Childhood Stuttering: Risks and Factors

Competition for Neural Resources

• A limited amount of brain resources can be applied to learning to speak and learning to walk.
• Tasks requiring great attention or neural activity result in fewer resources for other simultaneous tasks.

Life Events

• Stressful occurrences like parents' divorce or hospitalization can affect a child's life.

Speech and Language Environment

• Pertains to the communication style within a child’s home.
• Rapid speech, complex language, and frequent interruptions from parents, siblings, and relatives are factors.
• These factors are believed to cause stress, which can affect a child's speech.

Stuttering Risk

• Constitutional factors lie dormant until the two-word stage of language development.
• Rapid motor and cognitive development plus environmental factors contribute to the conditions where stuttering appears.
• Developmental and environmental factors can either induce or mitigate stuttering.
• Rapid language development can help a child keep up with complex sentences, bridging potential stuttering gaps.
• Modifying a child’s environment, like slowing down the pace of a fast-talking family and allowing the child time to speak, can help.

Van Riper's Observation

• Stuttering often emerges quietly, interacting with constitutional factors.
• Stuttering often begins under normal conditions without apparent conflicts, illnesses, or shocks.

Research on Developmental and Environmental Factors

• Research hasn't definitively determined critical developmental and environmental factors due to the normality of children's lives when stuttering starts.
• Most onsets occur during rapid preschool development.
• Stresses are sometimes linked to stuttering onset and remission.
• Higher incidences occur in competitive cultures with high standards and less tolerance like the United States and Japan.
• Lower incidences are seen in less competitive cultures like New Guinea and aboriginal Australia.
• Genetic studies show that genes alone don't cause stuttering, suggesting the involvement of environmental factors.

Interdependence of Factors

• Developmental and environmental factors don't operate independently.
• An evaluation should explore a child's developmental level and environmental challenges.

Neural Resources

• Competition for neural resources exists in children.
• The brain must share resources to manage sights, sounds, and feelings.
• As the brain nears maximum capacity, tasks are performed less efficiently.
• Immature nervous systems in children have less processing capacity.
• Uneven skill development may cause disfluency when physical and cognitive growth compete with speech coordination.
• Maturation of speech and language components are characteristic of children who stutter.

Example of Competition Between Language and Motor Abilities

• A 4-year-old repeated words/sounds excessively, had above-average language development (first words at 9 mos, sentences at 12 mos), but slower motor skills (walked at 18 mos).
• Her disfluencies resulted from high cerebral resources to express language, and less mature capacities for motor activities, including fluent speech.
• Disparity between language facility and motor speech ability can contribute to stuttering.

Child Development

• Development of the social, motor, and language domains occurs simultaneously
• A child needs to master many different abilities simultaneously
• Dyssynchronous development (slower in one or more areas) may contribute to stuttering if domains relevant to fluent speech are involved

Demands of Physical and Motor Development

• Physical growth spurts correlate with increased stuttering
• Intensive growth is a double-edged sword that spurs other motor developments which compete, and may interfere, with fluency
• Walking or talking usually learned first, but not at the same time

Change in Vocal Tract

• A challenge to speech motor control is the rapid physical change in the vocal tract between ages 2 and 5
• Structures in a child's head, neck and torso undergo their most accelerated growth
• Children maintain stable output via feedback to update motor commands

Delays in Motor Development

• Inefficient neurological structures, pathways, and networks in children who stutter, which are detected through various measures of motor coordination/movement instability
• Recent studies suggest that children who stutter have a delay in motor control development
• Children who persist in stuttering tend to show less mature speech motor development for their age
• Dissociation may contribute to onset/persistence because of strain on neural resources

Summary of the Effect of Physical and Motor Development on Fluency

• The neural demands of motor development will affect typically developing children, by postponing learning complex levels of phonology, morphology, syntax, and semantics
• Children with compromised speech motor may be more affected
• These delays appear greater in the children who persist with stuttering, and research suggests dissociations between motor and language in the children who stutter

Language Learning and the Onset of Stuttering

• Individuals who stutter may have a fragile speech production system that would be stressed by demands of needing more/more complex language
• Children who are learning language may be prone to disfluencies due to the load that a new and complex skill puts on speech production neural resources
• Early language is most frequently associated with the onset of stuttering

Language Learning Review

• At ages 2 and 3, a vocabulary jumps from 50 to well over 500 words
• Single word utterances develop into successive single-word pairs and multiword sentences
• Speech goes from simple, "syllable-timed" prosody to complex prosodic rhythms, a child overhauls a language storage system by: stocking whole words in the form of articulatory routines/gestural patterns, changing inventory, and stocking segments for building words from other segments.
• Also progresses during the same preschool years to learn active, negative, and passive constructions; present/future/past tenses, and increases complexity with the rate of utterances to synchronize the rates/rhythms for those close to them
• It isn't a surprise children stutter at this time, most clinician - researchers have speculated on the link between language learning and stuttering
• Dalton and Hardcastle observed "ever-increasing demands on linguistic competence and articulatory proficiency as major factors in the onset of some disfluency,”
• Sheehan found age onset is consistently related to stages in the developmental sequence Andrews pointed to the demands placed on speech by rapidly developing language

Connection of Greater Language, and Increase in Stuttering

• Utterance length may have a greater affect
• A longitudinal study indicated variability for longer sentences in the developing children

Disfluencies

• Normal disfluencies didn't emerge upon use of language constructions for nonstuttering children over time, but when mastered as a new construction and started using regularly
• Learning this routine has so much processing capacity, that speech production was short changed, the preliminary study needs follow-up with many more cases

Brain Structure

• Abnormally high levels of the right hemisphere with compromised matter
• Tasks using different neural networks for segment selection and utterances are reduced

Language Decrease Stuttering

• Hollister viewed language development in some cases reducing stuttering
• Recovering children easily manage the demands of producing longer sentences, speech is not stressed as a result

Delayed and Deviant Language Development

• Delay overall language development from inheritance and/or injury of children that stutter- language delays in that case could occur with stuttering, but not cause it
• The children become frustrated and develop fears about speaking
• A significant amount of people stutter and have like-disfluencies for language therapy/delayed to produce language may create the signs of stuttering

Nippold Surveyed

• Determined that the language capabilities of children who stutter are the same as those that do not
• Tested those from ages 2-5 and the children tested better in language measures.
• The study was a mix of recovered so to make sense: subdivided those who persist have lower measures, and those that recover is similar

Neuro Psychologists

• The study with Anderson, Pellowski and Conture in (2005) had poorer speech on average, although these patients were within normal ranges however It was noted that nearly 3 times as many in the stuttering group, in the matter to resolve speech that would lead to production

Summary Of Speech and Language Development

• The time when understanding produce speech and language occurs is commonly when children are most in line, this causes stress and more fragile communication systems. And are not always delayed but some might need work

Cognitive Development

• Refers to function to play roles and can be separate and intertwined
• can affect speech in two: through spurts and advanced abilities

Cognition and Onset of Fluctuation

• In certain environments the child’s growth is not as obvious or sudden or better in preschool if severe

Language/Thinking Relationship

• Solving the thinking and planning causes less availability to produce fluently
• Piaget’s period transition with assimilation and consolidation of learning
• Lingustic and Cognitive systems are more vulnerable to disfluencies

High Cognitive Demands

• Starkweather suggested some may temporarily make a child worse
• A multitude of studies say that incidence occurs, especially in the lower level because they need to acquire things faster

Research by Choo et al

• Stutter less in children who have functions, there is a possibility of speech that is better by having more resources needed to process, this allows a process to stutter has had poorer cognitive skills, and that will lead to low motor skills.

Cognition and Reactions

• Also can help form speech as they are older such as (3)
• Some are are more likely as something not right while other make fun

Emotions from Children Who Stutter

• It’s clear that that age they are comparing to others Em-barrasment and shame are rising those two in conjunction may play a part and make it harder to treat
• This can can cause tension and avoiding those responses

Summary of Developmental Effects

• the extra needs to compensate because of growth can affect their ability to manage speech, it precipitates or worsens but cognitive development is different.

Social and Emotional Development

• Children's are affected by what triggers emotion or worsens certain type of fluency

Disturbance of Speech

• Many people might may experience a disturbed voice or hard times to maintain steady breath the neural networks will not be strong

Interruption from Limbic System

• Signals will then lead to time and sequencing, and the system is interrupted with speech, this can be noticed in the beginning of speaking

Transitory Emotions

• During stuttering it is first notified when the activity, during other studies (johnson) they noticed that when the child told something or excited- so therefore normal and emotion and stuttering occur when arousal is there

• Further studies by Ntourou also supported that those are factors, with increased stuttering

• This is related also diverts with other systems

Social/Emotional

• Rothbart describes several stages that are stressful, if they are born they may result to their stress. And need to regulate as they become grown
• Soothing the need may be needed to increase coping skills that secure their stresses of children so parents have a great effect

Emotional Security

• As the parent begins role to develop their own and create new systems, there may be some severe outcomes in this can be a challenge for children

Consciousness

• the increasing awareness if a child is having issues can lead more self- correction
• And this what it is important to see temperment as the the child may increase

Conclusion from Eggers

• That those who have the negative re activit(reacting easy) and that does cause them to stutter
• So for both there might be an argument to have in some factors

Summary of Social Factors

• They could be predisposed during those times, but this is anecdotal
• As more the increase noise is created then it was become an issue
• The listener may become a trigger to react and worsen the problem.

Environmental Factors

• Pressure and stress at home or at school
• Conversational style at home
• Influence from genetic or develomental factors

The Diagnosogenic

• Is that misdignosis, disfluncies are not usually found

Parenting Tips

• Perfectionistic is also a factor but is mixed
• The result for parents
• Vigilant is also factor from children

Communication Styles With Home

• If the home doesn't follow the child might cause faltering
• Research
  • Rate of speech
  • Interruptions of speaking
  • Frequency of asking a question
  • Language complexity

Articulatory Rates

• Was confirmed by other studies that they were all tested, but the children slowed rates would make it severe. So those studies needed a decrease

Interruptions

• Are in addition also, because they have had evidence the stuttering were most in these environments those those studies also might need work. Deliberately also found that the amount was not effective but rather those issues need to be taken on as a whole

Questions for Children is Needed

• If they are in a non stuttering environment, that does not mean they are struggling
• Direct testing does exist but may be related in either condition

Language Complexity

• They focused on that compared to those who didn’t in language in the mom, by using different numbers of words to know those kids cannot recover over the 3 year period

Mile and Ranter Assessed

• Those who are not recovering, less language is better for the child
• But speech can precipate or worsen stress.

Life Events

• Delivery can have a big toll to secure it is so much there was a move that occurred that was getting worse
• It is important because the negative emotions was consuming even resources for the child

Connection Observations

• There children are more difficult
• The one to note were those types of changes

Clinical

• The reason or those that did stutter had the breakdown occurred in 9 year child when the teacher lost it
• The learning problems

Pulous And Webster

• The main point is traumatic is a trigger in families