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.     

Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter

PurposeMany school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter.MethodsTen children and adolescents who stutter (aged 9–17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions.ResultsResults show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment.ConclusionOur results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking.     

Delayed N2 response in Go condition in a visual Go/Nogo ERP study in children who stutter

Purpose of the studyThe main aim of the study was to investigate the attentional and inhibitory abilities and their underlying processes of children who stutter by using behavioural measurement and event-related potentials (ERP) in a visual Go/Nogo paradigm.MethodsParticipants were 11 children who stutter (CWS; mean age 8.1, age range 6.3–9.5 years) and 19 typically developed children (TDC; mean age 8.1, age range 5.8–9.6 years). They performed a visual Go/Nogo task with simultaneous EEG recording to obtain ERP responses.ResultsResults showed that CWS had longer N2 and P3 latencies in the Go condition compared to the TDC. In contrast, the groups did not differ significantly in the Nogo condition or behavioural measures.ConclusionsOur findings did not confirm less efficient inhibitory control in CWS but suggest atypical attentional processing such as stimulus evaluation and response selection.Educational Objectives: The reader will be able to (a) describe recent findings on attention and inhibitory control in children who stutter, (b) describe the measurement of attentional processing, including inhibitory control, and (c) describe the findings on attentional processing in children who stutter as indexed by the event-related potentials in a visual Go/Nogo paradigm.     

Relation of motor,linguistic and temperament factors in epidemiologic subtypes of persistent and recovered stuttering: Initial findings

PurposeThe purpose of this study was to determine the presence of any patterns reflecting underlying subtypes of persistence and recovery across epidemiologic, motor, language, and temperament domains in the same group of children beginning to stutter and followed for several years.MethodsParticipants were 58 2–4-year-old CWS and 40 age and gender matched NFC from four different sites in the Midwest. At the end of the multi-year study, stuttering children were classified as Persistent or Recovered. The same protocol obtaining data to measure stuttering, motor, language and temperament characteristics was used at each site. They have not been included in previous reports.ResultsThe Persistent group performed consistently differently from the Recovered and Control groups. They performed lower on standardized language tests and in phonological accuracy, had greater kinematic variability, and were judged by their parents to be more negative in temperament.ConclusionsThe present study provides data supporting the hypothesis that subtypes of stuttering can be identified along persistency/recovery lines, but results were not definitive.Educational Objectives: Readers will be able to (a) describe the current state of subtypes of stuttering research; (b) summarize possible contributions of epidemiologic, motoric, linguistic and temperament to such subtyping with regard to persistency and recovery.     

Parents’ reactions to children’s stuttering and style of coping with stress

PurposeThe aim of the research was to determine: (a) how parents react to their child’s stuttering, (b) what stress coping strategies they utilise, as well as (c) whether stress coping style depends on parents’ reaction to their child’s stuttering.MethodsThe research involved 23 mothers and 23 fathers of children who stutter (CWS) at the age of three to six years old. The Reaction to Speech Disfluency Scale (RSDS), developed by the authors, was used in the research. To determine the parents’ coping the Coping Inventory in Stressful Situations (CISS) by N.S. Endler and D.A Parker was applied.ResultsThe strongest reactions are observed on the cognitive level. Stronger cognitive, emotional and behavioural reactions are observed in the mothers towards their disfluently speaking sons and in the fathers towards their daughters. Having analysed the profiles of coping styles, it can be noticed that the task-oriented coping is most frequently adapted by the fathers. The mothers most often use the avoidance-oriented coping. No relevant correlation was observed between the fathers’ coping style and their reactions to the child’s disfluent speech. As far as the mothers are concerned, it has been proved that an increase in behavioural reactions correlates with the avoidance-oriented coping.ConclusionThe cognitive reactions of the parents’ towards their child’s stuttering were most frequent, while the emotional ones were the least frequent. Confronted with a stressful situation, the fathers most often adapt the task-oriented coping, whereas the mothers use the avoidance-oriented coping. Educational objectives: the reader will be able to (1) learn what the key reactions of parents to their children’s stuttering are, (2) describe stuttering as a stress factor for the parents, (3) describe the factors which influence parents’ reactions to their child’s stuttering and their coping style.     

Preliminary study of self-perceived communication competence amongst adults who do and do not stutter

PurposeAdults who stutter report a significant impact of stuttering on their quality of life, including negative thoughts and attitudes toward communication. In addition to this impact, adolescents who stutter also report lower levels of self-perceived communication competence (SPCC) compared to fluent peers. The purpose of this study was to extend the investigation of SPCC to adults who do and do not stutter. Additional aims investigated included if 1) SPCC predicted overall impact of stuttering, and, 2) stuttering frequency predicted SPCC among adults who stutter.MethodsTwenty-four adults who stutter and twenty-seven adults who do not stutter matched for age, gender, and education completed the Self-Perceived Communication Competence Scale (Richmond & McCroskey, 1997). All participants who stutter completed the Overall Assessment of the Speaker’s Experience of Stuttering (OASES [ages 18+]; Yaruss & Quesal, 2006) and speaking samples to measure stuttering frequency.ResultsAdults who stutter reported significantly lower SPCC scale total scores than adults who do not stutter. For adults who stutter, lower SPCC scale scores significantly predicted more severe overall impact of stuttering as measured by the OASES. Stuttering frequency did not predict SPCC scale scores.DiscussionThis is the first study to report differences in self-perceived communication competence between adults who do and do not stutter. Results suggest adults who stutter report lower self-perceived communication competence compared to adults who do not stutter. Adults who perceive themselves to have greater communication competence reported less severe overall impact of stuttering, and stuttering frequency did not influence SPCC. Clinical implications for intervention are discussed.     

Children and adolescents who stutter: Further investigation of anxiety

PurposeDespite the greatly increased risk of social anxiety disorder in adults who stutter, there is no clear indication of the time of onset of this disorder in childhood and adolescence. The purpose of this study was to explore this issue further using the Revised Children's Manifest Anxiety Scale (RCMAS), so that appropriate interventions can be developed prior to adulthood. This is the first time the RCMAS has been completed by children younger than 11 years. Using the same test for both school-age children and adolescents can potentially identify when anxiety starts to develop from age 6 years through to adulthood.MethodsThe RCMAS was administered to 18 school-age boys, five school-age girls, 41 adolescent boys and nine adolescent girls who were seeking treatment for their stuttering. Participants also rated the severity of their own stuttering.ResultsAll mean scaled scores on the four RCMAS subscales and Total Anxiety scores were within normal limits. However, for both groups of boys, scores on the Lie Scale were significantly higher than scores on the other three subscales.ConclusionsExperts suggest high scores on the RCMAS Lie Scale are indicative of participants attempting to present themselves in a positive light and so cast doubt on the veracity of their other responses on the test. One interpretation, then, is that the boys were concealing true levels of anxiety about their stuttering. The results suggest why findings of anxiety studies in children and adolescents to date are equivocal. Clinical implications are discussed.Educational objectives: The reader will be able to: (a) discuss why understanding when anxiety starts in people who stutter is important, (b) describe the function of the RCMAS Lie sub scale and (c) summarize the possible implications of the RCMAS findings in this study.     

A parent-report scale of behavioral inhibition: Validation and application to preschool-age children who do and do not stutter

PurposeThis 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.MethodParticipants 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).ResultsStudy 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).ConclusionFindings 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.     

Loci of stuttering of English- and Korean-speaking children who stutter: Preliminary findings

PurposeThe purpose of the study was to determine whether differences exist between young English- and Korean-speaking children who stutter (CWS) in the loci of stuttering.MethodParticipants were 10 Korean-speaking and 11 English-speaking CWS between the ages of 3 and 7 years. Participants produced narratives while viewing various picture scenes and a wordless picture book.ResultsFindings indicated that Korean-speaking CWS stuttered more on content than function words whereas English-speaking CWS stuttered more on function than content words. Furthermore, both Korean- and English-speaking CWS tended to stutter more on utterance-initial words. These findings appear to be related to the differences in linguistic/syntactic structures between Korean and English. Specifically, in the Korean-speaking CWS’s narratives, most utterance-initial words (73.60 %) were content words whereas in the English-speaking CWS’s narratives, most utterance-initial words (83.57 %) were function words.ConclusionThese preliminary findings, although in need of replication with a larger sample size, seem to suggest that the word class (i.e., content/function words) contributions to stuttering loci are more language-specific whereas the word position (i.e., utterance-initial position) contributions to stuttering loci are more language-nonspecific. Given that the true characteristics of stuttering may be rather language-nonspecific than language-specific, further research may need to focus more on stuttering loci related to word position than word class.     

Past tense marking in the spontaneous speech of preschool children who do and do not stutter

PurposeThe aim of this study was to identify whether different patterns of errors exist in irregular past-tense verbs in children who stutter (CWS) and children who do not stutter (CWNS).MethodSpontaneous language samples of thirty-one age- and gender-matched pairs of children (total N = 62) between the ages of 24 months and 59 months were analyzed.ResultsResults indicated that children who do and do not stutter over-regularize irregular past-tense verbs (i.e., saying runned for ran) with comparable frequency. However, two nonsignificant trends which suggest possible intra-group differences were noted. First, irregular past tense verbs represented a greater portion of total verbs for CWS than for CWNS. Second, CWS appeared to double-mark (i.e., say ranned for ran) more often than CWNS. Results are discussed in light of theories about the acquisition of the irregular past-tense and about differences in language skills between CWS and CWNS.Educational objectives: After reading this article, the reader will be able to: (a) summarize previous findings about connections between stuttering and language in CWS and CWNS; (b) describe similarities and differences between irregular past-tense verb use and errors in CWS and CWNS; (c) discuss possible connections between the declarative–procedural model and stuttering.     

Atypical central auditory speech-sound discrimination in children who stutter as indexed by the mismatch negativity

PurposeRecent theoretical conceptualizations suggest that disfluencies in stuttering may arise from several factors, one of them being atypical auditory processing. The main purpose of the present study was to investigate whether speech sound encoding and central auditory discrimination, are affected in children who stutter (CWS).MethodsParticipants were 10 CWS, and 12 typically developing children with fluent speech (TDC). Event-related potentials (ERPs) for syllables and syllable changes [consonant, vowel, vowel-duration, frequency (F0), and intensity changes], critical in speech perception and language development of CWS were compared to those of TDC.ResultsThere were no significant group differences in the amplitudes or latencies of the P1 or N2 responses elicited by the standard stimuli. However, the Mismatch Negativity (MMN) amplitude was significantly smaller in CWS than in TDC. For TDC all deviants of the linguistic multifeature paradigm elicited significant MMN amplitudes, comparable with the results found earlier with the same paradigm in 6-year-old children. In contrast, only the duration change elicited a significant MMN in CWS.ConclusionsThe results showed that central auditory speech-sound processing was typical at the level of sound encoding in CWS. In contrast, central speech-sound discrimination, as indexed by the MMN for multiple sound features (both phonetic and prosodic), was atypical in the group of CWS. Findings were linked to existing conceptualizations on stuttering etiology.Educational objectives: The reader will be able (a) to describe recent findings on central auditory speech-sound processing in individuals who stutter, (b) to describe the measurement of auditory reception and central auditory speech-sound discrimination, (c) to describe the findings of central auditory speech-sound discrimination, as indexed by the mismatch negativity (MMN), in children who stutter.     

Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering

PurposeRecent research has identified approximately half of children who stutter present with self-regulation challenges. These manifest in elevated inattentive and/or impulsive behaviours, aligned with attention deficit hyperactivity disorder (ADHD) symptoms. These symptoms have been found to influence the child’s responsiveness to their stuttering treatment, and may exacerbate the psychosocial consequences of stuttering for them and their families. Early stuttering intervention identifies parents as key agents of change in the management of their children’s stuttering. This study sought feedback from parents regarding their experiences with an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering, addressing the child’s self-regulation challenges.MethodEight parents of children who stutter who had co-occurring self-regulation challenges completed the integrated program. This incorporated the Triple P--Positive Parenting Program adapted for the developmental stuttering population, and the Curtin University Stuttering Program (CUSP). Semi-structured qualitative interviews were conducted to capture parents’ reflections on, and experiences with, the integrated program.ResultsThematic analysis identified several major themes regarding the parents’ experiences with the integrated program: emotional impact on parents, child self-regulation, link between stuttering and behaviour, parent self-regulation, impact on family dynamics, and overall positive perceptions of the integrated program. All of the parents indicated they would recommend the program to future parents of children who stutter.ConclusionThis study provides insights into parents’ perceptions regarding an integrated intervention approach for early stuttering and behavior management. It also indicates how adopting a holistic approach to stuttering intervention is positive and has social validity.     

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.     

An exploratory factor analysis of action responses to stuttering anticipation

PurposeWe previously introduced theStuttering Anticipation Scale (SAS; Jackson, E. S., Gerlach, H., Rodgers, N. H., & Zebrowski, P. M. (2018). My Client Knows That He’s About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? Seminars in Speech and Language, 39, 356–370) – a non-standardized self-report measure for children, teens, and adults who stutter (CWS, TWS, AWS) that quantifies how often they engage in 25 commonly reported action responses to anticipation. The purpose of this study was to leverage the SAS to explore the factor structure of action responses to stuttering anticipation.MethodsA total of 121 people who stutter completed the SAS online (27 CWS, 40 TWS, 54 AWS). We used exploratory factor analysis (EFA) to determine the underlying latent variables within the 25 SAS items that characterize how people who stutter respond to anticipation.ResultsA three-factor model was most appropriate for the data with regard to factor loadings and other model fit indices. The three factors were named: avoidance (17 items), physical change (4 items), and approach (4 items).ConclusionUnderstanding these three types of action responses to anticipation can help guide clinical decision-making by providing a novel framework for clinicians and their clients who stutter to discuss how the client tends to respond to anticipation, and explore ways to facilitate productive responses to anticipation.     

Elevated attention deficit hyperactivity disorder symptoms in children who stutter

PurposeThis study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken.MethodParticipants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria).ResultsOne-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment.ConclusionThe large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.     

An experiment on measuring awareness of stuttering in individuals with Down syndrome

BackgroundAwareness of stuttering is likely to depend upon the development of the metalinguistic skill to discriminate between fluent speech and stuttering and the ability to identify one’s own speech as fluent or stuttered. Presently, little is known about these abilities in individuals with Down syndrome (DS).PurposeThis study investigates whether individuals with DS and typically developing (TD) children who stutter and who do not stutter differ in their ability to discriminate between fluent speech and stuttering. The second purpose of this study is to discover if this ability is correlated with their self-identification ability.MethodAn experiment to investigate awareness with tasks for discrimination of stuttering and self-identification was developed. It was administered to 28 individuals (7–19 years) with DS, 17 of them stutter and 11 do not, and 20 TD children (3–10 years), 8 of them stutter and 12 do not. Skills to discriminate stuttering were compared between these groups and correlated with self-identification within these groups. The influence of stuttering severity and developmental/chronological age on their ability to discriminate was also investigated.ResultsThe ability to discriminate does not differ significantly between the DS and TD group, but is highly influenced by developmental age. This ability correlates with self-identification but only for the TD individuals who speak fluently.ConclusionThe ability to discriminate matures around the age of 7 and conscious awareness may rely on this ability. Differences between the present findings and earlier studies suggest that differentiation in levels and types of awareness is warranted.     

Visual exogenous and endogenous attention and visual memory in preschool children who stutter

PurposeAttention develops gradually from infancy to the preschool years and beyond. Exogenous attention, consisting of automatic responses to salient stimuli, develops in infancy, whereas endogenous attention, or voluntary attention, begins to develop later, in the preschool years. The purpose of this study was to examine (a) exogenous and endogenous attention in young children who stutter (CWS) and children who do not stutter (CWNS) through two conditions of a visual sustained selective attention task, and (b) visual short-term memory (STM) between groups within the context of this task.Method42 CWS and 42 CWNS, ages 3;0–5;5 (years;months), were pair-matched in age, gender (31 males, 11 females per group), and socioeconomic status. Children completed a visual tracking task (Track-It Task; Fisher et al., 2013) requiring sustained selective attention and engaging exogenous and endogenous processes. Following each item, children were asked to recall the item they had tracked, as a memory check.ResultsThe CWS group demonstrated significantly less accuracy in overall tracking and visual memory for the tracked stimuli, compared to the CWNS group. Across groups, the children performed better in sustained selective attention when the target stimuli were more salient (the condition tapping both exogenous and endogenous attention) than when stimuli were less so (the condition tapping primarily endogenous processes).ConclusionsRelative to peers, preschool-age CWS, as a group, display weaknesses in visual sustained selective attention and visual STM.     

Disfluency data of German preschool children who stutter and comparison children

This study compared the disfluencies of German-speaking preschool children who stutter (CWS, N = 24) with those produced by age- and sex-matched comparison children who do not stutter (CWNS, N = 24). In accordance with Yairi and Ambrose's [Yairi, E., & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminary report. Journal of Speech and Hearing Research, 35, 755-760] guidelines the CWS group had a narrow age range (2-5 years) and were seen close to the reported time of their stuttering onset (average of 8 months). Furthermore, over 95% of the CWS group had not received any type of speech therapy intervention. Consistent with previous findings for English-speaking preschool children, 'stuttering-like' disfluencies (prolongations, blocks, part- and one-syllable word repetitions) were significantly more frequent in CWS (mean = 9.2%) than in CWNS (mean = 1.2%), whereas no significant group differences occurred with respect to 'normal' disfluencies. The number of iterations in stuttering-like disfluencies was also significantly higher in CWS (mean = 1.28 iterations) than in CWNS (mean = 1.09 iterations). In contrast to previous findings, a sub-group of children who have been stuttering for a shorter time (1-5 months) did not differ from a sub-group who had stuttered for a longer period (8-22 months). EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how German-speaking preschool children who stutter and who do not stutter display stuttering-like and normal disfluencies including number of iterations; (2) explain how powerful classification measures for the diagnosis of stuttering are for German-speaking preschool children; (3) discuss how disfluency patterns of native English- and German-speaking children close to onset of stuttering differ.     

Multilingual children who stutter: clinical issues

Stuttering occurs across all languages and cultures. However, the impact of speaking more than one language on assessment and treatment of young children who stutter is not well documented. This paper discusses some of the challenges related to clinical issues pertaining to this population including (a) identifying stuttering in an unfamiliar language, (b) the influence of language proficiency, and (c) treatment of multilingual young children who stutter. The paper is written from the perspective of the author's experience treating multilingual children who stutter within the context of the linguistic and cultural diversity of Canada, notably in the French speaking Province of Quebec where many children grow up speaking two or more languages in everyday life. Clinical examples will be taken from the evidence-based literature as well as the author's clinical experience.Educational objectives: After reading this paper, the learner will be able to (1) summarize the literature regarding assessment and treatment of stuttering in young children speaking more than one language, (2) summarize some of the challenges related to this issue and (3) describe some of the findings associated with treatment of bilingual children who stutter and (4) be prepared to apply some of these suggestions in the treatment of bilingual children who stutter.     

Phonetically governed voicing onset and offset in preschool children who stutter

Phonetically governed changes in the fundamental frequency (F₀) of vowels that immediately precede and follow voiceless stop plosives have been found to follow consistent patterns in adults and children as young as four years of age. In the present study, F₀ onset and offset patterns in 14 children who stutter (CWS) and 14 children who do not stutter (CWNS) were investigated to evaluate differences in speech production. Participants produced utterances containing two VCV sequences. F₀ patterns in the last ten vocal cycles in the preceding vowel (voicing offset) and the first ten vocal cycles in the subsequent vowel (voicing onset) were analyzed. A repeated measures ANOVA revealed no group differences between the CWS and CWNS in either voicing onset or offset gestures. Both groups showed patterns of F₀ onset and offset that were consistent with the mature patterns seen in children and adults in previous studies. These findings suggest that in both CWS and CWNS, a mature pattern of voicing onset and offset is present by age 3;6. This study suggests that there is no difference between CWS and CWNS in the coordination of respiratory and laryngeal systems during voicing onset or offset.Educational objectives: The reader will be able to: (a) discuss the importance of investigating children who stutter close to the onset of stuttering; (b) describe the typical change in F₀ during voicing onset; (c) discuss the potential implications of these results with regard to future research.