Is Language A Risk Factor in Stuttering?
By Ehud Yairi, Ph.D., University of Illinois
A person's stuttering is not random. Linguistic factors have been considered relevant to stuttering especially since early research (Brown, 1937, 1945) demonstrated their strong influence on the occurrence of stuttering events, or 'moments of stuttering," in specific locations of the speech stream (e.g., the beginning of sentences and phrases) and in words of certain grammatical classes (e.g., verbs and adjectives). The link between stuttering and language is especially intuitive in young children. Several scholars have noted that stuttering onset, typically between ages 2 and 4, coincides with the critical period of accelerated expansion in children's expressive and receptive language (Levina, 1963; Yairi, 1983, Ratner, 1997). Thirty years ago, Cheverkeva (1977) proposed that stuttering is basically a disorder of language development, an idea recently echoed by Bloodstein (2002).
The possible stuttering-language link has become a focus of scientific interest, reflected in several stuttering models with psycholinguistic viewpoints. Among these are the Demands-Capacity Model (Starkweather, 1987), the Covert-Repair Hypothesis (Postma & Kolk, 1993), the Trade-Off Hypothesis (Ratner, 1997) and the Cognitive Interference Model (Bosshardt, 2002). Investigators have focused their studies on five distinct linguistic variables: (a) phonological aspects, (b) loci of stuttering, (c) language complexity, (d) pragmatics (child's use of language), and (e) language skills. For example, research concerned with the first variable listed above has provided evidence that stuttering is increased as a function of language complexity (Logan & Conture, 1995, Zackheim & Conture, 2003).
Regarding language as risk factor, perhaps most interesting to clinicians and parents has been a relatively longstanding view that stuttering children are more likely than normally speaking peers to have language learning difficulties or impairments (see reviews by Andrews, et al., 1983, and Ratner, 1997). A few current articles continue to propagate this view (Arndt & Healey, 2001; Wingate, 2001). On the other hand, over the past 15 years, extensive longitudinal studies at the University of Illinois Stuttering Research Program have revealed no delayed language development in young children who stutter. To the contrary, we have found that near onset they fall within normal range; in fact, often well above normal (Watkins, Yairi & Ambrose, 1999). Recent research in other laboratories in the U.S.A. and Europe supports this finding (Anderson & Conture, 2000; H??ge, 2001; Miles & Ratner, 2001), which seems to agree with many parents' reports that their child had a spurt of language development just prior to the onset of stuttering, speaking in longer sentences and using new words. (They often say that 'his brain seemed to be working faster than his mouth" could manage.) Furthermore, we have found that children who eventually persist in stuttering tend to perform above normative expectations at the early stage of stuttering and maintain that level over time. Children who eventually recover, however, tend to perform above normal at the early stage of the disorder but approach the norm as they recover (Watkins et al., 1999, Yairi & Ambrose, 2005). Strangely, then, high language skills rather than low ones might be a risk factor for stuttering, particularly for persistent, chronic stuttering. It is intriguing to theorize that the emergence of stuttering involves some type of trade-off in linguistic resources (e.g., advanced language at the expense of motoric fluency) and that recovery from stuttering would occur as these children reduce their early accelerated rate of language development. If our findings are valid, they will have important clinical implications for parent counseling and therapy programs.
To be sure, there is no consensus at this juncture concerning advanced language skills as a risk factor in early childhood stuttering. Recently, a few studies reported some results that differ from the Illinois findings. These studies, however, raise questions concerning their methods. For example, Anderson and Conture (2000) noted that although all their participants had language abilities at or above normal limits, the stuttering children still demonstrated somewhat lower skills in certain areas than normally speaking peers. Watkins and Johnson (2004), however, pointed out that in many past studies reporting lower language skills in children who stutter, the comparison groups of normally speaking subjects were selected in biased ways, often coming from appreciably higher social groups known to have richer language. In contrast, the Illinois studies addressed this problem by comparing the performance of the stuttering children to a much broader base of well-established normative data. It is possible, however, that further research with preschool children using more sensitive tools will reveal discrete language differences between groups. Other examples of disagreement are seen in studies with school aged children who stutter reporting between 9 and 13% of the children to exhibit concomitant language difficulties (Blood, Ridenhour, Qualls, & Hammer, 2003). Keep in mind however, that by this age at least 75% of the original stuttering population had disappeared due to natural recovery. The remaining (persistent) minority has been reported to possess some different genetic components. All in all, at the present, language alone is insufficient for making strong early predictions of eventual persistency or recovery.
In summary, although we believe that associations between stuttering and several linguistic variables do exist, so far no clear causal relations have been established, and there is no consensus on their precise role or contributions as risk factors for the onset of stuttering and its persistence, or their influence on natural recovery. This and several other aspects of the stuttering-language connection continue to be the subject of scientific discussions and controversies (Nippold, 2004; Wingate, 2001). Fortunately, it has attracted very rich and varied research activities, the fruits of which should significantly enhance our understanding and treatment of stuttering.
Anderson, J., & Conture, E. (2000). Language abilities of children who stutter: A preliminary study. Journal of Fluency Disorders, 25, 283-304.
Andrews, G., Craig, A., Feyer, A., Hoddinott, S., Howie, P., & Neilson, M. (1983). Stuttering: A review of research findings and theories circa 1982. Journal of Speech and Hearing Disorders, 48, 226-246.
Arndt, J., & Healey, C. (2001). Concomitant disorders in school-age
children who stutter. Language, Speech and Hearing Services in Schools, 32, 68-78.
Blood, G., Ridenour, V. J., Qualls, C. D., & Hammer, C. S. (2003). Co-occurring disorders in children who stutter. Journal of Communication Disorders, 36, 427-448.
Bloodstein, O. (2002). Early stuttering as a type of language difficulty. Journal of Fluency Disorders, 27, 163-167.
Bosshardt, H. (2002). Effects of concurrent cognitive processing on the fluency of word repetition: Comparison between persons who do and do not stutter. Journal of Fluency Disorders, 27, 93-114.
< span style="font-size: normal;">Brown, S. (1945). The locus of stuttering in the speech sequence. Journal of Speech Disorders, 10, 181-192.
Chevekeva, N. (1967). About methods of overcoming stuttering: A survey of the literature. Spetsial Shkola, 3, 9-15.
H??ge, A. (2001). K??nnen kognitive und linguistische F??higkeiten zur Verlaufsprognose kindlichen Stotterns beitragen? (Cognitive and linguistic abilities in young children: Are they able to predict the further development of stuttering?). Sprache Stimme Geh??r, 25, 20-24.
< span style="font-size: normal;">Levina, R. (1966). Study and treatment of stammering children. In A. D'yachov (Ed.), Specialized Schools, 120, (4). Moscow: Education Publishing House. (Translation published in Journal of Learning Disabilities (1968), 1, 26-29.)
Logan, K. & Conture, E. (1995). Relationships between length,grammatical complexity, rate, and fluency of conversational utterances in children who stutter. Journal of Fluency Disorders, 20, 35-61.
Miles, S., & Ratner, N. B. (2001). Parental language input to children at stuttering onset. Journal of Speech, Language and Hearing Research, 44, 1116-1130
Nippold, M. (2004). Phonological and language disorders in children who stutter: Impact on treatment considerations. Clinical Linguistics and Phonetics, 18(2), 145-159.
Ratner, N. (1997). Stuttering: A psycholinguistic perspective. In R. F. Curlee and G. M. Siegel (Eds.) Nature and Treatment of Stuttering: New Directions. Boston: Allyn & Bacon.
Postma, A., & Kolk, H. (1993). The covert repair hypothesis: Prearticulatory repair in normal and stuttered disfluencies. Journal of Speech and Hearing Research, 36, 472-487.
Starkweather, W. (1987). Fluency and Stuttering. Englewood Cliffs, NJ: Prentice-Hall.
Watkins, R. , & Johnson, B. (2004). Language abilities in young children who stutter: Toward improved research and clinical applications. Language, Speech and Hearing Services in Schools.
Watkins, R., Yairi, E., & Ambrose, N. (1999). Early childhood stuttering 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 children: A preliminary report. Journal of Speech and Hearing Disorders, 48, 171-177.
Yairi, E. & Ambrose, N. (2005). Early Childhood Stuttering. Austin: Pro Ed.
Zackheim, C. & Conture, E. (2003). Childhood stuttering and speech disfluencies in relation to children's mean length of utterance: A preliminary study. Journal of Fluency Disorders, 28, 115-142.