Disfluency Characteristics of 4- and 5-Year-Old Children Who Stutter and Their Relationship to Stuttering Persistence and Recovery

Abstract

Purpose The purpose of this study is to document disfluency behaviors expressed by 4- and 5-year-old children who stutter and to identify whether stuttering characteristics at this age are predictive of later stuttering recovery or persistence. Method We analyzed spontaneous speech samples from 47 children diagnosed with developmental stuttering when they were 4–5 years old. Based on their eventual diagnosis made the final year of participation in the longitudinal study when the children were 6–9 years old, the children were divided into two groups: children who eventually recovered from stuttering ( n = 29) and children who were persisting ( n = 18). We calculated a composite weighted stuttering-like disfluency (SLD) index of overall severity that considers the frequency, type, and number of repetition units of SLDs. The frequency and type of typical disfluencies were also examined. Results Higher weighted SLD scores at ages 4–5 years were associated with a higher probability of persistent stuttering. The weighted SLD also significantly discriminated between children who would eventually be diagnosed as persisting or recovered from stuttering. The frequency and type of typical disfluency did not distinguish the two groups of children; however, children who were persisting had significantly higher frequencies of part-word repetitions and dysrhythmic phonations (i.e., blocks, prolongations, and broken words) and maximum number of part-word repetitions compared to children who eventually recovered from stuttering. Conclusions Previous findings in younger, 2- to 3-year-old children who stutter did not suggest a relationship between the severity and type of children's SLDs and their eventual stuttering outcome. Yet, by the age of 4–5 years, we found that the weighted SLD, a clinically applicable tool, may be used to help identify children at greater risk for stuttering persistence. We propose that the weighted SLD be considered, along with other predictive factors, when assessing risk of stuttering persistence in 4- and 5-year-old children who are stuttering.

Exploring Relationships Among Risk Factors for Persistence in Early Childhood Stuttering

“…Yairi and Ambrose (1999) confirmed that the frequency of typical disfluencies did not differentiate groups of CWS and children who do not stutter (CWNS). We and others also note that the frequency of typical disfluencies is statistically similar between groups of CWS-ePer and CWS-eRec (Singer et al, 2020;Walsh et al, 2020). On the other hand, stuttering-like disfluencies (SLDs)-sound prolongations, blocks, sound/syllable repetitions, and monosyllabic whole-word repetitions-not only differentiate CWS from those who do not stutter but also distinguish CWS-ePer and CWS-eRec (Walsh et al, 2020).…”

“…Our longitudinal data also indicated that CWS-ePer (n = 18; M = 36.3 months) began stuttering approximately 2 months later than the group of CWS-eRec (n = 29; M = 34.3 months). This difference was also not statistically significant; the two groups largely overlapped (Walsh et al, 2020). The recent meta-analysis by Singer et al (2020) reported later ages at stuttering onset for children who would eventually persist.…”

“…It follows then that the chance of recovery decreases as a child continues to stutter past 15 months. In our recent study, we noted a lower recovery rate of approximately 62% for a cohort of forty-seven 4-and 5-year-old CWS (Walsh et al, 2020). These children had already been stuttering, on average, 21 months, so our sample did not include children whose stuttering resolved earlier than age 4-5 years.…”

“…Consequently, parents may be counseled to delay therapy to allow time for natural remission. Recovery rates decline, however, to 50%-60% by the time a child reaches age 5 years (Walsh et al, 2018(Walsh et al, , 2020Yairi & Ambrose, 2005). Delaying therapy for children at greater risk for persisting allows atypical neural speech motor networks to form (Chang & Zhu, 2013;Garnett et al, 2018;Hosseini et al, 2018;Walsh et al, 2017), resulting in a challenging speech disorder to treat.…”

“…Over the past 15 years, our longitudinal research has explored physiological, behavioral, and clinical factors associated with stuttering persistence and recovery in preschool children (for a review, see Walsh et al, 2018). In this prospective study, we focus on a subset of risk factors available to clinicians that were associated with stuttering persistence and recovery in ours and other's earlier work (Spencer & Weber-Fox, 2014;Walsh et al, 2020;Yairi & Ambrose, 2005). We examined whether epidemiological and clinical factors recorded when children who stutter (CWS) entered the study, between the ages of 3 and 5 years collectively confer an increased risk for stuttering persistence.…”