitatively.ResultsEighty-seven people (40 people who stutter [PWS], 39 speech-language pathologists [SLP]/SLP students, eight parents/close persons to a person who stutters), who had listened to “Je je je suis un podcast” participated in the survey. All three populations reported a greater accessibility, and a sense of identification and connection facilitated because of French. SLPs reported seeing the podcast as a way to support their practice, to gain perspective from PWS, and as a lever for change in the SLP field. PWS reported that the podcast gives them a sense of belonging that encourages involvement, as well as knowledge that empowers and supports them in managing their stuttering.Conclusion“Je je je suis un podcast” is a podcast about stuttering produced in French that increases accessibility to stuttering-related information and empowers PWS and SLPs.     

Auditory‐motor adaptation is reduced in adults who stutter but not in children who stutter

Previous studies have shown that adults who stutter produce smaller corrective motor responses to compensate for unexpected auditory perturbations in comparison to adults who do not stutter, suggesting that stuttering may be associated with deficits in integration of auditory feedback for online speech monitoring. In this study, we examined whether stuttering is also associated with deficiencies in integrating and using discrepancies between expected and received auditory feedback to adaptively update motor programs for accurate speech production. Using a sensorimotor adaptation paradigm, we measured adaptive speech responses to auditory formant frequency perturbations in adults and children who stutter and their matched nonstuttering controls. We found that the magnitude of the speech adaptive response for children who stutter did not differ from that of fluent children. However, the adaptation magnitude of adults who stutter in response to auditory perturbation was significantly smaller than the adaptation magnitude of adults who do not stutter. Together these results indicate that stuttering is associated with deficits in integrating discrepancies between predicted and received auditory feedback to calibrate the speech production system in adults but not children. This auditory‐motor integration deficit thus appears to be a compensatory effect that develops over years of stuttering.     

Statin Use,Ageing, and Cognition: A Review

Cholesterol performs a number of important roles in normal brain functioning, including the formation of myelin sheaths and communication between cells, and it has been theorised that statin use could disrupt these roles leading to deficits in cognition. Relevant research was identified via the La Trobe University library Summon^TM search tool, using search terms including “statin cognition,” “statins cognition,” “statin brain,” “cholesterol cognition,” “cholesterol brain,” and “statin adverse effects” in addition to examination of the reference lists of the retrieved research articles. Research was examined from the published literature across several different research modalities: systematic reviews and meta‐analyses, randomised control trials, cohort studies, and case reports. On the basis of the surveyed literature, it is not possible to indicate any consistent caution or limitation with regard to the use of statins and their effects upon cognitive functioning due to the contradictory and inconsistent results arising from this literature. In summary, it is not possible to conclusively determine whether there are either cognitive benefits or detriments associated with the use of the statins. The determination of the effect of these agents on neuropsychological functioning requires more methodologically controlled long‐term longitudinal follow‐up studies of these treatments due to the complex and multisystem effects of these agents.     

The role of executive functions in bilingual children with reading difficulties

To explore the joint effect of reading difficulties (RD) and bilingualism on executive functions, 190 children of four groups of 9–12 year‐olds (41 bilinguals with RD, 45 monolinguals with RD, 45 bilinguals without RD, and 59 monolinguals without RD) were examined on the Concentration game, Tower of Hanoi, and Stroop as measures of executive functioning tapping into inhibitory/attentional control, working memory and planning ability. The most prominent finding was that in terms of RD, the speed of performances decreased dramatically. This general decrease was more pronounced for bilingual children with RD than for their monolingual counterparts. In conclusion, the findings suggest that while bilinguals gain more from executive functions in normal reading, they lose in terms of RD. Such an outcome confirms that executive functions are essential components of both reading and bilingualism, which depending on whether reading conditions are normal or difficult will produce cognitive advantages or disadvantages. Further, it is argued that dissimilarity between the Farsi and Swedish languages may complicate handling of such a situation.