PurposeThe goal of the current study was to identify factors contributing to the overall impact of stuttering, as measured by the Overall Assessment of the Speaker’s Experience of Stuttering (OASES) in older children who stutter. Prior research suggests temperament and emotional functioning may influence stuttering impact, whereas findings regarding overt stuttering severity have been inconsistent.MethodParticipants were 306 children who stutter (241 boys, 65 girls), aged 9;0–14;11 years old, referred to a specialist center for stuttering. Measures included the Early Adolescent Temperament Questionnaire-Revised (EATQ-R), Stuttering Severity Instrument-4 (SSI-4), Revised Children’s Anxiety and Depression Scale (RCADS), and Overall Assessment of the Speaker’s Experience of Stuttering (OASES). A multiple linear regression was conducted with OASES total score as the outcome and predictors including: SSI-4 total score, temperament dimensions (Surgency, Negative Affect, and Effortful Control), RCADS total score, age, and sex.ResultsHigher Surgency predicted lower stuttering impact, whereas higher Negative Affect, greater anxiety and depression symptoms, older age, and higher overt stuttering severity predicted greater impact. Effortful Control and sex were not significant predictors. Temperament and internalizing symptoms contributed independently to stuttering impact, beyond overt severity. Predictors operated largely independently within the multivariate model, with no evidence of strong interaction effects.ConclusionThese findings add to the understanding of the factors that contribute to the impact that stuttering has on 9–14 year olds. The results indicate that the impact that stuttering has on a child can be predicted to some degree by their temperament, level of anxiety and depression, age and overt stuttering, but not sex. Future research is needed to identify/include other factors that may strengthen this predictive model, better understand how and why some children are more negatively impacted than others, and to inform clinical practice.

PURPOSE:Previous research on temperament in developmental stuttering has primarily treated emotional reactivity and self-regulation as separate constructs. Examining their interaction is likely to yield more comprehensive insights into their joint influence on stuttering-related outcomes. Therefore, this study examined how the interplay between emotional reactivity and self-regulation is reflected in differences in stuttering severity, speech attitude, levels of anxiety and depression, and the impact of stuttering. METHOD:A total of 322 younger (ages 3-8 years) and 468 older children (ages 9-15 years) who stutter were categorized into four temperament profiles based on dichotomization at the midpoint of scale scores for emotional reactivity and self-regulation, as reported in a parental temperament questionnaire. For younger children, an additional dichotomization was applied using U.K. population mean score. This procedure was conducted separately for positive and negative reactivity, each in relation to self-regulation, yielding four distinct temperament profiles per reactivity type (i.e., higher/lower reactivity × higher/lower self-regulation). Between-groups differences were investigated for stuttering severity, stuttering impact, speech attitude, and the level of anxiety/depression. RESULTS:There were no differences between the temperamental profiles and the differing measures in young children using the scale midpoint dichotomization method. However, when using U.K. population mean dichotomization, temperament profiles continued to show no associations with stuttering severity or speech attitude but did reveal significant differences in stuttering impact, indicating that lower positive reactivity combined with lower self-regulation is linked to greater perceived impact among younger children who stutter. Older children and teens with higher positive reactivity and higher self-regulation had less impact, anxiety, and depression, whereas those with higher positive reactivity and lower self-regulation had a lower overt stuttering severity compared to most other temperament profiles; higher negative reactivity in combination with lower self-regulation was related to more impact compared to most other temperament profiles. CONCLUSIONS:This is the first study to examine the interaction between reactivity and self-regulation and the relationship with several stuttering-related factors. These results suggest that the interplay between emotional reactivity and self-regulation does not appear to impact stuttering outcomes in early childhood but does during late childhood and early adolescence. The findings suggest that having higher positive reactivity and higher self-regulation temperamental profile has a protective role for older children in terms of their stuttering experience and that higher positive reactivity may serve as a protective factor for reduced self-regulatory abilities. Those who obtained higher negative reactivity scores experienced a greater impact of stuttering when this is combined with lower self-regulation, again suggesting that self-regulation exerts a protective role. These differences offer a clearer basis for understanding variability in the stuttering experience and provide insight into those children who may be at greater risk of an adverse experience.

Background Having a stammer can have a significant effect on a child’s social, emotional and educational development. With approximately 66,000 children in the UK having a stammer, there is a need to establish an adequate evidence base to inform clinical practice. We describe a feasibility trial to explore the effectiveness of a new therapy programme for children aged 8–14: Palin Stammering Therapy for School Children (Palin STSC(8–14)). Preliminary data from the Michael Palin Centre, where the programme was developed, indicate that Palin STSC(8–14) is effective in reducing stammering frequency and impact for children, with beneficial effects for parents too. We will investigate the feasibility of the methods required for a definitive randomised controlled trial to investigate the application of this therapy by NHS speech and language therapists (SLTs), compared with ‘treatment as usual’ (TAU), beyond the specialist context in which it was developed. Methods This is a two-arm feasibility cluster-randomised controlled trial of Palin STSC(8–14) with TAU control arm, and randomisation at the level of the SLT. Quantitative and qualitative data will be collected to examine the following: the recruitment and retention of therapists and families, the acceptability of the research processes and the therapeutic intervention and the appropriateness of the therapy outcome measures. Assessments will be completed by children and parents at baseline and 6 months later, including measures of stammering severity; the impact of child’s stammering on both children and parents; child temperament, behaviour and peer relations, anxiety; quality of life; and economic outcomes. There will also be a qualitative process evaluation, including interviews with parents, children, SLTs and SLT managers to explore the acceptability of both the research and therapy methods. Treatment fidelity will be examined through analysis of therapy session records and recordings. Discussion The findings of this feasibility trial will inform the decision as to whether to progress to a full-scale randomised controlled trial to explore the effectiveness of Palin STSC(8–14) when compared to Treatment as Usual in NHS SLT services. There is a strong need for an evidence-based intervention for school age children who stammer. Trial registration ISRCTN. ISRCTN17058884 . Registered on 18 December 2019.

INTRODUCTION:It is estimated that 8% of children who stutter (CWS) have autism spectrum disorder (ASD) Briley & Ellis (2018). There is evidence that interventions for CWS and interventions for children with ASD can be effective, but there is little evidence to guide clinical decision making when working with CWS with a co-existing diagnosis of ASD. Palin Parent-Child Interaction (PCI) therapy Kelman & Nicholas (2020) is an evidence-based intervention for CWS, with the authors suggesting that the approach may be beneficial for CWS with ASD. The aim of this study was to examine outcomes for three CWS with ASD who received Palin PCI at a specialist centre for stuttering in London.METHOD:The participants were three CWS with ASD aged 4;5, 6;7 and 7;7. Assessments were administered before therapy, and then at three, six and twelve months after therapy began. Outcome measures included stuttering frequency, child's communication attitude, parents' perception of the impact of stuttering on the child, the severity of stuttering and its impact on the parents, and parents' knowledge and confidence in managing stuttering.RESULTS:All three children showed improvement in three or more variables. Four out of five parents reported reduced impact of stuttering on the child and themselves following therapy, and change was maintained one year post-therapy. All five parents reported increased knowledge of stuttering and confidence in managing it after therapy, and four parents maintained these changes for a year.CONCLUSIONS:Over a one year period, these CWS with ASD who received Palin PCI showed change across multiple variables. The observed increases in parent knowledge and confidence were comparable to previously published data. These preliminary findings suggest that CWS with ASD and their parents can benefit from Palin PCI therapy and that further experimental evaluation of this approach with this client group is indicated.

There has been increasing interest over the past decade with regard to the health and wellbeing implications of time spent outdoors in nature for children. Universal systematic reviews of evidence report benefits to physical health, social-emotional mental health and wellbeing, cognition and academic learning. Internationally, there is indicative evidence to suggest outdoor engagement with nature may also impact children’s language and communication skills, skills that are critical to development, education, social relationships and life opportunities. Yet, at present such evidence has not been synthesised. Despite evidence for the benefits of the outdoors, the amount of time children are spending outdoors is in rapid decline, and has been further exacerbated by the COVID-19 pandemic. Alongside this are increasing numbers of children starting primary education with significant speech, language and communication needs (SLCN) which remain persistent over time. With established wide-reaching benefits of nature to children’s physical and mental health and psychological development, there is a need to further explore the more specific impacts of the natural environment on children’s language, communication and social skills, which could provide a unique opportunity to consider nature as a universal public health intervention for SLCN. The current review will aim to synthesise existing qualitative and quantitative evidence of the impact of time spent in natural outdoor spaces on the language, communication and social skills of 2–11-year-old children. Literature will be searched across seven databases and considered for inclusion against inclusion and exclusion criteria. Potential implications of the review include informing public health practice and policy for child development and education, informing priorities for speech, language, and communication interventions, and providing directions for future international research.

There has been much discussion about whether one treatment approach is better than another approach. In this chapter, we propose that the quest for the 'best therapy' is unlikely to provide us with the knowledge we seek. Instead, we suggest that it is better to ask ourselves why a treatment approach is effective and why certain approaches appear to work better with particular clients. We argue that this might be explained by the contextual model, which suggests that it is the similarities between treatment approaches, rather than the differences which account for successful outcomes.

INTRODUCTION:Increased emotional reactivity and decreased regulation have been associated with increased stuttering severity and frequency in preschool children who stutter (CWS) and may be predictors for the development of negative reactions to stuttering in young children. Understanding which children are likely to be impacted to a greater or lesser degree has implications for clinical decision making. Associations between temperament and stuttering impact have been explored with older CWS, but not with preschool CWS.AIM:To investigate the relationship between temperament (specifically emotional reactivity and regulation) and both stuttering frequency and stuttering impact in preschool CWS.METHODS:Data collected at initial assessment for 119 young CWS (age range= 3;00-6;11 years) at a specialist centre for stuttering in London, UK were analysed. The following measures were completed: The Children's Behaviour Questionnaire-Short Form (Putnam & Rothbart, 2006); Palin Parent Rating Scales (Millard & Davis, 2016); The Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007); and a stuttering frequency measure.RESULTS:Emotional reactivity and regulation were not significantly associated with stuttering frequency. Higher scores on negative reactivity were significantly associated with an increased impact of stuttering on the child (from parents' perspective), but not significantly associated with child-reported communication attitude. Positive reactivity was not significantly associated with parent-reported impact of stuttering or child-reported communication attitude. Additional investigation revealed negative affect as a significant predictor of parent-reported impact of stuttering before and after adjusting for age.DISCUSSION:The results provide evidence to support the role of temperament on the impact that stuttering has in the early years. While the directionality of the relationship between negative reactivity and impact of stuttering is unknown, the importance of targeting emotional reactions in therapy for young CWS is implicated.

Purpose: The main aim of this study was to gain insight into whether temperament and/or stuttering severity were associated with anxiety and depression in children who stutter. Additionally, the study also provided an indication into the prevalence of anxiety and depression in children who stutter in a clinical cohort. Method: The participants were 132 English-speaking children (105 boys and 27 girls) between 9;0 and 14;11 years old (M = 11;8, SD = 1;10) and their mothers. At their first visit to a specialist center for children who stutter, mothers and children completed the relevant versions of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R; Ellis & Rothbart, 2001) and a screening of children's anxiety and depression, using the Revised Children's Anxiety and Depression Scale (RCADS; Chorpita et al., 2000). Stuttering was evaluated using the Stuttering Severity Instrument Fourth Edition (SSI-4). Correlations were conducted between child and parent versions of the EATQ-R and RCADS; EATQ-R and RCADS; as well as the SSI-4 and RCADS. A comparison was made between those children who scored below the clinical threshold for anxiety and depression, and those who scored above. Results: Significant correlations were found for all mother and child EATQ-R factors and RCADS scales (except for Obsessive Compulsive Disorder). Correlations were also found between the child-and mother-reported temperament factors of positive reactivity, negative reactivity, and self-regulation and anxiety and depression. Children who scored above the clinical threshold for any category of anxiety or depression had significantly lower positive reactivity and higher negative reactivity scores, compared to those who scored below the threshold. There were no differences between the two groups with regard to SSI-4 scores. Conclusions: This is the first study to evaluate associations between temperament and anxiety and depression in children who stutter. Higher negative reactivity scores and lower positive reactivity and self-regulation scores are associated with elevated levels of anxiety and depression in children who stutter. Further, those who score above the clinical threshold have significantly higher levels of negative reactivity and lower levels of positive reactivity compared to those scoring below the threshold. Findings suggest that levels of anxiety that reach clinical threshold are more prevalent in children who stutter than would be expected based on population data. Current findings have implications for both the assessment and therapy of children who stutter presenting at clinics for support.

Purpose: During the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering. Methods: The authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form. Results: Seven contemporary issues for our field emerged from the Symposium. Conclusion: Effective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive

Purpose: The goal of this study was to evaluate possible associations between child-and mother-reported temperament, stuttering severity, and child-reported impact of stuttering in school-age children who stutter. Method: Participants were 123 children who stutter (94 boys and 29 girls) who were between 9;0 and 14;10 (years;months) and their mothers. Temperament was assessed with the revised child and parent version of the Early Adolescent Temperament Questionnaire-Revised (Ellis & Rothbart, 2001). The Overall Assessment of the Speaker's Experience of Stuttering (Yaruss & Quesal, 2006) was used to evaluate the stuttering impact. Results: Child-and mother-reported Early Adolescent Temperament Questionnaire-Revised temperament factors correlated moderately. No statistically significant associations were found between temperament and stuttering severity. The temperament factors of Surgency (both child-and mother reported) and Negative Affect (only child-reported) correlated moderately with the Overall Impact and several subsections (i.e., Speaker's Reactions, Daily Communication, and/or Quality of Life) of the Overall Assessment of the Speaker's Experience of Stuttering. Conclusions: More extraverted and less fearful/shy children experience a lower overall impact of their stuttering. Children with higher levels of irritability and frustration experience a higher overall impact of their stuttering. Since children's ratings of temperament were more sensitive to these associations than mothers, this study supports the inclusion of child-reported temperament questionnaires in future research.

Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.

Purpose:The aim of this article was to identify what school-aged children who stutter consider to be the most important outcomes from therapy.Method:A Delphi approach was employed for the study. Eighteen participants aged 9-13 years completed a survey, generating 90 statements that would constitute successful therapy outcomes. After categorization and reduction, 79 statements were sent to participants in a second survey to seek consensus on their importance. Fifteen participants aged 8-14 years completed this second survey. Statements with the highest median ratings and smallest standard deviations were retained.Results:Twenty-one statements were retained after analysis. These reflected hopes for affective and behavioral change in the young person and in other people after therapy. Important outcomes included, but are not limited to, increased fluency, greater independence, increased confidence at school, others knowing how to support the individual, and communication situations feeling easier.Conclusions:Participants identified a range of outcomes that were important to achieve as a result of speech and language therapy. The findings suggest a need for a more holistic view of what is meant by successful therapy, incorporating improvements in the ability to communicate and participate in daily situations. The findings suggest that an integrated or holistic approach to intervention would be required to achieve these goals and should include significant others from the child's environment. The important statements identified in this study could be used to inform the content of therapy and to evaluate change over time.Supplemental Material:https://doi.org/10.23641/asha.7144205.

Purpose:Palin Parent-Child Interaction therapy (Kelman & Nicholas, 2008) is an evidence-based intervention for young children who stutter. The evidence consists of multiple single-subject replicated studies, and this demonstrates that the intervention is effective. The aim of this study was to enhance the evidence base by exploring the effectiveness of the therapy with a large cohort of children who stutter.Method:Children and parents completed a range of assessments at 4 time points: start of therapy and then 3, 6, and 12 months later. The following variables were included: stuttering frequency, child's communication attitude, parents' perception of the impact of the stuttering on the child, the severity of stuttering and its impact on the parents, and their knowledge of stuttering and confidence in managing it. Hierarchical multiple regression analyses were conducted to explore whether the variables are predictive for the outcome "parent knowledge and confidence." In addition, we sought a preliminary view of factors associated with outcome level by separating children into 2 groups according to response to treatment (more successful and less successful).Results:The results demonstrated a significant improvement in all variables, and this improvement was maintained for 1 year posttreatment. Measures collected 3 months after the start of therapy showed significant improvement in child attitude to communication, parents' knowledge and confidence in how to manage stuttering, and mothers' ratings of stuttering severity and impact the child's stuttering has on the mothers. By 6 months after therapy onset, there was a significant reduction in stuttering frequency and fathers' perception of severity and their worry about it. Furthermore, these improvements were maintained 1 year posttherapy. Several variables predicted parents' knowledge and confidence 6 months after the start of therapy. Finally, those who made greater improvements had mothers who were more negative in their ratings of severity and worry, and had less knowledge and confidence at the start of therapy. There were no differences between the groups on a range of other variables.Conclusions:The results demonstrate that, over a year, children who attend a course of Palin Parent-Child Interaction show reduced stuttering frequency and a more positive attitude to speech. In addition, parents observe these improvements in the child, feel more confident in managing the stuttering, and are less worried about it. The different times at which specific variables significantly improved provides insight to a process of change over time. Results suggest that parents' ability to notice positive change in fluency and the impact that these observations have on both the child and the family are linked to their confidence in how to support the child. The preliminary findings with regard to response to treatment suggest that children can benefit from this program even with factors that might be predicted to reduce therapy success.

Purpose The purpose of this introduction is to provide an overview of the articles in this special issue of AJSLP . These articles originated from the presentations at the 11th Oxford Dysfluency Conference in September 2017.

Purpose: The goal of this study is to explore the psychometric properties of the Parent Rating Scales-V1 (S. K. Millard, S. Edwards, & F. M. Cook, 2009), an assessment tool for parents of children who stutter, and to refine the measure accordingly.Method: We included 259 scales completed prior to therapy. An exploratory factor analysis determined the test constructs and identified the items that had greatest loadings on those factors. Items that did not load on the factors were removed, and normative scores calculated.Results: The resulting 19-item questionnaire measures three factors: (a) the impact of stuttering on the child; (b) the severity of stuttering and its impact on the parents; and (c) the parents' knowledge about stuttering and confidence in managing it. Reliability was demonstrated, norms established, and an automated online version constructed.Conclusions: The Palin Parent Rating Scale is a valid and reliable tool, providing a method of exploring parents' perceptions of stuttering, the impact it has on the child and themselves, and the parents' knowledge of and confidence in managing the stuttering. This is an important addition to the existing range of assessments that may be used to evaluate stuttering in children up to age 14; 6 (years; months) and allows the wider targets of parent-led therapy programs to be evaluated.