Is language a risk factor in stuttering?

By Ehud Yairi, Ph.D.,
University of Illinoisalt text

A personƒ??s stuttering is not random. Linguistic factors have been?ÿconsidered relevant to stuttering especially since early research?ÿ(Brown, 1937, 1945) demonstrated their strong influence on the?ÿoccurrence of stuttering events, or ƒ??moments of stuttering,ƒ?? in?ÿspecific locations of the speech stream (e.g., the beginning of?ÿsentences and phrases) and?ÿ in words of certain grammatical classes?ÿ(e.g., verbs and adjectives). The link between stuttering and?ÿ language is especially intuitive in young children. Several scholars?ÿhave noted that stuttering onset, typically between ages 2 and 4, coincides with the critical period of accelerated expansion in?ÿchildrenƒ??s expressive and receptive language (Levina, 1963; Yairi,?ÿ1983, Ratner, 1997). Thirty years ago, Cheverkeva (1977) proposed?ÿthat stuttering is basically a disorder of language development, an?ÿidea recently echoed by Bloodstein (2002).

The possible stuttering-language link has become a focus of?ÿscientific interest, reflected in several stuttering models with?ÿpsycholinguistic viewpoints. Among these are the Demands-Capacity?ÿModel (Starkweather, 1987), the Covert-Repair Hypothesis (Postma &?ÿKolk, 1993), the Trade-Off Hypothesis (Ratner, 1997) and the?ÿCognitive Interference Model (Bosshardt, 2002). Investigators have?ÿfocused their studies on five distinct linguistic variables: (a)?ÿphonological aspects, (b) loci of stuttering, (c) language?ÿcomplexity, (d) pragmatics (childƒ??s use of language), and (e)?ÿlanguage skills. For example, research concerned with the first?ÿvariable listed above has provided evidence that stuttering is?ÿincreased as a function of language complexity (Logan & Conture,?ÿ1995, Zackheim & Conture, 2003).

Regarding language as risk factor, perhaps most interesting to?ÿclinicians and parents has been a relatively longstanding view that?ÿstuttering children are more likely than normally speaking peers to?ÿhave language learning difficulties or impairments (see reviews by?ÿAndrews, et al., 1983, and Ratner, 1997). A few current articles?ÿcontinue to propagate this view (Arndt & Healey, 2001; Wingate,?ÿ2001). On the other hand, over the past 15 years, extensive?ÿlongitudinal studies at the University of Illinois Stuttering?ÿResearch Program have revealed no delayed language development in?ÿyoung children who stutter.?ÿTo the contrary, we have found that near?ÿonset they fall within normal range; in fact, often well above normal?ÿ(Watkins, Yairi & Ambrose, 1999). Recent research in other?ÿlaboratories in the U.S.A. and Europe supports this finding (Anderson?ÿ& Conture, 2000; H??ge, 2001; Miles & Ratner, 2001), which seems to?ÿagree with many parentsƒ?? reports that their child had a spurt of?ÿlanguage development just prior to the onset of stuttering, speaking?ÿin longer sentences and using new words.?ÿ (They often say that ƒ??his?ÿbrain seemed to be working faster than his mouthƒ?? could manage.)?ÿFurthermore, we have found that children who eventually persist in?ÿstuttering tend to perform above normative expectations at the early?ÿstage of stuttering and maintain that level over time. Children who?ÿeventually recover, however, tend to perform above normal at the?ÿearly stage of the disorder but approach the norm as they recover?ÿ(Watkins et al., 1999, Yairi & Ambrose, 2005). Strangely, then, high?ÿlanguage skills rather than low ones might be a risk factor for?ÿstuttering, particularly for persistent, chronic stuttering.?ÿ It is?ÿintriguing to theorize that the emergence of stuttering involves some?ÿtype of trade-off in linguistic resources (e.g., advanced language at?ÿthe expense of motoric fluency) and that recovery from stuttering?ÿwould occur as these children reduce their early accelerated rate of?ÿlanguage development.?ÿ If our findings are valid, they will have?ÿimportant clinical implications for parent counseling and therapy?ÿprograms.

To be sure, there is no consensus at this juncture concerning?ÿadvanced language skills as a risk factor in early childhood?ÿstuttering. Recently, a few studies reported some results that differ?ÿfrom the Illinois findings.?ÿ These studies, however, raise questions?ÿconcerning their methods. For example, Anderson and Conture (2000)?ÿnoted that although all their participants had language abilities at?ÿor above normal limits, the stuttering children still demonstrated?ÿsomewhat lower skills in certain areas than normally speaking peers.?ÿWatkins and Johnson (2004), however, pointed out that in many past?ÿstudies reporting lower language skills in children who stutter, the?ÿcomparison groups of normally speaking subjects were selected in?ÿbiased ways, often coming from appreciably higher social groups known?ÿto have richer language. In contrast, the Illinois studies addressed?ÿthis problem by comparing the performance of the stuttering children?ÿto a much broader base of well-established normative data.?ÿ It is?ÿpossible, however, that further research with preschool children?ÿusing more sensitive tools will reveal discrete language differences?ÿbetween groups. Other examples of disagreement are seen in studies?ÿwith school aged children who stutter reporting between 9 and 13% of?ÿthe children to exhibit concomitant language difficulties (Blood,?ÿRidenhour, Qualls, & Hammer, 2003). Keep in mind however, that by?ÿthis age at least 75% of the original stuttering population had?ÿdisappeared due to natural recovery. The remaining (persistent)?ÿminority has been reported to possess some different genetic?ÿcomponents. All in all, at the present, language alone is?ÿinsufficient for making strong early predictions of eventual?ÿpersistency or recovery.

In summary, although we believe that associations between stuttering?ÿand several linguistic variables do exist, so far no clear causal?ÿrelations have been established, and there is no consensus on their?ÿprecise role or contributions as risk factors for the onset of?ÿstuttering and its persistence, or their influence on natural?ÿrecovery. This and several other aspects of the stuttering-language?ÿconnection continue to be the subject of scientific discussions and?ÿcontroversies (Nippold, 2004; Wingate, 2001). Fortunately, it has?ÿattracted very rich and varied research activities, the fruits of?ÿwhich should significantly enhance our understanding and treatment of?ÿstuttering.

REFERENCES
Anderson, J., & Conture, E. (2000). Language abilities of children?ÿwho stutter: A preliminary study. Journal of Fluency Disorders, 25,?ÿ283-304.

Andrews, G., Craig, A., Feyer, A., Hoddinott, S., Howie, P., &?ÿNeilson, M. (1983). Stuttering: A review of research findings and?ÿtheories circa 1982. Journal of Speech and Hearing Disorders, 48,?ÿ226-246.

Arndt, J., & Healey, C. (2001). Concomitant disorders in school-age?ÿ
children who stutter. Language, Speech and Hearing Services in?ÿSchools, 32, 68-78.

Blood, G., Ridenour, V. J., Qualls, C. D., & Hammer, C. S. (2003).?ÿCo-occurring disorders in children who stutter. Journal of?ÿCommunication Disorders, 36, 427-448.

Bloodstein, O. (2002). Early stuttering as a type of language?ÿdifficulty. Journal of Fluency Disorders, 27, 163-167.

Bosshardt, H. (2002).?ÿ Effects of concurrent cognitive processing on?ÿthe fluency of word repetition: Comparison between persons who do and do not stutter.?ÿ Journal of Fluency Disorders, 27, 93-114.

Brown, S. (1937). The influence of grammatical function on the?ÿincidence of stuttering. Journal of Speech Disorders, 3, 223-230.

Brown, S.?ÿ (1945). The locus of stuttering in the speech sequence.?ÿJournal of Speech Disorders, 10, 181-192.

Chevekeva, N. (1967). About methods of overcoming stuttering: A?ÿsurvey of the literature. Spetsial Shkola, 3, 9-15.

H??ge, A. (2001). K??nnen kognitive und linguistische F??higkeiten zur?ÿVerlaufsprognose kindlichen Stotterns beitragen? (Cognitive and?ÿlinguistic abilities in young children: Are they able to predict the?ÿfurther development of stuttering?).?ÿ Sprache Stimme Geh??r, 25, 20-24.

Levina, R. (1966). Study and treatment of stammering children. In A.?ÿDƒ??yachov (Ed.), Specialized Schools, 120, (4). Moscow: Education?ÿPublishing House. (Translation published in Journal of Learning?ÿDisabilities (1968), 1, 26-29.)

Logan, K. & Conture, E. (1995).?ÿ Relationships between?ÿlength,grammatical complexity, rate, and fluency of conversational?ÿutterances in children who stutter.?ÿ Journal of Fluency Disorders,?ÿ20, 35-61.

Miles, S., & Ratner, N. B. (2001). Parental language input to?ÿchildren at stuttering onset. Journal of Speech, Language and Hearing?ÿResearch, 44, 1116-1130

Nippold, M. (2004).?ÿ Phonological and language disorders in children?ÿwho stutter: Impact on treatment considerations.?ÿClinical?ÿLinguistics and Phonetics, 18(2), 145-159.

Ratner, N. (1997). Stuttering: A psycholinguistic perspective. In R.?ÿF. Curlee and G. M. Siegel (Eds.) Nature and Treatment of Stuttering:?ÿNew Directions. Boston: Allyn & Bacon.

Postma, A., & Kolk, H. (1993). The covert repair hypothesis:?ÿPrearticulatory repair in normal and stuttered disfluencies. Journal?ÿof Speech and Hearing Research, 36, 472-487.

Starkweather, W. (1987). Fluency and Stuttering. Englewood Cliffs,?ÿNJ: Prentice-Hall.

Watkins, R. , & Johnson, B. (2004).?ÿ Language abilities in young?ÿchildren who stutter: Toward improved research and clinical?ÿapplications.?ÿ Language, Speech and Hearing Services in Schools.

Watkins, R., Yairi, E., & Ambrose, N. (1999).?ÿ Early childhood?ÿstuttering III: Initial status of expressive language abilities. Journal of Speech, Language, and Hearing Research, 42, 1125-1135. Wingate, M. (2001). SLD is not stuttering. Journal of Speech, Language, and Hearing Research, 44, 381-383.

Yairi, E. (1983). The onset of stuttering in two- and three-year-old?ÿchildren: A preliminary report. Journal of Speech and Hearing?ÿDisorders, 48, 171-177.

Yairi, E. & Ambrose, N. (2005).?ÿ Early Childhood Stuttering.?ÿAustin: Pro Ed.

Zackheim, C. & Conture, E. (2003). Childhood stuttering and speech?ÿdisfluencies in relation to children's mean length of utterance: A?ÿpreliminary study. Journal of Fluency Disorders, 28,?ÿ115-142.?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ?ÿ